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March
Kinds of March Selected AbstractsABSTRACTS OF THE DUTCH SOCIETY OF CLINICAL PHARMACOLOGY AND BIOPHARMACY MEETING OF 30 MARCH 2007BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2008Article first published online: 30 JAN 200 First page of article [source] Recently Received Books (July 2003,March 2004)CONSERVATION BIOLOGY, Issue 4 2004Article first published online: 23 JUL 200 No abstract is available for this article. [source] Cr(III) reactivity and foot dermatitis in Cr(VI) positive patientsCONTACT DERMATITIS, Issue 3 2006Malene Barré Hansen Chromium allergy has become synonymous with Cr(VI) allergy. However, real exposure to chromium from leather products may include both Cr(III) and Cr(VI). In this study, we investigate the reactivity to both Cr(VI) and Cr(III) in consecutive patients to analyse the relation between foot eczema/leather exposure and reactivity to Cr(III). From March 2002 to December 2004, 2211 consecutive patients with suspected allergic contact dermatitis were patch tested with 0.5% potassium dichromate (Cr(VI)) and 13% chromium trichloride (Cr(III)). A total of 71 (3.2%) patients had a positive reaction to Cr(VI), of which 31 also had a positive Cr(III) reaction. No Cr(VI) negative patients had a positive reaction to Cr(III). An increased risk of foot dermatitis was found in Cr(VI) positive patients with a concomitant positive or doubtful reaction to Cr(III) compared with Cr(VI) positive patients with no reactions to Cr(III). The increased risk was not due to a higher degree of sensitivity to Cr(VI). Leather was reported most frequently as the suspected cause of chromium dermatitis (54%). However, Cr(VI) allergics having foot eczema and positive or doubtful Cr(III) reactions often had positive reactions to other shoe allergens. Thus, Cr(III) allergy is part of a multiple shoe allergy pattern. [source] WAL-MART AND BANKS: SHOULD THE TWAIN MEET?CONTEMPORARY ECONOMIC POLICY, Issue 4 2009A PRINCIPLES-BASED APPROACH TO THE ISSUES OF THE SEPARATION OF BANKING AND COMMERCE The application in July 2005 by Wal-Mart to obtain a specialized bank charter from the state of Utah and to obtain federal deposit insurance reopened a national debate concerning the separation of banking and commerce. Though Wal-Mart withdrew its application in March 2007, the issue and the debate continue. This article offers a principles-based approach to this issue that begins with the recognition that banks are special and that safety and soundness regulation of banks is therefore warranted. Building on that recognition, the article lays out the principle that the "examinability and supervisability" of an activity should determine if that activity should be undertaken by a bank. Even if an otherwise legitimate activity is not suitable for a bank, it should be allowed for a bank's owners (whether the owners are individuals or a holding company), so long as the financial transactions between the bank and its owners are closely monitored by bank regulators. The implications of this set of ideas for the Wal-Mart case and for banking and commerce generally are then discussed. (JEL G21, G28) [source] Board Structure, Process and Performance: evidence from public-listed companies in SingaporeCORPORATE GOVERNANCE, Issue 2 2005David Wan Past literature in board research has centred on board structure and company performance. Over the years, empirical studies do not reveal a conclusive relationship between these two variables (Dalton and Daily, 1999. Across the Board, March, 28,32). Until recently, the literature on board processes has been sparse. The reason for insufficient empirical work on board processes possibly is due to the difficulty of gaining access to boards. In this paper, we propose a conceptual model and tested the model on publicly listed companies in Singapore. Based on a sample of 212 company responses and 299 directors, we conclude that board structure does not affect board process while board process is related to board performance. In terms of individual parameters, effort norms, cognitive conflict and the presence and usage of skills are positively related to board roles and board transparency. Also, affective and process conflicts are negatively related to board roles and board transparency. Finally, board process does not mediate the relationship between board structure and board performance. [source] The Disclosure of UK Boardroom Pay: the March 2001 DTI proposalsCORPORATE GOVERNANCE, Issue 4 2001Martin J. Conyon In March 2001 the government announced that new disclosure rules relating to UK boardroom pay would be introduced. This paper critically evaluates these proposals. The new proposals emerged from the government's Directors Remuneration consultative document issued in July 1999. The current paper makes the following contributions to the governance literature. First, the new disclosure proposals are reviewed. I suggest that they are incomplete both in their detail and scope. I also suggest that the government has conceded that more US style executive compensation disclosure is required. Second, I describe US executive compensation disclosure practices. If convergence in disclosure practice is potentially desirable then a more systematic comparison and analysis of current disclosure policies in the two economies is warranted. [source] Prevalence and correlates of traumatic brain injury among delinquent youthsCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2008Brian E. Perron Background,Delinquent youth frequently exhibit high-risk behaviours that can result in serious injury. However, little is known about traumatic brain injuries (TBIs) and their correlates in this population. Aims,To examine the period prevalence and correlates of TBIs in delinquent youths. Method,Interviews were conducted with 720 (97.3%) residents of 27 Missouri Division of Youth Services rehabilitation facilities between March 1 and May 31, 2003. Participants [mean age (Mage) = 15.5, standard deviation (SD) = 1.2, 87% male] completed measures assessing TBI, substance use, psychiatric symptoms, and antisocial traits/behaviours. TBI was defined as ever having sustained a head injury causing unconsciousness for more than 20 minutes. Results,Nearly one-in-five youths (18.3%) reported a lifetime TBI. Youths with TBIs were significantly more likely than youths without to be male, have received a psychiatric diagnosis, report an earlier onset of criminal behaviour/substance use and more lifetime substance use problems and past-year criminal acts, evidence psychiatric symptoms, report lifetime suicidality, be impulsive, fearless, and external in locus of control and criminally victimized in the year preceding incarceration. Male gender and frequency of own criminal victimization were important predictors of TBI in multivariate analyses. Regression analyses adjusted for demographic factors, indicated that youths with TBIs were at significantly elevated risk for current depressive/anxious symptoms, antisocial behaviour, and substance abuse problems. Conclusions,TBI is common among delinquent youth and associated with wide ranging psychiatric dysfunction; however, the causal role of TBIs in the pathogenesis of co-morbid conditions remains unclear. Copyright © 2008 John Wiley & Sons, Ltd. [source] The validity of the Violence Risk Appraisal Guide (VRAG) in predicting criminal recidivismCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2007Carolin Kröner Introduction,The VRAG is an actuarial risk assessment instrument, developed in Canada as an aid to estimating the probability of reoffending by mentally ill offenders. Aim,To test the predictive validity of the VRAG with a German sample. Method,The predictive validity of the VRAG was tested on a sample of 136 people charged with a criminal offence and under evaluation for criminal responsibility in the forensic psychiatry department at the University of Munich in 1994,95. The predicted outcome was tested by means of ROC analysis for correlation with the observed rate of recidivism between discharge after the 1994,95 assessment and the census date of 31 March 2003. Recidivism rate was calculated from the official records of the National Conviction Registry. Results,Just over 38% of the sample had reoffended by 2003. Their mean time-at-risk was 58 months (SD 3.391; range 0,115 months). The VRAG yielded a high predictive accuracy in the ROC analysis with an AUC of 0.703. For a constant time-at-risk < = 7 years, the predicted probability and observed rates of recidivism correlated significantly with Pearson's r = 0.941. Conclusions,The validity of the VRAG was replicated with a German sample. The VRAG yielded good predictive accuracy, despite differences in sample and outcome variables compared with its original sample. Copyright © 2007 John Wiley & Sons, Ltd. [source] Teaching workshop on ,Implications of the Bologna Declaration for Teaching Physiology in Medical Education' at the joint meeting of the German Physiological Society and the Federation of European Physiological Societies, Cologne, 2,5 March 2008ACTA PHYSIOLOGICA, Issue 2 2008L. H. E. H. Snoeckx No abstract is available for this article. [source] Impact of National Aquarium in Baltimore on Visitors' Conservation Attitudes, Behavior, and KnowledgeCURATOR THE MUSEUM JOURNAL, Issue 1 2000LESLIE M. ADELMAN ABSTRACT This study at the National Aquarium in Baltimore (NAIB) was conducted to assess four key aspects of the visitor experience: (1) incoming conservation knowledge, attitudes, and behavior of NAIB visitors; (2) patterns of use and interaction with exhibition components throughout the NAIB; (3) exiting conservation knowledge, attitudes, and behaviors of visitors; and (4) over time, how the NAIB experience altered or affected individuals' conservation knowledge, attitudes, and behaviors. Three hundred six visitors participated in the study, which was conducted from March through July, 1999. The study utilized four data-collection techniques: (1) face-to-face interviews, (2) Personal Meaning Mapping (PMM), (3) tracking, and (4) follow-up telephone interviews. Participants were a self-selected population and were generally more knowledgeable about, more concerned about, and more involved in conservation-related issues than the general public. However, they were far from conservationists. Visitors in this study clearly absorbed the fundamental conservation message at the NAIB. In fact, the NAIB visit appeared to focus visitors' conservation-related thoughts, while also broadening their understanding of conservation. Changes in visitors' conservation knowledge, understanding, and interests by and large persisted over six to eight weeks after visiting NAIB. The NAIB experience also connected to visitors' lives in a variety of ways following their visit. However, these personal experiences rarely resulted in new conservation actions. In fact, their enthusiasm and emotional commitment to conservation (inspired during the NAIB visit) generally fell back to original levels, presumably in the absence of reinforcing experiences. The findings of this study are guiding subsequent investigations at the NAIB. More generally, the results suggest strategies to enhance current understanding of the impact free-choice learning institutions have on their visiting public. [source] THE ALPINE HOUSES OF KEWCURTIS'S BOTANICAL MAGAZINE, Issue 1 2007Richard Wilford Summary There has been an alpine house at Kew since 1887. The first house was a traditional design that was in use for nearly a century. Subsequent alpine houses at Kew have been more radical in their design and helped raise the profile of Kew's alpine collections. The latest, the innovative Davies Alpine House, opened in March 2006. [source] Frequency of intrusive luxation in deciduous teeth and its effectsDENTAL TRAUMATOLOGY, Issue 4 2010Vivian Carvalho Second, to investigate the sequelae of total and partial intrusive luxation in the primary anterior teeth and in their successors and finally, to establish whether the sequelae on both deciduous and permanent teeth were related to the child's age at the time of the intrusion. Data collected from records of 169 boys and 138 girls, all between the ages of zero and 10 years, who were undergoing treatment during the period of March 1996 to December 2004. The sample was composed of 753 traumatized deciduous teeth, of which 221 presented intrusive luxation injury. Children with ages ranging from one to 4 years were the most affected with falls being the main cause of intrusion. Of all intruded teeth 128 (57.9%) were totally intruded and 93 (42.1%) partially. Pulp necrosis/premature loss and color change were the most frequent sequelae in both total and partial intrusions. Concerning permanent dentition, the most common disturbances were color change and/or enamel hypoplasia. Both types of intrusion caused eruption disturbance. Total intrusion was the most frequent type of intrusive luxation. There was no significant correlation between the child's age at the time of intrusion and the frequency of subsequent sequela on primary injured teeth (P = 0.035), between the age at the time of injury and the developmental disturbances on permanent teeth (P = 0.140). [source] Incidence of dental trauma associated with facial trauma in Brazil: a 1-year evaluationDENTAL TRAUMATOLOGY, Issue 1 2004Alessandro Costa Da Silva Abstract,,, Dental trauma occurs frequently in young people, and mostly occurs in conjunction with facial trauma. In the literature, there are still few reports relating dental trauma, facial trauma, and soft-tissue injuries. This research aimed to evaluate: (i) the overall incidence of dental trauma in 340 patients who presented with facial trauma over a 1-year-period, (ii) the epidemiology of these related diseases, and (iii) the most common dental trauma when a facial trauma was present. Of all facial trauma, 15.29% presented dental trauma, of which luxations and avulsions were the most frequent injuries (40.30% each), occurring mainly on weekends (38.46%) and in October (15.38%), followed by March and June (13.46% each). The sex ratio presented the proportion of 3.3:1 (M:F). Trauma occurred mainly in the second decade (44.23%). These results highlight the high incidence of dental and facial trauma, and suggest the importance of the adoption of appropriate prevention protocols and effective therapeutic methods. [source] Modified Single-Sling Myocutaneous Island Pedicle Flap: Series of 61 ReconstructionsDERMATOLOGIC SURGERY, Issue 11 2008ANDREA WILLEY MD BACKGROUND Bilevel undermining above and below the transverse nasalis muscle in the construction of a myocutaneous island pedicle flap produces a bilateral or unilateral muscular sling with exceptional vascular supply for reconstruction of defects on the distal nose. We present further modification of the single-sling myocutaneous island pedicle flap that expands its application to a wide variety of nasal defects and further defines its usefulness in nasal reconstruction. METHODS A series of 61 consecutive myocutaneous island pedicle flap reconstructions performed after Mohs surgery between March 2005 and July 2006 are presented. Flap modifications are presented, and advantages and limitations are discussed. RESULTS Flap modifications introduce additional reach and rotational mobility to the flap that permit extension of the flap to defects on the nasal tip and distal ala. CONCLUSION Modifications of the bilevel approach to the single-sling nasalis myocutaneous island pedicle flap further define its practicality in nasal reconstruction and expand its application to a variety of nasal defects. [source] Adverse Event Reporting: Lessons Learned from 4 Years of Florida Office DataDERMATOLOGIC SURGERY, Issue 9 2005Brett Coldiron MD, FACP Background Patient safety regulations and medical error reporting systems have been at the forefront of current health care legislature. In 2000, Florida mandated that all physicians report, to a central collecting agency, all adverse events occurring in an office setting. Purpose To analyze the scope and incidence of adverse events and deaths resulting from office surgical procedures in Florida from 2000 to 2004. Methods We reviewed all reported adverse incidents (the death of a patient, serious injury, and subsequent hospital transfer) occurring in an office setting from March 1, 2000, through March 1, 2004, from the Florida Agency for Health Care Administration. We determined physician board certification status, hospital privileges, and office accreditation via telephone follow-up and Internet searches. Results Of 286 reported office adverse events, 77 occurred in association with an office surgical procedure (19 deaths and 58 hospital transfers). There were seven complications and five deaths associated with the use of intravenous sedation or general anesthesia. There were no adverse events associated with the use of dilute local (tumescent) anesthesia. Liposuction and/or abdominoplasty under general anesthesia or intravenous sedation were the most common surgical procedures associated with a death or complication. Fifty-three percent of offices reporting an adverse incident were accredited by the Joint Commission on Accreditation of Healthcare Organizations, American Association for Accreditation of Ambulatory Surgical Facilities, or American Association for Ambulatory Health Care. Ninety-four percent of the involved physicians were board certified, and 97% had hospital privileges. Forty-two percent of the reported deaths were delayed by several hours to weeks after uneventful discharge or after hospital transfer. Conclusions Requiring physician board certification, physician hospital privileges, or office accreditation is not likely to reduce office adverse events. Restrictions on dilute local (tumescent) anesthesia for liposuction would not reduce adverse events and could increase adverse events if patients are shifted to riskier approaches. State and/or national legislation establishing adverse event reporting systems should be supported and should require the reporting of delayed deaths. [source] Patient Injuries from Surgical Procedures Performed in Medical Offices: Three Years of Florida DataDERMATOLOGIC SURGERY, Issue 12p1 2004Brett Coldiron MD, FACP Background. Many state medical boards and legislatures are in the process of developing regulations that restrict procedures in the office setting with the intention of enhancing patient safety. The highest quality data in existence on office procedure adverse incidents have been collected by the state of Florida. Objective. The objective was to determine and analyze the nature of surgical incidents in office-based settings using 3 years of Florida data from March 2000 to March 2003. Methods. An incidence study with prospective data collection was performed. Individual reports that resulted in death or a hospital transfer were further investigated by determining the reporting physician's board certification status, hospital privilege status (excluding procedure specific operating room privileges), and office accreditation status. Results. In 3 years there were 13 procedure-related deaths and 43 procedure-related complications that resulted in a hospital transfer. Seven of the 13 deaths involved elective cosmetic procedures, 5 of which were performed under general anesthesia and 2 of which were performed with intravenous sedation anesthesia. Forty-two percent of the offices reporting deaths and 50% of the offices reporting procedural incidents that resulted in a hospital transfer were accredited by an independent accreditation agency. Ninety-six percent of physicians reporting surgical incidents were board-certified, and all had hospital privileges. Conclusions. Restrictions on office procedures for medically necessary procedures, such as requiring office accreditation, board certification, and hospital privileges, would have little effect on overall safety of surgical procedures. These data also show that the greatest danger to patients lies not with surgical procedures in office-based settings per se, but with cosmetic procedures that are performed in office-based settings, particularly when under general anesthesia. Our conclusions are dramatically different from those of a recent study, which claimed a 12-fold increased risk of death for procedures in the office setting. [source] Beijing Plus Ten: An Ambivalent Record on Gender JusticeDEVELOPMENT AND CHANGE, Issue 6 2005Maxine Molyneux The 1995 Fourth World Conference on Women (the ,Beijing Conference') was a landmark in policy terms, setting a global policy framework to advance gender equality. Ten years after Beijing, in March 2005, the UN's Commission on the Status of Women presided over an intergovernmental meeting in New York to review the progress achieved on the commitments made in the Beijing Declaration and Platform for Action. This ,Plus 10' event was decidedly low key. Its aim was not agenda setting but agenda confirming; not policy formulation but policy affirmation. Whether it proves to be part of an ongoing worldwide movement in support of gender equality, or whether it marks the decline of that process, is a question that many in international women's movements are asking. This article, drawing on research undertaken for the UNRISD report, Gender Equality: Striving for Justice in an Unequal World, reflects on the ambivalent record of progress achieved by women over the last decades and considers how the policy environment has changed over the period since the high point of global women's movements. It examines how the changing international policy and political climate over this period has given rise to new issues and challenges for those active in global women's movements. [source] The Diagnosis and Prediction of Bank Failures in Zambia, 1990,98DEVELOPMENT POLICY REVIEW, Issue 3 2002Samuel Munzele Maimbo This article presents a non-econometric, yet practical approach for regulators in developing countries. With limited financial resources to determine the ,safety and soundness' of a large number of financial institutuions, regulatory authorities are appreciative of any kind of mechanism that can identify banks that are in financial difficulties. The Zambian case is interesting, in that the bank failures of 1995 and 1997/8 brought into question the ability of the central bank to diagnose the financial condition of banks. This article evaluates the Bank of Zambia's experience over the period 1990 to March 1998 and makes recommendations on how to improve diagnosis and prediction of bank failures by incorporating non-financial factors into the analysis of bank performance. [source] Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic reviewACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2007S. Weinmann Objective:, To identify evidence from comparative studies on the effects of psychiatric guideline implementation on provider performance and patient outcome. Effects of different implementation strategies were reviewed. Method:, Articles published between 1966 and March 2006 were searched through electronic databases and hand search. A systematic review of comparative studies of structured implementation of specific psychiatric guidelines was performed. Rates of guideline adherence, provider performance data, illness detection and diagnostic accuracy rates were extracted in addition to patient relevant outcome data. Results:, Eighteen studies (nine randomized-controlled trials, six non-randomized-controlled studies and three quasiexperimental before-and-after studies) were identified. Effects on provider performance or patient outcome were moderate and temporary in most cases. Studies with positive outcomes used complex multifaceted interventions or specific psychological methods to implement guidelines. Conclusion:, There is insufficient high-quality evidence to draw firm conclusions on the effects of implementation of specific psychiatric guidelines. [source] Attention deficit hyperactivity disorder and suicide: a review of possible associationsACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2004A. James Objective:, To review the evidence of a possible association between attention deficit hyperactivity disorder (ADHD) and suicide. Design:, We searched the electronic data bases: Medline, Psych LIT, between 1966 and March 2003 looking for articles on ADHD, attention deficit disorder, hyperactivity and suicide. Results:, An association of ADHD and completed suicide was found, especially for younger males. However, the evidence for any direct or independent link was modest with an overall suicide rate from long-term follow-up studies of ADHD of 0.63,0.78%. The estimated relative risk ratio, compared with US national suicide rates (males 5,24 years) is 2.91 (95% confidence interval 1.47,5.7, ,2 = 9.3, d.f. = 1, P = 0.002). ADHD appears to increase the risk of suicide in males via increasing severity of comorbid conditions, particularly conduct disorder (CD) and depression. Conclusion:, Identification of those at risk, particularly males with comorbid ADHD, depression and CD, may represent a useful clinical means of reducing completed suicide. [source] Current literature in diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 3 2003Article first published online: 30 APR 200 In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 17 sections: 1 Books, Reviews & Symposia; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Prediction; 7 Prevention; 8 Intervention: a) General; b) Pharmacology; 9 Pathology: a) General; b) Cardiovascular; c) Neurological; d) Renal; 10 Endocrinology & Metabolism; 11 Nutrition; 12 Animal Studies; 13 Techniques. Within each section, articles are listed in alphabetical order with respect to author (4 Weeks journals - Search completed at 5th March 2003) [source] Seasonal variation of diagnosis of Type 1 diabetes mellitus in children worldwideDIABETIC MEDICINE, Issue 7 2009E. V. Moltchanova Abstract Aims, To determine if there is a worldwide seasonal pattern in the clinical onset of Type 1 diabetes. Methods, Analysis of the seasonality in diagnosis of Type 1 diabetes was based on the incidence data in 0- to 14-year-old children collected by the World Health Organization Diabetes Mondiale (WHO DiaMond) Project over the period 1990,1999. One hundred and five centres from 53 countries worldwide provided enough data for the seasonality analysis. The incidence seasonality patterns were also determined for age- and sex-specific groups. Results, Forty-two out of 105 centres exhibited significant seasonality in the incidence of Type 1 diabetes (P < 0.05). The existence of significant seasonal patterns correlated with higher level of incidence and of the average yearly counts. The correlation disappeared after adjustment for latitude. Twenty-eight of those centres had peaks in October to January and 33 had troughs in June to August. Two out of the four centres with significant seasonality in the southern hemisphere demonstrated a different pattern with a peak in July to September and a trough in January to March. Conclusions, The seasonality of the incidence of Type 1 diabetes mellitus in children under 15 years of age is a real phenomenon, as was reported previously and as is now demonstrated by this large standardized study. The seasonality pattern appears to be dependent on the geographical position, at least as far as the northern/southern hemisphere dichotomy is concerned. However, more data are needed on the populations living below the 30th parallel north in order to complete the picture. [source] Not all roads lead to Rome,a review of quality of life measurement in adults with diabetesDIABETIC MEDICINE, Issue 4 2009J. Speight Abstract Aims Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of self-management places great demands on the individual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately. Methods A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008. Results Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess ,QoL', only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)]. Conclusions No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully. [source] How many cases of Type 2 diabetes mellitus are due to being overweight in middle age?DIABETIC MEDICINE, Issue 1 2007Evidence from the Midspan prospective cohort studies using mention of diabetes mellitus on hospital discharge or death records Abstract Aims To relate body mass index (BMI) in middle age to development of diabetes mellitus. Methods Participants were 6927 men and 8227 women from the Renfrew/Paisley general population study and 3993 men from the Collaborative occupational study. They were aged 45,64 years and did not have reported diabetes mellitus. Cases who developed diabetes mellitus, identified from acute hospital discharge data and from death certificates in the period from screening in 1970,1976 to 31 March 2004, were related to BMI at screening. Results Of Renfrew/Paisley study men 5.4%, 4.8% of women and 5% of Collaborative study men developed diabetes mellitus. Odds ratios for diabetes mellitus were higher in the overweight group (BMI 25 to < 30 kg/m2) than in the normal weight group (BMI 18.5 to < 25 kg/m2) and highest in the obese group (BMI , 30 kg/m2). Compared with the normal weight group, age-adjusted odds ratios for overweight and obese Renfrew/Paisley men were 2.73 [95% confidence interval (CI) 2.05, 3.64] and 7.26 (95% CI 5.26, 10.04), respectively. Further subdividing the normal, overweight and obese groups showed increasing odds ratios with increasing BMI, even at the higher normal level. Assuming a causal relation, around 60% of cases of diabetes could have been prevented if everyone had been of normal weight. Conclusions Overweight and obesity account for a major proportion of diabetes mellitus, as identified from hospital discharge and death records. With recent increases in the prevalence of overweight, the burden of disease related to diabetes mellitus is likely to increase markedly. Primordial prevention of obesity would be a major strategy for reducing the incidence of diabetes mellitus in populations. [source] Heel ulcers don't heal in diabetes.DIABETIC MEDICINE, Issue 9 2005Or do they? Abstract Aim To obtain information on outcome of heel ulcers in diabetes. Methods Data were recorded prospectively on all patients with heel ulcers who were referred to a specialist multidisciplinary clinic between 1 January 2000 and 30 November 2003. Outcomes were assessed on 31 March 2004. Results There were 157 heel ulcers in the patients referred in the period. Three ulcers were excluded from analysis because of associated osteomyelitis. Of 154 remaining ulcers (121 limbs; 97 patients, 55 male; mean age 68.5 ± 12.8 sd years), 101 (65.6%) healed after a median (range) 200 (24,1225) days. Of 53 non-healed ulcers, 11 (7.1% of 154) were resolved by major amputation, 30 (19.5% of 154) were unhealed at time of patient's death, and 12 (7.8% of 154) remained unhealed. Ulcers healed in 59 of 97 affected patients (60.8%). Twenty-six patients (26.8% of 97) died during the period, of whom 20 died with ulcers unhealed. Worse outcomes were observed in larger ulcers (P = 0.001, Mann,Whitney U -test = 1883.5) and limbs with clinical evidence of peripheral arterial disease (P = 0.001, Mann,Whitney U -test = 1163.00). Backward step-wise logistic regression analysis showed 70.1% of healing could be predicted from these two baseline characteristics. Conclusions The common perception that ,heel ulcers don't heal' is not reflected in clinical practice. Outcome is generally favourable even in a population often affected by serious comorbidity and with limited life expectancy. These data can be used to help define management plans, as well as a basis for counselling of the individual patient. [source] In-patient management of diabetes mellitus and patient satisfactionDIABETIC MEDICINE, Issue 5 2002A. Bhattacharyya Abstract Aims To devise a system for assessing in-patient glycaemic control and care satisfaction in diabetic patients admitted to hospital for reasons other than their diabetes. Methods Consecutive January to March 2001 case-notes were reviewed. Admissions with acute metabolic complications, acute myocardial infarction and pregestational or gestational diabetes were excluded. Glycaemic control, frequency of blood monitoring and management of hyperglycaemia were recorded. The diabetes treatment satisfaction questionnaire was used to assess preadmission satisfaction with care. Post-admission a 12-stem questionnaire was used to assess satisfaction with in-patient diabetes management. Results Hypoglycaemia was common. Although none developed a hyperglycaemic emergency, high blood glucose was prevalent and, frequently, persistent hyperglycaemia or recurrent hypoglycaemia was not acted on appropriately. The overall score for in-patient satisfaction with treatment was fair (4.1 ± 1.8 on a six-point scale; 6 = very satisfied and 1 = very dissatisfied). Scores were higher among patients on surgical wards than on medical wards (P = 0.008), but satisfaction did not vary when patients were stratified according to sex, age and mode of treatment. Conclusion Current systems are not achieving satisfactory in-patient glycaemic control and there is poor satisfaction with medical in-patient diabetes care. Following changes intended to produce improvements, this assessment system can be used recurrently to monitor in-patient care and satisfaction. [source] AN ENDOCRINE CELL CARCINOMA WITH GASTRIC-AND-INTESTINAL MIXED PHENOTYPE ADENOCARCINOMA COMPONENT IN THE STOMACHDIGESTIVE ENDOSCOPY, Issue 4 2009Tsutomu Mizoshita A 77-year-old man complained of bodyweight loss, and a Borrmann 3 type lesion was observed endoscopically in the anterior wall of angular region of the stomach. The endocrine cell carcinoma (ECC) having the cytoplasmic staining of chromogranin A (CgA) was detected pathologically in the biopsy samples. The patient underwent distal gastrectomy plus systemic lymph node (LN) dissection (D2 LN dissection), and pathological examination revealed ECC invading the subserosa, and no LN metastasis (pT2N0M0). None of the gastric and intestinal endocrine cell marker expression was apparent in the ECC cells. The lesion also contained a moderately differentiated type tubular adenocarcinoma component, which was judged to be gastric-and-intestinal mixed (GI type) phenotype, using gastric and intestinal exocrine cell markers. After the surgery, he left the hospital and started oral doxifluridine (600 mg/day). The patient now (March 2008, about 19 months since the surgery) continues this chemotherapy with no recurrence. In conclusion, we experienced ECC with a GI type adenocarcinoma component. The ECC cases with the GI type adenocarcinoma component may have a relatively good prognosis, being similar to the results of advanced gastric cancers from the viewpoint of gastric and intestinal phenotypic expression. [source] Abstracts presented at the Poster and Video sessions at the 4th Korea-Japan Joint Symposium on Gastrointestinal Endoscopy held on 26 March 2005 in Seoul, KoreaDIGESTIVE ENDOSCOPY, Issue 2 2006Article first published online: 22 FEB 200 First page of article [source] Using the ,protective environment' framework to analyse children's protection needs in DarfurDISASTERS, Issue 4 2009Alastair Ager A major humanitarian concern during the continuing crisis in Darfur, Sudan, has been the protection of children, although there has been little in the way of comprehensive analysis to guide intervention. Founded on a situational analysis conducted between October 2005 and March 2006, this paper documents the significant threats to children's well-being directly linked to the political conflict. It demonstrates the role of non-conflict factors in exacerbating these dangers and in promoting additional protection violations, and it uses the ,protective environment' framework (UNICEF Sudan, 2006a) to identify systematic features of the current environment that put children at risk. This framework is shown to provide a coherent basis for assessment and planning, prompting broad, multidisciplinary analysis, concentrating on preventive and protective action, and fostering a systemic approach (rather than placing an undue focus on the discrete needs of ,vulnerable groups'). Constraints on its present utility in emergency settings are also noted. [source] The 2004 Madrid train bombings: an analysis of pre-hospital managementDISASTERS, Issue 1 2008Alejandro López Carresi The terrorist train bombings in Madrid, Spain, on 11 March 2004 triggered a swift and massive medical response., This paper analyses the pre-hospital response to the attacks to gain insight into current trends in disaster management among Madrid's Emergency Medical Services (EMSs). To this end, the existing emergency planning framework is described, the basic structures of the different EMSs are presented, and the attacks are briefly depicted before consideration is given to pre-hospital management. Finally, an explanation of the main underlying misconceptions in emergency planning and management in Madrid is provided to aid understanding of the origins of some of the problems detected during the response. These are attributable mainly to inappropriate planning rather than to mistakes in field-level decision-making. By contrast, many of the successes are attributable to individual initiatives by frontline medics who compensated for the lack of clear command by senior managers by making adaptive and flexible decisions. [source] | |||||||||||||||||||||||||||||||||||||||||||