Psychological distress in medical seeking ED care for somatic reasons: results of a systematic review

Objectives: The aim of this systematic literature review is to investigate (A) currently used instruments for assessing psychological distress, (B) the prevalence of psychological distress in medical emergency department (ED) patients with acute somatic conditions and (C) empirical evidence on how predictors are associated with psychological distress. Methods: We conducted an electronic literature search using three databases to identify studies that used validated instruments for detection of psychological distress in adult patients presented to the ED with somatic (non-psychiatric) complaints. From a total of 1688 potential articles, 18 studies were selected for in-depth review. Results: A total of 13 instruments have been applied for assessment of distress including screening questionnaires and briefly structured clinical interviews. Using these instruments, the prevalence of psychological distress detected in medical ED patients was between 4% and 47%. Psychological distress in general and particularly depression and anxiety have been found to be associated with demographic factors (eg, female gender, middle age) and illness-related variables (eg, urgency of triage category). Some studies reported that coexisting psychological distress of medical patients identified in the ED was associated with physical and psychological health status after ED discharge. Importantly, during routine clinical care, only few patients with psychological distress were diagnosed by their treating physicians. Conclusions: There is strong evidence that psychological distress is an important and prevalent cofactor in medically ill patients presenting to the ED with harmful associations with (subjective) health outcomes. To prove causality, future research should investigate whether screening and lowering psychological distress with specific interventions would result in better patient outcomes.

Reasons for discontinuation of recommended therapies according to the patients after acute coronary syndromes.

BACKGROUND The prescription of recommended medical therapies is a key factor to improve prognosis after acute coronary syndromes (ACS). However, reasons for cardiovascular therapies discontinuation after hospital discharge are poorly reported in previous studies. METHODS We enrolled 3055 consecutive patients hospitalized with a main diagnosis of ACS in four Swiss university hospitals with a prospective one-year follow-up. We assessed the self-reported use of recommended therapies and the reasons for medication discontinuation according to the patient interview performed at one-year follow-up. RESULTS 3014 (99.3%) patients were discharged with aspirin, 2983 (98.4%) with statin, 2464 (81.2%) with beta-blocker, 2738 (90.3%) with ACE inhibitors/ARB and 2597 (100%) with P2Y12 inhibitors if treated with coronary stent. At the one-year follow-up, the discontinuation percentages were 2.9% for aspirin, 6.6% for statin, 11.6% for beta-blocker, 15.1% for ACE inhibitor/ARB and 17.8% for P2Y12 inhibitors. Most patients reported having discontinued their medication based on their physicians' decision: 64 (2.1%) for aspirin, 82 (2.7%) for statin, 212 (8.6%) for beta-blocker, 251 (9.1% for ACE inhibitor/ARB) and 293 (11.4%) for P2Y12 inhibitors, while side effect, perception that medication was unnecessary and medication costs were uncommon reported reasons (<2%) according to the patients. CONCLUSIONS Discontinuation of recommended therapies after ACS differs according the class of medication with the lowest percentages for aspirin. According to patients, most stopped their cardiovascular medication based on their physician's decision, while spontaneous discontinuation was infrequent.

Fertility-preservation counselling and treatment for medical reasons: data from a multinational network of over 5000 women.

Fertility-preservation techniques for medical reasons are increasingly offered in national networks. Knowledge of the characteristics of counselled patients and techniques used are essential. The FertiPROTEKT network registry was analysed between 2007 and 2013, and included up to 85 university and non-university centres in Germany, Austria and Switzerland; 5159 women were counselled and 4060 women underwent fertility preservation. In 2013, fertility-preservation counselling for medical reasons increased significantly among nullipara and women aged between 21 and 35 years (n = 1043; P < 0.001). Frequency of GnRH applications slowly decreased, whereas tissue, oocytes and zygote cryopreservation increased. In 2013, women with breast cancer mainly opted for tissue freezing, whereas women with lymphoma opted for GnRH agonist. Women younger than 20 years predominantly opted for GnRH agonists and ovarian tissue cryopreservation; women aged between 20 and 40 years underwent a variety of techniques; and women over 40 years opted for GnRH agonists. The average number of aspirated oocytes per stimulation cycle decreased as age increased (< 30 years: 12.9; 31-35 years: 12.3; 36-46: 9.0; > 41 years: 5.7). For ovarian tissue cryopreservation, removal and cryopreservation of fewer than one ovary was preferred and carried out in 97% of cases in 2013.

Theory of Systems, Systems Metaphysics and Neoplatonism

Science has been developed from the rational-empirical methods, having as a consequence, the representation of existing phenomena without understanding the root causes. The question which currently has is the sense of the being, and in a simplified way, one can say that the dogmatic religion lead to misinterpretations, the empirical sciences contain the exact rational representations of phenomena. Thus, Science has been able to get rid of the dogmatic religion. The project for the sciences of being looks to return to reality its essential foundations; under the plan of theory of systems necessarily involves a search for the meaning of Reality.

La protezione delle minoranze in Italia e il mancato riconoscimento della minoranza rom: ragioni e conseguenze = "The protection of minorities in Italy and the non-recognition of the Roma minority: reasons and consequences." EDAP 03/2013

No abstract.

Derisory Results or Reasons to be Cheerful? Evaluating the Implantation of the European Neighbourhood Policy in Ukraine, Moldova and Belarus. Natolin Research Paper 01/January 2011

This paper considers the implementation of the European Neighbourhood Policy (ENP) in Ukraine, Moldova and Belarus. The paper presents a portrait of the three neighbours in terms of their current political and socio-economic profiles, as well as the status of their relations with the European Union. Subsequently, it provides an overview of the development of ENP. A general set of conclusions are offered in relation to the key issue of good governance, where, the paper argues, ENP has delivered derisory results, with patchy effects across the region. Moreover, the paper identifies the democratic back-sliding in Ukraine and entenched authoritarianism in Belarus, which ENP has done very little to address. The EU’s willingness to provide better mobility options for ENP citizens to visit and work in the EU is a key test for the Eastern Partnership (EaP) in the coming year. This paper sees that whilst there are reasons to be cheerful here, with the EU’s recent offer of greater Visa Liberalisation for Ukraine and Moldova, there remains much to be done and in the meantime the EU remains a ‘Fortress Europe’. The paper concludes with a set of recommendations for ENP, which include the need to finally tackle corruption in the region, bring more differentiation into ENP, soften the EU’s borders through more generous Visa regimes, develop a more robust Belarus strategy and to think more creatively about the use of ENP funds for regional and cross- border activities.

Report to the Secretary of State, with decisions showing the reasons for the allowance or disallowance of the claims /

Mode of access: Internet.

The Jewish faith: its spiritual consolation, moral guidance, and immortal hope; with a brief notice of the reasons for many of its ordinances and prohibitions; a series of letters answering the inquiries of youth.

Bound with the authors Shemaʻ Yiśraʾel. Philadelphia, 1864.