Predictors of Sexually Transmitted Infection in Australian Women: Evidence from the Australian Longitudinal Study on Women’s Health

This longitudinal study examined characteristics of women diagnosed with sexually transmitted infections (STI) for the first time in their later 20s and early 30s. Participants were 6,840 women (born 1973–1978) from the Australian Longitudinal Study on Women’s Health. Women aged 18–23 years were surveyed in 1996 (S1), 2000 (S2), 2003 (S3), and 2006 (S4). There were 269 women reporting an STI for the first time at S3 or S4. Using two multivariable logistic regression analyses (examining 18 predictor variables), these 269 women were compared (1) with 306 women who reported an STI at S2 and (2) with 5,214 women who never reported an STI across the four surveys. Women who reported an STI for the first time at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2. Women reporting a first STI at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2. Women were more likely to report an STI for the first time at S3 or S4 compared to women not reporting an STI at any survey if they were younger, unpartnered, had a higher number of sexual partners, had never been pregnant, were recently divorced or separated, and reported poorer access to Women’s Health or Family Planning Centres at S2. These findings demonstrate the value of longitudinal studies of sexual health over the life course beyond adolescence.     

Combined exposure of ELF magnetic fields and x-rays increased mutant yields compared with x-rays alone in pTN89 plasmids

We have examined mutations in the supF gene carried by pTN89 plasmids in Escherichia coli (E. coli) to examine the effects of extremely low frequency magnetic fields (ELFMFs) and/or X-rays to the plasmids. The plasmids were subjected to sham exposure or exposed to an ELFMF (5 mT), with or without X-ray irradiation (10 Gy). For the combined treatments, exposure to the ELFMF was immediately before or after X-ray irradiation. The mutant fractions were 0.94x10(-5 )for X-rays alone, 1.58x10(-5) for an ELFMF followed by X-rays, and 3.64x10(-5) for X-rays followed by an ELFMF. Increased mutant fraction was not detected following exposure to a magnetic field alone, or after sham exposure. The mutant fraction for X-rays followed by an ELFMF was significantly higher than those of other treatments. Sequence analysis of the supF mutant plasmids revealed that base substitutions were dominant on exposure to X-rays alone and X-rays plus an ELFMF. Several types of deletions were detected in only the combined treatments, but not with X-rays alone. We could not find any mutant colonies in sham irradiated and an ELFMF alone treatment, but exposure to ELFMFs immediately before or after X-ray irradiation may enhance the mutations. Our results indicate that an ELFMF increases mutation and alters the spectrum of mutations.     

Day hospital in medical oncology

Day hospital or ambulatory or outpatient therapy represent an important part of the activity in oncology in addition to the inpatient approach. PATIENTS AND METHODS: We analyse the data of the medical oncology day hospital from december 1995 to february 1996 in our institution. RESULTS: We collect 2661 consultants in medical oncology and 816 (31%) have been oriented to the day hospital for chemotherapy mainly adjuvant for breast cancer (68%), colo-rectal cancer (18%) or lymphoma (5%). All treatment are administered under antiemetics of setron types for 40% of the patients. We perform also transfusion of red cells or more rarely platelets. Day hospital cover also diagnostic procedures as bone marrow punctures or biopsies or therapeutic gests as pleural or lumbar punctures. CONCLUSION: Ambulatory chemotherapy represent an important component in medical oncology needing an adequate organisation and team synchronisation.     

Prostatic cancer and chronic respiratory and renal disease in British cadmium workers: a case control study

Deaths due to prostatic cancer, renal cancer, bronchitis or emphysema, and nephritis or nephrosis in three cohorts of cadmium workers have been investigated in a case-control study. Evidence of an association of risk for these diseases with intensity and duration of exposure to cadmium was sought. The only clearly statistically significant finding was of an association of deaths coded as bronchitis or emphysema with "high" levels of exposure to cadmium fume, which was related also to duration of exposure. There was suggestive evidence also (p congruent to 0.10) of an increased risk for nephritis or nephrosis after high exposure. Marginally increased risks were observed for prostatic cancer after high or "medium" exposure, but these were not statistically significant.     

Prostatic cancer and chronic respiratory and renal disease in British cadmium workers: a case control study.

Deaths due to prostatic cancer, renal cancer, bronchitis or emphysema, and nephritis or nephrosis in three cohorts of cadmium workers have been investigated in a case-control study. Evidence of an association of risk for these diseases with intensity and duration of exposure to cadmium was sought. The only clearly statistically significant finding was of an association of deaths coded as bronchitis or emphysema with "high" levels of exposure to cadmium fume, which was related also to duration of exposure. There was suggestive evidence also (p congruent to 0.10) of an increased risk for nephritis or nephrosis after high exposure. Marginally increased risks were observed for prostatic cancer after high or "medium" exposure, but these were not statistically significant.     

The bystander in highway injury accidents

The response of the bystander, or passerby, at the scene of an injury highway accident is an important but neglected aspect of an emergency medical system. Delays in notification, or long distances, may cause an ambulance to take a half-hour or more to get to a crash site, particularly in a rural area. Until medical help arrives there may be a need for someone willing and capable of providing basic life support for the injured. Good Samaritan laws alone cannot be expected to encourage positive bystander responses. What might help is an awareness of the problem and forethought on the part of individuals and communities.     

Security at work in terms of risk factors (author's transl)]

Accident epidemiology aims at determining those factors which are associated with an increased risk. Here accidents at work are considered in which any given situation involves: one or many individuals (I); one or many tasks (T); one or many machines or production tools (M); an environment (E). Eight factors are proposed for each of which one of the above components is dominant. Each factor is defined and examples are given. In addition, where applicable, the following are given: subfactors; references to studies which demonstrate the association between risk and factor; one or several possible action mechanisms; proposals enabling a quantitative evaluation to be made for statistical purposes; suggestions for prevention. The factors are: Individual disposition (I) or liability. Worker's inexperience (I). Stress (T) imposed on the worker. Recovery (T) (an exceptional task must be performed in order to regain normal work conditions). Catachresis (M) (a tool is used for an unusual purpose or a machine is required to exceed normal work load). Material wear (M) or damage. Interference (E) between partially independent processes. Insufficient information (E) concerning the state of the system.     

Disruptive Innovation: Value-Based Health Plans

Value and a Complex Healthcare Market

What Is Value to an Employer?

“Worth in usefulness or importance to the possessor; utility or merit.”American Heritage Dictionary“A principle, standard, or quality considered worthwhile or desirable.”American Heritage Stedman''s Medical Dictionary“A fair return or equivalent in goods, services, or money for something exchanged.”Merriam-Webster''s Dictionary of LawLike the everyday person, defining value for a payor of healthcare services varies depending on your perspective and application of the meaning. For a patient or employee, value means there is some worth in the usefulness of the subject or importance to possessing it. To a clinician, value relates to a standard of quality or a principle that is not only worthwhile, but also desirable. For an attorney, value is defined in contractual terms connoting an economic exchange or equivalence in goods or services. Thus, it is important for an employer, as a payor of healthcare services, to define value and its resulting business proposition to the organization''s mission or goals.Healthcare has traditionally been a contracted services arrangement for employers who “purchase” it through health plans and/or pharmacy benefit managers (PBMs). Costs for these services, however, have grown over time along with continual double-digit increases in the cost associated for a healthcare plan that is purchased (fully insured) or funded through a self-insurance plan. Consequently, there is intense interest in the value associated with a health plan for the business enterprise and its associated value proposition.     

Access to evidence-based care for eating disorders during the COVID-19 crisis

The COVID-19 pandemic has forced an abrupt change in the delivery of clinical services, including for individuals with an eating disorder. We present this Virtual Issue as a resource for the eating disorder community to showcase research published in the International Journal of Eating Disorders that provides information on effective strategies to help address the challenges arising from COVID-19-related disruptions. Articles included describe original research or systematic reviews on obstacles to health services use and strategies to improve access to care; technological tools to provide or enhance interventions; patients' and clinicians' attitudes or perspectives on using digital tools for clinical care; factors influencing therapeutic alliance; and ideas for improving reach and uptake of digital interventions. We hope that readers will find ways to observe and record their own experiences during this global crisis; the experiences of people at risk for developing or exhibiting an eating disorder; and the experiences of those who care for people with an eating disorder. These lived experiences will be invaluable in formulating hypotheses for future studies in service of advancing the understanding of eating disorders and improving interventions and policies for reducing the burden of suffering attributable to eating disorders.     

The discursive properties of "hope": a qualitative analysis of cancer patients' speech

The authors of this article question the usefulness of the empirico-realist search for a definitive definition of hope. Semistructured interviews on "do-not-resuscitate" issues with 23 oncology clinic outpatients were tape-recorded, transcribed, and analyzed following grounded-theory methodology and discursive analytical methodology. Twelve patients spontaneously spoke about hope as objective or subjective, a burden or a resource. Hope represented an evaluation of empirical states of affairs or the wish for desired outcomes and was a warrant for action or an excuse for inaction. It was attributed to both patient and caregiver, to individuals or situations. Hope was present or future oriented, both vulnerable and enduring. The variety of versions of hope has implications for interactions between health care workers and patients. Recognizing a taxonomy of hope might prove more useful than searching for definitions.     

Prevention of delayed recovery and disability of work-related upper extremity disorders

There is always a psychological component to any illness or injury, and unless it is appropriately addressed, such factors can complicate or delay the recovery from a work-related illness or injury. When a worker experiences delayed recovery and unexpected disability, significant contributing psychosocial factors must be assessed for and managed appropriately. A maladaptive belief or understanding about the condition and disability by a patient presents an obstacle to successful treatment. Using cognitive behavioral therapy techniques may be an effective means of managing this challenge for the clinician.     

Omissions of Care in Nursing Homes: A Uniform Definition for Research and Quality Improvement

Omission of care in US nursing homes can lead to increased risk for harm or adverse outcomes, decreased quality of life for residents, and increased healthcare expenditures. However, scholars and policymakers in long-term care have taken varying approaches to defining omissions of care, which makes efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders participated in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition that is clear, meaningful, and actionable for nursing homes. The resulting definition is “Omissions of care in nursing homes encompass situations when care—either clinical or nonclinical—is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident.” This concise definition is grounded in goal-concordant, resident-centered care, and can be used for a variety quality improvement purposes and for research.     

Practice guideline 'Medical treatment of COPD'

The practice guideline 'Medical treatment of COPD' completes the practice guideline for diagnostics and non-medicinal treatment. Patients with stable chronic obstructive pulmonary disease (COPD) and minor complaints can be treated with short-acting beta-2-adrenoceptor agonists or anticholinergics or a combination of these. In cases of insufficient clinical control of the condition or if patients use their medication for maintenance, a long-acting bronchodilator is the drug of choice. In patients with severe or very severe COPD (stage III-IV of the criteria of the Global Initiative for Obstructive Lung Disease (GOLD) or with cardiac comorbidity, there is a slight preference for the long-acting anticholinergic tiotropium. Inhaled corticosteroids (ICS) reduce the exacerbation frequency in patients with moderate to severe or very severe COPD (GOLD stage II-IV) and recurrent exacerbations. A combination of ICS with long-acting beta-2-adrenoceptor agonists (LABA) is prescribed in patients with GOLD stage III-IV with at least 2 exacerbations in the past year, a deterioration of the quality of life and with symptoms, if treatment with a LABA alone or an ICS alone results in insufficient improvement. Anticholinergics and beta-2-adrenoceptor agonists have a similar effect on bronchodilation in patients with an acute exacerbation of COPD. If improvement is inadequate, patients with an exacerbation should be treated with prednisolone 30 mg for a period of 7 to 14 days. In outpatients and clinical patients with an exacerbation ofCOPD, an antibiotic is added to prednisolone in very poor lung function (forced expiratory volume in 1 second (FEV1) < 30%) or another risk factor of a severe disease course, such as a respiratory rate > or = 30/min, a systolic blood pressure < 90 mmHg, and disorientation in time, place or person.     

The natural history of palpitations in a family practice

A retrospective cohort study was conducted to assess whether palpitations are an independent risk factor for increased cardiac morbidity or mortality. A cohort of 109 patients with palpitations, seen over a five-year period in a primary care setting, was compared with an age- and sex-matched control cohort. Mean length of follow-up was 42 months. There was no statistically significant difference in incidence of morbidity or mortality (6.4 percent for the cohort with palpitations and 7.2 percent for the control cohort) between the two groups. This study suggests that palpitations are not an independent risk factor for increased cardiac morbidity or mortality.     

Sexuelle Gesundheit von Männern aus sexualmedizinischer Sicht

Men’s sexual health can be impaired by a variety of sexual disorders, including numerous sexual dysfunctions (primary or due to general medical conditions or their treatment), but also paraphilias and gender identity disorders. These different disorders are often interwoven. This paper offers an overview of the prevalence, symptoms, and etiological factors of major sexual–medical disorders and of the basics of diagnostics and therapy. Special emphasis is given to the couple dimension and the biopsychosocial foundation of human sexuality, which requires an interdisciplinary approach. The paper argues for an improvement of continuing education in sexual medicine for healthcare providers in an effort to satisfy patients’ needs for preservation or restoration of sexual health as a major component of quality of life.     

Availability of schizophrenic patients and their families for genetic linkage studies: findings from the Maryland epidemiology sample

It has been suggested that collections of affected sib pairs, or their nuclear families, may be an efficient method for screening for genetic linkages in schizophrenia. We present the data collected in five years from 15 hospitals in the state of Maryland in an effort to determine if such a collection scheme will be feasible. Probands in our sample were eligible for inclusion in the sample if they were white, were age 16 years or older, and carried a research diagnosis of schizophrenia. Family data are reported for 258 probands. Using the most stringent category of affected (RDC schizophrenia) revealed ten families with two or more affected sibs. The broadest category of affected (any psychotic disorder or psychiatric hospitalization) identified only 36 families with two or more affected sibs. We conclude that, if schizophrenia is a heterogeneous disorder with decreased penetrance, an effort to collect multiplex nuclear families is unlikely to provide enough data to identify genetic linkage. Alternatively, an effort to seek out and collect larger multiplex, multigenerational families rather than a collection of affected sib pairs may be more efficacious.     

Assessing financial protection in health: Does the choice of poverty line matter?

Financial protection in health is an essential aspect of the universal health coverage discourse. It is about ensuring that paying for health services does not affect the ability of households and individuals to afford necessities. A well‐known way to assess financial protection is whether or not people are pushed into—or further into—poverty by paying out‐of‐pocket for health services. Although impoverishment from out‐of‐pocket health spending is not an explicit indicator of the sustainable development goals, it has gained prominence among researchers and policymakers because of its intuitive appeal and link to overall poverty reduction. Using data from Nigeria, this paper demonstrates that the choice of poverty line matters for assessing the impoverishing effect of paying out‐of‐pocket for health services. Among other things, the inconsistencies (or lack of dominance) could occur in ranking impoverishment levels by mutually exclusive groups within a country or in ranking different countries or a country over time. The implication is that the choice of poverty line could lead to manipulation of results for policy and for supporting an agenda that demonstrates an improvement in financial protection when this may not necessarily be the case.     

Perioperative management of patients receiving anticoagulant or antiplatelet therapy: a clinician-oriented and practical approach

The management of patients who are receiving warfarin, aspirin, clopidogrel, or combinations of these drugs and require their interruption because of an elective surgical or other invasive procedure is a common and sometimes challenging clinical problem. For the practicing clinician, there are 2 key issues for perioperative anticoagulant management: 1) having an approach to stratify patients according to their risk for thromboembolism when warfarin or antiplatelet drug therapy is interrupted, and also having an approach to stratify patients according to the risk of bleeding associated with the surgery or procedure; and 2) determining which patients may require bridging anticoagulation and, if required, how to administer bridging, typically with a low-molecular-weight heparin, before and after surgery in a manner that minimizes the risk for bleeding. The overall goal is to minimize patients' risk for thromboembolism and bleeding throughout the perioperative period. The objective of this article is to provide an evidence-based but practical approach relating to these 2 key issues in a manner than can be applied to everyday clinical practice.     

Estimation and extrapolation of optimal treatment and testing strategies

We review recent developments in the estimation of an optimal treatment strategy or regime from longitudinal data collected in an observational study. We also propose novel methods for using the data obtained from an observational database in one health-care system to determine the optimal treatment regime for biologically similar subjects in a second health-care system when, for cultural, logistical, or financial reasons, the two health-care systems differ (and will continue to differ) in the frequency of, and reasons for, both laboratory tests and physician visits. Finally, we propose a novel method for estimating the optimal timing of expensive and/or painful diagnostic or prognostic tests. Diagnostic or prognostic tests are only useful in so far as they help a physician to determine the optimal dosing strategy, by providing information on both the current health state and the prognosis of a patient because, in contrast to drug therapies, these tests have no direct causal effect on disease progression. Our new method explicitly incorporates this no direct effect restriction. Copyright (c) 2008 John Wiley & Sons, Ltd.     

Gastrointestinal surgery and gastroenterology. VI. Chronic pancreatitis: surgical aspects

The indications for surgical treatment of chronic pancreatitis are intractable pain or local complications. The purpose of preoperative investigation, apart from establishing the indications for operation, is to select the kind of procedure to be performed. Important factors include narrowing or dilatation of the pancreatic duct and the presence or absence of an inflammatory mass in the pancreas and of pseudocysts. A pylorus preserving pancreatoduodenectomy or duodenum preserving pancreatic head resection is performed in case of an inflammatory mass in the pancreatic head. In limited clinical trials, duodenum-preserving resection was associated with better recovery, this also applies to the Frey procedure, consisting of local resection of the pancreatic head in combination with lateral pancreaticojejunostomy. In case of dilatation of the pancreatic duct (> 8 mm), without an inflammatory mass drainage of the pancreatic ductal system by a lateral pancreaticojejunostomy is appropriate. A pancreatic tail or body resection can be performed for inflammatory lesions confined to the pancreatic tail or body. Symptomatic pseudocysts are drained internally into the stomach, duodenum or a jejunal loop.