Neurogastroenterology & Motility
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Τετάρτη 11 Μαΐου 2016
Diagnostic disagreement between tests of evacuatory function: a prospective study of 100 constipated patients
Materials, Vol. 9, Pages 352: Correction: First-Principles Study of Mo Segregation in MoNi(111): Effects of Chemisorbed Atomic Oxygen. Materials 2016, 9, 5
The authors wish to make the following corrections to this manuscript [1].[...]
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Functional and structural properties of ion channels at the nerve terminal depends on compact myelin
Abstract
Axon myelination increases the conduction velocity and precision of action potential propagation. Although the negative effects of demyelination are generally attributed to conduction failure, accumulating evidence suggests that myelination also regulates the structural properties and molecular composition of the axonal membrane. Here, we investigated how myelination affects ion channel expression and function, particularly at the last axon heminode before the nerve terminal, which regulates presynaptic excitability of the nerve terminal. We compared the structure and physiology of normal axons and those of the LES rat, which lacks compact myelin. The normal segregation of Na+ channel expression and dynamics at the heminode and terminal was lost in the LES rat. Specifically, NaV-α subunits were dispersed and NaVβ4 subunit was absent, whereas the density of K+ channels was increased at the heminode. Correspondingly, resurgent and persistent Na+ currents were reduced and K+ current was increased. Together these data suggest a specific role for compact myelin in orchestration of ion channel expression and function at the axon heminode and regulating excitability of the nerve terminal.
This article is protected by copyright. All rights reserved
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Applied Sciences, Vol. 6, Pages 145: Failure Mode Analysis and Dynamic Response of a Coal Mine Refuge Chamber with a Gas Explosion
A gas and coal dust explosion is potential hazard in majority coal mines. A coal mine mobile refuge chamber is a new class of device for miners those who are unable to escape after an accident which can provide basic survival conditions. In this paper, in order to study the propagation law of an underground methane/air mixture explosive wave, and check the failure mode of a coal mine mobile refuge chamber, a full-sized underground tunnel model and a refuge chamber model have been established in ANSYS/LS-DYNA (LSTC, R7.0.0, Livermore, CA, USA, 2014). The simulation results show that the reflected wave pressure on the front surface of the refuge chamber was about twice as high than the incident wave. The pressure on various locations of the chamber was also analyzed. When the peak pressure of the explosive shockwave reached 0.64 MPa, the maximum displacement and stress occur at the center of the front door and the joint of stiffeners and the front plate, respectively. Most parts of the coal mine mobile refuge chamber were in a plastic failure state and the refuge chamber could be defined as damaged. The front door, the front plate, the connecting flange, and the stiffeners on each side were the primary key components. In the end, suggestions were proposed for the refuge chamber.
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Fibers, Vol. 4, Pages 16: Global Consumption of Flame Retardants and Related Environmental Concerns: A Study on Possible Mechanical Recycling of Flame Retardant Textiles
Flame retardants (FRs) have been around us for decades to increase the chances of survival against fire or flame by limiting its propagation. The FR textiles, irrespective of their atmospheric presence are used in baby clothing, pushchairs, car seats, etc. The overall FR market in Asia, Europe, and the United States in 2007 was around 1.8 million metric tonnes. It is estimated that the worldwide consumption of FRs will reach 2.8 million tonnes in 2018. Unfortunately, a sustainable approach for textile waste, especially in the case of FR textiles, is absent. Incineration and landfill of FR textiles are hindered by various toxic outcomes. To address the need for sustainable methods of discarding FR textiles, the mechanical recycling of cotton curtains was evaluated.
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Symmetry, Vol. 8, Pages 35: Symmetry-Based Conflict Detection and Resolution Method towards Web3D-based Collaborative Design
In the process of web3D-based collaborative design, it is necessary to completely prevent operation conflicts among designers due to distributed environments and complex 3D models. Therefore, conflict detection and conflict resolution are of great significance to attain an acceptable result. In order to facilitate effective and smooth design work, a symmetry-based collaborative design framework is proposed using the X3D operation models. Combined considerations cover both models and operations, while different operation strategies are utilized for conflict resolution in web-based collaborative design. The strategy can achieve automatic operation, real-time conflict detection based on dynamically adjustable time, and conflict auto-detection and resolution with designers' customization. A proof-of-concept system is developed for verification. The proposed resolution shows good performance, scalability and interactivity in a case study.
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IJERPH, Vol. 13, Pages 488: A Mouse Model for Studying Nutritional Programming: Effects of Early Life Exposure to Soy Isoflavones on Bone and Reproductive Health
Over the past decade, our research group has characterized and used a mouse model to demonstrate that "nutritional programming" of bone development occurs when mice receive soy isoflavones (ISO) during the first days of life. Nutritional programming of bone development can be defined as the ability for diet during early life to set a trajectory for better or compromised bone health at adulthood. We have shown that CD-1 mice exposed to soy ISO during early neonatal life have higher bone mineral density (BMD) and greater trabecular inter-connectivity in long bones and lumbar spine at young adulthood. These skeletal sites also withstand greater forces before fracture. Because the chemical structure of ISO resembles that of 17-β-estradiol and can bind to estrogen receptors in reproductive tissues, it was prudent to expand analyses to include measures of reproductive health. This review highlights aspects of our studies in CD-1 mice to understand the early life programming effects of soy ISO on bone and reproductive health. Preclinical mouse models can provide useful data to help develop and guide the design of studies in human cohorts, which may, depending on findings and considerations of safety, lead to dietary interventions that optimize bone health.
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Toxins, Vol. 8, Pages 143: The Draft Genome Sequence of the Yersinia entomophaga Entomopathogenic Type Strain MH96T
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Nicotinamide Phosphoribosyltransferase Attenuates Methotrexate Response in Juvenile Idiopathic Arthritis and In Vitro
Variability in response to methotrexate (MTX) in the treatment of juvenile idiopathic arthritis (JIA) remains unpredictable and poorly understood. Based on previous studies implicating an interaction between nicotinamide phosphoribosyltransferase (NAMPT) expression and MTX therapy in inflammatory arthritis, we hypothesized that increased NAMPT expression would be associated with reduced therapeutic response to MTX in patients with JIA. A significant association was found between increased plasma concentrations of NAMPT and reduced therapeutic response in patients with JIA treated with MTX. Inhibition of NAMPT in cell culture by either siRNA-based gene silencing or pharmacological inhibition with FK-866 was found to result in a fourfold increase in the pharmacological activity of MTX. Collectively, these findings provide evidence that NAMPT inhibits the pharmacological activity of MTX and may represent a predictive biomarker of response, as well as a therapeutic target, in the treatment of JIA with MTX.
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IJERPH, Vol. 13, Pages 491: Preliminary Assessment of Health Risks of Potentially Toxic Elements in Settled Dust over Beijing Urban Area
To examine levels, health risks, sources, and spatial distributions of potentially toxic elements in settled dust over Beijing urban area, 62 samples were collected mostly from residential building outdoor surfaces, and their <63 μm fractions were measured for 12 potentially toxic elements. The results show that V, Cr, Mn, Co, Ni, and Ba in dust are from predominantly natural sources, whereas Cu, Zn, As, Cd, Sb, and Pb mostly originate from anthropogenic sources. Exposure to these elements in dust has significant non-cancer risks to children but insignificant to adults. Cancer risks of Cr, Co, Ni, As, and Cd via inhalation and dermal contact are below the threshold of 10−6–10−4 but As via dust ingestion shows a tolerable risk. The non-cancer risks to children are contributed mainly (75%) by As, Pb, and Sb, and dominantly (92%) via dust ingestion, with relatively higher risks mainly occurring in the eastern and northeastern Beijing urban areas. Although Cd, Zn, and Cu in dust are heavily affected by anthropogenic sources, their health risks are insignificant. Source appointments suggest that coal burning emissions, the dominant source of As, are likely the largest contributors to the health risk, and traffic-related and industrial emissions are also important because they contribute most of the Pb and Sb in dust.
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Cancers, Vol. 8, Pages 48: The Wnt Target Gene L1 in Colon Cancer Invasion and Metastasis
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IJERPH, Vol. 13, Pages 482: The Risk of Breast Cancer in Women Using Menopausal Hormone Replacement Therapy in Taiwan
Menopausal hormone replacement therapy (HRT) increases the risk of breast cancer in Western countries; however, there are fewer reports from the Asian population, which has a lower incidence of breast cancer. A population-based retrospective cohort study was conducted by analyzing longitudinal National Health Insurance claim data of a 200,000-person national representative cohort. A total of 22,929 women aged ≥45 years in 1997 without previous diagnosis of breast cancer were enrolled and stratified into two birth cohorts born before or after 1933. HRT prescriptions were traced in outpatient data files and incident breast cancer cases were identified from 1997 to 2004. The Cox proportional hazards model was used to analyze breast cancer hazard ratio (HR). HRT users were censored after they discontinued HRT. The results showed that women born during 1933–1952 had a twofold increased risk of breast cancer (HR = 2.10, 95% CI = 1.47–3.00) compared with women born before 1933, when adjusted for HRT use. When adjusted for the birth-cohort difference, HRT users had significantly increased breast cancer HR versus non-users after four years of use (adjusted HR = 1.48, 95% CI = 1.03–2.13); the HR further increased to 1.95 (95% CI = 1.34–2.84) after eight years of use. In conclusion, a longer duration of current HRT use was associated with a higher risk of breast cancer independent of the birth-cohort difference.
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IJERPH, Vol. 13, Pages 489: Identifying Ethical Issues in Mental Health Research with Minors Adolescents: Results of a Delphi Study
Research with minors, especially for preventive purposes, e.g., suicide prevention, investigating risk or self-destructive behaviors such as deviance, drug abuse, or suicidal behavior, is ethically sensitive. We present a Delphi study exploring the ethical implications of the needs formulated by researchers in an international pre-conference who would benefit from ethics support and guidance in conducting Mental Health Research with minors. The resulting List of Ethical Issues (LEI) was submitted to a 2-rounds Delphi process via the Internet, including 34 multidisciplinary experts. In the first round, the experts reviewed the LEI and completed a questionnaire. Results from this round were analyzed and grouped in nine categories comprising 40 items. In the second round, the experts had to agree/disagree with the needs expressed in the LEI leading to a final list of 25 ethical issues considered relevant for Mental Health Research with minors such as: confidentiality of the sensitive data, competence for consenting alone and risk of harm and stigma related to the methodology used in research. It was shown that studies like SEYLE (Saving and Empowering Young Lives in Europe) trigger among researchers wishes to obtain specific recommendations helping to comply with standards for good practice in conducting research with minors.
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IJERPH, Vol. 13, Pages 486: Attitude, Acceptability and Knowledge of HPV Vaccination among Local University Students in Hong Kong
The Human Papillomavirus (HPV) vaccine has the great potential to prevent HPV-related infections for millions of women and men worldwide. However, the success of the vaccine is highly dependent on the vaccination rate. Factors influencing the attitudes of undergraduate students towards HPV vaccination should be studied. This is a cross-sectional survey that was conducted to estimate the HPV vaccination rate among undergraduate students in Hong Kong, and to identify the predictors of their attitude towards HPV vaccination. The results showed that the HPV vaccination rate was 13.3%. Factors related to knowledge of vaccination were the main predictors of the students' attitude towards vaccination (there were seven predictors, with B = 1.36 to 2.30; p < 0.05), followed by gender (B = −1.40; p < 0.05), acceptable maximum price (B = 0.35; p < 0.05), and willingness to receive the HPV vaccine if it can protect against cervical/anal cancer and genital warts (B = −1.90; p < 0.001). The regression model that was developed based on the predictors had a moderate effect size (adj-R2 = 0.33). To conclude, the HPV vaccination rate among undergraduate students in Hong Kong was low. They should be provided with more active education and activities to promote HPV vaccination to improve their knowledge on the subject.
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Sustainability, Vol. 8, Pages 466: Sustainable Wearables: Wearable Technology for Enhancing the Quality of Human Life
This paper aims to elicit insights about sustainable wearables by investigating recent advancements in wearable technology and their applications. Wearable technology has advanced considerably from a technical perspective, but it has stagnated due to barriers without penetrating wider society despite early positive expectations. This situation is the motivation behind the focus on studies by many research groups in recent years into wearable applications that can provide the best value from a human-oriented perspective. The expectation is that a new means to resolve the issue can be found from a viewpoint of sustainability; this is the main point of this paper. This paper first focuses on the trend of wearable technology like bodily status monitoring, multi-wearable device control, and smart networking between wearable sensors. Second, the development intention of such technology is investigated. Finally, this paper discusses about the applications of current wearable technology from the sustainable perspective, rather than detailed description of the component technologies employed in wearables. In this paper, the definition of sustainable wearables is discussed in the context of improving the quality of individual life, social impact, and social public interest; those wearable applications include the areas of wellness, healthcare, assistance for the visually impaired, disaster relief, and public safety. In the future, wearables will not be simple data trackers or fun accessories but will gain extended objectives and meanings that play a valuable role for individuals and societies. Successful and sustainable wearables will lead to positive changes for both individuals and societies overall.
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Sensors, Vol. 16, Pages 672: Modeling of a Single-Notch Microfiber Coupler for High-Sensitivity and Low Detection-Limit Refractive Index Sensing
A highly sensitive refractive index sensor with low detection limit based on an asymmetric optical microfiber coupler is proposed. It is composed of a silica optical microfiber and an As2Se3 optical microfiber. Due to the asymmetry of the microfiber materials, a single-notch transmission spectrum is demonstrated by the large refractive index difference between the two optical microfibers. Compared with the symmetric coupler, the bandwidth of the asymmetric structure is over one order of magnitude narrower than that of the former. Therefore, the asymmetric optical microfiber coupler based sensor can reach over one order of magnitude smaller detection limit, which is defined as the minimal detectable refractive index change caused by the surrounding analyte. With the advantage of large evanescent field, the results also show that a sensitivity of up to 3212 nm per refractive index unit with a bandwidth of 12 nm is achieved with the asymmetric optical microfiber coupler. Furthermore, a maximum sensitivity of 4549 nm per refractive index unit can be reached while the radii of the silica optical microfiber and As2Se3 optical microfiber are 0.5 μm and a 0.128 μm, respectively. This sensor component may have important potential for low detection-limit physical and biochemical sensing applications.
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IJERPH, Vol. 13, Pages 492: A Primrose Path? Moderating Effects of Age and Gender in the Association between Green Space and Mental Health
This paper explored whether the association between green space and mental health is moderated by age and gender. Questionnaires on psychopathology and quality of life were filled out by 4924 individuals from the general Dutch population and regressed on greenness levels. Green space was associated with better mental health, but only in specific age and gender groups, and only in a 3 km, not a 1 km buffer. The moderating effects of age and gender may be explained by whether or not people have the opportunity to make use of their green living environment.
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Assembly force and taper angle difference influence the relative motion at the stem-neck interface of bi-modular hip prostheses
Bi-modular hip arthroplasty prostheses allow adaptation to the individual patient anatomy and the combination of different materials but introduce an additional interface, which was related lately to current clinical issues. Relative motion at the additional taper interface might increase the overall risk of fretting, corrosion, metallic debris and early failure. The aim of this study was to investigate whether the assembly force influences the relative motion and seating behaviour at the stem–neck interface of a bi-modular hip prosthesis (Metha®; Aesculap AG, Tuttlingen, Germany) and whether this relation is influenced by the taper angle difference between male and female taper angles. Neck adapters made of titanium (Ti6Al4V) and CoCr (CoCr29Mo) were assembled with a titanium stem using varying assembly forces and mechanically loaded. A contactless eddy current measurement system was used to record the relative motion between prosthesis stem and neck adapter. Higher relative motion was observed for Ti neck adapters compared to the CoCr ones (p < 0.001). Higher assembly forces caused increased seating distances (p < 0.001) and led to significantly reduced relative motion (p = 0.019). Independent of neck material type, prostheses with larger taper angle difference between male and female taper angles exhibited decreased relative motion (p < 0.001). Surgeons should carefully use assembly forces above 4 kN to decrease the amount of relative motion within the taper interface. Maximum assembly forces, however, should be limited to prevent periprosthetic fractures. Manufacturers should optimize taper angle differences to increase the resistance against relative motion.
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Effect of Inhaled Nitric Oxide on Outcomes in Children With Acute Lung Injury: Propensity Matched Analysis From a Linked Database.
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Concise Definitive Review: Stress Ulcer Prophylaxis.
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Approach behavior and sympathetic nervous system reactivity predict substance use in young adults
Publication date: Available online 10 May 2016
Source:International Journal of Psychophysiology
Author(s): J. Benjamin Hinnant, Alissa B. Forman-Alberti, Anna Freedman, Lindsay Byrnes, Kathryn A. Degnan
A behavioral measure of approach (performance on a resource gathering task) in combination with sympathetic nervous system (SNS) reactivity was used to predict substance use in a sample of young adults (n=93). Pre-ejection period reactivity (PEP-R), a cardiac index of SNS reactivity, was recorded during the resource gathering task (task PEP – resting PEP). Higher levels of approach behaviors on the task in combination with less PEP-R (blunted SNS reactivity) predicted the highest levels of substance use. Findings are discussed in the context of behavioral and physiological systems of approach and avoidance.
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Conscious brain, metacognition and schizophrenia
Publication date: Available online 10 May 2016
Source:International Journal of Psychophysiology
Author(s): Petr Bob, Ondrej Pec, Aaron L. Mishara, Tereza Touskova, Paul H. Lysaker
Recent findings indicate that the binding and synchronization of distributed neural activities are crucial for cognitive processes and consciousness. In addition, there is increasing evidence that disrupted feature binding is related to experiences of disintegration of consciousness in schizophrenia. These data suggest that the disrupted binding and disintegration of consciousness could be typically related to schizophrenia in terms of Bleuler's concept of "splitting". In this context, deficits in metacognitive capacity in schizophrenia may be conceptualized as a spectrum from more discrete to more synthetic activities, related to specific levels of neural binding and neurocognitive deficits. This review summarizes the recent research on metacognition and its relationship to deficits of conscious awareness that may be found in schizophrenia patients. Deficits in synthetic metacognition are likely linked to the integration of information during specific processes of neural binding. Those in turn may be related to a range of mental activities including reasoning style, learning potential and insight.
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Toxin structures as evolutionary tools: Using conserved 3D folds to study the evolution of rapidly evolving peptides
Three-dimensional (3D) structures have been used to explore the evolution of proteins for decades, yet they have rarely been utilized to study the molecular evolution of peptides. Here, we highlight areas in which 3D structures can be particularly useful for studying the molecular evolution of peptide toxins. Although we focus our discussion on animal toxins, including one of the most widespread disulfide-rich peptide folds known, the inhibitor cystine knot, our conclusions should be widely applicable to studies of the evolution of disulfide-constrained peptides. We show that conserved 3D folds can be used to identify evolutionary links and test hypotheses regarding the evolutionary origin of peptides with extremely low sequence identity; construct accurate multiple sequence alignments; and better understand the evolutionary forces that drive the molecular evolution of peptides.
Also watch the video abstract
3D structures remain greatly underutilized as tools for studying the evolution of cysteine-rich peptides. Using the inhibitor cystine knot (ICK) fold as an example, we highlight areas in which 3D structures are particularly useful for uncovering structural and functional adaptations in venom peptides and elucidating their evolutionary history.
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Sustainability, Vol. 8, Pages 467: Environmental Regulation, Economic Network and Sustainable Growth of Urban Agglomerations in China
In this paper, we examine the influence of environmental regulation on sustainable economic growth from both theoretical and empirical perspectives. Our research is twofold. First, we apply a modified NEG (New Economic Geography) model to analyze how environmental regulation influences firms' location choices and cities' sustainable economic growth. Second, we test a spatial econometric model employing panel data of the three largest urban agglomerations in China from 2003 to 2013 to study the relationship between environmental regulation and sustainable economic growth as well as the spillover channels of economic activities. The results reveal a remarkable negative effect of environmental regulation on economic growth. In addition, we find no sufficient evidence to prove the existence of long-term effects of environmental regulation on economic growth in the three urban agglomerations. Furthermore, using different weight matrices to illustrate the different economic networks of the urban agglomeration, we validate the difference in spillover mechanisms across these three urban agglomerations. Specifically, the disparity in environmental regulation acts as a spillover channel for the Yangtze River Delta and the Pearl River Delta, while it is not significant for Jing-Jin-Ji.
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Marine Drugs, Vol. 14, Pages 90: Effect of Experimental Parameters on Alginate/Chitosan Microparticles for BCG Encapsulation
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Sensors, Vol. 16, Pages 676: Spectrum and Image Texture Features Analysis for Early Blight Disease Detection on Eggplant Leaves
This study investigated both spectrum and texture features for detecting early blight disease on eggplant leaves. Hyperspectral images for healthy and diseased samples were acquired covering the wavelengths from 380 to 1023 nm. Four gray images were identified according to the effective wavelengths (408, 535, 624 and 703 nm). Hyperspectral images were then converted into RGB, HSV and HLS images. Finally, eight texture features (mean, variance, homogeneity, contrast, dissimilarity, entropy, second moment and correlation) based on gray level co-occurrence matrix (GLCM) were extracted from gray images, RGB, HSV and HLS images, respectively. The dependent variables for healthy and diseased samples were set as 0 and 1. K-Nearest Neighbor (KNN) and AdaBoost classification models were established for detecting healthy and infected samples. All models obtained good results with the classification rates (CRs) over 88.46% in the testing sets. The results demonstrated that spectrum and texture features were effective for early blight disease detection on eggplant leaves.
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Religions, Vol. 7, Pages 54: Spirituality Self-Care Practices as a Mediator between Quality of Life and Depression
The purpose of this study was to develop a midrange theory, building on Orem's self-care deficit nursing theory (SCDNT) to include constructs of religion, spirituality, and spiritual self‑care practices. This mid-range theory, White's theory of spirituality and spiritual self-care (WTSSSC), was developed and tested as part of a larger study of African American patients with heart failure (HF). The aim of the study was to determine if spiritual self-care practices were mediating the relationship between depression and quality of life for African Americans diagnosed with heart failure. Participants in this study included 142 African Americans diagnosed with HF who were recruited at the clinic where they were being treated. Four instruments were used to measure spiritual self-care practices (White's Spiritual Self-Care Practice Scale (WSPSCPC)), depression symptomology (Patient Health Questionnaire-9 (PHQ-9)), quality of life (World Health Organization QOL (WHOQOL-Bref)), and personal characteristics. Results of the analysis were statistically significant, indicating that spirituality self-care practices were mediating the relationship between depression and quality of life for African American individuals diagnosed with HF. As the population ages and chronic illness becomes more common, nurses need to promote the use of spirituality self-care practices to help patients maintain their well-being.
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Metals, Vol. 6, Pages 109: Effects of Reflow Time on the Interfacial Microstructure and Shear Behavior of the SAC/FeNi-Cu Joint
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IJERPH, Vol. 13, Pages 485: Migrant Sexual Health Help-Seeking and Experiences of Stigmatization and Discrimination in Perth, Western Australia: Exploring Barriers and Enablers
Increasing HIV notifications amongst migrant and mobile populations to Australia is a significant public health issue. Generalizations about migrant health needs and delayed or deterred help-seeking behaviors can result from disregarding the variation between and within cultures including factors, such as drivers for migration and country of birth. This study explored barriers and enablers to accessing sexual health services, including experiences of stigma and discrimination, within a purposive sample of sub-Saharan African, Southeast Asian, and East Asian migrants. A qualitative design was employed using key informant interviews and focus group discussions. A total of 45 people with ages ranging from 18 to 50 years, participated in focus group discussions. Common barriers and enablers to help seeking behaviors were sociocultural and religious influence, financial constraints, and knowledge dissemination to reduce stigma. Additionally, common experiences of stigma and discrimination were related to employment and the social and self-isolation of people living with HIV. Overcoming barriers to accessing sexual health services, imparting sexual health knowledge, recognizing variations within cultures, and a reduction in stigma and discrimination will simultaneously accelerate help-seeking and result in better sexual health outcomes in migrant populations.
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Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?
Objective
The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables.
Design and settingThis was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes.
ParticipantsPatients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED.
ResultsThere were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84).
ConclusionsLow acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients.
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Trends in suicidal behaviour in Dutch general practice 1983-2013: a retrospective observational study
Objectives
To analyse trends in suicidal behaviour as reported by the Dutch sentinel general practices from 1983 to 2013. Second, to examine the relationship between suicidal behaviour and several patient characteristics. Finally, to compare the relationship between suicidal behaviour and patient characteristics before (1983–2007) and after (2008–2013) the start of the crisis.
Setting40 general practices in the Netherlands during the period 1983–2013.
ParticipantsPatients with an ICPC code of P77 (suicide attempt).
Primary and secondary outcomesPrimary outcomes were age-adjusted and gender-specific trends in reported suicides (342) and suicide attempts (1614). Secondary outcomes were the relationship between suicidal behaviour and age, household composition, history of depression, recognition of suicide ideation, treatment before the suicidal behaviour and contact within the past month before suicidal behaviour for the period 1983–2013. Additionally, separate frequencies for the periods 1983–2007 and 2008–2013 were presented.
ResultsJoin-point analyses revealed a significant rise in male suicides from 2008 (b=0.32, SE=0.1, p=0.008), and an increase in male suicide attempts since 2009 (b=0.19, SE=0.04, p<0.001). Female suicidal behaviour showed a steady decrease from 1989 to 2013(b=–0.03, SE=0.007, p<0.0001 for female suicide, b=–0.02, SE=0.002, p<0.001 for female attempts). Before 2007, a history of depression was reported in 65% (168/257) of the suicides. After the start of the recession, a depression was recognised in 44% (22/50) of the patients who died by suicide.
ConclusionsSince 2008, there was a rise in the male suicide rate while female suicide behaviour has continued to decline. General practitioners less often reported a history of depression within patients who died due to suicide after 2007 than before. Training in the early recognition of suicide ideation in depressive patients might improve suicide prevention in primary care.
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Syphilis among middle-aged female sex workers in China: a three-site cross-sectional study
Objectives
This study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis, and its potential risk factors among middle-aged FSWs in China.
DesignA cross-sectional study with respondent-driven sampling (RDS).
SettingA multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao) with different levels of sexually transmitted diseases in 2014.
Participants1245 middle-aged female sex workers who were over 35 years old (about 400 per study site).
Main outcome measuresUnprotected commercial sex, and syphilis and HIV infection were biologically tested and measured.
ResultsThe RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao, and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was between 6.8% and 33.6% in the three cities. The proportion of unprotected sex in the past 48 h verified by the prostate-specific antigen test (PSA) was between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate that middle-aged FSWs who had 5 or more clients in the past week prior to interviews and engaged in unprotected sex were more likely to be active syphilitic cases. Middle-aged FSWs who had rural residency were less likely to be active syphilitic cases.
ConclusionsIn contrast with previous studies that reported low prevalence of syphilis and high prevalence of protected sex among FSWs in China, both the prevalence of syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based intervention programmes should be developed and evaluated among this vulnerable population in China and other countries with similar settings.
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Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: a retrospective cohort study
Objective
To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population.
MethodsA retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (≤18 kg/m2); normal weight (19–24 kg/m2); overweight (25–29 kg/m2); obese class I (30–34 kg/m2); obese class II (35–39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined.
ResultsWithin this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of ≥3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of ≥3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862).
ConclusionsWomen who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.
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Development and validation of an instrument to assess treatment adherence for each individual drug taken by a patient
Objective
To develop and validate an instrument to assess adherence to each individual drug taken by patients undergoing long-term treatment.
DesignMulticentre prospective observational validation study.
SettingSix general practitioners' clinics and 6 university hospitals in Paris, France.
ParticipantsPatients 18 years and older receiving at least one long-term treatment.
MethodsThe instrument was developed from a literature search and interviews with experts. Clarity and wording were assessed during pilot testing with 51 patients. The tool was validated in a sample of consecutive patients. We assessed agreement between adherence measured with our tool and drug diaries and compared measurements from our instrument with (1) the Lu instrument; (2) the Adherence Estimator (AE); (3) patient's adherence assessed by physicians; (4) the Morisky Medication Adherence Scale-4 items (MMAS-4); and (5) the Treatment Burden Questionnaire (TBQ). Reliability was assessed by a test–retest method.
ResultsA total of 243 patients taking 961 drugs were recruited in 2014. We found good agreement between adherence measured by our tool and drug diaries (intraclass correlation coefficient (ICC) 0.69, 95% CI 0.34 to 0.91) and a linear relationship between measurement with our tool and (1) the Lu instrument (p<0.01); (2) 2 items of the AE (perceived need for medication (p<0.01) and concerns about medication (p<0.01)); (3) patients' adherence assessed by their physicians (p<0.01); (4) the MMAS-4 (p<0.01) and (5) the TBQ (p<0.01). Reliability of the retest was good (ICC 0.67, 95% CI 0.42 to 0.85).
ConclusionsWe developed an instrument with acceptable validity and reliability to assess adherence for each drug taken by patients, usable in hospital and primary care settings.
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Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis
Objectives
The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).
SettingCM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.
ParticipantsAdults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.
InterventionCM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems.
Primary and secondary outcomesPrimary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources.
Results22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference –1.28 days (95% CI –2.04 to –0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions.
ConclusionsHospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.
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Effects of closure of an urban level I trauma centre on adjacent hospitals and local injury mortality: a retrospective, observational study
Objective
To determine the association of the Martin Luther King Jr Hospital (MLK) closure on the distribution of admissions on adjacent trauma centres, and injury mortality rates in these centres and within the county.
DesignObservational, retrospective study.
SettingNon-public patient-level data from the state of California were obtained for all trauma patients from 1999 to 2009. Geospatial analysis was used to visualise the redistribution of trauma patients to other hospitals after MLK closed. Variance of observed to expected injury mortality using multivariate logistic regression was estimated for the study period.
ParticipantsA total of 37 131 trauma patients were admitted to the five major south Los Angeles trauma centres from the MLK service area between 1999 and 2009.
Main outcome measures(1) Number and type of trauma admissions to trauma centres in closest proximity to MLK; (2) inhospital injury mortality of trauma patients after the trauma centre closure.
ResultsDuring and after the MLK closure, trauma admissions increased at three of the four nearby hospitals, particularly admissions for gunshot wounds (GSWs). This redistribution of patient load was accompanied by a dramatic change in the payer mix for surrounding hospitals; one hospital's share of uninsured more than tripled from 12.9% in 1999 to 44.6% by 2009. Overall trauma mortality did not significantly change, but GSW mortality steadily and significantly increased after the closure from 5.0% in 2007 to 7.5% in 2009.
ConclusionsThough local hospitals experienced a dramatic increase in trauma patient volume, overall mortality for trauma patients did not significantly change after MLK closed.
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Use of novel psychoactive substances by inpatients on general adult psychiatric wards
Objectives
Non-illicit alternatives to controlled drugs, known as novel psychoactive substances (NPS), have recently risen to prominence. They are readily available, with uncertain pharmacology and no widely available assay. Given that psychiatric patients are at risk of comorbid substance abuse, we hypothesised that NPS use would be present in the psychiatric population, and sought to determine its prevalence and investigate the characteristics of those who use these drugs with a retrospective review of discharge letters.
SettingGeneral adult inpatient wards of a psychiatric hospital in a Scottish city.
ParticipantsAll adult inpatients (18–65) discharged from general psychiatric wards between 1 July 2014 and 31 December 2014. Of the 483 admissions identified, 46 were admissions for maintenance electroconvulsive therapy (ECT) and were excluded. Of the remaining 437 admissions, 49 discharge letters were unobtainable, leaving 388 admissions to analyse.
Primary outcome measureThe mention, or lack thereof, of NPS use in discharge letters was our planned primary outcome measure and was also the primary outcome measure we used in our analysis.
ResultsNPS use was identified in 22.2% of admissions, contributing to psychiatric symptoms in 59.3%. In comparison to non-users, NPS users were younger (p<0.01), male and more likely to have a forensic history ((p<0.001) for both). The diagnosis of drug-induced psychosis was significantly more likely in NPS users (p<0.001, OR 18.7, 95% CI 8.1 to 43.0) and the diagnosis of depression was significantly less likely (p<0.005, OR 0.133, CI 0.031 to 0.558). Use of cannabis was significantly more likely in NPS users (p<0.001, OR 4.2, CI 2.5 to 7.1), as was substitute opiate prescribing (p<0.001, OR 3.7, CI 1.8 to 7.4).
ConclusionsNPS use was prevalent among young, male psychiatric inpatients, in particular those with drug-induced psychosis and often occurred alongside illicit drug use.
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Irie Classroom Toolbox: a study protocol for a cluster-randomised trial of a universal violence prevention programme in Jamaican preschools
Introduction
We aim to determine the effectiveness of a school-based violence prevention programme implemented in Jamaican preschools, on reducing the levels of aggression among children at school, and violence against children by teachers.
Methods and analysisThis is a 2-arm, single-blind, cluster-randomised controlled trial with parallel assignment. Clusters are 76 preschools in Kingston, and all teachers and classrooms in the selected schools are included in the study. In addition, a random sample of up to 12 children in the 4-year-old classes have been selected for evaluation of child-level outcomes. The intervention involves training teachers in classroom behaviour management and in strategies to promote children's social-emotional competence. Training is delivered through five full-day workshops, monthly in-class coaching over 2 school terms, and weekly text messages. The primary outcome measures are: (1) observed levels of child aggression and (2) observed violence against children by teachers. Secondary outcomes include observations of the levels of children's prosocial behaviour and the quality of the classroom environment, teachers' reports of their mental health, teacher-reported child mental health, direct tests of children's self-regulation and child attendance.
Ethics and disseminationIf this intervention were effective at improving the caregiving environment of young children in school, this would have significant implications for the prevention of child mental health problems, and prevention of violence against children in low and middle-income countries where services are often limited. The intervention is integrated into the school system and involves training existing staff, and thus, represents an appropriate strategy for large-scale implementation and benefits at the population level. Ethical consent for the study was given by the School of Psychology Ethics and Research Committee, Bangor University (ref: 2014-14167), and by the University of the West Indies Ethics Committee (ref: ECP 50,14/15).
Trial registration numberISRCTN11968472; Pre-results.
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Health coaching and pedometers to enhance physical activity and prevent falls in community-dwelling people aged 60 years and over: study protocol for the Coaching for Healthy AGEing (CHAnGE) cluster randomised controlled trial
Introduction
Prevention of falls and promotion of physical activity are essential for maximising well-being in older age. However, there is evidence that promoting physical activity among older people without providing fall prevention advice may increase fall rates. This trial aims to establish the impact of a physical activity and fall prevention programme compared with a healthy eating programme on physical activity and falls among people aged 60+ years.
Methods and analysisThis cluster randomised controlled trial will involve 60 groups of community-dwelling people aged 60+ years. Participating groups will be randomised to: (1) a physical activity and fall prevention intervention (30 groups), involving written information, fall risk assessment and prevention advice, a pedometer-based physical activity tracker and telephone-based health coaching; or (2) a healthy eating intervention (30 groups) involving written information and telephone-based dietary coaching. Primary outcomes will be objectively measured physical activity at 12 months post-randomisation and self-reported falls throughout the 12-month trial period. Secondary outcomes include: the proportion of fallers, the proportion of people meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and health and community service use. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will be preplanned, conducted while masked to group allocation, will take into account cluster randomisation, and will use an intention-to-treat approach.
Ethics and disseminationProtocol has been approved by the Human Research Ethics Committee at The University of Sydney, Australia (number 2015/517). Results will be disseminated via peer-reviewed journal articles, international conference presentations and participants' newsletters.
Trial registration numberACTRN12615001190594.
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Αλέξανδρος Γ. Σφακιανάκης Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,0030693260717...
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