Health Sciences

Epigenetic mechanism mediating the impact of child adversity on life-long adverse behavior

by Andrés Ginestet

Although epidemiological data provide evidence that early life experience plays a critical role in human development,... more Although epidemiological data provide evidence that early life experience plays a critical role in human development, the mechanism of how this works remains in question. Recent data from human and animal literature suggest that epigenetic changes, such as DNA methylation, are involved not only in cellular differentiation, but also in the modulation of genome function in response to early life experience affecting gene
function and the phenotype. Such modulations may serve as a mechanism for life-long genome adaptation.
These changes seem to be widely distributed across the genome and to involve central and peripheral systems. Examining the environmental circumstances associated with the onset and reversal of DNA methylation will be critical for understanding risk and resiliency.

CHURCH NEWS: NEW UNITY MOVEMENT STEPS PROPOSED

by Daniel Keeran MSW

by Daniel Keeran, MSW (distrbute freely without charge)

Against the unity prayer of Jesus in the gospel of John chapter 17, divisions within Christianity have been common... more Against the unity prayer of Jesus in the gospel of John chapter 17, divisions within Christianity have been common from the beginning. New steps for unity are outlined that provide grass-roots opportunities in local churches and communities.

Fundamental to the new unity movement are principles and a change in paradigm that give a fresh approach to the ancient problem of divisions among people who identify themselves as followers of Jesus.

Work-based mobile learning in the health sector-concept of a mobile learning system exemplified by educational scenarios of junior doctors

by Christoph Pimmer

Pimmer, C. (2009). Work-based mobile learning in the health sector: Concept of a mobile learning system exemplified by educational scenarios of junior doctors. Paper presented at the 3rd WLE Mobile Learning Symposium: Mobile Learning Cultures across Education, Work and Leisure WLE Centre, IOE London, UK.

From theory to 'measurement' in complex interventions: Methodological lessons from the development of an e-health normalisation instrument

by Frances Mair

Co-authored with:  Tracy L Finch, Catherine O'Donnell, Elizabeth Murray and Carl R May

Abstract (provisional)
Background
Although empirical and theoretical understanding of processes of... more Abstract (provisional)
Background
Although empirical and theoretical understanding of processes of implementation in health care is advancing, translation of theory into structured measures that capture the complex interplay between interventions, individuals and context remain limited. This paper aimed to (1) describe the process and outcome of a project to develop a theory-based instrument for measuring implementation processes relating to e-health interventions; and (2) identify key issues and methodological challenges for advancing work in this field.

Methods
A 30-item instrument (Technology Adoption Readiness Scale (TARS)) for measuring normalisation processes in the context of e-health service interventions was developed on the basis on Normalization Process Theory (NPT). NPT focuses on how new practices become routinely embedded within social contexts. The instrument was pre-tested in two health care settings in which e-health (electronic facilitation of healthcare decision-making and practice) was used by health care professionals.

Results
The developed instrument was pre-tested in two professional samples (N = 46; N = 231). Ratings of items representing normalisation 'processes' were significantly related to staff members' perceptions of whether or not e-health had become 'routine'. Key methodological challenges are discussed in relation to: translating multi-component theoretical constructs into simple questions; developing and choosing appropriate outcome measures; conducting multiple-stakeholder assessments; instrument and question framing; and more general issues for instrument development in practice contexts.

Conclusions
To develop theory-derived measures of implementation process for progressing research in this field, four key recommendations are made relating to (1) greater attention to underlying theoretical assumptions and extent of translation work required; (2) the need for appropriate but flexible approaches to outcomes measurement; (3) representation of multiple perspectives and collaborative nature of work; and (4) emphasis on generic measurement approaches that can be flexibly tailored to particular contexts of study.

Engineering love

by Brian Earp

Savulescu, J. and Sandberg, A. (2012). Love machine: Engineering lifelong romance. New Scientist, 2864, 28-29.

Essay partially adapted from Earp, B. D., Sandberg, A., and Savulescu, J. (2012). Natural selection, childrearing, and the ethics of marriage (and divorce): Building a case for the neuroenhancement of human relationships. Philosophy & Technology, forthcoming [see "profile" box in article].

Available at the New Scientist website: http://www.newscientist.com/article/mg21428646.200-love-machine-engineering-lifelong-romance.html

New Scientist BIG IDEA section, May 2012.

With break-up and divorce a major part of modern life, it looks... more New Scientist BIG IDEA section, May 2012.

With break-up and divorce a major part of modern life, it looks like we may be outliving our inborn capacity to love. But there could be a way to outwit evolution and make love last.

Also available at New Scientist: http://www.newscientist.com/article/mg21428646.200-love-machine-engineering-lifelong-romance.html.

Why your TeamSTEPPS program may not be working

by Timothy Clapper

Clapper, T. C., & Ng, G. M. (2012, in press). Why your TeamSTEPPS program may not be working. Clinical Simulation in Nursing. doi:10.1016/j.ecns.2012.03.007

Co-authored with Grace Ng

Team Strategies and Tools to Enhance Performance and Patient Safety ® (TeamSTEPPS) is a patient safety tool developed... more Team Strategies and Tools to Enhance Performance and Patient Safety ® (TeamSTEPPS) is a patient safety tool developed by the defense industry and based on four competencies: leadership, communication, situational monitoring, and mutual support. Unfortunately, there are barriers that prevent TeamSTEPPS from reaching its full potential, including: (a) lack of administrative support and resources, (b) lack of training focus to address hierarchal differences and incivility at all levels of health care practice and administration, (c) inadequate TeamSTEPPS instruction and simulation practices, and (d) educators’ resistance to change from crew resource management concepts. Suggestions for improvement include providing command and health care agency emphasis for the TeamSTEPPS program, providing adequate material and personnel resources, designing training that is geared to trainer implementation at the departmental level, prioritizing and saturating training, and striving toward a just culture.

Prevalencia del síndrome de burnout y estrategias de afrontamiento durante una epidemia por influenza AH1N1

by Fernando Austria Corrales

El objetivo de este estudio fue evaluar el síndrome de burnout en una muestra de 477 trabajadores de la salud durante... more El objetivo de este estudio fue evaluar el síndrome de burnout en una muestra de 477 trabajadores de la salud durante una epidemia por influenza AH1N1 en la Ciudad de México, e identificar si el uso de estrategias de afrontamiento tenía efectos protectores al burnout. Se realizó un estudio descriptivo transversal con una muestra no probabilística por cuotas, utilizando como instrumentos el Maslach Burnout Inventory versión Human Services y la Escala de Afrontamiento Frente a Riesgo Extremos. Se hizo una distribución de frecuencia y de normalidad para analizar las diferencias, un análisis de varianza en burnout y regresión lineal múltiple para estrategias de afrontamiento. A partir del análisis, se encontró que el 24% presentó el síndrome de burnout en grado moderado (cansancio
emocional y despersonalización, con presencia de realización personal); asimismo, fueron empleadas estrategias activas y pasivas. Se constató que el uso de estrategias de afrontamiento fue selectivo y las estrategias activas tuvieron una función moderadora al burnout, protectora a la escala de cansancio emocional, que aumentó cuando presentaban realización personal. El estudio propone el desarrollo de investigaciones cuantitativas y cualitativas, así como el uso de modelos mixtos de intervención: centradas en las personas.

“Dude! You mean you’ve never eaten a peanut butter and jelly sandwich?!?” Nut allergy as stigma in comic books

by Simon Weaver

with Sarah McNicol, Health Communication, Online 10th May 2012

This article examines the representation of nut allergy in comics aimed at children and young people. It maps the... more This article examines the representation of nut allergy in comics aimed at children and young people. It maps the signification and stigma of nut allergy in comics, and includes an outline of the imagery, stereotypes, and connotations that are created on this condition. Three texts are examined: first, Allergic, a semi-autobiographical story by Adrian Tomine aimed at young adults; second, What's Up With Paulina? from the Medikidz series of comic books that aim to help a pre-teenage audience learn about medical conditions; and third, Peanut, a forthcoming comic book by Ayun Halliday aimed at those in their early to mid teenage years. Using textual analysis, we focus on three principal areas of the texts. First, we consider the way in which the allergic character is represented in relation to examples of felt stigma, typified by feelings of shame and rejection, and compare this representation to common stereotypes of disability. Second, we look at the representation of other characters, drawing attention to the way in which stigma is enacted, highlighting acts of overt discrimination. Last, we examine the way in which the event of an allergic reaction is portrayed, considering how this might be used to help children and young people better understand nut allergy and combat the stigma attached to it. Throughout the article we compare the representation of stigma in comics with that depicted in empirical research on children living with nut allergies.

Alucinógenos, neuroplasticidad y salud mental

by José Manuel Rodríguez

Rodríguez, J.M. 2011. Alucinógenos, neuroplasticidad y salud mental. Semanario Universidad No. 1877: 22 Opinión.

Filingeri, D., Bianco, A., Jemni, M., Mammina, C., Paoli, A., Palma, A., Tabacchi, G., (2011) A web-based surveillance system for nutritional and physical activity in adolescence - The ASSO Project. Journal of Sports Medicine and Physical Fitness. 51 (Suppl.1 to No. 3): 57.

by Davide Filingeri

Multimorbidity in primary care: a systematic review of prospective cohort studies

by Frances Mair

Authors: France, Emma F1; Wyke, Sally2; Gunn, Jane M3; Mair, Frances S4; McLean, Gary4; Mercer, Stewart W4
Source: British Journal of General Practice, Volume 62, Number 597, April 2012 , pp. e297-e307(11)
Publisher: Royal College of General Practitioners

Abstract:
Background
Primary care increasingly deals with patients with multimorbidity, but relevant... more Abstract:
Background
Primary care increasingly deals with patients with multimorbidity, but relevant evidence-based interventions are scarce. Knowledge about multimorbidity over time is required to inform the development of effective interventions.
Aim
This review identifies prospective cohort studies of multimorbidity in primary care to determine: their nature, scope and key findings; the methodologies used; and gaps in knowledge.
Design
Systematic review.
Method
Studies were identified by searching electronic databases, reviewing citations, and writing to authors. Searches were limited to adult populations with no restrictions on publication date or language. In total, 996 articles were identified and screened.
Results
Of the 996 articles, six detailing five completed prospective cohort studies were selected as appropriate. Three of the studies were undertaken in the US and two in The Netherlands; none was nationally representative. The main focus of the studies was: healthcare utilisation and/or costs (n = 3); patients' physical functioning (n = 1); and risk factors for developing multimorbidity (n = 1). The conditions that were included varied widely. The findings of these studies showed that multimorbidity increased healthcare costs (n = 2), inpatient admission (n = 1), death rates (n = 1), and service use (n = 3), and reduced physical functioning (n = 1). One study identified psychosocial risk factors for multimorbidity. No study used random sampling, sample sizes were relatively small (414-3745 patients at baseline), and study duration was relatively short (1-4 years). No study focused on prevalence, treatment use, patient safety, service models, cultural or socioeconomic factors, and patient experience, and no study collected qualitative data.
Conclusion
Few longitudinal studies based in primary care have investigated multimorbidity. Further large, long-term prospective studies are required to inform healthcare commissioning, planning, and delivery.

Urinary DAP metabolite levels in Thai farmers and their families and exposure to pesticides from agricultural pesticide spraying.

by Frank de Vocht

Hanchenlaksh C, Povey A, O'Brien S, de Vocht F.

Introduction We conducted a biomarker study to characterise exposure to pesticides among farmers and their families in... more Introduction We conducted a biomarker study to characterise exposure to pesticides among farmers and their families in Thailand to assess the relative importance of the dermal exposure route and to identify important factors that determine exposure levels within farmers' families. Methods Sixteen farmers' families (eight vegetable and eight fruit farmers) participated in the study. Three morning spot urine samples were collected during a pesticide spraying week. Spot samples were grouped by individual and analysed for dialkylphosphate (DAP) metabolites and creatinine. Additional information on exposure and lifestyle was collected by means of questionnaires. Dermal exposure was assessed using a semi-quantitative observational method (DREAM). Results Urinary DAP levels varied 20-fold between farmers, with average (geometric mean) levels of 51.1 μg/g for vegetable and 122.2 μg/g for fruit farmers. A moderate correlation (r(s)∼0.45) was found between log(e)-transformed DREAM scores and DAP levels. Farmers' urinary metabolite levels were not correlated with those of their spouses (r(s)∼-0.30) or children (r(s)∼-0.00) collected on the same days. Detectable spouses' DAP levels were on average (geometric mean) 13.0 μg/g and those of children 7.6 μg/g. Discussion Farmers in Thailand as well as their families are exposed to pesticides in the spraying season and dermal exposure is an important route. The main route of exposure for farmers' families seems to be through transfer from the farmer to family members or contamination of the home environment, rather than family members helping or playing on the farm. Showering or washing immediately after pesticide spraying greatly reduces the potential exposure of family members to pesticide residues.

Knowledge about occupational latex allergy amongst Thai nurses and student nurses

by Frank de Vocht

Chompunuch Supapvanich, Andrew Povey, Frank de Vocht

Open Access

Glove usage, particularly powdered latex glove is a cause of latex allergy in hospital workers; therefore those... more Glove usage, particularly powdered latex glove is a cause of latex allergy in hospital workers; therefore those workers must have latex allergy knowledge to protect themselves and patients from serious health problems. This study aimed to examine knowledge about latex allergy among nurses and compare their performance with student nurses in Thailand. A knowledge ques-tionnaire was administered to a random sample of 30 nurses and 30 student nurses who worked in hospitals where powdered latex gloves were used. Overall, nurses and student nurses gave correct responses to 27% and 28% of the questions, respectively. There was no statistically significant difference in knowledge between nurses and student nurses. Both nurses and student nurses in Thailand have insufficient knowledge about latex allergy and its risk factors. Additional continuing education should be provided to reduce the probability of adverse reactions in sensitized staff and patients in Thai hospitals.

Performance of a microenviromental model for estimating personal NO2 exposure in children

by Frank de Vocht

Anna Mölter, Sarah Lindley, Frank de Vocht, Raymond Agius, Gina Kerry,
Katy Johnson, Mike Ashmore, Andrew Terry, Sani Dimitroulopoulou, Angela Simpson

A common problem in epidemiological studies on air pollution is exposure misclassification, because investigators... more A common problem in epidemiological studies on air pollution is exposure misclassification, because investigators often assume exposure is equivalent to outdoor concentrations at participants’ homes or at the nearest urban monitor.

The aims of this study were: (1) to develop a new microenvironmental exposure model (MEEM), combining time-activity data with modelled outdoor and indoor NO2 concentrations; (2) to evaluate MEEM against data collected with Ogawa™ personal samplers (OPS); (3) to compare its performance against datasets typically used in epidemiological studies.

Schoolchildren wore a personal NO2 sampler, kept a time-activity diary and completed a questionnaire. This information was used by MEEM to estimate individuals’ exposures. These were then compared against concentrations measured by OPS, modelled outdoor concentrations at the children’s home (HOME) and concentrations measured at the nearest urban monitoring station (NUM).

The mean exposure predicted by MEEM (mean = 19.6 μg m−³) was slightly lower than the mean exposure measured by OPS (mean = 20.4 μg m−³). The normalised mean bias factor (0.01) and normalised mean absolute error factor (0.25) suggested good agreement. In contrast, the HOME (mean = 31.2 μg m−³) and NUM (mean = 28.6 μg m−³) methods overpredicted exposure and showed systematic errors.

The results indicate that personal exposure can be modelled by MEEM with an acceptable level of agreement, while methods such as HOME and NUM show a poorer performance.

Comment on: Effects of Static Magnetic Fields on Cognition, Vital Signs, and Sensory Perception: A Meta-Analysis

by Frank de Vocht

de Vocht F, Stevens T, Kromhout H.

Letter to the Editor Letter to the Editor

DEVELOPMENTAL IMPLICATIONS OF HIV/AIDS, THE CASE OF AIDS ORPHANS & CAREGIVERS

by Philipos Gile

What Difference Does Our Difference Make In Researching Infertility?

by Yasmin Gunaratnam

Inequality Watch Newsletter

by TARKI Social Research Institute

Inequality Watch is supported by the Foundation Charles-Léopold Mayer pour le Progrès de l’Homme, in partnership with Veblen Institute, Afev and Alternatives Internationales

Inequality Watch, the European observatory of inequality, is a network resulting from the desire of associations and... more Inequality Watch, the European observatory of inequality, is a network resulting from the desire of associations and research centres to observe the state and evolution of inequality in Europe. It is the first independent information network for inequality in Europe. A better observation of inequality is necessary to be able to fight against it. To know and understand the evolution of inequality, the mechanisms that explain its increase or decrease and its consequences, is the key to develop more efficient policies to eliminate it.

Asymptomatic Carriage of Plasmodium in Urban Dakar: The Risk of Malaria Should Not Be Underestimated

by Sébastien Oliveau

Diallo A, Ndam NT, Moussiliou A, Dos Santos S, Ndonky A, Borderon M., Oliveau S, Lalou R., Le Hesran J-Y, (2012) Asymptomatic Carriage of Plasmodium in Urban Dakar: The Risk of Malaria Should Not Be Underestimated. PLoS ONE 7(2): e31100.

Introduction
The objective of this study was to measure the rate of asymptomatic carriage of plasmodium in the... more Introduction
The objective of this study was to measure the rate of asymptomatic carriage of plasmodium in the Dakar region two years after the implementation of new strategies in clinical malaria management.

Methodology
Between October and December 2008, 2952 households selected in 50 sites of Dakar area, were visited for interviews and blood sampling. Giemsa-stained thick blood smears (TBS) were performed for microscopy in asymptomatic adult women and children aged 2 to 10 years. To ensure the quality of the microscopy, we performed a polymerase chain reaction (PCR) with real time qPCR in all positive TBS by microscopy and in a sample of negative TBS and filter paper blood spots.

Results
The analysis has concerned 2427 women and 2231 children. The mean age of the women was 35.6 years. The mean age of the children was 5.4 years. The parasite prevalence was 2.01% (49/2427) in women and 2.15% (48/2231) in children. Parasite prevalence varied from one study site to another, ranging from 0 to 7.41%. In multivariate analysis, reporting a malaria episode in 2008 was associated with plasmodium carriage (OR = 2.57, P = 0.002) in women; in children, a malaria episode (OR = 6.19, P<0.001) and a travel out of Dakar during last 3 months (OR = 2.27, P = 0.023) were associated with plasmodium carriage.

Among the positive TBS, 95.8% (93/97) were positive by plasmodium PCR. Among the negative TBS, 13.9% (41/293) were positive by PCR. In blood spots, 15.2% (76/500) were positive by PCR. We estimated at 16.5% the parasite prevalence if PCR were performed in 4658 TBS.

Conclusion
Parasite prevalence in Dakar area seemed to be higher than the rate found by microscopy. PCR may be the best tool for measuring plasmodium prevalence in the context of low transmission. Environmental conditions play a major role in the heterogeneity of parasite prevalence within sites.

'Widening access to hospice care – a briefing paper for managers and trustees'

by Yasmin Gunaratnam

This is a practical guide on widening access to hospice and palliative care services, written in 2006 for Help the Hospices