Relieved after Doctor's Consultation? Primary Health Care Patients' Complaint-related Worries

Worry is one of the central factors in primary health care patients’ experience with their current complaint. Worry is associated with, e.g., patients’ expectations and the outcomes of doctor’s consultations. The aim of this study was to explore primary health care patients’ complaint-related worry and its changes, as well as contributing factors. Furthermore, the reasons behind patients’ pre-consultation worry and possible relief were examined. The study was conducted in a public primary health care centre in Forssa in Southern Finland. Patients, aged 18–39 years, with a current complaint were interviewed before and after a doctor’s consultation. The patients’ characteristics, perceptions of their complaint and their expectations and experiences concerning the consultation were obtained through interviews. In addition, two questionnaires were administered to measure general tendency to illness worry (IWS) and psychiatric symptoms (SCL-90). The patients’ ratings of the intensity of worry and the severity of their complaint were measured with a visual analogue scale (VAS 0–100). Changes in worry were measured by comparing pre- and post-consultation VAS ratings and asking the patients to compare their worry after the consultation with the worry they felt before it. In connection with these ratings the patients also gave reasons for their experiences in their own words. The patients’ doctors assessed the medical severity of the complaints and whether they had found a medical explanation for the complaints. Many patients were very worried before the consultation (65 % scored over 50 points on the VAS). Worry and severity ratings were associated with the duration and course of the complaint, with a general tendency to illness worry and hostility. On average, the patients were less worried after the consultation than before it. Persistent worry was associated with the patients’ uncertainty about their complaint, their perceiving it as severe, expectations for examinations and reporting symptoms of anxiety. Patients were most often worried about the nature of their complaint (e.g. duration or intensity), not knowing what was wrong, the possible harmful effects of the complaint on body functions, the complaint’s prognosis, e.g. will it get better, and their ability to function. Patients were relieved by getting an explanation or treatment or by having a positive view of the complaint’s prognosis. Patients who reported uncertainty (lack of an explanation, worry about the nature of the complaint) or worry about the complaint’s possible bodily harmfulness were relieved by getting an explanation, often accompanied with getting treatment. On the other hand, worries about the ability to function tended to persist. Doctors should bring up patients’ worries for discussion in order to be able to respond to them appropriately. Because it tends to persist, worry about the ability to function should be addressed. Uncertain patients with concerns about their complaint’s bodily harmfulness or psychological consequences need special attention from their doctor.

Primary bone neoplasms in dogs: 90 cases

A retrospective study of necropsy and biopsy cases of 90 primary bone tumors (89 malignant and one benign) in dogs received over a period of 22 years at the Laboratório de Patologia Veterinária, Universidade Federal de Santa Maria, was performed. Osteosarcoma was the most prevalent bone tumor, accounting for 86.7% of all malignant primary bone neoplasms diagnosed. Most cases occurred in dogs of large and giant breeds with ages between 6 and 10-years-old. The neoplasms involved mainly the appendicular skeleton, and were 3.5 times more prevalent in the forelimbs than in the hindlimbs. Osteoblastic osteosarcoma was the predominant histological subtype. Epidemiological and pathological findings of osteosarcomas are reported and discussed.

Density of primary and secondary epidermal laminae of equine hoof

Differences in the microscopic morphology of the hoof in forelimbs and hindlimbs of horses have been scarcely reported in the literature, especially concerning the distribution of primary and secondary epidermal laminae in the different regions. This study aimed to determine the density of primary and secondary epidermal laminae in the hoof of horses. For this, it was used fore and hindlimbs of 16 adult mixed breed horses. With a cross section 0.5 cm above the sole, it was quantified the primary epidermal laminae in the regions of the toe, and of lateral and medial quarters. Fragments with about 1cm ³ were taken from the proximal, middle and distal thirds of the hooves, in the different regions, subjected to conventional histological techniques and examined with an optical microscope. Data were statistically analyzed in relation to the fore and hindlimbs and between their various regions. The density of primary epidermal laminae varied around the hoof circumference, with greater values in the hoof toe, which gradually decreased towards the bulb of the hoof, without difference between thoracic and pelvic limbs. The average density of the secondary epidermal laminae per primary epidermal lamina does not change around the circumference of the hoof. Our findings indicated that the density of epidermal laminae is not different between fore and hindlimbs. The variation in the density of primary epidermal laminae around the hoof seems to be part of an adaptive response to different stresses in each region. A better understanding of the structural morphology contributes to a better understanding of the diagnosis, pathophysiology, and treatment of disorders that affect the hoof.

Morphometry of primary and secondary epidermal laminae in equine hoof

We studied the length of primary and secondary epidermal laminae of the toe and the lateral and medial quarters of horses, distributed into proximal, middle and distal thirds of the hooves. Eight limbs from adult crossbred horses, four females and four males, used to pull carts without pedal conditions. Fragments were taken from different regions of the hooves and subjected to conventional histological techniques. The samples were stained with hematoxylin-eosin and analyzed by light microscopy. The primary epidermal laminae were higher in the hooves of forelimbs compared to hindlimbs in the proximal and middle thirds and the regions of the medial quarter and toe. The secondary laminae were higher in forelimb of the middle third and medial quarter. Comparing the length of the epidermal laminae between hoof parts, it was seen that the primary laminae are lower in the proximal third and higher in the toe, while the secondary laminae are lower in the proximal third and medial quarter. The results suggested that the morphology of the laminae in the different regions of the hooves is influenced through the work performed by the animal, as well as through the different distribution of forces.

Pasteurella multocida type A as the primary agent of pneumonia and septicaemia in pigs

Abstract: In order to understand better the pathological aspects and spread of Pasteurella multocida type A as the primary cause of pneumonia in pigs, was made an experiment with intranasal inoculation of different concentrations of inocula [Group (G1): 108 Colony Forming Units (CFU)/ml; G2: 107 CFU/ml; G3: 106 CFU/ml and G4: 105 CFU/ml], using two pigs per group. The pigs were obtained from a high health status herd. Pigs were monitored clinically for 4 days and subsequently necropsied. All pigs had clinical signs and lesions associated with respiratory disease. Dyspnoea and hyperthermia were the main clinical signs observed. Suppurative cranioventral bronchopneumonia, in some cases associated with necrosuppurative pleuropneumonia, fibrinous pericarditis and pleuritic, were the most frequent types of lesion found. The disease evolved with septicaemia, characterized by septic infarctions in the liver and spleen, with the detection of P. multocida type A. In this study, P. multocida type A strain #11246 was the primary agent of fibrinous pleuritis and suppurative cranioventral bronchopneumonia, pericarditis and septicaemia in the pigs. All concentrations of inoculum used (105-108 CFU/ml) were able to produce clinical and pathological changes of pneumonia, pleuritis, pericarditis and septicemia in challenged animals.

Primary and secondary development of Cyperus giganteus Vahl rhizome (Cyperaceae)

In Cyperus giganteus, like in other Monocotyledoneae, the protoderm, procambium, fundamental meristem and primary thickening meristem (PTM) are differentiated from the rhizome promeristem. The PTM produces the inner cortical parenchyma, endodermis, pericycle and amphivasal vascular bundles, which are formed by the procambium too. After the primary body differentiates, cellular divisions continue only in the pericycle, and originate an irregular vascular system with vessel elements shorter and more branched than those found in the primary growth. This change of activity in the pericycle defines a secondary growth, where the secondary thickening meristem (STM) is the pericycle itself.

Primary and Revision Hip Replacement. A University Hospital Database and Registry Study

Large-headed total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) with metal-on-metal (MoM) bearings became popular during the last decade. Recently, it has become evident that the large-head MoM hip implants are associated with increased revision rates despite their theoretical advantages. The purpose of this study was to evaluate the early results of primary MoM hip replacements and of acetabular revisions. I analyzed retrospectively the results of four MoM implant designs and the survival rate of acetabular revisions with impaction bone grafting, as documented in the Turku University Hospital database. Further, I evaluated the correlation between femoral head size and dislocation rate, and used the Finnish Arthroplasty Register data to compare the survival of three large-head MoM THAs to analogous HRAs. The early results for the Magnum M2A–ReCap THA were good. A larger head size decreased the risk of dislocation. Articular surface replacement (ASR) THA yielded inferior results compared to analogous HRA. For two other designs the results were similar. The R3–Synergy THA yielded inferior results compared to the reference implants. The survival of acetabular reconstructions with impaction bone grafting was inferior compared to previous reports. In conclusion, the early results of the Biomet ReCap–Magnum design were promising, and large head sizes decreased the dislocation rate. The survival of different MoM hip implant designs varied. The survival of new designs and techniques may be inferior to those reported by the clinics where implants are developed. An important caveat is that early promising results of new devices may rapidly worsen. New implants need to be introduced in a controlled fashion to the market; here, arthroplasty registers are a valuable tool that needs to be used.

Temporal variations in the primary productivity of Eleocharis acutangula (Cyperaceae) in a tropical wetland environment

Wetland vegetation typically includes aquatic macrophytes with high primary production capacities. The present study investigated how hydrological variations affect biomass allocation and primary productivity in the emergent macrophyte Eleocharis acutangula (Roxb.) Schult. Eleocharis acutangula ramets were collected from the Campelo Lagoon flood plain (21°39'S, 41°12'W and 21°37S, 41°11'W) between March/2005 and February/2006. This region experienced an unusually short rainy period between November/2005 and February/2006 that generated atypically high primary production levels (128gDWm-2month-1) and total biomass gains (447gDWm-2) in May and June/2005 respectively. Our data indicated that primary production and biomass allocation were strongly influenced by variations in wetland water levels and that macrophytes quickly invested in biomass accumulation when surface water levels rised.

Cytogenetic study of 50 Brazilian patients with primary myelodysplastic syndrome

In this work we analyzed cytogenetically 50 patients with primary myelodysplastic syndrome from several hospitals of Rio de Janeiro, Brazil. The frequency of cytogenetic abnormalities was 32%. Patients with refractory anemia, or refractory anemia with ringed sideroblasts, presented normal karyotypes or single abnormalities such as del(5q) or -Y, while patients with refractory anemia with an excess of blasts, refractory anemia with an excess of blasts in transformation or chronic myelomonocytic leukemia showed complex karyotypes and single abnormalities involving chromosomes 7 or 8, which are related to a bad prognosis and an elevated risk of evolution to acute myeloid leukemia.

Deletion/inversion in the X-chromosome and increased telomeric associations in a female with primary amenorrhea

We describe a new case of a partial interstitial deletion and inversion of the long arm of the X-chromosome associated with a high incidence of telomeric associations in an 18-year old female who showed underdeveloped secondary sex characteristics, including small breasts and primary amenorrhea. Her karyotype was considered to be 46,X,del(Xq13 -> q22)inv(X)(q23-q27). The buccal mucosal cells showed absence of a typical Barr body, and the 5’-bromo-2-deoxyuridine incorporation studies revealed that neither the normal X-nor the abnormal X-chromosome was late replicating. The case is being presented for its extreme rarity

Upper esophageal sphincter pressure in patients with Chagas' disease and primary achalasia

The most important component of the upper esophageal sphincter (UES) is the cricopharyngeal muscle. During the measurement of sphincter pressure the catheter passed through the sphincter affects the pressure value. In Chagas' disease and primary achalasia there is an esophageal myenteric plexus denervation which may affect UES pressure. We measured the UES pressure of 115 patients with Chagas' disease, 28 patients with primary achalasia and 40 healthy volunteers. We used a round manometric catheter with continuous perfusion and the rapid pull-through method, performed in triplicate during apnea. Pressures were measured in four directions, and the direction with the highest pressure (anterior/posterior) and the average of the four directions were measured. The highest UES pressure in Chagas' disease patients without abnormalities upon radiologic esophageal examination (N = 63) was higher than in normal volunteers (142.8 ± 47.4 mmHg vs 113.0 ± 46.0 mmHg, mean ± SD, P<0.05). There was no difference in UES pressure between patients with primary achalasia and patients with Chagas' disease and similar esophageal involvement and normal volunteers (P>0.05). There was no difference between patients with or without esophageal dilation. In the group of subjects less than 50 years of age the UES pressure of primary achalasia (N = 21) was lower than that of Chagas' disease patients with normal radiologic esophageal examination (N = 41), measured at the site with the highest pressure (109.3 ± 31.5 mmHg vs 149.6 ± 45.3 mmHg, P<0.01) and as the average of the four directions (64.2 ± 17.1 mmHg vs 83.5 ± 28.6 mmHg, P<0.05). We conclude that there is no difference in UES pressure between patients with Chagas' disease, primary achalasia and normal volunteers, except for patients with minor involvement by Chagas' disease, for whom the UES pressure at the site with the highest pressure was higher than the pressure of normal volunteers and patients with primary achalasia.

Experiences among primary school teachers in Tanzania

The overall aim of the study was to explore primary school teachers’ experiences of constraints to their work, and actions taken for improvement after undergoing in-service courses in the Education Quality Improvement through Pedagogy program. The research interest was thus to deepen the understanding of teachers’ experiences of constraints to their work and experiences of actions taken to improve classroom actions. In order to achieve this ambition, the study was conducted with primary school teachers in Shinyanga district-Tanzania. Two research questions guided the study: What do teachers experience as constraints to their work? The second: How have teachers improved their classroom actions after undergoing professional development courses? The theoretical framework of the study is centred on limiting and enabling frames on teachers’ work and professional development. In order to understand the classroom situations, qualitative research was designed applying a phenomenological approach with semi-structured interview, observation and videotaping to collect data. Forty experienced primary school teachers from ten primary schools participated in the study. The results of the first research question indicate that teachers face many constraints in their work. Three categories identified as interactional, environmental and professional role constraints. The most critical experienced by all teachers is teaching in large classes and inadequate teaching and learning materials. The results of the second research question show that teachers’ actions taken for improving their work were influenced by professional development activities. Three main categories including expanded interaction, expanded use of environment and expanded professional roles were identified. Generally, the knowledge generated is relevant for viewing teachers’ experiences of the challenges they encounter in teaching and the importance of professional development beyond the sampled respondents. The results suggest that constant provision of teachers’ professional development could improve teaching performance.

Circulating forms of parathyroid hormone detected with an immunofluorometric assay in patients with primary hyperparathyroidism and in hyperparathyroidism secondary to chronic renal failure

In patients with uremia, intact parathyroid hormone (PTH) measurement appears to overestimate the biologically active hormone in circulation. The recent description of the accumulation in these patients of a non-intact PTH form measured by the standard immunometric assays, re-opened the question. In this study we submitted serum samples from 7 patients with primary hyperparathyroidism (PHP) and from 10 patients with hyperparathyroidism secondary to chronic renal failure (SHP) to preparative HPLC in order to discriminate the molecular forms measured by our currently used immunofluorometric assay for intact PTH. The elution profile obtained with the HPLC system showed two clearly defined peaks, the first one corresponding to a lower molecular weight form, and the second to the intact PTH (1-84) form. In patients with SHP the area under the curve for the first peak (mean 29.5%, range 20.6 to 40.4%) was significantly greater than that observed for patients with PHP (mean 15.6%, range 5.6 to 21.9%). This confirms previous studies showing accumulation of molecular forms of slightly lower molecular weight, presumably PTH (7-84), in patients with SHP and, to a lesser extent, in patients with PHP. The real necessity of assays that discriminate between these two molecular forms is debatable.

Advanced epithelial ovarian cancer – studies on preoperative [18F] FDG PET/CT and HE4 profile during primary chemotherapy

Epithelial ovarian cancer (EOC) is usually diagnosed in an advanced stage. The prognosis depends highly on the amount of the residual tumor in surgery. In patients with extensive disease, neoadjuvant chemotherapy (NACT) is used to diminish the tumor load before debulking surgery. New non-invasive methods are needed to preoperatively evaluate the disease dissemination and operability. [18F] FDG PET/CT (Positron emission tomography/computed tomography) is a promising method for cancer diagnostics and staging. The biomarker profiles during treatment can predict patient’s outcome. This prospective study included 41 EOC patients, 21 treated with primary surgery and 20 with NACT and interval surgery. The performances of preoperative contrast enhanced PET/CT (PET/ceCT) and diagnostic CT (ceCT) were compared. Perioperative visual estimation of tumor spread was studied in primary and interval surgery. The profile of the serum marker HE4 (Human epididymis 4) during primary chemotherapy was evaluated. In primary surgery, surgical findings were found to form an adequate reference standard for imaging studies. After NACT, the sensitivity for visual estimation of cancer dissemination was significantly worse. Preoperative PET/ceCT was more effective than ceCT alone in detecting extra-abdominal disease spread. The high number of supradiaphragmatic lymph node metastases detected by PET/ceCT at the time of diagnosis brings new insight in EOC spread patterns. The sensitivity of both PET/CT and ceCT remained modest in intra-abdominal areas important to operability. The HE4 profile was in concordance with the CA125 profile during primary chemotherapy. Its role in the evaluation of EOC chemotherapy response will be clarified in further studies.