bluuebunny/crossref_metadata_2025 huggingface dataset:
Interventions for edentate elders – what is the evidence?
Authors: Müller Frauke
Published: January 2014

Demographic developments indicate an increasing proportion of elderly persons in the population as well as longer life expectancies. Furthermore, the prevalence of edentulism is decreasing, and natural teeth are being retained until later in life. Geriatric patients are more frequently fragile with multiple co‐morbidities, including frequent medication‐related side effects such as xerostomia. Cognitive impairment also increases with age and presents a considerable challenge to oral hygiene and dental treatment. Edentulous patients present a particular challenge, as muscle skill and the ability to adapt to a new denture diminish with age. Duplication techniques reduce the adaptation of replacement dentures, and implants are increasingly used to stabilise lower complete dentures, significantly improving chewing efficiency and preventing peri‐implant bone loss. Implant overdentures may reverse some of the functional, psychological and psychosocial effects of tooth loss and thus increase the oral health‐related quality of life until late in life. Evidence from RCTs exists on the 10‐year survival of implants and implant overdentures, but few studies have investigated the problems and survival rates when the patient loses autonomy. The standard of care in geriatric patients has to be adapted to the patient's motivation, functional and cognitive impairment, and medical condition as well as his/her socio‐economic context.
The Seattle Care Pathway for securing oral health in older patients
Authors: Pretty Iain A. , Ellwood Roger P. , Lo Edward C.M. , MacEntee Michael I. , Müller Frauke , Rooney Eric , Murray Thomson William , Van der Putten Gert‐Jan , Ghezzi Elisa M. , Walls Angus , Wolff Mark S.
Published: January 2014

There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependancy and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients.
Patients who present late to HIV care and associated risk factors in Nigeria
Authors: Agaba PA , Meloni ST , Sule HM , Agbaji OO , Ekeh PN , Job GC , Nyango N , Ugoagwu PO , Imade GE , Idoko JA , Kanki PJ
Published: January 2014

Objectives

Our objectives were to assess trends in late presentation and advanced HIV disease (AHD) and determine associated risk factors.

Methods

We conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of Public Health−President's Emergency Plan for AIDS Relief (PEPFAR) programme at the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the European Consensus Definition to assess trends in late presentation (CD4 count < 350 cells/μL or AIDS‐defining illness) and AHD (CD4 count < 200 cells/μL or AIDS‐defining illness) and evaluated associated risk factors using logistic regression methods.

Results

Among 14 487 eligible patients, 12 401 (85.6%) were late presenters and 9127 (63.0%) presented with AHD. Late presentation decreased from 88.9% in 2005 to 80.1% in 2010 (P < 0.001). Similarly, AHD decreased from 67.8% in 2005 to 53.6% in 2010 (P < 0.001). In logistic regression models adjusting for sociodemographic and biological variables, male sex [adjusted odds ratio (aOR) = 1.80; 95% confidence interval (CI) 1.60–2.04], older age (aOR = 1.37; 95% CI 1.22–1.54), civil service employment (aOR = 1.48; 95% CI 1.00–2.21), referral from out‐patient (aOR = 2.18; 95% CI 1.53–3.08) and in‐patient (aOR = 1.55; 95% CI 1.11–2.17) services, and hepatitis B virus (aOR = 1.43; 95% CI 1.26–1.63) and hepatitis C virus (aOR = 1.18; 95% CI 1.02–1.37) coinfections were associated with late presentation. Predictors of AHD were male sex (aOR = 1.67; 95% CI 1.54–1.82), older age (aOR = 1.26; 95% CI 1.16–1.36), unemployment (aOR = 1.34; 95% CI 1.00–1.79), referral from out‐patient (aOR = 2.40; 95% CI 1.84–3.14) and in‐patient (aOR = 1.97; 95% CI 1.51–2.57) services and hepatitis B virus coinfection (aOR = 1.30; 95% CI 1.19–1.42).

Conclusions

Efforts to reduce the proportion of patients who first seek care at late stages of disease are needed. The identified risk factors should be utilized in formulating targeted public health interventions to improve early diagnosis and presentation for HIV care.
Effect of TiO2Doping on the Sintering Process, Mechanical and Magnetic Properties of NiFe2O4Ferrite Ceramics
Authors: Wang Bin , Du Jinjing , Liu Yihan , Yao Guangchun
Published: January 2014

TiO2‐doped NiFe2O4samples were prepared via ball‐milling and two‐step sintering processes. Besides NiFe2O4phase, two new phases, NiTiO3and Fe2TiO5, formed in TiO2‐doped samples. The temperature of sintering onset for 1.0 wt% TiO2‐doped samples is 230°C lower than that of undoped samples. Early‐stage synthesis process of TiO2‐doped NiFe2O4ceramics is controlled by grain boundary diffusion mechanism. Increasing TiO2content from 0 to 1.0 wt%, the apparent activation energy decreased from 813.919 KJ/mol to 639.361 KJ/mol. The values of relative density and bending strength reached their maximum value with 1.0 wt% TiO2. Saturation magnetization, residual magnetization ratio and coercivity decrease with increasing TiO2content.
Investigations of Structural and Magnetic Properties of Nanostructured Ni0.5+xZn0.5‐xFe2O4 Magnetic Feeders for CSEM Application
Authors: Niaz Akhtar Majid , Yahya Noorhana , Sattar Abdul , Ahmad Mukhtar , Idrees Muhammad , Hasan Asif Muhammad , Azhar Khan Muhammad
Published: January 2014

Marine CSEM is a new technique for detection of deep target hydrocarbons. Aluminum EM antenna was developed, and nanostructured NiZn magnetic feeders were used to increase the field strength from EM antenna for deep hydrocarbons. The doping of Ni2+ was aimed at the optimization of initial permeability and magnetic losses. Ni0.5+xZn0.5‐xFe2O4 (x = 0.3) samples sintered at 950°C presented highest initial permeability (106.23) and low magnetic loss (0.0002) as compared to other samples. Due to better magnetic properties, Ni0.5+xZn0.5‐xFe2O4 (x = 0.3) samples were used as magnetic feeders for EM antenna. Magnitude of EM waves from the antenna increased up to 186%.
Study on Gelcasting of Fused Silica Glass Using Glutinous Rice Flour as Binder
Authors: Wan Wei , Huang Chun‐e , Yang Jian , Qiu Tai
Published: January 2014

Gelcasting is a colloidal processing method for fabricating high‐strength and complex shape ceramic green bodies. However, industry has been reluctant to use the gelcasting technique because the most commonly used gel, acrylamide (AM), is a neurotoxin. Here, we report an attempt at the gelcasting of fused silica glass using a natural and nontoxic gel, glutinous rice flour (GRF) as binder. The GRF‐based aqueous system was found to behave excellently in the gelcasting process. Flexural strength of fused silica green bodies solidified with only 3 wt% GRF is up to 11.87 MPa. Bulk density and flexural strength of fused silica glass sintered at 1275 °C are 1.75 g/cm3 and 47.02 MPa, respectively.
Stroke: More than a ‘Brain Attack’
Authors: Teasell Robert , Hussein Norhayati , McClure Andrew , Meyer Matthew
Published: January 2014

Stroke is a life-altering event that potentially affects stroke survivors, their families, healthcare resources, and society in general. Stroke has often been described as ‘brain attack’, denoting emergency emphasis on the vascular pathology. Consequently, many national and provincial stroke strategies have emphasized vascular care through primary prevention strategies and thrombolysis. Despite being important initiatives, this has resulted in a stroke system that emphasizes the frontloading of stroke care, focusing on the vascular pathology. The advent of thrombolysis therapy has benefited a small proportion of patients while a vast majority are still affected by stroke-related impairments. Management of the vascular elements of stroke is important; however, the impact of rehabilitation on stroke recovery has been relatively undervalued. Stroke care is in need of a revolution toward a more comprehensive and balanced approach. It is anticipated that the major focus of stroke care will include promoting recovery, in line with the growing evidence on stroke rehabilitation interventions. A paradigm shift is necessary to ensure that comprehensive and balanced stroke care which incorporates rehabilitation is taken into account, leading to a stroke care system where patient needs are managed both as a ‘brain attack’ and an ‘injured brain’.
A descriptive cross‐sectional international study to explore current practices in the assessment, prevention and treatment of skin tears
Authors: LeBlanc Kimberly , Baranoski Sharon , Holloway Samantha , Langemo Diane , Regan Mary
Published: January 2014

This study presents the results of a descriptive, cross‐sectional, online international survey in order to explore current practices in the assessment, prediction, prevention and treatment of skin tears (STs). A total of 1127 health care providers (HCP) from 16 countries completed the survey. The majority of the respondents (69·6%, n = 695) reported problems with the current methods for the assessment and documentation of STs with an overwhelming majority (89·5%, n = 891) favouring the development of a simplified method of assessment. Respondents ranked equipment injury during patient transfer and falls as the main causes of STs. The majority of the samples indicated that they used non‐adhesive dressings (35·89%, n = 322) to treat a ST, with the use of protective clothing being the most common method of prevention. The results of this study led to the establishment of a consensus document, classification system and a tool kit for use by practitioners. The authors believe that this survey was an important first step in raising the global awareness of STs and to stimulate discussion and research of these complex acute wounds.
Evidence of mutualistic synzoochory between cryptogams and hummingbirds
Authors: Osorio‐Zuñiga Felipe , Fontúrbel Francisco E. , Rydin Håkan
Published: January 2014

Endozoochory is usually involved in seed dispersal mutualisms, whereas ectozoochory is non‐rewarding, and therefore neutral (or even negative) for the animal vector. Synzoochory is an intermediate dispersal type between endo and ectozoochory in which propagules are deliberately transported (usually in the mouth) but with no ingestion or gut passage involved. We present empirical evidence of synzoochoric mutualism between the hummingbird Sephanoides sephaniodes and cryptogams (one fern and seven moss species). Two species (Lophosoria quadripinnata and Ancistrodes genuflexa) constituted the bulk of nest biomass, and another six moss species were present in lesser quantity. The hummingbird was selective when collecting nest material so that the nests contained a higher density of reproductive structures (that could be dispersed further) than natural patches of the cryptogam species. Even after one year, the nests maintained half of the original reproductive structures (sporangia, sporophytes) and biomass, constituting an important dispersal source. These results show a new type of mutualism in which mosses could be dispersed throughout longer distances (several km) by hummingbirds and to higher positions (particularly for ground‐living species, promoting dispersal potential). The hummingbird benefits from collecting cryptogam material for nest building, and cryptogams benefit from the concentration and relocation of diaspore sources into more effective recruiting sites. Similar mutualistic relationships could be a general phenomenon, of importance in many ecosystems.
Regional mapping of myocardial hibernation phenotype in idiopathic end‐stage dilated cardiomyopathy
Authors: Lionetti Vincenzo , Matteucci Marco , Ribezzo Marco , Di Silvestre Dario , Brambilla Francesca , Agostini Silvia , Mauri Pierluigi , Padeletti Luigi , Pingitore Alessandro , Delsedime Luisa , Rinaldi Mauro , Recchia Fabio A. , Pucci Angela
Published: January 2014

Myocardial hibernation (MH) is a well‐known feature of human ischaemic cardiomyopathy (ICM), whereas its presence in human idiopathic dilated cardiomyopathy (DCM) is still controversial. We investigated the histological and molecular features of MH in left ventricle (LV) regions of failing DCM or ICM hearts. We examined failing hearts from DCM (n = 11; 41.9 ± 5.45 years; left ventricle‐ejection fraction (LV‐EF), 18 ± 3.16%) and ICM patients (n = 12; 58.08 ± 1.7 years; LVEF, 21.5 ± 6.08%) undergoing cardiac transplantation, and normal donor hearts (N, n = 8). LV inter‐ventricular septum (IVS) and antero‐lateral free wall (FW) were transmurally (i.e. sub‐epicardial, mesocardial and sub‐endocardial layers) analysed. LV glycogen content was shown to be increased in both DCM and ICM as compared with N hearts (P < 0.001), with a U‐shaped transmural distribution (lower values in mesocardium). Capillary density was homogenously reduced in both DCM and ICM as compared with N (P < 0.05 versus N), with a lower decrease independent of the extent of fibrosis in sub‐endocardial and sub‐epicardial layers of DCM as compared with ICM. HIF1‐α and nestin, recognized ischaemic molecular hallmarks, were similarly expressed in DCM‐LV and ICM‐LV myocardium. The proteomic profile was overlapping by ~50% in DCM and ICM groups. Morphological and molecular features of MH were detected in end‐stage ICM as well as in end‐stage DCM LV, despite epicardial coronary artery patency and lower fibrosis in DCM hearts. Unravelling the presence of MH in the absence of coronary stenosis may be helpful to design a novel approach in the clinical management of DCM.
Protection of neurons from high glucose‐induced injury by deletion of MAD2B
Authors: Meng Xianfang , Wang Xiaolan , Tian Xiujuan , Yang Zhihua , Li Man , Zhang Chun
Published: January 2014

Diabetic encephalopathy may lead to cognitive deficits in diabetic patients and diminish quality of life. It has been shown that protracted hyperglycaemia is directly associated with neuronal apoptosis, which is involved in diabetic encephalopathy. The anaphase‐promoting complex (APC) is essential for the survival of post‐mitotic neurons. In our previous study, we found that the mitotic arrest deficient protein MAD2B, one of APC inhibitors, was expressed in neurons in central nervous system. However, whether MAD2B is involved in hyperglycaemia‐induced apoptosis and thus takes part in diabetic encephalopathy is still unknown. To address this issue, we first explored the expression of MAD2B and cyclin B1 detected by immunofluorescence and Western blot. It was found that hyperglycaemia remarkably increased the expression of MAD2B and accumulation of cyclin B1 in cortices of diabetes mellitus rat model and in cultured primary neurons. To further explore the role of MAD2B in hyperglycaemia‐induced neuronal injury, we depleted MAD2B expression by a specifically targeted shRNA against MAD2B. We observed that MAD2B deficiency alleviated cyclin B1 expression and apoptotic neuronal death. These results demonstrate that MAD2B expression is the main culprit for accumulation of cyclin B1 and apoptosis in neurons under high glucose. Moreover, inhibition of the expression of MAD2B prevented neurons from entering an aberrant S phase that led differentiated neurons into apoptotic cell death. These results suggest that hyperglycaemia induced neuronal apoptosis through inducing expression of MAD2B, which represents a novel mechanism of diabetic encephalopathy.
Shared familial transmission of autism spectrum and attention‐deficit/hyperactivity disorders
Authors: Musser Erica D. , Hawkey Elizabeth , Kachan‐Liu Svetlana S. , Lees Paul , Roullet Jean‐Baptiste , Goddard Katrina , Steiner Robert D. , Nigg Joel T.
Published: January 2014

Background

To determine whether familial transmission is shared between autism spectrum disorders and attention‐deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission of both disorders in a large population‐based sample of children during a recent 7 year period.

Methods

Study participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician‐identified autism spectrum disorders (ASD) and/or attention‐deficit/hyperactivity disorder (ADHD) were identified via electronic medical records maintained for all KPNW members.

Results

Among children aged 6–12 years, prevalence was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6% of the ADHD sample) had co‐occurring ASD and ADHD, when all children were included. When mothers had a diagnosis of ADHD, first born offspring were at 6‐fold risk of ADHD alone (OR = 5.02, p < .0001) and at 2.5‐fold risk of ASD alone (OR = 2.52, p < .01). Results were not accounted for by maternal age, child gestational age, child gender, and child race.

Conclusions

Autism spectrum disorders shares familial transmission with ADHD. ADHD and ASD have a partially overlapping diathesis.
Mate competition and resource competition are inter‐related in sexual selection
Authors: Wacker S. , Amundsen T.
Published: January 2014

Sexual selection can be affected by the competition for limited breeding resources and/or the competition for limited mates. Although there is ample evidence for each type of competition by itself, little is known about their relative importance and interaction. To address these questions, we established 48 experimental breeding populations of the two‐spotted goby (Gobiusculus flavescens), a substrate‐breeding fish with paternal care. In three experimental treatments, males were limited in the access to either nest sites or mates or were provided with both nests and mates in excess. We quantified male competition behaviour (agonistic and courtship), the opportunity for selection and selection on male body size. Limited access to nests and mates produced similar opportunities for selection, but only limited access to mates increased male competitive behaviours and caused positive selection on male body size. Selection on body size in the mate‐limited treatment was due both to larger males being more likely to take up nests and to larger males being more likely to mate once they had a nest. These findings demonstrate that resource and mate limitation can differ in their effects on sexual selection. The results also reveal that resource and mating competition can be highly inter‐related and not always separated in time, implying that methods to disentangle the two processes must be chosen with care. Future research should consider experimental and analytical approaches similar to those of the present study in attempts to elucidate the interaction of resource and mating competition in animals.
Rapid increase in dispersal during range expansion in the invasive ladybird Harmonia axyridis
Authors: Lombaert E. , Estoup A. , Facon B. , Joubard B. , Grégoire J.‐C. , Jannin A. , Blin A. , Guillemaud T.
Published: January 2014

The evolutionary trajectories associated with demographic, genetic and spatial disequilibrium have become an issue of growing interest in population biology. Invasive species provide unique opportunities to explore the impact of recent range expansion on life‐history traits, making it possible to test for a spatial arrangement of dispersal abilities along the expanding range, in particular. We carried out controlled experiments in laboratory conditions to test the hypothesis of an increase in dispersal capacity with range expansion in Harmonia axyridis, a ladybird that has been invading Europe since 2001. We found a marked increase in the flight speed of the insects from the core to the front of the invasion range in two independent sampling transects. By contrast, we found that two other traits associated with dispersal (endurance and motivation to fly off) did not follow the same spatial gradient. Our results provide a striking illustration of the way in which predictable directional genetic changes may occur rapidly for some traits associated with dispersal during biological invasions. We discuss the consequences of our results for invasion dynamics and the evolutionary outcomes of spatially expanding populations.
Cryptic differences in colour among Müllerian mimics: how can the visual capacities of predators and prey shape the evolution of wing colours?
Authors: Llaurens V. , Joron M. , Théry M.
Published: January 2014

Antagonistic interactions between predators and prey often lead to co‐evolution. In the case of toxic prey, aposematic colours act as warning signals for predators and play a protective role. Evolutionary convergence in colour patterns among toxic prey evolves due to positive density‐dependent selection and the benefits of mutual resemblance in spreading the mortality cost of educating predators over a larger prey assemblage. Comimetic species evolve highly similar colour patterns, but such convergence may interfere with intraspecific signalling and recognition in the prey community, especially for species involved in polymorphic mimicry. Using spectrophotometry measures, we investigated the variation in wing coloration among comimetic butterflies from distantly related lineages. We focused on seven morphs of the polymorphic species Heliconius numata and the seven corresponding comimetic species from the genus Melinaea. Significant differences in the yellow, orange and black patches of the wing were detected between genera. Perceptions of these cryptic differences by bird and butterfly observers were then estimated using models of animal vision based on physiological data. Our results showed that the most strikingly perceived differences were obtained for the contrast of yellow against a black background. The capacity to discriminate between comimetic genera based on this colour contrast was also evaluated to be higher for butterflies than for birds, suggesting that this variation in colour, likely undetectable to birds, might be used by butterflies for distinguishing mating partners without losing the benefits of mimicry. The evolution of wing colour in mimetic butterflies might thus be shaped by the opposite selective pressures exerted by predation and species recognition.
Sublingual or subcutaneous immunotherapy for seasonal allergic rhinitis: an indirect analysis of efficacy, safety and cost
Authors: Dranitsaris George , Ellis Anne K.
Published: January 2014

Rationale, aims and objectives

The standard of preventive care for poorly controlled seasonal allergic rhinitis (AR) is subcutaneous immunotherapy (SCIT) with allergen extracts, administered in a physician's office. As an alternative to SCIT, sublingual immunotherapy (SLIT) is now an option for patients with seasonal AR. Oralair™, a SLIT tablet containing freeze‐dried allergen extracts of five grasses [cocksfoot (Dactylis glomerata), meadow grass (Poa pratensis), rye grass (Lolium perenne), sweet vernal grass (Anthoxanthum odoratum) and timothy grass (Phleum pratense)], and Grazax™, a SLIT tablet containing a standardized extract of grass pollen allergen from timothy grass (P pratenase), are two such agents currently available in many countries. However, head‐to‐head comparative data are not available. In this study, an indirect comparison on efficacy, safety and cost was undertaken between Oralair™, Grazax™ and SCIT.

Methods

A systematic review was conducted for double‐blind placebo‐controlled randomized trials evaluating Oralair™, Grazax™ or SCIT in patients with grass‐induced seasonal AR. Using placebo as the common control, an indirect statistical comparison between treatments was performed using meta regression analysis with active drug as the primary independent variable. An economic analysis, which included both direct and indirect costs for the Canadian setting, was also undertaken.

Results

Overall, 20 placebo‐controlled trials met the study inclusion criteria. The indirect analysis suggested improved efficacy with Oralair™ over SCIT [standardized mean difference (SMD) in AR symptom control = −0.21; P = 0.007] and Grazax™ (SMD = −0.18; P = 0.018). In addition, there were no significant differences in the risk of discontinuation due to adverse events between therapies. Oralair™ was associated with cost savings against year‐round SCIT ($2471), seasonal SCIT ($948) and Grazax™ ($1168) during the first year of therapy.

Conclusions

Oralair™ has at least non‐inferior efficacy and comparable safety against SCIT and Grazax™ at a lower annual cost.
Influence of psychiatric diagnosis on treatment uptake and interferon side effects in patients with hepatitis C
Authors: Wu Jing Yuan J , Shadbolt Bruce , Teoh Narci , Blunn Anne , To Caroline , Rodriguez‐Morales Ilys , Chitturi Shivakumar , Kaye Graham , Rodrigo Kalyana , Farrell Geoff
Published: January 2014

Background and Aim

Pegylated‐interferon‐α/ribavirin (PEG‐IFN/RBV) treatment can cure hepatitis C virus (HCV) infection but has frequent neuropsychiatric side‐effects. Patients with pre‐existing psychiatric illness may not be offered therapy. We established prevalence of self‐reported psychiatric comorbidity among HCV‐infected patients in a hospital‐liver clinic, and determined the impact of such diagnoses on uptake and tolerance to PEG‐IFN/RBV.

Methods

All HCV cases referred for assessment in Australian Capital Territory/surrounding regions April 2004–March 2012 were entered into a clinical database. We conducted univariate and multivariate analyses of variables correlating with uptake of antiviral therapy and frequency of treatment‐related side‐effects.

Results

Of 773 referred patients, 235 (30%) described pre‐existing psychiatric illness. Among these, 26% received antiviral therapy, compared with 30% of 538 without psychiatric comorbidity. History of depression (usually validated by liaison psychiatry) was associated with higher incidence of treatment‐related neuropsychiatric side‐effects (odds ratio 2.79 [1.35–5.70], P < 0.05) but did not affect treatment outcome. Twenty‐seven patients reported schizophrenia: three (11%) received antiviral therapy, compared with 30% admitting depression and 20% with bipolar affective disorder (all assessed by psychiatrist). In most schizophrenia cases, the reason for not offering antiviral treatment was psychological illness, yet none of five treated (these three plus two others in a psychiatric rehabilitation facility) experienced worsening psychiatric symptoms.

Conclusions

A history of depression is common with hepatitis C but does not affect initiation of antiviral treatment, despite substantially increased risk of psychiatric side‐effects. In contrast, pre‐existing schizophrenia appears to influence treatment decisions, despite little evidence that PEG‐IFN/RBV exacerbates the psychiatric condition, and well‐supervised antiviral therapy can have good outcomes.
Associations between intakes of individual nutrients or whole food groups and non‐alcoholic fatty liver disease among Korean adults
Authors: Han Jung Mi , Jo An Na , Lee Seung Min , Bae Hyun Suk , Jun Dae Won , Cho Yong Kyun , Suk Ki Tae , Yoon Jai Hoon , Ahn Sang Bong , Cho Yong Jin , Kim Seong Woo , Jang Eun Chul
Published: January 2014

Background and Aim

Dietary factors are closely associated with the risk of non‐alcoholic fatty liver disease (NAFLD). Asian and Western diets differ in energy‐nutrient composition, fatty‐acid composition, and main nutritional sources; therefore, the implications would be limited if the Western‐oriented study results were applied to Asian patients. We aimed to identify the nutrient and food group intakes of a typical Asian diet and assess their effects on NAFLD risk.

Methods

In total, 348 subjects were recruited from 5 participating hospitals. Information on sociodemographic characteristics and health‐related behaviors were obtained through face‐to‐face interviews. NAFLD was diagnosed by ultrasound. Dietary intakes were assessed with a 24‐h recall applying a multiple‐pass approach and 4‐day food records that included 1 or 2 weekend days.

Results

There were no significant differences in health‐related behaviors between the cases and controls except for smoking behavior. The cases had elevated triacylglycerol, fasting glucose, and low‐density lipoprotein cholesterol levels compared with the controls. In men, after adjusting for variables, low intakes of vitamin C (odds ratio [OR], 4.23), vitamin K (OR, 3.93), folate (OR, 3.37), omega‐3 fatty acids (OR, 2.16), and nuts and seeds (OR, 3.66) were associated with a significantly higher risk for developing NAFLD. In women, vitamin K (OR, 2.54) and vegetable (OR, 4.11) intakes showed a significant beneficial effect for lowering NAFLD risk.

Conclusions

Adequate intakes of vitamin C, vitamin K, folate, omega‐3 fatty acids, nuts and seeds, and vegetables may help in preventing NAFLD in Korean adults.
Influence of Frailty‐Related Diagnoses, High‐Risk Prescribing in Elderly Adults, and Primary Care Use on Readmissions in Fewer than 30 Days for Veterans Aged 65 and Older
Authors: Pugh Jacqueline A. , Wang Chen‐Pin , Espinoza Sara E. , Noël Polly H. , Bollinger Mary , Amuan Megan , Finley Erin , Pugh Mary Jo
Published: January 2014

Objectives

To determine the effect of two variables not previously studied in the readmissions literature (frailty‐related diagnoses and high‐risk medications in the elderly (HRME)) and one understudied variable (volume of primary care visits in the prior year).

Design

Retrospective cohort study using data from a study designed to examine outcomes associated with inappropriate prescribing in elderly adults.

Setting

All Veterans Affairs (VA) facilities with acute inpatient beds in fiscal year 2006 (FY06).

Participants

All veterans aged 65 and older by October 1, 2005, who received VA care at least once per year between October 1, 2004, and September 30, 2006, and were hospitalized at least once during FY06 on a medical or surgical unit.

Measurements

A generalized linear interactive risk prediction model included demographic and clinical characteristics (mental health and chronic medical conditions, frailty‐related diagnoses, number of medications) in FY05; incident HRME in FY06 before index hospitalization or readmission; chronic HRME in FY05; and FY05 emergency department (ED), hospital, geriatric, palliative, or primary care use. Facility‐level variables were complexity, rural versus urban, and FY06 admission rate.

Results

The mean adjusted readmission rate was 18.3%. The new frailty‐related diagnoses variable is a risk factor for readmission in addition to Charlson comorbidity score. Incident HRME use was associated with lower rates of readmission, as were higher numbers of primary care visits in the prior year.

Conclusion

Frailty‐related diagnoses may help to target individuals at higher risk of readmission to receive more‐intensive care transition services. HRME use does not help in this targeting. A higher number of face‐to‐face primary care visits in the prior year, unlike ED and hospital use, correlates with fewer readmissions and may be another avenue for targeting prevention strategies.
Homocysteine Levels and Treatment Effect in the Prospective Study of Pravastatin in the Elderly at Risk
Authors: Drewes Yvonne M. , Poortvliet Rosalinde K. E. , Blom Jeanet W. , de Ruijter Wouter , Westendorp Rudi G. J. , Stott David J. , Blom Henk J. , Ford Ian , Sattar Naveed , Wouter Jukema J. , Assendelft Willem J. J. , de Craen Anton J. M. , Gussekloo Jacobijn
Published: January 2014

Objectives

To assess the effect of preventive pravastatin treatment on coronary heart disease (CHD) morbidity and mortality in older persons at risk for cardiovascular disease (CVD), stratified according to plasma levels of homocysteine.

Design

A post hoc subanalysis in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), started in 1997, which is a double‐blind, randomized, placebo‐controlled trial with a mean follow‐up of 3.2 years.

Setting

Primary care setting in two of the three PROSPER study sites (Netherlands and Scotland).

Participants

Individuals (n = 3,522, aged 70–82, 1,765 male) with a history of or risk factors for CVD were ranked in three groups depending on baseline homocysteine level, sex, and study site.

Intervention

Pravastatin (40 mg) versus placebo.

Measurements

Fatal and nonfatal CHD and mortality.

Results

In the placebo group, participants with a high homocysteine level (n = 588) had a 1.8 higher risk (95% confidence interval (CI) = 1.2–2.5, P = .001) of fatal and nonfatal CHD than those with a low homocysteine level (n = 597). The absolute risk reduction in fatal and nonfatal CHD with pravastatin treatment was 1.6% (95% CI = −1.6 to 4.7%) in the low homocysteine group and 6.7% (95% CI = 2.7–10.7%) in the high homocysteine group (difference 5.2%, 95% CI = 0.11–10.3, P = .046). Therefore, the number needed to treat (NNT) with pravastatin for 3.2 years for benefit related to fatal and nonfatal CHD events was 14.8 (95% CI = 9.3–36.6) for high homocysteine and 64.5 (95% CI = 21.4–∞) for low homocysteine.

Conclusion

In older persons at risk of CVD, those with high homocysteine are at highest risk for fatal and nonfatal CHD. With pravastatin treatment, this group has the highest absolute risk reduction and the lowest NNT to prevent fatal and nonfatal CHD.
The Employment Footprints of Nations
Authors: Alsamawi Ali , Murray Joy , Lenzen Manfred
Published: January 2014

In this study, we present an analysis of the average wages paid for producing direct and indirect imports of nations using employment and income footprints. An employment footprint includes a country's domestic employment and that occurring along the supply chains of, and hence embodied in, its imported goods and services. Our results allow us to group the world's nations into “masters” that enjoy a lifestyle supported by workers in other countries and “servants” that support the lifestyle of master countries. We show that, in 2010, employment footprints of countries differed substantially from their own workforce footprints. Hong Kong, Singapore, the United Arab Emirates, and Switzerland occupy the top‐ranking positions of master countries, whereas many African and Asian countries are servants. Our findings show that the commodities that are “servant intensive,” such as electronics, agricultural products, and chemicals, tend to have complex supply chains often originating in third‐world countries. The quantification of these master‐servant relationships and the exposing of implicated supply chains could be of benefit to those concerned with their corporate social responsibility and committed to fairer trading or those developing policy around fair globalization.
Supported Decision-Making and Personal Autonomy for Persons with Intellectual Disabilities: Article 12 of the UN Convention on the Rights of Persons with Disabilities
Authors: Devi Nandini
Published: January 2014

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Adults with intellectual disabilities are characterized by the limitations in their intellectual functioning and in their adaptive behavior, which compromises three skill types (conceptual skills, social skills, and practical skills), and this starts before the age of 18. Though persons with intellectual disabilities are characterized by having these limitations, they are thought to face significant decisionmaking challenges due to their disability. Moving away from this generalization, Article 12 (Equal recognition before the law) of the United Nations (UN) Convention on the Rights of Persons with Disabilities (herewith called “the Convention”) addresses this issue of decision-making for persons with disabilities, recognizing the right tolegal capacity.
Disability, “Being Unhealthy,” and Rights to Health
Authors: Bickenbach Jerome
Published: January 2014

Often advocates for persons with disabilities are resistant to what might appear to be the banal truism that, at bottom, disability is a decrement in health. Disability advocates have long objected to the “medicalization” of disability, when that means focusing entirely on a person’s underlying impairments and ignoring all of the manifold obstacles in his or her environment — e.g., physical, human-built, attitudinal, social, political, and cultural — that makes living with those impairments at least disadvantageous and socially devalued. Over-medicalization is another and well understood problem that people with disabilities are justifiably concerned about. Yet it is somewhat of a mystery why anyone with an impairment would ever deny, or feel uncomfortable being told, that their impairment is a health problem. Surely, people with disabilities are unhealthy, by virtue of their impairments and to the degree according to the severity of those impairments. How could it be otherwise?
The Ethics of Intellectual Property Rights in an Era of Globalization
Authors: Shah Aakash Kaushik , Warsh Jonathan , Kesselheim Aaron S.
Published: January 2014

In recent decades, advances in information technology have given rise to a post-industrial society in which emphasis on the manufacture of material goods has been supplanted by the creation of intellectual property. Indeed, this new “knowledge economy” can be tracked by the exponential growth in patented products across a range of sectors since the 1980s (see Figure 1). According to the United States Patent and Trademark Office, the number of annual patent applications submitted grew from 112,379 to 520,277 over the past three decades, a 464% increase.

The transformation in the industrial markets has been accompanied by the rise of a new, global institution for coordinating intellectual property rights (IPRs): the World Trade Organization (WTO).
Obesity Prevention in the Early Care and Education Setting: Successful Initiatives across a Spectrum of Opportunities
Authors: Reynolds Meredith A. , Cotwright Caree Jackson , Polhamus Barbara , Gertel-Rosenberg Allison , Chang Debbie
Published: January 2014

The Early Care and Education (ECE) track presentations from CDC’s Weight of the Nation (WON) 2012 conference showcased innovative national, state, and community obesity prevention efforts. The track was organized around CDC’s “Spectrum of Opportunities” for obesity prevention in ECE (the Spectrum; Table 1), which outlines a common set of opportunities that can enhance the ECE environment with respect to nutrition, breastfeeding support, physical activity, and screen time — all important areas for obesity prevention targeting young children. Participants discussed the opportunities on the spectrum that had been pursued, the obesity prevention standards and best practices that had been the emphasis of their efforts, and common steps for developing, implementing, and evaluating initiatives. This paper provides background information on why ECE is an important component of any jurisdiction’s obesity prevention efforts, references for the primary national reports offering standards and best practice recommendations, an introduction to the Spectrum, and brief summaries of the WON ECE track presentations.
Workplace Health: Engaging Business Leaders to Combat Obesity
Authors: Lankford Tina , Lang Jason , Bowden Brian , Baun William
Published: January 2014

Worksites are an important setting to promote healthy behaviors as 143 million adults are employed full-time and spend 8-10 hours per day at the workplace. Participation in health promotion programs have been shown to have a “dose response” relationship with health care costs, meaning health care costs decrease as employee involvement in health promotion activities in the workplace increase. Also from the employer perspective, it is important to note that obesity is a risk factor for many other chronic conditions, diabetes, heart disease, and cancer and is known to be related to increase injuries and health care costs. Motivating employees to participate in a number of wellness activities may provide benefits not only for obesity prevention but other desired outcomes such as: risk reduction, risk avoidance, reduced health costs, and improved productivity measures. Employers should be concerned as forecasts suggest that by 2030, 42% of the adult population will be obese. In fact, among employers, the costs of medical expenses and absenteeism increase as employees become more obese. The cost burden of obesity (BMI 30 or greater) ranges from $462-$2,027 among men and $1,372-$2,164 among women in comparison to normal-weight employees. However, halting this trend over the next few decades by maintaining (vs. increasing) current prevalence of obesity could potentially save billions in medical care expenditures related to obesity. Employers can be part of the solution by offering workplace wellness programs and facilitating opportunities for physical activity, access to healthier foods and beverages, and incentives for disease management and prevention to help prevent weight gain among their employees.
Built Environment and Physical Activity Promotion: Place-Based Obesity Prevention Strategies
Authors: Trowbridge Matthew J. , Schmid Thomas L.
Published: January 2014

Physical inactivity is one of the leading “actual” causes of preventable premature mortality due in large part to its role in obesity and associated morbidities. Currently, less than half (47%) of U.S. adults meet recommendations for aerobic physical activity. For children the numbers are also low, 29% of high school students reported meeting the goal of 60 minutes of daily physical activity over the last week. There has also been a decline in the proportion of children walking or biking to school from 48% in 1969 to 13% in 2009. As a result, promoting physical activity both as recreational exercise and as a part of day-to-day utilitarian travel by foot or bicycle has emerged as a central goal of national and international efforts, often as part of obesity prevention and control efforts.
The Food and Water System: Impacts on Obesity
Authors: Pinard Courtney A. , Kim Sonia A. , Story Mary , Yaroch Amy L.
Published: January 2014

On May 7-9, 2012, obesity prevention leaders, including public health professionals across federal, state and local levels, policymakers and decision makers, community leaders as well as researchers engaged in policy, systems and environmental (PSE) efforts related to obesity prevention, convened at the Weight of the Nation (WON) conference in Washington, D.C. In recognition of the growing interest in the relationship between the food system and public health, and obesity in particular, organizers of the WON invited leading experts from multiple disciplines to work as a committee to plan five sessions related to these topics. These experts decided to expand the focus of the sessions to include public drinking water systems and to organize sessions with the goal of identifying solutions to create a healthy, sustainable, and equitable food and water system. This paper presents the key themes, challenges, and potential solutions and discussed within the Food and Water System: Agriculture, Access and Sustainability track (hereinafter referred to as the “Food and Water System Track”).
The care of older adults in hospital: if it's common sense why isn't it common practice?
Authors: Parke Belinda , Hunter Kathleen F
Published: January 2014

Aims and objectives

To present three converging myths that underlie the perception that nursing care for older persons in hospital is simple in comparison with its actual complexity.

Background

Literature provides strong evidence indicating that the myths we discuss inherently arise from ageism, the social value of older patients and the economic burden of being an older patient in hospital. These powerful social discourses promote harm to older patients. Harm emerges from both the omission of gerontological nursing knowledge and skill and the commission of acts that unintentionally harm. A corresponding ethical challenge results for acute care nurses.

Design

A discursive paper.

Methods

We illuminate gerontological issues by discussing three myths. In myth one, we detail four clusters of distinguishing characteristics in older hospitalised people. In the second myth, we challenge the idea that the role of the acute care hospital is to attend only to acute medical concerns. Finally, in the third myth, we address the issue of incorporating functional assessment into the acute care nursing assessment. We argue that functional assessment is poorly integrated and becomes acceptable only as long as the medical regimen is managed appropriately.

Conclusion

Safe quality care in hospital for older adults requires a hybrid practice that integrates acute care specialty knowledge with gerontological nursing knowledge and skill. Clinical reasoning that integrates this type of nursing knowledge can prevent harm.

Relevance to clinical practice

Integrating key elements of acute care nursing specialty knowledge with gerontological nursing principles aids to prevent the omission of care that is known to be harmful to older people. Conversely, the commission of gerontologically sensitive acute care can enhance safety and promote quality care in hospital.
Domestic abuse awareness and recognition among primary healthcare professionals and abused women: a qualitative investigation
Authors: Bradbury‐Jones Caroline , Taylor Julie , Kroll Thilo , Duncan Fiona
Published: January 2014

Aims and objectives

To investigate the dynamics of domestic abuse awareness and recognition among primary healthcare professionals and abused women.

Background

Domestic abuse is a serious, public health issue that crosses geographical and demographic boundaries. Health professionals are well placed to recognise and respond to domestic abuse, but empirical evidence suggests that they are reluctant to broach the issue. Moreover, research has shown that women are reluctant to disclose abuse.

Design

A two‐phase, qualitative study was conducted in Scotland.

Methods

Twenty‐nine primary health professionals (midwives, health visitors and general practitioners) participated in the first phase of the study, and 14 abused women took part in phase two. Data were collected in 2011. Semi‐structured, individual interviews were conducted with the health professionals, and three focus groups were facilitated with the abused women. Data were analysed using a framework analysis approach.

Findings

Differing levels of awareness of the nature and existence of abuse are held by abused women and primary healthcare professionals. Specifically, many women do not identify their experiences as abusive. A conceptual representation of domestic abuse – the “abused women, awareness, recognition and empowerment' framework – arising from the study – presents a new way of capturing the complexity of the disclosure process.

Conclusion

Further research is necessary to test and empirically validate the framework, but it has potential pedagogical use for the training and education of health professionals and clinical use with abused women.

Relevance to clinical practice

The framework may be used in clinical practice by nurses and other health professionals to facilitate open discussion between professionals and women. In turn, this may empower women to make choices regarding disclosure and safety planning.