Development and testing of a questionnaire to measure older people's experience of the Transition Care Program in Australia

Aim: Transition Care (TC) is a new program for older adults in Australia. At present, program quality is assessed using provider reports of compliance with key requirements established by the Australian Government Department of Health and Ageing. As part of the National Evaluation of the Transition Care Program, the authors developed a questionnaire to measure recipient experience of TC. Method: Validity and reliability were assessed via interviews with 582 recipients or proxies 3 months after discharge from TC. Results: Concordance between test–retest observations was high. Principal component analysis suggested three subscales were important: restoration, continuity of care and patient involvement. Recipients of TC in a residential care setting had lower mean scores on the restoration subscale compared to those who received services in the community. Conclusion: This study found that a standardised measure of recipient experience could inform quality improvement in TC and is feasible to administer via questionnaire.     

Health services analysis as a tool for evidence-based policy decisions: the case of the Ministry of Health and Social Security in Mexico

OBJECTIVES: To describe the strengths and weaknesses of two Mexican health care providers for poor populations [Ministry of Health (MoH) and Social Security (SS)] in order to facilitate policy decisions about the future of the two systems. METHODOLOGY: In four Mexican states we conducted (i) a household interview survey in 10 724 households; (ii) a user satisfaction survey in 1319 households; (iii) a satisfaction survey of 236 health workers; (iv) in-depth interviews with 190 health workers; (v) 188 focus-group discussions with different population groups; (vi) a document analysis. RESULTS: Both systems serve populations with similar characteristics of poverty. The availability of resources was better in the MoH system; SS care was better concerning process indicators (family planning, antenatal care; in-service delivery of drugs, staff productivity, user satisfaction and staff motivation), efficiency and effectiveness (reduction of morbidity and mortality). Possible explanatory factors for the better performance of the SS system were strong supervision, regular communication, joint data analysis and annual population surveys. CONCLUSION: Better service organization makes a difference regarding efficiency and effectiveness. Policy-makers, deciding on which kind of health services are best for the poor, should take into account health services' analyses.     

On the Effects of Hot Forging and Hot Rolling on the Microstructural Development and Mechanical Response of a Biocompatible Ti Alloy

Zr, Nb, and Ta as alloying elements for Ti alloys are important for attaining superior corrosion resistance and biocompatibility in the long term. However, note that the addition of excess Nb and Ta to Ti alloys leads to higher manufacturing cost. To develop low-cost manufacturing processes, the effects of hot-forging and continuous-hot-rolling conditions on the microstructure, mechanical properties, hot forgeability, and fatigue strength of Ti-15Zr-4Nb-4Ta alloy were investigated. The temperature dependences with a temperature difference (ΔT) from β-transus temperature (Tβ) for the volume fraction of the α- and β-phases were almost the same for both Ti-15Zr-4Nb-4Ta and Ti-6Al-4V alloys. In the α-β-forged Ti-15Zr-4Nb-4Ta alloy, a fine granular α-phase structure containing a fine granular β-phase at grain boundaries of an equiaxed α-phase was observed. The Ti-15Zr-4Nb-4Ta alloy billet forged at Tβ-(30 to 50) °C exhibited high strength and excellent ductility. The effects of forging ratio on mechanical strength and ductility were small at a forging ratio of more than 3. The maximum strength (σ_max) markedly increased with decreasing testing temperature below Tβ. The reduction in area (R.A.) value slowly decreased with decreasing testing temperature below Tβ. The temperature dependences of σ_max for the Ti-15Zr-4Nb-4Ta and Ti-6Al-4V alloys show the same tendency and might be caused by the temperature difference (ΔT) from Tβ. It was clarified that Ti-15Zr-4Nb-4Ta alloy could be manufactured using the same manufacturing process as for previously approved Ti-6Al-4V alloy, taking into account the difference (ΔT) between Tβ and heat treatment temperature. Also, the manufacturing equivalency of Ti-15Zr-4Nb-4Ta alloy to obtain marketing approval of implants was established. Thus, it was concluded that continuous hot rolling is useful for manufacturing α-β-type Ti alloy.     

Regional differences in the prevalence of sensitization to environmental allergens: Analysis on IgE antibody testing conducted at major clinical testing laboratories throughout Japan from 2002 to 2011

BackgroundIdentification of sensitized allergens for patients with respiratory allergy is an important step in disease care and environmental allergen control. The Japanese archipelago belongs to various climate categories due to its length from north to south which transverse the subarctic in the north to the subtropical in the south, suggesting substantial regional differences in dominant environmental allergens. However, few studies have assessed the regional differences in the prevalence of sensitization to environmental allergens.MethodsWe requested three major clinical testing laboratories to provide us with summarized results of antigen-specific IgE-antibody (Ab) measurements. These measurements were collected for clinical purposes throughout Japan from 2002 through 2011. The prevalence of positivity for IgE-Ab against 19 environmental allergens was calculated for each prefecture in order to evaluate regional differences.ResultsTest data on specific IgE-Ab of 19,969,753 orders were analyzed. The prevalence of positivity for house dust mites was high and the regional difference was low, whereas apparent regional differences were found for pollen, insects, and fungi. The prevalence of positivity for Japanese cedar was low in Hokkaido and Okinawa, while those to alder was highest in Hokkaido. Higher prevalence for insects was observed in southern areas (Okinawa and prefectures in Kyusyu).ConclusionsFindings of this study clearly demonstrated regional differences in the prevalence of sensitization to environmental allergens in Japan and the study also provides useful information for the clinician when deciding which allergens should preferentially be measured for IgE-Ab after considering regional difference.     

Impact of the free‐vaccine policy on timely initiation and completion of hepatitis B vaccination in Fujian,China

The extent to which the free‐vaccine policy impacts the initiation and completion of a hepatitis B vaccine series is poorly understood. The aim of this study was to evaluate the impact of the free‐vaccine policy on hepatitis B vaccination. A provincial survey was conducted in 2006 in Fujian Province, south‐east of China, where the free‐vaccine policy for hepatitis B was announced in 2002 and implemented in 2003. A total of 1628 children were investigated, and 1443 (88.6%) were included in this analysis. Among the children studied, 55.2% were vaccinated within 24 h of birth, and 76.1% completed the hepatitis B vaccine series on time. The rate of hepatitis B surface antibody positivity increased from 29.9% among children born in 1992 to 90.5% among children born in 2005, while the corresponding HBV infection rate decreased from 30.4% to 1.72%. Logistic regression indicated that, compared to children born between 1996 and 2001, the odds ratios (ORs) for timely initiation were 2.57 (95% confidence interval [CI], 1.71–3.84), 5.24 (95% CI, 3.26–8.43) and 9.06 (95% CI, 4.48–18.34) among children born in 2003, 2004 and 2005, respectively; the corresponding ORs for completing the vaccine series were 4.23 (95% CI, 1.97–9.10), 3.76 (95% CI, 1.81–7.82) and 4.94 (95% CI, 1.74–14.00) among children born in 2003, 2004 and 2005, respectively. Children with delayed vaccine initiation (>24 h after birth) were less likely to complete the vaccine series than those who received a timely first dose (OR = 0.02, 95% CI, 0.005–0.09). The impact of the free‐vaccine policy on vaccine initiation and vaccine series completion did not differ by children's residence area (rural vs urban). As hypothesized, the odds of completing the vaccine series increased after the free‐vaccine policy was announced in 2002 among children with delayed initiation (>24 h after birth) but not among those with timely initiation (≤24 h after birth). In conclusion, the free‐vaccine policy significantly improved the timely initiation and completion of the vaccine series. The impact of this policy on completion of the vaccine series was larger among children with delayed vaccine initiation.     

Genetic and environmental contributions to the diversity of substances used in adolescent twins: a longitudinal study of age and sex effects

Aims To determine how genetic and environmental contributions affecting the number of psychoactive substances used varies with age and gender over the course of adolescence. Design Estimates of genetic, shared environmental and non‐shared environmental contributions to total variance in diversity of substances used at ages 11, 14 and 17 years were obtained by fitting a multivariate behavior genetic (Cholesky) model. Participants A total of 711 male and 675 female twins. Measurements Participants reported whether they had used each of 11 substances. Findings The average diversity of substances used increased over time for both males and females, and males generally reported a wider diversity of substances used than females. Influences of genetic factors increased with age and were greater for males than for females at ages 14 and 17 years. Genetic factors remained consistent (i.e. highly correlated) across ages for both males and females, as did shared environmental influences for males. Non‐shared environmental factors for both sexes and females' shared environmental factors were age‐specific. Conclusions Regardless of sex, the proportion of variance in substances used attributable to genetic factors increases during adolescence, although it is greater for males than females at later ages. These findings indicate that prevention interventions may be most effective if they target early adolescence when environmental factors account for the majority of variance in substance use. The high correlation of genetic factors across ages suggests that early use may sometimes signal an early expression of a developmentally stable genetic predisposition.     

The Past as a Lens for Biodiversity Conservation on a Dynamically Changing Planet: The utility of body size as a functional trait to link the past and present in a diverse reptile clade

Understanding the relationships between functional traits and environment is increasingly important for assessing ecosystem health and forecasting biotic responses to future environmental change. Taxon-free analyses of functional traits (ecometrics) allow for testing the performance of such traits through time, utilizing both the fossil record and paleoenvironmental proxies. Here, we test the role of body size as a functional trait with respect to climate, using turtles as a model system. We examine the influence of mass-specific metabolic rate as a functional factor in the sorting of body size with environmental temperature and investigate the utility of community body size composition as an ecometric correlated to climate variables. We then apply our results to the fossil record of the Plio-Pleistocene Shungura Formation in Ethiopia. Results show that turtle body sizes scale with mass-specific metabolic rate for larger taxa, but not for the majority of species, indicating that metabolism is not a primary driver of size. Body size ecometrics have stronger predictive power at continental than at global scales, but without a single, dominant predictive functional relationship. Application of ecometrics to the Shungura fossil record suggests that turtle paleocommunity ecometrics coarsely track independent paleoclimate estimates at local scales. We hypothesize that both human disruption and biotic interactions limit the ecometric fit of size to climate in this clade. Nonetheless, examination of the consistency of trait–environment relationships through deep and shallow time provides a means for testing anthropogenic influences on ecosystems.

In healthy ecosystems, the distributions of functional traits should be sorted by environmental relationships (1–3) and are, therefore, important for conservation forecasting and response strategies (4–7). Trait–environmental relationships can be modeled across a range of communities and habitats, and the resultant models can be applied to future climate change projections to forecast expected trait distributions for communities adapted to particular future climatic conditions. Such distributions can then be used to identify which species are at risk for extirpation or extinction because their traits do not fall within the projected community distribution and, conversely, which species’ traits will be well suited for future climates.Key to utilizing traits is an understanding of the functional factors that govern performance. Hypotheses of trait function are determined through direct behavioral observation, experimental mechanistic approaches, or spatial correlation of trait distributions with environmental variables (8) with post hoc inference of functional relationships (9). The development of taxon-free analysis of functional traits (ecometrics) allows further tests of function across clades and through time (9–12). Application of modern ecometric models to trait distributions in fossil communities (hindcasting) allows us to evaluate histories of niche stability (13, 14). Comparing estimates from hindcasting to independent coeval paleoclimate proxies can provide data on trait resilience or shifts in functional factors over time, which should be established in order to use ecometric models to forecast community compositions in response to future climate change (11). Here we examine the utility of body size as an environmentally correlated functional trait in extant turtles, both in the context of metabolic scaling with temperature for species’ size maxima and as a community ecometric correlated to temperature and precipitation. We apply our ecometric models to the fossil record of turtles from the Plio-Pleistocene eastern African tropics to assess whether modern ecometric relationships persist through time, and are therefore potentially useful for conservation planning.Body size is an important functional trait for examining biotic responses to environmental change, with multiple functional factors sorting size, including metabolism, developmental rate, and changes in ecosystem structuring (15, 16). In poikilotherms, temperature-dependent metabolism has been proposed as a mechanism to explain either increases in body size with temperature for mass-specific metabolic rates or decreases in size based on increasing growth and metabolism (16, 17). Disentangling the relative roles of metabolism and life history processes in driving trait distribution is crucial for understanding potential responses to critical climate maxima and trophic responses to trait shifts (18, 19).Turtles are widely distributed and speciose (20) (Fig. 1A), and are a conservation concern, with over 50% of species classified as endangered due to habitat loss and human predation (21). Turtles are ecologically diverse, with habitats and habits ranging from fully terrestrial herbivores to obligately aquatic carnivores, and body sizes of extant species ranging from carapace lengths of 11 cm to 150 cm (Dataset S1). Previous analyses of body size distributions in extant taxa at a global scale have found positive correlations between size, latitude, geographic range, and temperature (22, 23), but have not found strong support for the functional factors underpinning these relationships. Analyses of within-lineage size trends have additionally found inverse relationships of body size to environmental temperature (24–26), further confounding functional inferences of the role of metabolism and the reliability of body size as a functional trait.Open in a separate windowFig. 1.(A) Geographic distributions of species richness (Top) and maximum body size, measured as carapace length (Bottom), for extant turtles. Rectangles denote ranges used for continental-scale ecometric analyses. (B) Turtle fossils from the Shungura Formation of Ethiopia (yellow star on Inset map). (Top) The aquatic trionychid turtle Trionyx cf. triunguis, carapace in dorsal view, rock hammer for scale, Member G. (Bottom) The terrestrial tortoise cf. Centrochelys sp., partial carapace, girdles, and appendicular skeleton in visceral view, with tape measure for scale, Member H.To determine whether turtle body size distributions are correlated to metabolic rate, we model expected maximum size for minimum mean annual temperature (MAT) within geographic ranges of aquatic and terrestrial species (SI Appendix) based on the size–MAT relationships for the largest living species, using a metabolic scaling model based on the Q₁₀ coefficient which describes oxygen consumption changes per temperature change by 10 °C (17). We compare model predictions with actual size–temperature relationships for living species. To model size as a community ecometric, we apply linear regression (LR) and maximum likelihood (ML) models to determine the predictive power of turtle body size distributions for estimating climate variables including MAT and mean annual precipitation (MAP). We use standard ecometric approaches and, additionally, train ecometric models using range predictions for turtle species derived from species distribution models (SDMs). SDMs model geographic ranges where environmental conditions are for each species, which minimizes the effects of anthropogenic extirpation and habitat loss on estimating trait–environmental relationships. Comparisons of these models reveal which input datasets and spatial scales capture the strongest ecometric relationships.We hindcasted modern ecometric and scaling relationships onto the turtle fossil record of the Plio-Pleistocene Shungura Formation of Ethiopia and compare results with other paleoclimate proxies to determine whether extant relationships are sufficient for predicting nonanalog climates of the past, and, by extension, the future. The Shungura Formation consists of fluviolacustrine sediments and intercalated volcanic tuffs cropping out west of the Omo River in southwestern Ethiopia (ref. 27 and references therein). It preserved a dense, well-sampled vertebrate fossil record representing both terrestrial and aquatic ecosystems, including a diversity of turtles (Fig. 1B), as well as paleoclimate estimates from paleobotanical, faunal, and geochemical proxy data (28–33). The Shungura Formation is precisely chronostratigraphically dated throughout from ∼3.6 Ma to 1.0 Ma, and thus records faunal responses of rich tropical vertebrate communities to climate parameters equivalent to projections of future anthropogenically mediated warming (34). As a result, it represents an excellent model system for testing functional traits beyond modern environments.     

上海市闸北区肺结核患者治疗费用分析及减免政策满意度调查

对上海市闸北区肺结核患者治疗费用情况和对闸北区现行的肺结核治疗费用减免政策的满意度进行调查,以便进一步优化、完善闸北区肺结核减免政策,切实为减轻患者医疗费用负担提供依据。     

Perception of chloroquine efficacy and alternative treatments for uncomplicated malaria in children in a holoendemic area of Tanzania: implications for the change of treatment policy

Prior to policy change from chloroquine (CQ) to sulphadoxine/pyrimethamine (S/P; Fansidar) we assessed the perception of CQ efficacy and the alternative treatment options for malaria in children among parents/guardians (N=527) of under-fives attending first level health facilities on account of fever. It was hypothesized that the long experience with CQ and its antipyretic effect (lacking in S/P) might impede acceptance of S/P for wider use as first-line drug. Malarial fevers in children were most commonly treated with CQ (92.8%), followed by quinine (60.7%) and S/P (28.7%). A 63.2% knew the reasons for non-response to antimalarial treatment, and only 50% were aware that CQ could fail to treat malaria, and 57.1% knew alternative treatment options, namely quinine (52.2%) and S/P (20.5%). Generally, decreased efficacy of CQ had been noticed, and quinine was prescribed for both suspected and proven CQ failures in first level health facilities and the district hospital. S/P was judged to be more effective than quinine, but too strong for children, and was the least known drug in the study area. All formulations of S/P cost more per dose for a child and an adult than CQ. The implications of these findings on the change of malaria treatment policy are discussed.     

Addiction Research Centres and the Nurturing of Creativity. Substance abuse research in a modern health care centre: the case of the Centre for Addiction and Mental Health

The Centre for Addiction and Mental Health is one of the premier centres for research related to substance use and addiction. This research began more than 50 years ago with the Addiction Research Foundation (ARF), an organization that contributed significantly to knowledge about the aetiology, treatment and prevention of substance use, addiction and related harm. After the merger of the ARF with three other institutions in 1998, research on substance use continued, with an additional focus on comorbid substance use and other mental health disorders. In the present paper, we describe the structure of funding and organization and selected current foci of research. We argue for the continuation of this successful model of integrating basic, epidemiological, clinical, health service and prevention research under the roof of a health centre.     

Weak and fragmented regulatory frameworks on the accuracy of blood pressure‐measuring devices pose a major impediment for the implementation of HEARTS in the Americas

Global HEARTS is a WHO initiative for cardiovascular disease prevention and control. Accurate blood pressure (BP) measurement is an essential component of the initiative. This study aimed to determine the regulatory frameworks governing the accuracy of BPMDs in countries of the Americas participating in the HEARTS initiative. Quantitative and qualitative analysis of the laws and regulations relevant to ensuring the accuracy of BPMDs were determined from the Ministries of Health/Regulatory Agencies among 13 countries in Latin America and the Caribbean. Analysis included characterizing the scope of regulations (ie, pre‐market approval, sales and promotion, labeling, cuff sizes, and procurement), information systems for monitoring the models of BPMDs used in primary health care (PHC), and systems to enforce compliance with regulations. Ten of the 13 countries had medical device laws, but regulations that specifically address BPMDs only existed in three countries. Only one country (Brazil) had regulations for mandatory accuracy validation testing and only two countries regulated internet sales of BPMDs. Labeling and cuff size regulations existed in four and two countries, respectively. Less than half the countries reported having a data repository on the BPMD models being used in PHC facilities (four countries) or sold (five countries). Weak and fragmented regulatory frameworks on the accuracy of BPMDs exist among countries of the Americas. This will adversely affect the accuracy of blood pressure assessment and hence poses a major impediment for successful implementation of HEARTS initiative.     

HIV rapid testing in the framework of an STI prevention project on a cohort of vulnerable Italians and immigrants

Introduction: Uptake of HIV tests is a challenging issue in vulnerable populations including immigrants, normally using standard diagnostic tools. Objectives of this study were to evaluate the acceptability of HIV rapid test; estimate the percentage of newly HIV diagnoses and evaluate knowledge, attitudes and perception (KAP) about HIV/AIDS and other STIs in a specific set of immigrants and vulnerable population in Rome (Italy). Methods: All immigrant and Italian people, aged 16–70 years, attending the infectious disease outpatient clinic of the National Institute for Health, Migration and Poverty (INMP) in Rome (Italy), during the period December 2012 to December 2013 were enrolled. HIV rapid testing was provided for free and patients were asked to fill in a questionnaire evaluating KAP about HIV/STIs. All patients with risky sexual behaviours or with a recent diagnosis of STIs were invited to come back after 3–6 months and a post-counselling questionnaire was offered. Results: Out of the total sample, 99.2% (n?=?825) accepted the “rapid test” and 10 new HIV diagnoses were found (1.22%; 95% CI 0.58%–2.22%). Three hundred and eighty-five participants (47%) answered the entry questionnaire and 58 (15%) completed the follow-up. Overall, we found high knowledge about HIV/AIDS; however, lower educational level and immigrant status were associated with poor knowledge about HIV, other STIs and prevention methods. Immigrants have lower perception of sexual risk and higher prejudice than Italians. Conclusions: Our study showed high acceptance of rapid test in this specific vulnerable population and this allowed to identify new HIV diagnoses in unaware people. Socioeconomic inequalities observed in the KAP questionnaire suggest the need for actions to support the reduction of cultural differences in knowledge of HIV/AIDS and for policies aimed at improving access to health services and preventions programmes of marginalized populations.