Sensitivity, specificity, and sex differences in symptoms reported on the 13-item acute coronary syndrome checklist.

BackgroundClinical symptoms are part of the risk stratification approaches used in the emergency department (ED) to evaluate patients with suspected acute coronary syndromes (ACS). The objective of this study was to determine the sensitivity, specificity, and predictive value of 13 symptoms for a discharge diagnosis of ACS in women and men.Methods and resultsThe sample included 736 patients admitted to 4 EDs with symptoms suggestive of ACS. Symptoms were assessed with the 13-item validated ACS Symptom Checklist. Mixed-effects logistic regression models were used to estimate sensitivity, specificity, and predictive value of each symptom for a diagnosis of ACS, adjusting for age, obesity, diabetes, and functional status. Patients were predominantly male (63%) and Caucasian (70.5%), with a mean age of 59.7±14.2 years. Chest pressure, chest discomfort, and chest pain demonstrated the highest sensitivity for ACS in both women (66%, 66%, and 67%) and men (63%, 69%, and 72%). Six symptoms were specific for a non-ACS diagnosis in both women and men. The predictive value of shoulder (odds ratio [OR]=2.53; 95% CI=1.29 to 4.96) and arm pain (OR 2.15; 95% CI=1.10 to 4.20) in women was nearly twice that of men (OR=1.11; 95% CI=0.67 to 1.85 and OR=1.21; 95% CI=0.74 to 1.99). Shortness of breath (OR=0.49; 95% CI=0.30 to 0.79) predicted a non-ACS diagnosis in men.ConclusionsThere were more similarities than differences in symptom predictors of ACS for women and men

The Influence of Minority Stress on Level of Depression among Thai LGBT Adults

In the US, lesbian, gay, bisexual, and transgender (LGBT) individuals report higher rates of depression compared with heterosexual and cisgender persons. To date, little is known about the mental health of LGBT adults in Thailand. Here, we examined rates and correlates of depression among a volunteer sample of Thai LGBTs. Data were collected as part of a larger cross-sectional survey study. Standardized measures of sexual orientation and gender identity, stress, coping style, and minority stressors were completed. Of the 411 participants, 40.3% met the criteria for depression. In multivariate analyses, the combined influences of sociodemographic factors, general stress, coping strategies, and minority-specific stress variables explained 47.2% of the variance in depression scores (F[16,367]= 20.48, p<.001). Correlates of depression included coping strategies and minority-specific stressors, including experiences of victimization, discrimination, and level of identity concealment. Study findings have implications for psychiatric nursing practice and the development of intervention research. Abstrak Di AS, individu lesbian, gay, biseksual, dan transgender (LGBT) melaporkan tingkat depresi yang lebih tinggi dibandingkan dengan orang heteroseksual dan cisgender. Saat ini, sedikit yang diketahui tentang kesehatan mental pada orang dewasa dengan LGBT di Thailand. Di sini, kami meneliti tingkat dan korelasi depresi di antara sampel sukarelawan LGBT Thailand. Data dikumpulkan sebagai bagian dari studi survei cross-sectional yang lebih besar. Pengukuran terstandar terhadap orientasi seksual dan identitas gender, stres, koping, dan stresor minoritas telah selesai. Dari 411 peserta, 40,3% memenuhi kriteria untuk depresi. Dalam analisis multivariat, pengaruh gabungan faktor sosiodemografi, stres umum, strategi koping, dan variabel stres spesifik-minoritas menjelaskan 47,2% dari varians dalam skor depresi (F [16,367]= 20,48, p< 0,001). Korelasi depresi termasuk strategi koping dan stres spesifik-minoritas, termasuk pengalaman viktimisasi, diskriminasi, dan tingkat penyembunyian identitas. Temuan penelitian memiliki implikasi untuk praktik keperawatan psikiatris dan pengembangan penelitian intervensi. Kata kunci: depresi, LGBT, minoritas seksual dan gender; stres minoritas, Thailan

The Influence of Minority Stress on Level of Depression among Thai LGBT Adults

In the US, lesbian, gay, bisexual, and transgender (LGBT) individuals report higher rates of depression compared with heterosexual and cisgender persons. To date, little is known about the mental health of LGBT adults in Thailand. Here, we examined rates and correlates of depression among a volunteer sample of Thai LGBTs. Data were collected as part of a larger cross-sectional survey study. Standardized measures of sexual orientation and gender identity, stress, coping style, and minority stressors were completed. Of the 411 participants, 40.3% met the criteria for depression. In multivariate analyses, the combined influences of sociodemographic factors, general stress, coping strategies, and minority-specific stress variables explained 47.2% of the variance in depression scores (F[16,367]= 20.48, p&lt;.001). Correlates of depression included coping strategies and minority-specific stressors, including experiences of victimization, discrimination, and level of identity concealment. Study findings have implications for psychiatric nursing practice and the development of intervention research. &nbsp; Abstrak Pengaruh Stres Minoritas terhadap Tingkat Depresi pada LGBT Thailand. Di AS, individu lesbian, gay, biseksual, dan transgender (LGBT) melaporkan tingkat depresi yang lebih tinggi dibandingkan dengan orang heteroseksual dan cisgender. Saat ini, sedikit yang diketahui tentang kesehatan mental pada orang dewasa dengan LGBT di Thailand. Di sini, kami meneliti tingkat dan korelasi depresi di antara sampel sukarelawan LGBT Thailand. Data dikumpulkan sebagai bagian dari studi survei cross-sectional yang lebih besar. Pengukuran terstandar terhadap orientasi seksual dan identitas gender, stres, koping, dan stresor minoritas telah selesai. Dari 411 peserta, 40,3% memenuhi kriteria untuk depresi. Dalam analisis multivariat, pengaruh gabungan faktor sosiodemografi, stres umum, strategi koping, dan variabel stres spesifik-minoritas menjelaskan 47,2% dari varians dalam skor depresi (F [16,367]= 20,48, p&lt; 0,001). Korelasi depresi termasuk strategi koping dan stres spesifik-minoritas, termasuk pengalaman viktimisasi, diskriminasi, dan tingkat penyembunyian identitas. Temuan penelitian memiliki implikasi untuk praktik keperawatan psikiatris dan pengembangan penelitian intervensi. Kata kunci: depresi, LGBT, minoritas seksual dan gender; stres minoritas, Thailan

Effects of Colon Cancer Risk Counseling for First-Degree Relatives

Background: Individuals with a first-degree relative who has had colorectal cancer are at increased risk for colorectal cancer and thus can benefit from early detection. Tailored risk counseling may increase adherence to screening guidelines in these persons. The present study evaluated a culturally sensitive Colon Cancer Risk Counseling (CCRC) intervention for relatives of colorectal cancer patients. Methods: A randomized trial evaluated personalized CCRC sessions with print materials and follow-up phone calls compared with a comparable General Health Counseling (GHC) intervention. One hundred and seventy-six siblings and children of colorectal cancer patients, living in Hawaii, were assessed at baseline and 4 and 12 months after intervention. Physician verification of colorectal cancer screening reports supplemented survey data. Results: The CCRC intervention had a significant treatment effect at 4 months (13% greater increase than for GHC) that plateaued to a trend at 12 months. For those who were nonadherent at baseline, the CCRC led to a 17% net increase in screening adherence. Participants rated the CCRC intervention better than GHC for the amount and usefulness of new information. Conclusions: Using a study design that compared risk counseling to an attention-matched and tailored control condition provided a rigorous test of CCRC that emphasized the relevance of family experience with colorectal cancer. The combination face-to-face, phone, and small media risk counseling intervention for people with a family history of colorectal cancer should be considered for adoption in health care and public health settings

Interaction between oxytocin receptor DNA methylation and genotype is associated with risk of postpartum depression in women without depression in pregnancy

Postpartum depression (PPD) affects up to 19% of women, negatively impacting maternal and infant health. Reductions in plasma oxytocin levels have been associated with PPD and heritability studies have established a genetic contribution. Epigenetic regulation of the oxytocin receptor gene (OXTR) has been demonstrated and we hypothesized that individual epigenetic variability at OXTR may impact the development of PPD and that such variability may be central to predicting risk. This case-control study is nested within the Avon Longitudinal Study of Parents and Children and included 269 cases with PPD and 276 controls matched on age group, parity, and presence or absence of depressive symptoms in pregnancy as assessed by the Edinburgh Postnatal Depression Scale. OXTR DNA methylation (CpG site -934) and genotype (rs53576 and rs2254298) were assayed from DNA extracted from blood collected during pregnancy. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association of elevated symptoms of PPD with genotype, methylation, and their interaction adjusted for psychosocial factors (n=500). There was evidence of an interaction between rs53576 and methylation in the OXTR gene amongst women who did not have depression prenatally but developed PPD (p interaction=0.026, adjusted for covariates, n=257). Those women with GG genotype showed 2.63 greater odds of PPD for every 10% increase in methylation level (95% CI: 1.37, 5.03), whereas methylation was unrelated to PPD amongst A carriers (OR=1.00, 95%CI: 0.58, 1.73). There was no such interaction among women with PPD and prenatal depression. These data indicate that epigenetic variation that decreases expression of OXTR in a susceptible genotype may play a contributory role in the etiology of postpartum depression

Perspectiva isométrica: traçado a mão livre

Este material tem como objetivo auxiliar estudantes das disciplinas de Desenho Técnico Básico a desenvolver habilidades para o desenho de perspectivas isométricas a mão livre, a partir da interpretação de vistas ortográficas. Os tópicos abordados são os seguintes: •Introdução ao conteúdo e tipos de perspectivas; •Perspectivas isométricas e traçado dos eixos isométricos; •Escolha dos eixos; •Desenho de perspectivas com planos inclinados e oblíquos; •Desenho de perspectivas com linhas curvas. A estrutura deste material foi baseada no livro de Bornancini, Petzold e Orlandi Júnior (1981), que ainda hoje é adotado nas disciplinas de Desenho Técnico I, disciplina esta que faz parte do currículo da maioria dos cursos de Engenharia da UFRGS. Da mesma forma, grande parte do conteúdo deste material (incluindo textos, imagens, exercícios e desenhos das animações) foi adaptado deste mesmo livro. Para auxiliar na execução dos exercícios, foram incluídas diversas animações, além de um vídeo.Vídeo: Não é possível instalar um arquivo de vídeo. Apenas transfira-o para seu computador e abra como um arquivo comum. Arquivos de vídeo não podem ser editados, mas podem ser visualizados em players como o VLC Media Player (que é gratuito), o Windows Media Player ou o QuickTime. Os formatos mais comuns de vídeo serão executados normalmente por estes players (avi, mpeg e mp4). PDF: Este arquivo não pode ser editado, pois é um formato fechado. Este formato permite que sejam feitas edições - como marcação de texto e comentários, além de preenchimento de formulários - caso o autor permita. Este arquivo pode ser visualizado em leitores de PDF como o Adobe Acrobat Reader ou em navegadores da web.Materiais de cursos e disciplinasUso como ferramenta de apoio nas disciplinas de Desenho Técnico Básico

Baseline Results from Hawaii's Nā Mikiniiki Project: A Physical Activity Intervention Tailored to Multiethnic Postpartum Women

During the postpartum period, ethnic minority women have higher rates of inactivity/under-activity than white women. The Nā Mikimiki (“the active ones”) Project is designed to increase moderate-to-vigorous physical activity over 18 months among multiethnic women with infants 2–12 months old. The study was designed to test, via a randomized controlled trial, the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website materials-only condition. Healthy, underactive women (mean age = 32 ± 5.6 years) with a baby (mean age = 5.7 ± 2.8 months) were enrolled from 2008–2009 (N = 278). Of the total sample, 84% were ethnic minority women, predominantly Asian–American and Native Hawaiian. Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition, ethnicity, infant's age, maternal body mass index, or maternal employment. Women had high scores on perceived benefits, self-efficacy, and environmental support for exercise but low scores on social support for exercise. This multiethnic sample's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women. The Nā Mikimiki Project's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women

Diffusion of an effective skin cancer prevention program: Design, theoretical foundations, and first-year implementation

This article describes the design and theoretical foundations of the Pool Cool Diffusion Trial and reports 1st-year findings. Aims of the study are to evaluate the effects of 2 strategies for diffusion of the Pool Cool sun safety program on implementation, maintenance, and sustainability; improvements in environmental supports for sun safety in swimming pools; and sun protection habits and sunburn among participating children. There was a high rate of program participation (86.6%; n = 375 swimming pools) in the 1st year and somewhat lower study participation (75.8%). Analysis of pool manager surveys revealed a time effect for overall sun safety programs and for sun safety policies, environmental strategies, and programs for pool users. There were few differences in implementation between treatment groups in year one