1,047 research outputs found
Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback
Background
Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia.
Methods
The intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management.
Results
Levels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period.
Conclusions
Improvements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity
Altered cardiac autonomic nervous function in depression
Background:Depression is an independent risk factor for coronary artery disease. Autonomic instability may play a mediating or moderating role in this relationship; however this is not well understood. The objective of this study was to explore cardiac autonomic function and cardiac arrhythmia in depression, the correlation between depression severity and Heart Rate Variability (HRV) related indices, and the prevalence of arrhythmia.Methods:Individuals (n = 53) with major depression as assessed by the Diagnostic and Statistical Manual of Mental Disorders, who had a Hamilton Rating Scale for Depression (HAMD) score ≥20 and a Zung Self-Rating Depression Scale score > 53 were compared to 53 healthy individuals, matched for age and gender. Multichannel Electrocardiograph ECG-92C data were collected over 24 hours. Long-term changes in HRV were used to assess the following vagally mediated changes in autonomic tone, expressed as time domain indices: Standard deviation of the NN intervals (SDNN), standard deviation of 5 min averaged NN intervals (SDANN), Root Mean Square of the Successive Differences (RMSSD) and percentage of NN intervals > 50 ms different from preceding interval (pNN50). Pearson’s correlations were conducted to explore the strength of the association between depression severity (using the SDS and HRV related indices, specifically SDNN and low frequency domain / high frequency domain (LF/HF)).Results:The values of SDNN, SDANN, RMSSD, PNN50 and HF were lower in the depression group compared to the control group (P<.05). The mean value of the LF in the depression group was higher than the in control group (P<.05). Furthermore the ratio of LF/HF was higher among the depression group than the control group (P<.05). A linear relationship was shown to exist between the severity of the depression and HRV indices. In the depression group, the prevalence of arrhythmia was significantly higher than in the control group (P<.05), particularly supraventricular arrhythmias.Conclusions:Our findings suggest that depression is accompanied by dysfunction of the cardiac autonomic nervous system, and further, that depression severity is linked to severity of this dysfunction. Individuals with depression appear to be susceptible to premature atrial and/or ventricular disease
Total hip arthroplasty in young adults, with focus on Perthes' disease and slipped capital femoral epiphysis: Follow-up of 540 subjects reported to the Norwegian Arthroplasty Register during 1987â2007
Psychiatric disorder in early adulthood and risk of premature mortality in the 1946 British Birth Cohort
<p>Abstract</p> <p>Background</p> <p>Few studies of the association between psychiatric disorder and premature death have adjusted for key confounders and used structured psychiatric interviews. We aimed to investigate if psychiatric disorder was associated with a higher risk of mortality and whether any excess mortality was due to suicide, or explained by other health or socioeconomic risk factors.</p> <p>Methods</p> <p>We used data from the MRC National Survey of Health and Development, a nationally representative UK birth cohort. 3283 men and women completed the Present State Examination at age 36. The main outcome measure was all-cause mortality before age 60.</p> <p>Results</p> <p>Those with psychiatric disorder at age 36 had a higher risk of death even after adjusting for potential confounders (Hazard ratio = 1.84, 95% C.I. 1.22-2.78). Censoring violent deaths and suicides led to similar results.</p> <p>Conclusions</p> <p>Psychiatric disorder was associated with excess premature mortality not explained by suicide or other health or socioeconomic risk factors.</p
Basel II and fostering the disclosure of banks\' internal credit ratings
ISSN:1566-7529ISSN:1741-620
The RR Lyrae Distance Scale
We review seven methods of measuring the absolute magnitude M_V of RR Lyrae
stars in light of the Hipparcos mission and other recent developments. We focus
on identifying possible systematic errors and rank the methods by relative
immunity to such errors. For the three most robust methods, statistical
parallax, trigonometric parallax, and cluster kinematics, we find M_V (at
[Fe/H] = -1.6) of 0.77 +/- 0.13, 0.71 +/- 0.15, 0.67 +/- 0.10. These methods
cluster consistently around 0.71 +/- 0.07. We find that Baade-Wesselink and
theoretical models both yield a broad range of possible values (0.45-0.70 and
0.45-0.65) due to systematic uncertainties in the temperature scale and input
physics. Main-sequence fitting gives a much brighter M_V = 0.45 +/- 0.04 but
this may be due to a difference in the metallicity scales of the cluster giants
and the calibrating subdwarfs. White-dwarf cooling-sequence fitting gives 0.67
+/- 0.13 and is potentially very robust, but at present is too new to be fully
tested for systematics. If the three most robust methods are combined with
Walker's mean measurement for 6 LMC clusters, V_{0,LMC} = 18.98 +/- 0.03 at
[Fe/H] = -1.9, then mu_{LMC} = 18.33 +/- 0.08.Comment: Invited review article to appear in: `Post-Hipparcos Cosmic Candles',
A. Heck & F. Caputo (Eds), Kluwer Academic Publ., Dordrecht, in press. 21
pages including 1 table; uses Kluwer's crckapb.sty LaTeX style file, enclose
Chemical Safety Assessment Using Read-Across: Assessing the Use of Novel Testing Methods to Strengthen the Evidence Base for Decision Making
Background: Safety assessment for repeated dose toxicity is one of the largest challenges in the
process to replace animal testing. This is also one of the proof of concept ambitions of SEURAT-1,
the largest ever European Union research initiative on alternative testing, co-funded by the
European Commission and Cosmetics Europe. This review is based on the discussion and outcome
of a workshop organized on initiative of the SEURAT-1 consortium joined by a group of international
experts with complementary knowledge to further develop traditional read-across and
include new approach data.
Objectives: The aim of the suggested strategy for chemical read-across is to show how a traditional
read-across based on structural similarities between source and target substance can be strengthened
with additional evidence from new approach dataâfor example, information from in vitro
molecular screening, â-omicsâ assays and computational modelsâto reach regulatory acceptance.
Methods: We identified four read-across scenarios that cover typical human health assessment
situations. For each such decision context, we suggested several chemical groups as examples
to prove when read-across between group members is possible, considering both chemical and
biological similarities.
Conclusions: We agreed to carry out the complete read-across exercise for at least one chemical
category per read-across scenario in the context of SEURAT-1, and the results of this exercise will
be completed and presented by the end of the research initiative in December 2015
Rationale, design and methodology of a double-blind, randomized, placebo-controlled study of escitalopram in prevention of Depression in Acute Coronary Syndrome (DECARD)
<p>Abstract</p> <p>Background</p> <p>The prevalence of depression in patients with acute coronary syndrome, i.e. myocardial infarction and unstable angina, is higher than in the general population. The prevalence of anxiety is higher as well. Both depression and anxiety are associated with poor cardiac outcomes and higher mortality. Comorbid depression in patients with acute coronary syndrome often goes undiagnosed, and it is therefore a challenging task to prevent this risk factor. The study of DEpression in Coronary ARtery Disease (DECARD) is designed to examine if it is possible to prevent depression in patients with acute coronary syndrome.</p> <p>Methods</p> <p>Two hundred forty non-depressed patients with acute coronary syndrome are randomized to treatment with either escitalopram or placebo for 1 year. Psychiatric and cardiac assessment of patients is performed to evaluate the possibility of preventing depression. Diagnosis of depression and Hamilton Depression Scale are the primary outcome measures.</p> <p>Discussion</p> <p>This is the first study of prevention of depression in patients after acute coronary syndrome with a selective serotonin reuptake inhibitor.</p> <p>Trial Registration</p> <p><url>http://www.ClinicalTrials.gov.</url> Identifier: NCT00140257</p
The Distances of the Magellanic Clouds
The present status of our knowledge of the distances to the Magellanic Clouds
is evaluated from a post-Hipparcos perspective. After a brief summary of the
effects of structure, reddening, age and metallicity, the primary distance
indicators for the Large Magellanic Cloud are reviewed: The SN 1987A ring,
Cepheids, RR Lyraes, Mira variables, and Eclipsing Binaries. Distances derived
via these methods are weighted and combined to produce final "best" estimates
for the Magellanic Clouds distance moduli.Comment: Invited review article to appear in ``Post Hipparcos Cosmic
Candles'', F. Caputo & A. Heck (Eds.), Kluwer Academic Publ., Dordrecht, in
pres
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