An exploration of the mental health needs of asylum seeking women and children in the UK: implications for health visiting practice

The aim of this article is to explore and to advance an understanding of the issues surrounding the mental health and wellbeing of asylum seekers in the UK as it relates to health visiting practice. This literature review will identify and evaluate literature on this subject area to facilitate the health visitor’s understanding of working with asylum seekers. It will look at how better awareness of cultural differences can help health visitors improve how they meet the needs - in particular the mental health needs -of this client group. This article will then look at some recommendations that may reduce health inequalities, therefore having an influence on public health policies in the UK

The Javanese Palm Flora, First Impression

In comparison with other South East Asian palm floras, the Javanese palm flora is relatively small; there are about 50 species native to the island, With the long history of botanical exploration in Java,and the large concentration of botanists in the island, it would seem surprising if much new remained to be discovered on the island.However, palms are [usually neglected and after my first three months collecting in West Java and working in the Herbarium Bogoriense,it has become obvious that we still know very little of the Taxonomy and natural history of the native Javanese palms

Beta-blockers in COPD:time for reappraisal

The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of beta-blockers in COPD has been proposed because of their known cardioprotective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of beta-blockers post-myocardial infarction and in heart failure they remain underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in older patients with COPD who have other comorbidities. Medium-term prospective placebo-controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of beta-blockers as well as evaluating their potential interaction with concomitant inhaled long-acting bronchodilator therapy. Several retrospective observational studies have shown impressive reductions in mortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised controlled trials. The real challenge is to establish whether beta-blockers confer benefits on mortality and exacerbations in all patients with COPD, including those with silent cardiovascular disease where the situation is less clear.</p

Phylogenetic Relationships Among the One-Flowered, Determinate Genera of Bambuseae (Poaceae: Bambusoideae)

Bambuseae (woody bamboos), one of two tribes recognized within Bambusoideae (true bamboos), comprise over 90% of the diversity of the subfamily, yet monophyly of the tribe is generally only moderately supported, and phylogenetic relationships within the tribe are poorly understood. In addition, there appears to be some level of conflict between morphological and molecular data within the tribe. We conducted a parsimony analysis of 43 species of Bambuseae, three of Olyreae (herbaceous bamboos), and two outgroup taxa using morphological and plastid rpl16 intron sequence data to (1) further test the monophyly of Bambuseae, (2) test the monophyly of Chusqueinae and Hickelinae (the two one-flowered, determinate subtribes), and (3) examine the apparent conflict between molecular and morphological data sets in the determinate, one-flowered genera of Bambuseae. We recovered a monophyletic Bambusoideae, Bambuseae, Olyreae, and Chusqueinae, although support for Bambuseae remained moderate. Our results suggest that the morphological similarities between Chusqueinae and Hickelinae are homoplasious, but robust resolution of relationships among the major lineages of woody bamboos is still wanting

New Spirometry Indices for Detecting Mild Airflow Obstruction.

The diagnosis of chronic obstructive pulmonary disease (COPD) relies on demonstration of airflow obstruction. Traditional spirometric indices miss a number of subjects with respiratory symptoms or structural lung disease on imaging. We hypothesized that utilizing all data points on the expiratory spirometry curves to assess their shape will improve detection of mild airflow obstruction and structural lung disease. We analyzed spirometry data of 8307 participants enrolled in the COPDGene study, and derived metrics of airflow obstruction based on the shape on the volume-time (Parameter D), and flow-volume curves (Transition Point and Transition Distance). We tested associations of these parameters with CT measures of lung disease, respiratory morbidity, and mortality using regression analyses. There were significant correlations between FEV1/FVC with Parameter D (r = -0.83; p &lt; 0.001), Transition Point (r = 0.69; p &lt; 0.001), and Transition Distance (r = 0.50; p &lt; 0.001). All metrics had significant associations with emphysema, small airway disease, dyspnea, and respiratory-quality of life (p &lt; 0.001). The highest quartile for Parameter D was independently associated with all-cause mortality (adjusted HR 3.22,95% CI 2.42-4.27; p &lt; 0.001) but a substantial number of participants in the highest quartile were categorized as GOLD 0 and 1 by traditional criteria (1.8% and 33.7%). Parameter D identified an additional 9.5% of participants with mild or non-recognized disease as abnormal with greater burden of structural lung disease compared with controls. The data points on the flow-volume and volume-time curves can be used to derive indices of airflow obstruction that identify additional subjects with disease who are deemed to be normal by traditional criteria

Risk factors for COPD exacerbations in inhaled medication users: the COPDGene study biannual longitudinal follow-up prospective cohort.

BackgroundDespite inhaled medications that decrease exacerbation risk, some COPD patients experience frequent exacerbations. We determined prospective risk factors for exacerbations among subjects in the COPDGene Study taking inhaled medications.Methods2113 COPD subjects were categorized into four medication use patterns: triple therapy with tiotropium (TIO) plus long-acting beta-agonist/inhaled-corticosteroid (ICS ± LABA), tiotropium alone, ICS ± LABA, and short-acting bronchodilators. Self-reported exacerbations were recorded in telephone and web-based longitudinal follow-up surveys. Associations with exacerbations were determined within each medication group using four separate logistic regression models. A head-to-head analysis compared exacerbation risk among subjects using tiotropium vs. ICS ± LABA.ResultsIn separate logistic regression models, the presence of gastroesophageal reflux, female gender, and higher scores on the St. George's Respiratory Questionnaire were significant predictors of exacerbator status within multiple medication groups (reflux: OR 1.62-2.75; female gender: OR 1.53 - OR 1.90; SGRQ: OR 1.02-1.03). Subjects taking either ICS ± LABA or tiotropium had similar baseline characteristics, allowing comparison between these two groups. In the head-to-head comparison, tiotropium users showed a trend towards lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p = 0.09) compared with ICS ± LABA users, especially in subjects without comorbid asthma (OR = 0.56 [95% CI 0.31, 1.00], p = 0.05).ConclusionsEach common COPD medication usage group showed unique risk factor patterns associated with increased risk of exacerbations, which may help clinicians identify subjects at risk. Compared to similar subjects using ICS ± LABA, those taking tiotropium showed a trend towards reduced exacerbation risk, especially in subjects without asthma.Trial registrationClinicalTrials.gov NCT00608764, first received 1/28/2008

Effect of information about organic production on beef liking and consumer willingness to pay

The present study was aimed to assess the effect of information about organic production on beef liking and consumer willingness to pay. Mean scores of perceived liking were higher for organic beef (OB) as compared to conventional beef (CB). Expected liking scores were higher for OB than for CB. For OB the expected liking was significantly higher than the perceived liking expressed in blind conditions (negative disconfirmation), whereas for CB no difference was observed. Consumers completely assimilated their liking for OB in the direction of expectations. Consumers showed a willingness to pay for OB higher than the suggested price (P < 0.001), the latter corresponding to the local commercial value for organic beef. We conclude that the information about organic farming can be a major determinant of beef liking, thus providing a potential tool for meat differentiation to traditional farms