Heterogeneity in Preferences for Primary Care Consultations: Results from a Discrete Choice Experiment

Abstract: Purpose: The increasing importance of flexibility in the general practitioner (GP) -patient consultation approach in primary care requires healthcare managers and physicians to find a balance among all the potentially important characteristics of consultation. This study used a discrete choice experiment (DCE) to assess patients' preferences for different attributes of GP consultation and how the rate at which they traded between different attributes is affected by socio-demographic characteristics and past experiences with primary care services . Methods: A survey was conducted to a sample of 6970 residents in Tuscany region, Italy. Besides socio-demographic characteristics the survey collected information about participants' past experience with GP consultation in the last 12 months. Moreover, participants were asked to select their preferred option in a series of pairwise choices, defined by the following attributes: level of involvement in decision making, amount of information received from the GP and waiting time for the visit. Results: Results revealed that receiving information from the GP was more important than being involved in the decisions and that, approximately, a complete involvement had the same importance as a partial involvement. Participants' past experience with GP's consultation appeared to have the greatest influence on the involvement level. The amount of information required by the respondents was also influenced by a complex interplay of personal and contextual factors. Conclusions: This large-scale study extends the body of literature on DCE applications for different GP consultation approaches, providing new information about the influence that patients' socio-demographic characteristics and past experiences could have on consultation preferences.

Characterization of circulating blood dendritic cell subsets DC123+ (lymphoid) and DC11C+ (myeloid) in prostate adenocarcinoma patients

PURPOSE. We verified whether prostate adenocarcinoma produces specific modifications in DC subsets count. METHODS. Twenty-one untreated prostate adenocarcinomas were divided on the basis of clinical stage in localized and metastatic disease. As control we used a population of 18 healthy male subjects. For DCs enumeration, peripheral blood (PB) samples were obtained in all cases. A single-platform flow cytometric assay based on Tru-COUNT was used for the enumeration of the two DCs subsets, myeloid (mDCs) and plasmacytoid (pDCs). RESULTS. We showed a statistically significant reduction in pDCs count in prostate cancer population when compared to healthy controls (P = 0.002). Comparing each clinical stage with healthy controls, significant differences were found between controls and the metastatic group in both pDCs and mDCs (P = 0.005 and P = 0.023 respectively) but not between controls and the localized group (P = 0.055 and P = 0.829 respectively). CONCLUSIONS. We showed that DCs count in PB is significantly affected by prostate adenocarcinoma progression in a metastatic disease. © 2006 Wiley-Liss, Inc

Soil bacterial community response to differences in agricultural management along with seasonal changes in a Mediterranean region

Land-use change is considered likely to be one of main drivers of biodiversity changes in grassland ecosystems. To gain insight into the impact of land use on the underlying soil bacterial communities, we aimed at determining the effects of agricultural management, along with seasonal variations, on soil bacterial community in a Mediterranean ecosystem where different land-use and plant cover types led to the creation of a soil and vegetation gradient. A set of soils subjected to different anthropogenic impact in a typical Mediterranean landscape, dominated by Quercus suber L., was examined in spring and autumn: a natural cork-oak forest, a pasture, a managed meadow, and two vineyards (ploughed and grass covered). Land uses affected the chemical and structural composition of the most stabilised fractions of soil organic matter and reduced soil C stocks and labile organic matter at both sampling season. A significant effect of land uses on bacterial community structure as well as an interaction effect between land uses and season was revealed by the EP index. Cluster analysis of culture-dependent DGGE patterns showed a different seasonal distribution of soil bacterial populations with subgroups associated to different land uses, in agreement with culture-independent T-RFLP results. Soils subjected to low human inputs (cork-oak forest and pasture) showed a more stable bacterial community than those with high human input (vineyards and managed meadow). Phylogenetic analysis revealed the predominance of Proteobacteria, Actinobacteria, Bacteroidetes, and Firmicutes phyla with differences in class composition across the site, suggesting that the microbial composition changes in response to land uses. Taken altogether, our data suggest that soil bacterial communities were seasonally distinct and exhibited compositional shifts that tracked with changes in land use and soil management. These findings may contribute to future searches for bacterial bio-indicators of soil health and sustainable productivity. X Maite Sampedro Pellicer, Affiliation: ENEA (Italian National Agency for New Technologies, Energy and Sustainable Economic Development) Casaccia Research Center, Technical Unit for Sustainable Development and Innovation of Agro-Industrial System, Rome, Italy X Maria Cristiana Papaleo, Affiliation: Laboratory of Microbial and Molecular Evolution, Department of Biology, University of Florence, Florence, Italy X Alessio Mengoni, Affiliation: Laboratory of Microbial and Molecular Evolution, Department of Biology, University of Florence, Florence, Italy X Luigi Ledda, Affiliation: Dipartimento di Agraria, University of Sassari, Sassari, Italy X Renato Fani, Affiliation: Laboratory of Microbial and Molecular Evolution, Department of Biology, University of Florence, Florence, Italy X Anna Benedetti, Affiliation: Consiglio per la Ricerca e la Sperimentazione in Agricoltura - Research Centre for the Soil-Plant System, Rome, Italy X Claudia Dalmastr

First Results of the 140^{140}Ce(n,γ)141^{141}Ce Cross-Section Measurement at n_TOF

An accurate measurement of the $^{140}$Ce(n,γ) energy-dependent cross-section was performed at the n_TOF facility at CERN. This cross-section is of great importance because it represents a bottleneck for the s-process nucleosynthesis and determines to a large extent the cerium abundance in stars. The measurement was motivated by the significant difference between the cerium abundance measured in globular clusters and the value predicted by theoretical stellar models. This discrepancy can be ascribed to an overestimation of the $^{140}$Ce capture cross-section due to a lack of accurate nuclear data. For this measurement, we used a sample of cerium oxide enriched in $^{140}$Ce to 99.4%. The experimental apparatus consisted of four deuterated benzene liquid scintillator detectors, which allowed us to overcome the difficulties present in the previous measurements, thanks to their very low neutron sensitivity. The accurate analysis of the p-wave resonances and the calculation of their average parameters are fundamental to improve the evaluation of the $^{140}$Ce Maxwellian-averaged cross-section

First Results of the 140^{140}Ce(n,γ)141^{141}Ce Cross-Section Measurement at n_TOF

An accurate measurement of the $^{140}$Ce(n,γ) energy-dependent cross-section was performed at the n_TOF facility at CERN. This cross-section is of great importance because it represents a bottleneck for the s-process nucleosynthesis and determines to a large extent the cerium abundance in stars. The measurement was motivated by the significant difference between the cerium abundance measured in globular clusters and the value predicted by theoretical stellar models. This discrepancy can be ascribed to an overestimation of the $^{140}$Ce capture cross-section due to a lack of accurate nuclear data. For this measurement, we used a sample of cerium oxide enriched in $^{140}$Ce to 99.4%. The experimental apparatus consisted of four deuterated benzene liquid scintillator detectors, which allowed us to overcome the difficulties present in the previous measurements, thanks to their very low neutron sensitivity. The accurate analysis of the p-wave resonances and the calculation of their average parameters are fundamental to improve the evaluation of the $^{140}$Ce Maxwellian-averaged cross-section

The economic development process in the Middle East and Nord Africa

The book addresses the issue of the economic development in the Middle East and North Africa by giving a rationale of the recent half-century transitional path the regional economies undertook. The development is represented as a shift from an old to a new socio economic system, creating new economic organizations and subjects, empowering new social and political actors, and cropping up the old state of affairs outside and inside the country. So the international environment, in which this process evolves, and the domestic institutional change have a central explanatory power, representing the framework enabling the country to manage its own economic capacity and the cultural legacy of Muslim societies transferred to the new arrangement. On this stance, the book endows the reader with knowledge concerning the strategic position of the regional economies, the interplay between state and society in shaping the economy, the impact of the demographic transition on the economic variables and on the welfare systems of the countries, the achievement and progress towards reforms and economic integration. The dialectic between a week state and a powerful society is the guideline in trying to explain the MENA development and in giving an answer to the issues facing economies

Why non-urgent patients choose emergency over primary care services? Empirical evidence and managerial implications

Objective To investigate structural and psychological factors that lead non-urgent patients to choose the Accidents & Emergency Department (A&ED) rather than primary care services. Data Sources Data were collected through interviews by means of a structured questionnaire. Data regarding the A&ED sample were also drawn from the database of the department. Study Design Hypotheses were tested in a survey comparing A&ED non-urgent patients and patients using GP surgeries. Different perceptions of the characteristics of A&ED and primary care services were measured and a perceptual map was created using the linear discriminant analysis (LDA). Data Collection Emergency services users were interviewed in the A&ED of the General Hospital of the Province of Macerata (Italy). Primary care users were interviewed in 4 GP surgeries. 527 patients were interviewed between December 2006 and February 2007. Principal Findings A&ED and primary care patients look for different characteristics as diagnostic and therapeutic potentialities, empathy and competence, quick access or long-lasting relationship. Information asymmetry explains part of the behaviour. Conclusions Use of A&ED services for non urgent care can be reduced. The understanding of reasons underlying the choice and a change in access, timing and contents of care/services provided by GPs might provide incentives for shifting from A&ED to GPs surgeries