bluuebunny/crossref_metadata_2025 huggingface dataset:
Anxiety, locus of control and sociodemographic factors associated with adherence to an annual clinical skin monitoring: a cross-sectional survey among 1000 high-risk French patients involved in a pilot-targeted screening programme for melanoma
Authors: Rat Cédric , Hild Sandrine , Gaultier Aurelie , Khammari Amir , Bonnaud-Antignac Angelique , Quereux Gaelle , Dreno Brigitte , Nguyen Jean Michel
Published: October 2017

Objective

The aim of the study was to assess whether adherence to annual clinical skin monitoring is dependent on patient sociodemographic characteristics or personality traits.

Design

The study was a questionnaire survey.

Setting and participants

Data were collected between February and April 2013 in a sample of 1000 patients at high risk of melanoma who participated in a pilot-targeted screening programme in western France.

Outcome measures

Sociodemographic data, overall anxiety level (State-Trait Anxiety Inventory questionnaire), locus of control (Multidimensional Health Locus of Control scale) and levels of anxiety specifically associated with screening and melanoma were collected. Actual participation in the skin monitoring examination was reported by 78 general practitioner investigators.

Statistical analysis

Statistical analysis was performed using R statistical software. Factors associated with non-adherence were identified by multivariate analysis.

Results

Our analysis included 687 responses (526 adherent patients and 161 non-adherent patients). Non-adherence was higher in younger patients and in men (OR=0.63 (0.41–0.99)). Viewing health status as dependent on external persons (OR=0.90, 95% CI 0.83 to 0.97) or determined by chance (OR=0.89, 95% CI 0.80 to 0.98) and overall anxiety (OR=0.98, 95% CI 0.97 to 0.99) were also factors associated with non-adherence. In contrast, there was no link between anxiety specifically associated with the screening performed or melanoma and patient adherence to monitoring. Adherence was higher in married patients (OR=1.68 95% CI 1.08 to 2.60).

Conclusions

The results of this study suggest that sociodemographic and psychological characteristics should be considered when including patients at elevated risk of melanoma in a targeted screening programme.

Trial registration number

NCT01610531; Post-results.
Emotion regulation group therapy for deliberate self-harm: a multi-site evaluation in routine care using an uncontrolled open trial design
Authors: Sahlin Hanna , Bjureberg Johan , Gratz Kim L , Tull Matthew T , Hedman Erik , Bjärehed Jonas , Jokinen Jussi , Lundh Lars-Gunnar , Ljótsson Brjánn , Hellner Clara
Published: October 2017

Objective

Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset.

Design

Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up.

Setting

14 adult outpatient psychiatric clinics across Sweden.

Participants

Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment.

Primary and secondary outcome measures

Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties.

Intervention

ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation.

Results

At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen’s d=0.52, p<0.001) as well as significant improvements in the secondary outcomes of self-harm versatility, emotion dysregulation, other self-destructive behaviours and general psychiatric symptomatology. These results were either maintained or further improved on at 6-month follow-up.

Conclusions

ERGT appears to be a feasible, transportable and useful treatment for deliberate self-harm and other self-destructive behaviours, emotion dysregulation and psychiatric symptoms when delivered by clinicians in the community.

Trial registration number

NCT01986257; results.
Cigarette smoking and the risk of nasopharyngeal carcinoma: a meta-analysis of epidemiological studies
Authors: Long Mengjuan , Fu Zhenming , Li Ping , Nie Zhihua
Published: October 2017

Objective

The role of cigarette smoking as an independent risk factor for patients with nasopharyngeal carcinoma (NPC) is controversial. We attempted to provide evidence of a reliable association between cigarette smoking and the risk of NPC.

Design

Meta-analysis.

Data sources

PubMed online and the Cochrane Library of relevant studies published up to February 2016.

Eligibility criteria

All studies had to evaluate the relationship between NPC and cigarette smoking with never smokers as the reference group.

Outcomes

The primary outcome was the adjusted OR, RR or HR of NPC patients comparing smoking with never-smoking; the second was the crude OR, RR or HR.

Results

We identified 17 case–control studies and 4 cohort studies including 5960 NPC cases and 429 464 subjects. Compared with never smokers, current smokers and ever smokers had a 59% and a 56% greater risk of NPC, respectively. A dose–response relationship was identified in that the risk estimate rose by 15% (p<0.001) with every additional 10 pack-years of smoking, and risk increased with intensity of cigarette smoking (>30 cigarettes per day). Significantly increased risk was only found among male smokers (OR, 1.36; 95% CI 1.15 to 1.60), not among female smokers (OR, 1.58; 95% CI 0.99 to 2.53). Significantly increased risk also existed in the differentiated (OR, 2.34; 95% CI 1.77 to 3.09) and the undifferentiated type of NPC (OR, 1.15; 95% CI 0.90 to 1.46). Moreover, people who started smoking at younger age (<18 years) had a greater risk than those starting later for developing NPC (OR, 1.78; 95% CI 1.41 to 2.25).

Conclusions

Cigarette smoking was associated with increased risk of NPC, especially for young smokers. However, we did not find statistical significant risks of NPC in women and in undifferentiated type, which might warrant further researches.
UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol
Authors: Lee Matthew J , Sayers Adele E , Drake Thomas M , Hollyman Marianne , Bradburn Mike , Hind Daniel , Wilson Timothy R , Fearnhead Nicola S
Published: October 2017

Introduction

Small bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population.

Methods and analysis

UK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation.

Ethics and dissemination

This will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives.
The effect of religion on the perception of health states among adults in the United Arab Emirates: a qualitative study
Authors: Elbarazi Iffat , Devlin Nancy J , Katsaiti Marina-Selini , Papadimitropoulos Emmanuel A , Shah Koonal K , Blair Iain
Published: October 2017

Objectives

Investigate how religion may affect the perception of health states among adults in the United Arab Emirates and the implications for research on self-reported health and quality of life and the use of values in cost-effectiveness analysis.

Design

Qualitative analysis of short-structured interviews with adult Emiratis carried out by a market research agency.The COREQ criteria have been used where appropriate to guide the reporting of our findings.

Setting

Participants were recruited from shopping malls and other public places in the cities of Al Ain and Abu Dhabi.

Participants

Two hundred adult Emiratis broadly representative of the Emirati population in terms of age and gender.

Results

Eighty one per cent of participants said that their perception of health states was influenced by their spiritual or religious beliefs. The two overarching themes that seemed to explain or classify these influences were ‘fatalism’ and ‘preservation of life’. Subthemes included powerlessness to change what is preordained by God, fear of disability (particularly diminished mobility) and appreciation of health and life and the requirement to look after one’s health. A final theme was that of acceptance, with respondents expressing a willingness to endure suffering and disability with patience in the expectation of rewards in the hereafter.

Conclusions

Our results emphasise the need for further work to establish locally relevant value sets for Muslim majority countries in the Middle East and elsewhere for use in health technology assessment decision-making, rather than relying on value sets from other regions.
Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China
Authors: Wei Li , Champman Sarah , Li Xiaomei , Li Xin , Li Sumei , Chen Ruoling , Bo Nie , Chater Angel , Horne Robert
Published: October 2017

Objectives

To investigate beliefs about medicines and their association with medicine adherence in patients with chronic diseases in China.

Design

A cross-sectional questionnaire-based study

Setting

Two large urban hospitals in Hefei and Tianjin, China

Participants

Hospital inpatients (313 stroke patients) and outpatients (315 diabetic patients and 339 rheumatoid arthritis (RA) patients) were recruited between January 2014 and September 2014.

Outcome measures

The Beliefs about Medicines Questionnaire (BMQ), assessing patients’ beliefs about the specific medicine (Specific-Necessity and Specific-Concerns) prescribed for their conditions (stroke/diabetes/RA) and more general background beliefs about pharmaceuticals as a class of treatment (BMQ-General Benefit, Harm and Overuse); the Perceived Sensitivity to Medicines scale (PSM) assessed patients’ beliefs about how sensitive they were to the effects of medicines and the Medication Adherence Report Scale. The association between non-adherence and beliefs about medicines was assessed using a logistic regression model.

Results

Patients with diabetes mellitus had a stronger perceived need for treatment (mean (SD) Specific-Necessity score, 3.75 (0.40)) than patients with stroke (3.69 (0.53)) and RA (3.66 (0.44)) (p=0.049). Moderate correlations were observed between Specific-Concerns and General-Overuse, General-Harm and PSM (Pearson correlation coefficients, 0.39, 0.49 and 0.49, respectively, p<0.01). Three hundred and eleven patients were non-adherent to their medicine (159 (51.0%) in the stroke group, 60 (26.7%) in the diabetes mellitus group and 62 (19.8%) in the RA group, p<0.01). Across the whole sample, after adjusting for demographic characteristics, non-adherence was associated with patients who had higher concerns about their medicines (OR, 1.35, 95% CI 1.07 to 1.71) and patients who believed that they were personally sensitive to the effects of medications (OR 1.44, 95% CI 1.16 to 1.85).

Conclusion

The BMQ is a useful tool to identify patients at risk of non-adherence. In the future, adherence intervention studies may use the BMQ to screen for patients who are at risk of non-adherence and to map interventional support.
Physical and mental health factors associated with work engagement among Finnish female municipal employees: a cross-sectional study
Authors: Veromaa Veera , Kautiainen Hannu , Korhonen Päivi Elina
Published: October 2017

Objectives

Work engagement is related to mental health, but studies of physical health’s association with work engagement are scarce. This study aims to evaluate the relationship between physical health, psychosocial risk factors and work engagement among Finnish women in municipal work units.

Methods

A cross-sectional study was conducted in 2014 among 726 female employees from 10 municipal work units of the city of Pori, Finland. Work engagement was assessed with the nine-item Utrecht Work Engagement Scale. The American Heart Association’s concept of ideal cardiovascular health (CVH) was used to define physical health (non-smoking, body mass index <25.0 kg/m2, physical activity at goal, healthy diet, total cholesterol <5.18mmol/L, blood pressure <120/80 mm Hg, normal glucose tolerance). Psychosocial risk factors (social isolation, stress, depressive symptoms, anxiety, hostility and type D personality) were included as core questions suggested by 2012 European Guidelines on cardiovascular disease prevention.

Results

Of the study subjects, 25.2% had favourable 5–7 CVH metrics. The sum of CVH metrics, healthy diet and physical activity at goal were positively associated with work engagement. In subjects without psychosocial risk factors (36.7%), work engagement was high and stable. Presence of even one psychosocial risk factor was associated with a lower level of work engagement regardless of the sum of ideal CVH metrics.

Conclusions

Both physical and mental health factors have a positive relationship with work engagement, whereas the presence of even one psychosocial risk factor has a negative association regardless of the level of classic cardiovascular risk factors.
Communicating risk in active surveillance of localised prostate cancer: a protocol for a qualitative study
Authors: Rapport Frances , Hogden Anne , Gurney Howard , Gillatt David , Bierbaum Mia , Shih Patti , Churruca Kate
Published: October 2017

Introduction

One in five men is likely to receive a diagnosis of prostate cancer (PCa) by the age of 85 years. Men diagnosed with low-risk PCa may be eligible for active surveillance (AS) to monitor their cancer to ensure that any changes are discovered and responded to in a timely way. Communication of risk in this context is more complicated than determining a numerical probability of risk, as patients wish to understand the implications of risk on their lives in concrete terms. Our study will examine how risk for PCa is perceived, experienced and communicated by patients using AS with their health professionals, and the implications for treatment and care.

Methods and analysis

This is a proof of concept study, testing out a multimethod, qualitative approach to data collection in the context of PCa for the first time in Australia. It is being conducted from November 2016 to December 2017 in an Australian university hospital urology clinic. Participants are 10 men with a diagnosis of localised PCa, who are using an AS protocol, and 5 health professionals who work with this patient group (eg, urologists and Pca nurses). Data will be collected using observations of patient consultations with health professionals, patient questionnaires and interviews, and interviews with healthcare professionals. Analysis will be conducted in two stages. First, observational data from consultations will be analysed thematically to encapsulate various dimensions of risk classification and consultation dialogue. Second, interview data will be coded to derive meaning in text and analysed thematically. Overarching themes will represent patient and health professional perspectives of risk communication.

Ethics and dissemination

Ethical approval for the study has been granted by Macquarie University Human Research Ethics Committee, approval 5201600638. Knowledge translation will be achieved through publications, reports and conference presentations to patients, families, clinicians and researchers.
Stepwise strategy to improve Cervical Cancer Screening Adherence (SCAN-CC): automated text messages, phone calls and face-to-face interviews: protocol of a population-based randomised controlled trial
Authors: Firmino-Machado João , Mendes Romeu , Moreira Amélia , Lunet Nuno
Published: October 2017

Introduction

Screening is highly effective for cervical cancer prevention and control. Population-based screening programmes are widely implemented in high-income countries, although adherence is often low. In Portugal, just over half of the women adhere to cervical cancer screening, contributing for greater mortality rates than in other European countries. The most effective adherence raising strategies are based on patient reminders, small/mass media and face-to-face educational programmes, but sequential interventions targeting the general population have seldom been evaluated. The aim of this study is to assess the effectiveness of a stepwise approach, with increasing complexity and cost, to improve adherence to organised cervical cancer screening: step 1a—customised text message invitation; step 1b—customised automated phone call invitation; step 2—secretary phone call; step 3—family health professional phone call and face-to-face appointment.

Methods

A population-based randomised controlled trial will be implemented in Portuguese urban and rural areas. Women eligible for cervical cancer screening will be randomised (1:1) to intervention and control. In the intervention group, women will be invited for screening through text messages, automated phone calls, manual phone calls and health professional appointments, to be applied sequentially to participants remaining non-adherent after each step. Control will be the standard of care (written letter). The primary outcome is the proportion of women adherent to screening after step 1 or sequences of steps from 1 to 3. The secondary outcomes are: proportion of women screened after each step (1a, 2 and 3); proportion of text messages/phone calls delivered; proportion of women previously screened in a private health institution who change to organised screening. The intervention and control groups will be compared based on intention-to-treat and per-protocol analyses.

Ethics and dissemination

The study was approved by the Ethics Committee of the Northern Health Region Administration and National Data Protection Committee. Results will be disseminated through communications in scientific meetings and peer-reviewed journals.

Trial number

NCT03122275
Outcomes of disease prevention and management interventions in food pantries and food banks: protocol for a scoping review
Authors: Long Christopher R , Rowland Brett , Steelman Susan C , McElfish Pearl A
Published: October 2017

Introduction

Food insecurity is a difficulty faced in many households. During periods of food insecurity, households often seek food supplied by food pantries and food banks. Food insecurity has been associated with increased risk for several health conditions. For this reason, food pantries and food banks may have great promise as intervention sites, and health researchers have begun targeting food pantries and food banks as sites for disease prevention or management interventions. The aim of the scoping review is to examine disease prevention or management interventions implemented in food pantries and food banks.

Methods and analysis

Relevant electronic databases (eg, MEDLINE, Cumulative Index to Nursing and Allied Health Literature-CINAHL Complete, Science Citation Index, Cochrane Database of Systematic Reviews) will be searched for articles with a publication date of 1997 or later using Medical Subject Headings and key terms, including food aid, food banks, food pantries, food shelves, hunger, food insecurity and related concepts. For each de-duplicated study record identified by the search strategy, two reviewers will independently assess whether the study meets eligibility criteria (eg, related to intervention type, context). The reviewers will examine studies’ titles, abstracts and full text, comparing eligibility decisions to address any discrepancies. For each eligible study, data extraction will be executed by two reviewers independently, comparing extracted data to address any discrepancies. Extracted data will be synthesised and reported in a narrative review assessing the coverage and gaps in existing literature related to disease prevention and management interventions implemented in food pantries.

Ethics and dissemination

The review’s results will be useful to healthcare practitioners who work with food-insecure populations, healthcare researchers and food pantry or food bank personnel. The results of this scoping review will be submitted for publication to a peer-reviewed journal, and the authors will share the findings with food pantry and food bank stakeholder groups with whom they work.
Study protocol of the internet user Cohort for Unbiased Recognition of gaming disorder in Early adolescence (iCURE), Korea, 2015–2019
Authors: Jeong Hyunsuk , Yim Hyeon Woo , Jo Sun-Jin , Lee Seung-Yup , Kim Eunjin , Son Hye Jung , Han Hyun-ho , Lee Hae Kook , Kweon Yong-Sil , Bhang Soo-young , Choi Jung-Seok , Kim Bung-Nyun , Gentile Douglas A , Potenza Marc N
Published: October 2017

Introduction

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) proposed nine internet gaming disorder (IGD) diagnostic criteria as a condition warranting further empirical and clinical research. The aim of this study is to clarify the natural and clinical courses of IGD proposed DSM-5 in adolescents and to evaluate its risk and protective factors.

Methods and analysis

The Internet user Cohort for Unbiased Recognition of gaming disorder in Early Adolescence (iCURE) study is an ongoing multidisciplinary, prospective, longitudinal cohort study conducted in 21 schools in Korea. Participant recruitment commenced in March 2015 with the goal of registering 3000 adolescents. The baseline assessment included surveys on emotional, social and environmental characteristics. A parent or guardian completed questionnaires and a structured psychiatric comorbidity diagnostic interview regarding their children. Adolescents with the Internet Game Use-Elicited Symptom Screen total scores of 6 or higher were asked to participate in the clinical diagnostic interview. Two subcohorts of adolescents were constructed: a representative subcohort and a clinical evaluation subcohort. The representative subcohort comprises a randomly selected 10% of the iCURE to investigate the clinical course of IGD based on clinical diagnosis and to estimate the false negative rate. The clinical evaluation subcohort comprised participants meeting three or more of the nine IGD criteria, determined by clinical diagnostic interview, to show the clinical course of IGD. Follow-up data will be collected annually for the 3 years following the baseline assessments. The primary endpoint is 2-year incidence, remission and recurrence rates of IGD. Cross-sectional and longitudinal associations between exposures and outcomes as well as mediation factors will be evaluated.

Ethics and dissemination

This study is approved by the Institutional Review Board of the Catholic University of Korea. Results will be published in peer-reviewed journals.

Trial registration number

ClinicalTrials.gov (identifier:NCT02415322).
Discovery of methylated circulating DNA biomarkers for comprehensive non-invasive monitoring of treatment response in metastatic colorectal cancer
Authors: Barault Ludovic , Amatu Alessio , Siravegna Giulia , Ponzetti Agostino , Moran Sebastian , Cassingena Andrea , Mussolin Benedetta , Falcomatà Chiara , Binder Alexandra M , Cristiano Carmen , Oddo Daniele , Guarrera Simonetta , Cancelliere Carlotta , Bustreo Sara , Bencardino Katia , Maden Sean , Vanzati Alice , Zavattari Patrizia , Matullo Giuseppe , Truini Mauro , Grady William M , Racca Patrizia , Michels Karin B , Siena Salvatore , Esteller Manel , Bardelli Alberto , Sartore-Bianchi Andrea , Di Nicolantonio Federica
Published: October 2017

Objective

Mutations in cell-free circulating DNA (cfDNA) have been studied for tracking disease relapse in colorectal cancer (CRC). This approach requires personalised assay design due to the lack of universally mutated genes. In contrast, early methylation alterations are restricted to defined genomic loci allowing comprehensive assay design for population studies. Our objective was to identify cancer-specific methylated biomarkers which could be measured longitudinally in cfDNA (liquid biopsy) to monitor therapeutic outcome in patients with metastatic CRC (mCRC).

Design

Genome-wide methylation microarrays of CRC cell lines (n=149) identified five cancer-specific methylated loci (EYA4, GRIA4, ITGA4, MAP3K14-AS1, MSC). Digital PCR assays were employed to measure methylation of these genes in tumour tissue DNA (n=82) and cfDNA from patients with mCRC (n=182). Plasma longitudinal assessment was performed in a patient subset treated with chemotherapy or targeted therapy.

Results

Methylation in at least one marker was detected in all tumour tissue samples and in 156 mCRC patient cfDNA samples (85.7%). Plasma marker prevalence was 71.4% for EYA4, 68.5% for GRIA4, 69.7% for ITGA4, 69.1% for MAP3K14-AS1% and 65.1% for MSC. Dynamics of methylation markers was not affected by treatment type and correlated with objective tumour response and progression-free survival.

Conclusion

This five-gene methylation panel can be used to circumvent the absence of patient-specific mutations for monitoring tumour burden dynamics in liquid biopsy under different therapeutic regimens. This method might be proposed for assessing pharmacodynamics in clinical trials or when conventional imaging has limitations.
Initial surgery versus conservative management of symptomatic severe mitral regurgitation in the elderly
Authors: Kang Duk-Hyun , Heo Ran , Lee Sahmin , Baek Seunghee , Kim Dae-Hee , Song Jong-Min , Song Jae-Kwan , Lee Jae Won
Published: October 2017

Objective

In elderly patients, the benefit of surgical correction of severe mitral regurgitation (MR) may not be greater than the operative risk. This study sought to compare the long-term clinical outcomes between initial surgery and conservative management in elderly patients (≥70 years of age) with severe MR.

Methods

We prospectively evaluated 157 consecutive patients (75 men, 74±4 years of age) with severe degenerative MR and mild symptoms. Mitral valve surgery was performed on 79 (initial surgery group), whereas the conservative strategy was chosen for 78 patients (conservative management group). We compared the overall and cardiac mortality and cardiac event between strategies in the overall and propensity-matched cohort (46 pairs).

Results

During the median follow-up of 5.4 years, overall death occurred less in the initial surgery group (16 vs 37 patients). This group showed reduced cardiac mortality (HR 0.31; 95% CI 0.13 to 0.73; p=0.007), overall mortality (HR 0.39; 95% CI 0.21 to 0.74; p=0.004) and cardiac event (HR 0.26; 95% CI 0.13 to 0.53; p<0.001). A significant reduction in cardiac mortality (HR 0.18; 95% CI 0.05 to 0.63; p=0.007), overall mortality (HR 0.36; 95% CI 0.15 to 0.86; p=0.022) and cardiac event (HR 0.20; 95% CI 0.07 to 0.52; p=0.001) in the initial surgery group was also observed in the propensity-matched cohort.

Conclusions

In elderly patients with severe degenerative MR and mild symptoms, initial surgical strategy was associated with significant long-term reductions in cardiac and overall mortality compared with conservative management.
Outcomes of de novo and acute decompensated heart failure patients according to ejection fraction
Authors: Choi Ki Hong , Lee Ga Yeon , Choi Jin-Oh , Jeon Eun-Seok , Lee Hae-Young , Cho Hyun-Jai , Lee Sang Eun , Kim Min-Seok , Kim Jae-Joong , Hwang Kyung-Kuk , Chae Shung Chull , Baek Sang Hong , Kang Seok-Min , Choi Dong-Ju , Yoo Byung-Su , Kim Kye Hun , Park Hyun-Young , Cho Myeong-Chan , Oh Byung-Hee
Published: October 2017

Objective

There are conflicting results among previous studies regarding the prognosis of heart failure with preserved ejection fraction (HFpEF) compared with heart failure with reduced ejection fraction (HFrEF). This study aimed to compare the outcomes of patients with de novo acute heart failure (AHF) or acute decompensated HF (ADHF) according to HFpEF (EF≥50%), or HFrEF (EF<40%) and to define the prognosis of patients with HF with mid-range EF (HFmrEF, 40≤EF<50%).

Methods

Between March 2011 and February 2014, 5625 consecutive patients with AHF were recruited from 10 university hospitals. A total of 5414 (96.2%) patients with EF data were enrolled, which consisted of 2867 (53.0%) patients with de novo and 2547 (47.0%) with ADHF. Each of the enrolled group was stratified by EF.

Results

In de novo, all-cause death rates were not significantly different between HFpEF and HFrEF (HFpEF vs HFrEF, 206/744 (27.7%) vs 438/1631 (26.9%), HRadj 1.15, 95% CI 0.96 to 1.38, p=0.14). However, among patients with ADHF, HFrEF had a significantly higher mortality rate compared with HFpEF (HFpEF vs HFrEF, 245/613 (40.0%) vs 694/1551 (44.7%), HRadj 1.25, 95% CI 1.06 to 1.47, p=0.007). Also, in ADHF, HFmrEF was associated with a significantly lower mortality rate within 1 year compared with HFrEF (HFmrEF vs HFrEF, 88/383 (23.0%) vs 430/1551 (27.7%), HRadj 1.31, 95% CI 1.03 to 1.65, p=0.03), but a significantly higher mortality rate after 1 year compared with HFpEF (HFmrEF vs HFpEF, 83/295 (28.1%) vs 101/469 (21.5%), HRadj 0.70, 95% CI 0.52 to 0.96, p=0.02).

Conclusions

HFpEF may indicate a better prognosis compared with HFrEF in ADHF, but not in de novo AHF. For patients with ADHF, the prognosis associated with HFmrEF was similar to that of HFpEF within the first year following hospitalisation and similar to HFrEF 1  year after hospitalisation.
Differences in relative and absolute effectiveness of oral P2Y12 inhibition in men and women: a meta-analysis and modelling study
Authors: Lee Kuan Ken , Welton Nicky , Shah Anoop S , Adamson Philip D , Dias Sofia , Anand Atul , Newby David E , Mills Nicholas L , McAllister David A
Published: October 2017

Objective

To estimate the absolute treatment effects of newer P2Y12 inhibitors (ticagrelor and prasugrel) compared with clopidogrel in men and women with acute coronary syndrome (ACS).

Methods

We searched Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials of oral P2Y12 inhibitors for acute stroke or ACS. Age-specific and sex-specific mortality was obtained for all patients admitted to hospital with myocardial infarction in Scotland from 2006 to 2010 (prior to introduction of prasugrel or ticagrelor).

Results

From 9277 articles, nine fulfilled our inclusion criteria. Three trials compared newer P2Y12 inhibitors to clopidogrel in ACS, in which the treatment rate ratio (RR) for major adverse cardiovascular events in men was 0.80 (95% CI 0.69 to 0.93). For the same outcome, across all nine trials, the sex–treatment interaction RR was 1.08 (95% CI 0.98 to 1.19). Combining these estimates yielded a treatment RR in women of 0.86 (95% CI 0.72 to 1.04).

17 842 women and 27 818 men were admitted to hospital with myocardial infarction. Mortality was higher for women than men for all-cause (5708, 32.0% vs 5891, 21.2%), cardiovascular (4032, 22.6% vs 4117, 14.8%) and bleeding (193, 1.1% vs 228, 0.8%) deaths.

On applying the sex-specific RRs to this population, the absolute risk reduction for mortality at 1 year was similar for women and men for all-cause (2.30% (95% CI −0.92% to 5.22%) vs 2.47% (95% CI 0.62% to 4.10%)), cardiovascular (2.70% (95% CI −0.63% to 5.74%)) vs 2.72% (95% CI 0.92% to 4.35%)) and bleeding (−0.27% (95% CI −1.06% to 0.30%) vs −0.18% (95% CI −0.71% to 0.24%)) deaths.

Conclusion

Newer P2Y12 inhibitors may be slightly less efficacious in women than men, but the absolute risk reduction is similar in both sexes.
Contemporary outcomes in reoperative mitral valve surgery
Authors: Mehaffey Hunter J , Hawkins Robert B , Schubert Sarah , Fonner Clifford , Yarboro Leora T , Quader Mohammed , Speir Alan , Rich Jeff , Kron Irving L , Ailawadi Gorav
Published: October 2017

Objective

Data suggest that redo mitral valve surgery is being performed in increasing numbers, possibly with superior results according to single-centre studies. The purpose of this study is to describe outcomes of redo mitral valve surgery and identify risk-adjusted predictors of poor outcomes.

Methods

All (11 973) open mitral valve cases were evaluated (2002–2016) from a regional Society of Thoracic Surgery (STS) database. Patients were stratified by primary versus redo mitral valve surgery. Mixed effects logistic regression models including hospital as a random effect were used to identify risk factors for patients undergoing redo mitral valve surgery.

Results

Of all mitral valve cases, 1096 (9.7%) had a previous mitral operation. Redo patients had higher rates of valve replacement and preoperative comorbidities resulting in more complications, operative mortalities (11.1%vs6.5%, p<0.0001) and higher resource utilisation. Several factors independently increased risk for composite STS major morbidity and 30-day mortality, including cardiogenic shock (OR 10.3, p=0.0001), severe tricuspid insufficiency (OR 2.3, p=0.001), urgent/emergent status (OR 1.8, p=0.001) and concurrent coronary artery bypass grafting (OR 2.4, p=0.002). The volume of redo mitral valve surgery increased 10% per year and the observed-to-expected ratios (O/E) for operative mortality in redo mitral surgery improved from 1.44 early in the study period to 0.72 in the most recent era.

Conclusions

Redo mitral valve surgery accounts for approximately 10% of mitral valve operations and is associated with increased risk and resource utilisation. However, as the volume of redo mitral surgery increases, outcomes have dramatically improved and are now better than predicted.
Mycobacteria in cats: an update
Authors: O'Halloran Conor , Gunn‐Moore Danielle
Published: October 2017

Mycobacterial infections are recognised with increasing frequency in cats in the UK. Over 1 per cent of all routine histopathological submissions from UK cats are found to have changes consistent with mycobacteriosis, which is thought to be an underestimate of the true prevalence. Mycobacteriosis can be highly variable in clinical presentation, challenging to definitively diagnose, and difficult to manage to obtain satisfactory clinical outcomes. Additionally, there is potential for zoonotic transmission of infection. Recent research efforts have improved our understanding of the aetiology, pathophysiology and therefore treatment options for these diseases. This article outlines an updated approach to diagnosing and managing clinical cases of feline mycobacteriosis in the UK.
Managing orthopaedic pain in horses
Authors: Bardell David
Published: October 2017

Pain in horses can be difficult to recognise, this combined with the limited available drugs means providing effective analgesia to horses can be challenging. This article discusses the drugs available for use in horses, their routes of administration and how to design an effective analgesia plan when treating different types of pain.
Ethical issues in the slaughterhouse
Authors: Cranley John
Published: October 2017

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.

In addition, a possible way forward is suggested; however, there is rarely a cut‐and‐ dried answer in such cases, and readers may wish to suggest an alternative. This month's dilemma, ‘Ethical issues in the slaughterhouse’, was submitted and is discussed by John Cranley. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.

The series is being coordinated by Steven McCulloch, a practising vet with a PhD in the ethics of veterinary policy. It aims to provide a framework that will help practitioners find solutions when facing similar dilemmas.
Determinants of social inequalities in stroke incidence across Europe: a collaborative analysis of 126 635 individuals from 48 cohort studies
Authors: Ferrario Marco M , Veronesi Giovanni , Kee Frank , Chambless Lloyd E , Kuulasmaa Kari , Jørgensen Torben , Amouyel Philippe , Arveiler Dominique , Bobak Martin , Cesana Giancarlo , Drygas Wojciech , Ferrieres Jean , Giampaoli Simona , Iacoviello Licia , Nikitin Yuri , Pajak Andrzej , Peters Annette , Salomaa Veikko , Soderberg Stefan , Tamosiunas Abdonas , Wilsgaard Tom , Tunstall-Pedoe Hugh
Published: October 2017

Background

Knowledge on the origins of the social gradient in stroke incidence in different populations is limited. This study aims to estimate the burden of educational class inequalities in stroke incidence and to assess the contribution of risk factors in determining these inequalities across Europe.

Materials and methods

The MORGAM (MOnica Risk, Genetics, Archiving and Monograph) Study comprises 48 cohorts recruited mostly in the 1980s and 1990s in four European regions using standardised procedures for baseline risk factor assessment and fatal and non-fatal stroke ascertainment and adjudication during follow-up. Among the 126 635 middle-aged participants, initially free of cardiovascular diseases, generating 3788 first stroke events during a median follow-up of 10 years, we estimated differences in stroke rates and HRs for the least versus the most educated individuals.

Results

Compared with their most educated counterparts, the overall age-adjusted excess hazard for stroke was 1.54 (95% CI 1.25 to 1.91) and 1.41 (95% CI 1.16 to 1.71) in least educated men and women, respectively, with little heterogeneity across populations. Educational class inequalities accounted for 86–413 and 78–156 additional stroke events per 100 000 person-years in the least compared with most educated men and women, respectively. The additional events were equivalent to 47%–130% and 40%–89% of the average incidence rates. Inequalities in risk factors accounted for 45%–70% of the social gap in incidence in the Nordic countries, the UK and Lithuania-Kaunas (men), but for no more than 17% in Central and South Europe. The major contributors were cigarette smoking, alcohol intake and body mass index.

Conclusions

Social inequalities in stroke incidence contribute substantially to the disease rates in Europe. Healthier lifestyles in the most disadvantaged individuals should have a prominent impact in reducing both inequalities and the stroke burden.
Effects of health-oriented descriptors on combustible cigarette and electronic cigarette packaging: an experiment among adult smokers in the United States
Authors: Sanders-Jackson Ashley , Tan Andy S L , Yie Kyeungyeun
Published: October 2017

Objective

Certain tobacco companies use health-oriented descriptors (eg, 100% organic) on product packaging and advertising of combustible cigarettes or electronic cigarettes (e-cigarettes) that create a ‘health halo’ around smoking and vaping. Previous observational research suggests that such language may be associated with more favourable attitudes and reduced risk perceptions toward these brands compared with others. This study aimed to determine the effects of health-oriented descriptors on smokers’ attitude toward the brand, perception of packaging information, comparative harm versus other brands and intention to purchase either combustible cigarettes or e-cigarettes.

Method

US adult smokers were randomly assigned to view either a health-oriented language package (‘100% organic,’ ‘all natural’ or ‘no additives’), traditional marketing language package (‘fine quality,’ ‘premium blend’ or ‘100% original’) or a no-language package of a combustible cigarette brand (Study 1, n=405) or an e-cigarette brand (Study 2, n=396) in an experimental design.

Results

Study 1: Participants in the health-oriented condition reported more favourable perceptions toward the package information, lower comparative harm and higher intention to purchase combustible cigarettes versus the no language control. In addition, participants in the health-oriented condition reported more positive attitude toward the brand and lower comparative harm versus the traditional marketing condition. Study 2: Compared with the traditional marketing condition, participants in the health-oriented condition reported greater intention to purchase Absolute e-cigarettes. There were no significant differences in attitude toward the brand, perception of packaging information and comparative harm versus other brands across conditions.

Conclusions

The effect of health-oriented language was significant for combustible cigarettesand e-cigarette packages. Policies to restrict health-oriented language on cigarette and e-cigarette packaging are recommended.
Comparison of medical and surgical treatment for acute cervical compressive hydrated nucleus pulposus extrusion in dogs
Authors: Borlace Tana , Gutierrez‐Quintana Rodrigo , Taylor‐Brown Frances Ellen , De Decker Steven
Published: October 2017

Although successful outcomes have been reported after medical and surgical treatment for dogs with cervical hydrated nucleus pulposus extrusion (HNPE), it is unknown which treatment option is preferred. Thirty‐four dogs treated medically (n=18) or surgically (n=16) for cervical HNPE were retrospectively identified. Signalment, clinical presentation and imaging findings were compared between medically and surgically treated dogs. Medical management consisted of restricted exercise in combination with physiotherapy. Surgical treatment consisted of a ventral slot procedure. Short‐term follow‐up information was retrieved from re‐examination visits. Long‐term outcome was obtained via telephone interviews. More dogs in the surgical group demonstrated cervical hyperaesthesia on initial clinical presentation (P=0.045), otherwise there was no significant difference in signalment, clinical presentation or imaging findings between both groups. Two dogs in the medically managed group underwent surgical decompression due to an unsatisfactory response to medical management. All cases for which long‐term information was available (n=30) were neurologically normal at the time of data collection. There were no significant differences for any of the short‐term or long‐term outcome variables between both treatment groups. This study demonstrated successful outcomes after medical or surgical treatment and suggests that both treatment modalities can be considered for dogs with cervical HNPE.
Thomas Wilson Groves
Authors: Jones Bruce Vivash
Published: October 2017

Tom was a kind, gentle and knowledgeable man who lived a long and interesting life.
Team Vet: working together
Authors: Fishwick John
Published: October 2017

John Fishwick, BVA's new President, introduces the theme he has chosen for his presidential year.
Mental health and the veterinary profession
Authors: Patterson Ellie
Published: October 2017

Ellie Patterson, Vetlife marketing officer, summarises the services offered by Vetlife – an independent, confidential and free charity for everyone in the veterinary community.
Making rural Young Vet Network events a success
Authors: Richardson Becky
Published: October 2017

Becky Richardson, Young Vet Network representative on BVA Council, discusses the anxieties and joys of hosting a rural YVN event.
Approximate analytical solutions to nonlinear peristaltic flow with temperature-dependent viscosity parameters: Application of multi-step differential transform method (MsDTM)
Authors: Elogail M.A. , Elshekhipy A.A.
Published: October 2017

This paper investigates the influence of temperature-dependent viscosity on peristaltic flow of a Newtonian fluid past a vertical asymmetric channel through a porous medium in the presence of heat and mass transfer. A mathematical model is analyzed under assumptions of long wavelength and small Reynolds number. The resulting system of coupled nonlinear differential equations with corresponding boundary conditions is computed in two different cases. In the first case (labeled as system I), all non-dimensional parameters, which are functions of viscosity, have been considered as constants within the flow (as treated in previous peristaltic flow problems). In the second case (labeled as system II), these mentioned parameters are then assumed to vary with temperature. Solutions in each case have been obtained using an easy and highly accurate series-based method called the multi-step differential transform method (MsDTM). The effects of the pertinent physical parameters on the longitudinal velocity, temperature, concentration, longitudinal pressure gradient, and pressure rise per wavelength are analyzed graphically and through tables for both systems I and II. The results reveal that the longitudinal pressure gradient and the pressure rise per wavelength in the case of system II are of lower magnitude than the equivalent values of system I. Another interesting observation is that the temperature field in the case of system II, increases with a decrease in the fluid viscosity, which is in accordance with physical observations, whereas the opposite behavior appears in the case of system I. A detailed comparison between system I and system II demonstrates that in modelling fluid problems with variable viscosity, treating the viscosity-dependent parameters as constants leads to unrealistic results. Such a model is applicable for the transportation of physiological flows (blood flow models) in the arteries with heat and mass transfer.
Sheath and presheath in a collisionless plasma containing negative ions with an open magnetic field
Authors: Phukan Ananya , Goswami K.S.
Published: October 2017

The effects of an axisymmetric magnetic mirror field with diverging field lines on the plasma presheath and sheath are numerically investigated by solving the plasma–sheath equation for a collisionless plasma in the presence of negative ions. The positive and negative ions with a finite temperature are generated throughout the volume where the sources vary according to the ionization rate. Electrons are assumed to obey the Boltzmann relation. The sheath formation and Debye shielding, which depends considerably on the magnetic strength profile, decrease remarkably on applying an expanding magnetic field. The dependence of the particle densities and the electrostatic potential on the magnetic field profiles are explicitly investigated in this study. Negative ions with sufficient energy penetrate into the sheath following the field lines and eventually reflect back at a point where the mirror force and the electrostatic force balance each other.