Παρασκευή, 15 Ιουλίου 2016

Rare sacral lytic lesions presenting as Low back ache – A report of three cases

Source: Case Study and Case Report
shyamasunder bhat N, vishnu senthil.
We report three cases of sacral tuberculosis, Intra-osseous sacral schwannoma and Aneurysmal bone cyst presenting as refractory low back pain with non-specific clinical features delaying in diagnosis of these rare tumors. All three tumours presented to us as intervertebral disc prolapse and upon failure of conservative treatment led to further detailed radiological evaluation. Awareness of these rare tumours as differential diagnosis and along with other common benign and malignant tumours of the sacral region helps in pre-operative planning regarding surgical approach and clearance. Intra-operative good clearance and biopsy is mandatory for accurate management and to prevent recurrence.

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Taste coding of complex naturalistic taste stimuli and traditional taste stimuli in the parabrachial pons of the awake, freely licking rat

Several studies have shown that taste-responsive cells in the brainstem taste nuclei of rodents respond to sensory qualities other than gustation. Such data suggest that cells in the classical gustatory brainstem may be better tuned to respond to stimuli that engage multiple sensory modalities than to stimuli that are purely gustatory. Here, we test this idea by recording the electrophysiological responses to complex, naturalistic stimuli in single neurons in the parabrachial pons (PbN, the second neural relay in the central gustatory pathway) in awake, freely licking rats. Following electrode implantation and recovery, we presented both prototypical and naturalistic taste stimuli and recorded the responses in the PbN. Prototypical taste stimuli (NaCl, sucrose, citric acid, and caffeine) and naturalistic stimuli (clam juice, grape juice, lemon juice, and coffee) were matched for taste quality and intensity (concentration). Umami (monosodium glutamate + inosine monophosphate) and fat (diluted heavy cream) were also tested. PbN neurons responded to naturalistic stimuli as much or more than to prototypical taste stimuli. Furthermore, they convey more information about naturalistic stimuli than about prototypical ones. Moreover, multidimensional scaling analyses showed that across unit responses to naturalistic stimuli were more widely separated than responses to prototypical taste stimuli. Interestingly, cream evoked a robust and widespread response in PbN cells. Collectively, these data suggest that natural foods are more potent stimulators of PbN cells than purely gustatory stimuli. Probing PbN cells with pure taste stimuli may underestimate the response repertoire of these cells.

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Neuronal hyperexcitability in the ventral posterior thalamus of neuropathic rats: modality selective effects of pregabalin

Neuropathic pain represents a substantial clinical challenge; understanding the underlying neural mechanisms and back-translation of therapeutics could aid targeting of treatments more effectively. The ventral posterior thalamus (VP) is the major termination site for the spinothalamic tract and relays nociceptive activity to the somatosensory cortex; however, under neuropathic conditions, it is unclear how hyperexcitability of spinal neurons converges onto thalamic relays. This study aimed to identify neural substrates of hypersensitivity and the influence of pregabalin on central processing. In vivo electrophysiology was performed to record from VP wide dynamic range (WDR) and nociceptive-specific (NS) neurons in anesthetized spinal nerve-ligated (SNL), sham-operated, and naive rats. In neuropathic rats, WDR neurons had elevated evoked responses to low- and high-intensity punctate mechanical stimuli, dynamic brushing, and innocuous and noxious cooling, but less so to heat stimulation, of the receptive field. NS neurons in SNL rats also displayed increased responses to noxious punctate mechanical stimulation, dynamic brushing, noxious cooling, and noxious heat. Additionally, WDR, but not NS, neurons in SNL rats exhibited substantially higher rates of spontaneous firing, which may correlate with ongoing pain. The ratio of WDR-to-NS neurons was comparable between SNL and naive/sham groups, suggesting relatively few NS neurons gain sensitivity to low-intensity stimuli leading to a "WDR phenotype." After neuropathy was induced, the proportion of cold-sensitive WDR and NS neurons increased, supporting the suggestion that changes in frequency-dependent firing and population coding underlie cold hypersensitivity. In SNL rats, pregabalin inhibited mechanical and heat responses but not cold-evoked or elevated spontaneous activity.

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Prospective study on clinical and epidemiological profiles of severe malaria at tertiary care hospital

Source: Journal of Clinical & Experimental Research
Dinesh A. Chavda, Satish D. Suthar, Nil H. Desai, Jayesh D. Balat, Bharti L. Desai.
Background and Objectives: There are limited published data on the clinical and epidemiological profiles of severe malaria from urban and rural centres in Gujarat. Malaria is one of the major public health problems and around 1.5 million laboratories confirmed cases are reported annually by the National Vector Borne Disease Control Programme (NVBDCP). Out of the total malaria cases, around 50% cases are due to Plasmodium falciparum. Among the rest of the cases, major cases are due to Plasmodium vivax followed by Plasmodium ovale. Methods: To assess the clinical and epidemiological profiles of severe malaria, Prospective, single centre study was carried out for 1 year and 6 months duration in 64 patients in the Medicine department of Guru Gobind Singh Hospital, Jamnagar, a tertiary care teaching hospital. Analyzed data included demographic, clinical and laboratory parameters. Results: Out of 64 patients, majority patients were in the age group of 12-30 years (59.68%), males (68.75%) as compared to females (31.25%), rural (60.93%) as compared to Urban (39.06%) and Labourer (29.68%) as compared to Farmer (18.75%). In our study at the time of presentation most common, symptom was fever with chills and rigors (100%), sign was tachycardia (31.25%) and complication was hepatopathy (40.62%). In this study there were patients infected by P. falciparum 43.75%, P. vivax 39.06% and both species 17.19%. Conclusion: In present study large numbers of patients were 21-30 years and rural labourer males with P. falciparum species. In present study most common symptom, signs and complication were fever with chills and rigors, tachycardia and hepatopathy respectively.

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Intensity-dependent EMG response for the biceps brachii during sustained maximal and submaximal isometric contractions



There have been recent attempts to characterize the mechanisms associated with fatigue-induced task failure. We compared the time to failure and the corresponding changes in the surface electromyogram (EMG) during sustained maximal and submaximal isometric force tasks.


EMG activity was measured from the biceps brachii of 18 male participants as they sustained either a maximal or submaximal (60 % MVC) isometric contraction of the dominant elbow flexors until force could not be maintained above 55 % MVC.


Intensity-dependent patterns of change were observed for EMG amplitude and mean power frequency (MNF) between the two force tasks. Interestingly, the only significant predictor of failure time was the rate of change in EMG MNF during the submaximal task (r 2 = 0.304). In addition, EMG amplitude at submaximal failure was significantly lower (p < 0.05) than the values obtained during MVC.


The patterns of EMG response emphasize the basis of neuromuscular fatigue and task dependency. Additionally, our data suggest that the EMG MNF should be used when monitoring the progression of local muscle fatigue.

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Remodeling of cortical activity for motor control following upper limb loss

Reorganization of neural networks has been evaluated in various clinical populations; however, less is known about neuroplasticity in upper extremity amputees. Upper extremity amputees have shown sensory reorganization (Cohen et al., 1991; Borsook et al., 1998; Chen et al., 1998), which tends to relate strongly to phantom sensations (Karl et al., 2001). While it is commonly thought that motor representations of the missing hand are occupied by the residual limb and lateral motor homunculus (Pascual-Leone et al., 1996), recent evidence suggests that the lateral shift may not always occur (Gagne et al., 2011).

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Characteristics and Mechanism of Perverted Head-Shaking Nystagmus in Central Lesions: Video-Oculography Analysis

Perverted head-shaking nystagmus (HSN) refers to the nystagmus that is evoked in the plane other than that being stimulated during head shaking (cross-coupled response) (Leigh and Zee 2006). It is mostly downbeat after horizontal head shaking either in the presence or absence of horizontal nystagmus (Leigh and Zee 2006). This cross-coupled HSN has been considered a sign indicating a central pathology that includes strokes (Choi et al. 2015; Huh and Kim 2011), demyelinating disorders (Minagar et al.

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Visual Cortex Hyperexcitability Contributes to The Pathophysiology of the Photoparoxysmal Response

Over recent years, a number of authors have increasingly explored the possible physiological basis of the photoparoxysmal response (PPR) in humans. A PPR consists of a specific electroencephalographic (EEG) signature, such as spikes, spike-waves and intermittent slow waves recorded from occipito-frontal regions in response to intermittent photic stimulation (IPS) (Fisher et al., 2005). Although PPR may be present in asymptomatic healthy subjects as an isolated EEG response, more commonly the PPR elicits focal or generalized myoclonus leading to isolated or recurrent seizures in specific epileptic syndromes (Rubboli et al., 1999; Koepp et al., 2016).

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A Review on Phyto-Pharmacological Potentials of Juniperus recurva

Source: Journal of Experimental and Integrative Medicine
Abila Rashid, Raja Amir Hassan Kuchay.
Juniperus recurva is a small tree or spreading shrub distributed from Afghanistan eastward through the Himalayas to southwest China. It is predominant in woodlands of the wetter areas of Himalayas (altitude of 1800 m to 3900 m), with moist and well-drained soils. It holds great potential as a medicinal plant. It has been traditionally used as anti-rheumatic, antiseptic, antispasmodic, antitoxic, aphrodisiac, astringent, carminative, rubificant and stomachic. However, very few authentic pharmacological studies on medicinal benefits of this plant have been conducted thus far. In a first of its kind, we review this plant for its chemical constituents, pharmacological activity and medicinal benefits. Keeping in view its success record as a traditional medicine to cure different ailments, it would be of interest to look for various bioactive natural products that might have therapeutic potential.

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Membrane Lipid Peroxidation and Redox Status in Erythrocytes of Sickle Cell Anaemia Patients Incubated in Leaf Extract of Gongronema latifolium

Source: Journal of Experimental and Integrative Medicine
Paul Chidoka Chikezie.
Aim/Background: The present study sought to ascertain the capacity of ethanolic leaf extract of Gongronema latifolium to deter membrane lipid peroxidation and exert appropriate redox status in sickle erythrocytes using in vitro models. Methods: Erythrocyte malondialdehyde (MDA) concentration, membrane thiobarbituric acid reactive substances (TBARS) concentration, ratio of reduced glutathione (GSH) to oxidized glutathione (GSSG) (GSH/GSSG ratio), methaemoglobin (MetHb) concentration and NADH-methaemoglobin reductase (NADH-MR) activity were monitored in the presence of ethanolic leaf extract of G. latifolium for 15 h using spectrophotometric methods. Results: Erythrocyte MDA concentration of the control sample incubated for 15 h was within the range of 2.43 ± 0.19 3.54 ± 0.31 mmol/mL representing 45.67% increase in MDA concentration. The capacity of the extract to lower erythrocyte MDA concentration was in a concentration dependent manner. Erythrocytes incubated for 5 h in 100 mg/dL extract caused 8.59% reduction in erythrocyte membrane TBARS, whereas erythrocytes incubated for 5 h in 400 mg/dL extract gave 22.44%; p 0.05. Conclusion: The present study showed that ethanolic leaf extract of G. latifolium deterred lipid peroxidation but did not completely obliterate the propensity of the sickle erythrocytes to undergo oxidative deterioration in vitro.

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The Road To Rio: Medical and Scientific Perspectives on the 2016 Paralympic Games

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Interaction between magnesium sulfate and neuromuscular blockers during the perioperative period. A systematic review and meta-analysis

Magnesium sulfate is used as an anesthetic adjuvant during general anesthesia. This drug interacts with neuromuscular blocking agents, but results from existing clinical trials that assessed this interaction are contradictory.

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Impact of time interval between remifentanil and propofol on propofol injection pain

To determine the most effective time interval between remifentanil and propofol (TimeRP) for the prevention of propofol injection pain in association with remifentanil dosage.

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Sevoflurane-induced arrhythmia in healthy adult

Inhalatory anesthetic agents are frequently used for anesthesia maintenance. Sevoflurane is considered one of the safest regarding its cardiac effects.We report a case of a cardiac arrhythmia induced by sevoflurane in an otherwise healthy adult and discuss sevoflurane's cardiac effects.

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“Are We hurting ourselves?” What is the prevalence of back pain in anesthesia providers?

Back injuries are a highly reported category of occupational injury in the health care setting. The daily clinical activities of an anesthesia provider, including lifting, pushing stretchers, transferring patients, and bending for procedures, are risk factors for developing low back pain. The purpose of this study is to investigate the prevalence of work related low back pain in anesthesia providers.

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A survey of patients' understanding and expectations of persistent postsurgical pain in a preoperative testing center

Acute postoperative pain may transition to persistent/chronic pain in up to 50% or more of patients after certain surgeries. Despite this concern, it is unclear that patients' preprocedure understanding and expectations are aligned with these potential outcomes. This study was designed to evaluate the extent of this alignment and the potential impact on the quality of risk/benefit discussions before procedures.

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Acute exacerbation of idiopathic pulmonary fibrosis after total hip replacement

An acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is routinely defined as a sudden acceleration of or an acute injury superimposed on IPE, and is characterized by an acute worsening of dyspnea and lung function [1]. AE-IPF is ascribed to the more frequent cause of death in patients with IPF with an annual incidence up to 20% and a short-term mortality around 50% [2]. Because Non-pulmonary surgery can trigger AE-IPF [3], it is crucial for perioperative practitioners to enhance the vigilance of this disease.

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Study citation irrespective of retraction status

Helmy et al [1] recently reported on a study that was designed to evaluate the therapeutic equivalence of balanced 6% hydroxyethyl starch (HES) 130/0.4 (Tetraspan) vs saline-based 6% HES 130/0.4 (Voluven) regarding the volume effect and the effect on acid-base status and renal functions in patients undergoing major urologic procedures. In the Introduction section of the article, reference was made to a study of Boldt et al [2] that needed to be retracted because of unethical publishing [3]. I propose that this error be corrected.

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Active perioperative patient warming using a self-warming blanket (BARRIER EasyWarm) is superior to passive thermal insulation: a multinational, multicenter, randomized trial

Incidence of inadvertent perioperative hypothermia is still high; therefore, present guidelines advocate "prewarming" for its prevention. Prewarming means preoperative patient skin warming, which minimizes redistribution hypothermia caused by induction of anesthesia. In this study, we compared the new self-warming BARRIER EasyWarm blanket with passive thermal insulation regarding mean perioperative patient core body temperature.

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Connecting occupational safety awareness, legislation, implementation and enforcement within the Ghanaian industrial economy

Source: Journal of Environmental and Occupational Science
Samson Obed Appiah.
Aim: The high incidence of workplace injuries and fatalities in Ghana raises concerns about potential disconnection between occupational safety legislations and their efficient enforcement within the Ghanaian industrial economy. This paper therefore sought to examine the extent to which legitimate occupational legislations are implemented and enforced and monitored in Ghanaian Industrial economy. Materials and Method: The study respondents were 70 comprising 50 workers (10 from each of the five departments in Pioneer Food Cannery), 3 Top management members, 5 Departmental heads, 5 Supervisors from the Safety department, 5 members of the Plant Safety Team and 2 officials from the Department of Factories Inspectorate in the Tema Industrial Area selected by simple random and purposive sampling methods. In-depth Interviews, key informant interviews and direct field observations were used to collect primary data in 2014/2015 and thematically analysed n 2015. Results: Though management had put in place some policies, mechanisms and regulations including the provision of personal protective equipment, the institution of safety committees, the supervision and enforcement of the mechanisms and policies in place was ineffective and inefficient as the safety department had only five supervisors.. Also the Department of Factories Inspectorate is woefully resourced in terms of personnel and logistics leading to poor inspection and enforcement of safety regulations. Conclusions: The paper posits that, there is a disconnection between occupational health and safety laws and their enforcement at the industrial level and calls for proper resourcing of the agencies responsible with enforcement.

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Vastus medialis H-reflex excitability is associated with pain level, self-reported function and chronicity in women with patellofemoral pain

Publication date: Available online 13 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Danilo de Oliveira Silva, Fernando Henrique Magalhães, Nathálie Clara Faria, Deisi Ferrari, Marcella Ferraz Pazzinatto, Evangelos Pappas, Fábio Mícolis de Azevedo
Objective(s): To determine the association between the amplitude of vastus medialis (VM) Hoffmann reflex (H-reflex) and pain level, self-reported physical function and chronicity of pain in women with patellofemoral pain (PFP).DesignCross-sectional study.SettingLaboratory of biomechanics and motor control.ParticipantsWomen diagnosed with PFP (N = 15) aged 18 to 35 years were recruited.Main Outcome Measure(s)Worst pain level during the previous month, self-reported physical function and symptom duration (chronicity) were collected from the participants. Maximum evoked responses were obtained by electrical stimulation applied to the femoral nerve and peak-to-peak amplitudes of normalized maximal H-reflexes (Hmax/Mmax ratios) of the VM were calculated. A Pearson product–moment correlation matrix (r) was used to explore the relationships among VM H-reflex and the worst pain during the previous month, self-reported function and chronicity of pain.ResultsStrong negative correlations were found among VM H-reflex and worst pain in the previous month (r = -0.71; p = 0.003) and chronicity (r = -0.74; p = 0.001). A strong positive correlation was found between VM H-reflex and self-reported physical function (r = 0.62; p = 0.012).Conclusion(s): The strong and significant relationships reported in this study suggest that women with PFP showing larger VM H-reflex excitability tend to have lower pain, better physical function and more recent symptoms. Therefore, rehabilitation strategies designed to increase the excitability of the monosynaptic stretch reflex should be considered in the treatment of women with PFP if their effectiveness is demonstrated in future studies.

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Association between MoCA scores and measures of functional mobility in lower extremity amputees after inpatient rehabilitation

Publication date: Available online 13 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Courtney Frengopoulos, Joshua Burley, Ricardo Viana, Michael WC. Payne, Susan W. Hunter
ObjectiveTo determine if scores on a cognitive measure are associated with walking endurance and functional mobility of individuals with transfemoral or transtibial amputations at discharge from inpatient prosthetic rehabilitation.DesignRetrospective cohort study.SettingRehabilitation hospital.ParticipantsConsecutive admissions (n=176, age 64.27 ± 13.23 years) with transfemoral or transtibial amputation that had data at admission and discharge from inpatient prosthetic rehabilitation program.InterventionsNot applicable.Main outcome measuresCognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The L Test and the 2 Minute Walk Test (2MWT) were used to estimate functional mobility and walking endurance.ResultsMean MoCA score was 24.05 (±4.09), range 6 to 30 and 56.3% of patients had scores < 26. MoCA scores had a small positive correlation with the 2MWT, r=0.29, p<0.01, and a small negative correlation to the L test, r=-0.24, p<0.01. In multivariable linear regression, compared to people with the highest MoCA score quartile, there was no difference on the 2MWT but people in the lowest two quartiles took longer to complete the L Test.ConclusionsCognitive impairment was very prevalent. The association between MoCA and functional mobility was statistically significant. These results highlight the potential for differences on complex motor tasks for individuals with cognitive impairment but does not indicate a need to exclude them from rehabilitation on the basis of cognitive impairment alone.

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Re-examining the validity and dimensionality of the Moorong Self-Efficacy Scale: improving its clinical utility

Publication date: Available online 13 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): James W. Middleton, Yvonne Tran, Charles Lo, Ashley Craig
ObjectiveTo improve the clinical utility of the Moorong Self-Efficacy Scale (MSES), by re-examining its factor structure and comparing its performance against a measure of general self-efficacy in persons with spinal cord injury (SCI).DesignCross-sectional survey designSettingParticipants living in the community with SCI were recruited through advertisements placed in SCI consumer magazines/newsletters and/or via websites, and by word of mouth, with completion via the internet and postal mail.ParticipantsOne hundred and sixty-one adults with SCI (118 males; 43 females) recruited from Australia (n=82) and United States of America (n=79); 86 having paraplegia and 75 with tetraplegia.InterventionsNone.Main Outcome MeasuresConfirmatory factor analysis deriving fit indices on reported 1, 2 and 3-factor structures for the Moorong Self-Efficacy Scale (MSES). Exploratory factor analysis of MSES using Principal Components Analysis (PCA) with promax oblique rotation and structure validation, with correlations and multiple regression using cross-sectional data from the Sherer General Self-Efficacy Scale (SGSES) and Medical Outcomes Survey Short Form-36 (SF-36).ResultsThe MSES was confirmed to have a three-factor structure, explaining 61% of variance. Two of the factors, labeled Social Function Self-Efficacy and Personal Function Self-Efficacy were SCI condition-specific, whereas the other factor (accounting for 9.7% of variance) represented General Self-Efficacy, correlating most strongly with the SGSES. Correlations and multiple regression analyses between MSES factors, SGSES total score, SF-36 Physical and Mental Component scores, and SF-36 domain scores support validity of this MSES factor structure. No significant cross-cultural differences existed between Australia and United States in total MSES or factor scores.ConclusionThe findings support a three-factor structure encompassing general as well as SCI domain-specific self-efficacy beliefs and better positions the MSES to assist SCI rehabilitation assessment, planning and research.

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Model Programs to Address Obesity and Cardiometabolic Disease: Interventions for Suboptimal Nutrition and Sedentary Lifestyles

Publication date: Available online 13 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mark S. Nash, Jochen Kressler
Problems posed by obesity-related endocrine diseases embody a national health crisis. Caloric excess and sedentary lifestyle from which they develop also pose significant challenges for rehabilitation providers. Almost 2/3 Americans are currently overweight or obese, a number that has increased by more than 10% within the past decade and is expected to grow. An overweight body habitus is strongly associated with clinical hazards including cardiometabolic syndrome, diabetes hypertension, and coronary artery disease. The component health risks of the cardiometabolic syndrome include coalescing of risk factors that predict a health calamity unless effective interventions can be developed and widely adopted. Obesity by itself is now considered an ADA-qualified disability, but is also disturbingly prevalent in other physical disability groupings of adults and children.This monograph describes successes of the Diabetes Prevention Program (DPP), an NIH multi-site randomized clinical trial that reported significant weight reduction and a 58% decreased incidence of type-2 diabetes accompanying one year of structured lifestyle intervention (LI). This treatment benefit: i) exceeded that of Metformin pharmacotherapy, ii) was so powerful that the trial was closed before reaching endpoints, and iii) was judged cost-effective for the patient and society. The DPP roadmap incorporating physical activity, diet, and behavioral approaches has been widely adapted to specific community, faith, racial, ethnic, school, and national populations with excellent outcomes success. The lockstep physical activity approach, activity prescription, and long-term success of the program are described and compared with other approaches programs to illustrate effective countermeasures for the pandemics of obesity and obesity-related cardioendocrine disease. We will illustrate adaptation of the DPP for a cohort of persons with disability from spinal cord injuries, and the benefits observed.

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An Item Bank to Measure Systems, Services, and Policies: Environmental Factors Affecting People with Disabilities

Publication date: Available online 14 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Jin-Shei Lai, Joy Hammel, Sara Jerousek, Arielle Goldsmith, Ana Miskovic, Carolyn Baum, Alex W.K. Wong, Jessica Dashner, Allen W. Heinemann
ObjectivesTo develop a measure of perceived Systems, Services, and Policies facilitators (Chapter 5 of the International Classification of Functioning, Disability, and Health) for people with neurological disabilities and evaluate the influence of perceived SSP facilitators on health-related quality of life.DesignA mixed-methods approach was used to develop items, refine them through cognitive interviews, and evaluate their psychometric properties. Confirmatory Factor Analysis (CFA) including one-factor CFA and bi-factor analysis were used to evaluate unidimensionality of items. Rasch analysis was used to identify misfitting items. Correlational and analysis of variance methods were used to evaluate construct validity.SettingCommunity-dwelling individuals participated in telephone interviews or traveled to the academic medical centers where this research took place.ParticipantsParticipants had a diagnosis of spinal cord injury, stroke or traumatic brain injury. They were age 18 or older and English speaking.InterventionNot applicableMain Outcome MeasureAn Item Bank to Evaluate Environmental Access and Support Levels of Services, Systems, and Policies for People with DisabilitiesResultsWe identified a general factor defined as "access and support levels of the Services, Systems and Policies at the level of community living" (abbreviation, SSP) and three local factors defined as "Health Services," "Community Living," and "Community Resources." The SSP measure correlated moderately with Participation measures: CPI – Involvement, CPI-Control over Participation, NeuroQOL - Ability to Participate, NeuroQOL – Satisfaction with Role Participation, PROMIS Ability to Participate, PROMIS Satisfaction with Role Participation, and PROMIS –Isolation.ConclusionsThe measure of Systems, Services and Policy facilitators contains items pertaining to health services, community living, and community resources. Investigators and clinicians can measure perceptions of SSP resources reliably with the items described here. Moderate relationships between SSP facilitators and PROMIS and CPI variables provide support for the measurement and theory of environmental influences on social functioning related to participation.

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Association between problematic internet use, socio-demographic variables and obesity among European adolescents

Background: Overweight of children and adolescents continues to be an important and alarming global public health problem. As the adolescent's time spent online has increased, problematic internet use (PIU) potentially leads to negative health consequences. This study aimed to examine the relation between PIU and overweight/obesity among adolescents in seven European countries and assess the effect of demographic and lifestyle factors recorded in the European Network for Adolescent Addictive Behaviour (EU NET ADB) survey (www.eunetadb.eu). Methods: A cross-sectional school-based survey of 14- to 17-year-old adolescents was conducted in seven European countries: Germany, Greece, Iceland, the Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included sociodemographic data, internet usage characteristics, school achievement, parental control and the Internet Addiction Test. Associations between overweight/obesity and potential risk factors were investigated by logistic regression analysis, allowing for the complex sample design. Results: The study sample consisted of 10 287 adolescents aged 14–17 years. 12.4% were overweight/obese, and 14.1% presented with dysfunctional internet behavior. Greece had the highest percentage of overweight/obese adolescents (19.8%) and the Netherlands the lowest (6.8%). Male sex [odds ratio (OR) = 2.89, 95%CI: 2.46–3.38], heavier use of social networking sites (OR = 1.26, 95%CI: 1.09–1.46) and residence in Greece (OR = 2.32, 95%CI: 1.79–2.99) or Germany (OR = 1.48, 95%CI: 1.12–1.96) were independently associated with higher risk of overweight/obesity. A greater number of siblings (OR = 0.79, 95%CI: 0.64–0.97), higher school grades (OR = 0.74, 95%CI: 0.63–0.88), higher parental education (OR = 0.89, 95%CI: 0.82–0.97) and residence in the Netherlands (OR = 0.49, 95%CI: 0.31–0.77) independently predicted lower risk of overweight/obesity. Conclusions: The results indicate an association of overweight/obesity with PIU and suggest the importance of formulating preventive public health policies that target physical health, education and sedentary online lifestyle early in adolescence with special attention to boys.

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Obesity continues to increase in the majority of the population in mid-Sweden--a 12-year follow-up

Background: The aim was to investigate trends in the prevalence of obesity by age and level of education in the general population in mid-Sweden from year 2000 to 2012. Methods: A postal questionnaire was sent to a random population sample aged 25–74 years in years 2000, 2004, 2008 and 2012. The overall response rates were 67%, 65%, 60% and 53%, respectively, and the study included 29 017, 27 385, 25 910 and 24 152 respondents, respectively. Obesity (BMI ≥ 30 kg/m2) was based on self-reported weight and height. Results: The age-standardized prevalence of obesity increased from 13% to 17% in women and from 12% to 17% in men between 2000 and 2012. Obesity increased in all age groups from 2000 to 2008 and continued to increase among the middle aged (45–64 years) between 2008 and 2012. The socioeconomic gradient in obesity changed during the study period since the absolute increase in obesity was steepest at the middle educational level. In 2012, the prevalence of obesity was almost twice as high at both middle and low educational levels compared with high educational level. The 'true' prevalence of adult obesity, corrected for self-reported weight and height, was around 20% in 2012 for both men and women. Conclusion: In the majority, among the middle-aged and those with secondary education, the prevalence of obesity continued to increase even between 2008 and 2012.

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Are migration patterns and mortality related among European regions?

Geographical inequalities in mortality across Europe may be influenced by migration between regions. The relationship between age- and sex-standardised death rates, 2008–2010, and population change resulting from migration 2000-2010, was analysed in 250 'Nomenclature of Statistical Territorial Units' (NUTS) level 2 regions in 26 European countries. Across Europe death rates were significantly higher in regions experiencing population loss. This association continued after adjustment for 2005 household income among all regions and Western regions but not among Eastern areas. This analysis suggests migration could contribute to Europe's persistent inequalities in mortality, and highlights the problems of Eastern regions with the highest death rates, lowest incomes and declining populations.

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Private and public modes of bicycle commuting: a perspective on attitude and perception

Background: Public bicycle-sharing initiatives can act as health enhancement strategies among urban populations. The aim of the study was to determine which attitudes and perceptions of behavioural control toward cycling and a bicycle-sharing system distinguish commuters with a different adherence to bicycle commuting. Methods: The recruitment process was conducted in 40 random points in Barcelona from 2011 to 2012. Subjects completed a telephone-based questionnaire including 27 attitude and perception statements. Based on their most common one-way commute trip and willingness to commute by bicycle, subjects were classified into Private Bicycle (PB), public bicycle or Bicing Bicycle (BB), Willing Non-bicycle (WN) and Non-willing Non-bicycle (NN) commuters. After reducing the survey statements through principal component analysis, a multinomial logistic regression model was obtained to evaluate associations between attitudinal and commuter sub-groups. Results: We included 814 adults in the analysis [51.6% female, mean (SD): age 36.6 (10.3) years]. BB commuters were 2.0 times [95% confidence interval (CI) = 1.1–3.7] less likely to perceive bicycle as a quick, flexible and enjoyable mode compared to PB. BB, WN and NN were 2.5 (95% CI = 1.46–4.24), 2.6 (95% CI = 1.53–4.41) and 2.3 times (95% CI = 1.30–4.10) more likely to perceive benefits of using public bicycles (bicycle maintenance and parking avoidance, low cost and no worries about theft and vandalism) than did PB. Conclusion: Willing non-bicycle and public-bicycle commuters had more favourable perception toward public-shared bicycles compared to private cyclists. Hence, public bicycles may be the impetus for those willing to start bicycle commuting, thereby increasing physical activity levels.

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European Public Health News * EUPHA Presidents Column * EUPHA Office Column * Message from the WHO Regional Director for Europe * Message from the EU Commissioner for Health and Food Safety * 9th European Public Health Conference--'All for Health--Health for All

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The German Energiewende--a matter for health?

Background: Germany's enormous transformation away from nuclear energy and fossil fuels towards a renewable and energy efficient system—called the Energiewende—is playing an essential role in Germany's economy and policymaking. This article summarises the current knowledge on possible health impacts of the Energiewende and describes the need and opportunities to incorporate health into energy-related policy. Methods: A structural model helped to narrow down specific topics and to conceptualise links between the Energiewende, the environment and health. A comprehensive literature search was conducted within policy documents and scientific databases with English and German language selections. Results: Of 7800 publications first identified only 46 explicitly related energy measures to health, of which 40 were grey literature. Notably, only 12% published by health authorities all others were issued by environmental, energy or consumer protection agencies, ministries or institutions. Conclusion: Our study shows that health impacts of the German Energiewende are rarely explicitly addressed. An integration of a health perspective into energy-related policy is needed including the involvement of public health authorities. A health impact assessment can be a suitable tool to support and evaluate Energiewende-related developments from a health perspective.

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Prevalence of impaired glucose regulation in Europe: a meta-analysis

Background: Impaired glucose regulation represents an opportunity to prevent Type 2 diabetes mellitus. It is important to have a clear understanding of the prevalence of this condition in order to be able to plan interventions and health care provision. This paper presents a meta-analysis of literature assessing the prevalence of impaired glucose regulation in the general population of developed countries in Europe. Methods: Five electronic databases were systematically searched in March 2014 to identify English language articles with general population samples aged 18 and over from developed countries in Europe. Values for the measures of interest were combined using a random effects model and analysis of the effects of moderator variables was carried out. Results: A total of 5594 abstracts were screened, with 46 studies included in the review. Overall prevalence of impaired glucose regulation was 22.3%. Mean prevalence of impaired glucose tolerance was 11.4% (10.1–12.8) and did not differ by gender. Sample age, diagnostic criteria and country were found to have a significant univariate effect on prevalence of impaired glucose tolerance but only diagnostic criteria remained significant in multivariate analysis. Mean prevalence of impaired fasting glucose was significantly higher in men at 10.1% (7.9–12.7) compared with 5.9% in women (4–8.7). The only moderator variable with a significant effect on impaired fasting glucose prevalence was country. Conclusions: This meta-analysis shows a moderate prevalence of impaired glucose regulation in developed Europe with over one in five people meeting the criteria for either impaired glucose tolerance, impaired fasting glucose or both.

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Mortality in Italian veterans deployed in Bosnia-Herzegovina and Kosovo

Background and Aims: The possible increase of cancer risk in military personnel deployed in Balkans during and after the 1992–1999 wars, mainly related to the depleted uranium, was addressed by several studies on European veterans of those war theatres. This article reports on the results of the mortality study on the Italian cohort of Bosnia and Kosovo veterans (Balkan cohort). Methods: Mortality rates for the Balkan cohort (71 144 persons) were compared with those of the Italian general population as well as to those of a comparable and unselected control cohort of not deployed military personnel (114 269 persons). Ascertainment of vital status during the period 1995–2008 of all the persons in the two cohorts has been carried out through deterministic record linkage with the national death records database, from information provided by the respective Armed Force General Staff, and through the civil registry offices of the veterans' residence or birth municipalities. Results: The Balkan cohort experienced a mortality rates lower than both the general population (SMR = 0.56; 95% CI 0.51–0.62) and the control group (SMR = 0.88; 95% CI 0.79–0.97). Cancer mortality in the deployed cohort group was half of that from the general population mortality rates (SMR = 0.50; 95% CI 0.40–0.62) and slightly lower if compared with the control group cancer mortality rates (SMR = 0.95; 95% CI 0.77–1.18). Conclusion: Balkan veteran cohort did not show any increase in general mortality or in cancer mortality.

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Self-perceived health in older Europeans: Does the choice of survey matter?

Background: Cross-national comparisons of health in European countries provide crucial information to monitor health and disease within and between countries and to inform policy and research priorities. However, variations in estimates might occur when information from cross-national European surveys with different characteristics are used. We compared the prevalence of very good or good self-perceived health across 10 European countries according to three European surveys and investigated which survey characteristics contributed to differences in prevalence estimates. Methods: We used aggregate data from 2004 to 2005 of respondents aged 55–64 years from the European Union Statistics on Income and Living Conditions (EU-SILC), the Survey of Health, Ageing and Retirement in Europe (SHARE) and the European Social Survey (ESS). Across the surveys, self-perceived health was assessed by the same question with response options ranging from very good to very bad. Results: Despite a good correlation between the surveys (intraclass correlation coefficient: 0.77), significant differences were found in prevalence estimates of very good or good self-perceived health. The survey response, sample size and survey mode contributed statistically significantly to the differences between the surveys. Multilevel linear regression analyses, adjusted for survey characteristics, showed a higher prevalence for SHARE (+6.96, 95% CIs: 3.14 to 10.8) and a lower prevalence (–3.12; 95% CIs: –7.11 to 0.86) for ESS, with EU-SILC as the reference survey. Conclusion: Three important health surveys in Europe showed substantial differences for presence of very good or good self-perceived health. These differences limit the usefulness for direct comparisons across studies in health policies for Europe.

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Establishing and sustaining health observatories serving urbanized populations around the world: scoping study and survey

Background: The 'health observatory' model has successfully proliferated across several world regions, this study being conducted to define the geographical and physical bases and main functions of health observatories serving largely urbanized populations and the support needed for set-up and sustainability. Methods: A scoping study of literature and observatory websites was undertaken to identify health observatories, main functions, year established and publications, followed by a self-completion survey to further investigate these characteristics, define the help observatories would have liked at set-up and later on, and how such help might effectively be accessed. Results: Of 69 health observatories contacted, 27 (39%) mainly established since 2000 completed the survey. Most responding observatories had a sub-national/regional or sub-regional/local geographical base and no one type of physical or organizational base predominated. Nearly all observatories undertook preparation of population-based health reports and intelligence, data analysis and interpretation services, and a primary commitment to working with local/regional partners to support evidence-based decision-making. Most prioritized help with deciding and defining the scope of the observatory, estimating the core resources required for establishing/developing it, addressing sustainability issues, identifying knowledge, skills and skill-mix required to undertake the health intelligence/analytic functions, accessing data/IT expertise and developing training and capacity-building programmes. The preferred means of accessing this support was a virtual network(s) of experts on particular topics to support mutual learning and toolboxes developed for specific observatory functions. Conclusions: Although the health observatory as an organizational model is maturing, the learning derived from sharing structured guidance and support is regarded as invaluable.

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Attrition analysed in five waves of a longitudinal yearly survey of smokers: findings from the ITC Netherlands survey

Background: Attrition bias can affect the external validity of findings. This article analyses attrition bias and assesses the effectiveness of replenishment samples on demographic and smoking-related characteristics for the International Tobacco Control Netherlands Survey, a longitudinal survey among smokers. Methods: Attrition analyses were conducted for the first five survey waves (2008–12). We assessed, including and excluding replenishment samples, whether the demographic composition of the samples changed between the first and fifth waves. Replenishment samples were tailored to ensure the sample remained representative of the smoking population. We also constructed a multivariable survival model of attrition that included all five waves with replenishment samples. Results: Of the original 1820 respondents recruited in 2008, 46% participated again in 2012. Demographic differences between waves due to attrition were generally small and replenishment samples tended to minimize them further. The multivariable survival analysis revealed that only two of the 10 variables analysed were significant predictors of attrition: a weak effect for gender (men dropped out more often) and weak to moderate effects for age (respondents aged 15–24 years dropped out more than aged 25–39 years, who dropped out more than those aged 40+ years). Conclusions: Weak to moderate attrition effects were found for men and younger age groups. This information could be used to minimize respondent attrition. Our findings suggest that sampling weights and tailored replenishment samples can effectively compensate for attrition effects. This is already being done for the International Tobacco Control Netherlands Survey, including the categories that significantly predicted attrition in this study.

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Cardiovascular risk factors among Russian, Somali and Kurdish migrants in comparison with the general Finnish population

Background: There is limited information on cardiovascular risk among migrants. We compared cardiovascular risk factors among three major migrant groups in Finland with the general population. Methods: Cross-sectional data from 30- to 64-year-old health examination participants (n = 921) of the Migrant Health and Wellbeing Study (2010–12) were used. Data for comparison with the general Finnish population were obtained from the Health 2011 Study (n = 892). Results: Russian men had a similar risk profile to that of the reference group. Kurdish men had lower prevalence of hypertension [prevalence ratio (PR) 0.55, 95% confidence interval (CI) 0.39–0.79] but higher prevalence of dyslipidaemia (PR: 1.12, 95% CI: 1.02–1.24) and hyperglycaemia (PR: 2.61, 95% CI: 1.88–3.64) compared with the reference group. Somali men had lower prevalence of smoking (PR: 0.18, 95% CI: 0.08–0.44), hypertension (PR: 0.55, 95% CI: 0.32–0.97)) and obesity (PR: 0.35, 95% CI: 0.17–0.71) but higher prevalence of hyperglycaemia (PR: 2.59, 95% CI: 1.73–3.86) compared with the reference group. Similar patterns were observed for women, except for higher prevalence of hyperglycaemia among Russian women (PR: 1.95, 95% CI: 1.26–3.01) and obesity among Kurdish and Somali women (PR: 1.41, 95% CI: 1.15–1.72 and PR: 1.68, 95% CI: 1.40–2.03, respectively) compared with the reference group. All migrant women had significantly lower prevalence of smoking than the reference group. Conclusions: There were significant variations in cardiovascular risk profiles of Kurdish and Somali migrants compared with the general population. Differences in cardiovascular risk factors by migrant group need to be taken into account in planning and implementing health promotion strategies.

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The rate of country-level improvements of the infant mortality rate is mainly determined by previous history

Background: Studies of country-level determinants of health have produced conflicting results even when the analyses have been restricted to high-income counties. Yet, most of these studies have not taken historical, country-specific developments into account. Thus, it is appropriate to separate the influence of current exposures from historical aspects. Methods: Determinants of the infant mortality rate (IMR) were studied in 28 OECD countries over the period 1990–2012. Twelve determinants were selected. They refer to the level of general resources, resources that specifically address child health and characteristics that affect knowledge dissemination, including level of trust, and a health related behaviour: the rate of female smoking. Results: Bivariate analyses with the IMR in year 2000 as outcome and the 12 determinants produced six statistically significant models. In multivariate analyses, the rate of decrease in the IMR was investigated as outcome and a history variable (IMR in 1990) was included in the models. The history variable alone explained 95% of the variation. None of the multivariate models, with the 12 determinants included, explained significantly more variation. Conclusion: Taking into account the historical development of the IMR will critically affect correlations between country-level determinants and the IMR.

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Promotion of safety culture in Italian schools: effectiveness of interventions on student injuries

Background: Numerous safety promotion interventions in schools exist but these are rarely subject to impact evaluation. Few available studies are focused on intermediate outcomes. Our objective is to evaluate the impact of prevention interventions on school injuries in a number of schools in Italy. Methods: A pre–post-study with a control group was used. One hundred and three intervention units were selected; control units were selected randomly from those which did not implement safety projects. The general objective was to promote a safety culture by increasing expertise and knowledge, and by enabling the adoption of appropriate behavior. All projects combined various elements: training and educational, information and communication, as well as organizational. The projects evaluated in this article were specifically aimed at safety in indoor premises; they were implemented in 2009–10. Injury rates standardized by gender were calculated for 5 school years (from 2007/2008 to 2011/2012) stratified by type of school and place of occurrence. To assess the effectiveness the difference-in-differences method was used. Results: Overall, 207 012 student-years and 2918 school injuries were considered. In all types of schools, the injury rates in indoor areas show a decreasing trend in the intervention units and an increasing trend in the control units. In high schools, there were no changes in the trend of injuries occurring in the gym and/or related to sports activities. Conclusions: The results suggest a positive short-term effect of the programs on injuries occurring in indoor premises. The quasi-experimental design has never been previously used to evaluate the effectiveness of a prevention program in schools.

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Barriers and facilitators to the nationwide dissemination of the Dutch school-based obesity prevention programme DOiT

Background: This article describes the barriers and facilitating factors to the adoption, implementation and continuation of the Dutch Obesity Intervention in Teenagers (DOiT) programme in the Netherlands. Methods: We evaluated the adoption, implementation and continuation of the programme at 20 voluntary prevocational schools, which adopted the programme. Interviews were conducted with DOiT coordinators and/or teachers (n = 44) at the end of the first and second school year of the 2-year implementation period. Interviews were recorded and transcribed verbatim. Data were coded by two researchers independently. Identified barriers and facilitating factors were categorized into four groups: (i) organizational factors, (ii) individual factors, (iii) characteristics of the programme and (iv) characteristics of the implementation strategy. Results: Teachers and DOiT coordinators identified various implementation barriers (e.g. lack of planning, other urgent unforeseen priorities, no plan to cope with teacher turnover and high teacher workload) as well as facilitating factors (e.g. involvement of DOiT coordinator and support from the DOiT office, sufficient communication and collaboration between teachers, strong teacher motivation and flexibility of the programme). Conclusion: Overall, DOiT implementers were satisfied with the compatibility, layout, content and potential for tailoring the programme. Barriers for successful implementation were mainly at the school and teacher level. Findings of this study can be used for further improvement of the DOiT programme and for the development and improvement of other health promotion programmes in the school setting.

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Child welfare clients have higher risks for teenage childbirths: which are the major confounders?

Background: Aiming to support effective social intervention strategies targeting high-risk groups for teenage motherhood, this study examined to what extent the elevated crude risks of teenage childbirth among child welfare groups were attributable to the uneven distribution of adverse individual and family background factors. Methods: Comprehensive longitudinal register data for more than 700 000 Swedish females born 1973–1989 (including around 29 000 child welfare clients) were analysed by means of binary logistic regression. The Karlson/Holm/Breen-method was used to decompose each confounding factor's relative contribution to the difference between crude and adjusted odds ratios (ORs). Results: Elevated crude risks for teenage childbirth are to a large extent attributable to selection on observables. Girls' school failure was the most potent confounder, accounting for 28–35% of the difference between crude and adjusted ORs. Conclusion: As in majority populations, girls' school failure was a strong risk factor for teenage childbirth among former child welfare children. At least among pre-adolescents, promoting school performance among children in the child welfare system seems to be a viable intervention path.

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Mobile and Web 2.0 interventions for weight management: an overview of review evidence and its methodological quality

Background: The use of Internet and related technologies for promoting weight management (WM), physical activity (PA), or dietary-related behaviours has been examined in many articles and systematic reviews. This overview aims to summarize and assess the quality of the review evidence specifically focusing on mobile and Web 2.0 technologies, which are the most utilized, currently available technologies. Methods: Following a registered protocol (CRD42014010323), we searched 16 databases for articles published in English until 31 December 2014 discussing the use of either mobile or Web 2.0 technologies to promote WM or related behaviors, i.e. diet and physical activity (PA). Two reviewers independently selected reviews and assessed their methodological quality using the AMSTAR checklist. Citation matrices were used to determine the overlap among reviews. Results: Forty-four eligible reviews were identified, 39 of which evaluated the effects of interventions using mobile or Web 2.0 technologies. Methodological quality was generally low with only 7 reviews (16%) meeting the highest standards. Suggestive evidence exists for positive effects of mobile technologies on weight-related outcomes and, to a lesser extent, PA. Evidence is inconclusive regarding Web 2.0 technologies. Conclusions: Reviews on mobile and Web 2.0 interventions for WM and related behaviors suggest that these technologies can, under certain circumstances, be effective, but conclusions are limited by poor review quality based on a heterogeneous evidence base.

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Immigrant disadvantage or the healthy immigrant effect? Evidence about low birth weight differences in the Czech Republic

Background: Most of the research about immigrants' birth outcomes comes from countries with high numbers of immigrants. This article provides evidence from the Czech Republic, a country with a short immigration history and a small immigrant population. Two hypotheses are tested: the immigrant disadvantage hypothesis and the healthy immigrant hypothesis. Methods: Live singleton births in 2013–14 from the national birth register are analysed. The odds of low birth weight (LBW) among the native population and five immigrant groups are compared using logistic regression. Control variables include maternal age, parity, education and marital status, paternal immigrant status, age and education. Results: All immigrant groups, except for Slovaks, showed smaller odds of LBW than native mothers. Adjusted odds ratios for non-Slovak immigrants range between 0.52 and 0.65. Furthermore, maternal immigrant status interacts with education. There is a wide educational gradient in LBW among Czech and Slovak mothers with low education representing a large disadvantage. Such pattern is not present among other ethnic groups. This makes the outcomes of Czech and Slovak mothers less favourable. Native mothers and immigrants with higher level of education show more similar outcomes. Paternal immigrant status does not have a net effect on LBW when maternal ethnicity is taken into account. Conclusions: Results provide evidence for the healthy immigrant effect. The favourable outcomes of non-Slovak immigrants seem to result from a combination of two factors, health selection of immigrants and relatively high prevalence of LBW in the native population caused by adverse outcomes of mothers with low education.

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Comparison of food and nutrient intakes between cohorts of the HAPIEE and Whitehall II studies

Background: Differences in dietary habits have been suggested as an important reason for the large health gap between Eastern and Western European populations. Few studies have compared individual-level nutritional data directly between the two regions. This study addresses this hypothesis by comparing food, drink and nutrient intakes in four large population samples. Methods: Czech, Polish and Russian participants of the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study, and British participants in the Whitehall II study, altogether 29 972 individuals aged 45–73 years, were surveyed in 2002–2005. Dietary data were collected by customised food frequency questionnaires. Reported food, drink and nutrient intake data were harmonised and compared between cohorts using multivariable adjusted quantile regression models. Results: Median fruit and vegetable intakes were lower in the pooled Eastern European sample, but not in all country cohorts, compared with British subjects. Median daily consumption of fruits were 275, 213, 130 and 256 g in the Czech, Polish, Russian and Whitehall II cohort, respectively. The respective median daily intakes of vegetables were 185, 197, 292 and 246 g. Median intakes of animal fat foods and saturated fat, total fat and cholesterol nutrients were significantly higher in the Czech, Polish and Russian cohorts compared with the British; for example, median daily intakes of saturated fatty acids were 31.3, 32.5, 29.2 and 25.4 g, respectively. Conclusion: Our findings suggest that there are important differences in dietary habits between and within Eastern and Western European populations which may have contributed to the health gap between the two regions.

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Economic Evaluations of Public Health Surveillance Systems: a Systematic Review

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Evaluation of antibacterial activity of Asparagus racemosus in urinary tract infection

Source: National Journal of Physiology, Pharmacy and Pharmacology
Jinish Jose, Denny Devassykutty.
Background: Asparagus racemosus (Shatavari) is widely used in Kerala, for the treatment of urinary tract infection (UTI) both by the rural folks and by traditional doctors without any scientific evidence. In this context, we decided to evaluate the antibacterial property of A. racemosus against common organisms causing UTI. Aims and Objective: To evaluate and compare the antibacterial activity of alcoholic extracts A. racemosus against common organisms causing UTIs against a standard drug. Materials and Methods: Fresh roots of A. racemosus were obtained from an organic farm and shade dried, and the ethanolic extract was obtained. The antibacterial activity of three different concentrations 100, 200, and 300 μg was studied using disc diffusion method. The standard drug used for comparison is ciprofloxacin 30 μg. Disc diffusion method was used. Quantitative variables will be expressed in mean standard deviation and their confidence interval. The significance of the difference between groups will be tested using ANOVA, and P

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A cross-sectional study to assess the awareness of the presence of trans-fat in packaged food items and their harmful effects in a metropolitan city of central India

Source: International Journal of Medical Science and Public Health
Ruchita Banseria, Sunil Gothwal, Sanjay Dixit, Satish Saroshe.
Background: Trans-fat has been shown to be consistently associated, in an intake-dependent way, with risk of coronary heart disease, which is the main contributor to the global burden of disease. Objectives: To assess the level of awareness about trans-fat in packaged foods among college students and to increase their awareness about trans-fats and their health hazards and to encourage students to go through the nutritional profiles of packaged food before consuming it. Material and Methods: An educational intervention cross-sectional study was conducted upon 100 students aged 1822 years randomly selected from two colleges of Indore city. Qualitative interviews were taken from those who gave informed consent. Pre- and post-interventional questionnaire containing questions related to awareness, knowledge, and practices regarding trans-fat was used as study tool. Educational intervention was done by using pamphlets and lectures with audio visual aids. All statistical analyses were conducted in SPSS (version 20). Statistical differences were examined using a Mc-Nemar test for dichotomous data and Wilcoxon sign rank test was used for non-parametric data; p-value

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Knowledge regarding pain management among nursing students of Swatantra Senani Uttamraoji Patil Nursing College, Aurangabad, Maharashtra, India

Source: International Journal of Medical Science and Public Health
Rohini S Kulkarni, Purushottam A Giri, Pankaj R Gangwal.
Background: Pain is a universal experience. It has well established that many people will suffer from pain at the end of life, and untreated pain contributes to reduction in the quality of life. Nurses play a crucial role in pain management; student nurses are the face of future nursing and must be highly knowledgeable to ensure their practices in the assessment and management of pain. Objectives: To assess the knowledge regarding pain management among nursing students of Swatantra Senani Uttamraoji Patil Nursing College, Aurangabad, Maharashtra. Material and Methods: A cross-sectional study was carried out from January to April 2016 among 85 nursing students of Swatantra Senani Uttamraoji Patil Nursing College, Aurangabad, Maharashtra, while their clinical posting period at Noor Hospital of Indian Institute of Medical Science & Research Medical College, Badnapur, Jalna, Maharashtra. A pre-designed questionnaire which assessed knowledge regarding pain management was the tool of data collection. Results were analyzed in the form of frequency, percentage, and mean whenever appropriate. Results: Out of 85 respondents, majority 40 (47.05%) were in the age group of 20 years, 58 (68.24%) were females, 75 (88.24%) were unmarried, 40 (47.05%) were in second year, and 72 (84.70%) were from rural area. Majority of them (61.18%) had average knowledge and only 17.65% had good knowledge regarding pain management. There was significant association between demographic variables like age (p = 0.0204), education (p = 0.0173), and marital status (p = 0.0432) with knowledge scores. Conclusion: The level of knowledge regarding pain management among nursing students was average. Considering the important role of nursing in pain management, there is need of close clinical supervision, additional training, and allotment of more hours to pain management unit in nursing curriculum.

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A prospective randomized double blind study to compare dexmedetomidine and midazolam in ear nose and throat surgery for monitored anesthesia care

Source: International Journal of Research in Medical Sciences
Manmath A. Delmade, Devangi A. Parikh.
Background: Analgesia and sedation are usually required for the comfort of the patient during ear, nose and throat surgery done under local anesthesia as a part of monitored anesthesia care (MAC). In this study, patients satisfaction scores and effectiveness of sedation and analgesia with dexmedetomidine were compared with midazolam. Methods: Thirty patients received intravenous dexmedetomidine 1µg/kg bolus for 10 minutes followed by continuous infusion at 0.5 µg/kg/hr (group D). Thirty patients received intravenous midazolam 40 µg/kg bolus for 10 minutes followed by infusion at 50 µg/kg/hr (group M). Intravenous fentanyl (2ug/kg) was administered in both the groups. Vital parameters such as heart rate, mean blood pressure (MBP), respiratory rate (RR), SpO2, ramsay sedation score (RSS) and visual analog scale (VAS) was observed and recorded throughout the operation and then three times in the recovery room i.e. at arrival 30 and 60 min. After achieving RSS = 3, local infiltration at surgical site was given. Results: The drop in HR and MBP from pre-operative value was observed at various intervals during the surgery and also in the recovery in both the groups but it was significant in group D (P

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A prospective, comparative, observational study of quality of spinal anaesthesia with 0.5% and 0.75% plain isobaric ropivacaine in lower abdomen and lower limb surgeries

Source: International Journal of Research in Medical Sciences
Hema B. Gupta, Sumit N. Amilkanthwar.
Background: Spinal anaesthesia or subarachnoid block remains one of the basic techniques in the arsenal of modern anaesthesiology. Aim of the study was to evaluate and compare quality of spinal anaesthesia with isobaric 0.5% and 0.75% intrathecal ropivacaine in patients undergoing lower abdominal and lower limb surgeries. Methods: 100 patients between 18 and 60 years, of either gender belonging to ASA class I or II, posted for elective lower abdominal and lower limb surgeries, planned under spinal anaesthesia using ropivacaine. Patients were grouped as group A: 3 ml (15 mg) of 0.5% plain ropivacaine and Group B: 3ml (22.5mg) of 0.75% plain ropivacaine. Parameters observed were onset and duration of sensory and motor block, maximum sensory level achieved degree of motor blockade, two segment regression, and haemodynamic changes. Results: No significant differences were noted in Mean time for onset and time to achieve maximum level of sensory and motor blockade in both groups. Maximal dermatomal level was T10 in group A and T8 in group B which was statistically significant. Also, 96% patients had grade III motor blockade in group B as compared to 80% in group A which was statistically significant. Significant differences were noted in Time for two segment regression (92.56±11.846 minutes in group A and 137.3±13.06 min in group B), the duration of sensory blockade (184.5±18.385 min in group A and 238.8±19.260 min in group B) and duration of motor blockade (120.3±15.59 min in group A and 178.8±16.053 min in group B). Conclusions: Intrathecal isobaric ropivacaine 0.5% and 0.75% are safe and effective with minimal intraoperative and postoperative side effects. Recommended for short duration orthopaedic and lower abdominal surgeries where prolonged motor blockade is undesirable.

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