Gynaecologists' awareness of bone healthcare in Switzerland

PRINCIPLES To assess gynaecologists' awareness of bone healthcare in women and the prevalence of application of national recommendations on bone healthcare in Switzerland. METHODS During the annual meeting of the Swiss Society of Gynaecology and Obstetrics 2012, the Swiss Association against Osteoporosis (SVGO) performed standardised interviews with conference participants (n = 210). Questions addressed responsibility for bone healthcare, and whether diagnostic procedures, initiation of bone-specific treatment and follow-up were performed in accordance with SVGO recommendations. RESULTS The majority of respondents were aged 30-50 years (60%), female (70%) and working as board-certified gynaecologists (69%). Ninety-three percent of respondents considered care for bone health as part of the gynaecologist's expertise. As diagnostic procedures, 44% recommended performing bone densitometry (DXA) only, 34% ordered additional laboratory testing. Seventy-two percent of respondents initiated a bone-specific treatment. Predictors for not performing diagnostic procedures and not initiating a bone-specific treatment were physician's age below 30, being a trainee gynaecologist, and working at a university clinic. Particularly, young trainee gynaecologists working at a university clinic were especially unlikely to initiate a bone-specific treatment (regression coefficient = -2.68; odds ratio [OR] 0.069, 95% confidence interval [CI] 0.01-0.61; p = 0.16). Follow-ups were performed by 77% of respondents, but were less likely to be by female physicians (OR 0.27, 95% CI 0.09-0.84; p = 0.024). CONCLUSIONS Although the majority of board-certified gynaecologists follow national recommendations on bone healthcare, current medical training in obstetrics and gynaecology does not sufficiently cover the subject of women's health. However, since this is a small study our findings may not reflect the findings in the total population.

Can the green economy enhance sustainable mountain development? The potential role of awareness building

Mountain socio-ecological systems produce valuable but complex ecosystem services resulting from biomes stratified by altitude and gravity. These systems are often managed and shaped by smallholders whose marginalization is exacerbated by uncertainties and a lack of policy attention. Human–environment interfaces in mountains hence require holistic policies. We analyse the potential of the Global Mountain Green Economy Agenda (GMGEA) in building awareness and thus prompting cross-sectoral policy strategies for sustainable mountain development. Considering the critique of the green economy presented at the Rio + 20 conference, we argue that the GMGEA can nevertheless structure knowledge and inform regional institutions about the complexity of mountain socio-ecological systems, a necessary pre-condition to prompt inter-agency collaboration and cross-sectoral policy formulation. After reviewing the content of the GMGEA, we draw on two empirical cases in the Pakistani and Nepali Himalayas. First, we show that lack of awareness has led to a sequence of fragmented interventions with unanticipated, and unwanted, consequences for communities. Second, using a green economy lens, we show how fragmentation could have been avoided and cross-sectoral policies yielded more beneficial results. Project fragmentation reflects disconnected or layered policies by government agencies, which inherently keep specialized agendas and have no incentive to collaborate. Awareness makes agencies more likely to collaborate and adopt cross-sectoral approaches, allowing them to target more beneficiaries, be more visible, and raise more funds. Nevertheless, we also identify four factors that may currently still limit the effect of the GMGEA: high costs of inter-agency collaboration, lack of legitimacy of the green economy, insufficiently-secured smallholder participation, and limited understanding of the mechanisms through which global agendas influence local policy.

Meta-Awareness During Day and Night: The Relationship Between Mindfulness and Lucid Dreaming

The present study explored the relationship between lucidity in dreams (awareness of dreams while dreaming) and mindfulness during wakefulness, also considering meditation as a possible moderating variable. An online survey was completed by 528 respondents, of whom 386 (73.1%) had lucid dream experiences. The reported frequency of lucid dreams was found to be positively related to higher dispositional mindfulness in wakefulness. This relationship was only present in those participants who reported acquaintance with meditation. Regarding the dimensions of mindfulness, lucid dream frequency was more strongly associated with mindful presence rather than acceptance. The findings support the notion of an existing relationship between lucidity in dreams and mindfulness during wakefulness, yet it remains unclear whether the relationship is influenced by actual meditation practice or whether it reflects some natural predispositions. Future studies should examine the role of different meditation practices, investigate personality variables that might influence the relationship, and explore how different facets of mindfulness and lucidity interrelate.

Awareness of Stroke Risk after TIA in Swiss General Practitioners and Hospital Physicians.

BACKGROUND Transient ischemic attacks (TIA) are stroke warning signs and emergency situations, and, if immediately investigated, doctors can intervene to prevent strokes. Nevertheless, many patients delay going to the doctor, and doctors might delay urgently needed investigations and preventative treatments. We set out to determine how much general practitioners (GPs) and hospital physicians (HPs) knew about stroke risk after TIA, and to measure their referral rates. METHODS We used a structured questionnaire to ask GPs and HPs in the catchment area of the University Hospital of Bern to estimate a patient's risk of stroke after TIA. We also assessed their referral behavior. We then statistically analysed their reasons for deciding not to immediately refer patients. RESULTS Of the 1545 physicians, 40% (614) returned the survey. Of these, 75% (457) overestimated stroke risk within 24 hours, and 40% (245) overestimated risk within 3 months after TIA. Only 9% (53) underestimated stroke risk within 24 hours and 26% (158) underestimated risk within 3 months; 78% (473) of physicians overestimated the amount that carotid endarterectomy reduces stroke risk; 93% (543) would rigorously investigate the cause of a TIA, but only 38% (229) would refer TIA patients for urgent investigations "very often". Physicians most commonly gave these reasons for not making emergency referrals: patient's advanced age; patient's preference; patient was multimorbid; and, patient needed long-term care. CONCLUSIONS Although physicians overestimate stroke risk after TIA, their rate of emergency referral is modest, mainly because they tend not to refer multimorbid and elderly patients at the appropriate rate. Since old and frail patients benefit from urgent investigations and treatment after TIA as much as younger patients, future educational campaigns should focus on the importance of emergency evaluations for all TIA patients.

Practice and attitude differences in physician cigarette use: A study of prevalence, physicians' role, and smoking policy awareness in Dubai, UAE

The use of tobacco products ruins the health of millions of people around the world. On average, tobacco users die nearly seven years earlier than non-tobacco users. n1 Cigarette smoking is a particular concern in the developing countries of the Middle East and Gulf Cooperation Council (GCC) region where smoking prevalence is expected to increase. This is due to the tobacco industry's vigorous commercial and marketing activities. n3 Smoking prevalence among physicians is considered to be an effective indicator of a society's readiness to identify the smoking epidemic and its related health diseases. n4 There is a lack of detailed data on the smoking prevalence among healthcare professionals, particularly physicians, in the United Arab Emirates (UAE). This cross sectional study is the first to address smoking practices among physicians working at the Department of Health and Medical Services (DOHMS); in Dubai, UAE. ^ This study describes the cigarette smoking prevalence among DOHMS Physicians, physician attitudes towards tobacco use and tobacco bans; physician attitudes towards smoking cessation techniques (among smokers and non-smokers); and physician awareness of official anti-smoking policies. Data for the study was collected through the use of an adapted WHO standardized questionnaire, the Global Health Professionals Survey. The questionnaire was administered by the researcher to physicians (n=288) at their work place. Date was analyzed using the SPSS analytic software program. ^ Twelve percent of DOHMS physicians smoked cigarettes. Regardless of smoking status, the majority supported a tobacco ban in hospitals and public places, and a ban on tobacco advertising. There is a significant relationship between physician smoking status and discussing risks of tobacco use (p < 0.05). Non-smoking physicians reported spending more time with patients discussing hazards of smoking (p < 0.01). Non-smokers reported providing more counseling than their smoking colleagues. The majority of DOHMS physicians (63%) reported a lack of knowledge about 5As/ 5Rs. The majority of physicians also reported they are aware of hospital smoking policies that restrict smoking. Regardless of physician smoking status, DOHMS physicians are not very actively involved in smoking cessation activities. This cross sectional study is the first to address smoking programs, policies, and practices among physicians in Dubai, UAE. Findings support the need for increased physical smoking cessation training as well as the development of smoking cessation programs for tobacco control, and programs with a focus on physician participation in reducing tobacco and cigarette use among the general population.^

Mexican Americans' awareness, knowledge, and beliefs of hypertension

Cardiovascular disease (CVD) is the number one cause of death for people in Texas as well as Mexico. The progressive morbidity and mortality of CVD can be prevented initially and controlled through regular health screenings or visits to the physician where health markers such as hypertension can be detected and treated. Yet, many people go unaware of existing hypertension not only due to lack of access to health care but to their own personal beliefs, ideas, or perceived barriers that prevent them from seeking preventative health care. ^ The main purpose of this study was to evaluate whether individuals of Mexican origin, who have some form of medical coverage, posses more knowledge, more perceived severity, less perceived barriers, and greater self-efficacy in regards to hypertension than those individuals who have no medical coverage. This was done by addressing the following specific aims: 1.To evaluate the association between individuals who have health care coverage and those who do not have health care coverage in regards to their beliefs of hypertension; 2. To evaluate if there exists a variation among the respondents demographic data and their beliefs of hypertension. ^ The total number of respondents were 150; with 75 being from Cuidad Juarez, and 75 being from El Paso, Texas. The results indicated that the individuals with some form of medical coverage perceived themselves to be more susceptible to suffering a cardiac event or developing heart disease than those who had no form of medical coverage. The individuals with some form of health care coverage also found themselves having less perceived barriers than those who had no health care coverage. The level of education seemed to have some association with individuals perceiving themselves as being susceptible to experiencing a cardiac event if they do not control their hypertension. Regarding self-efficacy, or the self-reported confidence in performing certain behaviors to controlling hypertension, those individuals who perceived themselves as having no self-efficacy had a lower level of education, compared to those who did perceive themselves as possessing self-efficacy. The findings of this study indicate that beliefs regarding hypertension and medical coverage are variables that need to be investigated further for individuals in the El Paso and Cuidad Juarez region. ^

Increasing awareness of colorectal cancer screening through targeted exam room based video messages

Colorectal cancer (CRC) is the third largest cause of cancer death in the United States. While the disease burden is high, there are proven methods to screen for CRC and detect it at a stage that is amenable to cure. Patients with low health literacy have difficulty navigating the health care system and are at increased risk to not receive preventive care services such as colorectal cancer screening (CRCS). To address this need, an exam-room based video was developed to be played for patients in the privacy of the exam room, while they are waiting to be seen by their medical provider. In roughly 2 minutes, the video informs the patient about CRC and CRCS and how they can successfully complete CRCS. One of the key barriers to completing CRCS is the need to increase patients' knowledge and improve attitudes surrounding CRCS. This study examines the impact of the video on patients' knowledge and attitudes about CRC and CRCS in a medically underserved patient population in Houston, Texas. ^ Sixty-one patients presenting for routine medical care were enrolled in the study. Depending on their randomization, the patients either received routine information about CRC and CRCS or they watched the video. We found that the patients who did watch the video did have improvements in their knowledge and improved attitudes about CRC and CRCS. Future studies will be needed to examine whether the video improves the patients' completion of CRCS.^

HPV knowledge, HPV vaccine awareness and initiation among Hispanics: The role of language, information seeking, and information scanning

Background. Among Hispanics, the HPV vaccine has the potential to eliminate disparities in cervical cancer incidence and mortality but only if optimal rates of vaccination are achieved. Media can be an important information source for increasing HPV knowledge and awareness of the vaccine. Very little is known about how media use among Hispanics affects their HPV knowledge and vaccine awareness. Even less is known about what differences exist in media use and information processing among English- and Spanish-speaking Hispanics.^ Aims. Examine the relationships between three health communication variables (media exposure, HPV-specific information scanning and seeking) and three HPV outcomes (knowledge, vaccine awareness and initiation) among English- and Spanish-speaking Hispanics.^ Methods. Cross-sectional data from a survey administered to Hispanic mothers in Dallas, Texas was used for univariate and multivariate logistic regression analyses. Sample used for analysis included 288 mothers of females aged 8-22 recruited from clinics and community events. Dependent variables of interest were HPV knowledge, HPV vaccine awareness and initiation. Independent variables were media exposure, HPV-specific information scanning and seeking. Language was tested as an effect modifier on the relationship between health communication variables and HPV outcomes.^ Results. English-speaking mothers reported more media exposure, HPV-specific information scanning and seeking than Spanish-speakers. Scanning for HPV information was associated with more HPV knowledge (OR = 4.26, 95% CI = 2.41 - 7.51), vaccine awareness (OR = 10.01, 95% CI = 5.43 - 18.47) and vaccine initiation (OR = 2.54, 95% CI = 1.09 - 5.91). Seeking HPV-specific information was associated with more knowledge (OR = 2.27, 95% CI = 1.23 - 4.16), awareness (OR = 6.60, 95% CI = 2.74 - 15.91) and initiation (OR = 4.93, 95% CI = 2.64 - 9.20). Language moderated the effect of information scanning and seeking on vaccine awareness.^ Discussion. Differences in information scanning and seeking behaviors among Hispanic subgroups have the potential to lead to disparities in vaccine awareness.^ Conclusion. Findings from this study underscore health communication differences among Hispanics and emphasize the need to target Spanish language media as well as English language media aimed at Hispanics to improve knowledge and awareness.^

Food quality awareness : cases from shrimp producers in Thailand and vegetable producers in Vietnam

The high number of import rejections of food commodities suggests that producers in exporting countries are not complying with established standards. To understand why this is the case, we explore the behavior of producers and consumers in developing countries. First, we examine the successful transformation of production practices adopted by shrimp producers in Thailand. In support of the dramatic change in practices, we observe an important role played by the public sector in providing a means to visualize chemical residues and to control processes upstream of the supply chain via a registration system and a traceability system called Movement Document. Furthermore, very active information sharing by the private sector contributes to the dissemination of useful technical and market information among producers. We also examine the knowledge and perceptions of consumers with respect to food safety in Vietnam. We find that consumers in Hanoi and Ho Chi Minh City behave differently toward the third-party certification VietGAP, probably owing to differences in the history of market mechanisms between the two cities.

Generating Awareness from Collaborative Working Environment using Social Data

Nowadays, Internet is a place where social networks have reached an important impact in collaboration among people over the world in different ways. This article proposes a new paradigm for building CSCW business tools following the novel ideas provided by the social web to collaborate and generate awareness. An implementation of these concepts is described, including the components we provide to collaborate in workspaces, (such as videoconference, chat, desktop sharing, forums or temporal events), and the way we generate awareness from these complex social data structures. Figures and validation results are also presented to stress that this architecture has been defined to support awareness generation via joining current and future social data from business and social networks worlds, based on the idea of using social data stored in the cloud.

Abstraction carrying code and resource-awareness

Proof-Carrying Code (PCC) is a general approach to mobile code safety in which the code supplier augments the program with a certifícate (or proof). The intended benefit is that the program consumer can locally validate the certifícate w.r.t. the "untrusted" program by means of a certifícate checker—a process which should be much simpler, eíñcient, and automatic than generating the original proof. Abstraction Carrying Code (ACC) is an enabling technology for PCC in which an abstract model of the program plays the role of certifícate. The generation of the certifícate, Le., the abstraction, is automatically carried out by an abstract interpretation-based analysis engine, which is parametric w.r.t. different abstract domains. While the analyzer on the producer side typically has to compute a semantic fixpoint in a complex, iterative process, on the receiver it is only necessary to check that the certifícate is indeed a fixpoint of the abstract semantics equations representing the program. This is done in a single pass in a much more efficient process. ACC addresses the fundamental issues in PCC and opens the door to the applicability of the large body of frameworks and domains based on abstract interpretation as enabling technology for PCC. We present an overview of ACC and we describe in a tutorial fashion an application to the problem of resource-aware security in mobile code. Essentially the information computed by a cost analyzer is used to genérate cost certificates which attest a safe and efficient use of a mobile code. A receiving side can then reject code which brings cost certificates (which it cannot validate or) which have too large cost requirements in terms of computing resources (in time and/or space) and accept mobile code which meets the established requirements.

A Monitoring Infrastructure for FPGA Self-Awareness and Dynamic Adaptation

Variabilities associated with CMOS evolution affect the yield and performance of current digital designs. FPGAs, which are widely used for fast prototyping and implementation of digital circuits, also suffer from these issues. Proactive approaches start to appear to achieve self-awareness and dynamic adaptation of these devices. To support these techniques we propose the employment of a multi-purpose sensor network. This infrastructure, through adequate use of configuration and automation tools, is able to obtain relevant data along the life cycle of an FPGA. This is realised at a very reduced cost, not only in terms of area or other limited resources, but also regarding the design effort required to define and deploy the measuring infrastructure. Our proposal has been validated by measuring inter-die and intra-die variability in different FPGA families.