Barriers to Preventive Health Screenings for Benefitted University of North Dakota Employees

Background and Purpose: The purpose of this study was to determine perception of the utilization of preventive health screenings as compared to actual utilization for benefitted University of North Dakota employees. The research was designed to determine the perception of compliance and barriers to receiving recommended health screenings for benefitted employees. The significance was that the University of North Dakota has created a Well ness Center and has begun the creation of a worksite well ness program for its employees. While there are a variety of worksite well ness program designs, very little has been done to ascertain utilization or barriers to utilization of preventive health screenings. Subjects: A stratified sample of 400 employees was selected from the 5,301 benefitted faculty and staff employed at UNO. As staff members at the University of North Dakota comprised 75% of the workforce (n = 3969) and faculty were the minority of the workforce (25% of the overall population at UNO (n = 1332)), a 3 to 1 ratio was set for target employees, staff to faculty. Of the 400 survey participants selected by random sample, a total of 102 survey instruments were returned, yielding a response rate of 26%. All University of North Dakota benefitted employees were included in the NDPERS health insurance utilization data analysis for years 1998 through 2002. Methods: Data were obtained through the use of survey instruments distributed to the random sample of benefitted employees of the University of North Dakota. Actual utilization preventive health screening data for the years 1998 through 2002 were provided by NDPERS. Results: While numerous provider and patient barriers have been reported in literature, it is also reported that patients with a primary care provider, insurance benefits, and sick leave are the most likely to receive the appropriate preventive health screenings. Of the surveyed University of North Dakota benefitted employees, 86% indicated they have a primary care provider. All benefitted employees have 100% paid coverage for preventive health screenings and paid sick leave, yet utilization for the USPSTF screenings are nowhere near expected compliance levels. Returned survey data indicate that over 49% of benefitted employees believe they are receiving the recommended preventive healths screenings. The preventive health screenings are recommended yearly, every two years, or every five years. Actual health insurance utilization data for a five-year period, 1998- 2002, indicates that overall compliance for all annual screenings is less than 30%; for screenings recommended every two years, overall compliance is less than 5%; and for screenings recommended every five years, overall compliance for years 1998-2002 is less than 2%. Conclusion and Discussion: Lack of awareness of screenings and costs as well as the general sense of being healthy and not needing to be seen by a physician are the leading causes of low participation in receiving the appropriate health screenings. The findings indicated a need to re-examine patient barriers which have a negative effect on the use of recommended preventive services. As the University of North Dakota is breaking ground for a new Wellness Center and recognizes the workplace is an ideal site for the establishment of a wellness program, it is more important than ever to re-examine existing benefits and barriers to preventive health screenings. Ultimately, ownership of our health belongs in the hands of each individual. Knowledge and empowerment are tools which worksite well ness can harness to assist the individual employee in taking that responsibility

North Dakota Needs and Feasibility Assessment for a Statewide Family-To-Family Network

The purpose of this study was to determine the need and feasibility of a family-to-family network within the state of North Dakota. The model for this family support network would include a process of matching experienced or veteran parents or a family member who has a child with a disability with parents or other family members who are just beginning to meet the challenge of a disability within the family. The research was designed to determine priorities of families with children with disabilities as well as effective methods of recruitment, referral, and training. Furthermore, the research identified agencies and programs within North Dakota that were currently providing family support services as well as opportunities for interagency collaboration. Data were obtained through the use of survey instruments distributed to agencies/providers working with families with children with disabilities ages birth through eighteen. Additionally, families with children with disabilities were involved in focus interview discussion groups to identify the needs and design of a family support network. While there are a variety of programs and agencies within the state of North Dakota which provide certain family support services, there does not exist an organized, coordinated, statewide family-to-family network or process for systematically matching experienced veteran parents of a family member with a disability with new parents or family members who are just beginning to meet the challenges of a disability within their family. Agencies/providers and families with children with disabilities agree that the need exists and that the implementation of a statewide network would be beneficial for both families and providers

Diagnostic value of reticulocyte indices for the assessment of the iron status of cats with chronic kidney disease.

BACKGROUND Reticulocyte indices have been suggested as alternatives to transferrin saturation (TSAT) for iron status assessment in humans and dogs but they have not been evaluated thoroughly in cats. OBJECTIVES To assess the value of the reticulocyte indices for the diagnosis of iron deficiency in cats with chronic kidney disease (CKD) and chronic hematuria associated with subcutaneous ureteral bypasses (SUBs). ANIMALS Sixty-four cats: 16 healthy, 14 CKD without SUB, and 34 CKD with SUB. METHODS Prospective observational cross-sectional study of cats presented for routine nephrology visits. Primary outcomes included assessment of the diagnostic values of erythrocyte indices (mean corpuscular volume, hemoglobin, and hemoglobin concentration: MCV, MCH, and MCHC) and reticulocyte indices (mean corpuscular volume, MCVr; corpuscular hemoglobin, CHr), using TSAT as reference. RESULTS Iron deficiency was diagnosed in 9/64 cats (14%). A receiver-operating characteristic curve analysis yielded a moderate discriminatory value for CHr in this diagnosis: area under the curve [AUC] = .75 (95% confidence interval, 0.48-0.89); P = .006; sensitivity 67%, specificity 82% for a cutoff of 15.9 pg. This compared favorably to MCVr (AUC = .63; P = .29), MCV (AUC = .58; P = .45), MCH (AUC = .64; P = .19), and MCHC (AUC = .7; P = .03). CONCLUSION AND CLINICAL IMPORTANCE CHr added moderate value to the diagnosis of iron deficiency in cats with CKD

3D-2D projective registration of free-form curves and surfaces

International audienceSome medical interventions require knowing the correspondence between an MRI/CT image and the actual position of the patient. Examples occur in neurosurgery and radiotherapy, but also in video surgery (laparoscopy). We present in this paper three new techniques for performing this task without artificial markers. To do this, we find the 3D-2D projective transformation (composition of a rigid displacement and a perspective projection) which maps a 3D object onto a 2D image of this object. Depending on the object model (curve or surface), and on the 2D image acquisition system (X-Ray, video), the techniques are different but the framework is common: Results are presented on a variety of real medical data to demonstrate the validity of our approach

3D-2D projective registration of free-form curves and surfaces

Some medical interventions require knowing the correspondence between an MRI/CT image and the actual position of the patient. Examples occur in neurosurgery and radiotherapy, but also in video surgery (laparoscopy). We present in this paper three new techniques for performing this task without artificial markers. To do this, we find the \bf 3D-2D projective transformation (composition of a rigid displacement and a perspective projection) which maps a 3D object onto a 2D image of this object. Depending on the object model (curve or surface), and on the 2D image acquisition system (X-Ray, video), the techniques are different but \bf the framework is common: \beginitemize \item We first find an estimate of the transformation using bitangent lines or bitangent planes. These are first order semi-differential invariants \citeMundy. \item Then, introducing the normal or tangent, we define a distance between the 3D object and the 2D image, and we minimize it using extensions of the Iterative Closest Point algorithm (\citeBesl,Zhang). \item We deal with the critical problem of outliers by computing Mahalanobis distances and performing generalized $\chi^2$ tests. \enditemize Results are presented on a variety of real medical data to demonstrate the validity of our approach

Cortical neuronal loss and hippocampal sclerosis are not detected by voxel-based morphometry in individual epilepsy surgery patients

Voxel-based morphometry (VBM) has detected differences between brains of groups of patients with epilepsy and controls, but the sensitivity for detecting subtle pathological changes in single subjects has not been established. The aim of the study was to test the sensitivity of VBM using statistical parametric mapping (SPM5) to detect hippocampal sclerosis (HS) and cortical neuronal loss in individual patients. T1-weighted volumetric 1.5 T MR images from 13 patients with HS and laminar cortical neuronal loss were segmented, normalised and smoothed using SPM5. Both modulated and non-modulated analyses were performed. Comparisons of one control subject against the rest (n ¼ 23) were first performed to ascertain the smoothing level with the lowest number of SPM changes in controls. Each patient was then compared against the whole control group. The lowest number of SPM changes in control subjects was found at a smoothing level of 10 mm full width half maximum for modulated and non-modulated data. In the patient group, no SPM abnormalities were found in the affected temporal lobe or hippocampus at this smoothing level. At lower smoothing levels there were numerous SPM findings in controls and patients. VBM did not detect any abnormalities associated with either laminar cortical neuronal loss or HS. This may be due to normalisation and smoothing of images and low statistical power in areas with larger interindividual differences. This suggests that the methodology may currently not be suitable to detect particular occult abnormalities possibly associated with seizure onset zone in individual epilepsy patients with unremarkable standard structural MRI

Histoire des chrétiens d’Orient (xvie-xxe s.)

Culture, idéologie et politique ecclésiastique (xviie-xviiie siècles) Les relations des melkites avec le monde orthodoxe (xviie-xviiie s.) Alors que jusqu’à récemment, l’attention des chercheurs (dont celle de B. Heyberger) se portait presque exclusivement sur le face-à-face entre les chrétiens arabophones d’Antioche et l’Église romaine, l’ouverture des archives et bibliothèques russes et roumaines et l’arrivée d’une nouvelle génération de chercheurs fait émerger tout un univers de contacts e..

Les ateliers de cuisine : un outil thérapeutique pour le soin et le plaisir des patients

Les patients atteints d’un cancer se retrouvent souvent confrontés à un ensemble de problématiques les conduisant à opérer des modifications dans leurs pratiques alimentaires. Cet article présente un dispositif d’ateliers culinaires à destination des patientes atteintes d’un cancer ainsi que son évaluation tendant à montrer qu’il s’agit d’un outil thérapeutique aidant les patients à mieux prendre en charge leur alimentation. Deux paramètres seront plus spécifiquement étudiés : la déconstruction des idées reçues autour de l’alimentation et l’animation pluridisciplinaire avec la présence d’un chef de cuisine. L’exploration de ces deux points permet d’illustrer que les discours alimentaires des patients en cours de traitement ne se nourrissent pas seulement d’un discours gastronomique autour du plaisir et de la convivialité mais entrent en interaction avec un discours médical lié à la santé et aux enjeux de soins.Les patients atteints d’un cancer se retrouvent souvent confrontés à un ensemble de problématiques les conduisant à opérer des modifications dans leurs pratiques alimentaires. Cet article présente un dispositif d’ateliers culinaires à destination des patientes atteintes d’un cancer ainsi que son évaluation tendant à montrer qu’il s’agit d’un outil thérapeutique aidant les patients à mieux prendre en charge leur alimentation. Deux paramètres seront plus spécifiquement étudiés : la déconstruction des idées reçues autour de l’alimentation et l’animation pluridisciplinaire avec la présence d’un chef de cuisine. L’exploration de ces deux points permet d’illustrer que les discours alimentaires des patients en cours de traitement ne se nourrissent pas seulement d’un discours gastronomique autour du plaisir et de la convivialité mais entrent en interaction avec un discours médical lié à la santé et aux enjeux de soins

Trochlear Nerve Palsy Associated with Claude Bernard-Horner Syndrome after Brainstem Stroke

The association of unilateral trochlear nerve palsy with Claude Bernard-Horner syndrome represents a rare clinical condition. We present the case of a patient with this unusual presentation. The investigation performed implicated cerebrovascular disease as the underlying cause of the condition in this patient