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Selected AbstractsOlder patients request more information: a survey of use of written patient education materials in general practiceAUSTRALASIAN JOURNAL ON AGEING, Issue 1 2003Kryss T. McKenna Objectives: To determine GPs' reported use of written education materials with older patients and older patients' reported receipt of these materials. To determine GPs' and older patients' perceptions of written materials. Method: Using self-report questionnaires, two populations were surveyed; a randomised sample of SO GPs (29 males and 21 females) practising in Brisbane's southern suburbs and a convenience sample of 188 older community-dwelling people (aged over 64 years). Results: All GPs reported using written materials with patients, although 28% had not given any to the last 10 patients. This increased to 46% when patients were older. Twenty percent of patients wanted more written information from their GP, while some GPs believed that older patients preferred verbal information and gave out written information only when they perceived patient interest. All GPs reported giving written materials at the time of consultation and over two-thirds discussed the content with patients. Just over 50% of patients reported receiving written information from GPs in the last six months and only half of these again discussed it directly with their GP. Overall, patients were more positive than GPs about the value of written education materials. Conclusions: Older patients' desire for written information may be better met if they are more assertive in requesting this of GPs and GPs may better serve their patients' needs if they make written information more readily available to them. Better access to materials and more financial incentives to give them out might also increase GPs' use of written materials. [source] Financing Constraints, Ownership Control, and Cross-Border M&As: Evidence from Nine East Asian EconomiesCORPORATE GOVERNANCE, Issue 6 2009Yenn-Ru Chen ABSTRACT Manuscript Type: Empirical Research Question/Issue: This study distinguishes between the effects of financial constraint determinants on cross-border mergers and acquisitions (M&As) and domestic M&As for all takeover bids announced in nine East Asian economies from 1998 to 2005. Research Findings/Insights: The results of logistic regressions verify that the extent of stock market and governance developments improves corporate financing conditions and subsequently encourages cross-border M&As in East Asia. The results also indicate that, except for ownership control variables, the firm-specific factors of financing constraints reduce the occurrence of cross-border M&As relative to domestic M&As. Although family- and state-controlled firms have better access to external financing, they are reluctant to risk diluting their management control and thus prefer domestic M&As to cross-border deals. Theoretical/Academic Implications: This study enhances the empirical studies of the relation between financing constraints and corporate investments based on the market imperfection hypothesis of corporate finance theories. In addition, this study also addresses the interaction between the market imperfection hypothesis and agency theory in explaining the effects of special ownership control on cross-border M&As relative to domestic deals. Furthermore, by examining the research questions across nine East Asian economies, this study provides an understanding of how such a relation applies to firms in countries where information asymmetry is high. Practitioner/Policy Implications: The findings indicate the importance of corporate governance and verify the effects of unique organizational structures on major corporate decisions. Specifically, family-controlled firms are often free of the financing constraints inherent in investment decisions. Thus, it is necessary to consider such organizational uniqueness when explaining the financing behavior of cross-border M&As conducted by Asian firms. [source] Ownership and Incentives in Joint Forest Management: A SurveyDEVELOPMENT POLICY REVIEW, Issue 1 2005Tuukka Castrén The relationship between the state and communities has been an overriding issue in the development of forestry institutions globally. In many countries, the trend is for communities to become co-managers of public forests. Meanwhile, in development co-operation both poverty and multiple rural livelihoods have received increased attention. In this article, the potential of joint community-state management of forests is discussed. Forest production has several characteristics that make it suitable for joint management where both parties benefit. Involving communities in management decreases the state's monitoring costs, while communities benefit from better access to market information. For this to take place, however, the state forest apparatus needs to be free from undue rent-seeking. The most advantageous solutions are case- and context-specific. [source] Local host ant specificity of Phengaris (Maculinea) teleius butterfly, an obligatory social parasite of Myrmica antsECOLOGICAL ENTOMOLOGY, Issue 5 2010MAGDALENA WITEK 1. Phengaris butterflies are obligatory social parasites of Myrmica ants. Early research suggested that there is a different Myrmica host species for each of the five European Phengaris social parasites, but more recent studies have shown that this was an oversimplification. 2. The pattern of host ant specificity within a Phengaris teleius metapopulation from southern Poland is reported. A combination of studying the frequency distribution of Phengaris occurrence and morphometrics on adult butterflies were used to test whether use of different host species is reflected in larval development. 3. Phengaris teleius larvae were found to survive in colonies of four Myrmica species: M. scabrinodis, M. rubra, M. ruginodis, and M. rugulosa. Myrmica scabrinodis was the most abundant species under the host plant but the percentage of infested nests was similar to other host ant species at two sites and lower in comparison to nests of M. rubra and M. ruginodis at the other two sites. Morphometric measurements of adult butterflies reared by wild colonies of M. scabrinodis and M. ruginodis showed that wing size and number of wing spots were slightly greater for adults eclosing from nests of M. ruginodis. 4. Our results suggest that P. teleius in the populations studied is less specialised than previously suggested. The results are consistent with the hypothesis that P. teleius is expected to be the least specific of the European Phengaris species, as it has the largest and best defended fourth-instar caterpillars and, as a predatory species, it spends less time in the central larval chambers of the host colonies. The fact that individuals reared by M. ruginodis had wider hind wings may suggest that P. teleius had better access to resources in M. ruginodis than in M. scabrinodis colonies. [source] The euro and the competitiveness of European firmsECONOMIC POLICY, Issue 57 2009Gianmarco I.P. Ottaviano SUMMARY EMU and competition Much attention has been paid to the impact of a single currency on actual trade volumes. Lower trade costs, however, matter over and beyond their effects on trade flows: as less productive firms are forced out of business by the tougher competitive conditions of international markets, economic integration fosters lower prices and higher average productivity. We assess the quantitative relevance of these effects calibrating a general equilibrium model using country, sector and firm-level empirical observations. The euro turns out to have increased the overall competitiveness of Eurozone firms, and the effects differ along interesting dimensions: they tend to be stronger for countries which are smaller or with better access to foreign markets, and for firms which specialize in sectors where international competition is fiercer and barriers to entry lower. , Gianmarco I.P. Ottaviano, Daria Taglioni and Filippo di Mauro [source] Determinants and effects of foreign direct investment: evidence from German firm-level data*ECONOMIC POLICY, Issue 41 2005Claudia M. Buch SUMMARY FDI Firm-level evidence Foreign direct investment is an essential aspect of ,globalization' yet its empirical determinants are not well understood. What we do know is based either on poor data for a wide range of nations, or good data for the US and Swedish cases. In this paper, we provide evidence on the determinants of the activities of German multinational firms by using a newly available firm-level data set from the Deutsche Bundesbank. The specific goal of this paper is to demonstrate the relative role of country-level and firm-level determinants of foreign direct investment. We focus on three main questions: First, what are the main driving forces of German firms' multinational activities? Second, is there evidence that sector-level and firm-level factors shape internationalization patterns? Third, is there evidence of agglomeration effects in the foreign activities of German firms? We find that the market access motive for internationalization dominates. Firms move abroad mainly to gain better access to large foreign markets. Cost-saving motives, however, are important for some manufacturing sectors. Our results strongly suggest that firm-level heterogeneity has an important influence on internationalization patterns , as stressed by recent models of international trade. We also find positive agglomeration effects for the activities of German firms that stem from the number of other German firms that are active on a given foreign market. In terms of lessons for economic policy, our results show that lowering barriers to the integration of markets and encouraging the formation of human capital can promote the activities of multinational firms. However, our results related to the heterogeneity of firms and agglomeration tendencies show that it might be difficult to fine-tune policies directed at the exploitation of synergies and at the creation of clusters of foreign firms. , Claudia M. Buch, Jörn Kleinert, Alexander Lipponer and Farid Toubal [source] Public Provision for Urban Water: Getting Prices and Governance RightGOVERNANCE, Issue 4 2008EDUARDO ARARAL Public sector monopolies are often associated with inefficiencies and inability to meet rising demand. Scholars attribute this to fundamental problems associated with public provision: (1) a tradition of below-cost pricing due to populist pressures, (2) owner,regulator conflicts of interest, and (3) perverse organizational incentives arising from non-credible threat of bankruptcy, weak competition, rigidities, and agency and performance measurement problems. Many governments worldwide have shifted to private provision, but recent experience in urban water utilities in developing countries has shown their limitations because of weak regulatory regimes compounded by inherent problems of information, incentives, and commitment. This article examines the paradoxical case of the Phnom Penh Water Supply in Cambodia to illustrate how public provision of urban water can be substantially improved by getting prices and governance right. Findings have implications for the search for solutions to provide one billion people worldwide with better access to potable water. [source] The information needs of doctors-in-training: case study from the Cairns Library, University of OxfordHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 3 2000Maureen Forrest The objective of this study was to find out more about the information needs of doctors-in-training and to identify their preferred sources of information. The methodology included interviews with consultants and administrators, a focus group discussion with library staff and a postal questionnaire sent to 347 doctors-in-training (there was a 43% return). The shortcomings of a questionnaire primarily composed of closed questions were addressed by the inclusion of one-to-one interviews which offered the opportunity for more in-depth commentary on specific issues highlighted in the questionnaire. Results indicated the frequency with which various types of information sources were consulted and how this related to the ,ease of access' of each information source. There was also the opportunity to comment on future information needs. It was clear from the interviews as well as comments made on the questionnaire that the two most important requirements for doctors-in-training were ,more time to find and obtain information' and ,better access to information sources when and where they are needed'. The results, although not surprising, included specific suggestions that have been used for the strategic planning of the library service to deliver the best possible support to users within the current framework of evidence-based medicine. [source] Prevention of mother to child transmission of HIV infection in Pacific countriesINTERNAL MEDICINE JOURNAL, Issue 4 2007P. Rupali Abstract Introduction: A generalized epidemic of HIV infection has been evolving in Papua New Guinea over the last decade, whereas in other Pacific Island countries and territories (PICT) HIV transmission has generally been less widespread. Programmes to detect HIV infection in pregnant women and to prevent mother to child transmission (MTCT) during either delivery or breast-feeding can decrease the incidence of infection in infants. The limited health infrastructure present in some PICT may delay the implementation of effective programmes to decrease MTCT of HIV. Methods: We used a standardized questionnaire to survey health-care providers in 22 PICT for information on the epidemiology of HIV infection and strategies used during 2004 to prevent MTCT of HIV infection in their country. We supplemented these survey responses with data obtained from regional organizations supporting national responses to HIV. Results: We obtained responses from 21 PICT. The reported prevalence of known HIV infection was >150 per 100 000 persons in Papua New Guinea, approximately 100 per 100 000 persons in French Polynesia, Guam, New Caledonia and Tuvalu and <50 per 100 000 persons in the remaining 14 PICT. Other than in Papua New Guinea, where an estimated 500 pregnant women had HIV infection diagnosed in 2004, reported HIV infection among pregnant women was rare. Ten PICT reported that an HIV antibody test was offered as a routine component of antenatal care and 11 reported that antiretroviral medications were available for the prevention of MTCT of HIV infection. Conclusion: The prevalence of HIV infection differs greatly between PICT with a varying risk of MTCT of HIV infection. Successful prevention of MTCT of HIV infection throughout the PICT will require improved uptake of antenatal HIV antibody testing and better access to antiretroviral medications. [source] Use of a molar clamp to isolate two adjacent single-rooted teeth: a clinical aidINTERNATIONAL ENDODONTIC JOURNAL, Issue 7 2004K. L. Chen Abstract Aim, To emphasize the importance of rubber dam isolation in root canal treatment and to present a technique to simultaneously isolate two single-rooted teeth using a molar clamp. Summary, Isolation of two adjacent teeth with inadequate tooth structure is a challenge. The split-dam technique or using two clamps have drawbacks. This report presents a technique to simultaneously isolate two adjacent single-rooted teeth that are difficult to isolate by conventional methods. Its advantages are efficiency, reduction of radiation exposure, better access, good visibility and isolation. Key learning points, ,,The basis of this technique is to isolate two teeth as two roots of a molar tooth. ,,The indications for this technique are two adjacent prepared crowns and crownless roots. ,,The appropriate molar clamp can be selected on the basis of the mesial,distal clamp jaw distance being equal to the mesial,distal spacing of the two roots. The buccal,lingual jaw distance of the clamp should be smaller than the dimension of the roots to provide adequate retention. [source] Integrated specialty mental health care among older minorities improves access but not outcomes: results of the PRISMe studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2008Patricia A. Areán Abstract Objective In this secondary data analysis of Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRIMSe) study, we hypothesized that older minorities who receive mental health services integrated in primary care settings would have greater service use and better mental health outcomes than older minorities referred to community services. Method We identified 2,022 (48% minorities) primary care patients 65 years and older, who met study inclusion criteria and had either alcohol misuse, depression, and/or anxiety. They were randomized to receive treatment for these disorders in the primary care clinic or to a brokerage case management model that linked patients to community-based services. Service use and clinical outcomes were collected at baseline, three months and six months post randomization on all participants. Results Access to and participation in mental health /substance abuse services was greater in the integrated model than in referral; there were no treatment by ethnicity effects. There were no treatment effects for any of the clinical outcomes; Whites and older minorities in both integrated and referral groups failed to show clinically significant improvement in symptoms and physical functioning at 6 months. Conclusions While providing services in primary care results in better access to and use of these services, accessing these services is not enough for assuring adequate clinical outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source] Age-related change in breeding performance in early life is associated with an increase in competence in the migratory barn swallow Hirundo rusticaJOURNAL OF ANIMAL ECOLOGY, Issue 5 2007JAVIER BALBONTÍN Summary 1We investigated age-related changes in two reproductive traits (laying date and annual fecundity) in barn swallows Hirundo rustica L. using a mixed model approach to di-stinguish among between- and within-individual changes in breeding performance with age. 2We tested predictions of age-related improvements of competence (i.e. constraint hypothesis) and age-related progressive disappearance of poor-quality breeders (i.e. selection hypothesis) to explain age-related increase in breeding performance in early life. 3Reproductive success increased in early life, reaching a plateau at middle age (e.g. at 3 years of age) and decreasing at older age (> 4 years). Age-related changes in breeding success were due mainly to an effect of female age. 4Age of both female and male affected timing of reproduction. Final linear mixed effect models (LME) for laying date included main and quadratic terms for female and male age, suggesting a deterioration in reproductive performance at older age for both males and females. 5We found evidence supporting the constraints hypothesis that increases in competence within individuals, with ageing being the most probable cause of the observed increase in breeding performance with age in early life. Two mechanisms were implicated: (1) advance in male arrival date with age provided middle-aged males with better access to mates. Yearling males arrived later to the breeding grounds and therefore had limited access to high-quality mates. (2) Breeding pairs maintaining bonds for 2 consecutive years (experienced pairs) had higher fecundity than newly formed inexperienced breeding pairs. 6There was no support for the selection hypothesis because breeding performance was not correlated with life span. 7We found a within-individual deterioration in breeding and migratory performance (arrival date) in the oldest age-classes consistent with senescence in these reproductive and migratory traits. [source] The stratification theory for plant coexistence promoted by one-sided competitionJOURNAL OF ECOLOGY, Issue 3 2009Takashi Kohyama Summary 1It is an essential feature of plants that leaves at higher levels have better access to light than those at lower levels. Thus, larger plants generally enjoy greater success in competing for light than smaller ones. We analyse the effect of such size-asymmetry, or one-sided competition, on the successful coexistence of plant species, using an analytically tractable model for stratified populations, in which a plant in the same layer exhibits the same crowding effect as any other, irrespective of species. 2A two-layer population that is reproductive in upper layer and juvenile in lower layer has a uniquely stable (plant-size-weighted) equilibrium density, as long as its fecundity is sufficient to compensate for its mortality rate. We also calculate a unique threshold lower-layer density of this layered population when there is no upper-layer plant. This threshold lower-layer density is larger than the weighted equilibrium density with upper layer, except for the case of perfect two-sided competition. 3A two-layer species can stably coexist with a one-layer, understorey species as a result of one-sided, but not two-sided competition. The coexistence condition is that the equilibrium density of the one-layer species lies between the threshold lower-layer density and the equilibrium density of the two-layer species. For an understorey species to coexist successfully with a two-layer species, any advantage in demographic performance, most prominently in a sufficiently high fecundity per plant must offset the disadvantage of living in dark conditions. 4Results from a model of multi-layer populations suggest that several species differing in terms of maximum layer and fecundity can coexist under conditions of one-sided competition. We demonstrate an example of the stable coexistence of eight species. The inter-specific trade-offs predicted by the model correspond to patterns observed in a rain forest. 5Synthesis. We propose a stratification theory that explains the generation and maintenance of the successful coexistence of plant species. Under the condition of one-sided competition, a canopy population that takes advantage of escaping from understorey competition shows an ability to invade an understorey with a density higher than its own equilibrium density, and which offers opportunities for an understorey population with high fecundity and/or shade tolerance to coexist. The predicted coexistence of species that share maximum canopy height is most pronounced for trees of tropical rain forests. [source] Gender, social capital and information exchange in rural UgandaJOURNAL OF INTERNATIONAL DEVELOPMENT, Issue 1 2008Enid Katungi Abstract Changing agricultural research and extension systems mean that informal mechanisms of information diffusion are often the primary source of information about improved seed and practices for farmers in sub-Saharan Africa. This paper investigates the interactions between gender, social capital and information exchange in rural Uganda. Within the framework of farmer-to-farmer models, we conceptualise the informal information diffusion process to comprise social capital accumulation and information exchange. We assume that each agent participates in information exchange with a fixed (predetermined) level of social capital and examine how endowments of social capital influence information exchange, paying close attention to gender differences. A multinomial logit model is used to analyse multiple participation choices of information exchange facing the farmer. Findings demonstrate that social capital is an important factor in information exchange, with men generally having better access to social capital than women. We also find strong evidence in support of group-based technology dissemination systems. Copyright © 2008 John Wiley & Sons, Ltd. [source] The Development of Advanced Nursing Practice GloballyJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2008Barbara Sheer Purpose: To examine the development of advanced nursing practice globally. Methods: Data were collected from documentary resources available in the International Nurse Practitioners/Advanced Practice Nurse Network (INP/APNN) of the International Council of Nurses. The areas examined were guided by the "key informant survey on advanced nursing practice self-administered questionnaire." Two core members of the INP/APNN who have rich experience in global advanced nursing development analyzed the data. A total of 14 countries and three regions from five continents were included in the analyses. The development of advanced nursing practice in these areas is facilitated by a need for better access to care in a cost-containment era and the enhancement of nursing education to postgraduate level. The mechanism for regulation of practice is in place in some countries. Conclusions: Confirms the development of advanced practice in nursing is a global trend. Clinical Relevance: APNs can improve global health with points to enhanced education in nursing and regulation of advanced practice. [source] Temporal changes of resource use, soil fertility and economic situation in upland Northwest VietnamLAND DEGRADATION AND DEVELOPMENT, Issue 1 2002A. Wezel Abstract Agricultural land in lowland Vietnam is scarce due to population growth. Hence, cultivation is increasingly practised on the steep upland slopes. Factors affecting resource use, soil fertility and household economics were studied in six villages of the Black Thai ethnic group in northwest Vietnam. Farmers were interviewed about their individual household situation. Yield development of major crops and cropping patterns in upland cultivation over the last 50 years were recorded in group discussions. In addition, soil fertility was analysed on different land-use units. Formerly predominant upland rice changed to maize and cassava production at present. Decreasing soil fertility and a shift from subsistence to market-oriented production, facilitated by new maize varieties and better access to markets are major causes. The Black Thai farmers economy has improved in recent years. The decline in soil fertility is concealed by higher maize yields from new varieties, and soil fertility conservation ranks low among farmers' priorities. The improved economy of the individual households might be of short duration if farmers cannot be sensitized to new resource management options. These have to be developed in line with farmers' priorities and the fragile environment of Vietnam's uplands. Copyright © 2002 John Wiley & Sons, Ltd. [source] Impact of irrigation on malaria in Africa: paddies paradoxMEDICAL AND VETERINARY ENTOMOLOGY, Issue 1 2001J. N. Ijumba Summary The high population growth rate of the African continent has led to an increased demand for food and is in danger of outstripping agricultural production. In order to meet this need, many governments have sought ways of improving food production by initiating large-scale irrigation projects, involving reclamation of arid and semi-arid areas for the cultivation of crops. Although crop irrigation promises one solution to alleviating hunger and encourages economic growth, irrigation has often been blamed for aggravating disease in local communities. Malaria is one of the major tropical diseases associated with irrigation schemes, and changes in the transmission pattern of this disease following irrigation development have been a perennial subject of debate. It has often been assumed that high numbers of malaria vector Anopheles mosquitoes (Diptera: Culicidae) resulting from irrigation schemes lead inevitably to increased malaria in local communities. However, recent studies in Africa have revealed a more complex picture. Increased numbers of vectors following irrigation can lead to increased malaria in areas of unstable transmission, where people have little or no immunity to malaria parasites, such as the African highlands and desert fringes. But for most of sub-Saharan Africa, where malaria is stable, the introduction of crop irrigation has little impact on malaria transmission. Indeed, there is growing evidence that for many sites there is less malaria in irrigated communities than surrounding areas. The explanation for this finding is still unresolved but, in some cases at least, can be attributed to displacement of the most endophilic and anthropophilic malaria vector Anopheles funestus Giles by An. arabiensis Patton with lower vectorial capacity, as the latter thrives more than the former in ricefields. Similarly, among members of the An. gambiae complex, some cytotypes of An. gambiae sensu stricto are more vectorial than others. For example, the Mopti form has high vectorial capacity and breeds perennially in irrigated sites, whereas the savanna form is often sympatric but more seasonal. Also we suggest that many communities near irrigation schemes benefit from the greater wealth created by these schemes. Consequently irrigation communities often have greater use of bednets, better access to improved healthcare and receive fewer infective bites compared with those outside such development schemes. Thus, in most cases, irrigation schemes in Africa do not appear to increase malaria risk, except in areas of unstable transmission. However, developers should take the opportunity to improve health-care facilities for local communities when planning irrigation schemes wherever they occur. [source] Ritualized combat as an indicator of intrasexual selection effects on male life history evolutionAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2010Brent M. Graves Trade-offs between survival, growth, current reproduction, and future reproduction influence life history evolution, leading to adaptive timing of investment in various strategies. If engagement in costly intrasexual contests to gain better access to mates is an important form of male reproductive investment, then the expression of characters that promote success in this process should be influenced by their fitness effects across the lifespan. To test this prediction, the ages at which human (Homo sapiens) males exhibit the greatest investment in morphological, behavioral, and physiological characters associated with intrasexual competition was estimated by examining the ages at which males succeed in a form of ritualized combat. The average age of international boxing champions was in the latter half of the twenties, and titles were held for about 2 years on average. Thus, peak investment in traits that enhance intrasexual competition abilities appears to coincide with ages at which males have highest reproductive success. Additionally, larger males reached peak probability of success in this ritualized combat at ages about 2.6 years greater than smaller males. Because body size is highly heritable and there is strong positive assortative mating relative to this character among humans, this may indicate a polymorphic set of reproductive strategies produced through maintenance of coadapted gene complexes. Am. J. Hum. Biol., 2010. © 2009 Wiley-Liss, Inc. [source] Credit Availability and the Structure of the Homebuilding IndustryREAL ESTATE ECONOMICS, Issue 4 2008Brent W. Ambrose We investigate the role of disruptions to the structure of the homebuilding industry due to fluctuations in the availability of bank credit. We find a sustained decline in the large private homebuilder market share series over the period from 1988 to 1993 when many banks with deteriorated health reduced their lending in order to raise capital ratios. Regression analysis at the metropolitan statistical area level supports the hypothesis that, in areas where banks were less well capitalized and had more problem construction loans, the market shares of large private homebuilders that relied primarily on bank credit to finance their production suffered at the expense of the public homebuilders that had better access to external funds, in large part due to their direct access to public capital markets. [source] Corporate Financial Policy and the Value of CashTHE JOURNAL OF FINANCE, Issue 4 2006MICHAEL FAULKENDER ABSTRACT We examine the cross-sectional variation in the marginal value of corporate cash holdings that arises from differences in corporate financial policy. We begin by providing semi-quantitative predictions for the value of an extra dollar of cash depending upon the likely use of that dollar, and derive a set of intuitive hypotheses to test empirically. By examining the variation in excess stock returns over the fiscal year, we find that the marginal value of cash declines with larger cash holdings, higher leverage, better access to capital markets, and as firms choose greater cash distribution via dividends rather than repurchases. [source] Development and characterization of a synthetic promoter for selective expression in proliferating endothelial cellsTHE JOURNAL OF GENE MEDICINE, Issue 4 2006P. Szymanski Abstract Background Systemic administration of non-viral gene therapy provides better access to tumors than local administration. Development of a promoter that restricts expression of cytotoxic proteins to the tumor vasculature will increase the safety of the system by minimizing expression in the non-dividing endothelial cells of the vasculature of non-target tissues. Methods Cell cycle promoters were tested for selective expression in dividing cells vs. non-dividing cells in vitro and promoter strength was compared to the cytomegalovirus (CMV) promoter. Successful promoter candidates were tested in vivo using two proliferating endothelium mouse models. Ovarectomized mice were injected with estradiol prior to lipoplex administration and expression levels were measured in the lungs and uterus 4 days after administration. The second model was a subcutaneous tumor model and expression levels were measured in the lungs and tumors. For both animal models, expression levels from the proliferating endothelium promoter were compared to that obtained from a CMV promoter. Results The results showed that the Cdc6 promoter yielded higher expression in proliferating vs. non-proliferating cells. Secondly, promoter strength could be selectively increased in endothelial cells by the addition of a multimerized endothelin enhancer (ET) to the Cdc6 promoter. Thirdly, comparison of expression levels in the lungs vs. uterus in the ovarectomized mouse model and lungs vs. tumor in the mouse tumor model showed expression was much higher in the uterus and the tumor than in the lungs for the ET/Cdc6 promoter, and expression levels were comparable to that of the CMV promoter in the hypervascularized tissues. Conclusions These results demonstrate that the combination of the endothelin enhancer with the Cdc6 promoter yields selective expression in proliferating endothelium and can be used to express cytotoxic proteins to treat vascularized tumors. Copyright © 2006 John Wiley & Sons, Ltd. [source] Fishing for a Living but Catching HIV: AIDS and Changing Patterns of the Organization of Work in Fisheries in UgandaANTHROPOLOGY OF WORK REVIEW, Issue 2 2009Janet Seeley Abstract Over the last decade evidence has emerged suggesting that fisherfolk, as an occupational group, are at greater risk to human immunodeficiency virus (HIV) than other groups in many countries, including Uganda. In this paper we argue that the organization of work in fisheries on Lake Victoria, both now and in the past, encourages patterns of sexual behavior among men and women involved in fishing, trading, and servicing the industry which over the last 20 years has promoted the spread of the HIV among those working in fisheries. We use a case study of a family, Kiwanuka's, to illustrate how patterns of behavior practiced in the past (by Kiwanuka) have much more disastrous consequences now (for his children) because of the existence of HIV. Kiwanuka was a fisherman on Lake Victoria during the 1960s. During that time fish were plentiful and he earned enough to purchase land and establish himself as a coffee farmer. Two of his sons are currently employed as daily laborers at the lake. They complain of poor fish catches and their inability to make money. One daughter, who is HIV-positive, is a dried fish trader. This family's experience illustrates the far-reaching effects of economic and health conditions generated by the fishing industry on distant rural areas and across generations. Rising HIV rates are severely affecting fishers and related occupations already hit by falling fish stocks. The findings show how the same patterns of sexual behavior and wealth generation practiced by the older generation in their youth now represent a deadly risk to their children, a population in urgent need of better access to treatment, prevention, and care. [source] Corticosteroid phobia and other confounders in the treatment of childhood atopic dermatitis explored using parent focus groupsAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2010Saxon D Smith ABSTRACT Background/Objectives:, Anxieties associated with corticosteroid treatment and preference for ,safer natural therapy' are common in parents of children with atopic dermatitis. We used focus groups to explore the source of these attitudes. Methods:, The study involved 16 parents. Parents expressed difficulties with living with and treating atopic dermatitis which were categorized into themes using qualitative data analysis software. Results:, Themes identified include: emotional impact of atopic dermatitis; difficulty in accepting ,control' verses ,cure'; topical corticosteroid negative perceptions; anxiety and confusion with treatment; preference for ,natural' therapy; and attitude-changing positive experiences. Conclusions:, Our findings illustrate the emotional impact of atopic dermatitis and the frustration with the lack of potential cure. ,Corticosteroid phobia' was universal among parents in our cohort and is a fear generated by doctors, pharmacists, close acquaintances and information from the internet. Participants expressed high levels of parental guilt linked to a desire for an eradicable ,cause' for atopic dermatitis, despite intellectually understanding this is a genetically determined condition. Parents were willing to change attitudes with accurate information from perceived reliable sources, positive hospitalization experiences and a relationship with a trusted dermatologist. Parents' suggestions to improve confidence included the provision of readily available information and better access to doctor- and nurse-led paediatric dermatology services. [source] Use of ,dual protection' and other combinations of contraceptive methods in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2007Nick Parr Abstract Objective: To examine the demographic profiles of contraceptive users in Australia, paying particular attention to the use of condoms with other methods. Method: Data from a specific section on contraceptive use in the 2005 Wave 5 of the nationwide, longitudinal Household Income and Labour Dynamics in Australia (HILDA) were analysed. The section was restricted to 2,221 women aged 18-44; women were excluded if they were pregnant or subfecund, or if they or their partner had been sterilised. Results: Two-thirds of respondents were using contraception, including more than 15% who indicated use of more than one method. The contraceptive pill (39%) was the most widely used method, followed by the condom (28%). Women using sex-related methods were more likely to be using more than one method. More than one-quarter of pill users (28%) were using condoms as well. The combination of pill and condom was significantly associated with age, being a student, and country of birth. Less than 3% of women reported using rhythm methods and of these two-thirds were using another method. Conclusions: Dual protection provided by the combination of the condom with the pill or other methods has become an important factor in the prevention of sexually transmitted infections and unwanted pregnancies, but continuing education on dual protection and better access to treatment is still necessary for both men and women, particularly among at-risk groups. [source] Access to dental care among adults with physical and intellectual disabilities: residence factorsAUSTRALIAN DENTAL JOURNAL, Issue 3 2009A Pradhan Abstract Background:, There is limited information about access and barriers to dental care among adults with disabilities. Methods:, A mailed questionnaire survey of carers of 18,44-year-old South Australians with physical and intellectual disabilities (care recipients; n = 485) in family homes, community housing and institutions. Bivariate associations were tested using chi-square tests. Odds ratios (ORs) and 95 per cent confidence intervals (CI) were estimated for irregular dental visits (IDV). Results:, Carers from family homes and community housing were more likely to report problems in obtaining dental care than those at institutions (p < 0.001). Lack of dentists with adequate skills in special needs dentistry (SND) was the most frequently reported problem for carers from family homes and community housing. IDV were less likely (p < 0.01) for care recipients in institutions and community housing than in family homes. After adjusting for care recipients' age, gender and disability, odds of IDV was lower in community housing (OR = 0.2, 95% CI = 0.1, 0.3) and in institutions (OR = 0.1, 95% CI = 0.04, 0.3) relative to family homes. Conclusions:, Care recipients in institutions and community housing had better access to dental care than those at family homes. The shortage of dentists in SND and treatment costs needs to be addressed. [source] Allergic reactions in the community: a questionnaire survey of members of the anaphylaxis campaignCLINICAL & EXPERIMENTAL ALLERGY, Issue 6 2005A. Uguz Summary Background Allergic reactions to food are well recognized in both children and adults, but because of their relative infrequency their typical features may not be readily recognized by patients and their medical care givers who are not allergists. Objective We sought to investigate the circumstances and clinical characteristics of food allergies in adults and children in the community. Methods Self-completed questionnaire responses over a 6-month period from 109 members of the Anaphylaxis Campaign, the major British patient resource group for people who have suffered severe allergic reactions. Results One hundred and nine respondents reported 126 reactions during the study period. Seventy-five were children (under 16 years, median age 6 years at the time of reaction). Predictably more boys than girls were reported to have had reactions but more women reported reactions than men (P<0.05). Although the groups were equally aware of their food allergies the children had undergone diagnostic tests more often (P<0.001). Foods were implicated in 112 (89%) of reports. Restaurants were implicated less often (14%) than in other series, probably reflecting British eating habits. Children with asthma reported more severe reactions than those without asthma (P=0.008), although frequency or severity of recent asthma symptoms was not associated with severity of allergic reaction reported. When available, self-injectable adrenaline was used in 35% of severe reactions and 13% of non-severe reactions (P=0.01). A quarter of adults who received one dose of adrenaline also received a second dose. Conclusion The allergens implicated in this report reflect previous data from similar patient groups in North America. Asthmatic children suffer more severe reactions than non-asthmatic children. It appears that British adults need better access to expert care of their allergies. Even when it is prescribed and available self-injectable adrenaline appears under-used in severe reactions. The incidence of severe but non-fatal allergic reactions in the UK may have been underestimated in the past. [source] Prospective community-based cluster census and case-control study of stillbirths and neonatal deaths in the West Bank and Gaza StripPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2008Henry D. Kalter Summary Obstetric complications and newborn illnesses amenable to basic medical interventions underlie most perinatal deaths. Yet, despite good access to maternal and newborn care in many transitional countries, perinatal mortality is often not monitored in these settings. The present study identified risk factors for perinatal death and the level and causes of stillbirths and neonatal deaths in the West Bank and Gaza Strip. Baseline and follow-up censuses with prospective monitoring of pregnant women and newborns from September 2001 to August 2002 were conducted in 83 randomly selected clusters of 300 households each. A total of 113 of 116 married women 15,49 years old with a stillbirth or neonatal death and 813 randomly selected women with a surviving neonate were interviewed, and obstetric and newborn care records of women with a stillbirth or neonatal death were abstracted. The perinatal and neonatal mortality rates, respectively, were 21.2 [95% confidence interval (CI) 16.5, 25.9] and 14.7 [95% CI 10.2, 19.2] per 1000 livebirths. The most common cause (27%) of 96 perinatal deaths was asphyxia alone (21) or with neonatal sepsis (5), while 18/49 (37%) early and 9/19 (47%) late neonatal deaths were from respiratory distress syndrome (12) or sepsis (9) alone or together (6). Constraint in care seeking, mainly by an Israeli checkpoint, occurred in 8% and 10%, respectively, of 112 pregnancies and labours and 31% of 16 neonates prior to perinatal or late neonatal death. Poor quality care for a complication associated with the death was identified among 40% and 20%, respectively, of 112 pregnancies and labour/deliveries and 43% of 68 neonates. (Correction added after online publication 5 June 2008: The denominators 112 pregnancies, labours, and labour/deliveries, and 16 and 68 neonates were included; and 9% of labours was corrected to 10%.) Risk factors for perinatal death as assessed by multivariable logistic regression included preterm delivery (odds ratio [OR] = 11.9, [95% CI 6.7, 21.2]), antepartum haemorrhage (OR = 5.6, [95% CI 1.5, 20.9]), any severe pregnancy complication (OR = 3.4, [95% CI 1.8, 6.6]), term delivery in a government hospital and having a labour and delivery complication (OR = 3.8, [95% CI 1.2, 12.0]), more than one delivery complication (OR = 4.4, [95% CI 1.8, 10.5]), mother's age >35 years (OR = 2.9, [95% CI 1.3, 6.8]) and primiparity in a full-term pregnancy (OR = 2.6, [1.1, 6.3]). Stillbirths are not officially reportable in the West Bank and Gaza Strip and this is the first time that perinatal mortality has been examined. Interventions to lower stillbirths and neonatal deaths should focus on improving the quality of medical care for important obstetric complications and newborn illnesses. Other transitional countries can draw lessons for their health care systems from these findings. [source] Outcomes Associated with Planned Home and Planned Hospital Births in Low-Risk Women Attended by Midwives in Ontario, Canada, 2003,2006: A Retrospective Cohort StudyBIRTH, Issue 3 2009Eileen K. Hutton PhD ABSTRACT: Background: Midwives in Ontario, Canada, provide care in the home and hospital and are required to submit data for all births to the Ontario Ministry of Health database. The purpose of this study was to compare maternal and perinatal/neonatal mortality and morbidity and intrapartum intervention rates for women attended by Ontario midwives who planned a home birth compared with similar low-risk women who planned a hospital birth between 2003 and 2006.Methods: The database provided outcomes for all women planning a home birth at the onset of labor (n = 6,692) and for a cohort, stratified by parity, of similar low-risk women planning a hospital birth.Results: The rate of perinatal and neonatal mortality was very low (1/1,000) for both groups, and no difference was shown between groups in perinatal and neonatal mortality or serious morbidity (2.4% vs 2.8%; relative risk [RR], 95% confidence intervals [CI]: 0.84 [0.68,1.03]). No maternal deaths were reported. All measures of serious maternal morbidity were lower in the planned home birth group as were rates for all interventions including cesarean section (5.2% vs 8.1%; RR [95% CI]: 0.64 [0.56, 0.73]). Nulliparas were less likely to deliver at home, and had higher rates of ambulance transport from home to hospital than multiparas planning home birth and had rates of intervention and outcomes similar to, or lower than, nulliparas planning hospital births.Conclusions: Midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulting in favorable outcomes for women planning both home or hospital births. [source] | |||||||||||||||||||