Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

Background: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the “OTC SOCIOMED”, conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. Methods: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs’ intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. Results: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. Conclusions: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries

Non-Hermitian Hamiltonians with a Real Spectrum and Their Physical Applications

We present an evaluation of some recent attempts at understanding the role of pseudo-Hermitian and PT-symmetric Hamiltonians in modeling unitary quantum systems and elaborate on a particular physical phenomenon whose discovery originated in the study of complex scattering potentials.Comment: 9 pages, contributed to Homi Bhabha Centenary Conference on Non-Hermitian Hamiltonians in Quantum Physics (8th International Workshop on Pseudo-Hermitian Hamiltonians in Quantum Physics), held in Mumbai, January 13-16, 200

A taste sensor device for unmasking admixing of rancid or winey-vinegary olive oil to extra virgin olive oil

Electrochemical sensor devices have gathered great attention in food analysis namely for olive oil evaluation. The adulteration of extra-virgin olive oil with lower-grade olive oil is a common worldwide fraudulent practice, which detection is a challenging task. The potentiometric fingerprints recorded by lipid polymeric sensor membranes of an electronic tongue, together with linear discriminant analysis and simulated annealing meta-heuristic algorithm, enabled the detection of extra-virgin olive oil adulterated with olive oil for which an intense sensory defect could be perceived, specifically rancid or winey-vinegary negative sensations. The homemade designed taste device allowed the identification of admixing of extra-virgin olive oil with more than 2.5% or 5% of rancid or winey-vinegary olive oil, respectively. Predictive mean sensitivities of 84±4% or 92±4% and specificities of 79±6% or 93±3% were obtained for rancid or winey-vinegary adulterations, respectively, regarding an internal-validation procedure based on a repeated K-fold cross-validation variant (4 folds×10 repeats, ensuring that the dataset was forty times randomly split into 4 folds, leaving 25% of the data for validation purposes). This performance was satisfactory since, according to the legal physicochemical and sensory analysis, the intentionally adulterated olive oil with percentages of 2.510%, could still be commercialized as virgin olive oil. It could also be concluded that at a 5% significance level, the trained panelists could not distinguish extra-virgin olive oil samples from those adulterated with 2.5% of rancid olive oil or up to 5% of winey-vinegary olive oil. Thus, the electronic tongue proposed in this study can be foreseen as a practical and powerful tool to detect this kind of worldwide common fraudulent practice of high quality olive oil.This work was financially supported by Project POCI-01–0145FEDER-006984 – Associate Laboratory LSRE-LCM, Project UID/QUI/ 00616/2013 – CQ-VR, Project UID/BIO/04469/2013 – CEB and strategic project PEst-OE/AGR/UI0690/2014 – CIMO all funded by FEDER - Fundo Europeu de Desenvolvimento Regional through COMPETE2020 - Programa Operacional Competitividade e Internacionalização (POCI) – and by national funds through FCT - Fundação para a Ciência e a Tecnologia, Portugal. Nuno Rodrigues thanks FCT, POPH-QREN and FSE for the Ph.D. Grant (SFRH/BD/104038/2014). Souheib Oueslati is also grateful for the support of the Tunisian Ministry of Agriculture.info:eu-repo/semantics/publishedVersio

"I should live and finish it": A qualitative inquiry into Turkish women's menopause experience

<p>Abstract</p> <p>Background</p> <p>While bio-medically, menopause could be treated as an illness, from a psychosocial and cultural perspective it could be seen as a "natural" process without requiring medication unless severe symptoms are present.</p> <p>Our objective is to explore the perceptions of Turkish women regarding menopause and Hormone Therapy (HT) to provide health care workers with an insight into the needs and expectations of postmenopausal women.</p> <p>Methods</p> <p>A qualitative inquiry through semi-structured, in-depth interviews was used to explore the study questions. We used a purposive sampling and included an equal number of participants who complained about the climacteric symptoms and those who visited the outpatient department for a problem other than climacteric symptoms but when asked declared that they had been experiencing climacteric symptoms. The interview questions focused on two areas; 1) knowledge, experiences, attitudes and beliefs about menopause and; 2) menopause-related experiences and ways to cope with menopause and perception of HT.</p> <p>Results</p> <p>Most of the participants defined menopause as a natural transition process that one should go through. Cleanliness, maturity, comfort of not having a period and positive changes in health behaviour were the concepts positively attributed to menopause, whereas hot flushes, getting old and difficulties in relationships were the negatives. Osteoporosis was an important concern for most of the participants. To deal with the symptoms, the non-pharmacological options were mostly favoured.</p> <p>Conclusion</p> <p>To our knowledge, this is the first qualitative study which focuses on Turkish women's menopausal experiences. Menopause was thought to be a natural process which was characterised by positive and negative features. Understanding these features and their implications in these women's lives may assist healthcare workers in helping their clients with menopause.</p

Theoretically-Efficient and Practical Parallel DBSCAN

The DBSCAN method for spatial clustering has received significant attention due to its applicability in a variety of data analysis tasks. There are fast sequential algorithms for DBSCAN in Euclidean space that take $O(n\log n)$ work for two dimensions, sub-quadratic work for three or more dimensions, and can be computed approximately in linear work for any constant number of dimensions. However, existing parallel DBSCAN algorithms require quadratic work in the worst case, making them inefficient for large datasets. This paper bridges the gap between theory and practice of parallel DBSCAN by presenting new parallel algorithms for Euclidean exact DBSCAN and approximate DBSCAN that match the work bounds of their sequential counterparts, and are highly parallel (polylogarithmic depth). We present implementations of our algorithms along with optimizations that improve their practical performance. We perform a comprehensive experimental evaluation of our algorithms on a variety of datasets and parameter settings. Our experiments on a 36-core machine with hyper-threading show that we outperform existing parallel DBSCAN implementations by up to several orders of magnitude, and achieve speedups by up to 33x over the best sequential algorithms

Monovarietal extra-virgin olive oil classification: a fusion of human sensory attributes and an electronic tongue

Olive oil quality grading is traditionally assessed by human sensory evaluation of positive and negative attributes (olfactory, gustatory, and final olfactorygustatory sensations). However, it is not guaranteed that trained panelist can correctly classify monovarietal extra-virgin olive oils according to olive cultivar. In this work, the potential application of human (sensory panelists) and artificial (electronic tongue) sensory evaluation of olive oils was studied aiming to discriminate eight single-cultivar extra-virgin olive oils. Linear discriminant, partial least square discriminant, and sparse partial least square discriminant analyses were evaluated. The best predictive classification was obtained using linear discriminant analysis with simulated annealing selection algorithm. A low-level data fusion approach (18 electronic tongue signals and nine sensory attributes) enabled 100 % leave-one-out cross-validation correct classification, improving the discrimination capability of the individual use of sensor profiles or sensory attributes (70 and 57 % leave-one-out correct classifications, respectively). So, human sensory evaluation and electronic tongue analysis may be used as complementary tools allowing successful monovarietal olive oil discrimination.This work was co-financed by FCT/MEC and FEDER under Program PT2020 (Project UID/EQU/50020/2013); by Fundacao para a Ciencia e Tecnologia under the strategic funding of UID/BIO/04469/2013 unit; and by Project POCTEP through Project RED/AGROTEC-Experimentation network and transfer for development of agricultural and agro industrial sectors between Spain and Portugal

Frequency of symptoms, determinants of severe symptoms, validity of and cut-off score for Menopause Rating Scale (MRS) as a screening tool: A cross-sectional survey among midlife Nepalese women

<p>Abstract</p> <p>Background</p> <p>Majority of Nepalese women live in remote rural areas, where health services are not easily accessible. We determined the validity of Menopause Rating Scale (MRS) as a screening tool for identification of women with severe menopausal symptoms and cut-off MRS score for referral.</p> <p>Methods</p> <p>A cross-sectional survey was carried out between February and August, 2008. Trained health workers administered MRS and a questionnaire to 729 women (40 to 65 years) attending health screening camps in Kaski district of Western Development Region of Nepal. Information about demographics, menopausal status, and use of hormone replacement therapy (HRT), chronic disease, self-perceived general health and reproductive history was also collected. Menopausal status was classified according to the Staging of Reproductive Ageing Workshop (STRAW). We calculated rates of menopausal symptoms, sensitivity, and specificity and likelihood ratios of MRS scores for referral to a gynaecologist. We also carried out multivariate analyses to identify the predictors for referral to a gynaecologist for severe symptoms.</p> <p>Results</p> <p>A total 729 women were interviewed. Mean age at menopause was 49.9 years (SD 5.6). Most frequently reported symptoms were, sleeping problems (574, 78.7%), physical and mental exhaustion (73.5%), hot flushes (508, 69.7%), joint and muscular discomfort (500, 68.6%) and dryness of vagina (449, 61.6%). Postmenopausal women (247, 33.9%) and perimenopausal (215, 29.5%) women together experienced significantly higher prevalence of all symptoms than the premenopausal (267, 36.6%) women. MRS score of ≥16 had highest ratio for (sensitivity + specificity)/2. Women who reported urogenital symptoms [OR 5.29, 95% CI 2.59, 10.78], and self perceived general health as poor [OR 1.29, 95% CI 1.11, 1.53] were more likely to be referred to a gynaecologist for severe menopausal symptoms. While women reporting somatic [OR 0.72, 95% CI 0.63, 0.82] and psychological [OR 0.86, 95% CI 0.74, 0.99] symptoms were less likely to be referred.</p> <p>Conclusion</p> <p>MRS may be used as a screening tool at a cut-off score of ≥16 with least misclassification rate. However, its utility may be limited by woman's general health status and occurrence of urogenital symptoms.</p