Occupational therapists’ perceptions of habits based on their professional experiences

Background: Habits are building blocks for occupation. If they are not explicitly approached, a vital aspect of occupation may be left out. Knowledge is lacking about how habits are understood and approached in occupational therapy practice.

Aim: To explore occupational therapists’ perceptions of habits based on their professional experiences.

Material and methods: A qualitative design with a focus group methodology was used. The qualitative data analysis was based on five focus group discussions, including 34 occupational therapists.

Results: An overarching theme, ‘the complexity of habits,’ representing the occupational therapists’ perception of habits, covers the content of three categories: ‘reflecting contradictoriness,’ including different forms of ambiguity that characterize habits, ‘reflecting identity and security’, that emphasize the meaning of habits for identity and structure in everyday life, and ‘reflecting context and society’, comprising perceptions of habits related to the life situation, time and social patterns and environment.

Conclusions: The occupational therapists’ perceptions gave a picture of habits as complex systems. Based on the findings, the therapeutic modes used when approaching clients’ habits should involve more explicit attention to habits and the inclusion of the client’s entire context.     

Prediction of the length of service at the onset of coal workers’ pneumoconiosis based on neural network

Abstract

Three environmental parameters, i.e. dust concentrations, dust dispersion, and free silica content, were introduced into the traditional indices of the neural network model in order to construct a new prediction index and explore a new method for preventing the incidence of pneumoconiosis with intelligent accuracy and universality. Data of the pneumoconiosis patients from Huabei Mining Group (HBMG) of China from 1980 to 2017 were collected. SPSS22.0 was used to develop the combined models based on Back Propagation (BP) neural network model, Radial Basis Function (RBF) neural network model, and Multiple Linear Regression (MLR) model. The paired sample t-test was performed between the real and predicted values. According to this model, it was predicted that 382 coal workers in HBMG were likely to suffer from pneumoconiosis in 2022 and the incidence rate was 4.48%. It is necessary to take prevention measures and transfer these workers from their current positions. In four combined models, the BP-MLR combined model achieved the optimal error parameters and the most accurate prediction. This study provided a scientific basis for effective control and prevention of the incidence of the pneumoconiosis.     

Effectiveness of cognitive–behavioral therapy based on the Mediterranean diet for the treatment of obesity

ObjectiveThe Mediterranean dietary pattern improves cardiovascular disease factors. More research is needed on the usefulness of a Mediterranean dietary pattern in terms of weight loss. The objective of this study was to assess the effectiveness of behavioral therapy based on the Mediterranean diet for the treatment of obesity and to determine the main obstacles to weight loss.MethodsA total of 1406 obese subjects (body mass index, 31 ± 5 kg/m²), aged 20–65 y, from a Mediterranean area in southeast Spain were subjected to a weight-reduction program. To evaluate effectiveness, weight loss, body fat distribution, biochemical variables, blood pressure changes, mean duration of treatment, percentage of attrition, and the ability to fulfill a Mediterranean diet pattern were assessed. To determine the main barriers to losing weight, a “Barriers to Weight Loss” checklist was completed.ResultsThe behavioral therapy program was effective for the treatment of obesity. The average weight loss was 7.7 kg. The duration of treatment was 34 wk. Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program, and all the variables studied were significantly improved. Attrition was 4–9%, with the main reason being stress (37%). Main obstacles to weight loss were “losing motivation,” being “prone to stress-related eating,” and being liable to eat when bored. Recording food intake and assisting group therapy were also important tools for losing weight (P ≤ 0.05).ConclusionsDietary/behavioral treatment based on Mediterranean dietary principles is effective in clinical practice. Nutrition professionals should encourage their patients to record food intake and to attend group therapy.     

Should the decisions of ethics committees be based on community values?

Medicine, Health Care and Philosophy -     

Are there subgroups of bulimia nervosa based on comorbid psychiatric disorders?

OBJECTIVE: The current study sought to determine whether there are subtypes of bulimia nervosa (BN) differentiated by comorbid psychiatric disorders. METHOD: Data on comorbid psychiatric diagnoses in female relatives of probands and controls in the Collaborative Study of the Genetics of Alcoholism (COGA) who met criteria for BN (as outlined in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders) were analyzed using latent class analysis. Resulting latent classes were compared on a variety of variables related to impulsive behaviors and psychological functioning. RESULTS: The best-fitting solution, a two-class model, yielded one class (72%) characterized by substance dependence, depression, antisocial personality disorder (ASPD), and anxiety disorders, and another characterized by depression. The highly comorbid class had more suicidality, more daily smokers, sought help for emotional problems, and had lower Global Assessment of Functioning (GAF) scores compared with those in the comorbid depression only class. DISCUSSION: Latent class findings suggest the existence of two classes of BN differentiated by substance dependence, impulsive behaviors, and poorer psychological functioning.     

Development and validation of a TaqMan® probe- based real-time PCR assay for detection of Ehrlichia canis

Ehrlichiosis is a potentially fatal zoonotic tick-borne disease, caused by a pleomorphic Gram-negative bacterium. It occurs worldwide and affects humans, domestic and wild animals. Dogs infected with Ehrlichia canis develop canine monocytic ehrlichiosis (CME), a significant infectious disease of canines. TaqMan® based real-time PCR assays to detect Ehrlichia spp. affecting dogs were developed and a real-time PCR assay specific for E. canis validated. The efficiency of the assay was 93% and the 95% limit of detection was 33 E. canis plasmid copies/µl of blood (95% confidence interval: 23 - 58). The assay was specific for E. canis when tested against other haemoparasites. Consistent repeatability was observed, with an inter-run standard deviation (SD) range between 0.33 and 1.29 and an intra-run SD range between 0.04 and 1.14. Field samples were tested in parallel by both the E. canis real-time PCR assay and a reverse line blot hybridization assay. The results were in agreement for the two assays, with an exception of two out of 121 samples. Bayesian latent class analysis was used to calculate a diagnostic sensitivity of the E. canis real-time PCR assay of 90% and a specificity of 92%. This assay is a sensitive and reliable molecular detection method for E. canis and will be a useful tool for early diagnosis and timely treatment for this haemoparasite.     

Prevalence of hemoglobin S in the State of Paraná, Brazil, based on neonatal screening

The Brazilian Ministry of Health created the National Neonatal Screening Program under ruling no. 822/2001, including neonatal screening for hemoglobinopathies. In the State of Paraná, neonatal screening is conducted by the Ecumenical Foundation for the Protection of the Handicapped. The prevalence rates were determined for homozygous and heterozygous hemoglobin S and Sbeta-thalassemia. Blood samples drawn on filter paper were examined by isoelectric focusing (IEF) and high-performance liquid chromatography (HPLC). From January 2002 to December 2004, 548,810 newborns were screened, with the detection of 21 with FS, two FSA/FS, and four FSA. After confirmatory tests at six months of age, 12 were defined as sickle-cell anemia, or a prevalence of 2.2:100,000 newborns; Sbeta-thalassemia was confirmed in 15 (2.7:100,000 newborns); and 8,321 newborns were diagnosed as heterozygous HbS (1,500:100,000 newborns). HbS prevalence in Paraná (in southern Brazil) is lower than in the Central-West, North, and Northeast of the country. Ethnic origin of the population, fetal deaths, and non-random procreation may contribute to the relatively low number of homozygous individuals in the State. Sbeta-thalassemia interaction suggests the presence of Euro-Mediterranean peoples in this population's miscegenation.     

Who are your public? A survey comparing the views of a population‐based sample with those of a community‐based public forum in Scotland

This paper describes a questionnaire survey, carried out in the NHS Grampian area of NE Scotland. It compares responses from 84 members of a community-based public forum (39 of whom were sent questionnaires) and a random sample of 10,000 adults registered with general practices in Grampian (2,449 of whom were sent questionnaires). Main outcome measures: differences in demographic profiles and opinions about different feedback mechanisms (patient representative, telephone helpline and NHS feedback website) and their likely effectiveness in three different scenarios. 46% of community forum members consented to take part compared to 24% of the population sample. Younger people and residents in more deprived areas were under-represented in both groups. Community forum members were older (only one under 40 years of age), more likely to be retired and not in employment. Internet access was similar in both groups. Opinions about different systems of feeding back views to the NHS varied but community forum members were more likely to be positive in their opinions about the value of different feedback mechanisms and less likely to think they were 'a waste of NHS money'. Responses to three scenarios revealed similar opinions, but on some issues, there were key differences in the responses from the two groups. Community forum members were more likely to consider writing a letter as a means of getting something done about a problem and were more likely to talk to their GP if experiencing a problem than respondents in the main group. In general their responses were more positive towards the NHS. There is a need to ensure a broad basis for membership of public forums and/or proactively seek the views of groups that are under-represented if public forums are to be used to represent the views of the wider population and inform decision making in the NHS.     

Geostatistical methods for estimation of toxicity of marine bottom sediments based on the Gdańsk Basin area

Toxicity assessment of environmental compartments, in particular sediments as a highly complex matrix, provides a more direct way to assess potential adverse effects of pollutants present in a sample in contrast to chemical analysis estimating only a quantitative level of xenobiotics. Interactions between chemicals, formations of derivatives and the influence of chemical properties of sediments such as the organic matter content causing the intensified sorption of hydrophobic pollutants suggest that a traditional approach to the sediment quality, based only on chemical analysis may be insufficient. The presented study describes the vertical and horizontal variability of toxicity of Gdańsk Basin sediments. Based on 128 surface sediments samples and using geostatistical methods, a prediction map for the EC50 parameter was created. This allowed the evaluation of the toxicity of the surface sediment layer at any selected point of the study area. The applied analysis can be functional for many other locations worldwide. In the present study, the hypothesis about the location of toxic sediments in the vicinity of Gdańsk Deep, outer Puck Bay and close to Vistula River mouth was further confirmed.     

Do community based self-reading sphygmomanometers improve detection of hypertension? A feasibility study

BACKGROUND: Hypertension is a major risk factor for stroke and ischaemic heart disease. Most hypertension is detected opportunistically by general practitioners. Those who rarely use medical services are less likely to have their blood pressure (BP) measured. We hypothesized that open access self-reading BP measurement would detect previously unrecognized hypertension. METHODS: Self-reading sphygmomanometers were placed at 13 public sites in Exeter, Devon, United Kingdom. Machine use was determined by users completing a proforma and by direct observation of sites. Users whose BP reading was above an action level of 135/85 mmHg were asked to attend their general practice. General practitioner records were reviewed 6 months after machine use to identify diagnoses of hypertension. A random sample of users was interviewed, and local general practices were asked about effects on their workload. RESULTS: A total of 758 first time users completed a proforma fully, although direct observations suggested total use was much higher. Of the total, 221 (29.2 per cent) readings were above the action level. Eleven new hypertensives were found, 1.4 per cent (95 per cent confidence interval (CI 0.7-2.5) of the total users. User acceptability was high. All general practice replies were supportive. CONCLUSION: Open access sphygmomanometry for detection of hypertension is feasible. This scheme led to the diagnosis of hypertension in 1.4 per cent of users, and allowed many people to measure their BP in a way convenient to them. Before recommending wider implementation we suggest a study examining if our results are transferable to other settings, and if this approach reduces inequalities and is cost-effective.     

Public preferences regarding adoption of personal genomic testing based on best–worst scaling

Aims

This study analyzes public preferences for the adoption of personal genomic testing (PGT) to determine the important attributes for PGT adoption and to qualitatively compare their relative importance.

Sex-differential effects of diphtheria-tetanus-pertussis vaccine for the outcome of paediatric admissions? A hospital based observational study from Guinea-Bissau

BackgroundIn spite of protection against the targeted infections, a large volume of observational data indicates that diphtheria-tetanus-pertussis (DTP) vaccine may have a negative impact on overall childhood mortality in low-income countries, especially in girls.MethodsIn an observational study using data from Bandim Health Project’s continuous registration of all admissions to the paediatric ward at the National Hospital Simão Mendes in Bissau, we investigated whether DTP was associated with higher female than male in-hospital mortality (female/male case fatality ratio (F/M CFR)) and whether the CFR comparing DTP-vaccinated and DTP-unvaccinated children differed by sex. We included children aged 6 weeks to 8 months (274 days) admitted to the paediatric ward with a vaccination card seen during admission.ResultsFrom May 2001 to January 2008, 4230 children aged 6 weeks to 8 months were admitted and 3450 (82%; 1997 boys, 1453 girls) presented a vaccination card. The proportion presenting a vaccination card and DTP coverage did not differ by sex. During admission, 16% (200/1250) of the girls and 13% (220/1694) of the boys who had received DTP died. The F/M CFR among the 2944 DTP-vaccinated children was 1.23 (1.03–1.46); while it was 0.95 (0.66–1.38) among the 506 children who had not received DTP. DTP-vaccinated children were older and had better socioeconomic status. Adjusted for age, BCG-vaccination, residence, and maternal education the CFR comparing DTP-vaccinated boys with DTP-unvaccinated boys was 0.84 (0.63–1.11), while the CFR comparing DTP-vaccinated girls with DTP-unvaccinated girls was 1.28 (0.90–1.83) (p = .07 for same effect in boys and girls).ConclusionAmong DTP-vaccinated children, female in-hospital mortality was higher than male in-hospital mortality and DTP-vaccination tended to be associated with higher mortality in girls. The data are consistent with DTP having negative effects on mortality for girls. Further studies are necessary to design the optimal vaccination programme for both sexes.     

Can women accurately assess the outcome of medical abortion based on symptoms alone?

BackgroundThe primary purpose of this study was to evaluate whether women undergoing medical abortion can accurately assess abortion outcome based on symptoms alone. Our secondary aim was to identify predictors of medical abortion failure.Study DesignWe conducted a case–control study of women undergoing medical abortion from January 1, 2004, to December 31, 2005, who were 63 days' gestation or less and received 200 mg mifepristone followed by 800 mcg of vaginal misoprostol 6–72 h later. Cases were defined as women who required uterine evacuation for a retained gestational sac or ongoing pregnancy. Separate analyses were conducted for the subset of cases with ongoing pregnancies. Controls were defined as women who successfully expelled the pregnancy without uterine evacuation.ResultsDuring the study period, 53 women had a retained gestational sac (N=26) or ongoing pregnancy (N=27), and a total of 53 controls were selected, matched by site and date of procedure. Case subjects were more likely than controls to report minimal vaginal bleeding and ongoing pregnancy symptoms and to express doubt that they expelled the pregnancy. When predictive modeling was performed, ongoing pregnancy symptoms, minimal bleeding and gestational age as determined by ultrasound measurement of gestational sac or crown-rump length accurately identified only 68% of medical abortion failures. We also found that the odds of medical abortion failure decreased progressively from approximately 4 to 7 weeks' gestational age, was lowest at approximately 7 weeks and increased from 7 to 9 weeks' gestation.ConclusionPatient symptomatology and self-assessment of complete abortion alone are moderately useful in identifying medical abortion failure. An objective measure of complete abortion, such as a pregnancy test, is still required.     

Direct and pulsed current annealing of p-MOSFET based dosimeter: the “MOSkin”

Contemporary radiation therapy (RT) is complicated and requires sophisticated real-time quality assurance (QA). While 3D real-time dosimetry is most preferable in RT, it is currently not fully realised. A small, easy to use and inexpensive point dosimeter with real-time and in vivo capabilities is an option for routine QA. Such a dosimeter is essential for skin, in vivo or interface dosimetry in phantoms for treatment plan verification. The metal-oxide-semiconductor-field-effect-transistor (MOSFET) detector is one of the best choices for these purposes, however, the MOSFETs sensitivity and its signal stability degrade after essential irradiation which limits its lifespan. The accumulation of positive charge on the gate oxide and the creation of interface traps near the silicon–silicon dioxide layer is the primary physical phenomena responsible for this degradation. The aim of this study is to investigate MOSFET dosimeter recovery using two proposed annealing techniques: direct current (DC) and pulsed current (PC), both based on hot charged carrier injection into the gate oxide of the p-MOSFET dosimeter. The investigated MOSFETs were reused multiple times using an irradiation-annealing cycle. The effect of the current-annealing parameters was investigated for the dosimetric characteristics of the recovered MOSFET dosimeters such as linearity, sensitivity and initial threshold voltage. Both annealing techniques demonstrated excellent results in terms of maintaining a stable response, linearity and sensitivity of the MOSFET dosimeter. However, PC annealing is more preferable than DC annealing as it offers better dose response linearity of the reused MOSFET and has a very short annealing time.