bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic hepatitis C virus infection is associated with all‐cause and liver‐related mortality in a cohort of HIV‐infected patients with alcohol problems
Authors: Fuster Daniel , Cheng Debbie M. , Quinn Emily K. , Nunes David , Saitz Richard , Samet Jeffrey H. , Tsui Judith I.
Published: October 2013

Aims

To assess the association between hepatitis C virus (HCV) infection and overall and liver‐related death in human immunodeficiency virus (HIV)‐infected patients with alcohol problems.

Design

We analyzed data from a cohort of HIV‐infected adults with current or past alcohol problems enrolled between 2001 and 2003, searching for causes of death until 2010 using the National Death Index.

Setting and participants

Participants were HIV‐infected adults with current or past alcohol problems, recruited in Boston, MA from HIV clinics at two hospitals, homeless shelters, drug treatment programs, subject referrals, flyers and another cohort study with comparable recruitment sites.

Measurements

The primary and secondary outcomes were all‐cause and liver‐related mortality, respectively. The main independent variable was hepatitis C virus (HCV) RNA status (positive versus negative). Mortality rates and Kaplan–Meier survival curves were calculated by HCV status for both overall and liver‐related mortality. Cox proportional hazards models were used to assess the association between HCV infection and overall and liver‐related death, adjusting for alcohol and drug use over time.

Findings

A total of 397 adults (50% HCV‐infected) were included. As of 31 December 2009, 83 cohort participants had died (60 HCV‐infected, 23 HCV‐uninfected; log‐rank test P < 0.001), and 26 of those deaths were liver‐related (21 HCV‐infected, five HCV‐uninfected; log‐rank test P < 0.001). All‐cause and liver‐related mortality rates were 4.68 and 1.64 deaths per 100 person‐years for HCV‐infected patients and 1.65 and 0.36 per 100 person‐years for those without HCV, respectively. In the fully adjusted Cox model, HCV infection was associated with both overall [hazard ratio (HR) = 2.55, 95% confidence interval (CI) = 1.50–4.33, P < 0.01], and liver‐related mortality (HR = 3.24, 95% CI = 1.18–8.94, P = 0.02].

Conclusion

Hepatitis C virus infection is associated independently with all‐cause and liver‐related mortality in human immunodeficiency virus‐infected patients with alcohol problems, even when accounting for alcohol and other drug use.
The teeth and faces of twins: providing insights into dentofacial development and oral health for practising oral health professionals
Authors: Hughes TE , Townsend GC , Pinkerton SK , Bockmann MR , Seow WK , Brook AH , Richards LC , Mihailidis S , Ranjitkar S , Lekkas D
Published: October 2013

The continuing studies of the teeth and faces of Australian twins and their families in the Craniofacial Biology Research Group in the School of Dentistry at the University of Adelaide began 30 years ago. Three main cohorts of twins have been recruited, enabling various objectives and specific hypotheses to be addressed about the roles of genetic, epigenetic and environmental influences on human dentofacial growth and development, as well as oral health.

This paper highlights some key findings arising from these studies, emphasizing those of direct relevance to practising oral health professionals. We also draw on published literature to review the significant developments in relation to the use of precision 2D and 3D imaging equipment, the application of modern molecular techniques, and the development of sophisticated computer software for analysing genetic relationships and comparing complex shapes. Such developments are valuable for current and future work.

Apart from the classical or traditional twin model, there are several other twin models that can be used in research to clarify the relative contributions of genetic, epigenetic and environmental contributions to phenotypic variation. The monozygotic (MZ) co‐twin model is one particularly valuable method, given that examination of only one pair of MZ twins can provide considerable insights into underlying causes of observed variation. This model can be used in a dental practice environment, with oral health professionals having the opportunity to explore differences in orofacial structures between MZ co‐twins who are attending as patients.

As researchers have become more aware of the complexities of the interactions between the genome, the epigenome and the environment during development, there is the need to collect more phenotypic data and define new phenotypes that will better characterize variations in growth processes and health status. When coupled with powerful new genetic approaches, including genome‐wide association studies and linkage analyses, exciting opportunities are opening up to unravel the causes of problems in craniofacial growth and common oral diseases in human populations.
Discuss the impact technological advances in equipment and materials have made on the delivery and outcome of endodontic treatment
Authors: Lababidi Emad Aldin
Published: October 2013

Recent advances in endodontic equipment and materials have considerably changed the manner in which endodontic treatment is delivered. Specific technological advances, including nickel‐titanium instruments, ultrasonic instruments and the dental operating microscope have been associated with increased efficiency and efficacy of treatment and simplification of delivery. The effects of most of these changes have been tested via in vitro studies and case reports. Ongoing studies should constantly investigate what effects technological advances might have on the outcome of endodontic treatment.
Occurrence of two different development patterns in Lobesia botrana (Lepidoptera: Tortricidae) larvae during the second generation
Authors: Pavan Francesco , Floreani Chiara , Barro Paola , Zandigiacomo Pietro , Dalla Montà Laura
Published: October 2013

In north‐eastern Italy, the second‐generation larvae of Lobesia botrana (Den. & Schiff.) (Lepidoptera: Tortricidae) can develop with two different time patterns. In particular, in ‘warmer’ areas, the developmental time is shorter than in ‘cooler’ areas and it is associated with an earlier and more economically important third generation.

Because the differences in temperature are not sufficient to explain the two patterns, research was carried out aiming to investigate whether the differences in larval development time are the result of a different number of instars and whether the photoperiod is a factor.

In the field, second‐generation larvae develop through five instars in a ‘warmer’ area and through six instars in a ‘cooler’ area. Laboratory and field data showed that decreasing photoperiod, which induces diapause, is also an important cue for inducing larvae to develop six instars.

In the light of climate warming and subsequent changes in L. botrana phenology over the last 30 years, the two different development patterns are interpreted as a means to ensure the best fit of the moth to environmental conditions. In ‘cooler’ areas, third‐generation larvae might not complete development before frost or harvest, and hence second‐generation larvae develop through six instars before producing overwintering pupae.
Impacts of subsidized hybrid seed on indicators of economic well‐being among smallholder maize growers in Zambia
Authors: Mason Nicole M. , Smale Melinda
Published: October 2013

We test the hypotheses that subsidies on hybrid seed change maize production, total household income, the severity of poverty, and relative deprivation among smallholder maize growers in Zambia. The analysis contributes to the literature by measuring the quantitative effects of seed (as compared to fertilizer) subsidies on indicators of household well‐being rather than input demand. We apply a combination of econometric approaches to a nationally representative, balanced panel of smallholder maize‐growing households, and invoke the chain rule to generate quantitative estimates of impacts per kilogram of subsidized seed. Our findings demonstrate that in the initial years of the program, subsidized seed enhanced the well‐being of smallholder maize growers according to each indicator, but by small magnitudes. Simple calculations suggest high private and social benefit‐cost ratios when benefits are measured in terms of household income, although magnitudes are sensitive to seed price and administrative costs.
Modern input promotion in sub‐Saharan Africa: insights from Asian green revolution
Authors: Rashid Shahidur , Dorosh Paul A. , Malek Mehrab , Lemma Solomon
Published: October 2013

Using case materials from four major cereal growing countries in Asia (Bangladesh, India, Indonesia, and Pakistan), the article analyzes key aspects of agricultural input policies in Asia. Results suggest that Asian policies differ from the current wave of African input subsidy programs in three important ways: (i) instead of focusing mostly on seed and chemical fertilizer, input promotion in Asia involved a package approach involving investments in agricultural R&D, irrigation, promotion of domestic fertilizer, and investments in rural roads; (ii) farmers in three of four countries paid higher prices (net taxed) for fertilizer during the height of the green revolution, suggesting that it was the profitability, not the subsidy, that was central to increasing fertilizer use; and (iii) Asian countries did not target input subsidies, but given leakage and diversion estimates of targeted programs, it is unclear whether targeting would have been more cost‐effective. Both continents have two challenges in common: degradation of soil health and increasingly larger shares of public spending on input subsidies. The first challenge calls for paying attentions to improving fertilizer use efficiency, which is an achievable target, with high pay off in the long run. The other challenge is now a historical fact—that is, once introduced, subsidies are hard to eliminate, even if they no longer contribute to agricultural productivity growth.
Subclinical hypothyroidism as a risk factor for placental abruption: Evidence from a low‐risk primigravid population
Authors: Breathnach Fionnuala M. , Donnelly Jennifer , Cooley Sharon M. , Geary Michael , Malone Fergal D.
Published: October 2013

Background

Subclinical thyroid hypofunction in pregnancy has been shown to have an association with neurodevelopmental delay in the offspring. It is unclear whether obstetric factors may account for this observation.

Aims

To establish the prevalence of subclinical hypothyroidism (SCH) in a low‐risk primigravid population and to explore its association with obstetric sequelae.

Materials and Methods

Nine hundred and fifty‐three primigravid women had thyroid hormone indices analysed in the early second trimester. Delivery and neonatal outcomes were available for 904 women who met the criteria for inclusion in the study. Women with subclinical hypothyroidism (thyroid‐stimulating hormone (TSH) values at or above the 98th percentile with a normal free thyroxine (fT4)) or isolated maternal hypothyroxinaemia (fT4 level at or below the second percentile with a normal‐range TSH) were compared with biochemically euthyroid controls. Chi‐squared test and analysis of variance were used for statistical analysis.

Results

The prevalence of SCH or isolated maternal hypothyroxinaemia was 4%. Positivity for antithyroid peroxidase (TPO) or antithyroglobulin (ATG) antibodies correlated with SCH status (P = 0.02). Placental abruption was observed more commonly in the setting of either SCH or isolated maternal hypothyroxinaemia when compared with euthyroid controls (P = 0.02 and 0.04, respectively).

Conclusions

Subclinical hypothyroidism and isolated maternal hypothyroxinaemia are associated with placental abruption. The observation of these effects in this healthy low‐risk population lends weight to the case for antenatal screening for diminished thyroid reserve.
The impact of introducing universal umbilical cord blood gas analysis and lactate measurement at delivery
Authors: White Christopher R.H. , Doherty Dorota A. , Newnham John P. , Pennell Craig E.
Published: October 2013

Background

There is growing support for umbilical cord blood gas analysis (UCBGA) to be conducted at delivery. A recent study in a tertiary level obstetric unit found that universal UCBGA was associated with improved perinatal outcomes, but there is less evidence of benefit in lower‐risk environments. In such settings, lactate analysis may be a suitable alternative.

Aims

This study evaluated the introduction of universal UCBGA into a secondary obstetric unit and universal umbilical cord lactate analysis program into primary and secondary units.

Methods

After education, universal UCBGA or lactate analysis was introduced into one primary and two secondary level obstetric units. Univariate and adjusted analysis assessed changes in UCBGA values and Apgar scores over the study period.

Results

There were no significant changes in mean blood gas and lactate values at any centre following introduction of universal UCBGA or lactate analysis. However, there was at the primary level obstetric unit a significant reduction in the proportion of neonates with moderate to severe elevations in umbilical artery lactate values. There was a non‐significant reduction in arterial pH values less than 7.10 at the secondary metropolitan centre.

Conclusion

The data presented in this study suggest that the benefits of introducing UCBGA into a tertiary obstetric centre may be reproduced in a primary obstetric centre within 12 months of implementation. Larger studies are required in secondary units to assess infrequent adverse obstetric and neonatal outcomes.
Why are some women with pelvic floor dysfunction unable to contract their pelvic floor muscles?
Authors: Kim Sia , Wong Vivien , Moore Kate H.
Published: October 2013

Introduction

Many women with pelvic floor dysfunction are unable to voluntarily contract their pelvic floor muscles. This study hypothesised that women who cannot contract their pelvic floor muscles, despite specialised pelvic floor physiotherapy, are likely to have avulsion defect of the levator ani muscle, visible on 3‐dimensional ultrasound.

Methods

Pelvic floor muscle strength was assessed by modified Oxford scale in all women presenting to a tertiary urogynaecology clinic with a main complaint of urinary incontinence ± pelvic organ prolapse. Women who could not contract their pelvic floor muscles (PFM) after having training with a specialised pelvic floor physiotherapist, (modified Oxford score of 0 or 1), were invited to participate in 3‐dimensional transperineal ultrasound.

Results

Of 625 women presenting with urinary incontinence and/or pelvic organ prolapse, 150 (24.0%) were unable to contract their PFM at initial assessment. After specialised pelvic floor physiotherapy, 20 of 150 (15.3%) could not contract and were termed ‘noncontractors’. Of these, 12 agreed to participate in transperineal ultrasound. Levator avulsion defects were detected in 8 of 12 (66.7%).

Conclusion

Our results show that 67% of women who cannot contract their PFM despite physiotherapy have levator avulsion defects. The mechanism affecting the remaining 33% is yet to be discovered.
Life events and internalizing problems among Chinese school children: An examination of the cognitive diathesis model
Authors: Lu Weili , Daleiden Eric , Pratt Sarah , Shay Alexander , Stone Brittany , Asaku‐Yeboah Michael
Published: October 2013

This study examined the cognitive diathesis model for child internalizing problems among 459 Chinese elementary school children in grades four to six. Life events were associated with beliefs about external control and threat perception bias, both of which were related to child internalizing problems. The relation of life events to internalizing problems was partially mediated by threat perception bias measured by ambiguous situation task. The main findings indicate that the cognitive diathesis theory for child internalizing problems might be applicable to Chinese children. This study contributes to the theoretical understanding of the internalizing problems of Chinese children, which can lead to use of more effective treatments.
Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti‐inflammatory drugs
Authors: Kowalski M. L. , Asero R. , Bavbek S. , Blanca M. , Blanca‐Lopez N. , Bochenek G. , Brockow K. , Campo P. , Celik G. , Cernadas J. , Cortellini G. , Gomes E. , Niżankowska‐Mogilnicka E. , Romano A. , Szczeklik A. , Testi S. , Torres M. J. , Wöhrl S. , Makowska J.
Published: October 2013

Hypersensitivity reactions to aspirin (acetylsalicylic acid) and other nonsteroidal anti‐inflammatory drugs (NSAIDs) constitute only a subset of all adverse reactions to these drugs, but due to their severity pose a significant burden to patients and are a challenge to the allergist. In susceptible individuals, NSAIDs induce a wide spectrum of hypersensitivity reactions with various timing, organ manifestations, and severity, involving either immunological (allergic) or nonimmunological mechanisms. Proper classification of reactions based on clinical manifestations and suspected mechanism is a prerequisite for the implementation of rational diagnostic procedures and adequate patient management. This document, prepared by a panel of experts from the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity, aims at reviewing the current knowledge in the field and proposes uniform definitions and clinically useful classification of hypersensitivity reactions to NSAIDs. The document proposes also practical algorithms for the diagnosis of specific types of NSAIDs hypersensitivity (which include drug provocations, skin testing and in vitro testing) and provides, when data are available, evidence‐based recommendations for the management of hypersensitive patients, including drug avoidance and drug desensitization.
Wide Complex Tachycardia in the Presence of Class I Antiarrhythmic Agents: A Diagnostic Challenge
Authors: Bhardwaj Bhaskar , Lazzara Ralph , Stavrakis Stavros
Published: October 2013

We present two patients with paroxysmal atrial fibrillation on class 1C antiarrhythmic drugs without concomitant atrioventricular (AV) nodal blocking agents who developed atrial flutter with 1:1 AV conduction. Their electrocardiogram revealed wide complex tachycardia with rates >200/minute. Atrial flutter with 1:1 conduction in the presence of class IC antiarrhythmic drugs may present a diagnostic challenge. These cases illustrate the importance of coadministering an AV nodal blocking agent with class IC antiarrhythmic agents in patients with atrial fibrillation. The differential diagnosis of wide complex tachycardia in patients taking class IC agents should include atrial flutter with 1:1 AV conduction.
Prognostic significance of epidermal growth factor receptor overexpression in pancreas cancer and nodal metastasis
Authors: Perini Marcos Vinicius , Montagnini Andre Luis , Coudry Renata , Patzina Rosely , Penteado Sonia , Abdo Emilio Elias , Diniz Alessandro , Jukemura Jose , da Cunha Jose Eduardo Monteiro
Published: October 2013

Background

Identification of molecular markers in pancreatic adenocarcinoma (PA) has the potential to guide targeted therapy. The objective of this study is to determine the prognostic significance of epidermal growth factor receptor (EGFR) expression (membrane and cytoplasmic) in resected PA and its correlation with lymph node metastasis and survival.

Methods

EGFR overexpression was determined by immunohistochemistry, and the pattern of expression was compared between the primary tumour, adjacent normal pancreas and involved lymph nodes.

Results

A total of 88 patients had curative resection. No difference was found in mEGFR overexpression between tumoural and metastatic nodal tissues (P = 0.28). Median overall survival time was 22.9 months. Overall cumulative 1‐, 3‐ and 5‐year survival was 48%, 20% and 18%, respectively. In positive mEGFR tumour expression, survival was 46% at 1 year, 8% at 3 years and 0% at 5 years (P < 0.05). Univariate analysis showed that male gender, portal vein (PV) resection, perineural, lymphovascular and peri‐pancreatic invasion, positive margins and positive mEGFR expression in tumour tissue had worse survival. Multivariate analysis showed that male gender, PV resection, vascular and perineural invasion remained independent predictors of poor survival.

Conclusion

Positive mEGFR overexpression is associated with decreased survival; however, it is not an independent prognostic factor.
Instrumental vaginal deliveries; are midwives safer practitioners? A retrospective cohort study
Authors: Black Mairead , Mitchell Elaine , Danielian Peter
Published: October 2013

Objective

To compare obstetric morbidity of midwife‐performed instrumental vaginal deliveries with those performed by doctors.

Design

Retrospective cohort study.

Setting

University Hospital, UK.

Population

Women undergoing an instrumental vaginal delivery of a singleton infant outside of the operating theater in Aberdeen Maternity Hospital, between June 2005 and June 2010.

Methods

Prospectively entered data were obtained from the hospital data management system. Obstetric outcomes of deliveries by midwives were compared with those performed by any doctor and, in a secondary analysis, with those by junior doctors (fewer than two years at ‘registrar’ level). Sociodemographic characteristics and clinical outcomes were compared using the chi‐squared test, Mann–Whitney U‐test and independent sample t‐test.

Main outcome measures

Third‐ or fourth‐degree tears.

Results

Among 2540 women identified, 330 (13%) were delivered by midwives. Maternal and clinical characteristics were comparable in each group. Midwives were more likely to use ventouse as their instrument of choice. Women delivered by midwives were less likely to suffer a third‐ or fourth‐degree tears than those delivered by doctors and junior doctors. This difference did not reach statistical significance once adjusted for instrument used: odds ratio 0.6 (95% confidence interval: 0.3–1.2) and odds ratio 0.6 (95% confidence interval: 0.3–1.1), respectively.

Conclusions

Instrumental vaginal deliveries performed by trained midwives are associated with equivalent maternal morbidity to those performed by doctors once adjusted for midwives' preference for the ventouse. This study highlights the potential contribution of an advanced role for midwives in the labor ward.
Causes of stillbirth at different gestational ages in singleton pregnancies
Authors: Stormdal Bring Hanna , Hulthén Varli Ingela A. , Kublickas Marius , Papadogiannakis Nikos , Pettersson Karin
Published: October 2013

Objective

To compare causes of stillbirth in preterm and term pregnancies.

Design

Cohort study.

Setting

All delivery wards in Stockholm, 1998–2009.

Population

Stillbirths from singleton pregnancies of gestational age ≥22+0 (n = 1089) extracted from a web‐based database including all stillbirths in the major Stockholm area since 1998.

Methods

The parents of the stillborns were all offered an extensive standardized investigation. The causes of death were assigned in a perinatal audit using the Stockholm classification of stillbirth. Singleton stillbirths were divided into preterm (gestational week 22+0–36+6) and term/post‐term (gestational week ≥37+0). The term/post‐term group was subdivided into term (gestational week 37+0–40+6) and post‐term stillbirths (gestational week ≥41+0).

Main outcome measure

Causes of stillbirth at different gestational ages.

Results

A higher proportion of placental abruption and preeclampsia/hypertension was seen in preterm stillbirths compared with term/post‐term stillbirths, which instead had a higher proportion of umbilical cord complications and infection. Infection was more common in post‐term than term stillbirths (46.5 vs. 19.8%, p < 0.001).

Conclusion

Increased knowledge of causes of stillbirth in different gestational ages may be valuable in developing strategies for prevention of fetal death. The high proportion of infection in post‐term stillbirths could be clinically important and warrants further studies.
Prevalence of intimate partner violence among women seeking termination of pregnancy compared to women seeking contraceptive counseling
Authors: Öberg Mariella , Stenson Kristina , Skalkidou Alkistis , Heimer Gun
Published: October 2013

Objective

To estimate the prevalence of intimate partner violence (IPV) among women seeking termination of pregnancy (TOP) in comparison to women seeking contraceptive counseling.

Design

Case–control study.

Setting

Family planning unit, Uppsala University Hospital.

Population

Women seeking TOP (n = 635) and women seeking contraceptive counseling (n = 591) answered a self‐administered questionnaire regarding experience of IPV. In addition, the women were interviewed by specially trained staff.

Method

Comparisons were made between the two groups and between those who had previously undergone TOP and those who had never done so with experience of IPV as the main outcome measure. Multivariate logistic regression was used to adjust for age, education and occupation.

Results

In total, 29% of women seeking TOP and 22% of women seeking contraceptive counseling reported experience of violence. Women seeking TOP were more likely to report physical violence [adjusted odds ratio (aOR) = 1.6, 95% confidence interval (CI) 1.2–2.1] and experience of violence during the past year (aOR = 2.3, 95% Cl 1.1–4.8). Women who had ever undergone TOP were also more likely to report IPV compared with women with no history of TOP (aOR = 1.7, 95% CI 1.3–2.3). Among women with repeated TOP, 51% reported experience of IPV.

Conclusion

Women seeking TOP reported to a greater extent experience of IPV. However, women seeking contraceptive counseling also had a high prevalence of violent experiences. These results stress the importance of caregivers approaching both groups of women with questions about IPV to identify exposed women and offer them help.
Optic nerve hypoplasia in children and adolescents; prevalence, ocular characteristics and behavioural problems
Authors: Teär Fahnehjelm Kristina , Dahl Sara , Martin Lene , Ek Ulla
Published: October 2013

Purpose

To report prevalence, ocular characteristics and coexisting behavioural problems in children and adolescents with optic nerve hypoplasia (ONH), which is a common cause of visual impairment in children in western countries, often associated with neurological or endocrinological problems and where autism has been reported in severe cases with blindness.

Methods

This is a population‐based cross‐sectional study of patients <20 years of age who had been diagnosed with ONH and lived in the county of Stockholm in December 2009. Ophthalmological assessments including fundus photographs with optic disc analyses were made. A questionnaire was used to screen for behaviour and development.

Results

The prevalence of ONH in all living children <18 years of age in Stockholm was 17.3/100 000 with a prevalence of visual impairment (<0.3) of 3.9/100 000. In total, 66 patients, median age 9.3 years (0.6–19.4), 36 with bilateral and 30 with unilateral ONH, were included in the current study; 53 were re‐examined clinically, group A, and 13 agreed to retrospective analyses of existing medical records, group B. Analyses of the optic discs were made in fundus photographs from 53 patients comparing a semi‐automated (Retinal Size Tool) and a manual method (Zeki). There was a strong curvilinear correlation (rS = −0.91 p < 0.0001 for both eyes). Behavioural problems were more common (p < 0.05) in bilateral ONH.

Conclusion

Optic nerve hypoplasia is a common ocular malformation with a prevalence of 17.3/100 000 children and adolescents <18 years of age in Stockholm. Unilateral ONH seems as common as bilateral.
Premature infants with birth weights of 1500–1999 g exhibit considerable delays in several developmental areas
Authors: Guerra Camila C , de Moraes Barros Marina C , Goulart Ana Lucia , Fernandes Luciana V , Kopelman Benjamin I , dos Santos Amélia MN
Published: October 2013

Aim

To establish the prevalence and factors associated with developmental scores and delays in premature infants.

Methods

A cross‐sectional study was conducted on 100 premature infants with corrected ages of 18–24 months (actual ages 19.9 ± 2.0 months) and birth weights of 1500–1999 g. Bayley III scales were used to assess developmental scores, percentage of children with developmental scores <85, factors associated with developmental scores and delays in at least one developmental domain.

Results

The percentages and 95% confidence intervals of those children with developmental delays were as follows: cognitive (2.0%; 0.6–7.0%), language (5.0%; 2.2–11.2%), motor (3.0%; 1.0–8.5%), socio‐emotional (13.0%; 7.8–20.1%), general adaptive (26.0%; 18.4–35.4%), conceptual (17.0%; 10.9–25.6%), social (46.0%; 36.6–55.7%) and practical (21.0%; 14.2–30.0%). Factors associated with delay in at least one developmental domain were as follows: caesarean delivery, low per capita income and peri‐intraventricular haemorrhage. Factors associated with a reduction in developmental scores were as follows: non‐white ethnicity, lower social class, caesarean delivery, male gender, peri‐intraventricular haemorrhage, mechanical ventilation and length of hospitalisation.

Conclusion

Premature infants with birth weights of 1500–1999 g exhibited considerable delays in several developmental areas. In addition to biological factors, environmental factors contributed to the reduced scores and/or developmental delays.
Motivational interviewing improves exclusive breastfeeding in an Australian randomised controlled trial
Authors: Elliott‐Rudder M , Pilotto L , McIntyre E , Ramanathan S
Published: October 2013

Aim

To increase maintenance of breastfeeding through improved primary care support.

Method

A cluster randomised controlled trial recruited 15 rural family doctor's offices and 330 women who were currently breastfeeding took part. Eight practices formed the intervention group (154 women) and seven formed the control group (176 women). The practice nurses who provided the intervention used a specially designed motivational flowchart to speak to the mothers when they brought their child for immunisation at 2, 4 and 6 months. The nurses also attended preparatory workshops on breastfeeding management, counselling skills, motivational interviewing and reflective practice and were given resources and support. Breastfeeding rates were measured at 4 and 6 months.

Results

Randomisation equally distributed all measured variables except prenatal intentions to rejoin employment within 12 months (70% intervention, 56% control, p < 0.05). After adjustment, the 4‐month figures showed significantly higher rates of exclusive breastfeeding (OR 1.88; 95%CI 1.01–3.50; p = 0.047) and full breastfeeding (water/juice allowed) (OR 1.95; 95%CI 1.03–3.69; p = 0.04) in the intervention group. There were no differences at 6 months.

Conclusion

A motivational interviewing intervention by primary care health professionals who have undertaken a replicable training programme is feasible and effective in increasing exclusive breastfeeding and full/predominant breastfeeding at 4 months.
Children with multiple viral respiratory infections are older than those with single viruses
Authors: Rotzén‐Östlund Maria , Eriksson Margareta , Tiveljung Lindell Annika , Allander Tobias , Zweygberg Wirgart Benita , Grillner Lena
Published: October 2013

Aim

To study the clinical impact of multiple viral respiratory infections compared to single infections.

Methods

Demographic data from 37 multiple infection periods in children <5 years of age were compared to data from 193 episodes with single infections. Clinical data derived from patient records of the multiple infection episodes were further compared to data from 93 matched control episodes with single infections.

Results

The mean age of patients with multiple viral findings was 12.7 months, compared to 5.7 months for those with single findings (p < 0.01). Wheezing was the most common diagnosis in both groups, except among children who were only infected with the coronavirus. No differences were found regarding duration of hospitalisation, oxygen treatment or admittance to the intensive care unit.

Conclusion

Children with multiple viral findings in their respiratory secretions were older than those with a single detected virus. Otherwise, no major differences in comorbidity, presentation or clinical outcome were observed between the two groups.
Lack of sleep could increase obesity in children and too much television could be partly to blame
Authors: Magee Christopher , Caputi Peter , Iverson Don
Published: October 2013

Aim

To examine the bidirectional relationship between short sleep duration and body mass index (BMI). A secondary aim was to investigate whether reduced physical activity and increased screen time (television and computer use) mediated these associations.

Methods

This study utilised data from the Longitudinal Study of Australian Children, which is an observational cohort study of Australian children. The sample included 2984 (52.4% boys) children followed from 4 to 5 years of age until 8 to 9 years of age. Sleep duration, screen time and covariates were reported by parents, with BMI measured objectively. Cross‐lagged modelling investigated the bidirectional association between sleep duration and BMI; lagged panel mediation modelling examined physical activity and screen time as potential mediators.

Results

Short sleep duration at 4 to 5 years of age was significantly associated with higher BMI at 8 to 9 years of age (β= −.07, p = .044). The relationship between short sleep duration at 4 to 5 years of age and higher BMI at 8 to 9 years of age was partially mediated by increased television viewing at 6 to 7 years of age (β = −.01, 95% confidence interval [−.02, −.002]).

Conclusion

Short sleep duration could be a risk factor for obesity in children. Increased television viewing may be one mechanism underlying this longitudinal relationship.
The triply troubled teenager – chronic conditions associated with fewer protective factors and clustered risk behaviours
Authors: Nylander Charlotte , Seidel Carina , Tindberg Ylva
Published: October 2013

Aim

This study aimed to measure protective factors and risk behaviour among adolescents with chronic conditions (CCs) and to evaluate the impact of protective factors on risk‐taking.

Methods

A population‐based study of 7262 students aged 15 and 17 years old was performed in Sörmland, Sweden 2008 (response rate 82%). The questionnaire explored background factors, CCs, risk behaviours and protective factors. CCs were reported by 8%, while 58% had no health problems.

Results

Girls with CCs encompassed less individual protective factors, while boys with CCs tended to over‐report all individual risk behaviours compared with healthy peers. Both boys and girls with CCs were more likely to report few protective factors and co‐occurrence of risk behaviours. The adjOR for clustered health risk behaviours was 1.6 (1.0–2.5) in youths with CCs and ≥4 protective factors and 6.3 (3.6–10.9) in youths with CCs and 0–3 protective factors, as compared to healthy peers with ≥4 protective factors.

Conclusion

Adolescents with CCs reported fewer protective factors and more risk behaviours than their healthy peers. The vulnerability of adolescents with CCs and few protective factors is important to acknowledge. Professionals should provide stronger protection for these adolescents, to prevent risky behaviour.
Acute molecular responses in untrained and trained muscle subjected to aerobic and resistance exercise training versus resistance training alone
Authors: Fernandez‐Gonzalo R. , Lundberg T. R. , Tesch P. A.
Published: October 2013

Aim

This study assessed and compared acute muscle molecular responses before and after 5‐week training, employing either aerobic (AE) and resistance exercise (RE) or RE only.

Methods

Ten men performed one‐legged RE, while the contralateral limb performed AE followed by RE 6 h later (AE+RE). Before (untrained) and after (trained) the intervention, acute bouts of RE were performed with or without preceding AE. Biopsies were obtained from m. vastus lateralis of each leg pre‐ and 3 h post‐RE to determine mRNA levels of VEGF, PGC‐1α, MuRF‐1, atrogin‐1, myostatin and phosphorylation of mTOR, p70S6K, rpS6 and eEF2.

Results

PGC‐1α and VEGF expression increased (P < 0.05) after acute RE in the untrained, but not the trained state. These markers showed greater response after AE+RE than RE in either condition. Myostatin was lower after AE+RE than RE, both before and after training. AE+RE showed higher MuRF‐1 and atrogin‐1 expression than RE in the untrained, not the trained state. Exercise increased (P < 0.05) p70S6K phosphorylation both before and after training, yet this increase tended to be more prominent for AE+RE than RE before training. Phosphorylation of p70S6K was greater in trained muscle. Changes in these markers did not correlate with exercise‐induced alterations in strength or muscle size.

Conclusion

Concurrent exercise in untrained skeletal muscle prompts global molecular responses consistent with resulting whole muscle adaptations. Yet, training blunts the more robust anabolic response shown after AE+RE compared with RE. This study challenges the concept that single molecular markers could predict training‐induced changes in muscle size or strength.
Review article: immunogenicity of anti‐TNF biologics in IBD – the role of patient, product and prescriber factors
Authors: Moss A. C. , Brinks V. , Carpenter J. F.
Published: October 2013

Background

Anti‐drug antibodies (ADAs) to biologic therapies contribute to the loss of response and infusion reactions to anti‐TNF drugs in patients with inflammatory bowel disease (IBD). The reasons behind this immunogenicity are complex, and have not been the focus of a dedicated review for prescribers.

Aim

To provide an overview of the patient, product and prescriber factors, which have been associated with the immunogenicity of anti‐TNF therapy, and draw conclusions for clinical practice.

Methods

Review of representative observational studies and clinical trials from the IBD and other literature, which report associations with ADA development, with a focus on infliximab and adalimumab.

Results

ADAs develop in 10–20% of patients receiving anti‐TNF maintenance therapy, and these patients are three times more likely to lose response as ADA‐negative patients. Patient genotype plays a role in ADA risk in a minority of patients, but age or disease type is not a major factor. Drug mishandling, such as agitation or freeze–thaw cycles, can induce protein aggregates, which are known to be immunogenic. Prescription of maintenance therapy with concomitant immunomodulators, and achieving suitable trough drug levels, reduces the risk of ADAs in patients with IBD.

Conclusions

Patients and prescribers can take several steps to reduce the risk of development of anti‐drug antibodies to anti‐TNF antibodies. Further research is required to determine if immunogenic factors identified in other situations apply to use of anti‐TNFs in IBD.
Optimising delivery of care in coeliac disease – comparison of the benefits of repeat biopsy and serological follow‐up
Authors: Sharkey L. M. , Corbett G. , Currie E. , Lee J. , Sweeney N. , Woodward J. M.
Published: October 2013

Background

The majority of deleterious health consequences of coeliac disease (CD) are most likely to be secondary to intestinal inflammation; hence, mucosal recovery is a desirable goal of therapy. Follow‐up in CD is controversial and serological response is often used as a surrogate for histological recovery.

Aims

To inform the clinical management of CD using comparative serological and histological data from a biopsy‐driven pathway of care.

Methods

A retrospective analysis of the Cambridge Coeliac Clinic database of 595 patients routinely followed up by biopsy and serology.

Results

Paired biopsy results were available for 391 patients (15% seronegative). Persisting villous atrophy (VA) occurred in 182 patients (47%). The sensitivity of anti‐tissue transglutaminase (TTG) antibody for ongoing VA was only 43.6%. Information on dietetic management and further biopsy to assess response was available for 94 initially unresponsive patients, in whom targeted dietetic intervention by removal of identified gluten sources or avoidance of trace amounts of gluten led to resolution of persistent VA in 50%. The effects of institution of a formal care pathway are analysed in 298 patients. Discharge to primary care and clinical management was facilitated by the information derived from repeat biopsy.

Conclusions

Serology appears to be a poor surrogate marker for mucosal recovery on a gluten‐free diet; dietary assessment fails to identify a potential gluten source in many patients with ongoing villous atrophy. The benefits of re‐biopsy on diet include stratification of patients with coeliac disease suitable for early discharge from secondary care or those requiring more intensive clinical management.
Randomised controlled trial: sequential vs. standard triple therapy for Helicobacter pylori infection in Chinese children–a multicentre, open‐labelled study
Authors: Huang J. , Zhou L. , Geng L. , Yang M. , Xu X.‐W. , Ding Z.‐L. , Mao M. , Wang Z.‐L. , Li Z.‐L. , Li D.‐Y. , Gong S.‐T.
Published: October 2013

Background

Studies have showed that 10‐day sequential treatment regimen achieved higher Helicobacter pylori eradication rate than standard triple therapies.

Aim

To compare a 10‐day sequential therapy and standard triple therapy in Chinese children with H. pylori infection.

Methods

A prospective, multicentre, open‐label, randomised controlled trial was conducted in four tertiary medical centres in China. Children with H. pylori gastritis were randomly assigned to a 10‐day sequential therapy consisting of omeprazole and amoxicillin for 5 days followed by omeprazole, clarithromycin and metronidazole for the remaining 5 days, or 7‐day or 10‐day standard triple therapy comprising of omeprazole, amoxicillin and clarithromycin. H. pylori eradication was assessed by H. pylori stool antigen test.

Results

A total of 360 patients were included. The eradication rate achieved with the 10‐day sequential therapy was significantly higher than either the 7‐day or 10‐day standard triple treatment, either by the intention‐to‐treat analysis (81.4% vs. 61.9% or 67.7%, P < 0.05) or per‐protocol analysis (89.7% vs. 70.8% or 77.8%, P < 0.05).

Conclusions

The 10‐day sequential regimen was significantly more effective than standard 7‐day or 10‐day triple regimens in eradicating H. pylori infection in Chinese children.
Significantly higher frequency of Helicobacter suis in patients with idiopathic parkinsonism than in control patients
Authors: Blaecher C. , Smet A. , Flahou B. , Pasmans F. , Ducatelle R. , Taylor D. , Weller C. , Bjarnason I. , Charlett A. , Lawson A. J. , Dobbs R. J. , Dobbs S. M. , Haesebrouck F.
Published: October 2013

Background

There is increased proportional mortality from Parkinson's disease amongst livestock farmers. The hypokinesia of Parkinson's disease has been linked to Helicobacter pylori. H. suis is the most common zoonotic helicobacter in man.

Aim

To compare the frequency of H. suis, relative to H. pylori, in gastric biopsies of patients with idiopathic parkinsonism (IP) and controls from gastroenterology services.

Methods

DNA extracts, archived at a Helicobacter Reference Laboratory, from IP patient and gastroenterology service biopsies were examined anonymously for H. suis, using species‐specific RT‐PCR.

Results

Relative risk of having H. suis in 60 IP patients compared with 256 controls was 10 times greater than that of having H. pylori. In patients with IP and controls, respectively, frequencies of H. suis were 27 (exact binomial 95% C.I. 15, 38) and 2 (0, 3)%, and of H. pylori, 28 (17, 40) and 16 (12, 21)%. Excess of H. suis in IP held when only the antral or corporal biopsy was considered. Of 16 IP patients with H. suis, 11 were from 19 with proven H. pylori eradication, 3 from 17 pre‐H. pylori eradication, 2 from 24 H. pylori culture/PCR‐negative. Frequency was different between groups (P = 0.001), greatest where H. pylori had been eradicated. Even without known exposure to anti‐H. pylori therapy, H. suis was more frequent in IP patients (5/41) than in controls (1/155) (P = 0.002). Partial multilocus sequence typing confirmed that strains from IP patients (6) and control (1) differed from RT‐PCR standard strain.

Conclusions

Greater frequency of H. suis in idiopathic parkinsonism appears exaggerated following H. pylori eradication. Multilocus sequence testing comparison with porcine strains may clarify whether transmission is from pigs/porcine products or of human‐adapted, H. suis‐like, bacteria.
Introduction – Field methods in ‘closed contexts’: undertaking research in authoritarian states and places
Authors: Koch Natalie
Published: October 2013

This special section on field methods in authoritarian states and places aims to move beyond the normative language of the liberal/illiberal binary by foregrounding the ways in which closure can be an authoritarian act. Illustrating the variety of scales and places at which these practices unfold, the contributors are concerned with what implications they have for conducting geographic fieldwork. The main questions raised by this set of papers are: how is research in ‘closed contexts’ different from (or similar to) more ‘open’ settings? Does it raise unique ethical and methodological dilemmas? In what ways are field methods themselves informed by particular notions of power, agency, and freedom, and how might these differ between more‐ or less‐closed settings? This article first provides some theoretical contextualization, before then introducing how each author variably highlights these themes through a critical reflection on their own experiences of conducting fieldwork in closed contexts, ranging from Vietnam to Kazakhstan, Mozambique, and the United States.
Social Class Myopia: The Case of Psychology and Labor Unions
Authors: Lott Bernice
Published: October 2013

This article explores the potential for a research agenda that includes scholarship on working class issues and organized labor. Such an agenda is consistent with the official mission of American Psychological Association—to advance knowledge that benefits society and improves people's lives. I focus on our paucity of interest in the institution that gives the American working class a voice—the labor union. We know that work is one of the central focuses in the lives of most people and that the work experience is deeply implicated in satisfaction with life. The efforts of organized labor to achieve economic fairness and justice, and a healthy workplace environment, are intertwined with multiple corollary consequences that constitute a wide and complex spectrum—from physical job safety and economic security on one end, to the psychological benefits of heightened self‐esteem, respect, dignity, empowerment, and affiliation on the other—all related to satisfaction with life. In addition, by advancing and protecting the rights of workers, unions are part of the larger movement for civil rights.