Σάββατο, 28 Μαΐου 2016

Efficacy of daclatasvir/asunaprevir according to resistance-associated variants in chronic hepatitis C with genotype 1

Abstract

Background

The present study explored the treatment outcome of daclatasvir (DCV) and asunaprevir (ASV) therapy combining oral direct-acting antiviral agents (DAAs) for chronic hepatitis C (HCV) including liver cirrhosis according to resistance-associated variants (RAVs) in NS3/NS5A region.

Methods

Overall, 641 patients enrolled in Japan with HCV-1b received DCV and ASV for 24 weeks. Baseline drug-resistant mutations L31F/I/M/V, Q54H, P58S, A92K, and Y93H in the HCV NS5A region and V36A, T54A/S, Q80K/L/R, R155K/T/Q, A156S/V/T, and D168A/E/H/T/V in the HCV NS3/4A region were assessed by direct sequencing.

Results

Overall, 86.9 % (543/625) of patients had SVR12, which was significantly higher in NS5A 93Y (wild) (88.3 %) compared with NS5A 93H at baseline (48.0 %), indicating the SVR12 rate was significantly lower in patients with 93H mutations. Additionally, 66.7 % (18/27) of patients with prior triple therapy including simeprevir (SMV) failure had virological failure. The virological failure rate of DCV/ASV therapy after SMV failure was significantly higher in those with preexisting NS3/4A 168 substitutions compared with without substitutions at baseline [84.2 % (16/19) vs. 28.6 % (2/7), p = 0.014]. The number of patients with multiple RAVs or deletions in NS5A increased from 0 to 85 % in failed patients. Alanine aminotransferase elevation was a frequent adverse event causing discontinuation of DCV/ASV therapy, although 87.5 % (14/16) patients achieved SVR12, subsequently.

Conclusions

History of SMV therapy and pre-existing NS5A Y93H were associated with virological failure of DCV/ASV therapy, resulting in the emergence of multiple RAVs. Patients with RAVs at baseline should be assessed to optimize future DAA therapies.



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Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians’ EBP Adoption Through Improved Organizational Culture and Capacity

Abstract

The development of efficient and scalable implementation strategies in mental health is restricted by poor understanding of the change mechanisms that increase clinicians' evidence-based practice (EBP) adoption. This study tests the cross-level change mechanisms that link an empirically-supported organizational strategy for supporting implementation (labeled ARC for Availability, Responsiveness, and Continuity) to mental health clinicians' EBP adoption and use. Four hundred seventy-five mental health clinicians in 14 children's mental health agencies were randomly assigned to the ARC intervention or a control condition. Measures of organizational culture, clinicians' intentions to adopt EBPs, and job-related EBP barriers were collected before, during, and upon completion of the three-year ARC intervention. EBP adoption and use were assessed at 12-month follow-up. Multilevel mediation analyses tested changes in organizational culture, clinicians' intentions to adopt EBPs, and job-related EBP barriers as linking mechanisms explaining the effects of ARC on clinicians' EBP adoption and use. ARC increased clinicians' EBP adoption (OR = 3.19, p = .003) and use (81 vs. 56 %, d = .79, p = .003) at 12-month follow-up. These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced job-related EBP barriers. A combined mediation analysis indicated the organizational culture-EBP intentions mechanism was the primary carrier of ARC's effects on clinicians' EBP adoption and use. ARC increases clinicians' EBP adoption and use by creating proficient organizational cultures that increase clinicians' intentions to adopt EBPs.



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The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators

Abstract

Latinos with serious mental illness get sick and die much younger than other adults. In this paper, we review findings of a community based participatory research project meant to identify important healthcare needs, barriers to these needs, solutions to the barriers, and the promise of peer navigators as a solution. Findings from focus groups reflected general concerns of people with mental illness (e.g., insurance, engagement, accessibility) and Latinos with serious mental illness (e.g., immigration, language, and family). Feedback and analyses especially focused on the potential of peer navigators. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.



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Characterization and fine mapping of osh15 ( t ), a novel dwarf mutant gene in rice ( Oryza sativa L.)

Abstract

Plant height is one of the most important agronomic traits of plant architecture, and also affects grain yield in rice. In this study, we obtained a novel dwarf rice mutant of japonica variety Shennong9816, designated Shennong9816d. Compared with wild-type, the Shennong9816d plant height was significantly reduced, and the tiller number significantly increased. Additionally, the mutant yield component, and the number of large and small vascular bundles were significantly decreased compared with wild-type. Genetic analysis indicated that the Shennong9816d dwarf phenotype was controlled by a recessive nuclear gene, while the plant was shown to be sensitive to gibberellic acid. Using a large F2 population derived from a cross between Shennong9816d and the indica rice variety Habataki, the osh15(t) gene was fine mapped between RM20891 and RM20898, within a physical distance of 73.78 kb. Sequencing analysis showed that Shennong9816d carries a 1 bp mutation and a 30 bp insertion in the OSH15 region. These results suggest that osh15(t) is a novel allelic mutant originally derived from japonica variety Shennong9816, which may be useful for introducing the semi-dwarf phenotype to improve plant architecture in rice breeding practice.



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A Dilemma in Stroke Application: Standard or Modified Motor Unit Number Index?

The recent advent of motor unit number index (MUNIX) technique has provided a convenient and clinically applicable approach to estimating motor unit population changes in a muscle (Nandedkar et al., 2004, 2010). It uses compound muscle action potential (CMAP) and surface electromyogram (EMG) at different voluntary contraction levels to produce an index associated with motor unit number changes in the muscle. Compared with laborious motor unit number estimation (MUNE) techniques, the MUNIX protocol is easy and quick to implement and can minimize discomforts caused by electrical stimuli.

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Recovery function of somatosensory evoked brain response in patients with carpal tunnel syndrome: a magnetoencephalographic study

Brain plasticity refers to the brain's ability to reorganize itself throughout life, which can occur according to peripheral and central conditions (Pascual-Leone et al., 2005). For example, plastic changes in the brain have been observed following peripheral lesions (Mohanty et al., 2015; Navarro et al., 2007), as well as lesions in the central nervous system (Isa and Nishimura, 2014; Nudo, 2007). These changes can be adaptive or maladaptive, but the outcome cannot be predicted based on the location of the primary lesion (Nava et al., 2011).

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Detecting epileptiform activity from deeper brain regions in spatially filtered MEG data

It is well known that signals from deep sources, such as mesial temporal epileptic foci, are often barely visible in MEG and EEG (Magneto-/Electro-encephalography) recordings. Here we show in two patients how spatial filtering, using a beamforming technique, can be used to identify epileptiform activity. In these patients, this procedure resulted in detection of hippocampal interictal epileptiform discharges, even though these discharges were poorly discernible by visual inspection of the raw MEG time series.

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Hospice Use for Infants With Life-Threatening Health Conditions, 2007 to 2010

Infant deaths account for a majority of all pediatric deaths. However, little is known about the factors that influence parents to use hospice care for their infant with a life-threatening health condition.

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Spatio-temporal expression of Sox genes in murine palatogenesis

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Publication date: Available online 27 May 2016
Source:Gene Expression Patterns
Author(s): Momoko Waranabe, Katsushige Kawasaki, Maiko Kawasaki, Thantrira Portaveetus, Shelly Oommen, James Blackburn, Takahiro Nagai, Atsushi Kitatmura, Atsushi Nishikawa, Yasumitsu Kodama, Ritsuo Takagi, Takeyasu Maeda, Paul T. Sharpe, Atsushi Ohazama
Members of the Sox gene family play critical roles in many biological processes including organogenesis. We carried out comparative in situ hybridization analysis of seventeen Sox genes (Sox1-14, 17, 18 and 21) during murine palatogenesis from initiation to fusion of the palatal shelves above the dorsal side of the tongue. At palatal shelf initiation (E12.5), the localized expression of six Sox genes (Sox2, 5, 6, 9, 12 and 13) was observed in the shelves, whereas Sox4 and Sox11 showed ubiquitious expression. During the down-growth of palatal shelves (E13.5), Sox4, Sox5, and Sox9 exhibited restricted expression to the interior side of the palatal shelves facing the tongue. Following elevation of the palatal shelves (E14.5), Sox2, Sox11 and Sox21 expression was present in the midline epithelial seam. We thus identify dynamic spatio-temporal expression of Sox gene family during the process of palatogenesis.



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Factors Associated with Recurrent Falls in Individuals with Traumatic Spinal Cord Injury – a Multi-Center Study

Publication date: Available online 27 May 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Vivien Jørgensen, Emelie Butler Forslund, Erika Franzén, Arve Opheim, Åke Seiger, Agneta Ståhle, Claes Hultling, Johan K. Stanghelle, Kerstin Wahman, Kirsti Skavberg Roaldsen
ObjectiveTo identify factors associated with recurrent falls in individuals with traumatic SCI.DesignCross-sectional multi-center study.SettingTwo specialized Rehabilitation Centers in EuropeParticipantsIncluded: individuals with traumatic SCI ≥1 year post-injury, ≥ 18 years of age. Excluded: individuals with motor complete injuries above C5 or below L5. Participants were consecutively recruited at regular follow-up. Totally 224 individuals (151 wheelchair users, 73 ambulatory), 77% men, mean age 50 (SD 15) years, median 15 (range 1-56) years since injury were included.InterventionsNot applicable.Main Outcome MeasurePrimary outcome was factors associated with recurrent falls (defined as low frequent [0-2] or recurrent [>2]), the previous year. Independent variables were demographic data, wheelchair user or ambulatory, work, health-related quality of life, risk willingness, alcohol consumption, ability to get up from the ground, and exercise habits.ResultsFifty percent reported recurrent falls. In the final multiple logistic regression model, ambulation (odds ratio [OR] = 2.67, 95% confidence interval [CI] = 1.33-5.37), ability to get up from the ground (OR= 2.22, 95% CI= 1.21-4.10),) and regular exercise (OR= 1.86, 95% CI= 1.05-3.31), were associated with recurrent falls (p≤0.05), and with increasing age the OR decreased (OR= 0.97, 95% CI= 0.95-0.99).ConclusionIndividuals with SCI should be considered at risk of recurrent falls, and thereby at risk of fall-related injuries. Fall prevention programs should be focused on ambulatory, younger and more active individuals who had the highest risks for recurrent falls.



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Hypomyelinating leukodystrophies – a molecular insight into the white matter pathology

ABSTRACT

Hypomyelinating leukodystrophies (HLDs) are a group of neurodevelopmental disorders that affect proper formation of the myelin sheath in the central nervous system. They are characterized by developmental delay, hypotonia, spasticity, and variable intellectual disability. In the past various classification systems for HLDs have been used, based on imaging findings, clinical manifestation, and organelle-specific disorders. Here we present a molecular insight into HLDs based on a defect in specific gene engaged in myelination. We discuss recent findings on pathogenesis, clinical presentation, and imaging related to these disorders. We focus on HLDs that are in use in differential diagnostics of Pelizaeus-Merzbacher disease (PMD), with a special emphasis on Allan-Herndon-Dudley syndrome (AHDS), an X-linked condition with delayed myelination due to thyroid transport disturbances. On the background of previously published patients we describe a proband initially considered as presenting with a severe PMD, whose diagnosis of AHDS due to a novel nonsense SLC16A2 mutation unravelled two previously undiagnosed generations of affected males who died in infancy from unexplained reasons. Since AHDS is found to be a relatively frequent cause of X-linked intellectual disability, we emphasize the need for determining the whole thyroid profile especially in hypotonic males with a delay of psychomotor development.

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Improved diagnostic yield of neuromuscular disorders applying clinical exome sequencing in patients arising from a consanguineous population

ABSTRACT

Neuromuscular diseases (NMDs) include a broad range of disorders affecting muscles, nerves and neuromuscular junctions. Their overlapping phenotypes and heterogeneous genetic nature have created challenges in diagnosis which calls for the implementation of massive parallel sequencing as a candidate strategy to increase the diagnostic yield. In this study, total of 45 patients, mostly offspring of consanguineous marriages were examined using whole exome sequencing. Data analysis was performed to identify the most probable pathogenic rare variants in known NMD genes which led to identification of causal variants for 33 out of 45 patients (73.3%) in the following known genes: CAPN3, Col6A1, Col6A3, DMD, DYSF, FHL1, GJB1, ISPD, LAMA2, LMNA, PLEC1, RYR1, SGCA, SGCB, SYNE1, TNNT1 and 22 novel pathogenic variants were detected. Today, the advantage of whole exome sequencing in clinical diagnostic strategies of heterogeneous disorders is clear. In this cohort, a diagnostic yield of 73.3% was achieved which is quite high compared to the overall reported diagnostic yield of 25 to 50%. This could be explained by the consanguineous background of these patients and is another strong advantage of offering clinical exome sequencing in diagnostic laboratories, especially in populations with high rate of consanguinity.

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The relation of psychological and sociodemographic variables to medication adherence in chronic obstructive pulmonary disease patients: a cross-sectional study in Greece

2016-05-28T03-33-00Z
Source: Journal of Behavioral Health
Paraskevi Theofilou.
Several studies have shown that non- adherence is a common and increasing problem regarding the individuals with chronic illnesses, including chronic obstructive pulmonary disease (COPD) patients. The present study aimed to investigate the influence of psychological and sociodemographic variables on medication adherence among patients with COPD. A sample of 177 participants was recruited from three General Hospitals in the broader area of Athens, consisting of COPD patients. Measurements were conducted with the following instruments: the Medication Adherence Rating Scale (MARS), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Multidimensional Health Locus of Control (MHLC). The results indicated that medication adherence was associated positively with the dimensions of internal health locus of control and doctors, measured by MHLC questionnaire. It was also related negatively to depression, measured by CES-D scale. The present study demonstrates the importance of depression in understanding medication adherence of COPD patients as well as the contribution of heath beliefs.


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Isolation Associations of Exercise Intensity on Inflammation: Does Engaging in Moderate or Vigorous Intensity Exercise in Isolation have an Influence on Inflammation?

2016-05-28T03-33-00Z
Source: Journal of Behavioral Health
Paul D. Loprinzi, Ovuokerie Addoh, Eveleen Sng.
Objective: The purpose of this study was to examine whether engaging in certain physical activity intensity levels in isolation (e.g., only vigorous exercise) are associated with C-reactive protein (CRP). Methods: Data were extracted from the 1999-2006 NHANES (7,564 adults; 18-50 yrs). CRP was assessed from a blood sample and participants reported whether or not they engaged in moderate-intensity physical activity (MPA), vigorous-intensity physical activity (VPA), or moderate-to-vigorous physical activity (MVPA). Results: After adjusting for age, gender, race-ethnicity and body mass index, when compared to those who engaged in MVPA, those who engaged in only MPA (βadjusted=0.08; 95% CI: 0.04-0.12; p


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Arab-Jewish gap in life expectancy in Israel

Background: Studies about the health status of ethnic minorities in the Middle East are rare. This article examines changes in the life expectancy gap during 1970–2010 between the Arab–Palestinian minority and the Jewish majority in Israel, a persistent gap that has widened over the last 20 years. It examines the gap in a period over which the minority group was undergoing an epidemiological transition and demonstrates consequences of the transition on changes in the main causes of death contributing to the life expectancy gap. Methods: Decomposition methods estimate the contribution of specific age groups and causes of death to the total gap in life expectancy at any given year and changes in these contributions over the studied period. Results: The contribution of mortality differentials at ages <45 years to the Arab–Jewish gap in life expectancy declined while that of differentials at ages >45 has been gradually growing reaching >70% of the total gap. For both males and females, trends in cancer and diabetes mortality differentials contributed to widening the gap among the elderly. Trends in heart mortality lead to increasing the gap among males but to decreasing it among females. Conclusions: While differences in infant and child mortality have declined, old-age (>45) mortality differentials have emerged and have been gradually widening. These findings calls for a special attention to the various factors responsible for the widening mortality gap including social inequality between Arabs and Jews and higher levels of smoking and obesity among the Arab population.



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Effects of small incentives on survey response fractions: randomised comparisons in national alcohol surveys conducted in New Zealand

We experimentally evaluate inexpensive interventions to increase response fractions in two alcohol surveys. Residents on the New Zealand General and Māori electoral rolls were randomized to receive a survey pack with or without an offer of entry to a $500 prize draw. Subsequent randomization of sample members who did not initially respond allowed estimation of effects of offering a $5 donation to charity as an incentive to respond. Offering prize draw entry did not significantly increase responses in either population. Contrary to expectation, promising a $5 donation to non-respondents reduced subsequent responding in the group previously offered the prize draw incentive.



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European Public Health News * EUPHA presidents column * EUPHA office column * Message from the WHO Regional Director for Europe * Message from Vytenis Andriukaitis, EU Commissioner for Health and Food Safety * 9th European Public Health Conference--'All for Health--Health for All



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What is generated and what is used: a description of public health research output and citation

The aim of this short report was to describe the output and citation rates of public health. Data-based publications and literature reviews from the year 2008, and their 5-year citation rates were extracted from 10 randomly selected public health journals. In total, 86.2% of publications were descriptive/epidemiological studies, 56.8% used cross-sectional (56.8%) designs and 77.8% were classified as research translation stage 2. Reviews and publications describing randomized controlled trials were the most highly cited, but were infrequently published. Strategies to address the discordance between public health research output and research citation may improve the impact of public health research.



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Inevitable? Doping attitudes among Berliners in 2011: the role of socialist state socialisation and athlete experience

To design effective and commonly accepted public health policies against performance-enhancing drugs (PED), it is important to understand general population attitudes. This article elicits PED attitudes in the Berlin population and compares response rates of former athletes (N = 496) with those of non-athletes (N = 1686). In addition, exploiting the natural experiment of the division of Germany, by comparing East (N = 687) to West Berliners (N = 1315), the article studies the long-term impact of state socialisation on PED attitudes. Former West German amateur athletes are a statistically significant 6ppt more likely to believe that athletes can be successful without doping. Former GDR amateur athletes are 8ppt more likely to believe that doping is inevitable in professional sports.



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Austerity and Abortion in the European Union

Economic hardship accompanying large recessions can lead families to terminate unplanned pregnancies. To assess whether abortions have risen during the recession, we collected crude abortion data from 2000 to 2012 from Eurostat for countries that had legal abortions and complete data. Declining trends in abortion ratios between 2000 and 2009 have been reversing. Excess abortions between 2010 and 2012 totaled 10.6 abortions per 1000 pregnancies ending in abortion or birth or 6701 additional abortions (95% CI 1190–9240) with stronger effects in younger ages. Economic shocks may increase recourse to abortion. Further research should explore causal pathways and protective factors.



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Violent injuries and regional correlates among women in China: results from 21 cities study in China

Background: Ecological models depict violent injuries against women being influenced by both individual and environmental characteristics. However, only few studies examined the association between regional variables and the likelihood of violent injuries. Our study is a preliminary assessment of the impact of regional variables on the likelihood that a woman has experienced violent injuries. Methods: Participants were 16 866 urban residents, who were identified through a multi-stage sampling process conducted in 21 Chinese cities. Out of the sampled population, 8071 respondents were female. Subsequent analyses focused solely on the female sample. Multilevel logistic regression analyses were performed to examine regional variation in violent injuries. Results: Prevalence of violent injuries against women is 10.7% (95% CI: 7.8%, 15.5%). After controlling for individual-level characteristics, higher regional male–female ratio (OR: 1.97, P < 0.05), population growth rate (OR: 4.12, P < 0.01) and unemployment rate (OR: 2.45, P < 0.01) were all associated with an elevated risk of violent injuries among Chinese women caused by physical attack. Conclusions: The results suggest violent injuries among Chinese women caused by physical attack have become an important social and public health problem. The findings point to the importance of developing effective health policies, laws and interventions that focuses on the unequal economic development between different regions.



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Psychological distress screener for risk of future mental sickness absence in non-sicklisted employees

Background: Recently, a three-item screener, derived from the 16-item distress scale of the Four-Dimensional Symptom Checklist (4DSQ), was used to measure psychological distress in sicklisted employees. The aim of the present study was to investigate the ability of the 16-item distress scale and three-item distress screener to identify non-sicklisted employees at risk of sickness absence (SA) due to mental disorders. Methods: Prospective cohort study including 4877 employees working in distribution and transport. The 4DSQ distress scale was distributed at baseline in November 2010. SA diagnosed within the International Classification of Diseases -10 chapter F was defined as mental SA and retrieved from an occupational health register during 2-year follow-up. The area under the receiver operating characteristic curve (AUC) was used to discriminate between workers with ('cases') and without ('non-cases') mental SA during follow-up. Results: A total of 2782 employees (57%) were included in complete cases analysis; 73 employees had mental SA during 2-year follow-up. Discrimination between cases and non-cases was similar for the 16-item distress scale (AUC = 0.721; 95% CI, 0.622–0.823) and the three-item screener (AUC = 0.715; 95% CI, 0.615–0.815). Conclusion: Healthcare providers could use the three-item distress screener to identify non-sicklisted employees at risk of future mental SA.



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Organisation of newborn hearing screening programmes in the European Union: widely implemented, differently performed

Background: Implementation of newborn hearing screening programmes is widely recommended and programme organisational designs may differ in practice. The objective of this article was to establish an overview of the newborn hearing screening programmes in the 28 countries of the European Union on four topics (policy-decision, financing, general designs, organisational features). Methods: National or regional programme coordinators completed an online self-administered questionnaire focusing on protocol description and programme organisation. Results: Thirty-nine key informants, representing 24 countries, from national or regional levels completed the questionnaire. Newborn hearing screening programmes are or will be shortly implemented largely in the European Union countries. Levels of policy decision-making and organisational decisions are diverse (national, regional or combined). Designs of the programmes (number of steps before diagnosis referral, single or dual target group protocol) highly varied. However, common organisational elements were observed: hearing screening tests are often performed by nursing staff, in hospitals and early in life. This pattern does not apply when a screening protocol is specifically implemented for newborns with risk factor(s) for hearing impairment or admitted to neonatal intensive care units. Hearing test financing frequently involved public sources, including government and public health funds. Conclusion: Despite the same goal of early identification of hearing-impaired children, there is a high level of diversity in programmes, including policy decisions, financing, general designs and pragmatic organisational choices (e.g. professionals involved, location or time for screening, number of steps in the protocol). Further investigations should analyse these differences in relation to the programmes' contexts and outcomes.



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Clinical effectiveness of cancer screening biomarker tests offered as self-pay health service: a systematic review

Background: Biomarker tests are increasingly being offered by laboratories and clinicians as self-pay health services to screen asymptomatic individuals; however, sufficient evidence may not be available to support this practice. We investigated the benefit-harm tradeoffs associated with 11 biomarkers currently offered in Germany as self-pay tests to screen for cancer. Methods: We systematically searched bibliographic databases for health technology assessments, systematic reviews and randomized-controlled trials (RCTs) through September 2015. We included publications that analysed cancer screening biomarkers and reported patient-relevant outcomes (mortality, morbidity, quality of life), and potential harms of screening, among asymptomatic individuals in screening and non-screening arms. Language was restricted to English and German. Two reviewers independently screened references; data were extracted and quality of included studies was evaluated by a reviewer and validated by a second reviewer. Results: Six publications of secondary literature and four publications reporting results from two RCTs were included. For 10 cancer screening biomarkers, no direct evidence on patient-relevant outcomes was available. Only one trial, which simultaneously assessed cancer antigen 125 (CA125) and vaginal ultrasound for ovarian cancer screening, provided the outcome of interest. Screening compared with usual care did not reduce ovarian cancer mortality. Patient harms included overdiagnosis and false-positive results. Conclusion: Although ovarian cancer screening with CA125 showed no benefit, false-positive tests, overdiagnosis and overtreatment were reported. Physicians and laboratories should provide patients with comprehensive information about the lack of evidence and potential harms caused by biomarker screening tests offered as a self-pay health service.



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The impact of introducing combined first-trimester trisomy 21 screening in the French population

Background: French state health insurance has funded trisomy 21 prenatal screening for all pregnant women since decades. First-trimester combined screening was introduced nationally and funded in 2010. Objective: To evaluate the impact of the introduction, of a national policy of prenatal trisomy 21 first-trimester screening on the reduction of invasive prenatal diagnostic procedures. Methods: The results of all prenatal trisomy 21 screening and invasive diagnostic procedures were collected for the whole country over the period 2009–12. The screen-positive rates (risk cut-off 1 : 250, including isolated nuchal translucency ≥ 3.5 mm), positive predictive values and percentage of cases diagnosed prenatally were calculated. Results: Over the study period the number of women undergoing serum screening (including first- and second-trimester screening tests) increased from 678 803 to 689 651 (83 to 85% of deliveries, P < 0.0001). By 2012, first-trimester combined screening accounted for 70% of all trisomy 21 screening. The screen-positive rate decreased from 9.5 to 4.8% (P < 0.001) resulting in a 37 478 (47%) drop (P < 0.001) in the number of invasive diagnostic procedures. The positive predictive value of screening increased from 2.6 to 6.1% from 2009 to 2012 (P < 0.001), due to the higher positive predictive value of first-trimester over second-trimester screening (9.1 vs. 1.8% over the period 2010–12, P < 0.001). The percentage of prenatally diagnosed cases remained high at around 80% between 2010 and 2012. Conclusions: The policy shift from second-trimester to first-trimester trisomy 21 screening allowed to reduce the number of invasive tests. The number of antenatal trisomy 21 diagnoses increased (+2.7%) over the study period.



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Mid-career work patterns and physical and mental functioning at age 60-64: evidence from the 1946 British birth cohort

Background: Previous studies of the associations between unemployment and health have primarily focused on mental health and long-term associations have not often been explored. This study investigated if discontinuous employment in mid-career was related to self-reported physical and mental functioning at age 60–64 years. Methods: Data come from the Medical Research Council National Survey of Health and Development, a British cohort that has been followed-up since birth in 1946. A total of 2061 study members had data available on mid-career employment patterns and physical and mental functioning assessed using the Short Form 36 questionnaire at age 60–64. Employment patterns in mid-career were categorized into: (i) continuous employment; and discontinuous employment during; (ii) early period (ages 36–43); (iii) late period (ages 43-53); and 4) both periods. Results: Continuous employment was reported by 63.3% of men and 38.7% of women, while 8.7% of men and 23.4% of women reported being in discontinuous employment during both early and late mid-career. When compared with those in continuous employment those in discontinuous employment during both early and late mid-career had poorer physical functioning, men adjusted β (difference in mean physical functioning T score) –3.84, 95% CI – 6.06 to – 1.63, P = 0.001 and women –3.62, 95% CI – 5.17 to – 2.08, P < 0.001. Findings were parallel but weaker for those in discontinuous employment during late mid-career. Discontinuous employment during both periods and particularly during late mid-career was associated with poorer mental functioning in early old age. Conclusions: Discontinuous employment during mid-career was associated with poorer self-reported physical and mental functioning around the age of retirement.



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Influenza in workplaces: transmission, workers adherence to sick leave advice and European sick leave recommendations

Background: Knowledge about influenza transmission in the workplace and whether staying home from work when experiencing influenza-like illness can reduce the spread of influenza is crucial for the design of efficient public health initiatives. Aim: This review synthesizes current literature on sickness presenteeism and influenza transmission in the workplace and provides an overview of sick leave recommendations in Europe for influenza. Methods: A search was performed on Medline, Embase, PsychINFO, Cinahl, Web of Science, Scopus and SweMed to identify studies related to workplace contacts, -transmission, -interventions and compliance with recommendations to take sick leave. A web-based survey on national recommendations and policies for sick leave during influenza was issued to 31 European countries. Results: Twenty-two articles (9 surveys; 13 modelling articles) were eligible for this review. Results from social mixing studies suggest that 20–25% of weekly contacts are made in the workplace, while modelling studies suggest that on average 16% (range 9–33%) of influenza transmission occurs in the workplace. The effectiveness of interventions to reduce workplace presenteeism is largely unknown. Finally, estimates from studies reporting expected compliance with sick leave recommendations ranged from 71 to 95%. Overall, 18 countries participated in the survey of which nine (50%) had issued recommendations encouraging sick employees to stay at home during the 2009 A(H1N1) pandemic, while only one country had official recommendations for seasonal influenza. Conclusions: During the 2009 A(H1N1) pandemic, many European countries recommended ill employees to take sick leave. Further research is warranted to quantify the effect of reduced presenteeism during influenza illness.



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A systematic review of studies in the contributions of the work environment to ischaemic heart disease development

Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.



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Local area unemployment, individual health and workforce exit: ONS Longitudinal Study

Background: In many developed countries, associations have been documented between higher levels of area unemployment and workforce exit, mainly for disability pension receipt. Health of individuals is assumed to be the primary driver of this relationship, but no study has examined whether health explains or modifies this relationship. Methods: We used data from 98 756 Office for National Statistics Longitudinal Study members who were aged 40–69 and working in 2001, to assess whether their odds of identifying as sick/disabled or retired in 2011 differed by local authority area unemployment in 2001, change in local area unemployment from 2001 to 2011 and individual reported health in 2001 (self-rated and limiting long-term illness). Results: Higher local area unemployment and worse self-rated health measures in 2001 were independently related to likelihood of identifying as sick-disabled or retired, compared to being in work, 10 years later, after adjusting for socio-demographic covariates. Associations for local area unemployment were stronger for likelihood of identification as sick/disabled compared to retired in 2011. Associations for changes in local area unemployment from 2001 to 2011 were only apparent for likelihood of identifying as retired. For respondents that identified as sick/disabled in 2011, effects of local area unemployment in 2001 were stronger for respondents who had better self-rated health in 2001. Conclusions: Strategies to retain older workers may be most effective if targeted toward areas of high unemployment. For persons in ill health, local area unemployment interventions alone will not be as efficient in reducing their exit from the workforce.



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Socioeconomic differentials in mortality by cause of death in the Republic of Ireland, 1984-2008

Context/problem: Comparative analysis of relative and absolute mortality differentials between socioeconomic groups are now available. These show consistently increasing relative increases in mortality differentials but complex trends in absolute mortality differentials. Objective: This paper provides an analysis of relative and absolute trends in mortality by cause of death and socioeconomic group (SEG) from 1984 to 2008 among men and active women aged 30–64 years in Ireland and compares these results with recent European and US studies to give an overview of trends. Methods: This paper uses mortality data from the Irish Central Statistics Office from 1984 to 2008 to calculate standardized death rates by age, sex, socioeconomic status and cause of death showing trends in SEG inequalities in mortality in Ireland. These show which specific causes of death are driving all-cause mortality trends. Results: SEG differentials in all-cause mortality among men and women have been increasing since the 1980s. Some of this increase reflects larger falls in cardiovascular causes among advantaged groups, but the trend is largely accounted for by increasing inequalities in mortality in digestive, neoplasm and external causes of deaths. Conclusions: These findings are in line with international findings that show that socioeconomic differentials in digestive, neoplasm and external cause deaths are driving general socioeconomic differentials in all-cause mortality. External cause deaths may have been influenced by levels of economic activity, particularly in construction, during the economic boom among manual workers. Furthermore, deaths from digestive diseases during the 1990s and 2000s may well be the result of increases in liver disease associated with excessive alcohol consumption.



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Individual socioeconomic status and breast cancer diagnostic stages: a French case-control study

Background: Health inequalities have increased over the last 30 years. Our goal was to investigate the relationship between low individual socioeconomic status and poor breast cancer prognosis. Our hypothesis was: low socioeconomic status patients have a higher risk of being diagnosed with late stage breast cancer than high socioeconomic status ones due to delayed diagnosis. Methods: We conducted a matched case–control study on 619 women with breast cancer, living in the Hérault, a French administrative area. Both Cases and Controls were recruited among invasive cases diagnosed in 2011 and 2012 and treated in Hérault care centers. Cases were defined as patients with advanced stages. Controls were composed of early stage patients. Individual socioeconomic status was assessed using a validated individual score adapted to the French population and health care system. Results: We observed that low socioeconomic status patients have a 2-fold risk of having late stage breast cancer regardless of cancer characteristics and detection mode (screening vs. clinical signs). Conclusion: One reason explaining those results could be that low socioeconomic status patients have less regular follow-up which can lead to later and poorer diagnosis. Follow-up is improved for women with a better awareness of breast cancer. Health policy makers could reduce health inequalities by reducing the delay in breast cancer diagnosis for low socioeconomic status women.



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Changes in psychosocial and physical working conditions and common mental disorders

Background: Previous studies on changes in working conditions and mental health are few and have typically focused only on psychosocial working conditions. We assessed the impact of changes in both psychosocial and physical working conditions on common mental disorders (CMDs) in a cohort of midlife and older employees. Methods: Repeat data were derived from the Helsinki Health Study, which is a cohort study on employees of the City of Helsinki, Finland (aged 40–60 years at baseline). Changes in working conditions were assessed between Phase 1 (2000–2002) and Phase 2 (2007). CMD was assessed at Phase 1, Phase 2 and Phase 3 (2012) using the 12-item General Health Questionnaire. In total, 4946 participants (82% women) who were still employed at Phase 2 were available for the analyses. Logistic regression analyses using generalized estimating equations were conducted to examine the association between changes in working conditions and the likelihood of CMD. ORs and their 95% CIs were estimated. Results: After adjustment for sex, age, marital status, health behaviours and obesity; increased and repeated exposure to low job control, high job demands and repetitive movements and repeated exposure to awkward postures and rotation of back were associated with a higher likelihood of CMD at Phases 1–3. Fully adjusted ORs ranged from 1.27 to 2.39 for psychosocial, and from 1.18 to 1.29 for physical working conditions. Conclusions: Repeated and increased exposures to several adverse psychosocial and physical working conditions are associated with a higher likelihood of CMD.



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Life-course social position, obesity and diabetes risk in the EPIC-Spain Cohort

Background: The literature has consistently shown that extreme social-economic groups predicted type 2 diabetes mellitus (T2D), rather than summarising the social gradient throughout all society stratification. Body mass index (BMI) was established as the principal mediator, with little support for other anthropometries. Our aim was to investigate an individual life-course social position (LiSoP) gradient and its mediators with T2D risk in the EPIC-Spain cohort. Methods: 36 296 participants (62% women), mostly aged 30–65 years, and free of T2D at baseline (1992–1996) were followed up for a mean of 12.1 years. A combined score of paternal occupation in childhood and own adult education assessed individual life-course social risk accumulation. Hazard ratios of T2D were estimated using Cox regression, stratifying by centre and age, and adjusting for different explanatory models, including anthropometric indices; dietary history; smoking and physical activity lifestyles; and clinical information. Results: Final models evidenced significant risks in excess of 63% for middle and 90% for lower classes of LiSoP in men; and of 104 and 126%, respectively, in women. Concurrently, LiSoP presented significant social gradients for T2D risk (P < 0.01) in both sexes. Waist circumference (WC) accounted for most of the risk excess in women, and BMI and WC in men. Conclusions: LiSoP gradient was related to T2D risk in Spanish men and women. WC mostly explained the relationship in both genders, together with BMI in men, yet LiSoP retained an independent effect in final models.



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Linking databases on perinatal health: a review of the literature and current practices in Europe

Background: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. Methods: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. Results: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. Conclusion: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance.



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Genomic and transcriptomic predictors of response levels to endurance exercise training

Predicting the responsiveness to regular exercise is a topic of great relevance due to its potential role in personalized exercise medicine applications. The present review focuses on cardiorespiratory fitness (commonly measured by maximal oxygen uptake, VO2max), a trait with wide-ranging impact on health and performance indicators. Gains in VO2max demonstrate large inter-individual variation even in response to standardized exercise training programs. The estimated delta VO2max heritability of 47 % suggests that genomic-based predictors alone are insufficient to account for the total trainability variance. Candidate gene and genome-wide linkage studies have not significantly contributed to our understanding of the molecular basis of trainability. A genome-wide association study suggested that VO2max trainability is influenced by multiple genes of small effects, but these findings still await rigorous replication. Valuable evidence, however, has been obtained by combining skeletal muscle transcript abundance profiles with common DNA variants for the prediction of VO2max response to exercise training. Although the physiological determinants of VO2max measured at a given time are largely enunciated, what is poorly understood are the details of tissue-specific molecular mechanisms that limit VO2max and related signalling pathways in response to exercise training. Bioinformatics explorations based on thousands of variants have been used to interrogate pathways and systems instead of single variants and genes, and the main findings, along with those from exercise experimental studies, have been summarized here in a working model of VO2max trainability.

This article is protected by copyright. All rights reserved



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Texas town approves ambulance station

By Joseph Alderman
The Rockwall County Herald-Banner

HEATH, Texas — Residents of Heath may sleep a little safer, if perhaps a little less soundly, as the city council of Heath approved a conditional use permit for Rockwall EMS to house an ambulance station within city limits.

Despite a change in meeting date, a number of Heath residents came out to hear the council's decision regarding the ambulance station. The issue has been one of contention due to the fact that the site chosen for the station is residentially zoned and some neighbors and council members expressed concern over lights, noise and traffic dangers the station may pose.

Martin Ramirez of Rockwall EMS addressed a number of these concerns, stating that lights and sirens would be avoided in residential areas whenever possible, and that the dangers to pedestrians and traffic are unfounded.

"This is our job," Ramirez said, "we know how to not hit kids. This station will probably have a safer view than our other stations."

Following the opening of the floor to the public and the council considering a number of different issues regarding the station, council member Barry Brooks motioned to approve the conditional use permit with a clause limiting the permit to five years. After five years, the Rockwall EMS may reapply if no violations of the permit have been committed.

This motion, seconded by Rich Krause, passed unanimously among the council.

"I think the community is better served by having it in the residential area than not at all," Brooks said.

The council also unanimously approved a rate increase to Atmos Energy for natural gas service to the city. The increase, which would total $29.9 million across the region, will translate to a $1.26 increase per month to residents and will go toward making improvements to pipelines and ensuring the safety and reliability of their infrastructure. This total had been negotiated down from what originally would have been a $1.52 increase per resident per month.

A construction contract for repairs on a section of McDonald Road was also awarded by the council, as well as the approval of the purchase of a new fire engine.

Motions to table items were approved for the purchase of a building for the housing of public works equipment and to approve a license agreement with Travis Ranch regarding landscaping, irrigation and signage. The council stated that both issues required further investigation.

Copyright 2016 the Rockwall County Herald-Banner



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