This study investigated potential risk factors for postpartum depression using patient records from 209 women. The researchers found that formula feeding instead of breastfeeding, a history of depression, and cigarette smoking were significant risk factors for higher scores on the Edinburgh Postnatal Depression Scale, indicating probable postpartum depression. The findings support results from previous studies on risk factors for postpartum depression. A larger study is recommended to further determine risk factors.
This study evaluated the relationship between Emergency Severity Index (ESI) triage scores, pain medication selection, and timeliness of pain medication administration. The records of 1,966 emergency department patients who received opioid pain medication were analyzed. While there were no significant differences in time to pain medication across ESI levels, patients given higher ESI scores (greater acuity) received stronger opioids more often than those with lower scores. The type of opioid administered differed significantly based on ESI level. However, ESI level was not related to timeliness of pain medication administration.
The document describes the development and validation of the Multidimensional Vaginal Penetration Disorder Questionnaire (MVPDQ) to assess lifelong vaginismus in Iranian women. It involved a qualitative phase to develop questionnaire items based on interviews with couples experiencing vaginismus. A 76-item questionnaire was then validated on 214 Iranian women diagnosed with lifelong vaginismus. Exploratory factor analysis identified 9 dimensions of the disorder. Reliability testing found Cronbach's alpha values between 0.70-0.87, indicating good internal consistency. The MVPDQ was determined to be a valid and reliable self-report tool for clinical assessment of lifelong vaginismus in women.
This document provides details of a 27-year-old pregnant woman's case. She presented with progressive lower limb weakness and was initially diagnosed with possible spinal cord compression or transverse myelitis. Further MRI scans revealed an intradural mass at C7. After delivery, she was scheduled for laminectomy and tumor excision but was undecided on the operation. She was discharged without surgery and never returned for follow up. Barriers to her care included her low socioeconomic status, lack of understanding of her illness, and lack of continuity of care. The document emphasizes the importance of a holistic and patient-centered approach to care.
Parkinson's disease is caused by a loss of dopamine in the brain. Clinical diagnosis requires two motor symptoms but can be inaccurate early on due to compensatory mechanisms. Single photon emission computed tomography (SPECT) imaging assesses the dopamine system and can increase diagnostic accuracy to 95-98% when used along with clinical examination, especially in later stages of the disease. While it cannot replace diagnosis, SPECT provides valuable information on disease progression and severity.
This document discusses the Brief Psychiatric Rating Scale for Children (BPRS-C), a 21-item clinician-rated scale used to assess symptoms in youth. It provides evidence that:
1) The BPRS-C demonstrates good reliability and concurrent validity when rated by clinicians for a sample of 547 youth aged 3-18 receiving psychiatric services. Interrater reliability and factor analysis supported the scale's structure.
2) Scores on the BPRS-C were found to be sensitive to symptomatic changes with treatment, such as decreases seen after hospitalization. It has also detected effects of some medications.
3) Further analysis revealed some errors in how items mapped onto scales. The authors propose
This document discusses genomic and precision medicine. It begins by highlighting early examples of precision medicine through identifying risk factors for diseases. It then outlines the progression from the Human Genome Project to using genomic and other individual data to optimize clinical care through tools like sequencing, data integration and analytics. The document concludes by noting some challenges to implementing genomic and precision medicine in healthcare settings, such as institutional acceptance, access to expertise and testing, integration with electronic health records, and establishing evidence through outcomes studies.
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)Karin Verspoor
A 68-year-old female presented to the emergency department with shortness of breath that had progressively worsened over 4-5 days. She was admitted and experienced intermittent severe shortness of breath. Testing found a positive D-dimer and chest imaging could not be done, so a nuclear scan was ordered but the patient was too unstable. Given the positive D-dimer and severity of symptoms, the patient was treated with anticoagulants due to concerns for a possible pulmonary embolism. She was admitted under a doctor for further care.
This study evaluated the relationship between Emergency Severity Index (ESI) triage scores, pain medication selection, and timeliness of pain medication administration. The records of 1,966 emergency department patients who received opioid pain medication were analyzed. While there were no significant differences in time to pain medication across ESI levels, patients given higher ESI scores (greater acuity) received stronger opioids more often than those with lower scores. The type of opioid administered differed significantly based on ESI level. However, ESI level was not related to timeliness of pain medication administration.
The document describes the development and validation of the Multidimensional Vaginal Penetration Disorder Questionnaire (MVPDQ) to assess lifelong vaginismus in Iranian women. It involved a qualitative phase to develop questionnaire items based on interviews with couples experiencing vaginismus. A 76-item questionnaire was then validated on 214 Iranian women diagnosed with lifelong vaginismus. Exploratory factor analysis identified 9 dimensions of the disorder. Reliability testing found Cronbach's alpha values between 0.70-0.87, indicating good internal consistency. The MVPDQ was determined to be a valid and reliable self-report tool for clinical assessment of lifelong vaginismus in women.
This document provides details of a 27-year-old pregnant woman's case. She presented with progressive lower limb weakness and was initially diagnosed with possible spinal cord compression or transverse myelitis. Further MRI scans revealed an intradural mass at C7. After delivery, she was scheduled for laminectomy and tumor excision but was undecided on the operation. She was discharged without surgery and never returned for follow up. Barriers to her care included her low socioeconomic status, lack of understanding of her illness, and lack of continuity of care. The document emphasizes the importance of a holistic and patient-centered approach to care.
Parkinson's disease is caused by a loss of dopamine in the brain. Clinical diagnosis requires two motor symptoms but can be inaccurate early on due to compensatory mechanisms. Single photon emission computed tomography (SPECT) imaging assesses the dopamine system and can increase diagnostic accuracy to 95-98% when used along with clinical examination, especially in later stages of the disease. While it cannot replace diagnosis, SPECT provides valuable information on disease progression and severity.
This document discusses the Brief Psychiatric Rating Scale for Children (BPRS-C), a 21-item clinician-rated scale used to assess symptoms in youth. It provides evidence that:
1) The BPRS-C demonstrates good reliability and concurrent validity when rated by clinicians for a sample of 547 youth aged 3-18 receiving psychiatric services. Interrater reliability and factor analysis supported the scale's structure.
2) Scores on the BPRS-C were found to be sensitive to symptomatic changes with treatment, such as decreases seen after hospitalization. It has also detected effects of some medications.
3) Further analysis revealed some errors in how items mapped onto scales. The authors propose
This document discusses genomic and precision medicine. It begins by highlighting early examples of precision medicine through identifying risk factors for diseases. It then outlines the progression from the Human Genome Project to using genomic and other individual data to optimize clinical care through tools like sequencing, data integration and analytics. The document concludes by noting some challenges to implementing genomic and precision medicine in healthcare settings, such as institutional acceptance, access to expertise and testing, integration with electronic health records, and establishing evidence through outcomes studies.
Medical Information Retrieval Workshop Keynote (MedIR@SIGIR2014)Karin Verspoor
A 68-year-old female presented to the emergency department with shortness of breath that had progressively worsened over 4-5 days. She was admitted and experienced intermittent severe shortness of breath. Testing found a positive D-dimer and chest imaging could not be done, so a nuclear scan was ordered but the patient was too unstable. Given the positive D-dimer and severity of symptoms, the patient was treated with anticoagulants due to concerns for a possible pulmonary embolism. She was admitted under a doctor for further care.
This study analyzed 114 cases of neonatal Candida bloodstream infection from a tertiary care hospital in central India over 5 years. Non-albicans Candida (NAC) infections like C. tropicalis and C. parapsilosis were associated with higher mortality and longer hospital stays. Resistance to fluconazole and amphotericin B was also higher in NAC infections. Prolonged use of central lines, nil oral intake, mechanical ventilation and longer hospital stays were identified as risk factors. The study highlights the need for timely identification of Candida species and antifungal susceptibility testing to help improve outcomes.
This study investigated whether older adults living in assisted living communities could experience successful aging. 200 participants aged 52-100 from 8 assisted living facilities in North Carolina completed questionnaires measuring successful aging, life satisfaction, depression, and sense of purpose. The results showed lower depression scores and higher successful aging scores. Women tended to experience more successful aging than men. The study provides evidence that older adults in assisted living can age successfully with preventative healthcare measures and support services. Larger, more diverse studies could further explore factors promoting successful aging.
2015 09-14 Precision Medicine 2015, London, Alain van GoolAlain van Gool
Outline of my view hoe personalized health(care) is more than just targeted medicines, also including personal motivation and actions towards disease prevention. It also outlines 4 key factors that should be in order for optimal personalized health(care): 1. start with patients first, 2. Accelerate translation research to application, 3. Copy best practice, 4. Spread the word.
The University of Rochester Batten Center has established several initiatives to advance research for JNCL:
1. They created a patient registry with 237 registrants from 198 families, 149 of which have JNCL, to facilitate research studies.
2. They developed the Unified Batten Disease Rating Scale to measure disease progression and validated its use in clinical trials. Over 300 exams have been completed on 120 children to establish natural history studies.
3. They validated a non-invasive buccal epithelial cell collection method for genetic testing, obtaining genetic confirmation for all 120 patients in the registry.
EBM is the practice of integrating individual clinical expertise with the best available clinical evidence from systematic research to maximize the quality and quantity of life for individual patients.
This study retrospectively reviewed medical records of patients with Krabbe disease or metachromatic leukodystrophy (MLD) who received general anesthesia between 2012-2014 at Children's Hospital of Pittsburgh. It categorized patient disease severity into classes based on symptoms and created an anesthesia analysis classification system. The results found an 8.1% complication rate, higher than the general population but largely due to the progressive nature of the diseases. Excluding bone marrow transplant patients, the rate was 4.4% and complications were generally mild and self-limiting. The study concluded that general anesthesia appears to be safe for these patient populations.
This study evaluated the effectiveness of a classroom intervention aimed at increasing students' knowledge of head safety and positive attitudes towards bicycle helmet use. 74 students ages 11-15 participated. They completed pre-and post-tests on safety knowledge and questionnaires on helmet use attitudes. Before the intervention, most students only wore helmets when forced by parents and few saw them as safety devices. After viewing presentations on head injuries, more students reported being likely to wear helmets. The study concluded the intervention successfully increased safety knowledge and positive helmet attitudes as intended.
This study examined the effect of resident work hour regulations on mortality in intensive care unit patients using data from 40 hospitals from 2001-2005. The study found no evidence that the 2003 regulation limiting resident work hours had any positive or negative effect on ICU mortality overall or when analyzed by hospital teaching status. Risk-adjusted mortality improved over time at all hospital types studied.
This study evaluated the effectiveness of a Dynamic Realistic endpoint Student Simulation (DReSS) teaching method compared to traditional teaching methods for improving undergraduate nursing students' ability to assess and manage a deteriorating patient. In a randomized control trial, students who received DReSS training performed significantly better in recognizing deterioration and calling for help. However, both groups struggled with accurately measuring respiratory rate and knowing when and how to activate a medical emergency team. The study highlights the need for refined deteriorating patient education for nursing students using simulation methods.
Challenges in pediatric ambulatory anesthesia kids are differentsxbenavides
The document discusses challenges and risks associated with pediatric ambulatory anesthesia. It addresses several categories of risk for children undergoing ambulatory surgery, including cardiovascular, respiratory, and potential for neurocognitive dysfunction in young children. Specific risks discussed include laryngospasm, difficult airway management, and postoperative nausea and vomiting. The document also examines guidelines for pediatric anesthesia care and improving outcomes.
This document provides clinical practice guidelines for the management of community-acquired pneumonia (CAP) in infants and children older than 3 months. It includes recommendations on site-of-care management decisions, diagnostic testing, antimicrobial and surgical therapy, and prevention. The expert panel developed evidence-based guidelines to assist clinicians in decreasing the morbidity and mortality of CAP in children. The guidelines cover practical questions of diagnosis and treatment of CAP in both outpatient and inpatient settings.
This document summarizes several studies that compare the efficacy of shorter courses of antibiotic therapy (3 days) to traditional longer courses (5 days or more) for treating community-acquired pneumonia. Two studies found that 3 days of antibiotics was as effective as 5 days for treating non-severe pneumonia in children. However, another study found 3 days was less effective than 5 or 10 days for treating pediatric pneumonia. Additionally, one study suggested 3 days of IV antibiotics followed by 5 days of oral antibiotics was not inferior to 8 days of treatment for mild to moderate pneumonia in hospitalized adults.
The study assessed the knowledge of nurses at BPKIHS regarding the care of patients with pacemakers. A total of 69 nurses working in selected wards participated in the study. The results showed that the majority of nurses had basic knowledge about pacemakers, such as the natural pacemaker of the heart and the function of pacemakers to regulate heart rhythm. However, fewer nurses demonstrated knowledge about more advanced topics such as the differences between single and dual chamber pacemakers. The average knowledge score was 67.6%. Nurses over 25 years old and those working in critical care units had significantly higher knowledge scores. The study concluded that while most nurses had satisfactory basic knowledge, their knowledge could be improved, especially regarding more complex pacemaker topics
This study examined the relationship between early rising and mental health issues in pharmaceutical science students. The author conducted an observational study of 10 students over the 2016-2017 academic year, collecting data on their sleep schedules, breakfast habits, and morning routines. The results showed that students performed best academically when classes started between 11am-9:30am, as this aligned better with their natural body clocks than the traditional 9am start time. Early mornings were found to impair performance and increase risks of issues like depression, obesity, and drug abuse due to sleep loss and circadian rhythm misalignment. The author concludes that later class start times would allow students to study at their most effective times.
1) The document discusses evaluating medical literature to answer a clinical question about whether duct tape is an effective treatment for warts in children.
2) A randomized controlled trial studied 61 patients comparing duct tape to cryotherapy treatment for common warts. It found that duct tape was significantly more effective, with an absolute risk reduction of 25%.
3) Key points to evaluate in studies include similarity of patients, interventions and outcomes measured, study design, results, and statistics reported like absolute risk reduction and number needed to treat.
This document discusses the use of case-control studies to evaluate vaccine efficacy and adverse effects after a vaccine has been introduced. Case-control studies can estimate the protective effect of a vaccine by comparing vaccination status between cases who developed the target disease and controls. They can also assess potential rare adverse effects. Key methodological issues for case-control vaccine studies include controlling for confounding, diagnosis/recall bias, and establishing temporal relationships between vaccination and disease/adverse event onset. The document reviews an example case-control study of meningococcal vaccine efficacy in Brazil and the National Childhood Encephalopathy Study which investigated adverse neurological events following pertussis vaccination in the UK.
This document provides an introduction to evidence-based practice for nursing students. It defines evidence-based practice and discusses the importance of nursing research. It outlines the history of evidence-based practice and nursing research, from Florence Nightingale's early work through modern developments. Key aspects of the evidence-based practice process are introduced, including different sources of knowledge, levels of evidence, and the nurse's role in integrating research into clinical decision making.
The document summarizes different types of genetic and genomic testing reports, including how variants are classified. It discusses fragile X DNA testing, microarrays, next generation sequencing, and whole exome sequencing. Variants are classified as pathogenic, likely pathogenic, variants of uncertain significance (VUS), likely benign, or benign. The document uses a case report to demonstrate how more information can be obtained over time to reclassify a VUS. It also discusses reporting guidelines for incidental findings from genetic testing and limitations of direct-to-consumer genetic testing.
Tushar Choudhari proposes starting an apiary business to produce honey and wax from 1000 beehives across 25 acres. The business would require an initial investment of Rs. 22.62 lakh. It is projected to produce 66.93 lakh rupees in revenue in the first year and break even after producing 42,724 kg of honey and wax. The apiary would be located in Kota, Rajasthan which is suitable for cultivating mustard and soya crops needed to support the bees. The international market for Indian honey is growing and it could potentially export up to 2 lakh tonnes annually.
This study analyzed 114 cases of neonatal Candida bloodstream infection from a tertiary care hospital in central India over 5 years. Non-albicans Candida (NAC) infections like C. tropicalis and C. parapsilosis were associated with higher mortality and longer hospital stays. Resistance to fluconazole and amphotericin B was also higher in NAC infections. Prolonged use of central lines, nil oral intake, mechanical ventilation and longer hospital stays were identified as risk factors. The study highlights the need for timely identification of Candida species and antifungal susceptibility testing to help improve outcomes.
This study investigated whether older adults living in assisted living communities could experience successful aging. 200 participants aged 52-100 from 8 assisted living facilities in North Carolina completed questionnaires measuring successful aging, life satisfaction, depression, and sense of purpose. The results showed lower depression scores and higher successful aging scores. Women tended to experience more successful aging than men. The study provides evidence that older adults in assisted living can age successfully with preventative healthcare measures and support services. Larger, more diverse studies could further explore factors promoting successful aging.
2015 09-14 Precision Medicine 2015, London, Alain van GoolAlain van Gool
Outline of my view hoe personalized health(care) is more than just targeted medicines, also including personal motivation and actions towards disease prevention. It also outlines 4 key factors that should be in order for optimal personalized health(care): 1. start with patients first, 2. Accelerate translation research to application, 3. Copy best practice, 4. Spread the word.
The University of Rochester Batten Center has established several initiatives to advance research for JNCL:
1. They created a patient registry with 237 registrants from 198 families, 149 of which have JNCL, to facilitate research studies.
2. They developed the Unified Batten Disease Rating Scale to measure disease progression and validated its use in clinical trials. Over 300 exams have been completed on 120 children to establish natural history studies.
3. They validated a non-invasive buccal epithelial cell collection method for genetic testing, obtaining genetic confirmation for all 120 patients in the registry.
EBM is the practice of integrating individual clinical expertise with the best available clinical evidence from systematic research to maximize the quality and quantity of life for individual patients.
This study retrospectively reviewed medical records of patients with Krabbe disease or metachromatic leukodystrophy (MLD) who received general anesthesia between 2012-2014 at Children's Hospital of Pittsburgh. It categorized patient disease severity into classes based on symptoms and created an anesthesia analysis classification system. The results found an 8.1% complication rate, higher than the general population but largely due to the progressive nature of the diseases. Excluding bone marrow transplant patients, the rate was 4.4% and complications were generally mild and self-limiting. The study concluded that general anesthesia appears to be safe for these patient populations.
This study evaluated the effectiveness of a classroom intervention aimed at increasing students' knowledge of head safety and positive attitudes towards bicycle helmet use. 74 students ages 11-15 participated. They completed pre-and post-tests on safety knowledge and questionnaires on helmet use attitudes. Before the intervention, most students only wore helmets when forced by parents and few saw them as safety devices. After viewing presentations on head injuries, more students reported being likely to wear helmets. The study concluded the intervention successfully increased safety knowledge and positive helmet attitudes as intended.
This study examined the effect of resident work hour regulations on mortality in intensive care unit patients using data from 40 hospitals from 2001-2005. The study found no evidence that the 2003 regulation limiting resident work hours had any positive or negative effect on ICU mortality overall or when analyzed by hospital teaching status. Risk-adjusted mortality improved over time at all hospital types studied.
This study evaluated the effectiveness of a Dynamic Realistic endpoint Student Simulation (DReSS) teaching method compared to traditional teaching methods for improving undergraduate nursing students' ability to assess and manage a deteriorating patient. In a randomized control trial, students who received DReSS training performed significantly better in recognizing deterioration and calling for help. However, both groups struggled with accurately measuring respiratory rate and knowing when and how to activate a medical emergency team. The study highlights the need for refined deteriorating patient education for nursing students using simulation methods.
Challenges in pediatric ambulatory anesthesia kids are differentsxbenavides
The document discusses challenges and risks associated with pediatric ambulatory anesthesia. It addresses several categories of risk for children undergoing ambulatory surgery, including cardiovascular, respiratory, and potential for neurocognitive dysfunction in young children. Specific risks discussed include laryngospasm, difficult airway management, and postoperative nausea and vomiting. The document also examines guidelines for pediatric anesthesia care and improving outcomes.
This document provides clinical practice guidelines for the management of community-acquired pneumonia (CAP) in infants and children older than 3 months. It includes recommendations on site-of-care management decisions, diagnostic testing, antimicrobial and surgical therapy, and prevention. The expert panel developed evidence-based guidelines to assist clinicians in decreasing the morbidity and mortality of CAP in children. The guidelines cover practical questions of diagnosis and treatment of CAP in both outpatient and inpatient settings.
This document summarizes several studies that compare the efficacy of shorter courses of antibiotic therapy (3 days) to traditional longer courses (5 days or more) for treating community-acquired pneumonia. Two studies found that 3 days of antibiotics was as effective as 5 days for treating non-severe pneumonia in children. However, another study found 3 days was less effective than 5 or 10 days for treating pediatric pneumonia. Additionally, one study suggested 3 days of IV antibiotics followed by 5 days of oral antibiotics was not inferior to 8 days of treatment for mild to moderate pneumonia in hospitalized adults.
The study assessed the knowledge of nurses at BPKIHS regarding the care of patients with pacemakers. A total of 69 nurses working in selected wards participated in the study. The results showed that the majority of nurses had basic knowledge about pacemakers, such as the natural pacemaker of the heart and the function of pacemakers to regulate heart rhythm. However, fewer nurses demonstrated knowledge about more advanced topics such as the differences between single and dual chamber pacemakers. The average knowledge score was 67.6%. Nurses over 25 years old and those working in critical care units had significantly higher knowledge scores. The study concluded that while most nurses had satisfactory basic knowledge, their knowledge could be improved, especially regarding more complex pacemaker topics
This study examined the relationship between early rising and mental health issues in pharmaceutical science students. The author conducted an observational study of 10 students over the 2016-2017 academic year, collecting data on their sleep schedules, breakfast habits, and morning routines. The results showed that students performed best academically when classes started between 11am-9:30am, as this aligned better with their natural body clocks than the traditional 9am start time. Early mornings were found to impair performance and increase risks of issues like depression, obesity, and drug abuse due to sleep loss and circadian rhythm misalignment. The author concludes that later class start times would allow students to study at their most effective times.
1) The document discusses evaluating medical literature to answer a clinical question about whether duct tape is an effective treatment for warts in children.
2) A randomized controlled trial studied 61 patients comparing duct tape to cryotherapy treatment for common warts. It found that duct tape was significantly more effective, with an absolute risk reduction of 25%.
3) Key points to evaluate in studies include similarity of patients, interventions and outcomes measured, study design, results, and statistics reported like absolute risk reduction and number needed to treat.
This document discusses the use of case-control studies to evaluate vaccine efficacy and adverse effects after a vaccine has been introduced. Case-control studies can estimate the protective effect of a vaccine by comparing vaccination status between cases who developed the target disease and controls. They can also assess potential rare adverse effects. Key methodological issues for case-control vaccine studies include controlling for confounding, diagnosis/recall bias, and establishing temporal relationships between vaccination and disease/adverse event onset. The document reviews an example case-control study of meningococcal vaccine efficacy in Brazil and the National Childhood Encephalopathy Study which investigated adverse neurological events following pertussis vaccination in the UK.
This document provides an introduction to evidence-based practice for nursing students. It defines evidence-based practice and discusses the importance of nursing research. It outlines the history of evidence-based practice and nursing research, from Florence Nightingale's early work through modern developments. Key aspects of the evidence-based practice process are introduced, including different sources of knowledge, levels of evidence, and the nurse's role in integrating research into clinical decision making.
The document summarizes different types of genetic and genomic testing reports, including how variants are classified. It discusses fragile X DNA testing, microarrays, next generation sequencing, and whole exome sequencing. Variants are classified as pathogenic, likely pathogenic, variants of uncertain significance (VUS), likely benign, or benign. The document uses a case report to demonstrate how more information can be obtained over time to reclassify a VUS. It also discusses reporting guidelines for incidental findings from genetic testing and limitations of direct-to-consumer genetic testing.
Tushar Choudhari proposes starting an apiary business to produce honey and wax from 1000 beehives across 25 acres. The business would require an initial investment of Rs. 22.62 lakh. It is projected to produce 66.93 lakh rupees in revenue in the first year and break even after producing 42,724 kg of honey and wax. The apiary would be located in Kota, Rajasthan which is suitable for cultivating mustard and soya crops needed to support the bees. The international market for Indian honey is growing and it could potentially export up to 2 lakh tonnes annually.
Planificación de clases utilizando recursos tecnológicosIlse Franco
Este documento presenta una estrategia de aprendizaje cooperativo utilizando la plataforma virtual educativa Moodle para la asignatura de Patología Clínica. La estrategia implica elaborar material didáctico y actividades dentro de Moodle, aplicar y evaluar el programa tanto en el aula como en línea, desarrollando habilidades de trabajo en equipo y pensamiento crítico en los estudiantes. El objetivo es formar profesionales competentes aplicando un modelo mixto de aprendizaje que integra lo mejor del aprendizaje presencial y
This study examined the prevalence and risk factors of postpartum depression among 1,379 Arab women in Qatar within 6 months of delivery. The Edinburgh Postnatal Depression Scale was used to screen participants. The prevalence of postpartum depression was found to be 17.6%. Mothers who were older, less educated, housewives, had lower incomes, maternal/infant complications, poor family/marital support, financial difficulties, prematurity, and dissatisfaction in marriage had higher rates of postpartum depression.
This document discusses the Model-View-Controller (MVC) pattern and its implementation for a canvas drawing application. It describes models that manage canvas contexts and children objects, views that render to the canvas, and controllers that handle events. Models contain data and logic, update child states, and call rendering. Children have attributes like position and draw to the canvas context during rendering. Events are handled by controllers calling methods on children.
Este documento presenta el currículum de Olga Lydia Salazar Villegas. Actualmente trabaja como profesora en Conalep Cadereyta y la Universidad Tecnológica Cadereyta. Tiene una licenciatura en psicología y maestría en administración de empresas. Cuenta con 5 años de experiencia como profesora en línea utilizando la plataforma Moodle. Su objetivo es mejorar el uso y entendimiento de la plataforma educativa entre profesores y alumnos.
Lets intern.com credentials and services for youth marketingRishabh712
This is a credential presentation of our body of work achieved in last 18 months. This illustrates only one part of the business focused towards getting brands access to youth communities or 18-24 age group through peer networks.
The document discusses JavaScript concepts including hashmaps, window functions, execution contexts, and variable scoping. It provides code examples of hash functions, window and function declarations, variable assignments within nested functions, and the use of execution contexts and scopes to resolve variable references.
This document discusses JavaScript prototypes and the prototype chain. It provides examples of how to set up prototype chains between functions to inherit and share properties and methods. It also demonstrates how the prototype property works and how to access properties and methods from different levels in the prototype chain.
Tips for writing scientific journal articlesaamirmub
This document provides tips for writing scientific journal articles. It discusses selecting a target journal, recommended writing order for article elements like the title, abstract, introduction, etc. It also covers submission and review, what reviewers look for, and reacting to reviewer comments. Additionally, it includes a chapter on language issues, discussing scientific writing as a persuasive narrative and necessary writing skills. The overall aim is to provide concrete guidance for researchers, especially doctoral students, in publishing their work.
Bamboo is a versatile building material with several advantages such as strength, flexibility, earthquake resistance, low cost and minimal environmental impact. However, untreated bamboo has low durability. Various treatments like borax-boric acid preservation, neem oil treatment can improve the durability. Bamboo can be used for walls, foundations, columns, beams and roofing. It provides cost and energy benefits compared to concrete while maintaining structural strength. However, limitations include jointing techniques, flammability and lack of codified design guidance.
El documento describe un proyecto para desarrollar un manual sobre el uso de la plataforma educativa Moodle de la Universidad Tecnológica Cadereyta. El manual se creará mediante la recopilación de información sobre la plataforma y los problemas comunes, y se difundirá a estudiantes y profesores para facilitar el uso de la plataforma y evitar problemas. El manual se someterá a comentarios y aprobación antes de su lanzamiento para su uso.
Autism Spectrum Disorder and Particulate Matter Air Pollution before, during ...joaquin_project
Pregnant women may nearly double their risk of giving birth to a child with autism by inhaling smog spewed by vehicles or smoke stacks, according to a new Harvard study that could help unlock the deepest autism mysteries.
The research fortifies previous scientific findings that linked air pollution to autism. And it offers fresh insights by showing women in their third trimesters seem most vulnerable if they breathe in elevated levels of tiny airborne particles emitted by power plants, fires and automobiles.
This study compared mortality rates in preterm infants with respiratory distress syndrome (RDS) treated with three surfactant preparations - poractant alfa, calfactant, or beractant. Using data from over 14,000 infants treated between 2005-2009, the study found:
1) Calfactant treatment was associated with a 49.6% greater likelihood of death compared to poractant alfa.
2) Beractant treatment showed a non-significant 37% higher mortality risk compared to poractant alfa.
3) There was no significant difference in mortality between calfactant and beractant.
4) Poractant alfa treatment was associated with significantly reduced mortality compared
This study compared mortality rates in preterm infants with respiratory distress syndrome (RDS) treated with three surfactant preparations - poractant alfa, calfactant, or beractant. Using data from over 14,000 infants treated between 2005-2009, the study found:
1) Calfactant treatment was associated with a 49.6% greater likelihood of death compared to poractant alfa.
2) Beractant treatment showed a non-significant 37% higher mortality risk compared to poractant alfa.
3) There was no significant difference in mortality between calfactant and beractant.
4) Poractant alfa treatment was associated with significantly reduced mortality compared
Running head CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS.docxtodd271
Running head: CRITIQUE QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
5
CRITIQUE OF QUANTITATIVE, QUALITATIVE, OR MIXED METHODS DESIGN
Critiquing Quantitative, Qualitative, or Mixed Methods Studies
Adenike George
Walden University
NURS 6052: Essentials of Evidence-Based Practice
April 11, 2019
Critique of Quantitative, Qualitative, or Mixed Method Design
Both quantitative and qualitative methods play a pivotal role in nursing research. Qualitative research helps nurses and other healthcare workers to understand the experiences of the patients on health and illness. Quantitative data allows researchers to use an accurate approach in data collection and analysis. When using quantitative techniques, data can be analyzed using either descriptive statistics or inferential statistics which allows the researchers to derive important facts like demographics, preference trends, and differences between the groups. The paper comprehensively critiques quantitative and quantitative techniques of research. Furthermore, the author will also give reasons as to why qualitative methods should be regarded as scientific.
The overall value of quantitative and Qualitative Research
Quantitative studies allow the researchers to present data in terms of numbers. Since data is in numeric form, researchers can apply statistical techniques in analyzing it. These include descriptive statistics like mean, mode, median, standard deviation and inferential statistics such as ANOVA, t-tests, correlation and regression analysis. Statistical analysis allows us to derive important facts from data such as preference trends, demographics, and differences between groups. For instance, by conducting a mixed methods study to determine the feeding experiences of infants among teen mothers in North Carolina, Tucker and colleagues were able to compare breastfeeding trends among various population groups. The multiple groups compared were likely to initiate breastfeeding as follows: Hispanic teens 89%, Black American teens 41%, and White teens 52% (Tucker et al., 2011).
The high strength of quantitative analysis lies in providing data that is descriptive. The descriptive statistics helps us to capture a snapshot of the population. When analyzed appropriate, the descriptive data enables us to make general conclusions concerning the population. For instance, through detailed data analysis, Tucker and co-researchers were able to observe that there were a large number of adolescents who ceased breastfeeding within the first month drawing the need for nurses to conduct individualized follow-ups the early days after hospital discharge. These follow-ups would significantly assist in addressing the conventional technical problems and offer support in managing back to school transition (Tucker et al., 2011).
Qualitative research allows researchers to determine the client’s perspective on healthcare. It enables researchers to observe certain behaviors and experiences amo.
Evidence Based Practice_lecture 5_slidesZakCooper1
This document provides an overview of evidence-based practice as it relates to assessing questions about harm or etiology. It discusses how these types of questions are best assessed through randomized controlled trials or observational studies like cohort and case-control studies. Examples are provided of questions about harm that have been studied, like whether silicone breast implants or weight-loss drugs cause certain health issues. The limitations of different study types are also outlined. Finally, the document discusses how prognosis questions are typically assessed through survival curve analysis and provides some examples of prognosis studies.
The number of existing functional somatic syndromes (fs ss) is an important r...Paul Coelho, MD
The study tested the hypothesis that the number of existing functional somatic syndromes (FSSs; e.g. fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome) predicts the development of new FSSs. The study found that the incidence of a new FSS increased with the number of pre-existing (antecedent) FSSs in both cases (women with interstitial cystitis) and controls. Specifically, the risk of a new FSS was highest for individuals with 3 or more antecedent FSSs. Logistic regression showed that the number of antecedent FSSs significantly predicted new FSSs even after accounting for other risk factors. This supports the idea that FSSs are linked
Fetal screening and selection medical dogma or parental preferenceKatharine Perry
This document discusses fetal screening and selection, and whether women's decisions to terminate pregnancies based on fetal abnormalities are truly autonomous. It notes that medical practitioners have significantly more positive views of terminating pregnancies for disabilities compared to patients. This difference in views threatens patients' autonomy during genetic counseling. The document examines discrepancies between medical and patient attitudes, how prenatal testing has advanced, and abortion rates after diagnoses. It argues that the medical community's tendency to over-medicalize and view disabilities as defining traits influences their support for fetal screening and selection in a way that can undermine patient consent.
This study examined whether psychosocial factors like depression, anxiety, coping style, and social support influence survival outcomes in young women diagnosed with early-stage breast cancer. The study followed 708 Australian women under age 60 diagnosed with non-metastatic breast cancer for a median of 8.2 years. Psychosocial factors were assessed via questionnaires administered about 11 months after diagnosis. The study found no statistically significant associations between the measured psychosocial factors and distant disease-free survival or overall survival after adjusting for known prognostic factors like tumor characteristics and treatment. One unadjusted analysis found higher anxious preoccupation was linked to poorer outcomes, but this association was explained by its relationship to worse prognostic factors and disappeared after adjustment. The findings do not support
This study examined the relationship between psychosocial factors (depression, anxiety, coping style, social support) and survival outcomes in 708 young women with early-stage breast cancer in Australia. Psychosocial factors were assessed via questionnaires administered about 11 months after diagnosis on average. Over a median follow-up of 8.2 years, 33% experienced distant cancer recurrence and 24% died. No statistically significant associations were found between any psychosocial factors and distant disease-free or overall survival after adjusting for known prognostic factors like tumor characteristics and treatment. Higher levels of anxious preoccupation were marginally associated with poorer survival in unadjusted analyses but not after adjustment, and anxious preoccupation was also associated with worse tumor features. The findings do
Do Anxiety Scores of Pregnant Women Correlate with Doppler Indices of Uterine...semualkaira
In The Diagnostic and Statistical Manual of Mental Disorders
(DSM-V), a stressor is defined as any emotional, physical, social,
economic, or otherwise unclassified factor that disrupts the normal
physiological, cognitive, emotional, or behavioural balance of an
individual [1]. Thus, as pregnancy alters the normal physiological
balance of pregnant women, it can be regarded as a stress factor
or stressor for all individuals who experience it
Assignment 2 Final Project Part III Designing a StudyYou are t.docxrock73
Assignment 2: Final Project Part III: Designing a Study
You are the hospital administrator in a medium-sized, urban, for-profit hospital that caters to middle-income groups. You wonder if patients' satisfaction with the hospital stay will increase significantly if they are given better and more flexible meal options. You decide to conduct a research study to find the answer. The first step is to design the study.
Design a descriptive study to investigate if better meal options will increase patient satisfaction. Include the following elements of design:
1. Develop a research question or purpose of the study
2. Selection of subjects for study (what is the sample)
3. Assignment of subjects to experimental or control groups
4. Study time period
5. Type of data to be gathered
6. Measures of meal options and of patient satisfaction
7. Method of data collection
8. Guidelines for data interpretation
After you complete building the study design, list three design elements you considered in your study that were not readily obvious in the one you read last week “Diagnosed with Breast Cancer While on a Family History Screening Programme: An Exploratory Qualitative Study.”
By Tuesday, February 21, 2017, submit your study design and list of three identified design elements in a Word document to the W3: Assignment 2 Dropbox.
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understoo ...
This study compared outcomes for head and neck cancer patients based on age. Younger patients (≤40 years old) had significantly better 5-year survival rates (65%) than middle-aged (41-64 years old, 52%) or older patients (≥65 years old, 38%). Younger patients also developed fewer recurrent tumors or new primary tumors. However, the reasons for the differences in outcomes based on age are unclear. The study aimed to analyze outcomes while controlling for other factors like smoking history, tumor stage, and treatment received to better understand the independent impact of age.
This document summarizes the challenges of communicating risk in prenatal screening tests. It discusses how:
1) Prenatal screening tests have a high rate of false positives, leading many women with healthy pregnancies to undergo invasive follow-up tests that carry risks of miscarriage. For example, a first trimester screening test with a 5% false positive rate could lead to around 50 unnecessary miscarriages among 100,000 screened women.
2) Calculating and understanding the positive predictive value of screening tests, which is needed for informed decision making, requires Bayesian reasoning that most people struggle with. As a result, risks are often underestimated.
3) While research has identified effective ways to communicate Bayesian concepts
An Epidemiologic Study of Gilles de la Tourette's Syndrome in IsraelAlfred Cohen
This study aimed to estimate the lifetime prevalence of Gilles de la Tourette's syndrome (GTS) in adolescents aged 16-17 in Israel. Over 28,000 adolescents were screened using a 4-item questionnaire followed by examination by a psychiatrist. 12 individuals met diagnostic criteria for GTS, yielding a point prevalence of 4.3 per 10,000. Rates of obsessive-compulsive disorder (OCD) were higher in those with GTS (41.7%) compared to the general population (3.4%), but rates of attention deficit hyperactivity disorder were similar. This study provides prevalence estimates for GTS in line with previous studies and highlights the high comorbidity between GTS and OCD.
Current Topics in CareA Case of Inappropriate ApolipoproteOllieShoresna
Current Topics in Care
A Case of Inappropriate Apolipoprotein E
Testing in Alzheimer’s Disease Due to
Lack of an Informed Consent Discussion
Christian D. Furman, MD, MSPH, AGSF1,
Lori A. Earnshaw, MD2, David J. Doukas, MD3,
Lindsay A. Farrer, MD4, and Robert P. Friedland, MD3
Abstract
Background/Objective: Apolipoprotein E (APOE) genetic testing is used to assist in the diagnosis of Alzheimer’s Disease (AD).
Whenever genetic testing is performed, an informed consent process should occur. Methods: In this case, a patient with memory
loss presented to the neurologist. The neurologist ordered a lumbar puncture (LP). The LP was performed by a neuroradiologist
who also ordered APOE genetic testing. The patient received no genetic counseling, nor was an informed consent document
offered. Results: After the testing was completed, the neurologist faced an ethical dilemma. His solution was to offer the genetic
testing to the patient in order to have an informed consent process. It was clear that the patient and her adult children did not
want the genetic testing and that they would have been burdened with the results. The neurologist opted not to disclose the
results. Conclusion: Genetic counseling and a signed informed consent document are required prior to any genetic testing. In
this case, neither occurred and it led to an ethical dilemma that was ultimately resolved by the neurologist. As the population ages
and AD becomes more prevalent, there is a need to expand the workforce of genetic counselors and educate physicians who
commonly treat AD about genetic testing.
Keywords
genetic testing, Alzheimer’s disease, ethics, informed consent
Introduction
Twenty years ago, the apolipoprotein E (APOE) e4 allele was
found to confer susceptibility to late-onset Alzheimer’s dis-
ease (AD) in caucasians.1 This association was extended to
noncaucasian populations, and the APOE-associated risk of
AD was demonstrated to vary with age and sex.2 Although the
presence of the e4 allele in a person with dementia increases
the probability of AD, this finding is not ‘‘diagnostic’’ of the
disease because more than one-half of e4 carriers surviving
to age 80 years do not develop AD.2,3 Thus, APOE e4 is best
viewed as a genetic risk factor for AD rather than a genetic
marker of the disease4 because the risk of developing AD for
individuals with at least 1 e4 allele by age 80 years is esti-
mated to be 29% compared to 9% for individuals lacking e4.5
Among caucasians, the odds of developing AD are 2 to 3 times
higher for e4 heterozygotes and 12 to 14 times higher for e4
homozygotes compared to persons who are APOE 3/3, the most
common genotype.2 However, these risks are dependent on age
and gender and are lower in some ethnic groups including African
Americans, Indians, and Israeli Arabs.2,6-9 Further, the APOE risk
appears to be attenuated by adequate control of hypertension.10
The 2/3 genotype is associated with an approximately 40%
decreased risk of ...
This document summarizes a seminar presentation on case control studies. It begins by defining epidemiological study cycles and analytical study types such as case control and cohort studies. It then focuses on case control studies, defining them, discussing their history, design, outcomes, limitations, advantages and applications. Examples of notable case control studies are provided, such as Lane Claypon's 1926 breast cancer study and studies from the 1950s linking smoking to lung cancer. Key aspects of case control study methodology like selection of cases and controls, and matching to control for confounding variables are explained.
Diagnosed with breast cancer while on a family historyscreen.docxduketjoy27252
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of Pr.
Diagnosed with breast cancer while on a family historyscreen.docxlynettearnold46882
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of Pr.
This document describes a study that examined practice variation in the diagnosis and treatment of chorioamnionitis among US obstetricians. The study involved distributing a survey to 500 obstetricians querying their demographics, practice setting, and chorioamnionitis management strategies. 212 surveys were analyzed. The results found wide variation in diagnostic criteria, antibiotic regimens, and postpartum treatment duration. Specifically, over 25 different antibiotic regimens were reported, with 30% using a single agent. Postpartum treatment duration ranged from no treatment to 48 hours. No practitioner characteristics were independently associated with diagnostic or treatment strategies. This variation may reflect a lack of high-quality evidence on best practices for chorio
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
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TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Risk factors ppd
1. ORIGINAL CONTRIBUTION
Risk Factors for Postpartum Depression: A Retrospective Investigation
at 4-Weeks Postnatal and a Review of the Literature
Sarah J. Breese McCoy, PhD; J. Martin Beal, DO; Stacia B. Miller Shipman, OMS IV ;
Mark E. Payton, PhD; and Gary H. Watson, PhD
Objective: To describe possible correlations between inci- patient characteristics routinely recorded in patient records
dence of postpartum depression and the following patient may be underutilized by physicians when screening patients
characteristics: age, breastfeeding status, tobacco use, mar- for PPD: age, breastfeeding status, tobacco use, marital status,
ital status, history of depression, and method of delivery. history of depression, and method of delivery.
Study Design: Data gathered at routine 4-week postnatal Identification of clear correlations between certain risk fac-
visits were obtained from the patient records of 209 women tors and a diagnosis of PPD could lead to earlier intervention
who gave birth between June 1, 2001, and June 1, 2003, at for these patients.
three university medical clinics in Tulsa, Okla. Inclusion cri-
teria required that the records of potential study subjects Materials and Methods
contain data on the characteristics noted as well as patient- Subjects
completed Edinburgh Postnatal Depression Scale forms. We sought to analyze patient records for the following patient
Results: Formula feeding in place of breastfeeding, a history characteristics at 4-weeks postnatal: EPDS numerical score,
of depression, and cigarette smoking were all significant breastfeeding status, method of delivery (ie, vaginal
risk factors for an Edinburgh Postnatal Depression Scale birth vs cesarean section), history of depression, marital status,
score of 13 or higher, indicating probable postpartum depres- tobacco use, and patient age (Ͻ 21 years vs у21 years). With
sion. regard to dividing subjects into two groups by patient age,
Conclusion: The authors’ findings corroborate the results of we used the same protocol used in a 1996 study by Chen.9
previous investigators. To facilitate prophylactic patient edu- Potential subjects for our study were women who gave
cation and intervention strategies, a larger study is recom- birth between June 1, 2001, and June 1, 2003, at three sites in the
mended to determine risk factors for postpartum depression. Oklahoma State University (OSU) Physician clinic system in
Tulsa. The urban population served by the OSU Physician
J Am Osteopath Assoc. 2006;106:193–198 clinic system is largely uninsured.
Our study was conducted prior to the implementation
P ostpartum depression (PPD) is a serious public health
concern1 that affects approximately 13% of women who
give birth.2 As routine screening for this condition has become
of universal screening for PPD in the OSU Physician clinic
system. However, screening for PPD was often conducted at
clinic sites during the standard 4-week postnatal visit.
more common in routine obstetric care,3,4 data are now more Study inclusion was dependent on the presence of com-
readily available to assist researchers in identifying patient plete patient data for the characteristics under investigation as
characteristics that may be associated with increased risk of well as a patient-completed EPDS from the 4-weeks postnatal
PPD. visit. In addition, to distinguish potential PPD from a pre-
The self-administered, 10-question Edinburgh Postnatal vious diagnosis of major depression, the records of patients
Depression Scale (EPDS)5 is an effective screening tool for whose list of current medications included an antidepressant
PPD because it is reliable, easy for clinicians to score, and were excluded from study. Finally, any patients whose infants
predictive of a clinical diagnosis of PPD.3–8 In addition, other were stillborn or died before the 4-week postnatal follow-up
were excluded from the study because we sought to examine
risk factors that correlate with typical PPD, rather than the
From the Departments of Obstetrics and Gynecology (McCoy, Beal) and grief process that accompanies the loss of an infant.
Research (Miller Shipman) at the Oklahoma State University College of Osteo- Because other relevant and potentially interesting data,
pathic Medicine in Tulsa. Also from the Department of Statistics (Payton) at such as race and family history of depression, were not avail-
Oklahoma State University in Stillwater and the Department of Biochem-
istry (Watson) at Georgia Campus–Philadelphia College of Osteopathic able in many patient records, these data were excluded from
Medicine in Suwanee, Ga. analysis in the present study.
Address correspondence to Sarah J. Breese McCoy, PhD, Office of Research, The study protocol was developed in accordance with
Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa,
OK 74107-1898. the Health Insurance Portability and Accountability Act guide-
E-mail: sjmccoy98@aol.com lines enacted in 2003, and patient confidentiality was
McCoy et al • Original Contribution JAOA • Vol 106 • No 4 • April 2006 • 193
2. ORIGINAL CONTRIBUTION
protected through all phases of this investigation. In addition, Results
the protocol described was reviewed and approved by During the study period, 1072 women delivered infants at
the institutional review board at the OSU Center for Health the three study sites. Of these 1072 potential subjects, 217 (20%)
Sciences. women had patient records in which none of the variables
noted was missing from their patient records.
Statistical Analysis Of the 217 women whose records contained a patient-
Patient data were systematically recorded by one investigator completed EPDS, 7 (3.2%) were eliminated from the study
(S.B.M.S.) and a medical student for analysis on a spreadsheet because their lists of current medications included an antide-
(Microsoft Excel 2003; Microsoft Corp, Redmond, Wash). pressant. One potential subject was excluded because her
After appropriate study subjects were identified, investi- infant was stillborn.
gators masked the identity of the patients, concealing patient Of the 209 women remaining in the study population
names and assigning a random number that was used as an after inclusion and exclusion criteria were applied, 128 (61%)
identifier. The master list that contained the name-number had an EPDS score of 12 or below (ie, not depressed), and
conversions was destroyed at the project’s close. All data pro- 81 (39%) had a score of 13 or higher (ie, depressed).
vided in the present study are reported as mean scores of all Among the 81 women whose EPDS results indicated a
study participants. possible diagnosis of PPD, there was no significant difference
Patient characteristics were analyzed individually against by patient age or marital status at 4-weeks postnatal (Table).
EPDS scores with 2 tests. Possible patient scores for the 10- Breastfeeding was associated with a significantly lower
question EPDS can range from 0 to 30. Test sensitivity and occurrence of PPD than formula feeding only (PϽ.001). The
specificity for the EPDS are reported at 86% and 78%, respec- relative risk factor for formula feeding only was 2.04 (PϽ.05).
tively.5 Cox et al,5 the instrument’s developers, recommend that There was a significant difference in the occurrence of
patients with EPDS scores higher than 12 receive a clinical PPD between women who had a history of depression noted
evaluation for diagnosis of PPD. in their records and those without a history of depression
Australian investigators in a 1993 study8 (N=103) reported (P=.003). The relative risk factor for women with a history of
even better results for the sensitivity (100%) and speci- depression was 1.87 (PϽ.05).
ficity (95.7%) of the EPDS when using the developers’ recom- Cigarette smoking was associated with a significantly
mended 12- or 13-point cutoff for a diagnosis of probable PPD. higher occurrence of PPD than was not smoking (P=.01). The
Although the 1993 article by Boyce and colleagues8 had a relative risk factor for cigarette smoking was 1.58 (PϽ.05).
sample population from Australia and New Zealand, and Vaginal birth was not associated with a significantly
their results, therefore, perhaps cannot be applied to the pre- lower occurrence of a positive screen for PPD than cesarean
sent study, we believe that the sensitivity and specificity values section (P=.09).
reported by the instrument’s developers5 may be conservative. Three combinations of patient characteristics were found
In light of the long-term reliable performance of the to have additive effects on the likelihood of subjects receiving
EPDS,4,5,8,10,11 we decided to label subjects as either “depressed” an EPDS score that was predictive of PPD:
or “not depressed” based on EPDS scores alone, with a score of ▫ not breastfeeding and a history of depression (P=.12),
13 on the EPDS indicating probable PPD. ▫ cigarette smoking and a history of depression (P=.29), and
We are aware that several other instruments may be used ▫ cigarette smoking and not breastfeeding (P=.96).
by clinicians to diagnose PPD more definitively than the
EPDS10 (eg, Beck Depression Inventory,12–14 Center for Epi- Comment
demiologic Studies Depression Scale,15 Zung’s Self-rating We acknowledge the limitations of a study based, as ours is,
Depression Scale,16 Hamilton Rating Scale for Depression17). on convenience sampling. However, we are persuaded that the
Physicians in the OSU Physician clinic system use the EPDS for statistical findings we have reported have merit because they
convenience (ie, it is reliable, easy to score, and highly predic- tend to support the findings in numerous randomized
tive). Therefore, the EPDS provided the only standardized data studies,7,10,18–29 as noted elsewhere.
related to PPD available in patient records for our retrospective Although PPD affects approximately 13% of women who
investigation. give birth,2 a disproportionately high number of women (81
We calculated the relative risk for each statistically sig- [39%]) in this patient sample had EPDS scores that indicated
nificant risk factor. Significant risk factors were then analyzed possible diagnosis for PPD. Because universal screening for
using log-linear models, or multidimensional 2 tests. We deter- PPD at 4-weeks postnatal was not in effect at the three study
mined that P values at the level of р.05 would be considered sites during the study period, our study may have been affected
statistically significant. Small P values (ie, Ͻ.05) were consid- by referral bias. Physicians may have been more likely to
ered to indicate a lack of additivity—or to indicate a lack of ask patients with signs and symptoms of depression to
independence of these factors as they affect PPD. Conversely, take the EPDS.
nonsignificant P values indicated some degree of additivity. A second contributing factor to the disparity between
194 • JAOA • Vol 106 • No 4 • April 2006 McCoy et al • Original Contribution
3. ORIGINAL CONTRIBUTION
Editor’s message: In the original
Table print publication, the Yes and No
Postpartum Depression by Patient Characteristic: column headings under “EPDS
Score, у13” were accidentally
Results of 2 Test Analysis (N=209)* reversed. The error has been cor-
rected here.
EPDS Score, у13
Characteristic n Yes No P
Ⅲ Age .57
▫ Ͻ21 y 72 26 (36) 46 (64)
▫ у21 y 137 55 (40) 82 (60)
Ⅲ Breastfeeding Ͻ.001
▫ Yes 70 16 (23) 54 (77)
▫ No 139 65 (47) 74 (53)
Ⅲ Married .28
▫ Yes 64 21 (33) 43 (67)
▫ No 145 60 (41) 85 (59)
Ⅲ History of depression .003
▫ Yes 26 17 (65) 9 (35)
▫ No 183 64 (35) 119 (65)
Ⅲ Cigarette smoker .01
▫ Yes 59 31 (53) 28 (47)
▫ No 150 50 (33) 100 (67)
Ⅲ Method of delivery .09
▫ Vaginal birth 163 58 (36) 105 (64)
▫ Cesarean section 46 23 (50) 23 (50)
* Data are reported as No. (%) unless otherwise specified. EPDS indicates Edinburgh Postnatal Depression
Scale.5 For the purposes of this study, investigators divided subject records into two categories. Subjects
with EPDS scores of 12 or lower were labeled “not depressed”; subjects with EPDS scores of 13 or higher
were labeled “depressed.”
this study group’s incidence of PPD and incidence levels EPDS in a study of 306 women, treating age as a continuum,
reported elsewhere8,10,30,28 may be that the population served rather than dividing the women into two or more distinct
by the three study sites is mostly poor and/or indigent. Poverty groups by age. The age of the mother was one of several inde-
is a risk factor for PPD and is associated with more than twice pendent variables associated with PPD, including poverty,
the documented rate of occurrence of PPD.31 Morris-Rush and previous mental disturbance, use of anesthesia during birth,
coauthors4 studied two inner city practices in New York and and family dysfunction.
found that 22% of patients who took the EPDS had results Although our results disagreed with those of Chen9 and
that were positive for PPD. Sierra Manzano et al,32 one possible reason for the discrep-
Having a sample of patients whose incidence of PPD ancy could relate to cultural factors or societal views of young
approached the known incidence of PPD across the general mothers. In our sample, most of the women were from dis-
population was not germane to the primary objective of our advantaged socioeconomic backgrounds.
study, however. We suggest that having more women with
possible PPD in our sample group does not significantly alter Breastfeeding Status
the results of the statistical tests that look for associations Misri and colleagues18 observed an association between patients
between PPD and the patient characteristics studied. with PPD and cessation of breastfeeding. However, in that
retrospective study18 (N=51), 83% of patients claimed that the
Review of the Literature and Research Synthesis symptoms of PPD began before the cessation of breastfeeding.
Age Fergerson and coauthors7 reported that a failed attempt at
Chen9 and Sierra Manzano and colleagues32 found a higher breastfeeding or early cessation of breastfeeding was found to
incidence of PPD in teenage or adolescent mothers than in be significantly associated with higher patient scores on the
older mothers. Sierra Manzano and coinvestigators32 used the EPDS (N=72). Abou-Saleh and colleagues19 reported that
McCoy et al • Original Contribution JAOA • Vol 106 • No 4 • April 2006 • 195
4. ORIGINAL CONTRIBUTION
women who breastfed their infants had significantly lower of alcohol, illegal drugs, and cigarettes.36 The authors of that
scores than their nonlactating counterparts on the EPDS as study36 suggested that the stresses of adolescent parenthood
well as on a standard measure of anxiety, the Present State predisposed young mothers to PPD, and the use of these sub-
Examination.33 Our findings strongly support the results of stances were likely coping mechanisms or attempts to self-
these earlier studies.7,18,19 medicate. Our findings, regarding the incidence of PPD as
Additional support for the association of breastfeeding measured through the EPDS in association with tobacco use,
with a lower incidence of PPD is provided by Labbok,20 who support the assertions of Barnet et al.36
observed that, in countries where exclusive breastfeeding is the
norm, incidence of PPD peaks at around 9-months postpartum; Method of Delivery: Vaginal Birth vs Cesarean Section
whereas, in countries where formula feeding is the norm, the The National Center for Health Statistics reports that the per-
incidence of PPD peaks at 3-months postpartum.20 If research centage of US births delivered by cesarean section in 2003 was
could demonstrate conclusively that women who breastfeed 27.5%, the highest level ever recorded in this country.28 Ascer-
are less likely to experience PPD, those data might provide taining whether this method of delivery is significantly asso-
additional motivation for women to choose breastfeeding over ciated with incidence of PPD could be a valuable tool in
formula feeding for their infants. assisting clinicians identify a large (and growing) number of
at-risk women.
Marital Status Bergant and coauthors29 report that cesarean section
Some studies10,21,30 have reported that unmarried women are was one of several variables considered to be a significant
more likely than their married counterparts to have PPD. In a risk factor for patients with “early postpartal depressive
1990 study of 69 white women recruited from Lamaze classes disorder” at 5 days after childbirth. Fisher and colleagues37
and obstetricians’ offices, Pfost and colleagues21 found that reported that cesarean section was associated with increased
marital status was a significant predictor of PPD. The strength risk to patients of PPD at 5-weeks postpartum in nulliparous
of this correlation was second only to that of preexisting depres- women.
sion.30 A 1995 Chilean study of 542 women found that single Our results tend to support those of the two previous
mothers (defined by researchers as unmarried, separated, or investigations.29,37 Although our results did not achieve a level
widowed) were twice as likely to have PPD as their married of statistical significance (PϽ.1), a trend can be described in
counterparts.30 Finally, a meta-analysis in 2001 of 84 studies which 36% of subjects who delivered vaginally had EPDS
found marital status to be a small but significant predictor of scores indicating possible PPD at 4-weeks postnatal vs 50% of
PPD (confidence interval, 0.21–0.35).10 subjects who underwent cesarean sections for delivery. We
Our results disagreed with those of Pfost et al,21 Jadresic recommend additional research on the relationship between
et al,31 and Beck.10 One possible explanation is that both Pfost method of delivery and PPD.
et al21 and Beck10 did their analyses on data obtained in the
1980s, a time when societal acceptance of unmarried mothers Additivity
in the United States may not have been as widespread as it is To determine whether multiple significant risk factors enhanced
today.22,25 Furthermore, as noted, the research published by clinicians’ abilities to identify women at increased risk of PPD,
Jadresic et al30 was conducted in Chile, which may have a dif- we assessed additivity of patient characteristics.
ferent set of cultural values than the United States. As noted elsewhere, we identified three significant risk fac-
tors: formula feeding in place of breastfeeding, history of
History of Depression depression, and cigarette smoking. None of the three possible
The meta-analysis by Beck10 found strong evidence that combinations of these risk factors were significantly nonaddi-
history of depression is a moderate predictor of PPD (confi- tive. In other words, all three possible combinations may be
dence interval 0.38–0.39). O’Hara and Swain2 found that somewhat additive.
prenatal depression, in particular, was a strong predictor of However, the association between increased incidence
PPD (d=0.75), as did Pfost et al.21 Both studies2,21 replicated the of PPD and the combination of formula feeding in place of
results of earlier work,24–26,34,35 and our results strongly concur. breastfeeding and prior history of depression was weakest
(ie, closest to significantly nonadditive). Therefore, based on the
Tobacco Use: Cigarette Smoking data reported, additivity between formula feeding only
Cigarette smoking is more common in patients with depres- and prior history of depression is least convincing.
sion than in people in the general population.23 Furthermore, Formula feeding and cigarette smoking were the most
cigarette smoking has been found to be a valuable predictor of additive, but cigarette smoking and history of depression
substance use (eg, illegal drugs and alcohol), which is also were also additive. In other words, a patient with two
associated with increased risk of moderate and severe depres- of these risk factors is even more likely to suffer from
sion.27 In addition, a survey of primiparous adolescents found PPD than ifshe had any one of these three risk factors
significant statistical associations between PPD and the use alone. Confirmation of these relationships with further
196 • JAOA • Vol 106 • No 4 • April 2006 McCoy et al • Original Contribution
5. ORIGINAL CONTRIBUTION
research could supply physicians with valuable information
for educating and evaluating their patients for PPD. 12. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for
measuring depression. Arch Gen Psychiatry. 1961;4:561–571.
Conclusion 13. Beck AT, Rial WY, Rickels K. Short form of depression inventory: cross-val-
It is our hope that researchers will assist clinicians in identifying idation. Psychol Rep. 1974;34:1184–1186.
the conditions and patient characteristics of postpartum women
that are associated with an increased risk of PPD. Researchers 14. Beck AT, Steer RA. Internal consistencies of the original and revised Beck
Depression Inventory. J Clin Psychol. 1984;40:1365–1367.
may then develop reliable screening tests that predate the
onset of postpartum dysphoria. 15. Radloff LS. The CES-D Scale: a self-report depression scale for research in
We recommend that physicians inquire about breast- the general population. Appl Psychol Meas. 1977;1:385–401. Available at:
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serve as valuable “red flags” to assist physicians in diagnosing 16. Zung WW. A self-rating depression scale. Arch Gen Psychiatry.
patients with PPD: formula feeding in place of breastfeeding, 1965;12:63–70.
history of depression, and cigarette smoking. The presence of
more than one of these risk factors in postpartum patients 17. Hamilton M. A rating scale for depression. J Neurol Neursurg Psychi-
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these patients should be observed, evaluated for, and edu- 18. Misri S, Sinclair D, Kuan A. Breast-feeding and postpartum depression: is
cated about PPD. As more women with PPD are diagnosed there a relationship? Can J Psychiatry. 1997;42:1061–1065.
earlier as a result of such precautions, it is our hope that the suf-
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