Patients satisfaction in an academic walk-in centre : a new model of residents training achieved by family doctors

Introduction Walk-in centers may improve access to healthcare for some patients, due to their convenient location and extensive opening hours, with no need for appointment. Herein we describe and assess a new model of walk-in centre, characterized by care provided by residents and supervision achieved by experienced family doctors. Main aim of the study was to assess patients satisfaction about the care they received from residents and the supervision by family doctors. Secondary aim was to describe walk-in patients demographic characteristics and to identify potential associations with satisfaction. Methods The study was conducted in the walk-in centre of Lausanne. Patients who consulted between in April 2011 were automatically included and received a questionnaire in French. We used a five-point Likert scale, from "not at all satisfied" to "very satisfied", converted from 1 to 5. We focused on the satisfaction regarding residents care and supervision by a family doctor. The former was divided in three categories: "Skills", "Treatment" and "Behaviour". Mean satisfaction was calculated for each category and a multivariable logistic model was applied in order to identify associations among patients demographics. Results Response rate was 47% [184/395], Walk-in patients were more likely to be women, young, with a high education level. Patients were very satisfied with residents care, with median satisfaction between 4.5 and 5, for each category. Over than 90% of patients were "satisfied" or "very satisfied" that a family doctor was involved in the consultation. Age showed the major association of satisfaction. Discussion Patients were highly satisfied with care provided by residents and with involvement of a family doctor in the consultation. Older age showed the major association with satisfaction with a positive impact. The high satisfaction reported by walk-in patients supports this new model of walk-in centre.

Laboratory evaluation of methanolic extract of Atlantia monophylla (Family: Rutaceae) against immature stages of mosquitoes and non-target organisms

Methanolic extracts of the leaves of Atlantia monophylla (Rutaceae) were evaluated for mosquitocidal activity against immature stages of three mosquito species, Culex quinquefasciatus, Anopheles stephensi, and Aedes aegypti in the laboratory.Larvae of Cx. quinquefasciatus and pupae of An. stephensi were found more susceptible, with LC50 values of 0.14 mg/l and 0.05 mg/l, respectively. Insect growth regulating activity of this extract was more pronounced against Ae. aegypti, with EI50 value 0.002 mg/l. The extract was found safe to aquatic mosquito predators Gambusia affinis, Poecilia reticulata, and Diplonychus indicus, with the respective LC50 values of 23.4, 21.3, and 5.7 mg/l. The results indicate that the mosquitocidal effects of the extract of this plant were comparable to neem extract and certain synthetic chemical larvicides like fenthion, methoprene, etc.

Bonding and Bridging Social Capital in Step- and First-Time Families and the Issue of Family Boundaries

Divorce and remarriage usually imply a redefinition of family boundaries, with consequences for the production and availability of social capital. This research shows that bonding and bridging social capitals are differentially made available by families. It first hypothesizes that bridging social capital is more likely to be developed in stepfamilies, and bonding social capital in first-time families. Second, the boundaries of family configurations are expected to vary within stepfamilies and within first-time families creating a diversity of family configurations within both structures. Third, in both cases, social capital is expected to depend on the ways in which their family boundaries are set up by individuals by including or excluding ex-partners, new partner's children, siblings, and other family ties. The study is based on a sample of 300 female respondents who have at least one child of their own between 5 and 13 years, 150 from a stepfamily structure and 150 from a first-time family structure. Social capital is empirically operationalized as perceived emotional support in family networks. The results show that individuals in first-time families more often develop bonding social capital and individuals in stepfamilies bridging social capital. In both cases, however, individuals in family configurations based on close blood and conjugal ties more frequently develop bonding social capital, whereas individuals in family configurations based on in-law, stepfamily or friendship ties are more likely to develop bridging social capital.

1.5 m for Finglas Addiction Support Team (FAST)

Noel Ahern T.D., Minister of State at the Department of Community, Rural and Gaeltacht Affairs with responsibility for the National Drugs Strategy, has announced funding of €1.5m under the Premises Initiative Fund to Finglas Addiction Support Team (FAST). FAST is a community-based initiative funded by the Department of Community, Rural & Gaeltacht Affairs under the National Drugs Strategy through Finglas/Cabra Local Drugs Task Force.This resource was contributed by The National Documentation Centre on Drug Use.

The serine repeat antigen (SERA) gene family phylogeny in Plasmodium: the impact of GC content and reconciliation of gene and species trees.

Plasmodium falciparum is the parasite responsible for the most acute form of malaria in humans. Recently, the serine repeat antigen (SERA) in P. falciparum has attracted attention as a potential vaccine and drug target, and it has been shown to be a member of a large gene family. To clarify the relationships among the numerous P. falciparum SERAs and to identify orthologs to SERA5 and SERA6 in Plasmodium species affecting rodents, gene trees were inferred from nucleotide and amino acid sequence data for 33 putative SERA homologs in seven different species. (A distance method for nucleotide sequences that is specifically designed to accommodate differing GC content yielded results that were largely compatible with the amino acid tree. Standard-distance and maximum-likelihood methods for nucleotide sequences, on the other hand, yielded gene trees that differed in important respects.) To infer the pattern of duplication, speciation, and gene loss events in the SERA gene family history, the resulting gene trees were then "reconciled" with two competing Plasmodium species tree topologies that have been identified by previous phylogenetic studies. Parsimony of reconciliation was used as a criterion for selecting a gene tree/species tree pair and provided (1) support for one of the two species trees and for the core topology of the amino acid-derived gene tree, (2) a basis for critiquing fine detail in a poorly resolved region of the gene tree, (3) a set of predicted "missing genes" in some species, (4) clarification of the relationship among the P. falciparum SERA, and (5) some information about SERA5 and SERA6 orthologs in the rodent malaria parasites. Parsimony of reconciliation and a second criterion--implied mutational pattern at two key active sites in the SERA proteins-were also seen to be useful supplements to standard "bootstrap" analysis for inferred topologies.

Pédiatrie. 5. Le partage de l'information médicale en 2012 [Pediatrics. Sharing of the medical letter with the patient].

Some paediatrics centres routinely send the medical consultation letter not only to the primary or referring physician but to the patient and his/her family as well. This way of sharing medical information is appreciated not only by the patients themselves but also by a majority of physicians.

Characterization of the rice PHO1 gene family reveals a key role for OsPHO1;2 in phosphate homeostasis and the evolution of a distinct clade in dicotyledons.

Phosphate homeostasis was studied in a monocotyledonous model plant through the characterization of the PHO1 gene family in rice (Oryza sativa). Bioinformatics and phylogenetic analysis showed that the rice genome has three PHO1 homologs, which cluster with the Arabidopsis (Arabidopsis thaliana) AtPHO1 and AtPHO1;H1, the only two genes known to be involved in root-to-shoot transfer of phosphate. In contrast to the Arabidopsis PHO1 gene family, all three rice PHO1 genes have a cis-natural antisense transcript located at the 5 ' end of the genes. Strand-specific quantitative reverse transcription-PCR analyses revealed distinct patterns of expression for sense and antisense transcripts for all three genes, both at the level of tissue expression and in response to nutrient stress. The most abundantly expressed gene was OsPHO1;2 in the roots, for both sense and antisense transcripts. However, while the OsPHO1;2 sense transcript was relatively stable under various nutrient deficiencies, the antisense transcript was highly induced by inorganic phosphate (Pi) deficiency. Characterization of Ospho1;1 and Ospho1;2 insertion mutants revealed that only Ospho1;2 mutants had defects in Pi homeostasis, namely strong reduction in Pi transfer from root to shoot, which was accompanied by low-shoot and high-root Pi. Our data identify OsPHO1;2 as playing a key role in the transfer of Pi from roots to shoots in rice, and indicate that this gene could be regulated by its cis-natural antisense transcripts. Furthermore, phylogenetic analysis of PHO1 homologs in monocotyledons and dicotyledons revealed the emergence of a distinct clade of PHO1 genes in dicotyledons, which include members having roles other than long-distance Pi transport.

Association of the presence of residual anti-Toxoplasma gondii IgM in pregnant women and their respective family groups in Miracema, Northwest Rio de Janeiro, Brazil

The seroprevalence of toxoplasmosis in 832 pregnant women in Miracema, Rio de Janeiro, was determined and 75.1% (625) and 2.0% (17) were anti-Toxoplasma gondii IgG and IgM positive, respectively. Out of the 17 IgM positive pregnant women, only one had low avidity IgG corresponding to the acute phase of the infection. All the other women presented with high avidity IgG and also presented with residual IgM anti-T. gondii. Of this sample, 106 received home visits (this includes 11 family nuclei of pregnant women with residual IgM anti-T. gondii, 68 nuclei of only IgG positive pregnant women and 27 nuclei of pregnant women with no antibodies to anti-T. gondii), resulting in 267 individuals visited. Out of these 267 individuals, 21 were positive for IgG and IgM anti-T. gondii and were candidates for the IgG avidity test. All of them presented with high avidity IgG and residual IgM. Five of these IgM+ individuals were (5/238; 2.1%) relatives of IgM negative pregnant women. The other 16 (16/29; 55.2%) were relatives of IgM+ pregnant women who were positive for residual IgM anti-T. gondii. This association was statistically significant (p = 0.0000). The analysis presented herein raises questions regarding the presence of residual IgM anti-T. gondii such as genetic determinants or even constant antigenic stimuli for the same family cluster.

Family history of cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.

Alcohol and tobacco consumption are well-recognized risk factors for head and neck cancer (HNC). Evidence suggests that genetic predisposition may also play a role. Only a few epidemiologic studies, however, have considered the relation between HNC risk and family history of HNC and other cancers. We pooled individual-level data across 12 case-control studies including 8,967 HNC cases and 13,627 controls. We obtained pooled odds ratios (OR) using fixed and random effect models and adjusting for potential confounding factors. All statistical tests were two-sided. A family history of HNC in first-degree relatives increased the risk of HNC (OR=1.7, 95% confidence interval, CI, 1.2-2.3). The risk was higher when the affected relative was a sibling (OR=2.2, 95% CI 1.6-3.1) rather than a parent (OR=1.5, 95% CI 1.1-1.8) and for more distal HNC anatomic sites (hypopharynx and larynx). The risk was also higher, or limited to, in subjects exposed to tobacco. The OR rose to 7.2 (95% CI 5.5-9.5) among subjects with family history, who were alcohol and tobacco users. A weak but significant association (OR=1.1, 95% CI 1.0-1.2) emerged for family history of other tobacco-related neoplasms, particularly with laryngeal cancer (OR=1.3, 95% CI 1.1-1.5). No association was observed for family history of nontobacco-related neoplasms and the risk of HNC (OR=1.0, 95% CI 0.9-1.1). Familial factors play a role in the etiology of HNC. In both subjects with and without family history of HNC, avoidance of tobacco and alcohol exposure may be the best way to avoid HNC.

Inter-informant agreement and prevalence estimates for mood syndromes: Direct interview vs. family history method.

BACKGROUND: The use of the family history method is recommended in family studies as a type of proxy interview of non-participating relatives. However, using different sources of information can result in bias as direct interviews may provide a higher likelihood of assigning diagnoses than family history reports. The aims of the present study were to: 1) compare diagnoses for threshold and subthreshold mood syndromes from interviews to those relying on information from relatives; 2) test the appropriateness of lowering the diagnostic threshold and combining multiple reports from the family history method to obtain comparable prevalence estimates to the interviews; 3) identify factors that influence the likelihood of agreement and reporting of disorders by informants. METHODS: Within a family study, 1621 informant-index subject pairs were identified. DSM-5 diagnoses from direct interviews of index subjects were compared to those derived from family history information provided by their first-degree relatives. RESULTS: 1) Inter-informant agreement was acceptable for Mania, but low for all other mood syndromes. 2) Except for Mania and subthreshold depression, the family history method provided significantly lower prevalence estimates. The gap improved for all other syndromes after lowering the threshold of the family history method. 3) Individuals who had a history of depression themselves were more likely to report depression in their relatives. LIMITATIONS: Low proportion of affected individuals for manic syndromes and lack of independence of data. CONCLUSIONS: The higher likelihood of reporting disorders by affected informants entails the risk of overestimation of the size of familial aggregation of depression.

Health-related quality of life assessment in people with multiple sclerosis and their family caregivers. A multicenter study in Catalonia (Southern Europe)

Objectives: To measure the health-related quality of life (HRQoL) of multiple sclerosis (MS) patients and their caregivers, and to assess which factors can best describe HRQoL. Methods: A cross-sectional multicenter study of nine hospitals enrolled MS patients and their caregivers who attended outpatient clinics consecutively. The instruments used were the SF-36 for patients and the SF-12 and GHQ-12 for caregivers. Classification and regression tree analysis was used to analyze the explanatory factors of HRQoL. Results: A total of 705 patients (mean age 40.4 years, median Expanded Disability Status Scale 2.5, 77.8% with relapsing-remitting MS) and 551 caregivers (mean age 45.4 years) participated in the study. MS patients had significantly lower HRQoL than in the general population (physical SF-36: 39.9; 95% confidence interval [CI]: 39.1–40.6; mental SF-36: 44.4; 95% CI: 43.5–45.3). Caregivers also presented lower HRQoL than general population, especially in its mental domain (mental SF-12: 46.4; 95% CI: 45.5–47.3). Moreover, according to GHQ-12, 27% of caregivers presented probable psychological distress. Disability and co-morbidity in patients, and co-morbidity and employment status in caregivers, were the most important explanatory factors of their HRQoL. Conclusions: Not only the HRQoL of patients with MS, but also that of their caregivers, is indeed notably affected. Caregivers’ HRQoL is close to population of chronic illness even that the patients sample has a mild clinical severity and that caregiving role is a usual task in the study context

Study of the SRR1-gene family in Arabidopsis, yeast and mouse cells

Abstract: Light is a very important environmental cue for plants. In addition to the energy for photosynthesis, it also provides information that is essential for many processes including seed germination, seedlings development, neighbours detection or transition from the vegetative to the reproductive state. Plants evolved different photoreceptors, among which the phytochromes (PHY), which are red/far-red photoreceptors. This family is composed of 5 members in Arabidopsis thaliana, among which phyB plays the major role for detection of red light. Phytochromes are also able to reset the phase of the circadian clock, which is composed of a complicated network of genes able to produce rhythms of about 24 hours, even in constant conditions. SRR1 (Sensitivity to Red light Reduced) is a gene that was shown to act in the phyB pathway as well as in the circadian clock. It was proposed to play a role in the maintenance of rhythms of the core oscillator because of the circadian phenotype of the srr1 mutant in constant light and in constant darkness. In the present study, we present data confirming the role of SRR1 in the core oscillator. Moreover, we show that SRR1 levels are not limiting for circadian rhythms nor for light perception. We show that the protein levels, the sub-cellular localisation or the complex in which SRR1 is found are not regulated in a circadian manner. Orthologues of SRR1 exist in numerous eukaryotes, forming a new gene family. None of the members of this family have been described. Here, we present data suggesting that the mouse orthologue of SRR1 may not be required for oscillation of the circadian clock of mouse cells in culture. The yeast gene (called BER1 for Benomyl REsistant) was studied to understand the biochemical function of this gene family. Based on synthetic genetic screens, a role of Ber1 was inferred in microtubules dynamics, N-terminal acetylation of protein and proteasome biogenesis. The effect of Ber1 on microtubules was confirmed by the observation that the ber1Δ mutant is more resistant to microtubule-depolymerising drugs and microscopic examination of microtubules in ber 1 Δ mutants. Complementation assays of ber1 Δ mutants and srrl mutants failed to reveal any obvious functional conservation of the mouse, yeast and Arabidopsis orthologues. In conclusion, the SRR1 family might encode genes that either plays different roles in different organisms, or have similar biochemical function but are involved in diverse pathway. Résumé: La lumière est un des facteurs abiotiques les plus important pour les plantes. En plus de l'énergie fournie pour la photosynthèse, elle fourni également de l'information nécessaire pour différents processus comme la germination, le développement des jeunes plantules, la détection de plantes avoisinantes ou encore la transition entre le développement végétatif et reproductif. Plusieurs types de photorécepteurs sont apparus chez les plantes au cours de l'évolution, notamment les phytochromes (PHI, qui perçoivent la lumière rouge et rouge lointaine. Cette famille est composé de 5 membres chez Arabidopsis thaliana, parmi lesquels phyB est le principal récepteur pour la lumière rouge. Les phytochromes sont aussi utiles pour la synchronisation entre les cycles jour-nuit dus à la rotation de la terre et l'horloge circadienne. Cette dernière est composée d'un réseau compliqué qui permet la production de rythmes capables de perdurer même en conditions constantes. SRRI (Sensitivity to Red light Reduced) est un gène qui agit dans la voie de signalisation de phyB ainsi que dans l'horloge circadienne. Il a été proposé que SRRI joue un rôle dans la maintenance des rythmes de l'oscillateur principal à cause des phénotypes circadiens du mutant srrl observés en lumière et en obscurité continue. Dans ce travail, nous présentons des données confirmant le rôle de SRR1 dans l'oscillateur principal. Nous montrons que les niveaux d'expression de SRRI ne sont pas limitants pour les rythmes circadiens ou la perception de la lumière. Enfin, nous montrons que le niveau d'accumulation de la protéine, sa localisation subcellulaire ou encore la taille du complexe dans lequel SRRl est trouvé ne sont pas régulés de façon circadiennes. Des orthologues de SRRI existent chez de nombreux eucaryotes, formant une nouvelle famille de gènes. Aucun des membres de cette famille n'a été étudié avant ce travail. Nous présentons des données suggérant que l'orthologue de la souris n'est peut-être pas requis pour les oscillations de l'horloge circadienne de cellules de souris en culture. Le gène de la levure (appelé SERI pour Benomyl REsistant) a été étudié afin de mieux comprendre la fonction biochimique de cette famille de gène. Une analyse par crible synthétique léthal a révélé un rôle de Ber1 dans la dynamique des microtubules, l'acétylation des protéines en N-terminal et la biogenèse du protéasome. L'effet de Ber1 sur les microtubules a été confirmé par l'observation du mutant ber1 en présence de drogue capable de dépolymériser les microtubules. Celui-ci est plus résistant à ces drogues que le type sauvage. Des expériences de complémentation n'ont pas montré de conservation de la fonction entre SRRI et ses homologues de souris ou de levure. En conclusion, la famille SRRI code pour des gènes qui pourraient avoir soit des rôles différents selon les organismes, soit la même fonction biochimique mais qui serait utile pour des voies de signalisation différentes.

Control of the peroxisomal beta-oxidation pathway by a novel family of nuclear hormone receptors.

Three novel members of the Xenopus nuclear hormone receptor superfamily have been cloned. They are related to each other and similar to the group of receptors that includes those for thyroid hormones, retinoids, and vitamin D3. Their transcriptional activity is regulated by agents causing peroxisome proliferation and carcinogenesis in rodent liver. All three Xenopus receptors activate the promoter of the acyl coenzyme A oxidase gene, which encodes the key enzyme of peroxisomal fatty acid beta-oxidation, via a cognate response element that has been identified. Therefore, peroxisome proliferators may exert their hypolipidemic effects through these receptors, which stimulate the peroxisomal degradation of fatty acids. Finally, the multiplicity of these receptors suggests the existence of hitherto unknown cellular signaling pathways for xenobiotics and putative endogenous ligands.

Excessive alcohol consumption in young men: is there an association with their earlier family situation? A baseline-analysis of the C-SURF-study (Cohort Study on Substance Use Risk Factors).

AIMS: To determine whether parental factors earlier in life (parenting, single parent family, parental substance use problem) are associated with patterns of alcohol consumption among young men in Switzerland. METHODS: This analysis of a population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF) included 5,990 young men (mean age 19.51 years), all attending a mandatory recruitment process for the army. These conscripts reported on parental monitoring and rule-setting, parental behaviour and family structure. The alcohol use pattern was assessed through abstention, risky single occasion drinking (RSOD), volume drinking and dependence. Furthermore, the impact of age, family socio-economic status, educational level of the parents, language region and civil status was analysed. RESULTS: A parental substance use problem was positively associated with volume drinking and alcohol dependence in young Swiss men. Active parenting corresponded negatively with RSOD, volume drinking and alcohol dependence. Single parent family was not associated with a different alcohol consumption pattern compared to standard family. CONCLUSION: Parental influences earlier in life such as active parenting (monitoring, rule-setting and knowing the whereabouts) and perceived parental substance use problem are associated with alcohol drinking behaviour in young male adults. Therefore, health professionals should stress the importance of active parenting and parental substance use prevention in alcohol prevention strategies.