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Sample records for major sections general

  1. 14 CFR Section 4 - General

    2010-01-01

    ... UNIFORM SYSTEM OF ACCOUNTS AND REPORTS FOR LARGE CERTIFICATED AIR CARRIERS Balance Sheet Classifications Section 4 General (a) The balance sheet accounts are designed to show the financial condition of the air... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false General Section 4 Section 4 Aeronautics and...

  2. 14 CFR Section 2 - General Accounting Policies

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false General Accounting Policies Section 2 Section 2 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION... General Accounting Provisions Section 2 General Accounting Policies ...

  3. Generalized Anxiety and Major Depressive syndrome ...

    Objective: Environmental exposure to manganese (Mn) may cause generalized anxiety (GA) and major depression (MD) in residents living in Mn-exposed areas. Marietta and East Liverpool are two Ohio towns identified as having elevated levels of Mn. The objective was to determine if levels of Mn exposure were associated with levels of GA and MD.Participants and methods: 186 participants (Mean age: 55.0 ± 10.80) were examined. Levels of air-Mn were assessed over a period of ten years using U.S. EPA’s AERMOD dispersion model. Average air-Mn exposure was 0.53 μg/m3 in the two towns. The GA syndrome was comprised of anxiety, obsessive-compulsive, and phobic scales from the Symptom Checklist (SCL-90-R). The MD syndrome was comprised of depression, anxiety, and psychoticism scales also from the SCL-90-R. Linear regression models were used to determine the relationship between Mn and GA, MD and the specific components of each.Results: Elevated air-Mn was associated with GA (β= 0.240, p=0.002), and MD (β= 0.202, p=0.011). Air-Mn was associated with specific components of GA anxiety (β= 0.255, p=0.001), phobic anxiety (β= 0.159, p=0.046), and obsessive-compulsive (β= 0.197, p=0.013). Similarly, components of MD syndrome suggested an association as well: depression (β= 0.180, p=0.023), anxiety (β= 0.255, p=0.001), and psychoticism (β= 0.188, p=0.018). Conclusions: The results suggest that residents with elevated exposure to environmental Mn have elevated levels of

  4. Norforce: Major General Edward Northey and the Nyasaland and ...

    The campaign in East and Central Africa during the First World War has received relatively little attention despite the remarkable exploits of Major General Edward Northey and Norforce. In field command for two and a half years, he successfully led a multi-ethnic and polyglot force across some of the most difficult terrain of ...

  5. General versus gender-specific attributes of the psychology major.

    McCray, Jason A; King, Alan R; Bailly, Matthew D

    2005-04-01

    In the present study, the authors extended the search for general and gender-specific factors associated with the selection of psychology as a college major by using the Family Environment Scale (FES; R. H. Moos & B. S. Moos, 1994) and Coolidge Axis II Inventory (CATI; F. L. Coolidge & M. M. Merwin, 1992). The findings were restricted to one general (Schizoid) and one gender-specific (Self-Defeating) set of personality traits that seemed to be associated with the selection of a college major. The intuitive role of many presumed gender-specific factors (e.g., women are more open to discussing personal problems with others) may prove difficult to establish empirically.

  6. Cross section recondensation method via generalized energy condensation theory

    Douglass, Steven; Rahnema, Farzad

    2011-01-01

    Highlights: → A new method is presented which corrects for core environment error from specular boundaries at the lattice cell level. → Solution obtained with generalized energy condensation provides improved approximation to the core level fine-group flux. → Iterative recondensation of the cross sections and unfolding of the flux provides on-the-fly updating of the core cross sections. → Precomputation of energy integrals and fine-group cross sections allows for easy implementation and efficient solution. → Method has been implemented in 1D and shown to correct the environment error, particularly in strongly heterogeneous cores. - Abstract: The standard multigroup method used in whole-core reactor analysis relies on energy condensed (coarse-group) cross sections generated from single lattice cell calculations, typically with specular reflective boundary conditions. Because these boundary conditions are an approximation and not representative of the core environment for that lattice, an error is introduced in the core solution (both eigenvalue and flux). As current and next generation reactors trend toward increasing assembly and core heterogeneity, this error becomes more significant. The method presented here corrects for this error by generating updated coarse-group cross sections on-the-fly within whole-core reactor calculations without resorting to additional cell calculations. In this paper, the fine-group core flux is unfolded by making use of the recently published Generalized Condensation Theory and the cross sections are recondensed at the whole-core level. By iteratively performing this recondensation, an improved core solution is found in which the core-environment has been fully taken into account. This recondensation method is both easy to implement and computationally very efficient because it requires precomputation and storage of only the energy integrals and fine-group cross sections. In this work, the theoretical basis and development

  7. The general profile of children and adolescents with major ...

    The main complaints presented by the parents or in the referral letter by the general practitioners were behavioural problems (37%) such as stealing, aggression and attention-seeking behaviour, followed by decrease in school performance (25%), suspected depression (21%), suicidal tendencies (17%), and school refusal ...

  8. Comparison of automatical thoughts among generalized anxiety disorder, major depressive disorder and generalized social phobia patients.

    Gül, A I; Simsek, G; Karaaslan, Ö; Inanir, S

    2015-08-01

    Automatic thoughts are measurable cognitive markers of the psychopathology and coping styles of individuals. This study measured and compared the automatic thoughts of patients with generalized anxiety disorder (GAD), major depressive disorder (MDD), and generalized social phobia (GSP). Fifty-two patients with GAD, 53 with MDD, and 50 with GSP and 52 healthy controls completed the validated Automatic Thoughts Questionnaire (ATQ) and a structured psychiatric interview. Patients with GAD, MDD, and GSP also completed the validated Generalized Anxiety Disorder-7 questionnaire, the Beck Depression Inventory (BDI), and the Liebowitz Social Anxiety Scale (LSAS) to determine the severity of their illnesses. All scales were completed before treatment and after diagnosis. The ATQ scores of all pairs of groups were compared. The ATQ scores of the GAD, MDD, and GSP groups were significantly higher than were those of the control group. We also found significant correlations among scores on the GAD-7, BDI, and LSAS. The mean age of patients with GSP was lower than was that of the other groups (30.90 ± 8.35). The significantly higher ATQ scores of the MDD, GAD, and GSP groups, compared with the control group, underscore the common cognitive psychopathology characterizing these three disorders. This finding confirms that similar cognitive therapy approaches should be effective for these patients. This study is the first to compare GAD, MDD, and GSP from a cognitive perspective.

  9. General Physics Section. Progress Report Fiscal Year 1969/70

    Braun, J

    1970-12-15

    This report contains information regarding that part of the work performed at the General Physics Section of AB Atomenergi during the period July 1969 - July 1970, which has been supported by grants from the Swedish Board of Technical Development (STU). For projects still in progress the current status is described, for terminated projects, or distinguishable parts thereof, a summary is given. Where available, reports describing the work are listed. A substantial part of our resources has been concentrated on the physics of energy conversion: Investigation of recombination processes in a pulsed helium discharge; Theoretical and experimental investigation of MHD gas flow; Isotopic battery in the muW-range. Our section's interest in nuclear dosimetry and the general aspects of metrology has been manifested in two additional projects: Application of mass spectrometry on He in solids to analysis, nuclear physics and material technology; Servo system filter. As general information it can be added that other, not STU-supported, activities of the section are material dosimetry for irradiation monitoring and a fairly broad range of radiation shielding activities

  10. General Physics Section. Progress Report Fiscal Year 1969/70

    Braun, J.

    1970-12-01

    This report contains information regarding that part of the work performed at the General Physics Section of AB Atomenergi during the period July 1969 - July 1970, which has been supported by grants from the Swedish Board of Technical Development (STU). For projects still in progress the current status is described, for terminated projects, or distinguishable parts thereof, a summary is given. Where available, reports describing the work are listed. A substantial part of our resources has been concentrated on the physics of energy conversion: Investigation of recombination processes in a pulsed helium discharge; Theoretical and experimental investigation of MHD gas flow; Isotopic battery in the μW-range. Our section's interest in nuclear dosimetry and the general aspects of metrology has been manifested in two additional projects: Application of mass spectrometry on He in solids to analysis, nuclear physics and material technology; Servo system filter. As general information it can be added that other, not STU-supported, activities of the section are material dosimetry for irradiation monitoring and a fairly broad range of radiation shielding activities

  11. Major depression, fibromyalgia and labour force participation: A population-based cross-sectional study

    Patten Scott B

    2006-01-01

    Full Text Available Abstract Background Previous studies have documented an elevated frequency of depressive symptoms and disorders in fibromyalgia, but have not examined the association between this comorbidity and occupational status. The purpose of this study was to describe these epidemiological associations using a national probability sample. Methods Data from iteration 1.1 of the Canadian Community Health Survey (CCHS were used. The CCHS 1.1 was a large-scale national general health survey. The prevalence of major depression in subjects reporting that they had been diagnosed with fibromyalgia by a health professional was estimated, and then stratified by demographic variables. Logistic regression models predicting labour force participation were also examined. Results The annual prevalence of major depression was three times higher in subjects with fibromyalgia: 22.2% (95% CI 19.4 – 24.9, than in those without this condition: 7.2% (95% CI 7.0 – 7.4. The association persisted despite stratification for demographic variables. Logistic regression models predicting labour force participation indicated that both conditions had an independent (negative effect on labour force participation. Conclusion Fibromyalgia and major depression commonly co-occur and may be related to each other at a pathophysiological level. However, each syndrome is independently and negatively associated with labour force participation. A strength of this study is that it was conducted in a large probability sample from the general population. The main limitations are its cross-sectional nature, and its reliance on self-reported diagnoses of fibromyalgia.

  12. Hematogenous candida pneumonia in major burn patients: plain chest radiograph and thin-section CT findings

    Kim, Hyo Heon; Lee, Eil Seong; Shim, Ya Seong; Kim, Ji Hun; Suh, Hong Kil; Cho, Sin Young; Kim, Dae Sun; Lee, Kil Woo; Kang, Ik Won

    1995-01-01

    To describe plain radiographic and thin-section CT findings of hematogenous candida pneumonia in major burn patients. We reviewed nine cases of hematogenous candida pneumonia in major burn patients who had positive blood culture for candida and findings of pneumonia on plain chest radiograph. On five of nine cases, thin-section CT was done. We evaluated retrospectively nine cases for onset, the pattern, distribution, and size of lesions on plain chest radiograph and thin-section CT. On plain chest radiograph, randomly distributed 2-10 mm nodules were seen in six cases(66%) and randomly distributed 10-15 mm consolidations in remaining three cases(33%). Lesion occurred in 11th to 75th post-burn day(average, 34th post-burn day). Other findings were cardiomegaly in three cases, atelectasis in three cases, and pulmonary edema in one case. Thin-section CT showed variable shaped subpleural nodules in all five cases. The size of nodules were 1-5 mm in two cases(40%) and 5-10 mm(60%) in three cases. Feeding vessel signs were seen in two cases. Other findings were atelectasis in three cases, cardiomegaly in three cases, ground-glass opacity and interlobular septal thickenings by pulmonary edema in two cases. Plain chest radiographic findings of hematogenous candida pneumonia in major burn patients are randomly distributed nodules or consolidations of variable size. Thin-section CT findings are variable shaped subpleural nodules less than 1 cm

  13. Generalized Majority Logic Criterion to Analyze the Statistical Strength of S-Boxes

    Hussain, Iqtadar; Shah, Tariq; Gondal, Muhammad Asif; Mahmood, Hasan

    2012-05-01

    The majority logic criterion is applicable in the evaluation process of substitution boxes used in the advanced encryption standard (AES). The performance of modified or advanced substitution boxes is predicted by processing the results of statistical analysis by the majority logic criteria. In this paper, we use the majority logic criteria to analyze some popular and prevailing substitution boxes used in encryption processes. In particular, the majority logic criterion is applied to AES, affine power affine (APA), Gray, Lui J, residue prime, S8 AES, Skipjack, and Xyi substitution boxes. The majority logic criterion is further extended into a generalized majority logic criterion which has a broader spectrum of analyzing the effectiveness of substitution boxes in image encryption applications. The integral components of the statistical analyses used for the generalized majority logic criterion are derived from results of entropy analysis, contrast analysis, correlation analysis, homogeneity analysis, energy analysis, and mean of absolute deviation (MAD) analysis.

  14. Major Deficiencies Preventing Auditors From Rendering Audit Opinions on DOD General Fund Financial Statements

    Rauu, Russell

    1995-01-01

    .... We plan to issue a similar report each year. The audit objective was to identify and summarize the major deficiencies that prevented auditors from rendering audit opinions, other than disclaimers, on Army and Air Force general fund financial...

  15. Chronic depression : Determinants and consequences of chronic major depression in the general population

    Spijker, Jan

    2002-01-01

    The subject of this thesis is chronicity of major depressive disorder (MDD). The main aims of the study are to examine: 1. the duration of a major depressive episode (MDE) and the rate of a chronic duration of MDE in the general population, 2. the determinants of (chronic) duration of

  16. Organizational justice and major depressive episodes in Japanese employees: a cross-sectional study.

    Inoue, Akiomi; Kawakami, Norito; Tsuno, Kanami; Tomioka, Kimiko; Nakanishi, Mayuko

    2013-01-01

    Several European studies showed that low organizational justice (i.e., procedural justice and interactional justice) was associated with major depressive disorders. In these studies, however, the diagnosis of major depressive disorders may be underestimated because they identified only individuals who visited a doctor and received a diagnosis. Moreover, these studies did not consider neurotic personality traits, which can affect the occurrence of major depressive disorders. The purpose of the present study was to investigate the cross-sectional association of organizational justice with major depressive episodes in the past 12 months more precisely in Japanese employees. A total of 425 males and 708 females from five branches of a manufacturing company in Japan completed self-administered questionnaires measuring organizational justice, other job stressors (i.e., job strain, social support at work, and effort-reward imbalance), neuroticism, and demographic characteristics. A web-based self-administered version of the computerized Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess major depressive episodes. Logistic regression analyses were conducted. In the univariate analysis, low procedural justice and low interactional justice were significantly associated with major depressive episodes in the past 12 months. After adjusting for other job stressors and demographic characteristics, only the association of interactional justice remained significant. The moderating effect of neuroticism on the association of organizational justice with major depressive episodes in the past 12 months was not significant. Low interactional justice may be associated with major depressive disorders regardless or other job stressors or neurotic personality traits.

  17. Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia

    Rosenberg, J; Oturai, P; Erichsen, C J

    1994-01-01

    STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... surgery and 16 patients undergoing middle ear surgery, both with comparable general anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with continuous pulse oximetry on one preoperative night and the second postoperative night. Significant episodic or constant hypoxemia did not occur...... on the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the development...

  18. 29 CFR 1977.3 - General requirements of section 11(c) of the Act.

    2010-07-01

    ... WILLIAMS-STEIGER OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 General § 1977.3 General requirements of... 29 Labor 9 2010-07-01 2010-07-01 false General requirements of section 11(c) of the Act. 1977.3 Section 1977.3 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH...

  19. Playing with Light: Adventures in Optics and Spectroscopy for Honors and Majors General Chemistry

    van Staveren, Marie N.; Edwards, Kimberly D.; Apkarian, V. A.

    2012-01-01

    A lab was developed for use in an undergraduate honors and majors general chemistry laboratory to introduce students to optics, spectroscopy, and the underlying principles of quantum mechanics. This lab includes four mini-experiments exploring total internal reflection, the tunneling of light, spectra of sparklers and colored candles, and emission…

  20. Design and Evaluation of a One-Semester General Chemistry Course for Undergraduate Life Science Majors

    Schnoebelen, Carly; Towns, Marcy H.; Chmielewski, Jean; Hrycyna, Christine A.

    2018-01-01

    The chemistry curriculum for undergraduate life science majors at Purdue University has been transformed to better meet the needs of this student population and prepare them for future success. The curriculum, called the 1-2-1 curriculum, includes four consecutive and integrated semesters of instruction in general chemistry, organic chemistry, and…

  1. Major Depressive Disorder, Obsessive-Compulsive Disorder, and Generalized Anxiety Disorder: Do the Sexual Dysfunctions Differ?

    Kendurkar, Arvind; Kaur, Brinder

    2008-01-01

    Objectives: Major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) are known to have significant impact on sexual functioning. They have been studied individually. Therefore, this study was planned to compare the sexual dysfunction between MDD, OCD, and GAD with healthy subjects as controls.

  2. A cross-sectional study of metabolic and endocrine complications in beta-thalassemia major

    Najafipour, F.; Aliasgarzadeh, A.; Aghamohamadzadeh, N.; Bahrami, A.; Mobasri, M.; Niafar, M.; Khoshbaten, M.

    2008-01-01

    Iron overload is a major problem in patients with beta-thalassemia major, and it has many structural and metabolic consequences. The aim of this study was evaluation of endocrine disturbances in patients with beta-thalassemia major who were older than 10 years of age. In this cross-sectional study, investigator collected demographic data and medical histories, as well as menstrual history in females, from the medical records of 56 patients with beta-thalassemia major. Patients were examined to determine their pubertal status and the standard deviation score for height for evaluation of short stature. For evaluation of glucose tolerance, a fasting blood glucose and oral glucose tolerance tests were performed. Evidence for diabetes mellitus was based on American Diabetes Association and World Health Organization criteria. Serum levels of calcium, phosphorous, thyroid-stimulating hormone, free thyroxin, luteinizing hormone and follicular-stimulating hormone and estradiol in girls and testosterone in boys were measured. The mean and standard deviation for age in the 56 patients (36 males and 20 females) was 15.62+-4.44 years. Diabetes mellitus was present in 5 patients (8.9%), impaired fasting glucose was found in 16 patients (28.6%) and an impaired glucose tolerance test was found in 4 patients (7.1%). Short stature (standard deviation score <-2) was seen in 25 (70%) boys and 14 (73%) girls. Impaired puberty was found in 40 patients (71%). Hypocalcaemia and primary overt hyperthyroidism were present in 23 (41%) and 9 patients (16%), respectively. Only eight patients (14.3%) had no endocrine abnormalities. Despite therapy with deferoxamine to treat iron overload, the risk of secondary endocrine dysfunction remained high. Hypogonadism was one of the most frequent endocrine complications. Impaired glucose tolerance, short stature, hypocalcemia, subclinical and overt hypothyroidism are also frequent. (author)

  3. A cross-sectional study of knife injuries at a London major trauma centre.

    Pallett, J R; Sutherland, E; Glucksman, E; Tunnicliff, M; Keep, J W

    2014-01-01

    No national recording systems for knife injuries exist in the UK. Understanding the true size and nature of the problem of knife injuries is the first stage in reducing the burden of this injury. The aim of this study was to survey every knife injury seen in a single inner city emergency department (ED) over a one-year period. A cross-sectional observational study was performed of all patients attending with a knife injury to the ED of a London major trauma centre in 2011. Demographic characteristics, patterns of injury, morbidity and mortality data were collected. A total of 938 knife injuries were identified from 127,191 attendances (0.77% of all visits) with a case fatality rate of 0.53%. A quarter (24%) of the major trauma team's caseload was for knife injuries. Overall, 44% of injuries were selfreported as assaults, 49% as accidents and 8% as deliberate self-harm. The highest age specific incident rate occurred in the 16-24 year age category (263/100,000). Multiple injuries were seen in 19% of cases, of which only 81% were recorded as assaults. The mean length of stay for those admitted to hospital was 3.04 days. Intrathoracic injury was seen in 26% of cases of chest trauma and 24% of abdominal injuries had a second additional chest injury. Violent intentional injuries are a significant contributory factor to the workload of the major trauma team at this centre. This paper contributes to a more comprehensive understanding of the nature of these injuries seen in the ED.

  4. How is occupational medicine represented in the major journals in general medicine?

    Gehanno, Jean-François; Rollin, Laetitia; Ladner, Joel; Darmoni, Stefan J

    2012-08-01

    Most physicians have received only limited training in occupational medicine (OM) during their studies. Since they rely mainly on one 'general medical' journal to keep their medical knowledge up to date, it is worthwhile questioning the importance of OM in these journals. The aim of this study was to measure the relative weight of OM in the major journals of general medicine and to compare the journals. The 14,091 articles published in the Lancet, the NEJM, the JAMA and the BMJ in 1997, 2002 and 2007 were analysed. The relative weight of OM and the other medical specialties was determined by categorisation of all the articles, using a categorisation algorithm, which inferred the medical specialties relevant to each MEDLINE article file from the major medical subject headings (MeSH) terms used by the indexers of the US National Library of Medicine to describe each article. The 14,091 articles included in this study were indexed by 22,155 major MeSH terms, which were categorised into 73 different medical specialties. Only 0.48% of the articles had OM as a main topic. OM ranked 44th among the 73 specialties, with limited differences between the four journals studied. There was no clear trend over the 10-year period. The importance of OM is very low in the four major journals of general and internal medicine, and we can consider that physicians get a very limited view of the evolution of knowledge in OM.

  5. A prediction algorithm for first onset of major depression in the general population: development and validation.

    Wang, JianLi; Sareen, Jitender; Patten, Scott; Bolton, James; Schmitz, Norbert; Birney, Arden

    2014-05-01

    Prediction algorithms are useful for making clinical decisions and for population health planning. However, such prediction algorithms for first onset of major depression do not exist. The objective of this study was to develop and validate a prediction algorithm for first onset of major depression in the general population. Longitudinal study design with approximate 3-year follow-up. The study was based on data from a nationally representative sample of the US general population. A total of 28 059 individuals who participated in Waves 1 and 2 of the US National Epidemiologic Survey on Alcohol and Related Conditions and who had not had major depression at Wave 1 were included. The prediction algorithm was developed using logistic regression modelling in 21 813 participants from three census regions. The algorithm was validated in participants from the 4th census region (n=6246). Major depression occurred since Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-diagnostic and statistical manual for mental disorders IV. A prediction algorithm containing 17 unique risk factors was developed. The algorithm had good discriminative power (C statistics=0.7538, 95% CI 0.7378 to 0.7699) and excellent calibration (F-adjusted test=1.00, p=0.448) with the weighted data. In the validation sample, the algorithm had a C statistic of 0.7259 and excellent calibration (Hosmer-Lemeshow χ(2)=3.41, p=0.906). The developed prediction algorithm has good discrimination and calibration capacity. It can be used by clinicians, mental health policy-makers and service planners and the general public to predict future risk of having major depression. The application of the algorithm may lead to increased personalisation of treatment, better clinical decisions and more optimal mental health service planning.

  6. Prevalence and relationship between major depressive disorder and lung cancer: a cross-sectional study

    Maneeton B

    2014-05-01

    Full Text Available Benchalak Maneeton,1 Narong Maneeton,1 Jirayu Reungyos,1 Suthi Intaprasert,1 Samornsri Leelarphat,1 Sumitra Thongprasert21Department of Psychiatry, 2Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandObjective: The aims of this study were to estimate the prevalence and examine the factors associated with major depressive disorder (MDD in lung cancer patients.Materials and methods: This cross-sectional study was carried out in the oncology clinic of the University Hospital, Chiang Mai University, Thailand. Patients with all stages of lung cancer were included in this study. Demographic data of eligible patients were gathered. The Mini-International Neuropsychiatric Interview, Thai version 5.0.0 was used to identify MDD. The Thai version of the Personal Health Questionnaire Depression Scale was used to assess depression severity.Results: A total of 146 lung cancer patients from the outpatient clinic from July to December 2012 were approached. The 104 patients were included and analyzed in this study. Based on the Mini-International Neuropsychiatric Interview, 14.4% of them were defined as having MDD. Multiple linear regression analysis revealed that Chalder Fatigue Scale, Functional Assessment of Cancer Therapy – Lung, and Pittsburgh Sleep Quality Index scores were significantly correlated with MDD in lung cancer patients.Conclusion: The results suggest that MDD is more prevalent in lung cancer patients. In addition, fatigue, poor quality of life, and sleep disturbance may increase associated MDD. Because of the small sample size, further studies should be conducted to confirm these results.Keywords: lung cancer, major depressive disorder, prevalence

  7. Caesarean Section at Full Dilatation and Risk of Major Obstetric Haemorrhage

    O’Dwyer, V

    2018-03-01

    The purpose of the study was to examine the risk factors for caesarean section (CS) at full dilatation and to assess the risk and management of haemorrhage. The study took place in a tertiary referral maternity hospital. Women who had a CS at full dilatation were included. Clinical and demographic details were recorded. There were 199 cases. The average age was 30.3 years and average BMI was 25.8kg\\/m2. There were 79.9 % (159) primigravidas and 20.1% (40) multigravidas. The average gestation at delivery was 39.4 weeks. Labour was induced in 46.9 % (92) and spontaneous in 53.8% (107). Oxytocin was used in 67.8 % (135). An instrumental delivery was attempted in 46.7 % (93). The rate of malposition was 46.5 % (92). The average birthweight was 3,629g and 9 babies weighed ≥4.5kg. The average estimated blood loss (EBL) was 665mls and 34 had EBL>1L. Most had an oxytocin infusion (141). Other uterotonic agents were used in 70 women. Seven women had blood transfusions. The highest rate of CS at full dilatation was in primigravidas due to malposition. There was a low rate of major obstetric haemorrhage.

  8. Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment.

    2017-01-01

    Major depressive disorder and generalized anxiety disorder are among the most commonly diagnosed mental illnesses in Canada; both are associated with a high societal and economic burden. Treatment for major depressive disorder and generalized anxiety disorder consists of pharmacological and psychological interventions. Three commonly used psychological interventions are cognitive behavioural therapy (CBT), interpersonal therapy, and supportive therapy. The objectives of this report were to assess the effectiveness and safety of these types of therapy for the treatment of adults with major depressive disorder and/or generalized anxiety disorder, to assess the cost-effectiveness of structured psychotherapy (CBT or interpersonal therapy), to calculate the budget impact of publicly funding structured psychotherapy, and to gain a greater understanding of the experiences of people with major depressive disorder and/or generalized anxiety disorder. We performed a literature search on October 27, 2016, for systematic reviews that compared CBT, interpersonal therapy, or supportive therapy with usual care, waitlist control, or pharmacotherapy in adult outpatients with major depressive disorder and/or generalized anxiety disorder. We developed an individual-level state-transition probabilistic model for a cohort of adult outpatients aged 18 to 75 years with a primary diagnosis of major depressive disorder to determine the cost-effectiveness of individual or group CBT (as a representative form of structured psychotherapy) versus usual care. We also estimated the 5-year budget impact of publicly funding structured psychotherapy in Ontario. Finally, we interviewed people with major depressive disorder and/or generalized anxiety disorder to better understand the impact of their condition on their daily lives and their experience with different treatment options, including psychotherapy. Interpersonal therapy compared with usual care reduced posttreatment major depressive disorder

  9. Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment

    McMartin, Kristen; Gajic-Veljanoski, Olga; Wells, David; Higgins, Caroline; Walter, Melissa

    2017-01-01

    Background Major depressive disorder and generalized anxiety disorder are among the most commonly diagnosed mental illnesses in Canada; both are associated with a high societal and economic burden. Treatment for major depressive disorder and generalized anxiety disorder consists of pharmacological and psychological interventions. Three commonly used psychological interventions are cognitive behavioural therapy (CBT), interpersonal therapy, and supportive therapy. The objectives of this report were to assess the effectiveness and safety of these types of therapy for the treatment of adults with major depressive disorder and/or generalized anxiety disorder, to assess the cost-effectiveness of structured psychotherapy (CBT or interpersonal therapy), to calculate the budget impact of publicly funding structured psychotherapy, and to gain a greater understanding of the experiences of people with major depressive disorder and/or generalized anxiety disorder. Methods We performed a literature search on October 27, 2016, for systematic reviews that compared CBT, interpersonal therapy, or supportive therapy with usual care, waitlist control, or pharmacotherapy in adult outpatients with major depressive disorder and/or generalized anxiety disorder. We developed an individual-level state-transition probabilistic model for a cohort of adult outpatients aged 18 to 75 years with a primary diagnosis of major depressive disorder to determine the cost-effectiveness of individual or group CBT (as a representative form of structured psychotherapy) versus usual care. We also estimated the 5-year budget impact of publicly funding structured psychotherapy in Ontario. Finally, we interviewed people with major depressive disorder and/or generalized anxiety disorder to better understand the impact of their condition on their daily lives and their experience with different treatment options, including psychotherapy. Results Interpersonal therapy compared with usual care reduced

  10. Computer-based, Jeopardy™-like game in general chemistry for engineering majors

    Ling, S. S.; Saffre, F.; Kadadha, M.; Gater, D. L.; Isakovic, A. F.

    2013-03-01

    We report on the design of Jeopardy™-like computer game for enhancement of learning of general chemistry for engineering majors. While we examine several parameters of student achievement and attitude, our primary concern is addressing the motivation of students, which tends to be low in a traditionally run chemistry lectures. The effect of the game-playing is tested by comparing paper-based game quiz, which constitutes a control group, and computer-based game quiz, constituting a treatment group. Computer-based game quizzes are Java™-based applications that students run once a week in the second part of the last lecture of the week. Overall effectiveness of the semester-long program is measured through pretest-postest conceptual testing of general chemistry. The objective of this research is to determine to what extent this ``gamification'' of the course delivery and course evaluation processes may be beneficial to the undergraduates' learning of science in general, and chemistry in particular. We present data addressing gender-specific difference in performance, as well as background (pre-college) level of general science and chemistry preparation. We outline the plan how to extend such approach to general physics courses and to modern science driven electives, and we offer live, in-lectures examples of our computer gaming experience. We acknowledge support from Khalifa University, Abu Dhabi

  11. Consanguinity and major genetic disorders in Saudi children: Acommunity-based cross-sectional study

    El-Mouzan, Mohammad I.; Al-Salloum, Abdullah A.; Al-Herbish, Abdullah S.; Qurachi, Mansour M.; Al-Omar, Ahmad A.

    2008-01-01

    There is a high rate of consanguinity in Saudi Arabia; however,information on its relationship with genetic disorders is limited. Theobjective of this cross-sectional study was to explore the role ofconsanguinity in genetic disorders. The study sample was determined by amultistage probability random sampling procedure. Primary care physiciansperformed a history and physical examination of all children and adolescentsyounger than 19 years and all cases of genetic diseases were recorded. Thechi-square test was used to compare proportions. During the two-year studyperiod (2004-2005), 11554 of 11874 (97%) mothers answered the question onconsanguinity and 6470 of 11554 (56%) were consanguineous. There was nosignificant association between first-cousin consanguinity and Down syndrome(P=0.55). Similarly, there was no significant association with either sicklecell disease (P=0.97) or glucose-6-phosphate dehydrogenase deficiency(P=0.67) for-cousin in consanguinity. A borderline statistical significancewas found for major congenital malformations (P=0.05). However, the mostsignificant association with first-cousin consanguinity was congenital heartdisease (CHD) (P=0.01). Finally, no significant association was found fortype 1 diabetes mellitus (P=0.92). For all types of consanguinity, similartrends of association were found, with a definite statistically significantassociation only with CHD (P=0.003). The data suggest a significant role ofparental consanguinity in CHD. However, a relationship between consanguinityand other genetic diseases could not be established. The effect ofconsanguinity on genetic diseases is not uniform and this should be takeninto consideration in genetic counseling. (author)

  12. How are the different specialties represented in the major journals in general medicine?

    Gehanno, Jean-Francois; Ladner, Joel; Rollin, Laetitia; Dahamna, Badisse; Darmoni, Stefan J

    2011-01-21

    General practitioners and medical specialists mainly rely on one "general medical" journal to keep their medical knowledge up to date. Nevertheless, it is not known if these journals display the same overview of the medical knowledge in different specialties. The aims of this study were to measure the relative weight of the different specialties in the major journals of general medicine, to evaluate the trends in these weights over a ten-year period and to compare the journals. The 14,091 articles published in The Lancet, the NEJM, the JAMA and the BMJ in 1997, 2002 and 2007 were analyzed. The relative weight of the medical specialities was determined by categorization of all the articles, using a categorization algorithm which inferred the medical specialties relevant to each article MEDLINE file from the MeSH terms used by the indexers of the US National Library of Medicine to describe each article. The 14,091 articles included in our study were indexed by 22,155 major MeSH terms, which were categorized into 81 different medical specialties. Cardiology and Neurology were in the first 3 specialties in the 4 journals. Five and 15 specialties were systematically ranked in the first 10 and first 20 in the four journals respectively. Among the first 30 specialties, 23 were common to the four journals. For each speciality, the trends over a 10-year period were different from one journal to another, with no consistency and no obvious explanatory factor. Overall, the representation of many specialties in the four journals in general and internal medicine included in this study may differ, probably due to different editorial policies. Reading only one of these journals may provide a reliable but only partial overview.

  13. Association of Major Dietary Patterns with General and Abdominal Obesity in Iranian Patients with Type 2 Diabetes Mellitus.

    Ghane Basiri, Marjan; Sotoudeh, Gity; Djalali, Mahmood; Reza Eshraghian, Mohammad; Noorshahi, Neda; Rafiee, Masoumeh; Nikbazm, Ronak; Karimi, Zeinab; Koohdani, Fariba

    2015-01-01

    The aim of this study was to identify dietary patterns associated with general and abdominal obesity in type 2 diabetic patients. We included 728 patients (35 - 65 years) with type 2 diabetes mellitus in this cross-sectional study. The usual dietary intake of individuals over 1 year was collected using a validated semi-quantitative food frequency questionnaire. Weight, height, and waist circumference were measured according to standard protocol. The two major dietary patterns identified by factor analysis were healthy and unhealthy dietary patterns. After adjustment for potential confounders, subjects in the highest quintile of the healthy dietary pattern scores had a lower odds ratio for the general obesity when compared to the lowest quintile (OR = 0.45, 95 % CI = 0.26 - 0.79, P for trend = 0.02), while patients in the highest quintile of the unhealthy dietary pattern scores had greater odds for the general obesity (OR = 3.2, 95 % CI = 1.8 - 5.9, P for trend diabetes mellitus, a healthy dietary pattern is inversely associated and an unhealthy dietary pattern is directly associated with general obesity.

  14. Danish obstetricians' personal preference and general attitude to elective cesarean section on maternal request: a nation-wide postal survey

    Bergholt, Thomas; Østberg, Birgitte; Legarth, Jesper

    2004-01-01

    OBJECTIVE: To assess Danish obstetricians' and gynecologists' personal preference and general attitude towards elective cesarean section on maternal request in uncomplicated single cephalic pregnancies at term. DESIGN: Nation-wide anonymous postal questionnaire. POPULATION: Four hundred and fifty......-five obstetricians and gynecologists identified in the records of the Danish Society of Obstetrics and Gynecology from January 2000. MAIN OUTCOME MEASURES: Personal preference on the mode of delivery and general attitude towards elective cesarean section on maternal request in an uncomplicated single cephalic...... indication. Obstetricians and gynecologists who had experienced a noninstrumental vaginal delivery themselves or practiced as a private gynecologist only, were less likely to agree with the woman's right to elective cesarean section on maternal request. CONCLUSION: The vast majority of Danish obstetricians...

  15. Changing author counts in five major general medicine journals: effect of author contribution forms.

    Baerlocher, Mark Otto; Gautam, Tina; Newton, Marshall; Tomlinson, George

    2009-08-01

    Objective and indirect evidence was used to determine whether required author contribution forms were associated with a decrease in author counts in four major general medicine journals (British Medical Journal [BMJ], Journal of the American Medical Association [JAMA], Canadian Medical Association Journal [CMAJ], and the Lancet). The number of authors listed per article before and after the introduction of explicit author contribution requirements were counted and compared with that found for the New England Journal of Medicine (NEJM) that did not require such disclosure. The primary hypothesis was that author counts decreased more in the BMJ, CMAJ, JAMA, and the Lancet after introduction of the rules than they did in the NEJM. The number of authors listed per original research article published in the five general medical journals with the greatest 2004 Impact Factors in the first issue of each month in the years before and after introduction of required author contribution forms was compared. Introduction of the required author contribution forms by the four leading general medical journals did not result in a drop in the rate of increasing authors per article per year, or in the number of authors per article compared with the control. Overall, there was a trend of an increasing number of authors listed per article. Based on the presented objective and indirect evidence, required author contribution forms were not associated with a decrease in author counts.

  16. Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes.

    Mpirimbanyi, Christophe; Nyirimodoka, Alexandre; Lin, Yihan; Hedt-Gauthier, Bethany L; Odhiambo, Jackline; Nkurunziza, Theoneste; Havens, Joaquim M; Omondi, Jack; Rwamasirabo, Emile; Ntirenganya, Faustin; Toma, Gabriel; Mubiligi, Joel; Bayitondere, Scheilla; Riviello, Robert

    2017-12-01

    Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15-60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.

  17. Relationship between the burden of major periodontal bacteria and serum lipid profile in a cross-sectional Japanese study.

    Choi, Youn-Hee; Kosaka, Takayuki; Ojima, Miki; Sekine, Shinichi; Kokubo, Yoshihiro; Watanabe, Makoto; Miyamoto, Yoshihiro; Ono, Takahiro; Amano, Atsuo

    2018-05-04

    The association of periodontal bacteria with lipid profile alteration remains largely unknown, although it has been suggested that chronic periodontitis increases the atherosclerotic risk. This cross-sectional study investigated the relationship between the prevalence and total burden of periodontal bacteria and serum lipid profile. Saliva from enrolled participants was collected to detect 4 major periodontal bacteria (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Prevotella intermedia) using Polymerase Chain Reaction method. High-density lipoprotein (HDL) cholesterol, triglycerides (TG), and low-density lipoprotein cholesterol were assessed using blood samples. We compared the averages of each lipid in association with the prevalence of each bacterial species, their burden (low, moderate, and high), and the combination of bacterial burden and periodontal status, defined as periodontitis, using the Community Periodontal Index, after adjustment for other potential confounding factors, by employing general linear models with least square means. A total of 385 Japanese individuals (176 men, 209 women; mean age 69.2 years) were enrolled. The number of bacterial species and their co-existence with periodontitis were significantly related to a decrease in HDL (p for trend Periodontal bacterial burden is suggested to be independently involved in lowering serum HDL level. Our findings suggest that bacterial tests in a clinical setting could be a useful approach for predicting the risk of HDL metabolism dysregulation.

  18. The general dynamic model of island biogeography revisited on the level of major plant families

    Lenzner, Bernd; Beierkuhnlein, Carl; Patrick, Weigelt

    2017-01-01

    Aim: The general dynamic model (GDM) proposed by Whittaker et al. (2008) is a widely accepted theoretical framework in island biogeography. In this study, we explore whether GDM predictions hold when overall plant diversity is deconstructed into major plant families. Location: 101 islands from 14...... oceanic archipelagos worldwide. Methods: Occurrence data for all species of nine large, cosmopolitan flowering plant families were used to test predictions derived from the GDM. We analyzed the effects of island area and age on species richness as well as number and percentage of single-island endemic...... species per family using mixed-effect models. Results: Total species and endemic richness as well as the percentage of endemic species showed a hump-shaped relationship with island age. The overall pattern was mainly driven by few species-rich plant families. Varying patterns were found for individual...

  19. Social responsibilities of a physician: reflections of Major General S L Bhatia (1891-1981).

    Hegde, Radhika; Vaz, Mario

    2017-01-01

    This paper examines various documents written by Major General SL Bhatia CIE, MC, IMS from the 1920s to the1960s on the "Social Responsibilities of a Physician". His reflections are of historical significance, since they provide us with an insight into the challenges confronting the people who attempted to rebuild a nation plagued by poverty resulting from fractured agricultural growth, a feudalistic social structure and the regional inequalities that accompany it, and prolonged imperial rule, among other things. Bhatia's thoughts, especially on medical education and the condition of rural health and sanitation, enable us to understand India's present health concerns through the prism of the past. The writings of Bhatia, who lived during a period of transition in India, reflect an understanding of health issues from the perspectives both of an administrator and a physician struggling to meet the challenges of a nascent nation. He insisted on rooting his medical teachings in the principles of the humanities and ethics.

  20. Repetitive transcranial magnetic stimulation for treatment of major depressive disorder with comorbid generalized anxiety disorder.

    White, Daniela; Tavakoli, Sason

    2015-08-01

    Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in treating individuals with behavioral disorders such as major depressive disorder (MDD), posttraumatic stress disorder, obsessive-compulsive disorder, and social anxiety disorder. A number of applications of rTMS to different regions of the left and right prefrontal cortex have been used to treat these disorders, but no study of treatment for MDD with generalized anxiety disorder (GAD) has been conducted with application of rTMS to both the left and right prefrontal cortex. We hypothesized that applying low-frequency rTMS to the right dorsolateral prefrontal cortex (DLPFC) before applying it to the left DLPFC for the treatment of depression would be anxiolytic in patients with MDD with GAD. Thirteen adult patients with comorbid MDD and GAD received treatment with rTMS in an outpatient setting. The number of treatments ranged from 24 to 36 over 5 to 6 weeks. Response was defined as a ≥ 50% reduction in symptoms from baseline, and remission was defined as a score of anxiety symptoms on the 7-item Generalized Anxiety Disorder (GAD-7) scale and depressive symptoms on the 21-item Hamilton Rating Scale for Depression (HAM-D-21). At the end of the treatment period, for the GAD-7 scale, 11 out of 13 (84.6%) patients' anxiety symptoms were in remission, achieving a score of depressive symptoms. In this small pilot study of 13 patients with comorbid MDD and GAD, significant improvement in anxiety symptoms along with depressive symptoms was achieved in a majority of patients after bilateral rTMS application.

  1. How to Mutually Advance General Education and Major-Based Education: A Grounded Theory Study on the Course Level

    Fang, Hualiang

    2018-01-01

    The author employs grounded theory to investigate the teaching process of an interdisciplinary general education course at A University as a case. The author finds that under the condition of rather concrete relations between the subject of a major-based course and that of an elected general education course, if the major course is taught with a…

  2. NUTRITIONAL ASSESSMENT IN PATIENTS PREDICTED TO MAJOR ABDOMINAL SURGERY AT THE GENERAL HOSPITAL CELJE

    Ernest Novak

    2001-12-01

    Full Text Available Background. Malnutrition has serious implications for recovery after surgery. Early detection of malnutrition with nutritional support minimizes postoperative complications. Nutritional assessment tools need to be simple and suitable for use in everyday practice. In our study we wanted to determine, how many patients might benefit from nutritional support.Methods. From April to August 1999 fifty consecutively admitted patients predicted to major abdominal surgery have been examined. We used Mini nutritional assessment (MNA, Buzby’s nutrition risk index (NRI, blood albumin level and weight loss in the last 3 months period prior to the examination, to assess nutritional status.Results. We examined 50 patients (27 males and 23 females, age 76.5 ± 16.5 and confirmed malnutrition in 40% of patients with MNA and serum albumin level. The increased risk for nutrition-associated complications was confirmed by NRI and weight loss in 44%.Conclusions. A confident diagnosis of malnutrition and increased risk for nutrition-associated complications can be established by using a combination of simple methods like MNA, NRI, weight loss and serum albumin level. Almost half of the patients admitted for major abdominal surgery in General hospital Celje suffer from malnutrition and they may benefit with early nutritional intervention.

  3. A general method for identifying major hybrid male sterility genes in Drosophila.

    Zeng, L W; Singh, R S

    1995-10-01

    The genes responsible for hybrid male sterility in species crosses are usually identified by introgressing chromosome segments, monitored by visible markers, between closely related species by continuous backcrosses. This commonly used method, however, suffers from two problems. First, it relies on the availability of markers to monitor the introgressed regions and so the portion of the genome examined is limited to the marked regions. Secondly, the introgressed regions are usually large and it is impossible to tell if the effects of the introgressed regions are the result of single (or few) major genes or many minor genes (polygenes). Here we introduce a simple and general method for identifying putative major hybrid male sterility genes which is free of these problems. In this method, the actual hybrid male sterility genes (rather than markers), or tightly linked gene complexes with large effects, are selectively introgressed from one species into the background of another species by repeated backcrosses. This is performed by selectively backcrossing heterozygous (for hybrid male sterility gene or genes) females producing fertile and sterile sons in roughly equal proportions to males of either parental species. As no marker gene is required for this procedure, this method can be used with any species pairs that produce unisexual sterility. With the application of this method, a small X chromosome region of Drosophila mauritiana which produces complete hybrid male sterility (aspermic testes) in the background of D. simulans was identified. Recombination analysis reveals that this region contains a second major hybrid male sterility gene linked to the forked locus located at either 62.7 +/- 0.66 map units or at the centromere region of the X chromosome of D. mauritiana.

  4. Assessment of cognitive function in children with beta-thalassemia major: a cross-sectional study.

    Raafat, Nelly; El Safy, Usama; Khater, Nahed; Hassan, Tamer; Hassan, Basheir; Siam, Ahmed; Youssef, Amira; El Shabrawy, Amany

    2015-03-01

    Multiple risk factors contribute to cognitive impairment in children with β-thalassemia major. For a more refined understanding of this issue, we attempted to evaluate cognitive function in β-thalassemia major patients and identify the relationship between possible cognitive dysfunction and the following: demography, transfusion and chelation characteristics, iron overload, and disease complications. We studied 100 β-thalassemia major children and 100 healthy controls who matched well in terms of age, sex, and socioeconomic status. All participants underwent psychometric assessment using Wechsler Intelligence Scale for Children-Third Edition, Arabic version. The mean Full-Scale IQ and Performance IQ of patients were significantly lower than those of controls, whereas no significant difference was found for Verbal IQ. No significant relationship existed between IQ and any of the assessed parameters. We concluded that Performance IQ, not Verbal IQ, was significantly affected in β-thalassemia major patients, but there was no clear association between IQ and any of the parameters. © The Author(s) 2014.

  5. Implementation of the rapid cross section adjustment approach at General Electric

    Cowan, C.L.; Kujawski, E.; Protsik, R.

    1978-01-01

    The General Electric rapid cross section adjustment approach was developed to use the shielding factor method for formulating multigroup cross sections. In this approach, space- and composition-dependent cross sections for a particular reactor or shield design are prepared from a generalized cross section library by the use of resonance self-shielding factors, and by the adjustment of elastic scattering cross sections for the local neutron flux spectra. The principal tool in the cross section adjustment package is the data processing code TDOWN. This code was specified to give the user a high degree of flexibility in the analysis of advanced reactor designs. Of particular interest in the analysis of critical experiments is the ability to carry out cell heterogeneity self-shielding calculations using a multiregion equivalence relationship, and the homogenization of the cross sections over the specified cell with the flux weighting obtained from transport theory calculations. Extensive testing of the rapid cross section adjustment approach, including comparisons with Monte Carlo methods, indicated that this approach can be utilized with a high degree of confidence in the design analysis of complex fast reactor systems. 2 figures, 1 table

  6. Fee Splitting among General Practitioners: A Cross-Sectional Study in Iran.

    Parsa, Mojtaba; Larijani, Bagher; Aramesh, Kiarash; Nedjat, Saharnaz; Fotouhi, Akbar; Yekaninejad, Mir Saeed; Ebrahimian, Nejatollah; Kandi, Mohamad Jafar

    2016-12-01

    Fee splitting is a process whereby a physician refers a patient to another physician or a healthcare facility and receives a portion of the charge in return. This survey was conducted to study general practitioners' (GPs) attitudes toward fee splitting as well as the prevalence, causes, and consequences of this process. This is a cross-sectional study on 223 general practitioners in 2013. Concerning the causes and consequences of fee splitting, an unpublished qualitative study was conducted by interviewing a number of GPs and specialists and the questionnaire options were the results of the information obtained from this study. Of the total 320 GPs, 247 returned the questionnaires. The response rate was 77.18%. Of the 247 returned questionnaires, 223 fulfilled the inclusion criteria. Among the participants, 69.1% considered fee splitting completely wrong and 23.2% (frequently or rarely) practiced fee splitting. The present study showed that the prevalence of fee splitting among physicians who had positive attitudes toward fee splitting was 4.63 times higher than those who had negative attitudes. In addition, this study showed that, compared to private hospitals, fee splitting is less practiced in public hospitals. The major cause of fee splitting was found to be unrealistic/unfair tariffs and the main consequence of fee splitting was thought to be an increase in the number of unnecessary patient referrals. Fee splitting is an unethical act, contradicts the goals of the medical profession, and undermines patient's best interest. In Iran, there is no code of ethics on fee splitting, but in this study, it was found that the majority of GPs considered it unethical. However, among those who had negative attitudes toward fee splitting, there were physicians who did practice fee splitting. The results of the study showed that physicians who had a positive attitude toward fee splitting practiced it more than others. Therefore, if physicians consider fee splitting unethical

  7. Uncertainty Analysis of Few Group Cross Sections Based on Generalized Perturbation Theory

    Han, Tae Young; Lee, Hyun Chul; Noh, Jae Man

    2014-01-01

    In this paper, the methodology of the sensitivity and uncertainty analysis code based on GPT was described and the preliminary verification calculations on the PMR200 pin cell problem were carried out. As a result, they are in a good agreement when compared with the results by TSUNAMI. From this study, it is expected that MUSAD code based on GPT can produce the uncertainty of the homogenized few group microscopic cross sections for a core simulator. For sensitivity and uncertainty analyses for general core responses, a two-step method is available and it utilizes the generalized perturbation theory (GPT) for homogenized few group cross sections in the first step and stochastic sampling method for general core responses in the second step. The uncertainty analysis procedure based on GPT in the first step needs the generalized adjoint solution from a cell or lattice code. For this, the generalized adjoint solver has been integrated into DeCART in our previous work. In this paper, MUSAD (Modues of Uncertainty and Sensitivity Analysis for DeCART) code based on the classical perturbation theory was expanded to the function of the sensitivity and uncertainty analysis for few group cross sections based on GPT. First, the uncertainty analysis method based on GPT was described and, in the next section, the preliminary results of the verification calculation on a VHTR pin cell problem were compared with the results by TSUNAMI of SCALE 6.1

  8. Major Dietary Patterns in Relation to General and Central Obesity among Chinese Adults

    Yu, Canqing; Shi, Zumin; Lv, Jun; Du, Huaidong; Qi, Lu; Guo, Yu; Bian, Zheng; Chang, Liang; Tang, Xuefeng; Jiang, Qilian; Mu, Huaiyi; Pan, Dongxia; Chen, Junshi; Chen, Zhengming; Li, Liming

    2015-01-01

    Limited evidence exists for the association between diet pattern and obesity phenotypes among Chinese adults. In the present study, we analyzed the cross-sectional data from 474,192 adults aged 30–79 years from the China Kadoorie Biobank baseline survey. Food consumption was collected by an interviewer-administered questionnaire. Three dietary patterns were extracted by factor analysis combined with cluster analysis. After being adjusted for potential confounders, individuals following a traditional southern dietary pattern had the lowest body mass index (BMI) and waist circumference (WC); the Western/new affluence dietary pattern had the highest BMI; and the traditional northern dietary pattern had the highest WC. Compared to the traditional southern dietary pattern in multivariable adjusted logistic models, individuals following a Western/new affluence dietary pattern had a significantly increased risk of general obesity (prevalence ratio (PR): 1.06, 95% confidence interval (CI): 1.03–1.08) and central obesity (PR: 1.07, 95% CI: 1.06–1.08). The corresponding risks for the traditional northern dietary pattern were 1.05 (1.02–1.09) and 1.17 (1.25–1.18), respectively. In addition, the associations were modified by lifestyle behaviors, and the combined effects with alcohol drinking, tobacco smoking, and physical activity were analyzed. Further prospective studies are needed to elucidate the diet-obesity relationships. PMID:26184308

  9. Major Dietary Patterns in Relation to General and Central Obesity among Chinese Adults

    Canqing Yu

    2015-07-01

    Full Text Available Limited evidence exists for the association between diet pattern and obesity phenotypes among Chinese adults. In the present study, we analyzed the cross-sectional data from 474,192 adults aged 30–79 years from the China Kadoorie Biobank baseline survey. Food consumption was collected by an interviewer-administered questionnaire. Three dietary patterns were extracted by factor analysis combined with cluster analysis. After being adjusted for potential confounders, individuals following a traditional southern dietary pattern had the lowest body mass index (BMI and waist circumference (WC; the Western/new affluence dietary pattern had the highest BMI; and the traditional northern dietary pattern had the highest WC. Compared to the traditional southern dietary pattern in multivariable adjusted logistic models, individuals following a Western/new affluence dietary pattern had a significantly increased risk of general obesity (prevalence ratio (PR: 1.06, 95% confidence interval (CI: 1.03–1.08 and central obesity (PR: 1.07, 95% CI: 1.06–1.08. The corresponding risks for the traditional northern dietary pattern were 1.05 (1.02–1.09 and 1.17 (1.25–1.18, respectively. In addition, the associations were modified by lifestyle behaviors, and the combined effects with alcohol drinking, tobacco smoking, and physical activity were analyzed. Further prospective studies are needed to elucidate the diet-obesity relationships.

  10. Sex- and age-specific associations between major depressive disorder and metabolic syndrome in two general population samples in Germany.

    Block, Andrea; Schipf, Sabine; Van der Auwera, Sandra; Hannemann, Anke; Nauck, Matthias; John, Ulrich; Völzke, Henry; Freyberger, Harald Jürgen; Dörr, Marcus; Felix, Stephan; Zygmunt, Marek; Wallaschofski, Henri; Grabe, Hans Jörgen

    2016-11-01

    Major depressive disorder (MDD) has been associated with the Metabolic Syndrome (MetS). As previous data strongly suggested sex and age effects on this association, this study aimed to analyse the association between MDD and MetS in two general population samples under explicit consideration of sex and age. This study analysed cross-sectional data based on two independent general population samples: SHIP-0 (n = 4083; 20-81 years; 49.4% male) and SHIP-TREND-0 (n = 3957; 20-83 years; 49.0% male) that were part of the Study of Health in Pomerania. MDD (SHIP-0: 12.6%; SHIP-TREND-0: 27.2%) was assessed using the Composite International Diagnostic-Screener (CID-S) in both samples. Interview assessment of MDD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria was performed in SHIP-TREND-0 (18.1% MDD). MetS was defined by abdominal obesity, elevated blood pressure, elevated glucose, elevated triglycerides and reduced high-density lipoprotein cholesterol according to established criteria. Data analysis was performed sex- and age-stratified. Prevalence of MetS was high in both samples: 19.4% of females and 30.2% of males in SHIP-0 and 22.1% and 33.2% in SHIP-TREND-0, respectively. Effect modifications were observed by sex and age on the association between MDD and MetS. Particularly, younger females (20-49 years) with MDD were more often affected by MetS than younger females without MDD: OR = 2.21 (95% CI = 1.39-3.50). This association vanished in elderly participants (50-82 years). The data suggest that especially younger (presumably pre-menopausal) females with MDD are more likely to have MetS than those without major depressive disorders, and that age extenuates this association.

  11. Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease

    Hyare, Harpreet; Desigan, Sharmini; Nicholl, Helen; Guiney, Michael J.; Brookes, Jocelyn A.; Lees, William R.

    2006-01-01

    Purpose: Major arterial hemorrhage is an uncommon but serious complication of pancreatitis with high morbidity and mortality. Digital subtraction angiography (DSA) has long been the gold standard for the detection of a visceral artery pseudoaneurysm or for the site of active bleeding in patients with pancreatitis. Multi-section CT angiography is a minimally invasive technique which can provide high-resolution and high-contrast images of the arterial lumen and wall, with a much lower risk of complication and morbidity compared to DSA. The aim of this study was to determine the accuracy of multi-section CT angiography for the diagnosis of arterial complications of inflammatory pancreatitic disease. Materials and methods: A retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis between 1998 and 2004 was performed. Twenty-nine studies in 25 patients (20 males, 5 females) with a mean age of 50.9 years (range 11-67 years) were identified where multi-section CT angiography was performed in the 24 h preceding the digital subtraction angiogram. Results: Digital subtraction angiography detected a pseudoaneurysm or contrast extravasation in 19 studies and no bleeding was demonstrated in 9 studies. CT angiography correctly identified the site and type of bleeding in 18 of the 19 positive studies. CT angiography detected extravasation of contrast in one study that was not demonstrated on digital subtraction angiography. The sensitivity and specificity for multi-section CT angiography for the detection of major arterial bleeding on a background of pancreatitis were 0.947 and 0.900, respectively. Conclusion: Multi-section CT angiography is a sensitive and accurate technique for the detection of major arterial hemorrhage in inflammatory pancreatic disease and should be considered as the first investigation in the management of these patients

  12. An analysis of trends in globalisation of origin of research published in major general medical journals.

    Falagas, M E; Alexiou, V G

    2008-01-01

    There is an ongoing discussion in the scientific community that even the leading scientific journals publish mainly research that is produced in the countries where these journals are based. We analysed data regarding the origin of publications in 11 leading general medical journals during the last 35 years: The Lancet, British Medical Journal, Journal of the American Medical Association, New England Journal of Medicine, Annals of Internal Medicine, Archives of Internal Medicine, American Journal of Medicine, Mayo Clinic Proceedings, Canadian Medical Association Journal, Medical Journal of Australia and Journal of Internal Medicine (previously called Acta Medica Scandinavica). Among the examined journals, The Lancet has been the most diverse regarding the origin of publications; in the period 1971-1975, 62.6% of its publications originated from the UK while the relevant figure dropped to 43.2% in the period 2001-2005 (19.4% decrease). During the period 2000-2005, the proportion of publications that originated from the country in which each one of the rest of the examined journals has been based ranged from 71.7% to 95.1%. This figure decreased by a proportion ranging from 10.9% to 19.4% for some major US- and UK-based medical journals during the 35-year study period. Our own interpretation of the findings of this study is that scientific journals will better serve the global scientific community as well as the public by adopting policies that increase the mixture of the origin of research that they publish, including work from scientists in developing countries, especially during the era we live.

  13. Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study

    Harding, Alex; Rosenthal, Joe; Al-Seaidy, Marwa; Gray, Denis Pereira; McKinley, Robert K

    2015-01-01

    Background Health care is increasingly provided in general practice. To meet this demand, the English Department of Health recommends that 50% of all medical students should train for general practice after qualification. Currently 19% of medical students express general practice as their first career choice. Undergraduate exposure to general practice positively influences future career choice. Appropriate undergraduate exposure to general practice is therefore highly relevant to workforce planning Aim This study seeks to quantify current exposure of medical students to general practice and compare it with past provision and also with postgraduate provision. Design and setting A cross-sectional questionnaire in the UK. Method A questionnaire regarding provision of undergraduate teaching was sent to the general practice teaching leads in all UK medical schools. Information was gathered on the amount of undergraduate teaching, how this was supported financially, and whether there was an integrated department of general practice. The data were then compared with results from previous studies of teaching provision. The provision of postgraduate teaching in general practice was also examined. Results General practice teaching for medical students increased from teaching in 1968 to 13.0% by 2008; since then, the percentage has plateaued. The total amount of general practice teaching per student has fallen by 2 weeks since 2002. Medical schools providing financial data delivered 14.6% of the clinical curriculum and received 7.1% of clinical teaching funding. The number of departments of general practice has halved since 2002. Provision of postgraduate teaching has tripled since 2000. Conclusion Current levels of undergraduate teaching in general practice are too low to fulfil future workforce requirements and may be falling. Financial support for current teaching is disproportionately low and the mechanism counterproductive. Central intervention may be required to solve

  14. Major changes in microbial diversity and community composition across gut sections of a juvenile Panchlora cockroach.

    Erin A Gontang

    Full Text Available Investigations of gut microbiomes have shed light on the diversity and genetic content of these communities, and helped shape our understanding of how host-associated microorganisms influence host physiology, behavior, and health. Despite the importance of gut microbes to metazoans, our understanding of the changes in diversity and composition across the alimentary tract, and the source of the resident community are limited. Here, using community metagenomics and 16S rRNA gene sequencing, we assess microbial community diversity and coding potential in the foregut, midgut, and hindgut of a juvenile Panchlora cockroach, which resides in the refuse piles of the leaf-cutter ant species Atta colombica. We found a significant shift in the microbial community structure and coding potential throughout the three gut sections of Panchlora sp., and through comparison with previously generated metagenomes of the cockroach's food source and niche, we reveal that this shift in microbial community composition is influenced by the ecosystems in which Panchlora sp. occurs. While the foregut is composed of microbes that likely originate from the symbiotic fungus gardens of the ants, the midgut and hindgut are composed of a microbial community that is likely cockroach-specific. Analogous to mammalian systems, the midgut and hindgut appear to be dominated by Firmicutes and Bacteroidetes with the capacity for polysaccharide degradation, suggesting they may assist in the degradation of dietary plant material. Our work underscores the prominence of community changes throughout gut microbiomes and highlights ecological factors that underpin the structure and function of the symbiotic microbial communities of metazoans.

  15. Major changes in microbial diversity and community composition across gut sections of a juvenile Panchlora cockroach.

    Gontang, Erin A; Aylward, Frank O; Carlos, Camila; Glavina Del Rio, Tijana; Chovatia, Mansi; Fern, Alison; Lo, Chien-Chi; Malfatti, Stephanie A; Tringe, Susannah G; Currie, Cameron R; Kolter, Roberto

    2017-01-01

    Investigations of gut microbiomes have shed light on the diversity and genetic content of these communities, and helped shape our understanding of how host-associated microorganisms influence host physiology, behavior, and health. Despite the importance of gut microbes to metazoans, our understanding of the changes in diversity and composition across the alimentary tract, and the source of the resident community are limited. Here, using community metagenomics and 16S rRNA gene sequencing, we assess microbial community diversity and coding potential in the foregut, midgut, and hindgut of a juvenile Panchlora cockroach, which resides in the refuse piles of the leaf-cutter ant species Atta colombica. We found a significant shift in the microbial community structure and coding potential throughout the three gut sections of Panchlora sp., and through comparison with previously generated metagenomes of the cockroach's food source and niche, we reveal that this shift in microbial community composition is influenced by the ecosystems in which Panchlora sp. occurs. While the foregut is composed of microbes that likely originate from the symbiotic fungus gardens of the ants, the midgut and hindgut are composed of a microbial community that is likely cockroach-specific. Analogous to mammalian systems, the midgut and hindgut appear to be dominated by Firmicutes and Bacteroidetes with the capacity for polysaccharide degradation, suggesting they may assist in the degradation of dietary plant material. Our work underscores the prominence of community changes throughout gut microbiomes and highlights ecological factors that underpin the structure and function of the symbiotic microbial communities of metazoans.

  16. A Cross Sectional Study of Kretek Smoking in Indonesia as a Major Risk to Public Health.

    Palipudi, Krishna; Mbulo, Lazarous; Kosen, Soewarte; Tjandra, Aditama; Kadarmanto; Qureshi, Farukh; Andes, Linda; Sinha, Dhirendra N; Asma, Samira

    2015-01-01

    Tobacco smoking is a major cause of preventable disease and death worldwide. Kreteks are clove-flavored cigarettes made from a combination of tobacco and ground-clove mixed with a sauce, smoked widely in Indonesia. Because health and social consequences of kretek smoking are potentially as great as those of traditional cigarettes, this study examines the prevalence of kretek smoking in Indonesia and associated risk factors. The study used nationally representative Indonesia Global Adult Tobacco Survey data. Multiple logistic regression analysis was employed to identify correlates of kretek smoking. One- third of Indonesian adults smoked tobacco of which about 90.0% smoked kreteks. Prevalence of kretek smoking among men (60.9%) was more than 25 times the rate among women (2.3%). Overall, the highest prevalence of kretek use was in the age group 45-54 years (36.5%), followed by 34-44 (35.1%), 25-34 (34.2 %), and 55-64 years (32.8%). By wealth index, prevalence of kreteks smoking among those in the middle index was almost 50% above the rate for the wealthiest group (36.4% vs 24.8% respectively). Logistic regression results showed that being male, being older, having less education, and being less wealthy were significant predictors of kretek smoking, while urban vs rural residence was not. Kretek smoking is common in Indonesia and is entrenched in the sociocultural fabric of the country. However, potential consequences of kretek smoking, particularly as risks for noncommunicable diseases, underscore the importance of a comprehensive approach to tobacco control as outlined in the World Health Organization's MPOWER strategies.

  17. Patterns of Alcohol and Other Drug Use Associated with Major Depression among Gay Men Attending General Practices in Australia

    Holt, Martin; Bryant, Joanne; Newman, Christy E.; Paquette, Dana M.; Mao, Limin; Kidd, Michael R.; Saltman, Deborah C.; Kippax, Susan C.

    2012-01-01

    Our aim was to clarify the role of alcohol and other drug (AOD) use in major depression among gay men attending general medical practices. A secondary analysis was conducted on survey data collected from 531 gay men attending high-HIV-caseload general practices in Adelaide and Sydney, Australia. The survey contained demographic, social,…

  18. General calculation of the cross section for dark matter annihilations into two photons

    Garcia-Cely, Camilo [Service de Physique Théorique, Université Libre de Bruxelles, Boulevard du Triomphe, CP225, 1050 Brussels (Belgium); Rivera, Andres, E-mail: Camilo.Alfredo.Garcia.Cely@ulb.ac.be, E-mail: afelipe.rivera@udea.edu.co [Instituto de Física, Universidad de Antioquia, Calle 70 No. 52-21, Medellín (Colombia)

    2017-03-01

    Assuming that the underlying model satisfies some general requirements such as renormalizability and CP conservation, we calculate the non-relativistic one-loop cross section for any self-conjugate dark matter particle annihilating into two photons. We accomplish this by carefully classifying all possible one-loop diagrams and, from them, reading off the dark matter interactions with the particles running in the loop. Our approach is general and leads to the same results found in the literature for popular dark matter candidates such as the neutralinos of the MSSM, minimal dark matter, inert Higgs and Kaluza-Klein dark matter.

  19. General calculation of the cross section for dark matter annihilations into two photons

    Garcia-Cely, Camilo; Rivera, Andres

    2017-01-01

    Assuming that the underlying model satisfies some general requirements such as renormalizability and CP conservation, we calculate the non-relativistic one-loop cross section for any self-conjugate dark matter particle annihilating into two photons. We accomplish this by carefully classifying all possible one-loop diagrams and, from them, reading off the dark matter interactions with the particles running in the loop. Our approach is general and leads to the same results found in the literature for popular dark matter candidates such as the neutralinos of the MSSM, minimal dark matter, inert Higgs and Kaluza-Klein dark matter.

  20. The Generalized Principle of the Golden Section and its applications in mathematics, science, and engineering

    Stakhov, A.P. [International Club of the Golden Section, 6 McCreary Trail, Bolton, ON, L7E 2C8 (Canada)] e-mail: goldenmuseum@rogers.com

    2005-10-01

    The 'Dichotomy Principle' and the classical 'Golden Section Principle' are two of the most important principles of Nature, Science and also Art. The Generalized Principle of the Golden Section that follows from studying the diagonal sums of the Pascal triangle is a sweeping generalization of these important principles. This underlies the foundation of 'Harmony Mathematics', a new proposed mathematical direction. Harmony Mathematics includes a number of new mathematical theories: an algorithmic measurement theory, a new number theory, a new theory of hyperbolic functions based on Fibonacci and Lucas numbers, and a theory of the Fibonacci and 'Golden' matrices. These mathematical theories are the source of many new ideas in mathematics, philosophy, botanic and biology, electrical and computer science and engineering, communication systems, mathematical education as well as theoretical physics and physics of high energy particles.

  1. The Generalized Principle of the Golden Section and its applications in mathematics, science, and engineering

    Stakhov, A.P.

    2005-01-01

    The 'Dichotomy Principle' and the classical 'Golden Section Principle' are two of the most important principles of Nature, Science and also Art. The Generalized Principle of the Golden Section that follows from studying the diagonal sums of the Pascal triangle is a sweeping generalization of these important principles. This underlies the foundation of 'Harmony Mathematics', a new proposed mathematical direction. Harmony Mathematics includes a number of new mathematical theories: an algorithmic measurement theory, a new number theory, a new theory of hyperbolic functions based on Fibonacci and Lucas numbers, and a theory of the Fibonacci and 'Golden' matrices. These mathematical theories are the source of many new ideas in mathematics, philosophy, botanic and biology, electrical and computer science and engineering, communication systems, mathematical education as well as theoretical physics and physics of high energy particles

  2. A general algorithm for calculating jet cross sections in NLO QCD

    Catani, S.; Catani, Stefano; Seymour, Michael H

    1997-01-01

    We present a new general algorithm for calculating arbitrary jet cross sections in arbitrary scattering processes to next-to-leading accuracy in perturbative QCD. The algorithm is based on the subtraction method. The key ingredients are new factorization formulae, called dipole formulae, which implement in a Lorentz covariant way both the usual soft and collinear approximations, smoothly interpolating the two. The corresponding dipole phase space obeys exact factorization, so that the dipole contributions to the cross section can be exactly integrated analytically over the whole of phase space. We obtain explicit analytic results for any jet observable in any scattering or fragmentation process in lepton, lepton-hadron or hadron-hadron collisions. All the analytical formulae necessary to construct a numerical program for next-to-leading order QCD calculations are provided. The algorithm is straightforwardly implementable in general purpose Monte Carlo programs.

  3. Academic Advising in Individualized Major Programs: Promoting the Three I's of General Education

    Egan, Kevin

    2015-01-01

    Academic advisers play an important role in making general education relevant and meaningful to student learning by helping to facilitate the three I's of general education: inter-disciplinarity, integration, and intentionality. This essay argues that the "advising as learning" model of academic advising embodies the kinds of advising…

  4. A Comparison of Satisfaction; Spinal versus General Anesthesia for Cesarean Section

    Meo, S. A.; Siddique, S.; Meo, R. A.

    2013-01-01

    Objective: To compare the patients satisfaction with spinal and general anesthesia after cesarean section at CMH Lahore. Study Design: Randomized controlled trials. Study Setting: The study was conducted at the department of Obstetrics and Gynaecology combined military Hospital, Lahore, for 6 months from July to Dec 2011. Patients and Methods: Total 70 patients were included in the study and randomly divided into two groups of 35 each using random numbers table. All patients between ages of 20-40 years admitted for elective cesarean section and presented for following up at day 5-7 who never had any type of anesthesia in the past. There included in the study patients with complaints of migraine, low backaches, positive history or any other medical disorder were excluded from the study. Results: A total number of patients included were 70. Out of these selected patients, 35 procedures were carried out under spinal anesthesia and 35 under general anesthesia. Insignificant difference was found in satisfaction level of both the groups (p=0.220). There is significant difference for the future choice between two groups (p<0.001). Conclusion: Spinal anesthesia provides equal satisfaction for patients of cesarean section than general anesthesia. (author)

  5. Major Deficiencies Preventing Auditors From Rendering Audit Opinions on DOD General Fund Financial Statements

    Rauu, Russell

    1995-01-01

    .... This report gives Congress, the Secretary of Defense, the DoD Chief Financial Officer, financial managers, and the audit community an assessment of progress made in audited financial statements of DoD general funds...

  6. The Forgotten Airman - Major General Oliver P. Echols and How He Won WWII

    2012-06-01

    Interwar US Army Aviation and the Air Corps Tactical School, 211. 63 Boyd L. Dastrup, The US Army Command and General Staff College: A Centennial ...Army Command and General Staff College: A Centennial History (Manhattan, KS: Sunflower University Press, 1982), 86. During Echols’ time at CGSS, the...a Depression -era work relief program established under President Franklin D. Roosevelt’s New Deal to provide employment to young unmarried men

  7. The factors associated to psychosocial stress among general practitioners in Lithuania. Cross-sectional study

    Vanagas Giedrius

    2005-06-01

    Full Text Available Abstract Background There are number of studies showing that general practice is one of the most stressful workplace among health care workers. Since Baltic States regained independence in 1990, the reform of the health care system took place in which new role and more responsibilities were allocated to general practitioners' in Lithuania. This study aimed to explore the psychosocial stress level among Lithuanian general practitioner's and examine the relationship between psychosocial stress and work characteristics. Methods The cross-sectional study of 300 Lithuanian General practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the R. Karasek scale. The analysis included descriptive statistics; interrelationship analysis between characteristics and multivariate logistic regression to estimate odds ratios for each of the independent variables in the model. Results Response rate 66% (N = 197. Our study highlighted highest prevalence of psychosocial stress among widowed, single and female general practitioners. Lowest prevalence of psychosocial stress was among males and older age general practitioners. Psychosocial stress occurs when job demands are high and job decision latitude is low (χ2 = 18,9; p Conclusion One half of respondents suffering from work related psychosocial stress. High psychological workload demands combined with low decision latitude has the greatest impact to stress caseness among GP's. High job demands, high patient load and young age of GP's can be assigned as significant predictors of psychosocial stress among GP's.

  8. Major depressive disorder and generalized anxiety disorder and response to treatment in hepatitis C patients in Egypt.

    MM, Bassiony; A, Yousef; U, Youssef; GM, Salah El-Deen; M, Abdelghani; H, Al-Gohari; E, Fouad; MM, El-Shafaey

    2015-01-01

    The aim of the study was to estimate the prevalence and associated correlates of major depressive disorder and generalized anxiety disorder in hepatitis C virus patients before and after treatment and to investigate the relationship between major depressive disorder and generalized anxiety disorder and treatment response. A total of 116 consecutive hepatitis C virus patients from hepatitis C virus treatment center in Zagazig city, Egypt, were included in the study and divided into treated group (N = 58) and untreated group (N = 58). All hepatitis C virus patients were screened for major depressive disorder and generalized anxiety disorder using hospital anxiety and depression scale, and those who screened positive were interviewed to confirm the diagnosis of major depressive disorder and generalized anxiety disorder using DSM-IV-TR diagnostic criteria. These measures were done at baseline and after 12 weeks of treatment or observation. At baseline, 3.5% and 12.1% of hepatitis C virus patients (treated group) had major depressive disorder and generalized anxiety disorder, respectively. After 12 weeks of treatment 37.9% of hepatitis C virus patients (treated group) had major depressive disorder and 46.6% had generalized anxiety disorder. There was a significant statistical difference between hospital anxiety and depression scale scores for depression (3.3 ± 2.3 vs. 6.4 ± 3.2, t = 9.6, p = 0.001) and for anxiety (4.6 ± 2.4 vs. 7.3 ± 3.0, t = 10.2, p = 0.001) before and after treatment. There was also significant statistical difference between treated group and untreated group regarding hospital anxiety and depression scale scores after treatment and observation (depression, treated group 6.4 ± 3.2 vs. untreated group 4.0 ± 2.4, t = 3.7, p = 0.001; anxiety, treated group 7.3 ± 3.0 vs. untreated group 4.5 ± 2.3, t = 4.4, p = 0.001). There was no association between major depressive disorder

  9. Association of translocator protein total distribution volume with duration of untreated major depressive disorder: a cross-sectional study.

    Setiawan, Elaine; Attwells, Sophia; Wilson, Alan A; Mizrahi, Romina; Rusjan, Pablo M; Miler, Laura; Xu, Cynthia; Sharma, Sarita; Kish, Stephen; Houle, Sylvain; Meyer, Jeffrey H

    2018-04-01

    People with major depressive disorder frequently exhibit increasing persistence of major depressive episodes. However, evidence for neuroprogression (ie, increasing brain pathology with longer duration of illness) is scarce. Microglial activation, which is an important component of neuroinflammation, is implicated in neuroprogression. We examined the relationship of translocator protein (TSPO) total distribution volume (V T ), a marker of microglial activation, with duration of untreated major depressive disorder, and with total illness duration and antidepressant exposure. In this cross-sectional study, we recruited participants aged 18-75 years from the Toronto area and the Centre for Addiction and Mental Health (Toronto, ON, Canada). Participants either had major depressive episodes secondary to major depressive disorder or were healthy, as confirmed with a structured clinical interview and consultation with a study psychiatrist. To be enrolled, participants with major depressive episodes had to score a minimum of 17 on the 17-item Hamilton Depression Rating Scale, and had to be medication free or taking a stable dose of medication for at least 4 weeks before PET scanning. Eligible participants were non-smokers; had no history of or concurrent alcohol or substance dependence, neurological illness, autoimmune disorder, or severe medical problems; and were free from acute medical illnesses for the previous 2 weeks before PET scanning. Participants were excluded if they had used brain stimulation treatments within the 6 months before scanning, had used anti-inflammatory drugs lasting at least 1 week within the past month, were taking hormone replacement therapy, had psychotic symptoms, had bipolar disorder (type I or II) or borderline antisocial personality disorder, or were pregnant or breastfeeding. We scanned three primary grey-matter regions of interest (prefrontal cortex, anterior cingulate cortex, and insula) and 12 additional regions and subregions using 18

  10. Depression is a major determinant of quality of life in patients with chronic systolic heart failure in general practice.

    Müller-Tasch, Thomas; Peters-Klimm, Frank; Schellberg, Dieter; Holzapfel, Nicole; Barth, Annika; Jünger, Jana; Szecsenyi, Joachim; Herzog, Wolfgang

    2007-12-01

    Quality of life (QoL) is severely restricted in patients with chronic heart failure (CHF). Patients frequently suffer from depressive comorbidity. It is not clear, to what extent sociodemographic variables, heart failure severity, somatic comorbidities and depression determine QoL of patients with CHF in primary care. In a cross-sectional analysis, 167 patients, 68.2 +/- 10.1 years old, 68.9% male, New York Heart Association (NYHA) functional class II-IV, Left ventricular ejection fraction (LVEF) < or = 40%, were recruited in their general practitioner's practices. Heart failure severity was assessed with echocardiography and N-terminal brain natriuretic peptide (NT-proBNP); multimorbidity was assessed with the Cumulative Illness Rating Scale (CIRS-G). QoL was measured with the Short Form 36 Health Survey (SF-36) and depression with the depression module of the Patient Health Questionnaire (PHQ-9). Significant correlations with all SF-36 subscales were only found for the CIRS-G (r = -0.18 to -0.36; P < .05) and the PHQ-9 (r = -0.26 to -0.75; P < .01). In multivariate forward regression analyses, the PHQ-9 summary score explained the most part of QoL variance in all of the SF-36 subscales (r2 = 0.17-0.56). LVEF and NT-proBNP did not have significant influence on QoL. Depression is a major determinant of quality of life in patients with chronic systolic heart failure, whereas somatic measures of heart failure severity such as NT-proBNP and LVEF do not contribute to quality of life. Correct diagnosis and treatment of depressive comorbidity in heart failure patients is essential.

  11. Major depressive disorder and suicide risk among adult outpatients at several general hospitals in a Chinese Han population.

    Li, Haiyan; Luo, Xinni; Ke, Xiaoyin; Dai, Qing; Zheng, Wei; Zhang, Chanjuan; Cassidy, Ryan M; Soares, Jair C; Zhang, XiangYang; Ning, Yuping

    2017-01-01

    Somatic complaints are often the presenting symptoms of major depressive disorder (MDD) in the outpatient context, because this may go unrecognized. It is well understood that MDD carries an increased risk of suicide. This study aimed to identify the risk factors and association with both MDD and suicidality among Han Chinese outpatients. A multicenter study was carried out in 5189 outpatient adults (≥18 years old) in four general hospitals in Guangzhou, China. The 1392 patients who had the Patient Health Questionnaire-9 (PHQ-9) score ≥ 5, indicating depressive symptoms were offered an interview with a psychiatrist by the Mini International Neuropsychiatric Interview (MINI); 819 patients consented and completed the MINI interview. MINI module B was used to assess suicidality. Stepwise binary logistic models were used to estimate the relationship between a significant risk factor and suicide or MDD. According to with or without MDD, the secondary analysis was performed using the logistic regression model for the risk of suicidility. The current prevalence of MDD and the one month prevalence of suicidality were 3.7% and 2.3% respectively. The odds ratio of suicidality in women was more than twice that in men (OR = 2.62; 95% CI 1.45-4.76). Other risk factors which were significantly associated with suicidality were: living alone, higher education, self-reported depression, getting psychiatric diagnoses (MDD, anxiety disorders, and bipolar disorders). Significant risk factors for MDD were also noticed, such as comorbid anxiety disorders, self-reported anxiety, insomnia, suicidal ideation. It's a cross-sectional study in outpatient clinics using self-report questionnaires. This study provides valuable data about the risk factors and association of MDD and suicide risk in adult outpatients in Han Chinese. Those factors allow better the employment of preventative measures.

  12. Double Differential Cross Sections and Generalized Oscillator Strength Distributions of Ammonia

    Yamamoto, Karin; Nogami, Keisuke; Hino, Yuta; Sakai, Yasuhiro

    2011-01-01

    The absolute double differential cross section (DDCS), the generalized oscillator strength distribution (GOSD), and the ionization efficiency of ammonia (NH 3 ) were investigated from the threshold to 40 eV under the condition of 200 and 400 eV incident electron energies and 6 and 8 degree scattering angles using electron energy-loss spectroscopy and electron- ion coincidence techniques. To determine the absolute values, we used a mixture of helium (He) and NH 3 and normalized the measured relative DDCS spectrum by the differential cross section for 2 1 P excitation of He. Our results are in close agreement with previous dipole (e, e) spectroscopy, although the incident electron energy is lower. The ionization efficiency curve obtained from coincidence measurements indicated the existence of doubly excited states that cause neutral dissociation.

  13. Citizen Warrior: Major General Joshua Lawrence Chamberlain a Study in Command Leadership

    2012-04-29

    anticipated―challenges. The complex, fluid environment of war demands the institutionalization of this intellectual energy to affect the necessary...choosing an appropriate course of action. I believe that these characteristics of “Military Genius” are as valuable in today’s environment as they were...1999) p. 303. 44 Wallace, p. 68. 45 James E. Kelly, Generals in Bronze, ed. William B. Styple, read Patrick Cullen (Ashland, Blackstone Audio, Inc

  14. The generalized nuclear contact and its application to the photoabsorption cross-section

    Weiss, Ronen; Barnea, Nir [The Hebrew University, The Racah Institute of Physics, Jerusalem (Israel); Bazak, Betzalel [The Hebrew University, The Racah Institute of Physics, Jerusalem (Israel); Universite Paris-Sud, Institut de Physique Nucleaire, CNRS/IN2P3, Orsay (France)

    2016-04-15

    Using the zero-range model, it was demonstrated recently that Levinger's quasi-deuteron model can be utilized to extract the nuclear neutron-proton contact. Going beyond the zero-range approximation and considering the full nuclear contact formalism, we rederive here the quasi-deuteron model for the nuclear photoabsorption cross-section and utilize it to establish relations and constraints for the general contact matrix. We also define and demonstrate the importance of the diagonalized nuclear contacts, which can be also relevant to further applications of the nuclear contacts. (orig.)

  15. Chapter A6. Section 6.0. General Information and Guidelines

    Wilde, Franceska D.; Radtke, Dean B.

    2005-01-01

    This report summarizes information, guidelines, and minimum requirements that apply generally to the seven field-measurement sections that comprise the rest of Chapter A6 of this U.S. Geological Survey (USGS) National Field Manual for the Collection of Water-Quality Data (NFM). Protocols are specified for establishing and maintaining data records, use of field-measurement instruments and methods, and quality assurance of data-collection and reporting methods that are relevant to surface-water and ground-water field-measurement activities.

  16. Student Learning through Journal Writing in a General Education Chemistry Course for Pre-Elementary Education Majors

    Dianovsky, Michael T.; Wink, Donald J.

    2012-01-01

    This paper describes research on the use of journals in a general education chemistry course for elementary education majors. In the journals, students describe their understanding of a topic, the development of that understanding, and how the topic connects to their lives. In the process, they are able to engage in reflection about several…

  17. Generalized Anxiety and Major Depressive syndrome measured by the SCL-90-R in Two Manganese (Mn) Exposed Ohio Towns

    Objective: Environmental exposure to manganese (Mn) may cause generalized anxiety (GA) and major depression (MD) in residents living in Mn-exposed areas. Marietta and East Liverpool are two Ohio towns identified as having elevated levels of Mn. The objective was to determine if l...

  18. Associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder among men and women.

    Zhang, Chenshu; Brook, Judith S; Leukefeld, Carl G; Brook, David W

    2016-01-01

    The objective of this study was to examine the associations between compulsive buying and substance dependence/abuse, major depressive episodes, and generalized anxiety disorder at the mean age of 43. Participants came from a community-based random sample of residents in 2 New York counties in 1975 (N = 548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (standard deviation = 2.8). Of the participants, 55% were females. Over 90% of the participants were Caucasian. The prevalence of substance dependence/abuse, major depressive episodes, and generalized anxiety disorder (during the past 5 years before the interviews) was 6.6, 13.7, and 11.5%, respectively. Logistic regression analyses showed that compulsive buying was significantly associated with substance dependence/abuse (adjusted odds ratio = 1.60), major depressive episodes (adjusted odds ratio = 1.70), and generalized anxiety disorder (adjusted odds ratio = 1.63), despite controlling for substance dependence/abuse, major depressive episodes, and generalized anxiety disorder, respectively, at the mean age of 37, and demographic factors. Since the study sample is limited to predominantly Caucasian participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, major depressive episodes, and generalized anxiety disorder consider the role of compulsive buying.

  19. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general

  20. Relationship between mobility, violence and major depression among female sex workers: a cross-sectional study in southern India.

    Patel, Sangram Kishor; Ganju, Deepika; Prabhakar, Parimi; Adhikary, Rajatashuvra

    2016-09-09

    The relationship between mobility, violence and mental health has largely been unexplored in developing countries. This study screens for signs of major depression, and assesses its association with mobility and violence among female sex workers (FSWs) in southern India. Data (N=2400) for this study were used from a cross-sectional Behavioral Tracking Survey (BTS-2014) conducted among FSWs from a southern state of India as part of the Avahan programme. Major depression of FSWs was assessed using the Patient Health Questionnaire-2 depression scale. Descriptive statistics, frequency, bivariate, interaction effect and multivariate logistic regression techniques were used for the analysis. More than one-fourth of FSWs (29%) screened positive for major depression. The likelihood of screening positive for major depression was 6 times higher among FSWs who were both mobile for sex work outside their district of residence and had experienced any violence (combined association) during the past 1 year (62% vs 19%, adjusted OR 6.1, 95% CI 4.4 to 8.6) compared with those who reported neither. The individual association results show that FSWs who reported being mobile outside the district, and FSWs who were beaten or raped in the past 1 year, were 3 times more likely to screen positive for major depression. The findings indicate that violence and mobility are independently associated with major depression among FSWs. The combined association of mobility and violence poses a greater risk to the mental health of FSWs than their independent association. These results point to the need for creating an enabling environment for FSWs to enhance existing efforts to reduce the spread of HIV and mental health problems. The study highlights that HIV prevention efforts among FSWs in India require evidence-based research and integrated programme approaches to address mental health issues. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  1. Age-Dependent Pleiotropy Between General Cognitive Function and Major Psychiatric Disorders.

    Hill, W David; Davies, Gail; Liewald, David C; McIntosh, Andrew M; Deary, Ian J

    2016-08-15

    General cognitive function predicts psychiatric illness across the life course. This study examines the role of pleiotropy in explaining the link between cognitive function and psychiatric disorder. We used two large genome-wide association study data sets on cognitive function-one from older age, n = 53,949, and one from childhood, n = 12,441. We also used genome-wide association study data on educational attainment, n = 95,427, to examine the validity of its use as a proxy phenotype for cognitive function. Using a new method, linkage disequilibrium regression, we derived genetic correlations, free from the confounding of clinical state between psychiatric illness and cognitive function. We found a genetic correlation of .711 (p = 2.26e-12) across the life course for general cognitive function. We also showed a positive genetic correlation between autism spectrum disorder and cognitive function in childhood (rg = .360, p = .0009) and for educational attainment (rg = .322, p = 1.37e-5) but not in older age. In schizophrenia, we found a negative genetic correlation between older age cognitive function (rg = -.231, p = 3.81e-12) but not in childhood or for educational attainment. For Alzheimer's disease, we found negative genetic correlations with childhood cognitive function (rg = -.341, p = .001), educational attainment (rg = -.324, p = 1.15e-5), and with older age cognitive function (rg = -.324, p = 1.78e-5). The pleiotropy exhibited between cognitive function and psychiatric disorders changed across the life course. These age-dependent associations might explain why negative selection has not removed variants causally associated with autism spectrum disorder or schizophrenia. Copyright © 2016 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Human brain receptor autoradiography using whole hemisphere sections: a general method that minimizes tissue artefacts

    Quirion, R.; Robitaille, Y.; Martial, J.; Chabot, J.G.; Lemoine, P.; Pilapil, C.; Dalpe, M.

    1987-01-01

    A general method for the preparation of high-quality, mostly ice-crystal-artefact-free whole human brain hemisphere sections is described. Upon receipt, hemispheres are divided; one is then fixed in buffered 10% formalin for neuropathological analysis while the other is cut in 8-10-mm-thick coronal slices that are then rapidly frozen in 2-methylbutane at -40 degrees C (10-15 sec) before being placed in the brain bank at -80 degrees C. Such rapid freezing markedly decreases the formation of ice-crystal artefacts. Whole-hemisphere 20-micron thick sections are then cut and mounted onto lantern-type gelatin-coated slides. These sections are subsequently used for both qualitative and quantitative in vitro receptor autoradiography. Examples of data obtained are given by using various radioligands labelling classical neutrotransmitter, neuropeptide, enzyme, and ion channel receptor binding sites. This method should be useful for the obtention of various receptor maps in human brain. Such information could be most useful for in vivo receptor visualization studies using positron emission tomography (PET) scanning. It could also indicate if a given receptor population is specifically and selectively altered in certain brain diseases, eventually leading to the development of new therapeutic approaches

  3. Patients' evaluations of patient safety in English general practices: a cross-sectional study.

    Ricci-Cabello, Ignacio; Marsden, Kate S; Avery, Anthony J; Bell, Brian G; Kadam, Umesh T; Reeves, David; Slight, Sarah P; Perryman, Katherine; Barnett, Jane; Litchfield, Ian; Thomas, Sally; Campbell, Stephen M; Doos, Lucy; Esmail, Aneez; Valderas, Jose M

    2017-07-01

    Description of safety problems and harm in general practices has previously relied on information from health professionals, with scarce attention paid to experiences of patients. To examine patient-reported experiences and outcomes of patient safety in primary care. Cross-sectional study in 45 general practices across five regions in the north, centre, and south of England. A version of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was sent to a random sample of 6736 patients. Main outcome measures included 'practice activation' (what a practice does to create a safe environment); 'patient activation' (how proactive are patients in ensuring safe healthcare delivery); 'experiences of safety events' (safety errors); 'outcomes of safety' (harm); and 'overall perception of safety' (how safe patients rate their practice). Questionnaires were returned by 1244 patients (18.4%). Scores were high for 'practice activation' (mean [standard error] = 80.4 out of 100 [2.0]) and low for 'patient activation' (26.3 out of 100 [2.6]). Of the patients, 45% reported experiencing at least one safety problem in the previous 12 months, mostly related to appointments (33%), diagnosis (17%), patient provider communication (15%), and coordination between providers (14%). Twenty-three per cent of the responders reported some degree of harm in the previous 12 months. The overall assessment of level of safety of practices was generally high (86.0 out of 100 [16.8]). Priority areas for patient safety improvement in general practices in England include appointments, diagnosis, communication, coordination, and patient activation. © British Journal of General Practice 2017.

  4. The Art of Astronomy: A New General Education Course for Non-Science Majors

    Pilachowski, Catherine A.; van Zee, Liese

    2017-01-01

    The Art of Astronomy is a new general education course developed at Indiana University. The topic appeals to a broad range of undergraduates and the course gives students the tools to understand and appreciate astronomical images in a new way. The course explores the science of imaging the universe and the technology that makes the images possible. Topics include the night sky, telescopes and cameras, light and color, and the science behind the images. Coloring the Universe: An Insider's Look at Making Spectacular Images of Space" by T. A. Rector, K. Arcand, and M. Watzke serves as the basic text for the course, supplemented by readings from the web. Through the course, students participate in exploration activities designed to help them first to understand astronomy images, and then to create them. Learning goals include an understanding of scientific inquiry, an understanding of the basics of imaging science as applied in astronomy, a knowledge of the electromagnetic spectrum and how observations at different wavelengths inform us about different environments in the universe, and an ability to interpret astronomical images to learn about the universe and to model and understand the physical world.

  5. Social relationship correlates of major depressive disorder and depressive symptoms in Switzerland: nationally representative cross sectional study

    2014-01-01

    Background The quality and quantity of social relationships are associated with depression but there is less evidence regarding which aspects of social relationships are most predictive. We evaluated the relative magnitude and independence of the association of four social relationship domains with major depressive disorder and depressive symptoms. Methods We analyzed a cross-sectional telephone interview and postal survey of a probability sample of adults living in Switzerland (N = 12,286). Twelve-month major depressive disorder was assessed via structured interview over the telephone using the Composite International Diagnostic Interview (CIDI). The postal survey assessed depressive symptoms as well as variables representing emotional support, tangible support, social integration, and loneliness. Results Each individual social relationship domain was associated with both outcome measures, but in multivariate models being lonely and perceiving unmet emotional support had the largest and most consistent associations across depression outcomes (incidence rate ratios ranging from 1.55-9.97 for loneliness and from 1.23-1.40 for unmet support, p’s social relationship domains except marital status were independently associated with depressive symptoms whereas only loneliness and unmet support were associated with depressive disorder. Conclusions Perceived quality and frequency of social relationships are associated with clinical depression and depressive symptoms across a wide adult age spectrum. This study extends prior work linking loneliness to depression by showing that a broad range of social relationship domains are associated with psychological well-being. PMID:24656048

  6. Social relationship correlates of major depressive disorder and depressive symptoms in Switzerland: nationally representative cross sectional study.

    Barger, Steven D; Messerli-Bürgy, Nadine; Barth, Jürgen

    2014-03-24

    The quality and quantity of social relationships are associated with depression but there is less evidence regarding which aspects of social relationships are most predictive. We evaluated the relative magnitude and independence of the association of four social relationship domains with major depressive disorder and depressive symptoms. We analyzed a cross-sectional telephone interview and postal survey of a probability sample of adults living in Switzerland (N=12,286). Twelve-month major depressive disorder was assessed via structured interview over the telephone using the Composite International Diagnostic Interview (CIDI). The postal survey assessed depressive symptoms as well as variables representing emotional support, tangible support, social integration, and loneliness. Each individual social relationship domain was associated with both outcome measures, but in multivariate models being lonely and perceiving unmet emotional support had the largest and most consistent associations across depression outcomes (incidence rate ratios ranging from 1.55-9.97 for loneliness and from 1.23-1.40 for unmet support, p'sdepressive symptoms whereas only loneliness and unmet support were associated with depressive disorder. Perceived quality and frequency of social relationships are associated with clinical depression and depressive symptoms across a wide adult age spectrum. This study extends prior work linking loneliness to depression by showing that a broad range of social relationship domains are associated with psychological well-being.

  7. Experiences of occupational violence in Australian urban general practice: a cross-sectional study of GPs.

    Magin, Parker J; Adams, Jon; Sibbritt, David W; Joy, Elyssa; Ireland, Malcolm C

    2005-10-03

    To establish the prevalence and characteristics of occupational violence in Australian urban general practice, and examine practitioner correlates of violence. Cross-sectional questionnaire survey mailed to all members (n = 1085) of three urban divisions of general practice in New South Wales in August and September 2004. The three divisions were chosen to provide a range of socioeconomic status (SES) demographics. Occupational violence towards general practitioners during the previous 12 months. 528 GPs returned questionnaires (49% response rate). Of these, 63.7% had experienced violence in the previous year. The most common forms of violence were "low level" violence - verbal abuse (42.1%), property damage/theft (28.6%) and threats (23.1%). A smaller proportion of GPs had experienced "high level" violence, such as sexual harassment (9.3%) and physical abuse (2.7%). On univariate analysis, violence was significantly more likely towards female GPs (P working in a lower SES status area (P disadvantage (P = 0.006), mental health problems (P home visits). On multivariate analysis, a significant association persisted between high level violence and lower SES area (odds ratio [OR], 2.86), being female (OR, 5.87), having practice populations with more drug-related problems (OR, 5.77), and providing home visits during business hours (OR, 4.76). More experienced GPs encountered less violence (OR, 0.77) for every additional 5 years of practice. Occupational violence is a considerable problem in Australian urban general practice. Formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training.

  8. Bilateral primary spontaneous pneumothoraces postcaesarean section – another reason to avoid general anaesthesia in pregnancy

    Aye, Christina Yi Ling; McKean, David; Dark, Allan; Akinsola, S Adeyemi

    2012-01-01

    A 36-year-old, healthy, primiparous female underwent a caesarean section under general anaesthetic. She had previously had a severe reaction to dye during a myelogram and therefore, had declined epidural analgesia or regional anaesthesia. Induction and maintenance of anaesthesia was uneventful, but on emergence, and before tracheal extubation, the patient coughed on the endotracheal tube and almost immediately developed right-sided subcutaneous emphysema of the face and neck. At this point her oxygen saturation began to fall and she was noted to be difficult to ventilate. Clinically and radiologically, she had a right-sided pneumothorax which was treated immediately with intercostal drain insertion. She went on to develop a left pneumothorax which also required intercostal drain insertion. She made an uneventful recovery and was discharged 8 days later. A subsequent CT scan of her chest revealed no pre-existing primary pulmonary pathology that would have accounted for the pneumothoraces. PMID:22927264

  9. Cross Sections for the Exclusive Photon Electroproduction on the Proton and Generalized Parton Distributions

    Jo, H. S.; Girod, F. X.; Avakian, H.; Burkert, V. D.; Garçon, M.; Guidal, M.; Kubarovsky, V.; Niccolai, S.; Stoler, P.; Adhikari, K. P.; Adikaram, D.; Amaryan, M. J.; Anderson, M. D.; Anefalos Pereira, S.; Ball, J.; Baltzell, N. A.; Battaglieri, M.; Batourine, V.; Bedlinskiy, I.; Biselli, A. S.; Boiarinov, S.; Briscoe, W. J.; Brooks, W. K.; Carman, D. S.; Celentano, A.; Chandavar, S.; Charles, G.; Colaneri, L.; Cole, P. L.; Compton, N.; Contalbrigo, M.; Crede, V.; D'Angelo, A.; Dashyan, N.; De Vita, R.; De Sanctis, E.; Deur, A.; Djalali, C.; Dupre, R.; Alaoui, A. El; Fassi, L. El; Elouadrhiri, L.; Fedotov, G.; Fegan, S.; Filippi, A.; Fleming, J. A.; Garillon, B.; Gevorgyan, N.; Ghandilyan, Y.; Gilfoyle, G. P.; Giovanetti, K. L.; Goetz, J. T.; Golovatch, E.; Gothe, R. W.; Griffioen, K. A.; Guegan, B.; Guler, N.; Guo, L.; Hafidi, K.; Hakobyan, H.; Harrison, N.; Hattawy, M.; Hicks, K.; Hirlinger Saylor, N.; Ho, D.; Holtrop, M.; Hughes, S. M.; Ilieva, Y.; Ireland, D. G.; Ishkhanov, B. S.; Jenkins, D.; Joo, K.; Joosten, S.; Keller, D.; Khachatryan, G.; Khandaker, M.; Kim, A.; Kim, W.; Klein, A.; Klein, F. J.; Kuhn, S. E.; Kuleshov, S. V.; Lenisa, P.; Livingston, K.; Lu, H. Y.; MacGregor, I. J. D.; McKinnon, B.; Meziani, Z. E.; Mirazita, M.; Mokeev, V.; Montgomery, R. A.; Moutarde, H.; Movsisyan, A.; Munevar, E.; Munoz Camacho, C.; Nadel-Turonski, P.; Net, L. A.; Niculescu, G.; Osipenko, M.; Ostrovidov, A. I.; Paolone, M.; Park, K.; Pasyuk, E.; Phillips, J. J.; Pisano, S.; Pogorelko, O.; Price, J. W.; Procureur, S.; Prok, Y.; Puckett, A. J. R.; Raue, B. A.; Ripani, M.; Rizzo, A.; Rosner, G.; Rossi, P.; Roy, P.; Sabatié, F.; Salgado, C.; Schott, D.; Schumacher, R. A.; Seder, E.; Simonyan, A.; Skorodumina, Iu.; Smith, G. D.; Sokhan, D.; Sparveris, N.; Stepanyan, S.; Strakovsky, I. I.; Strauch, S.; Sytnik, V.; Tian, Ye; Tkachenko, S.; Ungaro, M.; Voskanyan, H.; Voutier, E.; Walford, N. K.; Watts, D. P.; Wei, X.; Weinstein, L. B.; Wood, M. H.; Zachariou, N.; Zana, L.; Zhang, J.; Zhao, Z. W.; Zonta, I.; CLAS Collaboration

    2015-11-01

    Unpolarized and beam-polarized fourfold cross sections (d4σ /d Q2d xBd t d ϕ ) for the e p →e'p'γ reaction were measured using the CLAS detector and the 5.75-GeV polarized electron beam of the Jefferson Lab accelerator, for 110 (Q2,xB,t ) bins over the widest phase space ever explored in the valence-quark region. Several models of generalized parton distributions (GPDs) describe the data well at most of our kinematics. This increases our confidence that we understand the GPD H , expected to be the dominant contributor to these observables. Through a leading-twist extraction of Compton form factors, these results support the model predictions of a larger nucleon size at lower quark-momentum fraction xB.

  10. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report

    Márcio Luiz Benevides

    Full Text Available Abstract Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day.

  11. Interference generalized cross-section for the multiphoton detachment of H- in dichromatic fields

    Mercouris, Theodoros; Haritos, Costas; Nicolaides, Cleanthes A

    2005-01-01

    The paper reports results from the application of the many-electron, many-photon theory on the system 'H - 1s 2 1 S state plus two fields of weak strengths, F 1 and F 2 '. The two fields have commensurate frequencies (ω, 2ω) and (ω, 3ω), with ω ranging from 0.011 au to 0.028 au, field strengths from 5 x 10 -5 au to 1.7 x 10 -3 au and a phase difference ψ. It is possible to determine the regime where the dichromatic field is weak and to define and compute a corresponding 'interference generalized cross-section'. This cross-section is an intrinsic property of each state as a function of the pair (ω, mω), m = 2, 3,.... Its knowledge is directly relevant to deciding on the degree of effectiveness of coherent quantum control. The calculations show that, with respect to ψ, H - is more receptive to control if frequencies are low. The computed effects are large enough so as to be measurable

  12. [A cross-sectional study on iodine nutrition in general population from Zhejiang province, China].

    Mo, Zhe; Lou, Xiao-ming; Zhu, Wen-ming; Wang, Xiao-feng; Mao, Guang-ming; Zhou, Jin-shui; Ding, Gang-qiang

    2013-05-01

    To understand the current status of iodine nutrition among the community residents to compare the level of iodine nutrition in different areas and groups of populations in Zhejiang province. Stratified cluster sampling method was adopted and residents from twenty-two communities in Zhejiang province were selected. A cross-sectional survey was conducted, using questionnaires, laboratory tests, on urinary iodine, water iodine and the concentration of the iodine in salt, which had played positive roles in the calculation of the level of iodine nutrition. of the iodine nutrition in this cross-sectional survey were as follows: the median water iodine and salt iodine of Zhejiang were 2.42 µg/L and 28.8 mg/kg, respectively. The coverage of iodized salts was 79.54%, with the ingesting rate of qualified iodized-salt as 76.65% and the median content of urinary iodine in the population of Zhejiang was 161 µg/L. The average iodine content among pregnant women was 138 µg/L, with the percentage of samples less than 100 µg/L as 25.92%, more than 300 µg/L as 15.30%. The proportions of iodine intake through water, salt and other foods were 1.70%, 76.41% and 21.89%, respectively. The status of iodine nutrition in Zhejiang province in general seemed to be appropriate, but the level of iodine nutrition in pregnant women was less than the requirement, which should call for attention.

  13. On the report of the Nuclear Energy Section Meeting, General Survey Committee

    Okamura, Shigehiro

    1979-01-01

    The demand and supply of petroleum have relaxed temporarily, but in the long run, the difficulty of energy problem does not change. More powerful promotion of general energy policy with conformity and effectiveness is a worldwide problem. In order to cope with such situation, General Energy Survey Committee has examined the concrete measures, and drawn up the interim report in August, 1977. The present report does not change from the interim report in its basic framework, but the background on which this framework is based is clarified, and the contents of the concrete measures are examined in more detail. The Nuclear Energy Sectional Meeting has obtained the conclusions about the basic matters in the development and utilization of nuclear energy and the concrete measures required to be taken urgently. The domestic and foreign situations about the development and utilization of nuclear energy are explained, and the location of nuclear power stations is the most serious bottleneck, therefore the measures to obtain national consensus are the most important problem in every country. The nuclear power generation in Japan is expected to reach 33 million kW by 1985 and 60 million kW by 1990. As the concrete measures, improvement of safety and reliability, establishment of nuclear fuel cycle, development and adoption of new type nuclear reactors, strengthening of the base of nuclear energy industries, promotion of research and development, and contribution to international activities are briefly discussed. (Kako, I.)

  14. Investigation of fatigue by Australian general practice registrars: a cross-sectional study.

    Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Thomson, Allison; Wilson, Jessica; Scott, John; Spike, Neil A; McArthur, Lawrie; van Driel, Mieke L; Magin, Parker J

    2015-06-01

    Fatigue is the most common undifferentiated problem presenting in general practice. Previous studies have shown that this presentation leads to multiple investigations. There is no published literature describing the management of patients with fatigue by general practice (GP) registrars. To document the investigation-ordering behaviour of GP registrars in managing patients with a new diagnosis of unexplained fatigue. This was a cross-sectional analysis of data from Registrar Clinical Encounters in Training (ReCEnT), an ongoing cohort study of GP registrars' consultations. We established the prevalence of new diagnoses of unexplained fatigue and associations with that diagnosis, the rate of test ordering and the number and types of investigations ordered. 644 registrars contributed data from 68 986 encounters. In 0.78% of patient encounters, a new diagnosis of unexplained fatigue was made. Pathology was ordered in 78.4% of these problems (versus 18.1% in non-fatigue problems), at a rate of 488 tests per 100 new fatigue problems. Our study suggests that unexplained fatigue elicits a non-rational approach to test ordering by registrars. These findings contribute to the understanding of GP registrar management of fatigue, and undifferentiated presentations more broadly, and suggest educational approaches to improve practice, including dealing with uncertainty.

  15. Burnout syndrome in surgical oncology and general surgery nurses: a cross-sectional study.

    Książek, Ilona; Stefaniak, Tomasz J; Stadnyk, Magdalena; Książek, Janina

    2011-09-01

    The occurrence of burnout syndrome is strongly associated with and modulated by multiple personality and environmental factors. In Poland, nurses experience a discrepancy between the demands, expectations and social status of the position of their profession and low salaries. Such a situation provokes frustration and depression, and further leads to problems of adaptation including burnout syndrome. The aim of this study was to evaluate the occurrence of burnout syndrome among nurses working in general surgery and surgical oncology specialties. The study was designed as a cross-sectional questionnaire survey. It was undertaken in the largest Hospital in the Pomeranian region of Poland. The participants included 60 nurses working in two departments: General Surgery and Surgical Oncology. The study was based upon an anonymous self-test composed of a questionnaire and three psychological measures: Maslach Burnout Inventory (MBI), Psychological Burden Scale and a self-constructed questionnaire on job satisfaction. Intensity of burnout syndrome was significantly higher among oncology nurses than among surgical ones. There was also a strong but not significant trend towards higher Psychological Burden Scale in the group of oncology nurses. The study revealed a high degree of emotional burden and burnout in nurses working in the study hospital suggesting that nurses are at great occupational risk. The findings of the study provide evidence of the potential need to restructure the system and suggest that nurses need more control of their work including a higher degree of involvement in clinical decision-making. Copyright © 2010 Elsevier Ltd. All rights reserved.

  16. Physical Violence against General Practitioners and Nurses in Chinese Township Hospitals: A Cross-Sectional Survey.

    Kai Xing

    Full Text Available The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals.A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%.A total of 106 of the 840 (12.6% respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients' relatives (62.3%, followed by the patient (22.6%; 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60 resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%. Most respondents (62.8% did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc..Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue.

  17. Travel Medicine Encounters of Australian General Practice Trainees-A Cross-Sectional Study.

    Morgan, Simon; Henderson, Kim M; Tapley, Amanda; Scott, John; van Driel, Mieke L; Spike, Neil A; McArthur, Lawrie A; Davey, Andrew R; Catzikiris, Nigel F; Magin, Parker J

    2015-01-01

    Travel medicine is a common and challenging area of clinical practice and practitioners need up-to-date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel medicine advice. We aimed to describe the rate and nature of travel medicine consultations, including both the clinical and educational aspects of the consultations. A cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations was performed. Trainees contemporaneously recorded demographic, clinical, and educational details of consecutive patient consultations. Proportions of all problems/diagnoses managed in these consultations that were coded "travel-related" and "travel advice" were both calculated with 95% confidence intervals (CIs). Associations of a problem/diagnosis being "travel-related" or "travel advice" were tested using simple logistic regression within the generalized estimating equations (GEE) framework. A total of 856 trainees contributed data on 169,307 problems from 108,759 consultations (2010-2014). Travel-related and travel advice problems were managed at a rate of 1.1 and 0.5 problems per 100 encounters, respectively. Significant positive associations of travel-related problems were younger trainee and patient age; new patient to the trainee and practice; privately billing, larger, urban, and higher socioeconomic status practices; and involvement of the practice nurse. Trainees sought in-consultation information and generated learning goals in 34.7 and 20.8% of travel advice problems, respectively, significantly more than in non-travel advice problems. Significant positive associations of travel advice problems were seeking in-consultation information, generation of learning goals, longer consultation duration, and more problems managed. Our findings reinforce the importance of focused training in travel medicine for GP trainees and adequate exposure to patients in the practice

  18. Responses to clinical uncertainty in Australian general practice trainees: a cross-sectional analysis.

    Cooke, Georga; Tapley, Amanda; Holliday, Elizabeth; Morgan, Simon; Henderson, Kim; Ball, Jean; van Driel, Mieke; Spike, Neil; Kerr, Rohan; Magin, Parker

    2017-12-01

    Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of intolerance of uncertainty in this group. The aim of this study was to establish levels of tolerance of uncertainty in Australian general practice trainees and associations of uncertainty with demographic, educational and training practice factors. A cross-sectional analysis was performed on the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study. Scores on three of the four independent subscales of the Physicians' Reaction to Uncertainty (PRU) instrument were analysed as outcome variables in linear regression models with trainee and practice factors as independent variables. A total of 594 trainees contributed data on a total of 1209 occasions. Trainees in earlier training terms had higher scores for 'Anxiety due to uncertainty', 'Concern about bad outcomes' and 'Reluctance to disclose diagnosis/treatment uncertainty to patients'. Beyond this, findings suggest two distinct sets of associations regarding reaction to uncertainty. Firstly, affective aspects of uncertainty (the 'Anxiety' and 'Concern' subscales) were associated with female gender, less experience in hospital prior to commencing general practice training, and graduation overseas. Secondly, a maladaptive response to uncertainty (the 'Reluctance to disclose' subscale) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status, and being Australian-trained. This study has established levels of three measures of trainees' responses to uncertainty and associations with these responses. The current findings suggest differing 'phenotypes' of trainees with high 'affective' responses to uncertainty and those reluctant to disclose uncertainty to patients. More

  19. General practitioners' views of clinically led commissioning: cross-sectional survey in England.

    Moran, Valerie; Checkland, Kath; Coleman, Anna; Spooner, Sharon; Gibson, Jonathan; Sutton, Matt

    2017-06-08

    Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement. Survey of a random sample of GPs across England in 2015. The Eighth National GP Worklife Survey was distributed to GPs in spring 2015. Responses were received from 2611 respondents (response rate = 46%). We compared responses across different GP characteristics and conducted two sample tests of proportions to identify statistically significant differences in responses across groups. We also used multivariate logistic regression to identify the characteristics associated with wanting a formal CCG role in the future. While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as 'membership organisations' but only a minority of respondents reported feeling that they had 'ownership' of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do. CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted

  20. General practitioners’ views of clinically led commissioning: cross-sectional survey in England

    Moran, Valerie; Checkland, Kath; Coleman, Anna; Spooner, Sharon; Gibson, Jonathan; Sutton, Matt

    2017-01-01

    Objectives Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement. Design and setting Survey of a random sample of GPs across England in 2015. Method The Eighth National GP Worklife Survey was distributed to GPs in spring 2015. Responses were received from 2611 respondents (response rate = 46%). We compared responses across different GP characteristics and conducted two sample tests of proportions to identify statistically significant differences in responses across groups. We also used multivariate logistic regression to identify the characteristics associated with wanting a formal CCG role in the future. Results While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as ‘membership organisations’ but only a minority of respondents reported feeling that they had ‘ownership’ of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do. Conclusion CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership. PMID:28596217

  1. Fear of going under general anesthesia: A cross-sectional study.

    Ruhaiyem, M E; Alshehri, A A; Saade, M; Shoabi, T A; Zahoor, H; Tawfeeq, N A

    2016-01-01

    Fears related to anesthesia have affected a considerable number of patients going for surgery. The purpose of this survey was to identify the most common concerns about general anesthesia during the preoperative anesthetic clinic in different healthcare settings, and whether they are affected by patients' sex, age, education, or previous experience of anesthesia or not. Structured questionnaires with consent forms were distributed to patients in their preanesthesia clinic visit in three tertiary hospitals (King Abdul-Aziz Medical City, King Faisal Specialist Hospital, and King Khalid University Hospital) in Riyadh, Saudi Arabia. Patients' demographics and questions related to their fears regarding general anesthesia were included in the questionnaires. All categorical and interval variables were compared statically using a Chi-square test for independence and a t-test, respectively. All statistical tests were declared significant at α level of 0.05 or less. Among 450 questionnaires that were disturbed, 400 questionnaires were collected and analyzed. Eighty-eight percent experienced preoperative fear. The top three causes of their fears were fear of postoperative pain (77.3%), fear of intraoperative awareness (73.7%), and fear of being sleepy postoperatively (69.5%). Patients are less fearful of drains and needles in the operative theater (48%), of revealing personal issues under general anesthesia (55.2%), and of not waking up after surgery (56.4%). Age and gender were significant predictors of the overall fear among preanesthetic patients. Females are 5 times more likely to experience fear before surgery (P = 0.0009). Patients aged more than 40 years old are also at 75% higher risk of being afraid (P = 0.008). The majority of the patients going for surgery experienced a fear of anesthesia. Mostly females, especially those over 40, were at a higher risk of being afraid. Fear can bring anxiety which, in turn, might affect the patient's surgery.

  2. Harnessing Social Media to Explore Youth Social Withdrawal in Three Major Cities in China: Cross-Sectional Web Survey

    Liu, Lucia Lin; Li, Tim MH; Teo, Alan R; Kato, Takahiro A

    2018-01-01

    Background Socially withdrawn youth belong to an emerging subgroup of youth who are not in employment, education, or training and who have limited social interaction intention and opportunities. The use of the internet and social media is expected to be an alternative and feasible way to reach this group of young people because of their reclusive nature. Objective The aim of this study was to explore the possibility of using various social media platforms to investigate the existence of the phenomenon of youth social withdrawal in 3 major cities in China. Methods A cross-sectional open Web survey was conducted from October 2015 to May 2016 to identify and reach socially withdrawn youth in 3 metropolitan cities in China: Beijing, Shanghai, and Shenzhen. To advertise the survey, 3 social media platforms were used: Weibo, WeChat, and Wandianba, a social networking gaming website. Results In total, 137 participants completed the survey, among whom 13 (9.5%) were identified as belonging to the withdrawal group, 7 (5.1%) to the asocial group, and 9 (6.6%) to the hikikomori group (both withdrawn and asocial for more than 3 months). The cost of recruitment via Weibo was US $7.27 per participant. Conclusions Several social media platforms in China are viable and inexpensive tools to reach socially withdrawn youth, and internet platforms that specialize in a certain culture or type of entertainment appeared to be more effective in reaching socially withdrawn youth. PMID:29748164

  3. Utilisation of internet resources for continuing professional development: a cross-sectional survey of general practitioners in Scotland.

    MacWalter, Gordon; McKay, John; Bowie, Paul

    2016-01-21

    Participation in continuing professional development (CPD) is a professional and regulatory expectation of general practitioners (GPs). Traditionally, CPD activity was undertaken face-to-face in educational settings, but internet based formats have found increasing favour. The need for doctors to use the internet for service and educational purposes is growing, particularly in support of specialty training and appraisal. We aimed to determine how GPs in Scotland utilise online resources in support of their CPD. This involved identifying which resources are used and how frequently, along with their preferences as to how and why they access these resources. A cross sectional study was undertaken using an online questionnaire to survey general practitioners across Scotland. Data were subjected to descriptive analysis and differences in attitudinal responses between groups and Fischer's exact tests were calculated. Three hundred and eighty-three GP responses were received, with the majority being female (n = 232, 60.6%) and GP partners (n = 236, 61.6%). The majority used the internet on three or more working days per week or more frequently (n = 361, 94.3%) with the three most common reasons being to obtain information for a patient (n = 358, 93.5%), answering a clinical question (n = 357, 93.2%) and CPD purposes (n = 308, 80.4%). Of 37 online resources used by respondents, the top five were SIGN Guidelines (n = 303, 79.3%), BMJ Learning (n = 279, 73.0%), NICE Guidelines (n = 255, 66.8%), GP Notebook (n = 243, 63.6%) and Google (n = 234, 61.3%). Low use of social media such as Facebook (n = 11, 2.9%) and Twitter (n = 11, 2.9%) was reported for CPD. A majority agreed that 'reading information online' (95.0%) and 'completing online learning modules' (87.4%) were the most valued online activities. Slow internet connections (n = 240, 62.7%), website access restrictions (n = 177, 46.2%) and difficulties logging

  4. Effect of Intravenous Infusion of Lidocaine on Pain Reduction after Cesarean Section under General Anesthesia

    Anahita Hirmanpour

    2018-01-01

    Full Text Available Background: The present study was conducted to evaluate the effect of Lidocaine on pain reduction during and ileus and the need for opioids after caesarean section. Methods: For this randomized double-blind controlled clinical trial, 40 ASA I, II pregnant women who were candidates for caesarean section with general anesthesia, were randomly allocated into two groups of Lidocaine receivers and placebo using randomized block design; the Lidocaine group received 1.5 mg/kg of Lidocaine right before the surgery and then its infusion with a dose of 2 mg/kg.h until the end of the surgery and the placebo group received normal saline with the same volume and application. Patients’ pain intensity was measured using numerical rating scale (NRS, 0 (entering the recovery, 0.5, 1, 4, 12 and 24 hours after the surgery. Results: Lidocaine decreased the systolic and diastolic pressures of the patients only during the first minute after intubation, decreased the mean of arterial blood pressure at the 10th minute after intubation and 40th minute after surgery, and also decreased the mean of patients’ pain intensity, Diclofenac and Pethidine consumption, side effects (nausea and vomiting and reduced the time interval before the first time of tolerating oral liquids; but it had effect on infants’ Apgar score 1 and 5 minutes after delivery. Conclusions: Lidocaine was definitely effective on reducing the intensity of pain, opioid and non-steroidal anti-inflammatory drugs consumption and ileus after surgery with the least occurrence of side effects for mothers and infants.

  5. Effect of Intravenous Infusion of Lidocaine on Pain Reduction after Cesarean Section under General Anesthesia

    Anahita Hirmanpour

    2018-01-01

    Full Text Available Background: The present study was conducted to evaluate the effect of Lidocaine on pain reduction during and ileus and the need for opioids after caesarean section.Methods: For this randomized double-blind controlled clinical trial, 40 ASA I, II pregnant women who were candidates for caesarean section with general anesthesia, were randomly allocated into two groups of Lidocaine receivers and placebo using randomized block design; the Lidocaine group received 1.5 mg/kg of Lidocaine right before the surgery and then its infusion with a dose of 2 mg/kg.h until the end of the surgery and the placebo group received normal saline with the same volume and application. Patients’ pain intensity was measured using numerical rating scale (NRS, 0 (entering the recovery, 0.5, 1, 4, 12 and 24 hours after the surgery.Results: Lidocaine decreased the systolic and diastolic pressures of the patients only during the first minute after intubation, decreased the mean of arterial blood pressure at the 10th minute after intubation and 40th minute after surgery, and also decreased the mean of patients’ pain intensity, Diclofenac and Pethidine consumption, side effects (nausea and vomiting and reduced the time interval before the first time of tolerating oral liquids; but it had effect on infants’ Apgar score 1 and 5 minutes after delivery.Conclusions: Lidocaine was definitely effective on reducing the intensity of pain, opioid and non-steroidal anti-inflammatory drugs consumption and ileus after surgery with the least occurrence of side effects for mothers and infants.

  6. General Physicians’ Viewpoints Towards Nutrition Course in the Medical School: a Cross-Sectional Study

    Ebrahim Fallahi

    2009-02-01

    Full Text Available Background and Purpose: Although nutrition has a very important role in individual and society’s health and disease, it has not yet received proper attention in the medical curricula. The objective of this study is to assess the opinions of general physician who worked at private offices in Khorramabadcity about nutrition course in Iranian medical schools.Methods: In this cross-sectional study the data were collected by posting a self-administrated questionnaire to all GPs who worked at private offices in Khorramabad city of Lorestan province in 2005. Participants were asked to state their opinions about each topic considering the following issues: the appropriate phase for introduction of the topic (in basic sciences, pathophysiology, or clinical training; need for learning it (low, moderate, high; and the time devoted to instruction of that topic (inadequate, appropriate, or excessive.GPs opinions were also surveyed to determinetheir reference for the topics not included in current nutrition course. Study data were processed by SPSS version 11 software and analyzed using descriptive and Chi-square statistics with a level of significance of less than 0.05. Results Most of participants believed that clinical teaching periods (clerkship and internship are the appropriate stage for teaching disease- related or clinical aspects of nutrition. They also valued most of the topics listed in the questionnaire as important learning needs as well as 15 new nutrition topicsConclusions: Our results clearly indicate that there is a need to include clinical nutritional topics in the clinical training of medical students. New topics such as nutritional consideration in hypelipidemia, and heart disease should also be included in the nutrition education of physicians.Key words: NUTRITION EDUCATION, MEDICAL CURRICULUM. GENERAL PHYSICIANt 

  7. Overlap between Headache, Depression, and Anxiety in General Neurological Clinics: A Cross-sectional Study

    Cui-Bai Wei; Jian-Ping Jia; Fen Wang; Ai-Hong Zhou; Xiu-Mei Zuo; Chang-Biao Chu

    2016-01-01

    Background:Many studies have reported that depression and anxiety have bidirectional relationship with headache.However,few researches investigated the roles of depression or anxiety in patients with headache.We surveyed the prevalence of depression and anxiety as a complication or cause of headache among outpatients with a chief complaint of headache at neurology clinics in general hospitals.Additional risk factors for depression and anxiety were also analyzed.Methods:A cross-sectional study was conducted at 11 general neurological clinics.All consecutive patients with a chief complaint of headache were enrolled.Diagnoses of depression and anxiety were made using the Chinese version of the Mini International Neuropsychiatric Interview,and those for headache were made according to the International Classification of Headache Disorders,2nd Edition.The headache impact test and an 11-point verbal rating scale were applied to assess headache severity and intensity.Logistic regression was used to analyze risk factors of patients with headache for depression or anxiety.Results:A total of 749 outpatients with headache were included.Among them,148 (19.7%) were diagnosed with depression and 103 (13.7%) with anxiety.Further analysis showed that 114 (15.2%) patients complaining headache due to somatic symptoms of psychiatric disorders and 82 (10.9%) had a depression or anxiety comorbidity with headache.Most patients with depression or anxiety manifested mild to moderate headaches.Poor sleep and severe headache-related disabilities were predictors for either depression or anxiety.Conclusion:Clinicians must identify the etiology of headache and recognize the effects of depression or anxiety on headache to develop specific treatments.

  8. On the Terminological Mistake in the Biography of the Astrakhan Cossack Regiment Commander, Major General P.S. Popov

    Astafyev Evgeniy V.

    2016-01-01

    On the basis of authentic documents of the late 18th – early 19th centuries, stored in federal and regional archives of Russia, as well as published materials, the article analyzes the reasons of the terminological mistake made in the biography of commander of Astrakhan’s Cossack regiment, major general P.S. Popov, which had been reproduced in the scientific works for longer than 100 years. So well known person in the Lower Volga region, P.S. Popov was purposefully chosen as an object of hist...

  9. Non-physician-assisted suicide in The Netherlands: a cross-sectional survey among the general public.

    Schoonman, Merel Kristi; van Thiel, Ghislaine José Madeleine Wilhelmien; van Delden, Johannes Jozef Marten

    2014-12-01

    In The Netherlands, approximately 45% of patients' requests for euthanasia are granted by a physician. After a rejected request, some patients approach non-physicians and ask them for assistance in suicide. Recently, a non-physician who assisted his mother's suicide was declared guilty without punishment. The aim of the current study was to investigate the opinion of the Dutch general public on non-physician-assisted suicide. A cross-sectional survey among the Dutch general public was performed. A total of 1113 respondents were included (response rate 80%). The survey covered two case descriptions in which a patient asks a non-physician for assisted suicide after a non-granted request for physician-assisted dying. In both cases, a son, friend or professional facilitates the suicide by either the provision of information or the purchase of lethal medication. Respondents were invited to give their opinion on these cases and in addition on 10 propositions on non-physician-assisted suicide. When a son provides information on how to acquire lethal medication in case of a patient with a terminal illness, this involvement is accepted by 62% of the respondents. The actual purchase of lethal medication receives less support (38%). If the patient suffers without a serious disease, both forms of assistance are less accepted (46% and 24%, respectively). In addition, only 21% support the legalisation of non-physician-assisted suicide. The Dutch public prefer involvement of a physician in assisted suicide (69%). The Dutch general public consider non-physician-assisted suicide in some specific cases a tolerable alternative for patients with a rejected request for physician-assisted dying if the assistance is limited to the provision of information. However, the majority do not support the legalisation of non-physician-assisted suicide. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Cross-sectional survey: risk-averse French general practitioners are more favorable toward influenza vaccination.

    Massin, Sophie; Ventelou, Bruno; Nebout, Antoine; Verger, Pierre; Pulcini, Céline

    2015-01-29

    We tested the following hypotheses: (i) risk-averse general practitioners (GPs) are more likely to be vaccinated against influenza; (ii) and risk-averse GPs recommend influenza vaccination more often to their patients. In risk-averse GPs, the perceived benefits of the vaccine and/or the perceived risks of the infectious disease might indeed outweigh the perceived risks of the vaccine. In 2010-2012, we conducted a cross-sectional survey of a nationwide French representative sample of 1136 GPs. Multivariate analyses adjusted for four stratification variables (age, gender, urban/suburban/rural practice location and annual patient consultations) and for GPs' characteristics (group/solo practice, and occasional practice of alternative medicine, e.g., homeopathy) looked for associations between their risk attitudes and self-reported vaccination behavior. Individual risk attitudes were expressed as a continuous variable, from 0 (risk-tolerant) to 10 (risk-averse). Overall, 69% of GPs reported that they were very favorable toward vaccination in general. Self-reported vaccination coverage was 78% for 2009/2010 seasonal influenza and 62% for A/H1N1 pandemic influenza. Most GPs (72%) reported recommending the pandemic influenza vaccination to at-risk young adults in 2009, but few than half (42%) to young adults not at risk. In multivariate analyses, risk-averse GPs were more often vaccinated against seasonal (marginal effect=1.3%, P=0.02) and pandemic influenza (marginal effect=1.5%, P=0.02). Risk-averse GPs recommended the pandemic influenza vaccination more often than their more risk-tolerant colleagues to patients without risk factors (marginal effect=1.7%, P=0.01), but not to their at-risk patients and were more favorable toward vaccination in general (marginal effect=1.5%, P=0.04). Individual risk attitudes may influence GPs' practices regarding influenza vaccination, both for themselves and their patients. Our results suggest that risk-averse GPs may perceive the risks

  11. Shoulder pain after caesarean section: comparison between general and spinal anaesthesia.

    Zirak, N; Soltani, G; Hafizi, L; Mashayekhi, Z; Kashani, I

    2012-05-01

    This study investigated shoulder pain as a maternal complication after caesarean section (CS), evaluation of its prevalence and comparison between spinal anaesthesia (SA) and general anaesthesia (GA) groups. A total of 200 women as CS candidates were allocated into two equal groups; SA and GA. The total prevalence of shoulder pain was 39.45%. The two groups were matched according to demographic data. However, the incidence of shoulder pain in the GA group was more than that in the SA group (p =0.004). Shoulder pain in the right shoulder in the GA group was more prevalent than the left shoulder (p <0.001). Moderate severity of shoulder pain was significantly more in the GA group (p =0.000), while in the SA group, the mild severity was significant (p <0.001). Our study revealed that the incidence of shoulder pain after CS is significant. Moreover, shoulder pain was significantly more common in the GA group than the SA group.

  12. Organizational commitment among general practitioners: a cross-sectional study of the role of psychosocial factors.

    Kuusio, Hannamaria; Heponiemi, Tarja; Sinervo, Timo; Elovainio, Marko

    2010-06-01

    To examine whether general practitioners (GP) working in primary health care have lower organizational commitment compared with physicians working in other health sectors. The authors also tested whether psychosocial factors (job demands, job control, and colleague consultation) explain these differences in commitment between GPs and other physicians. Cross-sectional postal questionnaire. Setting and participants. A postal questionnaire was sent to a random sample of physicians (n = 5000) drawn from the Finnish Association database in 2006. A total of 2841 physicians (response rate 57%) returned the questionnaire, of which 2657 (545 GPs and 2090 other physicians) fulfilled all the participant criteria. Organizational commitment was measured with two different indicators: intention to change jobs and low affective commitment. GPs were less committed to their organizations than other physicians. Work-related psychosocial factors (high job demands, low job control, and poor colleague consultation) were all significant risk factors for low organizational commitment. The evidence collected suggests that policies that reduce psychological demands, such as job demands and low control, may contribute to better organizational commitment and, thus, alleviate the shortages of physicians in primary care. Furthermore, giving GPs a stronger say in decisions concerning their work and providing them with more variety in work tasks may even improve the quality of primary care. The strategies for workplace development should focus on redesigning jobs and identifying GPs at higher risk, such as those with especially high job strain.

  13. Anorectal pathology amongst HIV infected patients attending the Douala General Hospital: a cross-sectional study.

    Luma, Henry Namme; Eloumou, Servais Albert Fiacre Bagnaka; Fualefeh-Morfaw, Ellis Atemlefeh; Malongue, Agnes; Temfack, Elvis; Lekpa, Fernando Kemta; Donfack-Sontsa, Olivier; Ndip, Lucy; Ditah, Ivo Che

    2017-03-01

    While gastrointestinal disease is common among HIV infected individuals, the prevalence and distribution of ano-rectal pathology has not been well studied in our setting. The objective of this study therefore was to determine the prevalence and determinants of ano-rectal pathology in HIV infected patients attending the Douala General Hospital HIV treatment centre. A hospital-based cross-sectional study was undertaken. We collected socio-demographic, clinical and laboratory data using a structured questionnaire and patients' files. Each study participant had a full physical and ano-rectal examination. We further studied factors associated with having at least one ano-rectal lesion by logistic regression reporting odds ratios (ORs) and their 95% confidence intervals (CI). We included 390 HIV infected patients. The mean age was 41 (SD: 8) years and 48% were men. Median duration since HIV diagnosis was 3 (interquartile range: 2-5) years and median CD4 cell count was 411 (interquartile range: 234-601) cells/mm 3 . Prevalence of ano-rectal pathology was 22.8% (95% CI: 18.7-27.3). Hemorrhoids and proctitis were most common lesions found; each in 10% of patients. From multivariate logistic regression, factors associated with ano-rectal pathology were CD4 HIV infected patients. Care givers should actively investigate and treat them as this will improve the quality of life of people living with HIV/AIDS.

  14. Fear of going under general anesthesia: A cross-sectional study

    M E Ruhaiyem

    2016-01-01

    Results: Among 450 questionnaires that were disturbed, 400 questionnaires were collected and analyzed. Eighty-eight percent experienced preoperative fear. The top three causes of their fears were fear of postoperative pain (77.3%, fear of intraoperative awareness (73.7%, and fear of being sleepy postoperatively (69.5%. Patients are less fearful of drains and needles in the operative theater (48%, of revealing personal issues under general anesthesia (55.2%, and of not waking up after surgery (56.4%. Age and gender were significant predictors of the overall fear among preanesthetic patients. Females are 5 times more likely to experience fear before surgery (P = 0.0009. Patients aged more than 40 years old are also at 75% higher risk of being afraid (P = 0.008. Conclusion: The majority of the patients going for surgery experienced a fear of anesthesia. Mostly females, especially those over 40, were at a higher risk of being afraid. Fear can bring anxiety which, in turn, might affect the patient′s surgery.

  15. Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries.

    Brouwers, E P M; Mathijssen, J; Van Bortel, T; Knifton, L; Wahlbeck, K; Van Audenhove, C; Kadri, N; Chang, Ch; Goud, B R; Ballester, D; Tófoli, L F; Bello, R; Jorge-Monteiro, M F; Zäske, H; Milaćić, I; Uçok, A; Bonetto, C; Lasalvia, A; Thornicroft, G; Van Weeghel, J

    2016-02-23

    Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers' attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not). Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data. Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment. Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries

    Brouwers, E P M; Mathijssen, J; Van Bortel, T; Knifton, L; Wahlbeck, K; Van Audenhove, C; Kadri, N; Chang, Ch; Goud, B R; Ballester, D; Tófoli, LF; Bello, R; Jorge-Monteiro, M F; Zäske, H; Milaćić, I; Uçok, A; Bonetto, C; Lasalvia, A; Thornicroft, G; Van Weeghel, J

    2016-01-01

    Objective Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers’ attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not). Method Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data. Results Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment. Conclusions Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD. PMID:26908523

  17. Harnessing Social Media to Explore Youth Social Withdrawal in Three Major Cities in China: Cross-Sectional Web Survey.

    Liu, Lucia Lin; Li, Tim Mh; Teo, Alan R; Kato, Takahiro A; Wong, Paul Wc

    2018-05-10

    Socially withdrawn youth belong to an emerging subgroup of youth who are not in employment, education, or training and who have limited social interaction intention and opportunities. The use of the internet and social media is expected to be an alternative and feasible way to reach this group of young people because of their reclusive nature. The aim of this study was to explore the possibility of using various social media platforms to investigate the existence of the phenomenon of youth social withdrawal in 3 major cities in China. A cross-sectional open Web survey was conducted from October 2015 to May 2016 to identify and reach socially withdrawn youth in 3 metropolitan cities in China: Beijing, Shanghai, and Shenzhen. To advertise the survey, 3 social media platforms were used: Weibo, WeChat, and Wandianba, a social networking gaming website. In total, 137 participants completed the survey, among whom 13 (9.5%) were identified as belonging to the withdrawal group, 7 (5.1%) to the asocial group, and 9 (6.6%) to the hikikomori group (both withdrawn and asocial for more than 3 months). The cost of recruitment via Weibo was US $7.27 per participant. Several social media platforms in China are viable and inexpensive tools to reach socially withdrawn youth, and internet platforms that specialize in a certain culture or type of entertainment appeared to be more effective in reaching socially withdrawn youth. ©Lucia Lin Liu, Tim MH Li, Alan R Teo, Takahiro A Kato, Paul WC Wong. Originally published in JMIR Mental Health (http://mental.jmir.org), 10.05.2018.

  18. Danish obstetricians' personal preference and general attitude to elective cesarean section on maternal request: a nation-wide postal survey

    Bergholt, Thomas; Østberg, Birgitte; Legarth, Jesper

    2004-01-01

    OBJECTIVE: To assess Danish obstetricians' and gynecologists' personal preference and general attitude towards elective cesarean section on maternal request in uncomplicated single cephalic pregnancies at term. DESIGN: Nation-wide anonymous postal questionnaire. POPULATION: Four hundred and fifty......-five obstetricians and gynecologists identified in the records of the Danish Society of Obstetrics and Gynecology from January 2000. MAIN OUTCOME MEASURES: Personal preference on the mode of delivery and general attitude towards elective cesarean section on maternal request in an uncomplicated single cephalic...... and gynecologists would personally prefer vaginal delivery in uncomplicated pregnancies, but nearly 40% agree with the woman's right to request a cesarean section....

  19. A cross sectional study of surgical training among United Kingdom general practitioners with specialist interests in surgery.

    Ferguson, H J M; Fitzgerald, J E F; Reilly, J; Beamish, A J; Gokani, V J

    2015-04-08

    Increasing numbers of minor surgical procedures are being performed in the community. In the UK, general practitioners (family medicine physicians) with a specialist interest (GPwSI) in surgery frequently undertake them. This shift has caused decreases in available cases for junior surgeons to gain and consolidate operative skills. This study evaluated GPwSI's case-load, procedural training and perceptions of offering formalised operative training experience to surgical trainees. Prospective, questionnaire-based cross-sectional study. A novel, 13-item, self-administered questionnaire was distributed to members of the Association of Surgeons in Primary Care (ASPC). A total 113 of 120 ASPC members completed the questionnaire, representing a 94% response rate. Respondents were general practitioners practising or intending to practice surgery in the community. Respondents performed a mean of 38 (range 5-150) surgical procedures per month in primary care. 37% (42/113) of respondents had previously been awarded Membership or Fellowship of a Surgical Royal College; 22% (25/113) had completed a surgical certificate or diploma or undertaken a course of less than 1 year duration. 41% (46/113) had no formal British surgical qualifications. All respondents believed that surgical training in primary care could be valuable for surgical trainees, and the majority (71/113, 63%) felt that both general practice and surgical trainees could benefit equally from such training. There is a significant volume of surgical procedures being undertaken in the community by general practitioners, with the capacity and appetite for training of prospective surgeons in this setting, providing appropriate standards are achieved and maintained, commensurate with current standards in secondary care. Surgical experience and training of GPwSI's in surgery is highly varied, and does not yet benefit from the quality assurance secondary care surgical training in the UK undergoes. The Royal Colleges of

  20. Natural carcinogenic fiber and pleural plaques assessment in a general population: A cross-sectional study

    Ledda, Caterina, E-mail: cledda@unict.it [Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania (Italy); Hygiene and Public Health, Department Medical Sciences, Surgical and Advanced Technologies “GF Ingrassia”, University of Catania, Catania (Italy); Pomara, Cristoforo [Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia (Italy); Department of Anatomy, School of Medicine, University of Malta, Msida (Malta); Bracci, Massimo [Occupational Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona (Italy); Mangano, Dario [Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania (Italy); Ricceri, Vincenzo [Division of Radiology - Hospital of Biancavilla “Maria SS. Addolorata”, ASP Catania, Biancavilla (Italy); Musumeci, Andrea [Division of Radiology – University Hospital “Policlinico – Vittorio Emanuele”, University of Catania, Catania (Italy); Ferrante, Margherita [Hygiene and Public Health, Department Medical Sciences, Surgical and Advanced Technologies “GF Ingrassia”, University of Catania, Catania (Italy); Musumeci, Giuseppe; Loreto, Carla [Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, Catania (Italy); Fenga, Concettina [Occupational Medicine, Department of the Environment, Safety, Territory, Food and Health Sciences, University of Messina, Messina (Italy); Santarelli, Lory [Occupational Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona (Italy); Rapisarda, Venerando [Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania (Italy)

    2016-10-15

    Natural carcinogenic fibers are asbestos and asbestiform fibers present as a natural component of soils or rocks. These fibers are released into the environment resulting in exposure of the general population. Environmental contamination by fibers are those cases occurred in: rural regions of Turkey, in Mediterranean countries and in other sites of the world, including northern Europe, USA and China. Fluoro-edenite(FE) is a natural mineral species first isolated in Biancavilla, Sicily. The fibers are similar in size and morphology to some amphibolic asbestos fibers, whose inhalation can cause chronic inflammation and cancer. The aim of the current study is to assess the presence and features of pleural plaques (PPs) in Biancavilla's general population exposed to FE through a retrospective cross-sectional study. All High-Resolution Computed Tomography (HRCT) chest scans carried out between June 2009 and June 2015 in Biancavilla municipality hospital site (exposed subjects) were reviewed. The exposed groups were 1:1 subjects, matched according to age and sex distributions, with unexposed subjects (n.1.240) randomly selected among HRCT chest scans carried out in a Hospital 30 km away from Biancavilla. Subjects from Biancavilla with PPs were significantly more numerous than the control group ones (218 vs 38). Average age of either group was >60 years; the age of exposed subjects was significantly (p=0.0312) lesser than the unexposed group. In exposed subjects, in most PPs thickness ranged between 2 and 4.9 cm(38%, n=83); while in unexposed ones PPs thickness was less than 2 cm (55%, n=21). As to the size of PPs in exposed subjects, in most cases it ranged between 1 cm and 24% of chest wall (53%, n=116); while in unexposed ones the size of PPs was lesser than 1 cm (23%, n=58). Among exposed subjects, 36 cases (17%) PPs were detected with calcification, whereas in unexposed ones only three (8%) presented calcification. 137 lung parenchymal abnormalities were

  1. The role of the General Practitioner in weight management in primary care – a cross sectional study in General Practice

    Young Doris

    2008-12-01

    Full Text Available Abstract Background Obesity has become a global pandemic, considered the sixth leading cause of mortality by the WHO. As gatekeepers to the health system, General Practitioners are placed in an ideal position to manage obesity. Yet, very few consultations address weight management. This study aims to explore reasons why patients attending General Practice appointments are not engaging with their General Practitioner (GP for weight management and their perception of the role of the GP in managing their weight. Methods In February 2006, 367 participants aged between 17 and 64 were recruited from three General Practices in Melbourne to complete a waiting room self – administered questionnaire. Questions included basic demographics, the role of the GP in weight management, the likelihood of bringing up weight management with their GP and reasons why they would not, and their nominated ideal person to consult for weight management. Physical measurements to determine weight status were then completed. The statistical methods included means and standard deviations to summarise continuous variables such as weight and height. Sub groups of weight and questionnaire answers were analysed using the χ2 test of significant differences taking p as Results The population sample had similar obesity co-morbidity rates to the National Heart Foundation data. 74% of patients were not likely to bring up weight management when they visit their GP. Negative reasons were time limitation on both the patient's and doctor's part and the doctor lacking experience. The GP was the least likely person to tell a patient to lose weight after partner, family and friends. Of the 14% that had been told by their GP to lose weight, 90% had cardiovascular obesity related co-morbidities. GPs (15% were 4th in the list of ideal persons to manage weight after personal trainer Conclusion Patients do not have confidence in their GPs for weight management, preferring other health

  2. A sex-specific comparison of major depressive disorder symptomatology in the canadian forces and the general population.

    Erickson, Julie; Kinley, D Jolene; Bolton, James M; Zamorski, Mark A; Enns, Murray W; Sareen, Jitender

    2014-07-01

    To compare major depressive disorder (MDD) symptomatology within men and women in a large, representative sample of Canadian military personnel and civilians. We used the Canadian Community Health Survey: Mental Health and Well-Being (Cycle 1.2 and Canadian Forces Supplement) (n = 36 984 and n = 8441, respectively) to compare past-year MDD symptomatology among military and civilian women, and military and civilian men. Logistic regression models were used to determine differences in the types of depressive symptoms endorsed in each group. Men in the military with MDD were at lower odds than men in the general population to endorse numerous symptoms of depression, such as hopelessness (adjusted odds ratio [AOR] 0.44; 99% CI 0.23 to 0.83) and inability to cope (AOR 0.53; 99% CI 0.31 to 0.92). Military women with MDD were at lower odds of thinking about their death (AOR 0.52; 99% CI 0.32 to 0.86), relative to women with MDD in the general population. Different MDD symptomatology among males and females in the military, compared with those in the general population, may reflect selection effects (for example, personality characteristics and patterns of comorbidity) or occupational experiences unique to military personnel. Future research examining the mechanisms behind MDD symptomatology in military personnel and civilians is required.

  3. A cross sectional study of maternal 'near-miss' cases in major public hospitals in Egypt, Lebanon, Palestine and Syria.

    Bashour, Hyam; Saad-Haddad, Ghada; DeJong, Jocelyn; Ramadan, Mohammed Cherine; Hassan, Sahar; Breebaart, Miral; Wick, Laura; Hassanein, Nevine; Kharouf, Mayada

    2015-11-13

    The maternal near-miss approach has been increasingly used as a tool to evaluate and improve the quality of care in maternal health. We report findings from the formative stage of a World Health Organization (WHO) funded implementation research study that was undertaken to collect primary data at the facility level on the prevalence, characteristics, and management of maternal near-miss cases in four major public referral hospitals - one each in Egypt, Lebanon, Palestine and Syria. We conducted a cross sectional study of maternal near-miss cases in the four contexts beginning in 2011, where we collected data on severe maternal morbidity in the four study hospitals, using the WHO form (Individual Form HRP A65661). In each hospital, a research team including trained hospital healthcare providers carried out the data collection. A total of 9,063 live birth deliveries were reported during the data collection period across the four settings, with a total of 77 cases of severe maternal outcomes (71 maternal near-miss cases and 6 maternal deaths). Higher indices for the maternal mortality index were found in both Al Galaa hospital, in Egypt (8.6%) and Dar Al Tawleed hospital in Syria (14.3%), being large referral hospitals, compared to Ramallah hospital in Palestine and Rafik Hariri University hospital in Lebanon. Compared to the WHO's Multicountry Survey using the same data collection tool, our study's mortality indices are higher than the index of 5.6% among countries with a moderate maternal mortality ratio in the WHO Survey. Overall, haemorrhage-related complications were the most frequent conditions among maternal near-miss cases across the four study hospitals. In all hospitals, coagulation dysfunctions (76.1%) were the most prevalent dysfunction among maternal near-miss cases, followed by cardiovascular dysfunctions. The coverage of key evidence-based interventions among women experiencing a near-miss was either universal or very high in the study hospitals

  4. Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe.

    Ruscio, Ayelet Meron; Hallion, Lauren S; Lim, Carmen C W; Aguilar-Gaxiola, Sergio; Al-Hamzawi, Ali; Alonso, Jordi; Andrade, Laura Helena; Borges, Guilherme; Bromet, Evelyn J; Bunting, Brendan; Caldas de Almeida, José Miguel; Demyttenaere, Koen; Florescu, Silvia; de Girolamo, Giovanni; Gureje, Oye; Haro, Josep Maria; He, Yanling; Hinkov, Hristo; Hu, Chiyi; de Jonge, Peter; Karam, Elie G; Lee, Sing; Lepine, Jean-Pierre; Levinson, Daphna; Mneimneh, Zeina; Navarro-Mateu, Fernando; Posada-Villa, José; Slade, Tim; Stein, Dan J; Torres, Yolanda; Uda, Hidenori; Wojtyniak, Bogdan; Kessler, Ronald C; Chatterji, Somnath; Scott, Kate M

    2017-05-01

    Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of

  5. Types of Generalization: Introduction to Special Section of Perspectives on Psychological Science on Cultural Psychology.

    Sternberg, Robert J

    2017-09-01

    Cultural psychology represents one of the broadest types of generalization of psychological findings. We all need to pay attention to cultural findings because many of our most treasured "truisms" fail to generalize when looked at across cultural contexts.

  6. The Science Teaching Self-Efficacy of Prospective Elementary Education Majors Enrolled in Introductory Geology Lab Sections

    Baldwin, Kathryn A.

    2014-01-01

    This study examined prospective elementary education majors' science teaching self-efficacy while they were enrolled in an introductory geology lab course for elementary education majors. The Science Teaching Efficacy Belief Instrument Form B (STEBI-B) was administered during the first and last lab class sessions. Additionally, students were…

  7. Generalized Anxiety Disorder and Major Depressive Disorder in Pregnant and Postpartum Women: Maternal Quality of Life and Treatment Outcomes.

    Misri, Shaila; Swift, Elena

    2015-09-01

    Comorbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) in perinatal women is often under-diagnosed, resulting in suboptimal treatment and leading to significant maternal dysfunction. We describe a prospective, longitudinal study of the course, treatment outcomes, and quality of life (QoL) in pregnant and postpartum women with MDD and anxiety disorders. Two separate cohorts of women were recruited through the Reproductive Mental Health Program, Women's and Children's Hospital, Vancouver, British Columbia, for pharmacotherapy of depressed mood. One cohort was recruited during pregnancy and followed to one month postpartum; the other cohort was recruited postpartum and followed for 12 weeks. All women met the DSM-5 criteria for MDD and anxiety disorders. This non-lactating perinatal population completed measures of depression, anxiety, worry symptoms, and QoL at multiple study visits. Depressed women with GAD or excessive worry were compared to those without GAD in each cohort. Analysis revealed that despite the majority of women with MDD having remission of symptoms with treatment, those with postpartum GAD displayed a poorer quality of life, with persistent worry symptoms, and their illness was slower to remit. Pregnant depressed women with uncontrollable worry (a GAD indicator) showed a lower probability of achieving remission of symptoms with treatment than those without uncontrollable worry. All pregnant and postpartum women with GAD and MDD responded to pharmacotherapy, and the majority attained complete remission of MDD. However, their GAD symptoms persisted, and their QoL was compromised. Given the chronic debilitating course of concomitant MDD and GAD in the perinatal population, it is essential to focus on adjunctive therapies to aim for full recovery.

  8. Changes in major depressive and generalized anxiety disorders in the national French working population between 2006 and 2010.

    Malard, Lucile; Chastang, Jean-François; Niedhammer, Isabelle

    2015-06-01

    This study aimed at assessing the changes in mental disorders in the French working population between 2006 and 2010, using nationally representative prospective data and a structured diagnostic interview for major depressive episode (MDE) and generalized anxiety disorder (GAD), and also at exploring the differential changes in mental disorders according to age, origin, occupation, public/private sector, self-employed/employee status and work contract. The data came from the prospective national representative Santé et Itinéraire Professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The Mini International Neuropsychiatric Interview (MINI) was used to measure MDE and GAD. Analyses were performed using weighted generalized estimation equations, and were stratified by gender. No changes in MDE and GAD were observed for both genders among the working population. No differential changes were observed, except one: the prevalence of GAD increased among women working in the public sector while there was no change among women in the private sector. Two data collections over a 4-year period may not capture the effects of the crisis on mental disorders properly. No changes in mental disorders between 2006 and 2010 were found but the increase in the prevalence of anxiety among women in the public sector may be of particular interest for prevention policies. High levels of social protection in France might contribute to explain these non-significant results. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. On the coherence between high-energy total cross-section data when compared with general principles

    Gauron, P.; Nicolescu, B.; Paris-6 Univ., 75

    1993-12-01

    An essential model is performed - an independent study of the internal coherence between high-energy total cross-section data by using classes of functions satisfying general principles. The study is practically independent of the ρ-parameter values. This general analysis, made without any fit, reveals certain inconsistencies in the existing set of high-energy data. Some of these inconsistencies are eliminated by giving up arbitrary assumptions sometimes made in 'fitology'. It is shown that the ln 2 s increase of total cross-sections at high energies is clearly favoured when compared with other possible behaviours. (authors). 16 refs., 3 figs

  10. Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis.

    Bakker, D.H. de; Coffie, D.S.V.; Heerdink, E.R.; Dijk, L. van; Groenewegen, P.P.

    2007-01-01

    BACKGROUND: Current health policies assume that prescribing is more efficient and rational when general practitioners (GPs) work with a formulary or restricted drugs lists and thus with a limited range of drugs. Therefore we studied determinants of the range of drugs prescribed by general

  11. Assessment of the Cross-Sectional Areas of the Psoas Major and Multifidus Muscles in Patients With Adult Spinal Deformity: A Case-Control Study.

    Banno, Tomohiro; Yamato, Yu; Hasegawa, Tomohiko; Kobayashi, Sho; Togawa, Daisuke; Oe, Shin; Mihara, Yuki; Kurosu, Kenta; Yamamoto, Naoto; Matsuyama, Yukihiro

    2017-08-01

    This is a case-control study. The present study aimed to compare the cross-sectional areas of the psoas major and multifidus muscles between elderly patients with adult spinal deformity (ASD) and age-matched and body weight-matched controls, and to evaluate the associations between the cross-sectional areas of these muscles and the severity of spinal deformity. The study included 49 female kyphosis patients with mild scoliosis (Cobb angle muscles were calculated using preoperative L4/L5 axial computed tomography images. In group D, the following spinopelvic parameters were assessed: sagittal vertical axis, pelvic tilt, pelvic incidence, lumbar lordosis, and thoracic kyphosis. The relationships between the muscle cross-sectional areas and spinopelvic parameters were evaluated. The cross-sectional area of the multifidus muscle was lower in group D than in group C. However, the cross-sectional area of the psoas major muscle was not different between the 2 groups. In multiple regression analysis, the cross-sectional area of the multifidus muscle was significantly associated with all spinopelvic parameters. The cross-sectional area of the multifidus muscle might be lower in elderly patients with ASD than in controls. In the elderly population, the severity of sagittal spinal deformity might be correlated with the cross-sectional area of the multifidus muscle. Therefore, muscle imbalances between the flexors and extensors of the spine could participate in the pathology of ASD.

  12. Discrimination in the workplace, reported by people with major depressive disorder : A cross-sectional study in 35 countries

    Brouwers, E.P.M.; Mathijssen, J.J.P.; van Boxtel, T.; Knifton, L.; Wahlbeck, K.; Van Audenhove, C.; Kadri, N.; Chang, Ch.; Goud, B.R.; Ballester, D.; Tófoli, L.F.; Bello, R.; Jorge-Monteiro, M.F.; Zäske, H.; Milacic, I.; Uçok, A.; Lasalvia, A.; Thornicroft, G.; van Weeghel, J.

    2016-01-01

    Objective: Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers’ attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known

  13. Comorbid trajectories of substance use as predictors of Antisocial Personality Disorder, Major Depressive Episode, and Generalized Anxiety Disorder.

    Brook, Judith S; Zhang, Chenshu; Rubenstone, Elizabeth; Primack, Brian A; Brook, David W

    2016-11-01

    To determine longitudinal associations between patterns of comorbid cigarette, alcohol, and marijuana use and Antisocial Personality Disorder (ASPD), Major Depressive Episode (MDE), and Generalized Anxiety Disorder (GAD) in adulthood. A random community-based sample [X̅ age=36.6 (SD=2.8)] from the Children and Adults in the Community Study, an on-going investigation of substance use and psychiatric disorders. Data were collected at six time waves. Conjoint trajectories of cigarette, alcohol, and marijuana use spanning adolescence to adulthood were determined; multivariable logistic regression analyses assessed associations between trajectory group membership and having ASPD, MDE, or GAD in adulthood. Five conjoint trajectory groups were obtained: HHH (chronic cigarette, alcohol, and marijuana use), DDD (delayed/late-starting cigarette, alcohol, and marijuana use), LML (low/no smoking, moderate alcohol use, occasional marijuana use), HMN (chronic smoking, moderate alcohol use, no marijuana use), and NON (occasional alcohol use only). Compared with members of the NON group, those in the HHH group had significantly greater odds for having ASPD (Adjusted Odds Ratio [AOR]=28.52, 95% Confidence Interval [CI]=9.44-86.17), MDE (AOR=2.67, 95% CI=1.14-6.26), and GAD (AOR=6.39, 95% CI=2.62-15.56). Members of the DDD, LML, and HMN groups had weaker and less consistent associations with the three psychiatric outcomes. In a large, community-based sample, long-term concurrent use of more than one substance was associated with both externalizing and internalizing psychiatric disorders in adulthood. Prevention and treatment programs might target individuals in the community and general clinical populations with comorbid substance use, even if they haven't been identified as having a substance use disorder. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Cross-sectional survey of older patients' views regarding multidisciplinary care for chronic conditions in general practice.

    Bonney, Andrew; Magee, Christopher; Pearson, Russell

    2014-01-01

    The ageing population and increasing prevalence of chronic illness have contributed to the need for significant primary care reform, including increased use of multidisciplinary care and task substitution. This cross-sectional study explores conditions under which older patients would accept having health professionals other than their general practitioner (GP) involved in their care for chronic disease management (CDM). Ten practices were randomly sampled from a contiguous major city and inner regional area. Questionnaires were distributed to consecutive patients aged 60 years and over in each practice. Agency theory was used to inform analyses. Statistical analysis was undertaken using Wald's test, growth modelling and linear regression, controlling for the clustered design. The response rate was 53% (n=272). Most respondents (79%) had at least one chronic health condition. Respondents were more comfortable with GP than with practice nurse management in the CDM scenario (Wald's test=105.49, P<0.001). Comfort with practice nurse CDM was positively associated with increased contact with their GP at the time of the visit (β=0.41, P<0.001), negatively associated with the number of the respondent's chronic conditions (β=-0.13, P=0.030) and not associated with the frequency of other health professional visits. Agency theory suggests that patients employ continuity of care to optimise factors important in CDM: information symmetry and goal alignment. Our findings are consistent with the theory and lend support to ensuring that interpersonal continuity of care is not lost in health care reform. Further research exploring patients' acceptance of differing systems of care is required.

  15. Danish obstetricians' personal preference and general attitude to elective cesarean section on maternal request: a nation-wide postal survey

    Bergholt, Thomas; Østberg, Birgitte; Legarth, Jesper

    2004-01-01

    OBJECTIVE: To assess Danish obstetricians' and gynecologists' personal preference and general attitude towards elective cesarean section on maternal request in uncomplicated single cephalic pregnancies at term. DESIGN: Nation-wide anonymous postal questionnaire. POPULATION: Four hundred and fifty......-five obstetricians and gynecologists identified in the records of the Danish Society of Obstetrics and Gynecology from January 2000. MAIN OUTCOME MEASURES: Personal preference on the mode of delivery and general attitude towards elective cesarean section on maternal request in an uncomplicated single cephalic...... pregnancies at term. RESULTS: Of Danish specialists in obstetrics and gynecology, 1.1% would prefer an elective cesarean section in an uncomplicated pregnancy at 37 weeks of gestation with fetal weight estimation of 3.0 kg. This rose to 22.5% when the fetal weight estimation was 4.5 kg at 37 weeks. The main...

  16. Associations Between Compulsive Buying and Substance Dependence/Abuse, Major Depressive Episode, and Generalized Anxiety Disorder Among Men and Women

    Zhang, Chenshu; Brook, Judith S.; Leukefeld, Carl G.; Brook, David W.

    2016-01-01

    Aims The objective of this study was to examine the associations between compulsive buying (CB) and substance dependence/abuse, major depressive episode (MDE), and generalized anxiety disorder (GAD) at mean age 43. Methods Participants came from a community-based random sample of residents in two New York counties (N=548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (SD=2.8). Fifty five percent of the participants were females. Over 90% of the participants were white. The prevalence of substance dependence/abuse, MDE, and GAD (during the past 5 years before the interviews) was 6.6%, 13.7, and 11.5%, respectively. Results Logistic regression analyses showed that CB was significantly associated with substance dependence/abuse [Adjusted Odds Ratio (A.O.R.) = 1.60], MDE (A.O.R. = 1.70), and GAD (A.O.R. = 1.63), despite controlling for substance dependence/abuse, MDE, and GAD, respectively, at mean age 37, and demographic factors. Discussion Since the study sample is limited to predominantly white participants (over 90%) with a close association to a small geographic area, the findings may not be generalizable to racial/ethnic minority groups or individuals living in other parts of the country. Nevertheless, it is important that clinicians treating substance dependence/abuse, MDE, and GAD consider the role of CB. PMID:27215919

  17. Perseverative thought: a robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder.

    Ruscio, Ayelet Meron; Seitchik, Allison E; Gentes, Emily L; Jones, Jason D; Hallion, Lauren S

    2011-12-01

    Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently co-occur, yet the reasons for their comorbidity remain poorly understood. In the present experiment, we tested whether a tendency to engage in negative, repetitive thinking constitutes a common risk process for the two disorders. A mixed sample of adults with comorbid GAD-MDD (n=50), GAD only (n=35), MDD only (n=34), or no lifetime psychopathology (n=35) was administered noncontingent failure and success feedback on consecutive performance tasks. Perseverative thought (PT), measured by negative thought intrusions during a baseline period of focused breathing, emerged as a powerful prospective predictor of responses to this experimental challenge. Participants reporting more frequent negative thought intrusions at baseline, irrespective of thought content or diagnostic status, exhibited a stronger negative response to failure that persisted even after subsequent success. Higher PT over the course of the experiment was associated with later behavioral avoidance, with negative affect and other traits closely linked to anxiety and depression, and with the presence and severity of GAD and MDD. These findings provide evidence for a broadly-defined PT trait that is shared by GAD and MDD and contributes to adverse outcomes in these disorders. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Increased error-related brain activity distinguishes generalized anxiety disorder with and without comorbid major depressive disorder.

    Weinberg, Anna; Klein, Daniel N; Hajcak, Greg

    2012-11-01

    Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are so frequently comorbid that some have suggested that the 2 should be collapsed into a single overarching "distress" disorder. Yet there is also increasing evidence that the 2 categories are not redundant. Neurobehavioral markers that differentiate GAD and MDD would be helpful in ongoing efforts to refine classification schemes based on neurobiological measures. The error-related negativity (ERN) may be one such marker. The ERN is an event-related potential component presenting as a negative deflection approximately 50 ms following an erroneous response and reflects activity of the anterior cingulate cortex. There is evidence for an enhanced ERN in individuals with GAD, but the literature in MDD is mixed. The present study measured the ERN in 26 GAD, 23 comorbid GAD and MDD, and 36 control participants, all of whom were female and medication-free. Consistent with previous research, the GAD group was characterized by a larger ERN and an increased difference between error and correct trials than controls. No such enhancement was evident in the comorbid group, suggesting comorbid depression may moderate the relationship between the ERN and anxiety. The present study further suggests that the ERN is a potentially useful neurobiological marker for future studies that consider the pathophysiology of multiple disorders in order to construct or refine neurobiologically based diagnostic phenotypes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

  19. General Health Status Among Students of Islamic Azad University: A Cross-Sectional Study from Iran

    Mohammad Taghi Savadpour

    2015-06-01

    Full Text Available Background & Aims of the Study: Health is one of the basic needs of human. There is a close relationship between physical and mental health. Human psyche is directly affected by his physical condition, and mutually his body and actions of human systems are influenced by psychological and mental space. Students because of their particular circumstances are vulnerable to mental health problems. The purpose of this study is to determine the general health status of students of Islamic Azad University. Materials & Methods: This descriptive analytical research was conducted on 478 students of Khalkhal Islamic Azad University. Simple random sampling method was used. General health questionnaire (GHQ-28 was used as research tool. Following data collection, data were analyzed using SPSS Software 13. Results: The results show that mean score of general health of the subjects is higher than cutoff. In this study, 21.3 percent of students were suspected of impaired health. Also, status of general health of female students was worse than male students and significant statistical relationship was observed between general health status and all its sub-scales except depression and gender (P < 0.5. Conclusions: G eneral health of students especially female students is impaired which may considerably affect their learning and performance and academic achievement.

  20. Motivational deficits in major depressive disorder: Cross-sectional and longitudinal relationships with functional impairment and subjective well-being.

    Fervaha, Gagan; Foussias, George; Takeuchi, Hiroyoshi; Agid, Ofer; Remington, Gary

    2016-04-01

    Many individuals with major depressive disorder present with prominent motivational deficits; however, the effect of these symptoms on functional outcomes in the illness remains unclear. Individuals with major depression who participated in the Sequenced Treatment Alternatives to Relieve Depression study were included in the present investigation (N=1563). Motivational deficits were evaluated using a derived measure from the Hamilton Depression Rating Scale, while functioning was assessed using the Work and Social Adjustment Scale. Subjective outcomes were also evaluated using the Quality of Life Enjoyment and Satisfaction Questionnaire. After treatment with citalopram, over 70% of participants continued to experience some degree of motivational deficits. These deficits were significantly associated with greater functional impairments both globally and in each domain of functioning evaluated. These symptoms were also linked to worse subjective outcomes such as overall life satisfaction and quality of life. Change in the severity of motivational deficits over time was significantly linked with changes in outcome. Motivational deficits continued to demonstrate a significant association with outcomes, even after controlling for potentially confounding variables such as duration of depressive episode and severity of other depressive symptoms. Motivational deficits are significantly linked to the functional impairment present in many people with major depression, just as they are in other psychiatric illnesses such as schizophrenia. A greater understanding of the underlying mechanisms of these motivational deficits in particular, beyond other depressive symptoms, is critical to the development of strategies aimed at enhancing functional recovery and improved subjective well-being. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. COMPAR, NJOY, GROUPIE, FLANGE-2, ETOG-3, XLACS Multigroup Cross-Sections General Comparison

    Anaf, Jaime; Chalhoub, E.S.

    1990-01-01

    1 - Description of program or function: A system for comparing multigroup cross sections generated by NJOY, GROUPIE, FLANGE-II, ETOG-3 and XLACS. This system comprises the COMPAR program and interface (auxiliary) programs developed for each of the programs under consideration. These are REDCOMP for GROUPIE, FLACOMP for FLANGE-II, ETOCOMP for ETOG-3 and XLACOMP for XLACS. For the NJOY program there is RGENDF, a program developed apart from this system. It is a modular system in which the inclusion of new multigroup cross section generating program requires no more than the development of a new interface module. 2 - Method of solution: Refer to comments in main routine. 3 - Restrictions on the complexity of the problem: Refer to comments in main routine

  2. Remifentanil at induction of general anesthesia for cesarean section: Double blind,randomized clinical trial

    Behdad, Shekoufeh; Ayatollahi, Vida; Harrazi, Hamid; Nazemian, Naderali; Heiranizadeh, Najmeh; Baghianimoghadam, Behnam

    2013-01-01

    Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Socie...

  3. The functional consequences of Generalized Joint Hypermobility : a cross-sectional study

    Scheper, Mark C; de Vries, Janneke E; Juul-Kristensen, Birgit; Nollet, Frans; Engelbert, Raoul H H

    2014-01-01

    BACKGROUND: Generalized Joint Hypermobility (GJH) has been found to be associated with musculoskeletal complaints and disability. For others GJH is seen as a prerequisite in order to excel in certain sports like dance. However, it remains unclear what the role is of GJH in human performance.

  4. The functional consequences of generalized joint hypermobility: a cross-sectional study

    Scheper, Mark C.; de Vries, Janneke E.; Juul-Kristensen, Birgit; Nollet, Frans; Engelbert, Raoul H. H.

    2014-01-01

    Generalized Joint Hypermobility (GJH) has been found to be associated with musculoskeletal complaints and disability. For others GJH is seen as a prerequisite in order to excel in certain sports like dance. However, it remains unclear what the role is of GJH in human performance. Therefore, the

  5. Is Generalized Maternal Optimism or Pessimism During Pregnancy Associated with Unplanned Cesarean Section Deliveries in China?

    Cheryl A. Moyer

    2010-01-01

    Full Text Available This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Post-delivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and self-rated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions.

  6. Obesity genes and risk of major depressive disorder in a multiethnic population: a cross-sectional study.

    Samaan, Zainab; Lee, Yvonne K; Gerstein, Hertzel C; Engert, James C; Bosch, Jackie; Mohan, Viswanathan; Diaz, Rafael; Yusuf, Salim; Anand, Sonia S; Meyre, David

    2015-12-01

    Observational studies have shown a positive association between obesity (body mass index [BMI] ≥ 30 kg/m2) and depression. Around 120 obesity-associated loci have been identified, but genetic variants associated with depression remain elusive. Recently, our team reported that the fat mass and obesity-associated (FTO) gene rs9939609 obesity-risk variant is paradoxically inversely associated with the risk of depression. This finding raises the question as to whether other obesity-associated genetic variants are also associated with depression. Twenty-one obesity gene variants other than FTO were selected from a custom ∼50,000 single-nucleotide polymorphisms (SNPs) genotyping array (ITMAT-Broad-CARe array). Associations of these 21 SNPs and an unweighted genotype score with BMI and major depressive disorder (determined using the DSM-IV diagnostic criteria) were tested in 3,209 cases and 14,195 noncases, using baseline data collected from July 2001 to August 2003 from the multiethnic EpiDREAM study. Body mass index was positively associated with depression status (odds ratio [OR] = 1.02; 95% CI, 1.02-1.03 per BMI unit; P = 2.9 × 10(-12), adjusted for age, sex, and ethnicity). Six of 21 genetic variants (rs1514176 [TNN13K], rs2206734 [CDKAL1], rs11671664 [GIPR], rs2984618 [TAL1], rs3824755 [NT5C2], and rs7903146 [TCF7L2]) and the genotype score were significantly associated with BMI (1.47 × 10(-14) ≤ P ≤ .04). Of the 21 SNPs, TAL1 rs2984618 obesity-risk allele was associated with a higher risk of major depressive disorder (P = 1.79 × 10(-4), adjusted for age, sex, BMI, and ethnicity), and BDNF rs1401635 demonstrated significant ethnic-dependent association with major depressive disorder (OR = 0.88; 95% CI, 0.80-0.97; P = .01 in non-Europeans and OR = 1.11; 95% CI, 1.02-1.20; P = .02 in Europeans; Pinteraction = 2.73 × 10(-4)). The genotype score, calculated with or without FTO rs9939609, and adjusted for the same covariates, was not associated with

  7. Majority of never-smokers with airflow limitation do not have asthma: the Copenhagen General Population Study.

    Çolak, Yunus; Afzal, Shoaib; Nordestgaard, Børge G; Lange, Peter

    2016-07-01

    A substantial proportion of individuals with airflow limitation are never-smokers. However, whether never-smokers with airflow limitation have undiagnosed asthma is unknown. We hypothesised that the majority of never-smokers with respiratory symptoms and airflow limitation but without known asthma have undiagnosed asthma by comparing characteristics and prognosis in never-smokers with airflow limitation and asthma (NS+AFL+A) with never-smokers with airflow limitation but without asthma (NS+AFL-A). Among 94 079 participants aged 20-100 years from the general population, 39 102 (42%) were never-smokers. In this group, 13 719 (35%) reported to have respiratory symptoms of whom 1610 (12%) had airflow limitation. We investigated characteristics and risk of complications (asthma or COPD exacerbations, pneumonias and all-cause mortality) and comorbidities (lung cancer, ischaemic heart disease, myocardial infarction, deep venous thrombosis and PE) during 4.5 years median follow-up. NS+AFL-A compared with NS+AFL+A reported less allergy and respiratory symptoms, and had higher FEV1 and lower levels of eosinophils and IgE in peripheral blood. NS+AFL+A had increased risk of asthma and COPD exacerbations, but not of pneumonias; adjusted HRs in NS+AFL+A compared with NS+AFL-A were 16 (95% CI 3.7 to 73) for asthma exacerbations and 15 (2.8 to 80) for COPD exacerbations. Still, NS+AFL-A had increased risk of COPD exacerbations and pneumonias, but not of asthma exacerbations; adjusted HRs in NS+AFL-A compared with never-smokers without airflow limitation or asthma (NS-AFL-A) were 7.7 (2.8 to 21) for COPD exacerbations and 1.7 (1.3 to 2.3) for pneumonias. Risk of comorbidities or all-cause mortality was not increased in NS+AFL-A or NS+AFL+A compared with NS-AFL-A. Majority of NS+AFL-A do not seem to have undiagnosed asthma and may instead have airflow limitation caused by other risk factors. Published by the BMJ Publishing Group Limited. For permission to use (where not

  8. Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital: a cross-sectional study

    Saitoh Akiyoshi

    2010-04-01

    Full Text Available Abstract Background A general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital. Methods Patients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ. Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records. Results Among 312 patients, 27 (8.7% and 52 (16.7% were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8% were recognized by physicians as having a mental disorder, but only three (11.1% were diagnosed as having a mood disorder. Only two patients with major depressive disorder (7.4% had been prescribed antidepressants. Even among those (n = 15 whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7% were prescribed an antidepressant. Conclusions Despite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring

  9. Application of a general-purpose scintigraphic scanner to transverse-section (tomographic) gamma-ray imaging

    Bradstock, P.A.; Milward, R.C.

    1976-01-01

    The paper describes the recent application of a general-purpose commercial scintigraphic scanner to transverse-section radioisotope tomography. The principle of the method is to obtain the distribution of radioactive material in a thin transverse slice of the body or brain, from a mathematical reconstruction using the measured transverse projections of the activity within that slice. The usefulness of the radioisotope section-scanning technique for clinical diagnosis, as evidenced from one year's use of the machine at the Midland Centre for Neurology and Neurosurgery, Birmingham, U.K., is briefly discussed. (orig.) [de

  10. Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey

    Lacey, K; Bishop, JF; Cross, HL; Chondros, P; Lyratzopoulos, Georgios; Emery, JD

    2016-01-01

    OBJECTIVE: To assess variations in the number of general practitioner visits preceding a cancer diagnosis, and in the length of the interval between the patient first suspecting a problem and their seeing a hospital specialist. DESIGN, SETTING AND PARTICIPANTS: Analysis of data provided to the Cancer Patient Experience Survey (CPES; survey response rate, 37.7%) by 1552 patients with one of 19 cancer types and treated in one of five Victorian Comprehensive Cancer Centre hospitals, 1 October 20...

  11. Compatibility of scientific research and specialty training in general practice. A cross-sectional study.

    Kötter, Thomas; Carmienke, Solveig; Herrmann, Wolfram J

    2014-01-01

    In many departments of General Practice (GP) in Germany, young doctors who are trainees also work as researchers. Often these trainees work part time at the university and part time as a trainee in clinical practice. However, little is known about the situation of the actors involved. The aim of the study was to investigate the perspectives of GP trainees, heads of departments and GP trainers regarding the combination of research and GP training. We conducted a web-based survey with the heads of all German departments of General Practice, GP trainees who also conduct research and their GP trainers. The questionnaires consisted of open and closed questions. The results were analyzed using descriptive statistics and qualitative methods. 28 heads of GP departments and 20 GP trainees responded. The trainees were mostly very satisfied with their situation as a trainee. However, the trainees considered the combination of research and GP training as difficult. The respondents name as problems the coordination of multiple jobs and the lack of credibility given to research in General Practice. They name as solutions research-enabling training programs and uniform requirements in training regarding research. The combination of GP training and scientific research activity is perceived as difficult. However, well-organized and designed programs can improve the quality of the combination.

  12. An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery.

    Symons, Nicholas R A; Almoudaris, Alex M; Nagpal, Kamal; Vincent, Charles A; Moorthy, Krishna

    2013-01-01

    To investigate the nature of process failures in postoperative care, to assess their frequency and preventability, and to explore their relationship to adverse events. Adverse events are common and are frequently caused by failures in the process of care. These processes are often evaluated independently using clinical audit. There is little understanding of process failures in terms of their overall frequency, relative risk, and cumulative effect on the surgical patient. Patients were observed daily from the first postoperative day until discharge by an independent surgeon. Field notes on the circumstances surrounding any nonroutine or atypical event were recorded. Field notes were assessed by 2 surgeons to identify failures in the process of care. Preventability, the degree of harm caused to the patient, and the underlying etiology of process failures were evaluated by 2 independent surgeons. Fifty patients undergoing major elective general surgery were observed for a total of 659 days of postoperative care. A total of 256 process failures were identified, of which 85% were preventable and 51% directly led to patient harm. Process failures occurred in all aspects of care, the most frequent being medication prescribing and administration, management of lines, tubes, and drains, and pain control interventions. Process failures accounted for 57% of all preventable adverse events. Communication failures and delays were the main etiologies, leading to 54% of process failures. Process failures are common in postoperative care, are highly preventable, and frequently cause harm to patients. Interventions to prevent process failures will improve the reliability of surgical postoperative care and have the potential to reduce hospital stay.

  13. Occupational factors and subsequent major depressive and generalized anxiety disorders in the prospective French national SIP study.

    Niedhammer, Isabelle; Malard, Lucile; Chastang, Jean-François

    2015-02-28

    The literature has been extensive on the associations between psychosocial work factors and mental health. Nevertheless, the studies using prospective design, various concepts and more than one measurement point in time for these factors and diagnostic interview to assess mental disorders remain seldom in the literature. This study is an attempt to fill the gap in this topic. The study was based on a national representative sample of 4717 workers of the French working population (SIP survey), interviewed in 2006 and reinterviewed again in 2010 and free of mental disorders at baseline. Psychosocial work factors, measured in both 2006 and 2010, included: psychological demands, decision latitude, social support, reward, emotional demands, role conflict, ethical conflict, tensions with the public, job insecurity and work-life imbalance. Other occupational factors related to working time/hours and physical work environment were also studied. Major depressive (MDD) and generalized anxiety disorders (GAD) were measured using a standardised diagnostic interview (MINI). Covariates were age, occupation, marital status, having a child under 3 y, social support outside work and stressful life events. Multivariate analyses were performed using weighted logistic regression models. Using models taking all occupational factors into account simultaneously, low reward and job insecurity predicted MDD. Psychological demands, low reward, emotional demands and job insecurity were predictive of GAD. The more frequent the exposure to job insecurity, the higher the risk of MDD and GAD, and the more frequent the exposure to psychological demands and low reward, the higher the risk of GAD. No effect was observed for repeated exposure to occupational factors. Classical and emergent psychosocial work factors were predictive factors of depression and anxiety with dose-response associations in terms of frequency of exposure. More attention may be needed on emergent psychosocial work factors and

  14. On the Terminological Mistake in the Biography of the Astrakhan Cossack Regiment Commander, Major General P.S. Popov

    Astafyev Evgeniy V.

    2016-09-01

    Full Text Available On the basis of authentic documents of the late 18th – early 19th centuries, stored in federal and regional archives of Russia, as well as published materials, the article analyzes the reasons of the terminological mistake made in the biography of commander of Astrakhan’s Cossack regiment, major general P.S. Popov, which had been reproduced in the scientific works for longer than 100 years. So well known person in the Lower Volga region, P.S. Popov was purposefully chosen as an object of historical research. His biography is not typical for the people of provincial hereditary Russian nobility of this period, Astrakhan and Saratov’s nobility in this case, where, although rather conventionally, he was linked for a long time in the historical literature. Thanks to the current research, it was determined that P.S. Popov was born in Walachia, evidently not very rich noble family. For a long time he served in Bug Cossack regiment, where got promoted from Arnaut captain to officer rank. He took part in many campaigns of Russian-Turkish war, was repeatedly injured, and distinguished himself during the capture of the fortresses Ochakov and Ismail. P.S. Popov was awarded the order of St. John of Jerusalem, and golden mark for capture of Ismail. P.S. Popov was married to a daughter of Astrakhan priest, and had seven sons and daughters in this spousal. Already serving in Astrakhan province, he purchased a seigneury for himself and descendants in Tsaritsyn district of the Saratov province. His descendants settled in the Lower Volga region, kept the seigneury in possession, served in military and civil services.

  15. Separating generalized anxiety disorder from major depression using clinical, hormonal, and structural MRI data: A multimodal machine learning study.

    Hilbert, Kevin; Lueken, Ulrike; Muehlhan, Markus; Beesdo-Baum, Katja

    2017-03-01

    Generalized anxiety disorder (GAD) is difficult to recognize and hard to separate from major depression (MD) in clinical settings. Biomarkers might support diagnostic decisions. This study used machine learning on multimodal biobehavioral data from a sample of GAD, MD and healthy subjects to differentiate subjects with a disorder from healthy subjects (case-classification) and to differentiate GAD from MD (disorder-classification). Subjects with GAD ( n  = 19), MD without GAD ( n  = 14), and healthy comparison subjects ( n  = 24) were included. The sample was matched regarding age, sex, handedness and education and free of psychopharmacological medication. Binary support vector machines were used within a nested leave-one-out cross-validation framework. Clinical questionnaires, cortisol release, gray matter (GM), and white matter (WM) volumes were used as input data separately and in combination. Questionnaire data were well-suited for case-classification but not disorder-classification (accuracies: 96.40%, p   .22). The opposite pattern was found for imaging data (case-classification GM/WM: 58.71%, p  = .09/43.18%, p  > .66; disorder-classification GM/WM: 68.05%, p  = .034/58.27%, p  > .15) and for cortisol data (38.02%, p  = .84; 74.60%, p  = .009). All data combined achieved 90.10% accuracy ( p  < .001) for case-classification and 67.46% accuracy ( p  = .0268) for disorder-classification. In line with previous evidence, classification of GAD was difficult using clinical questionnaire data alone. Particularly cortisol and GM volume data were able to provide incremental value for the classification of GAD. Findings suggest that neurobiological biomarkers are a useful target for further research to delineate their potential contribution to diagnostic processes.

  16. The impact of general practitioner morale on patient satisfaction with care: a cross-sectional study

    McKinstry Brian

    2007-09-01

    Full Text Available Abstract Background The association between stress and morale among general practitioners (GP is well documented. However, the impact of GP stress or low morale on patient care is less clear. GPs in the UK now routinely survey patients about the quality of their care including organizational issues and consultation skills and the General Practice Assessment Questionnaire (GPAQ is widely used for this purpose. We aimed to see if there was a relationship between doctor morale as measured by a validated instrument, the Morale Assessment in General Practice Index (MAGPI and scores in the GPAQ. Methods All GPs in Lothian, Scotland who were collecting GPAQ data were approached and asked to complete the MAGPI. Using an anonymised linkage system, individual scores on the MAGPI were linked to the doctors' GPAQ scores. Levels of association between the scores were determined by calculating rank correlations at the level of the individual doctor. Hypothesised associations between individual MAGPI and GPAQ items were also assessed. Results 276 of 475 GPs who were approached agreed to complete a MAGPI questionnaire and successfully collected anonymous GPAQ data from an average of 49.6 patients. There was no significant correlation between the total MAGPI score and the GPAQ communication or enablement scale. There were weak correlations between "control of work" in the MAGPI scale and GPAQ items on waiting times to see doctors (r = 0.24 p Conclusion This study showed no relationship between overall GP morale and patient perception of performance. There was a weak relationship between patients' perceptions ofquality and doctors' beliefs about their workload and whether patients value them. Further research is required to elucidate the complex relationship between workload, morale and patients' perception of care.

  17. Chronic care management in Danish general practice - a cross‒sectional study of workload and multimorbidity

    Moth Grete

    2012-06-01

    Full Text Available Abstract Background About 30% of the Danish population has one or more chronic conditions, and general practitioners (GPs play a key role in effective chronic care management. However, little is known about these encounters in general practice. The aim was to describe the frequency of patients with one or more chronic conditions in general practice and how these consultations were experienced by the GPs. Methods All GPs in the Central Denmark Region were invited to register all contacts during one day in the 12‒month study period from December; 404 (46% accepted. For each patient contact, the GPs were asked to fill in a one‒page registration form covering information on chronic disease, reason for encounter, diagnosis, number of additional psychosocial problems raised by the patient during the consultation, time consumption, experienced burden of the consultation, referral to specialized care, and whether a nurse could have substituted the GP. Patients were categorized according to the number of chronic conditions (none, one, two, three or more and the categories compared with regard to the GP‒experienced burden of the contacts. Moreover, we examined which chronic conditions posed the the greatest challenge to the GPs. Results Patients aged 40 years or more had a total of 8,236 contacts. Among these patients 2,849 (34.6%; 95% CI 33.6‒35.6 had one and 2,596 (31.5%; CI 30.5‒32.5 had more than one chronic disease. The time consumption and the burden of their contacts tended to rise with the number of chronic conditions. Being present in 22.9% (CI 21.6‒24.3 of all face‒to‒face contacts, hypertension was the most common chronic condition. The burden of the contacts was experienced as particularly heavy for patients with depression and dementia due to more additional psychosocial problems and the time consumption. Conclusion General practitioners considered consultations with multimorbid patients demanding and not easily delegated to

  18. Seroepidemiology of pertussis in a cross-sectional study of an adult general population in Denmark

    Rønn, P F; Dalby, T; Simonsen, J

    2014-01-01

    SUMMARY An increase in pertussis has been observed in several countries over the last decades, especially in adult populations. The seroprevalence of pertussis was determined in a cross-sectional study of the adult population in the Copenhagen area, Denmark, conducted between 2006 and 2008....... Specific IgG antibodies against pertussis toxin (PT) were measured in 3440 persons resulting in an age-standardized seroprevalence of 3·0% (95% confidence interval 1·9-4·7) using an IgG anti-PT cut-off of 75 IU/ml. By using antibody decay profiles from longitudinal data the estimated seroincidence was 143....../1000 person-years. In contrast, an incidence of 0·03/1000 person-years was estimated from the official data of notified cases during the same period. Of the investigated risk factors, only age and education were significantly associated with pertussis infection. This study indicates that pertussis is highly...

  19. Low energy neutron scattering for energy dependent cross sections. General considerations

    Rothenstein, W; Dagan, R [Technion-Israel Inst. of Tech., Haifa (Israel). Dept. of Mechanical Engineering

    1996-12-01

    We consider in this paper some aspects related to neutron scattering at low energies by nuclei which are subject to thermal agitation. The scattering is determined by a temperature dependent joint scattering kernel, or the corresponding joint probability density, which is a function of two variables, the neutron energy after scattering, and the cosine of the angle of scattering, for a specified energy and direction of motion of the neutron, before the interaction takes place. This joint probability density is easy to calculate, when the nucleus which causes the scattering of the neutron is at rest. It can be expressed by a delta function, since there is a one to one correspondence between the neutron energy change, and the cosine of the scattering angle. If the thermal motion of the target nucleus is taken into account, the calculation is rather more complicated. The delta function relation between the cosine of the angle of scattering and the neutron energy change is now averaged over the spectrum of velocities of the target nucleus, and becomes a joint kernel depending on both these variables. This function has a simple form, if the target nucleus behaves as an ideal gas, which has a scattering cross section independent of energy. An energy dependent scattering cross section complicates the treatment further. An analytic expression is no longer obtained for the ideal gas temperature dependent joint scattering kernel as a function of the neutron energy after the interaction and the cosine of the scattering angle. Instead the kernel is expressed by an inverse Fourier Transform of a complex integrand, which is averaged over the velocity spectrum of the target nucleus. (Abstract Truncated)

  20. Demographic, dietary and physical activity predictors of general and abdominal obesity among university students: a cross-sectional study

    Mogre, Victor; Nyaba, Rauf; Aleyira, Samuel; Sam, Napoleon B.

    2015-01-01

    Background Obesity has become a disease of global public health concern in both developing and developed countries. We investigated the influence of socio-demographic, dietary habits and physical activity levels on general and abdominal obesity among a sample of university students in Ghana. Methods This cross-sectional study was carried out among a sample of 552 students attending the University for Development Studies, School of Medicine and Health Sciences, Tamale, Ghana. Demographic chara...

  1. The personal and general hygiene practices of food handlers in the delicatessen sections of retail outlets in South Africa.

    van Tonder, Izanne; Lues, Jan F R; Theron, Maria M

    2007-11-01

    This paper presents data on personal- and general-hygiene knowledge and practices among food handlers in the delicatessens of a major retail group in the Western Cape in South Africa. Food handlers were interviewed by means of a structured questionnaire. Although the majority of food handlers adhered to basic hygiene principles, there is definitely a need for proper and continuous training in personal and general hygiene, not only for food handlers, but also for management. The study reported here is of importance particularly in view of new local regulations governing the application of the hazard analysis and critical control point (HACCP) system. Management is responsible for the implementation of this system, and where supervision is not adequate, the manager of the outlet should intervene to ensure that staff conform to the requirements.

  2. Factors associated with continuing emergence of β-thalassemia major despite prenatal testing: a cross-sectional survey

    Al Sabbah H

    2017-09-01

    Full Text Available Haleama Al Sabbah,1 Sarah Khan,1 Abdallah Hamadna,2 Lamia Abu Ghazaleh,2 Anwar Dudin,2 Bashar Adnan Karmi3 1College of Natural and Health Sciences, Zayed University, Dubai, UAE; 2Faculty of Medicine, An-Najah National University, Nablus, Palestine; 3Thalassemia Patients’ Friends Society, Ramallah, Palestine Purpose: Health care initiatives focusing on prenatal testing and premarital genetic screening aiming to reduce the incidence of β-thalassemia have emerged during the last decade. In Palestine, 4% of the population are known thalassemia carriers with new cases continuing to appear despite the availability of prenatal testing. This study aims to identify factors that influence the decision to retain or abort fetuses affected by β-thalassemia in Palestine. Methods: Convenience sampling was used to select 32 women (72 fetuses who were at risk of having a baby with β-thalassemia. A questionnaire on prenatal testing, test results, pregnancy outcomes, and factors influencing the decision to terminate the pregnancy were used for this cross-sectional study. The data were analyzed using SPSS version 17. Results: Among the fetuses screened, 36 (50% were thalassemia carriers and 20 (28% had β-thalassemia; 17 (85% affected fetuses were aborted. Religious beliefs were the most cited reason for opposing abortion while prior experience with β-thalassemia patients and awareness programs promoted abortions. Mothers who opted to retain an affected fetus had modest educational attainment. Higher educational level was significantly associated with the decision to abort an affected fetus (p<0.05. Conclusion: A religious consensus is needed on the abortion of fetuses affected by β-thalassemia. Improving female education and increasing awareness on thalassemia could help reduce the incidence of β-thalassemia in Palestine and around the world. Keywords: abortion, Islam, fetus, awareness

  3. Frequent attenders in general practice and immigrant status in Norway: a nationwide cross-sectional study.

    Diaz, Esperanza; Gimeno-Feliu, Luis-Andrés; Calderón-Larrañaga, Amaia; Prados-Torres, Alexandra

    2014-12-01

    To compare the likelihood of being a frequent attender (FA) to general practice among native Norwegians and immigrants, and to study socioeconomic and morbidity factors associated with being a FA for natives and immigrants. Linked register data for all inhabitants in Norway with at least one visit to the general practitioner (GP) in 2008 (2 967 933 persons). Immigrants were grouped according to their country of origin into low- (LIC), middle- (MIC), and high-income countries (HIC). FAs were defined as patients whose attendance rate ranked in the top 10% (cut-off point > 7 visits). FAs were compared with other GP users by means of multivariate binary logistic analyses adjusting for socioeconomic and morbidity factors. Among GP users during the daytime, immigrants had a higher likelihood of being a FA compared with natives (OR (95% CI): 1.13 (1.09-1.17) and 1.15 (1.12-1.18) for HIC, 1.84 (1.78-1.89) and 1.66 (1.63-1.70) for MIC, and 1.77 (1.67-1.89) and 1.65 (1.57-1.74) for LIC for men and women respectively). Pregnancy, middle income earned in Norway, and having cardiologic and psychiatric problems were the main factors associated with being a FA. Among immigrants, labour immigrants and the elderly used GPs less often, while refugees were overrepresented among FAs. Psychiatric, gastroenterological, endocrine, and non-specific drug morbidity were relatively more prevalent among immigrant FA compared with natives. Although immigrants account for a small percentage of all FAs, GPs and policy-makers should be aware of differences in socioeconomic and morbidity profiles to provide equality of health care.

  4. Work motivation, task delegation and job satisfaction of general practice staff: a cross-sectional study.

    Riisgaard, Helle; Søndergaard, Jens; Munch, Maria; Le, Jette V; Ledderer, Loni; Pedersen, Line B; Nexøe, Jørgen

    2017-04-01

    Recent research has shown that a high degree of task delegation is associated with the practise staff's overall job satisfaction, and this association is important to explore since job satisfaction is related to medical as well as patient-perceived quality of care. This study aimed: (1) to investigate associations between degrees of task delegation in the management of chronic disease in general practice, with chronic obstructive pulmonary disease (COPD) as a case and the staff's work motivation, (2) to investigate associations between the work motivation of the staff and their job satisfaction. The study was based on a questionnaire to which 621 members of the practice staff responded. The questionnaire consisted of a part concerning degree of task delegation in the management of COPD in their respective practice and another part being about their job satisfaction and motivation to work. In the first analysis, we found that 'maximal degree' of task delegation was significantly associated with the staff perceiving themselves to have a large degree of variation in tasks, odds ratio (OR) = 4.26, confidence interval (CI) = 1.09, 16.62. In the second analysis, we found that this perceived large degree of variation in tasks was significantly associated with their overall job satisfaction, OR = 2.81, confidence interval = 1.71, 4.61. The results suggest that general practitioners could delegate highly complex tasks in the management of COPD to their staff without influencing the staff's work motivation, and thereby their job satisfaction, negatively, as long as they ensure sufficient variation in the tasks. © The Author 2017. Published by Oxford University Press.

  5. Respiratory symptoms and occupation: a cross-sectional study of the general population

    Smit Henriëtte A

    2002-12-01

    Full Text Available Abstract Background This study focused on respiratory symptoms due to occupational exposures in a contemporary general population cohort. Subjects were from the Dutch Monitoring Project on Risk Factors for Chronic Diseases (MORGEN. The composition of this population enabled estimation of respiratory risks due to occupation from the recent past for both men and women. Methods The study subjects (aged 20–59 were all inhabitants of Doetinchem, a small industrial town, and came from a survey of a random sample of 1104 persons conducted in 1993. A total of 274 cases with respiratory symptoms (subdivided in asthma and bronchitis symptoms and 274 controls without symptoms were matched for age and sex. Relations between industry and occupation and respiratory symptoms were explored and adjusted for smoking habits and social economic status. Results Employment in the 'construction' (OR = 3.38; 95%CI 1.02 – 11.27, 'metal' (OR = 3.17; 95%CI 0. 98 – 10.28, 'rubber, plastics and synthetics' (OR = 6.52; 95%CI 1.26 – 53.80, and 'printing' industry (OR = 3.96; 95%CI 0.85 – 18.48 were positively associated with chronic bronchitis symptoms. In addition, the 'metal' industry was found to be weakly associated with asthma symptoms (OR = 2.59; 95%CI 0.87 – 7.69. Duration of employment within these industries was also positively associated with respiratory symptoms. Conclusion Respiratory symptoms in the general population are traceable to employment in particular industries even in a contemporary cohort with relatively young individuals.

  6. Retaining the general practitioner workforce in England: what matters to GPs? A cross-sectional study.

    Dale, Jeremy; Potter, Rachel; Owen, Katherine; Parsons, Nicholas; Realpe, Alba; Leach, Jonathan

    2015-10-16

    The general practice (GP) workforce in England is in crisis, reflected in increasing rates of early retirement and intentions to reduce hours of working. This study aimed to investigate underlying factors and how these might be mitigated. GPs in central England were invited to participate in an on-line survey exploring career plans and views and experiences of work-related pressures. Quantitative data were analysed using logistic regression analysis and principal components analysis. Qualitative data were analysed using a thematic framework approach. Of 1,192 GPs who participated, 978 (82.0 %) stated that they intend to leave general practice, take a career break and/or reduce clinical hours of work within the next five years. This included 488 (41.9 %) who intend to leave practice, and almost a quarter (279; 23.2 %) intending to take a career break. Only 67 (5.6 %) planned to increase their hours of clinical work. For participants planning to leave practice, the issues that most influenced intentions were volume and intensity of workload, time spent on "unimportant tasks", introduction of seven-day working and lack of job satisfaction. Four hundred fifty five participants responded to open questions (39128 words in total). The main themes were the cumulative impact of work-related pressures, the changing and growing nature of the workload, and the consequent stress. Reducing workload intensity, workload volume, administrative activities, with increased time for patient care, no out-of-hour commitments, more flexible working conditions and greater clinical autonomy were identified as the most important requirements to address the workforce crisis. In addition, incentive payments, increased pay and protected time for education and training were also rated as important. New models of professionalism and organisational arrangements may be needed to address the issues described here. Without urgent action, the GP workforce crisis in England seems set to worsen.

  7. A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive-compulsive disorder.

    Gentes, Emily L; Ruscio, Ayelet Meron

    2011-08-01

    Intolerance of uncertainty (IU) has been suggested to reflect a specific risk factor for generalized anxiety disorder (GAD), but there have been no systematic attempts to evaluate the specificity of IU to GAD. This meta-analysis examined the cross-sectional association of IU with symptoms of GAD, major depressive disorder (MDD), and obsessive-compulsive disorder (OCD). Random effects analyses were conducted for two common definitions of IU, one that has predominated in studies of GAD (56 effect sizes) and another that has been favored in studies of OCD (29 effect sizes). Using the definition of IU developed for GAD, IU shared a mean correlation of .57 with GAD, .53 with MDD, and .50 with OCD. Using the alternate definition developed for OCD, IU shared a mean correlation of .46 with MDD and .42 with OCD, with no studies available for GAD. Post-hoc significance tests revealed that IU was more strongly related to GAD than to OCD when the GAD-specific definition of IU was used. No other differences were found in the magnitude of associations between IU and the three syndromes. We discuss implications of these findings for models of shared and specific features of emotional disorders and for future research efforts. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Diet in subjects with irritable bowel syndrome: A cross-sectional study in the general population

    Ligaarden Solveig C

    2012-06-01

    Full Text Available Abstract Background Patients with irritable bowel syndrome (IBS often relate symptoms to the intake of certain foods. This study assesses differences in diet in subjects with and without IBS. Methods The cross-sectional, population-based study was conducted in Norway in 2001. Out of 11078 invited subjects, 4621 completed a survey about abdominal complaints and intake of common food items. IBS and IBS subgroups were classified according to Rome II criteria. Results IBS was diagnosed in 388 subjects (8.4% and, of these, 26.5% had constipation-predominant IBS (C-IBS, 44.8% alternating IBS (A-IBS, and 28.6% diarrhoea-predominant IBS (D-IBS. Low intake of dairy products (portions/day (Odds Ratio 0.85 [CI 0.78 to 0.93], p = 0.001 and high intake of water (100 ml/day (1.08 [1.02 to 1.15], p = 0.002, tea (1.05 [1.01 to 1.10], p = 0.019 and carbonated beverages (1.07 [1.01 to 1.14], p = 0.023 were associated with IBS. A lower intake of dairy products and a higher intake of alcohol and carbonated beverages were associated with D-IBS and a higher intake of water and tea was associated with A-IBS. In subjects with IBS the severity of symptoms was associated with a higher intake of vegetables and potatoes in subjects with C-IBS, with a higher intake of vegetables in subjects with A-IBS, and with a higher intake of fruits and berries, carbonated beverages and alcohol in subjects with D-IBS. Conclusions In this study, the diet differed in subjects with and without IBS and between IBS subgroups and was associated with the severity of symptoms.

  9. Sociodemographic profiles regarding bitter food consumption: cross-sectional evidence from a general French population.

    Andreeva, Valentina A; Martin, Christophe; Issanchou, Sylvie; Hercberg, Serge; Kesse-Guyot, Emmanuelle; Méjean, Caroline

    2013-08-01

    Certain beneficial foods taste bitter (e.g., cruciferous vegetables) and might be aversive to consumers. Here, individual characteristics according to bitter food consumption patterns were assessed. The study included 2327 participants in the SU.VI.MAX antioxidant-based randomized controlled trial (1994-2002). The sample was drawn from the general French population. Dietary data were obtained from a minimum of twelve 24-h dietary records provided during the first 2years of follow-up. Two bitter food consumption scores were computed - one assessing the variety of items consumed (unweighted score) and the other reflecting exposure to bitterness estimated via complementary sensory panel data from the EpiPref project (weighted score). Associations with sociodemographic, health, and lifestyle factors were analyzed with multiple linear regression. Among men, the variety of bitter foods consumed was positively associated with educational level and alcohol intake and inversely associated with physical activity and rural area of residence. Among women, the same outcome was positively associated with alcohol intake and inversely associated with diabetes. In turn, Body Mass Index displayed a significant inverse association with the bitterness-weighted score across sex, whereas educational level was supported only in women. This study adds to the presently scant knowledge about non-genetic determinants or moderators of actual bitter food intake. Future studies should elucidate the impact of diabetes and body size on bitter food intake patterns. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. General Physical Problems Related to MHD. Shock Tubes. Introduction to Papers in Section 1-b

    NONE

    1966-10-15

    The papers which will be considered here are Nos. SM-74/26, 134, 172, 182 and 219. Each of the five papers will be discussed in turn, but before beginning this discussion, some general comments concerning shock tube studies of MHD generator plasmas seem in order. There is little doubt that the shock tube is an excellent facility-for the study of the basic processes which occur in the bulk of the plasma. It provides a large flow of uniform plasma with well-controlled properties. Because of the very short operating times, the materials problems, which plague continuously operating facilities, are eliminated. Depending upon the mode of operation of the shock tube, the gas dynamic conditions of an MHD generator may also be simulated more or less well. Three different modes have been used by the authors of the present papers. Abbas and Howatson have carried out their measurements in the driver plasma of an electrical shock tube. Both Zauderer and Mori, Kawada, Yamamoto and Imani have used the more conventional technique of experimenting in the plasma produced by the incident shock. Louis uses the plasma produced by reflection of the shock wave from the tube-end as a plasma source for the MHD channel.

  11. A cross sectional survey of the barriers for implementing rapid HIV testing among French general practitioners.

    Fraisse, Thibaut; Fourcade, Camille; Brazes-Sanz, Julie; Koumar, Yatrika; Lavigne, Jean Philippe; Sotto, Albert; Laureillard, Didier

    2016-10-01

    In France, almost 30,000 people are unaware of their HIV-positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 returned the questionnaires. The GPs' mean age was 52 years; 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk patients. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen for other sexually transmitted infections simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should be included in the GPs' arsenal for HIV testing. We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in to their routine activity. © The Author(s) 2016.

  12. Urinary Analysis of Fluid Retention in the General Population: A Cross-Sectional Study.

    Robert G Hahn

    Full Text Available Renal conservation (retention of fluid might affect the outcome of hospital care and can be indicated by increased urinary concentrations of metabolic waste products. We obtained a reference material for further studies by exploring the prevalence of fluid retention in a healthy population.Spot urine sampling was performed in 300 healthy hospital workers. A previously validated algorithm summarized the urine-specific gravity, osmolality, creatinine, and color to a fluid retention index (FRI, where 4.0 is the cut-off for fluid retention consistent with dehydration. In 50 of the volunteers, we also studied the relationships between FRI, plasma osmolality, and water-retaining hormones.The cut-off for fluid retention (FRI ≥ 4.0 was reached by 38% of the population. No correlation was found between the FRI and the time of the day of urine sample collection, and the FRI was only marginally correlated with the time period spent without fluid intake. Volunteers with fluid retention were younger, generally men, and more often had albuminuria (88% vs. 34%, P < 0.001. Plasma osmolality and plasma sodium were somewhat higher in those with a high FRI (mean 294.8 vs. 293.4 mosmol/kg and 140.3 vs. 139.9 mmol/l. Plasma vasopressin was consistently below the limit of detection, and the plasma cortisol, aldosterone, and renin concentrations were similar in subjects with a high or low FRI. The very highest FRI values (≥ 5.0, N = 61 were always accompanied by albuminuria.Fluid retention consistent with moderate dehydration is common in healthy staff working in a Swedish hospital.

  13. Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study.

    Meisingset, Ingebrigt; Woodhouse, Astrid; Stensdotter, Ann-Katrin; Stavdahl, Øyvind; Lorås, Håvard; Gismervik, Sigmund; Andresen, Hege; Austreim, Kristian; Vasseljen, Ottar

    2015-03-17

    Neck pain is associated with several alterations in neck motion and motor control. Previous studies have investigated single constructs of neck motor control, while few have applied a comprehensive set of tests to investigate cervical motor control. This comparative cross- sectional study aimed to investigate different motor control constructs in neck pain patients and healthy controls. A total of 166 subjects participated in the study, 91 healthy controls (HC) and 75 neck pain patients (NP) with long-lasting moderate to severe neck pain. Neck flexibility, proprioception, head steadiness, trajectory movement control, and postural sway were assessed using a 3D motion tracking system (Liberty). The different constructs of neck motion and motor control were based on tests used in previous studies. Neck flexibility was lower in NP compared to HC, indicated by reduced cervical ROM and conjunct motion. Movement velocity was slower in NP compared to HC. Tests of head steadiness showed a stiffer movement pattern in NP compared to HC, indicated by lower head angular velocity. NP patients departed less from a predictable trajectory movement pattern (figure of eight) compared to healthy controls, but there was no difference for unpredictable movement patterns (the Fly test). No differences were found for postural sway in standing with eyes open and eyes closed. However, NP patients had significantly larger postural sway when standing on a balance pad. Proprioception did not differ between the groups. Largest effect sizes (ES) were found for neck flexibility (ES range: 0.2-0.8) and head steadiness (ES range: 1.3-2.0). Neck flexibility was the only construct that showed a significant association with current neck pain, while peak velocity was the only variable that showed a significant association with kinesiophobia. NP patients showed an overall stiffer and more rigid neck motor control pattern compared to HC, indicated by lower neck flexibility, slower movement velocity

  14. Periodontitis is associated with endothelial dysfunction in a general population: a cross-sectional study.

    Birte Holtfreter

    Full Text Available A large body of evidence underlines an association between periodontal disease and cardiovascular disease. In contrast, data on its relation with endothelial dysfunction as a marker of early subclinical atherosclerosis is inconclusive and limited to patient-cohort studies. We therefore investigated the association between periodontal disease and flow-mediated dilation of the brachial artery (FMD as a measure of endothelial dysfunction in a general population, and also addressed a possible mediation via inflammation. The study population comprised 1,234 subjects (50.5% men aged 25-85 years from the 5-year follow-up of the Study of Health in Pomerania, a population-based cohort study. Clinical attachment loss (CAL and pocket probing depth (PPD as measures of periodontal disease were assessed half-mouth at four sites per tooth. Subjects were classified according to the periodontitis case definition proposed by Tonetti and Claffey (2005. Measurements of FMD and nitroglycerin-mediated dilation (NMD were performed using standardized ultrasound techniques. High-sensitive C-reactive protein, fibrinogen and leukocyte count were measured. Fully adjusted multivariate linear regression analyses revealed significant associations of the percentage of sites with PPD ≥ 6 mm with FMD (p(trend=0.048, with subjects within the highest category having a 0.74% higher FMD compared to subjects within the lowest category (p<0.05. Consistently, FMD values increased significantly across categories of the percentage of sites with CAL ≥ 6 mm (p(trend=0.01 and the periodontitis case definition (p(trend=0.006. Restrictions to subjects without antihypertensive or statin medication or current non-smokers confirmed previous results. Systemic inflammation did not seem to mediate the relation. Both PPD and CAL were not consistently associated with NMD. In contrast to previous studies, high levels of periodontal disease were significantly associated with high FMD values. This

  15. Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey.

    Lacey, Karen; Bishop, James F; Cross, Hannah L; Chondros, Patty; Lyratzopoulos, Georgios; Emery, Jon D

    2016-07-18

    To assess variations in the number of general practitioner visits preceding a cancer diagnosis, and in the length of the interval between the patient first suspecting a problem and their seeing a hospital specialist. Analysis of data provided to the Cancer Patient Experience Survey (CPES; survey response rate, 37.7%) by 1552 patients with one of 19 cancer types and treated in one of five Victorian Comprehensive Cancer Centre hospitals, 1 October 2012 - 30 April 2013. The primary outcome was the proportion of patients who had had three or more GP consultations about cancer-related health problems before being referred to hospital. The secondary outcome was the interval between the patient first suspecting a problem and their seeing a hospital specialist. 34% of the patients included in the final analyses (426 of 1248) had visited a GP at least three times before referral to a hospital doctor. The odds ratios (reference: rectal cancer; adjusted for age, sex, language spoken at home, and socio-economic disadvantage index score) varied according to cancer type, being highest for pancreatic cancer (3.2; 95% CI, 1.02-9.9), thyroid cancer (2.5; 95% CI, 0.9-6.6), vulval cancer (2.5; 95% CI, 0.7-8.7) and multiple myeloma (2.4; 95% CI, 1.1-5.5), and lowest for patients with breast cancer (0.4; 95% CI, 0.2-0.8), cervical cancer (0.5; 95% CI, 0.1-2.1), endometrial cancer (0.5; 95% CI, 0.2-1.4) or melanoma (0.7; 95% CI, 0.3-1.5). Cancer type also affected the duration of the interval from symptom onset to seeing a hospital doctor; it took at least 3 months for more than one-third of patients with prostate or colon cancer to see a hospital doctor. Certain cancer types were more frequently associated with multiple GP visits, suggesting they are more challenging to recognise early. In Victoria, longer intervals from the first symptoms to seeing a hospital doctor for colon or prostate cancer may reflect poorer community symptom awareness, later GP referral, or limited access to

  16. Transport methods: general. 2. Monte Carlo Particle Transport in Media with Exponentially Varying Time-Dependent Cross Sections

    Brown, Forrest B.; Martin, William R.

    2001-01-01

    exponential variation in cross section was described in a stepwise approximation using 250 separate regions of constant cross section. For each calculation, transmission through the outer boundary of the slab was tallied. The results show nearly perfect agreement in transmission over the range of exponential parameters for the varying cross section, verifying that the PDF and random-sampling procedure described earlier are correct. A PDF and random-sampling procedure for the distance to collision were derived for the case of exponentially varying cross sections. Numerical testing indicates that both are correct. This new sampling procedure has direct application in a new method for Monte Carlo radiation transport and may be generally useful for analyzing physical problems where the material cross sections change very rapidly in an exponential manner

  17. Dossier Madagascar - Introduction générale Special section on Madagascar - General introduction.

    Dominique Gommery

    2011-10-01

    Full Text Available Ce dossier spécial est consacré à Madagascar, le royaume naturel des lémuriens. Douze articles de disciplines diverses ont été regroupés dans le but de présenter une vue générale sur ce qui se fait en primatologie par ou impliquant des francophones. La majorité des travaux présentés concerne la conservation et la protection des lémuriens actuels dont beaucoup sont en danger. Les activités en conservation sont diverses mais les projets relatifs impliquent de plus en plus les relations avec les communautés locales et leur développement. Le soutien et l'engagement de celles-ci est une clé de réussite. Ces projets ne pourraient voir le jour s’il n'y avait pas d'études scientifiques en amont par exemple sur la biologie, le comportement et l'écologie de chaque population ou groupe taxonomique. Pour pouvoir protéger les lémuriens avec l'aide des populations locales, il faut aussi comprendre les traditions et les perceptions des habitants vis-à-vis de ces primates. La diversité des lémuriens était encore plus importante dans un passé assez proche et constitue une partie du patrimoine naturel malgache. Il est important de comprendre le passé pour comprendre l'actuel, et inversement. L'évolution de ces primates reste assez complexe et les recherches récentes permettent de corriger notre vision de celle-ci.This special issue is devoted to Madagascar, the natural kingdom of the lemurs. Twelve articles of various disciplines were gathered to present a general overview on what is done in primatology by or implying French-speaking people. The greatest part of this special issue relates to the conservation and the protection of the extant lemurs of which lot are in danger. The activities in conservation are varied but the projects are more and more in relationship with the local communities and implicated in their development. The support and the commitment of these populations are a key of success. These projects could not come

  18. Quality of life of gestational trophoblastic neoplasia survivors: a study of patients at the Philippine General Hospital trophoblastic disease section.

    Cagayan, M Stephanie Fay S; Llarena, Raquel T

    2010-01-01

    To evaluate the quality of life (QOL) of patients who were diagnosed with gestational trophoblastic neoplasia (GTN) at the Philippine General Hospital Trophoblastic Disease Section and who were in remission at the time of this study. A cross-sectional descriptive study designed to measure the QOL of all patients diagnosed as having GTN in remission and following up at the Philippine General Hospital Trophoblastic Disease Outpatient Clinic from May-August 2008 (N = 46). This study used the short form 12-question (SF-12) survey forms to evaluate the QOL of patients diagnosed with GTN. Scores from the SF-12 were analyzed using Pearson's correlation. Statistical significance was assumed for p values educational level and physical functioning. A negative correlation was found between the stage of GTN and patients' general health. In conclusion, the survivors' age, educational level and type of treatment had impact on the QOL among GTN survivors in terms of physical functioning. No relationship was established between the demographic variables and mental status. SF-12 appears to be a reliable instrument, suggesting its potential in measuring health status in GTN survivors. Age, educational attainment and type of treatment were shown to have an impact on the QOL of the surviving GTN patients.

  19. CRSEC: a general purpose Hauser--Feshbach code for the calculation of nuclear cross-sections and thermonuclear reaction rates

    Woosley, S.; Fowler, W.A.

    1977-09-01

    CRSEC is a FORTRAN IV computer code designed for the efficient calculation of average nuclear cross sections in situations where a statistical theory of nuclear reactions is applicable and where compound nuclear formation is the dominant reaction mechanism. This code generates cross sections of roughly factor of 2 accuracy for incident particle energies in the range of 10 keV to 10 MeV for most target nuclei from magnesium to bismuth. Exceptions usually involve reactions that enter the compound nucleus at such a low energy that fewer than 10 levels are present in the ''energy window of interest.'' The incident particle must be a neutron, proton, or alpha particle, and only binary reactions resulting in the emission of a single n, p, α, or γ (cascade) are calculated. CRSEC is quite fast, a complete calculation of 12 different reactions over a grid of roughly 150 energy points and the generation of Maxwellian averaged rates taking about 30 seconds of CDC7600 time. Also the semi-empirical parameterization of nuclear properties contained in CRSEC is very general. Greater accuracy may be obtained, however, by furnishing specific low-lying excited states, level density parameterization, and nuclear strength functions. A more general version of CRSEC, called CRSECI, is available that conserves isospin properly in all reactions and allows the user to specify a given degree of isospin mixing in the highly excited states of the compound nucleus. Besides the cross section as a function of center-of-mass energy, CRSEC also generates the Maxwell--Boltzmann averaged thermonuclear reaction rate and temperature dependent nuclear partition function for a grid of temperatures from 10 8 to 10 10 0 K. Sections of this report describe in greater detail the physics employed in CRSEC and how to use the code. 2 tables

  20. Large electron capture-cross-section of the major nonradiative recombination centers in Mg-doped GaN epilayers grown on a GaN substrate

    Chichibu, S. F.; Shima, K.; Kojima, K.; Takashima, S.; Edo, M.; Ueno, K.; Ishibashi, S.; Uedono, A.

    2018-05-01

    Complementary time-resolved photoluminescence and positron annihilation measurements were carried out at room temperature on Mg-doped p-type GaN homoepitaxial films for identifying the origin and estimating the electron capture-cross-section ( σ n ) of the major nonradiative recombination centers (NRCs). To eliminate any influence by threading dislocations, free-standing GaN substrates were used. In Mg-doped p-type GaN, defect complexes composed of a Ga-vacancy (VGa) and multiple N-vacancies (VNs), namely, VGa(VN)2 [or even VGa(VN)3], are identified as the major intrinsic NRCs. Different from the case of 4H-SiC, atomic structures of intrinsic NRCs in p-type and n-type GaN are different: VGaVN divacancies are the major NRCs in n-type GaN. The σ n value approximately the middle of 10-13 cm2 is obtained for VGa(VN)n, which is larger than the hole capture-cross-section (σp = 7 × 10-14 cm2) of VGaVN in n-type GaN. Combined with larger thermal velocity of an electron, minority carrier lifetime in Mg-doped GaN becomes much shorter than that of n-type GaN.

  1. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

    Anıl İçel Saygı

    Full Text Available CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section.DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital.METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50 and spinal anesthesia (n = 50 groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups.RESULTS: Mean bowel sounds (P = 0.036 and gas discharge time (P = 0.049 were significantly greater and 24th hour hemoglobin difference values (P = 0.001 were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively, urine volume at the first postoperative hour (P < 0.001 and median Apgar score at the first minute (P < 0.0005 were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042, in the spinal anesthesia group.CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

  2. The Effects of General and Epidural Anaesthesia in Maternal’s Stress Hormones and Blood Gases in Elective Cesarean Section

    Meral EZBERCI

    2005-09-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the effects of general and epidural anaesthesia in maternal’s stress hormones and blood gases in elective cesarean section.\tMATERIALS-METHODS: 50 patients in ASA II (American Society of Anesthesiology class who would undergo elective cesarean section in University of Kahramanmaras Sutcuimam, Department of Anaesthesiology and Reanimation included in the study and randomized into two equal groups (General anaesthesia: Group G and Epidural anaesthesia: Group E. In both groups, maternal stress hormones (TSH, cortisol, and insulin and blood gases were studied. All patients received famotidine and granisetron iv 30 min before operations in premedication room. In the general anaesthesia group; aritmal, propofol, and succinylcholine was used for induction and muscle relaxation. Following the induction, positive pressure ventilation of the lungs was started immediately using a 50% N2O + O2 mixture. After delivery of the baby, anaesthesia and muscle relaxation was maintained by 50% N2O +O2, 0,5-1% MAC isoflurane, and cisatracurium. In the epidural anaesthesia group; epidural anaesthesia was performed with 0,375 % bupivacaine. The epidural needle inserted through L2-3 or L3-4 interspace. After achieving T4-5 neural blockade, the operation was started. In general anaesthesia group; blood samples for maternal stres hormones were taken before induction and after delivery of the baby. In epidural anaesthesia group; blood samples for maternal stres hormones were taken catheter placement and after delivery of the baby. Blood samples for maternal blood gases were taken after the delivery of the baby.\tRESULTS: In both groups; there were statistically significant decrease in maternal TSH and insulin and there were no statistically significant changes in maternal cortisol. In maternal blood gases analyses, only PO2 and SO2 changes were statistically significant between two groups.\tCONCLUSION: With these results

  3. Standard Technical Specifications General Electric plants, BWR/4:Bases (Sections 3.4-3.10). Volume 3, Revision 1

    1995-04-01

    This report documents the results of the combined effort of the NRC and the industry to produce improved Standard Technical Specifications (STS), Revision 1 for General Electric BWR/4 Plants. The changes reflected in Revision 1 resulted from the experience gained from license amendment applications to convert to these improved STS or to adopt partial improvements to existing technical specifications. This NUREG is the result of extensive public technical meetings and discussions between the Nuclear Regulatory Commission (NRC) staff and various nuclear power plant licensees, Nuclear Steam Supply System (NSSS) Owners Groups, NSSS vendors, and the Nuclear Energy Institute (NEI). The improved STS were developed based on the criteria in the Final Commission Policy Statement on Technical Specifications Improvements for Nuclear Power Reactors, dated July 22, 1993. The improved STS will be used as the basis for individual nuclear power plant licensees to develop improved plant-specific technical specifications. This report contains three volumes. Volume 1 contains the specifications for all chapters and sections of the improved STS. Volume 2 contains he Bases for Chapters 2.0 and 3.0, and Sections 3.1-3.3 of the improved STS. This document, Volume 3, contains the Bases for Sections 3.4-3.10 of the improved STS

  4. Standard Technical Specifications General Electric plants, BWR/4: Bases (Sections 2.0-3.3). Volume 2, Revision 1

    1995-04-01

    This report documents the results of the combined effort of the NRC and the industry produce improved Standard Technical Specifications (STS), Revision 1 for General Electric BWR/4 Plants. The changes reflected in Revision 1 resulted from the experience gained from license amendment applications to convert to these improved ST or to adopt partial improvements to existing technical specifications. This NUREG is the result of extensive public technical meetings and discussions between the Nuclear Regulatory Commission (NRC) staff and various nuclear power plant licensees, Nuclear Steam Supply System (NSSS) Owners Groups, NSSS vendors, and the Nuclear Energy Institute (NEI). The improved STS were developed based on the criteria in the Final Commission Policy Statement on Technical Specifications Improvements for Nuclear Power Reactors, dated July 22, 1993. The improved STS will be used as the basis for individual nuclear power plant licensees to develop improved plant-specific technical specifications. This report contains three volumes. Volume I contains the Specifications for all chapters and sections of the improved STS. This document, Volume 2, contains the Bases for Chapters 2.0 and 3.0, and Sections 3.1-3.3 of the improved STS. Volume 3 contains the Bases for Sections 3.4-3.10 of the improved STS

  5. An Underlying Common Factor, Influenced by Genetics and Unique Environment, Explains the Covariation Between Major Depressive Disorder, Generalized Anxiety Disorder, and Burnout: A Swedish Twin Study.

    Mather, Lisa; Blom, Victoria; Bergström, Gunnar; Svedberg, Pia

    2016-12-01

    Depression and anxiety are highly comorbid due to shared genetic risk factors, but less is known about whether burnout shares these risk factors. We aimed to examine whether the covariation between major depressive disorder (MDD), generalized anxiety disorder (GAD), and burnout is explained by common genetic and/or environmental factors. This cross-sectional study included 25,378 Swedish twins responding to a survey in 2005-2006. Structural equation models were used to analyze whether the trait variances and covariances were due to additive genetics, non-additive genetics, shared environment, and unique environment. Univariate analyses tested sex limitation models and multivariate analysis tested Cholesky, independent pathway, and common pathway models. The phenotypic correlations were 0.71 (0.69-0.74) between MDD and GAD, 0.58 (0.56-0.60) between MDD and burnout, and 0.53 (0.50-0.56) between GAD and burnout. Heritabilities were 45% for MDD, 49% for GAD, and 38% for burnout; no statistically significant sex differences were found. A common pathway model was chosen as the final model. The common factor was influenced by genetics (58%) and unique environment (42%), and explained 77% of the variation in MDD, 69% in GAD, and 44% in burnout. GAD and burnout had additive genetic factors unique to the phenotypes (11% each), while MDD did not. Unique environment explained 23% of the variability in MDD, 20% in GAD, and 45% in burnout. In conclusion, the covariation was explained by an underlying common factor, largely influenced by genetics. Burnout was to a large degree influenced by unique environmental factors not shared with MDD and GAD.

  6. A GENERALIZED CLASS OF TRANSFORMATION MATRICES FOR THE RECONSTRUCTION OF SPHERE SIZE DISTRIBUTIONS FROM SECTION CIRCLE SIZE DISTRIBUTIONS

    Willi Pabst

    2017-03-01

    Full Text Available A generalized formulation of transformation matrices is given for the reconstruction of sphere diameter distributions from their section circle diameter distributions. This generalized formulation is based on a weight shift parameter that can be adjusted from 0 to 1. It includes the well-known Saltykov and Cruz-Orive transformations as special cases (for parameter values of 0 and 0.5, respectively. The physical meaning of this generalization is explained (showing, among others, that the Woodhead transformation should be bounded by the Saltykov transformation on the one side and by our transformation from the other and its numerical performance is investigated. In particular, it is shown that our generalized transformation is numerically highly unstable, i.e. introduces numerical artefacts (oscillations or even unphysical negative sphere frequencies into the reconstruction, and can lead to completely wrong results when a critical value of the parameter (usually in the range 0.7-0.9, depending on the type of distribution is exceeded. It is shown that this numerical instability is an intrinsic feature of these transformations that depends not only on the weight shift parameter value and is affected both by the type and the position of the distribution. It occurs in a natural way also for the Cruz-Orive and other transformations with finite weight shift parameter values and is not just caused by inadequate input data (e.g. as a consequence of an insufficient number of objects counted, as commonly assumed. Finally it is shown that an even more general class of transformation matrices can be defined that includes, in addition to the aformentioned transformations, also the Wicksell transformation.

  7. Insect Sting Reactions and Specific IgE to Venom and Major Allergens in a General Population

    Mosbech, H; Tang, L; Linneberg, A

    2016-01-01

    BACKGROUND: Insect sting reactions are frequently reported, but population studies documenting the frequency and the relation to IgE-sensitization and serum tryptase are scarce. METHODS: Questionnaire data and results from measurements of specific IgE against venom, major allergens and cross...... or wasp. IgE to CCDs occurred in only 0.7%, but 80% of these were DS. Finally, 36% with IgE to CCDs had had symptoms, mostly local. Serum tryptase was not associated with a history of sting reactions. CONCLUSIONS: In a temperate climate, self-reported insect sting reactions and sensitization to venom...

  8. Maternal and neonatal effects of nalbuphine given immediately before induction of general anesthesia for elective cesarean section

    Sabry M Amin

    2011-01-01

    Full Text Available Background: Although nalbuphine was studied extensively in labour analgesia and was proved to be acceptable analgesics during delivery, its use as premedication before induction of general anesthesia for cesarean section is not studied. The aim of this study was to evaluate the effect of nalbuphine given before induction of general anesthesia for cesarean section on quality of general anesthesia, maternal stress response, and neonatal outcome. Methods: Sixty full term pregnant women scheduled for elective cesarean section, randomly classified into two equal groups, group N received nalbuphine 0.2 mg/kg diluted in 10 ml of normal saline (n=30, and group C placebo (n=30 received 10 ml of normal saline 1 min before the induction of general anesthesia. Maternal heart rate and blood pressure were measured before, after induction, during surgery, and after recovery. Neonates were assisted by using APGAR0 scores, time to sustained respiration, and umbilical cord blood gas analysis. Result: Maternal heart rate showed significant increase in control group than nalbuphine group after intubation (88.2±4.47 versus 80.1±4.23, P<0.0001 and during surgery till delivery of baby (90.8±2.39 versus 82.6±2.60, P<0.0001 and no significant changes between both groups after delivery. MABP increased in control group than nalbuphine group after intubation (100.55±6.29 versus 88.75±6.09, P<0.0001 and during surgery till delivery of baby (98.50±2.01 versus 90.50±2.01, P<0.0001 and no significant changes between both groups after delivery. APGAR score was significantly low at one minute in nalbuphine group than control group (6.75±2.3, 8.5±0.74, respectively, P=0.0002 (27% of nalbuphine group APGAR score ranged between 4-6, while 7% in control group APGAR score ranged between 4-6 at one minute. All neonates at five minutes showed APGAR score ranged between 9-10. Time to sustained respiration was significantly longer in nalbuphine group than control group (81.8

  9. General discussion of data quality challenges in social media metrics: Extensive comparison of four major altmetric data aggregators

    2018-01-01

    The data collection and reporting approaches of four major altmetric data aggregators are studied. The main aim of this study is to understand how differences in social media tracking and data collection methodologies can have effects on the analytical use of altmetric data. For this purpose, discrepancies in the metrics across aggregators have been studied in order to understand how the methodological choices adopted by these aggregators can explain the discrepancies found. Our results show that different forms of accessing the data from diverse social media platforms, together with different approaches of collecting, processing, summarizing, and updating social media metrics cause substantial differences in the data and metrics offered by these aggregators. These results highlight the importance that methodological choices in the tracking, collecting, and reporting of altmetric data can have in the analytical value of the data. Some recommendations for altmetric users and data aggregators are proposed and discussed. PMID:29772003

  10. Influence of the width and cross-sectional shape of major connectors of maxillary dentures on the accuracy of speech production.

    Wada, Junichiro; Hideshima, Masayuki; Inukai, Shusuke; Matsuura, Hiroshi; Wakabayashi, Noriyuki

    2014-01-01

    To investigate the effects of the width and cross-sectional shape of the major connectors of maxillary dentures located in the middle area of the palate on the accuracy of phonetic output of consonants using an originally developed speech recognition system. Nine adults (4 males and 5 females, aged 24-26 years) with sound dentition were recruited. The following six sounds were considered: [∫i], [t∫i], [ɾi], [ni], [çi], and [ki]. The experimental connectors were fabricated to simulate bars (narrow, 8-mm width) and plates (wide, 20-mm width). Two types of cross-sectional shapes in the sagittal plane were specified: flat and plump edge. The appearance ratio of phonetic segment labels was calculated with the speech recognition system to indicate the accuracy of phonetic output. Statistical analysis was conducted using one-way ANOVA and Tukey's test. The mean appearance ratio of correct labels (MARC) significantly decreased for [ni] with the plump edge (narrow connector) and for [ki] with both the flat and plump edge (wide connectors). For [çi], the MARCs tended to be lower with flat plates. There were no significant differences for the other consonants. The width and cross-sectional shape of the connectors had limited effects on the articulation of consonants at the palate. © 2015 S. Karger AG, Basel.

  11. Internet health seeking behaviour of parents attending a general paediatric outpatient clinic: A cross-sectional observational study.

    Sebelefsky, Christian; Karner, Denise; Voitl, Jasmin; Klein, Frederic; Voitl, Peter; Böck, Andreas

    2015-10-01

    Our aim was to examine the internet health seeking behaviour of parents attending a general paediatric outpatient clinic. For this purpose, the proportion of parents going online to obtain child health information, the most commonly used online resources, and factors having an influence on internet usage were identified. This cross-sectional observational study was conducted at a general paediatric outpatient clinic in Vienna, Austria. Data collection was done by means of an anonymous questionnaire containing 14 items. A total number of 500 questionnaires were collected. Among parents visiting the outpatient clinic, 94.4% use the internet to obtain child health information in general and 21% to be informed about the reason for consultation. Most commonly used online resources are Google (91.4%), websites run by doctors (84.8%), Wikipedia (84.7%), health portals (76.4%), the outpatient clinic's homepage (76.4%), as well as health forums and communities (61.9%). Younger parents (p = 0.022) and parents of younger children (p parents with different completed educational levels (mothers: p = 0.078; fathers: p = 0.388) do not differ in this behaviour. Important reasons for high internet use might be the inexperience of young parents regarding child health as well as the frequent infections, vaccinations, and preventive check-ups which are associated with young age of children. In contrast to former findings relating to health seekers in general, internet usage of parents is independent of their sex and educational level. © The Author(s) 2015.

  12. Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam

    Geere, Jo-Anne; Bartram, Jamie; Bates, Laura; Danquah, Leslie; Evans, Barbara; Fisher, Michael B; Groce, Nora; Majuru, Batsirai; Mokoena, Michael M; Mukhola, Murembiwa S; Nguyen-Viet, Hung; Duc, Phuc Pham; Williams, Ashley Rhoderick; Schmidt, Wolf-Peter; Hunter, Paul R

    2018-01-01

    Background The Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household’s water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children. Methods A cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain. Results People who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, ‘axial compression’, which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, ‘soft tissue strain’, which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water

  13. Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam.

    Geere, Jo-Anne; Bartram, Jamie; Bates, Laura; Danquah, Leslie; Evans, Barbara; Fisher, Michael B; Groce, Nora; Majuru, Batsirai; Mokoena, Michael M; Mukhola, Murembiwa S; Nguyen-Viet, Hung; Duc, Phuc Pham; Williams, Ashley Rhoderick; Schmidt, Wolf-Peter; Hunter, Paul R

    2018-06-01

    The Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household's water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children. A cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain. People who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, 'axial compression', which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, 'soft tissue strain', which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water. The factor 'axial compression' was

  14. Maintaining capacity for in-practice teaching and supervision of students and general practice trainees: a cross-sectional study of early career general practitioners.

    Catzikiris, Nigel; Tapley, Amanda; Morgan, Simon; Holliday, Elizabeth G; Ball, Jean; Henderson, Kim; Elliott, Taryn; Spike, Neil; Regan, Cathy; Magin, Parker

    2017-08-10

    Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (Pinterest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add? This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners? Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to

  15. The majority of participants with abnormal spirometry at walk-in consult their general practitioner as recommended.

    Kølner-Augustson, Line; Thøgersen, Niels; Faaborg, Thea Heide; Weinreich, Ulla Møller

    2015-11-01

    A number of studies inviting citizens to perform spirometry without need for a previous appointment have been performed to determine the need for general screening of the population for chronic obstructive pulmonary disease (COPD). Yet, no studies have examined how many of the participants follow the advice given to consult their general practitioner (GP) afterwards. A walk-in spirometry was carried out on the island of Laesoe. All habitants above the age of 18 years were invited. In total, 142 were eligible for the study. Participants with an abnormal spirometry were recommended to consult their GP immediately, whereas smokers with symptoms, but with a normal spirometry, were recommended to consult their GP within a year for another spirometry. A follow-up was performed to investigate whether the participants had followed this advice. In total, 52% (74/142) of the participants were advised to contact their GP: 34 due to an abnormal spirometry and 40 due to smoking and respiratory symptoms. Among the participants with an abnormal spirometry, 79% saw their GP within three months, whereas 30% of the current smokers saw their GP within 9-15 months. Lung disease was diagnosed in 56% (19/34) of the participants who initially had an abnormal spirometry. Among the participants who had an abnormal spirometry at screening, 79% consulted their GP as recommended. Furthermore, 52% of the participants who had an abnormal spirometry were subsequently diagnosed with pulmonary disease by their GP. We conclude that walk-in spirometry is a useful tool for early diagnosis of COPD. none. not relevant.

  16. Calculation of 3-D free electron laser gain: Comparison with simulation and generalization to elliptical cross section

    Chin, Yong Ho; Kim, Kwang-Je; Xie, Ming.

    1992-08-01

    In the previous paper, we have derived a dispersion relation for the free electron laser (FEL) gain in the exponential regime taking account the diffraction and electron's betatron oscillation. Here, we compare the growth rates obtained by solving the dispersion relation with those obtained by simulation calculation for the waterbag and the Gaussian models for the electron's transverse phase space distribution. The agreement is found to be good except for the limiting case where the Rayleigh length is much longer than the gain length (1-D limit). We also generalize the analysis to the case where the electron beam cross section is elliptical as is usually the case in storage rings, and derive the first-order dispersion relation

  17. General beliefs about medicines among doctors and nurses in out-patient care: a cross-sectional study

    Hedenrud Tove

    2009-05-01

    Full Text Available Abstract Background Doctors and nurses are two natural partners in the healthcare team, but they usually differ in their perspectives on how to work for increased health. These professions may also have different beliefs about medicines, a factor important for adherence to medicines. The aim was to explore general beliefs about medicines among doctors and nurses. Methods Questionnaires were sent to 306 private practitioners (PPs, 298 general practitioners (GPs and 303 nurses in the county of Västra Götaland, Sweden. The questionnaire included sociodemographic questions and the general part of the Beliefs about Medicines Questionnaire (BMQ, which measures the beliefs people have about medicines in general. General beliefs about medicines in relation to background variables were explored with independent t-tests and ANOVA analyses. Differences between occupations and influences of interaction variables were analysed with multiple linear regression models for general beliefs about medicines. Results The data collection resulted in 616 questionnaires (62.1% PPs; 61.6% GPs; 80.5% nurses. The majority of the PPs and 40% of the GPs were male but most of the nurses were female. The GPs' mean age was 47 years, PPs' 60 years and nurses' 52 years. Few nurses originated from non-Nordic countries while 15% of the PPs and 25% of the GPs did. Nurses saw medicines as more harmful and less beneficial than did PPs and GPs. These differences could not be explained by the included interaction variables. GPs with a Nordic background saw medicines as more beneficial and less harmful than did GPs with a non-Nordic background. Furthermore, GPs of non-Nordic origin were most likely to believe that medicines were overprescribed by doctors. Conclusion Doctors were more positive about medicines than nurses. The differences in beliefs about medicines found between doctors and nurses could not be explained by any of the included interaction variables. These differences in

  18. Summary Report of the Technical Meeting on Inelastic Scattering and Capture Cross-section Data of Major Actinides in the Fast Neutron Region

    Plompen, Arjan; Kawano, Toshihiko; Capote Noy, Roberto

    2012-05-01

    Recently, tight target uncertainties on the capture and inelastic scattering data for major actinides were derived from advanced reactor sensitivity studies. A Technical Meeting on 'Inelastic Scattering and Capture Cross-section Data of Major Actinides in the Fast Neutron Region' was held at IAEA Headquarters, Vienna, Austria to review the status of nuclear data libraries for these cross sections, the status of the experimental results by which these can be tested and to evaluate what advances in nuclear modeling and measurement technique may bring to improve the knowledge of these cross sections. The participants compared recent evaluations with various modeling approaches that have not yet been adopted in data libraries. Several points of interest were found. First, different evaluations may show very similar performance for macroscopic benchmarks. Second, recent modeling improvements from different communities and using different codes tend to converge on the principles in the case of coupled channel calculations. In particular, it was shown that meaningful results require convergence with respect to the number of coupled channels and the use of the dispersive coupled channels potential based with an isospin dependent term to treat neutrons and protons in a coherent manner appears to be uncontested. Also, the issue regarding the use of transmission coefficients from coupled channels calculations in the Hauser Feshbach model was tackled. Recent and ongoing experimental efforts were presented for capture and inelastic scattering on the major actinides. Results from these are likely to become available in a period from 2 to 5 years. A discussion on the representation of the data in EXFOR revealed that care must be taken interpreting the numbers given in the case of inelastic scattering. It has been a long time since capture data were obtained for fissile nuclei and it is exciting to find new efforts are being considered at LANL, CERN and CENBG/IRMM. It was finally

  19. The presence of resuscitation equipment and influencing factors at General Practitioners' offices in Denmark: a cross-sectional study.

    Niegsch, Mark L; Krarup, Nikolaj T; Clausen, Niels Erikstrup

    2014-01-01

    Automated external defibrillators (AEDs) have proven effective when used by GPs. Despite this and the latest guidelines from the European Resuscitation Council, there are no recommendations for Danish GPs regarding proper equipment to treat cardiac arrest. Currently, there are no published data on the distribution of AEDs among GPs in Denmark. To assess the prevalence of resuscitation equipment and educated staff among Danish GPs and the parameters influencing the absence of AEDs at GP offices. A cross-sectional questionnaire-based survey among the 2030 GPs registered in Denmark. Questions concerned demographics, occurrence of resuscitation equipment and attitude towards acquisition of an AED. With a response rate >70%, we found that the prevalence of AEDs in GP offices is low (31.7%). Limited financial possibilities and relevant treatment by ambulance personnel were stated as the primary causes for not having an AED. In general, Danish primary care physicians believe that AEDs should be governmentally sponsored. Positive influential factors on the acquisition of an AED were education, number of physicians in the GP office and previous experience of cardiac arrest. Danish primary care physicians are generally not equipped with AEDs despite the proven effect of AEDs in GP offices. The main reasons for not acquiring an AED are financial considerations and believing that response time by ambulance services and nearby health facilities are the optimal treatment. We recommend better education and information in order to facilitate future acquisition of AEDs among GPs. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Chronic disease influences over 40 major life-changing decisions (MLCDs): a qualitative study in dermatology and general medicine.

    Bhatti, Z U; Finlay, A Y; Bolton, C E; George, L; Halcox, J P; Jones, S M; Ketchell, R I; Moore, R H; Salek, M S

    2014-10-01

    Chronic disease not only impairs patients' psycho-social well-being but also influences major life-changing decisions (MLCDs). There is little information about the types of MLCDs affected and the long-term consequences. The aims were to identify the MLCDs influenced by chronic disease, to define 'MLCD' and to suggest support strategies for patients taking MLCDs. Adult dermatology patients explained how their chronic disease had influenced MLCDs in individual interviews. Adult patients from other medical specialities gave similar information by postal survey. NVivo8 software was used for qualitative analysis of data. Themes were categorized through a coding-recoding iterative process. There were 308 evaluable responses (male 55.2%; mean age = 51.8 years, mean disease duration = 19 years) from the 365 (55.7%) responses to the 655 patient invitations. These were used to generate themes to conceptualize 'MLCDs'. The most frequently reported MLCDs in the dermatology interviews concerned career choice (66%), job (58%), choice of clothing (54%), relationships (52%), education (44%), stopping swimming (34%), moving abroad (32%), not socializing (34%), wearing make-up (22%) and having children (22%). In the postal survey early retirement (40.6%), impact on job (29.4%), having children (24.8%), career choice (22.4%) and relationships (15.5%) were most commonly reported. The number of MLCDs reported by individuals was inversely related to age. Forty-one affected MLCD themes were grouped into 18 MLCD categories. A definition of MLCD was developed and strategies suggested to support patients. Chronic diseases influence a wide range of MLCDs. MLCDs are a novel domain in disease burden assessment. Clinicians' knowledge about this is important in patient management. © 2013 European Academy of Dermatology and Venereology.

  1. Residential greenness and prevalence of major depressive disorders: a cross-sectional, observational, associational study of 94 879 adult UK Biobank participants

    Chinmoy Sarkar, PhD

    2018-04-01

    Full Text Available Summary: Background: Increased urbanisation and the associated reduced contact of individuals with natural environments have led to a rise in mental disorders, including depression. Residential greenness, a fundamental component of urban design, has been shown to reduce the public health burden of mental disorders. The present study investigates the association between residential green exposure and prevalence of major depressive disorders using a large and diverse cross-sectional dataset from the UK Biobank. Methods: In this cross-sectional, observational, associational study, we used baseline data from the UK Biobank cohort of participants aged 37–73 years from across the UK. Environmental exposure data were derived from a modelled and linked built environment database. Residential greenness was assessed with a 0·5 m resolution Normalised Difference Vegetation Index, which is derived from spectral reflectance measurements in remotely sensed colour infrared data and measured within geocoded dwelling catchments. Other environment metrics included street-level movement density, terrain, and fine particulate exposures. A series of logistic models examined associations between residential greenness and odds of major depressive disorder after adjusting for activity-influencing environments and individual covariates. Findings: Of 122 993 participants with data on major depressive disorder, the study analytical sample comprised 94 879 (77·1% participants recruited across ten UK Biobank assessment centres between April 29, 2009, and Oct 1, 2010. A protective effect of greenness on depression was consistently observed, with 4·0% lower odds of major depressive disorder per interquartile increment in Normalised Difference Vegetation Index greenness (odds ratio 0·960, 95% CI 0·93–0·99; p=0·0044. Interaction analyses indicated that the beneficial effects of greenness were more pronounced among women, participants younger than 60 years, and

  2. Socioeconomic inequalities in general and psychological health among adolescents: a cross-sectional study in senior high schools in Greece

    Zissi Anastasia

    2010-01-01

    Full Text Available Abstract Background Socioeconomic health inequalities in adolescence are not consistently reported. This may be due to the measurement of self-reported general health, which probably fails to fully capture the psychological dimension of health, and the reliance on traditional socio-economic indicators, such as parental education or occupational status. The present study aimed at investigating this issue using simple questions to assess both the physical and psychological dimension of health and a broader set of socioeconomic indicators than previously used. Methods This was a cross-sectional survey of 5614 adolescents aged 16-18 years-old from 25 senior high schools in Greece. Self-reported general and psychological health were both measured by means of a simple Likert-type question. We assessed the following socio-economic variables: parents' education, parents' employment status, a subjective assessment of the financial difficulties experienced by the family and adolescents' own academic performance as a measure of the personal social position in the school setting. Results One out of ten (10% and one out of three (32% adolescents did not enjoy good general and psychological health respectively. For both health variables robust associations were found in adolescents who reported more financial difficulties in the family and had worse academic performance. The latter was associated with psychological health in a more linear way. Father's unemployment showed a non-significant trend for an association with worse psychological health in girls only. Conclusions Socioeconomic inequalities exist in this period of life but are more easily demonstrated with more subjective socioeconomic indicators, especially for the psychological dimension of health.

  3. Association between social support and depression in the general population: the HUNT study, a cross-sectional survey.

    Grav, Siv; Hellzèn, Ove; Romild, Ulla; Stordal, Eystein

    2012-01-01

    The aim was to investigate the associations between perceived social support and depression in a general population in relation to gender and age. Social support is seen as one of the social determinants for overall health in the general population. Studies have found higher probability of experiencing depression among people who have a lack of social support; evidence from the general population has been more limited. Subjective perception that support would be available if needed may reduce and prevent depression and unnecessary suffering. A cross-sectional survey with self-reported health was used. A total of 40,659 men and women aged 20-89 years living in Nord-Trøndelag County of Norway with valid ratings of depression subscale of the Hospital Anxiety and Depression Scale in the The Nord-Trøndelag Health Study 3 were used. Logistic regression was used to quantify associations between two types of perceived support (emotional and tangible) and depression. Gender, age and interaction effects were controlled for in the final model. The main finding was that self-rated perceived support was significantly associated with Hospital Anxiety and Depression Scale-defined depression, even after controlling for age and gender; emotional support (OR = 3·14) and tangible support (OR = 2·93). The effects of emotional and tangible support differ between genders. Interaction effects were found for age groups and both emotional and tangible support. Self-rated perceived functional social support is associated with Hospital Anxiety and Depression Scale-defined depression. In the group of older people who have a lack of social support, women seem to need more emotional support and men tangible support. Health care providers should consider the close association between social support and depression in their continuing care, particularly in the older people. © 2011 Blackwell Publishing Ltd.

  4. Prevalence of fragrance contact allergy in the general population of five European countries: a cross-sectional study.

    Diepgen, T L; Ofenloch, R; Bruze, M; Cazzaniga, S; Coenraads, P J; Elsner, P; Goncalo, M; Svensson, Å; Naldi, L

    2015-12-01

    Contact allergy to fragrances is assessed mostly in clinical populations of patients. Studies in the general population are scarce and vary in their methodology across countries. To determine the prevalence of fragrance contact allergy in the European general population and to assess the clinical relevance of positive patch test reactions to different fragrances. In five European countries (Germany, Italy, the Netherlands, Portugal and Sweden) a random sample from the general population aged 18-74 years was drawn. In total, 12 377 subjects were interviewed in this cross-sectional study and a random sample (n = 3119) was patch tested using the TRUE Test and Finn Chamber techniques. Patch test procedures were harmonized by mandatory training before the study and monitoring during the study. The highest prevalence for contact allergy of 2·6% [95% confidence interval (CI) 2·1-3·2] was found for fragrance mix (FM) I in petrolatum, with a high content of atranol and chloratranol, followed by 1·9% (95% CI 1·5-2·4) for FM II in petrolatum. The conservatively estimated prevalence of fragrance contact allergy was 1·9% (95% CI 1·5-2·5). This is defined as the existence of a positive patch test to FM I or FM II; any of their individual materials; Myroxylon pereirae; sesquiterpene lactones or 3- and 4-hydroxyisohexyl 3-cyclohexene carboxaldehyde that show clinical relevance, defined conservatively as lifetime avoidance of scented products and an itchy skin rash lasting > 3 days in a lifetime. Using the reported lifetime prevalence of any contact dermatitis instead of the lifetime prevalence of any itchy skin rash, the prevalence is 0·8% (95% CI 0·5-1·2). The prevalence rates of contact allergy to fragrances in women are about twice those in men. This study helps to identify targets for prevention of fragrance allergy. © 2015 British Association of Dermatologists.

  5. Ten thousand steps: a pedometer study of junior dentists in a major British teaching hospital and a district general hospital.

    Keat, R M; Thomas, M; McKechnie, A

    2017-05-01

    Sedentary behaviour is widely associated with deleterious health outcomes that in modern medicine have similar connotations to smoking tobacco and alcohol misuse. The integration of e-portfolio, e-logbook, British National Formulary (BNF) and encrypted emails has made smartphones a necessity for trainees. Smartphones also have the ability to record the amount of exercise taken, which allows activity at work to be monitored. The aim of this study to compare the activity of the same group of dental core trainees when they worked within a large multisite teaching hospital and a smaller district general hospital, to find out if supplementary activity was needed outside work. Data were collected from smartphones. To ensure continuity, data were collected only from those who had calibrated iPhones (n=10). At the teaching hospital six of the trainees walked over 10 000 steps a day while working (mean (SD) 10 004 (639)). At the district hospital none of the trainees walked 10 000 steps. The mean (SD) number of steps completed by all trainees was 6265 (119). Walking at work provides the full quota of recommended daily exercise most of the time for those working in the teaching hospital, but additional exercise is occasionally required. While working at the district hospital they walk less, meaning that they should try to increase their activity outside work. Trainees working in the teaching hospital walk significantly more steps than in the district hospital. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Identifying current training provision and future training needs in allergy available for UK general practice trainees: national cross-sectional survey of General Practitioner Specialist Training programme directors.

    Ellis, Jayne; Rafi, Imran; Smith, Helen; Sheikh, Aziz

    2013-03-01

    There are ongoing concerns about the quality of care provision for allergy in primary care. To identify current training provision in allergy to GP trainees and to understand how this could be enhanced. A cross-sectional survey of GP Speciality Training (GPST) programme directors was undertaken. Programme directors of the 174 GPST schemes were sent an online questionnaire which was informed by the content of the Royal College of General Practitioners curriculum. Quantitative data were descriptively analysed and a thematic analysis was undertaken of free text responses. We obtained responses from 146 directors representing 106 training programmes. Responses indicated that two-thirds (62%, 95% CI 53.1 to 71.5) of programmes were providing at least some allergy training, with the remaining third stating that they either provided no training or were unsure. Overall, one-third (33%, 95% CI 22.7 to 42.2) of programme directors believed that all the relevant allergy-related curriculum requirements were being met. Where provided, this training was believed to be best for organ-specific allergic disorders but was thought to be poorer for systemic allergic disorders, particularly food allergy where 67% (95% CI 57.5 to 76.5) of respondents indicated that training was poor. There was considerable interest in increasing the allergy training provided, preferably through eLearning modules and problem-based learning materials supported by those with relevant specialist knowledge. This UK-wide survey has identified important gaps in the training of GP trainees in relation to allergy care. Addressing these gaps, particularly in the management of systemic allergic disorders, should help to improve delivery of primary care-based allergy care.

  7. Landscape scale ecological monitoring as part of an EIA of major construction activities: experience at the Turkish section of the BTC crude oil pipeline project.

    Sahin, Sükran; Kurum, Ekrem

    2009-09-01

    Ecological monitoring is a complementary component of the overall environmental management and monitoring program of any Environmental Impact Assessment (EIA) report. The monitoring method should be developed for each project phase and allow for periodic reporting and assessment of compliance with the environmental conditions and requirements of the EIA. Also, this method should incorporate a variance request program since site-specific conditions can affect construction on a daily basis and require time-critical application of alternative construction scenarios or environmental management methods integrated with alternative mitigation measures. Finally, taking full advantage of the latest information and communication technologies can enhance the quality of, and public involvement in, the environmental management program. In this paper, a landscape-scale ecological monitoring method for major construction projects is described using, as a basis, 20 months of experience on the Baku-Tbilisi-Ceyhan (BTC) Crude Oil Pipeline Project, covering Turkish Sections Lot B and Lot C. This analysis presents suggestions for improving ecological monitoring for major construction activities.

  8. Intimate partner violence and ways of coping with stress: cross-sectional survey of female patients in Russian general practice.

    Lokhmatkina, Natalia V; Agnew-Davies, Roxane; Costelloe, Ceire; Kuznetsova, Olga Yu; Nikolskaya, Irina M; Feder, Gene S

    2015-04-01

    Despite World Health Organization guidelines on health service responses to intimate partner violence (IPV) against women general practitioners (GPs) often overlook the problem. Training on IPV addresses GPs' barriers to asking women patients about abuse and responding appropriately. One of the barriers is stereotype of women as passive victims. Little is known about coping behaviour of women patients with a history of IPV. The objectives are (i) to compare problem- and emotion-focused coping used by patients who have experienced IPV with those who have not; (ii) to examine whether greater coping resources (health, education, employment and income) would be associated with more problem-focused coping. The Russian Ways of Coping Questionnaire was administered to every fifth woman who participated in a cross-sectional survey on IPV prevalence in 24 St Petersburg general practices. Linear regression was used (n = 159) to test associations between life-time IPV, coping resources and ways of coping. Mean problem-focused coping scores were 0.2-4.7 units higher in those patients who have experienced IPV compared with those who have not [95% confidence interval (CI): -4.2, 11.9; P = 0.16-0.92], while mean emotion-focused coping scores were 2.5-4.2 units higher (95% CI: -3.0, 11.0; P = 0.12-0.57). After adjustment for coping resources there was no evidence for an association between IPV and problem-focused coping. Patients who have experienced IPV use as much problem-focused and emotion-focused coping, as those patients who have not experienced IPV. These findings should be incorporated into training on IPV to address GPs' stereotypes towards patients who have experienced IPV. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Workplace violence in different settings and among various health professionals in an Italian general hospital: a cross-sectional study

    Ferri, Paola; Silvestri, Monica; Artoni, Cecilia; Di Lorenzo, Rosaria

    2016-01-01

    Background Workplace violence (WPV) against health professionals is a global problem with an increasing incidence. The aims of this study were as follows: 1) to examine the frequency and characteristics of WPV in different settings and professionals of a general hospital and 2) to identify the clinical and organizational factors related to this phenomenon. Methods The study was cross-sectional. In a 1-month period, we administered the “Violent Incident Form” to 745 professionals (physicians, head nurses, nurses, nursing assistants), who worked in 15 wards of a general hospital in northern Italy. Results With a response rate of 56%, 45% of professionals reported WPV. The most frequently assaulted were nurses (67%), followed by nursing assistants (18%) and physicians (12%). The first two categories were correlated, in a statistically significant way, with the risk of WPV (P=0.005, P=0.004, multiple logistic regression). The violent incidents more frequently occurred in psychiatry department (86%), emergency department (71%), and in geriatric wards (57%). The assailants more frequently were males whereas assaulted professionals more often were females. Men committed physical violence more frequently than women, in a statistically significant way (P=0.034, chi-squared test). Verbal violence (51%) was often committed by people in a lucid and normal state of consciousness; physical violence (49%) was most often perpetrated by assailants affected by dementia, mental retardation, drug and substance abuse, or other psychiatric disorders. The variables positively related to WPV were “calling for help during the attack” and “physical injuries suffered in violent attack” (P=0.02, P=0.03, multiple logistic regression). Conclusion This study suggests that violence is a significant phenomenon and that all health workers, especially nurses, are at risk of suffering aggressive assaults. WPV presented specific characteristics related to the health care settings, where

  10. Workplace violence in different settings and among various health professionals in an Italian general hospital: a cross-sectional study

    Ferri P

    2016-09-01

    Full Text Available Paola Ferri,1 Monica Silvestri,1 Cecilia Artoni,2 Rosaria Di Lorenzo3 1Department of Diagnostic, Clinical and Public Health Medicine, School of Nursing, 2School of Psychiatry, University of Modena and Reggio, 3Department of Mental Health, Service of Psychiatric Diagnosis and Treatment, Modena, Italy Background: Workplace violence (WPV against health professionals is a global problem with an increasing incidence. The aims of this study were as follows: 1 to examine the frequency and characteristics of WPV in different settings and professionals of a general hospital and 2 to identify the clinical and organizational factors related to this phenomenon. Methods: The study was cross-sectional. In a 1-month period, we administered the “Violent Incident Form” to 745 professionals (physicians, head nurses, nurses, nursing assistants, who worked in 15 wards of a general hospital in northern Italy. Results: With a response rate of 56%, 45% of professionals reported WPV. The most frequently assaulted were nurses (67%, followed by nursing assistants (18% and physicians (12%. The first two categories were correlated, in a statistically significant way, with the risk of WPV (P=0.005, P=0.004, multiple logistic regression. The violent incidents more frequently occurred in psychiatry department (86%, emergency department (71%, and in geriatric wards (57%. The assailants more frequently were males whereas assaulted professionals more often were females. Men committed physical violence more frequently than women, in a statistically significant way (P=0.034, chi-squared test. Verbal violence (51% was often committed by people in a lucid and normal state of consciousness; physical violence (49% was most often perpetrated by assailants affected by dementia, mental retardation, drug and substance abuse, or other psychiatric disorders. The variables positively related to WPV were “calling for help during the attack” and “physical injuries suffered in violent

  11. Development of a mathematical model for a single alkaline membrane fuel cell (AMFC) with fixed volume and general square section

    Sommer, Elise Meister; Vargas, Jose Viriato Coelho [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil). Centro Politecnico. Setor de Tecnologia], Email: jvargas@demec.ufpr.br; Martins, Lauber de Souza; Ordonez, Juan Carlos [Florida State University, Tallahasse, FL (United States). Dept. of Mechanical Engineering and Center for Advanced Power Systems], Emails: martins@caps.fsu.edu, ordonez@eng.fsu.edu

    2010-07-01

    The Alkaline Membrane Fuel Cell (AMFC) is a recently developed fuel cell type, which has shown good experimental results in the laboratory. This paper introduces a mathematical model for the single AMFC with fixed volume and general square section. The main objective is to produce a reliable model (and computationally fast) to predict the response of the single AMFC according to variations of the physical properties of manufacturing materials and operating and design parameters. The model is based on mass, momentum, energy and species conservation, and electrochemical principles, and takes into account pressure drops in the gas channels and temperature gradients with respect to space in the flow direction. The simulation results comprise the AMFC temperature distribution, net power and polarization curves. It is shown that temperature spatial gradients and gas channels pressure drops significantly affect fuel cell performance. Such effects are not usually investigated in the models available in the literature, with most of them assuming uniform pressure and temperature operation. Therefore, the model is expected to be a useful tool for AMFC design and optimization. (author)

  12. Sleep quality and health service utilization in Chinese general population: a cross-sectional study in Dongguan, China.

    Zhang, Hui-Shan; Mai, Yan-Bing; Li, Wei-Da; Xi, Wen-Tao; Wang, Jin-Ming; Lei, Yi-Xiong; Wang, Pei-Xi

    The aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization. In a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates. Higher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables. Copyright © 2016. Published by Elsevier B.V.

  13. Aerodynamic characteristics of wing-body configuration with two advanced general aviation airfoil sections and simple flap systems

    Morgan, H. L., Jr.; Paulson, J. W., Jr.

    1977-01-01

    Aerodynamic characteristics of a general aviation wing equipped with NACA 65 sub 2-415, NASA GA(W)-1, and NASA GA(PC)-1 airfoil sections were examined. The NASA GA(W)-1 wing was equipped with plain, split, and slotted partial- and full-span flaps and ailerons. The NASA GA(PC)-1 wing was equipped with plain, partial- and full-span flaps. Experimental chordwise static-pressure distribution and wake drag measurements were obtained for the NASA GA(PC)-1 wing at the 22.5-percent spanwise station. Comparisons were made between the three wing configurations to evaluate the wing performance, stall, and maximum lift capabilities. The results of this investigation indicated that the NASA GA(W)-1 wing had a higher maximum lift capability and almost equivalent drag values compared with both the NACA 65 sub 2-415 and NASA GA(PC)-1 wings. The NASA GA(W)-1 had a maximum lift coefficient of 1.32 with 0 deg flap deflection, and 1.78 with 41.6 deg deflection of the partial-span slotted flap. The effectiveness of the NASA GA(W)-1 plain and slotted ailerons with differential deflections were equivalent. The NASA GA(PC)-1 wing with full-span flaps deflected 0 deg for the design climb configuration showed improved lift and drag performance over the cruise flap setting of -10 deg.

  14. Are French general practitioners consulted before travel to developing countries? A cross-sectional study conducted in a French airport.

    Rovira, C; Buffel du Vaure, C; Partouche, H

    2015-08-01

    General practitioners (GPs) could play a central role in preventing travel-related health issues. The aim of this study was to assess, in travellers departing to developing countries from a French airport, the proportion of individuals having sought GP counseling before departure and to identify determinants for having consulted a GP. Cross-sectional study conducted between November 2012 and July 2013, in all adults living in France. Sociodemographic, health characteristics, type of travel and resources consulted before departure were collected. A descriptive analysis was performed. Determinants for having consulted a GP before departure were investigated using a logistic regression analysis. Of the 360 travellers included, 230 (64%) sought health counseling before departure. GPs were the main source of information for 134 (58%) travellers having sought health information and the only one for 49 (21%). Almost half of the travellers (48%) departing to sub-Saharan countries did not seek health counseling from a medical doctor (GP, non-GP specialist, specialist consulted in an international vaccination center or occupational physician). Individuals significantly more likely to travel without having consulted a GP were young and male, held foreign nationality, had travelled more than five times before, rarely consulted their GP and were travelling to a non-malarious area. GPs were the main but not the only source of information and counseling before traveling to a developing country. This study helps identify the characteristics of individuals likely to travel without having consulted a GP before departure. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  15. Knowledge, Attitude and Practice of General Practitioners toward Complementary and Alternative Medicine: a Cross-Sectional Study.

    Barikani, Ameneh; Beheshti, Akram; Javadi, Maryam; Yasi, Marzieh

    2015-08-01

    Orientation of public and physicians to the complementary and alternative medicine (CAM) is one of the most prominent symbols of structural changes in the health service system. The aim of his study was a determination of knowledge, attitude, and practice of general practitioners in complementary and alternative medicine. This cross- sectional study was conducted in Qazvin, Iran in 2013. A self-administered questionnaire was used for collecting data including four information parts: population information, physicians' attitude and knowledge, methods of getting information and their function. A total of 228 physicians in Qazvin comprised the population of study according to the deputy of treatment's report of Qazvin University of Medical Sciences. A total of 150 physicians were selected randomly, and SPSS Statistical program was used to enter questionnaires' data. Results were analyzed as descriptive statistics and statistical analysis. Sixty percent of all responders were male. About sixty (59.4) percent of participating practitioners had worked less than 10 years.96.4 percent had a positive attitude towards complementary and alternative medicine. Knowledge of practitioners about traditional medicine in 11 percent was good, 36.3% and 52.7% had average and little information, respectively. 17.9% of practitioners offered their patients complementary and alternative medicine for treatment. Although there was little knowledge among practitioners about traditional medicine and complementary approaches, a significant percentage of them had attitude higher than the lower limit.

  16. Prevalence of hepatitis B virus in patients with diabetes mellitus: a comparative cross sectional study at Woldiya General Hospital, Ethiopia.

    Mekonnen, Daniel; Gebre-Selassie, Solomon; Fantaw, Surafel; Hunegnaw, Andualem; Mihret, Adane

    2014-01-01

    The overall prevalence of HBV in Ethiopia varies from 4.7-16.8% for Hepatitis B surface antigen (HBsAg) and 70-76.38% for at least one marker positive. Patients suffering from type I Diabetes Mellitus (DM) incur high risk of infection with hepatotropic viruses because of frequent hospitalization and blood tests. A comparative cross sectional study was conducted at Woldiya General Hospital using 108 consented study populations from Diabetes and 108 non diabetes control groups during the period November 2010 - January 2011. VISITECT HBsAg rapid test kit and Humastat 80 chemistry analyzer were used. Multivariate logistic regression was used to see the association of HBV with clinical history of participants and Sociodemographic variables. All tests were two-sided with α-level of 0.05 and 80% power. Prevalence of HBsAg was equal between diabetic and non diabetic individuals, 3.7% indicating that there was no difference between the two groups. Only history of invasive procedures and chronic liver disease showed association with HBsAg seropositivity. In this study a positive relation was not indicated between HBV and Diabetes and the prevalence of HBsAg was equal between diabetic and non diabetic individuals.

  17. 28 CFR 68.55 - Referral of cases arising under sections 274A or 274C to the Attorney General for review.

    2010-07-01

    ...) Review by the Attorney General. When a final order of an Administrative Law Judge or the Chief... 274A or 274C to the Attorney General for review. 68.55 Section 68.55 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) RULES OF PRACTICE AND PROCEDURE FOR ADMINISTRATIVE HEARINGS BEFORE...

  18. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments.

    Parikh, Sagar V; Quilty, Lena C; Ravitz, Paula; Rosenbluth, Michael; Pavlova, Barbara; Grigoriadis, Sophie; Velyvis, Vytas; Kennedy, Sidney H; Lam, Raymond W; MacQueen, Glenda M; Milev, Roumen V; Ravindran, Arun V; Uher, Rudolf

    2016-09-01

    The Canadian Network for Mood and Anxiety Treatments (CANMAT) has revised its 2009 guidelines for the management of major depressive disorder (MDD) in adults by updating the evidence and recommendations. The target audiences for these 2016 guidelines are psychiatrists and other mental health professionals. Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Psychological Treatments" is the second of six sections of the 2016 guidelines. Evidence-informed responses were developed for 25 questions under 5 broad categories: 1) patient characteristics relevant to using psychological interventions; 2) therapist and health system characteristics associated with optimizing outcomes; 3) descriptions of major psychotherapies and their efficacy; 4) additional psychological interventions, such as peer interventions and computer- and technology-delivered interventions; and 5) combining and/or sequencing psychological and pharmacological interventions. First-line psychological treatment recommendations for acute MDD include cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and behavioural activation (BA). Second-line recommendations include computer-based and telephone-delivered psychotherapy. Where feasible, combining psychological treatment (CBT or IPT) with antidepressant treatment is recommended because combined treatment is superior to either treatment alone. First-line psychological treatments for maintenance include CBT and mindfulness-based cognitive therapy (MBCT). Patient preference, in combination with evidence-based treatments and clinician/system capacity, will yield the optimal treatment strategies for improving individual outcomes in MDD. © The Author(s) 2016.

  19. General practitioners versus other physicians in the quality of primary care: a cross-sectional study in Guangdong Province, China.

    Zou, Yaming; Zhang, Xiao; Hao, Yuantao; Shi, Leiyu; Hu, Ruwei

    2015-10-09

    The primary care in China can be provided by general practitioners (GPs) and other physicians (non-GPs). However, China's general practice system has never been really established. Chinese patients tend to consider the quality of primary care provided by GPs much lower than that of non-GPs. Besides, many GPs presently prefer leaving their own positions and seeking better development in big hospitals, which has made the already weak GP system weaker. Yet, few studies have specially compared the quality of primary care provided by Chinese GPs and other physicians and no studies have explored the independent predictors of Chinese GPs' intentions to stay on their current job. In this study, we aimed to compare the quality of primary care offered by GPs with non-GPs and to explore the independent predictors of GPs' future work intentions. This cross-sectional study applied multi-stage random cluster sampling methodology. The data were collected from November 2013 to September 2014 in Guangdong Province. In total, 401 effective questionnaires were selected from the physicians. Quality of primary care was assessed using the Primary Care Assessment Tool (PCAT) Provider Part, representing six primary care domains: ongoing care, coordination (i.e., referrals and information systems), comprehensiveness (i.e., service available and service provided), family-centeredness, community orientation and cultural competence. Of 401 participating physicians, 163 (40.6 %) were GPs. The total PCAT score was 26.32 ± 2.24 which was the sum score of the six domains and represent the quality of primary care. GPs achieved significantly different total scores and scores on three individual scales: comprehensiveness: service available, comprehensiveness: service provided and community orientation. Multiple linear regressions revealed GPs had a higher total score and scores for comprehensiveness: service provided and community orientation after adjusting for sociodemographic characteristics

  20. Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study.

    Luma, Henry Namme; Eloumou, Servais Albert Fiacre Bagnaka; Mboligong, Franklin Ngu; Temfack, Elvis; Donfack, Olivier-Tresor; Doualla, Marie-Solange

    2017-07-03

    Malnutrition is common in acutely ill patients occurring in 30-50% of hospitalized patients. Awareness and screening for malnutrition is lacking in most health institutions in sub-Saharan Africa. This study aimed at screening for malnutrition using anthropometric and laboratory indices in patients admitted to the internal medicine wards. A cross-sectional study. We screened for malnutrition in 251 consecutive patients admitted from January to March 2013 in the internal medicine wards. Malnutrition defined as body mass index (BMI) less than 18.5 kg/m 2 and/or mid upper arm circumference (MUAC) less than 22 cm in women and 23 cm in men. Weight loss greater than 10% in the last 6 months prior to admission, relevant laboratory data, diagnosis at discharge and length of hospital stay (LOS) were also recorded. Mean age was 47 (SD 16) years. 52.6% were male. Mean BMI was 24.44 (SD 5.79) kg/m 2 and MUAC was 27.8 (SD 5.0) cm. Median LOS was 7 (IQR 5-12) days. 42.4% of patients reported weight loss greater than 10% in the 6 months before hospitalization. MUAC and BMI correlated significantly (r = 0.78; p malnutrition by the two methods showed moderate agreement (κ = 0.56; p malnutrition was 19.34% (35/251). Blood albumin and hemoglobin were significantly lower in malnourished patients. Malnourished patients had a significantly longer LOS (p = 0.019) when compared to those with no malnutrition. Malnutrition was most common amongst patients with malignancy. Malnutrition is common in patients admitted to the medical wards of the Douala General Hospital. Nutritional screening and assessment should be integrated in the care package of all admitted patients.

  1. General Practitioners' Attitudes towards Essential Competencies in End-of-Life Care: A Cross-Sectional Survey.

    Giezendanner, Stéphanie; Jung, Corinna; Banderet, Hans-Ruedi; Otte, Ina Carola; Gudat, Heike; Haller, Dagmar M; Elger, Bernice S; Zemp, Elisabeth; Bally, Klaus

    2017-01-01

    Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain. To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist. Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014. Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models. The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training. GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in

  2. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia – case report

    Márcio Luiz Benevides

    2016-07-01

    Full Text Available Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day. Resumo: Justificativa e objetivos: O aumento na prevalência da obesidade na população geral se estende para mulheres na idade reprodutiva. O objetivo deste estudo é relatar o controle perioperatório de uma gestante obesa mórbida com índice de massa corporal >50 Kg/m2, submetida a parto cesariano sob anestesia geral. Relato do caso: Gestante de 35 anos com índice de massa corporal

  3. Knowledge and practices of general practitioners at district hospitals towards cervical cancer prevention in Burundi, 2015: a cross-sectional study.

    Ndizeye, Zacharie; Vanden Broeck, Davy; Vermandere, Heleen; Bogers, John Paul; Van Geertruyden, Jean-Pierre

    2018-01-16

    Well-organized screening and treatment programmes are effective to prevent Invasive Cervical Cancer (ICC) in LMICs. To achieve this, the World Health Organization (WHO) recommends the involvement of existing health personnel in casu doctors, nurses, midwives in ICC prevention. A necessary precondition is that health personnel have appropriate knowledge about ICC. Therefore, to inform policy makers and training institutions in Burundi, we documented the knowledge and practices of general practitioners (GPs) at district hospital level towards ICC control. A descriptive cross-sectional survey was conducted from February to April, 2015 among all GPs working in government district hospitals. A structured questionnaire and a scoring system were used to assess knowledge and practices of GPs. The participation rate was 58.2%. Majority of GPs (76.3%) had appropriate knowledge (score > 70%) on cervical cancer disease; but some risk factors were less well known as smoking and the 2 most important oncogenic HPV. Only 8.4% of the participants had appropriate knowledge on ICC prevention: 55% of the participants were aware that HPV vaccination exists and 48.1% knew cryotherapy as a treatment method for CIN. Further, 15.3% was aware of VIA as a screening method. The majority of the participants (87%) never or rarely propose screening tests to their clients. Only 2 participants (1.5%) have already performed VIA/VILI. Wrong thoughts were also reported: 39.7% thought that CIN could be treated with radiotherapy; 3.1% thought that X-ray is a screening method. In this comprehensive assessment, we observed that Burundian GPs have a very low knowledge level about ICC prevention, screening and treatment. Suboptimal practices and wrong thoughts related to ICC screening and treatments have also been documented. We therefore recommend an adequate pre- and in-service training of GPs and most probably nurses on ICC control before setting up any public health intervention on ICC control.

  4. Prevalence and determinants of unintended pregnancy among pregnant woman attending ANC at Gelemso General Hospital, Oromiya Region, East Ethiopia: a facility based cross-sectional study.

    Mohammed, Faiza; Musa, Abdulbasit; Amano, Abdella

    2016-08-17

    Unintended pregnancy is among the major public health problems that predispose women to maternal death and illness mainly through unsafe abortion and poor maternity care. The level of unintended pregnancy is high in developing countries. Hence, the purpose of this study is to assess the prevalence of unintended pregnancy and the associated factors among pregnant woman attending antenatal care at Gelemso General Hospital, East Ethiopia. A facility-based cross-sectional study was conducted from January 10 to April 13, 2015 among women who had attended antenatal care at Gelemso General Hospital. A systematic random sampling technique was used to select a sample of 413 participants. Data were collected via face-to-face interview using a structured and pre-tested questionnaire. Bivariate and multivariate analyses were made to check the associations among the variables and to control the confounding factors. Out of the 413 pregnancies, 112 (27.1 %) were unintended of which 90(21.9 %) were mistimed, and 22(5.2 %) were unwanted. Multivariate analysis revealed that single, divorced/widowed marital statuses, having more than 2 children, and having no awareness of contraception were significantly associated with unintended pregnancy. Over a quarter of women had an unintended pregnancy, a rate which is lower than previously reported. Designing and implementing strategies that address contraceptive needs of unmarried, divorced and widowed women, creating awareness of contraceptives at community level and reinforcing postnatal contraceptive counseling to all mothers giving birth at health institution is recommended to reduce the rate of the unintended pregnancy among parous women.

  5. General practitioners' attitudes and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP adoption in the West of Ireland: a cross sectional study

    O'Brien Timothy

    2010-01-01

    Full Text Available Abstract Background Electronic clinical decision support (CDS is increasingly establishing its role in evidence-based clinical practice. Considerable evidence supports its enhancement of efficiency in e-Prescribing, but some controversy remains. This study evaluated the practicality and identified the perceived benefits of, and barriers to, its future adoption in the West of Ireland. Methods This cross sectional study was carried out by means of a 27-part questionnaire sent to 262 registered general practitioners in Counties Galway, Mayo and Roscommon. The survey domains encompassed general information of individual's practice, current use of CDS and the practitioner's attitudes towards adoption of CDS-eP. Descriptive and inferential analyses were performed to analyse the data collected. Results The overall response rate was 37%. Nearly 92% of respondents employed electronic medical records in their practice. The majority acknowledged the value of electronic CDS in improving prescribing quality (71% and reducing prescribing errors (84%. Despite a high degree of unfamiliarity (73%, the practitioners were open to the use of CDS-eP (94% and willing to invest greater resources for its implementation (62%. Lack of a strategic implementation plan (78% is the main perceived barrier to the incorporation of CDS-eP into clinical practice, followed by i lack of financial incentives (70%, ii lack of standardized product software (61%, iii high sensitivity of drug-drug interaction or medication allergy markers (46%, iv concern about overriding physicians' prescribing decisions(44% and v lack of convincing evidence on the systems' effectiveness (22%. Conclusions Despite favourable attitudes towards the adoption of CDS-eP, multiple perceived barriers impede its incorporation into clinical practice. These merit further exploration, taking into consideration the structure of the Irish primary health care system, before CDS-eP can be recommended for routine

  6. Relative frequency of human papillomavirus genotypes and related sociodemographic characteristics in women referred to a general hospital in Tehran, 2014- 2015: A cross-sectional study

    Mahin Jamshidi Makiani

    2017-09-01

    Full Text Available Background: Human papilloma virus (HPV is one of the major public health problems and the main causes of cervical cancer. The prevalence HPV infection in developing countries with low financial resources is high. Objective: This study aimed to determine the relative frequency of HPV genotypes and its sociodemographic characteristics in women referred to a general hospital in Tehran, Iran from 2014-2015. Materials and Methods: This cross-sectional study was performed in 400 women with Pap smear samples, referring to to a general hospital in Tehran, Iran from 2014- 2015. The detection of 28 HPV genotypes was performed by using the Multiplex PCR technique. The sociodemographic survey was conducted for each HPV positive woman. Results: HPV-positive infection was detected in 155 (38.75% women aged 17-85 years. HPV 16 (19.1% was the most prevalent type, followed by HPV 39 (12.5% and HPV 18 (8.9%. The highest rate of HPV infection was observed at the age of 36 years (7.7%. The level of education and economic situation of each woman were showed most of HPV-positive women had a high school diploma (34.6% and average economic situation (67,9%. 60.9% of these women were a housewife, and 67.3% lived in the capital . Conclusion: Determination of HPV genotype and risk factor related to HPV infection in each geographical region can lead to the production of effective vaccines against the HPV virus. It can also be useful for disease management and high sensitivity diagnosis of cervical intraepithelial neoplasia

  7. Preventable Admissions on a General Medicine Service: Prevalence, Causes and Comparison with AHRQ Prevention Quality Indicators-A Cross-Sectional Analysis.

    Patel, Krishna K; Vakharia, Nirav; Pile, James; Howell, Erik H; Rothberg, Michael B

    2016-06-01

    Rates of preventable admissions will soon be publicly reported and used in calculating performance-based payments. The current method of assessing preventable admissions, the Agency of Healthcare Research and Quality (AHRQ) Preventable Quality Indicators (PQI) rate, is drawn from claims data and was originally designed to assess population-level access to care. To identify the prevalence and causes of preventable admissions by attending physician review and to compare its performance with the PQI tool in identifying preventable admissions. Cross-sectional survey. General medicine service at an academic medical center. Consecutive inpatient admissions from December 1-15, 2013. Survey of inpatient attending physicians regarding the preventability of the admissions, primary contributing factors and feasibility of prevention. For the same patients, the PQI tool was applied to determine the claims-derived preventable admission rate. Physicians rated all 322 admissions and classified 122 (38 %) as preventable, of which 31 (25 %) were readmissions. Readmissions were more likely to be rated preventable than other admissions (49 % vs. 35 %, p = 0.04). Application of the AHRQ PQI methodology identified 75 (23 %) preventable admissions. Thirty-one admissions (10 %) were classified as preventable by both methods, and the majority of admissions considered preventable by the AHRQ PQI method (44/78) were not considered preventable by physician assessment (K = 0.04). Of the preventable admissions, physicians assigned patient factors in 54 (44 %), clinician factors in 36 (30 %) and system factors in 32 (26 %). A large proportion of admissions to a general medicine service appeared preventable, but AHRQ's PQI tool was unable to identify these admissions. Before initiation of the PQI rate for use in pay-for-performance programs, further study is warranted.

  8. Reducing symptoms of major depressive disorder through a systematic training of general emotion regulation skills: protocol of a randomized controlled trial.

    Ehret, Anna M; Kowalsky, Judith; Rief, Winfried; Hiller, Wolfgang; Berking, Matthias

    2014-01-27

    Major Depressive Disorder is one of the most challenging mental health problems of our time. Although effective psychotherapeutic treatments are available, many patients fail to demonstrate clinically significant improvements. Difficulties in emotion regulation have been identified as putative risk and maintaining factors for Major Depressive Disorder. Systematically enhancing adaptive emotion regulation skills should thus help reduce depressive symptom severity. However, at this point, no study has systematically evaluated effects of increasing adaptive emotion regulation skills application on symptoms of Major Depressive Disorder. In the intended study, we aim to evaluate stand-alone effects of a group-based training explicitly and exclusively targeting general emotion regulation skills on depressive symptom severity and assess whether this training augments the outcome of subsequent individual cognitive behavioral therapy for depression. In the evaluation of the Affect Regulation Training, we will conduct a prospective randomized-controlled trial. Effects of the Affect Regulation Training on depressive symptom severity and outcomes of subsequent individual therapy for depression will be compared with an active, common factor based treatment and a waitlist control condition. The study sample will include 120 outpatients meeting criteria for Major Depressive Disorder. Depressive symptom severity as assessed by the Hamilton Rating Scale will serve as our primary study outcome. Secondary outcomes will include further indicators of mental health and changes in adaptive emotion regulation skills application. All outcomes will be assessed at intake and at 10 points in time over the course of the 15-month study period. Measures will include self-reports, observer ratings, momentary ecological assessments, and will be complemented in subsamples by experimental investigations and the analysis of hair steroids. If findings should support the hypothesis that enhancing

  9. Conodont succession and reassessment of major events around the Permian-Triassic boundary at the Selong Xishan section, southern Tibet, China

    Yuan, Dong-Xun; Zhang, Yi-Chun; Shen, Shu-Zhong

    2018-02-01

    A major discrepancy for the age of the Selong Group from middle Cisuralian (Early Permian) to Changhsingian resulted from previous reports of Sakmarian, Kungurian and Guadalupian (Middle Permian) conodonts and Lopingian (Late Permian) brachiopods. Recently, Cisuralian and Guadalupian conodonts were reported again from the Selong Group and the basal part of the Kangshare Formation at the Selong section, but the age discrepancy remains. We present our conodont materials based on large samples collected from the Selong Group and our interpretation based on identifications using a sample population approach. Three conodont zones are recognized in our re-investigation of the upper part of the Selong Group. They include the Vjalovognathus sp., the Mesogondolella hendersoni, and the M. sheni zones, in ascending order. These zones are overlain by the basal Triassic Hindeodus parvus Zone and the Otoceras woodwardi Zone. Our reassessment of conodonts reported by previous studies from Selong and nearby sections suggest that all specimens consistently point to a Lopingian age; the upper part of the Selong Group is latest Changhsingian in age based on the presence of Clarkina orchardi and Mesogondolella sheni. Previously reported early Cisuralian and Guadalupian conodonts are misidentified using a form species concept. A hiatus may be present at the erosional surface between the Selong Group and the Waagenites Bed of the basal part of the Kangshare Formation. However, the hiatus is minimal because conodont and brachiopod assemblages above and below this surface are very similar, and it results from a latest Changhsingian transgression just before the extinction that follows a global latest Changhsingian regression. There is a distinct rapid end-Permian mass extinction at Selong within the Waagenites Bed, as indicated by the disappearances of all benthic brachiopods, rugose corals and Permian bryozoans. The burst of Clarkina species in the Waagenites Bed and throughout the

  10. Plasma fluoxetine concentrations and clinical improvement in an adolescent sample diagnosed with major depressive disorder, obsessive-compulsive disorder, or generalized anxiety disorder.

    Blázquez, Ana; Mas, Sergi; Plana, Maria Teresa; Gassó, Patricia; Méndez, Iria; Torra, Mercè; Arnaiz, Joan Albert; Lafuente, Amàlia; Lázaro, Luisa

    2014-06-01

    Fluoxetine (FLX) has been one of the most widely studied selective serotonin reuptake inhibitors in adolescents. Despite its efficacy, however, 30% to 40% of patients do not respond to treatment. The aim of this study was to evaluate whether clinical improvement or adverse events are related to the corrected dose of FLX at 8 and 12 weeks after starting treatment in a sample of adolescents diagnosed with major depressive disorder, obsessive-compulsive disorder, or generalized anxiety disorder. Seventy-four subjects aged between 10 and 17 years participated in the study. Clinical improvement was measured with the Clinical Global Impression-Improvement Scale, whereas the UKU (Udvalg for Klinske Undersogelser) scale was administered to assess adverse effects of treatment. Fluoxetine per kilograms of body weight was related to serum concentration of FLX, NORFLX (norfluoxetine), FLX + NORFLX, and FLX/NORFLX. No relationship was found between dose-corrected FLX levels and therapeutic or adverse effects. No differences in serum concentrations were found between responders and nonresponders to treatment. Sex differences were observed in relation to dose and FLX serum concentration. The analysis by diagnosis revealed differences in FLX dose between obsessive-compulsive disorder patients and both generalized anxiety disorder and major depressive disorder patients. Fluoxetine response seems to be influenced by factors such as sex, diagnosis, or certain genes that might be involved in the drug's pharmacokinetics and pharmacodynamics. Clinical and pharmacogenetic studies are needed to elucidate further the differences between treatment responders and nonresponders.

  11. The impact of sitting time and physical activity on major depressive disorder in South Korean adults: a cross-sectional study.

    Nam, Jin Young; Kim, Juyeong; Cho, Kyoung Hee; Choi, Jaewoo; Shin, Jaeyong; Park, Eun-Cheol

    2017-07-28

    Previous studies have examined associations between sitting time and negative health outcomes and mental health. However, the relationship between overall sitting time and major depressive disorder (MDD) in South Korea has not been studied. This study examined the association between MDD and overall sitting time and physical activity in South Koreans. Data from the sixth Korean National Health and Nutrition Examination Survey (KNHANES), a cross-sectional, nationally representative survey, were analyzed. Total participants were 4145 in 2014. MDD was assessed using the Patient Health Questionnaire (PHQ-9). Participants' data regarding self-reported sitting time and physical activity were analyzed via multiple logistic regression. Results showed that people who sat for 8-10 h (OR: 1.56, 95% CI: 1.15-2.11) or more than 10 h (OR: 1.71, 95% CI: 1.23-2.39) had increased risk of MDD compared to those who sat for less than 5 h a day. Subgroup analysis showed that the strongest effect of reported sitting time on risk of MDD was found in men with lower levels of physical activity who sat for 8 to 10 h (OR: 3.04, 95% CI: 1.15-8.01) or more than 10 h (OR: 3.43, 95% CI: 1.26-9.35). Level of physical activity was not an independent predictor for MDD. Sitting for long periods was associated with greater risk of MDD in South Korean adults. Reducing sitting time in people with MDD could help to prevent associated physical health problems and may improve mental health.

  12. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 1. Disease Burden and Principles of Care.

    Lam, Raymond W; McIntosh, Diane; Wang, JianLi; Enns, Murray W; Kolivakis, Theo; Michalak, Erin E; Sareen, Jitender; Song, Wei-Yi; Kennedy, Sidney H; MacQueen, Glenda M; Milev, Roumen V; Parikh, Sagar V; Ravindran, Arun V

    2016-09-01

    The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section is the first of six guidelines articles. In Canada, the annual and lifetime prevalence of MDD was 4.7% and 11.3%, respectively. MDD represents the second leading cause of global disability, with high occupational and economic impact mainly attributable to indirect costs. DSM-5 criteria for depressive disorders remain relatively unchanged, but other clinical dimensions (sleep, cognition, physical symptoms) may have implications for depression management. e-Mental health is increasingly used to support clinical and self-management of MDD. In the 2-phase (acute and maintenance) treatment model, specific goals address symptom remission, functional recovery, improved quality of life, and prevention of recurrence. The burden attributed to MDD remains high, whether from individual distress, functional and relationship impairment, reduced quality of life, or societal economic cost. Applying core principles of care, including comprehensive assessment, therapeutic alliance, support of self-management, evidence-informed treatment, and measurement-based care, will optimize clinical, quality of life, and functional outcomes in MDD. © The Author(s) 2016.

  13. Comparison of the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in emergency departments of general hospitals in China.

    Wei, Shengnan; Li, Haiyan; Hou, Jinglin; Chen, Wei; Chen, Xu; Qin, Xiaoxia

    2017-01-01

    Major depressive disorder (MDD) is a known major risk factor for suicide due to the high suicide mortality. However, studies comparing the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in China are very limited. This study examined and compared the sociodemographic and psychological characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in emergency departments of general hospitals to better understand the risk factors for suicide attempts in China. All subjects were enrolled in the study between June 2007 and January 2008. A total of 127 suicide attempters-54 with MDD and 73 with no psychiatric diagnosis-were enrolled. The sociodemographic and clinical characteristics were compared between two groups using the statistical analysis performed using frequency distribution, Student's t test, Chi-square test, and Fisher's exact test and a logistic regression model. Suicide attempters with MDD were more likely to be more depressive, older, divorced or separated, unemployed, and living alone, and more likely to write a suicide note, have suicide ideation, and be motivated by reducing pain and burden. Suicide attempters with no psychiatric diagnosis were more likely to be younger and more impulsive, have self-rescue, and be motivated by threatening or taking revenge on others. Multivariate logistic regression analysis identified the following independent predictors of suicide attempts in individuals with MDD: a lower score on the quality of life scale, more years of education, and suicide ideation. The present study found both similarities and differences in the sociodemographic and clinical characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in the emergency departments of general hospitals in China. These findings will help us to recognize the characteristics of suicide attempters in both groups and develop specific interventions for the two

  14. 26 CFR 1.367(a)-1T - Transfers to foreign corporations subject to section 367(a): In general (temporary).

    2010-04-01

    ... share of partnership property shall be determined under the rules and principles of sections 701 through... shall be determined under the rules and principles of sections 701 through 761 and the regulations... in manufacturing activities or in marketing activities. A working interest in oil and gas properties...

  15. Occipito-atlanto-axial osteoarthritis: a cross sectional clinico-radiological prevalence study in high risk and general population.

    Badve, Siddharth A; Bhojraj, Shekhar; Nene, Abhay; Raut, Abhijit; Ramakanthan, Ravi

    2010-02-15

    A cross-sectional clinico-radiologic evaluation of occipito-atlantoaxial (OC1C2) region of 2 population groups. Determine the prevalence of OC1C2 osteoarthritis in porters involved in carrying loads on the head and general male population. Describe its clinico-radiologic manifestations. In addition to age, head loading is a known cause of degeneration affecting the occipito-cervical region. The impact of head loading in the population aged between third and sixth decade is unknown. Head loading is a common custom in the developing countries. Study group (n = 107) included randomly selected male porters from railway stations who underwent computed tomography (CT) study of the OC1C2 region, plain radiographs of the cervical spine and detailed clinical examination. Control group (n = 107) included randomly selected male patients undergoing CT scan study for diseases of paranasal sinuses with coincidental screening of OC1C2 region along with clinical assessment. The data were analyzed using SPSS 15 software. Mean age for study group was 32.6 years and controls was 34.6 years (P = 0.156). In the study group, duration of occupational exposure was 10.9 (+/-8.7) years; 81.3% porters being symptomatic with an age of 33.4 (+/-9.6) years. Radiologic prevalence of OC1C2 osteoarthritis in study group was 91.6% and in control group was 6.8%; age of affected individuals was 33.4 (+/-9.3) and 47.9 (+/-8.0) years, respectively. Most common complaint was suboccipital neck pain (69.7%); while the CT finding was decreased joint space with sclerosis and irregularity of the margins (81.3%). No statistically significant association was found between presence of radiologic changes and symptoms. Age, duration of occupational exposure and its relationship with various clinico-radiologic manifestations was studied. This condition has significant prevalence in porters, beginning at an early age. Diagnosis is based on the clinico-radiologic presentation. CT is the investigation of choice

  16. The contribution of demographic and morbidity factors to self-reported visit frequency of patients: a cross-sectional study of general practice patients in Australia

    Britt Helena

    2004-08-01

    Full Text Available Abstract Background Understanding the factors that affect patients' utilisation of health services is important for health service provision and effective patient management. This study aimed to investigate the specific morbidity and demographic factors related to the frequency with which general practice patients visit a general practitioner/family physician (GP in Australia. Methods A sub-study was undertaken as part of an ongoing national study of general practice activity in Australia. A cluster sample of 10,755 general practice patients were surveyed through a random sample of 379 general practitioners. The patient reported the number of times he/she had visited a general practitioner in the previous twelve months. The GP recorded all the patient's major health problems, including those managed at the current consultation. Results Patients reported an average of 8.8 visits to a general practitioner per year. After adjusting for other patient demographics and number of health problems, concession health care card holders made on average 2.6 more visits per year to a general practitioner than did non-card holders (p Conclusions Anxiety, back pain and depression are associated with greater patient demand for general practice services than other health problems. The effect of sociodemographic factors on patient utilisation of general practice services is complex. Equity of access to general practice services remains an issue for patients from remote areas, while concession health care card holders are attending general practice more frequently than other patients relative to their number of health problems.

  17. Burden and Determinants of Smoking among Prisoners with Respiratory Tract Infection: A Cross-Sectional Study of Nine Major Prison Setups in Northern Ethiopia.

    Abera, Semaw Ferede; Adane, Kelemework

    2016-01-01

    Morbidity, mortality and a wide range of associated risk factors are disproportionately clustered among prisoners compared to the general population. Smoking is one of the risk factors for the increased burden of unfavorable health outcomes particularly among prisoners. However, little is known about the level and determinants of smoking among the incarcerated population in Ethiopia. We collected data from 738 prisoners in nine major prison setups in Tigray region by nurses and clinical officers. Data were entered in to Epi Data 3.1 and exported to stata 13.0 for cleaning and further analysis. Multivariable logistic regression model was fitted to identify determinants of smoking at p value of less than 5%. The prevalence of smoking was 21 per cent (95%CI = 18.2%, 24.1). Urban residence (AOR = 2.15; 95%CI = 1.20, 3.84), previous history of incarceration (AOR = 1.91; 95%CI = 1.08, 3.40) and alcohol use before incarcerated (AOR = 4.20; 95%CI = 2.57, 6.87) were significantly associated with risk of smoking. In contrast, risk of smoking was significantly lower for farmers (AOR = 0.20; 95% CI = 0.08, 0.49), prisoners with family support (AOR = 0.52; 95% CI = 0.32, 0.87) and for those who were jailed in Shire prison site (AOR = 0.43; 95%CI = 0.20, 0.95). Our work clearly indicates that the observed smoking prevalence calls for the need of comprehensive and interdisciplinary interventions targeting prisoners.

  18. Burden and Determinants of Smoking among Prisoners with Respiratory Tract Infection: A Cross-Sectional Study of Nine Major Prison Setups in Northern Ethiopia.

    Semaw Ferede Abera

    Full Text Available Morbidity, mortality and a wide range of associated risk factors are disproportionately clustered among prisoners compared to the general population. Smoking is one of the risk factors for the increased burden of unfavorable health outcomes particularly among prisoners. However, little is known about the level and determinants of smoking among the incarcerated population in Ethiopia.We collected data from 738 prisoners in nine major prison setups in Tigray region by nurses and clinical officers. Data were entered in to Epi Data 3.1 and exported to stata 13.0 for cleaning and further analysis. Multivariable logistic regression model was fitted to identify determinants of smoking at p value of less than 5%.The prevalence of smoking was 21 per cent (95%CI = 18.2%, 24.1. Urban residence (AOR = 2.15; 95%CI = 1.20, 3.84, previous history of incarceration (AOR = 1.91; 95%CI = 1.08, 3.40 and alcohol use before incarcerated (AOR = 4.20; 95%CI = 2.57, 6.87 were significantly associated with risk of smoking. In contrast, risk of smoking was significantly lower for farmers (AOR = 0.20; 95% CI = 0.08, 0.49, prisoners with family support (AOR = 0.52; 95% CI = 0.32, 0.87 and for those who were jailed in Shire prison site (AOR = 0.43; 95%CI = 0.20, 0.95.Our work clearly indicates that the observed smoking prevalence calls for the need of comprehensive and interdisciplinary interventions targeting prisoners.

  19. Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey

    Warren, Fiona C; Abel, Gary; Lyratzopoulos, Georgios; Elliott, Marc N; Richards, Suzanne; Barry, Heather E; Roland, Martin; Campbell, John L

    2015-01-01

    Objective: To investigate the experience of users of out of hours general practitioner services in England, UK. Design: Population based cross sectional postal questionnaire survey. Setting: General Practice Patient Survey 2012-13. Main outcome measures: Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial)...

  20. Prevalence of fragrance contact allergy in the general population of five European countries : A cross-sectional study

    Diepgen, T. L.; Ofenloch, R.; Bruze, M.; Cazzaniga, S.; Coenraads, P. J.; Elsner, P.; Goncalo, M.; Svensson, A.; Naldi, L.

    2015-01-01

    Background Contact allergy to fragrances is assessed mostly in clinical populations of patients. Studies in the general population are scarce and vary in their methodology across countries. Objectives To determine the prevalence of fragrance contact allergy in the European general population and to

  1. End-of-life care in general practice: A cross-sectional, retrospective survey of 'cancer', 'organ failure' and 'old-age/dementia' patients

    Evans, N.C.; Pasman, H.R.W.; Donker, G.A.; Deliens, L.; Block, L.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Background: End-of-life care is often provided in primary care settings. Aim: To describe and compare general-practitioner end-of-life care for Dutch patients who died from 'cancer', 'organ failure' and 'old-age or dementia'. Design: A cross-sectional, retrospective survey was conducted within a

  2. Public School Principals' Experiences with Interpreting and Implementing Connecticut's Anti-Bullying Law (Connecticut General Statute Section 10-222d): A Statewide Survey

    LaRocco, Diana J.; Nestler-Rusack, Donna; Freiberg, Jo Ann

    2007-01-01

    Background: In June 2002, the State of Connecticut General Assembly (CGA) passed Public Act 02-119, An Act Concerning Bullying Behavior in Schools and Concerning the Pledge of Allegiance. Section 1 mandated that each local and regional board of education (school district) develop a policy to address bullying in its schools. Conn. Gen. Statute…

  3. Prevalence and demographic determinants of gastroesophageal reflux disease (GERD) in the Turkish general population: a population-based cross-sectional study.

    Mungan, Zeynel

    2012-08-01

    We aimed to establish the prevalence and demographic determinants of gastroesophageal reflux disease in the Turkish general population using the Turkish version of the gastroesophageal reflux disease questionnaire. A total of 8143 volunteers (mean age: 38.5 (13.3) years; 52.3% males) were included in this cross-sectional questionnaire study conducted via face-to-face administration of the questionnaire forms including items on sociodemographic features, past history of gastric disorders, gastroesophageal reflux disease, the influence of reflux symptoms on patients' lives, physician visits, diagnostic tests, and reflux medications. A past history of gastric symptoms was reported in half of the population. More female participants (p<0.001) had a past history of gastric symptoms that yielded a previous diagnosis of gastroesophageal reflux disease in 19.1% of the population. The likelihood of gastroesophageal reflux disease was low in the majority (75.3%) of the subjects evaluated. Gastroesophageal reflux disease with an inconveniencing or disrupting impact on the patient's life was present in 17.9% and 6.8% of the population. Total gastroesophageal reflux disease-questionnaire scores and reflux prevalence were higher in older age groups (p<0.001). Females were more likely to have gastroesophageal reflux disease prevalence based on reflux symptoms. The impact of gastroesophageal reflux disease on sleep and psychological/emotional well-being was more pronounced in older and female patients, whereas the impact on eating/drinking behaviors and physical-social activities was more marked among females independent of their age (p<0.001). Reflux prevalence was higher in subjects from East Anatolia, Central Anatolia, Mediterranean, and Black Sea regions of Turkey (p<0.001 for each). Prevalence and demographic determinants of gastroesophageal reflux disease are compatible with the profile of the disease in the other Western populations, with a predilection for females and

  4. Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey.

    Hélène Dumesnil

    Full Text Available French general practitioners (GPs refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates.This qualitative study aims to explore general practitioners' (GP opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression.In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content.We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists.Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.

  5. Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey

    Dumesnil, Hélène; Apostolidis, Thémis; Verger, Pierre

    2018-01-01

    Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area. PMID:29385155

  6. Factors influencing career intentions on completion of general practice vocational training in England: a cross-sectional study.

    Dale, Jeremy; Russell, Rachel; Scott, Emma; Owen, Katherine

    2017-08-17

    General practice is experiencing a growing crisis with the numbers of doctors who are training and then entering the profession in the UK failing to keep pace with workforce needs. This study investigated the immediate to medium term career intentions of those who are about to become general practitioners (GPs) and the factors that are influencing career plans. Online questionnaire survey, with quantitative answers analysed using descriptive statistics and free text data analysed using a thematic framework approach. Doctors approaching the end of 3-year GP vocational training in the West Midlands, England. 178 (57.2%) doctors completed the survey. Most participants planned to work as salaried GPs or locums rather than entering a general practice partnership for at least the first 5 years post-completion of training; others failed to express a career plan or planned to leave general practice completely or work overseas. Many were interested in developing portfolio careers.The quality of general practice experience across undergraduate, foundation and vocational training were reported as influencing personal career plans, and in particular perceptions about workload pressure and morale within the training practices in which they had been placed. Experience of a poor work-life balance as a trainee had a negative effect on career intentions, as did negative perceptions about how general practice is portrayed by politicians and the media. This study describes a number of potentially modifiable factors related to training programmes that are detrimentally influencing the career plans of newly trained GPs. In addition, there are sociodemographic factors, such as age, gender and having children, which are also influencing career plans and so need to be accommodated. With ever-increasing workload in general practice, there is an urgent need to understand and where possible address these issues at national and local level. © Article author(s) (or their employer(s) unless

  7. Long-term psychosocial behavioral outcomes in children following anesthesia: A comparison of the effects of general versus regional anesthesia on term infants delivered by elective cesarean section

    Aouni Alameddine

    2013-01-01

    Full Text Available Background: Data on the effects of general anesthesia on the fetal and neonatal brain are limited. Animal studies demonstrated that anesthetic agents leave their consequences in the form of learning and memory deficits. The effects of propofol on the fetal neurodevelopment are not clear yet. Materials and Methods: This is a telephone-based questionnaire survey that addressed the effect of general anesthesia by propofol during cesarean section at term with no perinatal complications on the psychosocial behavior of children at 8-10 years of age compared with children having same characteristics except for delivery under neuraxial anesthesia using the Pediatric Symptom Checklist as a score. Results: A total of 187 children were born at term between January 1, 2002 and December 31, 2004 with no perinatal distress under induction of general anesthesia by propofol. 66 children (35.3% were lost to follow-up and parents of two children (1.1% refused to participate. A total of 189 children were included in the study: 119 were born by cesarean section under general anesthesia and 70 were born by cesarean section under neuraxial block. The incidence of psychosocial behavior impairment at 8-10 years of age was not found to be affected by the mode of anesthesia during delivery by cesarean section nor by neonatal nor parental characteristics. Conclusion: Exposure to propofol as an induction agent for general anesthesia or cesarean section does not seem to increase the psychosocial behavior disorder development risk at 8-10 years of age.

  8. Overweight in patients with chronic obstructive pulmonary disease needs more attention: a cross-sectional study in general practice.

    Verberne, L.D.M.; Leemrijse, C.J.; Swinkels, I.C.S.; Dijk, C.E. van; Bakker, D.H. de; Nielen, M.M.J.

    2017-01-01

    Guidelines for management of chronic obstructive pulmonary disease (COPD) primarily focus on the prevention of weight loss, while overweight and obesity are highly prevalent in patients with milder stages of COPD. This cross-sectional study examines the association of overweight and obesity with the

  9. The impact of major life events on the use of complementary and alternative medicine among individuals with chronic pain: a cross-sectional study.

    Wang, Shu-Ming; Fortier, Michelle A; Cheng, David Y; Perret, Danielle; Hata, Justin; Tan, Edwin T; Kain, Zeev N

    2013-01-01

    Chronic pain affects millions of Americans. Treating chronic pain can be difficult because it is a complex condition influenced by genetic makeup and physiological and psychological factors. The experience of major life events has also been found to affect the psychosocial functioning, health, and health behaviors of patients. Whereas the impact of major life events on the use of traditional medical practices has been explored, only one study to date has examined the relationship between major life events and use of complementary and alternative medicine (CAM). This study examined the impact of major life events on the use of CAM among patients with chronic pain syndromes. Participants were consecutive patients seeking treatment at a pain clinic. The study occurred at a tertiary center for pain management in Southern California. Participants were adult patients experiencing chronic pain for at least 6 mo, seeking treatment at a pain center. Participants completed a measure assessing their use of CAM modalities as well as their receptiveness to using previously unused CAM modalities, and they provided demographic information, including the occurrence of major life events, such as a job loss. A total of 199 adults with chronic pain participated in the study. The majority (91.6%) of chronic pain patients in the study reported using at least one form of CAM, with an average of at least five different forms of CAM. Individuals reported receptiveness to CAM modalities that they had not previously used (P CAM use were greater among those that had experienced a major life event in the prior 6 mo (P chronic pain frequently use CAM therapies, especially those who had recently experienced a major life event. Major life events may motivate patients with chronic pain to seek out different forms of CAM as a way to manage their pain.

  10. German wide cross sectional survey on health impacts of electromagnetic fields in the view of general practitioners

    Kowall, Bernd; Breckenkamp, Jürgen; Heyer, Kristina

    2010-01-01

    OBJECTIVES: The proportion of general practitioners (GPs) in Germany who assume health impacts of electromagnetic fields (EMF) is assessed. Moreover, factors associated with this risk perception are examined. METHODS: A 7% random sample was drawn from online lists of all the GPs working in Germany...

  11. Association of general psychological factors with frequent attendance in primary care: a population-based cross-sectional observational study.

    Hajek, André; Bock, Jens-Oliver; König, Hans-Helmut

    2017-03-24

    Whereas several studies have examined the association between frequent attendance in primary care and illness-specific psychological factors, little is known about the relation between frequent attendance and general psychological factors. Thus, the aim of this study was to investigate the association between being a frequent attender in primary care and general psychological factors. Data were used from a large, population-based sample of community-dwelling individuals aged 40 and above in Germany in 2014 (n = 7,446). Positive and negative affect, life satisfaction, optimism, self-esteem, self-efficacy, and self-regulation were included as general psychological factors. The number of self-reported GP visits in the past twelve months was used to quantify frequency of attendance; individuals with more than 9 visits (highest decile) were defined as frequent attenders. Multiple logistic regressions showed that being a frequent attender was positively associated with less life satisfaction [OR: 0.79 (0.70-0.89)], higher negative affect [OR: 1.38 (1.17-1.62)], less self-efficacy [OR: 0.74 (0.63-0.86)], less self-esteem [OR: 0.65 (0.54-0.79)], less self-regulation [OR: 0.74 (0.60-0.91)], and higher perceived stress [OR: 1.46 (1.28-1.66)], after adjusting for sociodemographic factors, morbidity and lifestyle factors. However, frequent attendance was not significantly associated with positive affect and self-regulation. The present study highlights the association between general psychological factors and frequent attendance. As frequent GP visits produce high health care costs and are potentially associated with increased referrals and use of secondary health care services, this knowledge might help to address these individuals with high needs.

  12. Section 3. General issues in management : Heuristics or experience-based techniques for making accounting judgments and learning

    Schiller, Stefan

    2013-01-01

    The purpose of this paper is to further the development of initial accounting for internally generated intangible assets, relevant to both academics and practitioners, examining what happens when accountants are given principles-based discretion. This paper draws on existing insights into heuristics or experience-based techniques for making accounting judgments. Knowledge about judgment under uncertainty, and the general framework offered by the heuristics and biases program in particular, fo...

  13. Predictors of general self-efficacy and self-esteem in occupational therapy students: A cross-sectional study

    Bonsaksen, Tore

    2015-01-01

    A national survey reported college students showed higher risk of mental health problems than the general population. Using selfefficacy and self-esteem as indicators of mental health, this study explores sociodemographic, relational, educational, and work factors associated with these outcomes. A sample of 148 occupational therapy students in Norway participated, and data were analyzed with multiple linear regression. Factors associated with positive self-efficacy and self-esteem were higher...

  14. Compliance with referrals to medical specialist care: patient and general practice determinants: a cross-sectional study.

    van Dijk, Christel E; de Jong, Judith D; Verheij, Robert A; Jansen, Tessa; Korevaar, Joke C; de Bakker, Dinny H

    2016-02-01

    In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it. Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance. In 86.6% of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply. About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.

  15. Examination of the interrelations between the factors of PTSD, major depression, and generalized anxiety disorder in a heterogeneous trauma-exposed sample using DSM 5 criteria.

    Price, Matthew; van Stolk-Cooke, Katherine

    2015-11-01

    Exposure to traumatic events places individuals at high risk for multiple psychiatric disorders, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). The high rates of comorbidity among these conditions merit evaluation in order to improve diagnosis and treatment approaches. The current study evaluated the association between PTSD, MDD, and GAD factors as presented in the DSM 5. 602 trauma-exposed individuals who experienced an event that met Criterion A for the DSM 5 PTSD diagnosis were recruited through Amazon.com, Inc.'s Mechanical Turk (MTurk) to complete an assessment of the impact of stressful events on their lives. High interrelations were detected among the 4 PTSD factors, 2 MDD factors that corresponded to somatic and affective symptoms, and the single GAD factor. The affective factor of MDD was most strongly related to the emotional numbing factor of PTSD, whereas the somatic factor of MDD was most strongly related to the hyperarousal factor of PTSD. The GAD factor was most strongly related to the hyperarousal factor of PTSD, relative to the other PTSD factors. The strength of the interrelations between factors of the three disorders is largely a function of the overlap in symptoms and calls into question the uniqueness of negative affective symptoms of PTSD, MDD and GAD. Results suggest that improved understanding of the trauma reaction requires a focus on the unique presentation of each individual and assessment of multiple disorders. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. Comparative cost analysis of generalized anxiety disorder and major depressive disorder patients in secondary care from a national hospital registry in Finland.

    Kujanpää, Tero; Ylisaukko-Oja, Tero; Jokelainen, Jari; Linna, Miika; Timonen, Markku

    2014-07-01

    Major depressive disorder (MDD) has shown to cause high costs to society. Earlier research indicates that generalized anxiety disorder (GAD) also causes high costs, but only limited data is available in varying settings. To analyse the secondary care costs of GAD compared with those of MDD. Retrospective database analysis from Finnish Hospital Discharge Registers (FHDR). All GAD and MDD patients diagnosed between 1 January 2007 and 31 December 2007 in FHDR were recorded and individual-level secondary care costs during a 48-month follow-up period were measured. The total mean cost of GAD with history of MDD or some other anxiety disorder was significantly higher than that of MDD with history of GAD or some other anxiety disorder during the 48-month follow-up period. The costs of pure GAD were comparable with those of pure MDD, but after adjusting for age and sex, the costs of pure MDD were higher than those of pure GAD. The economic burden of individual GAD patients is comparable with that of MDD patients in secondary care.

  17. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L

    2016-01-01

    To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.

  18. Radio-Isotopes Section, radiation Safety Division, Ministry Of The Environment, Israel: A General Review, And Future Developments

    Ben-Zion, S.

    1999-01-01

    The section of radio-isotopes in the Ministry Of Environment, is responsible for preventing environmental hazards fi.om radio-isotopes ''from cradle to grave's'. The management and the supervision of radioactive materials, includes about 350 institutes in Israel. We are dealing with the implementation and the enforcement of the environmental regulations and safety standards, and licensing for each institution and installation. Among our tasks are the following: Follow-up of the import, transportation and distribution, usage and storage and disposal of radio-isotopes, as well as legislation, risk-assessments, inspection, , and ''education'. We are also participating in committees / working groups discussing specific topics: Radioactive stores, Low RW disposal, Y2K, GIS, penalties charging, transportation and more

  19. Socioeconomic disadvantage and its implications for population health planning of obesity and overweight, using cross-sectional data from general practices from a regional catchment in Australia

    Ghosh, Abhijeet; Charlton, Karen E; Batterham, Marijka J

    2016-01-01

    Objectives To identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity. Design Cross-sectional secondary analysis of data. Setting Primary healthcare?17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW). Participants A subset (n=36?674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118?794) that included information on disease status of all adult patients who had hei...

  20. Difficult medical encounters and job satisfaction - results of a cross sectional study with general practitioners in Germany.

    Goetz, Katja; Mahnkopf, Janis; Kornitzky, Anna; Steinhäuser, Jost

    2018-05-09

    In primary care 15% of patient encounters are perceived as challenging by general practitioners (GP). However it is unknown what impact these encounters have regarding job satisfaction. The aim of this study was to evaluate which encounters are perceived as challenging by German GPs and whether they were associated with job satisfaction. A total of 1538 questionnaires were sent to GPs in the federal state of Schleswig-Holstein, Germany. GPs should rate 14 medical conditions and 8 traits of patients on the perceived challenge using a Likert scale (1: 'not challenging at all' to 10: 'extremely challenging'). Job satisfaction was measured with the Warr-Cook-Wall job satisfaction scale. A linear regression analyses were used to explore potential associations between for the primary outcome variable 'overall job satisfaction'. Total response was 578 (38%). GPs perceived 16% of their patients as challenging. Psychiatric disorders such as somatization disorder (mean = 7.42), schizophrenia (mean = 6.83) and anxiety disorder (mean = 6.57) were ranked as high challenging while diabetes mellitus type 2 (mean = 4.87) and high blood pressure (mean = 3.22) were ranked as a rather low challenging condition. GPs were mostly satisfied with 'colleagues' (mean = 5.80) and mostly dissatisfied with their 'hours of work' (mean = 4.20). The linear regression analysis showed no association with challenging medical conditions and traits of patients but only with different aspects of job satisfaction concerning the outcome variable 'overall job satisfaction'. Especially psychiatric conditions are perceived as challenging the question arises, in what amount psychiatric competences are gained during the postgraduate specialty training in general practice and if GPs with a mandatory rotation in psychiatry perceive these conditions as less challenging. Interestingly this study indicates that challenging encounter in terms of challenging medical conditions and traits

  1. Metabolic syndrome, major depression, generalized anxiety disorder, and ten-year all-cause and cardiovascular mortality in middle aged and elderly patients.

    Butnoriene, Jurate; Bunevicius, Adomas; Saudargiene, Ausra; Nemeroff, Charles B; Norkus, Antanas; Ciceniene, Vile; Bunevicius, Robertas

    2015-01-01

    Studies investigating specifically whether metabolic syndrome (MetS) and common psychiatric disorders are independently associated with mortality are lacking. In a middle-aged general population, we investigated the association of the MetS, current major depressive episode (MDE), lifetime MDE, and generalized anxiety disorder (GAD) with ten-year all-cause and cardiovascular disease mortality. From February 2003 until January 2004, 1115 individuals aged 45 years and older were randomly selected from a primary care practice and prospectively evaluated for: (1) MetS (The World Health Organization [WHO], National Cholesterol Education Program/Adult Treatment Panel III and International Diabetes Federation [IDF] definitions); (2) current MDE and GAD, and lifetime MDE (Mini International Neuropsychiatric Interview); and (3) conventional cardiovascular risk factors. Follow-up continued through January, 2013. During the 9.32 ± 0.47 years of follow-up, there were 248 deaths, of which 148 deaths were attributed to cardiovascular causes. In women, WHO-MetS and IDF-MetS were associated with greater all-cause (HR-values range from 1.77 to 1.91; p-values ≤ 0.012) and cardiovascular (HR-values range from 1.83 to 2.77; p-values ≤ 0.013) mortality independent of cardiovascular risk factors and MDE/GAD. Current GAD predicted greater cardiovascular mortality (HR-values range from 1.86 to 1.99; p-values ≤ 0.025) independently from MetS and cardiovascular risk factors. In men, the MetS and MDE/GAD were not associated with mortality. In middle aged women, the MetS and GAD predicted greater 10-year cardiovascular mortality independently from each other; 10-year all-cause mortality was independently predicted by the MetS. MetS and GAD should be considered important and independent mortality risk factors in women. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. The association of generalized anxiety disorder and Somatic Symptoms with frequent attendance to health care services: A cross-sectional study from the Northern Finland Birth Cohort 1966.

    Kujanpää, Tero S; Jokelainen, Jari; Auvinen, Juha P; Timonen, Markku J

    2017-03-01

    Objective Generalized anxiety disorder is associated with higher rate of physical comorbities, unexplained symptoms, and health care utilization. However, the role of somatic symptoms in determining health care utilization is unclear. The present study aims to assess the association of frequent attendance of health care services between generalized anxiety disorder symptoms and somatic symptoms. Method This study was conducted cross-sectionally using the material of the 46-year follow-up survey of the Northern Finland Birth Cohort 1966. Altogether, 5585 cohort members responded to the questionnaires concerning health care utilization, illness history, physical symptoms, and generalized anxiety disorder-7 screening tool. Odds ratios belonging to the highest decile in health care utilization were calculated for generalized anxiety disorder symptoms and all (n = 4) somatic symptoms of Hopkins Symptom Checklist-25 controlled for confounding factors. Results Adjusted Odds ratios for being frequent attender of health care services were 2.29 (95% CI 1.58-3.31) for generalized anxiety disorder symptoms and 1.28 (95% CI 0.99-1.64), 1.94 (95% CI 1.46-2.58), 2.33 (95% CI 1.65-3.28), and 3.64 (95% CI 2.15-6.18) for 1, 2, 3, and 4 somatic symptoms, respectively. People with generalized anxiety disorder symptoms had on average a higher number of somatic symptoms (1.8) than other cohort members (0.9). Moreover, 1.6% of people without somatic symptoms tested positive for generalized anxiety disorder, meanwhile 22.6% of people with four somatic symptoms tested positive for generalized anxiety disorder. Conclusions Both generalized anxiety disorder symptoms and somatic symptoms are associated with a higher risk for being a health care frequent attender.

  3. Generalized Anxiety Disorder (GAD) and Comorbid Major Depression with GAD Are Characterized by Enhanced Nitro-oxidative Stress, Increased Lipid Peroxidation, and Lowered Lipid-Associated Antioxidant Defenses.

    Maes, Michael; Bonifacio, Kamila Landucci; Morelli, Nayara Rampazzo; Vargas, Heber Odebrecht; Moreira, Estefânia Gastaldello; St Stoyanov, Drozdstoy; Barbosa, Décio Sabbatini; Carvalho, André F; Nunes, Sandra Odebrecht Vargas

    2018-05-07

    Accumulating evidence shows that nitro-oxidative pathways play an important role in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD) and maybe anxiety disorders. The current study aims to examine superoxide dismutase (SOD1), catalase, lipid hydroperoxides (LOOH), nitric oxide metabolites (NOx), advanced oxidation protein products (AOPP), malondialdehyde (MDA), glutathione (GSH), paraoxonase 1 (PON1), high-density lipoprotein cholesterol (HDL), and uric acid (UA) in participants with and without generalized anxiety disorder (GAD) co-occurring or not with BD, MDD, or tobacco use disorder. Z unit-weighted composite scores were computed as indices of nitro-oxidative stress driving lipid and protein oxidation. SOD1, LOOH, NOx, and uric acid were significantly higher and HDL and PON1 significantly lower in participants with GAD than in those without GAD. GAD was more adequately predicted by increased SOD + LOOH + NOx and lowered HDL + PON1 composite scores. Composite scores of nitro-oxidative stress coupled with aldehyde and AOPP production were significantly increased in participants with comorbid GAD + MDD as compared with all other study groups, namely MDD, GAD + BD, BD, GAD, and healthy controls. In conclusion, GAD is characterized by increased nitro-oxidative stress and lipid peroxidation and lowered lipid-associated antioxidant defenses, while increased uric acid levels in GAD may protect against aldehyde production and protein oxidation. This study suggests that increased nitro-oxidative stress and especially increased SOD1 activity, NO production, and lipid peroxidation as well as lowered HDL-cholesterol and PON1 activity could be novel drug targets for GAD especially when comorbid with MDD.

  4. Predictors of perceived barriers to physical activity in the general adult population: a cross-sectional study.

    Herazo-Beltrán, Yaneth; Pinillos, Yisel; Vidarte, José; Crissien, Estela; Suarez, Damaris; García, Rafael

    The perception of personal barriers to physical activity varies according to the sociodemographic characteristics of individuals. To determine the predictors of the perception of barriers to physical activity in the adult population. A cross-sectional study with 1066 adult women and 1036 adult men. The sociodemographic variables (age, gender, marital status, socioeconomic level, level of education), the perception of barriers that do not allow performance of physical activity (i.e. lack of time, social support, energy, motivation, skill, resources, and fear of injury during practice); and the level of physical activity through the International Physical Activity Questionnaire in its short-form version were evaluated. Individuals from low socioeconomic level (1 and 2) have higher risks of perceiving barriers such as lack of motivation [OR 1.76 (95% CI (1.4-2.1))] and lack of resources [OR 1.37 (95% CI (1.1-1.6))]; individuals with partners did not perceive the lack of social support [OR 0.29 (95% CI (0.2-0.4))] and lack of motivation [OR 0.54 (95% CI (0.4-0.7))] as barriers to physical activity. Individuals with low schooling perceived lack of social support [OR 3.81 (95% CI (3-4.7))], lack of resources [OR 2.78 (95% CI (2.2-3.3))], and fear of injury [OR 2.70 (95% CI (2.2-3.3))] as barrier to physical activity. Factors such as socioeconomic level, marital status, level of education, and self-perception of health are predictors of barriers to physical activity. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  5. A cross-sectional study of self-reported general health, lifestyle factors, and disease: the Hordaland Health Study

    Randi Jepsen

    2014-10-01

    Full Text Available Background. Information on self-reported health is important for health professionals, and the aim of this study was to examine associations between lifestyle factors and self-reported health and the mediating effect of disease in a Norwegian population.Methods and Materials. The data collection was conducted as part of the Hordaland Health Study (HUSK 1997–99, which was a cross-sectional epidemiological study. All individuals in Hordaland county born in 1953–1957 were invited to participate (aged 40–44 years. Complete information for the present study was obtained from 12,883 individuals (44% response rate. Height and weight were measured at a physical examination. Information on lifestyle factors, self-reported health, disease (heart attack, apoplexy, angina pectoris, and diabetes, and socio-demographic variables was obtained from a self-administered questionnaire. Self-reported health was measured with a one-item question. Odds ratios for fair or poor self-reported health were calculated using multiple logistic regression analyses adjusted for disease and socio-demographic variables.Results. Respondents reporting adverse lifestyle behaviours (obesity (odds ratio (OR 1.7, p < 0.001, smoking (OR 1.2, p < 0.001, or excessive intake of alcohol (OR 3.3, p < 0.001 showed an increased risk of poor self-reported health. Furthermore, a moderate intake of wine (OR 0.6, p < 0.001 or strenuous physical activity (OR 0.5, p < 0.001 decreased the risk of poor health. Disease did not mediate the effect.Conclusion. A one-item question measuring self-reported health may be a suitable measure for health professionals to identify levels of subjective health and reveal a need to target lifestyle factors in relatively young individuals with or without disease.

  6. Violence against children, later victimisation, and mental health: a cross-sectional study of the general Norwegian population

    Thoresen, Siri; Myhre, Mia; Wentzel-Larsen, Tore; Aakvaag, Helene Flood; Hjemdal, Ole Kristian

    2015-01-01

    Background Violence in childhood is associated with mental health problems and risk of revictimisation. Less is known about the relative importance of the various types of childhood and adult victimisation for adult mental health. Objective To estimate the associations between various types of childhood and adult violence exposure, and their combined associations to adult mental health. Method This study was a cross-sectional telephone survey of the Norwegian adult population; 2,435 women and 2,092 men aged 18–75 participated (19.3% of those we tried to call and 42.9% of those who answered the phone). The interview comprised a broad array of violence exposure in both childhood and adulthood. Anxiety/depression was measured by the Hopkins Symptom Check List (HSCL-10). Results Victimisation was commonly reported, for example, child sexual abuse (women: 10.2%, men: 3.5%), childhood–parental physical violence (women: 4.9%, men: 5.1%), and lifetime forcible rape (women: 9.4%, men: 1.1%). All categories of childhood violence were significantly associated with adult victimisation, with a 2.2–5.0 times higher occurrence in exposed children (pviolence categories experienced (pviolence were significantly associated with anxiety/depression (pviolence/neglect had the highest levels of anxiety/depression. Conclusions Results should be interpreted in light of the low response rate. Childhood violence in all its forms was a risk factor for victimisation in adulthood. Adult anxiety/depression was associated with both the number of violence categories and the type of childhood violence experienced. A broad assessment of childhood and adult violence exposure is necessary both for research and prevention purposes. Psychological violence and neglect should receive more research attention, especially in combination with other types of violence. PMID:25591729

  7. [What Makes Happy Doctors? Job Satisfaction of General Practitioners in Mecklenburg-Western Pomerania - a Representative Cross-sectional Study].

    Löffler, C; Höck, J; Hornung, A; Kundt, G; Drewelow, E; Völker, S; Kreiser, B; Riedel, J; Altiner, A

    2015-12-01

    Studies provide evidence for the importance of general practitioners (GPs) job satisfaction for a secure and high quality health care provision. This study focuses on job satisfaction of GPs in Mecklenburg-Western Pomerania (MV), a rural area threatened by a lack of GPs. We investigate how satisfied GPs are with their job and which factors influence their job satisfaction. All 1 133 GPs working in MV in December 2011 were asked to complete a 57-item-questionnaire. The response rate reached 50.1%. The sample is representative for GPs in MV. Levels of job satisfaction are high and correlate with age and sex: females and GPs below 50 years of age are more satisfied. Factors contributing to high job satisfaction include a good doctor-patient relationship, fair pay, and the variety of reasons for doctor-patient consultations in primary care. Although all GPs were dissatisfied with bureaucracy, this factor has little impact on GPs' overall job satisfaction. In light of the imminent lack of GPs, in future it will be important to improve factors that have been demonstrated to increase job satisfaction. © Georg Thieme Verlag KG Stuttgart · New York.

  8. AWARENESS UNDER GENERAL ANAESTHESIA IN PATIENTS UNDERGOING ELECTIVE CAESAREAN SECTION USING THIOPENTONE AND KETAMINE AS INDUCTION AGENTS- A RANDOMISED PROSPECTIVE STUDY

    Somashekharappa Basavanneppa Kadur

    2016-12-01

    Full Text Available BACKGROUND Awareness during general anaesthesia for caesarean section is a big concern because of its serious adverse consequences. It has been reported that ketamine used as induction agent reduces awareness. This study was conducted to compare awareness under general anaesthesia when thiopentone and ketamine are used as induction agents for caesarean section. MATERIALS AND METHODS Fifty healthy mothers scheduled for elective caesarean section were randomly divided into two groups to receive thiopentone (4 mg/kg -1 or ketamine (1.5 mg/kg -1 for induction of anaesthesia. Mothers were examined for intraoperative awareness using isolated forearm technique until the delivery of the baby. Postoperatively, they were spoken about recall and any hallucination by using a set of questionnaire. RESULTS 15% patients who received thiopentone were able to follow the commands compared to 8% patients who received ketamine. 65% patients who received thiopentone made reaching movements of the isolated forearm towards the stimulus compared to 20% patients of ketamine group. None of the patients in thiopentone group experienced any hallucinations compared to 1 patient (4% in ketamine group who exhibited hallucinations. None of fifty patients could recall the intraoperative events like squeezing of hands or the pain of operation. CONCLUSION Ketamine can be used as substitute for thiopentone as an induction agent in a dose equal to 1.5 mg/kg -1 . Having profound analgesic effect, property to maintain foetoplacental exchange better than any other induction agents, ketamine can be used routinely as an induction agent for mothers undergoing caesarean section under general anaesthesia.

  9. Effects of General and Epidural Anaesthesia in Newborn’s Stres Hormones, Blood Gases, and Apgar Scores in Elective Cesarean Section

    Meral Ezberci

    2005-12-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the effects of general and epidural anaesthesia in newborn’s stres hormones, blood gases, and Apgar scores in elective cesarean section. MATERIALS-METHODS: 50 patients in ASA II (American Society of Anesthesiology class who would undergo elective cesarean section in University of Kahramanmaras Sutcuimam, Department of Anaesthesiology and Reanimation included in the study and randomized into two equal groups (General anaesthesia: Group G and Epidural anaesthesia: Group E. In both groups, newborn stres hormones (TSH, cortisol, and insulin, blood gases, and Apgar scores were studued. All patients received famotidine and granisetron iv 30 min before operations in premedication room. In the general anaesthesia group; aritmal, propofol, and succinylcholine was used for induction and muscle relaxation. Following the induction, positive pressure ventilation of the lungs was started immediately using a 50% N2O + O2 mixture. After delivery of the baby, anaesthesia and muscle relaxation was maintained by 50% N2O +O2, 0,5-1% MAC isoflurane, and cisatracurium. In the epidural anaesthesia group; epidural anaesthesia was performed with 0,375% bupivacaine. The epidural needle inserted through L2-3 or L3-4 interspace. After achieving T4-5 neural blockade, the operation was started. Blood samples for newborn stres hormones and blood gases were taken from umblical vein. The Apgar scores were recorded at 1 min and again at 5 min after the delivery by same person. RESULTS: There were no differences in newborn stress hormones between two groups. In newborn blood gases analyses, only SO2 changes were statistically significant between two groups. There were no differences in newborn Apgar scores between two groups. CONCLUSION: With these results, we concluded that each of the general and epidural anaesthesia techniques have similar effects on newborn blood gases, stress hormones and Apgar scores and can be acceptable

  10. A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising.

    Yancey, Antronette K; Cole, Brian L; Brown, Rochelle; Williams, Jerome D; Hillier, Amy; Kline, Randolph S; Ashe, Marice; Grier, Sonya A; Backman, Desiree; McCarthy, William J

    2009-03-01

    Commercial marketing is a critical but understudied element of the sociocultural environment influencing Americans' food and beverage preferences and purchases. This marketing also likely influences the utilization of goods and services related to physical activity and sedentary behavior. A growing literature documents the targeting of racial/ethnic and income groups in commercial advertisements in magazines, on billboards, and on television that may contribute to sociodemographic disparities in obesity and chronic disease risk and protective behaviors. This article examines whether African Americans, Latinos, and people living in low-income neighborhoods are disproportionately exposed to advertisements for high-calorie, low nutrient-dense foods and beverages and for sedentary entertainment and transportation and are relatively underexposed to advertising for nutritious foods and beverages and goods and services promoting physical activities. Outdoor advertising density and content were compared in zip code areas selected to offer contrasts by area income and ethnicity in four cities: Los Angeles, Austin, New York City, and Philadelphia. Large variations were observed in the amount, type, and value of advertising in the selected zip code areas. Living in an upper-income neighborhood, regardless of its residents' predominant ethnicity, is generally protective against exposure to most types of obesity-promoting outdoor advertising (food, fast food, sugary beverages, sedentary entertainment, and transportation). The density of advertising varied by zip code area race/ethnicity, with African American zip code areas having the highest advertising densities, Latino zip code areas having slightly lower densities, and white zip code areas having the lowest densities. The potential health and economic implications of differential exposure to obesity-related advertising are substantial. Although substantive legal questions remain about the government's ability to regulate

  11. Current status of percutaneous endoscopic gastrostomy (PEG) in a general hospital in Japan: a cross-sectional study

    Kusano, Chika; Yamada, Nobuo; Kikuchi, Kenji; Hashimoto, Masaji; Gotoda, Takuji

    2016-01-01

    Background: There has been debate over the indications for percutaneous endoscopic gastrostomy (PEG) in recent years in Japan. In addition, the level of satisfaction of patients and patient’s family after PEG remains unclear. The aim of this study was to investigate the current status of PEG and the level of satisfaction of patients and patients’ families after PEG in Japan. Methods: We reviewed the existing data of all patients who underwent PEG tube insertion at Yuri Kumiai General Hospital (Akita, Japan) between February 2000 and December 2010. We examined the following points: underlying diseases requiring PEG, levels of consciousness, and performance status. We also sent a questionnaire to the patients and patient’s families to ask about their satisfaction with and thoughts about PEG. Results: The data of 545 patients who underwent PEG were reviewed. There were 295 men and 250 women, with a mean age of 77.2 ± 11.4 years. PEG was indicated most frequently for cerebrovascular disorders (48.2%, 239/545). There were 515 (94.4%, 515/545) patients showing consciousness disturbance and 444 (81.5%, 444/545) bedridden patients. The questionnaire was answered by one patient himself and 316 patients’ families. When asked, “Was performing PEG a good decision?”, 57.5% (182/316) of the patients’ families answered yes. Meanwhile, when patients’ family members were asked if they would wish to undergo PEG if they were in the same condition as the patient, 28.4% (90/316) answered yes, whereas 55.3% (175/316) answered no. Conclusions: Few patients were able to make their own decision about PEG tube placement because of consciousness disturbance. As a result, many family members of the patients did not want to experience PEG for themselves. Future studies should be performed to clarify the quality of life and ethical aspects associated with PEG. PMID:27313796

  12. Violence against children, later victimisation, and mental health: a cross-sectional study of the general Norwegian population

    Siri Thoresen

    2015-01-01

    Full Text Available Background: Violence in childhood is associated with mental health problems and risk of revictimisation. Less is known about the relative importance of the various types of childhood and adult victimisation for adult mental health. Objective: To estimate the associations between various types of childhood and adult violence exposure, and their combined associations to adult mental health. Method: This study was a cross-sectional telephone survey of the Norwegian adult population; 2,435 women and 2,092 men aged 18–75 participated (19.3% of those we tried to call and 42.9% of those who answered the phone. The interview comprised a broad array of violence exposure in both childhood and adulthood. Anxiety/depression was measured by the Hopkins Symptom Check List (HSCL-10. Results: Victimisation was commonly reported, for example, child sexual abuse (women: 10.2%, men: 3.5%, childhood–parental physical violence (women: 4.9%, men: 5.1%, and lifetime forcible rape (women: 9.4%, men: 1.1%. All categories of childhood violence were significantly associated with adult victimisation, with a 2.2–5.0 times higher occurrence in exposed children (p<0.05 for all associations. Anxiety/depression (HSCL-10 associated with adult abuse increased with the number of childhood violence categories experienced (p<0.001. All combinations of childhood violence were significantly associated with anxiety/depression (p<0.001 for all associations. Individuals reporting psychological violence/neglect had the highest levels of anxiety/depression. Conclusions: Results should be interpreted in light of the low response rate. Childhood violence in all its forms was a risk factor for victimisation in adulthood. Adult anxiety/depression was associated with both the number of violence categories and the type of childhood violence experienced. A broad assessment of childhood and adult violence exposure is necessary both for research and prevention purposes. Psychological violence

  13. Sharing Responsibilities within the General Practice Team - A Cross-Sectional Study of Task Delegation in Germany.

    Mergenthal, Karola; Beyer, Martin; Gerlach, Ferdinand M; Guethlin, Corina

    2016-01-01

    Expected growth in the demand for health services has generated interest in the more effective deployment of health care assistants. Programs encouraging German general practitioners (GPs) to share responsibility for care with specially qualified health care assistants in the family practice (VERAHs) have existed for several years. But no studies have been conducted on the tasks German GPs are willing to rely on specially qualified personnel to perform, what they are prepared to delegate to all non-physician practice staff and what they prefer to do themselves. As part of an evaluation study on the deployment of VERAHs in GP-centered health care, we used a questionnaire to ask about task delegation within the practice team. From a list of tasks that VERAHs are specifically trained to carry out, GPs were asked to indicate which they actually delegate. We also asked GPs why they had employed a VERAH in their practice and for their opinions on the benefits and limitations of assigning tasks to VERAHs. The aim of the study was to find out which tasks GPs delegate to their specially qualified personnel, which they permit all HCAs to carry out, and which tasks they do not delegate at all. The survey was filled in and returned by 245 GPs (83%). Some tasks were exclusively delegated to VERAHs (e.g. home visits), while others were delegated to all HCAs (e.g. vaccinations). About half the GPs rated the assessment of mental health, as part of the comprehensive assessment of a patient's condition, as the sole responsibility of a GP. The possibility to delegate more complex tasks was the main reason given for employing a VERAH. Doctors said the delegation of home visits provided them with the greatest relief. In Germany, where GPs are solely accountable for the health care provided in their practices, experience with the transfer of responsibility to other non-physician health care personnel is still very limited. When HCAs have undergone special training, GPs seem to be

  14. Sharing Responsibilities within the General Practice Team – A Cross-Sectional Study of Task Delegation in Germany

    Mergenthal, Karola; Beyer, Martin; Gerlach, Ferdinand M.; Guethlin, Corina

    2016-01-01

    Background Expected growth in the demand for health services has generated interest in the more effective deployment of health care assistants. Programs encouraging German general practitioners (GPs) to share responsibility for care with specially qualified health care assistants in the family practice (VERAHs) have existed for several years. But no studies have been conducted on the tasks German GPs are willing to rely on specially qualified personnel to perform, what they are prepared to delegate to all non-physician practice staff and what they prefer to do themselves. Methods As part of an evaluation study on the deployment of VERAHs in GP-centered health care, we used a questionnaire to ask about task delegation within the practice team. From a list of tasks that VERAHs are specifically trained to carry out, GPs were asked to indicate which they actually delegate. We also asked GPs why they had employed a VERAH in their practice and for their opinions on the benefits and limitations of assigning tasks to VERAHs. The aim of the study was to find out which tasks GPs delegate to their specially qualified personnel, which they permit all HCAs to carry out, and which tasks they do not delegate at all. Results The survey was filled in and returned by 245 GPs (83%). Some tasks were exclusively delegated to VERAHs (e.g. home visits), while others were delegated to all HCAs (e.g. vaccinations). About half the GPs rated the assessment of mental health, as part of the comprehensive assessment of a patient’s condition, as the sole responsibility of a GP. The possibility to delegate more complex tasks was the main reason given for employing a VERAH. Doctors said the delegation of home visits provided them with the greatest relief. Conclusions In Germany, where GPs are solely accountable for the health care provided in their practices, experience with the transfer of responsibility to other non-physician health care personnel is still very limited. When HCAs have

  15. ENDF/B-VIII.0: The 8th Major Release of the Nuclear Reaction Data Library with CIELO-project Cross Sections, New Standards and Thermal Scattering Data

    Brown, D. A.; Chadwick, M. B.; Capote, R.; Kahler, A. C.; Trkov, A.; Herman, M. W.; Sonzogni, A. A.; Danon, Y.; Carlson, A. D.; Dunn, M.; Smith, D. L.; Hale, G. M.; Arbanas, G.; Arcilla, R.; Bates, C. R.; Beck, B.; Becker, B.; Brown, F.; Casperson, R. J.; Conlin, J.; Cullen, D. E.; Descalle, M.-A.; Firestone, R.; Gaines, T.; Guber, K. H.; Hawari, A. I.; Holmes, J.; Johnson, T. D.; Kawano, T.; Kiedrowski, B. C.; Koning, A. J.; Kopecky, S.; Leal, L.; Lestone, J. P.; Lubitz, C.; Márquez Damián, J. I.; Mattoon, C. M.; McCutchan, E. A.; Mughabghab, S.; Navratil, P.; Neudecker, D.; Nobre, G. P. A.; Noguere, G.; Paris, M.; Pigni, M. T.; Plompen, A. J.; Pritychenko, B.; Pronyaev, V. G.; Roubtsov, D.; Rochman, D.; Romano, P.; Schillebeeckx, P.; Simakov, S.; Sin, M.; Sirakov, I.; Sleaford, B.; Sobes, V.; Soukhovitskii, E. S.; Stetcu, I.; Talou, P.; Thompson, I.; van der Marck, S.; Welser-Sherrill, L.; Wiarda, D.; White, M.; Wormald, J. L.; Wright, R. Q.; Zerkle, M.; Žerovnik, G.; Zhu, Y.

    2018-02-01

    We describe the new ENDF/B-VIII.0 evaluated nuclear reaction data library. ENDF/B-VIII.0 fully incorporates the new IAEA standards, includes improved thermal neutron scattering data and uses new evaluated data from the CIELO project for neutron reactions on 1H, 16O, 56Fe, 235U, 238U and 239Pu described in companion papers in the present issue of Nuclear Data Sheets. The evaluations benefit from recent experimental data obtained in the U.S. and Europe, and improvements in theory and simulation. Notable advances include updated evaluated data for light nuclei, structural materials, actinides, fission energy release, prompt fission neutron and γ-ray spectra, thermal neutron scattering data, and charged-particle reactions. Integral validation testing is shown for a wide range of criticality, reaction rate, and neutron transmission benchmarks. In general, integral validation performance of the library is improved relative to the previous ENDF/B-VII.1 library.

  16. ENDF/B-VIII.0: The 8 th Major Release of the Nuclear Reaction Data Library with CIELO-project Cross Sections, New Standards and Thermal Scattering Data

    Brown, D. A.; Chadwick, M. B.; Capote, R.; Kahler, A. C.; Trkov, A.; Herman, M. W.; Sonzogni, A. A.; Danon, Y.; Carlson, A. D.; Dunn, M.; Smith, D. L.; Hale, G. M.; Arbanas, G.; Arcilla, R.; Bates, C. R.; Beck, B.; Becker, B.; Brown, F.; Casperson, R. J.; Conlin, J.; Cullen, D. E.; Descalle, M. -A.; Firestone, R.; Gaines, T.; Guber, K. H.; Hawari, A. I.; Holmes, J.; Johnson, T. D.; Kawano, T.; Kiedrowski, B. C.; Koning, A. J.; Kopecky, S.; Leal, L.; Lestone, J. P.; Lubitz, C.; Márquez Damián, J. I.; Mattoon, C. M.; McCutchan, E. A.; Mughabghab, S.; Navratil, P.; Neudecker, D.; Nobre, G. P. A.; Noguere, G.; Paris, M.; Pigni, M. T.; Plompen, A. J.; Pritychenko, B.; Pronyaev, V. G.; Roubtsov, D.; Rochman, D.; Romano, P.; Schillebeeckx, P.; Simakov, S.; Sin, M.; Sirakov, I.; Sleaford, B.; Sobes, V.; Soukhovitskii, E. S.; Stetcu, I.; Talou, P.; Thompson, I.; van der Marck, S.; Welser-Sherrill, L.; Wiarda, D.; White, M.; Wormald, J. L.; Wright, R. Q.; Zerkle, M.; Žerovnik, G.; Zhu, Y.

    2018-02-01

    We describe the new ENDF/B-VIII.0 evaluated nuclear reaction data library. ENDF/B-VIII.0 fully incorporates the new IAEA standards, includes improved thermal neutron scattering data and uses new evaluated data from the CIELO project for neutron reactions on 1H, 16O, 56Fe, 235U, 238U and 239Pu described in companion papers in the present issue of Nuclear Data Sheets. The evaluations benefit from recent experimental data obtained in the U.S. and Europe, and improvements in theory and simulation. Notable advances include updated evaluated data for light nuclei, structural materials, actinides, fission energy release, prompt fission neutron and γ-ray spectra, thermal neutron scattering data, and charged-particle reactions. Integral validation testing is shown for a wide range of criticality, reaction rate, and neutron transmission benchmarks. In general, integral validation performance of the library is improved relative to the previous ENDF/B-VII.1 library.

  17. Self-stigma in borderline personality disorder – cross-sectional comparison with schizophrenia spectrum disorder, major depressive disorder, and anxiety disorders

    Grambal A

    2016-09-01

    Full Text Available Ales Grambal,1 Jan Prasko,1 Dana Kamaradova,1 Klara Latalova,1 Michaela Holubova,1,2 Marketa Marackova,1 Marie Ociskova,1 Milos Slepecky3 1Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Faculty of Social Science and Health Care, Department of Psychology Sciences, Constantine the Philosopher University, Nitra, Slovak Republic Introduction: Self-stigma arises from one’s acceptance of societal prejudices and is common in psychiatric patients. This investigation compares the self-stigma of a sample of patients with borderline personality disorder (BPD, schizophrenia spectrum disorder (SCH, major depressive disorder (MDD, bipolar affective disorder (BAD, and anxiety disorders (AD and explores of the self-stigma with the subjective and objective measures of the severity of the disorder and demographic factors. Methods: The total of 184 inpatients admitted to the psychotherapeutic department diagnosed with BPD, SCH, MDD, BAP, and AD were compared on the internalized stigma of mental illness (ISMI scale. The ISMI-total score was correlated with the subjective and objective evaluation of the disorder severity (clinical global impression, and clinical and demographic factors. Results: The self-stigma levels were statistically significantly different among the diagnostic groups (BPD 71.15±14.74; SCH 63.2±13.27; MDD 64.09±12.2; BAD 62.0±14.21; AD 57.62±15.85; one-way analysis of variance: F=8.698, df=183; P<0.005. However after applying the Bonferroni’s multiple comparison test, the only significant difference was between the BPD patients and the patients with AD (P<0.001. Stepwise regression analysis showed that the strongest factors connected with the higher level of self-stigma were being without partner, the number of hospitalization, and the severity of the disorder. Conclusion: The BPD patients

  18. Iron deficiency was not the major cause of anemia in rural women of reproductive age in Sidama zone, southern Ethiopia: A cross-sectional study.

    Gebreegziabher, Tafere; Stoecker, Barbara J

    2017-01-01

    Anemia, which has many etiologies, is a moderate/severe public health problem in young children and women of reproductive age in many developing countries. The aim of this study was to investigate prevalence of iron deficiency, anemia, and iron deficiency anemia using multiple biomarkers and to evaluate their association with food insecurity and food consumption patterns in non-pregnant women from a rural area of southern Ethiopia. A cross-sectional study was conducted in 202 rural women of reproductive age in southern Ethiopia. Anthropometrics and socio-demographic data were collected. A venipuncture blood sample was analyzed for hemoglobin (Hb) and for biomarkers of iron status. Biomarkers were skewed and were log transformed before analysis. Mean, median, Pearson's correlations and ordinary least-squares regressions were calculated. Median (IQR) Hb was 138 (127, 151) g/L. Based on an altitude-adjusted (1708 m) cutoff of 125 g/L for Hb, 21.3% were anemic. Plasma ferritin was 1.0 g/L; four women (2%) had > 5 mg/L of C-reactive protein (CRP). Of the 43 women who were anemic, 23.3% (10 women) had depleted iron stores based on plasma ferritin. Three of these had elevated soluble transferrin receptors (sTfR). Hemoglobin (Hb) concentration was negatively correlated with sTfR (r = -0.24, p = 0.001), and positively correlated with ferritin (r = 0.17, p = 0.018), plasma iron (r = 0.15, p = 0.046), transferrin saturation (TfS) (r = 0.15, p = 0.04) and body iron (r = 0.14, p = 0.05). Overall prevalence of iron deficiency anemia was only 5%. Iron deficiency anemia was not prevalent in the study population, despite the fact that anemia would be classified as a moderate public health problem.

  19. Female sex work and international sport events - no major changes in demand or supply of paid sex during the 2010 Soccer World Cup: a cross-sectional study

    2012-01-01

    Background Important unanswered questions remain on the impact of international sporting events on the sex industry. Speculation about increased demand and supply of sex work often generates significant attention, but also additional funding for HIV programmes. This study assessed whether changes occurred in the demand and supply of paid sex during the 2010 Soccer World Cup in South Africa. Methods Trained sex worker interviewers conducted face-to-face semi-structured interviews among consenting female sex workers during May-September 2010. Using bivariate analyses we compared supply, demand, sexual risk-taking, and police and health services contact pre-World Cup, to levels during the World Cup and after the event. Results No increases were detected in indicators of sex work supply, including the proportion of sex workers newly arrived in the city ( 92.4% in all phases). Health-care utilisation decreased non-significantly from the pre- to during World Cup period (62.4% to 57.0%; P = 0.075). Across all periods, about thirty percent of participants had interacted with police in the preceding month, two thirds of whom had negative interactions. Conclusions Contrary to public opinion, no major increases were detected in the demand or supply of paid sex during the World Cup. Although the study design employed was unable to select population-based samples, these findings do not support the public concern and media speculation prior to the event, but rather signal a missed opportunity for public health action. Given the media attention on sex work, future sporting events offer strategic opportunities to implement services for sex workers and their clients, especially as health service utilisation might decrease in this period. PMID:22967260

  20. Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

    von Babo, Michelle; Chmiel, Corinne; Müggler, Simon Andreas; Rakusa, Julia; Schuppli, Caroline; Meier, Philipp; Fischler, Manuel; Urner, Martin

    2018-01-01

    Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC) greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland. In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed. 560 physicians of 71 hospitals (64%) responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

  1. Case management for the treatment of patients with major depression in general practices – rationale, design and conduct of a cluster randomized controlled trial – PRoMPT (Primary care Monitoring for depressive Patient's Trial [ISRCTN66386086] – Study protocol

    Krauth Christian

    2005-10-01

    Full Text Available Abstract Background Depression is a disorder with high prevalence in primary health care and a significant burden of illness. The delivery of health care for depression, as well as other chronic illnesses, has been criticized for several reasons and new strategies to address the needs of these illnesses have been advocated. Case management is a patient-centered approach which has shown efficacy in the treatment of depression in highly organized Health Maintenance Organization (HMO settings and which might also be effective in other, less structured settings. Methods/Design PRoMPT (PRimary care Monitoring for depressive Patients Trial is a cluster randomised controlled trial with General Practice (GP as the unit of randomisation. The aim of the study is to evaluate a GP applied case-management for patients with major depressive disorder. 70 GPs were randomised either to intervention group or to control group with the control group delivering usual care. Each GP will include 10 patients suffering from major depressive disorder according to the DSM-IV criteria. The intervention group will receive treatment based on standardized guidelines and monthly telephone monitoring from a trained practice nurse. The nurse investigates the patient's status concerning the MDD criteria, his adherence to GPs prescriptions, possible side effects of medication, and treatment goal attainment. The control group receives usual care – including recommended guidelines. Main outcome measure is the cumulative score of the section depressive disorders (PHQ-9 from the German version of the Prime MD Patient Health Questionnaire (PHQ-D. Secondary outcome measures are the Beck-Depression-Inventory, self-reported adherence (adapted from Moriskey and the SF-36. In addition, data are collected about patients' satisfaction (EUROPEP-tool, medication, health care utilization, comorbidity, suicide attempts and days out of work. The study comprises three assessment times: baseline

  2. 14 CFR Section 8 - General

    2010-01-01

    ... and infrequent occurrence. (7) Cumulative effect of changes in accounting principles. This primary classification (9800) shall include the cumulative effect of material changes in accounting principles. [ER-755... accounting period. (b) The prescribed system of accounts provides for the co-ordinate grouping of all...

  3. Major depression

    Depression - major; Depression - clinical; Clinical depression; Unipolar depression; Major depressive disorder ... providers do not know the exact causes of depression. It is believed that chemical changes in the ...

  4. Alcohol use, alcohol-related aggression and intimate partner abuse: A cross-sectional survey of convicted versus general population men in Scotland.

    Gilchrist, Elizabeth Allison; Ireland, Lana; Forsyth, Alasdair; Godwin, Jon; Laxton, Tim

    2017-01-01

    Scotland has a particular problem with alcohol, and the links between intimate partner abuse (IPA) and alcohol appear stronger here than elsewhere across Europe. This study explored differences in alcohol use, related aggression and relationship conflict across a number of groups: men convicted for intimate partner abuse, men convicted of general offences and men recruited from community sports teams. Participants (n = 64) completed three questionnaires exploring their experiences of alcohol use (Alcohol Use Disorders Identification Test, AUDIT); alcohol and aggression (Alcohol Related Aggression Questionnaire, ARAQ-28), and relationship conflict (Revised Conflict Tactics Scale, CTS-2). There were significant differences across the groups in terms of AUDIT and ARAQ-28 scores, IPA and general offenders scored higher than the community sample. CTS-2 scores showed significant differences: both offender groups reported more use of negotiation and psychological abuse, than the community men, and IPA offenders reported causing more physical harm than either general offenders or the community sample. ARAQ-28 scores correlated with psychological abuse for general offenders. Alcohol use was very high across all groups, but the community group did not endorse an aggression-precipitating view of alcohol and did not report high IPA. Discussed is the need for cross-cultural research to explore putative mediators and moderators in the relationship between alcohol, aggressiveness and IPA. [Gilchrist EA, Ireland L, Forsyth A, Godwin J, Laxton T. Alcohol use, alcohol-related aggression and intimate partner abuse: A cross-sectional survey of convicted versus general population men in Scotland. Drug Alcohol Rev 2017;36:20-23]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  5. Association of white and red meat consumption with general and abdominal obesity: a cross-sectional study among a population of Iranian military families in 2016.

    Dabbagh-Moghadam, Arasb; Mozaffari-Khosravi, Hassan; Nasiri, Morteza; Miri, Ali; Rahdar, Maliehe; Sadeghi, Omid

    2017-12-01

    To assess the association of red and white meat consumption with general and abdominal obesity among Iranian military families. In this cross-sectional study, 525 subjects with age range of 19-55 years belong to military families of Army of Islamic Republic of Iran were recruited during 2016. Dietary data were collected using semi-quantitative food-frequency questionnaire. A self-reported questionnaire was used to collect data on demographic characteristics and anthropometric measurements. General obesity was defined as body mass index ≥25 kg/m 2 and abdominal obesity as waist circumference ≥80 cm for women and ≥ 94 cm for men. Finally, we had complete data on 170 subjects for analysis. Mean age of subjects was 33.78 ± 6.48. We found a significant positive association between red meat consumption and abdominal obesity in fully adjusted model, so that subjects in the fourth quartile had 4.51 more odds to be abdominally obese compared with those in the first quartile of red meat consumption (OR 4.51, 95% CI 1.32-15.40). Such relationship was not seen for general obesity. In addition, white meat consumption was not associated with general and abdominal obesity either before or after adjustment for covariates. Red meat consumption was positively associated with abdominal obesity. No significant relationship was found between white meat consumption, and general and abdominal obesity. Therefore, further studies are needed to shed light our findings.

  6. The influence of perceived prejudice on willingness to be a nurse via the mediating effect of satisfaction with major: A cross-sectional study among chinese male nursing students.

    Feng, Danjun; Zhao, Wenjing; Shen, Shiyu; Chen, Jieru; Li, Lu

    2016-07-01

    The gender-based stereotype of nursing as a female profession has been a large obstacle to men entering the nursing profession. However, there is little quantitative research on the influence of prejudice induced by this stereotype on male nursing students' willingness to be nurses. To examine the effect of perceived prejudice on willingness to be a nurse via the mediating effect of satisfaction with major among Chinese male nursing students. A cross-sectional survey was used. Four hundred and sixty male nursing students who were enrolled either in bachelor's programs in universities or advanced diploma programs in colleges in Jinan, China, were surveyed using questionnaires measuring perceived prejudice, satisfaction with major, and willingness to be a nurse. Structural equation modeling with bias-corrected bootstrapping was employed to determine the influence of perceived prejudice on willingness to be a nurse with major satisfaction as a mediator. Male students who were in an advanced diploma nursing program and those for whom nursing was the first-choice major reported significantly less perceived prejudice, greater satisfaction with major, and greater willingness to be nurses than did those in a bachelor's nursing program and those for whom nursing was not the first-choice major, respectively. Moreover, although perceived prejudice had no significant direct effect on willingness to be a nurse (β=0.07, p>0.05), it did have a strong indirect effect (full mediation) via satisfaction with major (β=-0.59, pnursing students' willingness to be nurses via the full mediating effect of satisfaction with major. Because this obsolete stereotype of nursing as a female occupation gives birth to prejudice against male nursing students, effective measures should be taken to change this stereotype to recruit more men as nursing staff. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Decreased management of genital warts in young women in Australian general practice post introduction of national HPV vaccination program: results from a nationally representative cross-sectional general practice study.

    Christopher Harrison

    Full Text Available OBJECTIVES: Since the introduction of Australia's human papillomavirus vaccination program, the management rate of genital warts in sexual health clinics and private hospitals has decreased in women of vaccine-eligible age. However, most genital warts in Australia are managed in general practice. This study examines whether a similar decrease occurred in Australian general practice after the introduction of the program. METHODS: Analysis of a nationally representative cross-sectional database of Australian general practice activity (1,175,879 patient encounters with 11,780 general practitioners. Genital warts management rates were estimated for the periods before and after introduction of the program (Pre-program, July 2002-June 2006; Post-program, July 2008-June 2012. Control conditions included genital herpes and gardnerella/bacterial vaginosis in female patients and genital herpes and urethritis in male patients. Trends in management rates by year, pre-vaccine (July 2000-June 2007 and post-vaccine (July 2007-June 2012 were also calculated. RESULTS: Management rate of genital warts among women potentially covered by program (aged 15-27 years decreased by 61% from 4.33 per 1,000 encounters in the Pre-program period to 1.67 in the Post-program period. Trend analysis of the post-vaccine period showed, among women of vaccine eligible age, a significant year-on-year reduction in the rate of genital warts management (p<0.0001 and a significant increase in the management rate of control conditions per year (p<0.0001. For all other age-sex groups there was no significant change in the management rate of genital warts between the Pre- and Post-program periods. CONCLUSION: The large decrease in general practice management of genital warts in women of vaccine-eligible age highlights the success of the program in the wider community.

  8. Medical students' attitudes and wishes towards extending an educational general practice app to be suitable for practice: A cross-sectional survey from Leipzig, Germany.

    Sandholzer, Maximilian; Deutsch, Tobias; Frese, Thomas; Winter, Alfred

    2016-06-01

    In medical education and practice, smartphone apps are increasingly becoming popular. In general practice, apps could play an important future role in supporting medical education and practice. To explore medical students' perceptions regarding the potential of a general practice app for training and subsequent work as a physician. Cross-sectional survey among Leipzig fourth-year medical students who were provided with an app prototype for a mandatory general practice course. Response rate was 99.3% (n = 305/307); 59.0% were female and mean age was 24.5 years. Students certified that the app had a higher potential than textbooks in both education (57.4% vs. 18.0%) and practice (47.1% vs. 22.8%). Students' most desired possible app extensions when anticipating its use for subsequent work as a physician were looking up information for diagnostics, therapy and prediction (85.1%), access to electronic patient files (48.1%), communication and networking (44.3%), organization of medical training (42.9%) and online monitoring of patients (38.1%). Students experienced with medical smartphone apps were more interested in app extensions. Consideration to use the app to support the opening of their own practice was significantly associated with higher interest in accessing electronic patient files, networking with colleagues and telemedicine. Fourth year medical students from Leipzig see a high potential in smartphone apps for education and practice and are interested in further using the technology after undergraduate education.

  9. Practices and opinions regarding HPV vaccination among French general practitioners: evaluation through two cross-sectional studies in 2007 and 2010.

    Lasset, Christine; Kalecinski, Julie; Régnier, Véronique; Barone, Giovanna; Leocmach, Yann; Vanhems, Philippe; Chauvin, Franck; Lutringer-Magnin, Delphine

    2014-06-01

    To use both quantitative and qualitative methods to investigate the evolution of practices and opinions regarding human papillomavirus (HPV) vaccination among French general practitioners. A cross-sectional study (self-questionnaires) was performed in 2007 and repeated in 2010 among 271 general practitioners. Semi-structured interviews were conducted on 27 voluntary participants by a sociologist and analyzed according to content analysis. Acceptability of HPV vaccination had increased from 2007 to 2010 (79.9 vs. 87.1%, respectively), just as the practice of HPV vaccination among 14-year-old girls (19.0 vs. 49.1%, respectively). Though about 60% reported complications associated with HPV vaccination, irrespective of year, the types of difficulties have varied: difficulties related to "questions asked by patients" had decreased, though concerns about side effects had remained stable. During interviews, difficulties related to "the reason for medical consultation" and "the target age" were often associated with addressing the issue of sexuality, especially when the parents were present. Although the high level of acceptability of HPV vaccination among general practitioners, which increased from 2007 to 2010, there remain difficulties in addressing this practice.

  10. [A cross-sectional survey of the prevalence of depressive-anxiety disorders among general hospital outpatients in five cities in China].

    He, Yan-ling; Ma, Hong; Zhang, Lan; Liu, Zhe-ning; Jia, Fu-jun; Zhang, Ming-yuan

    2009-09-01

    To find the prevalence of depressive and anxiety disorders among general hospital outpatients and to evaluate the diagnoses and treatment provided by physicians in China. A multi-center, hospital-based cross-sectional study was conducted. A total of 8478 subjects were screened by using HADS and PHQ-15 together with medical history review list and were followed by regular clinical visit process. Physician's diagnoses and management were recorded. Mini International Neuropsychiatric Interview (MINI) was used to evaluate by psychiatrists afterwards for 4172 subjects scored >or= 8 on HADS. The adjusted prevalence rates of MINI-diagnosed depressive disorder, anxiety disorder, depression and anxiety, depression or anxiety disorders were 12.0%, 8.6%, 4.1% and 16.5%, respectively. The prevalence of depressive and/or anxiety disorder in outpatients visiting department of neurology and digestive diseases were higher than that in patients visiting departments of cardiovascular diseases and gynecology with statistical significance (P depressive and/or anxiety disorders were found in the general hospitals. In order to improve the status quo, training program for physicians and specialists other than psychiatric professionals in general hospitals should be enhanced together with psychiatric consultation.

  11. General Health Status, Music Performance Anxiety, and Coping Methods of Musicians Working in Turkish State Symphony Orchestras: A Cross-Sectional Study.

    Topoğlu, Onur; Karagülle, Derya; Keskin, Tuba U; Abacigil, Filiz; Okyay, Pinar

    2018-06-01

    This study assessed the general health, music performance anxiety (MPA), and coping methods of musicians working in six state orchestras in Turkey. All musicians working in the state symphony orchestras (n=384) were invited to participate in the study. In face-to-face interviews, the authors administered a questionnaire, which consisted of five sections: sociodemographic information, history of musical performance, health status, general health questionnaire-12 (GHQ-12), and MPA scale. Mann-Whitney U-test, Student's t-test, and Spearman's correlation test were used to analyze the questionnaire data. The 220 musicians who participated included 121 (55%) males and 99 (45%) females, with a mean age of 42.4±11.3 yrs. For musculoskeletal symptoms, 87.6% reported at least one symptom with the most common being pain. For general health status, the GHQ-12 showed 64% of musicians were at low risk, 18.7% at moderate risk, and 17.3% at high risk in terms of mental health. The prevalence of MPA before or during performance was 81.8%, and 60% of musicians stated that performance anxiety negatively affected their performances. Results indicate that musicians working in Turkish state symphony orchestras encounter numerous health problems (tinnitus, hearing loss, musculoskeletal symptoms, etc.) due to their profession. No specific health support is provided, especially education and health service provision.

  12. A Giant in the Shadows: Major General Benjamin Foulois and the Rise of the Army Air Service in World War I

    2013-05-01

    men departed New York and arrived in Brest , France, on 12 November 1917.90 On 27 November Pershing ap- pointed Foulois chief of Air Service, AEF...around the capital city of Paris , driving the Air Service’s deci- sion to establish its supply office there instead of at Chaumont with the rest of...units. He allowed the Sup- ply Section to remain in Paris with the understanding that once production from the United States eclipsed French production

  13. Evaluation of general practitioners' assessment of overweight among children attending the five-year preventive child health examination: a cross-sectional survey.

    Andersen, Merethe Kousgaard; Christensen, Bo; Obel, Carsten; Søndergaard, Jens

    2012-09-01

    To evaluate general practitioners' (GPs') assessment of potential overweight among children attending the five-year preventive child health examination (PCHE) by comparing their assessment of the children's weight-for-stature with overweight defined by body mass index (BMI) according to paediatric standard definitions. A cross-sectional survey. Data were obtained from a questionnaire survey of children's health in general and their growth in particular. The five-year preventive child health examination (PCHE) in general practice in the Central Denmark Region. Children attending the five-year PCHE in general practice, regardless of their weight status. Paediatric standard definitions for childhood overweight based on BMI were used as the gold standard for categorizing weight-for-stature. Identification of overweight was analysed with regard to sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the GPs' assessment of weight-for-stature. A total of 165 GPs conducted 1138 PCHEs. GPs assessed that 171 children had a weight-for-stature above normal. Use of the Danish Standards (DS), i.e. the Danish national growth charts for BMI, as the gold standard yielded a sensitivity of 70.1% (95% CI 62.0-77.3) and a specificity of 92.4% (95% CI 90.6-93.9). The sensitivity was influenced by the GPs' use of BMI and the presence of previous notes regarding abnormal weight development. At the five-year PCHE almost one-third of overweight children were assessed to be normal weight by GPs. Use of BMI and presence of notes on abnormal weight in medical records were positively associated with a higher identification. Hence, utilization of medical record data and BMI charts may refine GPs' assessment of childhood overweight.

  14. A New Era of Minimally Invasive Surgery: Progress and Development of Major Technical Innovations in General Surgery Over the Last Decade.

    Siddaiah-Subramanya, Manjunath; Tiang, Kor Woi; Nyandowe, Masimba

    2017-10-01

    Minimally invasive surgery (MIS) continues to play an important role in general surgery as an alternative to traditional open surgery as well as traditional laparoscopic techniques. Since the 1980s, technological advancement and innovation have seen surgical techniques in MIS rapidly grow as it is viewed as more desirable. MIS, which includes natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), is less invasive and has better cosmetic results. The technological growth and adoption of NOTES and SILS by clinicians in the last decade has however not been uniform. We look at the differences in new developments and advancement in the different techniques in the last 10 years. We also aim to explain these differences as well as the implications in general surgery for the future.

  15. Evaluation of Fire Resistance for H-Section Columns Made of Rolled Steels for General Structures and for Welded Structures by Analytic Method

    Kwon, In-Kyu

    2014-01-01

    Fire resistance is an important factor in sustaining the structural stability of steel framed buildings on fire. However, evaluation of the fire resistance of steel columns has been conducted using rolled steels for general structures, SS 400. Recently, rolled steels for welded structures, such as SM 400 and SM 490, have been used frequently because they have better performance of welding than the SS 400. However, there has been doubt about how much fire resistance SM 400 and SM 490 have. To evaluate by calculation the fire resistance of an H-section column made of SS 400 its mechanical and thermal properties were derived and suggested respectively in the form of regressive equations and the analysis was done based on heat transfer and thermal stress analysis. In this study, the results of the evaluation of H-section columns made of SS 400 with loaded fire tests turned out to be conservative. As a result, a new guideline is required to get the exact fire resistance of another structural steel.

  16. The effect of cooperative learning on the attitudes toward science and the achievement of students in a non-science majors' general biology laboratory course at an urban community college

    Chung-Schickler, Genevieve C.

    The purpose of this study was to evaluate the effect of cooperative learning strategies on students' attitudes toward science and achievement in BSC 1005L, a non-science majors' general biology laboratory course at an urban community college. Data were gathered on the participants' attitudes toward science and cognitive biology level pre and post treatment in BSC 1005L. Elements of the Learning Together model developed by Johnson and Johnson and the Student Team-Achievement Divisions model created by Slavin were incorporated into the experimental sections of BSC 1005L. Four sections of BSC 1005L participated in this study. Participants were enrolled in the 1998 spring (January) term. Students met weekly in a two hour laboratory session. The treatment was administered to the experimental group over a ten week period. A quasi-experimental pretest-posttest control group design was used. Students in the cooperative learning group (nsb1 = 27) were administered the Test of Science-Related Attitudes (TOSRA) and the cognitive biology test at the same time as the control group (nsb2 = 19) (at the beginning and end of the term). Statistical analyses confirmed that both groups were equivalent regarding ethnicity, gender, college grade point average and number of absences. Independent sample t-tests performed on pretest mean scores indicated no significant differences in the TOSRA scale two or biology knowledge between the cooperative learning group and the control group. The scores of TOSRA scales: one, three, four, five, six, and seven were significantly lower in the cooperative learning group. Independent sample t-tests of the mean score differences did not show any significant differences in posttest attitudes toward science or biology knowledge between the two groups. Paired t-tests did not indicate any significant differences on the TOSRA or biology knowledge within the cooperative learning group. Paired t-tests did show significant differences within the control group

  17. A vegetarian diet does not protect against nonalcoholic fatty liver disease (NAFLD): A cross-sectional study between Buddhist priests and the general population.

    Choi, Sung Hun; Oh, Dong Jun; Kwon, Ki Hwan; Lee, Jun Kyu; Koh, Moon Soo; Lee, Jin Ho; Kang, Hyoun Woo

    2015-07-01

    There is limited data that supports a role for a vegetarian diet in nonalcoholic fatty liver disease (NAFLD). The aim of this study is to evaluate the relationship between vegetarian diets and NAFLD, considering metabolic syndrome and obesity. This is a cross-sectional, retrospective study comparing the prevalence of NAFLD of 615 Buddhist priests and age-, sex-, Body mass index (BMI)-and presence/absence of metabolic syndrome-matched controls who underwent routine health checkups in a health promotion center. Diagnosis and severity of NAFLD was determined based on ultrasonographic findings. The prevalence of NAFLD was not statistically significantly different between the Buddhist priests and the general population (29.9% vs. 25.05%, p=0.055). The Buddhist priest group had higher serum albumin, serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), and serum triglyceride levels and lower serum total bilirubin, serum fasting glucose, and serum high density lipoprotein (HDL) levels than the general population group. In univariate analysis and multivariate analysis, NAFLD was associated with old age, male gender, increased BMI, increased waist circumference, metabolic syndrome, high albumin, high glucose, high AST, high ALT, high gamma glutamyl transpeptidase (GGT), high triglycerides, low HDL, high low density lipoprotein (LDL), and high total cholesterol. The vegetarian diet does not protect against NAFLD.

  18. Use of PSA for design of emergency mitigation systems in a hydrogen production plant using General Atomics SI cycle technology. Section 2: Sulphuric acid decomposition

    Mendoza, A.; Nelson, P.F.; Francois, J.L.

    2010-01-01

    Throughout the past decades, the need to reduce greenhouse gas emissions has prompted the development of technologies for the production of clean fuels through the use of zero emissions primary energy resources, such as heat from high temperature nuclear reactors. One of the most promising of these technologies is the generation of hydrogen by the sulphur-iodine cycle coupled to a high temperature nuclear reactor, initially proposed by General Atomics. By its nature and because these will have to be large-scale plants, development of these technologies from its current phase to its procurement and construction phase, will have to incorporate emergency mitigation systems in all its sections and nuclear-chemical 'tie-in points' to prevent unwanted events that can compromise the integrity of the plant and the nearby population centres. For the particular case of the SI thermochemical cycle, a large number of safety studies have been developed; however, most of these studies have focused on hydrogen explosions and failures in the primary cooling system. While these are the most catastrophic events, it is also true that there are many other events that without having a direct impact on the nuclear-chemical coupling, could jeopardise plant operations, safety of people in nearby communities and bring economic consequences. This study examined one of these events, which is the formation of a toxic cloud driven by an uncontrolled leakage of concentrated sulphuric acid in the second section of the General Atomics SI cycle. In this section, the concentration of sulphuric acid is close to 90% in conditions of high temperature and positive pressure. Under these conditions, sulphuric acid and sulphur oxides from the reactor would immediately form a toxic cloud, that in contact with operators could cause fatalities, or could produce choking, respiratory problems and eye irritation to people in neighbouring towns. The methodology used for this analysis is the design based on

  19. Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013-2014 and 2014-2015.

    Levene, Louis S; Baker, Richard; Wilson, Andrew; Walker, Nicola; Boomla, Kambiz; Bankart, M John G

    2017-01-01

    NHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups. To determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England. Cross-sectional study of all practices in England, in financial years 2013-2014 and 2014-2015. Descriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken. Several population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R 2 values were 0.359 (2013-2014) and 0.374 (2014-2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential. Population factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs. © British Journal of General Practice 2017.

  20. Food avoidance and restriction in adults: a cross-sectional pilot study comparing patients from an immunology clinic to a general practice.

    Fitzgerald, Michael; Frankum, Brad

    2017-01-01

    With the introduction of avoidant/restrictive food intake disorder (ARFID) in the Diagnostic and Statistical Manual - fifth edition, there is an increased need to understand the prevalence and pattern of food avoidance and restriction in adults. High rates of food allergy and intolerance in immunology clinic populations, and subsequent high rates of elimination diets, place these individuals at a greater risk of developing pathological eating behaviours. This descriptive cross sectional pilot study aims to provide preliminary data on the prevalence and nature of food avoidance and restriction in an adult population, and to explore the reasons for this behaviour. A self-administered questionnaire was designed and distributed to adults presenting to an immunology clinic and a general practice over the course of 6 months to describe the prevalence and nature of avoidant and restrictive eating behaviours in this population. Pearson's chi square test was used to examine the strength of a potential link to a formal diagnosis of avoidant restrictive food intake disorder in these patients. A total of 102 completed questionnaires were used for data analysis. Food avoidance or restriction was detected in 81 respondents (79%), with rates not significantly higher in the immunology clinic group compared to the general practice group ( p  = .242). Food allergy and intolerance were the most common reasons for disturbed eating patterns. Life impact secondary to food avoidance and restriction was reported by 26% of respondents, with significantly higher rates observed in the immunology clinic cohort compared to the general practice ( p  = .011). Eating disturbances similar to those characteristic of ARFID are very common in adults. Food avoidance and restriction due to perceived food allergy and intolerance are significant reasons for such disordered eating patterns, particularly in an immunology clinic population. Further investigation is needed to determine if such eating

  1. Motives of former interns in general practice for speciality-choice − Results of a cross-sectional study among graduates 2007 to 2012

    Abendroth, Jens; Schnell, Ute; Lichte, Thomas; Oemler, Matthias; Klement, Andreas

    2014-01-01

    Background: The influence of a final-year elective internship in general practice (IGP) on motives affecting graduates’ choice of specialty is the object of great public interest, yet still insufficiently evaluated. Longitudinal studies show the influence of numerous motives (e.g. work-life balance), but not following the IGP experience itself. Thus, we performed a cross-sectional questionnaire study of all graduates who completed the IGP in Saxony-Anhalt during 2007-2012 regarding their motives for choosing a speciality. Method: A standardized questionnaire was sent to 109 former interns in general practice. The questionnaire contained 29 items addressing three topics (personal attitudes, concept of personal and professional life, motives for speciality choice) and used single-choice and multiple-choice answers, as well as Likert scales. Correlation analysis was carried out by means of Kendall's tau. Results: The questionnaire reached 97 former interns, of which 45 (46%) responded. In the overall ranking of motives for speciality choice, family (71%), leisure time (66%) and job opportunities (48%) rated as more important than income (36%), mentoring (20%), status or scientific work (20%). Only 29% of the respondents stated that their speciality choice was changed by the IGP. If the speciality choice was already established before the IGP, the influence of the IGP on speciality choice was significantly low (r=-.5; pteacher during the IGP. Conclusion: The final-year IGP is an opportunity to change the perception of general practice in students who are still undecided. This can lead to different speciality choices in a subgroup. Personal attitudes and concepts of personal life and career were also important factors affecting speciality choice. The aspects of the positive influence exerted by medical teachers on those students who are still undecided during the IGP should be carefully evaluated. PMID:24575153

  2. Cross-sectional study on attitudes among general practitioners towards pneumococcal vaccination for middle-aged and elderly population in Hong Kong.

    Lancelot W H Mui

    Full Text Available OBJECTIVE: To study the attitudes among general practitioners towards pneumococcal vaccination for middle-aged (50-64 and elderly population (over 65 in Hong Kong and the factors affecting their decision to advise pneumococcal vaccination for those age groups. DESIGN: Cross-sectional study of general practitioners in private practice in Hong Kong. PARTICIPANTS: Members of Hong Kong Medical Association delivering general practice services in private sector. MEASURING TOOL: Self-administered questionnaire. MAIN OUTCOME MEASURES: Intention to recommend pneumococcal vaccination, barriers against pneumococcal vaccination. RESULTS: 53.4% of the respondents would actively recommend pneumococcal vaccination to elderly patients but only 18.8% would recommend for middle-aged patients. Consultation not related to pneumococcal vaccine was the main reason for not recommending pneumococcal vaccine (43.6%. Rarity of pneumonia in their daily practice was another reason with 68.4% of respondents attending five or less patients with pneumonia each year. In multivariate analysis, factors such as respondents would get vaccination when reaching age 50 (ORm 10.1, and attending 6 pneumonia cases or more per year (ORm 2.28 were found to be associated with increasing likelihood for recommending vaccination to the middle-aged. While concerns of marketing a product (ORm 0.41, consultation not related to vaccination (ORm 0.45 and limited time (ORm 0.38 were factors that reduced the likelihood. CONCLUSION: Public policy is needed to increase the awareness of impact of pneumococcal pneumonia and the availability of preventive measures.

  3. Major operations and activities

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the major operations and activities on the site. These operations and activities include site management, waste management, environmental restoration and corrective actions, and research and technology development.

  4. Major operations and activities

    Black, D.G.

    1995-01-01

    This section of the 1994 Hanford Site Environmental Report summarizes the major operations and activities on the site. These operations and activities include site management, waste management, environmental restoration and corrective actions, and research and technology development

  5. Major benzophenone concentrations and influence of food consumption among the general population in Korea, and the association with oxidative stress biomarker.

    Kim, Bokyung; Kwon, Bareum; Jang, Sol; Kim, Pan-Gyi; Ji, Kyunghee

    2016-09-15

    Benzophenones (BPs) have been used as sunscreen agents and as ultraviolet stabilizers in plastic surface coatings for food packaging. However, few studies have been performed to examine the level of human exposure to BPs and the potential sources of such exposure. We evaluated the exposure levels to six major BPs (BP-1, BP-2, BP-3, BP-4, BP-8, and 4-hydroxybenzophenone (4-OH-BP)) among the adult population in two cities in Korea, and investigated the potential dietary sources of the BPs. Urinary levels of malondialdehyde (MDA) as an oxidative stress biomarker as well as their association with the levels of BPs were also analyzed. Among the six BPs analyzed, 4-OH-BP, BP-1, BP-3, and BP-4 were detected in 77%, 49%, 27%, and 21% of the population, respectively. BP concentrations were relatively higher in younger (people in their 20s and 30s) cosmetic users and leaner women. Even after the adjustment of age, body mass index, and cosmetic use, the consumption of frozen storage food, instant noodles, and instant coffee was significantly correlated with urinary BPs, and these associations were sex-dependent. No significant correlation was observed between the levels of BPs and levels of MDA. The results of the present study will be useful for developing plans of public health management of BPs. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Chromosome mapping of repetitive DNAs in sergeant major fishes (Abudefdufinae, Pomacentridae): a general view on the chromosomal conservatism of the genus.

    Getlekha, Nuntaporn; Cioffi, Marcelo de Bello; Yano, Cassia Fernanda; Maneechot, Nuntiya; Bertollo, Luiz Antonio Carlos; Supiwong, Weerayuth; Tanomtong, Alongklod; Molina, Wagner Franco

    2016-10-01

    Species of the Abudefduf genus (sergeant-majors) are widely distributed in the Indian, Pacific and Atlantic oceans, with large schools inhabiting rocky coastal regions and coral reefs. This genus consists of twenty recognized species are of generalist habit, showing typical characteristics of colonizers. Some populations maintain gene flow between large oceanic areas, a condition that may influence their cytogenetic features. A number of species have been shown to be invaders and able to hybridize with local species. However, cytogenetic data in this genus are restricted to few species. In this way, the present study includes the chromosomal investigation, using conventional (Giemsa staining, Ag-NOR and C-banding) and molecular (in situ mapping of six different repetitive DNA classes) approaches in four Abudefduf species from different oceanic regions (A. bengalensis and A. sexfasciatus from the Indo-Pacific, A. vaigiensis from the Indian and A. saxatilis from the Atlantic oceans, respectively), to investigate the evolutionary events associated with the chromosomal diversification in this group. All species share a similar karyotype (2n = 48; NF = 52), except A. sexfasciatus (2n = 48; NF = 50), which possesses a characteristic pericentric inversion in the NOR-bearing chromosomal pair. Mapping of repetitive sequences suggests a chromosomal conservatism in this genus. The high karyotypic similarity between allopatric species of Abudefduf may be related to the success of natural viable hybrids among species with recent secondary contact.

  7. The comparison of severity and prevalence of major depressive disorder, general anxiety disorder and eating disorders before and after bariatric surgery.

    Matini, Diana; Ghanbari Jolfaei, Atefeh; Pazouki, Abdolreza; Pishgahroudsari, Mohadeseh; Ehtesham, Mehdi

    2014-01-01

    Severe obesity is highly co-morbid with psychiatric disorders and may have effect on the quality of life. This study aimed to compare severity and prevalence rate of depression, anxiety and eating disorders and quality of life in severe obese patients before and 6 months after the gastric bypass surgery. This was a prospective observational study which conducted at Hazarat Rasool-Akram Hospital in Tehran, 2012. Questionnaires included demographic questions, eating disorder Inventory (EDI), The Short Form Health Survey (SF-36) for quality of life, Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I) and Hamilton Rating Scale for Depression (HRSD) and anxiety (HRSA). Participants were interviewed two times, before surgery and six months after, to determine changes of the disorders. Patients with the history of bariatric surgery, individuals younger than 18 year old and those who disagreed to join the study were excluded. In assessing the eating disorder inventory-3rd version (EDI-3), Significant reduction in drive for thinness (DT) (p= 0.010), bulimia (B) (pdepression in HRSD (p= 0.311), prevalence of depression (p= 0.189) and prevalence of general anxiety disorder according to SCID (p=0.167) did not differ significantly, at this period. Although weight loss after bariatric surgery improved the physical component of quality of life, this improvement did not affect the mental aspect of life, depression and anxiety and it seems that these psychopathologies need attention and treatment in addition to weight loss treatments in patients with obesity.

  8. Transfusion practice in anemic, non-bleeding patients: Cross-sectional survey of physicians working in general internal medicine teaching hospitals in Switzerland.

    Michelle von Babo

    Full Text Available Transfusion practice might significantly influence patient morbidity and mortality. Between European countries, transfusion practice of red blood cells (RBC greatly differs. Only sparse data are available on transfusion practice of general internal medicine physicians in Switzerland.In this cross-sectional survey, physicians working in general medicine teaching hospitals in Switzerland were investigated regarding their self-reported transfusion practice in anemic patients without acute bleeding. The definition of anemia, transfusion triggers, knowledge on RBC transfusion, and implementation of guidelines were assessed.560 physicians of 71 hospitals (64% responded to the survey. Anemia was defined at very diverging hemoglobin values (by 38% at a hemoglobin <130 g/L for men and by 57% at <120 g/L in non-pregnant women. 62% and 43% respectively, did not define anemia in men and in women according to the World Health Organization. Fifty percent reported not to transfuse RBC according to international guidelines. Following factors were indicated to influence the decision to transfuse: educational background of the physicians, geographical region of employment, severity of anemia, and presence of known coronary artery disease. 60% indicated that their knowledge on Transfusion-related Acute Lung Injury (TRALI did not influence transfusion practice. 50% of physicians stated that no local transfusion guidelines exist and 84% supported the development of national recommendations on transfusion in non-acutely bleeding, anemic patients.This study highlights the lack of adherence to current transfusion guidelines in Switzerland. Identifying and subsequently correcting this deficit in knowledge translation may have a significant impact on patient care.

  9. Healthy life styles and perceived health status in the general population of a Northern Italian health district: a cross-sectional study

    Edoardo Colzani

    2010-09-01

    Full Text Available

    Background: Evidence should drive public health initiatives to better address the most important health issues. Chronic diseases represent the main burden of healthcare expenditure in Western countries and are determined by risk factors related to behaviour. Population-based surveys should lead to well informed decision making in this field.

    Methods: A cross-sectional survey was carried out among the general population aged between 18 and 69 in the district of Monza-Brianza in Northern Italy through phone interviews. A validated questionnaire investigating health-related lifestyles and behaviours was used. The questionnaire was divided into the following parts: general health status, physical activity, smoking habit, nutrition, alcohol consumption, driving safety, cardiovascular risk, cancer screening, mental health, domestic safety and socio-economic status.

    Results: In total, 308 interviews were carried out (response rate=76%. Almost 40% reported a body mass index >25, 64.9% had high school or university degrees, 60.4% worked full-time, 26.2% were assessed as physically inactive, and 13.3% were on a weight –loss diet. In addition, 19.7% had an “at risk” alcohol consumption , especially among younger age groups. Symptoms of depression were identified in 4.9% of the study subjects, particularly in women.

    Conclusions: Age, body mass index, education, and occupation were significantly associated with the likelihood of reporting poor health status. Young subjects were more likely to be smokers and drinkers at risk. Psychological health and appropriate prescription of anti-cholesterol and anti-hypertensive drugs areì areas deserving further investigations. Nutrition, physical activity, driving safety and youth health, especially concerning drinking

  10. Motives of former interns in general practice for speciality-choice--results of a cross-sectional study among graduates 2007 to 2012.

    Abendroth, Jens; Schnell, Ute; Lichte, Thomas; Oemler, Matthias; Klement, Andreas

    2014-01-01

    The influence of a final-year elective internship in general practice (IGP) on motives affecting graduates' choice of specialty is the object of great public interest, yet still insufficiently evaluated. Longitudinal studies show the influence of numerous motives (e.g., work-life balance), but not following the IGP experience itself. Thus, we performed a cross-sectional questionnaire study of all graduates who completed the IGP in Saxony-Anhalt during 2007-2012 regarding their motives for choosing a speciality. A standardized questionnaire was sent to 109 former interns in general practice. The questionnaire contained 29 items addressing three topics (personal attitudes, concept of personal and professional life, motives for speciality choice) and used single-choice and multiple-choice answers, as well as Likert scales. Correlation analysis was carried out by means of Kendall's tau. The questionnaire reached 97 former interns, of which 45 (46%) responded. In the overall ranking of motives for speciality choice, family (71%), leisure time (66%) and job opportunities (48%) rated as more important than income (36%), mentoring (20%), status or scientific work (20%). Only 29% of the respondents stated that their speciality choice was changed by the IGP. If the speciality choice was already established before the IGP, the influence of the IGP on speciality choice was significantly low (r = -.5; p life and career were also important factors affecting speciality choice. The aspects of the positive influence exerted by medical teachers on those students who are still undecided during the IGP should be carefully evaluated.

  11. The geography of diabetes among the general adults aged 35 years and older in Bangladesh: recent evidence from a cross-sectional survey.

    Md Mobarak Hossain Khan

    Full Text Available To report geographical variations of sex-specific diabetes by place of residence (large cities/city corporations, small towns/other urban areas, rural areas and region of residence (divided into seven divisions among general adults (35+ years of age in Bangladesh.The recent cross-sectional data, extracted from the nationally representative Bangladesh Demographic and Health Survey 2011, was used. A total of 3,720 men and 3,823 women aged 35+ years, who participated in the fasting blood sugar testing, were analysed. Any person with either fasting plasma glucose level (mmol/L ≥7.0 or taking medication for diabetes was considered as a person with diabetes.The prevalence of diabetes was 10.6% in men and 11.3% in women. Bivariable analyses indicated significant variations of diabetes by both geographical variables. The prevalence was highest in city corporations (men 18.0%, women 22.3%, followed by small towns (men 13.6%, women 15.2% and rural areas (men 9.3%, women 9.5%. Regional disparities in diabetes prevalence were also remarkable, with the highest prevalence in Chittagong division and lowest prevalence in Khulna division. Multivariable logistic regression analyses provided mixed patterns of geographical disparities (depending on the adjusted variables. Some other independent risk factors for diabetes were advancing age, higher level of education and wealth, having TV (a proxy indicator of physical activity, overweight/obesity and hypertension.Over 10% of the general adults aged 35 years and older were having diabetes. Most of the persons with diabetes were unaware of this before testing fasting plasma glucose level. Although significant disparities in diabetes prevalence by geographical variables were observed, such disparities are very much influenced by the adjusted variables. Finally, we underscore the necessities of area-specific strategies including early diagnosis and health education programmes for changing lifestyles to reduce the risk

  12. Prevalence of high frequency hearing loss consistent with noise exposure among people working with sound systems and general population in Brazil: A cross-sectional study

    Trevisani Virgínia FM

    2008-05-01

    Full Text Available Abstract Background Music is ever present in our daily lives, establishing a link between humans and the arts through the senses and pleasure. Sound technicians are the link between musicians and audiences or consumers. Recently, general concern has arisen regarding occurrences of hearing loss induced by noise from excessively amplified sound-producing activities within leisure and professional environments. Sound technicians' activities expose them to the risk of hearing loss, and consequently put at risk their quality of life, the quality of the musical product and consumers' hearing. The aim of this study was to measure the prevalence of high frequency hearing loss consistent with noise exposure among sound technicians in Brazil and compare this with a control group without occupational noise exposure. Methods This was a cross-sectional study comparing 177 participants in two groups: 82 sound technicians and 95 controls (non-sound technicians. A questionnaire on music listening habits and associated complaints was applied, and data were gathered regarding the professionals' numbers of working hours per day and both groups' hearing complaint and presence of tinnitus. The participants' ear canals were visually inspected using an otoscope. Hearing assessments were performed (tonal and speech audiometry using a portable digital AD 229 E audiometer funded by FAPESP. Results There was no statistically significant difference between the sound technicians and controls regarding age and gender. Thus, the study sample was homogenous and would be unlikely to lead to bias in the results. A statistically significant difference in hearing loss was observed between the groups: 50% among the sound technicians and 10.5% among the controls. The difference could be addressed to high sound levels. Conclusion The sound technicians presented a higher prevalence of high frequency hearing loss consistent with noise exposure than did the general population, although

  13. Socioeconomic disadvantage and its implications for population health planning of obesity and overweight, using cross-sectional data from general practices from a regional catchment in Australia.

    Ghosh, Abhijeet; Charlton, Karen E; Batterham, Marijka J

    2016-05-03

    To identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity. Cross-sectional secondary analysis of data. Primary healthcare-17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW). A subset (n=36 674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118 794) that included information on disease status of all adult patients who had height and weight measurements recorded in their electronic health records and had visited the included general practices within the Illawarra-Shoalhaven region of NSW between September 2011 and September 2013. Age-adjusted odds ratio (aOR) of overweight and obesity was determined for high and low levels of socioeconomic disadvantage based on Socio-Economic Indexes for Areas (SEIFA)-Index of Relative Socio-Economic Disadvantage (IRSD) scores of patients' residential statistical local area. In men, overweight was lowest in areas of highest socioeconomic disadvantage (aOR=0.910; 95% CI 0.830 to 0.998; pdisadvantage (aOR=1.292; 95% CI 1.210 to 1.379; pdata analysis reveals multiple layers of evidence that should be assessed for population health approaches to curb the epidemic of obesity and overweight. It strongly highlights the need for preventive health initiatives to be specific to gender and socioeconomic attributes of the target population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. A cross-sectional study of the knowledge, attitude, and practice of general practitioners regarding dog bite management in nothern India

    Abhishek Singh

    2013-01-01

    Full Text Available Context: There are many myths and false beliefs associated with wound management. These include application of oils, herbs, and red chilies on wound inflicted by rabid animals, and not washing the wound properly. General practitioners (GPs constitute a key source of medical care in study area and are approached for anti-rabies treatment by victims of animal bites. Aim: The aim of the present study is to assess the knowledge and practices among the general practitioners (GPs regarding dog bite management. Settings and Design : Community-based cross-sectional study. Materials and Methods: The present study was carried out in the private and public clinics of Ambala city from January 2012 to April 2012 using a pre-tested self-administered questionnaire. The study population composed of 100 GPs comprising 45 MBBS or above degree holders (Group 1 and 55 other GPs like BAMS, RMPs, etc (Group 2. Statistical Analysis Used: Interpretation of data was done using percentages and proportions. χ2 -Test was used to test the statistical difference in the knowledge between the two groups. Results: Out of the total, 68% and 29% respondents in Group 1 and Group 2, respectively, correctly told that wound must be washed with soap and water for minimum period of 15 min. A total 71% and 11% respondents in Group 1 and Group 2, respectively, could correctly answer about the target groups for pre-exposure prophylaxis. A total 62% GPs did not know the high-risk groups to whom pre-exposure prophylaxis has to be given. Conclusions: There was an apparent lack of awareness among the GPs regarding appropriate animal wound management and vaccine administration. Reorientation programs and continued medical education for GPs are required to highlight the WHO guidelines regarding treatment of animal bite.

  15. Factors associated with hepatitis C prevalence differ by the stage of liver fibrosis: A cross-sectional study in the general population in Poland, 2012-2016.

    Magdalena Rosińska

    Full Text Available There is a considerable burden of hepatitis C in Europe related to the lack of prompt diagnosis. We aimed to estimate the prevalence and related risk factors of HCV infections by the stages of liver fibrosis, using non-invasive methods, to understand testing needs in Poland.A cross-sectional study was conducted in 2012-2016 adopting a stratified random sampling of primary health care units followed by systematic sampling of patients within each unit. Study participants filled a questionnaire and donated blood for laboratory HCV testing. Additionally, the results of liver function tests and platelet count were collected to calculate APRI and FIB-4 scores. Cases were classified according to the level of fibrosis: 'significant fibrosis' (APRI≥0.7 or FIB4≥1.45 and 'no significant fibrosis' (APRI<0.7 and FIB4<1.45.Of 21 875 study participants, 102 were HCV-RNA positive. Prevalence of HCV infections and significant fibrosis was estimated at 0.47% (95% CI 0.38% - 0.57% and 0.12% (0.08% - 0.17%, respectively. Cases with significant fibrosis accounted for 51.6% (33.4%-69.9% in men and 34.4% (17.3%-51.4% in women. There was no correlation between the HCV prevalence and age. Blood transfusion prior to 1992 strongly predicted significant fibrosis as did the history of injecting drug use (IDU and ever having an HCV-infected sexual partner in men and caesarean sections in women. Factors associated with HCV infection without significant fibrosis were tattooing in men and younger age in women. We acknowledge limited possibility to study the associations between IDU and ever having HCV-infected sexual partner, given small sample sizes for these exposures.As no clear birth cohort affected by HCV could be identified, risk factor-based screening in the general population should be considered, taking into account the association between the increased risk of liver fibrosis and the history of transfusion prior to 1992 and caesarean sections.

  16. A Randomized, Placebo-Controlled Pilot Study of Quetiapine-XR Monotherapy or Adjunctive Therapy to Antidepressant in Acute Major Depressive Disorder with Current Generalized Anxiety Disorder.

    Li, Ranran; Wu, Renrong; Chen, Jun; Kemp, David E; Ren, Ming; Conroy, Carla; Chan, Philip; Serrano, Mary Beth; Ganocy, Stephen J; Calabrese, Joseph R; Gao, Keming

    2016-03-01

    To pilot efficacy and safety data of quetiapine-XR monotherapy or adjunctive therapy to antidepressant(s) in the acute treatment of MDD with current generalized anxiety disorder (GAD). The Mini International Neuropsychiatric Interview was used to ascertain the diagnosis of DSM-IV Axis I disorders. Eligible patients were randomly assigned to quetiapine-XR or placebo for up to 8 weeks. Changes from baseline to endpoint in Hamilton Depression Rating Scale-17 items (HAMD-17), Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression-Severity (CGI-S), Quick Inventory of Depression Symptomatology-16 items Self-Report (QIDS-16-SR) total scores, and other outcome measures were analyzed with the last observation carried forward strategy and/or mixed-effects modeling for repeated measures. Of the 34 patients screened, 23 patients were randomized to receive quetiapine-XR (n = 11) or placebo (n = 12), with 5 and 4 completing the study, respectively. The mean dose of quetiapine-XR was 154 ± 91 mg/d. The change from baseline to endpoint in the total scores of HAMD-17, HAM-A, QIDS-16-SR, and CGI-S were significant in the quetiapine-XR group, but only the change in HAM-A total score was significant in the placebo group. The differences in these changes between the two groups were only significant in CGI-S scores, with the rest of numerical larger in the quetiapine-XR group. The most common side effects from quetiapine-XR were dry mouth, somnolence/sedation, and fatigue. In this pilot study, quetiapine-XR was numerically superior to placebo in reducing depressive and anxiety symptoms in patients with MDD and current GAD. Large sample studies are warranted to support or refute these preliminary findings.

  17. Plasma Carotenoids, Tocopherols, and Retinol in the Age-Stratified (35-74 Years) General Population: A Cross-Sectional Study in Six European Countries.

    Stuetz, Wolfgang; Weber, Daniela; Dollé, Martijn E T; Jansen, Eugène; Grubeck-Loebenstein, Beatrix; Fiegl, Simone; Toussaint, Olivier; Bernhardt, Juergen; Gonos, Efstathios S; Franceschi, Claudio; Sikora, Ewa; Moreno-Villanueva, María; Breusing, Nicolle; Grune, Tilman; Bürkle, Alexander

    2016-09-30

    Blood micronutrient status may change with age. We analyzed plasma carotenoids, α-/γ-tocopherol, and retinol and their associations with age, demographic characteristics, and dietary habits (assessed by a short food frequency questionnaire) in a cross-sectional study of 2118 women and men (age-stratified from 35 to 74 years) of the general population from six European countries. Higher age was associated with lower lycopene and α-/β-carotene and higher β-cryptoxanthin, lutein, zeaxanthin, α-/γ-tocopherol, and retinol levels. Significant correlations with age were observed for lycopene ( r = -0.248), α-tocopherol ( r = 0.208), α-carotene ( r = -0.112), and β-cryptoxanthin ( r = 0.125; all p tocopherol with age remained when all covariates including cholesterol and use of vitamin supplements were included (1.7% vs. 2.4% per five-year age increase). The association of higher β-cryptoxanthin with higher age was no longer statistically significant after adjustment for fruit consumption, whereas the inverse association of α-carotene with age remained in the fully adjusted multivariable model (-4.8% vs. -3.8% per five-year age increase). We conclude from our study that age is an independent predictor of plasma lycopene, α-tocopherol, and α-carotene.

  18. Vitamin D status in patients with musculoskeletal pain, fatigue and headache: a cross-sectional descriptive study in a multi-ethnic general practice in Norway.

    Knutsen, Kirsten Valebjørg; Brekke, Mette; Gjelstad, Svein; Lagerløv, Per

    2010-09-01

    To investigate vitamin D levels in patients with non-specific musculoskeletal pain, headache, and fatigue. A cross-sectional descriptive study. A health center in Oslo, Norway, with a multi-ethnic population. A total of 572 patients referred by a general practitioner (GP) for an examination of hypovitaminosis D who reported musculoskeletal pain, headache, or fatigue. The patients' native countries were: Norway (n = 249), Europe, America, and South-East Asia (n = 83), and the Middle East, Africa, and South Asia (n = 240). Both genders and all ages were included. Vitamin D levels (25-hydroxyvitamin D) in nmol/L. Hypovitaminosis D (25-hydroxyvitamin D prevalence of hypovitaminosis D in patients with non-specific musculoskeletal pain, headache, or fatigue for whom the GP had suspected a low vitamin D level. Hypovitaminosis D was not restricted to immigrant patients. These results indicate that GPs should maintain awareness of hypovitaminosis D and refer patients who report headaches, fatigue, and musculoskeletal pain with minimal sun exposure and a low dietary vitamin D intake for assessment.

  19. Dual parametrization of the proton generalized parton distribution functions H and E, and description of the deeply virtual Compton scattering cross sections and asymmetries

    Guzey, V.; Teckentrup, T.

    2006-01-01

    We develop the minimal model of a new leading order parametrization of generalized parton distributions (GPDs) introduced by Polyakov and Shuvaev. The model for GPDs H and E is formulated in terms of the forward quark distributions, the Gegenbauer moments of the D-term, and the forward limit of the GPD E. The model is designed primarily for small and medium-size values of x B , x B ≤0.2. We examine two different models of the t dependence of the GPDs: the factorized exponential model and the nonfactorized Regge-motivated model. Using our model, we successfully described the deeply virtual Compton scattering (DVCS) cross section measured by H1 and ZEUS, the moments of the beam-spin A LU sinφ , the beam-charge A C cosφ , and the transversely polarized target A UT sinφcosφ DVCS asymmetries measured by HERMES and A LU sinφ measured by CLAS. The data on A C cosφ prefer the Regge-motivated model of the t dependence of the GPDs. The data on A UT sinφcosφ indicate that the u and d quarks carry only a small fraction of the proton total angular momentum

  20. A cross-sectional survey of the access of older people in the Scottish Highlands to general medical practices, community pharmacies and prescription medicines.

    Rushworth, Gordon F; Cunningham, Scott; Pfleger, Sharon; Hall, Jenny; Stewart, Derek

    2018-01-01

    Access to medicines and healthcare is more problematic in remote and rural areas. To quantify issues of access to general practitioners (GPs), community pharmacies and prescribed medicines in older people resident in the Scottish Highlands. Anonymized questionnaires were mailed to a random sample of 2000 older people (≥60 years) resident in the Scottish Highlands. Questionnaire items were: access and convenience to GP and pharmacy services (10 items); prescribed medicines (13 items); attitudinal statements based on the Theoretical Domains Framework (12 items); quality of life (SF8, 8 items); and demographics (12 items). Results were analysed using descriptive, inferential and spatial statistics, and principal component analysis (PCA) of attitudinal items. With a response rate of 54.2%, the majority reported convenient access to GPs (89.1%) and community pharmacies (84.3%). Older age respondents (p rural areas to community pharmacies (p rural areas and taking five or more prescribed medicines. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Major Links.

    Henderson, Tona

    1995-01-01

    Provides electronic mail addresses for resources and discussion groups related to the following academic majors: art, biology, business, chemistry, computer science, economics, health sciences, history, literature, math, music, philosophy, political science, psychology, sociology, and theater. (AEF)

  2. Major Roads

    Minnesota Department of Natural Resources — This data set contains roadway centerlines for major roads (interstates and trunk highways) found on the USGS 1:24,000 mapping series. These roadways are current...

  3. Wound Infection following Caesarean Section in a University ...

    Background: Caesarean section is a common operation in obstetric practice, but there is a general aversion to caesarean section amongst Nigerian women due to a myriad of reasons amongst which are its associated morbidity and mortality. Surgical site infection following caesarean section is both a major cause of ...

  4. Post-Traumatic Stress Disorder and other mental disorders in the general population after Lorca’s earthquakes, 2011 (Murcia, Spain): A cross-sectional study

    Salmerón, Diego; Vilagut, Gemma; Tormo, Mª José; Ruíz-Merino, Guadalupe; Escámez, Teresa; Júdez, Javier; Martínez, Salvador; Koenen, Karestan C.; Navarro, Carmen; Alonso, Jordi; Kessler, Ronald C.

    2017-01-01

    Aims To describe the prevalence and severity of mental disorders and to examine differences in risk among those with and without a lifetime history prior to a moderate magnitude earthquake that took place in Lorca (Murcia, Spain) at roughly the mid-point (on May 11, 2011) of the time interval in which a regional epidemiological survey was already being carried out (June 2010 –May 2012). Methods The PEGASUS-Murcia project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia. Main outcome measures are prevalence and severity of anxiety, mood, impulse and substance disorders in the 12 months previous to the survey, assessed using the Composite International Diagnostic Interview (CIDI 3.0). Sociodemographic variables, prior history of any mental disorder and earthquake-related stressors were entered as independent variables in a logistic regression analysis. Findings A total number of 412 participants (response rate: 71%) were interviewed. Significant differences in 12-month prevalence of mental disorders were found in Lorca compared to the rest of Murcia for any (12.8% vs 16.8%), PTSD (3.6% vs 0.5%) and other anxiety disorders (5.3% vs 9.2%) (p≤ 0.05 for all). No differences were found for 12-month prevalence of any mood or any substance disorder. The two major predictors for developing a 12-month post-earthquake mental disorder were a prior mental disorder and the level of exposure. Other risk factors included female sex and low-average income. Conclusions PTSD and other mental disorders are commonly associated with earthquake disasters. Prior mental disorders and the level of exposure to the earthquakes are the most important for the development of a consequent mental disorder and this recognition may help to identify those individuals that may most benefit from specific therapeutic intervention. PMID:28723949

  5. Post-Traumatic Stress Disorder and other mental disorders in the general population after Lorca's earthquakes, 2011 (Murcia, Spain): A cross-sectional study.

    Navarro-Mateu, Fernando; Salmerón, Diego; Vilagut, Gemma; Tormo, Mª José; Ruíz-Merino, Guadalupe; Escámez, Teresa; Júdez, Javier; Martínez, Salvador; Koenen, Karestan C; Navarro, Carmen; Alonso, Jordi; Kessler, Ronald C

    2017-01-01

    To describe the prevalence and severity of mental disorders and to examine differences in risk among those with and without a lifetime history prior to a moderate magnitude earthquake that took place in Lorca (Murcia, Spain) at roughly the mid-point (on May 11, 2011) of the time interval in which a regional epidemiological survey was already being carried out (June 2010 -May 2012). The PEGASUS-Murcia project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia. Main outcome measures are prevalence and severity of anxiety, mood, impulse and substance disorders in the 12 months previous to the survey, assessed using the Composite International Diagnostic Interview (CIDI 3.0). Sociodemographic variables, prior history of any mental disorder and earthquake-related stressors were entered as independent variables in a logistic regression analysis. A total number of 412 participants (response rate: 71%) were interviewed. Significant differences in 12-month prevalence of mental disorders were found in Lorca compared to the rest of Murcia for any (12.8% vs 16.8%), PTSD (3.6% vs 0.5%) and other anxiety disorders (5.3% vs 9.2%) (p≤ 0.05 for all). No differences were found for 12-month prevalence of any mood or any substance disorder. The two major predictors for developing a 12-month post-earthquake mental disorder were a prior mental disorder and the level of exposure. Other risk factors included female sex and low-average income. PTSD and other mental disorders are commonly associated with earthquake disasters. Prior mental disorders and the level of exposure to the earthquakes are the most important for the development of a consequent mental disorder and this recognition may help to identify those individuals that may most benefit from specific therapeutic intervention.

  6. Post-Traumatic Stress Disorder and other mental disorders in the general population after Lorca's earthquakes, 2011 (Murcia, Spain: A cross-sectional study.

    Fernando Navarro-Mateu

    Full Text Available To describe the prevalence and severity of mental disorders and to examine differences in risk among those with and without a lifetime history prior to a moderate magnitude earthquake that took place in Lorca (Murcia, Spain at roughly the mid-point (on May 11, 2011 of the time interval in which a regional epidemiological survey was already being carried out (June 2010 -May 2012.The PEGASUS-Murcia project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia. Main outcome measures are prevalence and severity of anxiety, mood, impulse and substance disorders in the 12 months previous to the survey, assessed using the Composite International Diagnostic Interview (CIDI 3.0. Sociodemographic variables, prior history of any mental disorder and earthquake-related stressors were entered as independent variables in a logistic regression analysis.A total number of 412 participants (response rate: 71% were interviewed. Significant differences in 12-month prevalence of mental disorders were found in Lorca compared to the rest of Murcia for any (12.8% vs 16.8%, PTSD (3.6% vs 0.5% and other anxiety disorders (5.3% vs 9.2% (p≤ 0.05 for all. No differences were found for 12-month prevalence of any mood or any substance disorder. The two major predictors for developing a 12-month post-earthquake mental disorder were a prior mental disorder and the level of exposure. Other risk factors included female sex and low-average income.PTSD and other mental disorders are commonly associated with earthquake disasters. Prior mental disorders and the level of exposure to the earthquakes are the most important for the development of a consequent mental disorder and this recognition may help to identify those individuals that may most benefit from specific therapeutic intervention.

  7. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study.

    Kimihiko Murase

    Full Text Available Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population.Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS score and a Roland-Morris disability questionnaire (RDQ score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality.Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR = 1.19, p<0.01; low back pain: OR = 1.13, p = 0.01 and poor sleep quality (knee pain: OR = 1.22, p<0.01; low back pain; OR = 1.57, p<0.01. The group in the highest tertile of the NRS or RDQ score had the highest risk for short sleep duration and poor sleep quality except for the relationship between the highest tertile of the RDQ score and short sleep duration.(the highest tertile of the NRS: OR for short sleep duration = 1.31, p<0.01; OR for poor sleep quality = 1.47, p<0.01; the highest tertile of the RDQ: OR for short sleep duration = 1.11, p = 0.12; OR for poor sleep quality = 1.81, p<0.01 Further, coincident knee and low back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, p<0.01 and poor sleep quality (either of knee or low back pain: OR

  8. Prevalence of Chronic Disabling Noncancer Pain and Associated Demographic and Medical Variables: A Cross-Sectional Survey in the General German Population.

    Häuser, Winfried; Schmutzer, Gabriele; Hilbert, Anja; Brähler, Elmar; Henningsen, Peter

    2015-10-01

    In population surveys, up to 30% of participants reported chronic pain. Reports of chronic pain do not necessarily imply disability associated with pain. We assessed the prevalence of chronic disabling noncancer pain and associated demographic and medical variables in a sample of the general German population. A cross-sectional survey was conducted with 4360 people aged 14 years and above, who were representative of the German population. Measures were obtained for demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (based on a chronic pain grade questionnaire), and disease load (based on the self-reported comorbidity questionnaire). Responses were received from 2508 people. The prevalence of chronic pain was 28.3% (95% [confidence interval] CI, 26.5%-30.1%). In all, 7.3% (95% CI, 5.9%-8.7%) of participants met the criteria of chronic disabling noncancer pain. Chronic disabling noncancer pain was associated with age above 65 years (odds ratios [OR]=4.81 [95% CI, 1.57-14.79]), low family income (OR=2.54 [95% CI, 1.36-4.74]), obesity (OR=3.58 [95% CI, 2.21-5.79]), heart disease (OR=2.23 [95% CI, 3.69-11.40]), stomach disease (OR=4.24 [95% CI, 2.12-8.49]), and rheumatic disease (OR=3.67 [95% CI, 2.16-6.23]) when compared with no chronic pain. Chronic disabling noncancer pain was associated with low family income (OR=2.29 [95% CI, 1.23-4.27]), obesity (OR=2.14 [95% CI, 1.30-3.52]), and depression (OR=3.26 [95% CI, 1.90-5.66]) when compared with chronic nondisabling noncancer pain. Prevalence rates of chronic disabling pain in the general population rather than prevalence rates of chronic pain might provide evidence in support of pain specialist care. The association of chronic disabling noncancer pain with mental disorders highlights the need for psychosocial services in chronic pain management.

  9. Can we bridge the gap? Knowledge and practices related to Diabetes Mellitus among general practitioners in a developing country: A cross sectional study.

    Katulanda, Prasad; Constantine, Godwin R; Weerakkody, Muditha I; Perera, Yashasvi S; Jayawardena, Mahesh G; Wijegoonawardena, Preethi; Matthews, David R; Sheriff, Mohamed Hr

    2011-11-24

    Diabetes mellitus is becoming a serious public health problem in Sri Lanka and many other developing countries in the region. It is well known that effective management of diabetes reduces the incidence and progression of many diabetes related complications, thus it is important that General Practitioners (GPs) have sound knowledge and positive attitudes towards all aspects of its management. This study aims to assess knowledge, awareness and practices relating to management of Diabetes Mellitus among Sri Lankan GPs. A cross-sectional study was conducted among all 246 GPs registered with the Ceylon College of General Practitioners using a pre-validated self-administered questionnaire. 205 responded to the questionnaire(response rate 83.3%). Their mean duration of practice was 28.7 ± 11.2 years. On average, each GP had 27 ± 25 diabetic-patient consultations per-week. 96% managed diabetic patients and 24% invariably sought specialist opinion. 99.2% used blood glucose to diagnose diabetes but correct diagnostic cut-off values were known by only 48.8%. Appropriate use of HbA1c and urine microalbumin was known by 15.2% and 39.2% respectively. 84% used HbA1c to monitor glyceamic control, while 90.4% relied on fasting blood glucose to monitor glyceamic control. Knowledge on target control levels was poor.Nearly 90% correctly selected the oral hypoglyceamic treatment for obese as well as thin type 2 diabetic patients. Knowledge on the management of diabetes in pregnancy was poor. Only 23.2% knew the correct threshold for starting lipid-lowering therapy. The concept of strict glycaemic control in preference to symptom control was appreciated only by 68%. The skills for comprehensive care in subjects with multiple risk factors were unsatisfactory. The study was done among experienced members of the only professional college dedicated to the specialty. However, we found that there is room for improvement in their knowledge and practices related to diabetes. We recommend

  10. Can we bridge the gap? Knowledge and practices related to Diabetes Mellitus among general practitioners in a developing country: A cross sectional study

    Katulanda Prasad

    2011-11-01

    Full Text Available Abstract Background Diabetes mellitus is becoming a serious public health problem in Sri Lanka and many other developing countries in the region. It is well known that effective management of diabetes reduces the incidence and progression of many diabetes related complications, thus it is important that General Practitioners (GPs have sound knowledge and positive attitudes towards all aspects of its management. This study aims to assess knowledge, awareness and practices relating to management of Diabetes Mellitus among Sri Lankan GPs. Methods A cross-sectional study was conducted among all 246 GPs registered with the Ceylon College of General Practitioners using a pre-validated self-administered questionnaire. Results 205 responded to the questionnaire(response rate 83.3%. Their mean duration of practice was 28.7 ± 11.2 years. On average, each GP had 27 ± 25 diabetic-patient consultations per-week. 96% managed diabetic patients and 24% invariably sought specialist opinion. 99.2% used blood glucose to diagnose diabetes but correct diagnostic cut-off values were known by only 48.8%. Appropriate use of HbA1c and urine microalbumin was known by 15.2% and 39.2% respectively. 84% used HbA1c to monitor glyceamic control, while 90.4% relied on fasting blood glucose to monitor glyceamic control. Knowledge on target control levels was poor. Nearly 90% correctly selected the oral hypoglyceamic treatment for obese as well as thin type 2 diabetic patients. Knowledge on the management of diabetes in pregnancy was poor. Only 23.2% knew the correct threshold for starting lipid-lowering therapy. The concept of strict glycaemic control in preference to symptom control was appreciated only by 68%. The skills for comprehensive care in subjects with multiple risk factors were unsatisfactory. Conclusions The study was done among experienced members of the only professional college dedicated to the specialty. However, we found that there is room for improvement in

  11. Characteristics of service users and provider organisations associated with experience of out of hours general practitioner care in England: population based cross sectional postal questionnaire survey.

    Warren, Fiona C; Abel, Gary; Lyratzopoulos, Georgios; Elliott, Marc N; Richards, Suzanne; Barry, Heather E; Roland, Martin; Campbell, John L

    2015-04-29

    To investigate the experience of users of out of hours general practitioner services in England, UK. Population based cross sectional postal questionnaire survey. General Practice Patient Survey 2012-13. Potential associations between sociodemographic factors (including ethnicity and ability to take time away from work during working hours to attend a healthcare consultation) and provider organisation type (not for profit, NHS, or commercial) and service users' experience of out of hours care (timeliness, confidence and trust in the out of hours clinician, and overall experience of the service), rated on a scale of 0-100. Which sociodemographic/provider characteristics were associated with service users' experience, the extent to which any observed differences could be because of clustering of service users of a particular sociodemographic group within poorer scoring providers, and the extent to which observed differences in experience varied across types of provider. The overall response rate was 35%; 971,232/2,750,000 patients returned surveys. Data from 902,170 individual service users were mapped through their registered practice to one of 86 providers of out of hours GP care with known organisation type. Commercial providers of out of hours GP care were associated with poorer reports of overall experience of care, with a mean difference of -3.13 (95% confidence interval -4.96 to -1.30) compared with not for profit providers. Asian service users reported lower scores for all three experience outcomes than white service users (mean difference for overall experience of care -3.62, -4.36 to -2.89), as did service users who were unable to take time away from work compared with service users who did not work (mean difference for overall experience of care -4.73, -5.29 to -4.17). Commercial providers of out of hours GP care were associated with poorer experience of care. Targeted interventions aimed at improving experience for patients from ethnic minorities and

  12. The Beliefs and Usage of Social Media Among General Practitioner Trainers from Eleven Provinces of China: A Cross-Sectional Survey.

    Liu, Ying; Ren, Wen; Qiu, Yan; Ren, Jingjing

    2018-05-07

    It has become a new lifestyle of using social media (SM) to acquire all kinds of information. The objectives of this study were to determine general practitioner (GP) trainers' current use of SM and their beliefs and attitudes regarding use of SM. A cross-sectional questionnaire survey was taken during a 1-week GP trainers' training program. Data probing GP trainers' use of SM and attitudes toward SM use in clinical work and education were collected and analyzed. Four hundred seven respondents participated in the survey, and the response rate was 61.4%. All the respondents reported that they have at least an SM account. A total of 99.3% of respondents replied that they would add a colleague as a friend via SM; however, only 68.6% of them would add a patient. More than half of the respondents have been contacted by a patient more than five times per year, whereas 67.2% of them attempted to contact a patient by SM less than three times per year. One hundred forty of 407 (34.4%) respondents used SM daily to explore medical information, whereas 42 of 407 (10.3%) contributed new information via SM on a daily basis. Nearly 50% of respondents believed that SM was useful and beneficial. SM is widely used among GP trainers from 11 provinces of China. Most of the participants believed that SM is useful and beneficial to their work. However, there are still some problems for them to use SM in healthcare and medical education, including separating personal and professional use of SM, SM policy, and the quality of information from SM.

  13. What are key factors influencing malnutrition screening in community-dwelling elderly populations by general practitioners? A large cross-sectional survey in two areas of France.

    Gaboreau, Y; Imbert, P; Jacquet, J-P; Marchand, O; Couturier, P; Gavazzi, G

    2013-11-01

    Malnutrition is associated with a high morbi-mortality in elderly populations and their institutionalization at an early stage. The incidence is well known despite being often under-diagnosed in primary care. General practitioners (GPs) have a key role in home care. What are the factors affecting malnutrition-screening implementation by French GPs? We conducted a cross-sectional survey in two areas in the southeast of France (Savoie and Isère). In May 2008, an anonymized survey was sent by e-mail and/or post to all GPs with a large clinical practice. Two months later, reminder letters were sent. Potential barriers were measured by dichotomous scale. On GPs' characteristics (socio-demographic, medical training, geriatric practice and knowledge), multiple regression logistic was performed to identify others factors affecting malnutrition screening. In all, 493 GPs (26.85%) answered and 72.2% felt that malnutrition screening was useful although only 26.6% implemented it each year and 11.9% every 2-5 years. The main barriers to the implementation were patient selection (60.4%) and forgetting to screen (26.6%). Minor barriers were lack of knowledge (19.5%) or time (15%). New factors were identified: unsuitable working conditions (19.1%), insufficient motivation (6.8%) or technical support (7.2%). The quality of malnutrition information received was found to be the only promoter of annual screening (odds ratio=1.44 (1.087-1.919); P=0.011). This survey is the first in France to reveal GPs' factors affecting malnutrition implementation. New obstacles were identified in this survey. The hope of implementing regular malnutrition screening by GPs seems to lie with the quality of malnutrition information received.

  14. General epidemiological parameters of viral hepatitis A, B, C, and E in six regions of China: a cross-sectional study in 2007.

    Lu, Jian; Zhou, Yongdong; Lin, Xiaojing; Jiang, Yongzhen; Tian, Ruiguang; Zhang, Yonghui; Wu, Jia; Zhang, Fengwei; Zhang, Yong; Wang, Yue; Bi, Shengli

    2009-12-24

    Viral hepatitis is a serious health burden worldwide. To date, few reports have addressed the prevalence of hepatitis A, B, C, and E in China. Therefore, the general epidemiological parameters of viral hepatitis remain unknown. In this cross-sectional study, we performed a serological prevalence analysis of viral hepatitis A, B, C, and E in 8,762 randomly selected Chinese subjects, which represented six areas of China. The overall prevalence of anti-Hepatitis C virus antibody (anti-HCV) was 0.58%, which was much lower than was estimated by WHO. The prevalences of Hepatitis B virus surface antigen (HBsAg), anti-Hepatitis B virus surface protein antibody (HBsAb), and anti-Hepatitis B virus core protein antibody (HBcAb) were 5.84%, 41.31%, and 35.92%, respectively, whereas in the group of subjects less than 5 years old, these prevalences were 1.16%, 46.77%, and 8.69% respectively, which suggests that the Hepatitis B virus (HBV)-carrier population is decreasing, and the nationwide HBV vaccine program has contributed to the lowered HBV prevalence in the younger generation in China. Meanwhile, a large deficit remains in coverage provided by the national HBV immune program. In addition, our data suggested the possibility that HBsAb may not last long enough to protect people from HBV infection throughout life. The overall prevalence of anti-Hepatitis A virus antibody (anti-HAV) and anti-Hepatitis E virus antibody (anti-HEV) were as high as 72.87% and 17.66%, respectively. The indices increased with age, which suggests that a large proportion of Chinese adults are protected by latent infection. Furthermore, the pattern of HEV infection was significantly different among ethnic groups in China. Our study provided much important information concerning hepatitis A, B, C, and E prevalence in China and will contribute to worldwide oversight of viral hepatitis.

  15. Relationship between smoking and obesity: a cross-sectional study of 499,504 middle-aged adults in the UK general population.

    Shadrach Dare

    Full Text Available There is a general perception that smoking protects against weight gain and this may influence commencement and continuation of smoking, especially among young women.A cross-sectional study was conducted using baseline data from UK Biobank. Logistic regression analyses were used to explore the association between smoking and obesity; defined as body mass index (BMI >30 kg/m2. Smoking was examined in terms of smoking status, amount smoked, duration of smoking and time since quitting and we adjusted for the potential confounding effects of age, sex, socioeconomic deprivation, physical activity, alcohol consumption, hypertension and diabetes.The study comprised 499,504 adults aged 31 to 69 years. Overall, current smokers were less likely to be obese than never smokers (adjusted OR 0.83 95% CI 0.81-0.86. However, there was no significant association in the youngest sub-group (≤40 years. Former smokers were more likely to be obese than both current smokers (adjusted OR 1.33 95% CI 1.30-1.37 and never smokers (adjusted OR 1.14 95% CI 1.12-1.15. Among smokers, the risk of obesity increased with the amount smoked and former heavy smokers were more likely to be obese than former light smokers (adjusted OR 1.60, 95% 1.56-1.64, p<0.001. Risk of obesity fell with time from quitting. After 30 years, former smokers still had higher risk of obesity than current smokers but the same risk as never smokers.Beliefs that smoking protects against obesity may be over-simplistic; especially among younger and heavier smokers. Quitting smoking may be associated with temporary weight gain. Therefore, smoking cessation interventions should include weight management support.

  16. Disentangling the determinants of interest and willingness-to-pay for breast cancer susceptibility testing in the general population: a cross-sectional Web-based survey among women of Québec (Canada)

    Blouin-Bougie, Jolyane; Amara, Nabil; Bouchard, Karine; Simard, Jacques; Dorval, Michel

    2018-01-01

    Objectives To identify common and specific individual factors that favour or impede women’s interest in and willingness-to-pay (WTP) for breast cancer susceptibility testing (BCST) and to identify the most impactful factors on both outcome measures. Design and methods This study used a self-administered cross-sectional Web-based questionnaire that included hypothetical scenarios about the availability of a new genetic test for breast cancer. Participants French-speaking women of the general population of Québec (Canada), aged between 35 and 69 years, were identified from a Web-based panel (2410 met the selection criteria, 1160 were reached and 1031 completed the survey). Measures The outcomes are the level of interest in and the range of WTP for BCST. Three categories of individual factors identified in the literature were used as potential explanatory factors, that is, demographic, clinical and psychosocial. Results Descriptive statistics indicated that the vast majority of sampled women are interested in BCST (90%). Among those, more than half of them are willing-to-pay for such a test (57%). The regression models pointed out several factors associated with both outcomes (eg, age, income, family history, locus of control-powerful others) and marginal effects were used to highlight the most impactful factors for each outcome. Conclusion The results of this study provide a proxy of the readiness of women of the general population to use and to pay for BCST. They also offer insights for developing inclusive and specific strategies to foster informed decision-making and guide the services offered by health organisations corresponding to women’s preferences and needs. PMID:29487071

  17. Disentangling the determinants of interest and willingness-to-pay for breast cancer susceptibility testing in the general population: a cross-sectional Web-based survey among women of Québec (Canada).

    Blouin-Bougie, Jolyane; Amara, Nabil; Bouchard, Karine; Simard, Jacques; Dorval, Michel

    2018-02-27

    To identify common and specific individual factors that favour or impede women's interest in and willingness-to-pay (WTP) for breast cancer susceptibility testing (BCST) and to identify the most impactful factors on both outcome measures. This study used a self-administered cross-sectional Web-based questionnaire that included hypothetical scenarios about the availability of a new genetic test for breast cancer. French-speaking women of the general population of Québec (Canada), aged between 35 and 69 years, were identified from a Web-based panel (2410 met the selection criteria, 1160 were reached and 1031 completed the survey). The outcomes are the level of interest in and the range of WTP for BCST. Three categories of individual factors identified in the literature were used as potential explanatory factors, that is, demographic, clinical and psychosocial. Descriptive statistics indicated that the vast majority of sampled women are interested in BCST (90%). Among those, more than half of them are willing-to-pay for such a test (57%). The regression models pointed out several factors associated with both outcomes (eg, age, income, family history, locus of control-powerful others) and marginal effects were used to highlight the most impactful factors for each outcome. The results of this study provide a proxy of the readiness of women of the general population to use and to pay for BCST. They also offer insights for developing inclusive and specific strategies to foster informed decision-making and guide the services offered by health organisations corresponding to women's preferences and needs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. A Cross-Sectional Study of Prisoners in Mexico City Comparing Prevalence of Transmissible Infections and Chronic Diseases with That in the General Population.

    Sergio Bautista-Arredondo

    Full Text Available To describe patterns of transmissible infections, chronic illnesses, socio-demographic characteristics and risk behaviors in Mexico City prisons, including in comparison to the general population, to identify those currently needing healthcare and inform policy.A cross-sectional study among 17,000 prisoners at 4 Mexico City prisons (June to December 2010. Participation was voluntary, confidential and based on informed consent. Participants were tested for HIV, Hepatitis B & C, syphilis, hypertension, obesity, and, if at risk, glucose and cholesterol. A subset completed a questionnaire on socio-demographic characteristics and risk behaviors. Positive results were delivered with counseling and treatment or referral.76.8% (15,517/20,196 of men and 92.9% (1,779/1,914 of women participated. Complete data sets were available for 98.8%. The following prevalence data were established for transmissible infections: HIV 0.7%; syphilis: Anti-TP+/VDRL+ 2.0%; Hepatitis B: HBcAb 2.8%, HBsAg 0.15%; Anti-HCV 3.2%. Obesity: 9.5% men, 33.8% women. Compared with national age- and sex-matched data, the relative prevalence was greater for HIV and syphilis among women, HIV and Hepatitis C in men, and all infections in younger participants. Obesity prevalence was similar for women and lower among male participants. The prevalence of previously diagnosed diabetes and hypertension was lower. Questionnaire data (1,934 men, 520 women demonstrated lower educational levels, increased smoking and substance use compared to national data. High levels of non-sterile tattooing, physical abuse and histories of sexual violence were found.The study identified that health screening is acceptable to Mexico City prisoners and feasible on a large-scale. It demonstrated higher prevalence of HIV and other infections compared to national data, though low rates compared to international data. Individual participants benefited from earlier diagnosis, treatment and support. The data collected

  19. A Cross-Sectional Study of Prisoners in Mexico City Comparing Prevalence of Transmissible Infections and Chronic Diseases with That in the General Population.

    Bautista-Arredondo, Sergio; González, Andrea; Servan-Mori, Edson; Beynon, Fenella; Juarez-Figueroa, Luis; Conde-Glez, Carlos J; Gras, Nathalie; Sierra-Madero, Juan; Lopez-Ridaura, Ruy; Volkow, Patricia; Bertozzi, Stefano M

    2015-01-01

    To describe patterns of transmissible infections, chronic illnesses, socio-demographic characteristics and risk behaviors in Mexico City prisons, including in comparison to the general population, to identify those currently needing healthcare and inform policy. A cross-sectional study among 17,000 prisoners at 4 Mexico City prisons (June to December 2010). Participation was voluntary, confidential and based on informed consent. Participants were tested for HIV, Hepatitis B & C, syphilis, hypertension, obesity, and, if at risk, glucose and cholesterol. A subset completed a questionnaire on socio-demographic characteristics and risk behaviors. Positive results were delivered with counseling and treatment or referral. 76.8% (15,517/20,196) of men and 92.9% (1,779/1,914) of women participated. Complete data sets were available for 98.8%. The following prevalence data were established for transmissible infections: HIV 0.7%; syphilis: Anti-TP+/VDRL+ 2.0%; Hepatitis B: HBcAb 2.8%, HBsAg 0.15%; Anti-HCV 3.2%. Obesity: 9.5% men, 33.8% women. Compared with national age- and sex-matched data, the relative prevalence was greater for HIV and syphilis among women, HIV and Hepatitis C in men, and all infections in younger participants. Obesity prevalence was similar for women and lower among male participants. The prevalence of previously diagnosed diabetes and hypertension was lower. Questionnaire data (1,934 men, 520 women) demonstrated lower educational levels, increased smoking and substance use compared to national data. High levels of non-sterile tattooing, physical abuse and histories of sexual violence were found. The study identified that health screening is acceptable to Mexico City prisoners and feasible on a large-scale. It demonstrated higher prevalence of HIV and other infections compared to national data, though low rates compared to international data. Individual participants benefited from earlier diagnosis, treatment and support. The data collected will also

  20. Opportunities Missed: A Cross-Sectional Survey of the Provision of Smoking Cessation Care to Pregnant Women by Australian General Practitioners and Obstetricians.

    Zeev, Yael Bar; Bonevski, Billie; Twyman, Laura; Watt, Kerrianne; Atkins, Lou; Palazzi, Kerrin; Oldmeadow, Christopher; Gould, Gillian S

    2017-05-01

    Similar to other high-income countries, smoking rates in pregnancy can be high in specific vulnerable groups in Australia. Several clinical guidelines exist, including the 5A's (Ask, Advice, Assess, Assist, and Arrange), ABCD (Ask, Brief advice, Cessation, and Discuss), and AAR (Ask, Advice, and Refer). There is lack of data on provision of smoking cessation care (SCC) of Australian General Practitioners (GPs) and Obstetricians. A cross-sectional survey explored the provision of SCC, barriers and enablers using the Theoretical Domains Framework, and the associations between them. Two samples were invited: (1) GPs and Obstetricians from a college database (n = 5571); (2) GPs from a special interest group for Indigenous health (n = 500). Dimension reduction for the Theoretical Domains Framework was achieved with factor analysis. Logistic regression was carried out for performing all the 5A's and the AAR. Performing all of the 5A's, ABCD, and AAR "often and always" was reported by 19.9%, 15.6%, and 49.2% respectively. "Internal influences" (such as confidence in counselling) were associated with higher performance of the 5A's (Adjusted OR 2.69 (95% CI 1.5, 4.8), p workplace routine) were associated with higher performance of AAR (Adjusted OR 1.7 (95% CI 1, 2.8), p = .035). Performance in providing SCC to pregnant women is low among Australian GPs and Obstetricians. Training clinicians should focus on improving internal influences such as confidence and optimism. The AAR may be easier to implement, and interventions at the service level should focus on ensuring easy, effective, and acceptable referral mechanisms are in place. Improving provision of the 5A's approach should focus on the individual level, including better training for GPs and Obstetricians, designed to improve specific "internal" barriers such as confidence in counselling and optimism. The AAR may be easier to implement in view of the higher overall performance of this approach. Interventions on a more

  1. Pandemic influenza (A/H1N1 vaccine uptake among French private general practitioners: a cross sectional study in 2010.

    Pierre Verger

    Full Text Available BACKGROUND: In July, 2009, French health authorities, like those in many other countries, decided to embark on a mass vaccination campaign against the pandemic A(H1N1 influenza. Private general practitioners (GPs were not involved in this campaign. We studied GPs' pandemic vaccine (pvaccine uptake, quantified the relative contribution of its potential explanatory factors and studied whether their own vaccination choice was correlated with their recommendations to patients about pvaccination. METHODOLOGY/PRINCIPAL FINDINGS: In this cross-sectional telephone survey, professional investigators interviewed an existing panel of randomly selected private GPs (N = 1431; response rate at inclusion in the panel: 36.8%; participation rate in the survey: 100%. The main outcome variable was GPs' own pvaccine uptake. We used an averaging multi-model approach to quantify the relative contribution of factors associated with their vaccination. The pvaccine uptake rate was 61% (95%CI = 58.3-63.3. Four independent factors contributed the most to this rate (partial Nagelkerke's R(2: history of previous vaccination against seasonal influenza (14.5%, perception of risks and efficacy of the pvaccine (10.8%, opinions regarding the organization of the vaccination campaign (7.1%, and perception of the pandemic's severity (5.2%. Overall, 71.3% (95%CI = 69.0-73.6 of the participants recommended pvaccination to young adults at risk and 40.1% (95%CI = 37.6-42.7 to other young adults. GPs' own pvaccination was strongly predictive of their recommendation to both young adults at risk (OR = 9.6; 95%CI = 7.2-12.6 and those not at risk (OR = 8.5; 95%CI = 6.4-11.4. CONCLUSIONS/SIGNIFICANCE: These results suggest that around 60% of French private GPs followed French authorities' recommendations about vaccination of health care professionals against the A(H1N1 influenza. They pinpoint priority levers for improving preparedness for future influenza pandemics. Besides encouraging GPs

  2. Seroprevalence of Toxoplasma gondii and associated risk factors among HIV-infected women within reproductive age group at Mizan Aman General Hospital, Southwest Ethiopia: a cross sectional study.

    Zeleke, Ayalew Jejaw; Melsew, Yayehirad Alemu

    2017-01-26

    Toxoplasmosis is serious in the case of immune suppression and prenatal transmission. In immunocompromised hosts, it is manifested primarily as a life-threatening condition, toxoplasmic encephalitis. Congenital toxoplasmosis results in abortion or congenitally acquired disorders which primarily affect the central nervous system. This study assessed seroprevalence of Toxoplasma gondii (T. gondii) infection and associated factors among HIV-infected women within the reproductive age group (18-49 years) at Mizan Aman General Hospital, Southwest Ethiopia. An institution based cross-sectional study was conducted from February 01 to May 30, 2015. Systematic random sampling technique was employed for participant selection. Enzyme linked immuno sorbent assay was used to test for T. gondii from venous blood specimens. Participants were interviewed using structured questionnaire for different variables. Descriptive statistics, binary and multivariable logistic regression analyses were performed during data analysis. P value of less than 0.05 was considered statistically significant. A total of 270 HIV-infected women within the reproductive age group were included in the study. Mean age of the respondents was 31 years (SD = ±6.5). Of the total study participants, 255 (94.4%), 95% CI (91.6, 97.2%) were found to be seropositive for T. gondii anti-immunoglobulin G (IgG) antibody, and 6 (2.2%), 95% CI (1.3, 3.1%) for anti-immunoglobulin M (IgM). All the anti-IgM positive samples were also positive for IgG. Multivariate analysis showed that; age within 28-37 years (Adjusted Odds Ratio [AOR] 2.58, 95% CI 1.01, 6.60), level of education with unable or only able to read and write (AOR = 4.46, 95% CI 1.20, 16.60), and substance abuse (AOR = 4.49, 95 CI 1.60, 12.55) were significantly associated with seropositivity of T. gondii infection. Seroprevalence of toxoplasmosis among the HIV-infected women in the childbearing age group in Mizan Aman was high. Age, educational status

  3. The impact of comorbid post-traumatic stress disorder in patients with major depressive disorder on clinical features, pharmacological treatment strategies, and treatment outcomes - Results from a cross-sectional European multicenter study.

    Dold, Markus; Bartova, Lucie; Kautzky, Alexander; Souery, Daniel; Mendlewicz, Julien; Serretti, Alessandro; Porcelli, Stefano; Zohar, Joseph; Montgomery, Stuart; Kasper, Siegfried

    2017-07-01

    This international, multicenter, cross-sectional study comprising 1346 adult in- and outpatients with major depressive disorder (MDD) investigated the association between MDD as primary diagnosis and comorbid post-traumatic stress disorder (PTSD). In a cross-sectional data collection process, the presence of comorbid PTSD was determined by the Mini International Neuropsychiatric Interview (MINI) and the patients' socio-demographic, clinical, psychopharmacological, and response information were obtained. Clinical features between MDD with and without concurrent PTSD were compared using descriptive statistics, analyses of covariance (ANCOVA), and binary logistic regression analyses. 1.49% of the MDD patients suffered from comorbid PTSD. Significantly more MDD + comorbid PTSD patients exhibited atypical features, comorbid anxiety disorders (any comorbid anxiety disorder, panic disorder, agoraphobia, and social phobia), comorbid bulimia nervosa, current suicide risk, and augmentation treatment with low-dose antipsychotic drugs. In the binary logistic regression analyses, the presence of atypical features (odds ratio (OR) = 4.49, 95%CI:1.01-20.12; p≤.05), any comorbid anxiety disorder (OR = 3.89, 95%CI:1.60-9.44; p = .003), comorbid panic disorder (OR = 6.45, 95%CI:2.52-16.51; p = .001), comorbid agoraphobia (OR = 6.51, 95%CI:2.54-16.68; p≤.001), comorbid social phobia (OR = 6.16, 95%CI:1.71-22.17; p≤.001), comorbid bulimia nervosa (OR = 10.39, 95%CI:1.21-88.64; p = .03), current suicide risk (OR = 3.58, 95%CI:1.30-9.91; p = .01), and augmentation with low-potency antipsychotics (OR = 6.66, 95%CI:2.50-17.77; pdisorders, and (3.) the increased suicide risk due to concurrent PTSD. Copyright © 2017 Elsevier B.V. and ECNP. All rights reserved.

  4. Book Review by Daniel Moran of The Iraq War: Strategy, Tactics, and Military Lessons, by Anthony H. Cordesman, and The Iraq War: A Military History, by Williamson Murray and Major General Robert H. Scales

    Moran, Daniel

    2004-01-01

    Reviewed: TThe Iraq War: Strategy, Tactics, and Military Lessons, by Anthony H. Cordesman, and The Iraq War: A Military History, by Williamson Murray and Major General Robert H. Scales The United States and its allies went to war against Iraq in 2003, as Williamson Murray and Robert Scales reasonably propose, “to make an example out of Saddam’s regime, for better or worse” (p. 44). Exactly what the war exemplified, and whether the results are better or worse than might have be...

  5. Associations between self-esteem, general self-efficacy and approaches to studying in occupational therapy students: A cross-sectional study

    Bonsaksen, Tore; Sadeghi, Talieh; Thørrisen, Mikkel Magnus

    2017-01-01

    The aim of this study was to explore associations between self-esteem, general self-efficacy, and the deep, strategic, and surface approaches to studying. Norwegian occupational therapy students (n = 125) completed questionnaires measuring study approaches, self-esteem, and general self-efficacy. Regression analyses were used to explore the direct relationships between self-esteem, general self-efficacy and the approaches to studying, after controlling for age, gender, prior higher education,...

  6. 23 July - Italian Director-General for Prevention G. Ruocco and Director-General for European and International Relations Ministry of Health D. Roderigo visiting the ATLAS experimental cavern with ATLAS Deputy Spokesperson B. Heinemann. Life Sciences Section M. Cirilli and Life Sciences Adviser M. Dosanjh present.

    Anna Pantelia

    2013-01-01

    23 July - Italian Director-General for Prevention G. Ruocco and Director-General for European and International Relations Ministry of Health D. Roderigo visiting the ATLAS experimental cavern with ATLAS Deputy Spokesperson B. Heinemann. Life Sciences Section M. Cirilli and Life Sciences Adviser M. Dosanjh present.

  7. General topology

    Willard, Stephen

    2004-01-01

    Among the best available reference introductions to general topology, this volume is appropriate for advanced undergraduate and beginning graduate students. Its treatment encompasses two broad areas of topology: ""continuous topology,"" represented by sections on convergence, compactness, metrization and complete metric spaces, uniform spaces, and function spaces; and ""geometric topology,"" covered by nine sections on connectivity properties, topological characterization theorems, and homotopy theory. Many standard spaces are introduced in the related problems that accompany each section (340

  8. End-of-life care in general practice: a cross-sectional, retrospective survey of ‘cancer’, ‘organ failure’ and ‘old-age/dementia’ patients.

    Evans, N.; Pasman, H.R.W.; Donker, G.A.; Deliens, L.; Block, L. van den; Onwuteaka-Philipsen, B.

    2014-01-01

    Background: End-of-life care is often provided in primary care settings. Aim: To describe and compare general-practitioner end-of-life care for Dutch patients who died from ‘cancer’, ‘organ failure’ and ‘old-age or dementia’. Design: A cross-sectional, retrospective survey was conducted within a

  9. Correlations between the cross-sectional area and moment arm length of the erector spinae muscle and the thickness of the psoas major muscle as measured by MRI and the body mass index in lumbar degenerative kyphosis patients

    Lee, Hyun; Lee, Sang Jin; Lee, Sang Ho

    2006-01-01

    Lumbar degenerative kyphosis (LDK) is a subgroup of the flatback syndrome, which is a condition caused by spinal degeneration. LDK is reported to be the most frequent cause of lumbar spine deformity in the farming districts of the 'oriental' countries. We investigated the relationship between the cross-sectional area (CSA) and the moment arm length (MAL) of the erector spinae muscle and the thickness of the psoas major muscle (PT) and the body mass index (BMI) by performing statistical analysis, and we tried to show the crucial role of these variables for diagnosing LDK. From July 2004 to April 2005, we retrospectively reviewed 17 LDK patients who had undergone anterior lumbar interbody fusion (ALIF) with posterior stabilization. We measured both the CSA and MAL on the transverse cross-sectional MR image of the trunk at the fourth to fifth vertebrae (L4/5). The MAL was defined as the anterior-posterior distance between the center of the erector spinae muscle and that of the vertebral body. A comparative study was undertaken between the LDK group and the matched (according to age and gender) control group with regard to the CSA, MAL, PT and BMI. The 17 LDK patients were all females [age: 62.5 ± 4.93 years, height: 157 ± 6.19 cm, weight: 55.59 ± 4.7 kg, and BMI: 22.58 ± 2.08 kg/m 2 ]. The control group patients were all female [age: 63.6 ± 2.27 years, height: 156 ± 5.05 cm, weight: 59.65 ± 7.39 kg and BMI: 24.38 ± 2.94 kg/m 2 ]. Spearman's rho indicated a positive association between the CSA and BMI (rho = 0.49, ρ = 0.046), between the MAL and BMI (rho = 0.808, ρ = 0.000) and between the CSA and PT (rho = 0.566, ρ = 0.018) in the LDK patients. In terms of the CSA versus MAL, there was a positive association in both groups (rho = 0.67, ρ = 0.000, MAL = 0.023CSA + 5.454 in the LDK group; rho = 0.564, ρ 0.018, MAL = 0.02CSA + 5.832 in the control group with using linear regression analysis). Independent t-tests revealed that both groups had statistically

  10. Validity of the brief Zung's scale for screening major depressive episode among the general population from Bucaramanga, Colombia Validez de la escala breve de Zung para tamizaje del episodio depresivo mayor en la población general de Bucaramanga, Colombia

    Luis Alfonso Díaz; Adalberto Campo; Germán Eduardo Rueda

    2011-01-01

    Introduction. Brief scales for identiying depressive disorder are as useful as long scales for screening. However, a validated scale with these characteristics is not avalaible in Colombia.
    Objective. To design a brief Zung's self-rating depression scale in order to screen major depressive episodes among adults dwelling in the general community.
    Materials and methods. After filling-out the 20-item Zung's self-rating depression scale, the ten items with the higher correl...

  11. Perceived green qualities were associated with neighborhood satisfaction, physical activity, and general health : Results from a cross-sectional study in suburban and rural Scania, southern Sweden

    de Jong, Kim; Albin, Maria; Skarback, Erik; Grahn, Patrik; Bjork, Jonas

    2012-01-01

    In this study using cross-sectional survey data from suburban and rural Scania, Sweden (N=24,847), we assessed how the recently validated index score of area-aggregated perceived green neighborhood qualities (Scania Green Score; SGS), and the five distinct qualities within this index were associated

  12. The prevalence of chronic diseases and major disease risk factors at different ages among 150 000 men and women living in Mexico City: cross-sectional analyses of a prospective study

    Peto Richard

    2009-01-01

    Full Text Available Abstract Background While most of the global burden from chronic diseases, and especially vascular diseases, is now borne by low and middle-income countries, few large-scale epidemiological studies of chronic diseases in such countries have been performed. Methods From 1998–2004, 52 584 men and 106 962 women aged ≥35 years were visited in their homes in Mexico City. Self reported diagnoses of chronic diseases and major disease risk factors were ascertained and physical measurements taken. Age- and sex-specific prevalences and means were analysed. Results After about age 50 years, diabetes was extremely common – for example, 23.8% of men and 26.9% of women aged 65–74 reported a diagnosis. By comparison, ischaemic heart disease was reported by 4.8% of men and 3.0% of women aged 65–74, a history of stroke by 2.8% and 2.3%, respectively, and a history of cancer by 1.3% and 2.1%. Cancer history was generally more common among women than men – the excess being largest in middle-age, due to breast and cervical cancer. At older ages, the gap narrowed because of an increasing prevalence of prostate cancer. 51% of men and 25% of women aged 35–54 smoked cigarettes, while 29% of men and 41% of women aged 35–54 were obese (i.e. BMI ≥30 kg/m2. The prevalence of treated hypertension or measured blood pressure ≥140/90 mmHg increased about 50% more steeply with age among women than men, to 66% of women and 58% of men aged 65–74. Physical inactivity was highly prevalent but daily alcohol drinking was relatively uncommon. Conclusion Diabetes, obesity and tobacco smoking are highly prevalent among adults living in Mexico City. Long-term follow-up of this and other cohorts will establish the relevance of such factors to the major causes of death and disability in Mexico.

  13. Perception of health risks of electromagnetic fields by MRI radiographers and airport security officers compared to the general Dutch working population: a cross sectional analysis.

    van Dongen, Diana; Smid, Tjabe; Timmermans, Daniëlle R M

    2011-11-09

    The amount of exposure to electromagnetic fields (EMF) at work is mainly determined by an individual's occupation and may differ from exposure at home. It is, however, unknown how different occupational groups perceive possible adverse health effects of EMF. Three occupational groups, the general Dutch working population (n = 567), airport security officers who work with metal detectors (n = 106), and MRI radiographers who work with MRI (n = 193), were compared on perceived risk of and positive and negative feelings towards EMF in general and of different EMF sources, and health concerns by using analyses of variances. Data were collected via an internet survey. Overall, MRI radiographers had a lower perceived risk, felt less negative, and more positive towards EMF and different sources of EMF than the general working population and the security officers. For security officers, feeling more positive about EMF was not significantly related to perceived risk of EMF in general or EMF of domestic sources. Feeling positive about a source did not generalize to a lower perceived risk, while negative feelings were stronger related to perceived risk. MRI radiographers had fewer health concerns regarding EMF than the other two groups, although they considered it more likely that EMF could cause physical complaints. These data show that although differences in occupation appear to be reflected in different perceptions of EMF, the level of occupational exposure to EMF as such does not predict the perceived health risk of EMF. © 2011 van Dongen et al; licensee BioMed Central Ltd.

  14. Perception of health risks of electromagnetic fields by MRI radiographers and airport security officers compared to the general Dutch working population: a cross sectional analysis

    van Dongen Diana

    2011-11-01

    Full Text Available Abstract Background The amount of exposure to electromagnetic fields (EMF at work is mainly determined by an individual's occupation and may differ from exposure at home. It is, however, unknown how different occupational groups perceive possible adverse health effects of EMF. Methods Three occupational groups, the general Dutch working population (n = 567, airport security officers who work with metal detectors (n = 106, and MRI radiographers who work with MRI (n = 193, were compared on perceived risk of and positive and negative feelings towards EMF in general and of different EMF sources, and health concerns by using analyses of variances. Data were collected via an internet survey. Results Overall, MRI radiographers had a lower perceived risk, felt less negative, and more positive towards EMF and different sources of EMF than the general working population and the security officers. For security officers, feeling more positive about EMF was not significantly related to perceived risk of EMF in general or EMF of domestic sources. Feeling positive about a source did not generalize to a lower perceived risk, while negative feelings were stronger related to perceived risk. MRI radiographers had fewer health concerns regarding EMF than the other two groups, although they considered it more likely that EMF could cause physical complaints. Conclusions These data show that although differences in occupation appear to be reflected in different perceptions of EMF, the level of occupational exposure to EMF as such does not predict the perceived health risk of EMF.

  15. The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II): a randomised, single-blind trial.

    Myles, Paul S; Leslie, Kate; Chan, Matthew T V; Forbes, Andrew; Peyton, Philip J; Paech, Michael J; Beattie, W Scott; Sessler, Daniel I; Devereaux, P J; Silbert, Brendan; Schricker, Thomas; Wallace, Sophie

    2014-10-18

    Nitrous oxide is commonly used in general anaesthesia but concerns exist that it might increase perioperative cardiovascular risk. We aimed to gather evidence to establish whether nitrous oxide affects perioperative cardiovascular risk. We did an international, randomised, assessor-blinded trial in patients aged at least 45 years with known or suspected coronary artery disease having major non-cardiac surgery. Patients were randomly assigned via automated telephone service, stratified by site, to receive a general anaesthetic with or without nitrous oxide. Attending anaesthetists were aware of patients' group assignments, but patients and assessors were not. The primary outcome measure was a composite of death and cardiovascular complications (non-fatal myocardial infarction, stroke, pulmonary embolism, or cardiac arrest) within 30 days of surgery. Our modified intention-to-treat population included all patients randomly assigned to groups and undergoing induction of general anaesthesia for surgery. This trial is registered at ClinicalTrials.gov, number NCT00430989. Of 10,102 eligible patients, we enrolled 7112 patients between May 30, 2008, and Sept 28, 2013. 3543 were assigned to receive nitrous oxide and 3569 were assigned not to receive nitrous oxide. 3483 patients receiving nitrous oxide and 3509 not receiving nitrous oxide were assessed for the primary outcome. The primary outcome occurred in 283 (8%) patients receiving nitrous oxide and in 296 (8%) patients not receiving nitrous oxide (relative risk 0·96, 95% CI 0·83–1·12; p=0·64). Surgical site infection occurred in 321 (9%) patients assigned to nitrous oxide, and in 311 (9%) patients in the no-nitrous oxide group (p=0·61), and severe nausea and vomiting occurred in 506 patients (15%) assigned to nitrous oxide and 378 patients (11%) not assigned to nitrous oxide (pnitrous oxide use in major non-cardiac surgery. Nitrous oxide did not increase the risk of death and cardiovascular complications or

  16. Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder

    Bech, Per; Lönn, Sara L; Overø, Kerstin F

    2010-01-01

    -Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization. RESULTS: All studies showed a statistically significant (P ...-Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery...... > 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill...

  17. Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder

    Bech, Per; Lönn, Sara L; Overø, Kerstin F

    2010-01-01

    -Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery......-Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization. RESULTS: All studies showed a statistically significant (P ... > 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill...

  18. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case

  19. IFLA General Conference, 1989. Division of Libraries Serving the General Public. Section on Library Services to Multicultural Populations; Round Table--International Association of Metropolitan City Libraries; Round Table on Mobile Libraries. Booklet 31.

    International Federation of Library Associations, The Hague (Netherlands).

    The seven papers in this collection continue the presentations from the Division of Libraries Serving the General Public: (1) "Multicultural Activities for Children and Young People at the Munich International Youth Library" (German and English versions; Lioba Betten); (2) "Multicultural Literature and Library Services for Children:…

  20. Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post-cesarean section pain management and lactation after general anesthesia - a prospective, randomized, double-blind, controlled study.

    Chi, Xiaohui; Li, Man; Mei, Wei; Liao, Mingfeng

    2017-01-01

    Acute pain is a common complication following cesarean section under general anesthesia. Post-cesarean section pain management is important for both the mother and the newborn. This study compared the effects of patient-controlled intravenous analgesia (PCIA) using sufentanil or tramadol on postoperative pain control and initiation time of lactation in patients who underwent cesarean section under general anesthesia. Primiparas (n=146) scheduled for cesarean section under general anesthesia were randomized to receive PCIA with sufentanil or tramadol. Movement-evoked and rest-pain intensity were assessed by the Numerical Rating Scale (NRS) postoperatively. The number of PCIA attempts, amount of drug consumed, initiation time of lactation, and Quality of Recovery Score 40 (QoR-40) were recorded at 4, 8, 12, and 24 h postoperatively. Pre- and postoperative serum prolactin levels were recorded. No between-group difference existed in the NRS at rest at any time point postoperatively. Patients on sufentanil had more movement-evoked pain and a higher sedation score at 4, 8, and 12 h postoperatively, as compared with the tramadol group. At 24 h, the QoR-40 was higher in the tramadol group compared with the sufentanil group. No significant between-group differences were present in patient satisfaction and nausea/vomiting scores. Postpartum prolactin levels were significantly higher in the tramadol group versus the sufentanil group, corresponding with a significant delay in initiation of lactation in the latter. PCIA with tramadol may be preferred due to lower movement-evoked pain, higher quality of recovery, and earlier lactation in patients following cesarean section under general anesthesia.

  1. 7 CFR 3052.520 - Major program determination.

    2010-01-01

    ... Auditors § 3052.520 Major program determination. (a) General. The auditor shall use a risk-based approach... section shall be followed. (b) Step 1. (1) The auditor shall identify the larger Federal programs, which... providing loans significantly affects the number or size of Type A programs, the auditor shall consider this...

  2. Weaving History through the Major

    Mayfield, Betty

    2014-01-01

    The benefits of including the study of the history of mathematics in the education of mathematics majors have been discussed at length elsewhere. Many colleges and universities now offer a History of Mathematics course for mathematics majors, for mathematics education majors, or for general credit. At Hood College, we emphasize our commitment to…

  3. Diabetic peripheral neuropathy in ambulatory patients with type 2 diabetes in a general hospital in a middle income country: a cross-sectional study.

    Lazo, María de Los Angeles; Bernabé-Ortiz, Antonio; Pinto, Miguel E; Ticse, Ray; Malaga, German; Sacksteder, Katherine; Miranda, J Jaime; Gilman, Robert H

    2014-01-01

    We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting. Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin.

  4. No association between nickel allergy and reporting cosmetic dermatitis from mascara or eye shadow: a cross-sectional general population study

    Thyssen, J P; Linneberg, A; Menné, T

    2010-01-01

    dermatitis and nickel in make-up products remains controversial. OBJECTIVE: This cross-sectional patch test study investigated whether the frequency of self-reported cosmetic dermatitis from mascara or eye shadow use was higher among nickel allergic Danish women than women without nickel allergy. METHODS......: In 2006, a total of 1843 18-69 year old women completed a postal questionnaire including questions on cosmetic dermatitis and were patch tested with nickel sulphate. Data were analysed by logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs......). RESULTS: The prevalence of nickel allergy was similar among women who reported cosmetic dermatitis from eye shadow or mascara and among women who did not report such symptoms. Cosmetic dermatitis was positively associated with self-reported atopic dermatitis and age. CONCLUSION: Overall, no association...

  5. Self-declared stock ownership and association with positive trial outcome in randomized controlled trials with binary outcomes published in general medical journals: a cross-sectional study.

    Falk Delgado, Alberto; Falk Delgado, Anna

    2017-07-26

    Describe the prevalence and types of conflicts of interest (COI) in published randomized controlled trials (RCTs) in general medical journals with a binary primary outcome and assess the association between conflicts of interest and favorable outcome. Parallel-group RCTs with a binary primary outcome published in three general medical journals during 2013-2015 were identified. COI type, funding source, and outcome were extracted. Binomial logistic regression model was performed to assess association between COI and funding source with outcome. A total of 509 consecutive parallel-group RCTs were included in the study. COI was reported in 74% in mixed funded RCTs and in 99% in for-profit funded RCTs. Stock ownership was reported in none of the non-profit RCTs, in 7% of mixed funded RCTs, and in 50% of for-profit funded RCTs. Mixed-funded RCTs had employees from the funding company in 11% and for-profit RCTs in 76%. Multivariable logistic regression revealed that stock ownership in the funding company among any of the authors was associated with a favorable outcome (odds ratio = 3.53; 95% confidence interval = 1.59-7.86; p < 0.01). COI in for-profit funded RCTs is extensive, because the factors related to COI are not fully independent, a multivariable analysis should be cautiously interpreted. However, after multivariable adjustment only stock ownership from the funding company among authors is associated with a favorable outcome.

  6. Is fatigue after work a barrier for leisure-time physical activity? Cross-sectional study among 10,000 adults from the general working population.

    Bláfoss, Rúni; Micheletti, Jéssica K; Sundstrup, Emil; Jakobsen, Markus D; Bay, Hans; Andersen, Lars L

    2018-04-01

    In spite of the many health-related benefits of regular physical activity, fatiguing work may be a barrier to performing leisure-time physical activity. This study investigates the association between work-related fatigue and the duration of low- and high-intensity leisure-time physical activity in workers with sedentary and physically demanding jobs. From the 2010 round of the Danish Work Environment Cohort Study, currently employed wage earners from the general working population ( N=10,427) replied to questions about work-related fatigue (predictor) and duration of low- and high-intensity leisure-time physical activity (outcome). Associations were modelled using general linear models controlling for various confounders. Among workers with physically demanding jobs, higher levels of work-related fatigue were associated with gradually lower levels of leisure-time physical activity - for low, moderate and high levels of work-related fatigue the duration of high-intensity leisure-time physical activity was 133 (95% confidence interval (CI) 127-178), 134 (95% CI 109-160) and 113 (95% CI 86-140) min per week, respectively (trend test pwork-related fatigue in workers with physically demanding jobs. Older workers perform less high-intensity physical activity than younger workers. Workplaces should consider initiatives to allow workers with physically demanding jobs and older workers to perform physical exercise during working hours and thereby increase physical capacity to meet the job demands.

  7. Long-acting reversible contraception for adolescents and young adults - a cross-sectional study of women and general practitioners in Oslo, Norway.

    Bratlie, Marte; Aarvold, Trine; Skårn, Elling Skeide; Lundekvam, Jonas Andre; Nesheim, Britt-Ingjerd; Askevold, Erik Tandberg

    2014-06-01

    To investigate awareness and use of long-acting reversible contraceptives (LARCs) in the Norwegian primary care sector. We surveyed 359 women aged 16 to 23 years visiting a free sexual health clinic and 140 general practitioners (GPs) in Oslo, Norway, to assess contraceptive usage patterns, knowledge, opinions, and counselling content. Eighty-two percent (n = 295) of the female respondents were current contraceptive users and of this group, 12% (n = 34) were LARC users. Combined oral contraceptives (COCs, 56%) and condoms (20%) were the methods most commonly used. Apart from those two, the women considered themselves insufficiently knowledgeable about other family planning modalities. Knowledge was an independent predictor of current LARC use (p Oslo, Norway. These young women need better contraceptive counselling. Dispelling misconceptions and improved provider training could encourage GPs to cover LARCs when giving contraceptive guidance.

  8. Validation of the "SmoCess-GP" instrument - a short patient questionnaire for assessing the smoking cessation activities of general practitioners: a cross-sectional study

    Wolf Jürgen

    2010-02-01

    Full Text Available Abstract Background We developed an instrument assessing the extent of smoking cessation activities by general practitioners (GPs within the Cologne Smoking Study (CoSmoS. The objective of the present study was to examine further psychometric quality of the "SmoCess-GP" instrument (Smoking Cessation by General Practitioners. Methods 127 current smokers who had participated in the Cologne Smoking Study (CoSmoS were included in our analyses. Confirmatory factor analysis (CFA was conducted to examine the model fit and to retest the single-factor structure of the instrument using the Mplus software. Further construct validity was tested with bivariate analysis using an instrument which measures patients' trust in physicians. Results CFA supported the unidimensional structure of the instrument. The factor loadings exceed the threshold of ≥ 0.50. All indicator reliabilities were higher than 0.30. The composite reliability was 0.86 and the average variance extracted (AVE resulted in a value of 0.50. The calculation of global fit indices identified a CFI value of 1.00 and for TLI a value of 1.02. The root mean square error of approximation (RMSEA indicates that 0% of the information is not accounted for by the model. The chi-square value was χ2df = 6 = 4.63 (p = 0.59. Analysis of discriminant validity resulted in a non-significiant correlation of r = 0.092 (p = 0.350. Conclusions Results indicate preliminary evidence for the construct validity of the "SmoCess-GP" instrument which therefore appears to be a promising tool for analyzing the extent of smoking cessation advice offered by GPs from the patients' perspective. Future research should examine the psychometric properties in a population based sample, further improvements of the instrument and should apply other methods of validation.

  9. Predictors of weight stigma experienced by middle-older aged, general-practice patients with obesity in disadvantaged areas of Australia: a cross-sectional study.

    Spooner, Catherine; Jayasinghe, Upali W; Faruqi, Nighat; Stocks, Nigel; Harris, Mark F

    2018-05-21

    Rates of obesity have increased globally and weight stigma is commonly experienced by people with obesity. Feeling stigmatised because of one's weight can be a barrier to healthy eating, physical activity and to seeking help for weight management. The aim of this study was to identify predictors of perceived weight among middle-older aged patients with obesity attending general practices in socioeconomically disadvantaged urban areas of Australia. As part of a randomised clinical trial in Australia, telephone interviews were conducted with 120 patients from 17 general practices in socioeconomically disadvantaged of Sydney and Adelaide. Patients were aged 40-70 years with a BMI ≥ 30 kg/m 2 . The interviews included questions relating to socio-demographic variables (e.g. gender, language spoken at home), experiences of weight-related discrimination, and the Health Literacy Questionnaire (HLQ). Multi-level logistic regression data analysis was undertaken to examine predictors of recent experiences of weight-related discrimination ("weight stigma"). The multi-level model showed that weight stigma was positively associated with obesity category 2 (BMI = 35 to stigma and gender, age, education or the other HLQ domains examined. Weight stigma disproportionately affected the patients with obesity most in need of support to manage their weight: those with more severe obesity, from non-English speaking backgrounds and who were not in employment. Additionally, those who had experienced weight stigma were less able to actively engage with healthcare providers further compounding their disadvantage. This suggests the need for a more proactive approach to identify weight stigma by healthcare providers. Addressing weight stigma at the individual, system and population levels is recommended. The trial was registered with the Australian Clinical Trials Registry ACTRN126400102162 .

  10. Under the radar: a cross-sectional study of the challenge of identifying at-risk alcohol consumption in the general practice setting.

    Paul, Christine; Yoong, Sze Lin; Sanson-Fisher, Rob; Carey, Mariko; Russell, Grant; Makeham, Meredith

    2014-04-28

    Primary care providers are an important source of information regarding appropriate alcohol consumption. As early presentation to a provider for alcohol-related concerns is unlikely, it is important that providers are able to identify at-risk patients in order to provide appropriate advice. This study aimed to report the sensitivity, specificity, positive predictive value and negative predictive value of General Practitioner (GP) assessment of alcohol consumption compared to patient self-report, and explore characteristics associated with GP non-detection of at-risk status. GP practices were selected from metropolitan and regional locations in Australia. Eligible patients were adults presenting for general practice care who were able to understand English and provide informed consent. Patients completed a modified AUDIT-C by touchscreen computer as part of an omnibus health survey while waiting for their appointment. GPs completed a checklist for each patient, including whether the patient met current Australian guidelines for at-risk alcohol consumption. Patient self-report and GP assessments were compared for each patient. GPs completed the checklist for 1720 patients, yielding 1565 comparisons regarding alcohol consumption. The sensitivity of GPs' detection of at-risk alcohol consumption was 26.5%, with specificity of 96.1%. Higher patient education was associated with GP non-detection of at-risk status. GP awareness of which patients might benefit from advice regarding at-risk alcohol consumption appears low. Given the complexities associated with establishing whether alcohol consumption is 'at-risk', computer-based approaches to routine screening of patients are worthy of exploration as a method for prompting the provision of advice in primary care.

  11. Quality of care for patients with type 2 diabetes in general practice according to patients' ethnic background: a cross-sectional study from Oslo, Norway

    Birkeland Kåre

    2010-05-01

    Full Text Available Abstract Background In recent decades immigration to Norway from Asia, Africa and Eastern Europe has increased rapidly. The aim of this study was to assess the quality of care for type 2 diabetes mellitus (T2DM patients from these ethnic minority groups compared with the care received by Norwegians. Methods In 2006, electronic medical record data were screened at 11 practices (49 GPs; 58857 patients. 1653 T2DM patients cared for in general practice were identified. Ethnicity was defined as self-reported country of birth. Chi-squared tests, one-way ANOVAs, multiple regression, linear mixed effect models and generalized linear mixed models were used. Results Diabetes was diagnosed at a younger age in patients from the ethnic minority groups (South Asians (SA: mean age 44.9 years, Middle East/North Africa (MENA: 47.2 years, East Asians (EA: 52.0 years, others: 49.0 years compared with Norwegians (59.7 years, p 85% of patients in all groups with minor differences between minority groups and Norwegians. A greater proportion of the minority groups were prescribed hypoglycaemic medications compared with Norwegians (≥79% vs. 72%, p 9% was higher in minority groups (SA: 19.6%, MENA: 18.9% vs. Norwegians: 5.6%, p Conclusions Mean age at the time of diagnosis of T2DM was 8-15 years younger in minority groups compared with Norwegians. Recording of important processes of care measures is high in all groups. Only one in four of most patient groups achieved all four treatment targets and prescribing habits may be sub-optimal. Patients from minority groups have worse glycaemic control than Norwegians which implies that it might be necessary to improve the guidelines to meet the needs of specific ethnic groups.

  12. Major depressive disorder and generalized anxiety disorder show different autonomic dysregulations revealed by heart-rate variability analysis in first-onset drug-naïve patients without comorbidity.

    Shinba, Toshikazu

    2017-02-01

    The aim of the present study was to examine whether depression and anxiety disorder manifest different autonomic dysregulations using heart-rate variability (HRV) and heart rate (HR) measurements. HRV and HR were recorded both at rest and during task execution (random-number generation) in first-onset drug-naïve patients with major depressive disorder (MDD, n = 14) and generalized anxiety disorder (GAD, n = 11) as well as in healthy controls (n = 41). The patients showed no comorbidity of depression and anxiety disorder. GAD patients did not exhibit panic or phobic symptoms at the time of measurement. Following power spectrum analysis of HR trend, the high- (HF) and low-frequency (LF) components, the sum (LF + HF), and the LF/HF ratio were compared among the groups. In the MDD patients, as previously reported, HF was low and the LF/HF ratio was high during the initial-rest condition, and HF was less reactive to the task. In contrast, GAD patients showed significantly high HF, although autonomic reactivity was not impaired. The results indicate that baseline autonomic activity and its reactivity to behavioral changes are different between MDD and GAD in the early stage of illness. High parasympathetic tone in GAD may reflect responses of the parasympathetic system to anxiety. MDD is accompanied by an autonomic shift toward sympathetic activation and a reduced reactivity to task. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

  13. Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?

    Merino, Hipólito; Ferreiro, Fátima

    2016-01-01

    This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection), anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms. PMID:27243462

  14. Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?

    Merino, Hipólito; Senra, Carmen; Ferreiro, Fátima

    2016-01-01

    This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection), anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms.

  15. Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?

    Hipólito Merino

    Full Text Available This study examines the relationships between neuroticism (higher-order vulnerability factor, the cognitive styles of worry, brooding and reflection (second-order vulnerability factors and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD, with Major Depressive Disorder (MDD and with Mixed Anxiety-Depressive Disorder (MADD. One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection, anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms.

  16. Diabetic peripheral neuropathy in ambulatory patients with type 2 diabetes in a general hospital in a middle income country: a cross-sectional study.

    María de Los Angeles Lazo

    Full Text Available We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN in a low-middle income country setting.Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c. DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years, glycaemic control (HbA1c <7% vs. ≥7%, microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios.DPN was observed in 73/129 (56.6% patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07-1.88 in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02-1.93 in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001, onychomycosis (p = 0.012, abnormal Achilles reflex (p<0.001, pain perception (p<0.001 and vibration perception (p<0.001.DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin.

  17. Frequency and risk factors for malnutrition in children undergoing general anaesthesia in a French university hospital: A cross-sectional observational study.

    Gerbaud-Morlaes, Louis; Frison, Eric; Babre, Florence; De Luca, Arnaud; Didier, Anne; Borde, Maryline; Zaghet, Brigitte; Batoz, Hélène; Semjen, François; Nouette-Gaulain, Karine; Enaud, Raphael; Hankard, Régis; Lamireau, Thierry

    2017-08-01

    Malnutrition is often underdiagnosed in hospitalised children, although it is associated with postoperative complications, longer hospital lengths of stay and increased healthcare-related costs. We aimed to estimate the frequency of, and identify factors associated with, malnutrition in children undergoing anaesthesia. Cross-sectional observational study. Paediatric anaesthesia department at the University Children's Hospital, Bordeaux, France. A total of 985 patients aged less than 18 years. Anthropometric measurements, American Society of Anesthesiologists physical status classification score and the Pediatric Nutritional Risk Score (PNRS) recorded at the pre-anaesthesia evaluation. When assessed as a Waterlow index less than 80%, malnutrition was present in 7.6% children. This increased to 8.1% of children assessed by clinical signs and to 11% of children when defined by a BMI less than the third percentile. In a univariate analysis, children with a BMI less than the third percentile were more often born prematurely (22.4 vs 10.4%; P = 0.0008), were small for gestational age at birth (18.4 vs 4.5%; P malnutrition. In the multivariate analysis, a premature birth, a lower birth weight and a higher Pediatric Nutritional Risk Score were significantly associated with a higher odds of malnutrition when defined by BMI. All children should be screened routinely for malnutrition or the risk of malnutrition at the pre-anaesthesia visit, allowing a programme of preoperative and/or postoperative nutritional support to be initiated. We suggest that as well as weight and height, BMI and a pediatric nutritional risk score such as PNRS should be recorded routinely at the pre-anaesthesia visit.

  18. Themes Underlying Australian General Practitioner Views towards Chiropractic and Osteopathy: An Assessment of Free Text Data from a Cross-Sectional Survey

    Sandra Grace

    2018-01-01

    Full Text Available The Australian chiropractic and osteopathic professions underwent a period of significant transformation between 1960 and 2000. This resulted in an improvement in the views held by the medical profession towards the two professions. However, a recent survey of Australian general practitioners (GPs reported that a number of GPs still hold negative views towards chiropractors and osteopaths. This paper examines these views from the perspective of critical realism and explores the generative mechanisms that can influence the willingness of health practitioners to collaborate over patient care. A qualitative analysis of open-ended responses to a survey of 630 Australian GPs was conducted. Unfavourable attitudes of GPs towards chiropractors and osteopaths included perceived lack of safety, efficacy, and inadequacy of training, despite chiropractic’s and osteopathy’s reliance on the same evidence base and similar training to those of other manual therapy professions such as physiotherapy. These attitudes may be underpinned by the professional biases against chiropractic and osteopathy that continue to marginalise the professions within the Australian healthcare system. Continued investment in the research base for chiropractic and osteopathic practice is required, along with raising the awareness of GPs about the education and skills of chiropractors and osteopaths.

  19. Overweight and obesity are progressively associated with lower work ability in the general working population: cross-sectional study among 10,000 adults.

    Andersen, Lars L; Izquierdo, Mikel; Sundstrup, Emil

    2017-11-01

    Obesity is associated with many diseases and functional limitations. Workplaces are not always designed to accommodate this challenge. This study investigated the association between body mass index (BMI) and work ability in the general working population. Currently employed wage earners (N = 10,427) from the 2010 round of the Danish Work Environment Cohort Study (DWECS) replied to questions about work and health. Cumulative logistic regression analyses controlling for age, gender, physical and psychosocial work factors, lifestyle, and chronic diseases modeled the associations between BMI and work ability. BMIs above the normal range were progressively associated with lower work ability in relation to the physical demands of the job. Odds ratios for having lower work ability were 1.11 (95% CI 1.01-1.22), 1.17 (95% CI 1.01-1.34), 1.43 (95% CI 1.09-1.88), 1.69 (95% CI 1.10-2.62) for overweight and obesity classes I, II, and III, respectively. In subgroup analyses, the associations between BMI and work ability were more pronounced among individuals with mainly sedentary work than among those with physically active work. BMI was not associated with work ability in relation to the mental demands of the work. BMIs above the normal range are progressively associated with lower work ability in relation to the physical demands of the job, especially among individuals with mainly sedentary work. Ergonomic research on how to optimally design workstations for workers with obesity are needed.

  20. Predictors for assessing electronic messaging between nurses and general practitioners as a useful tool for communication in home health care services: a cross-sectional study.

    Lyngstad, Merete; Hofoss, Dag; Grimsmo, Anders; Hellesø, Ragnhild

    2015-02-17

    Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. The aim of this study was to explore home health care nurses' assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, Pcommunicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services.

  1. Relationship between late-life depression and life stressors: large-scale cross-sectional study of a representative sample of the Japanese general population.

    Kaji, Tatsuhiko; Mishima, Kazuo; Kitamura, Shingo; Enomoto, Minori; Nagase, Yukihiro; Li, Lan; Kaneita, Yoshitaka; Ohida, Takashi; Nishikawa, Toru; Uchiyama, Makoto

    2010-08-01

    The purpose of the present study was to clarify the relationship between late-life depression and daily life stress in a representative sample of 10 969 Japanese subjects. Data on 10 969 adults aged > or =50 who participated in the Active Survey of Health and Welfare in 2000, were analyzed. The self-administered questionnaire included items on 21 reasons for life stressors and the magnitude of stress, as well as the Japanese version of the Center for Epidemiologic Studies Depression Scale (CES-D). The relationship between the incidence of life stressors and mild-moderate (D(16)) and severe (D(26)) depressive symptoms was examined using logistic regression analysis. A total of 21.9% of subjects had D(16) symptoms, and 9.3% had D(26) symptoms. Further, increased age and being female were associated with more severe depressive state. Logistic regression analysis indicated that the strongest relationship between both the incidence of D(16) and D(26) symptoms and life stressors stemmed from 'having no one to talk to' (odds ratio = 3.3 and 5.0, respectively). Late-life depression was also associated with 'loss of purpose in life', 'separation/divorce', 'having nothing to do', 'health/illness/care of self', and 'debt'. There is a relationship between late-life depression and diminished social relationships, experiences involving loss of purpose in life or human relationships, and health problems in the Japanese general population.

  2. The Association Between Physical Activity, Mental Status, and Social and Family Support with Five Major Non-Communicable Chronic Diseases Among Elderly People: A Cross-Sectional Study of a Rural Population in Southern China.

    Huang, Xiang; Yang, Huajie; Wang, Harry H X; Qiu, Yongjun; Lai, Xiujuan; Zhou, Zhiheng; Li, Fangjian; Zhang, Liwei; Wang, Jiaji; Lei, Jimin

    2015-10-21

    Non-communicable chronic diseases (NCDs) have become the top threat in China. This study aimed to estimate the prevalence of major NCDs among the elderly population in rural areas in southern China and explore its associated social determinants. A multistage cluster random sampling methodology was adopted to select a total of 9245 rural elderly people from 3860 rural households in Guangdong Province. Interviews and physical examinations were performed to collect patient information. Descriptive and logistic regression analyses were conducted to explore factors associated with the presence of major NCDs. Over one-third (38.5%) of the study population suffered from five major NCDs. The grade of activities of daily living (ADL), mental status, and social relationship of elderly people without NCDs were better than those with NCDs. The major factors associated with the presence of NCDs among the elderly people included age (70-79 years group and 80-89 years group), education level (senior high/technical secondary school and junior college and above), mental status (concentration, enrichment and happy life and memory), relationship with neighbours, activities of daily living (ADL) (being able to climb three floors and bend over), physical activity, marital status (bereft), and living conditions (with offspring and family members). The study identified several social determinants associated with the presence of major NCDs. A higher level of family support and physical exercise might contribute to improved physical condition, mental status, and ADL among the elderly people in rural areas in southern China.

  3. COPD Diagnostic Questionnaire (CDQ) for selecting at-risk patients for spirometry: a cross-sectional study in Australian general practice.

    Stanley, Anthony J; Hasan, Iqbal; Crockett, Alan J; van Schayck, Onno C P; Zwar, Nicholas A

    2014-07-10

    Using the COPD Diagnostic Questionnaire (CDQ) as a selection tool for spirometry could potentially improve the efficiency and accuracy of chronic obstructive pulmonary disease (COPD) diagnosis in at-risk patients. To identify an optimal single cut point for the CDQ that divides primary care patients into low or high likelihood of COPD, with the latter group undergoing spirometry. Former or current smokers aged 40-85 years with no prior COPD diagnosis were invited to a case-finding appointment with the practice nurse at various general practices in Sydney, Australia. The CDQ was collected and pre- and post-bronchodilator spirometry was performed. Cases with complete CDQ data and spirometry meeting quality standards were analysed (1,054 out of 1,631 patients). CDQ cut points were selected from a receiver operating characteristic (ROC) curve. The area under the ROC curve was 0.713. A cut point of 19.5 had the optimal combination of sensitivity (63%) and specificity (70%) with two-thirds below this cut point. A cut point of 14.5 corresponded to a sensitivity of 91%, specificity of 35% and negative predictive value of 96%, and 31% of patients below this cut point. The CDQ can be used to select patients at risk of COPD for spirometry using one cut point. We consider two possible cut points. The 19.5 cut point excludes a higher proportion of patients from undergoing spirometry with the trade-off of more false negatives. The 14.5 cut point has a high sensitivity and negative predictive value, includes more potential COPD cases but has a higher rate of false positives.

  4. Socioeconomic Inequalities in Smoking and Smoking Cessation Due to a Smoking Ban: General Population-Based Cross-Sectional Study in Luxembourg

    Tchicaya, Anastase; Lorentz, Nathalie; Demarest, Stefaan

    2016-01-01

    This study aimed to measure changes in socioeconomic inequalities in smoking and smoking cessation due to the 2006 smoking ban in Luxembourg. Data were derived from the PSELL3/EU-SILC (Panel Socio-Economique Liewen Zu Letzebuerg/European Union—Statistic on Income and Living Conditions) survey, which was a representative survey of the general population aged ≥16 years conducted in Luxembourg in 2005, 2007, and 2008. Smoking prevalence and smoking cessation due to the 2006 smoking ban were used as the main smoking outcomes. Two inequality measures were calculated to assess the magnitude and temporal trends of socioeconomic inequalities in smoking: the prevalence ratio and the disparity index. Smoking cessation due to the smoking ban was considered as a positive outcome. Three multiple logistic regression models were used to assess social inequalities in smoking cessation due to the 2006 smoking ban. Education level, income, and employment status served as proxies for socioeconomic status. The prevalence of smoking decreased by 22.5% between 2005 and 2008 (from 23.1% in 2005 to 17.9% in 2008), but socioeconomic inequalities in smoking persisted. Smoking prevalence decreased by 24.2% and 20.2% in men and women, respectively; this difference was not statistically significant. Smoking cessation in daily smokers due to the 2006 smoking ban was associated with education level, employment status, and income, with higher percentages of quitters among those with a lower socioeconomic status. The decrease in smoking prevalence after the 2006 law was also associated with a reduction in socioeconomic inequalities, including differences in education level, income, and employment status. Although the smoking ban contributed to a reduction of such inequalities, they still persist, indicating the need for a more targeted approach of smoke-free policies directed toward lower socioeconomic groups. PMID:27100293

  5. Diagnostic values of glycated haemoglobin and diagnosis of diabetes: Results of a cross-sectional survey among general practitioners in the province of Reggio Emilia, Italy.

    Ballotari, Paola; Roncaglia, Francesca; Chiatamone Ranieri, Sofia; Greci, Marina; Manicardi, Valeria; Giorgi Rossi, Paolo

    2016-03-01

    The aim of this study was to investigate whether subjects included in the diabetes register solely because their HbA1c was over the diagnostic threshold received a diagnosis of diabetes from their general practitioner (GP). The study included all registered cases in 2009-2010 aged 18 or over that were identified only by the laboratory database because they had one or more HbA1c over the 6.5% threshold and for whom we did not find any information in the search of full electronic clinical records. Multilevel logistic regression was used to examine the influence of GP and patient characteristics. There were 228 participating GPs (76.3% of those invited) and 832 assessed subjects (68.8% of study population). There was a strong clustering among the GPs (residual intraclass correlation = 0.52, 95% CI 0.40-0.64). About one in two (55.5%) subjects with two or more HbA1c > =6.5% has been diagnosed as diabetic and the percentage declined - unless zeroing - in case the abnormal value was only one (28.3%). The likelihood of being labelled 'no diabetes' was greater in subjects aged less than 65 or over 74 with respect to the reference age group (OR 1.89, 95% CI 1.13-3.15; OR 1.55 95% CI 0.94-2.53). The same likelihood consistently decreased when HbA1c test was accompanied by abnormal fasting plasma glucose (FPG) assay (OR 0.20, 95% CI 0.12-0.32). A permanent exchange of information between the diabetes register and GPs should be maintained to improve the care of patients and the awareness of criteria for diabetes diagnosis among GPs.

  6. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study.

    Gayoso-Diz, Pilar; Otero-González, Alfonso; Rodriguez-Alvarez, María Xosé; Gude, Francisco; García, Fernando; De Francisco, Angel; Quintela, Arturo González

    2013-10-16

    Insulin resistance has been associated with metabolic and hemodynamic alterations and higher cardio metabolic risk. There is great variability in the threshold homeostasis model assessment of insulin resistance (HOMA-IR) levels to define insulin resistance. The purpose of this study was to describe the influence of age and gender in the estimation of HOMA-IR optimal cut-off values to identify subjects with higher cardio metabolic risk in a general adult population. It included 2459 adults (range 20-92 years, 58.4% women) in a random Spanish population sample. As an accurate indicator of cardio metabolic risk, Metabolic Syndrome (MetS), both by International Diabetes Federation criteria and by Adult Treatment Panel III criteria, were used. The effect of age was analyzed in individuals with and without diabetes mellitus separately. ROC regression methodology was used to evaluate the effect of age on HOMA-IR performance in classifying cardio metabolic risk. In Spanish population the threshold value of HOMA-IR drops from 3.46 using 90th percentile criteria to 2.05 taking into account of MetS components. In non-diabetic women, but no in men, we found a significant non-linear effect of age on the accuracy of HOMA-IR. In non-diabetic men, the cut-off values were 1.85. All values are between 70th-75th percentiles of HOMA-IR levels in adult Spanish population. The consideration of the cardio metabolic risk to establish the cut-off points of HOMA-IR, to define insulin resistance instead of using a percentile of the population distribution, would increase its clinical utility in identifying those patients in whom the presence of multiple metabolic risk factors imparts an increased metabolic and cardiovascular risk. The threshold levels must be modified by age in non-diabetic women.

  7. Smoking, leisure-time exercise and frequency of self-reported common cold among the general population in northeastern China: a cross-sectional study.

    Zhou, Ge; Liu, Hongjian; He, Minfu; Yue, Mengjia; Gong, Ping; Wu, Fangyuan; Li, Xuanxuan; Pang, Yingxin; Yang, Xiaodi; Ma, Juan; Liu, Meitian; Li, Jinghua; Zhang, Xiumin

    2018-02-27

    Physical activity (PA) and smoking have been reported to be associated with the duration and severity of common cold symptoms. However, few studies have addressed the associations between the frequency of leisure-time exercise, cigarette smoking status and the frequency of the common cold in a cold area. This study was designed to investigate these issues in northeastern China. This cross-sectional study included individuals who participated in a regular health examination conducted in Jilin Province, China. Information on episodes of the common cold, the frequency of leisure-time exercise and cigarette smoking status in the past year were collected by self-administered health questionnaires. Ordinal logistic regression models were used to analyse the associations between the frequency of leisure-time exercise, cigarette smoking status and the retrospective frequency of common cold. A total of 1413 employees participated in the study, with an average age of 38.92 ± 9.04 years and 44.4% of them were male. Of all participants, 80.8% reported having experienced the common cold in the past year. After adjustment, the risk of suffering from the common cold more than once (odds ratios (ORs), 1.59; 95% confidence interval (CI), 1.27-1.99) in passive smokers was 1.59 times as high as that in non-smokers. Nevertheless, the results of the adjusted analysis showed no statistically significant relation between current smoking and the frequency of the common cold. A high frequency of leisure-time exercise (≥3 days/week) was associated with a 26% reduced risk of having at least one episode of the common cold (OR, 0.74; 95% CI, 0.55-0.98) compared with a low frequency group (exercise appears not to be obvious (current smokers: OR, 0.68; 95% CI, 0.33-1.43; passive smokers: OR, 1.15; 95% CI, 0.69-1.93). Passive smoking was associated with a higher risk of having self-reported common cold at least once, while a high frequency of leisure-time exercise was related to a lower

  8. Contact with child and adolescent psychiatric services among self-harming and suicidal adolescents in the general population: a cross sectional study.

    Tørmoen, Anita J; Rossow, Ingeborg; Mork, Erlend; Mehlum, Lars

    2014-01-01

    Studies have shown that adolescents with a history of both suicide attempts and non-suicidal self-harm report more mental health problems and other psychosocial problems than adolescents who report only one or none of these types of self-harm. The current study aimed to examine the use of child and adolescent psychiatric services by adolescents with both suicide attempts and non-suicidal self-harm, compared to other adolescents, and to assess the psychosocial variables that characterize adolescents with both suicide attempts and non-suicidal self-harm who report contact. Data on lifetime self-harm, contact with child and adolescent psychiatric services, and various psychosocial risk factors were collected in a cross-sectional sample (response rate = 92.7%) of 11,440 adolescents aged 14-17 years who participated in a school survey in Oslo, Norway. Adolescents who reported any self-harm were more likely than other adolescents to have used child and adolescent psychiatric services, with a particularly elevated likelihood among those with both suicide attempts and non-suicidal self-harm (OR = 9.3). This finding remained significant even when controlling for psychosocial variables. In adolescents with both suicide attempts and non-suicidal self-harm, symptoms of depression, eating problems, and the use of illicit drugs were associated with a higher likelihood of contact with child and adolescent psychiatric services, whereas a non-Western immigrant background was associated with a lower likelihood. In this study, adolescents who reported self-harm were significantly more likely than other adolescents to have used child and adolescent psychiatric services, and adolescents who reported a history of both suicide attempts and non-suicidal self-harm were more likely to have used such services, even after controlling for other psychosocial risk factors. In this high-risk subsample, various psychosocial problems increased the probability of contact with child and

  9. 7 CFR 600.9 - Major land resource area soil survey offices.

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Major land resource area soil survey offices. 600.9 Section 600.9 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE GENERAL ORGANIZATION § 600.9 Major land resource area soil survey offices. The United States is divide...

  10. 41 CFR 102-85.40 - What are the major components of the pricing policy?

    2010-07-01

    ... components of the pricing policy? 102-85.40 Section 102-85.40 Public Contracts and Property Management...-PRICING POLICY FOR OCCUPANCY IN GSA SPACE Pricing Policy-General § 102-85.40 What are the major components of the pricing policy? The major components of the pricing policy are: (a) An OA between a customer...

  11. Effects of parental gender and level of education on the quality of life and general health of pediatric patients with epilepsy: An outpatient cross-sectional survey.

    Iqbal, Meisam; Amirsalari, Susan; Radfar, Shokofeh; Haidari, Mohsen Reza

    2016-07-01

    The quality of life (QOL) of children with epilepsy has been widely studied, and several problems related to cognition, behavior, social lives, and physical activity among these children have been reported. Family life and parental care are important aspects of the lives of these patients. The impact of parental education on the QOL of pediatric patients with epilepsy is an understudied topic, especially in developing countries. In this study, we investigated the QOL and general health (GH) of patients with epilepsy presenting at the pediatric neurology clinic at Baqiyatallah Hospital and a private clinic. The Quality of Life in Childhood Epilepsy (QOLCE) questionnaire, which is a 92-item epilepsy-specific questionnaire covering physical activity, well-being, cognition, behavior, social activity, overall QOL, and GH, was used for interviewing parents. A total of 106 patients (m=61, 57.5% and f=45, 42.5%) aged 5-17years (mean: 10.31±2.91) participated in the study. Overall, there was no significant difference between the QOL and GH results of male and female patients. However, the maternal education level had a significant impact on the overall QOL (high school: 3.02±0.85 vs. B.Sc.: 3.67±0.61, peducation had no significant effect. A multiple linear regression showed that the maternal education level had an independently significant association with the physical activity of the patients (p=0.02, CI: 1.4-6.25), and the paternal education level had an independently significant association with the well-being of the patients (p=0.02, CI: 0.43-5.36). In addition, the maternal education level (high school vs. B.Sc.) had a significant effect on physical activity, well-being, cognition, and behavior for all of the patients (peducation level (high school vs. B.Sc.) had no significant impact. However, in a comparison of high school vs. higher education, paternal education had a significant effect on patients' physical activity and well-being (peducation play a significant

  12. Predictors for Assessing Electronic Messaging Between Nurses and General Practitioners as a Useful Tool for Communication in Home Health Care Services: A Cross-Sectional Study

    Hofoss, Dag; Grimsmo, Anders; Hellesø, Ragnhild

    2015-01-01

    Background Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. Objective The aim of this study was to explore home health care nurses’ assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. Methods The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Results Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, Pmessaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, Pmessaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). Conclusions This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full

  13. Validity of the Self- Mini Nutritional Assessment (Self- MNA) for the Evaluation of Nutritional Risk. A Cross- Sectional Study Conducted in General Practice.

    Donini, L M; Marrocco, W; Marocco, C; Lenzi, A

    2018-01-01

    Malnutrition is a frequent condition in the elderly especially in hospitals and in nursing homes, and even among the free-living elders the prevalence is not negligible (5-10%). Awareness towards malnutrition is still limited. The lack of time for nutritional assessment by the overcommitted healthcare personnel, including the general practitioners (GPs), may represent one possible explanation for limited recognition of malnutrition. Therefore, a self-administered instrument could be useful in raising alert on the GPs and allow early detection of malnutrition and early care provision. The aim of the present study was to analyze the validity of the Self-MNA that takes cue from the Mini Nutritional Assessment- Short Form (MNA-SF) and has been adapted to be self-administered by free-living elderly subjects. Participants were recruited from patients referring to the GP offices in Italy. Nutritional evaluation was performed through the administration of Full-MNA, MNA-SF and Self-MNA. The comorbidity level was assessed through the Cumulative Illness Rating Scale (CIRS). The level of difficulty in filling out the test was reported by the participants, and the time spent to complete the Self-MNA was also registered. A total of 226 subjects, 125 women and 101 men (75.1 ±8 and 75.3 ± 8 years old, respectively; p=0.89) were enrolled, and 214 (94.7%) of them completed the Self-MNA. According with the Full-MNA test score, 8.4% of women and 3.5% of men were classified as malnourished, whereas 32.7% of women and 31.4% of men were at risk of malnutrition. Agreement between Self-MNA and Full-MNA, and Self-MNA vs. MNA-SF was classified as "moderate" (k = 0.476 and 0.496 respectively; p < 0.001). Self-MNA showed a fair predictive value compared to the Full-MNA and MNA-SF tests (76.6 and 79.9%, respectively) with a barely adequate sensitivity (70.9 and 75.4%, respectively). The analysis of the characteristics of FN (false negative: subjects who were considered at risk of malnutrition

  14. Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions. A randomized controlled trial in the general hospital setting (CC-DIM

    Goorden M

    2017-07-01

    Full Text Available Maartje Goorden,1 Christina M van der Feltz-Cornelis,2,3 Kirsten M van Steenbergen-Weijenburg,4 Eva K Horn,5 Aartjan TF Beekman,6,7 Leona Hakkaart-van Roijen1 1Institute of Health Policy and Management (iBMG/Institute for Medical Technology Assessment (iMTA, Erasmus University Rotterdam, Rotterdam, 2Tranzo Department, Tilburg University, 3Clinical Centre of Excellence for Body, Mind and Health, GGzBreburg, Tilburg, 4Trimbos Instituut, Utrecht, 5Viersprong Institute for Studies on Personality Disorders, Halsteren, 6Department of Psychiatry, 7EMGO+ Research Institute VUmc, VU University Medical Centre, Amsterdam, the Netherlands Purpose: Major depressive disorder (MDD is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC may be a cost-effective treatment. However, its cost-effectiveness in this patient group has not yet been established. Therefore, the aim of this study was to evaluate the cost-utility of CC for the treatment of comorbid MDD in chronically ill patients in the outpatient general hospital setting. The study was conducted from a health care and societal perspective.Patients and methods: In this randomized controlled trial, 81 patients with moderate-to-severe MDD were included; 42 were randomly assigned to the CC group and 39 to the care as usual (CAU group. We applied the TiC-P, short-form Health-Related Quality of Life questionnaire, and EuroQol EQ-5D 3 level version, measuring the use of health care, informal care, and household work, respectively, at baseline and at 3, 6, 9, and 12 months follow-up.Results: The mean annual direct medical costs in the CC group were €6,718 (95% confidence interval [CI]: 3,541 to 10,680 compared to €4,582 (95% CI: 2,782 to 6,740 in the CAU group. The average quality-adjusted life years (QALYs gained were 0.07 higher

  15. Progress report - physics and health sciences - physics section 1990 January 01 - June 30

    Hardy, J.C.

    1990-10-01

    This is the ninth semi-annual report on the Physics section of Physics and Health Sciences. Major areas of discussion include: nuclear physics, accelerator physics, general physics, neutron's solid state physics, theoretical physics and fusion

  16. Cholesterol levels in panic disorder, generalized anxiety disorder and major depression Níveis de colesterol no transtorno de pânico, transtorno de ansiedade generalizada e depressão maior

    ACIOLY L.T. LACERDA

    2000-06-01

    Full Text Available Serum plasma total cholesterol levels were measured in 85 male or female outpatients with panic disorder (PD; N=41, generalized anxiety disorder (GAD; N=23 and major depression (MD; N=21 according to DSM-IV criteria. All the patients had a mean cholesterol level within the normal range; males (N=22 and females (N=63 had approximately the same serum cholesterol levels (p > .05. No significant differences in cholesterol levels emerged between PD, GAD and MD patient groups. Both female PD and female GAD subjects had a mean cholesterol level similar to their male counterparts (p>.05. It is concluded that both Hayward and colleagues and Bajwa et al. findings could not be replicated by our study.Foram medidos os níveis plasmáticos de colesterol total em 85 pacientes ambulatoriais com transtorno de pânico (TP; N = 41, transtorno de ansiedade generalizada (TAG; N = 23 e depressão maior (DM; N = 21, diagnosticados de acordo com os critérios do DSM-IV. O grupo de pacientes apresentou média do nível de colesterol dentro da faixa normal; homens (N = 22 e mulheres (N = 63 tiveram aproximadamente os mesmos níveis séricos de colesterol (p > 0,05. Não foram observadas diferenças nos níveis de colesterol entre os grupos de pacientes com TP, TAG e DM. Mulheres com TP e as com TAG apresentaram média dos níveis de colesterol semelhante aos seus pares masculinos (p > 0,05. Conclui-se que os resultados obtidos por Hayward et al. e por Bajwa et al. não foram replicados neste estudo.

  17. Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder.

    Bech, Per; Lönn, Sara L; Overø, Kerstin F

    2010-02-01

    Analyses of data from 4 relapse-prevention studies with escitalopram were conducted in order to compare patients with and without residual symptoms with regard to relapse rates and global illness during double-blind, 24-week continuation periods. Clinical Global Impressions-Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery-Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization. All studies showed a statistically significant (P 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill than patients without such a symptom. Patients who did not continue active treatment worsened, even if they were initially free of a residual symptom. In contrast, patients who continued receiving escitalopram remained stable or further improved, regardless of residual symptoms or diagnosis. No clear picture emerged regarding whether patients with residual symptoms had a higher relapse rate. The presence of residual symptoms is associated with significantly worse overall illness severity in all 4 diagnostic groups and with a higher (although not significantly) risk of relapse for patients with MDD or OCD. The greatest difference in all of the studies was between patients treated with escitalopram (relapse rates ~ 20%) and placebo (relapse rates of about 50%). Copyright 2010 Physicians Postgraduate Press, Inc.

  18. Effects of vilazodone on suicidal ideation and behavior in adults with major depressive disorder or generalized anxiety disorder: post-hoc analysis of randomized, double-blind, placebo-controlled trials.

    Thase, Michael E; Edwards, John; Durgam, Suresh; Chen, Changzheng; Chang, Cheng-Tao; Mathews, Maju; Gommoll, Carl P

    2017-09-01

    Treatment-emergent suicidal ideation and behavior are ongoing concerns with antidepressants. Vilazodone, currently approved for the treatment of major depressive disorder (MDD) in adults, has also been evaluated in generalized anxiety disorder (GAD). Post-hoc analyses of vilazodone trials were carried out to examine its effects on suicidal ideation and behavior in adults with MDD or GAD. Data were pooled from vilazodone trials in MDD (four studies) and GAD (three studies). The incidence of suicide-related events was analyzed on the basis of treatment-emergent adverse event reporting and Columbia-Suicide Severity Rating Scale (C-SSRS) monitoring. Treatment-emergent suicidal ideation was analyzed on the basis of a C-SSRS category shift from no suicidal ideation/behavior (C-SSRS=0) at baseline to suicide ideation (C-SSRS=1-5) during treatment. In pooled safety populations (MDD, n=2233; GAD, n=1475), suicide-related treatment-emergent adverse events occurred in less than 1% of vilazodone-treated and placebo-treated patients. Incidences of C-SSRS suicidal ideation were as follows: MDD (vilazodone=19.9%, placebo=24.7%); GAD (vilazodone=7.7%, placebo=9.4%). Shifts from no suicidal ideation/behavior at baseline to suicidal ideation during treatment were as follows: MDD (vilazodone=9.4%, placebo=10.3%); GAD (vilazodone=4.4%, placebo=6.1%). Data from placebo-controlled studies indicate little or no risk of treatment-emergent suicidal ideation or behavior with vilazodone in adults with MDD or GAD. Nevertheless, all patients should be monitored for suicidal thoughts and behaviors during antidepressant treatment.

  19. Cesarean Sections

    ... birth after a C-section, called a VBAC ) Emergency C-Sections Some C-sections are unexpected emergency ... side to nurse or using the clutch (or football) hold can take the pressure off your abdomen. ...

  20. Gram-negative bacilli are a major cause of secondary pneumonia in patients with pulmonary tuberculosis: evidence from a cross-sectional study in a tertiary hospital in Nigeria.

    Iliyasu, Garba; Mohammad, Aminu B; Yakasai, Ahmad M; Dayyab, Farouq M; Oduh, Joan; Habib, Abdulrazaq G

    2018-05-19

    This study was aimed at describing the profile of bacterial aetiology of secondary pneumonia in pulmonary tuberculosis (PTB) patients. A 22-month analysis of patients with PTB and secondary bacterial pneumonia was conducted. Data on isolates recovered and the antimicrobial susceptibility profile were recorded. Of the 141 patients, there were 79 (56%) males and the mean age was 35.98±15.93. Gram-negative bacilli were isolated with equal frequency as Streptococcus pneumoniae (63 [44.7%]). Most of the isolates tested were sensitive to levofloxacin, ceftriaxone or chloramphenicol. Gram-negative bacilli are a major cause of pneumonia in patients with PTB on treatment.

  1. Dirichlet polynomials, majorization, and trumping

    Pereira, Rajesh; Plosker, Sarah

    2013-01-01

    Majorization and trumping are two partial orders which have proved useful in quantum information theory. We show some relations between these two partial orders and generalized Dirichlet polynomials, Mellin transforms, and completely monotone functions. These relations are used to prove a succinct generalization of Turgut’s characterization of trumping. (paper)

  2. General Anaesthesia for Caesarean Section | Downing | South ...

    South African Medical Journal. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 47, No 8 (1973) >. Log in or Register to get access to full text downloads.

  3. 14 CFR Section 22 - General Reporting Instructions

    2010-01-01

    ... Balance sheet Q (1) X X B-1.1 Balance sheet SA (2) NA NA B-7 Airframe and aircraft engine acquisitions and...) December 30 P-1(a) T-100, T-100(f) 1 Due dates falling on a Saturday, Sunday or national holiday will.... (Approved by the Office of Management and Budget under control number 2138-0013) [ER-755, 37 FR 19726, Sept...

  4. Validity of the brief Zung's scale for screening major depressive episode among the general population from Bucaramanga, Colombia Validez de la escala breve de Zung para tamizaje del episodio depresivo mayor en la población general de Bucaramanga, Colombia

    Luis Alfonso Díaz

    2011-05-01

    Full Text Available Introduction. Brief scales for identiying depressive disorder are as useful as long scales for screening. However, a validated scale with these characteristics is not avalaible in Colombia.
    Objective. To design a brief Zung's self-rating depression scale in order to screen major depressive episodes among adults dwelling in the general community.
    Materials and methods. After filling-out the 20-item Zung's self-rating depression scale, the ten items with the higher correlation with total score were selected. Construct and criterion validity were computed for these ten items.
    Results. The ten chosen items showed an internal consistency of 0,803, one factor that accounted for 36,6% of the variance; sensitivity was 95,5%; specificity, 70,3%; Cohen's kappa, 0,415; and area under receptor-operator curve, 0,898.
    Conclusions. The brief Zung's self-rating depression scale exhibits psychometric properties similar to the long version. This brief scale can be used as a screening device in the general population.

    Introducción. Las escalas breves para identificar trastornos depresivos conservan la utilidad de las escalas extensas como instrumentos para tamizaje. Sin embargo, no se cuenta con una escala de estas características validada en población general colombiana.
    Objetivo. Diseñar una escala abreviada de la escala de Zung para depresión para tamizaje de episodio depresivo mayor en adultos residentes en la comunidad general.
    Materiales y métodos. A partir de la aplicación de la escala de Zung de veinte items se tomaron los diez items que mostraron la mayor correlación con la puntuación total. A estos items escogidos se les determinó la validez de constructo y la validez de criterio.
    Resultados. Los diez items escogidos mostraron una consistencia interna de 0,803, un único factor principal que explicaba el 36,6% de la varianza y sensibilidad de 95,5%, especificidad de 70,3%, kappa media de Cohen de 0

  5. Neutral pion electroproduction and virtual Compton scattering on proton with four-momentum transfer squared Q2 = 1 GeV2. Measurement of cross-sections and of generalized polarizabilities

    Laveissiere, G.

    2001-11-01

    In hadronic physics, the nucleon structure and the quarks confinement are still topical issues. The neutral pion electroproduction and virtual Compton scattering (VCS) reactions allow us to access new observables that describe this structure. This work is focussed on the VCS experiment performed at Jefferson Lab in 1998. The 4 GeV electron beam is scattered off a cryogenic hydrogen target, and the scattered electron and recoiled proton are detected in coincidence in the twin hall A spectrometers. The photon (pion) is reconstructed using a missing particle technique. The data analysis allowed to extract the cross sections relative to both process at four-momentum transfer squared Q 2 = 1 GeV 2 . The VCS cross section has been extracted for the first time in the proton resonance region (W between 1.O and 2.0 GeV) through the photon electroproduction reaction. Around the pion-production threshold up to the Delta(1232) resonance region, these results lead to the measurement of the generalized polarizabilities, that describe the proton structure in the same way as the elastic form factors. Moreover, the neutral pion electroproduction cross section measurement in the resonance region has brought new constraints on the existing phenomenological models. (author)

  6. Decree no 90-918 of 11 october 1990 on exercising rights to information on major risks, in implementation of Section 21 of act no 87-565 of 22 july 1987 on the organisation of public safety measures, forestry protection against fires and prevention of major risks

    1990-01-01

    This Decree specifies the content and type of information to which persons likely to be exposed to major risks must have access, in accordance with the 1987 Act. These provisions apply in the communes for which a special action plan has been prepared. The information includes a description of the risks and their foreseeable consequences for persons, property and the environment, and a statement on the preventive measures to limit their effects. A summary record of this information is established [fr

  7. Evaluated cross section libraries

    Maqurno, B.A.

    1976-01-01

    The dosimetry tape (ENDF/B-IV tape 412) was issued in a general CSEWG distribution, August 1974. The pointwise cross section data file was tested with specified reference spectra. A group averaged cross section data file (620 groups based on tape 412) was tested with the above spectra and the results are presented in this report

  8. How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study

    Volpi, Annalisa; Gordini, Giovanni; Ventura, Chiara; Barozzi, Marco; Caspani, Maria Luisa Rita; Fabbri, Andrea; Ferrari, Anna Maria; Ferri, Enrico; Giugni, Aimone; Marino, Massimiliano; Martino, Costanza; Pizzamiglio, Mario; Ravaldini, Maurizio; Russo, Emanuele; Trabucco, Laura; Trombetti, Susanna; De Palma, Rossana

    2017-01-01

    Objective To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. Setting ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. Participants 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only. Results A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit. Conclusion The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems. PMID:28965094

  9. Prevalence of short sleep duration and its association with obesity among adolescents 15- to 19-year olds: A cross-sectional study from three major cities in Saudi Arabia

    Hazzaa M Al-Hazzaa

    2012-01-01

    Full Text Available Background: Adequate sleep has been considered important for the adolescent′s health and well being. On the other hand, self-imposed sleep curtailment is now recognized as a potentially important and novel risk factor for obesity. The present study aimed to assess the prevalence of short sleep duration and its association with obesity among Saudi adolescents. Methods: This is a school-based cross-sectional study with self-reported sleep questionnaires. It was conducted during the years 2009/2010 in three cities in Saudi Arabia; Al-Khobar, Jeddah, and Riyadh. Participants were 2868 secondary-school males (1379 and females (1389 aged 15 to 19 years, randomly selected using a multistage stratified sampling technique. Measurements included weight, height, waist circumference, BMI, and sleeping duration. Logistic regression analysis while adjusted for age, gender, and location was used to examine the associations between sleep duration and obesity measures. Results: The mean (SD of sleep duration was 7.2 (1.6 hours/day with no significant differences between males and females. About 31% of the participants obtain less than 7 hours of sleep per day, while approximately 50% of the sample gets less than 8 hours of daily sleep. Two-way ANCOVA results while controlling for the effect of age revealed a significant gender by school-type interaction (P<0.001. In addition, adequate sleep duration increased the odds of having normal weight (adjusted odds ratios = 1.28, 95% CI = 1.08-1.50, P = 0.003. Conclusion: The present study observed a high prevalence of short sleep duration among Saudi adolescents 15- to 19-year olds and that short sleep duration was significantly associated with increased risk of overweight and obesity. Future interventions should investigate whether adopting a healthy lifestyle by adolescents with short sleep duration would improve their sleeping habits or not.

  10. Cardiovascular Reactivity in Patients With Major Depressive Disorder With High- or Low-Level Depressive Symptoms: A Cross-Sectional Comparison of Cardiovascular Reactivity to Laboratory-Induced Mental Stress.

    Wang, Mei-Yeh; Chiu, Chen-Huan; Lee, Hsin-Chien; Su, Chien-Tien; Tsai, Pei-Shan

    2016-03-01

    Depression increases the risk of adverse cardiac events. Cardiovascular reactivity is defined as the pattern of cardiovascular responses to mental stress. An altered pattern of cardiovascular reactivity is an indicator of subsequent cardiovascular disease. Because depression and adverse cardiac events may have a dose-dependent association, this study examined the differences in cardiovascular reactivity to mental stress between patients with major depressive disorder (MDD) with high depression levels and those with low depression levels. Moreover, autonomic nervous system regulation is a highly plausible biological mechanism for the pattern of cardiovascular reactivity to mental stress. The association between cardiovascular reactivity and parameters of heart rate variability (HRV), an index for quantifying autonomic nervous system activity modulation, was thus examined. This study included 88 patients with MDD. HRV was measured before stress induction. The Stroop Color and Word Test and mirror star-tracing task were used to induce mental stress. We observed no significant association between depressive symptom level and any of the cardiovascular reactivity parameters. Cardiovascular reactivity to mental stress was comparable between patients with MDD with high-level depressive symptoms and those with low-level depressive symptoms. After adjusting for confounding variables, the high-frequency domain of HRV was found to be an independent predictor of the magnitude of heart rate reactivity (β = -.33, p = .002). In conclusion, the magnitude of cardiovascular reactivity may be independent of depression severity in patients with MDD. The autonomic regulation of cardiovascular responses to mental stress primarily influences heart rate reactivity in patients with MDD. © The Author(s) 2015.

  11. Assessment of mode of delivery and predictors of emergency caesarean section among women living with HIV in a matched-pair setting with women from the general population in Denmark, 2002-2014

    Ørbaek, M; Thorsteinsson, K; Helleberg, M

    2017-01-01

    OBJECTIVES: We aimed to assess mode of delivery and predictors of emergency caesarean section (EmCS) in women living with HIV (WLWH) in a matched-pair setting with women from the general population (WGP) in Denmark. Further, we analysed birth plan in WLWH. METHODS: All WLWH giving birth to live...... in the study. At delivery, all WLWH were on antiretroviral therapy and 85.6% had HIV RNA HIV-1 RNA copies/mL. Mean age was 32.7 years [95% confidence interval (CI) 32.1-33.2 years]. Mode of delivery differed significantly between WLWH and WGP [vaginal delivery, 33.4% versus 73.3%, respectively; elective...

  12. Generalized Superconductivity. Generalized Levitation

    Ciobanu, B.; Agop, M.

    2004-01-01

    In the recent papers, the gravitational superconductivity is described. We introduce the concept of generalized superconductivity observing that any nongeodesic motion and, in particular, the motion in an electromagnetic field, can be transformed in a geodesic motion by a suitable choice of the connection. In the present paper, the gravitoelectromagnetic London equations have been obtained from the generalized Helmholtz vortex theorem using the generalized local equivalence principle. In this context, the gravitoelectromagnetic Meissner effect and, implicitly, the gravitoelectromagnetic levitation are given. (authors)

  13. Are general and strategic measures of organizational context and leadership associated with knowledge and attitudes toward evidence-based practices in public behavioral health settings? A cross-sectional observational study.

    Powell, Byron J; Mandell, David S; Hadley, Trevor R; Rubin, Ronnie M; Evans, Arthur C; Hurford, Matthew O; Beidas, Rinad S

    2017-05-12

    Examining the role of modifiable barriers and facilitators is a necessary step toward developing effective implementation strategies. This study examines whether both general (organizational culture, organizational climate, and transformational leadership) and strategic (implementation climate and implementation leadership) organizational-level factors predict therapist-level determinants of implementation (knowledge of and attitudes toward evidence-based practices). Within the context of a system-wide effort to increase the use of evidence-based practices (EBPs) and recovery-oriented care, we conducted an observational, cross-sectional study of 19 child-serving agencies in the City of Philadelphia, including 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Organizational variables included characteristics such as EBP initiative participation, program size, and proportion of independent contractor therapists; general factors such as organizational culture and climate (Organizational Social Context Measurement System) and transformational leadership (Multifactor Leadership Questionnaire); and strategic factors such as implementation climate (Implementation Climate Scale) and implementation leadership (Implementation Leadership Scale). Therapist-level variables included demographics, attitudes toward EBPs (Evidence-Based Practice Attitudes Scale), and knowledge of EBPs (Knowledge of Evidence-Based Services Questionnaire). We used linear mixed-effects regression models to estimate the associations between the predictor (organizational characteristics, general and strategic factors) and dependent (knowledge of and attitudes toward EBPs) variables. Several variables were associated with therapists' knowledge of EBPs. Clinicians in organizations with more proficient cultures or higher levels of transformational leadership (idealized influence) had greater knowledge of EBPs; conversely, clinicians in organizations with more resistant cultures

  14. Usage of purchased self-tests for HIV and sexually transmitted infections in Amsterdam, the Netherlands: results of population-based and serial cross-sectional studies among the general population and sexual risk groups.

    Bil, Janneke P; Prins, Maria; Stolte, Ineke G; Dijkshoorn, Henriëtte; Heijman, Titia; Snijder, Marieke B; Davidovich, Udi; Zuure, Freke R

    2017-09-21

    There are limited data on the usage of commercially bought self-tests for HIV and other sexually transmitted infections (STIs). Therefore, we studied HIV/STI self-test usage and its determinants among the general population and sexual risk groups between 2007 and 2015 in Amsterdam, the Netherlands. Data were collected in four different studies among the general population (S1 - 2) and sexual risk groups (S3 - 4). S1 - Amsterdam residents participating in representative population-based surveys (2008 and 2012; n=6044) drawn from the municipality register; S2 - Participants of a population-based study stratified by ethnicity drawn from the municipality register of Amsterdam (2011-2015; n=17 603); S3 - Men having sex with men (MSM) participating in an HIV observational cohort study (2008 and 2013; n=597) and S4 - STI clinic clients participating in a cross-sectional survey (2007-2012; n=5655). Prevalence of HIV/STI self-test usage and its determinants. The prevalence of HIV/STI self-test usage in the preceding 6-12 months varied between 1% and 2% across studies. Chlamydia self-tests were most commonly used, except among MSM in S3. Chlamydia and syphilis self-test usage increased over time among the representative sample of Amsterdam residents (S1) and chlamydia self-test usage increased over time among STI clinic clients (S4). Self-test usage was associated with African Surinamese or Ghanaian ethnic origin (S2), being woman or MSM (S1 and 4) and having had a higher number of sexual partners (S1-2). Among those in the general population who tested for HIV/STI in the preceding 12 months, 5-9% used a self-test. Despite low HIV/STI self-test usage, we observed increases over time in chlamydia and syphilis self-test usage. Furthermore, self-test usage was higher among high-risk individuals in the general population. It is important to continue monitoring self-test usage and informing the public about the unknown quality of available self-tests in the Netherlands and

  15. General general game AI

    Togelius, Julian; Yannakakis, Georgios N.; 2016 IEEE Conference on Computational Intelligence and Games (CIG)

    2016-01-01

    Arguably the grand goal of artificial intelligence research is to produce machines with general intelligence: the capacity to solve multiple problems, not just one. Artificial intelligence (AI) has investigated the general intelligence capacity of machines within the domain of games more than any other domain given the ideal properties of games for that purpose: controlled yet interesting and computationally hard problems. This line of research, however, has so far focuse...

  16. Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana.

    Omech, Bernard; Tshikuka, Jose-Gaby; Mwita, Julius C; Tsima, Billy; Nkomazana, Oathokwa; Amone-P'Olak, Kennedy

    2016-01-01

    Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients' attendances in Botswana. A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants' sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria. In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%, P=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference. Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors.

  17. Achondroplasia: anaesthetic challenges for caesarean section.

    Dubiel, L; Scott, G A; Agaram, R; McGrady, E; Duncan, A; Litchfield, K N

    2014-08-01

    Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman's postoperative care was complicated by respiratory compromise requiring high dependency care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. 49 CFR 520.5 - Guidelines for identifying major actions significantly affecting the environment.

    2010-10-01

    ... significantly affecting the environment. 520.5 Section 520.5 Transportation Other Regulations Relating to... significantly affecting the environment. (a) General guidelines. The phrase, “major Federal actions significantly affecting the quality of the human environment,” as used in this part, shall be construed with a...

  19. General characteristics and assessment of the scientific/technical feasibility of the next major device in the tokamak fusion program. Summary of the US contributions to the INTOR workshop

    Stacey, W.M. Jr.; Gilleland, J.R.; Kulcinski, G.L.; Rutherford, P.H.

    1979-09-01

    A substantial physics and technology data base for INTOR exists today, and this data base will be expanded over the next few years by currently planned programs. However, certain crucial information will not be developed by currently planned programs. Much of this missing information could be developed on the INTOR time scale by the expansion and/or acceleration of existing R and D programs and by the establishment of new R and D programs. On this basis, it is concluded that it is scientifically and technologically feasible to undertake the construction of an INTOR-like device to operate in the early 1990s, provided that the supporting R and D effort is expanded immediately to provide an adequate data base within the next few years in a few critical areas. Furthermore, it is concluded that the construction of an INTOR-like device to operate in the early 1990s is the appropriate next major step in the development of fusion power

  20. Major Sport Venues

    Department of Homeland Security — The Major Public Venues dataset is composed of facilities that host events for the National Association for Stock Car Auto Racing, Indy Racing League, Major League...

  1. Major Depression Among Adults

    ... Depressive Episode Among Adolescents Data Sources Share Major Depression Definitions Major depression is one of the most ... Bethesda, MD 20892-9663 Follow Us Facebook Twitter YouTube Google Plus NIMH Newsletter NIMH RSS Feed NIMH ...

  2. [TRANSPORT OF OXYGEN DURING GEOMETRICAL RECONSTRUCTION OF THE LEFT VENTRICLE IN CONJUNCTION WITH CORONARY ARTERY BYPASS GRAFTING AND USING OF HIGH THORACIC EPIDURAL ANESTHESIA AS A MAJOR COMPONENT OF GENERAL ANAESTHESIA].

    Zatevahina, M V; Farzutdinov, A F; Rahimov, A A; Makrushin, I M; Kvachantiradze, G Y

    2015-01-01

    The purpose of the study is to examine the perioperative dynamics of strategic blood oxygen transport indicators: delivery (DO2), consumption (VO2), the coefficient of oxygen uptake (CUO2) and their composition, as well as the dynamics of blood lactate indicators in patients with ischaemic heart disease (IHD) who underwent surgery under cardiopulmonary bypass with high thoracic epidural anaesthesia (HTEA) as the main component of anesthesia. Research was conducted in 30 patients with a critical degree of operational risk, during the correction of post-infarction heart aneurysmn using the V. Dor method in combination with coronary artery bypass grafting. The strategic blood oxygen transport indicators (delivery, consumption and the oxygen uptake coefficient) showed a statistically significant decrease compared to the physiological norm and to the initial data at two points of the research: the intubation of the trachea and during cardiopulmonary bypass. The system components of oxygen were influenced at problematic stages by the dynamics of SvO2 (increase), AVD (decrease), hemodilution withe fall of the HIb- in the process of JR in the persence of superficial hypothermia. The maintenance of optimal CA in the context of HTEA, combined with a balanced volemic load and a minimized cardiotonic support ensured the stabilisation of strategic blood oxygen transport indicators aithe postperfusion stage and during the immediate postoperative period The article is dedicated to the study of strategic blood oxygen transport indicators and their components during the operation of geometric reconstruc-tion of the left ventricle combined with coronary artery-bypass using cardiopulmonary bypass and with high thoracic epidural anesthesia as the main component of general anaesthesia. The analysis has covered the stagewise delivery dynamics, consumption and the oxygen uptake coefficient at II stages of the operation and of the immediate postoperative period. The study has ident (fled

  3. Organic research section. 1984 review and 1985 programs

    Glass, R.W.

    1985-02-01

    This report reviews the major activities and accomplishments of the Organic Research Section in 1984 and presents the 1985 work program. The three major areas of the Section's research work are non-metallic materials which includes applications and uses of plastics, petroleum products, coatings and elastomers; reactor waste management; and activity transport/decontamination of nuclear systems. In 1984, 50% of the Section's resources were used on studies in support of nuclear generation, 13% on reactor waste, and 37% on general activities and work in support of utilization, transmission and distribution, and thermal and hydraulic programs. About 60% of the section's work was supported by transfer and revenue funds as a result of urgent short-term work requirements which resulted in 68% of the work falling into the technical investigation, consulting and testing categories

  4. Pituitary gland in Bipolar Disorder and Major Depression: Evidence from structural MRI studies: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summarise relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders.

    Delvecchio, G; Altamura, A C; Soares, J C; Brambilla, P

    2017-08-15

    The function of the hypothalamo-pituitary-adrenal axis (HPA) has been widely investigated in mood disorders based on its role in regulating stress response. Particularly, Magnetic Resonance Imaging (MRI) reports have explored pituitary gland (PG) in both bipolar disorder (BD) and major depressive disorder (MDD). In this context, the present review summarizes the results from MRI studies with the final aim of commenting on the presence of common or distinct PG structural alterations between these two disabling illnesses. A bibliographic search on PUBMED of all MRI studies exploring PG volumes in BD and MDD as well as first-degree relatives (RELs) from 2000 up to October 2016 was performed. Following the screening process of the available literature it can be said that a) PG enlargement has been found in both BD and MDD, therefore potentially representing a common neurobiological marker characterizing mood disorders, and b) PG volumes are moderated by age and sex in both illnesses, although the direction and the extent of this moderation are still not fully clear. Few MRI studies with heterogeneous results. These hypotheses must be taken with caution especially because the heterogeneity of the results of the studies reviewed does not allow for a definite answer about the role of PG in affective disorders. Therefore, larger longitudinal studies investigating PG volumes in BD and MDD patients at the early phases of the illness, by considering females and males separately, are needed to further corroborate these findings. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Bibliography section

    Anon.

    1976-01-01

    This bibliography contains 2180 references. They are arranged according to the following subjects: gas chromatography, column chromatography, paper chromatography, thin-layer chromatography, and electrophoretic techniques. Each subject is in principle divided into 36 categories. The following category falls within the INIS scope: radioactive and other isotope compounds. For the above mentioned subjects there are 21 references in this category. Other categories that might be partially in scope are: reviews and books; fundamentals, theory and general; techniques; pollution

  6. Prospects after Major Trauma

    Holtslag, H.R.

    2007-01-01

    Introduction. After patients survived major trauma, their prospects, in terms of the consequences for functioning, are uncertain, which may impact severely on patient, family and society. The studies in this thesis describes the long-term outcomes of severe injured patients after major trauma. In

  7. Cancer section

    Fry, R.J.M.

    1985-01-01

    An overview is presented of the program at ORNL which is concerned with the study of cancer. The studies range from those at the molecular level and the control of gene expression to those concerning cell interactions and the role of immune responses. Since the agents capable of inducing cancer are multiple, the approaches must encompass the specific characteristics of chemical carcinogens, ionizing radiation, ultraviolet radiation and viruses. The approach of the molecular biological studies is centered on the role of activation of transposable gene elements. One investigation is concerned with the study of radiation-induced myelogenous leukemia. The other radiation carcinogenesis studies fall into two major groups. First, there are investigations of various facets of the mechanisms of cancer induction. The molecular and chromosomal studies fall into this category. The second group of studies includes those that are concerned with risk estimates

  8. A major safety overhaul

    2003-01-01

    A redefined policy, a revamped safety course, an environmental project... the TIS (Technical Inspection and Safety) Division has begun a major safety overhaul. Its new head, Wolfgang Weingarten, explains to the Bulletin why and how this is happening.

  9. Allegheny County Major Rivers

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset contains locations of major rivers that flow through Allegheny County. These shapes have been taken from the Hydrology dataset. The Ohio River,...

  10. Depression (Major Depressive Disorder)

    ... generally miserable or unhappy without really knowing why. Depression symptoms in children and teens Common signs and ... in normal activities, and avoidance of social interaction. Depression symptoms in older adults Depression is not a ...

  11. Major international sport profiles.

    Patel, Dilip R; Stier, Bernhard; Luckstead, Eugene F

    2002-08-01

    Sports are part of the sociocultural fabric of all countries. Although different sports have their origins in different countries, many sports are now played worldwide. International sporting events bring athletes of many cultures together and provide the opportunity not only for athletic competition but also for sociocultural exchange and understanding among people. This article reviews five major sports with international appeal and participation: cricket, martial arts, field hockey, soccer, and tennis. For each sport, the major aspects of physiological and biomechanical demands, injuries, and prevention strategies are reviewed.

  12. Generalized functions

    Gelfand, I M; Graev, M I; Vilenkin, N Y; Pyatetskii-Shapiro, I I

    Volume 1 is devoted to basics of the theory of generalized functions. The first chapter contains main definitions and most important properties of generalized functions as functional on the space of smooth functions with compact support. The second chapter talks about the Fourier transform of generalized functions. In Chapter 3, definitions and properties of some important classes of generalized functions are discussed; in particular, generalized functions supported on submanifolds of lower dimension, generalized functions associated with quadratic forms, and homogeneous generalized functions are studied in detail. Many simple basic examples make this book an excellent place for a novice to get acquainted with the theory of generalized functions. A long appendix presents basics of generalized functions of complex variables.

  13. Major New Initiatives

    First page Back Continue Last page Overview Graphics. Major New Initiatives. Multi-party multi-rate video conferencing OOPS. Live Lecture OOPS. Rural ATM Machine Vortex. Finger print detection HP-IITM. Medical Diagnostic kit NeuroSynaptic. LCD projection system TeNeT. Web Terminal MeTeL Midas. Entertainment ...

  14. Major planning enquiries

    Shore, P

    1978-11-01

    This is a speech delivered by the U.K. Secretary of State for the Environment in Manchester (UK) on September 13th 1978. It outlines the Minister's views on the role and significance of major planning inquiries - such as that proposed to be held on the Commercial Demonstration Fast Reactor. (CDFR) (author).

  15. Major Biomass Conference

    Top Scientists, Industry and Government Leaders to Gather for Major Biomass Conference America, South America and Europe will focus on building a sustainable, profitable biomass business at the Third Biomass Conference of the Americas in Montreal. Scheduled presentations will cover all biomass

  16. Unity in Major Themes

    Booss-Bavnbek, Bernhelm; Davis, Philip J.

    We describe and explain the desire, common among mathematicians, both for unity and independence in its major themes. In the dialogue that follows, we express our spontaneous and considered judgment and reservations; by contrasting the development of mathematics as a goal-driven process as opposed...

  17. Turbine airfoil having outboard and inboard sections

    Mazzola, Stefan; Marra, John J

    2015-03-17

    A turbine airfoil usable in a turbine engine and formed from at least an outboard section and an inboard section such that an inner end of the outboard section is attached to an outer end of the inboard section. The outboard section may be configured to provide a tip having adequate thickness and may extend radially inward from the tip with a generally constant cross-sectional area. The inboard section may be configured with a tapered cross-sectional area to support the outboard section.

  18. The Prototypical Majority Effect Under Social Influence.

    Koriat, Asher; Adiv-Mashinsky, Shiri; Undorf, Monika; Schwarz, Norbert

    2018-05-01

    Majority views are reported with greater confidence and fluency than minority views, with the difference increasing with majority size. This Prototypical Majority Effect (PME) was attributed generally to conformity pressure, but Koriat et al. showed that it can arise from the processes underlying decision and confidence independent of social influence. Here we examined the PME under conditions that differ in social influence. In Experiment 1, a robust PME emerged in the absence of information about the majority views, but the provision sof that information increased the choice of the majority view and magnified the PME. In Experiment 2, a PME emerged in a minority-biased condition that misled participants to believe that the majority view was the minority view, but the PME was stronger in a majority-biased condition. The results were discussed in terms of a dual-process view: The PME observed under social influence may contain externally driven and internally driven components.

  19. Usage of purchased self-tests for HIV and sexually transmitted infections in Amsterdam, the Netherlands: results of population-based and serial cross-sectional studies among the general population and sexual risk groups

    Bil, Janneke P.; Prins, Maria; Stolte, Ineke G.; Dijkshoorn, Henriëtte; Heijman, Titia; Snijder, Marieke B.; Davidovich, Udi; Zuure, Freke R.

    2017-01-01

    Objectives There are limited data on the usage of commercially bought self-tests for HIV and other sexually transmitted infections (STIs). Therefore, we studied HIV/STI self-test usage and its determinants among the general population and sexual risk groups between 2007 and 2015 in Amsterdam, the

  20. General anxiety, depression, and physical health in relation to symptoms of heart-focused anxiety- a cross sectional study among patients living with the risk of serious arrhythmias and sudden cardiac death

    Hamang Anniken

    2011-11-01

    Full Text Available Abstract Objective To investigate the role of three distinct symptoms of heart-focused anxiety (cardio-protective avoidance, heart-focused attention, and fear about heart sensations in relation to general anxiety, depression and physical health in patients referred to specialized cardio-genetics outpatient clinics in Norway for genetic investigation and counseling. Methods Participants were 126 patients (mean age 45 years, 53.5% women. All patients were at higher risk than the average person for serious arrhythmias and sudden cardiac death (SCD because of a personal or a family history of an inherited cardiac disorder (familial long QT syndrome or hypertrophic cardiomyopathy. Patients filled in, Hospital Anxiety and Depression Scale, Short-Form 36 Health Survey, and Cardiac Anxiety Questionnaire, two weeks before the scheduled counseling session. Results The patients experienced higher levels of general anxiety than expected in the general population (mean difference 1.1 (p Conclusion Avoidance and fear may be potentially modifiable symptoms. Because these distinct symptoms may have important roles in determining general anxiety, depression and physical health in at-risk individuals of inherited cardiac disorders, the present findings may have implications for the further development of genetic counseling for this patient group.

  1. General Editorial

    Home; Journals; Resonance – Journal of Science Education. General Editorial. Articles in Resonance – Journal of Science Education. Volume 19 Issue 1 January 2014 pp 1-2 General Editorial. General Editorial on Publication Ethics · R Ramaswamy · More Details Fulltext PDF. Volume 19 Issue 1 January 2014 pp 3-3 ...

  2. Sector-specific issues and reporting methodologies supporting the General Guidelines for the voluntary reporting of greenhouse gases under Section 1605(b) of the Energy Policy Act of 1992. Volume 2: Part 4, Transportation sector; Part 5, Forestry sector; Part 6, Agricultural sector

    1994-10-01

    This volume, the second of two such volumes, contains sector-specific guidance in support of the General Guidelines for the voluntary reporting of greenhouse gas emissions and carbon sequestration. This voluntary reporting program was authorized by Congress in Section 1605(b) of the Energy Policy Act of 1992. The General Guidelines, bound separately from this volume, provide the overall rationale for the program, discuss in general how to analyze emissions and emission reduction/carbon sequestration projects, and address programmatic issues such as minimum reporting requirements, time parameters, international projects, confidentiality, and certification. Together, the General Guidelines and the guidance in these supporting documents will provide concepts and approaches needed to prepare the reporting forms. This second volume of sector-specific guidance covers the transportation sector, the forestry sector, and the agricultural sector

  3. The Ursa Major supercluster

    Schuch, N.J.

    1983-01-01

    An optical and a radio survey have been carried out. The optical observations consist of a spectroscopic survey in which redshift data for cluster galaxies and optical identifications of radio sources were obtained with the 98-inch Isaac Newton telescope at the Royal Greenwich Observatory, and the 200-inch Hale telescope; the photographic survey in B, V and R colors was made with the 48-inch Schmidt telescope at Palomar. Some results on the galaxy distribution in the Ursa Major supercluster are briefly discussed. (Auth.)

  4. Neutral pion electroproduction and virtual Compton scattering on proton with four-momentum transfer squared Q{sup 2} = 1 GeV{sup 2}. Measurement of cross-sections and of generalized polarizabilities; Electroproduction de photons et de pions sur le proton au quadrimoment de transfert Q{sup 2} = 1.0 GeV{sup 2}. Mesure des sections efficaces et extraction des polarisabilites generalisees

    Laveissiere, G

    2001-11-01

    In hadronic physics, the nucleon structure and the quarks confinement are still topical issues. The neutral pion electroproduction and virtual Compton scattering (VCS) reactions allow us to access new observables that describe this structure. This work is focussed on the VCS experiment performed at Jefferson Lab in 1998. The 4 GeV electron beam is scattered off a cryogenic hydrogen target, and the scattered electron and recoiled proton are detected in coincidence in the twin hall A spectrometers. The photon (pion) is reconstructed using a missing particle technique. The data analysis allowed to extract the cross sections relative to both process at four-momentum transfer squared Q{sup 2} = 1 GeV{sup 2}. The VCS cross section has been extracted for the first time in the proton resonance region (W between 1.O and 2.0 GeV) through the photon electroproduction reaction. Around the pion-production threshold up to the Delta(1232) resonance region, these results lead to the measurement of the generalized polarizabilities, that describe the proton structure in the same way as the elastic form factors. Moreover, the neutral pion electroproduction cross section measurement in the resonance region has brought new constraints on the existing phenomenological models. (author)

  5. Generalized product

    Greco, Salvatore; Mesiar, Radko; Rindone, Fabio

    2014-01-01

    Aggregation functions on [0,1] with annihilator 0 can be seen as a generalized product on [0,1]. We study the generalized product on the bipolar scale [–1,1], stressing the axiomatic point of view. Based on newly introduced bipolar properties, such as the bipolar increasingness, bipolar unit element, bipolar idempotent element, several kinds of generalized bipolar product are introduced and studied. A special stress is put on bipolar semicopulas, bipolar quasi-copulas and bipolar copulas.

  6. Securing Major Events

    Loeoef, Susanna

    2013-01-01

    When asked why the IAEA should provide nuclear security support to countries that organize large public events, Nuclear Security Officer Sophia Miaw answers quickly and without hesitation. ''Imagine any major public event such as the Olympics, a football championship, or an Expo. If a dirty bomb were to be exploded at a site where tens of thousands of people congregate, the radioactive contamination would worsen the effects of the bomb, increase the number of casualties, impede a rapid emergency response, and cause long term disruption in the vicinity,'' she said. Avoiding such nightmarish scenarios is the driving purpose behind the assistance the IAEA offers States that host major sporting or other public events. The support can range from a single training course to a comprehensive programme that includes threat assessment, training, loaned equipment and exercises. The type and scope of assistance depends on the host country's needs. ''We incorporate nuclear security measures into their security plan. We don't create anything new,'' Miaw said

  7. Personal contact with HIV-positive persons is associated with reduced HIV-related stigma: cross-sectional analysis of general population surveys from 26 countries in sub-Saharan Africa.

    Chan, Brian T; Tsai, Alexander C

    2017-01-11

    HIV-related stigma hampers treatment and prevention efforts worldwide. Effective interventions to counter HIV-related stigma are greatly needed. Although the "contact hypothesis" suggests that personal contact with persons living with HIV (PLHIV) may reduce stigmatizing attitudes in the general population, empirical evidence in support of this hypothesis is lacking. Our aim was to estimate the association between personal contact with PLHIV and HIV-related stigma among the general population of sub-Saharan Africa. Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys and AIDS Indicator Surveys of 26 African countries between 2003 and 2008. We fitted multivariable logistic regression models with country-level fixed effects, specifying social distance as the dependent variable and personal contact with PLHIV as the primary explanatory variable of interest. We analyzed data from 206,717 women and 91,549 men living in 26 sub-Saharan African countries. We estimated a statistically significant negative association between personal contact with PLHIV and desires for social distance (adjusted odds ratio [AOR] = 0.80; p  interventions should be developed and tested to reduce the stigma of HIV.

  8. 21 CFR 1000.1 - General.

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false General. 1000.1 Section 1000.1 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) RADIOLOGICAL HEALTH GENERAL General Provisions § 1000.1 General. References in this subchapter J to regulatory sections of the...

  9. Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015

    Célina Lichtl

    2017-11-01

    Full Text Available Abstract Background Hospitalizations for ambulatory care sensitive (ACS conditions are established indicators for the availability and quality of ambulatory care. We aimed to assess the differences between asylum-seeking children and children of the general population in a German city with respect to (i the prevalence of ACS hospitalizations, and (ii the utilization of emergency outpatient services for ACS conditions. Methods Using anonymous account data, all children admitted to the University Hospital Heidelberg in 2015 were included in our study. A unique cost unit distinguished asylum seekers residing in a nearby reception center (exposed from the children of the general population. We adapted international lists of ACS conditions and calculated the prevalence of ACS hospitalizations and the utilization of emergency outpatient services for ACS conditions, attributable fractions among the exposed (Afe and the population attributable fraction among total admissions (PAF for each outcome. Differences in the prevalence of each outcome between exposed and controls were analyzed in logistic regression models adjusted for sex, age group and quarterly admission. Results Of the 32,015 admissions in 2015, 19.9% (6287 were from inpatient and 80.1% (25,638 from outpatient care. In inpatient care, 9.8% (622 of all admissions were hospitalizations for ACS conditions. The Afe of ACS hospitalizations was 46.57%, the PAF was 1.12%. Emergency service use for ACS conditions could be identified in 8.3% (3088 of all admissions (Afe: 79.57%, PAF: 5.08%. The odds ratio (OR of asylum-seeking children being hospitalized for ACS conditions in comparison to the control group was 1.81 [95% confidence interval, CI: 1.02; 3.2]. The OR of the asylumseeking population compared to the general population for the utilization of emergency service use for ACS conditions was 4.93 [95% CI: 4.11; 5.91]. Conclusions Asylum-seeking children had significantly higher odds of ACS

  10. Major Depressive Disorder

    G Grobler

    2013-08-01

    Full Text Available The treatment guideline draws on several international guidelines: (iPractice Guidelines of the American Psychiatric Association (APAfor the Treatment of Patients with Major Depressive Disorder, SecondEdition;[1](ii Clinical Guidelines for the Treatment of DepressiveDisorders by the Canadian Psychiatric Association and the CanadianNetwork for Mood and Anxiety Treatments (CANMAT;[2](iiiNational Institute for Clinical Excellence (NICE guidelines;[3](iv RoyalAustralian and New Zealand College of Psychiatrists Clinical PracticeGuidelines Team for Depression (RANZCAP;[4](v Texas MedicationAlgorithm Project (TMAP Guidelines;[5](vi World Federation ofSocieties of Biological Psychiatry (WFSBP Treatment Guideline forUnipolar Depressive Disorder;[6]and (vii British Association forPsychopharmacology Guidelines.[7

  11. Simulation of a major tokamak disruption

    White, R.B.; Monticello, D.A.; Rosenbluth, M.N.

    1977-08-01

    It is known that the internal tokamak disruption leads to a current profile which is flattened inside the surface where the safety factor equals unity. It is shown that such a profile can lead to m = 2 magnetic islands which grow to fill a substantial part of the tokamak cross section in a time consistent with the observations of the major disruption

  12. 21 CFR 610.11 - General safety.

    2010-04-01

    ... 21 Food and Drugs 7 2010-04-01 2010-04-01 false General safety. 610.11 Section 610.11 Food and... GENERAL BIOLOGICAL PRODUCTS STANDARDS General Provisions § 610.11 General safety. A general safety test... for administration to humans. The general safety test is required in addition to other specific tests...

  13. Exploring the relationship between general practice characteristics, and attendance at walk-in centres, minor injuries units and EDs in England 2012/2013: a cross-sectional study.

    Tammes, Peter; Morris, Richard W; Brangan, Emer; Checkland, Kath; England, Helen; Huntley, Alyson; Lasserson, Daniel; MacKichan, Fiona; Salisbury, Chris; Wye, Lesley; Purdy, Sarah

    2016-10-01

    For several years, EDs in the UK NHS have faced considerable increases in attendance rates. Walk-in centres (WiCs) and minor injuries units (MIUs) have been suggested as solutions. We aimed to investigate the associations between practice and practice population characteristics with ED attendance rates or combined ED/WiC/MIU attendance, and the associations between WiC/MIU and ED attendance. We used general practice-level data including 7462 English practices in 2012/2013 and present adjusted regression coefficients from linear multivariable analysis for relationships between patients' emergency attendance rates and practice characteristics. Every percentage-point increase in patients reporting inability to make an appointment was associated with an increase in emergency attendance by 0.36 (95% CI 0.06 to 0.66) per 1000 population. Percentage-point increases in patients unable to speak to a general practitioner (GP)/nurse within two workdays and patients able to speak often to their preferred GP were associated with increased emergency attendance/1000 population by 0.23 (95% CI 0.05 to 0.42) and 0.10 (95% CI 0.00 to 0.19), respectively. Practices in areas encompassing several towns (conurbations) had higher attendance than rural practices, as did practices with more non-UK-qualified GPs. Practice population characteristics associated with increased emergency attendance included higher unemployment rates, higher percentage of UK whites and lower male life expectancy, which showed stronger associations than practice characteristics. Furthermore, higher MIU or WiC attendance rates were associated with lower ED attendance rates. Improving availability of appointments and opportunities to speak a GP/nurse at short notice might reduce ED attendance. Establishing MIUs and WiCs might also reduce ED attendance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. General relativity

    Kenyon, I.R.

    1990-01-01

    General relativity is discussed in this book at a level appropriate to undergraduate students of physics and astronomy. It describes concepts and experimental results, and provides a succinct account of the formalism. A brief review of special relativity is followed by a discussion of the equivalence principle and its implications. Other topics covered include the concepts of curvature and the Schwarzschild metric, test of the general theory, black holes and their properties, gravitational radiation and methods for its detection, the impact of general relativity on cosmology, and the continuing search for a quantum theory of gravity. (author)

  15. Impetigo in General Practice

    S. Koning (Sander)

    2005-01-01

    textabstractImpetigo is a common skin infection, usually caused by Staphylococcus aureus that mainly occurs in children. Patients with impetigo usually consult their general practitioner, who also treats the vast majority of cases. Impetigo is considered highly infectious, and consequently

  16. Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland.

    Lukhele, Bhekumusa Wellington; Techasrivichien, Teeranee; Suguimoto, S Pilar; Musumari, Patou Masika; El-Saaidi, Christina; Haumba, Samson; Tagutanazvo, Oslinah Buru; Ono-Kihara, Masako; Kihara, Masahiro

    2016-01-01

    HIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions. This cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14-3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09-3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00-5.00; PHIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319). Structural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially

  17. Association of in utero exposure to maternal smoking with reduced semen quality and testis size in adulthood: a cross-sectional study of 1,770 young men from the general population in five European countries

    Jensen, Tina Kold; Jørgensen, N.; Punab, M.

    2004-01-01

    % in Oslo, Norway (n = 221), 13% in Turku, Finland (n = 313), 14% in Kaunas, Lithuania (n = 157), and 19% in Tartu, Estonia (n = 190). Each man provided a semen sample, was examined by a physician, and, in collaboration with his mother, completed a questionnaire about general and reproductive health...... with unexposed men. Percentages of motile and morphologically normal sperm cells were 1.85 (95% CI: 0.46, 3.23) and 0.64 (95% CI: -0.02, 1.30) percentage points lower, respectively, among men exposed in utero, and exposed men had a 1.15-ml (95% CI: 0.66, 1.64) smaller testis size. The associations were present...... when data from the study centers were analyzed separately (though not in Lithuania, where only 1% of mothers smoked during pregnancy), although the strength of the association varied. Maternal smoking may have long-term implications for the reproductive health of the offspring. This is another good...

  18. Inequalities theory of majorization and its applications

    Olkin, Ingram

    1980-01-01

    Although they play a fundamental role in nearly all branches of mathematics, inequalities are usually obtained by ad hoc methods rather than as consequences of some underlying ""theory of inequalities."" For certain kinds of inequalities, the notion of majorization leads to such a theory that is sometimes extremely useful and powerful for deriving inequalities. Moreover, the derivation of an inequality by methods of majorization is often very helpful both for providing a deeper understanding and for suggesting natural generalizations.Anyone wishing to employ majorization as a tool in applicati

  19. General problems

    2005-01-01

    This article presents the general problems as natural disasters, consequences of global climate change, public health, the danger of criminal actions, the availability to information about problems of environment

  20. Generalized Recovery

    Jensen, Christian Skov; Lando, David; Pedersen, Lasse Heje

    We characterize when physical probabilities, marginal utilities, and the discount rate can be recovered from observed state prices for several future time periods. Our characterization makes no assumptions of the probability distribution, thus generalizing the time-homogeneous stationary model...

  1. General Conformity

    The General Conformity requirements ensure that the actions taken by federal agencies in nonattainment and maintenance areas do not interfere with a state’s plans to meet national standards for air quality.

  2. Remarks On General Fibonacci Numbers

    Billal, Masum

    2015-01-01

    We dedicate this paper to investigate the most generalized form of Fibonacci Sequence, one of the most studied sections of the mathematical literature. One can notice that, we have discussed even a more general form of the conventional one. Although it seems the topic in the first section has already been covered before, but we present a different proof here. Later I found out that, the auxiliary theorem used in the first section was proven and even generalized further by F. T. Howard. Thanks...

  3. Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK

    Myrtveit Solbjørg

    2012-08-01

    Full Text Available Abstract Background Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. Methods Data from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99; N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45. Results Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p Conclusions The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model

  4. Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland.

    Bhekumusa Wellington Lukhele

    Full Text Available HIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions.This cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4% participated, out of which 297 (35.9% were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14-3.38; P = 0.008, and income below minimum wage (AOR, 1.81; CI, 1.09-3.01; P = 0.021 were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00-5.00; P<0.001, and ever cohabited (AOR, 2.39; CI, 1.66-3.43; P = 0.00. The most cited reason for having multiple sexual partners was financial gain. HIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319.Structural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into

  5. Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK)

    2012-01-01

    Background Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. Methods Data from the Norwegian population-based “Hordaland Health Study” (HUSK, 1997–99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45). Results Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (pwhiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash

  6. China English and ELT for English Majors

    Zhang, Mingjuan

    2008-01-01

    This paper is a general study of one of varieties of English--China English and its influence on English Language Teaching (ELT) for English majors. The status of English as an International language breaks the situation in which British English or American English is the sole standard. English becomes World Englishes, taking on a plural form,…

  7. Major and minor form of hereditary hyperekplexia

    Tijssen, MAJ; Vergouwe, MN; van Dijk, JG; Rees, M; Frants, RR; Brown, P

    Hyperekplexia is a hereditary neurological disorder characterized by excessive startle responses. Within the disorder two clinical forms can be distinguished. The major form is characterized by continuous generalized stiffness in the first year of life and an exaggerated startle reflex, accompanied

  8. Placebo and antidepressant treatment for major depression

    Hougaard, Esben

    2010-01-01

    Antidepressant medication is generally considered the primary treatment for major depressive disorders (MDD), but antidepressant treatment has recently approached a crisis with shrinking specific effects and growing placebo responses in current trials. The aim of the paper is to review the placebo...

  9. Majorization in Euclidean Geometry and Beyond

    Fiedler, Miroslav

    2015-01-01

    Roč. 466, 1 February (2015), s. 233-240 ISSN 0024-3795 Institutional support: RVO:67985807 Keywords : Majorization * Doubly stochastic matrix * Euclidean simplex * Star * Regular simplex * Volume of a simplex Subject RIV: BA - General Mathematics Impact factor: 0.965, year: 2015

  10. 7 CFR 987.104 - Major marketing promotion.

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Major marketing promotion. 987.104 Section 987.104... IN RIVERSIDE COUNTY, CALIFORNIA Administrative Rules Definitions § 987.104 Major marketing promotion. A major marketing promotion program is one requiring the expenditure of more than $500 of Committee...

  11. 47 CFR 76.51 - Major television markets.

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Major television markets. 76.51 Section 76.51... CABLE TELEVISION SERVICE Carriage of Television Broadcast Signals § 76.51 Major television markets. For purposes of the cable television rules, the following is a list of the major television markets and their...

  12. Early effect on general interest, and short-term antidepressant efficacy and safety of agomelatine (25-50mg/day) and escitalopram (10-20mg/day) in outpatients with Major Depressive Disorder. A 12-week randomised double-blind comparative study.

    Udristoiu, T; Dehelean, P; Nuss, Ph; Raba, V; Picarel-Blanchot, F; de Bodinat, C

    2016-07-15

    A double-blind, randomized, study was conducted in 29 centers in Romania to evaluate the effect of agomelatine 25-50mg/day (n=144 patients) on general interest, overall clinical efficacy, and functionality in comparison with escitalopram 10-20mg/day (n=143 patients) in out-patients diagnosed with moderate to severe Major Depressive Disorder (MDD). The primary endpoint of the study was the score difference between agomelatine and escitalopram were assessed on the item 13 of the Quick Inventory of Depressive Symptomatology (16-Item) Self-Report (QIDS-SR16) over the first week period. Secondary measures include the primary criterion on the 12-week period, the within-group evolution over 12 weeks of the 17-item Hamilton Depression Scale (HAM-D17) total score, CGI severity of illness (CGI-S) and CGI-I scores, and functionality by using the self-rated Sheehan Disability Scale (SDS). After one week, the mean General Interest score showed no statistically significant difference between treatments. Over 12 weeks, patients felt more and more interested in other people and activities than before having taken medication. Both agomelatine and escitalopram improved depressive symptoms and symptom-related functional impairment of patients. Both agomelatine and escitalopram were well-tolerated by patients. The strength of our results would benefit from additional data from trials using a similar design and other active comparators. There was no difference in week 1 changes of interest between agomelatine and escitalopram. The relatively good tolerability of agomelatine and escitalopram is confirmed. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Generalized polygons

    Van Maldeghem, Hendrik

    1998-01-01

    Generalized Polygons is the first book to cover, in a coherent manner, the theory of polygons from scratch. In particular, it fills elementary gaps in the literature and gives an up-to-date account of current research in this area, including most proofs, which are often unified and streamlined in comparison to the versions generally known. Generalized Polygons will be welcomed both by the student seeking an introduction to the subject as well as the researcher who will value the work as a reference. In particular, it will be of great value for specialists working in the field of generalized polygons (which are, incidentally, the rank 2 Tits-buildings) or in fields directly related to Tits-buildings, incidence geometry and finite geometry. The approach taken in the book is of geometric nature, but algebraic results are included and proven (in a geometric way!). A noteworthy feature is that the book unifies and generalizes notions, definitions and results that exist for quadrangles, hexagons, octagons - in the ...

  14. Performance profiles of major energy producers 1996

    1998-01-01

    This publication examines developments in the operations of the major US e energy-producing companies on a corporate level, by major line of business, by major function within each line of business, and by geographic area. In 1996, 24 companies filed Form EIA-28. The analysis and data presented in this report represents the operations of the Financial Reporting System companies in the context of their worldwide operations and in the context of the major energy markets which they serve. Both energy and nonenergy developments of these companies are analyzed. Although the focus is on developments in 1996, important trends prior to that time are also featured. Sections address energy markets in 1996; key financial developments; oil and gas exploration, development, and production; downstream petroleum in 1996; coal and alternative energy; and foreign direct investment in US energy. 30 figs., 104 tabs

  15. Performance profiles of major energy producers 1996

    NONE

    1998-01-01

    This publication examines developments in the operations of the major US e energy-producing companies on a corporate level, by major line of business, by major function within each line of business, and by geographic area. In 1996, 24 companies filed Form EIA-28. The analysis and data presented in this report represents the operations of the Financial Reporting System companies in the context of their worldwide operations and in the context of the major energy markets which they serve. Both energy and nonenergy developments of these companies are analyzed. Although the focus is on developments in 1996, important trends prior to that time are also featured. Sections address energy markets in 1996; key financial developments; oil and gas exploration, development, and production; downstream petroleum in 1996; coal and alternative energy; and foreign direct investment in US energy. 30 figs., 104 tabs.

  16. The prevalence and correlates of the positive Androgen Deficiency in the Aging Male (ADAM questionnaire among psychiatric outpatients: a cross-sectional survey of 176 men in a general hospital in Taiwan

    Lee CP

    2015-01-01

    Full Text Available Chin-Pang Lee,1,2 Yu Chen,2–4 Kun-Hao Jiang,2,4,5 Chun-Lin Chu,1,2,4 Shih-Chieh Hsu,1,2,4 Jiun-Liang Chen,2,4,5 Ching-Yen Chen1,2,41Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan; 2Men’s Health Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 3Department of Urology, Chang Gung Memorial Hospital, Linkou, Taiwan; 4School of Medicine, Chang Gung University, Taoyuan; 5Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou, TaiwanIntroduction: The Androgen Deficiency in the Aging Male (ADAM questionnaire is widely used to screen for late-onset hypogonadism. The positive response to the ADAM questionnaire (positive ADAM has been associated with depression and poorer quality of life in a number of studies. It is unclear whether there is any value of the ADAM questionnaire in psychiatric populations. In this study, we aimed to determine the utility of the ADAM questionnaire in a convenient sample of male psychiatric outpatients.Methods: One hundred and seventy-six men (mean age: 54.3 years; standard deviation: 10.7 years; range: 40–80 years completed the ADAM questionnaire, the Hospital Anxiety and Depression Scale (HADS, and the Aging Males’ Symptoms (AMS scale. Anxiety was defined as a HADS anxiety subscore ≥8; depression as a HADS depression subscore ≥8; and moderate/severe impairment of health-related quality of life (HQoL as AMS ≥37. ADAM, anxiety, and depression was used to model the moderate/severe impairment of HQoL.Results: One hundred and sixty-four (93% men had positive ADAM. Positive ADAM was associated with a lower body mass index (P<0.05 and moderate/severe impairment of HQoL (P<0.001, but was not associated with anxiety or depression (P>0.05. Positive ADAM was associated with five symptoms of the AMS scale: “decline of one’s feeling of general well-being”, “depressive mood”, and three sexual symptoms. In regression analysis, positive ADAM was associated with

  17. General conclusions

    Tubiana, M.

    1993-01-01

    In conclusion, a general consensus of a number of points which the author endeavours to summarize in this article: -doctors are an excellent channel for passing on information to the public -doctors feel that they do not know enough about the subject and a training on radiobiology and radiation protection is a necessity for them -communication between doctors and the general