Home  About us  Contact
 

Preceding Year (preceding + year)

Distribution by Scientific Domains
Medical Sciences58%
Psychology11%
Life Sciences11%

Selected Abstracts

Anemia and Cost in Medicare Patients With Congestive Heart Failure

CONGESTIVE HEART FAILURE, Issue 6 2006
Craig A. Solid MS
The objective of this study was to examine the total cost to Medicare associated with the presence of anemia in congestive heart failure (CHF) patients. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify anemia, CHF, and comorbid conditions in 2002, and total Medicare costs were calculated for 2003. The mean patient age was 77.8 years. Anemia, present in 32% of CHF patients, was associated with older age, female sex, non-white race, and increasing burden of comorbidity. The total per-member-per-month cost in 2003 was $1781.01 among CHF patients with anemia in the preceding year compared with $1142.38 for CHF patients without anemia, a ratio of 1.56 (95% confidence interval, 1.5589,1.5592). When adjustment was made for baseline demographic factors and comorbid conditions, the corresponding ratio was 1.25 (95% confidence interval, 1.2546,1.2548). Anemia, a common association of CHF in elderly patients, is an antecedent association of increased societal medical expenditure. [source]

Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy

DIABETIC MEDICINE, Issue 9 2000
U. Bott
SUMMARY Aims To evaluate a treatment and teaching programme including psychosocial modules for patients with Type 1 diabetes mellitus on intensified insulin therapy who failed to achieve their treatment goals despite participation in standard programmes. Methods The 5-day inpatient programme comprises small groups of 4,6 patients, focusing on individual needs and problems. Beyond the teaching lessons (most topics are deliberately chosen by the patients), the programme provides intensive group discussions and offers individual counselling concerning motivational aspects, psychosocial problems and coping strategies. Of the first consecutive 83 participants, 76 were re-examined after 17.5 ± 5.5 months (range 9,31 months). Results At follow-up, HbA1c was not improved compared to baseline (8.0 ± 1.3% vs. 8.1 ± 1.5%). However, the incidence of severe hypoglycaemia per patient/year (glucose i.v., glucagon injection) was substantially decreased: 0.62 ± 1.5 episodes at baseline compared to 0.16 ± 0.9 at follow-up (P < 0.001). Twenty-six per cent of the patients at baseline, and 4% at re-examination had experienced at least one episode of severe hypoglycaemia during the preceding year (P < 0.001). Sick leave days per patient/year decreased from 17.0 ± 38.5,7.7 ± 13.6 days (P < 0.05). Patients improved their perceptions of self-efficacy, their relationship to doctors and felt less externally controlled (P < 0.001). The majority of patients perceived an improved competence regarding diet (80.6%) and adaptation of insulin dosage (82.4%), an improved knowledge (82.2%), and a renewed motivation for the treatment (84.5%). Treatment success was significantly associated with baseline HbA1c, stability of motivation, frequency of blood glucose self-monitoring, control beliefs and change in subsequent outpatient care. Conclusions The programme improved glycaemic control mainly as a result of a substantial reduction in the incidence of severe hypoglycaemia. Patients with persistent poor glycaemic control may benefit from structured follow-up care focusing on motivational aspects of self-management and psychosocial support. [source]

Climate change and abundance of the Atlantic-Iberian sardine (Sardina pilchardus)

FISHERIES OCEANOGRAPHY, Issue 2 2004
C. Guisande
Abstract Climatic warming is affecting oceanic circulation patterns in coastal upwelling areas, but the impact of this climatic change on pelagic fish populations remains unclear. From juvenile landings collected over 38 years, the thresholds of environmental factors were determined that limited the optimal environmental window (OEW) for sardine (Sardina pilchardus recruitment success in the northwestern Iberian peninsula. The environmental factors considered were: water column stability in February, offshore water transport in March,April (QxMA), upwelling intensity in the preceding year from May to August (QxMJJA), and the winter North Atlantic Oscillation (NAO) index. From 1875 to the mid-1920s, the mean number of years within the OEW was relatively constant. However, since the mid-1920s, there have been oscillations and alternating decades with high and low number of years within the OEW, which were related to oscillations in sardine landings. From 1906 to 2000, there were four record, low sardine catches in the 1920s, 1950s, 1970s and 1990s, related to a high number of successive years with prevailing conditions out of the OEW. From 1875 to the present, a high year-to-year variation of the NAO, QxMJJA and water stability in February was observed, although with mean values usually within the OEW. The collapse in the 1950s was related, partly, to successive years with low QxMJJA. Successive years with high NAO values may be related to the collapse of the sardine fishery in the 1990s. QxMA has been the most significant factor controlling SRS in this area, being the factor related to the low catches observed in the 1920s, 1950s and 1970s. Water stability was not responsible for any of the collapses observed, but since the 1920s, there has been a significant trend toward decreasing water column stability before the onset of the spring bloom. [source]

Association of Sphaeropsis sapinea with insect-damaged red pine shoots and cones

FOREST PATHOLOGY, Issue 1 2003
E. Feci
Summary The association of the shoot blight and canker pathogen Sphaeropsis sapinea with red pine (Pinus resinosa) shoots and cones damaged by insects (especially Dioryctria sp.) was investigated. Samples from a single plantation approximately 35 years old, in Sauk Co., Wisconsin and also from three plantations, between approximately 40 and 50 years old, located in an area of pine shoot moth activity in the preceding year in Adams Co., Wisconsin were visually examined. Samples were arbitrarily collected from trees felled in the first plantation in May. Pycnidia of S. sapinea and insect damage were observed on 56 of 91 (62%) of closed cones and 17 of 165 (7%) of previous year's shoots. In the absence of insect damage, pycnidia of the pathogen were identified only on eight of 91 (9%) closed cones and never on previous year's shoots. In each of the other three plantations, 10 trees were located at intervals along transects in mid-June; one branch from the lower half of the crown per tree was pruned off, and both current and previous year's shoots were examined. Insect damage and S. sapinea pycnidia were too rare on current year's shoots to draw any conclusions. Insect damage occurred on 20,40% of over 2000 previous year's shoots that were examined, but pycnidia of the pathogen were identified on only about 5%. Although infrequent, S. sapinea was identified in association with insect-damaged previous year's shoots from these three plantations three times more frequently than those without insect damage. Random amplified polymorphic DNA (RAPD) markers from eight randomly selected isolates were consistent with the A group of S. sapinea, which can be aggressive on red pine. This ability to exploit insect-damaged shoots may facilitate long-term persistence of S. sapinea at low disease incidence and severity. The potential role of insect wounds as infection courts and insects as vectors of this important pathogen of pines deserves further study. Résumé L'étude a porté sur l'association entre le parasite de pousses et agent de chancre Sphaeropsis sapinea, et les pousses et cônes de Pinus resinosa endommagés par des insectes (surtout Dioryctria sp.). Des échantillons ont été examinés visuellement; ils provenaient d'une plantation d'environ 35 ans à Sauk Co., Wisconsin, et de trois plantations âgées d'environ 40 et 50 ans situées dans une zone où les insectes des pousses avaient été actifs l'année précédente à Adams Co., Wisconsin. Dans la première plantation, les échantillons ont été prélevés arbitrairement sur des arbres abattus en mai. Des pycnides de S. sapinea et des dégâts d'insectes ont été observés sur 56/91 (62%) des cônes fermés et sur 17/165 (7%) des pousses de l'année précédente. En l'absence de dégâts d'insectes, les pycnides n'ont été trouvées que sur 8/91 (9%) des cônes fermés, et jamais sur les pousses de l'année précédente. Dans chacune des trois autres plantations, 10 arbres ont été choisis à la mi-juin le long de transects ; sur chaque arbre une branche a été coupée dans la moitié inférieure de la couronne, et les pousses de l'année en cours et de l'année précédente ont été examinées. Sur les pousses de l'année, les dégâts d'insectes et les pycnides de S. sapineaétaient trop rares pour pouvoir en tirer des conclusions. Parmi plus de 2000 pousses de l'année précédente examinées, les dégâts d'insectes étaient présents sur 20,40% des pousses, mais les pycnides n'ont été trouvées que sur environ 5% d'entre elles. Bien que peu fréquent chez ces trois plantations, S. sapinea a été trouvé associé aux pousses de l'année précédente, 3 fois plus fréquemment chez celles endommagées par les insectes que chez les non endommagées. Pour huit isolats pris au hasard, les marqueurs RAPD ont indiqué leur appartenance au groupe A de S. sapinea qui peut être agressif sur P. resinosa. Cette aptitude de S. sapineaà utiliser les pousses endommagées par les insects peut faciliter sa persistance à long terme à des niveaux bas d'abondance et de dégâts. Le rôle potentiel des blessures d'insectes comme voies d'infection, et des insectes comme vecteurs du champignon parasite mérite d'être étudié. Zusammenfassung Es wurde die Assoziation zwischen Sphaeropsis sapinea (Erreger von Triebsterben und Rindennekrosen) und Schädigung an Trieben und Zapfen von Pinus resinosa untersucht, durch Insekten (vorwiegend Dioryctria sp.) untersucht. Proben von einer ca. 35 Jahre alten Plantage in Sauk Co., Wisconsin und von drei 40-50jährigen Plantagen mit Dioryctria -Befall im Vorjahr in Adams Co., Wisconsin wurden makroskopisch untersucht. Die Proben am ersten Standort wurden von Bäumen entnommen, die im Mai gefällt wurden (willkürliche Auswahl). Pyknidien und Schädigung durch Insekten wurden an 56/91 (62%) der geschlossenen Zapfen und an 17/165 (7%) der vorjährigen Triebe beobachtet. An Organen ohne Schädigung durch Insekten wurden die Pyknidien des Pathogens nur bei 8/91 (9%) der geschlossenen Zapfen und in keinem Fall an den vorjährigen Trieben nachgewiesen. In den anderen drei Plantagen wurden Mitte Juni je 10 Bäume entlang von Transekten untersucht; pro Baum wurde aus dem unteren Kronenbereich ein Ast abgeschnitten und sowohl die diesjährigen als auch die vorjährigen Triebe wurden untersucht. An den diesjährigen Triebabschnitten waren sowohl Schädigungen durch Insekten als auch Pyknidien von S. sapinea zu selten, um daraus Schlüsse zu ziehen. An den vorjährigen Triebabschnitten kamen Insektenschäden an 20,40% von über 2,000 untersuchten Objekten vor, aber Pyknidien des Pathogens wurden nur in 5% der Fälle nachgewiesen. Trotz des geringen Vorkommens wurde S. sapinea auf den vorjährigen und von Insekten beschädigten Trieben dreimal häufiger nachgewiesen als an Trieben ohne Beschädigung. Acht zufällig ausgewählte Isolate wurden anhand von RAPD Markern der Gruppe A von S. sapinea zugeordnet, die auf P. resinosa agressiv sein kann. Die Fähigkeit von S. sapinea, durch Insekten beschädigte Triebe zu nutzen, kann das Überdauern des Pilzes auf einem niedrigen Befallsniveau erleichtern. Die Bedeutung von Wunden, die durch Insekten verursacht werden, als Infektionspforten und die mögliche Rolle von Insekten als Vektoren dieses wichigen Pathogens sollte in weiteren Untersuchungen geklärt werden. [source]

Controls on runoff from a partially harvested aspen-forested headwater catchment, Boreal Plain, Canada

HYDROLOGICAL PROCESSES, Issue 1 2005
K. J. Devito
Abstract The water balance and runoff regime of a 55 ha aspen-forested headwater catchment located on the Boreal Plain, Alberta, Canada (55·1°N, 113·8°W) were determined for 5 years following a partial timber harvest. Variability in precipitation provided the opportunity to contrast catchment water balances in relatively dry (<350 mm year,1), wet (>500 mm year,1), and average precipitation years. In most years, the catchment water balance was dominated by soil water storage, evapotranspiration losses, and vertical recharge. In 1997, despite near-average annual precipitation (486 mm), there was significant runoff (250 mm year,1) with a runoff coefficient of 52%. A wet summer and autumn in the preceding year (1996) and large snow accumulation in the spring (1997) reduced the soil water storage potential, and large runoff occurred in response to a substantial July rainfall event. Maps of the surface saturated areas indicated that runoff was generated from the uplands, ephemeral draws, and valley-bottom wetlands. Following 1997, evapotranspiration exceeded precipitation and large soil water storage potentials developed, resulting in a reduction in surface runoff to 11 mm in 1998, and <2 mm in 1999,2001. During this time, the uplands were hydrologically disconnected from ephemeral draws and valley-bottom wetlands. Interannual variability was influenced by the degree of saturation and connectivity of ephemeral draws and valley wetlands. Variability in runoff from tributaries within the catchment was influenced by the soil water storage capacity as defined by the depth to the confining layer. An analysis of the regional water balance over the past 30 years indicated that the potential to exceed upland soil water storage capacity, to connect uplands to low-lying areas, and to generate significant runoff may only occur about once every 20 years. The spatial and temporal variability of soil water storage capacity in relation to evaporation and precipitation deficits complicates interpretation of forest harvesting studies, and low runoff responses may mask the impacts of harvesting of aspen headwater areas on surface runoff in subhumid climates of the Boreal Plain. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Prevalence of Tooth Loss and Dental Service Use in Older Mexican Americans

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2001
Whitney M. Randolph BS
OBJECTIVES: To describe the prevalence of tooth loss, to examine risk factors for having fewer teeth or no teeth, and to describe the use of dental services in an older Mexican-American population. DESIGN: Data from the baseline phase of the Hispanic Established Population for the Epidemiological Study of the Elderly survey conducted from 1993 to 1994, a cross-sectional survey of older Mexican Americans. SETTING: Five southwestern states: Texas, California, Arizona, New Mexico, and Colorado. PARTICIPANTS: 3,050 noninstitutionalized Mexican Americans age 65 to 99. RESULTS: Twenty-seven percent of the sample was completely edentulous and 22% reported visiting or speaking with a dental care professional in the preceding year. Logistic regression analyses showed that being older or being female was significantly associated with tooth loss, adjusting for education, income, smoking status, and diabetes mellitus. Current smokers (odds ratio (OR) = 1.69; 95% CI = 1.31,2.20) and diabetics (OR = 1.53; 95% CI = 1.27,1.84) were more at risk for tooth loss, as were persons of lower socioeconomic status. CONCLUSIONS: The prevalence of tooth loss and use of dental services in this population of older Mexican Americans is lower than what has been previously found among older people in the general population. [source]

Aggression towards health care staff in a UK general hospital: variation among professions and departments

JOURNAL OF CLINICAL NURSING, Issue 1 2004
Sue Winstanley BSc
Background., Aggression towards health care staff is an increasing problem and although many studies have examined psychiatric settings, few have considered general hospitals and in particular, variation among professions and locations. In addition, studies often fail to include all forms of aggression such as threatening behaviour and verbal aggression. Methods., This study extends existing research by evaluating physical assault, threatening behaviour and verbal aggression from patients/visitors towards general hospital staff in the context of different professions and departments. Results and conclusions., The survey of staff showed that aggression is widespread. Within the preceding year, 27% of the respondents were assaulted, 23% experienced threatening behaviour from patients and 15.5% experienced threatening behaviour from visitors. Over 68% reported verbal aggression, 25.7% experiencing it more regularly than monthly. By departments, over 42% of the medical department staff, 36% of the surgical staff and over 30% of the Accident and Emergency staff were assaulted. By profession, staff nurses and enrolled nurses reported the most assaults (43.4%) and doctors, the fewest (13.8%). Other nursing grades and health care professions all reported levels of physical assault in excess of 20%. Correspondingly high levels of threatening behaviour and verbal aggression were also reported although the patterns of victimization differed according to the various professions and departments. Independently, significant levels of assault, threatening behaviour and verbal aggression were reported. When aggregated they demonstrate the higher levels of victimization that general hospital staff experienced on a regular basis. Relevance to clinical practice., Institutional averages actually obscure the much higher levels of aggression experienced by the particular professions in particular departments. This study helps to localize the problem and identify those at most risk, but more research is needed into the aetiology of the aggression and of vulnerability factors associated with victimization. [source]

Expanding self-help group participation in culturally diverse urban areas: Media approaches to leveraging referent power

JOURNAL OF COMMUNITY PSYCHOLOGY, Issue 4 2004
Keith Humphreys
Accumulating research attests to the benefits of self-help groups for people who have various chronic health problems. Expansion of self-help group participation may enable a broader portion of society to experience these health benefits. The Media and Education for Self-Help (MESH) Project was an effort to increase interest in health-related self-help groups among middle- and lower-income people in two California urban areas with minority,majority populations. A diverse coalition of self-help group leaders designed English- and Spanish-language radio public service announcements and posters that were disseminated in Oakland and Los Angeles. The outcome measures in each urban area were self-help-group-related telephone inquiries to local information and referral agencies (English and Spanish language) and the number of individuals attending self-help groups at agencies hosting many groups. Telephone caller data were also gathered in a nonintervention control urban area (Sacramento). Los Angeles experienced an overall increase in telephone calls about self-help groups during the MESH intervention, whereas the control urban area had no change in the number of telephone calls over the same period. The initial sharp increase in self-help-group-related telephone calls was not sustained in Oakland, however. The number of Spanish-language calls about self-help groups increased 821% in Los Angeles and 149% in Oakland in the period from the 6 months that preceded the project through the first 6 months of the MESH Project. In the MESH Project urban areas, the number of visits to self-help groups was significantly higher in intervention months than in the same calendar months of the preceding year, particularly in Oakland, where the increase exceeded 300 visits to self-help groups per month. These intriguing findings are discussed in terms of their health policy and program evaluation implications. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 413,424, 2004. [source]

Latitudinal population differentiation in phenology, life history and flower morphology in the perennial herb Lythrum salicaria

JOURNAL OF EVOLUTIONARY BIOLOGY, Issue 6 2002
K. Olsson
Abstract In plants with a wide distribution, phenological characters can be expected to vary clinally along climatic gradients, whereas other characters important for adaptation to local biotic and abiotic factors may vary in a more mosaic fashion. We used common-garden experiments and controlled crosses to examine population differentiation in phenology, life history and morphology in the perennial herb Lythrum salicaria along a latitudinal transect through Sweden (57°N to 66°N). Northern populations initiated growth and flowering earlier, flowered for a shorter period, were shorter, produced more and larger winter buds, and were older at first reproduction than southern populations. Flower morphology varied significantly among populations, but was, with the exception of calyx length, not significantly related to latitude of origin. Survival in the common garden (at 63°49,N) was positively correlated with latitude of origin and the size and number of winter buds produced in the preceding year. The results suggest that the among-population differences in phenology and life history have evolved in response to latitudinal variation in length of the growing season. Further studies are required to determine whether population differentiation in flower morphology is maintained by selection. [source]

A pilot study of PTSD symptoms among Kalahari Bushmen

JOURNAL OF TRAUMATIC STRESS, Issue 5 2003
George J. McCall
Abstract This study reflects an attempt to assess posttraumatic stress disorder (PTSD) in a radically nonwestern culture, that of the Kalahari Bushmen, the Ju/'hoansi. After translating DSM-IV PTSD symptoms into their difficult and click-laden language, potential participants were nominated by village elders who were aware of domestic violence and symptoms during the preceding year. Ten men and 10 women, identified as meeting Criteria A, E, and F, were interviewed regarding their symptoms. Thirty-five percent of the sample met the criteria for PTSD for incidents occurring within the past year. All participants met the reexperiencing and arousal criteria but many otherwise distressed participants did not meet the avoidance criterion for PTSD. These results compare closely with PTSD assessments in other non-Western societies, while providing some empirical support of two new ideas about how the avoidance behaviors in such societies might be reconciled with information-processing theories of PTSD. [source]

Latest news and product developments

PRESCRIBER, Issue 17 2007
Article first published online: 6 NOV 200
Drug information stilllacking for mentally ill Half of people with mental illness still have no say in the medication they are prescribed and one-third are not informed about side-effects, according to the latest report by the Healthcare Commission and the Commission for Social Care Inspection (www.health-carecommission.org.uk). The annual national review of adult mental health services found overall improvement among local intervention teams in 2005/06 compared with the preceding year, though all could improve further and the performance of 46 per cent were rated as only fair or weak. A survey of 7446 people with schizophrenia also showed that only 46 per cent had access to psychological treatments. More incentives for shift of care in Scotland Scotland has made good progress on shifting NHS care into the community but joined-up thinking, better information and incentives are needed to overcome barriers to better management of long-term conditions in adults, says Audit Scotland (www.audit-scotland.gov.uk). Reviewing progress on the 2005 strategy document Delivering for Health, Audit Scotland found good progress on asthma and diabetes services , partly due to the effects of the GMS contract. Better information about clinical activity, costs and effectiveness is needed to help redesign services. Patients with more than one long-term condition do not receive co-ordinated care and many want greater involvement in their care, the report concluded. Acorn, QOF and Guy Rotherham awards Entries are invited for the 2007 annual Acorn, QOF and Guy Rotherham Awards. The awards are run in association with the NHS Alliance, Improvement Foundation, British Cardiac Society, British Cardiac Patients Society and Prescriber. The CHD QOF Award, sponsored by Schering-Plough, recognises the achievement of an individual practice that gains maximum points in the CHD and heart failure QOF domains, and a second award is given to the primary care organisation (PCO) that achieves the best average scores across its practices. The entry form can be found at www.escriber.com. The closing date is 12 October. Entries are also invited for the Guy Rotherham Award from PCOs that can demonstrate they have delivered a high-impact change resulting in better outcomes and services for patients. For online entry go to www.improvementfoundation.org/guy rotherhamaward. Closing date is 5 October. Award winners will receive free entry for three to the NHS Alliance conference and the conference dinner. The winner of the Guy Rotherham Award will also receive £3000. NICE scores five out of six NICE acted unreasonably in relying solely on the Mini-Mental State Examination (MMSE) to define severity of Alzheimer's disease in its updated technology appraisals, with the effect of discriminating against people with learning or language difficulties, the High Court has ruled. The five other claims by Eisai that NICE acted unreasonably and irrationally were not upheld. This was the first court action against NICE in its eight-year history. It has now promised to publish revised appraisals on its website on 7 September and is consulting with Eisai, Shire Pharmaceuticals and the Alzheimer's Society on the best approach. PPRS reform follows Office of Fair Trading report The Government is to renegotiate the Pharmaceutical Price Regulation Scheme (PPRS) following the critical report by the Office of Fair Trading (OFT). In February, the OFT recommended renegotiation of the PPRS to reward innovation and obtain better value for patients. In particular, it called for a pricing scheme based on value for patients, ie effectiveness, rather than profit controls. The DoH, acknowledging the report's complexity, says it will take four principles into account in its negotiations during the forthcoming months: value for money, promoting innovation, assisting the uptake of new cost-effective medicines and promoting market stability. MHRA launches e-bulletin The MHRA (www.mhra.gov.uk) has next issue can be downloaded. The launched an electronic bulletin to August bulletin includes items on provide health professionals with antidepressants and suicide, updates about the safe use of medi-adverse effects of dopamine ago-cines. Users need to sign up to nists and information about smokreceive an e-mail alert when the ing cessation and isotretinoin. DURG call for abstracts The Drug Utilisation Research Group is calling for abstracts for its 19th annual meeting ,Target-driven medicine , is this the end of prescribing freedom?' to be held on 7 February 2008 at the Royal Society of Medicine, London. Abstracts are requested on any aspects of drug utilisation research. A bursary of £500 will be awarded for the best abstract received. The closing date for receipt of abstracts is 26 November. Further information about abstract submission is available at www.durg.org.uk. GP prescribing up by half Prescription volume and costs in England increased by approximately half over the decade to 2006, according to data published by the Information Centre for Health and Social Care (www.ic.nhs.uk). The number of items dispensed per year increased by 55 per cent and the cost by 60 per cent in real terms. The average number of items per head of population was 10.0 in 1996 and 14.8 in 2006; older people received 21.2 items per head in 1996 but 40.8 in 2006. MR morphines similar Modified-release preparations of morphine are equivalent in the treatment of severe pain, according to a new review by Bandolier (www.jr2.ox.ac.uk). The analysis of 54 randomised trials, which reviewed the release mechanisms and clinical data for four brands, showed these preparations provide effective analgesia for malignant and nonmalignant pain; about 4 per cent of patients were unable to tolerate the adverse effects of morphine. NSAIDs compared in OA Etoricoxib (Arcoxia) and naproxen are equally effective in the long-term treatment of osteoarthritis (Ann Rheum Dis 2007;66:945,51). Extension studies for two one-year trials showed that, after a total of 138 weeks, the two drugs had almost identical effects on pain and function assessments. All treatments were generally well tolerated, but serious cardiovascular effects were more common with etoricoxib and serious GI effects more common with naproxen. CPN nystatin allowed Community practitioner nurses (CPNs) may now prescribe oral nystatin (Nystan) to treat oral thrush in neonates, following a special amendment to the regulations limiting their prescribing to licensed indications. CPNs may now prescribe oral nystatin at the dose recommended in the BNF for Children provided they are sure of the diagnosis. In doing so, they accept clinical and medicolegal responsibility for their actions. There are no other exceptions to the prohibition of off-label prescribing. Copyright © 2007 Wiley Interface Ltd [source]

Risk factors for suicide following hospital discharge among cancer patients

PSYCHO-ONCOLOGY, Issue 10 2009
Herng-Ching Lin
Abstract Objectives: This study aims to examine risk factors associated with 3-month post-discharge suicide among cancer patients using Taiwan's nationwide, population-based datasets. Methods: The study cohort comprised all cancer patients discharged from hospitals from 2002 to 2004, inclusive, who committed suicide within 90 days of discharge (n=311). The control group consisted of 1555 cancer patients who did not commit suicide within 90 days of discharge. The dependent variable was whether or not a patient committed suicide within 90 days of discharge, while the independent variables included patient, hospital and physician characteristics at index hospitalization. Cox proportional hazard regression was carried out to compute the 90-day survival rate, adjusting for possible confounding factors. Results: The mean interval from discharge to suicide was 39.7 days (±95.2) and almost half (46.3%) of the 3-month post-discharge suicides occurred within 14 days after discharge. The adjusted hazard of committing suicide for patients who were not hospitalized in the preceding year was 1.68 (p=0.009), 1.61 (p=0.033), and 2.51 (p<0.001) times greater, respectively, than patients who were hospitalized once, twice and more than twice within the year before index hospitalization. The hazard of committing suicide among patients who were unemployed was 1.71 (p<0.001) times that of their employed counterparts. Conclusions: We conclude that, while our study was limited to suicides among cancer patients within 90 days of discharge, around 60% of deaths occurred within the first month after discharge. The relevant risk factors include the number of hospitalizations within 1 year and employment status. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Strategic Party Government: Party Influence in Congress, 1789,2000

AMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 3 2007
Matthew J. Lebo
Why does the influence of Congressional parties fluctuate over time? Building on prevailing answers, we develop a model, Strategic Party Government, which highlights the electoral motives of legislative parties and the strategic interaction between parties. We test this theory using the entire range of House and Senate party behavior from 1789 to 2000 and find that the strategic behavior of parties complements members' preferences as an explanation for variation in party influence. Specifically, the strongest predictors of one party's voting unity are the unity of the opposing party and the difference between the parties in the preceding year. Moreover, we find strong links between party behavior in Congress and electoral outcomes: an increase in partisan influence on legislative voting has adverse electoral costs, while winning contested votes has electoral benefits. [source]

Impact of exposure to war stress on exacerbations of multiple sclerosis

ANNALS OF NEUROLOGY, Issue 2 2008
Daniel Golan MD
Objective To assess the relation between stress caused by the perils of rocket attack on civilian centers in northern Israel during the 2006 war between Hezbollah and Israel and multiple sclerosis (MS) exacerbations. Methods Participants were 156 patients with relapsing-remitting MS. We compared the number of relapses during and after the war with similar time periods at the preceding year. Exposure to war events and resulting subjective stress were evaluated by means of structured interviews using questionnaires previously validated. Results During the 33 days of the war, there were 18 relapses among our patients, compared with 1 to 6 relapses in similar time periods over the 12 months before the war (p < 0.001,0.02). There was no increase in relapse rate during the 3 months that followed the war (p = 0.58). The percentage of patients reporting the experience of intense subjective stress during the hostilities was significantly greater among patients with wartime relapse compared with the rest of the patients (44 vs 20%). The proportion of patients reporting high levels of distress associated with exposure to rocket attacks, displacement from home, and perceived life threat was greater in relapsing patients compared with those in remission (67 vs 42%, p = 0.05; 33 vs 11%, p = 0.02; and 33 vs 15%, p = 0.08, respectively). Interpretation Our data suggest that civilian exposure to war stress is associated with increased risk for MS relapse. These findings provide insight to stress-related risk factors associated with relapses of MS. Ann Neurol 2008 [source]

Identification of Fall Risk Factors in Older Adult Emergency Department Patients

ACADEMIC EMERGENCY MEDICINE, Issue 3 2009
Christopher R. Carpenter MD
Abstract Objectives:, Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED). Methods:, This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence. Results:, A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one's own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55). Conclusions:, Falls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non,fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping one's own toenails, and previous falls are all associated with falls after ED discharge. [source]

Risk factors for infections with multidrug-resistant Pseudomonas aeruginosa in patients with cancer

CANCER, Issue 1 2005
Norio Ohmagari M.D.
Abstract BACKGROUND Pseudomonas aeruginosa is responsible for a wide range of infections. In immunocompromised patients with cancer, the emergence of multidrug resistant P. aeruginosa may have grave consequences. METHODS Patients with cancer who were infected with multidrug-resistant P. aeruginosa with polyclonal DNA restriction patterns were used as the case group. Two control groups were used: one group of cancer patients who were infected with multidrug-susceptible P. aeruginosa and another group of cancer patients who had the same underlying disease and the same intensive care unit exposure as patients in the case group but who were not infected or colonized by P. aeruginosa. RESULTS Risk factors that were associated significantly with multidrug-resistant P. aeruginosa infection were the use of carbapenem for , 7 days, a history of P. aeruginosa infection during the preceding year, and a history of chronic obstructive pulmonary disease (P < 0.01). CONCLUSIONS Carbapenems may need to be used more judiciously as first-line empirical therapy for cancer patients with prior pseudomonal infection or chronic obstructive pulmonary disease who require hospitalization, and alternative, antipseudomonal antibiotic regimens may need to be considered, especially in this patient population. Cancer 2005. © 2005 American Cancer Society. [source]

Risk factors for extended-spectrum ,-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections

CLINICAL MICROBIOLOGY AND INFECTION, Issue 2 2010
Ö. K. Azap
Clin Microbiol Infect 2010; 16: 147,151 Abstract The aim of this prospective cohort study was to determine the risk factors for community-acquired urinary tract infections (UTIs) caused by extended-spectrum ,-lactamase (ESBL)-positive Escherichia coli and the distribution of the ESBL enzyme types. Structured forms were filled in for patients diagnosed with community-acquired UTI in four different geographical locations in Turkey. The forms and the isolates were sent to the central laboratory at Baskent University Hospital, Ankara. Antimicrobial susceptibility was determined according to the CLSI criteria. PCR and DNA sequencing were used to characterize the blaTEM, blaCTX-M and blaSHV genes. Multivariate analysis was performed using logistic regression. A total of 510 patients with UTI caused by Gram-negative bacteria were included in this study. ESBLs were detected in 17 of 269 (6.3%) uropathogenic E. coli isolates from uncomplicated UTIs and 34 of 195 (17.4%) E. coli isolates from complicated UTIs (p <0.001). According to multivariate analysis, more than three urinary tract infection episodes in the preceding year (OR 3.8, 95% CI 1.8,8.1, p <0.001), use of a ,-lactam antibiotic in the preceding 3 months (OR 4.6, 95% CI 2.0,0.7, p <0.001) and prostatic disease (OR 9.6, 95% CI 2.1,44.8, p 0.004) were found to be associated with ESBL positivity. The percentages of isolates with simultaneous resistance to trimethoprim,sulphamethoxazole, ciprofloxacin and gentamicin were found to be 4.6% in the ESBL-negative group and 39.2% in the ESBL-positive group (p <0.001). Forty-six of 51 ESBL-positive isolates (90.2%) were found to harbour CTX-M-15. Therapeutic alternatives for UTI, particularly in outpatients, are limited. Further clinical studies are needed to guide the clinicians in the management of community-acquired UTIs. [source]