Perspectives and experiences of healthcare professionals regarding the medicalisation of pregnancy and childbirth

Publication date: Available online 7 July 2018

Source: Women and Birth

Author(s): Mirko Prosen, Marina Tavčar Krajnc

Abstract

Background

Pregnancy and childbirth hold broader cultural and societal implications and entail more than simply a natural event. Today, these otherwise natural phenomena are driven by the development of surveillance medicine in a risk-averse society. This affects how both healthcare professionals and women perceive medicalisation and is influencing changes in clinical practice surrounding childbirth.

Aim

The aim of the study was to explore the phenomenon of the medicalisation of pregnancy and childbirth in Slovenia as perceived and experienced by healthcare professionals, namely midwives and obstetricians.

Methods

A descriptive phenomenological approach was used. A purposive sample included 16 midwives and 4 obstetricians working in perinatal healthcare. The data were collected using in-depth, semi-structured, one-to-one interviews and analysed using the phenomenological methodology approach proposed by Colaizzi.

Findings

The two professional groups are well aware of the medicalisation of pregnancy and childbirth, yet there are some differences in experiencing these phenomena. This is revealed with respect to three identified themes: (1) medicalisation as a social construct; (2) unrecognised importance of evidence-based practice in changing medicalised care; and (3) the dimensionalities of the Caesarean section.

Conclusion

Our study suggests woman-centred care that supports autonomy should be more strongly promoted and strategies supporting women with different childbirth preferences developed. The findings also show interprofessional collaboration should be further explored since midwives' autonomy and participatory decision-making in clinical settings is encountering some unresolved issues within the scope of midwifery practice that affect their professionalism.

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COMPLICATIONS AND TRAUMA SEQUELAE

Publication date: Available online 7 July 2018

Source: Injury

Author(s): Luis R. Ramos Pascua

https://ift.tt/2J3ZIm7

Evaluation of a commercial enzyme-linked immunosorbent assay (ELISA) for detecting antibodies against Toxoplasma gondii from naturally and experimentally infected pigs

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Late onset sepsis: comparison between coagulase-negative staphylococci and other bacteria in the neonatal intensive care unit

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https://ift.tt/2lYBiSa

“High” antiretroviral deintensification, a strategy to avoid drug interactions and unfavourable long-term effects of HAART

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https://ift.tt/2u9xktm

Infective endocarditis in Western Norway: a 20-year retrospective survey

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https://ift.tt/2m0J5Pp

Mammalian prion propagation in PrP transgenic Drosophila

Abstract

Mammalian prions propagate by template-directed misfolding and aggregation of normal cellular prion related protein PrP^C as it converts into disease-associated conformers collectively referred to as PrP^Sc. Mammalian species may be permissive for prion disease because these hosts have co-evolved specific co-factors that assist PrP^C conformational change and prion propagation. We have tested this hypothesis by examining whether faithful prion propagation occurs in the normally PrP^C-null invertebrate host Drosophila melanogaster. Ovine PrP transgenic Drosophila exposed at the larval stage to ovine scrapie showed a progressive accumulation of transmissible prions in adult flies. Strikingly, the biological properties of distinct ovine prion strains were maintained during their propagation in Drosophila. Our observations show that the co-factors necessary for strain-specific prion propagation are not unique to mammalian species. Our studies establish Drosophila as a novel host for the study of transmissible mammalian prions.

https://ift.tt/2m4y5jL

Silicone-Induced Foreign Body Reaction: An Unusual Differential Diagnosis of Posterolateral Hip Pain

Background. Silicone injection is commonly used for soft tissue augmentation for esthetic purposes. It is not without complications. Case presentation. We present a case of a 31-year-old woman presenting with refractory left lateral hip pain. Magnetic resonance imaging of the patient's pelvis revealed innumerable small low signal foci throughout the gluteus maximus and overlying subcutaneous fat bilaterally consistent with injectable material, possibly silicone. Conclusions. This case report emphasizes that silicone-induced granulomatosis must be considered in the differential diagnosis of hip pain when evaluating a patient who has had access to plastic surgery or clandestine operators.

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High Circulating Caspase-Cleaved Keratin 18 Fragments (M30) Indicate Short-Term Mortality in Critically Ill Patients

Caspase-cleaved fragments of the intermediate filament protein keratin 18 (cytokeratin-18 (CK18)) can be detected in serum as M30 levels and may serve as a circulating biomarker indicating apoptosis of epithelial and parenchymal cells. In order to evaluate M30 as a biomarker in critical illness, we analyzed circulating M30 levels in 243 critically ill patients (156 with sepsis, 87 without sepsis) at admission to the medical intensive care unit (ICU), in comparison to healthy controls (). M30 levels were significantly elevated in ICU patients compared with healthy controls. Circulating M30 was closely associated with disease severity but did not differ between patients with sepsis and ICU patients without sepsis. M30 serum levels were correlated with biomarkers of inflammation, cell injury, renal failure, and liver failure in critically ill patients. Patients that died at the ICU showed increased M30 levels at admission, compared with surviving patients. A similar trend was observed for the overall survival. Regression analyses confirmed that M30 levels are associated with mortality, and patients with M30 levels above 250.8 U/L displayed an excessive short-term mortality. Thus, our data support the utility of circulating levels of the apoptosis-related keratin fragment M30 as a prognostic biomarker at ICU admission.

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Protective effects of circulating microvesicles derived from ischemic preconditioning on myocardial ischemia/reperfusion injury in rats by inhibiting endoplasmic reticulum stress

Abstract

Microvesicles (MVs) have been shown to be involved in pathophysiology of ischemic heart diseases. However, the underlying mechanisms are still unclear. Here we investigated the effects of MVs derived from ischemic preconditioning (IPC-MVs) on myocardial ischemic/reperfusion (I/R) injury in rats. Myocardial IPC model was elicited by three cycles of ischemia and reperfusion of the left anterior descending (LAD) coronary artery. IPC-MVs from the peripheral blood of the above animal model were isolated by ultracentrifugation and characterized by flow cytometry and transmission electron microscopy. IPC-MVs were administered intravenously (7 mg/kg) at 5 min before reperfusion procedure in I/R injury model which was induced by 30-min ischemia and 120-min reperfusion of LAD in rats. We found that total IPC-MVs and different phenotypes, including platelet-derived MVs (PMVs), endothelial cell-derived MVs (EMVs), leucocyte-derived MVs and erythrocyte-derived MVs (RMVs) were all isolated which were identified membrane vesicles (< 1 µm) with corresponding antibody positive. The numbers of PMVs, EMVs and RMVs were significantly increased in circulation of IPC treated rats respectively. Additionally, treatment with IPC-MVs significantly alleviated damage of myocardium, and restored cardiac function of I/R injury rats, as evidenced by increased heart rate, and decreased the elevation of ST-segment. The size of myocardial infarction, lactate dehydrogenase activity, and the number of apoptotic cardiomyocytes were also reduced significantly with IPC-MVs treatment, coincident with the above function amelioration. Moreover, IPC-MVs decreased the activity of caspase 3, and the expression of endoplasmic reticulum stress (ERS) markers, GRP78, CHOP and caspase 12 indicating the involvement of ERS-specific apoptosis in I/R injury, and cardioprotective effects of IPC-MVs. In summary, our study demonstrated a novel mechanism of IPC in which circulating IPC-MVs could protect hearts from I/R injury in rats through attenuation of ERS-induced apoptosis. These findings provide new insight into therapeutic potential of IPC-induced MVs in cardioprotection against I/R injury.

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Staurosporine-induced apoptotic water loss is cell- and attachment-specific

Abstract

Apoptotic volume decrease (AVD) is a characteristic cell shrinkage observed during apoptosis. There are at least two known processes that may result in the AVD: exit of intracellular water and splitting of cells into smaller fragments. Although AVD has traditionally been attributed to water loss, direct evidence for that is often lacking. In this study, we quantified intracellular water in staurosporine-treated cells using a previously described optical microscopic technique that combines volume measurements with quantitative phase analysis. Water loss was observed in detached HeLa and in adherent MDCK but not in adherent HeLa cells. At the same time, adherent HeLa and adherent MDCK cells exhibited visually similar apoptotic morphology, including fragmentation and activation of caspase-3. Morphological changes and caspase activation were prevented by chloride channel blockers DIDS and NPPB in both adherent and suspended HeLa cells, while potassium channel blocker TEA was ineffective. We conclude that staurosporine-induced dehydration is not a universal cell response but depends on the cell type and substrate attachment and can only be judged by direct water measurements. The effects of potassium or chloride channel blockers do not always correlate with the AVD.

https://ift.tt/2ucQ4II

Correction to: Dying to communicate: apoptotic functions of Eph/Ephrin proteins

The original version of this article contained a mistake in reference. The references in Table 1 are incorrect. The corrected Table with proper citation is given below. The field codes ADDIN REFMGR.CITE inadvertently appeared along the article. This was overlooked during the process.

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Incremental Role of 18 FDG PET/CT in Assessment of Testicular Viability

Abstract

Testicular torsion is a common differential diagnosis of acute scrotal pain along with acute epididymo-orchitis, which may lead to testicular non-viability. Doppler ultrasound and testicular scintigraphy are two routinely used modalities for the assessment of testicular viability. However, in some cases, these investigations may prove inadequate in differentiating between the two entities with widely differing management. Here, we present a case of a 52-year-old male with questionable viability of testis, who was investigated initially using testicular scintigraphy and was further subjected to a regional 18F-FDG PET/CT scan, in view of inconclusive findings with the conventional modalities.

https://ift.tt/2ziYns9

A Comparison of the Accuracy of Different Single Plasma Sample Methods for Measuring Glomerular Filtration Rate Using 51 Cr-EDTA in Children

Abstract

Purpose

Among the different methods of measuring glomerular filtration rate (GFR) using ⁵¹Cr-ethylenediaminetetraacetic acid clearance, the two-plasma-sample method (TPSM) is widely used, and highly accurate. The single-plasma-sample method (SPSM) is occasionally used for simplicity, at the expense of accuracy. Our aims were (1) to investigate the correlation and (2) to compare the accuracy of six known SPSMs in pediatric patients in reference to TPSM.

Methods

We retrospectively reviewed 122 pediatric cases (65 boys, age 7.3 ± 4.6 years) and analyzed 307 GFR measurements. SPSMs included Groth and Aasted at 120 min, Ham at 120 min, Christensen and Groth at 120 and 240 min, and Jacobsson at 120 and 240 min. Reference GFR (GFR_ref) was defined using TPSM GFR corrected by the Jodal and Brochner-Mortensen equation. GFR_ref < 30 mL min⁻¹ 1.73 m⁻² were excluded. The standard error of the estimate (SEE) and the number of cases with differences > 10% (N_10%) were used to evaluate accuracy.

Results

SPSMs generally correlated well with GFR_ref (r = 0.92~0.99) and were relatively accurate (SEE = 9.21~15.60). Groth and Aasted showed the smallest SEE, while Jacobsson at 240 min showed the smallest N_10% for all GFR_ref ranges. As for the decreased GFR_ref, Ham was most accurate followed by Jacobsson at 240 min.

Conclusions

Jacobsson at 240 min provided good accuracy in all GFR_ref ranges and was well correlated with TPSM. Jacobsson at 240 min might be the most appropriate method to substitute for TPSM in pediatric patients. Ham could be an alternative in patients with impaired renal function.

https://ift.tt/2u1oChI

Appropriateness of end-of-life care in people dying from COPD. Applying quality indicators on linked administrative databases

Large-scale evaluations of the quality of end-of-life care in people with COPD are lacking. By means of a validated set of quality indicators, this study aims to:1. Assess appropriateness of end-of-life care in people dying from COPD,2. Examine variation between care regions,3. Establish performance standards.

https://ift.tt/2u1C451

The Design and Implementation of a Physician-Staffed, Referral-Based Advance Directive Clinic at an Academic Medical Center

The utilization and cost of critical care in the United States is rapidly growing (1). Evidence suggests that many patients receive unwanted medical treatments near the end of life, and clinical momentum in the intensive care unit may preclude patients from receiving their preferred plan of care (2). Some have proposed that improving the completion rate and availability of advance directives (ADs) may slow the momentum towards inappropriate, aggressive treatments at the end of life (3). At Loyola University Medical Center, only 17% of patients expiring in an ICU have an AD on file.

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Editorial Board

https://ift.tt/2u0BbcW

Table of Contents

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Establishing Goals of Care for Patients with Stroke and Feeding Problems: An Interdisciplinary Trigger-Based Continuous Quality Improvement Project

Few patients with dysphagia due to stroke receive early palliative care to align treatment goals with their values, as called for by practice guidelines, particularly before enteral access procedures for artificial nutrition.

https://ift.tt/2u1m8Qq

Re-framing Global palliative care advocacy for the Sustainable Development Goal era: a qualitative study of the views of international palliative care experts

The World Health Assembly Palliative Care Resolution in 2014 and the inclusion of palliative care within the Sustainable Development Goals raised optimism that palliative care would no longer be a peripheral aspect of global health. However, no funding, accountability measures or indicators for palliative care development accompanied these policy developments. This risks health actors continuing to prioritise the attainment of better known, target-driven aspects of healthcare.

https://ift.tt/2u9kds8

Escaping Sonder

TED talker John Koenig is on a mission "to find holes in the language of emotion and…fill them so that we have a way of talking about the human condition."1 His efforts caught my ear when he invented and defined the word sonder: "the awareness that everyone has a story," that the random passersby around us each have their own, rich emotional experiences, and that we may never know what those are. The word connotes a sense of melancholy, like a longing to be a part of, if not to know, the stories of others.

https://ift.tt/2u1uesb

Improving A Full Range of Advance Care Planning Behavior Change and Action Domains: the PREPARE Randomized Trial

Advance care planning (ACP) engagement includes a wide range of behaviors and actions related to discussions and documentation, yet few ACP intervention studies measure the full process.

https://ift.tt/2u85EFo

Palliative Care Competencies and Readiness for Independent Practice: A Report on the American Academy of Hospice and Palliative Medicine Review of the United States Medical Licensing Step Examinations

We reviewed USMLE Step examinations for palliative care (PC) content, assessing whether they tested PC knowledge necessary for graduating medical students and residents applying for licensure.

https://ift.tt/2u2pym2

Inferring ancient relationships with genomic data: a commentary on current practices

Abstract

Contemporary phylogeneticists enjoy an embarrassment of riches, not only in the volumes of data now available, but also in the diversity of bioinformatic tools for handling these data. Here, I discuss a subset of these tools I consider well-suited to the task of inferring ancient relationships with coding sequence data in particular, encompassing data generation, orthology assignment, alignment and gene tree inference, supermatrix construction, and analysis under the best-fitting models applicable to large-scale datasets. Throughout, I compare and critique methods, considering both their theoretical principles and the details of their implementation, and offering practical tips on usage where appropriate. I also entertain different motivations for analysing what are almost always originally DNA sequence data as codons, amino acids, and higher-order recodings. Although presented in a linear order, I see value in using the diversity of tools available to us to assess the sensitivity of clades of biological interest to different gene and taxon sets and analytical modes, which can be an indication of the presence of systematic error, of which a few forms remain poorly controlled by even the best available inference methods.

https://ift.tt/2NvEP6O

Behavior, Electrophysiology and Robotics Experiments to Study Lateral Line Sensing in Fishes

Abstract

The lateral line system is a sensory system unique to fishes and amphibians. It is composed of distributed mechanosensory hair cell organs on the head and body (neuromasts), which are sensitive to pressure gradients and water movements. Over the last decade, we have pursued an interdisciplinary approach by combining behavioral, electrophysiology and robotics experiments to study this fascinating sensory system. In behavioral and electrophysiology experiments, we have studied the larval lateral line system in the model genetic organism, zebrafish (Danio rerio). We found that the lateral line system, even in five-day old larvae, is involved in an array of behaviors that are critical to survival, and the deflection of a single neuromast can elicit a swimming response. In robotics experiments, we used a range of physical models with distributed pressure sensors to better understand the hydrodynamic environments from the local perspective of a fish or robot. So far, our efforts have focused on extracting control-related information for a range of application scenarios including characterizing unsteady flows such as Kármán vortex streets for station holding. We also used robot models to test biological hypotheses on how morphology and movement of fishes affect lateral line sensing. Overall, with this review we aim to increase the visibility and accessibility of this multi-disciplinary research approach.

https://ift.tt/2KUbK3h

The mitochondrial contribution to animal performance, adaptation, and life-history variation

Abstract

Animals display tremendous variation in their rates of growth, reproductive output, and longevity. While the physiological and molecular mechanisms that underlie this variation remain poorly understood, the performance of the mitochondrion has emerged as a key player. Mitochondria not only impact the performance of eukaryotes via their capacity to produce ATP, but they also play a role in producing heat and reactive oxygen species and function as a major signalling hub for the cell. The papers included in this special issue emerged from a symposium titled "Inside the Black Box: The Mitochondrial Basis of Life-history Variation and Animal Performance". Based on studies of diverse animal taxa, three distinct themes emerged from these papers. 1) When linking mitochondrial function to components of fitness, it is crucial that mitochondrial assays are performed in conditions as close as the intracellular conditions experienced by the mitochondria in vivo. 2) Functional plasticity allows mitochondria to retain their performance, as well as that of their host, over a range of exogenous conditions, and selection on mitochondrial and nuclear-derived proteins can optimize the match between the environment and the bioenergetic capacity of the mitochondrion. Finally, 3) studies of wild and wild-derived animals suggest that mitochondria play a central role in animal performance and life history strategy. Taken as a whole, we hope that these papers will foster discussion and inspire new hypotheses and innovations that will further our understanding of the mitochondrial processes that underlie variation in life history traits and animal performance.

https://ift.tt/2NzWFph

′The same thing that makes you live can kill you in the end′: exploring the effects of growth rates and longevity on cellular metabolic rates and oxidative stress in mammals and birds

Abstract

All aerobic organisms are subjected to metabolic by-products known as reactive species (RS).RS can wreak havoc on macromolecules by structurally altering proteins and inducing mutations in DNA, among other deleterious effects. . To combat accumulating damage, organisms have an antioxidant system to sequester RS before they cause cellular damage. The balance between RS production, antioxidant defences, and accumulated cellular damage is termed oxidative stress. Physiological ecologists, gerontologists and metabolic biochemists have turned their attention to whether oxidative stress is the principal, generalized mechanism that mediates and limits longevity, growth rates and other life-history trade-offs in animals, as may be the case in mammals and birds. At the crux of this theory lies the regulation and activities of the mitochondria with respect to the organism and its metabolic rate. At the whole-animal level, evolutionary theory suggests that developmental trajectories and growth rates can shape the onset and rate of aging. Mitochondrial function is important for aging since it is the main source of energy in cells, and the main source of RS. Altering oxidative stress levels, either increases in oxidative damage or reduction in antioxidants, has proven to also decrease growth rates, which implies that oxidative stress is a cost of, as well as a constraint on, growth. Yet, in nature, many animals exhibit fast growth rates that lead to higher loads of oxidative stress, which are often linked to shorter lifespans. In this paper, I summarize the latest findings on whole-animal life history trade-offs, such as growth rates and longevity, and how these can be affected by mitochondrial cellular metabolism, and oxidative stress.

https://ift.tt/2L1Knog

The RCR and ATP/O indices can give contradictory messages about mitochondrial efficiency

Abstract

Mitochondrial efficiency is typically taken to represent an animal's capacity to convert its resources into ATP. However, the term mitochondrial efficiency, as currently used in the literature, can be calculated as either the respiratory control ratio, RCR (ratio of mitochondrial respiration supporting ATP synthesis to that required to offset the proton leak) or as the amount of ATP generated per unit of oxygen consumed, ATP/O ratio. The question of how flexibility in mitochondrial energy properties (i.e. in rates of respiration to support ATP synthesis and offset proton leak, and in the rate of ATP synthesis) affects these indices of mitochondrial efficiency has tended to be overlooked. Furthermore, little is known of whether the RCR and ATP/O ratio vary in parallel, either among individuals or in response to environmental conditions. Using data from brown trout Salmo trutta we show that experimental conditions affect mitochondrial efficiency, but the apparent direction of change depends on the index chosen: a reduction in food availability was associated with an increased RCR (i.e. increased efficiency) but a decreased ATP/O ratio (decreased efficiency) in liver mitochondria. Moreover, there was a negative correlation across individuals held in identical conditions between their RCR and their ATP/O ratio. These results show that the choice of index of mitochondrial efficiency can produce different, even opposing, conclusions about the capacity of the mitochondria to produce ATP. Neither ratio is necessarily a complete measure of efficiency of ATP production in the living animal (RCR because it contains no assessment of ATP production, and ATP/O because it contains no assessment of respiration to offset the proton leak). Consequently, we suggest that a measure of mitochondrial efficiency obtained nearer to conditions where respiration simultaneously offsets the proton leak and produce ATP would be sensitive to changes in both proton leakage and ATP production, and is thus likely to be more representative of the state of the mitochondria in vivo.

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Adding Value to the Conversation About Colorectal Cancer Screening: Practical Pearls For Gastroenterologists

https://ift.tt/2KR78OJ

Decreased occipital alpha oscillation in children who stutter during a visual Go/Nogo task

In developmental stuttering speech is dysfluent due to interruptions, repetitions and prolongations that complicate communication, often causing anxiety or fear of speaking. Many theories have associated stuttering severity with temperamental factors as high emotional reactivity (Conture et al., 2006; Bloodstein and Bernstein Ratner, 2008; Eggers and Van den Bergh, 2010) and self-regulation and inattention (Eggers et al., 2012; Eggers et al., 2013; Eggers and Jansson-Verkasalo, 2017; please see also review by Alm, 2014).

https://ift.tt/2NveK7Y

Residents' journal review

Management of maxillary impacted canines requires a more complex and challenging treatment plan with generally greater cost and commitment. Thus, evidence-based information is needed regarding interceptive management of this condition. The practice of extracting maxillary deciduous canines to facilitate successful eruption of palatally displaced permanent canines has been promoted since the 1930s; yet the evidence from studies up to 2012 has been inconclusive. The authors of this systematic review and meta-analysis sought to analyze the quality of current evidence in randomized controlled trials supporting this practice.

https://ift.tt/2KSIux6

The truth be told

You've always enjoyed getting your haircut at Sal's Barber Shop. Sal has been your barber for over 30 years, and he considers himself to be an expert on everything from global politics to marital problems. As you sit down for your haircut, Sal tells you about the latest edition of Your City magazine that is dedicated to highlighting the best ice cream shops in your town. Evidently, Sal is also an expert on ice cream. At the end of the magazine is a section that lists the regional dental professionals as an advertising initiative.

https://ift.tt/2J27UUd

Erratum

Correction to: Nejaim Y, Aps JKM, Groppo FC, and Haiter Neto F. Evaluation of pharyngeal space and its correlation with mandible and hyoid bone in patients with different skeletal classes and facial types. Am J Orthod Dentofacial Orthop. 2018;153:825-33.

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Laparoscopic intersphincteric resection with intraoperative radiotherapy using low-energy X-rays for locally advanced ultra-low rectal cancer

Abstract

Background

In order to overcome the shortcomings of laparoscopic intersphincteric resection (Lap ISR), an alternative method of delivering intraoperative radiotherapy by Intrabeam X-rays radiotherapy system (XRS) is proposed in this paper. Intrabeam XRS is a device that uses low-energy X-rays source generated by a mobile controller unit, which is featured in accurate irradiation, reduced complications, and less exposure. The purpose of this study is to discuss the feasibility of Lap ISR with intra-operative radiotherapy using low-energy X-rays for locally advanced ultra-low rectal cancer in Asian woman. This novel proposed method will greatly increase the anus preserving probability and improved the quality of life.

Methods

A 53-year-old woman diagnosed with rectal adenocarcinoma had a strong desire to preserve the anal function and presented at the Jilin University Second Hospital, Jilin, China. The tumor's size was 4 cm × 3 cm. It was located 2 cm from the anus merge and invaded the levator ani muscle. Preoperative clinical staging was T4N1M0 and could be reached R0 resection. After the consent form was signed by the patient, Lap ISR combined with the applicator put through the anus (natural orifice) to the tumor bed was performed and prophylactic ileostomy synchronized the anastomosis. Patient only received 1-cycle chemotherapy regimen of oxaliplatin with capecitabine postoperatively due to personal reasons. Pre- or postoperative radiotherapy was not given.

Results

After clinical follow-up, until now, there is not any sign of local recurrence. Anus function and short-term complications are acceptable. The short-term effect is satisfying and we look forward to further assess the long-term effect.

Conclusion

Laparoscopic intersphincteric resection with IORT using low-energy X-rays for the patients with late-stage ultra-low rectal cancer could provide an opportunity of preserving the anus function, and it is feasible for the selected patients.

Trial registration

Retrospectively registered; Trial registration: NCT03393234; Registered time: 05 January 2017.

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Plasma levels of the proangiogenic protein CXCL16 remains elevated for 1 month after minimally invasive colorectal cancer resection

Abstract

Background

Inflammation-induced endothelial precursor cell recruitment and angiogenesis are thought to be associated with CXCL16-CXCR6 pair activity. This study's main purpose was to determine plasma CXCL16 levels after minimally invasive colorectal resection (MICR) for colorectal cancer (CRC); an adjunct study assessed wound fluid (WF) and plasma CXCL16 levels in a separate group of CRC patients.

Methods

CRC patients who had MICR and for whom plasma was available in a tissue bank were eligible. Plasma samples were collected preoperatively from all patients. Samples were also collected on postoperative days (POD) 1 and 3 and at various late postoperative time points (POD 7–34). In a separate study, blood and intra-abdominal wound fluid (WF) samples were collected from CRC MICR patients (pts). Samples were stored at − 80 °C. CXCL16 levels were determined via ELISA. The Wilcoxon signed-rank and Mann and Whitney tests were used for analysis.

Results

Main study: 86 CRC pts. were included. The mean preoperative plasma CXCL16 level was 2.36 ± 0.57 ng/ml. Elevated mean plasma levels (p <  0.0001 × first 4 time points) were noted on POD 1 (2.82 ± 0.81, n = 86), POD 3 (3.12 ± 0.77, n = 82), POD 7–13 (3.28 ± 0.88, n = 64), POD 14–20 (3.03 ± 0.62, n = 24), POD 21–27 (3.06 ± 0.67, n = 20, p = 0.0003), and POD 28–34 (3.17 ± 0.43, n = 11, p = 0.001) vs. preop levels. WF study: In the adjunct study, plasma and WF CXCL16 levels were determined for 23 CRC MICR pts. WF levels at all time points were significantly elevated over plasma levels.

Conclusion

Plasma CXCL16 levels were elevated for 4 weeks after minimally invasive colorectal resection for cancer. Also, WF CXCL16 levels were 3–10 times greater than the corresponding plasma concentrations. The source of the late plasma elevations may be the healing wound. Increased plasma CXCL16 levels may promote tumor angiogenesis in the first month after MICR.

https://ift.tt/2KXCXST

Proton pump inhibitors and suppression of duodenal eosinophilia in functional dyspepsia

We read with interest the study by Molina-Infante et al1 regarding proton pump inhibitor (PPI) responsive oesophageal eosinophilia. The authors emphasise that the benefit of PPI therapy may be secondary to anti-inflammatory effects (blocking of STAT 6) rather than antisecretory properties, which raises the question whether PPI therapy may be beneficial in other eosinophilic disease of the gastrointestinal tract. We report here novel observations of the effect of PPI therapy on duodenal eosinophilia in patients with functional dyspepsia (FD) which lends further support to this hypothesis.

FD is characterised by bothersome postprandial symptoms that cannot be easily be explained at upper gastrointestinal endoscopy.2 It is further subdivided into the postprandial distress syndrome (PDS), comprising patients who report early satiety or the inability to finish a regular sized meal, and the epigastric pain syndrome, comprising those with epigastric pain or burning which may or may not be postprandial. FD...

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Prox1 is essential for oligodendrocyte survival and regulates oligodendrocyte apoptosis via the regulation of NOXA

Abstract

Demyelinating diseases, such as multiple sclerosis, are known to result from acute or chronic injury to the myelin sheath and inadequate remyelination. Its underlying molecular mechanisms, however, remain unclear. The transcription factor prospero homeobox 1 (Prox1) plays an essential role during embryonic development of the central nervous system and cell differentiation. Thus, we aimed to investigate the role of Prox1 in the survival and differentiation of oligodendrocytes. Cell viability was measured by MTT assay. Flow cytometry was conducted to analyze cell apoptosis. Ectopic-Prox1 and shProx1 were used for the overexpression and knockdown respectively of Prox1 in FBD-102b cells. Real-time reverse transcriptase polymerase chain reaction and western blot analysis were used to assess the alterations of signaling pathway-related mRNAs and proteins, respectively. Results showed that Prox1 was upregulated in differentiating oligodendrocytes, and Prox1 knockdown inhibited the differentiation of oligodendrocytes. In addition, overexpression of Prox1 promoted oligodendrocyte differentiation, as shown by the change in myelin basic protein expression. The overexpression of Prox1 had no effect on oligodendrocyte survival, while Prox1 knockdown impaired cell survival. Further study demonstrated that Prox1 knockdown promoted oligodendrocyte apoptosis and activated NOXA, a pro-apoptotic member of the Bcl-2 protein family. Knockdown of NOXA by siRNA abrogated Prox1 knockdown-induced apoptosis. Our findings indicated that Prox1 regulated the differentiation of oligodendrocyte precursor cells via the regulation of NOXA. Therefore, Prox1 could be a potential modulator of demyelinating diseases in clinical settings.

https://ift.tt/2u2mp5u

S1P1 receptor inhibits kidney epithelial mesenchymal transition triggered by ischemia/reperfusion injury via the PI3K/Akt pathway

Abstract

Ischemia/reperfusion (I/R) is a major cause of acute kidney injury (AKI), along with delayed graft function, which can trigger chronic kidney injury by stimulating epithelial to mesenchymal transition (EMT) in the kidney canaliculus. Sphingosine 1-phosphate receptor 1 (S1P1) is a G protein-coupled receptor that is indispensable for vessel homeostasis. This study aimed to investigate the influence of S1P1 on the mechanisms underlying I/R-induced EMT in the kidney using in vivo and in vitro models. Wild-type (WT) and S1P1-overexpressing kidney canaliculus cells were subject to hypoxic conditions followed by reoxygenation in the presence or absence of FTY720-P, a potent S1P1 agonist. In vivo, bilateral arteria renalis in wild-type mice and mice with silenced S1P1 were clamped for 30 min to obtain I/R models. We found that hypoxia/reoxygenation (H/R) significantly enhanced the expressions of EMT biomarkers and down-regulated S1P1 expression in wild-type canaliculus cells. In contrast, FTY720-P treatment or overexpression of S1P1 significantly suppressed EMT in wild-type canaliculus cells. Furthermore, after 48–72 h, a significant upregulation of EMT biomarker expression was triggered by I/R in mice with silenced S1P1, while the expressions of these markers did not change in wild-type mice. A kt activity was increased with H/R-induced EMT, suggesting that the protective influence of FTY720-P was due to its inhibition of PI3K/Akt. Therefore, the results of this study provide evidence that down-regulation of S1P1 expression is essential for the generation and progression of EMT triggered by I/R. S1P1 exhibits a prominent inhibitory effect on kidney I/R-induced EMT in the kidney by affecting the PI3K/Akt pathway.

https://ift.tt/2zev1eq

RNA interference targeting CD147 inhibits metastasis and invasion of human breast cancer MCF-7 cells by downregulating MMP-9/VEGF expression

Abstract

Breast cancer is one of the most common malignancies. It is necessary to identify new markers for predicting tumor progression and therapeutic molecular targets. It has been reported that CD147 is one of the most commonly expressed proteins in primary tumors and in metastatic cells. In this study, we investigated the role of CD147 in human breast cancer metastasis and invasion, and examined its underlying molecular mechanisms. Immunohistochemistry results revealed high expression of CD147 in human breast tumor tissues, which was positively correlated with the malignancy of breast cancer. MCF-7 cells were transfected with CD147 siRNA eukaryotic expression vector, which resulted in significant knockdown of CD147. We found that CD147 siRNA dramatically inhibited cell proliferation, metastasis, and invasion. Furthermore, our results demonstrated that CD147 siRNA inhibited the synthesis of matrix metalloproteinase 9 (MMP-9) but had no significant effect on matrix metalloproteinase 2 (MMP-2). In addition, CD147 siRNA significantly inhibited the production of vascular endothelial growth factor (VEGF). Taken together, these data indicate that CD147 promotes breast cancer cell proliferation, metastasis, and invasion by modulating MMP-9 and VEGF expression. Thus, CD147 may be used as an important indicator for the judgment of malignant behavior of breast cancer, and may be a potential novel target for breast cancer therapy.

https://ift.tt/2u2mjLa

What is the Most Accurate Radiographic Criterion to Determine Anterior Cervical Fusion?

Publication date: Available online 7 July 2018

Source: The Spine Journal

Author(s): K. Daniel Riew, Jae Jun Yang, Dong-Gune Chang, Sang-Min Park, Jin S. Yeom, Jae Sung Lee, Eui-Chan Jang, Kwang-Sup Song

Abstract

Background context

The accuracy of radiographic criteria for determining anterior cervical fusion remains controversial, and inconsistency in the literature makes a comparison of published clinical results problematic. The descriptions of bridging bone are still lacking and subjective, and the interpretation of images can be influenced by the type of graft or cage used.

Purpose

To assess and validate the diagnostic accuracies of four radiographic fusion criteria using the results of surgical exploration.

Study design

Retrospective, radiographic, comparative study.

Patient sample

This study included patients who required anterior or posterior exploration of a previous anterior cervical arthrodesis level(s) ranging from C3-C4 to C7-T1 for suspected pseudarthrosis or adjacent-segment pathologies. They underwent radiologic examinations to determine the four fusion criteria. We included patients whose images were taken at least 1 year after the index surgery, and 82 patients with 151 cervical segments were enrolled.

Outcome measures

The inter- and intra-rater reliabilities and validity that correlated with the results of surgical exploration for the four fusion criteria were assessed using data (fusion or not) that were collected by two raters.

Methods

The four published radiographic fusion criteria were interspinous motion (ISM) < 1 mm and superjacent ISM ≥ 4 mm, seen on dynamic radiographs; conventional bridging bone, as seen on computed tomography (CT) scans; and extra-graft bridging bone (ExGBB) and intragraft bridging bone (InGBB), observed on multi-axial reconstructed CT scans. The criteria were evaluated by two raters (spine surgeons with 5 and 7 years of experience). The raters evaluated each criterion twice at two different time points, 3-4 weeks apart. First, ISM and conventional bridging bone on CT scans were evaluated, followed by ExGBB and InGBB, with a time interval of 4 months. This Research was supported by the Chung-Ang University Research Grants (less than 5,000 US dollars) in 2016.

Results

The inter- and intra-rater reliability values of the ExGBB (0.887-0.933) criteria were the highest, followed by those for the ISM (0.860-0.906), bridging bone (0.755-0.907), and InGBB (0.656-0.695) criteria. The validity values that correlated with the exploration results were the highest for the ExGBB criteria (k=0.889), followed by the ISM (k=0.776), bridging bone (k=0.757), and InGBB (k=0.656) criteria and ExGBB showed the highest sensitivity (91.7%) and specificity (98.4%). Regarding the graft materials that were used, all criteria had the highest values in the auto-cortical group and lowest values in the cage group. Of note, sensitivity and specificity of ExGBB were 100% in autocortical group. In the cage group, the validity values for the ExGBB (k=0.663) and ISM (k=0.666) criteria were higher than those for the bridging bone (k=0.504) and InGBB (k=0.308) criteria

Conclusion

The presence of ExGBB (anterior, posterior, or lateral to the graft or cage) correlated the best with surgical exploration. The ISM criteria demonstrated a similar accuracy to that of conventional bridging bone criteria on CT scans. In arthrodesed segments with auto-cortical bone, criteria showed the highest validity values. In cage group, ISM and ExGBB had acceptable accuracy, but the conventional bridging bone and InGBB were worse than guessing. We recommend that ISM and ExGBB criteria should be used to increase accuracy in patients who undergo arthrodesis with cages.

https://ift.tt/2KUaRei

The biomechanical influence of anterior vertebral body osteophytes on the lumbar spine: a finite element study

Publication date: Available online 7 July 2018

Source: The Spine Journal

Author(s): Kuan Wang, Chenghua Jiang, Lejun Wang, Huihao Wang, Wenxin Niu

Abstract

Background Context

Anterior vertebral body osteophytes are common with degeneration but their biomechanical influence on the whole lumbar spine remains unclear.

Purpose

To investigate the biomechanical influence of anterior vertebral body osteophytes on the whole lumbar spine.

Study Design/Setting

This is a study using finite element analysis.

Outcome Measures

Intersegmental rotation, maximum Mises stress and intradiscal pressure on the intervertebral discs of different lumbar levels were calculated.

Methods

A finite element model of an intact lumbar spine was constructed and validated against in vitro studies. The modified models, which had different degrees of anterior vertebral body osteophyte formation in combination with disc space narrowing, were applied with physiological loadings.

Results

The lumbar levels with various degrees of osteophyte formation altered the kinematics of these levels, which also affected the whole lumbar spine. In flexion and lateral bending, the segment that was one level inferior to the vertebra with osteophyte formation showed a trend towards increased range of motion. On the intervertebral discs that were one level inferior to the osteophyte formation level, a trend towards increase in the maximum von Mises stress was found on the annulus.

Conclusions

Segments adjacent to levels with anterior vertebral body osteophytes showed increased intersegmental rotation and maximum stress. Further clinical observation should be performed to verify the results in vivo.

https://ift.tt/2J6pd6m

Different but similar: personality traits of surgeons and internists--results of a cross-sectional observational study

Objectives

Medical practice may attract and possibly enhance distinct personality profiles. We set out to describe the personality profiles of surgical and medical specialties focusing on board-certified physicians.

Design

Prospective, observational.

Setting

Online survey containing the Ten-Item Personality Inventory (TIPI), an internationally validated measure of the Five Factor Model of personality dimensions, distributed to board-certified physicians, residents and medical students in several European countries and Canada. Differences in personality profiles were analysed using multivariate analysis of variance and Canonical Linear Discriminant Analysis on age-standardised and sex-standardised z-scores of the personality traits. Single personality traits were analysed using robust t-tests.

Participants

The TIPI was completed by 2345 board-certified physicians, 1453 residents and 1350 medical students, who also provided demographic information.

Results

Normal population and board-certified physicians' personality profiles differed (p<0.001). The latter scored higher on conscientiousness, extraversion and agreeableness, but lower on neuroticism (all p<0.001). There was no difference in openness to experience. Board-certified surgical and medical doctors' personality profiles were also different (p<0.001). Surgeons scored higher on extraversion (p=0.003) and openness to experience (p=0.002), but lower on neuroticism (p<0.001). There was no difference in agreeableness and conscientiousness. These differences in personality profiles were reproduced at other levels of training, that is, in students and training physicians engaging in surgical versus medical practice.

Conclusion

These results indicate the existence of a distinct and consistent average 'physician personality'. Despite high variability within disciplines, there are moderate but solid and reproducible differences between surgical and medical specialties.

https://ift.tt/2J6Dlgc

Association between QTc prolongation and mortality in patients with suspected poisoning in the emergency department: a transnational propensity score matched cohort study

Objectives

Poisoning is a frequent cause of admission to the emergency department (ED) and may involve drugs known to prolong the QT interval. This study aims to describe the prevalence of QTc prolongation among ED patients with suspected poisoning and to calculate the absolute and relative risk of mortality or cardiac arrest associated with a prolonged QTc interval.

Methods

We performed a register-based cohort study, including all adult first-time contacts with suspected poisoning to the ED of two Swedish hospitals (January 2010–December 2014) and two Danish hospitals (March 2013–April 2014). We used propensity score matching to calculate HRs for all-cause mortality or cardiac arrest (combined endpoint) within 30 days after contact comparing patients with a prolonged QTc interval (≥450 ms men, ≥460 ms women) with patients with a QTc interval of <440 ms.

Results

Among all first-time contacts with suspected poisoning that had an ECG recorded within 4 hours after arrival (n=3869), QTc prolongation occurred in 6.5%. The overall mortality after a 30-day follow-up period was 0.8% (95% CI 0.6 to 1.2), with an absolute risk of mortality or cardiac arrest in patients with QTc prolongation of 3.2% (95% CI 1.4 to 6.1). A prolonged QTc interval on arrival was associated with a HR of 3.6 (95% CI 1.0 to 12.2).

Conclusion

In the ED, a prolonged QTc interval in patients arriving with suspected poisoning seems to be associated with a threefold increased risk of 30-day all-cause mortality or cardiac arrest.

https://ift.tt/2KS5a0s

Does nephrotic syndrome without chronic kidney disease increase the risk of Parkinsons disease and secondary parkinsonism? A nationwide population-based study in Taiwan

Objectives

Previous research has shown that patients with nephrotic syndrome (NS) have a higher risk of cognitive impairment, dementia or neurodegenerative disorder. The present study aimed to examine a relationship, if any exists between NS and Parkinson's disease (PD), a neurodegenerative disorder and secondary parkinsonism (sPS).

Methods

A nationwide retrospective observational study conducted using data from the 2000–2010 Taiwan National Health Insurance Research Database. This study included 3663 patients with NS and 14 652 randomly selected, age-matched and sex-matched patients without NS. A Cox multivariable proportional hazards model was used to evaluate the risk of PD and sPS (PDsPS) in the NS cohort.

Results

This study identified a positive association between NS and the risk of PDsPS in both men and women and in all age groups (adjusted HR 1.51; 95% CI 1.37 to 1.66). Compared with patients without NS and comorbidities, those with NS with two or more comorbidities exhibited an 8.23-fold higher risk of PDsPS (95% CI 6.22 to 10.9) and patients with NS and one comorbidity exhibited a 2.93-fold higher risk of PDsPS (95% CI 2.37 to 3.63).

Conclusions

Patients with NS have an increased risk of PDsPS. This increased risk may be related to brain vascular damage or blood–brain barrier impairment. Further research is necessary to explore the underlying relationship between NS and PDsPS.

https://ift.tt/2KWuRK8

Care pathway and organisational features driving patient experience: statistical analysis of large NHS datasets

Objective

The aim of this study was to identify the care pathway and organisational factors that predict patient experience.

Design

Statistical analysis of large National Health Service (NHS) datasets.

Setting andparticipants

England; acute NHS organisational-level data.

Primary and secondary outcome measures

The relationship of care pathway and organisational variables to organisation-level patient experience.

Results

A framework of 18 care pathway and organisational variables were created based on the existing literature. 11 of these correlated to patient experience in univariate analyses. Multicollinearity tests resulted in 1 of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multilinear regression equation, including the final 10 variables, was found (F(10,108)=6.214, p<0.00), with an R2 of 0.365. Two variables were significant in predicting better in patient experience: Amount of support to clinical staff (beta=0.2, p=0.02) and the proportion of staff who would recommend the trust as a place to work or receive treatment (beta=0.26, p=0.01). Two variables were significant in predicting a negative impact on the patient's rating of their experience: Number of patients spending over 4 hours from decision to admit to admission (beta=–1.99, p=0.03) and the percentage of estates and hotel services contracted out (beta=–0.23, p=0.01).

Conclusions

These results indicate that augmenting clinical support and investing in the mechanisms that facilitate positive staff experience is essential to delivering appropriate, informative and patient-centric care. Reducing wait times and the extent of external contracting within hospitals is also likely to improve patient ratings of experience. Understanding the relationship between patient experience and objective, measurable organisational features promote a more patient-centric interpretation of quality and compel a better use of patient experience feedback to drive improvement.

https://ift.tt/2KQrAPO

Early Life Interventions for Childhood Growth and Development in Tanzania (ELICIT): a protocol for a randomised factorial, double-blind, placebo-controlled trial of azithromycin, nitazoxanide and nicotinamide

Introduction

In many developing areas in the world, a high burden of enteric pathogens in early childhood are associated with growth deficits. The tryptophan-kynurenine-niacin pathway has been linked to enteric inflammatory responses to intestinal infections. However, it is not known in these settings whether scheduled antimicrobial intervention to reduce subclinical enteric pathogen carriage or repletion of the tryptophan-kynurenine-niacin pathway improves linear growth and development.

Methods and analysis

We are conducting a randomised, placebo-controlled, factorial intervention trial in the rural setting of Haydom, Tanzania. We are recruiting 1188 children within the first 14 days of life, who will be randomised in a 2x2 factorial design to administration of antimicrobials (azithromycin and nitazoxanide, randomised together) and nicotinamide. The nicotinamide is administered as a daily oral dose, which for breast-feeding children aged 0–6 months is given to the mother and for children aged 6–18 months is given to the child directly. Azithromycin is given to the child as a single oral dose at months 6, 9, 12 and 15; nitazoxanide is given as a 3-day course at months 12 and 15. Mother/child pairs are followed via monthly in-home visits. The primary outcome is the child's length-for-age Z-score at 18 months. Secondary outcomes for the child include additional anthropometry measures; stool pathogen burden and bacterial microbiome; systemic and enteric inflammation; blood metabolomics, growth factors, inflammation and nutrition; hydrogen breath assessment to estimate small-intestinal bacterial overgrowth and assessment of cognitive development. Secondary outcomes for the mother include breastmilk content of nicotinamide, other vitamins and amino acids; blood measures of tryptophan-kynurenine-niacin pathway and stool pathogens.

Ethics and dissemination

This trial has been approved by the Tanzanian National Institute for Medical Research, the Tanzanian FDA and the University of Virginia IRB. Findings will be presented at national and international conferences and published in peer-review journals.

Protocol version

5.0, 4 December 2017.

Protocol sponsor

Haydom Lutheran Hospital, Haydom, Manyara, Tanzania.

Trial registration number

NCT03268902; Pre-results.

https://ift.tt/2J1QfvI

Framework to construct and interpret latent class trajectory modelling

Objectives

Latent class trajectory modelling (LCTM) is a relatively new methodology in epidemiology to describe life-course exposures, which simplifies heterogeneous populations into homogeneous patterns or classes. However, for a given dataset, it is possible to derive scores of different models based on number of classes, model structure and trajectory property. Here, we rationalise a systematic framework to derive a 'core' favoured model.

Methods

We developed an eight-step framework: step 1: a scoping model; step 2: refining the number of classes; step 3: refining model structure (from fixed-effects through to a flexible random-effect specification); step 4: model adequacy assessment; step 5: graphical presentations; step 6: use of additional discrimination tools ('degree of separation'; Elsensohn's envelope of residual plots); step 7: clinical characterisation and plausibility; and step 8: sensitivity analysis. We illustrated these steps using data from the NIH-AARP cohort of repeated determinations of body mass index (BMI) at baseline (mean age: 62.5 years), and BMI derived by weight recall at ages 18, 35 and 50 years.

Results

From 288 993 participants, we derived a five-class model for each gender (men: 177 455; women: 111 538). From seven model structures, the favoured model was a proportional random quadratic structure (model F). Favourable properties were also noted for the unrestricted random quadratic structure (model G). However, class proportions varied considerably by model structure—concordance between models F and G were moderate (Cohen : men, 0.57; women, 0.65) but poor with other models. Model adequacy assessments, evaluations using discrimination tools, clinical plausibility and sensitivity analyses supported our model selection.

Conclusion

We propose a framework to construct and select a 'core' LCTM, which will facilitate generalisability of results in future studies.

https://ift.tt/2NwUh2M

A systematic review of barriers and enablers to South Asian womens attendance for asymptomatic screening of breast and cervical cancers in emigrant countries

Objectives

The aim of this review was to identify the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance in South Asian populations, in order to improve uptake and propose priorities for further research.

Design

A systematic review of the literature for inductive, comparative, prospective and intervention studies. We searched the following databases: MEDLINE/In-Process, Web of Science, EMBASE, SCOPUS, CENTRAL, CDSR, CINAHL, PsycINFO and PsycARTICLES from database inception to 23 January 2018. The review included studies on the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance and cervical smear testing (Papanicolaou test) in South Asian populations and those published in the English language. The framework analysis method was used and themes were drawn out following the thematic analysis method.

Settings

Asymptomatic breast or cervical screening.

Participants

South Asian women, including Bangladeshi, Indian, Pakistani, Sri Lankan, Bhutanese, Maldivian and Nepali populations.

Results

51 included studies were published between 1991 and 2018. Sample sizes ranged from 25 to 38 733 and participants had a mean age of 18 to 83 years. Our review showed that South Asian women generally had lower screening rates than host country women. South Asian women had poorer knowledge of cancer and cancer prevention and experienced more barriers to screening. Cultural practices and assumptions influenced understandings of cancer and prevention, emphasising the importance of host country cultures and healthcare systems.

Conclusions

High-quality research on screening attendance is required using prospective designs, where objectively validated attendance is predicted from cultural understandings, beliefs, norms and practices, thus informing policy on targeting relevant public health messages to the South Asian communities about screening for cancer.

PROSPERO registration number

CSD 42015025284.

https://ift.tt/2KWl078

Barriers to uptake of referral services from secondary care to tertiary care and its associated factors in L V Prasad Eye Institute network in Southern India: a cross-sectional study

Objective

To examine barriers to the uptake of referral services from secondary care centres to higher level tertiary care centres.

Design

Cross-sectional study.

Setting

Secondary care hospital in Khammam District in the Telangana state of India.

Participants

Nine hundred and three patients who were referred from a secondary care centre to tertiary care centres between June 2011 and December 2012, were over the age of 18 and lived within 50 km of the secondary care centre were identified. Six hundred and sixteen (68.2%) of these patients were successfully contacted, and 611 (99%) of those contacted consented to participation in the study.

Interventions

Those who attended at higher centres after referral (compliant) and those who failed to attend (non-compliant) were interviewed with a standard questionnaire designed for the study.

Primary and secondary outcome measures

Outcome measures were barriers to the uptake of eye care services for the non-compliant participants and the associated risk factors for non-compliance.

Results

Of the contacted patients, 418 (68.4%) were compliant and 193 (31.6%) were non-compliant. The mean age of interviewed patients was 48.4 years (SD: 17.9 years) and 365 (59.7%) were male. Of those who did not comply with their referral, the major identified barriers were 'cannot afford treatment cost' (30%) and 'able to see adequately' (20.7%). Multivariable analysis showed that participants in the non-compliant group were more likely to have had only one prior visit to the centre (OR: 2.5, 95% CI 1.6 to 3.9), be referred for oculoplastic services (OR: 3.0, 95% CI 1.0 to 8.8) and to be the main earning member of the family (OR: 1.9, 95% CI 1.2 to 2.8).

Conclusions

Non-compliance with referrals in this population is largely attributable to economic and attitudinal reasons. Focusing on these specific barriers and targeting groups at higher risk of non-compliance could potentially improve uptake of referral services.

https://ift.tt/2NwyfwQ

Registration and publication of emergency and elective randomised controlled trials in surgery: a cohort study from trial registries

Objectives

Emergency surgical practice constitutes 50% of the workload for surgeons, but there is a lack of high quality randomised controlled trials (RCTs) in emergency surgery. This study aims to establish the differences between the registration, completion and publication of emergency and elective surgical trials.

Design

The clinicaltrials.gov and ISRCTN.com trials registry databases were searched for RCTs between 12 July 2010 and 12 July 2012 using the keyword 'surgery'. Publications were systematically searched for in Pubmed, MEDLINE and EMBASE.

Participants

Results with no surgical interventions were excluded. The remaining results were manually categorised into 'emergency' or 'elective' and 'surgical' or 'adjunct' by two reviewers.

Primary outcome measures

Number of RCTs registered in emergency versus elective surgery.

Secondary outcome measures

Number of RCTs published in emergency versus elective surgery; reasons why trials remain unpublished; funding, sponsorship and impact of published articles; number of adjunct trials registered in emergency and elective surgery.

Results

2700 randomised trials were registered. 1173 trials were on a surgical population and of these, 414 trials were studying surgery. Only 9.4% (39/414) of surgical trials were in emergency surgery. The proportion of trials successfully published did not significantly differ between emergency and elective surgery (0.46 vs 0.52; mean difference (MD) –0.06, 95% CI –0.24 to 0.12). Unpublished emergency surgical trials were statistically equally likely to be terminated early compared with elective trials (0.33 vs 0.16; MD –0.18, 95% CI –0.06 to 0.41). Low accrual accounted for a similar majority in both groups (0.43 vs 0.46; MD –0.04, 95% CI –0.48 to 0.41). Unpublished trials in both groups were statistically equally likely to still be planning publication (0.52 vs 0.71; MD –0.18, 95% CI –0.43 to 0.07).

Conclusion

Fewer RCTs are registered in emergency than elective surgery. Once trials are registered both groups are equally likely to be published.

https://ift.tt/2KZ8MdQ

Maintenance use of non-steroidal anti-inflammatory drugs and risk of gastrointestinal cancer in a nationwide population-based cohort study in Sweden

Objectives

Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are potential candidates for chemoprevention of gastrointestinal cancer. We aimed to assess the association between contemporary NSAID use (≥180 days) and gastrointestinal cancer.

Design

Nationwide Swedish population-based cohort study (2005–2012).

Setting

Sweden

Participants

All adults exposed to maintenance NSAIDs use (aspirin, n=783 870; unselective NSAIDs, n=566 209, selective cyclo-oxygenase (COX)-2 inhibitors, n=17 948) compared with the Swedish background population of the same age, sex and calendar period.

Outcome measures

The risk of different gastrointestinal cancer types expressed as standardised incidence ratios (SIR) and 95% CIs, taking into account concurrent proton pump inhibitors (PPIs) and statins usage.

Results

The SIR for gastrointestinal cancer for aspirin use was 1.02 (95% CI 1.00 to 1.04), with clearly reduced risk for long-term users (SIR=0.31, 95% CI 0.30 to 0.33 for 5.5–7.7 years), but an increased risk for short-term users (SIR=2.77, 95% CI 2.69 to 2.85), and stronger protective effect for low-dose aspirin (SIR=0.86, 95% CI 0.85 to 0.88). Users of non-selective NSAIDs showed an overall decreased risk of gastrointestinal cancer (SIR=0.79, 95% CI 0.77 to 0.82), in particular for cancer of the stomach, colorectum and oesophagus, and the SIRs were further decreased among long-term users. Users of selective COX-2 inhibitors showed a SIR=0.89 (95% CI 0.73 to 1.09) for gastrointestinal cancers. Both aspirin and unselective NSAIDs users who also were using PPIs, had higher risks for all gastrointestinal cancer types; and lower risk if using statins.

Conclusion

Long-term use of (low-dose) aspirin and non-selective NSAIDs was associated with a decreased risk of all gastrointestinal cancer types.

https://ift.tt/2Nwy7xm

Association between ATP2B1 and CACNB2 polymorphisms and high blood pressure in a population of Lithuanian children and adolescents: a cross-sectional study

Objectives

Recently, genome-wide associated studies have identified several genetic loci that are associated with elevated blood pressure and could play a critical role in intracellular calcium homeostasis. The aim of this study was to assess the associations of ATP2B1 rs2681472 and CACNB2 rs12258967 gene polymorphisms with high blood pressure (HBP) among Lithuanian children and adolescents aged 12–15 years.

Study design and participants

This was a cross-sectional study of a randomly selected sample of 646 12–15-year-old adolescents who participated in the survey 'The Prevalence and Risk Factors of HBP in 12–15 Year-Old Lithuanian Children and Adolescents (from November 2010 to April 2012)'. Anthropometric parameters and BP were measured. The participants with HBP were screened on two separate occasions. Subjects were genotyped ATP2B1 rs2681472 and CACNB2 rs12258967 gene polymorphisms using real-time PCR method.

Results

The prevalence of HBP was 36.7%, significantly higher for boys than for girls. In the multivariate analysis, after adjustment for body mass index and waist circumference, boys with CACNB2 CG genotype, CACNB2 GG genotype and CACNB2 CG +GG genotype had higher odds of having HBP in codominant (adjusted OR (aOR)=1.92; 95% CI 1.16 to 3.18, p=0.011; and aOR=2.64; 95% CI 1.19 to 5.90, p=0.018) and in dominant (aOR=2.05; 95% CI 1.27 to 3.30, p=0.003) inheritance models. Girls carrying CACNB2 CG genotype and CACNB2 CG +GG genotype had increased odds of HBP in codominant (aOR=1.82; 95% CI 1.02 to 3.24, p=0.044) and in dominant (aOR=1.89; 95% CI 1.09 to 3.28, p=0.023) inheritance models. Furthermore, significant associations were found in additive models separately for boys (aOR=1.72; 95% CI 1.20 to 2.46, p=0.003) and girls (aOR=1.52; 95% CI 1.05 to 2.20, p=0.027). No significant association was found between ATP2B1 gene polymorphism and the odds of HBP.

Conclusions

Our results indicate that CACNB2 gene polymorphism was significantly associated with higher odds of HBP in Lithuanian adolescents aged 12–15 years.

https://ift.tt/2J0KMWb

Early treatment response evaluation using FET PET compared to MRI in glioblastoma patients at first progression treated with bevacizumab plus lomustine

Abstract

Background

The goal of this prospective study was to compare the value of both conventional MRI and O-(2-¹⁸F-fluoroethyl)-L-tyrosine (FET) PET for response evaluation in glioblastoma patients treated with bevacizumab plus lomustine (BEV/LOM) at first progression.

Methods

After chemoradiation with concomitant and adjuvant temozolomide, 21 IDH wild-type glioblastoma patients at first progression (age range, 33–75 years; MGMT promoter unmethylated, 81%) were treated with BEV/LOM. Contrast-enhanced MRI and FET-PET scans were performed at baseline and after 8–10 weeks. We obtained FET metabolic tumor volumes (MTV) and tumor/brain ratios. Threshold values of FET-PET parameters for treatment response were established by ROC analyses using the post-progression overall survival (OS) ≤/>9 months as the reference. MRI response assessment was based on RANO criteria. The predictive ability of FET-PET thresholds and MRI changes on early response assessment was evaluated subsequently concerning OS using uni- and multivariate survival estimates.

Results

Early treatment response as assessed by RANO criteria was not predictive for an OS>9 months (P = 0.203), whereas relative reductions of all FET-PET parameters significantly predicted an OS>9 months (P < 0.05). The absolute MTV at follow-up enabled the most significant OS prediction (sensitivity, 85%; specificity, 88%; P = 0.001). Patients with an absolute MTV below 5 ml at follow-up survived significantly longer (12 vs. 6 months, P < 0.001), whereas early responders defined by RANO criteria lived only insignificantly longer (9 vs. 6 months; P = 0.072). The absolute MTV at follow-up remained significant in the multivariate survival analysis (P = 0.006).

Conclusions

FET-PET appears to be useful for identifying responders to BEV/LOM early after treatment initiation.

https://ift.tt/2KR01WG

MicroRNA-132 provides neuroprotection for tauopathies via multiple signaling pathways

Abstract

MicroRNAs (miRNA) regulate fundamental biological processes, including neuronal plasticity, stress response, and survival. Here, we describe a neuroprotective function of miR-132, the miRNA most significantly downregulated in neurons in Alzheimer's disease. We demonstrate that miR-132 protects primary mouse and human wild-type neurons and more vulnerable Tau-mutant neurons against amyloid β-peptide (Aβ) and glutamate excitotoxicity. It lowers the levels of total, phosphorylated, acetylated, and cleaved forms of Tau implicated in tauopathies, promotes neurite elongation and branching, and reduces neuronal death. Similarly, miR-132 attenuates PHF-Tau pathology and neurodegeneration, and enhances long-term potentiation in the P301S Tau transgenic mice. The neuroprotective effects are mediated by direct regulation of the Tau modifiers acetyltransferase EP300, kinase GSK3β, RNA-binding protein Rbfox1, and proteases Calpain 2 and Caspases 3/7. These data suggest miR-132 as a master regulator of neuronal health and indicate that miR-132 supplementation could be of therapeutic benefit for the treatment of Tau-associated neurodegenerative disorders.

https://ift.tt/2u1s3oN

MPZL2 is a novel gene associated with autosomal recessive nonsyndromic moderate hearing loss

Abstract

While recent studies have revealed a substantial portion of the genes underlying human hearing loss, the extensive genetic landscape has not been completely explored. Here, we report a loss-of-function variant (c.72delA) in MPZL2 in three unrelated multiplex families from Turkey and Iran with autosomal recessive nonsyndromic hearing loss. The variant co-segregates with moderate sensorineural hearing loss in all three families. We show a shared haplotype flanking the variant in our families implicating a single founder. While rare in other populations, the allele frequency of the variant is ~ 0.004 in Ashkenazi Jews, suggesting that it may be an important cause of moderate hearing loss in that population. We show that Mpzl2 is expressed in mouse inner ear, and the protein localizes in the auditory inner and outer hair cells, with an asymmetric subcellular localization. We thus present MPZL2 as a novel gene associated with sensorineural hearing loss.

https://ift.tt/2NrN83L

Pediatric neuroanesthesia

Purpose of review Pediatric neuroanesthesia is a fascinating, yet challenging branch of anesthesia. This review highlights some of the recent insights into pediatric neuroanesthesia from the past 18 months. Recent findings Although there are incontrovertible evidences in animals suggesting that prolonged exposure to general anesthesia causes long-term neurological impairment, the translational relevance of these findings in humans is debatable. Early surgery for pediatric drug-refractory epilepsy is supported by emerging literature, but poses unique perioperative problems for the treating neuroanesthesiologist. Similarly, minimizing intraoperative blood loss and blood transfusion concerns every anesthesiologist managing small children. The usefulness of tranexamic acid in children is further enhanced by some studies in spine surgeries. Some pertinent issues related to intraoperative neuromonitoring are also discussed in the text. Summary There are several logistical and ethical problems of carrying out high-quality prospective studies in children but important findings on prevention of anesthetic neurotoxicity; minimizing intraoperative blood loss, intraoperative neurophysiological monitoring, examining optimal doses and choices of anesthetic agents in epilepsy surgery have been published recently. Correspondence to Dr Girija P. Rath, MBBS, MD, DM, Professor, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Tel: +91 9810602272; e-mail: girijarath@yahoo.co.in Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2KWAdrU

Chronic pain, pain severity and analgesia use in Australian women of reproductive age

Publication date: Available online 7 July 2018

Source: Women and Birth

Author(s): April M. Miller, Kristy Sanderson, Raimondo B. Bruno, Monique Breslin, Amanda L. Neil

Abstract

Background

The increasing prevalence and adverse outcomes associated with opioid analgesia use in women of reproductive age have become a significant public health issue internationally, with use during pregnancy potentially affecting maternal and infant health outcomes.

Objective

This study aims to provide national estimates of chronic pain, pain severity and analgesia use in Australian women of reproductive age by pregnancy status.

Method

Data were obtained from the Australian Bureau of Statistics 2011–12 National Health Survey (n = 20,426). Weighting was applied to sample data to obtain population estimates. For this study data were analysed for pregnant (n = 166, N = 192,617) and non-pregnant women (n = 4710, N = 5,256,154) of reproductive age (15–49 years).

Results

Chronic or reoccurring pain was reported in 5.1% of pregnant women and 9.7% of non-pregnant women, and 0.7% and 2.6% of pregnant and non-pregnant women reported recent opioid analgesia use respectively. Moderate-to-very severe pain was more common in pregnant than non-pregnant women taking opioid analgesics, and no pain and very mild-to-mild pain in non-pregnant women.

Conclusion

Approximately 1 in 20 pregnant Australian women have chronic or reoccurring pain. Opioid analgesia was used by around 1% of Australian pregnant women during a two-week period, with use associated with moderate-to-very severe pain. Given that the safety of many analgesic medications in pregnancy remains unknown, pregnant women and health professionals require accurate, up-to-date information on the risks and benefits of analgesic use during pregnancy. Further evidence on the decision-making processes of pregnant women with pain should assist health professionals maximise outcomes for mothers and infants.

https://ift.tt/2KSE2OV

Effect of albumin-globulin score and albumin to globulin ratio on survival in patients with heart failure: a retrospective cohort study in China

Objective

To investigate the combined effect of albumin (ALB) and globulin (GLB) on the overall survival (OS) of patients with heart failure (HF).

Design

Retrospective cohort study.

Setting

A hospital.

Participants

404 patients first diagnosed with HF.

Measurements

Serum ALB and GLB were measured within 3 days after admission. The albumin to globulin ratio (AGR) was calculated as the ALB divided by the GLB. The receiver operating characteristic curve was used to calculate the cut-off points for ALB, GLB and AGR. Patients with low ALB levels (≤35.3 g/L) and high GLB levels (>27.0 g/L) were assigned an albumin-globulin score (AGS) of 2, those with only one of the two abnormalities were assigned an AGS of 1 and those with neither of the two abnormalities were assigned an AGS of 0.

Results

The mean age of the 404 patients was 62.69±15.62, and 54.5% were male. 14 patients were lost to follow-up. 120 patients died from HF and 211 patients were readmitted to the hospital for worsening HF. Multivariate Cox regression analysis showed that higher AGR was significantly associated with favourable OS (HR, 0.61, 95% CI 0.38 to 0.98, p=0.040) but not AGS.

Conclusion

Serum levels of ALB and GLB are objective and easily measurable biomarkers which can be used in combination to predict the survival of patients with HF.

https://ift.tt/2J15sgo

Alterations in maternally perceived fetal movement and their association with late stillbirth: findings from the Midland and North of England stillbirth case-control study

Objective

To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth.

Design

Case–control study.

Setting

41 maternity units in the UK.

Participants

Cases were women who had a late stillbirth ≥28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age.

Methods

Data were collected using an interviewer-administered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders.

Primary outcome measure

Association of maternally perceived fetal movements in relation to late stillbirth.

Results

In multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56).

Conclusions

Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth.

Trial registration number

NCT02025530.

https://ift.tt/2NzSDgy

Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: a prospective international cohort study

Objectives

Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac surgery.

NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function.

Setting and participants

We are recruiting study participants from 12 tertiary care hospitals in 10 countries on 5 continents.

Participants

We are enrolling patients ≥65 years of age, requiring hospital admission after non-cardiac surgery, who have an anticipated length of hospital stay of at least 2 days after elective non-cardiac surgery that occurs under general or neuraxial anaesthesia.

Primary and secondary outcome measures

Patients are recruited before elective non-cardiac surgery, and their cognitive function is measured using the Montreal Cognitive Assessment (MoCA) instrument. After surgery, a brain MRI study is performed between postoperative days 2 and 9 to determine the presence of acute brain infarction. One year after surgery, the MoCA is used to assess postoperative cognitive function. Physicians and patients are blinded to the MRI study results until after the last patient follow-up visit to reduce outcome ascertainment bias.

We will undertake a multivariable logistic regression analysis in which the dependent variable is the change in cognitive function 1 year after surgery, and the independent variables are acute perioperative covert stroke as well as other clinical variables that are associated with cognitive dysfunction.

Conclusions

The NeuroVISION study will characterise the epidemiology of covert stroke and its clinical consequences. This will be the largest and the most comprehensive study of perioperative stroke after non-cardiac surgery.

Trial registration number

NCT01980511; Pre-results.

https://ift.tt/2J2nFdH

Patient safety initiatives in obstetrics: a rapid review

Objectives

This review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs.

Design

A rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively.

Interventions

We included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015.

Primary and secondary outcome measures

RCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included.

Results

The search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500 000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs.

Conclusions

Our results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.

https://ift.tt/2KPSeIB

Protocol for a meta-integration: investigating positive aspects of caregiving in dementia

Introduction

The current work describes the protocol for a meta-integration investigating the positive aspects of providing care to someone living with dementia. We aim to understand the position of positive aspects in the caregiver experience as well as identify how positive aspects are commonly conceptualised, investigated and measured in literature.

Methods and analyses

Meta-integration is a method of investigation that synthesises findings from meta-analysis or systematic review of quantitative studies and meta-synthesis of qualitative studies, to provide a coherent and holistic account of a phenomenon. As a relatively new method, terminology and methodological approaches are varied. The current work describes the process of conducting an advanced convergent meta-integration, including protocol for systematic search, inclusion/exclusion screening phases, intramethod analysis synthesis and intermethod synthesis on quantitative, qualitative and mixed methods research pertaining to the positive aspects of providing care to someone living with dementia.

Ethics and dissemination

There are no ethics or safety concerns about dissemination, which includes plans for a conference presentation and publication.

https://ift.tt/2J0bGNV

Is mortality-to-incidence ratio associated with health disparity in pancreatic cancer? A cross-sectional database analysis of 57 countries

Objective

The colorectal cancer mortality-to-incidence ratio (MIR) can reflect healthcare disparities. However, a similar association has not yet been established between the MIR of pancreatic cancer and healthcare disparities.

Methods

In this study, the incidence and mortality rates of pancreatic cancer were obtained from the GLOBOCAN 2012 database. The WHO rankings and total expenditures on health/gross domestic product (e/GDP) were obtained from a public database. Linear regression was performed to determine correlations between the variables.

Results

57 countries met the inclusion criteria according to the data quality. Developed regions (Europe and the Americas) had high pancreatic cancer incidence and mortality rates. The MIRs were over 0.90 in all regions. No significant correlation was found between MIRs and the WHO rankings, e/GDP or per capita total expenditure on health for analysis in the 57 countries, indicating no association between MIRs and cancer care disparities for pancreatic cancer.

Conclusions

The MIR variations for pancreatic cancer do not correlate with healthcare disparities among countries. Further investigation is necessary to confirm this observation with secondary analysis of databases.

https://ift.tt/2NzT5LM

Influence of health literacy on acceptance of influenza and pertussis vaccinations: a cross-sectional study among Spanish pregnant women

Objectives

Immunisations against influenza and Bordetella pertussis infection are recommended to pregnant women in Valencia (Spain), yet vaccination rates remain low. Health literacy (HL) appears as a crucial factor in vaccination decision-making. We explored the relation between HL of pregnant women and decisions to receive influenza and pertussis immunisations.

Setting

University hospital in Valencia (Spain).

Participants

119 women who gave birth at a hospital in Valencia (Spain) between November 2015 and May 2016. Women in the immediate postpartum period (more than 27 weeks of gestation), between November 2015 and May 2016 were included in the study. Women with impairments, language barriers or illiteracy which prevented completion of the questionnaires, or those who were under 18 years were excluded from enrolment.

Primary and secondary outcome measures

HL level; influenza and pertussis immunisation rate; reasons for rejection of vaccination.

Results

119 participants were included (mean age 32.3±5.5 years, 52% primiparous, 95% full-term deliveries). A higher education level was associated with Short Assessment of Health Literacy for Spanish Adults _50 (adjusted R²=0.22, p=0.014) and Newest Vital Sign (adjusted R²=0.258, p=0.001) scores. Depending on the scale, 56%–85% of participants had adequate HL. 52% (62/119) and 94% (112/119) of women received influenza and pertussis immunisation, respectively. Women rejecting influenza vaccine had a higher HL level (measured by SALHSA_50 tool) than those accepting it (Kruskal-Wallis test p=0.022). 24% of women who declined influenza vaccination felt the vaccine was unnecessary, and 23% claimed to have insufficient information.

Conclusions

Influenza vaccination rate was suboptimal in our study. Women with high HL were more likely to decline immunisation. Information from professionals needs to match patients' HL levels to reduce negative perceptions of vaccination.

https://ift.tt/2KYA5VE

Community factors associated with stunting, overweight and food insecurity: a community-based mixed-method study in four Andean indigenous communities in Ecuador

Objectives

We aimed to implement participatory research to answer a question posed by four Kichwa indigenous communities in Andean Ecuador about what actionable factors are associated with childhood stunting, overweight and food insecurity among their people.

Design

We used mixed methods including household questionnaires, discussion groups with respondents of the questionnaires and anthropometric measurement of children (6 months to 12 years) from surveyed households.

Setting

The study involved four Andean indigenous communities transitioning from traditional to Western lifestyles. They subsist mainly on small-scale agriculture and have a rich cultural heritage including their traditional language.

Participants

Anthropometric data were collected from 298 children from 139 households in four communities; all households completed the questionnaire. We held five discussion groups (6–10 participants each): three composed of mothers and two of farmers.

Primary and secondary outcome measures

Primary outcomes were stunting, overweight, food insecurity and their relationship with demographics, dietary habits and agricultural habits.

Results

Of 298 children, 48.6% were stunted and 43.3% overweight for age. Stunted children were more likely to live in households that sold livestock (ORa 1.77, 95% CIa 1.06 to 2.95) and with illiterate primary caretakers (ORa 1.81, 95% CIa 1.07 to 3.06), but were less likely to live in households with irrigation (ORa 0.47, 95% CIa 0.27 to 0.81). Overweight children were more likely to be male (ORa 1.87, 95% CIa 1.02 to 3.43) and live in a household that sold livestock (ORa 2.14, 95% CIa 1.14 to 4.02). Some 67.8% of children lived in a household with food insecurity, more frequently in those earning below minimum wage (ORa 2.90, 95% CIa 1.56 to 5.41) and less frequently in those that ate quinoa in the past 24 hours (ORa 0.17, 95% CIa 0.06 to 0.48). Discussion groups identified irrigation and loss of agricultural and dietary traditions as important causes of poor childhood nutrition.

Conclusion

Many indigenous communities face tumultuous cultural, nutritional and epidemiological transitions. Community-based interventions on factors identified here could mitigate negative health outcomes.

https://ift.tt/2KU9Zq0

Risk of pleural empyema in patients with schizophrenia: a nationwide propensity-matched cohort study in Taiwan

Objective

Thoracic infection and pneumonia are prevalent in patients with schizophrenia; however, it is unclear whether patients with schizophrenia are at an increased risk of developing pleural empyema.

Design

A retrospective cohort study with propensity-matched cohorts with and without schizophrenia.

Setting

Using the National Health Insurance Research Database of Taiwan.

Participants

We identified 55 888 patients with schizophrenia newly diagnosed in 2000–2011 and same number of individuals without schizophrenia as the comparison cohort, frequency matched by propensity scores estimated using age, sex, occupation, income, urbanisation, year of diagnosis and comorbidities.

Primary outcome measures

We assessed incident pleural empyema by the end of 2011 and used the Cox proportional hazards model to calculate the schizophrenia cohort to comparison cohort HR of pleural empyema.

Results

The overall incidence of pleural empyema was 2.44-fold greater in the schizophrenia cohort than in the comparison cohort (4.39vs1.80 per 10 000 person-years), with an adjusted HR of 2.87(95% CI 2.14 to 3.84). Stratified analyses by age, sex, occupation, income, urbanisation and comorbidity revealed significant hazards for pleural empyema associated with schizophrenia in all subgroups.

Conclusions

Patients with schizophrenia are at an increased risk of developing pleural empyema and require greater attention and appropriate support.

https://ift.tt/2J1FHwO

Media use and excess body weight among women in Nigeria: a cross-sectional study

Objectives

To investigate the (1) time trends in body mass index (BMI) and (2) relationship between media use and body weight status among adult women in Nigeria. We hypothesise that higher frequency of media use is associated with higher likelihood of being overweight and obesity among adult women.

Study design

Cross-sectional.

Setting

Urban and rural settings in Nigeria.

Participants

Adult non-pregnant women aged between 15 and 49 years.

Methods

Data were derived from Nigeria Demographic and Health Surveys conducted in 2003, 2008 and 2013. The outcome variable was excess body weight (overweight and obesity), and main explanatory variables were frequency of reading newspaper, listening to radio and television (TV) viewing. Datasets were merged to perform pooled analysis, and were analysed using bivariate and multivariable regression techniques.

Results

Of the 69 401 participants, 16.2% had a BMI of 25.0–29.9 kg/m² (95% CI 15.8 to 16.6) and 6.6% had >30 kg/m² (95% CI 6.3 to 6.9). Between 2003 and 2013, the prevalence of overweight women increased by 4.1%, and that of obesity by 2.2%. Overall, radio was the most popular media followed by TV and newspaper. Respectively, 15.6% and 11.7% of the women reported using radio and TV almost every day and 30.6% and 25.1% at least once a week. In multivariable analysis, watching TV almost every day and at least once a week were associated with, respectively, 1.6 and 1.2 times higher odds of being overweight, and 2.7 and 1.5 times higher odds of being obese compared with those who never used radio. Similarly, significant associations were observed for newspaper and radio use as well.

Conclusion

The prevalence of overweight and obesity is noticeably high among Nigerian women and has been increasing steadily over the past decade. A statistically significant association exists between BMI and the use of newspaper, radio and TV. Further studies are required to develop a better understanding of the mechanisms that underlie this relationship.

https://ift.tt/2Nw7Zmt

Sipjeondaebo-tang in patients with breast cancer with fatigue: a protocol for a pilot, randomised, double-blind, placebo-controlled, cross-over trial

Introduction

Cancer-related fatigue is a frequent symptom in patients with cancer and one of the most distressing symptoms in patients with breast cancer. Sipjeondaebo-tang (Juzen-taiho-to in Japanese or Shi-Quan-Da-Bu-Tang in Chinese) is a widely used herbal medicine for the treatment of fatigue in Korea, China and Japan. The purpose of the present study is to evaluate the feasibility of Sipjeondaebo-tang for cancer-related fatigue.

Methods and analysis

The present study is a randomised, double-blind, placebo-controlled, cross-over study. Forty-eight patients with breast cancer who are indicated for doxorubicin and cyclophosphamide will be recruited. The participants will receive 3 g of Sipjeondaebo-tang or a placebo three times a day for 56 days. The primary outcome measurement is the change in the Brief Fatigue Inventory scores. The secondary outcome measurements include the changes in the Visual Analogue Scale (VAS) of fatigue, and quality of life measured by the European Organization for Research and Treatment of Cancer—QLQ-C30 and QLQ-BR23. VAS of fatigue will be measured on every visit, and other outcomes will be measured on visits 2, 4, 6 and 7. The total study period is 14 weeks.

Ethics and dissemination

This study has been approved by the Institutional Review Board of the Catholic Kwandong University International St Mary's Hospital (reference IS16MNSI0011). The results of this study will be published in a peer-reviewed journal and presented at a scientific conference.

Trial registration number

NCT02858856; Pre-results.

https://ift.tt/2J0SvDA

Initial use of supplementary oxygen for trauma patients: a systematic review

Objective

This systematic review aimed to identify and describe the evidence for supplementary oxygen for spontaneously breathing trauma patients, and for high (0.60–0.90) versus low (0.30–0.50) inspiratory oxygen fraction (FiO₂) for intubated trauma patients in the initial phase of treatment.

Methods

Several databases were systematically searched in September 2017 for studies fulfilling the following criteria: trauma patients (Population); supplementary oxygen/high FiO₂ (Intervention) versus no supplementary oxygen/low FiO₂ (Control) for spontaneously breathing or intubated trauma patients, respectively, in the initial phase of treatment; mortality, complications, days on mechanical ventilation and/or length of stay (LOS) in hospital/intensive care unit (ICU) (Outcomes); prospective interventional trials (Study design). Two independent reviewers screened and identified studies and extracted data from included studies.

Results

6142 citations were screened with an inter-rater reliability (Cohen's kappa) of 0.88. One interventional trial of intubated trauma patients was included. 68 trauma patients were randomised to receive an FiO₂ of 0.80 (intervention group) or 0.50 (control group) during mechanical ventilation (first 6 hours). There was no significant difference in hospital or ICU LOS between the groups. No patient died in either group. Another interventional trial, not strictly fulfilling the inclusion criteria, was presented for descriptive purposes. 21 trauma patients were alternately assigned to two types of mechanical ventilation (first 48 hours), both aiming at an FiO₂ of 0.40, but resulted in estimated mean FiO₂s of 0.45 (intervention group) and 0.60 (control group). No difference in days on mechanical ventilation was found. Two patients in the control group died, none in the intervention group. No prospective, interventional trials on spontaneously breathing trauma patients were identified.

Conclusions

Evidence for the use of supplementary oxygen for spontaneously breathing trauma patients is lacking, and the evidence for low versus high FiO₂ for intubated trauma patients is limited.

PROSPERO registration number

42016050552

https://ift.tt/2Nx1HTB

Towards a demographic risk profile for sedentary behaviours in middle-aged British adults: a cross-sectional population study

Objectives

In response to a call from the American Heart Association to more clearly identify the demographic factors associated with sedentary behaviours, this study aimed to identify the hierarchy of demographic characteristics associated with the sedentary behaviours of television viewing, recreational computer use and driving.

Design

Cross-sectional analysis of baseline data collected as part of the UK Biobank. The UK Biobank is a population cohort recruited from 22 centres across the UK. Participants aged between 37 and 73 years were recruited between 2006 and 2010.

Methods

Decision tree models were generated for the sedentary behaviour outcomes of hours/day spent television viewing, recreational computer use and all driving; a sum of time spent in these sedentary behaviours ('overall') was computed. Age, sex, race, college attendance, employment, shift-work, urban versus rural residence as well as physical activity were considered as predictors.

Results

The analytic sample comprised 415 666 adults who were mostly female (54.2%), white (95.2%), non-college attendee (64.5%), employed (61.7%), lived in an urban centre (85.5%), with a mean age of 56.6 (SD=8.1) years. Television viewing was most common sedentary behaviour (2.7 hour/day vs 1.1 for recreational computer use and 1.0 for all driving). Males (tier 1), who did not attend college (tier 2) were the highest risk group for overall sedentary time. Adults with no college attendance (tier 1) and were retired (tier 2) were the most high-risk demographic group for television viewing. College attendees (tier 1) were highest risk for recreational computer use. Adults who were employed (tier 1), male (tier 2) and did not attend college (tier 3) were most at risk for driving

Conclusions

Daily time spent in different sedentary behaviours varies by sex, employment status and college attendance status. The development of targeted interventions to reduce sedentary behaviour in different demographic subgroups is needed.

https://ift.tt/2J1FABo

Emotional reserve and prolonged post-concussive symptoms and disability: a Swedish prospective 1-year mild traumatic brain injury cohort study

Objective

Prolonged post-concussive symptoms (PCS) affect a significant minority of patients withmild traumatic brain injury (mTBI). The aetiology is multifactorial depending on preinjury as well as peri-injury and postinjury factors. In this study, we examine outcome from an emotional reserve perspective.

Design

Prospective cohort study.

Setting

Patients were recruited from three emergency departments in major university hospitals in Stockholm, Sweden. Follow-up data were collected in an outpatient setting at one of the recruiting hospitals.

Participants

122 patients with a history of blunt head trauma (aged 15–65 years; admitted for mTBI within 24 hours after trauma (Glasgow Coma Scale score of 14–15, loss of consciousness <30 min and/or post-traumatic amnesia <24 hours). Exclusion criteria were other significant physical injury and other major neurological disorder, including previous significant head injury.

Procedure

Recruitment in three emergency departments. Initial assessments were made within 1 week after the injury. Patients were mailed the follow-up questionnaires 1 year postinjury.

Outcome measures

A psychiatric assessment was performed at 1 week post injury. The participants also completed a personality inventory, measures of psychological resilience, depression, anxiety and post-traumatic symptoms. One-year outcome was measured by the Rivermead Post Concussion Symptoms and the Rivermead Head Injury Follow-Up questionnaires.

Results

The psychiatric assessment revealed more symptoms of anxiety, depression and post-traumatic symptoms in the acute stage for patients who later developed PCS.

After 1 year, 94 participants were still in the programme (male/female 57/37) and 12% matched the extended criteria for PCS (≥3 symptoms and ≥2 disabilities). PCS patients reported more preinjury and concurrent psychiatric problems, lower level of functioning before the injury and experienced more stress. They showed higher somatic trait anxiety, embitterment, mistrust and lower level of psychological resilience than recovered participants.

Conclusion

Intrapersonal emotional reserve shape the emergence and persistence of PCS after mTBI.

https://ift.tt/2KPSgAd