General practitioners' satisfaction with and attitudes to out-of-hours services

Background  

In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives.     

Finite element study of trochanteric gamma nail for trochanteric fracture

A three-dimensional finite element study of trochanteric fracture fixation by a trochanteric gamma nail (TGN) was investigated in this study. The analyses were performed under one-legged stance load boundary conditions to study the stress distribution and displacements. The influence of material properties (E-modulus) of the implant, the bone and contact condition in the fracture zone was determined. The results show that the stresses in the implant were lower in case of titanium alloy implant material but at the same time higher displacements occurred. The results also indicate that the stresses in the TGN gradually reduced throughout the healing process of the bone in the fracture zone.     

Q fever across the Dutch border in Limburg province, Belgium

Data from three different data sources were compiled to estimate the presence of Coxiella burnetii in the Belgian Limburg province for both humans and livestock. First, serological data of all samples sent to the Belgian reference centre (2003–2010) for human Q fever were analysed, showing evidence for an acute Q fever infection in 1–5% of the cases. Second, a multi-centre prospective survey was conducted in Limburg in 2010 to detect undiagnosed human cases; evidence for a recent infection with Coxiella burnetii was found in three out of 100 patients from which clinicians suspected a Mycoplasma pneumoniae infection. Third, we analyzed data from the Belgian livestock screening program (2009–2010) which consisted of investigating all reported abortions, sampling tank milk, and serological screening of cattle. The results suggest an endemicity in the Limburgian livestock which seems to be especially high in cattle.     

2010年欧洲神经病学联盟阿尔茨海默病诊疗指南

一、概述 (一)目的 2008年成立工作组的目的是修改前一版欧洲神经病学联盟(EFNS)的阿尔茨海默病(AD)诊疗指南.前一版指南采用了第4版诊断和统计手册(DSM Ⅳ)及美国国立神经病学、语言障碍和脑卒中研究所-阿尔茨海默病及相关疾病学会(NINCDS-ADRDA)对痴呆综合征和AD的诊断标准.     

CT模拟结肠镜在结肠病灶诊断中的应用

结肠癌是常见的消化道肿瘤,上海等地区的发病率有明显增高的趋势。在发达国家,结肠癌占肿瘤死亡率第二位,且与大肠腺瘤关系密切。如能早期发现有恶变先兆的息肉并切除之,可以预防结肠癌发生。目前,对结肠癌发病高危人群并未作大规模普查,部分由于患者缺乏早期主诉,或是由于现有普查手段不够有效。大便隐血试验只能发现３０％～４０％结肠肿瘤,乙状结肠镜不能进入近端结肠,并有１０％～１５％乙状结肠肿瘤漏诊。钡剂灌肠和结肠镜能检查全结肠,但有１０％～１５％患者行结肠镜检查失败,并且结肠镜可能使１０％～２０％病灶遗漏,尚…     

创伤患者输血与供者白细胞微嵌合的相关性

输血是挽救创伤患者生命而普遍使用的治疗方法,但其又存在着明显和潜在的危险性。当今,经血液传播传染病和输血反应很少发生,但仍然存在。尽管在临床治疗中试图控制创伤患者休克的发展及损伤的严重度,但其输血后细菌感染、多脏器功能衰竭、死亡的发生率仍较高。     

Necrophagy by a benthic omnivore influences biomagnification of methylmercury in fish

Omnivory has an important role in the movement of energy, nutrients, and contaminants between benthic and pelagic food webs. While top-predator fish are known to supplement a mostly piscivorous diet with benthic organisms, a more obscure benthic-pelagic coupling occurs when benthic invertebrates forage on fish carcasses, referred to as necrophagy. The combination of these two benthic-pelagic links, top-predator fish feeding on benthic organisms that have fed on dead fish, can generate a trophic feedback cycle that conserves energy and nutrients and may have implications for biomagnification of methylmercury (MeHg) in fish. We investigated the role of necrophagy by crayfish (Procambarus clarkii), via a trophic feedback cycle, on the biomagnification of MeHg in largemouth bass (Micropterus salmoides), a cosmopolitan top predator fish known to feed on crayfish. Controlled laboratory tests quantified the uptake of MeHg by both organisms from artificial and natural food (whole crayfish or bass tissue). Assimilation efficiency (AE) of MeHg was greater for bass fed crayfish (79±0.5%) than those fed artificial food (60±3%). Furthermore, AE of MeHg was greatest for largemouth bass fed crayfish that fed on MeHg-dosed dead fish (i.e., trophic feedback cycle; 94±17%). A model, parameterized with results of the laboratory experiments, was used to make steady-state projections of MeHg biomagnification factors. Model projections also indicate that MeHg biomagnification would be greatest for largemouth bass from a trophic feedback cycle. These results suggest that food web ecology has an important role in determining MeHg levels in predatory fish and underscore the need for further investigation into the magnitude that necrophagy may affect MeHg biomagnification in aquatic systems.     

Socio—cultural factors influencing insecticide treated bed net utilization in a malaria endemic city in north—central Nigeria

ObjectiveTo ascertain the socio-cultural factors influencing the rate of utilization of insecticide treated bed nets (ITNs) in a malaria endemic city of Makurdi, north central Nigeria.MethodsThe study was cross-sectional in nature using systematic sampling method to identify households. Both quantitative and qualitative data was generated from adult women using structured and semi structured questionnaires, and focused group discussions (FGDs) to obtain information on rate and patterns of utilization of ITNs. Information such as age, educational level, marital status, awareness or otherwise of the existence of malaria, and factors influencing rate of ownership and utilization of ITNs were obtained. FGDs were used to obtain qualitative information on rate of utilization of ITNs not captured in the questionnaires. Data obtained was analysed using Epi Info 6 statistical software.ResultsAmong the respondents interviewed, 97.0% (2 013/2 075) were aware of existence of malaria and 87.0% of these (1 751/2 013) would associate it with mosquitoes. The rate of ownership of any bed net, ITNs and untreated bed nets (UTNs) was 25.1%, 17.0% and 8.3%, respectively. Utilization of ITNs among children was 30.0% (112/373) and UTNs 12.9% (48/373). Positive contributors to ITNs utilization were literacy, enhanced economy, experience of marriage, and being gainfully employed (P<0.05); while negative contributors were ignorance, poverty and some cultural beliefs and values.ConclusionsA more synchronized advocacy should be carried out on the potential benefits of ITNs utilization and sustained. Also ITNs should be made available to the people of the community at minimal or no cost.