Evaluating a new methodology for providing individualized feedback in healthcare on quality of life and its importance, using the WHOQOL-BREF in a community population

© 2015, Springer International Publishing Switzerland. Purpose: We conducted an evaluation to find out how a novel quality of life (QoL) intervention containing guided individualized feedback was appraised. The importance of QoL was matched with QoL assessment for each subjective dimension, using graphical feedback. We examined whether this information was acceptable, feasible and valued beyond the clinical context, among the community. Methods: Using a mixed-methods cross-sectional design, the intervention was piloted with 129 participants from communities and registered in primary care. WHOQOL-BREF and WHOQOL Importance scores were graphically matched by dimension. Results were inspected and interpreted with directed guidance to identify good and poor QoL. We report the post-intervention evaluation of feedback, including qualitative themes. Follow-up interviews among those expecting feedback to be helpful explored potential self-management and healthcare uses. Results: After feedback, 65% reported changes in thoughts and perceptions of QoL, often describing insights as self-affirming. Goals or expectations changed for 34%, and motivation to change was reported. Over 50% evaluated the feedback as helpful in the short term or for the future. Follow-up interviews endorsed the value of the feedback and its usefulness in sharing with a healthcare professional (92%), suggesting it would facilitate professionals’ understandings of patients and enable health advice to be targeted. Conclusions: The benefits of using this novel feedback can be extended to the general population, as directed guidance aids interpretation, thereby saving health service costs. This complex pilot intervention needs testing in a blinded fully randomized controlled trial. Beyond independent self-management, graphs could be used during clinical decision-making

Access to health care : a descriptive analysis of a rural East Tennessee county

Three hundred and one individuals of Scott County, Tennessee were interviewed concerning their access to health care. By using utilization patterns, an estimate of access (as influenced by characteristics of the individual and the service) was obtained. Characteristics included: age, sex, presence of chronic illness, income, employment, education, cost, distance, and insurance coverage. Services which were studied were: total service usage, hospital, emergency room, general practitioner, and specialist. The greatest overall predictors of use of health care were presence of chronic illness and insurance coverage. Those individuals with a chronic illness and those with insurance coverage were among the most likely to utilize health care services. While not as strong an indicator across the service categories, age was also a determinant to amount of medical facility usage. Surprisingly, sex did not prove to be much of an indicator, except for total usage and general practitioner categories. Education proved to be significantly related to all service usage except for the emergency room. Distance was significant only in the case of general practitioner visits. Cost of service was significantly related to total service usage and general practitioner visits

Proposed reference models for atomic oxygen in the terrestrial atmosphere

A provisional Atomic Oxygen Reference model was derived from average monthly ozone profiles and the MSIS-86 reference model atmosphere. The concentrations are presented in tabular form for the altitude range 40 to 130 km

Longevity and mortality in Kennel Club registered dog breeds in the UK in 2014

Abstract Background The domestic dog is one of the most diverse mammalian species, exhibiting wide variations in morphology, behaviour and morbidity across breeds. Therefore, it is not unexpected that breeds should also exhibit variation in mortality and longevity. While shorter longevity per se may not necessarily be a welfare issue, a generally foreshortened lifespan in a breed that is accompanied by a high prevalence of a particular cause of death may reveal potentially serious welfare concerns and highlight scope to improve breed welfare. Survey data gathered directly from owners offer useful insights into canine longevity and mortality that can support the overall evidence base for welfare reforms within breeds. Results Mortality data on 5663 deceased dogs registered with the UK Kennel Club were collected from an owner-based survey. The most commonly reported causes of death were old age (13.8%), unspecified cancer (8.7%) and heart failure (4.9%); with 5.1% of deaths reported as unknown cause. Overall median age at death was 10.33 years (interquartile range: 7.17–12.83 years). Breeds varied widely in median longevity overall from the West Highland Terrier (12.71 years) to the Dobermann Pinscher (7.67 years). There was also wide variation in the prevalence of some common causes of death among breeds, and in median longevity across the causes of death. Conclusion Substantial variation in the median lifespan and the prominent causes of death exists across breeds. This study has identified some breeds with both a low median lifespan and also a high proportional mortality for one or more specific causes of death that should be considered as both potential welfare concerns as well as opportunities for improvement

Large-scale survey to estimate the prevalence of disorders for 192 Kennel Club registered breeds

Abstract Background Pedigree or purebred dogs are often stated to have high prevalence of disorders which are commonly assumed to be a consequence of inbreeding and selection for exaggerated features. However, few studies empirically report and rank the prevalence of disorders across breeds although such data are of critical importance in the prioritisation of multiple health concerns, and to provide a baseline against which to explore changes over time. This paper reports an owner survey that gathered disorder information on Kennel Club registered pedigree dogs, regardless of whether these disorders received veterinary care. This study aimed to determine the prevalence of disorders among pedigree dogs overall and, where possible, determine any variation among breeds. Results This study included morbidity data on 43,005 live dogs registered with the Kennel Club. Just under two thirds of live dogs had no reported diseases/conditions. The most prevalent diseases/conditions overall were lipoma (4.3%; 95% confidence interval 4.13-4.52%), skin (cutaneous) cyst (3.1%; 2.94-3.27%) and hypersensitivity (allergic) skin disorder (2.7%; 2.52-2.82%). For the most common disorders in the most represented breeds, 90 significant differences between the within breed prevalence and the overall prevalence are reported. Conclusion The results from this study have added vital epidemiological data on disorders in UK dogs. It is anticipated that these results will contribute to the forthcoming Breed Health & Conservation Plans, a Kennel Club initiative aiming to assist in the identification and prioritisation of breeding selection objectives for health and provide advice to breeders/owners regarding steps that may be taken to minimise the risk of the disease/disorders. Future breed-specific studies are recommended to report more precise prevalence estimates within more breeds

Do parental monitoring strategies, parental knowledge, and adolescent risk -taking differ based on family income and parental marital status? The role of resiliency

Adolescents living in low socioeconomic status (SES) are more likely to engage in risk-taking behaviors, such as alcohol and other drug use, sexual behavior, and vandalism. Resiliency theory suggests that protective factors could reduce adolescent risk-taking in low SES families. Parental monitoring, parent behaviors involved in tracking their adolescents\u27 whereabouts and activities, tends to be less evident in low SES families. However, it has also been identified as a protective factor in fostering resiliency in adolescents living in high-risk situations. The current study examined group differences in parental knowledge, parental monitoring strategies, and adolescent risk-taking based on two socioeconomic factors, parental income and parental marital status. Furthermore, it evaluated the group differences in adolescent risk-taking based on the type of parental monitoring strategy utilized. This study surveyed 526 parent/adolescent dyads throughout various counties in the state of West Virginia. A final sample of 518 participant dyads were included in the study. Data analyses revealed no significant differences in adolescent risk-taking or parental knowledge based on family income and parental marital status. Additionally, there were no significant differences in the use of direct, indirect, or restrictive parental monitoring strategies based on family income and parental marital status; however, there was a statistically significant interaction effect. Finally, an exploratory analysis was conducted to examine group differences in adolescent risk-taking based on the use of each parental monitoring strategy and significant group differences emerged. Clinical implications and limitations were discussed as well as suggestions for future research

Effectiveness of a Pilates exercise intervention on perceived functional disability and pain associated with non-specific chronic low back pain

Non-specific low back pain (LBP) is a symptom of unknown cause affecting one third of the UK adult population. In 2013, the UK Government reported that back pain was the leading cause of long-term sickness and accounted for more than 15 million lost work days; with an estimated annual cost of £12.3 billion (NHS, 2015). Pilates based exercise is becoming increasingly incorporated to spinal rehabilitation, yet there is limited evidence on the effectiveness of the technique. The aim of this study was to evaluate the effect of a 6-week Pilates based exercise programme on perceived functional disability and pain associated with nonspecific chronic low back pai

HIV-1 infection of microglial cells in a reconstituted humanized mouse model and identification of compounds that selectively reverse HIV latency.

Most studies of HIV latency focus on the peripheral population of resting memory T cells, but the brain also contains a distinct reservoir of HIV-infected cells in microglia, perivascular macrophages, and astrocytes. Studying HIV in the brain has been challenging, since live cells are difficult to recover from autopsy samples and primate models of SIV infection utilize viruses that are more myeloid-tropic than HIV due to the expression of Vpx. Development of a realistic small animal model would greatly advance studies of this important reservoir and permit definitive studies of HIV latency. When radiation or busulfan-conditioned, immune-deficient NSG mice are transplanted with human hematopoietic stem cells, human cells from the bone marrow enter the brain and differentiate to express microglia-specific markers. After infection with replication competent HIV, virus was detected in these bone marrow-derived human microglia. Studies of HIV latency in this model would be greatly enhanced by the development of compounds that can selectively reverse HIV latency in microglial cells. Our studies have identified members of the CoREST repression complex as key regulators of HIV latency in microglia in both rat and human microglial cell lines. The monoamine oxidase (MAO) and potential CoREST inhibitor, phenelzine, which is brain penetrant, was able to stimulate HIV production in human microglial cell lines and human glial cells recovered from the brains of HIV-infected humanized mice. The humanized mice we have developed therefore show great promise as a model system for the development of strategies aimed at defining and reducing the CNS reservoir