Primary care training during internship - quality and organization

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAims: In 2000 a new regulation regarding medical licensure came into effect requiring a three-month rotation at a primary health care centre during internship. The aim of this study was to explore the interns' attitude towards this experience, and particularly to find out how well the training was organized, the supervision they received, and the quality of teaching at the health care centres. Methods: In 2002 a survey was mailed to all interns (a total of 65) who had completed training at primary health care centres during 2000 and 2001. Five interns were unreachable and we obtained 38 replies (63% of those reachable, and 58% of target population). Results: The interns received clinical training in providing comprehensive services as well as formal teaching. If an intern needed assistance with patient care he/she was almost always able to obtain help within 10 minutes. In 92% of cases, experienced doctors were available for the interns to consult with during off-duty emergencies. Conclusions: Our results indicate that the current method of teaching interns in the primary health care setting is of good quality, the variety of work experience is positive, and the work environment is satisfactory. Overall the interns expressed satisfaction with their training. A few areas were identified as needing improvement. Further research is needed to assess whether the interns achieve their aims with regard to knowledge, attitude and skills in family practice.Markmið: Árið 2000 tók gildi ný reglugerð þar sem kveðið var á um þriggja mánaða dvöl á heilsugæslustöð sem hluta af starfsnámi unglækna á kandídatsári. Tilgangur þessarar rannsóknar var að kanna viðhorf unglækna til starfsnáms á heilsugæslustöð, einkum hvað varðar skipulag námsins, handleiðslu og kennslugetu stöðvanna. Aðferðir: Árið 2002 var sendur út spurningalisti til allra lækna (alls 65) sem höfðu verið í starfsnámi á heilsugæslustöð á árunum 2000-2001. Ekki náðist í fimm lækna og svör bárust frá 38 af þeim 60 (63%) sem til náðist (58% af markhópnum). Niðurstöður: Unglæknar fengu starfsþjálfun í almennum heilsugæslustörfum auk formlegrar kennslu. Aðgengi eða aðstoð frá leiðbeinandi lækni fékkst í nær öllum tilvikum innan 10 mínútna. Vaktir unglækna um kvöld og helgar voru að jafnaði studdar með bakvakt reynds læknis í 92% tilvika. Ályktanir: Niðurstöður benda til þess að skipulag námsins sé gott, verkefni fjölbreytt, handleiðsla og starfsaðstaða viðunandi og almenn ánægja með námið. Niðurstöður gefa nokkrar vísbendingar um það sem betur má fara. Frekari rannsókna er þörf á því hvort unglæknar nái settum markmiðum varðandi kunnáttu, viðhorf og færni á viðfangsefnum innan heilsugæslunnar

Multi-year observations of Breiðamerkurjökull, a marine-terminating glacier in southeastern Iceland, using terrestrial radar interferometry

Terrestrial radar interferometry (TRI) is a new technique for studying ice motion and volume change of glaciers. TRI is especially useful for temporally and spatially dense measurements of highly dynamic glacial termini. We conducted a TRI survey of Breiðamerkurjökull, a marine-terminating glacier in Iceland, imaging its terminus near the end of the melt season in 2011, 2012 and 2013. The ice velocities were as high as 5 m d−1, with the fastest velocities near the calving front. Retreat of the glacier over the 3 year observation period was accompanied by strong embayment formation. Iceberg tracking with the radar shows high current velocities near the embayment, probably indicating strong meltwater outflow and mixing with relatively warm lagoon water

Efficacy and safety of a contraceptive vaginal ring (NuvaRing) compared with a combined oral contraceptive: a 1-year randomized trial

Abstract This open-label, randomized, Phase III study compared the efficacy and tolerability of and compliance with NuvaRing, a combined contraceptive vaginal ring releasing 15 Ag of ethinylestradiol (EE) and 120 Ag of etonogestrel daily, with those of and with a combined oral contraceptive (COC) containing 150 Ag of levonorgestrel (LNG) and 30 Ag of EE. Subjects received NuvaRing or a COC for 13 cycles (3 weeks of ring/pill treatment followed by a 1-week ring-/pill-free period). A total of 1030 subjects (NuvaRing, n = 512; COC, n = 518) was randomized and started treatment (intent-to-treat [ITT] population). The percentage of women in the ITT population who completed the trial was 70.9% for the NuvaRing group and 71.2% for the COC group. Five in-treatment pregnancies occurred in each group, giving Pearl indices of 1.23 for NuvaRing and 1.19 for the COC. Compliance with both treatments was excellent and both were well tolerated. In conclusion, NuvaRing has comparable efficacy and tolerability with a COC containing 150 Ag of LNG and 30 Ag of EE and does not require daily dosing.

Balance perturbation system to improve balance compensatory responses during walking in old persons

Ageing commonly disrupts the balance control and compensatory postural responses that contribute to maintaining balance and preventing falls during perturbation of posture. This can lead to increased risk of falling in old adults (65 years old and over). Therefore, improving compensatory postural responses during walking is one of the goals in fall prevention programs. Training is often used to achieve this goal. Most fall prevention programs are usually directed towards improving voluntary postural control. Since compensatory postural responses triggered by a slip or a trip are not under direct volitional control these exercises are less expected to improve compensatory postural responses due to lack of training specificity. Thus, there is a need to investigate the use balance perturbations during walking to train more effectively compensatory postural reactions during walking

Sequence variant at 8q24.21 associates with sciatica caused by lumbar disc herniation.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesLumbar disc herniation (LDH) is common and often debilitating. Microdiscectomy of herniated lumbar discs (LDHsurg) is performed on the most severe cases to resolve the resulting sciatica. Here we perform a genome-wide association study on 4,748 LDHsurg cases and 282,590 population controls and discover 37 highly correlated markers associating with LDHsurg at 8q24.21 (between CCDC26 and GSDMC), represented by rs6651255[C] (OR=0.81; P=5.6 × 10(-12)) with a stronger effect among younger patients than older. As rs6651255[C] also associates with height, we performed a Mendelian randomization analysis using height polygenic risk scores as instruments to estimate the effect of height on LDHsurg risk, and found that the marker's association with LDHsurg is much greater than predicted by its effect on height. In light of presented findings, we speculate that the effect of rs6651255 on LDHsurg is driven by susceptibility to developing severe and persistent sciatica upon LDH.European Commission National Institutes of Healt

Surface elevation change and mass balance of Icelandic ice caps derived from swath mode CryoSat-2 altimetry

We apply swath processing to CryoSat-2 interferometric mode data acquired over the Icelandic ice caps to generate maps of rates of surface elevation change at 0.5 km postings. This high-resolution mapping reveals complex surface elevation changes in the region, related to climate, ice dynamics, and subglacial geothermal and magmatic processes. We estimate rates of volume and mass change independently for the six major Icelandic ice caps, 90% of Iceland's permanent ice cover, for five glaciological years between October 2010 and September 2015. Annual mass balance is highly variable; during the 2014/2015 glaciological year, the Vatnajökull ice cap (~70% of the glaciated area) experienced positive mass balance for the first time since 1992/1993. Our results indicate that between glaciological years 2010/2011and 2014/2015 Icelandic ice caps have lost 5.8 ± 0.7 Gt a−1 on average, ~40% less than the preceding 15 years, contributing 0.016 ± 0.002 mm a−1 to sea level rise

Social and ethical criteria for prioritizing patients: a survey of students and health professionals in Portugal

O estudo quali-quantitativo explora o dilema ético da microalocação dos recursos da saúde. Objetiva identificar e comparar a opinião de dois grupos da sociedade portuguesa - estudantes e profissionais de saúde sobre a importância das características pessoais dos pacientes no momento de os priorizar e se as escolhas se explicam por referenciais bioéticos de caráter utilitaristas ou deontológicos. Os dados foram recolhidos através de um questionário aplicado a uma amostra de 180 estudantes universitários e 60 profissionais de saúde. Os respondentes perante hipotéticos cená- rios de emergência clínica tiveram de escolher de entre dois pacientes (distinguidos por idade, sexo, responsabilidade social, situação económica e laboral, comportamentos lesivos da saúde e registo criminal) quem tratar e justificar a escolha. Foram usados testes estatísticos de associação para comparar as respostas dos dois grupos e análise de conteúdo para categorizar as justificações. Os resultados sugerem a existência de diferenças nas escolhas dos dois grupos, com os profissionais de saúde a revelarem aceitar menos a utilização de critérios sociais em contexto de escassez e coexistência de critérios utilitaristas e deontológicos, com predomínio da eficiência por parte dos profissionais de saúde e da equidade por parte dos estudantesThis qualitative/quantitative study examines the ethical dilemma of microallocation of health resources. It seeks to identify and compare the opinion of two groups in Portuguese society – students and health professionals – on the importance of personal characteristics of patients at the moment of prioritizing them and if the choices can be explained by bioethical references of a utilitarian or deontological nature. Data were collected by means of a questionnaire administered to a sample of 180 students and 60 health professionals. Faced with hypothetical emergency scenarios, the respondents had to choose between two patients (distinguished by: age, gender, social responsibility, economic and employment situation, harmful health behaviors and criminal record), duly selecting who to treat and then justifying their choice. The results suggest the existence of differences in choices between the two groups, with health professionals revealing they are less prepared to accept the use of social criteria in a context of scarce resources and co-existence of utilitarian and deontological criteria, with a predominance of efficiency on the part of health professionals and equity on the part of students.info:eu-repo/semantics/publishedVersio

Physiological Observations and Omics to Develop Personalized Sensormotor Adaptability Countermeasures Using Bed Rest and Space Flight Data

Astronauts experience sensorimotor disturbances during the initial exposure to microgravity and during the re-adapation phase following a return to an earth-gravitational environment. These alterations may disrupt the ability to perform mission critical functional tasks requiring ambulation, manual control and gaze stability. Interestingly, astronauts who return from space flight show substantial differences in their abilities to readapt to a gravitational environment. The ability to predict the manner and degree to which individual astronauts would be affected would improve the effectiveness of countermeasure training programs designed to enhance sensorimotor adaptability. For such an approach to succeed, we must develop predictive measures of sensorimotor adaptability that will allow us to foresee, before actual space flight, which crewmembers are likely to experience the greatest challenges to their adaptive capacities. The goals of this project are to identify and characterize this set of predictive measures that include: 1) behavioral tests to assess sensory bias and adaptability quantified using both strategic and plastic-adaptive responses; 2) imaging to determine individual brain morphological and functional features using structural magnetic resonance imaging (MRI), diffusion tensor imaging, resting state functional connectivity MRI, and sensorimotor adaptation task-related functional brain activation; 3) genotype markers for genetic polymorphisms in Catechol-O-Methyl Transferase, Dopamine Receptor D2, Brain-derived neurotrophic factor and genetic polymorphism of alpha2-adrenergic receptor that play a role in the neural pathways underlying sensorimotor adaptation. We anticipate these predictive measures will be significantly correlated with individual differences in sensorimotor adaptability after long-duration space flight and an analog bed rest environment. We will be conducting a retrospective study leveraging data already collected from relevant ongoing/completed bed rest and space flight studies. These data will be combined with predictor metrics that will be collected prospectively - behavioral, brain imaging and genomic measures; from these returning subjects to build models for predicting post-mission (bed rest - non-astronauts or space flight - astronauts) adaptive capability as manifested in their outcome measures. Comparisons of model performance will allow us to better design and implement sensorimotor adaptability training countermeasures that are customized for each crewmember's sensory biases, adaptive capacity, brain structure and functional capacities, and genetic predispositions against decrements in post-mission adaptive capability. This ability will allow more efficient use of crew time during training and will optimize training prescriptions for astronauts to ensure expected outcomes

A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-over trial

<p>Abstract</p> <p>Background</p> <p>Gait and balance impairments may increase the risk of falls, the leading cause of accidental death in the elderly population. Fall-related injuries constitute a serious public health problem associated with high costs for society as well as human suffering. A rapid step is the most important protective postural strategy, acting to recover equilibrium and prevent a fall from initiating. It can arise from large perturbations, but also frequently as a consequence of volitional movements. We propose to use a novel water-based training program which includes specific perturbation exercises that will target the stepping responses that could potentially have a profound effect in reducing risk of falling. We describe the water-based balance training program and a study protocol to evaluate its efficacy (Trial registration number #NCT00708136).</p> <p>Methods/Design</p> <p>The proposed water-based training program involves use of unpredictable, multi-directional perturbations in a group setting to evoke compensatory and volitional stepping responses. Perturbations are made by pushing slightly the subjects and by water turbulence, in 24 training sessions conducted over 12 weeks. Concurrent cognitive tasks during movement tasks are included. Principles of physical training and exercise including awareness, continuity, motivation, overload, periodicity, progression and specificity were used in the development of this novel program. Specific goals are to increase the speed of stepping responses and improve the postural control mechanism and physical functioning. A prospective, randomized, cross-over trial with concealed allocation, assessor blinding and intention-to-treat analysis will be performed to evaluate the efficacy of the water-based training program. A total of 36 community-dwelling adults (age 65–88) with no recent history of instability or falling will be assigned to either the perturbation-based training or a control group (no training). Voluntary step reaction times and postural stability using stabiliogram diffusion analysis will be tested before and after the 12 weeks of training.</p> <p>Discussion</p> <p>This study will determine whether a water-based balance training program that includes perturbation exercises, in a group setting, can improve speed of voluntary stepping responses and improve balance control. Results will help guide the development of more cost-effective interventions that can prevent the occurrence of falls in the elderly.</p