Analysis of the Morphological Characteristics of the Palatal Rugae for Three-Dimensional Superimposition of Digital Models in Korean Subjects

Objective. The aim of this study was to evaluate the morphological characteristics of the palatal rugae in Korean subjects to determine whether the palatal rugae can be used as an appropriate reference area for three-dimensional digital model superimpositions. Materials and Methods. In total, 343 patients (110 men, 233 women; mean age, 25.6±8.2 years) who had a digital model taken at their initial visit were included, and the numbers and types of right and left palatal rugae were investigated according to the primary, secondary, and fragmentary rugae. Finally, the differences in the positions of the third primary ruga were investigated according to the presence of additional rugae posterior to the third primary ruga. Results. The number of primary palatal rugae ranged from one to six, with 43.5% of the subjects having three primary rugae and 36.1% having four primary rugae; there were no significant differences between sexes. Except for the fragment rugae, the numbers of primary and secondary rugae were not significantly different between the left and right sides. The third primary ruga was located more significantly anteriorly when there was an additional ruga posterior to the third primary ruga (P

https://ift.tt/2Saiq0o

First Report of Chlamydia abortus in Farmed Fur Animals

Chlamydia (C.) abortus, a globally distributed obligate intracellular bacterium, has attracted increasing interest according to its veterinary importance and zoonotic nature. C. abortus can infect a variety of animals and cause foetal loss in livestock resulting in economic loss. In this study, the samples collected from two farms of foxes (n=20), raccoon dogs (n=15) and minks (n=20), were investigated by Chlamydiaceae- and Chlamydia species-specific real-time PCR. The results showed that all the tested foxes (20/20) and raccoon dogs (15/15) harbored Chlamydia spp., while 5% of minks (1/20) were positive for Chlamydia spp. C. abortus was identified in all positive samples as the dominant Chlamydia species, with C. pecorum DNA coexistence in some of the rectal samples (7/20) taken from foxes. Phylogenetic analysis based on specific gene fragments of 16S rRNA, IGS-23S rRNA, and ompA revealed that all sequences obtained in this study were assigned to the Chlamydiaceae family with high similarity to C. abortus S26/3 and B577 previously identified in ruminants. This is the first report confirming that farmed foxes, raccoon dogs, and minks carry C. abortus. Further studies are needed to fully elucidate the epidemiology and pathogenicity of this pathogen in farmed fur animals as well as the potential risks to public health.

https://ift.tt/2DXK2ml

Controversies and Misconceptions Related to Cerebrospinal Fluid Circulation: A Review of the Literature from the Historical Pioneers’ Theories to Current Models

Models of cerebrospinal fluid (CSF) circulation have been mainly proposed in the last century: CSF goes from the ventricles to the subarachnoidal space (SAS), passing through the aqueduct and the foramen of Luschka and Magendie. Indeed, new models, involving the Virchow-Robin space (VRS) and the perivascular space (PVS), have been proposed. We critically reviewed the literature, in order to clarify the "classical" errors and to discuss the "new" models that are evolving currently. Conclusions of past experiments are often not justified, due to lack of reproducibility and methodological issues. On the other hand, investigation on the microanatomy of Virchow-Robin spaces (VRS) and several new experiments showed a potential pathway for a more complex CSF "circulation," with chaotic and unpredictable flows. It seems reasonable to elaborate a new model of CSF physiology, including new findings and questioning old certainties. However, proved data are still missing and it is hazardous to come to final conclusions. More studies are needed.

https://ift.tt/2SdiNqZ

Peripheral Blood Lymphocyte-to-Monocyte Ratio as a Useful Prognostic Factor in Newly Diagnosed Multiple Myeloma

The survival of individuals with tumors may be predicted by the peripheral blood lymphocyte-to-monocyte ratio (LMR) upon diagnosis in recent studies. For patients with multiple myeloma (MM) in the era of novel agents, the prognostic significance of LMR remains unclear. In this study, the prognostic impact of LMR is evaluated by 285 patients with MM who are treated with proteasome inhibitor and/or immunomodulatory drug. LMR is a proven predictor of survival using the receiver operating characteristic curve, with 4.2 as the cutoff point. Patients with LMR ≤ 4.2 at diagnosis had poorer overall survival (OS) and progression-free survival (PFS) than those with LMR > 4.2. In addition, multivariate analysis showed that LMR less than 4.2 is an independent predictor for the OS (hazard ratio [HR]: 1.703; 95% confidence interval [CI]: 1.020–2.842; P = 0.042) and PFS (HR: 1.831; 95% CI: 1.098–3.053; P = 0.021). According to the test, the LMR at diagnosis, which functions as a simple index reflecting host systemic immunity, can predict clinical outcomes in patients with MM who are treated with new agents.

https://ift.tt/2E0PBk6

Racial/Ethnic Disparities in Longer-term Outcomes Among Emergency General Surgery Patients: The Unique Experience of Universally Insured Older Adults

Objectives: To determine whether racial/ethnic disparities in 30/90/180-day mortality, major morbidity, and unplanned readmissions exist among universally insured older adult (≥65 years) emergency general surgery patients; vary by diagnostic category; and can be explained by variations in geography, teaching status, age-cohort, and a hospital's percentage of minority patients. Summary of Background Data: As the US population ages and discussions surrounding the optimal method of insurance provision increasingly enter into national debate, longer-term outcomes are of paramount concern. It remains unclear the extent to which insurance changes disparities throughout patients' postacute recovery period among older adults. Methods: Survival analysis of 2008 to 2014 Medicare data using risk-adjusted Cox proportional-hazards models. Results: A total of 6,779,649 older adults were included, of whom 82.8% identified as non-Hispanic white (NHW), 9.2% non-Hispanic black (NHB), 5.6% Hispanic, and 1.5% non-Hispanic Asian (NHA). Relative to NHW patients, each group of minority patients was significantly less likely to die [30-day NHB vs NHW hazard ratio (95% confidence interval): 0.88 (0.86–0.89)]. Differences became less apparent as outcomes approached 180 days [180-day NHB vs NHW: 1.00 (0.98–1.02)]. For major morbidity and unplanned readmission, differences among NHW, Hispanic, and NHA patients were comparable. NHB patients did consistently worse. Efforts to explain the occurrence found similar trends across diagnostic categories, but significant differences in disparities attributable to geography and the other included factors that combined accounted for up to 50% of readmission differences between racial/ethnic groups. Conclusion: The study found an inversion of racial/ethnic mortality differences and mitigation of non-NHB morbidity/readmission differences among universally insured older adults that decreased with time. Persistent disparities among nonagenarian patients and hospitals managing a regionally large share of minority patients warrant particular concern.

https://ift.tt/2qFYxCQ

Scientific communication strategies of microbiologists in the era of social media

Abstract

Over the last decades, the world of communication underwent drastic changes, and internet and social media emerged as essential vehicles for exchanging information. Following these trends, it is important that scientists adapt to changes and adopt optimal strategies to communicate with colleagues, lay people and institutions. We conducted an online survey to investigate the communication strategies of microbiologists and their colleagues from other disciplines. We collected data from 527 scholars from 57 countries, with ∼42% of them being microbiologists. We focused particularly on social media and found that >80% of participants used them for work, and that ∼50% of interviewed actively shared and gathered scientific contents from social media. Compared to colleagues from other fields, microbiologists were less averse to use social media for work and were also less accustomed to use pre-prints as a source and vehicle of information. However, a large proportion of microbiologists declared to have planned pre-print publications in the future. Surprisingly, our data revealed that age is a poor predictor of social media usage, but it is strongly associated with the type of social media used, the activity undertaken on them and the attitude towards pre-print publications. Considering the kaleidoscopic variety of scientific communication tools, our data might help to optimize the scientific promotion strategies among microbiologists.

https://ift.tt/2KzxT7y

Erg6 gene is essential for stress adaptation in Kluyveromyces lactis

Abstract

We investigated the effect of Kluyveromyces lactis ERG6 gene deletion on plasma membrane function and showed increased susceptibility of mutant cells to salt stress, cationic drugs and weak organic acids. Contrary to Saccharomyces cerevisiae, Klerg6 mutant cells exhibited increased tolerance to tunicamycin. The content of cell wall polysacharides did not significantly vary between wild-type and mutant cells. Although the expression of the NAD⁺-dependent glycerol 3-phosphate dehydrogenase (KlGPD1) in the Klerg6 mutant cells was only half of that in the parental strain, it was induced in the presence of calcofluor white. Also, cells exposed to this drug accumulated glycerol. The absence of KlErg6p led to plasma membrane hyperpolarization but had no statistically significant influence on the plasma membrane fluidity. We propose that the phenotype of Klerg6 mutant cells to a large extent was a result of the reduced activity of specific plasma membrane proteins that require proper lipid composition for full activity.

https://ift.tt/2BxFVew

A Kiss to drive rhythms in reproduction

Abstract

Reproduction, like many other biological functions, exhibits marked daily and seasonal rhythms in order to anticipate and adapt breeding activity to environmental challenges. In recent years, studies investigating the neuroendocrine mechanisms driving rhythms in reproduction have unveiled the pivotal role of hypothalamic neurons expressing kisspeptin in integrating and forwarding daily and seasonal cues to the reproductive system. The objective of this review is to summarize the knowledge on the effect and role of this neuropeptide on the mammalian hypothalamo‐pituitary‐gonadal axis and describe how it is involved in the daily control of ovulation in females and long term adaptation of reproduction in seasonal breeders.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KBGPJW

Spontaneous pre‐stimulus oscillatory activity shapes the way we look:A concurrent imaging and eye‐movement study

Abstract

Previous behavioural studies have accrued evidence that response time plays a critical role in determining whether selection is influenced by stimulus saliency or target template. In the present work, we investigated to what extent the variations in timing and consequent oculomotor control are influenced by spontaneous variations in prestimulus alpha oscillations. We recorded simultaneously brain activity using magnetoencephalography (MEG) and eye movements while participants performed a visual search task. Our results show that slower saccadic reaction times were predicted by an overall stronger alpha power in the 500 ms time window preceding the stimulus onset, while a weaker alpha power was signature of faster responses. When looking separately at performance for fast and slow responses, we found evidence for two specific sources of alpha activity predicting correct versus incorrect responses. When saccades were quickly elicited, errors were predicted by stronger alpha activity in posterior areas, comprising the angular gyrus in the temporal‐parietal junction (TPJ) and possibly the lateral intraparietal area (LIP). Instead, when participants were slower in responding, an increase of alpha power in frontal eye fields (FEF), supplementary eye fields (SEF) and dorsolateral pre‐frontal cortex (DLPFC) predicted erroneous saccades. In other words, oculomotor accuracy in fast responses was predicted by alpha power differences in more posterior areas, while the accuracy in slow responses was predicted by alpha power differences in frontal areas, in line with the idea that these areas may be differentially related to stimulus‐driven and goal‐driven control of selection.

This article is protected by copyright. All rights reserved.

https://ift.tt/2By7CUv

Engineering synucleinopathy‐resistant human dopaminergic neurons by CRISPR‐mediated deletion of the SNCA gene

Abstract

An emerging treatment for Parkinson's disease (PD) is cell replacement therapy. Authentic midbrain dopaminergic (mDA) neuronal precursors can be differentiated from human embryonic stem cells (hESCs) and human induced pluripotent stem cells (iPSCs). These laboratory‐generated mDA cells have been demonstrated to mature into functional dopaminergic neurons upon transplantation into preclinical models of PD. However, clinical trials with human fetal mesenchephalic cells have shown that cell replacement grafts in PD are susceptible to Lewy body formation suggesting host‐to‐graft transfer of α‐synuclein pathology. Here we have used CRISPR/Cas9n technology to delete the endogenous SNCA gene, encoding for α‐synuclein, in a clinical‐grade hESC line to generate SNCA ^+/– and SNCA ^–/– cell lines. These hESC lines were first differentiated into mDA neurons, and then challenged with recombinant α‐synuclein pre‐formed fibrils (PFFs) to seed the formation for Lewy‐like pathology as measured by phosphorylation of serine‐129 of α‐synuclein (pS129‐αSyn). Wild‐type neurons were fully susceptible to the formation of protein aggregates positive for pS129‐αSyn, while SNCA ^+/– and SNCA ^–/– neurons exhibited significant resistance to the formation of this pathological mark. This work demonstrates that reducing or completely removing SNCA alleles by CRISPR/Cas9n‐mediated gene editing confers a measure of resistance to Lewy pathology.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KBGM0I

Striatal GABAergic Interneuron Dysfunction in the Q175 Mouse Model of Huntington's Disease

Abstract

The pathological hallmark of Huntington's disease (HD) is the massive loss of striatal and cortical neurons. Until recently, it was believed that striatal interneurons were spared from degeneration. This view has changed after the demonstration that parvalbumin (PV)‐expressing interneurons also are vulnerable in humans. Here we compared morphological and functional changes of striatal fast‐spiking interneurons (FSIs) and low‐threshold spiking (LTS) interneurons in the Q175 mouse model of HD at pre‐symptomatic (2 months) and symptomatic (12 months) stages of the disease. Electrophysiological intrinsic and synaptic properties of FSIs were significantly altered in symptomatic mice compared to wildtype (WT) littermates. Overall, FSIs became more excitable with disease progression. Sholl analysis also revealed a significant loss of dendritic complexity and excitatory synaptic inputs. The basic membrane and synaptic properties of LTS interneurons were similar in Q175 and WT mice regardless of disease stage. The resilience of LTS interneurons could be related to their sparsity of excitatory synaptic inputs compared with FSIs. However, in symptomatic mice, a subpopulation of LTS interneurons displayed an increase in action potential firing within oscillating bursts. Thus, we conclude that while both FSI and LTS interneurons demonstrate increases in excitability, the HD mutation differentially affects their membrane and synaptic properties as well as their ability to respond to compensatory challenges presented during the late stage of the disease. Alterations in GABAergic interneuron intrinsic activity and responsiveness to incoming signals may significantly affect SPN output thus contributing to abnormal motor movements in patients afflicted with HD.

This article is protected by copyright. All rights reserved.

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Doctor of philosophy [Humanities]

https://ift.tt/2TLw4sp

Tightening sanctions for physician sexual misconduct [News]

https://ift.tt/2ArTKt0

Comparative risk of harm associated with trazodone or atypical antipsychotic use in older adults with dementia: a retrospective cohort study [Research]

BACKGROUND:

Trazodone is increasingly prescribed for behavioural and psychological symptoms of dementia, but little is known about its risk of harm. Our objective was to describe the comparative risk of falls and fractures among older adults with dementia dispensed trazodone or atypical antipsychotics.

METHODS:

The study cohort included adults with dementia (excluding patients with chronic psychotic illnesses) living in long-term care and aged 66 years and older. Data were obtained from routinely collected, linked health administrative databases in Ontario, Canada. We compared new users of trazodone with new users of atypical antipsychotics (quetiapine, olanzapine or risperidone) between Dec. 1, 2009, and Dec. 31, 2015. The primary outcome was a composite of fall or major osteoporotic fracture within 90 days of first prescription. Secondary outcomes were falls, major osteoporotic fractures, hip fractures and all-cause mortality.

RESULTS:

We included 6588 older adults dispensed trazodone and 2875 dispensed an atypical antipsychotic, of whom 95.2% received a low dose of these medications. Compared with use of atypical antipsychotics, use of trazodone was associated with similar rates of falls or major osteoporotic fractures (weighted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.73 to 1.07), major osteoporotic fracture (weighted HR 1.03, 95% CI 0.73 to 1.47), falls (weighted HR 0.91, 95% CI 0.75 to 1.11) and hip fractures (weighted HR 0.92, 95% CI 0.59 to 1.43). Use of trazodone was associated with a lower rate of mortality (weighted HR 0.75, 95% CI 0.66 to 0.85).

INTERPRETATION:

Trazodone is not a uniformly safer alternative to atypical antipsychotics, given the similar risk of falls and fractures among older adults with dementia.

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Considering context within #MeToo and the medical profession [Letters]

https://ift.tt/2ArTCtw

How to pay for national pharmacare [Analysis]

https://ift.tt/2TItaop

Shining the light on #MeTooMedicine [Letters]

https://ift.tt/2AiWIzW

Psychotropic drugs for the behavioural and psychological symptoms of dementia: no free ride [Commentary]

https://ift.tt/2ArTuKy

Buprenorphine-naloxone [Practice]

https://ift.tt/2TLvCKJ

Acanthosis nigricans at sites of insulin injection in a man with diabetes [Practice]

https://ift.tt/2TJTPRW

Young doctors warned that social media vitriol could harm their mental health [News]

https://ift.tt/2Alws8c

Just a pedophile [Humanities]

https://ift.tt/2THa6qN

Canada must find ways to better use health innovations, says new CIHR scientific director [News]

https://ift.tt/2AkqG6Q

Feminism and Couple Finance: Power as a Mediator Between Financial Processes and Relationship Outcomes

Abstract

Feminism is rarely used as a theoretical framework for couple finance research. The purposes of the present paper are (a) to discuss couple finance research in the context of feminism to encourage more frequent and explicit use of feminism in couple finance research, (b) to present a gender and couple finances model, and (c) to test this model with longitudinal dyadic data. Using actor-partner interdependence models (APIM) and data from 327 U.S. mixed-gender couples, relational power was explored as a potential mediator between four couple financial processes (earners of money, access to money, management of money, and conflict about money) and two relationship outcomes (relationship quality and relationship stability). Results suggest that couple financial processes are associated with relationship outcomes and with joint management as well as low conflict being key longitudinally. Additionally, although power may not play a mediating role, it appears to be connected to couple financial processes and relationship outcomes concurrently. Gender differences as well as both actor and partner effects are explored. This research has implications for researchers, clinicians, and educators. For example, clinicians may want to encourage their clients to use joint bank accounts, manage their money jointly, and minimize financial conflict. Gender, and therefore power, are inseparably tied to couple finances. When both spouses are involved in financial processes, partners tend to be more empowered, and relationship quality and stability tend to be higher.

https://ift.tt/2AkQZtD

Determining the optimal time for liberation from renal replacement therapy in critically ill patients: protocol for a systematic review and meta-analysis (DOnE RRT)

Introduction

Renal replacement therapy (RRT) is a complex and expensive form of life-sustaining therapy, reserved for our most acutely ill patients. While a number of randomised trials have evaluated the optimal timing to start RRT among critically ill patients in the intensive care unit (ICU), there has been a paucity of trials providing guidance on when and under what circumstances to ideally liberate a patient from RRT. We are conducting a systematic review and meta-analysis to identify clinical and biochemical markers that predict kidney recovery and successful liberation from acute RRT among critically ill patients with acute kidney injury.

Methods and analysis

Our comprehensive search strategy was developed in consultation with a research librarian and independently peer-reviewed by a second librarian. We will search electronic databases: Ovid Medline, Ovid Embase and Wiley Cochrane Library. Selected grey literature sources will also be searched. Our search strategies will focus on concepts related to RRT (ie, intermittent haemodialysis, slow low-efficiency dialysis, continuous renal replacement therapy), intensive care (ie, involving any ICU setting) and discontinuation of therapy (ie, either clinical, physiological and biochemical parameters of weaning acute RRT) from 1990 to October 10, 2017. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. Studies will, where possible, be pooled in statistical meta-analysis. When deemed sufficiently clinically homogenous, and we have four or more studies reporting, sensitivities and specificities will be pooled simultaneously using a hierarchical summary receiver operator characteristic curve and bivariate analysis.

Ethics and dissemination

Our systematic review will synthesise the literature on clinical and biochemical markers that predict liberation from RRT. Research ethics approval is not required.

Trial registration number

CRD42018074615.

https://ift.tt/2DLSkx4

Differences in infant and child mortality before and after the Great East Japan Earthquake and Tsunami: a large population-based ecological study

Objectives

To examine associations between access to medical care, geological data, and infant and child mortality in the area of North-Eastern Japan that was impacted by the Great East Japan Earthquake and Tsunami (GEJET) in 2011.

Design

A population-based ecological study using publicly available data.

Setting

Twenty secondary medical areas (SMAs) in the disaster-affected zones in the north-eastern prefectures of Japan (Iwate, Fukushima and Miyagi). Participants: Children younger than 10 years who died in the 20 SMAs between 2008 and 2014 (n=1 748). Primary and secondary outcome measures: Multiple regression analysis for infant and child mortality rate. The mean values were applied for infant and child mortality rates and other factors before GEJET (2008–2010) and after GEJET (2012–2014).

Results

Between 2008 and 2014, the most common cause of death among children younger than 10 years was accidents. The mortality rate per 100 000 persons was 39.1±41.2 before 2011, 226.7±43.4 in 2011 and 31.4±39.1 after 2011. Regression analysis revealed that the mortality rate was positively associated with low age in each period, while the coastal zone was negatively associated with fewer disaster base hospitals in 2011. By contrast, the number of obstetrics and gynaecology centres (β=–189.9, p=0.02) and public health nurses (β=–1.7, p=0.01) was negatively associated with mortality rate per person in 2011.

Conclusions

In 2011, the mortality rate among children younger than 10 years was 6.4 times higher than that before and after 2011. Residence in a coastal zone was significantly associated with higher child mortality rates.

https://ift.tt/2QdUUm7

Effects of managed care on the proportion of inappropriate elective diagnostic coronary angiographies in non-emergency patients in Switzerland: a retrospective cross-sectional analysis

Objective

Guidelines recommend non-invasive ischaemia testing (NIIT) for the majority of patients with suspected ischaemic heart disease in a non-emergency setting. A substantial number of these patients undergo diagnostic coronary angiography (CA) without therapeutic intervention inappropriately due to lacking preceding NIIT. The aim of this study was to evaluate the effect of voluntary healthcare models with limited access on the proportion of patients without NIIT prior to elective purely diagnostic CA.

Design

Retrospective cross-sectional analysis of insurance claims data from 2012 to 2015. Data included claims of basic and voluntary healthcare models from approximately 1.2 million patients enrolled with the Helsana Insurance Group. Voluntary healthcare models with limited health access are divided into gate keeping (GK) and managed care (MC) capitation models. Inclusion criteria: patients undergoing CA. Exclusion criteria: Patients<18 years, incomplete health insurance data coverage, acute cardiac ischaemia and emergency procedures, therapeutic CA (coronary angioplasty/stenting or coronary artery bypass grafting). The effect of voluntary healthcare models on the proportion of NIIT undertaken within 2 months before diagnostic CA was assessed by means of multiple logistic regression analysis, controlled for influencing factors.

Results

9173 patients matched inclusion criteria. 33.2% (3044) did not receive NIIT before CA. Compared with basic healthcare models, MC was independently associated with a higher proportion of NIIT (p<0.001, OR 1.17, CI 1.045 to 1.312), when additionally controlled for demographics, insurance coverage, inpatient treatment, cardiovascular medication, chronic comorbidities, high-risk status (patients with therapeutic cardiac intervention 1 month after or 18 months prior to diagnostic CA). GK models showed no significant association with the rate of NIIT (p=0.07, OR 1.11, CI 0.991 to 1.253).

Conclusions

In a non-GK healthcare system, voluntary MC healthcare models with capitation were associated with a reduced inappropriate use of diagnostic CA compared with GK or basic models.

https://ift.tt/2DLSfJM

'Primary care sensitive situations that result in an ambulance attendance: a conversation analytic study of UK emergency '999 call recordings

Objectives

To explore common features of conversations occurring in a sample of emergency calls that result in an ambulance dispatch for a 'primary care sensitive' situation, and better understand the challenges of triaging this cohort.

Design

A qualitative study, applying conversation analytic methods to routinely recorded telephone calls made through the '999' system for an emergency ambulance. Cases were identified by a primary care clinician, observing front-line UK ambulance service shifts. A sample of 48 '999' recordings were analysed, corresponding to situations potentially amenable to primary care management.

Results

The analysis focuses on four recurring ways that speakers use talk in these calls. Progress can be impeded when call-taker's questions appear to require callers to have access to knowledge that is not available to them. Accordingly, callers often provide personal accounts of observed events, which may be troublesome for call-takers to 'code' and triage. Certain question formats—notably 'alternative question' formats—appear particularly problematic. Callers deploy specific lexical, grammatical and prosodic resources to legitimise the contact as 'urgent', and ensure that their perception of risk is conveyed. Difficulties encountered in the triage exchange may be evidence of misalignment between organisational and caller perceptions of the 'purpose' of the questions.

Conclusions

Previous work has focused on exploring the presentation and triage of life-threatening medical emergencies. Meaningful insights into the challenges of EMS triage can also be gained by exploring calls for 'primary care sensitive' situations. The highly scripted triage process requires precise, 'codeable' responses to questions, which can create challenges when the exact urgency of the problem is unclear to both caller and call-taker. Calling on behalf of someone else may compound this complexity. The aetiology of some common interactional challenges may offer a useful frame for future comparison between calls for 'primary care sensitive' situations and life-threatening emergencies.

https://ift.tt/2QlDvrE

Cluster randomised controlled trial of an online intervention to prevent ecstasy and new psychoactive substance use among adolescents: final results and implications for implementation

Objectives

To evaluate the effectiveness of the online Climate Schools: Ecstasy and Emerging Drugs module over 2 years, and examine the impact of intervention dose on outcomes.

Design

Cluster randomised controlled trial.

Setting

Secondary schools in Australia.

Participants

1126 students (aged 14.9 years) from 11 schools.

Intervention

Five schools were randomly allocated to the four-lesson internet-based Climate Schools: Ecstasy and Emerging Drugs module. This universal intervention uses cartoon storylines to deliver harm-minimisation information about ecstasy and new psychoactive substances (NPS). It was delivered during health education classes over 4 weeks. Six schools were randomised to the control group (health education as usual). Participants were not blinded to intervention allocation.

Outcomes measures

Students completed self-report surveys at baseline, post-test, 6, 12 and 24 months post-baseline. Intentions to use ecstasy and NPS (including synthetic cannabis and synthetic stimulants), knowledge about ecstasy and NPS and lifetime use of ecstasy and NPS were assessed. This paper reports the results at 24 months post-baseline.

Analysis

Mixed effects regressions were conducted to analyse intervention effects from baseline to 24 months. Post hoc analyses using Inverse Probability of Treatment Weighting compared controls with students who: i) completed all four lessons ('full dose') and ii) partially completed the intervention (≤three lessons, 'incomplete dose').

Results

Primary analyses found that controls were significantly more likely to intend on using synthetic cannabis compared with intervention group students (OR=3.56, p=0.01). Results from the weighted analyses indicated that controls reported significantly lower knowledge about ecstasy (p=0.001) and NPS (p=0.04) compared with the full-dose group. No significant differences were observed between the incomplete dose and control groups.

Conclusions

The online intervention was effective in modifying students' intentions to use synthetic cannabis up to 24 months; however, this study highlights the importance of delivering prevention programmes in full to maximise student outcomes.

Trial registration number

ACTRN12613000708752.

https://ift.tt/2DLSd4C

From embracing to managing risks

Objective

To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services.

Setting

Four acute National Health Service hospitals in England.

Participants

111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff.

Results

There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff.

Conclusions

The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.

https://ift.tt/2QgPVRE

Prevalence and associated factors of khat chewing among students in Ethiopia: a protocol for systematic review and meta-analysis

Introduction

These days, in Ethiopia, khat chewing is one of the widely spreading public health problems affecting the most productive segment of the population. The health implications of khat chewing among students are strongly linked with poor mental, physical and social performances. However, the national magnitude of khat chewing and the associated factors among Ethiopian students are unknown. Therefore, this systematic review and meta-analysis will answer the national prevalence of khat chewing and the associated factors among students in Ethiopia.

Methods

Published primary relevant articles will be accessed using various databases, such as Medline, PubMed, EMBASE and Scopus. Other electronic search engines, for instance, Google Scholar and Google, will be used. Furthermore, additional studies will be collected by communicating with the author(s) and following the references of relevant articles. To select eligible studies, the Joanna Briggs Institute quality appraisal checklist will be used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be followed to keep the scientific rigour of the study. Heterogeneity between studies will be examined through forest plot and I² heterogeneity tests. To identify influential studies, sensitivity analysis will be done. For substantial heterogeneity (I²>50%), the DerSimonian and Laird random-effects model will be employed. Subgroup analyses will be conducted using the random-effect model. Moreover, small studies' publication bias will be checked by funnel plots and objectively by Egger's regression test. If in case Egger's test was found to be statistically significant (p<0.05), trim and fill (Duval and Tweedie) analysis will be performed. The presence of association will be declared using p≤0.05 and OR with corresponding 95% CI.

Ethics and dissemination

Since the intention of the study is to describe earlier primary studies qualitatively and pool the results of those articles, ethical clearance will not be a concern. The results of the study will be published in a reputable peer-reviewed journal and presented at different scientific research conferences. It will also be disseminated to academic as well as other concerned institutions.

PROSPERO registration number

CRD-42,017,081,886.

https://ift.tt/2DHaUGu

Associations of lifestyle and vascular risk factors with Alzheimers brain biomarker changes during middle age: a 3-year longitudinal study in the broader New York City area

Objective

To investigate the associations between lifestyle and vascular risk factors and changes in Alzheimer's disease (AD) biomarkers (beta-amyloid load via ¹¹C-PiB PET, glucose metabolism via ¹⁸F-FDG PET and neurodegeneration via structural MRI) and global cognition in middle-aged asymptomatic participants at risk for AD.

Design

Prospective, longitudinal.

Setting

The study was conducted at New York University Langone/Weill Cornell Medical Centres in New York City.

Participants

Seventy cognitively normal participants from multiple community sources, aged 30–60 years with lifestyle measures (diet, intellectual activity and physical activity), vascular risk measures and two imaging biomarkers visits over at least 2 years, were included in the study.

Outcome measures

We examined MRI-based cortical thickness, fluoro-deoxy-glucose (FDG) glucose metabolism and PiB beta-amyloid in AD-vulnerable regions. A global cognitive z-score served as our summary cognition measure. We used regression change models to investigate the associations of clinical, lifestyle and vascular risk measures with changes in AD biomarkers and global cognition.

Results

Diet influenced changes in glucose metabolism, but not amyloid or cortical thickness changes. With and without accounting for demographic measures, vascular risk and baseline FDG measures, lower adherence to a Mediterranean-style diet was associated with faster rates of FDG decline in the posterior cingulate cortex (p≤0.05) and marginally in the frontal cortex (p=0.07). None of the other lifestyle variables or vascular measures showed associations with AD biomarker changes. Higher baseline plasma homocysteine was associated with faster rates of decline in global cognition, with and without accounting for lifestyle and biomarker measures (p=0.048). None of the lifestyle variables were associated with cognition.

Conclusions

Diet influenced brain glucose metabolism in middle-aged participants, while plasma homocysteine explained variability in cognitive performance. These findings suggest that these modifiable risk factors affect AD risk through different pathways and support further investigation of risk reduction strategies in midlife.

https://ift.tt/2QdUVXd

Biomedical authors awareness of publication ethics: an international survey

Objective

The extent to which biomedical authors have received training in publication ethics, and their attitudes and opinions about the ethical aspects of specific behaviours, have been understudied. We sought to characterise the knowledge and attitudes of biomedical authors about common issues in publication ethics.

Design

Cross-sectional online survey.

Setting and participants

Corresponding authors of research submissions to 20 journals.

Main outcome measure(s)

Perceived level of unethical behaviour (rated 0 to 10) presented in five vignettes containing key variables that were experimentally manipulated on entry to the survey and perceived level of knowledge of seven ethical topics related to publishing (prior publication, author omission, self-plagiarism, honorary authorship, conflicts of interest, image manipulation and plagiarism).

Results

4043/10 582 (38%) researchers responded. Respondents worked in 100 countries and reported varying levels of publishing experience. 67% (n=2700) had received some publication ethics training from a mentor, 41% (n=1677) a partial course, 28% (n=1130) a full course and 55% (n=2206) an online course; only a small proportion rated training received as excellent. There was a full range (0 to 10 points) in ratings of the extent of unethical behaviour within each vignette, illustrating a broad range of opinion about the ethical acceptability of the behaviours evaluated, but these opinions were little altered by the context in which it occurred. Participants reported substantial variability in their perceived knowledge of seven publication ethics topics; one-third perceived their knowledge to be less than 'some knowledge' for the sum of the seven ethical topics and only 9% perceived 'substantial knowledge' of all topics.

Conclusions

We found a large degree of variability in espoused training and perceived knowledge, and variability in views about how ethical or unethical scenarios were. Ethical standards need to be better articulated and taught to improve consistency of training across institutions and countries.

https://ift.tt/2DIeAru

Exploring the developmental tasks of emerging adults after paediatric heart transplantation: a cross-sectional case control study

Objective

Paediatric heart transplantation (PHTX) comprises 12% of all cardiac transplants and many of the children now survive into adulthood. Only a few studies have investigated the long-term psychosocial well-being of young adult patients after PHTX; no studies have investigated developmental tasks of emerging adulthood in different domains (family, social environment, education and profession, partnership, social environment).

Setting

Specialised heart centre in Germany.

Participants

Thirty-eight young adults aged 22.11 years (SD=4.7) who underwent PHTX and a control group of 46 participants with no known chronic diseases, aged 22.91 years (SD=1.8), participated in the study.

Outcome measures

All participants completed the following questionnaires: sociodemographic, the F-SozU, to measure perceived social support, the Gießener Beschwerde-Bogen to measure subjective complaints experienced by patients, the KIDSCREEN-27 to measure well-being and the SF-36 to measure health-related quality of life (QoL).

Results

'Family': the quality of the relationship with the parents was found to be equal in both groups, while PHTX patients stayed in closer spatial proximity to their parents. 'Social environment': PHTX patients reported lower social support by peers than the control group. 'Education and profession': PHTX patients most often worked full-time (23%), had no job and/or received a pension (21%). In comparison, most of the healthy controls did an apprenticeship (40%) and/or worked part time (32%). 'Partnership': fewer of the PHTX patients had a partner than the control group while relationship duration did not differ. In exploratory regression analyses, social support by peers predicted physical QoL, whereas physical complaints and the physical role predicted mental QoL in PHTX patients.

Conclusions

Our exploratory findings highlight important similarities and differences in specific developmental tasks between PHTX patients and healthy controls. Future studies should focus on developmental tasks of PHTX patients in this age group more systematically, investigating their role in physical and mental well-being in a confirmatory manner.

https://ift.tt/2QlLCEt

Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation: protocol for a multicentre, prospective, observational, longitudinal cohort study (Strawberry study)

Introduction

Non-valvular atrial fibrillation (NVAF) is known as a robust risk factor for stroke. Recent reports have suggested a risk of dementia with NVAF, but much remains unknown regarding the relationship between this mechanism and the potential protective effects of novel anticoagulants (direct oral anticoagulants (DOACs), or non-vitamin K oral anticoagulants).

Methods and analysis

This study, the strategy to obtain warfarin or DOAC's benefit by evaluating registry, is an investigator-initiated, multicentre, prospective, observational, longitudinal cohort study comparing the effects of warfarin therapy and DOACs on cerebrovascular diseases and cognitive impairment over an estimated duration of 36 months. Once a year for 3 years, the activities of daily living and cognitive functioning of non-demented patients with NVAF will be assessed. Demographics, risk factors, laboratory investigations, lifestyle, social background and brain MRI will be assessed.

Ethics and dissemination

This protocol has been approved by the ethics committee of the National Center for Geriatrics and Gerontology (No. 1017) and complies with the Declaration of Helsinki. Informed consent will be obtained before study enrolment and only coded data will be stored in a secured database. The results will be published in peer-reviewed journals and presented at scientific meetings to ensure the applicability of the findings in clinical practice.

Trial registration number

UMIN000025721.

https://ift.tt/2DJyGl1

Using the extended self-regulatory model to characterise diabetes medication adherence: a cross-sectional study

Objectives

To cluster the adherence behaviours of patients with type 2 diabetes based on their beliefs in medicines and illness perceptions and examine the psychosocial, clinical and sociodemographic characteristics of patient clusters.

Design

Cross-sectional study.

Setting

A face-to-face survey was administered to patients at two family medicine clinics in the Midwest, USA.

Participants

One hundred and seventy-four ≥20-year-old, English-speaking adult patients with type 2 diabetes who were prescribed at least one oral diabetes medicine daily were recruited using convenience sampling.

Primary and secondary outcome measures

Beliefs in medicines and illness perceptions were assessed using the Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire, respectively. Self-reported medication adherence was assessed using the Morisky Medication Adherence Scale. Psychosocial correlates of adherence, health literacy and self-efficacy were measured using the Newest Vital Sign and the Self-efficacy for Appropriate Medication Use, respectively. Two-step cluster analysis was used to classify patients.

Results

Participants' mean age was 58.74 (SD=12.84). The majority were women (57.5%). Four clusters were formed (non-adherent clusters: ambivalent and sceptical; adherent clusters: indifferent and accepting). The ambivalent cluster (n=30, 17.2%) included low-adherent patients with high necessity beliefs, high concern beliefs and high illness perceptions. The sceptical cluster (n=53, 30.5%) included low adherent patients with low necessity beliefs but high concern beliefs and high illness perceptions. Both the accepting (n=40, 23.0%) and indifferent (n=51, 29.3%) clusters were composed of patients with high adherence. Significant differences between the ambivalent, sceptical, accepting and indifferent adherent clusters were based on self-efficacy, illness perception domains (treatment control and coherence) and haemoglobin A1c (p<0.01).

Conclusions

Patients with diabetes in specific non-adherent and adherent clusters still have distinct beliefs as well as psychosocial characteristics that may help providers target tailored medication adherence interventions.

https://ift.tt/2QjldY1

Between-hospital and between-neighbourhood variance in trauma outcomes: cross-sectional observational evidence from the Detroit metropolitan area

Objective

Disparities in treatment outcomes for traumatic injury are an important concern for care providers and policy makers. Factors that may influence these disparities include differences in risk exposure based on neighbourhood of residence and differences in quality of care between hospitals in different areas. This study examines geographical disparities within a single region: the Detroit metropolitan area.

Design

Data on all trauma admissions between 2006 and 2014 were obtained from the Michigan State Inpatient Database. Admissions were grouped by patient neighbourhood of residence and admitting hospital. Generalised linear mixed modelling procedures were used to determine the extent of shared variance based on these two levels of categorisation on three outcomes. Patients with trauma due to common mechanisms (falls, firearms and motor vehicle traffic) were examined as additional subgroups.

Setting

66 hospitals admitting patients for traumatic injury in the Detroit metropolitan area during the period from 2006 to 2014.

Participants

404 675 adult patients admitted for treatment of traumatic injury.

Outcome measures

In-hospital mortality, length of stay and hospital charges.

Results

Intraclass correlation coefficients indicated that there was substantial shared variance in outcomes based on hospital, but not based on neighbourhood of residence. Among all injury types, hospital-level differences accounted for 12.5% of variance in mortality risk, 28.5% of variance in length of stay and 32.2% of variance in hospital charges. Adjusting the results for patient age, injury severity, mechanism and comorbidities did not result in significant reduction in the estimated variance at the hospital level.

Conclusions

Based on these data, geographical disparities in trauma treatment outcomes were more strongly attributable to differences in access to quality hospital care than to risk factors in the neighbourhood environment. Transfer of high-risk cases to hospitals with greater institutional experience in the relevant area may help address mortality disparities in particular.

https://ift.tt/2DLcoQ9

How does a new patient education programme for renal recipients become situated and adapted when implemented in the daily teaching practice in a university hospital? An ethnographic observation study

Objective

To understand how a new patient education programme for renal recipients becomes situated and adapted when implemented in daily hospital teaching practice. The analysis focuses in particular on how principles of individual tailoring and patient involvement are adapted.

Design

Ethnographic observation study. 19 teaching sessions were observed, resulting in 35 pages of data written observation notes.

Setting

A Norwegian University hospital. The study included the transplantation (TX) post, the medical post and the outpatient clinic.

Participants

10 newly transplanted patients receiving the education programme, and 13 nurses trained in the new programme participated in the study.

Results

We observed that the nurses attempted to implement the programme's core principles of individual tailoring and patient involvement as intended, but that patients found it difficult to formulate their knowledge needs and interest. Patients and nurses developed an approach to individual tailoring and patient involvement, which used knowledge about the patients' life and experiences as basis for translating generalised knowledge into knowledge that is individualised and meaningful for the patient. The individual tailoring was however also limited, as the nurses balanced between responsibilities for the programme's principles of individual adaption and patient involvement at the one hand, and responsibilities of safety and economy from a health systems perspective on the other hand.

Conclusion

Individual tailoring is observed to be a comprehensive practice which includes verbal, practical and emotional involvement with the patient's life world. This extends the notion and practice of individual tailoring as selecting among predefined, generalised knowledge based on an initial mapping of the patients' knowledge. While the adaptions to individual tailoring could have been seen as inaccurate implementation, in-depth analyses discloses that the extended approach to individual tailoring is in fact what retains the programme's core principles in the implementation context.

https://ift.tt/2QoFnzE

Surgical quality in organ procurement during day and night: an analysis of quality forms

Objectives

To analyse a potential association between surgical quality and time of day.

Design

A retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs from deceased donors.

Setting

Procurement procedures in the Netherlands are organised per region. All procedures are performed by an independent, dedicated procurement team that is associated with an academic medical centre in the region.

Participants

In 18 months' time, 771 organs were accepted and procured in The Netherlands. Of these, 17 organs were declined before transport and therefore excluded. For the remaining 754 organs, 591 (78%) sets of forms were completed (procurement and transplantation). Baseline characteristics were comparable in both daytime and evening/night-time with the exception of height (p=0.003).

Primary outcome measure

All complete sets of quality forms were retrospectively analysed for the primary outcome, procurement-related surgical injury. Organs were categorised based on the starting time of the procurement in either daytime (8:00–17:00) or evening/night-time (17:00–8:00).

Results

Out of 591 procured organs, 129 organs (22%) were procured during daytime and 462 organs (78%) during evening/night-time. The incidence of surgical injury was significantly lower during daytime; 22 organs (17%) compared with 126 organs (27%) procured during evening/night-time (p=0.016). This association persists when adjusted for confounders.

Conclusions

This study shows an increased incidence of procurement-related surgical injury in evening/night-time procedures as compared with daytime. Time of day might (in)directly influence surgical performance and should be considered a potential risk factor for injury in organ procurement procedures.

https://ift.tt/2DJLKH8

Prognostic factors for recovery and non-recovery in patients with non-specific neck pain: a protocol for a systematic literature review

Introduction

Neck pain is a common musculoskeletal disorder worldwide. It can result in significant disability and impaired quality of life. More than 50% of patients with neck pain still report symptoms 1 year later despite receiving different forms of non-pharmacological and pharmacological treatment. Identifying patient characteristics that are modifiable or predict recovery and non-recovery for an individual patient might identify ways of improving outcomes. This systematic review aims to comprehensively summarise the existing evidence regarding baseline patient characteristics associated with recovery and non-recovery, as defined by measures of pain intensity, disability and global perceived improvement.

Methods and analysis

Six electronic databases, PubMed, CINAHL, PEDro Database, EMBASE, Cochrane Library and Web of Science, will be searched, with terms related to the review question such as neck pain, prognostic or predictive research, from inception to 28 September of 2018. Studies will be included if they have investigated an association between patient characteristics and outcomes, with at least one follow-up time point. Two independent reviewers will screen the titles and abstracts followed by a full-text review to assess papers regarding their eligibility. Data from included papers will be extracted using standardised forms, including study and participants' characteristics, outcomes, prognostic factors and effect size of the association. The risk of bias of each study will be assessed using the Quality in Prognostic Studies tool. A narrative synthesis will be conducted considering the strength, consistency of results and the methodological quality.

Ethics and dissemination

This systematic review does not require ethical approval. The results will be disseminated through publication in a peer-review journal, as a chapter of a doctoral thesis and through presentations at national and international conferences.

PROSPERO registration number

CRD42018091183.

https://ift.tt/2QhzZ1n

Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study

Objectives

(1) To assess the levels of impoverishment and catastrophic expenditure due to out-of-pocket (OOP) payments for antenatal care (ANC) and delivery care in Yangon Region, Myanmar; and (2) to explore the determinants of impoverishment and catastrophic expenditure.

Design, setting and participants

A community-based cross-sectional survey among women giving birth within the past 12 months in Yangon, Myanmar, was conducted during October to November 2016 using three-stage cluster sampling procedure.

Outcome measures

Poverty headcount ratio, normalised poverty gap and catastrophic expenditure incidence due to OOP payments in the utilisation of ANC and delivery care as well as the determinants of impoverishment and catastrophic expenditure.

Results

Of 759 women, OOP payments were made by 75% of the women for ANC and 99.6% for delivery care. The poverty headcount ratios after payments increased to 4.3% among women using the ANC services, to 1.3% among those using delivery care and to 6.1% among those using both ANC and delivery care. The incidences of catastrophic expenditure after payments were found to be 12% for ANC, 9.1% for delivery care and 20.9% for both ANC and delivery care. The determinants of impoverishment and catastrophic expenditure were women's occupation, number of household members, number of ANC visits and utilisation of skilled health personnel and health facilities. The associations of the outcomes with these variables bear both negative and positive signs.

Conclusions

OOP payments for all ANC and delivery care services are a challenge to women, as one of fifteen women become impoverished and a further one-fifth incur catastrophic expenditures after visiting facilities that offer these services.

https://ift.tt/2DJPjNu

Influences of facial disfigurement and social support for psychosocial adjustment among patients with oral cancer in Taiwan: a cross-sectional study

Objective

To explore the influences of facial disfigurement and social support for psychosocial adjustment in patients with oral cancer.

Design

A cross-sectional design was used for the study.

Participants and setting

A convenience sample of 77 patients with oral cancer was recruited from the otolaryngology and oral and maxillofacial surgery outpatient clinics of three general hospitals in Taiwan.

Measures

Data were collected using the study questionnaires, including the Facial Disfigurement Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale.

Results

The mean score on the Psychosocial Adjustment to Illness Scale was 413.01 (SD=32.32); 71.4% of the participants were maladjusted. Results of multiple regression analysis showed statistically significant main effects of tumour site (beta=0.37), facial disfigurement (beta=0.35) and social support (beta=–1.01), and the interaction effect of facial disfigurement and social support (beta=0.79) (all p<0.05) on psychosocial adjustment after controlling for other sociodemographic and clinical variables. All variables together explained 62% of the variance in psychosocial adjustment (F(16, 55)=14.98, p<0.001).

Conclusions

The level of psychosocial adjustment in patients with oral cancer was suboptimal. Poorer psychosocial adjustment was reported by patients with more severe facial disfigurement and less social support. Patients with cancers in other areas of the oral cavity also reported poorer psychosocial adjustment than patients with cancers in the buccal mucosa. Medical professionals may use these variables to identify higher risk groups for early intensive intervention.

https://ift.tt/2QkPQfF

Serum alkaline phosphatase and the risk of coronary heart disease, stroke and all-cause mortality: Tehran Lipid and Glucose Study

Objectives

To investigate the association of alkaline phosphatase (ALP) levels with the risk of the composite end point of cardiovascular disease (CVD), and all-cause mortality as well as each of them separately.

Design

Prospective cohort study.

Setting

Within the framework of the Tehran Lipid and Glucose Study (TLGS) cohort, participants were followed from baseline examination (1999–2001) until March 2014.

Participants

A total of 2578 participants, aged ≥30 years free of prevalent CVD at baseline examination.

Primary outcome

The main outcome measures were composite end point of coronary heart disease (CHD), stroke, all-cause mortality and each per se.

Results

During a median follow-up of 11.3 years, 369, 68, 420, 170 and 495 participants experienced CHD, stroke, CVD, all-cause mortality and the composite outcome, respectively. In the multivariable Cox regression models, the adjusted HRs (95% CI) for mentioned events per one SD increase in ALP level after full adjustment were 1.11 (1.01 to 1.22), 1.20 (0.97 to 1.49, p=0.058), 1.10 (1.01 to 1.21), 1.16 (1.01 to 1.33) and 1.11 (1.02 to 1.21), respectively. Furthermore, participants with ALP levels in the highest tertile had significant adjusted HRs (95% CI) for stroke (1.88 (1.00 to 3.61)), CVD (1.30 (1.01 to 1.68)) and composite outcome (1.27 (1.00 to 1.61)). The cut-off value of ALP ≥199 IU/L for predicting composite outcome was derived using Youden's index, based on which this cut-off point was associated with significant risk of 80%, 26%, 43% and 26% for incident stroke, CVD, all-cause mortality and composite outcome. Additionally, no improvement was seen in the predictive ability of traditional risk factors models after adding ALP values, considering the levels of Akaike information criterion, C-index and Net Reclassification Index.

Conclusion

Independent associations between ALP levels and the risks of CVD and mortality events were shown, despite the fact that adding the data of ALP to known risk factors did not improve the prediction of these events.

https://ift.tt/2DJPfxe

Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

Objectives

Advance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.

Design, setting and participants

A qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.

Results

Approaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics.

Conclusions

Awareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients' access to ACP.

https://ift.tt/2Qp7Khu

Patient‐reported outcomes for NAFLD/NASH: rational for expanded use

Abstract

It is estimated that one in four adults around the world has non‐alcoholic fatty liver disease (NAFLD), a condition that can lead to non‐alcoholic steatohepatitis (NASH), serious liver damage and, ultimately, death. The arrival of new treatment options and prevention strategies for NAFLD/NASH will result in an increasing number of clinical trials targeting this disease. Younossi outlined (1) the increasing importance of including patient‐reported outcomes (PROs) in future clinical trials for NAFLD/NASH treatment. We fully agree and wish to underline additional points that deserve consideration when dealing with PROs and NAFLD/NASH.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BwN929

Future Costs in Cost-Effectiveness Analyses: Past, Present, Future

Abstract

There has been considerable debate on the extent to which future costs should be included in cost-effectiveness analyses of health technologies. In this article, we summarize the theoretical debates and empirical research in this area and highlight the conclusions that can be drawn for current practice. For future related and future unrelated medical costs, the literature suggests that inclusion is required to obtain optimal outcomes from available resources. This conclusion does not depend on the perspective adopted by the decision maker. Future non-medical costs are only relevant when adopting a societal perspective; these should be included if the benefits of non-medical consumption and production are also included in the evaluation. Whether this is the case currently remains unclear, given that benefits are typically quantified in quality-adjusted life-years and only limited research has been performed on the extent to which these (implicitly) capture benefits beyond health. Empirical research has shown that the impact of including future costs can be large, and that estimation of such costs is feasible. In practice, however, future unrelated medical costs and future unrelated non-medical consumption costs are typically excluded from economic evaluations. This is explicitly prescribed in some pharmacoeconomic guidelines. Further research is warranted on the development and improvement of methods for the estimation of future costs. Standardization of methods is needed to enhance the practical applicability of inclusion for the analyst and the comparability of the outcomes of different studies. For future non-medical costs, further research is also needed on the extent to which benefits related to this spending are captured in the measurement and valuation of health benefits, and how to broaden the scope of the evaluation if they are not sufficiently captured.

https://ift.tt/2Kx1TBg

How do palliative care doctors recognise imminently dying patients? A judgement analysis

Objectives

To identify a group of palliative care doctors who perform well on a prognostic test and to understand how they make their survival predictions.

Design

Prospective observational study and two cross-sectional online studies.

Setting

Phase I: an online prognostic test, developed from a prospective observational study of patients referred to palliative care. Phase II: an online judgement task consisting of 50 hypothetical vignettes.

Participants

All members of the Association of Palliative Medicine (APM) were eligible (n=~1100). 99 doctors completed the prognostic test and were included in the phase I analysis. The top 20% were invited to participate in phase II; 14/19 doctors completed the judgement task and were included in the phase II analysis.

Measures

Phase I: participants were asked to give a probability of death within 72 hours (0%–100%) for all 20 cases. Accuracy on the prognostic test was measured with the Brier score which was used to identify the 'expert' group (scale range: 0 (expert)–1 (non-expert)). Phase II: participants gave a probability of death within 72 hours (0%–100%). A mixed model regression analysis was completed using the percentage estimate as the outcome and the patient information included in the vignettes as the predictors.

Results

The mean Brier score of all participants was 0.237 (95% CI 0.235 to 0.239). The mean Brier score of the 'experts' was 0.184 (95% CI 0.176 to 0.192). Six of the seven prognostic variables included in the hypothetical vignettes were significantly associated with clinician predictions of death. The Palliative Performance Score was identified as being the most influential in the doctors' prognostic decision making (β=0.48, p<0.001).

Conclusions

This study identified six clinical signs and symptoms which influenced the judgement policies of palliative care doctors. These results may be used to teach novice doctors how to improve their prognostic skills.

https://ift.tt/2KwyaIt

Transforaminal Percutaneous Endoscopic Lumbar Decompression by Using Rigid Bendable Burr for Lumbar Lateral Recess Stenosis: Technique and Clinical Outcome

Background. Open laminectomy has been regarded as the standard surgical procedure for lumbar lateral recess stenosis during the last decades. Although percutaneous endoscopic lumbar decompression has led to successful results comparable with open decompression, its application in LSS with is still challenging and technically demanding. Here, we report the surgical procedure and preliminary clinical outcomes of transforaminal percutaneous endoscopic lumbar decompression (PELD) by using flexible burr for lumbar lateral recess stenosis. Method. A retrospective study was performed for the patients with lumbar lateral recess stenosis receiving PELD by using flexible burr. The indications of surgery were moderate to severe stenosis, persistent neurological symptoms, and failure of conservative treatment. The patients with mechanical back pain, more than grade I spondylolisthesis, or radiographic signs of instability were not included. Before the operation, the transforaminal epidural lidocaine injections were carried out to make the diagnosis more precise and accurate. Radiologic findings were investigated, and visual analog scale (VAS) for back and leg pain, Oswestry Disability Index, and modified Macnab criteria were analyzed at the different time of preoperation, postoperation, 3 months, 6 months, and 12 months. Results. The follow-up period was 12 months. The mean VAS scores for back and leg pain immediately improved from 7.9 ± 1.2 to 2.8± 1.3, 2.4 ± 1.0, and 2.3 ± 1.0, respectively. The mean visual analog scale scores (VAS) for back pain and leg pain were significantly improved after PELD. The preoperative ODI dropped from 69.1 ± 7.3 to 25.9 ± 8.7, 25.0± 6.9, and 24.7 ± 6.4, respectively. The final outcome was excellent in 39.6%, good in 47.9%, fair in 8.3%, and poor in 4.17%. 87.5% of excellent-to-good ratio was achieved on the basis of Macnab criteria at postoperative 12 months. The complications were limited to transient postoperative dysesthesia (one case), temporary pain aggravation (six cases), and neck pain during the operation (one case). Conclusion. This observation suggests that the clinical outcomes of PELD for lateral recess stenosis were excellent or showed good results. This minimally invasive technique would be helpful in choosing a surgical method for lateral recess stenosis.

https://ift.tt/2DWLFRk

Dioscin Inhibits Virulence Factors of Candida albicans

Candida albicans infections present a heavy burden upon public health, with only a few drugs available, while biofilms formed by C. albicans worsen this situation. Dioscin has antitumor, anti-inflammatory, and hepatoprotective effects, and this study was conducted to evaluate the effects of dioscin on the biofilm formation and development, as well as other virulence factors of C. albicans such as morphological transition, adhesion, and extracellular secreted phospholipase. Our results showed dioscin inhibits these virulence factors and has low cytotoxicity against mammalian cells. Considering protective effects of dioscin against damage on liver and kidney, dioscin may be used as a potential candidate for antifungal development.

https://ift.tt/2S9LrJJ

Questions and Answers: Impurities Found in Certain Generic Angiotensin II Receptor Blocker (ARB) Products

What is an angiotensin II receptor blocker (ARB)?What are the impurities found in some ARBs?Are all ARB products affected?How did the impurities get into the ARBs?Could the impurities be in other ARBs?What is the risk to patients who have taken the...

https://ift.tt/2zqBlx3

FDA warns marketers of products labeled as dietary supplements that contain tianeptine for making unproven claims to treat serious conditions, including opioid use disorder

November 20, 2018 -- The U.S. Food and Drug Administration today posted warning letters issued to two companies for the illegal marketing of products labeled as dietary supplements that contain tianeptine, a chemical compound that companies are...

https://ift.tt/2P2SqST

Bortezomib-Induced Pulmonary Toxicity: A Case Report and Review of Literature

Bortezomib, a proteasome inhibitor, is an established therapy against multiple myeloma. Bortezomib-induced lung injury, although not appreciated during the introductory time of the medication, has now been highlighted in multiple case reports. The objective of this study is to report a case of bortezomib-induced lung injury, review current literature, and perform exploratory analysis.

https://ift.tt/2BuQpv8

A Case Report of Acute Airway Compromise due to Subcutaneous Emphysema

In the acute management of a trauma patient, airway patency is of utmost importance. The present case describes a male patient who presented with delayed severe upper airway obstruction secondary to massive subcutaneous emphysema following blunt traumatic injury two days previously. Airway compromise is a rarely described but serious complication of subcutaneous emphysema. Current management of subcutaneous emphysema and its association with pneumothorax is summarized. Early decompression of underlying pneumothoraces in patients with significant subcutaneous emphysema should be performed to avoid this rare complication.

https://ift.tt/2Kwaqo0

Antenatal education for pregnant women attending maternal and child health clinics in Brunei Darussalam

Publication date: Available online 24 November 2018

Source: Women and Birth

Author(s): Aida-Syahirah H. Aji, Faezah Awg-Manan, Yura-Rahayu Abdullah, Ramlah Kisut, Hanif Abdul Rahman, Khadizah H. Abdul-Mumin

Abstract

Background

Antenatal education is an essential component of antenatal care that prepares and facilitates the acquisition of women's skills and confidence required for positive experiences throughout pregnancy, birth and the postnatal period.

Aim

To evaluate pregnant women's experiences of education during the antenatal period in Brunei Darussalam.

Methods

A descriptive cross-sectional study was conducted using a pre-designed instrument to examine the provision of antenatal education among 110 pregnant women attending two major Maternal and Child Health Clinics in Brunei Darussalam. The quantitative data was analysed descriptively whereby the scores of each scale was calculated and reported accordingly.

Findings

A majority of participants possess good health knowledge and live a healthy lifestyle. They have a positive perception about baby and postnatal care. However, participants only possess average knowledge about practical health techniques.

Discussion

Overall, the majority of women were satisfied with the antenatal education provided in the Maternal and Child Health Clinics in Brunei Darussalam. Good rapport and interactive learning were the two most quoted important characteristics in antenatal education classes. Breastfeeding, which required both practical knowledge and the acquisition of skills was found to be the most interesting antenatal education topic. Antenatal education provided through verbal information was identified as the least interesting to the women.

Conclusion

This first study, which aimed to evaluate antenatal education in Brunei Darussalam could provide baseline data and guide strategies to engage pregnant women and relevant agencies in antenatal education. Future studies involving a more in-depth exploration of the women's experiences are recommended.

https://ift.tt/2QfQon0

Change of Circulating and Tissue-Based miR-20a in Human Cancers and Associated Prognostic Implication: A Systematic Review and Meta-Analysis

Background. Previous literatures have investigated the change of miR-20a expression level in the progression of multiple cancers and its influence on patients' survival outcome, but results of now-available evidence are inconsistent. Objective. To elucidate the prognostic value of circulating and tissue-based miR-20a for patients with various cancers. Methods. A systematic search and review of eligible publications were carried out in three electronic databases including the Cochrane Library, PubMed, and Embase, and the methodological quality of included studies was assessed according to Newcastle-Ottawa Scale (NOS). Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for overall survival (OS), recurrence-free survival (RFS), disease-free survival (DFS), and progressive-free survival (PFS) of each study were pooled using a random effect model. Results. In total, 24 studies involving 4186 samples of multiple cancers published in 20 articles were included in the statistical analysis. As for circulating miR-20a, five kinds of cancers containing gastric cancer, lymphoma, glioblastoma, prostate cancer, and non-small-cell lung cancer reported upregulated level in patients compared with normal healthy control, and overexpressed circulating miR-20a could confer an unfavorable factor for OS (HR = 1.71, 95% CIs: 1.43 -2.04, p

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Evaluation of a Porous Bioabsorbable Interbody Mg-Zn Alloy Cage in a Goat Cervical Spine Model

Purpose. Bioabsorbable Mg-based implants were previously assessed due to their intrinsic advantages, but Mg-based cage related research is limited. The specific blood supply and stress of the intervertebral environment can affect the function of Mg-based implants. The objective of this study was to investigate the performance of a bioabsorbable Mg-Zn alloy cage in anterior cervical discectomy and fusion (ACDF) and evaluate the control of degradation of the Mg-Zn cage surface modified by microarc oxidation (MAO) technology containing Si under an intervertebral microenvironment. Methods. Twenty-four goats were divided into four groups according to the experimental period and all underwent ACDF at C2-3 and C4-5 with porous Mg-Zn cage covered with a MAO/Si-containing coating in one intervertebral space and with autologous iliac bone in another space. After 3, 6, 12, or 24 weeks after operation, the cervical spine specimens were harvested to evaluate the biocompatibility, fusion status, and degradation conditions using blood analysis, radiology, biomechanical testing, histology, and micro-CT. Results. The Mg-Zn cages showed ideal biocompatibility and biomechanical characterization; however, the fusion state, as evaluated with radiology and histology, was not acceptable. Modified by the MAO/Si-containing coating, the degradation rate of the Mg-Zn cages was controllable but slower than expected. Conclusion. MAO/Si-containing coating Mg-Zn alloy cages demonstrated excessive control of degradation and fusion failure after 24 weeks postoperatively. We conclude that further studies should be designed to improve the using of Mg-based materials at the intervertebral space.

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Cerclage wiring and intramedullary nailing, a helpful and safe option specially in proximal fractures. A multicentric study

Publication date: Available online 24 November 2018

Source: Injury

Author(s): Jordi Salvador, Samer Amhaz-Escanlar, Pablo Castillón, Iban Clares, Saioa Quintas, Martí Bernaus, Francesc Anglés, Alberto Jorge-Mora

Abstract

Purpose

Antegrade intramedullary nailing is an alternative for humeral shaft fracture treatment. This surgical technique can be especially demanding in some fracture patterns, leading to problems like malunion and non-union. The purpose of our study is to demonstrate that the use of a nail with cerclage wires could be a safe procedure that facilitate reduction, specially in fractures with abduction of the proximal fragment.

Materials and methods

Fifty-six patients were included, from January 2007 to March 2016. In this cohort forty-two patients were females and eighteen males; mean age was sixty-seven (32-89). The fractures were reduced using a cerclage wire through a small lateral or anterior approach, then, antegrade intramedullary nailing was performed. Fracture healing was established by clinical and radiographic evaluation. Shoulder function was assessed using the Constant Score.

Results

Fifty-three patients healed (94.6%) adequately. Two patients developed a non-union (3.5%). One patient developed an infection (1.8%). Transient radial nerve palsy was observed in two patients (3.5%). The mean Constant Score at the end of the study was 70 points (range from 34 to 98 points).

Conclusions

Surgical treatment of humeral shaft fractures with cerclage wire and intramedullary nailing is a safe technique to improve fracture reduction. The use of cerclage wires leads to better bone contact while minimizing malunions. The rate of non-union in our study is lower than the rate reported in the literature for humeral shaft fractures treated by intramedullary nailing alone.

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Factors Associated with Depression among the Elderly Living in Urban Vietnam

The proportion of elderly people in big cities of developing countries, including Vietnam, is rapidly increasing during the age of rampant urbanization. This is being followed by a sustained rise of illnesses, especially mental health issues. The objective of this study was to analyze the association between depression and the factors associated with depression among the elderly. In a cross-sectional study, 299 elderly living in Hanoi, Vietnam, were approached for data collection. Self-reported depression among the elderly was 66.9% (32.8% mild, 30.4% moderate, and 3.7% severe cases). In multivariate analysis, there were significant associations between age, number of physical activities, number of medicine intake, and 3 domains of quality of life (physical health, psychological health, and environmental health) and depression. Age and the number of medicine intake are positively correlated with depression, accounting for 57.94% and 58.93%, respectively. On the contrary, the number of physical activities and the 3 domains of quality life mentioned above are negatively correlated with depression. In the urban setting of a developing country like Vietnam, the elderly have experienced common depression. Recognizing depression among the elderly—which is individual and social—helps us design public health programs. Screening for early depression, joining social programming, and participating in physical activities may improve the mental life of the elderly.

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Choline Compounds of the Frontal Lobe and Temporal Glutamatergic System in Bipolar and Schizophrenia Proton Magnetic Resonance Spectroscopy Study

Purpose. Modern neuroimaging techniques allow investigating brain structures and substances involved in the pathophysiology of mental disorders, trying to find new markers of these disorders. To better understanding of the pathophysiology and differential diagnosis of schizophrenia and bipolar disorder, this study was conducted to assess the neurochemical alterations in the frontal and temporal lobes in hospitalized patients with schizophrenia and bipolar disorder. Methods. Twenty-one subjects with schizophrenia (paranoid and differentiated types), 16 subjects with bipolar I disorder (manic, depressive, and mixed episode), and 20 healthy subjects were studied. Magnetic resonance (MR) imaging and proton resonance magnetic spectroscopy (1H MRS) were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the left frontal and left temporal lobes. Results. Glx/H2O (GABA, glutamine, and glutamate/nonsuppressed water signal) ratios were significantly increased in the left temporal lobe in schizophrenia, but not in bipolar disorder, compared with controls. Cho/H2O (choline/nonsuppressed water signal) ratios in the left frontal lobe had a tendency to increase in bipolar disorder and schizophrenia, relative to controls. A lower temporal lobe NAA/H2O ratio in mixed than in manic and depressive episode of bipolar patients was also found. No other significant differences were found among three studied groups as regards NAA, Cr, and mI ratios. Conclusions. Our results partially confirm the role of a glutamatergic system in schizophrenia, however, only in a temporal lobe. We also point to the importance of the choline-containing compounds (marker of cellular density) in the frontal lobe of patients suffering from bipolar disorder and schizophrenia. We also found the deleterious effect of mixed bipolar episode on the integrity and functioning of the temporal lobe. Glutamatergic left temporal spectroscopic changes may potentially help in differential diagnosis of schizophrenia from bipolar disorder.

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A Case of Influenza B and Mycoplasma pneumoniae Coinfection in an Adult

A 19-year-old woman was referred to our hospital because of a persistent fever and cough that lasted for over a week. Influenza B virus infection was diagnosed using the rapid test kit. Initially, the patient was diagnosed with influenza B infection associated with lobar pneumonia and treated with an anti-influenza virus drug and sulbactam/ampicillin. The patient's fever persisted, and her respiratory condition worsened. On day 5, a computed tomography (CT) scan revealed an extension of the consolidation areas in the left lung and new opacities in the right lung. The antibiotic treatment was changed to meropenem and levofloxacin, and the patient's physical condition gradually improved. A sputum sample revealed the presence of Mycoplasma pneumoniae-specific DNA. Both influenza B virus and M. pneumoniae infections were confirmed serologically. This was a case of coinfection with influenza B virus and M. pneumoniae in a healthy young woman. The M. pneumoniae pneumonia diagnosis was delayed because the predominant feature observed in the CT scan was dense consolidation. M. pneumoniae should be considered as one of the causative pathogens in influenza coinfection cases with CT scan images presenting dense consolidation.

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Folate-Functionalized Mesoporous Hollow SnO2 Nanofibers as a Targeting Drug Carrier to Improve the Antitumor Effect of Paclitaxel for Liver Cancer Therapy

In this study, we prepared PTX-loaded mesoporous hollow SnO2 nanofibers conjugated with folic acid (SFNFP) for liver cancer therapy. According to SEM and TEM characterization, SFNF showed a mesoporous hollow structure. The average outer diameter was 200 nm, and the wall thickness was 50 nm. The DSC and XRD study showed that PTX in the channels of nanofibers was present in an amorphous state. The in vitro release experiments demonstrated that SFNF could efficiently improve the dissolution rate of PTX. Both in vitro cell experiments and in vivo antitumor experiments showed that SFNFP could efficiently inhibit the growth of liver cancer cells. Therefore, SFNF is a promising targeting antitumor drug delivery carrier.

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Association of Angiogenic and Inflammatory Markers with Power Doppler Ultrasound Vascularity Grade and DAS28-CRP in Early Rheumatoid Arthritis: A Comparative Analysis

Objective. Upregulation of various proinflammatory and angiogenic mediators orchestrates the typical pathological synovial alterations in rheumatoid arthritis (RA). DAS28-CRP is commonly used for assessment of RA disease activity and power Doppler ultrasonography (PDUS) is an important modality for assessing synovial vascularity. This study was intended to look for the association of various inflammatory and angiogenic mediators, with respect to different PDUS vascularity grades and disease activity status, in early RA patients. Methods. 50 early RA patients (

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Effects of Diet-Induced Obesity and Deficient in Vitamin D on Spermatozoa Function and DNA Integrity in Sprague-Dawley Rats

Obesity has adverse effects on male fertility and usually is diagnosed with a prevalence of vitamin D deficiency (VD-). Discussion on the impact of obesity/VD- on sperm function has been limited. This study analyzed the effects of diet-induced obesity/VD- on viability and plasma membrane integrity (PMI), superoxide anion () level, and DNA fragmentation () in sperm Sprague-Dawley rats. The males were randomized into four groups and fed for a period of 12 weeks: G1: control diet with vitamin D (C/VD+), G2: control diet without vitamin D (C/VD-), G3: high-fat diet with vitamin D (HF/VD+), and G4: high-fat diet without vitamin D (HF/VD-). Sperm function parameters were analyzed by flow cytometry. PMI percentages and levels were not affected by any of the diets. DNA fragmentation was increasing significantly (p

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Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia

Objectives

The epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning.

Design

A subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare's National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and X² analysis are reported and used to calculate case-fatality rates.

Setting

Australia, 1 July 2002 to 30 June 2015.

Participants

Unintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation.

Results

2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0–4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65–74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal.

Conclusions

This study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.

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