bluuebunny/crossref_metadata_2025 huggingface dataset:
Exercise, Energy Expenditure, and Body Composition in People With Spinal Cord Injury
Authors: Tanhoffer Ricardo A. , Tanhoffer Aldre I. P. , Raymond Jacqueline , Hills Andrew P. , Davis Glen M
Published: January 2015

Background:

The objective of this study was to verify the long-term effects of exercise on energy expenditure and body composition in individuals with spinal cord injury (SCI), as very little information is available on this population under free-living conditions.

Methods:

Free-living energy expenditure and body composition using doubly labeled water (DLW) was measured in 13 individuals with SCI, subdivided in 2 groups: (1) sedentary (SED; N = 7) and (2) regularly engaged in any exercise program, for at least 150 min·wk−1 (EXE; N = 6).

Results:

The total daily energy expenditure (TDEE) was significantly higher in the EXE group (33 ± 4.5 kcal·kg−1·day−1) if compared with SED group (27 ± 4.3 kcal·kg−1·day−1). The percentage of body fat was significantly higher in SED group than in EXE group (38 ± 6% and 28 ± 9%).

Conclusion:

Our findings revealed that, despite the severity of SCI, the actual ACSM’s guidelines for weight management for healthy adults exercise could significantly increase TDEE and BMR and improve body composition in individuals who regularly perform exercise. However, the EXE group still showed a high percentage of body fat, suggesting that a more specific approach might be considered (ie, increased intensity or volume, or combining with a diet program).
Contribution of Occupation to High Doses of Light-Intensity Activity and Cardiovascular Risk Factors among Mexican American Adults
Authors: Gay Jennifer L. , Kohl Harold W. , Salinas Jennifer J. , McCormick Joseph B. , Fisher-Hoch Susan P.
Published: January 2015

Background:

The association between light-intensity activity and cardiovascular disease risk is not well understood. The purpose of this study was to determine the association of light-intensity activity with census-based occupational activity classifications and cardiovascular risk factors among Mexican American adults.

Methods:

118 Mexican American adults (68.6% female) provided cross-sectional accelerometer and biological data. Self-reported occupations were classified by activity level (sedentary, low, moderate). Participants were classified as At-Risk for BMI, glucose, triglycerides, HDL, blood pressure, waist circumference, and percent body fat.

Results:

Participants engaged in > 5 hours of light-intensity activity on average, and those in sedentary occupations engaged in fewer light-intensity activity minutes than low-active or moderately active workers (P < .001). Self-reported occupation explained 14% of the variation in light-intensity activity (P < .001). Participants in moderately active occupations were at increased risk for high %body fat than other workers (P = .01), but no other associations between occupation and cardiovascular risk were detected.

Conclusion:

Early work in physical activity underscored the importance of occupational activity. This study presents evidence of a dose-response association for light-intensity activity by occupational category such that workers in sedentary occupations had less light-intensity activity than employees in more active occupations. Future research on how light-intensity activity derived from occupation may reduce the risk of chronic disease will contribute to improved interventions as light-intensity activity participation may be more feasible than meeting current physical activity guidelines.
In-Classroom Physical Activity and Its Impact on Physical Activity Outside of School in a Hispanic Community
Authors: Sirota Dana , Meyer Dodi , Nieto Andres , Zamula Arlen , Stockwell Melissa , Berger-Jenkins Evelyn
Published: January 2015

Background:

School-based physical activity programs can reach large populations of at-risk children however evidence for the sustainability of healthy behaviors as a result of these programs is mixed. Healthy Schools Healthy Families (HSHF) is a physical activity and nutrition program for elementary students in a predominantly minority community. The program includes short teacher led classroom-based physical activities, also known as Transition Exercises (TE). Our aim was to assess whether TE was associated with children’s reported recreational physical activity outside of school.

Methods:

We surveyed HSHF students in grade 5 (n = 383) about their recreational physical activity at the start and end of the school year. Multivariable analysis was used to determine what factors including TE contributed to their reported activity.

Results:

Students were predominantly Hispanic with a mean age of 10 ± .03. There was an increase in reported recreational physical activity from the start to the end of the school year (73.6% to 82.4%, P < .05). Students who participated in more TE had a 2.75 times greater odds of reporting participation in recreational activity than students who participated in less TE.

Conclusions:

For students in HSHF, TE was significantly associated with an increase in recreational physical activity.
Steps Per Day Required for Meeting Physical Activity Guidelines in Japanese Adults
Authors: Cao Zhen-Bo , Oh Taewoong , Miyatake Nobuyuki , Tsushita Kazuyo , Higuchi Mitsuru , Tabata Izumi
Published: January 2015

Background:

This study aimed to determine the optimal number of steps per day needed to meet the current physical activity guidelines in a large population sample of Japanese adults.

Methods:

An accelerometer-based activity monitor (Kenz Lifecorder) was used to simultaneously measure moderate-to-vigorous intensity physical activity (MVPA) and step counts in 940 Japanese adults (480 women) aged 20 to 69 years. The step count per day equivalents to 2 different physical activity recommendations (23 MET-h/wk and 150 min/wk of MVPA) were derived using linear regression analysis and receiver operating characteristic (ROC) methodology.

Results:

Linear regression analysis showed that daily step counts correlated with weekly PAEE (r = .83) and daily minutes of MVPA (r = .83). Linear regression analysis also showed that 23 MET-h/wk of MVPA is equivalent to 11,160 steps/d, and 150 min/wk of MVPA is equivalent to 7716 steps/d. ROC analysis yielded similar findings: 10,225 steps/d are required to accumulate ≥ 23 MET-h/wk of MVPA and 7857 steps/d are needed to meet the recommendation of ≥ 150 min/wk of MVPA.

Conclusions:

The findings suggest that 10,000 to 11,000 and 7700 to 8000 steps/d represent the optimal thresholds for accumulating ≥ 23 MET-h/wk of MVPA and ≥ 150 min/wk of MVPA, respectively, for Japanese adults.
Effects of Yoga on Psychological Health in Older Adults
Authors: Bonura Kimberlee Bethany , Tenenbaum Gershon
Published: January 2015

Background:

The objective of this study was to assess the effect of a yoga intervention on psychological health in older adults.

Method:

A randomized controlled trial study, conducted at 2 North Florida facilities for older adults. Subjects were 98 older adults, ages 65 to 92. Participants were randomly assigned to chair yoga, chair exercise, and control groups and assessed preintervention, postintervention, and 1-month follow-up on the State Anger Expression Inventory, State Anxiety Inventory, Geriatric Depression Scale, Lawton’s PGC Morale Scale, General Self-Efficacy Scale, Chronic Disease Self-Efficacy Scales, and Self- Control Schedule.

Results:

Yoga participants improved more than both exercise and control participants in anger (Cohen’s d = 0.89 for yoga versus exercise, and 0.90 for yoga versus control, pretest to posttest; and d = 0.90 and 0.72, pretest to follow-up), anxiety (d = 0.27, 0.39 and 0.62, 0.63), depression (d = 0.47, 0.49 and 0.53, 0.51), well-being (d = 0.14, 0.49 and 0.25, 0.61), general self-efficacy (d = 0.63, 1.10 and 0.30, 0.85), and self-efficacy for daily living (d = 0.52, 0.81 and 0.27, 0.42). Changes in self-control moderated changes in psychological health.

Conclusions:

Over a 6-week period, our findings indicate yoga’s potential for improving psychological health in older adults.
Gender- and Puberty-Dependent Association Between Physical Activity and Depressive Symptoms: National Survey Among Chinese Adolescents
Authors: Sun Ying , An Jing , Wang Xi , Zu Ping , Tao Fang-Biao
Published: January 2015

Background:

The study aims to understand the possible gender difference in the associations between physical activity and depressive symptoms during pubertal transition.

Methods:

Participants were 30,399 children and adolescents of Han ethnicity from urban and rural areas in 8 cities in China. Physical activity (PA) and depressive symptom was assessed by adapted Youth Risk Behavior Survey and Children Depression Inventory (CDI), respectively. Pubertal development was assessed by trained physicians.

Results:

In China, over 30% boys and 40% girls reported having no vigorous PA (VPA) or moderate PA (MPA) in the past week. In girls, participating in VPA 1 to 2 days/week showed protective effect for depressive symptoms; whereas in boys, participating in MPA 1 to 2 days/week showed protective effect for depressive symptoms at and after genital stage III (G3).

Conclusions:

Moderate frequency (1 to 2 days/week) in PA undertaken might be encouraged to prevent depressive symptoms among adolescents.
The Perceived Role and Influencers of Physical Activity Among Pregnant Women From Low Socioeconomic Status Communities in South Africa
Authors: Muzigaba Moise , Kolbe-Alexander Tracy L. , Wong Fiona
Published: January 2015

Background:

Facility-based and context-specific interventions to promote physical activity (PA) among pregnant women from economically underprivileged communities remain sparse and undocumented in South Africa. This study aimed to generate information about pregnant women’s views and experiences of PA during pregnancy, which will later be used to inform the development of a PA-based intervention targeting this group.

Methods:

Qualitative methods were used and framed on the Theory of Planned Behavior (TPB). Five focus group discussions were conducted at a Community Health Centre in Cape Town, each comprising a stratified random sample of between 8 and 6 pregnant women living in eight low socioeconomic status communities close to the facility. The participants included primi- and multigravida black and mixed racial ancestry women at different stages of pregnancy. Data were analyzed using a Framework approach.

Results:

PA was considered important for self and the baby for most participants. However, they reported a number of barriers for translating intentions into action including the lack of supportive environment, fear of hurting oneself and the growing baby, lack of time due to work and family responsibilities, and not knowing which and how much PA is safe to do. Some of the incentives to engage in PA included establishing community-based group exercise clubs, initiating antenatal PA education and PA sessions during antenatal visits.

Conclusion:

Based on our findings the need for an intervention to promote PA in pregnancy is evident. Such an intervention should, however, aim at addressing barriers reported in this study, particularly those related to the behavioral context.
Academic Performance of Young Competitive Swimmers is Associated With Physical Activity Intensity and Its Predominant Metabolic Pathway: A Pilot Study
Authors: Ayan Carlos , Carral Jose Cancela , Montero Carlos
Published: January 2015

Background:

The relationship between physical activity (PA) and academic performance has been previously studied. However, there is a need to determine if the intensity of the PA performed and its predominant metabolic pathway show any degree of association with the academic achievement.

Methods:

Cross-sectional data were gathered from Spanish young competitive swimmers. Academic achievement was based on individual grades for each student; the PA level was measured by means of the Physical Activity Questionnaire for Adolescents. Swimmers were classified according to the preferential energetic cost of the event in which they competed.

Results:

A total of 254 swimmers finished the study; 62.8% of them were considered moderate active. The statistical analysis showed that the higher the level of PA performed, the better the average grades achieved. This relationship was significant among the girls (P = .04). No significant differences were found regarding the influence of the kind of swimming event. However, taking part in aerobic events proved to have a significant influence on the academic achievement for girls (P = .01).

Conclusion:

The link between academic achievement and PA depends on the intensity in which the PA is performed, as well as on its predominant metabolic pathway. However, such associations seem to be gender-dependent.
Strength Training in Community Settings: Impact of Lay Leaders on Program Access and Sustainability for Rural Older Adults
Authors: Washburn Lisa T. , Cornell Carol E. , Phillips Martha , Felix Holly , Traywick LaVona
Published: January 2015

Background:

The effect of volunteer lay leaders on availability and sustainability of strength-training programs for older adults has not been well explored. We describe implementation of the StrongWomen strength training program by the Arkansas Cooperative Extension Service, and report on the relationship between delivery approach (agent-led, lay-led, or combination of agent- and lay-led) and program access and sustainability.

Methods:

All state Extension agents (n = 66) were surveyed on program implementation, continuance, and use of lay leaders. Program records were used to identify the number of trained lay leaders. Regression models were used to examine the relationship between delivery approach and group availability.

Results:

Counties using lay leaders had twice as many groups as counties using only agents. There was a significant, positive relationship between the number of lay leaders and the number of groups. Counties using lay leaders were 8.3 times more likely to have continuing groups compared with counties not using lay leaders.

Conclusions:

Program continuance was significantly and positively associated with lay leader use. Lay delivery expanded access to strength training programs and increased the likelihood that programs would continue. This approach can be used to increase access to and sustainability of strength training programs, particularly in resource-constrained areas.
Localized TRPA1 channel Ca
2+
signals stimulated by reactive oxygen species promote cerebral artery dilation
Authors: Sullivan Michelle N. , Gonzales Albert L. , Pires Paulo W. , Bruhl Allison , Leo M. Dennis , Li Wencheng , Oulidi Agathe , Boop Frederick A. , Feng Yumei , Jaggar Jonathan H. , Welsh Donald G. , Earley Scott
Published: January 2015

Peroxidized lipid metabolites trigger calcium influx through the channel TRPA1 to dilate cerebral arteries.
On Botulinum Neurotoxin Variability
Authors: Montecucco Cesare , Rasotto Maria Berica
Published: January 2015

The rapidly growing number of botulinum neurotoxin sequences poses the problem of the possible evolutionary significance of the variability of these superpotent neurotoxins for toxin-producing Clostridium species. To progress in the understanding of this remarkable phenomenon, we suggest that researchers should (i) abandon an anthropocentric view of these neurotoxins as human botulism-causing agents or as human therapeutics, (ii) begin to investigate in depth the role of botulinum neurotoxins in animal botulism in the wilderness, and (iii) devote large efforts to next-generation sequencing of soil samples to identify novel botulinum neurotoxins. In order to compare the fitness of the different toxins, we suggest that assays of all the steps from toxin production to animal death should be performed.
Structural and Molecular Basis for Resistance to Aminoglycoside Antibiotics by the Adenylyltransferase ANT(2″)-Ia
Authors: Cox Georgina , Stogios Peter J. , Savchenko Alexei , Wright Gerard D.
Published: January 2015

The aminoglycosides are highly effective broad-spectrum antimicrobial agents. However, their efficacy is diminished due to enzyme-mediated covalent modification, which reduces affinity of the drug for the target ribosome. One of the most prevalent aminoglycoside resistance enzymes in Gram-negative pathogens is the adenylyltransferase ANT(2″)-Ia, which confers resistance to gentamicin, tobramycin, and kanamycin. Despite the importance of this enzyme in drug resistance, its structure and molecular mechanism have been elusive. This study describes the structural and mechanistic basis for adenylylation of aminoglycosides by the ANT(2″)-Ia enzyme. ANT(2″)-Ia confers resistance by magnesium-dependent transfer of a nucleoside monophosphate (AMP) to the 2″-hydroxyl of aminoglycoside substrates containing a 2-deoxystreptamine core. The catalyzed reaction follows a direct AMP transfer mechanism from ATP to the substrate antibiotic. Central to catalysis is the coordination of two Mg
2+
ions, positioning of the modifiable substrate ring, and the presence of a catalytic base (Asp
86
). Comparative structural analysis revealed that ANT(2″)-Ia has a two-domain structure with an N-terminal active-site architecture that is conserved among other antibiotic nucleotidyltransferases, including Lnu(A), LinB, ANT(4′)-Ia, ANT(4″)-Ib, and ANT(6)-Ia. There is also similarity between the nucleotidyltransferase fold of ANT(2″)-Ia and DNA polymerase β. This similarity is consistent with evolution from a common ancestor, with the nucleotidyltransferase fold having adapted for activity against chemically distinct molecules.

IMPORTANCE
   To successfully manage the threat associated with multidrug-resistant infectious diseases, innovative therapeutic strategies need to be developed. One such approach involves the enhancement or potentiation of existing antibiotics against resistant strains of bacteria. The reduction in clinical usefulness of the aminoglycosides is a particular problem among Gram-negative human pathogens, since there are very few therapeutic options for infections caused by these organisms. In order to successfully circumvent or inhibit the activity of aminoglycoside-modifying enzymes, and to thus rejuvenate the activity of the aminoglycoside antibiotics against Gram-negative pathogens, structural and mechanistic information is crucial. This study reveals the structure of a clinically prevalent aminoglycoside resistance enzyme [ANT(2″)-Ia] and depicts the molecular basis underlying modification of antibiotic substrates. Combined, these findings provide the groundwork for the development of broad-spectrum inhibitors against antibiotic nucleotidyltransferases.
Protein A Suppresses Immune Responses during Staphylococcus aureus Bloodstream Infection in Guinea Pigs
Authors: Kim Hwan Keun , Falugi Fabiana , Thomer Lena , Missiakas Dominique M. , Schneewind Olaf
Published: January 2015

Staphylococcus aureusinfection is not associated with the development of protective immunity, and disease relapses occur frequently. We hypothesize that protein A, a factor that binds immunoglobulin Fcγ and cross-links VH3 clan B cell receptors (IgM), is the staphylococcal determinant for host immune suppression. To test this, vertebrate IgM was examined for protein A cross-linking. High VH3 binding activity occurred with human and guinea immunoglobulin, whereas mouse and rabbit immunoglobulins displayed little and no binding, respectively. Establishing a guinea pig model of S. aureus bloodstream infection, we show that protein A functions as a virulence determinant and suppresses host B cell responses. Immunization with SpAKKAA, which cannot bind immunoglobulin, elicits neutralizing antibodies that enable guinea pigs to develop protective immunity.

IMPORTANCE Staphylococcus aureusis the leading cause of soft tissue and bloodstream infections; however, a vaccine with clinical efficacy is not available. Using mice to model staphylococcal infection, earlier work identified protective antigens; however, corresponding human clinical trials did not reach their endpoints. We show that B cell receptor (IgM) cross-linking by protein A is an important immune evasion strategy of S. aureus that can be monitored in a guinea pig model of bloodstream infection. Further, immunization with nontoxigenic protein A enables infected guinea pigs to elicit antibody responses that are protective against S. aureus. Thus, the guinea pig model may support preclinical development of staphylococcal vaccines.
Haematuria and loin pain, could this be tuberculosis?
Authors: Biswas Anneka , Meghjee Salim P L
Published: January 2015

We report a case of an 18-year-old Caucasian male presenting with haematuria and loin pain while working as a locksmith. He was systemically well with normal vital signs. Peripheral blood testing demonstrated renal failure, secondary to hydronephrosis, caused by haemorrhagic cystitis with no obvious cause for the obstruction. The patient was diagnosed with a urinary tract infection and treated with antibiotics. He responded well and his renal function improved. Four months later he re-presented with the above symptoms, weight loss and night sweats, bladder wall biopsy at this point confirmed tuberculosis.
Granulicatella adiacenssubacute bacterial endocarditis as the underlying cause of type II mixed cryoglobulinaemia
Authors: Sim Benjamin W C , Koo Ray Mun , Hawkins Carolyn , Bowden Francis , Watson Ashley
Published: January 2015

A 57-year-old man with type II mixed cryoglobulinaemia presented to the emergency department with a history of worsening lethargy, malaise and non-drenching night sweats in a relapsing–remitting pattern. He was diagnosed with type II mixed cryoglobulinaemia 7 months ago following episodes of fever, night sweats, lethargy and malaise associated with a non-blanching, purpuric, raised erythematous rash that responded partially to immunosuppressive therapy and short courses of oral antibiotics. A single blood culture then yieldedGranulicatella adiacenswhich was reported as a possible contaminant and therefore, not pursued. Despite numerous other investigations, the underlying cause of his type II cryoglobulinaemia remained undetermined. On his current presentation, the physical examination revealed signs of infective endocarditis. Two further blood cultures grewG. adiacens.The diagnosis of infective endocarditis was established on a transoesophageal echocardiography, and the subsequent antibiotic and surgical therapy resulted in complete remission of his type II mixed cryoglobulinaemia.
Metastatic renal cell carcinoma mimicking diverticulitis in a patient with chronic lymphocytic leukaemia
Authors: Hwang S M , Kuyava J M , Grande J P , Swetz K M
Published: January 2015

We present an unusual case of metastatic renal cell carcinoma (RCC) mimicking diverticulitis in a 76-year-old man with a 16-year history of chronic lymphocytic leukaemia (CLL) and a 2 cm left renal mass. The patient presented with severe abdominal pain and lower gastrointestinal bleeding with anticoagulation from recent pulmonary embolism. His clinical course was troubled by recurrent hospitalisations and complications that delayed investigations and potential treatments. Radiographic findings revealed stable CLL, mild sigmoid diverticulitis and a small renal mass. Small renal masses (less than 4 cm) are considered low risk for metastasising and are, thus, often observed or ablated, rather than resected. Furthermore, gastrointestinal metastases from RCC are rare. This case adds new perspective to the unpredictable nature of RCC and how synchronous malignancies may be masked in patients with long-standing CLL.
Persistent unilateral central serous chorioretinopathy in a breastfeeding woman
Authors: Lopez-Yang Christine Elizabeth , Garcia Charles A
Published: January 2015

A 40-year-old woman presented with blurred vision and floaters in her right eye for the past 7 months. The patient was in the sixth month of pregnancy at onset of the ocular symptoms and had persistent ocular disturbances postpartum. Her medical and ocular history were unremarkable except for LASIK surgery. Examination revealed an uncorrected visual acuity of 20/30 and 20/20 in the right and left eye, respectively. Fundus examination showed a round, subretinal exudate involving the foveal centre. Central serous chorioretinopathy was diagnosed by fluorescein angiogram and optical coherence tomography (OCT) showing foveal neurosensory detachment and treated with intravitreal bevacizumab. At her 4-month follow-up (8 month postpartum), OCT continued to show persistent foveal subretinal fluid. Patient declined further treatment and on follow-up 1 year later, still showed a persistent neurosensory detachment on OCT testing.
Percutaneous breast implant herniation: a rare complication of miliary TB
Authors: Dale Adam P , Dedicoat Martin J , Saleem Tausif , Moran Ed
Published: January 2015

We describe the case of a 46-year-old female patient treated for disseminated tuberculosis (TB) infection involving the lungs, urinary tract and skin. Following initiation of antituberculous therapy, the patient's right breast implant eroded through the overlying skin and was seen to be herniating through the resulting defect. The breast implant was removed under local anaesthetic and histological analysis of the resected tissue demonstrated granuloma formation consistent with periprosthetic TB. Wound healing following implant removal was poor and future breast augmentation surgery was only considered following completion of 12 months anti-TB treatment. This case constitutes the first report in the literature of percutaneous breast implant herniation resulting from periprosthetic infection with TB. A high index of suspicion is required to ensure early detection and timely management of TB and, in cases where periprosthetic pus aspirate is sterile, mycobacterial infection must be actively excluded.
Subungual squamous cell carcinoma
Authors: Wong Kai Yuen , Ching Daniel L H , Gateley David
Published: January 2015

Subungual squamous cell carcinoma (SCC) is rare. We present a case of subungual SCC with invasion into the underlying bone and review the literature.
Sputum eosinophilia is a determinant of FEV1 decline in occupational asthma: results of an observational study
Authors: Talini Donatella , Novelli Federica , Bacci Elena , Bartoli Marialaura , Cianchetti Silvana , Costa Francesco , Dente Federico L , Di Franco Antonella , Latorre Manuela , Malagrinò Laura , Vagaggini Barbara , Celi Alessandro , Paggiaro Pierluigi
Published: January 2015

Objective

To evaluate the potential determinants of forced expiratory volume in 1 s (FEV1) decline in workers with occupational asthma (OA) still exposed to the causative agent. We hypothesised that sputum eosinophilia might be a predictor of poor asthma outcome after diagnosis.

Setting, design and participants

In a specialistic clinical centre of the University Hospital of Pisa, we studied 39 participants (28 M, 11 F) diagnosed as having OA, routinely followed up between 1990 and 2009. They were a subgroup of 94 participants diagnosed as affected by OA in that period: 9 had been removed from work at the diagnosis, 21 were excluded for having ceased occupational exposure after few months from diagnosis, and 25 were lost at the follow-up or had no acceptable sputum measurements at the diagnosis. Estimates of the decline in FEV1 were obtained by means of simple regression analysis during the period of occupational exposure after diagnosis. Logistic regression was used to analyse the effects of factors (baseline FEV1 and sputum inflammatory cells, duration and type of exposure) that may potentially influence FEV1 decline.

Results

At follow-up (5.7+3.7 years), most participants were still symptomatic despite inhaled corticosteroids (ICS) treatment and had their occupational exposure reduced. Participants with higher sputum eosinophils (>3%) at baseline had a significantly greater decline of FEV1 (–52.5 vs −18.6 mL/year, p=0.012). Logistic regression showed that persistent exposure and sputum eosinophilia were significantly associated with a greater decline in FEV1 (OR 11.5, 95% CI 1.8 to 71.4, p=0.009 and OR 6.7, 95% CI 1.1 to 41.7, p= 0.042, respectively).

Conclusions

Sputum eosinophilia at diagnosis, together with the persistence of occupational exposure during follow-up, may contribute to a greater decline in FEV1 in patients with OA still at work. Further long-term studies are required as to whether intensive ICS treatment may be beneficial for patients with OA and increase ad eosinophilic inflammation.
Healthcare professionals’ perceptions of clinical governance implementation: a qualitative New Zealand study of 3205 open-ended survey comments
Authors: Gauld Robin , Horsburgh Simon
Published: January 2015

Objectives

To investigate healthcare professional perceptions of local implementation of a national clinical governance policy in New Zealand.

Design

Respondent comments written at the end of a national healthcare professional survey designed to assess implementation of core components of the clinical governance policy.

Setting

The written comments were provided by respondents to a survey distributed to over 41 000 registered healthcare professionals employed in 19 of New Zealand's government-funded District Health Boards. Comments were analysed and categorised within emerging themes.

Results

3205 written comments were received. Five key themes illustrating barriers to clinical governance implementation were found, representing problems with: developing management–clinical relations; clinicians stepping up into clinical governance and leadership activities; interprofessional relations; training needs for governance and leadership; and having insufficient time to get involved.

Conclusions

Despite a national policy on clinical governance which New Zealand's government launched in 2009, this study found that considerable effort is required to build clinical governance at the local level. This finding parallels with other studies in the field. Two areas demand attention: building systems for organisational governance and leadership; and building professional governance arrangements.
Systematic review of mental health and well-being outcomes following community-based obesity prevention interventions among adolescents
Authors: Hoare Erin , Fuller-Tyszkiewicz Matthew , Skouteris Helen , Millar Lynne , Nichols Melanie , Allender Steven
Published: January 2015

Objectives

This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations.

Setting

Systematic review of literature from database inception to October 2014. Articles were sourced from CINAHL, Global Health, Health Source: Nursing and Academic Edition, MEDLINE, PsycARTICLES and PsycINFO, all of which were accessed through EBSCOhost. The Cochrane Database was also searched to identify all eligible articles. PRISMA guidelines were followed and search terms and search strategy ensured all possible studies were identified for review.

Participants

Intervention studies were eligible for inclusion if they were: focused on overweight or obesity prevention, community-based, targeted adolescents (aged 10–19 years), reported a mental health or well-being measure, and included a comparison or control group. Studies that focused on specific adolescent groups or were treatment interventions were excluded from review. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.

Primary and secondary outcome measures

Primary outcomes were measures of mental health and well-being, including diagnostic and symptomatic measures. Secondary outcomes included adiposity or weight-related measures.

Results

Seven studies met the inclusion criteria; one reported anxiety/depressive outcomes, two reported on self-perception well-being measures such as self-esteem and self-efficacy, and four studies reported outcomes of quality of life. Positive mental health outcomes demonstrated that following obesity prevention, interventions included a decrease in anxiety and improved health-related quality of life. Quality of evidence was graded as very low.

Conclusions

Although positive outcomes for mental health and well-being do exist, controlled evaluations of community-based obesity prevention interventions have not often included mental health measures (n=7). It is recommended that future interventions incorporate mental health and well-being measures to identify any potential mechanisms influencing adolescent weight-related outcomes, and equally to ensure interventions are not causing harm to adolescent mental health.
Primary bacteraemia is associated with a higher mortality risk compared with pulmonary and intra-abdominal infections in patients with sepsis: a prospective observational cohort study
Authors: Mansur Ashham , Klee Yvonne , Popov Aron Frederik , Erlenwein Joachim , Ghadimi Michael , Beissbarth Tim , Bauer Martin , Hinz José
Published: January 2015

Objective

To investigate whether common infection foci (pulmonary, intra-abdominal and primary bacteraemia) are associated with variations in mortality risk in patients with sepsis.

Design

Prospective, observational cohort study.

Setting

Three surgical intensive care units (ICUs) at a university medical centre.

Participants

A total of 327 adult Caucasian patients with sepsis originating from pulmonary, intra-abdominal and primary bacteraemia participated in this study.

Primary and secondary outcome measures

The patients were followed for 90 days and mortality risk was recorded as the primary outcome variable. To monitor organ failure, sepsis-related organ failure assessment (Sequential Organ Failure Assessment, SOFA) scores were evaluated at the onset of sepsis and throughout the observational period as secondary outcome variables.

Results

A total of 327 critically ill patients with sepsis were enrolled in this study. Kaplan-Meier survival analysis showed that the 90-day mortality risk was significantly higher among patients with primary bacteraemia than among those with pulmonary and intra-abdominal foci (58%, 35% and 32%, respectively; p=0.0208). To exclude the effects of several baseline variables, we performed multivariate Cox regression analysis. Primary bacteraemia remained a significant covariate for mortality in the multivariate analysis (HR 2.10; 95% CI 1.14 to 3.86; p=0.0166). During their stay in the ICU, the patients with primary bacteraemia presented significantly higher SOFA scores than those of the patients with pulmonary and intra-abdominal infection foci (8.5±4.7, 7.3±3.4 and 5.8±3.5, respectively). Patients with primary bacteraemia presented higher SOFA-renal score compared with the patients with other infection foci (1.6±1.4, 0.8±1.1 and 0.7±1.0, respectively); the patients with primary bacteraemia required significantly more renal replacement therapy than the patients in the other groups (29%, 11% and 12%, respectively).

Conclusions

These results indicate that patients with sepsis with primary bacteraemia present a higher mortality risk compared with patients with sepsis of pulmonary or intra-abdominal origins. These results should be assessed in patients with sepsis in larger, independent cohorts.
Prevalence of tinnitus and/or hyperacusis in children and adolescents: study protocol for a systematic review
Authors: Nemholt Susanne Steen , Schmidt Jesper Hvass , Wedderkopp Niels , Baguley David M
Published: January 2015

Introduction

There is some debate as to what extent epidemiological data for the prevalence of childhood tinnitus can be relied on. While indications are that the prevalence is relatively high, referral numbers for children with tinnitus are reported to be low and many of the studies have a number of methodological difficulties. We describe the protocol of a systematic review aimed at assessing the prevalence of tinnitus and/or hyperacusis in children and young people.

Methods and analysis

We will include studies of any design (except case reports or case series) comparing the prevalence of tinnitus and/or hyperacusis in children and young people with and without hearing loss, any known external exposure and psychological disorders. We will search the following databases: PubMed, EMBASE and Scopus. No restrictions of language will be applied in the search strategy but during the article selection language is limited to English, German and Scandinavian languages. Primary and additional outcomes will be the prevalence of tinnitus/hyperacusis and the severity, respectively.

Ethics and dissemination

No ethical issues are foreseen. The results will be published in a peer-reviewed journal and presented at national and international conferences of audiology and paediatrics.

Trail registration number

This review protocol is registered in the PROSPERO International Prospective Register of Systematic Reviews, registration number CRD42014013456.
Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics
Authors: Cripton Peter A , Shen Hui , Brubacher Jeff R , Chipman Mary , Friedman Steven M , Harris M Anne , Winters Meghan , Reynolds Conor C O , Cusimano Michael D , Babul Shelina , Teschke Kay
Published: January 2015

Objective

To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics.

Methods

Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics.

Results

Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission).

Conclusions

In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians.
Perception and use of massive open online courses among medical students in a developing country: multicentre cross-sectional study
Authors: Aboshady Omar A , Radwan Ahmed E , Eltaweel Asmaa R , Azzam Ahmed , Aboelnaga Amr A , Hashem Heba A , Darwish Salma Y , Salah Rehab , Kotb Omar N , Afifi Ahmed M , Noaman Aya M , Salem Dalal S , Hassouna Ahmed
Published: January 2015

Objectives

To assess the prevalence of awareness and use of massive open online courses (MOOCs) among medical undergraduates in Egypt as a developing country, as well as identifying the limitations and satisfaction of using these courses.

Design

A multicentre, cross-sectional study using a web-based, pilot-tested and self-administered questionnaire.

Settings

Ten out of 19 randomly selected medical schools in Egypt.

Participants

2700 undergraduate medical students were randomly selected, with an equal allocation of participants in each university and each study year.

Primary and secondary outcome measures

Primary outcome measures were the percentages of students who knew about MOOCs, students who enrolled and students who obtained a certificate. Secondary outcome measures included the limitations and satisfaction of using MOOCs through five-point Likert scale questions.

Results

Of 2527 eligible students, 2106 completed the questionnaire (response rate 83.3%). Of these students, 456 (21.7%) knew the term MOOCs or websites providing these courses. Out of the latter, 136 (29.8%) students had enrolled in at least one course, but only 25 (18.4%) had completed courses earning certificates. Clinical year students showed significantly higher rates of knowledge (p=0.009) and enrolment (p<0.001) than academic year students. The primary reasons for the failure of completion of courses included lack of time (105; 77.2%) and slow Internet speed (73; 53.7%). Regarding the 25 students who completed courses, 21 (84%) were satisfied with the overall experience. However, there was less satisfaction regarding student–instructor (8; 32%) and student–student (5; 20%) interactions.

Conclusions

About one-fifth of Egyptian medical undergraduates have heard about MOOCs with only about 6.5% actively enrolled in courses. Students who actively participated showed a positive attitude towards the experience, but better time-management skills and faster Internet connection speeds are required. Further studies are needed to survey the enrolled students for a better understanding of their experience.
Real-time patterns of smoking and alcohol use: an observational study protocol of risky-drinking smokers
Authors: Cohn Amy , Brandon Thomas , Armeli Stephen , Ehlke Sarah , Bowers Molly
Published: January 2015

Introduction

Despite the strong relationship between smoking and health-related consequences, very few smokers quit. Heavy drinking is a significant risk factor for health consequences, and is implicated in persistent smoking and less success at quitting smoking. Self-efficacy (SE) to abstain from smoking is an important determinant of smoking outcomes and may link alcohol use to poor quit rates. Even though research has demonstrated a strong association between drinking and smoking, and the multiplicative effect of these substances on cancer-related, heavy-drinking smokers has been largely ignored in the literature. Further, research has not taken advantage of innovative methods, such as ecological momentary assessment, to capture the impact of daily factors on smoking cessation outcomes in this particular group. The proposed study identifies daily changing factors that impede or promote SE and future smoking cessation efforts in risky-drinking smokers.

Methods and analysis

This is an observational study of 84 regular smokers (≥10 cigarettes per day) who drink at risky levels, report a desire to quit in the next 6 months, and show no evidence of psychiatric disturbance, severe history of alcohol withdrawal or drug dependence (excluding nicotine and caffeine). Participants report on their smoking, alcohol consumption and SE related to smoking twice a day for 28 days using interactive voice response (IVR) surveys. Multilevel regression and path models will examine within-person daily associations among drinking, smoking and SE, and how these variables predict the likelihood of future smoking behaviour at 1 and 6 months follow-up.

Ethics and dissemination

This protocol was approved by an accredited Institutional Review Board. The findings will help us understand the factors that promote or impede smoking cessation among a high-risk group of smokers (heavy-drinking smokers) and will be disseminated through peer-reviewed journal articles and presentations at national conferences.
Views and experiences of using integrated care pathways (ICPs) for caring for people in the last days to hours of life: results from a cross-sectional survey of UK professionals
Authors: Collins K A , Hughes P M , Ibbotson R , Foy G , Brooks D
Published: January 2015

Objectives

To determine the views and experiences of health and social care professionals on using integrated care pathways (ICPs)for caring for people in the last days to hours of life.

Methods

Online cross-sectional questionnaire survey of UK professionals working in UK primary and secondary care settings.

Results

1331 professionals returned completed questionnaires. Ninety-three per cent (1138/1228) of respondents used the Liverpool Care Pathway (LCP) or local variant. Eighty-eight (1089/1234) felt ICPs enabled professionals to provide better care for individuals and their families/carers. ICPs were viewed as promoting patient-centred holistic care, improving pain and symptom control, providing guidance and standards and improving communication with patients/families. Sixty-two per cent (770/1234) had no concerns regarding the use of ICPs. Areas of concern included incorrect use and implementation of the ICP, poor communication with families, junior level staff making decisions and insufficient education and support.

Conclusions

There was strong support for using ICPs for caring for people in the last days to hours of life. ICPs were viewed as supporting high-quality patient-centred holistic care. Given the recommendations of the More Care Less Pathway report, those that develop the guidance and support that replace the LCP need to incorporate the aspects of this that have resulted in the benefits seen by professionals within this survey, but also learn from the instances where ICPs have failed to prevent poor care, or worse, have contributed to it.
Physical and methylation status of human papillomavirus 16 in asymptomatic cervical infections changes with malignant transformation
Authors: Dutta Sankhadeep , Chakraborty Chandraditya , Dutta Arup Kumar , Mandal Ranajit Kumar , Roychoudhury Susanta , Basu Partha , Panda Chinmay Kumar
Published: January 2015

Aims

To evaluate how the genetic and epigenetic profile of human papillomavirus 16 (HPV16) changes from asymptomatic cervical infections to cervical cancer (CaCx) development.

Methods

HPV16 physical status, methylation of its early–late promoters and its upstream enhancer sequences were analysed in samples from asymptomatic cervical infections (n=89), pre-neoplastic lesions (low and high grade squamous intraepithelial lesions LSIL/HSIL, n=28) and primary CaCx (n=98).

Results

In asymptomatic infection (65%, 58/89) and LSIL/HSIL (57%, 16/28) samples, the episomal form of HPV16 was predominant whereas integration of HPV16 was significantly (p=0.01) higher in CaCx (59%, 57/98). The integrated viral form was also present in asymptomatic (27%, 24/89) and LSIL/HSIL (25%, 7/28) samples. The methylation of the enhancer region was comparable (29–34%) among asymptomatic, LSIL/HSIL and CaCx samples. The episomal form exhibited relatively higher methylation of the early promoter (52%) than that of the late promoter (40%) in asymptomatic infection but the integrated form in asymptomatic carriers showed the opposite methylation pattern (early promoter (42%) vs late-promoter (54%)). A similar pattern was observed in LSIL/HSIL samples, with comparable frequencies (44%) of early and late promoter methylation of the episomal form. However, irrespective of HPV16 physical status, higher methylation of late promoter than that of early promoter was observed in CaCx samples. An inverse correlation was observed between HPV16 integration and overall methylation of the early promoter–enhancer region in CaCx (p=0.05), LSIL/HSIL (p=0.09) and asymptomatic samples (p=0.09).

Conclusions

Our study indicates that integration of HPV16 along with changes in methylation pattern of early and late promoters is essential for neoplastic transformation of asymptomatic cervical infections.