Pros and cons of spaying female dogs

PòsterJun

Organització i avaluació de diàlegs polítics per al disseny de polítiques públiques en cronicitat: el cas de CHRODIS PLUS

Polítiques públiques; Malalties cròniques; CHRODIS PLUSPolíticas públicas; Enfermedades crónicas; CHRODIS PLUSPublic policies; Chronic diseases; CHRODIS PLUSL’objectiu d’aquest article és presentar la metodologia d’organització i avaluació dels diàlegs polítics, presentarne els resultats i extraure’n lliçons apreses que puguin servir per a un futur ús dels diàlegs polítics com a eina amb potencial en la definició de polítiques en salut

Eficacia y seguridad de la sanación espiritual activa: informe técnico

Sanación espiritual activa; Cuerpo energético; Técnica no invasivaSanació espiritual activa; Cos energètic; Tècnica no invasivaActive spiritual healing; Energy body; Non-invasive techniqueEste informe se centra en la aplicación de la “sanación espiritual activa” en las indicaciones para las cuales se han encontrado estudios en revistas indexadas, siendo artritis reumatoide la única indicación por la cual se ha encontrado evidencia de un estudio de alta calidad científica (ECA)1 .Para otras indicaciones más habituales del uso de la técnica (dolor inespecífico y/o crónico, problemas mentales y fatiga) sólo se ha incluido un estudio de menor calidad metodológica (observacional) en la discusión, con el fin central de ofrecer datos sobre la seguridad de la técnica, información inexistente en el único ECA incluido en el informe.This report focuses on the application of the “active spiritual healing” in the indications for which studies have been found in indexed journals, being rheumatoid arthritis the only indication for which evidence has been found in a high scientific quality (RCT)2 study. For other more common indications on the use of the technique (unspecific pain and/or chronic, mental problems and fatigue), only a lower methodological (observational) quality study has been included in the discussion, with the main aim of offering data on the safety of the technique, non-existent information in the only RCT included in the report

Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

<p>Abstract</p> <p>Background</p> <p>There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1) prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2) initiation of anticoagulation for patients with atrial fibrillation (AF), where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin.</p> <p>Methods</p> <p>For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2) to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes) for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be able to identify which variables have the greatest effect on physician judgments, and whether judgments are affected by inappropriate cues or incorrect weighting of appropriate cues. We will send antibiotics surveys to family physicians (300 per survey), and warfarin surveys to both family physicians and internal medicine specialists (300 per group per survey), for a total of 1,800 physicians. Each Type 1 survey will be two to four pages in length and take about fifteen minutes to complete, while each Type 2 survey will be eight to ten pages in length and take about thirty minutes to complete.</p> <p>Discussion</p> <p>This work will provide insight into the extent to which clinicians' judgments about the likelihood of important treatment outcomes explain inappropriate treatment decisions. This work will also provide information necessary for the development of an individualized feedback tool designed to improve treatment decisions. The techniques developed here have the potential to be applicable to a wide range of clinical areas where inappropriate utilization stems from biased judgments.</p

Daily sitting time and its association with non-communicable diseases and multimorbidity in Catalonia

Background: Non-communicable diseases (NCDs) account for 71% of deaths worldwide and individual behaviours such as sedentariness play an important role on their development and management. However, the detrimental effect of daily sitting on multiple NCDs has rarely been studied. This study sought (i) to investigate the association between sitting time and main NCDs and multimorbidity in the population of Catalonia and (ii) to explore the effect of physical activity as a modifier of the associations between sitting time and health outcomes. Methods: Cross-sectional data from the 2016 National Health Survey of Catalonia were analyzed, and multivariable logistic regression, adjusting for socio-demographics and individual risk factors (tobacco and alcohol consumption, diet, hyperlipidaemia, hypertension, body mass index) was used to estimated odds ratios (ORs) and 95% confidence intervals (CIs) of the association between sitting time and NCDs. Results: A total of 3320 people 15 years old were included in the study. Sitting more than 5 h/day was associated with a higher risk of cardiovascular disease (OR 1.90, 95% CI: 1.21-2.97), respiratory disease (OR 1.61, 95% CI: 1.13-2.30) and multimorbidity (OR 2.80, 95% CI: 1.53-5.15). Sitting more than 3 h/day was also associated with a higher risk of multimorbidity (OR 2.26, 95% CI: 1.23-4.16). Physical activity did not modify the associations between sitting time and any of the outcomes. Conclusions: Daily sitting time might be an independent risk factor for some NCDs, such as cardiovascular disease, respiratory disease and multimorbidity, independently of the level risk of physical inactivity

Study of the best condition for the use of combined drying technologies in artisanal noodle pasta, to improve the technological characteristic and consequent retention of nutrientes

Pasta is a popular food item that is produced in several shapes and dimensions. Therefore, the industry and research need updates regarding novel technologies applicable to the processing of new products. The aim of this work was to evaluate the effects of drying pasta arranged in nests using a convective dryer combined with a microwave oven and that influence the offer of a more nutritious product for the consumer. An experimental design was carried out in five assays with varying conditions of drying temperature and microwave oven power. After drying, moisture analyses were performed to assess whether or not the samples were in accordance with the legislation (moisture content not higher than 13%). Technological quality analyses were also carried out. Assay 5 (60°C / 107 W) led to the best drying condition, as indicated by the lowest loss of soluble solids and the shortest cooking time. Thus, this condition is considered ideal for conducting further research on the development and shelf life evaluations of pasta

Prevalence and prognostic factors of disability after major trauma

Background: The primary aim of this study was to assess the health-related quality of life of survivors of severe trauma 1 year after injury, specified according to all the separate dimensions of the EuroQol-5D (EQ-5D) and the Health Utilities Index (HUI). Methods: A prospective cohort study was conducted in which all severely injured trauma patients presented at a Level I trauma center were included. After 12 months, the EQ-5D, HUI2 and HUI3 were used to analyze the health status. Results: Follow-up assessments were obtained from 246 patients (response rate, 68%). The overall population EQ-5D (median) utility score was 0.73 (EQ-5D Dutch general population norm, 0.88). HUI2, HUI3, and EQ-5D Visual Analog Scale scores were 0.81, 0.65, and 70, respectively. Eighteen percent had at least one functional limitation 1 year after trauma, and 60% reported functional limitations on two or more domains using the EQ-5D. The female gender and comorbidity were significant independent predictors of disability. Conclusion: Functional outcome and quality of life of survivors of severe injury have not returned to normal 1 year after trauma. The prevalence of specific limitations in this population is very high (40-70%). Female gender and comorbidity are predictors of long-term disability. Copyrigh

A new method for determining physician decision thresholds using empiric, uncertain recommendations

<p>Abstract</p> <p>Background</p> <p>The concept of risk thresholds has been studied in medical decision making for over 30 years. During that time, physicians have been shown to be poor at estimating the probabilities required to use this method. To better assess physician risk thresholds and to more closely model medical decision making, we set out to design and test a method that derives thresholds from actual physician treatment recommendations. Such an approach would avoid the need to ask physicians for estimates of patient risk when trying to determine individual thresholds for treatment. Assessments of physician decision making are increasingly relevant as new data are generated from clinical research. For example, recommendations made in the setting of ocular hypertension are of interest as a large clinical trial has identified new risk factors that should be considered by physicians. Precisely how physicians use this new information when making treatment recommendations has not yet been determined.</p> <p>Results</p> <p>We derived a new method for estimating treatment thresholds using ordinal logistic regression and tested it by asking ophthalmologists to review cases of ocular hypertension before expressing how likely they would be to recommend treatment. Fifty-eight physicians were recruited from the American Glaucoma Society. Demographic information was collected from the participating physicians and the treatment threshold for each physician was estimated. The method was validated by showing that while treatment thresholds varied over a wide range, the most common values were consistent with the 10-15% 5-year risk of glaucoma suggested by expert opinion and decision analysis.</p> <p>Conclusions</p> <p>This method has advantages over prior means of assessing treatment thresholds. It does not require physicians to explicitly estimate patient risk and it allows for uncertainty in the recommendations. These advantages will make it possible to use this method when assessing interventions intended to alter clinical decision making.</p

Unanswered ethical and scientific questions for trials of invasive interventions for coronary disease: The case of single vessel disease

Trials in the 1990s demonstrated that medical therapy is as effective as invasive therapies for treating single-vessel coronary disease. Yet more recent studies enrolling patients with this condition have focused on evaluating only invasive approaches, namely, stenting versus coronary artery bypass surgery. Several ethical and scientific questions remain unanswered regarding the conduct of these later trials. Were they justified? Why wasn't a medical therapy arm included? Were subjects informed about the availability of medical therapy as an equivalent option? Was optimized medical therapy given prior to randomization? The absence of clear answers to these questions raises the possibility of serious bias in favor of invasive interventions. Considering that medical therapy is underutilized in patients with coronary disease, efforts should focus more on increasing utilization of medical therapy and proper selection of noninvasive interventions