Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

<p>Abstract</p> <p>Background</p> <p>Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner's (GP) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway.</p> <p>Methods</p> <p>The design was an exploratory prospective trial. The outcome measured was the number of patients referred to a preoperative smoking and alcohol cessation programme at the same time as being referred for elective surgery by their GP. The participants consisted of 72 high-risk patients who were referred for elective surgery by 47 local participating GPs.</p> <p>The GPs, nurses, and specialists in internal medicine, prehabilitation and surgery developed new clinical practice guidelines based on the literature and interviews with 11 local GPs about the specific barriers for implementing a smoking and alcohol cessation programme. The role of the GP was to be the gatekeeper: identifying daily smokers and hazardous drinkers when referring them to surgery; handing out information on risk reduction; and referring those patients identified to a preoperative smoking and alcohol cessation programme. The role of the hospital was to contact these patients to initiate smoking and alcohol cessation at the hospital out-patient clinic for life-style intervention.</p> <p>Results</p> <p>The GPs increased their referral to the smoking and alcohol cessation programme from 0% to 10% (7/72 patients) in the study period.</p> <p>Conclusion</p> <p>The effect of the study was limited in integrating the efforts of primary care providers and hospital surgical departments in increasing the up-take of preoperative smoking and alcohol cessation programmes aimed at smokers and harmful drinkers referred for surgery. New strategies for cooperation between GPs and surgical departments are urgently needed.</p> <p>Trial registration</p> <p>J.nr. 2005-54-1781 in Danish Data Protection Agency.</p> <p>J.nr. 07 268136 in Scientific Ethical Committee for Copenhagen and Frederiksberg Municipalities.</p

Vital Indicators of the Rural and Agricultural Population in the S. R. Croatia — The Demographical Breakdown

Stanovništvo SR Hrvatske nalazi se na kraju razdoblja demografske tranzicije. Godine 1982. imalo je natalitet 14,5 promila, mortalitet 11,0 promila, prirodni priraštaj 3,5 promila, a vitalni indeks 134,4. Ovakvo kretanje biovitalnih stopa rezultat je utjecaja industrijalizacijskih procesa na demografski razvitak, napose deagrarizacije. Postoje tipična seoska područja sa sekularnim trendovima niskog nataliteta, a nagli je pad naročito izražen između dva posljednja popisna razdoblja (1971—1981), tako da je 1981. imalo negativni prirodni priraštaj čak 49 općina, u kojima živi 24% ukupnog stanovništva republike. Na osnovi popisa stanovništva podataka i demografske statistike, autor analizira promjene u demografskim strukturama seoskog i poljoprivrednog stanovništva (po zajednicama općina i regijama), usporedno kretanje reproduktivnih stopa poljoprivrednog i nepoljoprivrednog stanovništva te seoskog i »neseoskog « stanovništva, starenje seoskog i poljoprivrednog stanovništva te obrazovnu strukturu poljoprivrednog stanovništva. Zaključno ističe da je većina seoskog i poljoprivrednog stanovništva u poodmakloj dobi, da je biološko pomlađivanje simbolično, te da su i dalje naglašene aspiracije prema nepoijoprivrednim zanimanjima.The population of the S. R. Croatia is at the end of a period of demographic transition. In 1982 the birth rate was 14.5 per thousand, the death rate 11.0 per thousand, the natural population increase 3.5 per thousand, and the viital index 134.4. This change in biovital rates is the result of the influence of industrialization on demographic development, and in particular the result of deagrarization. Some rural regions have typical age-old trends towards a low birth-rate, but the sudden decrease came to expression especially between the last two censuses (1971—1981), so that as many as 49 communes had a negative natural population increase in 1981. 24% of the total population of the republic lives in these communes. The author uses data from population censuses and demographic statistics to analyze changes in the demographic structure of the rural and agricultural population (according to communities and regions). He compares changes in rates of reproduction between the agricultural and the non-agricultural population, and between the rural and the »non-rural« population, studies the ageing of the rural and agricultural population, and the educational structure of the agricultural population. He concludes that most of the rural and agricultural population is aged, that biological rejuvenation is symbolic, and that aspirations towards noo-agricultural occupationstions are still very strong

Echolocation click parameters and biosonar behaviour of the dwarf sperm whale (Kogia sima)

PhD and fieldwork funding were provided by the Danmarks Grundforskningsfond (27125 to P.T.M.), the Oticon Fonden (18-0340 to C.E.M.) the Dansk Akustisk Selskab (to C.E.M.), the South Africa National Research Foundation (research career advancement fellowship to S.E.) and the Claude Leon Foundation (postdoctoral fellowship to T.G.).Dwarf sperm whales (Kogia sima) are small toothed whales that produce narrow-band high-frequency (NBHF) echolocation clicks. Such NBHF clicks, subject to high levels of acoustic absorption, are usually produced by small, shallow-diving odontocetes, such as porpoises, in keeping with their short-range echolocation and fast click rates. Here, we sought to address the problem of how the little-studied and deep-diving Kogia can hunt with NBHF clicks in the deep sea. Specifically, we tested the hypotheses that Kogia produce NBHF clicks with longer inter-click intervals (ICIs), higher directionality and higher source levels (SLs) compared with other NBHF species. We did this by deploying an autonomous deep-water vertical hydrophone array in the Bahamas, where no other NBHF species are present, and by taking opportunistic recordings of a close-range Kogia sima in a South African harbour. Parameters from on-axis clicks (n=46) in the deep revealed very narrow-band clicks (root mean squared bandwidth, BWRMS, of 3±1 kHz), with SLs of up to 197 dB re. 1 µPa peak-to-peak (μPapp) at 1 m, and a half-power beamwidth of 8.8 deg. Their ICIs (mode of 245 ms) were much longer than those of porpoises (<100 ms), suggesting an inspection range that is longer than detection ranges of single prey, perhaps to facilitate auditory streaming of a complex echo scene. On-axis clicks in the shallow harbour (n=870) had ICIs and SLs in keeping with source parameters of other NBHF cetaceans. Thus, in the deep, dwarf sperm whales use a directional, but short-range echolocation system with moderate SLs, suggesting a reliable mesopelagic prey habitat.Publisher PDFPeer reviewe

The long-range echo scene of the sperm whale biosonar

Sperm whales use their gigantic nose to produce the most powerful sounds in the animal kingdom, presumably to echolocate deep-sea prey at long ranges and possibly to debilitate prey. To test these hypotheses, we deployed sound recording tags (DTAG-4) on the tip of the nose of three sperm whales. One of these recordings yielded over 6000 echo streams from organisms detected up to 144 m ahead of the whale, supporting a long-range prey detection function of the sperm whale biosonar. The whale navigated this complex acoustic scene by maintaining a stable, long-range acoustic gaze suggesting continual resource evaluation. Less than 10% of the echoic organisms recorded by the tag were targeted for capture and only 18% of the buzzes were emitted within the 50 m depth interval of maximum organism encounter rate, demonstrating echo-guided prey selection. Buzzes were initiated more than 20 m from the prey, showing that sperm whales do not debilitate their prey with sound, but trade echo levels for reduced forward masking and rapid updates on prey location in keeping with the lower manoeuvrability of these large predators. We conclude that the powerful biosonar of sperm whales enables long-range echolocation and selection of prey, but not acoustic debilitation

First-year sperm whale calves echolocate and perform long, deep dives

Deep-diving sperm whales have a complex social structure and the largest brain of any animal, but very little is known about the ontogeny of their diving, foraging, echolocation, and communication skills. In large-brained terrestrial species, social skills develop earlier than locomotor abilities, but this may not be feasible for sperm whales, which require locomotor skills from birth to breathe, swim, and suckle. Here, we shed new light on the relative development of social and locomotor capabilities of a wild toothed whale. Sound and movement recording tags deployed on three first-year sperm whale calves for a total of 15 h revealed that these calves rarely produced codas for communication with adult whales, but likely tracked the ample passive acoustic cues emitted by clicking adults. The calves’ diving capabilities were well developed (maximum dive depth: 285, 337, and 662 m; maximum dive time: 11, 31, and 44 min) and they all produced clicks in a way that is consistent with echolocation. The calf performing the longest and deepest dives additionally emitted two echolocation buzzes, suggesting that it could have attempted to forage. Thus, sperm whale calves may supplement their milk diet with food caught independently at depth much earlier than previously believed. Contrary to terrestrial mammals, we propose that the maturation of locomotor, diving, and echolocation skills may be favored over investment in developing social communication skills at an early age in sperm whales. </p

Cancer incidence among patients with alcohol use disorders--long-term follow-up

Aims: The aim of this study was to compare the cancer morbidity in a large cohort of patients with alcohol use disorders in the general Danish population. Methods: We included 15,258 men and 3552 women free of cancer when attending the Copenhagen Outpatient Clinic for Alcoholics in the period from 1954 to 1992. The cancer incidence until 1999 of the patients and the general Danish population was obtained through linkage with the Danish Cancer Registry. The incidence rates were standardized (SIR) according to sex, age and calendar time. Results: A total of 2145 men developed cancer compared to 1140.8 expected cases (SIR = 1.9; 95% confidence interval (CI) 1.8–2.0), while 601 women developed cancer compared to 239.1 expected cases (SIR = 2.5; 95% CI 2.3–2.7). Highly significant and strongly elevated incidence rates were found for cancer of the tongue, mouth, pharynx, oesophagus, liver, larynx and lung. A higher incidence rate was seen for renal cancer for both men (1.4; 1.1–1.8) and women (2.1; 1.0–3.8). The incidence of breast cancer in women was non-significantly elevated, but significantly elevated incidence rate was found for cervical cancer (1.8; 1.2–2.6). We did not observe increased incidence of colon, rectal or urinary bladder cancer. Conclusions: In conclusion, this study confirms the well-established association between high alcohol intake and cancer of the upper digestive tract and liver. In addition, the results indicate a significantly elevated occurrence of renal cancer, but not of breast cancer and colorectal cancer, in patients with alcohol use disorders

Echolocation click parameters and biosonar behaviour of the dwarf sperm whale (<i>Kogia sima</i>)

Dwarf sperm whales (Kogia sima) are small toothed whales that produce narrow-band high-frequency (NBHF) echolocation clicks. Such NBHF clicks, subject to high levels of acoustic absorption, are usually produced by small, shallow-diving odontocetes, such as porpoises, in keeping with their short-range echolocation and fast click rates. Here, we sought to address the problem of how the little-studied and deep-diving Kogia can hunt with NBHF clicks in the deep sea. Specifically, we tested the hypotheses that Kogia produce NBHF clicks with longer inter-click intervals (ICIs), higher directionality and higher source levels (SLs) compared with other NBHF species. We did this by deploying an autonomous deep-water vertical hydrophone array in the Bahamas, where no other NBHF species are present, and by taking opportunistic recordings of a close-range Kogia sima in a South African harbour. Parameters from on-axis clicks (n=46) in the deep revealed very narrow-band clicks (root mean squared bandwidth, BWRMS, of 3±1 kHz), with SLs of up to 197 dB re. 1 µPa peak-to-peak (μPapp) at 1 m, and a half-power beamwidth of 8.8 deg. Their ICIs (mode of 245 ms) were much longer than those of porpoises (&lt;100 ms), suggesting an inspection range that is longer than detection ranges of single prey, perhaps to facilitate auditory streaming of a complex echo scene. On-axis clicks in the shallow harbour (n=870) had ICIs and SLs in keeping with source parameters of other NBHF cetaceans. Thus, in the deep, dwarf sperm whales use a directional, but short-range echolocation system with moderate SLs, suggesting a reliable mesopelagic prey habitat.</p