Diagonal ear lobe crease and atherosclerosis: a review of the medical literature and dental implications

In Spain a significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodromal symptoms. The diagonal ear lobe crease (DELC) has been characterized in the medical literature as a surrogate marker which can identify high risk patients having occult atherosclerosis. This topic however has not been examined in either the medical or dental literature emanating from Spain. The majority of clinical, angiography and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. A minority of studies have however failed to support this hypothesis. More recently reports using B mode ultrasound have also linked DELC to atherosclerosis of the carotid artery and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. DELC is readily visible during head and neck cancer screening examinations. In conjunction with the patient"s medical history, vital signs, and panoramic radiograph, the DELC may assist in atherosclerotic risk assessment

Localized prostate cancer in Norway, the United States, and Spain: between-country differences of variables before treatment among patients eligible for curative treatment

Between-country differences in medical and sociodemographic variables, and patient-related outcomes (PROs) before treatment might explain published variations of side effects after radical prostatecomy (RP) or radiotherapy (RAD) for prostate cancer (PCa). This hypothesis was tested among 1908 patients from the United States, Spain, and Norway. Significant between-country differences were observed for most factors investigated before treatment. The observations should be considered in comparison of the frequency and severity of internationally published studies. Background: In men with PCa, large variations of PROs after RP or high-dose RAD might be related to betweencountry differences of medical and sociodemographic variables, and differences in PROs before treatment in the sexual and urinary domains. Patients and Methods: In 1908 patients with localized PCa from Norway, the United States, or Spain, the relation between medical (prostate-specific antigen, Gleason score, cT-category) and sociodemographic variables (age, education, marital status) before treatment was investigated. Using the Expanded Prostate Cancer Index Composite questionnaire, PROs before treatment within the sexual and urinary domains were also considered. Results: Compared with the European patients, American patients were younger, fewer had comorbid conditions, and more had a high education level. Fifty-three percent of the US men eligible for RP had low-risk tumors compared with 42% and 31% among the Norwegian and the Spanish patients, respectively. Among the Spanish RAD patients, 54% had had low-risk tumors compared with 34% of the American and 21% of the Norwegian men planned for RAD, respectively. Compared with the European patients, significantly fewer US patients reported moderate or severe sexual dysfunction and related problems. In most subgroups, the number of patients with sexual or urinary dysfunction exceeded that of patients with bother related to the reported dysfunction. Conclusion: Statistically significant between-country differences were observed in medical and sociodemographic variables, and in PROs before treatment within the sexual and urinary domains. Large differences between reported dysfunction and related problems within the sexual and urinary domains indicate that dysfunction and bother should be reported separately in addition to calculation of summary scores. The documented differences, not at least regarding PROs, might in part explain the large variation of side effects after treatment evident in the medical literature

Myofascial pain associated to trigger points: A literature review. Part 2: Differential diagnosis and treatment

During the last decades the advance in knowledge of myofascial pain has been constant in the medical and dental community. However, although several aspects have been clarified in relation to its epidemiology, clinical characteristics and etiopathogenesis, many uncertainties remain. Many clinical conditions are included in the differential diagnosis of myofascial pain associated to trigger points. A good anamnesis and clinical exploration is thus required in order to ensure correct diagnosis and treatment. Among the numerous treatments used in application to trigger points, the spray-and-stretch technique and direct injection targeted to such trigger points have been found to be the most effective options. In chronic cases, psychosocial intervention is required, due to the high incidence of mood disorders and/or anxiety observed in these patients, who in turn present a poorer prognosis. This underscores the importance of early diagnosis and treatment.

Taxation of unhealthy consumption of food and drinks: An updated literature review

By means of a literature review this paper aims at shedding more light on the potentialities of unhealthy food/drink taxation in changing eating patterns and life styles and hence combating the obesity epidemic. One remarkable point that emerges when assessing the set of selected papers is the existence of a wide diversity of objectives, methodologies, settings and datasets, policies implemented and results achieved by all these studies, which undoubtedly adds complexity to any attempt to draw a general conclusion on fast food taxation. Most of the examined studies predict a rather modest fiscal impact on unhealthy food and drinks consumption and/or nutrition intake and consequently a poor result on weight loss and obesity, by the interplay of several factors among them the effects of cross-price elasticities.

Taxation of unhealthy consumption of food and drinks: An updated literature review

By means of a literature review this paper aims at shedding more light on the potentialities of unhealthy food/drink taxation in changing eating patterns and life styles and hence combating the obesity epidemic. One remarkable point that emerges when assessing the set of selected papers is the existence of a wide diversity of objectives, methodologies, settings and datasets, policies implemented and results achieved by all these studies, which undoubtedly adds complexity to any attempt to draw a general conclusion on fast food taxation. Most of the examined studies predict a rather modest fiscal impact on unhealthy food and drinks consumption and/or nutrition intake and consequently a poor result on weight loss and obesity, by the interplay of several factors among them the effects of cross-price elasticities.

Modeling usage of medical care services: the medical expenditure panel survey data, 1996-2000

We explore the determinants of usage of six different types of health care services, using the Medical Expenditure Panel Survey data, years 1996-2000. We apply a number of models for univariate count data, including semiparametric, semi-nonparametric and finite mixture models. We find that the complexity of the model that is required to fit the data well depends upon the way in which the data is pooled across sexes and over time, and upon the characteristics of the usage measure. Pooling across time and sexes is almost always favored, but when more heterogeneous data is pooled it is often the case that a more complex statistical model is required.

Likelihood-based approaches to modeling demand for medical care

We review recent likelihood-based approaches to modeling demand for medical care. A semi-nonparametric model along the lines of Cameron and Johansson's Poisson polynomial model, but using a negative binomial baseline model, is introduced. We apply these models, as well a semiparametric Poisson, hurdle semiparametric Poisson, and finite mixtures of negative binomial models to six measures of health care usage taken from the Medical Expenditure Panel survey. We conclude that most of the models lead to statistically similar results, both in terms of information criteria and conditional and unconditional prediction. This suggests that applied researchers may not need to be overly concerned with the choice of which of these models they use to analyze data on health care demand.

Optimal regulation of specialized medical care in a mixed system

We study the optimal public intervention in setting minimum standards of formation for specialized medical care. The abilities the physicians obtain by means of their training allow them to improve their performance as providers of cure and earn some monopoly rents.. Our aim is to characterize the most efficient regulation in this field taking into account different regulatory frameworks. We find that the existing situation in some countries, in which the amount of specialization is controlled, and the costs of this process of specialization are publicly financed, can be supported as the best possible intervention.

L' Aprenentatge basat en problemes a través de casos clínics simulats. Una proposta metodològica de disseny i avaluació docent

RESUM Les exigències actuals de la professió de d’infermeria requereixen que la docència vagi orientada a interrelacionar els diferents rols a desenvolupar enla pràctica diària, per adquirir experiència en l’aprenentatge i així augmentar la qualitat de les cures d’infermeria. Per assolir aquest objectiu és important l’aprenentatge basat enproblemes. Aquest pretén en primer lloc que els estudiants aprenguin allò que permet desenvolupar-se enla vida professional de la manera més natural possible a partir d’una idea clara i profunda de l’evidència sobre la que s’ha d’actuar. Amb aquesta finalitat es vandissenyar casos clínics amb uns objectius que requerien la integració de coneixements, actituds i valors, en diferents fases a desenvolupar en un període de temps predeterminat. També ens vam proposar una estratègia docent que permetés a l’estudiant incorporar el coneixement científic que dóna suport a la pràctica assistencial per aproximar teoria i pràctica. Es pretén que els estudiants busquin una resposta basada en la millor evidència científica disponible, per prendre una decisió respecte a les cures del pacient. Els objectius de l’estudi són: Avaluar globalment l’aprenentatge basat en la simulació de casos Avaluar com els estudiants valoren la integració del model d’infermeria i del procés d’atenció en l’aprenentatge basat en la simulació de casos. Valorar les sensacions percebudes per l’estudiant durant la simulació del cas. Valorar l’actitud d el’estudiant en relació a la incorporació de l’evidència científica per una millora en la pràctica clínica. Avaluar el grau de dificultat manifestat per l’estudiant en relació al procés de documentació. Avaluar la idonietat de l’argumentació i la decisió de l’estudiant a la pregunta formulada en el cas clínic. Metodologia: L’assignatura d’Infermeria Medicoquirúrgica. Adult I del Departament d’Infermeria de la Universitat de Vic, va iniciar una experiència d’aprenentatge basat en la resolució de problemes, amb estudiants de 2on curs. Les professores responsables dels seminaris van realitzar una avaluació de l’experiència a través d’una enquesta. Aquesta es responia al cap d’un mes de la simulació al laboratori, quan es contrastaven els resultats obtinguts en aquesta entre professores i estudiants després de visualitzar la gravació feta durant el mateix. En el context del seminari de simulació de casos, es va introduir una pregunta/problema, a partir de la que els estudiants, en grup, havien de documentar-se amb el suport d’una guia. Per valorar l’actitud davant aquesta pregunta/problema es va dissenyar un qustionari tipus Likert. L’avaluació del grau de dificultat s’ha registrat a través d’unes escales de puntuació. Per a l’avaluació de la decisió presa, es van valorar les síntesis resum entregades en els treballs escrits pels diferents grups. Resultats: La realització de la simulació en el laboratori va ser avaluada per un alt percentatge d’estudiants (68,8%) amb puntuacions entre 6 i 8 mentre que un 26,6% la van situar en tre 9 i 10, només un 4,7 % la van puntuar amb 5. La integració del model d’infermeria va ser valorada pel 86% amb una puntuació entre 7 i 10. La valoració global de la simulació va ser qualificada pels estudiants amb una puntuació de 8 (34,4%) seguida d’un 28,1% amb una consideració de 7. Un 7,2% van puntuar entre 9 i 10. El 93,3% van assegurar que conèixer les fonts documentals els serviria per millorar l’assistència, el 86,7% esperen obtenir arguments sòlids respecte les seves desicions si la documentació consultada és de qualitat. Un 77,8% dels estudiants consideren estar més satisfets al saber incorporar la presa de decisions basada en evidències. Respecte el grau de dificultat en el procés de documentació la dificultat més gran la presenten en com buscar en les bases de dades de referències bibliogràfiques. Conclusions: L’aprenentatge dels estudiants a través de la simulació de casos és una estratègia vàlida que l’estudiant valora positivament al mateix temps que permet desenvolupar habilitats per a la pràctica professional. L’estratègia docent dissenyada per integrar les evidències en la presa de decisions es considera positiva, no obstant, després d’analitzar els resultats, s’han de modificar alguns aspectes per a la seva millora; tutoritzar per a millorar el procés de documentació i incidir més en la crítica i reflexió, de manera que les troballes de la investigació siguin canalitzades cap a la pràctica.

Changes in the demand for private medical insurance following a shift in tax incentives

The 1998 Spanish reform of the Personal Income Tax eliminated the 15% deduction for private medical expenditures including payments on private health insurance (PHI) policies. To avoid an undesirable increase in the demand for publicly funded health care, tax incentives to buy PHI were not completely removed but basically shifted from individual to group employer-paid policies. In a unique fiscal experiment, at the same time that the tax relief for individually purchased policies was abolished, the government provided for tax allowances on policies taken out through employment. Using a bivariate probit model on data from National Health Surveys, we estimate the impact of said reform on the demand for PHI and the changes occurred within it. Our findings suggest that the total probability of buying PHI was not significantly affected. Indeed, the fall in the demand for individual policies (by 10% between 1997 and 2001) was offset by an increase in the demand for group employer-paid ones, so that the overall size of the market remained virtually unchanged. We also briefly discuss the welfare effects on the state budget, the industry and society at large.

Development of advanced silicon radiation detectors for high energy physics and medical imaging

The 1st chapter of this work presents the different experiments and collaborations in which I am involved during my PhD studies of Physics. Following those descriptions, the 2nd chapter is dedicated to how the radiation affects the silicon sensors, as well as some experimental measurements carried out at CERN (Geneve, Schwitzerland) and IFIC (Valencia, Spain) laboratories. Besides the previous investigation results, this chapter includes the most recent scientific papers appeared in the latest RD50 (Research & Development #50) Status Report, published in January 2007, as well as some others published this year. The 3rd and 4th are dedicated to the simulation of the electrical behavior of solid state detectors. In chapter 3 are reported the results obtained for the illumination of edgeless detectors irradiated at different fluences, in the framework of the TOSTER Collaboration. The 4th chapter reports about simulation design, simulation and fabrication of a novel 3D detector developed at CNM for ions detection in the future ITER fusion reactor. This chapter will be extended with irradiation simulations and experimental measurements in my PhD Thesis.

Reading Ng Kim Chew: Malaysian-Chineseness and memory in contemporary Malaysian Chinese literature in taiwan

The idea of Chineseness as a geographic, cultural-specific and ethnically-charged concept, and the pivotal role assumed by memory linger throughout the writings of most authors hailing from Chinese community in Southeast Asia. Among these communities, being the Malaysian Chinese the more prolific in terms of number of writers and pieces of literature produced, this paper deals specifically with it. Its focus is put on the literature produced by Malaysian Chinese authors residing in Taiwan, which topic constitutes an important part of the first chapter, and on one of its main representatives, Ng Kim Chew, to whom chapter two and three are fully dedicated. A literary analysis of one of his short stories, Huo yu tu, will allow the reader to have a first-hand experience, through excerpts from the original text, of the importance of Chineseness and memory in the literary production of Ng and of many authors sharing with him similar life and literary experiences. I started this research from the assumption that these authors make large use of their own memories and memories from their own community in their writing as a way to re-tie themselves to the Chineseness they left in their places of origin. However in the case of Ng Kim Chew, the analysis of his works led be to theorizing that the identity he is imbued with, if there is one, is not Chinese, nor Malaysian, but purely and distinctively Malaysian-Chinese. This paper can also serve as an introduction for the general public to the field of Sinophone literature from Southeast Asia and to promote wider and innovative paths of research within the realm of Chinese studies that go beyond China proper.

How to improve the formal analytic reasoning and scientific motivation in the intellectual training of medical students

A review article of the The New England Journal of Medicine refers that almost a century ago, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, undertook an assessment of medical education in 155 medical schools in operation in the United States and Canada. Flexner’s report emphasized the nonscientific approach of American medical schools to preparation for the profession, which contrasted with the university-based system of medical education in Germany. At the core of Flexner’s view was the notion that formal analytic reasoning, the kind of thinking integral to the natural sciences, should hold pride of place in the intellectual training of physicians. This idea was pioneered at Harvard University, the University of Michigan, and the University of Pennsylvania in the 1880s, but was most fully expressed in the educational program at Johns Hopkins University, which Flexner regarded as the ideal for medical education. (...)

Bringing actors and violent conflict into forced migration literature. A model of the decision to return

Populations displaced as a result of mass violent conflict have become one of the most pressing humanitarian concerns of the last decades. They have also become one salient political issue as a perceived burden (in economic and security terms) and as an important piece in the shift towards a more interventionist paradigm in the international system, based on both humanitarian and security grounds. The saliency of these aspects has detracted attention from the analysis of the interactions between relocation processes and violent conflict. Violent conflict studies have also largely ignored those interactions as a result of the consideration of these processes as mere reaction movements determined by structural conditions. This article takes the view that individual’s agency is retained during such processes, and that it is consequential, calling for the need to introduce a micro perspective. Based on this, a model for the individual’s decision of return is presented. The model has the potential to account for the dynamics of return at both the individual and the aggregate level. And it further helps to grasp fundamental interconnections with violent conflict. Some relevant conclusions are derived for the case of Bosnia-Herzegovina and about the implications of the politicization of return.