Irritable bowel syndrome in the general population : epidemiology, comorbidity and societal costs

Background: Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder characterised by abdominal pain and abnormal bowel function. It is associated with a high rate of healthcare consumption and significant health care costs. The prevalence and economic burden of IBS in Finland has not been studied before. The aims of this study were to assess the prevalence of IBS according to various diagnostic criteria and to study the rates of psychiatric and somatic comorbidity in IBS. In addition, health care consumption and societal costs of IBS were to be evaluated. Methods: The study was a two-phase postal survey. Questionnaire I identifying IBS by Manning 2 (at least two of the six Manning symptoms), Manning 3 (at least three Manning symptoms), Rome I, and Rome II criteria, was mailed to a random sample of 5 000 working age subjects. It also covered extra-GI symptoms such as headache, back pain, and depression. Questionnaire II, covering rates of physician visits, and use of GI medication, was sent to subjects fulfilling Manning 2 or Rome II IBS criteria in Questionnaire I. Results: The response rate was 73% and 86% for questionnaires I and II. The prevalence of IBS was 15.9%, 9.6%, 5.6%, and 5.1% according to Manning 2, Manning 3, Rome I, and Rome II criteria. Of those meeting Rome II criteria, 97% also met Manning 2 criteria. Presence of severe abdominal pain was more often reported by subjects meeting either of the Rome criteria than those meeting either of the Manning criteria. Presence of depression, anxiety, and several somatic symptoms was more common among subjects meeting any IBS criterion than by controls. Of subjects with depressive symptoms, 11.6% met Rome II IBS criteria compared to 3.7% of those with no depressiveness. Subjects meeting any IBS criteria made more physician visits than controls. Intensity of GI symptoms and presence of dyspeptic symptoms were the strongest predictors of GI consultations. Presence of dyspeptic symptoms and a history of abdominal pain in childhood also predicted non-GI visits. Annual GI related individual costs were higher in the Rome II group (497 ) than in the Manning 2 group (295 ). Direct expenses of GI symptoms and non GI physician visits ranged between 98M for Rome II and 230M for Manning 2 criteria. Conclusions: The prevalence of IBS varies substantially depending on the criteria applied. Rome II criteria are more restrictive than Manning 2, and they identify an IBS population with more severe GI symptoms, more frequent health care use, and higher individual health care costs. Subjects with IBS demonstrate high rates of psychiatric and somatic comorbidity regardless of health care seeking status. Perceived symptom severity rather than psychiatric comorbidity predicts health care seeking for GI symptoms. IBS incurs considerable medical costs. The direct GI and non-GI costs are equivalent to up to 5% of outpatient health care and medicine costs in Finland. A more integral approach to IBS by physicians, accounting also for comorbid conditions, may produce a more favourable course in IBS patients and reduce health care expenditures.

Expected Performance of the ATLAS Experiment - Detector, Trigger and Physics

A detailed study is presented of the expected performance of the ATLAS detector. The reconstruction of tracks, leptons, photons, missing energy and jets is investigated, together with the performance of b-tagging and the trigger. The physics potential for a variety of interesting physics processes, within the Standard Model and beyond, is examined. The study comprises a series of notes based on simulations of the detector and physics processes, with particular emphasis given to the data expected from the first years of operation of the LHC at CERN.

Overview on different sterilization techniques for baby food

The nutritional quality of the product as well as other quality attributes like microbiological and sensory quality are essential factors in baby food industry, and therefore different alternative sterilizing methods for conventional heating processes are of great interest in this food sector. This report gives an overview on different sterilization techniques for baby food. The report is a part of the work done in work package 3 ”QACCP Analysis Processing: Quality – driven distribution and processing chain analysis“ in the Core Organic ERANET project called Quality analysis of critical control points within the whole food chain and their impact on food quality, safety and health (QACCP). The overall objective of the project is to optimise organic production and processing in order to improve food safety as well as nutritional quality and increase health promoting aspects in consumer products. The approach will be a chain analysis approach which addresses the link between farm and fork and backwards from fork to farm. The objective is to improve product related quality management in farming (towards testing food authenticity) and processing (towards food authenticity and sustainable processes. The articles in this volume do not necessarily reflect the Core Organic ERANET’s views and in no way anticipate the Core Organic ERANET’s future policy in this area. The contents of the articles in this volume are the sole responsibility of the authors. The information contained here in, including any expression of opinion and any projection or forecast, has been obtained from sources believed by the authors to be reliable but is not guaranteed as to accuracy or completeness. The information is supplied without obligation and on the understanding that any person who acts upon it or otherwise changes his/her position in reliance thereon does so entirely at his/her own risk. The writers gratefully acknowledge the financial support from the Core Organic Funding Body: Ministry of Agriculture and Forestry, Finland, Swiss Federal Office for Agriculture, Switzerland and Federal Ministry of Consumer Protection, Food and Agriculture, Germany.

Depression and Cognition in Type 2 Diabetes from a Life Course Perspective

Background: Type 2 diabetes is linked to several complications which add to both physical and mental distress. Depression is a common co-morbidity of diabetes which can occur both as a cause and a consequence of type 2 diabetes. Depression has been shown to correlate with glucose regulation and treating depression might prove beneficial for glucose regulation as well as for mental well being. Another complication which might affect diabetes management is cognitive decline. Several risk factors and complications of diabetes might modify the risk for developing cognitive impairment, which is increased 1.5 times among subjects with type 2 diabetes. Type 2 diabetes, depression and impaired cognitive performance have all been linked to low birth weight. This thesis aimed to explore the effects and interactions of birth weight, depression and cognitive ability in relation to type 2 diabetes from a life course perspective. Subjects and methods: Studies I, II and V were part of the Helsinki Birth Cohort Study. 2003 subjects participated in an extensive clinical examination at an average age of 61 years. A standard glucose tolerance test (OGTT) was performed and depressive symptoms were assessed using the Beck Depression Inventory (BDI). In addition data was obtained from child welfare clinics and national registers. A subset of the cohort (n=1247) also performed a test on cognitive performance (CogState ®) at the average age of 64. Studies III and IV were randomised clinical trials where mildly depressed diabetic subjects were treated with paroxetine or placebo and the effect on metabolic parameters and quality of life was assessed. The first trial included 14 women and lasted 10 weeks, while the second trial included 43 subjects, both men and women, and lasted 6 months. Results: Type 2 diabetes was positively associated with the occurrence of depressive symptoms. Among diabetic subjects 23.6% had depressive symptoms, compared to 16.7% of subjects with normal glucose tolerance (OR = 1.77, p<0.001). Formal mediation analysis revealed that cardiovascular disease (CVD) is likely to act as a mediator in the association. Furthermore, low birth weight was found to modify the association between type 2 diabetes, CVD and depression. The association between BDI score and having type 2 diabetes or CVD was twice as strong in the subgroup with low birth weight (≤ 2500g) compared with the group with birth weight > 2500g (p for interaction 0.058). In the six months long randomised clinical trial (study IV) paroxetine had a transient beneficial effect on glycosylated haemoglobin A1c (GHbA1c) and quality of life when compared to placebo after three months of treatment. In study V we found that subjects with known diabetes had a consistently poorer level of cognitive performance than subjects with normal glucose tolerance in most of the tested cognitive domains. This effect was further amplified among those born with a small birth weight (p for interaction 0.002). Conclusions: Type 2 diabetes is associated with a higher occurrence of depressive symptoms compared to subjects with normal glucose tolerance. This association is especially strong among subjects with CVD and those born with a low birth weight. Treating depressed diabetic subjects with paroxetine has no long term effect on glucose regulation. Physicians should be aware of depression as an important co-morbidity of type 2 diabetes. Both depression and the cognitive decline often seen among diabetic subjects are increased if the subject is born with a low birth weight. Physicians should recognise low birth weight as an additional risk factor and modifier of diabetic complications.

The Effects of Reduction Mammaplasty

Symptomatic hypertrophic breasts cause a health burden with physical and psychosocial morbidity. The value of reduction mammaplasty in the treatment of symptomatic breast hypertrophy has been consistently reported by patients and has been well recognised by plastic surgeons for a long time. However, the scientific evidence of the effects of reduction mammaplasty has been weak or lacking. During the design of this study most of the previous studies were retrospective and the few prospective studies had methodological limitations. Therefore, an obvious need for prospective randomised studies was present. Nevertheless, practical and ethical considerations seemed to make this study design impossible, because the waiting time for the operation was several years. The legislation and subsequent introduction of the uniform criteria for access to non-emergency treatment in Finland removed these obstacles, as all patients received their treatment within a reasonable time. As a result, a randomised controlled trial with a six-month follow-up time was designed and conducted. In addition, a follow-up study with two to five years follow-up was also carried out later. The effects of reduction mammaplasty on the patients breast-related symptoms, psychological symptoms, pain and quality of life was assessed. In addition, factors affecting the outcome were investigated. This study was carried out in the Hospital District of Helsinki and Uusimaa, Finland. Eighty-two out of the approximately 300 patients on the waiting list in 2004 agreed to participate in the study. Patients were randomised either to be operated (40 patients) on or to be followed up (42 patients). The follow-up time for both groups was six months. The patients were operated on by plastic surgeons or trainees at the Department of Plastic Surgery at Helsinki University Central Hospital or at the Department of Surgery at Hyvinkää Hospital. The patients completed five questionnaires: the SF-36 and the 15D quality of life questionnaires, the Finnish Breast-Associated Symptoms questionnaire (FBAS), a mood questionnaire (Raitasalo s modification of the short form of the Beck Depression Inventory, RBDI), and a pain questionnaire (The Finnish Pain Questionnaire, FPQ). Sixty-two out of the original 82 patients agreed to participate in the prospective follow-up study. In this study, patients completed the 15D quality of life questionnaire, the Finnish Breast-Associated Symptoms questionnaire, and the RBDI mood questionnaire. After six months follow-up, patients who had undergone reduction mammaplasty had a significantly better quality of life, fewer breast-associated symptoms and less pain, and they were less depressed or anxious when compared to patients who had not undergone surgery. The change in quality of life was more than two times the minimal clinically important difference. The patients preoperative quality of life was significantly inferior when compared to the age-standardised general population. This health burden was removed with reduction mammaplasty. The health loss related to symptomatic breast hypertrophy was comparable to that of patients with major joint arthrosis. In terms of change in quality of life, the intervention effect of reduction mammaplasty was comparable to that of hip joint replacement and more pronounced than that of knee joint replacement surgery. The outcome of reduction mammaplasty was affected more by preoperative psychosocial factors than by changes in breast dimensions. The effects of reduction mammaplasty remained stable at two to five years follow-up. In terms of quality of life, symptomatic breast hypertrophy causes a considerable health loss comparable to that of major joint arthrosis. Patients who undergo surgery have fewer breast-associated symptoms and less pain, and they are less depressed or anxious and have an improved quality of life. The intervention effect is comparable to that of major joint replacement surgery, and it remains stable at two to five years follow-up. The outcome of reduction mammaplasty is affected by preoperative psychosocial factors.

Three Dimensional Line-Clipping by Systematic Enumeration

Three dimensional clipping is a critical component of the 3D graphics pipeline. A new 3D clipping algorithm is presented in this paper. An efficient 2D clipping routine reported earlier has been used as a submodule. This algorithm uses a new classification scheme for lines of all possible orientations with respect to a rectangular parallelopiped view volume. The performance of this algorithm has been evaluated using exact arithmetic operation counts. It is shown that our algorithm requires less arithmetic operations than the Cyrus-Beck 3D clipping algorithm in all cases. It is also shown that for lines that intersect the clipping volume, our algorithm performs better than the Liang-Barsky 3D clipping algorithm.

Non-conservatively loaded stochastic columns

A new finite element method is developed to analyse non-conservative structures with more than one parameter behaving in a stochastic manner. As a generalization, this paper treats the subsequent non-self-adjoint random eigenvalue problem that arises when the material property values of the non-conservative structural system have stochastic fluctuations resulting from manufacturing and measurement errors. The free vibration problems of stochastic Beck's column and stochastic Leipholz column whose Young's modulus and mass density are distributed stochastically are considered. The stochastic finite element method that is developed, is implemented to arrive at a random non-self-adjoint algebraic eigenvalue problem. The stochastic characteristics of eigensolutions are derived in terms of the stochastic material property variations. Numerical examples are given. It is demonstrated that, through this formulation, the finite element discretization need not be dependent on the characteristics of stochastic processes of the fluctuations in material property value.

Stability analysis of stochastically parametered nonconservative columns

Nonconservatively loaded columns. which have stochastically distributed material property values and stochastic loadings in space are considered. Young's modulus and mass density are treated to constitute random fields. The support stiffness coefficient and tip follower load are considered to be random variables. The fluctuations of external and distributed loadings are considered to constitute a random field. The variational formulation is adopted to get the differential equation and boundary conditions. The non self-adjoint operators are used at the boundary of the regularity domain. The statistics of vibration frequencies and modes are obtained using the standard perturbation method, by treating the fluctuations to be stochastic perturbations. Linear dependence of vibration and stability parameters over property value fluctuations and loading fluctuations are assumed. Bounds for the statistics of vibration frequencies are obtained. The critical load is first evaluated for the averaged problem and the corresponding eigenvalue statistics are sought. Then, the frequency equation is employed to transform the eigenvalue statistics to critical load statistics. Specialization of the general procedure to Beck, Leipholz and Pfluger columns is carried out. For Pfluger column, nonlinear transformations are avoided by directly expressing the critical load statistics in terms of input variable statistics.

Markov chain splitting methods in structural reliability integral estimation

Monte Carlo simulation methods involving splitting of Markov chains have been used in evaluation of multi-fold integrals in different application areas. We examine in this paper the performance of these methods in the context of evaluation of reliability integrals from the point of view of characterizing the sampling fluctuations. The methods discussed include the Au-Beck subset simulation, Holmes-Diaconis-Ross method, and generalized splitting algorithm. A few improvisations based on first order reliability method are suggested to select algorithmic parameters of the latter two methods. The bias and sampling variance of the alternative estimators are discussed. Also, an approximation to the sampling distribution of some of these estimators is obtained. Illustrative examples involving component and series system reliability analyses are presented with a view to bring out the relative merits of alternative methods. (C) 2015 Elsevier Ltd. All rights reserved.

Inventario agroecológico de las especies de Gallina ciega (Phyllophaga spp) en la Región I de Nicaragua y validación de trampas artesanales de luz para el control de adultos en dos localidades del municipio de Estelí, Nicaragua

De mayo a octubre de 1996 se hizo un inventario agroecológico de las especies de gallina ciega (Phyllophaga spp.) en la región T de Nicaragua con el objetivo de determinar la relación entre la diversidad de especies de gallina ciega con precipitación, tamaño y años de uso de la parcela y historial de daño(%) y validación de trampas luz artesanal para control de adultos de gallina ciega en Miraflor y Almaciguera, con el fin de confirmar su efectividad. Se muestrearon 61 localidades en 18 municipios, agrupados por rangos de precipitación en cuatro estratos. La unidad muestra! fué el número de insectos adultos de gallina ciega recolectados por los mismos agricultores en cada finca. Para la identificación se utilizaron las claves desarrolladas por King (1984); Morón (198S); Woodruffy Beck (1989) y Coto (1990). Se realizó un diagoóstico sobre conocimiento de la plaga y el manejo al cultivo por medio de encuestas. Se hizo análisis de correlación simple. La mayor parte de la encuesta fue analizada en términos de porcentajes. Se utilizó la metodología de captura y recaptura de insectos marcados con esmalte para uñas y escarchas de colores diferentes. Los insectos fueron hllerados desde S hasta 21m de distancia de la trampa marcándose grupos de cinco hasta SO insectos. Se consideró un factor correctivo de comparación entre distancias y analisis de frecuencia de recaptura con observaciones cada 15 minutos. Se realizó muestreo de larvas posterior a los ensayos de liberación. La población de gallina ciega en la región T es diviersa. Se reportan 17 especies de los cuales sólo 9 se identificaron: Phyllophaga (Chlaenobia) aequata (Bates), 1888; P. (Phytalus) cometes Bates, 1888; P. (Rorulenta) elenon.' Saylor, 1938; P. (P) lenis Horn, 1887; P.(P) menetriesi Blanchard, 1850; P. (P) obsoleta (Biancbard), 1850; P. (Chlaenobia) tumulosa (Bates), 1888; P. (Rorulenta) vicina Moser, 1918 y P. yucateca (Bates), 1889. Las especies no identificadas fueron distinguidas por números. Las especies 1, 3, 4, 5, 6, 7, 8 y 9 no se identificaron. P. Lenis, P. yucateca, P, vicina, P.elenon.f, P. menetriesi y P. obsoleta son las especies que, en este orden, sobresalen numéricamente. Las cantidades de especímenes por especies de gallina ciega no presentan relación con rangos de precipitación, historial de daño (%), tamaño y años de uso de la aparcela, ni entre ellas mismas. El 60"/o de los agricultores no conoce al adulto de gallina ciega y el 80% no logra diferenciar claramente los sintomas en una planta dañada. No se registraron recapturas de insectos adultos de gallina ciega en las trampas. El análisis cuantitativo no se realizó. La mayor parte de los insectos liberados establecieron vuelo. Muestreos de larvas de gallina ciega indican que sólo en Miraflor habían cantidades de adultos justificables a los ensayos. El promedio de plantas dañadas por gallina ciega según los agricultores es de 15%. Se recomienda impulsar estudios básicos sobre la diversidad de especies de gallina ciega en el país y difundir el conocimiento sobre la biología y manejo de gallina ciega entre los pequeños agricultores. Futuros ensayos con trampas luz deben considerar el aumento de la calidad y la consistencia de la fuente luminosa y establecerlas cerca de las plantas hospederas de adultos.

Effects and impacts of physical stress on entrained organisms.

Environmental studies of power plants have recently shifted their emphasis from examination of the effects of heated discharges to studies of the impacts of entire cooling systems. One of the major impacts arises when planktonic organisms are carried into and through a plant with the cooling water. Because of their relatively immobile, free-floating character, planktonic organisms are highly vulnerable to being "entrained" or passively drawn into the cooling water condenser systems of power plants. More than 70% of estuarine animals have planktonic eggs and larvae. The environmental impact of entrainment is related to the composition and abundance of affected organisms, the numbers of organisms in the adjacent waters, survival rates during entrainment as related to natural survival, the ecological roles of entrained organisms, and their reproductive strategies.

On Selecting the excess temperature to minimize the entrainment mortality rate

In selecting an excess temperature at which to operate a power plant cooling system it has been customary to consider only thermal stresses and to use the ratio of the number of organisms killed to the number of organisms entrained. This frequently leads to the selection of a low excess temperature, AT, which, in turn, requires a large volume flow of cooling water. When mortalities due to physical and chemical stresses are included and the total number of entrained organisms killed is taken as the measure of the environmental damage, it becomes evident that the choice of a low excess temperature is seldom, if ever, best.

Psicoterapia grupal realizada por enfermería para pacientes con trastorno depresivo en atención primaria

La depresión es un trastorno mental habitual, siendo uno de los trastornos psiquiátricos más prevalentes, ya que afecta a 340 millones de personas en el mundo; y es uno de los trastornos que más problemas de discapacidad genera. La prevalencia de la depresión en el ámbito de Atención Primaria (AP) es alta, por lo que es importante hacer un buen abordaje terapéutico desde esta área. El tratamiento habitual para este tipo de pacientes es la farmacoterapia, sin embargo, diversos estudios señalan que junto con la psicoterapia se obtiene mejores resultados. Además, la realización de técnicas psicoterapéuticas por personal de enfermería previamente formado, como es la Enfermera de Salud Mental, ha demostrado ser eficaz, pero a pesar de ello, en los centros de AP no existe la figura de Enfermera de Salud Mental. Objetivo: Evaluar la efectividad de un programa psicoeducativo grupal realizado en un centro de AP por una Enfermera de Salud Mental en el tratamiento de pacientes con sintomatología depresiva, como complemento del tratamiento estándar aplicado por el Médico de AP. Metodología: Ensayo clínico aleatorizado con un grupo control que recibirá el tratamiento estándar, y un grupo experimental que recibirá además la intervención psicoeducativa. La población a estudio serán los pacientes con sintomatología depresiva pertenecientes a los Centros de Salud de Repélega y Castaños de Portugalete y la selección de la muestra se realizará con un muestreo no probabilístico consecutivo con un periodo de reclutamiento. Se compararán los resultados en cada grupo, tras la recogida de datos mediante el cuestionario de Salud SF-36 y el Inventario de depresión de Beck.

The floods of the Lake District - Part I

This report summarises the annual rainfall of the River Derwent catchment area and examines the floods of 1931 and 1932. The author uses data from the Meteorological Office to examine if the floods were extraordinary and takes into account local lakes in reducing the magnitude of the flood. Areas that are presented in more detail are Bassenthwaite Lake, Thirlmere, Cockermouth, Keswick, Newlands and Coledale Beck. (PDF contains 38 pages)