Virulence and Antibiotic Resistance of Enterococci Isolated from Healthy Breastfed Infants

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


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A Long-Term Study of the Diversity of OXA-48-Like Carbapenemase-Producing Bacterial Strains in Infected Patients and Carriers

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


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Epidemiological Trends Observed from Molecular Characterization of Methicillin-Resistant Staphylococcus aureus Isolates from Blood Cultures at a Japanese University Hospital, 2012–2015

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


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Effectiveness of a Double-Carbapenem Regimen in a KPC-Producing Klebsiella pneumoniae Infection in an Immunocompromised Patient

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


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A simplified clinical prediction rule for prognosticating independent walking after spinal cord injury: a prospective study from a Canadian multicenter spinal cord injury registry

Context: Traumatic spinal cord injury (SCI) is a debilitating condition with limited treatment options for neurological or functional recovery. The ability to predict the prognosis of walking post-injury with emerging prediction models could aid in rehabilitation strategies and reintegration into the community.

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Incidence of and Risk Factors for Pancreatic Cancer in Chronic Pancreatitis: A Cohort of 1,656 Patients

Risk of pancreatic cancer may increase in chronic pancreatitis patients.

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What is the Happiest Country on Earth -- And Why?

We have advanced a little bit, on the "Happines Scale" Since this video was made, unlike some.ExEMTNor :-)

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What is the Happiest Country on Earth -- And Why?

We have advanced a little bit, on the "Happines Scale" Since this video was made, unlike some.ExEMTNor :-)

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What is the Happiest Country on Earth -- And Why?

We have advanced a little bit, on the "Happines Scale" Since this video was made, unlike some.ExEMTNor :-)

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Two Types of Etiological Mutation in the Limb-Specific Enhancer of Shh

An enhancer named MFCS1 regulates Sonic hedgehog (Shh) expression in the posterior mesenchyme of limb buds. Several mutations in MFCS1 induce ectopic Shh expression in the anterior limb bud, and these result in preaxial polydactyly (PPD). However, the molecular basis of ectopic Shh expression remains elusive, although some mutations are known to disrupt the negative regulation of Shh expression in the anterior limb bud. Here, we analyzed the molecular mechanism of ectopic Shh expression in PPD including in a mouse mutation—hemimelic extra toes (Hx)—and in other MFCS1 mutations in different species. First, we generated transgenic mouse lines with a LacZ reporter cassette flanked with tandem repeats of 40 bp MFCS1 fragments harboring a mutation. The transgenic mouse line with the Hx-type fragment showed reporter expression exclusively in the anterior, but not in the posterior margins of limb buds. In contrast, no specific LacZ expression was observed in lines carrying the MFCS1 fragment with other mutations. Yeast one-hybrid assays revealed that the msh-like homeodomain protein, MSX1, bound specifically to the Hx sequence of MFCS1. Thus, PPD caused by mutations in MFCS1 has two major types of molecular etiology: loss of a cis motif for negative regulation of Shh, and acquisition of a new cis motif binding to a preexisting transcription factor, as represented by the Hx mutation.

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3'-terminated Overhangs Regulate DNA Double-Strand Break Processing in Escherichia coli

Double-strand breaks (DSBs) are lethal DNA lesions, which are repaired by homologous recombination in Escherichia coli. To study DSB processing in vivo, we induced DSBs into the E. coli chromosome by gamma irradiation and measured chromosomal degradation. We show that the DNA degradation is regulated by RecA protein concentration and its rate of association with ssDNA. RecA decreased DNA degradation in wild-type, recB and recD strains, indicating that it is a general phenomenon in E. coli. On the other hand, DNA degradation was greatly reduced and unaffected by RecA in the recB1080 mutant (which produces long overhangs) and in a strain devoid of four exonucleases that degrade a 3' tail (ssExos). 3'-5' ssExos deficiency is epistatic to RecA deficiency concerning DNA degradation, suggesting that bound RecA is shielding 3' tail from degradation by 3'-5' ssExos. Since 3'-tail preservation is common to all these situations, we infer that RecA polymerization constitutes a subset of mechanisms for preserving the integrity of 3' tails emanating from DSBs, along with 3' tail's massive length, or prevention of their degradation by inactivation of 3'-5' ssExos. Thus, we conclude that 3' overhangs are crucial in controlling the extent of DSB processing in E. coli. This study suggests a regulatory mechanism for DSB processing in E. coli, wherein 3' tails impose a negative feedback loop on DSB processing reactions, specifically on helicase reloading onto dsDNA ends.

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What is the Happiest Country on Earth -- And Why?

We have advanced a little bit, on the "Happines Scale" Since this video was made, unlike some.ExEMTNor :-)

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Innovating With Rehabilitation Technology in the Real World: Promises, Potentials, and Perspectives.

In this article, we discuss robotic-assisted therapy as an emerging and significant field of clinical rehabilitation and its value proposition for innovating rehabilitation clinical practice. Attempts to achieve integration among clinicians' practices and bioengineers' machines often generate new challenges and controversies. To date, the literature is indicative of a sizeable number and variety of robotic devices in the field of clinical rehabilitation, some are commercially available; however, large-scale clinical outcomes are less positive than expected. The following main themes related to integrating rehabilitation technology in real-world clinical practice will be discussed: the application of current evidence-based practice and knowledge in relation to treatment in the rehabilitation clinic, perspectives from rehabilitation professionals using robotic-aided therapy with regard to challenges, and strategies for problem solving. Lastly, we present innovation philosophies with regard to sustainability of clinical rehabilitation technologies. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Development of Systemic Inflammatory Polyarthritis After Zygapophyseal Joint Injection With Hylan G-F 20 (Synvisc-One).

Hylan G-F 20 (Synvisc-One) is a hyaluronic acid derivative used for viscosupplementation of synovial fluid in osteoarthritic joints. Injection of hylan G-F 20 is Federal Drug Administration approved for use in knee osteoarthritis and is generally well tolerated with few reported adverse effects, the most common being local pain or swelling. We present the case of a 72-year-old man with bilateral, diffuse, joint pain and swelling with elevated inflammatory markers suggestive of a systemic inflammatory polyarthropathy that developed acutely 2 days after lumbar zygapophyseal joint injection with hylan G-F 20. Systemic effects after hylan G-F 20 injection have not been well documented, and this is the first reported case of systemic inflammatory polyarthritis after injection, to our knowledge. Further research is needed to better establish the safety and efficacy of lumbar zygapophyseal joint injections with hylan G-F 20. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Imaging Modalities for Correct Positioning of Percutaneous Right Ventricular Assist Device After Left Ventricular Assist Device Implantation.

No abstract available

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In Response.

No abstract available

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Esmolol Administration to Control Tachycardia in an Ovine Model of Peritonitis.

BACKGROUND: Excessive adrenergic signaling may be harmful in sepsis. Using [beta]-blockers to reduce sympathetic overactivity may modulate sepsis-induced cardiovascular, metabolic, immunologic, and coagulation alterations. Using a randomized ovine fecal peritonitis model, we investigated whether administration of a short-acting [beta]-blocker, esmolol, could control tachycardia without deleterious effects on hemodynamics, renal perfusion, cerebral perfusion, cerebral metabolism, or outcome. METHODS: After induction of fecal peritonitis, 14 anesthetized, mechanically ventilated, and hemodynamically monitored adult female sheep were randomly assigned to receive a continuous intravenous infusion of esmolol to control heart rate between 80 and 100 bpm (n = 7) or a saline infusion (control group, n = 7). Esmolol was discontinued when the mean arterial pressure decreased below 60 mm Hg. Fluid resuscitation was titrated to maintain pulmonary artery occlusion pressure at baseline values. Left renal blood flow and cerebral cortex perfusion and metabolism were monitored in addition to standard hemodynamic variables. RESULTS: Esmolol was infused for 11 (9-14) hours; the target heart rate (80-100 bpm) was achieved between 3 and 8 hours after feces injection. In the first 5 hours after the start of the infusion, the decrease in heart rate was compensated by an increase in stroke volume index; later, stroke volume index was not statistically significantly different in the 2 groups, so that the cardiac work index was lower in the esmolol than in the control group. Hypotension (mean arterial pressure

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Hyperbaric Versus Isobaric Bupivacaine for Spinal Anesthesia: Systematic Review and Meta-analysis for Adult Patients Undergoing Noncesarean Delivery Surgery.

BACKGROUND: It is widely believed that the choice between isobaric bupivacaine and hyperbaric bupivacaine formulations alters the block characteristics for the conduct of surgery under spinal anesthesia. The aim of this study was to systematically review the comparative evidence regarding the effectiveness and safety of the 2 formulations when used for spinal anesthesia for adult noncesarean delivery surgery. METHODS: Key electronic databases were searched for randomized controlled trials, excluding cesarean delivery surgeries under spinal anesthesia, without any language or date restrictions. The primary outcome measure for this review was the failure of spinal anesthesia. Two independent reviewers selected the studies and extracted the data. Results were expressed as relative risk (RR) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Seven hundred fifty-one studies were identified between 1946 and 2016. After screening, there were 16 randomized controlled clinical trials, including 724 participants, that provided data for the meta-analysis. The methodological reporting of most studies was poor, and appropriate judgment of their individual risk of bias elements was not possible. There was no difference between the 2 drugs regarding the need for conversion to general anesthesia (RR, 0.60; 95% CI, 0.08-4.41; P = .62; I2 = 0%), incidence of hypotension (RR, 1.15; 95% CI, 0.69-1.92; P = .58; I2 = 0%), nausea/vomiting (RR, 0.29; 95% CI, 0.06-1.32; P = .11; I2 = 7%), or onset of sensory block (MD = 1.7 minutes; 95% CI, -3.5 to 0.1; P = .07; I2 = 0%). The onset of motor block (MD = 4.6 minutes; 95% CI, 7.5-1.7; P = .002; I2 = 78%) was significantly faster with hyperbaric bupivacaine. Conversely, the duration of motor (MD = 45.2 minutes; 95% CI, 66.3-24.2; P

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Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery: A French Retrospective, Multicenter, Cohort Study.

BACKGROUND: Socioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy. Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery. This study aimed to examine the association between socioeconomic deprivation and (1) completion of a mandatory preanesthetic evaluation during pregnancy and (2) use of neuraxial analgesia during labor. METHODS: Data were from a cohort of 10,419 women who delivered between 2010 and 2011 in 4 public teaching hospitals in Paris. We used a deprivation index that included 4 criteria: social isolation, poor housing condition, no work-related household income, and state-funded health care insurance. Socioeconomic deprivation was defined as a deprivation index greater than 1. Preanesthetic evaluation was considered completed if performed more than 48 hours before delivery. The association between socioeconomic deprivation and completion of the preanesthetic evaluation and use of neuraxial labor analgesia was assessed by multivariable logistic regression adjusting for education level, country of birth, and maternal and pregnancy characteristics. RESULTS: Preanesthetic evaluation was completed for 8142 of the 8624 women (94.4%) analyzed and neuraxial labor analgesia was used by 6258 of the 6834 women analyzed (91.6%). After adjustment, socioeconomic deprivation was associated with reduced probability of completed preanesthetic evaluation (adjusted odds ratio 0.88 [95% confidence interval, 0.79-0.98]; P = .027) but not use of neuraxial labor analgesia (adjusted odds ratio 0.97 [95% confidence interval, 0.87-1.07]; P = .540). CONCLUSIONS: In a country providing universal health care coverage, women who were socioeconomically deprived showed reduced completion of preanesthetic evaluation during pregnancy but not reduced use of neuraxial labor analgesia. Interventions should be targeted to socioeconomically deprived women to increase the completion of the preanesthetic evaluation. (C) 2017 International Anesthesia Research Society

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Replication of Data Makes Statistical Analysis Difficult.

No abstract available

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Improving the Success Rate of Chest Compression-Only CPR by Untrained Bystanders in Adult Out-of-Hospital Cardiac Arrest: Maintaining Airway Patency May Be the Way Forward.

No abstract available

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Fixing Medical Prices.

No abstract available

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Exercise-Induced Fatigue in Severe Hypoxia Following an Intermittent Hypoxic Protocol.

Purpose: Exercise-induced central fatigue is alleviated following acclimatisation to high altitude. The adaptations underpinning this effect may also be induced with brief, repeated exposures to severe hypoxia. The purpose of this study was to determine whether (i) exercise tolerance in severe hypoxia would be improved following an intermittent hypoxic (IH) protocol and (ii) exercise-induced central fatigue would be alleviated following an IH protocol. Methods: Nineteen recreationally-active males were randomised into two groups who completed ten 2-h exposures in severe hypoxia (IH: PIO2 82 mmHg; n=11) or normoxia (control; n=8). Seven sessions involved cycling for 30 min at 25% peak power (W[spacing dot above]peak) in IH, and at a matched heart rate in normoxia. Participants performed baseline constant-power cycling to task failure in severe hypoxia (TTF-Pre). After the intervention, the cycling trial was repeated (TTF-Post). Pre- and post-exercise, responses to transcranial magnetic stimulation and supramaximal femoral nerve stimulation were obtained to assess central and peripheral contributions to neuromuscular fatigue. Results: From pre- to post-exercise in TTF-Pre, maximal voluntary force (MVC), cortical voluntary activation (VATMS) and potentiated twitch force (Qtw,pot) decreased in both groups (all p

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Self-reported Concussion History and Sensorimotor Tests Predict Head/Neck Injuries.

Purpose: Sports related concussion (SRC) is a risk for players involved in high impact, collision sports. A history of SRC is a risk factor for future concussions, but the mechanisms underlying this are unknown. Despite evidence that most visible signs and symptoms associated with sports concussion resolve within 7-10 days, it has been proposed that subclinical loss of neuromuscular control and impaired motor functioning may persist and be associated with further injury. Alternatively, indicators of poor sensorimotor performance could be independent risk factors. This study investigated if a history of SRC and/or pre-season sensorimotor performance predicted season head/neck injuries. Methods: 190 male rugby league, rugby union and Australian Football League players participated. Pre-season assessments included self-report of SRC within the previous 12 months and a suite of measures of sensorimotor function (balance, vestibular function, cervical proprioception and trunk muscle function). Head/neck injury data were collected in the playing season. Results: Forty-seven players (25%) reported a history of SRC. A history of concussion was related to changes in size and contraction of trunk muscles. Twenty-two (11.6%) players sustained a head/neck injury during the playing season, of which, 14 (63.6%) players had a previous history of SRC. Predictors of in-season head/neck injuries included history of SRC, trunk muscle function and cervical proprioceptive errors. Five risk factors were identified and players with three or more of these had 14 times greater risk of sustaining a season neck/head injury (sensitivity of 75% and specificity of 82.5%) than players with 2 or fewer risk factors. Conclusion: The modifiable risk factors identified could be used to screen football players in the pre-season and guide development of exercise programs aimed at injury reduction. (C) 2017 American College of Sports Medicine

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Chemotherapy-induced peripheral neuropathy: a review of recent findings.

Purpose of review: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, frequently chronic condition characterized by pain and decreased function. Given the growing number of cancer survivors and an increasing recognition of opioid therapy limitations, there is a need for critical analysis of the literature in directing an informed and thoughtful approach for the management of painful CIPN. Recent findings: A PubMed search for 'chemotherapy-induced peripheral neuropathy AND pain' identifies 259 publications between 1 January 2016 and 31 March 2017. Based on review of this literature, we aim to present a clinically relevant update of painful CIPN. Notably, the use of duloxetine as a first-line agent in treatment of CIPN is confirmed. Moreover, clinical trials focus on nonpharmacologic strategies for managing painful CIPN. Summary: Despite the volume of recent publications, there are limited preventive or therapeutic strategies for CIPN supported by high-level evidence. Duloxetine remains the only pharmacologic agent with demonstrated benefit; its clinical use should be routinely considered. Moving forward, nonopioid analgesic therapies will likely play an increasing role in CIPN treatment, but further research is necessary to confirm their utility. Promising therapies include vitamin B12 supplementation, physical therapy, and various forms of neuromodulation. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The courage to fail.

No abstract available

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Innovation Zone - MedixSafe

MedixSafe safes offer multiple layers of authentication for positive control over your narcotics and other vital equipment.

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Innovation Zone - MedixSafe

MedixSafe safes offer multiple layers of authentication for positive control over your narcotics and other vital equipment.

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Innovation Zone - MedixSafe

MedixSafe safes offer multiple layers of authentication for positive control over your narcotics and other vital equipment.

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Innovation Zone - MedixSafe

MedixSafe safes offer multiple layers of authentication for positive control over your narcotics and other vital equipment.

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Enhancing State Medical Home Capacity through a Care Coordination Technical Assistance Model

Abstract

Introduction A practice-based care coordination (CC) model was developed by Louisiana's Title V Children's Special Health Services (CSHS) program to meet the overwhelming needs of the New Orleans post-Katrina population. The pilot clinic demonstrated an improvement in medical home (MH) capacity over the course of 3 months. The purpose of the current study is to evaluate the replicability of the model and sustainability of MH improvement over at least 2 years, while identifying factors that may modify the effect of the intervention. Methods The CSHS CC model utilizing a practice based care coordinator was implemented in 15 academic primary care pediatric clinics. Increase in MH capacity was determined using the MH Index-Short Version (MHI-SV) tool. Results The analysis of the MHI-SV scores for the ten clinics with >2 years of data demonstrated a significant improvement with each of the ten MHI-SV indicators. The mean clinic MHI-SV score improved from 19.70 to 34.15 on a scale of 10–50. Characteristics associated with the greatest MHI score improvement were rural geographic location, having an electronic health record, and using social workers or nurses as care coordinators. Characteristics associated with lower MHI scores were physician or care coordinator turnover and using stand-alone databases rather than tracking CC activities within the central patient record. Conclusion This study provides a flexible framework for implementing CC services in pediatric, family medicine, and medicine-pediatric practices, and demonstrates the value of CC as a driver for improvement in medical home capacity.

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Hospital, ambulances using video to put doctors in rig with stroke patients

To improve outcomes for stroke patients, Catholic Medical Center is partnering with local EMS providers to use video conferencing so a neurologist can evaluate patients

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Police officers save man in cardiac arrest at Panera Bread

Officer Lawrence Guiler, who is a former EMT, was only a football field away when the heard the call about John Ogburn

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Inhibition of Parkinsonian tremor with cutaneous afferent evoked by transcutaneous electrical nerve stimulation

Recent study suggests that tremor signals are transmitted by way of multi-synaptic corticospinal pathway. Neurophysiological studies have also demonstrated that cutaneous afferents exert potent inhibition to d...

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Can Lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing Guidance force, Path control, and FreeD

Robot-assisted gait therapy is increasingly being used in pediatric neurorehabilitation to complement conventional physical therapy. The robotic device applied in this study, the Lokomat (Hocoma AG, Switzerlan...

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The impact of the 2008 recession on the health of older workers: data from 13 European countries

Abstract

Background: Fluctuations in the national economy shape labour market opportunities and outcomes, which in turn influence the health conditions of older workers. This study examined whether overall economic shifts during the 2008 recession was associated with four health indicators among older workers. Method: Data came from 4917 respondents (16 090 contacts) aged 50–70 in 13 European countries (Austria, Belgium, Czech Republic, Denmark, France, Germany, Israel, Italy, Netherlands, Poland, Spain, Sweden, Switzerland) participating in the Survey of Health, Ageing and Retirement in Europe. Health and employment assessments from 2004–13 were linked to annual data on fluctuations in Gross Domestic Product (GDP) per capita, life expectancy and unemployment rates for each country. Using fixed effects models, we assessed the recession's implications on four individual health outcomes: body mass index (BMI), drinking alcohol, depression and general health, while isolating cyclical variation within countries and individual changes over time. Results: Overall economic shifts had an effect on older workers: decreases in GDP were associated with a decline in average BMI, consumption of alcohol and deterioration in self-rated health; country-level unemployment rate had no effect on health outcomes, while life expectancy at birth was significant but not consistently across models. Being employed or retired were associated with fewer depressive symptoms and better self-rated health. Conclusions: Overall economic shifts during recessions affect certain health outcomes of older workers, and better health conditions together with being employed or retired may limit the negative health consequences of a recession.

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Contextual effects on health inequalities: a research agenda

The neighbourhood context in which we live can affect our health in many ways. Some are obvious: pollution incurred by living close to a motorway can impact on our respiratory health; or the lack of local possibilities for walking affects how much we exercise, potentially leading to weight gain or cardiovascular problems. Some contextual effects are less direct; mean neighbourhood income can influence the availability of goods, services and facilities in an area and, since these are available to everyone, affect the health of high- and low-income residents.¹ This is an example of the importance of distinguishing individual and contextual effects. Another example of a contextual effect would be neighbourhoods prone to crime and anti-social behaviour being a source of stress and thus increasing, among other things, the risk of mental illness among all of the residents. But then social capital at the neighbourhood level can be a modifying factor, providing resources which then affect social behaviours, leading to healthier lifestyles for all.

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Migrant health: putting the economic argument into the context of deservingness debates

The main arguments for improving access to health care for marginalised groups, including migrants and ethnic minorities, have mostly been based on public health considerations, human rights claims and ethical principles of equity. However, the respective political debates often focus on economic arguments such as moral hazard, (presumed) health expenses, and the need to safeguard scarce resources. Acknowledging the role of economic arguments in political decision-making processes, researchers and activists have begun to pay more attention to the fiscal implications of limiting migrants' access to care. As yet, however, empirical evidence on the economic implications of different policy responses to migration is scarce. As pointed out by Trummer and Krasnik,¹ the 'right to health care is acknowledged in many international declarations—however… only a few countries have adopted national policies on migrant and ethnic minority health to meet the challenges.' They also cite several recent studies indicating that restricting access to care for those groups does not help save costs.

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Migrant health: the economic argument

The right to health care is acknowledged in many international declarations—however, often with unclear statements regarding the population groups that should actually be provided with this right and the extent of services that should be included. National legislations of the European countries on the provision of health care are generally restricting entitlements to certain population groups. As a consequence, many migrants enjoy entitlements which are not comparable to those of the citizens of the country—depending of their formal status in the country.¹ Besides, the full enjoyment of health care requires not only formal entitlements, but also the existence of inclusive health services that are able to ensure quality of care when access has actually been obtained. An accumulating body of evidence in the field of health and migration concludes that the specific health needs of migrants and ethnic minorities are often poorly understood, communication between many health care providers and migrant patients remains poor and health systems are not fully equipped to respond adequately. Despite these facts, only a few countries have adopted national policies on migrant and ethnic minority health to meet the challenges. It is also pointed out that the research fields concerned with equity in health, human rights and health and migration are insufficiently connected to each other and therefore miss synergies to support policy change.

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Restricted access to health care for asylum-seekers: applying a human rights lens to the argument of resource constraints

Granting health care to vulnerable groups of the population including asylum seekers is often regarded as a 'benevolent handout (…) by state or third parties to ameliorate suffering of passive recipients of assistance'.¹ As opposed to this, the notion of health as part of human rights obliges states—legally and morally—to protect, respect and fulfill their right to health. This includes the right to health care² and the obligation of the signatory states with regard to the non-discriminatory realization of this right by refraining 'from denying or limiting equal access for all persons, including prisoners or detainees, minorities, asylum seekers and illegal immigrants, to preventive, curative and palliative health services' (General Comment No. 14, emphasis not in original).³

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Sleep and cardiovascular diseases: time for action and new methods

The importance of good sleep to health has been highlighted in numerous studies during previous decades. Consequently, dimensions of sleep are emerging as new and indisputable risk factors of many key public health problems, including cardiovascular diseases. The role of classical risk factors such as smoking, heavy drinking, physical inactivity, unhealthy diet and obesity is well established in cardiovascular health,¹ but public health research nor practice and recommendations can no longer ignore sleep alongside other risk factors to prevent and assess cardiovascular diseases. Accordingly, it has been suggested that poor sleep could be included in the list of leading 10 potentially modifiable cardiovascular risk factors.¹

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European Public Health News

In this European Public Health News, all authors are reflecting on the involvement and rights of the consumers. Muscat highlights e-health and the new ways of communication that change the roles for patients to interact with their health systems. Zeegers continues by emphasizing the need to put the public back in health research, reflecting on the discussions during the second annual forum of the Scientific Panel on Health Research. Jakab emphasises the importance of including the right to health for migrants and equitable access to people-centred and migrant/refugee sensitive health systems. Andriukaitis presents the European Pillar on Social Rights, a new tool that the European Commission hopes will become a reference framework, including health policy and the delivery of health services. Finally, Forsberg presents the attention given to resilience and health in action at community level, where direct interaction between health and social systems with the individual takes place. All in all, the involvement and rights of Europeans is clearly a starting point for all our work as public health community.

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Temporal changes in health within 5 years before and after disability pension–the HUNT Study

Abstract

Background: Health status has been reported to change before, during and after disability pension receipt. These associations might be subject to temporal changes according to changes in policy, incidence of disability pensions and other contextual factors. We compared the perceived health around time of disability retirement among persons receiving disability pension in the 1990 s and 2000 s in Norway. Methods: We linked data from two consecutive cross-sectional population based Norwegian health surveys, HUNT2 (1995–97) and HUNT3 (2006–08), to national registries, identifying those who received disability pension within 5 years before or after participation in the survey (HUNT2: n = 5362, HUNT3: n = 4649). We used logistic regression to assess associations of time from receiving a disability pension with self-rated health, insomnia, depression and anxiety symptoms and subsequently estimated adjusted prevalence over time. Results: Prevalence of poor self-rated health peaked around time of receiving disability pension in both decades. For those aged 50+, prevalence the year before disability pension was slightly lower in 2006–08 (74%, 95% CI 70–79%) than in 1995–97 (83%, 95% CI 79–87%), whereas peak prevalence was similar between surveys for those younger than 50. Depression symptoms peaked more pronouncedly in 1995–97 than in 2006–08, whereas prevalence of anxiety symptoms was similar at time of receiving disability pension between surveys. Conclusions: We found no strong evidence of differences in health selection to disability pension in the 2000 s compared to the 1990 s. However, we found indication of less depression symptoms around time of disability pension in the 2000 s compared to the 1990 s.

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Night work as a risk factor of future disability pension due to musculoskeletal diagnoses: a prospective cohort study of Swedish twins

Abstract

Background: This study investigated the associations between night work, sleep and disability pension (DP) due to musculoskeletal disorders (MSD), while controlling for several confounding factors including both genetic factors and shared family background. Methods: The study sample consisted of 27 165 Swedish twin individuals born in 1935–58 with comprehensive survey data on sociodemographic, health and lifestyle factors. Night work was assessed as years of working hours at night at least every now and then, and categorized into 'not at all, 1–10 years and over 10 years'. Data on DP with MSD (ICD-diagnoses M00–M99) were obtained from the National Social Insurance Agency. Follow-up was from the time of the interview in 1998–2003 until 2013. Information on the length and quality of sleep was available for a sub-sample of twins (n = 1684). Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: During the follow-up, 1338 (5%) participants were granted DP due to MSD. Both 1–10 years (HR 1.33, 95% CI 1.17–1.53) and over 10 years of night work (HR 1.39 95% CI 1.18–1.64) increased the risk of future DP. The associations were not affected by health, lifestyle or sleep factors. In the discordant twin pair analysis, the associations between night work and DP due to MSD attenuated. Conclusions: Night work was associated with increased risk of DP due to MSD independently from health and lifestyle factors. Familial confounding could not be ruled out.

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A baseline assessment by healthcare professionals of Dutch pharmacotherapeutic care for the elderly with polypharmacy

Abstract

Background: Polypharmacy is common in the elderly population and is associated with an increased risk of adverse drug events. To diminish this risk, the guideline 'Polypharmacy in the Elderly' has been developed in 2012. This study examines, to what extent Dutch pharmacotherapeutic practice amongst elderly with polypharmacy mirrors the best practice described in this guideline and which barriers threaten it. Methods: An observational study was conducted in 2013/14 using a questionnaire distributed amongst Dutch healthcare professionals and elderly patients with polypharmacy. Healthcare professionals were asked about their current practice and the presence of five significant barriers, selected through a literature review and from expert opinion. These barriers are: inadequate transfer of patient records; insufficient documentation of prescribed drugs; a lack of collaboration between professionals; a failure to take a full control of the medication and insufficient involvement of the patient. The patients were asked about their experience with pharmacotherapeutic care. Results: No more than 26% of the healthcare professionals indicated that they use the guideline. The five barriers threatening the pharmacotherapeutic care were found to be present. Forty-three percent of the patients mentioned that their medication was assessed last year. Conclusion: The guideline is not used frequently by the healthcare professionals, but there is a will to improve the care by following this guideline. However, the presence of the five barriers hampers its implementation. Good management of those barriers is necessary in order to improve the collaboration between primary and secondary care and to enhance the documentation of prescribed drugs.

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Health assessments for health governance—concepts and methodologies

Abstract

Background: For better supporting the science-governance interface, the potential of health assessments appears underrated. Aims: To identify what various types of health assessment have in common; how they differ; which assessment(s) to apply for which purpose; and what needs and options there are for future joint development. Methods: This review is based on five types of health assessment: monitoring/surveillance/reporting, assessment of health impact, of health technology, of health systems performance, health-related economic assessment. The approach is exploratory and includes: applying an agreed set of comparative criteria; circulating and supplementing synoptic tables; and interpreting the results. Results: Two of the assessments deal with the question 'Where do we stand?', two others with variants of 'What if' questions. Economic Assessment can take place in combination with any of the others. The assessments involve both overall 'procedures' and a variety of 'methods' which inescapably reflect some subjective assumptions and decisions, e.g. on issue framing. Resources and assistance exist for all these assessments. The paper indicates which type of assessment is appropriate for what purpose. Conclusions: Although scientific soundness of health assessments is not trivial to secure, existing types of health assessment can be interpreted as a useful 'toolkit' for supporting governance. If current traces of 'silo' thinking can be overcome, the attainability of a more unified culture of health assessments increases and such assessments might more widely be recognized as a prime, 'tried and tested' way to voice Public Health knowledge and to support rational governance and policy-making.

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Alcohol and cancer: risk perception and risk denial beliefs among the French general population

Abstract

Background: Worldwide, millions of deaths each year are attributed to alcohol. We sought to examine French people's beliefs about the risks of alcohol, their correlates, and their associations with alcohol use. Methods: Data came from the 2010 Baromètre Cancer survey, a random cross-sectional telephone survey of the French general population (n = 3359 individuals aged 15–75 years). Using principal component analysis of seven beliefs about alcohol risks, we built two scores (one assessing risk denial based on self-confidence and the other risk relativization). Two multiple linear regressions explored these scores' socio-demographic and perceived information level correlates. Multiple logistic regressions tested the associations of these scores with daily drinking and with heavy episodic drinking (HED). Results: About 60% of the respondents acknowledged that alcohol increases the risk of cancer, and 89% felt well-informed about the risks of alcohol. Beliefs that may promote risk denial were frequent (e.g. 72% agreed that soda and hamburgers are as bad as alcohol for your health). Both risk denial and risk relativization scores were higher among men, older respondents and those of low socioeconomic status. The probability of daily drinking increased with the risk relativization score and that of HED with both scores. Conclusions: Beliefs that can help people to deny the cancer risks due to alcohol use are common in France and may exist in many other countries where alcoholic beverages have been an integral part of the culture. These results can be used to redesign public information campaigns about the risks of alcohol.

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Changes in alcohol consumption in the 50- to 64-year-old European economically active population during an economic crisis

Abstract

Background: The aim was to compare alcohol drinking patterns in economically active people aged 50–64 years before the last economic crisis (2006) and during the crisis (2013). Methods: Cross-sectional study with data from 25 479 economically active people aged 50–64 years resident in 11 European countries who participated in wave 2 or wave 5 of the SHARE project (2006 and 2013). The outcome variables were hazardous drinking, abstention in previous 3 months and the weekly average number of drinks per drinker. The prevalence ratios of hazardous drinking and abstention, comparing the prevalence in 2013 vs. 2006, were estimated with Poisson regression models with robust variance, and the changes in the number of drinks per week with Poisson regression models. Results: The prevalence of hazardous drinking decreased among both men (PR = 0.75; 95%CI = 0.63–0.92) and women (PR = 0.91; 95%CI = 0.72–1.15), although the latter decrease was smaller and not statistically significant. The proportion of abstainers increased among both men (PR = 1.11; 95%CI = 0.99–1.29) and women (PR = 1.18; 95%CI = 1.07–1.30), although the former increase was smaller and not statistically significant. The weekly average number of drinks per drinker decreased in men and women. The decreases in consumption were larger in Italy and Spain. Conclusion: From 2006 to 2013, the amount of alcohol consumed by late working age drinkers decreased in Europe, with more pronounced declines in the countries hardest hit by the economic crisis.

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Whether people believe that overweight is unhealthy depends on their BMI

Abstract

An online experiment with 536 participants was conducted to investigate how people who differ in body weight perceive scientific information on body weight and mortality. The results showed that individuals who were aware that they are overweight were more inclined to trust a study that showed that overweight reduces mortality (P < 0.001). This finding is relevant as the BMI-mortality association remains a matter of scientific and public debate and people's risk perceptions influences their willingness to change behaviour.

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Binge drinking and well-being in European older adults: do gender and region matter?

Abstract

Background: We aimed to describe gender and region differences in the prevalence of binge drinking and in the association between binge drinking and well-being, among older adult Europeans. Methods: This is a cross-sectional study using the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 4, conducted between 2011 and 2012, including 58 489 individuals aged 50 years or older. Sixteen European countries were grouped in four drinking culture regions: South, Central, North and East. We categorized drinking patterns as: never, former, no-binge and binge drinkers. We used the CASP-12 questionnaire to measure well-being. To assess the association between binge drinking and well-being, we fitted two-level mixed effects linear models. Results: The highest percentage of binge drinkers was found in Central Europe (17.25% in men and 5.05% in women) and the lowest in Southern Europe (9.74% in men and 2.34% in women). Former, never and binge drinkers had a significant negative association with well-being as compared with no-binge drinkers. There was a significant interaction in this association by gender and region. Overall, associations were generally stronger in women and in Southern and Eastern Europe. The negative association of binge drinking with well-being was especially strong in Southern European women (β = −3.80, 95% CI: −5.16 to − 2.44, P value <0.001). Conclusion: In Southern and Eastern European countries the association between binge drinking and well-being is stronger, especially in women, compared with Northern and Central Europe. Cultural factors (such as tolerance to drunkenness) should be further explored.

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Lifetime abuse and perceived social support among the elderly: a study from seven European countries

Abstract

Background: Being a victim of abuse during one's life course may affect social relations in later life. The aims of this study were to: (i) examine the association between lifetime abuse and perceived social support and (ii) identify correlates of perceived social support among older persons living in seven European countries. Methods: A sample of 4467 women and men aged 60–84 years living in Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden was collected through a cross-sectional population-based study. Abuse (psychological, physical, sexual, financial and injury) was assessed through interviews or interviews/self-response questionnaire based on the Conflict Tactics Scale-2 and the UK study on elder abuse. Perceived social support was assessed by the Multidimensional Scale of Perceived Social Support. Results: Victims of lifetime abuse perceived poorer social support in later life. Multivariate analyses showed that high levels of perceived social support were associated with being from Greece and Lithuania (compared to Germany), being female, not living alone, consuming alcohol and physical activity. Poorer perceived social support was associated with being from Portugal, being old, having social benefits as the main source of income, experiencing financial strain and being exposed to lifetime psychological abuse and injuries. Conclusions: Our findings showed that exposure to psychological abuse and injuries across the lifespan were associated with low levels of perceived social support, emphasizing the importance of detection and appropriate treatment of victims of abuse during their life course. Future research should focus on coping strategies buffering the negative effects of abuse on social relationships.

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Inequalities in obesity in Portugal: regional and gender differences

Abstract

Background: Obesity levels vary considerably according to geographical region and socio-economic status. We evaluated the prevalence of obesity by education and occupational position across seven Portuguese regions. Relative and absolute inequalities in obesity were also assessed. Methods: Data was drawn from the Portuguese Health Survey 2005/6 (26 674 adults, 46.6% women). Education was categorized as ≤4, 5–11 and ≥12 complete years of education. Occupational position was grouped as upper white collar, lower white collar and blue collar. The Relative Index of Inequality (RII) and the Slope Index of Inequality (SII) were used to quantify relative and absolute inequalities in obesity, respectively. Results: In women, prevalence of obesity ranged between 10.0% (Algarve) and 20.3% (Azores); in men, it ranged between 13.3% (Algarve) and 16.4% (Lisbon). In women, the educational RII (95% confidence interval) ranged between 2.4 (1.1 to 5.1) in the Centre and 6.6 (3.0 to 14.2) in Alentejo, and the SII (95% CI) between 9.7 (−1.3 to 20.7) and 33.0 (26.0 to 40.0), respectively. In men, the RII ranged between 0.8 (0.4 to 1.5) in Madeira and 1.9 (1.0 to 4.5) in the Centre, and the SII between −8.3 (−19.0 to 2.5) and 9.5 (−0.1 to 19.1), respectively. Occupational RIIs were similar to those for education, although somewhat lower. Conclusion: In Portugal, large educational and occupational inequalities in obesity are observed, but they vary considerably by region and are larger among women than men.

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The link between perceived characteristics of neighbourhood green spaces and adults’ physical activity in UK cities: analysis of the EURO-URHIS 2 Study

Abstract

Background: Urban dwellers represent half the world's population and are increasing worldwide. Their health and behaviours are affected by the built environment and green areas may play a major role in promoting physical activity, thus decreasing the burden of chronic diseases, overweight and inactivity. However, the availability of green areas may not guarantee healthy levels of physical activity among the urban dwellers. It is therefore necessary to study how the perceived characteristics of green areas affect physical activity. Methods: Data from the EURO-URHIS 2 survey of residents of 13 cities across the UK were analyzed and a multivariable model was created in order to assess the association between their perceptions of the green areas in their neighbourhood and their engagement in physical activity. Results were adjusted for age, gender and other potential confounders. Results: Those who felt unable to engage in active recreational activities in their local green spaces were significantly less likely to carry out moderate physical exercise for at least 60 min per week (adjusted OR: 0.50; 95% 0.37–0.68). Availability of green areas within walking distance did not affect engagement in physical activity. Other characteristics such as accessibility and safety may play an important role. Conclusion: This study showed that the presence of green space may not itself encourage the necessary preventative health behaviours to tackle physical inactivity in urban populations. Development of more appropriate green spaces may be required. Further research is needed to shed light on the types green spaces that are most effective.

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Burden of smoking in Lithuania: attributable mortality and years of potential life lost

Abstract

Background: High mortality rates from smoking related diseases are a significant public health issue in Lithuania. Study aims to estimate the number of smoking attributable deaths (SADs) and years of potential life lost in Lithuania in 2013. Methods: Gender, age and disease specific mortality was calculated by applying the smoking attributable fractions (SAFs) to prevalence estimates of current and former smokers among Lithuanian adults aged ≥35 years that are based on the 2005 Lithuanian Health Interview Survey. Mortality data were obtained from the Institute of Hygiene Health Information Centre. Eight years lag was assumed between smoking rates and subsequent mortality. Sensitivity analysis was used to calculate SAFs applying smoking impact ratio method. Results: In 2013, 13.9% of total mortality or 5771 deaths in Lithuania were attributable to smoking (5181 men and 590 women). The two leading causes of SADs were ischaemic heart disease (2861) and lung cancer (1054) that accounted for 67.8% of the smoking attributable mortality. In the same year, smoking accounted for 39 279 years of potential life lost (34 663 years for men and 4615 years for women). Conclusions: Smoking causes a considerable mortality burden in Lithuania, killing nine times more males than females. Therefore reduction of smoking prevalence is an urgent public health need, which calls for implementation of effective and comprehensive tobacco control measures consistent with the World Health Organization Framework Convention on Tobacco Control Articles and Protocols and The Tobacco Products Directive.

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Economic evaluation of health promotion and primary prevention actions for older people—a systematic review

Abstract

Background: Healthy ageing and health promotion (HP) actions for older people have become an important health sector priority. At the same time, the application of economic evaluation methods in the field of health interventions in order to support allocative decision processes is of growing importance. The aims of the review were to analyze what the existing evidence is on cost-effectiveness of HP and/or primary prevention (PP) programmes for older people whilst providing deeper insight into methodological aspects of such studies, their overall quality and issues related to practical implementation of results. Methods: Systematic review of contemporary evidence (2000–15). Studies' eligibility criteria included target population 65 years old or older; interventions classified as HP or PP; a full economic evaluation conducted. The search strategy included five electronic databases and Internet websites of institutions or projects related to the topic. Quality assessment of the studies was based on the 'Drummond checklist'. Results: After screening 6450 records, 29 papers were included, the vast majority of which (22) focus on fall prevention strategies. In this area, there are examples of good and moderate quality studies which confirm the cost-effectiveness of diverse physical activity interventions in fall prevention. The existing studies are characterized by huge differences in the methods applied as well as overall quality which limits the comparability and generalizability of the results. Conclusions: There is a need for development and implementation of economically driven studies, with methods adjusted to particular character of HP and/or PP strategies for older population.

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Natural and artificial radionuclides in sludge, sand, granular activated carbon and reverse osmosis brine from a metropolitan drinking water treatment plant

Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): Dani Mulas, Antonia Camacho, Isabel Serrano, Sergio Montes, Ricard Devesa, Maria Amor Duch




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Study of the formation of the primary 137Cs vertical profile in the organic matter-rich sediments

Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): N. Tarasiuk, B. Lukšienė, E. Maceika, V. Filistovičius, Z. Žukauskaitė, L. Nedzveckienė, Š. Buivydas
A laboratory study of the formation of the primary vertical profile of the ¹³⁷Cs activity concentration in the anaerobic organic matter-rich sediments was carried out. The incubation was performed using sediment baths method (initial thickness of the water layer over the sediments ∼40 cm, initial radiocesium activity concentration in water ∼14.53 Bq·L⁻¹). An exponential profile (R²∼0.999) with the half-height width of ∼0.65 cm was formed after ∼32 days of the incubation. A further course of the experiment (sediments were sampled after 64, 130 and 293 days of the incubation) revealed deviations in the form of the radiocesium activity concentration profile related to the appearance of the additional Gauss factor with the increasing half-height width of ∼1.2, ∼1.3 and ∼3 cm, respectively. In spite of the evident growth of the half-height width, the radiocesium migration rate decreased from 0.02 cm·day⁻¹ for the first 32 days of incubation down to 0.009 cm·day⁻¹ at the end of the incubation experiment. Such a time-dependent decrease in the radiocesium migration is possibly related to the beginning of the second radiocesium migration phase depending on the retardation factor. Besides diffusion, the formation of vertical profiles of radiocesium activity concentrations in sediments was additionally induced by effects of buoyancy of the upper sediment layer due to the seepage of the above lying water into sediments.



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Plants as indicators of tritium concentration in ground water at the Semipalatinsk test site

Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): N.V. Larionova, S.N. Lukashenko, O.N. Lyakhova, A.O. Aidarkhanov, S.B. Subbotin, A.B. Yankauskas




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A rotating-slit-collimator-based gamma radiation mapper

Publication date: October 2017
Source:Journal of Environmental Radioactivity, Volume 177
Author(s): Jonas M.C. Nilsson, Robert R. Finck, Christopher L. Rääf
For situations with radioactive material out of control where it may be physically difficult or prohibited to access areas close to the source, measurements from distance may be the only way to assess the radiation environment. Using collimated detectors will provide means to locate the direction of the radiation from the source. To investigate the possibilities of mapping gamma emitting radioactive material in a closed non-enterable area, a tentative system for mapping radioactive materials from a distance was built. The system used a computer controlled cylindrical rotating slit collimator with a high purity germanium detector placed in the cylinder. The system could be placed on a car-towed trailer, with the centre of the detector about 1.4 m above ground. Mapping was accomplished by the use of a specially developed image reconstruction algorithm that requires measurements from two or more locations around the area to be investigated. The imaging capability of the system was tested by mapping an area, 25 by 25 m², containing three 330 MBq ¹³⁷Cs point sources. Using four locations outside the area with about 20 min measuring time in each location and applying the image reconstruction algorithm on the deconvoluted data, the system indicated the three source locations with an uncertainty of 1–3 m. The results demonstrated the potential of using collimated mobile gamma radiometry combined with image reconstruction to localize gamma sources inside non-accessible areas.



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Prognostic significance of central venous-to-arterial carbon dioxide difference during the first 24 hours of septic shock in patients with and without impaired cardiac function

Abstract

Objective: To investigate the prognostic significance of central venous-to-arterial carbon dioxide difference (cv-art CO₂ gap) during septic shock in patients with and without impaired cardiac function.Methods: We performed a prospective cohort study in 10 French intensive care units. Patients suffering from septic shock were assigned to the impaired cardiac function group ('cardiac group', n=123) if they had atrial fibrillation (AF) and/or left ventricular ejection fraction (LVEF) <50% at study entry and to the non-cardiac group (n=240) otherwise.Results: Central venous and arterial blood gases were sampled every 6 h during the first 24 h to calculate cv-art CO₂ gap. Patients in the cardiac group had a higher cv-art CO₂ gap [at study entry and 6 and 12 h (all P<0.02)] than the non-cardiac group. Patients in the cardiac group with a cv-art CO₂ gap >0.9 kPa at 12 h had a higher risk of day 28 mortality (hazard ratio=3.18; P=0.0049). Among the 59 patients in the cardiac group with mean arterial pressure (MAP) ≥65 mm Hg, central venous pressure (CVP) ≥8 mm Hg and central venous oxygen saturation (ScvO₂) ≥70% at 12 h, those with a high cv-art CO₂ gap (>0.9 kPa; n=19) had a higher day 28 mortality (37% vs. 13%; P=0.042). In the non-cardiac group, a high cv-art CO₂ gap was not linked to a higher risk of day 28 death, whatever the threshold value of the cv-art CO₂ gap.Conclusion: Patients with septic shock and with AF and/or low LVEF were more prone to a persistent high cv-art CO₂ gap, even when initial resuscitation succeeded in normalizing MAP, CVP, and ScvO₂. In these patients, a persistent high cv-art CO₂ gap at 12 h was significantly associated with higher day 28 mortality.

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The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery

Abstract

Background. A simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery is lacking.We conducted a retrospective analysis of data collected from the ACTA National Audit. For the derivation dataset, we included data from 20 036 patients, which we then externally validated using a further group of 1047 patients.Methods. We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to an integer-based system and tested it using the area under the receiver operator characteristic (AUC) statistic with a Hosmer-Lemeshow goodness-of-fit test. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score.Results. Several factors were independently associated with risk of transfusion, including age, sex, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac surgery patients with an AUC of 0.76. The external validation confirmed accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores, with a minor tendency to under-estimate transfusion risk in very high-risk patients.Conclusions. The ACTA-PORT score is a reliable, validated tool for predicting risk of transfusion for patients undergoing cardiac surgery. This and other scores can be used in research studies for risk adjustment when assessing outcomes, and might also be incorporated into a Patient Blood Management programme.

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Reproducibility of science and developmental anaesthesia neurotoxicity: a tale of two cities

Editor—Reproducing scientific observations is the foundation of trusted discoveries. In clinical sciences, specific questions are repeatedly asked by a multitude of observational studies or trials, and the rigorous meta-analysis of these multicentre datasets leads us closer toward the application of evidence-based medicine in our patients. A similar approach is less frequently applied to basic and even translational research, where differences in experimental protocols used, species studied, and outcome measures reported make direct comparison of laboratory studies at best very difficult.¹ The seeming lack of interest in thoroughly replicating experiments produced by other laboratories can be explained by a multitude of factors, amongst which the difficulties to obtain funding and dedicated researchers to conduct highly time- and money-consuming "non-innovative" projects are probably the most important. It is increasingly acknowledged that many preclinical studies are statistically underpowered and cannot be reproduced.²³ The absence of confirmation of an experimental finding by other independent laboratories can greatly weaken the confidence in any particular observation. Importantly, many clinical trials are fuelled by translational experimental datasets, and these preclinical works should be reliable and of the highest quality to provide a solid base for human studies.

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Fading whispers down the lane: signal propagation in anaesthetized cortical networks

An active area of enquiry in the neuroscientific investigation of general anaesthesia is the question of whether anaesthetic-induced unconsciousness is mediated by bottom-up or top-down mechanisms in the brain. Candidates for the bottom-up approach include suppression of arousal centres in the brainstem and diencephalon,¹² activation of sleep-promoting neurones or nuclei in similar locations,¹³ blockade of sensory information en route from the thalamus to the cortex,⁴ and a disabled thalamic conductor for the neuronal orchestra of the cortex.⁵ Candidates for the top-down approach include direct effects on long-latency activity in cortical networks,⁶ with a consequent disruption of higher-order information synthesis that occurs beyond the level of the primary sensory cortex.^7–9 This bottom-up vs top-down distinction is almost surely artificial given the integrated circuits required for the normal function of neural systems and the widespread effects of general anaesthetics on the brain. We recently proposed that anaesthetics alter the level of consciousness (e.g. awake vs somnolent) through bottom-up mechanisms while degrading the contents of consciousness (e.g. the particular qualities of experience) through top-down mechanisms.¹⁰ Developing a clearer understanding of these processes is important because it can inform (i) the neurobiology of consciousness, a fundamental question in science, and (ii) our approach to brain monitoring, a fundamental and unmet challenge in clinical anaesthesia. However, it is difficult to address this question by investigating individual brain areas or molecular targets in the laboratory and also difficult to distinguish cortical and subcortical mechanisms through human neuroimaging and neurophysiology. In this issue of the British Journal of Anaesthesia, Hentschke and colleagues¹¹ examine an intermediate level of neuroanatomy and neurophysiology in a cortical slice model, finding more profound effects of isoflurane on signal propagation through the cortex than to the cortex.

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21st Annual Scientific Meeting of the Difficult Airway Society: lessons learned and glimpses of the future

The 21st Annual Scientific Meeting of the Difficult Airway Society (DAS) took place in Torquay (Devon, UK) on November 16–18, 2016. The workshop day included traditional workshops, a tracheostomy workshop, and a 'can't intubate, can't oxygenate' (CICO) workshop. The next 2 days encompassed a variety of stimulating sessions, presentations, lunchtime symposia, a pro–con debate, free paper presentations, and poster presentations.

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Using medical exome sequencing to identify the causes of neurodevelopmental disorders: experience of two clinical units and 216 patients

Though whole exome sequencing is the gold standard for the diagnosis of neurodevelopmental disorders, it remains expensive for some genetic centers. Commercialized panels comprising all OMIM-referenced genes called "medical exome" constitute an alternative strategy to whole exome sequencing, but its efficiency is poorly known. In this study, we report the experience of two clinical genetic centers using medical exome for diagnosis of neurodevelopmental disorders.

We recruited 216 consecutive index patients with neurodevelopmental disorders in two French genetic centers, corresponded to the daily practice of the units and included non-syndromic intellectual disability (n=33), syndromic intellectual disability (n=122), pediatric neurodegenerative disorders (n=7) and autism spectrum disorder (n=54). We sequenced samples from probands and their parents (when available) with the Illumina TruSight One sequencing kit.

We found pathogenic or likely pathogenic variants in 56 index patients, for a global diagnostic yield of 25.9%. The diagnosis yield was higher in patients with intellectual disability as the main diagnosis (32%) than in patients with autism spectrum disorder (3.7%). Our results suggest that the use of medical exome is a valuable strategy for patients with intellectual disability when whole exome sequencing cannot be used as a routine diagnosis tool.

Graphical Abstract

TruSight One global diagnostic yield in 216 consecutive patients with neurodevelopmental disorder, negative for X fragile and chromosomal microarray from two French clinical genetic centers: 25.9%

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Whole-exome sequencing is a valuable diagnostic tool for inherited peripheral neuropathies: outcomes from a cohort of 50 families

Abstract

The inherited peripheral neuropathies (IPNs) are characterized by marked clinical and genetic heterogeneity and include relatively frequent presentations such as Charcot-Marie-Tooth disease and hereditary motor neuropathy, as well as more rare conditions where peripheral neuropathy is associated with additional features. There are over 250 genes known to cause IPN-related disorders but it is estimated that in ~50% of affected individuals a molecular diagnosis is not achieved. In this study, we examine the diagnostic utility of whole-exome sequencing (WES) in a cohort of 50 families with one or more affected individuals with a molecularly undiagnosed IPN with or without additional features. Pathogenic or likely pathogenic variants in genes known to cause IPN were identified in 24% (12/50) of the families. A further 22% (11/50) of families carried sequence variants in IPN genes in which the significance remains unclear. An additional 12% (6/50) of families had variants in novel IPN candidate genes, three of which have been published thus far as novel discoveries (KIF1A, TBCK, and MCM3AP). This study highlights the use of WES in the molecular diagnostic approach of highly heterogeneous disorders, such as IPNs, places it in context of other published neuropathy cohorts, while further highlighting associated benefits for discovery.

Graphical Abstract

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Novel non-neutral mitochondrial DNA mutations found in childhood acute lymphoblastic leukemia

Abstract

Mitochondria produce adenosine triphosphate (ATP) for energy requirements via the mitochondrial oxidative phosphorylation (OXPHOS) system. One of the hallmarks of cancer is the energy shift towards glycolysis. Low OXPHOS activity and increased glycolysis are associated with aggressive types of cancer. Mitochondria have their own genome (mtDNA) encoding for 13 essential subunits of the OXPHOS enzyme complexes. We studied mtDNA in childhood acute lymphoblastic leukemia (ALL) to detect potential pathogenic mutations in OXPHOS complexes. The whole mtDNA from blood and bone marrow samples at diagnosis and follow-up from 36 ALL patients were analyzed. Novel or previously described as pathogenic mtDNA mutations were identified in eight out of 36 patients. Six out of these eight patients had died from ALL. Five out of 36 patients had an identified poor prognosis genetic marker, and four of these patients had mtDNA mutations. Missense or nonsense mtDNA mutations were detected in the genes encoding subunits of OXPHOS complexes, as follows: MT-ND1, MT-ND2, MT-ND4L and MT-ND6 of Complex I; MT-CO3 of Complex IV; and MT-ATP6 and MT-ATP8 of Complex V. We discovered mtDNA mutations in childhood ALL supporting the hypothesis that non-neutral variants in mtDNA affecting the OXPHOS function may be related to leukemic clones.

Graphical Abstract

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Health, Social, and Economic Outcomes Experienced by Families as a Result of Receiving Assistance from a Community-Based Diaper Bank

Abstract

Objectives This paper aims to describe low-income recipients of a community-based diaper bank and the multiple daily challenges they face. Our paper seeks to document the health, social, and financial outcomes recipients experienced after receiving assistance. Methods We surveyed families (n = 150) about their experiences receiving diapers from a diaper bank in the southeastern United States. Additionally, we conducted short, focused interviews with families (n = 15) about outcomes after receiving diapers. Results Families experience regularly a range of challenges meeting basic needs. These difficulties include high unmet needs for transportation, food, and nonfood essentials such as personal hygiene items. Families experiencing the greatest difficulty in paying utility or medical bills were significantly more likely to have a high level of diaper need compared to families facing these challenges less often (AORs ranging from 3.40 to 9.39). As a result of receiving diapers, families reported positive health, social, and economic outcomes. Families reported positive changes in parental mood; improved child health and happiness; increased opportunities for childcare, work, and school attendance; and the ability to divert household finances toward other basic needs, including utilities and medical care. Conclusions for Practice The monetary value of the supplemental provision of diapers is a small investment in affected families' economic, social, and health outcomes. The positive effects continue far longer than the diapers provided. We demonstrate the social value of such an operation, and recommend the expansion of federal, state, and local safety net programs to help low-income families secure a steady supply of diapers.

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Examining Early Childhood Health Outcomes of Children Born Late Preterm in Urban Manitoba

Abstract

Objective The late preterm population [34–36 weeks gestational age (GA)] is known to incur increased morbidity in the infancy stage compared to the population born at term (39–41 weeks GA). This study aimed to examine the health of these children during their early childhood years, with specific attention to the role of socioeconomic status. Methods A retrospective cohort study was conducted using data from the Manitoba Centre for Health Policy, including all live-born children born at 34–36 and 39–41 weeks GA in urban Manitoba between 2000 and 2005 (n = 28,100). Multivariable logistic regression was used to examine the association of GA with early childhood morbidity after controlling for maternal, child and family level variables. Results The late preterm population was found to have significantly greater adjusted odds of lower respiratory tract infections in the preschool years (aOR = 1.59 [1.24, 2.04]) and asthma at school age (aOR = 1.33 [1.18, 1.47]) compared to the population born at term. The groups also differed in health care utilization at ages 4 (aOR = 1.19 [1.06,1.34]) and 7 years (aOR = 1.24 [1.09, 1.42]). Additional variables associated with poor outcomes suggest that social deprivation and GA simultaneously have a negative impact on early childhood development. Conclusions for Practice Adjustment for predictors of poor early childhood development, including socioeconomic status, were found to attenuate but not eliminate health differences between children born late preterm and children born at term. Poorer health outcomes that extend into childhood have implications for practice at the population level and suggest a need for further follow-up post discharge.

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Soft drinks consumption is associated with nonalcoholic fatty liver disease independent of metabolic syndrome in Chinese population

European Journal of Nutrition

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US to crack down on opioid treatment programs-Bloomberg

Reuters Health News

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Adjunctive use of chromoendoscopy may improve the diagnostic performance of narrow-band imaging for small sessile serrated adenoma/polyp

Journal of Gastroenterology and Hepatology

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Dark hair dye and chemical relaxers linked to breast cancer

Reuters Health News

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Is pancreaticogastrostomy safer than pancreaticojejunostomy after pancreaticoduodenectomy? A meta-regression analysis of randomized clinical trials

Pancreatology

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Prevalence of intestinal complications in inflammatory bowel disease: A comparison between paediatric-onset and adult-onset patients

European Journal of Gastroenterology & Hepatology

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Magnifying NBI patterns of gastric mucosa after Helicobacter pylori eradication and its potential link to the gastric cancer risk

Digestive Diseases and Sciences

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HBV reactivation in patients with HCV/HBV cirrhosis on treatment with direct acting antivirals

Journal of Viral Hepatitis

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Association of single nucleotide polymorphisms in microRNAs with susceptibility to hepatitis B virus infection and HBV-related liver complications: A study in a Saudi Arabian population

Journal of Viral Hepatitis

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Cirrhosis has no impact on therapeutic responses of entecavir for chronic hepatitis B

European Journal of Gastroenterology & Hepatology

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Incidence of norovirus-associated diarrhea and vomiting disease among children and adults in a community cohort in the Peruvian Amazon basin

Clinical Infectious Diseases

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The effects of diet and lifestyle interventions on insulin resistance in patients with nonalcoholic fatty liver disease: A systematic review

European Journal of Gastroenterology & Hepatology

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Antidepressants in pregnancy not tied to intellectual disability in kids

Reuters Health News

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No association between proton pump inhibitor use and risk of Alzheimer’s disease

The American Journal of Gastroenterology

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Vasoactive intestinal polypeptide and mast cells regulate increased passage of colonic bacteria in patients with irritable bowel syndrome

Gastroenterology

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Clinical course and core variability in HBV infected patients without detectable anti-HBc antibodies

Journal of Clinical Virology

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The prevalence of gastric heterotopia of the proximal esophagus is underestimated, but preneoplasia is rare - correlation with Barrett’s esophagus

BMC Gastroenterology

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Correction of abdominal distension by biofeedback-guided control of abdomino-thoracic muscular activity in a randomized, placebo-controlled trial

Clinical Gastroenterology and Hepatology

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Assessing the impact of colonoscopy complications on use of colonoscopy among primary care physicians and other connected physicians: An observational study of older Americans

BMJ Open

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A phase II trial of erlotinib monotherapy in advanced pancreatic cancer as a first- or second-line agent

Cancer Chemotherapy and Pharmacology

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The miR-1206 microRNA variant is associated with methotrexate-induced oral mucositis in pediatric acute lymphoblastic leukemia

Five-year survival rates of pediatric acute lymphoblastic leukemia (ALL) have reached 90% in the developed countries. However, toxicity because of methotrexate (MTX) occurs frequently. Variety in the occurrence of toxicity is partly determined by single nucleotide polymorphisms (SNPs) in coding regions. Recently, five SNPs in non-coding pre-microRNAs and microRNA processing (miRNA) genes were identified in association with MTX-induced oral mucositis. This study aimed to replicate the association of these miRNA variants in relation to MTX-induced oral mucositis in a prospective childhood ALL cohort. Three out of five SNPs with a minor allele frequency more than 0.15 [CCR4-NOT transcription complex (CNOT4) rs3812265, miR-1206 rs2114358, miR-2053 rs10505168] were analyzed in 117 pediatric ALL patients treated with 5 g/m2 MTX (DCOG ALL-10). Oral mucositis was defined as grade more than or equal to 3 according to the National Cancer Institute criteria. rs2114358 in miR-1206 was associated with oral mucositis [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.1–11.5], whereas we did not confirm the association of CNOT4 rs3812265 (OR: 0.69; 95% CI: 0.27–1.80) and miR-2053 rs10505168 (OR: 2.50; 95% CI: 0.76–8.24). Our results replicate the association between rs2114358 in miR-1206 and MTX-induced oral mucositis in childhood ALL. Genetic variation in miR-1206 has potential as a novel biomarker to predict MTX-induced toxicity.

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Genetic coding variants in the niacin receptor, hydroxyl–carboxylic acid receptor 2, and response to niacin therapy

Objective: Niacin has been used for seven decades to modulate plasma lipids, but its mechanism of action is still unclear. We sought to determine whether variants in the niacin receptor gene, hydroxyl–carboxylic receptor 2 (HCAR2), are associated with lipid response to treatment. Participants and methods: Coding variants, rs7314976 (p.R311C) and rs2454727 (p.M317I), were genotyped in 2067 participants from the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes (AIM-HIGH) trial. AIM-HIGH was a randomized, placebo-controlled trial that was conducted to assess the effect of extended-release niacin in patients with cardiovascular disease aggressively treated with low-density lipoprotein cholesterol-lowering therapy. Results: There was no association of p.R311C or p.M317I with changes in low-density lipoprotein cholesterol, triglycerides, or high-density lipoprotein cholesterol at 1 year in groups receiving placebo or extended-release niacin. In White patients, the reduction in lipoprotein (a) [Lp(a)] in response to niacin was greater in homozygous carriers of the major 317M allele (−22.7%; P=0.005) compared with minor allele carriers (−15.3%). This was directionally consistent in the Black participants. Upon combining both groups, the reduction in Lp(a) in response to niacin was significantly greater in the homozygous major allele carriers (−23.0%; P=0.003) compared with minor allele carriers (−15.2%). Conclusion: Understanding the genetic contribution toward variation in response to niacin therapy, including Lp(a) reduction, could uncover mechanisms by which niacin decreases Lp(a), an important independent risk factor for cardiovascular disease.

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Correlation between cytochrome P450 2C19 genetic polymorphism and treatment response to escitalopram in panic disorder

Objectives: Escitalopram (S-CT) is used widely to treat patients with panic disorder (PD) and the CYP2C19 enzyme is responsible for S-CT metabolism. We hypothesized that CYP2C19 polymorphisms were associated with S-CT treatment response in Chinese patients with PD. Patients and methods: Seventy-eight patients with PD completed the assessment by the Panic Disorder Severity Scale – Chinese Version (PDSS-CV) and the Hamilton Anxiety Scale (HAMA-14) during an 8-week period. All patients were administered a fixed dose of 10 mg/day S-CT. Three CYP2C19 metabolizer phenotypes were analyzed by PCR-genotyping microarray, including extensive metabolizer (EM), intermediate metabolizer, and poor metabolizer (PM). Results: This prospective, open-label and observational study showed that the proportion of EM (43.6%) was higher than that of PM (10.2%). There were higher response ratios of PDSS-CV in PM (the second to fourth week: 62.5–100%) than in EM (the second to fourth week: 23.5–55.9%) (Ps

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Genetics of pleiotropic effects of dexamethasone

Objectives: Glucocorticoids such as dexamethasone have pleiotropic effects, including desired antileukemic, anti-inflammatory, or immunosuppressive effects, and undesired metabolic or toxic effects. The most serious adverse effects of dexamethasone among patients with acute lymphoblastic leukemia are osteonecrosis and thrombosis. To identify inherited genomic variation involved in these severe adverse effects, we carried out genome-wide association studies (GWAS) by analyzing 14 pleiotropic glucocorticoid phenotypes in 391 patients with acute lymphoblastic leukemia. Patients and methods: We used the Projection Onto the Most Interesting Statistical Evidence integrative analysis technique to identify genetic variants associated with pleiotropic dexamethasone phenotypes, stratifying for age, sex, race, and treatment, and compared the results with conventional single-phenotype GWAS. The phenotypes were osteonecrosis, central nervous system toxicity, hyperglycemia, hypokalemia, thrombosis, dexamethasone exposure, BMI, growth trajectory, and levels of cortisol, albumin, and asparaginase antibodies, and changes in cholesterol, triglycerides, and low-density lipoproteins after dexamethasone. Results: The integrative analysis identified more pleiotropic single nucleotide polymorphism variants (P=1.46×10−215), and these variants were more likely to be in gene-regulatory regions (P=1.22×10−6) than traditional single-phenotype GWAS. The integrative analysis yielded genomic variants (rs2243057 and rs6453253) in F2RL1, a receptor that functions in hemostasis, thrombosis, and inflammation, which were associated with pleiotropic effects, including osteonecrosis and thrombosis, and were in regulatory gene regions. Conclusion: The integrative pleiotropic analysis identified risk variants for osteonecrosis and thrombosis not identified by single-phenotype analysis that may have importance for patients with underlying sensitivity to multiple dexamethasone adverse effects.

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PharmGKB summary: pazopanib pathway, pharmacokinetics

No abstract available

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Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study.

The aim of the study was to investigate the differences in the stability limits between patients with vascular and nonvascular unilateral transtibial amputation (UTA) and patients without amputation. Eighteen patients with UTA who used a prosthesis were divided into two groups: vascular (n=9) and nonvascular (n=9). Twenty-four patients without amputation served as the control group. Computerized dynamic posturography Smart EquiTest System, version 8.0 was used for measuring stability limits. The limits of stability test was used to assess the participants' ability to voluntarily sway to various locations in space. The measured parameters were maximum centre of gravity (COG) excursion, endpoint COG excursion and directional control. Single-factor analysis of variance and Bonferroni adjustment a posteriori tests was performed to investigate the differences between groups. The patients with vascular UTA had significantly lower endpoint COG excursion to oblique and forward direction compared with controls (P=0.017). In addition, the patients with vascular UTA had significantly lower maximum COG excursion to oblique and forward and to oblique and backward directions (P=0.031; 0.019). Patients with vascular UTA had significantly lower endpoint and maximum COG excursion to oblique and backward direction compared with patients with nonvascular UTA (P=0.30; 0.029). To summarize, patients with vascular UTA have substantially reduced limits of stability compared with patients without amputation and the patients with nonvascular UTA. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Electrical stimulation therapy for dysphagia: a follow-up survey of USA dysphagia practitioners.

The aim of this study was to compare current application, practice patterns, clinical outcomes, and professional attitudes of dysphagia practitioners regarding electrical stimulation (e-stim) therapy with similar data obtained in 2005. A web-based survey was posted on the American Speech-Language-Hearing Association Special Interest Group 13 webpage for 1 month. A total of 271 survey responses were analyzed and descriptively compared with the archived responses from the 2005 survey. Results suggested that e-stim application increased by 47% among dysphagia practitioners over the last 10 years. The frequency of weekly e-stim therapy sessions decreased while the reported total number of treatment sessions increased between the two surveys. Advancement in oral diet was the most commonly reported improvement in both surveys. Overall, reported satisfaction levels of clinicians and patients regarding e-stim therapy decreased. Still, the majority of e-stim practitioners continue to recommend this treatment modality to other dysphagia practitioners. Results from the novel items in the current survey suggested that motor level e-stim (e.g. higher amplitude) is most commonly used during dysphagia therapy with no preferred electrode placement. Furthermore, the majority of clinicians reported high levels of self-confidence regarding their ability to perform e-stim. The results of this survey highlight ongoing changes in application, practice patterns, clinical outcomes, and professional attitudes associated with e-stim therapy among dysphagia practitioners. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Robotic Hand-Assisted Training for Spinal Cord Injury Driven by Myoelectric Pattern Recognition: A Case Report.

A 51-year-old man with an incomplete C6 spinal cord injury sustained 26 yrs ago attended twenty 2-hr visits over 10 wks for robot-assisted hand training driven by myoelectric pattern recognition. In each visit, his right hand was assisted to perform motions by an exoskeleton robot, while the robot was triggered by his own motion intentions. The hand robot was designed for this study, which can perform six kinds of motions, including hand closing/opening; thumb, index finger, and middle finger closing/opening; and middle, ring, and little fingers closing/opening. After the training, his grip force increased from 13.5 to 19.6 kg, his pinch force remained the same (5.0 kg), his score of Box and Block test increased from 32 to 39, and his score from the Graded Redefined Assessment of Strength, Sensibility, and Prehension test Part 4.B increased from 22 to 24. He accomplished the tasks in the Graded Redefined Assessment of Strength, Sensibility, and Prehension test Part 4.B 28.8% faster on average. The results demonstrate the feasibility and effectiveness of robot-assisted training driven by myoelectric pattern recognition after spinal cord injury. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Effects of Altering Trunk Position During Landings on Patellar Tendon Force and Pain.

Purpose: To verify the immediate effects of altering sagittal plane trunk position during jump-landings on lower limb biomechanics, patellar tendon force and pain of athletes with and without patellar tendinopathy. Methods: Twenty-one elite male athletes were categorized into 3 groups, athletes with patellar tendinopathy (TG, n=7), asymptomatic athletes with patellar tendon abnormalities (AG, n=7) and asymptomatic athletes without tendon abnormalities (CG, n=7). A biomechanical evaluation was conducted while the athletes performed drop landings from a bench in a self-selected trunk position (SS). Afterwards, the athletes were randomly assigned to land with either a flexed trunk position (FLX) or an extended trunk position (EXT). Variables of interest for this study included sagittal plane peak kinematics, kinetics, patellar tendon force and pain during the landing tasks. Results: Peak patellar tendon force, knee extensor moment and knee pain decreased in the FLX landing compared to the SS landing, regardless of group. In addition, peak patellar tendon force, knee extensor moment and vertical ground reaction force were smaller in the FLX landing compared to the EXT landing. The TG had smaller peak ankle dorsiflexion than the CG during jump-landings, regardless of trunk position. Conclusion: Landing with greater trunk flexion decreased patellar tendon force in elite jumping athletes. An immediate decrease in knee pain was also observed in symptomatic athletes with a more flexed trunk position during landing. Increasing trunk flexion during landing might be an important strategy to reduce tendon overload in jumping athletes. (C) 2017 American College of Sports Medicine

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Pilot Trial of a Home-based Physical Activity Program for African American Women.

Purpose: To assess the feasibility of a Home-based, Individually-tailored Physical activity Print (HIPP) intervention for African American women in the Deep South. Methods: A pilot randomized trial of the HIPP intervention (N=43) vs. wellness contact control (N=41) was conducted. Recruitment, retention, and adherence were examined, along with physical activity (7-Day PARs, accelerometers) and related psychosocial variables at baseline and 6 months. Results: The sample included 84 overweight/obese African American women aged 50-69 in Birmingham, AL. Retention was high at 6 months (90%). Most participants reported being satisfied with the HIPP program and finding it helpful (91.67%). There were no significant between group differences in physical activity (p=0.22); however, HIPP participants reported larger increases (M=+73.9 minutes/week, SD=90.9) in moderate intensity or greater physical activity from baseline to 6 months than the control group (+41.5, SD=64.4). The HIPP group also reported significantly greater improvements in physical activity goal-setting (p=.02) and enjoyment (p=.04) from baseline to 6 months than the control group. There were no other significant between group differences [6MWT, weight, physical activity planning, behavioral processes, stage of change]; however, trends in the data for cognitive processes, self-efficacy, outcome expectations, and family support for physical activity indicated small improvements for HIPP participants (P> .05) and declines for control participants. Significant decreases in decisional balance (p=0.01) and friend support (p=0.03) from baseline to six months were observed in the control arm and not the intervention arm. Conclusion: The HIPP intervention has great potential as a low cost, high reach method for reducing physical activity-related health disparities. The lack of improvement in some domains may indicate that additional resources are needed to help this target population reach national guidelines. (C) 2017 American College of Sports Medicine

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