Σάββατο, 23 Σεπτεμβρίου 2017

Dynamics of defensive response mobilization during repeated terminations of exposure to increasing interoceptive threat

S01678760.gif

Publication date: Available online 23 September 2017
Source:International Journal of Psychophysiology
Author(s): Christoph Benke, Elischa Krause, Alfons O. Hamm, Christiane A. Pané-Farré
Resistant avoidance behaviors play a crucial role in the maintenance of anxiety disorders and are therefore central targets of therapeutic interventions. In the present study, the development of avoidance behavior was investigated in 24 healthy participants who repeatedly prematurely terminated the exposure to increasing interoceptive threat, i.e., the feeling of dyspnea induced by increasing inspiratory resistive loads that were followed by the ultimate threat, a short breathing occlusion. Physiological responses and subjective anxiety preceding terminations were compared to matched intervals of a matched control group (N=24) who completed the exposure. Initially, participants terminated during the ultimate threat, i.e., during occlusion. This first termination was preceded by a strong surge in autonomic arousal and reported anxiety. Startle reflex and the P3 component of event-related brain potentials to startle probes were strongly inhibited, indicating preparation for defensive action. With repetitive terminations, individuals successively terminated earlier, avoiding exposure to the occlusion. This avoidant behavior was accompanied by alleviated autonomic arousal as compared to the first termination. In addition, no indication of physiological response preparation was found implying that the avoidance behavior was performed in a rather habitual way. Matched controls did not show any indication of a defensive response surge in the matched intervals. In matched controls, no changes in physiological response patterns were detected while anxiety levels increased with repetitions. The present results shed new light on our understanding of the motivational basis of avoidance behavior and may help to refine etiological models, behavioral analysis and therapeutic strategies in treating anxiety disorders.



from Physiology via xlomafota13 on Inoreader http://ift.tt/2xZqdrU
via IFTTT

Histone Methylation and the DNA Damage Response

Publication date: Available online 23 September 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Fade Gong, Kyle M. Miller
Preserving genome function and stability are paramount for ensuring cellular homeostasis, an imbalance in which can promote diseases including cancer. In the presence of DNA lesions, cells activate pathways referred to as the DNA damage response (DDR). As nuclear DNA is bound by histone proteins and organized into chromatin in eukaryotes, DDR pathways have evolved to sense, signal and repair DNA damage within the chromatin environment. Histone proteins, which constitute the building blocks of chromatin, are highly modified by post-translational modifications (PTMs) that regulate chromatin structure and function. An essential histone PTM involved in the DDR is histone methylation, which is regulated by histone methyltransferase (HMT) and histone demethylase (HDM) enzymes that add and remove methyl groups on lysine and arginine residues within proteins respectively. Methylated histones can alter how proteins interact with chromatin, including their ability to be bound by reader proteins that recognize these PTMs. Here, we review histone methylation in the context of the DDR, focusing on DNA double-strand breaks (DSBs), a particularly toxic lesion that can trigger genome instability and cell death. We provide a comprehensive overview of histone methylation changes that occur in response to DNA damage and how the enzymes and reader proteins of these marks orchestrate the DDR. Finally, as many epigenetic pathways including histone methylation are altered in cancer, we discuss the potential involvement of these pathways in the etiology and treatment of this disease.



from Genetics via xlomafota13 on Inoreader http://ift.tt/2ykJq3m
via IFTTT

Hypoglycaemia Represents a Clinically Significant Manifestation of PIK3CA- and CCND2-Associated Segmental Overgrowth

The PI3K-AKT signalling cascade has a highly conserved role in a variety of processes including cell growth and glucose homoeostasis. Variants affecting this pathway can lead to one of several segmental overgrowth disorders. These conditions are genetically heterogeneous and require tailored, multidisciplinary involvement throughout life. Hypoglycaemia is common in other overgrowth syndromes but has been described only sporadically in association with PIK3CA and CCND2 variants. We report a cohort of 6 children with megalencephaly-capillary malformation syndrome (MCAP) and megalencephaly-polydactyly-polymicrogyria-hydrocephalus syndrome (MPPH) who developed clinically significant hypoglycaemia. Based on our findings, we suggest that segmental overgrowth patients should be screened for low blood glucose levels during childhood and there should be early specialist endocrine review in any children who develop hypoglycaemia.

Thumbnail image of graphical abstract

from Genetics via xlomafota13 on Inoreader http://ift.tt/2xBjp2E
via IFTTT

Pelvic Girdle Pain a Typical Female Condition? What About Men?

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Jan-Paul van Wingerden




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xmVVP9
via IFTTT

Cancer Survivors Awaiting Rehabilitation Rarely Achieve Recommended Physical Activity Guidelines

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Amy Dennett, Casey Peiris, Nora Shields, Nicholas Taylor




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2fHYMbw
via IFTTT

Editorial Board

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10





from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xmVUe3
via IFTTT

TheraBracelet Sensory Stimulation To Enhance Hand Functional Recovery Post Stroke

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Na Jin Seo, Ryan Downey, Blair Dellenbach, Rosemarie Imburgia, Abigail Lauer, V. Ramakrishnan, Leonardo Bonilha, Michelle Woodbury




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2fI7N4d
via IFTTT

Table of Contents

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10





from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xmF8Mb
via IFTTT

Editors' Selections From This Issue: Volume 98 / Number 10 / October 2017

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10





from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2fHnCbp
via IFTTT

Manual Therapy: Integration into a Speech and Swallowing Rehabilitation Program for Head and Neck Cancer

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Jan Lewin, Holly Woodall, Christine Porsche, Martha Barrow, Katherine Hutcheson




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jU7esI
via IFTTT

Withdrawn

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10





from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xZKBtd
via IFTTT

Masthead

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10





from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jQK9XC
via IFTTT

Information/Education Pages (I/EPs)

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10





from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2y0lHJK
via IFTTT

Study of Therapy and Assessment on Acupuncture Habilitation for Children with Cerebral Palsy

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Huan Liu




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jVsBdh
via IFTTT

Long-Term Functional Outcomes Among Childhood Cancer Survivors with Osteonecrosis

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Brian DeFeo, Mary Relling, Kirsten Ness, Tara Brinkman, Israel Fernandez-Pineda, Michael Neel, Deo Kumar Srivastava, Zhenghong Li, Melissa Hudson, Leslie Robison, Seth Karol, Sue Kaste




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xYm9YU
via IFTTT

A Medical Home for Individuals with Physical Disabilities: Addressing the Social Determinants of Health

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Nancy Flinn, Thomas Kelley




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jQJR2Y
via IFTTT

Fatigue and Functional Outcomes in Cancer Rehabilitation

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Monica Arrigo, Lisa Wood, Lynne Brady-Wagner, Twyla Fink, Karla Garrity, Amanda Mack




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xYvJLj
via IFTTT

Effects of Real-time Gait Biofeedback on Paretic Propulsion and Gait Biomechanics in Individuals Post-Stroke

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Katlin Genthe, Christopher Schenck, Steven Eicholtz, Steven Wolf, Trisha Kesar




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jSZ83x
via IFTTT

Importance of the Correct Use of Extracorporeal Shockwave Therapy

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Hannes Müller-Ehrenberg, Silvia Ramón, Wolfgang Schaden, Daniel Moya, María Cristina d'Agostino, Carlos Leal, José Ramón Aranzabal, José Eid




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2y0lGpa
via IFTTT

2017 ACRM Annual Conference Abstracts

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10





from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jQP62G
via IFTTT

Relationship Between Pain, Social Support and Socio-Economic Indicators in Individuals with Spinal Cord Injury

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Zahra Khazaeipour, Ehsan Ahmadipour, Vafa Rahimi-Movaghar, Fereshteh Ahmadipour, Alexander R. Vaccaro, Babak Babakhani




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xZotiv
via IFTTT

Development and Implementation of a Theory-Based Sedentary Behavior Change Intervention for People with Stroke

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Victor Ezeugwu, Patricia Manns




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xZojrp
via IFTTT

Ankle Control Differentiation as a Mechanism for Mobility Limitations

alertIcon.gif

Publication date: October 2017
Source:Archives of Physical Medicine and Rehabilitation, Volume 98, Issue 10
Author(s): Eric James, Jeffrey Hausdorff, Suzanne Leveille, Thomas Travison, Jonathan Bean




from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jQOLNs
via IFTTT

Using PLIN proteins to explain the Athlete's Paradox

Abstract

Modern humans over-consume calories so much that adipose tissue can no longer keep up with storage requirements, forcing other tissues, like skeletal muscle, to compensate by storing more lipids (IMTG).

This article is protected by copyright. All rights reserved



from Physiology via xlomafota13 on Inoreader http://ift.tt/2hpEJ1D
via IFTTT

Best practice guidelines for the measurement of physical activity levels in stroke survivors: a secondary analysis of an observational study.

The aim of this study was to investigate the phenomenon of activity (increased activity in response to monitor wear) and determine the minimum wear time of accelerometers when objectively measuring habitual physical activity levels of community dwelling stroke survivors. Exploratory, secondary analyses of cross-sectional data were carried out. Physical activity variables [sitting, standing and stepping time, step count, light physical activity and moderate-to-vigorous physical activity (MVPA)] were measured with two activity monitors for 7 days. Repeated-measures analysis of variance was used to assess reactivity. Minimum wear time was assessed using regression analyses and median absolute differences. Paired t-tests were used to assess differences between weekend and weekday activity levels. There was no evidence of reactivity. Minimum wear time was 3 days for all activity variables, with the exception of MVPA, for which 7 days of monitoring was required. There were no significant differences in weekend and weekday activity levels. To accurately measure activity levels of individuals with stroke, we recommend 3 days of monitoring for all activity variables, with the exception of MVPA, which requires 7 days. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2yjYZZ6
via IFTTT

What is the future of Public Health Policy within the European Union?

The future of Public Health Policy within the European Union (EU) institutions is currently attracting considerable debate. Since achieving a mandate for public health under the Maastricht Treaty in 1993, the EU has been responsible for implementing important public health policies, for example in the area of tobacco control. Much more however remains to be achieved.1 As the commercial and political determinants of health become increasingly shaped at supra-national levels, there is a clear and pressing need and role for an EU that is actively and visibly at the forefront promoting improvement for the health of European citizens. The EU has a vital role to play in enabling and supporting all Member States to reach the targets set by the Sustainable Development Goals—the vast majority of which will improve health—and assisting other countries with Sustainable Development Goal implementation. The goals are interconnected and provide strong support for health in all policies, also at EU level: the European Commission is commitment to mainstream them into their own priorities.

from Health via xlomafota13 on Inoreader http://ift.tt/2ywXeJ4
via IFTTT

European Public Health News

In this European public health news, we have six contributions all showing the need to work together, look beyond our field of expertise and combine facts with actions. 'Leaving no one behind' is addressed by all contributors. Azzopardi Muscat highlights the role national public health associations can play in setting the European agenda by engaging in the design and implementation during the EU presidencies. Jakab emphasizes the need for strong health systems to be able to attain the Sustainable Development Goals (SDGs). Andriukaitis presents the new antimicrobial resilience action plan that is based on a 'One Health' approach, where coordination and cooperation is necessary from all sides. Lindert stresses that public health includes public mental health and that action in this area is and should be a top priority. Forsberg and Zeegers both reflect on the Stockholm conference; Forsberg by commemorating Prof. Rosling who always taught to start with the facts, analyse the implications and then engage for change, Zeegers by emphasizing the need for our own positive commitment for resilience and for moving forward with action when needed.

from Health via xlomafota13 on Inoreader http://ift.tt/2yxiFd2
via IFTTT

In reply to the Letter to the Editor

We wish to thank Drs Biggs and Roberts for their interest in our work. We do not, however, agree that our study contradicts earlier literature, but rather adds to current knowledge. Research on teenage girls who undergo abortion is extremely sparse. Therefore, understanding of the hardships these girls may face before and after pregnancy is far from complete. As earlier, high-quality research shows, abortion itself does not seem to lead to mental health problems or other challenges in later life.3,4

from Health via xlomafota13 on Inoreader http://ift.tt/2xuQexJ
via IFTTT

Resilience and 21st century public health

The concept of 'resilience' is recently being increasingly used in academia, professional bodies, business, human rights and civil society organizations and in a wide-range of policy sectors. Its use in the field of public health has long been part and parcel of preventive policies designed to promote a long-term, holistic and socio-economic developmental approach to individual, community health and wellbeing. With today's protracted economic crisis, it is more vital than ever to be clear about its particular significance if we are to foster lasting and meaningful action to strengthen resilience to improve health and well-being.

from Health via xlomafota13 on Inoreader http://ift.tt/2ywSEL0
via IFTTT

Fatal flaws in recent analysis on the risk of premature death following teenage abortion and childbirth

We commend Jalanko et al.1 for taking advantage of Finnish registry data to answer important policy-relevant questions. However, a fatal flaw in their analysis calls into question the validity of its findings Furthermore, their results conflict with every rigorous study and review examining the effects of abortion on women's mental health outcomes, including suicidal behaviors and alcohol-related problems.2 It is critical that studies comparing the mental health outcomes of women following abortion and childbirth to never-pregnant women account for selection into these groups, particularly women's pre-pregnancy mental and physical health and substance use. Women who have abortions have a higher incidence of pre-pregnancy mental health conditions than women without a history of abortion2,3 and the reasons women seek abortion– financial, the desire to end an abusive relationship, and heavy alcohol and drug use4—can affect women's mental health post-abortion. However, Jalanko et al.1 failed to control for these pre-disposing factors. The higher rates of pre-pregnancy psychiatric illness and substance use disorders among the teenagers who became pregnant,5 likely explains the incongruity of their findings with the latest evidence. Without controls for these factors, it is not possible to attribute the outcomes to the abortion or pregnancy. Given that these are registry data, the authors likely had access to women's pre-pregnancy mental health and substance use history, and thus should have accounted for these variables. Not including controls for these factors raises serious questions about the legitimacy of the study findings.

from Health via xlomafota13 on Inoreader http://ift.tt/2xvzaro
via IFTTT

Healthy diets and a healthy planet

What we eat has always been a central component of culture, wherever in the world we live. Since time immemorial humans have eaten diets based on what was consumed locally, and, whatever they consisted of, diets generally were seen as 'healthy' and 'wholesome'.1 Not until the twentieth century were scientific diet research institutes established, but these were little noticed by other scientists until John Boyd Orr, the first Director of Aberdeen's Rowett Research Institute (later Lord Boyd Orr, the first Director General of the UN Food and Agriculture Organisation), published in 1936 his considerable study of the appalling levels of malnutrition among the British people, regardless of economic status;2 it was on the basis of this that the wartime coalition government invited Boyd Orr to design a scientifically based diet with the aim of keeping the UK population healthy during the Second World War.

from Health via xlomafota13 on Inoreader http://ift.tt/2xvBzme
via IFTTT

Avoidable hospitalization among migrants and ethnic minority groups: a systematic review

Abstract
Background
The numbers of migrants living in Europe are growing rapidly, and has become essential to assess their access to primary health care (PHC). Avoidable Hospitalization (AH) rates can reflect differences across migrant and ethnic minority groups in the performance of PHC. We aimed to conduct a systematic review of all published studies on AH comparing separately migrants with natives or different racial/ethnic groups, in Europe and elsewhere.
Methods
We ran a systematic search for original articles indexed in primary electronic databases on AH among migrants or ethnic minorities. Studies presenting AH rates and/or rate ratios between at least two different ethnic minority groups or between migrants and natives were included.
Results
Of the 35 papers considered in the review, 28 (80%) were conducted in the United States, 4 in New Zealand, 2 in Australia, 1 in Singapore, and none in Europe. Most of the studies (91%) used a cross-sectional design. The exposure variable was defined in almost all articles by ethnicity, race, or a combination of the two; country of birth was only used in one Australian study. Most of the studies found significant differences in overall AH rates, with minorities (mainly Black and Hispanics) showing higher rates than non-Hispanic Whites.
Conclusions
AH has been used, mostly in the US, to compare different racial/ethnic groups, while it has never been used in Europe to assess migrants' access to PHC. Studies comparing AH rates between migrants and natives in European settings can be helpful in filling this lack of evidence.

from Health via xlomafota13 on Inoreader http://ift.tt/2yxL7eL
via IFTTT

The growth of ‘Dry January’: promoting participation and the benefits of participation

Abstract
This article explores contributors to the rapid growth of the annual UK alcohol abstinence challenge 'Dry January' and the benefits of registration. Evidence from four sources is presented: (i) registrations via the Dry January website, (ii) surveys of population-representative samples of drinkers, (iii) surveys of Dry January registrants and (iv) surveys of a control group of drinkers who wanted to change to their drinking behaviour but had not registered for Dry January. The data revealed that Dry January registrations increased 15-fold in 4 years. Participants reported that encouragement received from Dry January helped them to avoid drinking. Comparisons of Dry January registrants to the control group suggest that registering for Dry January reduced problematic drinking and enhanced the capacity to refuse alcohol. The four sources of data suggest that 'social contagion' and 'diffusion' have aided the growth of the awareness, appeal and practice of Dry January.

from Health via xlomafota13 on Inoreader http://ift.tt/2xvi512
via IFTTT

Admissions to inpatient care facilities in the last year of life of community-dwelling older people in Europe

Abstract
Background
In the last year of life, many older people rather avoid admissions to inpatient care facilities. We describe and compare such admissions in the last year of life of 5092 community-dwelling older people in 15 European countries (+Israel).
Methods
Proxy-respondents of the older people, who participated in the longitudinal SHARE study, reported on admissions to inpatient care facilities (hospital, nursing home or hospice) during the last year of their life. Multivariable regression analyses assessed associations between hospitalizations and personal/contextual characteristics.
Results
The proportion of people who had been admitted at least once to an inpatient care facility in the last year of life ranged from 54% (France) to 76% (Austria, Israel, Slovenia). Admissions mostly concerned hospitalizations. Multivariable analyses showed that especially Austrians, Israelis and Poles had higher chances of being hospitalized. Further, hospitalizations were more likely for those being ill for 6 months or more (OR:1.67, CI:1.39–2.01), and less likely for persons aged 80+ (OR:0.54, CI:0.39–0.74; compared with 48–65 years), females (OR:0.74, CI:0.63–0.89) and those dying of cardiovascular diseases (OR:0.66, CI:0.51–0.86; compared with those dying of cancer).
Conclusions
Although healthcare policies increasingly stress the importance that people reside at home as long as possible, admissions to inpatient care facilities in the last year of life are relatively common across all countries. Furthermore, we found a striking variation concerning the proportion of admissions across countries which cannot only be explained by patient needs. It suggests that such admissions are at least partly driven by system-level or cultural factors.

from Health via xlomafota13 on Inoreader http://ift.tt/2yz26h0
via IFTTT

The increase in symptoms of anxiety and depressed mood among Icelandic adolescents: time trend between 2006 and 2016

Abstract
Background
Both research and popular media reports suggest that adolescent mental health has been deteriorating across societies with advanced economies. This study sought to describe the trends in self-reported symptoms of depressed mood and anxiety among Icelandic adolescents.
Methods
Data for this study come from repeated, cross-sectional, population-based school surveys of 43 482 Icelandic adolescents in 9th and 10th grade, with six waves of pooled data from 2006 to 2016. We used analysis of variance, linear regression and binomial logistic regression to examine trends in symptom scores of anxiety and depressed mood over time. Gender differences in trends of high symptoms were also tested for interactions.
Results
Linear regression analysis showed a significant linear increase over the course of the study period in mean symptoms of anxiety and depressed mood for girls only; however, symptoms of anxiety among boys decreased. The proportion of adolescents reporting high depressive symptoms increased by 1.6% for boys and 6.8% for girls; the proportion of those reporting high anxiety symptoms increased by 1.3% for boys and 8.6% for girls. Over the study period, the odds for reporting high depressive symptoms and high anxiety symptoms were significantly higher for both genders. Girls were more likely to report high symptoms of anxiety and depressed mood than boys.
Conclusions
Self-reported symptoms of anxiety and depressed mood have increased over time among Icelandic adolescents. Our findings suggest that future research needs to look beyond mean changes and examine the trends among those adolescents who report high symptoms of emotional distress.

from Health via xlomafota13 on Inoreader http://ift.tt/2ywYID4
via IFTTT

Effects of home-visit nursing services on hospitalization in the elderly with pressure ulcers: a longitudinal study

Abstract
Background
The risk of pressure ulcers in beneficiaries of long-term care insurance is expected to increase in South Korea's aging society. However, those who stay at home may not be managed appropriately with regard to pressure ulcer development. Here, we examined the relationship between home-visit nursing services and hospitalization related to pressure ulcers among beneficiaries with pressure ulcers in home-care settings.
Methods
We analyzed National Aging Cohort data from 2008 to 2013. The study population was defined as those who required nursing care for pressure ulcers and received home-care services at least once under long-term care insurance. Logistic regression analysis using generalized estimating equation models was performed to examine the association between home-visit nursing services and hospitalization related to pressure ulcers.
Results
Among 4,807 beneficiaries with pressure ulcers, 859 (17.9%) were admitted to hospitals during the study period. The use of home-visit nursing services was associated significantly with a lower risk of hospitalization (odds ratio = 0.68, 95% confidence interval = 0.49–0.93; reference, no use). This association was especially strong in beneficiaries with mildly impaired mobility and cognitive function.
Conclusions
Given the protective role of home-visit nursing services in the management of long-term care insurance beneficiaries with pressure ulcers who stay at home, healthcare professionals need to consider effective strategies for the activation of home-visit nursing services in South Korea.

from Health via xlomafota13 on Inoreader http://ift.tt/2xv1ytK
via IFTTT

Can a workplace ‘sit less, move more’ programme help Spanish office employees achieve physical activity targets?

Abstract
We evaluated the impact of a workplace 'sit less, move more' programme (Walk@WorkSpain, W@WS, 19-week) on self-reported activity-related energy expenditure (AREE) in Spanish office employees (n = 264; 42 ± 10 years; 171 female) randomly assigned to Intervention (IG; used W@WS; n = 129) or comparison groups (CGs; n = 135). A linear mixed model assessed changes in METs-min/wk of total, vigorous, moderate and light physical activity (IPAQ short form) between baseline and 2 months follow-up. Over the CG, IG significantly increased light intensity AREE (P = 0.027). W@WS secured sustained increases on AREE—but not on achieving PA recommendations—providing translational evidence that active living in office employees can be increased.

from Health via xlomafota13 on Inoreader http://ift.tt/2ywXc3U
via IFTTT

Assessment of informal caregiver’s needs by self-administered instruments: a literature review

Abstract
Background
Clinicians, researchers and politicians are seeking to better assess caregiver's needs. Challenges exist in broadly implementing this so as to provide appropriate support. The aim of this review was to compile self-administered instruments for assessment of caregiver's needs that are deemed to be scientifically robust.
Methods
The Medline database was searched for publications reporting self-administered instruments assessing caregiver's needs with acceptable psychometric properties. These instruments were analyzed in terms of the development context, target population, concept, purpose, structure, content and psychometric properties. The dimensions of the needs were listed and categorized.
Results
A total of nine self-administered instruments were analyzed. They averaged 32 items, they were specifically developed for a targeted subpopulation of caregivers and dedicated to epidemiological research. Response devices were based on Likert scales. The main dimensions of the needs identified were 'Health and Care', 'Psychological – Emotional Support', 'Information—Knowledge', 'Social Life—Work—Finance'. None was specifically geared toward caregivers for the elderly, children or teenagers. In the absence of transcultural validation, no instrument was directly usable in Europe.
Conclusions
Assessing caregivers' needs is a key part in providing caregivers with appropriate support. The development of self-administered instruments constitutes a complex field that is still underexplored at the international level; strict specifications with psychometric validation are essential. To be efficient, the instrument should be integrated in a larger process including: upstream, recognition, identification and assessment of the overall situation of the caregiver; and downstream, guidance, establishment and follow-up of a suitable action plan.

from Health via xlomafota13 on Inoreader http://ift.tt/2xvsLg4
via IFTTT

Lower fragmentation of coordination in primary care is associated with lower prescribing drug costs—lessons from chronic illness care in Hungary

Abstract
Improving patient care coordination is critical for achieving better health outcome measures at reduced cost. However, assessing the results of patient care coordination at system level is lacking. In this report, based on administrative healthcare data, a provider-level care coordination measure is developed to assess the function of primary care at system level. In a sample of 31 070 patients with diabetes we find that the type of collaborative relationship general practitioners build up with specialists is associated with prescription drug costs. Regulating access to secondary care might result in cost savings through improved care coordination.

from Health via xlomafota13 on Inoreader http://ift.tt/2yxL4j5
via IFTTT

Reasons for non-participation and ways to enhance participation in health examination surveys—the Health 2011 Survey

Abstract
High-participation rates to the health examination surveys are needed to obtain representative information about population health. This study aimed to examine reasons for non-participation and factors that could enhance participation using data from the Health 2011 Survey, conducted in 2011–12 in Finland (N = 8135). The most common reason for non-participation was unsuitable timing or location of the health examinations. Older persons also reported that they were too sick to participate. Flexibility on selection of examination times and places and getting feedback on the measurements were most often mentioned as factors which would increase willingness to participate in the future.

from Health via xlomafota13 on Inoreader http://ift.tt/2xvc1FH
via IFTTT

Doctor’s enquiry: an opportunity for promoting smoking cessation—findings from Global Adult Tobacco Surveys in Europe

Abstract
Background
Evidence suggests that advice from motivated physicians to their smoking patients is effective in promoting smoking cessation. Yet, detection rate of smokers is often low and, the proportion of smokers receiving special advice to quit varies. This study aimed to detect how frequently European physicians enquire about their patients' smoking status, and to compare and contrast how (if any) smokers benefit from physicians' enquiry and/or advice about smoking cessation.
Methods
The study was based on secondary analysis of data from six European countries that conducted Global Adult Tobacco Survey, namely, Greece, Poland, Romania, Russia, Turkey and Ukraine.
Results
Out of Global Adult Tobacco Survey participants who were smoking 12 months preceding the survey and had 'at least one visit to a physician' before the survey, half were asked by their physicians about their smoking status and only 37.7% got a brief advice from their physicians to quit smoking. Remarkably, 25% of current smokers did not get any advice from their physicians to quit even when the smoking status was enquired. The adjusted odds ratio was found as 1.55 (95% confidence interval=1.29–1.87) for the association between physician's enquiry about smoking status of a patient and his/her attempt to quit smoking.
Conclusion
Even a simple enquiry of the physician about smoking status of a patient could be effective in smoking cessation, yet, enquiry and advice rates are still far below expected. Regardless of the reason for admission, each contact with a patient should be used as an opportunity to combat smoking-related health risks.

from Health via xlomafota13 on Inoreader http://ift.tt/2ywSBPk
via IFTTT

How strongly related are health status and subjective well-being? Systematic review and meta-analysis

Abstract
Background
Health status is widely considered to be closely associated with subjective well-being (SWB), yet this assumption has not been tested rigorously. The aims of this first systematic review and meta-analysis are to examine the association between health status and SWB and to test whether any association is affected by key operational and methodological factors.
Methods
A systematic search (January 1980–April 2017) using Web of Science, Medline, Embase, PsycInfo and Global health was conducted according to Cochrane and PRISMA guidelines. Meta-analyses using a random-effects model were performed.
Results
Twenty nine studies were included and the pooled effect size of the association between health status and SWB was medium, statistically significant and positive (pooled r = 0.347, 95% CI = 0.309–0.385; Q = 691.51, I2 = 94.99%, P < 0.001). However, the association was significantly stronger: (i) when SWB was operationalised as life satisfaction (r = 0.365) as opposed to happiness (r = 0.307); (ii) among studies conducted in developing countries (r = 0.423) than it was in developed countries (r = 0.336) and (iii) when multiple items were used to assess health status and SWB (r = 0.353) as opposed to single items (r = 0.326).
Conclusion
Improving people's health status may be one means by which governments can improve the SWB of their citizens. Life satisfaction might be preferred to happiness as a measure of SWB because it better captures the influence of health status.

from Health via xlomafota13 on Inoreader http://ift.tt/2xuWgi0
via IFTTT

Do perceived barriers to clinical presentation affect anticipated time to presenting with cancer symptoms: an ICBP study

Abstract
Background
Cancer survival in the UK and Denmark are lower when compared with similar countries with late diagnosis a possible cause. We aimed to study the relationship between barriers to attending a primary care physician (GP) and anticipated time to help seeking (ATHS) with four cancer symptoms in six countries.
Methods
A population-based survey measuring cancer awareness and beliefs conducted within the International Cancer Benchmarking Partnership in Australia, Canada, Denmark, Norway, Sweden and UK. Data were collected on perceived barriers to GP consultation (including embarrassment, worry about wasting the doctors' time, fear about what the doctor might find and being too busy) and ATHS for persistent cough, abdominal swelling, rectal bleeding and breast changes. Relationships between perceived barriers and ATHS were investigated using multivariable analysis.
Results
Among 19 079 respondents, higher perceived barrier scores were associated with longer ATHS intervals for all symptoms studied (P < 0.01) responders with the highest barrier scores (>10.84) had between two and three times the odds of longer ATHS. ATHS was low in Australia for all symptoms and highest in Denmark for abdominal bloating.
Conclusions
Perceived barriers to help-seeking have a role in delaying GP presentation. Early diagnosis campaigns should address emotional and practical barriers that reduce early presentation with potential cancer symptoms.

from Health via xlomafota13 on Inoreader http://ift.tt/2yxmD5e
via IFTTT

Barriers to cervical cancer screening faced by immigrants: a registry-based study of 1.4 million women in Norway

Abstract
Background
Immigrants from certain low- and middle-income countries are more prone to cancers attributed to viral infections in early life. Cervical cancer is caused by human papillomavirus but is highly preventable by regular screening. We assessed participation among immigrants in a population-based cervical screening programme and identified factors that predicted non-adherence within different immigrant groups.
Methods
We used data from several nationwide registries. The study population consisted of 208 626 (15%) immigrants and 1 157 223 (85%) native Norwegians. Non-adherence was defined as no eligible screening test in 2008–12. We estimated prevalence ratios with 95% confidence intervals (CIs) for factors associated with non-adherence by modified Poisson regression.
Results
In total, 52% of immigrants were not screened. All immigrants showed 1.72 times higher non-adherence rates (95% CI 1.71–1.73) compared with native Norwegian women when adjusted for age and parity. The proportion of non-adherent immigrants varied substantially by region of origin and country of origin. Being unemployed or not in the workforce, being unmarried, having low income and having a male general practitioner was associated with non-adherence regardless of region of origin. Living <10 years in Norway was an evident determinant of non-adherence among most but not all immigrant groups.
Conclusions
An increasing proportion of immigrants and low screening participation among them pose new public health challenges in Europe. Immigrants are diverse in terms of their sociodemographic attributes and screening participation. Tailored information and service delivery may be necessary to increase cancer screening among immigrants.

from Health via xlomafota13 on Inoreader http://ift.tt/2xvu5zi
via IFTTT

A systematic review and meta-analysis of the effectiveness of nudging to increase fruit and vegetable choice

Abstract
Background
Nudging refers to interventions that organize the choice architecture in order to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. As a strategy to encourage healthy behaviour, nudging can serve as a complement to health education. However, the empirical evidence regarding the effectiveness of nudging as a way to influence food choice remains contradictory. To address this issue, a systematic review and meta-analysis was conducted to test the effects of nudging to encourage people to select more fruit and vegetables.
Methods
A systematic literature search was performed on PubMed, Medline, PsycInfo, Cochrane library, Scopus and Google Scholar. After quality assessment, 20 articles (23 studies) were retained for narrative synthesis. Twelve articles (14 studies) contained enough information to calculate effect-sizes for meta-analysis using Comprehensive Meta-analysis software.
Results
The meta-analysis shows that nudging interventions that aim to increase fruit and/or vegetable choice/sales/servings have a moderately significant effect (d = 0.30), with the largest effect for altering placement (d = 0.39) and combined nudges (d = 0.28).
Conclusion
The results of this review provide an indication of the effectiveness of nudging on fruit and vegetable choice in terms of actual effect-sizes, while also highlighting the problems that must be addressed before more definitive conclusions can be drawn.

from Health via xlomafota13 on Inoreader http://ift.tt/2yxmuPe
via IFTTT

Correlation between direction and severity of temporomandibular joint disc displacement and reduction ability during mouth opening

Abstract

Background

The most common temporomandibular joint (TMJ) internal derangement is an abnormal relationship of the disc with respect to the mandibular condyle, articular eminence, and glenoid fossa – disc displacement.

Objective

The aim of our study is to analyse the correlation between partial/complete disc displacement in the intercuspal position (IP) and its reduction in the open mouth position (OMP) in both oblique-sagittal and coronal plane on magnetic resonance imaging (MRI) in patients with temporomandibular disorders.

Materials and methods

Multi-section MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to RDC/TMD criteria (148 women, 43 men; aged 14-60 years). The disc position was evaluated on all oblique sagittal and coronal images in the IP and the OMP.

Results

Univariate logistic regression analysis showed that the severity of disc displacement in the sagittal plane is a statistically significant predictor of reduction ability during mouth opening (B=3,118; p<0.001). Moreover, the severity of disc displacement in both planes is also a significant predictor of disc reduction in OMP (B=2,200; p<0.05).

Conclusions

Reduction ability during mouth opening is associated with the severity of disc displacement in IP, in both sagittal and coronal plane. Multi-section analysis of all MR images allows distinguishing the correct disc position from disc displacement and can improve the ability to distinguish between various stages of TMJ internal derangement.

This article is protected by copyright. All rights reserved.



from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2xnjvvn
via IFTTT

A systematic review and meta-analysis of three-unit fixed dental prostheses: are the results of two abutment implants comparable to the results of two abutment teeth?

Summary

The purpose of the systematic review and meta-analysis was to compare the performance of three-unit bridges on teeth with three-unit bridges on implants, evaluating survival of the bridges, survival of the teeth or implants, condition of the hard and soft tissues surrounding the supports, complications and patient-reported outcome measures after a mean observation period of at least 1 year. A literature search was conducted using a combination of the search terms: fixed partial denture and fixed dental prostheses. An electronic search for data published until January 2017 was undertaken using the Medline, Embase and Cochrane Library databases. Eligibility criteria included clinical human studies, either randomized or not, interventional or observational, which evaluated the results of three-unit FDPs (fixed dental prostheses) on either two implants or two abutment teeth. The search identified 1686 unique references. After applying eligibility criteria 66 articles were included in the analysis. A total of 1973 three-unit FDPs were supported by teeth, and 765 were implant-supported. No significant differences were found either in the survival of the supporting abutments (P=0.52; 99% versus 98.7% survival per year) or in the survival of the prostheses (P=0.34; 96.4% versus 97.4% survival per year). Both treatments show an almost equally low complication rate, but there is a low level of reporting of hard and soft tissue conditions and patient-reported outcome measures. It is concluded that implant-supported three-unit FDPs seem to be a reliable treatment with survival rates not significantly different from the results of teeth-supported three-unit FDPs.

This article is protected by copyright. All rights reserved.



from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2fH0LN0
via IFTTT

A Youth Compendium of Physical Activities: Activity Codes and Metabolic Intensities.

Purpose: A Youth Compendium of Physical Activities (Youth Compendium) was developed to estimate the energy costs of physical activities using data on youth only. Methods: Based on a literature search and pooled data of energy expenditure measurements in youth, the energy costs of 196 activities were compiled in 16 activity categories to form a Youth Compendium of Physical Activities. To estimate the intensity of each activity, measured oxygen consumption (V[Combining Dot Above]O2) was divided by basal metabolic rate (Schofield age-, sex- and mass-specific equations) to produce a youth MET (METy). A mixed linear model was developed for each activity category to impute missing values for age ranges with no observations for a specific activity. Results: This Youth Compendium consists of METy values for 196 specific activities classified into 16 major categories for four age groups, 6-9, 10-12, 13-15, and 16-18 years. METy values in this Youth Compendium were measured (51%) or imputed (49%) from youth data. Conclusion: This Youth Compendium of Physical Activities uses pediatric data exclusively, addresses the age-dependency of METy and imputes missing METy values and thus represents advancement in the physical activity research and practice. This Youth Compendium will be a valuable resource for stakeholders interested in evaluating interventions, programs, and policies designed to assess and encourage physical activity in youth. 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. (C) 2017 American College of Sports Medicine

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2xoVNMH
via IFTTT

Absence of Fitness Improvement Is Associated with Outcomes in Heart Failure Patients.

Purpose: To examine the clinical impact of cardiorespiratory fitness (CRF) and improvements in CRF after cardiac rehabilitation (CR) in heart failure (HF) patients for their risk of all-cause mortality and unplanned hospitalization. Secondly, to investigate possible factors associated with the absence of improvement in CRF after rehabilitation. Methods: We included 155 HF patients receiving CR between October 2009 and January 2015. Patients performed an incremental bicycle test to assess CRF through peak oxygen uptake (VO2-peak) before and after CR-based supervised exercise training. Patients were classified as responders or non-responders based on pre-to-post CR changes in VO2-peak (>=6% and

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2xXVr2H
via IFTTT

Challenges with Percent Predicted Maximum VO2 in Patients with Heart Failure.

Purpose: To describe the influence of different equations to predict maximum oxygen uptake (MVO2) on the percent predicted MVO2 (ppMVO2) and the resultant categorization of patients with heart failure with reduced ejection fraction (HFrEF) into high or low risk. Methods: In this retrospective cohort study, ppMVO2 was calculated using six different equations to predict MVO2 among 1,168 patients with HFrEF (33% women). Repeated measures analysis of variance was used to compare within-subject differences in mean ppMVO2 between the prediction equations. Cochrane's Q test was used to compare the within-subject difference in the proportion of patients with ppMVO2 =75% (low risk) between the five prediction equations. Results: The ppMVO2 varied significantly (P<.001 between the mvo2 prediction equations with mean percentile ppmvo2 ranging from to in men and women. significant variation was also observed for proportion of patients>=75% in men and women. Conclusions: Statistically significant and clinically meaningful variations in the ppMVO2 are observed based on the reference equation used to predict MVO2. Future writing committees should specify the preferred reference equation when identifying a ppMVO2 criterion in guideline statements. (C) 2017 American College of Sports Medicine

from Sports Medicine via xlomafota13 on Inoreader http://ift.tt/2xoVKAv
via IFTTT

EUS-guided Transgastric Drainage of a Post-pancreatectomy Abdominal Fluid Collection Using a Lumen-apposing Metal Stent

imageNo abstract available

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xv4wyE
via IFTTT

Cystic Fibrosis–related Liver Disease: Research Challenges and Future Perspectives

imageObjectives: Hepatobiliary complications are a leading cause of morbidity and mortality in cystic fibrosis (CF) patients. Knowledge of the underlying pathological aspects and optimal clinical management is, however, sorely lacking. Methods: We provide a summary of the lectures given by international speakers at the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) monothematic conference on cystic fibrosis–related liver disease (CFLD) held in Paris in January 2016, to discuss the status of our current knowledge of liver disease in CF patients, to define the critical areas that need to be addressed, and to resolve actions to elucidate relevant mechanisms of disease to optimise future therapeutic options. Conclusions: The need for a universal consensus on the definition of CFLD to clarify disease stage and to identify relevant biomarkers to assess disease severity was highlighted. A deeper understanding of the pathophysiology and prognostic factors for the long-term evolution of CFLD is fundamental to move forward and has a strong bearing on identifying potential treatments. Novel experimental models and new treatment options under investigation are discussed and offer hope for the near future of CFLD.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xuXg5G
via IFTTT

Why Tax Sugar Sweetened Beverages?

No abstract available

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wNEa7d
via IFTTT

Frequency of Severe Infusion Reactions Associated With Outpatient Infusion of Infliximab Without Premedications

imageABSTRACT: In this report, we describe incremental changes, during a 2-year period at a single center with the administration of maintenance infliximab infusions. Given practice-driven changes consisting of 1-hour infusions and omission of premedications, we aimed to investigate if these changes contributed to severe infusion reactions. We reviewed approximately 900 infliximab infusions in a pediatric ambulatory infusion center from January 1, 2014, to December 31, 2015, for severe adverse reactions requiring either rescue epinephrine or a code blue or "rapid response" activation. In 2015, these practice changes resulted in a 51% decrease in total infusion hours (1281 to 630 infusion hours), despite a 9% increase in total number of infusions. No increase in severe adverse events associated with either rapid 1-hour infusion or omission of premedications. Our findings highlight a quality-improvement opportunity to standardize infliximab infusions to streamline care in an ambulatory setting.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wNE67t
via IFTTT

To Tax or Not to Tax Sugary Drinks? This Is the Question

No abstract available

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xuUNbn
via IFTTT

Vitamin D Status, Cardiometabolic, Liver, and Mental Health Status in Obese Youth Attending a Pediatric Weight Management Center

imageBackground: Vitamin D (VitD) deficiency and obesity are reaching epidemic proportions in North America, particularly in those with comorbid conditions such as diabetes or liver disease. The study objective was to determine the prevalence of suboptimal vitD status and interrelationships with anthropometric, cardiometabolic, liver, mental health, and lifestyle (sleep/screen time) parameters in an ambulatory population of children with obesity. Methods: Children (2–18 years) attending a pediatric weight management clinic (n = 217) were retrospectively reviewed. Variables studied included anthropometric (weight, height, body mass index, waist circumference), vitD (serum 25-hydroxyvitamin D), cardiometabolic (systolic blood pressure, diastolic blood pressure, glucose, insulin, homeostasis model assessment for insulin resistance, triglyceride, high-density lipoprotein, low-density lipoprotein, total cholesterol), liver enzymes (alanine aminotransferase, gamma-glutamyl transferase), and mental health (number, diagnosis) parameters. Results: Suboptimal vitD status (25-hydroxyvitamin D 100 cm were associated with lower vitD levels (58 ± 18 vs 65 ± 17 nmol/L; P = 0.01). VitD status ≥50 nmol/L was associated with lower insulin (15.8 [11.7–23.1] mU/L vs 21.1 [14.3–34.2] mU/L; P 

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xveX5e
via IFTTT

Role of Polyethylene Glycol in the Treatment of Functional Constipation in Children

imageABSTRACT: According to international guidelines, polyethylene glycol (PEG) is the laxative of first choice in the treatment of functional constipation in children, both for disimpaction and for maintenance treatment. PEG acts as an osmotic laxative and its efficacy is dose dependent. PEG is highly effective, has a good safety profile, and is well tolerated by children. Only minor adverse events have been reported. Overall the use of PEG in children has been reported to be safe, although in patients predisposed to water and electrolyte imbalances monitoring of serum electrolytes should be considered.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xvkPLW
via IFTTT

Commentary to Article Entitled “Vitamin D Deficiency Is Not Associated With Growth or the Incidence of Common Morbidities Among Tanzanian Infants”

No abstract available

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wMZt99
via IFTTT

Post-transplant Recurrent Bile Salt Export Pump Disease: A Form of Antibody-mediated Graft Dysfunction and Utilization of C4d

imageABSTRACT: Recurrent bile salt export pump (rBSEP) disease has been reported in progressive familial intrahepatic cholestasis type 2 (PFIC2) patients following liver transplantation (LT) and is often refractory to standard anti-cellular rejection immunosuppressants. The mechanism of rBSEP disease is proposed to be a form of type II hypersensitivity reaction with de novo anti-BSEP antibodies blocking the function of allograft BSEP. Utilization of C4d has not been evaluated in rBSEP. We describe a girl with 3 episodes of rBSEP with severe pruritus at 8.9, 10.3, and 11.0 years post-LT, respectively. Patient's serum reacted with normal liver canaliculi by indirect immunofluorescence (IF), whereas patient's liver showed canalicular immunoglobulin G deposition. The histologic features of all 3 liver biopsies recapitulate PFIC2 with cholestatic giant cell hepatitis. Canalicular BSEP expression was not detected in areas of feathery degeneration by immunohistochemistry, but was retained in morphologically normal liver. By direct IF, C4d showed diffuse sinusoidal staining in the third biopsy. Patient responded well to rituximab with or without intravenous immunoglobulin with subsiding symptoms and normalization of serum bile acid levels. In conclusion, rBSEP disease should be considered in the differential diagnosis when evaluating for rejection in a PFIC2 patient post-LT presenting with pruritus. A portion of liver core may be snap frozen in OCT medium for possible direct IF for C4d, that can serve as a surrogate marker for complement activation and antibody-mediated graft dysfunction.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wMZsSD
via IFTTT

Increasing Incidence and Altered Presentation in a Population-based Study of Pediatric Celiac Disease in North America

imageObjectives: Celiac disease (CD) is a common immune-mediated disorder that affects up to 1% of the general population. Recent reports suggest that the incidence of CD has reached a plateau in many countries. We aim to study the incidence and altered presentation of childhood CD in a well-defined population. Methods: Using the Rochester Epidemiology Project, we retrospectively reviewed Mayo Clinic and Olmsted Medical Center medical records from January 1994 to December 2014. We identified all CD cases of patients ages 18 years or younger at the time of diagnosis. Incidence rates were calculated by adjusting for age, sex, and calendar year and standardizing to the 2010 US white population. Results: We identified 100 patients with CD. Incidence of CD has increased from 8.1 per 100,000 person-years (2000–2002) to 21.5 per 100,000 person-years (2011–2014). There was an increase in CD prevalence in children from 2010 (0.10%) to 2014 (0.17%). Thirty-four patients (34%) presented with classical CD symptoms, 43 (43%) had nonclassical CD, and 23 (23%) were diagnosed by screening asymptomatic high-risk patients. Thirty-six patients (36%) had complete villous atrophy, 51 (51%) had partial atrophy, and 11 (11%) had increased intraepithelial lymphocytes. Two patients were diagnosed without biopsy. Most patients (67%) had a normal body mass index, 17% were overweight/obese, and only 9% were underweight. Conclusions: Both incidence and prevalence of CD have continued to increase in children during the past 15 years in Olmsted County, Minnesota. Clinical and pathologic presentations of CD are changing over time (more nonclassical and asymptomatic cases are emerging).

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wO296o
via IFTTT

Preterm Infants With Biliary Atresia: A Nationwide Cohort Analysis From The Netherlands

imageObjectives: Biliary atresia (BA) occurs in 0.54 of 10.000 of overall live births in the Netherlands. BA has an unfavorable prognosis:

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wNoHEc
via IFTTT

Growth and Nutritional Biomarkers of Preterm Infants Fed a New Powdered Human Milk Fortifier: A Randomized Trial

imageObjectives: The aim of this study was to assess growth and nutritional biomarkers of preterm infants fed human milk (HM) supplemented with a new powdered HM fortifier (nHMF) or a control HM fortifier (cHMF). The nHMF provides similar energy content, 16% more protein (partially hydrolyzed whey), and higher micronutrient levels than the cHMF, along with medium-chain triglycerides and docosahexaenoic acid. Methods: In this controlled, multicenter, double-blind study, a sample of preterm infants ≤32 weeks or ≤1500 g were randomized to receive nHMF (n = 77) or cHMF (n = 76) for a minimum of 21 days. Weight gain was evaluated for noninferiority (margin = –1 g/day) and superiority (margin = 0 g/day). Nutritional status and gut inflammation were assessed by blood, urine, and fecal biochemistries. Adverse events were monitored. Results: Adjusted mean weight gain (analysis of covariance) was 2.3 g/day greater in nHMF versus cHMF; the lower limit of the 95% CI (0.4 g/day) exceeded both noninferiority (P 

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wNCxX4
via IFTTT

Hepatic Portocholecystostomy: 97 Cases From a Single Institution

imageObjectives: Approximately 20% of cases of biliary atresia do not involve the gallbladder, the cystic duct, and the common bile duct. In these cases, a hepatoportocholecystostomy (HPC) may be performed instead of the classical hepatoportoenterostomy (HPE). Methods: We reviewed our cohort to investigate the efficacy of HPC and the associated surgical complications and clinical problems. Results: From 1984 to 2009, 97 patients underwent HPC in our institution. In the first 6 months of the postoperative period no patient presented with bacterial cholangitis. Nine patients had bile leakage, and 1 patient had a gallbladder obstruction. For these 10 patients, HPC was modified in HPE. Jaundice clearance was maintained after HPE, but 4 of the patients presented 1 or more cholangitis episodes. After 6 months, there were no cases of cholangitis recorded, 2 patients presented bile leakage and 4 patients experienced gallbladder obstruction. After 5 years of follow-up, 46% of the patients were jaundice free with their native liver and 29.4% were transplanted. Conclusions: In patients with biliary atresia with patent extrahepatic bile ducts, hepatoportocholecystomy is a good surgical technique that can prevent cholangitis. These results are counterbalanced by specific surgical complications that need to be known and looked for in the postoperative period.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wNCyKC
via IFTTT

NASPGHAN Clinical Report on Postoperative Recurrence in Pediatric Crohn Disease

imageABSTRACT: Pediatric Crohn disease is characterized by clinical and endoscopic relapses. The inflammatory process is considered to be progressive and may lead to strictures, fistulas, and penetrating disease that may require surgery. In addition, medically refractory disease may be treated by surgical resection of inflamed bowel in an effort to reverse growth failure. The need for surgery in childhood suggests severe disease and these patients have an increased risk for recurrent disease and potentially more surgery. Data show that up to 55% of patients had clinical recurrence in the first 2 years after initial surgery. The current clinical report on postoperative recurrence in pediatric Crohn disease reviews the risk factors for early surgery and postoperative recurrence, operative risk factors for recurrence, and prevention and monitoring strategies for postoperative recurrence. We also propose an algorithm for postoperative management in pediatric Crohn disease.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wNom4x
via IFTTT

Management of Pediatric Nonalcoholic Fatty Liver Disease by Academic Hepatologists in Canada: A Nationwide Survey

imageBackground: The literature on the optimal clinical management of pediatric patients with nonalcoholic fatty liver disease (NAFLD) is limited. The objective of this study was to identify discrepancies in the care provided to patients with NAFLD by hepatologists practicing in academic centers across Canada. Methods: A nationwide survey was distributed electronically to all pediatric hepatologists practicing in university-affiliated hospitals using the infrastructure of the Canadian Pediatric Hepatology Research Group. The responses were anonymous. Results: The response rate to the survey was 79%. Everyone reported diagnosing NAFLD based on a combination of elevated transaminases and imaging suggestive of steatosis in the context of an otherwise negative workup for other liver diseases. Only 14% use liver biopsy to confirm the diagnosis. There are significant discrepancies in the frequency of screening for other comorbidities (eg, hypertension, sleep apnea, etc) and in the frequency of laboratory investigations (eg, lipid profile, transaminases, international normalized ratio, etc). Frequency of outpatient clinic follow-up varies significantly. Treatment is consistently based on lifestyle modifications; however, reported patient outcomes in terms of body mass index improvements are poor. Conclusions: There are significant discrepancies in the care provided to children with NAFLD by hepatologists practicing in academic centers across Canada.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2wNB0Ap
via IFTTT

Role of Endoscopic Ultrasound in Children

No abstract available

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xv4tms
via IFTTT

Diagnosis of Chronic Intestinal Pseudo-obstruction and Megacystis by Sequencing the ACTG2 Gene

imageObjectives: The diagnosis of chronic intestinal pseudo-obstruction has depended on clinical features, manometry, and imaging. This report aimed to determine the efficacy of sequencing the actin γ-2 (ACTG2) gene for diagnosis. In addition, the goal was to determine how often a mutation would be found in our randomly collected cohort of probands and those probands published previously. Methods: Whole exome sequencing was performed in 4 probands with chronic intestinal pseudo-obstruction. Subsequently, only the ACTG2 gene was sequenced in another 24 probands (total 28). We analyzed published data of 83 probands and our 28 (total 111) and determined how many had pathogenic variants and the precise genotype. Results: Whole exome and Sanger sequencing revealed a pathogenic variant in the ACTG2 gene in 4 out of 28 of our probands and in 45 out of 83 published probands (49/111 [44.1%]). Moreover, a mutational hotspot in the ACTG2 gene was recognized. Genetic heterogeneity is evident. Conclusions: Pooled gene sequencing results from 1 individual in each of 111 families enabled a precise diagnosis of an ACTG2 mutation in 49 (44%). The benefit to patients and families of early confirmation of a motility disorder not only helps avoid unnecessary intervention, but also enables institution of appropriate treatments and avoidance of secondary disorders such as malnutrition and poor growth. Knowledge of a pathogenic variant in a parent, with a 50% risk of recurrence, provides an opportunity for genetic counseling.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xuwPNs
via IFTTT

Less Anti-infliximab Antibody Formation in Paediatric Crohn Patients on Concomitant Immunomodulators

imageObjectives: To evaluate the effect of immunomodulators on formation of antibodies to infliximab (ATI) in paediatric patients with Crohn disease (CD) and the association of ATI and loss of response. Methods: Retrospective multicentre observational study (January 2009–December 2014) among Dutch children with CD treated with infliximab (IFX). ATI formation was analysed with Chi-square test and time-to-ATI formation with Kaplan-Meier and log-rank test. Results: A total of 229 children were identified. ATIs were measured in 162 patients (70.7%) and 25 (15%) developed ATIs: 6 of 62 (10%) on continuous combined immunosuppression (CCI), 11 of 81 (14%) on early combined immunosuppression (ECI), and 8 of 19 (42%) on IFX monotherapy. ATI formation was higher in patients on IFX monotherapy compared to CCI (P = 0.003) and ECI (P = 0.008), whereas no significant difference was found between CCI and ECI. Sixteen out of 25 patients (64%) with ATIs had loss of response, compared with 32 of 137 patients (19%) without ATIs (P 

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xvg9oY
via IFTTT

Detailed Follow-up Study of Pediatric Orofacial Granulomatosis Patients

imageObjectives: Orofacial granulomatosis (OFG) is a chronic inflammatory condition affecting the orofacial area. Its connection to Crohn disease (CD) is debated. Our aim was to describe a cohort of pediatric patients with OFG in detail, study the long-term behavior of OFG, and evaluate factors predicting CD in patients with OFG. Methods: We invited patients diagnosed with OFG at 2 university hospitals, Finland for a follow-up appointment. Patients (n = 29) were examined by a dentist and an otorhinolaryngologist using a structural schema. Orofacial findings were also recorded using digital photographing. Patients filled in questionnaires about general health and special diets. Patients' nutrition was evaluated from food records. The findings were compared between patients with OFG only and OFG with CD. Results: Patients with CD had more findings in the orofacial area (total score for orofacial findings median 11) compared to patients with OFG only (total score median 7.5). There was no statistically significant difference in the type of lesions between these groups, except the upper lip was more often affected in patients with CD (n = 11) than in patients with OFG only (n = 0). Most of the patients had normal otorhinolaryngological findings. All patients with elevated anti–Saccharomyces cerevisiae antibody A levels had CD (n = 6) and they presented with more orofacial findings (total score) than patients with normal levels of anti–S cerevisiae antibody A (P = 0.0311). Conclusions: Long-term follow-up of pediatric-onset patients with OFG shows good prognosis. Patients with OFG do not seem to have otorhinolaryngological comorbidity. Anti–S cerevisiae antibody A may serve as a factor to indicate the possible presence of underlying CD in patients with OFG, but further studies are requested.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xvllt0
via IFTTT

Temporal Trend of Pediatric Inflammatory Bowel Disease: Analysis of National Registry Data 2004 to 2013 in Japan

imageABSTRACT: Increased incidence and prevalence of pediatric inflammatory bowel disease (IBD) have been reported in Western countries. Changes in the prevalence of pediatric IBD in Asian countries, however, remain unclear. We evaluated the changes in the prevalence of IBD among Japanese adults and children from 2004 to 2013, by using the Japanese national registry data of patients receiving financial aid. Data from children (ages 0–19 years) were compared with those from young adults (ages 20–39 years). In 2004, age-standardized prevalences of Crohn disease (CD) and ulcerative colitis (UC) among children were 4.2 of 100,000 and 11.0 of 100,000, respectively. The corresponding prevalences among young adults were 41.0 of 100,000 and 89.8 of 100,000, respectively. In 2013, age-standardized prevalences of pediatric CD and UC were 7.2 of 100,000 and 15.0 of 100,000, respectively. During this period, prevalence of pediatric CD increased by 73.8% among children and by 49.0% in young adults. The prevalence of UC increased by 45.0% among children, and by 73.7% among young adults.

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2xv8ZBg
via IFTTT