BACKGROUND & AIMS: BACKGROUND:Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age. OBJECTIVE:This study examines the percent of U.S. primary care physicians who report breast cancer screening practices that are not consistent with guidelines, and the characteristics of physicians who reported offering extra test modalities. DESIGN:We analyzed a subset of a 2008 cross-sectional Women's Health Care survey sent to primary care physicians randomly selected from the national American Medical Association (AMA) Physician Masterfile. A subset of physicians received a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. Responses were weighted to represent physicians nationally. PARTICIPANTS:1,654 U.S. family physicians, general internists, and obstetrician-gynecologists under age 65, who practiced in office or hospital based settings (62.8 % response rate). After exclusions, 553 study physicians remained for analysis. MAIN MEASURE:Physician self-report of breast cancer screening practices that are not consistent with the recommendations of the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined as almost always offering mammography. KEY RESULTS:36.0 % (95 % CI: 31.8 %-40.5 %) of physicians reported offering breast cancer screening tests inconsistent with national guidelines, with most offering extra tests (magnetic resonance imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted analysis, risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening tests. CONCLUSIONS:Physicians often report offering breast cancer screening test modalities beyond those recommended for a 51-year-old woman. Strategies, such as academic detailing regarding appropriate use of technology and provision of clinical decision support for breast cancer screening, could decrease overuse of resources.

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BACKGROUND & AIMS: BACKGROUND:Cardiovascular patients are likely to have an impaired health-related quality of life (HRQoL) due to functional and psycho-social limitations. The main objective of this study was to assess the distribution of HRQoL scores in coronary heart disease (CHD) patients across 22 European countries and to identify factors associated with the variation between patients. METHODS:Data from the EUROASPIRE III survey (European Action on Secondary and Primary Prevention by Intervention to Reduce Events), on 8734 patients, were used. Patients with a diagnosis of CHD (coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) or myocardial ischemia) were interviewed and examined at least 6 months after their acute coronary event. Quality of life of each patient was measured using 2 standardized questionnaires: the EuroQoL-5D (EQ-5D) and the 12-item short-form health survey (SF-12v2). RESULTS:HRQoL values differed significantly across countries. Lower HRQoL estimates were found in women, older patients, less educated patients, patients with myocardial infarction or ischemia as recruiting diagnosis, patients with a history of stroke and patients who suffered from a recurring CHD event. In addition, HRQoL was significantly associated with current smoking, central obesity, lack of exercise and inappropriate HbA1c control in patients with diabetes. Furthermore the number of risk factors is inversely associated with HRQoL. CONCLUSION:Overall, a large heterogeneity was observed in HRQoL values between countries and patient groups. There seems to be a significant association between quality of life and patient characteristics with lifestyle risk factors as important determinants of HRQoL.

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BACKGROUND & AIMS: :The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).

背景与目标： : 世界卫生组织欧洲地区是世界上耐多药结核病 (mdr-tb) 发病率最高的地区之一，每年都有许多易受感染的儿童。耐多药结核病暴露后预防性治疗的证据有限，目前的指导意见存在矛盾。进行了基于互联网的调查，以确定该地区的临床实践。来自25个国家的72名临床医生参加了会议。与筛选和决策相关的实践变化很大。刚刚超过一半的人为暴露于耐多药结核病的儿童提供了预防性治疗; 与提供相关的唯一特征是欧盟内部的实践 (调整或4.07，95% CI 1.33-12.5)。

BACKGROUND & AIMS: AIM:To explore nursing students' experiences of patient safety and peer reporting using hypothetical medication administration scenarios. BACKGROUND:Pre-registration nurse training is tasked with the preparation of students able to provide safe, high quality nursing care. How students' contextualise teaching related to patient safety, risk recognition and management in the clinical setting is less clear. METHOD:A total of 321 third year students enrolled in the final semester of an adult branch pre-registration nursing programme in 2011 in a UK university were surveyed. Using free texts, the questionnaire contained hypothetical medication administration scenarios where patient safety could potentially be at risk. Students' qualitative responses were analysed using thematic analysis. FINDINGS:The response rate was 58% (n = 186). Four themes were identified from the scenarios: (1) Protecting patient safety (2) Willingness to compromise; (3) Avoiding responsibility; (4) Consequences from my actions. CONCLUSION:The findings underscore the importance of contextual teaching about risk management, practical techniques for error management and leadership for optimal patient safety in nursing curricula. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers are role models for nursing students in the clinical setting. Nursing management must lead, by example, the patient safety agenda in the clinical setting.

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BACKGROUND & AIMS: :We investigated immunoglobulin G (IgG) subclass antibody responses to Plasmodium falciparum merozoite surface protein 1 (MSP-1) and MSP-2 in 112 malaria-exposed subjects in Brazil. IgG3 polarization was primarily epitope driven, being little affected by cumulative or current exposure to malaria and not affected by a subject's age and Fcgamma receptor IIA genotype.

背景与目标： : 我们调查了巴西112名疟疾暴露受试者对恶性疟原虫裂殖子表面蛋白1 (MSP-1) 和MSP-2的免疫球蛋白G (IgG) 亚类抗体反应。IgG3极化主要是表位驱动的，几乎不受累积或当前暴露于疟疾的影响，并且不受受试者年龄和Fcgamma受体IIA基因型的影响。

BACKGROUND & AIMS: :Autopsy rates remain disturbingly low in nursing homes despite the fact that 1 of 5 deaths occurs in this setting. To determine the autopsy rate for nursing homes, we analyzed all deaths occurring in New York State nursing homes from 1980 to 1984. Of 58,985 nursing home deaths, autopsies were performed in only 499 cases (0.8%). In comparison to the general nursing home population, autopsied residents were more likely to be male and never married and less likely to be widowed. Of 110 practicing nursing home physicians surveyed, 19% believed autopsies had little if any value in the nursing home population, whereas 71% saw autopsy as a valuable tool but rarely requested one. Fewer than 1 in 10 physicians routinely discussed autopsies with patients and/or families before death. Perceived obstacles included the emotional lability of patients and families and a lack of financial reimbursement. Concerns over religious objections, funeral delays, and unnecessary mutilation were cited by fewer than one third of respondents. Facilitation of consent, physician education, and cost sharing may all contribute to enhanced rates of autopsies in the future.

背景与目标： : 尽管5例死亡中有1例发生在这种情况下，疗养院的尸检率仍然低得令人不安。为了确定疗养院的尸检率，我们分析了1984年1980年在纽约州疗养院发生的所有死亡。在58,985例疗养院死亡中，只有499例 (0.8% 例) 进行了尸检。与一般疗养院人口相比，经过尸检的居民更有可能是男性且从未结婚，也不太可能丧偶。在接受调查的110名执业疗养院医生中，19% 人认为尸检对疗养院人群几乎没有价值，而71% 人认为尸检是一种有价值的工具，但很少要求尸检。在死亡前，只有不到十分之一的医生与患者和/或家属进行常规尸检。感知到的障碍包括患者和家人的情绪不安和缺乏经济补偿。不到3分之1的受访者提到了对宗教异议，葬礼延误和不必要的肢解的担忧。同意的便利，医师教育和费用分担都可能有助于将来提高尸检率。

BACKGROUND & AIMS: BACKGROUND & OBJECTIVE:Estimation of maternal mortality has been difficult because of large sample size requirement. A study using snowball technique for identification of households where maternal death has taken place and its related causes was conducted. We present here the feasibility of carrying out the snowball technique for capturing maternal deaths as against house-to-house survey and to obtain the estimates of maternal mortality ratio (MMR) in some selected States of India. METHODS:Five states representing high MMR (Uttar Pradesh), medium MMR (Maharashtra, Karnataka, Uttranchal) and low MMR (Delhi) were selected. A total of 8 PHCs and 3 (UFS) were covered. Study used both house-to-house survey and snowball technique to enumerate the maternal deaths in the selected PHCs in rural area and urban frame survey (UFS) in urban area. RESULTS:In all, 94 maternal deaths were captured through snowball technique as against 83 through house-to-house survey. The estimate of MMR for the five States combined was 356 per 100,000 live births, as compared to assumed 400 per 100,000 live births for the country as a whole. The relative standard error of the estimate of MMR was about 10 per cent. INTERPRETATION & CONCLUSION:Snowball technique captured more maternal deaths than those in house-to-house survey particularly in rural areas. The estimates also indicated the feasibility of replicating the proposed methodology for estimation of MMR as a time and cost-effective methodology.

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BACKGROUND & AIMS: BACKGROUND:Hypoglycemia is a frequent phenomenon in people being treated for diabetes mellitus, which can acutely disrupt driving performance. For the benefit of personal and public traffic safety, we decided to identify successful diabetes-related (SDR) behaviors to support safe driving for people with diabetes, from the perspective of experiential experts with diabetes mellitus. Experiential experts are people who can manage their own illness and conditions by developing expertise relevant to maintaining health and countering illness, and who are able to use this expertise to the benefit of peers. OBJECTIVE:The aim of our study was to objectify and systematize experiential expertise in terms of SDR behaviors, based on reports by experiential experts, to support safe driving for people with type 1 and type 2 diabetes mellitus. The emphasis was on preventing hypoglycemia as a short-term complication during driving. METHODS:We performed a mixed-methods study involving (i) semi-structured in-depth interviews with 33 experiential experts with diabetes mellitus from the Dutch Diabetes Association (DVN; Diabetesvereniging Nederland), in order to identify SDR behaviors regarding safe driving, and (ii) a validation study by means of a survey among a panel of 98 experiential experts (peers) from the DVN, to determine the extent to which they agreed with the communicability, importance, and feasibility of these behaviors for drivers with diabetes mellitus. RESULTS:We identified a comprehensive set of 11 SDR behaviors, differentiated into seven general and four specific behaviors, to support safe driving. The general behaviors concern the following topics: (i) acquiring knowledge and information; (ii) acquiring and using self-measuring of blood glucose (SMBG) equipment; (iii) knowing one's physical response pattern; (iv) obtaining knowledge about the medication used; (v) preventing long-term eye complications; (vi) influencing factors that can affect blood glucose; and (vii) renewal procedure for driving license. The four specific behaviors refer to the following topics: (i) measures to be taken before driving; (ii) responding effectively to hypoglycemia while driving; (iii) informing and instructing passengers; and (iv) preventing hypoglycemia in drivers with type 2 diabetes mellitus not using SMBG equipment. Key factors for safe driving proved to be the ability of drivers to anticipate and respond effectively to hypoglycemia while driving and to inform and instruct fellow passengers. Participants of the validation survey agreed to a considerable degree with the communicability, importance, and feasibility of these behaviors to support safe driving for people with diabetes mellitus. CONCLUSIONS:This study resulted in the identification and description of SDR behaviors to support safe driving. It proved possible to operationalize experiential expertise in terms of such behaviors. The next step is to have these behaviors validated by professional care providers in the field of diabetes, followed by translation into recommendations in self-management programs.

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BACKGROUND & AIMS: BACKGROUND:Informed consent in family planning includes knowledge of mechanism of action. Some methods of family planning occasionally work after fertilization. Knowing about postfertilization effects may be important to some women before choosing a certain family planning method. The objective of this survey is to explore women's attitudes towards postfertilization effects of family planning methods, and beliefs and characteristics possibly associated with those attitudes. METHODS:Cross-sectional survey in a sample of 755 potentially fertile women, aged 18-49, from Primary Care Health Centres in Pamplona, Spain. Participants were given a 30-item, self-administered, anonymous questionnaire about family planning methods and medical and surgical abortion. Logistic regression was used to identify variables associated with women's attitudes towards postfertilization effects. RESULTS:The response rate was 80%. The majority of women were married, held an academic degree and had no children. Forty percent of women would not consider using a method that may work after fertilization but before implantation and 57% would not consider using one that may work after implantation. While 35.3% of the sample would stop using a method if they learned that it sometimes works after fertilization, this percentage increased to 56.3% when referring to a method that sometimes works after implantation. Women who believe that human life begins at fertilization and those who consider it is important to distinguish between natural and induced embryo loss were less likely to consider the use of a method with postfertilization effects. CONCLUSION:Information about potential postfertilization effects of family planning methods may influence women's acceptance and choice of a particular family planning method. Additional studies in other populations are necessary to evaluate whether these beliefs are important to those populations.

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BACKGROUND & AIMS: BACKGROUND:Oppositional defiant disorder (ODD) is a leading cause of referral for youth mental health services; yet, many uncertainties exist about ODD given it is rarely examined as a distinct psychiatric disorder. We examined the lifetime prevalence, onset, persistence, and correlates of ODD. METHODS:Lifetime prevalence of ODD and 18 other DSM-IV disorders was assessed in a nationally representative sample of adult respondents (n = 3,199) in the National Comorbidity Survey Replication. Retrospective age-of-onset reports were used to test temporal priorities with comorbid disorders. RESULTS:Lifetime prevalence of ODD is estimated to be 10.2% (males = 11.2%; females = 9.2%). Of those with lifetime ODD, 92.4% meet criteria for at least one other lifetime DSM-IV disorder, including: mood (45.8%), anxiety (62.3%), impulse-control (68.2%), and substance use (47.2%) disorders. ODD is temporally primary in the vast majority of cases for most comorbid disorders. Both active and remitted ODD significantly predict subsequent onset of secondary disorders even after controlling for comorbid conduct disorder (CD). Early onset (before age 8) and comorbidity predict slow speed of recovery of ODD. CONCLUSIONS:ODD is a common child- and adolescent-onset disorder associated with substantial risk of secondary mood, anxiety, impulse-control, and substance use disorders. These results support the study of ODD as a distinct disorder. Prospective and experimental studies are needed to further delineate the temporal and causal relations between ODD and related disorders.

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BACKGROUND & AIMS: AIMS OF THE STUDY:The economic implications of co-morbid depression in patients with chronic medical disorders have been studied mainly in high-income countries. However, the applicability of such findings in developing countries cannot be assumed. In the present study we estimate diabetes related costs and explore the link between depression and diabetes related costs in Romania. In this former communist country, the general perception of practitioners and policy-makers is that psychological issues are far less important than medical concerns for patients with diabetes, a perception that may lead to the misallocation of already scarce resources. METHODS:Data related to costs of diabetes care and to co-morbid depression were collected from a sample of 1,171 diabetes patients at the Nutrition and Diabetes Center in Cluj-Napoca, Romania, using the Diabetes Costs Questionnaire (DCQ) and the Patient Health Questionnaire 9 (PHQ9). The gathered data were subjected to a bivariate analysis of the depression-cost relationship, as well as a regression analysis in order to isolate the effect of depression on diabetes related costs from the effect of covariates. RESULTS:Direct and indirect diabetes related costs equally contributed to the total costs. The repartition of the cost burden between the public system and private agents is nearly equal as well. The bivariate analysis of the depression-cost relationship reveals statistically significant larger diabetes related costs for patients with major depression than for patients with minor depression, and the latter have larger diabetes related costs than patients free of depression symptoms. When the pure effect of depression on diabetes related costs was isolated by means of regression techniques, the provisional diagnosis of major depression was found to significantly increase diabetes related costs. DISCUSSION:The equal distribution of diabetes related costs between direct and indirect measures, as well as the cost burden equally split between the public system and private agents can be explained by the costs of medication and the costs associated with time lost by the non-compensated caregivers. Consistent with Romanian cultural traditions, most of the patients rely on their relatives in an informal diabetes caregiving market for assistance. Alongside depression, the multivariate analysis revealed that factors such as Hungarian ethnicity, income, and number of years since diagnosis also significantly contribute to diabetes related costs. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Findings that depression increases diabetes related costs bear potential implications for health policies and health care provision (i.e., the effect of depression on costs can be minimized by adequate recognition and treatment). As such, screening and treatment of co-occurring depression in diabetes patients should become part of the diabetes treatment protocol, not only in Romania but in other Central and Eastern European countries as well.

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BACKGROUND & AIMS: INTRODUCTION AND AIMS:As the popularity of electronic cigarettes (e-cigarettes) increases, it is becoming important to find out more about the characteristics of e-cigarette users, why and how they use the product and whether e-cigarettes are used exclusively or in combination with conventional cigarettes. The objective of this study was to investigate patterns and effects of e-cigarette use and user beliefs about e-cigarette safety and benefits. DESIGN AND METHODS:E-cigarette users in Poland were recruited online and asked to participate in a web-based survey. The participants provided information on their smoking history, patterns of e-cigarette use, beliefs and attitudes regarding the product and information on concurrent use of conventional cigarettes. RESULTS:The survey was completed by 179 e-cigarette users. Almost all participants used e-cigarettes daily. E-cigarettes were primarily used to quit smoking or to reduce the harm associated with smoking (both 41%), and were successful in helping the surveyed users to achieve these goals with 66% not smoking conventional cigarettes at all and 25% smoking under five cigarettes a day. Most participants (82%) did not think that e-cigarettes were completely safe, but thought that they were less dangerous than conventional cigarettes. Sixty percent believed that e-cigarettes were addictive, but less so than conventional cigarettes. DISCUSSION AND CONCLUSIONS:The participants primarily used e-cigarettes as a stop-smoking aid or as an alternative to conventional cigarettes, and the majority reported that they successfully stopped smoking. More data on e-cigarette safety and its efficacy in harm-reduction and smoking cessation are needed.

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BACKGROUND & AIMS: OBJECTIVE:To investigate the characteristics of epidemiological distribution of the ossification of the ligamentum flavum (OLF) in the thoracic spine including the incidence, segmental distribution, and shape. METHODS:Chest spiral computed tomography scans of 993 cases (male 506, female 487, mean age 60 years, range 5-102 years) who presented due to chest symptoms were analyzed with axial slices combined with sagittal slices. The conditions of OLF in the thoracic spine, including segments, thickness, location, and dural sac compression, were recorded. Prevalence was standardized according to the "Age Structure of Population in Beijing 2008". RESULTS:Among the population investigated, the standardized prevalence rate was 63.9 %. The standardized prevalence rate for males (68.5 %) was higher than that for females (59.0 %). The highest prevalence rate of OLF was in the 50-59 years age group (79.2 %); however, high density originated it can be found in individuals aged 10-19 years. The comparison of different thoracic segments showed that T10-11 (44.0 %) and T11-12 (41.6 %) had the highest prevalence rates. CONCLUSION:The prevalence of ossification of the ligamentum flavum was highest in the 50-59 years group, but also occurred in early years. OLF occurs more frequently in the lower than in the upper and middle thoracic regions and its prevalence increases with aging.

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BACKGROUND & AIMS: :In this article, we have discussed recent progress in quantifying the genetically determined component of the resting EEG. This progress has been made possible in particular by the application of advanced information processing techniques such as "supervised learning," and the development of a problem-oriented "similarity" concept. Our work aimed at modeling previous findings regarding the distinct individuality of human brain-wave patterns, the high similarity between the EEGs of monozygotic twins, and the average within-pair similarity of dizygotic twins. Thus, we had three objectives: First, we wanted to improve the quantification of EEG characteristics with respect to reproducibility and specificity by means of adaptive procedures and repeated measurements. Second, we wanted to compare the "typical" within-subject EEG similarity with the "typical" within-pair EEG similarity of monozygotic and dizygotic twins brought up together. Finally, we were interested in the degree to which environmental factors affect the characteristics of human brain-wave patterns. Our investigations were based on the empirical data derived from five different populations: (1) 81 healthy subjects, (2) 24 pairs of monozygotic twins brought up together, (3) 25 pairs of dizygotic twins brought up together, (4) 28 pairs of monozygotic twins reared apart, and (5) 21 pairs of dizygotic twins reared apart. Following our similarity conception, repeated measurements on the set of 81 individuals were used as design samples, and new registrations from the same individuals taken 14 days later were referred to as test samples in order to develop the appropriate method and to determine all required calibration parameters. This specific approach allowed us to construct EEG spectral patterns which, with a specificity and reproducibility of greater than 90% each, largely met the requirements of genetic EEG studies. Hence, we were able systematically to investigate the within-pair EEG similarity of our twin samples.(ABSTRACT TRUNCATED AT 400 WORDS)

背景与目标： : 在本文中，我们讨论了量化静息脑电图的遗传确定成分的最新进展。特别是通过应用先进的信息处理技术 (例如 “监督学习”) 以及开发面向问题的 “相似性” 概念，使这一进展成为可能。我们的工作旨在对先前的发现进行建模，这些发现涉及人类脑电波模式的独特个性，单卵双胞胎的脑电图之间的高度相似性以及双卵双胞胎的平均配对内相似性。因此，我们有三个目标: 首先，我们希望通过自适应程序和重复测量来改善EEG特征在可重复性和特异性方面的量化。其次，我们想将 “典型” 的受试者内脑电图相似性与 “典型” 的单卵双胞胎和双卵双胞胎的 “典型” 内脑电图相似性进行比较。最后，我们对环境因素影响人类脑电波模式特征的程度感兴趣。我们的调查基于来自五个不同人群的经验数据 :( 1) 81名健康受试者，(2) 24对单卵双胞胎，(3) 25对双卵双胞胎，(4) 28对单卵双胞胎分开饲养，(5) 21对双卵双胞胎分开饲养。按照我们的相似性概念，对81个个体的重复测量被用作设计样本，并且在14天后从相同个体进行的新注册被称为测试样本，以便开发适当的方法并确定所有所需的校准参数。这种特定的方法使我们能够构建EEG光谱模式，其特异性和可重复性均大于90%，在很大程度上满足了遗传EEG研究的要求。因此，我们能够系统地研究我们的双胞胎样本的内对EEG相似性。(摘要截断在400个单词)

BACKGROUND & AIMS: BACKGROUND:The aim of this study was to examine the determinants of nutritional status among children under age 5 (0-59 months) in Ethiopia. Child malnutrition is an underlying cause of almost half (45%) of child deaths, particularly in low socioeconomic communities of developing countries. In Ethiopia, the prevalence of stunting decreased from 47% in 2005 to 39% in 2016, but the prevalence of wasting changed little over the same time period (from 11 to 10%). Despite improvements in reducing the prevalence of malnutrition, the current rate of progress is not fast enough to reach the World Health Organization global target for reducing malnutrition 40% by 2025. METHODS:This study used data from the 2016 Ethiopia Demographic and Heath Survey (EDHS). The analysis used stunting and wasting as dependent variables, while the independent variables were characteristics of children, mothers, and households. Logistic regression was used to analyze the determinants of nutritional status among children. Bivariate analysis was also used to analyze the association between the dependent and independent variables. RESULTS:Study results show that child's age, sex, and perceived birth weight, mother's educational status, body mass index (BMI), and maternal stature, region, wealth quintile, type of toilet facility, and type of cooking fuel had significant associations with stunting. Child's age, sex, and perceived birth weight, mother's BMI, and residence and region showed significant associations with wasting. The study found that child, maternal, and household characteristics were significantly associated with stunting and wasting among children under age 5. CONCLUSION:These findings imply that a multi-sectorial and multidimensional approach is important to address malnutrition in Ethiopia. The education sector should promote reduction of cultural and gender barriers that contribute to childhood malnutrition. The health sector should encourage positive behaviors toward childcare and infant feeding practices. More should be done to help households adopt improved types of toilet facilities and modern types of cooking fuels.

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