Assessment of cardiometabolic risk among shift workers in Hungary

February 3rd, 2012

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Aim: Shift workers may be at risk of different diseases. In order to assess cardiometabolic risk in shift workers, a cross-sectional study was performed among active workers.
Methods:
A total of 481 workers (121 men, 360 women) were investigated; most of them were employees in light industry (58.2%) or in public services (23.9%). Past medical history was recorded and physical examination was performed. Questionnaires were used to characterize daily activity. Fasting venous blood sample was collected for measuring laboratory parameters. Data from shift workers (n=234, age: 43.9+/-8.1 years) were compared to those of daytime workers (n=247, age: 42.8+/-8.5 years), men and women were analyzed separately.
Results:
In men, systolic blood pressure was higher in shift workers compared to daytime workers (133+/-8 vs 126+/-17 mmHg; p

Reliability and validity of the Norwegian child and parent versions of the DISABKIDS Chronic Generic Module (DCGM-37) and Diabetes-Specific Module (DSM-10)

February 3rd, 2012

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Background:
International guidelines on type 1 diabetes advocate routine screening of health-related quality of life (HRQOL). DISABKIDS questionnaires are the first instruments developed across cultures and nations to provide age-appropriate measures of HRQOL in children with chronic diseases. DISABKIDS includes a Chronic Generic Module 37 (DCGM-37) and disease-specific modules. The purpose of this study was to examine reliability and validity of the Norwegian versions of the DISABKIDS questionnaires in children and adolescents with type 1 diabetes.
Methods:
The DCGM-37 and the Diabetes Specific Module-10 (DDM-10) were translated into Norwegian using standard forward-backward translation. Eight to 19 year old children and adolescents with type 1 diabetes scheduled for routine follow-up at three diabetic clinics in Norway and one of their parents were invited to complete the DCGM-37 and the DDM-10. Internal consistency was determined using Cronbach’s alpha. Results were compared with those of the Child Health Questionnaire Children Form-87 (CHQ-CF87) and Child Health Questionnaire Parent Form-50 which are established generic questionnaires. DISABKIDS results were related to age, gender, duration of diabetes, mode of insulin delivery and metabolic control. Clinical data were obtained from the Norwegian Childhood Diabetes Registry.
Results:
Of 198 eligible child-parent dyads, 103 (52%) completed the questionnaires. Mean age was 13.6 (2.6), range 8-19 yrs, 52% were boys. Cronbach’s alpha was >0.70 for all the DISABKIDS sub-scales except two (physical ability and social inclusion). There were moderate to high correlations (0.65-0.81) between the DISABKIDS scales and mental/emotional sub-scales of CHQ-CF87. Increasing age and higher HbA1c were significantly associated with reduced HRQOL scores. Parents tended to score their child’s HRQOL lower than the children/adolescents themselves.
Conclusions:
The study shows that the DISABKIDS instruments are applicable to a Norwegian childhood diabetes population. They seem to be a relevant supplement to other clinical indicators in medical practice and research.

Airline insurers saw a big drop in claims last year, Aon says

January 29th, 2012

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The airline insurance sector experienced a 66% decrease in losses from claims last year, and prices were stable during renewa -More- 

Industry pushes Senate for a multi-year extension to NFIP

January 29th, 2012

Whole life insurance coverage premiums are more expensive than others for term life. But very existence also creates cash value. Some with the premiums is invested and grows in value. Policyholders can tap this cash value for needs such as college expenses or retirement.

Insurance lobbyists are encouraging the Senate to pass legislation that would reauthorize the National Flood Insurance Progra -More- 

Efficacy predictors of lung volume reduction with zephyr valves in a european cohort.

January 29th, 2012

Whole life insurance coverage premiums are more expensive than others for term life. But very existence also creates cash value. Some with the premiums is invested and grows in value. Policyholders can tap this cash value for needs such as college expenses or retirement.

Efficacy predictors of lung volume reduction with zephyr valves in a european cohort.
Eur Respir J. 2012 Jan 26;
Authors: Herth FJ, Noppen M, Valipour A, Leroy S, Vergnon JM, Ficker JH, Egan JJ, Gasparini S, Agusti C, Holmes-Higgin D, Ernst A,
Abstract
The Endobronchial Valve for Emphysema Palliation Trial (VENT) was a multi-center, prospective, randomized, controlled trial conducted to evaluate safety and effectiveness of unilateral endobronchial valve (EBV) treatment. The purpose of this analysis was to assess outcomes in the previously unreported European VENT study cohort.Patients with advanced emphysema were randomly assigned (2:1) to receive Zephyr® (Pulmonx Inc.) EBV treatment (n=111) or medical management (n=60).At 6 months, EBV patients demonstrated significant improvement compared to controls for average change in FEV1 (7±20% versus 0.5±19%, p=0.067), cycle ergometry (2±14 W versus -3±10 W, p=0.04), and SGRQ (-5±14 points versus 0.3±13 points, p=0.047). At 12 months, the magnitude of the difference between groups for change from baseline was of similar magnitude to differences seen at 6 months. Rates for complications did not differ significantly. EBV patients with CT suggestive of complete fissure and lobar occlusion had lobar volume reduction of -80±30% and >50% met minimal clinical difference thresholds. Degree of emphysema heterogeneity did not preclude excellent outcomes.Unilateral lobar volume reduction using endobronchial valve treatment is safe and superior clinical results correlated with CT suggestive of complete fissures and successful lobar occlusion. Emphysema heterogeneity was not critical for determining positive outcomes.Clinical trial registered with www.clinicaltrials.gov (NCT00129584).
PMID: 22282552 [PubMed - as supplied by publisher]

Caring for patients and families at end of life: the experiences of nurses during withdrawal of life-sustaining treatment.

January 29th, 2012

During the life span insurance application and underwriting process, you may well be required to get yourself a medical examination to verify your wellbeing. With regards to the company as well as the type of insurance you purchase, test might include blood and urine tests and a full check-up.

Caring for patients and families at end of life: the experiences of nurses during withdrawal of life-sustaining treatment.
Dynamics. 2011;22(4):31-5
Authors: Vanderspank-Wright B, Fothergill-Bourbonnais F, Brajtman S, Gagnon P
Abstract
BACKGROUND: Withdrawal of life-sustaining treatment is a process in which active treatment and the accompanying technology are removed, ending in the death of the patient.
PURPOSE: To understand the lived experience of critical care nurses who care for patients during the process of withdrawal of life-sustaining treatment.
METHODS: A phenomenological study was undertaken and interviews were conducted with six critical care nurses.
RESULTS: The essence of this experience was described by these nurses as “trying to do the right thing”. Three major themes emerged: A journey–creating comfort along the way, working in professional angst, and providing memories.
PMID: 22282952 [PubMed - in process]

Challenges in access to health services and its impact on Quality of Life: a randomised population-based survey within Turkish speaking immigrants in London

January 29th, 2012

During the life span insurance application and underwriting process, you may well be required to get yourself a medical examination to verify your wellbeing. With regards to the company as well as the type of insurance you purchase, test might include blood and urine tests and a full check-up.

Background and aim: There are a significant number of Turkish speaking immigrants living in London. Their special health issues including women’s health, mental health, and alcohol and smoking habits has been assessed. The aim of this study was to explore the ongoing challenges in access to health care services and its impact on Quality of Life of immigrants.Material and Methods: This cross-sectional population-based study was conducted between March and August 2010 with Turkish immigrants (n=416) living in London. Of these, 308 (74%) were Turkish and 108 (26%) were Turkish Cypriots. All healthy or unhealthy adults of 17-65 years of age were enrolled. A structured questionnaire with 44 items in five subcategories and 26-items WHOQOL BREF were used.
Results:
Mean duration of stay for Turkish Cypriots (26.9+/-13.9 years) was significantly longer than Turkish immigrants (13.3+/-7.5) (p

Evaluation of health related quality of life in irritable bowel syndrome patients

January 29th, 2012

According to the Connecticut Insurance Department, permanent insurance coverage, such as whole life insurance, builds cash value which you can use later to pay premiums for long-term care insurance.

Background:
Quality of life (QOL) is an important measure in the management of Irritable Bowel Syndrome (IBS). Controversy exists in the findings of studies evaluating QOL in IBS subtypes, and little is known about this issue in Iranian patients. Determination of the factors affecting QOL in IBS patients may influence treatment outcomes. The aims of this study are to: 1) compare QOL between subtypes in a sample of Iranian IBS patients, 2) determine the factors associated with QOL in IBS.
Methods:
This cross sectional study included two hundred and fifty IBS patients with the mean age (+/- standard deviation) of 31.62 (+/- 11.93) years that were referred to outpatient gastroenterology clinic. IBS patients were diagnosed based on Rome-3 criteria by a gastroenterologist, and then they were categorized into three subtypes according to the predominant type of bowel habit. The “QOL specific for IBS”, “Stait-trait anxiety inventory”, and “Beck depression inventory-2″ questioners were used to evaluate QOL, anxiety, and depression symptoms, respectively.
Results:
The mean QOL scores in IBS mixed subtype (71.7 +/- 25.57), constipation predominant subtype (80.28 +/- 25.57), and diarrhea predominant subtype (76.43 +/- 19.13) were not different. (P value: 0.05) In multivariate linear regression analysis, anxiety symptom scores were inversely correlated with QOL scores. [Standardized beta: -0.43, (95% confidence interval: -0.70, -0.39), P value:

Validation of the Self-Management Ability Scale (SMAS) and development and validation of a shorter scale (SMAS-S) among older patients shortly after hospitalisation

January 25th, 2012

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Background:
The 30-item Self-Management Ability Scale (SMAS) measures self-management abilities (SMA). Objectives of this study were to (1) validate the SMAS among older people shortly after hospitalisation and (2) shorten the SMAS while maintaining adequate validity and reliability.MethodS. Our study was conducted among older individuals (>65) who had recently been discharged from a hospital. Three months after hospital admission, 296/456 patients (65% response) were interviewed in their homes. We tested the instrument by means of structural equation modelling, and examined its validity and reliability. In addition, we tested internal consistency of the SMAS and SMAS-S among a study sample of patients at risk for cardiovascular diseases.
Results:
After eliminating 12 items, the confirmatory factor analyses revealed good indices of fit with the resulting 18-item SMAS (SMAS-S). To estimate construct validity of the instrument, we looked at correlations between SMAS subscale scores and overall well-being scores as measured by Social Product Function (SPF-IL) and Cantril’s ladder. All SMAS subscales of the original and short version significantly correlated with SPF-IL scores (all at p [less than or equal to] 0.001) and Cantril’s ladder (for the cognitive well-being subscale p [less than or equal to] 0.01; all other subscales at p [less than or equal to] 0.001). The findings indicated validity. Analyses of the SMAS and SMAS-S in the sample of patients at risk for cardiovascular diseases showed that both instruments are reliable.
Conclusions:
The psychometric properties of both the SMAS and SMAS-S are good. The SMAS-S is a promising alternate instrument to evaluate self-management abilities.

The proxy problem anatomized: Child-parent disagreement in Health Related Quality of Life reports of chronically ill adolescents

January 25th, 2012

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Background:
Discrepancy between self-reports and parent-proxy reports of adolescent health-related quality of life (HRQoL) has been repeatedly acknowledged in the literature as the proxy problem. However, little is known about the extent and direction of this discrepancy. The purpose of this study is to explore to what extent and in what direction HRQoL self-reports of adolescents with chronic conditions and those of their parents differ.
Methods:
A cross-sectional survey was conducted among adolescents suffering from chronic conditions and their parents. Socio-demographic and disease-related characteristics were collected and information about consequences of the chronic condition was assessed. HRQoL was measured with KIDSCREEN-10 and DISABKIDS condition generic measure (DCGM-10). Agreement was analysed through defining a threshold of agreement based on half of the standard deviation of the HRQoL score with the highest variance. Agreement occurred if the difference between adolescent and parent scores was less than or equal to half of the standard deviation. Intra-class correlation coefficients and Bland-Altman plots were also computed. The characteristics associated with direction of disagreement were statistically tested with one-way ANOVA and Chi-square tests.
Results:
584 paired HRQoL scores were obtained. Ratings from both adolescents and parents were high, even compared to European norm data. Differences between adolescents and parents were statistically significant, yet relatively small. Disagreement existed in both directions: in 24.5% (KIDSCREEN-10) and 16.8% (DCGM-10) of the cases adolescents rated their HRQoL lower than did their parent, while in 32.2% (KIDSCREEN-10) and 31.7% (DCGM-10) of the cases the opposite was true. Adolescent’s age, educational level and type of education, parent’s educational level, number of hospital admissions and several other disease-related factors influenced direction of disagreement.
Conclusions:
In a reasonable proportion of cases the adolescent and parent agreed on the adolescent’s HRQoL (43-51% of the cases) and most disagreement tended to be minor. Thus, the proxy problem may be smaller than presented in the literature and its extent may differ per population. As adolescents are expected to become partners in their own health care, it is recommended to focus on the adolescent’s own perceptions of HRQoL.