bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of Group B Streptococcal Disease in the United States: Shifting Paradigms
Authors: Schuchat Anne
Published: October 2018

Since its emergence 25 years ago, group B streptococcus has become recognized as a cause of serious illness in newborns, pregnant women, and adults with chronic medical conditions. Heavy colonization of the genital tract with group B streptococcus also increases the risk that a woman will deliver a preterm low-birthweight infant. Early-onset infections (occurring at <7 days of age) are associated with much lower fatality than when they were first described, and their incidence is finally decreasing as the use of preventive antibiotics during childbirth increases among women at risk. New serotypes of group B streptococcus have emerged as important pathogens in adults and newborns. Clinical and laboratory practices—in obstetrics, pediatrics, and clinical microbiology—have an impact on disease and/or its prevention, and protocols established at the institutional level appear to be critical tools for the reduction of perinatal disease due to group B streptococcus. Since intrapartum antibiotics will prevent at best only a portion of the full burden of group B streptococcal disease, critical developments in vaccine evaluation, including study of polysaccharide-protein conjugate vaccines, offer the potential for enhanced prevention in the relatively near future.
Prostatitis
Authors: Domingue Gerald J. , Hellstrom Wayne J. G.
Published: October 2018

The laboratory diagnosis of acute bacterial prostatitis is straightforward and easily accomplished in clinical laboratories. Chronic bacterial prostatitis, and especially chronic idiopathic prostatitis (most often referred to as abacterial prostatitis), presents a real challenge to the clinician and clinical microbiologist. Clinically, the diagnosis of chronic idiopathic prostatitis is differentiated from that of acute prostatitis by a lack of prostatic inflammation and no “significant” (controversial) leukocytes or bacteria in the expressed prostatic secretions. Despite these diagnostic criteria, the etiology of chronic idiopathic prostatitis is unknown. While this review covers the entire spectrum of microbially caused acute prostatitis (including common and uncommon bacteria, viruses, fungi, and parasites) and microbially associated chronic prostatitis, a special focus has been given to chronic idiopathic prostatitis. The idiopathic syndrome is commonly diagnosed in men but is poorly treated. Recent data convincingly suggests a possible bacterial etiology for the condition. Provocative molecular studies have been published reporting the presence of 16S rRNA bacterial sequences in prostate biopsy tissue that is negative for ordinary bacteria by routine culture in men with chronic idiopathic prostatitis. Additionally, special culture methods have indicated that difficult-to-culture coryneforms and coagulase-negative staphylococci are present in expressed prostatic secretions found to be negative by routine culture techniques. Treatment failures are not uncommon in chronic prostatitis. Literature reports suggest that antimicrobial treatment failures in chronic idiopathic prostatitis caused by organisms producing extracellular slime might result from the virulent properties of coagulase-negative staphylococci or other bacteria. While it is difficult to definitively extrapolate from animal models, antibiotic pharmokinetic studies with a murine model have suggested that treatment failures in chronic prostatitis are probably a result of the local microenvironment surrounding the persistent focal and well-protected small bacterial biofilms buried within the prostate gland. These conclusions support the molecular and culture data implicating bacteria as a cause of chronic idiopathic prostatitis.
Management of Infections Due to Antibiotic-Resistant
Streptococcus pneumoniae
Authors: Kaplan Sheldon L. , Mason Edward O.
Published: October 2018

Antibiotic-resistant strains of Streptococcus pneumoniae are becoming more prevalent throughout the world; this has resulted in modifications of treatment approaches. Management of bacterial meningitis has the greatest consensus. Strategies for treating other systemic infections such as pneumonia, bacteremia, and musculoskeletal infections are evolving, in part related to the availability of new antibiotics which are active in vitro against isolates resistant to penicillin and the extended-spectrum cephalosporins. However, there are currently very limited data related to the clinical efficacy of these new agents. The studies upon which current recommendations are based are reviewed. Otitis media represents the single most common infection due to S. pneumoniae. Recommendations for treatment of acute otitis media due to drug-resistant strains and the rationale for these recommendations are discussed.
Current and Emerging Azole Antifungal Agents
Authors: Sheehan Daniel J. , Hitchcock Christopher A. , Sibley Carol M.
Published: October 2018

Major developments in research into the azole class of antifungal agents during the 1990s have provided expanded options for the treatment of many opportunistic and endemic fungal infections. Fluconazole and itraconazole have proved to be safer than both amphotericin B and ketoconazole. Despite these advances, serious fungal infections remain difficult to treat, and resistance to the available drugs is emerging. This review describes present and future uses of the currently available azole antifungal agents in the treatment of systemic and superficial fungal infections and provides a brief overview of the current status of in vitro susceptibility testing and the growing problem of clinical resistance to the azoles. Use of the currently available azoles in combination with other antifungal agents with different mechanisms of action is likely to provide enhanced efficacy. Detailed information on some of the second-generation triazoles being developed to provide extended coverage of opportunistic, endemic, and emerging fungal pathogens, as well as those in which resistance to older agents is becoming problematic, is provided.
Candida glabrata
: Review of Epidemiology, Pathogenesis, and Clinical Disease with Comparison to
C. albicans
Authors: Fidel Paul L. , Vazquez Jose A. , Sobel Jack D.
Published: October 2018

Until recently, Candida glabrata was considered a relatively nonpathogenic commensal fungal organism of human mucosal tissues. However, with the increased use of immunosuppressive agents, mucosal and systemic infections caused by C. glabrata have increased significantly, especially in the human immunodeficiency virus-infected population. A major obstacle in C. glabrata infections is their innate resistance to azole antimycotic therapy, which is very effective in treating infections caused by other Candida species. Candida glabrata, formerly known as Torulopsis glabrata, contrasts with other Candida species in its nondimorphic blastoconidial morphology and haploid genome. C. glabrata currently ranks second or third as the causative agent of superficial (oral, esophageal, vaginal, or urinary) or systemic candidal infections, which are often nosocomial. Currently, however, there are few recognized virulence factors of C. glabrata and little is known about the host defense mechanisms that protect against infection. Two established animal models (systemic and vaginal) have been established to study treatment, pathogenesis, and immunity. Treatment of C. glabrata infections can include azoles but often requires amphotericin B or flucytosine. This review summarizes all known clinical and experimental information about C. glabrata infections with comparisons to C. albicans as a means of contrasting the two species commonly observed and emphasizing the many recognized differences.
Clinical Microbiology Reviews
: Genesis of a Journal
Authors: Morello Josephine A.
Published: October 2018

In 1986 planning for a new ASM review journal, Clinical Microbiology Reviews (CMR), began. CMR would publish articles primarily of interest to persons concerned with pathogenesis, laboratory diagnosis, epidemiology, and control of human and veterinary pathogens. The first issue was published in January 1988, with quarterly publication since then. The journal quickly became successful in terms of subscribers and impact on the field, earning a strong national and international reputation. The achievements of CMR are owed to many persons, including the editorial board, the production team, and especially the contributing authors.
Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features
Authors: Singh Ameeta E. , Romanowski Barbara
Published: October 2018

Syphilis is a chronic disease with a waxing and waning course, the manifestations of which have been described for centuries. It occurs worldwide, and the incidence varies significantly with geographic location. Transmission is mainly by sexual contact. The causative organism, Treponema pallidum, was first described in 1905, but because of the inability to culture the organism and the limitations of direct microscopy, serologic testing is the mainstay of laboratory diagnosis. The disease has been arbitrarily divided into several stages. The primary stage is defined by a chancre at the site of inoculation. The secondary stage is characterized by a polymorphic rash, lymphadenopathy, and other systemic manifestations. A variable asymptomatic latent period follows, which for epidemiologic purposes is divided into early (<1 year) and late (>1 year) stages. The early stages (primary, secondary, and early latent) are potentially infectious. The tertiary stage is the most destructive and is marked by cardiovascular and neurologic sequelae and gummatous involvement of any organ system. Congenital infection may result in protean early or late manifestations. Unlike many other bacteria causing infectious diseases, the organism remains sensitive to penicillin, and this remains the mainstay of therapy.
Clinical, Microbial, and Biochemical Aspects of the Exfoliative Toxins Causing Staphylococcal Scalded-Skin Syndrome
Authors: Ladhani Shamez , Joannou Christopher L. , Lochrie Denise P. , Evans Robert W. , Poston Susan M.
Published: October 2018

The exfoliative (epidermolytic) toxins of Staphylococcus aureus are the causative agents of the staphylococcal scalded-skin syndrome (SSSS), a blistering skin disorder that predominantly affects children. Clinical features of SSSS vary along a spectrum, ranging from a few localized blisters to generalized exfoliation covering almost the entire body. The toxins act specifically at the zona granulosa of the epidermis to produce the characteristic exfoliation, although the mechanism by which this is achieved is still poorly understood. Despite the availability of antibiotics, SSSS carries a significant mortality rate, particularly among neonates with secondary complications of epidermal loss and among adults with underlying diseases. The aim of this article is to provide a comprehensive review of the literature spanning more than a century and to cover all aspects of the disease. The epidemiology, clinical features, potential complications, risk factors, susceptibility, diagnosis, differential diagnoses, investigations currently available, treatment options, and preventive measures are all discussed in detail. Recent crystallographic data on the toxins has provided us with a clearer and more defined approach to studying the disease. Understanding their mode of action has important implications in future treatment and prevention of SSSS and other diseases, and knowledge of their specific site of action may provide a useful tool for physiologists, dermatologists, and pharmacologists.
Molecular Techniques for Detection, Species Differentiation, and Phylogenetic Analysis of Microsporidia
Authors: Franzen Caspar , Müller Andreas
Published: October 2018

Microsporidia are obligate intracellular protozoan parasites that infect a broad range of vertebrates and invertebrates. These parasites are now recognized as one of the most common pathogens in human immunodeficiency virus-infected patients. For most patients with infectious diseases, microbiological isolation and identification techniques offer the most rapid and specific determination of the etiologic agent. This is not a suitable procedure for microsporidia, which are obligate intracellular parasites requiring cell culture systems for growth. Therefore, the diagnosis of microsporidiosis currently depends on morphological demonstration of the organisms themselves. Although the diagnosis of microsporidiosis and identification of microsporidia by light microscopy have greatly improved during the last few years, species differentiation by these techniques is usually impossible and transmission electron microscopy may be necessary. Immunfluorescent-staining techniques have been developed for species differentiation of microsporidia, but the antibodies used in these procedures are available only at research laboratories at present. During the last 10 years, the detection of infectious disease agents has begun to include the use of nucleic acid-based technologies. Diagnosis of infection caused by parasitic organisms is the last field of clinical microbiology to incorporate these techniques and molecular techniques (e.g., PCR and hybridization assays) have recently been developed for the detection, species differentiation, and phylogenetic analysis of microsporidia. In this paper we review human microsporidial infections and describe and discuss these newly developed molecular techniques.
Respiratory Syncytial Virus Infection: Immune Response, Immunopathogenesis, and Treatment
Authors: Domachowske Joseph B. , Rosenberg Helene F.
Published: October 2018

Respiratory syncytial virus (RSV) is the single most important cause of lower respiratory tract infection during infancy and early childhood. Once RSV infection is established, the host immune response includes the production of virus-neutralizing antibodies and T-cell-specific immunity. The humoral immune response normally results in the development of anti-RSV neutralizing-antibody titers, but these are often suboptimal during an infant’s initial infection. Even when the production of RSV neutralizing antibody following RSV infection is robust, humoral immunity wanes over time. Reinfection during subsequent seasons is common. The cellular immune response to RSV infection is also important for the clearance of virus. This immune response, vital for host defense against RSV, is also implicated in the immunopathogenesis of severe lower respiratory tract RSV bronchiolitis. Many details of the immunology and immunopathologic mechanisms of RSV disease known at present have been learned from rodent models of RSV disease and are discussed in some detail. In addition, the roles of immunoglobulin E, histamine, and eosinophils in the immunopathogenesis of RSV disease are considered. Although the treatment of RSV bronchiolitis is primarily supportive, the role of ribavirin is briefly discussed. Novel approaches to the development of new antiviral drugs with promising anti-RSV activity in vitro are also described.
Aspergillus fumigatusand Aspergillosis
Authors: Latgé Jean-Paul
Published: October 2018

Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Humans and animals constantly inhale numerous conidia of this fungus. The conidia are normally eliminated in the immunocompetent host by innate immune mechanisms, and aspergilloma and allergic bronchopulmonary aspergillosis, uncommon clinical syndromes, are the only infections observed in such hosts. Thus, A. fumigatus was considered for years to be a weak pathogen. With increases in the number of immunosuppressed patients, however, there has been a dramatic increase in severe and usually fatal invasive aspergillosis, now the most common mold infection worldwide. In this review, the focus is on the biology of A. fumigatus and the diseases it causes. Included are discussions of (i) genomic and molecular characterization of the organism, (ii) clinical and laboratory methods available for the diagnosis of aspergillosis in immunocompetent and immunocompromised hosts, (iii) identification of host and fungal factors that play a role in the establishment of the fungus in vivo, and (iv) problems associated with antifungal therapy.
Human Cytomegalovirus and Human Herpesvirus 6 Genes That Transform and Transactivate
Authors: Doniger Jay , Muralidhar Sumitra , Rosenthal Leonard J.
Published: October 2018

This review is an update on the transforming genes of human cytomegalovirus (HCMV) and human herpesvirus 6 (HHV-6). Both viruses have been implicated in the etiology of several human cancers. In particular, HCMV has been associated with cervical carcinoma and adenocarcinomas of the prostate and colon. In vitro transformation studies have established three HCMV morphologic transforming regions (mtr), i.e., mtrI, mtrII, and mtrIII. Of these, only mtrII (UL111A) is retained and expressed in both transformed and tumor-derived cells. The transforming and tumorigenic activities of the mtrII oncogene were localized to an open reading frame (ORF) encoding a 79-amino-acid (aa) protein. Furthermore, mtrII protein bound to the tumor suppressor protein p53 and inhibited its ability to transactivate a p53-responsive promoter. In additional studies, the HCMV immediate-early protein IE86 (IE2; UL122) was found to interact with cell cycle-regulatory proteins such as p53 and Rb. However, IE86 exhibited transforming activity in vitro only in cooperation with adenovirus E1A. HHV-6 is a T-cell-tropic virus associated with AIDS-related and other lymphoid malignancies. In vitro studies identified three transforming fragments, i.e., SalI-L, ZVB70, and ZVH14. Of these, only SalI-L (DR7) was retained in transformed and tumor-derived cells. The transforming and tumorigenic activities of SalI-L have been localized to a 357-aa ORF-1 protein. The ORF-1 protein was expressed in transformed cells and, like HCMV mtrII, bound to p53 and inhibited its ability to transactivate a p53-responsive promoter. HHV-6 has also been proposed to be a cofactor in AIDS because both HHV-6 and human immunodeficiency virus type 1 (HIV-1) have been demonstrated to coinfect human CD4
+
T cells, causing accelerated cytopathic effects. Interestingly, like the transforming proteins of DNA tumor viruses such as simian virus 40 and adenovirus, ORF-1 was also a transactivator and specifically up-regulated the HIV-1 long terminal repeat when cotransfected into CD4
+
T cells. Finally, based on the interactions of HCMV and HHV-6 transforming proteins with tumor suppressor proteins, a scheme is proposed for their role in oncogenesis.
Pathogenesis of Onchocercal Keratitis (River Blindness)
Authors: Hall Laurie R. , Pearlman Eric
Published: October 2018

Onchocerciasis is a major cause of blindness. Although the World Health Organization has been successful in reducing onchocerciasis as a public health problem in parts of West Africa, there remain an estimated 17 million people infected with Onchocerca volvulus, the parasite that causes this disease. Ocular pathology can be manifested in any part of the eye, although disease manifestations are frequently characterized as either posterior or anterior eye disease. This review focuses on onchocerca-mediated keratitis that results from an inflammatory response in the anterior portion of the eye and summarizes what is currently known about human disease. This review also describes studies with experimental models that have been established to determine the immunological mechanisms underlying interstitial keratitis. The pathogenesis of keratitis is thought to be due to the host inflammatory response to degenerating parasites in the eye; therefore, the primary clinical symptoms of onchocercal keratitis (corneal opacification and neovascularization) are induced after injection of soluble O. volvulus antigens into the corneal stroma. Experimental approaches have demonstrated an essential role for sensitized T helper cells and shown that cytokines can regulate the severity of keratitis by controlling recruitment of inflammatory cells into the cornea. Chemokines are also important in inflammatory cell recruitment to the cornea, and their role in onchocerciasis is being examined. Further understanding of the molecular basis of the development of onchocercal keratitis may lead to novel approaches to immunologically based intervention.
Applications of Flow Cytometry to Clinical Microbiology
Authors: Álvarez-Barrientos Alberto , Arroyo Javier , Cantón Rafael , Nombela César , Sánchez-Pérez Miguel
Published: October 2018

Classical microbiology techniques are relatively slow in comparison to other analytical techniques, in many cases due to the need to culture the microorganisms. Furthermore, classical approaches are difficult with unculturable microorganisms. More recently, the emergence of molecular biology techniques, particularly those on antibodies and nucleic acid probes combined with amplification techniques, has provided speediness and specificity to microbiological diagnosis. Flow cytometry (FCM) allows single- or multiple-microbe detection in clinical samples in an easy, reliable, and fast way. Microbes can be identified on the basis of their peculiar cytometric parameters or by means of certain fluorochromes that can be used either independently or bound to specific antibodies or oligonucleotides. FCM has permitted the development of quantitative procedures to assess antimicrobial susceptibility and drug cytotoxicity in a rapid, accurate, and highly reproducible way. Furthermore, this technique allows the monitoring of in vitro antimicrobial activity and of antimicrobial treatments ex vivo. The most outstanding contribution of FCM is the possibility of detecting the presence of heterogeneous populations with different responses to antimicrobial treatments. Despite these advantages, the application of FCM in clinical microbiology is not yet widespread, probably due to the lack of access to flow cytometers or the lack of knowledge about the potential of this technique. One of the goals of this review is to attempt to mitigate this latter circumstance. We are convinced that in the near future, the availability of commercial kits should increase the use of this technique in the clinical microbiology laboratory.
Structural Basis for Human Norovirus Capsid Binding to Bile Acids
Authors: Kilic Turgay , Koromyslova Anna , Hansman Grant S.
Published: October 2018

Given that human norovirus virions likely interact with bile acid during a natural infection, our evidence that an HBGA nonbinder (GII.1) can be converted to an HBGA binder after bile acid binding is of major significance. Our data provide direct evidence that, like HBGAs, bile acid interaction on the capsid is an important cofactor for certain genotypes. However, more unanswered questions seem to arise from these new discoveries. For example, is there an association between the bile acid requirement and the prevalence of certain genotypes? That is, the GII.1 and GII.10 (bile acid binders) genotypes rarely caused outbreaks, whereas the GII.4 and GII.17 genotypes (bile acid nonbinders) were responsible for large epidemics. Therefore, it seems plausible that certain genotypes require bile acids, whereas others have modified their bile acid requirements on the capsid.
Editors’ perspectives on the peer-review process in biomedical journals: protocol for a qualitative study
Authors: Glonti Ketevan , Hren Darko
Published: October 2018

Introduction

Despite dealing with scientific output and potentially having an impact on the quality of research published, the manuscript peer-review process itself has at times been criticised for being ‘unscientific’. Research indicates that there are social and subjective dimensions of the peer-review process that contribute to this perception, including how key stakeholders—namely authors, editors and peer reviewers—communicate. In particular, it has been suggested that the expected roles and tasks of stakeholders need to be more clearly defined and communicated if the manuscript review process is to be improved. Disentangling current communication practices, and outlining the specific roles and tasks of the main actors, might be a first step towards establishing the design of interventions that counterbalance social influences on the peer-review process.

The purpose of this article is to present a methodological design for a qualitative study exploring the communication practices within the manuscript review process of biomedical journals from the journal editors’ point of view.

Methods and analysis

Semi-structured interviews will be carried out with editors of biomedical journals between October 2017 and February 2018. A heterogeneous sample of participants representing a wide range of biomedical journals will be sought through purposive maximum variation sampling, drawing from a professional network of contacts, publishers, conference participants and snowballing.

Interviews will be thematically analysed following the method outlined by Braun and Clarke. The qualitative data analysis software NVivo V.11 will be used to aid data management and analysis.

Ethics and dissemination

This research project was evaluated and approved by the University of Split, Medical School Ethics Committee (2181-198-03-04-17-0029) in May 2017. Findings will be disseminated through a publication in a peer-reviewed journal and presentations during conferences.
How much evidence is there that political factors are related to population health outcomes? An internationally comparative systematic review
Authors: Barnish Max , Tørnes Michelle , Nelson-Horne Becky
Published: October 2018

Objectives

To provide a 7-year update of the most recent systematic review about the relationships between political features and population health outcomes.

Setting

Internationally comparative scholarly literature.

Data sources

Ten scholarly bibliographic databases plus supplementary searches in bibliographies and Google Scholar were used to update a previous systematic review. The final search was conducted in November 2017.

Primary and secondary outcome measures

Any population health outcome measure, apart from healthcare spending.

Results

73 unique publications were identified from the previous systematic review. The database searches to update the literature identified 45 356 raw records with 35 207 remaining following de-duplication. 55 publications were identified from supplementary searches. In total, 258 publications proceeded to full-text review and 176 were included in narrative synthesis. 85 studies were assessed at low risk of bias, 89 at moderate risk of bias and none at high risk of bias. Assessment could not be conducted for two studies that had only book chapters. No meta-analysis was conducted. 102 studies assessed welfare state generosity and 79 found a positive association. Of the 17 studies that assessed political tradition, 15 were found to show a positive association with the left-of-centre tradition. 44 studies assessed democracy and 34 found a positive association. 28 studies assessed globalisation and 14 found a negative association, while seven were positive and seven inconclusive.

Conclusions

This review concludes that welfare state generosity, left-of-centre democratic political tradition and democracy are generally positively associated with population health. Globalisation may be negatively associated with population health, but the results are less conclusive. It is important for the academic public health community to engage with the political evidence base in its research as well as in stakeholder engagement, in order to facilitate positive outcomes for population health.
Assessing the chronic respiratory health risk associated with inhalation exposure to powdered toner for printing in actual working conditions: a cohort study on occupationally exposed workers over 10 years
Authors: Nakadate Toshio , Yamano Yuko , Yamauchi Takenori , Okubo Shigeko , Nagashima Daichi
Published: October 2018

Background

Little epidemiological evidence exists regarding the chronic respiratory effects of inhaled powdered toner exposure in humans, although several case reports have suggested the existence of lung disorders that might be related to exposure to toner dust.

Objective

We aimed to estimate the chronic health risk to humans associated with routine toner dust exposure in copier industry workers under current actual work conditions.

Design

A prospective observational cohort study of occupational population.

Methods

Changes in chest radiogram, spirometry measurements and serum and urine biomarkers of biomedical responses to extrinsic stress, as well as subjective symptoms were longitudinally observed for up to 10 years in Japanese copier industry workers responsible for the manufacturing, maintenance or recycling of powdered toner or toner-using machines. A total of 694 subjects who did not change their work category during the follow-up and were free from chronic respiratory diseases at the baseline survey provided reliable results on at least three survey occasions during 3 years or more of follow-up.

Results

Typical fibrosis findings associated with pneumoconiosis was not observed on chest radiograms. No significant differences associated with toner exposure were noted in the frequency of new incidence of either non-specific findings on chest radiogram or serum fibrosis biomarkers (sialylated carbohydrate antigen KL-6 and surfactant protein D). However, the exposed subjects tended to show increases in the frequency of respiratory symptoms and reduced spirometry results during the follow-up compared with the control group, although significant differences were only seen in chronic cough.

Conclusions

Under the current reasonably controlled work environmental conditions, lung fibrotic changes caused by inhaled dust exposure, including powdered toner, appear to be relatively uncommon; however, non-specific temporal irritation causing subjective symptoms and inflammatory responses might exist.
Body mass index, waist-to-hip ratio and cognitive function among Chinese elderly: a cross-sectional study
Authors: Zhang Tao , Yan Rui , Chen Qifeng , Ying Xuhua , Zhai Yujia , Li Fudong , Wang Xinyi , He Fan , Ye Chiyu , Lin Junfen
Published: October 2018

Objectives

To investigate the associations between body mass index (BMI), waist-to-hip ratio (WHR) and cognitive function among Chinese elderly.

Design

Cross-sectional study.

Setting

Community.

Participants

Data were obtained from the baseline survey of a community-based cohort in Zhejiang Province, and 9326 persons aged 60 years and older were enrolled.

Primary outcome measures

We investigated the association between BMI and cognition, and then explored the association between WHR and cognition across different quartiles of BMI.

Results

A sample of 9087 persons was used in this study, including 4375 men and 4712 women. Higher WHR increased cognitive impairment risk in those with BMI >25.3 kg/m2(OR (per 0.1 increase) 1.39; 95% CI 1.13 to 1.70). No statistically significant association was found in other BMI categories.

Conclusions

Higher WHR could increase the risk of cognitive impairment among elderly with BMI >25.3 kg/m2. Our results suggest that it could be of benefit to the elderly with high BMI to control WHR.
Dyslipidaemias in women using hormonal contraceptives: a cross sectional study in Mulago Hospital Family Planning Clinic, Kampala, Uganda
Authors: Bakesiima Ritah , Byakika-Kibwika Pauline , Tumwine James K , Kalyango Joan N , Nabaasa Gloria , Najjingo Irene , Nabaggala Grace S , Olweny Francis , Karamagi Charles
Published: October 2018

Objective

To determine the prevalence and factors associated with dyslipidaemias in women using hormonal contraceptives.

Design

Cross-sectional study

Setting

Mulago Hospital, Kampala, Uganda

Participants

Three hundred and eighty-four consenting women, aged 18–49 years, who had used hormonal contraceptives for at least 3 months prior to the study.

Study outcome

Dyslipidaemias (defined as derangements in lipid profile levels which included total cholesterol ≥200 mg/dL, high-density lipoprotein <40 mg/dL, triglyceride >150 mg/dL or low-density lipoprotein ≥160 mg/dL) for which the prevalence and associated factors were obtained.

Results

The prevalence of dyslipidaemias was 63.3% (95% CI: 58.4 to 68.1). Body mass index (BMI) (PR=1.33, 95% CI: 1.15 to 1.54, p<0.001) and use of antiretroviral therapy (ART) (PR=1.21, 95% CI: 1.03 to 1.42, p=0.020) were the factors significantly associated with dyslipidaemias.

Conclusion

Dyslipidaemias were present in more than half the participants, and this puts them at risk for cardiovascular diseases. The high-risk groups were women with a BMI greater than 25 Kg/m2and those who were on ART. Therefore, lipid profiles should be assessed in women using hormonal contraceptives in order to manage them better.
Symptoms and feelings valued by patients after a percutaneous coronary intervention: a discrete-choice experiment to inform development of a new patient-reported outcome
Authors: Barker Anna L , Peeters Geeske , Morello Renata T , Norman Richard , Ayton Darshini , Lefkovits Jeffrey , Brennan Angela , Evans Sue M , Zalcberg John , Reid Christopher , Ahern Susannah , Soh Sze-Ee , Stoelwinder Johannes , McNeil John J
Published: October 2018

Objective

To inform the development of a patient-reported outcome measure, the aim of this study was to identify which symptoms and feelings following percutaneous coronary intervention (PCI) are most important to patients.

Design

Discrete-choice experiment consisting of two hypothetical scenarios of 10 symptoms and feelings (pain or discomfort; shortness of breath; concern/worry about heart problems; tiredness; confidence to do usual activities; ability to do usual activities; happiness; sleep disturbance; dizziness or light-headedness and bruising) experienced after PCI, described by three levels (never, some of the time, most of the time). Preference weights were estimated using a conditional logit model.

Setting

Four Australian public hospitals that contribute to the Victorian Cardiac Outcomes Registry (VCOR) and a private insurer’s claim database.

Participants

138 people aged >18 years who had undergone a PCI in the previous 6 months.

Main outcome measures

Patient preferences via trade-offs between 10 feelings and symptoms.

Results

Of the 138 individuals recruited, 129 (93%) completed all 16 choice sets. Conditional logit parameter estimates were mostly monotonic (eg, moving to worse levels for each individual symptom and feeling made the option less attractive). When comparing the magnitude of the coefficients (based on the coefficient of the worst level relative to best level in each item), feeling unhappy was the symptom or feeling that most influenced perception of a least-preferred PCI outcome (OR 0.42, 95% CI 0.34 to 0.51, p<0.0001) and the least influential was bruising (OR 0.81, 95% CI 0.67 to 0.99, p=0.04).

Conclusion

This study provides new insights into how patients value symptoms and feelings they experience following a PCI.
Prognostic utility of the combination of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NSTEMI after primary percutaneous coronary intervention: a retrospective cohort study
Authors: Fan Zeyuan , Li Yang , Ji Hanhua , Jian Xinwen
Published: October 2018

Objectives

This study aimed to evaluate prognostic value of the combination of monocyte-to-lymphocyte ratio (MLR) with neutrophil-to-lymphocyte ratio (NLR) for predicting long-term major adverse cardiac events (MACE) in patients with non-ST elevated myocardial infarction (NSTEMI) who underwent primary percutaneous coronary intervention (PCI).

Design

Retrospective cohort study.

Setting

Civil Aviation General Hospital, Beijing, China.

Participants

678 patients with NSTEMI undergoing primary PCI between July 2010 and July 2015 were enrolled.

Main outcome measures

The main outcomes were MACE. The cumulative MACE-free survival rates were calculated by Kaplan-Meier analysis and the independent predictors of MACE were assessed by Cox regression analysis.

Results

According to the cut-off values of MLR 0.36 and NLR 2.15, the study population was classified into four groups: low MLR + low NLR group (n=319), low MLR + high NLR group (n=126), high MLR + low NLR group (n=102) and high MLR + high NLR group (n=131). The high MLR + high NLR group had a lower MACE-free survival rate than the other three groups (p logrank <0.001). Both MLR (HR 2.128, 95% CI 1.458 to 3.105) and NLR (HR 1.925, 95% CI 1.385 to 2.676) were independent predictors of long-term MACE. Moreover, the patients in the high MLR + high NLR group had an HR of 4.055 (95% CI 2.550 to 6.448) for long-term MACE, with the low-MLR + low NLR group as reference. Comparisons of receiver operating characteristic curves revealed that the combination of MLR with NLR achieved better performance in differentiating long-term MACE, compared with MLR, NLR, high-sensitivity C reactive protein and brain natriuretic peptide alone, and had similar performance to all other pairwise combinations of the four biomarkers.

Conclusions

Elevated levels of MLR and NLR were independent predictors of long-term MACE in patients with NSTEMI. Moreover, the combination of MLR and NLR could improve the prognostic value in predicting long-term MACE.
Asymptomatic malaria parasitaemia and seizure control in children with nodding syndrome; a cross-sectional study
Authors: Ogwang Rodney , Anguzu Ronald , Akun Pamela , Ningwa Albert , Kayongo Edward , Marsh Kevin , Newton Charles R J C , Idro Richard
Published: October 2018

Objective

Plasmodium falciparumis epileptogenic and in malaria endemic areas, is a leading cause of acute seizures. In these areas, asymptomatic infections are common but considered benign and so, are not treated. The effects of such infections on seizures in patients with epilepsy is unknown. This study examined the relationship betweenP. falciparuminfection and seizure control in children with a unique epilepsy type, the nodding syndrome.

Design

This cross-sectional study was nested in an ongoing trial ‘Doxycycline for the treatment of nodding syndrome (NCT02850913)’. We hypothesised that, in patients with epilepsy, infection byP. falciparum,including asymptomatic infections, increases the risk of seizures and impairs seizure control.

Setting and participants

Participants were Ugandan children with nodding syndrome, age ≥8 years, receiving sodium valproate. All had standardised testing including documentation of the number of seizures in the past month, a rapid malaria test and if positive, the peripheral blood parasite density.

Outcomes

The primary outcome was the number of seizures in the past month (30 days).

Results

A total of 164/240 (68%) had malaria. Asymptomatic infections (without fever) were seen in 160/240 (67%) and symptomatic infections in 4/240 (2.7%). In participants without malaria, the median (IQR) number of seizures in the past month was 2.0 (1.0–4.0) and it was 4.0 (2.0–7.5) in participants with malaria, p=0.017. The number of seizures in asymptomatic persons was 3.0 (IQR 2.0–7.3) and 6.0 (IQR 4.0–10.0) in symptomatic individuals, p=0.024. Additionally, in asymptomatic patients, a positive correlation was observed between the parasite density and number of seizures, r=0.33, p=0.002.

Conclusion

In patients with nodding syndrome, both asymptomatic and symptomatic malaria are associated with an increased risk of seizures and poorer seizure control. Similar effects should be examined in other epilepsy disorders. Malaria prevention should be strengthened for these patients and chemotreatment and prevention studies considered to improve seizure control.
Evaluating the effects of community treatment orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study
Authors: Weich Scott , Duncan Craig , Bhui Kamaldeep , Canaway Alastair , Crepaz-Keay David , Keown Patrick , Madan Jason , McBride Orla , Moon Graham , Parsons Helen , Singh Swaran , Twigg Liz
Published: October 2018

Introduction

Supervised community treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of community treatment orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of sociospatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data.

Methods and analysis

Four years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models. Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first readmission and mortality. Outputs from these models will be used to populate predictive models of healthcare resource use.

Ethics and dissemination

Ethical approval has been granted by the National Health Service Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure microdata laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy-makers and other stakeholders.
Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews
Authors: Taylor Cath , Xyrichis Andreas , Leamy Mary C , Reynolds Ellie , Maben Jill
Published: October 2018

Objectives

(i) To synthesise the evidence-base for Schwartz Center Rounds (Rounds) to assess any impact on healthcare staff and identify key features; (ii) to scope evidence for interventions with similar aims, and compare effectiveness and key features to Rounds.

Design

Systematic review of Rounds literature; scoping reviews of comparator interventions (action learning sets; after action reviews; Balint groups; caregiver support programme; clinical supervision; critical incident stress debriefing; mindfulness-based stress reduction; peer-supported storytelling; psychosocial intervention training; reflective practice groups; resilience training).

Data sources

PsychINFO, CINAHL, MEDLINE and EMBASE, internet search engines; consultation with experts.

Eligibility criteria

Empirical evaluations (qualitative or quantitative); any healthcare staff in any healthcare setting; published in English.

Results

The overall evidence base for Rounds is limited. We developed a composite definition to aid comparison with other interventions from 41 documents containing a definition of Rounds. Twelve (10 studies) were empirical evaluations. All were of low/moderate quality (weak study designs including lack of control groups). Findings showed the value of Rounds to attenders, with a self-reported positive impact on individuals, their relationships with colleagues and patients and wider cultural changes. The evidence for the comparative interventions was scant and also low/moderate quality. Some features of Rounds were shared by other interventions, but Rounds offer unique features including being open to all staff and having no expectation for verbal contribution by attenders.

Conclusions

Evidence of effectiveness for all interventions considered here remains limited. Methods that enable identification of core features related to effectiveness are needed to optimise benefit for individual staff members and organisations as a whole. A systems approach conceptualising workplace well-being arising from both individual and environmental/structural factors, and comprising interventions both for assessing and improving the well-being of healthcare staff, is required. Schwartz Rounds could be considered as one strategy to enhance staff well-being.
Hypermobility and sports injury
Authors: Nathan Joseph Alexander , Davies Kevin , Swaine Ian
Published: October 2018

Objective

To determine whether there is an association between hypermobility and sports injury.

Methods

A quantitative observational approach using a cross-sectional survey was adopted. Individuals were identified as hypermobile or not. All participants were asked to complete two questionnaires: one asking demographic information and the other injury-specific. Fisher’s exact test was used for statistical analysis.

Results

114 individuals participated in the study, 62 women and 52 men. 26% of the participants were hypermobile. There was no significant association between hypermobility and sports injury (p=0.66). There was a significant increase in joint and ligament sprain among the non-hypermobile (NH) group covering all sports (p=0.03). Joint dislocation was found exclusively among hypermobile individuals. The duration of injury in hypermobile individuals was higher than NH. The use of oral painkillers or anti-inflammatories in the semiprofessional group was greater than the general population.

Conclusion

Hypermobility is relatively common among individuals, and there is a lot of anecdotal evidence associating it with increased rates of injuries. This project finds that NH individuals are more likely to sustain a ligament or joint sprain in sports. This is due to increased joint laxity and flexibility preventing injury. There were important limitations to this study which will be addressed in further work. These include assessing for pauciarticular hypermobility and focusing on one sport to investigate its association with sports injury in those who are hypermobile or not. It would also be important to focus on one specific joint, assessing its flexibility and association with injury.
Estimation of quadriceps femoris muscle dysfunction in the early period after surgery of the knee joint using shear-wave elastography
Authors: Kawai Makoto , Taniguchi Keigo , Suzuki Tomoyuki , Katayose Masaki
Published: October 2018

Objectives

Orthopaedic surgery of the knee joint results in functional deterioration of the quadriceps femoris muscle. However, little is known about quadriceps femoris muscle dysfunction in the early postsurgical period. Therefore, we examined the stiffness of the quadriceps femoris muscle in the early postsurgical period.

Methods

Seven patients and seven healthy controls performed quadriceps contraction exercises. In resting and contraction conditions, the shear modulus, muscle thickness and pennation angle were measured for the vastus medialis (VM), vastus lateralis (VL) and the rectus femoris (RF) using ultrasound elastography.

Results

The shear moduli of the VM, VL and RF in the control group did not significantly interact, while the shear moduli in the patient group did show a significant interaction. In the resting condition, there was no difference between the unaffected and affected sides in the patient group, but the shear moduli of the VM and VL in the contraction condition was significantly lower on the affected side than the unaffected side.

The contraction ratios between muscles by limbs did not significantly interact. However, there were main effects due to muscle and limb factors. The VM and VL had a significantly higher contraction ratio than the RF, and the control and unaffected limbs had a higher contraction ratio than the affected limb.

Conclusion

The results demonstrated a decrease in muscle stiffness during contraction in patients with quadriceps femoris dysfunction. Measurement of the shear modulus has potential as a new evaluation index and with high sensitivity to decreases in muscle contraction.