Follow-up Inquiry Research Articles

Parenteral Nutrition Order Entry Privileges for Registered Dietitians: Unique Approach to Improve Patient Outcomes

Methods: The National MS Society and The MS Foundation were used for recruitment. Participants completed an online survey, demographic questionnaire including supplementation habits, and the MS Quality of Life-54 (Vickrey et al., 1995). Participants also completed their 3-day food record utilizing MyPyramid Tracker and follow-up inquiry evaluated strengths and weaknesses of MyPyramid Tracker. Results: Participants, (n23) ranged 24 to 64 years old (M 44.3 years). Majority, white (91.3%), married (73.9%) and diagnosed with Relapsing-Remitting MS (87%). Increased consumption of milk, protein, riboflavin, vitamin B12, calcium, phosphorus and zinc showed a statistically significant positive correlation to overall QOL scores (p 0.05). Participants who met or exceeded their specific Recommended Dietary Allowance (RDA) for vitamin B6, calcium, zinc and selenium also showed higher statistically significant overall QOL scores than individuals who did not met or exceed the RDA for those micronutrients (p 0.05). Fat consumption (saturated or unsaturated) indicated no significant correlation to overall QOL scores. Conclusions: Dietary intake studies could assist in producing dietary guidelines for individuals with MS, which are absent from the Nutrition Care Manual. Efforts of nutrition professionals could focus on improving the individual’s QOL through specific macro and micronutrient recommendations.

Home Care Workers in Maine: Increasingly Essential Workers Face Difficult Job Conditions

As the population in Maine ages, the need for home care workers is increasing. Turnover is high in this field and the longitudinal Home Care Retention Study (HCWRS; n = 261) reported herein examined predictors of turnover and work experiences of home care aides in Maine. Younger age, lack of health insurance and poorer mental health were among the predictors of termination for the 90 study participants who left their jobs. In telephone interviews, they spoke of low wages, inconsistent hours, unreimbursed mileage and poor communication with employers in describing why they had left their jobs. A follow-up inquiry with 31 of the HCWRS study participants who were aged 63 to 80 provides information on how the job is experienced by older workers—those most likely to stay in the field. The article concludes with current policy activity affecting home care workers in Maine.

Locking Compression Plate Osteosynthesis of Sacral Fractures in Three Heifers

To describe a technique used for reduction and internal fixation of sacral fractures in cattle. Case series. Three heifers aged 19-32 months with deformation of the tail head and tail paralysis attributable to a closed fracture of S5 or S4 and S5. Fractures were reduced and repaired under general anesthesia. A narrow, 6-10-hole, locking compression plate (LCP) was placed on the spinous processes of S5 and the first coccygeal (Co1) using 5.0 mm locking head screws. Follow-up inquiries were made by telephone (3/3), and cows were examined clinically and radiographically 2 (1 cow) to 9 (1 cow) months postoperatively. No complications were encountered. The range of movement of the tail improved so that soiling of the tail during defecation was no longer a problem. In all heifers, the normal top line was restored and there was no narrowing of the pelvic canal. Unassisted calving occurred in all heifers, and follow-up radiographs for 2 cows showed complete fracture healing. LCP-osteosynthesis of the spinous processes provided sufficient stability for internal fixation of sacral fractures. Marked improvement in tail function occurred postoperatively without decompression by laminectomy.

Are active sun exposure habits related to lowering risk of type 2 diabetes mellitus in women, a prospective cohort study?

Aim An inverse relationship exists between vitamin D levels and diabetes mellitus. However, little is known about the correlation of sun exposure habits and type 2 diabetes mellitus (DM). Methods A South Swedish cohort study comprising 1000 women from each age group between 25 and 64 ( n = 40,000) drawn from the Southern Swedish population registry 1990–1992. At the inception of the study 74% answered the inquiry ( n = 29,518) and provided detailed information on their sun exposure habits and other variables. A follow-up inquiry was sent 2000–2002 which 24,098 women answered. The mean follow-up time was 11 years. Logistic regression analysis was used and the main outcome was the relationship between type 2 DM and sun exposure habits. Results Our findings indicated that women with active sun exposure habits were at a 30% lower risk of having DM, as compared to those with non-active habits. There was an inverse relation between this risk reduction and BMI. Conclusion Our investigation gives possible epidemiological explanation to ethnic and seasonal differences in type 2 DM and metabolic control. The study supports that sunlight is involved in the glucose metabolism.

A population-based cohort study on sun habits and endometrial cancer

Background:No large cohort study has examined the risk of endometrial cancer in relation to sun exposure.Methods:A population-based cohort study of 29 508 women who answered a questionnaire in 1990–92, of whom 24 098 responded to a follow-up enquiry in 2000–02. They were followed for an average of 15.5 years.Results:Among the 17 822 postmenopausal women included, 166 cases of endometrial cancer were diagnosed. We used a multivariate Cox regression analysis adjusting for age and other selected demographic variables to determine the risk of endometrial cancer. Women using sun beds >3 times per year reduced their hazard risk (HR) by 40% (0.6, 95% confidence interval (CI) 0.4–0.9) or by 50% when adjusting for body mass index or physical activity (HR 0.5, 95% CI 0.3–0.9), and those women who were sunbathing during summer reduced their risk by 20% (HR 0.8 95% CI 0.5–1.5) compared with women who did not expose themselves to the sun or to artificial sun (i.e., sun beds).Conclusion:Exposure to artificial sun by the use of sun beds >3 times per year was associated with a 40% reduction in the risk of endometrial cancer, probably by improving the vitamin D levels during winter.

Federal Preemption of State Regulation Over Air Ambulances

Federal Preemption of State Regulation Over Air Ambulances

Reaching proficiency in laparoscopic splenectomy

To study the association between self-reported peptic ulcer and childhood adversities. The Health and Social Support Study (HeSSup) population consisted of a stratified random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44 and 50-54. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. A follow-up questionnaire was sent during 2003 to all those who responded to the first. Altogether 19,626 individuals returned the follow-up questionnaire; a response rate of 75.8%. The subjects were asked whether a doctor had told them that they have or have had peptic ulcer. The analyses covered those who responded affirmatively to both the baseline and the follow-up enquiries (n = 718). Those not reporting a peptic ulcer in either of the two questionnaires (n = 17,677) were taken as controls. The subjects were further requested (through six questions) to think about their childhood adversities. The most common adversities mentioned were long-lasting financial difficulties in the family, serious conflicts in the family, and a family member seriously or chronically ill. All the adversities reported, except parental divorce, were more common among peptic ulcer patients than among controls (P values varied between < 0.001 and 0.003). Age- and sex-adjusted odds ratios (OR) of childhood adversities in the multivariate logistic analysis for self-reported peptic ulcer varied between 1.45 and 2.01. Adjusting for smoking, heavy drinking, stress and nonsteroidal anti-inflammatory drug use had no further influence (ORs between 1.22 and 1.73). Our findings suggest that childhood adversities maintain a connection with and have a predictive role in the development of peptic ulcer.

The relationship between lifestyle factors and venous thromboembolism among women: a report from the MISS study

There has been a great advance in our knowledge of the role that thrombophilic factors play in the risk of venous thromboembolic events (VTE). However, the effect of lifestyle factors on VTE has been inadequately explored in large scale studies of women. This cohort study comprised one thousand native Swedish women for each age year between 25 and 64 inclusive (total = 40,000) drawn from the South Swedish population registry for 1990 (n = 40,000), who were followed for a mean of eleven years. Seventy-four percent completed a questionnaire at the inception of the study (n = 29,518) and 24,098 women responded to a follow-up inquiry between the years 2000-2002. The main outcome was the relationship between VTE and physical exercise, smoking habits, and alcohol consumption. Moderate drinkers of alcohol (10-15 g/d) and women engaged in strenuous exercise were at half the risk of VTE compared to those who consumed little or no alcohol or lived a sedentary life. Heavy smoking was associated with a 30% increased risk of VTE. Lifestyle factors have a major impact on the risk of VTE. Women non-smokers who were physically active and who consumed alcohol in moderation were at a lower risk of VTE.

An exploration of factors influencing workplace learning among novice teachers in Malaysia

With the rapid pace of development in Malaysia, workplace learning in the teaching profession is becoming ever more critical as the expectations on both teachers and students continue to rise. Little is known, however, about how novice teachers in Malaysia perceive their work environments from the point of view of learning. In response to this gap, an exploratory study was conducted to develop and conduct preliminary testing of the PFIL (perceptions toward factors influencing workplace learning among novice teachers) inventory. Following survey construction, the 20-item PFIL inventory was tested among 90 recent graduates of one teacher training institute in Sarawak, Malaysia. Exploratory factor analysis resulted in four unique subscales named Personal Attitude, Working Conditions, Learning System and Work Expectations. Descriptive analysis indicated significant differences by sex for the Learning System Subscale and for the Working Conditions and Work Expectations subscales by length of service. Follow-up inquiry calls for expanding the sampling framework throughout Malaysia and conducting confirmatory factor analysis and additional instrument validation on the PFIL.

Assisted Living Literature Through May 2004: Taking Stock

This article assesses the state of research on assisted living (AL) from 1989 to May 2004. We undertook keyword searches for AL research and amplified these with searches of Web sites, conference proceedings, and follow-up inquiries. We annotated and coded the resultant items according to categories reflecting the research methods used and the topics studied. We did additional comparisons for 38 studies with quantitative data that permitted summarizing resident characteristics, settings, and entry and move-out patterns. The 411 identified items ranged across a large number of topics. Qualitative studies outnumbered quantitative ones, and longitudinal studies were rare. We found little standardization in the way variables were measured, making cross-study comparisons difficult. As AL research has become more common, some items are directed at studying ways to proceed within AL as opposed to globally commenting on the worth of AL as a service sector. The research base for AL has grown rapidly but is still underdeveloped. We recommend using more consistent sets of standardized measures in AL studies and reporting analyses based on them. We also recommend fuller reporting of details on sampling, time frames, and measures in AL research.

Influence of prostaglandin E2 on parturition in cattle

A double-blinded, randomised, placebo-controlled field study of the influence of prostaglandin E2 (pge2) on cattle at parturition was carried out. The extent of cervical opening and the intensity of labour...

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported. Psychiatrists participating in a nationally representative mailed survey (N=209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year. Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company. Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Well-Composedness and the Topological Repairing of 2-D and 3-D Digital Images

In an earlier submission, we considered 2-D and 3-D digital binary images topologically characterized by their well-composedness. Well-composed images exhibit important topological and geometrical properties not shared by their ill-composed counterparts. These properties have important implications for various algorithms used by the ITK community such as thinning algorithms and Marching Cubes.A natural follow-up inquiry to our original submission concerns the possible extension of the binary algorithm to accommodate images with multiple labels. In this paper, we describe such a generalization of our previous submission which also subsumes the binary approach. For completeness and clarity of exposition, we develop the idea of well-composedness within the binary image context and later generalize the discussion to include those images with multiple labels.

Honesty When Lighting Votive Candles in Church: Another Look

An informal 3-yr. follow-up enquiry of a prior study suggested that the use of electrical, rather than wax, candles seemingly is not a variable relevant to peoples' behavior in paying for lighting votive candles in church. Also, the number of people paying apparently continues to decline: now down (from about 30 percent in 2003) to approximately 25 percent.

Enhancing a Delphi study on family-focused prevention

This article discusses how additional inquiries can enhance Delphi findings. We argue that inquiries aimed at supporting and refining Delphi findings is both theoretically and practically meaningful. We illustrate our argument on the basis of a framework for family-focused prevention that was developed through a Delphi study. The results of individual and group interviews conducted as a follow-up to the implementation of the framework provided us with effective ways to support and refine it. We draw the conclusion that adequate follow-up inquiries can enhance Delphi findings, from theoretical and application perspectives.

New World of Communication Raises Concerns for M.D.'s

New World of Communication Raises Concerns for M.D.'s

Fracture risk and bone density of peri- and early postmenopausal women with uterine leiomyomas

Objectives Fracture risk and bone mineral density (BMD) among peri- and early postmenopausal women with leiomyomas requiring hysterectomy was evaluated. Methods We counted fractures among women with or without leiomyomas using data from the Kuopio Osteoporosis Study. The study population consisted of 6086 women aged 47–56 years with never-use of hormone replacement therapy (HRT) responding to the baseline and 5-year follow-up inquiries. Part of the sample ( n = 1271) underwent bone densitometry. Results Hysterectomy was carried out in 927 women, and 59% reported that this was attributable to leiomyomas. The hazard ratio (HR) was 0.68 (95% CI 0.49–0.94) for any and 0.73 (95% CI 0.43–1.26) for distal forearm fracture among women with leiomyomas compared to those without any. Among women postmenopausal at baseline, the corresponding HRs were 0.62 (95% CI 0.44–0.87) and 0.54 (95% CI 0.31–0.96); after adjusting for age, time since menopause weight, height and previous fracture 0.69 (95% CI 0.49–0.97) and 0.63 (95% CI 0.35–1.11). The baseline BMDs were 1.15 g/cm 2 among hysterectomized leiomyoma and 1.12 g/cm 2 (ns) among non-hysterectomized women at lumbar (L2–L4), and 0.94 and 0.93 g/cm 2 (ns) at femoral sites. The follow-up lumbar BMDs were 1.13 and 1.09 g/cm 2 ( p < 0.001) and the corresponding femoral values were 0.90 and 0.89 g/cm 2 (ns), respectively. Among postmenopausal women, the corresponding baseline lumbar BMDs were 1.15 and 1.08 g/cm 2 ( p < 0.001), femoral 0.93 and 0.90 g/cm 2 ( p = 0.003); the follow-up lumbar BMDs 1.13 g/cm 2 versus 1.07 g/cm 2 ( p < 0.001); femoral BMDs 0.89 versus 0.87 (ns). Conclusions Peri- and early postmenopausal women with a history of leiomyomas seem to have better BMD and less fractures compared with those without leiomyomas. This may be mediated through higher estrogen levels leading to higher BMD and the growth of leiomyomas.

New dimensions of work ability

Work ability was constructed and defined in 1981 in a follow-up study of aging employees. The conceptual definition was, “How good is the worker at present, in the near future, and how able is he or she to do his or her work with respect to the work demands, health and mental resources?” To measure the work ability, a method called Work Ability Index (WAI) was developed and its validity was tested by clinical examinations and by the follow-up inquiries over 4 and 11 years. Since 1990s, the WAI has been used widely both in research and in occupational health services. The purpose of this research was to find out what are the relationships of human resources and work life factors with WAI today in different age groups. A representative population sample was used for linear regression models of different dimensions of work ability among 30- to 64-year-old men and women ( n=3157–3774). The results showed, that health and functional capacities ( R 2=0.39) as well as the factors of work ( R 2=0.33) explained the best the WAI. In the oldest group, the health (symptoms) and functional capacity (physical) ( R 2=0.34) and the work factors (mental strain) were strongly related to the level of WAI. The competence, values and attitudes as well as family and community factors were less significant, and their role to explain the WAI decreased with age. The results suggest that the balance between human health resources and work demands and characteristics are also today important dimensions of work ability. However, the importance of competence, attitudes and values and other life-related dimensions of work ability were confirmed and indicated the complex and multidimensional feature of work ability.

Depression and Suicide

Depression and Suicide