Lipid-soluble Vitamins A, D, and E in HIV-Infected Pregnant women in Tanzania.

There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings. This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 micromol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 micromol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals. Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01). Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions

Diagnostic scope in out-of-hours primary care services in eight European countries: an observational study

Background: In previous years, out- of-hours primary care has been organised in large-scale organisations in many countries. This may have lowered the threshold for many patients to present health problems at nights and during the weekend. Comparisons of out-of-hours care between countries require internationally comparable figures on symptoms and diagnoses, which were not available. This study aimed to describe the symptoms and diagnoses in out-of-hours primary care services in regions in eight European countries. Methods: We conducted a retrospective observational study based on medical records from out-of-hours primary care services in Belgium, Denmark, Germany, the Netherlands, Norway, Slovenia, Spain, and Switzerland. We aimed to include data on 1000 initial contacts from up to three organisations per country. Excluded were contacts with an administrative reason. The International Classification for Primary Care (ICPC) was used to categorise symptoms and diagnoses. In two countries (Slovenia and Spain) ICD10 codes were translated into ICPC codes. Results: The age distribution of patients showed a high consistency across countries, while the percentage of males varied from 33.7% to 48.3%. The ICPC categories that were used most frequently concerned: chapter A 'general and unspecified symptoms' (mean 13.2%), chapter R 'respiratory' (mean 20.4%), chapter L 'musculoskeletal' (mean 15.0%), chapter S 'skin' (mean 12.5%), and chapter D 'digestive' (mean 11.6%). So, relatively high numbers of patients presenting with infectious diseases or acute pain related syndromes. This was largely consistent across age groups, but in some age groups chapter H ('ear problems'), chapter L ('musculoskeletal') and chapter K ('cardiovascular') were frequently used. Acute life-threatening problems had a low incidence. Conclusions: This international study suggested a highly similar diagnostic scope in out-of-hours primary care services. The incidence rates of acute life-threatening health problems were low in all countries

Influence of social support on cognitive function in the elderly

BACKGROUND: Social support is important in daily activities of the elderly. This study tests the hypothesis that there is an association between social support and cognitive function among the elderly in a community setting. METHODS: Face-to-face interviews were conducted in a cross-sectional stratified random sample of 4,993 elderly (≥65 years) city residents. Using multiple regression analysis, we investigated the influence of social support on cognitive function. RESULTS: 12% were over 80 years old. 53.28% were men. 67.14% were married. Higher Short Portable Mental Status Questionnaire (SPMSQ) scores (higher score means better cognitive function) were associated with strong social support, as measured by marital status and perceived positive support from friends. Lower cognitive function was associated with older and with female respondents. Only instrumental activities of daily living (IADL) were statistically and negatively related to SPMSQ. Lower functional status was associated with lower cognitive function. Elders with grade school educations had lower SPMSQ scores than did elders with high school educations. CONCLUSIONS: In Taiwan, higher cognitive function in community-living elderly was associated with increased social support. Life-style management should provide social activities for the elderly to promote a better quality of life

Relationship between disease course in the temporomandibular joints and mandibular growth rotation in patients with juvenile idiopathic arthritis followed from childhood to adulthood

<p>Abstract</p> <p>Objective</p> <p>To investigate the relationship between radiographic JIA disease course in the TMJs and mandibular growth rotation, compared with growth in healthy individuals.</p> <p>Methods</p> <p>From a larger series of JIA patients followed from childhood to adulthood, 26 were included; 11 without and 15 with bilateral radiographic TMJ involvement. Joint morphology and function were assessed at baseline, 2-, 4-, 6- and 27 years follow-up. Mandibular growth rotation (anterior, posterior or none) was assessed from cephalometric evaluations at childhood and adulthood, with observations from 16 healthy individuals as controls. TMJ disease course and mandibular growth rotation were assessed independently and their relationship analysed. Non-parametric statistical methods were applied to test differences between groups.</p> <p>Results</p> <p>In the normal TMJ group of JIA patients the joint morphology was similar at the follow-ups and all patients had good function both in childhood and in adulthood. The mandibular growth rotation was similar to that of healthy controls, i.e. predominantly in anterior direction. In the abnormal TMJ group different JIA TMJ disease courses were observed and associated with changes in the mandibular growth rotation (p = 0.007).</p> <p>Progressing JIA TMJ disease course was related to posterior mandibular growth rotation and improving disease course to anterior mandibular growth rotation.</p> <p>Conclusion</p> <p>A relationship was found between JIA disease course in the TMJs and mandibular growth rotation, suggesting that a favourable growth could be regained in patients with improvement in TMJ morphology and/or TMJ function. To confirm this, further research on larger patient series is needed.</p

The contribution of theory to the design, delivery, and evaluation of interprofessional curricula: BEME Guide No. 49

BACKGROUND: Interprofessional curricula have often lacked explicit reference to theory despite calls for a more theoretically informed field that illuminates curricular assumptions and justifies curricular practices. AIM: To review the contributions of theory to the design, delivery, and evaluation of interprofessional curricula. METHODS: Four databases were searched (1988-2015). Studies demonstrating explicit and a high-quality contribution of theory to the design, delivery or evaluation of interprofessional curricula were included. Data were extracted against a comprehensive framework of curricular activities and a narrative synthesis undertaken. RESULTS: Ninety-one studies met the inclusion criteria. The majority of studies (86%) originated from the UK, USA, and Canada. Theories most commonly underpinned "learning activities" (47%) and "evaluation" (54%). Theories of reflective learning, identity formation, and contact hypothesis dominated the field though there are many examples of innovative theoretical contributions. CONCLUSIONS: Theories contribute considerably to the interprofessional field, though many curricular elements remain under-theorized. The literature offers no "gold standard" theory for interprofessional curricula; rather theoretical selection is contingent upon the curricular component to which theory is to be applied. Theories contributed to interprofessional curricula by explaining, predicting, organizing or illuminating social processes embedded in interprofessional curricular assumptions. This review provides guidance how theory might be robustly and appropriately deployed in the design, delivery, and evaluation of interprofessional curricula

Low Vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study

Extent: 6p.Background: Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories. Methods: In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees (n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011. Results: 16.5% of participants had Vitamin B12 deficiency (<150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%. Conclusion: Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes, treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.Jill Benson, Christine Phillips, Margaret Kay, Murray T. Webber, Alison J. Ratcliff, Ignacio Correa-Velez, Michelle F. Lorime

The safety attitudes questionnaire – ambulatory version: psychometric properties of the Norwegian translated version for the primary care setting

Background Patient safety culture is how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. The Safety Attitudes Questionnaire is the most widely used instrument to measure safety attitudes among health care providers. The instrument may identify possible weaknesses in clinical settings, and motivate and guide quality improvement interventions and reductions in medical errors. The Safety Attitudes Questionnaire – Ambulatory Version was developed for measuring safety culture in the primary care setting. The original version includes six major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, Working conditions and Stress recognition. We describe the results of a validation study using the Norwegian translation of the questionnaire in the primary care setting, and present the psychometric properties of this version. Methods The study was done in seven Out-of-hours casualty clinics and 17 regular GP practices employing a total of 510 primary health care providers (194 nurses and 316 medical doctors). In October and November 2012, the translated Safety Attitudes Questionnaire – Ambulatory Version was distributed by e-mail. Data were collected electronically using the program QuestBack, whereby the participants responded anonymously. SPSS was used to estimate the Cronbach’s alphas, item-to-own-factor correlations, intercorrelations of factors and item-descriptive statistics. The confirmatory factor analysis was done by AMOS. Results Of the 510 invited health care providers, 266 (52%) answered the questionnaire - 72% of the registered nurses (n = 139) and 39% of the medical doctors (n = 124). In the confirmatory factor analysis, the following five factor model was shown to have acceptable goodness-of-fit values in the Norwegian primary care setting: Teamwork climate, Safety climate, Job satisfaction, Working conditions and Perceptions of management. Conclusions The results of our study indicate that the Norwegian translated version of the Safety Attitudes Questionnaire – Ambulatory Version, with the five confirmed factors, might be a useful tool for measuring several aspects of patient safety culture in the primary care setting. Further research should investigate whether there is an association between patient safety culture in primary care, as measured by the Safety Attitudes Questionnaire – Ambulatory Version, and occurrence of medical errors and negative patient outcome

Songs of silence: painting, phenomenology, aesthetics

The aim of my research is to explore the aesthetic potentialities of gestural painting and reductive spatiality in two dimensional and three dimensional forms. I have conducted an investigation into aesthetic experience through the phenomenological framework of the French philosopher, Merleau-Ponty and the foundational thinking of American theorist, Ellen Dissanayake in relation to art. I have addressed gesture and materiality as both a communicative tool and an aesthetic strategy. The work of Katharina Grosse (b. 1961), Fabienne Verdier (b.1962) and Anish Kapoor (b.1954) is investigated, especially in relation to aspects of visual art practice such as large scale works; the use of gesture in painting; spatiality in two and three dimensions; attention to surface and the strategic use of colour. The void and the sublime is also addressed, especially in the works of Anish Kapoor and Fabienne Verdier. My studio work is based on an initial series of mark making experiments in ink/paint on paper. The emphasis was on the phenomenological experience and aesthetic dimensions of verticality, in relation to falling and floating. The gestural marks are improvised, repetitive and experimental in nature; and the spatial activation of the white ground and its surface is also a primary consideration in these experiments. Painting in three dimensional space emerged through the studio practice and its theoretical concerns. This culminated in gestural experimental painting on 4.5m vertically suspended drops of muslin using both viscous and watery paint. The muslin was also sculpted and draped in various ways which evoked a multitude of bodily and experiential associations