Special Advice Research Articles

‘A Paradise of Invalids’

Nineteenth-century Madeira was a popular destination for wealthy British people suffering from consumption and other pulmonary ailments. A rich store of sources from the period provide first-hand accounts of invalids on the island or offer special advice for the invalid traveller. After positioning medical travel within the context of contemporary science about climate, health and acclimatization, this article will provide a brief account of existing sources related to medical travel to Madeira. This article then examines this material for what it reveals about contemporary ideas about the Madeiran climate upon health, as well as cultural interaction between the British and the island. In particular, the article will trace how writing about Madeira conforms or diverges from popularly held views about the southern European climate and southern European people, as well as what resonance such views may have in the present.

Surgical Technique for Weight Regain after Roux-en-Y Gastric Bypass: Pouch-resizing and the MiniMIZER® Gastric Ring.

Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is a commonly used method in bariatric surgery that leads to sufficient long-term weight loss and consequently to improvement or resolution of obesity-associated diseases. The nadir weight is commonly reached between six months and two years after surgery. Despite this initially good weight loss, weight regain is observed in up to 20% of the patients. Besides intensive dietological evaluation, bariatric re-operation can be an option in these cases. Before the surgical reintervention, an intensive evaluation of the esophagus, pouch, anastomosis, and adjacent small bowel using upper GI-endoscopy and radiological examinations (X-ray and/or 3D-CT volumetry) is mandatory. In patients with a dilated pouch, pouch-resizing with a MiniMIZER® Gastric Ring (Bariatric Solutions GmbH, Stein am Rhein, Switzerland) could be an option to reestablish restriction in the long term. Currently, there is no gold standard for the choice of the weight regain procedure or for the technique used in the procedure itself. This article focuses on the standardized procedure of pouch resizing with implantation of a MiniMIZER® Gastric Ring for the surgical therapy of weight regain due to pouch dilatation and/or dilatation of the gastrojejunostomy and the adjacent small bowel (usually approximately the first 20cm), resulting in a huge neo-stomach after RYGB, as performed at the Medical University of Vienna. Further, indications for revisional surgery for weight regain, mandatory examinations, and recommended conservative therapy options prior to surgery will be described. Next, the fast-track concept and its advantages are explained. Lastly, the surgical procedure, including positioning of the patient, placement of trocars, the intraoperative process, and special advice, is presented. Exact planning of the procedure and postoperative follow-up are indispensable for a further long-term success after weight regain surgery. In conclusion, pouch-resizing and implantation of the MiniMIZER® Gastric Ring represent a practical and effective solution in patients with dilated pouch/anastomosis/adjacent small bowel with weight regain after RYGB, if conservative therapy, including dietitian counseling and new drugs (e.g., Semaglutide), has failed.

Praktek Pemberian ASI Eksklusif pada Ibu Pekerja di Desa Batusuya Kabupaten Donggala

Breast milk (ASI) is an ideal source of nutrition and the safest food for babies for 0-6 months of life. Basic Health Research Data (Riskesdas) in 2018 shows that the proportion of infants aged 0-6 months who receive exclusive breastfeeding is 74.5%, while those who do not receive exclusive breastfeeding are 25.5%. The purpose of this study was to describe the practice of exclusive breastfeeding for working mothers in Batusuya Village, Sindue Tumbusbora District, Donggala Regency. This type of research is a descriptive study. The population of this study were all working mothers who have children aged 0-6 months. The sample in this study amounted to 60 people. Data analysis in this study used univariate analysis. The results of this study showed that most children were not exclusively breastfed, namely 51 children (85.0%), and only 9 children (15.0%) were exclusively breastfed. Meanwhile, most working mothers are self-employed, namely 34 respondents (56.7%), It can be concluded that most working mothers do not provide exclusive breastfeeding to their children. This is because mothers do not bring their children to work with the percentage (85.0), and most mothers do not know how to store breast milk in the freezer with a percentage (93.3%). Special advice for working mothers to pay more attention to the importance of exclusive breastfeeding.

Special advice on the Uses of Mobility devices for persons withvisual impairment: practical approach of teaching Orientation and Mobility in University of Calabr.Cross River State, Nigeria.

This paper examines mobility devices for people with visual impairment. The major worry of this study is the lack of awareness and availabilityq of mobility devices to the public and people with visual impairment. A historical background of the mobility aids of the blind was traced and the importance of technology on mobility of people with visual impairment was identified. Various mobility aids with pictures such as white canes, guide dogs and optical aids were highlighted and their importance enumerated with the aim of creating awareness to the public as well as calling for stakeholders support on the availability of the mobility aids for people with visual impairment. Some limitations affecting the use of mobility aids such as information limitation, expenses, auditory cues, training difficulties and lack of performance measures were also identified. Conclusion was drawn on the basis of the importance and usefulness of mobility aids to the independence mobility of people with visual impairment

COVID-19 and intellectual disability/autism spectrum disorder with high and very high support needs: issues of physical and mental vulnerability

Purpose The COVID-19 outbreak has profoundly plagued the world, and current health efforts are focused on providing prevention and ensuring access to intensive services for people with the most severe symptomatology. Many reports have already described substantial psychological distress in the general population. Nevertheless, disasters tend to affect vulnerable subjects disproportionately, and individuals with intellectual disabilities/autism spectrum disorder with high and very high support needs (PwID/ASD-HSN) seem to be counted among the hardest hit populations. The present paper aims to provide a comprehensive discussion and evaluation of COVID-19 related issues specific to PwID/ASD-HSN. Design/methodology/approach Commentary on available literature and analysis of new preliminary data on PwID/ASD-HSN’s physical and psychic vulnerability factors. This knowledge is fundamental to provide families and caregivers special advice to counteract the risks associated with the current pandemic. Findings PwID/ASD-HSN represent one of the most vulnerable population to the COVID-19 outbreak and the associated factors of mental distress for several reasons, including multimorbidity, low levels of health literacy, difficulties to understand and communicate, reliance on other people for care, low compliance with complex hygiene rules, the strong need of routine/sameness and low adaptive skills. Originality/value In the present work, the authors analyze the specific factors of physical and mental vulnerability in PwID/ASD-HSN, corroborating the dissertation with a discussion on the first data published worldwide and with preliminary data collected on the Italian territory for what concerns prevalence rates of COVID-19 and complications in persons with PwID/ASD-HSN and signs and symptoms of psychic distress during the mass quarantine period.

Improving Successful Introduction after a Negative Food Challenge Test: How to Achieve the Best Result?

Oral food challenges (OFC) confirm or exclude the presence of a food allergy. The outcome can be positive (allergic symptoms), inconclusive, or negative (no symptoms). In the case of a negative OFC, parents and children are advised to introduce the challenged food allergen into their diet. However, previous studies showed difficulties in a successful introduction at home. The aim of this prospective non-randomized intervention study is to evaluate the effect of a new strategy with more guidance regarding the dietary introduction after a negative food challenge test. We compared two cohorts: an historical (retrospective) control group of 157 children, previously described, who did not receive any special advice after a negative OFC, versus a new cohort consisting of 104 children, who were guided according to our new strategy of written introduction schemes, food diaries, and several phone calls. In the historical control group, introduction was successful in 56%, partially successful in 16%, and 28% failed to introduce at home. After introduction of our new strategy, complete introduction was found in 82%, 11% had partially introduced, and only 8% failed to introduce the allergen. In conclusion, comprehensive advice and dietary recommendation after a negative OFC results in an increase in successful home introduction. Therefore, more attention, guidance, and follow-up of children and parents are desirable after a negative OFC.

Risk of Impingement on Polyethylene Liner of Total Hip Arthroplasty Prosthesis during Muslim Prayer (Salat) Activity

Total hip arthroplasty (THA) is one of the most successful orthopedic surgical procedures. Impingement believed to be the most common mechanism of dislocation after THA. Salat consist of several repeated physical movements which require several extreme hip joint movements. The potential impingement positions during salat activity have been revealed by the previous computer simulation study, some evidences of impingement from retrieved polyethylene liner also have been revealed from our recent preliminary data. Although further study is still needed in this field, we may give special advice to modify some movement for Muslim patient who receive THA when performing Salat activity.

Editorial comments: Special Advice on Competition Policy for the Digital Era

Editorial comments: Special Advice on Competition Policy for the Digital Era

Study on Yield and Yield Components of Onion (Allium Cepa L.) Under Hatseva Condition, Israel

Onion is one of the most important food crops and cultivated in many countries in different climatic zones, including temperate, tropical and sub-tropical regions. Yield parameters like harvest index, total bulb yield, marketable bulb yield, unmarketable bulb yield, total bulb number, marketable bulb number, unmarketable bulb number, and bulb quality parameters like small size bulb number, medium size bulb number and large size bulb number. Generally, the study showed that the mean marketable bulb number, the mean unmarketable bulb number and the mean total bulb number per dunam were calculated and found to be 17, 395.84, 24, 270.83 and 41, 666.67 respectively. Similarly the average marketable bulb yield, the average unmarketable bulb yield and the average total bulb yield per dunam were also calculated and found to be 6.18 ton/dunam, 2.44 ton/dunam and 8.62 ton/dunam respectively. On the other hand, the mean value of Small size bulb number, the mean value of Medium size bulb number and the mean value of Large size bulb number per dunam were found to be 270.83, 11, 250.00 and 250.00 respectively with the average harvest index of 70.84 %. For the potential onion growers or farmers in the study area special advice and training is essential on how to produce and get high yield of onion. Thus, onion (var. uri) growers in the study area can benefit if they are distributed well with the over all packages and production technologies. Therefore, further studies need to be conducted on various green houses, under different temperature conditions to generate more reliable information and acceptable practical evidences on onion production improvement in the Arava region

Carer perception of palliative care service at Provincial General Hospital, Ratnapura

Introduction: Palliative care improves quality of care for patients with life threatening illnesses and their families. It is common for families and, less often, friends to willingly take on the role of informal carer, even though this is often at considerable psychological, physical, social, and financial cost to themselves. Objectives: To describe carer perception towards the Palliative Care Service in Provincial General Hospital, Ratnapura. Methods: Palliative care services were provided at the Hospital for 172 patients from June 2014 to August 2016. We conducted a qualitative study to understand carer perceptions towards this new service. Semi-structured telephone interviews were conducted using qualitative research methods among 22 carers of patients who have obtained this service for over 3 months. These interviews were conducted with the aid of a preformed interviewer guide based on themes, satisfaction towards palliative care services, benefits received through the service and difficulties faced in caring for the ill person. All interviews were transcribed and analysed qualitatively using open explorative thematic coding. Results: Mean age of the carers was 44.9 years (SD 11.1), 63.6% (n=14) were females, majority (50%) were educated up to O/L, duration of care giving in the majority (50%) was 6-12 months, majority of the care givers were a child of the patient (50%). Mean age of patients was 63 years (SD 11), majority had malignancies (68.1%, n=15), and approximately half had 1-2 comorbidities. Majority stated that the palliative care service listened to and understood the needs of the patients, that adequate information and education was Opportunity was provided to share our views and worries, and talk about our roles as carers, and support was provided. Majority were highly satisfied with the service. Benefits obtained through the service were, patients could be cared for in their own homes with family members, and patients had comfortable and peaceful death. Special advice and guidance provided was beneficial to improve the physical and psychological state of patients and carers, such as pain relief, improved sleep, appetite and feeding. Carers were able to understand the disease prognosis and pre-plan to fulfil patient expectations. Some patients also received assistive devices through the service which greatly benefitted them. The service was also able to avoid frequent hospital admissions, arrange hospice care when needed, and arranged financial assistance. Difficulties faced in caring for the patient included loss of job and occupation, financial difficulties, hardships in transporting patients from home to hospital, having to travel long distances, poor support from some family members in caring for the patient which increased carer burden, and children’s schooling and education being adversely affected. Conclusions: The majority of carers were satisfied with the service provided and perceived benefit from the Palliative Care Service provided by Provincial General Hospital, Ratnapura.

The Company Core Data Sheet in Light of XML-Authoring and IDMP Master Data Implementation.

Labeling decisions for core labeling and/or local labeling capture the outcome of all discussions on the product statements that are necessary to ensure safe and effective handling of pharmaceutical products, with a special focus on the decision concerning known, suspected, or hypothetical risks. Such decisions may determine if a topic is to be included in the label or provide a rationale for exclusion from the label. The need to provide special advice to users and the type of advice (eg, contraindications, precautions) are subject to labeling decisions as well. While the problem is well known to pharmaceutical companies, and technical solutions such as XML-based authoring/coding systems try to offer support from the information technology sector to handle the business problem, the current identification of medicinal products (IDMP) requirements raised by health authorities worldwide have put a new focus on the problem. This article will elaborate on the basic business problem and its requirements with respect to a solution.

The risk of emergency cesarean section after failure of vaginal delivery according to prepregnancy body mass index or gestational weight gain by the 2009 Institute of Medicine guidelines.

ObjectiveTo evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines.MethodsA retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain.ResultsThree-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain.ConclusionObese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.

SP0175 Services Provided by Patient Associations for People with RMDS Who Are Growing Old in Europe

The general reduction of mobility and social participation of the elderly may result in lower overall satisfaction and quality of life. These problems are even more pronounced in individuals with...

Basic Online Pennsylvania Legal Research for Librarians

Librarians engage in reference interviews where knowledge oflegal research is necessary, but they may not have formal training in legal research. Understanding a few basic elements of legal research will create a foundation of knowledge from which librarians can learn to effectively help patrons locate legal resources. The author presents these elements and describes their application in the context of researching free online Pennsylvania legal resources, including special advice to clarify the librarian’s role when working with patrons who are conducting legal research. The author also discusses the value of librarians creating a toolkit of free online Pennsylvania resources.

Basic investigations in Saccharomyces cerevisiae.

This chapter aims to provide the reader with a one-stop reference to the basic procedures needed to access, grow, store, mate, and sporulate yeast cells. It starts with an introduction to the Web-based yeast resources, which are becoming increasingly important in the investigation of S. cerevisiae in the post-genomic era. It then goes on to describe recipes for the different types of media and to explain how cells are grown to the appropriate cell numbers at the correct stage in the growth cycle. It also provides a detailed explanation on both short- and long-term storage of yeast cells. It ends by explaining how to set up genetic crosses with special advice on the demanding technique of diploid cell sporulation and spore isolation.

Prevalence of cold‐related musculoskeletal pain according to self‐reported threshold temperature among the Finnish adult population

Exposure to cold reportedly increases musculoskeletal pains. We assessed the prevalence of such pain and self-reported threshold temperature (TT) at which the pain emerges. A random sample of 6591 people in Finland, aged 25-74 years, answered a questionnaire on repeated cold-related musculoskeletal pain (CMP) and its TT. The response rate was 64%. We used quantile regression to quantify the effects of personal characteristics and region of residence on TT at various locations of its distribution. Of the participants, 1892 (30%) experienced CMP in at least one body site and 1692 reported TT. Ten percent of the participants who perceived CMP did so at -2 °C, 50% at -14 °C and 90% at -23 °C. Residence in the South elevated TT by 1-6 °C compared with residence in the North, depending on the proportion of participants reporting CMP at various temperatures. Joint disorders increased TT at milder temperatures, at which only 10% of all participants perceived CMP, whereas back disorders did so mainly at lower temperatures, at which 70% were affected. Overweight was associated with a 2 °C lower TT, and physical inactivity with a 1 °C higher TT, and TT increased by 1 °C per 10-year increase in age. The greatest model-estimated difference in median TT between subgroups was 12 °C. People suffering from musculoskeletal disorders and those living in the warmer areas of Finland need special advice to protect themselves against the cold. Our study provides preliminary information to support such advice.

Evaluation of the COSHH Essentials Model with a Mixture of Organic Chemicals at a Medium-Sized Paint Producer

The Control of Substances Hazardous to Health (COSHH) Essentials model was evaluated using full-shift exposure measurements of five chemical components in a mixture [acetone, ethylbenzene, methyl ethyl ketone, toluene, and xylenes] at a medium-sized plant producing paint materials. Two tasks, batch-making and bucket-washing, were examined. Varying levels of control were already established in both tasks and the average exposures of individual chemicals were considerably lower than the regulatory and advisory 8-h standards. The average exposure fractions using the additive mixture formula were also less than unity (batch-making: 0.25, bucket-washing: 0.56) indicating the mixture of chemicals did not exceed the combined occupational exposure limit (OEL). The paper version of the COSHH Essentials model was used to calculate a predicted exposure range (PER) for each chemical according to different levels of control. The estimated PERs of the tested chemicals for both tasks did not show consistent agreement with exposure measurements when the comparison was made for each control method and this is believed to be because of the considerably different volatilities of the chemicals. Given the combination of health hazard and exposure potential components, the COSHH Essentials model recommended a control approach ‘special advice’ for both tasks, based on the potential reproductive hazard ascribed to toluene. This would not have been the same conclusion if some other chemical had been substituted (for example styrene, which has the same threshold limit value as toluene). Nevertheless, it was special advice, which had led to the combination of hygienic procedures in place at this plant. The probability of the combined exposure fractions exceeding unity was 0.0002 for the batch-making task indicating that the employees performing this task were most likely well protected below the OELs. Although the employees involved in the bucket-washing task had greater potential to exceed the threshold limit value of the mixture (P > 1 = 0.2375), the expected personal exposure after adjusting for the assigned protection factor for the respirators in use would be considerably lower (P > 1 = 0.0161). Thus, our findings suggested that the COSHH essentials model worked reasonably well for the volatile organic chemicals at the plant. However, it was difficult to override the reproductive hazard even though it was meant to be possible in principle. Further, it became apparent that an input of existing controls, which is not possible in the web-based model, may have allowed the model be more widely applicable. The experience of using the web-based COSHH Essentials model generated some suggestions to provide a more user-friendly tool to the model users who do not have expertise in occupational hygiene.

Mosquito-borne Diseases

Despite centuries of control efforts, mosquito-borne diseases are flourishing worldwide. With a disproportionate effect on children and adolescents, these conditions are responsible for substantial global morbidity and mortality. Malaria kills more than 1 million children annually, chiefly in sub-Saharan Africa. Dengue virus has expanded its range over the past several decades, following its principal vector, Aedes aegypti, back into regions from which it was eliminated in the mid-20th century and causing widespread epidemics of hemorrhagic fever. West Nile virus has become endemic throughout the Americas in the past 10 years, while chikungunya virus has emerged in the Indian Ocean basin and mainland Asia to affect millions. Japanese encephalitis virus, too, has expanded its range in the Indian subcontinent and Australasia, mainly affecting young children. Filariasis, on the other hand, is on the retreat, the subject of a global eradication campaign. Efforts to limit the effect of mosquito-borne diseases in endemic areas face the twin challenges of controlling mosquito populations and delivering effective public health interventions. Travelers to areas endemic for mosquito-borne diseases require special advice on mosquito avoidance, immunizations, and malaria prophylaxis.

Effects of Behavioral Therapy on Weight Loss in Overweight and Obese Patients With Schizophrenia or Schizoaffective Disorder

Obesity is common in persons with schizophrenia. Besides its adverse health effects, obesity reduces quality of life and contributes to the social stigma of schizophrenia. This 14-week, multicenter, open-label, rater-blinded, randomized study evaluated the effects of a group-based behavioral treatment (BT) for weight loss in overweight and obese stable patients with DSM-IV schizophrenia or schizoaffective disorder who had been switched from olanzapine to risperidone. Participants were randomly assigned to receive BT or usual clinical care (UC). BT included 20 sessions during which patients were taught to reduce caloric intake. In UC, patients were encouraged to lose weight but received no special advice about weight reduction. The primary outcome measure was change in body weight. Seventy-two patients were enrolled. The mean +/- SD weight loss at endpoint was significant in both groups (p < .05) and numerically greater in patients receiving BT than in those receiving UC (-2.0 +/- 3.79 and -1.1 +/- 3.11 kg, respectively). More patients in the BT group than in the UC group had lost > or = 5% of their body weight at endpoint (26.5% [9/34] and 10.8% [4/37], respectively; p = .082). A post hoc analysis of patients attending at least 1 BT session showed that significantly more patients in the BT than the UC group had lost > or = 5% of their body weight at endpoint (32.1% [9/28] vs. 10.8% [4/37], respectively, p = .038) and at week 14 (complete population; 40.9% [9/22] and 14.3% [4/28], respectively, p = .027). BT may be an effective method for weight reduction in patients with chronic psychotic illness.

C1 inhibitor deficiency: consensus document

We present a consensus document on the diagnosis and management of C1 inhibitor deficiency, a syndrome characterized clinically by recurrent episodes of angio-oedema. In hereditary angio-oedema, a rare autosomal dominant condition, C1 inhibitor function is reduced due to impaired transcription or production of non-functional protein. The diagnosis is confirmed by the presence of a low serum C4 and absent or greatly reduced C1 inhibitor level or function. The condition can cause fatal laryngeal oedema and features indistinguishable from gastrointestinal tract obstruction. Attacks can be precipitated by trauma, infection and other stimulants. Treatment is graded according to response and the clinical site of swelling. Acute treatment for severe attack is by infusion of C1 inhibitor concentrate and for minor attack attenuated androgens and/or tranexamic acid. Prophylactic treatment is by attenuated androgens and/or tranexamic acid. There are a number of new products in trial, including genetically engineered C1 esterase inhibitor, kallikrein inhibitor and bradykinin B2 receptor antagonist. Individual sections provide special advice with respect to diagnosis, management (prophylaxis and emergency care), special situations (childhood, pregnancy, contraception, travel and dental care) and service specification.