Differences in triage and medical confidentiality between prisons of Belgium and the Netherlands

Objectives: The aim of this study is to describe the opinions of prison doctors, and to compare the primary health care in prisons between Belgium and the Netherlands. Methods: Structured interviews, audio-recorded and transcribed verbatim, were conducted with prison doctors in Dutch-speaking prisons in Flanders/Belgium and in the Netherlands. Two investigators analysed the content of the interviews and discussed each individual interview. Results: In total 37 interviews were conducted in 28 prisons (14 in each country). In Belgium, 14 of 17 prison doctors, compared to 1 of 12 in the Netherlands, experienced higher time pressure during their consultations in prison, compared to their private medical work (P < 0.001). In the Netherlands, compared to Belgium, there is more access to psychiatric support (14/14 vs 11/22, P = 0.002), psychological care (13/13 vs 7/22, P < 0.001), and interpreter facilities (15/22 vs 0/14, P < 0.001). Prison doctors in both countries agree that the possibility for a strictly personal encounter with the patient - without the presence of other medical staff - can be very useful (21/22 in Belgium vs 15/15 in the Netherlands). In Belgium, individual consultations with the detainee are not possible. Conclusions: Compared to the situation in the Netherlands, the medical work of prison doctors in Belgium is characterized by time pressure and lack of psychiatric and psychological support. The absence of interpreter facilities in Belgium handicaps the quality of the primary health care in prisons. In addition, the lack of private encounters with a doctor in Belgian prisons violates the patient rights of the detainee

Acceptance and well-being in adolescents and young adults with cystic fibrosis: a prospective study

Objective To prospectively investigate the role of acceptance in well-being in adolescents and young adults with cystic fibrosis (CF). Method A total of 40 adolescents and young adults with CF (ages 14-22 years) completed questionnaires assessing acceptance, anxiety and depressive symptoms, physical functioning, role functioning, emotional functioning, and social functioning. After 6 months, 28 of them completed the questionnaires on anxiety and depressive symptoms, physical functioning, role functioning, emotional functioning, and social functioning a second time. Results More acceptance (Time 1) was related to less depressive symptoms (Time 1 and 2), and to better role, emotional, and social functioning (Time 1). Conclusions Results indicate that accepting the limitations imposed by chronic disease and readjusting life goals may have a positive effect upon well-being in adolescents and young adults with CF. Further research is needed to clarify whether acceptance-based interventions are useful in promoting well-being in adolescents and young adults with CF

Child's and parent's catastrophizing about pain is associated with procedural fear in children: a study in children with diabetes and their mothers

The contribution of the child's and parents' catastrophizing about pain was explored in explaining procedural pain and fear in children. Procedural fear and pain were investigated in 44 children with Type I diabetes undergoing a finger prick. The relationships between parents' catastrophizing and parents' own fear and estimates of their child's pain were also investigated. The children and their mothers completed questionnaires prior to a routine consultation with the diabetes physician. Children completed a situation-specific measure of the Pain Catastrophizing Scale for Children (PCS-C) and provided ratings of their experienced pain and fear on a 0-10 numerical rating scale (NRS). Parents completed a situation-specific measure of the Pain Catastrophizing Scale For Parents (PCS-P) and provided estimates of their child's pain and their own experienced fear on a 0-10 NRS. Analyses indicated that higher catastrophizing by children was associated with more fear and pain during the finger prick. Scores for parents' catastrophizing about their children's pain were positively related to parents' scores for their own fear, estimates of their children's pain, and child-reported fear, but not the amount of pain reported by the child. The findings attest to the importance of assessing for and targeting child and parents' catastrophizing about pain. Addressing catastrophizing and related fears and concerns of both parents and children may be necessary to assure appropriate self-management. Further investigation of the mechanisms relating catastrophizing to deleterious outcomes is warranted

Simultaneous delivery of two patent arterial duct coils via one venous sheath

A female child, 10 months of age, weighing 7.2 kg, was catheterised for closure of a patent arterial duct. Aortography was performed in the lateral projection and the minimum diameter of the arterial duct was assessed by comparing it to the size of the catheter. The duct size was estimated between 3 and 3.5 mm at the narrowest point, therefore, it was decided to deliver two 5 mm patent arterial duct coils to avoid placement of an 8 mm coil in this small child. Similar operations were subsequently performed in two further children. Simultaneous delivery of two coils via a single long venous sheath is easy, fast, and safe. This simple and inexpensive procedure can reduce irradiation and anaesthesia time

Effect of a serotonin blocking agent on renal hemodynamics in the normal rat

Effect of a serotonin blocking agent on renal hemodynamics in the normal rat. These studies were designed to explore the effects of ketanserin (K), a serotonergic S2-receptor blocker on glomerular filtration rate (GFR), renal plasma flow (RPF) and autoregulation of renal blood flow (RBF) in the normal, anesthetized rat. Two doses of ketanserin were used: a high dose that, in addition to its serotonin blocking effect, possessed alpha 1-adrenergic blocking capacities; and a low dose that acted only as a serotonin S2 blocking agent. The effects of the high dose were compared to the effects of phenotolamine. Both the high dose of K and phentolamine resulted in a similar fall of systemic blood pressure from 117 ± 4 to 78 ± 3 and from 121 ± 4.5 to 76 ± 5mm Hg, respectively (P < 0.01). Despite this fall, GFR and RPF remained unchanged from 2.36 ± 0.16 ± to 2.26 ± 0.12 ml/min, and from 5.33 ± 0.41 to 5.76 ± 0.5ml/min with K, while both parameters significantly decreased with phentolamine. A remarkable preservation of the autoregulation of RBF until a renal perfusion pressure (RPP) of 70 to 75mm Hg was noted with K, but not with phentolamine or Ringer infusion. With the low dose of K, a significant rise in GFR and PAH clearance was noted, from 2.12 ± 0.17 to 2.59 ± 0.18 and from 4.81 ± 0.35 to 5.66 ± 0.48 ml/min, respectively (P < 0.05). A similar preservation of autoregulation of RBF was observed. Our studies suggest that in the pressure ranges below normal autoregulation of RBF in the rat, serotonin blockade is associated with maintenance of both GFR and RBF

Is it possible to register the ideas, concerns and expectations behind the reason for encounter as a means of classifying patient preferences with ICPC-2?

BackgroundFamily practice aims to recognize the health problems and needs expressed by the person rather than only focusing on the disease. Documenting person-related information will facilitate both the understanding and delivery of person-focused care.AimTo explore if the patients’ ideas, concerns and expectations (ICE) behind the reason for encounter (RFE) can be coded with the International Classification of Primary Care, version 2 (ICPC-2) and what kinds of codes are missing to be able to do so.MethodsIn total, 613 consultations were observed, and patients’ expressions of ICE were narratively recorded. These descriptions were consequently translated to ICPC codes by two researchers. Descriptions that could not be translated were qualitatively analysed in order to identify gaps in ICPC-2.ResultsIn all, 613 consultations yielded 672 ICE expressions. Within the 123 that could not be coded with ICPC-2, eight categories could be defined: concern about the duration/time frame; concern about the evolution/severity; concern of being contagious or a danger to others; patient has no concern, but others do; expects a confirmation of something; expects a solution for the symptoms without specification of what it should be; expects a specific procedure; and expects that something is not done.DiscussionAlthough many ICE can be registered with ICPC-2, adding eight new categories would capture almost all ICE.</jats:sec

Asymétrie d’information et marchés financiers : une synthèse de la littérature récente

Cet article est une synthèse des recherches récentes en matière d’asymétrie d’informations sur les marchés financiers. L’impact de différentes hypothèses sur l’existence et l’efficience informationnelle des équilibres est étudié. Le cas de la concurrence parfaite est d’abord analysé (Grossman et Stiglitz, 1980). Puis la concurrence imparfaite est analysée. On distingue deux cas, selon que le bruit qui empêche le prix d’être parfaitement révélateur provient d’une offre exogène (KyIe, 1985, 1989), ou d’une dotation aléatoire des agents informés (Glosten, 1989; Bhattacharya et Spiegel, 1990; Bossaerts et Hughson, 1991). Dans le premier cas, l’équilibre existe toujours. Dans le second cas, il n’existe que si le bruit est assez élevé ou si le support de sa distribution est borné.The impact of different hypotheses on the existence and informativeness of rational expectations equilibria is analyzed within a simple synthetic model. The case of perfect competition is first analyzed (Grossman and Stiglitz, 1980). Second imperfect competition with exogenous noise trading is studied (KyIe 1985, 1989). Informational efficiency is lower than in the previous case, because of the strategic behaviour of the insider. Third, imperfect competition without noise trader, but with unknown random endowments of the informed agent is analyzed (Glosten, 1989; Bhattacharya and Spiegel, 1990; Bossaerts and Hughson, 1991). In contrast with the previous case, equilibrium exists only if there is enough noise

Parents who experience their child’s chronic pain as highly threatening and distressing have a higher priority for pain control goals

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Determinants of ferritin and soluble transferrin receptors as iron status parameters in young adult women

Objective: To investigate associations between nutritional and non-nutritional variables and Fe status parameters, i.e. serum ferritin and Soluble transferrin receptors (sTfR). Design: Cross-sectional design. Fe status parameters were determined on a fasting venous blood sample. Nutritional variables were assessed using a 2d food record and non-nutritional variables by a general questionnaire. A general linear model was used to investigate associations between the variables and Fe status parameters. Setting: Region of Ghent, Dutch-speaking part of Belgium. Subjects: Random sample of 788 women (aged 18-39 years). Results: Median (interquartile range) ferritin and sTfP, were 26.3 (15.9, 48.9) ng/ml and 1.11 (0.95, 1.30) mg/l, respectively. BMI and alcohol intake were positively associated and tea intake was negatively associated with serum ferritin. Women who Used a non-hormonal intra-Uterine device, who gave blood within the past year or who had been pregnant within the past year had lower serum ferritin Values than their counterparts. Significant determinants of sTfR were smoking habit and pregnancy, with higher values for non-smokers and women who had been pregnant within the past year. Conclusions: The present study indicates that contraceptive use, time since last blood donation, time since last pregnancy, BMI, alcohol and tea intake are determinants of Fe stores, whereas smoking habit and time since last pregnancy are determinants of tissue Fe needs. When developing strategies to improve Fe status, special attention should be given to women Who use a non-hormonal intra-uterine device, gave blood within the past year and had been pregnant within the past year