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Kinds of Attendants Terms modified by Attendants Selected AbstractsIncidence of Cancer Among Female Flight Attendants: A Meta-AnalysisJOURNAL OF TRAVEL MEDICINE, Issue 3 2006Osamu Tokumaru MD Background Airline flight personnel work in a unique environment with exposure to known or suspected carcinogens and mutagens including ionizing cosmic radiation. A meta-analysis was conducted to study whether the occupational exposure of female flight attendants (FA) increased their relative risk of cancer incidence. Methods A bibliographical computer search from 1966 to 2005 of cancer incidence cohort studies of female FA was performed. Combined relative risks (RRc) in cancer incidence were calculated by means of meta-analysis. Results RRc and 95% confidence interval (CI) for malignant melanoma and breast cancer in female FA were 2.13 (95% CI: 1.58,2.88) and 1.41 (1.22,1.62) (p < 0.0001). Excess risk was not significant for all-site cancer with RRc of 1.10 (0.99,1.21). Conclusions The meta-analysis confirmed the significantly increased risks for malignant melanoma and breast cancer in female FA. Increased exposure to cosmic radiation during flight has been suggested as a potential occupational risk factor. Ultraviolet radiation exposure on board seems an unlikely occupational risk, but nonoccupational leisure time sun exposure is a possible risk factor. The etiology of the observed increase in incidence of some cancers remains controversial because assessment of possible confounders, especially nonoccupational exposure factors, has thus far been limited. [source] Among- and within-population variability in tolerance to cadmium stress in natural populations of Daphnia magna: Implications for ecological risk assessmentENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 5 2002Carlos Barata Abstract Previous attempts to test the hypothesis that laboratory selection of isogenetic populations can produce test organisms with a significantly increased mean tolerance to toxic substances have failed. One possible explanation for such failure is that the tolerance of laboratory populations is largely constrained by their origins (were the source populations composed of tolerant genotypes?). To address this question, among- and within-population variability in stress tolerance was assessed by calculating the variance in individual fitness and longevity across a cadmium gradient (0,10 ,g/L). The study employed Daphnia magna clones from four geographically separate European populations. Results revealed significant differences in tolerance to lethal levels of toxic stress among populations. The distribution of tolerances within two of the studied populations showed high amounts of genetic variation in tolerance. Genetic relationships between tolerance traits and life history performance under nonstressful environments differed among the studied populations. One population showed significant but low costs associated with tolerance, whereas no costs were associated with tolerance in the other population. These results suggest that laboratory selection will favor individuals with high fitness or reproductive performance under optimal laboratory conditions resulting in laboratory populations with similar or lower tolerance to toxic stress than their original field populations. Given that populations can exhibit high levels of genetic variability in tolerance to toxic stress, minimizing genetic diversity in toxicity tests will increase the uncertainty attendant in extrapolating from the lab to the field. [source] English Further Education through American EyesHIGHER EDUCATION QUARTERLY, Issue 4 2009Kevin J. Dougherty This article examines various commonalities and divergences between the English further education system and its nearest US equivalent, the community college system. In terms of commonalities, the article discusses the reliance on sub-university institutions to provide access to higher education, persistent dilemmas attendant to that reliance and conflicts over efforts to make non-university post-secondary institutions become more specialised in their missions. With regard to divergences, this article examines differences between the two types of institution in the strength of transfer arrangements, the ability to award the baccalaureate degree, the competitive environment and the balance between national and sub-national governance. [source] Incomplete Contracting, Commission Discretion and the Origins of EU Merger Control,JCMS: JOURNAL OF COMMON MARKET STUDIES, Issue 3 2009THOMAS DOLEYS Council Regulation 4064/89 on the Control of Concentration between Undertakings, more commonly known as the Merger Regulation , was a watershed development in the evolution of the EU's competition policy regime. In this article we seek to cast new analytical light on what, in many respects, is an established narrative. To do this we draw on insights from the new institutional economics (NIE). Specifically, we draw on the complementary concepts of incomplete contracting and delegation. We demonstrate how the Commission utilized the discretion attendant to its delegated authority to interpret and apply the indeterminate language of treaty competition articles so as to alter the economic, political and legal environment as it pertained to merger activity. It did so to such an extent that Member States, long resistant to Commission proposals for a merger control regulation, came to regard legislative action as preferable to the uncertainty represented by the evolving status quo. [source] Ocean liner shipping: Organizational and contractual response by agribusiness shippers to regulatory changeAGRIBUSINESS : AN INTERNATIONAL JOURNAL, Issue 4 2003Hayden G. Stewart The Ocean Shipping Reform Act of 1998 (OSRA) promotes changes in international ocean liner shipping. An important policy issue attendant to the passage of OSRA is the Act's likely impact on the international competitiveness of the sectors that depend upon ocean shipping. Thus, to establish how freight rates and other logistical costs of using ocean liner services are now determined, this study examines emerging methods of organization and contracting among exporters of food and forest products. We find that, although many shippers negotiate private contracts with carriers, many others utilize a third-party agent to negotiate a rate with a carrier on their behalf. This article also identifies differences between two key types of third-party agents. Finally, given that a shipper in this trade does not contract directly with a carrier, this article explains the shipper's conditional choice about which type of agent to use. [EconLit citations: L140, L980, Q130]. © 2003 Wiley Periodicals, Inc. Agribusiness 19: 459,472, 2003. [source] Multicontextual occupational therapy intervention: a case study of traumatic brain injuryOCCUPATIONAL THERAPY INTERNATIONAL, Issue 1 2001Belkis Landa-Gonzalez Abstract Cognitive deficits after a traumatic brain injury can result in significant functional limitations in all areas of daily living. An individual's ability to generalize learning may be limited, thus making it harder to live independently in the community. Assessing a client's metacognitive skills and awareness level may help to establish a baseline understanding about the supervision required and the most suitable living arrangements. This study describes a multicontextual, community re-entry occupational therapy programme directed at awareness training and compensation for cognitive problems in a 34-year-old man with traumatic brain injury. Intervention consisted of metacognitive training, exploration and use of effective processing strategies, task gradations and practice of functional activities in multiple environmental contexts. Strategies such as self-prediction, self-monitoring, role reversal and the use of checklists were used. Results after six months of intervention show improvements in the client's awareness level, enhancement of his occupational function, increased satisfaction with performance and a decrease in the level of attendant care. Additional studies are recommended to validate the findings. Copyright © 2001 Whurr Publishers Ltd. [source] Development of historical exposure estimates of cosmic radiation and circadian rhythm disruption for cohort studies of Pan Am flight attendants,,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2009Martha A. Waters PhD Abstract Background The National Institute for Occupational Safety and Health is conducting cohort studies of flight crew employed by the former Pan American World Airways company (Pan Am) as part of an effort to examine flight crew workplace exposures and health effects. Flight crew are exposed to elevated levels of cosmic radiation and to disruption of circadian rhythm when flying across multiple time zones. Methods exist to calculate cosmic radiation effective doses on individual flights; however, only work histories which provided an employee's domicile (home base) history rather than a record of every flight flown were available. Methods/Results We developed a method for estimating individual cumulative domicile-based cosmic radiation effective doses and two metrics for circadian rhythm disruption for each flight attendant: cumulative times zones crossed and cumulative travel time during the standard sleep interval. Conclusions The domicile-exposure matrix developed was used to calculate exposure estimates for a cohort mortality study of former Pan Am flight attendants. Am. J. Ind. Med. 52:751,761, 2009. Published 2009 Wiley-Liss, Inc. [source] Proceedings of the 20th Annual Conference of the Japanese Association for Adolescent Psychotherapy, 16 November 2002, Tokyo, JapanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2003Article first published online: 28 AUG 200 Inpatient treatment of obsessive,compulsive disorder in a child and adolescent psychiatry ward M. USAMI National Center of Neurology and Psychiatry, Kohnodai Hospital, Chiba, Japan This is a case report of a 13-year-old-boy (2nd grade in junior high school). His father had poor communication; his mother was a very fragile woman. The boy had been overprotected by his parents, as long as he responded to their expectations. He did not have any other siblings. He played well with his friends since he was young, and did not have problems until the 1st term (from April to July) of 1st grade in junior high school. However, in September he started to have difficulties going well with his friends, and going to school. He spent most of his time in his room, and began to repeat checking and hand-washing frequently. Even at midnight, he forced his mother to touch the shutter from outside of the house for many times. He also ritually repeated to touch his mother's body, after he licked his hands, for over an hour. He became violent, when his parents tried to stop him. In April, year X, his parents visited our hospital for the first time. From then, his mother could not tolerate her son's coerciveness any longer. His father explained to the boy that ,your mother has been hospitalized', and she started to live in the next room to the boy's without making any noise. After 3 months he noticed that his mother was not hospitalized, and he got very excited. He was admitted to our hospital with his family and relatives, in October, year X. At the initial stage of hospitalization he showed distrust and doubt towards the therapist and hospital. He had little communication with other boys and did not express his feelings. Therefore, there was a period of time where he seemed to wonder whether he could trust the treatment staff or not. During his interviews with his therapist he repeated only ,I'm okay' and did not show much emotional communication. For the boy, exposing himself was equivalent to showing his vulnerability and incompleteness. Therefore, the therapist considered that he was trying to denying his feelings to avoid this. The therapist set goals for considering his own feelings positively and expressing them appropriately. Also, the therapist carried out behavioral restrictions towards him. He hardly had any emotional communication with the staff, and his peer relationship in the ward was superficial. Therefore, he gradually had difficulty spending his time at the end of December On the following day in which he and the therapist decided to return to his house for the first time, he went out of the ward a few days before without permission. From thereon it was possible for him to share feelings such as hostility and aggression, dependence and kindness with the therapist. The therapist changed his role from an invasive one to a more protective one. Then, his unsociability gradually faded. He also developed good peer relationships with other boys in the ward and began to express himself feeling appropriately. He was also able to establish appropriate relations with his parents at home, and friends of his neighborhood began to have normal peer relationships again. During childhood and adolescence, boys with obsessive,compulsive disorder are known to have features such as poor insight and often involving their mothers. We would like to present this case, through our understanding of dynamic psychiatry throughout his hospitalization, and also on the other therapies that were performed. Psychotherapy with a graduate student that discontinued after only three sessions: Was it enough for this client? N. KATSUKI Sophia University, Tokyo, Japan Introduction: Before and after the psychotherapy, SWT was administrated in this case. Comparing these two drawings, the therapist was provided with some ideas of what kind of internal change had taken place inside this client. Referring to the changes observed, we would like to review the purposes and the ways of the psychotherapy, as well as the adequacy of the limited number of the sessions (vis-a-vis result attained.) Also we will discuss later if any other effective ways could be available within the capacities of the consulting system/the clinic in the university. Case: Ms. S Age 24 years. Problems/appeal: (i) awkwardness in the relationship with the laboratory colleagues; (ii) symptoms of sweating, vomiting and quivering; and (iii) anxiety regarding continuing study and job hunting. Diagnosis: > c/o PTSD. Psychotherapeutic setting: At the therapy room in the clinic, placed at the university, 50 min-session; once a week; paralleled with the medical treatment. Process: (1) Since she was expelled from the study team in the previous year, it has become extremely difficult for her to attend the laboratory (lab) due to the aforementioned symptoms. She had a feeling of being neglected by the others. When the therapist suggested that she compose her mental confusions in the past by attending the therapy room, she seemed to be looking forward to it, although she said that she could remember only a few. (2) She reported that she overdosed on sedatives, as she could not stop irritating. She was getting tough with her family, also she slashed the mattress of her bed with a knife for many times. She complained that people neither understood nor appreciated her properly. and she said that she wanted revenge on the leader of the lab by punishing him one way or other. (3) Looking back the previous session, she said ,I had been mentally mixed up at that time, but I feel that now I can handle myself, as I stopped the medication after consulting the psychiatrist. According to what she said, when she disclosed the occurrences in the lab to her mother, she felt to be understood properly by her mother and felt so relieved. and she also reported that she had been sewing up the mattress which she slashed before, without any reason. She added, " although I don't even know what it means, I feel that this work is so meaningful to me, somehow". Finally, she told that she had already made her mind to cope with the situation by herself from now on, although it might result in a flinch from the real solution. Situations being the above, the session was closed. Swt: By the remarkable changes observed between the two drawings, the meanings of this psychotherapy and its closure to the client would be contemplated. Question of how school counselors should deal with separation attendant on students' graduation: On a case in which the separation was not worked through C. ASAHARA Sophia University, Tokyo, Japan Although time limited relationship is one of the important characteristics in school counseling, the question of separation attendant on it has not been much discussed based on specific cases. This study focuses on the question of separation through looking at a particular case, in which the separation was not worked through, and halfway relationship continued even after the student's graduation and the counselor's resignation. I was a part time school counselor at a junior high school in Tokyo. The client was a 14-year-old female student, who could not go to her classroom, and spent a few hours in a sick bay when she came to school. She was in the final grade and there was only half a year left before graduation when we first met, and we started to see each other within a very loose structure. As her personality was hyper-vigilant and defensive, it took almost 2 months before I could feel that she was nearer. Her graduation was the first occasion of separation. On that occasion, I found that there had been a discrepancy between our expectations; while I took it for granted that our relationship would end with the graduation, she expected to see me even after she graduated, and she actually came up to see me once in a while during the next year. A year later, we faced another occasion of separation, that was my resignation. Although I worried about her, all I have done for her was to hand a leaflet of a counseling office, where I work as a part time counselor. Again I could not refer to her feelings or show any concrete directions such as making a fixed arrangement. After an occasional correspondence for the next 10 months (about 2 years after her graduation), she contacted me at the counseling office asking for a constant counseling. Why could I not deal with both occasions? and how did that affect the client thereafter? There were two occasions of separation. At the time of the client's graduation, I seemed to be enmeshed in the way of separation that is peculiar to the school setting. In general in therapeutic relationship, mourning work between counselor and client is regarded as being quite important. At school, however, separation attendant on graduation is usually taken for granted and mourning work for any personal relationship tends to be neglected. Graduation ceremony is a big event but it is not about mourning over one's personal relationships but separation from school. That may be why I did not appreciate how the client counted on our relationship. At the time of my resignation I was too worried about working through a change from very loose structure which is peculiar to the school setting to a usual therapeutic structure (fees are charged, and time, place are fixed). That is why I did nothing but give her a leaflet. In this way, we never talked about her complex feelings such as sadness or loneliness, which she was supposed to experience on separation. Looking at the aforementioned process from the client's viewpoint, it can be easily imagined that she could not accept the fact of separation just because she graduated. and later, she was forced to be in double-bind situation, in which she was accepted superficially (handed a leaflet), while no concrete possibility was proposed concerning our relationship (she could never see me unless she tries to contact me.) As a result, she was left alone and at a loss whether she could count on me or not. The halfway situation or her suspense was reflected in her letter, in which she appeared to be just chatting at first sight, but between the lines there was something more implying her sufferings. Above discussion suggests that in some case, we should not neglect the mourning work even in a school setting. To whom or how it is done is the next theme we should explore and discuss in the future. For now, we should at least be conscious about the question of separation in school setting. Study of the process of psychotherapy with intervals for months M. TERASHIMA Bunkyo Gakuin University, Tokyo, Japan This is a report on the process of psychotherapy of an adolescent girl who showed manic and depressive state. At the time of a depressed state, she could not go to a college and withdrew into home, and the severe regressive situation was shown. Her therapy began at the age of 20 and she wanted to know what her problem was. The process of treatment went on for 4 years but she stopped coming to sessions for several months because of failure of the therapist. She repeated the same thing twice. After going through these intervals the client began to remember and started to talk about her childhood , suffering abusive force from her father, with vivid impressions. They once were hard for her to accept, but she began to establish the consistent figure of herself from past to present. In this case, it could be thought that the intervals of the sessions had a certain role, with which the client controlled the structure of treatment, instead of an attack against the therapist. Her object relation, which is going to control an object offensively, was reflected in these phenomena. That is, it can be said that the ambivalence about dependency , difficult to depend but desirous of the object , was expressed. Discontinuation of the sessions was the product of the compromise formation brought about the ambivalence of the client, and while continuing to receive this ambivalence in the treatment, the client started to realize discontinuance of her memories and then advanced integration of her self-image. For the young client with conflict to dependence such as her, an interval does not destroy the process of treatment but in some cases it could be considered as a therapeutic element. In the intervals the client could assimilate the matter by herself, that acquired by the sessions. Psychotherapy for a schizoid woman who presented eccentric speech and behaviour M. OGASAWARA Osaka University Graduate School of Medicine, Osaka, Japan Case presentation: A case of a 27-year-old woman at the beginning of therapy. Life history: She had been having a wish for death since she was in kindergarten and she had been feeling strong resistance to do the same as others after school attendance. She had a history of ablutomania from the age of 10,15, but the symptom disappeared naturally. and she said that she had been eliminated from groups that she tried to enter. After graduating a junior college, she changed jobs several times without getting a full-time position. Present history: Scolded by her boy friend for her coming home too late one day, she showed confusion such as excitement, self-injury or terror. She consulted a psychiatrist in a certain general hospital, but she presented there eccentric behaviours such as tense facial expression, stiffness of her whole body, or involuntary movement of limbs. and because she felt on bad terms with the psychiatrist and she had come to cause convulsion attacks in the examination room, she was introduced to our hospital. Every session of this psychotherapy was held once a week and for approximately 60 min at a time. Treatment process: She sometimes presented various eccentric attitudes, for example overturning to the floor with screaming (1), going down on her knees when entrance at the door (5), entering with a knife in her mouth and hitting the wall suddenly (7), stiffening herself just outside the door without entering the examination room (9), taking out a knife abruptly and putting it on her neck (40), exclaiming with convulsion responding to every talk from the therapist (41), or stiffening her face and biting herself in the right forearm suddenly (52). She also repeated self-injuries or convulsion attacks outside of the examination room in the early period of the therapy. Throughout the therapy she showed hypersensitivity for interpersonal relations, anxiety about dependence, terror for self-assertion, and avoidance for confrontation to her emotional problems. Two years and 6 months have passed since the beginning of this therapy. She ceased self-injury approximately 1 year and 6 months before and her sense of obscure terror has been gradually reduced to some extent. Discussion: Her non-verbal wariness and aggression to the therapist made the sessions full of tension and the therapist felt a sense of heaviness every time. In contrast, she could not express aggression verbally to the therapist, and when the therapist tried to identify her aggression she denied it. Her anxiety, that she will be thoroughly counterattacked to self-disintegration if she shows aggression to other persons, seems to be so immeasurably strong that she is compelled to deny her own aggression. Interpretations and confrontations by the therapist make her protective, and occasionally she shows stronger resistance in the shape of denial of her problems or conversion symptoms (astasia, aphonia, or involuntary movements) but she never expresses verbal aggression to the therapist. and the therapist feels much difficulty to share sympathy with her, and she expresses distrust against sympathetic approach of the therapist. However, her obvious disturbance that she expresses when she feels the therapist is not sympathetic shows her desire for sympathy. Thus, because she has both strong distrust and desire for sympathy, she is in a porcupine dilemma, which is characteristic of schizoid patients as to whether to lengthen or to shorten the distance between herself and the therapist. This attitude seems to have been derived from experience she might have had during her babyhood and childhood that she felt terror to be counterattacked and deserted when she showed irritation to her mother. In fact, existence of severe problems of the relationship between herself and her mother in her babyhood and childhood can be guessed from her statement. Although she has been repeating experiences to be excluded from other people, she shows no attitude to construct interpersonal relationship actively. On the contrary, by regarding herself to be a victim or devaluating other persons she externalizes responsibility that she herself should assume essentially. The reason must be that her disintegration anxiety is evoked if she recognizes that she herself has problems; that is, that negative things exist inside of her. Therefore, she seems to be inhibited to get depressive position and obliged to remain mainly in a paranoid,schizoid position. As for the pathological level, she seems to have borderline personality organization because of frequent use of mechanisms to externalize fantastically her inner responsibility. For her high ability to avoid confronting her emotional problems making the most of her verbal ability, every intervention of the therapist is invalidated. So, it seems very difficult for her to recognize her own problems through verbal interpretations or confrontation by the therapist, for the present. In general, it is impossible to confront self problems without containing negative emotions inside of the self, but her ability seemed to be insufficient. So, to point out her problems is considered to be very likely to result in her confusion caused by persecution anxiety. Although the therapy may attain the stage on which verbal interpretation and confrontation work better some day, the therapist is compelled to aim at promoting her ability to hold negative emotion inside of herself for the time being. For the purpose, the therapist is required to endure the situation in which she brings emotion that makes the therapist feel negative counter-transference and her process to experience that the therapeutic relation itself would not collapse by holding negative emotion. On supportive psychotherapy with a male adolescent Y. TERASHIMA Kitasato University Health Care Center, Kanagawa, Japan Adolescent cases sometimes show dramatic improvements as a consequence of psychotherapy. The author describes how psychotherapy can support an adolescent and how theraputic achievements can be made. Two and a half years of treatment sessions with a male adolescent patient are presented. The patient was a 19-year-old man, living with his family. He had 5 years of experience living abroad with his family and he was a preparatory school student when he came to a mental clinic for help. He was suffering from not being able to sleep well, from difficulties concerning keeping his attention on one thing, and from fear of going to distant places. He could barely leave his room, and imagined the consequence of overdosing or jumping out of a window. He claimed that his life was doomed because his family moved from a town that was familiar to him. At the first phase of psychotherapy that lasted for approximately 1 year, the patient seldom responded to the therapist. The patient was basically silent. He told the therapist that the town he lives in now feels cold or that he wants to become a writer. However, these comments were made without any kind of explanation and the therapist felt it very difficult to understand what the patient was trying to say. The sessions continued on a regular basis. However, the therapist felt very useless and fatigued. Problems with the patient and his family were also present at this phase of psychotherapy. He felt unpleasant at home and felt it was useless to expect anything from his parents. These feelings were naturally transferred to the therapist and were interpreted. However, interpretation seemed to make no changes in the forms of the patient's transference. The second phase of psychotherapy began suddenly. The patient kept saying that he did not know what to talk about. However, after a brief comment made by the therapist on the author of the book he was reading, the patient told the therapist that it was unexpected that the therapist knew anything of his favorite writer. After this almost first interaction between the patient and the therapist, the patient started to show dramatic changes. The patient started to bring his favorite rock CDs to sessions where they were played and the patient and the therapist both made comments on how they felt about the music. He also started asking questions concerning the therapist. It seemed that the patient finally started to want to know the therapist. He started communicating. The patient was sometimes silent but that did not last long. The therapist no longer felt so useless and emotional interaction, which never took place in the first phase, now became dominant. The third phase happened rapidly and lasted for approximately 10 months. Conversations on music, art, literature and movies were made possible and the therapist seldom felt difficulties on following the patient's line of thought. He started to go to schools and it was difficult at first but he started adjusting to the environment of his new part-time jobs. By the end of the school year, he was qualified for the entrance to a prestigious university. The patient's problems had vanished except for some sleeping difficulties, and he did not wish to continue the psychotherapy sessions. The therapist's departure from the clinic added to this and the therapy was terminated. The patient at first reminded the therapist of severe psychological disturbances but the patient showed remarkable progress. Three points can be considered to have played important roles in the therapy presented. The first and the most important is the interpretation by behavior. The patient showed strong parental transference to the therapist and this led the therapist to feel useless and to feel fatigue. Content analysis and here-and-now analysis seemed to have played only a small part in the therapy. However, the therapist tried to keep in contact with the patient, although not so elegant, but tried to show that the therapist may not be useless. This was done by maintaining the framework of the therapy and by consulting the parents when it was considered necessary. Second point is the role that the therapist intentionally took as a model or target of introjection. With the help of behavioral interpretation that showed the therapist and others that it may not be useless, the patient started to introject what seemed to be useful to his well being. It can be considered that this role took some part in the patient going out and to adjust to the new environment. Last, fortune of mach must be considered. The patient and the therapist had much in common. It was very fortunate that the therapist knew anything about the patient's favorite writer. The therapist had some experience abroad when he was young. Although it is a matter of luck that the two had things in common, it can be said that the congeniality between the patient and the therapist played an important role in the successful termination of the therapy. From the physical complaint to the verbal appeal of A's recovery process to regain her self-confidence C. ITOKAWA and S. KAZUKAWA Toyama Mental Health Center, Toyama, Japan This is one of the cases at Toyama Mental Health Center about a client here, we will henceforth refer to her simply as ,A'. A was a second grade high school student. We worked with her until her high school graduation using our center's full functions; counseling, medical examination and the course for autogenic training (AT). She started her counseling by telling us that the reason for her frequent absences from school began because of stomach pains when she was under a lot of stress for 2 years of junior high school, from 2nd grade to 3rd grade. Due to a lack of self confidence and a constant fear of the people around her, she was unable to use the transportation. She would spend a large amount of time at the school infirmary because she suffered from self-diagnosed hypochondriac symptoms such as nausea, diarrhea and a palpitation. She continued that she might not be able to have the self-confidence to sit still to consult me on her feelings in one of our sessions. A therapist advised her to take the psychiatric examination and the use of AT and she actually saw the medical doctor. In counseling (sessions), she eventually started to talk about the abuse that started just after her entering of junior high school; she approached the school nurse but was unable to tell her own parents because she did not trust them. In doing so, she lost the rest of her confidence, affecting the way she looked at herself and thought of how others did. At school she behaved cheerfully and teachers often accused her of idleness as they regarded this girl's absences along with her brightly dyed hair and heavy make-up as her negligent laziness. I, as her therapist, contacted some of the school's staff and let them know of her situation in detail. As the scolding from the teachers decreased, we recognized the improvement of her situation. In order to recover from the missed academic exposure due to her long absence, she started to study by herself. In a couple of months her physical condition improved gradually, saying ,These days I have been doing well by myself, haven't I?' and one year later, her improved mental condition enabled her to go up to Tokyo for a concert and furthermore even to enjoy a short part-time job. She continued the session and the medical examination dually (in tangent) including the consultation about disbelief to the teachers, grade promotion, relationships between friends and physical conditions. Her story concentrated on the fact that she had not grown up with sufficiently warm and compassionate treatment and she could not gain any mental refuge in neither her family nor her school, or even her friends. Her prospects for the future had changed from the short-ranged one with no difficulty to the ambitious challenge: she aimed to try for her favorite major and hoped to go out of her prefecture. But she almost had to give up her own plan because the school forced her to change her course as they recommended. (because of the school's opposition with her own choice). So without the trust of the teachers combined with her low self-esteem she almost gave up her hopes and with them her forward momentum. In this situation as the therapist, I showed her great compassion and discussed the anger towards the school authorities, while encouraging this girl by persuading her that she should have enough self-confidence by herself. Through such sessions, she was sure that if she continued studying to improve her own academic ability by herself she could recognize the true meaning of striving forward. and eventually, she received her parents' support who had seemed to be indifferent to her. At last she could pass the university's entrance exams for the school that she had yearned to attend. That girl ,A' visited our center 1 month later to show us her vivid face. I saw a bright smile on her face. It was shining so brightly. [source] The functional correlates of jaw-muscle fiber architecture in tree-gouging and nongouging callitrichid monkeysAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 3 2009Andrea B. Taylor Abstract Common (Callithrix jacchus) and pygmy (Cebuella pygmaea) marmosets and cotton-top tamarins (Saguinus oedipus) share broadly similar diets of fruits, insects, and tree exudates. Marmosets, however, differ from tamarins in actively gouging trees with their anterior dentition to elicit tree exudates flow. Tree gouging in common marmosets involves the generation of relatively wide jaw gapes, but not necessarily relatively large bite forces. We compared fiber architecture of the masseter and temporalis muscles in C. jacchus (N = 18), C. pygmaea (N = 5), and S. oedipus (N = 13). We tested the hypothesis that tree-gouging marmosets would exhibit relatively longer fibers and other architectural variables that facilitate muscle stretch. As an architectural trade-off between maximizing muscle excursion/contraction velocity and muscle force, we also tested the hypothesis that marmosets would exhibit relatively less pinnate fibers, smaller physiologic cross-sectional areas (PCSA), and lower priority indices (I) for force. As predicted, marmosets display relatively longer-fibered muscles, a higher ratio of fiber length to muscle mass, and a relatively greater potential excursion of the distal tendon attachments, all of which favor muscle stretch. Marmosets further display relatively smaller PCSAs and other features that reflect a reduced capacity for force generation. The longer fibers and attendant higher contraction velocities likely facilitate the production of relatively wide jaw gapes and the capacity to generate more power from their jaw muscles during gouging. The observed functional trade-off between muscle excursion/contraction velocity and muscle force suggests that primate jaw-muscle architecture reflects evolutionary changes related to jaw movements as one of a number of functional demands imposed on the masticatory apparatus. Am J Phys Anthropol, 2009. © 2009 Wiley-Liss, Inc. [source] A comparison of auditory brainstem responses and behavioral estimates of hearing sensitivity in Lemur catta and Nycticebus coucangAMERICAN JOURNAL OF PRIMATOLOGY, Issue 3 2010Marissa A. Ramsier Abstract Primates depend on acoustic signals and cues to avoid predators, locate food, and share information. Accordingly, the structure and function of acoustic stimuli have long been emphasized in studies of primate behavioral and cognitive ecology. Yet, few studies have addressed how well primates hear such stimuli; indeed, the auditory thresholds of most primate species are unknown. This empirical void is due in part to the logistic and economic challenges attendant on traditional behavioral testing methods. Technological advances have produced a safe and cost-effective alternative,the auditory brainstem response (ABR) method, which can be utilized in field conditions, on virtually any animal species, and without subject training. Here we used the ABR and four methods of threshold determination to construct audiograms for two strepsirrhine primates: the ring-tailed lemur (Lemur catta) and slow loris (Nycticebus coucang). Next, to verify the general efficacy of the ABR method, we compared our results to published behaviorally-derived audiograms. We found that the four ABR threshold detection methods produced similar results, including relatively elevated thresholds but similarly shaped audiograms compared to those derived behaviorally. The ABR and behavioral absolute thresholds were significantly correlated, and the frequencies of best sensitivity and high-frequency limits were comparable. However, at frequencies ,2,kHz, ABR thresholds were especially elevated, resulting in decreased agreement with behavioral thresholds and, in Lemur, the ABR 10-dB range starting points were more than 2 octaves higher than the behavioral points. Finally, a comparison of ABR- and behaviorally-derived audiograms from various animal taxa demonstrates the widespread efficacy of the ABR for estimating frequency of best sensitivity, but otherwise suggests caution; factors such as stimulus properties and threshold definition affect results. We conclude that the ABR method is a promising technique for estimating primate hearing sensitivity, but that additional data are required to explore its efficacy for estimating low-frequency thresholds. Am. J. Primatol. 72:217,233, 2010. © 2009 Wiley-Liss, Inc. [source] "In the Front Line"?: Internment and Citizenship Entitlements in the Second World WarAUSTRALIAN JOURNAL OF POLITICS AND HISTORY, Issue 2 2007Christina Twomey This paper analyses the experiences of Australian civilian internees of the Japanese in the Second World War and the Australian government's responses to their desires for repatriation, compensation and rehabilitation. It argues that civilian internees stood in awkward relation to understandings about sacrifice in wartime and entitlements to compensation. The dominance of the citizen-soldier in Australian narratives of war placed civilian internees in an ambiguous position. Civilian internees had not played a direct part in battle but did have direct contact with the military enemy. They had personally suffered privation at the hands of the enemy, but were not military personnel in service of their country. Civilian internees expose the tensions around citizenship and citizenship entitlement attendant upon the elevation of war service as the ultimate sacrifice for one's country. [source] Die Rückkehr der Wölfe.BIOLOGIE IN UNSERER ZEIT (BIUZ), Issue 4 2010Das erste Jahrzehnt Abstract Seit dem Jahr 2000 ziehen in Sachsen wieder Wölfe ihre Jungen auf. In ganz Deutschland leben derzeit mindestens 60 bis 80 Wölfe. Um den damit verbundenen Konflikten zu begegnen, wurde ein "Wolfsmanagement" entwickelt, das Wolfsmonitoring, Öffentlichkeitsarbeit und Schadensausgleich umfasst. Wissenschaftliche Untersuchungen zeigten, dass die Wölfe sich fast ausschließlich von wildlebenden Huftieren ernähren, Haus- und Nutztiere dagegen kaum eine Rolle spielen. Über genetische Analysen konnte die ursprüngliche Herkunft der nach Deutschland zugewanderten Wölfe aus Nordost-Polen geklärt werden. Mit Hilfe der Radiotelemetrie wurden wichtige Erkenntnisse über die Anpassung der Wölfe in die vom Menschen veränderte Landschaft gewonnen. The first decade: the return of the wolves Wolves returned to Saxony in the year 2000 since then they have been regularly rearing pups. Nowadays at least 60-80 wolves are living in Germany. To face its attendant conflicts a wolf management has been installed including wolf monitoring, public relation work and damage compensation. According to the monitoring wolves feed almost completely on wild ungulates, whereas livestock does not play a major role. The wolves' natural origin from north-eastern Poland could be proven by genetic analyses. By the use of radiotelemetry important information could be gained on the adaption of the wolves to the anthropogenic landscape. [source] Cesarean Delivery in Native American Women: Are Low Rates Explained by Practices Common to the Indian Health Service?BIRTH, Issue 3 2005Sheila F. Mahoney CNM ABSTRACT:,Background: Studying populations with low cesarean delivery rates can identify strategies for reducing unnecessary cesareans in other patient populations. Native American women have among the lowest cesarean delivery rates of all United States populations, yet few studies have focused on Native Americans. The study purpose was to determine the rate and risk factors for cesarean delivery in a Native American population. Methods: We used a case-control design nested within a cohort of Native American live births, , 35 weeks of gestation (n = 789), occurring at an Indian Health Service hospital during 1996,1999. Data were abstracted from the labor and delivery logbook, the hospital's primary source of birth certificate data. Univariate and multivariate analyses examined demographic, prenatal, obstetric, intrapartum, and fetal factors associated with cesarean versus vaginal delivery. Results: The total cesarean rate was 9.6 percent (95% CI 7.2,12.0). Nulliparity, a medical diagnosis, malpresentation, induction, labor length > 12.1 hours, arrested labor, fetal distress, meconium, and gestations < 37 weeks were each significantly associated with cesarean delivery in unadjusted analyses. The final multivariate model included a significant interaction between induction and arrested labor (p < 0.001); the effect of arrested labor was far greater among induced (OR 161.9) than noninduced (OR 6.0) labors. Other factors significantly associated with cesarean delivery in the final logistic model were an obstetrician labor attendant (OR 2.4; p = 0.02) and presence of meconium (OR 2.3; p = 0.03). Conclusions: Despite a higher prevalence of medical risk factors for cesarean delivery, the rate at this hospital was well below New Mexico (16.4%, all races) and national (21.2%, all races) cesarean rates for 1998. Medical and practice-related factors were the only observed independent correlates of cesarean delivery. Implementation of institutional and practitioner policies common to the Indian Health Service may reduce cesarean deliveries in other populations. [source] Non-hospital delivery and permanent congenital and early-onset hearing loss in a developing countryBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2008BO Olusanya Objective, The objective of this study was to determine the role of non-hospital delivery and other risk factors for permanent congenital and early-onset hearing loss (PCEHL) in a developing country. Design, Matched case,control study. Setting, Four primary healthcare centres in inner-city Lagos, Nigeria. Population, Fifty-six infants with PCEHL and 280 normal hearing controls matched for age and sex from a population of infants not older than 3 months attending Bacille de Calmette-Guérin immunisation clinics. Methods, Conditional logistic regression analyses of infant and maternal characteristics associated with PCEHL, and the evaluation of population exposure to each risk factor. Main outcome measures, Adjusted matched odds ratios and population attributable risk percent (PAR%). Results, Children with PCEHL were significantly more likely to be first born (OR 1.9, 95% CI 1.1,3.6) without skilled attendants at birth (OR 2.4, 95% CI 1.3,4.5) and have a history of neonatal jaundice requiring exchange blood transfusion (NNJ/EBT) (OR 9.6, 95% CI 2.4,38.2) but less likely to be small for gestational age (SGA) (OR 0.1, 95% CI 0.0,0.5). After controlling for other covariates, the absence of skilled attendants at birth (OR 4.2, 95% CI 2.0,8.6) and NNJ/EBT (OR 19.1, 95% CI 4.3,85.5) emerged as predictors of PCEHL, while SGA (OR 0.1, 95% CI 0.0,0.2) retained its inverse relationship with PCEHL. The PAR% was 35.9% for the lack of skilled attendants at birth and 10.6% for having NNJ/EBT. About 23% of children with PCEHL did not exhibit any risk factors. Conclusions, NNJ/EBT and the absence of skilled attendant at birth rather than the place of delivery are significant predictors of PCEHL in this study population. Targeted hearing screening using these risk factors would facilitate the detection of about 77% of children with PCEHL. [source] Outcome for children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndromeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2001A.G. Sutcliffe Objective To examine the postnatal development of a group of children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndrome. Design Retrospective cohort outcome study involving assessment of neurodevelopment and physical well being. Setting Harris Birthright Centre, King's College Hospital, London. Participants Twins and singleton survivors treated via laser ablation therapy for twin-to-twin transfusion syndrome over a four-year period. Methods Of 54 families contacted to participate in the study, who had been treated for twin-to-twin transfusion syndrome during a four-year period, 24 families attended for paediatric assessment; 12 pairs of twins and 12 singleton survivors were assessed for perinatal, neurological and neurodevelopmental outcome using the Griffiths scales of mental development. A further 20 families were assessed via a proforma after contact with their general practitioner. A comparison of these groups showed no significant differences in sociodemographic factors or severity of disease between responders (44 families, 81.5%) and non-responders (10 families). Results The group of children assessed by a paediatrician had low birthweight (1619g donor, 1814g recipient, 1877g singleton) and had been born preterm (33 weeks twins, 31.2 weeks singleton) with attendant increased resuscitation, neonatal unit admission (mean 40 days) and instrumental delivery. Mean Griffiths scores were within the normal range of ability (91.2 donor vs 97.7 recipient and 101.6 singletons) with the only significant difference being in the locomotor subscale where donor (82.6) and recipient (85.3) were less than singletons: -99.1 (P<0.05). There was no cerebral palsy in the singleton survivors, but there were five cases in the twin group. All except one affected child (with quadriplegia) had mean Griffiths scores in the normal range. In the GP proforma group there was one case, in a twin, of cerebral palsy. Conclusion The overall cerebral palsy rate was 9%: 0% in the singleton survivors group and 13.3% in the twin survivors group. This pilot data highlights the need for careful long term follow up of children affected by twin-to-twin transfusion syndrome. [source] The Gendered Violence of Development: Imaginative Geographies of Exclusion in the Imposition of Neo-liberal CapitalismBRITISH JOURNAL OF POLITICS & INTERNATIONAL RELATIONS, Issue 2 2007Lara Coleman In this article I consider how gendered hierarchies are constitutive of neo-liberal development and the violence attendant upon it. Building on Arturo Escobar's observation that violence is constitutive of development, I explore how the violent imposition of neo-liberal development is legitimised through the inscription of gendered imaginative geographies, which define ,savage' spaces of exclusion in need of ,civilising' development interventions. Drawing on the example of contemporary Colombia, I trace how the development discourse produces space in this way by normalising certain identities and political rationalities,those associated with competition and rational economic behaviour,while representing others as errant, as hyper-masculine subjects prone to violence or ,pre-rational' feminised subjects. [source] Economics and quality of care for patients with acute coronary syndromes: The impending crisisCLINICAL CARDIOLOGY, Issue S1 2002Eric J. Topol M.D. Abstract Several factors are placing significant financial burdens on the health care system today. These include the growing older population, the obesity and type II diabetes epidemics, and the attendant increased prevalence of heart disease, which remains the leading cause of death in the United States. In response, cardiovascular medicine is undergoing sweeping change in the use of advanced technology and interventions. In addition, biomarkers, such as troponin, are emerging as critical predictors of responses to therapy, particularly for coronary stenting. Future trends in the treatment of acute coronary syndromes (ACS) will embrace the use of genomic solutions, such as gene expression profiling, to predict therapeutic outcomes. Careful consideration will need to be given to these innovative approaches to ensure they are cost effective. [source] Therapy of environmental mycobacterial infectionsDERMATOLOGIC THERAPY, Issue 3 2008Caterina Fabroni ABSTRACT: Environmental mycobacteria are the causative factors of an increasing number of infections worldwide. Cutaneous infections as a result of environmental mycobacteria are often misdiagnosed, and their treatment is difficult because these agents can show in vivo and in vitro multidrug resistance. The most common environmental mycobacteria that can cause cutaneous infections are Mycobacterium fortuitum and Mycobacterium marinum. All mycobacteria are characterized by low pathogenicity and they can contaminate affected or traumatized skin only in immunocompetent subjects (mainly in fishermen, swimming-pool attendants, and aquarium owners) whereas medical and esthetic procedures are at risk for the infections because of the quick-growing mycobacteria. Immunocompromised subjects can instead easily develop environmental mycobacterial infections of differing degrees of severity. [source] A study of a single variant allele (rs1426654) of the pigmentation-related gene SLC24A5 in Greek subjectsEXPERIMENTAL DERMATOLOGY, Issue 2 2009Gerasimos Dimisianos Abstract:, The SLC24A5 gene, the human orthologue of the zebrafish golden gene, has been shown to play a key role in human pigmentation. In this study, we investigate the prevalence of the variant allele rs1426654 in a selected sample of Greek subjects. Allele-specific polymerase chain reaction was performed in peripheral blood samples from 158 attendants of a dermatology outpatient service. The results were correlated with pigmentary traits and MC1R genotype. The vast majority of subjects (99%) were homozygous for the Thr111 allele. Only two subjects from the control group (1.26%) were heterozygous for the alanine and threonine allele. Both of these Thr111/Ala111 heterozygotes carried a single polymorphism of MC1R (one with the V92M variant and another with the V60L variant). Following reports of the rs1426654 polymorphism reaching fixation in the European population, our study of Greek subjects showed a prevalence of the Thr111 allele, even among subjects with darker skin pigmentation or phototype. [source] Attending to the world: competition, cooperation and connectivity in the World City networkGLOBAL NETWORKS, Issue 2 2002J. V. Beaverstock World Cities are acknowledged to be a key aspect of globalization. In many accounts, these cities are depicted as rivals in a global marketplace, their economic success a result of their competitive advantage. However, what has not been fully acknowledged is their connectivity and, in addition, the time and effort taken by specific ,attendants' to produce the World City network. Accordingly, this article aims to advance understanding of World City network formation by developing a conceptual model that focuses on four major attendants (firms, sectors, cities and states) that enact network formation through two nexuses ,,city-firm' and ,statesector', and two communities ,,cities within states' and ,firms within sectors'. The utility of this model is demonstrated by drawing upon interviews conducted in offices of 39 advanced producer service firms in banking and law. These interviews were undertaken in three World Cities (London, New York and Singapore) in the wake of the East Asian financial crisis, an event that challenged the consistency of the World City network. Showing how attendants sought to maintain and transform the World City network at this key moment of crisis, we conclude that studies of city competitiveness ultimately need to focus on the cooperative work that sustains global networks. [source] Queenship: Politics and Gender in Tudor EnglandHISTORY COMPASS (ELECTRONIC), Issue 2 2006Retha Warnicke In the Tudor century both queens consort and queens regnant presided at court. The role of consorts reflected that of noblewomen, who were expected to produce a male heir to continue their husband's line, to oversee some household functions, to supervise their female attendants, and to support religious enterprises deemed appropriate to women. In addition, their royal status offered consorts opportunities to engage in court politics and to influence patronage. Because giving birth to a male heir defined the success of their reign, their inability to reproduce or to protect their honor sometimes endangered their position as consort, as Henry VIII's wives discovered. By contrast, in addition to marrying and securing the succession, Mary and Elizabeth Tudor were expected to rule as monarchs. The perceived inability of women to govern led to demands that they heed their male councilors' advice. Concerns about whether her husband would dominate royal decision-making raised questions about Philip II's role in Mary's reign. Elizabeth compensated for her singleness by devising strategies for dealing with her male councilors and through representations of her public persona as male. [source] Effect of an interdisciplinary educational program on antipsychotic prescribing among nursing home residents with dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2008Johanne Monette Abstract Objective To assess the effect of an interdisciplinary educational program in reducing the use of antipsychotics in nursing home residents with dementia. Methods We conducted a longitudinal pilot study to test the implementation of a 7-month interdisciplinary educational program in a fixed cohort of residents with dementia receiving antipsychotics. The program included consciousness-raising, educational sessions, and clinical follow-up. Administrators, physicians, pharmacists, nursing staff, and personal care attendants were involved. The effect of the program was assessed over a 6-month period, in terms of the proportion of discontinuations and dose reductions of antipsychotics. Repeated measures for use of other psychotropics and restraints, frequency of disruptive behaviors, and stressful events experienced by nursing staff and personal care attendants were simultaneously assessed. Results Among the 81 residents still present at the end of the program, there were 40 (49.4%) discontinuations and 11 (13.6%) dose reductions. No significant changes were found in the use of other psychotropics, the use of restraints, or in the number of stressful events experienced by nursing staff and personal care attendants. The frequency of disruptive behaviors decreased significantly over the 6-month period (p,<,0.001). Conclusions Our interdisciplinary educational program led to a substantial reduction in the number of residents receiving antipsychotics and to a decrease in the frequency of disruptive behaviors. Our findings suggest that implementation of recognized practice guidelines could be an effective way to target residents who might not benefit from antipsychotics or who may tolerate a dose reduction. Copyright © 2007 John Wiley & Sons, Ltd. [source] Uncivil aviation: a review of the air rage phenomenonINTERNATIONAL JOURNAL OF TOURISM RESEARCH, Issue 6 2001Michelle Morgan Abstract This article examines the issue of air rage. Attempting to define and identify the extent of this phenomenon provides the context in which to review contributory factors. The analysis of violence or aggression directed at flight attendants is developed with recourse to the work of Poyner and Warne, who offer a framework for understanding violence to staff. Use of this framework suggests that air rage remains a multifaceted phenomenon, with a number of contributory factors. Identification of a variety of factors is then used to develop an analysis of possible solutions to the air rage phenomenon. These solutions are concerned with controlling the assailant and, more proactively, supporting flight attendants through initiatives such as enhanced training programmes. Finally, the article suggests a number of areas for future research that may add to an understanding of a so-far under investigated phenomenon. Copyright © 2001 John Wiley & Sons, Ltd. [source] Increasing trend of acute hepatitis A in north India: Need for identification of high-risk population for vaccinationJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2006Zahid Hussain Abstract Background and Aims:, Hepatitis A (HAV) is endemic in India and most of the population is infected asymptomatically in early childhood with lifelong immunity. Because of altered epidemiology and decreasing endemicity, the pattern of acute HAV infection is changing from asymptomatic childhood infection to an increased incidence of symptomatic disease in the 18,40 age group. The aims of the present study were to assess whether the proportion of adults with acute HAV infection has been increasing over the years and to analyze the seroprevalence of immunoglobulin G (IgG) anti-HAV antibodies in young adults above the age of 15 years as well as in cases of chronic liver disease. Methods:, Sera collected from 3495 patients with acute (1932) and chronic (1563) liver disease attending the Medical Outpatient Department of Lok Nayak Hospital during the previous five years (1999,2003) were tested for various serological markers of acute (HBsAg, HBcIgM, anti-HCV, HEV-IgM, and HAV-IgM) and chronic (HBsAg, HBcIgG, HBeAg, and anti-HCV) hepatitis. In addition, 500 normal healthy attendants of the patients above the age of 15 years were tested for IgG anti-HAV as controls. Results:, Of 1932 patients with acute viral hepatitis, 221 (11.4%) were positive for immunoglobulin M (IgM) anti-HAV. The patients who were IgM anti-HAV negative included hepatitis B (321 patients), C (39 patients), E (507 patients) and unclassified (844 patients). Although the frequency of HAV infection among children had increased (10.6% to 22.0%) in the 5-year period, the frequency of HAV infection among adults had also increased (3.4% to 12.3%) during the same period. A total of 300 patients with chronic liver diseases that were etiologically related to hepatitis B (169), C (73) or dual infection (10) and alcoholic liver injury (48) were tested for the presence of IgG anti-HAV antibody; 98% (294/300) were positive for the antibody. Conclusions:, Although universal vaccination against HAV is not currently indicated, selective vaccination of the high-risk population, based on their serological evidence of HAV antibody, would be a rational and cost-effective approach. [source] Human immunodeficiency virus type 1 and hepatitis C virus Co-infection and viral subtypes at an HIV testing center in BrazilJOURNAL OF MEDICAL VIROLOGY, Issue 6 2006G.A.S. Pereira Abstract Human immunodeficiency virus (HIV) testing sites have been recognized recently as potential settings for hepatitis C virus (HCV) screening since both viruses share common routes of transmission. HIV and HCV prevalence, predictors, co-infection rates, and viral subtypes were studied in 592 attendants at an anonymous HIV Counseling and Testing Center in central Brazil. Anti-HIV-1 and -HCV antibodies were screened by ELISA, and Western blots were used to confirm HIV infection. Among HIV-seropositive samples, reverse transcriptase-polymerase chain reaction (RT-PCR) and nested-PCR were used to subtype HIV-1 by the Heteroduplex Mobility Analysis (HMA) and HCV by the line probe assay (INNO-LiPA). HIV and HCV seroprevalence was 3.2% (95% CI 2.0,4.9) and 2.5% (95% CI 1.5,4.0), respectively. Intravenous drug use was the risk factor most strongly associated with both HIV and HCV infections, even in a population with few intravenous drug users (n,=,6); incarceration was also associated with HCV. HIV/AIDS-positive sexual partner and homosexual/bisexual behaviors were associated independently with HIV-1. The prevalence of HCV infection among HIV-positive persons was 42% (95% CI 20,66), higher than in HIV-negative persons (1.2%; 95% CI 0.5,2.5). HIV-1 subtype B was identified in the env and gag regions of the genome. HCV subtype 3a predominated among co-infected persons and one HCV subtype 1a was detected. Overall, a similar prevalence of HIV and HCV infections and a higher prevalence of HCV among HIV-positive persons were observed. Integrated HIV and HCV screening at HIV testing sites may represent a unique opportunity to provide diagnosis and prevention strategies at a single visit. J. Med. Virol. 78:719,723, 2006. © 2006 Wiley-Liss, Inc. [source] Maternity waiting homes in Southern Lao PDR: The unique ,silk home'JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2008Elizabeth Eckermann Abstract The concept of maternity waiting homes (MWH) has a long history spanning over 100 years. The research reported here was conducted in the Thateng District of Sekong Province in southern Lao People's Democratic Republic (PDR) to establish whether the MWH concept would be affordable, accessible, and most importantly acceptable, as a strategy to improve maternal outcomes in the remote communities of Thateng with a high proportion of the population from ethnic minority groups. The research suggested that there were major barriers to minority ethnic groups using existing maternal health services (reflected in very low usage of trained birth attendants and hospitals and clinics) in Thateng. Unless MWH are adapted to overcome these potential barriers, such initiatives will suffer the same fate as existing maternal facilities. Consequently, the Lao iteration of the concept, as operationalized in the Silk Homes project in southern Lao PDR is unique in combining maternal and infant health services with opportunities for micro credit and income generating activities and allowing non-harmful traditional practices to co-exist alongside modern medical protocols. These innovative approaches to the MWH concept address the major economic, social and cultural barriers to usage of safe birthing options in remote communities of southern Lao PDR. [source] Risk of Norovirus Transmission during Air TravelJOURNAL OF TRAVEL MEDICINE, Issue 5 2009Krista Kornylo MPH Background. During October 2006, an outbreak of norovirus gastroenteritis sickened 200 (59%) of the 379 passengers and 26 (18%) of the 144 crew members on a riverboat. In November 2006, CDC was notified that a group of ill passengers had boarded a commercial flight from St Louis, Missouri, to Atlanta, Georgia. A recent study demonstrated probable norovirus transmission from eight symptomatic flight attendants to passengers on board an aircraft during an international flight; however, there are no published reports of transmission of norovirus on flights of short duration. Methods. We investigated the risk of norovirus transmission on a short flight as part of an outbreak response. Using a standardized questionnaire, we conducted interviews of passengers and flight attendants who were on the flight. We collected information on traveler demographics and illness before, during, and after the flight. We also collected information about potential onboard risk factors for norovirus transmission, such as proximity and contact with ill appearing persons during the flight, as well as use of onboard lavatories and hand hygiene. Results. We were able to complete questionnaires for 50 (56%) of the 89 passengers on the flight and 2 (67%) of the 3 flight attendants. Two (5%) of 42 possible secondary cases were identified. These two passengers neither sat in proximity to an index-case passenger during the flight nor reported use of an onboard lavatory. Conclusions. Although onboard transmission cannot be excluded, likelihood of norovirus transmission on a short flight when ill travelers do not have episodes of vomiting or diarrhea appears minimal. [source] Incidence of Cancer Among Female Flight Attendants: A Meta-AnalysisJOURNAL OF TRAVEL MEDICINE, Issue 3 2006Osamu Tokumaru MD Background Airline flight personnel work in a unique environment with exposure to known or suspected carcinogens and mutagens including ionizing cosmic radiation. A meta-analysis was conducted to study whether the occupational exposure of female flight attendants (FA) increased their relative risk of cancer incidence. Methods A bibliographical computer search from 1966 to 2005 of cancer incidence cohort studies of female FA was performed. Combined relative risks (RRc) in cancer incidence were calculated by means of meta-analysis. Results RRc and 95% confidence interval (CI) for malignant melanoma and breast cancer in female FA were 2.13 (95% CI: 1.58,2.88) and 1.41 (1.22,1.62) (p < 0.0001). Excess risk was not significant for all-site cancer with RRc of 1.10 (0.99,1.21). Conclusions The meta-analysis confirmed the significantly increased risks for malignant melanoma and breast cancer in female FA. Increased exposure to cosmic radiation during flight has been suggested as a potential occupational risk factor. Ultraviolet radiation exposure on board seems an unlikely occupational risk, but nonoccupational leisure time sun exposure is a possible risk factor. The etiology of the observed increase in incidence of some cancers remains controversial because assessment of possible confounders, especially nonoccupational exposure factors, has thus far been limited. [source] Phlebotomy training for patient attendants in MalawiMEDICAL EDUCATION, Issue 11 2009Victoria Walker No abstract is available for this article. [source] Gender and professional identity in psychiatric nursing practice in Alberta, Canada, 1930,75NURSING INQUIRY, Issue 4 2005Geertje Boschma This paper examines gender-specific transformations of nursing practice in institutional mental health-care in Alberta, Canada, based on archival records on two psychiatric hospitals, Alberta Hospital Ponoka and Alberta Hospital Edmonton, and on oral histories with psychiatric mental health nurses in Alberta. The paper explores class and gender as interrelated influences shaping the work and professional identity of psychiatric mental health nurses from the 1930s until the mid-1970s. Training schools for nurses in psychiatric hospitals emerged in Alberta in the 1930s under the influence of the mental hygiene movement, evolving quite differently for female nurses compared to untrained aides and male attendants. The latter group resisted their exclusion from the title ,nurse' and successfully helped to organize a separate association of psychiatric nurses in the 1950s. Post-World War II, reconstruction of health-care and a de-institutionalization policy further transformed nurses' practice in the institutions. Using social history methods of analysis, the paper demonstrates how nurses responded to their circumstances in complex ways, actively participating in the reconstruction of their practice and finding new ways of professional organization that fit the local context. After the Second World War more sophisticated therapeutic roles emerged and nurses engaged in new rehabilitative practices and group therapies, reconstructing their professional identities and transgressing gender boundaries. Nurses' own stories help us to understand the striving toward psychiatric nursing professionalism in the broader context of changing gender identities and work relationships, as well as shifting perspectives on psychiatric care. [source] | |||||||||||||||||||||||||||||||