A Multidisciplinary Assessment of ChatGPT's Knowledge of Amyloidosis: Observational Study

BACKGROUND

Amyloidosis, a rare multisystem condition, often requires complex, multidisciplinary care. Its low prevalence underscores the importance of efforts to ensure the availability of high-quality patient education materials for better outcomes. ChatGPT (OpenAI) is a large language model powered by artificial intelligence that offers a potential avenue for disseminating accurate, reliable, and accessible educational resources for both patients and providers. Its user-friendly interface, engaging conversational responses, and the capability for users to ask follow-up questions make it a promising future tool in delivering accurate and tailored information to patients.

OBJECTIVE

We performed a multidisciplinary assessment of the accuracy, reproducibility, and readability of ChatGPT in answering questions related to amyloidosis.

METHODS

In total, 98 amyloidosis questions related to cardiology, gastroenterology, and neurology were curated from medical societies, institutions, and amyloidosis Facebook support groups and inputted into ChatGPT-3.5 and ChatGPT-4. Cardiology- and gastroenterology-related responses were independently graded by a board-certified cardiologist and gastroenterologist, respectively, who specialize in amyloidosis. These 2 reviewers (RG and DCK) also graded general questions for which disagreements were resolved with discussion. Neurology-related responses were graded by a board-certified neurologist (AAH) who specializes in amyloidosis. Reviewers used the following grading scale: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Questions were stratified by categories for further analysis. Reproducibility was assessed by inputting each question twice into each model. The readability of ChatGPT-4 responses was also evaluated using the Textstat library in Python (Python Software Foundation) and the Textstat readability package in R software (R Foundation for Statistical Computing).

RESULTS

ChatGPT-4 (n=98) provided 93 (95%) responses with accurate information, and 82 (84%) were comprehensive. ChatGPT-3.5 (n=83) provided 74 (89%) responses with accurate information, and 66 (79%) were comprehensive. When examined by question category, ChatGTP-4 and ChatGPT-3.5 provided 53 (95%) and 48 (86%) comprehensive responses, respectively, to "general questions" (n=56). When examined by subject, ChatGPT-4 and ChatGPT-3.5 performed best in response to cardiology questions (n=12) with both models producing 10 (83%) comprehensive responses. For gastroenterology (n=15), ChatGPT-4 received comprehensive grades for 9 (60%) responses, and ChatGPT-3.5 provided 8 (53%) responses. Overall, 96 of 98 (98%) responses for ChatGPT-4 and 73 of 83 (88%) for ChatGPT-3.5 were reproducible. The readability of ChatGPT-4's responses ranged from 10th to beyond graduate US grade levels with an average of 15.5 (SD 1.9).

CONCLUSIONS

Large language models are a promising tool for accurate and reliable health information for patients living with amyloidosis. However, ChatGPT's responses exceeded the American Medical Association's recommended fifth- to sixth-grade reading level. Future studies focusing on improving response accuracy and readability are warranted. Prior to widespread implementation, the technology's limitations and ethical implications must be further explored to ensure patient safety and equitable implementation.

Assessment of the Satisfaction of Patients Treated by Undergraduate Dental Students at a Saudi Government University: A Cross Sectional Study

Purpose

The long-term success of any organization is highly dependent on client satisfaction. This applies to the medical and dental fields, where patient satisfaction is considered an indirect indicator of the quality of service provided. This study aimed to assess the level of satisfaction of patients treated by final-year undergraduate students at King Abdulaziz University Dental Hospital (KAUDH).

Patients and Methods

In this cross-sectional study, an online questionnaire was distributed to patients (aged ≥14 years) treated at KAUDH by sixth year students during the academic year 2020/2021. The questionnaire comprised 36 items, including demographic and general data, type of dental problems, type of dental treatment received, and satisfaction assessment based on the Dental Satisfaction Questionnaire. Data were analyzed using one-way ANOVA and independent sample t-tests (α=0.05).

Results

A total of 203 responses were received (58% response rate). The reliability of the satisfaction tool (Cronbach's alpha) was 0.88, indicating a high reliability. The overall satisfaction level was 80.1% (±14.2). The satisfaction levels related to pain management, quality of care, and access to care were 76.4% (±19.9), 86.2% (±17.1), and 77.5% (±16.5) respectively. The highest satisfaction level (91.5%) was related to the quality item "The student was always treating me with respect". Age, number of visits, length of treatment, case severity, and treatment complexity were not significantly correlated with patient satisfaction (p ≥ 0.116). New patients who had their files directly opened by a sixth-year student and were treated immediately were more satisfied than patients who already had files at KAUDH and were referred to sixth-year students for treatment (p=0.029).

Conclusion

Patients treated by final-year students at KAUDH showed high satisfaction levels in relation to pain management, treatment quality, and access. However, the satisfaction of existing old patients was lower than that of new patients, which warrants further assessment, particularly regarding the hospital referral system.

[Prevention of elder abuse during hospitalization: evaluation of health professional's work practices to better understand the risks]

Elder abuse and neglect in institutions is frequent, but is still not studied enough. This study aims to better understand the risks of elder abuse, through daily experiences of health professionals. This is a monocentric, qualitative study, with semi-structured interviews of health professionals working in a geriatric hospital. Geriatrics is a specialty at risk of abuse and neglect. There is a real taboo around this issue. The difficulty for its reporting is multifactorial (tolerance, trivialization of abusive behaviors, isolation, and apprehension of caregivers...). The lack of human, material, and educational resources provided by health institutions does not enable professionals, whoever they may be, to care for patients humanely. The guidance and support of caregivers (training, increased team cohesion, and dedicated time for multidisciplinary reflection) are aimed at improving patient care and quality of care. All health professionals are concerned with elder abuse and neglect. It is necessary to break the taboo around mistreatment, to learn to talk about it among colleagues, and to recognize and evaluate oneself in order to change, evolve, and train others to treat patients the best way possible. Health professionals have to train and learn about the specificities of geriatrics early, repetitively, and continuously during their training. Health professionals must be able to work in a stable environment, with a supportive management. Their work must be valued in a sustainable way. Better working conditions should enable a more caring and compassionate approach by healthcare professionals toward their patients.

[Setting up, running and evaluating NMIs as part of the "ageing well" project]

Non-drug interventions (NDIs) are recommended as a first-line treatment in gerontology to address the psychological and behavioral symptoms of dementia. This article illustrates the NMIs implemented, how they are carried out and how they are evaluated as part of the Bien vieillir project at Nice University Hospital.

[FUNCTIONING OF THE INSTITUTIONS FOR ASSESSING QUALIFICATIONS OF MEDICAL SPECIALISTS IN OUTPATIENT AND INPATIENT SETTINGS]

The study of the level of appropriateness of the institutions for assessing qualifications of medical specialists with regard to their purpose is relevant due to a number of manifestations of the dysfunction of these institutions and the need to eliminate them. It is advisable to analyze these phenomena not only in general, but also from individual angles, including in the context of their functioning in outpatient and inpatient conditions. This perspective allows us to identify additional aspects of the dysfunction. The study was carried out on the basis of statistics of the Moscow Healthcare Department and materials of two surveys of medical specialists conducted in 2019 and 2022 by the Department. Opinions of medical personnel in polyclinics and hospitals about advantages and disadvantages of the work of institutions of accreditation and certification to get a qualification category were studied. The shortcomings were associated with the dysfunction factors. It is established that these shortcomings are ranked according to the level of significance. The most significant out of them (high workload and lessened incentives for advancement in skills) are characteristic of both types of medical institutions and their divisions, but more pronounced in outpatient settings. It is shown that a number of shortcomings were eliminated by legislation and due to the development of the infrastructure for continuing medical education. However, some shortcomings cannot be eliminated within the institutions themselves, and further reforming of the healthcare system is required.

Nursing preceptorship in Ekiti State, Southwest Nigeria: Perceptions of nursing students and clinical preceptors

Nursing preceptors play a vital role in providing skills-oriented opportunities for students in the clinical environment. This study assessed the perceptions of nursing students regarding the clinical learning experience provided by preceptors, and the perceptions of nursing preceptors regarding their roles in ensuring beneficial clinical accompaniment in the three nursing institutions in Ekiti State, Southwestern Nigeria. A concurrent mixed-methods design consisting of a survey and semi-structured interviews were used. A multistage (consecutive, purposive, and convenience) sampling technique was used to obtain quantitative data from 120 nursing students and qualitative data from 20 preceptors. Data were analyzed using descriptive and thematic content analysis. Findings showed that overall students' perceptions of the clinical learning experience were good (92%), 91.7% of the students wanted direct supervision and inadequate support was reported due to the low preceptor-to-student ratio. Preceptors acknowledged that clinical accompaniment is one of their roles, challenges mentioned include few number of preceptors, lack of policy requirements to guide their duties, and limited equipment. We conclude that there is a need to provide adequate preceptors in clinical settings, as they are vital to the training of nurses. A unified policy and standardized procedure manual will improve the quality of the delivery of preceptorships in training institutions.

Evaluation of apathy among institutionalized older persons: Its mediating role between cognitive functioning and lack of awareness

OBJECTIVES

The main objective of this study was to determine the directions of the relationships between apathy, cognitive deficits and lack of awareness.

METHODS

One hundred and twenty-one older persons living in nursing homes, aged between 65 and 99 years old, participated in the study. Cognitive functioning, autonomy, depressive and anxious symptoms, general self-efficacy, self-esteem and apathy were evaluated through tests and questionnaires. Lack of awareness was calculated using the patient-caregiver discrepancy method. The sample was divided into two groups (n1 = 60, n2 = 61) depending on cognitive functioning level (Dementia Rating Scale < median score: 120). We first explored the characteristics of each group. Then, we compared the mode of evaluation of apathy. Finally, we investigated the direction of relationships by applying mediation analyses.

RESULTS

Older persons in the low cognitive functioning group were less autonomous, had a lower cognitive functioning level, higher caregiver-rated apathy and higher lack of awareness than the high cognitive functioning group (ps < 0.05). Evaluation differences were found only in the low cognition group. Caregiver-rated apathy totally mediated the relationship between cognitive functioning (predictor) and lack of awareness (dependent variable) for the whole sample (90%) and for the low cognitive functioning group (100%).

CONCLUSIONS

Cognitive deficits should be taken into account when evaluating apathy. Interventions should combine cognition training and emotion intervention to reduce lack of awareness. Future research should develop a therapy dedicated to apathy among older persons without pathologies.

Tools of war and virtue-Institutional structures as a source of ethical deskilling

Shannon Vallor has raised the possibility of ethical deskilling as a potential pitfall as AI technology is increasingly being developed for and implemented in military institutions. Bringing the sociological concept of deskilling into the field of virtue ethics, she has questioned if military operators will be able to possess the ethical wherewithal to act as responsible moral agents as they find themselves increasingly removed from the battlefield, their actions ever more mediated by artificial intelligence. The risk, as Vallor sees it, is that if combatants were removed, they would be deprived of the opportunity to develop moral skills crucial for acting as virtuous individuals. This article constitutes a critique of this conception of ethical deskilling and an attempt at a reappraisal of the concept. I argue first that her treatment of moral skills and virtue, as it pertains to professional military ethics, treating military virtue as a sui generis form of ethical cognition, is both normatively problematic as well as implausible from a moral psychological view. I subsequently present an alternative account of ethical deskilling, based on an analysis of military virtues, as a species of moral virtues essentially mediated by institutional and technological structures. According to this view, then, professional virtue is a form of extended cognition, and professional roles and institutional structures are parts of what makes these virtues the virtues that they are, i.e., constitutive parts of the virtues in question. Based on this analysis, I argue that the most likely source of ethical deskilling caused by technological change is not how technology, AI, or otherwise, makes individuals unable to develop appropriate moral-psychological traits but rather how it changes the institution's capacities to act.

The Transformation of 40-Year Coastal Wetland Policies in China: Network Analysis and Text Analysis

The notable improvement of China's wetland management policies over the last four decades prompted this study's goal to quantitatively analyze the transformation of China's coastal wetland policies from 1979 to 2022 by applying an institutional network analysis and policy text analysis. The results of the institutional network analysis revealed an administrative management transformation from a multidepartmental mode to an integrated management framework. Furthermore, the policy text analysis results revealed a change in policy priorities (from exploitation to protection) and management targets (from a single environmental element to a comprehensive ecosystem and further to collaborative governance). In addition, the overall outcome of this study instigated proposals for the improvement of future wetland policies on climate change, integrated planning, natural capital, and public participation. Hence, this study presents an example of wetland policy analysis based on a quantitative review, which we hope will also be valuable for other countries.

Worldwide Productivity and Research Trend of Publications Concerning Cancer-Related Neuropathic Pain: A Bibliometric Study

Cancer-related neuropathic pain is a common adverse effect in the process of cancer development and treatment and has gradually attracted the attention of researchers. The purpose of this article is to systematically review the articles on cancer-related neuropathic pain published between 2012 and 2021 and visualize the data through CiteSpace and R software. The results show that in the past 10 years, a total of 5715 articles have been published, involving 118 categories, of which the most is Clinical Neurology, followed by Neurosciences, Pharmacology Pharmacy. The country with the most published articles is the United States, followed by China and Italy. A total of 22,228 authors were involved in the study of cancer-related neuropathic pain. These historical opinions about cancer-related neuropathic pain could be an important practical basis for further research into potential development trends.

Investigating Employment Quality for Population Health and Health Equity: A Perspective of Power

Employment quality (EQ) has gained increasing attention as a determinant of health, but the debate among occupational health researchers over the measurement of EQ poses a challenge to advancing the literature. This is especially problematic when the concept is used across social, cultural, and national borders, as EQ is shaped by power dynamics within sociopolitical and economic contexts that are specific to each society. Investigating EQ in context could help develop a clearer understanding as to why EQ is configured in certain ways, how best EQ could be measured, how EQ impacts health, and ultimately how EQ could be improved. In this paper, we propose that attention to social context-and in particular power-may help advance the research on EQ and health. We present an allegory, or a visual description, that articulates the power balance in the employer-worker relation as well as in the sociopolitical context in which the employer-worker relation takes place. We end by proposing specific approaches for occupational health researchers to incorporate a perspective of power in EQ research that may clarify the concept and measurement of EQ. A clearer recognition of EQ as a product of power in social context aligns with the research approach of addressing work as a social structural determinant of health.

A Nationwide Survey of Dementia Prevalence in Long-Term Care Facilities in Taiwan

Background: As the average life expectancy of global citizens has increased, the prevalence of dementia has increased rapidly. The number of patients with dementia has increased by 6.7 times, reaching 300,000 in the past three decades in Taiwan. To realize the latest actual situation, the need for institutional care for elderly patients with dementia, and also a reference basis for government agencies to formulate dementia-related care policies, we investigated the institutional prevalence of dementia. Methods: We randomly sampled 299 out of the 1607 registered long-term care facilities including senior citizens’ institutions, nursing homes, and veteran homes in every administrative region of Taiwan. Then, a two-phase survey including MMSE screening, CDR, and clinical confirmation was conducted on each subject from 2019 to 2020. Results: Among 5753 enrolled subjects, 4765 from 266 facilities completed the examinations with a response rate of 82.8%. A total of 4150 subjects were diagnosed with dementia, 7.4% of whom had very mild dementia. The prevalence of all-cause dementia, including very mild dementia, was 87.1% in all facilities, 87.4% in senior citizens’ institutions, 87.1% in nursing homes, and 83.3% in veteran homes. Advanced age, low education, hypertension, Parkinsonism, respiratory disease, stroke, and intractable epilepsy were associated with dementia risk. Conclusions: We show that in an aged society, the prevalence of all-cause dementia in long-term care institutions can be as high as 87.1%. This study was completed before the outbreak of COVID-19 and provides a precious hallmark for future epidemiological research. We recommend that the long-term care policy in an aged society needs to take into account the increasing high prevalence of dementia in the institution.

The institution, mental disability and the psychoanalyst: Prospects presented by a revival of intersubjective receptivity in groups

This presentation aims at giving an account of a novel group project, conducted with adults with mental and/or psychic disabilities. The evolution of post-war psychiatry in France is marked by several important changes. The development of psychotherapy in institutions asserts the role of psychoanalysis in the institutional sphere. We then will describe the environmental contexts for the reception and support of the mentally disabled subject as it currently exists in France, highlighting their effects on psychic disability. This novel project takes place in a medico-social institution, a residential home in which live eight adults with disabilities, women and men, aged 19 to 55, and at a particular moment in institutional history. Sustained by several mediations, it is first through the support of a jigsaw puzzle project that the experience is initiated. Then a writing workshop will be organised, whereby residues of proceedings will find a form in which to be recorded. The objective will be the implementation of intersubjective space, despite the impediment identified at the level of individual subjective psyches. The effectiveness of the methods used can be detected in the intersubjective connections, allowing the renewal of symbolization and creativity.

Institutional end-of-life care policy for inpatients at a tertiary care centre in India: A way forward to provide a system for a dignified death

India has a high share in the global burden of chronic terminal illnesses. However, there is a lack of a uniform system in providing better end-of-life care (EOLC) for large patients in their terminal stage of life. Institutional policies can be a good alternative as there is no national level policy for EOLC. This article describes the important aspects of the EOLC policy at one of the tertiary care institutes of India. A 15 member institutional committee including representatives from various departments was formed to develop this institutional policy. This policy document is aimed at helping to recognize the potentially non-beneficial or harmful treatments and provide transparency and accountability of the process of limitation of treatment through proper documentation that closely reflects the Indian legal viewpoint on this matter. Four steps are proposed in this direction: (i) recognition of a potentially non-beneficial or harmful treatment by the physicians, (ii) consensus among all the caregivers on a potentially non-beneficial or harmful treatment and initiation of the best supportive care pathway, (iii) initiation of EOLC pathways, and (iv) symptom management and ongoing supportive care till death. The article also focuses on the step-by-step process of formulation of this institutional policy, so that it can work as a blueprint for other institutions of our country to identify the infrastructural needs and resources and to formulate their own policies.

[Professional identity and care practice in adolescent psychiatry]

In psychiatric wards, nurses are an essential professional group in institutional and hospital life. In full hospitalization units for adolescents with psychological disorders, their professional identity is constructed in a care approach, at the crossroads of care and education. Motivated by individuation and by a feeling of collective and institutional belonging in their care practices, this identity construction seems to be beneficial for the patients since it is reinvested in the therapeutic relationship between caregiver and patient.

Co-Occurrence of Geriatric Syndromes and Diseases in the General Population: Assessment of the Dimensions of Aging

OBJECTIVES

The co-occurrence of multiple medical or psycho-social conditions (geriatric syndromes (GS) and age-related diseases) is a growing concern in older people. Given the diversity of these conditions and their complex interactions, our aim was to determine whether they could be structured into synthetic dimensions in order to facilitate the management of multimorbidity.

DESIGN

The underlying structure of 10 GSs and 8 age-related diseases was identified using a multiple correspondence analysis (MCA), and confronted to subjective and objective health outcomes.

SETTING

community residents from Bordeaux City (France) older than 75 years in 2010.

PARTICIPANTS

630 adults aged 75+ years who lived in Bordeaux and participated in the 10-year follow-up of the Three-City study.

MEASUREMENTS

GSs included physical frailty, cognitive impairment and dementia, dependency, depressive symptoms, polymedication, thinness, falls, sensory deficit, social isolation, incontinence. Age-related diseases were cancer, cardiac diseases, peripheral vascular diseases, diabetes, hypertension, pulmonary diseases, osteoporosis, other chronic diseases. Association of the MCA-derived independent dimensions was assessed with 10-year visit subjective health and well-being, and with incident death and entry into institution during the remaining cohort follow-up.

RESULTS

Most of the participants (82%) had at least two age-related syndromes or diseases. The MCA structured the 18 conditions into three major dimensions: Degradation (D) driven by GS, Vascular (V), and Psychosocial (P) representing 68.7%, 7.4%, and 5.7% of the total variance, respectively. Dimension D was a strong predictor of future death and institutionalization. Dimensions D and P were strongly associated with current well-being.

CONCLUSIONS

This work confirmed that multimorbidity is very common among older adults, and demonstrated the essential role of GS as manifestations of aging, even more than age-related diseases.

Values Evolution in Transitional China: An Institutional Perspective

The values are greatly affected by the social and economic environment of a country. Thus, social transformation can lead to the values evolution. China has been experiencing a huge social, political, and economic transition in the past four decades. The previous studies that explore the value changes in China mainly compare the values across the regions or generation cohorts. This research investigates the issue from an institutional perspective. Specifically, we propose that the diversification of ownership types-the essence of the economic and institutional reform since 1978 may result in value change. By surveying 327 participants from the state-owned enterprises (SOEs) and 220 respondents from the privately owned enterprises (POEs), the comparisons between SOEs and POEs on four value dimensions-individualism, power distance, risk aversion, and money orientation-were performed. The results basically support cross-vergence theory in the values evolution. The implications and limitations are presented as well.

[Identifying and preventing violence in healthcare settings]

The concept of care, of the patient and of illness has evolved over the course of history, changing at the same time as society. It is marked by the scientific, cultural and religious references of our country, which have led to a modification of the relationship with the patient, which can give rise to certain forms of violence. If violence seems to be inevitably intertwined with care, going back to the origins of the latter, to its individual and intersubjective stakes, and to the possible perspectives for limiting this violence, offers some elements of understanding.

Behavioral and psychological symptoms in institutional residents with dementia in Taiwan

AIM

Behavioral and psychological symptoms of dementia (BPSD) are important predictors for institutional placement, caregiver distress and depression for patients with dementia. We aim to investigate BPSD in institutional residents with dementia in Taiwan.

METHODS

We conducted a nationwide study surveying institutional residents in Taiwan. Institutional residents from 22 counties and cities in Taiwan were recruited and analyzed in our study. We recorded demographic data, severity of dementia and disability, presence of BPSD, and past medical history of institutional residents in Taiwan. We recorded the characteristics of BPSD and analyzed the possible risks of BPSD in residents with dementia.

RESULTS

A total of 4722 institutional residents were recruited and analyzed in our study. The prevalence of dementia was 87.2% (4119 residents). Among residents with dementia, 1546 (37.5%) had presented BPSD in the past 3 months. The most frequent three types of BPSD were nighttime behavior (17.9%), resistance against care (13.4%) and depression (12.9%). Old age, female gender, and lower MMSE (Mini-Mental State Examination) scores were associated with BPSD. Moderate dementia (OR = 1.73, 95% CI = 1.30-2.31) and mild activities of daily living (ADL) dependence (OR = 2.13, 95% CI = 1.06-4.27) increased the risks of BPSD. Reviews of past medical history showed that orthopedic disease, eye disease, genitourinary disease, dementia, psychiatric disorder and intellectual disability were associated with increasing risks of BPSD.

CONCLUSIONS

We concluded that moderate dementia and mild ADL dependence increased the risks of BPSD in institutional residents with dementia. Geriatr Gerontol Int 2021; 21: 718-724.

Searching for New Model of Digital Informatics for Human-Computer Interaction: Testing the Institution-Based Technology Acceptance Model (ITAM)

The fourth industrial revolution has produced new information technology (IT) that is widely used in the healthcare industry. Although the nature of the institution affects IT adoption, the Technology Acceptance Model (TAM), a dominant theory, has dismissed its role and influence. Our research investigates how institutions influence the adoption of new IT by using the Institution-based Technology Acceptance Model (ITAM). We conducted an empirical test by using survey data collected from 300 employees in the public sector. Structural equation modeling was applied to test the proposed hypotheses. The results showed the total effect of institutions on the intention to use new IT is positive and significant. Second, IT adoption is not only affected by external institutions but also by type of institution; the external institution takes a greater role in inducing perceived usefulness, perceived ease of use, and intention to use than does the internal. Third, perceived ease of use and perceived usefulness play mediating roles between institution and IT adoption. Fourth, an alternative expanded model to which more individual and organizational factors were added confirmed the results of the base model. We concluded that institutions have a strong impact on the level of intention for IT use through perceived ease of use and perceived usefulness.

Perceived Preparedness of Dental Academic Institutions to Cope with the COVID-19 Pandemic: A Multi-Country Survey

Dental academic institutions are affected by COVID-19. We assessed the perceived COVID-19 preparedness of these institutions and the characteristics of institutions with greater perceived preparedness. An international cross-sectional survey of dental academics was conducted from March to August 2020 to assess academics’ and institutional attributes, perceived preparedness, and availability of infection prevention and control (IPC) equipment. Principal component analysis (PCA) identified perceived preparedness components. Multilevel linear regression analysis assessed the association between perceived preparedness and fixed effect factors (academics’ and institutions’ attributes) with countries as random effect variable. Of the 1820 dental academics from 28 countries, 78.4% worked in public institutions and 75.2% reported temporary closure. PCA showed five components: clinic apparel, measures before and after patient care, institutional policies, and availability of IPC equipment. Significantly less perceived preparedness was reported in lower-middle income (LMICs) (B = −1.31, p = 0.006) and upper-middle income (UMICs) (B = −0.98, p = 0.02) countries than in high-income countries (HICs), in teaching only (B = −0.55, p < 0.0001) and in research only (B = −1.22, p = 0.003) than teaching and research institutions and in institutions receiving ≤100 patients daily than those receiving >100 patients (B = −0.38, p < 0.0001). More perceived preparedness was reported by academics with administrative roles (B = 0.59, p < 0.0001). Academics from low-income countries (LICs) and LMICs reported less availability of clinic apparel, IPC equipment, measures before patient care, and institutional policies but more measures during patient care. There was greater perceived preparedness in HICs and institutions with greater involvement in teaching, research, and patient care.

Intersectionality and trauma analysis in bioarchaeology

Intersectionality, the theory named by Kimberlé Crenshaw, outlines how multiple elements of an individual's social identity overlap to create and preserve societal inequalities and discrimination. Recently bioarchaeology's engagement with intersectionality has become increasingly explicit, as the field recognizes the lived experience of multiple axes of an individual's identity. Evidence of trauma can remain observable in an individual's skeleton for years, making it an ideal subject of study for intersectional analyses in bioarchaeology. Using contrasting case studies of two individuals who died in hospitals and were unclaimed after death, we explore the theoretical and methodological application of intersectionality to investigations of accidental and interpersonal trauma. Differences in identities and structural inequalities affect bone quality and health outcomes. As we demonstrate, a broken bone is the intersecting result of biological, histomorphological, sociocultural, and behavioral factors. This approach allows for a better acknowledgement of the inherent complexity of past lives, elevating and amplifying previously silenced voices. In this way, intersectionality in bioarchaeology demands social justice.

[Ethics: supporting the sexuality of people with a mental disability in an institution]

The question of the sexuality of people with a disability in an institution touches on two sensitive aspects: sexuality, between taboo and unknown, and disability-related particularities. Within the microsociety of an institution, the protocols, daily living rules and therapeutic framework guide institutional life, and caregivers are sometimes helpless. An ethical perspective can help professionals support people with a mental disability with regard to their emotional and sexual life.

Allocating resources for land protection using continuous optimization: biodiversity conservation in the United States

Spatial optimization approaches that were originally developed to help conservation organizations determine protection decisions over small spatial scales are now used to inform global or continental scale priority setting. However, the different decision contexts involved in large-scale resource allocation need to be considered. We present a continuous optimization approach in which a decision-maker allocates funding to regional offices. Local decision-makers then use these funds to implement habitat protection efforts with varying effectiveness when evaluated in terms of the funder's goals. We illustrate this continuous formulation by examining the relative priority that should be given to different counties in the coterminous United States when acquiring land to establish new protected areas. If weighting all species equally, counties in the southwest United States, where large areas can be bought cheaply, are priorities for protection. If focusing only on species of conservation concern, priorities shift to locations rich in such species, particularly near expanding exurban areas facing high rates of future habitat conversion (e.g., south-central Texas). Priorities for protection are sensitive to what is assumed about local ecological and decision-making processes. For example, decision-makers who doubt the efficacy of local land protection efforts should focus on a few key areas, while optimistic decision-makers should disperse funding more widely. Efforts to inform large-scale conservation priorities should reflect better the types of choice that decision-makers actually face when working over these scales. They also need to report the sensitivity of recommended priorities to what are often unstated assumptions about local processes affecting conservation outcomes.

Oral health status and care of institutionalized elderly individuals in Lebanon

Background

Oral health of the elderly is a major public health challenge. Data on oral health and dental care of the institutionalized elderly is lacking in Lebanon.

Aims

(1) Assess the oral health of Lebanese people aged 65 years and over living in residential facilities; and (2) identify factors associated with poor oral status.

Materials and Methods

A.

sample of 526 nursing home residents aged 65 years and older was randomly selected from 46 residential facilities. Information collected were sociodemographic characteristics, degree of autonomy regarding toilet use and nutrition, presence of chronic diseases and medications, dry mouth sensation, dental brushing, access to oral health and reasons of dental visits. A structured oral examination was conducted to gather data on DMFT index, oral hygiene indices modified gingival index, and the unmet need for prosthesis. Statistical methods included bivariate and multivariate analyses.

Results

55.9% of the participants were edentates, 41.4% used partial and/or complete dentures, and the minority used dentures with good hygiene. 15% of the dentate sample reported regular tooth brushing, 7% reported to have visited the dental office in the past 12 months, and 57% presented an unmet need for prosthesis. Oral health status was significantly related to age, smoking, daily tooth brushing, and autonomy (P < 0.05). Subjects with chronic diseases and consuming medications were more likely to have xerostomia.

Conclusion

Oral health status is poor in the elderly institutionalized Lebanese population, which should promote a multidisciplinary team sharing responsibility for daily oral hygiene and access to dental treatment.

[Architecture and intimacy: Reflections for institutional living places]

A reflection can be carried out on intimacy within private areas in institutions. An analysis of the concepts that currently underpin the architectural design of rooms in health and medico-social institutions helps to understand the reasons why privacy and a sense of home are often undermined. A sensitive approach makes it possible to explore people's lived experiences and to propose avenues for reflection to improve living conditions in institutions.

Growth Mindset as a Personal Preference Predicts Teachers' Favorable Evaluation of Positive Education as an Imported Practice When Institutional and Normative Support for It Are Both Strong or Both Weak

Past research on pathways to cultural influence on judgment has compared the explanatory power of personal preferences, perceived descriptive norms and institutionalization. Positive education is an education movement inspired by Western positive psychology. The present study examined how these factors jointly predict Hong Kong teachers’ evaluation of imported positive education programs in their schools. In a field study, we measured teachers’ personal endorsement of growth mindset (a positive psychology construct developed in the US) and their evaluation of adopting positive education programs in their schools. We also measured teachers’ perception of the extent of institutional and normative support for positive education in their schools. The results show that teachers’ personal preferences for growth mindset predict more favorable evaluation of positive education programs when institutional and normative support for positive education programs are both weak, or when they are both strong. We interpret these effects from the perspectives of the strong situation hypothesis and the intersubjective theory of culture.

Ripple effect of a clinical teaching fellow programme in an Australian paediatric hospital

AIM

Bedside teaching performed by experienced clinicians is an expected component of medical student training. As clinicians often have high clinical demands and a lack of formal training in teaching methods, clinical teaching fellowships have been established. In clinical teaching fellowships, clinicians with an interest and expertise in medical education provide medical students with standardised teaching. Studies about the impact of clinical teaching fellowships have demonstrated benefits for both clinical teaching fellows (CTFs) and medical students. However, studies have not evaluated the impact of these fellowships on other clinicians or learning relationships within the institution. In this study, we aimed to address this gap by gathering data on the perspectives of CTFs, medical students and hospital consultants.

METHOD

A mixed-method design was used, utilising a combination of surveys for CTFs, medical students and hospital consultants and semi-structured telephone interviews for CTFs. Quantitative and qualitative data were obtained.

RESULTS

The combination of data from CTFs, medical students and consultants enabled a more comprehensive understanding of the impact of the CTF programme within the institution. Although benefits were identified for CTFs and medical students, the consultant group noted that they were less involved in teaching medical students and that the CTFs were not well integrated into the ward team.

CONCLUSION

This research highlights the importance of considering not only direct outcomes of teaching and learning but broader influences on more implicit teaching opportunities and relationships within hospital teams.

Sir Matthew Tierney and the foundation of the 1804 Sussex Vaccine Institution

Irish physician Sir Matthew John Tierney (1776-1845) was a vaccine pioneer who learnt the procedure directly from Edward Jenner in Gloucestershire. In 1802 Tierney completed an MD at Glasgow on vaccination and moved to Brighton, where he was appointed physician to the Prince of Wales (the future King George IV). This paper considers Tierney's role in the foundation of the 1804 Sussex Vaccine Institution. Tierney was the first president of the Institution's Medical Council. His leadership lay in his knowledge of vaccination (including transporting cowpox material) and his close relationship with the Prince of Wales. The Institution's official name was the Royal Sussex Jennerian Society for the Extermination of the Small-pox and offered vaccination at 16 stations across the county and one in Kent. Vaccination was undertaken by local surgeons at their houses at set hours. In its first year, the Institution vaccinated 946 individuals, of whom 509 for free. Despite this, concerns were raised over uptake by poorer members of society. The Institution's Brighton station was probably absorbed into the new 1809 dispensary. Tierney's promotion of vaccination and instructions for new practitioners represent the embryonic beginnings of evidence-based medicine and modern medical education in Brighton.

[Establishing an observation group in the nursery]

In the nursery, the implementation of a working group on observation was a real step forward in the proposed support. Observation is both taking into account the child's internal world, a way of valuing his or her skills and the possibility of co-constructing finer representations, common to all professionals.

Comparing proxy rated quality of life of people living with dementia in care homes

BACKGROUND

Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes.

METHODS

We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews.

RESULTS

Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as 'Poor' (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents' QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia.

CONCLUSION

Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.

[Art therapy in enhanced accommodation units]

When cognitive disorders in the elderly are significant, for caregivers there remains the possibility of empathy, relational calm, time needed to help them access their memory, and escape the terrible sensation of not knowing. Entering a closed space dedicated to these seniors means creating contact with people who are lost in the twists and turns of a story they no longer recognise as their own. Feedback from an art-therapy workshop with cognitively fragile seniors, cut off from all references.

Advancing research integrity: a programme to embed good practice in Africa

In Africa, training programmes as well as institutional policies on research integrity are lacking. Institutions have a responsibility to oversee research integrity through various efforts, including policies and training. We developed, implemented and evaluated an institutional approach to promote research integrity at African institutions, comprising a workshop for researchers ("bottom-up") and discussions with senior faculty on institutional policies ("top-down"). During the first day, we facilitated a workshop to introduce research integrity and promote best practices with regards to authorship, plagiarism, redundant publication and conflicts of interest. We used a variety of interactive teaching approaches to facilitate learning, including individual and group activities, small group discussions and case-based learning. We met with senior faculty on the following day to provide feedback and insights from the workshop, review current institutional policies and provide examples of what other research groups are doing. We evaluated the process. Participants actively engaged in discussions, recognised the importance of the topic and acknowledged that poor practices occurred at their institution. Discussions with senior researchers resulted in the establishment of a working group tasked with developing a publication policy for the institution. Our approach kick-started conversations on research integrity at institutions. There is a need for continued discussions, integrated training programmes and implementation of institutional policies and guidelines to promote good practices.

[Improving support for HIV-positive elderly people in nursing homes]

The number of HIV-positive people requiring care in nursing homes is still low. However, there are obstacles to their admission or care in such institutions. Consequently, they often find themselves being cared for in a hospital setting. Anticipating the needs of these people will help to improve the care and support available and give rise to alternative residential facilities.

Path-dependent institutions drive alternative stable states in conservation

Intrinsic institutional or ecological differences are often invoked to explain resource conservation success or failure. However, alternative conservation outcomes instead may be caused by path-dependent processes, where historical contingencies trap similar institutions in dramatically different, but predictable, states. We model social-ecological processes in cooperatively managed natural resources and show that institutional path dependence can create alternative stable states of conservation or overharvesting. We find that the model significantly explains a large dataset of well-studied marine fisheries. Highly productive and costly resources are, unexpectedly, most likely to exhibit the alternative stable states of strong depletion or conservation. Path dependence presents challenges and opportunities, including the possibility that short but intensive harvest reduction efforts can generate self-perpetuating conservation outcomes.

Understanding why some renewable resources are overharvested while others are conserved remains an important challenge. Most explanations focus on institutional or ecological differences among resources. Here, we provide theoretical and empirical evidence that conservation and overharvest can be alternative stable states within the same exclusive-resource management system because of path-dependent processes, including slow institutional adaptation. Surprisingly, this theory predicts that the alternative states of strong conservation or overharvest are most likely for resources that were previously thought to be easily conserved under optimal management or even open access. Quantitative analyses of harvest rates from 217 intensely managed fisheries supports the predictions. Fisheries’ harvest rates also showed transient dynamics characteristic of path dependence, as well as convergence to the alternative stable state after unexpected transitions. This statistical evidence for path dependence differs from previous empirical support that was based largely on case studies, experiments, and distributional analyses. Alternative stable states in conservation appear likely outcomes for many cooperatively managed renewable resources, which implies that achieving conservation outcomes hinges on harnessing existing policy tools to navigate transitions.

[Emotional life and sexuality, the institution as their guarantor]

An individual's emotional and/or sex life all too often remains taboo in social and medical-social facilities. However, institutions must to a certain extent be its guarantor, as intimated by the user's intimacy. In this context, it is important to consider the cardinal principal of the person's consent, which is a prerequisite and necessary condition of emotional and/or sexual relations.

Cultural Differences in Strength of Conformity Explained Through Pathogen Stress: A Statistical Test Using Hierarchical Bayesian Estimation

The severity of the environment has been found to have played a selective pressure in the development of human behavior and psychology, and the historical prevalence of pathogens relate to cultural differences in group-oriented psychological mechanisms, such as collectivism and conformity to the in-group. However, previous studies have also proposed that the effectiveness of institutions, rather than pathogen stress, can account for regional variation in group-oriented psychological mechanisms. Moreover, previous studies using nations as units of analysis may have suffered from a problem of statistical non-independence, namely, Galton's problem. The present study tested whether or not regional variation in pathogen stress, rather than government effectiveness, affected collectivism and conformity to social norms by adjusting the effect of global regions using hierarchical Bayesian estimation. We found that the overall effect of pathogen stress remained significant in only one out of the four indices of the regional variability of conformity, and the effects of the government effectiveness also disappeared. Instead, we found that significant effects of both pathogen stress and government effectiveness in specific regions of the world, but these effects were not stable across the measurements. These results indicate that both the effects of pathogen stress and government effectiveness need further reevaluation.

[When burnout sweeps into CMPs]

There have been significant changes in recent years in what psychiatrists are expected to accomplish in CMP [centre médicopsychologique (medical-psychological centre)] consultations. Back in the 1980s, most of the patients seen were psychotic. Then, all of a sudden, psychiatrists began to see a whole new category of cases at CMPs: patients who were exhausted and no longer able to do their jobs properly. This included a wave of civil servants affected by restructuring, followed by private sector employees. These days, most of those who consult for burnout are health workers.

[Training caregivers to improve violence prevention and response]

Confronted with the phenomena of violence, hospital managers are putting in place continuing training sessions addressing the theme of prevention. These so-called 'violent' situations are generally triggered by patients or by their family. The analyses carried out subsequently enable the different mechanisms, notably institutional, which might have contributed to the emergence of these situations, to be identified.

CAREGIVER SENSITIVITY AND CONSISTENCY AND CHILDREN'S PRIOR FAMILY EXPERIENCE AS CONTEXTS FOR EARLY DEVELOPMENT WITHIN INSTITUTIONS

The current study addressed whether two institution-wide interventions in St. Petersburg, Russian Federation, that increased caregiver sensitivity (Training Only: TO) or both caregiver sensitivity and consistency (Training plus Structural Changes: T+SC) promoted better socioemotional and cognitive development than did a No Intervention (NoI) institution during the first year of life for children who were placed soon after birth. It also assessed whether having spent less than 9 versus 9 to 36 months with a family prior to institutionalization was related to children's subsequent socioemotional and cognitive development within these three institutions. The Battelle Developmental Inventory (J. Newborg, J.R. Stock, L. Wnek, J. Guidubaldi, & J. Svinicki, 1988) was used to assess the socioemotional and cognitive functioning of children in NoI (n = 95), TO (n = 104), and T+SC (n = 86) at two to three time points during their first 6 to 12 months of residency. Results suggest that improving caregiver sensitivity can improve the cognitive development of infants in the first year of institutionalization whereas improving caregiver consistency in addition to sensitivity is more beneficial for socioemotional development than is sensitivity alone. Similarly, for children in T+SC, longer time with a family prior to institutionalization (consistent caregiver, unknown sensitivity) was associated with better socioemotional, but not cognitive, baseline scores and more rapid cognitive than socioemotional development during institutionalization. These results suggest caregiver sensitivity is more highly related to cognitive development whereas caregiver consistency is more related to socioemotional development in the first years of life.

Improvising livestock service in hilly regions through indigenous wisdom towards control of tick infestation: Institutional relationships

Aim:

This study was conducted to demonstrate the acaricide efficacy of novel indigenous veterinary medication shared by an outstanding knowledge holder against naturally infested cattle and efforts in mainstreaming such wisdom.

Materials and Methods:

An indigenous herbal medication in control of tick infestation was documented, and experimentation was held against naturally affected cattle. Eighteen clinically infested cattle population comprising 16 crossbred and 2 non-descript cattle were purposively selected. Majority of them were adult females, reported with a higher incidence of tick at Veterinary institution. The average pre-treatment tick count at 24 sites of observations among these animals was 18.91±2.04 (Mean [x̄]±standard error [SE]). The medication was topically applied once daily for 2 days and post-treatment observations were recorded for an experimental period of 14 days’ duration.

Results:

During 24-h post-treatment observation, the medication had shown 92.95% acaricidal property with clinically irrelevant rate of tick infestation of 1.33±0.39 (x̄ ±SE) was noticed before application of subsequent (second) dosage. This practice was found significantly effective at 5% level of significance (t_{0.05, 23}=9.08) illustrating faster relief to livestock. Animals were treated with herbal medication as per dosage on the second day and no reinfestation was noticed up to 14 days of experimental observation.

Conclusion:

The study strengthens the belief that indigenous herbal acaricide can facilitate quality livestock service at geographically distant locations. These medications can provide quicker relief, minimize tick resistance and are favorable to the environment.

The role of leadership in place-based development and building institutional arrangements

In various case studies across Europe the vital role of rural place leadership in enabling a place-based approach to local and regional development has been highlighted, although not always explicitly addressed as such. This paper aims to do so by reviewing the findings from a selection of earlier research projects within a framework of the role of rural leadership in place-based development. Building on the increasing body of literature on place leadership, the review reveals how place leadership in rural areas is performed by varied public, private and civic actors; is able to bridge vested stakes and make new connections; is supportive to joint learning and innovation and an increasing range of bottom-up grassroots initiatives. Effective rural place leadership initiates joint reflection and enforces a collaborative spirit resulting in an expanding spiral of new alliances and new (institutional) arrangements. This underpins the importance of rural place leadership in building collective agency and its capacity to better attune the institutional setting to the specificities of place and thus enhance place-based development.

Protected areas as social-ecological systems: perspectives from resilience and social-ecological systems theory

Conservation biology and applied ecology increasingly recognize that natural resource management is both an outcome and a driver of social, economic, and ecological dynamics. Protected areas offer a fundamental approach to conserving ecosystems, but they are also social-ecological systems whose ecological management and sustainability are heavily influenced by people. This editorial, and the papers in the invited feature that it introduces, discuss three emerging themes in social-ecological systems approaches to understanding protected areas: (1) the resilience and sustainability of protected areas, including analyses of their internal dynamics, their effectiveness, and the resilience of the landscapes within which they occur; (2) the relevance of spatial context and scale for protected areas, including such factors as geographic connectivity, context, exchanges between protected areas and their surrounding landscapes, and scale dependency in the provision of ecosystem services; and (3) efforts to reframe what protected areas are and how they both define and are defined by the relationships of people and nature. These emerging themes have the potential to transform management and policy approaches for protected areas and have important implications for conservation, in both theory and practice.

[Joris or the story of a programmed break]

The case of Joris, a young patient with an atypical clinical presentation, highlights the malaise present in our institutions. In this situation, the passage from paedopsychiatry to adult psychiatry could only end in alienation. This case study provides a basis to explore the clinical and institutional cogwheel of a transitional period that is often difficult.

Use of care and the oral health status of people aged 60 years and older in France: results from the National Health and Disability Survey

Objective

We aimed to analyze, from the data in a national survey, the use of oral care and the oral health status of patients living at home or in an institution.

Background

Patients aged 60 years and older have important oral health needs, but their oral management may differ according to their immediate environment. The fact of living at home or in an institution can influence the use of care and alter the patients’ perception of their oral health status.

Methods

The data analyzed were taken from a survey on disability and health carried out in 2008–2009, which is representative of the population living in France. It consists of two sections, one centered on disability and health among home-dwellers and the other on patients living in an institution. In each of these two populations, we carried out descriptive analysis of three themes: use of care, forgoing of care, and oral health.

Results

Although visits to physicians and specialists were frequent, visits to dentists were lower in both populations. While a minority of patients forwent care, it was dental care that was mainly forgone by both home-dwellers and institutionalized patients. The cost factor remained the principal reason, but other factors such as fear or accessibility problems were cited. Use of a dental appliance was considerably more frequent among institutionalized patients than among home-dwellers, with just over half the institutionalized population wearing a dental appliance. Perceived state of oral health remained difficult to interpret.

Conclusion

To improve access to oral care for the elderly, the patients, their entourage and health providers need increased awareness and information on the importance of good oral health. Better information must be associated with regular clinical examination.

Influence of environmental factors on food intake among nursing home residents: a survey combined with a video approach

Background

In addition to the well-known physiological factors, dietary behavior that affects health seems to be influenced by a wide variety of environmental factors. The aim of this study was to assess, by means of an original video approach, the influence of the environment on food intake in nursing homes.

Methods

The perception of the environment during meals in nursing homes was evaluated by residents and by two groups of volunteers who either work in the field of geriatrics, or who do not work in the field of geriatrics. First, a random sample of residents answered a self-administered questionnaire related to different indicators (ie, noise, space, comfort, light, odors, perceived satisfaction of meals, taste of meals, presentation of meals, service and setting). Second, two separate panels, one including the people who work in the field of geriatrics (ie, experts) and one including the people who have no particular interest in geriatrics (ie, nonexperts), were asked to answer a questionnaire on their perception of the environment after having watched a video of the lunch in each nursing home. Then, the food intake of the residents was measured by a precise food-weighing method.

Results

A total of 88 residents from nine different nursing homes, 18 experts and 45 nonexperts answered the questionnaires. This study highlighted that, on the one hand, after adjustment on confounding variables, the perception of the quantity of food served by the residents is the only single factor associated with food consumption (P=0.003). On the other hand, experts and nonexperts did not perceive any environmental factor that seems to be significantly associated with residents’ food intake.

Conclusion

Our results highlighted that, in a nursing home setting, environmental factors have limited influence on the food intake of the residents, with the exception of their own perception of the quantity served. The relevance of this factor deserves further investigation.

[Acting with compassion, designing care together]

Making care and compassion a central concern in the hospital, and more widely within the community, is essential. This means reflecting on the existential questioning imposed by illness, on the key role of the nursing function and the need to act with compassion, as well as on the awareness of our common vulnerability and the need to support it.

Social engineering of societal knowledge in livestock science: Can we be more empathetic?

Questions are raised in effective utilization of farmer’s wisdom by communities in their farming. Planners support to livelihood emphasize mostly of inputs from outside and not setting up sustainable goals. Formal institutions and planners of program are finding constraints and sceptical in wider dissemination of indigenous knowledge research system (IKRS). This is in spite of evidence that considerable number of farmer’s in livestock sector depends on IKRS. In this context, it is pertinent to showcase dissemination potential of these knowledge system(s) in larger geographical areas. The review illustrates different challenges encountered while control of livestock ailments like ectoparasite infestation through IKRS. Several times, it was opinioned to provide or share IKRS to thwart ailments in a specific region. This is interesting as it was narrated how formal system is unable to recognize farmer’s problem and challenges in integrating these sustainable practices. It has to be noted that disseminating activities seldom takes into account the experimental potential of farmers. This review paper articulates various evidences generated in enhancing diffusion thereby dissemination of IKRS. The nature of support extended by IKRS in entrepreneurial activity of smallholder farming units did not get adequate recognition. There needs to be minimum standard protocol in deriving benefit from such low-cost alternative technologies. This will enrich incremental innovation activities as per location specific need and provide scope for wider dissemination.

Breast cancer and screening in persons with an intellectual disability living in institutions in France

BACKGROUND

We aimed to describe, among a population of women with intellectual disabilities (ID) living in institutions in France, the characteristics in whom breast cancer (BC) was diagnosed and of those who participated in BC screening.

METHODS

Study was performed in 2009 among a random, representative sample of women with ID living in institutions in France. Participants answered a questionnaire either directly by themselves, or with the help of an intermediary.

RESULTS

In total, 978 women with ID aged over 18 years were included, and 14 were diagnosed with BC. The incidence observed in this sample of women with ID is similar to that of the general population (standardised incidence ratio, SIR 0.857, 95% confidence interval (CI) 0.42-1.53). Average age at diagnosis was 47.8 years, and the risk of developing BC before the age of 50 was 2.03% (0.4-3.66). This risk was not significantly different from that of the general population (2.4%, 1.0-3.78). Obesity was almost twice as frequent in women who had BC as compared to those without BC (43% vs. 22.5%, P = 0.0196). Among the 310 women aged >50 years and eligible for the national BC screening programme, 238 (77%) had already had at least one mammogram, and 199 had had it within the previous 2 years. Adherence to the screening programme was 64.2% (199/310) in the participating institutions. This rate was slightly higher than the national average of 62% for the same period.

CONCLUSIONS

The results of this study show that BC is equally as frequent among women with ID living in institutions as in the general population, and occurs at around the same age. Obesity was significantly more frequent among women in whom BC was diagnosed in our study. Participation in BC screening is slightly higher among women with ID living in institutions than among the general population.

[The shared nursing function]

The Chair of Philosophy at Hôtel-Dieu hospital in Paris, is a place for the sharing of knowledge and recognition. It provides a place where the subjective, institutional and political dimension of care can be considered, by all stakeholders: patients, nurses, families and citizens. The aim is to invent a shared nursing function.