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This research addresses dementia and driving cessation, a major life event for affected individuals, and an immense challenge in primary care. In Australia, as with many other countries, it is primarily general practitioners (GPs) who identify changes in cognitive functioning and monitor driving issues with their patients with dementia. Qualitative evidence from studies with family members and other health professionals shows it is a complicated area of practice. However we still know little from GPs about how they manage the challenges with their patients and the strategies that they use to facilitate driving cessation.
Data were collected through five focus groups with 29 GPs at their primary care practices in metropolitan and regional Queensland, Australia. A semi-structured topic guide was used to direct questions addressing decision factors and management strategies. Discussions were audio recorded, transcribed verbatim and thematically analyzed.
Regarding the challenges of raising driving cessation, four key themes emerged. These included: (i) Considering the individual; (ii) GP-patient relationships may hinder or help; (iii) Resources to support raising driver retirement; and (iv) Ethical dilemmas and ethical considerations. The impact of discussing driving cessation on GPs is discussed.
The findings of this study contribute to further understanding the experiences and needs of primary care physicians related to managing driving retirement with their patients with dementia. Results support a need for programs regarding identification and assessment of fitness to drive, to upskill health professionals and particularly GPs to manage the complex issues around dementia and driving cessation, and explore cost-effective and timely delivery of such support to patients.
Red meat from grass-fed animals, compared with concentrate-fed animals, contains increased concentrations of long-chain (LC) n-3 PUFA. However, the effects of red meat consumption from grass-fed animals on consumer blood concentrations of LC n-3 PUFA are unknown. The aim of the present study was to compare the effects on plasma and platelet LC n-3 PUFA status of consuming red meat produced from either grass-fed animals or concentrate-fed animals. A randomised, double-blinded, dietary intervention study was carried out for 4 weeks on healthy subjects who replaced their habitual red meat intake with three portions per week of red meat (beef and lamb) from animals offered a finishing diet of either grass or concentrate (n 20 consumers). Plasma and platelet fatty acid composition, dietary intake, blood pressure, and serum lipids and lipoproteins were analysed at baseline and post-intervention. Dietary intakes of total n-3 PUFA, as well as plasma and platelet concentrations of LC n-3 PUFA, were significantly higher in those subjects who consumed red meat from grass-fed animals compared with those who consumed red meat from concentrate-fed animals (P < 0·05). No significant differences in concentrations of serum cholesterol, TAG or blood pressure were observed between groups. Consuming red meat from grass-fed animals compared with concentrate-fed animals as part of the habitual diet can significantly increase consumer plasma and platelet LC n-3 PUFA status. As a result, red meat from grass-fed animals may contribute to dietary intakes of LC n-3 PUFA in populations where red meat is habitually consumed.
The prevalence, incidence and outcomes of haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopaenic purpura (TTP) are not well established in adults or children from prospective studies. We sought to identify both outcomes and current management strategies using prospective, national surveillance of HUS and TTP, from 2003 to 2005 inclusive. We also investigated the links between these disorders and factors implicated in the aetiology of HUS and TTP including infections, chemotherapy, and immunosuppression. Most cases of HUS were caused by verocytotoxin-producing Escherichia coli (VTEC), of which serotype O157 predominated, although other serotypes were identified. The list of predisposing factors for TTP was more varied although use of immunosuppressive agents and severe sepsis, were the most frequent precipitants. The study demonstrates that while differentiating between HUS and TTP is sometimes difficult, in most cases the two syndromes have quite different predisposing factors and clinical parameters, enabling clinical and epidemiological profiling for these disorders.
An investigation was conducted to test the hypothesis that dietary oil inclusion increases ammonia nitrogen (NH3-N) emission from the manure, due to a negative effect of either unsaturated or saturated oil on microbial activity in the intestine. Dietary oil was included at 45 g/kg, as either crude palm oil (PO), soya oil (SO) or a 50: 50 SO: PO blend (OB), to a basal barley-soya-wheat diet (control) at the expense of dextrose and maize starch. Diets were formulated to contain 13·2 MJ digestible energy per kg and 11·0 g/kg lysine. Four boars were assigned to each dietary treatment, and were transferred to metabolism crates (mean live weight, 74·0 (± 2·89) kg) following 14 days dietary acclimatization. Urine and faeces were collected separately over a 5-day digestibility/nitrogen (N) balance period and a 2-day manure collection period. Inclusion of dietary oil increased apparent digestibility of oil (P < 0·01) and decreased the apparent digestibility of dry matter (P < 0·01) and gross energy (P < 0·05). Dietary oil did not affect the apparent digestibility of nitrogen, acid-detergent fibre, neutral-detergent fibre or hemicellulose. Apparent digestibility of oil was lower when oil was included as PO compared with SO and OB (P < 0·001). The concentration of faecal volatile fatty acid (VFA) was similar in all treatments, although the acetic: propionic acid ratio was lower when oil was included as PO and OB compared with SO (P < 0·05). N balance, manure N concentration and NH3-N emission was not affected by oil inclusion or oil source. In conclusion, dietary oil inclusion reduced apparent dry matter and energy digestibilities, although no effect on fermentation was indicated by digestibility of fibre or faecal VFA content. Consequently, ammonia emission was not affected by dietary oil included at 45 g/kg.
A 2 ✕ 2 factorial arrangement of treatments used 280 growing pigs and 240 finishing pigs to examine the main effects and interactions between two levels of stocking density (0·75 m2 v. 0·45 m2 per growing pig and 0·88 m2 v. 0·53 m2 per finishing pig) and grouping (static groups v. regrouped) on pig growth performance, carcass characteristics, nutrient digestibility and measurements of physiological indicators of stress responses. Regrouping was achieved by moving four unfamiliar pigs between replicate groups every 14 days. Average daily gain (ADG) and average daily food intake (ADFI) were reduced by an additive interaction between high density and regrouping in growing pigs (P < 0·01). In finishing pigs, regrouping reduced ADG (P 0·05) and carcass weight (P 0·05). Regrouping reduced apparent dry matter and gross energy digestibility in finishing pigs (P 0·05). Rectal temperature increased 3 h after mixing finishing pigs (P 0·05), but not growing pigs. In growing pigs, the neutrophil: lymphocyte ratio tended to increase (P 0·1) after regrouping, although plasma cortisol concentration was unaffected. In finishing pigs, the response to a Newcastle disease virus antigen challenge tended to decrease at high stocking density (P 0·1), although total IgG concentration was unaffected. In conclusion, the growth performance of growing and finishing pigs was affected by social stressors. However, effects on the physiological measurements did not concur with effects on growth performance.
The production of potent toxins by bloom-, scum- and mat-forming cyanobacteria, in fresh-, brackish and marine waters, appears to be a
global phenomenon. Cyanobacterial toxins can also be produced by cyanobacteria from terrestrial sources. The range and number of
known cyanobacterial toxins are increasing apace as associated poisoning incidents are investigated, and increasingly powerful analytical
methods are applied to complement toxicity-based studies on both natural samples and laboratory isolates of cyanobacteria. Water quality
management to reduce toxic cyanobacterial mass developments, and schemes to mitigate the potential effects of cyanobacterial toxins,
require an understanding of the occurrence and properties of the toxins and of the exposure routes via which the toxins present risks to
health. Here, we review advances in the recognition of cyanobacterial toxins and their toxicity, and of the exposure routes with reference
to human health, namely via skin contact, inhalation, haemodialysis and ingestion (the oral route).
Ceroplastes sinensis Del Guercio is a pest of commercial citrus in Australia and has been recorded from New Zealand, southern Europe, northern Africa, North America and Mexico. Its distribution is mainly temperate and it is more restricted climatically than previously believed. Uncertainty concerning the place of origin of C. sinensis has thwarted previous attempts at biological control. In the present study, a novel and cost-effective approach using cladistic estimates is demonstrated to determine the place of its origin. Cladistically derived phylogenies are commonplace for many organisms, but the method has not been used before to predict the area of origin of a cosmopolitan pest. Cladistic analysis of the wax scales predicts a native range for C. sinensis within Central or South America. This prediction appears to have been confirmed by the recent discovery of heavily parasitized individuals of C. sinensis in Argentina. The cladistic analysis also allows prediction of the geographical origin of three other widespread wax scale speries:Ceroplastes ceriferus (Fabricius) may be of Neotropical origin, C. rubens Maskell and C. rusci (Linnaeus) are probably native to the Afrotropical region. The approach used has wide implications because the native areas of many other economically important pests are still unknown or uncertain.
The use of microwave frequency radiation as an alternative energy source for processing materials is currently receiving considerable worldwide attention. The ability of a material to extract energy from the microwave field depends upon its dielectric properties, however these change as the material heats. There is, therefore, a need for obtaining measurements of the microwave dielectric properties at elevated temperatures. This paper outlines some of the current work on high temperature dielectric measurements which is in progress at the University of Nottingham as part of the Materials and Microwave Processing Group initiative and some results on engineering ceramics are presented.
Interviews were conducted with the co-resident supporters of 79 elderly subjects. Forty of these elderly subjects had been diagnosed as being demented (20 mildly, 12 moderately and eight severely) following psychiatric assessment. The supporters were screened for psychological well-being with the 60-item General Health Questionnaire (GHQ) and the Relatives' Stress Scale (RSS). Supporters of demented relatives showed significantly raised levels of stress on the RSS, but no increase in psychiatric morbidity on the GHQ, when compared with the supporters of non-demented relatives. The implications of these findings are discussed.
A community sample of elderly married couples completed the 60-item General Health Questionnaire and the Leeds General Scales for the Self-Assessment of Depression and Anxiety. Significant concordance was demonstrated between the spouses' scores on these scales. Concordance was higher for depression than for anxiety. There was little to support previous findings that wives are more likely than husbands to be concordant with an ill spouse. The spouse concordance rates for psychiatric morbidity were similar to those found in studies of younger married couples.
In a general practice population, 274 elderly married couples completed the Mental Status Questionnaire (MSQ), the 60-item General Health Questionnaire (GHQ) and the Leeds General Scales for the Self-assessment of Depression and Anxiety. The only relationship detected between cognitive impairment on the MSQ and psychiatric morbidity in the partner was a fairly weak negative correlation between the wives' MSQ and the Leeds Depression score of their husbands. These findings differ from those of previous studies, which have found high rates of psychiatric morbidity in the relatives of demented patients, and the possible reasons for these differences are discussed. Most importantly, other studies have involved the relatives of patients referred to psychiatric services, and these families may be quite different from those in which the demented relative is not referred to a psychiatrist.
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