Polyp Resection - Controversial Practices and Unanswered Questions

Detection and complete removal of precancerous neoplastic polyps are central to effective colorectal cancer screening. The prevalence of neoplastic polyps in the screening population in the United States is likely 450%. However, most persons with neoplastic polyps are never destined to develop cancer, and do not benefit for finding and removing polyps, and may only be harmed by the procedure. Further 70–80% of polyps are diminutive (≤5 mm) and such polyps almost never contain cancer. Given the questionable benefit, the high-cost and the potential risk changing our approach to the management of diminutive polyps is currently debated. Deemphasizing diminutive polyps and shifting our efforts to detection and complete removal of larger and higher-risk polyps deserves discussion and study. This article explores three controversies, and emerging concepts related to endoscopic polyp resection. First, we discuss challenges of optical resect-and-discard strategy and possible alternatives. Second, we review recent studies that support the use of cold snare resection for ≥ 5 mm polyps. Thirdly, we examine current evidence for prophylactic clipping after resection of large polyps

Employee Assistance Program i USA och Finland åren 1995-2001 : en metautvärdering

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.EAP är en metod för att utveckla företagshälsovården, arbetsskyddet, arbetsförmågan, samarbetet mellan förmännen och ledarna. Programmet täcker alla problem i det personliga livet. EAP:s syfte är att fungera som en stödande modell och programhelhet för hela personalen och dess närmaste. Mitt syfte är att beskriva EAP-modellen och specificera den som styrmedel, granska hur EAP utvärderats och analysera de resultat utvärderingarna ger, granska vilken inlärningsmodell implicit ligger i bakgrunden för EAP-modellen och vilken inlärningsmodell den här typen av styrmedel bygger på samt att granska hur EAP skulle placera sig utgående från den nuvarande arbetslagstiftningen i Finland. Jag har gjort en metautvärdering, där granskningen stöder sig på interventionsmodellen. Erfarenheterna från USA är valda så att de gör det så exakt som möjligt att bedöma modellens starka och svaga sidor på enhets- och programnivå, respektive politisk nivå. Den kunskapsmodell som stämmer bäst på alla olika nivåerna inom EAP är upplysningsmodellen. Informationen är styrmedelet. Resultaten visar att de som använder EAP upplever det positivare och effektivare än de som inte använder. En positiv attityd och tro på att EAP är effektivt ökar sannolikheten att programmet används. EAP har hjälpt att minska orättvisor på arbetsplatsen. Ett bättre hälsotillstånd kan öka användningen av EAP, men EAP minskar inte nödvändigtvis sjukdagarna. Det finns inget bevis på att EAP är bättre än någon annan metod. EAP täcker kostnaderna och påverkar inte negativt på karriären. Det förekommer ingen undergrupp som skulle använda EAP mera än någon annan, förutom kvinnor. Kvinnor drar mera nytta av att vara i grupp när EAP ges än män. Kunskapen om EAP är bristfällig, mera information och utbildning behövs. Den juridiska kopplingen mellan EAP och lagstiftningen i Finland är inte tydlig, men befrämjas av lagstiftningen. Lagen utgör inget hinder för EAP-verksamheten. Det är dock en definitiv brist i lagtexten att det centrala begreppet arbetsförmåga inte är definierat. Mina studier baserar sig på att jag har systematiskt gått igenom tillgängliga vetenskapliga artiklar, tidskrifter, rapporter, ett tiotal amerikanska undersökningar och litteratur gjorda åren 1995–2001 om Employee Assistance Programs, EAP, i USA och arbetslivets reglering i Finland

Beiträge zur forensischen Chemie des Solanin : Inaugural-Dissertation zur Erlangugng des Grades eines Doctors der Medizin

http://tartu.ester.ee/record=b2448024~S1*es

The MINDMAP project: mental well-being in urban environments

__Background:__ The MINDMAP consortium (2016–2019) aims to identify opportunities provided by the urban environment for the promotion of mental well-being and functioning of older people in Europe by bringing together European cities with urban longitudinal ageing studies: GLOBE, HAPIEE, HUNT, LASA, LUCAS, RECORD, Rotterdam Study, Turin Study. A survey on mental healthcare planning policies and programmes dedicated to older persons covering the range from health promotion to need of nursing care was performed for profound data interpretation in Amsterdam, Eindhoven, Hamburg, Helsinki, Kaunas, Krakow, London, Nord-Trøndelag, Paris, Prague, Rotterdam and Turin. __Objectives:__ To collect detailed information on healthcare planning policies and programmes across these European cities to evaluate variations and to delineate recommendations for sciences, policies and planners using experience from evidence-based practice feedback from the MINDMAP cities. __Materials and methods:__ The MINDMAP partners identified experts in the 12 cities with the best background knowledge of the mental health sector. After pretesting, semi-structured telephone interviews (1–2 h) were performed always by the same person. A structured evaluation matrix based on the geriatric functioning continuum and the World Health Organization (WHO) Public Health Framework for Healthy Ageing was applied. __Results:__ A complete survey (12 out of 12) was performed reporting on 41 policies and 280 programmes on the city level. It appeared from extensive analyses that the focus on older citizens, specific target groups, and multidimensional programmes could be intensified. __Conclusion:__ There is a broad variety to cope with the challenges of ageing in health, and to address both physical and mental capacities in older individuals and their dynamic interactions in urban environments

Multidimensional Geriatric Assessment: Back to the Future Preclinical Disability as a Risk Factor for Falls in Community-Dwelling Older Adults

Background. Falls are common and serious problems in older adults. The goal of this study was to examine whether preclinical disability predicts incident falls in a European population of community-dwelling older adults. Methods. Secondary data analysis was performed on a population-based longitudinal study of 1644 community-dwelling older adults living in London, U.K.; Hamburg, Germany; Solothurn, Switzerland. Data were collected at baseline and 1-year follow-up using a self-administered multidimensional health risk appraisal questionnaire, including validated questions on falls, mobility disability status (high function, preclinical disability, task difficulty), and demographic and health-related characteristics. Associations were evaluated using bivariate and multivariate logistic regression analyses. Results. Overall incidence of falls was 24%, and increased by worsening mobility disability status: high function (17%), preclinical disability (32%), task difficulty (40%), test-of-trend p <.003. In multivariate analysis adjusting for other fall risk factors, preclinical disability (odds ratio [OR] = 1.7, 95% confidence interval [CI], 1.1-2.5), task difficulty (OR = 1.7, 95% CI, 1.1-2.6) and history of falls (OR = 4.7, 95% CI, 3.5-6.3) were the strongest significant predictors of falls. In stratified multivariate analyses, preclinical disability equally predicted falls in participants with (OR = 1.7, 95% CI, 1.0-3.0) and without history of falls (OR = 1.8, 95% CI, 1.1-3.0). Conclusions. This study provides longitudinal evidence that self-reported preclinical disability predicts incident falls at 1-year follow-up independent of other self-reported fall risk factors. Multidimensional geriatric assessment that includes preclinical disability may provide a unique early warning system as well as potential targets for interventio

Social network assessment in community-dwelling older persons: results from a study of three European populations

Background and aims: In clinical practice, the status of living alone is often used as the only measure describing an older person's social network. We evaluated whether additional use of a brief social network measure provides relevant additional information in relation to social support and engagement. Methods: Cross-sectional survey of 6982 community-dwelling adults 65 years or older living in London, UK; Hamburg, Germany; and Solothurn, Switzerland. Data were collected using the self-administered multidimensional Health Risk Appraisal Questionnaire. Multivariate models were used to analyse adjusted correlations between the two measures of social network (living alone status, risk for social isolation with marginal family and friend network subscales) and potential consequences of inadequate social network (marginal emotional or instrumental support, lack of social engagement). Results: Living alone status was more strongly associated with marginal instrumental support [OR=7.6 (95% CI 6.3, 9.1)] than with marginal emotional support [OR=4.2 (95% CI 3.4, 5.1)], and showed no statistically significant association with lack of social engagement [OR=0.9 (95% CI 0.8, 1.0)]. Risk of social isolation was more strongly related to marginal emotional support [OR=6.6 (95% CI 5.4, 8.0)] than to marginal instrumental support [OR=3.3 (95% CI 2.8, 4.0)], and was moderately related to lack of social engagement [OR=2.9 (95% CI 2.5, 3.4]. Marginal family and friend network subscales showed consistent and unique associations with social support and social engagement. Conclusion: Findings suggest that living alone status and a brief measure of social network identifies distinctive at-risk groups and potential pathways for intervention. Geriatric assessment programs including both social network measures may provide useful information about potentially modifiable social network risks in older person

Divisibility structure and finitely generated ideals in the disc algebra

The main purpose of this paper is the following algebraic generalization of the corona theorem for the disc algebra : If d is a greatest common divisor of the functions , then there exist functions with d = f 1 g 1 +...+ f n g n . This generalization is false for many algebras of holomorphic functions, e. g. in case of the Banach algebra H ∞ . Under the assumption that a greatest common divisor d exists, also a description of d is given.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41632/1/605_2005_Article_BF01304378.pd