bluuebunny/crossref_metadata_2025 huggingface dataset:
Olfactory and vomeronasal innervation of the olfactory bulbs are not essential for GnRH-1 neuronal migration to the brain
Authors: Taroc Ed Zandro , Prasad Aparna , Lin Jennifer M. , Forni Paolo E.
Published: June 2017

Gonadotropin releasing hormone-1 (GnRH-1) neurons migrate from the developing olfactory pit into the hypothalamus during embryonic development. Migration of the GnRH-1 neurons is required for mammalian reproduction as these cells control release of gonadotropins from the anterior pituitary gland. Disturbances in GnRH-1 cell migration, GnRH-1 synthesis, secretion or signaling lead to varying degrees of hypogonadotropic hypogonadism (HH), which impairs pubertal onset and fertility. HH associated with congenital olfactory defects is clinically defined as Kallmann Syndrome (KS).

The association of olfactory defects with HH in KS suggested potential direct relationship between defective olfactory axonal routing, lack of olfactory bulbs and aberrant GnRH-1 cell migration. However, it has never been experimentally proven that the formation of axonal connections of the olfactory and vomeronasal neurons to their functional targets are necessary for the migration GnRH-1 neurons to the hypothalamus. Loss-of-function of theArx-1homeobox gene leads to the lack of proper formation of the olfactory bulbs with abnormal axonal termination of olfactory sensory neurons (Yoshihara et al., 2005). We exploited the Arx-1nullmouse line to investigate the role of the olfactory system (olfactory/vomeronasal fibers and OBs) in controlling GnRH-1 migration to the hypothalamus. Our data proves that correct development of the OBs, and axonal connection of the olfactory and vomeronasal sensory neurons to the forebrain are not needed for GnRH-1 neuronal migration. Moreover, we prove that the terminal nerve, which forms the GnRH-1 migratory scaffold, follows different guidance cues and differs in its genetic expression from olfactory and vomeronasal sensory neurons.

Significance Statement

Gonadotropin Releasing Hormone-1 (GnRH-1) neurons control the reproductive axis of vertebrates. During embryonic development, these neurons migrate from the olfactory pit to the hypothalamus. GnRH-1 cell migration is commonly believed to take place along the olfactory axons. Our work reveals that correct olfactory bulb development and targeting of the olfactory and vomeronasal sensory neurons to the brain are not required for this migration. Our work challenges the idea that GnRH-1 neuronal migration to the hypothalamus relies on correct routing of the olfactory and vomeronasal sensory neurons. We provide a new basis for interpreting genetic correlations between anosmia, lack of olfactory bulbs, and hypogonadotropic hypogonadism in Kallmann Syndrome.
The Association of Health Literacy With Preventable Emergency Department Visits: A Cross‐sectional Study
Authors: Balakrishnan Meenakshi P. , Herndon Jill Boylston , Zhang Jingnan , Payton Thomas , Shuster Jonathan , Carden Donna L.
Published: June 2017

Background

Policymakers argue that emergency department (ED) visits for conditions preventable with high‐quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor, and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high‐quality ambulatory care is unknown.

Objective

The objective was to determine the association of health literacy with preventable ED visits.

Methods

We conducted an observational cross‐sectional study of potentially preventable ED visits (outcome) among adults (≥18 years old) in an ED serving an urban community. We assessed health literacy (predictor) through structured interviews with the Rapid Estimate of Adult Literacy in Medicine (REALM). We recorded age, sex, race, employment, payer, marital and health status, and number of comorbidities through structured interviews or electronic record review. We identified potentially preventable ED visits in the 2 years before the index ED visit by applying Agency for Healthcare Research and Quality technical specifications to identify ambulatory care sensitive conditions using ED discharge diagnoses in hospital administrative data. We used Poisson regression to evaluate the number of preventable ED visits among patients with limited (REALM < 61) versus adequate (REALM ≥ 61) health literacy after adjusting for covariates.

Results

Of 1,201 participants, 709 (59%) were female, 370 (31%) were African American, mean age was 41.6 years, and 394 (33%) had limited health literacy. Of 4,444 total ED visits, 423 (9.5%) were potentially preventable. Of these, 260 (61%) resulted in hospital admission and 163 (39%) were treat and release. After covariates were adjusted for, patients with limited literacy had 2.3 (95% confidence interval [CI] = 1.7–3.1) times the number of potentially preventable ED visits resulting in hospital admission compared to individuals with adequate health literacy, 1.4 (95% CI = 1.0–2.0) times the number of treat‐and‐release visits, and 1.9 (95% CI = 1.5–2.4) times the number of total preventable ED visits.

Conclusions

Our results suggest that the ED may be an important site to deploy universal literacy‐sensitive precautions and to test literacy‐sensitive interventions with the goal of reducing the burden of potentially preventable ED visits on patients and the healthcare system.
Morin, a novel liver X receptor α/β dual antagonist, has potent therapeutic efficacy for nonalcoholic fatty liver diseases
Authors: Gu Ming , Zhang Yu , Liu Chuhe , Wang Dongshan , Feng Li , Fan Shengjie , Yang Baican , Tong Qingchun , Ji Guang , Huang Cheng
Published: June 2017

Background and Purpose

Morin is a natural occurring flavonoid in many dietary plants and has a wide range of beneficial effects on metabolism; however, the mechanism underlying its action remains elusive.

Experimental Approach

A reporter assay and the time‐resolved FRET assay were used to identify morin as a dual antagonist of liver X receptor (LXR)‐α and ‐β. Morin (100 mg.100 g‐1 diet) was administered to high‐fat diet‐induced obese or LXRβ−/− mice. The pharmacological effects and mechanism of action of morin were evaluated by Western blot and RT‐PCR analyses.

Key Results

From the in vitro assays, morin was shown to be a dual antagonist of LXRα and LXRβ. In vivo, morin blunted the development of liver hepatic steatosis, reduced body weight gains, lowered triglyceride levels and improved glucose and insulin tolerance in mice fed a high‐fat diet. Mechanistically, morin inhibited 3T3‐L1 adipocyte differentiation and lipid formation in human hepatic HepG2 cells and suppressed the mRNA expression of genes downstream of LXR. Consistently, the effects of morin on metabolic disorders were attenuated in LXRβ−/− mice.

Conclusion and Implications

Our data reveal that morin is a dual antagonist of LXRα and LXRβ and suggest that morin may alleviate hepatic steatosis and other associated metabolic disorders via the suppression of LXR signalling and, therefore, shows promise as a novel therapy or nutraceutical for nonalcoholic fatty liver disease.
Synthesis of novel and functionally selective non‐competitive muscarinic antagonists as chemical probes
Authors: Boulos John F. , Jakubik Jan , Boulos John M. , Randakova Alena , Momirov Jelena
Published: June 2017

Muscarinic receptors are known to play important biological roles and are drug targets for several human diseases. In a pilot study, novel muscarinic antagonists were synthesized and used as chemical probes to obtain additional information of the muscarinic pharmacophore. The design of these ligands made use of current orthosteric and allosteric models of drug–receptor interactions together with chemical motifs known to achieve muscarinic receptor selectivity. This approach has led to the discovery of several non‐competitive muscarinic ligands that strongly bind at a secondary receptor site. These compounds were found to be non‐competitive antagonists that completely abolished carbachol activation in functional assays. Several of these compounds antagonized functional response to carbachol with great potency at M1 and M4 than at the rest of receptor subtypes.
Surgical site infection after occlusion of the internal carotid artery with a thrombectomy catheter: Can this be prevented?
Authors: Freeman D. E.
Published: June 2017

Based on available evidence, the embolisation methods guided by fluoroscopy (nitinol plugs and transarterial coil embolisation) are preferred when available to occlude the bleeding artery in horses with guttural pouch mycosis. All attempts should be made to submit suitable candidates to hospitals with the necessary equipment and expertise for these procedures. However, when this opportunity is not available, the nondetachable balloon catheter could still offer a viable and effective alternative. Although the risk of surgical site infection is a delayed complication of this method, risk of infection can be reduced by planned removal at 10–14 days after catheter placement.
Insect pollinators collect pollen from wind‐pollinated plants: implications for pollination ecology and sustainable agriculture
Authors: Saunders Manu E.
Published: June 2017

Current research, management and outreach programmes relevant to insect pollinator conservation are strongly focused on relationships between pollinators and insect‐pollinated crops and wild plants.

Pollinators also visit wind‐pollinated plants to collect pollen, or for nest sites and materials, but these interactions are largely overlooked. I review documented records of bee and syrphid fly species collecting pollen from wind‐pollinated plant taxa, including economically important crops, and provide the most comprehensive collation of peer‐reviewed records of pollinators visiting wind‐pollinated plants to date. I argue for more basic research into functional relationships between insect pollinators and wind‐pollinated plants.

I found over 200 visitation records for 101 wind‐pollinated plant genera in 25 families, including 4 of the 12 gymnosperm families. Almost half the records (49%) were for grasses and sedges (Poales). I also identified records of bees and/or syrphid flies visiting 10 economically important wind‐pollinated crop plant species, including three major grain crops (rice, corn, and sorghum). Most records (70%) were from indirect pollen analysis from hives, nest cells or insect bodies, highlighting the need for more direct observational studies of plant–pollinator interactions.

Insect pollinator communities require resource diversity to persist in a landscape. Hence, researchers and land managers aiming to identify links between pollinators and ecosystem function should also consider broader interactions beyond the standard traits of the entomophily syndrome.
Community mental health work: Negotiating support of users' recovery
Authors: Reed Nina Petersen , Josephsson Staffan , Alsaker Sissel
Published: June 2017

Mental health services have changed over the past decades through an increased emphasis on deinstitutionalization and normalization, and with recovery processes situated in everyday life as a new locus of support. These changes have led to a need for new knowledge and methods concerning the provision of community mental health services. The aim of the present study was to explore how community mental health workers provide support to users, by investigating professionals' own narratives of how they work. Seven community mental health workers participated in narrative interviews, which were subject to a qualitative, interpretive analysis. A primary finding was that community mental health workers provide flexible and individually‐adjusted support through engaging in negotiations with users, management, and others. Our findings show both opportunities and challenges of negotiating support, raising the following question for discussion: How and when are negotiations a valuable way for professionals and users to collaborate?
Definition of healthcare‐associated influenza: A review and results from an international survey
Authors: Munier‐Marion Elodie , Bénet Thomas , Vanhems Philippe
Published: June 2017

Aim

To describe definitions of healthcare‐associated influenza (HAI) in recent literature and in hospitals participating in a survey of Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) members.

Method

A review with PubMed search was undertaken to retrieve articles published between 2008 and 2016, focusing on the subject headings “influenza, human” and “cross infection.” Definitions of clinical influenza‐like illness (ILI) and HAI were identified. An invitation to participate in the survey was sent to 218 SRN members via email.

Results

Of 75 articles on HAI included in the review, 30 presented a standardized definition of clinical ILI based on fever (100%), cough (80%), and sore throat (70%). Forty studies (53%) contained a standardized HAI definition, grounded on threshold delay from admission in 29 of them, this delay ranging from 48 to 196 hour (median: 72 hour). Fifty‐five SRN members responded to the survey, with a standardized definition of HAI adopted by 76% of them. This definition was based on clinical features for 24%, virological features for 31%, and both for 45%. Fever (mean threshold: 38.0°C) was part of the definition for 82%. The features required most frequently in the clinical definition were cough (46%) and sore throat (26%). Median threshold delay between admission and symptoms onset adopted for HAI definition was 48 hour (range: 24‐96 hour).

Conclusion

This work underlined the heterogeneity of HAI definitions in different countries. A standardized definition would be helpful to evaluate HAI spread, outcomes in patients and healthcare systems, and the impact of prevention measures, including vaccination.
Severe menses‐associated hypertension successfully treated with gonadotropin‐releasing hormone agonist
Authors: Laffin Luke J. , Jafar Munnam S. , Bakris George L.
Published: June 2017

A case of a 32‐year‐old nulliparous white woman referred for a 5‐year history of severe hypertension, hypokalemia, and resultant systolic dysfunction is presented. She additionally had a left ventricular ejection fraction of 30% including left ventricular dilation and normal left ventricular mass index, as measured by cardiac magnetic resonance imaging when she initially presented to us. Her history revealed that her severe hypertension episodes were monthly and would occur around the catamenial (menses‐associated) time. Two weeks following her menses, blood pressure decreased significantly but remained elevated above 140/90 mm Hg. This cycle repeated monthly and required multiple hospitalizations for hypertensive emergency in the form of acute decompensated heart failure and severe headaches. She required potassium supplementation. This prompted a complete evaluation for secondary causes of hypertension, which was negative. Female and male sex hormone levels, including testosterone, were also within normal limits. She received an injection of leuprolide acetate depot (11.25 mg every 3 months), a gonadotropin‐releasing hormone agonist. This significantly reduced the magnitude of these episodes.
Atopic dermatitis is inversely associated with hepatitis B antigen positivity: a population‐based cohort study
Authors: Kim H.Y. , Kim C.W. , Choi J.Y. , Yu D.S. , Kim J.W. , Han K.D. , Park Y.G. , Lee Y.B.
Published: June 2017

Background

No clear association between hepatitis B virus (HBV) infection and atopic dermatitis (AD) has been established. Some studies have reported that subjects with HBV had an increased risk of atopy; other studies reported an inverse association between HBV seropositivity and allergic diseases.

Objective

We evaluated the association between AD and hepatitis B antigen (HBsAg) positivity using Korean National Health and Nutrition Examination Survey data.

Methods

In total, 14 776 participants aged >19 years were included in the analysis. Multiple logistic regression analyses were used to evaluate the odds ratio of HBsAg positivity in association with AD and asthma.

Results

The prevalence of HBsAg positivity was lower in individuals with AD than in those without AD (mean [SE], 0.7% [0.4] vs. 3.7% [0.2]; P < 0.001). However, HBsAg positivity was not significantly associated with asthma (3.7% [0.2] vs. 2.8% [0.8]; P < 0.001). HBsAg positivity decreased the risk of AD significantly (OR = 0.223; 95% CI = 0.069–0.72).

Conclusions

This study demonstrates an inverse association between AD and HBsAg positivity using a nationwide, population‐based, cross‐sectional health examination and survey.
Characteristics of systemic inflammation in hepatitis B‐precipitated ACLF: Differentiate it from No‐ACLF
Authors: Wu Wei , Yan Huadong , Zhao Hong , Sun Wenjie , Yang Qiao , Sheng Jifang , Shi Yu
Published: June 2017

Background & Aims

Patients with severe exacerbation of chronic hepatitis B (SE‐CHB) are at risk of developing acute‐on‐chronic liver failure (ACLF). Systemic inflammation (SI) is a major driver of ACLF. The aim of this study was to identify characteristics of SI in hepatitis B‐precipitated‐ACLF (HB‐ACLF), which may be distinct from No‐ACLF patients with SE‐CHB.

Methods

Two cohorts of patients with SE‐CHB were enrolled in two tertiary hospitals. The associations between circulating leucocyte counts/subsets and ACLF progression and prognoses were analysed in Cohort A. Cytokine measurements, leucocyte phenotyping and whole blood transcriptomic analyses were performed using peripheral blood samples obtained from patients in Cohort B.

Results

Circulating leucocyte counts were higher in the HB‐ACLF patients than in the No‐ACLF patients (P < .001). Peripheral neutrophilic leucocytosis and monocytosis were associated with lymphopenia. The neutrophil‐to‐lymphocyte ratio (NLR) and monocyte‐to‐lymphocyte ratio (MLR) were correlated with risk of death in patients with SE‐CHB. NLR independently predicted progression to ACLF in patients without ACLF at enrolment and short‐term mortality in ACLF patients. Plasma IL‐6, IL‐10, G‐CSF and GM‐CSF levels were higher in ACLF patients (P < .05). Blood transcriptome analyses showed that genes associated with cell migration and mobility and responses to wounding and bacteria were expressed at higher levels while genes involved in lymphocyte‐mediated immunity were expressed at lower levels in HB‐ACLF patients than in No‐ACLF patients.

Conclusions

Systemic inflammation in HB‐ACLF was characterized by an excessive innate immune response, which was associated with disease progression and mortality.
Aerosolization of Mycotoxins after Growth of Toxinogenic Fungi on Wallpaper
Authors: Aleksic Brankica , Draghi Marjorie , Ritoux Sebastien , Bailly Sylviane , Lacroix Marlène , Oswald Isabelle P. , Bailly Jean-Denis , Robine Enric
Published: June 2017

Many fungi can develop on building material in indoor environments if the moisture level is high enough. Among species that are frequently observed, some are known to be potent mycotoxin producers. This presence of toxinogenic fungi in indoor environments raises the question of the possible exposure of occupants to these toxic compounds by inhalation after aerosolization. This study investigated mycotoxin production by
Penicillium brevicompactum
,
Aspergillus versicolor
, and
Stachybotrys chartarum
during their growth on wallpaper and the possible subsequent aerosolization of produced mycotoxins from contaminated substrates. We demonstrated that mycophenolic acid, sterigmatocystin, and macrocyclic trichothecenes (sum of 4 major compounds) could be produced at levels of 1.8, 112.1, and 27.8 mg/m
2
, respectively, on wallpaper. Moreover, part of the produced toxins could be aerosolized from the substrate. The propensity for aerosolization differed according to the fungal species. Thus, particles were aerosolized from wallpaper contaminated with
P. brevicompactum
when an air velocity of just 0.3 m/s was applied, whereas
S. chartarum
required an air velocity of 5.9 m/s.
A. versicolor
was intermediate, since aerosolization occurred under an air velocity of 2 m/s. Quantification of the toxic content revealed that toxic load was mostly associated with particles of size ≥3 μm, which may correspond to spores. However, some macrocyclic trichothecenes (especially satratoxin H and verrucarin J) can also be found on smaller particles that can deeply penetrate the respiratory tract upon inhalation. These elements are important for risk assessment related to moldy environments.

IMPORTANCE
The possible colonization of building material by toxinogenic fungi in cases of moistening raises the question of the subsequent exposure of occupants to aerosolized mycotoxins. In this study, we demonstrated that three different toxinogenic species produce mycotoxins during their development on wallpaper. These toxins can subsequently be aerosolized, at least partly, from moldy material. This transfer to air requires air velocities that can be encountered under real-life conditions in buildings. Most of the aerosolized toxic load is found in particles whose size corresponds to spores or mycelium fragments. However, some toxins were also found on particles smaller than spores that are easily respirable and can deeply penetrate the human respiratory tract. All of these data are important for risk assessment related to fungal contamination of indoor environments.
Staphylococcus aureus Strain Newman Photoinactivation and Cellular Response to Sunlight Exposure
Authors: McClary Jill S. , Sassoubre Lauren M. , Boehm Alexandria B.
Published: June 2017

Sunlight influences microbial water quality of surface waters. Previous studies have investigated photoinactivation mechanisms and cellular photostress responses of fecal indicator bacteria (FIB), including
Escherichia coli
and enterococci, but further work is needed to characterize photostress responses of bacterial pathogens. Here we investigate the photoinactivation of
Staphylococcus aureus
(strain Newman), a pigmented, waterborne pathogen of emerging concern. We measured photodecay using standard culture-based assays and cellular membrane integrity and investigated photostress response by measuring the relative number of mRNA transcripts of select oxidative stress, DNA repair, and metabolism genes. Photoinactivation experiments were performed in both oxic and anoxic systems to further investigate the role of oxygen-mediated and non-oxygen-mediated photoinactivation mechanisms.
S. aureus
lost culturability much faster in oxic systems than in anoxic systems, indicating an important role for oxygen in photodecay mechanisms.
S. aureus
cell membranes were damaged by sunlight exposure in anoxic systems but not in oxic systems, as measured by cell membrane permeability to propidium iodide. After sunlight exposure,
S. aureus
increased expression of a gene coding for methionine sulfoxide reductase after 12 h of sunlight exposure in the oxic system and after 6 h of sunlight exposure in the anoxic system, suggesting that methionine sulfoxide reductase is an important enzyme for defense against both oxygen-dependent and oxygen-independent photostresses. This research highlights the importance of oxygen in bacterial photoinactivation in environmentally relevant systems and the complexity of the bacterial photostress response with respect to cell structure and transcriptional regulation.

IMPORTANCE
Staphylococcus aureus
is a pathogenic bacterium that causes gastrointestinal, respiratory, and skin infections. In severe cases,
S. aureus
infection can lead to life-threatening diseases, including pneumonia and sepsis. Cases of community-acquired
S. aureus
infection have been increasing in recent years, pointing to the importance of considering
S. aureus
transmission pathways outside the hospital environment. Associations have been observed between recreational water contact and staphylococcal skin infections, suggesting that recreational waters may be an important environmental transmission pathway for
S. aureus
. However, prediction of human health risk in recreational waters is hindered by incomplete knowledge of pathogen sources, fate, and transport in this environment. This study is an in-depth investigation of the inactivation of a representative strain of
S. aureus
by sunlight exposure, one of the most important factors controlling the fate of microbial contaminants in clear waters, which will improve our ability to predict water quality changes and human health risk in recreational waters.
Perforated duodenal diverticulum: a rare complication in a common condition
Authors: Branco Cláudio , Carneiro Teresa , Luis Dina , Gomes António
Published: June 2017

The authors present a rare case of perforated duodenal diverticulum diagnosed in an 80-year-old Caucasian woman with vomiting and abdominal pain localised to the epigastrium. CT scan showed thickening of the second portion of the duodenum with retroperitoneal fat stranding and perihepatic free fluid, with a presumptive diagnosis of a duodenal perforation. A laparotomy was performed which showed a perforated diverticulum in the second portion of the duodenum. A diverticulectomy with single-layer closure was performed, without complications. The postoperative course was uneventful.
Head injuries in professional male football (soccer) over 13 years: 29% lower incidence rates after a rule change (red card)
Authors: Beaudouin Florian , aus der Fünten Karen , Tröß Tobias , Reinsberger Claus , Meyer Tim
Published: June 2017

Background

Absolute numbers of head injuries in football (soccer) are considerable because of its high popularity and the large number of players. In 2006 a rule was changed to reduce head injuries. Players were given a red card (sent off) for intentional elbow-head contact.

Aims

To describe the head injury mechanism and examine the effect of the rule change.

Methods

Based on continuously recorded data from the German football magazine “kicker”, a database of all head injuries in the 1stGerman Male Bundesliga was generated comprising seasons 2000/01-2012/13. Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) as well as incidence rate ratios (IRR) to assess differences before and after the rule change were calculated.

Results

356 head injuries were recorded (IR 2.22, 95% CI 2.00 to 2.46 per 1000 match hours). Contact with another player caused most head injuries, more specifically because of head-head (34%) or elbow-head (17%) contacts. After the rule change, head injuries were reduced by 29% (IRR 0.71, 95% CI 0.57 to 0.86, p=0.002). Lacerations/abrasions declined by 42% (95% CI 0.39 to 0.85), concussions by 29% (95% CI 0.46 to 1.09), contusions by 18% (95% CI 0.43 to 1.55) and facial fractures by 16% (95% CI 0.55 to 1.28).

Conclusions

This rule change appeared to reduce the risk of head injuries in men’s professional football.
Role, structure and effects of medical tourism in Africa: a systematic scoping review protocol
Authors: Mogaka John JO , Tsoka-Gwegweni Joyce M , Mupara Lucia M , Mashamba-Thompson Tivani
Published: June 2017

Introduction

Some patients travel out of, while others come into Africa for medical care through a growing global phenomenon referred to as medical tourism (MT): the travel in search of medical care that is either unavailable, unaffordable or proscribed at home healthcare systems. While some castigate MT as promoting healthcare inequity, others endorse it as a revenue generator, promising local healthcare system strengthening. Currently, however, the understanding of this component of healthcare in Africa is inadequate. This study seeks to determine the level of knowledge on the role, structure and effect of MT in Africa as it relates to healthcare systems in the region.

Methods

Conduct a systematic scoping review to outline the role, structure and effect of MT in Africa. Databases: Academic Search Complete, Business Source Complete. Studies mapped in two stages: (1) mapping the studies based on the relevance of their titles and subject descriptors; (2) applying further inclusion criteria on studies from stage 1. Two reviewers will independently assess study quality and abstract data. Both quantitative and qualitative data analysis will be performed, using STATA V.13 and NVIVO, respectively.

Ethics and dissemination

The study results will be disseminated by publication in peer-reviewed journals and findings presented at academic and industry conferences related to MT, public health, health systems strengthening and tourism.

Discussion

MT spurs cutting-edge medical technologies, techniques and best practices in healthcare delivery. The two-tier healthcare landscape in Africa, however, presents an exceptionally unique context in which to situate this study. Much has been written about MT globally, but not much is known about the phenomenon in Africa; hence the appropriateness of this scientific assessment of MT in the region. By elucidating the role, structure and effect of this phenomenon, this study hopes to contribute to health systems strengthening in Africa.

PROSPERO registration number

CRD42016039745.
Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England
Authors: Shackley David Clifford , Whytock Cameron , Parry Gareth , Clarke Laurence , Vincent Charles , Harrison Abigail , John Amber , Provost Lloyd , Power Maxine
Published: June 2017

Introduction

Harm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary catheters between patient groups, settings, specialities and over time.

Methods

A prospective study (July 2012 to April 2016) of National Health Service (NHS) patients surveyed by healthcare professionals, following a standardised protocol to determine the presence of a urinary catheter and duration of use, on 1 day per month using the NHS Safety Thermometer.

Results

1314 organisations (253 NHS trusts) and 9 266 284 patients were included. Overall, 12.9% of patients were catheterised, but utilisation varied. There was higher utilisation of catheters in males (15.7% vs 10.7% p<0.001) and younger people (18–70 year 14.0% vs >70 year 12.8% p<0.001), utilisation was highest in hospital settings (18.6% p<0.001), particularly in critical care (76.6% p<0.001). Most catheters had been in situ <28 days (72.9% p<0.001). No clinically significant changes were seen over time in any setting or specialty.

Conclusion

Catheter prevalence in patients receiving NHS-funded care varies according to gender, age, setting and specialty, being most prevalent in males, younger people, hospitals and critical care. Utilisation has changed only marginally over 46 months, and further guidance is indicated to provide clarity for clinicians on the insertion and removal of catheters to supplement the existing guidance on care.
Effects of socioeconomic factors on cardiovascular-related symptoms among residents in Fukushima after the Great East Japan Earthquake: a cross-sectional study using data from the Fukushima Health Management Survey
Authors: Zhang Wen , Ohira Tetsuya , Yasumura Seiji , Maeda Masaharu , Otsuru Akira , Harigane Mayumi , Horikoshi Naoko , Suzuki Yuriko , Yabe Hirooki , Nagai Masato , Nakano Hironori , Hirosaki Mayumi , Uemura Mayu , Takahashi Hideto , Kamiya Kenji , Yamashita Shunichi , Abe Masafumi
Published: June 2017

Objective

To investigate the association between socioeconomic factors and the exacerbation of cardiovascular symptoms among evacuees after the Great East Japan Earthquake.

Methods

A sample of 73 433 individuals was included in the Fukushima Health Management Survey. Self-report questionnaires were used to determine the influence of socioeconomic factors including living arrangements, loss of employment and decreased income on the exacerbation of headache, dizziness, palpitations and shortness of breath. Odds ratios (ORs) and 95% CIs of the effect of socioeconomic factors were estimated for each symptom using multiple logistic regression analyses.

Results

Exacerbation of headaches was reported by 1893 individuals, dizziness by 1229, palpitations by 1085 and shortness of breath by 626 individuals. Evacuation accommodation was associated with all of these symptoms. Compared with participants living in their own home (OR=1.00), individuals living in relatives’ homes had increased probability of experiencing exacerbation of headache (1.58; 95% CI 1.19 to 2.09) and dizziness (1.42; 95% CI 1.02 to 1.98); those living in rental housing or apartments experienced exacerbation of headache (1.54; 95% CI 1.32 to 1.80), dizziness (1.45; 95% CI 1.20 to 1.75), palpitations (1.25; 95% CI 1.03 to 1.51) and shortness of breath (1.76; 95% CI 1.35 to 2.28); participants living in evacuation shelters experienced exacerbation of headache (1.80; 95% CI 1.09 to 2.96); and refugees living in temporary housing also experienced exacerbation of headache (1.42; 95% CI 1.15 to 1.72), dizziness (1.40; 95% CI 1.09 to 1.79) and shortness of breath (1.49; 95% CI 1.07 to 2.08). Compared with the evacuees who retained their jobs, unemployed individuals showed increased probability of exacerbation of headache (1.28, 95% CI 1.12 to 1.46), dizziness (1.26, 95% CI 1.07 to 1.48) and palpitations (1.21, 95% CI 1.01 to 1.45). Decreased income was associated with exacerbation of headache (1.39, 95% CI 1.22 to 1.60).

Conclusion

After the earthquake, living in non-home conditions was more likely to result in exacerbated cardiovascular symptoms among evacuees. Loss of employment was another risk factor related to exacerbated headache and dizziness.
Cervical cancer survivors’ perceived cognitive complaints and supportive care needs in mainland China: a qualitative study
Authors: Zeng Yingchun , Cheng Andy SK , Liu Xiangyu , Chan Chetwyn CH
Published: June 2017

Objectives

This study explores Chinese cervical cancer survivors’ perceived cognitive complaints and relevant supportive care needs after primary cancer treatment.

Design

This study utilised a qualitative research design. A semi-structured interview was used to probe cervical cancer patients’ perceived cognitive complaints and supportive care needs.

Setting

This study was conducted at a secondary cancer care centre located in South China.

Participants

31 women with cervical cancer after primary cancer treatment, aged 18–60 years, were purposively selected using non-random sampling procedures.

Results

31 cervical cancer survivors joined this study. Of these, 20 women (64.5%) reported cognitive complaints after cancer treatment. The most common complaint was loss of concentration (n=17, 85.0%). Perceived contributing factors to these cognitive complaints included chemotherapy (n=15, 75.0%) and ageing (n=8, 40.0%). These cognitive problems most commonly impacted daily living (n=20, 100%). Common supportive care needs included symptom management strategies (n=11, 55.0%) and counselling services (n=8, 40.0%).

Conclusion

This study adds new insight into the growing body of research on cognitive complaints by cancer survivors, in particular Chinese cervical cancer survivors. Improved understanding of cognitive complaints could subsequently facilitate the development of relevant therapeutic interventions for prevention as well as the provision of supportive care services, such as educational and counselling services, to reduce cognitive impairment in women with cervical cancer.
Is there an ethnic variation in the epidemiology of gonorrhoea? A retrospective population-based study from northern Israel over 15 years between 2001 and 2015
Authors: Kridin Khalaf , Grifat Rami , Khamaisi Mogher
Published: June 2017

Objective

To investigate the trends in the incidence of gonorrhoea through an extended period of time and to compare the epidemiology of gonorrhoea infection between 2 distinct ethnic groups (Jews and Arabs).

Design

A retrospective population-based cohort study was conducted on all consecutive patients diagnosed with gonorrhoea through the years 2001–2015.

Setting

National Department of Epidemiology of the Ministry of Health, Haifa District, Israel.

Participants

A total of 837 reports on gonorrhoea were received, derived from 779 (93.1%) male and 58 (6.9%) female patients. Approximately 1 million people reside in the Haifa region.

Primary and secondary outcome measures

We examined the incidence rate of gonorrhoea among residents of Haifa District, northern Israel from 2001 to 2015, by reviewing archives of the Department of Epidemiology, Israeli Ministry of Health. Notified cases were stratified by age, gender and ethnicity.

Results

The overall gonorrhoea incidence was 6.4 cases per 100 000 population per year. The annual incidence rate dropped from 20.5 per 100 000 population in 2001 to a period of 2.2 cases per 100 000 population in 2005, showing a >9-fold decline. This was followed by a relatively steady increase of incidence of 2.5–4.5 per 100 000 population from 2006 to 2015. Men were predominantly more affected than women, with a 13.4-fold higher incidence rate. The most affected age group was residents between 25 and 34 years old. The estimated rate among Jews was 2.5-fold higher relative to Arabs. Only 1.3% recurrent episodes of gonorrhoea were reported. The prevalence of HIV positivity among patients with gonorrhoea is significantly higher than that of the general population (500.0 vs 88.1 cases per 100 000 population, respectively, p<0.001).

Conclusions

Gonorrhoea incidence rate decreased dramatically until 2005, with no substantial subsequent fluctuations. The infection is much more prevalent among patients of Jewish ethnicity, possibly due to riskier sex practices.
Efficacy of adding a physiotherapy rehabilitation programme to arthroscopic management of femoroacetabular impingement syndrome: a randomised controlled trial (FAIR)
Authors: Bennell Kim L , Spiers Libby , Takla Amir , O’Donnell John , Kasza Jessica , Hunter David J , Hinman Rana S
Published: June 2017

Objectives

Although several rehabilitation programmes following hip arthroscopy for femoracetabular impingement (FAI) syndrome have been described, there are no clinical trials evaluating whether formal physiotherapy-prescribed rehabilitation improves recovery compared with self-directed rehabilitation. The objective of this study was to evaluate the efficacy of adding a physiotherapist-prescribed rehabilitation programme to arthroscopic surgery for FAI syndrome.

Design

Randomised controlled trial.

Methods

People aged ≥16 years with FAI syndrome scheduled for hip arthroscopy were recruited and randomly allocated to physiotherapy (PT) or control. The PT group received seven PT sessions (one preoperative and six postoperative) incorporating education, manual therapy and a progressive rehabilitation programme of home, aquatic and gym exercises while the control group did not undertake PT rehabilitation. Measurements were taken at baseline (2 weeks presurgery) and 14 and 24 weeks postsurgery. The primary outcomes were the International Hip Outcome Tool (iHOT-33) and the sport subscale of the Hip Outcome Score (HOS) at week 14.

Results

Due to slower than expected recruitment and funding constraints, recruitment was ceased after 23 months. Thirty participants (14 PT and 16 control) were randomised and 28 (14 PT and 14 control; 93%) and 22 (11 PT and 11 control; 73%) completed week 14 and 24 measurements, respectively. For the 14-week primary outcomes, the PT group showed significantly greater improvements on the iHOT-33 (mean difference 14.2 units; 95% CI 1.2 to 27.2) and sport subscale of the HOS (13.8 units; 95% CI 0.3 to 27.3). There were no significant between-group differences at week 24.

Conclusions

An individual PT treatment and rehabilitation programme may augment improvements in patient-reported outcomes following arthroscopy for FAI syndrome. However, given the small sample size, larger trials are needed to validate the findings.

Trial registration number

Trial registered with the Australian New Zealand Clinical Trials Registry :ACTRN12613000282785, Results.
Cognitive screening and behavioural observation of functional ability in patients with multiple episode schizophrenia: an exploratory study
Authors: Norlin Bagge Eva , Esbjörnsson Eva , Sunnerhagen Katharina S
Published: June 2017

Objectives

To evaluate the usability of a neuropsychological screening instrument and two observation scales of everyday behaviour to describe cognitive and functional capacity of patients with multiepisode schizophrenia and considerable care needs, who frequently refuse to participate in cognitive testing or performance-based functional measurement.

Setting

One psychiatric unit specialised in severe mental illness at the Sahlgrenska University Hospital, Gothenburg, Sweden.

Participants

Patients were included consecutively from date of admission to the unit. Inclusion criteria: age 18–65 years, International Classification of Diseases 10 diagnoses F20.0–F20.9 (schizophrenia) or F25.0-F25.9 (schizoaffective disorder) since at least 5 years. Exclusion criteria: acute serious psychotic episodes or physical illness, alcohol or drug abuse during the year before the study, diagnosed cerebral disorder at admission to the unit, and insufficient ability to speak Swedish. 64 patients filled the criteria and 19 accepted participation: 14 males, 5 females, median age 56 years.

Outcome measures

Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) scores, measured by a psychologist; Frontal Systems Behaviour Scale (FrSBe) Family Version and Functional Independence Measure (FIM) V.4.0 scores, measured by nursing staff. Non-parametric statistics were consistently applied to process the data.

Results

Failure analysis showed differences regarding gender and subdiagnoses between participants and non-participants. All participants had BNIS scores indicating cognitive dysfunction. FrSBe group medians showed apathy and executive problems, indicating possible frontal lobe disturbance. FIM showed dependency on others for linguistic and social communication, everyday problem solving, and remembering persons and daily routines. Correlations between FrSBe and FIM (p≤0.01) suggested executive dysfunction being crucial to explain difficulties in performing activities of daily functioning.

Conclusions

Indications of considerable cognitive and functional difficulties found among the participants suggestedthat the instruments are clinically applicable for tentative assessment of cognitive and functional ability among patients with multiepisode schizophrenia and considerable care needs.
Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology
Authors: Muche-Borowski Cathleen , Lühmann Dagmar , Schäfer Ingmar , Mundt Rebekka , Wagner Hans-Otto , Scherer Martin
Published: June 2017

Objective

The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs.

Study design

Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures.

Setting

Primary care.

Intervention

The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts’ opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm.

Results

The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta-algorithm illustrates a superordinate process that permanently keeps the entire patient in view.

Conclusion

The meta-algorithm represents the back bone of the multimorbidity guideline of the German College of General Practitioners and Family Physicians. This article presents solely the development phase; the meta-algorithm needs to be piloted before it can be implemented.
Association between chronic obstructive pulmonary disease and increased risk of benign prostatic hyperplasia: a retrospective nationwide cohort study
Authors: Peng Yi-Hao , Huang Chien-Wen , Liao Wei-Chih , Chen Hsuan-Ju , Yin Ming-Chien , Huang Yu-Ming , Wu Trong-Neng , Ho Wen-Chao
Published: June 2017

Objective

Chronic obstructive pulmonary disease (COPD) and benign prostatic hyperplasia (BPH) are common disorders in ageing male populations. Nevertheless, the relationship between the two diseases has rarely been explored. The objective of this study was to examine whether patients with COPD are at an increased risk of BPH.

Design

Retrospective nationwide cohort study.

Setting

Data retrieved from the Taiwan National Health Insurance Research Database.

Participants

Overall, 19 959 male patients aged 40 years and over with newly diagnosed COPD between 2000 and 2006 were included as the COPD group, and 19 959 sex-matched and age-matched enrollees without COPD were included as the non-COPD group. Both groups were followed-up until the end of 2011.

Outcome measures

A Cox proportional hazards regression model was used to compute the risk of BPH in patients with COPD compared with enrollees without COPD.

Results

The overall incidence rate of BPH was 1.53 times higher in the COPD group than that in the non-COPD group (44.7 vs 25.7 per 1000 person-years, 95% CI 1.46 to 1.60) after adjusting for covariates. An additional stratified analysis revealed that this increased risk of BPH in patients with COPD remained significantly higher than that in enrollees without COPD in all men aged 40 years and over.

Conclusion

After adjustment for covariates, male patients with COPD were found to be at a higher risk of BPH. We suggest that clinicians should be cautious about the increased risk of BPH in male patients with COPD.