Health service utilization patterns of primary care patients with osteoarthritis

Contains fulltext : 53455.pdf ( ) (Open Access)BACKGROUND: To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners) by primary care patients with osteoarthritis (OA). METHODS: Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF) to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9) to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. RESULTS: 1021 of 1250 (81.6%) questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU) varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the "symptom" scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. CONCLUSION: Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done successfully

Confirmation of beach accretion by grain-size trend analysis: Camposoto beach, Cádiz, SW Spain

An application of the grain size trend analysis (GSTA) is used in an exploratory approach to characterize sediment transport on Camposoto beach (Cádiz, SW Spain). In May 2009 the mesotidal beach showed a well-developed swash bar on the upper foreshore, which was associated with fair-weather conditions prevailing just before and during the field survey. The results were tested by means of an autocorrelation statistical test (index I of Moran). Two sedimentological trends were recognized, i.e. development towards finer, better sorted and more negatively skewed sediment (FB–), and towards finer, better sorted and less negatively or more positively skewed sediment (FB+). Both vector fields were compared with results obtained from more classical approaches (sand tracers, microtopography and current measurements). This revealed that both trends can be considered as realistic, the FB+ trend being identified for the first time in a beach environment. The data demonstrate that, on the well-developed swash bar, sediment transported onshore becomes both finer and better sorted towards the coast. On the lower foreshore, which exhibits a steeper slope produced by breaking waves, the higherenergy processes winnow out finer particles and thereby produce negatively skewed grain-size distributions. The upper foreshore, which has a flatter and smoother slope, is controlled by lower-energy swash-backwash and overwash processes. As a result, the skewness of the grain-size distributions evolves towards less negative or more positive values. The skewness parameter appears to be distributed as a function of the beach slope and, thus, reflects variations in hydrodynamic energy. This has novel implications for coastal management

Bacterial Niche-Specific Genome Expansion Is Coupled with Highly Frequent Gene Disruptions in Deep-Sea Sediments

The complexity and dynamics of microbial metagenomes may be evaluated by genome size, gene duplication and the disruption rate between lineages. In this study, we pyrosequenced the metagenomes of microbes obtained from the brine and sediment of a deep-sea brine pool in the Red Sea to explore the possible genomic adaptations of the microbes in response to environmental changes. The microbes from the brine and sediments (both surface and deep layers) of the Atlantis II Deep brine pool had similar communities whereas the effective genome size varied from 7.4 Mb in the brine to more than 9 Mb in the sediment. This genome expansion in the sediment samples was due to gene duplication as evidenced by enrichment of the homologs. The duplicated genes were highly disrupted, on average by 47.6% and 70% for the surface and deep layers of the Atlantis II Deep sediment samples, respectively. The disruptive effects appeared to be mainly due to point mutations and frameshifts. In contrast, the homologs from the Atlantis II Deep brine sample were highly conserved and they maintained relatively small copy numbers. Likely, the adaptation of the microbes in the sediments was coupled with pseudogenizations and possibly functional diversifications of the paralogs in the expanded genomes. The maintenance of the pseudogenes in the large genomes is discussed

Renewable energy from Cyanobacteria: energy production optimization by metabolic pathway engineering

The need to develop and improve sustainable energy resources is of eminent importance due to the finite nature of our fossil fuels. This review paper deals with a third generation renewable energy resource which does not compete with our food resources, cyanobacteria. We discuss the current state of the art in developing different types of bioenergy (ethanol, biodiesel, hydrogen, etc.) from cyanobacteria. The major important biochemical pathways in cyanobacteria are highlighted, and the possibility to influence these pathways to improve the production of specific types of energy forms the major part of this review

Hydrothermal input in recent sediments proximal to the Eastern Lau Spreading Centre, Lau Basin, SW Pacific

The partition geochemistry and recent Mn accumulation rates have been studied in 14 sediment cores collected adjacent to the Eastern Lau Spreading Centre (ELSC) in the Lau Basin, SW Pacific. The sediments are oxic in nature, formed of ash with abundant nannofossil ooze and hydrothermal Mn oxides dispersed within the calcareous sediments. These oxides represent distal plume fallout derived mainly from the hydrothermal fields along the ELSC and possibly from the nearby Central Lau Spreading Centre (CLSC). Nickel, Mo, Pb and, to a lesser extent, Co and V are associated with the Mn-oxide phase, possibly scavenged by Mn precipitates. Only low proportions of Fe, Zn and Cu are found in the oxide phase, these elements being mainly associated with the detrital/altered-detrital sediment phases. Some peaks in the Mn distribution downcore appear to correlate among the cores studied, indicating common pulses of hydrothermal plume fallout. The similar Fe/Mn oxide ratios (1.4–1.9) in surficial sediments proximal to the Eastern and Central Lau Spreading Centres, suggest similar plume fallout compositions in these two areas. Mean Mn accumulation rates average 26 mg cm–2 ka–1. The hydrothermal sedimentation near the ELSC is probably related to a fully developed hydrothermal plumbing at the spreading centre and thus the ELSC has a good potential for hosting massive sulphide deposits, although a lower hydrothermal input at its northernmost tip may indicate a drop in magmatic activity and mineral potential in the oldest section of this spreading ridge