Effectiveness of structured educational program on knowledge of middle-aged women regarding prevention of osteoporosis

2016-06-15T22-07-27Z
Source: International Journal of Medical Science and Public Health
Shipra Sachan, Kamli Prakash, Upma George.
Background: Osteoporosis is a skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to bone fragility and consequent increase in fracture risk. Objective: To determine the effectiveness of structured educational program on the knowledge of middle-aged women and to determine the association between demographic variables and knowledge score. Materials and Methods: A preexperimental design with one group pretest and posttest approach was selected to carry out the study. A total of 108 middle-aged women were selected by using nonprobability, purposive sampling technique. Structured questionnaire was used for data collection. Data were collected by interview method. The posttest was conducted after 7 days of intervention. Result: The pretest mean knowledge score was 10.44 ± 2.26, which was increased to 19.66 ± 2.28 in posttest. The knowledge of middle-aged women was statistically significantly and it was not associated with their age, marital status, number of children, education, occupation, socioeconomic status, previous knowledge about osteoporosis, and source of information. Conclusion: The structured educational program was effective in increasing the knowledge of middle-aged women regarding prevention of osteoporosis.


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Morphine-induced synaptic plasticity in the VTA is reversed by HDAC inhibition

Dopamine (DA) dysfunction originating from the ventral tegmental area (VTA) occurs as a result of synaptic abnormalities following consumption of drugs of abuse and underlies behavioral plasticity associated with drug abuse. Drugs of abuse can cause changes in gene expression through epigenetic mechanisms in the brain that underlie some of the lasting neuroplasticity and behavior associated with addiction. Here we investigated the function of histone acetylation and histone deacetylase (HDAC2) in the VTA in recovery of morphine-induced synaptic modifications following a single in vivo exposure to morphine. Using a combination of immunohistochemistry, Western blot and whole-cell patch clamp recording in rat midbrain slices, we show that morphine increased HDAC2 activity in VTA DA neurons and reduced histone H3 acetylation at lysine 9 (Ac-H3K9) in the VTA 24 hours following the injection. Morphine-induced synaptic changes at glutamatergic synapses involved endocannabinoid (eCB) signaling to reduce GABAergic synaptic strength onto VTA DA neurons. Both plasticities were recovered by in vitro incubation of midbrain slices with a class I specific HDAC inhibitor (HDACi), CI-994, through an increase in acetylation of histone H3K9. Interestingly, HDACi incubation also increased levels of Ac-H3K9, and triggered GABAergic and glutamatergic plasticities in DA neurons of saline-treated rats. Our results suggest that acute morphine-induced changes in VTA DA activity and synaptic transmission engage HDAC2 activity locally in the VTA to maintain synaptic modifications through histone hypoacetylation.

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Looking for symmetry: fixational eye movements are biased by image mirror symmetry

Humans are highly sensitive to symmetry. During scene exploration, the area of the retina with dense light receptor coverage acquires most information from relevant locations determined by gaze fixation. We characterised patterns of fixational eye movements made by observers staring at synthetic scenes either freely (i.e. free exploration) or during a symmetry orientation discrimination task (i.e. active exploration). Stimuli could be mirror-symmetric or not. Both free and active exploration generated more saccades parallel to the axis of symmetry than along other orientations. Most saccades were small (<2deg) leaving the fovea within a 4-degree radius of fixation. The analysis of saccade dynamics showed that the observed parallel orientation selectivity emerged within 500ms of stimulus onset and persisted throughout the trials under both viewing conditions. Symmetry strongly distorted existing anisotropies in gaze direction in a seemingly automatic process. We argue that this bias serves a functional role in which adjusted scene sampling enhances and maintains sustained sensitivity to local spatial correlations arising from symmetry.

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Self-reinnervated muscles lose autogenic length feedback but intermuscular feedback can recover functional connectivity

In this study, we sought to identify sensory circuitry responsible for motor deficits or compensatory adaptations after peripheral nerve cut and repair. Self-reinnervation of the ankle extensor muscles abolishes the stretch reflex and increases ankle yielding during downslope walking, but it remains unknown whether this finding generalizes to other muscle groups and whether muscles become completely deafferented. In decerebrate cats at least 19 weeks after nerve cut and repair, we examined the influence of quadriceps muscles' self-reinnervation on autogenic length feedback, as well as intermuscular length and force feedback among the primary extensor muscles in the cat hindlimb. Effects of gastrocnemius and soleus self-reinnervation on intermuscular circuitry was also evaluated. We found that autogenic length feedback was lost after quadriceps self-reinnervation indicating loss of the stretch reflex appears to be a generalizable consequence of muscle self-reinnervation. However, intermuscular force and length feedback evoked from self-reinnervated muscles was preserved in most of the interactions evaluated with similar relative inhibitory or excitatory magnitudes. These data indicate intermuscular spinal reflex circuitry has the ability to regain functional connectivity, but the restoration is not absolute. Explanations for the recovery of intermuscular feedback are discussed based on identified mechanisms responsible for lost autogenic length feedback. Functional implications due to permanent loss of autogenic length feedback and potential for compensatory adaptations from preserved intermuscular feedback are discussed.

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{alpha}1- and {alpha}2-adrenergic receptors in the retrotrapezoid nucleus differentially regulate breathing in anesthetized adult rats

Norepinephrine (NE) is a potent modulator of breathing that can increase/decrease respiratory activity by α₁-/ α₂-adrenergic receptors (AR) activation, respectively. The retrotrapezoid nucleus (RTN) is known to contribute to central chemoreception, inspiration and active expiration. Here we investigate the sources of catecholaminergic inputs to the RTN and identify respiratory effects produced by activation of ARs in this region. By injecting the retrograde tracer FluorGold into the RTN we identified back-labeled catecholaminergic neurons in the A7 region. In urethane-anesthetized, vagotomized and artificial ventilated male Wistar rats unilateral injection of NE or moxonidine (α₂-ARagonist) blunted Dia_EMG frequency and amplitude, without changing AbdEMG. Those inhibitory effects were reduced by pre-application of yohimbine (α2-AR antagonist) into the RTN. Conversely, unilateral RTN injection of phenylephrine (α₁-AR agonist) increased Dia_EMG amplitude, frequency and facilitated active expiration. This response was blocked by prior RTN injection of prazosin (α₁-AR antagonist). Interestingly, RTN injection of propranolol (β-AR antagonist) had no effect on respiratory inhibition elicited by applications of NE into the RTN, however, the combined blockade of α₂- and β-ARs (co-application of propranolol and yohimbine) revealed an α₁-AR-dependent excitatory response to NE that resulted in increase in Dia_EMG frequency and facilitation of active expiration. However, blockade of α₁-, α₂-, or β-ARs in the RTN had minimal effect on baseline respiratory activity, on central or peripheral chemoreflexes. These results suggest that NE signaling can modulate RTN chemoreceptor function; however, endogenous NE signaling does not contribute to baseline breathing or the ventilatory response to central or peripheral chemoreceptor activity in urethane-anesthetized rats.

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Validating silicon polytrodes with paired juxtacellular recordings: method and dataset

Cross-validating new methods for recording neural activity is necessary to accurately interpret and compare the signals they measure. Here we describe a procedure for precisely aligning two probes for in vivo "paired-recordings" such that the spiking activity of a single neuron is monitored with both a dense extracellular silicon polytrode and a juxtacellular micro-pipette. Our new method allows for efficient, reliable, and automated guidance of both probes to the same neural structure with micron resolution. We also describe a new dataset of paired-recordings, which is available online. We propose that our novel targeting system, and ever expanding cross-validation dataset, will be vital to the development of new algorithms for automatically detecting/sorting single-units, characterizing new electrode materials/designs, and resolving nagging questions regarding the origin and nature of extracellular neural signals.

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Using melanopsin to study G protein signaling in cortical neurons

Our understanding of G protein-coupled receptors in the central nervous system has been hampered by the limited availability of tools allowing for the study of their signaling with precise temporal control. To overcome this, we tested the utility of the bistable mammalian opsin melanopsin to examine G protein signaling in CNS neurons. Specifically we used biolistic (gene gun) approaches to transfect melanopsin into cortical pyramidal cells maintained in organotypic slice culture. Whole cell recordings from transfected neurons indicated that application of blue light effectively activated the transfected melanopsin to elicit the canonical biphasic modulation of membrane excitability previously associated with the activation of G protein-coupled receptors coupling to Gα_q/11. Remarkably, full mimicry of exogenous agonist concentration could be obtained with pulses as short as a few milliseconds, suggesting that their triggering required a single melanopsin activation deactivation cycle. The resulting temporal control over melanopsin activation allowed us to compare the activation kinetics of different components of the electrophysiological response. We also replaced the intracellular loops of melanopsin with those of the 5-HT_2A receptor to create a light-activated GPCR capable of interacting with the 5-HT_2A receptor interacting proteins. The resulting chimera expressed weak activity but validated the potential usefulness of melanopsin as a tool for the study of G protein signaling in CNS neurons.

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Purkinje cell intrinsic excitability increases after synaptic long term depression

Coding in cerebellar Purkinje cells not only depends on synaptic plasticity but also on their intrinsic membrane excitability. We performed whole cell patch clamp recordings of Purkinje cells in sagittal cerebellar slices in mice. We found that inducing long term depression (LTD) in the parallel fiber (PF) to Purkinje cell (PC) synapses results in an increase in the gain of the firing rate response. This increase in excitability is accompanied by an increase in the input resistance and a decrease in the amplitude of the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel mediated voltage sag. Application of a HCN channel blocker prevents the increase in input resistance and excitability without blocking the expression of synaptic LTD. We conclude that induction of PF-PC LTD is accompanied by an increase in excitability of Purkinje cells through down-regulation of the HCN mediated h current. We suggest that HCN down-regulation is linked to the biochemical pathway that sustains synaptic LTD. Given the diversity of information carried by the parallel fiber system, we suggest that changes in intrinsic excitability enhance the coding capacity of the Purkinje cell to specific input sources.

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Active sensing without efference copy: referent control of perception

Although action and perception are different behaviors, they are likely to be interrelated, as implied by the notions of perception-action coupling and active sensing. Traditionally, it has been assumed that the nervous system directly pre-programs motor commands required for actions and uses a copy of them called efference copy (EC) to also influence our senses. This review offers a critical analysis of the EC concept by identifying its limitations in solving several problems of perception and action. An alternative to the EC concept is based on the experimentally confirmed notion that sensory signals from receptors are perceived relative to referent signals specified by the brain. These referents also underlie the control of motor actions by pre-determining where, in the spatial domain, muscles can work without pre-programming of how they should work in terms of motor commands or EC. This approach is helpful in explaining several sensory experiences, including position sense and sense that the world remains stationary despite changes in its retinal image during eye or body motion (visual space constancy). The phantom limb phenomenon and other kinesthetic illusions are also explained in this framework.

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Human parietal cortex lesions impact the precision of spatial working memory

The neural mechanisms that support working memory (WM) depend on persistent neural activity. Within topographically organized maps of space in dorsal parietal cortex, spatially selective neural activity persists during WM for location. However, to date the necessity of these topographic subregions of human parietal cortex for WM remain unknown. To test the causal relationship of these areas to WM, we compared the performance of patients with lesions to topographically organized parietal cortex to controls on a memory-guided saccade (MGS) task as well as a visually-guided saccade (VGS) task. The MGS task allowed us to measure WM precision continuously with great sensitivity, while the VGS task allowed us to control for any deficits in general spatial or visuomotor processing. Compared to controls, patients generated memory-guided saccades that were significantly slower and less accurate, while visually-guided saccades were unaffected. These results provide key missing evidence for the causal role of topographic areas in human parietal cortex for WM, as well as the neural mechanisms supporting WM.

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Effect of current focusing on the sensitivity of inferior colliculus neurons to amplitude modulated stimulation

In multichannel cochlear implants (CIs), current is delivered to specific electrodes along the cochlea in the form of amplitude-modulated pulse trains, to convey temporal and spectral cues. Our previous studies have shown that focused multipolar (FMP) and tripolar (TP) stimulation produce more restricted neural activation and reduced channel interactions in the inferior colliculus (IC), compared to traditional monopolar (MP) stimulation, suggesting that focused stimulation could produce better transmission of spectral information. The present study explored the capability of IC neurons to detect modulated CI stimulation with FMP and TP stimulation, compared to MP stimulation. The study examined multiunit responses of IC neurons in acutely deafened guinea pigs by systematically varying the stimulation configuration, modulation depth and stimulation level. Stimuli were sinusoidal amplitude-modulated pulse trains (carrier rate of 120 pulses/sec). Modulation sensitivity was quantified by measuring modulation detection thresholds (MDTs), defined as the lowest modulation depth required to differentiate the response of a modulated stimulus from an unmodulated one. While MP stimulation showed significantly lower MDTs than FMP and TP stimulation (p-values<0.05) at stimulation ≤ 2 dB above threshold, all stimulation configurations were found to have similar modulation sensitivities at 4 dB above threshold. There was no difference found in modulation sensitivity between FMP and TP stimulation. The present study demonstrates that current focusing techniques such as FMP and TP can adequately convey amplitude modulation, and are comparable to MP stimulation especially at higher stimulation levels, although there may be some trade-off between spectral and temporal fidelity with current focusing stimulation.

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Synaptic and intrinsic homeostasis cooperate to optimize single neuron response properties and tune integrator circuits

Homeostatic processes that provide negative feedback to regulate neuronal firing rate are essential for normal brain function, and observations suggest that multiple such processes may operate simultaneously in the same network. We pose two questions: why might a diversity of homeostatic pathways be necessary, and how can they operate in concert without opposing and undermining each other? To address these questions, we perform a computational and analytical study of cell-intrinsic homeostasis and synaptic homeostasis in single-neuron and recurrent circuit models. We demonstrate analytically and in simulation that when two such mechanisms are controlled on a long time scale by firing rate via simple and general feedback rules, they can robustly operate in tandem to tune the the mean and variance of single neuron's firing rate to desired goals. This property allows the system to recover desired behavior after chronic changes in input statistics. We illustrate the power of this homeostatic tuning scheme by using it to regain high mutual information between neuronal input and output after major changes in input statistics. We then show that such dual homeostasis can be applied to tune the behavior of a neural integrator, a system that is notoriously sensitive to variation in parameters. These results are robust to variation in goals and model parameters. We argue that a set of homeostatic processes that appear to redundantly regulate mean firing rate may work together to control firing rate mean and variance and thus maintain performance in a parameter-sensitive task such as integration.

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Distinct contributions of explicit and implicit memory processes to weight prediction when lifting objects and judging their weights: an aging study.

Weight predictions used to scale lifting forces adapt quickly when repeatedly lifting unusually weighted objects, and are readily updated by explicit information provided about weight. In contrast, weight predictions used when making perceptual judgments about weight are more resistant to change and are largely unaffected by explicit information about weight. These observations suggest that distinct memory systems underlie weight prediction when lifting objects and judging their weights. Here we examined whether these weight predictions differ in their reliance on declarative and non-declarative memory resources by comparing the adaptability of these predictions in older adults, who exhibit relatively impaired declarative memory processes, to younger adults. In the size condition, we measured lift forces as participants repeatedly lifted a pair of size-weight inverted objects in alternation. To assess weight judgments, we measured the size-weight illusion every 10 lifts. The material condition was similar except that we used material-weight inverted objects and measured the material-weight illusion. The strengths of these illusions prior to lifting, and the attenuation of the illusions that arise when lifting inverted objects, was similar for both groups. The magnitude of the change in the illusions was positively correlated with implicit memory performance in both groups, suggesting that predictions used when judging weight rely on non-declarative memory resources. Updating of lifting forces also did not differ between groups. However, within the older group the success with which lifting forces were updated was positively correlated with working memory performance, suggesting that weight predictions used when lifting rely on declarative memory resources.

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In vitro characterization of noradrenergic modulation of chemosensitive neurons in the retrotrapezoid nucleus

Chemosensitive neurons in the retrotrapezoid nucleus (RTN) regulate breathing in response to CO₂/H⁺ changes, and serve as an integration center for other autonomic centers including brainstem noradrenergic neurons. Norepinephrine (NE) contributes to respiratory control and chemoreception, and since disruption of NE signaling may contribute to several breathing disorders; we sought to characterize effects of NE on RTN chemoreception. All neurons included in this study responded similarly to CO₂/H⁺ but showed differential sensitivity to NE; we found that NE activated (79%), inhibited (7%), or had no effect on activity (14%) of RTN chemoreceptors. The excitatory effect of NE on RTN chemoreceptors was dose dependent, retained in the presence of neurotransmitter receptor blockers, and could be mimicked and blocked by pharmacological manipulation of α1-adrenergic receptors (ARs). In addition, NE-activation was blunted by XE991 (KCNQ channel blocker), and partially occluded the firing response to serotonin, suggesting involvement of KCNQ channels. However, in whole-cell voltage-clamp, activation of α1-ARs decreased outward current and conductance by what appears to be a mixed effect on multiple channels. The inhibitory effect of NE on RTN chemoreceptors was blunted by an α2-AR antagonist. A third group of RTN chemoreceptors was insensitive to NE. We also found that chemosensitive RTN astrocytes do not respond to NE with a change in voltage or by releasing ATP to enhance activity of chemosensitive neurons. These results indicate NE modulates subsets of RTN chemoreceptors by mechanisms involving α1- and α2-ARs.

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Ampakine CX717 potentiates intermittent hypoxia-induced hypoglossal long term facilitation

Glutamatergic currents play a fundamental role in regulating respiratory motor output, and are partially mediated by α-amino-3-hydroxy-5-methyl-isoxazole-propionic acid (AMPA) receptors throughout the premotor and motor respiratory circuitry. Ampakines are pharmacological compounds that enhance glutamatergic transmission by altering AMPA receptor channel kinetics. Here we examined if ampakines alter the expression of respiratory long term facilitation (LTF), a form of neuroplasticity manifested as a persistent increase in inspiratory activity following brief periods of reduced O2 (intermittent hypoxia, IH). Current synaptic models indicate enhanced effectiveness of glutamatergic synapses after IH, and we hypothesized that ampakine pretreatment would potentiate IH-induced LTF of respiratory activity. Inspiratory bursting was recorded from the hypoglossal nerve of anesthetized, and mechanically ventilated mice. During baseline (BL) recording conditions, burst amplitude was stable for at least 90-min (98 ± 5 %BL). Exposure to IH (3x1 min, 15%O2) resulted in a sustained increase in burst amplitude (218 ± 44 %BL at 90 min following final bout of hypoxia). Mice given an intraperitoneal (IP) injection of ampakine CX717 (15 mg/kg) 10 min prior to IH showed enhanced LTF (500 ± 110 %BL at 90 min). Post-hoc analyses indicated that CX717 potentiated LTF only when initial baseline burst amplitude was low. We conclude that under appropriate conditions, ampakine pretreatment can potentiate IH-induced respiratory LTF. These data suggest that ampakines may have therapeutic value in the context of hypoxia-based neurorehabilitation strategies, particularly in disorders with blunted respiratory motor output such as spinal cord injury.

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High Prevalence of Non-ST131 CTX-M-15-Producing Escherichia coli in Healthy Cattle in Lebanon

Microbial Drug Resistance , Vol. 0, No. 0.


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Electromyographic changes of trunk muscles during the graded lumbar stabilization exercises

Lumbar stabilization exercises are effective for the treatment of patients with low back pain. However, personalized exercise programs are required to facilitate more efficient treatment, as each individual exhibits the different characteristics of the trunk muscles and pain.

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Health Benefits of Zumba® fitness training: a systematic review

As an alternative to the traditional approach to physical exercise, new kinds of organized physical activity have been developed designed to engage large segments of the population. Among these, Zumba® fitness is extremely popular with a growing number of participants. This document aims to summarize and analyze the body of evidence on the effects of Zumba® fitness interventions (ZFIs) on physical function, fitness and wellbeing.

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Sonographic findings in subcoracoid impingement syndrome: a case report and literature review

Subcoracoid impingement syndrome is a rare and under-recognized cause of anterior shoulder pain. Currently, subcoracoid impingement syndrome is understood to involve impingement of anatomic structures such as the subcoracoid bursa and subscapularis tendon within the coracohumeral space, and there are no reports of sonographic findings in subcoracoid impingement syndrome other than the impingement of thickened subscapularis bursa. Here we report a case of subcoracoid impingement syndrome, including a novel sonographic finding, arthroscopic findings, and a proposed pathophysiology.

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Characteristics of intratendinous microcirculation shortly after an Achilles rupture and subsequent treatment outcomes

Early microcirculatory responses after experimental tenotomy are critical to the healing of tendons and their ultimate tensile strength. However, the effects of changes in microcirculation on the outcomes of tendon healing have not been determined.

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Does the Physical Medicine and Rehabilitation Self-Assessment Examination for Residents Predict the Chances of Passing the Part 1 Board Certification Examination?

Each year, residents in accredited United States Physical Medicine and Rehabilitation (PMR) residency programs can take the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Self-Assessment Examination for Residents (SAE-R). This 150 question multiple choice examination is intended for self-assessment of physiatric knowledge but its predictive value for performance on the part 1 American Board of Physical Medicine and Rehabilitation Certification Examination (ABPMR-CE) is unknown.

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Ultrasonographic Evaluation and Feasibility of Posterior Superior Internal Impingement Syndrome: A Case Series

Posterosuperior impingement (PSI) is an underdiagnosed cause of posterior shoulder pain and should be differentiated from classic and external impingement. PSI involves the internal impingement of soft tissues, including the undersurface of the rotator cuff against the posterosuperior labrum when the arm is brought into abduction and external rotation (ABER). Ultrasonography (US) can be useful in the assessment of PSI because of its high resolution and ability to perform during dynamic maneuvers in ABER.

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Obstetric Provider Maldistribution: Georgia, USA, 2011

Abstract

Objectives In 2010, Georgia had the nation's highest maternal mortality rate, sixteenth highest infant mortality rate, and a waning obstetrician/gynecologist (ob/gyn) workforce. Statewide ob/gyn workforce data, however, masked obstetric-specific care shortages and regional variation in obstetric services. The Georgia Maternal and Infant Health Research Group thereby assessed each Georgia region's obstetric provider workforce to identify service-deficient areas. Methods We identified 63 birthing facilities in the 82 Primary Care Service Areas (PCSAs) outside metropolitan Atlanta and interviewed nurse managers and others to assess the age, sex, and expected departure year of each delivering professional. Using accepted annual delivery rates of 155 per obstetrician (OB), 100 per certified nurse midwife (CNM), and 70 per family medicine physician (FP) we converted obstetric providers into "OB equivalents" to standardize obstetric services available in any given area. Using facility births and computed OB equivalents (contemporary and 2020 estimates), we calculated current and projected average annual births per provider (AABP) for each PCSA, categorizing its obstetric provider workforce as "adequate" (AABP < 144), "at risk" (144 ≤ AABP ≤ 166), or "deficient" (AABP > 166). We mapped results using ArcGIS. Results Of 82 surveyed PCSAs, 52 % (43) were deficient in obstetric care; 16 % (13) had a shortage and 37 % (30) lacked obstetric providers entirely. There were no delivering FPs in 89 % (73) of PCSAs and no CNMs in 70 % (56). If Georgia fails to recruit delivering providers, 72 % (58/77) of PCSAs will have deficient or no obstetric care by 2020. Conclusions Obstetric provider shortages in Georgia hinder access to prenatal and delivery services. Care-deficient areas will expand if recruitment and retention of delivering professionals does not improve.

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The Relation of Neighborhood Income to the Age-Related Patterns of Preterm Birth Among White and African-American Women: The Effect of Cigarette Smoking

Abstract

Objectives We investigated the contributions of cigarette smoking to the age-related patterns of preterm (<37 weeks) birth (PTB) rates among African-American and White women within the context of lifelong neighborhood income. Methods Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of non-Hispanic White and African-American infants (1989–1991) and their mothers (1956–1976) with appended US census income information. Results: Among non-smoking African-American women (n = 20,107) with a lifelong residence in lower income neighborhoods, PTB rates decreased from 18.5 % for teens to 15.0 % for 30–35 year-olds, p < 0.0001. The opposite pattern occurred among African-American women smokers (n = 5936) with a lifelong residence in lower income neighborhoods, p < 0.01. Among upwardly mobile African-American women smokers (n = 756), PTB rates increased from 11.1 % for teens to 24.9 % for 30–35 year-olds, p < 0.05. Cigarette smoking was not associated with an age-related increase in PTB rates among African-American women with a lifelong residence in upper income neighborhoods. No subgroup of White women, even cigarette smokers with a lifelong residence in lower income neighborhoods, exhibited weathering with regard to PTB. Conclusions A weathering pattern of rising PTB rates with advancing age occurs only among African-American women cigarette smokers with an early-life or lifelong residence in lower income neighborhoods, underscoring the public health policy importance of targeted smoking cessation programs in eliminating the racial disparity in the age-related patterns of PTB rates.

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Ethnic Differences in Gestational Weight Gain: A Population-Based Cohort Study in Norway

Abstract

Objectives To explore ethnic differences in gestational weight gain (GWG). Methods This was a population-based cohort study conducted in primary care child health clinics in Groruddalen, Oslo, Norway. Participants were healthy pregnant women (n = 632) categorised to six ethnic groups (43 % were Western European women, the reference group). Body weight was measured at 15 and 28 weeks' gestation on average. Data on pre-pregnancy weight and total GWG until delivery were self-reported. The main method of analysis was linear regression adjusting for age, weeks' gestation, pre-pregnancy body mass index, education and severe nausea. Results No ethnic differences were observed in GWG by 15 weeks' gestation. By 28 weeks' gestation, Eastern European women had gained 2.71 kg (95 % confidence interval, CI 1.10–4.33) and Middle Eastern women 1.32 kg (95 % CI 0.14–2.50) more weight on average than the Western European women in the fully adjusted model. Among Eastern European women, the total adjusted GWG was 3.47 kg (95 % CI 1.33–5.61) above the reference group. Other ethnic groups (South Asian, East Asian and African) did not differ from the reference group. When including non-smokers (n = 522) only, observed between-group differences increased and Middle Eastern women gained more weight than the reference group by all time points. Conclusions Eastern European and Middle Eastern women had higher GWG on average than Western European women, especially among the non-smokers. Although prevention of excessive GWG is important for all pregnant women, these ethnic groups might need special attention during pregnancy.

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Prevalence of CTX-M enzyme and qnrA, qnrB, qnrC, qnrS, aac-(6)-Ib genes among ESBL (Extended spectrum beta lactamase)-positive isolates in patients undergoing transrectal needle prostate biopsy in Turkey.

2016-06-15T18-32-38Z
Source: Disease and Molecular Medicine
Elif Tükenmez Tigen, Zafer Tandoğdu, Gülşen Altınkanat, Arzu Doğru, Buket Erturk Sengel, Korten Volkan.
Fecal carriage is one of the most important reasons for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) causing infections. We aimed to demonstrate epidemiological features for subtype of ESBL-PE-encoding TEM, SHV and CTX-M as well as for qnrA, qnrB, qnrC, qnrS, aac-(6)-Ib genes through polymerase chain reaction (PCR) in patients undergoing transrectal needle prostate biopsy (TRNBP). Between October 2008 and February 2010, we collected 400 fecal swabs from patients prior to TRNBP in four separate centers. After detecting ESBL- PE isolates in the material, we further analyzed TEM, SHV and CTX-M enzymes, as well as three types of qnr genes of qnrA, qnrB, qnrC and aac-(6)-Ib by PCR. We detected 80 ESBL-PE isolates in 400 fecal samples. Of the 80 isolates; blaSHV, blaTEM and blaCTX-M were observed in 12, 46 and 79 isolates, respectively. All three genes were present in eight isolates. Resistance to Quinolone was identified in 67 (83.7%) isolates, resistance to aminoglycoside in 52 (65%) isolates, and resistance to both antibiotics in 46 (57.5%) isolates. Subsequently, we determined qnrB, qnrS and aac-(6)-Ib genes in 7 (8.8%), 11 (14%) and 60 (76%) isolates, respectively. qnrA and qnrC were not detected in any of the isolates. CTX-M-producing ESBL-PE is the most common pathogen responsible for fecal carriage in the community. Plasmid mediated quinolone resistance genes (qnr, aac-(6)-Ib) are the reason behind the dissemination of ESBLs.


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How do medical students develop the selfawareness as social entities during the longitudinal communication experience with citizens?

2016-06-15T17-07-20Z
Source: Journal of Contemporary Medical Education
Takuya Saiki, Keiko Abe, Chihiro Kawakami, Kazuhiko Fujisaki, Yasuyuki Suzuki.
Objective: Diverse interactions with local citizens are known to broaden the health perspectives of medical students, stimulating their motivation to learn, and improving their communication skills. In recent years, the rapid decrease in birth rates and the transition toward a nuclear family structure have posed a challenge for medical students in Japan, given their lack of experience in communicating with citizens who are older than they are or whose social backgrounds differ from their own. We aim at exploring how a longitudinal interaction with citizens can develop medical students communication skills and understanding of themselves as social entities. Method: Thematic analysis was used to analyze descriptive comments submitted to an e-portfolio by 100 first-year medical students who participated in longitudinal community-based experiential learning for six weeks with one of three different kinds of citizens such as the elderly, pregnant mothers, or nursery school children in 2011. Five independent researchers extracted themes from comments collected from 45 individual students on each six weekly encounters. The remaining data were used to confirm data saturation. Results: Two different themes emerged from the analysis: 1) understanding of citizens centeredness in communication, and 2) understanding of human relationship and expansion of world as a social existence. The first theme contained three different stages: i) survival, ii) trial and error, and iii) shifting gaze. The second theme contained four different stages: i) narrow, self-centered worlds, ii) awareness of the citizens existence, iii) understanding the worlds of the citizens and expanding their views of life, and iv) self-realization as a social entity within an expanded worldview. These two themes became progressively deeper through the longitudinal and mutual interaction. Conclusion: The longitudinal, mutual communication experiences with citizens has an impact on the students development of self-awareness as social entities accompanied with improving their communication skills.


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Ethno-Specific Risk Factors for Adverse Pregnancy Outcomes: Findings from the Born in Bradford Cohort Study

Abstract

Objectives Preterm birth (PTB) and small for gestational age (SGA) are major causes of perinatal mortality and morbidity. Previous studies indicated a range of risk factors associated with these poor outcomes, including maternal psychosocial and economic wellbeing. This paper will explore a range of psycho-social and economic factors in an ethnically diverse population. Methods The UK's Born in Bradford cohort study recruited pregnant women attending a routine antenatal appointment at 26–28 weeks' gestation at the Bradford Royal Infirmary (2007–2010). This analysis includes 9680 women with singleton live births who completed the baseline questionnaire. Data regarding maternal socio-demographic and mental health were recorded. Outcome data were collected prospectively, and analysed using multivariate regression models. The primary outcomes measured were: PTB (<37 weeks' gestation) and SGA (<10th customised centile). Results After adjustment for socio-demographic and medical factors, financial strain was associated with a 45 % increase in PTB (OR 1.45: 95 % CI 1.06–1.98). Contrary to expectation, maternal distress in Pakistani women was negatively associated with SGA (OR 0.65: CI 0.48–0.88). Obesity in White British women was protective for PTB (OR 0.67: CI 0.45–0.98). Previously recognized risk factors, such as smoking in pregnancy and hypertension, were confirmed. Conclusions This study confirms known risk factors for PTB and SGA, along with a new variable of interest, financial strain. It also reveals a difference in the risk factors between ethnicities. In order to develop appropriate targeted preventative strategies to improve perinatal outcome in disadvantaged groups, a greater understanding of ethno-specific risk factors is required.

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Commentary on Obstetric Care in Rural Georgia

Abstract

This is an invited commentary on five articles on obstetric care in rural Georgia.

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Obstetric Provider Trainees in Georgia: Characteristics and Attitudes About Practice in Obstetric Provider Shortage Areas

Abstract

Objectives In Georgia, 52 % of the primary care service areas outside metropolitan Atlanta have a deficit of obstetric providers. This study was designed to identify factors associated with the likelihood of Georgia's obstetric trainees (obstetrics and gynecology (OB/GYN) residents and certified nurse midwifery (CNM) students) to practice in areas of Georgia that lack obstetric providers and services, i.e. rural Georgia. Methods Pilot-tested electronic and paper surveys were distributed to all of Georgia's OB/GYN residents (N = 95) and CNM students (N = 28). Mixed-methods survey questions assessed characteristics, attitudes, and incentives that might be associated with trainee desire to practice in areas of Georgia that lack obstetric providers and services. Surveys also gathered information about concerns that may prevent trainees from practicing in shortage areas. Univariate and bivariate analyses were performed, and qualitative themes were abstracted from open-ended questions. Results The survey response rate was 87.8 % (108/123). Overall, 24.4 % (19/78) of residents and 53.6 % (15/28) of CNM students expressed interest in practicing in rural Georgia, and both residents and CNM students were more likely to desire to practice in rural Georgia with the offer of any of six financial incentives (P < 0.001). Qualitative themes highlighted trainees' strong concerns about Georgia's political environment as it relates to reproductive healthcare. Conclusions Increasing state-level, rurally-focused financial incentive programs and emphasizing the role of CNMs may alleviate obstetric provider shortages in Georgia.

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Caffeine and Stress Promote a More Liberal Bias on Tasks Assessing Hallucination-Like Experiences and False Memory in a Nonclinical Sample

Journal of Caffeine Research , Vol. 0, No. 0.


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Grandmothers’ Beliefs and Practices in Infant Safe Sleep

Abstract

Background Sudden infant death syndrome (SIDS) and suffocation are leading causes of infant mortality. Supine sleep position and use of appropriate sleep surfaces reduce SIDS risk but are not universally practiced. Mothers' decisions about sleep position and environment may be influenced by guidance provided by infants' grandmothers and other caregivers. Methods A survey was conducted of a convenience sample of grandmothers aged 30–70 years who provide care at least weekly for an infant grandchild <6 months old. The survey was distributed through community partners of a university-based research team. Respondents received home safety items as compensation. Analyses focused on the relationship of grandmother demographic characteristics and beliefs on their reported practices related to infant sleep. Results Among the 239 grandmothers, 45 % reported placing infants to sleep supine on an appropriate sleep surface at the grandmother's house, while 58 % reported doing so when the infant was sleeping in the mother's house. After adjusting for other factors, respondents were less likely to adhere to recommended guidelines when they believed supine position increased choking risk (OR 0.34, 95 % CI 0.18–0.62) or believed infants are more comfortable or sleep longer when on their stomachs (OR 0.51, 95 % CI 0.28–0.93). Discussion Grandmothers do not universally observe evidence-based safe sleep practices, particularly if the infant is not sleeping in the home of the parent. Interventions for senior caregivers focused on perceived choking risk, infant comfort in the supine position, and other recent changes in recommended safety practices are warranted.

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Caffeine and Stress Promote a More Liberal Bias on Tasks Assessing Hallucination-Like Experiences and False Memory in a Nonclinical Sample

Journal of Caffeine Research , Vol. 0, No. 0.


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Are Parental Perceptions of Child Activity Levels and Overall Health More Important than Perceptions of Weight?

Abstract

Objectives To examine relationships between parental perceptions of child weight and overall health, reported lifestyle behaviors and measured body mass index (BMI). Methods Using community-partnered methods, we surveyed families residing in a two census tract area identified for targeted interventions to decrease diabetes related disparities. The survey included demographics, child dietary and physical activity behaviors, and parental perception of child's health and weight. We measured child BMI using a standardized protocol. Results We surveyed parents of 116 children with a mean age of 7 years (range 3–15) with 51 % boys, 74 % Hispanic, and 26 % Black. Over half of the children (55 %) were overweight or obese. Half (50 %) of the parents underestimated their children's weight. Reported daily hours of walking and/or running trended higher (3.6 vs. 2.6 h, p = 0.08) for children perceived to be of normal weight. Parents who correctly estimated their child's weight status reported more hours of daily walking/running than parents who underestimated child weight status, 4.5 versus 2.4 h, p = 0.0002. Parents of healthy weight children were more likely to report that children were in excellent or very good health compared to parents of overweight/obese children, 75 versus 56 % respectively (p = 0.04). We found significant racial/ethnic differences in reported diet and physical activity behaviors and perception of overall health. Conclusions for Practice Parental perceptions of child health and physical activity level may be related to perceptions of their child's weight status. Study findings informed community-based initiatives for reducing diabetes risk among children.

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The Effect of Local Smokefree Regulations on Birth Outcomes and Prenatal Smoking

Abstract

Objectives We assessed the impact of varying levels of smokefree regulations on birth outcomes and prenatal smoking. Methods We exploited variations in timing and regulation restrictiveness of West Virginia's county smokefree regulations to assess their impact on birthweight, gestational age, low birthweight, very low birthweight, preterm birth, and prenatal smoking. We conducted regression analysis using state Vital Statistics individual-level data for singletons born to West Virginia residents between 1995–2010 (N = 293,715). Results Only more comprehensive smokefree regulations were associated with statistically significant favorable effects on birth outcomes in the full sample: Comprehensive (workplace/restaurant/bar ban) demonstrated increased birthweight (29 grams, p < 0.05) and gestational age (1.64 days, p < 0.01), as well as reductions in very low birthweight (−0.4 %, p < 0.05) and preterm birth (−1.5 %, p < 0.01); Restrictive (workplace/restaurant ban) demonstrated a small decrease in very low birthweight (−0.2 %, p < 0.05). Among less restrictive regulations: Moderate (workplace ban) was associated with a 23 g (p < 0.01) decrease in birthweight; Limited (partial ban) had no effect. Comprehensive's improvements extended to most maternal groups, and were broadest among mothers 21+ years, non-smokers, and unmarried mothers. Prenatal smoking declined slightly (−1.7 %, p < 0.01) only among married women with Comprehensive. Conclusions Regulation restrictiveness is a determining factor in the impact of smokefree regulations on birth outcomes, with comprehensive smokefree regulations showing promise in improving birth outcomes. Favorable effects on birth outcomes appear to stem from reduced secondhand smoke exposure rather than reduced prenatal smoking prevalence. This study is limited by an inability to measure secondhand smoke exposure and the paucity of data on policy implementation and enforcement.

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Maternal Depression and Childhood Overweight in the CHAMACOS Study of Mexican-American Children

Abstract

Objective Although previous studies have examined the impact of maternal depression on child overweight and obesity, little is known about the relationship in Latino families, who suffer from high risks of depression and obesity. We prospectively investigated the association between depressive symptoms in women with young children and child overweight and obesity (overweight/obesity) at age 7 years among Latino families. Methods Participants included 332 singletons with anthropometric measures obtained at 7 years from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study, a birth cohort study. Maternal depression was assessed using the Center for Epidemiologic Studies-Depression (CES-D) scale when the children were 1, 3.5, and 7 years. Overweight and obesity was measured by body mass index (kg/m²) at age 7 years. Results 63 % of women had CES-D scores consistent with depression in at least one of the 3 given assessments. Compared to children whose mothers were never depressed, children whose mothers were depressed at all three assessments had 2.4 times the adjusted odds of overweight/obesity at age 7 years (95 % CI 1.1–5.6). However, a single positive maternal depression screen was not associated with child overweight/obesity and there was no difference in the odds of overweight/obesity by the age of the child when maternal depression occurred. Conclusion Chronic maternal depression during a child's early life was associated with child overweight/obesity at 7 years. Addressing maternal depression is a critical component of comprehensive obesity prevention and treatment strategies for Latino children.

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Prediction of development of hepatocellular carcinoma using a new scoring system involving virtual touch quantification in patients with chronic liver diseases

Abstract

Background

This study aimed to establish a new scoring system that combined several risk factors, including virtual touch quantification (VTQ) values and fasting plasma glucose (FPG) levels, for predicting the development of hepatocellular carcinoma (HCC) in patients with chronic liver disease.

Methods

A total of 1808 chronic liver disease patients who underwent VTQ measurement were analyzed. Risk factors for developing HCC were selected by multivariate Cox proportional hazards models.

Results

VTQ (>1.33 m/s), FPG (≥110 mg/dl), sex (male), age (≥55 years), and α-fetoprotein (AFP) level (≥5 ng/ml) were independently selected as risk factors for HCC development by multivariate analysis. Using these parameters, we established a new scoring system (0 to 5 points), based on VTQ, FPG, sex, age, and AFP level, named VFMAP. As compared with the low VFMAP score group (0 or 1 point), the hazard ratio for the incidence of HCC was 17.37 [95 % confidence interval (CI), 2.35–128.40] in the intermediate-score group (2 or 3 points) and 66.82 (95 % CI, 9.01–495.80) in the high-score group (4 or 5 points). The area under the receiver operating characteristic curve of the VFMAP score for predicting HCC development within 5 years was 0.82 (95 % CI, 0.76–0.87), indicating a moderate diagnostic value. A VFMAP cutoff value of 3 excluded HCC within 5 years with a high negative predictive value (98.2 %).

Conclusion

The VFMAP score accurately predicted HCC in patients with chronic liver disease.

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Ambulatory anesthesia for cosmetic surgery in Brazil.

Purpose of review: Outpatient plastic surgery is growing around the world. This industry faces unique challenges in terms of patient selection and standards of practice to ensure safety and cost-effectiveness. This review will highlight information about anesthesia practice for outpatient cosmetic surgery in Brazil, especially regarding regulation, legislation, and medical tourism. Recent findings: Medical tourism is growing worldwide, with a flow of patients traveling from developed to developing countries where procedures can be done at a fraction of the cost as in the patient's home country. Though generally well tolerated, there are concerns about incomplete data on outcomes of office-based surgeries and lack of safety standards. Summary: Brazil is one of the world's leaders in cosmetic surgery. Strong legislation governing outpatient facilities and continued development of accrediting standards for healthcare facilities are indications of a commitment to patient safety and high quality of care. Although the market for medical tourism in this country is high, there are still barriers to overcome before Brazil reaches its full potential in this industry. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Going the distance: Mapping mobility in the Kalahari Desert during the Middle Stone Age through multi-site geochemical provenancing of silcrete artefacts

Publication date: July 2016
Source:Journal of Human Evolution, Volume 96
Author(s): David J. Nash, Sheila Coulson, Sigrid Staurset, J. Stewart Ullyott, Mosarwa Babutsi, Martin P. Smith
This study utilises geochemical provenancing of silcrete raw materials, in combination with chaîne opératoire analyses, to explore lithic procurement and behavioural patterns in the northern Kalahari Desert during the Middle Stone Age (MSA). New data from the sites of Rhino Cave, Corner Cave, and ≠Gi in northwest Botswana, combined with earlier results from White Paintings Shelter, reveal that the long distance transport of silcrete for stone tool manufacture was a repeated and extensively used behaviour in this region. Silcrete was imported over distances of up to 295 km to all four sites, from locations along the Boteti River and around Lake Ngami. Significantly, closer known sources of silcrete of equivalent quality were largely bypassed. Silcrete artefacts were transported at various stages of production (as partially and fully prepared cores, blanks, and finished tools) and, with the exception of ≠Gi, in large volumes. The import occurred despite the abundance of locally available raw materials, which were also used to manufacture the same tool types. On the basis of regional palaeoenvironmental data, the timing of the majority of silcrete import from the Boteti River and Lake Ngami is constrained to regionally drier periods of the MSA. The results of our investigation challenge key assumptions underlying predictive models of human mobility that use distance–decay curves and drop-off rates. Middle Stone Age peoples in the Kalahari appear to have been more mobile than anticipated, and repeatedly made costly choices with regard to both raw material selection and items to be transported. We conclude that (i) base transport cost has been overemphasised as a restrictive factor in predictive models, and (ii) factors such as source availability and preference, raw material quality, and potential sociocultural influences significantly shaped prehistoric landscape use choices.



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A comparative study of treatment-emergent adverse events following use of common bowel preparations among a colonoscopy screening population: Results from a post-marketing observational study

Digestive Diseases and Sciences

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Liver stiffness measurement using acoustic radiation force impulse elastography in hepatitis C virus-infected patients with a sustained virological response

Alimentary Pharmacology and Therapeutics

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Outcomes of bridging versus mesh augmentation in laparoscopic repair of small and medium midline ventral hernias

Surgical Endoscopy

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Primary tumor site is a useful predictor of cetuximab efficacy in the third-line or salvage treatment of KRAS wild-type (exon 2 non-mutant) metastatic colorectal cancer: a nationwide cohort study

BMC Cancer

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Significant elevation of CEA levels in abdominal drains after colorectal surgery may indicate early anastomotic dehiscence

The American Journal of Surgery

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Safety and effectiveness of response-guided therapy using pegylated interferon and ribavirin for chronic hepatitis C virus infection in patients on maintenance dialysis

Nephrology

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Computed tomography evaluation of esophagogastric necrosis after caustic ingestion

Annals of Surgery

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Effects of age, sex, body weight, and quantity of alcohol consumption on occurrence and severity of alcoholic hepatitis

Clinical Gastroenterology and Hepatology

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A novel prediction model of prognosis after gastrectomy for gastric carcinoma: Development and validation using Asian databases

Annals of Surgery

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National practice patterns of antireflux medication for chronic rhinosinusitis

JAMA Otolaryngology—Head & Neck Surgery

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Liver disease in patients undergoing head and neck surgery: Incidence and risk for postoperative complications

The Laryngoscope

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Increased small intestinal permeability and its RNA expression profiles of mucosa from terminal ileum in patients with diarrhoea-predominant irritable bowel syndrome

Digestive and Liver Diseases

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The real-world effectiveness and safety of vedolizumab for moderate–severe Crohn’s disease: Results from the US VICTORY consortium

The American Journal of Gastroenterology

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A Synthesis of Hepatitis C prevalence estimates in Sub-Saharan Africa: 2000-2013

BMC Infectious Diseases

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A prospective, multicenter, observational study on quality of life after laparoscopic inguinal hernia repair with ProGrip laparoscopic, self-fixating mesh according to the European Registry for Abdominal Wall Hernias Quality of Life Instrument

Surgery

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The internalization of Helicobacter pylori plays a role in the failure of H. pylori eradication

Helicobacter

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A prospective analysis of GERD after POEM on anterior myotomy

Surgical Endoscopy

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Comparative effectiveness and cost-effectiveness of a multi-target stool DNA test to screen for colorectal neoplasia

Gastroenterology

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Reducing colorectal surgical site infections: A novel, resident-driven, quality initiative

The American Journal of Surgery

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Maximum levels of hepatitis C virus lipoviral particles are associated with early and persistent infection

Liver International

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Effectiveness of a WellnessProgram for Individuals with Spina Bifida and Spinal Cord Injuries within an Integrated Delivery System

Publication date: Available online 14 June 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Brad E. Dicianno, John Lovelace, Pamela Peele, Christopher Fassinger, Patricia Houck, Alexandra Bursic, Michael L. Boninger
ObjectiveTo determine whether an evidence-based wellness program for individuals with spina bifida (SB) and spinal cord injury (SCI) would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability.Design: non-randomized, non-controlled cohort study; two years of enrollmentSettingAcademic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated healthcare delivery and financing systemParticipantsSixty nine individuals with SB and SCI were consented, 4 were excluded, and the remaining 65 participated in the intervention.Interventionevidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives.Main Outcome Measure(s)validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; utilization and cost.Resultsimprovements in all main outcome measures were seen after two years of enrollment. Although cost in year 1 of enrollment increased due to hospitalizations, and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment.Conclusionsparticipation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.



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The Spectrum of Hair Dye Poisoning in India and the Significance of Early Gastric Lavage; A Cross Sectional Study.

2016-06-15T01-48-25Z
Source: European Journal of Forensic Sciences
Ankita Kakkar, Alok Kumar, Sushil Kumar, Archana Verma.
Worldwide, suicide is a major public health problem, especially in developing countries, including India. This study was undertaken to ascertain the magnitude and clinical presentations in cases of hair dye poisoning. We reviewed 94 cases of acute hair dye poisoning, during a span of one year. Special attention was given to the effect of the Gastric Lavage on the outcome. We found that young females were most commonly affected (63.8%). In most patients, significant improvement was seen where gastric lavage was performed within 2 to 3 hours. Total mortality was 12.8%, which was principally due to acute renal failure and asphyxia due to laryngeal oedema. 95.7% cases were suicidal and 4.2% cases were of accidental poisoning. No case of homicidal intent was recorded. We conclude that Hair dye poisoning is a major cause of suicidal death among young Indian population with a significant female preponderance. Early institution of gastric lavage plays and important role in saving precious lives.


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Interpreting short and medium exposure etched-track radon measurements to determine whether an action level could be exceeded

Publication date: October 2016
Source:Journal of Environmental Radioactivity, Volumes 162–163
Author(s): A.R. Denman, R.G.M. Crockett, C.J. Groves-Kirkby, P.S. Phillips
Radon gas is naturally occurring, and can concentrate in the built environment. It is radioactive and high concentration levels within buildings, including homes, have been shown to increase the risk of lung cancer in the occupants. As a result, several methods have been developed to measure radon. The long-term average radon level determines the risk to occupants, but there is always pressure to complete measurements more quickly, particularly when buying and selling the home. For many years, the three-month exposure using etched-track detectors has been the de facto standard, but a decade ago, Phillips et al. (2003), in a DEFRA funded project, evaluated the use of 1-week and 1-month measurements. They found that the measurement methods were accurate, but the challenge lay in the wide variation in radon levels - with diurnal, seasonal, and other patterns due to climatic factors and room use. In the report on this work, and in subsequent papers, the group proposed methodologies for 1-week, 1-month and 3-month measurements and their interpretation. Other work, however, has suggested that 2-week exposures were preferable to 1-week ones. In practice, the radon remediation industry uses a range of exposure times, and further guidance is required to help interpret these results. This paper reviews the data from this study and a subsequent 4-year study of 4 houses, re-analysing the results and extending them to other exposures, particularly for 2-week and 2-month exposures, and provides comprehensive guidance for the use of etched-track detectors, the value and use of Seasonal Correction Factors (SCFs), the uncertainties in short and medium term exposures and the interpretation of results.



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Utility of Routine Colonic Biopsies in Pediatric Colonoscopic Polypectomy for Benign Juvenile Hamartomatous Polyps.

Introduction: Benign juvenile hamartomatous polyps are common in pediatric gastrointestinal practice. We hypothesize that in the absence of gross mucosal abnormalities, the likelihood of histologic abnormalities from routine random colonic biopsies is low. Methods: We performed a retrospective chart review identifying patients aged 1 to 18 years who underwent complete colonoscopy and polypectomy for suspected colorectal polyps from January 1, 2004 to July 1, 2014. Indication, age, number of polyps, gross and histologic findings, and any management changes resulting from endoscopy were recorded. Exclusion criteria included history of polyposis syndrome, more than 5 polyps on colonoscopy, inflammatory bowel disease, and incomplete documentation. Practice patterns were assessed by online survey distributed via Pediatric Gastroenterology listserv. Results: 141 patients underwent colonoscopy with anticipated polypectomy. 72 (63% male) were included. Mean age was 6.5 years. Indication was hematochezia in 71. Findings other than polyps were found in 7 (10%). Juvenile hamartomatous polyps were documented by histologic examination in 68 patients (94%). Routine colonic biopsies were performed in 55 patients (76%). In 8 (15%), histologic abnormalities were seen that did not result in management changes. 73 providers responded to the online survey; 56% reported not taking ileo-colonic biopsies in the absence of other mucosal abnormalities; 45% routinely biopsied from the terminal ileum and/or colon. None would biopsy the terminal ileum only. Conclusion: In children with benign juvenile hamartomatous polyps, routine colonic biopsies are not required in the absence of mucosal abnormalities. Overuse of pathology services, increased procedural time, risk, and cost can be avoided. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Percutaneous Transhepatic Cholangioplasty to Treat Multiple Intrahepatic Biliary Strictures After Hepatoportoenterostomy.

In children with biliary atresia (BA), hepatoportoenterostomy (HP) is recommended to improve bile flow. Biliary strictures are known potential complications following HP which can again impair bile flow often leading to biliary cirrhosis and liver transplantation. In patients who are status post HP and have biliary strictures, non-surgical therapeutic options such as endoscopic dilation can pose technical difficulties due to altered anatomy. Percutaneous transhepatic cholangiography with cholangioplasty (PTC-C) is a valuable tool for obstructive cholangiopathies, but to our knowledge this has not been previously demonstrated to be successful in patients with multiple intrahepatic biliary strictures status post HP. Herein, we present three patients status post HP who presented with multiple intrahepatic biliary strictures and underwent successful PTC-C. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Self-referential processing in adolescents: Stability of behavioral and ERP markers

Abstract

The self-referential encoding task (SRET)—an implicit measure of self-schema—has been used widely to probe cognitive biases associated with depression, including among adolescents. However, research testing the stability of behavioral and electrocortical effects is sparse. Therefore, the current study sought to evaluate the stability of behavioral markers and ERPs elicited from the SRET over time in healthy, female adolescents (n = 31). At baseline, participants were administered a diagnostic interview and a self-report measure of depression severity. In addition, they completed the SRET while 128-channel ERP data were recorded to examine early (P1) and late (late positive potential [LPP]) ERPs. Three months later, participants were readministered the depression self-report measure and the SRET in conjunction with ERPs. Results revealed that healthy adolescents endorsed, recalled, and recognized more positive and fewer negative words at each assessment, and these effects were stable over time (rs = .44–.83). Similarly, they reported a faster reaction time when endorsing self-relevant positive words, as opposed to negative words, at both the initial and follow-up assessment (r = .82). Second, ERP responses, specifically potentiated P1 and late LPP positivity to positive versus negative words, were consistent over time (rs = .56–.83), and the internal reliability of ERPs were robust at each time point (rs = .52–.80). As a whole, these medium-to-large effects suggest that the SRET is a reliable behavioral and neural probe of self-referential processing.

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Association of adenovirus type 2 with encephalitis: A new case report from Kerala, India.

2016-06-14T23-56-57Z
Source: The Southeast Asian Journal of Case Report and Review
Thounaojam Asia Devi, Balakrishnan Anukumar, Mun Amol Baburao.
Adenovirus is a common respiratory pathogen in children that sometime produces encephalitis symptoms in affected children. Very few reports are available on association of adenovirus type 2 with encephalitis cases. However, none of the cases have been reported from India. We have detected and characterized the adenovirus from the clinical specimens collected from a six year old boy who had the symptoms of encephalitis. The adenovirus was isolated from all the three specimens; CSF, serum and throat swab in HEK-293 cells. The presence of adenovirus was confirmed by PCR. Sequencing and BLAST search analysis confirmed that the isolated adenovirus belonged to adenovirus type 2. As per our knowledge this is the first report of adenovirus type 2 associated with encephalitis case from India.


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Remission in Pediatric Inflammatory Bowel Disease Correlates with Prescription Refill Adherence Rates.

Objectives: To utilize pharmacy benefit management (PBM) prescription claims data to assess refill adherence in pediatric inflammatory bowel disease (IBD) and correlate adherence with clinical outcomes in pediatric IBD. Methods: We identified 362 pediatric IBD patients seen at Washington University from 9/1/2012 to 8/31/2013 and matched them within Express Scripts' member eligibility files for clients allowing use of prescription drug data for research purposes. Maintenance IBD medication possession ratios (MPR) were determined through PBM prescription claims data and chart review. Demographic and prospectively captured physician global assessments (PGA) were retrospectively extracted from the medical record. MPR was analyzed as continuous data and also dichotomized as greater or less than 80%. Results: Among our 362 patients, we matched 228 (63%) within Express Scripts' eligibility data files. Of those, 78 patients were continuously eligible for benefits and had at least one outpatient prescription IBD medication. Their mean MPR was 0.63 +/- 0.31 (SD) and 40% had an MPR >= 80%. Patients in clinical remission had a higher mean MPR than those with an active PGA (0.72 +/- 0.28 vs. 0.51 +/- 0.32, P = 0.002) and patients whose MPR were >= 80% were more likely to have a PGA of remission than those with whose MPR were

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Symptoms and Mucosal Changes Stable During Rapid Increase of Pediatric Celiac Disease in Norway.

Objectives: We aimed to study whether the incidence of pediatric celiac disease (CD) in South-Eastern Norway changed from 2000-2010. We also examined if there was a change in symptoms and histopathological morphology in the duodenal biopsies during the same period. Methods: In three hospitals in South-Eastern Norway, records from pediatric patients (0-14.9 years) diagnosed with CD during two three-year periods (2000-2002 and 2008-2010) were reviewed. Only cases with a duodenal biopsy diagnosis of CD classified, as Marsh grade 2 and 3a-c were included. Frequencies of symptoms, anthropometric data and laboratory results were compared, in addition to re-examinations of histological sections from one of the hospitals. Results: A total number of 400 cases were diagnosed with a female:male ratio of 1.5:1. The incidence rate for 2000-2002 was 15.9 cases per 100 000 person-years (95% CI 12.8-19.4), compared to 45.5 cases per 100 000 person-years during 2008-2010 (95% CI 40.5-50.9), p

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