Novel computerized health risk appraisal may improve longitudinal health and wellness in primary care: a pilot study.

OBJECTIVES: Health Risk Appraisals (HRAs) have been implemented in a variety of settings, however few studies have examined the impact of computerized HRAs systematically in primary care. The study aimed at the development and pilot testing of a novel, comprehensive HRA tool in primary care practices. METHODS: We designed, implemented and pilot tested a novel, web-based HRA tool in four pair-matched intervention and control primary care practices (N = 200). Outcomes were measured before and 12 months after the intervention using the HRA, patient surveys, and qualitative feedback. Intervention patients received detailed feedback from the HRA and they were encouraged to discuss the HRA report at their next wellness visit in order to develop a personalized wellness plan. RESULTS: Estimated life expectancy and its derivatives, including Real Age and Wellness Score were significantly impacted by the HRA implementation (P<0.001). The overall rate of 10 preventive maneuvers improved by 4.2% in the intervention group vs. control (P = 0.001). The HRA improved the patient-centeredness of care, measured by the CAHPS PCC-10 survey (P = 0.05). HRA use was strongly associated with better self-rated overall health (OR = 4.94; 95% CI, 3.85-6.36) and improved up-to-dateness for preventive services (OR = 1.22; 95% CI, 1.12-1.32). A generalized linear model suggested that increase in Wellness Score was associated with improvements in patient-centeredness of care, up-to-dateness for preventive services and being in the intervention group (all P<0.03). Patients were satisfied with their HRA-experience, found the HRA report relevant and motivating and thought that it increased their health awareness. Clinicians emphasized that the HRA tool helped them and their patients converge on high-impact, evidence-based preventive measures. CONCLUSIONS: Despite study limitations, results suggest that a comprehensive, web-based, and goal-directed HRA tool can improve the receipt of preventive services, patient-centeredness of care, behavioral health outcomes, and various wellness indicators in primary care settings.

Skin disease in sheep farmers.

BACKGROUND: An unusual inflammation of the pinna has been reported to occur in some sheep farmers at the time of lambing. AIMS: To explore the prevalence of this disorder and its possible causal associations. METHODS: While on attachment to sheep farms during lambing, veterinary students used a standardized questionnaire to interview a sample of farmers about their work and about symptoms of skin inflammation in their hands, face and ears. RESULTS: Interviews were completed by 76 (67%) of the farmers approached. Among 74 farmers who had carried out lambing, 3 (4%, 95% CI 1-11%) had experienced temporally related ear symptoms, all on multiple occasions. No farmers with ear symptoms had ever been involved in calving or farrowing, and no ear symptoms were reported in relation to shearing or dipping sheep. There was also an excess of hand symptoms related to lambing outdoors (24% of those who had done such work) and indoors (also 24%) compared with other farming activities. CONCLUSIONS: Our findings suggest that temporally related ear inflammation occurs in at least 1% of farmers who carry out lambing but not in association with the other farming activities investigated. Lambing appears to be associated also with hand inflammation, but the pathology may differ from that in the pinna.

Resistance of Diploid Vaccinium spp. to the Fruit Rot Stage of Mummy Berry Disease.

Mummy berry disease caused by Monilinia vaccinii-corymbosi is the most widespread economically important problem of cultivated blueberry in North America. In an attempt to identify new sources of resistance to the fruit rot (mummification) phase of mummy berry, 140 accessions from a total of 21 populations from seven wild diploid species of blueberry were evaluated for resistance under greenhouse conditions. Six isolates of M. vaccinii-corymbosi from three states were used as inoculum. A highly resistant response to mummy berry fruit rot was exhibited by all accessions of Vaccinium boreale, V. myrtilloides, V. pallidum, and V. tenellum, and by most accessions of V. darrowi. Most of the V. corymbosum and V. elliottii accessions were moderately to highly susceptible. Introgression of the resistance found in the wild diploid species into horticulturally desirable cultivars could significantly improve available resistance.

Studies of seed development in Pisum sativum : II. Ribosomal RNA contents in reciprocal crosses.

Comparisons have been made at different developmental stages of the amounts of ribosomal RNA (rRNA) and of DNA in the cotyledons of two varieties of peas having different seed sizes. That with large seed has more rRNA per cell. The nature of the control of rRNA has been examined by the use of reciprocal crosses between the varieties. rRNA contents in the cells of a seed are not primarily dependent on the amounts of rDNA in those cells, but are regulated by the maternal parent; two hypotheses of the nature of this control are considered.