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Selected AbstractsAdministering the class: Tradeoffs and balancing characterize the tasks after a mediated settlementALTERNATIVES TO THE HIGH COST OF LITIGATION, Issue 5 2005Margaret L. Shaw Last month, Margaret L. Shaw, of New York, and Linda R. Singer, of Washington, D.C., described mediation use in class action cases; in the second of two parts this month, they dissect the challenges in administering a class action settlement. [source] Long-term efficacy and safety of insulin detemir compared to Neutral Protamine Hagedorn insulin in patients with Type 1 diabetes using a treat-to-target basal,bolus regimen with insulin aspart at meals: a 2-year, randomized, controlled trialDIABETIC MEDICINE, Issue 4 2008P. C. Bartley Abstract Aims This 24-month, multi-national, open-label, parallel group trial investigated the long-term efficacy and safety of insulin detemir and Neutral Protamine Hagedorn insulin in combination with mealtime insulin aspart in patients with Type 1 diabetes using a treat-to-target concept. Methods Patients were randomized 2 : 1 to detemir (n = 331) or NPH (n = 166) groups. Basal insulin was initiated once daily (evening) and titrated individually based on self-measured plasma glucose (PG) levels, aiming for pre-breakfast and pre-dinner targets , 6.0 mmol/l. A second basal morning dose could be added according to pre-defined criteria. Results After 24 months, superiority of glycated haemoglobin (HbA1c) was achieved with detemir compared to NPH (detemir 7.36%, NPH 7.58%, mean difference ,0.22% points) [95% confidence interval (CI) ,0.41 to ,0.03%], with reductions of 0.94% and 0.72% points, respectively. Fasting PG (FPGlab) was also lower with detemir (detemir 8.35 mmol/l, NPH 9.43 mmol/l; P = 0.019). Twenty-two per cent of patients treated with detemir reached an HbA1c , 7.0% in the absence of confirmed hypoglycaemia during the last month of treatment vs. 13% on NPH (P = 0.019). Risk of major and nocturnal hypoglycaemia was 69% and 46% lower with detemir than with NPH (P < 0.001), respectively; patients treated with detemir gained less weight (detemir 1.7 kg, NPH 2.7 kg; P = 0.024). The overall safety profile was similar in the two groups and treatment with detemir did not result in any unexpected findings. Conclusions Long-term treatment with the insulin analogues detemir + aspart was superior to NPH + aspart in reducing HbA1c, with added benefits of less major and nocturnal hypoglycaemia and less weight gain. [source] Client satisfaction and risk behaviours of the users of syringe dispensing machines: a pilot studyDRUG AND ALCOHOL REVIEW, Issue 1 2008MD MOFIZUL ISLAM MSc Abstract Introduction and Aims. The study examines risk behaviours of the users of syringe dispensing machines (SDMs) and evaluates the usefulness of these machines in providing injecting drug users (IDUs) with sterile injecting equipment. Design and Methods. Self-administered questionnaires were used among users of SDMs in an Area Health Service of Sydney. Results. The majority of the 167 participants reported being happy with the quality of the SDM services. Problems identified with machines were that they were often broken or jammed (32.8% respondents), not in the right place (21.9%) or require money (16.7%). Just over half (50.9%) of the IDUs use SDMs only from 5 p.m. to 9 a.m., the time when almost all other outlets for accessing sterile injecting equipment remain closed. Relatively young IDUs (age , 30 years) were more likely to prefer SDMs over staffed needle syringe programmes (NSPs) compared with older users (age > 30) and to identify stigma (a desire to hide their identity or not liking the way people treat them at staffed NSPs or chemists) as a main reason for using these machines. Primary users of SDMs do not differ from primary users of NSP/chemists in terms of sharing of needles. Those users who had shared in the last month were nearly four times as likely to have never used condoms in sexual encounters over that period (95% confidence interval: 1.2,14.5). Discussion and Conclusion. SDMs appear to complement other outlets of NSPs. Providing free-of-cost equipment from SDMs should be considered carefully, as needing money to buy equipment was a reason given for sharing of needles by 35% of those who shared. [source] Problems experienced by community pharmacists delivering opioid substitution treatment in New South Wales and Victoria, AustraliaADDICTION, Issue 2 2010Adam R. Winstock ABSTRACT Aims To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers. Design Cross-sectional postal survey. Setting All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia. Participants Completed questionnaires were received from 669 pharmacists (68% response rate). Measurements The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers. Findings In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or ,3 missed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P < 0.001). Treatment termination in last month was predicted having more clients (P < 0.001), the provision of buprenorphine treatment (P = 0.008), having a separate dosing area (P = 0.021), and being a female pharmacist (P = 0.013). Past month refusal to dose was predicted by the pharmacy being in VIC (P < 0.001) and having more clients (P < 0.001). Problems experienced most commonly in the past month with prescribers were difficulty contacting prescriber (21%) and provision of takeaway doses to clients considered unstable by the pharmacist (19%) (higher in VIC: both P < 0.001). Conclusions This study highlights the range of problems experienced by community pharmacists in the delivery of OST and the consequences for people in treatment. Particular attention should be focused upon considering number of clients per pharmacy and improving professional communication between pharmacists and prescribers. [source] A comparison of changes in dental students' and medical students' approaches to learning during professional trainingEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2001Robert Lindemann The purposes of this study were 1) to compare the learning approaches of dental students (DS) and medical students (MS) for the Class of 1998 at a single institution at admission and graduation and 2) to determine if their learning approaches changed over the course of their studies. An Approaches to Studying Inventory (ASI) was administered to DS and MS at two times: their first month in school and their last month in school. Means and standard deviations were calculated for three ASI orientations to studying: ,Meaning', ,Reproducing', and ,Achieving'. An additional domain referred to as ,Styles and Pathologies' identified learning problems. In comparison, DS and MS demonstrated a different pattern of learning approaches at matriculation; however, at graduation these differences were less apparent. Over time, DS reported a decreased use, and MS reported an increased use of the Reproducing orientation bringing them closer together. MS also demonstrated an increased use of the Achieving orientation. The Meaning orientation, which indicates a deep approach to learning, was equivalently used by both groups at entry and remained unaltered. [source] Delusion symptoms are associated with ApoE ,4 allelic variant at the early stage of Alzheimer's disease with late onsetEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2006G. Spalletta Alzheimer's disease (AD) is a neurodegenerative disorder with mixed cognitive and behavioural clinical manifestations. The possession of apolipoprotein-E (ApoE) ,4 allelic variant is one of the most important risk factors for developing late-onset AD (LOAD). In this study we analysed the relationship between the entire range of behavioural symptoms, cognitive deficit, and sociodemographic characteristics and ApoE ,4 allele possession with multivariate logistic regression models in LOAD patients. Patients included (n = 171) were consecutively admitted in a memory clinic for the first diagnostic visit. Levels of behaviour and cognition within the last month were assessed by the Neuropsychiatric Inventory and Mini Mental State Examination. Presence of clinically significant psychosis, delusions and hallucinations at the early stage of the illness, from the onset to the first visit, was measured with diagnostic criteria. ApoE ,4 allele possession was associated with increased levels of delusions within the last month from the first visit (OR 1.23; 95% CI 1.01,1.50; P < 0.05) and with the presence of categorical delusions at the early stage until the first visit (OR 3.11; 95% CI 1.21,8.01; P < 0.02). In this study, which considers the entire range of behavioural expressions in LOAD patients at the early stage of the illness, the relationship between behaviour and ApoE ,4 allele is confirmed for delusions only. [source] Ultrastructural clues for the potent therapeutic effect of melatonin on aging skin in pinealectomized ratsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 6 2006Mukaddes E Abstract Recently we have reported a significant reduction in the thickness of epidermis and epidermis + dermis in the back, abdominal and thoracic skin of the long-term pinealectomized rats and the potent therapeutic effect of melatonin on the pinealectomy-induced morphometric changes. The present study was aimed to determine the fine structure of the abdominal and thoracic skin in pinealectomized rats and the effect of melatonin on skin ultrastructure. Rats were pinealectomized or sham operated (control) for 6 months. Half of the pinealectomized rats were treated with 4 mg/kg melatonin during the last month of the experiment. Pinealectomy resulted in prominent ultrastructural changes in the skin. Epidermal atrophy, disorganization and cytological atypia were obvious. Tonofilament distribution was not uniform, and intercellular space was narrow. Nuclear irregularity and heterochromatin condensation were detected. Many mitochondria were irregular and edematous with increased translucence of the matrix, either partial or total destruction of crests and frequently the presence of vacuoles, myelin figures and dense bodies. Microprojections of basal cells into the dermis were observed. The dermis was thin, and collagenous fibers were loosely arranged. The epidermis in melatonin administered pinealectomized rats was obviously thicker than that of pinealectomized rats. The cells of each layers had characteristic morphological and ultrastructural features. Nuclear irregularity and heterochromatin condensation were not seen. Mitochondria were generally normal in ultrastructural appearance but rarely vacuoles and myelin figures were observed. The dermis was thick, and collagenous fibers were closely packaged. This paper provides an additional ultrastructural evidence that the damage to mitochondria is the major contributory factor to skin aging and that melatonin has potent therapeutic effects in reducing age-related changes via protecting fine structure of the skin. [source] Effects of taxation for option writers: an Australian perspectiveACCOUNTING & FINANCE, Issue 1 2007Karen Alpert G180; C200; K340 Abstract Writing an option is a taxable event for Australian investors. This method of taxation penalizes investors who hold open short option positions over the tax year end by accelerating their tax liability relative to the timing of the economic gain from writing options. This paper examines the levels of open interest in the Australian Stock Exchange over the change in financial year to determine whether investors time their transactions to avoid this tax acceleration. The results show that level of open interest is lower in the last month of the financial year after controlling for non-tax determinants of option demand. [source] The Reach of the Disposition Effect: Large Sample Evidence Across Investor Classes,INTERNATIONAL REVIEW OF FINANCE, Issue 1-2 2006Philip Brown ABSTRACT We examine detailed daily Australian Stock Exchange share registry data for investors in IPO and index stocks between 1995 and 2000 and find that the ,disposition effect,' investors' reluctance to crystallize losses and relative eagerness to realize gains, is pervasive across investor classes. However, traders instigating larger investments tend to be affected less by the disposition bias. Our novel findings include that (a) the disposition effect ameliorates over time, being undetectable from around 200 trading days after purchase, (b) the ,house money' effect tempers the disposition effect, (c) shareholder loyalty schemes also partially offset investors' relative preference for selling winning stocks, and (d) the reversal of the disposition effect in June (the last month of the Australian tax year) does not occur among investors unable to take advantage of tax shields. In line with earlier research, our results support a tax-related explanation for the June effect rather than window dressing or momentum explanations. Finally, we confirm Odean's finding that the disposition effect is not driven by diversification motives, or by higher transaction costs associated with lower-priced stocks. [source] Do Palliative Consultations Improve Patient Outcomes?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008David Casarett MD OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care. DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life. SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics. PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey. MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items). RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62,66) versus 54 (95% CI=51,56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (,=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support. CONCLUSION: Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit. [source] End-of-Life Care in Assisted Living and Related Residential Care Settings: Comparison with Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2003Philip D. Sloane MD Objectives: To define the current state of end-of-life care in residential care/assisted living (RC/AL) facilities and nursing homes (NHs) and to compare these two types of care settings. Design: Interviews of staff and family informants about deaths that occurred during a longitudinal study. Setting: Fifty-five RC/AL facilities and 26 NHs in Florida, Maryland, New Jersey, and North Carolina. Participants: Two hundred twenty-four staff and family informants that best knew the 73 RC/AL residents and 72 NH residents who died in or within 3 days after discharge from a study facility. Measurements: Telephone interviews conducted with the facility staff member who knew the decedent best and the family member who was most involved in care during the last month of life of the decedent. Data were collected on circumstances of death, perceptions of dying process, cause of death, care during the last month of life, mood, discomfort, and family satisfaction. Results: Most decedents died in the facility where they had resided, and more than half of the subjects were alone when they died. Greater proportions of staff and family in the NHs knew that the resident's death was only days or weeks away. Both RC/AL and NH residents experienced few highly negative moods, and even on their most uncom-fortable day, the overall discomfort was low for residents in both facility types. Summary ratings of family satisfaction were significantly higher for the RC/AL (32.1) than the NH (41.2) group (P=.016). Conclusion: These data suggest that end-of-life care in RC/AL settings appears similar in process and outcomes to that provided in NHs. Thus, aging and dying-in-place can effectively occur in RC/AL. [source] Is good ,quality of life' possible at the end of life?JOURNAL OF CLINICAL NURSING, Issue 4 2001An explorative study of the experiences of a group of cancer patients in two different care cultures INFORMATION POINT: Factor analysis ,,The purpose of this paper was to explore how a group of gravely ill patients, cared for in different care cultures, assessed their quality of life during their last month of life. ,,The study material comprised quality of life assessments from 47 cancer patients, completed during their last month of life. Two quality of life questionnaires, the EORTC QLQ-C30 and a psychosocial well-being questionnaire, were used. The data were treated in accordance with instructions for the respective questionnaires, and the results are presented primarily as means, mostly at the group level. Assessments from patients in two different care cultures, care-orientated and cure-orientated, were compared. ,,The results show that despite having an assessed lower quality of life in many dimensions than people in general, several patients experienced happiness and satisfaction during their last month of life. ,,,Cognitive functioning' and ,emotional functioning' were the dimensions that differed least from those of the general population, and ,physical functioning', ,role functioning' and ,global health status/quality of life' differed the most. ,Fatigue' showed the highest mean for the symptom scales/items. ,,There was a tendency for those cared for in the cure-orientated care culture to report more symptoms than those in the care-orientated care culture. An exception to this was ,pain', which was reported more often by those in the care-orientated care culture. ,,The implications of the results are discussed from different angles. The significance of knowledge concerning how patients experience their quality of life is also discussed with respect to the care and the planning of care for dying patients. [source] Prevalence of myofascial temporomandibular disorder in US community womenJOURNAL OF ORAL REHABILITATION, Issue 11 2008M. N. JANAL Summary, This study estimates the prevalence of the myofascial subtype of temporomandibular disorders (M-TMD) defined by Research Diagnostic Criteria (RDC), and relates that prevalence to the surveyed report of facial pain. From among 20 000 women selected at random in the NY metropolitan area who completed a telephone survey of facial pain, 2000 were invited for an RDC/TMD examination; 782 examinations were completed. Prevalence was estimated in analyses that were weighted to correct sampling biases. Differences among demographic strata were evaluated with logistic regression. The prevalence of M-TMD was estimated to be 10·5% (95% CL = 8·5,13·0%). Prevalence was significantly higher among younger women, among women of lower socio-economic status, among Black women, and among non-Hispanic women. The report of facial pain in the telephone survey (10·1%) had high specificity for M-TMD diagnosis (94·7%), but low sensitivity (42·7%). M-TMD is a fairly common disorder among American women. Among those reporting facial pain during the last month, half met RDC palpation criteria for M-TMD; thus, a formal physical examination is imperative to establish this diagnosis. Prevalence varies with age, socio-economic status, race and Hispanic ethnicity. A substantial number of RDC-diagnosed cases of M-TMD did not report facial pain in the survey; the reason for this requires further study. [source] Potent therapeutic effect of melatonin on aging skin in pinealectomized ratsJOURNAL OF PINEAL RESEARCH, Issue 3 2005Mukaddes E Abstract:, It is generally agreed that one of the major contributors to skin aging is reactive oxygen species. As organisms reach advanced age, free radical generation increases and the activity of tissue antioxidant enzyme system decreases. Melatonin is an antioxidant and free radical scavenger. The present study was first aimed to determine the morphometric and biochemical changes caused by long-term pinealectomy in order to investigate the role of melatonin as skin architecture. Secondly, the effect of exogenous melatonin administration on these changes was determined. Rats were pinealectomized or sham operated (control) for 6 months. Half of the pinealectomized rats were treated with 4 mg/kg melatonin during the last month of the experiment. Pinealectomy resulted in important morphometric and biochemical changes in the back, abdominal and thoracic skin. The thickness of epidermis and dermis and the number of dermal papillae and hair follicles were reduced. Melatonin administration to pinealectomized rats significantly improved these alterations in all body areas (P < 0.005). On the contrary, in pinealectomized rats the levels of antioxidant enzymes, catalase and glutathione peroxidase were decreased. Melatonin restored the levels of these enzymes. The pinealectomy-induced increases in lipid peroxidation in the abdominal and thoracic skin were significantly reduced by melatonin treatment (P < 0.005 and 0.01 respectively). These results suggest that melatonin is highly efficient anti-aging factor and, as melatonin levels decrease with age, melatonin treatment may reduce age-related skin changes. [source] Intake of Energy Drinks in Association With Alcoholic Beverages in a Cohort of Students of the School of Medicine of the University of MessinaALCOHOLISM, Issue 10 2007Alessandro Oteri Background:, Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and , -complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. Methods:, With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. Results:, A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. Conclusions:, Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence. [source] Development changes of anthocyanins in Vitis vinifera grapes grown in the Douro Valley and concentration in respective winesJOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 14 2002Nuno Mateus Abstract Grapes of Touriga Nacional and Touriga Francesa red Vitis vinifera varieties have been sampled from two vineyard sites at different altitudes during three consecutive vintage years (1997, 1998 and 1999) in the Douro Valley. The total anthocyanidin monoglucosides (AMGs) detected by HPLC/DAD and the red colour of grape skin extracts were monitored during the last month of maturation. Microvinifications were performed with the grapes studied and the resulting Port wines were analysed. Malvidin 3-glucoside and its acylated esters were the major AMGs irrespective of cultivar at harvest date. Vineyard altitude, together with other variables, was found to be an important factor contributing to the amount of anthocyanin compounds found in grapes of Touriga Nacional and Touriga Francesa. Overall, the climatic conditions observed at higher vineyard sites appeared to be advantageous, resulting in larger amounts of AMGs in grapes. The same outcome was obtained in the resulting wines, which showed higher levels of AMGs when made from grapes grown at higher altitude, especially for Touriga Francesa. © 2002 Society of Chemical Industry [source] Health and risk behaviors in survivors of childhood acute myeloid leukemia: A report from the Children's Oncology Group,PEDIATRIC BLOOD & CANCER, Issue 1 2010Kris Ann P. Schultz MD Abstract Background Survivors of childhood acute myeloid leukemia (AML) face increased risks of chronic disease and secondary malignancies. Substance exposure may compound these risks. Procedures Participants were diagnosed with AML at <21 years of age and survived ,5 years following diagnosis. All underwent chemotherapy alone or followed by autologous BMT (chemo,±,autoBMT) or underwent allogeneic BMT (alloBMT) if an HLA-matched related donor was available. Survivors completed a health questionnaire and a Youth Risk Behavior Survey (YRBS). Results Of eligible survivors, 117 were ,18 years of age and completed a YRBS. Survivors were a mean age of 10 years at diagnosis and 24 years at interview. Of the substance exposures assessed by YRBS, tobacco, alcohol, and marijuana were most common. Twenty-two percent (22%) had smoked cigarettes in the last 30 days. One-quarter (25%) reported binge drinking in the last month. None of these exposures varied by treatment group. Less than 10% of survivors reported cocaine, heroin, or methamphetamine use. Men were more likely to report high substance exposure (P,=,0.004). Sadness/suicidality score was associated with cancer-related anxiety (P,=,0.006) and multiple health conditions (P,=,0.006). Conclusions This analysis reveals exposure to tobacco, alcohol, and marijuana in young adults with few differences based on treatment received. Survivors with cancer-related anxiety or multiple health conditions were more likely to report sadness/hopelessness. Pediatr Blood Cancer 2010;55:157,164. © 2010 Wiley-Liss, Inc. [source] Investigation of risk factors for penicillin-resistant Streptococcus pneumoniae carriage in Turkish childrenPEDIATRICS INTERNATIONAL, Issue 4 2001AbstractBackground: Nasopharyngeal colonization plays an important role for infections caused by Streptococcus pneumoniae. Emergence of penicillin resistance in this organism has made it difficult to treat pneumococcal infections. The objectives of this study were to investigate the risk factors for nasopharyngeal colonization with S. pneumonia and for nasopharyngeal colonization with penicillin-resistant S. pneumoniae. Methods: Three hundred children with or without evidence of infection were investigated for various risk factors. Streptococcus pneumoniae isolated from children's nasopharyngeal swabs were examined for penicillin susceptibility. Results: Day-care attendance (odds ratio OR=2.82, P=0.003) and upper respiratory tract infection within the last month (OR=1.83, P=0.02), have been determined to be risk factors for S. pneumoniae carriage. The use of antibiotics within the last 3 months (OR=81.07, P<0.001), the presence of more than five people living in the house of the child (OR=6.63, P=0.03), and having a sibling under 5-years-old (OR=4.60, P=0.03) have been determined to be risk factors for penicillin-resistant S. pneumoniae carriage. Conclusion: Some children are inevitably exposed to and colonized with penicillin susceptible or resistant S. pneumoniae. Changes in day-care organizations, better living conditions, and restriction of antibiotic use seems to be useful precautions to prevent the emerging and colonization with penicillin-susceptible or -resistant S. pneumoniae. [source] Prescription and non-prescription analgesic use among the US adult population: results from the third National Health and Nutrition Examination Survey (NHANES III),PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2003Ryne Paulose-Ram PhD Abstract Purpose To estimate prescription and non-prescription analgesic use in a nationally representative sample of US adults. Methods Data collected during the third National Health and Nutrition Examination Survey (1988,1994), for persons 17 years and older were analyzed (n,=,20,050). During the household interview, respondents reported use, in the last month, of prescription and non-prescription analgesics. Results An estimated 147 million adults reported monthly analgesic use, Prescription analgesic use was 9% while non-prescription use was 76%. Females were more likely than males to use prescription (11 vs. 7%, p,<,0.001) and non-prescription (81 vs. 71%, p,<,0.001) analgesics. Across race,ethnicity groups, males (,8%) and females (11,13%) had similar age-adjusted prescription analgesic use. Non-prescription analgesic use was higher among non-Hispanic whites than non-Hispanic blacks and Mexican,Americans for males (76 vs. 53% (p,<,0.001) and 59% (p,<,0.001), respectively) and females (85 vs. 68% (p,<,0.001) and 71% (p,<,0.001), respectively). With increasing age, prescription analgesic use increased whereas non-prescription use decreased. Approximately 30% of adults used multiple analgesics during a 1-month period. This was more common among females (35%) than males (25%, p,<,0.001) and among younger (17,44 years, 33%) rather than older age groups (45+ years, 26%, p,<,0.001). Conclusions Analgesic use among US adults is extremely high, specifically of non-prescription analgesics. Given this, health care providers and consumers should be aware of potential adverse effects and monitor use closely. Published in 2002 by John Wiley & Sons, Ltd. [source] 11th annual NICE conference: innovation and valuePRESCRIBER, Issue 1-2 2010Article first published online: 4 FEB 2010 NICE held their annual conference last month with the theme of innovation and value. We have highlighted a selection of the principal sessions. Copyright © 2010 Wiley Interface Ltd [source] Effects of Constant, 9 and 16-h Light Cycles on Sperm Quality, Semen Storage Ability and Motile Sperm Subpopulations Structure of Boar SemenREPRODUCTION IN DOMESTIC ANIMALS, Issue 5 2006MM Rivera Contents This study was performed to test the effect that two separate, daily, constant-light regimes of both 9 and 16 h could have on the main parameters of boar-semen quality analysis, as well as on the motile sperm subpopulations structure and the ability of its conservation at 16°C. Results show that both luminous regimes have slight, specific effects on the main parameters of boar-semen quality analysis, as well as on the motile sperm subpopulations structure. Furthermore, the conservation ability at 16°C of boar semen was not significantly different between both photoperiods. When a temporal study was performed, results showed that semen quality and motility parameter changes were stabilized at nearly constant values from the second month of the study to the last month in both luminous regimes, indicating a rapid light-related effect on testicular function. Our results indicate that light regimes oscillating from 9 h daily to 16 h daily are of little importance in the control of boar-semen quality in a farming environment. [source] Luteal Deficiency and Embryo Mortality in the MareREPRODUCTION IN DOMESTIC ANIMALS, Issue 3-4 2001WR Allen Four separate components combine to produce the progesterone and biologically active 5,-reduced pregnanes needed to maintain pregnancy in the mare. The primary corpus luteum (CL) is prolonged beyond its cyclical lifespan by the down-regulation of endometrial oxytocin receptors to prevent activation of the luteolytic pathway and its waning progesterone production is supplemented from day 40 of gestation by the formation of a series of accessory CL which develop in the maternal ovaries as a result of the gonadotrophic actions of pituitary FSH and the equine chorionic gonadotrophin (eCG). From around day 100 the allantochorion secretes progesterone and progestagens directly to the endometrium and underlying myometrium and, in the last month of gestation, the enlarging foetal adrenal gland secretes appreciable quantities of pregnenelone which is also utilized by the placenta to synthesize progestagens. Between 10 and 15% of mares undergo foetal death and abortion at some time in gestation and the majority of these losses occur during the first 40 days of gestation when the primary CL is the sole source of progesterone. Yet, all the available evidence suggests that untoward luteolysis is not common in this period and the losses that do occur have other underlying causes. Beyond day 40 the secondary CL receive powerful luteotrophic support from eCG and from day 80,100 until term the supply organ (placenta) and target tissues (endometrium and myometrium) are in direct contact with each other over their entire surface. In the face of this interlocking and failsafe system for progestagen production throughout pregnancy, and despite a paucity of evidence that a deficiency of progesterone production is a cause of pregnancy loss in the mare, it is surprising, and worrying, that annually many thousands of pregnant mares throughout the world are given exogenous progestagen therapy during part or all of their gestation as a form of preventative insurance against the possibility of pregnancy failure. Basic investigative research is required urgently to validate or debunk the practice. [source] Hypothalamic input is required for development of normal numbers of thyrotrophs and gonadotrophs, but not other anterior pituitary cells in late gestation sheepTHE JOURNAL OF PHYSIOLOGY, Issue 4 2008Eva Szarek To evaluate the hypothalamic contribution to the development of anterior pituitary (AP) cells we surgically disconnected the hypothalamus from the pituitary (hypothalamo-pituitary disconnection, HPD) in fetal sheep and collected pituitaries 31 days later. Pituitaries (n= 6 per group) were obtained from fetal sheep (term = 147 ± 3 days) at 110 days (unoperated group) of gestation and at 141 days from animals that had undergone HPD or sham surgery at 110 days. Cells were identified by labelling pituitary sections with antisera against the six AP hormones. Additionally, we investigated the colocalization of glycoprotein hormones. The proportions of somatotrophs and corticotrophs were unchanged by age or HPD. Lactotrophs increased 80% over time, but the proportion was unaffected by HPD. Thyrotrophs, which were unaffected by age, increased 70% following HPD. Gonadotrophs increased with gestational age (LH+ cells 55%; FSH+ cells 19-fold), but this was severely attenuated by HPD. We investigated the possible existence of a reciprocal effect of HPD on multipotential glycoprotein-expressing cells. Co-expression of LH and TSH was extremely rare (< 1%) and unchanged over the last month of gestation or HPD. The increase of gonadotrophs expressing FSH only or LH and FSH was attenuated by HPD. Therefore, the proportions of somatotrophs, lactotrophs and corticotrophs are regulated independently of hypothalamic input in the late gestation fetal pituitary. In marked contrast, the determination of the thyrotroph and gonadotroph lineages over the same time period is subject to complex mechanisms involving hypothalamic factors, which inhibit differentiation and/or proliferation of thyrotrophs, but stimulate gonadotrophs down the FSH lineage. Development of a distinct population of gonadotrophs, expressing only LH, appears to be subject to alternative mechanisms. [source] Budgeting for the budgetASTRONOMY & GEOPHYSICS, Issue 3 2009Article first published online: 29 MAY 200 In a time of tight belts and political uncertainty in the UK, a budget settlement that does not decrease money awarded to science has to be a good step, but it is clear that the maintenance of funding announced last month has a price for the research councils. [source] Efficacy and tolerability of zonisamide as add-on in brain tumor-related epilepsy: preliminary reportACTA NEUROLOGICA SCANDINAVICA, Issue 3 2009M. Maschio Background,, Zonisamide (ZNS) is an antiepileptic drug (AED) with broad spectrum action that demonstrated a good efficacy in controlling seizures as add-on in adult and pediatric epilepsy. To date there have been no studies on ZNS in patients with brain tumor-related epilepsy (BTRE). Aim of the study,, To evaluate efficacy and tolerability of ZNS as add-on in BTRE. Methods, We followed six patients suffering from BTRE who had already been treated with other AEDs and who had had not experienced adequate seizure control. Three patients underwent chemotherapy while being treated with ZNS. Mean duration of follow-up was 8 months. Results,, Mean seizure number in the last month prior to the introduction of ZNS had been 27.7/month. ZNS mean dosage was of 283.3 mg/day. At last follow-up, the mean seizure number was reduced to 8.8/month. Responder rate was 83.3%. Two patients discontinued the drug because of side effects. There were no other reported side effects. Conclusions,, Preliminary data on the use of ZNS in add-on in patients with BTRE indicate that this drug may represent a valid alternative as add-on in this particular patient population. However, larger samples are necessary to draw definitive conclusions. [source] What is chronic headache in the general population?ACTA NEUROLOGICA SCANDINAVICA, Issue 2009The Akershus study of chronic headache Background ,, Studies of chronic headache including both primary and secondary causes from the general population is lacking. Aims ,, To provide prevalence data on chronic headache. Materials & Methods ,, We studied chronic headaches defined as headache 15 days per month on average for at least 3 months in the general population. An age and gender stratified random sample of 30,000 persons aged 30,44 years received a mailed questionnaire. Those with self-reported headache on 15 days or more within the last month and/or headache on more than 180 days within the last year were invited to an interview and examination by a neurological resident. The criteria of the International Classification of Headache Disorders were applied. Results ,, Chronic headache occurred in 3.71% of the general population.Women had chronic headache twice as often as men. About half of those with chronic headache also had medication overuse, irrespectively of the types of chronic headache. Secondary chronic headaches attributed to chronic rhinosinusitis, head injury, whiplash injury and cervicogenic headache were relatively frequent, i.e. from 1 of 300 to 1 of 600 persons from the general population. Discussion ,, Primary and secondary chronics headaches should not be ignored. Conclusion ,, Primary and secondary chronic headaches are common in the general population. [source] A national evaluation of school breakfast clubs: evidence from a cluster randomized controlled trial and an observational analysisCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2004I. Shemilt Abstract Study objective To measure the health, educational and social impacts of breakfast club provision in schools serving deprived areas across England. Design A cluster randomized controlled trial and an observational analysis. Setting England, the UK. Intervention: funding to establish a school-based breakfast club vs. control (no funding). Main results Intention to treat analysis showed improved concentration (Trail Making Test Part A) amongst the intervention group at 3 months. Fewer pupils within the intervention group reported having skipped classes within the last month and fewer pupils within the intervention group reported having skipped 1 or more days of school within the last month at 1 year. Observational analysis at 1 year showed a higher proportion of primary-aged breakfast club attendees reported eating fruit for breakfast in comparison to non-attendees. A higher proportion of breakfast club attendees had borderline or abnormal conduct and total difficulties scores (primary-aged pupils) and prosocial score (secondary-aged pupils). Conclusions Analyses revealed a mixed picture of benefit and apparent disbenefit. This study illustrated the challenges of evaluating a complex intervention in which the evaluators had less control than is usual in randomized trials over recruitment, eligibility checking and implementation. If the impact of new policy initiatives is to be assessed using the most robust forms of evaluation, social policy needs to be organized so that evaluations can be constructed as experiments. This is likely to prove most difficult where the perceived value of implementing an intervention rapidly is high. [source] The prognosis of occupational asthma due to detergent enzymes: clinical, immunological and employment outcomesCLINICAL & EXPERIMENTAL ALLERGY, Issue 4 2006A. Brant Summary Background Little is known about the prognosis of occupational asthma induced by high molecular weight proteins. Objective Our objective was to measure the clinical, immunological and employment outcomes of individuals with occupational asthma induced by detergent enzymes. Methods We undertook a workforce-based follow-up study in 35 (78%) of the 45 ex-employees from a single factory with occupational asthma. In each case the diagnosis was supported by evidence of specific sensitization and characteristic changes in peak flow or a positive response to specific bronchial provocation testing. Results This group had left the factory on average 37 months before study. On review 25 (71%) reported chest symptoms during the last month. Compared with when working at the factory, most (86%) reported that their symptoms had improved. Twenty continued to attend their general practitioner for respiratory symptoms and 19 still used asthma medications. Since leaving the factory 16 (46%) and four (11%) had found full-time or part-time employment, respectively; of these 16 found they were paid less than when they worked at the factory. The remaining 15 subjects had not had any paid employment. All but two had positive skin prick tests to one or more three detergent enzymes. The estimated half-life of serum-specific IgE antibodies was 20 months for protease, and 21 months for cellulase and amylase. Conclusions Population-based follow-up studies of the prognosis of occupational asthma are rare but probably avoid the bias in clinic-derived surveys. This study demonstrates that 3 years after the avoidance of exposure with detergent enzymes most patients continue to be troubled by, albeit improved, symptoms and experience difficulty in re-employment. [source] Changes in Korean Corporate Governance: A Response to CrisisJOURNAL OF APPLIED CORPORATE FINANCE, Issue 1 2008E. Han Kim In the last months of 1997, the value of the Korean currency lost over half its value against the dollar, and the ruling party was swept from power in presidential elections. One of the fundamental causes of this national economic crisis was the widespread failure of Korean companies to earn their cost of capital, which contributed to massive shareholder losses and calls for corporate governance reform. Among the worst performers, and hence the main targets of governance reform, were family-controlled Korean business groups known as chaebol. Besides pursuing growth and size at the expense of value, such groups were notorious for expropriating minority shareholders through "tunneling" activities and other means. The reform measures introduced by the new administration were a mix of market-based solutions and government intervention. The government-engineered, large-scale swaps of business units among the largest chaebol,the so-called "big deals" that were designed to force each of the groups to identify and specialize in a core business,turned out to be failures, with serious unwanted side effects. At the same time, however, new laws and regulations designed to increase corporate transparency, oversight, and accountability have had clearly positive effects on Korean governance. Thanks to reductions in barriers to foreign ownership of Korean companies, such ownership had risen to about 37% at the end of 2006, up from just 13% ten years earlier. And in addition to the growing pressure for better governance from foreign investors, several newly formed Korean NGOs have pushed for increased transparency and accountability, particularly among the largest chaebol. The best governance practices in Korea today can be seen mainly in three kinds of corporations: (1) newly privatized companies; (2) large corporations run by professional management; and (3) banks with substantial equity ownership in the hands of foreign investors. The improvements in governance achieved by such companies,notably, fuller disclosure, better alignment of managerial incentives with shareholder value, and more effective oversight by boards,have enabled many of them to meet the global standard. And the governance policies and procedures of POSCO, the first Korean company to list on the New York Stock Exchange,as well as the recent recipient of a large equity investment by Warren Buffett,are held up as a model of best practice. At the other end of the Korean governance spectrum, however, there continue to be many large chaebol-affiliated or family-run companies that have resisted such reforms. And aided by the popular resistance to globalization, the lobbying efforts of such firms have succeeded not only in reducing the momentum of the Korean governance reform movement, but in reversing some of the previous gains. Most disturbing is the current push to allow American style anti-takeover devices, which, if successful, would weaken the disciplinary effect of the market for corporate control. [source] | |||||||||||||||||||||||||||||||