bluuebunny/crossref_metadata_2025 huggingface dataset:
A Mouse Model for Human Norovirus
Authors: Taube Stefan , Kolawole Abimbola O. , Höhne Marina , Wilkinson John E. , Handley Scott A. , Perry Jeffrey W. , Thackray Larissa B. , Akkina Ramesh , Wobus Christiane E.
Published: July 2013

Human noroviruses (HuNoVs) cause significant morbidity and mortality worldwide. However, despite substantial efforts, a small-animal model for HuNoV has not been described to date. Since “humanized” mice have been successfully used to study human-tropic pathogens in the past, we challenged BALB/c mice deficient in recombination activation gene (Rag) 1 or 2 and common gamma chain (γc) (Rag-γc) engrafted with human CD34
+
hematopoietic stem cells, nonengrafted siblings, and immunocompetent wild-type controls with pooled stool isolates from patients positive for HuNoV. Surprisingly, both humanized and nonhumanized BALB/c Rag-γc-deficient mice supported replication of a GII.4 strain of HuNoV, as indicated by increased viral loads over input. In contrast, immunocompetent wild-type BALB/c mice were not infected. An intraperitoneal route of infection and the BALB/c genetic background were important for facilitating a subclinical HuNoV infection of Rag-γc-deficient mice. Expression of structural and nonstructural proteins was detected in cells with macrophage-like morphology in the spleens and livers of BALB/c Rag-γc-deficient mice, confirming the ability of HuNoV to replicate in a mouse model. In summary, HuNoV replication in BALB/c Rag-γc-deficient mice is dependent on the immune-deficient status of the host but not on the presence of human immune cells and provides the first genetically manipulable small-animal model for studying HuNoV infection.

IMPORTANCE
Human noroviruses are a significant cause of viral gastroenteritis worldwide, resulting in significant morbidity and mortality. Antivirals and vaccines are currently not available, in part due to the inability to study these viruses in a genetically manipulable, small-animal model. Herein, we report the first mouse model for human noroviruses. This model will accelerate our understanding of human norovirus biology and provide a useful resource for evaluating antiviral therapies.
Diagnosis and acute management of patients with concussion at children's hospitals
Authors: Colvin Jeffrey D , Thurm Cary , Pate Brian M , Newland Jason G , Hall Matt , Meehan William P
Published: July 2013

Objectives

To describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients.

Design

Cross-sectional study.

Setting

Children's hospitals participating in the Pediatric Health Information System in the USA during a 10-year period.

Patients

All emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion.

Main outcome measures

The proportion of concussion patients who were hospitalised, underwent imaging or received medication, and the adjusted costs of visits for concussion.

Results

The number of ED visits for concussion increased between 2001 and 2010 (2126 (0.36% of all ED visits) vs 4967 (0.62% of all ED visits); p<0.001), while the number of admissions remained stable. Of ED visits for concussion, 59.9% received CT and 47.7% received medications or intravenous fluids. Non-narcotic analgesics were the most common medication administered. Adjusted costs of patient visits were significantly higher when imaging was obtained (US$695, IQR US$472–$1009, vs US$191, IQR US$114–$287). An ED visit with CT, however, cost less than a hospitalisation without CT (US$1907, IQR US$1292–$3770).

Conclusions

Although the number of ED patients diagnosed with concussion has increased, the number admitted has remained stable. Concussion patients at paediatric hospitals in the USA commonly undergo CT imaging and receive medication.
Take your shoes off to reduce patellofemoral joint stress during running
Authors: Bonacci Jason , Vicenzino Bill , Spratford Wayne , Collins Paul
Published: July 2013

Aim

Elevated patellofemoral joint stress is thought to contribute to the development and progression of patellofemoral pain syndrome. The purpose of this study was to determine if running barefoot decreases patellofemoral joint stress in comparison to shod running.

Methods

Lower extremity kinematics and ground reaction force data were collected from 22 trained runners during overground running while barefoot and in a neutral running shoe. The kinematic and kinetic data were used as input variables into a previously described mathematical model to determine patellofemoral joint stress. Knee flexion angle, net knee extension moment and the model outputs of contact area, patellofemoral joint reaction force and patellofemoral joint stress were plotted over the stance phase of the gait cycle and peak values compared using paired t tests and standardised mean differences calculated.

Results

Running barefoot decreased peak patellofemoral joint stress by 12% (p=0.000) in comparison to shod running. The reduction in patellofemoral joint stress was a result of reduced patellofemoral joint reaction forces (12%, p=0.000) while running barefoot.

Conclusions

Elevated patellofemoral joint stress during shod running might contribute to patellofemoral pain. Running barefoot decreases patellofemoral joint stress.
Does spatial proximity drive norovirus transmission during outbreaks in hospitals?
Authors: Harris John P , Lopman Ben A , Cooper Ben S , O'Brien Sarah J
Published: July 2013

Objective

To assess the role of spatial proximity, defined as patients sharing bays, in the spread of norovirus during outbreaks in hospitals.

Design

Enhanced surveillance of norovirus outbreaks between November 2009 and November 2011.

Methods

Data were gathered during 149 outbreaks of norovirus in hospital wards from five hospitals in two major cities in England serving a population of two million. We used the time between the first two cases of each outbreak to estimate the serial interval for norovirus in this setting. This distribution and dates of illness onset were used to calculate epidemic trees for each outbreak. We then used a permutation test to assess whether proximity, for all outbreaks, was more extreme than would be expected by chance under the null hypothesis that proximity was not associated with transmission risk.

Results

65 outbreaks contained complete data on both onset dates and ward position. We estimated the serial interval to be 1.86 days (95% CI 1.6 to 2.2 days), and with this value found strong evidence to reject the null hypothesis that proximity was not significant (p<0.001). Sensitivity analysis using different values of the serial interval showed that there was evidence to reject the null hypothesis provided the assumed serial interval was less than 2.5 days.

Conclusions

Our results provide evidence that patients occupying the same bay as patients with symptomatic norovirus infection are at an increased risk of becoming infected by these patients compared with patients elsewhere in the same ward.
Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study
Authors: Sadowski Alexander , Todorow Michelle , Yazdani Brojeni Parvaneh , Koren Gideon , Nulman Irena
Published: July 2013

Objectives

Second-generation antipsychotics (SGAs), in conjunction with other psychotropic medications, are increasingly used to treat psychiatric disorders in pregnancy. The few available studies investigating the reproductive safety of SGAs did not reach conclusive results, and none have compared monotherapy with polytherapy involving other psychotropic medications.

Design

Descriptive cohort study using a prospectively collected database.

Setting

Motherisk Program, The Hospital for Sick Children, Toronto, Canada.

Participants

133 women exposed to SGAs and other psychotropic drugs and 133 matched healthy controls were assessed and analysed. Outcomes of mother–child pairs exposed to SGAs in monotherapy (N=37) were compared with those exposed to SGAs with other psychotropic medications (in polytherapy; N=96).

Main outcome measures

Maternal, pregnancy, delivery and neonatal outcomes.

Results

72% of exposed women received SGAs in polytherapy, and 101 women took their medications throughout pregnancy. These women had significantly higher pre-pregnancy weight, experienced more associated comorbidities and instrumental deliveries, and delivered a greater proportion of large for gestational age neonates. There were no differences in maternal weight gain in pregnancy between the exposed and comparison groups and between the monotherapy-exposed and polytherapy-exposed subgroups. The exposed neonates were more likely to be born premature, were admitted more often to the neonatal intensive care unit, presented with poor neonatal adaptation signs and had higher rates of congenital malformations. All the aforementioned neonatal outcomes were found mainly in the polytherapy subgroup.

Conclusions

The use of SGAs in polytherapy was prevalent in the assessed cohort and was associated with adverse pregnancy outcomes for both the mother and the child. In utero exposure to SGA monotherapy appears to be associated with less risk to the fetus. Future research should focus on polytherapy in pregnancy in order to define its reproductive safety and to separate the effects of medication exposure, underlying psychopathology and associated comorbidities.
Mortality and its determinants among patients infected with HIV-1 on antiretroviral therapy in a referral centre in Yaounde, Cameroon: a retrospective cohort study
Authors: Poka-Mayap Virginie , Pefura-Yone Eric Walter , Kengne André Pascal , Kuaban Christopher
Published: July 2013

Objectives

Mortality has declined in people with HIV infection, subsequent to the improved access to antiretroviral therapy (ART). We assessed the incidence and determinants of mortality among patients with HIV-1 infection who were started on ART in a referral treatment centre for HIV infection in Yaounde, Cameroon.

Design

Cohort study with baseline assessment between 2007 and 2008, and follow-up during 5 years until June 2012.

Setting

The accredited HIV treatment centre of the Yaounde Jamot Hospital in the capital city of Cameroon.

Participants

People living with HIV infection who started ART between 2007 and 2008 at the study centre.

Outcome measures

All-cause mortality over time; accelerated failure time models used to relate baseline characteristics to mortality occurrence during follow-up.

Results

Of the 1444 patients included, 827 (53.7%) were men, and the median age (25–75th centiles) was 38 (31–45) years. The median duration of follow-up was 14.1 (1.1–46.4) months, during which 235 deaths were recorded (cumulative incidence rate: 16.3%), including 208 (88.5%) during the first year of follow-up. Baseline predictors of mortality were male gender (adjusted HR 2.15 (95% CI 1.34 to 3.45)), active tuberculosis (2.35 (1.40 to 3.92)), WHO stages III–IV of the disease (3.63 (1.29 to 10.24)), low weight (1.03 (1.01 to 1.05)/kg), low CD4 count (1.04 (1.01 to 1.07)/10/mm3lower CD4) and low haemoglobin levels (1.12 (1.00 to 1.26)/g/dL lower).

Conclusions

Mortality rate among patients with HIV is very high within the first year of starting ART in this centre. Early start of the treatment at a less advanced stage of the disease, and favourable levels of CD4 could reduce early mortality, but would have to be tested.
Use of health information technology to reduce diagnostic errors
Authors: El-Kareh Robert , Hasan Omar , Schiff Gordon D
Published: July 2013

Background

Health information technology (HIT) systems have the potential to reduce delayed, missed or incorrect diagnoses. We describe and classify the current state of diagnostic HIT and identify future research directions.

Methods

A multi-pronged literature search was conducted using PubMed, Web of Science, backwards and forwards reference searches and contributions from domain experts. We included HIT systems evaluated in clinical and experimental settings as well as previous reviews, and excluded radiology computer-aided diagnosis, monitor alerts and alarms, and studies focused on disease staging and prognosis. Articles were organised within a conceptual framework of the diagnostic process and areas requiring further investigation were identified.

Results

HIT approaches, tools and algorithms were identified and organised into 10 categories related to those assisting: (1) information gathering; (2) information organisation and display; (3) differential diagnosis generation; (4) weighing of diagnoses; (5) generation of diagnostic plan; (6) access to diagnostic reference information; (7) facilitating follow-up; (8) screening for early detection in asymptomatic patients; (9) collaborative diagnosis; and (10) facilitating diagnostic feedback to clinicians. We found many studies characterising potential interventions, but relatively few evaluating the interventions in actual clinical settings and even fewer demonstrating clinical impact.

Conclusions

Diagnostic HIT research is still in its early stages with few demonstrations of measurable clinical impact. Future efforts need to focus on: (1) improving methods and criteria for measurement of the diagnostic process using electronic data; (2) better usability and interfaces in electronic health records; (3) more meaningful incorporation of evidence-based diagnostic protocols within clinical workflows; and (4) systematic feedback of diagnostic performance.
Staying just one step ahead: providing care for patients with motor neurone disease
Authors: McConigley R , Kristjanson L J , Aoun S M , Oldham L , Currow DC , O'Connor M , Holloway K
Published: July 2013

Introduction

There is limited information about the experiences and educational needs of health professionals who may be required to provide care for people with Motor Neurone Disease (MND) especially in the later stages of the disease. The aim of this study was to determine the experiences of, and need for, education of these health professionals.

Methods

Interviews and focus groups were conducted with 31 health professionals with some experience in providing palliative care for people with MND. Thematic content analysis was used to identify common themes.

Results

A key theme,Just One Step Ahead, emerged, that describes the central capability health professionals identified as necessary to help individuals plan and prepare for disease and lifestyle changes just before they arise. Two subthemes also emerged:Expertise in MNDandBespoke Communication. Expertise in MNDdescribed the required understanding of the disease and the particular individual's version of the disease to allow the health professional to plan, advise, support and anticipate the needs of the person living with MND.Bespoke Communicationwas the facility to tailor care messages sensitively and effectively to the range of people involved in care (patients, family, healthcare team members).

Conclusions

Care of people with MND requires up-to-date expertise about the disease and skilled communication abilities to manage complexity and change. Timely and focused education and specialist MND support for care providers are essential to tailored and responsive care and a widely available education programme has been developed to address these needs.
Attitudes and practices regarding resuscitation in emergency departments in Trinidad and Tobago
Authors: Baird Georgia , Sammy Ian , Nunes Paula , Paul Joanne
Published: July 2013

Background

Ethical issues with regard to resuscitation are increasingly important. Understanding how emergency physicians deal with these problems is essential for the development of policies for resuscitative care.

Objectives

To identify the knowledge, opinions and practices of emergency physicians employed full time in public hospitals in Trinidad and Tobago, with respect to cardiopulmonary resuscitation. To compare the differences in responses between physicians in training and those who were not. In addition, to compare these responses with those expressed in a similar study in the USA in 2007.

Methods

All emergency physicians (120) who fulfilled the eligibility criteria for the study were asked to record anonymous responses to survey questions about ethical issues regarding resuscitation.

Results

Of the 98 respondents, most (79.6%) had been practising emergency medicine for ≤5 years and about 38% had had some training in emergency medicine. Most respondents agreed that survival rates for cardiopulmonary resuscitation (CPR) were poor. However, 41.2% of respondents had performed CPR >10 times in the past 3 years despite expected futility. More participants in the US study than in the local study thought that the existence of an advance directive was important in making decisions about CPR and that legal concerns should not, but do, affect CPR decisions in practice.

Conclusions

Local emergency physicians are as affected by legal and ethical CPR issues as are US emergency physicians. Education programmes and policies that deal with these concerns would better assist the emergency physician in dealing with them.
A systematic review of the activity and impact of emergency care practioners in the NHS
Authors: Hill Harry , McMeekin Peter , Price Christopher
Published: July 2013

Background

The NHS has seen a great expansion in the number of emergency care practitioners (ECPs) working in prehospital, primary and acute care settings since the role was introduced in 2003. This paper updates and expands on two previous reviews of ECP roles by identifying and discussing all empirical studies to date that examined the impact of ECP services in the NHS.

Objectives

To summarise the national evidence-based literature on the impact of ECPs on healthcare delivery, effectiveness of practice and related health service resource use.

Methods

Searches in MEDLINE, EMBASE and CINAHL databases, and two internet search engines (Google and Google Scholar). Identified publications were screened for relevance and quality before a description and synthesis of their findings. No statistical comparison was undertaken.

Results

Studies from the peer-reviewed literature (n=15) and project reports (n=6) were included. Overall, there was evidence that investment in ECP roles is beneficial for the quality of care reported by patients and cost efficiency savings. There was clear support from staff and patients for ECP services, and a number of studies of high methodological quality described care processes (diagnosis, investigations instigated and treatment initiated) provided by ECPs to be equivalent to or better to that provided by practitioners with traditional roles. Prehospital ECPs provided ‘added value’ by treating more patients at the scene thereby reducing unnecessary referral to emergency departments. It was often unclear whether the ECP intervention was part of a larger service change and/or new investment.

Conclusions

Successful implementation of the ECP role has been described. Further evaluations should consider whether the beneficial impact of the role transfers equally across all operational settings and patient groups, and is not just a reflection of new investment in clinical services.
“Can you send an ambulance please?”: a comparison of callers’ requests for emergency medical dispatch in non-stroke and stroke calls
Authors: Leathley Michael J , Jones Stephanie P , Gibson Josephine M E , Ford Gary A , McAdam Joanna J , Quinn Tom , Watkins Caroline L
Published: July 2013

Background

Identifying ‘true stroke’ from an emergency medical services (EMS) call is challenging, with over 50% of strokes being misclassified. In a previous study, we examined the relationship between callers’ descriptions of stroke symptoms to the emergency medical dispatcher and the subsequent classification and prioritisation of EMS response. The aim of this subsequent study was to explore further the use of keywords by callers when making emergency calls, comparing stroke and non-stroke calls.

Methods

All non-stroke calls to one EMS dispatch centre between 8 March 2010 and 14 March 2010 were analysed. These were compared with the stroke calls made to one EMS dispatch centre between 1 October 2006 and 30 September 2007. Content analysis was used to explore the problems described by the caller, and findings were compared between non-stroke and stroke calls.

Results

277 non-stroke calls were identified. Only eight (3%) callers mentioned stroke, 12 (4%) and 11 (4%) mentioned limb weakness and speech problems, respectively, while no caller mentioned more than one classic stroke symptom. This contrasted with 473 stroke calls, where 188 (40%) callers mentioned stroke, 70 (15%) limb weakness and 72 (15%) speech problems, and 14 (3%) mentioned more than one classic stroke symptom.

Conclusions

People who contact the EMS about non-stroke conditions rarely say stroke, limb weakness, speech problems or facial weakness. These words are more frequently used when people contact the EMS about stroke, although many calls relating to stroke patients do not mention any of these keywords.
Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial
Authors: Jennings Paul A , Cameron Peter , Bernard Stephen , Walker Tony , Jolley Damien , Fitzgerald Mark , Masci Kevin
Published: July 2013

Introduction

Improved early pain control may affect the longer-term prevalence of persistent pain. In a previous randomised, controlled trial, we found that the administration of ketamine on hospital arrival decreased pain scores to a greater extent than morphine alone in patients with prehospital traumatic pain. In this follow-up study, we sought to determine the prevalence of persistent pain and whether there were differences in patients who received ketamine or morphine.

Methods

This study was a long-term follow-up study of the prehospital, prospective, randomised, controlled, open-label study comparing ketamine with morphine in patients with trauma and a verbal pain score of >5 after 5 mg intravenous morphine. Patients were followed-up by telephone 6–12 months after enrolment, and a questionnaire including the SF-36 (V.2) health-related quality of life survey and the Verbal Numerical Rating Scale for pain was administered.

Results

A total of 97/135 (72%) patients were able to be followed-up 6–12 months after enrolment between July 2008 and July 2010. Overall, 44/97 (45%) participants reported persistent pain related to their injury, with 3/97 (3%) reporting persistent severe pain. The prevalence of persistent pain was the same between study groups (22/50 (44%) for the ketamine group vs 22/47 (46%) for the morphine group). There was no difference in the SF-36 scores between study arms.

Conclusions

There is a high incidence of persistent pain after traumatic injury, even in patients with relatively minor severity of injury. Although decreased pain scores at hospital arrival are achieved with ketamine compared with morphine, this difference does not affect the prevalence of persistent pain or health-related quality of life 6 months after injury. Further larger studies are required to confirm this finding.

Trial Registration Number

Australian and New Zealand Clinical Trials Registry (ACTRN12607000441415).
Clinical significance of E-cadherin, β-catenin, vimentin and S100A4 expression in completely resected squamous cell lung carcinoma
Authors: Zhang Hua , Liu Jun , Yue Dongsheng , Gao Liuwei , Wang Daowei , Zhang Hongdian , Wang Changli
Published: July 2013

Objective

The aim of this study was to evaluate the prognostic value of E-cadherin, β-catenin, vimentin and S100A4 expression in a cohort of squamous cell lung carcinoma (SqCC) patients.

Methods

Tumours from 204 patients with surgically resected SqCC were used for the immunohistochemical analyses of E-cadherin, β-catenin, vimentin and S100A4 expression. Correlations between the expression of these markers and clinicopathological parameters were analysed using the χ2test. The prognostic value of these markers was evaluated using univariate Kaplan–Meier survival analyses and multivariate Cox proportional hazards model analyses.

Results

Significant associations between E-cadherin expression and T stage (p=0.040), histological differentiation (p=0.005), lymph node metastasis (p<0.001), and recurrence (p<0.001) were identified. Decreased β-catenin expression was significantly correlated with T stage (p=0.003) and lymph node metastasis (p=0.010). Vimentin expression was associated with histological differentiation (p=0.017) and lymph node metastasis (p=0.001). Moreover, significant correlations were observed between S100A4 expression and lymph node metastasis (p=0.020) and recurrence (p<0.001). In the univariate analyses, high E-cadherin expression was a positive indicator for overall survival (OS) (p<0.001) and disease-free survival (DFS) (p<0.001), whereas high S100A4 or vimentin expression were negative indicators for OS (p<0.001 and p=0.010, respectively) and DFS (p<0.001 and p=0.006, respectively). In the multivariate analyses, E-cadherin and S100A4 expression were independent prognostic factors for OS (HR 0.697, 95% CI 0.524 to 0.926, p=0.013, and HR 1.508, 95% CI 1.122 to 2.027, p=0.007, respectively) and DFS (HR 0.634, 95% CI 0.471 to 0.852, p=0.003, and HR 1.490, 95% CI 1.101 to 2.015, p=0.010, respectively).

Conclusions

Effective analysis of E-cadherin and S100A4 expression may allow for the identification of patients who are at a high risk of recurrence and poor prognosis in SqCC.
Reference intervals for red cell variables and platelet counts in infants at 2, 5 and 13 months of age: a cohort study
Authors: Hinchliffe R F , Bellamy G J , Bell F , Finn A , Vora A J , Lennard L
Published: July 2013

Aims

To derive reference values for red cell variables and platelet counts from a cohort of infants sampled at precise ages during the first 13 months of life.

Methods

Blood counts, reticulocyte counts and zinc protoporphyrin concentrations were obtained from healthy term infants of North European ancestry at 2, 5 and 13 months of age.

Results

Mean cell volume (MCV) and mean cell haemoglobin (MCH) values did not differ significantly between 5 and 13 months and MCH concentration was unaffected by age. Values of all other variables at any one age differed significantly from those at the other two. Haemoglobin, mean cell haemoglobin, zinc protoporphyrin and platelet values (95% ranges) at 2 (n=119), 5 (n=97) and 13 months (n=42) were, respectively, 91–125, 101–129 and 105–133 g/L; 28.6–33.1, 24.5–28.7 and 24.3–28.7 pg; 36–116, 25–91 and 27–57 micromol/mol haem; and 216–658, 241–591 and 209–455×109/L. At 2 and 5 months, respectively, 26.9% and 10.8% of subjects had platelet counts >500×109/L. Reticulocyte counts at 2 months and MCV and MCH values at 5 months were significantly higher in girls. In boys, red cell distribution width values were significantly higher at 5 months, and zinc protoporphyrin values at both 2 and 5 months.

Conclusions

These findings indicate the value of obtaining reference data at precise ages during infancy and confirm and extend earlier reports indicating a gender difference in laboratory measures used to assess iron status in early infancy.
Prediction of low birthweight and small for gestational age from symphysis-fundal height mainly in developing countries: a meta-analysis
Authors: Goto Eita
Published: July 2013

Background

A highly sensitive and simple screening procedure is required for early detection of low birthweight and small for gestational age, especially in developing countries.

Methods

A meta-analysis was performed to evaluate use of symphysis-fundal height for prediction of low birthweight and small for gestational age. PubMed (MEDLINE) and other databases were used with no limitation on the date of publication (January 2012). The inclusion criteria were moderate-to-high-quality studies, that is, Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) score ≥8, published in English, which provided true and false, positive and negative results for prediction. 2×2 tables were constructed and diagnostic meta-analysis was performed.

Results

46 studies, which were conducted mostly in hospitals, evaluated the prediction of low birthweight (n=12) or small for gestational age (n=34). Only specificity to predict small for gestational age (0.87) was relatively high. Sensitivity to predict low birthweight (0.72) or small for gestational age (0.58) and specificity to predict low birthweight (0.73) were not sufficiently high. Regardless of predicting low birthweight or small for gestational age, the diagnostic accuracy was moderate (0.7 ≤ area under the curve≤0.9) and informational value was small (but sometimes important; positive and negative likelihood ratios of 2–5 and 0.5–0.2, respectively).

Conclusions

The present meta-analysis suggested that symphysis-fundal height is unsuitable for primary screening of low birthweight or small for gestational age. The results may be overly optimistic due to the inclusion of hospital-based versus community-based studies.
Neighbourhood food environments and body mass index among New York City adults
Authors: Stark James H , Neckerman Kathryn , Lovasi Gina S , Konty Kevin , Quinn James , Arno Peter , Viola Deborah , Harris Tiffany G , Weiss Christopher C , Bader Michael D M , Rundle Andrew
Published: July 2013

Background

Studies evaluating the impact of the neighbourhood food environment on obesity have summarised the density or proximity of individual food outlets. Though informative, there is a need to consider the role of the entire food environment; however, few measures of whole system attributes have been developed. New variables measuring the food environment were derived and used to study the association with body mass index (BMI).

Methods

Individual data on BMI and sociodemographic characteristics were collected from 48 482 respondents of the 2002–2006 community health survey in New York City and linked to residential zip code-level characteristics. The food environment of each zip code was described in terms of the diversity of outlets (number of types of outlets present in a zip code), the density of outlets (outlets/km2) and the proportion of outlets classified as BMI-unhealthy (eg, fast food, bodegas).

Results

Results of the cross-sectional, multilevel analyses revealed an inverse association between BMI and food outlet density (−0.32 BMI units across the IQR, 95% CI −0.45 to −0.20), a positive association between BMI and the proportion of BMI-unhealthy food outlets (0.26 BMI units per IQR, 95% CI 0.09 to 0.43) and no association with outlet diversity. The association between BMI and the proportion of BMI-unhealthy food outlets was stronger in lower (<median for % poverty) poverty zip codes than in high-poverty zip codes.

Conclusions

These results support a more nuanced assessment of the impact of the food environment and its association with obesity.
Time series analysis of maternal mortality in Africa from 1990 to 2005
Authors: DerSarkissian Maral , Thompson Caroline A , Arah Onyebuchi A
Published: July 2013

Objectives

Most global maternal deaths occur in Africa and Asia. In response, the Millennium Development Goal (MDG-5) calls for a 75% reduction in maternal mortality from 1990 to 2015. To assess the potential for progress in MDG-5 in Africa, we examined the cross-sectional and longitudinal associations of socioeconomic, demographic and population-health factors with maternal mortality rates in Africa.

Methods

We used data from global agencies and the published literature to identify socioeconomic, demographic and population-health explanatory factors that could be correlated with maternal mortality in 49 countries of Africa for the years 1990, 1995, 2000 and 2005. We used correlation, negative binomial and mixed Poisson regression models to investigate whether there exist associations between potential explanatory factors and maternal mortality.

Results

Some African countries have made substantial progress towards achieving MDG-5 while others have fallen behind. Lower gross domestic product (GDP) and female enrolment in primary schools, but higher HIV prevalence, neonatal mortality rate and total fertility rate, were associated with higher maternal mortality.

Conclusions

Maternal mortality rates in African countries appear to be declining. The mean maternal mortality ratios in Africa decreased from 695.82 in 1990 to 562.18 in 2005. Yet some countries are more likely than others to achieve MDG-5. Better socioeconomic, demographic and population health development appear to be conducive to better maternal health in Africa. Sustained efforts on all these fronts will be needed to close the gap in maternal survival and achieve MDG-5 in Africa.
Children's and adolescents' sedentary behaviour in relation to socioeconomic position
Authors: Coombs Ngaire , Shelton Nicola , Rowlands Alex , Stamatakis Emmanuel
Published: July 2013

Background

Sedentary behaviour is an emerging cardiometabolic risk factor in young people. Little is known about how socioeconomic position (SEP) and sedentary behaviour are associated in children and adolescents. This study examines associations between SEP and sedentary behaviour in school-age children and adolescents.

Methods

The core sample comprised 3822 Health Survey for England 2008 participants aged 5–15 years with complete information on SEP (household income, head of household occupational social class and area deprivation) and self-reported sedentary time (television viewing and other sitting during non-school times). Accelerometer-measured total sedentary time was measured in a subsample (N=587). We examined multivariable associations between SEP (including a composite SEP score) and sedentary time using generalised linear models, adjusting for age, sex, body mass index, physical activity, accelerometer wear time and mutually adjusting for the other SEP indicators.

Results

Participants in the highest SEP category spent 16 min/day less (95% CI 6 to 25, p=0.003) watching TV than participants in the lowest SEP category; yet they spent 7 (2 to 16, p=0.010) and 17 (5 to 29, p<0.000) min/day more in non-TV sitting and total (accelerometry-measured) sedentary time, respectively. Associations across individual SEP components varied in strength. Area deprivation was not associated with sedentary time.

Conclusions

Low SEP is linked with higher television times but with lower total (accelerometer-measured) sedentary time, and non-TV sitting during non-school time in children and adolescents. Associations between sedentary time and SEP differ by type of sedentary behaviour. TV viewing is not a good proxy for total sedentary time in children.
Geographic access to mammography screening centre and participation of women in the Quebec Breast Cancer Screening Programme
Authors: St-Jacques Sylvie , Philibert Mathieu D , Langlois André , Daigle Jean-Marc , Pelletier Éric , Major Diane , Brisson Jacques
Published: July 2013

Background

This study evaluated the impact of distance between women's residences and designated screening centres (DSC) on participation in the Quebec Breast Cancer Screening Programme, whether this impact varied according to the rural–urban classification and the proportion of participants who used the DSC nearest to their home.

Methods

Travel distance between the residence of 833 856 women and the nearest DSC (n=85) was estimated. Data were obtained from administrative and screening programme databases. The analysis made use of a log-binomial regression model adjusting for age and material and social deprivation. The proportions of participants who used the DSC nearest to their residence were measured.

Results

Compared to women living <2.5 km from a DSC, absolute decreases of 6.3% and 9.8% in participation rate were observed for distances of 50.0 to <75.0 km (rate ratios (RR)=0.88, 95% CI 0.86 to 0.89) and ≥75.0 km (RR=0.81, 95% CI 0.79 to 0.83), respectively. The lowest participation (42%) was observed in Montreal Island. The distance at which participation started to decrease materially varied according to rural–urban classification. Participation rates decreased at distances of ≥25.0 km in the Montreal suburbs and midsize cities, at ≥12.5 km in small cities and at ≥50.0 km in rural areas (interaction p<0.0001). The proportion of participants who had their mammography at the nearest DSC decreased with increasing distance.

Conclusions

Distance affects participation and this effect varies according to rural–urban classification. The lower participation in Montreal Island, where all women lived <12.5 km from a DSC, argues for a major impact of other characteristics or other dimensions of accessibility.
A survey of post-amputation pains in serving military personnel
Authors: Aldington Dominic , Small C , Edwards D , Ralph J , Woods P , Jagdish S , Moore R A
Published: July 2013

Introduction

Amputation is a common injury in survivors of current military conflicts. The primary aim of this study was to establish the prevalence rate of phantom limb pain (PLP) in military personnel undergoing rehabilitation at the UK's Defence Medical Rehabilitation Centre. The secondary aims were to establish treatment failure rates and prevalence rates of phantom limb sensations (PLS) and residual limb pains (RLP).

Method

A questionnaire survey was developed from that used in a previous study of pains in veterans. Questions were asked of the intensity of PLP, RLP and PLS over the previous month and the entire time since amputation. Treatment failure was defined as greater than ‘mild’ pain. A literature review for similar studies was undertaken.

Results

There were 48 responders with 65 amputations. PLP in the previous month was reported by 49% of respondents and 20% were classed as treatment failures; 76% had PLP at some point and 56% were analgesic failures. PLS was commoner with 70% reported over the previous month and 66% at any time. 65% had RLP over the previous month, 31% were treatment failures and 80% had experienced RLP at some point and 63% of these were failures of treatment. Eight other papers were found for comparison.

Conclusions

This is the first paper that describes prevalence of pains associated with amputation in a serving military population. It also describes the use of analgesic failure as a concept and provides an encouraging rate of as low as 20% in this population.
KL01 Ending the HIV/AIDS Pandemic: From Scientific Advances to Public Health Implementation
Authors: Fauci A S
Published: July 2013

Extraordinary advances in basic and clinical HIV/AIDS research over three decades have led to the development of effective interventions, particularly for treating and preventing HIV infection. These interventions have clearly been shown to be efficacious in clinical trials and effective when properly implemented “on the ground.” For example, combination antiretroviral therapy (ART) dramatically improves the health and longevity of HIV-infected people. Adult male circumcision is highly effective in protecting heterosexual men from acquiring HIV infection. Preventing mother-to-child transmission of HIV infection with antiretroviral drugs has been highly successful. Antiretroviral drugs also play a critical role in preventing the sexual transmission of HIV; thus, treatment of HIV-infected people decreases dramatically the likelihood that they will transmit the virus to others. In addition, pre-exposure prophylaxis with antiretroviral drugs delivered orally or at the genital mucosa reduces the risk of acquiring HIV infection. Significant scientific challenges remain in HIV research, notably in developing a cure and a vaccine for HIV infection; however, the scientifically proven interventions currently available offer unprecedented opportunities to make major gains in the fight against HIV/AIDS. In many settings, the implementation of these interventions in a cohort or well-defined population has already resulted in impressive results, strongly indicating that global implementation scale-up could have the effect of dramatically changing the trajectory of the HIV/AIDS pandemic and ultimately leading to the end of the AIDS pandemic. We are on scientifically solid ground that this goal is achievable with a major global commitment.
PL01.1 Antimicrobial Resistance inNeisseria Gonorrhoeaeand Possible Emergence of Untreatable Gonorrhoea: How, When and Essential Actions?
Authors: Unemo M
Published: July 2013

The WHO estimated 106 million gonorrhoea cases in 2008 globally and antimicrobial resistance (AMR) inNeisseria gonorrhoeaeis a major public health concern that compromises effective treatment and disease control efforts worldwide. The new superbugNeisseria gonorrhoeaehas retained high-level resistance to antimicrobials previously recommended for first-line treatment and, recently, the first extensively drug-resistant (XDR) gonococcal strains with high-level resistance to the extended-spectrum cephalosporin (ESC) ceftriaxone, the last remaining option for first-line empiric monotherapy of gonorrhoea, were reported. This is of grave concern and it is feared that gonorrhoea may become untreatable under certain circumstances. In this talk, with particular emphasis on ESCs the evolution, origin, emergence and spread of AMR and genetic AMR determinants; their relevance and effects (including interplay and epistasis) on AMR and biological fitness of gonococcal strains; gonococcal population dynamics and international spread of biologically “successful” AMR gonococcal clones; genetic AMR detection methods; current situation regarding verified treatment failures with ESCs, and suggested future treatment options will be discussed. Essential actions to combat the emergence of multidrug resistant and possibly untreatable gonorrhoea will also be highlighted, such as implementing the WHO Global Action Plan and national or regional action/response plans, e.g., the ECDC Response plan for the European Union and the CDC Response Plan for the USA; enhancing surveillance of gonococcal antimicrobial resistance, treatment failures and antimicrobial use/misuse; and improving prevention, early diagnosis and treatment of gonorrhoea to reduce the gonorrhoea burden. All these responses will be valuable in detaining the global spread of AMR, however, in a longer term not sufficient to prevent the emergence and spread of potentially untreatable gonorrhoea. Few promising new antimicrobials are in sight, and it is essential to promptly focus research on timely development of novel effective drugs for treatment of gonorrhoea, and ideally, a vaccine.
PL01.2 HPV: Changing Screening Algorithms and Scaling Up Vaccination
Authors: Franco E L
Published: July 2013

Since 2006, when the first human papillomavirus (HPV) vaccine was approved, there has been much progress on the prevention of diseases associated with HPV infection, particularly cervical cancer. A decade earlier, the first clinically validated HPV assay was approved as an adjunct test in cervical cancer screening. As the two cervical cancer prevention fronts, i.e., primary via vaccination and secondary via screening, progressed more or less in parallel they have begun to intersect in recent years, as it has become clear that effective deployment of these strategies requires integration of resources and planning. However, acceptance of these technologies has not been without obstacles. Up until recently, although the evidence for the superior value of HPV testing in cervical cancer screening had become unequivocal, consensus guidelines in the U.S. tended to indicate uncertainty as to the degree and strength of evidence associated with this test. This state of affairs changed in March 2012 with the simultaneous publication of the guidelines from the US Preventive Services Task Force and from the joint society consortium that involved the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society of Clinical Pathology. These guidelines placed greater emphasis on HPV testing in primary screening and discouraged unnecessary screening at younger ages and overly frequent screening. While co-testing is still favoured by the new US guidelines, other high-resource countries began to pilot or even to implement programmatically the strategy of HPV testing as the sole primary screening test, reserving Pap cytology for the triage of women who are HPV positive. The author will review the historical milestones of how HPV-based strategies have moved to centre stage in cervical cancer prevention and discuss the research directions in the area, particularly with respect to how these strategies intersect.
PL02.3 HIV Transmission Dynamics; Can We Translate Knowledge into Action
Authors: Quinn T C
Published: July 2013

Background

There are 34 million people living with HIV globally, and 2.5 million people become newly infected last year. Although there have been some successes in prevention, the epidemic continues unabated in many populations, requiring more intensive and integrated behaviour and biomedical prevention programmes if we are to control HIV spread.

Methods

A comprehensive review of randomised trials of behavioural and biomedical interventions aimed at decreasing HIV transmission and acquisition was performed and will be presented.

Results

In addition to male circumcision, the most successful biomedical intervention has been the use of antiretroviral drugs (ARVs) for prevention of HIV perinatal transmission and sexual transmission among HIV discordant couples, and for the prevention of HIV acquisition via microbicides and oral pre-exposure prophylaxis (PrEP). All of thetransmissionstudies have demonstrated that reductions in viral load with ARVs to undetectable viral blood levels during birth, breast-feeding, or sexual intercourse reduces transmission by > 96%. This has been the greatest success in the HIV prevention field over the past two decades and continual scale-up of access to ARVs can be associated with marked reductions in HIV transmission and incidence. Decreasingacquisitionwith use of ARVs is totally dependent on high adherence (> 90%) to the medications in an uninfected population. Studies have had mixed results with some populations with high adherence demonstrating high efficacy using PrEP (> 70% efficacy) or microbicide (> 50% efficacy), while others with low adherence as measured by non-detectable blood levels of ARVs demonstrated no efficacy.

Conclusion

Multiple studies have confirmed that effective use of ARVs substantially reduces transmission and emphasise the critical importance of integrated behavioural and biomedical strategies. When treatment with ARVs is combined with other interventions involving voluntary counselling and testing, condoms, adherence to medications, and circumcision, the possibility of controlling HIV becomes a feasible and achievable goal.