Family power structure and identity styles in delinquent and nondelinquent Adolescents: A Comparative study in Tehran

  Background: The present study was conducted to investigate the Family Power Structure (FPS) and identity style in delinquent and non-delinquent juveniles in Tehran.  Methods: To accomplish the goal of the study, 80 adolescent delinquents of the Correction and Rehabilitation Centers, aged between 15 and 18, were selected following cluster sampling procedure as well as 80 students of secondary school, aged between 15 and 18, in Tehran in 2014. To obtain data, FPS (Saidian, 2004) and Identity Style Inventory (ISI-6G: White et al, 1998) instruments were used. Data was analyzed between these two groups using independent t test, and Chi square test.  Results: The findings indicated that there is a significant difference between delinquent and non-delinquent juveniles in FPS and its subscales (P<0.001) and identity style (P<0.001). Moreover, the informational identity style was related to lower levels of delinquency. In addition, a diffuse-evident identity style was found to be related to the delinquency.  Conclusion: These findings emphasize that an inappropriate decision-making process pattern in a family has a significant effect on deviant behavior and identity style in adolescents. So, family counselors must pay attention to FPS in the therapeutic interventions (prevention and treatment) for adolescent delinquency

Global competencies in family medicine

Introduction:This project was devised to provide a global snapshot of required national competencies in Family Medicine, and is the result of an international collaboration of the International Fellowship of Primary Care Research Networks (IFPCRN). The Research team, which devised the questionnaire and original list of competencies, was drawn from around 30 countries and 15 countries responded to the questionnaire and contributed national data. These countries however represented close to two thirds of our global population and included Low, Middle and High Income countries (based on World Bank Purchasing price Parity (PPP) 2005) as well Parity (PPP) 2005) as well as representing a good cross section of climatological, socio economic and geographical situations. Aims and Objectives: To compile a list of competencies required of global family doctors, via global consultation, and use them in the form of a questionnaire to survey national family medicine representatives to ascertain if family doctors are required to be competent in these disciplines. The Objective is to provide a ‘global snapshot’ of competencies and trends in family medicine Materials and Methods: A representative list of family medicine competencies was compiled by an International Fellowship of Primary Care Research Networks (IFPCRN) group, from 30 countries over a 3-month period, commencing June 2009. A list of 57 expanded items, and 44 core items was then compiled and formed the basis of a questionnaire, with provision for adding additional competencies that did not appear in the list of 57. This was broadcast by list server to the IFPCRN email group. Results: 15 Family medicine/ primary care representatives completed the survey on behalf of their nation (or region in the case of West Africa). Results showed a trend toward a globally standard curriculum but still much variation in competencies taught

Equity in healthcare: status, barriers, and challenges

Global health provides a challenge for primary care and general practice which will become increasingly important in the future as the prevalence of multimorbidity increases. There is increasing likelihood of survival from acute illnesses and increase an in the elderly population. This literature review focuses on the health inequities, the role of family medicine and the factors that are essential in overcoming these inequalities. Health disparities refer to gaps in the quality of health and delivery of health care across racial, ethnic, gender and socioeconomic groups. The health disparities vary among different countries and the factors that lead to these disparities differ across the world. Family medicine plays a crucial role in bridging this gap and is an essential backbone of the society in developing nations as well as the wealthier nations in providing equity in health care to all people. There are many factors leading to inequity in health care. Family medicine should be recognized as a specialty across the world, as family medicine with its person centered care can bring about a global change in health care. This issue has to be taken up more seriously by the institutions like the WHO, UN and also individual governments along with the political parties to create uniformity in health care. In the current setting of the global economic and financial crisis, a truly global solution is needed. The WHO has come up with various strategies to solve the issue of financial crises and ensuring equity in health globally. This will ensure equal health care to all people especially the underprivileged in developing countries who do not have access to better healthcare due to lack of resources. This factor is a major contributor to the premature death of individuals at all stages of life from new born to the elderly and includes infant mortality and mortality due to chronic diseases. This is important in creating uniformity in health care across the world but has to be considered at a global level to have an impact

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Background: High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods: We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK-based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053. Findings: Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants' systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (p<0·0001), and diastolic blood pressure was lowered by 2·6 mm Hg (p=0·0026) at hospital admission. We found no difference in mRS between the groups in participants with a final diagnosis of stroke or transient ischaemic stroke (cohort 1): 3 (IQR 2–5; n=420) in the GTN group versus 3 (2–5; n=408) in the sham group, adjusted common odds ratio for poor outcome 1·25 (95% CI 0·97–1·60; p=0·083); we also found no difference in mRS between all patients (cohort 2: 3 [2–5]; n=544, in the GTN group vs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups. Interpretation: Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultra-acute prehospital setting

Baseline characteristics of the 4011 patients recruited into the 'Efficacy of Nitric Oxide in Stroke' (ENOS) trial

BACKGROUND: High blood pressure is common in acute stroke and associated with a worse functional outcome. Many patients who present with acute stroke are taking prescribed antihypertensive therapy before their stroke. AIMS: ENOS tested whether lowering blood pressure and continuing pre-stroke antihypertensive therapy are each safe and effective. METHODS: This study is an international multi-centre prospective randomized single-blind blinded-endpoint parallel-group partial-factorial controlled trial of transdermal glyceryl trinitrate(a nitric oxide donor, given for seven-days) vs. no glyceryl trinitrate, and of continuing vs. stopping (temporarily for seven-days) pre-stroke antihypertensive drugs if relevant, inpatients with acute ischaemic stroke or intracerebral haemorrhage and high systolic blood pressure (140–220 mmHg). RESULTS: Recruitment ran from July 2001 to October 2013. Four thousand eleven patients [2097 (52·3%) in the continue/stop arm] were recruited from 173 sites across 23 countries in 5 continents (Asia 14%, Continental Europe 16%, UK 64%). Baseline characteristics include: mean age 70 (standard deviation 12) years; male 57%; mean time from stroke to recruitment 26 (13) h; mean severity (Scandinavian Stroke Scale) 34(13) of 58; mean blood pressure 167 (19)/90 (13) mmHg; ischaemic stroke 83%; and intracerebral haemorrhage 16%. The main trial results will be presented in May 2014. The results will also be presented in updated Cochrane systematic reviews and included in individual patient data meta-analyses of all relevant randomized controlled trials. CONCLUSION: ENOS is a large completed international trial of blood pressure management in acute stroke and includes patients representative of many stroke services worldwide

Practical methods for incorporating summary time-to-event data into meta-analysis

Background: In systematic reviews and meta-analyses, time-to-event outcomes are most appropriately analysed using hazard ratios (HRs). In the absence of individual patient data (IPD), methods are available to obtain HRs and/or associated statistics by carefully manipulating published or other summary data. Awareness and adoption of these methods is somewhat limited, perhaps because they are published in the statistical literature using statistical notation.Methods: This paper aims to 'translate' the methods for estimating a HR and associated statistics from published time-to-event-analyses into less statistical and more practical guidance and provide a corresponding, easy-to-use calculations spreadsheet, to facilitate the computational aspects.Results: A wider audience should be able to understand published time-to-event data in individual trial reports and use it more appropriately in meta-analysis. When faced with particular circumstances, readers can refer to the relevant sections of the paper. The spreadsheet can be used to assist them in carrying out the calculations.Conclusion: The methods cannot circumvent the potential biases associated with relying on published data for systematic reviews and meta-analysis. However, this practical guide should improve the quality of the analysis and subsequent interpretation of systematic reviews and meta-analyses that include time-to-event outcomes

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053. Findings Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants’ systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (p<0·0001), and diastolic blood pressure was lowered by 2·6 mm Hg (p=0·0026) at hospital admission. We found no difference in mRS between the groups in participants with a final diagnosis of stroke or transient ischaemic stroke (cohort 1): 3 (IQR 2–5; n=420) in the GTN group versus 3 (2–5; n=408) in the sham group, adjusted common odds ratio for poor outcome 1·25 (95% CI 0·97–1·60; p=0·083); we also found no difference in mRS between all patients (cohort 2: 3 [2–5]; n=544, in the GTN group vs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups. Interpretation Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultraacute prehospital setting. Funding British Heart Foundation