Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease.

The diagnosis of inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), continues to present difficulties due to unspecific symptoms and limited test accuracies. We aimed to determine the diagnostic delay (time from first symptoms to IBD diagnosis) and to identify associated risk factors. A total of 1591 IBD patients (932 CD, 625 UC, 34 indeterminate colitis) from the Swiss IBD cohort study (SIBDCS) were evaluated. The SIBDCS collects data on a large sample of IBD patients from hospitals and private practice across Switzerland through physician and patient questionnaires. The primary outcome measure was diagnostic delay. Diagnostic delay in CD patients was significantly longer compared to UC patients (median 9 versus 4 months, P < 0.001). Seventy-five percent of CD patients were diagnosed within 24 months compared to 12 months for UC and 6 months for IC patients. Multivariate logistic regression identified age <40 years at diagnosis (odds ratio [OR] 2.15, P = 0.010) and ileal disease (OR 1.69, P = 0.025) as independent risk factors for long diagnostic delay in CD (>24 months). In UC patients, nonsteroidal antiinflammatory drug (NSAID intake (OR 1.75, P = 0.093) and male gender (OR 0.59, P = 0.079) were associated with long diagnostic delay (>12 months). Whereas the median delay for diagnosing CD, UC, and IC seems to be acceptable, there exists a long delay in a considerable proportion of CD patients. More public awareness work needs to be done in order to reduce patient and doctor delays in this target population.

Does history of falling predict length of stay in post-acute geriatric rehabilitation?

Objectives:To investigate the associations between falls before hospital¦admission, falls during hospitalization, and length of stay in elderly¦people admitted to post-acute geriatric rehabilitation. Method: History¦of falling in the previous 12 months before admission was recorded¦among 249 older persons (mean age 82.3±7.4 years, 69.1% women)¦consecutively admitted to post-acute rehabilitation. Data on medical,¦functional and cognitive status were collected upon admission. Falls¦during hospitalization and length of stay were recorded at discharge.¦Results: Overall, 92 (40.4%) patients reported no fall in the 12 months¦before admission; 63(27.6%) reported 1 fall, and 73(32.0%) reported¦multiple falls. Previous falls occurrence (one or more falls) was significantly¦associated with in-stay falls (19.9% of previous fallers fell¦during the stay vs 7.6% in patients without history of falling, P=.01),¦and with a longer length of stay (22.4 ± 10.1 days vs 27.1 ± 14.3 days,¦P=.01). In multivariate robust regression controlling for gender, age,¦functional and cognitive status, history of falling remained significantly¦associated with longer rehabilitation stay (2.8 days more in single fallers,¦p=.05, and 3.3 days more in multiple fallers, p=.0.1, compared to¦non-fallers). Conclusion: History of falling in the 12 months prior to¦post acute geriatric rehabilitation is independently associated with a¦longer rehabilitation length of stay. Previous fallers have also an¦increased risk of falling during rehabilitation stay. This suggests that¦hospital fall prevention measures should particularly target these high¦riskpatients.

Validation of the French version of the Hierarchical Personality Inventory for Children (HiPIC): Influence of gender and age on personality traits from 8 to 12 years

The study was designed to investigate the psychometric properties of the French version and the cross-language replicability of the Hierarchical Personality Inventory for Children (HiPIC). The HiPIC is an instrument aimed at assessing the five dimensions of the Five-Factor Model for Children. Subjects were 552 children aged between 8 and 12 years, rated by one or both parents. At the domain level, reliability ranged from .83 to .93 and at the facet level, reliability ranged from .69 to .89. Differences between genders were congruent with those found in the Dutch sample. Girls scored higher on Benevolence and Conscientiousness. Age was negatively correlated with Extraversion and Imagination. For girls, we also observed a decrease of Emotional Stability. A series of exploratory factor analyses confirmed the overall five-factor structure for girls and boys. Targeted factor analyses and congruence coefficients revealed high cross-language replicability at the domain and at the facet levels. The results showed that the French version of the HiPIC is a reliable and valid instrument for assessing personality with children and has a particularly high cross-language replicability.

Gender, family and employment in comparative perspective: the realities and representations of rqual rpportunities in Britain and France

In this paper, we will explore how contrasting national discourses relating to women, and gender equality have been incorporated into and reflected in national policies. In the first section, we will outline the recent history of EU equal opportunities policy, in which positive action has been replaced by a policy of 'mainstreaming'. Second, we will describe the evolution of policies towards women and equal opportunities in Britain and France. It will be argued that whereas some degree of positive action for women has been accepted in Britain, this policy is somewhat alien to French thinking about equality - although pro-natalist French policies have resulted in favourable conditions for employed mothers in France. In the third section, we will present some attitudinal evidence, drawn from national surveys, which would appear to reflect the national policy differences we have identified in respect of the 'equality agenda'. In the fourth section, we will draw upon biographical interviews carried out with men and women in British and French banks in order to illustrate the impact of these cross-national differences within organizations and on individual lives. We demonstrate that positive action gender equality policies have made an important impact in British banks, while overt gender exclusionary practices still persist in the French banks studied. In the conclusion, we reflect on the European policy implications of our findings.

Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel

Aim: The diagnosis of inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), continues to present difficulties due to unspecific symptoms and limited test accuracies. We aimed to determine the diagnostic delay (time from first symptoms to IBD diagnosis) and to identify associated risk factors in a national cohort in Switzerland.¦Materials and Methods: A total of 1,591 IBD patients (932 CD, 625 UC, 34 indeterminate colitis) from the Swiss IBD cohort study (SIBDCS) were evaluated. The SIBDCS collects data on a large sample of IBD patients from hospitals and private practice across Switzerland through physician and patient questionnaires. The primary outcome measure was the diagnostic delay.¦Results: Diagnostic delay in CD patients was significantly longer compared to UC patients (median 9 vs. 4 months, P < 0.001). Seventy-five percent of CD patients were diagnosed within 24 months compared to 12 months for UC and 6 months for IC patients. Multivariate logistic regression identified age <40 years at diagnosis (OR 2.15, P = 0.010) and ileal disease (OR 1.69, P = 0.025) as independent risk factors for long diagnostic delay in CD (>24 months). A trend for long diagnostic delay (>12 months) was associated with NSAID intake (OR 1.75, P = 0.093) and male gender (OR 0.59, P = 0.079) in UC patients.¦Conclusions: Whereas the median delay for diagnosing CD, UC, and IC seems to be acceptable, there exists a long delay in a considerable proportion of CD patients. More public awareness work needs to be done in order to reduce patient's and doctor's delay in this target population.

Perceptions of aging across 26 cultures and their culture-level associates

College students (N = 3,435) in 26 cultures reported their perceptions of age-related changes in physical cognitive, and socioemotional areas of functioning and rated societal views of aging within their culture. There was widespread cross-cultural consensus regarding the expected direction of aging trajectories with (a) perceived declines in societal views of aging, physical attractiveness, the ability to perform everyday tasks, and new learning; (b) perceived increases in wisdom, knowledge, and received respect; and (c) perceived stability in family authority and life satisfaction. Cross-cultural variations in aging perceptions were associated with culture-level indicators of population aging, education levels, values, and national character stereotypes. These associations were stronger for societal views on aging and perceptions of socioemotional changes than for perceptions of physical and cognitive changes. A consideration of culture-level variables also suggested that previously reported differences in aging perceptions between Asian and Western countries may be related to differences in population structure.

Environmental effects of Deccan volcanism across the Cretaceous-Tertiary transition in Meghalaya, India

The Urn Sohryngkew section of Meghalaya, NE India, located 800-1000 km from the Deccan volcanic province, is one of the most complete Cretaceous-Tertiary boundary (KTB) transitions worldwide with all defining and supporting criteria present: mass extinction of planktic foraminifera, first appearance of Danian species, delta(13)C shift, Ir anomaly (12 ppb) and KTB red layer. The geochemical signature of the KTB layer indicates not only an extraterrestrial signal (Ni and all Platinum Group Elements (PGEs)) of a second impact that postdates Chicxulub, but also a significant component resulting from condensed sedimentation (P), redox fluctuations (As, Co, Fe, Pb, Zn, and to a lesser extent Ni and Cu) and volcanism. From the late Maastrichtian C29r into the early Danian, a humid climate prevailed (kaolinite: 40-60%, detrital minerals: 50-80%). During the latest Maastrichtian, periodic acid rains (carbonate dissolution; CIA index: 70-80) associated with pulsed Deccan eruptions and strong continental weathering resulted in mesotrophic waters. The resulting super-stressed environmental conditions led to the demise of nearly all planktic foraminiferal species and blooms (>95%) of the disaster opportunist Guembelitria cretacea. These data reveal that detrimental marine conditions prevailed surrounding the Deccan volcanic province during the main phase of eruptions in C29r below the KTB. Ultimately these environmental conditions led to regionally early extinctions followed by global extinctions at the KTB. (C) 2011 Elsevier B.V. All rights reserved.

The Swiss Systemic lupus erythematosus Cohort Study (SSCS) - cross-sectional analysis of clinical characteristics and treatments across different medical disciplines in Switzerland.

OBJECTIVES: To describe disease characteristics and treatment modalities in a multidisciplinary cohort of systemic lupus erythematosus (SLE) patients in Switzerland. METHODS: Cross-sectional analysis of 255 patients included in the Swiss SLE Cohort and coming from centres specialised in Clinical Immunology, Internal Medicine, Nephrology and Rheumatology. Clinical data were collected with a standardised form. Disease activity was assessed using the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), an integer physician's global assessment score (PGA) ranging from 0 (inactive) to 3 (very active disease) and the erythrocyte sedimentation rate (ESR). The relationship between SLE treatment and activity was assessed by propensity score methods using a mixed-effect logistic regression with a random effect on the contributing centre. RESULTS: Of the 255 patients, 82% were women and 82% were of European ancestry. The mean age at enrolment was 44.8 years and the median SLE duration was 5.2 years. Patients from Rheumatology had a significantly later disease onset. Renal disease was reported in 44% of patients. PGA showed active disease in 49% of patients, median SLEDAI was 4 and median ESR was 14 millimetre/first hour. Prescription rates of anti-malarial drugs ranged from 3% by nephrologists to 76% by rheumatologists. Patients regularly using anti-malarial drugs had significantly lower SELENA-SLEDAI scores and ESR values. CONCLUSION: In our cohort, patients in Rheumatology had a significantly later SLE onset than those in Nephrology. Anti-malarial drugs were mostly prescribed by rheumatologists and internists and less frequently by nephrologists, and appeared to be associated with less active SLE.

Adolescent drinking patterns across countries: associations with alcohol policies.

Early consumption of full servings of alcohol and early experience of drunkenness have been linked with alcohol-related harmful effects in adolescence, as well as adult health and social problems. On the basis of secondary analysis of county-level prevalence data, the present study explored the current pattern of drinking and drunkenness among 15- and 16-year-old adolescents in 40 European and North American countries. Data from the 2006 Health Behavior in School Children survey and the European School Survey Project on Alcohol and other Drugs were used. The potential role of alcohol control and policy measures in explaining variance in drinking patterns across countries was also examined. Policy measures and data on adult consumption patterns were taken from the WHO Global Information System on Alcohol and Health, Eurostat and the indicator of alcohol control policy strength developed by Brand DA, Saisana M, Rynn LA et al. [(2007) Comparative analysis of alcohol control policies in 30 countries. PLoS Med 4:e151.]. We found that a non-significant trend existed whereby higher prices and stronger alcohol controls were associated with a lower proportion of weekly drinking but a higher proportion of drunkenness. It is important that future research explores the causal relationships between alcohol policy measures and alcohol consumption patterns to determine whether strict policies do in fact have any beneficial effect on drinking patterns, or rather, lead to rebellion and an increased prevalence of binge drinking.

Gender differences in HIV progression to AIDS and death in industrialized countries: slower disease progression following HIV seroconversion in women.

To evaluate sex differences in human immunodeficiency virus (HIV) disease progression before (pre-1997) and after (1997-2006) introduction of highly active antiretroviral therapy, the authors used data from a collaboration of 23 HIV seroconverter cohort studies from Europe, Australia, and Canada restricted to the 6,923 seroconverters infected through injecting drug use and sex between men and women. Within a competing risk framework, they used Cox proportional hazards models allowing for late entry to evaluate sex differences in time from HIV seroconversion to death, to acquired immunodeficiency syndrome (AIDS), and to each first AIDS-defining disease and death without AIDS. While no significant sex differences were found before 1997, from 1997 onward, women had a lower risk of AIDS (adjusted cumulative relative risk (aCRR) = 0.76, 95% confidence interval (CI): 0.63, 0.90) and death (adjusted hazard ratio = 0.68, 95% CI: 0.56, 0.82) than men did. Compared with men, women also had lower risks of AIDS dementia complex (aCRR = 0.23, 95% CI: 0.07, 0.74), tuberculosis (aCRR = 0.60, 95% CI: 0.39, 0.92), Kaposi's sarcoma (aCRR = 0.27, 95% CI: 0.07, 0.99), lymphomas (aCRR = 0.47, 95% CI: 0.23, 0.96), and death without AIDS (aCRR = 0.74, 95% CI: 0.56, 0.98). Sex differences in HIV disease progression have become larger and statistically significant in the era of highly active antiretroviral therapy, supporting a stronger impact of health interventions among women.