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Summary Sleepiness and apathy are often reported in patients with normal pressure hydrocephalus. However, research on outcomes after shunt surgery has mainly focused on the classical triad symptoms, that is, gait, cognition, and bladder dysfunction. This study aimed to describe the effects of shunt treatment on excessive daytime sleepiness and whether there was a relation to changes in ventricular volume. Pre‐ and postsurgical excessive daytime sleepiness was investigated using the Epworth sleepiness scale in a sample of 32 patients with normal pressure hydrocephalus who underwent shunt surgery. Data were gathered before surgery and at 1, 2, and 3 months after surgery and with different settings of the shunt. In the total sample, the Epworth sleepiness scale improved by a median of 1.5 points at 1 month after surgery, p = 0.026. The improvement was predominately found in the group (n = 6) with high presurgical daytime sleepiness (Epworth sleepiness scale >12) (median = 12 points, p = 0.035) compared with a median change of 0 points (p = 0.47) in the group with Epworth sleepiness scale ≤12 (n = 26). Between the postsurgical follow‐ups, no further change in the Epworth sleepiness scale score was observed. The Epworth sleepiness scale score did not correlate with clinical tests nor with ventricular volume. Daytime sleepiness seems to be another domain of normal pressure hydrocephalus symptomatology in addition to the classical triad that is responsive to treatment, at least when pronounced. The Epworth sleepiness scale is a quick test to administer and could be a valuable addition to pre‐surgical screening for treatable symptoms. [ABSTRACT FROM AUTHOR]

EAACI position paper on diet diversity in pregnancy, infancy and childhood: novel concepts and implications for studies in allergy and asthma. Allergy prevention, diet diversity, food allergy, offspring, pregnancy The aetiology behind food allergy (FA) and eczema is multifactorial and involves both environmental and genetic factors. Keywords: allergy prevention; diet diversity; food allergy; offspring; pregnancy EN allergy prevention diet diversity food allergy offspring pregnancy 963 968 6 09/05/23 20230901 NES 230901 Key messages Diet diversity in pregnancy was associated with reduced risk of food allergy in early life. [Extracted from the article]

Aim: Psychotropic medication can contribute to arrhythmia and identifying individuals at risk is crucial. This Swedish study compared the corrected QT (QTc) intervals of adolescents on psychotropic medication with unmedicated controls, when supine and after rising rapidly. Methods: The study was carried out at Östersund County Hospital in March 2022 and February to March 2023. It comprised 16 cases, aged 10–17 years and 28 controls. QTc intervals were measured with electrocardiography and calculated using Bazett's and Fridericia's formulas. Univariate and multiple linear regressions were used to assess differences in QTc intervals between the cases and controls and across sex, age and body mass index. Results: The mean QTc interval when supine, calculated with Bazett's formula, was longer for the adolescents on psychotropic medication than the controls (p = 0.046). The same was true for the mean QTc interval after rising rapidly from the supine position, calculated with both Bazett's formula (p = 0.009) and Fridericia's formula (p = 0.007). Mean QTc intervals varied by sex and age groups. Psychotropic medication prolonged QTc intervals, particularly in girls. Conclusion: Longer QTc intervals were found in adolescents on psychotropic medication, particularly after rising rapidly from the supine position. [ABSTRACT FROM AUTHOR]

Background: The basophil activation test is an emerging clinical tool in the diagnosis of cow's milk allergy (CMA). The aim was to assess the association between the basophil allergen threshold sensitivity to the major milk protein casein (casein‐specific CD‐sens), the levels of milk‐ and casein‐specific Immunoglobulin E antibodies (IgE‐ab), and the severity of allergic reactions at milk challenges. Methods: We enrolled 34 patients aged 5–15 (median 9) years who underwent a double‐blind placebo‐controlled milk‐challenge (DBPCMC) as screening before inclusion in an oral immunotherapy study for CMA. The severity of the allergic reaction at the DBPCMC was graded using Sampson's severity score. Venous blood was drawn before the DBPCMC. Milk‐ and casein‐specific IgE‐ab were analyzed. Following in vitro stimulation of basophils with casein, casein‐specific CD‐sens, was determined. Results: Thirty‐three patients completed the DBPCMC. There were strong correlations between casein‐specific CD‐sens and IgE‐ab to milk (rs = 0.682, p <.001), and between casein‐specific CD‐sens and IgE‐ab to casein (rs = 0.823, p <.001). There was a correlation between the severity of the allergic reaction and casein‐specific CD‐sens level (rs = 0.395, p =.041) and an inverse correlation between casein‐specific CD‐sens level and the cumulative dose of milk protein to which the patient reacted at the DBPCMC (rs = −0.418, p =.027). Among the 30 patients with an allergic reaction at the DBPCMC, 67% had positive casein‐specific CD‐sens, 23% had negative casein‐specific CD‐sens, and 10% were declared non‐responders. Conclusion: Two thirds of those reacting at the DBPMC had positive casein‐specific CD‐sens, but reactions also occurred despite negative casein‐specific CD‐sens. The association between casein‐specific CD‐sens and the severity of the allergic reaction and cumulative dose of milk protein, respectively, was moderate. [ABSTRACT FROM AUTHOR]

The cover image is based on the Research Letter Diet diversity in pregnancy and early allergic manifestations in the offspring by Stina Bodén et al., https://doi.org/10.1111/cea.14346. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate clinically relevant improvement after conservative self-management of urinary incontinence via a mobile app. It further aimed to establish Minimum Important Differences (MIDs) based on the severity and type of urinary incontinence. Methods: Data was collected in a prospective cohort study that evaluated the freely available app Tät®. The app provided pelvic floor muscle training (PFMT) and life-style advice. Non-pregnant, non-postpartum women (≥ 18 years) who downloaded the app to treat urinary incontinence were included, if they completed the Patient Global Impression of Improvement (PGI-I) question at the 3-month follow-up (n = 1,733). Participants answered the International Consultation on Incontinence Questionnaire (ICIQ-UI SF) at baseline and after 3 months. The score change was analysed for correlation (Spearman) with the PGI-I. We then analysed one-way ANOVAs to determine whether there were significant differences between the groups based on the answers to the PGI-I. The MID was set to the mean change of the group that selected the answer "a little better" to the PGI-I question. Results: The one-way ANOVA showed significant differences between PGI-I groups (p < 0.001). The MID for the general group was set to 1.46 (95% Confidence Interval [CI] 1.26–1.67). In the sub-group analyses, a MID for the group with slight incontinence could not be determined. For the group with moderate severity the MID was determined to be 1.33 (95% CI 1.10–1.57) and for the severe/very severe group it was 3.58 (95% CI 3.08–4.09). Analysis of different types of incontinence showed no difference in MIDs. Conclusions: The MID for self-management via a mobile app was lower than previously established MIDs, but differed depending on baseline severity. This study shows that MIDs need adjustment for baseline severity and treatment intensity when interpreting clinical trial results. If using MIDs as exact numbers, the study population and the treatment must be comparable. [ABSTRACT FROM AUTHOR]

In a population-based case-control study, we investigated whether familial confounding influenced the associations between maternal overweight/obesity and risks of stillbirth and infant mortality by including both population and sister controls. Using nationwide data from the Swedish Medical Birth Register (1992-2011), we included all primiparous women with singleton births who also had a sister with a first birth during that time period. We used logistic regression analyses to calculate odds ratios (and 95% confidence intervals) adjusted for maternal age, height, smoking habits, education, and time period (5-year groups) of child's birth. Body mass index (BMI) was calculated as weight (kg)/height (m)². Compared with population controls with a normal BMI (18.5-24.9), stillbirth risk increased with increasing BMI (BMI 25-29.9: odds ratio (OR) = 1.51 (95% confidence interval (CI): 1.21, 1.89); BMI 30-34.9: OR = 1.77 (95% CI: 1.24, 2.50); BMI ≥35: OR= 3.16 (95% CI: 2.10, 4.76)). The sister case-control analyses revealed similar results. Offspring of obese women (BMI ≥30) had an increased risk of infant mortality when population controls were used (OR = 2.41, 95% CI: 1.83, 3.16), and an even higher risk was obtained when sister controls were used (OR = 4.04, 95% CI: 2.25, 7.25). We conclude that obesity in early pregnancy is associated with increased risks of stillbirth and infant mortality independently of genetic and early environmental risk factors shared within families. [ABSTRACT FROM AUTHOR]

Blood culture is a key method for diagnosing bloodstream infections. In this prospective study, we aimed to investigate whether blood cultures collected with the one-puncture method results in fewer contaminants, i.e. microorganisms from the skin or the environment, and the same detection of relevant pathogens compared to the two-puncture method. Further, we aimed to investigate if the time to blood culture positivity could be useful in evaluating contaminants. Patients planned for blood cultures were asked to participate in the study. From each recruited patient, six blood culture bottles were drawn, bottles 1–4 from the first venipuncture and bottles 5–6 from the second venipuncture. Within each patient, bottles 1–4 were compared to bottles 1, 2, 5, and 6 for contaminants and relevant pathogens. A sub-analysis was conducted on patients admitted to the ICU and those in the haematology department. We also assessed time-to-positivity for coagulase-negative staphylococci. In the final analysis, 337 episodes from 312 patients were included. Relevant pathogens were identified in 62/337 (18.4%) episodes in both methods. Contaminants were detected in 12 (3.6%) and 19 episodes (5.6%) using the one-puncture and two-puncture method (p =.039), respectively. Corresponding results were observed in the sub-analysis. Notably, relevant coagulase-negative staphylococci demonstrated a shorter time-to-positivity compared to contaminant coagulase-negative staphylococci. Blood cultures obtained using the one-puncture method resulted in significantly fewer contaminants and detected relevant pathogens equally to the two-puncture method. Time-to-positivity may be a useful additive indicator for predicting coagulase-negative staphylococci contamination in blood cultures. [ABSTRACT FROM AUTHOR]

Background: Gastroesophageal reflux is overrepresented in people with obstructive sleep apnea (OSA) and it has been suggested that OSA worsens gastroesophageal reflux symptoms. Aggravated reflux might lead to an increased risk of Barrett’s esophagus. Aim: To assess the association between sleep apnea symptoms and Barrett’s esophagus. Methods: Included in a case-control study in Brisbane, Australia were 237 patients with histologically confirmed Barrett’s esophagus and 247 population controls. The controls were randomly selected from the electoral roll and frequency-matched to the cases by age and sex. Information on OSA symptoms (excessive daytime sleepiness and sleep related apnea symptoms), gastroesophageal reflux symptoms and anthropometric measures were collected through interviews and written questionnaires. Multivariable logistic regression provided odds ratios (OR) and 95% confidence intervals (CI), adjusted for potential confounding by BMI and gastroesophageal reflux. Results: The prevalence of Barrett’s esophagus was higher among people with excessive daytime sleepiness than those without (24% vs. 18%; p-value 0.1142) and in participants with sleep-related apnea symptoms (20% vs. 13%; p-value 0.1730). However, there were non-significantly increased ORs of Barrett’s esophagus among people with excessive daytime sleepiness (OR 1.42, 95% CI 0.90–2.34) and sleep related apnea symptoms (OR 1.32, 95% CI 0.74–2.36) when adjusting for age, sex and BMI. After further adjustment for gastroesophageal reflux symptoms, the point ORs were no longer increased (OR 1.02, 95% CI 0.61–1.70 for daytime sleepiness and OR 0.72, 95% CI 0.38–1.38 for sleep related apnea symptoms). Conclusions: Symptoms of OSA are possibly associated with an increased risk of Barrett’s esophagus, an association that appears to be mediated entirely by gastroesophageal reflux. [ABSTRACT FROM AUTHOR]

The common comparison of depression to diabetes enables the construction of depression as a nonstigmatizing chronic illness that requires medication. We explore, through the use of discourse analysis, how both long-term users of antidepressants and family physicians invoked this analogy in research interviews. Specifically, we show how these participants explicitly or implicitly challenged the aptness of the depression–diabetes analogy as framed either within a generic (and presumably type 1) conception of diabetes or within the model of type 2 diabetes. These challenges include demonstrating how the elements or inferences of the analogy do not correspond, and how the analogy does not have its intended effects. We consider the implications of the unraveling of this analogy for the construction of depression as a chronic medical condition, for the supposed ease of prescribing and taking antidepressants, and for the reduction of stigma. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Tobacco smoking increases the risk of gastroesophageal reflux symptoms (GERS), but whether tobacco smoking cessation improves GERS is unclear. The aim of this study was to clarify if tobacco smoking cessation improves GERS.METHODS:The study was based on the Nord-Trøndelag health study (the HUNT study), a prospective population-based cohort study conducted from 1995-1997 to 2006-2009 in Nord-Trøndelag County, Norway. All residents of the county from 20 years of age were invited. The study included 29,610 individuals (61% response rate) who reported whether they had heartburn or acid regurgitation. The association between tobacco smoking cessation and improvement in GERS was assessed by logistic regression, providing odds ratios (ORs) with 95% confidence intervals (CIs). The analyses were stratified by antireflux medication, and the results were adjusted for sex, age, body mass index (BMI), alcohol consumption, education, and physical exercise. Subgroup analyses were also stratified by BMI.RESULTS:Among individuals using antireflux medication at least weekly, cessation of daily tobacco smoking was associated with improvement in GERS from severe to no or minor complaints (adjusted OR 1.78; 95% CI: 1.07-2.97), compared with persistent daily smoking. This association was present among individuals within the normal range of BMI (OR 5.67; 95% CI: 1.36-23.64), but not among overweight individuals. There was no association between tobacco smoking cessation and GERS status among individuals with minor GERS or individuals using antireflux medication less than weekly.CONCLUSIONS:Tobacco smoking cessation was associated with improvement in severe GERS only in individuals of normal BMI using antireflux medication at least weekly, but not in other individual with GERS. [ABSTRACT FROM AUTHOR]

Diversity policies and programs continue to be a prominent yet problematic feature of organizational life. This study explored tensions arising as 30 employees talk about their experience with Equal Employment Opportunity (EEO), Affirmative Action (AA), and diversity in a midwestern human service organization. Tensions related to fairness and fear emerged as interpretive themes prompting majority group members to avoid interacting about racial differences and minority group members to do the work of making difference meaningful. We argue that formal policies and diversity programs be re-imagined so as to ease interaction constraints between groups. [ABSTRACT FROM AUTHOR]

Depression is a condition that is routinely diagnosed; however, controversies about the diagnosis remain. Some argue that depression goes undiagnosed, while others argue that the diagnosis is applied too readily and broadly. The focus of this article is how those with a diagnosis of depression respond to such controversy. We interviewed 11 long-term users of antidepressants, queried them about their diagnosis and medication history, and presented them with arguments about the diagnosis of depression. Informed by the methodology of discursive psychology, we attended to the rhetorical strategies participants used to argue for and/or against the over- and under-diagnosis of depression. We show how they employed strategies such as invoking biomedical knowledge and implicating patients as responsible for health care to defend their own diagnostic status and to legitimize depression as a routinely diagnosed condition. This article adds the voice of long-term antidepressant users to the debate over the diagnosis of depression. [ABSTRACT FROM PUBLISHER]

Two experiments investigated the impact of affect on the working self-concept. Following an affect induction, participants completed the Twenty Statements Test (TST) to assess their working self-concepts. Participants in predominantly happy and angry states used more abstract statements to describe themselves than did participants in predominantly sad and fearful states. Evaluations of the statements that participants generated (Experiment 2) demonstrate that these effects are not the result of (1) participants describing positively and negatively valenced information at different levels of abstraction, or (2) valence-based affective priming. Further, half of the participants in Experiment 2 were led to attribute their affect to the manipulation prior to completing the TST. This manipulation eliminated the influence of affect on the working self-concept. Taken together, these results are consistent with theory and research on the informative functions of affect. [ABSTRACT FROM AUTHOR]

We conducted a qualitative study of male sex work in St. Petersburg Russia with a focus on social vulnerabilities, HIV-risk perception and HIV-related behaviours. In-depth interviews were conducted with individuals knowledgeable about male sex work through their profession and with male sex workers themselves. Male sex work involves a variety of exchanges, including expensive vacations, negotiated monetary amounts or simply access to food. Methods of finding clients included the Internet, social venues (e.g. gay clubs and bars) and public places (e.g. parks). Use of the Internet greatly facilitated male sex work in a variety of ways. It was used by both individuals and agencies to find clients, and appeared to be increasing. Men often reported not being professionally connected to other male sex workers and limited disclosure about their work. Many were aware of the work-related risks to personal safety, including violence and robbery by clients. Perceived risk for HIV was mostly abstract and several exceptions to condom use with clients were noted. Alcohol use was reported as moderate but alcohol was consumed frequently in association with work. These data suggest that the most salient risks for male sex workers include professional isolation, threats to personal safety, limited perceived HIV risk and sub-optimal levels of condom use. [ABSTRACT FROM AUTHOR]

OBJECTIVES:High body mass index (BMI) is an established risk factor of gastroesophageal reflux symptoms (GERS). The aim of this study was to clarify if weight loss reduces GERS.METHODS:The study was part of the Nord-Trøndelag health study (the HUNT study), a prospective population-based cohort study conducted in Nord-Trøndelag County, Norway. All residents of the county from 20 years of age were invited. In 1995-1997 (HUNT 2) and 2006-2009 (HUNT 3), 58,869 and 44,997 individuals, respectively, responded to a questionnaire on heartburn and acid regurgitation. Among these, 29,610 individuals (61% response rate) participated at both times and were included in the present study. The association between weight loss and reduction of GERS was calculated using logistic regression. The analyses were stratified by antireflux medication and the results adjusted for sex, age, cigarette smoking, alcohol consumption, education, and physical exercise.RESULTS:Weight loss was dose-dependently associated with a reduction of GERS and an increased treatment success with antireflux medication. Among individuals with >3.5 units decrease in BMI, the adjusted odds ratio (OR) of loss of any (minor or severe) GERS was 1.98 (95% confidence interval (CI) 1.45-2.72) when using no or less than weekly antireflux medication, and 3.95 (95% CI 2.03-7.65) when using at least weekly antireflux medication. The corresponding ORs of loss of severe GERS was 0.90 (95% CI 0.32-2.55) and 3.11 (95% CI 1.13-8.58).CONCLUSIONS:Weight loss was dose-dependently associated with both a reduction of GERS and an increased treatment success with antireflux medication in the general population. [ABSTRACT FROM AUTHOR]

This study examines the influence of personality on the spirituality of Oriental Orthodox priests, who account for approximately 1400 Christian leadership positions in America. The personality types of Orthodox priests are explored and evaluated in terms of their association with different aspects of spirituality as defined by the God Image Inventory, the Intrinsic/Extrinsic ‐ Revised (I/E ‐ R), and the Religious Coping Activities Scale. The 16‐Personality Factors is used to examine personality. Descriptive statistics reveal that no prototypical personality profile exists among Coptic Orthodox priests. Multiple regression analysis reveals that there are no significant relationships between personality and religious coping activities. However, the four personality constructs of anxiety, tough‐mindedness, independence, and self‐control do have a meaningful influence on one's God image and religious motivation. The study reveals five significant relationships between personality and spirituality. [ABSTRACT FROM PUBLISHER]

Malawi women are in the ironic juxtaposition of being socially disempowered while, at the same time, thought to hold the key to shaping an effective community response to the HIV crisis. Based on this juxtaposition, a descriptive, qualitative study was conducted in Malawi and the United States where 26 participants from nongovernmental organizations (NGOs) and community-based organizations (CBOs) discussed the roles of Malawi women. Interviews were audiotaped, transcribed, and analyzed. We identified an improvement in women's economic status as the strongest factor in reducing gender inequities. Through providing stipends for rural Malawi women, one NGO created unintended changes in gender roles. [ABSTRACT FROM AUTHOR]

Hurricane Katrina created an unprecedented mental health crisis in New Orleans. Once they could return to work, local mental health professionals attempted to treat survivors of the storm while dealing with the storm's impact on themselves. Those working in public settings were offered in-service training and supervision. But clinicians in private practice often found themselves bearing the brunt of posttraumatic uncertainty alone. The current paper includes four experiential reports from area clinicians describing their early struggles to maintain a sense of continuity in their ongoing clinical work, only to realize how much of the personal is also professional in the aftermath of a disaster of this magnitude, and how personal and professional inevitably inform one another when clinicians and patients survived similar dangers and losses. The introduction locates these four papers in the larger context of post-Katrina New Orleans and a program that was specifically tailored to meet the needs of local clinicians. This program demonstrated the ways in which psychoanalytic ideas can be used to give meaning to a traumatized mental health community's profound disorientation. [ABSTRACT FROM PUBLISHER]

Background: Dietary habits influence the risk of cancer of the oesophagus and oesophago-gastric junction, but the role of proportions of the main dietary macronutrients carbohydrates, fats and proteins is uncertain. Methods: Data was derived from a nationwide Swedish population-based case-control study conducted in 1995-1997, in which case ascertainment was rapid, and all cases were uniformly classified. Information on the subjects' history of dietary intake was collected in personal interviews. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, with adjustment for potentially confounding factors. Results: Included were 189 oesophageal adenocarcinomas, 262 oesophago-gastric adenocarcinomas, 167 oesophageal squamous cell carcinomas, and 820 control subjects. Regarding oesophageal or oesophago-gastric junctional adenocarcinoma, a high dietary proportion of carbohydrates decreased the risk (OR 0.50, CI 0.34-0.73), and a high portion of fat increased the risk (OR 1.96, CI 1.34-2.87), while a high proportion of protein did not influence the risk (OR 1. 08, 95% CI 0.75-1.56). Regarding oesophageal squamous cell carcinoma, the single macronutrients did not influence the risk statistically significantly. Conclusions: A diet with a low proportion of carbohydrates and a high proportion of fat might increase the risk of oesophageal adenocarcinoma. [ABSTRACT FROM AUTHOR]

Objective Changes in the occurrence of gastrooesophageal reflux symptoms (GORS) in the population remain uncertain. This study aimed to determine the prevalence changes, the incidence and the spontaneous loss of GORS. Design This population-based cohort study was conducted within the Nord-Trøndelag Health Study (the HUNT study), a longitudinal series of population-based health surveys in Nord-Trøndelag County, Norway. The study base encompassed all adult residents in the county, and the participants reported the degree of GORS during the previous 12 months. The number of participants included were 58 869 (64% response rate) in 1995e7 and 44 997 (49%) in 2006e9. Of these, 29 610 persons (61%) were prospectively followed up for an average of 11 years. Results Between 1995e7 and 2006e9, the prevalence of any, severe and at least weekly GORS increased by 30% (from 31.4% to 40.9%), 24% (from 5.4% to 6.7%) and 47% (from 11.6% to 17.1%), respectively. The average annual incidence of any and severe GORS was 3.07% and 0.23%, respectively. In women, but not men, the incidence of GORS increased with increasing age. The average annual spontaneous loss (not due to antireflux medication) of any and severe GORS was 2.32% and 1.22%, respectively. The spontaneous loss of GORS decreased with increasing age. Conclusion Between 1995e7 and 2006e9 the prevalence of GORS increased substantially. At least weekly GORS increased by 47%. The average annual incidence of severe GORS was 0.23%, and the corresponding spontaneous loss was 1.22%. The incidence and spontaneous loss of GORS were influenced by sex and age. INSET: Significance of this study. [ABSTRACT FROM AUTHOR]

Background & Aims: Previous studies indicate an association between sleep problems and gastroesophageal reflux disease (GERD). Although both these conditions separately have moderate heritabilities, confounding by genetic factors has not previously been taken into account. This study aimed to reveal the association between sleep problems and GERD, while adjusting for heredity and other potential confounding factors. Methods: This cross-sectional population-based study included all 8,014 same-sexed twins of at least 65 years of age and born in Sweden between 1886 and 1958, who participated in telephone interviews in 1998-2002. Three logistic regression models were used 1) external control analysis, 2) within-pair co-twin analysis with dizygotic (DZ) twin pairs discordant for GERD, and 3) within-pair co-twin analysis with monozygotic (MZ) twin pairs discordant for GERD. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and adjusted for established risk factors for GERD, i.e. sex, age, body mass index (BMI), tobacco smoking, and educational level. Results: A dose-response association was identified between increasing levels of sleep problems and GERD in the external control analysis. Individuals who often experienced sleep problems had a two-fold increased occurrence of GERD compared to those who seldom had sleep problems (OR 2.0, 95% CI 1.8-2.4). The corresponding association was of similar strength in the co-twin analysis including 356 DZ pairs (OR 2.2, 95% CI 1.6-3.4), and in the co-twin analysis including 210 MZ pairs (OR 1.5, 95% CI 0.9-2.7). Conclusion: A dose-dependent association between sleep problems and GERD remains after taking heredity and other known risk factors for GERD into account. [ABSTRACT FROM AUTHOR]

The monitoring-blunting theory of coping suggests that when faced with a threatening situation, individuals can respond by either monitoring or avoiding (blunting) threatening information. The current study sought to validate a scale of children's preferences for monitoring or blunting in dental situations (the Monitoring Blunting Dental Scale or MBDS). The psychometric characteristics of the scale were assessed in a sample of 240 New Zealand children aged 11–13. Reliability was adequate for both monitoring (α = 0.74) and blunting (α = 0.76) subscale scores. Convergent validity was indicated by strong correlations (>0.6) between the measure's subscales and those of a related scale, although discriminant validity with respect to dental anxiety was problematic for the blunting subscale. Exploratory factor analysis supported a two-factor monitoring-blunting model, although confirmatory factor analysis indicated reasonable but imperfect fit for this model, SBχ2(251) = 510.7, p < 0.001, RMSEA = 0.066. We reflect on conceptual issues which may underlie the difficulties experienced here and elsewhere in developing psychometrically sound measures of Miller's blunting construct and suggest that the monitoring subscale of the study scale may be most useful to other researchers. [ABSTRACT FROM PUBLISHER]

In Russia, sexual transmission of HIV is increasing and street-based female sex workers (FSW) have a high HIV prevalence, but the role of male clients of FSW in HIV transmission and bridging to the general population has not been studied. Sixty-two male clients completed structured interviews during February–March of 2010 in St. Petersburg Russia. Descriptive analyses focused on condom use with different types of sex partners, substance use, and STI/HIV testing histories. The median lifetime and past 12 month numbers of FSW partners were 10 and 3, respectively. A majority of clients (74%) reported having non-FSW partners during the past 12 months, and nearly half (47%) reported having regular sex partners. Consistent condom use was reported in 61% of relationships with FSW partners and in 43% of relationships with non-FSW partners. A majority of clients (58%) was classified as active or potential bridgers based on having both FSW and non-FSW partners and reporting inconsistent condom use with their non-FSW partners. A majority (61%) also reported concurrent partnerships with FSW and non-FSW partners. Nearly half (48%) of last contacts with FSW partners involved consumption of alcohol by the client. Noninjection and injection drug use in the past 30 days were reported by 15% and 7% of clients, respectively. Twenty-nine percent reported history of a sexually transmitted infection (STI) and 74% reported a previous HIV test; active/potential bridgers were significantly less likely than unlikely bridgers to have ever been tested for HIV. These data signal the potential for HIV/STI transmission among male clients of street-based FSW in St. Petersburg Russia due to their variety of partner types, sub-optimal condom use, and concurrent partnerships. Larger studies are needed to confirm these findings, further explore the roles of alcohol and drug use, and identify effective strategies and interventions for HIV prevention. [ABSTRACT FROM PUBLISHER]

Background:Gastrectomy has been indicated as a risk factor for laryngeal cancer, and possibly also for pharyngeal cancer, but few studies are available. The postulated mechanism is increased bile reflux following gastrectomy.Methods:This was a population-based cohort study of patients who underwent gastrectomy for peptic ulcer disease between 1964 and 2008 in Sweden. Follow-up data for cancer was obtained from the Swedish Cancer Register. Relative risk was calculated as standardised incidence ratios (SIRs) with 95% confidence intervals (CIs).Results:The gastrectomy cohort comprises 19 767 patients, contributing 348 231 person-years at risk. The observed number of patients with laryngeal (n=56) and pharyngeal cancer (n=28) was two-fold higher than the expected (SIR: 2.0, 95% CI: 1.5-2.6 and SIR: 2.4, 95% CI: 1.6-3.5, respectively). After exclusion of 5536 cohort members with tobacco- or alcohol-related disease, the point SIRs remained increased (SIR: 1.6, 95% CI: 1.1-2.2 and SIR: 1.7, 95% CI: 0.9-2.8, respectively). The SIRs of laryngeal and pharyngeal cancer increased with time after gastrectomy (P for trend <0.0001), and were particularly increased 30 years after gastrectomy (SIR: 4.8, 95% CI: 2.1-9.5 and SIR: 10.2, 95% CI: 3.7-22.3, respectively).Conclusion:Gastrectomy for peptic ulcer disease might entail a long-term increased risk of laryngeal and pharyngeal cancer. [ABSTRACT FROM AUTHOR]

Abstract: Background: The influence of bile reflux in the development of oesophageal adenocarcinoma remains controversial. This was tested in a cohort of patients who had undergone gastrectomy, a procedure often entailed by substantial bile reflux. Methods: A population-based cohort study of patients who had undergone gastrectomy for peptic ulcer disease in 1964–2008 in Sweden. Follow-up for cancer and censoring for death were achieved through linkages to nationwide registries of Cancer and Population, respectively. The number of observed cancer cases in the gastrectomy cohort was divided by the expected number, calculated from the incidence of the entire Swedish population of corresponding age, sex and calendar year. Relative risks were thus presented as standardised incidence ratios with 95% confidence intervals. Results: After exclusion of all person-years the first year after surgery, the final gastrectomy cohort comprised of 19,767 patients. These patients were followed up for a median of 17years, and contributed with a total of 348,231 person-years at risk. The observed number of patients with oesophageal adenocarcinoma (n =7) was not higher than the expected (n =11.6), providing a standardised incidence ratio of 0.6 (95%CI 0.2–1.2). There were no clear differences between sexes, age groups or latency intervals after gastrectomy. Conclusions: Gastrectomy for peptic ulcer disease does not appear to increase the risk of oesophageal adenocarcinoma. [Copyright &y& Elsevier]

This study explores the relationship between church-based informal social support and lifetime prevalence of suicide ideation and attempts within a representative national sample of African American and Black Caribbean adults. Characteristics of church-based social support networks, as well as emotional support and negative interaction with church members were examined in relation to lifetime suicide ideation and attempts. This study used data from the National Survey of American Life (2001–2003). Frequency of interaction with church members was positively associated with suicide attempts, while subjective closeness to church members was negatively associated with suicide ideation. Emotional support, service attendance, and negative interaction with church members were unrelated to both suicide ideation and attempts. Findings are discussed in relation to research on church-based support networks, different models linking church support and suicidality, and the mechanisms by which church-based networks deter suicide ideation and attempts. [ABSTRACT FROM PUBLISHER]

This article will present findings related to critical needs in a group of 281 incarcerated women with co-occurring disorders. The women completed interviews while incarcerated and again at various time points after community reentry. Findings revealed that the number of basic needs increased over time, and a low level of social support was related to negative outcomes. Recommendations for this population include holistic evaluation assessments and integrated treatment plans that encourage staff to comprehensively assess clients at intake and link them to support services during and after incarceration. Implications of this female empowerment model will be discussed. [ABSTRACT FROM AUTHOR]

During the past half-century, an increasing number of American academic institutions established archives, and numerous academic archives owe their existence to efforts by dedicated historians to preserve and document their heritage. Although public interest in safeguarding heritage materials continues to grow, recent economic challenges confront twenty-first century academic archivists. The story of the origins of the Colorado State University Archives illustrates the influence of historians on the preservation of archival records and offers examples of archival outreach activities that support the institution's mission while building the repository. [ABSTRACT FROM AUTHOR]

Events have been part of every society and culture throughout history. Although general demographic information about event planners, such as age, gender, and education, has been collected, either as part of a larger study or as the focus of the research, this is still an area that is lacking. This exploratory study focuses on collecting standard demographic information, such as age and gender, and then delves deeper to examine event managers' education and years of experience. The data collected in this study can assist in developing and marketing educational offerings to event professionals. [ABSTRACT FROM AUTHOR]

Alder (Alnus: Betulaceae) pollen grains are common in coal beds of the Miocene Beluga and the Pliocene Sterling formations exposed in the Kenai lowland, Alaska. All alder pollen grains of the Beluga Formation and the lower part of the overlying Sterling Formation are dominated by 4-pored grains (42-67% of total alder), with no exceptions. There is a striking transition to a 5-pored dominance (32-67%) with an accompanying increase in 6-, 7-, and even 8-pored grains in outcrops of the Sterling Formation along the Cook Inlet shore, north of Clam Gulch and at the head of Kachemak Bay, in upper Swift Creek Canyon, and in two canyon tributaries to Fox Creek. The general zone of this transition includes a previously correlated volcanic ash and gives credence to the rock strata being synchronous in these widely separated outcrops. It should thus be possible to correlate these strata across the Kenai lowland by the alder pore numbers combined with the volcanic ash. The cause of the transition to a ≥ 5-pored Alnus dominance in the Pliocene of the Kenai lowland can only be suggested. Using pore numbers to determine alder species is not an accurate method because pollen of different alder species may have similar percentages of pore numbers. Nevertheless, when taking into account percentages of 5-, 6-, and 7-pored grains combined with the presence or absence of polar arci, it can be suggested that a shift occurred from the 4-pore dominated subgenus Alnus, represented by Alnus incana, to the 5-pore dominated, cold-adapted subgenus Alnobetula through dispersion and hybridization of Asian species such as Alnus maximowiczii, Alnus firma, and possibly Alnus sieboldiana. The pollen of these three species contain between 2-40% circular polar arci, which are also present in high-pore-numbered grains above the transition in this study. [ABSTRACT FROM AUTHOR]

Rationale: Prolonged exposure (PE) therapy has been found to reduce symptoms of posttraumatic stress disorder (PTSD); however, it is difficult for many patients to engage fully in the obligatory retelling of their traumatic experiences. This problem is compounded by the fact that habituation and cognitive restructuring -- the main mechanisms through which PE is hypothesized to work -- are not instantaneous processes, and often require several weeks before the distress associated with imaginal exposure abates. Case reports: Two cases are described that respectively illustrate the use of hydrocortisone and placebo, in combination with PE, for the treatment of combat-related PTSD. Based on known effects of glucocorticoids on learning and memory performance, we hypothesized that augmentation with hydrocortisone would improve the therapeutic effects of PE by hastening "new" learning and facilitating decreases in the emotional impact of fear memories during the course of treatment. The veteran receiving hydrocortisone augmentation of PE displayed an accelerated and ultimately greater decline in PTSD symptoms than the veteran receiving placebo. Conclusions: While no general conclusion can be derived from comparison of two patients, the findings are consistent with the rationale for augmentation. These case reports support the potential for an appropriately designed and powered clinical trial to examine the efficacy of glucocorticoids in augmenting the effects of psychotherapy for PTSD. [ABSTRACT FROM AUTHOR]

Following a positively quantified statement such as, 'A few of the children sang the chorus,' a plural pronoun is likely to refer to the set of children who sang (the reference set). Negative natural language quantifiers (NLQs) such as few or not many, on the other hand, are more likely to be followed by reference to the complement set of children who did not sing. According to the presupposition-denial account of negative NLQs, the complement set is available for pronominal reference following these expressions because they imply a shortfall between the amount denoted and a presupposed larger amount. Focus on the shortfall set is effectively focus on the complement set. Previous support for this account is largely based on a series of experiments which show that complement set focus is also possible following positive NLQs if a previously mentioned character expects a larger amount, thereby creating a shortfall between the character's expectations and the amount denoted by the NLQ. It is not clear, however, whether the shortfall implied by a negative NLQ must be based on expectation per se, or whether the NLQ-based implication is more general. This article reports 3 experiments which show that a shortfall can also be created between an NLQ and a character's desire for a particular quantity. Results suggest that the implication of negative NLQs that a larger amount is denied need not be based on expectation, but may be less specific. [ABSTRACT FROM AUTHOR]

In this article, the author discusses aspects of global and local processing styles which have been associated with the difference in the perception, mood and face recognition among persons. The author is critical of mood switching, which includes perception, judgments, and behavior, that affects the happy mood on global processing. Furthermore, the GLOMOsys, which is an overwhelming account on the occurrence of local and global processing, is discussed.

There has been a long history of Chinese learning and teaching (CLT) in the UK, but until recently CLT was predominantly confined to community schools for Chinese children at weekends and a small number of other schools and universities. Therefore, it had remained peripheral for a long time in terms of student numbers and its position in the education system. This situation has changed dramatically over the last 10 years, as CLT has experienced an unprecedented and rapid development during the period. Today almost all British universities offer some kind of Chinese courses. More and more secondary schools have started, or plan to start, Chinese courses as part of their curriculum ever since Chinese was officially recognised by the government as belonging to modern foreign languages (MFLs). Chinese language and culture activities are getting into more primary schools than ever before. In addition, Chinese language courses have also become commonly available in both public and private institutions for adult and professional learners. This situation presents opportunities as well as challenges. This article aims first to describe briefly the current provision of CLT in the UK, its background and characteristics, and then to give some preliminary analyses of the issues and a prediction of possible trends concerning the development of CLT in the UK in the next few years. [ABSTRACT FROM AUTHOR]

This study examined differences in religious participation and spirituality among African Americans, Caribbean blacks (black Caribbeans) and non-Hispanic whites. Data are taken from the National Survey of American Life, a nationally representative study of African Americans, black Caribbeans and non-Hispanic whites. Selected measures of organizational, non-organizational and subjective religious participation were examined. African American and Caribbean blacks were largely similar in their reports of religious involvement; both groups generally indicated higher levels of religious participation than non-Hispanic whites. African Americans were more likely than black Caribbeans to be official members of their places of worship, engage in activities (choirs, church clubs) at their place of worship and request prayer from others. Black Caribbeans reported reading religious materials more frequently than African Americans. The discussion notes the importance of examining ethnic differences within the black American population of the United States. [ABSTRACT FROM AUTHOR]

This article analyses the permeable boundaries between slavery and freedom which developed in the context of illicit inter-imperial trade in the seventeenth and eighteenth-century Caribbean, focusing on ties between the Dutch island of Curacao and the neighbouring northern coast of Spanish South America. As smuggling opened opportunities for enslaved people to cross political borders, it spurred authorities to develop flexible legal frameworks to meet the challenge of conducting free trade in colonial slave societies. The evidence indicates that, even in the eighteenth-century Caribbean, slavery sometimes existed along a legal continuum, rather than as an immutable, absolute category. [ABSTRACT FROM AUTHOR]

This paper provides an overview of the arguments for the central role of families, defined very broadly, and we emphasise the importance of efforts to strengthen families to support children affected by HIV and AIDS. We draw on work conducted in the Joint Learning Initiative on Children and AIDS's Learning Group 1: Strengthening Families, as well as published data and empirical literature to provide the rationale for family strengthening. We close with the following recommendations for strengthening families to ameliorate the effects of HIV and AIDS on children. Firstly, a developmental approach to poverty is an essential feature of responses to protect children affected by HIV and AIDS, necessary to safeguard their human capital. For this reason, access to essential services, such as health and education, as well as basic income security, must be at the heart of national strategic approaches. Secondly, we need to ensure that support garnered for children is directed to families. Unless we adopt a family oriented approach, we will not be in a position to interrupt the cycle of infection, provide treatment to all who need it and enable affected individuals to be cared for by those who love and feel responsible for them. Thirdly, income transfers, in a variety of forms, are desperately needed and positively indicated by available research. Basic economic security will relieve the worst distress experienced by families and enable them to continue to invest in the health care and education of their children. Lastly, interventions are needed to support distressed families and prevent knock-on negative outcomes through programmes such as home visiting, and protection and enhancement of children's potential through early child development efforts. [ABSTRACT FROM AUTHOR]

The current article seeks to critically examine Maryland's policy of mandatory abuse reporting as it applies to adult female survivors of sexual abuse in therapy. An overview of mandatory reporting legislation in the United States and Maryland is presented. The article addresses the significance of mandatory reporting as a general problem for therapists and their clients, with a focus on the aforementioned population. More specifically, the article seeks to answer the following question: What are the intended and unintended consequences of the policy for individuals and families? Finally, solutions to address the unintended consequences of the policy are offered, as are suggestions for further research to inform the debate. [ABSTRACT FROM AUTHOR]

The authors review the types of experiential peace education programs available to teens in the US and provide a classification guide for educators, parents, other concerned adults and teens who may be interested in developing conflict, peace and/or violence prevention knowledge, skills and attitudes. The authors identify experiential programs in the US and the tools that are effectively achieving peace education, violence prevention and conflict resolution objectives. They conclude by offering an explanation of the orientation, mission and activities in each type of program and explain the contributions each program makes towards the goal of experiential peace education. [ABSTRACT FROM AUTHOR]

In the HIV and AIDS sphere, children remain on the margins with respect to advocacy, prevention, treatment and care. Moreover, concern is generally limited to specific categories of children, most especially children living with HIV, orphaned children and child-headed households. Excluded from view are the very large numbers of children affected by generalized HIV/AIDS epidemics, now in advanced stages, in already impoverished countries in southern Africa. In this paper, we use information from comparable national household surveys in South Africa, in five waves between 1995 and 2005, to examine the impact of HIV and AIDS on children and on the structure of the households in which they find themselves. The question posed is whether it is appropriate to target orphans and child-headed households in this context. The data indicate that orphaning, particularly loss of a mother, tripled during this period, as is to be expected from rising adult mortality. Though they remain a small proportion, child-only households also rose markedly during this time. However, difficult as their situation is, neither orphans nor child-only households appear to be the worst-off children, at least from the point of view of reported sources of financial support and per capita monthly expenditure. Households headed by single adults and young adults are economically vulnerable groups not yet included in efforts to support affected children and families. Poverty is a pitiless backdrop to the AIDS epidemic and needs to be at the heart of strategies to address the needs of all vulnerable children in hard-hit communities. [ABSTRACT FROM AUTHOR]

OCLC (Online Computer Library Center) involvement with the Dublin Core Metadata Element Set dates to 1995, when it hosted a meeting of parties interested in metadata schema for use in the World Wide Web environment. The Dublin Core Metadata Element Set grew from the conversations at that meeting. Since that time, OCLC has developed within its cataloging interfaces functionalities to allow OCLC libraries to implement Dublin Core elements. This article provides a brief overview of OCLC's efforts in this area. [ABSTRACT FROM AUTHOR]

In this paper we examine flexible ethnic identity formation as a mechanism of accommodation and resistance deployed by a particular social group with origins in the periphery as they respond to changing political and economic forces in the world-system. This paper addresses criticisms that world-system analyses are 'too macro' or 'structurally deterministic' by examining on the ground action and responses by a local oppositional movement within its broad political and economic context. Its focus is an historical case study of a particular group of people whose origins lie in European colonial expansion into the Caribbean in the seventeenth century. The paper begins by recounting ethnographic reports of Garifuna origin myths, then sketches this group's forced incorporation in a colonial world-system (and their responses), discusses their assignment to 'minority group' status within newly independent Belize at about the same time they are establishing transnational communities via migration to the United States, and concludes with some thoughts on the emerging 'virtual communities' of Garifuna and indigenous peoples around the world that are emerging on the worldwide web today. We explore what the notion of ethnic identity means in this particular case, and how and why it changes over time. We also try to understand if this flexible identity, and the social movements that arise as it is redefined, can be understood as a form of 'resistance'. Finally, we ask if diasporic identity movements of indigenous people, like the Garifuna, actually or potentially can contribute to rising challenges against the forces of contemporary 'globalization'. [ABSTRACT FROM AUTHOR]

The review summarizes recent developments in the preparation and use of new initiators for the ring opening polymerization of lactide. The review compares different classes of initiator including metal complexes, classed according to their group in the periodic table, and carbon-based initiators/organocatalysts. Emphasis is placed on the polymerization kinetics and the control exhibited by the different types of initiators. Where useful properties, such as high rates or stereocontrol, have been observed a more detailed examination of the initiator is provided. A further focus of the review is initiators displaying low toxicity and biocompatibility. [ABSTRACT FROM AUTHOR]

The Records of the Colorado Flower Growers Association (CFGA) is an archival collection documenting the association prior to its 1979 name change. The CFGA was founded in 1928 to support the production and marketing of greenhouse flowers grown commercially in the state. In 1979, the organization changed its name to the Colorado Greenhouse Growers Association to reflect the increasing diversification of the industry. The collection consists of documents dated 1928 to 1980 (with the bulk falling between 1958 and 1972), and includes minutes from general, board, and committee meetings; correspondence; newsletters; financial reports; scrapbooks; clippings; and photographic materials. This article provides a history of Colorado carnations, information on the collection, and describes a digital project supported by a cooperative agreement between the Agriculture Network Information Center (AgNIC) and the Colorado State University (CSU) Libraries to make a selection of the scrapbooks, clippings, newsletters, and photographic materials available online to researchers through the AgNIC Web site. In addition to providing access to more than 500 digital images, project staff developed important metadata to facilitate their discovery, retrieval, and management using the Standard NAL Metadata and the Collaborative Digitization Project (CDP)'s Dublin Core Metadata Best Practices. [ABSTRACT FROM AUTHOR]

The incidence of esophageal adenocarcinoma (EA) and its precursor condition, Barrett's esophagus, has risen rapidly in the United States for reasons that are not fully understood. Therefore, we evaluated the association between use of supplemental vitamins and minerals and risk of neoplastic progression of Barrett's esophagus and EA. The Seattle Barrett's Esophagus Program is a prospective study based on 339 men and women with histologically confirmed Barrett's esophagus. Participants underwent baseline and periodic follow-up exams, which included endoscopy and self-administered questionnaires on diet, supplement use, and lifestyle characteristics. Use of multivitamins and 4 individual supplements was calculated using time-weighted averages of reported use over the observational period. Cox proportional-hazards models were used to calculate hazard ratios (HR) for each endpoint: EA, tetraploidy, and aneuploidy. During a mean follow-up of 5 yr, there were 37 cases of EA, 42 cases of tetraploidy, and 34 cases of aneuploidy. After controlling for multiple covariates including diet, nonsteroidal anti-inflammatory drug use, obesity, and smoking, participants who took 1 or more multivitamin pills/day had a significantly decreased risk of tetraploidy [HR = 0.19; 95% confidence interval (CI) = 0.08-0.47) and EA (HR = 0.38; 95% CI = 0.15-0.99] compared to those not taking multivitamins. Significant inverse associations were also observed between risk of EA and supplemental vitamin C (≥ 250 mg vs. none: HR = 0.25; 95% CI = 0.11-0.58) and vitamin E (≥ 180 mg vs. none: HR = 0.25; 95% CI = 0.10-0.60). In this cohort study, use of multivitamins and single antioxidant supplements was associated with a significantly reduced risk of EA and markers of neoplastic progression among individuals with Barrett's esophagus. [ABSTRACT FROM AUTHOR]

All young children need to interact with their environments to achieve maximum development and learning. Technology has great potential for supporting the learning needs of all young children in early childhood programs supported by the Reggio Emilia philosophy. This article discusses possible uses of technologies that are appropriate for young children, including assistive technology devices (from low to high tech) for children with special needs. Additional uses of technology for educators and family members are included, such as for documentation, assessment, communication, and training. [ABSTRACT FROM AUTHOR]

Two studies investigate manipulating implicit theories as a function of participants' self-theories. Women were primed with a malleable or fixed view of math intelligence before completing a math test. Study 1 utilized highly skilled participants and revealed that entity theorists experienced less anxiety when exposed to a malleable prime versus a fixed prime; however, entity theorists in the fixed condition performed better on the math test than incremental theorists. Incremental theorists were unaffected by the malleable prime. Study 2 utilized moderately skilled participants and found that incremental theorists attempted more math questions when exposed to a malleable prime versus a fixed prime, whereas entity theorists were unaffected by the primes. The relationship between self-theories and different ability levels is discussed. [ABSTRACT FROM AUTHOR]

The article comments on Carlos Saura's "El Sur" which is based on selected short stories by Jorge Luis Borges. There is a marked differentiation between the original literary work and the cinematic adaptation of Carlos Saura. A self proclaimed auteur, Saura intended to cast his own impression in the adaptation highlighting Borges' style.

Discusses studies on the underlying root conditions and causes of genocide and mass violence. Integration and augmentation of the theoretical models and the research related to genocide and mass violence to create a risk analysis model aimed at the prevention of genocide; Risk for fomentation of enmity within a group and directed against those defined as other; Factors underlying mass violence and genocide, including group cultural history, situational factors, social psychological factors and context, and interpersonal factors; Variations of the risk analysis model that can be applied to mass violence in many forms and contexts; Fundamental features of the model, such as risk factors associated with group cultural history, the role of authoritarian leaders, and the manipulation of social psychological factors to propel a group down the path of mass violence remain the same.