Equal employment opportunity : rising trends in EEO complaint caseloads in the federal sector : briefing report to Congressional requestors /

"B-279407"--P. 1.

Association between apolipoprotein E epsilon 4 and neuropsychiatric symptoms during interferon alpha treatment for chronic hepatitis C

Neuropsychiatric complications are common in patients with chronic hepatitis C undergoing treatment with interferon alpha. These side effects include alterations of mood, cognition, and neuroendocrine function and are unpredictable. In a number of neurological disorders characterized by neuropsychiatric symptoms and cognitive dysfunction, inheritance of an apolipoprotein E (APOE) epsilon4 allele is associated with adverse neuropsychiatric outcomes. The authors present evidence that the APOE genotype may influence a patient's neuropsychiatric response to interferon alpha treatment. The inheritance of APOE genotypes was examined in 110 patients with chronic hepatitis C treated with interferon alpha. A retrospective investigation was conducted by assessing the rates of psychiatric referral and neuropsychiatric symptoms experienced during treatment along with other complaints indicating psychological distress. A highly statistically significant association was seen between APOE genotypes and interferon-induced neuropsychiatric symptoms. Patients with an epsilon4 allele were more likely to be referred to a psychiatrist and had more neuropsychiatric symptoms during antiviral treatment than those without an epsilon4 allele. Additionally, patients with an epsilon4 allele were more likely to experience irritability or anger and anxiety or other mood symptoms. These data demonstrate that an individual's APOE genotype may influence the neuropsychiatric response to antiviral therapy with interferon alpha. Prospective studies evaluating the importance of APOE in susceptibility to interferon alpha-induced neuropsychiatric complications are needed. Moreover, pathways involving APOE should be considered in understanding the pathophysiology of interferon alpha-induced neuropsychiatric complications.

Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test

Study Design. Cross-sectional study. Objective. The present study compared activity of deep and superficial cervical flexor muscles and craniocervical flexion range of motion during a test of craniocervical flexion between 10 patients with chronic neck pain and 10 controls. Summary of Background Data. Individuals with chronic neck pain exhibit reduced performance on a test of craniocervical flexion, and training of this maneuver is effective in management of neck complaints. Although this test is hypothesized to reflect dysfunction of the deep cervical flexor muscles, this has not been tested. Methods. Deep cervical flexor electromyographic activity was recorded with custom electrodes inserted via the nose and fixed by suction to the posterior mucosa of the oropharynx. Surface electrodes were placed over the superficial neck muscles ( sternocleidomastoid and anterior scalene). Root mean square electromyographic amplitude and craniocervical flexion range of motion was measured during five incremental levels of craniocervical flexion in supine. Results. There was a strong linear relation between the electromyographic amplitude of the deep cervical flexor muscles and the incremental stages of the craniocervical flexion test for control and individuals with neck pain ( P = 0.002). However, the amplitude of deep cervical flexor electromyographic activity was less for the group with neck pain than controls, and this difference was significant for the higher increments of the task ( P < 0.05). Although not significant, there was a strong trend for greater sternocleidomastoid and anterior scalene electromyographic activity for the group with neck pain. Conclusions. These data confirm that reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles and support the validity of this test for patients with neck pain.

Medial upper eyelid shortening to correct medial eyelid laxity in floppy eyelid syndrome: A new surgical approach

Purpose: To describe and present the results of a new surgical technique for patients with floppy eyelid syndrome, based on the medial upper eyelid stretching encountered in this condition. Methods: A case series of 24 patients with floppy eyelid syndrome who where found to have symptomatic predominately medial upper eyelid laxity was analyzed. The history, clinical features, histopathology, and outcome were reviewed after patients underwent medial upper eyelid shortening with or without upper eyelid skin reduction as the first surgical procedure. Results: Of the 24 patients, 18 were men (75%) with a mean age at referral of 56 years, having ocular discomfort and conjunctival irritation/papillary conjunctivitis as the main complaints at presentation. Obesity was present in 96% of cases, with lower eyelid laxityl/ectropion (50%) and upper eyelid eyelash ptosis (29%) in conjunction with the upper eyelid laxity. The affected side was related to sleeping habits or recurrent mechanical eyelid trauma. Histologic studies showed a nonspecific inflammatory cell infiltrate and loss of elastin with loose dermal connective tissue. After surgery, complete relief of ocular symptoms and good functional and cosmetic results were present in all cases after 18 months of follow-up. Conclusions: This new surgical approach is based on the presence of predominately medial upper laxity in patients with floppy eyelid syndrome. The excision of this stretched area stabilized the upper eyelid in an anatomic fashion, providing a good and stable long-term result. The possible mechanisms involved in the medial upper eyelid stretching are discussed.

Is the method of signal analysis and test selection important for measuring standing balance in subjects with persistent whiplash?

Dizziness and or unsteadiness, associated with episodes of loss of balance, are frequent complaints in those suffering from persistent problems following a whiplash injury. Research has been inconclusive with respect to possible aetiology, discriminative tests and analyses used. The aim of this pilot research was to identify the test conditions and the most appropriate method for the analysis of sway that may differentiate subjects with persistent whiplash associated disorders (WAD) from healthy controls. The six conditions of the Clinical Test for Sensory Interaction in Balance was performed in both comfortable and tandem stance in 20 subjects with persistent WAD compared to 20 control subjects. The analyses were carried out using a traditional method of measurement, total sway distance, to results obtained from the use of wavelet analysis. Subjects with WAD were significantly less able to complete the tandem stance tests on a firm surface than controls. In comfortable stance, using wavelet analysis, significant differences between subjects with WAD and the control group were evident in total energy of the trace for all test conditions apart from eyes open on the firm surface. In contrast, the results of the analysis using total sway distance revealed no significant differences between groups across all six conditions. Wavelet analysis may be more appropriate for detecting disturbances in balance in whiplash subjects because the technique allows separation of the noise from the underlying systematic effect of sway. These findings will be used to direct future studies on the aeitiology of balance disturbances in WAD. (c) 2004 Elsevier B.V. All rights reserved.

Is health care seeking for irritable bowel syndrome and functional dyspepsia a socially learned response to illness?

In a population-based study of 207 subjects with irritable bowel syndrome (IBS) or functional dyspepsia (FD) and controls (n = 100), we aimed to determine whether dimensions of abnormal illness behavior from the Abnormal Illness Behaviour Questionnaire and aspects of social learning of illness behavior from the Social Learning of Illness Behaviour scale were independent predictors of health care seeking for IBS and FD. Results showed that dimensions of abnormal illness behavior and aspects of social learning of illness behavior (encouragement, reinforcement, and modeling) did not significantly differentiate between consulters and nonconsulters with IBS and/or FD. The Disease Conviction scale (OR = 1.55; 95% CI, 1.15-2.09) of the Abnormal Illness Behaviour Questionnaire was an independent predictor of having a diagnosis of IBS and/or FD, independent of age and gender, psychiatric diagnoses, and symptom severity. We conclude that a belief in the presence of serious pathology characterizes community subjects with IBS and FD, but not health care seeking.

Ross River virus disease clusters and spatial relationship with mosquito biting exposure in Redland Shire, southern Queensland, Australia

The spatial heterogeneity in the risk of Ross River virus (family Togaviridae, genus Alphavirus, RRV) disease, the most common mosquito-borne disease in Australia, was examined in Redland Shire in southern Queensland, Australia. Disease cases, complaints from residents of intense mosquito biting exposure, and human population data were mapped using a geographic information system. Surface maps of RRV disease age-sex standardized morbidity ratios and mosquito biting complaint morbidity ratios were created. To determine whether there was significant spatial variation in disease and complaint patterns, a spatial scan analysis method was used to test whether the number of cases and complaints was distributed according to underlying population at risk. Several noncontiguous areas in proximity to productive saline water habitats of Aedes vigilax (Skuse), a recognized vector of RRV, had higher than expected numbers of RRV disease cases and complaints. Disease rates in human populations in areas which had high numbers of adult Ae. vigilax in carbon dioxide- and octenol-baited light traps were up to 2.9 times those in areas that rarely had high numbers of mosquitoes. It was estimated that targeted control of adult Ae. vigilax in these high-risk areas could potentially reduce the RRV disease incidence by an average of 13.6%. Spatial correlation was found between RRV disease risk and complaints from residents of mosquito biting. Based on historical patterns of RRV transmission throughout Redland Shire and estimated future human population growth in areas with higher than average RRV disease incidence, it was estimated that RRV incidence rates will increase by 8% between 2001 and 2021. The use of arbitrary administrative areas that ranged in size from 4.6 to 318.3 km2, has the potential to mask any small scale heterogeneity in disease patterns. With the availability of georeferenced data sets and high-resolution imagery, it is becoming more feasible to undertake spatial analyses at relatively small scales.

Combined external-endonasal approach for complete excision of the lacrimal drainage apparatus

Purpose: The purpose of this study was to describe a new surgical technique for the complete excision of the lacrimal drainage apparatus (LDA) that combines external and endoscopic approaches. Methods: This study involved a noncomparative, retrospective chart review of the clinical and pathological findings of four patients presenting with LDA papillomas who underwent a combined open and endonasal excision of the lacrimal system. Results. Of the four patients, three were male. The mean age at referral was 41 years, and all cases were unilateral. Histopathology revealed two transitional cell papillomas, one squamous cell papilloma, and one combined transitional/squamous papilloma. Epiphora and an external lesion were the main complaints at presentation. Nasolacrimal duct obstruction was present in all four patients. Papilloma virus infection was suggested in two cases and was confirmed in the only patient who had recurrence. CT identified a solid enhancing mass in two cases. The surgical approach in all cases was performed with the patient under general anesthetic supplemented with infiltration of local anesthesia with vasoconstriction. The lacrimal sac was exposed as per an external dacryocystorhinostomy with biopsy collection from the lacrimal sac lumen to confirm the diagnosis prior LDA excision. The superior aspect of the LDA was isolated by using lacrimal probes in each canaliculus to stabilized parallel incisions and careful dissection toward the common canaliculus until they met the medial aspect of the lacrimal sac. The sac was then separated from the periosteum from the medial orbital wall, using sharp dissection. Finally, an endoscopic dissection of the lower end of the nasolacrimal duct released the most inferior aspect of the LDA, allowing the surgeon to pull and excise the complete system from the external wound. Conclusions: Extensive LDA papillomas required complete excision of the drainage system to prevent recurrence and/or malignant transformation. The use of a combined approach through an open excision of the superior part of the LDA in conjunction with the direct manipulation of the nasolacrimal duct guided by the nasal endoscope facilitates the complete excision of the system for extensive benign lesions.

Interaction of psychosocial risk factors explain increased neck problems among female office workers

This study investigated the relationship between psychosocial risk factors and (1) neck symptoms and (2) neck pain and disability as measured by the neck disability index (NDI). Female office workers employed in local private and public organizations were invited to participate, with 333 completing a questionnaire. Data were collected on various risk factors including age, negative affectivity, history of previous neck trauma, physical work environment, and task demands. Sixty-one percent of the sample reported neck symptoms lasting greater than 8 days in the last 12 months. The mean NDI of the sample was 15.5 out of 100, indicating mild neck pain and disability. In a hierarchical multivariate logistic regression, low supervisor support was the only psychosocial risk factor identified with the presence of neck symptoms. Similarly, low supervisor support was the only factor associated with the score on the NDI. These associations remained after adjustment for potential confounders of age, negative affectivity, and physical risk factors. The interaction of job demands, decision authority, and supervisor support was significantly associated with the NDI in the final model and this association increased when those with previous trauma were excluded. Interestingly, and somewhat contrary to initial expectations, as job demands increased, high decision authority had an increasing effect on the NDI when supervisor support was low. Crown copyright (c) 2006 Published by Elsevier B.V. All rights reserved.

Screening for anxiety in mild cognitvely impaired individuals

Anxiety disorders are one of the most common psychiatric complaints across aU age cohorts, including older adults over age 65 (Regier et al., 1988; Regier, Narrow & Rae, 1990). Despite being a common complaint among older adults, anxiety remains underreported by patients and under diagnosed by health professionals (Stanley & Beck, 2000). Anxiety disorders have been less well studied in older adults than depression, both in terms of the assessment as well as treatment. While several anxiet)' inventories have normative data available for older populations, few anxiet)' measures have been specifically designed to be used with older populations. The primar)' aim of this pilot project was to evaluate the utility of a new anxiety screen specifically designed for older adults, the Geriatric Anxiet)' Inventor)' (GAI) on an older cohort with mild cognitive deficits.

SUBVERSÃO E SUBMISSÃO EM HABAKKUK: A conversão do profeta ou duas teologias em conflito?

O livro de Habakkuk retrata um conflito entre a fé do profeta e sua realidade histórica. Enquanto sua teologia descreve YHWH, seu Deus, como alguém que vê a opressão, ouve o clamor do oprimido e o liberta da opressão, a realidade de seus dias era de opressão e clamor por socorro divino, mas YHWH não estava ouvindo o clamor, estava vendo a opressão, mas não está salvando o oprimido. O profeta não consegue entender o que está acontecendo. Finalmente, YHWH lhe responde, mas para anunciar o envio do império neobabilônico para punir os opressores que, a princípio, são pessoas dentre o próprio povo do profeta, ou seja, a elite governante judaíta dos dias do rei Joaquim entre 608 e 598 a.C. O conflito do profeta aumenta, pois, com esta medida, YHWH apenas mudará a opressão de mãos. O profeta insiste em seu clamor por uma intervenção de YHWH que resolva a questão da opressão tanto interna quanto externa. Então a resposta vem. YHWH determinou um dia quando vai ajustar contas com todo tipo de ímpio, seja interno, seja externo. YHWH vai fazer com que suas impiedades se voltem sobre suas próprias cabeças. Esta resposta põe fim ao conflito do profeta. Finalmente, o Deus que vê a opressão, que ouve o clamor do oprimido e age para liberta-lo, está novamente ativo em favor do seu povo. O livro revela que a teologia que move as queixas do profeta endereçadas a YHWH por causa do conflito entre sua fé e sua realidade histórica, é a teologia do Êxodo. O Êxodo é a experiência fundante da fé israelita. Assim, desde o princípio, Israel conheceu YHWH como aquele que ouve o clamor do oprimido, vê sua opressão e age para liberta-lo de seus opressores. Quando a opressão está reinando e YHWH não está agindo e, pior, quando o povo clama por ajuda e YHWH não ouve, se instala o conflito entre a fé e a realidade histórica conforme experimentada pelo profeta Habakkuk. O livro termina com um salmo que celebra o agir poderoso de YHWH que livra o seu povo e luta contra o ímpio. No fim o justo sabe que o seu Deus libertador está ativo e não o abandonou. Por isso, não deve desistir. Deve sim, continuar lutando contra toda sorte de opressão apoiando sua fé incondicional em YHWH e submetendo-se a ele mesmo quando não consegue entender seu modo de agir.

PENSAR A CIBERCULTURA AMBIENTALISTA: Comunicação, mobilização e as estratégias discursivas do Greenpeace Brasil

Nossa Tese postula a existência de uma cibercultura ambientalista, própria do movimento ambiental, que conta com uma dinâmica comunicativa caracterizada por estratégias de discurso e mobilização específicas. O movimento ambiental, aqui representado pela organização de espectro internacional Greenpeace, soube se apropriar das ferramentas digitais, difundir a problemática em um cenário de redes sociais digitais, ciberativismo, interatividade e composição de uma esfera pública em rede, que colocamos em debate. Para entender esse panorama realizamos uma ampla discussão teórica, em permanente diálogo com nosso objeto de estudo, abrangendo a trajetória do ambientalismo e seu lugar enquanto movimento social; as tecnologias da sociabilidade, a Internet e suas mídias como espaço de resistência e controle, assinalando a cibercultura como a própria cultura contemporânea, pautada pelas influências tecnológicas. Realizamos entrevistas com voluntários, seguidores, além de responsáveis pela comunicação do Greenpeace que nos permitiram traçar as motivações da participação e confirmar que o engajamento na causa ambiental foi fortemente impulsionado pelas facilidades do ciberespaço. As estratégias discursivas foram desvendadas com as coordenadas metodológicas da Análise do Discurso, focada na identificação do ethos e das cenas de enunciação, com base em um protocolo de análise que formulamos para compreender a maneira de dizer que leva os sujeitos aderirem maciçamente ao discurso ambiental. Na primeira etapa da análise realizamos diagnóstico de perspectiva quantitativa e caráter exploratório para levantar as campanhas/temáticas principais e avaliar a repercussão dos assuntos nas redes sociais digitais e na mídia convencional. Posteriormente, selecionamos os textos das principais campanhas que passaram pela fase qualitativa, que abarcou os itens lexicais, as técnicas argumentativas e os elementos de destacabilidade, além de aspectos externos ao texto linguístico, como fotos, vídeos, cores e cenas predominantes. O discurso na cibercultura ambiental desvela o ethos do amigo, do parceiro, que oscila entre o drama e a agressividade para chamar atenção à causa. Problemas graves como denúncias ambientais são tratados com um ethos lúdico, até mesmo infantil, usando de linguagem coloquial e de códigos da cultura contemporânea desenhos animados, jogos virtuais, belos animais que cantam e dançam que para os nossos olhos revelam uma cenografia esquizofrênica, mas é justamente o que garante o êxito das campanhas.

A COMUNICAÇÃO INTERPESSOAL COMO REGULADORA DA PERCEPÇÃO DA QUALIDADE DOS SERVIÇOS DE SAÚDE

Quem utiliza, hoje, os serviços de uma organização especializada na área da saúde, encontra pela frente profissionais que desenvolvem atividades assistenciais, cujo exercício está a exigir bem mais do que apenas competência técnica. São médicos, enfermeiros, psicólogos, fisioterapeutas, nutricionistas, terapeutas ocupacionais, assistentes sociais, entre outros, que, além das ações e procedimentos relacionados às suas áreas específicas de conhecimento, têm de estabelecer sempre, com as pessoas que atende, relações de caráter interpessoal. Existe literatura suficiente indicando haver considerável alívio por parte dos pacientes (clientes) e melhoria das condições do trabalho assistencial quando o profissional de saúde está apto a conhecer mais de perto os motivos para muitos dos comportamentos dos seus pacientes. Nessa perspectiva, uma interação para melhor compreender suas necessidades, angústias, raivas e expectativas é de fundamental importância. É também conhecido o fato de que muitas das reclamações e insatisfações dos serviços prestados nessas instituições poderiam ser evitados ou atenuados quando os pacientes se sentem compreendidos e respeitados pelos profissionais envolvidos no seu atendimento. A falta de acolhimento das demandas da clientela e a observação, por parte desta, de que os aspectos emocionais na relação com quem o assiste está sendo negligenciada pode conduzir este paciente, enquanto cliente, à conclusão de que o serviço prestado é de má qualidade. Este estudo terá por objetivo conhecer, dentro do fenômeno da comunicação interpessoal, as modalidades de interações sociais constituídas através dela à formação das exigências, expectativas e percepções desses atores sociais, além do entendimento de como se dá a relação entre paciente e atendente. Para isso, estudaremos os principais conceitos de serviços, qualidade e os fundamentos teóricos do modelo conceitual formulado por PARASURAMAN, ZEITHAML & BERRY e seus posteriores refinamentos , que resultaram na escala Servqual, cuja concepção determina que a qualidade dos serviços de qualquer natureza detectada por uma clientela, resulta do hiato entre as expectativas iniciais e a performance percebida do serviço. A escala Servqual se constituirá assim, no principal instrumento teórico a ser utilizado neste trabalho. Entendendo a sociedade de hoje como uma rede sistêmica, estudaremos, por fim, as lacunas entre as expectativas e percepções de uma clientela específica dos serviços oferecidos por uma empresa hospitalar especializada na área de maternidade. É uma pesquisa na qual se procurará determinar em que dimensões da qualidade a comunicação interpessoal apresenta maior influência, funcionando como um mecanismo regulador da percepção dos serviços prestados sob uma ótica qualitativa.

SINDICATO DOS PROFESSORES DA REDE PÚBLICA DE EDUCAÇÃO DO ESTADO DE SÃO PAULO: COMO VAI O MOVIMENTO NA ERA NEOLIBERAL?

O estudo sociopolítico aqui contido analisa a ausência da participação dos professores do ensino público da rede estadual de São Paulo nos movimentos sindicais, a partir da década de 2000. À desvalorização da carreira e os baixos salários continuam sendo queixas semelhantes ao passado; o que difere é que não há mais movimento como no passado. Para pesquisar tal inércia partimos da observação da participação dos professores nos movimentos sindicais a partir de 1980 até 2009 e dividimos em dois períodos: o primeiro período, que vai de 1980 a 1989 e 1990 a 1999, (porque neles, ocorreram as maiores movimentações da categoria), e um segundo período que vai de 2000 a 2009 (onde se observa claramente o declínio de tais movimentos). O objetivo dessa pesquisa é responder por que o professor atualmente não participa mais dos movimentos sindicais e o que provoca a ausência dos professores nos movimentos da categoria. Faremos a pesquisa com duas gerações de professores distintas: uma geração que vivenciou os movimentos da categoria nas décadas de 1980 e 1990, e que ainda está ativa na rede pública, e outra geração de jovens professores que ingressaram a partir de 2000. A hipótese aqui levantada é a de que as diferenças da origem de classe social dos professores, a formação política e a formação universitária dentro dos moldes neoliberais e a política neoliberal adotada para a educação pública do Estado de São Paulo, foram os fatores que influenciaram o nível de participação dos docentes em movimentos sindicais, gerando diferenças de comportamento reivindicatório entre as gerações. A pesquisa não tem por objetivo a análise das entidades sindicais e sim do pensamento e sentimento dos elementos que compõem esses sindicatos e formam a alma dos movimentos: os professores.

"Well did you feel jealous?" Control and ideology in police interviews with rape complainants

The methods used by the UK Police to investigate complaints of rape have unsurprisingly come under much scrutiny in recent times, with a 2007 joint report on behalf of HM Crown Prosecution Service Inspectorate and HM Inspectorate of Constabulary concluding that there were many areas where improvements should be made. The research reported here forms part of a larger project which draws on various discourse analytical tools to identify the processes at work during police interviews with women reporting rape. Drawing on a corpus of video recorded police interviews with women reporting rape, this study applies a two pronged analysis to reveal the presence of these ideologies. Firstly, an analysis of the discourse markers ‘well’ and ‘so’ demonstrates the control exerted on the interaction by interviewing officers, as they attach importance to certain facts while omitting much of the information provided by the victim. Secondly, the interpretative repertoires relied upon by officers to ‘make sense’ of victim’s accounts are subject to scrutiny. As well as providing micro-level analyses which demonstrate processes of interactional control at the local level, the findings of these analyses can be shown to relate to a wider context – specifically prevailing ideologies about sexual violence in society as a whole.