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To assess the perception of Ghanaian medical students about factors influencing their career interest in psychiatry and to explore gender differences in these perceptions.
This is a cross-sectional quantitative survey of 5th and 6th year medical students in four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics using SPSS version 20.
Responses were obtained from 545 medical students (response rate of 52%). Significantly, more male medical students expressed that stigma is an important consideration for them to choose or not to choose a career in psychiatry compared to their female counterparts (42.7% v. 29.7%, respectively). Over two-thirds of the medical students perceived that psychiatrists were at risk of being attacked by their patients, with just a little over a third expressing that risk was an important consideration for them to choose a career in psychiatry. There were no gender differences regarding perceptions about risk. Around 3 to 4 out of 10 medical students will consider careers in psychiatry if offered various incentives with no gender differences in responses provided.
Our study presents important and novel findings in the Ghanaian context, which can assist health policy planners and medical training institutions in Ghana to formulate policies and programs that will increase the number of psychiatry residents and thereby increase the psychiatrist-to-patient ratio in Ghana.
The Age-Period-Cohort-Improvement (APCI) model is a new addition to the canon of mortality forecasting models. It was introduced by Continuous Mortality Investigation as a means of parameterising a deterministic targeting model for forecasting, but this paper shows how it can be implemented as a fully stochastic model. We demonstrate a number of interesting features about the APCI model, including which parameters to smooth and how much better the model fits to the data compared to some other, related models. However, this better fit also sometimes results in higher value-at-risk (VaR)-style capital requirements for insurers, and we explore why this is by looking at the density of the VaR simulations.
Introduction: The World Health Organization recommends emergency care training for laypeople in low-resource settings, but the effects of these programs on patient outcomes and community health have not been systematically reviewed. Our objective was to identify the individual and community health effects of educating laypeople to deliver emergency care in low-resource settings. Methods: We conducted a systematic review to address this question: in low-resource populations (P), does emergency care education for laypeople (I) confer any measurable effect on patient morbidity and mortality, or community capacity and resilience for emergency health conditions (O), in comparison with no training or other education(C)? We searched 12 electronic databases and grey literature for quantitative studies. We conducted duplicate and independent title and abstract screening, methodological and outcomes extraction, and study quality assessment using the Effective Public Health Practice Tool. We developed a narrative summary of findings. (PROSPERO: CRD42014009685) Results: We reviewed 16,017 abstracts and 372 full-text papers. 38 met inclusion criteria. Most topically relevant papers were excluded because they assessed educational outcomes. Cardiopulmonary resuscitation training (6 papers) improved cardiac arrest survival and enhanced capacity to respond to cardiac arrest in rural Norway, Denmark and commercial aircraft operations. A public education campaign in remote Denmark improved absolute cardiac arrest survival by 5.4% (95%CI 2-12). Lay trauma training (12 papers) reduced absolute injury mortality and improved community capacity in Iraq, Cambodia, Iran and Indigenous New Zealand communities. A trauma care program in Iraq and Cambodia reduced absolute mortality by 25% (95%CI 17.2-33). Education for mothers on paediatric fevers in Ethiopia was associated with 40% relative reductions in under-5 mortality (95%CI 29.2-50.6). Similar training improved access to care for paediatric malnutrition, malaria, pneumonia, and gastrointestinal disease in Nigeria, Kenya, Senegal, Burkina Faso, Mali, and India (13 papers). Overdose education and naloxone distribution was associated with reductions in opioid overdose deaths (3 papers), including in Massachusetts where high-uptake communities for overdose education had significantly lower overdose fatality rates than no-uptake communities (rate ratio 0.54, 95%CI 0.39-0.76). Community education improved measures of access to emergency care for remote Indigenous populations in Canada, Alaska and Nepal (3 papers) and adolescent mental health capacity in Australia (1 paper). Studies were of low or medium quality. Conclusion: In addition to established interventions for injury and cardiac arrest, emergency care training can improve community capacity in underserviced populations, and save lives in opioid overdose, paediatric infectious disease and malnutrition.
Increased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity.
Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS.
Respondents of the 2013 HRS HCNS with household incomes <300 % of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0–1, 2–4, ≥5 conditions), with multiple chronic conditions (MCC) defined as ≥2 conditions.
The prevalence of food insecurity was 27·8 %. Compared with those having 0–1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2–4 conditions being 2·12 (95 % CI 1·45, 3·09) and for those with ≥5 conditions being 3·64 (95 % CI 2·47, 5·37).
A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.
Polygenic risk scores (PRS) for depression correlate with depression status and chronicity, and provide causal anchors to identify depressive mechanisms. Neuroticism is phenotypically and genetically positively associated with depression, whereas psychological resilience demonstrates negative phenotypic associations. Whether increased neuroticism and reduced resilience are downstream mediators of genetic risk for depression, and whether they contribute independently to risk remains unknown.
Moderating and mediating relationships between depression PRS, neuroticism, resilience and both clinical and self-reported depression were examined in a large, population-based cohort, Generation Scotland: Scottish Family Health Study (N = 4166), using linear regression and structural equation modelling. Neuroticism and resilience were measured by the Eysenck Personality Scale Short Form Revised and the Brief Resilience Scale, respectively.
PRS for depression was associated with increased likelihood of self-reported and clinical depression. No interaction was found between PRS and neuroticism, or between PRS and resilience. Neuroticism was associated with increased likelihood of self-reported and clinical depression, whereas resilience was associated with reduced risk. Structural equation modelling suggested the association between PRS and self-reported and clinical depression was mediated by neuroticism (43–57%), while resilience mediated the association in the opposite direction (37–40%). For both self-reported and clinical diagnoses, the genetic risk for depression was independently mediated by neuroticism and resilience.
Findings suggest polygenic risk for depression increases vulnerability for self-reported and clinical depression through independent effects on increased neuroticism and reduced psychological resilience. In addition, two partially independent mechanisms – neuroticism and resilience – may form part of the pathway of vulnerability to depression.
Plasma inorganic iodine concentrations (PII, ng/ml) are increasingly used in preference to plasma thyroxine concentrations (T4) for diagnostic purposes. PII represents current dietary iodine intake and responds rapidly (within a very few days) to increases and decreases in dietary iodine (I) intake by cows (Rogers and Mee, 1966). This study measured changes in PII in response to different I intakes supplied by contrasting methods to beef cows during late pregnancy and early lactation.
Satellite imagery has been used to acquire seasonal terminus positions of tidewater Hubbard Glacier, Alaska, USA, from 1992 to 2006. During this 15 year time period, the width-averaged advance of the entire terminus has been ∼620 m at a mean rate of 35 m a−1. Seasonal fluctuation of the terminus ranges from 150 to 200 m on average and varies spatially. A section of the terminus, near a narrow gap where the glacier has now twice closed off 40 km long Russell Fiord, exhibited little to no mean advance during this time period but displayed seasonal fluctuations of 300–500 m. Seasonal variability in surface ice speeds and surface sea-water temperatures was also observed; both are potential forcing mechanisms for terminus fluctuations. Seasonal changes in sea-water temperature of 10–12°C, as well as seasonal changes in subglacial freshwater discharge, are inferred to influence calving and submarine melting at the terminus, driving seasonal variations. Displacements of the medial moraine separating Hubbard and Valerie Glaciers at the terminus suggest surge-like pulses of the latter, with a periodicity of several years. The timing of these pulses suggests they may influence the Hubbard terminus near Gilbert Point and have implications for future closures of Russell Fiord.
We present the first description of an antimicrobial stewardship program (ASP) used to successfully manage a multi-antimicrobial drug shortage. Without resorting to formulary restriction, meropenem utilization decreased by 69% and piperacillin-tazobactam by 73%. During the shortage period, hospital mortality decreased (P=.03), while hospital length of stay remained unchanged.
Dengue is the world's most prevalent mosquito-borne disease, with more than 200 million people each year becoming infected. We used a mechanistic virus transmission model to determine whether climate warming would change dengue transmission in Australia. Using two climate models each with two carbon emission scenarios, we calculated future dengue epidemic potential for the period 2046–2064. Using the ECHAM5 model, decreased dengue transmission was predicted under the A2 carbon emission scenario, whereas some increases are likely under the B1 scenario. Dengue epidemic potential may decrease under climate warming due to mosquito breeding sites becoming drier and mosquito survivorship declining. These results contradict most previous studies that use correlative models to show increased dengue transmission under climate warming. Dengue epidemiology is determined by a complex interplay between climatic, human host, and pathogen factors. It is therefore naive to assume a simple relationship between climate and incidence, and incorrect to state that climate warming will uniformly increase dengue transmission, although in general the health impacts of climate change will be negative.
To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective.
Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care.
Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients’ records for three years from diagnosis (‘newly diagnosed’ patients) or for the most recent three years (‘established’ patients).
Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and ‘newly diagnosed’ patients were significantly more likely to visit their GP for pain management than ‘established’ patients. Although ‘newly diagnosed’ patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups.
This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use.
Our aim was to describe the epidemiology and incidence of community-onset invasive S. aureus disease in children presenting to our hospital, and to compare the clonal complexes and virulence genes of S. aureus strains causing invasive and non-invasive disease. The virulence gene repertoire of invasive disease isolates was characterized using DNA microarray and compared with the virulence gene repertoire of non-invasive S. aureus isolates. Over the study period, 163 children had an invasive S. aureus infection. There was no difference in the distribution of clonal complexes or in the prevalence of genes encoding virulence factors between invasive and non-invasive isolates. Future research should include a strong focus on identifying the host and environmental factors that, along with organism virulence factors, are contributing to the patterns of invasive S. aureus disease observed in New Zealand.
The device performance of GaAs p-i-n solar cells containing stacked layers of self-assembled InAs quantum dots is investigated. The solar cells demonstrate enhanced external quantum efficiency below the GaAs band gap relative to a control device without quantum dots. This is attributed to the capture of sub-band gap photons by the quantum dots. Analysis of the current density versus voltage characteristic for the quantum dot solar cell reveals a decrease in the series resistance as the device area is reduce from 0.16 cm2 to 0.01 cm2. This is effect is not observed in control devices and is quantum dot related. Furthermore, low temperature measurements of the open circuit voltage for both quantum dot and control devices provide experimental verification of the conditions required to realise an intermediate band gap solar cell.
The Consumer Information Working Party has published this paper which explores how we can better engage consumers with long-term savings and investments. The working party considered the current state of consumer information, which is a long way from ideal, including: consumer insights and touch points, the current consumer information model, relevant considerations from behavioural economics, examples of information failures and some successes from other fields. They then propose a way to deliver more effective information, including a possible framework and some ideas for its application. They finish with proposals for immediate next steps and urge the Actuarial Profession to take a lead in this area.
Longevity risk faced by annuity portfolios and defined-benefit pension schemes is typically long-term, i.e. the risk is of an adverse trend which unfolds over a long period of time. However, there are circumstances when it is useful to know by how much expectations of future mortality rates might change over a single year. Such an approach lies at the heart of the one-year, value-at-risk view of reserves, and also for the pending Solvency II regime for insurers in the European Union. This paper describes a framework for determining how much a longevity liability might change based on new information over the course of one year. It is a general framework and can accommodate a wide choice of stochastic projection models, thus allowing the user to explore the importance of model risk. A further benefit of the framework is that it also provides a robustness test for projection models, which is useful in selecting an internal model for management purposes.
The peak energy of the room temperature photoluminescence of porous silicon is compared with the bandgap determined from photoelectron spectroscopy measurements for a series of porous silicon samples prepared under different conditions. The photoluminescence bandgap is found to be smaller than the photoelectron spectroscopy bandgap, but exhibits the same trend with preparation conditions. The width of both the photoluminescence spectrum and the L-absorption edge increases when the current density during the preparation is increased or the sample is allowed to soak in HF after preparation.