Travelling with a Stoma: A literature Review

This document is the Accepted Manuscript version of a Published Work that appeared in final form in Gastrointestinal Nursing, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see http://www.magonlinelibrary.com/toc/gasn/currentGiven the daily challenges that unfamiliar environments, food and culture bring, many ostomates find the prospect of travelling with a stoma stressful. Yet with good advice, international travel can be enjoyed, whether experienced for leisure or work purposes. To practice safely, nurses require knowledge of research evidence, combined with a wealth of practical knowledge, derived from patient experience. This article examines how these types of knowledge can be brought together to ensure that people with a stoma are able to anticipate travel in a more positive way.Peer reviewedFinal Accepted Versio

Health-industry linkages for local health: reframing policies for African health system strengthening

The benefits of local production of pharmaceuticals in Africa for local access to medicines and to effective treatment remain contested. There is scepticism among health systems experts internationally that production of pharmaceuticals in sub-Saharan Africa (SSA) can provide competitive prices, quality and reliability of supply. Meanwhile low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. We present evidence from interviews in 2013–15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. We then identify key policies that can ensure that local health systems benefit from the investments. We argue for a ‘local health’ policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health–industry linkages and strengthening of both sectors. We argue that this local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with ‘global health’ frameworks but poses a challenge to some of its underlying assumptions

Societal Costs and Benefits of Treatment with Trastuzumab in Patients with Early HER2neu-Overexpressing Breast Cancer in Singapore

<p>Abstract</p> <p>Background</p> <p>Trastuzumab has revolutionized the way we treat early Her2Neu-positive breast cancer, as it significantly improves disease-free and overall survival. Little is known about the societal costs and benefits of treatment with trastuzumab in the adjuvant setting in Southeast Asia.</p> <p>Methods</p> <p>Societal costs (benefits) were estimated as the sum of direct and indirect costs minus benefits in the base case. Direct costs were derived from 4 treatment centers in Singapore (2 private and 2 public, comprising 60-70% of all patients with cancer seen in the island-nation); indirect costs were assessed as the loss of productivity caused by the disease or treatment. Benefits to society were based on extra years of productivity, as measured by GNI per capita, resulting from the quality adjusted life-years (QALYs) saved with the use of trastuzumab as determined in the models by Kurian, Liberato and Garrison.</p> <p>Results</p> <p>Incremental costs in Singapore, in 2005 US dollars, were $26,971.05. Average Cost per QALY was$19,174.59 (Median: $18,993.70). Costs (benefits) to society ranged from a cost of$79.42 to a benefit of $9,263.06, depending on the model used (Average benefit:$4,375.89, Median $3,944.03). Sensitivity analysis ranged from a cost of$10,685.00 to a Benefit of US$17,298.79</p> <p>Conclusions</p> <p>Treatment with adjuvant trastuzumab is likely to generate net societal economic benefits in Singapore. Nevertheless, the lower range of possible outcomes does not refute the possibility that treatment may actually generate costs. These costs however clearly fall within the usual range of acceptable cost-effectiveness.</p

1st Symposium in immunology of sport and physical activity: proceedings book

FCT e Salimetric

Occupational and leisure time physical activity in contrasting relation to ambulatory blood pressure

Background: While moderate and vigorous leisure time physical activities are well documented to decrease the risk for cardiovascular disease, several studies have demonstrated an increased risk for cardiovascular disease in workers with high occupational activity. Research on the underlying causes to the contrasting effects of occupational and leisure time physical activity on cardiovascular health is lacking. The aim of this study was to examine the relation of objective and self-report measures of occupational and leisure time physical activity with 24-h ambulatory systolic blood pressure (BP). Methods: Results for self-reported physical activity are based on observations in 182 workers (60% male, mean age 51 years), while valid objective physical activity data were available in 151 participants. The usual level of physical activity was assessed by 5 items from the Job Content Questionnaire (high physical effort, lifting heavy loads, rapid physical activity, awkward body positions and awkward positions of head or arms at work) and one item asking about the general level of physical activity during non-working time. On a regular working day, participants wore an ambulatory BP monitor and an accelerometer physical activity monitor during 24 h. Associations were examined by means of Analysis of Covariance. Results: Workers with an overall high level of self-reported occupational physical activity as well as those who reported to often lift heavy loads at work had a higher mean systolic BP at work, at home and during sleep. However, no associations were observed between objectively measured occupational physical activity and BP. In contrast, those with objectively measured high proportion of moderate and vigorous leisure time physical activity had a significantly lower mean systolic BP during daytime, while no differences were observed according to self-reported level of leisure time physical activity. Conclusions: These findings suggest that workers reporting static occupational physical activities, unlike general physically demanding tasks characterized by dynamic movements of large muscle groups, are related to a higher daily systolic BP, while high objective levels of moderate and vigorous leisure time physical activity are related to lower daytime systolic BP. Ambulatory systolic BP may be a physiological explanatory factor for the contrasting effects of occupational and leisure time physical activity

Comparison of Attitudes Regarding Quality of Life between Insulin-Treated Subjects with Diabetes Mellitus and Healthy Populations

BackgroundDiabetes mellitus is a chronic disease and one of the main causes of mortality in developing countries. The main objective of treating all chronic diseases, of course, is to improve well-being and attain a satisfactory quality of life (QOL). The major goal of this study is comparison of attitude toward QOL in insulin-dependent subjects with diabetes mellitus and healthy subjects.MethodsIn this study, insulin-dependent subjects with diabetes mellitus and healthy subjects were gathered via convenience sampling. The subjects were asked to complete the Hanestad & Albrektsen Attitude to Quality of Life Questionnaire. The questionnaire evaluates five quality of life dimensions-physical, social, mental-emotional, behavioral-activity, and economic-using a scoring system similar to the Likert scale. The Wilcoxon test was used to compare scores between the two groups.ResultsThe mean total score on attitude toward QOL in the healthy control group was 53.8, and it in the insulin-dependent subjects with diabetes mellitus group was 35.9. The mean total score of attitude toward QOL in the physical dimension, mental-emotional and feelings of well-being dimension, and behavioral-activity dimension were significantly higher in the healthy population than they were in diabetes mellitus groups. Such a difference was not seen in the social and economic dimensions.ConclusionSince the attitudes of insulin-dependent subjects with diabetes mellitus toward QOL are used as an index of individual and societal health levels, it appears that this group may benefit from education and professional counseling to improve their QOLs

Low pay and the living wage

Editorial Introducing Special Issue of Employee Relation

Levels of Oxidized LDL and Advanced Glycation End Products–Modified LDL in Circulating Immune Complexes Are Strongly Associated With Increased Levels of Carotid Intima-Media Thickness and Its Progression in Type 1 Diabetes

OBJECTIVE High cholesterol levels in circulating immune complexes (IC), surrogate markers of modified LDL, are associated with increased carotid intima-media thickness (IMT) and cardiovascular events in type 1 diabetes. Different modifications of LDL are involved in IC formation, but which of these are predictive of vascular events is not known. Therefore, we measured oxidized LDL (oxLDL), advanced glycation end products–modified LDL (AGE-LDL), and malondialdehyde-modified LDL (MDA-LDL) in IC and determined their relationship with increased carotid IMT and compared the strength of the association with that observed with conventional risk factors. RESEARCH DESIGN AND METHODS Levels of oxLDL, AGE-LDL, and MDA-LDL were measured in circulating IC isolated from sera of 479 patients of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort, collected at baseline. Internal and common carotid IMT were measured 8 and 14 years later by DCCT/EDIC. RESULTS OxLDL, AGE-LDL, and MDA-LDL levels in circulating IC were significantly correlated with diabetes duration, BMI, and lipid and blood pressure, but not with age. Multivariate logistic regression models indicated that individuals in the highest versus lowest quartile of oxLDL and AGE-LDL in IC had a 6.11-fold [confidence interval (CI) 2.51–14.8] and a 6.4-fold (CI 2.53–16.2) increase in the odds of having high carotid IMT, respectively, after adjusting for conventional risk factors. Parallel analyses resulted in odds ratios of 2.62 (CI 1.24, 5.55) for LDL-C, 1.45 (CI 0.69, 3.03) for diastolic blood pressure, and 2.33 (CI 1.09, 4.99) for A1C. CONCLUSIONS OxLDL and AGE-LDL in circulating IC were significantly associated with progression and increased levels of carotid IMT in type 1 diabetes

Developing a robust tool: advancing the multiple mini interview in pre-registration student midwife selection in a UK setting

Background: Published research has shown the multiple mini interview (MMI) to be a reliable assessment instrument in medical and nursing student selection internationally. Objectives: To develop, pilot and examine the reliability of MMIs in pre-registration student midwife selection in one Higher Education Institution a UK setting. Design and setting: BSc (Hons) Midwifery Studies students at a Higher Education Institution in the UK volunteered to participate in ‘mock’ MMI circuits during the first week of their programme. DeVellis’s framework for questionnaire development underpinned the generation of interview scenarios. Participants’ responses to scenario questions were rated on a 7 point scale. Internal consistency was calculated for each station. Results: An eight station model was piloted. Communication skills were assessed at each station as a generic attribute. Station specific attributes assessed included compassion and empathy, respect for difference and diversity, honesty and integrity, intellectual curiosity and reflective nature, advocacy, respect for privacy and dignity, team working and initiative, the role of the midwife and motivation to become a midwife. Cronbach’s alpha scores for each station ranged from 0.91 – 0.97. Conclusion: The systematic development of the MMI model and scenarios resulted in ‘excellent’ reliability across all stations. These findings endorse the MMI technique as a reliable alternative to the personal interview in informing final decisions in pre-registration student midwife selection