Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36
Filtrar
Mais filtros

Bases de dados
País/Região como assunto
Tipo de documento
Intervalo de ano de publicação
1.
Arthroscopy ; 39(6): 1483-1489.e1, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36567182

RESUMO

PURPOSE: The purpose of this study was to compare failure rates and patient-reported outcomes between transosseus (TO) suture and suture anchor (SA) quadriceps tendon repairs. METHODS: Following institutional review board approval, patients who underwent primary repair for quadriceps tendon rupture with TO or SA techniques between January 2009 and August 2018 were identified from an institutional database and retrospectively reviewed. Patients were contacted for satisfaction (1-10 scale), current function (0-100 scale), failure (retear), and revision surgeries; International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were also collected to achieve a minimum of 2-year follow-up. RESULTS: Sixty-four patients (34 SA, 30 TO) were available by phone or e-mail at a mean of 4.81 ± 2.60 years postoperatively. There were 10 failures, for an overall failure rate of 15.6%. Failure incidence did not significantly differ between treatment groups (P = .83). Twenty-seven patients (47% of nonfailed patients) had completed patient-reported outcomes. The SA group reported higher subjective function (SA: 90 [85-100] vs TO: 85 [60-93], 95% CI of difference: -19.9 to -2.1 × 10-5, P = .042), final IKDC (79.6 [50.0-93.6] vs 62.1 [44.3-65.5], 95% CI of difference: -33.0 to -0.48, P = .048), KOOS Pain (97.2 [84.7-97.2] vs 73.6 [50.7-88.2], 95% CI of difference: -36.1 to -3.6 × 10-5, P = .037), Quality of Life (81.3 [56.3-93.8] vs 50.0 [23.4-56.3], 95% CI of difference: -50.0 to -6.2, P = .026), and Sport (75.0 [52.5-90.0] vs 47.5 [31.3-67.5], 95% CI of the difference: -45.0 to -4.1 × 10-5, P = .048). CONCLUSIONS: There is no significant difference in failure rate between transosseus and suture anchor repairs for quadriceps tendon ruptures (P = .83). Most failures occur secondary to a traumatic reinjury within the first year postoperatively. Despite the lack of difference in failure rates, at final follow-up, patients who undergo suture anchor repair may report significantly greater subjective function and final IKDC, KOOS Pain, Quality of Life, and Sport scores. LEVEL OF EVIDENCE: III, retrospective cohort study.


Assuntos
Âncoras de Sutura , Traumatismos dos Tendões , Humanos , Estudos Retrospectivos , Qualidade de Vida , Traumatismos dos Tendões/cirurgia , Técnicas de Sutura , Medidas de Resultados Relatados pelo Paciente , Tendões/cirurgia
2.
Knee Surg Sports Traumatol Arthrosc ; 31(11): 5067-5076, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37823904

RESUMO

PURPOSE: The purpose of this study was to assess the validity, floor and ceiling effects, and dimensionality of PROMIS Physical Function (PF) and Pain compared to legacy patient reported outcome (PRO) measures in patients undergoing medial patellofemoral ligament (MPFL) reconstruction. METHODS: Patients who underwent MPFL reconstruction between 2018 to 2020 were retrospectively reviewed. Preoperatively, patients completed the IKDC, VR-12, Kujala, SF-12, KOOS JR, PROMIS PF and Pain surveys. Inter-survey convergence was assessed with Spearman correlations. Psychometric analysis included investigations of inter-survey convergent validity, intra-survey floor and ceiling effects, and Rasch analyses with person-item fit and iterative question elimination model fit testing. RESULTS: A total of 76 patients (mean age: 22.6 ± 8.4 years) who completed preoperative surveys were included (compliance: 91.7-96.2%). Preoperatively, age was significantly associated with both PROMIS PF (coefficient: - 0.291, P = 0.005) and Pain scores (coefficient: 0.294, P = 0.002). PROMIS PF had a Very Good correlation with IKDC and PROMIS Pain had a Very Good correlation with KOOS JR. Other correlations ranged from Poor to Good. No significant floor or ceiling effects were observed for any PRO. On iterative question elimination Rasch modelling, only two questions from PROMIS PF remained after 6 rounds of elimination while PROMIS Pain had no questions remaining after 3 rounds of elimination. CONCLUSION: Preoperative PROMIS PF and Pain provided only Fair to Good correlations with most legacy PROs. Although no significant floor and ceiling effects were observed, PROMIS PF and Pain did not perform well psychometrically in this population of patients undergoing MPFL reconstruction. These results suggest PROMIS questionnaires should be used with caution in this population, especially if used in isolation, when discussing clinical expectations with patients. The authors recommend continued use of legacy PROs specific to assessment of patellar instability and function that have established validity in patellar instability populations. LEVEL OF EVIDENCE: Level IV.


Assuntos
Instabilidade Articular , Articulação Patelofemoral , Humanos , Adolescente , Adulto Jovem , Adulto , Estudos Retrospectivos , Dor , Ligamentos , Medidas de Resultados Relatados pelo Paciente
3.
J Hered ; 113(1): 102-108, 2022 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-34634803

RESUMO

Recently, researchers have documented variation between groups in collective behavior. However, how genetic variation within and between groups contributes to population-level variation for collective behavior remains unclear. Understanding how genetic variation of group members relates to group-level phenotypes is evolutionarily important because there is increasing evidence that group-level behavioral variation influences fitness and that the genetic architecture of group-level traits can affect the evolutionary dynamics of traits. Social insects are ideal for studying the complex relationship between individual and group-level variation because they exhibit behavioral variation at multiple scales of organization. To explore how the genetic composition of groups affects collective behavior, we constructed groups of pharaoh ants (Monomorium pharaonis) from 33 genetically distinct colonies of known pedigree. The groups consisted of either all workers from the same single colony or workers from two genetically different colonies, and we assayed the exploration and aggression of the groups. We found that collective exploration, but not aggression, depended on the specific genotypic combination of group members, i.e., we found evidence for genotype-by-genotype epistasis for exploration. Group collective behavior did not depend on the pedigree relatedness between genotypes within groups. Overall, this study highlights that specific combinations of genotypes influence group-level phenotypes, emphasizing the importance of considering nonadditive effects of genotypic interactions between group members.


Assuntos
Formigas , Agressão , Animais , Formigas/genética , Comportamento Animal , Genótipo , Eventos de Massa , Fenótipo
4.
BMC Health Serv Res ; 21(1): 699, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271930

RESUMO

BACKGROUND: Aboriginal and/or Torres Strait Islander people experience dementia at a rate three to five times higher than the general Australian population. Aboriginal Community Controlled Health Services (ACCHSs) have a critical role to play in recognising symptoms of cognitive impairment, facilitating timely diagnosis of dementia, and managing the impacts of dementia. Little is known about the barriers and enablers to Aboriginal people receiving a timely dementia diagnosis and appropriate care once diagnosed. This study aims to explore, from the perspective of healthcare providers in the ACCHS sector across urban, regional and remote communities, the barriers and enablers to the provision of dementia diagnosis and care. METHODS: A qualitative study involving semi-structured interviews with staff members working in the ACCHS sector. Aboriginal Health Workers, General Practitioners, nurses, practice or program managers, and Chief Executive Officers were eligible to participate. Consenting ACCHS staff completed a telephone interview administered by a trained interviewer. Interviews were audio-recorded, transcribed, and analysed using qualitative content analysis. RESULTS: Sixteen staff from 10 ACCHSs participated. Most participants perceived their communities had a limited understanding of dementia. Symptoms of dementia were usually noticed by the GP or another healthcare worker at the ACCHS who had an ongoing relationship with the person. Most participants reported that their service had established referral pathways with either hospital-based geriatricians, geriatricians located with aged care assessment teams, or specialists who visited communities periodically. Key enablers to high quality dementia care included the use of routine health assessments as a mechanism for diagnosis; relationships within communities to support diagnosis and care; community and family relationships; comprehensive and holistic care models; and the use of tailored visual resources to support care. Key barriers to high quality care included: denial and stigma; dementia being perceived as a low priority health condition; limited community awareness and understanding of dementia; lack of staff education and training about dementia; and numerous gaps in service delivery. CONCLUSIONS: Substantially increased investments in supporting best-practice diagnosis and management of dementia in Aboriginal communities are required. ACCHSs have key strengths that should be drawn upon in developing solutions to identified barriers to care.


Assuntos
Demência , Serviços de Saúde do Indígena , Idoso , Austrália , Demência/diagnóstico , Demência/terapia , Pessoal de Saúde , Humanos , Havaiano Nativo ou Outro Ilhéu do Pacífico
5.
Am Nat ; 196(5): 541-554, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33064586

RESUMO

AbstractCollective behaviors are widespread in nature and usually assumed to be strongly shaped by natural selection. However, the degree to which variation in collective behavior is heritable and has fitness consequences-the two prerequisites for evolution by natural selection-is largely unknown. We used a new pharaoh ant (Monomorium pharaonis) mapping population to estimate the heritability, genetic correlations, and fitness consequences of three collective behaviors (foraging, aggression, and exploration), as well as of body size, sex ratio, and caste ratio. Heritability estimates for the collective behaviors were moderate, ranging from 0.17 to 0.32, but lower than our estimates for the heritability of caste ratio, sex ratio, and body size of new workers, queens, and males. Moreover, variation in collective behaviors among colonies was phenotypically correlated, suggesting that selection may shape multiple colony collective behaviors simultaneously. Finally, we found evidence for directional selection that was similar in strength to estimates of selection in natural populations. Altogether, our study begins to elucidate the genetic architecture of collective behavior and is one of the first studies to demonstrate that it is shaped by selection.


Assuntos
Formigas/genética , Aptidão Genética , Comportamento Social , Agressão , Animais , Formigas/fisiologia , Comportamento Apetitivo , Tamanho Corporal , Feminino , Masculino , Fenótipo , Seleção Genética , Razão de Masculinidade
6.
Proc Biol Sci ; 287(1928): 20201029, 2020 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-32517627

RESUMO

In social insects, cuticular hydrocarbons function in nest-mate recognition and also provide a waxy barrier against desiccation, but basic evolutionary features, including the heritability of hydrocarbon profiles and how they are shaped by natural selection are largely unknown. We used a new pharaoh ant (Monomorium pharaonis) laboratory mapping population to estimate the heritability of individual cuticular hydrocarbons, genetic correlations between hydrocarbons, and fitness consequences of phenotypic variation in the hydrocarbons. Individual hydrocarbons had low to moderate estimated heritability, indicating that some compounds provide more information about genetic relatedness and can also better respond to natural selection. Strong genetic correlations between compounds are likely to constrain independent evolutionary trajectories, which is expected, given that many hydrocarbons share biosynthetic pathways. Variation in cuticular hydrocarbons was associated with variation in colony productivity, with some hydrocarbons experiencing strong directional selection. Altogether, this study builds on our knowledge of the genetic architecture of the social insect hydrocarbon profile and indicates that hydrocarbon variation is shaped by natural selection.


Assuntos
Formigas/fisiologia , Hidrocarbonetos/metabolismo , Seleção Genética , Animais , Formigas/genética , Característica Quantitativa Herdável
7.
CNS Spectr ; 25(5): 630-637, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32252850

RESUMO

The rediscovery of the importance of mental illness in the risk assessment and management of those who threaten, approach, and harm public figures has led to a new way of dealing with those that threaten public figures. This approach emphasises the role of "fixation" which may be defined as an intense preoccupation pursued to an abnormally intense degree. It integrates a threat assessment paradigm with the literature on stalking. The need for such an approach was highlighted in research on the prevalence of harassment of public figures. Psychiatry has a key role in this approach which sees mental health clinicians and Police work together in Fixated Threat Assessment Centres (FTACs). An FTAC functions by assessing the level of concern and sharing information to facilitate interventions that are often mental health based. The purpose is not the hopeless task of identifying those who will go on to perpetrate serious violence, rather to intervene in the group they emerge from, to prevent harm. As well as decreasing risk to the persons fixated upon, this approach improves care to the mentally disordered people who harass and threaten them and, in doing so, decreases the likelihood of their criminalization while enhancing their quality of life. As expertise in the area has grown, policing and security agencies in several countries have expanded the FTAC model to cover individuals thought at risk of lone-actor grievance-fueled violence, a term that captures both different forms of mass killing and lone actor terrorism.


Assuntos
Psiquiatria Legal/métodos , Saúde Mental , Violência/prevenção & controle , Psiquiatria Legal/organização & administração , Humanos , Violência/psicologia
8.
BMC Health Serv Res ; 19(1): 111, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736763

RESUMO

BACKGROUND: This cross-sectional study aimed to explore, among a sample of patients attending one of four Aboriginal Health Services (ACCHSs), the degree of concordance between self-report and medical records for whether screening for key healthcare items had ever been undertaken, or had been undertaken within the recommended timeframe. METHODS: Across the four ACCHSs, a convenience sample of 109 patients was recruited. Patients completed a self-report computer survey assessing when they last had preventive care items undertaken at the service. ACCHS staff completed a medical record audit for matching items. The degree of concordance (i.e. the percentage of cases in which self-reports matched responses from the medical record) was calculated. RESULTS: Concordance was relatively high for items including assessment of Body Mass Index and blood pressure, but was substantially lower for items including assessment of waist circumference, alcohol intake, physical activity, and diet. CONCLUSIONS: Reliance on either patient self-report or medical record data for assessing the level of preventive care service delivery by ACCHSs requires caution. Efforts to improve documentation of some preventive care delivery in medical records are needed. These findings are likely to also apply to patients in other general practice settings.


Assuntos
Auditoria Médica , Havaiano Nativo ou Outro Ilhéu do Pacífico , Medicina Preventiva/normas , Qualidade da Assistência à Saúde , Populações Vulneráveis , Adulto , Serviços de Saúde Comunitária/normas , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Queensland , Autorrelato
9.
J Natl Compr Canc Netw ; 16(1): 35-41, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29295879

RESUMO

Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-life (EOL) care. Using a sample of Australian medical oncology outpatients, this study examined (1) their preferred location of EOL care; (2) their perceived benefits and worries of receiving care in that location; (3) the percentage who had discussed preferences with their doctor and/or support person; and (4) whether they wanted their doctor to ask them where they wanted to die. Methods: Adults with a confirmed diagnosis of cancer were approached between September 2015 and January 2016 in the waiting room of an Australian oncology outpatient clinic. Consenting participants completed a home-based pen-and-paper survey indicating preferred location of care, perceived benefits and worries of that location, whether they had discussed preferences with their doctors, and whether they were willing to be asked about their preferences. Results: A total of 203 patients returned the survey (47% of those eligible). Less than half preferred to be cared for at home (47%), 34% preferred a hospice/palliative care unit, and 19% preferred the hospital. Common benefits and worries associated with locations included perceived burden on others, familiarity of environment, availability of expert medical care, symptom management, and likelihood of having wishes respected. More patients had discussed preferences with their support persons (41%) than doctors (7%). Most wanted a doctor to ask them about preferred location of care (87%) and thought it was important to die in the location of their choice (93%). Conclusions: Patients were willing to have clinicians to ask them where they wanted to die, although few had discussed their preferences with doctors. Although home was the most preferred location for many patients, the overall variation suggests that clinicians should adopt a systematic approach to eliciting patient preferences.


Assuntos
Oncologia , Neoplasias/epidemiologia , Pacientes Ambulatoriais/psicologia , Percepção , Assistência Terminal , Idoso , Feminino , Humanos , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Neoplasias/psicologia , Vigilância em Saúde Pública
10.
J Natl Compr Canc Netw ; 16(5): 498-505, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29752324

RESUMO

Objectives: This study surveyed a sample of medical oncology outpatients to determine (1) the proportion who have already discussed and documented their end-of-life (EOL) wishes; (2) when and with whom they would prefer to convey their EOL wishes; (3) the EOL issues they would want to discuss; and (4) the association between perceived cancer status and advance care planning (ACP) participation. Methods: Adult medical oncology outpatients were approached in the waiting room of an Australian tertiary treatment center. Consenting participants completed a pen-and-paper survey assessing participation in ACP, preferences for conveying EOL wishes, timing of EOL discussions, and EOL issues they want to be asked about. Results: A total of 203 patients returned the survey (47% of eligible). EOL discussions occurred more frequently with support persons (47%) than with doctors (7%). Only 14% had recorded their wishes, and 45% had appointed an enduring guardian. Those who perceived their cancer as incurable were more likely to have participated in ACP. If facing EOL, patients indicated that they would want family involved in discussions (85%), to be able to write down EOL wishes (82%), and to appoint enduring guardians (91%). Many (45%) preferred the first discussion to happen when their disease became incurable. Slightly less than one-third thought discussions regarding EOL should be patient-initiated. Most agreed doctors should ask about preferred decision-making involvement (92%), how important it is that pain is managed well (95%), and how important it is to remain conscious (82%). Fewer (55%) wanted to be asked about the importance of care extending life. Conclusions: Many patients would like to have discussions regarding EOL care with their doctor and involve their support persons in this process. Only a small percentage of respondents had discussed EOL care with their doctors, recorded their wishes, or appointed an enduring guardian. The first step requires clinicians to ask whether an individual patient wishes to discuss EOL issues, in what format, and at what level of detail.


Assuntos
Pacientes Ambulatoriais/psicologia , Assistência Terminal/métodos , Idoso , Feminino , Humanos , Masculino
11.
Support Care Cancer ; 26(10): 3593-3599, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29725803

RESUMO

OBJECTIVES: To explore in a sample of medical oncology outpatients and their nominated support persons (SPs): (1) the relative influence of pain, consciousness and life extension on end-of-life choices using a discrete choice experiment (DCE); (2) the extent to which SPs can predict the choices of index patients and (3) whether having a previous end-of-life discussion was associated with dyad agreement. METHODS: Adult medical oncology patients and their SPs were approached for consent to complete a survey containing a DCE. Participants chose between three unlabelled care scenarios characterised by three attributes: pain (mild, moderate or severe), consciousness (some, half or most of time) and extension of life (1, 2 or 3 weeks). Respondents selected (1) most-preferred and (2) least-preferred scenarios within each question. SPs answered the same questions but from patient's perspective. RESULTS: A total of 110 patients and 64 SPs responded overall (42 matched patient-SP dyads). For patients, pain was the most influential predictor of most- and least-preferred scenarios (z = 12.5 and z = 12.9). For SPs, pain was the only significant predictor of most and least-preferred scenarios (z = 9.7 and z = 11.5). Dyad agreement was greater for choices about least- (69%) compared to most-preferred scenarios (55%). Agreement was slightly higher for dyads reporting a previous EOL discussion (68 versus 48%; p = 0.065). CONCLUSION: Patients and SPs place significant value on avoiding severe pain when making end-of-life choices, over and above level of consciousness or life extension. People's views about end-of-life scenarios they most as well as least prefer should be sought.


Assuntos
Comportamento de Escolha , Neoplasias/terapia , Sistemas de Apoio Psicossocial , Qualidade da Assistência à Saúde , Assistência Terminal/métodos , Assistência Terminal/normas , Adulto , Planejamento Antecipado de Cuidados , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Oncologia/métodos , Oncologia/normas , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/psicologia , Inquéritos e Questionários
12.
Support Care Cancer ; 26(10): 3579-3586, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29725799

RESUMO

PURPOSE: To explore the actions cancer patients reported they would take in response to a range of common side effects of chemotherapy and whether these were considered appropriate based on current guidelines and evidence; and to explore the sociodemographic and cancer-related variables associated with patients selecting the appropriate action (immediate medical attention or reporting) for two potentially life-threatening side effects: fever, and unusual bleeding and bruising. METHODS: Four hundred thirty-six medical oncology and haematology patients receiving chemotherapy completed two surveys to provide demographic, disease and treatment characteristics, and details on how they would respond if they experienced a range of specified side effects of chemotherapy (for example, nausea and vomiting, fatigue, and skin rash or nail changes). The proportion of patients reporting the appropriate action for each side effect was calculated. Multiple logistic regressions examined the patient demographic and cancer characteristics associated with selecting the appropriate action (seeking immediate medical attention) for two potentially life-threatening side effects of chemotherapy: high fever of 38 °C or more, and unusual bleeding or bruising. RESULTS: Two thirds of patients indicated that they would seek immediate medical attention for high fever (67%), but only 41% would seek immediate attention for bleeding or bruising. Cancer type and time since diagnosis were significantly associated with patients indicating that they would seek immediate medical attention for high fever; while time since diagnosis was the only variable significantly associated with patients reporting that they would seek immediate medical attention for unusual bleeding or bruising. For chronic side effects, like skin rash or nail changes, and tingling or numbness, which usually do not require urgent reporting, only between 12 and 16% would report them immediately. A significant proportion of patients reported that they would "do nothing" about fatigue or tiredness (24%). By comparison, less than 10% patients reported that they would do nothing for the other side effects investigated. CONCLUSIONS: Tools need to be created so that patients better understand the side effects after being treated with chemotherapy and what action they should take.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Autorrelato , Idoso , Barreiras de Comunicação , Fadiga/induzido quimicamente , Fadiga/epidemiologia , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/epidemiologia , Neoplasias/psicologia , Qualidade de Vida , Estudos Retrospectivos , Autorrelato/normas , Inquéritos e Questionários , Fatores de Tempo , Vômito/induzido quimicamente , Vômito/epidemiologia
13.
Intern Med J ; 48(1): 60-66, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28980381

RESUMO

BACKGROUND: The perceptions of those called on to make decisions on behalf of patients who lack capacity at the end of life must accurately reflect patient preferences. AIMS: To establish the extent to which the views of medical oncology outpatients are understood by their support persons, specifically with regards to (i) preferred type and location of end-of-life care, (ii) preferred level of involvement in end-of-life decision-making and (iii) whether the patient has completed an advance care plan or appointed an enduring guardian. METHODS: Adults with a confirmed cancer diagnosis and their nominated support persons were approached between September 2015 and January 2016 in the waiting room of an Australian tertiary referral clinic. Consenting participants completed a pen-and-paper survey. Nominated support persons answered the same questions from the patient's perspective. RESULTS: In total, 208 participants (39% of eligible dyads) participated. Observed agreement across the five outcomes ranged from 54% to 84%. Kappa values for concordance between patient-support person responses were fair to moderate (0.24-0.47) for enduring guardian, decision-making, advance care plan and care location outcomes. A slight level of concordance (k = 0.15; 95% confidence interval: -0.02, 0.32) was found for the type of care outcome. CONCLUSION: Relying on support persons' views does not guarantee that patients' actual preferences will be followed. Strategies that make patient preferences known to healthcare providers and support persons while they still have the capacity to do so is a critical next step in improving quality cancer care.


Assuntos
Planejamento Antecipado de Cuidados , Cuidadores/psicologia , Oncologia/métodos , Neoplasias/psicologia , Preferência do Paciente/psicologia , Assistência Terminal/psicologia , Planejamento Antecipado de Cuidados/tendências , Idoso , Austrália/epidemiologia , Feminino , Humanos , Consentimento Livre e Esclarecido/psicologia , Masculino , Oncologia/tendências , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/terapia , Assistência Terminal/tendências
14.
Fam Pract ; 32(6): 664-71, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26477009

RESUMO

BACKGROUND: Detection of lifestyle risk factors by GPs is the first step required for intervention. Despite significant investment in preventive health care in general practice, little is known about whether GP detection of lifestyle risk factors have improved over time. OBJECTIVES: To examine whether sensitivity and specificity of GP detection of smoking, risky alcohol consumption and overweight and obesity has increased in patients presenting to see their GP, by comparing results from four Australian studies conducted between 1982 and 2011. METHODS: Demographic characteristics of patient and GP samples and the prevalence, sensitivity and specificity of detection of each risk factor were extracted from published studies. Differences between GP and patient sample characteristics were examined. To identify trends over time in prevalence of risk factors, sensitivity and specificity of detection across studies and the Cochran-Armitage test for trend were calculated for each risk factor for the overall sample and by male and female subgroups. RESULTS: There were no statistically significant changes in the sensitivity of GP detection of smoking or overweight or obesity over time. Specificity of detection of smoking increased from 64.7% to 98% (P < 0.0001) and decreased for overweight or obesity from 92% to 89% (P = 0.01). There was a small decrease in the sensitivity of detection of alcohol consumption (P = 0.02) and an increase in specificity (P = 0.01). CONCLUSIONS: Despite significant investment to increase GP detection and intervention for lifestyle risk factors, accurate detection of smoking, risky alcohol consumption and overweight and obesity occurs for less than two-thirds of all patients.


Assuntos
Alcoolismo/diagnóstico , Competência Clínica , Clínicos Gerais , Obesidade/diagnóstico , Tabagismo/diagnóstico , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Austrália/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Padrões de Prática Médica , Prevalência , Fatores de Risco , Sensibilidade e Especificidade , Fumar/epidemiologia , Inquéritos e Questionários , Adulto Jovem
15.
Aust N Z J Psychiatry ; 49(7): 634-41, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25954019

RESUMO

OBJECTIVE: Due to the nature of their work, politicians are at greater risk of stalking, harassment and attack than the general population. The small, but significantly elevated risk of violence to politicians is predominantly due not to organised terrorism or politically motivated extremists but to fixated individuals with untreated serious mental disorders, usually psychosis. Our objective was to ascertain the frequency, nature and effects of unwanted harassment of politicians in New Zealand and the possible role of mental illness in this harassment. METHODS: New Zealand Members of Parliament were surveyed, with an 84% response rate (n = 102). Quantitative and qualitative data were collected on Parliamentarians' experiences of harassment and stalking. RESULTS: Eighty-seven percent of politicians reported unwanted harassment ranging from disturbing communications to physical violence, with most experiencing harassment in multiple modalities and on multiple occasions. Cyberstalking and other forms of online harassment were common, and politicians felt they (and their families) had become more exposed as a result of the Internet. Half of MPs had been personally approached by their harassers, 48% had been directly threatened and 15% had been attacked. Some of these incidents were serious, involving weapons such as guns, Molotov cocktails and blunt instruments. One in three politicians had been targeted at their homes. Respondents believed the majority of those responsible for the harassment exhibited signs of mental illness. CONCLUSION: The harassment of politicians in New Zealand is common and concerning. Many of those responsible were thought to be mentally ill by their victims. This harassment has significant psychosocial costs for both the victim and the perpetrator and represents an opportunity for mental health intervention.


Assuntos
Pessoas Mentalmente Doentes/estatística & dados numéricos , Política , Comportamento Social , Perseguição/epidemiologia , Perseguição/psicologia , Violência/psicologia , Humanos , Nova Zelândia/epidemiologia , Violência/estatística & dados numéricos
16.
Cost Eff Resour Alloc ; 12: 23, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25873787

RESUMO

Research priority setting aims to gain consensus about areas where research effort will have wide benefits to society. While general principles for setting health research priorities have been suggested, there has been no critical review of the different approaches used. This review aims to: (i) examine methods, models and frameworks used to set health research priorities; (ii) identify barriers and facilitators to priority setting processes; and (iii) determine the outcomes of priority setting processes in relation to their objectives and impact on policy and practice. Medline, Cochrane, and PsycINFO databases were searched for relevant peer-reviewed studies published from 1990 to March 2012. A review of grey literature was also conducted. Priority setting exercises that aimed to develop population health and health services research priorities conducted in Australia, New Zealand, North America, Europe and the UK were included. Two authors extracted data from identified studies. Eleven diverse priority setting exercises across a range of health areas were identified. Strategies including calls for submission, stakeholder surveys, questionnaires, interviews, workshops, focus groups, roundtables, the Nominal Group and Delphi technique were used to generate research priorities. Nine priority setting exercises used a core steering or advisory group to oversee and supervise the priority setting process. None of the models conducted a systematic assessment of the outcomes of the priority setting processes, or assessed the impact of the generated priorities on policy or practice. A number of barriers and facilitators to undertaking research priority setting were identified. The methods used to undertake research priority setting should be selected based upon the context of the priority setting process and time and resource constraints. Ideally, priority setting should be overseen by a multi-disciplinary advisory group, involve a broad representation of stakeholders, utilise objective and clearly defined criteria for generating priorities, and be evaluated.

18.
bioRxiv ; 2024 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-38328135

RESUMO

How evolutionary changes in genes and neurons encode species variation in complex motor behaviors are largely unknown. Here, we develop genetic tools that permit a neural circuit comparison between the model species Drosophila melanogaster and the closely-related species D. yakuba, who has undergone a lineage-specific loss of sine song, one of the two major types of male courtship song in Drosophila. Neuroanatomical comparison of song patterning neurons called TN1 across the phylogeny demonstrates a link between the loss of sine song and a reduction both in the number of TN1 neurons and the neurites serving the sine circuit connectivity. Optogenetic activation confirms that TN1 neurons in D. yakuba have lost the ability to drive sine song, while maintaining the ability to drive the singing wing posture. Single-cell transcriptomic comparison shows that D. yakuba specifically lacks a cell type corresponding to TN1A neurons, the TN1 subtype that is essential for sine song. Genetic and developmental manipulation reveals a functional divergence of the sex determination gene doublesex in D. yakuba to reduce TN1 number by promoting apoptosis. Our work illustrates the contribution of motor patterning circuits and cell type changes in behavioral evolution, and uncovers the evolutionary lability of sex determination genes to reconfigure the cellular makeup of neural circuits.

19.
Curr Biol ; 34(11): 2319-2329.e6, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38688283

RESUMO

How evolutionary changes in genes and neurons encode species variation in complex motor behaviors is largely unknown. Here, we develop genetic tools that permit a neural circuit comparison between the model species Drosophila melanogaster and the closely related species D. yakuba, which has undergone a lineage-specific loss of sine song, one of the two major types of male courtship song in Drosophila. Neuroanatomical comparison of song-patterning neurons called TN1 across the phylogeny demonstrates a link between the loss of sine song and a reduction both in the number of TN1 neurons and the neurites supporting the sine circuit connectivity. Optogenetic activation confirms that TN1 neurons in D. yakuba have lost the ability to drive sine song, although they have maintained the ability to drive the singing wing posture. Single-cell transcriptomic comparison shows that D. yakuba specifically lacks a cell type corresponding to TN1A neurons, the TN1 subtype that is essential for sine song. Genetic and developmental manipulation reveals a functional divergence of the sex determination gene doublesex in D. yakuba to reduce TN1 number by promoting apoptosis. Our work illustrates the contribution of motor patterning circuits and cell type changes in behavioral evolution and uncovers the evolutionary lability of sex determination genes to reconfigure the cellular makeup of neural circuits.


Assuntos
Comunicação Animal , Drosophila , Comportamento Sexual Animal , Comportamento Sexual Animal/fisiologia , Drosophila/classificação , Drosophila/citologia , Drosophila/fisiologia , Vias Eferentes/citologia , Neurônios/citologia , Análise da Expressão Gênica de Célula Única , Proteínas de Drosophila/genética , Proteínas de Drosophila/metabolismo , Animais
20.
Front Psychiatry ; 15: 1357907, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38690205

RESUMO

Background: High levels of harassment and threats against parliamentarians are being reported internationally, especially in the social media space. This is occurring alongside changes in our social landscape, with increasing political polarisation and the ongoing ramifications from the COVID-19 pandemic. Harassment of politicians has been shown to have implications for psychological wellbeing and physical safety. Objectives: To investigate harassment and violence towards parliamentarians in the COVID-19 pandemic and recovery era, including whether there had been a change in its nature and quantity, and to explore the contribution of social media. Methods: A survey of all New Zealand's parliamentarians was fielded in 2022, focusing on their experiences of harassment analysed quantitatively and with manifest and latent content analysis of free text responses. Data were disaggregated and compared by gender. Secondary analyses were conducted on similar data collected from parliamentarians in 2014 to compare trends over time. Findings: We obtained a cleaned achieved survey sample of 54 Members of Parliament (MPs). Harassment was reported by 98% of respondents, ranging from disturbing communication to actual physical violence. The vast majority of MPs endorsed multiple modalities of harassment occurring on multiple occasions. Ninety-six percent of MPs had been harassed over social media, with over half being threatened, including threats of physical violence (40%), sexual violence (14%), threats made towards MP's family members (19%), threats towards staff (12%), and death threats (27%). Almost all forms of harassment had increased significantly since 2014. Most MPs reported experiencing abuse related to the Government response to the COVID-19 pandemic (e.g. lockdowns and vaccine mandates). Many MPs commented that the frequency and intensity of abuse increased markedly during the COVID pandemic and had not subsequently abated. Women were at significantly higher risk of certain types of social media harassment including gendered abuse, sexualised comments, threat of sexual violence, and threats toward their family. Conclusion: Harassment of parliamentarians is an escalating issue. Online threats and misogyny are increasingly apparent. This harassment has significant psychosocial costs for victims, their family and staff, and for democratic processes.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA