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The paper explores the contribution that theories of large-scale transformation can make to the design of palliative and end of life care services in health and social care.

The paper explores the contribution that theories of large-scale transformation can make to the design of palliative and end of life care services in health and social care.Background . Hashimoto's thyroiditis (HT) is an auto-immune condition characterized with lymphocytic and fibroblastic infiltration of the thyroid gland. The rate of uric acid and HDL cholesterol; so called as uric acid to HDL ratio (UHR) has been shown to be elevated in inflammatory conditions diseases. We aimed to compare UHR and other laboratory parameters of the patients with HT to those values in healthy controls. Methods . The patients whom diagnosed with HT by medical history, physical examination, elevated thyroid autoantibodies in serum and characteristic sonographic findings in outpatient internal medicine clinics of our institution were enrolled to the present retrospective study. Age and sex matched healthy volunteers were enrolled as controls. UHR of the HT patients and control subjects were compared. Results . Mean UHR of the HT group was 11% ± 4 %, while UHR of the control group was 8% ± 2% (p less then 0.001). UHR was significantly and positively correlated with thyroid stimulating hormone (TSH) (r=0.26, p=0.01) and negatively correlated with free T4 (FT4) (r=-0.22, p=0.04) levels. The sensitivity and specificity of the UHR level greater than 8.3% were 74% and 52%, respectively (AUC 0.74, p less then 0.001, 95% CI 0.64-0.84). Conclusion . We suggest that UHR is a reliable and useful marker for HT. Therefore, it may be helpful in establishing the diagnosis of HT in addition to other diagnostic tools.Rosemary officinalis L., Pelargonium graveolens L., and Mentha piperita L., essential oils are used by complementary medicine specialists simultaneously with traditional antibiotics for treatment purposes. The chemical composition of essential oils was analyzed by the gas chromatography-mass spectrometry method. In vitro antibacterial and antibiofilm activities of the essential oils were tested against extreme drug-resistant (XDR) colistin-resistant and colistin susceptible Acinetobacter baumannii clinical strains. The synergistic activities between essential oils and colistin antibiotics were investigated by the checkerboard method. The highest antibacterial effect was detected in mint essential oil (2.5-5 μl/ml), followed by pelargonium essential oil (5-20 μl/ml) and rosemary essential oil (5-20 μl/ml). The combination of rosemary essential oil or pelargonium essential oil with colistin showed strong synergistic activity in most of the bacterial strains tested (fractional inhibitory concentration index ≤ 0.5; synergy). As a result of the combination of mint essential oil and colistin, an indifferent effect was observed in only two bacterial strains, and other strains could not be evaluated. No antagonistic effects were observed in any of the tested essential oils. As a result of the effectiveness of the combination, the minimum inhibitory concentration (MIC) values of colistin in XDR-A. baumannii clinical isolates decreased 2-32 fold. Additionally, the sub-MIC concentration of essential oils exhibited an inhibitory effect (48-90%) against the biofilm layer of tested A. baumannii strains.

Familial dysalbuminemic hyperthyroxinemia (FDH) is an autosomal dominant condition caused by heterozygous gain-of-function mutations in the human

gene.

We report, a three-year-old boy with FDH due to p.R242P (or p.R218P without signal peptide) mutation in the

gene with a phenotype characterized by extremely high serum total and free thyroxine concentrations. His parents had normal thyroid function tests (TFT), so the mutation detected in this patient is assumed "

". Although the most frequent variant was p.R242H in Caucasians and p.R242P in Japanese, our patient had p.R242P variant.

Early identification of FDH is fundamental to prevent unnecessary repeats of TFT with different methods. We encourage the

gene hot spot sequencing initially and indicate that this molecular diagnosis is a rapid and simple method to diagnose FDH in individuals with euthyroid hyperthyroxinemia.

Early identification of FDH is fundamental to prevent unnecessary repeats of TFT with different methods. We encourage the ALB gene hot spot sequencing initially and indicate that this molecular diagnosis is a rapid and simple method to diagnose FDH in individuals with euthyroid hyperthyroxinemia.

Non-alcoholic fatty liver disease (NAFLD) is a common obesity-related comorbidity in childhood. In this study, we aimed to evaluate predictors of NAFLD by comparing clinical, endocrine and metabolic findings in obese children with and without hepatosteatosis.

Two hundred and eight obese children aged 6-18 years were included. The patients were divided into group 1 (patients with NAFLD, n=94) and group 2 (patients without NAFLD, n=114). Anthropometric measurements, pubertal stage, lipid profiles, fasting glucose and insulin, homeostatic model of assessment for insulin resistance (HOMA-IR), uric acid, total bilirubin, alanine aminotransferase (ALT), blood urea nitrogen, thyroid-stimulating hormone and free thyroxine parameters were compared retrospectively.

The mean body weight, body mass index (BMI), height, tri-ponderal mass index (TMI), insulin, HOMA-IR, triglyceride, ALT and uric acid values were significantly higher, while high-density lipoprotein-cholesterol (HDL-C) values were significantly lower ies not have a better utility in estimating obesity-induced hepatosteatosis in children. This is the first study to show the association between TMI and hepatosteatosis in children.Introduction Fibromyalgia syndrome (FS) comprises general body pain, sleep disturbances, and fatigue. Vitamin B12 (VB), Vitamin D (VD), and iron deficiencies lead to similar complaints. First, this study aimed to evaluate the VB, VD, and ferritin levels of patients with FS. Second, it aimed to investigate whether there was a relationship between these parameters and FS severity.Material and Methods The study included 58 female patients with FS and 58 healthy females as a control group. The patients completed the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), fatigue questionnaire, Pittsburgh sleep quality scale, and the Short Form-36 (SF-36). This study examined the VD, VB, and ferritin levels of the patient and control groups.Results The VB (240.0 [110.0-394.0] vs 291.0 [210.0-609.0] pg/ml, p less then 0.001), VD (12.5 [3.0-45.0] vs 20.0 [5.0-54.0] ng/ml, p=0.013), and ferritin levels (21.2 [4.0-86.0] vs 32.0 [7.1-120.0], ng/ml, p=0.009) of the FS patients were determined to be significantly lower than those of the control group. A negative correlation was determined between the number of tender points and VB, VD, and ferritin levels. In the regression analysis, we found low ferritin levels (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.015-1.058, p less then 0.001) and VB (OR 1.010, CI 1.002-1.018, p=0.010) to be an independent risk factor for FS.Conclusions There may be a relationship between VB, VD, and ferritin levels and the number of tender points in patients with FS. Levels of iron and VB may play a vital role in FS etiopathogenesis. However, VD levels may not risk factor for FS etiopathogenesis.Mindfulness has been widely studied in Western psychology for reducing psychological distress. However, several scholars noted that in the East, where the concept originated, mindfulness may be understood differently. In Eastern cultures such as Thailand, mindfulness is not only employed to deal with suffering but also to promote well-being. To the best of our knowledge, no studies have been undertaken to evaluate the relationship between traditional mindfulness and eudaimonic well-being in Eastern contexts. SHP099 price In the present study, we investigated the relationships between mindfulness and eudaimonic well-being in Thai contexts. We also explored the mediating roles of rumination and emotion dysregulation on this relationship. Data were collected from 312 Thai undergraduates who completed a measure of Eudaimonic Well-Being, the Freiburg Mindfulness Inventory, the Rumination-Reflection Questionnaire, and the Difficulties in Emotion Regulation Scale. Results largely supported our hypotheses. Mindfulness was found to have a positive and direct association with eudaimonic well-being. Rumination and emotion dysregulation partially mediated this association. Additionally, both rumination and emotion dysregulation had negative and direct association with eudaimonic well-being. The findings highlight the positive influences of mindfulness on well-being. The benefits of mindfulness for improvement of eudaimonic well-being through reducing rumination and emotion dysfunction are discussed.Obesity has been identified mainly as a raise in the body's adiposity leading to prolonged overshoot of caloric intake over expenditure. Obesity has significant health-altering implications which have been shown to be implicated in the pathogenesis and progression of other diseases through its extensive physiological assaults. The prevalence of overweight and obesity has been an increasing epidemic worldwide. The number of obese births was even on the increase, with an increasing number of women of reproductive age registering as obese. link2 Obesity is related to adverse perinatal outcomes and increased morbidity and mortality in pregnant women. The potential risk for multiple antenatal, postpartum, intrapartum, and neonatal complications is maternal obesity. link3 Greater risk of developing Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), pre-eclampsia, risk of venous embolism, increased need for labor induction, and cesarean sections in the mother have been recorded in a comprehensive analysis of pregnancy complications associated with obesity. The link between obesity, gestational diabetes, and pregnancy outcomes will be briefly shown in this article.

The study assessed the prevalence and associated factors of behavioural risk factors of non-communicable diseases (NCDs) among adolescents in four Caribbean countries.

In all 9,143 adolescents (15 years=median age) participated in the cross-sectional "2016 Dominican Republic, 2016 Suriname, 2017 Jamaica, and 2017 Trinidad and Tobago Global School-Based Student Health Survey (GSHS)". Eight behavioural risk factors of NCDs were assessed by a self-administered questionnaire.

Prevalence of each behavioural NCD risk factor was physical inactivity (84.2%), inadequate fruit and vegetable intake (82.2%), leisure-time sedentary behaviour (49.6%), daily≥2 soft drinks intake (46.8%), ever drunk (28.6%), twice or more days a week fast food consumption (27.6%), having overweight/obesity (27.4%), and current tobacco use (13.8%). Students had on average 3.6 (SD=1.4), and 79.0% had 3-8 behavioural NCD risk factors. In multivariable linear regression, psychological distress and older age increased the odds, and attending school and parental support decreased the odds of multiple behavioural NCD risk factors.

A high prevalence and co-occurrence of behavioural risk factors of NCDs was discovered and several factors independently contributing to multiple behavioural NCD risk factors were identified.

A high prevalence and co-occurrence of behavioural risk factors of NCDs was discovered and several factors independently contributing to multiple behavioural NCD risk factors were identified.