General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease:implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

<strong>Objective</strong> The Scottish Care Information - Diabetes Collaboration (SCI-DC) developed a computer- based information system to create a shared electronic record for use by all involved in the care of patients with diabetes mellitus. The objectives of this study were to understand primary care practitioners' views towards screening for diabetic foot disease and their experience of the SCI-DC system. <strong>Method</strong> We conducted an exploratory study using qualitativemethods. Semi-structured interviews were audiotape-recorded, transcribed and subjected to thematic analysis. Seven practice nurses and six general practitioners (GPs) with special responsibility for diabetes care inNHS Lothian participated. <strong>Results</strong> Primary care clinicians reported good systems in place to screen for diabetes-related complications and to refer their patients to specialist care. Foot ulceration was rarely observed; other diabetesrelated conditions were seen as a higher priority. Most had heard of the SCI-DC foot assessment tool, but its failure to integrate with other primary care information technology (IT) systems meant it was not used in these general practices. <strong>Conclusions</strong> Adoption of the SCI-DC foot assessment tool in primary care is not perceived as clinically necessary. Although information recorded by specialist services on SCI-DC is helpful, important structural barriers to its implementation mean the potential benefits associated with its use are unlikely to be realised; greater engagement with primary care priorities for diabetes management is needed to assist its successful implementation and adoption

Stimulating job demand:The design of effective hiring subsidies in Europe. The Netherlands

Viewing the hiring subsidies in the Netherlands over the past decade, there seems to be a constant change in Acts: abolishing existing regulations and introducing new ones. The main measures focus on people at a considerable distance from the labour market, including long-term unemployed welfare recipients and people who have a work disability. There have also been some incentives for employers to hire older workers or young people; however, these schemes are smaller and more often of a temporary nature

Game (wildlife) meat safety: understanding the game meat supply chain and the roles of role-players in a multifaceted control environment

Moderator: Lyle Renecker.Presented at the 8th international congress for wildlife and livelihoods on private and communal lands: livestock, tourism, and spirit, that was held on September 7-12, 2014 in Estes Park, Colorado.As in other parts of the world, the South African game industry is expanding and game meat is finding its way in the local and international food supply chain. In order to do effective game meat control, one must have an understanding of the game meat supply chain and the stakeholders therein. The term 'food supply chain' refers to the total supply process from agricultural production, harvest / slaughter, through processing and handling of a food and its ingredients, storage and distribution up to consumption. In the case of game meat, the supply chain will include the relevant food and meat control authorities, primary producers (farmers), suppliers of feed and veterinary drugs to farmers, hunters, abattoirs, small and large scale processors, wholesale and retail, suppliers of processing materials, import and export agencies, transport and the consumer. From this it is clear that several role-players are involved, which leads to a multifaceted and fragmented food control environment. It was necessary to determine the control points essential for meat safety and the responsibilities of the role-players for the execution of these control points along the game meat supply chain. Information regarding the study was obtained through a desk top study and analysis of questionnaire responses from game farmers, hunters and national, provincial and municipal control authorities. Game meat is often entering the supply chain in an uncontrolled manner while there is a lack of a single formal framework for its operation amongst the stakeholders. To address this issue, the research looked for insight into the game meat supply chain; the differences between the game meat supply chain and the conventional meat supply chain; the respective role-players in the supply chain; and the essential meat safety control points along the supply chain. The crucial meat safety link between the supply chain and the roles of stakeholders in ensuring that safe meat is supplied to the consumer is often vague. The introduction of a mechanism to reduce the indistinctness is essential for this growing industry. The mechanism suggested relates to the establishment of a game meat safety forum whereby all role-players are involved

Anomalous negative excursion of carbon isotope in organic carbon after the last Paleoproterozoic glaciation in North America

Early Paleoproterozoic time (2.5–2.0 Ga) spanned a critical phase in Earth's history, characterized by repeated glaciations and an increase in atmospheric oxygen (the Great Oxidation Event (GOE)). Following the last and most intense glaciation of this period, marine carbonates record a large positive excursion of δ^(13)C value (termed the “Lomagundi event”) between about 2.2 and 2.1 Ga coinciding with the global appearances of red beds and sulfates, which suggest an accumulation of high levels of atmospheric oxygen. Here we report the discovery of large negative excursions of δ^(13)C in organic matter (down to −55‰) from quartzose sandstones (of the Marquette Range and the Huronian Supergroups, North America) intermediate in age between the last Paleoproterozoic glaciation and the possible onset of the Lomagundi event. The negative excursion is concomitant with the appearance of intensely weathered quartzose sandstones, which may represent hot and humid conditions. There are some interpretations that potentially explain the negative excursions: (1) redeposition of older ^(13)C-depleted kerogen, (2) later post-depositional infiltration of oil, (3) active methane productions by methanogens in shallow-marine environments, or (4) dissociation of methane hydrate. If the latter two were the case, they would provide clues for understanding the environmental change connecting the intense glaciation and an increase in oxygen

Re-Regulating Dietary Supplements

In 1994, Congress introduced the Dietary Supplement Health and Education Act (DSHEA) to create a regulatory framework for the dietary supplement industry. Despite the increased market size of dietary supplements, the Food and Drug Administration’s (FDA) pre-market authority to regulate the introduction of dietary supplements into the stream of commerce has remained subdued. Under DSHEA, the FDA has limited authority to review dietary supplements before entering the market. Unlike pharmaceuticals, which must be proven safe and effective prior to approval and marketing, dietary supplements can be sold to consumers without such reassurances. We call on Congress to amend DSHEA to grant the FDA the additional express statutory authority to fix these problems

Re-Regulating Dietary Supplements

In 1994, Congress introduced the Dietary Supplement Health and Education Act (DSHEA) to create a regulatory framework for the dietary supplement industry. Since the passage of DSHEA nearly thirty years ago, U.S. adults have steadily increased their annual consumption of dietary supplements. The once $4 billion industry comprising approximately 4,000 products has swelled to a$40 billion trade with anywhere from 50,000 to 80,000 dietary supplements available over-the-counter. Despite the increased market size of dietary supplements, the Food and Drug Administration’s (FDA) pre-market authority to regulate the introduction of dietary supplements into the stream of commerce has remained subdued. Under DSHEA, the FDA has limited authority to review dietary supplements before entering the market. Unlike pharmaceuticals, which must be shown to be safe and effective prior to approval and marketing, dietary supplements can be sold to consumers without such reassurances. Instead, the FDA’s authority is generally limited to post-market enforcement under DSHEA. In fact, the FDA lacks the express authority to remove dietary supplements from the market unless it can establish that the products are unsafe, adulterated, mislabeled or misbranded. Given the morbidity and mortality associated with adulterated dietary supplements and the challenges in addressing the latest fads before they cause harm, Congress must give the FDA the power it needs to be proactive. The FDA desperately needs the tools to regulate the dietary supplement industry and remove harmful dietary supplements from the market. We call on Congress to amend DSHEA to grant the FDA the express statutory authority to (1) regulate dietary supplements prior to entering the market; (2) require manufacturers to submit Supplement Labels to the FDA for pre-market review; (3) require that supplements undergo both pre-market composition testing and post-market randomized composition testing; (4) strengthen agency authority to remove adulterated dietary supplements from the market; and (5) establish an excise tax on dietary supplements

Re-Regulating Dietary Supplements

In 1994, Congress introduced the Dietary Supplement Health and Education Act (DSHEA) to create a regulatory framework for the dietary supplement industry. Despite the increased market size of dietary supplements, the Food and Drug Administration’s (FDA) pre-market authority to regulate the introduction of dietary supplements into the stream of commerce has remained subdued. Under DSHEA, the FDA has limited authority to review dietary supplements before entering the market. Unlike pharmaceuticals, which must be proven safe and effective prior to approval and marketing, dietary supplements can be sold to consumers without such reassurances. We call on Congress to amend DSHEA to grant the FDA the additional express statutory authority to fix these problems

The mass miniature chest radiography programme in Cape Town, South Africa, 1948 - 1994: The impact of active tuberculosis case finding

Background. Tuberculosis (TB) control programmes rely mainly on passive detection of symptomatic individuals. The resurgence of TB has rekindled interest in active case finding. Cape Town (South Africa) had a mass miniature radiography (MMR) screening programme from 1948 to 1994.Objective. To evaluate screening coverage, yield and secular trends in TB notifications during the MMR programme.Methods. We performed an ecological analysis of the MMR programme and TB notification data from the City of Cape Town Medical Officer of Health reports for 1948 - 1994.Results. Between 1948 and 1962, MMR screening increased to 12% of the population per annum with yields of 14 cases per 1 000 X-rays performed, accounting for &gt;20% of total annual TB notifications. Concurrent with increasing coverage (1948 - 1965), TB case notification decreased in the most heavily TB-burdened non-European population from 844/100 000 population to 415/100 000. After 1966, coverage declined and TB notifications that initially remained stable (1967 - 1978) subsequently increased to 525/100 000. MMR yields remained low in the European population but declined rapidly in the non-European population after 1966, coincidental with forced removals from District 6. An inverse relationship between screening coverage and TB notification rates was observed in the non-European adult population. Similar secular trends occurred in infants and young children who were not part of the MMR screening programme.Conclusion. MMR of a high-burdened population may have significantly contributed to TB control and was temporally associated with decreased transmission to infants and children. These historical findings emphasise the importance of re-exploring targeted active case finding strategies as part of population TB control

The spectrum and prognosis of AIDS-defining illnesses in Cape Town

Objectives. To describe the incidence, spectrum and prognosis of AIDS-defining illnesses (ADI) in patients without access to antiretroviral therapy (ART). Design. Prospective cohort study. Subjects. 1 215 HIV-infected patients attending adult HIV clinics affiliated to the University of Cape Town in the New Somerset and Groote Schuur Hospitals from 1992 to 2000. Main outcome measures. Incidence rate (IR) of ADIs and survival after the ..

Framing Options as Choice or Opportunity

Objective. Health professionals must enable patients to make informed decisions about health care choices through unbiased presentation of all options. This study examined whether presenting the decision as "opportunity" rather than "choice" biased individuals' preferences in the context of trial participation for cancer treatment. Methods. Self-selecting healthy women (N = 124) were randomly assigned to the following decision frames: opportunity to take part in the trial (opt-in), opportunity to be removed from the trial (opt-out), and choice to have standard treatment or take part in the trial (choice). The computer-based task required women to make a hypothetical choice about a real-world cancer treatment trial. The software presented the framed scenario, recorded initial preference, presented comprehensive and balanced information, traced participants' use of information during decision making, and recorded final decision. A posttask paper questionnaire assessed perceived risk, attitudes, subjective norm, perceived behavioral control, and satisfaction with decision. Results. Framing influenced women's immediate preferences. Opportunity frames, whether opt-in or opt-out, introduced a bias as they discouraged women from choosing standard treatment. Using the choice frame avoided this bias. The opt-out opportunity frame also affected women's perceived social norm; women felt that others endorsed the trial option. The framing bias was not present once participants had had the opportunity to view detailed information on the options within a patient decision aid format. There were no group differences in information acquisition and final decisions. Sixteen percent changed their initial preference after receiving full information. Conclusions. A "choice" frame, where all treatment options are explicit, is less likely to bias preferences. Presentation of full information in parallel, option-by-attribute format is likely to "de-bias" the decision frame. Tailoring of information to initial preferences would be ill-advised as preferences may change following detailed information