Sexually Transmitted Diseases Among Pregnant Women: 5 States, United States, 2009–2011

Abstract

Introduction Screening for specific sexually transmitted diseases (STDs) during pregnancy has been a longstanding public health recommendation. Prior studies have described associations between these infections and socioeconomic factors such as race/ethnicity and education. Objectives We evaluated the prevalence of STDs and the correlation socioeconomic factors have with the presence of these infections among pregnant women in the United States. Methods We conducted an analysis using self-reported data from 12,948 recently pregnant women from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 5 states during 2009–2011. Responses to questions about curable STDs (chlamydia, gonorrhea, syphilis, trichomoniasis) diagnosed during pregnancy were utilized to calculate weighted STD prevalence estimates and 95% confidence intervals (CI). A logistic regression was also conducted to identify maternal socioeconomic characteristics significantly associated with STDs; results are displayed as adjusted prevalence ratios (aPR). The PRAMS protocol was approved at PRAMS participating sites and by CDC's Institutional Review Board. Results Overall, 3.3% (CI 2.9–3.7) reported ≥ 1 curable STD during her most recent pregnancy. The adjusted STD prevalence was higher among women with younger age (aPR, 2.4; CI 1.8–3.4), non-Hispanic black race/ethnicity (aPR, 3.3; CI 2.4–4.1), unmarried status (aPR, 2.1; CI 1.4–3.0), no college education (aPR, 1.4; CI 1.0–1.9), annual income < $25,000 (aPR, 2.0; CI 1.3–3.2), and no pre-pregnancy health insurance (aPR, 1.4; CI 1.1–1.8). Conclusions for Practice This is the largest study of prevalence of self-reported curable STDs among U.S. pregnant women. Differences in STD prevalence highlight the association between certain socioeconomic factors and the presence of STDs.

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Association of Maternal Depressive Symptoms and Offspring Physical Health in Low-Income Families

Abstract

Objectives The present study sought to examine the association between maternal depressive symptoms and characteristics of offspring physical health, including health status, health behaviors, and healthcare utilization, among low-income families. Maternal engagement was explored as a mediator of observed effects. Methods Cross-sectional survey data from a community sample of 4589 low-income women and their preschool-age children participating in the WIC program in Los Angeles County were analyzed using logistic, Poisson, and zero-inflated negative binomial regression. Mediation was tested via conditional process analyses. Results After controlling for the effects of demographic characteristics including maternal health insurance coverage, employment status, education, and preferred language, children of depressed women (N = 1025) were significantly more likely than children of non-depressed women (N = 3564) to receive a "poor" or "fair" maternal rating of general health (OR 2.34), eat fewer vegetables (IRR: 0.94) more sweets (IRR: 1.20) and sugary drinks daily (IRR: 1.32), and consume fast food more often (OR 1.21). These children were also less likely to have health insurance (OR 1.59) and more likely to receive medical care from a public medical clinic or hospital emergency room (OR 1.30). Reduced maternal engagement partially mediated associations between maternal depressive symptoms and several child health outcomes including poor diet, health insurance coverage, and use of public medical services. Conclusions for Practice Maternal depressive symptoms are associated with poor health among preschool-age children in low-income families. Prevention, screening, and treatment efforts aimed at reducing the prevalence of maternal depression may positively affect young children's health.

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Rehabilitation Course and Specification of Dysmetria of a Patient with Ataxia, Dysmetria and Hemiparesis Following a Stroke in the Corona Radiata: A Case Presentation

We present a case of a patient with ataxia, dysmetria and hemiparesis following a stroke in the corona radiata. The patient had an excellent clinical course with near resolution of symptoms in two and a half weeks, and returned and back to work fully duty and full-time a couple of weeks later. We use a video of severeal neurological tests to demonstrate and characterize the dysmetria. Interestingly, a key characteristic of the dysmetria appears to be different from that seen in patients with dysmetria arising from a cerebellar, thalamic or pontine lesion.

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Editorial Board

Publication date: March 2018
Source:Journal of Environmental Radioactivity, Volume 183





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Sequential analyses of actinides in large-size soil and sediment samples with total sample dissolution

Publication date: Available online 6 February 2018
Source:Journal of Environmental Radioactivity
Author(s): Maoyi Luo, Shan Xing, Yonggang Yang, Lijuan Song, Yan Ma, Yadong Wang, Xiongxin Dai, Steffen Happel
There is a growing demand for the determination of actinides in soil and sediment samples for environmental monitoring and tracing, radiological protection, and nuclear forensic reasons. A total sample dissolution method based on lithium metaborate fusion, followed by sequential column chromatography separation, was developed for simultaneous determination of Pu, Am and Cm isotopes in large-size environmental samples by alpha spectrometry and mass spectrometric techniques. The overall recoveries of both Pu and Am for the entire procedure were higher than 70% for large-size soil samples. The method was validated using 20 g of soil samples spiked with known amounts of ²³⁹Pu and ²⁴¹Am as well as the certified reference materials IAEA-384 (Fangataufa Lagoon sediment) and IAEA-385 (Irish Sea sediment). All the measured results agreed very well with the expected values.



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Comparative Evaluation of Broth Microdilution with Polystyrene and Glass-Coated Plates, Agar Dilution, E-Test, Vitek, and Disk Diffusion for Susceptibility Testing of Colistin and Polymyxin B on Carbapenem-Resistant Clinical Isolates of Acinetobacter baumannii

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


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Functional Predominance of msr(D), Which Is More Effective as mef(A)-Associated Than mef(E)-Associated, Over mef(A)/mef(E) in Macrolide Resistance in Streptococcus pyogenes

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


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Impaired cognitive performance in endothelial nitric oxide synthase knock-out mice after ischemic stroke, a pilot study

ABSTRACTObjectivesCognitive dysfunction and dementia are common following ischemic stroke. Endothelial nitric oxide synthase (eNOS) has been found to play an important role in neurological function and cognition. The purpose of the present study was to assess the specific role of eNOS in cognitive performance after stroke.DesignMale wildtype (WT) and mice lacking eNOS (eNOS-/-) underwent middle cerebral artery occlusion (MCAO) or sham-surgery. Primary outcomes were repeated measures of neurological score, limb asymmetry, sensory/motor function and spatial memory/learning assessed at intervals up to 28-days post-surgery. Group differences in brain microglia activation and infiltration, and levels of interferon-gamma (IFN-γ) were examined.ResultsThere was no genotype x surgery interaction effect on the pattern of change in neurological score, limb asymmetry, or sensory motor function across the 28-days post-surgery. In the Morris Water Maze, eNOS-/- MCAO mice displayed learning and memory deficits not evident in WT MCAO mice. Poorer spatial memory and learning in eNOS-/- MCAO mice was associated with a reduction in the number of activated microglia in the striatum on the lesion side and decreased brain tissue levels of IFN-γ.ConclusionsOur data support a role for eNOS in cognitive performance after stroke. This finding may lead to the development of novel interventions to treat post-stroke cognitive deficits. Objectives Cognitive dysfunction and dementia are common following ischemic stroke. Endothelial nitric oxide synthase (eNOS) has been found to play an important role in neurological function and cognition. The purpose of the present study was to assess the specific role of eNOS in cognitive performance after stroke. Design Male wildtype (WT) and mice lacking eNOS (eNOS-/-) underwent middle cerebral artery occlusion (MCAO) or sham-surgery. Primary outcomes were repeated measures of neurological score, limb asymmetry, sensory/motor function and spatial memory/learning assessed at intervals up to 28-days post-surgery. Group differences in brain microglia activation and infiltration, and levels of interferon-gamma (IFN-γ) were examined. Results There was no genotype x surgery interaction effect on the pattern of change in neurological score, limb asymmetry, or sensory motor function across the 28-days post-surgery. In the Morris Water Maze, eNOS-/- MCAO mice displayed learning and memory deficits not evident in WT MCAO mice. Poorer spatial memory and learning in eNOS-/- MCAO mice was associated with a reduction in the number of activated microglia in the striatum on the lesion side and decreased brain tissue levels of IFN-γ. Conclusions Our data support a role for eNOS in cognitive performance after stroke. This finding may lead to the development of novel interventions to treat post-stroke cognitive deficits. S Li and Y Wang contributed equally. The study was performed at Stroke Biological Recovery Laboratory, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, the teaching affiliate of Harvard Medical School, Charlestown, MA 02129 Co-coresponding author and eighth author: Lisa J. Wood, PhD, RN, FAAN, School of Nursing, Fatigue Research Laboratory, MGH Institute of Health Professions, 96 13th street, Charlestown, MA 02129, USA Phone: 617-724-3454, Email: ljwood@mghihp.edu Corresponding author and Last author: Qing Mei Wang, MD, PhD, Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, The teaching affiliate of Harvard Medical School, 96 13th street, Charlestown, MA 02129, USA. Email: wang.qingmei@mgh.harvard.edu Disclosures: This work was funded by the National Institutes of Health [grant number HD074668, 2013-2016). The funding organization was not involved in study design, in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. An abstract was presented at the annual meeting of American Association of Physiatrists in February 2016. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Amputee Locomotion: Joint Moment Adaptations to Running Speed using Running-Specific Prostheses after Unilateral Transtibial Amputation

AbstractObjectiveThe objective of this study was to investigate 3D lower extremity joint moment differences between limbs and speed influences on these differences in individuals with lower extremity amputations using running-specific prostheses.Design8 individuals with unilateral transtibial amputations and 8 control subjects with no amputations ran overground at three constant velocities (2.5, 3.0, and 3.5 m/s). A 2x2x3 (group x leg x speed) repeated-measures ANOVA with Bonferroni adjustments determined statistical significance.ResultsThe prosthetic limb generated significantly greater peak ankle plantarflexion moments and smaller peak ankle varus, knee stance extension, knee swing flexion, knee internal rotation, hip stance flexion, hip swing flexion, hip swing extension, hip valgus, and hip external rotation moments than the intact limb. The intact limb had greater peak hip external rotation moments than control limbs, but all other peak moments were similar between these limbs. Increases in peak hip stance and knee swing flexion moments associated with speed were greater in the intact limb than the prosthetic limb.ConclusionIndividuals with amputation relied on the intact limb more than the prosthetic limb to run at a particular speed when wearing running-specific prostheses, but the intact joints were not overloaded relative to the control limbs. Objective The objective of this study was to investigate 3D lower extremity joint moment differences between limbs and speed influences on these differences in individuals with lower extremity amputations using running-specific prostheses. Design 8 individuals with unilateral transtibial amputations and 8 control subjects with no amputations ran overground at three constant velocities (2.5, 3.0, and 3.5 m/s). A 2x2x3 (group x leg x speed) repeated-measures ANOVA with Bonferroni adjustments determined statistical significance. Results The prosthetic limb generated significantly greater peak ankle plantarflexion moments and smaller peak ankle varus, knee stance extension, knee swing flexion, knee internal rotation, hip stance flexion, hip swing flexion, hip swing extension, hip valgus, and hip external rotation moments than the intact limb. The intact limb had greater peak hip external rotation moments than control limbs, but all other peak moments were similar between these limbs. Increases in peak hip stance and knee swing flexion moments associated with speed were greater in the intact limb than the prosthetic limb. Conclusion Individuals with amputation relied on the intact limb more than the prosthetic limb to run at a particular speed when wearing running-specific prostheses, but the intact joints were not overloaded relative to the control limbs. Corresponding Author: Jae Kun Shim, PhD, Department of Kinesiology, University of Maryland, College Park, 0110F School of Public Health (Bldg #225), 2242 Valley Drive, College Park, MD 20742, E-mail address: jkshim@umd.edu Disclosures: The authors have no conflicts of interest. This work was funded by the National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS) R03 Award #1R03AR062321 and the University of Maryland Department of Kinesiology Graduate Research Initiative Fund. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Sonographic Evaluation of the Posterior Interosseous Nerve in a Patient with Wrist Drop

No abstract available

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Quantifying Effect of Onabotulinum Toxin A on Passive Muscle Stiffness in Children with Cerebral Palsy Using Ultrasound Shear Wave Elastography

ABSTRACTObjectiveA pilot study to longitudinally quantify effect of onabotulinum toxin A (BoNT-A) on passive muscle properties in children with cerebral palsy (CP) using ultrasound shear wave elastography (SWE).DesignProspective longitudinal cohort studyResultsBetween 1 and 3 months post-BoNT-A, a significant improvement in the shear modulus of the lateral gastrocnemius was found at 10° plantar flexion (PF) (-7.57 [-10.98, -5.07], p=0.02) and 0° PF (-14.74 [-18.21, -9.38], p=0.03). There was a notable, but non-significant difference in shear modulus at 20° PF, 10° PF, 0° PF between pre-BoNT-A and 1 month post-BoNT-A. Pre-BoNT-A shear modulus was not significantly different than 3 months post-BoNT-A at all foot positions. No significant differences in ankle passive range of motion or spasticity were found.ConclusionDespite no significant change in ankle range of motion or spasticity, SWE was able to detect a difference in lateral gastrocnemius passive muscle properties in children with CP following BoNT-A injections. The difference in passive muscle properties resolved by 3 months post-BoNT-A. Objective A pilot study to longitudinally quantify effect of onabotulinum toxin A (BoNT-A) on passive muscle properties in children with cerebral palsy (CP) using ultrasound shear wave elastography (SWE). Design Prospective longitudinal cohort study Results Between 1 and 3 months post-BoNT-A, a significant improvement in the shear modulus of the lateral gastrocnemius was found at 10° plantar flexion (PF) (-7.57 [-10.98, -5.07], p=0.02) and 0° PF (-14.74 [-18.21, -9.38], p=0.03). There was a notable, but non-significant difference in shear modulus at 20° PF, 10° PF, 0° PF between pre-BoNT-A and 1 month post-BoNT-A. Pre-BoNT-A shear modulus was not significantly different than 3 months post-BoNT-A at all foot positions. No significant differences in ankle passive range of motion or spasticity were found. Conclusion Despite no significant change in ankle range of motion or spasticity, SWE was able to detect a difference in lateral gastrocnemius passive muscle properties in children with CP following BoNT-A injections. The difference in passive muscle properties resolved by 3 months post-BoNT-A. Corresponding Author: Joline E. Brandenburg, MD, Department of Physical Medicine and Rehabilitation, Mayo Clinic – 200 First Street SW, Rochester, MN 55905 Author Disclosures: We would like to disclose that National Institutes of Health (NIH) (grants KL2TR000136, K12HD00109, F30 AG044075) and the Mayo Clinic Department of Physical Medicine and Rehabilitation for supported this research. In addition, this publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). We would also like to disclose that there may be a perceived conflict of interest for author Pengfei Song, PhD, due to patents and licensing in the field of ultrasound elastography. A portion of this work was presented at the Association of Academic Physiatrists Annual Meeting in Sacramento, California on February 20th, 2016 as part of the Rehabilitation Medicine Scientist Training Program Presentations. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Relationship of Spinal Cord Injury Level and Duration to Peak Aerobic Capacity with Arms-Only and Hybrid FES-Rowing

ABSTRACTObjectiveTo assess the relationship of spinal cord injury level and duration to peak aerobic capacities during arms-only (AO) rowing compared to hybrid Functional Electrical Stimulation (FES) rowing.DesignComparison of peak aerobic capacity (VO2peak), peak ventilation (VEpeak), peak respiratory exchange ratio (RERpeak), and peak heart rate (HRpeak) were measured during AO-rowing and FES-rowing obtained from graded exercise tests.ResultsPeak aerobic values were strongly related to injury level and injury duration for both AO-rowing (r=0.67, p

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fNIRS-based Neurorobotic Interface for gait rehabilitation

In this paper, a novel functional near-infrared spectroscopy (fNIRS)-based brain-computer interface (BCI) framework for control of prosthetic legs and rehabilitation of patients suffering from locomotive disor...

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Precise isometric hand grip learning of hemiparetic stroke patients

Rehabilitation of hand movements after stroke aims at skills that can be well retained and transferred to novel conditions. These functions may be altered by training schedules such as constant and variable practice. A total of 36 participants with hemiparesis completed one of these schedules counterbalanced. Precise isometric hand grip force production was practiced for 4 days with a target force of 25% maximum voluntary contraction. The constant group practiced only the target force, whereas the variable group practiced the same amount including ±5 and 10% maximum voluntary contraction. Target force presentation and feedback were provided visually. Results indicated that both practice schedule led to learning. Variable practice resulted in a superior performance in retention and transfer tests, suggesting that it may be effective not only in the healthy population but also in stroke rehabilitation. Correspondence to Tibor Vámos, MA, Bárczi Gusztáv Faculty of Special Needs Education, Institute for Methodology of Special Needs Education and Rehabilitation, Eötvös Loránd University, Ecseri út 3, H-1097 Budapest, Hungary Tel: +361 358 5519; e-mail: vamos.tibor@barczi.elte.hu Received November 17, 2017 Accepted January 11, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Spectrum of APC and MUTYH germ-line mutations in Russian patients with colorectal malignancies

Abstract

Distribution of cancer-predisposing mutations demonstrates significant interethnic variations. This study aimed to evaluate patterns of APC and MUTYH germ-line mutations in Russian patients with colorectal malignancies. APC gene defects were identified in 26/38 (68%) subjects with colon polyposis; 8/26 (31%) APC mutations were associated with two known mutational hotspots (p.E1309Dfs*4 (n = 5) and p.Q1062fs* (n = 3)), while 6/26 (23%) mutations were novel (p.K73Nfs*6, p.S254Hfs*12, p.S1072Kfs*9, p.E1547Kfs*11, p.L1564X and p.C1263Wfs*22). Biallelic mutations in MUTYH gene were revealed in 3/12 (25%) remaining subjects with polyposis and in 6/90 (6.7%) patients with colorectal cancer (CRC) carrying KRAS p.G12C substitution, but not in 231 early-onset CRC cases negative for KRAS p.G12C allele. In addition to known European founder alleles p.Y179C and p.G396D, this study revealed a recurrent character of MUTYH p.R245H germ-line mutation. Besides that, three novel pathogenic MUTYH alleles (p.L111P, p.R245S and p.Q293X) were identified. Targeted next generation sequencing of 7 APC/MUTYH mutation-negative DNA samples identified novel potentially pathogenic POLD1 variant (p.L460R) in one patient and known low-penetrant cancer-associated allele CHEK2 I157T in three patients. The analysis of 1120 healthy subjects revealed 15 heterozygous carriers of recurrent MUTYH mutations, thus the expected incidence of MUTYH-associated polyposis in Russia is likely to be 1:23 000.

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Phenotypic Characterization of KCTD3-related Developmental Epileptic Encephalopathy

ABSTRACT

The association between KCTD3 gene and neurogenetic disorders has only been published recently. In this report, we describe the clinical phenotype associated with two pathogenic variants in KCTD3 gene. Seven individuals (including one set of monozygotic twin) from four consanguineous families presented with developmental epileptic encephalopathy, global developmental delay, central hypotonia, progressive peripheral hypertonia, and variable dysmorphic facial features. Posterior fossa abnormalities (ranging from Dandy-Walker malformation to isolated hypoplasia of the cerebellar vermis) were consistently observed in addition to other variable neuroradiological abnormalities such as hydrocephalus and abnormal brain myelination. One patient also had a multicystic kidney. Whole exome sequencing revealed two likely pathogenic homozygous variants in KCTD3 gene that fully segregated with the disease. KCTD3 gene belongs to a family of accessory subunits that regulate the biophysical properties of ion channels, and is highly expressed in the kidney and brain. In this largest series to date on KCTD3-mutated patients, we show that biallelic loss of function mutations in KCTD3 lead to a consistent phenotype of developmental epileptic encephalopathy and abnormal cerebellum on brain imaging.

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Advanced Maternal Age and Maternal Education Disparity in Children with Autism Spectrum Disorder

Abstract

Objective Previous studies have shown inconsistent results with regard to the association between advanced parental age and autism spectrum disorder (ASD). The sociodemographic status of parents has been found to be associated with children with ASD, however. Therefore, a pathway analysis was undertaken of the roles of maternal age and education in ASD diagnosis and community screening, in a national birth cohort database, using a propensity score matching (PSM) method. Method The 6- and 66-month Taiwan Birth Cohort Study dataset was used (N = 20,095). The PSM exact matching method was used to select 1700 families (ratio of 1:4 between ASD diagnosis and control) from the Taiwan Birth Cohort Study dataset. Results (1) The results from the complete dataset and the PSM exact matching dataset both show that the risk of a child being diagnosed with ASD was increased by the mother being over 40 years old. (2) Although more children of mothers with lower-than-average education were positive on screening, more children of mothers with higher-than-average education were also diagnosed with ASD. Conclusions for Practice Advanced maternal age had a higher association with the diagnosis of ASD, and maternal educational disparity was found between ASD clinical diagnosis and community screening. Community and primary medical care services should pay more attention to children of parents with lower education during ASD screening to prevent delayed diagnosis.

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Subdecadal phytolith and charcoal records from Lake Malawi, East Africa imply minimal effects on human evolution from the ∼74 ka Toba supereruption

Publication date: March 2018
Source:Journal of Human Evolution, Volume 116
Author(s): Chad L. Yost, Lily J. Jackson, Jeffery R. Stone, Andrew S. Cohen
The temporal proximity of the ∼74 ka Toba supereruption to a putative 100–50 ka human population bottleneck is the basis for the volcanic winter/weak Garden of Eden hypothesis, which states that the eruption caused a 6-year-long global volcanic winter and reduced the effective population of anatomically modern humans (AMH) to fewer than 10,000 individuals. To test this hypothesis, we sampled two cores collected from Lake Malawi with cryptotephra previously fingerprinted to the Toba supereruption. Phytolith and charcoal samples were continuously collected at ∼3–4 mm (∼8–9 yr) intervals above and below the Toba cryptotephra position, with no stratigraphic breaks. For samples synchronous or proximal to the Toba interval, we found no change in low elevation tree cover, or in cool climate C3 and warm season C4 xerophytic and mesophytic grass abundance that is outside of normal variability. A spike in locally derived charcoal and xerophytic C4 grasses immediately after the Toba eruption indicates reduced precipitation and die-off of at least some afromontane vegetation, but does not signal volcanic winter conditions. A review of Toba tuff petrological and melt inclusion studies suggest a Tambora-like 50 to 100 Mt SO2 atmospheric injection. However, most Toba climate models use SO2 values that are one to two orders of magnitude higher, thereby significantly overestimating the amount of cooling. A review of recent genetic studies finds no support for a genetic bottleneck at or near ∼74 ka. Based on these previous studies and our new paleoenvironmental data, we find no support for the Toba catastrophe hypothesis and conclude that the Toba supereruption did not 1) produce a 6-year-long volcanic winter in eastern Africa, 2) cause a genetic bottleneck among African AMH populations, or 3) bring humanity to the brink of extinction.



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Evidence for rapid faunal change in the early Miocene of East Africa based on revised biostratigraphic and radiometric dating of Bukwa, Uganda

Publication date: March 2018
Source:Journal of Human Evolution, Volume 116
Author(s): Susanne Cote, John Kingston, Alan Deino, Alisa Winkler, Robert Kityo, Laura MacLatchy
Field expeditions to Bukwa in the late 1960s and early 1970s established that the site had a small but diverse early Miocene fauna, including the catarrhine primate Limnopithecus legetet. Initial potassium-argon radiometric dating indicated that Bukwa was 22 Ma, making it the oldest of the East African early Miocene fossil localities known at the time. In contrast, the fauna collected from Bukwa was similar to other fossil localities in the region that were several million years younger. This discrepancy was never resolved, and due to the paucity of primate remains at the site, little subsequent research took place.We have collected new fossils at Bukwa, reanalyzed the existing fossil collections, and provided new radiometric dating. ⁴⁰Ar/³⁹Ar incremental heating ages on lavas bracketing the site indicate that the Bukwa fossils were deposited ∼19 Ma, roughly 3 Ma younger than the original radiometric age. Our radiometric dating results are corroborated by a thorough reanalysis of the faunal assemblage. Bukwa shares taxa with both stratigraphically older localities (Tinderet, Napak) and with stratigraphically younger localities (Kisingiri, Turkana Basin) perfectly corresponding to our revised radiometric age.This revised age for Bukwa is important because it indicates that significant faunal turnover may have occurred in East Africa between 20 and 19 Ma. Bukwa samples immigrant taxa such as large suids, large ruminants, and ochotonids that are absent from stratigraphically older but well-sampled localities in the region, such as Tinderet (∼20 Ma) and Napak (20 Ma). Further age refinements for Bukwa and the entire East African early Miocene sequence will help to constrain the timing of this faunal turnover event, of particular importance in paleoanthropology since this temporal sequence also provides us with what is currently our best window into the early evolution of cercopithecoid and hominoid primates.



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Associations between physical activity, resilience, and quality of life in people with inflammatory bowel disease

Abstract

Aim

Research has shown that moderate-to-vigorous physical activity (MVPA) is associated with higher health-related quality of life (HRQOL) in healthy individuals. Recent studies have suggested that low- to moderate-intensity physical activity can be beneficial to HRQOL in people with inflammatory bowel diseases (IBD); however, studies investigating associations between MVPA and HRQOL in this population are lacking. PURPOSE: To understand the relationships among walking, MVPA, resilience, and HRQOL in people with IBD.

Methods

People with IBD (n = 242) completed questions about physical activity, resilience and HRQOL. Pearson product-moment correlations and multiple regression analyses were used to identify associations between physical activity and HRQOL. Analysis of covariance was used to compare HRQOL over quartiles of walking and MVPA with demographic variables as covariates.

Results

Both walking and MVPA were independently associated with physical (β = 0.21 and β = 0.26, respectively; p ≤ 0.001) but not mental HRQOL (p > 0.05). Higher volumes of MVPA were significantly associated with physical HRQOL (quartile 1 40.3 ± 9.0 vs. quartile 4 47.4 ± 9.0; p < 0.001) while higher volumes of walking were associated with both physical and mental HRQOL (p ≤ 0.01).

Conclusions

The findings suggest that engaging in higher volumes of MVPA above 150 min/week and walking, particularly above 60 min/week, are associated with improved HRQOL in people with IBD. Research would benefit from investigating participation in MVPA as a coping strategy, in a longitudinal manner, to determine which modes of activity may be most beneficial to people with IBD.

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Effects of sprint interval training on ectopic lipids and tissue-specific insulin sensitivity in men with non-alcoholic fatty liver disease

Abstract

Purpose

This study examined the feasibility of sprint interval exercise training (SIT) for men with non-alcoholic fatty liver disease (NAFLD) and its effects on intrahepatic triglyceride (IHTG), insulin sensitivity (hepatic and peripheral), visceral (VAT) and subcutaneous adipose tissue (ScAT).

Methods

Nine men with NAFLD (age 41 ± 8 years; BMI 31.7 ± 3.1 kg m⁻²; IHTG 15.6 ± 8.3%) were assessed at: (1) baseline (2) after a control phase of no intervention (pre-training) and (3) after 6 weeks of SIT (4–6 maximal 30 s cycling intervals, three times per week). IHTG, VAT and ScAT were measured using magnetic resonance spectroscopy or imaging and insulin sensitivity was assessed via dual-step hyperinsulinaemic-euglycaemic clamp with [6,6-D2] glucose tracer.

Results

Participants adhered to SIT, completing ≥ 96.7% of prescribed intervals. SIT increased peak oxygen uptake [ \({\dot{V}} \text{O}_2\) peak: + 13.6% (95% CI 8.8–18.2%)] and elicited a relative reduction in IHTG [− 12.4% (− 31.6 to 6.7%)] and VAT [− 16.9% (− 24.4 to − 9.4%); n = 8], with no change in body weight or ScAT. Peripheral insulin sensitivity increased throughout the study (n = 8; significant main effect of phase) but changes from pre- to post-training were highly variable (range − 18.5 to + 58.7%) and not significant (P = 0.09), despite a moderate effect size (g* = 0.63). Hepatic insulin sensitivity was not influenced by SIT.

Conclusions

SIT is feasible for men with NAFLD in a controlled laboratory setting and is able to reduce IHTG and VAT in the absence of weight loss.

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Challenges Faced by Family Physicians Providing Advanced Maternity Care

Abstract

Introduction Maldistribution of maternity care (MC) providers in the U.S. limits access to full spectrum MC services. Obstetricians are concentrated in urban areas with many rural areas reliant on family physicians (FP) to provide MC, yet fewer FPs are providing MC. The objective of this study was to understand the challenges FPs face in gaining skills in and providing advanced MC. Methods We conducted qualitative semi-structured interviews with 51 purposively sampled key stakeholders in family medicine MC (21 family medicine-OB fellowship directors, 19 past fellows, and 10 family medicine residency directors of programs with advanced MC training). Interviews were recorded, transcribed, and analyzed using an inductive approach to qualitative content analysis. Results Three primary challenges for FPs providing advanced MC emerged from the interviews. Training: most family medicine residency programs do not provide sufficient surgical OB training, so fellowship training is an important alternative for FPs to acquire such skills. Credentialing: obtaining hospital privileges to perform cesarean sections is unpredictable and highly variable by institution. Professional relationships: "turf battles" with other MC providers can limit FPs' ability to provide care commensurate with their level of training. Discussion As the predominant provider of MC in rural and underserved areas, FPs need to be supported to provide advanced MC services. Possible strategies to accomplish this include: enhanced family medicine training in MC; policy changes to address credentialing inconsistencies; and improved team-based care for pregnant women to ensure that every woman has access to high quality MC.

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‘Recovery’ in the Real World: Service User Experiences of Mental Health Service Use and Recommendations for Change 20 Years on from a First Episode Psychosis

Abstract

Little is known about how recovery oriented policy and legislative changes influence service users' perceptions of mental health care over time. Although the recovery approach is endorsed in many countries, qualitative research examining its impact on service use experiences has been lacking. This study aimed to explore this impact as well as experiences of service utilisation and suggestions for change with people diagnosed with a First Episode Psychosis between 1995 and 1999. Participants had used services during the 10 year period prior to, and 10 years post, policy and legislative shifts to the recovery approach. Semi-structured interviews were conducted with 10 participants who met criteria for 'full functional recovery' and 10 who did not. Data were analysed using Thematic Networks Analysis to develop Basic, Organising, and Global Themes. Over time, recovered participants perceived an improvement in service quality through the 'humanising' of treatment and non-recovered participants experienced their responsibility in recovery being recognised, but felt abandoned to the recovery approach. Findings suggest the importance of viewing service users as demonstrating personhood and having societal value; examining the personal meaning of psychotic experiences; and matching expectations with what services can feasibly provide. The implementation and the principal tenets of the recovery approach warrant further investigation.

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The Need to Objectively Measure Physical Activity During Pregnancy: Considerations for Clinical Research and Public Health Impact

Abstract

Engaging in recommended levels of physical activity during pregnancy can provide a host of physical and mental health benefits for the expecting mother and her child. However, methodological issues related to physical activity measurement have plagued many studies examining the effects of physical activity during this important life stage. Burgeoning support exists for the more widespread use of objective methods, and accelerometers specifically, for an accurate appraisal of maternal physical activity. In this commentary, we highlight discrepancies between activity estimates obtained via self-report and objective measures and describe the implications of erroneous measurement when making clinical recommendations and in conducting future physical activity and pregnancy research. Most importantly, we aim to foster academic discussion and propose a call to action requiring a paradigm shift where we acknowledge the shortcomings of self-report and move toward an empirically driven approach for physical activity measurement. Results from more high-quality research studies will help support public health messaging and facilitate trust among health care providers, clinical researchers, and expecting mothers regarding the health benefits of physical activity recommendations.

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The Fertility Management Experiences of Australian Women with a Non-communicable Chronic Disease: Findings from the Understanding Fertility Management in Contemporary Australia Survey

Abstract

Introduction Despite the considerable and increasing proportion of women of reproductive age with a chronic non-communicable disease (NCD) and the potential adverse implications of many NCDs for childbearing, little is known about the fertility management experiences of women with an NCD, including their contraceptive use, pregnancy experiences and outcomes, and reproductive health care utilisation. The aim of this study was to investigate the fertility management experiences of women with an NCD and draw comparisons with women without an NCD. Method A sample of 18–50 year-old women (n = 1543) was randomly recruited from the Australian electoral roll in 2013. Of these women, 172 women reported a physical, chronic non-communicable disease: diabetes, arthritis, asthma, hypertension, heart disease, thyroid disorders, and cystic fibrosis. Respondents completed an anonymous, self-administered questionnaire. Factors associated with fertility management were identified in multivariable analyses. Results Women who reported having an NCD were significantly more likely than women who did not report an NCD to have ever been pregnant (75.9 vs. 67.5%, p = 0.034), have had an unintended pregnancy (33.47 vs. 25.5%, p = 0.026), and have had an abortion (20.3 vs. 14.2%, p = 0.044); they were less likely to consult a healthcare provider about fertility management (45.0 vs. 54.4%, p = 0.024). Similar proportions were using contraception (48.8 vs. 54.5%, p = 0.138). Conclusion The findings have implications for healthcare providers and women with an NCD and highlight the importance of addressing possible assumptions about the inability of women with an NCD to become pregnant, and ensuring women receive information about suitable methods of contraception and pre-pregnancy care.

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Changes in central and peripheral neuromuscular fatigue indices after concentric versus eccentric contractions of the knee extensors

Abstract

Purpose

To better understand neuromuscular characteristics of eccentric exercise-induced muscle damage, this study compared between concentric (CONC) and eccentric (ECC) exercises of knee extensor muscles, and the first (ECC1) and second bouts of the eccentric exercise (ECC2) for central and peripheral parameters associated with neuromuscular fatigue.

Methods

Twelve young men performed three exercise bouts separated by at least 1 week between CONC and ECC1, and 2 weeks between ECC1 and ECC2. In each exercise, maximal voluntary concentric or eccentric contractions of the knee extensors were performed until a reduction in maximal voluntary isometric contraction (MVC) torque of at least 40% MVC was achieved immediately post-exercise. MVC torque, central (voluntary activation and normalised electromyographic activity), and peripheral neuromuscular indices (evoked torque and M-wave amplitude), and muscle soreness were assessed before (PRE), immediately after (POST), 1 h (1H), and 1–4 days after exercise (D1, D2, D3, and D4).

Results

MVC torque decreased at only POST for CONC (− 52.8%), but remained below the baseline at POST (− 48.6%), 1H (− 34.1%), and D1–D4 (− 34.1 to − 18.2%) after ECC1, and at POST (− 45.2%), 1H (− 24.4%) and D1 (− 13.4%) after ECC2 (p < 0.05). Voluntary activation decreased immediately after ECC1 (− 21.6%) and ECC2 (− 21.1%), but not after CONC. Electrically evoked torques decreased similarly at POST and 1H for the three conditions, but remained below the baseline at D1 only post-ECC1.

Conclusion

These results showed that both central and peripheral factors contributed to the MVC decrease after ECC1 and ECC2, but the decrease was mainly due to peripheral factors after CONC.

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The Impact of a Cultural Lifestyle Intervention on Metabolic Parameters After Gestational Diabetes Mellitus A Randomized Controlled Trial

Abstract

Objectives

The prevalence of type 2 diabetes in Israel is increasing in all ethnic groups but most markedly in the Bedouin population. We aimed to assess the effects of a lifestyle change intervention on risk markers for type 2 diabetes after gestational diabetes mellitus (GDM).

Methods

One hundred eighty Jewish and Bedouin post-GDM women were randomly assigned to a lifestyle intervention group (IG) or a control group (CG) starting 3–4 months after delivery. The IG participated in healthy lifestyle sessions led by a dietician and a sports instructor for 24 months after delivery. The IG participants had three individual 45-min counseling sessions and four 90-min group meetings (10 women each). The dietary and exercise recommendations were culturally adapted. The primary outcome of the study was HOMA-IR. We monitored clinical and chemical biomarkers 1 and 2 years after delivery.

Results

After 1 and 2 years of intervention, the metabolic measures improved substantially. The intervention reduced the insulin, glucose and HOMA-IR levels in the IG compared with those in the CG (p < 0.001).

Conclusions

This novel culturally tailored lifestyle intervention program significantly improved the metabolic and morphometric indices measured 1 and 2 years after delivery. These results highlight and underscore the importance of effective lifestyle change education following GDM.

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