How head and neck consultants manage patients’ emotional distress during cancer follow-up consultations : a multilevel study

Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants’ responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients’ expressions of emotional distress and consultants’ responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant reduce space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1–20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants’ responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.PostprintPeer reviewe

Apropriação participativa da tecnologia Fossa séptica biodigestora: olhares múltiplos.

Este documento relata o grau de envolvimento por gênero e geração na implantação e acompanhamento de um projeto de pesquisa participativa com uso de fossas sépticas biodigestoras (FSB’s) em três lotes de assentamentos rurais localizados na Borda Oeste do Pantanal, Corumbá, MS. Entre junho de 2008 e dezembro de 2009, foi possível verificar diferenças significativas quanto ao questionamento e o grau de envolvimento dos componentes das famílias parceiras no manejo do sistema proposto. Importantes intervenções foram realizadas graças à percepção das mulheres e contribuição dos jovens, constatando-se de fundamental importância o maior envolvimento destes no projeto, bem como nos temas vinculados à qualidade ambiental da propriedade e da comunidade. This document reports the degree of involvement by gender and generation in the implementation and monitoring of a participatory research project using the septic tank digesters (FSB's) in three groups of rural settlements in the West Edge of the Pantanal, Corumbá, MS. Between June 2008 and December 2009, we observed significant differences regarding the questioning and the degree of involvement of members of such families partner in the management of the proposed system. Important interventions were performed because of the perception of women and contributions of young people, noting to be of fundamental importance the greater involvement of the project, as well as on themes entailed to environmental quality of the propriety and of the community

Eficiência da biodigestão de efluentes com águas salobras e doces em fossas sépticas biodigestoras.

O presente estudo avaliou a eficiência de biodigestão de efluentes produzidos a partir de águas salobras e doces em fossas sépticas biodigestoras (FSB's) instaladas sob as condições da Borda Oeste do Pantanal, Mato Grosso do Sul

Produção de capim-elefante sob diferentes doses de efluentes de fossa séptica biodigestora em região de águas salobras.

Objetivou-se com o presente trabalho avaliar a produção de capim elefante (Penisetum purpureaum Schumach cv. Botucatu) sob diferentes doses de efluentes Produzidos em fossa séptica biodigestora instalada em região de águas salobras. O experimento foi conduzido em casa de vegetação na Embrapa Pantanal, situada em Corumbá, Mato Grosso do Sul, entre agosto de 2009 e março de 2010. Foi avaliado o efeito de quatro doses de efluentes e duas épocas de corte sob as produções de matéria seca a 105oC (MS) de folhas (F), de hastes (H) e total (F+H), a participação da fração folha na massa seca total (F%) e a relação F/H. A aplicação de doses crescentes de efluentes da fossa séptica biodigestora instalada em região de águas salobras resultou em maior produção do capim-elefante nas duas épocas avaliadas e favoreceu, no primeiro período de avaliação, maior participação da fração folha das plantas, fato que indica efeito positivo do uso deste tipo efluente sobre o valor nutritivo da forrageira cultivada na região

Diagnostic accuracy of non-specialist versus specialist health workers in diagnosing hearing loss and ear disease in Malawi.

OBJECTIVE: To determine whether a non-specialist health worker can accurately undertake audiometry and otoscopy, the essential clinical examinations in a survey of hearing loss, instead of a highly skilled specialist (i.e. ENT or audiologist). METHODS: A clinic-based diagnostic accuracy study was conducted in Malawi. Consecutively sampled participants ≥ 18 years had their hearing tested using a validated tablet-based audiometer (hearTest) by an audiologist (gold standard), an audiology officer, a nurse and a community health worker (CHW). Otoscopy for diagnosis of ear pathologies was conducted by an ENT specialist (gold standard), an ENT clinical officer, a CHW, an ENT nurse and a general nurse. Sensitivity, specificity and kappa (κ) were calculated. 80% sensitivity, 70% specificity and kappa of 0.6 were considered adequate. RESULTS: Six hundred and seventeen participants were included. High sensitivity (>90%) and specificity (>85%) in detecting bilateral hearing loss was obtained by all non-specialists. For otoscopy, sensitivity and specificity were >80% for all non-specialists in diagnosing any pathology except for the ENT nurse. Agreement in diagnoses for the ENT clinical officer was good (κ = 0.7) in both ears. For other assessors, moderate agreement was found (κ = 0.5). CONCLUSION: A non-specialist can be trained to accurately assess hearing using mobile-based audiometry. However, accurate diagnosis of ear conditions requires at least an ENT clinical officer (or equivalent). Conducting surveys of hearing loss with non-specialists could lower costs and increase data collection, particularly in low- and middle-income countries, where ENT specialists are scarce

An approach to hearing loss in children

Hearing loss in children is common and can be difficult to identify, especially in young children. There are a variety of pathologies involved in these children, which make the problem challenging to diagnose and manage. This update describes how new technologies have evolved over the last 10 years to assist in the early detection of hearing loss even in very young children. The article aims to highlight the role and assist the general practitioner in managing these children, so that effective intervention and rehabilitation can occur and the long-term benefit, namely that the children become functioning members of the hearing world, is achieved. This article is not a comprehensive review on the subject, but aims to remind the reader of risk factors and gives guidelines for the clinical assessment of a child with hearing loss. In addition, middle ear disease is also widespread and impacts significantly on the quality of life in this age group, and therefore these problems are also discussed for the sake of completeness. The Ivan Tom’s infant hearing screening programme based in Cape Town is presented as a pilot project for future universal neonatal screening projects in South Africa

SPINAL ANTINOCICEPTION BY MORPHINE IN RATS IS ANTAGONIZED BY GALANIN RECEPTOR ANTAGONISTS

Galanin, a 29 amino acid peptide, has been reported to possess antinociceptive properties at the spinal site and to potentiate opioid-induced antinociception. Our aim was to investigate whether also endogenous galanin interacts with an exogenously administered opioid, morphine, in the rat spinal cord. This question was investigated by use of the recently developed galanin receptor antagonists galantide [M-15, galanin-(1-13)-substance P-(5-11) amide] and M-35 [galanin-(1-13)-bradykinin-(2-9) amide]. Nociception was assessed in the rat tail-flick test using radiant heat and the rat Randall-Selitto model of inflammatory pain using vocalization as the nociceptive criterion. Intrathecal (i.t.) injections were performed in rats under ether anaesthesia. Morphine was administered either i.t. or intraperitoneally (i.p.), and the antagonists were injected i.t. [I-125]Galanin binding experiments were performed on crude synaptosomal membranes of the rat spinal cord. In the rat tail-flick test, i.t. injection of 3 mu g morphine evoked antinociception of about 75% of the maximal possible effect (% MPE). Co-injection of either 2 mu g galantide or 2 mu g M-35 with morphine almost completely abolished the antinociceptive effect of morphine. I.p. injection of 2.15 mg/kg morphine elicited about 80% MPE when given 10 min prior to i.t. saline injection. Injection of the antagonists instead of saline antagonised the antinociceptive effect of morphine partially thus showing the spinal proportion of the overall antinociceptive effect. In the rat Randall-Selitto test, 3 mu g morphine, injected i.t., produced antinociception of almost 100% MPE. Co-injection of the antagonists reduced the maximum effect partially by about 25-35%. I.p. injection of 7.5 mg/kg morphine 10 min prior to i.t. injection of saline elicited an antinociceptive effect of 90-100% MPE; injection of the antagonists instead of saline reduced the peak effect to a similar degree as after i.t. injection of 3 mu g morphine. To exclude a direct interference by morphine with the galanin receptor, in vitro binding of [I-125]galanin to a spinal synaptosomal fraction was assessed. Morphine, 10 mu M, did not interfere with the specific [I-125]galanin binding. These results provide further evidence that galanin is involved in spinal nociceptive processing. It seems to be involved in the mediation of the effects of morphine at this site, either as a co-transmitter, or subsequent to mu-receptor activation on nerve terminals or on interneurones