Lower Quality (lower + quality)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Levels of evidence available for techniques in antireflux surgery

M. Neufeld
SUMMARY., The objective of this study was to determine the levels of evidence and grades of recommendations available for techniques in antireflux surgery. Areas of technical controversy in antireflux surgery were identified and developed into eight answerable questions. The external evidence was surveyed using the databases Medline and EMBASE. Abstracts and appropriate articles were identified from January 1966 to December 2005. A set of search strategies was systematically employed to determine the levels of evidence available for each clinical question. Primary outcome measures included the determination of levels of evidence and grade of recommendation based on The Oxford Center for Evidence-Based Medicine. Secondary outcome measures included for randomized controlled trials were Jadad scores, noting the presence of a sample size calculation, and the determination of an effect estimate and the reporting of a confidence interval. Higher quality randomized controlled trials (mostly level 2b, occasional level 1b) existed to answer three questions: whether to complete a 360° or partial wrap; whether or not to divide the short gastric vessels; and whether to perform laparoscopic or open surgery. Lower quality randomized controlled trials were available to determine whether the use of mesh was helpful, whether or not to use a bougie catheter for calibration of the wrap, and whether an anterior or posterior wrap results in a superior outcome. This was deemed to be of inferior grade of recommendation due to the lack (< 2) of trials available and the sole presence of level 2b evidence. The final two questions: whether to complete fundoplication using a thoracic or abdominal approach and whether to use intraoperative manometry relied exclusively upon level 4 evidence and thus received a lower grade of recommendation. A higher Jadad score seemed to be associated with studies having a higher level of evidence available to answer the question. Sample size calculations were given to answer three questions. Effect estimate was difficult to interpret given inconsistent findings, composite outcomes and lack of reported confidence intervals. In conclusion, antireflux surgery has many randomized controlled trials available upon which to base clinical practice. Unfortunately, these are generally of poor quality. We recommend that esophageal surgeons determine consistent outcome measures and endeavor to improve the quality of randomized controlled trials they perform. [source]

Trade-off in oviposition strategy: choosing poor quality host plants reduces mortality from natural enemies for a salt marsh planthopper

Abstract 1.,Both host plant nutrition and mortality from natural enemies have been predicted to significantly impact host plant selection and oviposition behaviour of phytophagous insects. It is unclear, however, if oviposition decisions maximise fitness. 2.,This study examined whether the salt marsh planthopper Pissonotus quadripustulatus prefers higher quality host plants for oviposition, and if oviposition decisions are made so as to minimise mortality at the egg stage. 3.,A controlled laboratory experiment and 4 years of field data were used to assess the rates of planthopper oviposition on higher quality ,green' and lower quality ,woody' stems of the host plant Borrichia frutescens. The numbers and percentages of healthy eggs and eggs that were killed by parasitoids or the host plant were recorded. 4.,In all years, including the laboratory experiment, Pissonotus planthoppers laid more eggs on lower quality woody stems than on higher quality green stems. While host plant related egg mortality was higher in woody stems, the percentage of eggs parasitised was much greater in green stems. This resulted in a lower total mortality of eggs on woody stems. 5.,The results of this study demonstrate that, although Pissonotus prefers lower quality host plants for oviposition, this actually increases fitness. These data seem to support the enemy free space hypothesis, and suggest that for phytophagous insects that experience the majority of mortality in the egg stage, oviposition choices may be made such that mortality is minimised. [source]

Genetic differences in growth of an invasive tree species

Evan Siemann
Invasive plants are often more vigorous in their introduced ranges than in their native ranges. This may reflect an innate superiority of plants from some habitats or an escape from their enemies. Another hypothesis proposes that invasive plants evolve increased competitive ability in their introduced range. We present the results of a 14-year common garden experiment with the Chinese Tallow Tree (Sapium sebiferum) from its native range (Asia), place of introduction to North America (Georgia) and areas colonized a century later (Louisiana and Texas). Invasive genotypes, especially those from recently colonized areas, were larger than native genotypes and more likely to produce seeds but had lower quality, poorly defended leaves. Our results demonstrate significant post-invasion genetic differences in an invasive plant species. Post-introduction adaptation by introduced plants may contribute to their invasive success and make it difficult to predict problem species. [source]

Effects of Predation Threat on the Structure and Benefits from Vacancy Chains in the Hermit Crab Pagurus bernhardus

ETHOLOGY, Issue 11 2009
Mark Briffa
Vacancy chains occur when individuals occupy discrete re-useable resource units, which once abandoned by the current owner can then be occupied by a new owner. In order to enter the newly vacated resource the new owner must first vacate its current resource unit, such that a vacancy chain consists of a series of linked moves between resource units of different value, equivalent to different ,strata' in the chain. Vacancy chains may represent an important route by which resources are distributed through populations. Indeed, the arrival of a new resource has the potential to initiate a series of moves propagating beyond the individual that encounters the new resource unit. Thus, the chain participants as a whole may experience ,aggregate benefits' from the arrival of the new resource unit. The extent of these benefits, however, may not necessarily be evenly distributed between all chain participants; some individuals could receive greater than average benefits by moving through more than one stratum (,skipping') and some individuals could experience a reduction in resource value by moving to a resource unit of lower quality than that occupied initially (a ,backward move'). Such moves represent deviations from the ,ideal' vacancy chains assumed by theory. Here we analyse the aggregate benefits and benefits to individuals participating in vacancy chains of empty gastropod shells in the hermit crab Pagurus bernhardus. We also investigate the effect of predation risk on these two levels of benefits and on chain structure. Adding a new shell at the top of the chain causes an overall increase in shell quality after 24 h but the distribution of benefits between strata in the chain varies with the presence and absence of the predator cue. Although there was significant concordance between chain structure in the presence and absence of the predator cue, the structure was significantly different from an ideal vacancy chain in the absence but not the presence of the predator cue. [source]

Educational needs, metabolic control and self-reported quality of life

A study among people with type 2 diabetes treated in primary health care
Abstract The prevalence of type 2 diabetes is increasing. In order to reduce long-term complications and to promote a better life for these patients, health care professionals are important advocates in education and counselling. More knowledge is therefore needed to explore the association between educational needs and quality of life. In total, 211 people with type 2 diabetes (response rate 48%) were recruited from general practices in a geographically well-defined district in Bergen, Norway. All participants completed a questionnaire measuring demographical and clinical variables, quality of life (WHOQOL-Bref), satisfaction with education and counselling, and symptoms related to the disease. A blood sample was taken from each patient for determination of HbA1c. The participants reported receiving most information on diet, physical activity and treatment and less information on foot care and long-term complications. Satisfaction with education was significantly positively correlated with self-reported overall quality of life, and quality of life within domains for psychological health, social relationships and environment. More intensive treatment was significantly associated with lower quality of life within the physical health and social relationships domains. For 32% of the participants, HbA1c values did not satisfy the Norwegian guidelines (adjusted for age). The results from the present study emphasise a need for health education in diabetes primary health care especially in relation to foot care and long-term complications. The association between satisfaction with education and quality of life makes it important to develop educational and counselling methods for nurses in primary health care. Copyright © 2005 FEND. [source]

Do competition and managed care improve quality?

Nazmi SariArticle first published online: 22 JUL 200
Abstract In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992,1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Private Higher Education and Diversity: An Exploratory Survey

Pedro Teixeira
In this preliminary review, the authors analyse the effects of privatisation on diversity in higher education (HE) systems by exploring the consequences of the establishment of HE Institutions by non-public organisations. The rising importance of privatisation in Europe (Western and transitional economies), Latin America, and Southeast Asia is analysed. Then follows detailed examinations of private-sector HE in countries representative of all these geographical areas to determine how far privatisation has stimulated diversity. The preliminary results indicate that in each case the private sub-sector has promoted limited and partial diversification. In general, though, the more recent private establishments, created to satisfy increasing demand for HE, have nonetheless focused predominately on teaching, have undertaken little, or no, research and appear to be of lower quality than the older institutions. The private sub-sector is characterised mostly by its low-risk behaviour, and a concentration on low-cost and/or safer initiatives. Public authorities must share at least a partial responsibility for some of the negative side effects of the development of private higher education. [source]

Two-Sided Search, Marriages, and Matchmakers

Francis Bloch
This article analyzes the provision of matching services in a model of two-sided search. Agents belong to two heterogeneous populations and are distributed on [0, 1]. Their utility is equal to the index of their mate. In a search equilibrium agents form subintervals and are only matched to agents inside their class. Marriage brokers match agents according to a centralized procedure. If the matchmaker charges a uniform participation fee, only agents of higher quality participate in the centralized procedure. If the matchmaker charges a commission on the matching surplus, only agents of lower quality go to the intermediary. [source]

The Impact of Generating Initial Hypothesis Sets of Different Sizes on the Quality of the Initial Set, and the Resulting Time Efficiency and Final Judgment Accuracy

Sudip Bhattacharjee
This study examines the impact of generating initial hypothesis sets of different sizes on the quality of the hypotheses generated (i.e., the ability to consider both the direction and accounts that are over- or understated). We also examine the time efficiency, information search effectiveness, and the final judgment accuracy, conditional on the quality of the initial hypothesis set. Sixty auditors performed an analytical procedures task where they were asked to generate and test either a specific number of initial hypotheses (one, three, or six), or any number of hypotheses desired in order to uncover an error seeded in the financial statements. The results indicate that the three hypotheses group initially generated hypotheses of the highest quality and maintained the hypothesis quality after efficiently searching information and generating additional causes. The one hypothesis group improved the quality of their hypotheses only after generating and testing several causes. However, auditors who generated six hypotheses or any number desired (as in audit practice) considered hypotheses of lower quality in the initial set, and did not improve the hypotheses quality after going through the information search stage. These results suggest that the size of the initial hypothesis set can lead to differences in the gains that accrue from the hypothesis generation and information search stages of diagnostic decisions. [source]

High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain

A. P. M. S. Romăo
Summary Background:, Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with consequent difficulty in diagnosis and treatment. Patients with CPP have high levels of anxiety and depression, with a consequent impairment of their quality of life. Aims:, The objective of this study was to determine the prevalence of anxiety and depression and their impact on the quality of life of women with CPP. Materials and methods:, A cross-sectional controlled study was conducted on 52 patients with CPP and 54 women without pain. Depression and anxiety were evaluated by the Hospital Anxiety and Depression Scale, and quality of life was evaluated by the World Health Organization Quality of life Whoqol-bref questionnaire. Data were analysed statistically by the Mann-Whitney U -test, the Fisher exact test, chi-square test and Spearman correlation test. Results:, The prevalence of anxiety was 73% and 37% in the CPP and control groups, respectively, and the prevalence of depression was 40% and 30% respectively. Significant differences between groups were observed in the physical, psychological and social domains. Patients with higher anxiety and depression scores present lower quality of life scores. Discussion:, The fact that DPC is a syndromic complex, many patients enter a chronic cycle of search for improvement of medical symptoms. The constant presence of pain may be responsible for affective changes in dynamics, family, social and sexual. Initially the person is facing the loss of a healthy body and active, to a state of dependence and limitations. In this study, patients with higher scores of anxiety and depression scores had lower quality of life and patients with lower scores of anxiety and depression had scores of quality of life. These results show that perhaps the depression and anxiety may be related to the negative impact on quality of life of these patients. Conclusion:, In view of this association, we emphasise the importance of a specific approach to the treatment of anxiety and depression together with clinical treatment to improve the quality of life of these patients. [source]

Community pharmacy provision of allergic rhinitis treatments: a longitudinal study of patient reported outcome

Dr. Hazel Sinclair Phd research fellow
Objective To monitor and compare the symptoms, and reported quality of life, of two groups of people who obtained treatment for allergic rhinitis from community pharmacies (prescribed or purchased). Method Subjects were recruited by 64 community pharmacies in 2001 and followed up by postal questionnaire at four time points: five days, four weeks, eight weeks and 26 weeks. Setting Primary care: community pharmacies in Grampian, Scotland. Results Response rates: five days , 84%; four weeks , 63%; eight weeks , 59%; 26 weeks , 56%. Three hundred and twenty-four subjects completed the five-day questionnaire (138 prescribed, 186 purchased). There were no important differences between groups in socio-economic variables monitored. The commonest treatments provided were antihistamines (non-sedating: 63% prescribed, 59% purchased; sedating: 3% prescribed, 16% purchased). Despite treatment, symptoms and quality-of-life impairments remained high; the prescribed group reported higher levels of many symptoms (including asthma), and lower quality of life at early time points. Most were satisfied with their treatment and few reported unmet need for pharmacy advice (11% prescribed, 3% purchased group). Conclusion Despite high levels of patient satisfaction with allergic rhinitis treatment, symptoms and quality-of-life impairments remained high in both groups. Widespread implementation of ,allergic rhinitis and its impact on asthma' (ARIA) guidelines for physicians and for pharmacists might improve management of symptoms and quality of life of patients. [source]

Factors associated with lower quality of life among patients receiving palliative care

Ying Yu Chui
Abstract Title.,Factors associated with lower quality of life among patients receiving palliative care. Aim., This paper is a report of a study conducted to (1) assess the quality of life (QoL) and physical functioning status of patients diagnosed with advanced cancer and receiving palliative care; (2) determine if there was a statistically significant relationship between their physical functioning and QoL and (3) identify the demographic and disease-related variables related to their QoL. Background., Achieving the best possible QoL is a major goal in palliative care. However, research findings about the relationship between QoL and demographic variables have been inconsistent. Method., Three hundred patients with advanced cancer were recruited from four district hospitals in Hong Kong between February 2005 and July 2006. Their QoL and physical functioning status were assessed by face-to-face interview, using the McGill Quality of Life Questionnaire (Hong Kong version) and the Palliative Performance Scale respectively. Results., Participants reported reduced ambulation, inability to perform hobbies or housework, and the need for occasional assistance in self-care (mean: 64·6 out of 100, sd: 19·3, range: 20,100). QoL was fair (mean: 6·2 out of 10, sd: 1·5, range: 0·9,10). There was a weak positive association between physical functioning and QoL scores. Multiple regression analysis showed that patients who were older, female, had ever been married, or had higher physical functioning tended to have better QoL. Conclusion., More could be done in symptom and psychosocial management to improve patients' QoL, in particular for those who are younger, male or single, or who have lower physical functioning. [source]

Temperature and life history: experimental heating leads female tree swallows to modulate egg temperature and incubation behaviour

Daniel R. Ardia
Summary 1Life-history decisions are strongly affected by environmental conditions. In birds, incubation is energetically expensive and affected significantly by ambient temperature. We reduced energetic constraints for female tree swallows (Tachycineta bicolor) by experimentally heating nests during incubation by an average of 6·9 °C to test for changes in incubation behaviour. 2Females in heated boxes (hereafter ,heated females') increased time spent incubating and maintained higher on-bout and off-bout egg temperatures. This indicates that female energetic constraints, not maximizing developmental conditions of offspring, determine incubation investment. Furthermore, this result suggests that embryonic developmental conditions in unmanipulated nests are suboptimal. 3We found individual variation in how females responded to experimental heating. Early-laying (i.e. higher phenotypic quality) females with heated nests increased egg temperatures and maintained incubation constancy, while later-laying (lower quality) heated females increased incubation constancy. Changes in egg temperature were due to changes in female behaviour and not due directly to increases in internal nest-box temperatures. 4Behaviour during the incubation period affected hatching asynchrony. Decreased variation in egg temperature led to lower levels of hatching asynchrony, which was also generally lower in heated nests. 5Our study finds strong support for the prediction that intermittent incubators set their incubation investment at levels dictated by energetic constraints. Furthermore, females incubating in heated boxes allocated conserved energy primarily to increased egg temperature and increased incubation attentiveness. These results indicate that studies investigating the role of energetics in driving reproductive investment in intermittent incubators should consider egg temperature and individual variation more explicitly. [source]

Manipulation of offspring number and size: benefits of large body size at birth depend upon the rearing environment

Tuula A. Oksanen
Summary 1Allocation of reproductive effort between the number and size of offspring determines the immediate rearing environment for the growing young. As the number of offspring increases, the amount of parental investment per individual offspring decreases, and the quality of the rearing environment is expected to decrease. This may result in a lower quality of offspring reared in such conditions. 2We studied the effects of the rearing environment on the quality of juvenile bank voles, Clethrionomys glareolus, with different initial body sizes at birth in a 2 × 2 factorial experiment. The rearing environment was manipulated by enlarging both the litter size by two extra pups, and mean offspring body size at birth by replacing the original litter with heavier pups from smaller litters. Offspring quality was estimated from body size measurements, parasitic infection with Eimeria spp. and the level of immune response to a novel antigen. 3The analyses revealed that large body size at birth was an advantage in ,normal' rearing environments, but a disadvantage in poor ones. The initially normal sized offspring grown in enlarged litters had a relatively good capacity for growth and high immune function confirming that a poor rearing environment alone does not reduce their quality. 4Our findings that the benefits of large body size depend on the rearing environment suggest that offspring body size is adjusted in relation to litter size, and thus the evolution of these two traits is combined. [source]

Is good ,quality of life' possible at the end of life?

An 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]

Promoting development and use of systematic reviews in a developing country

Reza Yousefi-Nooraie MD
Abstract Introduction, One major barrier to develop health systems is the limited capacity for conducting research and implementation of research findings. We assessed the views of researchers, decision makers and research policy makers on how the development and usage of evidence from systematic reviews can be promoted in a country with limited resources. Methods, We surveyed 131 participants in six systematic review workshops for their views on important items influencing the production and usage of systematic reviews in a developing country. They were also asked to propose interventions to deal with potential barriers. We analysed the quantitative data using multidimensional scaling methods, and the qualitative data using content analysis approach. Results, We identified seven clusters of items that contribute to the promotion of conducting and using systematic reviews. For each cluster a set of interventions are proposed that health care decision makers and research policy makers may use for promoting conduct and use of systematic reviews. The clusters are ,importance for policy makers', ,access to international research', ,priority and support for systematic reviews', ,competency and willingness of researchers to conduct reviews', ,importance for end-users', ,quality of local primary research' and ,visibility and access to local research'. Discussion, The proposed interventions focus on national level initiatives for making the systematic reviews ,wanted' and improving the capacity to conduct research. Our findings emphasize the essential role of policy makers for promoting systematic reviews. They demonstrate that many barriers stem from the lower quality of and lack of access to primary research originating from developing countries. [source]

The More the Merrier?

Multiple Parent-Adult Child Relations
Although parent-adult child ties are generally positive, most parents have multiple children whose relations may yield collective ambivalence combining higher and lower quality. Little research has investigated these multiple relations. NSFH respondents aged 50+ with adult children (N = 2,270) are used to assess patterns of quality and contact across multiple children in the same family. This illuminates mixed experiences, especially for lowest quality and contact across children, contributing to collective ambivalence in parent-adult child relations within families. Having more children increases prevalence of both positive and negative relations. Stepchildren exhibit more negative relations than nonstepchildren, even in the same family. Mothers have more positive but not more negative relations than fathers, but mothers have more negative relations with stepchildren. [source]

Social and Financial Resources and High-Risk Alcohol Consumption Among Older Adults

ALCOHOLISM, Issue 4 2010
Rudolf H. Moos
Background:, This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life. Method:, A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption. Results:, Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members. Conclusions:, These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption. [source]

Quality of Care for Acute Myocardial Infarction in Elderly Patients with Alcohol-Related Diagnoses

ALCOHOLISM, Issue 1 2006
David A. Fiellin
Background: Elderly adults with alcohol-related diagnoses represent a vulnerable population that may receive lower quality of treatment during hospitalization for acute myocardial infarction. We sought to determine whether elderly patients with alcohol-related diagnoses are less likely to receive standard indicators of quality care for acute myocardial infarction. Methods: We conducted a retrospective cohort analysis using administrative and medical record data from the Cooperative Cardiovascular Project. Subjects were Medicare beneficiaries with a confirmed principal discharge diagnosis of acute myocardial infarction from all acute care hospitals in the United States over an 8-month period. Our primary outcome was the receipt of 7 guideline-recommended care measures among all eligible patients and patients who were ideal candidates for a given measure. Results: In all, 1,284 (1%) of the 155,026 eligible patients met criteria for an alcohol-related diagnosis. Among the alcohol-related diagnoses, 1,077/1,284 (84%) were for the diagnoses of alcohol dependence or alcohol abuse. Patients with alcohol-related diagnoses were less likely than those without alcohol-related diagnoses to receive ,-blockers at the time of discharge (55% vs. 60%, p=0.02). We found no other significant differences in performance of the quality indicators after stratifying by indication and adjustment for baseline characteristics. Conclusions: Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction. [source]

Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome

Aliment Pharmacol Ther,31, 424,431 Summary Background, Quality of life among women with irritable bowel syndrome may be affected by pelvic floor disorders. Aim, To assess the association of self-reported irritable bowel syndrome with urinary incontinence, pelvic organ prolapse, sexual function and quality of life. Methods, We analysed data from the Reproductive Risks for Incontinence Study at Kaiser Permanente, a random population-based study of 2109 racially diverse women (mean age = 56). Multivariate analyses assessed the association of irritable bowel syndrome with pelvic floor disorders and quality of life. Results, The prevalence of irritable bowel syndrome was 9.7% (n = 204). Women with irritable bowel had higher adjusted odds of reporting symptomatic pelvic organ prolapse (OR 2.4; 95% CI, 1.4,4.1) and urinary urgency (OR 1.4; 95% CI, 1.0,1.9); greater bother from pelvic organ prolapse (OR 4.3; 95% CI, 1.5,11.9) and faecal incontinence (OR 2.0; 95% CI, 1.3,3.2); greater lifestyle impact from urinary incontinence (OR 2.2; 95% CI, 1.3,3.8); and worse quality of life (P < 0.01). Women with irritable bowel reported more inability to relax and enjoy sexual activity (OR 1.8; 95% CI, 1.3,2.6) and lower ratings for sexual satisfaction (OR 1.8; 95% CI, 1.3,2.5), but no difference in sexual frequency, interest or ability to have an orgasm. Conclusions, Women with irritable bowel are more likely to report symptomatic pelvic organ prolapse and sexual dysfunction, and report lower quality of life. [source]

Chemical composition and nutritive value of peach palm (Bactris gasipaes Kunth) in rats

Pascal Leterme
Abstract The peach palm (Bactris gasipaes Kunth) is the starchy fruit of a palm tree widely cultivated in Central and South America. The present study aimed at determining its chemical composition and its nutritive value in rats. The average chemical composition of 17 samples was as follows: 410 g kg,1 water and, in g kg,1 of dry matter (DM), 54 g crude protein, 114 g oil, 39 g neutral detergent fibre, 716 g starch, 21 g sugars and 18 g ash. The main variability was observed for the oil (60,180 g kg,1 DM) and starch (590,780 g DM) contents. The proteins contained, on average, in g kg,1 of proteins, 49 g lysine, 13 g methionine, 19 g cysteine, 39 g threonine and 7 g tryptophan. The mineral fraction contained, per kg DM: 1.0 g Ca, 0.8 g P, 0.6 g Mg, 0.3 g Na, 44 mg Fe, 4 mg Cu and 10 mg Zn. The digestibility of four peach palm genotypes was determined in rats fed a diet composed of 350 g kg,1 of peach palm and 650 g of a control diet based on maize and soybean meal. The digestibility of DM, energy, starch and protein of peach palm alone reached, on average 91, 87, 96 and 95%, respectively. No difference was observed between varieties, except for starch (p < 0.05). On average, peach palm contained 51 g of truly digestible protein kg,1 DM and 3.691 kcal digestible energy kg,1 DM. A growth trial was also carried out for 1 month on rats (initial weight: 78 g) fed a diet containing 0, 200, 400, 600 or 800 g peach palm kg,1, at the expense of a diet composed of maize starch and casein. The growth rate of the rats decreased (p < 0.05) as the peach palm concentration increased. The growth decrease was due to a decrease (p < 0.05) in DM intake and to the lower quality of the peach palm protein. It is concluded that peach palm is mainly an energy source for humans and animals. It is poor in protein and minerals but can be consumed in large amounts. Copyright © 2005 Society of Chemical Industry [source]

Quality of life in hepatitis C

Edna Strauss
Abstract: A number of different studies have shown a clear reduction in the quality of life of hepatitis C virus (HCV)-related liver-disease patients. Quality of life can be assessed by means of both generic and specific instruments, depending on the aim of the study and the population being studied. The application of a specific instrument to patients with liver diseases provides a broader assessment of different parameters related to hepatic disorders. In hepatitis C, alterations such as the stigma of liver disease, concerns about the disease and symptoms of the disease could be demonstrated with this type of instrument. The impact of the diagnosis of hepatitis C, a potentially serious disease, and the presence of comorbidities such as alcohol and drugs may lead to lower quality of life. Longitudinal studies have proved that, following diagnosis, the stigma of liver disease becomes more apparent over time. Women report worse quality of life than men, supporting that gender differences in hepatitis are also important when assessing quality of life. Alterations in the quality of life of patients submitted to treatment are mainly related to the somatic side effects of Interferon and Ribavirin and are most noticeable in the first weeks of therapy. Early improvement in the quality of life of patients who become HCV-RNA negative suggests that the virus itself plays a biological role. There is no doubt that liver transplantation leads to an improvement in quality of life. Nevertheless, a major concern is the relapse of HCV, with the associated lower quality of life. [source]

Strategic behavior in a service industry

Pekka Ilmakunnas
A model of service duopoly is formulated, where the arrival of customers and their service time in the firm are stochastic. The firms first choose the service capacity, and given the capacity they then choose the price in a Bertrand competition. Capacity choices have a negative externality on the competitor, since increased capacity in one firm decreases its expected full price (price plus cost of waiting) and leads to a flow of customers from the other firm. If the firms choose capacities strategically, it is optimal to underinvest compared to the non-strategic case, but this result may arise in different ways. By underinvesting the firms commit themselves to longer queues (lower quality) to relax price competition. Copyright © 2002 John Wiley & Sons, Ltd. [source]

The socio-economic burden of asthma is substantial in Europe

ALLERGY, Issue 1 2008
S. Accordini
Background: Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. Methods: In 1999,2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socio-economic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. Results: The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4,15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1,16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18,4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52,5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63,4.61) and sixfold (RRR = 5.76; 95% CI: 3.25,10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16,3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9,27.1%). Conclusions: The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females. [source]

How nurses' experiences of domestic violence influence service provision: Study conducted in North-west province, South Africa

Nicola J. Christofides
Abstract This study was undertaken to determine whether nurses' experiences of domestic violence (DV) influence their management of DV and rape cases. In total, 212 nurses were interviewed in two South African health districts using a standardized questionnaire. We measured sociodemographic characteristics, quality of care in the areas of rape and DV management, and experiences of DV in their own lives and amongst family and friends. A total of 39% nurses reported having experienced either physical or emotional abuse themselves and 40.6% amongst family and friends. Having personally experienced DV had no influence on DV identification and management. Those with experience from friends and family were more likely to have provided better care for patients who presented after DV (mean quality of care score = 23.1), while nurses who reported no personal experience of DV, either in their own lives or among family and friends, had a lower quality of care score of 19.8 (P = 0.02). Having ever intervened in a domestic dispute was associated with higher quality of care (P < 0.001). This suggests that the greater degree to which nurses identify with DV and intervene, the more likely they are to provide higher quality of care. Training of nurses in DV must try to build such empathy. [source]

Quality of life in Swedish workers exposed to hand,arm vibration

Ragnhild Cederlund
Abstract The objective of the present study was to analyse whether differences existed among workers exposed to hand,arm vibration (HAV) with regard to quality of life (QoL) issues. One hundred and eight male workers from a heavy manufacturing plant, with and without HAV symptoms, and workers referred to a hand surgery department with severe HAV symptoms participated in the study. The participants attended a clinical interview, were given a physical examination of the hands and administered the Göteborg Quality of Life instrument and the Evaluation of Daily Activity Questionnaire (EDAQ). Results indicated that workers referred to a hand surgery department with more severe HAV symptoms described a lower quality of life, defined here as lower subjective well-being, more symptoms of ill-health and difficulties with activities of daily living (ADL), than workers with no HAV symptoms. Workers from a heavy manufacturing plant with HAV symptoms experienced more difficulties with ADL, especially while working outdoors in cold weather, than workers with no HAV symptoms. Limitations of the present study include the use of a subjective scale to describe HAV symptoms. Further research is recommended on a larger sample of workers at risk for HAV symptoms to develop preventative ergonomic strategies. Copyright © 2007 John Wiley & Sons, Ltd. [source]

How Should a Firm Manage Deteriorating Inventory?

Mark E. Ferguson
Firms selling goods whose quality level deteriorates over time often face difficult decisions when unsold inventory remains. Since the leftover product is often perceived to be of lower quality than the new product, carrying it over offers the firm a second selling opportunity, a product line extension to new and unsold units, and the ability to price discriminate. By doing so, however, the firm subjects sales of its new product to competition from the leftover product. We present a two period model that captures the effect of this competition on the firm's production and pricing decisions. We characterize the firm's optimal strategy and find conditions under which the firm is better off carrying all, some, or none of its leftover inventory. We also show that, compared to a firm that acts myopically in the first period, a firm that takes into account the effect of first period decisions on second period profits will price its new product higher and stock more of it in the first period. Thus, the benefit of having a second selling opportunity dominates the detrimental effect of cannibalizing sales of the second period new product. [source]

Interest in services among prostate cancer patients receiving androgen deprivation therapy

Pamela J. Shapiro
Treatment side effects and decreased quality of life associated with androgen deprivation therapy (ADT) suggest the need for supportive services for prostate cancer (PC) patients receiving ADT. Nonetheless, uptake of services is low, suggesting that PC patients' preferences are not being addressed. We examined interest in supportive services and predictors of interest among 118 PC patients receiving ADT. Overall interest in services was associated with lower quality of life (p=0.01). The majority of participants expressed interest in informational services (70%), with a minority (22%) expressing interest in psychosocial services. Interest in psychosocial services was associated with younger age (p=0.02), and shorter duration of ADT (p<0.04), but was unrelated to psychological distress or social support. Although most men (68%) reported that they would prefer not to take medication for depression, 75% would do so if advised by their physician. Overall, results suggest that PC patients on ADT prefer individualized informational support. Substantial interest (61%) in Oncolink, an internet-based informational resource, suggests the Internet may provide an acceptable mode of service delivery. Health care providers should consider integrating increased informational support into routine care and, more generally, consider patient preferences in prioritizing and designing support services. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Niche expansion of a cryptic primate, Callimico goeldii, while in mixed species troops

Leila M. Porter
Abstract We examined the effects of polyspecific associations on the behavior of one group of Callimico goeldii in northwestern Bolivia. Data were collected for 1 year using focal animal sampling at 5-min intervals, for a total of 1,375 observation hours. In total, C. goeldii formed mixed species troops with five groups of Saguinus fuscicollis and six groups of S. labiatus, and these were maintained during 81% of observations. C. goeldii rested more and traveled less while alone than while associated, but neither vigilance behavior in the understory nor habitat use were affected by association status. The composition of the group's diet was different while alone (higher in structural carbohydrates [fungi] and lower in simple sugars [ripe fruits] and protein [insects]) than while associated (fungi 65 vs. 37%; fruits 13 vs. 32%; insects 5 vs. 15%). We propose therefore, that C. goeldii has a lower quality and more narrowly based diet while alone as compared to while associated. The factors that allow for this dietary expansion while in mixed species troops require further investigation. Am. J. Primatol. 69:1340,1353, 2007. © 2007 Wiley-Liss, Inc. [source]

Sexlessness among Married Chinese Adults in Hong Kong: Prevalence and Associated Factors

Jean H. Kim ScD
ABSTRACT Introduction., Despite recent media coverage in the topic of sexless marriages in East Asia, population-based studies examining the absence of sexual activity among nonelderly married individuals are scant. Previous studies have not simultaneously examined sociodemographic, physiological, and lifestyle predictors of sexless marriages. Aims., To determine the prevalence of past-year sexlessness and the associated factors among the married Chinese adults in Hong Kong. Methods., An anonymous, population-based telephone survey was conducted on 2,846 married Chinese men and women between the ages of 25 and 59 in Hong Kong. Main Outcome Measures., The prevalence of past-year sexlessness and the associated factors and mental health symptoms were examined. Results., The prevalence of past-year sexlessness between the ages of 25,34 years, 35,44 years and 45,59 years was 5.5, 5.1, and 17.0%, respectively, among married males, and 8.3, 12.4, and 31.6%, respectively, among married females. Older age and poor spousal relationship were associated with sexlessness for females, whereas lack of interest in sex, older age, and lower education were significant factors for males. Married women demonstrated statistically significant associations between sexlessness and poorer mental health indicators, such as lower quality of life and being bothered by the unavailability of a sex partner. Conclusions., Sexlessness is prevalent among certain subgroups of urban Chinese couples in Hong Kong, and the large discrepancy in sexlessness between married men and women in each age strata suggests a high prevalence of extramarital relationships. Contrary to commonly held beliefs, there was a stronger association between sexlessness and poorer psychosocial symptoms among married females than males. Sexless marriages are an underappreciated phenomenon among urban Chinese individuals. Kim JH, Lau JTF, and Cheuk KK. Sexlessness among married Chinese adults in Hong Kong: Prevalence and associated factors. J Sex Med 2009;6:2997,3007. [source]