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Selected AbstractsMind the Gap, Please: The Changing Nature of Entry Jobs in BritainECONOMICA, Issue 268 2000Paul Gregg We examine wages in jobs taken by those out of work,entry jobs,and the characteristics of the individuals who fill them. There are large entry wage gaps relative to other jobs. More importantly, real entry wages have fallen by around 20 log points relative to all other jobs since 1979. One-quarter of this decline is accounted for by differences in individual and job characteristics and around 40% from an unexplained fall in the position of entry jobs in the wage distribution. That entry wages differ from the stock of all wages should be incorporated into labour supply modelling. [source] Violent victimization and drug involvement among Mexican middle school studentsADDICTION, Issue 6 2006Luciana Ramos-Lira ABSTRACT Aims To answer the following research questions: (a) is there an association between violent victimization and exposure to opportunities to use marijuana, inhalants and cocaine and (b) is there an association between violent victimization and actual drug use among youth with drug-using opportunities? Design Cross-sectional survey. Setting Two middle schools located in the Historic Downtown area of Mexico City. Participants The entire body of students (n = 767; mean age 13.8 years, 52% males). Measurements Qualitative research was used to develop questions on drug exposure opportunities and violent victimization. Standardized questions on life-time alcohol, tobacco, marijuana, inhalant drugs and cocaine use were also included, as well as questions on violent victimization and other covariates. Findings One-quarter (25%) of students had an opportunity to try marijuana, inhalant drugs or cocaine; 35% who had an opportunity actually used at least one drug. In this sample, 59% had been victimized violently. Youth who had been victimized had greater odds of opportunities to use drugs compared to those who had not been victimized [adjusted odds ratio (OR) = 3.8; 95% confidence interval (CI), 2.4, 6.1]. Once exposure opportunity is taken into consideration, no association was evident between violent victimization and actual drug use (adjusted OR = 0.9; 95% CI, 0.4, 2.1). Conclusions It is possible to trace back the association between violent victimization and drug use to differences in exposure to opportunities. Limitations considered, this study suggests interventions to improve micro and macro contexts, such as families, schools and communities, so young people can have better places to live and develop. [source] Towards DSM-V: considering other withdrawal-like symptoms of pathological gambling disorderINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2009Renee M. Cunningham-Williams Abstract Despite clinical reports of other withdrawal-like symptoms, the DSM-IV considers only restlessness/irritability as a withdrawal-like criterion comprising pathological gambling disorder (PGD). We explored whether this criterion should be broadened to include other gambling withdrawal-like symptoms. Community-recruited adult gamblers (n = 312) participated in telephone interviews about gambling and related behaviors as a part of a larger psychometric study. Frequency and chi-square analyses described the association of gambling withdrawal-like symptoms by gambling disorder status. Multinomial forward selection logistic regression obtained a multivariate model describing the simultaneous relationship between these symptoms and gambling disorder status. One-quarter of the sample experienced the DSM-IV PGD criterion of restlessness/irritability. However, 41% experienced additional gambling withdrawal-like symptoms when attempting to quit or control gambling. A model including restlessness/irritability and three additional non-DSM-IV withdrawal-like symptoms (i.e. feelings of anger, guilt, and disappointment) is a stronger model of gambling disorder (,2 = 217.488; df = 8, p < 0.0001; R2 = 0.5428; p < 0.0001) than restlessness/irritability alone (,2 = 151.278; df = 2, p < 0.0001; R2 = 0.4133). The overlap of gambling withdrawal-like symptoms with substance use withdrawal (11%) and depressive symptoms (34%) failed to fully account for these associations with gambling disorder status. Future PGD conceptualization and potential criteria revisions for DSM-V may warrant a broader inclusion of gambling withdrawal-like symptoms. Copyright © 2009 John Wiley & Sons, Ltd. [source] Danish dentists' knowledge, attitudes and management of procedural dental pain in children: association with demographic characteristics, structural factors, perceived stress during the administration of local analgesia and their tolerance towards painINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2005J. K. RASMUSSEN Summary., Objective., The aim of the present study was to describe Danish dentists' knowledge of, attitudes towards and management of procedural pain during paediatric dental care, and to assess the importance of demographic characteristics, structural factors, perceived stress during administration of local analgesia and the dentists' own tolerance towards procedural dental pain. Design., A cross-sectional questionnaire study was conducted in Denmark in May 2001. Subjects and methods., The subjects were a random sample of 30% of Danish dentists treating children. Usable information was obtained from 327 (80·3%) of the dentists in the sample. Results., One-quarter of the respondents answered that a 3,5-year-old child could report pain only with uncertainty. More than 80% of the dentists stated that they never compromised on painlessness. Very few agreed to the statement that children forget pain faster than adults. One-third agreed to, or were neutral to, the statement that all restorative care in primary teeth could be performed painlessly using N2O-O2 sedation alone. The majority of the respondents reported using three or more methods to assess the effect of their pain control methods. Almost 90% reported using local analgesia for restorative work ,always' or ,often'. A similar proportion reported using topical analgesia before injection ,always' or ,often'. Administering a mandibular block to preschool children was the procedure perceived as the most stressful (33·6%) pain control method. Demographic factors (gender), structural factors (always working alone and treating 3,5-year-old children daily), perceived stress during the administration of a mandibular block in preschool children and the dentists' own willingness to accept potentially painful dental treatment without local analgesia were associated with knowledge of, attitudes towards and management of procedural dental pain in children. Conclusions., Danish dentists treating children demonstrate concern about procedural dental pain in children. Factors amenable to change via training and reorganization into larger clinical units seem to determine their knowledge of, attitudes towards and management of procedural dental pain in children. [source] Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004(See editorial comments by Dr. Debra Weiner on pp 1020, 1022) Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain. Design: Cross-sectional study. Setting: Nursing homes from 10 U.S. states. Participants: A total of 21,380 nursing home residents aged 65 and older with persistent pain. Measurements: Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes. Results: Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One-quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one-third of NSAIDs were prescribed at high doses. Conclusion: In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain. [source] Health and risk behaviors in survivors of childhood acute myeloid leukemia: A report from the Children's Oncology Group,PEDIATRIC BLOOD & CANCER, Issue 1 2010Kris Ann P. Schultz MD Abstract Background Survivors of childhood acute myeloid leukemia (AML) face increased risks of chronic disease and secondary malignancies. Substance exposure may compound these risks. Procedures Participants were diagnosed with AML at <21 years of age and survived ,5 years following diagnosis. All underwent chemotherapy alone or followed by autologous BMT (chemo,±,autoBMT) or underwent allogeneic BMT (alloBMT) if an HLA-matched related donor was available. Survivors completed a health questionnaire and a Youth Risk Behavior Survey (YRBS). Results Of eligible survivors, 117 were ,18 years of age and completed a YRBS. Survivors were a mean age of 10 years at diagnosis and 24 years at interview. Of the substance exposures assessed by YRBS, tobacco, alcohol, and marijuana were most common. Twenty-two percent (22%) had smoked cigarettes in the last 30 days. One-quarter (25%) reported binge drinking in the last month. None of these exposures varied by treatment group. Less than 10% of survivors reported cocaine, heroin, or methamphetamine use. Men were more likely to report high substance exposure (P,=,0.004). Sadness/suicidality score was associated with cancer-related anxiety (P,=,0.006) and multiple health conditions (P,=,0.006). Conclusions This analysis reveals exposure to tobacco, alcohol, and marijuana in young adults with few differences based on treatment received. Survivors with cancer-related anxiety or multiple health conditions were more likely to report sadness/hopelessness. Pediatr Blood Cancer 2010;55:157,164. © 2010 Wiley-Liss, Inc. [source] New Evidence on the Urbanization of Global PovertyPOPULATION AND DEVELOPMENT REVIEW, Issue 4 2007Martin Ravallion One-quarter of the world's consumption poor live in urban areas, and that proportion has been rising over time. Over 1993,2002, the count of the "$1 a day" poor fell by 150 million in rural areas but rose by 50 million in urban areas. The poor have been urbanizing even more rapidly than the population as a whole. By fostering economic growth, urbanization helped reduce absolute poverty in the aggregate. There are marked regional differences: Latin America has the most urbanized poverty problem, East Asia has the least; there has been a "ruralization" of poverty in Eastern Europe and Central Asia; in marked contrast to other regions, Africa's urbanization process has not been associated with falling overall poverty. [source] Latest news and product developmentsPRESCRIBER, Issue 8 2007Article first published online: 23 JUL 200 Lamotrigine for partial, valproate for generalised A large UK trial has shown that lamotrigine is the most effective choice in the treatment of partial epilepsy (Lancet 2007;369: 1000-15). The SANAD trial, commissioned by the National Institute for Health Research's Health Technology Assessment programme, randomised 1721 patients (for whom carbamazepine monotherapy would have been the treatment of choice) to treatment with carbamazepine, gabapentin, lamotrigine, oxcarbazepine (Trileptal) or topiramate (Topamax). Lamotrigine was associated with a longer time to treatment failure, though time to 12-month remission favoured carbamazepine. Over four years' follow-up, lamotrigine was numerically but not significantly superior. The authors concluded lamotrigine is clinically superior to carbamazepine for partial epilepsy A second arm of the trial, yet to be published, evaluated the treatment of generalised epilepsy and found valproate to be clinically most effective, though topiramate was cost effective for some patients. Chronic pain common in nursing homes Most residents in nursing homes say they have long- term pain but only one in seven say a health professional has ever discussed its treatment with them, according to a report by the Patients' Association (www.patients-association.org.uk). Pain in Older People ,A Hidden Problem was a qualitative study of 77 older residents in care homes in England. Most were frail and suffered long-term illness. The study found that 85 per cent of residents said they were often troubled by aches or pains and these lasted over a year in 74 per cent. Most described their pain as moderate (33 per cent) or severe (38 per cent) but 8 per cent said it was excruciating. Many reported limitations on mobility and social activities despite a high level of stoicism. All but one were taking medication to relive pain; one-third experienced adverse effects but 78 per cent believed drugs offered the most effective treatment. One-quarter said a doctor or nurse had discussed how to stop their pain worsening, and 15 per cent said they had discussed how to treat their pain. Visits from GPs appeared to be uncommon. Atherothrombotic events despite treatment Between one in five and one in seven of high-risk patients experience atherothrombotic events despite evidence-based treatment, the REACH study has shown (J Am Med Assoc 2007;297:1197-1206). REACH (REduction of Atherothrombosis for Continued Health) is an international observational study involving 68 236 patients with atherothrombotic disease or at least three risk factors. Most were taking conventional evidence-based medication. After one year, the incidence of the combined endpoint of cardiovascular death, myocardial infarction, stroke or hospitalisation for atherothrombotic events was approximately 15 per cent for patients with coronary artery disease or cardiovascular disease, and 21 per cent in patients with peripheral artery disease and established coronary disease. Event rates increased with the number of vascular beds affected, rising to 26 per cent in patients with three symptomatic arterial disease locations. Extended CD prescribing by nurses and pharmacists The Medicines and Healthcare products Regulatory Agency (MHRA) is consulting on expanding the prescribing of controlled drugs (CDs) by nonmedical prescribers. Currently, nurse independent prescribers can prescribe 12 CDs, including diamorphine and morphine, but pharmacist independent prescribers may not prescribe any CDs. The proposal is to allow both professions to prescribe any CDs within their competence, with the exception of cocaine, diamorphine or dipipanone for the management of addiction. The closing date for consultation is 15 June. Consultation is also underway on expanding the range of CDs nurses and pharmacists can prescribe under a patient group direction (PGD), and their use for pain relief. The closing date for consultation is 20 April. Intrinsa: transdermal testosterone for women A transdermal formulation of testosterone has been introduced for the treatment of low sexual desire associated with distress in women who have experienced an early menopause following hysterectomy involving a bilateral oophorectomy and are receiving concomitant oestrogen therapy. Manufacturer Procter & Gamble says that Intrinsa, a twice-weekly patch, delivers testosterone 300µg every 24 hours, achieving premenopausal serum testosterone levels. Clinical trials showed that Intrinsa reduced distress in 65-68 per cent and increased satisfying sexual activity in 51-74 per cent of women. A month's treatment (eight patches) costs £28.00. Fish oil for secondary ,not primary ,prevention of CHD Supplementing statin therapy with eicosapentaenoic acid (EPA) reduces the risk of major coronary events in patients with coronary heart disease (CHD) ,but not in patients with no history of CHD Lancet 2007;369:1090-8). The five-year study in 18 645 patients with total cholesterol levels of 6.5mmol per litre or greater found that the incidence of sudden cardiac death, fatal and nonfatal myocardial infarction in CHD patients treated with EPA plus a statin was 8.7 per cent compared with 10.7 per cent with a statin alone (relative risk reduction 19 per cent). A similar relative risk reduction in patients with no CHD was not statistically significant. There was no difference in mortality between the groups but EPA did reduce unstable angina and nonfatal coronary events. Department pilots information prescriptions The Department of Health has announced 20 sites to pilot information prescriptions prior to a nationwide roll-out in 2008. The prescriptions will guide people with long-term conditions such as diabetes and cancer to sources of support and information about their condition. The Department hopes the project will increase patients' understanding of their discussions with health professionals, empower them to locate the information they need, and provide long-term support. NPSA guidelines for safer prescribing The National Patient Safety Agency (www.npsa.nhs.uk) has published five guidelines to improve medication safety in the NHS. Targeting ,high-risk issues', the guidance covers anticoagulant prescribing, liquid medicines for oral or enteral administration, injectable medicines, epidural injections and infusions, and paediatric intravenous infusions. The implementation of each guide is supported by additional tools and resources. Better adherence not matched to outcomes A systematic review has found that interventions can increase adherence to prescribed medication but there is no evidence that clinical outcomes also improve (Arch Intern Med 2007;167:540-9). The review of 37 trials identified 20 reporting increased adherence. The most effective interventions were behavioural changes to reduce dose demands and those involving monitoring and feedback. Improvements in clinical outcomes were variable and did not correspond to changes in adherence. Antidepressant plus mood stabiliser no better US investigators have found that combining a mood stabiliser with an antidepressant is no more effective than a mood stabiliser alone in preventing mood changes (N Engl J Med 2007; published online 28 March, doi.10.1056/NEJMoa064135). The study found durable recovery occurred in 23.5 per cent of patients treated with a mood stabiliser and adjunctive antidepressant therapy for six months compared with 27.3 per cent of those taking a mood stabiliser plus placebo. [source] Club Drug Use in Hispanic College StudentsTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2010Michelle R. Resor BA Club drug use and correlates were examined among 251 Hispanic college students on the Texas,México border. Participants completed questionnaires on substance use, club drug attitudes and beliefs, sexual risk-taking behaviors, depressive symptoms, and acculturation. One-quarter of participants reported club drug use. Regression analyses demonstrated that frequency and history of lifetime use were consistently associated with more permissive drug attitudes and other substance use but not sexual risk-taking, depression symptoms, or acculturation. Acculturation was negatively associated with frequency of club drug use, yet positively associated with use of other illicit substances. Avenues for future studies are suggested.,(Am J Addict 2010;00:1,6) [source] Australian veterinarians who work with horses: an analysisAUSTRALIAN VETERINARY JOURNAL, Issue 6 2004TJ HEATH Objective To define and describe the population of Australian veterinarians who work with horses. Method Questionnaires were mailed to 866 veterinarians who had been identified as working with horses, and 87% were completed and returned. Data were entered onto an Excel spreadsheet, and analysed using the SAS System for Windows. Results About 12% of Australia's veterinarians were doing all the veterinary work with horses, and about 3% worked exclusively (> 90%) with horses, but did more than half (58%) of the horse work. Veterinarians working with horses included more males (80%) than the veterinary population as a whole (approximately 60%). Males had an average age of 47 years, females 35. Almost all (94%) worked in private practice, with 31% being employees, 28% partners and 41% sole owners. Females were more likely to be employees than males. Males reported working 55 hours/week; females 49. More females (44%) than males (16%) had worked less than full-time for more than a year. Males expected to work for another 12 years in full-time equivalents, and females for 16. One quarter (24%) saw only horses, but treated 58% of total horse cases. One-half had < 25% horses, and 29% had < 10% of horses in their caseloads. More of the older (54% of those aged > 60) than younger respondents (27% of those < 40) had grown up on farms with animals. One-quarter (24%) decided to become a veterinarian while in primary school, and females decided at a younger age than males. Overall, younger respondents decided at a younger age than did their older counterparts. A veterinarian contributed to the decision for 21% of these veterinarians. Conclusion In this survey, Australian veterinarians who work with horses were found to be typically male, and advanced in their careers. As these older veterinarians retire, there may not be enough veterinarians who are committed to and competent with horses to take their places. [source] Why are alcohol-related emergency department presentations under-detected?DRUG AND ALCOHOL REVIEW, Issue 6 2008An exploratory study using nursing triage text Abstract Introduction and Aims. This study examined two methods of detecting alcohol-related emergency department (ED) presentations, provisional medical diagnosis and nursing triage text, and compared patient and service delivery characteristics to determine which patients are being missed from formal diagnosis in order to explore why alcohol-related ED presentations are under-detected. Design and Methods. Data were reviewed for all ED presentations from 2004 to 2006 (n = 118 881) for a major teaching hospital in Sydney, Australia. Each record included two nursing triage free-text fields, which were searched for over 60 alcohol-related terms and coded for a range of issues. Adjusted odds ratios were used to compare diagnostically coded alcohol-related presentations to those detected using triage text. Results. Approximately 4.5% of ED presentations were identified as alcohol-related, with 24% of these identified through diagnostic codes and the remainder identified by triage text. Diagnostic coding was more likely if the patient arrived by ambulance [odds ratio (OR) = 2.35] or showed signs of aggression (OR = 1.86). Failure to code alcohol-related issues was more than three times (OR = 3.23) more likely for patients with injuries. Discussion and Conclusions. Alcohol-related presentations place a high demand on ED staff and less than one-quarter have an alcohol-related diagnosis recorded by their treating doctor. In order for routine ED data to be more effective for detecting alcohol-related ED presentations, it is recommended that additional resources such as an alcohol health worker be employed in Australian hospitals. These workers can educate and support ED staff to identify more clearly and record the clinical signs of alcohol and directly provide brief interventions. [source] Trajectories of resilience over 25 years of individuals who as adolescents consulted for substance misuse and a matched comparison groupADDICTION, Issue 7 2010Peter Larm ABSTRACT Aims To examine trajectories of resilience over 25 years among individuals who as adolescents received treatment for substance misuse, the clinical sample (CS) and a matched general population sample (GP). Design Comparison of the CS and GP over 25 years using Swedish national registers of health care and criminality. Setting A substance misuse clinic for adolescents in an urban area in Sweden. Measurements Resilience was defined as the absence of substance misuse, hospitalizations for physical illnesses related to substance misuse, hospitalization for mental illness and law-abiding behaviour from ages 21 to 45 years. Participants The CS included 701 individuals who as adolescents had consulted a clinic for substance misuse. The GP included 731 individuals selected randomly from the Swedish population and matched for age, sex and birthplace. Findings A total of 52.4% of the GP and 24.4% of the CS achieved resilience in all domains through 25 years. Among the CS, another one-third initially displayed moderate levels of resilience that rose to high levels over time, one-quarter displayed decreasing levels of resilience over time, while 9.3% showed little but improving resilience and 8.8% showed no resilience. Levels of resilience were associated with the severity of substance misuse and delinquency in adolescence. Conclusions Individuals who had presented substance misuse problems in adolescence were less likely to achieve resilience over the subsequent 25 years than was a matched general population sample, and among them, four distinct trajectories of resilience were identified. The severity and type of problems presented in adolescence distinguished the four trajectories. [source] Cannabis and schizophrenia: model projections of the impact of the rise in cannabis use on historical and future trends in schizophrenia in England and WalesADDICTION, Issue 4 2007Matthew Hickman ABSTRACT Aims To estimate long-term trends in cannabis use and projections of schizophrenia assuming a causal relation between cannabis use and schizophrenia. Methods Trends in cannabis use were estimated from a national survey, 2003; and incidence of schizophrenia was derived from surveys in three English cities, 1997,99. A difference equation cohort model was fitted against estimates of schizophrenia incidence, trends in cannabis exposure and assumptions on association between cannabis and schizophrenia. The model projects trends in schizophrenia incidence, prevalence and attributable fraction of cannabis induced schizophrenia. Results Between 1970 and 2002 cannabis exposure increased: incidence by fourfold; period prevalence by 10-fold; and use among under 18-year-olds by 18-fold. In 1997,99 incidence and prevalence of schizophrenia were 17 per 100 000 and 0.63% among men and 7.3 per 100 000 and 0.23% among women, respectively. If cannabis use causes schizophrenia, earlier increases in cannabis use would lead to increases in overall schizophrenia incidence and prevalence of 29% and 12% among men between 1990 and 2010. By 2010 model projections which assume an association between schizophrenia and light and heavy users suggest that approximately one-quarter of new schizophrenia cases could be due to cannabis, whereas if the association is twofold and confined to heavy cannabis users, then approximately 10% of schizophrenia cases may be due to cannabis. Conclusions If cannabis use causes schizophrenia, and assuming other causes are unchanged, then relatively substantial increases in both prevalence and incidence of schizophrenia should be apparent by 2010. More accurate data on cannabis consumption and future monitoring of schizophrenia are critical. [source] Prevalence of Active Epilepsy and Health-Related Quality of Life among Adults with Self-Reported Epilepsy in California: California Health Interview Survey, 2003EPILEPSIA, Issue 10 2007Rosemarie Kobau Summary:,Purpose: To examine the prevalence of self-reported epilepsy and active epilepsy, associated burden of impaired health-related quality of life, risk factors, and access to care in adults with self-reported epilepsy, and those classified as having active epilepsy with and without recent seizures. Methods: We analyzed data from adults aged ,18 years (n = 41,494) who participated in the 2003 California Health Interview Survey (CHIS). Results: In California, 1.2% of adults reported ever being told they had epilepsy or seizure disorder, and 0.7% were classified as having active epilepsy. About three-fourths of adults with active epilepsy with recent seizures reported fair or poor health status. Adults with active epilepsy with recent seizures reported almost two weeks of poor physical or mental health and activity limitation days compared with two to 4 days per month in those without epilepsy. Among adults with active epilepsy and recent seizures, about one-quarter reported not taking any medicine to control their seizure disorder or epilepsy. About one-third reported physical disability/unable to work compared to a small proportion of the general population. The majority of adults with active epilepsy reported having a regular source of medical care. Conclusion: Our findings highlight the burden of epilepsy among adults in California. CHIS serves as a model demonstrating the value of including questions about epilepsy on public health surveillance systems to ascertain the burden of the disorder and to guide intervention research and public policy to improve HRQOL in people with epilepsy. [source] New Mexico's 1998 drive-up liquor window closure.ADDICTION, Issue 5 2004Study II: economic impact on owners ABSTRACT Aims This study examined the economic impact of the New Mexico legislative action closing drive-up liquor windows on the retail establishments that operated them. Design A telephone survey was conducted 20 months after the closure seeking information and owners' opinions about how their outlets had changed since the closure and how this affected their business. In addition, 2 years of aggregated pre- and post-closure total gross receipts revenues were obtained from the New Mexico Taxation and Revenue Department, with convenience stores as a comparison group. Findings Interviews were completed for 149 of 220 establishments. Over one-quarter of former drive-up liquor windows (28%) had been converted to ,step-in' sales, defined as an outside door where customers can stop and enter the premises while their car is running. Almost two-thirds (61%) of owners reported decreased annual gross revenues following closure, with a reported average 15% reduction in alcohol sales. This is consistent with findings of decreased gross receipts for operators of non-urban, but not urban, drive-up liquor windows compared to convenience store gross receipts. Almost three-quarters (72%) of those surveyed would re-open the drive-up window if the law were rescinded. Conclusion Over one-quarter of the drive-up owners converted to step-in alcohol sales that still allow a form of drive-up liquor sales. Despite this, the forced closure of New Mexico's drive-up liquor windows negatively impacted total sales and liquor sales revenues of establishments that operated them. [source] Living with anorexia nervosa: the experience of a cohort of sufferers from anorexia nervosa 7.5 years after initial presentation to a specialized eating disorders serviceEUROPEAN EATING DISORDERS REVIEW, Issue 2 2001Eric J. Button Abstract Objective The main aim of the present study was to further understand how sufferers from anorexia nervosa view the disorder, how it affects their lives and how they experience treatment and help. Method A cohort of anorectic patients were followed up 7.5 years after presentation at a specialist locally-based eating disorders service for adults. All subjects were invited to take part in a semi-structured interview and complete a series of questionnaires. Results Thirty-six subjects were interviewed and the group as a whole showed marked improvement compared with initial presentation, but only 14 per cent were judged to be free of the disorder and about one-quarter remained entrenched in the world of anorexia nervosa. The main results focus on common themes which emerged from the interview and extensive quotes from subjects are used for illustrative purposes. Although each person expressed a very individual experience of the disorder, a common theme was of it emerging as a response to a sense of loss of control in one or more areas of their lives, often centering on their self-image and problems in relationships with others. Although the disorder was commonly experienced as having a devastating effect on their lives, the focus on weight and eating at least offered them some semblance of control. A wide range of experiences of treatment were reported, but there was considerable consensus regarding the importance of individual psychotherapy/counselling and of the quality of relationship with a therapist. Discussion This study confirms the often long-term psychological problems experienced by sufferers from anorexia nervosa and helps to illuminate the client's perspective on the disorder and other people's attempts to help. The individual views of the sufferer are an important consideration for those involved in the planning and delivery of services for these vulnerable people. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Use of morphine and 6-monoacetylmorphine in blood for the evaluation of possible risk factors for sudden death in 192 heroin usersADDICTION, Issue 4 2003Anna Fugelstad Abstract Aims, To detect risk factors for sudden death from heroin injection. Design, Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order to select heroin intoxication cases. Setting, Stockholm, Sweden. Measurements, Autopsy investigation and toxicological analysis of blood and urine; and police reports. Findings, In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from 50 to 1200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations were found. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. Conclusions, We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors. [source] Metabolism of cholesterol ester of apolipoprotein B100-containing lipoproteins in dogs: evidence for disregarding cholesterol ester transferEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 8 2004E. Bailhache Abstract Background, It has been shown that dogs exhibit no cholesterol ester transfer protein (CETP) activity in vitro, in contrast to humans. The aim of our study was to determine modalities of in vivo plasma cholesterol ester turnover in this species, using a kinetic approach with stable isotopes. Materials and methods, Kinetics of very low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) were studied in seven adult male Beagle dogs using a dual isotope approach through endogenous labelling of both their cholesterol moiety and their protein moiety. A primed constant infusion of both [1,213C]acetate and [5,5,5- 2H3]leucine enabled us to obtain measurable deuterium enrichments by gas chromatography-mass spectrometry for plasma leucine and apoB100, as well as measurable 13C enrichment by gas chromatography-combustion-isotopic ratio mass spectrometry for unesterified cholesterol and cholesterol ester in the VLDL and LDL. Two identical multicompartmental models (SAAM II) were used together for the analysis of tracer kinetics' data of proteins and cholesterol. Results, Characterization of the apoB100-containing lipoprotein cholesterol ester model allowed determination of kinetic parameters of VLDL and LDL cholesterol ester metabolism. We succeeded in modelling VLDL and LDL cholesterol ester metabolism and apoB100 metabolism simultaneously. Fractional catabolic rate (FCR) of apoB100 and CE had the same values. Introducing cholesterol ester transfer between lipoproteins in the model did not significantly improve the fit. Total VLDL FCR was 2·97 ± 01·47 h,1. Approximately one-quarter corresponded to the direct removal of VLDL (0·81 ± 00·34 h,1) and the remaining three-quarters corresponded to the fraction of VLDL converted to LDL, which represented a conversion of VLDL into LDL of 2·16 ± 01·16 h,1. Low-density lipoproteins were produced exclusively from VLDL conversion and were then removed (0·031 ± 0·004 h,1) from plasma. Conclusion, These kinetic data showed that VLDL cholesterol ester and LDL cholesterol ester metabolism followed VLDL and LDL apoB100 metabolism, and that consequently there is no in vivo transfer of cholesterol ester in dogs. [source] Mesoscale eddies and survival of late stage Pacific sardine (Sardinops sagax) larvaeFISHERIES OCEANOGRAPHY, Issue 1 2001Elizabeth A. Logerwell We examined the distribution of sardine larvae relative to environmental conditions with the purpose of identifying and characterizing habitat that encourages high larval growth and survival, based on the 1983,1998 surveys of the California Cooperative Oceanic Fisheries Investigations (CalCOFI). Long-term averages show that sardine ,survivors' (spatially aggregated larvae , 18 days old) were most abundant offshore, whereas sardine egg density, chlorophyll biomass and zooplankton volume were greatest inshore. In contrast, mesoscale eddies, observed in remotely sensed sea surface temperature imagery, were found only in offshore regions. To further examine the link between eddies , which often result in locally elevated chlorophyll and zooplankton , and sardine survival, we compared the distribution of larvae and eddies survey by survey. Sardine survivors were most abundant offshore in only one-quarter of the research surveys, and when they were most abundant offshore they were associated with eddies. This indicates that the offshore eddy habitat produced exceptionally large numbers of survivors, as evidenced by the disproportionate effect on the long-term average. [source] Origin, age and petrogenesis of Neoproterozoic composite dikes from the Arabian-Nubian Shield, SW JordanGEOLOGICAL JOURNAL, Issue 2 2004G. Jarrar Abstract The evolution of a Pan-African (c. 900,550,Ma) suite of composite dikes, with latite margins and rhyolite interiors, from southwest Jordan is discussed. The dikes cut the Neoproterozoic calc-alkaline granitoids and high-grade metamorphic rocks (c. 800,600,Ma) of the northern Arabian-Nubian Shield in Jordan and have been dated by the Rb-Sr isochron method at 566±7,Ma. The symmetrically distributed latite margins constitute less than one-quarter of the whole dike thickness. The rhyolite intruded a median fracture within the latite, while the latter was still hot but completely solidified. The dikes are alkaline and bimodal in composition with a gap in SiO2 between 61 and 74,wt%. Both end members display similar chondrite-normalized rare earth element patterns. The rhyolites display the compositional signature of A-type granites. The (La/Lu)N values are 6.02 and 4.91 for latites and rhyolites, respectively, and the rhyolites show a pronounced negative Eu anomaly, in contrast to the slight negative Eu anomaly of the latites. The chemical variability (e.g. Zr/Y, Zr/Nb, K/Rb) within and between latites and rhyolites does not support a fractional crystallization relationship between the felsic and mafic members of the dikes. We interpret the magma genesis of the composite dikes as the result of intrusion of mantle-derived mafic magma into the lower crust in an extensional tectonic regime. The mafic magma underwent extensive fractional crystallization, which supplied the necessary heat for melting of the lower crust. The products of the initial stages of partial melting (5,10%) mixed with the fractionating mafic magma and gave rise to the latite melts. Further partial melting of the lower crust (up to 30%) produced a felsic melt, which upon 50% fractional crystallization (hornblende 15%, biotite 5%, feldspars 60%, and quartz 20%) gave rise to the rhyolitic magma. Copyright © 2004 John Wiley & Sons, Ltd. [source] Hospital care of people living in residential care facilities: Profile, utilization patterns and factors impacting on quality and safety of careGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2007Sanjay Jayasinghe Background: Residents in residential care facilities (RCF) are frequent users of acute hospital services. However, the interface between the two sectors remains relatively unexplored. Our objective was to determine the patterns of utilization, characteristics and experiences of RCF residents accessing a tertiary referral center (TRC). Methods: An observational study of RCF residents presenting to the TRC emergency department (ED). The experiences of acute care services were explored for more than one-quarter of this group 2,3 days postdischarge. The carer within the RCF acted as the proxy respondent. Results: During the study period, RCF residents accounted for 2.3% of all ED presentations. These presentations involved 526 residents. The dimension "continuity of care" for the Picker Patient Experience questionnaire had the highest proportion (53.1%) reporting a problem. The likelihood of reporting a problem for "continuity of care" (odds ratio [OR], 3.58; confidence interval [CI], 1.72,7.45) and "information and education" (OR, 2.62; CI, 1.14,3.01) were higher if the resident was admitted to a ward compared to ED only. If the resident had a low level care status the likelihood of reporting a problem for "continuity of care" (OR, 2.8; CI, 1.02,7.72) also increased. The odds of RCF staff reporting a problem for "ambulance service" were significantly higher if the resident's presentation was related to a fall. (OR, 3.35; CI, 1.28,8.8). Conclusion: The utilization rates for acute hospital care in our study were similar to the two previous Australian studies. Factors at the patient and organizational level impacted significantly on problems relating to the quality and safety of care being reported. [source] Trends in Inpatient Treatment Intensity among Medicare Beneficiaries at the End of LifeHEALTH SERVICES RESEARCH, Issue 2 2004Amber E. Barnato Objective. Although an increasing fraction of Medicare beneficiaries die outside the hospital, the proportion of total Medicare expenditures attributable to care in the last year of life has not dropped. We sought to determine whether disproportionate increases in hospital treatment intensity over time among decedents are responsible for the persistent growth in end-of-life expenditures. Data Source. The 1985,1999 Medicare Medical Provider Analysis and Review (MedPAR) and Denominator files. Study Design. We sampled inpatient claims for 20 percent of all elderly fee-for-service Medicare decedents and 5 percent of all survivors between 1985 and 1999 and calculated age-, race-, and gender-adjusted per-capita inpatient expenditures and rates of intensive care unit (ICU) and intensive procedure use. We used the decedent-to-survivor expenditure ratio to determine whether growth rates among decedents outpaced growth relative to survivors, using the growth rate among survivors to control for secular trends in treatment intensity. Data Collection. The data were collected by the Centers for Medicare and Medicaid Services. Principal Findings. Real inpatient expenditures for the Medicare fee-for-service population increased by 60 percent, from $58 billion in 1985 to $90 billion in 1999, one-quarter of which were accrued by decedents. Between 1985 and 1999 the proportion of beneficiaries with one or more intensive care unit (ICU) admission increased from 30.5 percent to 35.0 percent among decedents and from 5.0 percent to 7.1 percent among survivors; those undergoing one or more intensive procedure increased from 20.9 percent to 31.0 percent among decedents and from 5.8 percent to 8.5 percent among survivors. The majority of intensive procedures in the United States were performed in the more numerous survivors, although in 1999 50 percent of feeding tube placements, 60 percent of intubations/tracheostomies, and 75 percent of cardiopulmonary resuscitations were in decedents. The proportion of beneficiaries dying in a hospital decreased from 44.4 percent to 39.3 percent, but the likelihood of being admitted to an ICU or undergoing an intensive procedure during the terminal hospitalization increased from 38.0 percent to 39.8 percent and from 17.8 percent to 30.3 percent, respectively. One in five Medicare beneficiaries who died in the hospital in 1999 received mechanical ventilation during their terminal admission. Conclusions. Inpatient treatment intensity for all fee-for-service beneficiaries increased between 1985 and 1999 regardless of survivorship status. Absolute changes in per-capita hospital expenditures, ICU admissions, and intensive inpatient procedure use were much higher among decedents. Relative changes were similar except for ICU admissions, which grew faster among survivors. The secular decline in in-hospital deaths has not resulted in decreased per capita utilization of expensive inpatient services in the last year of life. This could imply that net hospital expenditures for the dying might have been even higher over this time period if the shift toward hospice had not occurred. [source] The Costs of Decedents in the Medicare Program: Implications for Payments to Medicare+Choice PlansHEALTH SERVICES RESEARCH, Issue 1 2004Melinda Beeuwkes Buntin Objective. To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life,a group that accounts for more than one-quarter of Medicare's annual expenditures. Data Source. Medicare administrative claims for 1994 and 1995. Study Design. We calculated the payment a plan would have received under three risk-adjustment systems for each beneficiary in our 1995 sample based on his or her age, gender, county of residence, original reason for Medicare entitlement, and principal inpatient diagnoses received during any hospital stays in 1994. We compared these amounts to the actual costs incurred by those beneficiaries. We then looked for clinical categories that were predictive of costs, including costs in a beneficiary's last year of life, not accounted for by the risk adjusters. Data Extraction Methods. The analyses were conducted using claims for a 5 percent random sample of Medicare beneficiaries who died in 1995 and a matched group of survivors. Principal Findings. Medicare is currently implementing the Principal Inpatient Diagnostic Cost Groups (PIP-DCG) risk adjustment payment system to address the problem of risk selection in the Medicare+Choice program. We quantify the strong financial disincentives to enroll terminally ill beneficiaries that plans still have under this risk adjustment system. We also show that up to one-third of the selection observed between Medicare HMOs and the traditional fee-for-service system could be due to differential enrollment of decedents. A risk adjustment system that incorporated more of the available diagnostic information would attenuate this disincentive; however, plans could still use clinical information (not included in the risk adjustment scheme) to identify beneficiaries whose expected costs exceed expected payments. Conclusions. More disaggregated prospective risk adjustment methods and alternative payment systems that compensate plans for delivering care to certain classes of patients should be considered to ensure access to high-quality managed care for all beneficiaries. [source] Effect of caffeine on prospective and retrospective duration judgementsHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 5 2003Ronald P. Gruber Abstract The effects of caffeine on prospective and retrospective duration judgements were evaluated in a double-blind placebo-controlled experiment. After taking either 200,mg caffeine or a placebo, participants touched a 17-sided polygon for 15,s. Then they verbally estimated the number of angles and the duration. Participants in the prospective group were told in advance they would be making a duration estimate, whereas those in the retrospective group were not told. Caffeine reduced duration estimates in the prospective condition but not in the retrospective condition. The effect of caffeine on very long duration comparisons (the past year compared with a year at one-half and one-quarter of one's age) was also evaluated, but none was found. The findings do not support the hypothesis that caffeine affects duration experience by increasing the internal clock rate as a result of its dopamine D2 agonist properties. The hypothesis that caffeine produces its effect by enhancing memory was considered and rejected. The most parsimonious explanation is that caffeine increased arousal level, which led to a narrowing of the focus of attention to the most salient task. Copyright © 2003 John Wiley & Sons, Ltd. [source] Mode of delivery and risk of fecal incontinence in women with or without inflammatory bowel disease: Questionnaire survey,INFLAMMATORY BOWEL DISEASES, Issue 11 2007J.P.L. Ong MRCP Abstract Background: Elective cesarean section (CS) may be recommended for patients with Crohn's disease and perineal involvement. Little is known about CS rates in parous women with inflammatory bowel disease (IBD), nor the possible long-term impact of vaginal delivery and episiotomy on continence in women with IBD. Methods: Questionnaires were sent to all 777 regional members of a Colitis and Crohn's Disease patient association. Male members were asked to request their unaffected female spouse/partner to complete the forms in order to give a "control" group for comparison. Results: Forms were returned by 491 members (response rate 63%). CS had been undertaken for 37 of the 229 parous women with IBD (16%) versus 15 of the 116 without IBD (13%) (,2 = 0.62, P = NS). Only 2 women had undergone CS due to IBD. Of the parous women with IBD, 75 (33%) had persisting problems with fecal incontinence, of whom 21 (28%) dated this back to the time of vaginal delivery. By contrast, only 2 (2%) of the parous control group had suffered persisting fecal incontinence following vaginal delivery (,2 = 8.27, P < 0.01). Conclusions: Persisting fecal incontinence is reported by a significant minority of parous women with IBD, of whom over one-quarter date this back to vaginal delivery. CS is rarely recommended due to IBD alone. If our findings are confirmed in prospective studies, the threshold for recommending CS may need to be lowered for patients with IBD. (Inflamm Bowel Dis 2007) [source] Sexual boundary violations in residential drug-free therapeutic community treatmentINTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES, Issue 4 2008William H. Gottdiener Abstract The purpose of this study was to investigate the phenomenon of sexual boundary violations in residential therapeutic community (TC) programs for substance abusers using secondary data analysis methods. One hundred and ninety-seven participants who had been treated in TCs in New York City were interviewed 30 days post-discharge. Sexual boundary violations were reported by approximately one-quarter of the sample. Possible psychodynamic causes (e.g. enactments, group dynamics) of sexual boundary violations are discussed. Implications for research, theory, and for prevention of sexual boundary violations in TC programs are addressed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Burden of stroke in SingaporeINTERNATIONAL JOURNAL OF STROKE, Issue 1 2008N. Venketasubramanian Stroke is Singapore's fourth leading cause of death, with a crude death rate of 40·4/100 000 in 2006, a prevalence of 3·65% and an incidence of 1·8/1000, and is among the top 10 causes of hospitalization. Approximately one-quarter of strokes are hemorrhagic. Hospital care for acute stroke costs about US$5000. Subsidized healthcare is widely available for primary level and hospital care, as are rehabilitative services. A national stroke support group has been established. With our rapidly aging population, coupled with the high prevalence of stroke risk factors in the community, the burden of stroke is expected to increase dramatically in the years to come, posing challenges to the healthcare system and society. A national disease management plan incorporating high-quality clinical care coupled with research would be essential. [source] Backpackers in the Northern Territory of Australia,motives, behaviours and satisfactionsINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 2 2003Asad Mohsin Abstract This paper reports the findings of a study of 475 backpackers in the Northern Territory of Australia. It finds that backpackers tend to visit many of the same locations as other tourists, and like those tourists, are attracted to the natural sights of the Territory. It is also found that the backpackers can be divided into various groups. For example, of this sample about one-third had left their previous career to travel, and about 12% had just completed studies. On the other hand about one-quarter were holidaying during periods of normal paid holiday leave. It is argued that the market is not solely comprised of ,life change' or rite de passage holidaymakers. Additionally, differences are found between national groupings. Copyright © 2003 John Wiley & Sons, Ltd. [source] Predicting plant species' responses to grazingJOURNAL OF APPLIED ECOLOGY, Issue 5 2001Peter A. Vesk Summary 1The aim of this study was to identify whether plant species show consistent responses to livestock grazing. The analyses were based on 35 published studies from Australian rangelands providing 55 species response lists. The primary data set comprised 1554 responses from 829 species. 2Eight-hundred and twenty-nine species were categorized as increasers, decreasers or neutral under grazing. Of 324 species that occurred in at least two response lists, 133 (41%) responded inconsistently, increasing at least once and decreasing at least once. While 59% of species responded consistently, these results suggest that our ability to predict vegetation change under grazing is limited. 3Particular species were not inherently more or less consistent. Rather, as species occurred in more trials, the likelihood of at least one opposite response increased; no species that occurred at least eight times was wholly consistent. A binomial model indicated that the probability of an opposite response, across all species, was 0·275. 4Contrary responses within species must result from context rather than from species' traits. Species were more likely to decrease in response to grazing at lower rainfall than at higher rainfall. Forbs tended to increase under grazing at sites where wet seasons were cooler. Changing the grazing animal was weakly correlated with change in response direction, although not enough for it to be useful for manipulating pasture composition. We found little support for ideas that different responses within species are due to differences in alternative forage available, or due to non-linearity of response to grazing intensity. 5At present it appears we can predict species response direction about three-quarters of the time, at a continental scale. This represents an upper limit of the reliability of prediction based on species' traits alone. Presently we do not know what aspects of the context might allow us to predict reliably the remaining one-quarter of responses. [source] Native American impacts on fire regimes of the California coastal rangesJOURNAL OF BIOGEOGRAPHY, Issue 3 2002Jon E. Keeley Aim Native American burning impacts on California shrubland dominated landscapes are evaluated relative to the natural lightning fire potential for affecting landscape patterns. Location Focus was on the coastal ranges of central and southern California. Methods Potential patterns of Indian burning were evaluated based upon historical documents, ethnographic accounts, archaeological records and consideration of contemporary land management tactics. Patterns of vegetation distribution in this region were evaluated relative to environmental factors and the resilience of the dominant shrub vegetation to different fire frequencies. Results Lightning fire frequency in this region is one of the lowest in North America and the density of pre-Columbian populations was one of the highest. Shrublands dominate the landscape throughout most of the region. These woody communities have weak resilience to high fire frequency and are readily displaced by annual grasses and forbs under high fire frequency. Intact shrublands provided limited resources for native Americans and thus there was ample motivation for using fire to degrade this vegetation to an open mosaic of shrubland/grassland, not unlike the agropastoral modification of ecologically related shrublands by Holocene peoples in the Mediterranean Basin. Alien-dominated grasslands currently cover approximately one-quarter of the landscape and less than 1% of these grasslands have a significant native grass presence. Ecological studies in the Californian coastal ranges have failed to uncover any clear soil or climate factors explaining grassland and shrubland distribution patterns. Main conclusions Coastal ranges of California were regions of high Indian density and low frequency of lightning fires. The natural vegetation dominants on this landscape are shrubland vegetation that often form dense impenetrable stands with limited resources for Native Americans. Natural fire frequencies are not high enough to maintain these landscapes in habitable mixtures of shrublands and grasslands but such landscape mosaics are readily produced with additional human subsidy of ignitions. It is hypothesized that a substantial fraction of the landscape was type converted from shrubland to grassland and much of the landscape that underwent such type conversion has either been maintained by Euro-American land management practices or resisted recolonization of native shrublands. It appears that these patterns are disturbance dependent and result from anthropogenic alteration of landscapes initiated by Native Americans and sustained and expanded upon by Euro-American settlers. [source] | |||||||||||||||||||||||||||||||||||||||||||