Studies and initiatives such as the “Choosing wisely” (CW) campaign emphasise evidence-based investigations and treatment to avoid overdiagnosis and overtreatment. The perception of the extent of ...medical overactivity among professionals and drivers behind are not well studied in the paediatric field.
Aim
We aimed to investigate the physicians‘ opinion and clarify the main drivers regarding medical overactivity in member countries of the European Academy of Paediatrics (EAP).
Methods
In this study, paediatricians, paediatric residents, primary care paediatricians, and family doctors treating children were surveyed in Norway, Lithuania, Ukraine, Italy, and Switzerland. Over-investigation was defined as “diagnostic work-up or referral that is unlikely to provide information which is relevant for a patient” and overtreatment was defined as “treatment that does not benefit or can harm more than benefit the patient.” The original questionnaire was developed in 2018 by a working group from the Norwegian Paediatric Association.
Results
Overall, 1,416 medical doctors participated in the survey, ranging from 144 in Lithuania to 337 in Switzerland. 83% stated that they experienced over-investigation/overtreatment, and 81% perceived this as a problem. The majority (83%) perceived expectations from family and patients as the most important driver for overtreatment in their country. Other drivers for overuse were use of national guidelines/recommendations, worry for reactions, and reduction of uncertainty.
Conclusion
This is the first study investigating knowledge and attitude toward medical overactivity in European countries. Despite different cultural and economic environments, the patterns and drivers of increased investigations and medicalisation are similar.
Abstract Introduction Psychosocial factors have been associated with both a prothrombotic state and an increased risk of venous thromboembolism (VTE). We examined the relation of depressive symptoms ...and social support with D-dimer, an integrative measure of enhanced coagulation activity, and several additional prothrombotic measures in patients with VTE. Methods We studied 173 patients with a previous deep venous thrombosis and/or pulmonary embolism (mean age ± SD 45 ± 14 years, 55% men). Clinical and lab assessments took place ≥ 3 months after VTE and ≥ 1 month after discontinuation of oral anticoagulants. The patients rated depressive symptoms and social support by validated questionnaires. Results After adjusting for sociodemographic and medical covariates, interactions emerged between depressive symptoms and social support for D-dimer (p = 0.012) and aPTT (p = 0.002). As opposed to patients with high levels of social support, those with low levels of social support showed a direct association of depressive symptoms with D-dimer (r = 0.19, p = 0.014) and an inverse relationship with aPTT (r = -0.14, p < 0.09). Depressive symptoms were associated with levels of thrombin-antithrombin complex (r = 0.19, p = 0.016). Greater social support was associated with prolonged aPTT (r = 0.16, p = 0.046). There were no significant associations of depressive symptoms and social support with D-dimer, fibrinogen, FII:C, FV:C, FVII:C, FVIII:C, FX:C, INR, and thrombin time. Conclusions Depressive symptoms are associated with enhanced coagulation activity in patients with VTE, particularly so in those who perceive low levels of social support. Conversely, high levels of social support may contribute directly and through buffering the effect of depressive symptoms to attenuated clotting activity in VTE patients.
Angiostrongylus vasorum is a cardiopulmonary nematode, causing several clinical manifestations in dogs, e.g., severe respiratory signs, coagulopathy, and gastrointestinal or neurological signs. In ...the last decades, this parasite has been described to spread and emerge in Europe and North America. Scant studies on A. vasorum occurrence in South America exist. Recently, A. vasorum was detected in gastropod intermediate hosts in Colombia, where data on definitive host prevalence, e.g., dogs and wild canids, are still limited. Therefore, the sera of 955 dogs, varying in age and breed from seven different departments all over Colombia, were collected and analysed for A. vasorum antigens and parasite-specific antibodies by ELISA. In total, 1.05 % (n = 10; 95 % CI 0.40–1.69) of the samples were antigen-positive and 2.62 % (n = 25; 95 % CI 1.61–3.63) were antibody-positive. These results confirm the presence of A. vasorum in Colombia, although positive results in antigen and antibody reactions in the same dog were not detected. This study is the first large-scale survey on A. vasorum seroprevalences in dogs from Colombia.
Bone and joint infection (BJI) epidemiology and outcomes in solid organ transplant recipients (SOTr) remain largely unknown. We aim to describe BJI in a multi‐center cohort of SOTr (Swiss Transplant ...Cohort Study). All consecutive SOTr with BJI (01.05.2008–31.12.2019) were included. A nested case–control study to identify risk factors for BJI was performed. Among 4482 patients, 61 SOTr with 82 BJI were included, at an incidence of 1.4% (95% CI 1.1–1.7), higher in heart and kidney‐pancreas SOTr (Gray's test p < .01). Although BJI were predominately late events (median of 18.5 months post‐SOT), most infections occurred during the first year post‐transplant in thoracic SOTr. Diabetic foot osteomyelitis was the most frequent infection (38/82, 46.3%), followed by non‐vertebral osteomyelitis (26/82, 31.7%). Pathogens included Gram‐positive cocci (70/131, 53.4%), Gram‐negative bacilli (34/131, 26.0%), and fungi (9/131, 6.9%). BJI predictors included male gender (OR 2.94, 95% CI 1.26–6.89) and diabetes (OR 2.97, 95% CI 1.34–6.56). Treatment failure was observed in 25.9% (21/81) patients and 1‐year mortality post‐BJI diagnosis was 14.8% (9/61). BJI remain a rare event in SOTr, associated with subtle clinical presentations, high morbidity and relapses, requiring additional studies in the future.
In solid organ transplant recipients, bone and joint infections, rare complications with subtle clinical presentation, high morbidity and frequent relapse, require special attention from treating physicians.
Joining the Army, a new installation or a new unit are times of significant stress for Soldiers. Support provided during these transitions can affect unit cohesion, Soldier well-being, retention, and ...mission readiness. This research aimed to explore how Soldiers experience the Army onboarding process as well as perceptions of the welcome experience. Nineteen focus groups were conducted with 120 Soldiers using a semistructured interview protocol. Thematic analysis of focus group transcripts revealed two major themes, varied welcome experience and an inconsistent Total Army Sponsorship Program. Soldiers reported varied transition experiences ranging from positive, neutral, nonexistent, to negative. Results indicate that Soldiers welcome experience was dependent on the specific installation, leaders, and unit. Findings demonstrate that at the installation and unit level, the Army currently lacks standardized processes for onboarding new service members. We note the research limitations and offer several recommendations that can be drawn from the present findings.
Angiostrongylus vasorum is a cardiopulmonary nematode, causing several clinical manifestations in dogs, e.g., severe respiratory signs, coagulopathy, and gastrointestinal or neurological signs. In ...the last decades, this parasite has been described to spread and emerge in Europe and North America. Scant studies on A. vasorum occurrence in South America exist. Recently, A. vasorum was detected in gastropod intermediate hosts in Colombia, where data on definitive host prevalence, e.g., dogs and wild canids, are still limited. Therefore, the sera of 955 dogs, varying in age and breed from seven different departments all over Colombia, were collected and analysed for A. vasorum antigens and parasite-specific antibodies by ELISA. In total, 1.05 % (n = 10; 95 % CI 0.40–1.69) of the samples were antigen-positive and 2.62 % (n = 25; 95 % CI 1.61–3.63) were antibody-positive. These results confirm the presence of A. vasorum in Colombia, although positive results in antigen and antibody reactions in the same dog were not detected. This study is the first large-scale survey on A. vasorum seroprevalences in dogs from Colombia.
1. Termites (Isoptera) in tropical savannas are known as ecosystem engineers, affecting the spatial and temporal distribution of water, carbon, cations, and nutrients through their mound structures. ...Their mounds, however, also offer habitation to diverse taxa and feeding guilds of other invertebrates; a keystone role that has not been properly quantified. 2. The aim of this study was to explore the ecosystem role of termitaria in determining invertebrate diversity and their potential trophic interactions. We used stable isotopes to distinguish termite-feeding invertebrates from invertebrates merely living in termite mounds under field conditions. 3. The results suggest that inquiline spiders (Arachnida) do not feed on termites directly, but on other invertebrates within the termitaria that are termitophagous, elevating the spiders three trophic levels higher than the termites. 4. This study is the first to demonstrate food web interactions among inquiline invertebrates with a stable isotope approach. It provides evidence that termites play a keystone role in the system by providing habitat for various, trophically interacting invertebrates. These results illustrate a rather unexplored ecosystem property of savanna termites.
L'ampleur des changements environnementaux est aujourd’hui bien établie. Face à cette situation inédite dans l’histoire de l’humanité, quels « cadres » et catégories mobiliser pour penser ces ...bouleversements et guider l’action ? La mise en évidence de l’origine humaine de ces changements et la critique du dualisme Nature/Culture ont conduit à souligner les limites d’approches strictement scientifiques et techniques. C’est pourquoi le présent guide propose un état inédit et original des savoirs des Lettres et Sciences Humaines et Sociales sur la nature. Il rassemble les travaux de spécialistes (civilisation, ethnologie, géographie, histoire, littérature, philosophie, psychologie, sociologie, science politique, urbanisme…) afin de montrer comment l’idée de nature, dans les défis qu’elle adresse aux sociétés contemporaines, reconfigure les cadres de pensée, les disciplines et leurs objets pour produire de nouveaux champs de questionnements et de pratiques qui marquent l’émergence des Humanités environnementales.
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