Sexuality and old age

Sexuality in older people is a multifaceted field of study. Ageing may offer opportunities for and restrictions on sexuality. Ageing individuals may have increased time for and may wish to explore their sexuality, for example, by considering a same-sex relationship, after a long-term partner dies. However, they may also lack a partner or autonomy. They may develop or have increased symptoms from chronic diseases. Consequent medication may affect their sexual functioning. Their attitudes to sex often change and their capacity for sexual activity may diminish unless they seek help. However, they may lack the confidence to do so and the health professionals consulted may be disinclined or ill-equipped to assist them. They may have concerns regarding how their sexuality or their sexual orientation would be perceived should they require residential care or start to lose their memory. We consider the recent work relating to this broad range of influences on sexuality in old age and conclude that, whilst the challenge for researchers is to accurately clarify the impact of individual factors on sexuality and identify helpful potential interventions, increased academic and educational focus on this area is enhancing the prospects for a sexually enjoyable old age.     

Application of legal and regulatory rules and policies to benchmarking systems

Although there are few federal or state laws that address benchmarking systems, there are legal issues of which those who develop or use benchmarking system should be aware. Benchmarks may be used as standards of care in tort or professional discipline actions. Use of benchmark data to set fees or exclude providers may raise antitrust concerns. Payers may use benchmark data to set coverage policies or payment rates. Which data are included in benchmarking systems and who has access to those data raise issues of confidentiality. Lastly, benchmarking system developers may want to protect their intellectual property rights and may need to consider medical device laws if they claim that the systems may be used in patient management.     

A decade of international change in abortion law: 1967-1977

Modern thinking on abortion, reflected in recent legal developments around the world, has turned from concentration upon criminality in favor of female and family well-being. New laws enacted during the last decade are coming to focus upon conditions of health and social welfare of women and their existing families as indications for lawful termination of pregnancy. Regulations governing the delivery of services may be restrictive, however, so as to limit in practice access to means of safe, legal abortion made available in theory. Requirements may be imposed that only medical personnel with unduly high qualifications perform procedures, or that they be undertaken only in institutions meeting standards higher than similar health care requires. Approval procedures may be established involving second medical opinions or committees to monitor observance of the law, which may delay abortions and therefore increase their hazards. Parental and spousal consent requirements may exist in addition with the same effects, or to veto a pregnant female's request. Regulations may be employed more positively, however, to encourage contraceptive practice. A disappointment with legislative reform is that it may fail to improve circumstances if public resources are not applied to achieve the supply of services newly rendered legitimate, and illegal practice may persist.     

Legumes And Gastrointestinal Function in Relation to Diets for Diabetics

Diets containing large quantities of beans may have sp ecial advantages for diabetic patients, as the carbohydrate from beans may be digested and absorbed more slowly from beans than from other foods. The mechanism by which this may occur could be similar to those by which some types of dietary fibre and dietary fibre components appear to slow absorption. Direct studies of mechanisms of action in man may be difficult; the pig may be a suitable model for study.     

基于半定量风险评估和专家会商法的重点传染病疫情风险评估

目的 评估2019年广东省面临的重点传染病疫情风险,并分析风险相关关键要素。方法 收集整理相关信息,采用半定量风险评估和专家会商法对疫情风险进行研判。结果 2019年广东省面临的登革热病例境外输入风险将常年存在,本地疫情可能于5—6月开始出现。人禽流感疫情可能维持在较低水平。诺如病毒感染发病水平可能高于2017—2018冬春季。季节性流感可能存在冬春季和夏季流行高峰。手足口病发病强度可能高于2018年或持平,重症及死亡可能维持较低水平。麻疹疫情可能较2018年小幅增长。水痘和流行性腮腺炎疫情可能较2018年下降。基孔肯雅热和寨卡病毒病输入风险持续存在。不排除脊髓灰质炎、疟疾、中东呼吸综合征、埃博拉病毒病等病例输入以及输入引起本地传播的可能。结论 2019年广东省应特别关注登革热疫情,重点关注人禽流感、诺如病毒感染、季节性流感、手足口病等疫情,需要关注麻疹、水痘、流行性腮腺炎疫情,以及基孔肯雅热等输入性传染病相关疫情。     

On the economic foundations of CEA. Ladies and gentlemen, take your positions!

There are still many ongoing debates about several aspects of the methodology of economic evaluations of health care interventions. Some of the disparities in recommendations on methodological issues may be traced back to different viewpoints on cost-effectiveness analysis (CEA) in general. Two important views are the welfarist approach, which aims at embedding CEA into traditional welfare economics, and the decision maker's approach, which takes a broader and more pragmatic view on CEA. The focus in welfarism may be on utility while that of the decision maker's approach may be considered to be on health. In this paper it is examined how these two views differ and how these differences may subsequently lead to debates in methodological areas. It is indicated that embedding the practical operationalization of CEA in welfare economics seems impossible. In a strict welfarist approach it is necessary to view QALYs as being utilities, although one may question whether such an approach to QALYs is appropriate. Also, equity considerations may play an important role in cost-effectiveness analysis and these should preferably be taken into account in a way that reflects societal attitudes towards an equitable distribution of health care. These equity considerations may not always be directly related to utility or efficiency. Furthermore, both camps may prefer different methods for cost measurement in areas such as productivity costs and informal care. A better recognition of the contents and origins of controversies and disputes may enhance the clarity of discussions.     

Lessons from my left foot

A personal experience with a chronic foot injury taught me 4 lessons about living with a chronic condition: people with chronic conditions may blame themselves, may feel guilty that other people have to help them, often have a depression that may be worse than the chronic condition, and may lose confidence in their capacity to do anything useful in life. These feelings need to be elicited and addressed when family physicians provide care to people with chronic conditions.     

Decision making in thermally stressful environments

The literature on investigations into effects of thermal stress of psychological performance is reviewed in order to hypothesize ways in which functions of a decision-making process may be affected by exposure of a decision maker to hot and cold environmental conditions. A theoretical model is described relating psycho-physiological strain, associated with exposure to environmental thermal stress, to efficiency of performance of psychological tasks, categorized in terms of demands made on the human operator. From the evidence available, it appears that three aspects of decision making may be vulnerable to adverse effects of thermal stress. The initiation of the process of decision making may occur less reliably when cold or heat stress leads to signals, which may be serving as decision-making process prompts, being missed. Cognitive operations relating to information processing and evaluative procedures may be subject to decrements in efficiency when conducted in thermally stressful conditions. Thirdly, actions intending to implement decisions taken may be less effectively performed in thermally extreme environments.     

Review: Juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy does not seem to be recognized as often as it should be, accounting as it does for about one in 10 of those with epilepsy. In addition to the myoclonus, absence seizures and tonic-clonic fits can occur. The interictal EEG shows polyspike and wave discharges, and during the myoclonus, medium to high amplitude 16 Hz spikes. Patients may not be seen by a doctor until a major seizure occurs, and if a history of myoclonus is not obtained, inappropriate treatment may be given. The myoclonus may attributed to clumsiness. The inheritance of the condition is most probably polygenic, although it is claimed that juvenile myoclonic epilepsy may be determined by a single autosomal recessive gene. The most effective treatment is with sodium valproate, and this may have to be life-long. In the presence of major seizures carbamazapine should be used with caution as it may exacerbate minor attacks.     

The impact of the COVID-19 pandemic on eating disorder risk and symptoms

The current COVID-19 pandemic has created a global context likely to increase eating disorder (ED) risk and symptoms, decrease factors that protect against EDs, and exacerbate barriers to care. Three pathways exist by which this pandemic may exacerbate ED risk. One, the disruptions to daily routines and constraints to outdoor activities may increase weight and shape concerns, and negatively impact eating, exercise, and sleeping patterns, which may in turn increase ED risk and symptoms. Relatedly, the pandemic and accompanying social restrictions may deprive individuals of social support and adaptive coping strategies, thereby potentially elevating ED risk and symptoms by removing protective factors. Two, increased exposure to ED-specific or anxiety-provoking media, as well as increased reliance on video conferencing, may increase ED risk and symptoms. Three, fears of contagion may increase ED symptoms specifically related to health concerns, or by the pursuit of restrictive diets focused on increasing immunity. In addition, elevated rates of stress and negative affect due to the pandemic and social isolation may also contribute to increasing risk. Evaluating and assessing these factors are key to better understanding the impact of the pandemic on ED risk and recovery and to inform resource dissemination and targets.     

HIV viral dynamic models with dropouts and missing covariates

In recent years HIV viral dynamic models have received great attention in AIDS studies. Often, subjects in these studies may drop out for various reasons such as drug intolerance or drug resistance, and covariates may also contain missing data. Statistical analyses ignoring informative dropouts and missing covariates may lead to misleading results. We consider appropriate methods for HIV viral dynamic models with informative dropouts and missing covariates and evaluate these methods via simulations. A real data set is analysed, and the results show that the initial viral decay rate, which may reflect the efficacy of the anti-HIV treatment, may be over-estimated if dropout patients are ignored. We also find that the current or immediate previous viral load values may be most predictive for patients' dropout. These results may be important for HIV/AIDS studies.     

Changing strategy in malaria control

Residual-insecticide spraying methods may lead to the eradication of malaria from a country or from an area of it, and therefore to the possibility that the spraying campaign may eventually be discontinued. This is the final target to be aimed at in planning national malaria-control campaigns. As it is now known that some anopheline vector species may develop resistance to insecticides, a plea is made that control programmes should be planned to cover such large areas and with such criteria of efficiency as to eradicate malaria and to enable the campaign to be discontinued before resistance may have developed.     

Adjunctive therapy for nutritional support in hospitalized patients

It would be unrealistic to expect that a single adjuvant modality may be applicable to all patients receiving nutritional support, either IV or enterally. Further characterization of the optimal application of each adjuvant modality may establish the precise role of adjuvant anabolic stimulation throughout the clinical course. Better definition of IV formulas with addition of stable glutamine dipeptides may be of benefit in patients at high risk for sepsis and significant skeletal muscle wasting, while use of met-hGH may improve nitrogen retention and whole-body net protein accrual under these circumstances. Chronic, low- to moderate-intensity exercise may be applicable in a select group of patients, particularly patients at risk for developing complications after surgical intervention in whom aggressive nutritional support has been shown to improve operative outcome.     

The lost IUD: don't look too far for it

The IUD is a reliable contraceptive. Plastic IUDs can remain in situ for life; copper IUDs must be changed every 3-5 years. If the string of the IUD cannot be seen during a checkup, the following may have occurred: 1) the IUD may have moved to the cavum uteri; 2) it may have been expelled spontaneously; 3) it may have perforated the uterine wall; and 4) pregnancy may have occurred so that the IUD may be in the uterus. Through the use of echoscopy, the IUD, or parts of it, can be detected and removed by hysteroscopic retrieving forceps. The entire procedure takes 5-15 minutes and the patient may go home at once. To avoid unnecessary tests and X-rays, IUDs can even be retrieved from pregnant women in this manner. Copper IUDs generally disappear in 1 piece; plastic ones may break off during removal.     

Health hazards of photography

Photographers are exposed to chemical, physical, and psychological hazards during the course of their work. Photojournalists are at physical risk from motor vehicle crashes and work in war zones. Ergonomic risk comes from handling heavy equipment as well as work in awkward postures in dangerous positions. Darkroom exposure to chemical agents may lead to respiratory, allergic, and nervous system disease. Psychological problems come from chaotic work organization. Digital photography may reduce the prevalence of chemical exposure, although it may increase the risk of musculoskeletal illness. Simple hygiene measures may prevent illness in photographers. An increasing number of printed resources is available to professional and amateur photographers; this information may help them protect their health while they enjoy their art.     

The imitation of madness: the influence of psychopathology upon culture

Psychiatry and ethnography have been reluctant to consider the possibility that psychosis may provide a model for social organisation and belief. The situations in which this may occur are considered and two examples discussed: the historical leader of a Jewish messianic movement and the contemporary founder of a Trinidadian sect. Individual delusions may be converted into a shared public culture by the manipulation of previously accepted symbolism and a simple inversion of the traditional values in some area may enable the whole community to attain a more sophisticated conceptualisation. In particular, antinomian acts rooted in psychopathology may generate more universal dispensations out of systems of dual classification.     

Coronavirus Disease 2019: Considerations for Health Technology Assessment From the National Centre for Pharmacoeconomics Review Group

It is expected that the coronavirus disease 2019 (COVID-19) pandemic will leave large deficits in the budgets of many jurisdictions. Funding for other treatments, in particular new treatments, may become more constrained than previously expected. Therefore, a robust health technology assessment (HTA) system is vital. Many clinical trials carried out during the pandemic may have been temporarily halted, while others may have had to change their protocols. Even trials that continue as normal may experience external changes as other aspects of the healthcare service may not be available to the patients in the trial, or the patients themselves may contract COVID-19. Consequently, many limitations are likely to arise in the provision of robust HTAs, which could have profound consequences on the availability of new treatments. Therefore, the National Centre for Pharmacoeconomics Review Group wishes to discuss these issues and make recommendations for applicants submitting to HTA agencies, in ample time for these HTAs to be prepared and assessed. We discuss how the pandemic may affect the estimation of the treatment effect, costs, life-years, utilities, discontinuation rates, and methods of evidence synthesis and extrapolation. In particular, we note that trials conducted during the pandemic will be subject to a higher degree of uncertainty than before. It is vital that applicants clearly identify any parameters that may be affected by the pandemic. These parameters will require considerably more scenario and sensitivity analyses to account for this increase in uncertainty.     

Complex dynamics of adaptation in a nonaxenic microcystis culture. 2. Computer simulation of dinotrophenol effects

A hypothesis was modeled to account for complex 20-day dynamics in a culture of blue-green algae Microcystis and heterotrophic bacteria exposed to 2,4-dinitrophenol (DNP). In trials with little or no added DNP, a limiting factor (light or CO(2)) may cause algal density to fluctuate after 14 days of increase. Such factors may be unimportant at levels of DNP that restrict photosynthesis. Bacterial growth may be limited by organic substrate, and bacteria may be more resistant to DNP than blue-green algae. Hence, at intermediate levels of DNP, substrate provided by increased algal death stimulates bacterial growth more than DNP retards it, causing a bacterial peak. Sorption of DNP to cells may cause the DNP decline. Greater growth and slower DNP decline in experiments with preexposed organisms indicate lower DNP sorption affinity in preexposed cells. Bacterial assimilation of DNP-containing substrate may cause the reappearance of DNP. The model reproduced the fluctuation in algal density after growth was limited and better growth and lower DNP decline with preexposed organisms. Reappearance of DNP occurred, but was not obvious. Bacterial dynamics were least well reproduced. Changes in bacterial constants most affected output. Despite model inadequacies, probable aspects of toxicant action in nature have been revealed. Ecological relationships among populations of different species and genetic differences among individuals may have led to lower than expected toxicity, adaptation, and even growth stimulation. Responses of single species tested in isolation may be inadequate to predict toxicant impact.     

Personal meanings in the construction of need for total knee replacement surgery

This study explores patients' personal meanings of knee osteoarthritis (OA) and total knee replacement (TKR). Personal meanings are important because decisions regarding the need for TKR do not seem to be explained by symptoms alone. A total of 18 semi-structured interviews were conducted with a purposive sample of respondents who were listed for TKR at one UK specialist orthopaedic hospital, and who had lower than average disease burden according to standard quantitative criteria. Data were analysed using interpretive phenomenological analysis. Several themes related to need for TKR emerged: adoption of the medical model, a person's social network, pain, functional loss, feelings of vulnerability, dependency, low mood and fatigue, ideas related to disease progression and expectations of TKR. Results suggest that the decision to undergo TKR is not related to symptoms alone, but to personal meanings. Some of these personal meanings may not be useful in accurately assessing the need for TKR, and may result in mis-targeting of treatment. It is important for health professionals to explore and tackle personal meanings when considering treatment. In particular, it may be important to consider gender differences that may influence when men and women are listed for TKR. For example: women may be less likely to discuss treatment options with their doctor; they may be more likely to have heard negative examples of TKR from friends or family; they may be more likely to discuss pain and mobility issues than activities requiring higher function; and they may be more likely to discuss the effect on their mood and the emotional impact of OA.     

Work, obesity, and occupational safety and health

There is increasing evidence that obesity and overweight may be related, in part, to adverse work conditions. In particular, the risk of obesity may increase in high-demand, low-control work environments, and for those who work long hours. In addition, obesity may modify the risk for vibration-induced injury and certain occupational musculoskeletal disorders. We hypothesized that obesity may also be a co-risk factor for the development of occupational asthma and cardiovascular disease that and it may modify the worker's response to occupational stress, immune response to chemical exposures, and risk of disease from occupational neurotoxins. We developed 5 conceptual models of the interrelationship of work, obesity, and occupational safety and health and highlighted the ethical, legal, and social issues related to fuller consideration of obesity's role in occupational health and safety.