The effects of obesity in critical illness

Obesity continues to cripple the United States in terms of increasing health care expenditures and its rising rate of prevalence in epidemic proportions. The comorbidities associated with obesity have continued to represent some of the most deadly chronic health diseases. The most vulnerable subpopulation, the critically ill, suffers from not only the comorbid conditions but also the complications encountered within their specialized care. Taking into account the rising prevalence rates of obesity and critical care patients, it has come to the attention of many researchers to measure the trends associated with these two health conditions. Hospital mortality was found to be lower in higher BMI groups whereas there was no difference between BMI groups for ICU mortality. Length of stay and mechanical ventilation were both higher for obese rather than non-obese patients. The most prevalent disease states among the obese critically injured was cardiovascular and pulmonary disease. In conclusion, obesity is not independently associated with increased ICU mortality, but the comorbidities linked to obesity prove a greater threat to vitality.^

Validity of using item response theory to analyze data from the Work Limitations Questionnaire

The Work Limitations Questionnaire (WLQ) is used to determine the amount of work loss and productivity which stem from certain health conditions, including rheumatoid arthritis and cancer. The questionnaire is currently scored using methodology from Classical Test Theory. Item Response Theory, on the other hand, is a theory based on analyzing item responses. This study wanted to determine the validity of using Item Response Theory (IRT), to analyze data from the WLQ. Item responses from 572 employed adults with dysthymia, major depressive disorder (MDD), double depressive disorder (both dysthymia and MDD), rheumatoid arthritis and healthy individuals were used to determine the validity of IRT (Adler et al., 2006).^ PARSCALE, which is IRT software from Scientific Software International, Inc., was used to calculate estimates of the work limitations based on item responses from the WLQ. These estimates, also known as ability estimates, were then correlated with the raw score estimates calculated from the sum of all the items responses. Concurrent validity, which claims a measurement is valid if the correlation between the new measurement and the valid measurement is greater or equal to .90, was used to determine the validity of IRT methodology for the WLQ. Ability estimates from IRT were found to be somewhat highly correlated with the raw scores from the WLQ (above .80). However, the only subscale which had a high enough correlation for IRT to be considered valid was the time management subscale (r = .90). All other subscales, mental/interpersonal, physical, and output, did not produce valid IRT ability estimates.^ An explanation for these lower than expected correlations can be explained by the outliers found in the sample. Also, acquiescent responding (AR) bias, which is caused by the tendency for people to respond the same way to every question on a questionnaire, and the multidimensionality of the questionnaire (the WLQ is composed of four dimensions and thus four different latent variables) probably had a major impact on the IRT estimates. Furthermore, it is possible that the mental/interpersonal dimension violated the monotonocity assumption of IRT causing PARSCALE to fail to run for these estimates. The monotonicity assumption needs to be checked for the mental/interpersonal dimension. Furthermore, the use of multidimensional IRT methods would most likely remove the AR bias and increase the validity of using IRT to analyze data from the WLQ.^

The cost of insuring the uninsured in the U.S.

Objectives: This study included two overarching objectives. Through a systematic review of the literature published between 1990 and 2012, the first objective aimed to assess whether insuring the uninsured would result in higher costs compared to insuring the currently insured. Studies that quantified the actual costs associated with insuring the uninsured in the U.S. were included. Based upon 2009 data from the Medical Expenditure Panel Survey (MEPS), the second objective aimed to assess and compare the self-reported health of populations with four different insurance statuses. The second part of this study involved a secondary data analysis of both currently insured and currently uninsured individuals who participated in the MEPS in 2009. The null hypothesis was that there were no differences across the four categories of health insurance status for self-reported health status and healthcare service use. The alternative hypothesis was that were differences across the four categories of health insurance status for self-reported health status and healthcare service use. Methods: For the systematic review, three databases were searched using search terms to identify studies that actually quantified the cost of insuring the uninsured. Thirteen studies were selected, discussed, and summarized in tables. For the secondary data analysis of MEPS data, this study compared four categories of health insurance status: (1) currently uninsured persons who will become eligible for Medicaid under the Patient Protection and Affordable Care Act (PPACA) healthcare reforms in 2014; (2) currently uninsured persons who will be required to buy private insurance through the PPACA health insurance exchanges in 2014; (3) persons currently insured under Medicaid or SCHIP; and (4) persons currently insured with private insurance. The four categories were compared on the basis of demographic information, health status information, and health conditions with relatively high prevalence. Chi-square tests were run to determine if there were differences between the four groups in regard to health insurance status and health status. With some exceptions, the two currently insured groups had worse self-reported health status compared to the two currently uninsured groups. Results: The thirteen studies that met the inclusion criteria for the systematic review included: (1) three cost studies from 1993, 1995, and 1997; (2) four cost studies from 2001, 2003, and 2004; (3) one study of disabilities and one study of immigrants; (4) two state specific studies of uninsured status; and (5) two current studies of healthcare reform. Of the thirteen studies reviewed, four directly addressed the study question about whether insuring the uninsured was more or less expensive than insuring the currently insured. All four of the studies provided support for the study finding that the cost of insuring the uninsured would generally not be higher than insuring those already insured. One study indicated that the cost of insuring the uninsured would be less expensive than insuring the population currently covered by Medicaid, but more expensive to insure than the populations of those covered by employer-sponsored insurance and non-group private insurance. While the nine other studies included in the systematic review discussed the costs associated with insuring the uninsured population, they did not directly compare the costs of insuring the uninsured population with the costs associated with insuring the currently insured population. For the MEPS secondary data analysis, the results of the chi-square tests indicated that there were differences in the distribution of disease status by health insurance status. As anticipated, with some exceptions, the uninsured reported lower rates of disease and healthcare service use. However, for the variable attention deficit disorder, the uninsured reported higher disease rates than the two insured groups. Additionally, for the variables high blood pressure, high cholesterol, and joint pain, the currently insured under Medicaid or SCHIP group reported a lower rate of disease than the two currently insured groups. This result may be due to the lower mean age of the currently insured under Medicaid or SCHIP group. Conclusion: Based on this study, with some exceptions, the costs for insuring the uninsured should not exceed healthcare-related costs for insuring the currently uninsured. The results of the systematic review indicated that the U.S. is already paying some of the costs associated with insuring the uninsured. PPACA will expand health insurance coverage to millions of Americans who are currently uninsured, as the individual mandate and insurance market reforms will require. Because many of the currently uninsured are relatively healthy young persons, the costs associated with expanding insurance coverage to the uninsured are anticipated to be relatively modest. However, for the purposes of construing these results, it is important to note that once individuals obtain insurance, it is anticipated that they will use more healthcare services, which will increase costs. (Abstract shortened by UMI.)^

Comportamiento de coníferas bajo riego : Mendoza, Argentina

La provincia de Mendoza, ubicada en el centro-oeste de la Argentina, tiene una extensión de 150 830 km2. Prácticamente todas las actividades agropecuarias y forestales están concentradas en el 3 % de su territorio que es posible irrigar. Al oeste, en el límite con Chile, está la cadena montañosa que forma parte de la región fitogeográfica del Desierto Andino que se extiende por más de 500 km, con un ancho promedio de 100 km. El objetivo del trabajo fue introducir algunas especies de coníferas y evaluar su comportamiento en dicha región fitogeográfica, con la finalidad de lograr un aprovechamiento forestal, proteger el suelo contra la erosión hídrica y/o eólica, modificar el paisaje y desarrollar áreas de explotación turística. Las especies seleccionadas en esta primera etapa fueron: Cedrus deodara, Cupressus arizonica, Cupressus macrocarpa, Juniperus virginiana, Pinus griffithii, Pinus halepensis, Pinus nigra, Pinus pinaster, Pinus pinea y Pinus radiata. Las experiencias se llevaron a cabo en dossitios, separados por más de 150 km, y situados a 1 050 y 2 000 msnm, respectivamente. Se tomaron datos de supervivencia, altura y diámetro de los individuos, y se efectuaron observaciones sobre su hábito de crecimiento y condiciones fitosanitarias. Las principales conclusiones fueron las siguientes: 1. Todas las especies mostraron buen estado fitosanitario sin haberse detectado ninguna plaga o enfermedad de importancia. 2. El hábito de crecimiento fue el correspondiente a cada especie; sólo hubo fustes bifurcados en algunos individuos de Pinus pinea. 3. Las especies que evidenciaron mayor aptitud fueron: Juniperus virginiana, Cupressus arizonica, Pinus pinea, Pinus pinaster y Cupressus macrocarpa.

Patient-oriented computerized clinical guidelines for mobile decision support in gestational diabetes

The risks associated with gestational diabetes (GD) can be reduced with an active treatment able to improve glycemic control. Advances in mobile health can provide new patient-centric models for GD to create personalized health care services, increase patient independence and improve patients’ self-management capabilities, and potentially improve their treatment compliance. In these models, decision-support functions play an essential role. The telemedicine system MobiGuide provides personalized medical decision support for GD patients that is based on computerized clinical guidelines and adapted to a mobile environment. The patient’s access to the system is supported by a smartphone-based application that enhances the efficiency and ease of use of the system. We formalized the GD guideline into a computer-interpretable guideline (CIG). We identified several workflows that provide decision-support functionalities to patients and 4 types of personalized advice to be delivered through a mobile application at home, which is a preliminary step to providing decision-support tools in a telemedicine system: (1) therapy, to help patients to comply with medical prescriptions; (2) monitoring, to help patients to comply with monitoring instructions; (3) clinical assessment, to inform patients about their health conditions; and (4) upcoming events, to deal with patients’ personal context or special events. The whole process to specify patient-oriented decision support functionalities ensures that it is based on the knowledge contained in the GD clinical guideline and thus follows evidence-based recommendations but at the same time is patient-oriented, which could enhance clinical outcomes and patients’ acceptance of the whole system.

Debonding identification in FRP-plated RC structures using PZT sensors

The application of the Electro-Mechanical Impedance (EMI) method for damage detection in Structural Health Monitoring has noticeable increased in recent years. EMI method utilizes piezoelectric transducers for directly measuring the mechanical properties of the host structure, obtaining the so called impedance measurement, highly influenced by the variations of dynamic parameters of the structure. These measurements usually contain a large number of frequency points, as well as a high number of dimensions, since each frequency range swept can be considered as an independent variable. That makes this kind of data hard to handle, increasing the computational costs and being substantially time-consuming. In that sense, the Principal Component Analysis (PCA)-based data compression has been employed in this work, in order to enhance the analysis capability of the raw data. Furthermore, a Support Vector Machine (SVM), which has been widespread used in machine learning and pattern recognition fields, has been applied in this study in order to model any possible existing pattern in the PCAcompress data, using for that just the first two Principal Components. Different known non-damaged and damaged measurements of an experimental tested beam were used as training input data for the SVM algorithm, using as test input data the same amount of cases measured in beams with unknown structural health conditions. Thus, the purpose of this work is to demonstrate how, with a few impedance measurements of a beam as raw data, its healthy status can be determined based on pattern recognition procedures.

Estimación del coste de almacenamiento de una solución de preservación de la privacidad en archivos BAM reales

A menudo los científicos secuencian el ADN de un gran número de personas con el objetivo de determinar qué genes se asocian con determinadas enfermedades. Esto permite meóon del genoma humano. El precio de un perfil genómico completo se ha posicionado por debajo de los 200 dólares y este servicio lo ofrecen muchas compañías, la mayor parte localizadas en EEUU. Como consecuencia, en unos pocos a~nos la mayoría de las personas procedentes de los países desarrollados tendrán los medios para tener su ADN secuenciado. Alrededor del 0.5% del ADN de cada persona (que corresponde a varios millones de nucleótidos) es diferente del genoma de referencia debido a variaciones genéticas. Así que el genoma contiene información altamente sensible y personal y representa la identidad biológica óon sobre el entorno o estilo de vida de uno (a menudo facilmente obtenible de las redes sociales), sería posible inferir el fenotipo del individuo. Multiples GWAS (Genome Wide Association Studies) realizados en los últimos a~nos muestran que la susceptibilidad de un paciente a tener una enfermedad en particular, como el Alzheimer, cáncer o esquizofrenia, puede ser predicha parcialmente a partir de conjuntos de sus SNP (Single Nucleotide Polimorphism). Estos resultados pueden ser usados para medicina genómica personalizada (facilitando los tratamientos preventivos y diagnósticos), tests de paternidad genéticos y tests de compatibilidad genética para averiguar a qué enfermedades pueden ser susceptibles los descendientes. Estos son algunos de los beneficios que podemos obtener usando la información genética, pero si esta información no es protegida puede ser usada para investigaciones criminales y por compañías aseguradoras. Este hecho podría llevar a discriminaci ón genética. Por lo que podemos concluir que la privacidad genómica es fundamental por el hecho de que contiene información sobre nuestra herencia étnica, nuestra predisposición a múltiples condiciones físicas y mentales, al igual que otras características fenotópicas, ancestros, hermanos y progenitores, pues los genomas de cualquier par de individuos relacionados son idénticos al 99.9%, contrastando con el 99.5% de dos personas aleatorias. La legislación actual no proporciona suficiente información técnica sobre como almacenar y procesar de forma segura los genomas digitalizados, por lo tanto, es necesaria una legislación mas restrictiva ---ABSTRACT---Scientists typically sequence DNA from large numbers of people in order to determine genes associated with particular diseases. This allows to improve the modern healthcare and to provide a better understanding of the human genome. The price of a complete genome profile has plummeted below $200 and this service is ofered by a number of companies, most of them located in the USA. Therefore, in a few years, most individuals in developed countries will have the means of having their genomes sequenced. Around 0.5% of each person's DNA (which corresponds to several millions of nucleotides) is diferent from the reference genome, owing to genetic variations. Thus, the genome contains highly personal and sensitive information, and it represents our ultimate biological identity. By combining genomic data with information about one's environment or lifestyle (often easily obtainable from social networks), could make it possible to infer the individual's phenotype. Multiple Genome Wide Association Studies (GWAS) performed in recent years have shown that a patient's susceptibility to particular diseases, such as Alzheimer's, cancer, or schizophrenia, can be partially predicted from sets of his SNPs. This results can be used for personalized genomic medicine (facilitating preventive treatment and diagnosis), genetic paternity tests, ancestry and genealogical testing, and genetic compatibility tests in order to have knowledge about which deseases would the descendant be susceptible to. These are some of the betefts we can obtain using genoma information, but if this information is not protected it can be used for criminal investigations and insurance purposes. Such issues could lead to genetic discrimination. So we can conclude that genomic privacy is fundamental due to the fact that genome contains information about our ethnic heritage, predisposition to numerous physical and mental health conditions, as well as other phenotypic traits, and ancestors, siblings, and progeny, since genomes of any two closely related individuals are 99.9% identical, in contrast with 99.5%, for two random people. The current legislation does not ofer suficient technical information about safe and secure ways of storing and processing digitized genomes, therefore, there is need for more restrictive legislation.

FADIGA E DEPRESSÃO NO IDOSO

A fadiga é um sintoma inespecífico, encontrado com freqüência na população. Ela é definida como sensação de cansaço físico profundo, perda de energia ou mesmo sensação de exaustão, e é importante a sua diferenciação com depressão ou fraqueza. Os transtornos depressivos e ansiosos constituem os transtornos psiquiátricos mais freqüentes no idoso, e quase sempre dão lugar a conseqüências graves neste grupo etário. Este estudo visa avaliar a influência da ansiedade e depressão sobre o desencadeamento de fadiga e evolução de problemas de saúde e de comportamentos peculiares ao processo de envelhecimento. Trata-se de um estudo, do tipo caso-controle investigando ansiedade, depressão e fadiga. Foram avaliados 61 indivíduos com 60 anos de idade ou mais. Um grupo controle constituído por 60 indivíduos jovens (idade até 35 anos), foram selecionados entre estudantes do Centro Universitário de Santo André que responderam um Questionário de Características Gerais, um Inventário de Ansiedade traço-estado, um Inventário de Depressão de Beck e uma Escala de Severidade de Fadiga. O grupo de idosos apresentou um escore significativamente maior em relação ao grupo controle na escala de severidade de fadiga. O grupo de idosos apresentou escore médio de 36,87 ± 14,61 enquanto o grupo controle apresentou escore médio de 31,47 ± 12,74 (t = 2,167; df = 119; p = 0,032). No entanto, o grupo de idosos apresentou escores significativamente maiores na escala de Beck (10,54 ± 8,63) em relação aos controles (6,83 ± 7,95); t = 2,455; df = 119; p = 0,016). Analisando-se apenas o grupo de indivíduos idosos, observou-se uma correlação significativa entre os escore da escala de severidade de fadiga e a escala de depressão de Beck (correlação de Pearson = 0,332; p = 0,009). Ainda trabalhando apenas com o grupo de indivíduos idosos, observou-se um escore significativamente maior da escala de severidade de fadiga naqueles indivíduos que praticavam atividade física regular, sendo, escore médio de 31,55 ± 13,36; (t = 2,203; df = 58; p = 0,032). A partir da análise dos resultados deste estudo pôde-se concluir que o grupo de indivíduos idosos apresentam estatisticamente significante escore maior, quando comparado com o grupo controle, apresentando mais sintomas de fadiga e depressão. Estes sintomas de fadiga ocorreram em conjunto com sintomas depressivos sugerindo uma possível correlação entre estes. Quando se observou apenas os idosos, esta correlação foi confirmada. Analisado-se ainda somente o grupo de indivíduos idosos observa-se que o grupo de idosos que praticam atividade física regularmente apresentam menos sintomas fadiga que o grupo que não pratica atividade física.(AU)

FADIGA E DEPRESSÃO NO IDOSO

A fadiga é um sintoma inespecífico, encontrado com freqüência na população. Ela é definida como sensação de cansaço físico profundo, perda de energia ou mesmo sensação de exaustão, e é importante a sua diferenciação com depressão ou fraqueza. Os transtornos depressivos e ansiosos constituem os transtornos psiquiátricos mais freqüentes no idoso, e quase sempre dão lugar a conseqüências graves neste grupo etário. Este estudo visa avaliar a influência da ansiedade e depressão sobre o desencadeamento de fadiga e evolução de problemas de saúde e de comportamentos peculiares ao processo de envelhecimento. Trata-se de um estudo, do tipo caso-controle investigando ansiedade, depressão e fadiga. Foram avaliados 61 indivíduos com 60 anos de idade ou mais. Um grupo controle constituído por 60 indivíduos jovens (idade até 35 anos), foram selecionados entre estudantes do Centro Universitário de Santo André que responderam um Questionário de Características Gerais, um Inventário de Ansiedade traço-estado, um Inventário de Depressão de Beck e uma Escala de Severidade de Fadiga. O grupo de idosos apresentou um escore significativamente maior em relação ao grupo controle na escala de severidade de fadiga. O grupo de idosos apresentou escore médio de 36,87 ± 14,61 enquanto o grupo controle apresentou escore médio de 31,47 ± 12,74 (t = 2,167; df = 119; p = 0,032). No entanto, o grupo de idosos apresentou escores significativamente maiores na escala de Beck (10,54 ± 8,63) em relação aos controles (6,83 ± 7,95); t = 2,455; df = 119; p = 0,016). Analisando-se apenas o grupo de indivíduos idosos, observou-se uma correlação significativa entre os escore da escala de severidade de fadiga e a escala de depressão de Beck (correlação de Pearson = 0,332; p = 0,009). Ainda trabalhando apenas com o grupo de indivíduos idosos, observou-se um escore significativamente maior da escala de severidade de fadiga naqueles indivíduos que praticavam atividade física regular, sendo, escore médio de 31,55 ± 13,36; (t = 2,203; df = 58; p = 0,032). A partir da análise dos resultados deste estudo pôde-se concluir que o grupo de indivíduos idosos apresentam estatisticamente significante escore maior, quando comparado com o grupo controle, apresentando mais sintomas de fadiga e depressão. Estes sintomas de fadiga ocorreram em conjunto com sintomas depressivos sugerindo uma possível correlação entre estes. Quando se observou apenas os idosos, esta correlação foi confirmada. Analisado-se ainda somente o grupo de indivíduos idosos observa-se que o grupo de idosos que praticam atividade física regularmente apresentam menos sintomas fadiga que o grupo que não pratica atividade física.(AU)

An un-mounted horse care group for children and youth with an Autism Spectrum Disorder: Recommendations for program development and treatment intervention

Equine Assisted Activities and Therapies (EAAT) including Therapeutic Horseback Riding (THR) and un-mounted equine assisted activities are interventions aimed at improving the daily functioning and success of individuals with disabilities, including those with an autism spectrum disorder (ASD). While THR is frequently utilized as a treatment intervention for children with ASD, there are many limitations (individual's weight, horse health, weather, physical limitations, health conditions, etc.) that prevent this population from participating in mounted programs. Un-mounted equine assisted activities are often utilized as an alternative, but they are not informed by empirical research or a standardized treatment model. This paper provides a comprehensive review of the literature for EAAT including un-mounted programs, examination of organizational guidelines as they apply to un-mounted programs, and consultation with program directors regarding current practices in the field, and finally it establishes recommendations for the development of a standard curriculum that would strengthen un-mounted horse care group programs serving children with ASD.

La transición sanitaria en España desde 1900 a 1990

Fundamento: El concepto de transición sanitaria trata de explicar, desde un enfoque plural, los cambios en las condiciones de salud que contribuyeron al descenso de la mortalidad que acompaño a la transición demográfica. El objetivo de este trabajo es analizar la transición sanitaria en España a lo largo del presente siglo ( 1900- 1990). Método: El estudio de los distinto componentes de la transición sanitaria (transición epidemiológica, transición de riesgos y transición de la atención sanitaria) se ha basado en las series históricas disponibles procedentes de los Movimientos Naturales de la Población, Anuarios Estadísticas y Censos de viviendas. Resultados: La evolución de las tasas de mortalidad general y mortalidad infantil refleja una tendencia descendente que se manifiesta a lo largo de todo el periodo: la mortalidad general se ha reducido un 70%. mientras que la infantil lo ha hecho en un 96%. Respecto a la esperanza de vida al nacer, la ganancia ha sido de 43 años entre 1900 (35 años) y 1990 (77 años), lo que en términos relativos supone un aumento del 130%. Conclusiones: El nuevo perfil epidemiológico que fue emergiendo durante el período considerado, aparece relacionado con mejoras en las infraestructuras sanitarias, con el aumento del gasto y de las prestaciones sanitarias. pero también con la aparición de nuevos problemas de salud relacionados con las condiciones de trabajo, el crecimiento masivo del medio urbano (a partir, sobre todo, de la década de los 60) o las modificaciones en los patrones de vida.

Diseño y análisis comparativo de un inventario de indicadores de mortalidad evitable adaptado a las condiciones sanitarias de Colombia

Objetivos. Elaborar un inventario de indicadores de mortalidad evitable (INIME) que permita analizar las fallas en el control de los riesgos de mortalidad predominantes en Colombia y comparar los resultados de su aplicación con los obtenidos mediante dos enfoques ampliamente utilizados. Métodos. Se revisaron los registros oficiales de mortalidad de Colombia de 1985 a 2001; las causas básicas de muerte se clasificaron según la CIE-9. Se seleccionaron los indicadores de mortalidad evitable (ME) mediante un algoritmo que combinó las listas de Holland y de Taucher, la definición de Rutstein y colaboradores y el principio de Uemura. Se compararon las proporciones de muertes evitables resultantes de aplicar el INIME y las dos listas de ME a una base de datos con los registros oficiales de defunciones de Colombia de 1993 a 1996. Resultados. De las 680 617 defunciones registradas en el período de estudio, se clasificaron como evitables 18,2% según la lista de Holland y 51,3% según la lista de Taucher. La ME según el INIME ascendió a 76,7%. Este patrón se mantuvo relativamente estable entre 1993 y 1996. Las diferencias observadas en la proporción de muertes evitables según el INIME y las dos listas de ME se relacionaron con el perfil epidemiológico local y el enfoque conceptual de cada lista. Conclusiones. Las diferencias entre el INIME y las listas de ME de Holland y de Taucher muestran las consecuencias de usar una u otra clasificación en el contexto colombiano. El INIME puede constituir un recurso valioso para fundamentar y evaluar políticas sanitarias, pero debe ajustarse a la situación específica en que se aplique.

Extending working life in Finland. CEPS Working Document No. 387, 22 November 2013

This report reviews national and private initiatives to allow the elderly to continue their participation in the Finnish labour market and provides an analysis of the labour market and living conditions of seniors. We are interested in how those over 50 can be engaged in various forms of employment and lifelong learning. We find strong evidence that Finland generally provides good institutional conditions for active ageing. The quick and early ageing process was tackled by the fundamental pension reform that already prolonged retirement substantially and will probably facilitate later retirement as the attitudes concerning retirement change. On the other hand, Finland still seems to lag behind the other Nordic welfare states, has considerable problems in providing the same health conditions to low educated people in physically demanding occupations and could - – with respect to family pension in particular – invest further efforts in reforming the pension system. While many of the reforms Finland has conducted seem to be favourable and transferable to other European countries that still face the steepest phases of ageing in their societies, a reluctance towards changing attitudes that we observe in Finland, shows that organizing active ageing is a long-term project.

Immunomodulating effects of environmentally realistic copper concentrations in Mytilus edulis adapted to naturally low salinities, link to supplementary material

The monitoring of organisms' health conditions by the assessment of their immunocompetence may serve as an important criterion for the achievement of the Good Environmental Status (GES) as defined in the Marine Strategy Framework Directive (EU). In this context, the complex role of natural environmental stressors, e.g. salinity, and interfering or superimposing effects of anthropogenic chemicals, should be carefully considered, especially in scenarios of low to moderate contamination. Organisms from the Baltic Sea have adapted to the ambient salinity regime, however energetically costly osmoregulating processes may have an impact on the capability to respond to additional stress such as contamination. The assessment of multiple stressors, encompassing natural and anthropogenic factors, influencing an organisms' health was the main aim of the present study. Immune responses of Mytilus edulis, collected and kept at natural salinities of 12 per mil (LS) and 20 per mil (MS), respectively, were compared after short-term exposure (1, 7 and 13 days) to low copper concentrations (5, 9 and 16 µg/L Cu). A significant interaction of salinity and copper exposure was observed in copper accumulation. LS mussels accumulated markedly more copper than MS mussels. No combined effects were detected in cellular responses. Bacterial clearance was mostly achieved by phagocytosis, as revealed by a strong positive correlation between bacterial counts and phagocytic activity, which was particularly pronounced in LS mussels. MS mussels, on the other hand, seemingly accomplished bacterial clearance by employing additional humoral factors (16 µg/L Cu). The greatest separating factor in the PCA biplot between LS and MS mussels was the proportion of granulocytes and hyalinocytes while functional parameters (phagocytic activity and bacterial clearance) were hardly affected by salinity, but rather by copper exposure. In conclusion, immune responses of the blue mussel may be suitable and sensitive biomarkers for the assessment of ecosystem health in brackish waters (10-20 per mil S).

Screening for physical activity in family practice - Evaluation of two brief assessment tools

Background: Physical activity (PA) is relevant to the prevention and management of many health conditions in family practice. There is a need for an efficient, reliable, and valid assessment tool to identify patients in need of PA interventions. Methods: Twenty-eight family physicians in three Australian cities assessed the PA of their adult patients during 2004 using either a two- (2Q) or three-question (3Q) assessment. This was administered again approximately 3 days later to evaluate test-retest reliability. Concurrent validity was evaluated by measuring agreement with the Active Australia Questionnaire, and criterion validity by comparison with 7-day Computer Science Applications, Inc. (CSA) accelerometer counts. Results: A total of 509 patients participated, with 428 (84%) completing a repeat assessment, and 415 (82%) accelerometer monitoring. The brief assessments had moderate test-retest reliability (2Q k = 58.0%, 95% confidence interval [CI] = 47.2-68.8%; 3Q k = 55.6%, 95% CI = 43.8-67.4%); fair to moderate concurrent validity (2Q k = 46.7%, 95% CI = 35.657.9%; 3Q k = 38.7%, 95% CI = 26.4-51.1%); and poor to fair criterion validity (2Q k = 18.2%, 95% CI = 3.9-32.6%; 3Q k = 24.3%, 95% CI = 11.6-36.9%) for identifying patients as sufficiently active. A four-level scale of PA derived from the PA assessments was significantly correlated with accelerometer minutes (2Q rho = 0.39, 95% CI = 0.28-0.49; 3Q rho = 0.31, 95% CI = 0.18-0.43). Physicians reported that the assessments took I to 2 minutes to complete. Conclusions: Both PA assessments were feasible to use in family practice, and were suitable for identifying the least active patients. The 2Q assessment was preferred by clinicians and may be most appropriate for dissemination.