The Pitfalls of a Positive Concept of Health\u27

Objectives: To present and discuss options to both the dichotomous and reductionist biomedical model, and to the difficulties that such alternatives imply for the concept of extended health coverage

Estudos radiométricos sobre a oxidação de (U-14C) L-aminoácidos por micobactérias sensíveis e resistentes a drogas

A radiometric assay system has been used to study oxidation patterns of (U-14C) L-amino acids by drug-susceptible and drug-resistant mycobacteria. Drug-susceptible M. tuberculosis (H37Rv TMC 102 and Erdman) along with the drug-resistant organism M. tuberculosis (H37 Rv TMC 303), M. bovis, M. avium, M. intracellulare, M. kansasii and M. chelonei were used. The organisms were inoculated into a sterile reaction system with liquid 7H9 medium and one of the (U-14C) L-amino acids. Each organism displayed a different pattern of amino acid oxidation, but these patterns were not distinctive enough for identification of the organism. Complex amino acids such as proline, phenylalanine and tyrosine were of no use in identification of mycobacteria, since virtually all organisms failed to oxidize them. There was no combination of substrates able to separate susceptible from resistant organisms.Um sistema radiométrico foi utilizado para estudar os padrões de oxidação dos (U-14C) L-aminoácidos por micobactérias sensíveis e resis tentes a drogas. Foram usadas duas cepas do M. tuberculosis sensíveis a todas as drogas, H37Rv e Erdman. As micobactérias resistentes foram M. tuberculosis H37Rv resistente a 5 ug/ml de hidrazida, M. bovis, M. avium, M. intracellulare, M. kansasii e M. chelonei. As micobac térias foram inoculadas em frascos estéreis contendo o meio líquido 7H9 e um dos (U-14C) L-aminoácidos. Cada micobactéria apresentou um padrão de oxidação de aminoácidos, mas estes padrões não foram suficientemente diferentes para identificá-la. Aminoácidos complexos como a prolina, fenilalanina e tirosina não tiveram utilidade na identificação das micobactérias, pois praticamente todos os microorganismos foram incapazes de oxidá-los. Nenhuma combinação de aminoácidos foi capaz de separar as micobactérias sensíveis das resistentes a drogas

Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing

BACKGROUND: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. OBJECTIVE: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. METHODS: We employed a user-centered software design strategy led by a multidisciplinary team. The application was tested for usability with a target sample of suicidal patients. Detailed observations, structured usability ratings, and Think Aloud procedures were used. Suicidal ideation intensity and perceived ability to cope were assessed pre-post engagement with the Web application. RESULTS: A total of 30 participants were enrolled. Usability ratings were generally strong, and all patients successfully built a safety plan. However, the completeness of the safety plan varied. The mean number of steps completed was 5.5 (SD 0.9) out of 6, with 90% (27/30) of participants completing at least 5 steps and 67% (20/30) completing all 6 steps. Some safety planning steps were viewed as inapplicable to some individuals. Some confusion in instructions led to modifications to improve understandability of each step. Ratings of suicide intensity after completion of the application were significantly lower than preratings, pre: mean 5.11 (SD 2.9) versus post: mean 4.46 (SD 3.0), t27=2.49, P=.02. Ratings of ability to cope with suicidal thoughts after completion of the application were higher than preratings, with the difference approaching statistical significance, pre: mean 5.93 (SD 2.9), post: mean 6.64 (SD 2.4), t27=-2.03, P=.05. CONCLUSIONS: We have taken the first step toward identifying the components needed to maximize usability of a self-administered, Web-based safety planning application. Results support initial consideration of the application as an adjunct to clinical contact. This allows for the clinician or other personnel to provide clarification, when needed, to help the patient build the plan, and to help review and revise the draft

Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers

BACKGROUND: The emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. However, little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling. METHODS: ED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling. RESULTS: Three hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r = 0.09), gender (average Likert score = 2.75 for men, 2.42 for women), education (average Likert score = 2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r = 0.10) were significant at the p \u3c 0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling. CONCLUSIONS: In this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options

Effect of Monthly High-Dose Vitamin D Supplementation on Risk of Cancer: the Vitamin D Assessment Study (a Randomized Controlled Trial)

Importance: Previous randomized controlled trials have provided inconsistent results on the effect of vitamin D supplementation on cancer incidence. Objective: To determine if monthly high-dose vitamin D supplementation, without calcium, reduces cancer incidence and cancer mortality in the general population. Design: Randomized, double-blind, placebo-controlled trial, participants recruited from April 2011 to November 2012, follow-up until December 2015. Setting: Recruited mostly from family practices in Auckland, New Zealand. Participants: Community-resident adults, aged 50-84 years. Out of 47,905 adults invited from family practices, and 163 from community groups, 5,110 participants were randomized to vitamin D3 (n=2,558) or placebo (n=2,552). Two participants withdrew consent, and all others (n=5,108) were included in the primary analysis. Intervention: Oral vitamin D3, initial bolus dose of 200,000 IU, followed one month later by monthly doses of 100,000 IU, or placebo, for median of 3.3 years (range: 2.5–4.2 years). Main Outcomes and Measures: The post-hoc primary outcome was all primary neoplasms (invasive and in-situ), aside from non-melanoma skin cancers, diagnosed from randomization to stopping the study medication (31 July 2015). Secondary outcomes were all neoplasms: from randomization to 31 December 2015; from >12 months after randomization to both stopping the study medication and also to 31 December 2015; and fatal neoplasms from randomization to 31 December 2015.Major funding was provided by the Health Research Council of New Zealand (grant 10/400), and by the Accident Compensation Corporation of New Zealand

State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006

BACKGROUND: Emergency departments (EDs) are an essential component of any developed health care system. There is, however, no national description of EDs in Switzerland. Our objective was to establish the number and location of EDs, patient visits and flow, medical staff and organization, and capabilities in 2006, as a benchmark before emergency medicine became a subspecialty in Switzerland. METHODS: In 2007, we started to create an inventory of all hospital-based EDs with a preliminary list from the Swiss Society of Emergency and Rescue Medicine that was improved with input from ED physicians nationwide. EDs were eligible if they offered acute care 24 h per day, 7 days per week. Our goal was to have 2006 data from at least 80% of all EDs. The survey was initiated in 2007 and the 80% threshold reached in 2012. RESULTS: In 2006, Switzerland had a total of 138 hospital-based EDs. The number of ED visits was 1.475 million visits or 20 visits per 100 inhabitants. The median number of visits was 8,806 per year; 25% of EDs admitted 5,000 patients or less, 31% 5,001-10,000 patients, 26% 10,001-20,000 patients, and 17% >20,000 patients per year. Crowding was reported by 84% of EDs with >20,000 visits/year. Residents with limited experience provided care for 77% of visits. Imaging was not immediately available for all patients: standard X-ray within 15 min (70%), non-contrast head CT scan within 15 min (38%), and focused sonography for trauma (70%); 67% of EDs had an intensive care unit within the hospital, and 87% had an operating room always available. CONCLUSIONS: Swiss EDs were significant providers of health care in 2006. Crowding, physicians with limited experience, and the heterogeneity of emergency care capabilities were likely threats to the ubiquitous and consistent delivery of quality emergency care, particularly for time-sensitive conditions. Our survey establishes a benchmark to better understand future improvements in Swiss emergency care