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Urgency
Kinds of Urgency Terms modified by Urgency Selected AbstractsBed Rest First for Hypertensive Urgencies?JOURNAL OF CLINICAL HYPERTENSION, Issue 9 2008Marvin Moser MD No abstract is available for this article. [source] The Conundrum of Biological Control: Weighing Urgency Against UncertaintyCONSERVATION, Issue 2 2003Jason Van Driesche First page of article [source] Categorizing Urgency of Infant Emergency Department Visits: Agreement between CriteriaACADEMIC EMERGENCY MEDICINE, Issue 12 2006Rakesh D. Mistry MD Abstract Background The lack of valid classification methods for emergency department (ED) visit urgency has resulted in large variation in reported rates of nonurgent ED utilization. Objectives To compare four methods of defining ED visit urgency with the criterion standard, implicit criteria, for infant ED visits. Methods This was a secondary data analysis of a prospective birth cohort of Medicaid-enrolled infants who made at least one ED visit in the first six months of life. Complete ED visit data were reviewed to assess urgency via implicit criteria. The explicit criteria (adherence to prespecified criteria via complete ED charts), ED triage, diagnosis, and resources methods were also used to categorize visit urgency. Concordance and agreement (,) between the implicit criteria and alternative methods were measured. Results A total of 1,213 ED visits were assessed. Mean age was 2.8 (SD ± 1.78) months, and the most common diagnosis was upper respiratory infection (21.0%). Using implicit criteria, 52.3% of ED visits were deemed urgent. Urgent visits using other methods were as follows: explicit criteria, 51.8%; ED triage, 60.6%; diagnosis, 70.3%; and resources, 52.7%. Explicit criteria had the highest concordance (78.3%) and agreement (,= 0.57) with implicit criteria. Of limited data methods, resources demonstrated the best concordance (78.1%) and agreement (,= 0.56), while ED triage (67.9%) and diagnosis (71.6%) exhibited lower concordance and agreement (,= 0.35 and ,= 0.42, respectively). Explicit criteria and resources equally misclassified urgency for 11.1% of visits; ED triage and diagnosis tended to overclassify visits as urgent. Conclusions The explicit criteria and resources methods best approximate implicit criteria in classifying ED visit urgency in infants younger than six months of age. If confirmed in further studies, resources utilized has the potential to be an inexpensive, easily applicable method for urgency classification of infant ED visits when limited data are available. [source] The More the Scarier: Adult Richardson's Ground Squirrels (Spermophilus richardsonii) Assess Response Urgency Via the Number of Alarm SignallersETHOLOGY, Issue 5 2008Jennifer L. Sloan Richardson's ground squirrels (RGS) produce alarm calls that warn conspecifics of potential predators. We presented free-living adult and juvenile RGS with playbacks of repetitive alarm calls from one vs. two juvenile callers broadcast sequentially through two spatially separated loudspeakers. Adult RGS spent a greater proportion of time vigilant in response to two vs. one calling squirrel, whereas juvenile RGS did not respond differentially to two vs. one caller. Apparently then, the relative inexperience of juvenile RGS with alarm calls and the context in which such calls are emitted precludes their enumeration of alarm callers. Taken together with our earlier finding that adult but not juvenile RGS ignore information regarding response urgency encoded in the rate of juvenile produced repetitive calls, our present results suggest a developmental shift in response-urgency perception. Adult RGS selectively extract information regarding response urgency via discrimination of the number of callers, ignoring less reliable information encoded in the rate of repetitive calls issued by inexperienced juvenile signallers. [source] Responses of Redfronted Lemurs to Experimentally Modified Alarm Calls: Evidence for Urgency-Based Changes in Call StructureETHOLOGY, Issue 9 2002Claudia Fichtel Alarm calls can serve as model systems with which to study this general question. Therefore, we examined the information content of terrestrial predator alarm calls of redfronted lemurs (Eulemur fulvus rufus), group-living Malagasy primates. Redfronted lemurs give specific alarm calls only towards raptors, whereas calls given in response to terrestrial predators (woofs) are also used in other situations characterized by high arousal. Woofs may therefore have the potential to express the perceived risk of a given threat. In order to examine whether different levels of arousal are expressed in call structure, we analysed woofs given during inter-group encounters or in response to playbacks of a barking dog, assuming that animals engaged in inter-group encounters experience higher arousal than during the playbacks of dog barks. A multivariate acoustic analysis revealed that calls given during group encounters were characterized by higher frequencies than calls given in response to playbacks of dog barks. In order to examine whether this change in call structure is salient to conspecifics, we conducted playback experiments with woofs, modified in either amplitude or frequencies. Playbacks of calls with increased frequency or amplitude elicited a longer orienting response, suggesting that different levels of arousal are expressed in call structure and provide meaningful information for listeners. In conclusion, the results of our study indicate that the information about the sender's affective state is expressed in the structure of vocalizations. [source] Validation of the UPPS impulsive behaviour scale: a four-factor model of impulsivityEUROPEAN JOURNAL OF PERSONALITY, Issue 7 2005Stephen P. Whiteside The current study attempts to clarify the multi-faceted nature of impulsivity through the use of the four-factor UPPS Impulsive Behaviour scale. In order to build the nomological network surrounding this scale, the UPPS was administered to individuals with borderline personality disorder (BPD), pathological gamblers (PG), alcohol abusers (divided into two groups based on the presence of antisocial features), and a control group. Several of the UPPS scales (e.g. Urgency, lack of Premeditation, and Sensation Seeking) differentiated the BPD, PG, and alcohol abusers with antisocial features from a group of non-antisocial alcohol abusers and a control group. Overall, the UPPS scales accounted for between 7% (pathological gambling) and 64% (borderline personality disorder features) of the overall variance in the psychopathology measures. Individual UPPS scales also made unique contributions to several of these disorders, which may provide insight into which of these personality traits may predispose individuals to behave in maladaptive or problematic ways. The results provide support for the differentiation of impulsivity-related constructs into the current four-factor model. Copyright © 2005 John Wiley & Sons, Ltd. [source] Solifenacin treatment for overactive bladder in Hispanic patients: patient-reported symptom bother and quality of life outcomes from the VESIcare® Open-Label TrialINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2008J. P. Capo' Jr Summary Objective:, The primary goal of overactive bladder (OAB) treatment is to reduce symptoms and improve health-related quality of life (HRQoL). Although trials open enrolment to everyone, most OAB studies feature Caucasians. Here we present Hispanic data. Methods:, VESIcare® Open-Label Trial was a 12-week, open-label, flexible-dosing study in patients with OAB symptoms for , 3 months. All patients started on solifenacin 5 mg/day, with a dosing option of 5 or 10 mg/day at weeks 4 and 8. Three patient-reported outcome (PRO) measures assessed symptom improvement and treatment satisfaction: the Patient Perception of Bladder Condition (PPBC) scale, a Visual Analogue Scale (VAS), the Overactive Bladder Questionnaire (OAB-q). Results:, 94/2205 patients in the full population were Hispanic. Urgency was most frequently reported at baseline (93.6%), followed by frequency (91.5%), nocturia (84.0%) and urge incontinence (UI) (67.0%). Frequency was reported as the most bothersome symptom (MBS) by a higher proportion of Hispanics than the full population (40.4% vs. 28.1%). UI was reported as the MBS by a smaller proportion of Hispanics (18.1% vs. 27.3%). Patients reporting moderate-to-severe problems related to bladder condition at baseline reported improvement to ,some minor problems' at week 12. Over 72.0% of patients experienced PPBC score improvement. Both groups reported significant improvements in urgency, UI, frequency and nocturia on the VAS (all p < 0.001) and all OAB-q domains (all p < 0.001) at week 12. Conclusion:, Although numbers were small, Hispanics receiving solifenacin for OAB reported improvement from baseline in symptom bother and HRQoL, as assessed by three independent PRO measures. [source] From the Politics of Urgency to the Governance of Preparedness: A Research Agenda on Urban VulnerabilityJOURNAL OF CONTINGENCIES AND CRISIS MANAGEMENT, Issue 2 2005Will Medd To date, little social science understanding has been developed about what it would mean to strategically build resilience in the context of such rich interdependencies between social, technical and natural worlds. We argue that shifts in strategies to deal with urban crises marks a turn from the politics of urgency, characteristic of crisis management, towards a governance of preparedness, characterised by strategies to build urban resilience. Social science needs to develop research agendas that critically engage with different understandings of resilience and the challenges of building resilience across different scales of urban governance. [source] Overactive Bladder in Female Patients with Chronic Diseases Visiting Primary Care Doctors: Effect of Age on Prevalence and BothersomenessLUTS, Issue 1 2009Masaki YOSHIDA Objectives: We evaluated the effects of age on the prevalence and bothersomeness of overactive bladder (OAB) in female patients with chronic diseases visiting primary care doctors. Methods: We used the pooled data of the SURPRISE survey in which 121 doctors and 1388 female patients aged 40 years or older responded to questionnaires. Results: The OAB prevalence rate in patients was estimated by doctors to be 9.5%. However, the OAB prevalence rate according to patients, as defined by the OAB symptom score, was 22.3%. The rate was increased with age. The number of patients with OAB was much higher than estimated by doctors. Approximately 25% of patients were dissatisfied with their present urinary condition. The rate was increased with age. Dissatisfaction with present urinary condition was strongly correlated with severe urgency score in all age groups. In elderly patients, contribution of urgency incontinence and nocturia to dissatisfaction was also increased. Thirteen percent of patients were receiving treatment for their OAB. However, 15.8% were untreated, regardless of having OAB, suggesting that treated patients comprise less than half of all OAB patients. This tendency was observed in all age groups. In the correlation between satisfaction with pharmacological treatment and each OAB symptom, contribution of urgency to satisfaction with pharmacological treatment was the highest. Conclusion: Urgency is the most bothersome symptom and shows the highest contribution to treatment satisfaction. In elderly patients, urgency incontinence and nocturia are proportionally greater problems. Management of urgency is essential for improving quality of life and satisfaction with treatment in OAB patients. [source] Urgency: All or none phenomenon?,NEUROUROLOGY AND URODYNAMICS, Issue 4 2010Stefan De Wachter Abstract Urgency is the key symptom of a very prevalent symptom complex, the overactive bladder syndrome. Addressing urgency as a hallmark for detrusor overactivity is for physicians very comfortable, but appears to be an oversimplification of a very complex symptom entity. This overview tries to put the relevant literature on urgency against the question whether urgency is an all or none phenomenon, and summarizes the current views on how urgency is perceived. Neurourol. Urodynam. 29:616,617, 2010. © 2010 Wiley-Liss, Inc. [source] Sacral nerve stimulation for faecal incontinence in the UK,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2004M. E. D. Jarrett Background: Sacral nerve stimulation (SNS) is an effective therapy for faecal incontinence. Published studies derive largely from single centres and there is a need to determine the broader applicability of this procedure. Methods: Prospective data were collected for all patients undergoing SNS in the UK. Records were reviewed to determine the outcome of treatment. Results: In three UK centres 59 patients underwent peripheral nerve evaluation, with 46 (78 per cent) proceeding to permanent implantation. Of these 46 patients (40 women) all but two had improved continence at a median of 12 (range 1,72) months. Faecal incontinence improved from a median (range) of 7·5 (1,78) to 1 (0,39) episodes per week (P < 0·001). Urgency improved in all but five of 39 patients in whom ability to defer defaecation was determined, improving from a median of 1 (range 0,5) to 10 (range from 1 to more than 15) min (P < 0·001). Maximum anal squeeze pressure and sensory function to rectal distension changed significantly. Significant improvement occurred in general health (P = 0·024), mental health (P = 0·008), emotional role (P = 0·034), social function (P = 0·013) and vitality (P = 0·009) subscales of the Short Form 36 health survey questionnaire. There were no major complications. One implant was removed. Conclusion: SNS is a safe and effective treatment, in the medium to long term, for faecal incontinence when conservative treatment has failed. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Long-term failure and function after restorative proctocolectomy , a multi-centre study of patients from the UK national ileal pouch registryCOLORECTAL DISEASE, Issue 5 2010P. P. Tekkis Abstract Objective, There is little information on the long-term failure and function after restorative proctocolectomy (RPC). The results of data submitted to a national registry were analysed. Method, The UK National Pouch Registry was established in 2004. By 2006, it comprised data collected from ten centres between 1976 and 2006. The long-term failure and functional outcome were determined. Trends over time were assessed using the gamma statistic or the Kruskal,Wallis statistic wherever appropriate. Results, In all, 2491 patients underwent primary RPC over a median of 54 months (range 1 month to 28.9 years). Of these, 127 (5.1%) underwent abdominal salvage surgery. The incidence of failure (excision or indefinite diversion) was 7.7% following primary and 27.5% following salvage RPC (P < 0.001). The median frequency of defaecation/24 h was five including one at night. Nocturnal seepage occurred in 8% at 1 year, rising to 15.4% at 20 years (P = 0.037). Urgency was experienced by 5.1% of patients at 1 year rising to 9.1% at 15 years (P = 0.022). Stool frequency and the need for antidiarrhoeal medication were greater following salvage RPC. Conclusion, In patients retaining anal function after RPC, frequency of defaecation was stable over 20 years. Faecal urgency and minor incontinence worsened with time. Function after salvage RPC was significantly worse. [source] Involuntary detrusor contractions: Correlation of urodynamic data to clinical categoriesNEUROUROLOGY AND URODYNAMICS, Issue 3 2001Lauri J. Romanzi Abstract Data regarding the prevalence and urodynamic characteristics of involuntary detrusor contractions (IDC) in various clinical settings, as well as in neurologically intact vs. neurologically impaired patients, are scarce. The aim of our study was to evaluate whether the urodynamic characteristics of IDC differ in various clinical categories. One hundred eleven consecutive neurologically intact patients and 21 consecutive neurologically impaired patients, referred for evaluation of persistent irritative voiding symptoms, were prospectively enrolled. All patients were presumed by history to have IDC, and underwent detailed clinical and urodynamic evaluation. Based on clinical evaluation, patients were placed into one of four categories according to the main presenting symptoms and the existence of neurological insult: 1) frequency/urgency; 2) urge incontinence; 3) mixed stress incontinence and irritative symptoms; and 4) neurogenic bladder. IDC was defined by detrusor pressure of ,,15,cm H2O whether or not the patient perceived the contraction; or <,15,cm H2O if perceived by the patient. Eight urodynamic characteristics of IDC were analyzed and compared between the four groups. IDC were observed in all of the neurologically impaired patients, compared with 76% of the neurologically intact patients (P,<,0.001). No correlation was found between amplitude of IDC and subjective report of urgency. All clinical categories demonstrated IDC at approximately 80% of cystometric capacity. Eighty-one percent of the neurologically impaired patients, compared with 97% of the neurologically intact patients, were aware of the IDC at the time of urodynamics (P,<,0.04). The ability to abort the IDC was significantly higher among continent patients with frequency/urgency (77%) compared with urge incontinent patients (46%) and neurologically impaired patients (38%). In conclusion, when evaluating detrusor overactivity, the characteristics of the IDC are not distinct enough to aid in differential diagnosis. However, the ability to abort IDC and stop incontinent flow may have prognostic implications, especially for the response to behavior modification, biofeedback, and pelvic floor exercise. Neurourol. Urodynam. 20:249,257, 2001. © 2001 Wiley-Liss, Inc. [source] The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal childrenBJU INTERNATIONAL, Issue 9 2002H.G. Pohl Objective,To describe the tolerability and efficacy of clean intermittent catheterization (CIC) in the management of dysfunctional voiding in patients who are neurologically and anatomically normal. Patients and methods,The medical records were reviewed in 23 patients (16 girls, mean age 9 years, range 6,14.5, and seven males, mean age 8 years, range 5,20.5) with urinary incontinence and/or urinary tract infection (UTI) who were offered CIC because they had a large postvoid residual urine volume (PVR). All had extensive instruction before starting CIC. All patients underwent urodynamic studies, and urinary and fecal elimination habits were recorded. Detrusor hyperactivity, when present, was treated with anticholinergic medication. The follow-up evaluation included tolerance of CIC, continence status and the incidence of UTI. Behavioural modification or biofeedback training was not used in any patient. Results,Of the 23 patients, 13 presented with both UTI and urinary incontinence, five with incontinence only, four with UTI only, one with frequency and no incontinence, and one with haematuria. Associated symptoms included frequency/urgency, constipation or soiling, and straining to void or incomplete emptying (in nine each), and infrequent voiding in six. CIC was performed within 2 days by 15 patients, while four others required up to 2 weeks to master CIC. However, three of the four patients (all older girls) who needed 2 weeks to learn the technique did not tolerate CIC and discontinued it within 3 weeks. Four other adolescents (three girls and one boy) refused to learn CIC. Of the 16 patients remaining on CIC only three had cystitis; no patient had a febrile UTI. Once successfully instituted, all patients became continent while on CIC. Six boys (mean follow-up 4 months) had a marked decrease in their PVR. CIC was discontinued in three girls who voided normally to emptiness within 6 months of starting CIC; they remained dry and infection-free 16 months (two) and 6 years later. Conclusion,CIC is a viable therapeutic option for the treatment of dysfunctional voiding, associated with a large PVR, in the absence of any neurological abnormality. CIC is well tolerated in the sensate patient and provides a means for expeditiously achieving continence and improving bladder emptying cost-effectively. [source] Randomized study of single early instillation of (2,R)-4,- O -tetrahydropyranyl-doxorubicin for a single superficial bladder carcinomaCANCER, Issue 9 2002Kikuo Okamura M.D., Ph.D. Abstract BACKGROUND Although transurethral resection of a bladder tumor (TUR-Bt) alone has been standard treatment for single superficial bladder carcinoma, some authors reported a certain prophylactic effect of a single immediate intravesical instillation of chemotherapeutic agent after TUR-Bt. A prospective randomized study was conducted to determine whether a single (2,R)-4,- O -tetrahydropyranyl-doxorubicin (THP) instillation immediately after TUR-Bt is beneficial to patients with a single superficial bladder carcinoma. METHODS One hundred seventy patients with a single resectable superficial bladder carcinoma (Ta-1, primary or recurrent with no recurrence during the last 1 year) were enrolled in this study. THP (30 mg/30 mL of normal saline) was administered into the bladder within 6 hours after TUR-Bt in arm A, while TUR-Bt alone was done in arm B. RESULTS Of the 170 patients, 160 (94.1%) were eligible and were followed up for a median time of 40.8 months. There was a significant difference in the recurrence free curve between the 2 arms (log-rank test; P = 0.0026), with 92.4% recurrence free rate at 1 year, 82.7% at 2 years, and 78.8% at 3 years in arm A (84 patients) and 67.0%, 55.7%, and 52.6%, respectively, in arm B. The recurrence rate per year was 0.11 ± 0.22 in arm A and 0.24 ± 0.36 in arm B, with a significant difference (P = 0.007). Toxicity included pain with micturition in 9 patients (10.7%), urinary frequency/urgency in 5 patients (6.0%), and macroscopic hematuria in 7 patients (8.3%). CONCLUSIONS These data indicate that a single THP instillation immediately after TUR reduces the recurrence of superficial bladder carcinoma. Cancer 2002;94:2363,8. © 2002 American Cancer Society. DOI 10.1002/cncr.10496 [source] Management of perioperative hypertensive urgencies with parenteral medications,JOURNAL OF HOSPITAL MEDICINE, Issue 2 2010Kartikya Ahuja MD Abstract BACKGROUND: Hypertension is the major risk factor for cardiovascular (CV) disease such as myocardial infarction (MI) and stroke. This risk is well known to extend into the perioperative period. Although most perioperative hypertension can be managed with the patient's outpatient regimen, there are situations in which oral medications cannot be administered and parenteral medications become necessary. They include postoperative nil per os status, severe pancreatitis, and mechanical ventilation. This article reviews the management of perioperative hypertensive urgency with parenteral medications. METHODS: A PubMed search was conducted by cross-referencing the terms "perioperative hypertension," "hypertensive urgency," "hypertensive emergency," "parenteral anti-hypertensive," and "medication." The search was limited to English-language articles published between 1970 and 2008. Subsequent PubMed searches were performed to clarify data from the initial search. RESULTS: As patients with hypertensive urgency are not at great risk for target-organ damage (TOD), continuous infusions that require intensive care unit (ICU) monitoring and intraarterial catheters seem to be unnecessary and a possible misuse of resources. CONCLUSIONS: When oral therapy cannot be administered, patients with hypertensive urgency can have their blood pressure (BP) reduced with hydralazine, enalaprilat, metoprolol, or labetalol. Due to the scarcity of comparative trials looking at clinically significant outcomes, the medication should be chosen based on comorbidity, efficacy, toxicity, and cost. Journal of Hospital Medicine 2010;5:E11,E16. © 2010 Society of Hospital Medicine. [source] Categorizing Urgency of Infant Emergency Department Visits: Agreement between CriteriaACADEMIC EMERGENCY MEDICINE, Issue 12 2006Rakesh D. Mistry MD Abstract Background The lack of valid classification methods for emergency department (ED) visit urgency has resulted in large variation in reported rates of nonurgent ED utilization. Objectives To compare four methods of defining ED visit urgency with the criterion standard, implicit criteria, for infant ED visits. Methods This was a secondary data analysis of a prospective birth cohort of Medicaid-enrolled infants who made at least one ED visit in the first six months of life. Complete ED visit data were reviewed to assess urgency via implicit criteria. The explicit criteria (adherence to prespecified criteria via complete ED charts), ED triage, diagnosis, and resources methods were also used to categorize visit urgency. Concordance and agreement (,) between the implicit criteria and alternative methods were measured. Results A total of 1,213 ED visits were assessed. Mean age was 2.8 (SD ± 1.78) months, and the most common diagnosis was upper respiratory infection (21.0%). Using implicit criteria, 52.3% of ED visits were deemed urgent. Urgent visits using other methods were as follows: explicit criteria, 51.8%; ED triage, 60.6%; diagnosis, 70.3%; and resources, 52.7%. Explicit criteria had the highest concordance (78.3%) and agreement (,= 0.57) with implicit criteria. Of limited data methods, resources demonstrated the best concordance (78.1%) and agreement (,= 0.56), while ED triage (67.9%) and diagnosis (71.6%) exhibited lower concordance and agreement (,= 0.35 and ,= 0.42, respectively). Explicit criteria and resources equally misclassified urgency for 11.1% of visits; ED triage and diagnosis tended to overclassify visits as urgent. Conclusions The explicit criteria and resources methods best approximate implicit criteria in classifying ED visit urgency in infants younger than six months of age. If confirmed in further studies, resources utilized has the potential to be an inexpensive, easily applicable method for urgency classification of infant ED visits when limited data are available. [source] FS13.5 Occupational contact dermatitis: printer worker's viewpointsCONTACT DERMATITIS, Issue 3 2004Terry Brown Introduction:, Occupational contact dermatitis (OCD) is very common in the printing industry due to contact with chemicals, paper, and wet work. It can be avoided by adequate protective measures, but the effectiveness of intervention depends heavily on the employer's and employee's awareness of this health risk. Objectives:, The study aimed to collect information on the knowledge, attitudes and beliefs of print workers about the risk of OCD and methods of prevention. Methods:, A series of focus groups were held with print workers, health and safety officers and managers to discuss their awareness of dermal risk factors, risk behaviour at work, attitudes to health and safety and options on possible preventive measures. A number of companies were also visited to observe, overtly and covertly, the normal work practices. Results:, OCD was not perceived to be either a major problem or a health and safety priority. There was general agreement about the processes and work practices that could cause skin problems. However, work practices varied considerably and did not always reflect this awareness. There was general concern about the type and availability of personal protective equipment, especially gloves and after-work skin cream. The provision of an occupational health service was generally felt to be inadequate, and no company had a policy in place that specifically addressed skin care. Conclusions:, These findings highlight the urgency to intensify health and safety education on skin care within the printing industry. Recommendations were developed for the evaluation of a series of risk reduction strategies. [source] Personality traits as prospective predictors of suicide attemptsACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009S. Yen Objective:, To examine higher order personality factors of negative affectivity (NA) and disinhibition (DIS), as well as lower order facets of impulsivity, as prospective predictors of suicide attempts in a predominantly personality disordered sample. Method:, Data were analyzed from 701 participants of the Collaborative Longitudinal Personality Disorders Study with available follow-up data for up to 7 years. Cox proportional hazards regression analyses was used to examine NA and DIS, and facets of impulsivity (e.g. urgency, lack of perseverance, lack of premeditation and sensation seeking), as prospective predictors of suicide attempts. Results:, NA, DIS and all facets of impulsivity except for sensation seeking were significant in univariate analyses. In multivariate models which included sex, childhood sexual abuse, course of major depressive disorder and substance use disorders, only NA and lack of premeditation remained significant in predicting suicide attempts. DIS and the remaining impulsivity facets were not significant. Conclusion:, NA emerged as a stronger and more robust predictor of suicide attempts than DIS and impulsivity, and warrants greater attention in suicide risk assessment. Distinguishing between facets of impulsivity is important for clinical risk assessment. [source] Diabetes control and complications: the role of glycated haemoglobin, 25 years onDIABETIC MEDICINE, Issue 7 2004S. L. Jeffcoate Abstract The long-term complications of diabetes have major consequences for individual subjects and growing healthcare delivery and cost implications for society. Evidence for the benefits of good glycaemic control, as monitored by glycated haemoglobin measurements, has been developed in the 25 years since they were introduced to the point where HbA1c assays play central roles in patient management, clinical guidance and audit, and clinical trial design. In this review this evidence is examined and three classes of uncertainty identified that diminish confidence in the effectiveness of these roles for HbA1c. 1Analytical variability between different methods for HbA1c has restricted the application of clinical targets and this problem has recently been addressed by reference method standardization. There are two approaches to this which result in different HbA1c values and this discrepancy needs to be resolved. 2Biological variability in HbA1c values between individuals also restricts its predictive role when applied to populations. The correlations between HbA1c measurements and various components of glycaemia (overall, fasting, postprandial) are still uncertain and differences in protein glycation and de-glycation are greater between subjects than often thought. The influence of variability in erythrocyte life span is an area where research is needed, especially in diabetic subjects. 3Clinical variability is the most important and complex area of uncertainty. A predictive link between HbA1c and clinical outcomes is not as clear-cut as often stated. The correlation with the development of microvascular disease is well established in Type 1 diabetes, but in Type 2 subjects (90% of those with diabetes) the evidence that HbA1c monitoring is of value in predicting or preventing macrovascular disease is not strong, although it is the major cause of morbidity and early death in this group. It is recommended that, as a matter of urgency, these issues be examined, particularly within the context of self-care in diabetes. Diabet. Med. **, ***,*** (2003) [source] Reliability of Computerized Emergency TriageACADEMIC EMERGENCY MEDICINE, Issue 3 2006Sandy L. Dong MD Objectives: Emergency department (ED) triage prioritizes patients based on urgency of care. This study compared agreement between two blinded, independent users of a Web-based triage tool (eTRIAGE) and examined the effects of ED crowding on triage reliability. Methods: Consecutive patients presenting to a large, urban, tertiary care ED were assessed by the duty triage nurse and an independent study nurse, both using eTRIAGE. Triage score distribution and agreement are reported. The study nurse collected data on ED activity, and agreement during different levels of ED crowding is reported. Two methods of interrater agreement were used: the linear-weighted , and quadratic-weighted ,. Results: A total of 575 patients were assessed over nine weeks, and complete data were available for 569 patients (99.0%). Agreement between the two nurses was moderate if using linear , (weighted ,= 0.52; 95% confidence interval = 0.46 to 0.57) and good if using quadratic , (weighted ,= 0.66; 95% confidence interval = 0.60 to 0.71). ED overcrowding data were available for 353 patients (62.0%). Agreement did not significantly differ with respect to periods of ambulance diversion, number of admitted inpatients occupying stretchers, number of patients in the waiting room, number of patients registered in two hours, or nurse perception of busyness. Conclusions: This study demonstrated different agreement depending on the method used to calculate interrater reliability. Using the standard methods, it found good agreement between two independent users of a computerized triage tool. The level of agreement was not affected by various measures of ED crowding. [source] Does Italy's plight threaten European Monetary Union?ECONOMIC OUTLOOK, Issue 3 2005Article first published online: 27 JUL 200 The Italian economy is in a mess. GDP is expected to contract by 0.6% this year and the budget deficit is heading towards 4% of GDP , it is hard to see a way out of the mire. And after the rejection of the European constitution in France and the Netherlands, questions are being asked about the very future of the European project. With Italy fundamentally uncompetitive across a whole range of both price and non-prices measures, and with an industrial structure ill-equipped to deal with the challenges of globalisation, Italy's long-term membership of the Euro is being debated. This article by Keith Church sets out Italy's problems and argues that, if the economy stagnates for a prolonged period, pressure to leave EMU will become irresistible. This can be avoided if the government finally implements structural reforms instead of continually ,muddling through'. At the same time, the ECB needs to realise the urgency of the current situation and start to show greater flexibility. [source] Alcohol and Russian mortality: a continuing crisisADDICTION, Issue 10 2009David A. Leon ABSTRACT Background Russia remains in the grip of a mortality crisis in which alcohol plays a central role. In 2007, male life expectancy at birth was 61 years, while for females it was 74 years. Alcohol is implicated particularly in deaths among working-age men. Aims To review the current state of knowledge about the contribution of alcohol to the continuing very high mortality seen among Russian adults Results Conservative estimates attribute 31,43% of deaths among working-age men to alcohol. This latter estimate would imply a minimum of 170 000 excess deaths due to hazardous alcohol consumption in Russia per year. Men drink appreciably more than women in Russia. Hazardous drinking is most prevalent among people with low levels of education and those who are economically disadvantaged, partly because some of the available sources of ethanol are very cheap and easy to obtain. The best estimates available suggest that per capita consumption among adults is 15,18 litres of pure ethanol per year. However, reliable estimation of the total volume of alcohol consumed per capita in Russia is very difficult because of the diversity of sources of ethanol that are available, for many of which data do not exist. These include both illegal spirits, as well as legal non-beverage alcohols (such as medicinal tinctures). In 2006 regulations were introduced aimed at reducing the production and sale of non-beverage alcohols that are commonly drunk. These appear to have been only partially successful. Conclusion There is convincing evidence that alcohol plays an important role in explaining high mortality in Russia, in particular among working age men. However, there remain important uncertainties about the precise scale of the problem and about the health effects of the distinctive pattern of alcohol consumption that is prevalent in Russia today. While there is a need for further research, enough is known to justify the development of a comprehensive inter-sectoral alcohol control strategy. The recent fall in life expectancy in Russia should give a renewed urgency to attempts to move the policy agenda forward. [source] The role of personality dispositions to risky behavior in predicting first-year college drinkingADDICTION, Issue 2 2009Melissa A. Cyders ABSTRACT Aims US college student drinking is associated with enormous risks to health, safety and productivity. Recent advances in personality research that have delineated multiple, separate dispositions to engage in risky behaviors may help to clarify the personality contribution to risk for this problem. Design The authors compared the prospective roles of sensation seeking, lack of planning, lack of perseverance, negative urgency and positive urgency (dispositions to engage in rash action when in an unusually negative or positive mood, respectively) in predicting increases in drinking frequency, drinking quantity and negative outcomes from consumption across the first year of college. Setting University of Kentucky campus. Participants A total of 418 first-year US college students enrolled in an Introduction to Psychology course during the first assessment; 293 participants completed both phases of the study. Measurements Participants completed self-report measures of personality and drinking behavior twice during the first year of college [the UPPS-R Impulsive Behavior Scale, positive urgency measure (PUM) and Drinking Styles Questionnaire (DSQ)]. Findings Whereas sensation seeking related to increases in the frequency with which college students drank alcohol, positive urgency predicted increases in (i) the quantity of alcohol students consumed at any given drinking episode and (ii) negative outcomes experienced from drinking. Conclusions It appears that although sensation seeking is a risk factor for participation in drinking behaviors, risk for increased quantity of consumption and its negative outcomes may be more a function of dyscontrol stemming from high positive mood for college students. [source] UK smokers' and ex-smokers' reactions to cigarettes promising reduced riskADDICTION, Issue 1 2007Saul Shiffman ABSTRACT Aims This study evaluated the impact of exposure to information about a novel cigarette claiming to reduce exposure to tobacco toxins (,potential reduced exposure product' cigarette or PREP-C) on smokers' and ex-smokers' perceptions of PREP-C, on quit interest among smokers and on interest in resuming smoking among ex-smokers. Design and Participants A random digit-dialed telephone survey was conducted in the United Kingdom with 500 current smokers and 106 ex-smokers who had quit within the last 2 years. Intervention The interviewer described a novel cigarette that claimed to significantly reduce exposure to smoke toxins. Measurements Respondents' interest in purchasing the PREP-C, beliefs about its safety and risk reduction and smokers' quit interest, as measured by stage of change, before and after exposure to PREP-C information. Findings Among smokers, 76.5% were interested in purchasing PREP-C; interest did not vary by stage of change. Almost all smokers (90.6%) thought PREP-C was safer than regular cigarettes, with 5.4% indicating that the health risks were equivalent to not smoking at all. Exposure to PREP-C description did not change quit interest. Among ex-smokers, 5.6% believed PREP-C carried no health risk and 7.1% expressed purchase interest. Conclusions Smokers and ex-smokers interpreted claims of reduced toxin exposure as reduced health risk and responded positively towards PREP-Cs. With the increasing introduction of PREP-Cs world-wide, evaluation of these products and their claims on quitting among smokers and on relapse among ex-smokers is a matter of public health urgency. [source] The More the Scarier: Adult Richardson's Ground Squirrels (Spermophilus richardsonii) Assess Response Urgency Via the Number of Alarm SignallersETHOLOGY, Issue 5 2008Jennifer L. Sloan Richardson's ground squirrels (RGS) produce alarm calls that warn conspecifics of potential predators. We presented free-living adult and juvenile RGS with playbacks of repetitive alarm calls from one vs. two juvenile callers broadcast sequentially through two spatially separated loudspeakers. Adult RGS spent a greater proportion of time vigilant in response to two vs. one calling squirrel, whereas juvenile RGS did not respond differentially to two vs. one caller. Apparently then, the relative inexperience of juvenile RGS with alarm calls and the context in which such calls are emitted precludes their enumeration of alarm callers. Taken together with our earlier finding that adult but not juvenile RGS ignore information regarding response urgency encoded in the rate of juvenile produced repetitive calls, our present results suggest a developmental shift in response-urgency perception. Adult RGS selectively extract information regarding response urgency via discrimination of the number of callers, ignoring less reliable information encoded in the rate of repetitive calls issued by inexperienced juvenile signallers. [source] Autonomic symptoms in patients and pre-manifest mutation carriers of Huntington's diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2010N. A. Aziz Background and purpose:, Although autonomic function tests have revealed abnormalities of the autonomic nervous system in Huntington's disease (HD), autonomic symptoms and their association with other symptoms and signs of HD have not yet been assessed in large groups of patients or pre-manifest mutation carriers. Therefore, we aimed at delineating the characteristics and correlates of autonomic symptoms in HD. Methods:, Using the scales for outcomes in Parkinson's disease-autonomic symptoms (SCOPA-AUT) and Beck Depression Inventory questionnaires, autonomic symptoms and depressed mood were assessed in 63 patients with HD, 21 pre-manifest mutation carriers, and 85 controls. The Unified Huntington's Disease Rating Scale was used to assess other HD symptoms and signs. Results:, Relative to controls, patients with HD experienced significantly more gastrointestinal, urinary, cardiovascular and, in men, sexual problems. The most prevalent symptoms were swallowing difficulties, erection and ejaculation problems, dysphagia, sialorrhea, early abdominal fullness, straining for defecation, fecal and urinary incontinence, urgency, incomplete bladder emptying, and light-headedness whilst standing. Pre-manifest mutation carriers experienced significantly more swallowing difficulties and light-headedness on standing up compared with controls. In patients with HD, autonomic symptoms were associated with a greater degree of functional disability, more severe depression, and antidepressant drugs use. However, depression was the only independent predictor of autonomic dysfunction. Conclusions:, Autonomic symptoms are highly prevalent in patients with HD and may even precede the onset of motor signs. Moreover, autonomic dysfunction is related to functional disability and depression in HD. [source] Structure versus culture again: Corporatism and the ,new politics' in 16 Western European countriesEUROPEAN JOURNAL OF POLITICAL RESEARCH, Issue 5 2003Bojan Todosijevi This article analyzes the relationships between corporatism and ,new politics' using Siaroff's (1999) corporatism scores for 16 West European countries and data from Inglehart et al.'s (1998) World Value Survey. The results of the analysis show that corporatism is related to higher membership in peace movements and also to belief in the urgency of ecological problems. However, it is unrelated to postmaterialist values, votes for ,new parties', approval of the environmentalist and feminist movements, and willingness to contribute financially to environmental protection. The relationships between corporatism and ,new politics' is shown to be somewhat mediated by economic factors, while the hypothesis that postmaterialism is a principal factor behind the popularity of the new social movements is not substantiated. [source] The ,Whole Man': The Longing for a Masculine World in Nineteenth,Century GermanyGENDER & HISTORY, Issue 1 2003Martina Kessel Through the lens of advice literature, letters and autobiographical documents, this article examines the construction of middle,class masculinity in nineteenth,century Germany. Between the end of the eighteenth century and the fin,de,siècle gender debates, masculinity was paradoxically configured. On the one hand, manhood was said to be relational, that is notions of the masculine were related to notions of the feminine. On the other hand, the concept of the ,whole man' encompassed aspects gendered both as female and as male, thus inviting visions of a society without women. This paradoxical construction became the site of discussions, projections and contestations: women used the figure of the whole man in order to voice their desires or criticise male claims to dominance and control, but it frequently also served as the basis for male self,descriptions. In the course of the nineteenth century, notions of integral masculinity became ever more precarious since the sociable, well,rounded, artistically inclined man propagated in the first half of the nineteenth century was increasingly superseded by the ,soldier of work' which gave the fin,de,siècle gender debates a particular urgency. [source] Developing an instrument to support oral care in the elderlyGERODONTOLOGY, Issue 1 2003Yasunori Sumi Abstract Background: The dramatic increase in the number of dependent elderly in developed countries has created a great need for their improved oral care. However, optimal oral care by caregivers is not possible because of time constraints, difficulty involved in brushing other individuals' teeth, lack of co-operation, and the lack of perceived need. Therefore, the development of an effective instrument simplifying and supporting oral care to relieve the strain on caregivers is a matter of some urgency. Purpose: In order to clean the mouths of elderly dependent patients, we have developed a new oral care support instrument (an electric toothbrush in combination with an antibacterial-agent supply and suction system). The purpose of the present study was to develop and evaluate a new oral care support instrument. Methods: a) Plaque removal study: The plaque- removing ability of this new instrument in 70 outpatients was compared with the Plak Control D9011 (Braun Gillette Japan Inc.) as a control by means of the Turesky modification of the Quigley and Hein plaque index, b) Clinical study: The subjects were 10 dependent elderly who received oral care using the new oral care support instrument for two weeks. The plaque and gingival indices were used for clinical evaluations. Results: a) Plaque removal study: Brushing with the new oral care support instrument removed significantly more plaque than with the Plak Control D9011. b) Clinical study: The new oral care support instrument allows a more effective removal of dental plaque and shows a significant improvement in the gingival indices in dependent elderly. Conclusion: It is concluded that the new oral care support instrument is effective and can be recommended for oral care in the dependent elderly. 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