What factors influence concordance with medications? Findings from the UK Asian Diabetes study

Aims: To investigate concordance with medication, as assessed at baseline and at 1- and 2-year follow-up, and to examine factors associated with non-concordance in a UK-resident South-Asian population. Methods: Data from the UK Asian Diabetes Study were analysed. Concordance with medications was assessed and recorded at three time points during the study. Multiple logistic regression was used to investigate the factors associated with non-concordance; the associations of baseline factors with year 1 concordance and baseline plus year 1 factors with year 2 concordance. Results: Data for 403 patients from seven practices participating in the UK Asian Diabetes Study were analysed. The numbers of patients who were non-concordant were: 63 (16%) at baseline 101 (25%) at year 1; and 122 (30%) at year 2. The baseline-measured variables that were significantly associated with year 1 non-concordance included diabetes duration, history of cardiovascular disease, components of the EuroQol quality of life questionnaire, the EQ-5D score, and number of medications prescribed. In multivariable analyses, the most important determinant of year 1 non-concordance was baseline non-concordance: odds ratio 13.6 (95% confidence limits 4.7, 39.9). Number of medications prescribed for blood pressure control was also significant: odds ratio 1.8 (95% confidence limits 1.4, 2.4). Similar results were observed for year 2 non-concordance. Conclusions: Non-concordance with medications was common and more likely in people prescribed more medications. The current target-driven management of risk factor levels may lead to increasing numbers and doses of medications. Considering the high cost of medications and the implications of poor health behaviours on morbidity and mortality, further investigation of prescribing behaviours and the factors affecting patient concordance are required.

How doctors' communication style and race concordance influence African-Caribbean patients when disclosing depression

Objective: To determine the impact of doctors' communication style and doctor-patient race concordance on UK African-Caribbeans' comfort in disclosing depression. Methods: 160 African-Caribbean and 160 white British subjects, stratified by gender and history of depression, participated in simulated depression consultations with video-recorded doctors. Doctors were stratified by black or white race, gender and a high (HPC) or low patient-centred (LPC) communication style, giving a full 2. ×. 2. ×. 2 factorial design. Afterwards, participants rated aspects of doctors' communication style, their comfort in disclosing depression and treatment preferences. Results: Race concordance had no impact on African-Caribbeans' comfort in disclosing depression. However a HPC versus LPC communication style made them significantly more positive about their interactions with doctors (p = 0.000), their overall comfort (p = 0.003), their comfort in disclosing their emotional state (p = 0.001), and about considering talking therapy (p = 0.01); but less positive about considering antidepressant medication (p =0.01). Conclusion: Doctors' communication style was shown to be more important than patient race or race concordance in influencing African Caribbeans' depression consultation experiences. Changing doctors' communication style may help reduce disparities in depression care. Practice Implications: Practitioners should cultivate a HPC style to make African-Caribbeans more comfortable when disclosing depression, so that it is less likely to be missed.

Governing through parents: a genealogical enquiry of education policy and the construction of neoliberal subjectivities in England

In this paper we explore the various spaces and sites through which the figure of the parent is summoned and activated to inhabit and perform market norms and practices in the field of education in England. Since the late 1970s successive governments have called on parents to enact certain duties and obligations in relation to the state. These duties include adopting and internalizing responsibility for all kinds of risks, liabilities and inequities formerly managed by the Keynesian welfare state. Rather than characterize this situation in terms of the ‘hollowing of the state’, we argue that the role of the state includes enabling the functioning of the parent as a neoliberal subject so that they may successfully harness the power of the market to their own advantage and (hopefully) minimize the kinds of risk and inequity generated through a market-based, deregulated education system. In this paper we examine how parents in England are differently, yet similarly, compelled to embody certain market norms and practices as they navigate the field of education. Adopting genealogical enquiry and policy discourse analysis as our methodology, we explore how parents across three policy sites or spaces are constructed as objects and purveyors of utility and ancillaries to marketisation. This includes a focus on how parents are summoned as 1) consumers or choosers of education services; 2) governors and overseers of schools; and 3) producers and founders of schools.

Le degré de concordance dans l’interprétation du rôle du directeur d’école, entre les directeurs d’école et les directeurs généraux, par rapport au Comité de Gestion, au Conseil de Participation Scolaire, au Comité d'école et au Conseil d'Orientation, selon la Loi 71.

[…] À la fin de notre essai, nous aurons: 1. Identifié les articles de la Loi 71 qui touchent aux droits, aux pouvoirs et aux fonctions du directeur d'école face au Comité de gestion, au Conseil de participation scolaire, au Comité d'École et au Conseil d'orientation scolaire selon la Loi 71. 2. Traduit les obligations et les fonctions du directeur d'école, en termes de tâches à accomplir en relation avec le Comité de gestion, le Conseil de participation scolaire, le Comité d'École et le Conseil d'orientation. 3. Vérifié auprès des directeurs d'école et des directeurs généraux de différentes Commissions Scolaires l'interprétation du rôle du directeur d'école selon la Loi 71, en relation avec le Comité de gestion, le Conseil de participation scolaire, le Comité d'École et le Conseil d'orientation. 4. Comparé l'analyse des résultats entre les directeurs d'école, entre les directeurs généraux, et entre les directeurs d'école et les directeurs généraux, de la perception du rôle du directeur d'école selon la Loi 71, face au Comité de gestion, au Conseil de participation scolaire, au Comité d'École et au Conseil d'orientation. 5. Identifié les principaux points discordants entre les directeurs d'école, entre les directeurs généraux, et entre les directeurs généraux et les directeurs d'école afin de proposer des moyens pour combler l'écart qui existe ou pourrait exister face à la Loi 71, en relation avec le Comité de gestion, le Conseil de participation scolaire, le Comité d'École et le Conseil d'orientation scolaire.

Performance des MRC et des municipalités locales de la CMM à protéger leurs milieux naturels en concordance avec le Plan métropolitain d'aménagement et de développement

Au début des années 1990, une prise de conscience de la valeur des milieux naturels et de leur biodiversité s’observa à différentes échelles. La Convention sur la diversité biologique, publiée en 1992 lors de la Conférence des Nations Unies sur l’environnement et le développement, fut un élément déclencheur en matière de protection des milieux naturels. En 2010, la Convention adopta un plan stratégique établissant entre autres l’objectif de protéger 17 % des milieux terrestres pour 2020. C’est de cet objectif, repris par le gouvernement du Québec, que la Communauté métropolitaine de Montréal s’inspira afin d’élaborer son propre objectif de protéger le même pourcentage de son territoire. L’atteinte de celui-ci est tributaire d’un processus de concordance établi par la Loi sur l’aménagement et l’urbanisme entre le Plan métropolitain d’aménagement et de développement, les schémas d’aménagement et de développement des municipalités régionales de comté et les outils d’urbanismes des municipalités locales. L’objectif principal de cet essai est d’analyser, à l’échelle de la Communauté métropolitaine de Montréal, la performance des municipalités régionales de comté et des municipalités locales à traduire, dans leur outil d’aménagement et d’urbanisme, les orientations, les objectifs et les critères définis au Plan métropolitain d’aménagement et de développement en matière de protection des milieux naturels. Cette performance est mesurée à l’aide d’un indicateur élaboré pour cet essai. Pour y parvenir, un portrait des milieux naturels de la Communauté métropolitaine de Montréal est dressé. L’essai s’appuie sur celui-ci afin de sélectionner deux municipalités régionales de comté et cinq municipalités locales sur lesquelles utiliser l’indicateur de performance. L’analyse des résultats révèle que les municipalités régionales de comté performent mieux que les municipalités locales. De plus, c’est par rapport à la réalisation d’un plan de conservation des milieux humides que ces dernières performent le moins bien. En s’appuyant sur ces analyses, l’essai recommande notamment que l’élaboration du plan de conservation des milieux humides soit réalisée à l’échelle des municipalités régionales de comté plutôt qu’à celle des municipalités locales. Ce travail pourrait servir au gouvernement québécois afin d’améliorer la protection des milieux naturels, non seulement à l’échelle du Grand Montréal, mais également à celle de la province.

High Diagnostic Accuracy And Reproducibility Of Fine-needle Aspiration Cytology For Diagnosing Salivary Gland Tumors: Cytohistologic Correlation In 182 Cases.

The purpose of this study was to assess the efficacy and reproducibility of the cytologic diagnosis of salivary gland tumors (SGTs) using fine-needle aspiration cytology (FNAC). The study aimed to determine diagnostic accuracy, sensitivity, and specificity and to evaluate the extent of interobserver agreement. We retrospectively evaluated SGTs from the files of the Division of Pathology at the Clinics Hospital of São Paulo and Piracicaba Dental School between 2000 and 2006. We performed cytohistologic correlation in 182 SGTs. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 94%, 100%, 100%, 100%, and 99%, respectively. The interobserver cytologic reproducibility showed significant statistical concordance (P < .0001). FNAC is an effective tool for performing a reliable preoperative diagnosis in SGTs and shows high diagnostic accuracy and consistent interobserver reproducibility. Further FNAC studies analyzing large samples of malignant SGTs and reactive salivary lesions are needed to confirm their accuracy.

Encephalization And Diversification Of The Cranial Base In Platyrrhine Primates.

The cranial base, composed of the midline and lateral basicranium, is a structurally important region of the skull associated with several key traits, which has been extensively studied in anthropology and primatology. In particular, most studies have focused on the association between midline cranial base flexion and relative brain size, or encephalization. However, variation in lateral basicranial morphology has been studied less thoroughly. Platyrrhines are a group of primates that experienced a major evolutionary radiation accompanied by extensive morphological diversification in Central and South America over a large temporal scale. Previous studies have also suggested that they underwent several evolutionarily independent processes of encephalization. Given these characteristics, platyrrhines present an excellent opportunity to study, on a large phylogenetic scale, the morphological correlates of primate diversification in brain size. In this study we explore the pattern of variation in basicranial morphology and its relationship with phylogenetic branching and with encephalization in platyrrhines. We quantify variation in the 3D shape of the midline and lateral basicranium and endocranial volumes in a large sample of platyrrhine species, employing high-resolution CT-scans and geometric morphometric techniques. We investigate the relationship between basicranial shape and encephalization using phylogenetic regression methods and calculate a measure of phylogenetic signal in the datasets. The results showed that phylogenetic structure is the most important dimension for understanding platyrrhine cranial base diversification; only Aotus species do not show concordance with our molecular phylogeny. Encephalization was only correlated with midline basicranial flexion, and species that exhibit convergence in their relative brain size do not display convergence in lateral basicranial shape. The evolution of basicranial variation in primates is probably more complex than previously believed, and understanding it will require further studies exploring the complex interactions between encephalization, brain shape, cranial base morphology, and ecological dimensions acting along the species divergence process.

Comparação entre métodos para mensuração da potência aeróbia em atletas tetraplégicos= : Comparison of methods for aerobic power assessment in athletes with tetraplegia

Universidade Estadual de Campinas . Faculdade de Educação Física

Confiabilidade do questionário Lista de Atividades Físicas em crianças

OBJETIVO: Avaliar a confiabilidade do questionário Lista de Atividades Físicas em crianças. MÉTODOS: O estudo é parte da adaptação transcultural do questionário, realizado com 83 escolares de sete a dez anos, matriculados do segundo ao quinto ano do ensino fundamental da cidade de São Paulo, SP, em 2008. O questionário foi respondido pela criança por meio de entrevista individual, apresenta lista com 21 atividades físicas moderadas a vigorosas realizadas no dia anterior, é dividido em períodos (antes, durante e após a escola) e possui seção de avaliação da entrevista. O questionário permite quantificar: tempo em atividades físicas e sedentárias; e custos metabólicos total e ponderado. A confiabilidade foi avaliada comparando-se duas entrevistas realizadas com intervalo médio de três horas. Para a seção C (avaliação da entrevista), compararam-se dados da primeira entrevista e de um avaliador externo. Utilizaram-se a proposta de Bland & Altman e os coeficientes de correlação intraclasse e de correlação de concordância de Lin na avaliação da confiabilidade. RESULTADOS: Os limites inferiores dos coeficientes de correlação intraclasse para os desfechos analisados variaram de 0,84 a 0,96. A precisão e concordância variaram, respectivamente, de 0,83 a 0,97 e de 0,99 a 1. A reta estimada a partir de pares de valores obtidos nas duas aplicações para atividade física indica elevada precisão dos dados. O item da entrevista com pior resultado foi a habilidade em estimar tempo (regular em 27,7% das entrevistas). Os itens da seção C apresentaram coeficientes de correlação intraclasse entre 0,60 e 0,70, exceto o nível de cooperação (0,46). CONCLUSÕES: A Lista de Atividades Físicas apresenta alta confiabilidade para aferir atividade física e sedentária do dia anterior em crianças.

Sub-telomere directed gene expression during initiation of invasive aspergillosis

Aspergillus fumigatus is a common mould whose spores are a component of the normal airborne flora. Immune dysfunction permits developmental growth of inhaled spores in the human lung causing aspergillosis, a significant threat to human health in the form of allergic, and life-threatening invasive infections. The success of A. fumigatus as a pathogen is unique among close phylogenetic relatives and is poorly characterised at the molecular level. Recent genome sequencing of several Aspergillus species provides an exceptional opportunity to analyse fungal virulence attributes within a genomic and evolutionary context. To identify genes preferentially expressed during adaptation to the mammalian host niche, we generated multiple gene expression profiles from minute samplings of A. fumigatus germlings during initiation of murine infection. They reveal a highly co-ordinated A. fumigatus gene expression programme, governing metabolic and physiological adaptation, which allows the organism to prosper within the mammalian niche. As functions of phylogenetic conservation and genetic locus, 28% and 30%, respectively, of the A. fumigatus subtelomeric and lineage-specific gene repertoires are induced relative to laboratory culture, and physically clustered genes including loci directing pseurotin, gliotoxin and siderophore biosyntheses are a prominent feature. Locationally biased A. fumigatus gene expression is not prompted by in vitro iron limitation, acid, alkaline, anaerobic or oxidative stress. However, subtelomeric gene expression is favoured following ex vivo neutrophil exposure and in comparative analyses of richly and poorly nourished laboratory cultured germlings. We found remarkable concordance between the A. fumigatus host-adaptation transcriptome and those resulting from in vitro iron depletion, alkaline shift, nitrogen starvation and loss of the methyltransferase LaeA. This first transcriptional snapshot of a fungal genome during initiation of mammalian infection provides the global perspective required to direct much-needed diagnostic and therapeutic strategies and reveals genome organisation and subtelomeric diversity as potential driving forces in the evolution of pathogenicity in the genus Aspergillus.