Perceived effects of the economic recession on population mental health, well-being and provision of care by primary care users and professionals: a qualitative study protocol in Portugal

Introduction

Economic recession periods can pose accentuated risks to population's mental health and well-being as well as additional threats to health systems. Users and health professionals are key stakeholders in care delivery; however, little attention has been given to their experiences of the crisis. This paper presents a qualitative study protocol to assess users' and health professionals' perceptions about the effects of the post-2008 economic recession on mental health and care delivery in the Lisbon Metropolitan Area, Portugal.

Methods and analysis

The methodology to assess perceived effects of the economic recession by primary care users and professionals on population mental health, well-being and provision of care is presented. Focus groups with users and semistructured interviews with health professionals will be carried out in three primary healthcare units in Lisbon areas especially affected by the crisis. Thematic analysis of full-transcribed interviews will be conducted using an iterative and reflexive approach.

Ethics and dissemination

The study protocol was approved by the Ethics Committee of NOVA Medical School, NOVA University of Lisbon. The findings will be useful for other researchers and policy-makers to develop and implement the assessment of prevailing experiences of users and health professionals on the effects of the economic recession on mental health and quality of care in primary health context, promoting their involvement and contribution to services responsiveness.

http://ift.tt/2vEM4Et

Can health indicators and psychosocial characteristics predict attrition in youths with overweight and obesity seeking ambulatory treatment? Data from a retrospective longitudinal study in a paediatric clinic in Luxembourg

Objectives

The current study aimed to identify factors that could predict attrition in youths starting ambulatory treatment to control or lose weight.

Design

Retrospective longitudinal study.

Setting

Paediatric clinic: ambulatory treatment programme.

Patients and measures

A youth sample (n=191; 89 boys; aged 7–17 years) completed measures of demographic characteristics, and health and psychosocial traits before starting an ambulatory weight management programme. Anthropometric and biological markers related to obesity were also obtained. Tests of mean differences and regression analyses were used to investigate the relationship between these variables and attrition after 1 year.

Results

The ²and t test results showed both psychosocial and health indicators differentiated between participants who continued attending the treatment programme and those who dropped out. More specifically, youths that dropped out of treatment were significantly older, had higher body mass index z scores, higher levels of insulin, triglycerides and HOMA-IR, reported poorer health, had more conduct problems and were more dissatisfied with themselves and their bodies before starting treatment. Results of regression analyses revealed that weight status (anthropometric and biological markers), age and body dissatisfaction predicted attrition (overall prediction success 73%; prediction success for continued attendance 90/91%; prediction success for dropouts 42/44%).

Conclusion

Attrition, but especially the continued attendance in treatment, can be successfully predicted by age, weight status and body dissatisfaction. For patients who present with one or more risk factors, careful consideration is needed to decide which (combination of) inpatient or outpatient programme may facilitate prolonged engagement of the patient and hence may be most effective in establishing weight loss.

http://ift.tt/2wzh1H3

Correction: Using patients experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above

Walton M, Smith-Merry J, Harrison R, et al. Using patients' experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above. BMJ Open 2014;4:e006599. doi: 10.1136/bmjopen-2014-006599

The authors have been alerted to the omission of the following important details in the reporting of their study protocol:

The Sax Institute is acknowledged as the managing organisation for the 45 and Up Study.

Prospective 45 and Up participants were randomly sampled from the Department of Human Services (formerly Medicare Australia) enrolment database, which provides near complete coverage of the population. People aged 80 and over and residents of rural and remote areas were oversampled. Those who agreed to participate completed a baseline questionnaire (between Jan 2006 and December 2009) and gave signed consent for follow-up and linkage of their information to routine health databases

...

http://ift.tt/2vE07dt

Guideline use behaviours and needs of primary care practitioners in China: a cross-sectional survey

Objectives

Clinical guidelines have been recognised as an effective way to improve healthcare performance. However, little is known about the uptake and implementation of guidelines by general practitioners in China. The aim of this study was to investigate the guideline use behaviours and needs of practitioners in primary care settings in China.

Methods

We conducted a cross-sectional survey from December 2015 to May 2016 that included practitioners at 268 institutions in 15 provinces in China. Questionnaire development was informed by the execution of a literature review and consultation of experts. On-site surveys were implemented using a paper questionnaire to minimise missing responses. A multivariate logistic regression analysis was performed to identify factors associated with provider knowledge of and attitudes towards clinical guidelines.

Results

Of the respondents, 91.7% (1568/1708) were aware of clinical guidelines, but only 11.3% (177/1568) frequently used them. The main mechanism by which primary care practitioners accessed guidelines was public search engines (63.4%; 911/1438), and practitioners seldom reported using biomedical databases. The most frequently identified barriers to guideline use were lack of training (49.9%; 778/1560), lack of access (44.6%; 696/1560) and lack of awareness (38.0%; 592/1560). Less than one-quarter of respondents considered current guidelines 'entirely appropriate' for use in primary care (23.5%; 339/1442). Most participants (96.2%; 1509/1568) believed it was necessary to develop primary care guidelines. Provider attitudes towards current guidelines were associated with the location and level of the institution and professional title of the practitioner (p<0.05).

Conclusion

Our survey revealed poor knowledge and uptake of clinical guidelines in primary care, and we identified a gap between the needs of practitioners and availability of clinical guidelines for use in primary care in China. In addition, lacking access to and training in guidelines also prevented primary healthcare practitioners from using guidelines in daily practice.

http://ift.tt/2wAadJD

Study protocol for a matter of heart: a qualitative study of patient factors driving overuse of cardiac catheterisation

Introduction

Overuse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other regions, although percutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. Various studies investigated health system, physician and patient factors driving non-adherence to guidelines which recommend a stepwise approach with invasive procedures only in case of signs of ischaemia in non-invasive testing. In a larger-scale project, we aim to better understand the patients' perspective in order to develop an intervention that enhances patient's acceptance of this stepwise diagnostic approach for stable CAD. As a first step, this qualitative study aims to identify patient factors that prevent and promote the described overuse.

Methods and analysis

The exploratory qualitative interview study will include about 20 patients with stable CAD and a history of acute coronary syndrome from two German teaching practices. Narrative, structured interviews designed to last 30 to 90 min will be conducted. The interviews will be analysed using qualitative content analysis by Mayring. The analysis will address the following questions: (1) What are reasons for stable patients to undergo CC? (2) How do patients deal with their heart disease (secondary prevention)? (3) Which processes do patients describe regarding decision-making for non-invasive and invasive coronary procedures? (4) What information needs exist on behalf of patients to better understand the stepwise diagnostic approach outlined in guidelines and thereby avoid low-appropriate CCs? Based on these data, empirical typification will be conducted.

Ethics and dissemination

Ethical approval for the study was obtained. All participants will provide written informed consent. Data will be pseudonymised for analysis. The findings will contribute to the development of an appropriate intervention. Results will be disseminated by conference presentations and journal publications.

http://ift.tt/2vEbbHj

Exploring the association between chorangioma and infantile haemangioma in singleton and multiple pregnancies: a case-control study in a Swedish tertiary centre

Objectives

Placenta or placental chorangioma could be the origin site of infantile haemangioma since they share various histochemical and genetic characteristics with placental vascular tissue. The aim of the current study was to investigate the association between chorangiomas and infantile haemangiomas in singleton and multiple pregnancies.

Materials and methods

An informative questionnaire enquiring about the presence or not of infantile haemangioma and including illustrative photos of haemangioma was sent to 469 (153 cases with chorangioma and 316 controls) mothers of 323 singleton (104 cases and 219 controls) and 146 multiple (49 cases and 97 controls) liveborn neonates registered in Sweden. Overall, 310 mothers (66.1%) from 216 singleton and 94 multiple pregnancies (96 cases and 214 controls) provided feedback and their consent to participate in the current case–control study.

Results

The incidence of infantile haemangioma showed no statistically significant differences between cases and controls (18.8% vs 18.2%) or between singleton and multiple pregnancies (18.9% vs 17.0%). The frequency of pre-eclampsia was significantly higher in cases with chorangioma compared with controls (41.7% vs 24.3%, OR=2.22, 95% CI 1.33 to 3.71, p=0.0022) and in singleton compared with multiple pregnancies (33.3% vs 21.3%, OR=1.85, 95% CI 1.04 to 3.26, p=0.034), whereas there were no significant differences in the incidence of infantile haemangioma in neonates of mothers with or without pre-eclampsia or in neonates of mothers with multiple compared with singleton pregnancies.

Conclusion

There was no association between placental chorangiomas and infantile haemangiomas. Multiple pregnancies or pre-eclampsia were not significantly related to higher incidence of infantile haemangioma.

http://ift.tt/2vEsJ6o

Intermittent catheter users symptom identification, description and management of urinary tract infection: a qualitative study

Objectives

To elucidate the views of intermittent catheter (IC) users regarding urinary tract infection (UTI) symptom presentation, terminology for describing signs and symptoms, the cause of UTI and management strategies.

Design

Qualitative study with semi-structured interviews. The transcribed text was analysed thematically.

Setting

12 general practitioner (GP) surgeries in Hampshire and Dorset, UK.

Participants

A convenience sample of 30 IC users, aged over 18, using IC for at least 3 months who had at least one self-reported UTI since starting IC.

Results

Participants reported a variety of signs and symptoms, such as urine cloudiness and smell, as indicators of UTI. The terms used often differed from those in the modified National Institute on Disability and Rehabilitation Research (NIDRR) symptom set. IC users had difficulty distinguishing possible UTI symptoms from those of their comorbidities. They expressed uncertainty about the cause of UTI, often attributing it to poor hygiene and lifestyle behaviours. Whereas some viewed UTI as an expected consequence of IC use that could be self-managed, others felt more concerned and were more reliant on their GP for support. A range of management strategies was described, including drinking more fluids, increased attention to personal hygiene and self-medicating with antibiotics.

Conclusions

There is uncertainty among IC users about UTI signs and symptoms and when to seek help. Individual accounts of UTI fitted generally within the modified NIDRR descriptors but adopted less technical and more 'lay' language. IC users' descriptions of UTI signs and symptoms can lack precision, owing partly to the presence of underlying health conditions. This, together with differing levels of concern about the need to seek help and self-medication with antibiotics, presents challenges for the GP. This study provides the basis for developing a self-help tool which may aid identification of UTI and enhance communication with healthcare professionals.

http://ift.tt/2vDmj7z

Economic impact of ulipristal acetate on surgical procedures for uterine fibroids in France

Objective

To assess the budget impact of using ulipristal acetate (UPA) 5 mg to treat women with uterine fibroids (UF) causing moderate to severe symptoms.

Design

We modelled trends in the number of surgical procedures for symptomatic UF, with and without the use of UPA for preoperative or intermittent treatment and assessed the budget impact of UPA use from the French national healthcare insurance system perspective.

Setting

A French national hospital database (PMSI) that records admissions and relative procedures to public and private hospitals.

Participants

Women eligible for surgical procedures for uterine fibroids.

Main outcome measures

Economic impact of UPA treatment.

Results

This study based on observational retrospective data shows that the current use of UPA in its preoperative indication was associated with 5645 fewer surgeries from 2013 to 2015. Extrapolation suggests 17 885 fewer surgeries from 2016 to 2019. Overall, preoperative use of UPA results in substantial cost savings for the French national healthcare insurance system, with a cumulated budget impact estimated at –5 million from 2013 to 2015 and –13.5 million from 2016 to 2019. In addition, treating women nearing the menopause (≥48 years old) with intermittent treatment from 2017 to 2019 could produce an incremental cost saving of 19 million.

Conclusions

This study shows that the use of UPA in women eligible for surgical procedures for UF is associated with considerable savings for the French national healthcare insurance system in both preoperative and intermittent indications by decreasing the need to perform surgeries.

http://ift.tt/2wzVH4A

Telemedicine-guided education on secondary stroke and fall prevention following inpatient rehabilitation for Texas patients with stroke and their caregivers: a feasibility pilot study

Introduction

The aftermath of stroke leaves many consequences including cognitive deficits and falls due to imbalance. Stroke survivors and families struggle to navigate the complex healthcare system with little assistance posthospital discharge, often leading to early hospital readmission and worse stroke outcomes. Telemedicine Guided Education on Secondary Stroke and Fall Prevention Following Inpatient Rehabilitation feasibility study examines whether stroke survivors and their caregivers find value in telerehabilitation (TR) home visits that provide individualised care and education by a multidisciplinary team after discharge from inpatient rehabilitation.

Methods and analysis

A prospective, single arm, pilot study is designed to evaluate the feasibility of weekly TR home visits initiated postdischarge from inpatient rehabilitation. Newly diagnosed patients with stroke are recruited from a Houston-based comprehensive stroke centre inpatient rehabilitation unit, loaned an iPad with data plan and trained to use information technology security-approved videoconferencing application. After hospital discharge, six weekly TR home visits are led by rotating specialists (pharmacist, physical/occupational therapist, speech therapist, rehabilitation physician, social worker, geriatrician specialised in fracture prevention) followed by satisfaction survey on week 7. Specialists visually assess patients in real time, educate them on secondary stroke and fall prevention and suggest ways to improve function including direct medical interventions when indicated. Primary outcomes are proportion of eligible patients consenting to the study, participation rate in all six TR home visits and satisfaction score. The study started 31 December 2015 with plan to enrol up to 50 patients over 24 months. Feasibility study results will inform us as to whether a randomised controlled trial is warranted to determine efficacy of TR home visit intervention in improving stroke outcomes.

Ethics and dissemination

Ethics approval obtained by the Institutional Review Board (IRB), Committee for the Protection of Human Subjects, IRB number: HSC-MS-14–0994. Study results will be submitted for publication in a peer-reviewed journal.

http://ift.tt/2vEpcF1

Performance of a postnatal metabolic gestational age algorithm: a retrospective validation study among ethnic subgroups in Canada

Objectives

Biological modelling of routinely collected newborn screening data has emerged as a novel method for deriving postnatal gestational age estimates. Validation of published models has previously been limited to cohorts largely consisting of infants of white Caucasian ethnicity. In this study, we sought to determine the validity of a published gestational age estimation algorithm among recent immigrants to Canada, where maternal landed immigrant status was used as a surrogate measure of infant ethnicity.

Design

We conducted a retrospective validation study in infants born in Ontario between April 2009 and September 2011.

Setting

Provincial data from Ontario, Canada were obtained from the Institute for Clinical Evaluative Sciences.

Participants

The dataset included 230 034 infants born to non-landed immigrants and 70 098 infants born to immigrant mothers. The five most common countries of maternal origin were India (n=10 038), China (n=7468), Pakistan (n=5824), The Philippines (n=5441) and Vietnam (n=1408). Maternal country of origin was obtained from Citizenship and Immigration Canada's Landed Immigrant Database.

Primary and secondary outcome measures

Performance of a postnatal gestational age algorithm was evaluated across non-immigrant and immigrant populations.

Results

Root mean squared error (RMSE) of 1.05 weeks was observed for infants born to non-immigrant mothers, whereas RMSE ranged from 0.98 to 1.15 weeks among infants born to immigrant mothers. Area under the receiver operating characteristic curve for distinguishing term versus preterm infants (≥37 vs <37 weeks gestational age or >34 vs ≤34 weeks gestational age) was 0.958 and 0.986, respectively, in the non-immigrant subgroup and ranged from 0.927 to 0.964 and 0.966 to 0.99 in the immigrant subgroups.

Conclusions

Algorithms for postnatal determination of gestational age may be further refined by development and validation of region or ethnicity-specific models. However, our results provide reassurance that an algorithm developed from Ontario-born infant cohorts performs well across a range of ethnicities and maternal countries of origin without modification.

http://ift.tt/2vEM5s1

The role of pragmatism in explaining heterogeneity in meta-analyses of randomised trials: a protocol for a cross-sectional methodological review

Introduction

There has been increasing interest in pragmatic trials methodology. As a result, tools such as the Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) are being used prospectively to help researchers design randomised controlled trials (RCTs) within the pragmatic-explanatory continuum. There may be value in applying the PRECIS-2 tool retrospectively in a systematic review setting as it could provide important information about how to pool data based on the degree of pragmatism.

Objectives

To investigate the role of pragmatism as a source of heterogeneity in systematic reviews by (1) identifying systematic reviews with meta-analyses of RCTs that have moderate to high heterogeneity, (2) applying PRECIS-2 to RCTs of systematic reviews, (3) evaluating the inter-rater reliability of PRECIS-2, (4) determining how much of this heterogeneity may be explained by pragmatism.

Methods

A cross-sectional methodological review will be conducted on systematic reviews of RCTs published in the Cochrane Library from 1 January 2014 to 1 January 2017. Included systematic reviews will have a minimum of 10 RCTs in the meta-analysis of the primary outcome and moderate to substantial heterogeneity (I²≥50%). Of the eligible systematic reviews, a random selection of 10 will be included for quantitative evaluation. In each systematic review, RCTs will be scored using the PRECIS-2 tool, in duplicate. Agreement between raters will be measured using the intraclass correlation coefficient. Subgroup analyses and meta-regression will be used to evaluate how much variability in the primary outcome may be due to pragmatism.

Dissemination

This review will be among the first to evaluate the PRECIS-2 tool in a systematic review setting. Results from this research will provide inter-rater reliability information about PRECIS-2 and may be used to provide methodological guidance when dealing with pragmatism in systematic reviews and subgroup considerations. On completion, this review will be submitted to a peer-reviewed journal for publication.

http://ift.tt/2vE0hBB

Understanding symptom appraisal and help-seeking in people with symptoms suggestive of pancreatic cancer: a qualitative study

Objective

Pancreatic cancer has poor survival rates due to non-specific symptoms leading to later diagnosis. Understanding how patients interpret their symptoms could inform approaches to earlier diagnosis. This study sought to explore symptom appraisal and help-seeking among patients referred to secondary care for symptoms suggestive of pancreatic cancer.

Design

Qualitative analysis of semistructured in-depth interviews. Data were analysed iteratively and thematically, informed by the Model of Pathways to Treatment.

Participants and setting

Pancreatic cancer occurs rarely in younger adults, therefore patients aged ≥40 years were recruited from nine hospitals after being referred to hospital with symptoms suggestive of pancreatic cancer; all were participants in a cohort study. Interviews were conducted soon after referral, and where possible, before diagnosis.

Results

Twenty-six interviews were conducted (cancer n=13 (pancreas n=9, other intra-abdominal n=4), non-cancer conditions n=13; age range 48–84 years; 14 women). Time from first symptoms to first presentation to healthcare ranged from 1 day to 270 days, median 21 days. We identified three main themes. Initial symptom appraisal usually began with intermittent, non-specific symptoms such as tiredness or appetite changes, attributed to diet and lifestyle, existing gastrointestinal conditions or side effects of medication. Responses to initial symptom appraisal included changes in meal type or frequency, or self-medication. Symptom changes such as alterations in appetite and enjoyment of food or weight loss usually prompted further appraisal. Triggers to seek help included a change or worsening of symptoms, particularly pain, which was often a 'tipping point'. Help-seeking was often encouraged by others. We found no differences in symptom appraisal and help-seeking between people diagnosed with cancer and those with other conditions.

Conclusions

Greater public and healthcare professional awareness of the combinations of subtle and intermittent symptoms, and their evolving nature, is needed to prompt timelier help-seeking and investigation among people with symptoms of pancreatic cancer.

http://ift.tt/2wAfZdW

Biopsychosocial factors associated with non-recovery after a minor transport-related injury: protocol for a systematic review

Introduction

Globally, road transport accidents contribute substantially to the number of deaths and also to the burden of disability. Up to 50 million people suffer a transport-related non-fatal injury each year, which often leads to long-term disability. It has been shown that substantial number of people with minor injuries struggle to recover and the reasons are still not well explored.

Despite the high prevalence, little is known about the factors hindering recovery following minor traffic-related injuries. The aim of this paper is to present a protocol for the systematic review aiming to understand biopsychosocial factors related to non-recovery and identify current gaps in the literature.

Methods and analysis

The review will be conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol guidelines. A search of the electronic databases, MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, will be undertaken, in addition to Google Scholar and grey literature to identify studies in period from 2006 to 2016. Quantitative and qualitative research articles describing and identifying biopsychosocial factors associated with non-recovery and health outcomes such as pain, disability, functional recovery, health-related quality of life, post-traumatic stress disorder, depression, anxiety and return to work will be included. A conceptual framework developed to identify biopsychosocial factors will be applied to assure defined criterion.

At present, there is little anticipation for meta-analyses due to the heterogeneity of factors and outcomes assessed. Therefore, a narrative synthesis based on study findings will be conducted.

Ethics and dissemination

Ethical approval is not required as primary data will not be collected. Review results will be published as a part of thesis, peer-reviewed journal and conferences.

Trialregistration number

PROSPEROregistration number: CRD42016052276.

http://ift.tt/2wA2omX

Prevalence of stroke and associated risk factors: a population based cross sectional study from northeast China

Objectives

Epidemiological studies aimed at stroke and its risk factors can help identify persons at higher risk and therefore promote stroke prevention strategies. We aimed to explore the current prevalence of stroke and its associated risk factors in northeast China.

Design

Population based cross sectional study.

Setting

Data were collected using a structured precoded questionnaire designed by the Stroke Screening and Prevention Programme of the National Health and Family Planning Commission of China, between January and March 2016.

Participants

4100 permanent residents, aged 40 years or older, who had lived in Dehui City of Jilin Province for more than 6 months volunteered to participate in the survey, with a response rate of 92.2%. For the purpose of the present analysis, 48 subjects were excluded due to missing values, giving a total of 4052 people included in this analysis.

Main outcome measure

The questionnaire included demographic characteristics, stroke related behavioural factors, personal and family medical history of stroke, physical examination and laboratory testing.

Results

The overall prevalence of stroke in Jilin Province was 7.2% (95% CI 6.3% to 8.2%). Of all stroke cases, 91.7% (95% CI 87.4% to 94.6%) were ischaemic stroke and 8.3% (95% CI 5.4% to 12.6%) were haemorrhagic stroke. The prevalence rates of dyslipidaemia, smoking and hypertension were ranked as the top three cerebrovascular risk factors and were 62.1%, 61.8% and 57.3%, respectively. We found that hypertension, dyslipidaemia and lack of exercise were associated with ischaemic stroke. However, only hypertension (OR=4.064, 95% CI 1.358 to 12.160) was significantly associated with haemorrhagic stroke.

Conclusions

The prevalence of stroke, especially ischaemic stroke, and associated cerebrovascular risk factors among adults aged 40 years or older in northeast China were high. A higher regional prevalence of hypertension, dyslipidaemia and lack of exercise may be responsible.

http://ift.tt/2vE8Nk2

Effectiveness of two psychological interventions for pain management, emotional regulation and promotion of quality of life among adult Portuguese men with haemophilia (PSY-HaEMOPEQ): study protocol for a single-centre prospective randomised controlled trial

Introduction

Haemophilia is a bleeding disorder associated with significant pain, emotional distress, quality of life (QoL) impairment and considerable healthcare costs. Psychosocial health and effective pain management are considered essential end points for optimal haemophilia care, but there is a significant gap in evidence-based treatments targeting these outcomes in people with haemophilia (PWH). Psychological interventions are cost-effective in promoting emotional well-being, QoL and pain control, although these have been scarcely used in haemophilia field. This investigation aims to evaluate the effectiveness of two psychological interventions for pain management, emotional regulation and promotion of QoL in PWH.

Methods and analysis

This is a single-centre parallel randomised controlled trial conducted at a European Haemophilia Comprehensive Care Centre in Portugal, with five assessment points: baseline (T0), postintervention (T1), 3 (T2), 6 (T3) and 12 (T4) months follow-up. Eligible adult males, with moderate or severe haemophilia A or B will be randomised to experimental (EG) or control (CG) group. Intervention is either cognitive-behavioural therapy (EG1) or hypnosis (EG2), both consisting of four weekly sessions following standardised scripts delivered by trained psychologists. Randomisation will be computer generated, allocation concealment will be guaranteed and outcome assessors will be blind to EG/CG allocation. Main outcomes are pain and haemophilia-related QoL and secondary outcomes include clinical (clotting factor replacement consumption, joint bleeding episodes, analgesic intake) and psychological (pain coping strategies, anxiety, depression, illness perceptions) variables, functional assessment of the joints, inflammatory biomarkers (cytokines, high-sensitivity C reactive protein) and white blood cell count.

Ethics and dissemination

This study was approved by the competent authorities and all procedures will comply with international ethical guidelines for clinical studies involving humans. Written informed consent will be obtained from all participants. The dissemination plan includes peer-reviewed scientific publications, conference participation and web and media coverage.

Trial registration number

NCT02870452.

http://ift.tt/2wA2jzF

Impact of chronic obstructive pulmonary disease on patients with aortic aneurysms: a nationwide retrospective cohort study in Taiwan

Objectives

Aortic aneurysm (AA) is a leading cause of death worldwide. Chronic obstructive pulmonary disease (COPD) is a risk factor for AA, and the prognoses of COPD patients with AA who underwent/did not undergo an operation warrant investigation.

Design

A nationwide retrospective cohort study.

Setting

We included patients with AA older than 18 years who received their first AA diagnosis between 2005 and 2011 in Taiwan.

Participants

This study enrolled 3263 COPD patients with AA before propensity score matching and 2127 COPD patients with AA after propensity score matching.

Outcome measures

The main outcomes were all-cause mortality and rehospitalisation for AA or operation. The outcomes of COPD patients with AA and COPD patients without AA during an 8-year follow-up period were examined using Cox proportional hazards models.

Results

In the AA population, patients with COPD showed higher rates of mortality and rehospitalisation than patients without COPD with adjusted HRs of 1.12 (95% CI 1.03 to 1.22) and 1.11 (95% CI 1.01 to 1.23), respectively, after propensity score matching. Analysis of the patients who underwent an operation revealed that the rates of mortality of COPD and non-COPD patients were not significantly different. In contrast, among the patients who did not receive an operation, patients with COPD showed a higher mortality rate than patients without COPD with an adjusted HR of 1.11 (95% CI 1.0 to 1.22).

Conclusions

The outcomes of COPD patients with AA undergoing an operation were improved, but the mortality rate of non-COPD patients with AA remained high. An effective treatment to reduce mortality in this group warrants further investigation.

http://ift.tt/2wAilte

Effect of Baduanjin exercises on elevated blood lipid levels of middle-aged and elderly individuals: protocol for a systematic review and meta-analysis of randomised controlled trials

Objective

To assess the safety and effect on elevated blood lipid levels of Baduanjin exercises in middle-aged and elderly individuals.

Methods

A systematic literature search for articles up to March 2017 will be conducted using seven databases: PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodicals Database, Chinese BioMedical Database and Wanfang Data. Inclusion criteria are randomised controlled trials of Baduanjin exercises that examine blood lipid levels in middle-aged and elderly individuals. The primary outcome measures will be total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Stata V.13.0 software will be used for data synthesis, sensitivity analysis, metaregression, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Begg and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence.

Ethics and dissemination

This systematic review will be submitted to a peer-reviewed journal. Our findings will provide information about the safety of Baduanjin exercises for middle-aged and elderly individuals and their effect on elevated blood lipid levels.

Trial registration number

PROSPERO CRD 42017060613.

http://ift.tt/2wA2MC6

Health-related quality of life in residents aged 18 years and older with and without disease: findings from the First Provincial Health Services Survey of Hunan, China

Objective

Published research has not considered acute diseases and injuries in assessing the impact of varying disease counts on health-related quality of life (HRQoL). We used Chinese value sets of EQ-5D-3L to examine the relationship between the number of diseases individuals had (including chronic diseases, acute diseases and injuries) and their HRQoL.

Methods

A total of 19 387 individuals aged 18 years and older were included in the study. Using data from the First Provincial Health Services Survey of Hunan, China, HRQoL was assessed with the EQ-5D-3L scale, a standardized instrument developed by the EuroQoL group. The EQ-5D-3L utility score was calculated using the Chinese EQ-5D-3L value set. This survey coded disease using the list of 133 conditions that was defined by the First Provincial Health Services Survey of Hunan, China, based on the 10th International Classification of Diseases. 126 conditions were disease-related and were therefore included in data analysis.

Results

Of 15 245 respondents, urban residents and male constituted 53.0% and 48.2%, respectively. 19.3% of respondents had one disease and 5.0% had at least two diseases. Of the five dimensions of the EQ-5D-3L, the pain/discomfort dimension had the highest proportion of moderate or serious problems among the respondents (14.4%, 95% CI 10.5% to 18.2%). The average Visual Analogue Scale (VAS) score and utility score were 78.0 (95% CI 76.9 to 79.1) and 0.958 (95% CI 0.946 to 0.970), respectively. Residents with 1 and ≥2 diseases had higher proportions of moderate or serious problems in five dimensions of the EQ-5D-3L scale during the previous 2 weeks than those without disease after controlling for location (urban/rural), sex, age, education level and household income, respectively (adjusted ORs: 3.1–3.7 and 4.4–6.6, respectively). The mean of the EQ VAS score was 8.4 and 13.6 points lower in respondents with 1 and ≥2 diseases than in respondents without disease; the corresponding mean score difference was 0.048 and 0.086 in EQ-5D-3L utility score. Disease-specific analyses were not conducted due to the inadequacy of sample size.

Conclusions

The HRQoL of residents aged 18 years and older declines distinctly as the number of diseases increases. Actions should be taken to improve the HRQoL of residents with multiple diseases in China (including acute diseases, chronic diseases and injuries).

http://ift.tt/2vDIwSR

The economic impact of childhood acute gastroenteritis on Malawian families and the healthcare system

Objectives

This prospective cohort study sought to estimate health system and household costs for episodes of diarrhoeal illness in Malawi.

Setting

Data were collected in two Malawian settings: a rural health centre in Chilumba and an urban tertiary care hospital in Blantyre.

Participants

Children under 5 years of age presenting with diarrhoeal disease between 1 January 2013 and 21 November 2014 were eligible for inclusion. Illnesses attributed to other underlying causes were excluded, as were illnesses commencing more than 2 weeks prior to presentation. Complete data were collected on 514 cases at both the time of the initial visit to the participating healthcare facility and 6 weeks after discharge.

Primary and secondary outcome measures

The primary outcome measure was the total cost of an episode of illness. Costs to the health system were gathered from chart review (drugs and diagnostics) and actual hospital expenditure (staff and facility costs). Household costs, including lost income, were obtained by interview with the parents/guardians of patients.

Results

Total costs in 2014 US$ for rural inpatient, rural outpatient, urban inpatient and urban outpatient were $65.33, $8.89, $60.23 and $14.51, respectively (excluding lost income). Mean household contributions to these costs were 15.8%, 9.8%, 21.3% and 50.6%.

Conclusion

This study found significant financial burden from childhood diarrhoeal disease to the healthcare system and to households. The latter face the risk of consequent impoverishment, as the study demonstrates how the costs of seeking treatment bring the income of the majority of families in all income strata below the national poverty line in the month of illness.

http://ift.tt/2wzVzlC

Scoping review protocol: education initiatives for medical psychiatry collaborative care

Introduction

The collaborative care model is an approach providing care to those with mental health and addictions disorders in the primary care setting. There is a robust evidence base demonstrating its clinical and cost-effectiveness in comparison with usual care; however, the transitioning to this new paradigm of care has been difficult. While there are efforts to train and prepare healthcare professionals, not much is known about the current state of collaborative care training programmes. The objective of this scoping review is to understand how widespread these collaborative care education initiatives are, how they are implemented and their impacts.

Methods and analysis

The scoping review methodology uses the established review methodology by Arksey and O'Malley. The search strategy was developed by a medical librarian and will be applied in eight different databases spanning multiple disciplines. A two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing collaborative care education initiative for healthcare providers. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardised form. The extracted data will undergo a 'narrative review' or a descriptive analysis of the contextual or process-oriented data and simple quantitative analysis using descriptive statistics.

Ethics and dissemination

Research ethics approval is not required for this scoping review. The results of this scoping review will inform the development of a collaborative care training initiative emerging from the Medical Psychiatry Alliance, a four-institution philanthropic partnership in Ontario, Canada. The results will also be presented at relevant national and international conferences and published in a peer-reviewed journal.

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A ventral glomerular deficit in Parkinson’s disease revealed by whole olfactory bulb reconstruction

Abstract

Olfactory dysfunction is common in Parkinson's disease and is an early symptom, but its pathogenesis remains poorly understood. Hindering progress in our mechanistic understanding of olfactory dysfunction in Parkinson's disease is the paucity of literature about the human olfactory bulb, both from normal and Parkinson's disease cases. Qualitatively it is well established that the neat arrangement of the glomerular array seen in the mouse olfactory bulb is missing in humans. But rigorous quantitative approaches to describe and compare the thousands of glomeruli in the human olfactory bulb are not available. Here we report a quantitative approach to describe the glomerular component of the human olfactory bulb, and its application to draw statistical comparisons between olfactory bulbs from normal and Parkinson's disease cases. We subjected horizontal 10 µm sections of olfactory bulbs from six normal and five Parkinson's disease cases to fluorescence immunohistochemistry with antibodies against vesicular glutamate transporter-2 and neural cell adhesion molecule. We scanned the immunostained sections with a fluorescence slide scanner, segmented the glomeruli, and generated 3D reconstructions of whole olfactory bulbs. We document the occurrence of atypical glomerular morphologies and glomerular-like structures deep in the olfactory bulb, both in normal and Parkinson's disease cases. We define a novel and objective parameter: the global glomerular voxel volume, which is the total volume of all voxels that are classified immunohistochemically as glomerular. We find that the global glomerular voxel volume in Parkinson's disease cases is half that of normal cases. The distribution of glomerular voxels along the dorsal-ventral dimension of the olfactory bulb in these series of horizontal sections is significantly altered in Parkinson's disease cases: whereas most glomerular voxels reside within the ventral half of olfactory bulbs from normal cases, glomerular voxels are more evenly spread among the ventral and dorsal halves of olfactory bulbs from Parkinson's disease cases. These quantitative whole-olfactory bulb analyses indicate a predominantly ventral deficit in the glomerular component in Parkinson's disease, consistent with the olfactory vector hypothesis for the pathogenesis of this neurodegenerative disease. The distribution of serine 129-phosphorylated α-synuclein immunoreactive voxels correlates with that of glomerular voxels. The higher the serine 129-phosphorylated α-synuclein load of an olfactory bulb from a Parkinson's disease case, the lower the global glomerular voxel volume. Our rigorous quantitative approach to the whole olfactory bulb will help understand the anatomy and histology of the normal human olfactory bulb and its pathological alterations in Parkinson's disease.

http://ift.tt/2eBjInh

Distinct spatiotemporal patterns of neuronal functional connectivity in primary progressive aphasia variants

Abstract

Primary progressive aphasia is a syndrome characterized by progressive loss of language abilities with three main phenotypic clinical presentations, including logopenic, non-fluent/agrammatic, and semantic variants. Previous imaging studies have shown unique anatomic impacts within language networks in each variant. However, direct measures of spontaneous neuronal activity and functional integrity of these impacted neural networks in primary progressive aphasia are lacking. The aim of this study was to characterize the spatial and temporal patterns of resting state neuronal synchronizations in primary progressive aphasia syndromes. We hypothesized that resting state brain oscillations will show unique deficits within language network in each variant of primary progressive aphasia. We examined 39 patients with primary progressive aphasia including logopenic variant (n = 14, age = 61 ± 9 years), non-fluent/agrammatic variant (n = 12, age = 71 ± 8 years) and semantic variant (n = 13, age = 65 ± 7 years) using magnetoencephalographic imaging, compared to a control group that was matched in age and gender to each primary progressive aphasia subgroup (n = 20, age = 65 ± 5 years). Each patient underwent a complete clinical evaluation including a comprehensive battery of language tests. We examined the whole-brain resting state functional connectivity as measured by imaginary coherence in each patient group compared to the control cohort, in three frequency oscillation bands—delta-theta (2–8 Hz); alpha (8–12 Hz); beta (12–30 Hz). Each variant showed a distinct spatiotemporal pattern of altered functional connectivity compared to age-matched controls. Specifically, we found significant hyposynchrony of alpha and beta frequency within the left posterior temporal and occipital cortices in patients with the logopenic variant, within the left inferior frontal cortex in patients with the non-fluent/agrammatic variant, and within the left temporo-parietal junction in patients with the semantic variant. Patients with logopenic variant primary progressive aphasia also showed significant hypersynchrony of delta-theta frequency within bilateral medial frontal and posterior parietal cortices. Furthermore, region of interest-based analyses comparing the spatiotemporal patterns of variant-specific regions of interest identified in comparison to age-matched controls showed significant differences between primary progressive aphasia variants themselves. We also found distinct patterns of regional spectral power changes in each primary progressive aphasia variant, compared to age-matched controls. Our results demonstrate neurophysiological signatures of network-specific neuronal dysfunction in primary progressive aphasia variants. The unique spatiotemporal patterns of neuronal synchrony signify diverse neurophysiological disruptions and pathological underpinnings of the language network in each variant.

http://ift.tt/2gwbmu2

Issue Cover (September 2017)

Cover image by Dr. Natalie Doig (MRC Brain Network Dynamics Unit, Department of Pharmacology, Oxford). The cover image is of a frontal section of mouse brain showing many regions of the basal ganglia. The section was triple-immunostained to reveal tyrosine hydroxylase (TH; cyan), parvalbumin (PV; green) and choline acetyltransferase (magenta).

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Simple Elimination of Background Fluorescence in Formalin-Fixed Human Brain Tissue for Immunofluorescence Microscopy

Background autofluorescence of biological samples often complicates fluorescence-based imaging techniques, especially in aged human postmitotic tissues. This protocol describes how autofluorescence from these samples can be effectively removed using a commercially available light emitting diode light source to photobleach the sample prior to immunostaining.

http://ift.tt/2eSjFAi

Mutation in the AGK gene in two siblings with unusual Sengers syndrome

Abstract

Sengers syndrome is a rare autosomal recessive metabolic disorder caused by lack of acylglycerol kinase due to mutations in the AGK gene. It is characterized by congenital cataract, hypertrophic cardiomyopathy, myopathy and lactic acidosis. Two clinical forms have been described: a severe neonatal form, and a more benign form displaying exercise intolerance. We describe two siblings with congenital cataract, cardiomyopathy, hypotonia, intellectual disability and lactic acidosis. Whole exome sequencing revealed a homozygous c.1035dup mutation in the two siblings, supporting a diagnosis of Sengers syndrome. Our patients presented an intermediate form with intellectual deficiency, an unusual feature in Sengers syndrome. This permitted a prenatal diagnosis for a following pregnancy.

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Adjuvant Peptide Pulsed Dendritic Cell Vaccination in Addition to T Cell Adoptive Immunotherapy for Cytomegalovirus Infection in Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients.

Related Articles

Adjuvant Peptide Pulsed Dendritic Cell Vaccination in Addition to T Cell Adoptive Immunotherapy for Cytomegalovirus Infection in Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients.

Biol Blood Marrow Transplant. 2017 Aug 29;:

Authors: K K Ma C, Clancy L, Simms R, Burgess J, Deo S, Blyth E, Micklethwaite KP, Gottlieb DJ

Abstract
Adoptive cellular immunotherapy has been shown to be effective in the management of CMV reactivation and disease. It is unknown whether adjuvant dendritic cell vaccination will provide additional benefit in prophylaxis or treatment of CMV in HSCT patients. In this study, we administered prophylactic CMV-peptide specific T cell infusions, followed by 2 doses of intradermal CMV peptide-pulsed dendritic cell (DC) vaccine to 4 HSCT patients. There were no immediate adverse events associated with T cell infusion or DC vaccinations. 1 of 4 patients developed grade III acute gut graft versus host disease. Immune reconstitution against CMV was detected in all 4 patients. Patients receiving CMV peptide-specific T cells and DC vaccination had peak immune reconstitution at least 10 days after the second DC vaccination. In summary, combining DC vaccine with T cell infusion appears feasible, although further study is required to ascertain its safety and efficacy in augmenting the effects of infusing donor-derived CMV-specific T cells.

PMID: 28864137 [PubMed - as supplied by publisher]

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Clinical efficacy and IL-17 targeting mechanism of Indigo naturalis as a topical agent in moderate psoriasis

Indigo naturalis is a Traditional Chinese Medicine (TCM) ingredient long-recognized as a therapy for several inflammatory conditions, including psoriasis. However, its mechanism is unk...

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A Rare Presentation of Synovial Sarcoma as Cervical Lymphadenopathy in a Pediatric Patient—a Case Report

Abstract

Synovial sarcoma is the uncommon malignant tumor of children and adolescents. It usually involves the soft tissues of the upper and lower joints and most commonly affects adults in their fourth decade of life. We report a rare case of synovial sarcoma of the head and neck region in a five-year-old child who has presented with right side cervical lymphadenopathy associated with dysphagia and hoarseness of voice. Patient was managed by modified radical neck dissection followed by chemotherapy.

http://ift.tt/2gtRGqy

Upregulation of Treg-Related Genes in Addition with IL6 Showed the Significant Role for the Distant Metastasis in Colorectal Cancer

Abstract

T helper 17 (Th17) and T regulatory (Treg) cytokines appear to be contributing greatly to colorectal cancer (CRC) development and progression. The aim of the current study was to investigate the expression of Foxp3; IL10; TGFB1; IL17A; IL6 and NOS2 genes in tumor tissue, regional positive lymph nodes and distant metastasis obtained from 26 patients with advanced CRC. Quantitative real-time polymerase chain reaction (qPCR) was performed for mRNA detection by TaqMan gene expression assay. In distant metastasis, IL6 was strongly expressed, over 7.5 fold, followed by Treg-related genes Foxp3; IL10 and TGFB1 in contrast to IL17A and NOS2. The similar pattern of expression was observed in positive regional lymph node in addition to significant down-regulation of NOS2 (RQ = 0.287; p = 0.011) and a trend for the elevation of IL17A. In tumor tissue, Fopx3 was significantly upregulated and Foxp3 mRNA positively correlated with TGFB1 in all investigated tissue types. In tumor tissue, expression of IL17A was correlated with NOS2 (r = 0.68; p = 0.005), while in distant metastasis IL10 was in strong relation with TGFB1 and IL6. In addition, a reverse correlation between IL6 and NOS2 (r = −0.66; p = 0.009), was observed in distant metastasis. The simultaneous expression of given Treg and Th17-related genes found both in the primary tumor and in the regional lymph nodes appears to provide suitable microenvironment sufficient for promoting metastatic growth. The upregulation of Foxp3; IL10, TGFB1 and IL6 might be a transcriptional profile hallmark for colorectal metastases.

http://ift.tt/2euq8kp

In human brain ornithine transcarbamylase (OTC) immunoreactivity is strongly expressed in a small number of nitrergic neurons

Abstract

There is recent evidence for ornithine transcarbamylase (OTC) expression in adult human brain. We decided to immunocytochemically map OTC throughout brain, and to further characterize OTC-immunopositive neurons. By using double immunolabeling technique for OTC and neuronal nitric oxide synthase (nNOS) OTC protein expression was revealed in a small subset of nitrergic (nNOS) neurons. Since citrulline (the reaction product of OTC) enhances the bioavailability of L-arginine, the substrate of nNOS, it is conceivable that OTC activity supports NO production in nitrergic neurons.

http://ift.tt/2wxIx7T