Improving access to high-quality primary care for socioeconomically disadvantaged older people in rural areas: a mixed method study protocol

Introduction: The UK has an ageing population, especially in rural areas, where deprivation is high among older people. Previous research has identified this group as at high risk of poor access to healthcare. The aim of this study is to generate a theory of how socioeconomically disadvantaged older people from rural areas access primary care, to develop an intervention based on this theory and test it in a feasibility trial. Methods and analysis: On the basis of the MRC Framework for Developing and Evaluating Complex Interventions, three methods will be used to generate the theory. First, a realist review will elucidate the patient pathway based on existing literature. Second, an analysis of the English Longitudinal Study of Ageing will be completed using structural equation modelling. Third, 15 semistructured interviews will be undertaken with patients and four focus groups with health professionals. A triangulation protocol will be used to allow each of these methods to inform and be informed by each other, and to integrate data into one overall realist theory. Based on this theory, an intervention will be developed in discussion with stakeholders to ensure that the intervention is feasible and practical. The intervention will be tested within a feasibility trial, the design of which will depend on the intervention. Lessons from the feasibility trial will be used to refine the intervention and gather the information needed for a definitive trial. Ethics and dissemination: Ethics approval from the regional ethics committee has been granted for the focus groups with health professionals and interviews with patients. Ethics approval will be sought for the feasibility trial after the intervention has been designed. Findings will be disseminated to the key stakeholders involved in intervention development, to researchers, clinicians and health planners through peer-reviewed journal articles and conference publications, and locally through a dissemination event

Lions and Kings: The Transformation of Lions as an Index of Power in the Middle East

Honors (Bachelor's)International StudiesUniversity of Michiganhttps://deepblue.lib.umich.edu/bitstream/2027.42/147390/1/nsalive.pd

Demographic, criminal and psychiatric factors related to inmate suicide

A review of 19 studies suggests that it may be feasible to identify prisoners with suicide risk on the basis of demographic, psychiatric, and criminal characteristics. The present study aimed to identify combinations of characteristics that are capable of identifying potential suicide victims. Characteristics of 95 suicide victims in the Dutch prison system were compared with those of a random sample of 247 inmates in ten jails. Combinations of indicators for suicide risk were also tested for their capability of identifying 209 suicides in U.S. jails and 279 prison suicides in England and Wales. A combination of six characteristics (age 40+, homelessness, history of psychiatric care, history of drug abuse, one prior incarceration, violent offence) was capable of correctly classifying 82% of the Dutch suicide victims (82% specificity). Less powerful combinations correctly classified 53% of the U.S. suicides and 47% of the U.K. suicides. It is concluded that a set of demographic and criminal characteristics and indicators of psychiatric problems is useful for the identification of suicide risk in jails and prisons

Assessing threats and mitigation for Scarlet Ammannia (Ammannia robusta) in Southwestern Ontario

Scarlet Ammannia (Ammannia robusta) is an annual emergent wetland plant of the Lythraceae family. Throughout most of its distribution, the species population is stable under present conditions. However, this is not the case in Canada, where A. robusta is considered endangered with only a few small populations documented in British Columbia and Ontario. In response, a recovery strategy was created for A. robusta outlining the lack of information on the species biology and ecology, with a primary objective to assess the populations in Ontario and gain information on what may be contributing to the species rarity. To assess the population status of A. robusta in Southwestern Ontario, a series of vegetation surveys and seed bank assays were conducted in historically populated or newly identified suitable areas in Essex County during 2016, 2017, and 2018 growing seasons. Although A. robusta was not seen in all historic locations, seed bank studies revealed its presence in all but one of the historic locations. The number of seedlings germinating from soil cores ranged from 0.04 ± 0.02 to 1.14 ± 0.42 seedlings per cm2. To evaluate the interaction between A. robusta and its neighbouring species, field and greenhouse trials were conducted to test the hypothesis that the number of A. robusta plants and their above- and below-ground biomass would increase with the removal of competition. However, these comparisons were inhibited by the lack of seed germination. Additionally, germination trials were conducted in a growth chamber to determine the effects of light intensity (% full light), light duration (daylight hours), or temperature (°C) on A. robusta germination. It is hypothesized that the percentage of A. robusta seeds germinating will increase with increasing light intensity, duration, and temperature. The results showed that light duration, and the interaction between light intensity and the number of weeks, had significant effects on A. robusta germination. The percentage of seeds germinating increased with an increase in light intensity (100% full light) and light duration (up to 15 hours of daylight). The interaction between temperatures and sampling days were also observed to have significant effects on A. robusta germination. Ammannia robusta’s minimum, maximum, and optimal temperature requirements were observed to be 10/5 to 15/10, 40/35 to 35/30, and 20/15°C, respectively. The results do not support the view that A. robusta germination is limited by light or temperature in the field since both requirements for germination are satisfied at most sites. Based on the results, we believe that since A. robusta is prevalent in the seed bank where it occurs, but seeds exhibit low rates of germination, other factors must impede seedling establishment. Future research and management treatments focussed on assessing such factors, including the effects of invasive species on A. robusta germination, combined with consistent monitoring programs, will assist in finding the proper mitigation plans to improve A. robusta’s distribution

Las tendencias del mundo en la música publicitaria

Comunicador (a) SocialPregrad

Impairments in hearing and vision impact on mortality in older people: the AGES-Reykjavik Study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.to examine the relationships between impairments in hearing and vision and mortality from all-causes and cardiovascular disease (CVD) among older people.population-based cohort study.the study population included 4,926 Icelandic individuals, aged ≥67 years, 43.4% male, who completed vision and hearing examinations between 2002 and 2006 in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) and were followed prospectively for mortality through 2009.participants were classified as having 'moderate or greater' degree of impairment for vision only (VI), hearing only (HI), and both vision and hearing (dual sensory impairment, DSI). Cox proportional hazard regression, with age as the time scale, was used to calculate hazard ratios (HR) associated with impairment and mortality due to all-causes and specifically CVD after a median follow-up of 5.3 years.the prevalence of HI, VI and DSI were 25.4, 9.2 and 7.0%, respectively. After adjusting for age, significantly (P < 0.01) increased mortality from all causes, and CVD was observed for HI and DSI, especially among men. After further adjustment for established mortality risk factors, people with HI remained at higher risk for CVD mortality [HR: 1.70 (1.27-2.27)], whereas people with DSI remained at higher risk of all-cause mortality [HR: 1.43 (1.11-1.85)] and CVD mortality [HR: 1.78 (1.18-2.69)]. Mortality rates were significantly higher in men with HI and DSI and were elevated, although not significantly, among women with HI.older men with HI or DSI had a greater risk of dying from any cause and particularly cardiovascular causes within a median 5-year follow-up. Women with hearing impairment had a non-significantly elevated risk. Vision impairment alone was not associated with increased mortality.National Institutes of Health, National Institute on Aging (NIA) N01-AG-12100 NIA Z01-AG007380 National Eye Institute (NEI) ZIAEY000401 National Institute on Deafness and Other Communication Disorders (NIDCD) Division of Scientific Programs/IAA Y2-DC-1004-02 Hjartavernd (Icelandic Heart Association) Althingi (Icelandic Parliament

Till death do us apart: an approach to the meaning of the wedding dress in Bogotá (1920-1930)

Vestirse e interactuar en distintos espacios genera instancias narrativas que reflejan la experiencia de habitar, a la vez que resignifican el sentido de los lugares. Cada práctica, como ir a cine, a cenar, realizar un deporte, asistir a una fiesta, discutir en un café o participar en un acto de caridad, supone una indumentaria en que pueden leerse signos de diferenciación social y roles de género, entre otros significados asociados a cómo se entienden los modos de verse y actuar según las ceremonias en que se participa. En el caso de las mujeres, cada uno de los vestidos que se asocian con su ciclo de vida, develan la concepción sobre su rol en la sociedad. Así, de 1920 a 1930, el matrimonio y la viudez, son vistos como parte de las representaciones de ser mujer, por las que transita este artículo

Clinical intervals and diagnostic characteristics in a cohort of prostate cancer patients in Spain: a multicentre observational study

Background: Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment. Methods: We conducted a multicentre, cohort study in seven hospitals in Spain. Patients' characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients' structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR). Results: 470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4 % were physically active. Tumour size was classified as T1 in 41.0 % and as T2 in 40 % of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1 % had low risk cancer according to the D'Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29-2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45-4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026). Conclusions: Most incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently

Prisoners co-infected with tuberculosis and HIV: a systematic review.

INTRODUCTION: Almost from the beginning of the HIV epidemic in 1981, an association with tuberculosis (TB) was recognized. This association between HIV and TB co-infection has been particularly evident amongst prisoners. However, despite this, few studies of TB in prisons have stratified results by HIV status. Given the high prevalence of HIV-positive persons and TB-infected persons in prisons and the documented risk of TB in those infected with HIV, it is of interest to determine how co-infection varies amongst prison populations worldwide. For this reason we have undertaken a systematic review of studies of co-infected prisoners to determine the incidence and/or prevalence of HIV/TB co-infection in prisons, as well as outcomes in this group, measured as treatment success or death. METHODS: A literature search was undertaken using the online databases PubMed, Embase, IBSS, Scopus, Web of Science, Global Health and CINAHL Plus. No restrictions were set on language or publication date for article retrieval, with articles included if indexed up to 18 October 2015. A total of 1975 non-duplicate papers were identified. For treatment and outcome data all eligible papers were appraised for inclusion; for incidence/prevalence estimates papers published prior to 2000 were excluded from full text review. After full text appraisal, 46 papers were selected for inclusion in the review, 41 for incidence/prevalence estimates and nine for outcomes data, with four papers providing evidence for both outcomes and prevalence/incidence. RESULTS: Very few studies estimated the incidence of TB in HIV positive prisoners, with most simply reporting prevalence of co-infection. Co-infection is rarely explicitly measured, with studies simply reporting HIV status in prisoners with TB, or a cross-sectional survey of TB prevalence amongst prisoners with HIV. Estimates of co-infection prevalence ranged from 2.4 to 73.1% and relative risks for one, given the other, ranged from 2.0 to 10.75, although some studies reported no significant association between HIV and TB. Few studies provided a comparison with the risk of co-infection in the general population. CONCLUSIONS: Prisoners infected with HIV are at high risk of developing TB. However, the magnitude of risk varies between different prisons and countries. There is little evidence on treatment outcomes in co-infected prisoners, and the existing evidence is conflicting in regards to HIV status influence on prisoner treatment outcomes.PROSPERO Number: CRD42016034068