The psychometric properties of the Spanish version of the Foot Health Status Questionnaire

Purpose: Clinical studies suggest that foot pain may be problematic in one-third of patients in early disease. The Foot Health Status Questionnaire (FHSQ) was developed and validated to evaluate the effectiveness of conservative (orthoses, taping, stretching) and surgery interventions. Despite this fact, there are few validated instruments that measure foot health status in Spanish. Thus, the primary aim of the current study was to translate and evaluate psychometrically a Spanish version of FHSQ. Methods: A cross-sectional study was designed in a university community-based podiatric clinic located in south of Spain. All participants (n = 107) recruited consecutively completed a Spanish version of FHSQ and EuroQoL Health Questionnaire 5 dimensions, and 29 participants repeated these same measures 48 h later. Data analysis included test–retest reliability, construct and criterion-related validity and factor analyses. Results: Construct validity was appropriate with moderate-to-high corrected item–subscale correlations (α = ≥0.739) for all subscales. Test–retest reliability was satisfactory (ICC > 0.932). Factor analysis revealed four dimensions with 86.6 % of the common variance explained. The confirmatory factor analysis findings demonstrated that the proposed structure was well supported (comparative fit index = 0.92, standardized root mean square = 0.09). The Spanish EuroQoL 5D score negatively correlated with the FHSQ pain (r = −0.445) and positively with general foot health and function (r = 0.261 − 0.579), confirming criterion-related validity. Conclusion: The clinimetric properties of the Spanish version of FHSQ were satisfactory.

A Critical Perspective of the Indonesian Institutional Framework for PPP Toll Roads

The development of toll roads in Indonesia started around 1978. Initially, the management and development of toll roads sat directly under the Government of Indonesia (GoI) being undertaken through PT JasaMarga, a state owned enterprise specifically established to provide toll roads. Due to the slow growth and low capability of toll roads to fulfil infrastructure needs in the first ten years of operation (only 2.688kms/year), GoI changed its strategy in 1989 to one of using private sector participation for roads delivery through a Public Private Partnership (PPP) scheme. In this latter period, PT JasaMarga had two roles, both as regulator on behalf of the private sector as well as being the operator. However, from 1989 to 2004 the growth rate of toll roads actually decreased further to 2.300kms/year. Facing this challenge of low growth rate of toll roads, in 2004GoI changed the toll road management system and the role of regulator was returned to the Government through the establishment of the Toll Road Regulatory Agency (BPJT). GoI also amended the institutional framework to strengthen the toll road management system. Despite the introduction of this new institutional framework, the growth of toll roads still showed insignificant change. This problem in toll road development has generated an urgent need for research into this issue. The aim of the research is to understand the performance of the new institutional framework in enhancing PPP procured toll road development. The methodology of the research was to undertake a questionnaire survey distributed to private sector respondents involved in toll road development. The results of this study show that there are several problems inherent in the institutional framework, but the most significant problem comes from the uncertainty of the function of the strategic executive body in the land expropriation process.

Trade secrets: a ten year overview of the illegal import of sea turtle products into the United States

For more than 25 years all sea turtle products have been prohibited from international commerce by the 170-member nations of the Convention on International Trade in Endangered Species (CITES). Sea turtles continue to be threatened by direct take (including poaching) and illegal trade despite multi-national protection efforts. Although take may contribute significantly to sea turtle decline, illegal take is difficult to measure since there are few quantified records associated with legal fisheries and fewer still for illegal take (poaching). We can, however, quantify one portion of the illegal sea turtle trade by determining how many illegal products were seized at United States ports of entry over a recent 10-year period. The United States Fish and Wildlife Service (USFWS) oversees the import and export of wildlife and wildlife products, ensuring that wildlife trade complies with United States laws and international treaties. Additionally, the USFWS has legal authority to target suspected illegal wildlife activity through undercover and field investigations. In an effort to assess the scale of illegal sea turtle take and trade, we have conducted a 10-year (1994 – 2003) review of the law enforcement database maintained by the USFWS. This database tracks the number and type of wildlife cases, the quantity of seized products, and the penalties assessed against violators. These data are minimum estimates of the sea turtle products passing through the United States borders, as smuggled wildlife is oftentimes not detected.

Wadge Bank trawl fishery studies. Pt. 5. Rational exploitation of the resident demersal stock

The general history of the trawl fishery of the Wadge Bank off Cape Comorin, South India (Fig. 1), the nature and composition of its demersal fish population, and the present state of its fishery has been given by various authors (Malpas 1926, Pearson and Malpas 1926, Sivalingam and Medcof 1957, Medcof 1963, Mendis 1965a, 1965b, Sivalingam 1966a, 1966b, 1969a and 1969b). It has been shown earlier (Sivalingam and Medcof 1957, Sivalingam 1969a) that the Wadge Bank stock is made up of two groups. The resident stock which is present on the fishing grounds throughout the year and the migrant stock that appears on the fishing grounds only during the southwest monsoon months. The object of this paper is to discuss the effect of fishing on the resident stock between 1945 and 1962 and based on the information available; assess the maximum sustained yield of the resident stock. The "Bigfish" of the resident stock is the mainstay of the Wadge Bank trawl fishery (Sivalingam 1969a) and it will be shown that this stock has been overexploited from 1953 to 1957. The first sign of recovery was evident in 1960 and continued till 1962. The data since 1962 are not available to the author for analysis. It has been reported by Mendis (1965b) that considerable expansion of the trawler fleet was anticipated in 1966, and if so, the history of the fishery from 1953 to 1957 may be repeated. The assessment presented in this paper should form a rational basis for management programs.

A perspective of the carp industry in the Philippines

Fish farmers in Laguna de Bay are facing conflict of the use of the lake which is being tapped as freshwater source for domestic use. The article documents the perspectives of some fish farmers and researchers on the development of carp aquaculture industry in the lake. According to carp farmers and researchers, the industry is profitable; however, marketing, post harvest and processing strategies remain poor. In this regard, Southeast Asian Fisheries Development Center, Aquaculture Department (SEAFDEC/AQD) should be the frontline ally of carp growers since SEAFDEC/AQD developed the technology for lake culture.

A one-year investigation of the relationship between serum GH levels and the growth of F-4 transgenic and non-transgenic common carp Cyprinus carpio

It has been demonstrated that growth hormone (GH) transgenic fish often posses a trait for fast growth. Here, we investigated the growth of F-4 'all-fish' GH transgenic carp Cyprinus carpio and their serum GH levels for a year. The results showed that F-4 all-fish GH transgenic carp were significantly larger in body mass (c. two-fold, P < 0 center dot 001) and body length (c. 1 center dot 3 fold, P < 0 center dot 001), compared with the non-transgenic group. The discrepancy of serum GH levels between the transgenic carp group and control group is 54 fold, when the water temperature was 12-34 degrees C. When the water temperature decreased to 3 center dot 5 degrees C in January, the discrepancy was 256 fold. The serum GH level of the transgenic group was relatively constant, while that of control varied greatly based on month and water temperature. The changes of growth rates between the transgenic group and the control group were similar for a year. Taken together, the results indicated that F-4 all-fish GH transgenic carp had not only higher and constant serum GH levels but also a significant fast-growing effect, compared with the control. To our knowledge, this is the first report on a one-year investigation of growth trait and serum growth hormone level in F-4 all-fish GH transgenic carp.

Use of the child health utility and strengths and difficulties outcome measures in economic evaluations of school-based interventions: data from a cluster-randomised controlled trial in Northern Ireland

Background There is growing evidence linking early social and emotional wellbeing to later academic performance and various health outcomes including mental health. An economic evaluation was designed alongside the Roots of Empathy cluster-randomised trial evaluation, which is a school-based intervention for improving pupils’ social and emotional wellbeing. Exploration of the relevance of the Strengths and Diffi culties Questionnaire (SDQ) and Child Health Utility 9D (CHU9D) in school-based health economic evaluations is warranted. The SDQ is a behavioural screening questionnaire for 4–17-year-old children, consisting of a total diffi culties score, and also prosocial behaviour,
which aims to identify positive aspects of behaviour. The CHU9D is a generic preference-based health-related quality of life instrument for 7–17-year-old children.

When innovation fails: An institutional perspective of the (non)adoption of boundary spanning IT innovation

We combine the concepts of legitimacy, institutional (mis)alignments, strategic responses and organizing visions to develop a conceptual framework to analyse the adoption of innovations that span organisational fields. We apply the framework to examine a telehealth innovation connecting a public sector hospital-based eye clinic with private sector optometry practices. We find that while compromise strategies were successful in encouraging adoption within each field, the innovation ultimately failed as fields developed different organising visions which could not be reconciled. The findings suggest that institutional misalignments within and between fields interact to amplify their overall effect on the adoption of hybrid innovations.

Late effects of cancer and cancer treatment-the perspective of the patient

PURPOSE: Understanding the experience of late effects from the perspective of cancer survivors is essential to inform patient-centred care. This study investigated the nature and onset of late effects experienced by survivors and the manner in which late effects have affected their lives.

METHODS: Sixteen purposively selected cancer survivors participated in a qualitative interview study. The data were analysed inductively using a narrative schema in order to derive the main themes that characterised patients' accounts of late effects.

RESULTS: Individual survivors tended to experience more than one late effect spanning a range of physical and psychological effects. Late effects impacted on relationships, working life, finances and the ability to undertake daily activities. Survivors reported experiencing psychological late effects from around the end of treatment whereas the onset of physical effects occurred later during the post-treatment period. Late effects were managed using formal health services, informal social support and use of 'wellbeing strategies'. Survivors engaged in a process of searching for reasons for experiencing late effects and struggled to make sense of their situation. In particular, a process of 'peer-patient comparison' was used by survivors to help them make sense of, or cope with, their late effects. There appeared to be an association between personal disposition and adaptation and adjustment to the impact of late effects.

CONCLUSIONS: Cancer survivors identified potential components for supported self-management or intervention programmes, as well as important considerations in terms of peer comparisons, personal disposition and making sense of experienced late effects.

Chancen und herausforderungen der rückversicherung in der gesetzlichen krankenversicherung (Chances and challenges of reinsurance in the social health scheme)

In 2009 a so-called morbidity orientated risk structure equalization scheme was installed for the German statutory health insurance in order to minimize structural differences between different providers with respect to revenue and expenditures. Even with this mechanism some risks to the individual health insurance providers remain. Reinsurance could be a way to mitigate these risks, but so far only very few contracts have been signed. Moreover the existing reinsurance contracts only focus on the periphery of the statutory health insurance system such as travel health insurance. In this article we therefore analyse existing risks for individual health insurance providers and evaluate their (re-)insurability. Hereafter the potential for reinsurance solutions in the German statutory health insurance itself as well as in newer forms of healthcare provision (e.g. integrated health care and managed care) is discussed. We find that reinsurance may be a reasonable solution for many of the risks in the statutory health insurance scheme. But as research in this area is very young further analysis of the nature of risks is necessary.

Stress, social support, and health risk behaviours as mediators of the forgiveness-health relation /

The mediating roles of stress, social support, and health risk behaviours in the relationships between dispositional forgiveness and mental and physical health were examined. Participants were 748 undergraduate students (554 women, 194 men) entering their first year of studies at Brock University. Participants, ranging in age from 17 to 25 years, completed the Brock University First Year Health Study and were provided monetary compensation. Dispositional forgiveness, stress, social support, health risk behaviours, mental health, and physical health were measured using self-report methods. The data were analyzed separately for women and men because there were significant mean differences on many of the study'S variables. Analyses revealed that the mediated relationships between dispositional forgiveness and health were generally stronger for women than men. Stress was the most robust mediator of the forgiveness-health relation for both women and men. The only health risk behaviour that mediated the forgivenesshealth relation was physical fitness and this result was found for women only. Social support mediated several of the relationships between forgiveness and health but not others. Results were discussed with reference to the literature on forgiveness and health. Several directions for future research were offered, such as conducting longitudinal research designs to assess the direction of causality better, investigating moderator variables of the forgiveness-health relation, and building models, which incorporate multiple mediators using structural equation modelling techniques.

Biased selection within the social health insurance market in Colombia

Las regulaciones como primaje comunitario, paquetes estandarizados y afiliación abierta, orientadas a reducir el impacto de las fallas en los mercados de seguros, tienen un efecto limitado puesto que abren espacio a la selección sesgada. A partir de 1993, el sistema de seguridad social en salud en Colombia fue reformado hacia un enfoque de mercado con la expectativa de mejorar el desempeño de los monopolios preexistentes exponiéndolos a la competencia de nuevos entrantes. La hipótesis que se maneja en el trabajo es que las fallas de mercado pueden llevar a selección sesgada favoreciendo a los nuevos entrantes. Se analizaron dos encuestas de hogares utilizando el estado de salud auto reportado y la presencia de enfermedad crónica como indicadores prospectivos del riesgo de los afiliados. Se encuentra que hay selección sesgada, llevando a selección adversa entre los aseguradores preexistentes, y a selección favorable entre los nuevos entrantes. Este patrón se observa en 1997 y se incrementa en el 2003. Aunque las entidades preexistentes son entidades públicas, y su tamaño disminuyó sustancialmente entre estos años, se analizan sus implicaciones fiscales en términos de financiación adicional por parte del gobierno.

Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5-year follow-up: the Japanese-Brazilian thyroid study

Objective: The currently available data concerning the influence of subclinical thyroid disease (STD) on morbidity and mortality are conflicting. Our objective was to investigate the relationships between STD and cardiometabolic profile and cardiovascular disease at baseline, as well as with all-cause and cardiovascular mortality in a 7.5-year follow-up. Design: Prospective, observational study. Methods: An overall of 1110 Japanese-Brazilians aged above 30 years, free of thyroid disease, and not taking thyroid medication at baseline were studied. In a cross-sectional analysis, we investigated the prevalence of STD and its relationship with cardiometabolic profile and cardiovascular disease. All-cause and cardiovascular mortality rates were assessed for participants followed for up to 7.5 years. Association between STD and mortality was drawn using multivariate analysis, adjusting for potential confounders. Results: A total of 913 (82.3%) participants had euthyroidism, 99 (8.7%) had subclinical hypothyroidism, and 69 (6.2%) had subclinical hyperthyroidism. At baseline, no association was found between STD and cardiometabolic profile or cardiovascular disease. Multivariate-adjusted hazard ratios (HRs (95% confidence interval)) for all-cause mortality were significantly higher for individuals with both subclinical hyperthyroidism (HR, 3.0 (1.5-5.9); n=14) and subclinical hypothyroidism (HR, 2.3 (1.2-4.4); n=13) than for euthyroid subjects. Cardiovascular mortality was significantly associated with subclinical hyperthyroidism (HR, 3.3 (1.4-7.5); n=8), but not with subclinical hypothyroidism (HR, 1.6 (0.6-4.2); n=5). Conclusion: In the Japanese-Brazilian population, subclinical hyperthyroidism is an independent risk factor for all-cause and cardiovascular mortality, while subclinical hypothyroidism is associated with all-cause mortality.

Family visitors and companions of hospitalized elderly and adults: analysis of the experience from the perspective of the nursing working process

Trata-se de estudo qualitativo, utilizando-se como referencial metodológico a Grounded Theory e como referencial teórico o Processo de Trabalho em Enfermagem, para compreender o papel assumido pelo enfermeiro perante as normas e rotinas hospitalares, relativas aos familiares visitantes e acompanhantes de adultos e idosos internados em um Hospital Universitário. A análise dos dados permitiu a identificação do tema: definindo-se a modalidade de apoio familiar durante a hospitalização, que reúne duas categorias principais: tornando-se familiar visitante e tornando-se familiar acompanhante. Por meio da análise, pôde-se aprofundar a compreensão do quanto as regras estabelecidas, com o objetivo de disciplinar e tornar eficiente o trabalho desenvolvido no hospital, podem explicitar o desprovimento de autonomia no processo de trabalho, para modificar as relações nesse contexto e o quanto a apropriação do familiar como parte da equipe de saúde, está distante de ser pensada no concreto das instituições.