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Sample records for primary controlling factor

  1. Factors affecting the local control of stereotactic body radiotherapy for lung tumors including primary lung cancer and metastatic lung tumors

    International Nuclear Information System (INIS)

    Hamamoto, Yasushi; Kataoka, Masaaki; Yamashita, Motohiro

    2012-01-01

    The purpose of this study was to identify factors affecting local control of stereotactic body radiotherapy (SBRT) for lung tumors including primary lung cancer and metastatic lung tumors. Between June 2006 and June 2009, 159 lung tumors in 144 patients (primary lung cancer, 128; metastatic lung tumor, 31) were treated with SBRT with 48-60 Gy (mean 50.1 Gy) in 4-5 fractions. Higher doses were given to larger tumors and metastatic tumors in principle. Assessed factors were age, gender, tumor origin (primary vs. metastatic), histological subtype, tumor size, tumor appearance (solid vs. ground glass opacity), maximum standardized uptake value of positron emission tomography using 18 F-fluoro-2-deoxy-D-glucose, and SBRT doses. Follow-up time was 1-60 months (median 18 months). The 1-, 2-, and 3-year local failure-free rates of all lesions were 90, 80, and 77%, respectively. On univariate analysis, metastatic tumors (p<0.0001), solid tumors (p=0.0246), and higher SBRT doses (p=0.0334) were the statistically significant unfavorable factors for local control. On multivariate analysis, only tumor origin was statistically significant (p=0.0027). The 2-year local failure-free rates of primary lung cancer and metastatic lung tumors were 87 and 50%, respectively. A metastatic tumor was the only independently significant unfavorable factor for local control after SBRT. (author)

  2. Osteopathic Manipulative Treatment of Primary Dysmenorrhea and Related Factors: A Randomized Controlled Trial

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    Dario Zecchillo

    2017-11-01

    Full Text Available Objectives: This study is aimed to evaluate if the osteopathic manipulative treatment (OMT is effective in patients with primary dysmenorrhea (PD. Methods: Randomized single-blinded controlled trial with OMT group and lighttouch treatment (LTT group. Recruited women were 18-40 years (mean age 27 years, with regular menstrual cycle, normal body mass index (BMI, and a medical diagnosis of PD. Intervention: Patients received five OMT or five LTT over a menstrual cycle. The primary outcomes were average menstrual pain assessed by the numeric rating scale (NRS, the duration of pain, and quality of life (QoL assessed by the SF-12 Short Form Health Survey and Patient Global Impression Change (PGIC. The secondary outcomes were NSAIDs intake, hours of absence from school/work, and menstrual-related symptoms. Results: 31 subjects were enrolled, of which five were excluded and the remaining 26 were randomized. Patients in OMT group had significant improvement in every outcome, including the average menstrual pain that decreased from 5.35 ± 0.28 to 1.98 ± 0.24 (-63.0%; p<0.001. The mean SF-12 physical component score (PCS improved from 31.35 ± 1.70 to 49.56 ± 1.92 (+58.1%, p<0.001, the mean SF-12 mental component score (MCS improved from 38.36 ± 1.16 to 52.04 ± 0.94 (+35.7%; p<0.001. LTT group showed no improvements. Conclusion: OMT was effective in reducing menstrual pain and improving Quality of Life of dysmenorrheic women.

  3. Health locus of control as a psychological factor in improving treatment results in adolescents with primary hypertension and diabetes

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    Marta Anna Biernacka

    2016-10-01

    Full Text Available Background The belief that an individual can influence and control the course of events is a factor which enables a person to overcome difficulties. Some studies, however, have questioned the universality of this statement. This study aims to investigate and explore the relationship between the self-health locus of control and the effectiveness of cooperation in the treatment process in adolescents with chronic diseases. Participants and procedure One hundred and sixty-four adolescent patients suffering from chronic diseases (61 girls and 103 boys ranging from 11 to 17 years old participated in the study. Eighty-seven had primary hypertension and 77 had type 1 diabetes. To investigate their sense of health control we used the Health Locus of Control Scale (HLC. Cooperation in the treatment process was assessed using a 4-item scale completed by a doctor. Results Better results in the treatment were positively correlated with a better internal health locus of control. A negative correlation between the chance health locus of control and results in the treatment was found. Differences in the health locus of control proved to be dependent on gender, age and different clinical groups. Conclusions Health locus of control in patients with chronic diseases seems to be a crucial factor in determining the results of the treatment process in such patients.

  4. Identifying risk factors for blindness from primary open-angle glaucoma by race: a case-control study.

    Science.gov (United States)

    Williams, Andrew M; Huang, Wei; Muir, Kelly W; Stinnett, Sandra S; Stone, Jordan S; Rosdahl, Jullia A

    2018-01-01

    To examine the factors associated with blindness from primary open-angle glaucoma (POAG) among black and white patients at our institution. For this retrospective, case-control study, patients legally blind from POAG ("cases") were matched on age, race, and gender with non-blind POAG patients ("controls"). Thirty-seven black case-control pairs and 19 white case-control pairs were included in this study. Clinical variables were compared at initial presentation and over the course of follow-up. Black case-control pairs and white case-control pairs had similar characteristics at presentation, including cup-to-disc ratio and number of glaucoma medications. However, over the course of follow-up, black cases underwent significantly more glaucoma surgeries than matched controls (2.4 versus 1.2, p =0.001), whereas white cases and controls had no significant difference in glaucoma operations (0.9 versus 0.6, p =0.139). Our analysis found that glaucoma surgery is associated with blindness in black patients (odds ratio [OR] 1.6, 95% CI 1.1-2.2) but not in white patients (OR 1.5, 95% CI 0.7-3.2). Black and white case-control pairs with POAG shared similar risk factors for blindness at presentation. However, over the follow-up period, black cases required significantly more glaucoma surgeries compared to black controls, whereas there was no significant difference in surgery between white cases and controls. There was no difference in medication changes in either case-control set.

  5. Documentation of body mass index and control of associated risk factors in a large primary care network

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    Grant Richard W

    2009-12-01

    Full Text Available Abstract Background Body mass index (BMI will be a reportable health measure in the United States (US through implementation of Healthcare Effectiveness Data and Information Set (HEDIS guidelines. We evaluated current documentation of BMI, and documentation and control of associated risk factors by BMI category, based on electronic health records from a 12-clinic primary care network. Methods We conducted a cross-sectional analysis of 79,947 active network patients greater than 18 years of age seen between 7/05 - 12/06. We defined BMI category as normal weight (NW, 18-24.9 kg/m2, overweight (OW, 25-29.9, and obese (OB, ≥ 30. We measured documentation (yes/no and control (above/below of the following three risk factors: blood pressure (BP ≤130/≤85 mmHg, low-density lipoprotein (LDL ≤130 mg/dL (3.367 mmol/L, and fasting glucose Results BMI was documented in 48,376 patients (61%, range 34-94%, distributed as 30% OB, 34% OW, and 36% NW. Documentation of all three risk factors was higher in obesity (OB = 58%, OW = 54%, NW = 41%, p for trend Conclusions In a large primary care network BMI documentation has been incomplete and for patients with BMI measured, risk factor control has been poorer in obese patients compared with NW, even in those with obesity and CVD or diabetes. Better knowledge of BMI could provide an opportunity for improved quality in obesity care.

  6. Season of infectious mononucleosis as a risk factor for multiple sclerosis: A UK primary care case-control study.

    Science.gov (United States)

    Downham, Christina; Visser, Elizabeth; Vickers, Mark; Counsell, Carl

    2017-10-01

    Infectious mononucleosis (IM) and vitamin D deficiency are both risk factors for multiple sclerosis (MS). We wished to establish if IM in the winter months when vitamin D levels are low may be a greater risk factor for MS than IM in the summer months. We identified all patients with MS diagnosed aged 16-60 in a large primary care database in the United Kingdom and matched each by age, sex, general practice and observation period with up to six controls. We identified a coded diagnosis of IM prior to the index date (date of diagnosis). Logistic regression was used to calculate the odds ratio for prior IM exposure in cases versus controls and for winter versus summer exposure in cases and controls with prior IM exposure. Based on 9247 cases and 55,033 matched controls (246 and 846 with prior IM respectively), IM was associated with the development of MS (OR 1.77, 95%CI 1.53-2.05) but there was no evidence that IM in the winter as opposed to summer was associated with developing MS (OR 1.09, 95%CI 0.72-1.66). We found no evidence that the season of IM influences the risk of subsequent MS. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa.

    Science.gov (United States)

    Engelbrecht, Michelle; Janse van Rensburg, André; Kigozi, Gladys; van Rensburg, Hcj Dingie

    2016-11-04

    Despite the availability of TB infection control guidelines, and good levels of healthcare worker knowledge about infection control, often these measures are not well implemented. This study sought to determine the factors associated with healthcare workers' good TB infection control practices in primary health care facilities in the Free State Province, South Africa. A cross-sectional self-administered survey among nurses (n = 202) and facility-based community healthcare workers (n = 34) as well as facility observations were undertaken at all 41 primary health care facilities in a selected district of the Free State Province. The majority of respondents were female (n = 200; 87.7 %) and the average age was 44.19 years (standard deviation ±10.82). Good levels of knowledge were recorded, with 42.8 % (n = 101) having an average score (i.e. 65-79 %) and 31.8 % (n = 75) a good score (i.e. ≥ 80 %). Most respondents (n = 189; 80.4 %) had positive attitudes towards TB infection control practices (i.e. ≥ 80 %). While good TB infection control practices were reported by 72.9 % (n = 161) of the respondents (i.e. ≥75 %), observations revealed this to not necessarily be the case. For every unit increase in attitudes, good practices increased 1.090 times (CI:1.016-1.169). Respondents with high levels of knowledge (≥80 %) were 4.029 (CI: 1.550-10.469) times more likely to have good practices when compared to respondents with poor levels of knowledge (control were the main factors associated with good infection control practices. Although many respondents reported good infection control practices - which was somewhat countered by the observations - there are areas that require attention, particularly those related to administrative controls and the use of personal protective equipment.

  8. Poor blood pressure control and its associated factors among older people with hypertension: A cross-sectional study in six public primary care clinics in Malaysia

    Directory of Open Access Journals (Sweden)

    Cheong Ai Theng

    2015-07-01

    Full Text Available Hypertension is highly prevalent in the older people. Chronic disease care is a major burden in the public primary care clinics in Malaysia. Good blood pressure (BP control is needed to reduce the morbidity and mortality of cardiovascular disease (CVD. This study aimed to determine the status of BP control and its associated factors among older people with hypertension in public primary care clinics.

  9. Risk factors control for primary prevention of cardiovascular disease in men: Evidence from the Aragon Workers Health Study (AWHS).

    Science.gov (United States)

    Aguilar-Palacio, Isabel; Malo, Sara; Feja, Cristina; Lallana, MªJesús; León-Latre, Montserrat; Casasnovas, José Antonio; Rabanaque, MªJosé; Guallar, Eliseo

    2018-01-01

    Benefits of cardiovascular disease (CVD) risk factors control are well known, but goals achievement remains low. The objective of this study is to evaluate the prevalence of CVD risk factors among men ina worker's cohort with no previous CVD, to study control variations across time and the factors associated with poor control. To this end, we conducted a cohort reexamination (2010-2014) within the context of the Aragon Workers Health Study (AWHS). Data from working characteristics, analytical values and pharmacological prescription were included in the analysis. Prevalences of risk factor diagnosis and control were calculated, as well as factors associated with poor control. The prevalence of CVD risk factors was high. In 2014dyslipidaemia was the most prevalent (85.2%) followed by Hypertension (HT) (42.0%). People under treatment increased for the period analysed (pcontrolled, decreasing to 21.9% in Diabetes and 11.0% in dyslipidaemia (2014). Working in a turn different to central shift was associated with poor control, especially for those working at night with HT (Odds Ratio in 2010: 3.6; Confidence Interval 95% 1.8-7.4) and dyslipidaemia (Odds Ratio 2010: 4.7; Confidence Interval 95% 1.3-16.4). We conclude that, although CVD control has increased significantly for the period studied, there are still many people that do not receive any treatment, and control goals are normally not achieved.

  10. Prevalence of and risk factors for otitis media with effusion in primary school children: case control study in Erzurum, Turkey.

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    Kucur, Cüneyt; Şimşek, Eda; Kuduban, Ozan; Özbay, İsa

    2015-01-01

    A total of 1,021 children attending 2 primary schools in districts in Erzurum were enrolled in a study evaluating the prevalence of otitis media with effusion (OME) and its relationship with various risk factors. The prevalence of OME in this study was 6.8% (69/1021). The difference in OME prevalence between age groups (9 years) was statistically significant (p0.05), consanguineous marriage (p>0.05) and history of hearing loss in the parents (p>0.05) were not statistically significant. Parents need to be informed about the symptoms of and risk factors for OME to avoid delayed diagnosis, which can lead to permanent hearing loss.

  11. Risk factors associated with non-alcoholic fatty liver disease in subjects from primary care units. A case-control study

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    Bernad Jesús

    2008-10-01

    Full Text Available Abstract Background Non alcoholic fatty liver disease (NAFL consists in the accumulation of fat vacuoles in the cytoplasm of hepatocytes. Many etiologic factors are associated with NAFL, such as, the metabolic syndrome factors, medications, bariatric surgery, nutritional disorders. However, very little information is available on the clinical relevance of this disorder as a health problem in the general population. Methods and design The aim of the study is establish the risk factors most frequently associated with NAFL in a general adult population assigned to the primary care units and to investigate the relationship between each component of the metabolic syndrome and the risk of having a NAFL. A population based case-control, observational and multicenter study will be carried out in 18 primary care units from the "Area de Gestión del Barcelonés Nord y Maresme" (Barcelona attending a population of 360,000 inhabitants and will include 326 cases and 370 controls. Cases are defined as all subjects fulfilling the inclusion criteria and with evidence of fatty liver in an abdominal ultrasonography performed for any reason. One control will be randomly selected for each case from the population, matched for age, gender and primary care center. Controls with fatty liver or other liver diseases will be excluded. All cases and controls will be asked about previous hepatic diseases, consumption of alcohol, smoking and drugs, and a physical examination, biochemical analyses including liver function tests, the different components of the metabolic syndrome and the HAIR score will also be performed. Paired controls will also undergo an abdominal ultrasonography. Discussion This study will attempt to determine the factors most frequently associated with the presence of NAFL investigate the relationship between the metabolic syndrome and the risk of fatty liver and study the influence of the different primary care professionals in avoiding the evolution

  12. Poor blood pressure control and its associated factors among older people with hypertension: A cross-sectional study in six public primary care clinics in Malaysia.

    Science.gov (United States)

    Cheong, A T; Sazlina, S G; Tong, S F; Azah, A S; Salmiah, S

    2015-01-01

    Hypertension is highly prevalent in the older people. Chronic disease care is a major burden in the public primary care clinics in Malaysia. Good blood pressure (BP) control is needed to reduce the morbidity and mortality of cardiovascular disease (CVD). This study aimed to determine the status of BP control and its associated factors among older people with hypertension in public primary care clinics. A cross-sectional study on hypertensive patients aged 18 years and above was conducted in six public primary care clinics in Federal Territory, Malaysia. A total of 1107 patients were selected via systematic random sampling. Data from 441 (39.8%) patients aged 60 years and more were used in this analysis. BP control was determined from the average of two BP readings measured twice at an interval of 5 min. For patients without diabetes, poor BP control was defined as BP of ≥140/90 mm Hg and ≥150/90 for the patients aged 80 years and more. For patients with diabetes, poor control was defined as BP of ≥140/80 mm Hg. A total of 51.7% (n = 228) of older patients had poor BP control. The factors associated with BP control were education level (p = 0.003), presence of comorbidities (p = 0.015), number of antihypertensive agents (p = 0.001) and number of total medications used (p = 0.002). Patients with lower education (less than secondary education) (OR = 1.7, p = 0.008) and the use of three or more antihypertensive agents (OR = 2.0, p = 0.020) were associated with poor BP control. Among older people with hypertension, those having lower education level, or using three or more antihypertensive agents would require more attention on their BP control.

  13. A health dialogue intervention reduces cardiovascular risk factor levels: a population based randomised controlled trial in Swedish primary care setting with 1-year follow-up

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    Mats Hellstrand

    2017-08-01

    Full Text Available Abstract Background The total number of cardiovascular (CVD deaths accounted for almost a third of all deaths globally in 2013. Population based randomised controlled trials, managed within primary care, on CVD risk factor interventions are scarce. The aim of the study was to evaluate the effects of a health dialogue intervention in a primary care setting offered to a population at the age of 55 years, focusing on CVD risk factors. Methods The study was performed in five primary health care centres in the county of Västmanland, Sweden between April 2011 and December 2012. Men and women were randomly assigned to intervention (n = 440 and control groups (n = 440. At baseline, both groups filled in a health questionnaire and serum cholesterol, fasting plasma glucose, glycated haemoglobin (HbA1c, weight, height, waist (WC and hip circumference, waist hip ratio (WHR and systolic/diastolic blood pressure were measured. Intervention group attended a health dialogue, supported by a visualised health profile, with a possibility for further activities. Participation rates at baseline were 53% and 52% respectively. A 1-year follow-up was carried out. Results The intervention group (n = 165 showed reductions compared to the control group (n = 177 concerning body mass index (BMI (0.3 kg/m2, p = .031, WC (2.1 cm, p ≤ .001 and WHR (.002, p ≤ .001 at the 1-year follow-up. No differences between the intervention and control groups were found in other variables. Intervention group, compared to baseline, had reduced weight, BMI, WC, WHR, HbA1c, and diet, while the men in the control group had reduced their alcohol consumption. Conclusions A health dialogue intervention at the age of 55 years, conducted in ordinary primary care, showed a moderate effect on CVD risk factor levels, in terms of BMI, WC and WHR. Trial registration number BioMed Central, ISRCTN22586871 , date assigned; 10/12/2015

  14. A retrospective study of the role of intracavitary brachytherapy and prognotic factors determining local tumour control after primary radical radiotherapy in 903 non-disseminated nasopharyngeal carcinoma patients

    International Nuclear Information System (INIS)

    Teo, P.M.L.; Kwan, W.H.; Yu, P.; Lee, W.Y.; Leung, S.F.; Choi, P.

    1996-01-01

    The aims of this retrospective study were to determine the role of intracavitary brachytherapy given shortly after external beam radiotherapy in the primary radical treatment of non-metastatic nasopharyngeal (NPC) cancer patients, and the prognostic factors governing local tumour control. From 1984 to 1989, 903 patients with non-disseminated NPC who had no previous treatment were managed at the Prince of Wales Hospital, Hong Kong, where investigation and treatment methods had been standardized according to a departmental protocol. In the 903 non-disseminated NPCs, the patient's age and tumour involvement of the skull base and cranial nerves were significant independent prognostic factors governing local tumour control. In the 358 patients with Ho T 3 disease, tumour involvement of the orbits and the laryngopharynx significantly worsened local tumour control. The presence of local persistence at 4 weeks after external radiotherapy, for which therapeutic brachytherapy was given, was marginally significant as a prognostic factor in addition to the presence of cranial nerve palsy. (author)

  15. What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips.

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    Fessy, M H; Putman, S; Viste, A; Isida, R; Ramdane, N; Ferreira, A; Leglise, A; Rubens-Duval, B; Bonin, N; Bonnomet, F; Combes, A; Boisgard, S; Mainard, D; Leclercq, S; Migaud, H

    2017-09-01

    Dislocation after total hip arthroplasty (THA) is a leading reason for surgical revision. The risk factors for dislocation are controversial, particularly those related to the patient and to the surgical procedure itself. The differences in opinion on the impact of these factors stem from the fact they are often evaluated using retrospective studies or in limited patient populations. This led us to carry out a prospective case-control study on a large population to determine: 1) the risk factors for dislocation after THA, 2) the features of these dislocations, and 3) the contribution of patient-related factors and surgery-related factors. Risk factors for dislocation related to the patient and procedure can be identified using a large case-control study. A multicenter, prospective case-control study was performed between January 1 and December 31, 2013. Four patients with stable THAs were matched to each patient with a dislocated THA. This led to 566 primary THA cases being included: 128 unstable, 438 stable. The primary matching factors were sex, age, initial diagnosis, surgical approach, implantation date and type of implants (bearing size, standard or dual-mobility cup). The patients with unstable THAs were 67±12 [37-73]years old on average; there were 61 women (48%) and 67 men (52%). Hip osteoarthritis (OA) was the main reason for the THA procedure in 71% (91/128) of the unstable group. The dislocation was posterior in 84 cases and anterior in 44 cases. The dislocation occurred within 3 months of the primary surgery in 48 cases (38%), 3 to 12 months after in 23 cases (18%), 1 to 5years after in 20 cases (16%), 5 to 10years after in 17 cases (13%) and more than 10years later in 20 cases. The dislocation recurred within 6 months of the initial dislocation in 23 of the 128 cases (18%). The risk factors for instability were a high ASA score with an odds ratio (OR) of 1.93 (95% CI: 1.4-2.6), neurological disability (cognitive, motor or psychiatric disorders) with

  16. A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia.

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    Hans J Overgaard

    2016-11-01

    Full Text Available As many neglected tropical diseases are co-endemic and have common risk factors, integrated control can efficiently reduce disease burden and relieve resource-strained public health budgets. Diarrheal diseases and dengue fever are major global health problems sharing common risk factors in water storage containers. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Integrating improved water management and educational strategies for both diseases in the school environment can potentially improve the health situation for students and the larger community. The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to diarrheal disease and dengue entomological risk factors in schools.A factorial cluster randomized controlled trial was carried out in 34 rural primary schools (1,301 pupils in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Schools were randomized to one of four study arms: diarrhea interventions (DIA, dengue interventions (DEN, combined diarrhea and dengue interventions (DIADEN, and control (CON. Interventions had no apparent effect on pupil school absence due to diarrheal disease (p = 0.45 or on adult female Aedes aegypti density (p = 0.32 (primary outcomes. However, the dengue interventions reduced the Breteau Index on average by 78% (p = 0.029, with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms, respectively compared to 37.5 and 46.9 in the DIA and CON arms, respectively. The diarrhea interventions improved water quality as assessed by the amount of Escherichia coli colony forming units (CFU; the ratio of Williams mean E. coli CFU being 0.22, or 78% reduction (p = 0.008.Integrated control of dengue and diarrhea has never been conducted before

  17. A Cluster-Randomized Controlled Trial to Reduce Diarrheal Disease and Dengue Entomological Risk Factors in Rural Primary Schools in Colombia

    Science.gov (United States)

    Overgaard, Hans J.; Alexander, Neal; Matiz, Maria Ines; Jaramillo, Juan Felipe; Olano, Victor Alberto; Vargas, Sandra; Sarmiento, Diana; Lenhart, Audrey; Stenström, Thor Axel

    2016-01-01

    Background As many neglected tropical diseases are co-endemic and have common risk factors, integrated control can efficiently reduce disease burden and relieve resource-strained public health budgets. Diarrheal diseases and dengue fever are major global health problems sharing common risk factors in water storage containers. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Integrating improved water management and educational strategies for both diseases in the school environment can potentially improve the health situation for students and the larger community. The objective of this trial was to investigate whether interventions targeting diarrhea and dengue risk factors would significantly reduce absence due to diarrheal disease and dengue entomological risk factors in schools. Methodology/Principal Findings A factorial cluster randomized controlled trial was carried out in 34 rural primary schools (1,301 pupils) in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Schools were randomized to one of four study arms: diarrhea interventions (DIA), dengue interventions (DEN), combined diarrhea and dengue interventions (DIADEN), and control (CON). Interventions had no apparent effect on pupil school absence due to diarrheal disease (p = 0.45) or on adult female Aedes aegypti density (p = 0.32) (primary outcomes). However, the dengue interventions reduced the Breteau Index on average by 78% (p = 0.029), with Breteau indices of 10.8 and 6.2 in the DEN and DIADEN arms, respectively compared to 37.5 and 46.9 in the DIA and CON arms, respectively. The diarrhea interventions improved water quality as assessed by the amount of Escherichia coli colony forming units (CFU); the ratio of Williams mean E. coli CFU being 0.22, or 78% reduction (p = 0.008). Conclusions/Significance Integrated

  18. Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings.

    LENUS (Irish Health Repository)

    Murphy, Mark E

    2017-08-04

    Poorly controlled type 2 diabetes mellitus (T2DM) is a major international health problem. Our aim was to assess the effectiveness of healthcare interventions, specifically targeting patients with poorly controlled T2DM, which seek to improve glycaemic control and cardiovascular risk in primary care settings.

  19. Factors influencing the prevalence of primary dysmenorrhoea ...

    African Journals Online (AJOL)

    ... of primary dysmenorrhoea amongst Abia State university medical students, South ... its impact on school and social activities and the students' management strategies. ... is high, and not consistently associated with demographic risk factors.

  20. Questionnaire Based Assessment of Risk Factors for Primary Biliary Cirrhosis

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    Lammert, Craig; Nguyen, Douglas L.; Juran, Brian D.; Schlicht, Erik; Larson, Joseph J.; Atkinson, Elizabeth J.; Lazaridis, Konstantinos N.

    2013-01-01

    Background Primary Biliary Cirrhosis is a cholestatic liver disease characterized by immune-mediated destruction of bile ducts. Its pathogenesis is largely unknown, although complex interactions between environment and genetic predisposition are proposed. Aims Identify disease risk factors using a detailed patient questionnaire and compare study findings to 3 published reports. Methods Questionnaire data were prospectively collected from 522 cases and 616 controls of the Mayo Clinic Primary Biliary Cirrhosis Genetic Epidemiology Registry. Case and control responses were compared using logistic regression, adjusting for recruitment age, sex, and education level. Results Cases reported ever regularly smoking cigarettes more frequently than controls (P < 0.001). History of urinary tract infection (UTI) was similar between groups; however, cases reported multiple UTIs more commonly than controls (P < 0.001). Frequency of other autoimmune disease was higher in cases than controls (P < 0.001). As well, prevalence of primary biliary cirrhosis among first-degree relatives was higher in case families than control families (P < 0.001). Conclusions Our study confirms prior reported risk factors associated with disease risk. Given the potential importance of gene and environment interactions, further examination of environmental risk factors considering genetic background may provide new insight into primary biliary cirrhosis pathogenesis. PMID:23490343

  1. Human factors and ergonomics for primary care.

    Science.gov (United States)

    Bowie, Paul; Jeffcott, Shelly

    2016-03-01

    In the second paper of this series, we provide a brief overview of the scientific discipline of human factors and ergonomics (HFE). Traditionally the HFE focus in healthcare has been in acute hospital settings which are perceived to exhibit characteristics more similar to other high-risk industries already applying related principles and methods. This paper argues that primary care is an area which could benefit extensively from an HFE approach, specifically in improving the performance and well-being of people and organisations. To this end, we define the purpose of HFE, outline its three specialist sub-domains (physical, cognitive and organisational HFE) and provide examples of guiding HFE principles and practices. Additionally, we describe HFE issues of significance to primary care education, improvement and research and outline early plans for building capacity and capability in this setting.

  2. Empirical and dynamic primary energy factors

    International Nuclear Information System (INIS)

    Wilby, Mark Richard; Rodríguez González, Ana Belén; Vinagre Díaz, Juan José

    2014-01-01

    Current legislation, standards, and scientific research in the field of energy efficiency often make use of PEFs (primary energy factors). The measures employed are usually fixed and based on theoretical calculations. However given the intrinsically variable nature of energy systems, these PEFs should rely on empirical data and evolve in time. Otherwise the obtained efficiencies may not be representative of the actual energy system. In addition, incorrect PEFs may cause a negative effect on the energy efficiency measures. For instance, imposing a high value on the PEF of electricity may discourage the use of renewable energy sources, which have an actual value close to 1. In order to provide a solution to this issue, we propose an application of the Energy Networks (ENs), described in a previous work, to calculate dynamic PEFs based on empirical data. An EN represents an entire energy system both numerically and graphically, from its primary energy sources to their final energy forms, and consuming sectors. Using ENs we can calculate the PEF of any energy form and depict it in a simple and meaningful graph that shows the details of the contribution of each primary energy and the efficiency of the associated process. The analysis of these PEFs leads to significant conclusions regarding the energy models adopted among countries, their evolution in time, the selection of viable ways to improve efficiency, and the detection of best practices that could contribute to the overall energy efficiency targets. - Highlights: • Primary Energy Factors (PEFs) are foundation of much energy legislation and research. • Traditionally, they have been treated as geotemporally invariant. • This work provides a systematic and transparent methodology for adding variability. • It also shows the variability between regions due to market, policy, and technology. • Finally it demonstrates the utility of extended PEFs as a tool in their own right

  3. [Establishment of Primary Adult MDS Nested Case-Control Study Cohort and Study of Risk Factors Associated with MDS Evolution to Leukemia].

    Science.gov (United States)

    Ma, Yan; Chen, Bo-Bin; Wang, Xiao-Qin; Xu, Xiao-Ping; Lin, Guo-Wei

    2015-12-01

    To establish a nested case-control study cohort in myelodysplastic syndrome (MDS) patients and investigate the clinical characteristics, WHO subtype and risk factors associated with MDS evolution to leukemia of this cohort. All patients, ≥18 years of age, provided by 24 Shanghai hospitals with initial clinical findings consistent with a hematopoietic abnormality between June 2003 and April 2007, were the candidates for inclusion in this study. The blood and bone marrow samples of every patient should be provided at baseline. Diagnosis was made by incorporating morphologic, immunophenotypic, cytogenetic and molecular features according to WHO classification criteria. Cytogenetic analysis was performed using conventional G-banding karyotyping and fluorescence in situ hybridization (FISH) techniques. Cumulative risk of evolution was estimated by Kaplan-Meier method. Prognostic factors were evaluated by univariate Log-rank method and multivariate Cox proportional hazard models. A total of 435 patients were diagnosed as MDS. The median age of MDS onset was 58(18-90) years, with 248 male patients and 187 female patients (male: female 1.33: 1). The percentage of cases with refractory cytopenia with multilineage dysplasia (RCMD) was the highest (65.5%), while that of refraetory anemia (RA) (2.3%), refractory anenia with ring sideroblast (RARS) (1.1%) and 5q-syndrome (0.5%) was lower. Trisomy 8 (+8) was the most common chromosome abnormalities (71 cases, 12.7%). The mean follow-up time was 20.3 (4.2-57.1) months. Cases were patients with evolution by the end of follow-up, while controls were patients without evolution by that time. Case group included 41 patients and control group included 342 patients. Univariate analysis showed that the age, sex, WHO subtype, WBC count, absolute neutrophil count (ANC), IPSS cytogenetic subgroup, IPSS group and bone marrow blast percentage were significant risk factors for leukemia-free survival (LFS). Multivariate analysis of COX model

  4. [Modifiable risk factors for primary headache. A systematic review].

    Science.gov (United States)

    Albers, L; Ziebarth, S; von Kries, R

    2014-08-01

    Strategies to prevent primary headaches could be very beneficial, especially given that primary headaches can lead to the development of chronic headache. In order to establish headache prevention strategies, the modifiable risk factors for primary headaches need to be identified. A systematic literature search on the risk factors for primary headaches was conducted independently by two persons using the databases MEDLINE and Embase. Further inclusion criteria were observational studies in adult general populations or case-control studies, where the effect sizes were reported as odds ratios or where the odds ratios could be calculated from the given data. In all, 24 studies were included in the analysis. There was a large amount of heterogeneity among the studies concerning headache acquisition, headache classification, and risk factors for headache development. Independent of headache trigger and definition of headache, the association between headache and the risk factor "stress" was very high: The meta-analysis shows an overall effect of 2.26 (odds ratio; 95 %-CI = [1.79; 2.85]). Studies evaluating neck and shoulder pain also report a strong association with headache; however, these results could not be summarized in a meta-analysis. Equally, the overall effects of smoking and coffee consumption on headaches could not be verified because the effect sizes were rather small and predominantly noticeable only at higher doses. A strong association between headache and the risk factors stress and neck and shoulder pain was confirmed. The effect sizes of smoking and coffee consumption on headaches were rather small.

  5. The time frame of Epstein-Barr virus latent membrane protein-1 gene to disappear in nasopharyngeal swabs after initiation of primary radiotherapy is an independently significant prognostic factor predicting local control for patients with nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Lin, S.-Y.; Chang, K.-P.; Hsieh, M.-S.; Ueng, S.-H.; Hao, S.-P.; Tseng, C.-K.; Pai, P.-C.; Chang, F.-T.; Tsai, M.-H.; Tsang, N.-M.

    2005-01-01

    Purpose: The presence of Epstein-Barr virus latent membrane protein-1 (LMP-1) gene in nasopharyngeal swabs indicates the presence of nasopharyngeal carcinoma (NPC) mucosal tumor cells. This study was undertaken to investigate whether the time taken for LMP-1 to disappear after initiation of primary radiotherapy (RT) was inversely associated with NPC local control. Methods and Materials: During July 1999 and October 2002, there were 127 nondisseminated NPC patients receiving serial examinations of nasopharyngeal swabbing with detection of LMP-1 during the RT course. The time for LMP-1 regression was defined as the number of days after initiation of RT for LMP-1 results to turn negative. The primary outcome was local control, which was represented by freedom from local recurrence. Results: The time for LMP-1 regression showed a statistically significant influence on NPC local control both univariately (p < 0.0001) and multivariately (p = 0.004). In multivariate analysis, the administration of chemotherapy conferred a significantly more favorable local control (p = 0.03). Advanced T status (≥ T2b), overall treatment time of external photon radiotherapy longer than 55 days, and older age showed trends toward being poor prognosticators. The time for LMP-1 regression was very heterogeneous. According to the quartiles of the time for LMP-1 regression, we defined the pattern of LMP-1 regression as late regression if it required 40 days or more. Kaplan-Meier plots indicated that the patients with late regression had a significantly worse local control than those with intermediate or early regression (p 0.0129). Conclusion: Among the potential prognostic factors examined in this study, the time for LMP-1 regression was the most independently significant factor that was inversely associated with NPC local control

  6. Factores asociados al no control de la presión arterial en pacientes inscritos al programa de hipertensión de una Entidad Promotora de Salud en Cali-Colombia, 2004 Factors associated with lack of blood pressure control in patients enrolled in a hypertension control program of a private primary Health Care Organization in Cali, Colombia, in 2004

    Directory of Open Access Journals (Sweden)

    Rodolfo Herrera

    2009-08-01

    factors associated to the lack of control of arterial blood pressure in patients enrolled in a hypertension control program of a private primary health care organization in Cali, Colombia in 2004. Methods: descriptive cross-sectional study. 356 patients >18 years were randomly chosen from the hypertension control program. Those patients with systolic blood pressure >139 mm Hg or diastolic blood pressure >89 mm Hg were classified as patients with lack of blood pressure control. Risk factors that could not be modified, behavioral, biological and administrative factors, were considered independent variables. Through a bivariate and multivariate analysis, factors associated to lack of blood pressure control were identified. Results: the prevalence of lack of blood pressure control in this health care organization was 30,1% (95% CI, 25,3-34,8, being higher in males (c2= 9,368; p=0,002. Adherence to pharmacological treatment was 56,2% (95% CI: 51,0% - 61,3%. Odds ratio (OR for lack of blood pressure control adjusted by gender and according to hypolipemic drugs combination was 1,71 (95% CI: 1,0-2,94; OR according to the contracted health care organization in comparison with the institutional health care was 2.13 (95% CI: 1.3 - 3.5. Conclusions: the prevalence of lack of blood pressure control in a hypertension control program of a private health care organization was 30,1%. Associated factors were: type of health care organization, male gender, use of inhibitors on angiotensing-converting enzyme and drug interaction with concomitant use of hypolipemis.

  7. What interventions can improve quality of life or psychosocial factors of individuals with knee osteoarthritis? A systematic review with meta-analysis of primary outcomes from randomised controlled trials.

    Science.gov (United States)

    Briani, Ronaldo Valdir; Ferreira, Amanda Schenatto; Pazzinatto, Marcella Ferraz; Pappas, Evangelos; De Oliveira Silva, Danilo; Azevedo, Fábio Mícolis de

    2018-03-16

    To systematically review evidence of primary outcomes from randomised controlled trials (RCTs) examining the effect of treatment strategies on quality of life (QoL) or psychosocial factors in individuals with knee osteoarthritis (OA). Systematic review with meta-analysis. Medline, Embase, SPORTDiscus, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from inception to November 2017. We included RCTs investigating the effect of conservative interventions on QoL or psychosocial factors in individuals with knee OA. Only RCTs considering these outcomes as primary were included. Pooled data supported the use of exercise therapy compared with controls for improving health-related and knee-related QoL. There was limited evidence that a combined treatment of yoga, transcutaneous electrical stimulation and ultrasound may be effective in improving QoL. Limited evidence supported the use of cognitive behavioural therapies (with or without being combined with exercise therapy) for improving psychosocial factors such as self-efficacy, depression and psychological distress. Exercise therapy (with or without being combined with other interventions) seems to be effective in improving health-related and knee-related QoL or psychosocial factors of individuals with knee OA. In addition, evidence supports the use of cognitive behavioural therapies (with or without exercise therapy) for improving psychosocial factors such as self-efficacy, depression and psychological distress in individuals with knee OA. CRD42016047602. © 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.

  8. Primary contention 12RU1 radiological control

    International Nuclear Information System (INIS)

    Padilla C, I.

    2007-01-01

    In the primary contention of the Laguna Verde central reactors those are located the main components and control and safety systems related directly with the reactor vessel. Space, accesses, location, maneuvers, armor-plating, movements of components and radiological conditions require of a constant attention to maintain the control of the activities during a fuel reload period. Knowledge, analysis, strategies and attention to the detail in the preparation stages and execution of the fuel reload are fundamental to sum up the objectives. The reload stop 12 of the Unit 1, it required a specific attention in the radiation source due to the addition of noble metals and hydrogen to the vessel internals that generated an increment in the soluble elements of Cobalt and that it was reflected in the radiation fields in the primary contention. Movement of armor-plating of the structures of the biological armor-plating demand to establish new strategies in the control of activities for the next fuel reloads. The analysis and control of the relief valves safety of the reactor vessel, of the exchange of the activation mechanisms of the control bars, as well as of the isolation valves of main vapor and of flow control valves of the reactor recirculation system, its required of a particular attention due to their particular radiological environment, in a brief time space. The importance of this work is located in the detail of critical activities to fulfill the established goals, with successes that can be optimized, and improvement areas that require of investigation and analysis for the implementation of new technologies tend toward to the dose optimization. The reload stop 12 of the unit 1 conclude with 2.43 Sv-person in a period of 27.5 days. (Author)

  9. Cholgate - a randomized controlled trial comparing the effect of automated and on-demand decision support on the management of cardiovascular disease factors in primary care

    NARCIS (Netherlands)

    J.T. van Wyk (Jacobus); M.A.M. van Wijk (Marc); P.W. Moorman (Peter); M. Mosseveld (Mees); J. van der Lei (Johan)

    2003-01-01

    textabstractAutomated and on-demand decision support systems integrated into an electronic medical record have proven to be an effective implementation strategy for guidelines. Cholgate is a randomized controlled trial comparing the effect of automated and on-demand decision

  10. 14 CFR 29.673 - Primary flight controls.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Primary flight controls. 29.673 Section 29... AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Design and Construction Control Systems § 29.673 Primary flight controls. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

  11. 14 CFR 27.673 - Primary flight control.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Primary flight control. 27.673 Section 27... AIRWORTHINESS STANDARDS: NORMAL CATEGORY ROTORCRAFT Design and Construction Control Systems § 27.673 Primary flight control. Primary flight controls are those used by the pilot for immediate control of pitch, roll...

  12. 14 CFR 23.673 - Primary flight controls.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Primary flight controls. 23.673 Section 23... Control Systems § 23.673 Primary flight controls. Primary flight controls are those used by the pilot for the immediate control of pitch, roll, and yaw. [Doc. No. 4080, 29 FR 17955, Dec. 18, 1964, as amended...

  13. Hierarchical Control of Thermostatically Controller Loads for Primary Frequency Control

    DEFF Research Database (Denmark)

    Zhao, Haoran; Wu, Qiuwei; Huang, Shaojun

    2016-01-01

    reserve references. At the middle level, distribution substations estimate the available power of TCLs based on the aggregated bin model, and dispatch control signals to individual TCLs. At the local level, a supplementary frequency control loop is implemented at the local controller, which makes TCLs...... respond to the frequency event autonomously. Case studies show that the proposed controller can efficiently respond to frequency events and fulfill the requirement specified by the system operator. The users’ comforts are not compromised and the short cycling of TCLs is largely reduced. Due...... to the autonomous control, the communication requirement is minimized....

  14. Cardiac autonomic control in adolescents with primary hypertension

    Directory of Open Access Journals (Sweden)

    Havlíceková Z

    2009-12-01

    Full Text Available Abstract Background Impairment in cardiovascular autonomic regulation participates in the onset and maintenance of primary hypertension. Objective The aim of the present study was to evaluate cardiac autonomic control using long-term heart rate variability (HRV analysis in adolescents with primary hypertension. Subjects and methods Twenty two adolescent patients with primary hypertension (5 girls/17 boys aged 14-19 years and 22 healthy subjects matched for age and gender were enrolled. Two periods from 24-hour ECG recording were evaluated by HRV analysis: awake state and sleep. HRV analysis included spectral power in low frequency band (LF, in high frequency band (HF, and LF/HF ratio. Results In awake state, adolescents with primary hypertension had lower HF and higher LF and LF/HF ratio. During sleep, HF was lower and LF/HF ratio was higher in patients with primary hypertension. Conclusions A combination of sympathetic predominance and reduced vagal activity might represent a potential link between psychosocial factors and primary hypertension, associated with increased cardiovascular morbidity.

  15. Evaluation of factors inhibiting effective performance of primary ...

    African Journals Online (AJOL)

    Therefore, the following are the factors that are inhibiting the productivity of the primary school teachers in Oyo state, Nigeria, viz: lack of motivation on the ... Headmasters or the local government education area officers in cash or kind and illegal deduction from primary school teacher's salary on the account of bank charges.

  16. Factors affecting guidance and counseling programme in primary ...

    African Journals Online (AJOL)

    The objective of this study was to establish the factors that affect guidance and counseling in primary schools. Guidance and counseling seems not to be adequately helping pupils with physical and psychological problems in Nairobi province of Kenya. Many primary schools are faced with indiscipline and poor performance ...

  17. Factors controlling metal fuel lifetime

    International Nuclear Information System (INIS)

    Porter, D.L.; Hofman, G.L.; Seidel, B.R.; Walters, L.C.

    1986-01-01

    The reliability of metal fuel elements is determined by a fuel burnup at which a statistically predicted number of fuel breaches would occur, the number of breaches determined by the amount of free fission gas which a particular reactor design can tolerate. The reliability is therefore measured using experimentally determined breach statistics, or by modelling fuel element behavior and those factors which contribute to cladding breach. The factors are fuel/cladding mechanical and chemical interactions, fission gas pressure, fuel phase transformations involving volume changes, and fission product effects on cladding integrity. Experimental data for EBR-II fuel elements has shown that the primary, and perhaps the only significant factor affecting metal fuel reliability, is the pressure-induced stresses caused by fission gas release. Other metal fuel/cladding systems may perform similarly

  18. Low prevalence of cardiovascular risk factors among primary school ...

    African Journals Online (AJOL)

    Background: Identification of obesity and other risk factors for cardiovascular disease in childhood is strongly recommended for prevention of the diseases in adulthood. Objectives: To determine the prevalence of the conventional cardiovascular risk factors among primary school children aged 6-15 years in Urban Dar es ...

  19. Twin Specific Risk Factors in Primary School Achievements

    NARCIS (Netherlands)

    de Zeeuw, L.E.J.; van Beijsterveldt, C.E.M.; de Geus, E.J.C.; Boomsma, D.I.

    2012-01-01

    The main aim of this study was to examine twin specific risk factors that influence educational achievement in primary school. We included prenatal factors that are not unique to twins, except for zygosity, but show a higher prevalence in twins than in singletons. In addition, educational

  20. Risk factors for dementia diagnosis in German primary care practices.

    Science.gov (United States)

    Booker, Anke; Jacob, Louis Ec; Rapp, Michael; Bohlken, Jens; Kostev, Karel

    2016-07-01

    Dementia is a psychiatric condition the development of which is associated with numerous aspects of life. Our aim was to estimate dementia risk factors in German primary care patients. The case-control study included primary care patients (70-90 years) with first diagnosis of dementia (all-cause) during the index period (01/2010-12/2014) (Disease Analyzer, Germany), and controls without dementia matched (1:1) to cases on the basis of age, sex, type of health insurance, and physician. Practice visit records were used to verify that there had been 10 years of continuous follow-up prior to the index date. Multivariate logistic regression models were fitted with dementia as a dependent variable and the potential predictors. The mean age for the 11,956 cases and the 11,956 controls was 80.4 (SD: 5.3) years. 39.0% of them were male and 1.9% had private health insurance. In the multivariate regression model, the following variables were linked to a significant extent with an increased risk of dementia: diabetes (OR: 1.17; 95% CI: 1.10-1.24), lipid metabolism (1.07; 1.00-1.14), stroke incl. TIA (1.68; 1.57-1.80), Parkinson's disease (PD) (1.89; 1.64-2.19), intracranial injury (1.30; 1.00-1.70), coronary heart disease (1.06; 1.00-1.13), mild cognitive impairment (MCI) (2.12; 1.82-2.48), mental and behavioral disorders due to alcohol use (1.96; 1.50-2.57). The use of statins (OR: 0.94; 0.90-0.99), proton-pump inhibitors (PPI) (0.93; 0.90-0.97), and antihypertensive drugs (0.96, 0.94-0.99) were associated with a decreased risk of developing dementia. Risk factors for dementia found in this study are consistent with the literature. Nevertheless, the associations between statin, PPI and antihypertensive drug use, and decreased risk of dementia need further investigations.

  1. Performance ratings and personality factors in radar controllers.

    Science.gov (United States)

    1970-09-01

    The purpose of the study was to determine whether primary or second-order personality questionnaire factors were related to job performance ratings on the Employee Appraisal Record in a sample of 264 radar controllers. A Pearson correlation matrix wa...

  2. Primary controls on species richness in higher taxa.

    Science.gov (United States)

    Rabosky, Daniel L

    2010-12-01

    The disparity in species richness across the tree of life is one of the most striking and pervasive features of biological diversity. Some groups are exceptionally diverse, whereas many other groups are species poor. Differences in diversity among groups are frequently assumed to result from primary control by differential rates of net diversification. However, a major alternative explanation is that ecological and other factors exert primary control on clade diversity, such that apparent variation in net diversification rates is a secondary consequence of ecological limits on clade growth. Here, I consider a likelihood framework for distinguishing between these competing hypotheses. I incorporate hierarchical modeling to explicitly relax assumptions about the constancy of diversification rates across clades, and I propose several statistics for a posteriori evaluation of model adequacy. I apply the framework to a recent dated phylogeny of ants. My results reject the hypothesis that net diversification rates exert primary control on species richness in this group and demonstrate that clade diversity is better explained by total time-integrated speciation. These results further suggest that it may not possible to estimate meaningful speciation and extinction rates from higher-level phylogenies of extant taxa only.

  3. INSOMNIA AND CORRELATION WITH PSYCHOSOCIAL FACTORS IN PRIMARY HEALTH CARE

    OpenAIRE

    Made Gede Cahyadi Permana

    2013-01-01

    Insomnia is regarded as sleep disorder that most often affects people in the world, both in primary and in the presence of comorbid conditions. Based on those facts, insomnia could be a serious problem at the level of primary health care. General Practitioner should be able to diagnose insomnia and able to perform the appropriate treatment for the patient. Psychosocial factors may related to the degree of severity of insomnia, among others are health status, depression, dysfunctional beliefs ...

  4. Organizational factors influencing successful primary care and public health collaboration.

    Science.gov (United States)

    Valaitis, Ruta; Meagher-Stewart, Donna; Martin-Misener, Ruth; Wong, Sabrina T; MacDonald, Marjorie; O'Mara, Linda

    2018-06-07

    Public health and primary care are distinct sectors within western health care systems. Within each sector, work is carried out in the context of organizations, for example, public health units and primary care clinics. Building on a scoping literature review, our study aimed to identify the influencing factors within these organizations that affect the ability of these health care sectors to collaborate with one another in the Canadian context. Relationships between these factors were also explored. We conducted an interpretive descriptive qualitative study involving in-depth interviews with 74 key informants from three provinces, one each in western, central and eastern Canada, and others representing national organizations, government, or associations. The sample included policy makers, managers, and direct service providers in public health and primary care. Seven major organizational influencing factors on collaboration were identified: 1) Clear Mandates, Vision, and Goals; 2) Strategic Coordination and Communication Mechanisms between Partners; 3) Formal Organizational Leaders as Collaborative Champions; 4) Collaborative Organizational Culture; 5) Optimal Use of Resources; 6) Optimal Use of Human Resources; and 7) Collaborative Approaches to Programs and Services Delivery. While each influencing factor was distinct, the many interactions among these influences are indicative of the complex nature of public health and primary care collaboration. These results can be useful for those working to set up new or maintain existing collaborations with public health and primary care which may or may not include other organizations.

  5. Environmental factors associated with primary care access among urban older adults.

    Science.gov (United States)

    Ryvicker, Miriam; Gallo, William T; Fahs, Marianne C

    2012-09-01

    Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors - in particular, the primary care infrastructure - inform older adults' primary care use. Using geographic data on primary care physician supply and surveys from 1260 senior center attendees in New York City, we examined factors that facilitate and hinder primary care use for individuals living in service areas with different supply levels. Supply quartiles varied in primary care use (visit within the past 12 months), racial and socio-economic composition, and perceived neighborhood safety and social cohesion. Primary care use did not differ significantly after controlling for compositional factors. Individuals who used a community clinic or hospital outpatient department for most of their care were less likely to have had a primary care visit than those who used a private doctor's office. Stratified multivariate models showed that within the lowest-supply quartile, public transit users had a higher odds of primary care use than non-transit users. Moreover, a higher score on the perceived neighborhood social cohesion scale was associated with a higher odds of primary care use. Within the second-lowest quartile, nonwhites had a lower odds of primary care use compared to whites. Different patterns of disadvantage in primary care access exist that may be associated with - but not fully explained by - local primary care supply. In lower-supply areas, racial disparities and inadequate primary care infrastructure hinder access to care. However, accessibility and elder-friendliness of public transit, as well as efforts to improve social cohesion and support, may facilitate primary care access for individuals living in low-supply areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Factors shaping intersectoral action in primary health care services.

    Science.gov (United States)

    Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael

    2014-12-01

    To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.

  7. Factor structure of functional state of primary school age children

    Directory of Open Access Journals (Sweden)

    Davidenko O.V.

    2011-02-01

    Full Text Available The examination of primary school children to determine the ranking of significant factors that determine the structure of their functional state depending on the level of physical health. It is shown that the main factor in the structure of the functional state of younger schoolchildren in low-and lower-middle level of physical fitness is selected morpho-functional status, which characterizes the functions of the body at rest. For children with average or above average level of physical fitness is a leading factor in physical fitness of schoolchildren.

  8. Correlation Factors Describing Primary and Spatial Sensations of Sound Fields

    Science.gov (United States)

    ANDO, Y.

    2002-11-01

    The theory of subjective preference of the sound field in a concert hall is established based on the model of human auditory-brain system. The model consists of the autocorrelation function (ACF) mechanism and the interaural crosscorrelation function (IACF) mechanism for signals arriving at two ear entrances, and the specialization of human cerebral hemispheres. This theory can be developed to describe primary sensations such as pitch or missing fundamental, loudness, timbre and, in addition, duration sensation which is introduced here as a fourth. These four primary sensations may be formulated by the temporal factors extracted from the ACF associated with the left hemisphere and, spatial sensations such as localization in the horizontal plane, apparent source width and subjective diffuseness are described by the spatial factors extracted from the IACF associated with the right hemisphere. Any important subjective responses of sound fields may be described by both temporal and spatial factors.

  9. Association of Psychologic and Nonpsychologic Factors With Primary Dysmenorrhea

    Science.gov (United States)

    Faramarzi, Mahbobeh; Salmalian, Hajar

    2014-01-01

    Background: Primary dysmenorrhea seems to be one the most common gynecologic condition in women of childbearing age. Objectives: The aim of this research was to evaluate psychologic and nonpsychologic risk factors of primary dysmenorrhea. Materials and Methods: A cross-sectional study was conducted on medical sciences students of Babol University of Medical Sciences. In this study, 180 females with dysmenorrhea and 180 females without dysmenorrhea were enrolled. Psychological risk factors were evaluated in four domains including affect, social support, personality, and alexithymia. Four questionnaires were used to assessed aforementioned domains, namely, Social Support Questionnaire (SSQ), depression, anxiety, stress (DAS-21), 20-item Toronto Alexithymia Scale (TAS-20), and NEO-Five Factor Inventory of Personality (NEO-FFI). In addition, nonpsychologic factors were evaluated in three domains including demographic characteristics, habits, and gynecologic factors. Data were analyzed using the χ2 test and multiple logistic regression analysis. Results: The strongest predictor of primary dysmenorrhea was low social support (OR = 4.25; 95% CI, 2.43-7.41). Risk of dysmenorrhea was approximately 3.3 times higher in women with alexithymia (OR = 3.26; 95% CI, 1.88-5.62), 3.1 times higher in women with menstrual bleeding duration ≥ 7 days (OR = 3.06; 95% CI, 1.73-5.41), 2.5 times higher in women with a neurotic character (OR = 2.53; 95% CI, 1.42-4.50), 2.4 times higher in women with a family history of dysmenorrhea (OR = 2.43; 95% CI, 1.42-4.50), and twice higher in women with high caffeine intake (OR = 1.97; 95% CI, 1.09-3.59). Conclusions: Low social support, alexithymia, neuroticism trait, long menstrual bleeding, family history of dysmenorrhea, and high-caffeine diet are important risk factors for women with primary dysmenorrhea. This study recommended considering psychologic factors as an adjuvant to medical risks in evaluation and treatment of primary dysmenorrhea

  10. Primary Hyperaldosteronism As A Risk Factor For Recurrent Nephrolithiasis

    Directory of Open Access Journals (Sweden)

    Ekamol Tantisattamo

    2012-06-01

    Hyperaldosteronism can cause hypercalciuria, phosphaturia, and hypocitraturia, all of which are risk factors for nephrolithiasis. Additionally, hyperaldosteronism and deoxycorticosterone mediated hypertension have been associated with hypocalcemia and secondary hyperparathyroidism. Our case augments earlier literature suggesting increased risk for nephrolithiasis in patients with hyperaldosteronism and suggests that hyperaldosteronism should be considered as a risk factor for patient with nephrolithiasis. It remains unclear if both primary and secondary hyperaldosteronism increase the relative risk for nephrolithiasis and the role of aldosterone receptor antagonist therapy for recurrent nephrolithiasis associated with hyperaldosteronism.

  11. Dietary Factors Associated To Obesity In Ahwaz Primary School Pupils

    Directory of Open Access Journals (Sweden)

    Dorosty A.R; Tabatabaei M

    2005-05-01

    Full Text Available Background: Increase in obesity prevalence in recent years are associated to genetics as well environmental and behavioral factors. Change in dietary patterns including fatty and high density energy foods consumption have been reported to be very important. This study aimed to determine dietary factors (daily energy and macronutrient intakes, energy percentage of macronutrient, energy and macronutrient intakes per kilogram body weight, frequency of cola, natural fruit juice drinking, dairy products except cheese, tomato chips, puff, chocolate and fast food consumption and eating speed associated to obesity in Ahwaz primary school pupils. Materials and Methods: Using two stage cluster sampling from 35 Ahwaz primary schools, all 10-11y students who had a BMI 95th percentile of Hosseini et al. (1999 reference, were identified as obese (n=150 and 150 same age and gender pupils (having BMI0.05. macronutrient intakes per kilogram body weight were significantly lower in obese group (p0.05. Obese students used to eat faster (p<0.05. Conclusion: In conclusion, high intakes of energy, protein, carbohydrate, tomato chips and puff and high eating speed were associated to obesity in Ahwaz primary school pupils.

  12. Teacher's Perceptions of Class Control in the Upper Primary School.

    Science.gov (United States)

    Roberts, Alasdair

    1984-01-01

    Reports that 73% of 66 elementary school (primary) teachers interviewed in the Aberdeen, Scotland, area operated using moderate policies of class control, rather than the permissive policies commonly found in small rural schools or the more traditional restrictive policies. (SB)

  13. Twin specific risk factors in primary school achievements.

    Science.gov (United States)

    de Zeeuw, Eveline L; van Beijsterveldt, Catherina E M; de Geus, Eco J C; Boomsma, Dorret I

    2012-02-01

    The main aim of this study was to examine twin specific risk factors that influence educational achievement in primary school. We included prenatal factors that are not unique to twins, except for zygosity, but show a higher prevalence in twins than in singletons. In addition, educational achievement was compared between twins and their nontwin siblings in a within-family design. Data were obtained from parents and teachers of approximately 10,000 twins and their nontwin siblings registered with the Netherlands Twin Register. Teachers rated the proficiency of the children on arithmetic, language, reading, and physical education, and reported a national educational achievement test score (CITO). Structural equation modeling showed that gestational age, birth weight, and sex were significant predictors of educational achievement, even after correction for socioeconomic status. Mode of delivery and zygosity did not have an effect, while parental age only influenced arithmetic. Mode of conception, incubator time, and birth complications negatively affected achievement in physical education. The comparison of educational achievement of twins and singletons showed significantly lower ratings on arithmetic, reading, and language in twins, compared to their older siblings, but not compared to their younger siblings. Low gestational age and low birth weight were the most important risk factors for lower educational achievement of twins in primary school. It seems that the differences observed between twins and their nontwin siblings in educational achievement can largely be explained by birth order within the family.

  14. Factors associated with primary care residents' satisfaction with their training.

    Science.gov (United States)

    Randall, C S; Bergus, G R; Schlechte, J A; McGuinness, G; Mueller, C W

    1997-01-01

    Satisfaction is known to impact work performance, learning, recruitment, and retention. This study identifies the factors associated with primary care residents' satisfaction with their training. We used a cross-sectional survey based on the Price-Mueller model of job satisfaction. The model included 14 job characteristics, four personal characteristics, and four demographic factors. Data were collected in February and March 1996 from residents in three primary care training programs (family practice, pediatrics, and internal medicine) at a large academic medical center. The same standardized, self-administered questionnaires were used in all three departments. Seventy-five percent (n = 119) of the residents returned questionnaires. Five job characteristics were positively associated with resident satisfaction: continuity of care, autonomy, collegiality, work that encourages professional growth, and work group loyalty. Role conflict, a sixth job characteristic, was negatively associated with satisfaction. The personal characteristic of having an optimistic outlook on life was also positively associated with satisfaction. The model explained 66% of the variation in self-reported satisfaction. The satisfaction of the residents was significantly associated with six job characteristics and one personal factor. Interventions based on these job characteristics may increase resident satisfaction and may lead to better patient outcomes, better work performance, greater patient satisfaction, and more success in recruiting top students into a residency.

  15. Factors associated with job satisfaction by Chinese primary care providers.

    Science.gov (United States)

    Shi, Leiyu; Song, Kuimeng; Rane, Sarika; Sun, Xiaojie; Li, Hui; Meng, Qingyue

    2014-01-01

    This study provides a snapshot of the current state of primary care workforce (PCW) serving China's grassroots communities and examines the factors associated with their job satisfaction. Data for the study were from the 2011 China Primary Care Workforce Survey, a nationally representative survey that provides the most current assessment of community-based PCW. Outcome measures included 12 items on job satisfaction. Covariates included intrinsic and extrinsic factors associated with job satisfaction. In addition, PCW type (i.e., physicians, nurses, public health, and village doctors) and practice setting (i.e., rural versus urban) were included to identify potential differences due to the type of PCW and practice settings. The overall satisfaction level is rather low with only 47.6% of the Chinese PCW reporting either satisfied or very satisfied with their job. PCW are least satisfied with their income level (only 8.6% are either satisfied or very satisfied), benefits (12.8%), and professional development (19.5%). They (particularly village doctors) are also dissatisfied with their workload (37.2%). Lower income and higher workload are the two major contributing factors toward job dissatisfaction. To improve the general satisfaction level, policymakers must provide better pay and benefits and more opportunities for career development, particularly for village doctors.

  16. Combination of recombinant factor VIIa and fibrinogen corrects clot formation in primary immune thrombocytopenia at very low platelet counts

    DEFF Research Database (Denmark)

    Larsen, Ole H; Stentoft, Jesper; Radia, Deepti

    2013-01-01

    Haemostatic treatment modalities alternative to platelet transfusion are desirable to control serious acute bleeds in primary immune thrombocytopenia (ITP). This study challenged the hypothesis that recombinant activated factor VII (rFVIIa) combined with fibrinogen concentrate may correct whole b...

  17. Infected primary knee arthroplasty: Risk factors for surgical treatment failure

    Directory of Open Access Journals (Sweden)

    Joao Gabriel Duarte Paes Pradella

    2013-09-01

    Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.

  18. Platelet-Released Growth Factors Induce Differentiation of Primary Keratinocytes

    Science.gov (United States)

    Tohidnezhad, Mersedeh; Lammel, Justus; Lippross, Sebastian; Behrendt, Peter; Klüter, Tim; Pufe, Thomas; Jahr, Holger; Cremer, Jochen; Rademacher, Franziska; Gläser, Regine; Harder, Jürgen

    2017-01-01

    Autologous thrombocyte concentrate lysates, for example, platelet-released growth factors, (PRGFs) or their clinically related formulations (e.g., Vivostat PRF®) came recently into the physicians' focus as they revealed promising effects in regenerative and reparative medicine such as the support of healing of chronic wounds. To elucidate the underlying mechanisms, we analyzed the influence of PRGF and Vivostat PRF on human keratinocyte differentiation in vitro and on epidermal differentiation status of skin wounds in vivo. Therefore, we investigated the expression of early (keratin 1 and keratin 10) and late (transglutaminase-1 and involucrin) differentiation markers. PRGF treatment of primary human keratinocytes decreased keratin 1 and keratin 10 gene expression but induced involucrin and transglutaminase-1 gene expression in an epidermal growth factor receptor- (EGFR-) dependent manner. In concordance with these results, microscopic analyses revealed that PRGF-treated human keratinocytes displayed morphological features typical of keratinocytes undergoing terminal differentiation. In vivo treatment of artificial human wounds with Vivostat PRF revealed a significant induction of involucrin and transglutaminase-1 gene expression. Together, our results indicate that PRGF and Vivostat PRF induce terminal differentiation of primary human keratinocytes. This potential mechanism may contribute to the observed beneficial effects in the treatment of hard-to-heal wounds with autologous thrombocyte concentrate lysates in vivo. PMID:28808357

  19. Platelet-Released Growth Factors Induce Differentiation of Primary Keratinocytes

    Directory of Open Access Journals (Sweden)

    Andreas Bayer

    2017-01-01

    Full Text Available Autologous thrombocyte concentrate lysates, for example, platelet-released growth factors, (PRGFs or their clinically related formulations (e.g., Vivostat PRF® came recently into the physicians’ focus as they revealed promising effects in regenerative and reparative medicine such as the support of healing of chronic wounds. To elucidate the underlying mechanisms, we analyzed the influence of PRGF and Vivostat PRF on human keratinocyte differentiation in vitro and on epidermal differentiation status of skin wounds in vivo. Therefore, we investigated the expression of early (keratin 1 and keratin 10 and late (transglutaminase-1 and involucrin differentiation markers. PRGF treatment of primary human keratinocytes decreased keratin 1 and keratin 10 gene expression but induced involucrin and transglutaminase-1 gene expression in an epidermal growth factor receptor- (EGFR- dependent manner. In concordance with these results, microscopic analyses revealed that PRGF-treated human keratinocytes displayed morphological features typical of keratinocytes undergoing terminal differentiation. In vivo treatment of artificial human wounds with Vivostat PRF revealed a significant induction of involucrin and transglutaminase-1 gene expression. Together, our results indicate that PRGF and Vivostat PRF induce terminal differentiation of primary human keratinocytes. This potential mechanism may contribute to the observed beneficial effects in the treatment of hard-to-heal wounds with autologous thrombocyte concentrate lysates in vivo.

  20. [Job satisfaction and improvement factors in primary care professionals].

    Science.gov (United States)

    Pérez-Ciordia, I; Guillén-Grima, F; Brugos, A; Aguinaga, I

    2013-09-06

    The quality of services in a health system is related to the level of satisfaction of its professionals. The aim of this article is to determine job satisfaction in primary care professionals and rank those factors capable of improving it. Descriptive study carried out in Navarre in 2010. A validated questionnaire was sent by post to the population of the study: primary care doctors, pediatricians and nurses. Variables on socio-demographic data were collected and job satisfaction was self-evaluated on a scale of 1 to 10. Respondents were asked to rank 10 factors that could improve the previously mentioned satisfaction. Averages were compared and bivariate analysis was carried out using the chi-square test, studying the association between variables through the Odds Ratio (OR). The adjusted analysis was realized through unconditional logistic regression. We collected 432 questionnaires (77.5%). Average satisfaction was 6.7 (scale of 1 to 10), higher in nursing. Women showed a higher average than men (6.90:6.34). The workers at urban health centers (OR: 1.71; CI: 1.10-2.65) showed a higher risk of dissatisfaction with respect to professionals at rural centers. The training activities of the professional is the most highly valued item, followed by economic questions and questions of care pressure, with no differences found by profession. Job satisfaction is a dimension of quality management in primary care and its study enables identification of problems or opportunities for improvement with an impact on the quality of the services offered.

  1. Risk Factors for Blood Transfusion With Primary Posterior Lumbar Fusion.

    Science.gov (United States)

    Basques, Bryce A; Anandasivam, Nidharshan S; Webb, Matthew L; Samuel, Andre M; Lukasiewicz, Adam M; Bohl, Daniel D; Grauer, Jonathan N

    2015-11-01

    Retrospective cohort study. To identify factors associated with blood transfusion for primary posterior lumbar fusion surgery, and to identify associations between blood transfusion and other postoperative complications. Blood transfusion is a relatively common occurrence for patients undergoing primary posterior lumbar fusion. There is limited information available describing which patients are at increased risk for blood transfusion, and the relationship between blood transfusion and short-term postoperative outcomes is poorly characterized. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing primary posterior lumbar fusion from 2011 to 2013. Multivariate analysis was used to find associations between patient characteristics and blood transfusion, along with associations between blood transfusion and postoperative outcomes. Out of 4223 patients, 704 (16.7%) had a blood transfusion. Age 60 to 69 (relative risk [RR] 1.6), age greater than equal to 70 (RR 1.7), American Society of Anesthesiologists class greater than equal to 3 (RR 1.1), female sex (RR 1.1), pulmonary disease (RR 1.2), preoperative hematocrit less than 36.0 (RR 2.0), operative time greater than equal to 310 minutes (RR 2.9), 2 levels (RR 1.6), and 3 or more levels (RR 2.1) were independently associated with blood transfusion. Interbody fusion (RR 0.9) was associated with decreased rates of blood transfusion. Receiving a blood transfusion was significantly associated with any complication (RR 1.7), sepsis (RR 2.6), return to the operating room (RR 1.7), deep surgical site infection (RR 2.6), and pulmonary embolism (RR 5.1). Blood transfusion was also associated with an increase in postoperative length of stay of 1.4 days (P risk factors for these occurrences were characterized. Strategies to minimize blood loss might be considered in these patients to avoid the associated complications. 3.

  2. Dose rate determining factors of PWR primary water

    International Nuclear Information System (INIS)

    Terachi, Takumi; Kuge, Toshiharu; Nakano, Nobuo

    2014-01-01

    The relationship between dose rate trends and water chemistry has been studied to clarify the determining factors on the dose rates. Therefore dose rate trends and water chemistry of 11 PWR plants of KEPCO (Kansai Electric Power Co., Inc.) were summarized. It is indicated that the chemical composition of the oxide film, behaviour of corrosion products and Co-58/Co-60 ratio in the primary system have effected dose rate trends based on plant operation experiences for over 40 years. According to plant operation experiences, the amount of Co-58 has been decreasing with the increasing duration of SG (Steam Generator) usage. It is indicated that the stable oxide film formation on the inner surface of SG tubing, is a major beneficial factor for radiation sources reduction. On the other hand, the reduction of the amount of Co-60 for the long term has been not clearly observed especially in particular high dose plants. The primary water parameters imply that considering release and purification balance on Co-59 is important to prevent accumulation of source term in primary water. In addition, the effect of zinc injection, which relates to the chemical composition of oxide film, was also assessed. As the results, the amount of radioactive Co has been clearly decreased. The decreasing trend seems to correlate to the half-life of Co-60, because it is considered that the injected zinc prevents the uptake of radioactive Co into the oxide film on the inner surface of the components and piping. In this paper, the influence of water chemistry and the replacement experiences of materials on the dose rates were discussed. (author)

  3. A system look at electromechanical actuation for primary flight control

    NARCIS (Netherlands)

    Lomonova, E.A.

    1997-01-01

    An overview is presented of the emergence of the ALL Electric flight control system (FCS) or power-by-wire (PBW) concept. The concept of fly-by-power refers to the actuator using electrical rather than hydraulic power. The development of the primary flight control Electromechanical Actuators (EMAs)

  4. Cardiovascular risk factors and primary selection into shift work

    DEFF Research Database (Denmark)

    Nabe-Nielsen, Kirsten; Garde, Anne Helene; Tüchsen, Finn

    2008-01-01

    OBJECTIVES: This study examined differences between future shift workers and future day workers as regards cardiovascular risk factors before they began different work schedules and the differences that remained after control for sociodemographic factors and general self-efficacy. METHODS......: In the unadjusted analyses, baseline obesity was associated with fixed evening work at follow-up. Minimal or light-to-moderate leisure-time physical activity was associated with a decrease in the odds ratio (OR) for two or three shifts including night work. Smoking status was associated with fixed evening work......, fixed night work, and two- or three- shift work including night work. After adjustment for sociodemographic factors and general self-efficacy, smoking was prospectively associated with fixed evening work [OR 1.56, 95% confidence interval (95% CI) 1.21-2.02] and fixed night work (OR 1.64, 95% CI 1...

  5. Relevant principal factors affecting the reproducibility of insect primary culture.

    Science.gov (United States)

    Ogata, Norichika; Iwabuchi, Kikuo

    2017-06-01

    The primary culture of insect cells often suffers from problems with poor reproducibility in the quality of the final cell preparations. The cellular composition of the explants (cell number and cell types), surgical methods (surgical duration and surgical isolation), and physiological and genetic differences between donors may be critical factors affecting the reproducibility of culture. However, little is known about where biological variation (interindividual differences between donors) ends and technical variation (variance in replication of culture conditions) begins. In this study, we cultured larval fat bodies from the Japanese rhinoceros beetle, Allomyrina dichotoma, and evaluated, using linear mixed models, the effect of interindividual variation between donors on the reproducibility of the culture. We also performed transcriptome analysis of the hemocyte-like cells mainly seen in the cultures using RNA sequencing and ultrastructural analyses of hemocytes using a transmission electron microscope, revealing that the cultured cells have many characteristics of insect hemocytes.

  6. Risk factors leading to mucoperiosteal flap necrosis after primary palatoplasty in patents with cleft palate.

    Science.gov (United States)

    Rossell-Perry, Percy; Figallo-Hudtwalcker, Olga; Vargas-Chanduvi, Roberto; Calderon-Ayvar, Yvette; Romero-Narvaez, Carolina

    2017-10-01

    Few studies have been published reporting risk factors for flap necrosis after primary palatoplasty in patients with cleft palate. This complication is rare, and the event is a disaster for both the patient and the surgeon. This study was performed to explore the associations between different risk factors and the development of flap necrosis after primary palatoplasty in patients with cleft palate. This is a case-control study. A 20 years retrospective analysis (1994-2015) of patients with nonsyndromic cleft palate was identified from medical records and screening day registries). Demographical and risk factor data were collected using a patient´s report, including information about age at surgery, gender, cleft palate type, and degree of severity. Odds ratios and 95% confident intervals were derived from logistic regression analysis. All cases with diagnoses of flap necrosis after primary palatoplasty were included in the study (48 patients) and 156 controls were considered. In multivariate analysis, female sex, age (older than 15 years), cleft type (bilateral and incomplete), and severe cleft palate index were associated with significantly increased risk for flap necrosis. The findings suggest that female sex, older age, cleft type (bilateral and incomplete), and severe cleft palatal index may be associated with the development of flap necrosis after primary palatoplasty in patients with cleft palate.

  7. [Factors associated with influenza immunization in primary care health workers].

    Science.gov (United States)

    Montserrat-Capdevila, Josep; Godoy, Pere; Marsal, Josep Ramon; Barbé-Illa, Ferran

    2015-01-01

    To identify the influenza vaccination coverage in healthcare workers in primary care and to determine the factors associated with vaccination (2013-2014 season). A cross-sectional study was carried out among 287 healthcare workers who completed a questionnaire that included questions about knowledge, beliefs and attitudes to influenza and vaccination. We estimated the vaccine coverage and identified the variables associated with vaccination of healthcare workers by using non-conditional logistic regression models. The participation rate was 47.2%. Vaccination coverage was 60.3% and was higher in workers older than 55 years, women and pediatricians. The factors associated with healthcare worker vaccination were the perception that vaccination confers protection (aOR: 11.1; 95%CI: 3.41-35.9) and the perception that it is effective (aOR: 7.5; 95%CI: 0.9-59.3). No association was found between receiving the vaccine and knowledge of influenza or vaccination. However, an association was found with prescribing vaccination to pregnant women, to persons older than 65 years, and to immunosuppressed individuals. Strategies should be designed to increase coverage, based on changing negative attitudes of healthcare workers to vaccination. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  8. Factors affecting nutritional status of Malaysian primary school children.

    Science.gov (United States)

    Zaini, M Z Anuar; Lim, C T; Low, W Y; Harun, F

    2005-01-01

    This paper investigates the nutritional status of a randomly selected cohort of school children and the factors affecting it. This random survey was conducted in the state of Selangor, involving 1,405 primary students (aged 9-10 years from 54 national primary schools). Physical examination was carried out on all the students. Information on the students was also obtained from the parents. Blood samples were taken by using the finger pricking technique. Body mass index (BMI) was used as a measure of physical growth. The students were mainly from urban areas (82.9%). The mean age was 9.71 years and a higher proportion was females (51%). Malays constituted 83.6%, Indians 11.6% and Chinese 4.2% of the study population. The mean weight and height were 32.30 kg and 135.18 cm respectively. The mean BMI was 17.42 kg/m2, with 1.2% of the students underweight, 76.3% normal BMI, 16.3% overweight and 6.3% were obese. Nutritional status was significantly related to blood pressure, history of breast feeding, eating fast food, taking canned/bottled drinks, income and educational level of parents. Significant differences in nutritional status between sexes and locations (rural/urban) were also found. The prevalence of overweight and obese children was of concern. There is thus an urgent need for the School Health Program to periodically monitor the school children's eating habits and physical growth. Appropriate counselling on nutritional intake and physical activities should be given not only to schoolchildren but also to their teachers and parents or caregivers.

  9. Quality Control in Primary Schools: Progress from 2001-2006

    Science.gov (United States)

    Hofman, Roelande H.; de Boom, Jan; Hofman, W. H. Adriaan

    2010-01-01

    This article presents findings of research into the quality control (QC) of schools from 2001-2006. In 2001 several targets for QC were set and the progress of 939 primary schools is presented. Furthermore, using cluster analysis, schools are classified into four QC-types that differ in their focus on school (self) evaluation and school…

  10. Modeling and Control of Primary Parallel Isolated Boost Converter

    DEFF Research Database (Denmark)

    Mira Albert, Maria del Carmen; Hernandez Botella, Juan Carlos; Sen, Gökhan

    2012-01-01

    In this paper state space modeling and closed loop controlled operation have been presented for primary parallel isolated boost converter (PPIBC) topology as a battery charging unit. Parasitic resistances have been included to have an accurate dynamic model. The accuracy of the model has been...

  11. Control Method for Variable Speed Wind Turbines to Support Temporary Primary Frequency Control

    DEFF Research Database (Denmark)

    Wang, Haijiao; Chen, Zhe; Jiang, Quanyuan

    2014-01-01

    This paper develops a control method for variable speed wind turbines (VSWTs) to support temporary primary frequency control of power system. The control method contains two parts: (1) up-regulate support control when a frequency drop event occurs; (2) down-regulate support control when a frequen...

  12. Reliable control using the primary and dual Youla parameterizations

    DEFF Research Database (Denmark)

    Niemann, Hans Henrik; Stoustrup, J.

    2002-01-01

    Different aspects of modeling faults in dynamic systems are considered in connection with reliable control (RC). The fault models include models with additive faults, multiplicative faults and structural changes in the models due to faults in the systems. These descriptions are considered...... in connection with reliable control and feedback control with fault rejection. The main emphasis is on fault modeling. A number of fault diagnosis problems, reliable control problems, and feedback control with fault rejection problems are formulated/considered, again, mainly from a fault modeling point of view....... Reliability is introduced by means of the (primary) Youla parameterization of all stabilizing controllers, where an additional loop is closed around a diagnostic signal. In order to quantify the level of reliability, the dual Youla parameterization is introduced which can be used to analyze how large faults...

  13. A STUDY ON PLASMA 25 - HYDROXY VITAMIN D LEVELS AS A RISK FACTOR IN PRIMARY HYPERTENSION

    Directory of Open Access Journals (Sweden)

    Ravinandana Gowda

    2015-07-01

    Full Text Available BACKGROUND: Recent research shows that vitamin D deficiency could be a risk factor in many chronic diseases like hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, some cancers, auto immune disease and tuberculosis. AIMS AND OBJECTIVES: To determine serum 25 - hydroxy vitamin D levels in patients with primary hypertension. This study also attempts to demonstrate an inverse co - relation between vitamin D levels and primary hypertension. MATERIALS AND METHOD S: 30 patients who are primary hype rtensive were selected, their vitamin D levels measured and the vitamin D levels were compared to age and sex matched non hypertensive controls. STATISTICAL METHODS: Descriptive and inferential statistical analysis has been carried out in the present study . ANOVA test and Chi - square test was applied for quantitative and qualitative data respectively to find significant associations between two variables. RESULTS: It is seen from this study that serum vitamin D levels was lower in hypertensive patients when compared to non - hypertensive controls. Hypertensive patients had lower levels of vitamin D with vitamin D status of deficiency in 50% of the cases and insufficiency in 43.3% of the cases and normal levels in 6.7% of the cases. Non hypertensive controls sho wed vitamin D status of normal in 66.7% of controls and insufficiency in 33.3% of the controls without deficiency. Age of the cases, duration of hypertension, systolic blood pressure and diastolic blood pressure inversely correlated to vitamin D levels. Bo dy mass index, diet of the patient, alcohol consumption, number of anti - hypertensive drugs, drug compliance, family history of hypertension and fundus status did not correlate to vitamin D levels. CONCLUSIONS: Based on the observations of the study, Vitami n D is an independent risk factor that is associated with primary or essential hypertension. The level of vitamin D also correlated inversely to age, duration of

  14. Population prevalence and control of cardiovascular risk factors: What electronic medical records tell us

    Directory of Open Access Journals (Sweden)

    Arantxa Catalán-Ramos

    2014-01-01

    Conclusions: Hypertension was the most prevalent cardiovascular risk factor in the Catalan population attended at primary care centers. About two thirds of individuals with hypertension or DM2 were adequately controlled; hypercholesterolemia control was particularly low.

  15. Epidermal growth factor receptor in primary human lung cancer

    International Nuclear Information System (INIS)

    Yu Xueyan; Hu Guoqiang; Tian Keli; Wang Mingyun

    1996-01-01

    Cell membranes were prepared from 12 human lung cancers for the study of the expression of epidermal growth factor receptors (EGFR). EGFR concentration was estimated by ligand binding studies using 125 I-radiolabeled EGF. The dissociation constants of the high affinity sites were identical, 1.48 nmol and 1.1 nmol in cancer and normal lung tissues, the EGFR contents were higher in lung cancer tissues (range: 2.25 to 19.39 pmol·g -1 membrane protein) than that in normal tissues from the same patients (range: 0.72 to 7.43 pmol·g -1 membrane protein). These results suggest that EGF and its receptor may play a role in the regulatory mechanisms in the control of lung cellular growth and tumor promotion

  16. Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors.

    Science.gov (United States)

    Valaitis, Ruta K; O'Mara, Linda; Wong, Sabrina T; MacDonald, Marjorie; Murray, Nancy; Martin-Misener, Ruth; Meagher-Stewart, Donna

    2018-04-12

    AimThe aim of this paper is to examine Canadian key informants' perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration. Primary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context. This interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor - effective communication - interacted with all of them. Results support and extend our understanding of what influences

  17. Identification of factors associated with diagnostic error in primary care

    Science.gov (United States)

    2014-01-01

    Background Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason’s taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed. Methods Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician’s initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians’ perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified. Discussion This work sets out a new approach to studying the

  18. Identification of factors associated with diagnostic error in primary care.

    Science.gov (United States)

    Minué, Sergio; Bermúdez-Tamayo, Clara; Fernández, Alberto; Martín-Martín, José Jesús; Benítez, Vivian; Melguizo, Miguel; Caro, Araceli; Orgaz, María José; Prados, Miguel Angel; Díaz, José Enrique; Montoro, Rafael

    2014-05-12

    Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason's taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed. Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician's initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians' perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified. This work sets out a new approach to studying the diagnostic decision-making process

  19. Primary Tumor Thickness is a Prognostic Factor in Stage IV Melanoma: A Retrospective Study of Primary Tumor Characteristics.

    Science.gov (United States)

    Luen, Stephen; Wong, Siew Wei; Mar, Victoria; Kelly, John W; McLean, Catriona; McArthur, Grant A; Haydon, Andrew

    2018-01-01

    Stage IV melanoma exhibits a diverse range of tumor biology from indolent to aggressive disease. Many important prognostic factors have already been identified. Despite this, the behavior of metastatic melanoma remains difficult to predict. We sought to determine if any primary tumor characteristics affect survival following the diagnosis of stage IV melanoma. All patients diagnosed with stage IV melanoma between January 2003 and December 2012 were identified from the Victorian Melanoma Service database. Retrospective chart review was performed to collect data on primary tumor characteristics (thickness, ulceration, mitotic rate, melanoma subtype, or occult primary). Known and suspected prognostic factors were additionally collected (time to diagnosis of stage IV disease, age, sex, stage, receipt of chemotherapy, and era of recurrence). The effect of primary tumor characteristics on overall survival from the date of diagnosis of stage IV disease was assessed. A total of 227 patients with a median follow-up of 5 years from diagnosis of stage IV disease were identified. Median overall survival of the cohort was 250 days.Of the primary tumor characteristics assessed, only tumor thickness affected survival from diagnosis of stage IV disease, hazard ratio=1.09 (1.02 to 1.16), P=0.008. This remained significant in multivariate analysis, P=0.007. Other primary tumor characteristics did not significantly influence survival. Primary tumor thickness is a significant prognostic factor in stage IV melanoma. Our data suggest that the biology of the primary melanoma may persist to influence the behavior of metastatic disease.

  20. Factors affecting the referral of primary health care doctors toward ...

    African Journals Online (AJOL)

    Hend Al-Namash

    2011-06-08

    Jun 8, 2011 ... There is a worldwide epidemic of overweight, obesity, and morbid obesity ... the evolution of bariatric surgery.4 Controversy exists regard- ing the best ..... attitudes and practices among Israeli primary care physicians. Int J.

  1. PWR primary system chemistry control during hot functional testing

    International Nuclear Information System (INIS)

    Reid, Richard D.; Little, Michael J.

    2014-01-01

    Hot Functional Testing (HFT) involves a number of pre-operational exercises performed to confirm the operability of plant systems at conditions expected during both normal and off-normal operation of a pressurized water reactor (PWR), including operability of safety systems. While the primary purposes of HFT are to demonstrate operability of plant systems and satisfy regulatory requirements, chemistry control during HFT is important to long-term integrity and performance of plant systems. Specifically, HFT is the first time plant equipment is exposed to high temperature water and the chemistry maintained during HFT can impact the passivation layers that form on wetted surfaces and long-term release of metals from these surfaces. Metals released from the inner surfaces of steam generator tubing and reactor coolant loop piping become activated in the core and can redeposit on ex-core surfaces. Because HFT is performed before fuel is loaded in the core, HFT provides an opportunity to produce a passive layer on primary surfaces that is free of activated corrosion products, resistant to metals release during subsequent plant operation, and also resistant to incorporation of activated corrosion products (once fuel is loaded in the core). Thus, maintaining desirable primary chemistry control during HFT is important for source term management, minimization of future shutdown activity releases, minimization of dose rates, and asset preservation. This paper presents an overview of passive film formation in the austenitic stainless steel and high nickel alloys that make up the majority of the primary circuit in advanced PWR designs. Based on this information, a summary is provided of the effects on passive film formation of key chemistry parameters that may be controlled during HFT. (author)

  2. Environmental Factors Associated with Primary Care Access Among Urban Older Adults

    OpenAIRE

    Ryvicker, Miriam; Gallo, William T.; Fahs, Marianne C.

    2012-01-01

    Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors – in particular, the primary care infrastructure – inform older adults’ primary care use. Using geographic data on primary care physician supply and surveys from 1,260 senior center attendees in New York City, we examined factors that facilitate and ...

  3. Human factors challenges for advanced process control

    International Nuclear Information System (INIS)

    Stubler, W.F.; O'Hara, J..M.

    1996-01-01

    New human-system interface technologies provide opportunities for improving operator and plant performance. However, if these technologies are not properly implemented, they may introduce new challenges to performance and safety. This paper reports the results from a survey of human factors considerations that arise in the implementation of advanced human-system interface technologies in process control and other complex systems. General trends were identified for several areas based on a review of technical literature and a combination of interviews and site visits with process control organizations. Human factors considerations are discussed for two of these areas, automation and controls

  4. Chapter 10 the primary cilium coordinates signaling pathways in cell cycle control and migration during development and tissue repair

    DEFF Research Database (Denmark)

    Christensen, Søren T; Pedersen, Stine F; Satir, Peter

    2008-01-01

    Cell cycle control and migration are critical processes during development and maintenance of tissue functions. Recently, primary cilia were shown to take part in coordination of the signaling pathways that control these cellular processes in human health and disease. In this review, we present...... an overview of the function of primary cilia and the centrosome in the signaling pathways that regulate cell cycle control and migration with focus on ciliary signaling via platelet-derived growth factor receptor alpha (PDGFRalpha). We also consider how the primary cilium and the centrosome interact...... with the extracellular matrix, coordinate Wnt signaling, and modulate cytoskeletal changes that impinge on both cell cycle control and cell migration....

  5. Decentralized DC Microgrid Monitoring and Optimization via Primary Control Perturbations

    Science.gov (United States)

    Angjelichinoski, Marko; Scaglione, Anna; Popovski, Petar; Stefanovic, Cedomir

    2018-06-01

    We treat the emerging power systems with direct current (DC) MicroGrids, characterized with high penetration of power electronic converters. We rely on the power electronics to propose a decentralized solution for autonomous learning of and adaptation to the operating conditions of the DC Mirogrids; the goal is to eliminate the need to rely on an external communication system for such purpose. The solution works within the primary droop control loops and uses only local bus voltage measurements. Each controller is able to estimate (i) the generation capacities of power sources, (ii) the load demands, and (iii) the conductances of the distribution lines. To define a well-conditioned estimation problem, we employ decentralized strategy where the primary droop controllers temporarily switch between operating points in a coordinated manner, following amplitude-modulated training sequences. We study the use of the estimator in a decentralized solution of the Optimal Economic Dispatch problem. The evaluations confirm the usefulness of the proposed solution for autonomous MicroGrid operation.

  6. Cardiovascular risk factor assessment after pre-eclampsia in primary care

    Directory of Open Access Journals (Sweden)

    Numans Mattijs E

    2009-12-01

    Full Text Available Abstract Background Pre-eclampsia is associated with an increased risk of development of cardiovascular disease later in life. It is not known how general practitioners in the Netherlands care for these women after delivery with respect to cardiovascular risk factor management. Methods Review of medical records of 1196 women in four primary health care centres, who were registered from January 2000 until July 2007 with an International Classification of Primary Care (ICPC code indicating pregnancy. Records were searched for indicators of pre-eclampsia. Of those who experienced pre-eclampsia and of a random sample of 150 women who did not, the following information on cardiovascular risk factor management after pregnancy was extracted from the records: frequency and timing of blood pressure, cholesterol and glucose measurements - and vascular diagnoses. Additionally the sensitivity and specificity of ICPC coding for pre-eclampsia were determined. Results 35 women experienced pre-eclampsia. Blood pressure was more often checked after pregnancy in these women than in controls (57.1% vs. 12.0%, p Conclusion Despite the evidence of increased risk of future cardiovascular disease in women with a history of pre-eclampsia, follow-up of these women is insufficient and undeveloped in primary care in the Netherlands.

  7. [Epidemiology, risk factors and molecular pathogenesis of primary liver cancer].

    Science.gov (United States)

    Hagymási, Krisztina; Tulassay, Zsolt

    2008-03-23

    Primary liver cancer is the fifth most common cancer worldwide. Hepatocellular carcinoma accounts for 85-90% of primary liver cancers. Distribution of hepatocellular carcinoma shows variations among geographic regions and ethnic groups. Males have higher liver cancer rates than females. Hepatocellular carcinoma occurs within an established background of chronic liver disease and cirrhosis (70-90%). Major causes (80%) of hepatocellular carcinoma are hepatitis B, C virus infection, and aflatoxin exposition. Its development is a multistep process. We have a growing understanding on the molecular pathogenesis. Genetic and epigenetic changes activate oncogenes, inhibit tumorsuppressor genes, which result in autonomous cell proliferation. The chromosomal instability caused by telomere dysfunction, the growth-retrained environment and the alterations of the micro- and macroenvironment help the expansion of the malignant cells. Understanding the molecular mechanisms could improve the screening of patients with chronic liver disease, or cirrhosis, and the prevention as well as treatment of hepatocellular carcinoma.

  8. Primary Commodity Dependency: A Limiting Factor for Achieving Democracy

    Science.gov (United States)

    2010-03-24

    two ~gricultural crops, minerals, petroleum, or fisheries can be considered primary commodity dependent. Tea, coffee, and cocoa ; peanuts and cotton...Rostow’s Development Model Pre-conditions for take-off mass consumption democracy. In 1960s, economists, associated democratization to a developmental...Commodities can be renewable or non-renewable. Petroleum, diamonds, cocoa , bananas, coffee, and timber are just a few of the commodities that have

  9. Risk factors for development of impaired renal function in Type 2 diabetes mellitus patients in primary care.

    NARCIS (Netherlands)

    Naushahi, M.J.; Grauw, W.J.C. de; Avery, A.J.; Gerwen, W.H.E.M. van; Lisdonk, E.H. van de; Weel, C. van

    2004-01-01

    AIMS: To evaluate risk factors for the development of an impaired renal function, defined as a glomerular filtration rate (GFR) by Cockcroft-Gault formula < 50.5 ml/min, in primary care patients with Type 2 diabetes mellitus. METHODS: A case-control study of Type 2 diabetes mellitus patients with

  10. Patient and carer identified factors which contribute to safety incidents in primary care: a qualitative study.

    Science.gov (United States)

    Hernan, Andrea L; Giles, Sally J; Fuller, Jeffrey; Johnson, Julie K; Walker, Christine; Dunbar, James A

    2015-09-01

    Patients can have an important role in reducing harm in primary-care settings. Learning from patient experience and feedback could improve patient safety. Evidence that captures patients' views of the various contributory factors to creating safe primary care is largely absent. The aim of this study was to address this evidence gap. Four focus groups and eight semistructured interviews were conducted with 34 patients and carers from south-east Australia. Participants were asked to describe their experiences of primary care. Audio recordings were transcribed verbatim and specific factors that contribute to safety incidents were identified in the analysis using the Yorkshire Contributory Factors Framework (YCFF). Other factors emerging from the data were also ascertained and added to the analytical framework. Thirteen factors that contribute to safety incidents in primary care were ascertained. Five unique factors for the primary-care setting were discovered in conjunction with eight factors present in the YCFF from hospital settings. The five unique primary care contributing factors to safety incidents represented a range of levels within the primary-care system from local working conditions to the upstream organisational level and the external policy context. The 13 factors included communication, access, patient factors, external policy context, dignity and respect, primary-secondary interface, continuity of care, task performance, task characteristics, time in the consultation, safety culture, team factors and the physical environment. Patient and carer feedback of this type could help primary-care professionals better understand and identify potential safety concerns and make appropriate service improvements. The comprehensive range of factors identified provides the groundwork for developing tools that systematically capture the multiple contributory factors to patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not

  11. Risk factors for treatment failure in surgery for primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Madsen, Anders Rørbæk; Rasmussen, Lars; Godballe, Christian

    2016-01-01

    Surgery for primary hyperparathyroidism (pHPT) has a high cure-rate and few complications. Preoperative localization procedures have permitted a dramatic shift from routine bilateral exploration to focused, minimally invasive procedures. At Odense University Hospital, Denmark, the introduction...... University hospital, Denmark, was analyzed. A shift in strategy was made in 2006 and at the same time new surgeons started training in parathyroid surgery. Biochemical-, clinical- and follow-up data were analyzed. Overall cure-rate was 90.7 %. Complication rates were 1.1 % for hemorrhage, 1.1 % for wound...

  12. [Evolution of burnout and associated factors in primary care physicians].

    Science.gov (United States)

    Matía Cubillo, Angel Carlos; Cordero Guevara, José; Mediavilla Bravo, José Javier; Pereda Riguera, Maria José; González Castro, Maria Luisa; González Sanz, Ana

    2012-09-01

    To analyse the course of burnout and develop an explanatory model. Prospective cohort dynamics. SITE: All primary health care centres in Burgos. All physicians except medical emergencies, paediatrics and residents. Anonymous self-report questionnaire: Maslach Burnout Inventory (MBI) and related variables. An analysis was performed using the Student-t, X(2) test and logistic regression. The response rate was 47.76% in 2007, which was lower than that of 2005. There were significant differences between 2005 and 2007, for increases in the percentage of physicians who smoked, postgraduate training, residency, and those who believe that coordination with nursing and specialist care and institutional communication is appropriate. There was an increase in the prevalence of burnout by almost one point compared with 2005, a decrease in maximum burnout and emotional exhaustion (EC), and an increase in depersonalisation (DP) and personal accomplishment (RP). The incidence density of burnout was 1/113. 5 primary care physicians per year. The existence of burnout is associated with the use of chronic medication and inadequate coordination between nursing and EC, and also with the high workload. The increase in the prevalence found is consistent with the idea of burnout as a dynamic development and the theoretical model described. Stable and quality employment is one way to indirectly mitigate (by encouraging internal communication) professional burnout. In the multivariate analysis, the most critical variable in the onset of burnout is the inadequate coordination with nursing. Copyright © 2008 Elsevier España, S.L. All rights reserved.

  13. Original Article Blood Loss and Influencing Factors in Primary Total ...

    African Journals Online (AJOL)

    KIGZ

    aid the surgeon in the African region estimate the expected blood loss after total hip replacement. We conducted a study to quantify the blood loss following total hip arthroplasty and to determine the factors .... Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in ...

  14. Factors associated with enuresis among primary school children in ...

    African Journals Online (AJOL)

    of treatment in 89(41.6%), 42 (19.6%) and 6 (2.8%) children respectively. Conclusion: Arousal difficulty, positive family history of enuresis and family stress were common risk factors for enuresis. Also, enuretic children had higher rates of poor school performance compared with non-enuretic children. The inappropriate ...

  15. Factor Stability of Primary Scales of the General Organization Questionnaire

    Science.gov (United States)

    1980-10-01

    leadership , climate , and processes function optimally. The Leadership and Organizational Effectiveness Work Unit re- searches personal, small-group...the Litwin and Stringer (1968) Organizational Climate Questionnaire found a factor structure that was dif- ferent from the a priori structure...number) General Organization Questionnaire (GOQ) Organizational climate Organizational effectiveness 20. ATRACT (Cnm N eriwem7 d Iderntify by block numbst

  16. Novel cost controlled materials and processing for primary structures

    Science.gov (United States)

    Dastin, S. J.

    1993-01-01

    Textile laminates, developed a number of years ago, have recently been shown to be applicable to primary aircraft structures for both small and large components. Such structures have the potential to reduce acquisition costs but require advanced automated processing to keep costs controlled while verifying product reliability and assuring structural integrity, durability and affordable life-cycle costs. Recently, resin systems and graphite-reinforced woven shapes have been developed that have the potential for improved RTM processes for aircraft structures. Ciba-Geigy, Brochier Division has registered an RTM prepreg reinforcement called 'Injectex' that has shown effectivity for aircraft components. Other novel approaches discussed are thermotropic resins producing components by injection molding and ceramic polymers for long-duration hot structures. The potential of such materials and processing will be reviewed along with initial information/data available to date.

  17. Factors associated with a primary surgical approach for sinonasal squamous cell carcinoma.

    Science.gov (United States)

    Cracchiolo, Jennifer R; Patel, Krupa; Migliacci, Jocelyn C; Morris, Luc T; Ganly, Ian; Roman, Benjamin R; McBride, Sean M; Tabar, Viviane S; Cohen, Marc A

    2018-03-01

    Primary surgery is the preferred treatment of T1-T4a sinonasal squamous cell carcinoma (SNSCC). Patients with SNSCC in the National Cancer Data Base (NCDB) were analyzed. Factors that contributed to selecting primary surgical treatment were examined. Overall survival (OS) in surgical patients was analyzed. Four-thousand seven hundred and seventy patients with SNSCC were included. In T1-T4a tumors, lymph node metastases, maxillary sinus location, and treatment at high-volume centers were associated with selecting primary surgery. When primary surgery was utilized, tumor factors and positive margin guided worse OS. Adjuvant therapy improved OS in positive margin resection and advanced T stage cases. Tumor and non-tumor factors are associated with selecting surgery for the treatment of SNSCC. When surgery is selected, tumor factors drive OS. Negative margin resection should be the goal of a primary surgical approach. When a positive margin resection ensues, adjuvant therapy may improve OS. © 2017 Wiley Periodicals, Inc.

  18. Platelet-Released Growth Factors Induce Differentiation of Primary Keratinocytes

    OpenAIRE

    Bayer, Andreas; Tohidnezhad, Mersedeh; Lammel, Justus; Lippross, Sebastian; Behrendt, Peter; Klüter, Tim; Pufe, Thomas; Jahr, Holger; Cremer, Jochen; Rademacher, Franziska; Gläser, Regine; Harder, Jürgen

    2017-01-01

    Autologous thrombocyte concentrate lysates, for example, platelet-released growth factors, (PRGFs) or their clinically related formulations (e.g., Vivostat PRF?) came recently into the physicians' focus as they revealed promising effects in regenerative and reparative medicine such as the support of healing of chronic wounds. To elucidate the underlying mechanisms, we analyzed the influence of PRGF and Vivostat PRF on human keratinocyte differentiation in vitro and on epidermal differentiatio...

  19. Comorbidity and glycemia control among patients with type 2 diabetes in primary care

    Directory of Open Access Journals (Sweden)

    Catherine Hudon

    2008-11-01

    Full Text Available Catherine Hudon1,3, Martin Fortin1,3, Marie-France Dubois2, José Almirall31Department of Family Medicine, 2Department of Community Health Sciences, Sherbrooke University, Sherbrooke, Quebec, Canada; 3Centre de Santé et de Services Sociaux de Chicoutimi, Quebec, CanadaAbstract: Reports on the relationship between comorbidity and glycemia control in diabetic patients are conflicting and the method of measuring comorbidity varies widely among studies. The aim of the present study was to evaluate the relationship between diabetes control and comorbidity, taking into account all comorbidities and their severity, in a primary care setting. We performed a retrospective descriptive study based on chart review of 96 randomly selected type 2 diabetic patients. Comorbidity was measured with the cumulative illness rating scale (CIRS, an exhaustive comorbidity index. Diabetes was considered as controlled if the mean value of two measurements of glycosylated hemoglobin A (HbA1c was less than 7%. Taking diabetes control as the dependent variable, its relationship with the CIRS score, age, sex, diabetes duration, and diabetes-related complications was explored. Diabetes control was not significantly related with the CIRS score, age, sex or diabetes severity. Diabetes duration was the only variable significantly related to diabetes control. Our study suggests that comorbidity measured with the CIRS in patients with type 2 diabetes is not a factor that prevents the achievement of a good glycemia control.Keywords: glycemia control, type 2 diabetes mellitus, comorbidity, primary care

  20. Gynecobstetric risk factors for cervical cancer in primary health care

    International Nuclear Information System (INIS)

    Dunan Cruz, Liam Kandel; Cala Calvinno, Leidys; Infante Tabio, Nadia Ines; Hernandez Lin, Tania

    2011-01-01

    A descriptive and cross-sectional study of 50 women with some kind of alteration in their Pap smear results in the last triennium, and who belong to the health area of 'Jose Marti Perez' University Polyclinic from Santiago de Cuba, was carried out during the first semester of 2008 in order to determine the gynecobstetric risk factors in the cervical cancer course. Multiparity and the intergenesic period over a year, as well as the beginning of sexual intercourse in adolescence, the use of hormonal contraceptives, and history of sexually transmitted infections were predominant among them. (author)

  1. Trichostatin A, a critical factor in maintaining the functional differentiation of primary cultured rat hepatocytes

    International Nuclear Information System (INIS)

    Henkens, Tom; Papeleu, Peggy; Elaut, Greetje; Vinken, Mathieu; Rogiers, Vera; Vanhaecke, Tamara

    2007-01-01

    Histone deacetylase inhibitors (HDI) have been shown to increase differentiation-related gene expression in several tumor-derived cell lines by hyperacetylating core histones. Effects of HDI on primary cultured cells, however, have hardly been investigated. In the present study, the ability of trichostatin A (TSA), a prototype hydroxamate HDI, to counteract the loss of liver-specific functions in primary rat hepatocyte cultures has been investigated. Upon exposure to TSA, it was found that the cell viability of the cultured hepatocytes and their albumin secretion as a function of culture time were increased. TSA-treated hepatocytes also better maintained cytochrome P450 (CYP)-mediated phase I biotransformation capacity, whereas the activity of phase II glutathione S-transferases (GST) was not affected. Western blot and qRT-PCR analysis of CYP1A1, CYP2B1 and CYP3A11 protein and mRNA levels, respectively, further revealed that TSA acts at the transcriptional level. In addition, protein expression levels of the liver-enriched transcription factors (LETFs) hepatic nuclear factor 4 alpha (HNF4α) and CCAAT/enhancer binding protein alpha (C/EBPα) were accordingly increased by TSA throughout culture time. In conclusion, these findings indicate that TSA plays a major role in the preservation of the differentiated hepatic phenotype in culture. It is suggested that the effects of TSA on CYP gene expression are mediated via controlling the expression of LETFs

  2. Demand-Side Contribution to Primary Frequency Control With Wind Farm Auxiliary Control

    DEFF Research Database (Denmark)

    Gomez-Lazaro, Emilio; Munoz-Benavente, Irene; Hansen, Anca Daniela

    2014-01-01

    Maintaining a close balance between power generation and demand is essential for sustaining the quality and reliability of a power system. Currently, due to increased renewable energy generation, frequency deviations and power fluctuations of greater concern are being introduced to the grid...... to the primary frequency control together with an auxiliary frequency control, which is carried out by variable-speed wind turbines through an additional control loop that synthesizes virtual inertia. We have evaluated both the suitability of these two additional control actions counteracting frequency deviation...

  3. Equivalence of Primary Control Strategies for AC and DC Microgrids

    Directory of Open Access Journals (Sweden)

    Eneko Unamuno

    2017-01-01

    Full Text Available Microgrid frequency and voltage regulation is a challenging task, as classical generators with rotational inertia are usually replaced by converter-interfaced systems that inherently do not provide any inertial response. The aim of this paper is to analyse and compare autonomous primary control techniques for alternating current (AC and direct current (DC microgrids that improve this transient behaviour. In this context, a virtual synchronous machine (VSM technique is investigated for AC microgrids, and its behaviour for different values of emulated inertia and droop slopes is tested. Regarding DC microgrids, a virtual-impedance-based algorithm inspired by the operation concept of VSMs is proposed. The results demonstrate that the proposed strategy can be configured to have an analogous behaviour to VSM techniques by varying the control parameters of the integrated virtual-impedances. This means that the steady-state and transient behaviour of converters employing these strategies can be configured independently. As shown in the simulations, this is an interesting feature that could be, for instance, employed for the integration of different dynamic generation or storage systems, such as batteries or supercapacitors.

  4. Job Satisfaction and Affecting Factors in Primary Health Care Providers

    Directory of Open Access Journals (Sweden)

    Ferit Kaya

    2016-06-01

    Full Text Available Objective: The aim of this study is to assess the job sat­isfaction of the primary health care providers and the fac­tors affecting it. Methods: This cross-sectional and descriptive study was carried out among the staff in The Public Health Care Centers (PHCC by performing a questionnaire under di­rect observation. Results: Out of 310 people consisting of the study uni­verse, 282 participants (94% were reached. The par­ticipants were 104 doctors, 132 assistant health care providers and 46 others (janitors, drivers The mean age of the participants was 37.21±7.70; 60.6% of them were women, 80.1% married, 96.5% graduated from at least High school. The mean of the general job satisfac­tion point of the participants in the study is 63.24±13.63. While the mean of the general job satisfaction point of the physicians and the nurses is found higher, the mean of the general job satisfaction point of janitors and other staff was found lower. The mean of the general job sat­isfaction point was found higher among the permanent and contract employee, women, health care staff, those whose wife/husband works, who chose his job willingly, more educated; who has longer working hours, high in­come, has 3 or less children and finds his job suitable for his skills; however the marital status, having children and age do not affect the mean job satisfaction point. Conclusion: Subjects having high income, found his job suitable for his skills, chose his job willingly had higher job satisfaction scores. This implies that there should be a wage balance among the staff with the same status. The lower job satisfaction score in PHCC indicates the neces­sity of improving the conditions of these centers.

  5. An explorative study of factors contributing to the job satisfaction of primary care midwives

    NARCIS (Netherlands)

    Warmelink, J.C.; Hoijtink, K.; Noppers, M.; Wiegers, T.A.; de Cock, T.P.; Klomp, T.; Hutton, E.K.

    2015-01-01

    Objective: the main objectives of our study was to gain an understanding of how primary care midwives in the Netherlands feel about their work and to identify factors associated with primary care midwives' job satisfaction and areas for improvement. Design: a qualitative analysis was used, based on

  6. An explorative study of factors contributing to the job satisfaction of primary care midwives.

    NARCIS (Netherlands)

    Warmelink, J.C.; Hoijtink, K.; Noppers, M.; Wiegers, T.A.; Cock, T.P. de; Klomp, T.; Hutton, E.K.

    2015-01-01

    Objective: the main objectives of our study was to gain an understanding of how primary care midwives in the Netherlands feel about their work and to identify factors associated with primary care midwives׳ job satisfaction and areas for improvement. Design: a qualitative analysis was used, based on

  7. Interprofessional collaboration regarding patients' care plans in primary care : a focus group study into influential factors

    NARCIS (Netherlands)

    Stephanie Anna Lenzen; Trudy van der Weijden; Anna Beurskens; Marloes Amantia van Bokhoven; Ramon Daniëls; Jerôme Jean Jacques van Dongen

    2016-01-01

    Background: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding

  8. Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors

    NARCIS (Netherlands)

    Dongen, J.J. van; Lenzen, S.A.; Bokhoven, M.A. van; Daniels, R.; Weijden, T.T. van der; Beurskens, A.

    2016-01-01

    BACKGROUND: The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding

  9. Risk Factors for Anemia in Pregnancy: A Case Control Study

    Directory of Open Access Journals (Sweden)

    Rutuja Pundkar

    2017-12-01

    Full Text Available Background: Aim of the study was to find the risk factors leading to Anemia in pregnancy. The main objective was to study the various sociodemographic factors leading to anemia. And to assess the knowledge about anemia among study participants. Material and methods: The present Case control study was carried out at Primary Health Centre, to determine the risk factors leading to anemia in pregnancy. A total of 308 pregnant females were registered. Among them two groups were made, group I cases and group II controls. Each group had 50 cases each. Laboratory test were done and females having hemoglobin less than 11mg/dl were considered anemic. Anemic females were considered cases and females having Hb >11mg/dl were considered controls. Data analysis was done using SPSS software. Results: The overall mean haemoglobin (Hb was 11.55g/dL in controls, whereas it was seen that among the cases it was 9.58g/dL.It would seem that diet, family size, education, social class, gravida and parity are associated with anemia in pregnancy. Conclusion: After adjusting for all the possible covariates there seems to be significant association between Hb levels and age group, education level, family size, diet, gravida and parity.

  10. Factors associated with professional satisfaction in primary care: Results from EUprimecare project.

    Science.gov (United States)

    Sanchez-Piedra, Carlos Alberto; Jaruseviciene, Lina; Prado-Galbarro, Francisco Javier; Liseckiene, Ida; Sánchez-Alonso, Fernando; García-Pérez, Sonia; Sarria Santamera, Antonio

    2017-12-01

    Given the importance of primary care to healthcare systems and population health, it seems crucial to identify factors that contribute to the quality of primary care. Professional satisfaction has been linked with quality of primary care. Physician dissatisfaction is considered a risk factor for burnout and leaving medicine. This study explored factors associated with professional satisfaction in seven European countries. A survey was conducted among primary care physicians. Estonia, Finland, Germany and Hungary used a web-based survey, Italy and Lithuania a telephone survey, and Spain face to face interviews. Sociodemographic information (age, sex), professional experience and qualifications (years since graduation, years of experience in general practice), organizational variables related to primary care systems and satisfaction were included in the final version of the questionnaire. A logistic regression analysis was performed to assess the factors associated with satisfaction among physicians. A total of 1331 primary care physicians working in primary care services responded to the survey. More than half of the participants were satisfied with their work in primary care services (68.6%). We found significant associations between satisfaction and years of experience (OR = 1.01), integrated network of primary care centres (OR = 2.8), patients having direct access to specialists (OR = 1.3) and professionals having access to data on patient satisfaction (OR = 1.3). Public practice, rather than private practice, was associated with lower primary care professional satisfaction (OR = 0.8). Elements related to the structure of primary care are associated with professional satisfaction. At the individual level, years of experience seems to be associated with higher professional satisfaction.

  11. Portion control for the treatment of obesity in the primary care setting

    Directory of Open Access Journals (Sweden)

    Harris Katherine I

    2011-09-01

    Full Text Available Abstract Background The increasing prevalence of obesity is a significant health threat and a major public health challenge. A critical need exists to develop and evaluate practical methods for the treatment of obesity in the clinical setting. One of the factors contributing to the obesity epidemic is food portion sizes. Limited data are available on the efficacy of visual or tactile devices designed to enhance patient understanding and control of portion sizes. A portion control plate is a commercially-available product that can provide visual cues of portion size and potentially contribute to weight loss by enhancing portion size control among obese patients. This tool holds promise as a useful adjunct to dietary counseling. Our objective was to evaluate a portion control intervention including dietary counseling and a portion control plate to facilitate weight loss among obese patients in a primary care practice. Findings We randomized 65 obese patients [body mass index (BMI ≥ 30 and vs. -0.5% ± 2.2%; p = 0.041 and a non significant trend in weight change from baseline at 6 months (-2.1% ± 3.8% vs. -0.7% ± 3.7%; p = 0.232 compared with usual care. Nearly one-half of patients assigned to the portion control intervention who completed the study reported the overall intervention was helpful and the majority would recommend it to others. Conclusions Our findings suggest that a portion control intervention incorporating dietary counseling and a portion control plate may be effective for enhancing weight loss among obese subjects. A portion control intervention deserves further evaluation as a weight control strategy in the primary care setting. Trial registration Current controlled trials NCT01451554

  12. Safety factor profile control in a tokamak

    CERN Document Server

    Bribiesca Argomedo, Federico; Prieur, Christophe

    2014-01-01

    Control of the Safety Factor Profile in a Tokamak uses Lyapunov techniques to address a challenging problem for which even the simplest physically relevant models are represented by nonlinear, time-dependent, partial differential equations (PDEs). This is because of the  spatiotemporal dynamics of transport phenomena (magnetic flux, heat, densities, etc.) in the anisotropic plasma medium. Robustness considerations are ubiquitous in the analysis and control design since direct measurements on the magnetic flux are impossible (its estimation relies on virtual sensors) and large uncertainties remain in the coupling between the plasma particles and the radio-frequency waves (distributed inputs). The Brief begins with a presentation of the reference dynamical model and continues by developing a Lyapunov function for the discretized system (in a polytopic linear-parameter-varying formulation). The limitations of this finite-dimensional approach motivate new developments in the infinite-dimensional framework. The t...

  13. Study of gastrointestinal polypeptides controlling gastric acid secretion in patients with primary antibody deficiency.

    Science.gov (United States)

    Alonso Falcón, F; Codoceo Alquinta, R; Polanco Allué, I; Aguado Gil, A; Fontán Casariego, G

    1999-01-01

    Gastric abnormalities are a common feature in patients with primary antibody deficiency. The most important problem is the high incidence of stomach cancer found in these patients. Chronic atrophic gastritis with pernicious anemia is also a common finding that predisposes to gastric adenocarcinoma. The aim of the present study was to identify factors predictive of high risk for developing gastric cancer in patients with primary antibody deficiency. We studied gastric hormones (gastrin, somatostatin and gastrin-releasing peptide, GRP) in 47 patients (23 children and 24 adults) with primary antibody deficiency. In accordance with the World Health Organization (WHO) classification, patients were diagnosed as having X-linked agammaglobulinemia (Bruton disease) in 13 cases, common variable immunodeficiency in 28, and hypogammaglobulinemia with hyperIgM in 6. Gastric biopsy was performed in 22 patients (16 children and 6 adults). Hormone determinations were carried out by radioimmunoassay. Baseline serum gastrin levels were normal or increased compared with controls, but the response to stimulation with a hyperproteic diet was delayed in 18 patients and lower than in controls in 7. In 4 adult patients, all with pernicious anemia, gastric biopsy revealed chronic atrophic gastritis involving the stomach corpus and antrum (type B gastritis). The absence of a normal response of gastrin secretion to stimulation with a hyperproteic diet may be explained by this finding. Serum somatostatin and GRP levels were higher than in controls. No correlations were found between these findings and patient age, type of immunodeficiency or duration of clinical manifestations.

  14. Comparison of atherogenic risk factors among poorly controlled and well-controlled adolescent phenylketonuria patients.

    Science.gov (United States)

    Gündüz, Mehmet; Çakar, Sevim; Kuyum, Pınar; Makay, Balahan; Arslan, Nur

    2016-06-01

    Previous studies investigating the known risk factors of atherosclerosis in phenylketonuria patients have shown conflicting results. The primary aim of our study was to investigate the serum atherogenic markers in adolescent classical phenylketonuria patients and compare these parameters with healthy peers. The secondary aim was to compare these atherogenic markers in well-controlled and poorly controlled patients. A total of 59 patients (median age: 12.6 years, range: 11-17 years) and 44 healthy controls (median age: 12.0 years, range: 11-15 years) were enrolled in our study. Phenylketonuria patients were divided into two groups: well-controlled (serum phenylalanine levels below 360 µmol/L; 24 patients) and poorly controlled patients (serum phenylalanine levels higher than 360 µmol/L). The mean high-density lipoprotein cholesterol levels of well-controlled patients (1.0±0.2 mmol/L) were significantly lower compared with poorly controlled patients and controls (1.1±0.2 mmol/L, p=0.011 and 1.4±0.2 mmol/L, pphenylketonuria patients. In particular, these changes were more prominent in well-controlled patients. We conclude that phenylketonuria patients might be at risk for atherosclerosis, and therefore screening for atherosclerotic risk factors should be included in the phenylketonuria therapy and follow-up in addition to other parameters.

  15. Clinical outcome and prognostic factors of primary gastric mucosa-associated lymphoid tissue lymphoma: a retrospective analysis of 77 cases

    International Nuclear Information System (INIS)

    Wang Shulian; Song Yongwen; Jin Jing; Wang Weihu; Liu Yueping; Liu Xinfan; Yu Zihao; Li Yexiong; Xue Liyan; Lv Ning

    2009-01-01

    Objective: To analyze the clinical results and prognostic factors of patients with early-stage primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: Seventy-seven patients with primary gastric MALT lymphoma treated from 1985 to 2006 were retrospectively analyzed. All patients were pathologically confirmed as MALT lymphoma in stage I, II and II E (by modified Blackedge staging system). Thirty-seven patients had stage I disease, 23 stage II and 17 stage II E . Sixty patients underwent surgical resection and 17 received non-surgical treatment. Survival rates were calculated by the Kaplan-Meier analysis with the Logrank test. Results: With a median follow up of 57 months for the surviving patients (ranging from 1 to 198 months for all patients), the 5-year overall survival rate, disease-free survival rate, loco-regional control rate and distant metastasis free survival rate were 74%, 70%, 76% and 87%, respectively. In univariate analysis, clinical stage was significantly associated with overall survival. Patients with stage I or II disease had a better overall survival than those with stage II E (P=0.01). Tumor size and surgical resection were significantly associated with disease-free survival. Patients with primary tumor 8 cm or less in diameter had better disease-free survival than those with primary tumor more than 8 cm in diameter (P =0.03). Patients who underwent complete resection had better disease-free survival than those who underwent incomplete resection or no surgery (P=0.02). Clinical stage, tumor size and surgical resection were significantly associated with loco-regional control. Patients with stage I or II disease had better loco-regional control than those with stage II E (P=0.03). Patients with primary tumor 8 cm or less in diameter had better loco-regional control than those with primary tumor more than 8 cm in diameter (P=0.01). Patients who underwent complete resection had better loco-regional control than those who underwent

  16. Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria

    Science.gov (United States)

    Ofoedu, John N.; Njoku, Patrick U.; Amadi, Agwu N.; Godswill-Uko, Ezinne U.

    2013-01-01

    Abstract Background As the case detection rates of hypertension increase in adult Nigerians, achieving target blood pressure (BP) control has become an important management challenge. Objectives To describe medication adherence and BP control amongst adult Nigerians with primary hypertension attending a primary care clinic of a tertiary hospital in a resource-poor environment in Eastern Nigeria. Methods A cross-sectional study was carried out in 140 adult patients with primary hypertension who have been on treatment for at least 6 months at the primary care clinic of Federal Medical Centre, Umuahia. A patient was said to have achieved goal BP control if the BP was < 140 per 90 mmHg. Adherence was assessed in the previous 30 days using a pretested researcher-administered questionnaire on 30 days of self-reported therapy. Adherence was graded using an ordinal scoring system of 0–4; an adherent patient was one who scored 4 points in the previous 30 days. Reasons for non-adherence were documented. Results Adherence to medication and BP control rates were 42.9% and 35.0% respectively. BP control was significantly associated with medication adherence (p = 0.03), antihypertensive medication duration ≥3 years (p = 0.042), and taking ≥ one form of antihypertensive medication (p = 0.04). BP at the recruitment visit was significantly higher than at the end of the study (p = 0.036). The most common reason for non-adherence was forgetfulness (p = 0.046). Conclusions The rate of BP control amongst the study population was low, which may be connected with low medication adherence. This study urges consideration of factors relating to adherence alongside other factors driving goal BP control.

  17. Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria

    Directory of Open Access Journals (Sweden)

    Gabriel UP. Iloh

    2013-02-01

    Full Text Available Background: As the case detection rates of hypertension increase in adult Nigerians, achieving target blood pressure (BP control has become an important management challenge.Objectives: To describe medication adherence and BP control amongst adult Nigerians with primary hypertension attending a primary care clinic of a tertiary hospital in a resource-poor environment in Eastern Nigeria.Methods: A cross-sectional study was carried out in 140 adult patients with primary hypertension who have been on treatment for at least 6 months at the primary care clinic of Federal Medical Centre, Umuahia. A patient was said to have achieved goal BP control if the BP was < 140 per 90 mmHg. Adherence was assessed in the previous 30 days using a pretested researcher-administered questionnaire on 30 days of self-reported therapy. Adherence was graded using an ordinal scoring system of 0–4; an adherent patient was one who scored 4 points in the previous 30 days. Reasons for non-adherence were documented.Results: Adherence to medication and BP control rates were 42.9% and 35.0% respectively. BP control was significantly associated with medication adherence (p = 0.03, antihypertensive medication duration ≥3 years (p = 0.042, and taking ≥ one form of antihypertensive medication (p = 0.04. BP at the recruitment visit was significantly higher than at the end of the study (p = 0.036. The most common reason for non-adherence was forgetfulness (p = 0.046. Conclusion: The rate of BP control amongst the study population was low, which may be connected with low medication adherence. This study urges consideration of factors relating to adherence alongside other factors driving goal BP control.

  18. Ursodeoxycholic acid for treatment of primary sclerosing cholangitis: a placebo-controlled trial

    NARCIS (Netherlands)

    Beuers, U.; Spengler, U.; Kruis, W.; AYDEMIR, U.; WIEBECKE, B.; HELDWEIN, W.; WEINZIERL, M.; Pape, G. R.; Sauerbruch, T.; Paumgartner, G.

    1992-01-01

    The efficacy and safety of ursodeoxycholic acid for the treatment of primary sclerosing cholangitis were evaluated in a prospective, randomized, double-blind, placebo-controlled trial. Fourteen patients with primary sclerosing cholangitis documented by cholestatic serum enzyme pattern, liver

  19. Water quality control device and water quality control method for reactor primary coolant system

    International Nuclear Information System (INIS)

    Wada, Yoichi; Ibe, Eishi; Watanabe, Atsushi.

    1995-01-01

    The present invention is suitable for preventing defects due to corrosion of structural materials in a primary coolant system of a BWR type reactor. Namely, a concentration measuring means measures the concentration of oxidative ingredients contained in a reactor water. A reducing electrode is disposed along a reactor water flow channel in the primary coolant system and reduces the oxidative ingredients. A reducing counter electrode is disposed along the reactor water flow channel in the primary coolant system, and electrically connected to the reducing electrode. The reactor structural materials are used as a reference electrode providing a reference potential to the reducing electrode and the reducing counter electrode. A potential control means controls the potential of the reducing electrode relative to the reference potential based on the signals from the concentration measuring means. A stable reference potential in a region where an effective oxygen concentration is stable can be obtained irrespective of the change of operation conditions by using the reactor structural materials disposed to a boiling region in the reactor core as a reference electrode. As a result, the water quality can be controlled at high accuracy. (I.S.)

  20. Factors Influencing Belize District Primary School Teachers' Attitudes toward Inclusive Education

    Science.gov (United States)

    McKay, Maxine

    2012-01-01

    Inclusive education continues to be a reoccurring challenge as various factors affect to what extent teachers or educators are willing to educate children with disabilities in the regular education setting alongside their non-disabled peers. This quantitative study examined factors influencing Belize District Primary School teachers' attitudes…

  1. A Case-control Study on Non-smoking Primary Lung Cancers in Sichuan, China

    Directory of Open Access Journals (Sweden)

    Feifei LIU

    2010-05-01

    Full Text Available Background and objective The incidence of lung cancer in non-smokers is increasing in recent years. The aim of this investigation is to explore main risk factors of non-smoking primary lung cancers in Sichuan province in order to provide more accurate data for clinical. Methods One hundred and fourty-five non-smoking pairs of cases and 145 of controls were matched by age and sex. The patients were newly-diagnosed definitely as primary lung cancer at West China Hospital of Sichuan University from March to December 2009. Results Seventeen exposure factors were explored as epidemic agents for non-smoking lung cancer in Sichuan by using univariate analysis; mutivariate conditional Logistic regression analysis showed that passive smoking, moved into newly renovated homes over the past 10 years, family cancer history from second/third-degree relatives, lack of emotion regulation, heavy work pressure and poor quality of sleep were main risk agents for the non-smoking lung cancer incidence with OR 2.267 (95%CI: 1.231-4.177, 5.080 (95%CI: 1.632-15.817, 7.937 (95%CI: 1.815-34.705, 2.491 (95%CI: 1.230-4.738, 5.769 (95%CI: 2.030-16.396, 2.538 (95%CI: 1.277-4.861, respectively. While higher body mass index, eating fruit and vegetable and regular participating in physical exercise might be protective factors with OR 0.419 (95%CI: 0.226-0.779, 0.344 (95%CI: 0.155-0.762, 0.507 (95%CI: 0.274-0.937, respectively. Conclusion The occurrence of non-smoking primary lung cancer associated with a variety of exposure factors including passive smoking, history of exposure to harmful environmental, family cancer history, mental and psychological factors in Sichuan Province.

  2. Primary dysmenorrhea: prevalence in adolescent population of Tbilisi, Georgia and risk factors

    Science.gov (United States)

    Gagua, Tinatin; Tkeshelashvili, Besarion; Gagua, David

    2012-01-01

    Objective The study aimed to determine the prevalence of dysmenorrhea in female adolescents living in Tbilisi, Georgia; find possible risk factors and establish an association, if any, with nutrition and sleep hygiene. Material and Methods A cross-sectional study was used. A retrospective case control study was used to identify risk factors. Participants: A total of 2561 women consented to participate in the research. 431 participants were included in the case-control study. Interventions: Detailed questionnaire included: reproductive history, demographic features, menstrual pattern, severity of dysmenorrhea and associated symptoms; information about nutrition and sleep hygiene. Results The prevalence of dysmenorrhea was 52.07%. Due to pain, 69.78% reported frequent school absenteeism. The risk of dysmenorrhea in students who had a family history of dysmenorrhea was approximately 6 times higher than in students with no prior history. The prevalence of dysmenorrhea was significantly higher among smokers compared with non-smokers 3.99% vs. 0.68% (p=.0.05 OR:6.102). Those women reporting an increased intake of sugar reported a marked increase of dysmenorrhea compared to women reporting no daily sugar intake (55.61% vs. 44.39%, p=.0023 LR:0.0002). However, alcohol, family atmosphere and nationality showed no correlation with dysmenorrhea. Our study revealed two most important risk factors of dysmenorrhea: meal skipping 59.78% vs. 27.03%, p=.00000 LR: 0.00000 OR:4.014 and sleep hygiene-receiving less sleep 38.77% vs. 19.59%, p=0.000055 LR: 0.000036 OR:2.598. Conclusion Primary dysmenorrhea is a common problem in the adolescent population of Tbilisi Geogia. It adversely affects their educational performance. Meal skipping and sleep quantity are associated with dysmenorrhea and may cause other reproductive dysfunctions. PMID:24592031

  3. Controllability and stability of primary frequency control from thermostatic loads with delays

    DEFF Research Database (Denmark)

    Ziras, Charalampos; Vrettos, Evangelos; You, Shi

    2017-01-01

    There is an increasing interest in exploiting the flexibility of loads to provide ancillary services to the grid. In this paper we study how response delays and lockout constraints affect the controllability of an aggregation of refrigerators offering primary frequency control (PFC). First we...... examine the effect of delays in PFC provision from an aggregation of refrigerators, using a two-area power system. We propose a framework to systematically address frequency measurement and response delays and we determine safe values for the total delays via simulations. We introduce a controllability...... index to evaluate PFC provision under lockout constraints of refrigerators compressors. We conduct extensive simulations to study the effects of measurement delay, ramping times, lockout durations and rotational inertia on the controllability of the aggregation and system stability. Finally, we discuss...

  4. Factors controlling contrail cirrus optical depth

    Directory of Open Access Journals (Sweden)

    B. Kärcher

    2009-08-01

    Full Text Available Aircraft contrails develop into contrail cirrus by depositional growth and sedimentation of ice particles and horizontal spreading due to wind shear. Factors controlling this development include temperature, ice supersaturation, thickness of ice-supersaturated layers, and vertical gradients in the horizontal wind field. An analytical microphysical cloud model is presented and validated that captures these processes. Many individual contrail cirrus are simulated that develop differently owing to the variability in the controlling factors, resulting in large samples of cloud properties that are statistically analyzed. Contrail cirrus development is studied over the first four hours past formation, similar to the ages of line-shaped contrails that were tracked in satellite imagery on regional scales. On these time scales, contrail cirrus optical depth and microphysical variables exhibit a marked variability, expressed in terms of broad and skewed probability distribution functions. Simulated mean optical depths at a wavelength of 0.55 μm range from 0.05-0.5 and a substantial fraction 20-50% of contrail cirrus stay subvisible (optical depth <0.02, depending on meteorological conditions.

    A detailed analysis based on an observational case study over the continental USA suggests that previous satellite measurements of line-shaped persistent contrails have missed about 89%, 50%, and 11% of contrails with optical depths 0-0.05, 0.05-0.1, and 0.1-0.2, respectively, amounting to 65% of contrail coverage of all optical depths. When comparing observations with simulations and when estimating the contrail cirrus climate impact, not only mean values but also the variability in optical depth and microphysical properties need to be considered.

  5. Primary Otomycosis in the Indian Subcontinent: Predisposing Factors, Microbiology, and Classification

    Directory of Open Access Journals (Sweden)

    Sampath Chandra Prasad

    2014-01-01

    Full Text Available Objective. To define otomycosis and determine the predisposing factors and microbiology in primary otomycosis. Study Design. Prospective study of two years and review of the literature. Setting. Academic Department of Otolaryngology in a coastal city in India. Patients. 150 immunocompetent individuals of whom 100 consecutive patients with a clinical diagnosis of otomycosis are considered as the study group and 50 consecutive patients with no otomycosis are considered as the control group. Results and Observations. Instillation of coconut oil (42%, use of topical antibiotic eardrops (20%, and compulsive cleaning of external ear with hard objects (32% appeared to be the main predisposing factors in otomycosis. Aspergilli were the most common isolates (80% followed by Penicillium (8%, Candida albicans (4%, Rhizopus (1%, and Chrysosporium (1%, the last being reported for the first time in otomycosis. Among aspergilli, A. niger complex (38% was the most common followed by A. fumigatus complex (27% and A. flavus complex (15%. Bacterial isolates associated with fungi in otomycosis were S. aureus, P. aeruginosa, and Proteus spp. In 42% of healthy external ears fungi were isolated. Conclusion. Aspergillus spp. were the most common fungi isolated, followed by Penicillium. Otomycotic ears are often associated with bacterial isolates when compared to normal ears. Fungi are also present in a significant number of healthy external auditory canals and their profiles match those in cases of otomycosis. The use of terms “primary” and “secondary” otomycosis is important to standardize reporting.

  6. [Nutritional factors associated with dyslipidemia in users of service in primary health care].

    Science.gov (United States)

    Ferreira, Nathália Luíza; Rodrigues, Maria Tereza; Abreu, Mery Natali; Lopes, Aline Cristine

    2011-12-01

    Dyslipidemias are relevant to public health because are one of the major risk factors for Non-Communicable Diseases and Disorders, especially cardiovascular diseases. Identify factors associated with dyslipidemias on users of Primary Health Care Center. Users were assessed through the nutritional anamnesis (demographic data, consumption of foods and nutrients and morbidity) and anthropometry. Was performed descriptive analysis, t-Student, Chi-Square and Mann Whitney tests (ppercentage of adequacy monounsaturated fatty acids (MUFA) (p=0.007). In contrast, had higher proportion of adequacy of lipid (p=0.017), lower mean weight (p=0.044) and lower inadequate intake of fatty meat (p=0.005). Multivariate analysis showed that insufficient consumption of MUFA (p=0.005) and inadequate intake of lard (p=0.021) were the main variables which influenced the presence of dyslipidemia. The results show that important dietary changes for the prevention and control of dyslipidemia have not been implemented, demonstrating the importance of nutritional interventions aimed at to clarify new dietary strategies, such as reduce consumption of sugar and to maintain an adequate consumption of lipid fractions.

  7. Risk factors for gallbladder cancer: a case-control study.

    Science.gov (United States)

    Jain, Kajal; Sreenivas, V; Velpandian, T; Kapil, Umesh; Garg, Pramod Kumar

    2013-04-01

    Risk factors for gallbladder cancer (GBC) except gallstones are not well known. The objective was to study the risk factors for GBC. In a case-control study, 200 patients with GBC, 200 healthy controls and 200 gallstones patients as diseased controls were included prospectively. The risk factors studied were related to socioeconomic profile, life style, reproduction, diet and bile acids. On comparing GBC patients (mean age 51.7 years; 130 females) with healthy controls, risk factors were chemical exposure [odd ratios (OR): 7.0 (2.7-18.2); p < 0.001)], family history of gallstones [OR: 5.3 (1.5-18.9); p < 0.01)], tobacco [OR: 4.1 (1.8-9.7); p < 0.001)], fried foods [OR: 3.1 (1.7-5.6); p < 0.001], joint family [OR: 3.2 (1.7-6.2); p < 0.001], long interval between meals [OR: 1.4 (1.2-1.6); p < 0.001] and residence in Gangetic belt [OR: 3.3 (1.8-6.2); p < 0.001]. On comparing GBC cases with gallstone controls, risk factors were female gender [OR: 2.4 (1.3-4.3); p = 0.004], residence in Gangetic belt [OR: 2.3 (1.2-4.4); p = 0.012], fried foods [OR: 2.5 (1.4-4.4); p < 0.001], diabetes [OR: 2.7 (1.2-6.4); p = 0.02)], tobacco [OR 3.8 (1.7-8.1); p < 0.001)] and joint family [OR: 2.1 (1.2-3.4); p = 0.004]. The ratio of secondary to primary bile acids was significantly higher in GBC cases than gallstone controls (20.8 vs. 0.44). Fried foods, tobacco, chemical exposure, family history of gallstones, residence in Gangetic belt and secondary bile acids were significant risk factors for GBC. Copyright © 2012 UICC.

  8. Association of increased levels of plasma tumor necrosis factor alpha with primary open-angle glaucoma

    Directory of Open Access Journals (Sweden)

    Kondkar AA

    2018-04-01

    Full Text Available Altaf A Kondkar, Tahira Sultan, Faisal A Almobarak, Hatem Kalantan, Saleh A Al-Obeidan, Khaled K Abu-Amero Glaucoma Research Chair, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia Purpose: Retinal ganglion cell (RGC death is a key feature of glaucoma. Elevated levels of tumor necrosis factor alpha (TNF-α, a pro-inflammatory cytokine, can induce RGC apoptosis and play a critical role in glaucomatous neurodegeneration. Based on the possible role of inflammation and oxidative stress in the pathogenesis of primary open-angle glaucoma (POAG, we investigated the association between plasma levels of TNF-α and POAG or its clinical indices in comparison to non-glaucomatous controls. Patients and methods: In a case–control retrospective cohort of 51 POAG cases and 88 controls, plasma TNF-α levels were measured using an enzyme-linked immunosorbent assay (ELISA. The assay was performed in duplicates on an automated ELISA analyzer. Results: Mean TNF-α level was significantly elevated in POAG cases (1.88 ± 2.17 pg/mL than the controls (0.93 ± 1.49 pg/mL; p = 0.003. The overall dose–response trend was significant (Χ2 = 6.12, df = 2; p = 0.047. No statistical difference was seen in age, gender and systemic disease distribution. A modest negative and significant correlation was seen between TNF-α level and number of antiglaucoma medications, an important clinical index of POAG severity. Moreover, logistic regression analysis showed that the risk of POAG was most significantly affected by TNF-α level and not by age and sex. Conclusion: High systemic level of an inflammatory cytokine, TNF-α, is associated with POAG; however, its possible use as a biomarker for early glaucoma diagnosis and/or disease severity needs further investigation. Keywords: apoptosis, biomarker, cytokines, ELISA, inflammation, neurodegeneration, oxidative stress

  9. Factors influencing turnover intention among primary care doctors: a cross-sectional study in Chongqing, China.

    Science.gov (United States)

    Wen, Tong; Zhang, Yan; Wang, Xue; Tang, Guo

    2018-02-13

    The intention to leave a job, known as turnover intention, among primary care doctors has a significant impact on primary health care service delivery. We investigated primary care doctors' turnover intention and analysed associated factors involved in primary health facilities in Chongqing, China. A total of 440 doctors were interviewed, they were selected using a multi-stage stratified random sampling method. The survey instrument was a self-administered questionnaire which assessed socio-demographic and work-related characteristics, job satisfaction and turnover intention. The data were analysed using χ 2 test, one-way analysis of variance, exploratory factor analysis and linear regression analysis. Our study found that 42.3% of the primary care doctors we sampled in Chongqing, China, intended to resign. Location, age, job title, doctor's position level, work pressure and job satisfaction were associated with turnover intention. Job satisfaction included both employment-related job satisfaction (including "your chance of promotion", "your rate of pay" and two other items) and satisfaction with the job itself (including "the freedom to choose your own method of working", "your job safety" and two other items). Improving job satisfaction, in terms of salary, promotion and job safety, is crucial for reducing turnover intention among primary care doctors. Therefore, we suggest that the government increase its financial investment in primary care facilities, especially in less-developed areas, and reform incentive mechanisms to improve the job satisfaction of primary care doctors. The government should consider policies such as establishing a social pension programme for village-level doctors and providing more opportunities for job promotion among primary care doctors, especially township-level doctors. Attention should also be paid to the impact of rapid urbanization, which could lead to increased workload or increased opportunities for career development, thus

  10. Primary care in the United States: practice-based innovations and factors that influence adoption.

    Science.gov (United States)

    Goldberg, Debora Goetz

    2012-01-01

    This study aims to explore the use of specific innovations in primary care practices. The research seeks to examine whether a relationship exists between environmental factors and organizational characteristics and the level of innovation in primary care practices in Virginia. The study utilized multiple secondary data sets and an organizational survey of primary care practices to define the external environment and the level of innovation. Institutional theory was used to explain the connection between innovations in primary care practices and institutional forces within the environment. Resource dependency theory was used to explain motivators for change based on a dependence on scarce financial, human, and information resources. Results show a positive association between organizational size, organizational relationships, and stakeholder expectations on the level of innovation. A negative association was found between competition and the level of innovation. No relationship was found between degree of Medicare and managed care penetration and innovation, nor between knowledge of, and difficulty complying with, payer organization requirements and innovation. Primary care physician practices exist in a market-driven environment characterized by high pressure from regulatory sources, decreasing reimbursement levels, increasing rate of change in technologies, and increasing patient and community expectations. This study contributes new information on the relationship between organizational characteristics, the external environment and specific innovations in primary care practices. Information on the contributing factors to innovation in primary care is important for improving delivery of health care services and the ability of these practices to survive.

  11. Primary contention 12RU1 radiological control; Contencion primaria 12RU1 control radiologico

    Energy Technology Data Exchange (ETDEWEB)

    Padilla C, I. [CFE, Central Laguna Verde, Subgerencia General de Operacion, Proteccion Radiologica, Veracruz (Mexico)]. e-mail: ipadilla@cfe.gob.mx

    2007-07-01

    In the primary contention of the Laguna Verde central reactors those are located the main components and control and safety systems related directly with the reactor vessel. Space, accesses, location, maneuvers, armor-plating, movements of components and radiological conditions require of a constant attention to maintain the control of the activities during a fuel reload period. Knowledge, analysis, strategies and attention to the detail in the preparation stages and execution of the fuel reload are fundamental to sum up the objectives. The reload stop 12 of the Unit 1, it required a specific attention in the radiation source due to the addition of noble metals and hydrogen to the vessel internals that generated an increment in the soluble elements of Cobalt and that it was reflected in the radiation fields in the primary contention. Movement of armor-plating of the structures of the biological armor-plating demand to establish new strategies in the control of activities for the next fuel reloads. The analysis and control of the relief valves safety of the reactor vessel, of the exchange of the activation mechanisms of the control bars, as well as of the isolation valves of main vapor and of flow control valves of the reactor recirculation system, its required of a particular attention due to their particular radiological environment, in a brief time space. The importance of this work is located in the detail of critical activities to fulfill the established goals, with successes that can be optimized, and improvement areas that require of investigation and analysis for the implementation of new technologies tend toward to the dose optimization. The reload stop 12 of the unit 1 conclude with 2.43 Sv-person in a period of 27.5 days. (Author)

  12. The role of the primary care physician in helping adolescent and adult patients improve asthma control.

    Science.gov (United States)

    Yawn, Barbara P

    2011-09-01

    Many adolescents and adults with asthma continue to have poorly controlled disease, often attributable to poor adherence to asthma therapy. Failure to adhere to recommended treatment may result from a desire to avoid regular reliance on medications, inappropriate high tolerance of asthma symptoms, failure to perceive the chronic nature of asthma, and poor inhaler technique. Primary care physicians need to find opportunities and methods to address these and other issues related to poor asthma control. Few adolescents or adults with asthma currently have asthma "checkup" visits, usually seeking medical care only with an exacerbation. Therefore, nonrespiratory-related office visits represent an important opportunity to assess baseline asthma control and the factors that most commonly lead to poor control. Tools such as the Asthma Control Test, the Asthma Therapy Assessment Questionnaire, the Asthma Control Questionnaire, and the Asthma APGAR provide standardized, patient-friendly ways to capture necessary asthma information. For uncontrolled asthma, physicians can refer to the stepwise approach in the 2007 National Asthma Education and Prevention Program guidelines to adjust medication use, but they must consider step-up decisions in the context of quality of the patient's inhaler technique, adherence, and ability to recognize and avoid or eliminate triggers. For this review, a literature search of PubMed from 2000 through August 31, 2010, was performed using the following terms (or a combination of these terms): asthma, asthma control, primary care, NAEPP guidelines, assessment, uncontrolled asthma, burden, impact, assessment tools, triggers, pharmacotherapy, safety. Studies were limited to human studies published in English. Articles were also identified by a manual search of bibliographies from retrieved articles and from article archives of the author.

  13. Course, risk factors, and prognostic factors in elderly primary care patients with mild depression: a two-year observational study.

    Science.gov (United States)

    Magnil, Maria; Janmarker, Lena; Gunnarsson, Ronny; Björkelund, Cecilia

    2013-03-01

    The aim of this study was to observe course, risk factors, and prognostic factors in a primary care cohort aged > 60 with mild to moderate depression during two-year follow-up. Observational study. Primary care. During an 11-month period all (n = 302) consecutive patients aged 60 and above attending a primary care centre in Gothenburg, Sweden were screened by a nurse for depressive symptoms with the Primary Care Evaluation of Mental Disorders, Patient Questionnaire (PRIME-MD PQ) and the Montgomery-Åsberg Depression Rating Scale, self-rated version (MADRS-S) and by a GP with a patient-centred consultation model. In the second step, the GPs diagnosed depression in screen-positives by use of the PRIME-MD Clinical Evaluation Guide (PRIME-MD CEG). All patients with mild to moderate depression were followed up for two years to assess course with several MADRS-S score assessments. Main outcome measures. Risk factors, prognostic factors, and symptoms at baseline and after two years were tested with logistic regression, using the DSM-IV and MADRS-S (cut-off > 13) respectively. Course patterns were observed and described. A total of 54 patients were diagnosed with depression. Follow-up revealed declining median MADRS-S scores and three course patterns: remitting, stable, and fluctuating. History of depression, significant life events, lacking leisure activities, and use of sedatives were risk factors for depression, all previously known. An important finding was that lacking leisure activities also increased the risk of depressive symptoms after two years (odds ratio 12, confidence interval 1.1-136). It is desirable to identify elderly individuals with less severe depression. Three course patterns were observed; this finding requires further study of the clinical characteristics related to the different patterns. Awareness of risk factors may facilitate identification of those at highest risk of poor prognosis.

  14. Automatic control of a primary electric thrust subsystem

    Science.gov (United States)

    Macie, T. W.; Macmedan, M. L.

    1975-01-01

    A concept for automatic control of the thrust subsystem has been developed by JPL and participating NASA Centers. This paper reports on progress in implementing the concept at JPL. Control of the Thrust Subsystem (TSS) is performed by the spacecraft computer command subsystem, and telemetry data is extracted by the spacecraft flight data subsystem. The Data and Control Interface Unit, an element of the TSS, provides the interface with the individual elements of the TSS. The control philosophy and implementation guidelines are presented. Control requirements are listed, and the control mechanism, including the serial digital data intercommunication system, is outlined. The paper summarizes progress to Fall 1974.

  15. Physical control of primary productivity on a seasonal scale in ...

    Indian Academy of Sciences (India)

    Keywords. Primary production; upwelling; winter cooling; Ekman-pumping, nutrient transport; Arabian Sea ... on the other hand, is driven by advection from the Somalia upwelling. Surface cooling and convection resulting from reduced solar radiation and increased evaporation make the northern region productive in winter.

  16. Diarrhea and dengue control in rural primary schools in Colombia: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Overgaard, Hans J; Alexander, Neal; Mátiz, Maria Ines; Jaramillo, Juan Felipe; Olano, Victor Alberto; Vargas, Sandra; Sarmiento, Diana; Lenhart, Audrey; Seidu, Razak; Stenström, Thor Axel

    2012-10-03

    Diarrheal diseases and dengue fever are major global health problems. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Poor household water management and sanitation are therefore potential determinants of both diseases. Little is known of the role of stored water for the combined risk of diarrhea and dengue, yet a joint role would be important for developing integrated control and management efforts. Even less is known of the effect of integrating control of these diseases in school settings. The objective of this trial was to investigate whether interventions against diarrhea and dengue will significantly reduce diarrheal disease and dengue entomological risk factors in rural primary schools. This is a 2×2 factorial cluster randomized controlled trial. Eligible schools were rural primary schools in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Eligible pupils were school children in grades 0 to 5. Schools were randomized to one of four study arms: diarrhea interventions (DIA); dengue interventions (DEN); combined diarrhea and dengue interventions (DIADEN); and control (C). Schools were allocated publicly in each municipality (strata) at the start of the trial, obviating the need for allocation concealment. The primary outcome for diarrhea is incidence rate of diarrhea in school children and for dengue it is density of adult female Aedes aegypti per school. Approximately 800 pupils from 34 schools were enrolled in the trial with eight schools in the DIA arm, nine in the DEN, eight in the DIADEN, and nine in the control arms. The trial status as of June 2012 was: completed baseline data collections; enrollment, randomization, and allocation of schools. The trial was funded by the Research Council of Norway and the Lazos de Calandaima Foundation. This is the first trial

  17. Diarrhea and dengue control in rural primary schools in Colombia: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Overgaard Hans J

    2012-10-01

    Full Text Available Abstract Background Diarrheal diseases and dengue fever are major global health problems. Where provision of clean water is inadequate, water storage is crucial. Fecal contamination of stored water is a common source of diarrheal illness, but stored water also provides breeding sites for dengue vector mosquitoes. Poor household water management and sanitation are therefore potential determinants of both diseases. Little is known of the role of stored water for the combined risk of diarrhea and dengue, yet a joint role would be important for developing integrated control and management efforts. Even less is known of the effect of integrating control of these diseases in school settings. The objective of this trial was to investigate whether interventions against diarrhea and dengue will significantly reduce diarrheal disease and dengue entomological risk factors in rural primary schools. Methods/design This is a 2×2 factorial cluster randomized controlled trial. Eligible schools were rural primary schools in La Mesa and Anapoima municipalities, Cundinamarca, Colombia. Eligible pupils were school children in grades 0 to 5. Schools were randomized to one of four study arms: diarrhea interventions (DIA; dengue interventions (DEN; combined diarrhea and dengue interventions (DIADEN; and control (C. Schools were allocated publicly in each municipality (strata at the start of the trial, obviating the need for allocation concealment. The primary outcome for diarrhea is incidence rate of diarrhea in school children and for dengue it is density of adult female Aedes aegypti per school. Approximately 800 pupils from 34 schools were enrolled in the trial with eight schools in the DIA arm, nine in the DEN, eight in the DIADEN, and nine in the control arms. The trial status as of June 2012 was: completed baseline data collections; enrollment, randomization, and allocation of schools. The trial was funded by the Research Council of Norway and the Lazos de

  18. Toxoplasma gondii infection: seroprevalence and associated risk factors among primary schoolchildren in Lagos City, Southern Nigeria

    Directory of Open Access Journals (Sweden)

    Vincent Pam Gyang

    2015-02-01

    Full Text Available INTRODUCTION: Toxoplasma gondii infection has been described as the most widespread zoonotic infection of humans and other animals. Information concerning T. gondii infection among schoolchildren is unavailable in Lagos City, Nigeria. METHODS: This cross-sectional study investigated the seroprevalence and risk factors associated with T. gondii infection among primary schoolchildren (PSC from a community located in the center of Lagos, southern Nigeria, from November 2013 to March 2014. A total of 382 PSC were screened for the presence of sera anti-T. gondii antibodies using a latex agglutination test (TOXO Test-MT, Tokyo, Japan. A cutoff titer of ≥ 1:32 was considered positive, while titers ≥ 1:1,024 indicated high responders. Questionnaires were also used to obtain data on possible risk factors from parents/guardians. RESULTS: The overall seroprevalence was 24% (91/382, and 83.5% (76/91 of seropositive PSC were classified as high responders. Among the risk factors tested, including contact with cats and soil, consumption of raw meat and vegetables, and drinking unboiled water, none showed statistical significance after multivariate adjustment. No associations were observed among age, gender, body mass index (BMI, and parents' occupation/educational level. CONCLUSIONS: The findings in this study show evidence of active infection, and hence, there is need for urgent preventive measures in this city. Further investigation is required to clarify the transmission routes. Policy makers also need to initiate prevention and control programs to protect pregnant women and immunocompromised patients in particular because they are more severely affected by T. gondii infection.

  19. Belongingness in Early Secondary School: Key Factors that Primary and Secondary Schools Need to Consider.

    Directory of Open Access Journals (Sweden)

    Sharmila Vaz

    Full Text Available It is unknown if, and how, students redefine their sense of school belongingness after negotiating the transition to secondary school. The current study used longitudinal data from 266 students with, and without, disabilities who negotiated the transition from 52 primary schools to 152 secondary schools. The study presents the 13 most significant personal student and contextual factors associated with belongingness in the first year of secondary school. Student perception of school belongingness was found to be stable across the transition. No variability in school belongingness due to gender, disability or household-socio-economic status (SES was noted. Primary school belongingness accounted for 22% of the variability in secondary school belongingness. Several personal student factors (competence, coping skills and school factors (low-level classroom task-goal orientation, which influenced belongingness in primary school, continued to influence belongingness in secondary school. In secondary school, effort-goal orientation of the student and perception of their school's tolerance to disability were each associated with perception of school belongingness. Family factors did not influence belongingness in secondary school. Findings of the current study highlight the need for primary schools to foster belongingness among their students at an early age, and transfer students' belongingness profiles as part of the hand-over documentation. Most of the factors that influenced school belongingness before and after the transition to secondary are amenable to change.

  20. Failed anterior cruciate ligament reconstruction: analysis of factors leading to instability after primary surgery.

    Science.gov (United States)

    Ma, Yong; Ao, Ying-Fang; Yu, Jia-Kuo; Dai, Ling-Hui; Shao, Zhen-Xing

    2013-01-01

    Revision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing. This study aims to investigate the factors causing instability after primary ACL reconstruction, which may provide an essential scientific base to prevent surgical failure. One hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012. There were 74 men and 36 women, and the mean age at the time of revision was 27.6 years (range 16 - 56 years). The factors leading to instability after primary ACL reconstruction were retrospectively reviewed. Fifty-one knees failed because of bone tunnel malposition, with too anterior femoral tunnels (20 knees), posterior wall blowout (1 knee), vertical femoral tunnels (7 knees), too posterior tibial tunnels (12 knees), and too anterior tibial tunnels (10 knees). There was another knee performed with open surgery, where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior. Five knees were found with malposition of the fixation. One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft. Three knees met recurrent instability after postoperative infection. The other factors included traumatic (48 knees) and unidentified (12 knees). Technical errors were the main factors leading to instability after primary ACL reconstructions, while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.

  1. Prevalence of suicidal behaviour & associated factors among tuberculosis patients in public primary care in South Africa.

    Science.gov (United States)

    Peltzer, Karl; Louw, Julia

    2013-01-01

    In spite of the high prevalence of tuberculosis worldwide, there are only a few studies on its psychiatric complications such as suicidal behaviour. We undertook this study to assess the prevalence of suicidal behaviour and its associated factors among tuberculosis patients in public primary care in South Africa. In a cross-sectional survey conducted in three provinces of South Africa new TB and new re-treatment patients were assessed within one month of anti-tuberculosis treatment. The sample included 4900 (54.5% men and women 45.5%) consecutively selected tuberculosis patients from 42 public primary care clinics in three districts in South Africa. A total of 322 patients (9.0%) reported suicidal ideation and 131 (3.1%) had a history of a suicide attempt. In multivariate analysis female gender [Odds Ratio (OR)= 0.56, Confidence Interval (CI)= 0.43-0.74], psychological distress (OR=2.36, CI=1.04-2.29), post-traumatic stress disorders (PTSD) (OR=4.98, CI=3.76-6.59), harmful alcohol use (OR=1.97, CI=1.25-3.09) and being a TB re-treatment patient (OR=1.76, CI=1.32-2.34) were associated with suicidal ideation, and psychological distress (OR=3.27, CI=1.51-7.10), PTSD symptoms (OR=4.48, CI=3.04-6.61) and harmful alcohol use (OR=3.01, CI=1.83-4.95) were associated with a suicide attempt. Our findings suggest that co-morbid illnesses of psychological distress, PTSD and harmful alcohol use and HIV infection should be assessed in TB patients under TB control programmes to prevent suicidal behaviour. Clinicians should be aware about suicidality in tuberculosis patients to reduce mortality.

  2. Prevalence of suicidal behaviour & associated factors among tuberculosis patients in public primary care in South Africa

    Directory of Open Access Journals (Sweden)

    Karl Peltzer

    2013-01-01

    Full Text Available Background & objectives: In spite of the high prevalence of tuberculosis worldwide, there are only a few studies on its psychiatric complications such as suicidal behaviour. We undertook this study to assess the prevalence of suicidal behaviour and its associated factors among tuberculosis patients in public primary care in South Africa. Methods: In a cross-sectional survey conducted in three provinces of South Africa new TB and new re-treatment patients were assessed within one month of anti-tuberculosis treatment. The sample included 4900 (54.5% men and women 45.5% consecutively selected tuberculosis patients from 42 public primary care clinics in three districts in South Africa. Results: A total of 322 patients (9.0% reported suicidal ideation and 131 (3.1% had a history of a suicide attempt. In multivariate analysis female gender [Odds Ratio (OR= 0.56, Confidence Interval (CI= 0.43-0.74], psychological distress (OR=2.36, CI=1.04-2.29, post-traumatic stress disorders (PTSD (OR=4.98, CI=3.76-6.59, harmful alcohol use (OR=1.97, CI=1.25-3.09 and being a TB re-treatment patient (OR=1.76, CI=1.32-2.34 were associated with suicidal ideation, and psychological distress (OR=3.27, CI=1.51-7.10, PTSD symptoms (OR=4.48, CI=3.04-6.61 and harmful alcohol use (OR=3.01, CI=1.83-4.95 were associated with a suicide attempt. Interpretation & conclusions: Our findings suggest that co-morbid illnesses of psychological distress, PTSD and harmful alcohol use and HIV infection should be assessed in TB patients under TB control programmes to prevent suicidal behaviour. Clinicians should be aware about suicidality in tuberculosis patients to reduce mortality.

  3. Factor analysis of the Children's Behaviour Questionnaire in a Nigerian paediatric primary care population

    Directory of Open Access Journals (Sweden)

    O O Omigbodun

    2004-04-01

    Full Text Available Objective. This paper examines the factor structure of the Yoruba translation of the Children’s Behaviour Questionnaire for Completion by Parents (CBQ administered in a Nigerian paediatric primary care population. Design. A cross-sectional questionnaire survey. Subjects. Four hundred and seventy-eight children aged 7 - 14 years who attended a primary care clinic in Ibadan, Nigeria, over a 3-month period. Methods. Parents’ ratings of the children were obtained using the Yoruba translation of the CBQ. The factor structure of this instrument was examined using principal component analysis with varimax rotation. Only factors with eigenvalues of greater than 1 were examined further. Results. The first seven dimensions were readily conceptu- alised. These factors are conduct problem, hyperactivity, emotional problem, irritability, problems with elimination, a somatic complaint and a school problem dimension. Conclusion. These factors are similar to what has been observed in other studies involving populations of children with psychopathology, with the exception of the somatic com- plaint and school problem dimension. The emergence of these two factors, which are quite different from what has been observed in other studies, may demonstrate differences that reflect the influence of language, culture and the peculiarities of a primary care setting. On the other hand the similarity of most of the factors to those found in previous studies con- firms the broad similarities in the behaviour of children across different cultures.

  4. Factors controlling upper tropospheric relative humidity

    Directory of Open Access Journals (Sweden)

    B. Kärcher

    2004-03-01

    Full Text Available Factors controlling the distribution of relative humidity in the absence of clouds are examined, with special emphasis on relative humidity over ice (RHI under upper tropospheric and lower stratospheric conditions. Variations of temperature are the key determinant for the distribution of RHI, followed by variations of the water vapor mixing ratio. Multiple humidity modes, generated by mixing of different air masses, may contribute to the overall distribution of RHI, in particular below ice saturation. The fraction of air that is supersaturated with respect to ice is mainly determined by the distribution of temperature. The nucleation of ice in cirrus clouds determines the highest relative humdity that can be measured outside of cirrus clouds. While vertical air motion and ice microphysics determine the slope of the distributions of RHI, as shown in a separate study companion (Haag et al., 2003, clouds are not required to explain the main features of the distributions of RHI below the ice nucleation threshold. Key words. Atmospheric composition and structure (pressure, density and temperature; troposphere – composition and chemistry; general or miscellaneous

  5. Factors controlling upper tropospheric relative humidity

    Directory of Open Access Journals (Sweden)

    B. Kärcher

    2004-03-01

    Full Text Available Factors controlling the distribution of relative humidity in the absence of clouds are examined, with special emphasis on relative humidity over ice (RHI under upper tropospheric and lower stratospheric conditions. Variations of temperature are the key determinant for the distribution of RHI, followed by variations of the water vapor mixing ratio. Multiple humidity modes, generated by mixing of different air masses, may contribute to the overall distribution of RHI, in particular below ice saturation. The fraction of air that is supersaturated with respect to ice is mainly determined by the distribution of temperature. The nucleation of ice in cirrus clouds determines the highest relative humdity that can be measured outside of cirrus clouds. While vertical air motion and ice microphysics determine the slope of the distributions of RHI, as shown in a separate study companion (Haag et al., 2003, clouds are not required to explain the main features of the distributions of RHI below the ice nucleation threshold.

    Key words. Atmospheric composition and structure (pressure, density and temperature; troposphere – composition and chemistry; general or miscellaneous

  6. [Risk factors and burnout levels in Primary Care nurses: A systematic review].

    Science.gov (United States)

    Gómez-Urquiza, Jose L; Monsalve-Reyes, Carolina S; San Luis-Costas, Concepción; Fernández-Castillo, Rafael; Aguayo-Estremera, Raimundo; Cañadas-de la Fuente, Guillermo A

    2017-02-01

    To determine the risk factors and levels of burnout in Primary Care nurses. A systematic review was performed. CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015. The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date. The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level. Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout. High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  7. Colon cancer controls versus population controls in case-control studies of occupational risk factors

    DEFF Research Database (Denmark)

    Kaerlev, Linda; Lynge, Elsebeth; Sabroe, Svend

    2004-01-01

    are interchangeable with the experience for population controls. Patient controls may even be preferable from population controls under certain conditions. In this study we examine if colon cancer patients can serve as surrogates for proper population controls in case-control studies of occupational risk factors...... about occupational, medical and life style conditions. RESULTS: No statistical significant difference for educational level, medical history or smoking status was seen between the two control groups. There was evidence of a higher alcohol intake, less frequent work as a farmer and less exposure...... to pesticides among colon cancer controls. CONCLUSIONS: Use of colon cancer controls may provide valid exposure estimates in studies of many occupational risk factors for cancer, but not for studies on exposure related to farming....

  8. [Current status of malaria control knowledge awareness of primary and sec- ondary school students in Xuzhou City].

    Science.gov (United States)

    Sun, Xing-sheng; Li, Li; Zhang, Kan-kan

    2015-12-01

    To understand the current status of malaria control knowledge awareness of primary and secondary school students and its influencing factors in Yunlong District, Xuzhou City, so as to provide the evidence for improving the malaria prevention work. A total of 800 students from 4 urban and rural primary and secondary schools were randomly selected and investigated with questionnaires. The total awareness rate of malaria control knowledge was 61.27%, and the awareness rates of symptoms of malaria and malaria prevention were only 38.99% and 57.59% respectively. The main approach of obtaining the malaria control knowledge was media (51.52%). The univariate analysis showed that sex, area and different education levels affected the awareness rates of malaria control knowledge (P knowledge of country students was lower than that of urban students (P knowledge of the secondary school students was higher than that of the primary school students (P knowledge of primary and secondary school students in Yunlong District is lower than that required by the national standard. Therefore, the health education of malaria control should be strengthened, especially in countryside school students and primary school students.

  9. Primary Neuroendocrine Carcinoma of the Breast: Histopathological Criteria, Prognostic Factors, and Review of the Literature

    Science.gov (United States)

    Marinova, Lena; Vicheva, Snezhinka

    2016-01-01

    We present here a case of a 42-year-old woman diagnosed with primary neuroendocrine carcinoma of the breast (NECB). We discuss the importance of histological criteria for primary neuroendocrine mammary carcinoma, established by WHO in 2003 and 2012. After an overview of different cases of primary neuroendocrine carcinoma of the breast published in the literature, we present information about differential diagnosis, prognostic factors, and surgical and adjuvant treatment. Prognosis of NECB is not different from that of other invasive breast carcinomas and the most important prognostic factor is tumor grade (G). There is no standard treatment and patients should be treated similarly to patients with invasive ductal carcinoma, NOS (not otherwise specified), whose choice of therapy depends on tumor's size, degree of differentiation, clinical stage, and hormonal status. PMID:27840759

  10. Development of a Scale for Domain General Perceived Control Scale Primary School ChildrensAND#8217;

    Directory of Open Access Journals (Sweden)

    Esra Dereli

    2012-06-01

    Full Text Available SUMMARY AIM: This study aimed to develop a scale to measure domain general perceived control scale for elementary age children. METHOD: Participants were a total of 341 primary school children, 4th and f4th grade for 152 students, 6th, 7th and 8th grade for 162 students aged between 10-14.Skinner (1996, perceived control based on the theory is created 12-item scale of perceived control of the general form of the trial for primary education children and this form, within the scope of the research subjects, are given in order to make the validity and reliability studies. In order to test the validity of the scale developed, Satisfaction with Life was used. This scale was developed by Diener et al. (1985 and adapted into Turkish by Yetim (1993. RESULTS:Exploratory and confirmatory factor analysises and certain reliability analyses were used in the study. As a result of the analysis, four Likert-type five items scale were obtained. The findings revealed one -dimensional scale, 46.35% of whose variance was explained. Cronbach’s coefficient alpha provided evidence for the internal consistency of the exploratory the Scale. The reliability of the scale was 0.70 and indicated that the 5 item scale had good internal consistency for the sample. CONCLUSION: The scale that resulted was given the title “Scale for Primary School Children’ Time Orientation during Classroom Disengagement”. This instrument may be used in various studies in the future, thus contributing to the development of the field. [TAF Prev Med Bull 2012; 11(3.000: 331-338

  11. Main Factors of Job Satisfaction among Primary School Educators: Factor Analysis of the Greek Reality

    Science.gov (United States)

    Saiti, Anna

    2007-01-01

    Job satisfaction is an important issue, but remains a complex one as it is difficult to measure. A wide range of factors such as the working environment, its manner of organisation, demography and individual circumstances, etc., can substantially affect the level of job satisfaction attained by individuals. Job satisfaction and the teaching…

  12. Diversity in Primary Teacher Education Gender Differences in Student Factors and Curriculum Perception

    Science.gov (United States)

    Geerdink, Gerda; Bergen, Theo; Dekkers, Hetty

    2011-01-01

    In the Netherlands only a small number of male students opt for primary school teaching and a relatively large percentage of them leave without graduating. A small-scale research project was set up to explore the question: Can gender-specific student factors be identified in relation to the initial teacher education curriculum that leads to the…

  13. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care.

    NARCIS (Netherlands)

    Prins, M.A.; Verhaak, P.F.; Smolders, M.; Laurant, M.G.H.; Meer, K. de; Spreeuwenberg, P.; Marwijk, H.W.J. van; Penninx, B.W.J.H.; Bensing, J.M.

    2010-01-01

    OBJECTIVE: To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. DESIGN: Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). PARTICIPANTS: Seven hundred and

  14. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care

    NARCIS (Netherlands)

    Prins, M.A.; Verhaak, P.; Smolders, M.; Laurant, M.G.H.; van der Meer, K; Spreeuwenberg, P.; van Marwijk, H.W.J.; Penninx, B.W.J.H.; Bensing, J.M.

    2010-01-01

    Objective: To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Design: Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Participants: Seven hundred and

  15. Patient Factors Associated with Guideline-concordant Treatment of Anxiety and Depression in Primary Care

    NARCIS (Netherlands)

    Prins, Marijn A.; Verhaak, Peter F. M.; Smolders, Mirrian; Laurant, Miranda G. H.; van der Meer, Klaas; Spreeuwenberg, Peter; van Marwijk, Harm W. J.; Penninx, Brenda W. J. H.; Bensing, Jozien M.

    To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Seven hundred and twenty-one patients with a current

  16. Diversity in Primary Teacher Education : Gender differences in Student Factors and Curriculum perception

    NARCIS (Netherlands)

    Gerda Geerdink; H. Dekkers; T. Bergen

    2011-01-01

    In the Netherlands only a small number of male students opt for primary school teaching and a relatively large percentage of them leave without graduating. A small-scale research project was set up to explore the question: Can gender-specific student factors be identified in relation to the initial

  17. Diversity in primary teacher education gender differences in student factors and curriculum perception

    NARCIS (Netherlands)

    Geerdink, G.M.T.; Bergen, T.C.M.; Dekkers, H.P.J.M.

    2011-01-01

    In the Netherlands only a small number of male students opt for primary school teaching and a relatively large percentage of them leave without graduating. A small-scale research project was set up to explore the question: Can genderspecific student factors be identified in relation to the initial

  18. Factors Related to Perceived Needs of Primary Caregivers of Patients with Schizophrenia

    Directory of Open Access Journals (Sweden)

    Ling-Ling Yeh

    2008-08-01

    Conclusion: Four clusters of caregivers' perceived needs were identified and found to be related to psychopathologic and demographic factors. These data are of value in designing appropriate community psychiatric programs to improve the quality of care and enhance the capacity of primary caregivers to care for patients.

  19. Modeling the Factors Associated with Children's Mental Health Difficulties in Primary School: A Multilevel Study

    Science.gov (United States)

    Humphrey, Neil; Wigelsworth, Michael

    2012-01-01

    The current study explores some of the factors associated with children's mental health difficulties in primary school. Multilevel modeling with data from 628 children from 36 schools was used to determine how much variation in mental health difficulties exists between and within schools, and to identify characteristics at the school and…

  20. Employing the Five-Factor Mentoring Instrument: Analysing Mentoring Practices for Teaching Primary Science

    Science.gov (United States)

    Hudson, Peter; Usak, Muhammet; Savran-Gencer, Ayse

    2009-01-01

    Primary science education is a concern around the world and quality mentoring within schools can develop pre-service teachers' practices. A five-factor model for mentoring has been identified, namely, personal attributes, system requirements, pedagogical knowledge, modelling, and feedback. Final-year pre-service teachers (mentees, n = 211) from…

  1. Diversity in primary teacher education gender differences in student factors and curriculum perception

    NARCIS (Netherlands)

    Geerdink, G.; Bergen, T.C.M.; Dekkers, Hetty

    2010-01-01

    In the Netherlands only a small number of male students opt for primary school teaching and a relatively large percentage of them leave without graduating. A small-scale research project was set up to explore the question: Can gender-specific student factors be identified in relation to the initial

  2. Investigation of Primary Education Second Level Students' Motivations toward Science Learning in Terms of Various Factors

    Science.gov (United States)

    Sert Çibik, Ayse

    2014-01-01

    The purpose of this research was to investigate the primary education second level students' motivations towards science learning in terms of various factors. Within the research, the variation of the total motivational scores in science learning according to the gender, class, socio-economic levels, success in science-technology course and…

  3. Quality control in radiography: a primary responsibility of the technologist

    International Nuclear Information System (INIS)

    Koenig, G.F.

    1973-01-01

    The relationship between quality control in radiography and radiation protection is emphasized. Methods of dose reduction discussed are the 0.1 mm fractional focal spot, the use of high speed intensifying screens, and automatic exposure control. The need for recommendations for the establishment of improved systems of radiography is discussed. The development of revised educational concepts for radiologists is considered. (U.S.)

  4. Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial

    Science.gov (United States)

    Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen; Friede, Tim; Stables, David

    2010-01-01

    Background Primary care databases contain cardiovascular disease risk factor data, but practical tools are required to improve identification of at-risk patients. Aim To test the effects of a system of electronic reminders (the ‘e-Nudge’) on cardiovascular events and the adequacy of data for cardiovascular risk estimation. Design of study Randomised controlled trial. Setting Nineteen general practices in the West Midlands, UK. Method The e-Nudge identifies four groups of patients aged over 50 years on the basis of estimated cardiovascular risk and adequacy of risk factor data in general practice computers. Screen messages highlight individuals at raised risk and prompt users to complete risk profiles where necessary. The proportion of the study population in the four groups was measured, as well as the rate of cardiovascular events in each arm after 2 years. Results Over 38 000 patients' electronic records were randomised. The intervention led to an increase in the proportion of patients with sufficient data who were identifiably at risk, with a difference of 1.94% compared to the control group (95% confidence interval [CI] = 1.38 to 2.50, P<0.001). A corresponding reduction occurred in the proportion potentially at risk but requiring further data for a risk estimation (difference = –3.68%, 95% CI = –4.53 to –2.84, P<0.001). No significant difference was observed in the incidence of cardiovascular events (rate ratio = 0.96, 95% CI = 0.85 to 1.10, P = 0.59). Conclusion Automated electronic reminders using routinely collected primary care data can improve the adequacy of cardiovascular risk factor information during everyday practice and increase the visibility of the at-risk population. PMID:20353659

  5. Predictive factors for postoperative visual function of primary chronic rhegmatogenous retinal detachment after scleral buckling.

    Science.gov (United States)

    Fang, Wei; Li, Jiu-Ke; Jin, Xiao-Hong; Dai, Yuan-Min; Li, Yu-Min

    2016-01-01

    To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB). Totally 48 patients (51 eyes) with primary chronic RRD were included in this prospective interventional clinical cases study, which underwent SB alone from June 2008 to December 2014. Age, sex, symptoms duration, detached extension, retinal hole position, size, type, fovea on/off, proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), baseline best corrected visual acuity (BCVA), operative duration, follow up duration, final BCVA were measured. Pearson correlation analysis, Spearman correlation analysis and multivariate linear stepwise regression were used to confirm predictive factors for better final visual acuity. Student's t-test, Wilcoxon two-sample test, Chi-square test and logistic stepwise regression were used to confirm predictive factors for better vision improvement. Baseline BCVA was 0.8313±0.6911 logMAR and final BCVA was 0.4761±0.4956 logMAR. Primary surgical success rate was 92.16% (47/51). Correlation analyses revealed shorter symptoms duration (r=0.3850, P=0.0053), less detached area (r=0.5489, Ppredictive factors were better baseline BCVA [partial R-square (PR(2))=0.5316, Ppredictive factors for better vision improvement were better baseline vision [odds ratio (OR) =50.369, P=0.0041] and longer follow up duration (OR=1.144, P=0.0067). Independent predictive factors for better visual outcome of primary chronic RRD after SB are better baseline BCVA, shorter symptoms duration, shorter operative duration and longer follow up duration, while independent predictive factors for better vision improvement after operation are better baseline vision and longer follow up duration.

  6. [Prevalence of dyslipidemia and its influential factors in 2 028 students from primary and middle schools in Changsha].

    Science.gov (United States)

    Li, Yamei; Luo, Jiayou; Ma, Jun; Zou, Zhiyong; Liu, Xiaoqun; Li, Huixia

    2017-06-28

    To determine the prevalence of dyslipidemia in students from the primary and middle schools and the influential factors, and to provide evidence for the prevention and control of dyslipidemia and relevant chronic diseases in primary and middle schools. 
 Methods: A total of 2 028 students aged 7 to 17 from the primary and middle schools in Changsha were selected by stratified random cluster sampling. The contents of the study included questionnaire survey, physical measurement and blood tests for fasting blood triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels. Non-high-density lipoprotein cholesterol (non-HDL-C) level was calculated by TC level minus HDL-C level. Chi-square test and non-conditional logistic regression model were used to analyze the factors that contributed to dyslipidemia.
 Results: The dyslipidemia rate was 18.6%, and the abnormal rates of TG, TC, LDL-C, non-HDL-C and HDL-C were 6.8%, 5.6%, 2.3%, 4.2% and 8.6%, respectively. By chi-square test, the dyslipidemia rate in students with different ages, home locations, BMI groups, central obesity, time on watching TV or playing computer per day, and daily sleep time was statistically significant. Non-conditional logistic regression analysis showed that home location for the city (OR=1.332), overweight (OR=1.548), obesity (OR=2.201), central obesity (OR=1.695), watching TV or playing computer for more than 2 hours per day (OR=1.357), daily sleep time longer than 11 hours (OR=2.518) were the risk factors for dyslipidemia in students from the primary and middle schools. 
 Conclusion: Nearly 1/5 primary and middle school students show dyslipidemia, which is associated with obesity and other bad behaviors.

  7. Volumetric and chemical control auxiliary circuit for a PWR primary circuit

    International Nuclear Information System (INIS)

    Costes, D.

    1990-01-01

    The volumetric and chemical control circuit has an expansion tank with at least one water-steam chamber connected to the primary circuit by a sampling pipe and a reinjection pipe. The sampling pipe feeds jet pumps controlled by valves. An action on these valves and pumps regulates the volume of the water in the primary circuit. A safety pipe controlled by a flap automatically injects water from the chamber into the primary circuit in case of ruptures. The auxiliary circuit has also systems for purifying the water and controlling the boric acid and hydrogen content [fr

  8. Effects of cutbacks on motivating factors among nurses in primary health care.

    Science.gov (United States)

    Halldorsdottir, Sigridur; Einarsdottir, Emilia J; Edvardsson, Ingi Runar

    2018-03-01

    When financial cuts are made, staff redundancies and reorganisation in the healthcare system often follow. Little is known how such cutbacks affect work motivation of nurses in primary health care. Examine the effects of cutbacks on motivating factors among nurses in primary health care. A phenomenological approach involving a purposeful sample of ten nurses in primary health care. Average age 44. The participants identified the job itself, autonomy, independence, good communication with co-workers, and the potential for professional training, learning and development as the main internal motivational factors related to their work. However, increased stress and uncertainty, growing fatigue and understaffing were starting to have a negative impact on these internal motivational factors. Moreover, reduced opportunities for professional training and development had negative effects on the participants. Many saw these opportunities as a vital part of recognition for their job performance. Regarding external motivation, the factors identified were job security, salaries and rewards, and interaction with management. The participants expressed their interest in more consultation with managers and most preferred an increased flow of information from managers to staff members during cutbacks. Salaries, professional training opportunities and appreciation were rewards named by participants for a job well done. All agreed that salaries are stronger motivational factors than before cutbacks. In the case of cutbacks, nursing managers should increase consultations with staff and make sure that nurses maintain their independence, autonomy, opportunities for professional training as well as appreciation for job well done. © 2017 Nordic College of Caring Science.

  9. A Primary Human Critical Success Factors Model for the ERP System Implementation

    Directory of Open Access Journals (Sweden)

    Jenko Aleksander

    2016-08-01

    Full Text Available Background and Purpose: Many researchers have investigated various Critical success factors (CSFs and the different causes of ERP implementation project failures. Despite a detailed literature preview, we were unable to find an appropriate research with a comprehensive overview of the true causes behind CSFs, observed from a human factors perspective. The objective of this research was therefore to develop and evaluate the Primary human factors (PHFs model and to confirm the significant impact of PHFs on traditional CSFs and on the project success.

  10. Psychiatric disorders in children attending a Nigerian primary care unit: functional impairment and risk factors

    Directory of Open Access Journals (Sweden)

    Tunde-Ayinmode Mosunmola

    2012-07-01

    Full Text Available Abstract Background There is dearth of data on the level of functional impairment and risk factors for psychiatric morbidity in children attending primary care services in developing countries like Nigeria. The risk factors for psychiatric morbidity and functional impairment in children attending the primary care unit of a teaching hospital in Ilorin, Nigeria was therefore investigated to obtain data that could be used in improving service provision by primary care physicians. Methods A cross-sectional two-stage design was employed for the study. The first stage involved administration of the Child Behavior Questionnaire (CBQ to 350 children while the children’s version of the schedule for affective disorders and schizophrenia was used for the second stage involving 157 children, all high scorers on CBQ (score of ≥ 7 and 30% of low scorers (score  In addition, the Children Global Assessment Scale was used to assess the functional status of the children (score of ≤ 70 indicates functional impairment while the mothers’ mental health status was assessed with the 12-item version of the General Health Questionnaire, a score of 3 or more on this instrument indicate presence of mental morbidity. Results It was observed that 11.4% of the children had diagnosable psychiatric disorders and 7.1% were functionally impaired; and those with psychiatric disorders were more functionally impaired than those without. Thus, significant negative correlation was noted between CBQ scores and CGAS (r = 0.53; p  Conclusions Child psychiatric disorders are prevalent in the primary care unit studied. Many of the risk factors identified in the study population are modifiable. Collaborative efforts between psychiatrists and primary care physicians could therefore help to reduce level of risk and functional impairment and psychiatric morbidity among children attending the primary care unit studied. It could also help improve referral rates of

  11. Long-term primary patency prognostic factors after endovascular therapy for acute lower limb ischemia

    International Nuclear Information System (INIS)

    Zhang Di; Gu Jianping; Lou Wensheng; He Xu; Chen Liang; Chen Guoping; Su Haobo; Song Jinhua; Wang Tao

    2012-01-01

    Objective: To assess prognostic factors regarding long-term primary patency for patients who underwent intra-arterial thrombolysis and/or adjuvant endovascular techniques due to acute lower limb ischemia. Methods: Consecutive patients with ALI of the lower extremities treated via interventional methods between January 2005 and June 2010 were identified and reviewed (exclude patient suffered from aortic dissection involved artery of lower extremity or trauma). Analyze the potential variables with univariable analysis and only factors associated with long-term primary patency with a P value less than 0.1 in univariable analysis were introduced into the Cox regression mode. Total long-term primary patency and grouped primary patency were assessed using Kaplan-Meier estimation. Results: The analyzed dataset included 107 limbs treated in 101 patients presenting with ALI (class Ⅰ 15, class Ⅱ A 36, class Ⅱ B to Ⅲ 56, according to Rutherford classification). Eight nine limbs were enrolled in follow-up.The mean followup was 34 months (range: 1 to 53 months). Primary patency at 12, 24 and 36 months was 87%, 68% and 55%, respectively. Multivariable analyses identified patients presenting with diabetes mellitus (P=0.00), PAOD (P<0.02) and thrombolysis time (P<0.02) were associated with primary patency. Compare the patency rate of patients with different thrombolysis time, the results showed that the patency rate of the patients thrombolysis time less than 4 d was higher than those more than 4 c. Conclusions: Interventional therapy remains an effective treatment option for patients presenting with lower extremity ALI. Diabetes mellitus and PAOD negatively affect the rates of limb primary patency. Thrombolysis should be limited to <4 days. (authors)

  12. Identification of transcriptional factors and key genes in primary osteoporosis by DNA microarray.

    Science.gov (United States)

    Xie, Wengui; Ji, Lixin; Zhao, Teng; Gao, Pengfei

    2015-05-09

    A number of genes have been identified to be related with primary osteoporosis while less is known about the comprehensive interactions between regulating genes and proteins. We aimed to identify the differentially expressed genes (DEGs) and regulatory effects of transcription factors (TFs) involved in primary osteoporosis. The gene expression profile GSE35958 was obtained from Gene Expression Omnibus database, including 5 primary osteoporosis and 4 normal bone tissues. The differentially expressed genes between primary osteoporosis and normal bone tissues were identified by the same package in R language. The TFs of these DEGs were predicted with the Essaghir A method. DAVID (The Database for Annotation, Visualization and Integrated Discovery) was applied to perform the GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway enrichment analysis of DEGs. After analyzing regulatory effects, a regulatory network was built between TFs and the related DEGs. A total of 579 DEGs was screened, including 310 up-regulated genes and 269 down-regulated genes in primary osteoporosis samples. In GO terms, more up-regulated genes were enriched in transcription regulator activity, and secondly in transcription factor activity. A total 10 significant pathways were enriched in KEGG analysis, including colorectal cancer, Wnt signaling pathway, Focal adhesion, and MAPK signaling pathway. Moreover, total 7 TFs were enriched, of which CTNNB1, SP1, and TP53 regulated most up-regulated DEGs. The discovery of the enriched TFs might contribute to the understanding of the mechanism of primary osteoporosis. Further research on genes and TFs related to the WNT signaling pathway and MAPK pathway is urgent for clinical diagnosis and directing treatment of primary osteoporosis.

  13. Organizational factors and depression management in community-based primary care settings

    Directory of Open Access Journals (Sweden)

    Kilbourne Amy M

    2009-12-01

    Full Text Available Abstract Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT infrastructure, and external incentives and process features (e.g., staff performance, degree of integrated depression care, and IT performance. Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition

  14. Primary graft dysfunction of the liver: definitions, diagnostic criteria and risk factors.

    Science.gov (United States)

    Neves, Douglas Bastos; Rusi, Marcela Balbo; Diaz, Luiz Gustavo Guedes; Salvalaggio, Paolo

    2016-01-01

    Primary graft dysfunction is a multifactorial syndrome with great impact on liver transplantation outcomes. This review article was based on studies published between January 1980 and June 2015 and retrieved from PubMed database using the following search terms: "primary graft dysfunction", "early allograft dysfunction", "primary non-function" and "liver transplantation". Graft dysfunction describes different grades of graft ischemia-reperfusion injury and can manifest as early allograft dysfunction or primary graft non-function, its most severe form. Donor-, surgery- and recipient-related factors have been associated with this syndrome. Primary graft dysfunction definition, diagnostic criteria and risk factors differ between studies. RESUMO A disfunção primária do enxerto hepático é uma síndrome multifatorial com grande impacto no resultado do transplante de fígado. Foi realizada uma ampla revisão da literatura, consultando a base de dados PubMed, em busca de estudos publicados entre janeiro de 1980 e junho de 2015. Os termos descritivos utilizados foram: "primary graft dysfunction", "early allograft dysfunction", "primary non-function" e "liver transplantation". A disfunção traduz graus diferentes da lesão de isquemia e reperfusão do órgão, e pode se manifestar como disfunção precoce ou, na forma mais grave, pelo não funcionamento primário do enxerto. Fatores relacionados ao doador, ao transplante e ao receptor contribuem para essa síndrome. Existem definições diferentes na literatura quanto ao diagnóstico e aos fatores de risco associados à disfunção primária.

  15. Field Test of Boiler Primary Loop Temperature Controller

    Energy Technology Data Exchange (ETDEWEB)

    Glanville, P.; Rowley, P.; Schroeder, D.; Brand, L.

    2014-09-01

    Beyond these initial system efficiency upgrades are an emerging class of Advanced Load Monitoring (ALM) aftermarket controllers that dynamically respond to the boiler load, with claims of 10% to 30% of fuel savings over a heating season. For hydronic boilers specifically, these devices perform load monitoring, with continuous measurement of supply and in some cases return water temperatures. Energy savings from these ALM controllers are derived from dynamic management of the boiler differential, where a microprocessor with memory of past boiler cycles prevents the boiler from firing for a period of time, to limit cycling losses and inefficient operation during perceived low load conditions. These differ from OTR controllers, which vary boiler setpoint temperatures with ambient conditions while maintaining a fixed differential. PARR installed and monitored the performance of one type of ALM controller, the M2G from Greffen Systems, at multifamily sites in the city of Chicago and its suburb Cary, IL, both with existing OTR control. Results show that energy savings depend on the degree to which boilers are over-sized for their load, represented by cycling rates. Also savings vary over the heating season with cycling rates, with greater savings observed in shoulder months. Over the monitoring period, over-sized boilers at one site showed reductions in cycling and energy consumption in line with prior laboratory studies, while less over-sized boilers at another site showed muted savings.

  16. Burnout among primary school teachers in Iraq: prevalence and risk factors.

    Science.gov (United States)

    Al-Asadi, Jasim; Khalaf, Shukrya; Al-Waaly, Aqeel; Abed, Alaa; Shami, Sabah

    2018-06-10

    Studies from various parts of the world have shown that teachers are likely to suffer from burnout. So far, there has been no research on burnout among primary school teachers in Basrah, Iraq. We aimed to determine the prevalence and predisposing factors of self-reported burnout among primary school teachers in Basrah. This was a cross-sectional study in 32 governmental primary schools during November 2014-February 2015. A self-administered questionnaire was used to collect sociodemographic and work-related data using the Oldenburg Burnout Inventory. Of 800 questionnaires distributed, 706 (88.3%) were completed; 58.4% were from women. The prevalence of burnout was 24.5% (95% CI: 21.5-27.8). A statistically significant association was found between burnout and age, sex and marital status. Work-related factors that showed significant association with burnout were: work overload, problems related to career advancement, high number of students per class and student misbehaviour. Burnout is an important health problem among primary school teachers in Basrah. A number of risk factors, particularly those related to work, are amenable to modification since they are related to the education policy. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

  17. Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

    Science.gov (United States)

    Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka-Wandabwa, Christopher; Haregu, Tilahun N; Juma, Pamela A; Mohammed, Shukri; Wambui, David; Gong, Enying; Yan, Lijing L; Kyobutungi, Catherine

    2018-05-09

    In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. This review revealed

  18. Field Test of Boiler Primary Loop Temperature Controller

    Energy Technology Data Exchange (ETDEWEB)

    Glanville, P. [Partnership for Advanced Residential Retrofit, Des Plaines, IL (United States); Rowley, P. [Partnership for Advanced Residential Retrofit, Des Plaines, IL (United States); Schroeder, D. [Partnership for Advanced Residential Retrofit, Des Plaines, IL (United States); Brand, L. [Partnership for Advanced Residential Retrofit, Des Plaines, IL (United States)

    2014-09-01

    Beyond these initial system efficiency upgrades are an emerging class of Advanced Load Monitoring (ALM) aftermarket controllers that dynamically respond to the boiler load, with claims of 10% to 30% of fuel savings over a heating season. For hydronic boilers specifically, these devices perform load monitoring, with continuous measurement of supply and, in some cases, return water temperatures. Energy savings from these ALM controllers are derived from dynamic management of the boiler differential, where a microprocessor with memory of past boiler cycles prevents the boiler from firing for a period of time, to limit cycling losses and inefficient operation during perceived low load conditions. These differ from OTR controllers, which vary boiler setpoint temperatures with ambient conditions while maintaining a fixed differential.

  19. Photovoltaic (PV) contribution to the primary frequency control

    International Nuclear Information System (INIS)

    Rafa, Adel Hamad

    2012-01-01

    Photovoltaic (PV) technology is among the most efficient and cost effective renewable energy kinds currently available on the market. The connection of a large number of PVs to the grid may influence the frequency and voltage stability of the power system. This paper proposes load-frequency control technique for system with high penetration of photovoltaic (PV). The proposed controller has been successfully implemented and tested using PSCAD/EMTDC. In this study, the impact of photovoltaic (PV) on frequency stability of the system is studies in detail. This study shows that large penetration of photovoltaic (PV) with load and frequency control has a significant impact on the stability and security level of electrical network.(author)

  20. Growth hormone-releasing factor induces c-fos expression in cultured primary pituitary cells

    DEFF Research Database (Denmark)

    Billestrup, Nils; Mitchell, R L; Vale, W

    1987-01-01

    GH-releasing factor (GRF) and somatostatin regulates the secretion and biosynthesis of GH as well as the proliferation of GH-producing cells. In order to further characterize the mitogenic effect of GRF, we studied the expression of the proto-oncogene c-fos in primary pituitary cells. Maximal...... induction of c-fos mRNA was observed 20-60 min after stimulation with 5 nM GRF, returning to basal levels after 2 h. Somatostatin-14 (5 nM) partially inhibited the GRF induced c-fos expression. Forskolin and phorbol 12, 13 dibutyrate induced c-fos gene in cultured primary pituitary cells with similar...

  1. Predictors of relational continuity in primary care: patient, provider and practice factors.

    Science.gov (United States)

    Kristjansson, Elizabeth; Hogg, William; Dahrouge, Simone; Tuna, Meltem; Mayo-Bruinsma, Liesha; Gebremichael, Goshu

    2013-05-31

    Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of care provided by different models of primary care. This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient's perspective. Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider

  2. Rate and Risk Factors for Periprosthetic Joint Infection Among 36,494 Primary Total Hip Arthroplasties.

    Science.gov (United States)

    Triantafyllopoulos, Georgios K; Soranoglou, Vasileios G; Memtsoudis, Stavros G; Sculco, Thomas P; Poultsides, Lazaros A

    2018-04-01

    As periprosthetic joint infections (PJIs) can have tremendous health and socioeconomic implications, recognizing patients at risk before surgery is of great importance. Therefore, we sought to determine the rate of and risk factors for deep PJI in patients undergoing primary total hip arthroplasty (THA). Clinical characteristics of patients treated with primary THA between January 1999 and December 2013 were retrospectively reviewed. These included patient demographics, comorbidities (including the Charlson/Deyo comorbidity index), length of stay, primary diagnosis, total/allogeneic transfusion rate, and in-hospital complications, which were grouped into local and systemic (minor and major). We determined the overall deep PJI rate, as well as the rates for early-onset (occurring within 2 years after index surgery) and late-onset PJI (occurring more than 2 years after surgery). A Cox proportional hazards regression model was constructed to identify risk factors for developing deep PJI. Significance level was set at 0.05. A deep PJI developed in 154 of 36,494 primary THAs (0.4%) during the study period. Early onset PJI was found in 122 patients (0.3%), whereas late PJI occurred in 32 patients (0.1%). Obesity, coronary artery disease, and pulmonary hypertension were identified as independent risk factors for deep PJI after primary THA. The rate of deep PJIs of the hip is relatively low, with the majority occurring within 2 years after THA. If the optimization of modifiable risk factors before THA can reduce the rate of this complication remains unknown, but should be attempted as part of good practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Multiple Primary LED Lamp Colour Controller with Inherent Brightness Limitation

    NARCIS (Netherlands)

    Barcena, R.; Ackermann, B.

    2007-01-01

    There is a strong interest in using LEDs for general illumination due to the potential they offer for energy saving, environmental friendliness, new opportunities in lighting design, and control of the intensity, colour, and spatial distribution of light. General illumination requires primarily

  4. Primary antiphospholipid syndrome: absence of premature atherosclerosis in patients without traditional coronary artery disease risk factors.

    Science.gov (United States)

    Andrade, D; Bortolotto, L; Bonfá, E; Borba, E

    2016-04-01

    To investigate if patients with Primary Antiphospholipid Syndrome (PAPS) with venous and/or arterial thrombosis without traditional coronary artery disease (CAD) risk factors develop early atherosclerotic vascular damage. 27 female patients with PAPS (Sidney criteria) and 27 age, body mass index (BMI), and sex matched controls were consecutively selected. Exclusion criteria were: black race, age ≥55 years, traditional cardiovascular risk factors, other thrombophilias or connective tissue diseases, corticosteroids use and pregnancy. All subjects underwent Pulse Wave Velocity (PWV) and Echo-Tracking (ET), both in carotidal bed, to analyse vascular functional properties. Age (p = 0.92) and BMI (p = 0.91) were comparable in both groups. PAPS patients and controls had similar PWV (9.07 ± 1.08 m/s vs 9.42 ± 1.47 m/s, p = 0.34) as well as echo tracking parameters such as intima-media thickness (683 ± 171 µm vs 636 ± 140 µm, p = 0.52), carotideal diameter (p = 0.26), distensibility (p = 0.92), compliance coefficients (p = 0.36) and elastic modulus (p = 0.78). Patients with exclusively venous thrombosis showed lower PWV than patients with arterial thrombosis (8.55 ± 0.70 m/s vs 9.56 ± 0.94 m/s, p = 0.01), but no difference regarding intima-media thickness (683 ± 171 µm vs 636 ± 140 µm, p = 0.52) was observed. Patients with PAPS do not seem to be at higher risk of developing premature atherosclerosis. Patients who suffered exclusively venous thrombosis seem to be at lower risk than those with exclusively arterial events. Other studies need to confirm our findings. © The Author(s) 2015.

  5. The prevalence and risk factors of stunting among primary school children in North Sumatera, Indonesia

    Science.gov (United States)

    Lestari, S.; Fujiati, I. I.; Keumalasari, D.; Daulay, M.

    2018-03-01

    Stunting in primary school-aged children is a kind of health and nutrition problem in Indonesia which has an impact on the human quality resources degradation. This research aimed to determine the stunting prevalence and the risk factors associated with stunting in primary school children in North Sumatra Province. This research is an analysis of cross-sectional approach. The total sampleis 400 children aged 8-13 years old were in the study from the Medan city and Langkat regency in July - October 2017. Data collected by using questionnaire and anthropometric assessment. Stunting (<-2 SD of height-for-age Z-score) were defined by using the World Health Organization reference 2007. Chi-square analysis and logistic regression were used toassess the association between risk factors and stunting. The prevalence of stunting in primary school children was 38.87%. The factors associated with stunting school children were theeducation of mother (OR=1.53), income (OR=2.27), work of mother (OR=1.39), energy intake (OR=2.66) and protein intake (OR=2.02). The dominant factor that influences stunting in school children was energy intake. The conclusion of this study is stunting prevalence in school children in NorthSumatra higher.

  6. Risk factors for revision of primary total hip arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Prokopetz Julian JZ

    2012-12-01

    Full Text Available Abstract Background Numerous papers have been published examining risk factors for revision of primary total hip arthroplasty (THA, but there have been no comprehensive systematic literature reviews that summarize the most recent findings across a broad range of potential predictors. Methods We performed a PubMed search for papers published between January, 2000 and November, 2010 that provided data on risk factors for revision of primary THA. We collected data on revision for any reason, as well as on revision for aseptic loosening, infection, or dislocation. For each risk factor that was examined in at least three papers, we summarize the number and direction of statistically significant associations reported. Results Eighty-six papers were included in our review. Factors found to be associated with revision included younger age, greater comorbidity, a diagnosis of avascular necrosis (AVN as compared to osteoarthritis (OA, low surgeon volume, and larger femoral head size. Male sex was associated with revision due to aseptic loosening and infection. Longer operating time was associated with revision due to infection. Smaller femoral head size was associated with revision due to dislocation. Conclusions This systematic review of literature published between 2000 and 2010 identified a range of demographic, clinical, surgical, implant, and provider variables associated with the risk of revision following primary THA. These findings can inform discussions between surgeons and patients relating to the risks and benefits of undergoing total hip arthroplasty.

  7. Clinical Outcome in Gamma Knife Radiosurgery for Metastatic Brain Tumors from the Primary Breast Cancer : Prognostic Factors in Local Treatment Failure and Survival

    OpenAIRE

    Choi, Seung Won; Kwon, Do Hoon; Kim, Chang Jin

    2013-01-01

    Objective Brain metastases in primary breast cancer patients are considerable sources of morbidity and mortality. Gamma knife radiosurgery (GKRS) has gained popularity as an up-front therapy in treating such metastases over traditional radiation therapy due to better neurocognitive function preservation. The aim of this study was to clarify the prognostic factors for local tumor control and survival in radiosurgery for brain metastases from primary breast cancer. Methods From March 2001 to Ma...

  8. Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors.

    Science.gov (United States)

    van Dongen, Jerôme Jean Jacques; Lenzen, Stephanie Anna; van Bokhoven, Marloes Amantia; Daniëls, Ramon; van der Weijden, Trudy; Beurskens, Anna

    2016-05-28

    The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding interprofessional collaboration related to care plan development in primary care. A qualitative study, including four semi-structured focus group interviews (n = 4). In total, a heterogeneous group of experts (n = 16) and health care professionals (n = 15) participated. Participants discussed viewpoints, barriers, and facilitators regarding interprofessional collaboration related to care plan development. The data were analysed by means of inductive content analysis. The findings show a variety of factors influencing the interprofessional collaboration in developing a care plan. Factors can be divided into 5 key categories: (1) patient-related factors: active role, self-management, goals and wishes, membership of the team; (2) professional-related factors: individual competences, domain thinking, motivation; (3) interpersonal factors: language differences, knowing each other, trust and respect, and motivation; (4) organisational factors: structure, composition, time, shared vision, leadership and administrative support; and (5) external factors: education, culture, hierarchy, domain thinking, law and regulations, finance, technology and ICT. Improving interprofessional collaboration regarding care plan development calls for an integral approach including patient- and professional related factors, interpersonal, organisational, and external factors. Further, the leader of the team seems to play a key role in watching the patient perspective, organising and coordinating interprofessional collaborations, and guiding the team through developments. The results of this study can be used as input for developing tools and interventions targeted at executing and improving interprofessional

  9. Primary drug-resistant tuberculosis in Hanoi, Viet Nam: present status and risk factors.

    Directory of Open Access Journals (Sweden)

    Nguyen Thi Le Hang

    Full Text Available INTRODUCTION: Resistance of Mycobacterium tuberculosis (MTB to anti-tuberculosis (TB drugs presents a serious challenge to TB control worldwide. We investigated the status of drug resistance, including multidrug-resistant (MDR TB, and possible risk factors among newly diagnosed TB patients in Hanoi, the capital of Viet Nam. METHODS: Clinical and epidemiological information was collected from 506 newly diagnosed patients with sputum smear- and culture-positive TB, and 489 (96.6% MTB isolates were subjected to conventional drug susceptibility testing, spoligotyping, and 15-locus variable numbers of tandem repeats typing. Adjusted odds ratios (aORs were calculated to analyze the risk factors for primary drug resistance. RESULTS: Of 489 isolates, 298 (60.9% were sensitive to all drugs tested. Resistance to isoniazid, rifampicin, streptomycin, ethambutol, and MDR accounted for 28.2%, 4.9%, 28.2%, 2.9%, and 4.5%, respectively. Of 24 isolates with rifampicin resistance, 22 (91.7% were MDR and also resistant to streptomycin, except one case. Factors associated with isoniazid resistance included living in old urban areas, presence of the Beijing genotype, and clustered strains [aOR = 2.23, 95% confidence interval (CI 1.15-4.35; 1.91, 1.18-3.10; and 1.69, 1.06-2.69, respectively. The Beijing genotype was also associated with streptomycin resistance (aOR = 2.10, 95% CI 1.29-3.40. Human immunodeficiency virus (HIV coinfection was associated with rifampicin resistance and MDR (aOR = 5.42, 95% CI 2.07-14.14; 6.23, 2.34-16.58, respectively. CONCLUSION: Isoniazid and streptomycin resistance was observed in more than a quarter of TB patients without treatment history in Hanoi. Transmission of isoniazid-resistant TB among younger people should be carefully monitored in urban areas, where Beijing strains and HIV coinfection are prevalent. Choosing an optimal treatment regimen on the basis of the results of drug susceptibility tests and monitoring of treatment

  10. Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: Analysis of prognostic factors

    Science.gov (United States)

    Kwon, Jong-Bum; Park, Khun; Kim, Young-Du; Seo, Jong-Hee; Moon, Seok-Whan; Cho, Deog-Gon; Kim, Yong-Whan; Kim, Dong-Goo; Yoon, Seung-Kew; Lim, Hyeon-Woo

    2008-01-01

    AIM: To review the surgical outcomes in terms of the surgical indications and relevant prognostic factors. METHODS: Sixteen patients underwent therapeutic lung surgery between March 1999 and May 2006. The observation period was terminated on May 31, 2007. The surgical outcomes and the clinicopathological factors were compared. RESULTS: There was no mortality or major morbidity encountered in this study. The mean follow-up period after metastasectomy was 26.7 ± 28.2 (range: 1-99 mo), and the median survival time was 20 mo. The 1- and 5-year survival rates were 56% and 26%, respectively. At the end of the follow-up, 1 patient died from hepatic failure without recurrence, 6 died from hepatic failure with a recurrent hepatocellular carcinoma (HCC), and 4 died from recurrent HCC with cachexia. Among several clinical factors, Kaplan-Meier analysis revealed that liver transplantation as a treatment for the primary lesion, grade of cell differentiation, and negative evidence HBV infection were independent predictive factors. On Cox’s proportional hazard model, there were no significant factors affecting survival after pulmonary metastasectomy in patients with HCC. CONCLUSION: A metastasectomy should be performed before other treatments in selected patients. Although not significant, patients with liver transplantation of a primary HCC survived longer. Liver transplantation might be the most beneficial modality that can offer patients better survival. A multi-institutional and collaborative study would be needed for identifying clinical prognostic factors predicting survival in patients with HCC and lung metastasis. PMID:18837090

  11. Selection of unusual actinomycetal primary sigma70 factors by plant-colonizing Frankia strains.

    Science.gov (United States)

    Lavire, Céline; Blaha, Didier; Cournoyer, Benoit

    2004-02-01

    Functional adaptations of sigma70 transcriptional factors led to the emergence of several paralogous lineages, each one being specialized for gene transcription under particular growth conditions. Screening of a Frankia strain EaI-12 gene library by sigma70 DNA probing allowed the detection and characterization of a novel actinomycetal primary (housekeeping) sigma70 factor. Phylogenetic analysis positioned this factor in the RpoD cluster of proteobacterial and low-G+C-content gram-positive factors, a cluster previously free of any actinobacterial sequences. sigma70 DNA probing of Frankia total DNA blots and PCR screening detected one or two rpoD-like DNA regions per species. rpoD matched the conserved region in all of the species tested. The other region was found to contain sigA, an alternative primary factor. sigA appeared to be strictly distributed among Frankia species infecting plants by the root hair infection process. Both genes were transcribed by Frankia strain ACN14a grown in liquid cultures. The molecular phylogeny of the sigma70 family determined with Frankia sequences showed that the alternative actinomycetal factors and the essential ones belonged to the same radiation. At least seven distinct paralogous lineages were observed among this radiation, and gene transfers were detected in the HrdB actinomycetal lineage.

  12. An explorative study of factors contributing to the job satisfaction of primary care midwives.

    Science.gov (United States)

    Warmelink, J Catja; Hoijtink, Kirsten; Noppers, Marloes; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K

    2015-04-01

    the main objectives of our study was to gain an understanding of how primary care midwives in the Netherlands feel about their work and to identify factors associated with primary care midwives׳ job satisfaction and areas for improvement. a qualitative analysis was used, based on the constructivist/interpretative paradigm. Three open-ended questions in written or online questionnaire, analysed to identify factors that are linked with job satisfaction, were as follows: 'What are you very satisfied with, in your work as a midwife?', 'What would you most like to change about your work as a midwife?' and 'What could be improved in your work?'. 20 of the 519 primary care practices in the Netherlands in May 2010 were included. at these participating practices 99 of 108 midwives returned a written or online questionnaire. in general, most of the participating primary care midwives were satisfied with their job. The factors positively associated with their job satisfaction were their direct contact with clients, the supportive co-operation and teamwork with immediate colleagues, the organisation of and innovation within their practice group and the independence, autonomy, freedom, variety and opportunities that they experienced in their work. Regarding improvements, the midwives desired a reduction in non-client-related activities, such as paperwork and meetings. They wanted a lower level of work pressure, and a reduced case-load in order to have more time to devote to individual clients׳ needs. Participants identified that co-operation with other partners in the health care system could also be improved. our knowledge, our study is the first explorative study on factors associated with job satisfaction of primary care midwives. While there are several studies on job satisfaction in health care; little is known about the working conditions of midwives in primary care settings. Although the participating primary care midwives in the Netherlands were satisfied with their

  13. Factors associated with anemia among Sri Lankan primary school children in rural North Central Province.

    Science.gov (United States)

    Amarasinghe, Gayani Shashikala; Naottunna, Naotunna Palliya Guruge Chamidri Randika; Agampodi, Thilini Chanchala; Agampodi, Suneth Buddhika

    2017-03-27

    Despite interventions, childhood anemia is still a major public health problem in low and middle income countries. Purpose of the present study is to determine factors associated with anemia among rural primary school children in Sri Lanka, a country undergoing rapid socioeconomic changes. Multi stage cluster sampling was used to select 100 rural schools in NCP and a maximum of 50 children aged 60-131 months were enrolled from each school. Self-administered questionnaires were sent to parents. Anthropometric measurements and blood samples were obtained by trained investigators. Blood reports were analyzed in a commercial laboratory with external quality control measures. Total of 4412 children were included in the analysis. A Multiple regression was performed for hemoglobin. Only 4.2% of the change in hemoglobin could be explained by the model. District (p > 0.001), age (p > 0.001), timing of warm treatment(p = 0.026) and BMI for age (p = 0.002) uniquely contributed 1.12%, 1.19%, 0.13% and 0.26% to change in hemoglobin level respectively whereas, sex, monthly family income and frequency of meat and green leaf consumption didn't contribute significantly. Peripheral blood film analyses were available for 146 anemic children. Blood film was reported as normal in 19.9% while evidence of iron deficiency (18.5%), early iron deficiency (32.5%) and thalassemia trait with iron deficiency (29.5%) were reported in the rest. Serum ferritin level was available for 417 children with hemoglobin less than 12 g/dl. Mean ferritin level was 63.7 microgram/l. Only 0.5% had depleted iron stores. A multiple regression was performed for serum ferritin and R 2 was 0.123 (p nutrition of younger children in Sri Lanka, studying weather behaviors are related to anemia in primary school children is important. Possible etiologies including but not limited to nutritional deficiencies need to be studied further.

  14. Factors influencing the profitability of optimizing control systems

    International Nuclear Information System (INIS)

    Broussaud, A.; Guyot, O.

    1999-01-01

    Optimizing control systems supplement conventional Distributed Control Systems and Programmable Logic Controllers. They continuously implement set points, which aim at maximizing the profitability of plant operation. They are becoming an integral part of modern mineral processing plants. This trend is justified by economic considerations, optimizing control being among the most cost-effective methods of improving metallurgical plant performance. The paper successively analyzes three sets of factors, which influence the profitability of optimizing control systems, and provides guidelines for analyzing the potential value of an optimizing control system at a given operation: external factors, such as economic factors and factors related to plant feed; features of the optimizing control system; and subsequent maintenance of the optimizing control system. It is shown that pay back times for optimization control projects are typically measured in days. The OCS software used by the authors for their applications is described briefly. (author)

  15. Continuous Trailing-Edge Flaps for Primary Flight Control of a Helicopter Main Rotor

    Science.gov (United States)

    Thornburgh, Robert P.; Kreshock, Andrew R.; Wilbur, Matthew L.; Sekula, Martin K.; Shen, Jinwei

    2014-01-01

    The use of continuous trailing-edge flaps (CTEFs) for primary flight control of a helicopter main rotor is studied. A practical, optimized bimorph design with Macro-Fiber Composite actuators is developed for CTEF control, and a coupled structures and computational fluid dynamics methodology is used to study the fundamental behavior of an airfoil with CTEFs. These results are used within a comprehensive rotorcraft analysis model to study the control authority requirements of the CTEFs when utilized for primary flight control of a utility class helicopter. A study of the effect of blade root pitch index (RPI) on CTEF control authority is conducted, and the impact of structural and aerodynamic model complexity on the comprehensive analysis results is presented. The results show that primary flight control using CTEFs is promising; however, a more viable option may include the control of blade RPI, as well.

  16. Ovarian metastases resection from extragenital primary sites: outcome and prognostic factor analysis of 147 patients

    International Nuclear Information System (INIS)

    Li, Wenhua; Wang, Huaying; Wang, Jian; LV, Fangfang; Zhu, Xiaodong; Wang, Zhonghua

    2012-01-01

    To explore the outcomes and prognostic factors of ovarian metastasectomy intervention on overall survival from extragenital primary cancer. Patients with ovarian metastases from extragenital primary cancer confirmed by laparotomy surgery and ovarian metastases resection were retrospectively collected in a single institution during an 8-year period. A total of 147 cases were identified and primary tumor sites were colorectal region (49.0%), gastric (40.8%), breast (8.2%), biliary duct (1.4%) and liver (0.7%). The pathological and clinical features were evaluated. Patients’ outcome with different primary tumor sites and predictive factors for overall survival were also investigated by univariate and multivariate analysis. Metachronous ovarian metastasis occurred in 92 (62.6%) and synchronous in 55 (37.4%) patients. Combined metastases occurred in 40 (27.2%). Bilateral metastasis was found in 97 (66%) patients. The median ovarian metastasis tumor size was 9 cm. There were 39 (26.5%) patients with massive ascites ≥ 1000 mL on intraoperative evaluation. With a median follow-up of 48 months, the median OS after ovarian metastasectomy for all patients was 8.2 months (95% CI 7.2-9.3 months). In univariate analyses, there is significant (8.0 months vs. 41.0 months, P = 0.000) difference in OS between patients with gastrointestinal cancer origin from breast origin, and between patients with gastric origin from colorectal origin (7.4 months vs. 8.8 months, P = 0.036). In univariate analyses, synchronous metastases, locally invasion, massive intraoperative ascites (≥ 1000 mL), and combined metastasis, were identified as significant poor prognostic factors. In multivariate analyses combined metastasis (RR, 1.72; 95% CI, 1.09-2.69, P = 0.018), locally invasion (RR, 1.62; 95% CI, 1.03-2.54, P = 0.038) and massive intraoperative ascites (RR, 1.58; 95% CI, 1.02-2.49, P = 0.04) were independent factors for predicting unfavorable overall survival. Ovarian metastases are more

  17. Primary Candida guilliermondii Infection of the Knee in a Patient without Predisposing Factors

    Directory of Open Access Journals (Sweden)

    Gun Woo Lee

    2012-01-01

    Full Text Available Isolated primary candidal infection of joint is extremely rare, with only a few reported cases. It occurs as a result of accidental implantations of fungus during traumatic procedures, such as surgery, and is usually reported in patients with predisposing factors such as immunosuppression, malignancy, and drug abuse. If left untreated, irreversible deformity and pain with severe osteoarticular destruction occur. Thus, early diagnosis and treatment are important. This paper presents a case of 72-year-old man with primary C. guilliermondii infection of knee joint without predisposing factors and previous traumatic procedures, who was misdiagnosed with advanced degenerative osteoarthritis. Our case is the second case of primary C. guilliermondii arthritis of knee to be reported in the English-language literature and the first to be successfully treated with total knee arthroplasty following IV amphotericin B and oral fluconazole. Primary candidal infection of joint is generally asymptomatic or involves only mild pain and swelling in the affected knee. Thus, although the majority of knee joint infections are of a pyogenic or tuberculous origin, if a patient complains of mild pain and swelling in the knee and has mild signs of infection, the possibility of fungal infection should be considered.

  18. Factors Associated with Primary School Teachers' Attitudes Towards the Inclusion of Students with Disabilities.

    Science.gov (United States)

    Vaz, Sharmila; Wilson, Nathan; Falkmer, Marita; Sim, Angela; Scott, Melissa; Cordier, Reinie; Falkmer, Torbjörn

    2015-01-01

    Teachers' attitudes toward inclusion are often based on the practical implementation of inclusive education rather than a specific ideology and understanding of inclusiveness. This study aimed to identify the factors associated with primary school teachers' attitudes towards inclusion of students with all disabilities in regular schools. Seventy four primary school teachers participated in a cross-sectional survey conducted in Western Australia. Teachers' attitudes and efficacy toward integration of students with disabilities were measured using the Opinions Relative to Integration of Students with Disabilities scale and Bandura's Teacher Efficacy scale respectively. Four teacher attributes-age, gender, teaching self-efficacy and training collectively explained 42% of the variability in teachers' attitude toward including students with disabilities. The current study further contributes to the accumulation of knowledge that can unpack the complex pattern of factors that should be considered to promote positive attitudes towards inclusive schools.

  19. Depression screening and management among adolescents in primary care: factors associated with best practice.

    Science.gov (United States)

    Taliaferro, Lindsay A; Hetler, Joel; Edwall, Glenace; Wright, Catherine; Edwards, Anne R; Borowsky, Iris W

    2013-06-01

    To compare depression identification and management perceptions and practices between professions and disciplines in primary care and examine factors that increase the likelihood of administering a standardized depression screening instrument, asking about patients' depressive symptoms, and using best practice when managing depressed adolescents. Data came from an online survey of clinicians in Minnesota (20% response rate). Analyses involved bivariate tests and linear regressions. The analytic sample comprised 260 family medicine physicians, 127 pediatricians, 96 family nurse practitioners, and 54 pediatric nurse practitioners. Overall, few differences emerged between physicians and nurse practitioners or family and pediatric clinicians regarding addressing depression among adolescents. Two factors associated with administering a standardized instrument included having clear protocols for follow-up after depression screening and feeling better prepared to address depression among adolescents. Enhancing clinicians' competence to address depression and developing postscreening protocols could help providers implement universal screening in primary care.

  20. Factors Associated with Primary School Teachers' Attitudes Towards the Inclusion of Students with Disabilities.

    Directory of Open Access Journals (Sweden)

    Sharmila Vaz

    Full Text Available Teachers' attitudes toward inclusion are often based on the practical implementation of inclusive education rather than a specific ideology and understanding of inclusiveness. This study aimed to identify the factors associated with primary school teachers' attitudes towards inclusion of students with all disabilities in regular schools.Seventy four primary school teachers participated in a cross-sectional survey conducted in Western Australia. Teachers' attitudes and efficacy toward integration of students with disabilities were measured using the Opinions Relative to Integration of Students with Disabilities scale and Bandura's Teacher Efficacy scale respectively.Four teacher attributes-age, gender, teaching self-efficacy and training collectively explained 42% of the variability in teachers' attitude toward including students with disabilities.The current study further contributes to the accumulation of knowledge that can unpack the complex pattern of factors that should be considered to promote positive attitudes towards inclusive schools.

  1. Factors Associated with Primary School Teachers’ Attitudes Towards the Inclusion of Students with Disabilities

    Science.gov (United States)

    Vaz, Sharmila; Wilson, Nathan; Falkmer, Marita; Sim, Angela; Scott, Melissa; Cordier, Reinie; Falkmer, Torbjörn

    2015-01-01

    Objective Teachers' attitudes toward inclusion are often based on the practical implementation of inclusive education rather than a specific ideology and understanding of inclusiveness. This study aimed to identify the factors associated with primary school teachers' attitudes towards inclusion of students with all disabilities in regular schools. Method Seventy four primary school teachers participated in a cross-sectional survey conducted in Western Australia. Teachers' attitudes and efficacy toward integration of students with disabilities were measured using the Opinions Relative to Integration of Students with Disabilities scale and Bandura's Teacher Efficacy scale respectively. Results Four teacher attributes—age, gender, teaching self-efficacy and training collectively explained 42% of the variability in teachers' attitude toward including students with disabilities. Conclusion The current study further contributes to the accumulation of knowledge that can unpack the complex pattern of factors that should be considered to promote positive attitudes towards inclusive schools. PMID:26317862

  2. Tumor Necrosis Factor Inhibitor Primary Failure Predicts Decreased Ustekinumab Efficacy in Psoriasis Patients.

    Science.gov (United States)

    Sorensen, Eric P; Fanucci, Kristina A; Saraiya, Ami; Volf, Eva; Au, Shiu-chung; Argobi, Yahya; Mansfield, Ryan; Gottlieb, Alice B

    2015-08-01

    Additional studies are needed to examine the efficacy of ustekinumab in psoriasis patients who have previously been exposed to tumor necrosis factor inhibitors (TNFi). To examine the predictive effect of TNFi primary failure and the number of TNFi exposures on the efficacy of ustekinumab in psoriasis treatment. This retrospective study examined 44 psoriasis patients treated at the Tufts Medical Center Department of Dermatology between January 2008 and July 2014. Patients were selected if they were treated with ustekinumab and had ≥ 1 previous TNFi exposure. The following subgroups were compared: patients with vs without a previous TNFi primary failure, and patients with one vs multiple previous TNFi exposures. The efficacy measure used was the previously validated Simple Measure for Assessing Psoriasis Activity (S-MAPA), which is calculated by the product of the body surface area and physician global assessment. The primary outcome was the percentage improvement S-MAPA from course baseline at week 12 of ustekinumab treatment. Secondary outcomes were the psoriasis clearance, primary failure, and secondary failure rates with ustekinumab treatment. Patients with a previous TNFi primary failure had a significantly lower percentage improvement in S-MAPA score at week 12 of ustekinumab treatment compared with patients without TNFi primary failure (36.2% vs 61.1%, P=.027). Multivariate analysis demonstrated that this relationship was independent of patient demographics and medical comorbidities. Patients with multiple TNFi exposures had a non-statistically significant lower percentage S-MAPA improvement at week 12 (40.5% vs 52.9%, P=.294) of ustekinumab treatment compared with patients with a single TNFi exposure. Among psoriasis patients previously exposed to TNFi, a history of a previous TNFi primary failure predicts a decreased response to ustekinumab independent of patient demographics and medical comorbidities.

  3. Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial.

    Science.gov (United States)

    Yang, Mingxiao; Chen, Xiangzhu; Bo, Linna; Lao, Lixing; Chen, Jiao; Yu, Siyi; Yu, Zheng; Tang, Hongzhi; Yi, Ling; Wu, Xi; Yang, Jie; Liang, Fanrong

    2017-01-01

    Though moxibustion is frequently used to treat primary dysmenorrhea in China, relevant evidence supporting its effectiveness is still scanty. This study was a pragmatic randomized, conventional drug controlled, open-labeled clinical trial. After initial screen, 152 eligible participants were averagely randomized to receive two different treatment strategies: Moxibustion and conventional drugs. Participants and practitioners were not blinded in this study. The duration of each treatment was 3 months. The primary outcome was pain relief measured by the Visual Analogue Scale. The menstrual pain severity was recorded in a menstrual pain diary. 152 eligible patients were included but only 133 of them eventually completed the whole treatment course. The results showed that the menstrual pain intensity in experimental group and control group was reduced from 6.38±1.28 and 6.41±1.29, respectively, at baseline, to 2.54±1.41 and 2.47±1.29 after treatment. The pain reduction was not significantly different between these two groups (P = 0.76), however; the pain intensity was significantly reduced relative to baseline for each group (Ppain-related symptoms. The serum levels of pain mediators, such as PGF2α, OT, vWF, β-EP, PGE2, were significantly improved after treatment in both groups (Ppain, given their treatment effects and economic costs. This study as a pragmatic trial only demonstrates the effectiveness, not the efficacy, of moxibustion for menstrual pain. It can't rule out the effect of psychological factors during treatment process, because no blind procedure or sham control was used due to availability. In clinical practice, moxibustion should be used at the discretion of patients and their physicians. ClinialTrials.gov NCT01972906.

  4. Draft of diagnostic techniques for primary coolant circuit facilities using control computer

    International Nuclear Information System (INIS)

    Suchy, R.; Procka, V.; Murin, V.; Rybarova, D.

    A method is proposed of in-service on-line diagnostics of primary circuit selected parts by means of a control computer. Computer processing will involve the measurements of neutron flux, pressure difference in pumps and in the core, and the vibrations of primary circuit mechanical parts. (H.S.)

  5. What should primary health care practitioners know about factors influencing young people’s food choices?

    OpenAIRE

    Louise Holmberg; John Coveney; Julie Henderson; Samantha Meyer

    2010-01-01

    BackgroundTo identify factors that determine the nature and extent ofyoung consumers trust in food; sources of information whichinfluence young consumer food choices; and how trustimpacts on young people’s food choices.MethodIn-depth qualitative research interviews were conducted withyoung women and men, who are the primary food purchasersin their household (n=8)ResultsFood choices of young adults were generally determined bycost and convenience. The overall perception was thatAustralian food...

  6. Factor structure and measurement invariance across various demographic groups and over time for the PHQ-9 in primary care patients in Spain.

    Directory of Open Access Journals (Sweden)

    César González-Blanch

    Full Text Available The Patient Health Questionnaire (PHQ-9 is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demographic groups (i.e., gender, age, marital status, level of education, and employment situation and over time. Both one-factor and two-factor re-specified models met all the pre-established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86, the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting.

  7. Factors controlling superelastic damping capacity of SMAs

    Czech Academy of Sciences Publication Activity Database

    Heller, Luděk; Šittner, Petr; Pilch, Jan; Landa, Michal

    2009-01-01

    Roč. 18, 5-6 (2009), 603-611 ISSN 1059-9495 Institutional research plan: CEZ:AV0Z10100520; CEZ:AV0Z20760514 Keywords : shape memory alloys * superelastic damping * thermomechanical testing Subject RIV: BM - Solid Matter Physics ; Magnetism Impact factor: 0.592, year: 2009

  8. Integrated real time control of influent pumping station and primary settling tanks at WWTP Eindhoven

    NARCIS (Netherlands)

    van Daal-Rombouts, P.M.M.; de Jonge, J; Langeveld, J.G.; Clemens, F.H.L.R.

    2016-01-01

    This research deals with the design and implementation of an integrated control for the WWTP of Eindhoven. The control influences the operation of the primary settling tanks and influent pumping station to reduce reduce ammonia peaks in the WWTP effluent. The control takes into account the treatment

  9. Primary screen for potential sheep scab control agents.

    Science.gov (United States)

    Dunn, J A; Prickett, J C; Collins, D A; Weaver, R J

    2016-07-15

    The efficacy of potential acaricidal agents were assessed against the sheep scab mite Psoroptes ovis using a series of in vitro assays in modified test arenas designed initially to maintain P. ovis off-host. The mortality effects of 45 control agents, including essential oils, detergents, desiccants, growth regulators, lipid synthesis inhibitors, nerve action/energy metabolism disruptors and ecdysteroids were assessed against adults and nymphs. The most effective candidates were the desiccants (diatomaceous earth, nanoclay and sorex), the growth regulators (buprofezin, hexythiazox and teflubenzuron), the lipid synthesis inhibitors (spirodiclofen, spirotetramat and spiromesifen) and the nerve action and energy metabolism inhibitors (fenpyroximate, spinosad, tolfenpyrad, and chlorantraniliprole). Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  10. Analysis of the correlative factors for velopharyngeal closure of patients with cleft palate after primary repair.

    Science.gov (United States)

    Chen, Qi; Li, Yang; Shi, Bing; Yin, Heng; Zheng, Guang-Ning; Zheng, Qian

    2013-12-01

    The objective of this study was to analyze the correlative factors for velopharyngeal closure of patients with cleft palate after primary repair. Ninety-five nonsyndromic patients with cleft palate were enrolled. Two surgical techniques were applied in the patients: simple palatoplasty and combined palatoplasty with pharyngoplasty. All patients were assessed 6 months after the operation. The postoperative velopharyngeal closure (VPC) rate was compared by χ(2) test and the correlative factors were analyzed with logistic regression model. The postoperative VPC rate of young patients was higher than that of old patients, the group with incomplete cleft palate was higher than the group with complete cleft palate, and combined palatoplasty with pharyngoplasty was higher than simple palatoplasty. Operative age, cleft type, and surgical technique were the contributing factors for postoperative VPC rate. Operative age, cleft type, and surgical technique were significant factors influencing postoperative VPC rate of patients with cleft palate. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Head Lice Infestation (Pediculosis and Associated Factors among Primary School Girls in Sirik County, Southern Iran

    Directory of Open Access Journals (Sweden)

    Alireza Sanei-Dehkordi

    2017-12-01

    Full Text Available Background Head lice infestation (pediculosis is a serious health problem that can cause a high level of anxiety and psychological frustration, especially in developing countries.Socio-demographic factors are important determinants of the occurrence of head lice infestation. This study aimed to determine the head lice infestations and the factors affecting the rate of infestationin primary school girls.   Materials and Methods In this cross-sectional study, a total of 358 school girls from two urban and three rural primary school girls in Sirik County, Southern Iran, were randomly selected. For the diagnosis of head lice infestation, students were examined carefully by visual inspection of the scalp and hair for the presence of lice. Self-administered questionnaire was used to collect data on socio-demographic and associated factors of head lice infestation. SPSS version 21.0 was used to analyze the data. Results The prevalence of head lice infestation among primary school girls was 56.15%. There were significant associations between head lice infestation and age (p

  12. Impact of socioeconomic factors on nutritional status in primary school children

    International Nuclear Information System (INIS)

    Babar, N.F.; Khan, M.A.

    2010-01-01

    Child malnutrition is a major public health and development concern in most of the poor communities leading to high morbidity and mortality. Various studies have highlighted the factors involved. The present study focuses on socioeconomic inequality resulting in malnutrition. Objectives of the Study were to find the Impact of socio-economic factors on nutritional status in primary school children. Methods: It was a cross sectional survey conducted at Lahore from February to August 2005 among primary schools from public and private sectors to assess the nutritional status of primary school going children age 5-11 years belonging to different socio economic classes of the society. Systematic random sampling technique was applied to collect the sample. Body Mass Index in relation to NHANES reference population was used for assessing nutritional status. Results: The nutritional status of children from lower socio economic class was poor as compared to their counter parts in upper socio economic class. Children with BMI <5 percentile were 41% in lower class while in upper class it was 19.28%. Prevalence of malnutrition was 42.3% among children of illiterate mothers as compare to 20% in those of literate mothers. Conclusion: Poverty, low literacy rate, large families, food insecurity, food safety, women's education appears to be the important underlying factors responsible for poor health status of children from low socioeconomic class. It requires economic, political and social changes as well as changes for personal advancement mainly through educational opportunities to improve the nutritional status of the children. (author)

  13. Impact of socioeconomic factors on nutritional status in primary school children.

    Science.gov (United States)

    Babar, Nabeela Fazal; Muzaffar, Rizwana; Khan, Muhammad Athar; Imdad, Seema

    2010-01-01

    Child malnutrition is a major public health and development concern in most of the poor communities leading to high morbidity and mortality. Various studies have highlighted the factors involved. The present study focuses on socioeconomic inequality resulting in malnutrition. Objectives of the Study were to find the Impact of socio-economic factors on nutritional status in primary school children. It was a cross sectional survey conducted at Lahore from February to August 2005 among primary schools from public and private sectors to assess the nutritional status of primary school going children age 5-11 years belonging to different socio economic classes of the society. Systematic random sampling technique was applied to collect the sample. Body Mass Index in relation to NHANES reference population was used for assessing nutritional status. The nutritional status of children from lower socio economic class was poor as compared to their counter parts in upper socio economic class. Children with BMI children of illiterate mothers as compare to 20% in those of literate mothers. Poverty, low literacy rate, large families, food insecurity, food safety, women's education appears to be the important underlying factors responsible for poor health status of children from low socioeconomic class. It requires economic, political and social changes as well as changes for personal advancement mainly through educational opportunities to improve the nutritional status of the children.

  14. Factors influencing the adoption, implementation, and continuation of physical activity interventions in primary health care: A Delphi study

    NARCIS (Netherlands)

    Huijg, J.M.; Crone, M.R.; Verheijden, M.W.; Zouwe, N. van der; Middelkoop, B.J.; Gebhardt, W.A.

    2013-01-01

    Background: The introduction of efficacious physical activity interventions in primary health care is a complex process. Understanding factors influencing the process can enhance the development of effective introduction strategies. This Delphi study aimed to identify factors most relevant for the

  15. Factors Related to the Glycemic Control in Lithuanian Adolescents with Type 1 Diabetes Mellitus

    OpenAIRE

    Kassem, Salem

    2017-01-01

    1) Adolescent female patients with type 1 diabetes mellitus have better glycemic control and higher levels of diabetes distress than male patients. 2) Parents of adolescents using insulin pumps experience higher diabetes distress than parents of adolescents using multiple daily injections. 3) No differences in diabetes-related factors, emotional state, diabetes-related distress (in adolescent patients and in their primary care-givers) and social factors in groups of adolescent patients ...

  16. HUMAN FACTORS GUIDANCE FOR CONTROL ROOM EVALUATION

    International Nuclear Information System (INIS)

    OHARA, J.; BROWN, W.; STUBLER, W.; HIGGINS, J.; WACHTEL, J.; PERSENSKY, J.J.

    2000-01-01

    The Human-System Interface Design Review Guideline (NUREG-0700, Revision 1) was developed by the US Nuclear Regulatory Commission (NRC) to provide human factors guidance as a basis for the review of advanced human-system interface technologies. The guidance consists of three components: design review procedures, human factors engineering guidelines, and a software application to provide design review support called the ''Design Review Guideline.'' Since it was published in June 1996, Rev. 1 to NUREG-0700 has been used successfully by NRC staff, contractors and nuclear industry organizations, as well as by interested organizations outside the nuclear industry. The NRC has committed to the periodic update and improvement of the guidance to ensure that it remains a state-of-the-art design evaluation tool in the face of emerging and rapidly changing technology. This paper addresses the current research to update of NUREG-0700 based on the substantial work that has taken place since the publication of Revision 1

  17. Factors Affecting Sustainable Animal Trypanosomosis Control in ...

    African Journals Online (AJOL)

    trypanosomiasis control in parts of Kaduna State within the sub- humid savannah ... livestock farmers in planning and implementation. Across ... help to ensure a better management of livestock in tsetse fly infested areas with minimal loses in .... market and administered by them. This drug ... Table 2 shows the analysis of.

  18. What factors control dimerization of coniferyl alcohol?

    Science.gov (United States)

    Carl J. Houtman

    1999-01-01

    Data suggest that the dimerization of coniferyl alcohol is not under thermodynamic control. In this study, molecular dynamics calculations were used to estimate the effect of the solvent environment. In water, the coniferyl alcohol radicals were forced to associate by the formation of a solvent cage. In glycerol, the solvent cage effect appeared to be absent. These...

  19. Soft-Starting Power-Factor Motor Controller

    Science.gov (United States)

    Nola, F. J.

    1983-01-01

    Three-phase power-factor controller with soft start is based on earlier version that does not control starting transients. Additional components serve to turn off "run" command signal and substitute gradual startup command signal during preset startup interval. Improved controller reduces large current surge that usually accompanies starting. Controller applies power smoothly, without causing motor vibrations.

  20. Human factors methods for nuclear control room design. Volume I. Human factors enhancement of existing nuclear control rooms. Final report

    International Nuclear Information System (INIS)

    Seminara, J.L.; Seidenstein, S.; Eckert, S.K.; Smith, D.L.

    1979-11-01

    Human factors engineering is an interdisciplinary specialty concerned with influencing the design of equipment systems, facilities, and operational environments to promote safe, efficient, and reliable operator performance. Human factors approaches were applied in the design of representative nuclear power plant control panels. First, methods for upgrading existing operational control panels were examined. Then, based on detailed human factors analyses of operator information and control requirements, designs of reactor, feedwater, and turbine-generator control panels were developed to improve the operator-control board interface, thereby reducing the potential for operator errors. In addition to examining present-generation concepts, human factors aspects of advanced systems and of hybrid combinations of advanced and conventional designs were investigated. Special attention was given to warning system designs. Also, a survey was conducted among control board designers to (1) develop an overview of design practices in the industry, and (2) establish appropriate measures leading to a more systematic concern for human factors in control board design

  1. Factors influencing primary health care professionals' physical activity promotion behaviors: a systematic review.

    Science.gov (United States)

    Huijg, Johanna M; Gebhardt, Winifred A; Verheijden, Marieke W; van der Zouwe, Nicolette; de Vries, Juriena D; Middelkoop, Barend J C; Crone, Mathilde R

    2015-02-01

    Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired. To help understand why efficacious PHC-based PA interventions are not effectively translated to practice, this study systematically reviewed the literature on factors influencing PHC professionals' PA promotion practices. Literature searches were conducted in Web of Science, PubMed, and PsycINFO for peer-reviewed articles published in English from 1990 onwards. Studies were included that met the following criteria: (1) involving PHC-based PA interventions, and (2) reporting factors influencing PHC professionals' PA promotion behaviors. Two researchers independently screened studies and extracted data. A narrative synthesis using thematic analysis was conducted to identify factors. Of the 4,469 identified articles, 59 were included in the review. Factors were identified by qualitative methods, barrier/facilitator ratings, and the examination of the relationship between factors and PA promotion, and the effectiveness of introduction strategies. Many factors related to the development, delivery, and effects of the innovation, the sociopolitical and organizational culture, resources, and support, patient and PHC professional characteristics, and innovation strategies were identified as potential influences on PHC professionals' PA promotion practices. However, the lack of evidence on the relationship between factors and PA promotion indicated insufficient evidence on PA promotion determinants. This extensive overview of potential factors can inform intervention developers and implementers on which factors may play a role when introducing PA interventions in PHC. Future research should further investigate relationships between factors and PA promotion, which should be guided by qualitative in-depth knowledge on influencing factors.

  2. Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient.

    Science.gov (United States)

    Tabenkin, Hava; Eaton, Charles B; Roberts, Mary B; Parker, Donna R; McMurray, Jerome H; Borkan, Jeffrey

    2010-01-01

    The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England. Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12-4.40) and obesity (OR = 2.14; 95% CI, 1.30-3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30-3.18) and diabetes (OR = 6.55; 95% CI, 2.01-21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25-0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22-0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15-0.58). Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient.

  3. Prevalence and Risk Factors of Voice Problems Among Primary School Teachers in India.

    Science.gov (United States)

    Devadas, Usha; Bellur, Rajashekhar; Maruthy, Santosh

    2017-01-01

    Teachers are more prone to develop voice problems (VPs) when compared with other professional voice users. The aim of present study was to investigate the prevalence and risk factors of VPs among primary school teachers in India. Epidemiological cross-sectional survey. Self-reporting questionnaire data were collected from 1082 teachers. Out of 1082 teachers who participated in the present study, 188 teachers reported VPs that account for a prevalence rate of 17.4%. Tired voice after long hours of talking was the most frequently reported symptom, followed by sore/dry throat, strain in voice, neck muscle tension, and difficulty in projecting voice. The adjusted odds ratio values showed number of years of teaching, high background noise levels in the classroom, experiencing psychological stress while teaching classes, improper breath management (holding breath while speaking), poor focus of the tone (clenching jaw/teeth while speaking), upper respiratory tract infection, thyroid problems, and acid reflux as significant risk factors for the development of VPs in the current cohort of teachers. Current results suggest that teachers develop VPs due to multiple risk factors. These factors may be either biological, psychomotor, or environment-related factors. A holistic approach (which could include educating teachers about voice care during their training, and if they develop VP during their career, then managing the VP by taking into consideration different risk factors) addressing all these factors needs to be adopted to prevent VPs in primary school teachers. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  4. The importance of motivation factors in career development of primary and secondary school professionals

    Directory of Open Access Journals (Sweden)

    Petra Stepišnik

    2017-03-01

    Full Text Available This research examines the career motivation factors among Slovene teachers. They go hand in hand with two other processes: the psycho-social development of individuals and their family life. We present the results of the empirical research that was carried out on a sample of 360 professionals from primary and secondary schools. We established a scale for determining the importance of motivation factors by asking the professionals to grade their level of agreement with the statements considering the following motivational factors: the legislation and the organization of files in the context of school, the organisational climate and culture at schools, the school management, schools as learning organisations, the need of individuals for career development. We were interested if there exist any differences in the opinions of professionals in primary and secondary schools regarding the importance of individual motivation factors. We were also interested if there exists an interdependence between the final results and the individual variables. The findings are important for professionals and school management in schools that encourage career development. It would be sensible to take these findings into consideration when planning, as well as monitoring career development of school professionals.

  5. Occupational low back pain in primary and high school teachers: prevalence and associated factors.

    Science.gov (United States)

    Mohseni Bandpei, Mohammad A; Ehsani, Fatemeh; Behtash, Hamid; Ghanipour, Marziyeh

    2014-01-01

    The purposes of this study were to investigate the prevalence of and risk factors for low back pain (LBP) in teachers and to evaluate the association of individual and occupational characteristics with the prevalence of LBP. In this cross-sectional study, 586 asymptomatic teachers were randomly selected from 22 primary and high schools in Semnan city of Iran. Data on the personal, occupational characteristics, pain intensity, and functional disability as well as the prevalence and risk factors of LBP were collected using different questionnaires. Point, last month, last 6 months, annual, and lifetime prevalence rates of LBP were 21.8%, 26.3%, 29.6%, 31.1%, and 36.5%, respectively. The highest prevalence was obtained for the high school teachers. The prevalence of LBP was significantly associated with age, body mass index, job satisfaction, and length of employment (P teachers appears to be high. High school teachers were more likely to experience LBP than primary school teachers. Factors such as age, body mass index, length of employment, job satisfaction, and work-related activities were significant factors associated with LBP in this teacher population. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  6. Pediculosis capitis among Primary School Children and Related Risk Factors in Urmia, the Main City of West Azarbaijan, Iran.

    Science.gov (United States)

    Tappeh, K Hazrati; Chavshin, Ar; Hajipirloo, H Mohammadzadeh; Khashaveh, S; Hanifian, H; Bozorgomid, A; Mohammadi, M; Gharabag, D Jabbari; Azizi, H

    2012-01-01

    Pediculosis capitis is cosmopolitan health problem. In addition to its physical problems, its psychological effects especially on pupils are more important. This study was conducted to determine the Pediculosis capitis among primary school pupils and also find out the role of probable related risk factors in Urmia city, Iran 2010. 35 primary schools of Urmia City according to the defined clusters randomly have been selected during 2010. 2040 pupils (866 boys and 1174 girls) were included and examined individually and privately by experts. Presence of adult or immature lice or having nits less than 1 cm from the hair basis were defined as positive. Data about demographic features and factors which their effect should be determined were recorded in standard questionnaire. Data were analyzed by SPSS software with proper statistical test. Infestation was determined around 4%. Girls show significantly greater infestation. The availability of suitable warm water for bathing and hair length (separately in girls and boys) are significantly related to infestation load as well as infestation among different age groups. There was no significant relation between parent's education and job and infestation as well as bathing repetition per week and the kind of energy source which they have. Also there is no significant correlation between educational grades and head lice infestation. The head louse pediculosis is a health problem and remains a health threatening for school children.Effective risk factors should be determined carefully and regionally. Proper training plays a great role in order to prevent and control the problem.

  7. Controls of vegetation structure and net primary production in restored grasslands

    Science.gov (United States)

    Munson, Seth M.; Lauenroth, William K.

    2014-01-01

    1. Vegetation structure and net primary production (NPP) are fundamental properties of ecosystems. Understanding how restoration practices following disturbance interact with environmental factors to control these properties can provide insight on how ecosystems recover and guide management efforts. 2. We assessed the relative contribution of environmental and restoration factors in controlling vegetation structure, above- and below-ground investment in production across a chronosequence of semiarid Conservation Reserve Program (CRP) fields recovering from dryland wheat cropping relative to undisturbed grassland. Importantly, we determined the role of plant diversity and how seeding either native or introduced perennial grasses influenced the recovery of vegetation properties. 3. Plant basal cover increased with field age and was highest in CRP fields seeded with native perennial grasses. In contrast, fields seeded with introduced perennial grasses had tall-growing plants with relatively low basal cover. These vegetation structural characteristics interacted with precipitation, but not soil characteristics, to influence above-ground NPP (ANPP). Fields enrolled in the CRP program for >7 years supported twice as much ANPP as undisturbed shortgrass steppe in the first wet year of the study, but all CRP fields converged on a common low amount of ANPP in the following dry year and invested less than half as much as the shortgrass steppe in below-ground biomass. 4. ANPP in CRP fields seeded with native perennial grasses for more than 7 years was positively related to species richness, whereas ANPP in CRP fields seeded with introduced perennial grasses were controlled more by dominant species. 5. Synthesis and applications. Seeding with introduced, instead of native, perennial grasses had a strong direct influence on vegetation structure, including species richness, which indirectly affected NPP through time. However, the effects of restoring either native or introduced

  8. Control of Cellular Morphology by Mechanical Factors

    Science.gov (United States)

    Thoumine, Olivier

    1996-11-01

    This short review deals with the influence of mechanical factors on eucaryotic cell morphology and structure. We classify these factors into two types: i) external forces (e.g. gravitational forces or hemodynamic stresses), which when applied experimentally allow characterization of passive mechanical properties; and ii) internal forces, e.g. generated by molecular motors or polymerization processes. Perturbation of one or more of these forces induces significant changes in cell shape, cytoskeleton and pericellular matrix organization. We describe these phenomena in view of current models. Cette brève revue traite de l'influence des facteurs mécaniques sur la morphologie et la structure des cellules eucaryotes. Nous classifions ces facteurs en deux catégories : i) les forces externes (par exemple les forces de gravitation et les contraintes hèmodynamiques) qui, imposées in vitro, permettent de caractériser les propriétés mécaniques passives ; et ii) les forces internes, par exemple celles générées par les moteurs moléculaires ou les processus de polymérisation. La perturbation de l'une ou de l'autre de ces forces provoque des changements significatifs de la morphologie cellulaire ainsi que l'organisation du cytosquelette et de la matrice péricellulaire. Nous décrivons ces phénomènes en fonction de modèles existants.

  9. Platelet-released growth factors inhibit proliferation of primary keratinocytes in vitro.

    Science.gov (United States)

    Bayer, Andreas; Tohidnezhad, Mersedeh; Berndt, Rouven; Lippross, Sebastian; Behrendt, Peter; Klüter, Tim; Pufe, Thomas; Jahr, Holger; Cremer, Jochen; Rademacher, Franziska; Simanski, Maren; Gläser, Regine; Harder, Jürgen

    2018-01-01

    Autologous thrombocyte concentrate lysates as platelet-released growth factors (PRGF) or Vivostat Platelet Rich Fibrin (PRF ® ) represent important tools in modern wound therapy, especially in the treatment of chronic, hard-to-heal or infected wounds. Nevertheless, underlying cellular and molecular mechanisms of the beneficial clinical effects of a local wound therapy with autologous thrombocyte concentrate lysates are poorly understood. Recently, we have demonstrated that PRGF induces antimicrobial peptides in primary keratinocytes and accelerates keratinocytes' differentiation. In the present study we analyzed the influence of PRGF on primary human keratinocytes' proliferation. Using the molecular proliferation marker Ki-67 we observed a concentration- and time dependent inhibition of Ki-67 gene expression in PRGF treated primary keratinocytes. These effects were independent from the EGFR- and the IL-6-R pathway. Inhibition of primary keratinocytes' proliferation by PRGF treatment was confirmed in colorimetric cell proliferation assays. Together, these data indicate that the clinically observed positive effects of autologous thrombocytes concentrates in the treatment of chronic, hard-to-heal wounds are not based on an increased keratinocytes proliferation. Copyright © 2017 Elsevier GmbH. All rights reserved.

  10. [Analysis of prevalence of self-reported hearing loss and associated factors: primary versus proxy informant].

    Science.gov (United States)

    Quevedo, André Luis Alves de; Leotti, Vanessa Bielefeldt; Goulart, Bárbara Niegia Garcia de

    2017-07-03

    The objective was to evaluate differences between prevalence rates for self-reported hearing loss and associated factors, obtained from responses by primary and proxy informants in a Population-Based Study on Human Communication Disorders (DCH-POP in Portuguese). This was a study on epidemiological methods using data from a cross-sectional household survey with a sample of 1,253 individuals from Southern Brazil. To verify differences between prevalence rates comparing primary informants and proxy informants, we used the chi-square or Fisher's exact test for categorical variables and Mann-Whitney for continuous variables. The log-binomial model was adjusted for hearing loss as the dependent variable, considering three datasets: the entire sample, only primary informants, and only proxy informants, estimating association by prevalence ratios. In the final models, only the independent variables age and dizziness were associated with hearing loss, independently of the dataset that was used. Proxy informants generally underestimated the prevalence rates for the target outcomes, when compared to primary informants.

  11. Factors affecting subspecialty referrals by pediatric primary care providers for children with obesity-related comorbidities.

    Science.gov (United States)

    Walsh, Carolyn O; Milliren, Carly E; Feldman, Henry A; Taveras, Elsie M

    2013-08-01

    To determine referral patterns from pediatric primary care to subspecialists for overweight/obesity and related comorbidities. We used the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to identify overweight/obesity and 5 related comorbidities in primary care visits between 2005 and 2009 by children 6 to 18 years. The primary outcome was whether the visit ended in referral. We used multivariable analysis to examine factors associated with referral. We identified 34,225 database visits. A total of 17.1% were with overweight (body mass index=85th to 94th percentile) or obese (body mass index≥95th percentile) patients. A total of 7.1% of primary care visits with overweight/obese children ended in referral. Referral was more likely when obesity was the reason for visit (odds ratio=2.83; 95% confidence interval=1.61-4.97) but was not associated with presence of a comorbidity (odds ratio=1.35; 95% confidence interval=0.75-2.44). Most overweight or obese children are not referred, regardless of comorbidity status. One reason may be low levels of appropriate diagnosis.

  12. Predictive Factors for Natural Pregnancy after Microsurgical Reconstruction in Patients with Primary Epididymal Obstructive Azoospermia

    Directory of Open Access Journals (Sweden)

    Mihai Harza

    2014-01-01

    Full Text Available Primary epididymal obstructive azoospermia (OA is the most prevalent form of OA in nonvasectomized patients and has been less studied. We aim to assess the results with microsurgical vasoepididymostomy used in the treatment of men diagnosed with primary epididymal obstructive azoospermia and to identify the factors associated with natural pregnancy occurring after microsurgical reconstruction. This prospective study included consecutive patients with epididymal OA who underwent microsurgical reconstruction in our center. Clinical and biological data were obtained every three months during follow-up. Occurrence of natural pregnancy was the primary study outcome. In total, 36 patients underwent microsurgical reconstruction. The mean age was 34±4.5 years (range 24–46 years. Median follow-up time was 15 [IQR 12–21] months. The total patency rate was 77.7% (n=28. During follow-up, 8 (22.2% natural pregnancies occurred. The overall live birth rate was 100%. Low FSH levels (HR: 0.22; 95% CI: 0.052–0.88; P=0.032 and higher total motile sperm count (TMSC (HR: 1.001; 95% CI 1–1.001; P=0.012 were associated with a higher rate of natural pregnancy. Our data suggest that microsurgical vasoepididymostomy is an effective therapy of primary epididymal OA. Baseline lower FSH and higher TMSC were independent predictors for natural pregnancy occurrence.

  13. Predictive factors for natural pregnancy after microsurgical reconstruction in patients with primary epididymal obstructive azoospermia.

    Science.gov (United States)

    Harza, Mihai; Voinea, Sebastian; Ismail, Gener; Gagiu, Cristian; Baston, Catalin; Preda, Adrian; Manea, Ioan; Priporeanu, Tiberiu; Sinescu, Ioanel

    2014-01-01

    Primary epididymal obstructive azoospermia (OA) is the most prevalent form of OA in nonvasectomized patients and has been less studied. We aim to assess the results with microsurgical vasoepididymostomy used in the treatment of men diagnosed with primary epididymal obstructive azoospermia and to identify the factors associated with natural pregnancy occurring after microsurgical reconstruction. This prospective study included consecutive patients with epididymal OA who underwent microsurgical reconstruction in our center. Clinical and biological data were obtained every three months during follow-up. Occurrence of natural pregnancy was the primary study outcome. In total, 36 patients underwent microsurgical reconstruction. The mean age was 34 ± 4.5 years (range 24-46 years). Median follow-up time was 15 [IQR 12-21] months. The total patency rate was 77.7% (n = 28). During follow-up, 8 (22.2%) natural pregnancies occurred. The overall live birth rate was 100%. Low FSH levels (HR: 0.22; 95% CI: 0.052-0.88; P = 0.032) and higher total motile sperm count (TMSC) (HR: 1.001; 95% CI 1-1.001; P = 0.012) were associated with a higher rate of natural pregnancy. Our data suggest that microsurgical vasoepididymostomy is an effective therapy of primary epididymal OA. Baseline lower FSH and higher TMSC were independent predictors for natural pregnancy occurrence.

  14. Role of Anatomic and Salivary Factors in Dental Calculus Formation in Primary and Mixed Dentition Stages.

    Science.gov (United States)

    Afshar, Hossein; Ghandehari, Mehdi; Khorsand, Afshin; Ansari, Ghassem; Nahvi, Azam; Baniameri, Zahra

    2016-01-01

    Clinical experience shows that formation of calculus is a very rare phenomenon in primary teeth, but it increases as the permanent teeth erupt. The purpose of this study was to assess the relationship between dental calculus, dental anatomy, and salivary factors in primary and mixed dentition stages. A cross-sectional study was carried out to determine the buccolingual dimensions of the most concave and the most convex surfaces of the lingual aspect of mandibular central incisor crowns in a sample group of 120 three- to five-old children and 120 eight- to 10-year old children. Saliva samples were collected from 20 in each group. Data were analyzed using t tests. Significant differences were found between the ratio of the buccolingual dimensions of the most convex to the most concave areas of the lingual surfaces in primary and permanent incisors (P=0.028). Saliva analysis revealed significant differences in total protein (P=0.002), sodium (P=0.037), bicarbonate (P=0.003), and ammonia (P=0.025) between the two age groups. Anatomic and salivary factors may be important reasons for the differences in calculus formation.

  15. Factors affecting job satisfaction among primary and secondary school teachers in the autonomous province of Vojvodina

    Directory of Open Access Journals (Sweden)

    Majstorović Nebojša Z.

    2017-01-01

    Full Text Available The study presented in this paper analyses the impact of the individual factors of mental and physical health and life satisfaction, as well as the importance of some organizational factors such as the climate in schools, the composition of classes in the case of class teachers, and certain demographic characteristics on primary and secondary school teachers' job satisfaction. The data were collected from a convenience sample of 176 teachers of primary and secondary schools in Serbia's autonomous province of Vojvodina, of different ages, genders, and years of service. The principal results indicate that job satisfaction is higher among teachers who perceive the climate in their school as positive, among teachers with higher life satisfaction, and among teachers who are in good health and, most importantly, lacking depressive reactions. When it comes to perceptions of the climate, the best predictor of job satisfaction is the degree of respondents' satisfaction with collaboration with colleagues and with decision making processes. The results also indicate that secondary school teachers report a higher level of overall job satisfaction, specifically, a higher level of satisfaction with school governance, co-workers and communication than primary school teachers. As regards demographic characteristics, the results suggest that there are no significant gender differences in job satisfaction levels and that job satisfaction declines with the number of years of service, with respondents who had between 21 and 30 years of service reporting the lowest levels of job satisfaction, which tended to rise towards the end of the teaching career.

  16. Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa

    Science.gov (United States)

    Ojji, Dike B; Ojji, Dike B Ojji; Lamont, Kim; Sliwa, Karen; Ojji, Olubunmi I; Egenti, Bibiana Nonye; Sliwa, Karen

    2017-01-01

    Summary Cardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemic heart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub- Saharan Africa. One major challenge of such an approach is how to equip primary care to respond promptly and effectively to this burden. We present a practical approach on how primary care in sub-Saharan Africa could effectively address the prevention, treatment and control of CVD on the subcontinent. For effective prevention, control and treatment of CVD in sub-Saharan Africa, there should be strategic plans to equip primary care clinics with well-trained allied healthcare workers who are supervised by physicians. PMID:28752890

  17. PWSCC Growth Assessment Model Considering Stress Triaxiality Factor for Primary Alloy 600 Components

    Directory of Open Access Journals (Sweden)

    Jong-Sung Kim

    2016-08-01

    Full Text Available We propose a primary water stress corrosion cracking (PWSCC initiation model of Alloy 600 that considers the stress triaxiality factor to apply to finite element analysis. We investigated the correlation between stress triaxiality effects and PWSCC growth behavior in cold-worked Alloy 600 stream generator tubes, and identified an additional stress triaxiality factor that can be added to Garud's PWSCC initiation model. By applying the proposed PWSCC initiation model considering the stress triaxiality factor, PWSCC growth simulations based on the macroscopic phenomenological damage mechanics approach were carried out on the PWSCC growth tests of various cold-worked Alloy 600 steam generator tubes and compact tension specimens. As a result, PWSCC growth behavior results from the finite element prediction are in good agreement with the experimental results.

  18. Factors of Innate and Adaptive Local Immunity in Children with Primary Deficiencies of Antibody Formation

    Directory of Open Access Journals (Sweden)

    L.I. Chernyshova

    2013-10-01

    Full Text Available In 40 children with various types of primary immunodeficiencies (PID of antibody formation we examined factors of local immunity in saliva. It is found that in the saliva of children with PID of antibody formation in comparison with immunocompetent children the concentration of factors of adaptive immunity is significantly reduced. Lack of adaptive immunity in the PID of antibody formation to some extent is compensated by increased concentrations of innate immune factors on the mucous membranes — the free Sc, as well as lactoferrin in selective immunodeficiency of IgA. At PID of antibody formation we observed increased TNF-α level in the saliva, which may indicate the persistence of local inflammation on the membranes of the respiratory tract.

  19. Primary control of upper gingiva and hard palate squamous cell carcinoma. A clinical evaluation

    International Nuclear Information System (INIS)

    Beppu, Takeshi; Mitani, Hiroki; Kawabata, Kazuyoshi

    2005-01-01

    The primary control of upper gingiva and hard palate squamous cell carcinoma was evaluated clinically. From 1985 to 1999, there were 51 cases that received definitive treatment in our hospital with a primary control rate of 70.6%. The primary control rates according to treatment modality were: 73.3% for surgery alone (69.2% for partial maxillectomy, 80% for total maxillectomy); 71.4% for definitive radiation therapy; and 68% for combined surgery and radiation therapy. The primary control rates according to the T stage were: 85.7% for T1; 60% for T2; 77.8% for T3; and 80% for T4. In general, primary control was better when the tumor was located anteriorly rather than posterolaterally in the oral cavity. Frequent recurrent sites following the operation were the infratemporal fossa and/or the pterygopalatine fossa, especially when the tumor had been located posterolaterally. In such cases, a salvage operation was often impossible, and the uncontrollable primary lesion progressed and caused death. Therefore, when the tumor is located posterolaterally, and especially if it has invaded deeply into the infratemporal fossa and the pterygopalatine fossa, it is vitally important to properly plan the surgical approach and to ensure a good visual operative field. (author)

  20. Temperature Dependence of Factors Controlling Isoprene Emissions

    Science.gov (United States)

    Duncan, Bryan N.; Yoshida, Yasuko; Damon, Megan R.; Douglass, Anne R.; Witte, Jacquelyn C.

    2009-01-01

    We investigated the relationship of variability in the formaldehyde (HCHO) columns measured by the Aura Ozone Monitoring Instrument (OMI) to isoprene emissions in the southeastern United States for 2005-2007. The data show that the inferred, regional-average isoprene emissions varied by about 22% during summer and are well correlated with temperature, which is known to influence emissions. Part of the correlation with temperature is likely associated with other causal factors that are temperature-dependent. We show that the variations in HCHO are convolved with the temperature dependence of surface ozone, which influences isoprene emissions, and the dependence of the HCHO column to mixed layer height as OMI's sensitivity to HCHO increases with altitude. Furthermore, we show that while there is an association of drought with the variation in HCHO, drought in the southeastern U.S. is convolved with temperature.

  1. Occupational and environmental risk factors of adult primary brain cancers: a systematic review.

    Science.gov (United States)

    Gomes, J; Al Zayadi, A; Guzman, A

    2011-04-01

    The incidence of brain neoplasm has been progressively increasing in recent years in the industrialized countries. One of the reasons for this increased incidence could be better access to health care and improved diagnosis in the industrialized countries. It also appears that Caucasians have a higher incidence than blacks or Hispanics or Asians. A number of risk factors have been identified and described including the genetic, ethnic and age-based factors. Certain occupational and environmental factors are also believed to influence the risk of primary adult brain tumors. Potential occupational and environmental factors include exposure to diagnostic and therapeutic radiations, electromagnetic radiation from cellular phones and other wireless devices, infectious agents, air pollution and residence near landfills and high-voltage power lines and jobs as firefighters, farmers, physician, chemists and jobs in industries such as petrochemical, power generation, synthetic rubber manufacturing, agricultural chemicals manufacturing. The purpose of this systematic review is to examine occupational and environmental risk factors of brain neoplasm. A range of occupational and environmental exposures are evaluated for significance of their relationship with adult primary brain tumors. On the basis of this review we suggest a concurrent evaluation of multiple risk factors both within and beyond occupational and environmental domains. The concurrent approach needs to consider better exposure assessment techniques, lifetime occupational exposures, genotypic and phenotypic characteristics and lifestyle and dietary habits. This approach needs to be interdisciplinary with contributions from neurologists, oncologists, epidemiologists and molecular biologists. Conclusive evidence that has eluded multitude of studies with single focus and single exposure needs to multifaceted and multidisciplinary.

  2. Factors associated with student learning processes in primary health care units: a questionnaire study.

    Science.gov (United States)

    Bos, Elisabeth; Alinaghizadeh, Hassan; Saarikoski, Mikko; Kaila, Päivi

    2015-01-01

    Clinical placement plays a key role in education intended to develop nursing and caregiving skills. Studies of nursing students' clinical learning experiences show that these dimensions affect learning processes: (i) supervisory relationship, (ii) pedagogical atmosphere, (iii) management leadership style, (iv) premises of nursing care on the ward, and (v) nursing teachers' roles. Few empirical studies address the probability of an association between these dimensions and factors such as student (a) motivation, (b) satisfaction with clinical placement, and (c) experiences with professional role models. The study aimed to investigate factors associated with the five dimensions in clinical learning environments within primary health care units. The Swedish version of Clinical Learning Environment, Supervision and Teacher, a validated evaluation scale, was administered to 356 graduating nursing students after four or five weeks clinical placement in primary health care units. Response rate was 84%. Multivariate analysis of variance is determined if the five dimensions are associated with factors a, b, and c above. The analysis revealed a statistically significant association with the five dimensions and two factors: students' motivation and experiences with professional role models. The satisfaction factor had a statistically significant association (effect size was high) with all dimensions; this clearly indicates that students experienced satisfaction. These questionnaire results show that a good clinical learning experience constitutes a complex whole (totality) that involves several interacting factors. Supervisory relationship and pedagogical atmosphere particularly influenced students' satisfaction and motivation. These results provide valuable decision-support material for clinical education planning, implementation, and management. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Experimental evaluation of radiator control based on primary supply temperature for district heating substations

    International Nuclear Information System (INIS)

    Gustafsson, Jonas; Delsing, Jerker; Deventer, Jan van

    2011-01-01

    Highlights: → We compared a new radiator system control approach with traditional control. → This is an experimental verification of previous simulation results. → We examine changes in delta-T and indoor comfort. → The indoor comfort were not affected by the introduction of alt. radiator control. → The alternative control method can contribute to an increased delta-T. -- Abstract: In this paper, we evaluate whether the primary supply temperature in district heating networks can be used to control radiator systems in buildings connected to district heating; with the purpose of increasing the ΔT. The primary supply temperature in district heating systems can mostly be described as a function of outdoor temperature; similarly, the radiator supply temperature in houses, offices and industries can also be described as a function of outdoor temperature. To calibrate the radiator control system to produce an ideally optimal radiator supply temperature that produces a maximized ΔT across the substation, the relationship between the primary supply temperature and outdoor temperature must be known. However, even if the relation is known there is always a deviation between the expected primary supply temperature and the actual temperature of the received distribution media. This deviation makes the radiator control system incapable of controlling the radiator supply temperature to a point that would generate a maximized ΔT. Published simulation results show that it is possible and advantageous to utilize the primary supply temperature for radiator system control. In this paper, the simulation results are experimentally verified through implementation of the control method in a real district heating substation. The primary supply temperature is measured by the heat-meter and is shared with the radiator control system; thus no additional temperature sensors were needed to perform the experiments. However additional meters were installed for surveillance purposes

  4. Dealing With A Controllable Risk Factor Like Diet In The ...

    African Journals Online (AJOL)

    Cardiovascular disease (CVD) is a silent killer in Nigeria and many parts of the world. Certain factors increase the risk of CVD. While there are controllable factors that contribute and predispose to the development of CVD like diet, exercise, tobacco use, high blood pressure and obesity, there are uncontrollable factors like ...

  5. Q-factor of coolant flow in the primary circuit of NPP with pressurised water reactors

    International Nuclear Information System (INIS)

    Proskuryakov, K.N.; Belikov, S.O.; Novikov, K.S.

    2011-01-01

    Systems of preoperational vibration dynamic monitoring in of WWER are presented. The results of measurements during commission of NPP with WWER are presented. The paper provides the result of the research, that estimation of coolant fluctuations caused by pulse perturbation of pressure in the primary circuit NPP. It is shown that results could be received at known value of a Q - factor of acoustical oscillatory system only. The research demonstrates the results of dependence of the sound speed from the mass steam content in the coolant flow thru reactor core. The worked out results can be used for identification of the reasons of abnormal growth of level of vibrations of fuel assembly, fuel rod, equipment and internals, and for forecasting the operation conditions which provide of vibration - acoustical resonances in the primary loop equipment. (author)

  6. Primary care specialty career choice among Canadian medical students: Understanding the factors that influence their decisions.

    Science.gov (United States)

    Osborn, Heather Ann; Glicksman, Jordan T; Brandt, Michael G; Doyle, Philip C; Fung, Kevin

    2017-02-01

    To identify which factors influence medical students' decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non-front-line specialties. Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Ontario medical school. An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). The main factors that influenced participants' decision to choose a career in primary care or pediatrics, and the main factors that influenced participants' decision to choose a career in a non-front-line specialty. A total of 323 participants were included in this study. Factors that significantly influenced participants' career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [ P = .005], acceptable on-call demands [ P = .012], and lifestyle flexibility [ P = .006]); a robust physician-patient relationship (ability to promote individual health promotion [ P = .014] and the opportunity to form long-term relationships [ P  < .001], provide comprehensive care [ P = .001], and treat patients and their families [ P = .006]); and duration of residency program ( P = .001). The career-related factors that significantly influenced participants' decision to choose a non-front-line specialty were as follows: becoming an expert ( P  < .001), maintaining a focused scope of practice ( P  < .001), having a procedure-focused practice ( P = .001), seeing immediate results from one's actions ( P  < .001), potentially earning a high income ( P  < .001), and having a perceived status among colleagues ( P  < .001). In this study, 8 factors were found to positively influence medical students' career choice in family medicine and pediatrics, and 6 factors influenced the decision to choose a career in a non-front-line specialty. Medical students can be

  7. Some behavioural risk factors for intestinal helminthiasis in nursery and primary school children in Enugu, south eastern Nigeria.

    Science.gov (United States)

    Ilechukwu, G C; Ilechukwu, C G A; Ozumba, A N; Ojinnaka, N C; Ibe, B C; Onwasigwe, C N

    2010-09-01

    The objective of this study was to determine some common behavioural risk factors for intestinal helminthiasis in nursery and primary school children in Enugu. A cross-sectional survey on 460 children attending nursery and primary schools in Enugu was carried out in 2003 with a view to determine some behavioural risk factors for intestinal helminthiasis. This study was carried out in the research laboratory of the Federal Ministry of Health, National Arbovirus and Vector Research Centre, Enugu. Intestinal helminthiasis was diagnosed using the kato-katz method in analysing fresh stool samples collected from nursery and primary school children in Enugu. These fresh stool samples were collected into appropriately labeled clean containers. Questionnaires were administered by the researchers to obtain data from the children and their parents or guardians as regards some behavioural risk factors for intestinal helminthiasis. The results from this study showed that the prevalence of intestinal helminthiasis was significantly affected by various behavioural risk factors. The rate of helminthic infection varied significantly with hand washing habits after defeacation (chi2 = 75.77; df= 2; p = 0.001) and with different habits of washing fruits before eating (chi2 = 52.79; df=2; p = 0.001) among the pupils. Also, the rate ofhelminthic infection varied significantly with the source of drinking water (chi2 = 55.12; df = 3; p = 0.01), water boiling habits (chi2 = 40.89; df = 2; p = 0.001), use of footwear after school hours (chi2 = 30.72; df = 2; p = 0.001). Sites utilized for defeacation by the pupils (chi2 = 80.25; df=3; p = 0.001) also significantly influenced the rate ofhelminthic infection. Various behavioural factors which significantly affect the rate of helminthic infection abound in children living in Enugu. The government should give attention to the control of these behavioural risk factors. A lot of health education will be needed to curb the poor personal hygienic

  8. Risk factors for caries - control and prevention

    Directory of Open Access Journals (Sweden)

    Melida Hasanagić

    2008-08-01

    Full Text Available Objectives. To investigate a prevalence of caries, filled permanentand extracted permanent teeth, as well as caries risk factors inschool children aged 7, 9 and 11.Methods. The survey included 800 children (296 children aged7; 254 children aged 9 and 250 children aged 11 from the MostarMunicipality, 400 of them living in both rural and urban areas.A dental mirror and standard light of dental chair were used forexamination. The DMF index (Dental Caries, Missing Teeth andFilled Teeth was determined, as well as failure in keeping teethhygiene, sugar intake with food, and incidence of oral cavity infection.Results. The dental state of permanent teeth in children aged 7and 9 has shown significant difference between the children fromrural and urban areas (p < 0,001. Out of 2,698 and 2,790 permanentteeth in children aged 11 from rural and urban areas, 1,086(40,25 % and 884 (31.68 % had caries, respectively (p < 0.01.The difference between these groups of children has been foundin relation to the index of oral hygiene too (p < 0.05.Conclusion. An identification of risk groups for getting caries wasvery important and could help health and social structures to maintaintheir programs in order to improve oral health.

  9. Chemical factors that control lignin polymerization.

    Science.gov (United States)

    Sangha, Amandeep K; Davison, Brian H; Standaert, Robert F; Davis, Mark F; Smith, Jeremy C; Parks, Jerry M

    2014-01-09

    Lignin is a complex, branched polymer that reinforces plant tissue. Understanding the factors that govern lignin structure is of central importance to the development of technologies for converting lignocellulosic biomass into fuels because lignin imparts resistance to chemical, enzymatic, and mechanical deconstruction. Lignin is formed by enzymatic oxidation of phenolic monomers (monolignols) of three main types, guaiacyl (G), syringyl (S), and p-hydroxyphenyl (H) subunits. It is known that increasing the relative abundance of H subunits results in lower molecular weight lignin polymers and hence more easily deconstructed biomass, but it is not known why. Here, we report an analysis of frontier molecular orbitals in mono-, di-, and trilignols, calculated using density functional theory, which points to a requirement of strong p-electron density on the reacting phenolic oxygen atom of the neutral precursor for enzymatic oxidation to occur. This model is consistent with a proton-coupled electron transfer (PCET) mechanism and for the first time explains why H subunits in certain linkages (β-β or β-5) react poorly and tend to "cap" the polymer. In general, β-5 linkages with either a G or H terminus are predicted to inhibit elongation. More broadly, the model correctly accounts for the reactivity of the phenolic groups in a diverse set of dilignols comprising H and G subunits. Thus, we provide a coherent framework for understanding the propensity toward growth or termination of different terminal subunits in lignin.

  10. Factors associated with strabismus after cataract extraction and primary intraocular lens implantation in congenital cataracts

    Directory of Open Access Journals (Sweden)

    Soo Jung Lee

    2014-06-01

    Full Text Available AIM: To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation.METHODS: The medical records of 122 patients, aged 1.5mo to 9y, who had undergone cataract extraction with primary intraocular lens implantation between January 1993 and August 2011 were reviewed. Fourteen patients (17 eyes with strabismus before cataract surgery were excluded. Patients were divided into those with congenital bilateral cataracts (64 patients, 128 eyes and those with unilateral cataracts (44 patients, 44 eyes. The associations between the development of strabismus and age at cataract surgery, pre- and post-cataract extraction corrected distance visual acuity (CDVA, interocular CDVA difference, nystagmus, surgical method, and secondary cataract were evaluated.RESULTS: Factors significantly associated with the development of strabismus included age at cataract surgery (≤1y, preoperative mean CDVA ≤20/100, presence of nystagmus in the bilateral cataract group and postoperative interocular CDVA difference >20/70 in the unilateral group. Postoperative CDVA ≤20/100 and preservation of posterior capsule, and presence of secondary cataract were significant factors in both groups.CONCLUSION: Children with congenital cataracts should be monitored carefully after cataract surgery for the development of strabismus, especially when they underwent surgery at age ≤1y, and they have nystagmus, large postoperative interocular CDVA difference, poor preoperative and postoperative CDVA, preservation of the posterior capsule, or secondary cataract.

  11. [Relevant factors of early puberty timing in urban primary schools in Chongqing].

    Science.gov (United States)

    Luo, Yan; Liu, Qin; Wen, Yi; Liu, Shudan; Lei, Xun; Wang, Hong

    2016-05-01

    To investigate the status of puberty timing and relevant factors of early puberty timing in children from grade one to four in urban primary schools of Chongqing. According to the purposive sample method, four urban primary schools in Chongqing were selected and of which 1471 children from grade one to four who have obtained informed consent were recruited. Questionnaire survey on social-demographic characteristics and family environment (e.g., age, parents' relationship, diet and lifestyle, etc), and Pubertal Development Scale (PDS) survey and physical examination (measurements of height, weight, pubertal development status, etc) were conducted. P25, P50, P75 ages of each important pubertal event were calculated by probit regression. Univariate and multivariate analysis were used to analyze relevant factors. The detection rate of early puberty timing was 17.7%, and the median ages of the onset of breast and testicular development were 10.77 and 11.48 years old, respectively. Multivariate logistic regression showed that early puberty timing occurred more likely in girls than in boys (OR = 0.561, 95% CI 0.406-0.774), and bad relationship between parents (OR = 1.320, 95% CI 1.007-1.729) and hair-products-use (OR = 1.685, 95%, CI 1.028-2.762) were risk factors of early puberty timing. Early onset of puberty in urban Chongqing is still exist. Gender, parents' relationship, and hair-products-use have an essential impact on early puberty timing.

  12. Local environment and social factors in primary school children's afterschool commute in China

    Directory of Open Access Journals (Sweden)

    John Zacharias

    2017-09-01

    Full Text Available The rapid decline in young children's active commutes to and from school has prompted investigations into ways to raise activity levels. The period after school is recognized as very important in the daily activity regime of primary school children. In this study, we examine the relative effects of local environmental factors and socio-economic status on children's after-school commute mode choice. Environmental factors are pedestrian priority streets, street intersection density, motorways, shops, and play spaces. Property values are used as a proxy for income. Twenty-four school districts are selected using intersection density and motorway length as criteria. All children's exit behaviors were film-recorded on October weekdays and extracted as four choices–alone, in a group of children, on foot with a parent or guardian, on e-bike driven by an adult. A multinomial logistic regression reveals that gated communities, higher priced housing, motorways and bus stops are associated with children accompanied by adults. The presence of pedestrian streets is associated with children travelling alone and in groups. Greater travel distance is also associated with parents accompanying children on foot or on e-bike. The amount of play space is associated with children leaving school in groups. Overall, social and environmental factors are influential in the independent travel of primary school children after the school day ends in south China.

  13. Predictive factors of user acceptance on the primary educational mathematics aids product

    Science.gov (United States)

    Hidayah, I.; Margunani; Dwijanto

    2018-03-01

    Mathematics learning in primary schools requires instructional media. According to Piaget's theory, students are still in the concrete operational stage. For this reason, the development of the primary level mathematics aids is needed to support the development of successful mathematics learning. The stages of this research are the stages of commercialization with preparatory, marketing, and measurement analysis procedures. Promotion as part of marketing is done by doing a demonstration to the teacher. Measurements were performed to explore the predictive factors of user feasibility in adopting the product. Measurements were conducted using the concept of Technology Acceptance Model (TAM). Measurement variables include external variables, perceived usefulness, perceived ease of use, attitude, intention to use, and actual use. The result of this research shows that the contribution of predictive factors of mathematics teachers on the teaching aids product as follows: the external variable and perceived ease of use at 74%, perceived usefulness at 72%, intention to use (behavioral) at 58%, attitude at 52%, and the consequence factor (actual use) at 42%.

  14. [Prevalence of burnout syndrome and its associated factors in Primary Care staff].

    Science.gov (United States)

    Navarro-González, D; Ayechu-Díaz, A; Huarte-Labiano, I

    2015-01-01

    Burnout syndrome is an emerging disease among health professionals. The aim of this study is to determine the prevalence of occupational burnout among Primary Care staff, as well as to determine the differences in prevalence between family doctors, paediatricians, nurses, administrative-officers, and social-workers, and to evaluate the different related factors. A cross-sectional, descriptive study was conducted on 178 professionals from 5 different occupational groups in 54 Primary Care centres in Navarre from September to December 2010. An anonymous, self-administered questionnaire that included: the Maslach Burnout Inventory and a questionnaire on socio-demographic and work-related factors. Burnout was detected in 39.3% of staff. Those with higher levels are administrative-officers and family doctors, with an OR compared to nurses of 4.58 and 5.37, respectively in the dimension of emotional exhaustion, 4.98 and 2.87 in depersonalization, and 8.37 for administrative-officers in personal accomplishment. An association was found between burnout and the following factors: to be a male (for the dimensions of emotional exhaustion and depersonalization, 25.5 and 31.9%, respectively), to be employed in an urban area (for emotional exhaustion and depersonalization, 20 and 27.8%, respectively), use of psychiatric medication (for emotional exhaustion, 30%), size of patient-quota (for depersonalization, with an average of 1,565 patients), and welfare pressure (for emotional exhaustion and depersonalization, averages of 170.35 and 153.54 patients/week, respectively). About one-third of Primary Care professionals have a high level of burnout, which is mainly associated with the working area, the size of the quota, and professional group, with higher prevalence in administrative-officers and family doctors. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Psychological risk factors of micro- and macrovascular outcomes in primary care patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Nefs, Giesje; Pouwer, François; Denollet, Johan

    2010-01-01

    tests and physical examinations, and pharmacy medication records. The DiaDDZoB Study uses data that have been collected during the original baseline assessment in 2005 (M0; N = 2,460) and the 2007 (M1; N = 2,225) and 2008 (M2; N = 2,032) follow-up assessments. DISCUSSION: The DiaDDZoB Study is expected......BACKGROUND: Depression is a common psychiatric complication of diabetes, but little is known about the natural course and the consequences of depressive symptoms in primary care patients with type 2 diabetes. While depression has been related to poor glycemic control and increased risk....... METHODS/DESIGN: This prospective cohort study will examine: (1) the course of depressive symptoms in primary care patients with type 2 diabetes; (2) whether depressive symptoms and Type D personality are associated with the development of microvascular and/or macrovascular complications and with the risk...

  16. Underlying Factors for Practicality of the Production Control Systems

    DEFF Research Database (Denmark)

    Arica, Emrah; Strandhagen, Jan Ola; Hvolby, Hans-Henrik

    2012-01-01

    and communication technology, coordination and feedback, human factors and decision making, and measurement are the identified factors to be taken into account. Industrial interviews with three case companies, that are participating to the research program called The Norwegian Manufacturing Future (SFI NORMAN......This paper gives indications to important factors that must be considered for effectiveness of the production control systems under uncertainty. Five key factors have been identified by the literature study. Production schedule generation and execution approach under uncertainty, information...

  17. Surface topography regulates wnt signaling through control of primary cilia structure in mesenchymal stem cells

    Science.gov (United States)

    McMurray, R. J.; Wann, A. K. T.; Thompson, C. L.; Connelly, J. T.; Knight, M. M.

    2013-01-01

    The primary cilium regulates cellular signalling including influencing wnt sensitivity by sequestering β-catenin within the ciliary compartment. Topographic regulation of intracellular actin-myosin tension can control stem cell fate of which wnt is an important mediator. We hypothesized that topography influences mesenchymal stem cell (MSC) wnt signaling through the regulation of primary cilia structure and function. MSCs cultured on grooves expressed elongated primary cilia, through reduced actin organization. siRNA inhibition of anterograde intraflagellar transport (IFT88) reduced cilia length and increased active nuclear β-catenin. Conversely, increased primary cilia assembly in MSCs cultured on the grooves was associated with decreased levels of nuclear active β-catenin, axin-2 induction and proliferation, in response to wnt3a. This negative regulation, on grooved topography, was reversed by siRNA to IFT88. This indicates that subtle regulation of IFT and associated cilia structure, tunes the wnt response controlling stem cell differentiation. PMID:24346024

  18. Socioeconomic status and geographical factors associated with active listing in primary care: a cross-sectional population study accounting for multimorbidity, age, sex and primary care.

    Science.gov (United States)

    Ranstad, Karin; Midlöv, Patrik; Halling, Anders

    2017-06-09

    Socioeconomic status and geographical factors are associated with health and use of healthcare. Well-performing primary care contributes to better health and more adequate healthcare. In a primary care system based on patient's choice of practice, this choice (listing) is a key to understand the system. To explore the relationship between population and practices in a primary care system based on listing. Cross-sectional population-based study. Logistic regressions of the associations between active listing in primary care, income, education, distances to healthcare and geographical location, adjusting for multimorbidity, age, sex and type of primary care practice. Population over 15 years (n=123 168) in a Swedish county, Blekinge (151 731 inhabitants), in year 2007, actively or passively listed in primary care. The proportion of actively listed was 68%. Actively listed in primary care on 31 December 2007. Highest ORs for active listing in the model including all factors according to income had quartile two and three with OR 0.70 (95% CI 0.69 to 0.70), and those according to education less than 9 years of education had OR 0.70 (95% CI 0.68 to 0.70). Best odds for geographical factors in the same model had municipality C with OR 0.85 (95% CI 0.85 to 0.86) for active listing. Akaike's Information Criterion (AIC) was 124 801 for a model including municipality, multimorbidity, age, sex and type of practice and including all factors gave AIC 123 934. Higher income, shorter education, shorter distance to primary care or longer distance to hospital is associated with active listing in primary care.Multimorbidity, age, geographical location and type of primary care practice are more important to active listing in primary care than socioeconomic status and distance to healthcare. © 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 unless otherwise expressly granted.

  19. Novel electro-hydraulic position control system for primary mirror supporting system

    Directory of Open Access Journals (Sweden)

    Xiongbin Peng

    2016-05-01

    Full Text Available In the field of modern large-scale telescope, primary mirror supporting system technology faces the difficulties of theoretically uniform output force request and bias compensation. Therefore, a novel position control system combining hydraulic system with servo motor system is introduced. The novel system ensures uniform output force on supporting points without complicating the mechanical structure. The structures of both primary mirror supporting system and novel position system are described. Then, the mathematical model of novel position control system is derived for controller selection. A proportional–derivative controller is adopted for simulations and experiments of step response and triangle path tracking. The results show that proportional–derivative controller guarantees the system with micrometer-level positioning ability. A modified proportional–derivative controller is utilized to promote system behavior with faster response overshoot. The novel position control system is then applied on primary mirror supporting system. Coupling effect is observed among actuator partitions, and relocation of virtual pivot supporting point is chosen as the decoupling measurement. The position keeping ability of the primary mirror supporting system is verified by rotating the mirror cell at a considerably high rate. The experiment results show that the decoupled system performs better with smaller bias and shorter recovery time.

  20. Parental 'affectionless control' as an antecedent to adult depression: a risk factor refined.

    Science.gov (United States)

    Mackinnon, A; Henderson, A S; Andrews, G

    1993-02-01

    It has been well established that individuals with a history of depression report their parents as being less caring and more overprotective of them than do controls. 'Affectionless control' in childhood has thus been proposed as a risk factor for depression. Evidence is presented from a logistic regression analysis of data from a volunteer community sample that lack of care rather than over-protection is the primary risk factor. No evidence for an interaction effect of low care and over-protection was found.

  1. Factors associated with integrating self-management support into primary care.

    Science.gov (United States)

    Crespo, Richard; Shrewsberry, Molly

    2007-06-01

    The purpose of this article is to expand the understanding of self-management support by describing factors that contribute to implementing a comprehensive self-management program in primary care. Four rural health centers in medically underserved areas participated in a study to document the implementation of a self-management program. This program consisted of a social marketing plan and decision-making tools to guide patients in making self-management behavior changes. The stages of change constructs of the transtheoretical model were used to design the social marketing plan. Key informant interviews were conducted at 6-month and 9-month intervals to document the implementation process. A standardized set of questions was used in the interviews. The data from the interviews were analyzed using content analysis techniques. One of the principle findings is that self-management support requires putting a system in place, not just adding a new component to primary care. The health centers that fully implemented the self-management program made an organizational commitment to keep self-management on the agenda in management meetings, clinical staff set the example by adopting self-management behaviors, and patient self-management support was implemented in multiple patient care venues. Primary care centers with limited financial resources are able to integrate self-management support into their system of chronic illness care.

  2. FACTORS THAT INFLUENCE THE SELECTION OF LEARNING OPPORTUNITIES FOR STUDENT NURSES IN PRIMARY HEALTH CARE

    Directory of Open Access Journals (Sweden)

    H. lita

    2002-11-01

    The study therefore focused on the following objective: To identify the factors that influence the selection of learning opportunities for primary health care in hospital units. A qualitative research design utilising focus group discussions were used. The population consisted of conveniently selected lecturers, student nurses and registered nurses. The same initial question was asked in each focus group to initiate the discussions. The data were analysed according to Tesch's method. The results indicated that there is positive commitment from the lecturers and registered nurses to be involved in selecting appropriate learning opportunities. The student nurses also demonstrated a willingness to learn and to be exposed to learning opportunities in primary health care. There were however certain constraints that emerged as themes, namely: • Managerial constraints • Educational constraints Under the theme "managerial constraints" categories such as workload, nursing staff shortages and communication problems were identified. Under the theme "educational constraints" categories such as a lack of guidance, and the correlation of theory and practice emerged. Recommendations based on this research report include improvement of in-service education on managerial and educational aspects to facilitate the primary health care approach in hospitals.

  3. Nuclear Power and Resource Efficiency—A Proposal for a Revised Primary Energy Factor

    Directory of Open Access Journals (Sweden)

    Ola Eriksson

    2017-06-01

    Full Text Available Measuring resource efficiency can be achieved using different methods, of which primary energy demand is commonly used. The primary energy factor (PEF is a figure describing how much energy from primary resources is being used per unit of energy delivered. The PEF for nuclear power is typically 3, which refers to thermal energy released from fission in relation to electricity generated. Fuel losses are not accounted for. However; nuclear waste represents an energy loss, as current plans for nuclear waste management mostly include final disposal. Based on a literature review and mathematical calculations of the power-to-fuel ratio for nuclear power, PEF values for the open nuclear fuel cycle (NFC option of nuclear power and different power mixes are calculated. These calculations indicate that a more correct PEF for nuclear power would be 60 (range 32–88; for electricity in Sweden (41% nuclear power PEF would change from 1.8 to 25.5, and the average PEF for electricity in the European Union (EU would change from 2.5 to 18. The results illustrate the poor resource efficiency of nuclear power, which paves the way for the fourth generation of nuclear power and illustrates the policy implication of using PEFs which are inconsistent with current waste management plans.

  4. Factors associated with motor performance among overweight and nonoverweight Tyrolean primary school children.

    Science.gov (United States)

    Ruedl, Gerhard; Greier, Klaus; Kirschner, Werner; Kopp, Martin

    2016-01-01

    The increasing prevalence of overweight and obesity among children is often associated with motor deficits. Motor performance among children partly depends on modifiable factors, for example, weight status, electronic media use, sports club participation, and on nonmodifiable factors, for example, sex, age, migration background, or socio-economic status. To evaluate factors associated with motor performance among overweight and nonoverweight Tyrolean primary school children. Height, weight, and sport motor performance of primary school children were measured using the German motor performance test DMT 6-18. In addition, children were asked about migration background, sports club participation, and electronic media use in their room. A total of 304 children (48.7% girls) with a mean age of 8.0 ± 1.2 years were tested. In total, 61 (20.1%) children were overweight or obese. Regarding motor performance, nonoverweight children showed significantly higher total z-scores (106.8 ± 5.7 vs. 102.4 ± 6.8). For the total cohort, results of the multiple linear regression analysis (R (2) = 0.20) revealed that factors male sex (β = 0.12), nonoverweight children (β = 0.28), higher school grade (β = 0.23), sports club participation (β = 0.18),and > 2 weekly lessons of physical education (β = 0.26) were associated with an increased motor performance. For nonoverweight children results of the multiple linear regression analysis (R (2) = 0.09) found that a higher school grade (β = 0.17), sports club participation (β = 0.16),and more than 2 weekly lessons of physical education (β = 0.22) were associated with an increased motor performance. For the overweight children, results of the multiple linear regression analysis (R (2) = 0 .43) showed that no migration background (β = 0.23), a higher school grade (β = 0.55), sports club participation (β = 0.33) and more than 2 weekly lessons of physical

  5. Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices.

    Science.gov (United States)

    Dahrouge, Simone; Hogg, William E; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K; Kristjansson, Elizabeth; Fletcher, John

    2012-02-07

    Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = -6.3, 95% confidence interval [CI] -11.9 to -0.6) and practices in the established capitation model (β = -9.1, 95% CI -14.9 to -3.3) but not for those with salaried remuneration (β = -0.8, 95% CI -6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely

  6. Prognostic factors for survival among patients with primary bone sarcomas of small bones

    Directory of Open Access Journals (Sweden)

    Wang Z

    2018-05-01

    predictors of CSS. However, no significant differences were observed in OS and CSS among patients with different primary tumor locations and tumor subtypes. Additionally, the most significant prognostic factor was whether metastasis had occurred at the time of initial diagnosis. Conclusion: Among patients with primary bone sarcomas of the hands or feet, younger age (<40 years, localized stage, low grade, surgical treatment, and first primary tumor are favorable factors for prolonging survival. Keywords: chondrosarcoma, Ewing sarcoma, osteosarcoma, short bone, prognosis

  7. Risk factors for perioperative hyperglycemia in primary hip and knee replacements

    Science.gov (United States)

    Jämsen, Esa; Nevalainen, Pasi I; Eskelinen, Antti; Kalliovalkama, Jarkko; Moilanen, Teemu

    2015-01-01

    Background and purpose Background and purpose — Perioperative hyperglycemia has been associated with adverse outcomes in several fields of surgery. In this observational study, we identified factors associated with an increased risk of hyperglycemia following hip and knee replacement. Patients and methods Patients and methods — We prospectively monitored changes in glucose following primary hip and knee replacements in 191 patients with osteoarthritis. Possible associations of patient characteristics and operation-related factors with hyperglycemia (defined as glucose > 7.8 mmol/L in 2 consecutive measurements) and severe hyperglycemia (glucose > 10 mmol/L) were analyzed using binary logistic regression with adjustment for age, sex, operated joint, and anesthesiological risk score. Results Results — 76 patients (40%) developed hyperglycemia, and 48 of them (25% of the whole cohort) had severe hyperglycemia. Glycemic responses were similar following hip replacement and knee replacement. Previously diagnosed diabetes was associated with an increased risk of hyperglycemia and severe hyperglycemia, compared to patients with normal glucose metabolism, whereas newly diagnosed diabetes and milder glucose metabolism disorders had no effect. In patients without previously diagnosed diabetes, increased values of preoperative glycosylated hemoglobin (HbA1c) and fasting glucose on the day of operation were associated with hyperglycemia. Higher anesthesiological risk score—but none of the operation-related factors analyzed—was associated with an increased risk of hyperglycemia. Interpretation Interpretation — Perioperative hyperglycemia is common in primary hip and knee replacements. Previously diagnosed diabetes is the strongest risk factor for hyperglycemia. In patients with no history of diabetes, preoperative HbA1c and fasting glucose on the day of operation can be used to stratify the risk of hyperglycemia. PMID:25409255

  8. Risk factors and outcome in patients with primary sclerosing cholangitis with persistent biliary candidiasis.

    Science.gov (United States)

    Rupp, Christian; Bode, Konrad Alexander; Chahoud, Fadi; Wannhoff, Andreas; Friedrich, Kilian; Weiss, Karl-Heinz; Sauer, Peter; Stremmel, Wolfgang; Gotthardt, Daniel Nils

    2014-10-23

    Candidiasis is commonly observed in patients with primary sclerosing cholangitis (PSC), but the clinical risk factors associated with its presence have not been fully investigated. In this study, we aimed to analyse the incidence, risk factors, and transplantation-free survival in primary sclerosing cholangitis (PSC) patients with persistent biliary candidiasis. We retrospectively analysed patients diagnosed with PSC who were admitted to our department during 2002 to 2012. One-hundred fifty patients whose bile cultures were tested for fungal species were selected, and their clinical and laboratory parameters were investigated. The results of endoscopic retrograde cholangiography (ERC) and bile cultures were analysed using chart reviews. The cases of biliary candidiasis were sub-classified as transient or persistent. Thirty out of 150 (20.0%) patients had biliary candidiasis. Although all patients demonstrated comparable baseline characteristics, those with biliary candidiasis showed significantly reduced transplantation-free survival (p candidiasis. A subgroup analysis showed reduced survival with a greater necessity for orthotopic liver transplantation (OLT) only in patients with persistence of Candida (p = 0.007). The survival in the patients with transient biliary candidiasis was comparable to that in candidiasis-free patients. In a multivariate regression analysis that included Mayo risk score (MRS), sex, age, dominant stenosis, inflammatory bowel disease, autoimmune hepatitis overlap syndrome, and number of times ERC was performed, biliary candidiasis was an independent risk factor for reduced survival (p = 0.008). Risk factors associated with acquisition of biliary candidiasis were age at PSC diagnosis and number of ERCs. The persistence of biliary candidiasis is associated with markedly reduced transplantation-free survival in PSC patients. By contrast, actuarial survival in patients with transient biliary candidiasis approaches that for patients without any

  9. Gross primary production controls the subsequent winter CO2 exchange in a boreal peatland.

    Science.gov (United States)

    Zhao, Junbin; Peichl, Matthias; Öquist, Mats; Nilsson, Mats B

    2016-12-01

    In high-latitude regions, carbon dioxide (CO 2 ) emissions during the winter represent an important component of the annual ecosystem carbon budget; however, the mechanisms that control the winter CO 2 emissions are currently not well understood. It has been suggested that substrate availability from soil labile carbon pools is a main driver of winter CO 2 emissions. In ecosystems that are dominated by annual herbaceous plants, much of the biomass produced during the summer is likely to contribute to the soil labile carbon pool through litter fall and root senescence in the autumn. Thus, the summer carbon uptake in the ecosystem may have a significant influence on the subsequent winter CO 2 emissions. To test this hypothesis, we conducted a plot-scale shading experiment in a boreal peatland to reduce the gross primary production (GPP) during the growing season. At the growing season peak, vascular plant biomass in the shaded plots was half that in the control plots. During the subsequent winter, the mean CO 2 emission rates were 21% lower in the shaded plots than in the control plots. In addition, long-term (2001-2012) eddy covariance data from the same site showed a strong correlation between the GPP (particularly the late summer and autumn GPP) and the subsequent winter net ecosystem CO 2 exchange (NEE). In contrast, abiotic factors during the winter could not explain the interannual variation in the cumulative winter NEE. Our study demonstrates the presence of a cross-seasonal link between the growing season biotic processes and winter CO 2 emissions, which has important implications for predicting winter CO 2 emission dynamics in response to future climate change. © 2016 John Wiley & Sons Ltd.

  10. [What factors help to explain satisfaction with Primary Health care in Spain?].

    Science.gov (United States)

    Arrazola-Vacas, M; de Hevia-Payá, J; Rodríguez-Esteban, L

    2015-01-01

    To find out the factors that determine satisfaction with public primary health care in Spain. The work has considered a wide group of potential determining factors of that satisfaction, which are organised into 3 blocks of variables: Those related to the perceived quality in the care received, socioeconomic, and those relative to the state of health. The micro data of the Barómetro Sanitario (BS) of 2013, which are representative at a national level, were employed. After a prior first descriptive analysis, 2 multivariate models were estimated: One in which satisfaction is considered as being of a cardinal nature (regression model), and another in which it is contemplated as being of an ordinal nature (ordered probit model). There were practically no differences between the results obtained with one or other of the multivariate models. Not all the variables considered were statistically significant. Of the 3 blocks of variables studied, the one related to the perceived quality in the care received in the health centre exerts the greatest relevance in the explanation of satisfaction. The results obtained show that, by means of the management of the variables related to the perception of quality of care in health centres, public administrators and health professionals may have a highly favourable influence on the levels of satisfaction of primary health care patients. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  11. Primary prophylaxis for children with severe congenital factor VII deficiency - Clinical and laboratory assessment.

    Science.gov (United States)

    Kuperman, A A; Barg, A A; Fruchtman, Y; Shaoul, E; Rosenberg, N; Kenet, G; Livnat, T

    2017-09-01

    Severe congenital factor VII (FVII) deficiency is a rare bleeding disorder. Prophylaxis with replacement therapy has been suggested to patients, yet the most beneficial dosing regimens and therapy intervals are still to be defined. Due to the lack of evidence-based data, we hereby present our experience with long-term administration and monitoring primary prophylaxis in children with severe FVII deficiency and an extremely high bleeding risk. Four children with familial FVII deficiency, treated by prophylactic recombinant activated factor VII (rFVIIa), 15-30μg/kg/dose, given 2-3 times weekly since infancy, are discussed. Clinical follow up and monitoring laboratory assays, including thrombin generation, measured at various time points after prophylactic rFVIIa administration are presented. Among our treated patients neither FVII activity nor thrombin generation parameters (both already declined 24h post rFVIIa administration) were able to predict the impact of prophylaxis, and could not be used as surrogate markers in order to assess the most beneficial treatment frequency. However, the long clinical follow-up and comprehensive laboratory assessment performed, have shown that early primary prophylaxis as administered in our cohort was safe and effective. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. The role of growth differentiation factor 15 in the pathogenesis of primary myelofibrosis

    International Nuclear Information System (INIS)

    Uchiyama, Tatsuki; Kawabata, Hiroshi; Miura, Yasuo; Yoshioka, Satoshi; Iwasa, Masaki; Yao, Hisayuki; Sakamoto, Soichiro; Fujimoto, Masakazu; Haga, Hironori; Kadowaki, Norimitsu; Maekawa, Taira; Takaori-Kondo, Akifumi

    2015-01-01

    Growth differentiation factor 15 (GDF15) is a pleiotropic cytokine that belongs to the transforming growth factor-β superfamily. Elevated serum concentrations of this cytokine have been reported in patients with various malignancies. To assess the potential roles of GDF15 in hematologic malignancies, we measured its serum levels in patients with these diseases. We found that serum GDF15 levels were elevated in almost all these patients, particularly in patients with primary myelofibrosis (PMF). Immunohistochemical staining of bone marrow (BM) specimens revealed that GDF15 was strongly expressed by megakaryocytes, which may be sources of increased serum GDF15 in PMF patients. Therefore, we further assessed the contribution of GDF15 to the pathogenesis of PMF. Recombinant human (rh) GDF15 enhanced the growth of human BM mesenchymal stromal cells (BM-MSCs), and it enhanced the potential of these cells to support human hematopoietic progenitor cell growth in a co-culture system. rhGDF15 enhanced the growth of human primary fibroblasts, but it did not affect their expression of profibrotic genes. rhGDF15 induced osteoblastic differentiation of BM-MSCs in vitro, and pretreatment of BM-MSCs with rGDF15 enhanced the induction of bone formation in a xenograft mouse model. These results suggest that serum levels of GDF15 in PMF are elevated, that megakaryocytes are sources of this cytokine in BM, and that GDF15 may modulate the pathogenesis of PMF by enhancing proliferation and promoting osteogenic differentiation of BM-MSCs

  13. Personality assessment based on the five-factor model of personality structure in patients with primary open-angle glaucoma.

    Science.gov (United States)

    Mabuchi, Fumihiko; Yoshimura, Kimio; Kashiwagi, Kenji; Shioe, Kunihiko; Kanba, Shigenobu; Iijima, Hiroyuki; Tsukahara, Shigeo

    2005-01-01

    Several characteristic personality types have been reported for glaucoma patients in previous studies. However, none of the previous studies used a common structural theory of personality. In this study, we conducted a multicenter cross-sectional case-control study using the recently established five-factor model of personality structure. Personality was evaluated using the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI), which is a questionnaire specifically designed to test the five-factor model of personality: neuroticism (N), extraversion (E), openness (O), agreeableness (A), and conscientiousness (C). Eligible questionnaires were obtained from 196 patients with primary open-angle glaucoma (POAG) (99 men, 97 women) and 223 reference subjects with no ocular disease except cataract (87 men, 136 women). The mean score of each NEO-FFI factor for POAG patients was compared to the scores for the reference subjects. Compared with the reference subjects, the mean N score was significantly higher (P = 0.013), the mean scores for A and C were significantly lower (P = 0.007 and P = 0.001, respectively), and the mean E score tended to be lower (P = 0.055) in male POAG patients. The mean E score was significantly lower (P = 0.023) in female POAG patients. Characteristic personality traits were noted in POAG patients, and a more significant relationship was found between personality and glaucoma in men than in women.

  14. Effects on coagulation factor production following primary hepatomitogen-induced direct hyperplasia.

    Science.gov (United States)

    Tatsumi, Kohei; Ohashi, Kazuo; Taminishi, Sanae; Takagi, Soichi; Utoh, Rie; Yoshioka, Akira; Shima, Midori; Okano, Teruo

    2009-11-14

    To investigate the molecular mechanisms involved in coagulation factor expression and/or function during direct hyperplasia (DH)-mediated liver regeneration. Direct hyperplasia-mediated liver regeneration was induced in female C57BL/6 mice by administering 1,4-bis[2-(3,5-dichloropyridyloxy)] benzene (TCPOBOP), a representative hepatomitogen. Mice were weighed and sacrificed at various time points [Day 0 (D0: prior to injection), 3 h, D1, D2, D3, and D10] after TCPOBOP administration to obtain liver and blood samples. Using the RNA samples extracted from the liver, a comprehensive analysis was performed on the hepatic gene expression profiling of coagulation-related factors by real-time RT-PCR (fibrinogen, prothrombin, factors V, VII, VIII, IX, X, XI, XII, XIIIbeta, plasminogen, antithrombin, protein C, protein S, ADAMTS13, and VWF). The corresponding plasma levels of coagulation factors (fibrinogen, prothrombin, factors V, VII, VIII, IX, X, XI, XII, XIII, and VWF) were also analyzed and compared with their mRNA levels. Gavage administration of TCPOBOP (3 mg/kg body weight) resulted in a marked and gradual increase in the weight of the mouse livers relative to the total body weight to 220% by D10 relative to the D0 (control) ratios. At the peak of liver regeneration (D1 and D2), the gene expression levels for most of the coagulation-related factors (fibrinogen, prothrombin, factors V, VII, VIII, IX, XI, XII, XIIIbeta, plasminogen, antithrombin, protein C, ADAMTS13, VWF) were found to be down-regulated in a time-dependent manner, and gradually recovered by D10 to the basal levels. Only mRNA levels of factor X and protein S failed to show any decrease during the regenerative phase. As for the plasma levels, 5 clotting factors (prothrombin, factors VIII, IX, XI, and XII) demonstrated a significant decrease (Pfactors, factor IX and factor XI showed the most dramatic decline in their activities by about 50% at D2 compared to the basal levels, and these reductions in

  15. Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial

    Science.gov (United States)

    Bo, Linna; Lao, Lixing; Chen, Jiao; Yu, Siyi; Yu, Zheng; Tang, Hongzhi; Yi, Ling; Wu, Xi; Yang, Jie; Liang, Fanrong

    2017-01-01

    Background Though moxibustion is frequently used to treat primary dysmenorrhea in China, relevant evidence supporting its effectiveness is still scanty. Methods This study was a pragmatic randomized, conventional drug controlled, open-labeled clinical trial. After initial screen, 152 eligible participants were averagely randomized to receive two different treatment strategies: Moxibustion and conventional drugs. Participants and practitioners were not blinded in this study. The duration of each treatment was 3 months. The primary outcome was pain relief measured by the Visual Analogue Scale. The menstrual pain severity was recorded in a menstrual pain diary. Results 152 eligible patients were included but only 133 of them eventually completed the whole treatment course. The results showed that the menstrual pain intensity in experimental group and control group was reduced from 6.38±1.28 and 6.41±1.29, respectively, at baseline, to 2.54±1.41 and 2.47±1.29 after treatment. The pain reduction was not significantly different between these two groups (P = 0.76), however; the pain intensity was significantly reduced relative to baseline for each group (P<0.01). Three months after treatment, the effectiveness of moxibustion sustained and started to be superior to the drug’s effect (-0.87, 95%CI -1.32 to -0.42, P<0.01). Secondary outcome analyses showed that moxibustion was as effective as drugs in alleviating menstrual pain-related symptoms. The serum levels of pain mediators, such as PGF2α, OT, vWF, β-EP, PGE2, were significantly improved after treatment in both groups (P<0.05). No adverse events were reported in this trial. Conclusions Both moxibustion and conventional drug showed desirable merits in managing menstrual pain, given their treatment effects and economic costs. This study as a pragmatic trial only demonstrates the effectiveness, not the efficacy, of moxibustion for menstrual pain. It can’t rule out the effect of psychological factors during

  16. Advantages and disadvantages of unstructured cardiovascular risk factor screening for follow-up in primary care.

    Science.gov (United States)

    de Boer, Anna W; de Mutsert, Renée; den Heijer, Martin; Rosendaal, Frits R; Jukema, Johan W; Blom, Jeanet W; Numans, Mattijs E

    2016-07-01

    In contrast to structured, integrated risk assessment in primary care, unstructured risk factor screening outside primary care and corresponding recommendations to consult a general practitioner (GP) are often based on one abnormal value of a single risk factor. This study investigates the advantages and disadvantages of unstructured screening of blood pressure and cholesterol outside primary care. After the baseline visit of the Netherlands Epidemiology of Obesity study (population-based prospective cohort study in persons aged 45-65 years, recruited 2008-2012) all participants received a letter with results of blood pressure and cholesterol, and a recommendation to consult a GP if results were abnormal. Four years after the start of the study, participants received a questionnaire about the follow-up of their results. The study population consisted of 6343 participants, 48% men, mean age 56 years, mean body mass index 30 kg/m(2). Of all participants 66% had an abnormal result and, of these, 49% had a treatment indication based on the risk estimation system SCORE-NL 2006. Of the 25% of the participants who did not consult a GP, 40% had a treatment indication. Of the participants with an abnormal result 19% were worried, of whom 60% had no treatment indication. In this population 51% of the participants with an abnormal result had unnecessarily received a recommendation to consult a GP, and 10% were unnecessarily worried. GPs should be informed about the complete risk assessment, and only participants at intermediate or high risk should receive a recommendation to consult a GP. © The European Society of Cardiology 2015.

  17. Analysis of Trends and Factors in Breast Multiple Primary Malignant Neoplasms

    Directory of Open Access Journals (Sweden)

    Igor Motuzyuk

    2018-02-01

    Full Text Available Background: The study aims to evaluate the current state and tendencies in multiple primary breast cancer incidence, behavior, and treatment in Ukraine. Methods: A total of 2032 patients who received special treatment at the Department of Breast Tumors and Reconstructive Surgery of the National Cancer Institute from 2008 to 2015 were included in the study. Among them, there were 195 patients with multiple primary malignant neoplasms: 54.9% patients with synchronous cancer and 45.1% patients with metachronous cancer. The average age of patients was 46.6 years, and the percentage of postmenopausal women was 63.1%. Among patients with synchronous cancer, there were 56.1% patients with only breast localizations and 43.9% with combination of breast and other localizations, and among patients with metachronous cancer, there were 46.6% patients with only breast localizations and 53.4% with combination of breast and other localizations. All the patients were evaluated in terms of aggressiveness of the disease, survival rates, as well as risk factors and treatment options. Results: A more aggressive course of breast cancer is observed in patients exposed to radiation from the Chernobyl accident under the age of 30 years ( P  < .01. The clinical course of disease in patients with synchronous cancer is worse and prognostically unfavorable compared with metachronous cancer ( P  < .01. The course of the disease in patients who underwent mastectomy is worse compared with patients who underwent breast-conserving surgery ( P  < .01. Plastic and reconstructive surgery in patients with synchronous cancer was proven to be reasonable in terms of increase in survival ( P  < .01. Conclusions: The patients with multiple primary breast cancer should have attentive management and treatment. Multidisciplinary team should concern all the risk factors and provide the most sufficient option of management. This is crucial to continue research in this

  18. Frequency and predictive factors for overlap syndrome between autoimmune hepatitis and primary cholestatic liver disease.

    Science.gov (United States)

    Gheorghe, Liana; Iacob, Speranta; Gheorghe, Cristian; Iacob, Razvan; Simionov, Iulia; Vadan, Roxana; Becheanu, Gabriel; Parvulescu, Iuliana; Toader, Cristina

    2004-06-01

    To evaluate the frequency of cholestatic pattern in patients with autoimmune hepatitis (AIH) and to identify predictive factors associated with the development of the overlap syndrome. Eighty-two consecutive patients diagnosed with AIH at the referral centre between January 1998 and June 2002 were included in the study. The new scoring system modified by the International Autoimmune Hepatitis Group was used to classify patients as definite/probable. Overlap syndrome was considered when the patient had clinical, serological and histological characteristics of two conditions: AIH and primary biliary cirrhosis (PBC) or AIH and primary sclerosing cholangitis (PSC). From the 82 AIH patients (76 female and six male), 84.1% presented definite AIH (> 15 points) and 15.9% probable AIH (10 - 15 points). The frequency of the overlap syndrome was 20%: 13% with PBC and 7% with PSC. In the univariate analysis the overlap syndrome was associated with male gender (P = 0.01), age < 35 years (P < 0.0001), histopathological aspect of cholestasis (P < 0.0001), suboptimal response to treatment (P < 0.0001) and probable AIH (P < 0.0001). Age < 35 years, probable AIH and the absence of anti-nuclear antibody (ANA) have been identified as independent indicators of the overlap diagnosis by the logistic regression analysis. Patients with overlap syndrome between AIH and primary cholestatic liver disease are frequently diagnosed in clinical practice, representing 20% of AIH cases in our study. The independent predictive factors associated with the diagnosis of overlap syndrome are young age, ANA(-) profile, and probable diagnosis according with the scoring system for AIH.

  19. Risk factors associated with lipomyelomeningocele: a case-control study.

    Science.gov (United States)

    Esmaeili, Arash; Hanaei, Sara; Fadakar, Kaveh; Dadkhah, Sahar; Arjipour, Mahdi; Habibi, Zohreh; Nejat, Farideh; El Khashab, Mostafa

    2013-01-01

    In general, it seems that both genetic and environmental factors play important roles in the induction of neural tube defects. Lipomyelomeningocele (LipoMMC) is a rather common type of closed neural tube defect, but only limited studies have investigated the potential risk factors of this anomaly. Therefore, the purpose of this case-control study was to investigate the risk factors involved in LipoMMC formation. Various risk factors were evaluated in 35 children between 1 month and 10 years of age with LipoMMC in a hospital-based case-control study. The 2 control arms consisted of 35 children with myelomeningocele (MMC group) and 35 children with congenital anomalies other than central nervous system problems (control group). All groups were matched for age and visited the same hospital. A structured questionnaire was used for the collection of all data, including the mothers' weight and height during pregnancy, education, reproductive history, previous abortions, and socioeconomic status, as well as the parents' consanguinity and family history of the same anomalies. Univariate analysis of the children with LipoMMC compared to the control group showed that the use of periconceptional folic acid supplementation was significantly lower in the MMC and LipoMMC groups compared to the control group. In addition, comparison of the MMC and control groups revealed statistically significant differences regarding the use of folic acid and maternal obesity. In multivariate analysis, use of folic acid in the periconceptional period and during the first trimester was an independent risk factor for LipoMMC and MMC. Furthermore, maternal obesity was a significantly positive risk factor for MMC. The probable risk factors for LipoMMC were investigated in this case-control study. Consumption of folic acid in the periconceptional period and during the first trimester is an independent protective factor against LipoMMC. It seems that larger studies are needed to examine other possible

  20. Microcystins: Potential risk factors in carcinogenesis of primary liver cancer in Serbia

    Directory of Open Access Journals (Sweden)

    Drobac Damjana

    2011-01-01

    Full Text Available The Primary Liver Carcinoma (PLC is one of the most common malignant diseases in the world. In Central Serbia during the period from 2000 to 2006 the average incidence was 16.9/100 000 that complies to the European epidemiology. The main risk factors for PLC are considered to be cirrhosis of liver and viral chronic Hepatitis B and C. The goal of this research was to analyze epidemiological data of these diseases and to state the correlation between PLC, liver cirrhosis and Hepatitis B and C in Serbia. During the research period of 6 years the correlations between PLC and the corresponding risk factors were negative. For this reason it was necessary to examine other risk factors. The high incidence of PLC in Nišavski, Toplički and Šumadijski region correlate with emerging blooms of Cyanobacteria in water reservoirs supplying these areas with drinking water. Since we examined only 7 years span and have no completed cyanotoxin analysis, it is necessary to complete more research in this field. The identification of cyanotoxins as risk factors that contribute to the development of liver cancer will help in the prevention of this disease.

  1. Risk factors for renal scarring in children with primary vesicoureteral reflux disease

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    Sevgi Mir

    2013-01-01

    Full Text Available To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR and the possible risk factor(s, we studied 90 children (60 girls and 30 boys with VUR followed in the Pediatric Nephrology Unit at the Ege University Hospital from 1998 to 2003. All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m technetium dimercapto-succinic acid scintigraphy. All infants with VUR were given low-dose prophylactic antibiotics and followed-up until resolution of the reflux. Grade of reflux and number of urinary tract infection (UTI episodes (≥3 were found to be statistically significant risk factors for renal scarring (P 0.05. Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05. We conclude that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore, identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure.

  2. Factors Associated with Increased Pain in Primary Dysmenorrhea: Analysis Using a Multivariate Ordered Logistic Regression Model.

    Science.gov (United States)

    Tomás-Rodríguez, María I; Palazón-Bru, Antonio; Martínez-St John, Damian R J; Navarro-Cremades, Felipe; Toledo-Marhuenda, José V; Gil-Guillén, Vicente F

    2017-04-01

    In the literature about primary dysmenorrhea (PD), either a pain gradient has been studied just in women with PD or pain was assessed as a binary variable (presence or absence). Accordingly, we decided to carry out a study in young women to determine possible factors associated with intense pain. A cross-sectional observational study. A Spanish University in 2016. A total of 306 women, aged 18-30 years. A questionnaire was filled in by the participants to assess associated factors with dysmenorrhoea. Our outcome measure was the Andersch and Milsom scale (grade from 0 to 3). grade 0 (menstruation is not painful and daily activity is unaffected), grade 1 (menstruation is painful but seldom inhibits normal activity, analgesics are seldom required, and mild pain), grade 2 (daily activity affected, analgesics required and give relief so that absence from work or school is unusual, and moderate pain), and grade 3 (activity clearly inhibited, poor effect of analgesics, vegetative symptoms and severe pain). Factors significantly associated with more extreme pain: a higher menstrual flow (odds ratio [OR], 2.11; P < .001), a worse quality of life (OR, 0.97; P < .001) and use of medication for PD (OR, 8.22; P < .001). We determined factors associated with extreme pain in PD in a novel way. Further studies are required to corroborate our results. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  3. Nodal Control and Surgical Salvage after Primary Radiotherapy in 1,782 Patients with Laryngeal and Pharyngeal Carcinoma

    International Nuclear Information System (INIS)

    Vendelbo Johansen, Lars; Grau, Cai; Overgaard, Jens

    2004-01-01

    The purpose of this study was to evaluate the ultimate neck control after primary radiotherapy and surgical salvage in laryngeal and pharyngeal cancer patients. Some 1,782 consecutive patients with squamous cell carcinoma were treated by radiotherapy. At presentation 26% of the patients had metastatic lymph nodes. A total of 298 primary or secondary nodal recurrences were seen, 159 were treated, and 53 (∼18%) were controlled. Isolated N-recurrence was fatal in 2.7% (36/1,324) of the N0 patients. Univariate actuarial analysis of nodal control demonstrated that the region of origin, T-classification, T-size, N-classification, tumor stage, differentiation, hemoglobin, and radiation time were significant prognostic factors. In a Cox analysis the independent significant parameters were gender, region of origin, N-classification, and differentiation. The conclusions were that in patients with nodal recurrence a little over half were treated and of these a third of the nodal recurrences were controlled. Significant prognostic factors in multivariate analysis were gender, region of origin, N-classification, and tumor differentiation

  4. Factors associated with primary care prescription of opioids for joint pain.

    Science.gov (United States)

    Green, D J; Bedson, J; Blagojevic-Burwell, M; Jordan, K P; van der Windt, D

    2013-02-01

    Opioids are commonly prescribed in primary care and can offer pain relief but may also have adverse effects. Little is known about the characteristics of people likely to receive an opioid prescription in primary care. The aim is to identify what factors are associated with primary care prescribing of high-strength analgesics in a community sample of older people with joint pain. A prospective two-stage postal survey completed at baseline and 3-year follow-up in a population aged 50 and over registered with eight general practitioner (GP) practices in North Staffordshire (North Staffordshire Osteoarthritis Project cohorts) linked with data from medical records. Participants were selected who reported joint pain in one or more joints at baseline. Outcome measures were the number of prescriptions for high-strength pain medication (opioids) in the following 3 years. Socio-demographic and health status factors associated with prescription were assessed using a zero-inflated Poisson model. 873 (19%) people were prescribed opioids (out of 4652 providing complete data) ranging from 1 to 76 prescriptions over 3 years. Baseline factors significantly associated with increased rates of prescription were younger age group [65-74 group: incidence rate ratio (IRR) = 1.26 (1.18-1.35)], male gender [IRR = 1.17 (1.12-1.23)], severe joint pain [IRR = 1.19 (1.12-1.26)] poor physical function [IRR = 0.99 (0.99-0.99)] and lower frequency of alcohol consumption [once/twice a year: IRR = 1.13 (1.06-1.21), never: IRR = 1.14 (1.06-1.22)]. Restricting the analysis to those without prior prescriptions for strong opioids showed similar results. Poor physical function and participation restrictions were strongly associated with prescriptions of stronger opioids in addition to several socio-demographic and lifestyle factors. Given the uncertainties over the effectiveness and risks of opioid use, future research could investigate decision making of GPs, exploring reasons for prescribing them.

  5. [Chronic kidney disease in Primary Health Care: prevalence and associated risk factors].

    Science.gov (United States)

    Salvador González, Betlem; Rodríguez Pascual, Mercedes; Ruipérez Guijarro, Laura; Ferré González, Antonia; Cunillera Puertolas, Oriol; Rodríguez Latre, Luisa M

    2015-04-01

    To determine the prevalence of chronic kidney disease and associated risk factors in subjects over 60 years of age, as well as its staging by determining the glomerular filtration rate (GFR). Cross-sectional observational study. Primary Health Care. Patients≥60 years of age who were seen in 40 Primary Health Care centres with serum creatinine measured in a central laboratory between January 1 and December 31, 2010. kidney transplant, home care. Social-demographic and anthropometric data, cardiovascular risk factors, and diseases established according to electronic clinical records. Serum creatinine was measured using standardised Jaffe kinetic method, and GFR estimated with MDRD-4-IDMS and CKD-EPI. A total of 97,665 subjects (57.3% women, median age 70.0 years [Q1: 65.0, Q3: 77.0]). GFR-MDRD prevalence<60=15.1% (16.6% in women, 13.2% in men; P<.001) and increased with age. Multivariate analysis showed a positive association between GFR-MDRD<60 and age (OR=1.74; 95% CI 1.70 to 1.77), hypertension (OR=2.18; 95% CI 2.08 to 2.30), heart failure (OR=2.03; 95% CI 1.83 to 2.25), atrial fibrillation (OR=1.57; 95% CI 1.41 to 1.76), ischaemic heart disease (OR=1.40; 95% CI 1.30 to 1.50), peripheral arterial disease (OR=1.31; 95% CI 1.09 to 1.57), dyslipidaemia (OR=1.28; 95% CI 1.23 to 1.33), diabetes (OR=1.26; 95% CI 1.17 to 1.34), and stroke (OR=1.17; 95% CI 1.09 to 1.25). The GFR-CKD-EPI model showed an increase in OR with age and male sex, that became significant as a chronic kidney disease risk factor. Chronic kidney disease has considerable prevalence in subjects≥60 years seen in Primary Health Care, more in women, and increasing with age. Hypertension, more than diabetes, was the main associated cardiovascular risk factor. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  6. Factors influencing warfarin control in Australia and Singapore.

    Science.gov (United States)

    Bernaitis, Nijole; Ching, Chi Keong; Teo, Siew Chong; Chen, Liping; Badrick, Tony; Davey, Andrew K; Crilly, Julia; Anoopkumar-Dukie, Shailendra

    2017-09-01

    Warfarin is widely used for patients with non-valvular atrial fibrillation (NVAF). Variations in warfarin control, as measured by time in therapeutic range (TTR), have been reported across different regions and ethnicities, particularly between Western and Asian countries. However, there is limited data on comparative factors influencing warfarin control in Caucasian and Asian patients. Therefore, the aim of this study was to determine warfarin control and potential factors influencing this in patients with NVAF in Australia and Singapore. Retrospective data was collected for patients receiving warfarin for January to June 2014 in Australia and Singapore. TTR was calculated for individuals with mean patient TTR used for analysis. Possible influential factors on TTR were analysed including age, gender, concurrent co-morbidities, and concurrent medication. The mean TTR was significantly higher in Australia (82%) than Singapore (58%). At both sites, chronic kidney disease significantly lowered this TTR. Further factors influencing control were anaemia and ageWarfarin control was significantly higher in Australia compared to Singapore, however chronic kidney disease reduced control at both sites. The different levels of control in these two countries, together with patient factors further reducing control may impact on anticoagulant choice in these countries with better outcomes from warfarin in Australia compared to Singapore. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Primary Coolant pH Control for Soluble Boron-Free PWRs

    International Nuclear Information System (INIS)

    Cheon, Yang Ho; Lee, Nam Yeong; Park, Byeong Ho; Park, Seong Chan; Kim, Eun Kee

    2015-01-01

    These should be considered when evaluating and designing the operating pH program for nuclear power plants. This paper discusses the advanced water chemistry strategies to keep pace with the recent global trends related to pH control in the primary water system for soluble boron pressurized water reactor (PWR) plants. Finally, the objective of this work is to study primary coolant pH control for soluble boron-free PWR plants. This paper reviewed the advanced water chemistry strategies to keep pace with the recent global trends related to pH control in the primary water chemistry system for soluble boron PWR plants. The new chemistry trend for the primary coolant is towards adaption of the constant and elevated chemistry. Finally, this work studied primary coolant pH control for soluble boron-free PWR plants. The ammonia-based water chemistry related to pH control for boron-free PWR plants was discussed. The ammonia-based water chemistry is not recommended to avoid fluctuation of the pH value by ammonia radiolysis and to reduce C-14 production in reactor coolant from reaction with dissolved nitrogen. Also, the potassium-based water chemistry related to pH control for boron-free PWR plants was discussed. KOH has a potential as an alternative pH control agent for soluble boron-free PWR plants. The potassium-based water chemistry related to pH control is recommended for boron-free operation as follows

  8. Factors Influencing Prevention and Control of Malaria among ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    investigate factors that influence malaria prevention and control practices among pregnant ... treatment of clinical cases and the promotion of ... influence their decision regarding malaria ..... have the ability to purchase anti-malaria drugs that.

  9. Factors influencing the introduction of physical activity interventions in primary health care: a qualitative study.

    Science.gov (United States)

    Huijg, Johanna M; van der Zouwe, Nicolette; Crone, Mathilde R; Verheijden, Marieke W; Middelkoop, Barend J C; Gebhardt, Winifred A

    2015-06-01

    The introduction of efficacious physical activity (PA) interventions in routine primary health care (PHC) is a complex process. Understanding factors influencing the process can enhance the development of successful introduction strategies. The aim of this qualitative study was to explore stakeholders' perceptions on factors influencing the introduction, i.e., adoption, implementation, and continuation, of PA interventions in PHC. Twenty-eight semistructured interviews were held with intervention managers, PHC advisors, intervention providers, and referring general practitioners of five PA interventions delivered in PHC. A theoretical framework on the introduction of innovations in health care was used to guide the data collection. Influencing factors were identified using thematic analysis. Stakeholders reported preconditions for the introduction of PA interventions in PHC (e.g., support, resources, and networks and collaborations), in addition to characteristics of PA interventions (e.g., compatibility, flexibility, and intervention materials) and characteristics of PHC professionals (e.g., knowledge, positive attitudes, and beliefs about capabilities) perceived to enhance the introduction process. Furthermore, they proposed strategies for the development of PA interventions (e.g., involvement of future stakeholders, full development, and refinement) and strategies to introduce PA interventions in PHC (e.g., training, assistance, and reinforcement). The majority of the influencing factors were discussed specifically in relation to one or two stages. This study presents an overview of factors that are perceived to influence the introduction of PA interventions in PHC. It underscores the importance of taking these factors into account when designing introduction strategies and of giving special attention to the distinct stages of the process.

  10. Revisiting factors controlling methane emissions from high-Arctic tundra

    DEFF Research Database (Denmark)

    Mastepanov, M.; Sigsgaard, C.; Tagesson, T.

    2013-01-01

    controlling methane emission, i.e. temperature and water table position. Late in the growing season CH4 emissions were found to be very similar between the study years (except the extremely dry 2010) despite large differences in climatic factors (temperature and water table). Late-season bursts of CH4...... short-term control factors (temperature and water table). Our findings suggest the importance of multiyear studies with a continued focus on shoulder seasons in Arctic ecosystems....

  11. Human factors methods for nuclear control room design. Volume 2. Human factors survey of control room design practices

    International Nuclear Information System (INIS)

    Seminara, J.L.; Parsons, S.O.

    1979-11-01

    An earlier review of the control rooms of operating nuclear power plants identified many design problems having potential for degrading operator performance. As a result, the formal application of human factors principles was found to be needed. This report demonstrates the use of human factors in the design of power plant control rooms. The approaches shown in the report can be applied to operating power plants, as well as to those in the design stage. This study documents human factors techniques required to provide a sustained concern for the man-machine interface from control room concept definition to system implementation

  12. Development of a control logic for nuclear heating operation for primary system for SMART

    International Nuclear Information System (INIS)

    Seo, Jae Kwang; Kang, H. O.; Yoon, J. H.; Kim, K. K.; Lee, D. J.

    2000-11-01

    A nuclear heating concept is adopted in the SMART compared with the commercial nuclear power plant using the primary coolant pumps for heating the primary system. In this report, five options of heatup control logic are proposed and each option is evaluated using MMS code. In option 1, control rod is controlled by a signal of difference in require heatup rate (dT/dt)req. and actual heatup rate (dT/dt)act., which is calculated from the measured value of core outlet temperature. In option 2, control rod is controlled by a signal of difference in reference temperature and actual measured temperature. In option 3, control rod is controlled by a signal of difference in required core power Qcore and actual measured core power N. Primary side temperature difference in measured values between steam generator (SG) inlet and outlet is used in determining Qcore in option 3. Because of this dependency on difference in measured temperature Qcore, in conjunction with measurement channel error in temperature, involves certain uncertainty during specially low flow conditions where primary side temperature difference in SG inlet and outlet is very small. Option 4 is a modified version of option 3. In option 4, SG outlet temperature is not needed to calculate Qcore. However a compensating program which enable Qcore to be evaluated without SG outlet temperature is needed. In option 5, control rod is controlled by a signal of difference in required preset step core power Qcore and actual measured core power N. From the simulation results it is concluded that option 5 using step power setting during heatup operation is suitable for as a heatup control logic for SMART

  13. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care.

    Science.gov (United States)

    Prins, Marijn A; Verhaak, Peter F M; Smolders, Mirrian; Laurant, Miranda G H; van der Meer, Klaas; Spreeuwenberg, Peter; van Marwijk, Harm W J; Penninx, Brenda W J H; Bensing, Jozien M

    2010-07-01

    To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Seven hundred and twenty-one patients with a current anxiety or depressive disorder, recruited from 67 general practitioners (GPs), were included. Diagnoses according to the Diagnostic and Statistic Manual of Mental Disorders, fourth edition (DSM-IV) were made using a structured and widely validated assessment. Socio-demographic and enabling characteristics, severity of symptoms, disability, (under treatment for) chronic somatic conditions, perceived need for care, beliefs and evaluations of care were measured by questionnaires. Actual care data were derived from electronic medical records. Criteria for guideline-concordant care were based on general practice guidelines, issued by the Dutch College of General Practitioners. Two hundred and eighty-one (39%) patients received guideline-concordant care. High education level, accessibility of care, comorbidity of anxiety and depression, and severity and disability scores were positively associated with receiving guideline-concordant care in univariate analyses. In multivariate multi-level logistic regression models, significant associations with the clinical need factors disappeared. Positive evaluations of accessibility of care increased the chance (OR = 1.31; 95%-CI = 1.05-1.65; p = 0.02) of receiving guideline-concordant care, as well as perceiving any need for medication (OR = 2.99; 95%-CI = 1.84-4.85; p depression than clinical need factors. Initiatives to improve GPs' communication skills around mental health issues, and to improve recognition of people suffering from anxiety disorders, could increase the number of patients receiving treatment for depression and anxiety in primary care.

  14. [Detection of intimate partner violence in primary care and related factors].

    Science.gov (United States)

    Rodríguez-Blanes, Gloria M; Vives-Cases, Carmen; Miralles-Bueno, Juan José; San Sebastián, Miguel; Goicolea, Isabel

    Intimate partner violence (IPV) against women is a significant public health and human rights problem. Primary care professionals play a key role in detecting and addressing this issue. The aim of this study is to determine the frequency of IPV and its associated factors in primary care by means of a screening questionnaire and to describe the main actions taken in identified cases. Cross-sectional study in 15 health centres in four autonomous regions of Spain with a total of 265 health professionals. The information was collected through the self-administered PREMIS questionnaire (Physician Readiness to Manage Intimate Partner Violence Survey), which includes variables concerning screening questions, sociodemographic factors, level of training/knowledge about IPV, perceptions and actions. A descriptive and analytical study was conducted. 67.2% of participants said they ask about IPV during consultations. The most frequent actions were: referring patients to other departments, individual counselling and information delivery. ≥21hours of training, an advanced training level, knowledge of policies and programmes and the implementation of an appropriate protocol and reference resources were all factors that increased the likelihood of investigating IPV. The asking of questions increases in line with professionals' perceived level of training in IPV and the provision of a case management protocol. Two thirds of health professional respondents said they inquire about IPV. Given the influence of training in IPV and awareness of the resources to address the issue, it is essential to continue investing in the IPV training of healthcare personnel. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Factors Predictive of Sentinel Lymph Node Involvement in Primary Breast Cancer.

    Science.gov (United States)

    Malter, Wolfram; Hellmich, Martin; Badian, Mayhar; Kirn, Verena; Mallmann, Peter; Krämer, Stefan

    2018-06-01

    Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) for axillary staging in patients with early-stage breast cancer. The need for therapeutic ALND is the subject of ongoing debate especially after the publication of the ACOSOG Z0011 trial. In a retrospective trial with univariate and multivariate analyses, factors predictive of sentinel lymph node involvement should be analyzed in order to define tumor characteristics of breast cancer patients, where SLNB should not be spared to receive important indicators for adjuvant treatment decisions (e.g. thoracic wall irradiation after mastectomy with or without reconstruction). Between 2006 and 2010, 1,360 patients with primary breast cancer underwent SLNB with/without ALND with evaluation of tumor localization, multicentricity and multifocality, histological subtype, tumor size, grading, lymphovascular invasion (LVI), and estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 status. These characteristics were retrospectively analyzed in univariate and multivariate logistic regression models to define significant predictive factors for sentinel lymph node involvement. The multivariate analysis demonstrated that tumor size and LVI (pbreast cancer. Because of the increased risk for metastatic involvement of axillary sentinel nodes in cases with larger breast cancer or diagnosis of LVI, patients with these breast cancer characteristics should not be spared from SLNB in a clinically node-negative situation in order to avoid false-negative results with a high potential for wrong indication of primary breast reconstruction or wrong non-indication of necessary post-mastectomy radiation therapy. The prognostic impact of avoidance of axillary staging with SLNB is analyzed in the ongoing prospective INSEMA trial. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  16. Assessing Asthma control in UK primary care: Use of routinely collected prospective observational consultation data to determine appropriateness of a variety of control assessment models

    Directory of Open Access Journals (Sweden)

    Norman Paul D

    2011-09-01

    Full Text Available Abstract Background Assessing asthma control using standardised questionnaires is recommended as good clinical practice but there is little evidence validating their use within primary care. There is however, strong empirical evidence to indicate that age, weight, gender, smoking, symptom pattern, medication use, health service resource use, geographical location, deprivation, and organisational issues, are factors strongly associated with asthma control. A good control measure is therefore one whose variation is most explained by these factors. Method Eight binary (Yes = poor control, No = good control models of asthma control were constructed from a large UK primary care dataset: the Royal College of Physicians 3-Questions (RCP-3Qs; the Jones Morbidity Index; three composite measures; three single component models. Accounting for practice clustering of patients, we investigated the effects of each model for assessing control. The binary models were assessed for goodness-of-fit statistics using Pseudo R-squared and Akaikes Information Criteria (AIC, and for performance using Area Under the Receiver Operator Characteristic (AUROC. In addition, an expanded RCP-3Q control scale (0-9 was derived and assessed with linear modelling. The analysis identified which model was best explained by the independent variables and thus could be considered a good model of control assessment. Results 1,205 practices provided information on 64,929 patients aged 13+ years. The RCP-3Q model provided the best fit statistically, with a Pseudo R-squared of 18%, and an AUROC of 0.79. By contrast, the composite model based on the GINA definition of controlled asthma had a higher AIC, an AUROC of 0.72, and only 10% variability explained. In addition, although the Peak Expiratory Flow Rate (PEFR model had the lowest AIC, it had an AUROC of 71% and only 6% of variability explained. However, compared with the RCP-3Qs binary model, the linear RCP-3Q Total Score Model (Scale 0

  17. Socio-Economic Factors Affecting Parents' Involvement in Homework: Practices and Perceptions from Eight Johannesburg Public Primary Schools

    Science.gov (United States)

    Ndebele, Misheck

    2015-01-01

    This paper examines socio-economic factors influencing parental involvement in homework at the Foundation Phase in eight Johannesburg public primary schools. The research was conducted among over 600 parents from schools in different geographical and socio-economic areas such as the inner city, suburban and township. Two primary schools were…

  18. PMBLDC motor drive with power factor correction controller

    DEFF Research Database (Denmark)

    George, G.J.; Ramachandran, Rakesh; Arun, N.

    2012-01-01

    reliability, and low maintenance requirements. The proposed Power Factor Controller topology improves power quality by improving performance of PMBLDCM drive, such as reduction of AC main current harmonics, near unity power factor. PFC converter forces the drive to draw sinusoidal supply current in phase...

  19. Simplifying the audit of risk factor recording and control

    DEFF Research Database (Denmark)

    Zhao, Min; Cooney, Marie Therese; Klipstein-Grobusch, Kerstin

    2016-01-01

    BACKGROUND: To simplify the assessment of the recording and control of coronary heart disease risk factors in different countries and regions. DESIGN: The SUrvey of Risk Factors (SURF) is an international clinical audit. METHODS: Data on consecutive patients with established coronary heart disease...

  20. Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

    Science.gov (United States)

    Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

    2013-01-01

    Background Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. Methods One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. Results The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). Conclusion The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB. PMID:24098461

  1. Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.

    Science.gov (United States)

    Claassens, Mareli M; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J; Enarson, Donald A; Beyers, Nulda; Borgdorff, Martien W

    2013-01-01

    Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

  2. Comparison of pulsed fluoroscopy by direct control using a grid-controlled x-ray tube with pulsed fluoroscopy by primary control

    International Nuclear Information System (INIS)

    Chida, Koichi; Zuguchi, Masayuki; Ito, Daisuke; Sato, Kunihiko; Shimura, Hirotaka; Sasaki, Masatoshi

    2001-01-01

    Interventional radiology (IVR) procedures may involve high radiation doses that are potentially harmful to the patient. In IVR procedures, pulsed fluoroscopy can greatly decrease the radiation that the physician and patient receive. There are two types of pulsed fluoroscopy: direct control and primary (indirect) control. The purpose of this study was to compare pulsed fluoroscopy by direct control, using a grid-controlled x-ray tube, with pulsed fluoroscopy using primary control. For both types of pulsed fluoroscopy, we measured the waveforms (x-ray tube voltage, x-ray tube current, and x-ray output) and the relative radiation dose. In addition, we compared the decrease in radiation during pulsed fluoroscopy using a care filter. The studies were performed using a Siemens Bicor Plus x-ray System (direct control) and a Siemens Multistar Plus x-ray System (primary control). Using primary pulse control, a 50% decrease in the x-ray output waveform took approximately 0.5-1.0 msec, or longer with a lower x-ray tube current. Using direct pulse control, a 50% decrease in the x-ray output waveform took approximately 0.1 msec, and was independent of x-ray tube current. The rate of radiation reduction with primary pulse control using the care filter with a lower x-ray tube current had a slope exceeding 10%. Pulsed fluoroscopy by direct control using a grid-controlled x-ray tube permits an optimal radiation dose. To decrease the radiation in primary pulse control, a care filter must be used, particularly with a lower x-ray tube current. (author)

  3. Primary ventriculoperitoneal shunting outcomes: a multicentre clinical audit for shunt infection and its risk factors.

    Science.gov (United States)

    Woo, P Ym; Wong, H T; Pu, J Ks; Wong, W K; Wong, L Yw; Lee, M Wy; Yam, K Y; Lui, W M; Poon, W S

    2016-10-01

    To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors. This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture). Secondary endpoints were shunt malfunction, defined as unsatisfactory cerebrospinal fluid drainage that required shunt reinsertion, and 30-day mortality. A primary ventriculoperitoneal shunt was inserted in 538 patients during the study period. The mean age of patients was 48 years (range, 13-88 years) with a male-to-female ratio of 1:1. Aneurysmal subarachnoid haemorrhage was the most common aetiology (n=169, 31%) followed by intracranial tumour (n=164, 30%), central nervous system infection (n=42, 8%), and traumatic brain injury (n=27, 5%). The mean operating time was 75 (standard deviation, 29) minutes. Shunt reinsertion and infection rates were 16% (n=87) and 7% (n=36), respectively. The most common cause for shunt reinsertion was malfunction followed by shunt infection. Independent predictors for shunt infection were: traumatic brain injury (adjusted odds ratio=6.2; 95% confidence interval, 2.3-16.8), emergency shunting (2.3; 1.0-5.1), and prophylactic vancomycin as the sole antibiotic (3.4; 1.1-11.0). The 30-day all-cause mortality was 6% and none were directly procedure-related. This is the first Hong Kong

  4. [Human ecology and interdisciplinary cooperation for primary prevention of environmental risk factors for public health].

    Science.gov (United States)

    Dobrowolski, Jan W

    2007-01-01

    training activity in ecologically-based primary prevention. Training in this important field is not adequate in medical, technological, and also natural subjects of studies. There is not enough opportunity for education of the students and graduates toward the application of integrated system approach of new achievements in different sciences and technologies. Interesting are experiences connected with long-term case studies in highly polluted regions in Poland, Japan, India, as well as exchange of methodological experiences during the series of International Summer Schools on the Human Environment from 1972, as well as during series of 11 International Conferences on Sustainable Development organized at AGH-UST from 1989 to 2006 and Polish Conferences in 2004 and 2007. It seems necessary not only to develop a training of experts that would be adequate to present needs, but also education of the whole society (including formal activities at all levels of education) as well as informal education (e.g. at Open Universities and Distance Education, based on the Internet) to achieve the integration of activity of scientists, practitioners and the whole society. It would be useful to focus this activity on crucial problems and selected regions. Let me propose as the top priority for inhabitants of Tarnow region as well as pilot projects for Poland; utilization of all possible achievements of science and technology for primary prevention of health hazard for inhabitants of Gmina Szczucin that is very polluted by asbestos, and also model management reducing risk factors for the natural environment and health of inhabitants in the regions of new motor-ways, as well as better primary prevention against flood accidents and connected with their effects (higher humidity of housing environment and its contamination by toxinogenic moulds) risk factors for health of communities living in rivers regions. For the purpose of optimisation of preventive action, it is necessary not only to

  5. COMPLIANCE AS FACTORING BUSINESS RISK MANAGEMENT: CONTROL ASPECTS

    Directory of Open Access Journals (Sweden)

    V.K. Makarovych

    2016-03-01

    Full Text Available Indetermination of modern economy conditions and the lack of theoretical knowledge gained by domestic scientists about risk in factoring business actualize the research concerning the methodology and technique of factoring companies’ risk management. The article examines compliance which is the technology innovative for Ukrainian market of factoring risk management technologies. It is determined that the compliance is the risk management process directed to free will correspondence to state, international legislation as well as to the ethics standards accepted in the field of regulated legal relations and to the traditions of business circulation to sustain the necessary regulations and standards of market behaviour, and to consolidate the image of a factoring company. Compliance risks should be understood as the risks of missed profit or losses caused by the conflicts of interests and the discrepancy of employees’ actions to internal and external standard documents. The attention is paid to the control over the compliance. The author singles out 3 kinds of the compliance control such as institutional, operational and the compliance control over the observance of conducting business professional ethics regulations which are necessary for providing of efficient management of factoring business risks. The paper shows the organizing process of factoring business compliance control (by the development of internal standard documents, a compliance program, the foundation of compliance control subdivision, monitoring of the risks cause the choice, made by management entities of a factoring company, of the management methods of risks for their business. The development of new and improvement of existed forms of compliance control organizing process help satisfy users’ information needs and requests of the risk management factoring company department. The suggestions proposed create the grounds for the transformation and improvement of factoring

  6. Pediculosis capitis Among Primary School Children and Related Risk Factors in Urmia, the Main City of West Azarbaijan, Iran

    Directory of Open Access Journals (Sweden)

    K Hazrati Tappeh

    2012-06-01

    Full Text Available Background: Pediculosis capitis is cosmopolitan health problem. In addition to its physical problems, its psycho­logical effects especially on pupils are more important. This study was conducted to determine the Pediculosis capitis among primary school pupils and also find out the role of probable related risk factors in Urmia city, Iran 2010.Methods: 35 primary schools of Urmia City according to the defined clusters randomly have been selected during 2010. 2040 pupils (866 boys and 1174 girls were included and examined individually and privately by experts. Presence of adult or immature lice or having nits less than 1 cm from the hair basis were defined as positive.Data about demographic features and factors which their effect should be determined were recorded in standard questionnaire. Data were analyzed by SPSS software with proper statistical test.Results: Infestation was determined around 4%. Girls show significantly greater infestation. The availability of suit­able warm water for bathing and hair length (separately in girls and boys are significantly related to infestation load as well as infestation among different age groups.There was no significant relation between parent’s education and job and infestation as well as bathing repetition per week and the kind of energy source which they have. Also there is no significant correlation between educational grades and head lice infestation.Conclusion: The head louse pediculosis is a health problem and remains a health threatening for school chil­dren.Effective risk factors should be determined carefully and regionally. Proper training plays a great role in order to prevent and control the problem

  7. Evaluation of factors affecting adherence to asthma controller ...

    African Journals Online (AJOL)

    Evaluation of factors affecting adherence to asthma controller therapy in chest clinics in a sub-Saharan African setting: a cross-sectional study. ... Background: Adherence to controller therapy in asthma is a major concern during the management of the disease. Objective: To determine the adherence rate and identify the ...

  8. Antenatal risk factors for symptomatic congenital CMV disease following primary maternal CMV infection.

    Science.gov (United States)

    Hadar, Eran; Salzer, Liat; Dorfman, Elizabeta; Amir, Jacob; Pardo, Joseph

    2016-04-01

    This study aimed to evaluate antenatal risk factors associated with symptomatic congenital cytomegalovirus (CMV) disease, following in utero vertical infection. This study included a retrospective cohort of 155 neonates with congenital CMV infection, following primary maternal CMV infection during pregnancy, and were divided to symptomatic (n=95) and asymptomatic (n=60) newborns. Young maternal age (29.1±5.12 vs. 31.6±5.36 years, P=0.005), high risk occupation for viral exposure (20.0% vs. 11.7%, P=0.04), CMV IgG seroconversion at diagnosis (83.1% vs. 63.3%, P=0.005) and abnormal fetal MRI (11.6% vs. 0%, P=0.003) were found to be prognostic risk factors associated with symptomatic CMV disease of the newborn. Maternal febrile illness at diagnosis, IgG avidity, US findings and the timing of maternal infection were not associated with the occurrence of neonatal symptoms. Knowledge of the reported risk factors may assist in counseling parents with intra uterine CMV infection.

  9. On aging factors, aging mechanisms and their combinations in the primary circuit of NPPs

    International Nuclear Information System (INIS)

    Varga, T.; Brumovsky, M.

    1993-01-01

    Ageing is the dominating problem of elder nuclear power plant (NPP) components but still can not be neglected even for the newest ones. Ageing may express itself in different ways: irradiated steel parts may become embrittled, chromium alloy steels may decompose, fatigue life may become exhausted so that cracks may be formed and finally, corrosion attack may result in stress corrosion cracking. However, even synthetics and rubber parts may become inelastic, swell, shrink or crack, electric contacts may be oxydised, or isolations may lose their high electric resistance. Therefore, experts in the different components and their materials have collected and published not only plenty of observations, but also a number of more or less systematic approaches. A general picture, however, still seems to be lacking, due to the fact that ageing factors and mechanisms are not defined and used properly, i.e. - ageing factors act because of the service conditions of the components, as well as the characteristics of the materials which provoke ageing mechanisms - ageing mechanisms cause the changing of properties of the materials involved - combinations of single ageing mechanisms, which can be double, triple or multiple, change and accelerate the ageing process - the consequence of ageing mechanisms is the altering of the properties of the material depending on the lifetime. In this paper we shall try to show a systematic approach to a potential ageing analysis concerning the main metallic components of primary circuits of NPP's - connection between ageing factors, ageing mechanisms and their consequences/effects on component behaviour

  10. Risk factors associated with diabesity in primary school students in the Amazon region of Brazil

    Directory of Open Access Journals (Sweden)

    Maria Virgínia Filgueiras de Assis Mello

    2013-12-01

    Full Text Available Objective. Identifying risk factors for diabesity (diabetes plus obesity in primary students in the Brazilian Amazon. Methodology. Descriptive study carried out in 2009 with the participation of 1218 students. A questionnaire from the Ministry of Health of Brazil was employed with the question ''How is your diet?'' and a form was created to record the socio-demographic, clinical, anthropometric and food variables. Results. The mean age was 12 years and 57% were female. 64% of respondents reported no health problems, 37% had a family history of diabetes mellitus and 29% of students were overweight (17% overweight and 12% obese. A sedentary lifestyle was prevalent in the study group (70%. The dietary guidelines for consumption of fruits, vegetables, legumes, and complex carbohydrates are not properly fulfilled. Fast foods or 'junk' food was consumed by 43.5% of students. Conclusion. Most of the identified risk factors were related to unhealthy lifestyles that can lead to diabesity and other chronic non-communicable diseases. Identifying these factors allows planning nursing interventions for students, teachers and families.

  11. Cardiovascular Risk Factors in Primary Relatives of Sudden Cardiac Death Victims

    Science.gov (United States)

    1991-01-01

    hypertriglyceridemia and hypertension as risk factors in relatives of sudden death victims. The sample for both studies will be the same. 5 Chapter II The...provided most of the research information on SCD. Pathology of Sudden Cardiac Death There appear to be several different pathologic scenarios which render a...had severe two or three vessel disease. By comparison, 100 age matched controls who died of other causes, had a combined 27% incidence of two and

  12. Cost-effectiveness of primary offer of IVF vs. primary offer of IUI followed by IVF (for IUI failures) in couples with unexplained or mild male factor subfertility.

    Science.gov (United States)

    Pashayan, Nora; Lyratzopoulos, Georgios; Mathur, Raj

    2006-06-23

    In unexplained and mild male factor subfertility, both intrauterine insemination (IUI) and in-vitro fertilisation (IVF) are indicated as first line treatments. Because the success rate of IUI is low, many couples failing IUI subsequently require IVF treatment. In practice, it is therefore important to examine the comparative outcomes (live birth-producing pregnancy), costs, and cost-effectiveness of primary offer of IVF, compared with primary offer of IUI followed by IVF for couples failing IUI. Mathematical modelling was used to estimate comparative clinical and cost effectiveness of either primary offer of one full IVF cycle (including frozen cycles when applicable) or "IUI + IVF" (defined as primary IUI followed by IVF for IUI failures) to a hypothetical cohort of subfertile couples who are eligible for both treatment strategies. Data used in calculations were derived from the published peer-reviewed literature as well as activity data of local infertility units. Cost-effectiveness ratios for IVF, "unstimulated-IUI (U-IUI) + IVF", and "stimulated IUI (S-IUI) + IVF" were 12,600 pounds sterling, 13,100 pound sterling and 15,100 pound sterling per live birth-producing pregnancy respectively. For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, compared with primary offer of IVF, 6 cycles of "U-IUI + IVF" or of "S-IUI + IVF" would cost an additional 174,200 pounds sterling and 438,000 pounds sterling, representing an opportunity cost of 54 and 136 additional IVF cycles and 14 to 35 live birth-producing pregnancies respectively. For couples with unexplained and mild male factor subfertility, primary offer of a full IVF cycle is less costly and more cost-effective than providing IUI (of any modality) followed by IVF.

  13. Cost-effectiveness of primary offer of IVF vs. primary offer of IUI followed by IVF (for IUI failures in couples with unexplained or mild male factor subfertility

    Directory of Open Access Journals (Sweden)

    Lyratzopoulos Georgios

    2006-06-01

    Full Text Available Abstract Background In unexplained and mild male factor subfertility, both intrauterine insemination (IUI and in-vitro fertilisation (IVF are indicated as first line treatments. Because the success rate of IUI is low, many couples failing IUI subsequently require IVF treatment. In practice, it is therefore important to examine the comparative outcomes (live birth-producing pregnancy, costs, and cost-effectiveness of primary offer of IVF, compared with primary offer of IUI followed by IVF for couples failing IUI. Methods Mathematical modelling was used to estimate comparative clinical and cost effectiveness of either primary offer of one full IVF cycle (including frozen cycles when applicable or "IUI + IVF" (defined as primary IUI followed by IVF for IUI failures to a hypothetical cohort of subfertile couples who are eligible for both treatment strategies. Data used in calculations were derived from the published peer-reviewed literature as well as activity data of local infertility units. Results Cost-effectiveness ratios for IVF, "unstimulated-IUI (U-IUI + IVF", and "stimulated IUI (S-IUI + IVF" were £12,600, £13,100 and £15,100 per live birth-producing pregnancy respectively. For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, compared with primary offer of IVF, 6 cycles of "U-IUI + IVF" or of "S-IUI + IVF" would cost an additional £174,200 and £438,000, representing an opportunity cost of 54 and 136 additional IVF cycles and 14 to 35 live birth-producing pregnancies respectively. Conclusion For couples with unexplained and mild male factor subfertility, primary offer of a full IVF cycle is less costly and more cost-effective than providing IUI (of any modality followed by IVF.

  14. Human factors survey of advanced instrumentation and controls

    International Nuclear Information System (INIS)

    Carter, R.J.

    1989-01-01

    A survey oriented towards identifying the human factors issues in regard to the use of advanced instrumentation and controls (I ampersand C) in the nuclear industry was conducted. A number of United States (US) and Canadian nuclear vendors and utilities were participants in the survey. Human factors items, subsumed under the categories of computer-generated displays (CGD), controls, organizational support, training, and related topics, were discussed. The survey found the industry to be concerned about the human factors issues related to the implementation of advanced I ampersand C. Fifteen potential human factors problems were identified. They include: the need for an advanced I ampersand C guideline equivalent to NUREG-0700; a role change in the control room from operator to supervisor; information overload; adequacy of existing training technology for advanced I ampersand C; and operator acceptance and trust. 11 refs., 1 tab

  15. What should primary health care practitioners know about factors influencing young people’s food choices?

    Directory of Open Access Journals (Sweden)

    Louise Holmberg

    2010-04-01

    Full Text Available BackgroundTo identify factors that determine the nature and extent ofyoung consumers trust in food; sources of information whichinfluence young consumer food choices; and how trustimpacts on young people’s food choices.MethodIn-depth qualitative research interviews were conducted withyoung women and men, who are the primary food purchasersin their household (n=8ResultsFood choices of young adults were generally determined bycost and convenience. The overall perception was thatAustralian food regulation was effective and therefore, foodsafety need not be questioned. Health including long termhealth, although considered, was not central in food choicebehaviour. Trustworthy nutrition information sourcesincluded family and friends. While food labels were used theywere considered scientific and complex. The media and thefood industry were deemed to be untrustworthy informationsources.ConclusionCost and convenience were major determinants of foodchoice in this group of young people who generally lacked areflexive capacity with regards to food safety and health. Afailure to prioritise health raises questions regarding theengagement of young people in public health initiatives, andshould be of interest to primary health care practitioners.These data suggest that general practitioners should beaware that cost and convenience may take priority overhealth issues for young people. Further research isrequired to confirm the findings of this small study, withfuture studies aiming to include young people fromvarying socio-demographic backgrounds in order to gain amore comprehensive view of young people’s trust infood.

  16. Human factors evaluation of the engineering test reactor control room

    International Nuclear Information System (INIS)

    Banks, W.W.; Boone, M.P.

    1981-03-01

    The Reactor and Process Control Rooms at the Engineering Test Reactor were evaluated by a team of human factors engineers using available human factors design criteria. During the evaluation, ETR, equipment and facilities were compared with MIL-STD-1472-B, Human Engineering design Criteria for Military Systems. The focus of recommendations centered on: (a) displays and controls; placing displays and controls in functional groups; (b) establishing a consistent color coding (in compliance with a standard if possible); (c) systematizing annunciator alarms and reducing their number; (d) organizing equipment in functional groups; and (e) modifying labeling and lines of demarcation

  17. Preoperative diagnosis of N-factor by MR in primary lung cancer

    International Nuclear Information System (INIS)

    Akata, Soichi; Amino, Saburo; Abe, Kimihiko

    1993-01-01

    We compared the accuracies of preoperative diagnosis of N-factor by CT and MR in 71 cases of primary lung cancer. Lymph nodes larger than 10 mm in diameter were defined as positive. As a result, CT and MR both achieved an accuracy of more than 80%. MR was inefficient in detecting calcification and showed lower spatial resolution than CT; however, MR was useful in detecting hilar lymph nodes because of the signal loss of blood vessels. MR should be used to detect the contralateral hilar lymph nodes swelling because the sensitivity in the hilus is 20% higher in MR than in CT and the information about the contralateral hilar lymph nodes is more important than ipsilateral hilar lymph nodes for operation. (author)

  18. Dietary pattern and lifestyle factors in asthma control

    Directory of Open Access Journals (Sweden)

    Mohammed Noufal Poongadan

    2016-01-01

    Full Text Available Background: The prevalence of asthma in adults varied from 0.96% to 11.03% while in children ranged from 2.3% to 11.9% in India. A number of factors including genetic predisposition, environment, and lifestyle factors including dietary habits influence the development and expression of asthma. The goal of asthma treatment is to achieve and maintain clinical control, which can be achieved in a majority of patients with pharmacologic intervention strategy. Objective: To assess the role of diet and lifestyle factors in asthma control in Indian population. Materials and Methods: Diagnosed asthma patients (aged 12-40 years were enrolled from the outpatient clinics. All patients were followed up and reassessed after 4 weeks with asthma control test (ACT and dietary and lifestyle questionnaire. The assessment of dietary pattern was performed by food frequency questionnaire (Nordic Nutrition Recommendations-Danish Physical Activity Questionnaire. The lifestyle factor included body mass index, smoking status, tobacco chewing, alcohol consumption, duration of travel (h/week, mental stress (visual analog scale: 0-10, sports activity - h/day, television (TV watching/video games - h/day, duration of sleep - h/day. Results: Seventy-five asthma patients (43 males and 32 females were divided into three groups according to ACT, 18 (24% patients in poorly-controlled asthma, 35 (46.7% in well-controlled asthma, and 22 (29.3% patients with totally-controlled asthma. Increased consumption of vegetables and cereals in patients with total-controlled asthma while increased consumption of sugar, nonvegetarian, fast food, salted and fried snacks in patients with poorly-controlled asthma. Poorly-controlled asthma had the highest duration of watching TV and sleep and least duration of travel and sports, though the results failed to reach statistical significance. Conclusion: The dietary and lifestyle factors too contribute to degree of control of asthma in India.

  19. Evaluation of pN factors in patients with primary lung cancer by using perfusion, inhalation and ventilation studies

    International Nuclear Information System (INIS)

    Tamai, Toyosato; Tanabe, Masatada; Satoh, Katashi

    1987-01-01

    The interpretation of scintigraphic patterns and the role of pathophysiological mechanisms in patients with primary lung cancer were investigated. To determine the relative roles of perfusion, inhalation and ventilation scintigraphy, the relationship between the count ratio of the affected side to the healthy side and the post-surgical histological lymph nodes factors were observed in this study. These scintigraphic count ratio's in patients with primary lung cancer did not reflect the pN factors except in the perfusion study in patients with hilar primary lung cancer. (author)

  20. Topology identification for multiple-bus DC MicroGrids via primary control perturbations

    DEFF Research Database (Denmark)

    Angjelichinoski, Marko; Stefanovic, Cedomir; Popovski, Petar

    2017-01-01

    We propose a Least Squares Estimation procedure for estimating the admittance matrix of multi-bus DC MicroGrids (MGs). In the proposed solution, the generators simultaneously inject training signals in the form of small deterministic perturbations of the primary droop control parameters and measure...

  1. Aggregation of Plug-in Electric Vehicles in Power Systems for Primary Frequency Control

    NARCIS (Netherlands)

    Izadkhast, S.

    2017-01-01

    The number of plug-in electric vehicles (PEVs) is likely to increase in the near future and these vehicles will probably be connected to the electric grid most of the day time. PEVs are interesting options to provide a wide variety of services such as primary frequency control (PFC), because they

  2. Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa

    NARCIS (Netherlands)

    Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

    2013-01-01

    Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB

  3. Taking account of human factors in control-room design

    International Nuclear Information System (INIS)

    Dien, Y.; Montmayeul, R.

    1995-07-01

    Since the Three Mile Island accident two ways for improving the Human-Machine Interface have mainly been followed: the development of computerized operator aids in existing control-rooms and the design of advanced control-rooms. Insufficient attention paid to human factors in the design of operator aids has generally led to these aids being neglected or unused by their potential users. While for the design of advanced control-rooms efforts have been made for dealing with human factors in more extensive way. Based upon this experience, a general method for taking account of human factors in a control-room design has been devised and is described in this paper. (author)

  4. Optimal Control Method for Wind Farm to Support Temporary Primary Frequency Control with Minimized Wind Energy Cost

    DEFF Research Database (Denmark)

    Wang, Haijiao; Chen, Zhe; Jiang, Quanyuan

    2015-01-01

    This study proposes an optimal control method for variable speed wind turbines (VSWTs) based wind farm (WF) to support temporary primary frequency control. This control method consists of two layers: temporary frequency support control (TFSC) of the VSWT, and temporary support power optimal...... dispatch (TSPOD) of the WF. With TFSC, the VSWT could temporarily provide extra power to support system frequency under varying and wide-range wind speed. In the WF control centre, TSPOD optimally dispatches the frequency support power orders to the VSWTs that operate under different wind speeds, minimises...... the wind energy cost of frequency support, and satisfies the support capabilities of the VSWTs. The effectiveness of the whole control method is verified in the IEEE-RTS built in MATLABSimulink, and compared with a published de-loading method....

  5. Key factors determining success of primary eye care through vision centres in rural India: Patients′ perspectives

    Directory of Open Access Journals (Sweden)

    Vilas Kovai

    2012-01-01

    Full Text Available Aim : This paper intends to discuss the patients′ perspective on the determinants of primary eye care services from vision centers (VC in rural India. Materials and Methods : A retrospective study design and interview method was used on 127 randomly selected patients who accessed the 4 VCs in 2007. Factor analyses and linear regression models were used to predict the associations with patient satisfaction. Results : The three factors derived from factor analyses were: (1-vision technician (VT, (2-location of VC, and (3-access to VC; explaining 60% of the variance in total patients′ satisfaction with VC. The first model (R2 : 0.61; F 1,124=144.36, P <0.001, indicated that respondents who had ′difficulty to travel to the place of VC′ and those who can afford to pay had less satisfaction with VT services. The second model (R2 =0.18; F 1,124=29.5, P <0.001 explained that respondents′ difficulty to identify the building of VC had decreased patients′ satisfaction and the third model (R2 =0.36; F 1,124=45.6, P <0.001 indicated that those who had to travel<5 km to the VC and had 0.38 units of increased satisfaction level with the services of VC. Conclusion : A good VT can enhance patient satisfaction. However, patient expectations are not only confined to the provider but also other factors such as ability to pay and convenient transportation that helps patients reach the location of the VC with ease.

  6. Risk Factors for Primary Open-Angle Glaucoma in Western Turkey

    Directory of Open Access Journals (Sweden)

    Güliz Fatma Yavaş

    2013-04-01

    Full Text Available Pur po se: To evaluate the prevalence of primary open-angle glaucoma (POAG in subjects aged over 40 years in Western Turkey and to quantify its association with several systemic risk factors. Ma te ri al and Met hod: The research was conducted in Afyonkarahisar, a middle Anatolian city, between November 2005 and February 2006. A total of 1533 subjects aged 40 years or more were included in the study. Diabetes mellitus, hypertension, atherosclerotic cardiac disease, obesity, smoking, alcohol consumption, and dietary habitus (meat, chicken, and fish consumption were asked. Level of blood glucose, serum total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, very-low-density lipoprotein, Vitamin B12, and thyroid-stimulating-hormone were determined. Ophthalmic examination was performed, and intraocular pressure was measured by tonopen. Subjects with an IOP of 21 mmHg or more and/or with a cupping/disc ratio of 0.3 or more were told to come to the clinic for visual field analysis and gonioscopy. Subjects with a typical glaucomatous visual field defect and an open angle were recorded as POAG. Risk factors for POAG were determined by chi-square test. Re sults: Prevalence of POAG was found to be 2% (30 subjects and the only associated risk factor was age (p=0.05. Dietary habitus was also not associated with glaucoma (p>0.05. Dis cus si on: This study provides a population-based data about the prevalence and risk factors of POAG in Turkey. (Turk J Ophthalmol 2013; 43: 87-90

  7. Treatment of Advanced Glaucoma Study: a multicentre randomised controlled trial comparing primary medical treatment with primary trabeculectomy for people with newly diagnosed advanced glaucoma-study protocol.

    Science.gov (United States)

    King, Anthony J; Fernie, Gordon; Azuara-Blanco, Augusto; Burr, Jennifer M; Garway-Heath, Ted; Sparrow, John M; Vale, Luke; Hudson, Jemma; MacLennan, Graeme; McDonald, Alison; Barton, Keith; Norrie, John

    2017-10-26

    Presentation with advanced glaucoma is the major risk factor for lifetime blindness. Effective intervention at diagnosis is expected to minimise risk of further visual loss in this group of patients. To compare clinical and cost-effectiveness of primary medical management compared with primary surgery for people presenting with advanced open-angle glaucoma (OAG). Design : A prospective, pragmatic multicentre randomised controlled trial (RCT). Twenty-seven UK hospital eye services. Four hundred and forty patients presenting with advanced OAG, according to the Hodapp-Parish-Anderson classification of visual field loss. Participants will be randomised to medical treatment or augmented trabeculectomy (1:1 allocation minimised by centre and presence of advanced disease in both eyes). The primary outcome is vision-related quality of life measured by the National Eye Institute-Visual Function Questionnaire-25 at 24 months. Secondary outcomes include generic EQ-5D-5L, Health Utility Index-3 and glaucoma-related health status (Glaucoma Utility Index), patient experience, visual field measured by mean deviation value, logarithm of the mean angle of resolution visual acuity, intraocular pressure, adverse events, standards for driving and eligibility for blind certification. Incremental cost per quality-adjusted life-year (QALY) based on EQ-5D-5L and glaucoma profile instrument will be estimated. The study will report the comparative effectiveness and cost-effectiveness of medical treatment against augmented trabeculectomy in patients presenting with advanced glaucoma in terms of patient-reported health and visual function, clinical outcomes and incremental cost per QALY at 2 years. Treatment of Advanced Glaucoma Study will be the first RCT reporting outcomes from the perspective of those with advanced glaucoma. ISRCTN56878850, Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial

  8. Acupuncture to Treat Primary Dysmenorrhea in Women: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Caroline A. Smith

    2011-01-01

    Full Text Available We examined the effectiveness of acupuncture to reduce the severity and intensity of primary dysmenorrhea. A randomized controlled trial compared acupuncture with control acupuncture using a placebo needle. Eligible women were aged 14–25 years with a diagnosis of primary dysmenorrhea. Women received nine sessions of the study treatment over 3 months. The primary outcomes were menstrual pain intensity and duration, overall improvement in dysmenorrhea symptoms and reduced need for additional analgesia, measured at 3, 6 and 12 months from trial entry. A total of 92 women were randomly assigned to the intervention (acupuncture =46 and control =46. At 3 months although pain outcomes were lower for women in the acupuncture group compared with the control group, there was no significant difference between groups. Women receiving acupuncture reported a small reduction in mood changes compared with the control group, relative risk (RR 0.72, 95% confidence interval (CI 0.53–1.00, =.05. Follow-up at 6 months found a significant reduction in the duration of menstrual pain in the acupuncture group compared with the control group, mean difference –9.6, 95% CI –18.9 to –0.3, =.04, and the need for additional analgesia was significantly lower in the acupuncture group compared with the control group, RR 0.69, 95% CI 0.49–0.96, =.03, but the follow-up at 12 months found lack of treatment effect. To conclude, although acupuncture improved menstrual mood symptoms in women with primary dysmenorrhea during the treatment phase, the trend in the improvement of symptoms during the active phase of treatment, and at 6 and 12 months was non-significant, indicating that a small treatment effect from acupuncture on dysmenorrhea may exist. In the study, acupuncture was acceptable and safe, but further appropriately powered trials are needed before recommendations for clinical practice can be made.

  9. Evaluation of aldehyde dehydrogenase 1 and transcription factors in both primary breast cancer and axillary lymph node metastases as a prognostic factor.

    Science.gov (United States)

    Ito, Maiko; Shien, Tadahiko; Omori, Masako; Mizoo, Taeko; Iwamoto, Takayuki; Nogami, Tomohiro; Motoki, Takayuki; Taira, Naruto; Doihara, Hiroyoshi; Miyoshi, Shinichiro

    2016-05-01

    Aldehyde dehydrogenase 1 (ALDH1) is a marker of breast cancer stem cells, and the expression of ALDH1 may be a prognostic factor of poor clinical outcome. The epithelial-mesenchymal transition may produce cells with stem-cell-like properties promoted by transcription factors. We investigated the expression of ALDH1 and transcription factors in both primary and metastatic lesions, and prognostic value of them in breast cancer patients with axillary lymph node metastasis (ALNM). Forty-seven breast cancer patients with ALNM who underwent surgery at Okayama University Hospital from 2002 to 2008 were enrolled. We retrospectively evaluated the levels of ALDH1 and transcription factors, such as Snail, Slug and Twist, in both primary and metastatic lesions by immunohistochemistry. In primary lesions, the positive rate of ALDH1, Snail, Slug and Twist was 19, 49, 40 and 26%, respectively. In lymph nodes, that of ALDH1, Snail, Slug and Twist was 21, 32, 13 and 23%, respectively. The expression of ALDH1 or transcription factors alone was not significantly associated with a poor prognosis. However, co-expression of ALDH1 and Slug in primary lesions was associated with a shorter DFS (P = 0.009). The evaluation of the co-expression of ALDH1 and transcription factors in primary lesions may be useful in prognosis of node-positive breast cancers.

  10. Factors Associated with Long-Term Control of Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Mohammed Badedi

    2016-01-01

    Full Text Available Aims. This study assessed factors associated with glycemic control among Saudi patients with Type 2 diabetes mellitus (T2DM. Methods. We conducted an analytical cross-sectional study, which included a random sample of 288 patients with T2DM proportional to the diabetes population of each primary health care center in Jazan city, Kingdom of Saudi Arabia. Results. More than two-thirds (74% of patients had poor glycemic control. Lack of education, polypharmacy, and duration of diabetes ≥ 7 years were significantly associated with higher glycated hemoglobin (HbA1c. Moreover, patients who were smoker or divorced were significantly more likely to have higher HbA1c. The patients who did not comply with diet or take their medications as prescribed had poor glycemic control. The study found lower HbA1c levels among patients who received family support or had close relationship with their physicians. Similarly, knowledgeable patients towards diabetes or those with greater confidence in ability to manage self-care behaviors had a lower HbA1c. In contrast, risk factors such as depression or stress were significantly correlated with poorer glycemic control. Conclusion. The majority of T2DM patients had poor glycemic control. The study identified several factors associated with glycemic control. Effective and tailored interventions are needed to mitigate exposure to these risk factors. This would improve glycemic control and reduce the risks inherent to diabetes complications.

  11. Factors Associated with Long-Term Control of Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Badedi, Mohammed; Solan, Yahiya; Darraj, Hussain; Sabai, Abdullah; Mahfouz, Mohamed; Alamodi, Saleh; Alsabaani, Abdullah

    2016-01-01

    Aims. This study assessed factors associated with glycemic control among Saudi patients with Type 2 diabetes mellitus (T2DM). Methods. We conducted an analytical cross-sectional study, which included a random sample of 288 patients with T2DM proportional to the diabetes population of each primary health care center in Jazan city, Kingdom of Saudi Arabia. Results. More than two-thirds (74%) of patients had poor glycemic control. Lack of education, polypharmacy, and duration of diabetes ≥ 7 years were significantly associated with higher glycated hemoglobin (HbA1c). Moreover, patients who were smoker or divorced were significantly more likely to have higher HbA1c. The patients who did not comply with diet or take their medications as prescribed had poor glycemic control. The study found lower HbA1c levels among patients who received family support or had close relationship with their physicians. Similarly, knowledgeable patients towards diabetes or those with greater confidence in ability to manage self-care behaviors had a lower HbA1c. In contrast, risk factors such as depression or stress were significantly correlated with poorer glycemic control. Conclusion. The majority of T2DM patients had poor glycemic control. The study identified several factors associated with glycemic control. Effective and tailored interventions are needed to mitigate exposure to these risk factors. This would improve glycemic control and reduce the risks inherent to diabetes complications.

  12. A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

    OpenAIRE

    Noel Polly H; Culler Steven D; Pugh Jacqueline A; Parchman Michael L; Arar Nedal H; Romero Raquel L; Palmer Raymond F

    2008-01-01

    Abstract Background Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids – three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adapti...

  13. Incidence, Mortality, and Predictive Factors of Hepatocellular Carcinoma in Primary Biliary Cirrhosis

    Directory of Open Access Journals (Sweden)

    Kenichi Hosonuma

    2013-01-01

    Full Text Available Background. The study aims to analyze in detail the incidence, mortality using the standardized incidence ratio (SIR, and standardized mortality ratio (SMR of hepatocellular carcinoma (HCC in primary biliary cirrhosis (PBC, because no large case studies have focused on the detailed statistical analysis of them in Asia. Methods. The study cohorts were consecutively diagnosed at Gunma University and its affiliated hospitals. Age- or sex-specific annual cancer incidence and deaths were obtained from Japanese Cancer Registry and Death Registry as a reference for the comparison of SIR or SMR of HCC. Moreover, univariate analyses and multivariate analyses were performed to clarify predictive factors for the incidence of HCC. Results. The overall 179 patients were followed up for a median of 97 months. HCC had developed in 13 cases. SIR for HCC was 11.6 (95% confidence interval (CI, 6.2–19.8 and SMR for HCC was 11.2 (95% CI, 5.4–20.6 in overall patients. The serum albumin levels were a predictive factor for the incidence of HCC in overall patients. Conclusions. The incidence and mortality of HCC in PBC patients were significantly higher than those in Japanese general population. PBC patients with low serum albumin levels were populations at high risk for HCC.

  14. Prevalence and risk factors for allergic rhinitis in primary schoolchildren in Budapest.

    Science.gov (United States)

    Sultész, Monika; Katona, Gábor; Hirschberg, Andor; Gálffy, Gabriella

    2010-05-01

    There is growing evidence that the prevalence of allergic diseases is increasing, especially among children. The aim of this study was to evaluate the incidence and risk factors of allergic rhinitis in 6-12-year-old schoolchildren in Budapest. A total of 6335 children aged between 6 and 12 years attending 21 randomly selected primary schools in Budapest were surveyed in September 2007 by using a questionnaire consisting in part of questions compiled by the International Study of Asthma and Allergies in Childhood and in part of questions based on our own experience. 3933 of the questionnaires (1976 M/1957 F) were appropriately completed by the parents. The prevalence of current allergic rhinitis was 14.9% (n=530), that of physician-diagnosed allergic rhinitis was 11.6% (n=413), and that of cumulative allergic rhinitis was 26.5% (n=943). Male gender (pBudapest was 14.9%, which is higher than reported from other European countries. Our findings differ from those on other cohorts in that exposure to ragweed and to indoor environmental factors in concrete housing estates in Budapest may be of particular importance as concerns allergic sensitization. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  15. Factors associated with developing a fear of falling in subjects with primary open-angle glaucoma.

    Science.gov (United States)

    Adachi, Sayaka; Yuki, Kenya; Awano-Tanabe, Sachiko; Ono, Takeshi; Shiba, Daisuke; Murata, Hiroshi; Asaoka, Ryo; Tsubota, Kazuo

    2018-02-13

    To investigate the relationship between clinical risk factors, including visual field (VF) defects and visual acuity, and a fear of falling, among patients with primary open-angle glaucoma (POAG). All participants answered the following question at a baseline ophthalmic examination: Are you afraid of falling? The same question was then answered every 12 months for 3 years. A binocular integrated visual field was calculated by merging a patient's monocular Humphrey field analyzer VFs, using the 'best sensitivity' method. The means of total deviation values in the whole, superior peripheral, superior central, inferior central, and inferior peripheral VFs were calculated. The relationship between these mean VF measurements, and various clinical factors, against patients' baseline fear of falling and future fear of falling was analyzed using multiple logistic regression. Among 392 POAG subjects, 342 patients (87.2%) responded to the fear of falling question at least twice in the 3 years study period. The optimal regression model for patients' baseline fear of falling included age, gender, mean of total deviation values in the inferior peripheral VF and number of previous falls. The optimal regression equation for future fear of falling included age, gender, mean of total deviation values in the inferior peripheral VF and number of previous falls. Defects in the inferior peripheral VF area are significantly related to the development of a fear of falling.

  16. Factors influencing survival and recurrence-free intervals after treatment of primary breast cancer

    International Nuclear Information System (INIS)

    O'Higgins, N.; Brady, H.R.; Clark, C.G.

    1984-01-01

    A retrospective analysis of 739 patients with breast cancer is presented. Factors influencing overall survival, recurrence-free interval and survival after first recurrence are analysed and discussed. None of the factors was affected by age or menopausal status at the time of presentation. Overall survival and recurrence-free intervals varied significantly with tumour size, extent of nodal spread and tumour site. Medially situated tumours, large tumours and extensive nodal spread were associated with earlier first recurrence and poor prognosis. No difference in survival or recurrence-free interval was observed between different surgical operations. Although overall survival was longer in patients who received post-operative radiotherapy, no significant differences in survival or disease-free intervals were noted when patients were standardised for operation or tumour stage. Survival after local recurrence was longer than survival after distant metastases, although the time of onset of local and distant disease followed an identical pattern. These results suggest that the tumour characteristics of size, site and nodal spread are important determinants of survival and recurrence-free interval in primary breast cancer. Local recurrence should be regarded as a manifestation of systemic disease. (author)

  17. Factors affecting 18 F FDOPA standardized uptake value in patients with primary brain tumors after treatment

    International Nuclear Information System (INIS)

    Chiaravalloti, Agostino; Fiorentini, Alessandro; Villani, Veronica; Carapella, Carmine; Pace, Andrea; Di Pietro, Barbara; Di Russo, Carmen; Palumbo, Barbara; Floris, Roberto; Schillaci, Orazio

    2015-01-01

    Aim: To investigate the factors affecting 18 F FDOPA uptake in patients with primary brain tumors (PBT) after treatment. Materials and methods: 97 patients with PBT (6 were grade I, 40 were grade II, 29 were grade III and 22 were grade IV) underwent 18 F FDOPA positron emission tomography/computed tomography (PET/CT) after treatment. Intervals from surgery, chemotherapy (CHT) and radiotherapy (RT) were 41.48 (± 42.27), 16.04 (± 29.08) and 28.62 (± 34.49) months respectively. Results: 18 F FDOPA uptake in the site of recurrence was not related to the interval from surgery and CHT while a significant relationship has been found with the interval from RT and tumor grade. Conclusions: The results of our study show that the interval from RT and the grade of PBT should be considered carefully when evaluating brain PET/CT scans since these factors could directly affect 18 F FDOPA uptake

  18. Factors associated with dental caries in the primary dentition of children with cerebral palsy

    Directory of Open Access Journals (Sweden)

    Luana Leal Roberto

    2012-10-01

    Full Text Available The aim of this study was to investigate factors associated with caries experience in the primary dentition of one- to five-year-old children with cerebral palsy. A total of 266 dental records were examined, and caries experience was measured by dmft. The following variables were also analyzed: gender, oral hygiene, history of gastroesophageal reflux, use of medications for gastroesophageal reflux, gingival status, sugar intake and reports of polyuria, excessive thirst and xerostomia. For analysis purposes, the individuals were categorized as those with and without caries experience and subcategorized into the following age groups: one year; two to three years; and four to five years. After bivariate analysis, variables with a p-value < 0.25 were selected for incorporation into the Poisson regression models. Considering the limitations of the protocol, the level of oral hygiene perceived on the first appointment was the only factor associated with caries experience among two-to-fiveyear-old children with cerebral palsy.

  19. Experience in vibro-acoustic control of primary coolant circuit aggregates

    International Nuclear Information System (INIS)

    Sedov, V.K.; Adamenkov, K.A.

    1977-01-01

    Fundamental principles and possibilities of vibro-acoustic control of the primary coolant circuit in nuclear power plants for detecting failures (slack parts, penetration of foreign bodies, crack formation, etc.) are presented. As a result of pressure and flow rate fluctuations such failures give rise to characteristic changes in apmplitude and frequency of vibration and technological noise from the different aggregates with respect to a 'calibration' spectrum taken in the intact state. Nature and location of the failures may be determined by statistical analysis of the signals recorded from pressure and acceleration gauges. Certain parts of the primary circuit are controlled, especially the main circulation pumps. Additionally, neutron noise has been measured in order to control the core insertions. The method is illustrated by means of measurements performed in the units 1 to 4 of the Novovoronezh nuclear power plant during start-up operation and continuous operation. (author)

  20. Experience in vibro-acoustic control of primary coolant circuit aggregates

    Energy Technology Data Exchange (ETDEWEB)

    Sedov, V K; Adamenkov, K A [Nuclear power plant Novo-Voronesh (USSR)

    1977-10-01

    Fundamental principles and possibilities of vibro-acoustic control of the primary coolant circuit in nuclear power plants for detecting failures (slack parts, penetration of foreign bodies, crack formation, etc.) are presented. As a result of pressure and flow rate fluctuations such failures give rise to characteristic changes in apmplitude and frequency of vibration and technological noise from the different aggregates with respect to a 'calibration' spectrum taken in the intact state. Nature and location of the failures may be determined by statistical analysis of the signals recorded from pressure and acceleration gauges. Certain parts of the primary circuit are controlled, especially the main circulation pumps. Additionally, neutron noise has been measured in order to control the core insertions. The method is illustrated by means of measurements performed in the units 1 to 4 of the Novovoronezh nuclear power plant during start-up operation and continuous operation.

  1. Identification of risk factors for postoperative dysphagia after primary anti-reflux surgery.

    Science.gov (United States)

    Tsuboi, Kazuto; Lee, Tommy H; Legner, András; Yano, Fumiaki; Dworak, Thomas; Mittal, Sumeet K

    2011-03-01

    Transient postoperative dysphagia is not uncommon after antireflux surgery and usually runs a self-limiting course. However, a subset of patients report long-term dysphagia. The purpose of this study was to determine the risk factors for persistent postoperative dysphagia at 1 year after surgery. All patients who underwent antireflux surgery were entered into a prospectively maintained database. After obtaining institutional review board approval, the database was queried to identify patients who underwent primary antireflux surgery and were at least 1 year from surgery. Postoperative severity of dysphagia was evaluated using a standardized questionnaire (scale 0-3). Patients with scores of 2 or 3 were defined as having significant dysphagia. A total of 316 consecutive patients underwent primary antireflux surgery by a single surgeon. Of these, 219 patients had 1 year postoperative symptom data. Significant postoperative dysphagia at 1 year was reported by 19 (9.1%) patients. Thirty-eight patients (18.3%) required postoperative dilation for dysphagia. Multivariate logistic regression analysis identified preoperative dysphagia (odds ratio (OR), 4.4; 95% confidence interval (CI), 1.2-15.5; p = 0.023) and preoperative delayed esophageal transit by barium swallow (OR, 8.2; 95% CI, 1.6-42.2; p = 0.012) as risk factors for postoperative dysphagia. Female gender was a risk factor for requiring dilation during the early postoperative period (OR, 3.6; 95% CI, 1.3-10.2; p = 0.016). No correlations were found with preoperative manometry. There also was no correlation between a need for early dilation and persistent dysphagia at 1 year of follow-up (p = 0.109). Patients with preoperative dysphagia and delayed esophageal transit on preoperative contrast study were significantly more likely to report moderate to severe postoperative dysphagia 1 year after antireflux surgery. This study confirms that the manometric criteria used to define esophageal dysmotility are not reliable

  2. Feedback control of primary circulation pump of PIUS-Type reactor

    International Nuclear Information System (INIS)

    Fujii, Mikiya; Anoda, Yoshinari; Murata, Hideo; Yonomoto, Taisuke; Kukita, Yutaka; Tasaka, Kanji.

    1991-05-01

    In operating the PIUS-Type reactor, it is required to keep stationary density interfaces between the primary loop hot water and the poison tank cold, borated water by maintaining pressure balance between the primary-loop and the poison-tank. The authors have developed a primary circulation pump speed control system and tested it in small-scale experiments. This control system regulates the pump speed based on measurements of the density lock differential pressure which is proportional to the elevation of the interface in the density lock. This pump speed control facilitated the normal plant operation which included core power changes. However, the elevation of the density interface indicated oscillatory behavior when the pump speed was regulated as a linear function of the density lock differential pressure. The mechanism responsible for such oscillatory behavior was found to be manometric oscillations that could be eliminated by adding a damping term to compensate for the mechanical delay of the primary pump speed. The passive shutdown function of the reactor was retained by setting an upper limit to the pump speed. This was confirmed in a loss-of-feedwater abnormal transient test. (author)

  3. Clinical coaching in primary care: Capable of improving control in patients with type 2 diabetes mellitus?

    Science.gov (United States)

    González-Guajardo, Eduardo Enrique; Salinas-Martínez, Ana María; Botello-García, Antonio; Mathiew-Quiros, Álvaro

    2016-06-01

    Few clinical coaching studies are both endorsed by real cases and focused on reducing suboptimal diabetes control. We evaluated the effectiveness of coaching on improving type 2 diabetes goals after 3 years of implementation in primary care. A cross-sectional study with follow up was conducted during 2008-2011. Coaching consisted of guiding family doctors to improve their clinical abilities, and it was conducted by a medical doctor trained in skill building, experiential learning, and goal setting. Effectiveness was assessed by means of fasting plasma glucose and glycosylated hemoglobin outcomes. The main analysis consisted of 1×3 and 2×3 repeated measures ANOVAs. A significant coaching×time interaction was observed, indicating that the difference in glucose between primary care units with and without coaching increased over time (Wilks' lambda multivariate test, PCoaching increased 1.4 times (95%CI 1.3, 1.5) the possibility of reaching the fasting glucose goal after controlling for baseline values. There was also a significant improvement in glycosylated hemoglobin (Bonferroni-corrected p-value for pairwise comparisons, Pcoaching was found to be worth the effort to improve type 2 diabetes control in primary care. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  4. A smart rotary technique versus conventional pulpectomy for primary teeth: A randomized controlled clinical study.

    Science.gov (United States)

    Mokhtari, Negar; Shirazi, Alireza-Sarraf; Ebrahimi, Masoumeh

    2017-11-01

    Techniques with adequate accuracy of working length determination along with shorter duration of treatment in pulpectomy procedure seems to be essential in pediatric dentistry. The aim of the present study was to evaluate the accuracy of root canal length measurement with Root ZX II apex locator and rotary system in pulpectomy of primary teeth. In this randomized control clinical trial complete pulpectomy was performed on 80 mandibular primary molars in 80, 4-6-year-old children. The study population was randomly divided into case and control groups. In control group conventional pulpectomy was performed and in the case group working length was determined by electronic apex locator Root ZXII and instrumented with Mtwo rotary files. Statistical evaluation was performed using Mann-Whitney and Chi-Square tests ( P <0.05). There were no significant differences between electronic apex locator Root ZXII and conventional method in accuracy of root canal length determination. However significantly less time was needed for instrumenting with rotary files ( P =0.000). Considering the comparable results in accuracy of root canal length determination and the considerably shorter instrumentation time in Root ZXII apex locator and rotary system, it may be suggested for pulpectomy in primary molar teeth. Key words: Rotary technique, conventional technique, pulpectomy, primary teeth.

  5. Study of Factors Preventing Children from Enrolment in Primary School in the Republic of Honduras: Analysis Using Structural Equation Modelling

    Science.gov (United States)

    Ashida, Akemi

    2015-01-01

    Studies have investigated factors that impede enrolment in Honduras. However, they have not analysed individual factors as a whole or identified the relationships among them. This study used longitudinal data for 1971 children who entered primary schools from 1986 to 2000, and employed structural equation modelling to examine the factors…

  6. Factors Related to Soil Transmitted Helminth Infection on Primary School Children

    Directory of Open Access Journals (Sweden)

    Liena Sofiana

    2018-01-01

    Full Text Available ABSTRACT Infeksi Soil Transmitted Helminth (STH is the third ranks of the top 10 common infectious diseases in the world with an incidence rate of about 1.4 billion per year. The incidence of STH in Indonesia is still quite high. This figure occurs in primary school students of 60-80%, while for all ages of 40% -60%. The purpose of this study was to determine factors related to STH infection in elementary school children at primary school of Moyudan Sleman. The type of research used was analytic observational with the cross-sectional design. The population in this study were all students of class I, II, and III in Moyudan Sleman primary school with total sampling technique of 60 respondents. Data analysis used chi-square. The test results showed that the habit of hand washing before eating (sig= 0.010; RP= 3.850, the habit of hand washing  after defecating(sig= 0.007; RP= 4.571, nail hygiene (sig= 0.179; RP= 2.138, the habit of wearing footwear (sig= 0.008; RP= 3.714, and bowel habits (sig= 0.004; RP= 4.000. It can be concluded that there was a relationship between hand washing before eating, hand washing after defecating, the habit of wearing footwear, bowel habits and STH infection on the students of Moyudan Sleman primary school but there was no relationship between nail hygiene and STH infection. ABSTRAK Infeksi Soil Transmitted Helminth (STH adalah penyakit yang menempati urutan ketiga dari 10 penyakit menular di dunia dengan tingkat kejadian sekitar 1,4 miliar per tahun. Insiden STH di Indonesia masih cukup tinggi. Angka tersebut terjadi pada siswa di sekolah dasar mencapai 60-80%, sedangkan untuk semua usia berkisar antara 40%-60%. Tujuan dari penelitian ini adalah untuk mengetahui faktor yang berhubungan dengan infeksi STH pada anak sekolah dasar di SD Negeri Moyudan Sleman. Penelitian ini adalah observasional analitik dengan rancangan cross sectional. Populasi dalam penelitian ini adalah semua siswa kelas I, II, dan III di SD Moyudan

  7. Fast and Reliable Primary Frequency Reserves From Refrigerators with Decentralized Stochastic Control

    DEFF Research Database (Denmark)

    Vrettos, Evangelos; Ziras, Charalampos; Andersson, Goran

    2016-01-01

    in the controller to account for thermostat resolution limitations, and finally, we modify the control design to account for refrigerator door openings. Extensive simulations with actual frequency signal data and with different aggregation sizes, load characteristics, and control parameters, demonstrate......Due to increasing shares of renewable energy sources, more frequency reserves are required to maintain power system stability. In this paper, we present a decentralized control scheme that allows a large aggregation of refrigerators to provide Primary Frequency Control (PFC) reserves to the grid...... based on local frequency measurements and without communication. The control is based on stochastic switching of refrigerators depending on the frequency deviation. We develop methods to account for typical lockout constraints of compressors and increased power consumption during the startup phase...

  8. Digit ratio (2D:4D) in primary brain tumor patients: A case-control study.

    Science.gov (United States)

    Bunevicius, Adomas; Tamasauskas, Sarunas; Deltuva, Vytenis Pranas; Tamasauskas, Arimantas; Sliauzys, Albertas; Bunevicius, Robertas

    2016-12-01

    The second-to-fourth digit ratio (2D:4D) reflects prenatal estrogen and testosterone exposure, and is established in utero. Sex steroids are implicated in development and progression of primary brain tumors. To investigate whether there is a link between 2D:4D ratio and primary brain tumors, and age at presentation. Digital images of the right and left palms of 85 primary brain tumor patients (age 56.96±13.68years; 71% women) and 106 (age 54.31±13.68years; 68% women) gender and age matched controls were obtained. The most common brain tumor diagnoses were meningioma (41%), glioblastoma (20%) and pituitary adenoma (16%). Right and left 2D:4D ratios, and right minus left 2D:4D (D r-l ) were compared between patients and controls, and were correlated with age. Right and left 2D:4D ratios were significantly lower in primary brain tumor patients relative to controls (t=-4.28, pbrain tumor patients and controls (p=0.27). In meningioma and glioma patients, age at presentation correlated negatively with left 2D:4D ratio (rho=-0.42, p=0.01 and rho=-0.36, p=0.02, respectively) and positively with D r-l (rho=0.45, p=0.009 and rho=0.65, p=0.04, respectively). Right and left hand 2D:4D ratios are lower in primary brain tumor patients relative to healthy individuals suggesting greater prenatal testosterone and lower prenatal estrogen exposure in brain tumor patients. Greater age at presentation is associated with greater D r-l and with lower left 2D:4D ratio of meningioma and glioma patients. Due to small sample size our results should be considered preliminary and interpreted with caution. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Better than sham? A double-blind placebo-controlled neurofeedback study in primary insomnia.

    Science.gov (United States)

    Schabus, Manuel; Griessenberger, Hermann; Gnjezda, Maria-Teresa; Heib, Dominik P J; Wislowska, Malgorzata; Hoedlmoser, Kerstin

    2017-04-01

    See Thibault et al. (doi:10.1093/awx033) for a scientific commentary on this article.Neurofeedback training builds upon the simple concept of instrumental conditioning, i.e. behaviour that is rewarded is more likely to reoccur, an effect Thorndike referred to as the 'law of effect'. In the case of neurofeedback, information about specific electroencephalographic activity is fed back to the participant who is rewarded whenever the desired electroencephalography pattern is generated. If some kind of hyperarousal needs to be addressed, the neurofeedback community considers sensorimotor rhythm neurofeedback as the gold standard. Earlier treatment approaches using sensorimotor-rhythm neurofeedback indicated that training to increase 12-15 Hz sensorimotor rhythm over the sensorimotor cortex during wakefulness could reduce attention-deficit/hyperactivity disorder and epilepsy symptoms and even improve sleep quality by enhancing sleep spindle activity (lying in the same frequency range). In the present study we sought to critically test whether earlier findings on the positive effect of sensorimotor rhythm neurofeedback on sleep quality and memory could also be replicated in a double-blind placebo-controlled study on 25 patients with insomnia. Patients spent nine polysomnography nights and 12 sessions of neurofeedback and 12 sessions of placebo-feedback training (sham) in our laboratory. Crucially, we found both neurofeedback and placebo feedback to be equally effective as reflected in subjective measures of sleep complaints suggesting that the observed improvements were due to unspecific factors such as experiencing trust and receiving care and empathy from experimenters. In addition, these improvements were not reflected in objective electroencephalographic-derived measures of sleep quality. Furthermore, objective electroencephalographic measures that potentially reflected mechanisms underlying the efficacy of neurofeedback such as spectral electroencephalographic

  10. Factors leading to poor water sanitation hygiene among primary school going children in Chitungwiza

    Directory of Open Access Journals (Sweden)

    Blessing Dube

    2012-03-01

    Full Text Available Although the world has progressed in the area of water and sanitation, more than 2.3 billion people still live without access to sanitation facilities and some are unable to practice basic hygiene. Access to water and basic sanitation has deteriorated in Chitungwiza and children are at risk of developing illness and missing school due to the deterioration. We sought to investigate the predisposing, enabling and reinforcing factors that are causally related to water- and sanitation- related hygiene practices among school going children. A random sample of 400 primary school children (196 males, 204 females in four schools in Chitungwiza town, Zimbabwe was interviewed. Behavioural factors were assessed through cross examination of the PROCEED PRECEDE Model. The respondents had been stratified through the random sampling where strata were classes. A structured observation checklist was also administered to assess hygiene enabling facilities for each school. Children’s knowledge and perceptions were inconsistent with hygienic behaviour. The family institution seemed to play a more important role in life skills training and positive reinforcement compared to the school (50% vs 27.3%. There was no association between a child’s sex, age and parents’ occupation with any of the factors assessed (P=0.646. Schools did not provide a hygiene enabling environment as there were no learning materials, policy and resources on hygiene and health. The challenges lay in the provision of hygiene enabling facilities, particularly, the lack of access to sanitation for the maturing girl child and a school curriculum that provides positive reinforcement and practical life skills training approach.

  11. Human Factors Engineering Aspects of Modifications in Control Room Modernization

    Energy Technology Data Exchange (ETDEWEB)

    Hugo, Jacques [Idaho National Lab. (INL), Idaho Falls, ID (United States); Clefton, Gordon [Idaho National Lab. (INL), Idaho Falls, ID (United States); Joe, Jeffrey [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2017-06-01

    This report describes the basic aspects of control room modernization projects in the U.S. nuclear industry and the need for supplementary guidance on the integration of human factors considerations into the licensing and regulatory aspects of digital upgrades. The report pays specific attention to the integration of principles described in NUREG-0711 (Human Factors Engineering Program Review Model) and how supplementary guidance can help to raise general awareness in the industry regarding the complexities of control room modernization projects created by many interdependent regulations, standards and guidelines. The report also describes how human factors engineering principles and methods provided by various resources and international standards can help in navigating through the process of licensing digital upgrades. In particular, the integration of human factors engineering guidance and requirements into the process of licensing digital upgrades can help reduce uncertainty related to development of technical bases for digital upgrades that will avoid the introduction of new failure modes.

  12. Parental perception and factors associated with treatment strategies for primary nocturnal enuresis.

    Science.gov (United States)

    Tai, Thomson T; Tai, Brent T; Chang, Yu-Jun; Huang, Kuo-Hsuan

    2017-06-01

    The aim was to investigate the factors influencing parents seeking reasonable managements for their child and their overall outlook toward primary nocturnal enuresis (PNE). We recruited 93 children with PNE from enuresis clinics and requested their parents to complete questionnaires regarding their child's medical history and behavior, their methods for coping with PNE, and their perception of enuresis. Logistic regression models were applied to investigate factors influencing the parents to adopt a positive approach toward enuresis and to subsequently seek a medical consultation. One-third of the parents had an encouraging attitude toward children with PNE, whereas slightly less than half reacted with anger. The more educated the father or the younger the child with NE, the larger the possibility of the parents utilizing a positive approach, such as encouragement, for coping with NE. Factors that influenced parents to seek medical consultation for NE were socioeconomic status, maternal educational level, and the age and birth order of their child. From our results, angry and frustrated parents (43.0%) were significantly more likely to punish their child for bedwetting than were parents who approached NE positively (comfort and encouragement; 33.3%). A lack of encouragement may negatively affect the self-esteem of children with NE. Moreover, an individual's self-esteem or confidence, both of which can help them eliminate NE, determines the person's behavioral response to bedwetting. In our study, approximately 50% of the parents who approached NE positively (comfort and encouragement) or inconsistently (ambivalence) reported that they comforted their child after bedwetting. Nearly half the parents reacted angrily to children with NE, and some parents even punished their child. The parents' socioeconomic background, education, and the age and birth order of the child were the factors associated with their seeking active treatment for NE. A father's education and

  13. [Overweight in primary school-age children. Prevalence and risk factors].

    Science.gov (United States)

    Funk, M B; Bausback-Schomakers, S; Hanschmann, K M; Gerhards, B; Kuhn, K; Krackhardt, B

    2015-10-01

    Various studies show that pre-school age is a sensitive period for the development of overweight and obesity. During a longitudinal study between 2010 and 2013, the municipal health authority (city of Frankfurt) in cooperation with the university children's hospital investigated the development of weight in children aged 5 to 8. The weight and height of a collective of 5720 children were measured (2010/11). In addition, nutritional and exercise habits, as well as media consumption was documented for 4758 children through a questionnaire during the school enrolment procedure. The weight and height of 3481 children were measured again in the second grade (2012/13). Over a period of 24 months, the percentage of overweight (not obese) children increased from 7.5 to 9.4 % and that of obese children from 4.5 to 5.0 %. 164 of 2818 children with a normal initial weight (5.8 %) changed to percentile class overweight or obese. 79 of 260 children who were initially overweight, not obese (30 %), changed to the group of normal weight, but only 4 out of 156 obese children (3 %). Increased TV consumption (> 1 h per day), availability of their own television, lack of physical activity, and consumption of high-calorie drinks were risk factors for the development of overweight during the primary school age. 72 % of parents of overweight children and 22 % of obese children falsely classified their children as normal weight. Targeted education about the risk of obesity in the primary school age and offers for early intervention should be established in the healthcare services concerned.

  14. Elevated blood pressure among primary school children in Dar es salaam, Tanzania: prevalence and risk factors.

    Science.gov (United States)

    Muhihi, Alfa J; Njelekela, Marina A; Mpembeni, Rose N M; Muhihi, Bikolimana G; Anaeli, Amani; Chillo, Omary; Kubhoja, Sulende; Lujani, Benjamin; Maghembe, Mwanamkuu; Ngarashi, Davis

    2018-02-13

    Whilst the burden of non-communicable diseases is increasing in developing countries, little data is available on blood pressure among Tanzanian children. This study aimed at determining the blood pressure profiles and risk factors associated with elevated blood pressure among primary school children in Dar es Salaam, Tanzania. We conducted a cross sectional survey among 446 children aged 6-17 years from 9 randomly selected primary schools in Dar es Salaam. We measured blood pressure using a standardized digital blood pressure measuring machine (Omron Digital HEM-907, Tokyo, Japan). We used an average of the three blood pressure readings for analysis. Elevated blood pressure was defined as average systolic or diastolic blood pressure ≥ 90th percentile for age, gender and height. The proportion of children with elevated blood pressure was 15.2% (pre-hypertension 4.4% and hypertension 10.8%). No significant gender differences were observed in the prevalence of elevated BP. Increasing age and overweight/obese children were significantly associated with elevated BP (p = 0.0029 and p < 0.0001) respectively. Similar associations were observed for age and overweight/obesity with hypertension. (p = 0.0506 and p < 0.0001) respectively. In multivariate analysis, age above 10 years (adjusted RR = 3.63, 95% CI = 1.03-7.82) was significantly and independently associated with elevated BP in this population of school age children. We observed a higher proportion of elevated BP in this population of school age children. Older age and overweight/obesity were associated with elevated BP. Assessment of BP and BMI should be incorporated in school health program in Tanzania to identify those at risk so that appropriate interventions can be instituted before development of associated complications.

  15. Prediction factors for failure to seek treatment following traumatic dental injuries to primary teeth

    Directory of Open Access Journals (Sweden)

    Ramon Targino Firmino

    2014-06-01

    Full Text Available The objective of this study was to evaluate prediction factors for failure to seek treatment following a traumatic dental injury (TDI to primary teeth among preschool children in the city of Campina Grande, Brazil. A cross-sectional study was carried out involving 277 children 3 to 5 years of age, with TDI, enrolled in public and private preschools. Parents filled out a form addressing demographic data and whether or not they had sought treatment. Clinical examinations were performed by three dentists who had undergone a calibration exercise (Kappa: 0.85 to 0.90 for the evaluation of TDI. Bivariate and multivariate Poisson regression models were constructed (α = 5%. Enamel fracture was the most prevalent type of TDI (48.7% and the upper central incisors were the most affected teeth (88.4%. The frequency of seeking dental treatment was low (9.7%. The following variables were associated with failure to seek treatment following TDI: a household income greater than one minimum wage (PR = 1.170; 95%CI 1.018-1.341, parents/caregivers’ perception of a child’s oral health as poor (PR = 1.100; 95%CI 1.026-1.176, and the non-perception of TDI by parents/caregivers (PR = 1.250; 95%CI 1.142-1.360. In the present study, the frequency of seeking treatment following TDI was low, and parents/caregivers with a higher income, a poor perception of their child’s oral health and a lack of awareness regarding the trauma were more likely to fail to seek treatment following TDI to primary teeth.

  16. Factors that affect television viewing time in preschool and primary schoolchildren.

    Science.gov (United States)

    Songül Yalçin, Siddika; Tugrul, Belma; Naçar, NazIre; Tuncer, Murat; Yurdakök, Kadriye

    2002-12-01

    Excessive viewing of television (TV) has been linked to aggressive behavior, violence and childhood obesity. A cross-sectional study was conducted among preschool children and primary schoolchildren in Ankara during March and April 1999 to detect the factors that affect TV viewing time and to evaluate their parents' knowledge, attitudes and practices with regard to TV. The parents were asked to fill out a questionnaire about TV habits of their family, the number and location of TVs in the household and the effect of TV on children. Of 400 questionnaires, 350 answered the questions appropriately for this study. Children were divided into two groups, preschool children and primary schoolchildren. Television viewing time was given daily, as a mean of weekday. The mean age for becoming a TV viewer was 2.7 +/- 1.6 years. Of all, 62% of children spent >/= 2h/day watching TV and 8.3% of children spent > 4 h. The TV viewing time of child was significantly and positively correlated with that of siblings, mother and father for both groups. Age and sleeping time of the child, age and the education level of mother, presence of TV in the child's room and the starting age watching TV did not affect the viewing time. One-half of parents reported that the TV programs watched included violence, and one-third thought TV depicts child abuse, especially emotional abuse. It was found that the TV watching habits of parents had an influence on those of their children. Therefore, pediatricians should take 'TV histories' of children and their parents and educate parents how to become good TV viewers.

  17. Contribution of immunological and virological factors to extremely severe primary HIV-1 infection

    Science.gov (United States)

    Dalmau, Judith; Puertas, Maria Carmen; Azuara, Marta; Mariño, Ana; Frahm, Nicole; Mothe, Beatriz; Izquierdo-Useros, Nuria; Buzón, Maria José; Paredes, Roger; Matas, Lourdes; Allen, Todd M.; Brander, Christian; Rodrigo, Carlos; Clotet, Bonaventura; Martinez-Picado, Javier

    2009-01-01

    Background During acute HIV infection, high viral loads and the induction of host immune responses typically coincide with the onset of clinical symptoms. However, clinically severe presentations during acute HIV-1 infection, including AIDS-defining symptoms, are unusual. Methods Virus isolates were tested for clade, drug susceptibility, coreceptor usage, and growth rate for two cases of clinically severe sexual transmission. HLA genotype was determined, and HIV-1-specific CTL responses to an overlapping peptide set spanning the entire HIV clade A and clade B proteome were assayed. Results The virus isolated from the two unrelated cases of severe primary HIV-1 infection showed R5/X4 dual/mixed tropism, belonged to clade B and CRF02-AG, and were highly replicative in peripheral blood mononuclear cell culture. Impaired humoral responses were paralleled by a profound absence of HIV-1-specific CTL responses to the entire viral proteome in the two study cases. One case for which the virus source was available, showed a remarkable HLA similarity between the transmission pair as all 4 HLA-A and -B alleles were HLA supertype-matched between the subjects involved in the transmission case. Conclusions The data suggest that concurrence of viral and host factors contribute to the clinical severity of primary HIV-1 infection and that subjects infected with highly replicative dual tropic viruses are more prone to develop AIDS-defining symptoms during acute infection if they are unable to mount humoral and cellular HIV-1-specific immune responses. Concordant HLA supertypes might facilitate the preferential transmission of HLA-adapted viral variants, further accelerating disease progression. PMID:19093810

  18. BURNOUT SYNDROME, JOB SATISFACTION LEVELS AND RELATED FACTORS IN CENTRAL TRABZON PROVINCE PRIMARY HEALTH CENTER WORKERS

    Directory of Open Access Journals (Sweden)

    Asuman YAVUZYILMAZ

    2007-02-01

    Full Text Available Burnout manifests itself in individuals working in professions involving face-to-face contact with the public in depersonalization towards others, feelings of emotional exhaustion, and reduced feelings of personal achievement and adequacy. The objective in this study was to determine burnout and job satisfaction levels and related factors in primary health center personnel in the central part of the Turkish province of Trabzon. A total of 227 people working in central Trabzon province primary health centers participated in this cross-sectional study, a level of 90.4%. The Maslach Burnout Inventory was used to determine burnout level and the Job Satisfaction Inventory for job satisfaction. Burnout levels in health personnel were high among women (15.06±5.57, married individuals (14.80±5.65 and those dissatisfied with their working conditions (16.80±5.81; physicians (5.00±2.79, those without children (5.19±2.54, those whose spouses were not working (4.69±2.70 and smokers (4.71±3.29 had a high level of depersonalization; and married individuals were determined to have a low personal achievement level (10.24±4.14 (p=0.020, p=0.028, p=0.011, p=0.038, p=0.028, p=0.012 and p=0.010, respectively. In conclusion, gender, marital status, age, satisfaction with working conditions and income level were determined to be related to burnout and job satisfaction. [TAF Prev Med Bull 2007; 6(1.000: 41-50

  19. BURNOUT SYNDROME, JOB SATISFACTION LEVELS AND RELATED FACTORS IN CENTRAL TRABZON PROVINCE PRIMARY HEALTH CENTER WORKERS

    Directory of Open Access Journals (Sweden)

    Murat TOPBAS

    2007-02-01

    Full Text Available Burnout manifests itself in individuals working in professions involving face-to-face contact with the public in depersonalization towards others, feelings of emotional exhaustion, and reduced feelings of personal achievement and adequacy. The objective in this study was to determine burnout and job satisfaction levels and related factors in primary health center personnel in the central part of the Turkish province of Trabzon. A total of 227 people working in central Trabzon province primary health centers participated in this cross-sectional study, a level of 90.4%. The Maslach Burnout Inventory was used to determine burnout level and the Job Satisfaction Inventory for job satisfaction. Burnout levels in health personnel were high among women (15.06±5.57, married individuals (14.80±5.65 and those dissatisfied with their working conditions (16.80±5.81; physicians (5.00±2.79, those without children (5.19±2.54, those whose spouses were not working (4.69±2.70 and smokers (4.71±3.29 had a high level of depersonalization; and married individuals were determined to have a low personal achievement level (10.24±4.14 (p=0.020, p=0.028, p=0.011, p=0.038, p=0.028, p=0.012 and p=0.010, respectively. In conclusion, gender, marital status, age, satisfaction with working conditions and income level were determined to be related to burnout and job satisfaction. [TAF Prev Med Bull. 2007; 6(1: 41-50

  20. Rate and rhythm control strategies for apraxia of speech in nonfluent primary progressive aphasia.

    Science.gov (United States)

    Beber, Bárbara Costa; Berbert, Monalise Costa Batista; Grawer, Ruth Siqueira; Cardoso, Maria Cristina de Almeida Freitas

    2018-01-01

    The nonfluent/agrammatic variant of primary progressive aphasia is characterized by apraxia of speech and agrammatism. Apraxia of speech limits patients' communication due to slow speaking rate, sound substitutions, articulatory groping, false starts and restarts, segmentation of syllables, and increased difficulty with increasing utterance length. Speech and language therapy is known to benefit individuals with apraxia of speech due to stroke, but little is known about its effects in primary progressive aphasia. This is a case report of a 72-year-old, illiterate housewife, who was diagnosed with nonfluent primary progressive aphasia and received speech and language therapy for apraxia of speech. Rate and rhythm control strategies for apraxia of speech were trained to improve initiation of speech. We discuss the importance of these strategies to alleviate apraxia of speech in this condition and the future perspectives in the area.

  1. Rate and rhythm control strategies for apraxia of speech in nonfluent primary progressive aphasia

    Directory of Open Access Journals (Sweden)

    Bárbara Costa Beber

    Full Text Available ABSTRACT The nonfluent/agrammatic variant of primary progressive aphasia is characterized by apraxia of speech and agrammatism. Apraxia of speech limits patients' communication due to slow speaking rate, sound substitutions, articulatory groping, false starts and restarts, segmentation of syllables, and increased difficulty with increasing utterance length. Speech and language therapy is known to benefit individuals with apraxia of speech due to stroke, but little is known about its effects in primary progressive aphasia. This is a case report of a 72-year-old, illiterate housewife, who was diagnosed with nonfluent primary progressive aphasia and received speech and language therapy for apraxia of speech. Rate and rhythm control strategies for apraxia of speech were trained to improve initiation of speech. We discuss the importance of these strategies to alleviate apraxia of speech in this condition and the future perspectives in the area.

  2. Radon in indoor air of primary schools: determinant factors, their variability and effective dose.

    Science.gov (United States)

    Madureira, Joana; Paciência, Inês; Rufo, João; Moreira, André; de Oliveira Fernandes, Eduardo; Pereira, Alcides

    2016-04-01

    Radon is a radioactive gas, abundant in granitic areas, such as in the city of Porto at the north-east of Portugal. This gas is a recognized carcinogenic agent, being appointed by the World Health Organization as the leading cause of lung cancer after smoking. The aim of this preliminary survey was to determine indoor radon concentrations in public primary schools, to analyse the main factors influencing their indoor concentration levels and to estimate the effective dose in students and teachers in primary schools. Radon concentrations were measured in 45 classrooms from 13 public primary schools located in Porto, using CR-39 passive radon detectors for about 2-month period. In all schools, radon concentrations ranged from 56 to 889 Bq/m(3) (mean = 197 Bq/m(3)). The results showed that the limit of 100 Bq/m(3) established by WHO IAQ guidelines was exceeded in 92 % of the measurements, as well as 8 % of the measurements exceeded the limit of 400 Bq/m(3) established by the national legislation. Moreover, the mean annual effective dose was calculated as 1.25 mSv/y (ranging between 0.58 and 3.07 mSv/y), which is below the action level (3-10 mSv). The considerable variability of radon concentration observed between and within floors indicates a need to monitor concentrations in several rooms for each floor. A single radon detector for each room can be used, provided that the measurement error is considerably lower than variability of radon concentration between rooms. The results of the present survey will provide useful baseline data for adopting safety measures and dealing effectively with radiation emergencies. In particular, radon remediation techniques should be used in buildings located in the highest radon risk areas of Portugal. The results obtained in the current study concerning radon levels and their variations will be useful to optimize the design of future research surveys.

  3. Improving insomnia in primary care patients: A randomized controlled trial of nurse-led group treatment.

    Science.gov (United States)

    Sandlund, Christina; Hetta, Jerker; Nilsson, Gunnar H; Ekstedt, Mirjam; Westman, Jeanette

    2017-07-01

    Insomnia is a common health problem, and most people who seek help for insomnia consult primary care. In primary care, insomnia treatment typically consists of hypnotic drugs, although cognitive behavioral therapy for insomnia is the recommended treatment. However, such treatment is currently available to few primary care patients. To evaluate the effects of a group treatment program for insomnia led by nurses in primary care. were the Insomnia Severity Index, a 2-week sleep diary, and a questionnaire on frequency of hypnotic drug use. A randomized controlled trial with pre- and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group. Routine primary health care; 7 primary care centers in Stockholm, Sweden. Patients consulting primary care for insomnia were assessed for eligibility. To be included, patients had to have insomnia disorder and be 18 years or older. Patients were excluded if they if they worked night shifts or had severe untreated somatic and/or mental illness, bipolar disorder, or untreated sleep disorder other than insomnia. One-hundred and sixty-five patients 20 to 90 years were included. Most were women, and many had co-existing somatic and/or mental health problems. The post-treatment dropout rate was 20%. The intervention was a nurse-led group treatment for insomnia based on the techniques of cognitive behavioral therapy for insomnia. The nurses had 2days of training in how to deliver the program. Ninety patients were randomized to the intervention and 75 to the control group (treatment as usual). Data from 82 in the intervention and 71 in the control group were analyzed in accordance with intention-to-treat principles. Fifty-four of the 72 in the intervention group who participated in the group treatment program were followed up after 1year. Mean Insomnia Severity Index score decreased significantly from 18.4 to 10.7 after group treatment but remained unchanged after treatment as usual (17.0 to 16.6). The effect

  4. Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Jessie Nallely Zurita-Cruz

    Full Text Available Abstract Objectives: In prepubertal type 1 diabetic patients (DM1, the availability of an informal primary caregiver (ICP is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire, family functionality (family APGAR, support of another person in patient care, stress (Perceived Stress Scale, and socioeconomic status (Bronfman questionnaire. Multivariate logistic and linear regression analyses were performed. Results: The patients' median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06-151.9, p = 0.001. While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238-1.743, p = 0.011 and stress (β 1.918, 95% CI 1.10-2.736, p = 0.001 in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336-2.177, p = 0.008 were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.

  5. Transcription Factor Zbtb20 Controls Regional Specification of Mammalian Archicortex

    DEFF Research Database (Denmark)

    Rosenthal, Eva Helga

    2010-01-01

    Combinatorial expression of sets of transcription factors (TFs) along the mammalian cortex controls its subdivision into functional areas. Unlike neocortex, only few recent data suggest genetic mechanisms controlling the regionalization of the archicortex. TF Emx2 plays a crucial role in patterning...... later on becoming restricted exclusively to postmitotic neurons of hippocampus (Hi) proper, dentate gyrus (DG), and two transitory zones, subiculum (S) and retrosplenial cortex (Rsp). Analysis of Zbtb20-/- mice revealed altered cortical patterning at the border between neocortex and archicortex...

  6. Active Power Factor Correction Using a Sliding Mode Controller

    Directory of Open Access Journals (Sweden)

    Korhan KAYIŞLI

    2008-03-01

    Full Text Available In this paper, a sliding mode controller is designed for active shaping of the input current in the boost converter. Robustness of the designed controller is tested with variable output voltage references, different loads and network voltage variations. For the simulations, MATLAB/Simulink programme is used. From simulation results, the same phase was provided between input current and input voltage and nearly unity power factor was obtained.

  7. On frequency-weighted coprime factorization based controller reduction

    OpenAIRE

    Varga, Andras

    2003-01-01

    We consider the efficient solution of a class of coprime factorization based controller approximation problems by using frequency-weighted balancing related model reduction approaches. It is shown that for some special stability enforcing frequency-weights, the computation of the frequency-weighted controllability and observability grammians can be done by solving reduced order Lyapunov equations. The new approach can be used in conjunction with accuracy enhancing square-root and balancing-fr...

  8. Primary versus secondary closure of cutaneous abscesses in the emergency department: a randomized controlled trial.

    Science.gov (United States)

    Singer, Adam J; Taira, Breena R; Chale, Stuart; Bhat, Rahul; Kennedy, David; Schmitz, Gillian

    2013-01-01

    Cutaneous abscesses have traditionally been treated with incision and drainage (I&D) and left to heal by secondary closure. The objective was to compare the healing rates of cutaneous abscesses following I&D after primary or secondary closure. This was a randomized, controlled, trial, balanced by center, with blocked randomization created by a random-number generator. One urban and one suburban academic emergency department (ED) participated. Subjects were randomized to primary or secondary wound closure following I&D of the abscess. Main outcome measures were the percentage of healed wounds (wound was completely closed by visual inspection; a 40% difference in wound healing was sought) and overall failure rate (need for additional intervention including suture removal, additional drainage, antibiotics, or admission within 7 days after drainage). Fifty-six adult patients with simple localized cutaneous abscesses were included; 29 were randomized to primary closure, and 27 were randomized to secondary closure. Healing rates at 7 days were similar between the primary and secondary closure groups (69.6%, 95% confidence interval [CI] = 49.1% to 84.4% vs. 59.3%, 95% CI = 40.7% to 75.5%; difference 10.3%, 95% CI = -15.8% to 34.1%). Overall failure rates at 7 days were also similar between the primary and secondary closure groups (30.4%, 95% CI = 15.6% to 50.9% vs. 28.6%, 95% CI = 15.2% to 47.1%; difference 1.8%, 95% CI = -24.2% to 28.8%). The rates of wound healing and treatment failure following I&D of simple abscesses in the ED are similar after primary or secondary closure. The authors did not detect a difference of at least 40% in healing rates between primary and secondary closure. © 2013 by the Society for Academic Emergency Medicine.

  9. Potential risk factors for diabetic neuropathy: a case control study

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    Nooraei Mahdi

    2005-12-01

    Full Text Available Abstract Background Diabetes mellitus type II afflicts at least 2 million people in Iran. Neuropathy is one of the most common complications of diabetes and lowers the patient's quality of life. Since neuropathy often leads to ulceration and amputation, we have tried to elucidate the factors that can affect its progression. Methods In this case-control study, 110 diabetic patients were selected from the Shariati Hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS was used to differentiate cases from controls. The diagnosis of neuropathy was confirmed by nerve conduction studies (nerve conduction velocity and electromyography. The multiple factors compared between the two groups included consumption of angiotensin converting enzyme inhibitors (ACEI, blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality. Results Statistically significant relationships were found between neuropathy and age, gender, quality of diabetes control and duration of disease (P values in the order: 0.04, 0.04, Conclusion In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control reduces the incidence of neuropathy, slows its progression and improves the diabetic patient's quality of life. More attention must be paid to elderly male diabetic patients with poor diabetes control with regard to regular foot examinations and more practical education.

  10. Automatic control of the effluent turbidity from a chemically enhanced primary treatment with microsieving.

    Science.gov (United States)

    Väänänen, J; Memet, S; Günther, T; Lilja, M; Cimbritz, M; la Cour Jansen, J

    2017-10-01

    For chemically enhanced primary treatment (CEPT) with microsieving, a feedback proportional integral controller combined with a feedforward compensator was used in large pilot scale to control effluent water turbidity to desired set points. The effluent water turbidity from the microsieve was maintained at various set points in the range 12-80 NTU basically independent for a number of studied variations in influent flow rate and influent wastewater compositions. Effluent turbidity was highly correlated with effluent chemical oxygen demand (COD). Thus, for CEPT based on microsieving, controlling the removal of COD was possible. Thereby incoming carbon can be optimally distributed between biological nitrogen removal and anaerobic digestion for biogas production. The presented method is based on common automation and control strategies; therefore fine tuning and optimization for specific requirements are simplified compared to model-based dosing control.

  11. Brain-Derived Neurotrophic Factor in Patients with Primary Open-Angle Glaucoma and Age-related Cataract.

    Science.gov (United States)

    Shpak, Alexander A; Guekht, Alla B; Druzhkova, Tatiana A; Kozlova, Ksenia I; Gulyaeva, Natalia V

    2018-02-01

    To study brain-derived neurotrophic factor (BDNF) content in aqueous humor (AH), lacrimal fluid (LF), and blood serum (BS) in patients with age-related cataract and primary open-angle glaucoma (POAG). BDNF was studied in 57 patients with age-related cataract, 55 patients with POAG combined with cataract, and 29 healthy controls (one eye in each person). AH was sampled during cataract surgery. The levels of BDNF in LF and BS did not differ in cataract patients and controls. The concentration of BDNF (pg/mL) in patients with POAG and cataract was lower than in cataract patients in AH (35.2 ± 14.2 vs. 54.6 ± 29.6, P early POAG and relatively increased in the next stages of the disease, inversely correlating with visual field index (Pearson's correlation coefficient r = -0.404, P = 0.002) and average retinal nerve fiber layer thickness (r = -0.322, P = 0.018). BDNF contents in LF and BS were also the lowest in early POAG. BDNF in AH strongly correlated with its content in LF (r = 0.66, P early POAG and relative increase in the next stages of the disease. A strong correlation exists between BDNF contents in AH and LF.

  12. Factors controlling the geochemical evolution of fumarolic encrustations, Valley of Ten Thousand Smokes, Alaska

    Science.gov (United States)

    Kodosky, L.G.; Keith, T.E.C.

    1993-01-01

    Factor and canonical correlation analysis of geochemical data from eight fossil fumaroles suggest that six major factors controlled the formation and evolution of fumarolic encrustations on the 1912 ash-flow sheet in the Valley of Ten Thousand Smokes (VTTS). The six-factor solution model explains a large proportion (low of 74% for Ni to high of 99% for Si) of the individual element data variance. Although the primary fumarolic deposits have been degraded by secondary alteration reactions and up to 75 years of weathering, the relict encrustations still preserve a signature of vapor-phase element transport. This vapor-phase transport probably occurred as halide or oxyhalide species and was significant for As, Sb and Br. At least three, and possibly four, varied temperature leaching events affected the fumarolic deposits. High-temperature gases/liquids heavily altered the ejecta glass and mineral phases adjacent to the fumarolic conduit. As the fumaroles cooled. Fe-rich acidic condensate leached the ejecta and primary fumarolic deposits and resulted in the subsequent precipitation of Fe-hydroxides and/or Fe-oxides. Low- to ambient-temperature leaching and hydration reactions generated abundant hydrated amorphous phases. Up to 87% of the individual element data variance is apparently controlled by the chemistry of the ejecta on which the relict encrustations are found. This matrix chemistry factor illustrates that the primary fumarolic minerals surrounding the active VTTS vents observed by earlier workers have been effectively removed by the dissolution reactions. Element enrichment factors calculated for the VTTS relict encrustations support the statistical factor interpretations. On the average, the relict encrustations are enriched, relative to visibly unaltered matrix protolith, in As, Br, Cr, Sb, Cu, Ni, Pb, Fe, and LOI (an indirect measure of sample H2O content). ?? 1993.

  13. Factors Related to the Work Performance of Midwives in the IUD Contraception Service in Primary Healthcare Centers of Surabaya City

    OpenAIRE

    Anggasari, Yasi; Kartasurya, Martha Irene; Suparwati, Anneke

    2013-01-01

    The decrease of IUD active family planning participants' coverage in Surabaya in the last three years, from 12.27% to 6.1%, became a special attention for Surabaya district health office. The decrease was caused by inadequate work performance of midwives in implementing IUD contraception service in the primary healthcare centers in Surabaya area. Objective of the study was to analyze factors related to the work performance of midwives in the IUD contraception service in the primary healthcare...

  14. Prevalence and factors associated with breast milk donation in banks that receive human milk in primary health care units,

    OpenAIRE

    Meneses, Tatiana Mota Xavier de; Oliveira, Maria Inês Couto de; Boccolini, Cristiano Siqueira

    2017-01-01

    Abstract Objective: To estimate the prevalence and to analyze factors associated with breast milk donation at primary health care units in order to increase the human milk bank reserves. Methods: Cross-sectional study carried out in 2013 in Rio de Janeiro, Brazil. A representative sample of 695 mothers of children younger than 1 year attended to at the nine primary health care units with human milk donation services were interviewed. A hierarchical approach was used to obtain adjusted preva...

  15. Prevalence and factors associated with breast milk donation in banks that receive human milk in primary health care units

    OpenAIRE

    Tatiana Mota Xavier de Meneses; Maria Inês Couto de Oliveira; Cristiano Siqueira Boccolini

    2017-01-01

    Abstract Objective: To estimate the prevalence and to analyze factors associated with breast milk donation at primary health care units in order to increase the human milk bank reserves. Methods: Cross-sectional study carried out in 2013 in Rio de Janeiro, Brazil. A representative sample of 695 mothers of children younger than 1 year attended to at the nine primary health care units with human milk donation services were interviewed. A hierarchical approach was used to obtain adjusted preva...

  16. Factors Associated With Medication-Overuse Headache in Patients Seeking Treatment for Primary Headache.

    Science.gov (United States)

    Peck, Kelly R; Roland, Malcolm M; Smitherman, Todd A

    2018-03-09

    Although risk factors for medication-overuse headache have been identified within the general population, most studies have neglected clinical samples. The present study examined the relative and combined associations of these factors with medication-overuse headache in a sample of US adults seeking treatment for primary headache disorders. Treatment-seeking headache patients provided data on demographics, headache variables, psychiatric variables, use of headache medications, and use of other prescription medications and substances. A classification tree selection strategy was utilized within this cross-sectional study to differentiate between those with and without medication-overuse headache, and a final multivariable model assessed their combined utility. Forty-three of 164 participants (26.2%) met diagnostic criteria for medication-overuse headache. Relative to non-medication-overuse headache participants, participants with medication-overuse headache reported greater headache-related disability (odds ratio = 1.09, 95% confidence interval = 1.01-1.18), escape and avoidance responses indicative of fear of pain (odds ratio = 1.07, 95% confidence interval = 1.00-1.15), and use of combination medications for headache (odds ratio = 3.10, 95% confidence interval = 1.51-6.36). The final multivariable model differentiated well between the 2 groups (area under the receiver operating characteristic curve = .78; 95% confidence interval = .71-.86). Items that assess headache-related disability, use of combination medications, and fear of pain help identify patients who are currently overusing acute headache medications and may serve as indicators of treatment progress. Future studies should apply similar analytic approaches longitudinally to identify headache sufferers at risk for medication-overuse headache prior to headache progression. © 2018 American Headache Society.

  17. Surveillance of primary sclerosing cholangitis with ERC and brush cytology: risk factors for cholangiocarcinoma.

    Science.gov (United States)

    Boyd, Sonja; Mustonen, Harri; Tenca, Andrea; Jokelainen, Kalle; Arola, Johanna; Färkkilä, Martti A

    2017-02-01

    Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease leading to bile duct strictures and fibrosis, and predisposing to cholangiocarcinoma (CCA). Biliary dysplasia is a known precursor of CCA. In our unit, PSC patients undergo regular surveillance with ERC and brush cytology (BC), and liver transplantation is an option in case with biliary dysplasia. We evaluated the risk factors for biliary dysplasia and CCA based on ERC imaging, BC and liver function tests. Seven hundred and eighty-eight ERCs were performed with BC for 447 PSC patients. ERC images were evaluated using the modified Amsterdam score, neutrophilic inflammation was assessed in BC, and liver function tests were collected. Ploidy analysis with DNA flow cytometry was performed in cases with advanced PSC or previous suspicious BC/aneuploidy. The endpoint was either a benign disease course (follow-up for ≥2.4 years after the latest ERC), benign histology, biliary dysplasia or CCA. Benign disease course was seen in 424/447 (including 23 cases with biliary dysplasia), and CCA in 17 (3.8%) patients. Gallbladder carcinoma/carcinoma in situ was diagnosed in three patients. Advanced ERC findings, male gender, suspicious BC, aneuploidy in flow cytometry, inflammation, and elevation of ALP, bilirubin, ALT, AST, GGT, CEA and CA19-9 represented significant risk factors for CCA in univariate analysis. PSC patients with advanced bile duct disease and elevated liver enzymes, CEA or CA19-9, inflammation or suspicious BC are most likely to develop CCA. These patients may benefit from surveillance with BC if early liver transplantation is possible.

  18. Outcome and risk factors of recurrence after thoracoscopic bullectomy in young adults with primary spontaneous pneumothorax.

    Science.gov (United States)

    Nakayama, Takashi; Takahashi, Yusuke; Uehara, Hirofumi; Matsutani, Noriyuki; Kawamura, Masafumi

    2017-07-01

    To investigate the risk factors of recurrence of pneumothorax following thoracoscopic bullectomy in young adults. Between January, 2005 and September, 2015, 167 patients aged ≤40 years underwent initial thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) at our hospital. Recurrence-free probability was calculated from the date of surgery to recurrence or last follow-up, using the Kaplan-Meier method. Sixteen (9.6%) of the 167 patients suffered a recurrence (collective total, 16 recurrences). The recurrence-free intervals were 3-107 months (median 25.8 months), and the 5-year recurrence-free probability was 85.9%. Multivariate Cox analysis demonstrated that age ≤23 years (p = 0.029) and a history of ipsilateral pneumothorax before surgery (p = 0.029) were significantly associated with higher risk of recurrence. The 5-year recurrence-free probability was 72.3% for patients aged ≤23 years and a history of ipsilateral pneumothorax before surgery and 94.1% for those with neither of these factors (p = 0.001). Recurrence developed within 3 years after surgery in 14 of the 16 patients. Patients ≤23 years of age with a history of ipsilateral pneumothorax before surgery are at significantly high risk of its recurrence, frequently within 3 years; thus, the risk of postoperative recurrence of a pneumothorax must be kept in mind.

  19. Factors influencing referral of patients with voice disorders from primary care to otolaryngology.

    Science.gov (United States)

    Cohen, Seth M; Kim, Jaewhan; Roy, Nelson; Courey, Mark

    2014-01-01

    To evaluate the frequency, timing, and factors that influence referral of patients with laryngeal/voice disorders to otolaryngology following initial evaluation by a primary care physician (PCP). Retrospective analysis of a large, national administrative US claims database. Patients with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by a PCP as an outpatient (with or without otolaryngology involvement), and continuously enrolled for 12 months were included. Patient age, gender, geographic region, last PCP laryngeal diagnosis, comorbid conditions, time from first PCP visit to first otolaryngology visit, number of PCP outpatient visits, and number of PCP laryngeal diagnoses were collected. Cox and generalized linear regressions were performed. A total of 149,653 unique patients saw a PCP as an outpatient for a laryngeal/voice disorder, with 136,152 (90.9%) only seeing a PCP, 6,013 (4.0%) referred by a PCP to an otolaryngologist, and 3,820 (2.6%) self-referred to an otolaryngologist. Acute laryngitis had a lower hazard ratio (HR) for otolaryngology referral than chronic laryngitis, nonspecific dysphonia, and laryngeal cancer. Having multiple comorbid conditions was associated with a greater HR for otolaryngology referral than having no comorbidities. Patient age, gender, and geographic region also affected otolaryngology referral. The time to otolaryngology evaluation ranged from 3 months. PCP-referred patients had less time to the otolaryngology evaluation than self-referred patients. Multiple factors affected otolaryngology referral for patients with laryngeal/voice disorders. Further education of PCPs regarding appropriate otolaryngology referral for laryngeal/voice disorders is needed. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Incidence of dental caries in primary dentition and risk factors: a longitudinal study.

    Science.gov (United States)

    Corrêa-Faria, Patrícia; Paixão-Gonçalves, Suzane; Paiva, Saul Martins; Pordeus, Isabela Almeida

    2016-05-20

    The objectives of this prospective, longitudinal, population-based study were to estimate the incidence of dental caries in the primary dentition, identify risk factors and determine the proportion of children receiving dental treatment, through a two-year follow up. The first dental exam was conducted with 381 children aged one to five years, at health centers during immunization campaigns; 184 of them had dental caries and 197 had no caries experience. The second exam was carried out two years later at a nursery or at home with the same individuals who participated in the first exam. The diagnosis of dental caries was performed using the dmft criteria. Parents were interviewed regarding socioeconomic indicators. Descriptive, bivariate and adjusted Poisson regression analyses were performed. Among the 381 children, 234 were reexamined after two years (non-exposed: 139; exposed: 95). The overall incidence of dental caries was 46.6%. The greatest incidence of dental caries was found in the group of children with previous caries experience (61.1%). Among the children without dental caries in the first exam, 36.7% exhibited caries in the second exam. The majority of children (72.6%) received no treatment for carious lesions in the two-year interval between examinations. Children with previous dental caries (RR: 1.52, 95%CI: 1.12-2.05) had a greater risk of developing new lesions, compared with the children without previous dental caries. The incidence of dental caries was high and most of children's caries were untreated. Previous caries experience is a risk factor for developing new carious lesions in children.

  1. Perinatal mortality and associated risk factors: a case control study ...

    African Journals Online (AJOL)

    BACKGROUND: Perinatal mortality is reported to be five times higher in developing than in developed nations. Little is known about the commonly associated risk factors for perinatal mortality in Southern Nations National Regional State of Ethiopia. METHODS: A case control study for perinatal mortality was conducted in ...

  2. Factors affecting sustainable animal trypanosomosis control in parts ...

    African Journals Online (AJOL)

    This study examined the factors affecting sustainable trypanosomiasis control in parts of Kaduna State within the sub-humid savannah ecological zone of Nigeria. Focus group discussions were ... More awareness and preference for pour-on and aerial spraying were higher than the use of traps, target or screens. Rearing of ...

  3. Physiology and Endocrinology Symposium. Factors controlling puberty in beef heifers

    Science.gov (United States)

    The Physiology and Endocrinology Symposium on “Factors controlling puberty in beef heifers” was held at the joint annual meeting of the American Dairy Science Association and the American Society of Animal Science in New Orleans, Louisiana, USA, July 10 to 14, 2011. The objective of the symposium w...

  4. Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa

    OpenAIRE

    Ojji, Dike B; Ojji, Dike B Ojji; Lamont, Kim; Sliwa, Karen; Ojji, Olubunmi I; Egenti, Bibiana Nonye; Sliwa, Karen

    2017-01-01

    Summary Cardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemic heart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub- Saharan A...

  5. The Centers for Disease Control program to prevent primary and secondary disabilities in the United States.

    OpenAIRE

    Houk, V N; Thacker, S B

    1989-01-01

    The Disabilities Prevention Program builds on traditional Centers for Disease Control (CDC) strengths in public health surveillance, epidemiology, and technology transfer to State and local governments in translating the findings of research into prevention programs. The objectives of the CDC program are to provide a national focus for the prevention of primary and secondary disabilities, build capacity at the State and community levels to maintain programs to prevent disabilities, and increa...

  6. Effects of a Video on Organ Donation Consent Among Primary Care Patients: A Randomized Controlled Trial.

    Science.gov (United States)

    Thornton, J Daryl; Sullivan, Catherine; Albert, Jeffrey M; Cedeño, Maria; Patrick, Bridget; Pencak, Julie; Wong, Kristine A; Allen, Margaret D; Kimble, Linda; Mekesa, Heather; Bowen, Gordon; Sehgal, Ashwini R

    2016-08-01

    Low organ donation rates remain a major barrier to organ transplantation. We aimed to determine the effect of a video and patient cueing on organ donation consent among patients meeting with their primary care provider. This was a randomized controlled trial between February 2013 and May 2014. The waiting rooms of 18 primary care clinics of a medical system in Cuyahoga County, Ohio. The study included 915 patients over 15.5 years of age who had not previously consented to organ donation. Just prior to their clinical encounter, intervention patients (n = 456) watched a 5-minute organ donation video on iPads and then choose a question regarding organ donation to ask their provider. Control patients (n = 459) visited their provider per usual routine. The primary outcome was the proportion of patients who consented for organ donation. Secondary outcomes included the proportion of patients who discussed organ donation with their provider and the proportion who were satisfied with the time spent with their provider during the clinical encounter. Intervention patients were more likely than control patients to consent to donate organs (22 % vs. 15 %, OR 1.50, 95%CI 1.10-2.13). Intervention patients were also more likely to have donation discussions with their provider (77 % vs. 18 %, OR 15.1, 95%CI 11.1-20.6). Intervention and control patients were similarly satisfied with the time they spent with their provider (83 % vs. 86 %, OR 0.87, 95%CI 0.61-1.25). How the observed increases in organ donation consent might translate into a greater organ supply is unclear. Watching a brief video regarding organ donation and being cued to ask a primary care provider a question about donation resulted in more organ donation discussions and an increase in organ donation consent. Satisfaction with the time spent during the clinical encounter was not affected. clinicaltrials.gov Identifier: NCT01697137.

  7. Factors associated with patients' satisfaction in Brazilian dental primary health care.

    Science.gov (United States)

    Aldosari, Muath Abdullah; Tavares, Mary Angela; Matta-Machado, Antônio Thomaz Gonzaga; Abreu, Mauro Henrique Nogueira Guimarães

    2017-01-01

    To assess factors associated with patients' satisfaction with the treatment by dentists in primary health care (PHC) in Brazil. The dataset was part of a nationwide cross-sectional survey for evaluating PHC teams conducted by the Brazilian Ministry of Health. Patients from each of 16,202 oral health teams were interviewed. In addition to sociodemographic information, the questionnaire included information about patient experience domains: access and booking of dental appointments, bonding and accountability, welcoming of the patient, and their perception of dental facilities. The dependent variable was the answer to the question 'From 0 to 10, how would you grade your satisfaction with treatment received from the dentist?' Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios and corresponding 95% confidence interval. The mean patient satisfaction was 9.4 (±2.3). Higher patient satisfaction with PHC was associated with lower education and the patient's perception of the clinic conditions. Moreover, higher satisfaction was associated with positive reception and hospitality, enough time for treatment, and instructions that met patients' needs. Lower satisfaction with PHC was associated with patients who have jobs compared to those who do not work. Patient satisfaction is increased with friendly and understanding PHC staff. Moreover, meeting patient expectations by taking time to understand the needs and giving the right instructions is associated with higher satisfaction.

  8. Factors associated with patients’ satisfaction in Brazilian dental primary health care

    Science.gov (United States)

    Tavares, Mary Angela; Matta-Machado, Antônio Thomaz Gonzaga

    2017-01-01

    Objective To assess factors associated with patients’ satisfaction with the treatment by dentists in primary health care (PHC) in Brazil. Materials and methods The dataset was part of a nationwide cross-sectional survey for evaluating PHC teams conducted by the Brazilian Ministry of Health. Patients from each of 16,202 oral health teams were interviewed. In addition to sociodemographic information, the questionnaire included information about patient experience domains: access and booking of dental appointments, bonding and accountability, welcoming of the patient, and their perception of dental facilities. Statistical analysis The dependent variable was the answer to the question ‘From 0 to 10, how would you grade your satisfaction with treatment received from the dentist?’ Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios and corresponding 95% confidence interval. Results The mean patient satisfaction was 9.4 (±2.3). Higher patient satisfaction with PHC was associated with lower education and the patient’s perception of the clinic conditions. Moreover, higher satisfaction was associated with positive reception and hospitality, enough time for treatment, and instructions that met patients’ needs. Lower satisfaction with PHC was associated with patients who have jobs compared to those who do not work. Conclusion Patient satisfaction is increased with friendly and understanding PHC staff. Moreover, meeting patient expectations by taking time to understand the needs and giving the right instructions is associated with higher satisfaction. PMID:29145438

  9. Social factors associated with mental disorders with risk situations in the primary health care

    Directory of Open Access Journals (Sweden)

    Bruno Lopes da Costa Drummond

    2014-01-01

    Full Text Available OBJECTIVE: To evaluate patients with mental disorders, with or without risk situations, treated at primary health care (PHC units. METHOD: A cross-sectional study was performed in samples of 240 patients living in a region of high social vulnerability in Belo Horizonte. The response variable was mental disorders with risk situations (MD-WR. The explanatory variables were gender, age, marital status, literacy, education, employment, social benefits and per capita income. Instruments from Berkman and Syme (social network, Sherbourne and Stewart (social support, adapted for Brazil, were applied. Pearson's χ2 test and binary logistic regression were used for the adjusted analyzes. RESULTS: The factors associated with MD-WR were being male (OR = 3.62; 95%CI 1.84 - 7.09; having "up to one confident relative" only (OR = 2.53; 95%CI 1.18 - 5.42; being "not able to return home" when away from their living area (OR = 3.49; 95%CI 1.40 - 8.71. The reduction in the affective dimension of the Medical Outcomes Study (MOS scale increases the chance of MD-WR. Conclusion: The availability and access to social and support networks are lower for patients with MD-WR and need to be strengthened to promote autonomy and citizenship among its users. We conclude that there is the need of public policies to increase the availability of social networking equipment and social support projects, encouraging the participation of families.

  10. Simplified method to predict mutual interactions of human transcription factors based on their primary structure

    KAUST Repository

    Schmeier, Sebastian

    2011-07-05

    Background: Physical interactions between transcription factors (TFs) are necessary for forming regulatory protein complexes and thus play a crucial role in gene regulation. Currently, knowledge about the mechanisms of these TF interactions is incomplete and the number of known TF interactions is limited. Computational prediction of such interactions can help identify potential new TF interactions as well as contribute to better understanding the complex machinery involved in gene regulation. Methodology: We propose here such a method for the prediction of TF interactions. The method uses only the primary sequence information of the interacting TFs, resulting in a much greater simplicity of the prediction algorithm. Through an advanced feature selection process, we determined a subset of 97 model features that constitute the optimized model in the subset we considered. The model, based on quadratic discriminant analysis, achieves a prediction accuracy of 85.39% on a blind set of interactions. This result is achieved despite the selection for the negative data set of only those TF from the same type of proteins, i.e. TFs that function in the same cellular compartment (nucleus) and in the same type of molecular process (transcription initiation). Such selection poses significant challenges for developing models with high specificity, but at the same time better reflects real-world problems. Conclusions: The performance of our predictor compares well to those of much more complex approaches for predicting TF and general protein-protein interactions, particularly when taking the reduced complexity of model utilisation into account. © 2011 Schmeier et al.

  11. Vascular endothelial growth factor A-stimulated signaling from endosomes in primary endothelial cells.

    Science.gov (United States)

    Fearnley, Gareth W; Smith, Gina A; Odell, Adam F; Latham, Antony M; Wheatcroft, Stephen B; Harrison, Michael A; Tomlinson, Darren C; Ponnambalam, Sreenivasan

    2014-01-01

    The vascular endothelial growth factor A (VEGF-A) is a multifunctional cytokine that stimulates blood vessel sprouting, vascular repair, and regeneration. VEGF-A binds to VEGF receptor tyrosine kinases (VEGFRs) and stimulates intracellular signaling leading to changes in vascular physiology. An important aspect of this phenomenon is the spatiotemporal coordination of VEGFR trafficking and intracellular signaling to ensure that VEGFR residence in different organelles is linked to downstream cellular outputs. Here, we describe a series of assays to evaluate the effects of VEGF-A-stimulated intracellular signaling from intracellular compartments such as the endosome-lysosome system. These assays include the initial isolation and characterization of primary human endothelial cells, performing reverse genetics for analyzing protein function; methods used to study receptor trafficking, signaling, and proteolysis; and assays used to measure changes in cell migration, proliferation, and tubulogenesis. Each of these assays has been exemplified with studies performed in our laboratories. In conclusion, we describe necessary techniques for studying the role of VEGF-A in endothelial cell function. © 2014 Elsevier Inc. All rights reserved.

  12. Simplified method to predict mutual interactions of human transcription factors based on their primary structure.

    Directory of Open Access Journals (Sweden)

    Sebastian Schmeier

    Full Text Available BACKGROUND: Physical interactions between transcription factors (TFs are necessary for forming regulatory protein complexes and thus play a crucial role in gene regulation. Currently, knowledge about the mechanisms of these TF interactions is incomplete and the number of known TF interactions is limited. Computational prediction of such interactions can help identify potential new TF interactions as well as contribute to better understanding the complex machinery involved in gene regulation. METHODOLOGY: We propose here such a method for the prediction of TF interactions. The method uses only the primary sequence information of the interacting TFs, resulting in a much greater simplicity of the prediction algorithm. Through an advanced feature selection process, we determined a subset of 97 model features that constitute the optimized model in the subset we considered. The model, based on quadratic discriminant analysis, achieves a prediction accuracy of 85.39% on a blind set of interactions. This result is achieved despite the selection for the negative data set of only those TF from the same type of proteins, i.e. TFs that function in the same cellular compartment (nucleus and in the same type of molecular process (transcription initiation. Such selection poses significant challenges for developing models with high specificity, but at the same time better reflects real-world problems. CONCLUSIONS: The performance of our predictor compares well to those of much more complex approaches for predicting TF and general protein-protein interactions, particularly when taking the reduced complexity of model utilisation into account.

  13. Magnitude and risk factors for burnout among primary health care physicians in Asir Province, Saudi Arabia.

    Science.gov (United States)

    Al-Sareai, N S; Al-Khaldi, Y M; Mostafa, O A; Abdel-Fattah, M M

    2013-05-01

    Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory (MBI) with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15,000-20,000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20,000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for > or =5 years and more annual vacation.

  14. Factors Associated with Dental Caries in Primary Dentition in a Non-Fluoridated Rural Community of New South Wales, Australia

    Directory of Open Access Journals (Sweden)

    Amit Arora

    2017-11-01

    Full Text Available Dental caries persists as one of the most prevalent chronic diseases among children worldwide. This study aims to determine factors that influence dental caries in primary dentition among primary school children residing in the rural non-fluoridated community of Lithgow, New South Wales, Australia. A total of 495 children aged 5–10 years old from all the six primary schools in Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation in 2014. Following parental consent, children were clinically examined for caries in their primary teeth, and parents were requested to complete a questionnaire on previous fluoride exposure, diet and relevant socio-demographic characteristics that influence oral health. Multiple logistic regression analysis was employed to examine the independent risk factors of primary dentition caries. Overall, 51 percent of children had dental caries in one or more teeth. In the multiple logistic regression analysis, child’s age (Adjusted Odd’s Ratio (AOR = 1.30, 95% CI: 1.14–1.49 and mother’s extraction history (AOR = 2.05, 95% CI: 1.40–3.00 were significantly associated with caries experience in the child’s primary teeth. In addition, each serve of chocolate consumption was associated with 52 percent higher odds (AOR = 1.52, 95% CI: 1.19–1.93 of primary dentition caries.

  15. Factors Associated with Dental Caries in Primary Dentition in a Non-Fluoridated Rural Community of New South Wales, Australia.

    Science.gov (United States)

    Arora, Amit; Manohar, Narendar; John, James Rufus

    2017-11-23

    Dental caries persists as one of the most prevalent chronic diseases among children worldwide. This study aims to determine factors that influence dental caries in primary dentition among primary school children residing in the rural non-fluoridated community of Lithgow, New South Wales, Australia. A total of 495 children aged 5-10 years old from all the six primary schools in Lithgow were approached to participate in a cross-sectional survey prior to implementation of water fluoridation in 2014. Following parental consent, children were clinically examined for caries in their primary teeth, and parents were requested to complete a questionnaire on previous fluoride exposure, diet and relevant socio-demographic characteristics that influence oral health. Multiple logistic regression analysis was employed to examine the independent risk factors of primary dentition caries. Overall, 51 percent of children had dental caries in one or more teeth. In the multiple logistic regression analysis, child's age (Adjusted Odd's Ratio (AOR) = 1.30, 95% CI: 1.14-1.49) and mother's extraction history (AOR = 2.05, 95% CI: 1.40-3.00) were significantly associated with caries experience in the child's primary teeth. In addition, each serve of chocolate consumption was associated with 52 percent higher odds (AOR = 1.52, 95% CI: 1.19-1.93) of primary dentition caries.

  16. Risk factors for cataract: A case control study

    Directory of Open Access Journals (Sweden)

    Ughade Suresh

    1998-01-01

    Full Text Available The present study was designed as a hospital-based, group-matched, case-control investigation into the risk factors associated with age-related cataract in central India. The study included 262 cases of age-related cataract and an equal number of controls. A total of 21 risk factors were evaluated: namely, low socioeconomic status (SES, illiteracy, marital status, history of diarrhoea, history of diabetes, glaucoma, use of cholinesterase inhibitors, steroids, spironolactone, nifedipine, analgesics, myopia early in life, renal failure, heavy smoking, heavy alcohol consumption, hypertension, low body mass index (BMI, use of cheaper cooking fuel, working in direct sunlight, family history of cataract, and occupational exposure. In univariate analysis, except marital status, low BMI, renal failure, use of steroids, spironolactone, analgesics, and occupational exposure, all 14 other risk factors were found significantly associated with age-related cataract. Unconditional multiple logistic regression analysis confirmed the significance of low SES, illiteracy, history of diarrhoea, diabetes, glaucoma, myopia, smoking, hypertension and cheap cooking fuel. The etiological role of these risk factors in the outcome of cataract is confirmed by the estimates of attributable risk proportion. The estimates of population attributable risk proportion for these factors highlight the impact of elimination of these risk factors on the reduction of cataract in this population.

  17. Retrofitting the instrumentation and control system of primary cooling circuit from TRIGA INR 14 MW reactor

    International Nuclear Information System (INIS)

    Preda, M.; Ciocanescu, M.; Ana, E. M.; Cristea, D.

    2008-01-01

    Activities of retrofitting the instrumentation and control system from TRIGA INR primary cooling circuit consists in replacement of actual system for: - parameter measurement; - safety; - reactor external scramming; - protection, command and supply for electrical elements of the system. This retrofitting project is designed to ensure the necessary features of reactor external safety and for technological parameter measurement. The new safety system of main cooling circuit is completely separated from its operating system and is arranged in a panel assembly in reactor control room. The operating system has the following features: - data acquisition; - parameter value and state of command elements displaying; - command elements on hierarchical levels; - operator information through visual and acoustic alarm. (authors)

  18. The Impact of Inattention and Emotional Problems on Cognitive Control in Primary School Children

    DEFF Research Database (Denmark)

    Sørensen, Lin; Plessen, Kerstin J; Lundervold, Astri J

    2012-01-01

    by the Behavior Rating Inventory of Executive Function (BRIEF) and performance-based tests (i.e.,Color Trail Test and Digit Span Test). Symptoms of inattention and emotional problems were measured with parent and teacher reports on Swanson Nolan and Pelham-IV questionnaire and Strengths and Difficulties......Objective: The present study investigated the predictive value of parent/teacher reports of inattention and emotional problems on cognitive control function in 241 children in primary school. Method: Cognitive control was measured by functions of set-shifting and working memory as assessed...

  19. [Prevalence of myopia and influencing factors among primary and middle school students in 6 provinces of China].

    Science.gov (United States)

    Zhou, Jia; Ma, Yinghua; Ma, Jun; Zou, Zhiyong; Meng, Xiangkun; Tao, Fangbiao; Luo, Chunyan; Jing, Jin; Pan, Dehong; Luo, Jiayou; Zhang, Xin; Wang, Hong; Zhao, Haiping

    2016-01-01

    To understand the prevalence of myopia in primary and middle school students in 6 provinces and the possible influencing factors. Primary and middle school students were selected through multistage cluster sampling in 60 primary and middle schools in 6 provinces in China. The questionnaire survey and eyesight test were conducted among all the students selected according to the national student's physique and health survey protocol. Pearson chi-square test and binary multivariate logistic regression analysis were done to identify the influencing factors for myopia in students. The prevalence of myopia among primary and middle school students surveyed was 55.7%, the gender specific difference was statistically significant (59.7% for girls, 51.9% for boys) (Psleep time, average outdoor activity time during last week, school sport activities in the afternoon, the size of television set at home, time spent on watching TV and playing computer were the influencing factors for myopia. The prevalence of myopia is till high in primary and middle school students. Myopia is associated with both genetic factors and individual eye health related behaviors.

  20. Diabetic retinopathy and its risk factors in patients with type 2 diabetes attending rural primary healthcare facilities in Tamil Nadu.

    Science.gov (United States)

    Fredrick, Tony; Kaur, Prabhdeep; Murhekar, Manoj V; Jayaraman, Yuvaraj; Kolandaswamy, K; Rao, Sudha Ramachandra; David, Joseph K

    2016-01-01

    India has a high burden of diabetic retinopathy ranging from 12.2% to 20.4% among patients with type 2 diabetes mellitus (T2DM). A T2DM management programme was initiated in the public sector in Tamil Nadu. We estimated the prevalence of diabetic retinopathy and its associated risk factors. We did a cross-sectional survey among patients with T2DM attending two primary health centres for treatment and follow-up in Kancheepuram, Tamil Nadu in January- March 2013. We did a questionnaire-based survey, and measured blood pressure and biochemical parameters (serum creatinine, plasma glucose, etc.) of the patients. We examined their eyes by direct and indirect ophthalmoscopy and defined diabetic retinopathy using a modified classification by Klein et al. We calculated the proportion and 95% CI for the prevalence and adjusted odds ratio (AOR) for risk factors associated with diabetic retinopathy. Among the 270 patients, the mean (SD) age was 54.5 (10) years. The median duration of T2DM was 48 months. The prevalence of diabetic retinopathy was 29.6%. Overall, 65.9% of patients had hypertension, 14.4% had nephropathy (eGFR 5 years (AOR 6.5, 95% CI 3.6-11.7), poor glycaemic control (AOR 2.4, 95% CI 1.4-4.4), and nephropathy (AOR 2.3, 95% CI 1.1-4.6). There was a high burden of undetected retinopathy and other comorbid conditions among patients with T2DM. Early detection of comorbid conditions and glycaemic control can be improved by training care-providers and educating patients.

  1. Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study.

    Science.gov (United States)

    Borghi, Claudio; Tubach, Florence; De Backer, Guy; Dallongeville, Jean; Guallar, Eliseo; Medina, Jesús; Perk, Joep; Roy, Carine; Banegas, José R; Rodriguez-Artalejo, Fernando; Halcox, Julian P

    2016-09-01

    The prevalence of and factors associated with uncontrolled hypertension and apparent resistant hypertension were assessed in the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; NCT00882336). EURIKA was a cross-sectional observational study including patients being treated for the primary prevention of cardiovascular disease in 12 European countries. Patients were assessed if they were being treated for hypertension (N=5220). Blood pressure control was defined according to European guidelines, with sensitivity analysis taking account of patients' age and diabetes status. Associated factors were assessed using multivariate analysis. In the primary analysis, a total of 2691 patients (51.6%) had uncontrolled hypertension. Factors significantly associated with an increased risk of having uncontrolled hypertension included female sex (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.93-2.73), body mass index (BMI; OR per kg/m(2): 1.03; 95% CI: 1.01-1.04), and geographic location. A total of 749 patients (14.3%) had apparent resistant hypertension. Factors significantly associated with an increased risk of having apparent resistant hypertension included BMI (OR per kg/m(2): 1.06; 95% CI: 1.04-1.08), diabetes (OR: 1.28; 95% CI: 1.06-1.53), use of statins (OR: 1.36; 95% CI: 1.15-1.62), serum uric acid levels (OR: 1.16; 95% CI: 1.09-1.23), and geographic location. Similar results were seen in sensitivity analyses. Over 50% of patients treated for hypertension continued to have uncontrolled blood pressure and 14.3% had apparent resistant hypertension. Positive associations were seen with other cardiovascular risk factors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Recurrent rates and risk factors associated with recurrent painful bullous keratopathy after primary phototherapeutic keratectomy

    Directory of Open Access Journals (Sweden)

    Kasetsuwan N

    2015-09-01

    Full Text Available Ngamjit Kasetsuwan, Kanokorn Sakpisuttivanit, Usanee Reinprayoon, Vilavun Puangsricharern Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand Objective: To assess the recurrent rate, mean survival time, and risk factors associated with recurrent painful bullous keratopathy (BK after primary treatment with phototherapeutic keratectomy.Methods: Medical records from 72 patients (72 eyes who had phototherapeutic keratectomy for painful BK were evaluated. Data for sex, age, duration of BK, associated ocular and systemic diseases (hypertension, diabetes mellitus, ischemic heart disease, asthma, dyslipidemia, and rheumatoid arthritis, frequency and degree of pain (grade 1–3, visual acuity, corneal thickness, intraocular pressure, and laser setting were extracted and analyzed.Results: The mean age of the patients was 64.2±11.4 years. The mean preoperative duration of BK was 15.0±11.0 months. Most patients had pseudophakic BK (69.40%. Majority of the cases had grade 3 degree of pain (48.60%. Glaucoma and hypertension were markedly found among these patients (51.40% and 19.40%, respectively. Preoperative mean intraocular pressure and corneal thickness were 13.70±4.95 mmHg and 734.1±83.80 µm, respectively. The mean laser diameter and depth were 8.36±1.22 mm and 38.89±8.81 µm, respectively. Systemic disease was significantly associated with the risk for developing recurrent painful BK (P=0.022, hazard ratio [HR] 1.673, 95% confidence interval [CI] 1.08–2.58. The overall recurrent rate was 51%. The average duration time of recurrent painful BK was 17.3±12.9 months (range 1–50 months. The median survival time before recurrence was 29.0±6.6 months.Conclusion: Systemic disease was found to be the only risk factor significantly associated with the development of recurrent painful BK. Low recurrent rate and long mean survival time showed that phototherapeutic

  3. Evaluating factors affecting the implementation of evidence based medicine in primary healthcare centers in Dubai.

    Science.gov (United States)

    Albarrak, Ahmed I; Ali Abbdulrahim, Suhair Aqil; Mohammed, Rafiuddin

    2014-07-01

    To assess the current evidence based medicine (EBM) knowledge, attitude and perceptions of physicians at Dubai Primary Health Care Sector (PHCS). Further to evaluate barrier and facilitator factors toward implementing the EBM practice. A cross-sectional study, at Dubai PHCS, UAE between June and August 2010. The survey was composed of two phases. The first phase was a self administrated questionnaire employed for data collection and the second phase was qualitative method, which was in the form of individual interviews. Statistical Package for Social Sciences (SPSS) was used for data analysis. In total 48 participants responded to the survey questionnaire and 13 responded to individual interviews. The response rate was 70.0%. Mean age was 42.18 (SD 10.46). The majority were females (64.6%). The physicians who attended EBM courses reported 70.30% using EBM and showed statistical significance (p = 0.002) from those who did not attend the EBM courses. 65.0% believe that 50-75% of the patients are capable of participating in clinical decision while 71.8% disagreed that the concept of EBM is not applicable to their culture. In addition they showed significance (p = 0.03) between physician beliefs with regard to patient capacity to take decision. About 67.0% of the family physicians were knowledgeable and followed systematic review as the strongest evidence. They had no access to the EBM resources (37.0%) and had no time to practice the EBM (38.0%). Nearly 40.0% interviewees reported lack of encouragement to attend EBM courses. EBM activities (22.0%) and active audit (18.0%) were top rated facilitating factors. EBM is not fully utilized by indefinite physicians in the Dubai PHC sector. Factors associated with non-utilization of EBM in the PHCS are lack of encouragement to attend EBM courses, senior physicians resist adoption of EBM, lack of time and insufficient dissemination process for implementing the clinical guideline.

  4. Primary intracranial tumors among atomic bomb survivors and controls, Hiroshima and Nagasaki, 1961-75

    International Nuclear Information System (INIS)

    Seyama, Shinichi; Ishimaru, Toranosuke; Iijima, Soichi; Mori, Kazuo.

    1980-02-01

    An analysis was made of the relationship of radiation dose to the occurrence of primary intracranial tumors among atomic bomb survivors and nonexposed controls, Hiroshima and Nagasaki, in the fixed cohort of the Life Span Study (LSS) extended sample during the period 1961-75, or 16 to 30 years after the A-bombs. Based on various medical sources, 104 cases of primary intracranial tumors were identified among approximately 99,000 LSS extended sample members who were alive as of 1 January 1961. Of these 104 cases, 45 had manifested clinical signs of brain tumors, but, 59 cases were identified incidentally at postmortem examination. The distributions of morphologic type, age, and size of tumor were quite different for those primary intracranial tumors with and without a clinical sign of brain tumor. Glioma was the most frequent type of tumor with a clinical sign and meningioma was the most frequent type without. In relation to radiation dose the incidence rate of primary intracranial tumors with a clinical sign showed a significant excess risk for males in the high dose group who received 100 rad or more after adjustment for age at the time of the bomb (ATB). The standardized relative risk is around 5 in this group. The data also suggest that the crude relative risk of glioma is greater in the high dose group for younger ages ATB. However, there is no increased risk in females. Among the 5,012 autopsy subjects in the LSS extended sample during 1961-75, there is no relationship between radiation dose and the prevalence rate of primary intracranial tumors in those identified incidentally by autopsy. The relative risk of subclinical adenoma of the pituitary gland between high dose subjects and controls was also examined for a sample of 95 sex- and age-matched pairs using Hiroshima autopsy materials for 1961-74, but no relationship to dose was observed. (author)

  5. Reasons for receiving or not receiving HPV vaccination in primary schoolgirls in Tanzania: a case control study.

    Science.gov (United States)

    Watson-Jones, Deborah; Tomlin, Keith; Remes, Pieter; Baisley, Kathy; Ponsiano, Riziki; Soteli, Selephina; de Sanjosé, Silvia; Changalucha, John; Kapiga, Saidi; Hayes, Richard J

    2012-01-01

    There are few data on factors influencing human papillomavirus (HPV) vaccination uptake in sub-Saharan Africa. We examined the characteristics of receivers and non-receivers of HPV vaccination in Tanzania and identified reasons for not receiving the vaccine. We conducted a case control study of HPV vaccine receivers and non-receivers within a phase IV cluster-randomised trial of HPV vaccination in 134 primary schools in Tanzania. Girls who failed to receive vaccine (pupil cases) and their parents/guardians (adult cases) and girls who received dose 1 (pupil controls) of the quadrivalent vaccine (Gardasil™) and their parents/guardians (adult controls) were enrolled from 39 schools in a 1∶1 ratio and interviewed about cervical cancer, HPV vaccine knowledge and reasons why they might have received or not received the vaccine. Conditional logistic regression was used to determine factors independently associated with not receiving HPV vaccine. We interviewed 159 pupil/adult cases and 245 pupil/adult controls. Adult-factors independently associated with a daughter being a case were older age, owning fewer household items, not attending a school meeting about HPV vaccine, and not knowing anyone with cancer. Pupil-factors for being a case included having a non-positive opinion about the school de-worming programme, poor knowledge about the location of the cervix, and not knowing that a vaccine could prevent cervical cancer. Reasons for actively refusing vaccination included concerns about side effects and infertility. Most adult and pupil cases reported that they would accept the HPV vaccine if it were offered again (97% and 93% respectively). Sensitisation messages, especially targeted at older and poorer parents, knowledge retention and parent meetings are critical for vaccine acceptance in Tanzania. Vaccine side effects and fertility concerns should be addressed prior to a national vaccination program. Parents and pupils who initially decline vaccination should be

  6. Reasons for receiving or not receiving HPV vaccination in primary schoolgirls in Tanzania: a case control study.

    Directory of Open Access Journals (Sweden)

    Deborah Watson-Jones

    Full Text Available There are few data on factors influencing human papillomavirus (HPV vaccination uptake in sub-Saharan Africa. We examined the characteristics of receivers and non-receivers of HPV vaccination in Tanzania and identified reasons for not receiving the vaccine.We conducted a case control study of HPV vaccine receivers and non-receivers within a phase IV cluster-randomised trial of HPV vaccination in 134 primary schools in Tanzania. Girls who failed to receive vaccine (pupil cases and their parents/guardians (adult cases and girls who received dose 1 (pupil controls of the quadrivalent vaccine (Gardasil™ and their parents/guardians (adult controls were enrolled from 39 schools in a 1∶1 ratio and interviewed about cervical cancer, HPV vaccine knowledge and reasons why they might have received or not received the vaccine. Conditional logistic regression was used to determine factors independently associated with not receiving HPV vaccine.We interviewed 159 pupil/adult cases and 245 pupil/adult controls. Adult-factors independently associated with a daughter being a case were older age, owning fewer household items, not attending a school meeting about HPV vaccine, and not knowing anyone with cancer. Pupil-factors for being a case included having a non-positive opinion about the school de-worming programme, poor knowledge about the location of the cervix, and not knowing that a vaccine could prevent cervical cancer. Reasons for actively refusing vaccination included concerns about side effects and infertility. Most adult and pupil cases reported that they would accept the HPV vaccine if it were offered again (97% and 93% respectively.Sensitisation messages, especially targeted at older and poorer parents, knowledge retention and parent meetings are critical for vaccine acceptance in Tanzania. Vaccine side effects and fertility concerns should be addressed prior to a national vaccination program. Parents and pupils who initially decline vaccination

  7. Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

    Directory of Open Access Journals (Sweden)

    Bailey Kerry A

    2010-08-01

    Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

  8. Correlation between dmft, Diet and Social Factors in Primary School Children of Tehran-Iran in 2009-2010

    OpenAIRE

    Mozhgan Faezi; Sareh Farhadi; Hossein NikKerdar

    2012-01-01

    Introduction: One of the factors that can affect dental caries is the type of diet. So, this study was designed to evaluate the correlation between diet, social factors and dmft in primary school children of Tehran in 2009 and 2010.Materials & Methods: Eight handred and twenty primary school children of 6-12 years old (boys and girls) in Tehran were randomly selected in this descriptive study and after filling out the forms, underwent dental examinations. The data were analyzed by chi-square ...

  9. Quantitative evaluation of emission controls on primary and secondary organic aerosol sources during Beijing 2008 Olympics

    Directory of Open Access Journals (Sweden)

    S. Guo

    2013-08-01

    Full Text Available To assess the primary and secondary sources of fine organic aerosols after the aggressive implementation of air pollution controls during the 2008 Beijing Olympic Games, 12 h PM2.5 values were measured at an urban site at Peking University (PKU and an upwind rural site at Yufa during the CAREBEIJING-2008 (Campaigns of Air quality REsearch in BEIJING and surrounding region summer field campaign. The average PM2.5 concentrations were 72.5 ± 43.6 μg m−3 and 64.3 ± 36.2 μg m−3 (average ± standard deviation, below as the same at PKU and Yufa, respectively, showing the lowest concentrations in recent years. Combining the results from a CMB (chemical mass balance model and secondary organic aerosol (SOA tracer-yield model, five primary and four secondary fine organic aerosol sources were compared with the results from previous studies in Beijing. The relative contribution of mobile sources to PM2.5 concentrations was increased in 2008, with diesel engines contributing 16.2 ± 5.9% and 14.5 ± 4.1% and gasoline vehicles contributing 10.3 ± 8.7% and 7.9 ± 6.2% to organic carbon (OC at PKU and Yufa, respectively. Due to the implementation of emission controls, the absolute OC concentrations from primary sources were reduced during the Olympics, and the contributions from secondary formation of OC represented a larger relative source of fine organic aerosols. Compared with the non-controlled period prior to the Olympics, primary vehicle contributions were reduced by 30% at the urban site and 24% at the rural site. The reductions in coal combustion contributions were 57% at PKU and 7% at Yufa. Our results demonstrate that the emission control measures implemented in 2008 significantly alleviated the primary organic particle pollution in and around Beijing. However, additional studies are needed to provide a more comprehensive assessment of the emission control effectiveness on SOA formation.

  10. A randomised controlled trial of three very brief interventions for physical activity in primary care

    Directory of Open Access Journals (Sweden)

    Sally Pears

    2016-09-01

    Full Text Available Abstract Background Very brief interventions (VBIs for physical activity are promising, but there is uncertainty about their potential effectiveness and cost. We assessed potential efficacy, feasibility, acceptability, and cost of three VBIs in primary care, in order to select the most promising intervention for evaluation in a subsequent large-scale RCT. Methods Three hundred and ninety four adults aged 40–74 years were randomised to a Motivational (n = 83, Pedometer (n = 74, or Combined (n = 80 intervention, delivered immediately after a preventative health check in primary care, or control (Health Check only; n = 157. Potential efficacy was measured as the probability of a positive difference between an intervention arm and the control arm in mean physical activity, measured by accelerometry at 4 weeks. Results For the primary outcome the estimated effect sizes (95 % CI relative to the Control arm for the Motivational, Pedometer and Combined arms were respectively: +20.3 (−45.0, +85.7, +23.5 (−51.3, +98.3, and −3.1 (−69.3, +63.1 counts per minute. There was a73% probability of a positive effect on physical activity for each of the Motivational and Pedometer VBIs relative to control, but only 46 % for the Combined VBI. Only the Pedometer VBI was deliverable within 5 min. All VBIs were acceptable and low cost. Conclusions Based on the four criteria, the Pedometer VBI was selected for evaluation in a large-scale trial. Trial registration Current Controlled Trials ISRCTN02863077 . Retrospectively registered 05/10/2012.

  11. Correlation of primary tumor FDG uptake with clinicopathologic prognostic factors in invasive ductal carcinoma of the breast

    International Nuclear Information System (INIS)

    Jo, I; Kim, Sung Hoon; Kim, Hae Won; Kang, Sung Hee; Zeon, Seok Kil; Kim, Su Jin

    2015-01-01

    The purpose of this study was to investigate the correlation of primary tumor FDG uptake to clinicopathological prognostic factors in invasive ductal carcinoma of the breast. We retrospectively reviewed 136 of 215 female patients with pathologically proven invasive ductal breast cancer from January 2008 to December 2011 who underwent F-18 FDG PET/CT for initial staging and follow-up after curative treatment with analysis of estrogen receptor (ER), progesterone receptor (PR) and human epithelial growth factor receptor 2 (HER2). The maximum standardized uptake value (SUV max ) of the primary breast tumor was measured and compared with hormonal receptor and HER2 overexpression status. The high SUV max of primary breast tumors is significantly correlated with the clinicopathological factors: tumor size, histologic grade, TNM stage, negativity of ER, negativity of PR, HER2 overexpression and triple negativity. The recurrent group with non-triple negative cancer had a higher SUV max compared with the non-recurrent group, though no significant difference in FDG uptake was noted between the recurrence and non-recurrent groups in subjects with triple-negative cancer. Lymph node involvement was the independent risk factor for cancer recurrence in the multivariate analysis. In conclusion, high FDG uptake in primary breast tumors is significantly correlated with clinicopathological factors, such as tumor size, histologic grade, TNM stage, negativity of the hormonal receptor, HER2 overexpression and triple negativity. Therefore, FDG PET/CT is a helpful prognostic tool to direct the further management of patients with breast cancer

  12. CT findings at the primary site of oropharyngeal squamous cell carcinoma within 6-8 weeks after definitive radiotherapy as predictors of primary site control

    International Nuclear Information System (INIS)

    Ojiri, Hiroya; Mendenhall, William M.; Mancuso, Anthony A.

    2002-01-01

    Purpose: To determine whether findings on CT studies, done 6 weeks after radiotherapy (RT), can predict the likelihood of ultimate control at the primary site in oropharyngeal carcinoma. Methods and Materials: Forty-six patients with oropharyngeal squamous cell carcinoma underwent RT with curative intent. A minimal 2-year clinical follow-up after RT was required. The primary site CT findings were graded for risk of recurrence on a modified 3-point scale as follows: Grade 0, no detectable focal abnormalities; Grade 1, anatomic asymmetry or focal mass 10 mm (2a) or 10 mm at the primary site, the likelihood of local control is high (93%). The study results indicate that CT findings, based on this relatively small series, may not add incremental information beyond that of clinical examination for predicting local control but may be useful as a baseline if imaging surveillance is contemplated

  13. The role of primary health care in patient education for diabetes control.

    Science.gov (United States)

    Koura, M R; Khairy, A E; Abdel-Aal, N M; Mohamed, H F; Amin, G A; Sabra, A Y

    2001-01-01

    The major components of diabetes management are dietary therapy, exercise and drug treatment. Therefore, education of people with diabetes is the cornerstone of management. The aim of the present work was to study the role of primary health care (PHC) in patient education for diabetes control in Alexandria. Accordingly, the knowledge and perception concerning diabetes and its management of all 88 PHC physicians and 104 nurses working in the two rural health centers and two randomly chosen urban health centers of Alexandria governorate were assessed by pre-designed self-administered questionnaire. All diabetic patients over 20 years of age attending the study health facilities over a period of two months were assessed for their knowledge and attitude concerning diabetes and self-management and asked about their degree of satisfaction with the provided PHC services by a pre-designed interview questionnaire. They amounted to 560 diabetic patients. The results revealed that the PHC physicians had sufficient knowledge about causes and complications of the disease, but insufficient knowledge about diagnosis and management, as only 10.2% & 4.5% of the physicians recognized the importance of regular exercise and patient education for diabetes management. Some misconceptions and false beliefs were observed among PHC nurses, as many of them considered diabetes a contagious disease or primarily caused by stress; that liver failure, hearing impairment and splenomegaly are among the complications of diabetes and that young age and immunodeficiency disorders are among the risk factors for developing diabetes. Moreover, most of them believed that the amount of carbohydrates given to diabetic patients should be reduced or even completely restricted; that vitamins are essential for all diabetic patients and that hot-water bottles are good for providing warmth to the diabetic feet. They also disagreed on the use of artificial sweeteners as sugar substitutes. Most of the diabetic

  14. Risk factors for syphilis in women: case-control study

    Directory of Open Access Journals (Sweden)

    Vilma Costa de Macêdo

    2017-08-01

    Full Text Available ABSTRACT OBJECTIVE To determine the sociodemographic, behavioral, and health care factors related to the occurrence of syphilis in women treated at public maternity hospitals. METHODS This is a case-control study (239 cases and 322 controls with women admitted to seven maternity hospitals in the municipality of Recife, Brazil, from July 2013 to July 2014. Eligible women were recruited after the result of the VDRL (Venereal Disease Research Laboratory under any titration. The selection of cases and controls was based on the result of the serology for syphilis using ELISA (enzyme-linked immunosorbent assay. The independent variables were grouped into: sociodemographic, behavioral, clinical and obstetric history, and health care in prenatal care and maternity hospital. Information was obtained by interview, during hospitalization, with the application of a questionnaire. Odds ratios and 95% confidence intervals were estimated using logistic regression to identify the predicting factors of the variable to be explained. RESULTS The logistic regression analysis identified as determinant factors for gestational syphilis: education level of incomplete basic education or illiterate (OR = 2.02, lack of access to telephone (OR = 2.4, catholic religion (OR = 1.70 , four or more pregnancies (OR = 2.2, three or more sexual partners in the last year (OR = 3.1, use of illicit drugs before the age of 18 (OR = 3.0, and use of illicit drugs by the current partner (OR = 1.7. Only one to three prenatal appointments (OR = 3.5 and a previous history of sexually transmitted infection (OR = 9.7 were also identified as determinant factors. CONCLUSIONS Sociodemographic, behavioral, and health care factors are associated with the occurrence of syphilis in women and should be taken into account in the elaboration of universal strategies aimed at the prevention and control of syphilis, but with a focus on situations of greater vulnerability.

  15. Risk factors for syphilis in women: case-control study

    Science.gov (United States)

    de Macêdo, Vilma Costa; de Lira, Pedro Israel Cabral; de Frias, Paulo Germano; Romaguera, Luciana Maria Delgado; Caires, Silvana de Fátima Ferreira; Ximenes, Ricardo Arraes de Alencar

    2017-01-01

    ABSTRACT OBJECTIVE To determine the sociodemographic, behavioral, and health care factors related to the occurrence of syphilis in women treated at public maternity hospitals. METHODS This is a case-control study (239 cases and 322 controls) with women admitted to seven maternity hospitals in the municipality of Recife, Brazil, from July 2013 to July 2014. Eligible women were recruited after the result of the VDRL (Venereal Disease Research Laboratory) under any titration. The selection of cases and controls was based on the result of the serology for syphilis using ELISA (enzyme-linked immunosorbent assay). The independent variables were grouped into: sociodemographic, behavioral, clinical and obstetric history, and health care in prenatal care and maternity hospital. Information was obtained by interview, during hospitalization, with the application of a questionnaire. Odds ratios and 95% confidence intervals were estimated using logistic regression to identify the predicting factors of the variable to be explained. RESULTS The logistic regression analysis identified as determinant factors for gestational syphilis: education level of incomplete basic education or illiterate (OR = 2.02), lack of access to telephone (OR = 2.4), catholic religion (OR = 1.70 ), four or more pregnancies (OR = 2.2), three or more sexual partners in the last year (OR = 3.1), use of illicit drugs before the age of 18 (OR = 3.0), and use of illicit drugs by the current partner (OR = 1.7). Only one to three prenatal appointments (OR = 3.5) and a previous history of sexually transmitted infection (OR = 9.7) were also identified as determinant factors. CONCLUSIONS Sociodemographic, behavioral, and health care factors are associated with the occurrence of syphilis in women and should be taken into account in the elaboration of universal strategies aimed at the prevention and control of syphilis, but with a focus on situations of greater vulnerability. PMID:28832758

  16. Primary repair of civilian colon injuries is safe in the damage control scenario.

    Science.gov (United States)

    Kashuk, Jeffry L; Cothren, C Clay; Moore, Ernest E; Johnson, Jeffrey L; Biffl, Walter L; Barnett, Carlton C

    2009-10-01

    Although the safety of primary repair/anastomosis for civilian colon injuries after standard laparotomy (SL) has been established, recent civilian and military reports have questioned the advisability of this technique in the patient requiring damage control laparotomy (DL). We hypothesized that, even in the high-risk DL group, primary repair could be safely used after patient stabilization and that the open abdomen would facilitate the safety of this procedure. All patients admitted to our level 1 trauma center with a colon injury over a 7-year period were reviewed from a prospectively collected database. Patients were categorized as having undergone either SL or DL at initial operation. Primary variables of interest were as follows: injury patterns; method of primary repair (suture repair, resection and primary anastomosis, resection and delayed anastomosis); diversion techniques (planned diversion or diversion for anastomotic dehiscence); and colon-related morbidity and mortality. High-risk status in the DL group was identified by the following physiologic variables: mean injury severity score (ISS), red blood cell (RBC) transfusions, ventilator days, and intensive care unit (ICU) duration of stay. During the study period, 309 patients had colonic wounds identified at laparotomy. Of these 309 patients, 280 (91%) underwent SL, of which 277 (98.9%) had primary colonic repair/anastomosis. In the SL group, 1 (0.3%) patient required diversion for subsequent leak and 2 (0.6%) patients had planned diversion The remaining 29 hemodynamically unstable patients required DL. Mean +/- standard deviation indices of injury severity in this group included: ISS = 36.2 +/- 15.8, RBC = 28.7 +/- 25.4 units, ventilator days = 20.1 +/- 16.3, ICU duration of stay = 29.5 +/- 21.6 days. Of the 29 patients in the DL group, 21 (72%) had bowel continuity successfully reestablished in 2.6 +/- 2 days after initial attempts at primary suture repair or resection/anastomosis. A total of 4 (16

  17. Factores de necesidad asociados al uso adecuado del control prenatal

    Directory of Open Access Journals (Sweden)

    Clarybel Miranda Mellado

    2016-07-01

    Full Text Available Introducción: Por las implicaciones sociales de la mortalidad y morbilidad materna es importante determinar los factores de necesidad que influyen en el uso adecuado del control prenatal en gestantes de Sincelejo. Materiales y Métodos: Estudio analítico de corte transversal, que incluyó 730 gestantes, seleccionadas mediante muestreo aleatorio por conglomerados, de las comunas de la ciudad. La información fue recolectada por medio de una encuesta sociodemográfica, una ficha de uso de control prenatal y un Cuestionario para evaluar los factores de necesidad  propuestos por el Modelo de Promoción de la Salud de Nola Pender. Las gestantes fueron contactadas en sus domicilios y diligenciaron los instrumentos. Los datos fueron analizados aplicando estadística descriptiva e inferencial para determinar las asociaciones entre variables. Resultados: El 97,7% (713 de las gestantes asistía al control prenatal, con una mediana de 4 controles prenatales. Un 2,3% (17 no lo habían iniciado al momento de la encuesta y 24,4% (178 hizo uso inadecuado. El 80,7% (589 de las gestantes califican su estado de salud como bueno o muy bueno, 94,8% (692 percibieron beneficios del control prenatal. Se encontró asociación significativa entre la percepción de beneficios y el uso adecuado de control prenatal [OR=5,5 (IC 95%: 2,8 - 10,8]. Discusión y Conclusiones: La percepción que las mujeres tienen sobre los buenos resultados que reporta la asistencia al control prenatal, es el principal factor que puede explicar la adherencia al control y el cumplimiento regular de las consultas. Cómo citar este artículo: Miranda C, Castillo IY. Factores de necesidad asociados al uso adecuado del control prenatal. Rev Cuid. 2016; 7(2: 1345-51. http://dx.doi.org/10.15649/cuidarte.v7i2.340

  18. Pilot simulation tests of propulsion control as backup to loss of primary flight controls for a mid-size jet transport

    Science.gov (United States)

    1995-12-01

    Partial failures of aircraft primary flight-control systems and structural : damages to aircraft during flight have led to catastrophic accidents with : subsequent loss of life. These accidents can be prevented if sufficient : alternate control autho...

  19. Population prevalence and control of cardiovascular risk factors: what electronic medical records tell us.

    Science.gov (United States)

    Catalán-Ramos, Arantxa; Verdú, Jose M; Grau, María; Iglesias-Rodal, Manuel; del Val García, José L; Consola, Alicia; Comin, Eva

    2014-01-01

    To analyze the prevalence, control, and management of hypertension, hypercholesterolemia, and diabetes mellitus type 2 (DM2). Cross-sectional analysis of all individuals attended in the Catalan primary care centers between 2006 and 2009. History of cardiovascular diseases, diagnosis and treatment of hypertension, hypercholesterolemia, DM2, lipid profile, glycemia and blood pressure data were extracted from electronic medical records. Age-standardized prevalence and levels of management and control were estimated. Individuals aged 35-74 years using primary care databases. A total of 2,174,515 individuals were included (mean age 52 years [SD 11], 47% men). Hypertension was the most prevalent cardiovascular risk factor (39% in women, 41% in men) followed by hypercholesterolemia (38% and 40%) and DM2 (12% and 16%), respectively. Diuretics and angiotensin-converting enzyme inhibitors were most often prescribed for hypertension control (women treated). Hypercholesterolemia was controlled (low-density lipoprotein cholesterol women with no history of cardiovascular disease, despite lipid-lowering treatment, primarily (90%) with statins. The percentage of women and men with DM2 and with glycated hemoglobin DM2 were adequately controlled; hypercholesterolemia control was particularly low. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  20. Role of pressuriser in enhancing pressure control system capability in primary system of 500 MWe PHWR

    Energy Technology Data Exchange (ETDEWEB)

    Walia, M P.S.; Misri, Vijay; Bapat, C N; Sharma, V K [Nuclear Power Corporation, Bhabha Atomic Research Centre, Mumbai (India)

    1994-06-01

    The primary heat transport system of a pressurized heavy water reactor (PHWR) extracts and transports the heat produced in the fuel (located inside coolant channel assemblies) to the steam generators where steam is generated to run the turbo-generator. The heat transport medium (primary coolant) is heavy water which is kept in a pressurized liquid state with the help of a pressure control system. Feed and bleed circuits with associated equipment of PHT main system have traditionally constituted the pressure control system. However, for large size reactors of 500 MWe capacity, a surge tank known as pressurizer was incorporated due to the presence of relatively large inventory in PHT main circuit. The pressurizer acts as a cushion for pressure variations resulting from various transients. This significantly reduces the onerous demand on feed and bleed system, thereby reducing reactor outages on system pressure excursions. The paper describes in detail the pressure control system of 500 MWe PHWR involving pressuriser and feed and bleed system including their functions and instrumentation. The results of mathematical modelling/analysis undertaken to establish the response adequacy of pressure control system, to postulated plant transients vis-a-vis the role of pressurizer are presented. (author). 10 figs.

  1. Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England.

    Science.gov (United States)

    Davies-Kershaw, Hilary; Petersen, Irene; Nazareth, Irwin; Stevenson, Fiona

    2018-04-01

    Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower. To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies. A semi-structured qualitative interview study of GPs working in general practices across England. Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis. The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR. When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies. © British Journal of General Practice 2018.

  2. Malnutrition and some related factors in primary school children, Semnan, Iran.

    Science.gov (United States)

    Karimi, Batool; Ghorbani, Raheb; Niaki, Mehri A

    2016-12-01

    Malnutrition places a direct and indirect burden on individuals, especially children and communities. Malnutrition or growth failure can occur because of various reasons. This study aimed to determine the prevalence of thinness, underweight, stunting, and their related factors in students aged 6-12 years in Semnan province, central Iran. Using multistage sampling, a total of 2195 primary students in Semnan province, between November 2012 and March 2013, were selected randomly and the prevalences of wasting, underweight, and stunting among the students were estimated. Students' weights were measured using a Burer digital scale (Germany), with an accuracy of 100 g. Students' heights were measured using a nonstretchable tape measure. The BMI was calculated. Using the CDC 2000 standards, values less than the fifth percentile of BMI, weight-for-age, and height-for-age were defined as thinness, underweight, and stunting, respectively. In the total sample, 12.5, 9.2, and 9.0% of the students, respectively, were affected by thinness, underweight, and stunting. Lack of access to a computer increased the odds ratio (OR) of thinness by 1.38 times [OR=1.38, 95% confidence interval (CI): 1.06-1.78, P=0.015). Other variables (including age) did not show a significant association with the prevalence of thinness. Similarly, of all the variables studied, only access to a computer showed a significant association with the prevalence of underweight (OR=1.37, 95% CI: 1.02-1.84, P=0.036). The prevalence of stunting was associated significantly with a history of parasitic infection (OR=2.32, 95% CI: 1.53-3.51, Pmalnutrition among students is high. Hence, families and stakeholders must pay special attention to various measures including healthcare services to improve the condition. Education, health, and support programs must be strengthened and continued.

  3. Primary localization and tumor thickness as prognostic factors of survival in patients with mucosal melanoma.

    Directory of Open Access Journals (Sweden)

    Tarun Mehra

    Full Text Available Data on survival with mucosal melanoma and on prognostic factors of are scarce. It is still unclear if the disease course allows for mucosal melanoma to be treated as primary cutaneous melanoma or if differences in overall survival patterns require adapted therapeutic approaches. Furthermore, this investigation is the first to present 10-year survival rates for mucosal melanomas of different anatomical localizations.116 cases from Sep 10 1984 until Feb 15 2011 retrieved from the Comprehensive Cancer Center and of the Central Register of the German Dermatologic Society databases in Tübingen were included in our analysis. We recorded anatomical location and tumor thickness, and estimated overall survival at 2, 5 and 10 years and the mean overall survival time. Survival times were analyzed with the Kaplan-Meier method. The log-rank test was used to compare survival times by localizations and by T-stages.We found a median overall survival time of 80.9 months, with an overall 2-year survival of 71.7%, 5-year survival of 55.8% and 10-year survival of 38.3%. The 10-year survival rates for patients with T1, T2, T3 or T4 stage tumors were 100.0%, 77.9%, 66.3% and 10.6% respectively. 10-year survival of patients with melanomas of the vulva was 64.5% in comparison to 22.3% of patients with non-vulva mucosal melanomas.Survival times differed significantly between patients with melanomas of the vulva compared to the rest (p = 0.0006. It also depends on T-stage at the time of diagnosis (p < 0.0001.

  4. Is Primary Hyperparathyroidism a Risk Factor for Papillary Thyroid Cancer? An Exemplar Study and Literature Review

    Directory of Open Access Journals (Sweden)

    Cinamon, Udi

    2014-12-01

    Full Text Available Introduction Primary hyperparathyroidism (PHPT is associated with several cancer types, including papillary thyroid carcinoma (PTC. Objective To explore further the relation between PHPT and PTC. Methods By considering patients with PHPT as extra-suspicious for PTC, we studied an exemplar group of patients with PHPT with a small (≤1 cm thyroid nodule, which was negative in preoperative cytologic examination. During parathyroidectomy, a frozen section biopsy of the thyroid nodule confirmed PTC, as did the final surgical specimen, revealing that the preoperative cytology was false-negative. Additionally, relevant reports retrieved from the English literature addressing thyroid cancer and hyperparathyroidism were reviewed and processed. Results Four patients with PHPT were studied. Three had a multifocal thyroid disease, and three had neck lymph node metastasis. Processing previous report data supported an association between PHPT and PTC. Although thyroid nodularity among patients with PHPT was similar to the general population, PTC incidence was higher. This was true also for patients with secondary hyperparathyroidism. Conclusions This study emphasized that PHPT should be considered as a noteworthy risk factor for PTC. Fine needle aspiration of a thyroid nodule is the most valuable diagnostic procedure for thyroid cancer. Yet, false-negative results were reported in up to 10% of cases, especially in small, subcentimeter nodules. In line with our data and the literature, patients with PHPT should have both a detailed ultrasound addressing the thyroid and cytology of any thyroid nodule, including small subcentimeter lesions. Moreover, surgical flexibility, allowing intraoperative thyroid nodule sampling, should be considered even for “innocent” nodules.

  5. Prevalence of Primary Dysmenorrhea and Factors Associated with Its Intensity Among Undergraduate Students: A Cross-Sectional Study.

    Science.gov (United States)

    Habibi, Nahal; Huang, Mary Soo Lee; Gan, Wan Ying; Zulida, Rejali; Safavi, Sayyed Morteza

    2015-12-01

    Primary dysmenorrhea is a womanhood problem around the world and negatively affects quality of life. This study was designed to investigate the prevalence of primary dysmenorrhea and to determine the factors associated with its intensity. A cross-sectional study was carried out among 311 undergraduate female students aged 18 to 27 years in Isfahan University of Medical Sciences, Iran. Socio-demographic characteristics and menstrual factors were obtained through interviews with the help of a pretested questionnaire. The prevalence of primary dysmenorrhea was 89.1%. Residing at home, younger age, lower number of years of formal education for the mother, positive family history of dysmenorrhea, higher severity of bleeding, and shorter menstrual period intervals were significantly associated with the higher intensity of primary dysmenorrhea. Primary dysmenorrhea is a common health concern among young women. Being aware of the factors that are associated with its intensity makes it possible for health professionals to organize better focused programs to reduce the adverse effects of dysmenorrhea. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  6. PREVALENCE AND RISK FACTORS OF OBESITY IN PRIMARY SCHOOL IN URBAN AND RURAL AREAS

    Directory of Open Access Journals (Sweden)

    Made Ratna Dewi

    2013-10-01

    Full Text Available Normal 0 false false false IN X-NONE X-NONE Obesity has become a continous increasing global health problem. Obesity can happen in adult population and also on children as well as teenagers. There are several factors that influence the occurrence of obesity. The aim of this study is to determine the prevalence and risk factors for obesity in primary school children in urban and rural areas. A cross sectional study was conducted with a total sample of 241 pupils in several elementary schools. Anthropometric status determine using body mass index for age and obesity stated if measurement exceed ?95th percentile based on CDC 2000. Analysis data perform with the Pearson Chi-square, Fisher's Exact Test, and logistic regression. A P value of <0.05 was considered significant. This study showed the prevalence of obesity was 15%. The prevalence of obesity in urban areas was 21% and rural areas was 5%. The result showed risk of obesity multiplied by 3.8 times in urban children as they had a habit of "snacking" had risk of suffering obesity by 3.4 times (95% CI 1.2 to 9.0. Children who had habit of having fast food more than 2 times per week had the more risk of obesity by 5 times (95% CI 1.9 to 13.5. Mothers education in urban areas as a protective factor. Conclusion of this study show that the prevalence of obesity in urban areas is 21% and 5% in rural areas. “Snacking” habit and eating fast food more than 2 times per week increase the risk of obesity in urban areas, while in rural areas no risk factors consider significant for obesity. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso

  7. Prevalence and control of high blood pressure in primary care: results from the German Metabolic and Cardiovascular Risk Study (GEMCAS).

    Science.gov (United States)

    Balijepalli, Chakrapani; Bramlage, Peter; Lösch, Christian; Zemmrich, Claudia; Humphries, Karin H; Moebus, Susanne

    2014-06-01

    Contemporary epidemiological data on blood pressure readings, hypertension prevalence and control in unselected patient populations covering a broad age range are scarce. The aim here is to report the prevalence of high blood pressure and to identify factors associated with blood pressure control in a large German primary care sample. We used data from the German Metabolic and Cardiovascular Risk Study including 35 869 patients aged 18-99 years. High blood pressure was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg or using antihypertensive therapy. Factors associated with blood pressure control among patients receiving antihypertensive therapy were examined using multiple logistic regressions to estimate odds ratios and 95% confidence intervals. The prevalence of high blood pressure, uncontrolled high blood pressure and untreated high blood pressure was 54.8%, 21.3% and 17.6%, respectively. Age >50 years (1.52; 1.40-1.65), male sex (1.30; 1.20-1.41), elevated waist circumference (1.55; 1.45-1.65), high cholesterol (1.24; 1.16-1.33), high triglycerides (1.11; 1.04-1.19) and concomitant diabetes (1.29; 1.20-1.40) were independently associated with uncontrolled high blood pressure. In a majority of patients we observed hypertension despite treatment for high blood pressures. Studies examining the reasons for treatment failure are highly warranted.

  8. A randomized, controlled trial to increase discussion of breast cancer in primary care.

    Science.gov (United States)

    Kaplan, Celia P; Livaudais-Toman, Jennifer; Tice, Jeffrey A; Kerlikowske, Karla; Gregorich, Steven E; Pérez-Stable, Eliseo J; Pasick, Rena J; Chen, Alice; Quinn, Jessica; Karliner, Leah S

    2014-07-01

    Assessment and discussion of individual risk for breast cancer within the primary care setting are crucial to discussion of risk reduction and timely referral. We conducted a randomized controlled trial of a multiethnic, multilingual sample of women ages 40 to 74 years from two primary care practices (one academic, one safety net) to test a breast cancer risk assessment and education intervention. Patients were randomly assigned to control or intervention group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room before visit for intervention). Intervention (BreastCARE) patients and their physicians received an individualized risk report to discuss during the visit. One-week follow-up telephone surveys with all patients assessed patient-physician discussion of family cancer history, personal breast cancer risk, high-risk clinics, and genetic counseling/testing. A total of 655 control and 580 intervention women completed the risk assessment and follow-up interview; 25% were high-risk by family history, Gail, or Breast Cancer Surveillance Consortium risk models. BreastCARE increased discussions of family cancer history [OR, 1.54; 95% confidence interval (CI), 1.25-1.91], personal breast cancer risk (OR, 4.15; 95% CI, 3.02-5.70), high-risk clinics (OR, 3.84; 95% CI, 2.13-6.95), and genetic counseling/testing (OR, 2.22; 95% CI, 1.34-3.68). Among high-risk women, all intervention effects were stronger. An intervention combining an easy-to-use, quick risk assessment tool with patient-centered risk reports at the point of care can successfully promote discussion of breast cancer risk reduction between patients and primary care physicians, particularly for high-risk women. Next steps include scaling and dissemination of BreastCARE with integration into electronic medical record systems. ©2014 American Association for Cancer Research.

  9. The Impact of Antidepressant Therapy on Glycemic Control in Canadian Primary Care Patients With Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Justin Gagnon

    2018-06-01

    Full Text Available Context: Depression is common in people with diabetes and is associated with poor glycemic control. Evidence suggests that certain antidepressants (AD increase the risk of poor control. Few population-based studies have examined the impact of individual ADs on glycemic control. This study's objective is to measure the impact of Citalopram, Amitriptyline, Venlafaxine, Trazodone and Escitalopram on glycated hemoglobin (HbA1c in Canadian primary care patients with diabetes.Methods: A retrospective study of electronic medical records (EMR from 115 primary care practices across Canada was undertaken. Data were obtained from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN. The sample population comprised 1,084 diabetic patients with 1,127 prescriptions of one of the five selected ADs and with baseline and post-exposure HbA1c measurements. Generalized linear mixed models were computed to estimate the effect of the ADs on HbA1c.Results: Mean HbA1c ratios for Amitriptyline, Venlafaxine, Trazodone and Escitalopram were all numerically lower than Citalopram. The confidence intervals included the minimum detectable effect, however the differences were not statistically significant. The lowest clinically relevant HbA1c ratios, relative to Citalopram, were found in patients prescribed Trazodone and Escitalopram. Accounting for the prescription of Trazodone for indications other than depression, this research suggests that Escitalopram may be safer than Citalopram for people with diabetes and depression, in terms of its effect on blood glucose.Conclusion: This study can inform future research examining the relationship between ADs and blood glucose and provides insight into the limitations pertaining to the use of health data in health research. Future research should seek to control for, across multiple time points: depression symptoms, depression severity, depression duration, weight, diabetes medication, tobacco and alcohol consumption and

  10. The persistence of gender inequality in Zimbabwe: factors that impede the advancement of women into leadership positions in primary schools

    OpenAIRE

    Chabaya, Owence; Rembe, Symphorosa; Wadesango, Newman

    2009-01-01

    We investigated and analysed the factors that women teachers consider as barriers to their advancement to headship positions in Zimbabwean primary schools. Specifically, we sought to identify the factors perceived by women school heads to be causes of persistent under-representation of women in school headship positions. Data were collected through structured face-to-face inter­views and focus group discussions with 13 experienced women school heads. The findings revealed that although the ma...

  11. Human factors in aviation: Terminal control area boundary conflicts

    Science.gov (United States)

    Monan, William P.

    1989-01-01

    Air-to-air conflicts in the vicinity of Terminal Control Area (TCA) boundaries were studied to obtain a better understanding of the causal dynamics of these events with particular focus on human factor issues. The study dataset consisted of 381 Instrument Flight Rules/Visual Flight Rules (IFR/VFR) traffic conflicts in airspace layers above TCA ceiling and below TCA floors; 213 reports of incursions in TCA terminal airspace by VFR aircraft, of which 123 resulted in conflicts; and an additional set of reports describing problems with Air Traffic Control (ATC) services in and around TCAs. Results and conclusions are detailed.

  12. Bodies or organisms? Medical encounter as a control apparatus at a primary care centre in Barcelona

    Directory of Open Access Journals (Sweden)

    Alejandro Zaballos Samper

    2013-07-01

    Full Text Available Medical practice is driven by technology, discourses, and knowledge about health and illness. This has resulted in its gaining a dominating position in power relations achieved by means of diagnosis, medicalization, and habit and conduct creation and maintenance. Interaction at primary care centres is built on mainstream biomedical views of both the medical discourse and the social practices related to health, illness and the human body. Moreover, it is also rooted on the ideologies conveyed by those social concepts, which in turn, permeate interaction all through with power relations. The present paper takes ethnographic data and in-depth interviews as a departing point to analyse how diagnosis, medicalization, and biopolicies for health prevention and improvement carried out in primary care centres in Barcelona make up a control apparatus. Furthermore, this essay also explores how the apparatus is developed in the medical encounter and turns the body into an organism.

  13. The W. M. Keck Telescope segmented primary mirror active control system software

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, R.W. (Lawrence Berkeley Lab., CA (USA) California Association for Research in Astronomy, Kamuela, HI (USA)); Andreae, S.; Biocca, A.K.; Jared, R.C.; Llacer, J.; Meng, J.D.; Minor, R.H.; Orayani, M. (Lawrence Berkeley Lab., CA (USA))

    1989-07-01

    The active control system (ACS) uses both parallel and distributed processing techniques to measure and control the positions of the 36 segments of the Keck Observatory Telescope primary mirror. The main function of the software is to maintain the mirror figure; to accomplish this goal the software uses a predictive, feed-forward'' mechanism which effectively increases the system bandwidth for the most important sources of perturbation. The software executes on a set of twelve 68000-family processors under the supervision of a VAX workstation. An array of nine parallel I/O processors collect and process data from 168 displacement sensors and transmit motion commands to 108 actuators. Three additional processors simultaneously compute actuator commands, monitor system performance, compute sensor control parameters and communicate with other observatory computers. The software is highly optimized for speed. 6 refs., 7 figs.

  14. The human factors specialist in nuclear control centre design

    International Nuclear Information System (INIS)

    Wilson, R.B.; Beattie, J.D.

    The main focus at Ontario Hydro for man-machine interface design is in the design of control centres. Because the control of a nuclear generating unit is highly centralized there is an increasing need for effective information display and control layout. Control panel design innovations such as the use of CRT displays and the extended use of computerized control in the Darlington station have made it possible for Ontario Hydro to continue to have one first operator for each generating unit. The human factors specialist involved in control panel design must deal with people who know much more about the specific systems being controlled, and must become a generalist in all these systems as well. Designers have to use conceptual techniques such as task analysis, systems design, panel mock-ups, anthropometric data, and personal judgement based on experience as they design panels. They must find a balance between becoming locked into existing technology and methods, slavishly following the latest technological trends, and forgetting that real people will be using what they design

  15. Functional bowel disorders in primary care: factors associated with health-related quality of life and doctor consultation.

    Science.gov (United States)

    Lee, Victoria; Guthrie, Else; Robinson, Andrew; Kennedy, Anne; Tomenson, Barbara; Rogers, Anne; Thompson, David

    2008-02-01

    The role of psychological factors in irritable bowel syndrome (IBS) remains unclear, particularly in a primary care setting, where relatively little research on this common and costly condition has been carried out. The aim of this study was to investigate the relative contribution of physical and psychological factors to health-related quality of life and health-care utilization in patients with functional bowel disease (IBS-like symptoms) in primary care. We also wished to establish the relevance of formal diagnostic criteria to IBS in the primary care setting. This study used a cross-sectional design. Four hundred twenty patients with functional bowel disorders in primary care completed a series of measures, including bowel symptom status and severity, severity of psychological distress, personality, and quality of life. The number of visits to a general practitioner (GP) in the previous 12 months was recorded. The following variables were independently and highly significantly associated with health-related quality of life in patients with functional bowel disorders in primary care: total psychological symptom score, diarrhea severity, abdominal pain for >12 weeks, and abdominal distension. A similar pattern emerged between patients who met meet Rome II criteria for IBS and patients who did not meet Rome II criteria for IBS. Relatively few variables (either physical or psychological) had a major impact on the number of GP consultations, with the exception of frequency of bowel movements. This study confirms that psychological factors are significantly associated with health-related quality of life in patients with IBS in primary care. Physical symptom severity is also important. Relatively few symptom measures, either physical or psychological, have a major impact on doctor consultation rates in primary care.

  16. Integration of Lithium-Ion Battery Storage Systems in Hydroelectric Plants for Supplying Primary Control Reserve

    Directory of Open Access Journals (Sweden)

    Fabio Bignucolo

    2017-01-01

    Full Text Available The ever-growing diffusion of renewables as electrical generation sources is forcing the electrical power system to face new and challenging regulation problems to preserve grid stability. Among these, the primary control reserve is reckoned to be one of the most important issues, since the introduction of generators based on renewable energies and interconnected through static converters, if relieved from the primary reserve contribution, reduces both the system inertia and the available power reserve in case of network events involving frequency perturbations. In this scenario, renewable plants such as hydroelectric run-of-river generators could be required to provide the primary control reserve ancillary service. In this paper, the integration between a multi-unit run-of-river power plant and a lithium-ion based battery storage system is investigated, suitably accounting for the ancillary service characteristics as required by present grid codes. The storage system is studied in terms of maximum economic profitability, taking into account its operating constraints. Dynamic simulations are carried out within the DIgSILENT PowerFactory 2016 software environment in order to analyse the plant response in case of network frequency contingencies, comparing the pure hydroelectric plant with the hybrid one, in which the primary reserve is partially or completely supplied by the storage system. Results confirm that the battery storage system response to frequency perturbations is clearly faster and more accurate during the transient phase compared to a traditional plant, since time delays due to hydraulic and mechanical regulations are overpassed. A case study, based on data from an existing hydropower plant and referring to the Italian context in terms of operational constraints and ancillary service remuneration, is presented.

  17. Prevalence of Nocturnal Enuresis and Its Associated Factors in Primary School and Preschool Children of Khorramabad in 2013

    Directory of Open Access Journals (Sweden)

    Katayoun Bakhtiar

    2014-01-01

    Full Text Available Background. Nocturnal enuresis refers to an inability to control urination during sleep. This study aimed to determine the prevalence of nocturnal enuresis and its associated factors in children in the city of Khorramabad. Materials and Methods. In this descriptive-analytic, cross-sectional study, 710 male and female children were divided into two groups with equal numbers. The samples were selected from the schools of Khorramabad using the multistage cluster and stratified random sampling methods based on the diagnostic criteria of DSM-IV. The data was analyzed using the logistic regression. Results. The results showed that 8% of the children had nocturnal enuresis, including 5.2% of primary nocturnal enuresis and 2.8% of secondary nocturnal enuresis. The prevalence of nocturnal enuresis in the boys (10.7% was higher compared with that in the girls (5.4% (P=0.009. There were statistically significant relationships between nocturnal enuresis and history of nocturnal enuresis in siblings (P=0.023, respiratory infections (P=0.036, deep sleep (P=0.007, corporal punishment at school (P=0.036, anal itching (P=0.043, and history of seizures (P=0.043. Conclusion. This study showed that the prevalence of nocturnal enuresis in the boys was higher compared with that in the girls.

  18. Prevalence of nocturnal enuresis and its associated factors in primary school and preschool children of khorramabad in 2013.

    Science.gov (United States)

    Bakhtiar, Katayoun; Pournia, Yadollah; Ebrahimzadeh, Farzad; Farhadi, Ali; Shafizadeh, Fathollah; Hosseinabadi, Reza

    2014-01-01

    Background. Nocturnal enuresis refers to an inability to control urination during sleep. This study aimed to determine the prevalence of nocturnal enuresis and its associated factors in children in the city of Khorramabad. Materials and Methods. In this descriptive-analytic, cross-sectional study, 710 male and female children were divided into two groups with equal numbers. The samples were selected from the schools of Khorramabad using the multistage cluster and stratified random sampling methods based on the diagnostic criteria of DSM-IV. The data was analyzed using the logistic regression. Results. The results showed that 8% of the children had nocturnal enuresis, including 5.2% of primary nocturnal enuresis and 2.8% of secondary nocturnal enuresis. The prevalence of nocturnal enuresis in the boys (10.7%) was higher compared with that in the girls (5.4%) (P = 0.009). There were statistically significant relationships between nocturnal enuresis and history of nocturnal enuresis in siblings (P = 0.023), respiratory infections (P = 0.036), deep sleep (P = 0.007), corporal punishment at school (P = 0.036), anal itching (P = 0.043), and history of seizures (P = 0.043). Conclusion. This study showed that the prevalence of nocturnal enuresis in the boys was higher compared with that in the girls.

  19. Impact of Primary and Secondary Social Origin Factors on the Transition to University in the Czech Republic

    Czech Academy of Sciences Publication Activity Database

    Simonová, Natalie; Soukup, P.

    2015-01-01

    Roč. 36, č. 5 (2015), s. 707-728 ISSN 0142-5692 Institutional support: RVO:68378025 Keywords : educational inequality * social origin * primary and secondary effects Subject RIV: AO - Sociology, Demography Impact factor: 1.220, year: 2015 http://dx.doi.org/10.1080/01425692.2013.854690

  20. Childhood Anxiety in a Diverse Primary Care Population: Parent-Child Reports, Ethnicity and SCARED Factor Structure

    Science.gov (United States)

    Wren, Frances J.; Berg, Eric A.; Heiden, Lynda A.; Kinnamon, Carolyn J.; Ohlson, Lirio A.; Bridge, Jeffrey A.; Birmaher, Boris; Bernal, M. Pilar

    2007-01-01

    Objective: To explore in a multiethnic primary care population the impact of child gender and of race/ethnicity on parent and child reports of school-age anxiety and on the factor structure of the Screen for Childhood Anxiety and Related Emotional Disorders (SCARED). Method: A consecutive sample of 515 children (8 to less than 13 years) and their…

  1. Principals' Attitudes towards Risky Internet Use of Primary School Students: The Role of Occupational Factors

    Science.gov (United States)

    Touloupis, Thanos; Athanasiades, Christina

    2018-01-01

    The present study aimed to investigate primary school principals' attitudes towards risky internet use of school-aged students and how occupational factors, such as work self-efficacy, job satisfaction, and burnout, may affect these attitudes especially in a context of economic crisis, which has adversely affected working conditions and duties of…

  2. Relationship between insulin-like growth factor-1 and radiographic disease in patients with primary osteoarthritis: a systematic review.

    NARCIS (Netherlands)

    Claessen, K.M.; Ramautar, S.R.; Pereira, A.M.; Smit, J.W.A.; Biermasz, N.R.; Kloppenburg, M.

    2012-01-01

    OBJECTIVE: To evaluate the association between radiographic osteoarthritis (OA) and either serum insulin-like growth factor-1 (IGF-1) levels or IGF-1 gene polymorphisms in patients with primary OA. METHODS: We conducted a systematic review of reported associations between circulating IGF-1 and/or

  3. Public and Private School Distinction, Regional Development Differences, and Other Factors Influencing the Success of Primary School Students in Turkey

    Science.gov (United States)

    Sulku, Seher Nur; Abdioglu, Zehra

    2015-01-01

    This study investigates the factors influencing the success of students in primary schools in Turkey. TIMSS 2011 data for Turkey, measuring the success of eighth-grade students in the field of mathematics, were used in an econometric analysis, performed using classical linear regression models. Two hundred thirty-nine schools participated in the…

  4. Characterization of connective tissue growth factor expression in primary cultures of human tubular epithelial cells: modulation by hypoxia

    NARCIS (Netherlands)

    Kroening, Sven; Neubauer, Emily; Wullich, Bernd; Aten, Jan; Goppelt-Struebe, Margarete

    2010-01-01

    Kroening S, Neubauer E, Wullich B, Aten J, Goppelt-Struebe M. Characterization of connective tissue growth factor expression in primary cultures of human tubular epithelial cells: modulation by hypoxia. Am J Physiol Renal Physiol 298:F796-F806, 2010. First published December 23, 2009;

  5. Primary cilia and coordination of receptor tyrosine kinase (RTK) and transforming growth factor β (TGF-β) signaling

    DEFF Research Database (Denmark)

    Christensen, Søren Tvorup; Morthorst, Stine Kjær; Mogensen, Johanne Bay

    2017-01-01

    are at the root of a pleiotropic group of diseases and syndromic disorders called ciliopathies. In this review, we present an overview of primary cilia-mediated regulation of receptor tyrosine kinase (RTK) and transforming growth factor β (TGF-β) signaling. Further, we discuss how defects in the coordination...

  6. Control of exogenous factors affecting plasma homovanillic acid concentration.

    Science.gov (United States)

    Davidson, M; Giordani, A B; Mohs, R C; Mykytyn, V V; Platt, S; Aryan, Z S; Davis, K L

    1987-04-01

    Measurements of plasma homovanillic acid (pHVA) concentrations appear to be a valid research strategy in psychiatric disorders in which a central dopamine (DA) abnormality has been implicated. This study provides guidance about the control of some of the exogenous factors affecting pHVA concentrations. Fasting for 14 hours eliminates the dietary effects on pHVA in healthy human subjects. Changing position, walking for 30 minutes, or smoking two cigarettes has no effect on pHVA concentrations.

  7. Observations of infection prevention and control practices in primary health care, Kenya.

    Science.gov (United States)

    Bedoya, Guadalupe; Dolinger, Amy; Rogo, Khama; Mwaura, Njeri; Wafula, Francis; Coarasa, Jorge; Goicoechea, Ana; Das, Jishnu

    2017-07-01

    To assess compliance with infection prevention and control practices in primary health care in Kenya. We used an observational, patient-tracking tool to assess compliance with infection prevention and control practices by 1680 health-care workers during outpatient interactions with 14 328 patients at 935 health-care facilities in 2015. Compliance was assessed in five domains: hand hygiene; protective glove use; injections and blood sampling; disinfection of reusable equipment; and waste segregation. We calculated compliance by dividing the number of correct actions performed by the number of indications and evaluated associations between compliance and the health-care worker's and facility's characteristics. Across 106 464 observed indications for an infection prevention and control practice, the mean compliance was 0.318 (95% confidence interval, CI: 0.315 to 0.321). The compliance ranged from 0.023 (95% CI: 0.021 to 0.024) for hand hygiene to 0.871 (95% CI: 0.866 to 0.876) for injection and blood sampling safety. Compliance was weakly associated with the facility's characteristics (e.g. public or private, or level of specialization) and the health-care worker's knowledge of, and training in, infection prevention and control practices. The observational tool was effective for assessing compliance with infection prevention and control practices across multiple domains in primary health care in a low-income country. Compliance varied widely across infection prevention and control domains. The weak associations observed between compliance and the characteristics of health-care workers and facilities, such as knowledge and the availability of supplies, suggest that a broader focus on behavioural change is required.

  8. New factors controlling the balance between osteoblastogenesis and adipogenesis.

    Science.gov (United States)

    Abdallah, Basem M; Kassem, Moustapha

    2012-02-01

    The majority of conditions associated with bone loss, including aging, are accompanied by increased marrow adiposity possibly due to shifting of the balance between osteoblast and adipocyte differentiation in bone marrow stromal (skeletal) stem cells (MSC). In order to study the relationship between osteoblastogenesis and adipogenesis in bone marrow, we have characterized cellular models of multipotent MSC as well as pre-osteoblastic and pre-adipocytic cell populations. Using these models, we identified two secreted factors in the bone marrow microenviroment: secreted frizzled-related protein 1 (sFRP-1) and delta-like1 (preadipocyte factor 1) (Dlk1/Pref-1). Both exert regulatory effects on osteoblastogenesis and adipogenesis. Our studies suggest a model for lineage fate determination of MSC that is regulated through secreted factors in the bone marrow microenvironment that mediate a cross-talk between lineage committed cell populations in addition to controlling differentiation choices of multipotent MSC. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. A randomized controlled trial of single point acupuncture in primary dysmenorrhea.

    Science.gov (United States)

    Liu, Cun-Zhi; Xie, Jie-Ping; Wang, Lin-Peng; Liu, Yu-Qi; Song, Jia-Shan; Chen, Yin-Ying; Shi, Guang-Xia; Zhou, Wei; Gao, Shu-Zhong; Li, Shi-Liang; Xing, Jian-Min; Ma, Liang-Xiao; Wang, Yan-Xia; Zhu, Jiang; Liu, Jian-Ping

    2014-06-01

    Acupuncture is often used for primary dysmenorrhea. But there is no convincing evidence due to low methodological quality. We aim to assess immediate effect of acupuncture at specific acupoint compared with unrelated acupoint and nonacupoint on primary dysmenorrhea. The Acupuncture Analgesia Effect in Primary Dysmenorrhoea-II is a multicenter controlled trial conducted in six large hospitals of China. Patients who met inclusion criteria were randomly assigned to classic acupoint (N = 167), unrelated acupoint (N = 167), or non-acupoint (N = 167) group on a 1:1:1 basis. They received three sessions with electro-acupuncture at a classic acupoint (Sanyinjiao, SP6), or an unrelated acupoint (Xuanzhong, GB39), or nonacupoint location, respectively. The primary outcome was subjective pain as measured by a 100-mm visual analog scale (VAS). Measurements were obtained at 0, 5, 10, 30, and 60 minutes following the first intervention. In addition, patients scored changes of general complaints using Cox retrospective symptom scales (RSS-Cox) and 7-point verbal rating scale (VRS) during three menstrual cycles. Secondary outcomes included VAS score for average pain, pain total time, additional in-bed time, and proportion of participants using analgesics during three menstrual cycles. Five hundred and one people underwent random assignment. The primary comparison of VAS scores following the first intervention demonstrated that classic acupoint group was more effective both than unrelated acupoint (-4.0 mm, 95% CI -7.1 to -0.9, P = 0.010) and nonacupoint (-4.0 mm, 95% CI -7.0 to -0.9, P = 0.012) groups. However, no significant differences were detected among the three acupuncture groups for RSS-Cox or VRS outcomes. The per-protocol analysis showed similar pattern. No serious adverse events were noted. Specific acupoint acupuncture produced a statistically, but not clinically, significant effect compared with unrelated acupoint and nonacupoint acupuncture in

  10. Mitochondrial respiratory control is lost during growth factor deprivation.

    Science.gov (United States)

    Gottlieb, Eyal; Armour, Sean M; Thompson, Craig B

    2002-10-01

    The ability of cells to maintain a bioenergetically favorable ATP/ADP ratio confers a tight balance between cellular events that consume ATP and the rate of ATP production. However, after growth factor withdrawal, the cellular ATP/ADP ratio declines. To investigate these changes, mitochondria from growth factor-deprived cells isolated before the onset of apoptosis were characterized in vitro. Mitochondria from growth factor-deprived cells have lost their ability to undergo matrix condensation in response to ADP, which is accompanied by a failure to perform ADP-coupled respiration. At the time of analysis, mitochondria from growth factor-deprived cells were not depleted of cytochrome c and cytochrome c-dependent respiration was unaffected, demonstrating that the inhibition of the respiratory rate is not due to loss of cytochrome c. Agents that disrupt the mitochondrial outer membrane, such as digitonin, or maintain outer membrane exchange of adenine nucleotide, such as Bcl-x(L), restored ADP-dependent control of mitochondrial respiration. Together, these data suggest that the regulation of mitochondrial outer membrane permeability contributes to respiratory control.

  11. Therapeutic interventions and success in risk factor control for secondary prevention of stroke.

    Science.gov (United States)

    Alvarez-Sabin, Jose; Quintana, Manuel; Hernandez-Presa, Miguel Angel; Alvarez, Carlos; Chaves, Jose; Ribo, Marc

    2009-01-01

    We sought to evaluate the success rates in achieving preventive therapeutic goals in patients who experienced an ischemic stroke (IS) and compare them with those achieved in patients with coronary artery disease (CAD). This was an observational multicenter case-control study (3 patients with IS and one control subject with CAD) performed in 1444 primary health centers in Spain. Preventive therapeutic objectives according to American Heart Association guidelines were predefined. Demographic data, vascular risk factors, and success/failure in achievement of objectives were recorded and compared between patients with IS and CAD. A total of 5458 patients were included, 4098 (75.1%) had IS and 1360 (24.9%) had CAD. Although more than 90% of patients with hypertension, diabetes, or dyslipidemia were under specific drug regimens, only about 25% achieved the recommended therapeutic objective for each risk factor. Success rate was especially low among patients with IS compared with CAD: hypertension (23.8% v 27.2%; P = .028); dyslipidemia (13.6% v 20.3%; P risk factors under control, compared with 5.6% of those with CAD (P = .006). For all patients, multivariate logistic regression model showed that independent predictors of full risk factor control were: presence of CAD as compared with IS (odds ratio [OR] 2.11; 95% confidence interval [CI] 1.35-3.29; P = .001), older age (OR 1.02; 95% CI 1.00-1.04; P = .028), and having less than 3 risk factors (OR 16.98; 95% CI 9.02-31.97; P risk factor control.

  12. Coordinated Primary and Secondary Control with Frequency-Bus-Signaling for Distributed Generation and Storage in Islanded Microgrids

    DEFF Research Database (Denmark)

    Wu, Dan; Tang, Fen; Dragicevic, Tomislav

    2013-01-01

    In this paper, a distributed coordinated control scheme based on frequency-bus-signaling (FBS) method for a low-voltage AC three phase microgrid is proposed. The control scheme is composed by two levels. Firstly a primary local control which is different for the DGs and the ESS is proposed. The ESS...... control is implemented to restore the frequency deviation produced by the primary ESS controller while preserving the coordinated control performance. Real-time simulation results show the feasibility of the proposed approach by showing the operation of the microgrid in different scenarios....

  13. Evaluation of a nurse-led dementia education and knowledge translation programme in primary care: A cluster randomized controlled trial.

    Science.gov (United States)

    Wang, Yao; Xiao, Lily Dongxia; Ullah, Shahid; He, Guo-Ping; De Bellis, Anita

    2017-02-01

    The lack of dementia education programmes for health professionals in primary care is one of the major factors contributing to the unmet demand for dementia care services. To determine the effectiveness of a nurse-led dementia education and knowledge translation programme for health professionals in primary care; participants' satisfaction with the programme; and to understand participants' perceptions of and experiences in the programme. A cluster randomized controlled trial was used as the main methodology to evaluate health professionals' knowledge, attitudes and care approach. Focus groups were used at the end of the project to understand health professionals' perceptions of and experiences in the programme. Fourteen community health service centres in a province in China participated in the study. Seven centres were randomly assigned to the intervention or control group respectively and 85 health professionals in each group completed the programme. A train-the-trainer model was used to implement a dementia education and knowledge translation programme. Outcome variables were measured at baseline, on the completion of the programme and at 3-month follow-up. A mixed effect linear regression model was applied to compare the significant differences of outcome measures over time between the two groups. Focus groups were guided by four semi-structured questions and analysed using content analysis. Findings revealed significant effects of the education and knowledge translation programme on participants' knowledge, attitudes and a person-centred care approach. Focus groups confirmed that the programme had a positive impact on dementia care practice. A dementia education and knowledge translation programme for health professionals in primary care has positive effects on their knowledge, attitudes, care approach and care practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Factors controlling floc settling velocity along a longitudinal estuarine transect

    Science.gov (United States)

    Manning, A.J.; Schoellhamer, D.H.

    2013-01-01

    A 147 km longitudinal transect of flocculated cohesive sediment properties in San Francisco Bay (SFB) was conducted on June 17th, 2008. Our aim was to determine the factors that control floc settling velocity along the longitudinal axis of the estuary. The INSSEV-LF video system was used to measure floc diameters and settling velocities at 30 stations at a distance of 0.7 m above the estuary bed. Floc sizes (D) ranged from 22 μm to 639 μm and settling velocities (Ws) ranged between 0.04 mm·s− 1 and 15.8 mm·s− 1 during the longitudinal transect. Nearbed turbulent shear stresses throughout the transect duration were within the 0.2–0.5 Pa range which typically stimulates flocculation growth. The individual D–Ws–floc density plots suggest the suspended sediments encountered throughout SFB were composed of both muddy cohesive sediment and mixed sediments flocs. Mass-weighted population mean settling velocity (Wsmass) ranged from 0.5 mm·s− 1 to 10 mm·s− 1. The macrofloc and microfloc (demarcation at 160 μm) sub-populations demonstrated parameterised settling velocities which spanned nearly double the range of the sample mean settling velocities (Wsmean). The macroflocs tended to dominate the suspended mass (up to 77% of the ambient suspended solid concentration; SSC) from San Pablo Bay to Carquinez Strait (the vicinity of the turbidity maximum zone). Microfloc mass was particularly significant (typically 60–100% of the SSC) in the northern section of South Bay and most of Central Bay. The transect took eleven hours to complete and was not fully synoptic. During slack tide, larger and faster settling flocs deposited, accounting for most of the longitudinal variability. The best single predictor of settling velocity was water velocity 39 min prior to sampling, not suspended-sediment concentration or salinity. Resuspension and settling lags are likely responsible for the lagged response of settling velocity to water velocity. The distribution of

  15. Wind tunnel testing to predict control room atmospheric dispersion factors

    International Nuclear Information System (INIS)

    Holmquist, L.J.; Harden, P.A.; Muraida, J.E.

    1993-01-01

    Recent concerns at Palisades about control room habitability in the event of a loss-of-coolant accident have led to an extensive effort to increase control room habitability margin. The heating, ventilating and air-conditioning (HVAC) system servicing the control room has the potential for unfiltered in-leakage through its normal outside air intake louvered isolation dampers during emergency mode. The current limiting control room habitability analysis allows for 1.2 x 10 -2 m 3 /s (25 ft 3 /min) unfiltered in-leakage into the control room envelope. This leakage value was not thought to be achievable with the existing as-built configuration. Repairing the system was considered as a potential solution; however, this would be costly and could negatively affect plant operation. In addition, the system would still be required to meet the low specified unfiltered in-leakage. A second approach to this problem was to determine the atmospheric dispersion factors (x/Q's) through a wind tunnel test using a scale model of Palisades. The results of the wind tunnel testing could yield more realistic x/Q's for control room habitability than previously employed methods. Palisades selected the wind tunnel study option based on its ease of implementation, realistic results, and low cost. More importantly, the results of the study could increase the allowable unfiltered in-leakage

  16. Cooperative research for human factors review of advanced control rooms

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Woon; Park, Jae Chang; Lee, Yong Hee; Oh, In Seok; Lee, Hyun Chul

    2000-12-01

    This project has been performed as cooperative research between KAERI and USNRC. Human factors issues related to soft controls, which is one of key features of advanced HSI, are identified in this project. The issues are analyzed for the evaluation approaches in either experimental or analytical ways. Also, issues requiring additional researches for the evaluation of advanced HSI are identified in the areas of advanced information systems design, computer-based procedure systems, soft controls, human systems interface and plant modernization process, and maintainability of digital systems. The issues are analyzed to discriminate the urgency of researches on it to high, medium, and low levels in consideration of advanced HSI development status in Korea, and some of the issues that can be handled by experimental researches are identified. Additionally, an experimental study is performed to compare operator's performance on human error detection in advanced control rooms vs. in conventional control rooms. It is found that advanced control rooms have several design characteristics hindering operator's error detection performance compared to conventional control rooms.

  17. Cooperative research for human factors review of advanced control rooms

    International Nuclear Information System (INIS)

    Lee, Jung Woon; Park, Jae Chang; Lee, Yong Hee; Oh, In Seok; Lee, Hyun Chul

    2000-12-01

    This project has been performed as cooperative research between KAERI and USNRC. Human factors issues related to soft controls, which is one of key features of advanced HSI, are identified in this project. The issues are analyzed for the evaluation approaches in either experimental or analytical ways. Also, issues requiring additional researches for the evaluation of advanced HSI are identified in the areas of advanced information systems design, computer-based procedure systems, soft controls, human systems interface and plant modernization process, and maintainability of digital systems. The issues are analyzed to discriminate the urgency of researches on it to high, medium, and low levels in consideration of advanced HSI development status in Korea, and some of the issues that can be handled by experimental researches are identified. Additionally, an experimental study is performed to compare operator's performance on human error detection in advanced control rooms vs. in conventional control rooms. It is found that advanced control rooms have several design characteristics hindering operator's error detection performance compared to conventional control rooms

  18. The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians.

    Science.gov (United States)

    Parlier, Anna Beth; Galvin, Shelley L; Thach, Sarah; Kruidenier, David; Fagan, Ernest Blake

    2018-01-01

    To examine the literature documenting successes in recruiting and retaining rural primary care physicians. The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention. The authors' proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work-life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice. Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences.

  19. Equivalent to Represent Inertial and Primary Frequency Control Effects of an External System

    DEFF Research Database (Denmark)

    Weckesser, Johannes Tilman Gabriel; Van Cutsem, Thierry

    2017-01-01

    This paper presents a novel equivalent, which is suitable for simulation of inertial and primary frequency control effects. In the model reduction procedure, dynamic power injectors are used to replace the external system and to mimic its dynamic behavior. The parameters of the equivalents...... are tuned with a simple approach presented in this paper. The effectiveness of the proposed method is demonstrated on a modified version of the ENTSO-E Dynamic Study Model. The results show that the system frequency response of the unreduced system is retained and a speedup of the simulations of around 4...

  20. Stability test and analysis of the Space Shuttle Primary Reaction Control Subsystem thruster

    Science.gov (United States)

    Applewhite, John; Hurlbert, Eric; Krohn, Douglas; Arndt, Scott; Clark, Robert

    1992-01-01

    The results are reported of a test program conducted on the Space Shuttle Primary Reaction Control Subsystem thruster in order to investigate the effects of trapped helium bubbles and saturated propellants on stability, determine if thruster-to-thruster stability variations are significant, and determine stability under STS-representative conditions. It is concluded that the thruster design is highly reliable in flight and that burn-through has not occurred. Significantly unstable thrusters are screened out, and wire wrap is found to protect against chamber burn-throughs and to provide a fail-safe thruster for this situation.

  1. Factor structure of the Wechsler Intelligence Scale for Children-Fifth Edition: Exploratory factor analyses with the 16 primary and secondary subtests.

    Science.gov (United States)

    Canivez, Gary L; Watkins, Marley W; Dombrowski, Stefan C

    2016-08-01

    The factor structure of the 16 Primary and Secondary subtests of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V; Wechsler, 2014a) standardization sample was examined with exploratory factor analytic methods (EFA) not included in the WISC-V Technical and Interpretive Manual (Wechsler, 2014b). Factor extraction criteria suggested 1 to 4 factors and results favored 4 first-order factors. When this structure was transformed with the Schmid and Leiman (1957) orthogonalization procedure, the hierarchical g-factor accounted for large portions of total and common variance while the 4 first-order factors accounted for small portions of total and common variance; rendering interpretation at the factor index level less appropriate. Although the publisher favored a 5-factor model where the Perceptual Reasoning factor was split into separate Visual Spatial and Fluid Reasoning dimensions, no evidence for 5 factors was found. It was concluded that the WISC-V provides strong measurement of general intelligence and clinical interpretation should be primarily, if not exclusively, at that level. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  2. Drug adherence in treatment resistant and in controlled hypertension-Results from the Swedish Primary Care Cardiovascular Database (SPCCD).

    Science.gov (United States)

    Holmqvist, Lina; Boström, Kristina Bengtsson; Kahan, Thomas; Schiöler, Linus; Qvarnström, Miriam; Wettermark, Björn; Hjerpe, Per; Hasselström, Jan; Manhem, Karin

    2018-03-01

    To assess drug adherence in patients treated with ≥3 antihypertensive drug classes, with both controlled and uncontrolled blood pressure and describe associated factors for nonadherence. Patients with hypertension, without cardiovascular comorbidity, aged >30 years treated with ≥3 antihypertensive drug classes were followed for 2 years. Both patients with treatment resistant hypertension (TRH) and patients with controlled hypertension were included. Clinical data were derived from a primary care database. Pharmacy refill data from the Swedish Prescribed drug registry was used to calculate proportion of days covered (PDC). Patients with a PDC level ≥ 80% were included. We found 5846 patients treated ≥3 antihypertensive drug classes, 3508 with TRH (blood pressure ≥ 140/90), and 2338 with controlled blood pressure (drug therapy had similar decline in adherence over time regardless of initial blood pressure control. Diabetes was associated with better adherence, which may imply that the structured caregiving of these patients enhances antihypertensive drug treatment. Copyright © 2018 John Wiley & Sons, Ltd.

  3. Why do mothers encourage their children to control their weight? A cross-sectional study of possible contributing factors

    OpenAIRE

    Schreiber, Anja C; Kesztyüs, Dorothea; Wirt, Tamara; Erkelenz, Nanette; Kobel, Susanne; Steinacker, Jürgen M

    2014-01-01

    Background Mothers encouraging their children to control their weight is problematic as it is associated with children’s body dissatisfaction and weight concerns as well as further weight gain. The aim of this study was to identify factors in children and mothers associated with mothers encouraging their children to control their weight and possible gender differences therein. Methods Cross-sectional questionnaire data was available from 1658 mothers of primary school children (mean age 7.1 ±...

  4. [Factors associated with primary care professionals' readiness to respond to intimate partner violence in Spain].

    Science.gov (United States)

    Murillo, Pilar; Sebastián, Miguel San; Vives-Cases, Carmen; Goicolea, Isabel

    2017-05-22

    To analyse the Spanish primary care professionals' readiness to respond to intimate partner violence (IPV) in primary care and identify possible determinants that could facilitate a better response. A cross-sectional study with a non-probabilistic sampling by convenience was performed among healthcare professionals working in 15 primary care centres in Spain. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), the version validated and translated into Spanish, was the instrument used to collect information about knowledge, opinions and practices regarding intimate partner violence. Descriptive analysis and, simple and multiple linear regression analysis were performed. A total of 265 completed questionnaires were received, with a response rate of 80.3%. An exposure-response effect was observed, where at higher hours of training a higher score was obtained on the questionnaire sections (p <0.05). Age, type of profession, years of experience in primary care, hours of IPV training and reading the protocol showed positive association with knowledge (perceived preparation, perceived knowledge, actual knowledge), opinions (staff preparation, legal requirements, self-efficacy, workplace issues, constraints, understanding of the victim) and practice of healthcare professionals. Reading the regional/national protocol for action and receiving training in IPV were the most important interventions associated to a better primary care professionals' readiness to respond to IPV in Spanish primary care settings. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Metallurgical and mechanical parameters controlling alloy 718 stress corrosion cracking resistance in PWR primary water

    International Nuclear Information System (INIS)

    Deleume, J.

    2007-11-01

    Improving the performance and reliability of the fuel assemblies of the pressurized water reactors requires having a perfect knowledge of the operating margins of both the components and the materials. The choice of alloy 718 as reference material for this study is justified by the industrial will to identify the first order parameters controlling the excellent resistance of this alloy to Stress Corrosion Cracking (SCC). For this purpose, a specific slow strain rate (SSR) crack initiation test using tensile specimen with a V-shaped hump in the middle of the gauge length was developed and modeled. The selectivity of such SSR tests in simulated PWR primary water at 350 C was clearly established by characterizing the SCC resistance of nine alloy 718 thin strip heats. Regardless of their origin and in spite of a similar thermo-mechanical history, they did not exhibit the same susceptibility to SCC crack initiation. All the characterized alloy 718 heats develop oxide scale of similar nature for various exposure times to PWR primary medium in the temperature range [320 C - 360 C]. δ phase precipitation has no impact on alloy 718 SCC initiation behavior when exposed to PWR primary water, contrary to interstitial contents and the triggering of plastic instabilities (PLC phenomenon). (author)

  6. Dyslipidemia in primary care – prevalence, recognition, treatment and control: data from the German Metabolic and Cardiovascular Risk Project (GEMCAS

    Directory of Open Access Journals (Sweden)

    Wasem Jürgen

    2008-10-01

    Full Text Available Abstract Background Current guidelines from the European Society of Cardiology (ESC define low thresholds for the diagnosis of dyslipidemia using total cholesterol (TC and LDL-cholesterol (LDL-C to guide treatment. Although being mainly a prevention tool, its thresholds are difficult to meet in clinical practice, especially primary care. Methods In a nationwide study with 1,511 primary care physicians and 35,869 patients we determined the prevalence of dyslipidemia, its recognition, treatment, and control rates. Diagnosis of dyslipidemia was based on TC and LDL-C. Basic descriptive statistics and prevalence rate ratios, as well as 95% confidence intervals were calculated. Results Dyslipidemia was highly frequent in primary care (76% overall. 48.6% of male and 39.9% of female patients with dyslipidemia was diagnosed by the physicians. Life style intervention did however control dyslipidemia in about 10% of patients only. A higher proportion (34.1% of male and 26.7% female was controlled when receiving pharmacotherapy. The chance to be diagnosed and subsequently controlled using pharmacotherapy was higher in male (PRR 1.15; 95%CI 1.12–1.17, in patients with concomitant cardiovascular risk factors, in patients with hypertension (PRR 1.20; 95%CI 1.05–1.37 and cardiovascular disease (PRR 1.46; 95%CI 1.29–1.64, previous myocardial infarction (PRR 1.32; 95%CI 1.19–1.47, and if patients knew to be hypertensive (PRR 1.18; 95%CI 1.04–1.34 or knew about their prior myocardial infarction (PRR 1.17; 95%CI 1.23–1.53. Conclusion Thresholds of the ESC seem to be difficult to meet. A simple call for more aggressive treatment or higher patient compliance is apparently not enough to enhance the proportion of controlled patients. A shift towards a multifactorial treatment considering lifestyle interventions and pharmacotherapy to reduce weight and lipids may be the only way in a population where just to be normal is certainly not ideal.

  7. Role of hormonal factor in development of primary and secondary tumorous process in the brain

    Directory of Open Access Journals (Sweden)

    O. I. Kit

    2016-01-01

    Full Text Available Introduction. Causes of the development onset of primary malignant cerebral neoplasms have not yet been determined. Not excluded is a possibility of unfavorable effect of the environment, genetic abnormalities, changes alterations in the hormonal background as well as metabolism, ionizing radiation: possible is also the role of viral infections and injuries. One of the main most severest complications of malignant tumors remain are metastatic lesions of the central nervous system whose proportion increases as with the patients’ longlivity. Cerebral metastases of malignant tumors are encountered more often than primary neoplasms of the central nervous system. The brain is not only a hormone-dependent organ the effect of sex hormones as early the embryonic state conditions normal development of the body as a whole and controls the sex related differentiation. It is known that neurons and glyocites like gonads and adrenal glands are able to produce steroid hormones. The enzymes responsible for the synthesis of neurosteroids were detected in the brain tissue in the embryonic period of the development. The human brain is not only a hormone-dependent organ effect influence of sex hormones as early as in the embrional state conditiones normal development of the body as a whole and controls sexual gender differentiation. It is known that neurons and glyocytes like gonads and adrenal glands are able to produce steroid hormones. Enzymes responsible for synthesis of neurosteroids were revealed in cerebral tissue both in during the embryonic period of the development and in adult condition. Besides there are have been obtained large amount of data on the presence in the cerebral cells of receptors to steroidal hormones. In various periods of life the influence effect exerted by steroids on nervous cells can change the morphofunctional state of the brain and manifests as altering myelinization, neuronal growth, and differentiation of nerve cells

  8. Community pharmacist intervention in depressed primary care patients (PRODEFAR study: randomized controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Travé Pere

    2009-08-01

    Full Text Available Abstract Background Treatment of depression, the most prevalent and costly mental disorder, needs to be improved. Non-concordance with clinical guidelines and non-adherence can limit the efficacy of pharmacological treatment of depression. Through pharmaceutical care, pharmacists can improve patients' compliance and wellbeing. The aim of this study is to evaluate the effectiveness and cost-effectiveness of a community pharmacist intervention developed to improve adherence and outcomes of primary care patients with depression. Methods/design A randomized controlled trial, with 6-month follow-up, comparing patients receiving a pharmaceutical care support programme in primary care with patients receiving usual care. The total sample comprises 194 patients (aged between 18 and 75 diagnosed with depressive disorder in a primary care health centre in the province of Barcelona (Spain. Subjects will be asked for written informed consent in order to participate in the study. Diagnosis will be confirmed using the SCID-I. The intervention consists of an educational programme focused on improving knowledge about medication, making patients aware of the importance of compliance, reducing stigma, reassuring patients about side-effects and stressing the importance of carrying out general practitioners' advice. Measurements will take place at baseline, and after 3 and 6 months. Main outcome measure is compliance with antidepressants. Secondary outcomes include; clinical severity of depression (PHQ-9, anxiety (STAI-S, health-related quality of life (EuroQol-5D, satisfaction with the treatment received, side-effects, chronic physical conditions and socio-demographics. The use of healthcare and social care services will be assessed with an adapted version of the Client Service Receipt Inventory (CSRI. Discussion This trial will provide valuable information for health professionals and policy makers on the effectiveness and cost-effectiveness of a pharmaceutical

  9. The use of clinical practice guidelines in primary care: professional mindlines and control mechanisms.

    Science.gov (United States)

    Gené-Badia, Joan; Gallo, Pedro; Caïs, Jordi; Sánchez, Emília; Carrion, Carme; Arroyo, Liliana; Aymerich, Marta

    2016-01-01

    To identify the relevant barriers and enablers perceived by primary care professionals in implementing the recommendations of clinical practice guidelines (CPG). Two focus groups were conducted with primary care physicians and nurses in Catalonia (Spain) between October and December 2012. Thirty-nine health professionals were selected based on their knowledge and daily use of CPG. Finally, eight general practitioners and eight nurses were included in the discussion groups. Participants were asked to share their views and beliefs on the accessibility of CPG, their knowledge and use of these documents, the content and format of CPG, dissemination strategy, training, professional-patient relationship, and the use of CPG by the management structure. We recorded and transcribed the content verbatim and analysed the data using qualitative analysis techniques. Physicians believed that, overall, CPG were of little practical use and frequently referred to them as a largely bureaucratic management control instrument that threatened their professional autonomy. In contrast, nurses believed that CPG were rather helpful tools in their day-to-day practice, although they would like them to be more sensitive to the current role of nurses. Both groups believed that CPG did not provide a response to most of the decisions they faced in the primary care sett