BACKGROUND: It is common that physicians go to work while sick and therefore it is important to understand the reasons behind. Previous research has shown that women and men differ in health and health related behavior. In this study, we examine gender differences among general practitioners who work while sick. METHODS: General practitioners (GP’s) working in outpatient care in a Swedish city participated in the study (n = 283; women = 63 %; response rate = 41 %). Data were obtained from a large web-based questionnaire about health and organization within primary care. Two questions about sickness presenteeism (going to work while sick) were included; life-long and during the past 12 months, and five questions about reasons. We controlled for general health, work-family conflict and demographic variables. RESULTS: Female physicians reported sickness presenteeism more often than male physicians. Work-family conflict mediated the association between gender and sickness presenteeism. Women reported reasons related with “concern for others” and “workload” more strongly than men. Men reported reasons related with “capacity” and “money” more strongly than women. These differences are likely effects of gender stereotyping and different family-responsibilities. CONCLUSIONS: Gender socialization and gender stereotypes may influence work and health-related behavior. Because sickness presenteeism is related with negative effects both on individuals and at organizational levels, it is important that managers of health organizations understand the reasons for this, and how gender roles may influence the prevalence of sickness presenteeism and the reasons that female and male GPs give for their behavior.
Ambulatory Care ; Delivery of Health Care* ; Female ; Gender Identity ; General Practitioners ; Humans ; Male ; Presenteeism* ; Prevalence ; Primary Health Care ; Socialization ; Stereotyping

OBJECTIVES: This article seeks to describe the current state of informatics supported collaborative care and to point out areas of future research in this highly interdisciplinary field. METHODS: In this article, person-centered collaborative care is seen as a concept addressing both the provision of care over organizational borders between health and social care, and within care teams as well as the changed patient/client-care provider relationship characterized by increased patient/client involvement. RESULTS: From a health systems perspective, there are several attempts to describe the conceptual and theoretical basis for collaborative care indicating that agreement on core concepts and terminology is difficult. From an informatics perspective, focus is on standardization of clinical content models and terminology to achieve interoperability of information technology systems and to support standardized care pathways. Few examples look into how ad-hoc collaborative care processes can be supported using information technology and informatics standards. Nevertheless, promising examples do exist showing that integrational Information Communication Technology services can be supportive for collaborative care developments. However, the current landscape consists of many fragmented, often technology-driven eHealth solutions targeting specific diagnostic groups in geographically and/or organizationally restricted settings. CONCLUSIONS: A systematic approach incorporating organizational, clinical, informatics and social science knowledge is needed to perform further research in areas such as virtual team partnerships, new paradigms of care delivery, data and knowledge management as well as its secure sharing. Also organizational and legal aspects need to be further researched in order to facilitate the coordinated provision of health and social care to citizens including self-management, utilizing informatics support in a societal context.
Cooperative Behavior ; Health Information Management ; Holistic Health ; Informatics ; Jurisprudence ; Knowledge Management ; Self Care ; Social Sciences ; Social Welfare ; Telemedicine

Electrocardiographic (ECG) artefacts may closely simulate both supraventricular and ventricular tachycardias. We describe a case initially diagnosed as rapid atrial fibrillation, based on 12-lead surface ECG (especially the limb leads) and monitor tracing. The arrhythmia was resistant to beta blockers. Because of the at times apparently regular rhythm, an esophageal ECG recording was performed, and adenosine was administered. When the presumed atrial fibrillation terminated after sodium pentothal was administered while preparing for electrical cardioversion, the oesophageal ECG recordings and the ECGs during adenosine administration were reviewed. An ECG artefact diagnosis was suspected, and then confirmed, during relapse of the "arrhythmia," with simple palpation of the radial pulse and cardiac auscultation.
Adenosine/diagnostic use ; Adult ; *Artifacts ; Atrial Fibrillation/*diagnosis/physiopathology/therapy ; *Diagnostic Errors ; *Electrocardiography ; Female ; Humans ; Predictive Value of Tests ; Tachycardia, Supraventricular/*diagnosis/physiopathology/therapy ; Time Factors ; *Unnecessary Procedures

Breast-feeding(BF) failures are common in industrialized societies and can only partly be explained by social, psychologic, cultural and cognitive factors. The more profound causes remain unknown. This annotation presents clinical observations suggesting that several nursing care rituals in delivery rooms and maternity wards interfere with innate behavioural programs and consequently may disturb the unfolding feeding behaviour. Mother-infant interaction including BF depend on the activation of a complex network of neuronal pathways in "the old mammalian brain", as well as of certain hormonal systems especially within the neuropeptide family. Since this organization shows an evolutionary stability one can assume that it has partly been preserved in the human. Initiation and promotion of breast-feeding will benefit if the perinatal care of mother and baby supports their innate behavioural agendas. Mothers who fail often have a low confidence in their ability to breast-feed. The self-confidence is strengthened when the mother experiences that her baby all by itself can find the nipple and begin to suck within an hour of delivery. Similarly this early start helps the baby to develop an adequate sucking technique.
Breast Feeding* ; Breast* ; Ceremonial Behavior ; Delivery Rooms ; Female ; Humans ; Lactation ; Mother-Child Relations ; Mothers ; Neurons ; Neuropeptides ; Nipples ; Nursing Care ; Perinatal Care

A combined cartilage holder and crusher is described that allows the surgeon to hold, crush, morselize, and suture a single piece or stack of cartilage graft without letting it slip. The customized slit-shaped jaws allow adequate room for the suture needle, while the serrated surfaces hold the cartilage firmly. The use of this instrument is advocated primarily in rhinoplasty for manipulating and suturing a small cartilage graft or a stack of grafts. The use of this instrument may be extended to aesthetic or reconstructive cases where cartilage grafts need to be sutured or shaped, as in eyelid, ear, and nipple reconstruction.
Cartilage ; Ear ; Eyelids ; Jaw ; Linear Energy Transfer ; Needles ; Nipples ; Rhinoplasty ; Sutures ; Transplants

No abstract available.
Uterine Cervical Neoplasms

Sporadic conventional colon adenomas are microscopically built of 2 intertwined compartments: one on top, harboring the dysplastic tissue that defines their histo-biomolecular attributes, and the other below, composed of non-dysplastic crypts with corrupted shapes (CCS). The CCS of 306 colon adenomas revealed asymmetric, haphazardly-distributed proliferating cell-domains (PC). In contrast, the PC-domains in normal controls were symmetric, being limited to the lower thirds of the crypts. In 28% out of 501 sporadic conventional adenomas, foci of p53-upregulated dysplastic tissue were found. The CCS in 30% of 108 sporadic adenomas showed p53-upregulated single cells, suggesting mounting somatic mutations. No p53-upregulated cells were found in the crypts of controls. In polypoid adenomas, the mucosa of the stalk without dysplastic tissue on top disclosed CCS with asymmetrical PC-domains and single p53-upregulated cells. The latter observations suggested that CCS had developed prior to and not after the growth of the dysplastic tissue on top. CCS were also found below colon adenomas in carcinogen-treated rats. It is concluded that the 2 intertwined histo-biological compartments of sporadic conventional colon adenomas are probably interdependent components. These findings may open new directions aimed to uncover the link between the normal colonic mucosa and the histogenesis of, conventional adenomas.

A plethora of negative long-term outcomes have been associated with congenital adrenal hyperplasia (CAH). The causes are multiple and involve supra-physiological gluco- and mineralocorticoid replacement, excess adrenal androgens both intrauterine and postnatal, elevated steroid precursor and adrenocorticotropic hormone levels, living with a congenital condition as well as the proximity of the cytochrome P450 family 21 subfamily A member 2 (CYP21A2) gene to other genes. This review aims to discuss the different long-term outcomes of CAH.

Opportunistic bacteria in apical periodontitis (AP) may pose a risk for systemic dissemination. Mucosal-associated invariant T (MAIT) cells are innate-like T cells with a broad and potent antimicrobial activity important for gut mucosal integrity. It was recently shown that MAIT cells are present in the oral mucosal tissue, but the involvement of MAIT cells in AP is unknown. Here, comparison of surgically resected AP and gingival tissues demonstrated that AP tissues express significantly higher levels of Vα7.2-Jα33, Vα7.2-Jα20, Vα7.2-Jα12, Cα and tumour necrosis factor (TNF), interferon (IFN)-γ and interleukin (IL)-17A transcripts, resembling a MAIT cell signature. Moreover, in AP tissues the MR1-restricted MAIT cells positive for MR1-5-OP-RU tetramer staining appeared to be of similar levels as in peripheral blood but consisted mainly of CD4 subset. Unlike gingival tissues, the AP microbiome was quantitatively impacted by factors like fistula and high patient age and had a prominent riboflavin-expressing bacterial feature. When merged in an integrated view, the examined immune and microbiome data in the sparse partial least squares discriminant analysis could identify bacterial relative abundances that negatively correlated with Vα7.2-Jα33, Cα, and IL-17A transcript expressions in AP, implying that MAIT cells could play a role in the local defence at the oral tissue barrier. In conclusion, we describe the presence of MAIT cells at the oral site where translocation of oral microbiota could take place. These findings have implications for understanding the immune sensing of polymicrobial-related oral diseases.
Adult ; Aged ; Female ; Humans ; Immunity, Mucosal ; immunology ; Male ; Microbiota ; Middle Aged ; Mucosal-Associated Invariant T Cells ; Natural Killer T-Cells ; immunology ; Periapical Periodontitis ; microbiology ; surgery