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A multifunction cognitive orthotic system is designed to assist people with cognitive disorders in the performance of ecologically relevant activities. This personal computer-based compensatory approach applies neuroscience and technology to the rehabilitation needs and challenges of people with chronic brain damage. The primary goal of this approach is the independent accomplishment of practical, applied tasks integral to daily living, at home, at work, at school and in the community. This paper will describe the 'Essential Steps' cognitive orthotic system, and describe its potential to facilitate skill acquisition and enhance self-sufficient life management. The software was designed to guide and protect the user as he or she progresses through each 'essential step' in the progression required for completion of a targeted task. The discussion will explicate the underlying principles promoting skill acquisition with this application of a cognitive orthotic. Data have shown that this compensatory aid can promote rapid skill acquisition and support reliable performance, even long past the time when rapid recovery and progress are customarily expected. Discussion will focus on issues of design for people with brain damage, the significance of this system's prototypical structure, and research findings and clinical observations made with people using 'Essential Steps'. [ABSTRACT FROM AUTHOR]

This study measured the attitudes of students before and after volunteering in a two-day camp for persons with disabilities. The Attitudes Toward Disabled Persons scale (ATDP) Form A was used to measure the attitudes of 54 university students in various health care majors. Twenty-five experimental group participants were volunteers at the camp. The students completed the scale three times: before, immediately following, and six weeks after the camp. The control group consisted of twenty-nine students and were administered the ATDP scale initially, then at one week and six weeks later during a scheduled health professions class. Results showed no significant difference in ATDP scores between groups and suggest that the camp alone was not a strong enough factor to produce a difference in attitudes. Further analysis did suggest that the camp may promote positive attitude changes for students with less positive attitudes initially, while not further changing the attitudes of students which were already positive. This study adds to the body of knowledge exploring different methods to change attitudes towards persons with disabilities and suggests that a camp could serve as a observation experience for students in occupational therapy curricula as a way to provide contact with persons with disabilities. [ABSTRACT FROM AUTHOR]

We tested Pekin ducks with playbacks of 5 different vocalizations plus a no noise and white noise stimulus as our controls (N = 15 ducks/sex/treatment). The "AM long" call is a common vocalization made by both sexes. "Honk" is also produced by both sexes and is thought to be an alarm or distress call. "Pips" and "harmonics" are common vocalizations made only by hens. The "egg laying squiggle" is also only made by hens. Trials consisted of an initial recording in a quiet condition with 5 consecutive measurements of heart rate, blood pressure and respiratory rate. A specific vocalization was then played on repeat while 8 more measurements of blood pressure, heart rate and respiratory rate were taken. Finally, 5 measurements of heart rate and blood pressure were taken post playback along with a final recording of respiratory rate. Data from all blood pressure measurements (systolic, diastolic and mean arterial pressure [MAP]), heart rate (HR) and respiratory rate (RR) were subject to a principal component analysis (Proc Princomp in SAS 9.4). The significant principal components (Prin 1 loaded strongly on blood pressure and Prin 2 loaded strongly on HR and RR) were then analyzed by ANOVA with repeated measures (Proc Mixed, SAS 9.4, subject=duck ID). Our results showed there was a significant main effect of playback type on the blood pressure of ducks during the playbacks (P = 0.0276). Ducks experienced an increase in blood pressure when played back the honk vocalization, as well as the white noise control. Additionally, there was a significant interaction between sex and treatment on the after-stimulus blood pressure (P = 0.0008): after the harmonic vocalization was played, the drakes still experienced an increase in blood pressure, but the hens experienced a decrease. The drakes, but not the hens, experienced a decrease in blood pressure after the AM long vocalization was played. Our data show that there are sex differences when it comes to vocalization playbacks in Pekin ducks, but overall, the honk vocalization and white noise control significantly increased ducks' blood pressure. This study represents a critical steppingstone toward understanding how Pekin duck vocalizations affect conspecific physiology., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Despite the many benefits of smartphones, researchers have raised concerns over problematic smartphone use (PSU) and its negative effects on physical and psychological well-being. Studies examining PSU and its impact among adults remain limited. Hence, we aim to examine the prevalence of PSU among adults in Singapore, and explore its associations with smartphone activities, sleep quality, and psychological well-being, as well as age and gender-related differences in these associations., Methods: A household survey (n = 1200) was conducted among multi-ethnic Singapore adults aged 21 to 60. The survey employed a proportionate stratified random sampling approach. The Smartphone Addiction Scale-Short Version was used to determine risk of PSU. Adjusted multivariable logistic regressions, age-stratified (21-30, and above 30) analyses and sensitivity analyses were performed., Results: The survey response rate was 45.7%. PSU prevalence rate was estimated to be 34.0%. Adults at risk were younger (OR = 3.72, p < 0.001), had poor sleep quality (OR = 2.94), reported depressive (OR = 2.84, p = 0.001) or anxiety symptoms (OR = 2.44, p < 0.001), tend to use smartphones for social media (OR = 2.81, p = 0.002) or entertainment (OR = 2.72, p < 0.001). Protective factors include higher levels of social support (OR = 0.76, p = 0.007), using smartphones for calling family (OR = 0.39, p = 0.003) and friends (OR = 0.53, p = 0.030), and spending four hours or less of smartphone usage duration (OR = 0.40, p < 0.001). Sensitivity analyses confirmed these findings. Associations between PSU and poor sleep quality (OR = 3.72, p < 0.001), depressive (OR = 3.83, p < 0.001), and anxiety symptoms (OR = 2.59, p = 0.004) and social media usage (OR = 3.46, p < 0.001) were more pronounced in adults over 30. PSU was more prevalent among females in those aged 21-30 (OR = 2.60, p = 0.022). Social support appears to be a protective factor for adults over 30 (OR = 0.64, p < 0.001) but was not observed in those aged 21-30. Among males, younger age (21-30 years), poor sleep quality, depressive symptoms, and anxiety symptoms, and using social media and entertainment apps were significantly associated with PSU. Females showed similar associations. Social support appears to be a protective factor for females (OR = 0.70, p = 0.018), but this association was not observed for males. Shorter smartphone usage times were inversely associated with PSU in both genders., Conclusion: A substantial proportion of adults exhibited PSU. Findings highlight the differential associations between PSU and psychological well-being, social support, interactions with technology, and sleep quality. These associations are influenced by age which has implications for preventive efforts., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Lighting is a critical environmental factor that influences production performance and welfare of poultry, however Pekin ducks can typically be housed under 24 h (24 h) of light. 460 hatchlings were randomly allocated to 4 rooms with two pens in each room. The rooms were allocated to 24 h light or PS. PS was achieved by gradually increasing photoperiod by half an hour per week from days 112 to 238 and held at 18 h light for the rest of life. Prior to the onset of lay, pens were organized with 30 hens and 7 drakes/pen (4 pens/treatment). We measured bodyweight at weeks 0, 1, 2, 5, 10, 19, and 29, feed intake at weeks 1 to 7 and feed conversion ratio (FCR) was calculated for weeks 1, 2, and 5. Eggs laid were recorded daily from weeks 20 to 31. Novel object test (NOT) was done at weeks 1, 5, 10, 19, and 29, transect welfare scoring at week 30, egg quality assessment at weeks 28 and 29, and fertility was determined at weeks 28 and 29. Statistical analyses were done using 2-way ANOVA, T-test, or Friedman Test with a Tukey-Kramer test as post-hoc. A p ≤ 0.05 was considered significant. Drakes bodyweight was higher in the PS compared to 24h treatment at weeks 5 (p < 0.01) and 10 (p < 0.001). No difference was observed in FCR, fertility, or transect data. NOT showed lower fear response (p < 0.05) at weeks 5 and 10 in the PS compared to 24 h treatment. The 24 h treatment increased the percent eggs laid at weeks 23 (p < 0.05), 24 (p < 0.01) and 25 (p < 0.05) compared to the PS. However, there was a higher egg weight (p < 0.001), yolk weight (p < 0.05), Haugh unit (p < 0.05), and shell weight (p = 0.05) in the PS compared to 24 h treatment. Our findings support that PS may help decrease fearfulness, improve growth performance and egg quality of breeder ducks., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Preening cups are a semi-open water source for Pekin duck enrichment. To evaluate the ducks' affective state, we combined measuring welfare by walking a transect in the barn with mass spectrometry and qRT-PCR to measure brain neurotransmitter levels and gene expression for serotonin (5-HT) and dopamine (DA) synthesis and metabolism. 5-HT and DA have been established as indicators of mental state and emotions. We visited 4 standard commercial barns that housed approximately 6000-9000 ducks (one preening cup per 1500 ducks) and collected samples on d21 prior to preening cup placement, d28 one week after preening cup placement, and d35 one day prior to processing. Litter samples (n = 3/barn/day) were collected and transect walks were conducted to evaluate the welfare of the birds. Brain samples (n = 8/day/barn) were collected from two locations: ducks actively using the preening cups (PC) and ducks across the barn not actively using the preening cups (CON). The brains were hemisected and dissected in three brain areas: caudal mesencephalon (CM), rostral mesencephalon (RM), and diencephalon (DI). Litter samples showed no significant differences between collection dates. The transect showed significant differences in feather quality, feather cleanliness, and eye due to age, but not preening cups. The right hemisphere showed no differences in 5-HT turnover. For DA turnover, there are differences in CM (p < 0.05) and DI (p < 0.001) over time, but no differences between PC and CON. The left hemisphere measured TPH1, TPH2, and TH. CM and DI brain areas are not significantly different. Within the RM, there is a significant increase in TPH1 expression for ducks on d35 when compared to ducks on d28 and d21. These results suggest that 5-HT and DA do not differ due to duck location. However, DA activity increases as these ducks age. DA is an important neurotransmitter and activity increases as an animal grows allowing for behavioral development. Our data shows that commercial preening cups do not negatively impact ducks' welfare or affective state., Competing Interests: Disclosures The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Previous studies from our lab suggest that transportation of early adulthood ducks can have long lasting physiological effects. To better understand how transportation affects the ducks' physiology, we evaluated several central and peripheral parameters. Thirty-six, 23-week-old ducks were collected at a commercial breeder facility and randomly assigned to one of three treatment groups (n = 6/sex/treatment): 1) caught and euthanized (control), 2) caught and put in a crated in the pen for 90 min (crate), or 3) caught, crated, and transported in a truck for 90 min (transport) to simulate actual transportation. Blood was collected for serum corticosterone and blood smear analyses. Brains were hemisected and each half was dissected into three brain areas: caudal mesencephalon (CM), rostral mesencephalon (RM), and diencephalon (DI). Mass spectrometry was run on the right half of the brain, and gene expression of TPH1, TPH2, TH, CRH, and NPY were measured on the left half of brain using qRT-PCR. Serum corticosterone levels were increased (p = 0.01) in crated hens and in transported hens and drakes (p = 0.0084) when compared to control. HLR was increased (p = 0.035) in crated hens and transported hens and drakes compared to control. No differences in serotonin turnover were observed in drakes but increased in hens within the CM and RM from control to crate (p = 0.01) and crate to transport (p = 0.016). There were no differences in DA turnover or in gene expression for all brain areas for drakes and CM and RM for hens. Within the DI, hens showed a decrease (p = 0.03) in TPH1 for transport compared to crate. Overall, transportation elicits an acutely stressful event that increases corticosterone and HLR in a sex dependent manner where hens appear to be more reactive to the stressor than drakes. Our data supports that when assessing a stress response, care must be given to the sex of the bird and to the relative timepoint of sampling compared to the perceived onset of the stressor., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Preening cups are a form of environmental enrichment that provides Pekin ducks a semi-open water source to express their natural behaviors. We recently observed that preening cups may increase feather pecking behaviors in ducks. Thus, we set out to determine if this form of enrichment can impact the affective state of Pekin ducks. To accomplish this goal, we evaluated the effect of preening cups on serotonin (5-HT) and dopamine (DA) turnover via mass spectrometry and their respective synthetic enzyme gene expression via qRT-PCR. Our study investigated the link between aggressive pecking with levels and activity of brain 5-HT and DA. Brain 5-HT and DA levels and activity have been established for decades to be associated with affective states. Grow-out Pekin ducks (n = 260) were housed at Purdue and raised per industry standards. On day 18, brains were collected from ducks in pens before preening cups were placed (PRE, n = 6) and, again on day 43, in pens with (PC, n = 6) and without (CON, n = 6) preening cups. Brains were dissected into right and left halves, then further microdissected into 4 brain areas: caudal mesencephalon (CM), rostral mesencephalon (RM), diencephalon (DI), and forebrain (FB). The right hemisphere was used for mass spectrometry to determine the neurotransmitter concentration (ng/mg of tissue) and those concentrations were applied to neurotransmitter turnover equations. There were no differences across treatments for 5-HT turnover in any brain area. There were differences in DA turnover across age (P = 0.0067) in the CM and across treatments (P = 0.003) in the RM. The left hemisphere of the brain was used to perform qRT-PCR on the genes of 5-HT and DA production enzymes. Within the CM, day 43 duck brains had increased (P = 0.022) tryptophan hydroxylase and tyrosine hydroxylase relative mRNA levels. All other brain areas showed no differences. Our data suggest that ducks housed with preening cups and that showed increased feather pecking are associated with increased brain DA activity. The increased DA in the brain may lead to a predisposition for increased aggression in the form of feather pecking., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Despite the uncontested benefits of physical activity, its promotion lags behind in the public health agenda of low- and middle-income countries (LMICs). School-based interventions are promising strategies to foster health during childhood, but evidence of their effectiveness is limited and inconclusive for LMICs. Thus, further investigation is needed on contextual factors associated with intervention implementation in low-resource settings. We studied the acceptability and feasibility of the KaziKidz health promotion intervention and its implementation and make recommendations to improve future adoption and sustainability., Methods: KaziKidz was implemented in four primary schools from low-income communities in South Africa in 2019. Semi-structured interviews with four school principals, three focus group interviews with 16 educators, and another three with 16 caregivers were conducted between October and November 2021. Participants were purposively recruited. Interview transcripts were analyzed via thematic analysis using a deductive and reflexive approach., Results: Three main themes influencing intervention implementation and adoption were identified: (1) prioritizing teachers' needs (2), integrating the program into the school structure, and (3) creating opportunities in the community. Supporting recommendations included: (theme 1) adopting intervention approaches that are inclusive of educators' health and providing them with capacity development and external support; (theme 2) fostering a feeling of ownership and belonging among school stakeholders to adapt interventions to specific resources and needs; and (theme 3) raising community awareness to encourage individuals to claim power over and actively engage with the program., Conclusions: Comprehensive interventions comprising health support, adequate training, and ongoing assistance for educators combined with school-wide and community outreach actions seeking to strengthen program ownership, accountability, and engagement can enhance uptake of school-based interventions and long-term maintenance., Trial Registration: ISRCTN15648510, registered on 17/04/2020., (© 2024. The Author(s).)

Background: Nutri-score is now widely available in food packages in Europe., Aim: To study the overall nutritional quality of the diet in relation to risks of Crohn's disease (CD) and ulcerative colitis (UC), in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort METHODS: We collected dietary data at baseline from validated food frequency questionnaires. We used a dietary index based on the UK Food Standards Agency modified nutrient profiling system (FSAm-NPS-DI) underlying the Nutri-Score label, to measure the nutritional quality of the diet. We estimated the association between FSAm-NPS-DI score, and CD and UC risks using Cox models stratified by centre, sex and age; and adjusted for smoking status, BMI, physical activity, energy intake, educational level and alcohol intake., Results: We included 394,255 participants (68.1% women; mean age at recruitment 52.1 years). After a mean follow-up of 13.6 years, there were 184 incident cases of CD and 459 incident cases of UC. Risk of CD was higher in those with a lower nutritional quality, that is higher FSAm-NPS-DI Score (fourth vs. first quartile: aHR: 2.04, 95% CI: 1.24-3.36; p-trend: <0.01). Among items of the FSAm-NPS-DI Score, low intakes of dietary fibre and fruits/vegetables/legumes/nuts were associated with higher risk of CD. Nutritional quality was not associated with risk of UC (fourth vs. first quartile of the FSAm-NPS-DI Score: aHR: 0.91, 95% CI: 0.69-1.21; p-trend: 0.76)., Conclusions: A diet with low nutritional quality as measured by the FSAm-NPS-DI Score is associated with a higher risk of CD but not UC., (© 2023 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)

Background & Aims: Industrial foods have been associated with increased risks of several chronic conditions. We investigated the relationship between the degree of food processing and risks of Crohn's disease (CD) and ulcerative colitis (UC) in the European Prospective Investigation into Cancer and Nutrition cohort., Methods: Analyses included 413,590 participants (68.6% women; mean baseline age, 51.7 y) from 8 European countries. Dietary data were collected at baseline from validated country-specific dietary questionnaires. Associations between proportions of unprocessed/minimally processed and ultraprocessed food intake and CD and UC risks were estimated using Cox models to obtain hazard ratios (HRs) and 95% CIs. Models were stratified by center, age, and sex, and adjusted for smoking status, body mass index, physical activity, energy intake, educational level, and alcohol consumption., Results: During a mean follow-up period of 13.2 years, 179 incident cases of CD and 431 incident cases of UC were identified. The risk of CD was lower in people consuming high proportions of unprocessed/minimally processed foods (adjusted HR for the highest vs lowest quartile: 0.57; 95% CI, 0.35-0.93; P trend < .01), particularly fruits and vegetables (adjusted HRs, 0.54; 95% CI, 0.34-0.87 and 0.55; 95% CI, 0.34-0.91, respectively). There was no association between unprocessed/minimally processed food intake and the risk of UC. No association was detected between ultraprocessed food consumption and CD or UC risks., Conclusions: In the European Prospective Investigation into Cancer and Nutrition cohort, consumption of unprocessed/minimally processed foods was associated with a lower risk of CD. No association between UC risk and food processing was found., (Copyright © 2023. Published by Elsevier Inc.)

Background and Aims: We aimed to investigate the association between protein intake and risk of inflammatory bowel disease [IBD] in the European Prospective Investigation into Cancer and Nutrition., Methods: A total of 413 593 participants from eight European countries were included. Dietary data were collected at baseline from validated food frequency questionnaires. Dietary data were calibrated to correct errors in measures related to each country-specific questionnaire. Associations between proteins [total, animal, and vegetable] or food sources of animal proteins, and IBD risk were estimated by Cox proportional hazard models., Results: After a mean follow-up of 16 years, 177 patients with Crohn's disease [CD] and 418 with ulcerative colitis [UC], were identified. There was no association between total protein, animal protein, or vegetable protein intakes and CD or UC risks. Total meat and red meat intakes were associated with UC risk (hazard ratio [HR] for the 4th vs 1st quartile = 1.40, 95% confidence interval [CI] = 0.99-1.98, p-trend = 0.01; and 1.61, 95% CI = 1.10-2.36, p-trend = 0.007, respectively]. There was no association between other food sources of animal protein [processed meat, fish, shellfish, eggs, poultry] and UC. We found no association between food sources of animal proteins and CD risk., Conclusions: Meat and red meat consumptions are associated with higher risks of UC. These results support dietary counselling of low meat intake in people at high-risk of IBD., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: A large literature shows important effects of self-esteem and stress on mental and physical health in young adulthood. Negative life events are one type of stressor associated with poor health, but it is less clear whether more neutral stressors are also associated with poor health. This study contributes to the existing literature by investigating the association between different types of stressful life events, self-esteem, and health during the transition from adolescence to early adulthood in Switzerland., Methods: We draw on the "Transitions from Education to Employment" (TREE) panel study, a nationally representative longitudinal survey of a cohort of Swiss young adults, using logistic regression analysis. The study includes eight waves over a 10-year period, from 2001, average age 16, to 2010, average age 26. Our dependent variable is a dichotomized health self-assessment, and key independent variables include self-esteem and three measures of cumulative significant life events (SLEs): total cumulative SLEs, cumulative negative SLEs, and cumulative neutral SLEs., Results: Self-esteem had a significant positive impact on health, whereas cumulative SLEs had a significant negative impact. Negative SLEs had a larger negative impact than total SLEs, and neutral SLEs had a smaller impact. Considered individually, negative SLEs were more likely to have a significant negative impact on health., Conclusions: In addition to their known influence on mental health, stress and self-esteem are important factors influencing individuals' general health, even in adolescence and young adulthood. While all types of stressors have a negative impact on health, the negative stressors seem to have more prominent effects than neutral stressors.

Most studies on sustainable mobility focus on technological, socio-structural, or psychosocial influences while neglecting individual motivations and practices. In this study, we examine mobility motivations and practices as part of a complex interplay between psychosocial and socio-structural dimensions within the mobility infrastructure of Metrorail in the Western Cape. Drawing on Albert Bandura's theory of personal agency and the model of triadic reciprocal causation, we interviewed 38 commuters (mean age 33 years, SD 11, 50% women/men) and analyzed the data using hermeneutic content analysis and multidimensional scaling. Based on our analyses, we identified three pathways that describe the mobility practices of Metrorail users, each with its own purpose and function. We explore these pathways and their consequences for sustainable mobility in relation to daily commuter agency, motivations, and past experiences.

Background: Specific nutrients or foods have been inconsistently associated with ulcerative colitis (UC) or Crohn's disease (CD) risks. Thus, we investigated associations between diet as a whole, as dietary patterns, and UC and CD risks., Methods: Within the prospective EPIC (European Prospective Investigation into Cancer) study, we set up a nested matched case-control study among 366,351 participants with inflammatory bowel disease data, including 256 incident cases of UC and 117 of CD, and 4 matched controls per case. Dietary intake was recorded at baseline from validated food frequency questionnaires. Incidence rate ratios of developing UC and CD were calculated for quintiles of the Mediterranean diet score and a posteriori dietary patterns produced by factor analysis., Results: No dietary pattern was associated with either UC or CD risks. However, when excluding cases occurring within the first 2 years after dietary assessment, there was a positive association between a "high sugar and soft drinks" pattern and UC risk (incidence rate ratios for the fifth versus first quintile, 1.68 [1.00-2.82]; Ptrend = 0.02). When considering the foods most associated with the pattern, high consumers of sugar and soft drinks were at higher UC risk only if they had low vegetables intakes., Conclusions: A diet imbalance with high consumption of sugar and soft drinks and low consumption of vegetables was associated with UC risk. Further studies are needed to investigate whether microbiota alterations or other mechanisms mediate this association.

Objective: To assess the relationship between hospital patients' quality of care ratings and their experiences with health-related information exchanges and communication during hospitalization., Design: Cross-sectional multivariate dimensional analysis of data from a quality of care experience questionnaire of hospital patients comparing scores across three levels of reported satisfaction., Setting and Participants: Five thousand nine hundred and fifty-two patients from a Swiss University Hospital responded to the questionnaire at discharge during 2010., Main Outcome Measures: Survey questions measuring patients' evaluation of quality of care, patient loyalty and overall satisfaction., Results: Different levels of reported satisfaction are associated with differing experiences of health-related information and communication during a hospital stay., Conclusions: Patients who report lower satisfaction appear to attribute to the hospital staff enduring negative dispositions from behaviours that may be due to specific situational contexts. Negative experiences appear to influence scores on most other communication and information domains. Patients who report higher satisfaction, in contrast, appear to differentiate negative experiences and positive experiences and they appear to relativize and compartmentalize negative experiences associated with their hospital stay.

Background: In epidemiological studies, Helicobacter pylori infection is usually detected by enzyme-linked immunosorbent assay (ELISA). However, infection can spontaneously clear from the mucosa during the progression of atrophy and could lead to substantial under-detection of infection and underestimation of its effect on gastric cancer (GC) risk. Antibodies detected by western blot are known to persist longer after the loss of the infection., Methods: In a nested case-control study from the Eurogast-EPIC cohort, including 88 noncardia GC cases and 338 controls, we assessed the association between noncardia GC and H. pylori infection comparing antibodies detected by western blot (HELICOBLOT2.1) to those detected by ELISA (Pyloriset EIA-GIII(®))., Results: By immunoblot, 82 cases (93.2%) were H. pylori positive, 10 of these cases (11.4%) were negative by ELISA and only 6 cases (6.8%) were negative by both ELISA and immunoblot. Multivariable odds ratio (OR) for noncardia GC comparing immunoglobulin G positive versus negative by ELISA was 6.8 [95% confidence interval (CI) 3.0-15.1], and by immunoblot, the OR was 21.4 (95% CI 7.1-64.4)., Conclusions: Using a western blot assay, nearly all noncardia GC were classified as H. pylori positive and the OR was more than threefold higher than the OR assessed by ELISA, supporting the hypothesis that H. pylori infection is a necessary condition for noncardia GC.

The worldwide incidence of gastric adenocarcinoma (GC) is lower in women than in men. Furthermore, cancer patients treated with estrogens have been reported to have a lower subsequent risk of GC. The authors conducted a prospective analysis of menstrual and reproductive factors, exogenous hormone use, and GC in 335,216 women from the European Prospective Investigation Into Cancer and Nutrition, a cohort study of individuals aged 35-70 years from 10 European countries. After a mean follow-up of 8.7 years (through 2004), 181 women for whom complete exposure data were available developed GC. Adjusted hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models. All statistical tests were 2-sided. Women who had ovariectomy had a 79% increased risk of GC (based on 25 cases) compared with women who did not (hazard ratio = 1.79, 95% confidence interval: 1.15, 2.78). Total cumulative years of menstrual cycling was inversely associated with GC risk (fifth vs. first quintile: hazard ratio = 0.55, 95% confidence interval: 0.31, 0.98; P(trend) = 0.06). No other reproductive factors analyzed were associated with risk of GC. The results of this analysis provide some support for the hypothesis that endogenous ovarian sex hormones lower GC incidence in women.

Objective: Most studies on tobacco smoking have focused on daily-smokers. Occasional smokers, who have never smoked daily, have often been included in the reference group of never-smokers. We have investigated the association between occasional smoking and cancer of the bladder, kidney, pancreas, upper aero-digestive tract and lung., Methods: The study population consisted of 158,488 persons, who provided information on occasional smoking, within the European Prospective Investigation into Cancer and Nutrition (EPIC), 780 of whom developed a smoking-related cancer. We used Cox proportional hazard model, stratified by gender and country to estimate incidence rate ratios (IRR) for smoking-related cancers., Results: The results suggest that occasional smokers have a higher risk of bladder cancer (IRR: 1.92, 95% confidence interval (CI) 0.93-3.98) and of the major smoking-related cancers combined (IRR: 1.24, 95% CI 0.80-1.94) than true never-smokers. Including occasional smokers in the reference group resulted in a lower risk estimate for former and current smokers., Conclusions: Occasional smoking should be discouraged.

Background: Properly designed software can be compensatory, and possibly remedial, for people with significant deficits from traumatic brain injury (TBI)., Objective: This article will provide a historical overview of the use of microcomputers in brain injury rehabilitation. Emphasis will be placed on the evolution of compensatory assistive technology for overcoming cognitive impairments, with theoretical discussion of the design considerations for an effective cognitive orthotic., Conclusions: Discussion will focus on findings and observations made with a particular multifunction cognitive orthotic system to assist people with TBI in the performance of ecologically relevant activities. Additional observations will address the impact of the current US health care environment on technological innovation.

In this paper we use the 1994-1997 Youth Surveys of the British Household Panel Study to examine the wellbeing of young adolescents. We conceptualize wellbeing as a multi-dimensional construct and we develop and test models of gender and age differences. Using confirmatory factor analysis, we find clear gender differences in self-esteem, self-efficacy, unhappiness and worries. We confirm that wellbeing and some health-risk behaviours (fighting and smoking) are linked. We test models that examine how family structure, father's occupation, tenure, and household income, affect adolescent wellbeing. While socio-economic factors affect health-risk behaviours and also adolescents' reported worries, they have little impact on other aspects of youth wellbeing. The implications of these findings are discussed., (Copyright 2001 The Association for Professionals in Services for Adolescents.)

Smoking-cessation advice may be more effective and acceptable if it is based on strategies used by people who quit smoking on their own. The objective of this study was to identify these self-change strategies and to develop and validate questionnaires measuring the frequency of their use in current and former smokers. Development of questionnaire items was based on qualitative data provided by 120 current and former smokers, and the validation study was conducted by mail in 638 smokers and ex-smokers in Geneva, Switzerland, from 1996 to 1998. We identified 5 distinct and interpretable self-change strategies in current smokers and 5 strategies in former smokers, and measured their frequency of use with a 19-item questionnaire in current smoker (SCS-CS) and with a 17 item questionnaire in former smokers (SCS-FS). Eight items and 2 strategies were common to both current and former smokers. the scales fulfilled criteria of test-retest reliability, and content, construct, and predictive validity. Participants who quit smoking between the baseline survey and the 1-month follow-up had higher baseline scores for all self-change strategies (+0.65 to +1.16 standard deviation units) than participants who remained smokers at follow-up. These scales may be used to describe and understand the processes of smoking cessation and relapse, as well as to produce input data for computer systems which produce individually-tailored smoking cessation advice.

Aims: To develop and test the validity of a questionnaire measuring the confidence of current and former smokers in their ability to abstain from smoking in high-risk situations., Design and Participants: We collected qualitative data in a first mail survey in 115 smokers and ex-smokers, and used these data to develop survey items. We collected quantitative data in a second mail survey in 529 smokers and ex-smokers to finalize the instrument., Setting: General population in Geneva, Switzerland, 1995, 1997 and 1998., Findings: The study resulted in a two-dimensional 12-item scale: the "Smoking Self-Efficacy Questionnaire" (SEQ-12). The two six-item subscales measure confidence in ability to refrain from smoking when facing internal stimuli (e.g. feeling depressed) and external stimuli (e.g. being with smokers). Internal consistency coefficients were high ("internal stimuli": alpha = 0.95; "external stimuli": alpha = 0.94). Test-retest intraclass correlation coefficients were high (0.95 and 0.93 for the two scales, respectively). In smokers, baseline self-efficacy scores predicted smoking cessation at 16-month follow-up. Finally, the scale respected criteria of content- and construct validity., Conclusion: SEQ-12 is a valid and reliable scale, which has applications in both research and clinical settings. It can also produce input data for computer systems that generate counselling reports tailored to the characteristics of each individual smoker.

Aim: To develop and test the validity of a scale measuring attitudes towards smoking in current and former cigarette smokers., Design and Participants: In a first mail survey, we collected qualitative data from 616 smokers. In a second mail survey, we collected quantitative data from 529 smokers and ex-smokers. We conducted a 16-month follow-up survey among 93 participants in the second survey., Setting: Geneva, Switzerland, 1995-98., Findings: The study resulted in a three-dimensional, 18-item scale: the "Attitudes Towards Smoking Scale" (ATS-18). The scale was validated with reference to criteria of content-, construct- and predictive validity. The three subscales measure perceptions of adverse effects of smoking (10 items), psychoactive benefits (four items) and pleasure of smoking (four items). Internal consistency coefficients (0.85, 0.88 and 0.81) and test-retest correlations were high (0.90, 0.75, 0.89, respectively). Differences in attitude scores between smokers in the pre-contemplation and preparation stages of change were -0.83, 0.71 and 1.23 standard deviation units, respectively. A differential score (advantages minus disadvantages of smoking) predicted smoking cessation in baseline smokers and relapse in baseline ex-smokers., Conclusion: ATS-18 is a valid and reliable instrument which can be used in both research and clinical settings.

A multifunction cognitive orthotic (CO), designed for individuals with significant deficits from traumatic brain injury, enables rapid unassisted reliable performance of a targeted task and facilitates transfer of training across subsequent activity tasks for most participants. Consistency in design ensures consistent cues and organization as well as unchanging procedural format as content and tasks vary. Of the 41 participants provided a clinical assessment trial with a CO, 36 (88%) demonstrated rapid achievement of success on the initial task. Thereafter, transfer of training was achieved across subsequent targeted activity tasks by changing only the content, in the context of stable CO design. Many individuals with brain injury can be self-sufficient in performing, unassisted, the essential steps of targeted activities when provided a properly designed compensatory assistive device.

A patient with a history of diabetes, coronary artery disease, stroke, previous renal transplantation, and multiple hospital admissions for recurrent pancreatitis was transferred to the hospital from a chronic care facility because of fever and severe epigastric discomfort. At the time of admission, she was receiving hyperalimentation through a central venous TPN catheter. Multiple blood cultures obtained on the first and second hospital days yielded pure cultures of the yeast, Pichia ohmeri. The patient developed acute renal failure, and despite high-dose amphotericin B therapy, ultimately expired.

The third-generation cephalosporins offer considerable appeal for treatment of specific life-threatening infections (nosocomial pneumonia, meningitis, urosepsis) in elderly patients when the disorders are caused by aerobic gram-negative bacilli. Despite the frequent presence of cross-reactive antibodies in the sera of recipients of cephalosporins, clinically evident serious reactions to cephalosporins occur infrequently in patients with known penicillin allergy.

Community-acquired bacterial pneumonia remains a formidable problem for the elderly. Patients' clinical presentations do not invariably coincide with those "classically" described. Predisposing factors, clinical manifestations, laboratory assessment, and differential diagnosis are discussed. The pivotal role of the technically adequate chest x-ray and the potential limitations of its interpretation are underscored. A comprehensive treatment program is presented, including supportive measures and specific antibiotic strategies. Immunoprophylaxis, its advantages and limitations, is also outlined.

Nephrotoxicity due to vancomycin is relatively uncommon and usually occurs in patients receiving concomitant therapy with an aminoglycoside or in patients with preexisting renal disease receiving prolonged courses of therapy and who exhibited excessive serum levels. We treated a healthy young woman who developed acute interstitial nephritis and moderate reversible azotemia associated with intravenous vancomycin hydrochloride therapy.