Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review

<p>Abstract</p> <p>Background</p> <p>The diagnosis of dementia in primary care is perceived as a problem across countries and systems, resulting in delayed recognition and adverse outcomes for patients and their carers. Improving its early detection is an area identified for development in the English National Dementia Strategy 2009; there are thought to be multiple benefits to the patient, family, and resources by doing this. The aim of this review was to carry out a rapid appraisal in order to inform the implementation of this policy.</p> <p>Method</p> <p>Publications in English up to August 2009 relating to barriers to the recognition of dementia, were identified by a broad search strategy, using electronic databases MEDLINE, EMBASE, and psycINFO. Exclusion criteria included non-English language, studies about pharmacological interventions or screening instruments, and settings without primary care.</p> <p>Results</p> <p>Eleven empirical studies were found: 3 quantitative, 6 qualitative, and 2 with mixed methodologies. The main themes from the qualitative studies were found to be lack of support, time constraints, financial constraints, stigma, diagnostic uncertainty, and disclosing the diagnosis. Quantitative studies yielded diverse results about knowledge, service support, time constraints, and confidence. The factors identified in qualitative and quantitative studies were grouped into 3 categories: patient factors, GP factors and system characteristics.</p> <p>Conclusion</p> <p>Much can still be done in the way of service development and provision, GP training and education, and the eradication of stigma attached to dementia, to improve the early detection and management of dementia. Implementation of dementia strategies should include attention to all three categories of barriers. Further research should focus on their interaction, using different methods from studies to date.</p

Childhood tuberculosis is associated with decreased abundance of T cell gene transcripts and impaired T cell function

The WHO estimates around a million children contract tuberculosis (TB) annually with over 80 000 deaths from dissemination of infection outside of the lungs. The insidious onset and association with skin test anergy suggests failure of the immune system to both recognise and respond to infection. To understand the immune mechanisms, we studied genome-wide whole blood RNA expression in children with TB meningitis (TBM). Findings were validated in a second cohort of children with TBM and pulmonary TB (PTB), and functional T-cell responses studied in a third cohort of children with TBM, other extrapulmonary TB (EPTB) and PTB. The predominant RNA transcriptional response in children with TBM was decreased abundance of multiple genes, with 140/204 (68%) of all differentially regulated genes showing reduced abundance compared to healthy controls. Findings were validated in a second cohort with concordance of the direction of differential expression in both TBM (r2 = 0.78 p = 2x10-16) and PTB patients (r2 = 0.71 p = 2x10-16) when compared to a second group of healthy controls. Although the direction of expression of these significant genes was similar in the PTB patients, the magnitude of differential transcript abundance was less in PTB than in TBM. The majority of genes were involved in activation of leucocytes (p = 2.67E-11) and T-cell receptor signalling (p = 6.56E-07). Less abundant gene expression in immune cells was associated with a functional defect in T-cell proliferation that recovered after full TB treatment (p<0.0003). Multiple genes involved in T-cell activation show decreased abundance in children with acute TB, who also have impaired functional T-cell responses. Our data suggest that childhood TB is associated with an acquired immune defect, potentially resulting in failure to contain the pathogen. Elucidation of the mechanism causing the immune paresis may identify new treatment and prevention strategies

Search for the Standard Model Higgs Boson with the OPAL Detector at LEP

This paper summarises the search for the Standard Model Higgs boson in e+e- collisions at centre-of-mass energies up to 209 GeV performed by the OPAL Collaboration at LEP. The consistency of the data with the background hypothesis and various Higgs boson mass hypotheses is examined. No indication of a signal is found in the data and a lower bound of 112.7GeV/C^2 is obtained on the mass of the Standard Model Higgs boson at the 95% CL.This paper summarises the search for the Standard Model Higgs boson in e+e- collisions at centre-of-mass energies up to 209 GeV performed by the OPAL Collaboration at LEP. The consistency of the data with the background hypothesis and various Higgs boson mass hypotheses is examined. No indication of a signal is found in the data and a lower bound of 112.7GeV/C^2 is obtained on the mass of the Standard Model Higgs boson at the 95% CL

Julkiseen työnvälitykseen ilmoitettujen avointen työpaikkojen rekisteriaineisto 2022

Aineisto sisältää tietoja julkiseen työnvälitykseen vuonna 2022 ilmoitetuista työpaikoista. Aineisto on koottu työpaikkailmoituksista, joista on laskettu kussakin ilmoituksessa avoinna olevien työpaikkojen määrä. Aineisto sisältää tietoja avoinna olleista työpaikoista, niitä tarjoavista työnantajista ja työpaikan täyttöprosessista. Aineistossa mainitaan avoinna olevista työpaikoista muun muassa työpaikan sijaintikunta, työpaikan ammatti, työnantajan toimiala, työpaikan koulutusvaatimus, työaika, työn kesto, henkilökunnan koko, työnantajan sektori ja työpaikan tyyppi. Lisäksi aineistossa ovat tiedot työpaikan viimeisestä hakupäivämäärästä, aiottu työn alkamispäivä, avoinnaolon alkamis- ja päättymispäivä sekä täyttötieto. Muuttujina ovat myös työpaikkojen määrä ilmoituksessa, työpaikkailmoitusrivien alkuperäinen määrä ilmoituksessa ja työhönosoitusten määrä. Aineistossa ovat myös työ- ja elinkeinotoimistot (TE-toimistot) sekä elinkeino-, liikenne- ja ympäristökeskukset (ELY-keskukset), joiden alueella työpaikka on ollut. Aineistoon on lisätty erilaisia kestomuuttujia. Tällaisia ovat muun muassa avoinnaolon kesto, rekrytointiaika ja täyttöviive. Näille muuttujille on omat laskentasääntönsä, ks. esim. Räisänen, Heikki (2004): Työvoiman hankinta julkisessa työnvälityksessä. VATT-tutkimuksia 107. Aineistossa ovat mukana myös aluemuuttujat seutukunta, tilastollinen kuntatyyppi ja suurkaupunki.The data contain information on the vacancies notified to the Public Employment Service in Finland in 2022. The data have been compiled from job advertisements, and each individual vacancy mentioned in the advertisements has been counted. The data include information on open vacancies, employers, and the process of filling the job vacancies. The information on open vacancies covers variables such as the location, occupation, and duration of the vacancy, the employer's industry of employment, educational requirements, working hours, staff size, type of workplace, deadline for applications, and the starting date of the job. In addition, the data contain variables providing information on the number of open vacancies in the advertisements, the number of rows in the advertisement, and the number of job offers. The public employment agencies (TE Offices) and Centres for Economic Development, Transport and the Environment (ELY Centres) located in the region of the open vacancies are also included in the data. Various duration variables have been added to the data. These variables include the duration the vacancy was open, the time of recruiting, and the time it took to fill the vacancy. These variables have their own calculation rules. The data also include regional variables such as the sub-region, municipality type, and town

Preconception care for diabetic women for improving maternal and fetal outcomes : a systematic review and meta-analysis

Background Preexisting diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. Despite improvement in the access and quality of antenatal care recent population based studies demonstrating increased congenital abnormalities and perinatal mortality in diabetic mothers as compared to the background population. This systematic review was carried out to evaluate the effectiveness and safety of preconception care in improving maternal and fetal outcomes for women with preexisting diabetes mellitus. Methods We searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINAHL up to December 2009, without language restriction, for any preconception care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women of reproductive age group with type I or type II diabetes. Study design were trials (randomized and non-randomized), cohort and case-control studies. Of the 1612 title scanned 44 full papers were retrieved of those 24 were included in this review. Twelve cohort studies at low and medium risk of bias, with 2502 women, were included in the meta-analysis. Results Meta-analysis suggested that preconception care is effective in reducing congenital malformation, RR 0.25 (95% CI 0.15-0.42), NNT17 (95% CI 14-24), preterm delivery, RR 0.70 (95% CI 0.55-0.90), NNT = 8 (95% CI 5-23) and perinatal mortality RR 0.35 (95% CI 0.15-0.82), NNT = 32 (95% CI 19-109). Preconception care lowers HbA1c in the first trimester of pregnancy by an average of 2.43% (95% CI 2.27-2.58). Women who received preconception care booked earlier for antenatal care by an average of 1.32 weeks (95% CI 1.23-1.40). Conclusion Preconception care is effective in reducing diabetes related congenital malformations, preterm delivery and maternal hyperglycemia in the first trimester of pregnancy