Increased use of emergency services by older people after health screening

Background: evaluation of the 'Keep Well At Home' (KWAH) Project in West London indicated that a programme of screening persons aged 75 and over had not reduced rates of emergency attendances and admissions to hospital. However, coverage of the target population was incomplete. The present analysis addresses 'efficacy'-whether individuals who completed the screening protocol as intended did subsequently use Accident & Emergency (A&E) services less often. Methods: the target population was divided into five groups, depending on whether an individual had completed none, one or both phases of screening, and whether deviations from the protocol related to incomplete coverage or refusal to participate further. We ascertained use of emergency services before screening and for up to 3 years afterwards by linkage of records from KWAH to those of local A&E Departments. Patterns of emergency care were examined as crude races and, via proportional hazards models, after adjustment for available confounders. Results: there was an increase of 51% (95% CI 22-86%) in the crude rate of emergency admissions in the year after first-phase screening compared with the 12 months before assessment. This was most obvious in individuals deemed at high risk who also underwent the second-phase assessment (adjusted hazard ratio relative to individuals not 'at risk'= 2.33; 95% CI 1.59-3.42). Conclusions: the available data do not allow us to distinguish between several possible explanations for the paradoxical increase in use of emergency services. However, what seem to be sensible policies do not necessarily have their intended effects when implemented in practice.

Perinatal outcomes with laser surgery for twin-twin transfusion syndrome

The aim of this tertiary hospital-based cohort study was to determine and compare perinatal outcome and neonatal morbidities of pregnancies with twin-twin transfusion syndrome (TTTS) before and after the introduction of a treatment program with laser ablation of placental communicating vessels. Twenty-seven pregnancies with Stage II-IV TTTS treated with amnioreduction were identified (amnioreduction group). The data were compared with that obtained from the first 31 pregnancies with Stage II-IV TTTS managed with laser ablation of placental communicating vessels (laser group). Comparisons were made for perinatal survival and neonatal morbidities including abnormalities on brain imaging. The median gestation at therapy was similar between the two groups (20 vs. 21 weeks, p = .24), while the median gestation at delivery was significantly greater in the laser treated group (34 vs. 28 weeks, p = .002). The perinatal survival rate was higher in the laser group (77.4% vs. 59.3%, p = .03). Neonatal morbidities including acute respiratory distress, chronic lung disease, requirement for ventilatory assistance, patent ductus arteriosus, hypotension, and oliguric renal failure had a lower incidence in the laser group. On brain imaging, ischemic brain injury was seen in 12% of the amnioreduction group and none of the laser group of infants (p = .01). In conclusion, these findings indicate that perinatal outcomes are improved with less neonatal morbidity for monochorionic pregnancies with severe TTTS treated by laser ablation of communicating placental vessels when compared to treatment by amnioreduction.

QUALIDADE DE VIDA, PERCEPÇÃO DE SUPORTE SOCIAL E CONSUMO DE MEDICAMENTOS EM IDOSAS PARTICIPANTES DA UNIVERSIDADE PARA A TERCEIRA IDADE

A presente dissertação de mestrado abordou a qualidade de vida, a percepção de suporte social e o consumo de medicamentos em idosas participantes de um programa da Universidade para a Terceira Idade, no município de São Caetano do Sul - São Paulo - Brasil. O estudo objetivou descrever uma possível relação entre o perfil sociodemografico da amostra, a percepção subjetiva da qualidade de vida, a percepção subjetiva de suporte social, e o consumo de medicamentos, submetendo a testes estatísticos, um conjunto de possíveis relações entre as características sociodemográficas, percepção de qualidade de vida, percepção de suporte social e consumo de medicamentos. Utilizou-se o método descritivo exploratório, de corte transversal, e de caráter quantitativo. Os dados foram coletados entre os meses de agosto a outubro de 2014, através de uma amostra de conveniência, formada por 150 mulheres, com idade média de 66,13 anos. Foram utilizados instrumentos autoaplicáveis: WHOQOL-OLD e WHOQOL-BREF (Word Health Organization Quality of Life Instrument); Escala de Percepção de Suporte Social (EPSS); um questionário sobre a utilização de medicamentos de uso geral, e um questionário contendo os dados sociodemográficos. Dos resultados, 59,3% da amostra concluiu o ensino fundamental, 49,3% é casada, 79,3% não exerce atividade remunerada, e 78,7% não exerce atividades voluntárias. Apresentou boa percepção de Qualidade de Vida Global (82,90%), sendo o domínio com menor valor médio o Funcionamento do Sensório (12,56%), e maior escore médio no domínio Autonomia (14,66%). Sente segurança ao recorrer à rede de suporte social prático (53,08%), e insegurança ao recorrer à sua rede de apoio social emocional (28,88%). A prevalência do uso de medicamentos foi de 3,6%, todos prescritos, e os princípios ativos mais utilizados pertenciam aos tratamentos da hipertensão e sistema cardiovascular. Não foram evidenciadas correlações significativas relevantes entre as variáveis do estudo, do ponto de vista estatístico. Apesar de residirem em um município com elevado Índice de Desenvolvimento Humano, conclui-se que o aumento das possíveis incapacidades físicas das idosas apontam dificuldades de acesso aos recursos do ambiente, onde a amostra estava inserida. Sugere-se a criação de pesquisas e intervenções com idosas, incluindo nos programas de educação continuada, espaços para debate com o tema da finitude e o envelhecimento, bem como a realização de novos estudos de natureza qualitativa, para aprofundar o conhecimento sobre a qualidade de vida, a percepção do suporte social e o consumo de medicamentos nesta população, como também a inclusão de outros grupos sociodemográficos de idosas, em estudos longitudinais.

Metformin and the gastrointestinal tract

Metformin is an effective agent with a good safety profile that is widely used as a first-line treatment for type 2 diabetes, yet its mechanisms of action and variability in terms of efficacy and side effects remain poorly understood. Although the liver is recognised as a major site of metformin pharmacodynamics, recent evidence also implicates the gut as an important site of action. Metformin has a number of actions within the gut. It increases intestinal glucose uptake and lactate production, increases GLP-1 concentrations and the bile acid pool within the intestine, and alters the microbiome. A novel delayed-release preparation of metformin has recently been shown to improve glycaemic control to a similar extent to immediate-release metformin, but with less systemic exposure. We believe that metformin response and tolerance is intrinsically linked with the gut. This review examines the passage of metformin through the gut, and how this can affect the efficacy of metformin treatment in the individual, and contribute to the side effects associated with metformin intolerance.

'Compliance or contradiction'? Teaching 'History' in the 'New' Ukraine. A view from Ukraine's Eastern borderlands

Whilst much academic rigour has been devoted to analysing the ‘contents’ of historical textbooks in Ukraine, this article examines the teacher's role in the ‘transfer’ of the state's message to schoolchildren. This article demonstrates that in Ukraine's eastern borderlands teachers are highly active in negotiating the new historical narrative. Teachers are found to subtly change the accent or focus away from the ‘nationalist’ stance towards Russia, as found in the school history textbooks, to a more tolerant stance which aims to promote rather than negate Ukraine's historical interactions with Russia. Thus, this simultaneously reinforces a particular ‘regional’ understanding of historical events.

Hamid Tafazoli und Richard T. Gray (Hg.): Außenraum – Mitraum – Innenraum. Heterotopien in Kultur und Gesellschaft

Review of Hamid Tafazoli und Richard T. Gray (Hg.): Außenraum – Mitraum – Innenraum. Heterotopien in Kultur und Gesellschaft

Institutional multilingualism in NGOs:Amnesty International's strategic understanding of multilingualism

Institutional multilingualism is most often associated with large intergovernmental institutions such as the European Union and the United Nations. Institutional multilingualism in non-governmental organisations (NGOs), however, has remained invisible to a large extent. Like international governmental organisations (IGOs), NGOs operate across linguistic borders. This raises the question whether NGOs use language and translation in the same way as IGOs. The present article takes Amnesty International as a case study, and explores what institutional multilingualism means for this organisation, how it is reflected in its language policy, and how it is put into practice. By gaining insight into the particular case of Amnesty International, this article aims to make a contribution to institutional translation studies.

A monetáris politika hatása a magyar gazdaságra. Elemzés strukturális, dinamikus faktormodellel

A monetáris politika magyar gazdaságra gyakorolt hatásait vizsgáló strukturális, dinamikus faktormodell számos makrogazdasági és ágazati idősor együttes tanulmányozását teszi lehetővé, így az eddigi idősoros elemzéseknél gazdagabb képet nyújt a monetáris transzmisszióról. A modell kvalitatív következtetései általában összhangban állnak a korábbi, VAR modelleken alapuló elemzésekkel, ám erősebbnek tűnnek a monetáris politika munkapiacra, illetve lakossági fogyasztásra gyakorolt hatásai. Az általunk vizsgált modell szerint a makrogazdasági folyamatokat 2000 óta elsősorban a kereslet ingadozásai határozták meg. A monetáris politika hosszabb távon szisztematikusan reagál a gazdaságot ért sokkokra, a meglepetésszerű monetáris politikai lépések szerepe mérsékelt.

Az Európai Unió kohéziós politikájának integrációs jelentősége és szabályozásának jövője

Az Európai Unió regionális fejlesztési - más néven kohéziós - politikájának eredményes működése az integrációs folyamat egésze szempontjából stratégiai fontosságú kérdés. A gazdasági, társadalmi és területi kohézió erősítése, a tagországok és régiók közötti fejlettségi különbségek csökkentése nemcsak az integráció egyik meghatározó célja, de a tagországokban élő emberek jogos elvárása is. A kohéziós transzfereket olyan tényezők támogatására kell fordítani, amelyek a leginkább hozzájárulhatnak az adott régió fejlődési kilátásainak és versenyképességének javulásához. A regionális fejlődéssel foglalkozó elméletek egymásnak sokszor ellentmondó következtetésekre jutnak a fejlettségi különbségek hosszú távú alakulásával összefüggésben. A sikeres fejlesztéspolitika kapcsán az endogén tényezők, az innovációs képesség és a megfelelően működő intézményi környezet meghatározó szerepe egyértelműen előtérbe került. A szerző a kapcsolódó elméleti megfontolások vizsgálata után az EU-ban kialakított regionális politika hatásait és következményeit elemzi, és mindezek tükrében megvizsgálja a 2014-2020 közötti időszakra javasolt szabályozási keretek fő elemeit.

Data compilation on the biological response to ocean acidification: environmental and experimental context of data sets and related literature

The exponential growth of studies on the biological response to ocean acidification over the last few decades has generated a large amount of data. To facilitate data comparison, a data compilation hosted at the data publisher PANGAEA was initiated in 2008 and is updated on a regular basis (doi:10.1594/PANGAEA.149999). By January 2015, a total of 581 data sets (over 4 000 000 data points) from 539 papers had been archived. Here we present the developments of this data compilation five years since its first description by Nisumaa et al. (2010). Most of study sites from which data archived are still in the Northern Hemisphere and the number of archived data from studies from the Southern Hemisphere and polar oceans are still relatively low. Data from 60 studies that investigated the response of a mix of organisms or natural communities were all added after 2010, indicating a welcomed shift from the study of individual organisms to communities and ecosystems. The initial imbalance of considerably more data archived on calcification and primary production than on other processes has improved. There is also a clear tendency towards more data archived from multifactorial studies after 2010. For easier and more effective access to ocean acidification data, the ocean acidification community is strongly encouraged to contribute to the data archiving effort, and help develop standard vocabularies describing the variables and define best practices for archiving ocean acidification data.

Utilização de mapas conceituais como ferramenta de ensino para o desenvolvimento do raciocínio clínico no curso de medicina da Universidade Federal do Rio Grande do Norte

BACKGROUND: Among the wide range of skills displayed by a medical doctor is undoubtedly the need to use cohesive and well grounded clinical reasoning in order for medical care to be indeed effective. It is in this respect that conceptual maps emerge; these are a methodological innovation that allows a comprehensive, panoramic and associative outlook of theoretical content, making it more practical and applicable to the reality of clinical observation. Promoting learning, learning resources and a feedback system between professor and students, as well as assessing and monitoring the performance of students during their academic training, are the main features of this tool. OBJETIVE: Assess the use of conceptual maps as a teaching-learning tool in the training of undergraduate medical students at Universidade Federal do Rio Grande do Norte (UFRN). METHODOLOGY: Interventional, randomized, cross-sectional study conducted with students from the 3rd and 5th periods of the medical course at UFRN, during the second semester of 2014, totaling 86 participants, divided into two groups: GI (intervention – clinical case resolution with a conceptual map) and GII (control – clinical case resolution without a conceptual map) in each period. RESULTS: The use of conceptual maps to teach liver failure syndrome resulted in a statistically significant cognitive gain for G1 students from the 5th period (GI: 6.8±1.6 and 8.0±1.5, p = 0.024; GII: 7.2±2.1 and 8.0±1.7, p = 0.125, pre and post-intermediate means, respectively), a result not observed in the period 3rd (GI: 7.7±1.3 and 8.0±1.4, p = 0.501; GII: 6.7±1.8 and 7.8±1.8; p=0.068, pre and post-intermediate means, respectively). Students in the 3 rd period gave better responses to the first clinical case, with a larger number of suitable concepts and crosslinks, when they used conceptual maps (GI: 91.3±13.15 and GII: 64.84±22.84, p=0,002). Students in the 5th period exhibited better clinical reasoning and more complete responses using the tool (p=0,01). Most of the students were not aware of the tool (53.8% from the 3rd period and 65.3% from the 5th period). Among those who knew about conceptual maps, most (59.3%) had only used them during high school, 14.8% had never used them and only seven students (25.9%) used them during the medical course. Analysis of open responses, obtained in process assessment showed clear satisfaction and enthusiasm with learning about the new tool, and frequent suggestions to use it at other moments in the course. Assessment of learning profile, using the VARK questionnaire, showed that most students from both periods exhibited a multimodal style. CONCLUSION: Despite their scant knowledge regarding the tool, good acceptability and understanding was observed in the study participants. The conceptual maps allowed cognitive gains, better responses and clinical reasoning in teaching liver failure syndrome to 5th period students.

Redefining Access: Embracing multimodality, memorability and shared experience in Museums

Disability access to museums, both physical and intellectual, is generally considered a minority issue. Whilst museums and cultural institutions acknowledge the moral and legal importance of equal access to their establishments, there is generally a conflict between the perceived number of potential visitors that will benefit and the cost implications. Set in the context of research on multisensory learning, this article discusses why disability access is, in fact, a majority issue. It discusses two case studies where an “access for all” museological approach has been applied to access to the collections, with differing success. The article considers how an “access for all” approach would potentially enhance learning, long-term memorability and the ‘cultural value’ of a museum experience for all visitors.

Crisis communication in politics: forgiveness as image restoration tool

Crisis communication is a widely treated field. There are lot of works and guides which provide helpful information in order to face crisis situations successfully (Alcat, 2005, Benoit, 1997) and articles about case studies (Nespereira, 2014, Blaney y Benoit 2001). Nonetheless, most of times, these guides are focused on business or corporations (Abeler, 2010) and there are not such information about crisis communications in politics (Gaspar e Ibeas, 2015). The field is smaller if we speak about forgiveness as restoration image tool in politics (Harris 2006). Despite all, we live in “forgiveness era” as Krauze said (1998) where people demand to politicians to apologize when they have mistakes (Harris et al. 2006:716). So, we will try to make an approach to forgiveness in politics as a image restoration tool and analyze its capabilities in order to face crisis management.

Anáfora con artículo definido y construcción del discurso: comparación entre español y chino

En el marco de la escala de accesibilidad (Givenness Hierarchy), este trabajo presenta el mecanismo en chino que lleva a cabo la misma función anafórica que desempeña el artículo definido en español y analiza desde una perspectiva contrastiva las aportaciones que contribuye la anáfora nominal a la construcción del discurso. Se llega a la conclusión de que a pesar de algunas diferencias en los comportamientos concretos, en ambas lenguas la anáfora favorece a la organización del discurso manteniendo la coherencia discursiva y diversificando las expresiones.