Factors contributing to poor sleep quality as perceived by heart transplant recipients in Taiwan.

PubMed

Tseng, P H; Shih, F Jong; Yang, F C; Shih, F Jin; Wang, S S

2014-04-01

The aims of this project were to explore the factors contributing to poor sleep quality at 1 to 3 years after heart transplantation (post-HT), and to explore economic problems and social support for HT recipients (HTRs). This study used a cross-sectional retrospective triangulation approach combining qualitative and quantitative research method designs. Quantitative data included data from the visual analog scale and the Taiwanese version of the World Health Organization Quality of Life questionnaire. Qualitative data were derived from questions that explored physiological, psychological, and economic factors contributing to poor sleep quality postprocedure for HTRs. Sixty-four subjects (81% male, 19% female) participated in this research. Their ages ranged from 20 to 70 (M = 46.88 ± 12.12) years old. Their post-HT timeframe ranged from 1 to 4.10 years; 33% received preoperative extracorporeal membrane oxygenation support. Sleeping disturbances were reported by 72.7% of subjects after HT. Poor sleeping quality at 2 to 3 years post-HT (P = .028) was a complaint, and was worse than at 1 to 2 years post-HT (P = .008). Six physiological (62.5%) and 3 psychological (37.5%) contributing factors were further identified in qualitative interviews. Physiological factors were the major causes affecting their sleep quality 2 to 3 years after HT, whereas psychological factors arose from various family roles, responsibilities, and economic-related pressures. Medical teams should find the causes that lead to sleep disturbances and use the findings to improve HTR sleep quality. When the family financial status is affected, these teams should offer assistance and suggestions for patients who are unable to work due to post-HT physical decline. Establishing and providing good family support systems or patient support groups may allow patients to obtain physical, psychological, and spiritual comfort. Copyright © 2014 Elsevier Inc. All rights reserved.

Pityriasis versicolor in primary school children in Medan Labuhan

NASA Astrophysics Data System (ADS)

Febriyanti; Paramita, DA; Eyanoer, P.

2018-03-01

Personal hygiene is an activity in which done by someone, directly and indirectly, to keep healthy to prevent the risk of diseases. Personal hygiene is also a factor that plays a role in the occurrence of skin diseases and one of them is Pityriasis versicolor. Pityriasis versicolor is a superficial fungal infection caused by Malassezia furfur which is a saprophytic organism in the skin. Activation of M. furfur into a pathogenic form due to changes in the normal flora of the skin that caused by several factors and one of them is poor personal hygiene. A cross-sectional study consist of 115 eligible students is done to determine the relationship between personal hygiene with the occurrence of Pityriasis versicolor among students in primary school in Medan Labuhan district. The result showed that 59.8% of the subject with poor personal hygiene and there is a significant association between personal hygiene with Pityriasis versicolor (p<0.05).

Risk Factors and Prevention Strategies for Suicide among the Elderly

ERIC Educational Resources Information Center

Franks, Rebecca; Burnett, Donna O.; Evans, Retta R.

2012-01-01

Suicide is a preventable public health concern affecting the nation as the 10th leading cause of death. The prevalence of suicide among the elderly is higher than any other group. Risk factors attributed to this phenomenon are depression, social isolation, substance abuse, poor physical health or function, financial stress, and access to lethal…

Causes of the Decline of Education in Pakistan and Its Remedies

ERIC Educational Resources Information Center

Ghazi, Safdar Rehman; Ali, Riasat; Khan, Muhammad Saeed; Hussain, Shaukat; Fatima, Zakia Tanzeela

2010-01-01

Low literacy rate and poor quality of education are the major drawbacks of the educational system in Pakistan. Our education is influenced by a number of factors that cause this downfall. Some of them are more prominent, such as low enrollment and high dropout rate at the primary level, different standards of education, low budget allocation for…

Epidemiology and outcomes of acute encephalitis.

PubMed

Venkatesan, Arun

2015-06-01

This review seeks to describe recent advances in the epidemiology, outcomes, and prognostic factors in acute encephalitis. Infectious causes continue to account for the largest proportion of encephalitis cases in which a cause is identified, although autoimmune causes are increasingly recognized. Type-A gamma-aminobutyric acid (GABAa) receptor antibodies have been recently identified in encephalitis with refractory seizures, whereas the roles of antibodies to the glycine receptor and dipeptidyl peptidase-like protein 6 have been defined in progressive encephalomyelitis with rigidity and myoclonus. Recent findings in the US cases of encephalomyelitis presenting with acute flaccid paralysis raise the possibility that enterovirus D68, a common respiratory pathogen, may cause central nervous system disease. Mortality from acute encephalitis occurs in about 10% of cases, with a large proportion of survivors suffering from cognitive or physical disability. In addition to delay in institution of appropriate antiviral or immune therapy, several potentially reversible factors associated with poor prognosis have been identified, including cerebral edema, status epilepticus, and thrombocytopenia. Encephalitis imposes a significant worldwide health burden and is associated with poor outcomes. Supportive treatment and early institution of therapy may improve outcomes. Careful neurocognitive assessment of survivors of encephalitis is needed to better define long-term outcomes.

Prevalence and factors promoting the occurrence of vitamin D deficiency in the elderly.

PubMed

Wyskida, Magdalena; Wieczorowska-Tobis, Katarzyna; Chudek, Jerzy

2017-03-13

Vitamin D deficiency affects a large part of the population of elderly people, especially women, who live in moderate climate countries due to a reduced amount of vitamin D in the diet (small sea fish consumption) and reduced content of 7-dehydrocholesterol, which causes decreased skin synthesis. The lowest seasonal concentration of 25(OH)D3 is usually observed during winter and spring. Sun exposure influences 25(OH)D3 concentration more strongly in men than in women. Sociodemographic factors that increase the risk of vitamin D deficiency in the elderly include poor environmental conditions, low economic status, lower educational level, drug exposure (smoking), reduced physical activity, overall poor health and obesity, which causes reduced skin exposure to sunlight. The use of medications or supplements that contain vitamin D and staying in a nursing home that employ such supplementation are factors that prevent deficiency. Significant prevalence of diseases of the gastrointestinal tract may contribute to cholecalciferol and ergocalciferol malabsorption or impair their liver transformation. In addition, the high incidence of chronic kidney disease in old age reduces processing hydroxylation of vitamin D and the formation of active metabolites. Vitamin D deficiency can not only cause bone mineralization disorders, but also increase incidence of cardiovascular diseases, cancers, type 2 diabetes and depression. The aim of this study was to summarize current knowledge about the risk factors of vitamin D deficiency development in the elderly population.

Eating habits and appetite control in the elderly: the anorexia of aging.

PubMed

Donini, Lorenzo M; Savina, Claudia; Cannella, Carlo

2003-03-01

Although a high prevalence of overweight is present in elderly people, the main concern in the elderly is the reported decline in food intake and the loss of the motivation to eat. This suggests the presence of problems associated with the regulation of energy balance and the control of food intake. A reduced energy intake causing body weight loss may be caused by social or physiological factors, or a combination of both. Poverty, loneliness, and social isolation are the predominant social factors that contribute to decreased food intake in the elderly. Depression, often associated with loss or deterioration of social networks, is a common psychological problem in the elderly and a significant cause of loss of appetite. The reduction in food intake may be due to the reduced drive to eat (hunger) resulting from a lower need state, or it arises because of more rapidly acting or more potent inhibitory (satiety) signals. The early satiation appears to be predominantly due to a decrease in adaptive relaxation of the stomach fundus resulting in early antral filling, while increased levels and effectiveness of cholecystokinin play a role in the anorexia of aging. The central feeding drive (both the opioid and the neuropeptide Y effects) appears to decline with age. Physical factors such as poor dentition and ill-fitting dentures or age-associated changes in taste and smell may influence food choice and limit the type and quantity of food eaten in older people. Common medical conditions in the elderly such as gastrointestinal disease, malabsorption syndromes, acute and chronic infections, and hypermetabolism often cause anorexia, micronutrient deficiencies, and increased energy and protein requirements. Furthermore, the elderly are major users of prescription medications, a number of which can cause malabsorption of nutrients, gastrointestinal symptoms, and loss of appetite. There is now good evidence that, although age-related reduction in energy intake is largely a physiologic effect of healthy aging, it may predispose to the harmful anorectic effects of psychological, social, and physical problems that become increasingly frequent with aging. Poor nutritional status has been implicated in the development and progression of chronic diseases commonly affecting the elderly. Protein-energy malnutrition is associated with impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, and ultimately increased morbidity and mortality. An increasing understanding of the factors that contribute to poor nutrition in the elderly should enable the development of appropriate preventive and treatment strategies and improve the health of older people.

Improving Adherence to Treatment and Reducing Economic Costs of Hypertension: The Role of Olmesartan-Based Treatment.

PubMed

Costa, Francesco Vittorio

2017-09-01

Poor adherence to antihypertensive treatment is the single most important factor of unsatisfactory blood pressure (BP) control. This review focuses on therapy-related factors affecting adherence and suggests how to improve it with a wise choice of treatment schedule. Complex drug treatment schemes, poor tolerability and drug substitutions are frequent causes of poor adherence which, in turn, causes insufficient BP control, greater incidence of cardiovascular events and, finally, higher global health costs. The effects of prescribing generic drugs and of drug substitutions on adherence is also discussed. In terms of adherence, generic drugs do not seem to be better than branded drugs, unless patients have to bear very high "out of pocket" expenses to buy original drugs, suggesting no advantages in switching drug with the mere goal of reducing the cost of therapy. An important role in improving adherence (and thus cardiovascular events and health expenditure) is also played by the availability of fixed-dose combinations; among antihypertensive drugs, angiotensin receptor blockers (ARBs) are those associated with higher levels of adherence and persistence. Among ARBs, olmesartan stands out for a wide choice of effective fixed-dose combinations.

Sleep quality in long haul truck drivers: A study on Iranian national data.

PubMed

Sadeghniiat-Haghighi, Khosro; Yazdi, Zohreh; Kazemifar, Amir-Mohammad

2016-08-01

Iran has a high rate of road traffic accidents. Poor quality of sleep brings about loss of attention, which is an important cause of road traffic accidents particularly in monotonous roads. The causes of poor quality of sleep in occupational drivers are multifactorial. The objective of the present study was to assess the prevalence of poor sleep quality among occupational drivers with rotating work schedules and analyze its different risk factors. 2200 professional long-haul truck drivers who had been referred to the Occupational Health Clinic for routine education course were invited. We obtained data from eight provinces from various parts of Iran during 2012-2013. Data were collected using a questionnaire including questions about demographic and job characteristics. Pittsburg Sleep Quality Index (PSQI) was used to assess drivers' sleep quality. Mean working (driving) time was (9.3±2.5) hours daily and (55.5 ± 18.29) hours weekly. About 23.5% of the drivers reported history of smoking, 14.5% had low job satisfaction and 60% had irregular work schedule. 16.4% of drivers had an accidents leading to injury during the past five years. The mean PSQI score was 4.2 ± 2.7; 54% had a PSQI>5 (poor quality of sleep). Multivariate logistic regression showed that smoking, job satisfaction, history of accidents, shift work and work hours per day were the most important risk factors for poor sleep quality. Results obtained from the current study showed a high prevalence of poor quality of sleep among professional drivers. It warrants more attention to this significant problem using some measures to improve working conditions in professional drivers, as well as health promotion interventions.

Risk factors for work-related stress and health in head teachers.

PubMed

Phillips, Samantha J; Sen, Dil; McNamee, Roseanne

2008-12-01

Work-related stress (WRS) is known to cause ill-health and decreased productivity. Work in the education sector is thought to be particularly stressful. Few studies have considered risk factors for WRS and health in head teachers. To investigate health in head teachers in West Sussex. To determine personal risk factors most likely to predict cases of WRS and of poor health in head teachers. A cross-sectional study, in a population of 290 head teachers and principals of colleges of further education, using a validated questionnaire, 'a short stress evaluation tool' (ASSET) and additional questions derived from earlier studies. Results were compared with the ASSET database 'norm' groups: a general population of workers (GPN) group and a group of managers and professionals (MPN). 'Caseness' was defined as respondents who felt work was 'very or extremely stressful'. Head teachers had poor physical and mental health compared to the GPN group. Psychological well-being, particularly of females and primary head teachers was worse than a comparative group of managers and professionals. Teaching<5 h/week was a significant predictor of caseness and being female was the main risk factor for poor psychological well-being. Prevalence of self-reported stress in head teachers in West Sussex is high. Female head teachers had worse health outcomes. Our study identified possible personal risk factors predicting WRS and/or poor health in head teachers.

Sleep disorders in kidney disease.

PubMed

De Santo, R M; Perna, A; Di Iorio, B R; Cirillo, M

2010-03-01

Sleep disorders are common in patients with end stage renal disease receiving hemodialysis or peritoneal dialysis. However also a well functioning renal graft does not cure the poor sleep pattern which now emerges as a problem even in early chronic kidney disease (CKD). When patients are made aware for the first time of a disease such as CKD, which may brink to dialysis or at the best to a renal transplant patients begin to experience a disordered sleep. Sleeping disorders include insomnia (I), sleep apnoea (SAS), restless legs syndrome (RLS), periodic limb movement disorder (PLMD), excessive daily sleeping (EDS), sleepwalking, nightmares, and narcolepsy. Disordered sleep did not meet the clinical and scientific interest it deserves, in addition and we do not have a well defined solution for sleeping complaints. However, awareness that a poor sleep is associated with poor quality of life and carries an increase in mortality risk has recently stimulated interest in the field. There are many putative causes for a disordered sleep in chronic kidney disease and in end-stage renal disease. For a unifying hypothesis demographic factors, lifestyles, disease related factors, psychological factors, treatment related factors, and social factor must be taken into consideration.

The effect of compensation on general health in patients sustaining fractures in motor vehicle trauma.

PubMed

Harris, Ian A; Young, Jane M; Jalaludin, Bin B; Solomon, Michael J

2008-04-01

The receipt or pursuit of compensation after injury has been associated with poor outcomes. This study aims to determine the association between compensation-related factors and general health in patients with fractures sustained in motor vehicle trauma. Prospective survey. Metropolitan trauma centers. The study population was patients aged 18 years and older, presenting acutely with at least one fracture involving the long bones, pelvis, patella, talus, or calcaneus, resulting from motor vehicle trauma, and presenting acutely to 1 of 15 hospitals. Patients were surveyed on admission to determine general factors, injury factors, and socioeconomic factors. Employment status at follow-up, compensation-related factors, and the main outcome variables were measured by survey at 6 months after injury. Multiple regression was used to determine significant predictors of outcome. Physical and mental health summaries of the SF-36 General Health Survey. Of the 306 patients recruited to the study, five were excluded, and completed questionnaires were available for 232 (75.8%). Claiming compensation was strongly associated with poor physical and mental health on univariate analysis, but it was not significant on multivariate analysis. The use of a lawyer in relation to the injury was the most significant variable associated with poor physical and mental health, after adjusting for other factors. Lawyer involvement, rather than pursuit of compensation, is associated with poor general health after fractures sustained in motor vehicle injuries. Although this may represent a direct effect, further research is recommended to determine the cause for this association.

Evaluation of near-miss and adverse events in radiation oncology using a comprehensive causal factor taxonomy.

PubMed

Spraker, Matthew B; Fain, Robert; Gopan, Olga; Zeng, Jing; Nyflot, Matthew; Jordan, Loucille; Kane, Gabrielle; Ford, Eric

Incident learning systems (ILSs) are a popular strategy for improving safety in radiation oncology (RO) clinics, but few reports focus on the causes of errors in RO. The goal of this study was to test a causal factor taxonomy developed in 2012 by the American Association of Physicists in Medicine and adopted for use in the RO: Incident Learning System (RO-ILS). Three hundred event reports were randomly selected from an institutional ILS database and Safety in Radiation Oncology (SAFRON), an international ILS. The reports were split into 3 groups of 100 events each: low-risk institutional, high-risk institutional, and SAFRON. Three raters retrospectively analyzed each event for contributing factors using the American Association of Physicists in Medicine taxonomy. No events were described by a single causal factor (median, 7). The causal factor taxonomy was found to be applicable for all events, but 4 causal factors were not described in the taxonomy: linear accelerator failure (n = 3), hardware/equipment failure (n = 2), failure to follow through with a quality improvement intervention (n = 1), and workflow documentation was misleading (n = 1). The most common causal factor categories contributing to events were similar in all event types. The most common specific causal factor to contribute to events was a "slip causing physical error." Poor human factors engineering was the only causal factor found to contribute more frequently to high-risk institutional versus low-risk institutional events. The taxonomy in the study was found to be applicable for all events and may be useful in root cause analyses and future studies. Communication and human behaviors were the most common errors affecting all types of events. Poor human factors engineering was found to specifically contribute to high-risk more than low-risk institutional events, and may represent a strategy for reducing errors in all types of events. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Infectious and dietary risk factors of oral cancer.

PubMed

Meurman, Jukka H

2010-06-01

In addition to the classic risk factors of oral cancer, namely alcohol and tobacco, other factors both infectious and environmental are thought to be associated with the development of oral malignancy. Infections in the oral cavity may be an important preventable cause of cancer. Poor oral hygiene, periodontal disease, chronic candidiasis, human papilloma virus (HPV) and herpesvirus infections link statistically with cancer but the mechanisms involved are largely unknown. Infections may trigger cell proliferation, inhibit apoptosis, interfere with cellular signaling mechanisms and up-regulate tumor promoters. In addition, several oral micro-organisms metabolize alcohol to carcinogenic acetaldehyde thus explaining the association between poor oral hygiene, alcohol consumption and carcinogenesis. With regards to dietary factors the Mediterranean-type fruit and vegetable rich diet has been shown to reduce the risk of oral cancer but the evidence is weak, the effect of individual food components and trace elements on carcinogenesis remains unclear at present. Copyright 2010 Elsevier Ltd. All rights reserved.

A metabolic way to investigate related hurdles causing poor bioavailability in oral delivery of isoacteoside in rats employing ultrahigh-performance liquid chromatography/quadrupole time-of-flight tandem mass spectrometry.

PubMed

Cui, Qingling; Pan, Yingni; Yan, Xiaowei; Qu, Bao; Liu, Xiaoqiu; Xiao, Wei

2017-02-28

Isoacteoside (ISAT), a phenylethanoid glycoside that acts as the principal bioactive component in traditional Chinese medicines, possesses broad pharmacological effects such as neuroprotective, antihypertensive and hepatoprotective activities. However, its pharmaceutical development has been severely limited due to the poor oral bioavailability. It is essential and significant to investigate related hurdles leading to the poor bioavailability of isoacteoside. Whole animal metabolism studies were conducted in rats, followed by metabolic mechanism including gastrointestinal stability, intestinal flora metabolism and intestinal enzyme metabolism employing the powerful method ultrahigh-performance liquid chromatography combined with quadrupole time-of-flight tandem mass spectrometry (UPLC/QTOF-MS/MS). A simple, rapid and sensitive method has been developed which comprehensively revealed the underlying cause of poor bioavailability of ISAT in a metabolic manner. The prototype of ISAT and its combined metabolites have not been detected in plasma. Furthermore, the residual content of the parent compound in in vitro experiments was approximately 59%, 5% and barely none in intestinal bacteria, intestinal S9 and simulated intestinal juice at 6 h, respectively. The present work has demonstrated that the factors causing the poor bioavailability of isoacteoside should be attributed to the metabolism. In general, the metabolism that resulted from intestinal flora and intestinal enzymes were predominant reasons giving rise to the poor bioavailability of ISAT, which also suggested that metabolites might be responsible for the excellent pharmacological effect of ISAT. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments.

PubMed

Vohs, Jenifer L; George, Sunita; Leonhardt, Bethany L; Lysaker, Paul H

2016-10-01

Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops. To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause. Expert commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.

Intensity Variation Normalization for Finger Vein Recognition Using Guided Filter Based Singe Scale Retinex

PubMed Central

Xie, Shan Juan; Lu, Yu; Yoon, Sook; Yang, Jucheng; Park, Dong Sun

2015-01-01

Finger vein recognition has been considered one of the most promising biometrics for personal authentication. However, the capacities and percentages of finger tissues (e.g., bone, muscle, ligament, water, fat, etc.) vary person by person. This usually causes poor quality of finger vein images, therefore degrading the performance of finger vein recognition systems (FVRSs). In this paper, the intrinsic factors of finger tissue causing poor quality of finger vein images are analyzed, and an intensity variation (IV) normalization method using guided filter based single scale retinex (GFSSR) is proposed for finger vein image enhancement. The experimental results on two public datasets demonstrate the effectiveness of the proposed method in enhancing the image quality and finger vein recognition accuracy. PMID:26184226

Intensity Variation Normalization for Finger Vein Recognition Using Guided Filter Based Singe Scale Retinex.

PubMed

Xie, Shan Juan; Lu, Yu; Yoon, Sook; Yang, Jucheng; Park, Dong Sun

2015-07-14

Finger vein recognition has been considered one of the most promising biometrics for personal authentication. However, the capacities and percentages of finger tissues (e.g., bone, muscle, ligament, water, fat, etc.) vary person by person. This usually causes poor quality of finger vein images, therefore degrading the performance of finger vein recognition systems (FVRSs). In this paper, the intrinsic factors of finger tissue causing poor quality of finger vein images are analyzed, and an intensity variation (IV) normalization method using guided filter based single scale retinex (GFSSR) is proposed for finger vein image enhancement. The experimental results on two public datasets demonstrate the effectiveness of the proposed method in enhancing the image quality and finger vein recognition accuracy.

Causes and correlates of anemia in 200 patients with acute cardiogenic pulmonary edema.

PubMed

Rovellini, Angelo; Graziadei, Giovanna; Folli, Christian; Brambilla, Anna Maria; Cosentini, Roberto; Canetta, Ciro; Monzani, Valter

2012-12-01

Acute heart failure has a poor prognosis and the presence of anemia may increase the risk of adverse outcomes. However, the clinical and laboratory characteristics of anemia in acute heart failure are poorly known. We aimed to assess the causes and the clinical and laboratory correlates of anemia in patients with acute cardiogenic pulmonary edema (ACPE). This observational study, performed in an Emergency Unit, enrolled 200 patients treated with medical therapy and continuous positive airway pressure. Anemia was found in 36% of patients (38.5% of females and 32.5% of males) and was severe (hemoglobin <9 g/dL) in 6.9% of cases. The most frequent causes of anemia were chronic renal failure (27.8%), chronic inflammatory states (27.8%) and the clustering of multiple factors (18.1%). A wider spectrum of etiological factors was found in females than in males. Microcytic anemia was observed only in females (20% of those anemic), mainly due to iron deficiency/chronic blood loss. Glomerular filtration rate, serum iron, serum albumin, total cholesterol and diastolic blood pressure were independently associated with hemoglobin levels. The etiology of anemia in ACPE is heterogeneous, with several causal factors besides impaired renal function. The pattern of anemia is different between genders, suggesting that sex-specific diagnostic and therapeutic targets should be implemented. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

A Poor Buy

ERIC Educational Resources Information Center

Cochran, Thomas B.; And Others

1975-01-01

Both economic and environmental factors are affecting the further development of liquid metal fast breeder reactors. Rising costs of plant production and the possible environmental effects of the breeder system have caused the U.S. to consider carefully this method of energy production. Alternative energy sources are being studied also. (MA)

Efficacy of caesarean scar defect repair in improving postmenstrual bleeding and factors associated with poor effect.

PubMed

Xu, He-Yang; Yang, Meng-Yi; Zhang, Xuyin; Wang, Qing; Yi, Xiao-Fang; Ding, Jing-Xin; Hua, Ke-Qin

2017-11-01

Caesarean scar defect (CSD) can cause postmenstrual bleeding. Defect repair is an effective technique to improve this symptom, but there are still a few patients getting little improvement. This retrospective study evaluates the efficacy of scar repair and explores the factors associated with poor effect. In total, 123 patients were involved in the final analysis. All of them complained about menstruation period >7 days due to postmenstrual bleeding. Before surgery, 87.8% of patients had a menstruation period more than 10 days and 20.3% had a period more than 15 days. After surgery, a normal menstruation period (< =7 days) was achieved in 46.3% (95%CI 37.3%-55.6%) of patients and a menstruation period lasting no more than 10 days was achieved in 74.8% (95%CI 66.2%-82.2%). Through multivariate logistic analysis, four factors were found dependently associated with poor effect (defined as menstruation period >10 days after surgery): repeated caesarean section (OR 9.75, 95%CI 2.30-41.36, 0.002) was a risk factor, while defect volume >600 mm 3 (OR 0.14, 95%CI 0.03-0.56, 0.006), interval from caesarean section to symptom emerging >3 months (OR 0.25, 95%CI 0.07-0.94, 0.041) and straight or retroflexed uterus (OR 0.19, 95%CI 0.05-0.79, 0.022) were protective factors. Impact statement What is already known on this subject? Caesarean scar defect can cause postmenstrual bleeding. Defect repair can improve this symptom, but there are still a few patients getting little improvement after surgery. What do the results of this study add? Defect volume >600 mm 3 , interval from caesarean section to symptom emerging >3 months and straight or retroflexed uterus are protective factors of poor effect (defined as menstruation period >10 days after surgery), and repeated caesarean section is a risk factor. What are the implications of these findings for clinical practice and/or further research? These findings may help in counselling the patients and in medical decision. Further researches are needed to explore other factors associated with surgical effect and build prediction models.

Maternal mortality in Syria: causes, contributing factors and preventability.

PubMed

Bashour, Hyam; Abdulsalam, Asmaa; Jabr, Aisha; Cheikha, Salah; Tabbaa, Mohammed; Lahham, Moataz; Dihman, Reem; Khadra, Mazen; Campbell, Oona M R

2009-09-01

To describe the biomedical and other causes of maternal death in Syria and to assess their preventability. A reproductive age mortality study (RAMOS) design was used to identify pregnancy related deaths. All deaths among women aged 15-49 reported to the national civil register for 2003 were investigated through home interviews. Verbal autopsies were used to ascertain the cause of death among pregnancy related maternal deaths, and causes and preventability of deaths were assessed by a panel of doctors. A total of 129 maternal deaths were identified and reviewed. Direct medical causes accounted for 88%, and haemorrhage was the main cause of death (65%). Sixty nine deaths (54%) occurred during labour or delivery. Poor clinical skills and lack of clinical competency were behind 54% of maternal deaths. Ninety one percent of maternal deaths were preventable. The causes of maternal death in Syria and their contributing factors reflect serious defects in the quality of maternal care that need to be urgently rectified.

Motivating the Underprepared Unmotivated Community College Student.

ERIC Educational Resources Information Center

Kelly, Diana K.

In support of the premise that a better understanding of the causes of poor student motivation may lead to the development of techniques to stop unmotivated students from dropping out of college, this paper reviews the literature on the nature of motivation among adolescents and factors influencing academic achievement. After introductory comments…

Nature and Causes of Locomotor Disabilities in India

ERIC Educational Resources Information Center

Halder, Santoshi; Talukdar, Arindam

2013-01-01

A large proportion of disability around the world is preventable. Levels of disability in many poor countries can be reduced by achieving the international development targets for economic, social and human development. In this paper, the author studied the different contributory and causative factors of locomotor disability, disease states and…

Helping Students Cope with Test Anxiety. ERIC Digest.

ERIC Educational Resources Information Center

Harris, Henry L.; Coy, Doris R.

One of the most threatening events that causes anxiety in students today is testing. When students develop an extreme fear of performing poorly on an examination, they experience test anxiety. Test anxiety is a major factor contributing to a variety of negative outcomes including psychological distress, academic underachievement, academic failure,…

Inflated Grades, Deflated Courses: Has Insecurity Induced Compromise?

ERIC Educational Resources Information Center

Cohen, Henry

1984-01-01

Economic factors in education are among the important causes of poor student performance. The time that students must work to support themselves has increased greatly to the extent that students are stretched thin between their desire to graduate as rapidly as possible and their need to have an income. (MLW)

High pressure treatment of human norovirus-like particles: factors affecting destruction efficacy

USDA-ARS?s Scientific Manuscript database

Human norovirus (HuNoV) is the leading cause of foodborne diseases worldwide. High pressure processing (HPP) is considered a promising non-thermal technology to inactivate viral pathogens in foods. However, the effectiveness of HPP on inactivating HuNoV remains poorly understood because it cannot be...

Why Does Military Combat Experience Adversely Affect Marital Relations?

ERIC Educational Resources Information Center

Gimbel, Cynthia; Booth, Alan

1994-01-01

Describes investigation of ways in which combat decreases marital quality and stability. Results support three models: (1) factors propelling men into combat also make them poor marriage material; (2) combat causes problems that increase marital adversity; and (3) combat intensifies premilitary stress and antisocial behavior which then negatively…

Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort

PubMed Central

Ding, Ding; Rogers, Kris; van der Ploeg, Hidde; Stamatakis, Emmanuel; Bauman, Adrian E.

2015-01-01

Background Lifestyle risk behaviors are responsible for a large proportion of disease burden worldwide. Behavioral risk factors, such as smoking, poor diet, and physical inactivity, tend to cluster within populations and may have synergistic effects on health. As evidence continues to accumulate on emerging lifestyle risk factors, such as prolonged sitting and unhealthy sleep patterns, incorporating these new risk factors will provide clinically relevant information on combinations of lifestyle risk factors. Methods and Findings Using data from a large Australian cohort of middle-aged and older adults, this is the first study to our knowledge to examine a lifestyle risk index incorporating sedentary behavior and sleep in relation to all-cause mortality. Baseline data (February 2006– April 2009) were linked to mortality registration data until June 15, 2014. Smoking, high alcohol intake, poor diet, physical inactivity, prolonged sitting, and unhealthy (short/long) sleep duration were measured by questionnaires and summed into an index score. Cox proportional hazards analysis was used with the index score and each unique risk combination as exposure variables, adjusted for socio-demographic characteristics. During 6 y of follow-up of 231,048 participants for 1,409,591 person-years, 15,635 deaths were registered. Of all participants, 31.2%, 36.9%, 21.4%, and 10.6% reported 0, 1, 2, and 3+ risk factors, respectively. There was a strong relationship between the lifestyle risk index score and all-cause mortality. The index score had good predictive validity (c index = 0.763), and the partial population attributable risk was 31.3%. Out of all 96 possible risk combinations, the 30 most commonly occurring combinations accounted for more than 90% of the participants. Among those, combinations involving physical inactivity, prolonged sitting, and/or long sleep duration and combinations involving smoking and high alcohol intake had the strongest associations with all-cause mortality. Limitations of the study include self-reported and under-specified measures, dichotomized risk scores, lack of long-term patterns of lifestyle behaviors, and lack of cause-specific mortality data. Conclusions Adherence to healthy lifestyle behaviors could reduce the risk for death from all causes. Specific combinations of lifestyle risk behaviors may be more harmful than others, suggesting synergistic relationships among risk factors. PMID:26645683

Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort.

PubMed

Ding, Ding; Rogers, Kris; van der Ploeg, Hidde; Stamatakis, Emmanuel; Bauman, Adrian E

2015-12-01

Lifestyle risk behaviors are responsible for a large proportion of disease burden worldwide. Behavioral risk factors, such as smoking, poor diet, and physical inactivity, tend to cluster within populations and may have synergistic effects on health. As evidence continues to accumulate on emerging lifestyle risk factors, such as prolonged sitting and unhealthy sleep patterns, incorporating these new risk factors will provide clinically relevant information on combinations of lifestyle risk factors. Using data from a large Australian cohort of middle-aged and older adults, this is the first study to our knowledge to examine a lifestyle risk index incorporating sedentary behavior and sleep in relation to all-cause mortality. Baseline data (February 2006- April 2009) were linked to mortality registration data until June 15, 2014. Smoking, high alcohol intake, poor diet, physical inactivity, prolonged sitting, and unhealthy (short/long) sleep duration were measured by questionnaires and summed into an index score. Cox proportional hazards analysis was used with the index score and each unique risk combination as exposure variables, adjusted for socio-demographic characteristics. During 6 y of follow-up of 231,048 participants for 1,409,591 person-years, 15,635 deaths were registered. Of all participants, 31.2%, 36.9%, 21.4%, and 10.6% reported 0, 1, 2, and 3+ risk factors, respectively. There was a strong relationship between the lifestyle risk index score and all-cause mortality. The index score had good predictive validity (c index = 0.763), and the partial population attributable risk was 31.3%. Out of all 96 possible risk combinations, the 30 most commonly occurring combinations accounted for more than 90% of the participants. Among those, combinations involving physical inactivity, prolonged sitting, and/or long sleep duration and combinations involving smoking and high alcohol intake had the strongest associations with all-cause mortality. Limitations of the study include self-reported and under-specified measures, dichotomized risk scores, lack of long-term patterns of lifestyle behaviors, and lack of cause-specific mortality data. Adherence to healthy lifestyle behaviors could reduce the risk for death from all causes. Specific combinations of lifestyle risk behaviors may be more harmful than others, suggesting synergistic relationships among risk factors.

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures.

PubMed

Khan, S K; Karuppaiah, K; Bajwa, A S

2012-07-01

Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified 'poor consent' as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. A prospective study was conducted at a tertiary unit. Fifty NOF patients (cases) and fifty total hip replacement (THR) patients (controls) were assessed for process factors (adequacy and validity of consent) as well as patient factors (comprehension and retention) using consent forms and structured interview proformas. The two groups were matched for ASA (American Society of Anesthesiologists) grade and AMTS. The consent forms were adequate in both groups but scored poorly for validity in the NOF group. Only 26% of NOF patients remembered correctly what surgery they had while only 48% recalled the risks and benefits of the procedure. These results were significantly poorer than in THR patients (p = 0.0001). This study confirms that NOF patients are poor at remembering the information conveyed to them at the time of consent when compared with THR patients despite being intellectually and physiologically matched. We suggest using preprinted consent forms (process factors), information sheets and visual aids (patient factors) to improve retention and recall.

Coronary artery disease in Bangladesh: A review

PubMed Central

Islam, A.K.M. Monwarul; Majumder, A.A.S.

2013-01-01

Coronary artery disease (CAD) is an increasingly important medical and public health problem, and is the leading cause of mortality in Bangladesh. Like other South Asians, Bangladeshis are unduly prone to develop CAD, which is often premature in onset, follows a rapidly progressive course and angiographically more severe. The underlying pathophysiology is poorly understood. Genetic predisposition, high prevalence of metabolic syndrome and conventional risk factors play important role. Lifestyle related factors, including poor dietary habits, excess saturated and trans fat, high salt intake, and low-level physical activity may be important as well. Some novel risk factors, including hypovitaminosis D, arsenic contamination in water and food-stuff, particulate matter air pollution may play unique role. At the advent of the new millennium, we know little about our real situation. Largescale epidemiological, genetic and clinical researches are needed to explore the different aspects of CAD in Bangladesh. PMID:23993003

Germination and growth of native and invasive plants on soil associated with biological control of Tamarisk (Tamarix spp.)

USDA-ARS?s Scientific Manuscript database

Introductions of biocontrol beetles (tamarisk beetles) are causing dieback of exotic tamarisk in riparian zones across the western U.S., yet factors that determine plant communities that follow tamarisk dieback are poorly understood. Tamarisk-dominated soils are generally higher in nutrients, organi...

Reproducing Southern Hardwoods is Easier Than You Think

Treesearch

R. L. Johnson; R. C. Biesterfeldt

1971-01-01

Throughout the South poor upland hardwood stands are being converted to pine, while bottom-land hardwood stands are largely ignored. Why are Southern foresters preoccupied with pines? Uncertainties about hardwood markets and gaps in available information about hardwood management are contributing causes, but fear is probably a key factor. Foresters much prefer the well...

The State of the World's Children 1998: Focus on Nutrition.

ERIC Educational Resources Information Center

Bellamy, Carol

This report on the well-being of the world's children focuses on the issue of malnutrition and its impact on children's lives. Chapter 1: (1) discusses the incidence of malnutrition and the complex interplay of factors that cause malnutrition, including poor health services and discrimination against women; (2) presents several approaches to…

The effect of infectious bursal disease virus induced immunosuppression on vaccination against highly pathogenic avian influenza virus

USDA-ARS?s Scientific Manuscript database

Poor efficacy of avian influenza virus (AIV) vaccines in chickens has been documented in the field in spite of good results in experimental settings. Although the causes are multi-factorial and complex, one contributing factor may be prior infection with immunosuppressive viruses. In an effort to ...

Cfh genotype interacts with dietary glycemic index to modulate age-related macular degeneration-like features in mice

USDA-ARS?s Scientific Manuscript database

Age-related macular degeneration (AMD) is a leading cause of visual impairment worldwide. Genetics and diet contribute to the relative risk for developing AMD, but their interactions are poorly understood. Genetic variations in Complement Factor H (CFH), and dietary glycemic index (GI) are major ris...

Workload management and geographic disorientation in aviation incidents: A review of the ASRS data base

NASA Technical Reports Server (NTRS)

Williams, Henry P.; Tham, Mingpo; Wickens, Christopher D.

1993-01-01

NASA's Aviation Safety Reporting System (ASRS) incident reports are reviewed in two related areas: pilots' failures to appropriately manage tasks, and breakdowns in geographic orientation. Examination of 51 relevant reports on task management breakdowns revealed that altitude busts and inappropriate runway usee were the most frequently reported consequences. Task management breakdowns appeared to occur at all levels of expertise, and prominent causal factors were related to breakdowns in crew communications, over-involvement with the flight management system and, for small (general aviation) aircraft, preoccupation with weather. Analysis of the 83 cases of geographic disorientation suggested that these too occurred at all levels of pilot experience. With regard to causal factors, a majority was related to poor cockpit resource management, in which inattention led to a loss of geographic awareness. Other leading causes were related to poor weather and poor decision making. The potential of the ASRS database for contributing to research and design issues is addressed.

Prevalence and Risk Factors of Hookworm-Related Cutaneous Larva Migrans (HrCLM) in a Resource-Poor Community in Manaus, Brazil.

PubMed

Reichert, Felix; Pilger, Daniel; Schuster, Angela; Lesshafft, Hannah; Guedes de Oliveira, Silas; Ignatius, Ralf; Feldmeier, Hermann

2016-03-01

Hookworm-related cutaneous larva migrans (HrCLM) is a neglected tropical skin disease associated with significant clinical pathology. Little knowledge exists about prevalence and risk factors of HrCLM in endemic regions. To understand the epidemiology of HrCLM in Amazonia, we conducted a cross-sectional study in a resource-poor township in Manaus, Brazil. HrCLM was diagnosed in 8.2% (95% CI, 6.3-10.1%) of the study population (N = 806) with a peak prevalence of 18.2% (95% CI, 9.3-27.1%) in children aged 10-14. Most of the tracks (62.4%) were located on the feet, and 10.6% were superinfected. HrCLM was associated independently with age under 15, male sex, presence of animal faeces on the compound, walking barefoot on sandy ground and poverty. HrCLM is common in resource-poor communities in Amazonia and is related to poverty. To reduce the disease burden caused by HrCLM, living conditions have to be improved.

Organizational Failure in an NHS Hospital Trust: A Qualitative Study.

PubMed

Ravaghi, Hamid; Mannion, Russell; Sajadi, Haniye Sadat

2015-01-01

The objective was to explore the key factors associated with organizational failure in an NHS Hospital Trust. This case study adopted a qualitative design. Fifty-seven semistructured interviews and document analyses were conducted as well. Data were analyzed using a framework analysis method. A range of symptoms of organizational performance failure was identified. These relate to a financial deficit, lack of good external relationships, inability to meet core targets, a lack of clear management systems, and low staff morale. These markers had not been taken seriously by the previous senior management team. Symptoms of failure were the reflection of presence of secondary and primary causes of failure. Poor managerial leadership, poor financial control and performance management, lack of open culture, distraction by 2 large projects, and the lack of clinician engagement were perceived as internal causes of failure and the high level of policy changes within the NHS as the key external cause. The level of deprivation in the area was also thought to have had a negative impact on performance. The findings reinforce and expand on those of recent studies across the public sector. Tracking an organization's performance and early diagnosis of performance problems, focusing on performance management systems, and taking into account contextual factors are issues that should be considered.

Inequity and health. Is malnutrition really caused by poor nutrition?

PubMed

Bharmal, F Y

2000-08-01

To look at inequities leading to malnutrition and from the wider picture to find root causes and deal with them in order to alleviate malnutrition. Literature review. The health of the population is adversely affected by the inequities in the country. Women and children being most vulnerable are worst affected. The prevalence of Protein Energy Malnutrition (P.E.M.) in children under five years of age is 51 percent. Such a magnitude of malnutrition in a country, where availability of food per capita is more than adequate, points towards the fact that the inequities within the country are at the root of the problem. Poor income is not the only predictor of malnutrition, gender, urban-rural differences in access, utilization and quality of health care also influence health. In addition, there are some underlying factors such as illiteracy, unawareness of the mother about healthy behaviors, lack of decision-making power of women, along with deep-rooted cultural values of a patriarchal system. Malnutrition is caused by a multitude of factors, some of which are biological, others are environmental, cultural or social. Education of the invisible half of the population, who actually look after the children and the family, is an important strategy to alleviate this problem.

Patient education - A route to improved patient experience in Chinese hospitals?

PubMed

Hu, Yinhuan; Zhang, Zixia

2015-06-23

Poor patient experience may trigger serious doctor-patient conflicts in China. Health system challenges related to access and financing may cause frustration in patients, but inadequate health literacy is an additional factor. This letter argues from two aspects that patient education is an effective and feasible pathway to improve patient experience, but its effects are influenced by underlying systemic problems and contextual factors in China. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Patterns and causes of observed piñon pine mortality in the southwestern United States

USGS Publications Warehouse

Meddens, Arjan J.H.; Hicke, Jeff H.; Macalady, Alison K.; Buotte, P.C.; Cowles, T.R.; Allen, Craig D.

2015-01-01

Recently, widespread piñon pine die-off occurred in the southwestern United States. Here we synthesize observational studies of this event and compare findings to expected relationships with biotic and abiotic factors. Agreement exists on the occurrence of drought, presence of bark beetles and increased mortality of larger trees. However, studies disagree about the influences of stem density, elevation and other factors, perhaps related to study design, location and impact of extreme drought. Detailed information about bark beetles is seldom reported and their role is poorly understood. Our analysis reveals substantial limits to our knowledge regarding the processes that produce mortality patterns across space and time, indicating a poor ability to forecast mortality in response to expected increases in future droughts.

Work, work-life conflict and health in an industrial work environment.

PubMed

Hämmig, O; Bauer, G F

2014-01-01

Work-life conflict has been poorly studied as a cause of ill-health in occupational medicine. To study associations between physical and psychosocial working conditions, including work-life conflict on the one hand and general, physical and mental health outcomes on the other. Cross-sectional data were used from an employee survey among the workforces of four medium-sized and large companies in Switzerland. Physical work factors included five demands and exposures such as heavy loads, repetitive work and poor posture. Psychosocial factors included 14 demands and limited resources such as time pressure, overtime, monotonous work, job insecurity, low job autonomy, low social support and work-life conflict. Health outcomes studied were self-rated health, sickness absence, musculoskeletal disorders, sleep disorders, stress and burnout. There was a response rate of 49%; 2014 employees participated. All adverse working conditions were positively associated with several poor health outcomes in both men and women. After mutual adjustment for all work factors and additional covariates, only a few, mainly psychosocial work factors remained significant as risk factors for health. Work-life conflict, a largely neglected work-related psychosocial factor in occupational medicine, turned out to be the only factor that was significantly and strongly associated with all studied health outcomes and was consistently found to be the strongest or second strongest of all the studied risk factors. Even in an industrial work environment, psychosocial work factors, and particularly work-life conflict, play a key role and need to be taken into consideration in research and workplace health promotion.

The prevention of selected and imposed posture-caused injury.

PubMed

Kemp, D

1977-09-01

It has been recognized for centuries that posture and health are interrelated. Poor health and injuries impose their own specific postures, and poor posture can contribute towards injury and poor health. The correlation between posture and health is not absolute. We can say that a certain posture will increase the probability of injury. Individual differences of age, sex, somatype, fitness, fatigue, load and frequency of posture adoption will dictate if injury will occur, or not, with any individual. There is no doubt that some postures are more stressful than others. The individual factors mentioned dictate whether the resulting strain is above or below the critical amount required for injury. Copyright © 1977 Australian Physiotherapy Association. Published by . All rights reserved.

Epidemiology of ovarian cancer.

PubMed

Permuth-Wey, Jennifer; Sellers, Thomas A

2009-01-01

Ovarian cancer represents the sixth most commonly diagnosed cancer among women in the world, and causes more deaths per year than any other cancer of the female reproductive system. Despite the high incidence and mortality rates, the etiology of this disease is poorly understood. Established risk factors for ovarian cancer include age and having a family history of the disease, while protective factors include increasing parity, oral contraceptive use, and oophorectomy. Lactation, incomplete pregnancies, and surgeries such as hysterectomy and tubal ligation may confer a weak protective effect against ovarian cancer. Infertility may contribute to ovarian cancer risk among nulliparous women. Other possible risk factors for ovarian cancer include postmenopausal hormone-replacement therapy and lifestyle factors such as cigarette smoking and alcohol consumption. Many of the causes of ovarian cancer are yet to be identified. Additional research is needed to better understand the etiology of this deadly disease.

Growth and Nutrition Disorders in Children with Cerebral Palsy

PubMed Central

Kuperminc, Michelle N.; Stevenson, Richard D.

2010-01-01

Growth and nutrition disorders are common secondary health conditions in children with cerebral palsy (CP). Poor growth and malnutrition in CP merit study because of their impact on health, including psychological and physiological function, healthcare utilization, societal participation, motor function, and survival. Understanding the etiology of poor growth has led to a variety of interventions to improve growth. One of the major causes of poor growth, malnutrition, is the best-studied contributor to poor growth; scientific evidence regarding malnutrition has contributed to improvements in clinical management and, in turn, survival over the last 20 years. Increased recognition and understanding of neurological, endocrinological, and environmental factors have begun to shape care for children with CP, as well. The investigation of these factors relies on advances made in the assessment methods available to address the challenges inherent in measuring growth in children with CP. Descriptive growth charts and norms of body composition provide information that may help clinicians to interpret growth and intervene to improve growth and nutrition in children with CP. Linking growth to measures of health will be necessary to develop growth standards for children with CP in order to optimize health and well-being. PMID:18646022

Nature Versus Nurture: Does Proteostasis Imbalance Underlie the Genetic, Environmental, and Age-Related Risk Factors for Alzheimer's Disease?

PubMed

Kikis, Elise A

2017-08-22

Aging is a risk factor for a number of "age-related diseases", including Alzheimer's disease (AD). AD affects more than a third of all people over the age of 85, and is the leading cause of dementia worldwide. Symptoms include forgetfulness, memory loss, and cognitive decline, ultimately resulting in the need for full-time care. While there is no cure for AD, pharmacological approaches to alleviate symptoms and target underlying causes of the disease have been developed, albeit with limited success. This review presents the age-related, genetic, and environmental risk factors for AD and proposes a hypothesis for the mechanistic link between genetics and the environment. In short, much is known about the genetics of early-onset familial AD (EO-FAD) and the central role played by the Aβ peptide and protein misfolding, but late-onset AD (LOAD) is not thought to have direct genetic causes. Nonetheless, genetic risk factors such as isoforms of the protein ApoE have been identified. Additional findings suggest that air pollution caused by the combustion of fossil fuels may be an important environmental risk factor for AD. A hypothesis suggesting that poor air quality might act by disrupting protein folding homeostasis (proteostasis) is presented.

Athletes' perception of the causes of injury in gymnastics.

PubMed

Kolar, Edvard; Pavletič, Mitija S; Smrdu, Maja; Atiković, Almir

2017-05-01

Gymnastics requires a high level of flexibility, conditioning and complete body recruitment that is infrequently matched by other sports. Artistic gymnastics has a relatively high incidence of injuries, which are generally of minor or medium severity. With all its complexity, it poses a unique diagnostic and treatment challenge to medical practitioners. The present study examined athletes' perception of the causes of injury and of the possible ways to reduce their incidence. The research involved 63 quality athletes, of whom 20 were in men's artistic gymnastics, 21 in women's artistic gymnastics, and 22 in rhythmic gymnastics. We used the self-assessment method. Factors inducing injury were grouped into three different categories: training, the athlete himself, and the environment. We used the χ2 test to test the association between a risk factor and injuries. The association between injuries and risk factors was also tested using a multivariate logistic regression analysis. Overall, an incidence of 184 injuries was found, of which 67 (36.4%) were acute and 117 (63.5%) were chronic injuries. According to binary logistic regression analyses, psychological factors significantly associated with the prevalence of acute and chronic injury in both sexes for all disciplines were: a poor technique, improper methods of teaching, and an inadequate load. In our study, higher rates of acute and chronic injury were observed among male gymnasts, who reported their occurrence during training by overload, and among female gymnasts, who reported a poor technique, improper methods of teaching, and an inadequate load as main causes of their occurrence. Improving the communication between athletes and coaches, taking the opinion of an athlete into account, and the athlete's active involvement in preparation of the program include the most crucial points for reducing the incidence of injuries.

Social inequalities in mental health and mortality among refugees and other immigrants to Sweden – epidemiological studies of register data

PubMed Central

Hollander, Anna-Clara

2013-01-01

The aim of this PhD project was to increase knowledge, using population-based registers, of how pre- and post-migration factors and social determinants of health are associated with inequalities in poor mental health and mortality among refugees and other immigrants to Sweden. Study I and II had cross-sectional designs and used logistic regression analysis to study differences in poor mental health (measured with prescribed psychotropic drugs purchased) between refugee and non-refugee immigrants. In Study I, there was a significant difference in poor mental health between female refugees and non-refugees (OR=1.27; CI=1.15–1.40) when adjusted for socio-economic factors. In Study II, refugees of most origins had a higher likelihood of poor mental health than non-refugees of the same origin. Study III and IV had cohort designs and used Cox regression analysis. Study III analysed mortality rates among non-labour immigrants. Male refugees had higher relative risks of mortality from cardiovascular disease (HR=1.53; CI=1.04–2.24) and external causes (HR=1.59; CI=1.01–2.50) than male non-refugees did, adjusted for socio-economic factors. Study IV included the population with a strong connection to the labour market in 1999 to analyse the relative risk of hospitalisation due to depressive disorder following unemployment. The lowest relative risk was found among employed Swedish-born men and the highest among foreign-born females who lost employment during follow-up (HR=3.47; CI=3.02–3.98). Immigrants, and particularly refugees, have poorer mental health than native Swedes. Refugee men have a higher relative mortality risk for cardiovascular disease and external causes of death than do non-refugees. The relative risk of hospitalisation due to depressive disorder following unemployment was highest among immigrant women. To promote mental health and reduce mortality among immigrants, it is important to consider pre- and post-migration factors and the general social determinants of health. PMID:23810108

Vascular dysfunction in preeclampsia.

PubMed

Brennan, Lesley J; Morton, Jude S; Davidge, Sandra T

2014-01-01

Preeclampsia is a complex disorder which affects an estimated 5% of all pregnancies worldwide. It is diagnosed by hypertension in the presence of proteinuria after the 20th week of pregnancy and is a prominent cause of maternal morbidity and mortality. As delivery is currently the only known treatment, preeclampsia is also a leading cause of preterm delivery. Preeclampsia is associated with maternal vascular dysfunction, leading to serious cardiovascular risk both during and following pregnancy. Endothelial dysfunction, resulting in increased peripheral resistance, is an integral part of the maternal syndrome. While the cause of preeclampsia remains unknown, placental ischemia resulting from aberrant placentation is a fundamental characteristic of the disorder. Poor placentation is believed to stimulate the release of a number of factors including pro- and antiangiogenic factors and inflammatory activators into the maternal systemic circulation. These factors are critical mediators of vascular function and impact the endothelium in distinctive ways, including enhanced endothelial oxidative stress. The mechanisms of action and the consequences on the maternal vasculature will be discussed in this review. © 2013 John Wiley & Sons Ltd.

Five-year study of ocular injuries due to fireworks in India.

PubMed

Malik, Archana; Bhala, Soniya; Arya, Sudesh K; Sood, Sunandan; Narang, Subina

2013-08-01

To study the demographic profile, cause, type and severity of ocular injuries, their complications and final visual outcome following fireworks around the time of Deepawali in India. Case records of patients who presented with firework-related injuries during 2005-2009 at the time of Deepawali were reviewed. Data with respect to demographic profile of patients, cause and time of injury, time of presentation and types of intervention were analyzed. Visual acuity at presentation and final follow-up, anterior and posterior segment findings, and any diagnostic and surgical interventions carried out were noted. One hundred and one patients presented with firework-related ocular injuries, of which 77.5 % were male. The mean age was 17.60 ± 11.9 years, with 54 % being ≤14 years of age. The mean time of presentation was 8.9 h. Seventeen patients had open globe injury (OGI) and 84 had closed globe injury (CGI). Fountains were the most common cause of CGI and bullet bombs were the most common cause of OGI. Mean log MAR visual acuity at presentation was 0.64 and 1.22 and at last follow-up was 0.09 and 0.58 for CGI and OGI, respectively (p < 0.05). Patients with CGI had a better visual outcome. Three patients with OGI developed permanent blindness. Factors associated with poor visual outcome included poor initial visual acuity, OGI, intraocular foreign body (IOFB), retinal detachment and development of endophthalmitis. Firework injuries were seen mostly in males and children. Poor visual outcome was associated with poor initial visual acuity, OGI, IOFB, retinal detachment and development of endophthalmitis, while most patients with CGI regained good vision.

Integrating Physical Activity into Academic Pursuits

ERIC Educational Resources Information Center

Gaus, Mark D.; Simpson, Cynthia G.

2009-01-01

Children of today may be the first generation in the United States in more than 200 years to have a life expectancy shorter than their parents. Low levels of fitness caused by physical inactivity and poor nutritional habits of many of today's youth may be a contributing factor. Combating low fitness levels with physical activity is of utmost…

[The impact of socioeconomic factors on the gender differences of disability and subjective health among elderly Koreans].

PubMed

Jeon, Gyeong Suk; Jang, Soong Nang; Rhee, Seon Ja

2009-05-01

Research on the gender differences of health among older Korean people has been limited compared with the research for other stages of life. This study first examined the patterns and magnitude of the gender differences of health in later life. Second, we examined the gender differences in the health of older men and women that were attributable to differing socioeconomic conditions. Using the nationally representative 2005 Korean National Health and Nutrition Examination Survey, the gender differences in disability and subjective poor health were assessed by calculating the age adjusted and gender-specific prevalence. Logistic regression analyses were used to assess if the differences between the men and women for health could be explained by differential exposure to socioeconomic factors and/or the differential vulnerability of men and women to these socioeconomic factors. Our results indicated that older women were more likely than the men to report disability and poor subjective health. The health disadvantage of older women was diminished by differential experiences with socioeconomic factors, and especially education. The differences shrink as much as 43.7% in the case of disability and 35.4% in the case of poor subjective health by the differential exposure to educational attainment. Any differential vulnerability to socioeconomic factors was not found between the men and women, which means that socioeconomic factors may have similar effect on health in both genders. Differential socioeconomic experience and exposure between the men and women might cause gender difference in health in old age Koreans.

[Epidemiology of lung tumors].

PubMed

Ott, S; Geiser, T

2012-07-01

Approximately one out of 500 chest radiographs shows the incidental finding of a solitary pulmonary nodule and almost one half of these pulmonary lesions are caused by a tumor. Unfortunately, only 2% to 5% of all lung tumors are of benign origin, e. g. lipoma, fibroma, hamartoma, and chondroma, and the majority are malignant neoplasms, most commonly primary lung cancer followed by metastases of extrapulmonary primary carcinomas. Thus, a careful diagnostic work up of solitary pulmonary nodules, including histological diagnosis, is mandatory for an adequate management and treatment of patients with pulmonary lesions. Despite all recent improvements of treatment modalities, lung cancer continues to be a major cause of morbidity and mortality among malignant diseases worldwide. The prognosis of affected patients is still very poor and a 5-years survival rate of only 14% makes lung cancer the number one cause of death due to cancer in Switzerland. Active and passive tobacco smoking are by far the best known risk factor for the development of lung cancer, but there are severe other probably less known factors that may increase the individual risk for malignant neoplasms of the lung. These risk factors include e. g. exposure to natural ionic radiation, consisting of terrestrial radiation and indoor radiation caused by radon gas, exposure to respirable dust and Diesel engine emissions, asbestos, and polycyclic aromatic hydrocarbons. In the majority of cases, the latency between exposure and development of cancer is years to decades and the person concerned was occupationally exposed. Therefore, a detailed evaluation of a patient's medical and occupational history is needed. Due to its poor prognosis, prevention and early diagnosis of lung cancer is crucial to improve our patients' outcome. Good knowledge of epidemiology and aetiology of pulmonary tumors is the key to preventive measures and identification of individuals at increased risk for lung cancer. An overview will be provided on the epidemiology of lung tumors and predominantly preventable risk factors for lung cancer.

Minimizing medical litigation, Part 1.

PubMed

Harold, Tan Keng Boon

2006-01-01

The global rise in medical litigation has led to defensive medical practices and rising malpractice insurance premiums. There is a need to review all possible factors influencing litigiousness of the society and to develop strategies to control such factors. Some of the contributory causes of rising litigiousness include higher patients' expectations, poor provider-patient communication, and adversarial legalism of the society. A good combination of system, professional, and legislative strategies may keep medical litigation in check. Part 2 of this article will address the development of a dispute resolution framework.

Cardiometabolic diseases of civilization: history and maturation of an evolving global threat. An update and call to action.

PubMed

Kones, Richard; Rumana, Umme

2017-05-01

Despite striking extensions of lifespan, leading causes of death in most countries now constitute chronic, degenerative diseases which outpace the capacity of health systems. Cardiovascular disease is the most common cause of death in both developed and undeveloped countries. In America, nearly half of the adult population has at least one chronic disease, and polypharmacy is commonplace. Prevalence of ideal cardiovascular health has not meaningfully improved over the past two decades. The fall in cardiovascular deaths in Western countries, half due to a fall in risk factors and half due to improved treatments, have plateaued, and this reversal is due to the dual epidemics of obesity and diabetes type 2. High burdens of cardiovascular risk factors are also evident globally. Undeveloped nations bear the burdens of both infectious diseases and high childhood death rates. Unacceptable rates of morbidity and mortality arise from insufficient resources to improve sanitation, pure water, and hygiene, ultimately linked to poverty and disparities. Simultaneously, about 80% of cardiovascular deaths now occur in low- and middle-income nations. For these reasons, risk factors for noncommunicable diseases, including poverty, health illiteracy, and lack of adherence, must be targeted with unprecedented vigor worldwide. Key messages In developed and relatively wealthy countries, chronic "degenerative" diseases have attained crisis proportions that threaten to reverse health gains made within the past decades. Although poverty, disparities, and poor sanitation still cause unnecessary death and despair in developing nations, they are now also burdened with increasing cardiovascular mortality. Poor adherence and low levels of health literacy contribute to the high background levels of cardiovascular risk.

Hepatitis A complicated with acute renal failure and high hepatocyte growth factor: A case report.

PubMed

Oe, Shinji; Shibata, Michihiko; Miyagawa, Koichiro; Honma, Yuichi; Hiura, Masaaki; Abe, Shintaro; Harada, Masaru

2015-08-28

A 58-year-old man was admitted to our hospital. Laboratory data showed severe liver injury and that the patient was positive for immunoglobulin M anti-hepatitis A virus (HAV) antibodies. He was also complicated with severe renal dysfunction and had an extremely high level of serum hepatocyte growth factor (HGF). Therefore, he was diagnosed with severe acute liver failure with acute renal failure (ARF) caused by HAV infection. Prognosis was expected to be poor because of complications by ARF and high serum HGF. However, liver and renal functions both improved rapidly without intensive treatment, and he was subsequently discharged from our hospital on the 21(st) hospital day. Although complication with ARF and high levels of serum HGF are both important factors predicting poor prognosis in acute liver failure patients, the present case achieved a favorable outcome. Endogenous HGF might play an important role as a regenerative effector in injured livers and kidneys.

Risk factors associated with deforming oral habits in children aged 5 to 11: a case-control study.

PubMed

Reyes Romagosa, Daniel Enrique; Paneque Gamboa, María Rosa; Almeida Muñiz, Yamilka; Quesada Oliva, Leticia María; Escalona Oliva, Damiana; Torres Naranjo, Sonia

2014-03-31

Dental and maxillofacial anomalies have multiple and complex causes. Most frequent among these are poor oral habits. A large number of children present with oral malocclusions, most of which are caused by deforming oral habits. It is important to learn about risk factors for this condition in order to institute preventive measures, early detection and treatment, and identification of low- and high-risk groups. To identify risk factors associated with deforming oral habits, which, if maintained over time, are responsible for occlusion defects, speech disorders, and can affect physical and emotional child development. A case-control study of children presenting with deforming oral habits in the municipality of Manzanillo in Granma province was conducted between January and August 2013. 540 children aged 5 to 11 were included of which 180 had deforming oral habits and were asked to fill out a survey to identify specific type of habits leading to malocclusion. The case group was composed of children with deforming habits, and the remaining 360 children without poor oral habits were the control group. Each case was randomly matched to two control cases. The children mothers were also surveyed to gather supplemental information. Children with deforming oral habits were mostly female. At age 10, onychophagia was the predominant oral deforming habit. Risk factors detected for these habits were sociobiological maternal and child variables such as low and high birth weight, maternal breastfeeding inexperience, and discord in the family. The study identified likely risk factors associated with deforming oral habits. These are discord in the family, birth weight, and lack of breastfeeding experience.

Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients.

PubMed

Gupta, A; Gupta, A; Singh, T K; Saxsena, A

2016-01-01

Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

Exploring the Individual Contributory Personality Factors of Stress: A Survey of Washington State Elementary Teachers

ERIC Educational Resources Information Center

Dean, Effie J.

2010-01-01

Prolonged stress is shown to lead to low productivity, which is one of the leading causes of poor performance, and high absenteeism/turnover in occupational fields (Norton, 2002). The field of education is a prime example of low productivity resulting from prolonged stress (Norton, 2002). Currently, there are many existing studies on environmental…

"Cause That's the Only Skills in School You Need": A Qualitative Analysis of Revenge Goals in Poor Urban Youth

ERIC Educational Resources Information Center

Jäggi, Lena; Kliewer, Wendy

2016-01-01

Revenge goals are correlated with maladjustment, and retaliation is a factor driving youth violence. However, revenge might be an important social tool adolescents use to achieve (self-)justice in environments where institutionalized interventions from authorities such as teachers or police are limited. This qualitative secondary analysis of 50…

Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

ERIC Educational Resources Information Center

Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

2016-01-01

Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

Invasive meningococcal disease--improving management through structured review of cases in the Hunter New England area, Australia.

PubMed

Guimont, Chantal; Hullick, Carolyn; Durrheim, David; Ryan, Nick; Ferguson, John; Massey, Peter

2010-03-01

Invasive meningococcal disease (IMD) is the most common infectious cause of death in childhood in developed countries. This disease may cause severe disability or death if a patient is sub-optimally managed. An audit was performed in Australia of all 2005-06 notified IMD cases to elicit correctable issues. Over the 2 year period, 24 cases were notified in the Hunter New England Health area. These cases were reviewed by an expert panel to highlight key correctable issues in recognition and management of IMD. The 24 patients were aged between 1 month and 70 years. Thirteen (54%) were children and 14 (58%) were women. Six (25%) cases developed complications, two being severe (one death, one limb amputations). These patients had risk factors for IMD. The emergency department average delay between assessment and administration of antibiotics was 57.8 min. There were avoidable factors identified in both patients with a poor outcome. Length of delay in initiating antibiotic therapy has been associated with poor outcome, thus the delay in our series is of concern. The audit highlighted many potentially correctable issues in the medical, laboratory and public health management of IMD cases.

Prevalence and Risk Factors of Hookworm-Related Cutaneous Larva Migrans (HrCLM) in a Resource-Poor Community in Manaus, Brazil

PubMed Central

Reichert, Felix; Pilger, Daniel; Schuster, Angela; Lesshafft, Hannah; Guedes de Oliveira, Silas; Ignatius, Ralf; Feldmeier, Hermann

2016-01-01

Background Hookworm-related cutaneous larva migrans (HrCLM) is a neglected tropical skin disease associated with significant clinical pathology. Little knowledge exists about prevalence and risk factors of HrCLM in endemic regions. Methodology/ Principal Findings To understand the epidemiology of HrCLM in Amazonia, we conducted a cross-sectional study in a resource-poor township in Manaus, Brazil. HrCLM was diagnosed in 8.2% (95% CI, 6.3–10.1%) of the study population (N = 806) with a peak prevalence of 18.2% (95% CI, 9.3–27.1%) in children aged 10–14. Most of the tracks (62.4%) were located on the feet, and 10.6% were superinfected. HrCLM was associated independently with age under 15, male sex, presence of animal faeces on the compound, walking barefoot on sandy ground and poverty. Conclusions/ Significance HrCLM is common in resource-poor communities in Amazonia and is related to poverty. To reduce the disease burden caused by HrCLM, living conditions have to be improved. PMID:27010204

Risk factors for arbovirus infections in a low-income community of Rio de Janeiro, Brazil, 2015-2016

PubMed Central

Daumas, Regina Paiva; de Almeida, Andrea Sobral; dos Santos, Reinaldo Souza; Koster, Isabella; Rodrigues, Pedro Pinheiro; Gomes, Marcelly de Freitas; Macedo, Auriane de Fátima; Gerardi, Alyssa; Leite, Iúri da Costa

2018-01-01

Background Dengue epidemics have occurred in the city of Rio de Janeiro (Brazil) since 1986. In the year 2015, Zika and chikungunya viruses were introduced in the city, causing sequential and simultaneous epidemics. Poor socioeconomic conditions have been suggested as contributing factors of arboviral infection. Objective To describe the spatial distribution of human cases of symptomatic arboviral infections and to identify risk factors for infection in a poor community of Rio de Janeiro in the years 2015 and 2016. Methods We built thematic maps of incidence rates for 78 micro-areas in the Manguinhos neighborhood. The micro-areas congregate about 600 inhabitants. Simple and multiple multilevel logistic regression models were used to evaluate the association between the incidence of arboviral diseases and socio-demographic factors at both the individual and micro-area levels. Results From 2015 to 2016, 370 human cases of arbovirus infection were reported in the Manguinhos community: 123 in 2015 and 247 in 2016. There was a significant difference in the risk of arbovirus diseases among different micro-areas, but this was not explained by water and sanitation indicators. The cumulative incidence rate was 849/100,000 in two years. The incidence was greater in those individuals with familiar vulnerability (1,156/100,000 vs. 794/100,000). The multilevel adjusted model showed that the odds of acquiring an arbovirus infection was 55% greater in those with familiar vulnerability. Conclusion Arbovirus infections cause a high burden of disease in Brazilian urban centers. Our results suggest that even in poor neighborhoods, there is a high spatial variability in the risk of acquiring an arbovirus infection. The conditions that favor vector proliferation and infection by arboviruses are complex and involve both individual and environmental characteristics that vary from place to place. To reduce the burden of arboviral diseases, continued public health policies and basic services should be provided to the communities at risk that consider specific local needs. PMID:29879155

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors.

PubMed

Mahmood, Mohammad Afzal; Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien; Wahabi, Hayfaa A

2018-01-01

Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

PubMed Central

Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien

2018-01-01

Background Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Method Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. Findings The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. Conclusion There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped. PMID:29682538

[Potential role of the angiogenic factor "EG-VEGF" in gestational trophoblastic diseases].

PubMed

Boufettal, H; Feige, J-J; Benharouga, M; Aboussaouira, T; Nadifi, S; Mahdaoui, S; Samouh, N; Alfaidy, N

2013-10-01

Gestational trophoblastic disease (MGT) includes a wide spectrum of pathologies of the placenta, ranging from benign precancerous lesions, with gestational trophoblastic tumors. Metastases are the leading causes of death as a result of this tumor. They represent a major problem for obstetrics and for the public health system. To date, there is no predictor of the progression of molar pregnancies to gestational trophoblastic tumor (GTT). Only an unfavorable plasma hCG monitoring after evacuation of hydatidiform mole is used to diagnose a TTG. The causes of the development of this cancer are still poorly understood. Increasing data in the literature suggests a close association between the development of this tumor and poor placental vascularization during the first trimester of pregnancy. The development of the human placenta depends on a coordination between the trophoblast and endothelial cells. A disruption in the expression of angiogenic factors could contribute to uterine or extra-uterine tissue invasion by extravillous trophoblast, contributing to the development of TTG. This review sheds lights on the phenomenon of angiogenesis during normal and abnormal placentation, especially during the MGT and reports preliminary finding concerning, the variability of expression of "Endocrine Gland-Derived Vascular Endothelial Growth Factor" (EG-VEGF), a specific placental angiogenic factor, in normal and molar placentas, and the potential role of differentiated expressions of the main placental angiogenic factors in the scalability of hydatidiform moles towards a recovery or towards the development of gestational trophoblastic tumor. Deciphering the mechanisms by which the angiogenic factor influences these processes will help understand the pathophysiology of MGT and to create opportunities for early diagnosis and treatment of the latter. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The effect of cigarette smoking, alcohol consumption and fruit and vegetable consumption on IVF outcomes: a review and presentation of original data.

PubMed

Firns, Sarah; Cruzat, Vinicius Fernandes; Keane, Kevin Noel; Joesbury, Karen A; Lee, Andy H; Newsholme, Philip; Yovich, John L

2015-12-16

Lifestyle factors including cigarette smoking, alcohol consumption and nutritional habits impact on health, wellness, and the risk of chronic diseases. In the areas of in-vitro fertilization (IVF) and pregnancy, lifestyle factors influence oocyte production, fertilization rates, pregnancy and pregnancy loss, while chronic, low-grade oxidative stress may underlie poor outcomes for some IVF cases. Here, we review the current literature and present some original, previously unpublished data, obtained from couples attending the PIVET Medical Centre in Western Australia. During the study, 80 % of females and 70 % of male partners completed a 1-week diary documenting their smoking, alcohol and fruit and vegetable intake. The subsequent clinical outcomes of their IVF treatment such as quantity of oocytes collected, fertilization rates, pregnancy and pregnancy loss were submitted to multiple regression analysis, in order to investigate the relationship between patients, treatment and the recorded lifestyle factors. Of significance, it was found that male smoking caused an increased risk of pregnancy loss (p = 0.029), while female smoking caused an adverse effect on ovarian reserve. Both alcohol consumption (β = 0.074, p < 0.001) and fruit and vegetable consumption (β = 0.034, p < 0.001) had positive effects on fertilization. Based on our results and the current literature, there is an important impact of lifestyle factors on IVF clinical outcomes. Currently, there are conflicting results regarding other lifestyle factors such as nutritional habits and alcohol consumption, but it is apparent that chronic oxidative stress induced by lifestyle factors and poor nutritional habits associate with a lower rate of IVF success.

[The role of psychological factors and psychiatric disorders in skin diseases].

PubMed

Kieć-Swierczyńska, Marta; Dudek, Bohdan; Krecisz, Beata; Swierczyńska-Machura, Dominika; Dudek, Wojciech; Garnczarek, Adrianna; Turczyn, Katarzyna

2006-01-01

In this paper, the relation between psychological factors and psychiatric disorders in patients with skin diseases is discussed. On the one hand psychological factors (stress, negative emotions) can influence the generation and aggravation of skin disorders (urticaria, atopic dermatitis, vitiligo), on the other hand psychological disorders can result in some skin diseases (psoriasis, atopic dermatitis). In the majority of cases the quality of life is poorly estimated by patients with skin problems. Psychodermatology is divided into three categories according to the relationship between skin diseases and mental disorders: 1) psychophysiologic disorders caused by skin diseases triggering different emotional states (stress), but not directly combined with mental disorders (psoriasis, eczema); 2) primary psychiatric disorders responsible for self-induced skin disorders (trichotillomania); and 3) secondary psychiatric disorders caused by disfiguring skin (ichthyosis, acne conglobata, vitiligo), which can lead to states of fear, depression or suicidal thoughts.

Public beliefs about causes and risk factors for mental disorders: a comparison of Japan and Australia

PubMed Central

Nakane, Yoshibumi; Jorm, Anthony F; Yoshioka, Kumiko; Christensen, Helen; Nakane, Hideyuki; Griffiths, Kathleen M

2005-01-01

Background Surveys of the public in a range of Western countries have shown a predominant belief in social stressors as causes of mental disorders. However, there has been little direct cross-cultural comparison. Here we report a comparison of public beliefs about the causes of mental disorders in Japan and Australia. Methods Surveys of the public were carried out in each country using as similar a methodology as feasible. In both countries, household interviews were carried out concerning beliefs about causes and risk factors in relation to one of four case vignettes, describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. In Japan, the survey involved 2000 adults aged between 20 and 69 from 25 regional sites spread across the country. In Australia, the survey involved a national sample of 3998 adults aged 18 years or over. Results In both countries, both social and personal vulnerability causes were commonly endorsed across all vignettes. The major differences in causal beliefs were that Australians were more likely to believe in infection, allergy and genetics, while Japanese were more likely to endorse "nervous person" and "weakness of character". For risk factors, Australians tended to believe that women, the young and the poor were more at risk of depression, but these were not seen as higher risk groups by Japanese. Conclusion In both Japan and Australia, the public has a predominant belief in social causes and risk factors, with personal vulnerability factors also seen as important. However, there are also some major differences between the countries. The belief in weakness of character as a cause, which was stronger in Japan, is of particular concern because it may reduce the likelihood of seeking professional help and support from others. PMID:16174303

Environmental factors associated with adolescent antisocial behavior in a poor urban community in Brazil.

PubMed

Curto, Bartira Marques; Paula, Cristiane Silvestre; do Nascimento, Rosimeire; Murray, Joseph; Bordin, Isabel A

2011-12-01

Investigating risk factors for anti-social behavior (ASB) is particularly relevant in a poor urban and violent community of a developing country where homicide is the primary cause of death among 15-24-year olds. To identify individual and environmental factors associated with ASB in adolescents from an urban poor community in the outskirts of São Paulo City, Brazil. This cross-sectional study was based on a probabilistic sample of clusters that included all eligible households (women aged 15-49 years with a son or daughter <18 years of age). One mother-child pair was randomly selected per household (n = 813; response rate: 82.4%). This study is focused on the age group 11-17 years (n = 248). ASB was identified by externalizing scores in the clinical range on the Child Behavior Checklist and/or the Youth Self Report. Potential correlates included individual, maternal, paternal, and familial characteristics. Backward logistic regression analysis identified independent correlates and significant interactions. Youths with high ASB scores were more likely to be victims of severe physical punishment and have an absent father/substitute. Maternal anxiety/depression was a risk factor only among older adolescents (15-17 years), while the presence of internalizing problems was a risk factor only among younger adolescents (11-14 years). Having a non-working mother increased the risk for ASB only among low-income adolescents. The recognition that certain environmental factors may have harmful effects on adolescents' mental health, and the identification of more vulnerable groups can contribute to the development of effective strategies for prevention and treatment of ASB.

High expression of forkhead box protein C2 is associated with aggressive phenotypes and poor prognosis in clinical hepatocellular carcinoma.

PubMed

Shimoda, Yuki; Ubukata, Yasunari; Handa, Tadashi; Yokobori, Takehiko; Watanabe, Takayoshi; Gantumur, Dolgormaa; Hagiwara, Kei; Yamanaka, Takahiro; Tsukagoshi, Mariko; Igarashi, Takamichi; Watanabe, Akira; Kubo, Norio; Araki, Kenichiro; Harimoto, Norifumi; Katayama, Ayaka; Hikino, Toshiaki; Sano, Takaaki; Ogata, Kyoichi; Kuwano, Hiroyuki; Shirabe, Ken; Oyama, Tetsunari

2018-05-25

Hepatocellular carcinoma (HCC) is one of the major causes of tumor death; thus, the identification of markers related to its diagnosis and prognosis is critical. Previous studies have revealed that epithelial-to-mesenchymal transition (EMT) is involved in tumor invasion and metastasis, and the forkhead box protein C2 (FOXC2) has been shown to promote tumor cell proliferation, invasion, and EMT. In the present study, we examined the clinicopathological significance of FOXC2 and EMT-related markers in clinical HCC specimens and identified factors related to the diagnosis and prognosis of HCC. The expression of FOXC2 and EMT-related markers was evaluated by immunohistochemistry in 84 cases of hepatocellular carcinoma. A high expression of FOXC2 was observed in 26 of 84 cases, and expression was significantly correlated with background liver cirrhosis, poor tumor differentiation, high serum AFP, and elevated cell proliferation markers. In addition, this high expression was related to the induction of the Cadherin switch and vimentin expression and was an independent predictor for poor prognosis. The high expression of FOXC2 in HCC is correlated with tumor malignancy and poor prognosis, suggesting that FOXC2 may be an important prognostic factor for HCC.

Causes and Adverse Impact of Physician Burnout: A Systematic Review.

PubMed

Azam, Kamran; Khan, Anwar; Alam, Muhammad Toqeer

2017-08-01

To review the significant causes and effects of physician burnout in published literature. Asystematic review was conducted for searching published literature on the causes and effects of burnout in three online databases. Inclusion and exclusion criteria were developed for final selection of papers. The selected papers were critically appraised and thematic analysis was done to identify major themes related to physician burnout. Thirty-one papers were finally selected among the 2,828 identified studies. The thematic analysis revealed demographic factors, e.g. age, gender, marital status, specialty and job position; and organizational factors, e.g. workload, interpersonal demands, job insecurity and lack of resources, as significant causes of burnout. The consequences of burnout included individual and organizational effects. The individual effects of burnout included physical health problems; while organizational effects included poor job performance, low organizational commitment, and turnover intentions. Burnout is a recognized workplace hazard in the healthcare sector. The individual characteristics of physicians and working environment within hospitals are contributory factors of burnout. Therefore, proactive interventions should be taken at individual and institutional levels for preventing physician burnout by improving the personal lifestyle of physician and working environment in hospitals.

Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.

PubMed

Murray, C J; Lopez, A D

1997-05-17

Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons. DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed. Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene. The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.

Etiology of oral habits.

PubMed

Bayardo, R E; Mejia, J J; Orozco, S; Montoya, K

1996-01-01

The pedodontic admission histories of 1600 Mexican children were analyzed, to determine general epidemiologic factors or oral habits, as well as their relationship with identifiable biopsychosociologic factors. Fifty-six percent of the children gave evidence of an oral habit, with significant predisposition among female patients, single children, subjects in poor physical health (particularly from allergies), as well as children with histories of chronic health problems. Oral habits should be considered a major health hazard because of their high incidence. Successful treatment requires a multidisciplinary approach to the basic cause of the problem.

Does poor school performance cause later psychosocial problems among children in foster care? Evidence from national longitudinal registry data.

PubMed

Forsman, Hilma; Brännström, Lars; Vinnerljung, Bo; Hjern, Anders

2016-07-01

Research has shown that children in foster care are a high-risk group for adverse economic, social and health related outcomes in young adulthood. Children's poor school performance has been identified as a major risk factor for these poor later life outcomes. Aiming to support the design of effective intervention strategies, this study examines the hypothesized causal effect of foster children's poor school performance on subsequent psychosocial problems, here conceptualized as economic hardship, illicit drug use, and mental health problems, in young adulthood. Using the potential outcomes approach, longitudinal register data on more than 7500 Swedish foster children born 1973-1978 were analyzed by means of doubly robust treatment-effect estimators. The results show that poor school performance has a negative impact on later psychosocial problems net of observed background attributes and potential selection on unobservables, suggesting that the estimated effects allow for causal interpretations. Promotion of school performance may thus be a viable intervention path for policymakers and practitioners interested in improving foster children's overall life chances. Copyright © 2016 Elsevier Ltd. All rights reserved.

Physical characteristics related to bra fit.

PubMed

Chen, Chin-Man; LaBat, Karen; Bye, Elizabeth

2010-04-01

Producing well-fitting garments has been a challenge for retailers and manufacturers since mass production began. Poorly fitted bras can cause discomfort or pain and result in lost sales for retailers. Because body contours are important factors affecting bra fit, this study analyses the relationship of physical characteristics to bra-fit problems. This study has used 3-D body-scanning technology to extract upper body angles from a sample of 103 college women; these data were used to categorise physical characteristics into shoulder slope, bust prominence, back curvature and acromion placement. Relationships between these physical categories and bra-fit problems were then analysed. Results show that significant main effects and two-way interactions of the physical categories exist in the fit problems of poor bra support and bra-motion restriction. The findings are valuable in helping the apparel industry create better-fitting bras. STATEMENT OF RELEVANCE: Poorly fitted bras can cause discomfort or pain and result in lost sales for retailers. The findings regarding body-shape classification provide researchers with a statistics method to quantify physical characteristics and the findings regarding the relationship analysis between physical characteristics and bra fit offer bra companies valuable information about bra-fit perceptions attributable to women with figure variations.

Domestic violence and its associated factors among married women of a village development committee of rural Nepal.

PubMed

Sapkota, Diksha; Bhattarai, Sailesh; Baral, Dharanidhar; Pokharel, Paras K

2016-03-19

Violence against women is a global public health problem occurring in multitude of contexts and domestic violence is considered to be the most pervasive one. Poor enforcement of policies, limitation of researches and expertise in this field largely accounts for persistence of this problem and nature of domestic violence and its associated factors are poorly understood. This research aimed to estimate the magnitude of different forms of domestic violence and identify its associated factors. Community based cross sectional study was conducted among 355 married women of reproductive age group of Kusheshwor, Sindhuli, Nepal. The questionnaire adapted from the World Health Organization Multi-Country Study was used for the face to face interviews. Occurrence of current domestic violence was used as outcome variable in logistic regression. Descriptive and multivariate analysis were performed in order to assess the magnitude of domestic violence and to identify its associated factors respectively. Self-reported lifetime prevalence of physical violence was 29.6% and past year prevalence was 15.2%, while corresponding figures for sexual violence were 6.8 and 2.3%, and for psychological violence were 31.0 and 18.3%. Lifetime domestic violence was 38.6% while in past 12 months, prevalence was 23.1%. Furthermore, 12.4% of women were experiencing all forms of violence concurrently. Women with controlling husband and having poor mental health were found to be at higher risk of domestic violence. Domestic violence is still rampant in our society with several forms of violence occurring together. In a country like Nepal, differentials power in relationship and poor mental health was found to be positively associated with violent episodes. This study highlights the infringement of women rights which can be the cause for serious public health consequences.

The Decline of Mortality of Cottonwood Clone Stoneville 124 on a Clay Soil

Treesearch

John K. Francis; Francis I. McCracken

1985-01-01

A decline sequence involving multiple factors was proposed as the cause of death and diminished crowns of 12-year-old cottonwood planted on a clay site. Stoneville clone 124, of which the plantation was formed, has proved to be poorly adapted to clay soils. Rates of death and weakened crowns were shown to be related to minor elevation differences within the plantation...

MTHFR and HFE, but not preproghrelin and LBP, polymorphisms as risk factors for all-cause end-stage renal disease development.

PubMed

Bloudíčková, S; Kuthanová, L; Hubáček, J A

2014-01-01

End-stage renal disease (ESRD) is a serious health problem worldwide. The high prevalence of cardiovascular diseases and chronic inflammation remains a major cause of morbidity and mortality in haemodialysed patients. Beside some external factors, genetic predisposition both to renal failure and poor prognosis has been assumed. We have collected a total of 1,014 haemodialysed patients and 2,559 unrelated healthy Caucasians. Single-nucleotide polymorphisms (SNPs) in genes for preproghrelin (GHRL), lipopolysaccharide-binding protein (LBP), HFE and MTHFR were genotyped. In the group of patients, significantly more carriers presented the MTHFR T667T (P = 0.002) and HFE Asp63Asp (P = 0.001) and Cys282Cys (P = 0.01) genotypes. The frequencies of individual SNPs within GHRL and LBP genes did not differ between the patients and controls. The trends in genotype frequencies did not differ between the subgroups of patients with different time on haemodialysis. Common variants in MTHFR and HFE could be a risk factor for all-cause ESRD development, but are not predictors for the survival on haemodialysis.

Complex genetics of familial exudative vitreoretinopathy and related pediatric retinal detachments

PubMed Central

Kondo, Hiroyuki

2015-01-01

Familial exudative vitreoretinopathy (FEVR) is a hereditary vitreoretinal disorder that can cause various types of retinal detachments. The abnormalities in eyes with FEVR are caused by poor vascularization in the peripheral retina. The genetics of FEVR is highly heterogeneous, and mutations in the genes for Wnt signaling and a transcription factor have been reported to be responsible for FEVR. These factors have been shown to be the regulators of the pathophysiological pathways of retinal vascular development. Studies conducted to identify the causative genes of FEVR have uncovered a diverse and complex relationship between FEVR and other diseases; for example, Norrie disease, a Mendelian-inherited disease; retinopathy of prematurity, a multifactorial genetic disease; and Coats disease, a nongenetic disease, associated with pediatric retinal detachments. PMID:29018668

Knowledge and Attitude Regarding Organ Donation among Relatives of Patients Referred to the Emergency Department.

PubMed

Pouraghaei, Mahboob; Tagizadieh, Mohammad; Tagizadieh, Ali; Moharamzadeh, Payman; Esfahanian, Samaneh; Shahsavari Nia, Kavous

2015-01-01

Organ donation is one of the surviving procedures, which can increase the life expectancy of end-stage patients. Inappropriate beliefs and attitude of individuals to organ donation, their poor knowledge, and the socio-economic level are one of the most important barriers for organ donation. Therefore, here knowledge and attitude levels among relatives of trauma patients regarding organ donation were evaluated. This cross-sectional study was done on relatives of trauma patients referred to the emergency department of Sina Hospital, Tabriz, Iran, through 2013 to 2014. The questionnaire included parts of demographic data and socio-economic situations as well as status of knowledge and attitude regarding organ donation. A score between 0-7 was belonged to each person based on his/her level of knowledge. Attitude level had a score between 0-12. Chi- square, Fisher, and Mann-Whitney U test were performed to assess the relation between demographic variables and the level of knowledge and attitude. P<0.05 was considered as a significant level. 79 persons (57.1% male) with the mean age of 31.3±11.3 years were evaluated. 57 (73.1%) of subjects agreed with organ transplant. The main causes of disagreement among relatives regarding organ donation were dissatisfaction of the donor's relatives (25%) and religious issues (15%). 49 (62.02%) studied people had inappropriate attitude and 27 (34.2%) ones had good knowledge. male gender (OR=5.87; 95%CI: 3.32-8.42; p=0.001) and self-employed job (OR=7.78; 95%CI: 4.64-10.92; p=0.001) are independent factors associated with poor knowledge about organ donation. Self-employed job (OR=3.86; 95%CI: 1.41-6.11; p=0.009) and poor knowledge (OR=15.3; 95%CI: 9.03-21.57; p<0.001) were related to inappropriate attitude toward organ donation. The present study showed that 73.1% of participants agreed with organ donation. The major causes of disagreements were dissatisfaction of other relatives and religious beliefs. 62.0% of the studied people had positive view regarding organ donation and 34.2% of them well informed about. The most important causative factors for poor knowledge in this context were male gender and self-employed occupation. In addition, poor knowledge and self-employed job were two factors associated with inappropriate attitude toward organ donation.

Theory of Mind in Schizophrenia: Associations With Clinical and Cognitive Insight Controlling for Levels of Psychopathology.

PubMed

Popolo, Raffaele; Dimaggio, Giancarlo; Luther, Lauren; Vinci, Giancarlo; Salvatore, Giampaolo; Lysaker, Paul H

2016-03-01

Poor insight in schizophrenia is a risk factor for both poor outcomes and treatment adherence. Accordingly, interest in identifying causes of poor insight has increased. This study explored whether theory of mind (ToM) impairments are linked to poor clinical and cognitive insight independent of psychopathology. Participants with schizophrenia (n = 37) and control subjects (n = 40) completed assessments of ToM with the Hinting Task and the Brüne Picture Sequencing Task, clinical insight and psychopathology with the Positive and Negative Syndrome Scale, and cognitive insight with the Beck Cognitive Insight Scale. Results indicated that the schizophrenia group had greater impairments in ToM relative to control subjects. In the schizophrenia group, the Hinting Task performance was related to both cognitive and clinical insight, with only the relationship with cognitive insight persisting after controlling for psychopathology. Picture Sequencing Task performance was related to cognitive insight only. Future research directions and clinical implications are discussed.

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments.

PubMed

Lysaker, Paul H; Pattison, Michelle L; Leonhardt, Bethany L; Phelps, Scott; Vohs, Jenifer L

2018-02-01

Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture. © 2018 World Psychiatric Association.

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

PubMed Central

Lysaker, Paul H.; Pattison, Michelle L.; Leonhardt, Bethany L.; Phelps, Scott; Vohs, Jenifer L.

2018-01-01

Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social‐cognitive, metacognitive and socio‐political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others’ perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture. PMID:29352540

Potential misdiagnosis of von Willebrand disease and haemophilia caused by ineffective mixing of thawed plasma.

PubMed

Favaloro, E J; Oliver, S; Mohammed, S; Ahuja, M; Grzechnik, E; Azimulla, S; McDonald, J; Lima-Oliveira, G; Lippi, G

2017-09-01

von Willebrand disease (VWD) reflects a loss or dysfunction in von Willebrand factor (VWF), while haemophilia represents a loss or dysfunction of clotting factors such as factor VIII (FVIII) or FIX. Their diagnosis requires laboratory testing, with this potentially compromised by preanalytical events, including poor sample quality. This study assessed the effect of inadequate mixing as a potential cause of VWD and haemophilia misdiagnosis. After completion of requested testing, 48 consecutive patient samples comprising separate aliquots from single collections were individually pooled, appropriately mixed, then frozen in separate aliquots, either at -20°C or -80°C for 2-7 days. Each sample set was then thawed and the separate aliquots subjected to separate mixing protocols (several inversions, blood roller, vortex) vs a non-mix sample, and all aliquots then tested for various VWF and factor assays. Non-mixing led to substantial reduction in VWF and factors in about 25% of samples, that in some cases could lead to misdiagnosis of VWD or haemophilia. Interestingly, there were also some differences observed with respect to different mixing protocols. Our study identified ineffective or variable mixing of thawed plasma samples as potential causes of misdiagnosis of VWD or haemophilia. Further education regarding the importance of appropriate mixing appears warranted. © 2017 John Wiley & Sons Ltd.

The association of health risks with on-the-job productivity.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Conti, Daniel J; Schultz, Alyssa B; Pransky, Glenn; Edington, Dee W

2005-08-01

Decreased on-the-job productivity represents a large yet poorly characterized indirect cost to employers. We studied the impact of employee health risk factors on self-reported worker productivity (presenteeism). Using a brief version of the Work Limitation Questionnaire incorporated into a Health Risk Appraisal, 28,375 employees of a national company responded to the survey. The association between health risks and work limitation and each of the four domains was examined. Percentage of lost productivity also was estimated. Ten of 12 health risk factors studied were significantly associated with self-reported work limitations. The strength of the associations varied between risks and the four domains of work limitation. Perception-related risk factors such as life dissatisfaction, job dissatisfaction, poor health, and stress showed the greatest association with presenteeism. As the number of self-reported health risk factors increased, so did the percentage of employees reporting work limitations. Each additional risk factor was associated with 2.4% excess productivity reduction. Medium and high-risk individuals were 6.2% and 12.2% less productive than low-risk individuals, respectively. The annual cost of lost productivity in this corporation was estimated at between 99Mdollars and 185Mdollars or between 1392dollars and 2592dollars per employee. Health risk factors represent additional causes of lost productivity.

Mechanisms of, and Adjuvants for, Bone Pain.

PubMed

Figura, Nicholas; Smith, Joshua; Yu, Hsiang-Hsuan Michael

2018-06-01

Metastatic bone pain is a complex, poorly understood process. Understanding the unique mechanisms causing cancer-induced bone pain may lead to potential therapeutic targets. This article discusses the effects of osteoclast overstimulation within the tumor microenvironment; the role of inflammatory factors at the tumor-nociceptor interface; the development of structural instability, causing mechanical nerve damage; and, ultimately, the neuroplastic changes in the setting of sustained pain. Several adjuvant therapies are available to attenuate metastatic bone pain. This article discusses the role of pharmacologic therapies, surgery, kyphoplasty, vertebroplasty, and radiofrequency ablation. Copyright © 2018 Elsevier Inc. All rights reserved.

Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance.

PubMed

Ritsema, David F; Watson, Jennifer M; Stiteler, Amanda P; Nguyen, Mike M

2013-04-11

Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors. 100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs. Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1-3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance. Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety.

The use of audit to identify maternal mortality in different settings: is it just a difference between the rich and the poor?

PubMed

van Dillen, Jeroen; Stekelenburg, Jelle; Schutte, Joke; Walraven, Gijs; van Roosmalen, Jos

2007-01-01

To illustrate how maternal mortality audit identifies different causes of and contributing factors to maternal deaths in different settings in low- and high-income countries and how this can lead to local solutions in reducing maternal deaths. Descriptive study of maternal mortality from different settings and review of data on the history of reducing maternal mortality in what are now high-income countries. Kalabo district in Zambia, Farafenni division in The Gambia, Onandjokwe district in Namibia, and the Netherlands. Population of rural areas in Zambia and The Gambia, peri-urban population in Namibia and nationwide data from the Netherlands. Data from facility-based maternal mortality audits from three African hospitals and data from the latest confidential enquiry in the Netherlands. Maternal mortality ratio (MMR), causes (direct and indirect) and characteristics. MMR ranged from 10 per 100,000 (the Netherlands) to 1,540 per 100,000 (The Gambia). Differences in causes of deaths were characterized by HIV/AIDS in Namibia, sepsis and HIV/AIDS in Zambia, (pre-)eclampsia in The Netherlands and obstructed labour in The Gambia. Differences in maternal mortality are more than just differences between the rich and poor. Acknowledging the magnitude of maternal mortality and harnessing a strong political will to tackle the issues are important factors. However, there is no single, general solution to reduce maternal mortality, and identification of problems needs to be promoted through audit, both national and local.

The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States.

PubMed

Mokdad, Ali H; Ballestros, Katherine; Echko, Michelle; Glenn, Scott; Olsen, Helen E; Mullany, Erin; Lee, Alex; Khan, Abdur Rahman; Ahmadi, Alireza; Ferrari, Alize J; Kasaeian, Amir; Werdecker, Andrea; Carter, Austin; Zipkin, Ben; Sartorius, Benn; Serdar, Berrin; Sykes, Bryan L; Troeger, Chris; Fitzmaurice, Christina; Rehm, Colin D; Santomauro, Damian; Kim, Daniel; Colombara, Danny; Schwebel, David C; Tsoi, Derrick; Kolte, Dhaval; Nsoesie, Elaine; Nichols, Emma; Oren, Eyal; Charlson, Fiona J; Patton, George C; Roth, Gregory A; Hosgood, H Dean; Whiteford, Harvey A; Kyu, Hmwe; Erskine, Holly E; Huang, Hsiang; Martopullo, Ira; Singh, Jasvinder A; Nachega, Jean B; Sanabria, Juan R; Abbas, Kaja; Ong, Kanyin; Tabb, Karen; Krohn, Kristopher J; Cornaby, Leslie; Degenhardt, Louisa; Moses, Mark; Farvid, Maryam; Griswold, Max; Criqui, Michael; Bell, Michelle; Nguyen, Minh; Wallin, Mitch; Mirarefin, Mojde; Qorbani, Mostafa; Younis, Mustafa; Fullman, Nancy; Liu, Patrick; Briant, Paul; Gona, Philimon; Havmoller, Rasmus; Leung, Ricky; Kimokoti, Ruth; Bazargan-Hejazi, Shahrzad; Hay, Simon I; Yadgir, Simon; Biryukov, Stan; Vollset, Stein Emil; Alam, Tahiya; Frank, Tahvi; Farid, Talha; Miller, Ted; Vos, Theo; Bärnighausen, Till; Gebrehiwot, Tsegaye Telwelde; Yano, Yuichiro; Al-Aly, Ziyad; Mehari, Alem; Handal, Alexis; Kandel, Amit; Anderson, Ben; Biroscak, Brian; Mozaffarian, Dariush; Dorsey, E Ray; Ding, Eric L; Park, Eun-Kee; Wagner, Gregory; Hu, Guoqing; Chen, Honglei; Sunshine, Jacob E; Khubchandani, Jagdish; Leasher, Janet; Leung, Janni; Salomon, Joshua; Unutzer, Jurgen; Cahill, Leah; Cooper, Leslie; Horino, Masako; Brauer, Michael; Breitborde, Nicholas; Hotez, Peter; Topor-Madry, Roman; Soneji, Samir; Stranges, Saverio; James, Spencer; Amrock, Stephen; Jayaraman, Sudha; Patel, Tejas; Akinyemiju, Tomi; Skirbekk, Vegard; Kinfu, Yohannes; Bhutta, Zulfiqar; Jonas, Jost B; Murray, Christopher J L

2018-04-10

Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state. To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016. A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year. Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed. Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states). There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

Management of source and drinking-water quality in Pakistan.

PubMed

Aziz, J A

2005-01-01

Drinking-water quality in both urban and rural areas of Pakistan is not being managed properly. Results of various investigations provide evidence that most of the drinking-water supplies are faecally contaminated. At places groundwater quality is deteriorating due to the naturally occurring subsoil contaminants or to anthropogenic activities. The poor bacteriological quality of drinking-water has frequently resulted in high incidence of waterborne diseases while subsoil contaminants have caused other ailments to consumers. This paper presents a detailed review of drinking-water quality in the country and the consequent health impacts. It identifies various factors contributing to poor water quality and proposes key actions required to ensure safe drinking-water supplies to consumers.

Heart failure patient adherence: epidemiology, cause, and treatment.

PubMed

Corotto, Paul S; McCarey, Melissa M; Adams, Suzanne; Khazanie, Prateeti; Whellan, David J

2013-01-01

Poor adherence to therapeutic regimens is a significant impediment to improving clinical outcomes in the HF population. Typical rates of adherence to prescribed medications, low-sodium diets, and aerobic exercise programs remain lower than that needed to decrease morbidity and mortality associated with HF. Factors contributing to poor adherence include multiple comorbidities, clinical depression, and decreased cognitive functioning. HF education and programs to enhance self-management skills have improved patient quality of life but have yet to decrease mortality or rehospitalization rates significantly. Telemonitoring to improve adherence behaviors and self-management interventions within broader HF management programs have demonstrated significant clinical improvements in this population. Copyright © 2013 Elsevier Inc. All rights reserved.

Who is food-insecure in California? Findings from the California Women's Health Survey, 2004.

PubMed

Kaiser, Lucia; Baumrind, Nikki; Dumbauld, Sheila

2007-06-01

To identify factors associated with food insecurity in California women. The California Women's Health Survey is an ongoing annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Food insecurity of the women was measured by a 6-item subset of the Food Security Module. Statistical procedures included chi-square tests, t-tests, logistic regression analysis and analysis of covariance. California, USA. Four thousand and thirty-seven women (18 years or older). Prevalence of food insecurity was 25.7%. After controlling for income, factors associated with greater food insecurity were Hispanic or Black race/ethnicity; less than a 12th grade education; being unmarried; less than 55 years old; being Spanish-speaking; having spent less than half of one's life in the USA; sadness/depression; feeling overwhelmed; poor physical/mental health interfering with activities; and fair to poor general health. Among Food Stamp Program (FSP) participants, 71% were food-insecure. Among FSP-eligible women who had not applied for the programme, the prevalence of food insecurity was lower among women responding that they did not need food stamps than in women giving other reasons for not applying (23.9% vs. 66.9%, P < 0.001). Factors associated with food insecurity in FSP recipients included being unable to make food stamps last for 30 days, feeling overwhelmed, and having a birthplace in Mexico or Central America. Along with several socio-economic variables, poor physical and mental health is associated with food insecurity. Whether food insecurity is a cause or effect of poor health remains in question.

Indoor air quality: A psychosocial perspective

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boxer, P.A.

1990-05-01

The incidence of indoor air quality problems has increased dramatically over the past decade. Investigation of these problems has yielded a definitive cause in only one third of the cases. Psychosocial factors may play a key role in the development and propagation of symptoms attributed to poor indoor air quality. Guidelines for managing indoor air quality problems from the organizational perspective are based upon psychosocial principles and elements of risk perception.

Evaluating the Impact of Disseminating of Information in Learners on Fighting Corruption in Kenya through a Kiswahili Set Book Mstahiki Meya

ERIC Educational Resources Information Center

Kuyuni, Stephen Muhala

2017-01-01

Corruption has been a worldwide issue in the contemporary world today. Many parts the world including Kenya is affected by corruption. Many writers and critics have shown that it's spreading at a very high rate just like HIV/AIDS and environmental degradation. They have noted that corruption is caused by the following factors: poor governance,…

Qualitative study of perceived causes of tuberculosis treatment default among health care workers in Morocco.

PubMed

Kizub, D; Ghali, I; Sabouni, R; Bourkadi, J E; Bennani, K; El Aouad, R; Dooley, K E

2012-09-01

In Morocco, tuberculosis (TB) treatment default is increasing in some urban areas. To provide a detailed description of factors that contribute to patient default and solutions from the point of view of health care professionals who participate in TB care. In-depth interviews were conducted with 62 physicians and nurses at nine regional public pulmonary clinics and local health clinics. Participants had a median of 24 years of experience in health care. Treatment default was seen as a result of multilevel factors related to the patient (lack of means, being a migrant worker, distance to treatment site, poor understanding of treatment, drug use, mental illness), medical team (high patient load, low motivation, lack of resources for tracking defaulters), treatment organization (poor communication between treatment sites, no systematic strategy for patient education or tracking, incomplete record keeping), and health care system and society. Tailored recommendations for low- and higher-cost interventions are provided. Interventions to enhance TB treatment completion should take into account the local context and multilevel factors that contribute to default. Qualitative studies involving health care workers directly involved in TB care can be powerful tools to identify contributing factors and define strategies to help reduce treatment default.

Challenges in Achieving Food Security in India

PubMed Central

Upadhyay, R Prakash; Palanivel, C

2011-01-01

First Millennium Development Goal states the target of “Halving hunger by 2015”. Sadly, the recent statistics for India present a very gloomy picture. India currently has the largest number of undernourished people in the world and this is in spite of the fact that it has made substantial progress in health determinants over the past decades and ranks second worldwide in farm output. The causes of existing food insecurity can be better viewed under three concepts namely the: ‘traditional concept’ which includes factors such as unavailability of food and poor purchasing capacity; ‘socio-demographic concept’ which includes illiteracy, unemployment, overcrowding, poor environmental conditions and gender bias; ‘politico-developmental concept’ comprising of factors such as lack of intersectoral coordination and political will, poorly monitored nutritional programmes and inadequate public food distribution system. If the Millennium Development Goal is to be achieved by 2015, efforts to improve food and nutrition security have to increase considerably. Priority has to be assigned to agriculture and rural development along with promoting women empowerment, ensuring sustainable employment and improving environmental conditions (water, sanitation and hygiene). As the problem is multi-factorial, so the solution needs to be multi-sectoral. PMID:23113100

Relapsed or refractory pediatric acute lymphoblastic leukemia: current and emerging treatments.

PubMed

Martin, Alissa; Morgan, Elaine; Hijiya, Nobuko

2012-12-01

Relapsed acute lymphoblastic leukemia (ALL) represents a major cause of morbidity and mortality in pediatrics. With contemporary chemotherapy, >85% of patients with newly diagnosed ALL survive. Unfortunately, 20% of these patients will relapse and for these children, outcomes remain poor despite our best known chemotherapy protocols. Most of these children will achieve a second complete remission, but maintaining this remission remains difficult. Because relapsed ALL is such a significant cause of morbidity and mortality, it is the focus of much research interest. Efforts have been made and continue to focus on understanding the underlying biology that drives relapse. The role of hematopoietic stem cell transplantation in relapsed ALL remains unclear, but many clinicians still favor this for high-risk patients given the poor prognosis with current chemotherapy alone. It is important to use new drugs with little cross-resistance in the treatment of relapsed ALL. New classes of agents are currently being studied. We also discuss prognostic factors and the biology of relapsed ALL.

Aberrant expression of CXCR4 significantly contributes to metastasis and predicts poor clinical outcome in breast cancer.

PubMed

Yang, P; Liang, S-X; Huang, W-H; Zhang, H-W; Li, X-L; Xie, L-H; Du, C-W; Zhang, G-J

2014-01-01

Triple negative breast cancer is known for its visceral metastasis. We have found that CXCR4 is overexpressed in triple negative breast cancer and is associated with visceral metastasis. We further investigated whether CXCR4 is a prognostic factor affecting survival following visceral metastasis in breast cancer patients. Our results indicate that increased CXCR4 expression among breast cancer patients with visceral metastasis was positively correlated with poor overall survival (P<0.001). Silencing of CXCR4 was associated with a decrease in the tumorigenic properties of MDA-MB-231 breast cancer cells, caused reversion of EMT and suppression of MMP-9, increased apoptosis, and caused a reduced incidence of tumor lung metastasis in mice. These results are indicative of CXCR4 having a predictive role in patients with visceral metastasis and indicate that shRNA knock down of CXCR4 might be a novel therapeutic strategy to prevent breast cancer metastasis when CXCR4 is overexpressed.

Pelvic inflammatory disease: a clinical syndrome with social causes.

PubMed

Brabin, L; Raleigh, V S; Dumella, S

1992-08-01

Prevalence of pelvic inflammatory disease (PID) reflects community and individual risk factors. Cultural and behavioural factors influence community prevalence of sexually transmitted disease (STD), illegal abortion, puerperal sepsis and contraceptive usage--all of which influence risk of PID. The relative importance of these factors will vary by region. Individual risk factors for the ascent of a lower genital tract infection are still poorly understood but are thought to be behavioural and immunological. Prevention of PID must be undertaken at several levels. At primary level, it requires a reduction in community risk. At secondary level, individual risk can be modified by ensuring diagnosis and treatment of STD before damage of the upper genital tract occurs. More attention to cultural factors should increase the potential for prevention at both levels.

[Ecologic factors and risk of rehospitalization of psychotic patients].

PubMed

Klusmann, D; Angermeyer, M C

1986-01-01

The present study investigates the relationship between ecological factors and the community tenure patients with functional psychoses. Data were gathered from the records of three psychiatric hospitals in the city of Hamburg. The analysis controls for the effects of sociodemographic variables and variables pertaining to the last impatient treatment. Variations in readmission rates can be explained by the latter to a certain extent, but only poorly by sociodemographic variables and hardly at all by ecological factors. These findings are discussed with respect to the methodological limitations of the study and as substantive results. Two lines of interpretation are offered. Firstly, equal readmission rates may have been caused by different sets of ecological factors; secondly, patients released from mental hospital may be relatively insusceptible to the impact of ecological factors.

The Potential Role of the Proteases Cathepsin D and Cathepsin L in the Progression and Metastasis of Epithelial Ovarian Cancer.

PubMed

Pranjol, Md Zahidul Islam; Gutowski, Nicholas; Hannemann, Michael; Whatmore, Jacqueline

2015-11-20

Epithelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancies and has a poor prognosis due to relatively unspecific early symptoms, and thus often advanced stage, metastasized cancer at presentation. Metastasis of EOC occurs primarily through the transcoelomic route whereby exfoliated tumor cells disseminate within the abdominal cavity, particularly to the omentum. Primary and metastatic tumor growth requires a pool of proangiogenic factors in the microenvironment which propagate new vasculature in the growing cancer. Recent evidence suggests that proangiogenic factors other than the widely known, potent angiogenic factor vascular endothelial growth factor may mediate growth and metastasis of ovarian cancer. In this review we examine the role of some of these alternative factors, specifically cathepsin D and cathepsin L.

PHYSIOLOGY AND ENDOCRINOLOGY SYMPOSIUM:The effects of poor maternal nutrition during gestation on offspring postnatal growth and metabolism.

PubMed

Hoffman, M L; Reed, S A; Pillai, S M; Jones, A K; McFadden, K K; Zinn, S A; Govoni, K E

2017-05-01

Poor maternal nutrition during gestation has been linked to poor growth and development, metabolic dysfunction, impaired health, and reduced productivity of offspring in many species. Poor maternal nutrition can be defined as an excess or restriction of overall nutrients or specific macro- or micronutrients in the diet of the mother during gestation. Interestingly, there are several reports that both restricted- and over-feeding during gestation negatively affect offspring postnatal growth with reduced muscle and bone deposition, increased adipose accumulation, and metabolic dysregulation through reduced leptin and insulin sensitivity. Our laboratory and others have used experimental models of restricted- and over-feeding during gestation to evaluate effects on early postnatal growth of offspring. Restricted- and over-feeding during gestation alters body size, circulating growth factors, and metabolic hormones in offspring postnatally. Both restricted- and over-feeding alter muscle growth, increase lipid content in the muscle, and cause changes in expression of myogenic factors. Although the negative effects of poor maternal nutrition on offspring growth have been well characterized in recent years, the mechanisms contributing to these changes are not well established. Our laboratory has focused on elucidating these mechanisms by evaluating changes in gene and protein expression, and stem cell function. Through RNA-Seq analysis, we observed changes in expression of genes involved in protein synthesis, metabolism, cell function, and signal transduction in muscle tissue. We recently reported that satellite cells, muscle stem cells, have altered expression of myogenic factors in offspring from restricted-fed mothers. Bone marrow derived mesenchymal stem cells, multipotent cells that contribute to development and maintenance of several tissues including bone, muscle, and adipose, have a 50% reduction in cell proliferation and altered metabolism in offspring from both restricted- and over-fed mothers. These findings indicate that poor maternal nutrition may alter offspring postnatal growth by programming stem cell populations. In conclusion, poor maternal nutrition during gestation negatively affects offspring postnatal growth, potentially through impaired stem and satellite cell function. Therefore, determining the mechanisms that contribute to fetal programming is critical to identifying effective management interventions for these offspring and improving efficiency of production.

The association between dental health and nutritional status in chronic obstructive pulmonary disease.

PubMed

Terashima, Takeshi; Chubachi, Shotaro; Matsuzaki, Tatsu; Nakajima, Takahiro; Satoh, Minako; Iwami, Eri; Yoshida, Kyouko; Katakura, Akira; Betsuyaku, Tomoko

2017-11-01

Chronic obstructive pulmonary disease (COPD) and periodontitis are chronic inflammatory systemic diseases with common risk factors (smoking and aging). In COPD, poor periodontal health could result in inadequate nutrition, potentially causing loss of muscle volume. The purpose of this case-control study was to examine our hypothesis that COPD patients have poorer periodontal health and poorer nutritional status than non-COPD patients. Periodontal status was assessed using bleeding on probing (BOP), pocket depth (PD), and plaque-control ratio (PCR). Nutritional status was assessed using body mass index, lean body mass, and serum albumin levels. The COPD group ( n = 60) had fewer remaining teeth, greater BOP, greater PD, and lower serum albumin levels compared with smokers without COPD ( n = 41) and nonsmokers ( n = 35; p < 0.001). COPD was an independent risk factor for poor periodontal health, demonstrated by fewer remaining teeth (relative risk (RR), 5.48; p = 0.0024), BOP (RR, 12.8; p = 0.0009), and having >30% of remaining teeth with a PD ≥ 4 mm (RR, 4.82; p = 0.011). A significant negative correlation existed between the number of teeth with a PD ≥ 4 mm and serum albumin level ( r 2 = 0.127; p = 0.013). We demonstrated that poor periodontal health was associated with hypoalbuminemia, suggesting poor nutritional status and inflammation in COPD.

Underlying pathology and associated factors of hemiplegic shoulder pain.

PubMed

Kalichman, Leonid; Ratmansky, Motti

2011-09-01

The prevalence of hemiplegic shoulder pain is approximately 22%-23% in the general population of stroke survivors and approximately 54%-55% among stroke patients in rehabilitation settings. Hemiplegic shoulder pain causes a reduced quality-of-life, poor functional recovery, depression, disturbed sleep, and prolonged hospitalization. Herein, we attempted to understand, based on a literature review and experts' opinion, the pathologic processes underlying hemiplegic shoulder pain and the major associated factors contributing to its development. The systematization of underlying pathologies was proposed, which might eventually enable a more constructive clinical approach in evaluating and treating patients with hemiplegic shoulder pain.

Osteomalacia: a forgotten cause of fractures in the elderly

PubMed Central

Rokan, Z; Kealey, W D

2015-01-01

We present a case of a man who suffered bilateral neck of femur fractures secondary to osteomalacia, attributable to a combination of his reclusive lifestyle, poor diet and long-term anticonvulsant therapy. These fractures may have been prevented if certain risk factors had been identified early. This case aims to highlight the importance of identifying vulnerable older adults in the community who are at risk of fragility fractures secondary to osteomalacia. It should be recognised that not only osteoporosis but other factors can precipitate these fractures as well and that preventative measures should be undertaken in those individuals at risk. PMID:25666245

A fuzzy MICMAC analysis for improving supply chain performance of basic vaccines in developing countries.

PubMed

Chandra, Dheeraj; Kumar, Dinesh

2018-03-01

In recent years, demand to improve child immunization coverage globally, and the development of the latest vaccines and technology has made the vaccine market very complex. The rise in such complexities often gives birth to numerous issues in the vaccine supply chain, which are the primary cause of its poor performance. Figuring out the cause of the performance problem can help you decide how to address it. The goal of the present study is to identify and analyze important issues in the supply chain of basic vaccines required for child immunization in the developing countries. Twenty-five key issues as various factors of the vaccine supply chain have been presented in this paper. Fuzzy MICMAC analysis has been carried out to classify the factors based on their driving and dependence power and to develop a hierarchy based model. Further, the findings have been discussed with the field experts to identify the critical factors. Three factors: better demand forecast, communication between the supply chain members, and proper planning and scheduling have been identified as the critical factors of vaccine supply chain. These factors should be given special care to improve vaccine supply chain performance.

Causal Factors of Corruption in Construction Project Management: An Overview.

PubMed

Owusu, Emmanuel Kingsford; Chan, Albert P C; Shan, Ming

2017-11-11

The development of efficient and strategic anti-corruption measures can be better achieved if a deeper understanding and identification of the causes of corruption are established. Over the past years, many studies have been devoted to the research of corruption in construction management (CM). This has resulted in a significant increase in the body of knowledge on the subject matter, including the causative factors triggering these corrupt practices. However, an apropos systematic assessment of both past and current studies on the subject matter which is needful for the future endeavor is lacking. Moreover, there is an absence of unified view of the causative factors of corruption identified in construction project management (CPM). This paper, therefore, presents a comprehensive review of the causes of corruption from selected articles in recognized construction management journals to address the mentioned gaps. A total number of 44 causes of corruption were identified from 37 publications and analyzed in terms of existing causal factors of corruption, annual trend of publications and the thematic categorization of the identified variables. The most identifiable causes were over close relationships, poor professional ethical standards, negative industrial and working conditions, negative role models and inadequate sanctions. A conceptual framework of causes of corruption was established, after categorizing the 44 variables into five unique categories. In descending order, the five constructs are Psychosocial-Specific Causes, Organizational-Specific Causes, Regulatory-Specific Causes, Project-Specific Causes and Statutory-Specific Causes. This study extends the current literature of corruption research in construction management and contributes to a deepened understanding of the causal instigators of corruption identified in CPM. The findings from this study provide valuable information and extended knowledge to industry practitioners and policymakers as well as anti-corruption agencies in the formulation and direction of anti-corruption measures. To corruption researchers in CM, this study is vital for further research.

Placental stress and pre-eclampsia: a revised view.

PubMed

Redman, C W G; Sargent, I L

2009-03-01

In pre-eclampsia, poor placentation causes both oxidative and endoplasmic reticulum stress of the placenta. It is believed placental hypoxia stimulates excessive production of soluble fms-like tyrosine kinase 1 (sFlt-1), which binds and deactivates circulating vascular endothelial growth factor (VEGF). When maternal endothelium is deprived of VEGF it becomes dysfunctional hence leading to the clinical syndrome of the mother. In this paper the previous claim that poor placentation may predispose more to placental oxidative stress than hypoxia is reiterated. We show why pre-eclampsia is not only an endothelial disease, but also a disorder of systemic inflammation. We question that hypoxia is the only or indeed the main stimulus to release of sFlt-1; and emphasise the role of inflammatory mechanisms. Hypoxia cannot be assumed simply because hypoxia-inducible transcription factors (HIF) are upregulated. Concurrent assessments of nuclear factor-kappaB (NF-kappaB), a transcription factor for inflammatory responses are desirable to obtain a more complete picture. We point out that the pre-eclampsia placenta is the source of bioactive circulating factors other than sFlt-1 in concentrations that are much higher than in normal pregnancy. These may also contribute to the final inflammatory syndrome. We propose a modified version of the two-stage model for pre-eclampsia.

Factors involved in the etiology of temporomandibular disorders - a literature review

PubMed Central

CHISNOIU, ANDREA MARIA; PICOS, ALINA MONICA; POPA, SEVER; CHISNOIU, PETRE DANIEL; LASCU, LIANA; PICOS, ANDREI; CHISNOIU, RADU

2015-01-01

Background and aim This review aims at presenting a current view on the most frequent factors involved in the mechanisms causing temporomandibular disorders (TMD). Method We conducted a critical review of the literature for the period January 2000 to December 2014 to identify factors related to TMD development and persistence. Results The etiology of TMD is multidimensional: biomechanical, neuromuscular, bio-psychosocial and biological factors may contribute to the disorder. Occlusal overloading and parafunctions (bruxism) are frequently involved as biomechanical factors; increased levels of estrogen hormones are considered biological factors affecting the temporo-mandibular-joint. Among bio-psychosocial factors, stress, anxiety or depression, were frequently encountered. Conclusions The etiopathogenesis of this condition is poorly understood, therefore TMDs are difficult to diagnose and manage. Early and correct identification of the possible etiologic factors will enable the appropriate treatment scheme application in order to reduce or eliminate TMDs debilitating signs and symptoms. PMID:26732121

Factors associated with poor sleep during menopause: results from the Midlife Women's Health Study.

PubMed

Smith, Rebecca L; Flaws, Jodi A; Mahoney, Megan M

2018-05-01

Poor sleep is one of the most common problems reported during menopause, and is known to vary throughout the menopause transition. The objective of this study was to describe the dynamics of poor sleep among participants of the Midlife Women's Health Study and to identify risk factors associated with poor sleep during the menopausal transition. Annual responses to surveys that included questions about the frequency of sleep disturbances and insomnia were analyzed to determine the likelihood of persistent poor sleep throughout the menopausal transition and the correlation of responses to the different sleep-related questions, including frequency of restless sleep during the first year of the study. Responses to questions about a large number of potential risk factors were used to identify risk factors for poor sleep. Poor sleep in premenopause was not predictive of poor sleep in perimenopause, and poor sleep in perimenopause was not predictive of poor sleep in postmenopause. Frequencies of each of the measures of poor sleep were highly correlated. For all sleep outcomes, high frequency of depression was related to a high frequency of poor sleep. Vasomotor symptoms were also significantly related with a higher frequency of all poor sleep outcomes. A history of smoking was also associated with higher frequencies of insomnia and sleep disturbances. The risk factors identified for poor sleep, depression and vasomotor symptoms, were consistently associated with poor sleep throughout the menopausal transition. The likelihood of these risk factors changed from premenopause, through perimenopause, and into postmenopause, however, which could explain changes in sleep difficulties across the menopausal transition. Treatment of these risk factors should be considered when addressing sleep difficulties in menopausal women. Copyright © 2018 Elsevier B.V. All rights reserved.

[Multi-causality in nursing work accidents with biological material].

PubMed

Soares, Leticia Gramazio; Sarquis, Leila Maria Mansano; Kirchhof, Ana Lúcia Cardoso; Felli, Vanda Elisa Andres

2013-12-01

In order to analyze the multiple causes of occupational accidents with biological exposure among nursing staff was carried out a descriptive and exploratory research in a medium-sized hospital in the State of Paraná, in the period between January 2008 and January 2009. The population was 26 nursing staff of the medical clinic. Data collection was performed by semi-structured interviews with five of the eight injured in the period and its contents were analyzed by Causes and Effects Diagram. The categories of causes material, organizational, institutional and worker's behavior, showed the inappropriate disposal of sharps, work overload, no use of bio-security standards and poor supervision and training of workers, as factors for the occurrence of these accidents. The adoption of the tool of Causes and Effects Diagram provided an analysis of accidents in its multiple causes, showing the interaction between them.

Framing Progress In Global Tobacco Control To Inform Action On Noncommunicable Diseases.

PubMed

Wipfli, Heather L; Samet, Jonathan

2015-09-01

Much has been learned about the tobacco epidemic, including its consequences, effective measures to control it, and the actors involved. This article identifies lessons learned that are applicable to the other principal external causes of noncommunicable diseases: alcohol abuse, poor nutrition, and physical inactivity. Among these lessons are the development of evidence-based strategies such as proven cessation methods, tax increases, and smoke-free policies; the role of multinational corporations in maintaining markets and undermining control measures; and the need for strategies that reach across the life course and that begin with individuals and extend to higher levels of societal organization. Differences are also clear. Tobacco products are relatively homogeneous and have no direct benefit to consumers, whereas food and alcohol consumed in moderation are not inherently dangerous. Some tobacco-related diseases have the singular predominant cause of smoking, while many noncommunicable diseases have multiple interlocking causes such as poor diet, excess alcohol consumption, insufficient physical activity, and smoking, along with genetics. Thus, the tobacco control model of comprehensive multilevel strategies is applicable to the control of noncommunicable diseases, but the focus must be on multiple risk factors. Project HOPE—The People-to-People Health Foundation, Inc.

A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy.

PubMed

Bell, Kristie L; Boyd, Roslyn N; Tweedy, Sean M; Weir, Kelly A; Stevenson, Richard D; Davies, Peter S W

2010-04-06

Cerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may impact detrimentally on physical and cognitive development, health care utilisation, participation and quality of life in later childhood. The impact of modifiable factors (dietary intake and physical activity) on growth, nutritional status, and body composition (taking into account motor severity) in this population is poorly understood. This study aims to investigate the relationship between a range of factors - linear growth, body composition, oral motor and feeding dysfunction, dietary intake, and time spent sedentary (adjusting for motor severity) - and health outcomes, health care utilisation, participation and quality of life in young children with cerebral palsy (from corrected age of 18 months to 5 years). This prospective, longitudinal, population-based study aims to recruit a total of 240 young children with cerebral palsy born in Queensland, Australia between 1st September 2006 and 31st December 2009 (80 from each birth year). Data collection will occur at three time points for each child: 17 - 25 months corrected age, 36 +/- 1 months and 60 +/- 1 months. Outcomes to be assessed include linear growth, body weight, body composition, dietary intake, oral motor function and feeding ability, time spent sedentary, participation, medical resource use and quality of life. This protocol describes a study that will provide the first longitudinal description of the relationship between functional attainment and modifiable lifestyle factors (dietary intake and habitual time spent sedentary) and their impact on the growth, body composition and nutritional status of young children with cerebral palsy across all levels of functional ability.

A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy

PubMed Central

2010-01-01

Background Cerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may impact detrimentally on physical and cognitive development, health care utilisation, participation and quality of life in later childhood. The impact of modifiable factors (dietary intake and physical activity) on growth, nutritional status, and body composition (taking into account motor severity) in this population is poorly understood. This study aims to investigate the relationship between a range of factors - linear growth, body composition, oral motor and feeding dysfunction, dietary intake, and time spent sedentary (adjusting for motor severity) - and health outcomes, health care utilisation, participation and quality of life in young children with cerebral palsy (from corrected age of 18 months to 5 years). Design/Methods This prospective, longitudinal, population-based study aims to recruit a total of 240 young children with cerebral palsy born in Queensland, Australia between 1st September 2006 and 31st December 2009 (80 from each birth year). Data collection will occur at three time points for each child: 17 - 25 months corrected age, 36 ± 1 months and 60 ± 1 months. Outcomes to be assessed include linear growth, body weight, body composition, dietary intake, oral motor function and feeding ability, time spent sedentary, participation, medical resource use and quality of life. Discussion This protocol describes a study that will provide the first longitudinal description of the relationship between functional attainment and modifiable lifestyle factors (dietary intake and habitual time spent sedentary) and their impact on the growth, body composition and nutritional status of young children with cerebral palsy across all levels of functional ability. PMID:20370929

Fault architecture and deformation processes within poorly lithified rift sediments, Central Greece

NASA Astrophysics Data System (ADS)

Loveless, Sian; Bense, Victor; Turner, Jenni

2011-11-01

Deformation mechanisms and resultant fault architecture are primary controls on the permeability of faults in poorly lithified sediments. We characterise fault architecture using outcrop studies, hand samples, thin sections and grain-size data from a minor (1-10 m displacement) normal-fault array exposed within Gulf of Corinth rift sediments, Central Greece. These faults are dominated by mixed zones with poorly developed fault cores and damage zones. In poorly lithified sediment deformation is distributed across the mixed zone as beds are entrained and smeared. We find particulate flow aided by limited distributed cataclasis to be the primary deformation mechanism. Deformation may be localised in more competent sediments. Stratigraphic variations in sediment competency, and the subsequent alternating distributed and localised strain causes complexities within the mixed zone such as undeformed blocks or lenses of cohesive sediment, or asperities at the mixed zone/protolith boundary. Fault tip bifurcation and asperity removal are important processes in the evolution of these fault zones. Our results indicate that fault zone architecture and thus permeability is controlled by a range of factors including lithology, stratigraphy, cementation history and fault evolution, and that minor faults in poorly lithified sediment may significantly impact subsurface fluid flow.

How Individual and Contextual Factors Affects Antisocial and Delinquent Behaviors: A Comparison between Young Offenders, Adolescents at Risk of Social Exclusion, and a Community Sample

PubMed Central

Duran-Bonavila, Silvia; Vigil-Colet, Andreu; Cosi, Sandra; Morales-Vives, Fabia

2017-01-01

The problems associated with violence during adolescence have been on the rise in recent decades. Many studies have focused only on environmental causes or individual causes of violence, although a combination of both variables would seem to be the best option for prediction. The current study aims to assess the relevance of individual characteristics (personality traits, intelligence, and historical and clinical factors linked to the risk of violence), contextual risk factors and protective factors in explaining antisocial and delinquent behaviors in adolescence by comparing three different samples: a community sample, a sample at risk of social exclusion, and a sample of juvenile offenders. The results show that the samples at risk of social exclusion and the sample of juvenile offenders have a very similar profile in terms of personality traits and intelligence, although they differ from the community sample. However, these two samples do differ in such contextual variables as peer delinquency, poor parental management, community disorganization, or early caregiver disruption. PMID:29104551

How Individual and Contextual Factors Affects Antisocial and Delinquent Behaviors: A Comparison between Young Offenders, Adolescents at Risk of Social Exclusion, and a Community Sample.

PubMed

Duran-Bonavila, Silvia; Vigil-Colet, Andreu; Cosi, Sandra; Morales-Vives, Fabia

2017-01-01

The problems associated with violence during adolescence have been on the rise in recent decades. Many studies have focused only on environmental causes or individual causes of violence, although a combination of both variables would seem to be the best option for prediction. The current study aims to assess the relevance of individual characteristics (personality traits, intelligence, and historical and clinical factors linked to the risk of violence), contextual risk factors and protective factors in explaining antisocial and delinquent behaviors in adolescence by comparing three different samples: a community sample, a sample at risk of social exclusion, and a sample of juvenile offenders. The results show that the samples at risk of social exclusion and the sample of juvenile offenders have a very similar profile in terms of personality traits and intelligence, although they differ from the community sample. However, these two samples do differ in such contextual variables as peer delinquency, poor parental management, community disorganization, or early caregiver disruption.

Effectiveness of Oral Proficiency in English for Secondary Schools (OPS-English) Programme in Improving English Language Vocabulary among Secondary School Students

ERIC Educational Resources Information Center

Singh, Manesha Kaur Rajendra; Singh, Manjet Kaur Mehar; Eng, Lin Siew

2015-01-01

Speaking is an important skill that needs to be mastered as it is the best way to communicate with other people in order to deliver opinions and express ideas, but the fact is that secondary school students' ability in speaking English is low in Malaysia. It is caused by several factors such as lack of vocabulary, poor pronunciation, weak grammar…

The association of corporate work environment factors, health risks, and medical conditions with presenteeism among Australian employees.

PubMed

Musich, Shirley; Hook, Dan; Baaner, Stephanie; Spooner, Michelle; Edington, Dee W

2006-01-01

To investigate the impact of selected corporate environment factors, health risks, and medical conditions on job performance using a self-reported measure of presenteeism. A cross-sectional survey utilizing health risk appraisal (HRA) data merging presenteeism with corporate environment factors, health risks, and medical conditions. Approximately 8000 employees across ten diverse Australian corporations. Employees (N = 1523; participation rate, 19%) who completed an HRA questionnaire. Self-reported HRA data were used to test associations of defined adverse corporate environment factors with presenteeism. Stepwise multivariate logistic regression modeling assessed the relative associations of corporate environment factors, health risks, and medical conditions with increased odds of any presenteeism. Increased presenteeism was significantly associated with poor working conditions, ineffective management/leadership, and work/life imbalance (adjusting for age, gender, health risks, and medical conditions). In multivariate logistic regression models, work/life imbalance, poor working conditions, life dissatisfaction, high stress, back pain, allergies, and younger age were significantly associated with presenteeism. Although the study has some limitations, including a possible response bias caused by the relatively low participation rate across the corporations, the study does demonstrate significant associations between corporate environment factors, health risks, and medical conditions and self-reported presenteeism. The study provides initial evidence that health management programming may benefit on-the-job productivity outcomes if expanded to include interventions targeting work environments.

Soil erosion in developing countries: A politicoeconomic explanation

NASA Astrophysics Data System (ADS)

Thapa, Gopal B.; Weber, Karl E.

1991-07-01

Soil erosion is accelerating in developing countries of Asia, Africa, and Latin America. It has threatened the livelihood of millions of peasants, for agriculture is their economic mainstay. A probe into the forces causing erosion reveals that the elite’s resolve to accumulate ever more wealth and to maintain, consolidate, or expand their sociopolitical power and the necessity of the poor to fulfill their requirements of food, fuelwood, and fodder are the two major factors accelerating soil erosion. Unless the vast masses of poor people are integrated into the national mainstream through the implementation of equitable and redistributive development policies, it is impossible to control the accelerating rate of soil erosion and thus to achieve the objective of sustainable development.

Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.

PubMed

Lichtman, Judith H; Froelicher, Erika S; Blumenthal, James A; Carney, Robert M; Doering, Lynn V; Frasure-Smith, Nancy; Freedland, Kenneth E; Jaffe, Allan S; Leifheit-Limson, Erica C; Sheps, David S; Vaccarino, Viola; Wulsin, Lawson

2014-03-25

Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome. Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes. Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

Features and risk factors of nonfatal injury among the rural children: a survey of seven schools in a mountain area in Southwest China.

PubMed

Shi, Xiu-Quan; Qi, Yong-Hong; Shi, Dan; Yan, Cheng; Shi, Junxin; Cao, Bo-Ling; Liu, Dan; Luo, Li-Rong; Wang, Hai-Yan

2014-01-01

We aimed to investigate the patterns and risk factors of nonfatal injuries among rural mountain-area children in southwest China. A stratified sampling method was used to recruit rural children aged 8 to 17 years (mainly 9-14 years) from 7 schools. Self-reported injuries during the past 12 months and relevant concerns were collected from June to December 2012 by using a structured questionnaire in a class interview. The mean age of the 2,854 children was 12.2 ± 1.5 years. The probability of annual injury was 16.7% (95% confidence interval [95% CI] 15.3-18.1%), with slightly higher injury risk for boys than girls (17.7% vs. 16.0%; P>0.05). The top 3 causes of injuries were falls (37.3%), animal-related incidents (20.6%), and burns (14.9%). The main injury risk factors included being involved in a violent episode (odds ratio [OR] 1.34, 95% CI 1.08-1.66, P = 0.007), maltreatment by parents or guardians (1.42, 1.17-1.72, P<0.001), and being from a single-child family (1.30, 1.10-1.66, P = 0.039). Older age was a protective factor (0.81, 0.76-0.87, P<0.001). The incidence of nonfatal injury among rural children was high, and falls were the leading cause. Younger children and boys from poor-care and poor-living environments were at increased risk of injury, which requires urgent attention. Injury prevention programs targeting these issues are needed in this mountain area and similar rural regions of China.

Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance

PubMed Central

2013-01-01

Background Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors. Methods 100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs. Results Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1–3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance. Conclusions Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety. PMID:23578129

Features and Risk Factors of Nonfatal Injury among the Rural Children: A Survey of Seven Schools in a Mountain Area in Southwest China

PubMed Central

Shi, Xiu-Quan; Qi, Yong-Hong; Shi, Dan; Yan, Cheng; Shi, Junxin; Cao, Bo-Ling; Liu, Dan; Luo, Li-Rong; Wang, Hai-Yan

2014-01-01

Objective We aimed to investigate the patterns and risk factors of nonfatal injuries among rural mountain-area children in southwest China. Methods A stratified sampling method was used to recruit rural children aged 8 to 17 years (mainly 9–14 years) from 7 schools. Self-reported injuries during the past 12 months and relevant concerns were collected from June to December 2012 by using a structured questionnaire in a class interview. Results The mean age of the 2,854 children was 12.2±1.5 years. The probability of annual injury was 16.7% (95% confidence interval [95% CI] 15.3–18.1%), with slightly higher injury risk for boys than girls (17.7% vs. 16.0%; P>0.05). The top 3 causes of injuries were falls (37.3%), animal-related incidents (20.6%), and burns (14.9%). The main injury risk factors included being involved in a violent episode (odds ratio [OR] 1.34, 95% CI 1.08–1.66, P = 0.007), maltreatment by parents or guardians (1.42, 1.17–1.72, P<0.001), and being from a single-child family (1.30, 1.10–1.66, P = 0.039). Older age was a protective factor (0.81, 0.76–0.87, P<0.001). Conclusions The incidence of nonfatal injury among rural children was high, and falls were the leading cause. Younger children and boys from poor-care and poor-living environments were at increased risk of injury, which requires urgent attention. Injury prevention programs targeting these issues are needed in this mountain area and similar rural regions of China. PMID:25010712

Long-term outcome and risk factors for uncontrolled seizures after a first seizure in children with hematological malignancies.

PubMed

Khan, Raja B; Morris, E Brannon; Pui, Ching-Hon; Hudson, Melissa M; Zhou, Yinmei; Cheng, Cheng; Ledet, Davonna S; Howard, Scott C

2014-06-01

Long-term outcomes of seizures that develop during treatment of childhood hematological malignancies have not been described. We analyzed seizure outcome in 62 children with leukemia or lymphoma treated at our institution. There was a median follow-up of 6.5 years since first seizure. Seizure etiology included intrathecal or systemic methotrexate in 24, leucoencephalopathy in 11, brain hemorrhage or thrombosis in 11, meningitis in 4, and no identifiable cause in 12. Seizures remained uncontrolled in 18, and risk factors for poor control included female sex (P = .02), no seizure control with first antiseizure drug (P = .08), and longer interval between cancer diagnosis and seizure onset (P = .09). Poor seizure control after initial antiseizure drug also predicted recurrent seizure after drug withdrawal (P = .04). In conclusion, seizures are controlled with medications in a majority of patients with hematological cancer. After a period without seizures, antiseizure drug withdrawal in appropriately selected patient has a high success rate. © The Author(s) 2013.

Community-Acquired Meningitis in Older Adults: Clinical Features, Etiology, and Prognostic Factors

PubMed Central

Wang, Amy Y.; Machicado, Jorge D.; Khoury, Nabil T.; Wootton, Susan H.; Salazar, Lucrecia; Hasbun, Rodrigo

2014-01-01

Background Bacterial meningitis in older adults is a well-studied and serious disease, but few studies have investigated the epidemiology and outcomes of community-acquired meningitis in older adults. Methods We conducted a retrospective study of 619 adults in Houston, Texas, with community-acquired meningitis hospitalized between January 1, 2005, and January 1, 2010. Patients were categorized as older if age ≥65 (N=54) and younger if age 18–64 (N=565). An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. Results Older patients consisted of 8.7% (54/619) of the total cohort and had higher rates of comorbidities, abnormal neurological and laboratory findings, abnormalities on computed tomography and magnetic resonance imaging of the head and adverse clinical outcomes (ACO) (p<0.05). The majority of patients (65.8%) had meningitis of unknown etiology. Bacterial meningitis was an infrequent cause (7.4%). Of the known causes, bacterial meningitis and West Nile virus were more common in older patients. In contrast, younger patients more frequently had cryptococcal and viral meningitis. On logistic regression, female gender was predictive of a poor outcome in the older patients, whereas abnormal neurologic exam, fever, and CSF glucose <45mg/dLwere significant poor prognostic factors in younger patients (p<0.05). Conclusion Most cases of community-acquired meningitis are of unknown origin. Older patients are more likely to have bacterial meningitis and West Nile virus infection when a cause can be identified. They also have more neurologic abnormalities, laboratory and imaging abnormalities, as well as adverse clinical outcomes. PMID:25370434

Biomechanical factors associated with mandibular cantilevers: analysis with three-dimensional finite element models.

PubMed

Gonda, Tomoya; Yasuda, Daiisa; Ikebe, Kazunori; Maeda, Yoshinobu

2014-01-01

Although the risks of using a cantilever to treat missing teeth have been described, the mechanisms remain unclear. This study aimed to reveal these mechanisms from a biomechanical perspective. The effects of various implant sites, number of implants, and superstructural connections on stress distribution in the marginal bone were analyzed with three-dimensional finite element models based on mandibular computed tomography data. Forces from the masseter, temporalis, and internal pterygoid were applied as vectors. Two three-dimensional finite element models were created with the edentulous mandible showing severe and relatively modest residual ridge resorption. Cantilevers of the premolar and molar were simulated in the superstructures in the models. The following conditions were also included as factors in the models to investigate changes: poor bone quality, shortened dental arch, posterior occlusion, lateral occlusion, double force of the masseter, and short implant. Multiple linear regression analysis with a forced-entry method was performed with stress values as the objective variable and the factors as the explanatory variable. When bone mass was high, stress around the implant caused by differences in implantation sites was reduced. When bone mass was low, the presence of a cantilever was a possible risk factor. The stress around the implant increased significantly if bone quality was poor or if increased force (eg, bruxism) was applied. The addition of a cantilever to the superstructure increased stress around implants. When large muscle forces were applied to a superstructure with cantilevers or if bone quality was poor, stress around the implants increased.

Knowledge and Attitude Regarding Organ Donation among Relatives of Patients Referred to the Emergency Department

PubMed Central

Pouraghaei, Mahboob; Tagizadieh, Mohammad; Tagizadieh, Ali; Moharamzadeh, Payman; Esfahanian, Samaneh; Shahsavari Nia, Kavous

2015-01-01

Introduction: Organ donation is one of the surviving procedures, which can increase the life expectancy of end-stage patients. Inappropriate beliefs and attitude of individuals to organ donation, their poor knowledge, and the socio-economic level are one of the most important barriers for organ donation. Therefore, here knowledge and attitude levels among relatives of trauma patients regarding organ donation were evaluated. Methods: This cross-sectional study was done on relatives of trauma patients referred to the emergency department of Sina Hospital, Tabriz, Iran, through 2013 to 2014. The questionnaire included parts of demographic data and socio-economic situations as well as status of knowledge and attitude regarding organ donation. A score between 0-7 was belonged to each person based on his/her level of knowledge. Attitude level had a score between 0-12. Chi- square, Fisher, and Mann–Whitney U test were performed to assess the relation between demographic variables and the level of knowledge and attitude. P<0.05 was considered as a significant level. Results: 79 persons (57.1% male) with the mean age of 31.3±11.3 years were evaluated. 57 (73.1%) of subjects agreed with organ transplant. The main causes of disagreement among relatives regarding organ donation were dissatisfaction of the donor's relatives (25%) and religious issues (15%). 49 (62.02%) studied people had inappropriate attitude and 27 (34.2%) ones had good knowledge. male gender (OR=5.87; 95%CI: 3.32-8.42; p=0.001) and self-employed job (OR=7.78; 95%CI: 4.64-10.92; p=0.001) are independent factors associated with poor knowledge about organ donation. Self-employed job (OR=3.86; 95%CI: 1.41-6.11; p=0.009) and poor knowledge (OR=15.3; 95%CI: 9.03-21.57; p<0.001) were related to inappropriate attitude toward organ donation. Conclusion: The present study showed that 73.1% of participants agreed with organ donation. The major causes of disagreements were dissatisfaction of other relatives and religious beliefs. 62.0% of the studied people had positive view regarding organ donation and 34.2% of them well informed about. The most important causative factors for poor knowledge in this context were male gender and self-employed occupation. In addition, poor knowledge and self-employed job were two factors associated with inappropriate attitude toward organ donation. PMID:26512367

The less healthy urban population: income-related health inequality in China.

PubMed

Yang, Wei; Kanavos, Panos

2012-09-18

Health inequality has been recognized as a problem all over the world. In China, the poor usually have less access to healthcare than the better-off, despite having higher levels of need. Since the proportion of the Chinese population living in urban areas increased tremendously with the urbanization movements, attention has been paid to the association between urban/rural residence and population health. It is important to understand the variation in health across income groups, and in particular to take into account the effects of urban/rural residence on the degree of income-related health inequalities. This paper empirically assesses the magnitude of rural/urban disparities in income-related adult health status, i.e., self-assessed health (SAH) and physical activity limitation, using Concentration Indices. It then uses decomposition methods to unravel the causes of inequalities and their variations across urban and rural populations. Data from the China Health and Nutrition Survey (CHNS) 2006 are used. The study finds that the poor are less likely to report their health status as "excellent or good" and are more likely to have physical activity limitation. Such inequality is more pronounced for the urban population than for the rural population. Results from the decomposition analysis suggest that, for the urban population, 76.47 per cent to 79.07 per cent of inequalities are driven by non-demographic/socioeconomic-related factors, among which income, job status and educational level are the most important factors. For the rural population, 48.19 per cent to 77.78 per cent of inequalities are driven by non-demographic factors. Income and educational attainment appear to have a prominent influence on inequality. The findings suggest that policy targeting the poor, especially the urban poor, is needed in order to reduce health inequality.

The less healthy urban population: income-related health inequality in China

PubMed Central

2012-01-01

Background Health inequality has been recognized as a problem all over the world. In China, the poor usually have less access to healthcare than the better-off, despite having higher levels of need. Since the proportion of the Chinese population living in urban areas increased tremendously with the urbanization movements, attention has been paid to the association between urban/rural residence and population health. It is important to understand the variation in health across income groups, and in particular to take into account the effects of urban/rural residence on the degree of income-related health inequalities. Methods This paper empirically assesses the magnitude of rural/urban disparities in income-related adult health status, i.e., self-assessed health (SAH) and physical activity limitation, using Concentration Indices. It then uses decomposition methods to unravel the causes of inequalities and their variations across urban and rural populations. Data from the China Health and Nutrition Survey (CHNS) 2006 are used. Results The study finds that the poor are less likely to report their health status as “excellent or good” and are more likely to have physical activity limitation. Such inequality is more pronounced for the urban population than for the rural population. Results from the decomposition analysis suggest that, for the urban population, 76.47 per cent to 79.07 per cent of inequalities are driven by non-demographic/socioeconomic-related factors, among which income, job status and educational level are the most important factors. For the rural population, 48.19 per cent to 77.78 per cent of inequalities are driven by non-demographic factors. Income and educational attainment appear to have a prominent influence on inequality. Conclusion The findings suggest that policy targeting the poor, especially the urban poor, is needed in order to reduce health inequality. PMID:22989200

Beliefs and perceptions about the causes of breast cancer: a case-control study.

PubMed

Thomson, Allyson K; Heyworth, Jane S; Girschik, Jennifer; Slevin, Terry; Saunders, Christobel; Fritschi, Lin

2014-08-21

Attributions of causality are common for many diseases, including breast cancer. The risk of developing breast cancer can be reduced by modifications to lifestyle and behaviours to minimise exposure to specific risk factors, such as obesity. However, these modifications will only occur if women believe that certain behaviours/lifestyle factors have an impact on the development of breast cancer. The Breast Cancer, Environment and Employment Study is a case-control study of breast cancer conducted in Western Australia between 2009 and 2011. As part of the study 1109 women with breast cancer and 1633 women without the disease completed a Risk Perception Questionnaire in which they were asked in an open-ended question for specific cause/s to the development of breast cancer in themselves or in others. The study identified specific causal beliefs, and assessed differences in the beliefs between women with and without breast cancer. The most common attributions in women without breast cancer were to familial or inherited factors (77.6%), followed by lifestyle factors, such as poor diet and smoking (47.1%), and environmental factors, such as food additives (45.4%). The most common attributions in women with breast cancer were to mental or emotional factors (46.3%), especially stress, followed by lifestyle factors (38.6%) and physiological factors (37.5%), particularly relating to hormonal history. While the majority of participants in this study provided one or more causal attributions for breast cancer, many of the reported risk factors do not correspond to those generally accepted by the scientific community. These misperceptions could be having a significant impact on the success of prevention and early detection programs that seek to minimise the pain and suffering caused by this disease. In particular, women who have no family history of the disease may not work to minimise their exposure to the modifiable risk factors.

The Potential Role of the Proteases Cathepsin D and Cathepsin L in the Progression and Metastasis of Epithelial Ovarian Cancer

PubMed Central

Pranjol, Md Zahidul Islam; Gutowski, Nicholas; Hannemann, Michael; Whatmore, Jacqueline

2015-01-01

Epithelial ovarian cancer (EOC) is the leading cause of death from gynecologic malignancies and has a poor prognosis due to relatively unspecific early symptoms, and thus often advanced stage, metastasized cancer at presentation. Metastasis of EOC occurs primarily through the transcoelomic route whereby exfoliated tumor cells disseminate within the abdominal cavity, particularly to the omentum. Primary and metastatic tumor growth requires a pool of proangiogenic factors in the microenvironment which propagate new vasculature in the growing cancer. Recent evidence suggests that proangiogenic factors other than the widely known, potent angiogenic factor vascular endothelial growth factor may mediate growth and metastasis of ovarian cancer. In this review we examine the role of some of these alternative factors, specifically cathepsin D and cathepsin L. PMID:26610586

Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda.

PubMed

Kasamba, Nassar; Kaye, Dan K; Mbalinda, Scovia N

2013-12-10

Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse.

Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda

PubMed Central

2013-01-01

Background Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. Methods A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. Results The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Conclusion Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse. PMID:24321441

Leishmania (Viannia) guyanensis in tegumentary leishmaniasis.

PubMed

Borges, Arissa Felipe; Gomes, Rodrigo Saar; Ribeiro-Dias, Fátima

2018-06-01

Leishmania (Viannia) guyanensis is a causal agent of American tegumentary leishmaniasis (ATL). This protozoan has been poorly investigated; however, it can cause different clinical forms of ATL, ranging from a single cutaneous lesion to severe lesions that can lead to destruction of the nasopharyngeal mucosa. L. (V.) guyanensis and the disease caused by this species can present unique aspects revealing the need to better characterize this parasite species to improve our knowledge of the immunopathological mechanisms and treatment options for ATL. The mechanisms by which some patients develop a more severe form of ATL remain unclear. It is known that the host immune profile and parasite factors may influence the clinical manifestations of the disease. Besides intrinsic parasite factors, Leishmaniavirus RNA 1 (LRV1) infecting L. guyanensis can contribute to ATL immunopathogenesis. In this review, general aspects of L. guyanensis infection in humans and mouse models are presented.

Assessment of infection control practices in teaching hospitals of Quetta.

PubMed

Anwar, Muhammad; Majeed, Abdul; Saleem, Rana Muhammad; Manzoor, Farkhanda; Sharif, Saima

2016-08-01

To identify the gaps in infection control and prevention practices in teaching hospitals. This cross-sectional study was conducted at Bolan Medical Complex and Sandeman Medical College Hospital, Quetta, from August 2012 to January 2013.The study comprised members (n=7) of infection control committee who were interviewed through a self-developed, closed-ended questionnaire and their perception regarding infection control and prevention was recorded. Data was analysed using SPSS 16. Only 3(42.9%) of the committee members believed that the administrative factors for causing hospital-acquired infections were nurse-patient ratio. On the patient care side, 1(14.3%) participants at one of the hospitals attributed infections to antibiotic use, 5(71.4%) to invasive medical device and 1(14.3%) to other factors. Poor perception held by the members of infection control committee was the basic cause of bad outcome. Capacity-building of all the stakeholders is required.

Age-associated chronic diseases require age-old medicine: role of chronic inflammation.

PubMed

Prasad, Sahdeo; Sung, Bokyung; Aggarwal, Bharat B

2012-05-01

Most chronic diseases--such as cancer, cardiovascular disease (CVD), Alzheimer disease, Parkinson disease, arthritis, diabetes and obesity--are becoming leading causes of disability and death all over the world. Some of the most common causes of these age-associated chronic diseases are lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption. All the risk factors linked to these chronic diseases have been shown to up-regulate inflammation. Therefore, downregulation of inflammation-associated risk factors could prevent or delay these age-associated diseases. Although modern science has developed several drugs for treating chronic diseases, most of these drugs are enormously expensive and are associated with serious side effects and morbidity. In this review, we present evidence on how chronic inflammation leads to age-associated chronic disease. Furthermore, we discuss diet and lifestyle as solutions for age-associated chronic disease. Published by Elsevier Inc.

[Clinical aspects and prognostic factors of icterohemorrhagic leptospirosis in adults. Apropos of 249 cases in La Reunion].

PubMed

Pertuiset, E; Fen Chong, M; Duval, G; Génin, R

1988-01-01

Human leptospirosis of the classical and severe icterohemorrhagic type, usually due to the L. icterohaemorrhagiae serogroup, is frequent in La Réunion. In a retrospective study conducted between 1980 and 1984 in 249 adult patients, the mortality rate was 13 p. 100. Our data and those found in the literature indicate that the main cause of death is pneumopathy, followed by profuse haemorrhages, arrhythmias and cardiovascular collapse. Acute renal failure is common and often severe; it facilitates gastrointestinal bleeding and is of poor prognosis, particularly in patients with prolonged anuria, a possible cause of lethal hyperkalaemia. Other factors of unfavourable outcome have been demonstrated statistically; they include disturbances of consciousness, hypoprothrombinaemia, epigastric muscle rigidity, hyperleukocytosis, thrombocytopenia, high aspartate aminotransferase levels and chronic alcoholism. At the moment, pulmonary, cardiac and haemorrhagic complications concur with renal failure to darken the prognosis of these severe forms of leptospirosis.

Health locus of control and attributions of cause and blame in adjustment to spinal cord injury.

PubMed

Waldron, B; Benson, C; O'Connell, A; Byrne, P; Dooley, B; Burke, T

2010-08-01

The Symptom Checklist 90 Revised (SCL-90-R) was used to assign participants to either a good adjustment group or a poor adjustment group. Group differences were analyzed with chi (2), t-tests and correlations on factors shown in previous research to be related to coping with spinal cord injury (SCI). This study examines health locus of control (HLC) and attributions of cause and blame in relation to SCI. The replication of study findings in multiple settings is a cornerstone of the evidence base for developing interventions. Previous studies do not show a consensus on the role of attributions of cause and blame in persons with SCI. Similarly, their relationship to adjustment after SCI is unclear. Another attribution, HLC, is similarly analyzed in relation to adjustment. Republic of Ireland. Thirty people with SCI participated. They rated scales measuring psychological adjustment, locus of control (LOC) for health and attributions of cause and blame for the injury. The well-adjusted group had a less external HLC. In addition, participants who were well adjusted endorsed the notion they could have avoided their accident significantly more than the poorly adjusted group. Similarly, they rated the belief that they could have caused the accident at a somewhat greater level. They did not, however, blame themselves any more or any less. Results are consistent with general LOC theory, and suggest an adaptive or protective internal LOC for accepting responsibility for the injury.

Protein energy malnutrition in India: the plight of our under five children.

PubMed

Bhutia, Dechenla Tshering

2014-01-01

Protein energy malnutrition (PEM) is a major public health problem in India. This affects the child at the most crucial period of time of development, which can lead to permanent impairment in later life. PEM is measured in terms of underweight (low weight for age), stunting (low height for age) and wasting (low weight for height). The prevalence of stunting among under five is 48% and wasting is 19.8% and with an underweight prevalence of 42.5%, it is the highest in the world. Undernutrition predisposes the child to infection and complements its effect in contributing to child mortality. Lalonde model (1974) is used to look into the various determinants of PEM in under five children and its interrelation in causation of PEM. The determinants of PEM are broadly classified under four distinct categories: Environmental factors including the physical and social environment, behavioral factors, health-care service related and biological factors. The socio-cultural factors play an important role wherein, it affects the attitude of the care giver in feeding and care practices. Faulty feeding practice in addition to poor nutritional status of the mother further worsens the situation. The vicious cycle of poor nutritional status of the mother leading to low birth weight child further exposes the child to susceptibility to infections which aggravates the situation. However, it is seen that percapita income of the family did not have much bearing on the poor nutritional status of the child rather lack of proper health-care services adversely contributed to poor nutritional status of the child. PEM is a critical problem with many determinants playing a role in causing this vicious cycle of undernutrition. With almost half of under five children undernourished in India, the Millennium Development Goal (MDG) of halving the prevalence of underweight by 2015 seems a distant dream.

Maternal conditions and perinatal characteristics associated with autism spectrum disorder and intellectual disability.

PubMed

Langridge, Amanda T; Glasson, Emma J; Nassar, Natasha; Jacoby, Peter; Pennell, Craig; Hagan, Ronald; Bourke, Jenny; Leonard, Helen; Stanley, Fiona J

2013-01-01

As well as being highly comorbid conditions, autism spectrum disorders (ASD) and intellectual disability (ID) share a number of clinically-relevant phenomena. This raises questions about similarities and overlap in diagnosis and aetiological pathways that may exist for both conditions. To examine maternal conditions and perinatal factors for children diagnosed with an ASD, with or without ID, and children with ID of unknown cause, compared with unaffected children. The study population comprised all live singleton births in Western Australia (WA) between January 1984 and December 1999 (N = 383,153). Univariate and multivariate multinomial logistic regression models were applied using a blocked modelling approach to assess the effect of maternal conditions, sociodemographic factors, labour and delivery characteristics and neonatal outcomes. In univariate analyses mild-moderate ID was associated with pregnancy hypertension, asthma, urinary tract infection, some types of ante-partum haemorrhage, any type of preterm birth, elective C-sections, breech presentation, poor fetal growth and need for resuscitation at birth, with all factors showing an increased risk. Severe ID was positively associated with poor fetal growth and need for resuscitation, as well as any labour or delivery complication. In the multivariate analysis no maternal conditions or perinatal factors were associated with an increased risk of ASD without ID. However, pregnancy hypertension and small head circumference were associated with a reduced risk (OR = 0.64, 95% CI: 0.43, 0.94; OR = 0.58, 95% CI: 0.34, 0.96, respectively). For ASD with ID, threatened abortion before 20 weeks gestation and poor fetal growth were associated with an increased risk. Findings show that indicators of a poor intrauterine environment are associated with an elevated risk of ID, while for ASD, and particularly ASD without ID, the associations are much weaker. As such, these findings highlight the importance of accounting for the absence or presence of ID when examining ASD, if we are to improve our understanding of the causal pathways associated with these conditions.

Logic Learning Machine creates explicit and stable rules stratifying neuroblastoma patients

PubMed Central

2013-01-01

Background Neuroblastoma is the most common pediatric solid tumor. About fifty percent of high risk patients die despite treatment making the exploration of new and more effective strategies for improving stratification mandatory. Hypoxia is a condition of low oxygen tension occurring in poorly vascularized areas of the tumor associated with poor prognosis. We had previously defined a robust gene expression signature measuring the hypoxic component of neuroblastoma tumors (NB-hypo) which is a molecular risk factor. We wanted to develop a prognostic classifier of neuroblastoma patients' outcome blending existing knowledge on clinical and molecular risk factors with the prognostic NB-hypo signature. Furthermore, we were interested in classifiers outputting explicit rules that could be easily translated into the clinical setting. Results Shadow Clustering (SC) technique, which leads to final models called Logic Learning Machine (LLM), exhibits a good accuracy and promises to fulfill the aims of the work. We utilized this algorithm to classify NB-patients on the bases of the following risk factors: Age at diagnosis, INSS stage, MYCN amplification and NB-hypo. The algorithm generated explicit classification rules in good agreement with existing clinical knowledge. Through an iterative procedure we identified and removed from the dataset those examples which caused instability in the rules. This workflow generated a stable classifier very accurate in predicting good and poor outcome patients. The good performance of the classifier was validated in an independent dataset. NB-hypo was an important component of the rules with a strength similar to that of tumor staging. Conclusions The novelty of our work is to identify stability, explicit rules and blending of molecular and clinical risk factors as the key features to generate classification rules for NB patients to be conveyed to the clinic and to be used to design new therapies. We derived, through LLM, a set of four stable rules identifying a new class of poor outcome patients that could benefit from new therapies potentially targeting tumor hypoxia or its consequences. PMID:23815266

Logic Learning Machine creates explicit and stable rules stratifying neuroblastoma patients.

PubMed

Cangelosi, Davide; Blengio, Fabiola; Versteeg, Rogier; Eggert, Angelika; Garaventa, Alberto; Gambini, Claudio; Conte, Massimo; Eva, Alessandra; Muselli, Marco; Varesio, Luigi

2013-01-01

Neuroblastoma is the most common pediatric solid tumor. About fifty percent of high risk patients die despite treatment making the exploration of new and more effective strategies for improving stratification mandatory. Hypoxia is a condition of low oxygen tension occurring in poorly vascularized areas of the tumor associated with poor prognosis. We had previously defined a robust gene expression signature measuring the hypoxic component of neuroblastoma tumors (NB-hypo) which is a molecular risk factor. We wanted to develop a prognostic classifier of neuroblastoma patients' outcome blending existing knowledge on clinical and molecular risk factors with the prognostic NB-hypo signature. Furthermore, we were interested in classifiers outputting explicit rules that could be easily translated into the clinical setting. Shadow Clustering (SC) technique, which leads to final models called Logic Learning Machine (LLM), exhibits a good accuracy and promises to fulfill the aims of the work. We utilized this algorithm to classify NB-patients on the bases of the following risk factors: Age at diagnosis, INSS stage, MYCN amplification and NB-hypo. The algorithm generated explicit classification rules in good agreement with existing clinical knowledge. Through an iterative procedure we identified and removed from the dataset those examples which caused instability in the rules. This workflow generated a stable classifier very accurate in predicting good and poor outcome patients. The good performance of the classifier was validated in an independent dataset. NB-hypo was an important component of the rules with a strength similar to that of tumor staging. The novelty of our work is to identify stability, explicit rules and blending of molecular and clinical risk factors as the key features to generate classification rules for NB patients to be conveyed to the clinic and to be used to design new therapies. We derived, through LLM, a set of four stable rules identifying a new class of poor outcome patients that could benefit from new therapies potentially targeting tumor hypoxia or its consequences.

Numerical Ergonomics Analysis in Operation Environment of CNC Machine

NASA Astrophysics Data System (ADS)

Wong, S. F.; Yang, Z. X.

2010-05-01

The performance of operator will be affected by different operation environments [1]. Moreover, poor operation environment may cause health problems of the operator [2]. Physical and psychological considerations are two main factors that will affect the performance of operator under different conditions of operation environment. In this paper, applying scientific and systematic methods find out the pivot elements in the field of physical and psychological factors. There are five main factors including light, temperature, noise, air flow and space that are analyzed. A numerical ergonomics model has been built up regarding the analysis results which can support to advance the design of operation environment. Moreover, the output of numerical ergonomic model can provide the safe, comfortable, more productive conditions for the operator.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Virtanen, H.E.; Rajpert-De Meyts, E.; Main, K.M.

Patients with 45,X0/46XY karyotype often present with intersex phenotype and testicular dysgenesis. These patients may also have undescended testes (cryptorchidism), hypospadias and their spermatogenesis is severely disrupted. They have a high risk for testicular cancer. These patients have the most severe form of testicular dysgenesis syndrome (TDS). We have hypothesized that testicular cancer, cryptorchidism, hypospadias and poor spermatogenesis are all signs of a developmental disturbance that was named as testicular dysgenesis syndrome. The hypothesis is based on clinical and epidemiological findings and on biological and experimental evidence. Signs of TDS share several risk factors, such as small birth weight (particularlymore » being small for gestational age), and they are risk factors for each other. All of them have background in fetal development. They show strong epidemiological links so that countries with high incidence of testicular cancer, such as Denmark, tend to also have high prevalence rates of cryptorchidism and hypospadias and poor semen quality. Vice versa, in countries with good male reproductive health, e.g., in Finland, all these aspects are better than in Denmark. Although genetic abnormalities can cause these disorders, in the majority of cases, the reasons remain unclear. Adverse trends in the incidence of male reproductive disorders suggest that environmental and life style factors contribute to the problem. Endocrine disrupters are considered as prime candidates for environmental influence. Fetal exposure to high doses of dibutyl phthalate was shown to cause a TDS-like phenotype in the rats. Studies are underway to assess whether there is any exposure-outcome relation with selected chemicals (persistent organic pollutants, pesticides, phthalates) and cryptorchidism00.« less

Substance use and risk of death in young offenders: a prospective data linkage study.

PubMed

Kinner, Stuart A; Degenhardt, Louisa; Coffey, Carolyn; Hearps, Stephen; Spittal, Matthew; Sawyer, Susan M; Patton, George C

2015-01-01

Young offenders are at increased risk of preventable death after release from custody, but risk factors for death in this population are poorly understood. Despite their poor health profiles, no studies have examined mortality outcomes in young people who have served community-based orders. The aims of this study were to describe the causes and identify risk factors for death in a cohort of young offenders in Victoria, Australia. We interviewed young people serving a custodial (n = 273) or community-based order (n = 242) in Victoria, Australia in 2002-2003. Measures included demographics and family history, offence history, experience of victimisation, mental illness, self-harm and substance use. Deaths up to 31 December 2011 were identified through a probabilistic linkage with the National Death Index. The all-cause crude mortality rate was 4.2 (95% confidence interval 2.7-6.8) per 1000 person years and was not significantly different for those who had served custodial and community-based orders. Most deaths were due to drug overdose, traffic accidents or suicide. Adjusting for age, sex and order type, risk factors for death from the baseline interview included weekly use of opioids, sleeping pills or painkillers, polydrug use and injecting drug use. Young people who have served community-based and custodial orders are at an increased risk of preventable death. Those engaging in risky substance use, particularly injecting drug use and use of multiple central nervous system depressants, are at greatest risk. There is an urgent need to develop and rigorously evaluate preventive interventions. © 2014 Australasian Professional Society on Alcohol and other Drugs.

[Diagnosis and treatment guidelines for difficult-to-control asthma in children].

PubMed

Navarro Merino, M; Andrés Martín, A; Asensio de la Cruz, O; García García, M L; Liñán Cortes, S; Villa Asensi, J R

2009-12-01

Children suffering from difficult-to-control asthma (DCA) require frequent appointments with their physician, complex treatment regimes and often admissions to hospital. Less than 5% of the asthmatic population suffer this condition. DCA must be correctly characterised to rule out false causes of DCA and requires making a differential diagnosis from pathologies that mimic asthma, comorbidity, environmental and psychological factors, and analysing the factors to determine poor treatment compliance. In true DCA cases, inflammation studies (exhaled nitric oxide, induced sputum, broncho-alveolar lavage and bronchial biopsy), pulmonary function and other clinical aspects can classify DCA into different phenotypes which could make therapeutic decision-making easier.

Osteomalacia: a forgotten cause of fractures in the elderly.

PubMed

Rokan, Z; Kealey, W D

2015-02-09

We present a case of a man who suffered bilateral neck of femur fractures secondary to osteomalacia, attributable to a combination of his reclusive lifestyle, poor diet and long-term anticonvulsant therapy. These fractures may have been prevented if certain risk factors had been identified early. This case aims to highlight the importance of identifying vulnerable older adults in the community who are at risk of fragility fractures secondary to osteomalacia. It should be recognised that not only osteoporosis but other factors can precipitate these fractures as well and that preventative measures should be undertaken in those individuals at risk. 2015 BMJ Publishing Group Ltd.

Uterine atony: definition, prevention, nonsurgical management, and uterine tamponade.

PubMed

Breathnach, Fionnuala; Geary, Michael

2009-04-01

Uterine atony, or failure of the uterus to contract following delivery, is the most common cause of postpartum hemorrhage. This review serves to examine the prevention and treatment of uterine atony, including risk-factor recognition and active management of the third stage of labor. A range of uterotonic agents will be compared for efficacy, safety, and ease of administration. Oxytocin and ergot alkaloids represent the cornerstone of uterotonic therapy, while prostaglandin therapy has been studied more recently as an attractive alternative, particularly for resource-poor settings. Newer supplementary medical therapies, such as recombinant factor VII and hemostatic agents, and adjunctive nonsurgical methods aimed at achieving uterine tamponade will be evaluated.

Epidemiologic characteristics, knowledge and risk factors of unintentional burns in rural children in Zunyi, Southwest China

PubMed Central

Shi, Shangpeng; Yang, Huajun; Hui, Ya; Zhou, Xiang; Wang, Tao; Luo, Ya; Xiang, Huiyun; Shi, Xiuquan

2016-01-01

We investigated the knowledge level and risk factors for pediatric unintentional burns in rural Southwest China with an aim to provide basic evidence for the prevention strategies. A stratified sampling method was used to recruit 1842 rural children from 9 schools. Self-reported burns during the past 12 months and relevant risk factors were collected by questionnaires. The burn incidence of all surveyed children was 12.7% (95% confidence interval [95% CI] 11.2–14.2%). We found that burn incidence had a trend to increase with the increasing school grade level and a trend to decrease with increasing knowledge scores on burns. The top two causes of burns were hot liquids (36.3%) and hot object (29.5%). More than 30% of children had little knowledge about preventive measures and how to give first-aid after burns. The main risk factors for burns included female gender, left-behind children by parents who were working in cities, and poor mother school education level. As the incidence of pediatric unintentional burns was high in rural southwest China, schools, families, and local public health agencies should put efforts into health education targeting burn prevention and first-aid measures after burns, particularly in “left-behind” children and those with mothers with poor education. PMID:27748426

Identifying the determinants of tuberculosis control in resource-poor countries: insights from a qualitative study in The Gambia.

PubMed

Harper, M; Ahmadu, F A; Ogden, J A; McAdam, K P; Lienhardt, C

2003-01-01

Despite the availability of effective treatment, tuberculosis (TB) remains a major cause of death from an infectious disease in the world, particularly in resource-poor countries. Among the chief reasons for this are deficiencies in case tracing and in adherence to treatment. In order to investigate the contribution of non-biological factors to these deficiencies, we carried out a qualitative study in The Gambia, West Africa, from October 2000 to March 2001. The methods used were focus group discussions, interviews, participant and non-participant observation, and case histories. Four domains were distinctively investigated: the TB patients, the community, the health care providers (including programme staff), and the donors and policy makers. Analysis of the data from all these sources indicated the contribution of a wide range of socio-anthropological factors which influence the success or otherwise of the TB control programme in The Gambia, i.e. gender, urban/rural residence, recourse to traditional healers, adherence to national health policies, knowledge about TB, migration, and socio-economic factors. It is concluded that all these factors must be taken into account in formulating interventions to improve detection of TB cases and patient adherence to treatment within the framework of the national TB control programmes, and proposals have been made for targeted interventions.

A Q methodology study of perceptions of poverty among midwestern nursing students.

PubMed

Work, Janel; Hensel, Desiree; Decker, Kim A

2015-02-01

Providing patient-centered care involves understanding how social factors, including poverty, affect health outcomes. The purpose of this study was to explore nursing students' beliefs surrounding the poor. A Q methodology design was used to discover patterns of perceptions towards those living in poverty. The study took place on two campuses of a large public, university in the Midwestern United States. The purposeful sample of 23 Q participants was drawn from students enrolled in the second, third, and final year of study in a baccalaureate nursing program. Participants rank-ordered their level of agreement with a set of 30 statements regarding poverty. Data were analyzed by a three-step process that included correlating participant profiles, performing factor analysis, and generating factor scores. A factor array and narrative were used to explain the findings. Three viewpoints were identified: Judges who tended to feel that poverty was linked to individual behavior; Allies who mostly saw societal reasons for poverty and felt a strong need to assist the poor, and Observers who did not blame individual for their circumstances, but were not as compelled to champion their cause. Given these different perspectives, educators may need to use variety of teaching approaches to help students achieve patient-centered care competencies with their poorest patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Endophthalmitis caused by Fusarium: An emerging problem in patients with corneal trauma. A case series.

PubMed

Barrios Andrés, José Luis; López-Soria, Leyre Mónica; Alastruey Izquierdo, Ana; Echevarría Ecenarro, Jaime; Feijoó Lera, Raquel; Garrido Fierro, Jesus; Cabrerizo Nuñez, Francisco Javier; Canut Blasco, Andrés

Although fortunately very rare in countries with a temperate climate, certain factors, such as clinical or pharmacological immunosuppression, may cause Fusarium-related fungal infections to become an emerging problem. Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers. The aim of this series of clinical cases is to identify characteristic clinical findings that may allow an early diagnosis and more efficient management of this ophthalmologic emergency. Three cases of endophthalmitis due to Fusarium solani and Fusarium oxysporum, diagnosed in 2009, 2010, and 2014 in patients from two different health regions belonging to the same health system and separated by around 43 miles, are presented. The Fusarium isolates were initially identified microscopically and the species subsequently confirmed by sequencing the elongation factor alpha (EFα) and internal transcribed spacers (ITS). Susceptibility to antifungal agents was determined using the EUCAST broth dilution method. Evolution was poor as two of the three patients progressed to phthisis bulbi despite surgical measures and broad-spectrum antifungal antibiotic therapy. It is essential to rapidly instigate multidisciplinary measures to combat suspected endophthalmitis due to Fusarium given the poor prognosis of this type of infection. Copyright © 2018 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

Influence of environmental factors on mental health within prisons: focus group study.

PubMed

Nurse, Jo; Woodcock, Paul; Ormsby, Jim

2003-08-30

To increase understanding of how the prison environment influences the mental health of prisoners and prison staff. Qualitative study with focus groups. A local prison in southern England. Prisoners and prison staff. Prisoners reported that long periods of isolation with little mental stimulus contributed to poor mental health and led to intense feelings of anger, frustration, and anxiety. Prisoners said they misused drugs to relieve the long hours of tedium. Most focus groups identified negative relationships between staff and prisoners as an important issue affecting stress levels of staff and prisoners. Staff groups described a "circle of stress," whereby the prison culture, organisation, and staff shortages caused high staff stress levels, resulting in staff sickness, which in turn caused greater stress for remaining staff. Staff shortages also affected prisoners, who would be locked up for longer periods of time, the ensuing frustration would then be released on staff, aggravating the situation still further. Insufficient staff also affected control and monitoring of bullying and reduced the amount of time in which prisoners were able to maintain contact with their families. Greater consideration should be given to understanding the wider environmental and organisational factors that contribute to poor mental health in prisons. This information can be used to inform prison policy makers and managers, and the primary care trusts who are beginning to work in partnership with prisons to improve the mental health of prisoners.

Maxillary post-traumatic outcome correction literature review and our experience. Part I: maxillary bone non-unions-"poor bone positioning".

PubMed

D'Agostino, A; Toffanetti, G; Scala, R; Trevisiol, L; Ferrari, F

2004-04-01

Still today, there is no classification of non-unions in maxillofacial traumatology. There is a broad spectrum of definitions that simultaneously describe the pathological conditions and functional implications determined by the anatomical location of the fractures and the time factor. In this article the authors describe a literature review about bone non-union classification. Weber, in 1973, introduced the term "pseudo-arthrosis" to describe an altered process of bone healing characterised by the presence of fibrous tissue interposed between the fracture segments, that was lined with cartilaginous tissue and joined by a capsule; Spiessl, in 1988, used the term "non-union" to define any alteration of the bone healing process after a time period of more than 6 months from the initial traumatic event; Rosen, in 1990, proposed a new classification of the modes of altered bone healing in fractures, distinguishing 5 categories: delayed consolidation, non-union, non-union vascular, non union avascular, pseudoarthrosis. The authors also talk about "poor bone positioning". This factor describes the incorrect anatomical position of the bone fragments despite perfectly normal healing according to Gruss. In this article they also discuss about the treatment of non-unions and the treatment of occlusal alterations caused by poor post-traumatic bone positioning.

Sex and age differences in the associations between sleep behaviors and all-cause mortality in older adults: results from the National Health and Nutrition Examination Surveys

PubMed Central

Beydoun, Hind A.; Beydoun, May A.; Chen, Xiaoli; Chang, Jen Jen; Gamaldo, Alyssa A.; Eid, Shaker M.; Zonderman, Alan B.

2017-01-01

Objective Our aim was to examine sex- and age-specific relationships of sleep behaviors with all-cause mortality rates. Methods A retrospective cohort study was conducted among 5288 adults (≥50 years) from the 2005–2008 National Health and Nutrition Examination Surveys who were followed-up for 54.9 ± 1.2 months. Sleep duration was categorized as < 7 h, 7—8 h and >8 h. Two sleep quality indices were generated through factor analyses. ‘Help-seeking behavior for sleep problems’ and ‘diagnosis with sleep disorders’ were defined as yes/no questions. Sociodemographic covariates-adjusted Cox regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results A positive relationship was observed between long sleep and all-cause mortality rate in the overall sample (HR = 1.90, 95% CI: 1.38, 2.60), among males (HR = 1.48, 95% CI: 1.05, 2.09), females (HR = 2.32, 95% CI: 1.48, 3.61) and elderly (≥65 years) people (HR = 1.80, 95% CI: 1.30, 2.50). ‘Sleepiness/sleep disturbance’ (Factor I) and all-cause mortality rate were positively associated among males (HR = 1.22, 95% CI: 1.03,1.45), whereas ‘poor sleep-related daytime dysfunction’ (Factor II) and all-cause mortality (HR = 0.75, 95% CI: 0.62, 0.91) were negatively associated among elderly people. Conclusions Sex- and age-specific relationships were observed between all-cause mortality rate and specific sleep behaviors among older adults. PMID:28735912

Cardiovascular Risk Assessment and Management in Prerenal Transplantation Candidates.

PubMed

Lindley, Eric M; Hall, Amanda K; Hess, Jordan; Abraham, Jo; Smith, Brigham; Hopkins, Paul N; Shihab, Fuad; Welt, Frederick; Owan, Theophilus; Fang, James C

2016-01-01

Cardiovascular (CV) assessment in prerenal transplant patients varies by center. Current guidelines recommend stress testing for candidates if ≥ 3 CV risk factors exist. We evaluated the CV assessment and management in 685 patients referred for kidney transplant over a 7-year period. All patients had CV risk factors, and the most common cause of end-stage renal disease was diabetes. Thirty-three percent (n = 229) underwent coronary angiography. The sensitivity of stress testing to detect obstructive coronary artery disease (CAD) was poor (0.26). Patients who had no CAD, nonobstructive CAD, or CAD with intervention had significantly higher event-free survival compared with patients with obstructive CAD without intervention. There were no adverse clinical events (death, myocardial infarction, stroke, revascularization, and graft failure) within 30 days post-transplant in patients who had preoperative angiography (n = 77). Of the transplanted patients who did not have an angiogram (n = 289), there were 8 clinical events (6 myocardial infarctions) in the first 30 days. In conclusion, our results indicate that stress testing and usual risk factors were poor predictors of obstructive CAD and that revascularization may prove beneficial in these patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Nonfatal work-related injuries among agricultural machinery operators in northern China: a cross-sectional study.

PubMed

Zheng, Lei; Zhao, Na; Chen, Dingyan; Hu, Meirong; Fu, Xianghua; Stallones, Lorann; Xiang, Huiyun; Wang, Zengzhen

2014-03-01

To identify the annual prevalence and potential risk factors of nonfatal agricultural machinery injuries among agricultural machinery operators in the northern areas of China. A quota sampling method was used to study 1921 agricultural machinery operators in 5 provinces in northern China. Agricultural machinery injuries that occurred between July 1, 2008, and June 30, 2009 were investigated. Data on nonfatal injuries and related factors were obtained by in-person interviews. The prevalence of agricultural machinery-related injuries among the surveyed operators was 13.1%. Being male, having lower family income and/or poor hearing, being in debt, and feeling stressed were five significant risk factors for injuries. The majority of injuries took place on farmlands (46.6%), roads (26.3%), or in backyards (17.5%). The four most common causes of injuries were being stuck by starting handles that slipped, being slashed or stabbed by sharp objects, being struck by falling objects, and falls from stationary vehicles. The prevalence of agricultural machinery-related injuries in our study was high. Males, low family income, poor hearing, and stress were associated with high risk of injury occurrence. Copyright © 2013 Elsevier Ltd. All rights reserved.

Nonfatal work-related injuries among agricultural machinery operators in northern China: A cross-sectional study

PubMed Central

Zheng, Lei; Zhao, Na; Chen, Dingyan; Hu, Meirong; Fu, Xianghua; Stallones, Lorann; Xiang, Huiyun; Wang, Zengzhen

2013-01-01

Purpose To identify the annual prevalence and potential risk factors of nonfatal agricultural machinery injuries among agricultural machinery operators in the northern areas of China. Methods A quota sampling method was used to study 1921 agricultural machinery operators in 5 provinces in northern China. Agricultural machinery injuries that occurred between July 1, 2008, and June 30, 2009 were investigated. Data on nonfatal injuries and related factors were obtained by in-person interviews. Results The prevalence of agricultural machinery-related injuries among the surveyed operators was 13.1%. Being male, having lower family income and/or poor hearing, being in debt, and feeling stressed were five significant risk factors for injuries. The majority of injuries took place on farmlands (46.6%), roads (26.3%), or in backyards (17.5%). The four most common causes of injuries were being stuck by starting handles that slipped, being slashed or stabbed by sharp objects, being struck by falling objects, and falls from stationary vehicles. Conclusions The prevalence of agricultural machinery-related injuries in our study was high. Males, low family income, poor hearing, and stress were associated with high risk of injury occurrence. PMID:23915490

Development of a Risk Score Based on Aortic Calcification to Predict 1-year Mortality After Transcatheter Aortic Valve Replacement.

PubMed

Lantelme, Pierre; Eltchaninoff, Hélène; Rabilloud, Muriel; Souteyrand, Géraud; Dupré, Marion; Spaziano, Marco; Bonnet, Marc; Becle, Clément; Riche, Benjamin; Durand, Eric; Bouvier, Erik; Dacher, Jean-Nicolas; Courand, Pierre-Yves; Cassagnes, Lucie; Dávila Serrano, Eduardo E; Motreff, Pascal; Boussel, Loic; Lefèvre, Thierry; Harbaoui, Brahim

2018-05-11

The aim of this study was to develop a new scoring system based on thoracic aortic calcification (TAC) to predict 1-year cardiovascular and all-cause mortality. A calcified aorta is often associated with poor prognosis after transcatheter aortic valve replacement (TAVR). A risk score encompassing aortic calcification may be valuable in identifying poor TAVR responders. The C 4 CAPRI (4 Cities for Assessing CAlcification PRognostic Impact) multicenter study included a training cohort (1,425 patients treated using TAVR between 2010 and 2014) and a contemporary test cohort (311 patients treated in 2015). TAC was measured by computed tomography pre-TAVR. CAPRI risk scores were based on the linear predictors of Cox models including TAC in addition to comorbidities and demographic, atherosclerotic disease and cardiac function factors. CAPRI scores were constructed and tested in 2 independent cohorts. Cardiovascular and all-cause mortality at 1 year was 13.0% and 17.9%, respectively, in the training cohort and 8.2% and 11.8% in the test cohort. The inclusion of TAC in the model improved prediction: 1-cm 3 increase in TAC was associated with a 6% increase in cardiovascular mortality and a 4% increase in all-cause mortality. The predicted and observed survival probabilities were highly correlated (slopes >0.9 for both cardiovascular and all-cause mortality). The model's predictive power was fair (AUC 68% [95% confidence interval [CI]: 64-72]) for both cardiovascular and all-cause mortality. The model performed similarly in the training and test cohorts. The CAPRI score, which combines the TAC variable with classical prognostic factors, is predictive of 1-year cardiovascular and all-cause mortality. Its predictive performance was confirmed in an independent contemporary cohort. CAPRI scores are highly relevant to current practice and strengthen the evidence base for decision making in valvular interventions. Its routine use may help prevent futile procedures. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Inflammation, edema and poor outcome are associated with hyperthermia in hypertensive intracerebral hemorrhages.

PubMed

Iglesias-Rey, Ramón; Rodríguez-Yáñez, Manuel; Arias, Susana; Santamaría, María; Rodríguez-Castro, Emilio; López-Dequidt, Iria; Hervella, Pablo; Sobrino, Tomás; Campos, Francisco; Castillo, José

2018-05-11

The deleterious effect of hyperthermia on intracerebral hemorrhage (ICH) has been studied, however the results are not completely conclusive and new studies are needed to elucidate clinical factors that condition the poor outcome. The aim of this study was to identify the clinical factors (including ICH etiology) that influence the poor outcome associated with hyperthermia on ICH. We additionally tried to identify potential mechanisms involved in hyperthermia during ICH. From a prospective registry, we conducted a retrospective study enrolling non-traumatic ICH patients. We used logistic regression models to analyze the influence of hyperthermia in relation to different inflammatory and endothelial dysfunction markers, hematoma growth and edema volume in hypertensive and non-hypertensive ICH patients. We included 887 ICH patients: 433 hypertensive, 50 amyloid, 117 by anticoagulants and 287 by other causes. Patients with hypertensive ICH showed the higher body temperature (37.5±0.8°C) as well as the maximum increase in temperature (0.9±0.1°C) within the first 24 hours. ICH patients with hypertensive etiologic origin, who presented hyperthermia, showed a 5.3 fold-higher risk to have poor outcome at 3 months. We found a positive relationship (r=0.717, P<0.0001) between edema volume and hyperthermia during the first 24 hours but only in ICH patients with hypertensive etiologic origin, and this relationship seems to be mediated by inflammatory markers. Our data suggest that hyperthermia, together with inflammation and edema is associated with poor outcome only in ICH from hypertensive etiology. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Perturbation of nucleo-cytoplasmic transport affects size of nucleus and nucleolus in human cells.

PubMed

Ganguly, Abira; Bhattacharjee, Chumki; Bhave, Madhura; Kailaje, Vaishali; Jain, Bhawik K; Sengupta, Isha; Rangarajan, Annapoorni; Bhattacharyya, Dibyendu

2016-03-01

Size regulation of human cell nucleus and nucleolus are poorly understood subjects. 3D reconstruction of live image shows that the karyoplasmic ratio (KR) increases by 30-80% in transformed cell lines compared to their immortalized counterpart. The attenuation of nucleo-cytoplasmic transport causes the KR value to increase by 30-50% in immortalized cell lines. Nucleolus volumes are significantly increased in transformed cell lines and the attenuation of nucleo-cytoplasmic transport causes a significant increase in the nucleolus volume of immortalized cell lines. A cytosol and nuclear fraction swapping experiment emphasizes the potential role of unknown cytosolic factors in nuclear and nucleolar size regulation. © 2016 Federation of European Biochemical Societies.

Buckling Analysis of Single and Multi Delamination In Composite Beam Using Finite Element Method

NASA Astrophysics Data System (ADS)

Simanjorang, Hans Charles; Syamsudin, Hendri; Giri Suada, Muhammad

2018-04-01

Delamination is one type of imperfection in structure which found usually in the composite structure. Delamination may exist due to some factors namely in-service condition where the foreign objects hit the composite structure and creates inner defect and poor manufacturing that causes the initial imperfections. Composite structure is susceptible to the compressive loading. Compressive loading leads the instability phenomenon in the composite structure called buckling. The existence of delamination inside of the structure will cause reduction in buckling strength. This paper will explain the effect of delamination location to the buckling strength. The analysis will use the one-dimensional modelling approach using two- dimensional finite element method.

Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals.

PubMed

Rabøl, Louise Isager; Andersen, Mette Lehmann; Østergaard, Doris; Bjørn, Brian; Lilja, Beth; Mogensen, Torben

2011-03-01

Poor teamwork and communication between healthcare staff are correlated to patient safety incidents. However, the organisational factors responsible for these issues are unexplored. Root cause analyses (RCA) use human factors thinking to analyse the systems behind severe patient safety incidents. The objective of this study is to review RCA reports (RCAR) for characteristics of verbal communication errors between hospital staff in an organisational perspective. Two independent raters analysed 84 RCARs, conducted in six Danish hospitals between 2004 and 2006, for descriptions and characteristics of verbal communication errors such as handover errors and error during teamwork. Raters found description of verbal communication errors in 44 reports (52%). These included handover errors (35 (86%)), communication errors between different staff groups (19 (43%)), misunderstandings (13 (30%)), communication errors between junior and senior staff members (11 (25%)), hesitance in speaking up (10 (23%)) and communication errors during teamwork (8 (18%)). The kappa values were 0.44-0.78. Unproceduralized communication and information exchange via telephone, related to transfer between units and consults from other specialties, were particularly vulnerable processes. With the risk of bias in mind, it is concluded that more than half of the RCARs described erroneous verbal communication between staff members as root causes of or contributing factors of severe patient safety incidents. The RCARs rich descriptions of the incidents revealed the organisational factors and needs related to these errors.

The Middle-Aged Marathon Runner

PubMed Central

Valentine, Anthony S.

1982-01-01

Middle-aged runners form an appreciable number of those engaged in marathon running. They tend to have above average intelligence, high socioeconomic status, and better levels of aerobic fitness than sedentary members of the same age group. “Too much too soon” is the commonest cause of injury. Training before a marathon should last 18 months to two years. Middle-aged runners tend to experience fewer injuries than other marathoners. However, relatively minor complaints will be disastrous to them if they have to stop running. Injuries can occur from lack of warm up exercises, environmental factors such as weather, poor street lighting, carbon monoxide from car exhausts, etc. Some contraindications to marathon running are: poorly controlled diabetes, recent acute pulmonary disease, active rheumatoid arthritis, and recent cardiac conditions. Finishing a marathon involves both agony and ecstasy. PMID:21286102

Pharmacogenetics/pharmacogenomics and antirheumatic drugs in rheumatology.

PubMed

Ferraccioli, Gianfranco; De Santis, Maria; Tolusso, Barbara

2004-12-01

Genomic medicine has raised many expectations with regard to individualized therapies. Drug response is a complex function of many genes interacting with environmental and behavioral factors. In addition, poor prescribing, interactions between drugs and an incomplete understanding of the metabolism of many drugs, which are administered simultaneously to treat concomitant morbidities, are leading causes of the occurrence of adverse drug reactions in chronic non-inflammatory and autoimmune rheumatic diseases. Symptomatic non-steroidal anti-inflammatory drugs, as well as disease-modifying drugs, are complicated by drop-outs (poor patient compliance) in a large percentage of patients. Even though intensive and careful monitoring is always clearly advisable, preliminary data suggest that typing of genes controlling the effects, metabolism and response of drugs might be of clinical utility to define the 'at-risk' genotype.

Impact of documentation errors on accuracy of cause of death coding in an educational hospital in Southern Iran.

PubMed

Haghighi, Mohammad Hosein Hayavi; Dehghani, Mohammad; Teshnizi, Saeid Hoseini; Mahmoodi, Hamid

2014-01-01

Accurate cause of death coding leads to organised and usable death information but there are some factors that influence documentation on death certificates and therefore affect the coding. We reviewed the role of documentation errors on the accuracy of death coding at Shahid Mohammadi Hospital (SMH), Bandar Abbas, Iran. We studied the death certificates of all deceased patients in SMH from October 2010 to March 2011. Researchers determined and coded the underlying cause of death on the death certificates according to the guidelines issued by the World Health Organization in Volume 2 of the International Statistical Classification of Diseases and Health Related Problems-10th revision (ICD-10). Necessary ICD coding rules (such as the General Principle, Rules 1-3, the modification rules and other instructions about death coding) were applied to select the underlying cause of death on each certificate. Demographic details and documentation errors were then extracted. Data were analysed with descriptive statistics and chi square tests. The accuracy rate of causes of death coding was 51.7%, demonstrating a statistically significant relationship (p=.001) with major errors but not such a relationship with minor errors. Factors that result in poor quality of Cause of Death coding in SMH are lack of coder training, documentation errors and the undesirable structure of death certificates.

Common causes of dyspnoea in athletes: a practical approach for diagnosis and management

PubMed Central

Mohseni, Zahra S.; Berwager, Jeffrey D.; Hegedus, Eric J.

2016-01-01

Key points “Dyspnoea” during exercise is a common complaint in seemingly otherwise healthy athletes, which may be associated with fatigue and underperformance. Because dyspnoea is an general term and may be caused by numerous factors, ranging from poor aerobic fitness to serious, potentially fatal respiratory and nonrespiratory pathologies, it is important for clinicians to obtain an appropriate case history and ask relevant exercise-specific questions to fully characterise the nature of the complaint so that a targeted diagnostic plan can be developed. Exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction are two common causes of dyspnoea in athletes, and both are regularly misdiagnosed and mismanaged due to poor adherence to available practice parameters. Aside from airway dysfunction, iron deficiency and anaemia, infectious disease, and musculoskeletal conditions are common problems in athletes which ultimately may lead to complaints of dyspnoea. Educational aims To inform readers of the common causes of dyspnoea encountered in athletes. To highlight that airway diseases, such as asthma and exercise-induced bronchoconstriction, are commonly misdiagnosed and mismanaged. To introduce readers to common nonairway causes of dyspnoea in athletes, including clinical features and general principles of diagnosis, and management. To emphasise the importance of a detailed case history and proper adherence to established protocols in evaluating and managing the dyspnoeic athlete. To provide readers with a general framework of appropriate questions that are useful for developing a targeted diagnostic plan for evaluating dyspnoeic athletes. Dyspnoea during exercise is a common chief complaint in athletes and active individuals. It is not uncommon for dyspnoeic athletes to be diagnosed with asthma, “exercise-induced asthma” or exercise-induced bronchoconstriction based on their symptoms, but this strategy regularly leads to misdiagnosis and improper patient management. Dyspnoea during exercise can ultimately be caused by numerous respiratory and nonrespiratory conditions, ranging from nonpathological to potentially fatal in severity. As, such it is important for healthcare providers to be familiar with the many factors that can cause dyspnoea during exercise in seemingly otherwise-healthy individuals and have a general understanding of the clinical approach to this patient population. This article reviews common conditions that ultimately cause athletes to report dyspnoea and associated symptoms, and provides insight for developing an efficient diagnostic plan. PMID:27408644

Diabetic nephropathy: a strong predictor of sleep quality in hemodialysis patients.

PubMed

Edalat-Nejad, Mahnaz; Jafarian, Nahid; Yousefichaijan, Parsa

2014-07-01

Sleep complaints are common in hemodialysis (HD) patients. Sleep quality (SQ) is a predictor of quality of life and mortality risk in HD. The aim of this study was to examine factors that may have a role in SQ. In this cross-sectional analytic study, 138 end-stage renal disease patients receiving maintenance HD for >3 months were included. The Pittsburgh Sleep Quality Index (PSQI) was used to measure individual's SQ. Patients with a global PSQI score >5 were assumed as poor sleepers. Eighty-eight patients (64%) were classified as poor sleepers. Poor sleepers were older and more likely had diabetes. They had significantly higher serum ferritin and calcium levels and lower serum parathyroid hormone level (all P-values <0.05). The global PSQI score was positively correlated with age, serum calcium level and presence of diabetes as the underlying cause of renal failure. In the multi-variable binary regression model, presence of diabetes (Odds Ratio (OR) = 3.67, P = 0.008) and body pain (OR = 1.182, P = 0.014) were the significant independent predictors for poor SQ. Poor SQ was common among our HD patients, especially among diabetic cases and, therefore, there is a need to pay more attention to the care of this subgroup with regard to the diagnosis and management of sleep complaints.

Causes of shortage and delay in material supply: a preliminary study

NASA Astrophysics Data System (ADS)

Rahman, M. M.; Yap, Y. H.; Ramli, N. R.; Dullah, M. A.; Shamsuddin, M. S. W.

2017-11-01

Shortage and delay in materials supply is argued to be one of the most important factors that lead to delay in construction project delivery globally. However, the relevant underlying reasons vary from country to country. As such, this paper summarises the outcomes of a study that targeted identifying causes of shortage and delay in materials supply in Brunei Darussalam. The study was conducted through fifteen semi-structured interviews of contractors and materials suppliers in Brunei. The study identified six causes of shortageof materials and nine causes of delay in materials supply in Brunei. The most importantcausefor shortage of materials relates to the origin or availability of construction materials. On the other hand, the most influential cause of delay in material supply was found to be poor materials procurement and inventory management system, which has other underlying reasons such as late identification of the type of materials needed. The observations are expected to help in formulating or reviewing relevant policies, in order to ensure on-time project delivery.

Inadequate response to treatment in coronary heart disease : adverse effects of type D personality and younger age on 5-year prognosis and quality of life.

PubMed

Denollet, J; Vaes, J; Brutsaert, D L

2000-08-08

Improvement in treatment of patients with coronary heart disease (CHD) has caused longer survival but also an increase in the number of patients at risk for subsequent cardiac events and impaired quality of life (QOL). We hypothesized that chronic emotional distress confers an increased risk of poor outcome despite appropriate treatment. This prospective study examined the 5-year prognosis of 319 patients with CHD. Baseline assessment included symptoms of depression/anxiety and distressed personality type (type D-ie, high negative affectivity and social inhibition). The main end points were cardiac death or nonfatal myocardial infarction and impaired QOL. There were 22 cardiac events (16 nonfatal); they were related to left ventricular ejection fraction (LVEF)

Computed tomographic assessment of the causal factors of unsuccessful medialization thyroplasty.

PubMed

Iwahashi, Toshihiko; Ogawa, Makoto; Hosokawa, Kiyohito; Mochizuki, Ryuichi; Inohara, Hidenori

2015-03-01

The present results demonstrate that a small implant size, undercorrection of the vocal fold, antero-posterior implant malposition, and the use of expanded polytetrafluoroethylene (ePTFE) are the primary factors that cause a poor outcome of medialization thyroplasty (MT). To assess the postoperative laryngeal condition using computed tomography (CT) in patients with unilateral vocal fold paralysis who underwent MT alone, and to identify the primary causal factors in terms of the surgical procedures that affect the outcomes of MT. Twenty-two patients who underwent MT alone were divided into two groups based on either the maximal phonation time or the perceived vocal breathiness. Two laryngologists assessed the postoperative laryngeal CT images during sustained vowel phonation and judged whether there were abnormalities of the arytenoid cartilage position, window position, implant size, and implant position, as well as the degree of correction of the vocal fold. As implant material, a silicone block, ePTFE, and hydroxyapatite had been inserted in 2, 9, and 11 patients, respectively. Comparisons of the prevalence of abnormalities in the abovementioned factors between the different outcomes and between the types of material used for the implant were performed. Twelve patients with a poor outcome and 10 with a good outcome showed 36 and 18 abnormal findings identified by either of the two laryngologists, respectively. In the poor outcome group, a smaller implant size and undercorrection of the vocal fold showed both high kappa values and a significantly higher prevalence than those in the good outcome group (p < 0.001 and p < 0.05), respectively. The comparison between material types demonstrated that the sheet-like material (ePTFE) group exhibited a significantly higher prevalence of undercorrection than the block-like material group (p < 0.05).

Usefulness of Desirable Lifestyle Factors to Attenuate the Risk of Heart Failure Among Offspring whose Parents had Myocardial Infarction before Age 55 Years

PubMed Central

Khawaja, Owais; Kotler, Gregory; Gaziano, John Michael; Djoussé, Luc

2012-01-01

Heart failure (HF) is one of the leading causes of hospitalization and death in United States and throughout Europe. While a higher risk of HF with antecedent myocardial infarction (MI) has been reported in offspring whose parents had MI before age 55, it is unclear whether adherence to healthful behaviors could mitigate that risk. The aim of the current study was therefore to prospectively examine if adherence to healthy weight, regular exercise, moderate alcohol consumption, and abstinence from smoking can attenuate such increased HF risk. The information on parental history of MI and lifestyle factors was collected using questionnaires. Subjects adhering to at least three healthy lifestyle factors were classified as having good vs. poor lifestyle score. Incident HF was assessed via yearly follow-up questionnaires and validated in a subsample. During an average follow up of 21.7 (6.5) years, 1,323 new HF cases (6.6%) of which 190 (14.4%) were preceded by MI occurred. Compared to subjects with good lifestyle score and no parental history of premature MI, multivariable adjusted hazard ratios (95% CI) for incident HF with antecedent MI was 3.21 (1.74–5.91) for people with good lifestyle score and parental history of premature MI; 1.52 (1.12–2.07) for individuals with poor lifestyle score and no parental history of premature MI; and 4.60 (2.55–8.30) for people with poor lifestyle score and parental history of premature MI. In conclusion, our data suggest that even in people at higher risk of HF due to genetic predisposition, adherence to healthful lifestyle factors may attenuate such an elevated HF risk. PMID:22516528

The Hinton train disaster.

PubMed

Smiley, A M

1990-10-01

In February of 1986 a head-on collision occurred between a freight train and a passenger train in western Canada killing 23 people and causing over $30 million of damage. A Commission of Inquiry appointed by the Canadian government concluded that human error was the major reason for the collision. This report discusses the factors contributing to the human error: mainly poor work-rest schedules, the monotonous nature of the train driving task, insufficient information about train movements, and the inadequate backup systems in case of human error.

Vasoplegic syndrome during Whipple procedure.

PubMed

Anandaswamy, Tejesh C; Rajappa, Geetha C; Krishnamachar, Harish

2017-02-01

Vasoplegic syndrome is an unusual cause of refractory hypotension under general anesthesia. It is commonly described in the setting of cardiac surgery, but rarely seen in noncardiac setting. We describe successful management of vasoplegic syndrome during Whipple procedure with vasopressin infusion. A high index of suspicion and prompt treatment with vasopressin can be lifesaving in patients with risk factors for vasoplegic syndrome who present with severe refractory hypotension and who respond poorly to fluid administration and routine vasopressor infusion. Copyright © 2016 Elsevier Inc. All rights reserved.

Accurately Assessing Lines on the Aging Face.

PubMed

Renton, Kim; Keefe, Kathy Young

The ongoing positive aging trend has resulted in many research studies being conducted to determine the characteristics of aging and what steps we can take to prevent the extrinsic signs of aging. Much of this attention has been focused on the prevention and treatment of facial wrinkles. To treat or prevent facial wrinkles correctly, their causative action first needs to be determined. published very compelling evidence that the development of wrinkles is complex and is caused by more factors than just the combination of poor lifestyle choices.

[Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictive factors of a poor prognosis].

PubMed

Torres, Moisés Ulises; Delgado, Ligia Victoria; Giraldo, Natalia; Urueña, Piedad; Franco, Sergio; Hernández, Olga Helena

2017-04-01

Posterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified.A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible encephalopathy syndrome provide opportunities to investigate the susceptibility for the development of this condition and to establish appropriate preventive measures.

Plant MYB Transcription Factors: Their Role in Drought Response Mechanisms

PubMed Central

Baldoni, Elena; Genga, Annamaria; Cominelli, Eleonora

2015-01-01

Water scarcity is one of the major causes of poor plant performance and limited crop yields worldwide and it is the single most common cause of severe food shortage in developing countries. Several molecular networks involved in stress perception, signal transduction and stress responses in plants have been elucidated so far. Transcription factors are major players in water stress signaling. In recent years, different MYB transcription factors, mainly in Arabidopsis thaliana (L.) Heynh. but also in some crops, have been characterized for their involvement in drought response. For some of them there is evidence supporting a specific role in response to water stress, such as the regulation of stomatal movement, the control of suberin and cuticular waxes synthesis and the regulation of flower development. Moreover, some of these genes have also been characterized for their involvement in other abiotic or biotic stresses, an important feature considering that in nature, plants are often simultaneously subjected to multiple rather than single environmental perturbations. This review summarizes recent studies highlighting the role of the MYB family of transcription factors in the adaptive responses to drought stress. The practical application value of MYBs in crop improvement, such as stress tolerance engineering, is also discussed. PMID:26184177

Plant MYB Transcription Factors: Their Role in Drought Response Mechanisms.

PubMed

Baldoni, Elena; Genga, Annamaria; Cominelli, Eleonora

2015-07-13

Water scarcity is one of the major causes of poor plant performance and limited crop yields worldwide and it is the single most common cause of severe food shortage in developing countries. Several molecular networks involved in stress perception, signal transduction and stress responses in plants have been elucidated so far. Transcription factors are major players in water stress signaling. In recent years, different MYB transcription factors, mainly in Arabidopsis thaliana (L.) Heynh. but also in some crops, have been characterized for their involvement in drought response. For some of them there is evidence supporting a specific role in response to water stress, such as the regulation of stomatal movement, the control of suberin and cuticular waxes synthesis and the regulation of flower development. Moreover, some of these genes have also been characterized for their involvement in other abiotic or biotic stresses, an important feature considering that in nature, plants are often simultaneously subjected to multiple rather than single environmental perturbations. This review summarizes recent studies highlighting the role of the MYB family of transcription factors in the adaptive responses to drought stress. The practical application value of MYBs in crop improvement, such as stress tolerance engineering, is also discussed.

An engineered tale-transcription factor rescues transcription of factor VII impaired by promoter mutations and enhances its endogenous expression in hepatocytes.

PubMed

Barbon, Elena; Pignani, Silvia; Branchini, Alessio; Bernardi, Francesco; Pinotti, Mirko; Bovolenta, Matteo

2016-06-24

Tailored approaches to restore defective transcription responsible for severe diseases have been poorly explored. We tested transcription activator-like effectors fused to an activation domain (TALE-TFs) in a coagulation factor VII (FVII) deficiency model. In this model, the deficiency is caused by the -94C > G or -61T > G mutation, which abrogate the binding of Sp1 or HNF-4 transcription factors. Reporter assays in hepatoma HepG2 cells naturally expressing FVII identified a single TALE-TF (TF4) that, by targeting the region between mutations, specifically trans-activated both the variant (>100-fold) and wild-type (20-40-fold) F7 promoters. Importantly, in the genomic context of transfected HepG2 and transduced primary hepatocytes, TF4 increased F7 mRNA and protein levels (2- to 3-fold) without detectable off-target effects, even for the homologous F10 gene. The ectopic F7 expression in renal HEK293 cells was modestly affected by TF4 or by TALE-TF combinations. These results provide experimental evidence for TALE-TFs as gene-specific tools useful to counteract disease-causing promoter mutations.

Asthma-specific health-related quality of life of people in Great Britain: A national survey.

PubMed

Upton, Jane; Lewis, Carine; Humphreys, Emily; Price, David; Walker, Samantha

2016-11-01

Although the ultimate goal of asthma treatment is to improve asthma-specific Health-Related Quality-Of-Life (HRQOL), in the UK population this is insufficiently studied. National asthma-specific HRQOL data is needed to inform strategies to address this condition. To benchmark asthma-specific HRQOL in a national survey of adults with asthma, and explore differences in this measure within subsections of the population. We analysed answers to the Marks Asthma Quality-of-Life Questionnaire (AQLQ-M) from a representative sample of 658 adults with asthma. Respondents answered asthma-specific questions to assess control, previous hospital admissions, asthma attacks and an indicator of severity. Higher scores indicate poorer HRQOL (maximum = 60). The highest quintile formed a subgroup 'Poor HRQOL'. Data were weighted to correct for any biases caused by differential non-response. Chi-square analyses were used to determine differences between good and poor quality of life and regression analyses performed to determine what factors are associated with poor HRQOL. The response rate was 49%. AQLQ-M median (IQR) scores were 5 (2-13) for the total sample (poor HRQOL = 21, good HRQOL = 3). Significant differences between good and poor HRQOL were observed in smoking status, SES, employment status and co-morbidities, but no differences were found between age groups. Those with poorly controlled asthma were significantly more likely to have poor HRQOL, ≥1 breathing related hospital admission or ≥1 asthma attack. This article provides benchmarking data on asthma-specific HRQOL. Improved strategies are needed to target interventions towards people experiencing poor HRQOL.

Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey.

PubMed

Gilbert, Clare E; Shah, S P; Jadoon, M Z; Bourne, R; Dineen, B; Khan, M A; Johnson, G J; Khan, M D

2008-01-05

To explore the association between blindness and deprivation in a nationally representative sample of adults in Pakistan. Cross sectional population based survey. 221 rural and urban clusters selected randomly throughout Pakistan. Nationally representative sample of 16 507 adults aged 30 or above (95.3% response rate). Associations between visual impairment and poverty assessed by a cluster level deprivation index and a household level poverty indicator; prevalence and causes of blindness; measures of the rate of uptake and quality of eye care services. 561 blind participants (<3/60 in the better eye) were identified during the survey. Clusters in urban Sindh province were the most affluent, whereas rural areas in Balochistan were the poorest. The prevalence of blindness in adults living in affluent clusters was 2.2%, compared with 3.7% in medium clusters and 3.9% in poor clusters (P<0.001 for affluent v poor). The highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence of total blindness (bilateral no light perception) was more than three times higher in poor clusters than in affluent clusters (0.24% v 0.07%, P<0.001). The prevalences of blindness caused by cataract, glaucoma, and corneal opacity were lower in affluent clusters and households. Reflecting access to eye care services, cataract surgical coverage was higher in affluent clusters (80.6%) than in medium (76.8%) and poor areas (75.1%). Intraocular lens implantation rates were significantly lower in participants from poorer households. 10.2% of adults living in affluent clusters presented to the examination station wearing spectacles, compared with 6.7% in medium clusters and 4.4% in poor cluster areas. Spectacle coverage in affluent areas was more than double that in poor clusters (23.5% v 11.1%, P<0.001). Blindness is associated with poverty in Pakistan; lower access to eye care services was one contributory factor. To reduce blindness, strategies targeting poor people will be needed. These interventions may have an impact on deprivation in Pakistan.

The changing aetiology of head and neck squamous cell cancer: a tale of three cancers?

PubMed

Thomas, Steven J; Penfold, Chris M; Waylen, Andrea; Ness, Andrew R

2018-05-16

Head and neck cancers are the sixth most common cancers worldwide and an important cause of ill health.(1) Each year about 9000 cases are reported in the UK.(2) Survival is poor and despite advances in treatment, has not improved until recently.(3) The majority of head and neck cancers are squamous cell carcinomas, affecting the larynx, oropharynx and oral cavity. The aetiology is changing and this has implications for prevention and treatment. Twenty years ago, tobacco and alcohol consumption were considered to be the established risk factors and it was estimated that these risk factors accounted for about 75% of cases.(4) More recently human papillomavirus (HPV) has emerged as a likely cause of oropharyngeal cancer.(4) Here we argue that each cancer site is predicted differently by smoking, alcohol and sexual behaviour. We also suggest that these risk factors do not fully explain the changing pattern of disease observed in the UK. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Marriage is a dependent risk factor for mortality of colon adenocarcinoma without a time-varying effect

PubMed Central

Yu, Wei; Chen, Jie; Xiong, Weibin; Chen, Shuang; Yu, Li

2017-01-01

Background It has been well recognized that the effects of many prognostic factors could change during long-term follow-up. Although marriage has been proven to be a significant prognostic factor for the survival of colon cancer, whether the effect of marriage is constant with time remain unknown. This study analyzed the impact of marital status on the mortality of colon cancer patients with an extended Cox model that allowed for time-varying effects. Methods We identified 71,955 patients who underwent colectomy between 2004 and 2009 to treat colon adenocarcinoma from the Surveilance, Epidemiology and End Results Database. The multivariate extended Cox model was used to evaluate the effect of marital status on all-cause mortality, while the Fine-Gray competing risks model was used for colon cancer-specific mortality, with death from other causes as the competing risk. Results The unmarried patients carried a 1.37-fold increased risk of all-cause mortality compared with the married patients (95%CI: 1.33-1.40; p<0.001), and the hazard ratio remained constant over time. Being unmarried was at a higher risk of death from colon adenocarcinoma as well as death from other causes. Four variables including tumor site, tumor grade, sex and TNM stage were proved to have time-varying effects on survival. Conclusions Marriage is a dependent prognosis factor for survival of surgically treated colon adenocarcinoma patients. Psychological interventions are suggested to improve receipt of treatment among unmarried patients, as their poor survival may be due to the inefficient treatment. PMID:28423614

Marriage is a dependent risk factor for mortality of colon adenocarcinoma without a time-varying effect.

PubMed

Liu, Minling; Li, Lixian; Yu, Wei; Chen, Jie; Xiong, Weibin; Chen, Shuang; Yu, Li

2017-03-21

It has been well recognized that the effects of many prognostic factors could change during long-term follow-up. Although marriage has been proven to be a significant prognostic factor for the survival of colon cancer, whether the effect of marriage is constant with time remain unknown. This study analyzed the impact of marital status on the mortality of colon cancer patients with an extended Cox model that allowed for time-varying effects. We identified 71,955 patients who underwent colectomy between 2004 and 2009 to treat colon adenocarcinoma from the Surveilance, Epidemiology and End Results Database. The multivariate extended Cox model was used to evaluate the effect of marital status on all-cause mortality, while the Fine-Gray competing risks model was used for colon cancer-specific mortality, with death from other causes as the competing risk. The unmarried patients carried a 1.37-fold increased risk of all-cause mortality compared with the married patients (95%CI: 1.33-1.40; p<0.001), and the hazard ratio remained constant over time. Being unmarried was at a higher risk of death from colon adenocarcinoma as well as death from other causes. Four variables including tumor site, tumor grade, sex and TNM stage were proved to have time-varying effects on survival. Marriage is a dependent prognosis factor for survival of surgically treated colon adenocarcinoma patients. Psychological interventions are suggested to improve receipt of treatment among unmarried patients, as their poor survival may be due to the inefficient treatment.

Let's stay together? Intrinsic and extrinsic factors involved in pair bond dissolution in a recolonizing wolf population.

PubMed

Milleret, Cyril; Wabakken, Petter; Liberg, Olof; Åkesson, Mikael; Flagstad, Øystein; Andreassen, Harry Peter; Sand, Håkan

2017-01-01

For socially monogamous species, breeder bond dissolution has important consequences for population dynamics, but the extent to which extrinsic or intrinsic population factors causes pair dissolution remain poorly understood, especially among carnivores. Using an extensive life-history data set, a survival analysis and competing risks framework, we examined the fate of 153 different wolf (Canis lupus) pairs in the recolonizing Scandinavian wolf population, during 14 winters of snow tracking and DNA monitoring. Wolf pair dissolution was generally linked to a mortality event and was strongly affected by extrinsic (i.e. anthropogenic) causes. No divorce was observed, and among the pair dissolution where causes have been identified, death of one or both wolves was always involved. Median time from pair formation to pair dissolution was three consecutive winters (i.e. approximately 2 years). Pair dissolution was mostly human-related, primarily caused by legal control actions (36·7%), verified poaching (9·2%) and traffic-related causes (2·1%). Intrinsic factors, such as disease and age, accounted for only 7·7% of pair dissolutions. The remaining 44·3% of dissolution events were from unknown causes, but we argue that a large portion could be explained by an additional source of human-caused mortality, cryptic poaching. Extrinsic population factors, such as variables describing the geographical location of the pair, had a stronger effect on risk of pair dissolution compared to anthropogenic landscape characteristics. Population intrinsic factors, such as the inbreeding coefficient of the male pair member, had a negative effect on pair bond duration. The mechanism behind this result remains unknown, but might be explained by lower survival of inbred males or more complex inbreeding effects mediated by behaviour. Our study provides quantitative estimates of breeder bond duration in a social carnivore and highlights the effect of extrinsic (i.e. anthropogenic) and intrinsic factors (i.e. inbreeding) involved in wolf pair bond duration. Unlike the effects of intrinsic and extrinsic factors that are commonly reported on individual survival or population growth, here we provide quantitative estimates of their potential effect on the social unit of the population, the wolf pair. © 2016 The Authors. Journal of Animal Ecology published by John Wiley & Sons Ltd on behalf of British Ecological Society.

Aviation and insurance

NASA Technical Reports Server (NTRS)

Mayo, R H

1922-01-01

This article considers some of the causes which hinder the development of aircraft insurance. Different risks are discussed as well as the causes of aircraft accidents. Pilot error, poor airdromes, weather conditions, poorly adapted airplanes, and engine failures are all examined and some conclusions are made.

The relationship between insulin secretion, the insulin-like growth factor axis and growth in children with cystic fibrosis.

PubMed

Ripa, Paulus; Robertson, Ian; Cowley, David; Harris, Margaret; Masters, I Brent; Cotterill, Andrew M

2002-03-01

Cystic fibrosis-related diabetes mellitus (CFRD) is an increasingly common complication of cystic fibrosis. CFRD is preceded by a progressive decline in insulin secretion but there is no accepted definition of the prediabetic state in CFRD. This prediabetic state appears to have adverse effects on clinical status, nutrition and lung function, but there is no direct evidence that the impaired glucose homeostasis is the cause of these deteriorations. This study examined the prevalence of glucose intolerance and impaired insulin secretion in a population of children with CF without CFRD. Severe CF lung disease is often associated with poor weight gain and slower growth but the mechanism for this is still unclear. The relationships between the current state of glucose homeostasis, insulin secretion and the insulin-like growth factor axis, height velocity, nutrition status and lung function were therefore studied. Eighteen children with cystic fibrosis aged 9.5-15 years had oral glucose tolerance tests and 14 of these also had intravenous glucose tolerance tests (four refused). Blood samples were collected for insulin, C-peptide, glucose, HbA1c, insulin-like growth factor (IGF)-I, IGF-II, IGF-binding protein (IGFBP)-1 and IGFBP-3. Data on height, weight, puberty status, clinical score (Shwachman score) and lung function were recorded. Height velocity, height and weight standard deviation scores (SDS) were calculated using WHO/CDC data. The mean height SDS (-0.52 +/- 0.17) was less than the normal population (P = 0.007) and the mean height velocity was 4.6 +/- 0.5 cm/year, 39% with a height velocity less than the third percentile for age. The weight SDS and body mass index (BMI) were similar to the normal population. Four children had impaired glucose tolerance. The first-phase insulin response (FPIR) was below the first percentile of normal population values in nine (65%). Impaired FPIR or impaired glucose tolerance did not correlate with the Shwachman score, nutritional status or pulmonary function. There was a significant positive correlation between insulin secretion (area under the curve) and height velocity (P = 0.001) and serum IGFBP-3 levels (P = 0.001). Impaired glucose tolerance was present in 20% of children with cystic fibrosis. Impaired insulin secretion was common (65%) even in children with normal glucose tolerance. The mean height SDS for the group was low and the height velocity was abnormally slow in 39%, yet nutritional status as measured by BMI was appropriate for age. Relative insulin deficiency rather than nutritional deprivation or poor clinical status thus appears to be implicated in the poor linear growth of these children with relatively stable lung disease. This was a small study and firm conclusions on this chronic suppurative disease as to the cause of poor growth are not possible. The causes of poor growth are likely to be complex; nevertheless, the apparent decrease in insulin secretion combined with the expected increased demands on insulin production during pubertal growth raises the question as to whether insulin therapy should be considered in children with cystic fibrosis before the onset of cystic fibrosis-related diabetes mellitus.

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital

PubMed Central

Kurumi, Hiroki; Takeda, Yohei; Yashima, Kazuo; Isomoto, Hajime

2017-01-01

Background Peptic ulcer bleeding (PUB) is the main cause of non-variceal upper gastrointestinal bleeding (UGIB). Endoscopic treatment and acid suppression with proton-pump inhibitors (PPIs) are most important in the management of PUB and these treatments have reduced mortality. However, elderly patients sometimes have a poor prognostic outcome due to severe comorbidities. Methods A retrospective study was performed on 504 cases with acute non-variceal UGIB who were examined in our hospital, in order to reveal the risk factor of a poor outcome in elderly patients. Results Two hundred and thirty-four cases needed hemostasis; 11 cases had unsuccessful endoscopic treatments; 31 cases had re-bleeding after endoscopic hemostasis. Forty-three cases died within 30 days after the initial urgent endoscopy, but only seven cases died from bleeding. Elderly patients aged over 65 years had more severe comorbidities, and were prescribed non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents and/or anticoagulation agents, more frequently, compared with non-elderly patients. The significant risk factor of needing hemostatic therapy was the taking of two or more NSAIDs, antiplatelet agents and/or anticoagulation agents. The most important risk of a poor outcome in elderly patients was various kinds of severe comorbidities. And so, it is important to predict such an outcome in these cases. AIMS65 is a simple and relatively useful scoring system that predicts the risk of a poor outcome in UGIB. High-score patients via AIMS65 were associated with a high mortality rate because of death from comorbidities. Conclusions The elderly patients in whom were prescribed two or more NSAIDs, antiplatelet agents and/or anticoagulation agents, should have UGIB prevented using a PPI. The most significant risk of a poor outcome in elderly patients was severe comorbidities. We recommend that elderly patients with UGIB should be estimated as having a poor outcome as soon as possible via the risk scoring system AIMS65. PMID:28616396

Management for non-variceal upper gastrointestinal bleeding in elderly patients: the experience of a tertiary university hospital.

PubMed

Kawaguchi, Koichiro; Kurumi, Hiroki; Takeda, Yohei; Yashima, Kazuo; Isomoto, Hajime

2017-04-01

Peptic ulcer bleeding (PUB) is the main cause of non-variceal upper gastrointestinal bleeding (UGIB). Endoscopic treatment and acid suppression with proton-pump inhibitors (PPIs) are most important in the management of PUB and these treatments have reduced mortality. However, elderly patients sometimes have a poor prognostic outcome due to severe comorbidities. A retrospective study was performed on 504 cases with acute non-variceal UGIB who were examined in our hospital, in order to reveal the risk factor of a poor outcome in elderly patients. Two hundred and thirty-four cases needed hemostasis; 11 cases had unsuccessful endoscopic treatments; 31 cases had re-bleeding after endoscopic hemostasis. Forty-three cases died within 30 days after the initial urgent endoscopy, but only seven cases died from bleeding. Elderly patients aged over 65 years had more severe comorbidities, and were prescribed non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents and/or anticoagulation agents, more frequently, compared with non-elderly patients. The significant risk factor of needing hemostatic therapy was the taking of two or more NSAIDs, antiplatelet agents and/or anticoagulation agents. The most important risk of a poor outcome in elderly patients was various kinds of severe comorbidities. And so, it is important to predict such an outcome in these cases. AIMS65 is a simple and relatively useful scoring system that predicts the risk of a poor outcome in UGIB. High-score patients via AIMS65 were associated with a high mortality rate because of death from comorbidities. The elderly patients in whom were prescribed two or more NSAIDs, antiplatelet agents and/or anticoagulation agents, should have UGIB prevented using a PPI. The most significant risk of a poor outcome in elderly patients was severe comorbidities. We recommend that elderly patients with UGIB should be estimated as having a poor outcome as soon as possible via the risk scoring system AIMS65.

Using Operational Analysis to Improve Access to Pulmonary Function Testing.

PubMed

Ip, Ada; Asamoah-Barnieh, Raymond; Bischak, Diane P; Davidson, Warren J; Flemons, W Ward; Pendharkar, Sachin R

2016-01-01

Background. Timely pulmonary function testing is crucial to improving diagnosis and treatment of pulmonary diseases. Perceptions of poor access at an academic pulmonary function laboratory prompted analysis of system demand and capacity to identify factors contributing to poor access. Methods. Surveys and interviews identified stakeholder perspectives on operational processes and access challenges. Retrospective data on testing demand and resource capacity was analyzed to understand utilization of testing resources. Results. Qualitative analysis demonstrated that stakeholder groups had discrepant views on access and capacity in the laboratory. Mean daily resource utilization was 0.64 (SD 0.15), with monthly average utilization consistently less than 0.75. Reserved testing slots for subspecialty clinics were poorly utilized, leaving many testing slots unfilled. When subspecialty demand exceeded number of reserved slots, there was sufficient capacity in the pulmonary function schedule to accommodate added demand. Findings were shared with stakeholders and influenced scheduling process improvements. Conclusion. This study highlights the importance of operational data to identify causes of poor access, guide system decision-making, and determine effects of improvement initiatives in a variety of healthcare settings. Importantly, simple operational analysis can help to improve efficiency of health systems with little or no added financial investment.

[Causes of iron deficiency in children].

PubMed

Olives, J-P

2017-05-01

Iron deficiency and iron deficiency anemia are common conditions worldwide affecting especially children. In developing countries, iron deficiency is caused by poor iron intake and parasitic infection. Poor iron intake linked to inadequate diets, low iron intestinal absorption, chronic blood losses and increased requirements are common causes in high-income countries. © 2017 Elsevier Masson SAS. Tous droits réservés.

Modifiable risk and protective factors for depressive symptoms in low-income African American mothers.

PubMed

Siefert, Kristine; Finlayson, Tracy L; Williams, David R; Delva, Jorge; Ismail, Amid I

2007-01-01

Low-income African American mothers of young children experience high rates of depression, but many of the risk factors that have been identified provide little direction for intervention. The authors examined modifiable risk and protective factors for probable depression (Center for Epidemiological Studies Depression Scale >or= 23) in 824 African American mothers living in the 39 poorest census tracts in Detroit. Household food insufficiency and deteriorated housing significantly increased the odds of likely depression, whereas availability of a loan in a crisis, help with childcare, and transportation were protective. However, more frequent experiences of everyday discrimination greatly increased the odds of elevated depressive symptoms. These findings support the need for interventions that operate across individual and societal levels to address the fundamental causes of poor mental health.

Low Cerebral Blood Volume Identifies Poor Outcome in Stent Retriever Thrombectomy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Protto, Sara, E-mail: sara.protto@pshp.fi; Pienimäki, Juha-Pekka; Seppänen, Janne

BackgroundMechanical thrombectomy (MT) is an efficient treatment of acute stroke caused by large-vessel occlusion. We evaluated the factors predicting poor clinical outcome (3-month modified Rankin Scale, mRS >2) although MT performed with modern stent retrievers.MethodsWe prospectively collected the clinical and imaging data of 105 consecutive anterior circulation stroke patients who underwent MT after multimodal CT imaging. Patients with occlusion of the internal carotid artery and/or middle cerebral artery up to the M2 segment were included. We recorded baseline clinical, procedural and imaging variables, technical outcome, 24-h imaging outcome and the clinical outcome. Differences between the groups were studied with appropriatemore » statistical tests and binary logistic regression analysis.ResultsLow cerebral blood volume Alberta stroke program early CT score (CBV-ASPECTS) was associated with poor clinical outcome (median 7 vs. 9, p = 0.01). Lower collateral score (CS) significantly predicted poor outcome in regression modelling with CS = 0 increasing the odds of poor outcome 4.4-fold compared to CS = 3 (95% CI 1.27–15.5, p = 0.02). Lower CBV-ASPECTS significantly predicted poor clinical outcome among those with moderate or severe stroke (OR 0.82, 95% CI 0.68–1, p = 0.05) or poor collateral circulation (CS 0–1, OR 0.66, 95% CI 0.48–0.90, p = 0.009) but not among those with mild strokes or good collaterals.ConclusionsCBV-ASPECTS estimating infarct core is a significant predictor of poor clinical outcome among anterior circulation stroke patients treated with MT, especially in the setting of poor collateral circulation and/or moderate or severe stroke.« less

Schedule Matters: Understanding the Relationship between Schedule Delays and Costs on Overruns

NASA Technical Reports Server (NTRS)

Majerowicz, Walt; Shinn, Stephen A.

2016-01-01

This paper examines the relationship between schedule delays and cost overruns on complex projects. It is generally accepted by many project practitioners that cost overruns are directly related to schedule delays. But what does "directly related to" actually mean? Some reasons or root causes for schedule delays and associated cost overruns are obvious, if only in hindsight. For example, unrealistic estimates, supply chain difficulties, insufficient schedule margin, technical problems, scope changes, or the occurrence of risk events can negatively impact schedule performance. Other factors driving schedule delays and cost overruns may be less obvious and more difficult to quantify. Examples of these less obvious factors include project complexity, flawed estimating assumptions, over-optimism, political factors, "black swan" events, or even poor leadership and communication. Indeed, is it even possible the schedule itself could be a source of delay and subsequent cost overrun? Through literature review, surveys of project practitioners, and the authors' own experience on NASA programs and projects, the authors will categorize and examine the various factors affecting the relationship between project schedule delays and cost growth. The authors will also propose some ideas for organizations to consider to help create an awareness of the factors which could cause or influence schedule delays and associated cost growth on complex projects.

Chancroid: from clinical practice to basic science.

PubMed

Lewis, D A

2000-01-01

Chancroid is a sexually transmitted disease caused by the bacterium Haemophilus ducreyi. It usually presents as a genital ulcer and may be associated with regional lymphadenopathy and bubo formation. H. ducreyi infection is predominantly seen in tropical resource-poor regions of the world where it is frequently the most common etiological cause of genital ulceration. Genital ulcer disease has been shown to be an extremely important co-factor in HIV transmission. With the advent of the AIDS epidemic, there has been increased research effort to elucidate those factors involved in the pathogenesis of chancroid. Several putative virulence factors have now been identified and isogenic H. ducreyi mutants constructed by mutagenesis of their encoding genes. This approach has facilitated investigations into the role each of these putative virulence factors may play in H. ducreyi pathogenesis through the use of in vitro and in vivo model systems. One major goal of current chancroid research is to identify antigens which are immunogenic and could form the basis of a vaccine against H. ducreyi infection. Such a vaccine, if shown to be effective in decreasing the prevalence of chancroid, could have the added benefit of slowing down the HIV incidence rates in those populations where chancroid is a major co-factor for HIV transmission.

[Systemic and local mechanisms leading to cachexia in cancer].

PubMed

Grabiec, Kamil; Burchert, Marta; Milewska, Marta; Błaszczyk, Maciej; Grzelkowska-Kowalczyk, Katarzyna

2013-12-31

Cachexia is a multifactorial syndrome of atrophy of skeletal muscle and adipose tissue, resulting in progressive loss of body weight associated with low quality of life and poor prognosis in cancer. Studies on experimental animal models and observations on patients have shown that the soluble factors secreted by tumor cells and tissues of the patient can participate in regulation of the wasting process. Cachexia is often accompanied by anorexia, which is caused by predominance of signals inhibiting appetite in the hypothalamus, such as release of proopiomelanocortin and anorexigenic action of proinflammatory cytokines (IL-1α, IL-1β, IL-6, TNF-α). Cachexia is also accompanied by extensive metabolic changes consisting of increase of resting energy expenditure and disturbance of carbohydrate, protein and lipid metabolism. Increased expression of protein uncoupling phosphorylation leads to increased thermogenesis in skeletal muscle. Tumor tissue hypoxia caused by its growth beyond blood vessels activates the transcription factor HIF-1, which results in increase in glycolysis, and leads to lactic acid accumulation and activation of the energy inefficient Cori cycle. Loss of fat tissue is caused by increase of lipolysis induced by lipid-mobilizing factor (LMF) and proinflammatory cytokines. Skeletal muscle wasting in cachexia is caused by a reduction of protein synthesis at the stage of initiation and elongation of translation and the simultaneous increase of protein degradation via ubiquitin-dependent and lysosomal pathways. The main mediators of skeletal muscle wasting in cancer are proteolysis-inducing factor (PIF), proinflammatory cytokines, and angiotensin II acting through increased levels of reactive oxygen species (ROS) and nuclear factor NF-κB activation, as well as glucocorticoid activated FOXO transcription factors and myostatin. Understanding of the complexity of the interaction of factors produced by the tumor and the patient's body may form the basis for the development of effective treatments for cachexia in cancer and other pathological conditions.

Decomposing the gap in childhood undernutrition between poor and non-poor in urban India, 2005-06.

PubMed

Kumar, Abhishek; Singh, Aditya

2013-01-01

Despite the growing evidence from other developing countries, intra-urban inequality in childhood undernutrition is poorly researched in India. Additionally, the factors contributing to the poor/non-poor gap in childhood undernutrition have not been explored. This study aims to quantify the contribution of factors that explain the poor/non-poor gap in underweight, stunting, and wasting among children aged less than five years in urban India. We used cross-sectional data from the third round of the National Family Health Survey conducted during 2005-06. Descriptive statistics were used to understand the gap in childhood undernutrition between the urban poor and non-poor, and across the selected covariates. Blinder-Oaxaca decomposition technique was used to explain the factors contributing to the average gap in undernutrition between poor and non-poor children in urban India. Considerable proportions of urban children were found to be underweight (33%), stunted (40%), and wasted (17%) in 2005-06. The undernutrition gap between the poor and non-poor was stark in urban India. For all the three indicators, the main contributing factors were underutilization of health care services, poor body mass index of the mothers, and lower level of parental education among those living in poverty. The findings indicate that children belonging to poor households are undernourished due to limited use of health care services, poor health of mothers, and poor educational status of their parents. Based on the findings the study suggests that improving the public services such as basic health care and the education level of the mothers among urban poor can ameliorate the negative impact of poverty on childhood undernutrition.

Decomposing the Gap in Childhood Undernutrition between Poor and Non–Poor in Urban India, 2005–06

PubMed Central

Kumar, Abhishek; Singh, Aditya

2013-01-01

Background Despite the growing evidence from other developing countries, intra-urban inequality in childhood undernutrition is poorly researched in India. Additionally, the factors contributing to the poor/non-poor gap in childhood undernutrition have not been explored. This study aims to quantify the contribution of factors that explain the poor/non-poor gap in underweight, stunting, and wasting among children aged less than five years in urban India. Methods We used cross-sectional data from the third round of the National Family Health Survey conducted during 2005–06. Descriptive statistics were used to understand the gap in childhood undernutrition between the urban poor and non-poor, and across the selected covariates. Blinder–Oaxaca decomposition technique was used to explain the factors contributing to the average gap in undernutrition between poor and non-poor children in urban India. Result Considerable proportions of urban children were found to be underweight (33%), stunted (40%), and wasted (17%) in 2005–06. The undernutrition gap between the poor and non-poor was stark in urban India. For all the three indicators, the main contributing factors were underutilization of health care services, poor body mass index of the mothers, and lower level of parental education among those living in poverty. Conclusions The findings indicate that children belonging to poor households are undernourished due to limited use of health care services, poor health of mothers, and poor educational status of their parents. Based on the findings the study suggests that improving the public services such as basic health care and the education level of the mothers among urban poor can ameliorate the negative impact of poverty on childhood undernutrition. PMID:23734231

CAUSES OF POOR SEALANT PERFORMANCE IN SOIL-GAS- RESISTANT FOUNDATIONS

EPA Science Inventory

The paper discusses causes of poor sealant performance in soil-gas-resistant foundations. ealants for radon-resistant foundation construction must seal the gap between concrete sections. odern sealants have such low permeability that seal performance depends only on the permeabil...

Systematic literature review of the risk factors, comorbidities, and consequences of hypogonadism in men.

PubMed

Zarotsky, V; Huang, M-Y; Carman, W; Morgentaler, A; Singhal, P K; Coffin, D; Jones, T H

2014-11-01

The objective of this review was to summarize the literature on the risk factors, comorbidities, and consequences of male hypogonadism, which is defined as a syndrome complex that includes biochemical confirmation of low testosterone (T) and the consistent symptoms and signs associated with low T. A systematic literature search was performed in PubMed/MEDLINE, EMBASE, Cochrane Library for articles published in the last 10 years on risk factors, comorbidities, and consequences of male hypogonadism. Of the 53 relevant studies identified, nine examined potential risk factors, 14 examined potential comorbidities, and 30 examined potential consequences of male hypogonadism. Based on studies conducted in Asia, Australia, Europe, and North & South America, the important factors that predicted and correlated with hypogonadism were advanced age, obesity, a diagnosis of metabolic syndrome (MetS), and a poor general health status. Diabetes mellitus was correlated with hypogonadism in most studies, but was not established as a risk factor. Although diseases, such as coronary heart disease, hypertension, stroke, and peripheral arterial disease did not predict hypogonadism, they did correlate with incident low T. The data reviewed on potential consequences suggest that low T levels may be linked to earlier all-cause and cardiovascular related mortality among men. This literature review suggests that men with certain factors, such as advanced age, obesity, MetS, and poor general health, are more likely to have and develop hypogonadism. Low levels of T may have important long-term negative health consequences. © 2014 American Society of Andrology and European Academy of Andrology.

How Root Cause Analysis Can Improve the Value Methodology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wixson, James Robert

2002-05-01

Root cause analysis (RCA) is an important methodology that can be integrated with the VE Job Plan to generate superior results from the VE Methodology. The point at which RCA is most appropriate is after the function analysis and FAST Model have been built and functions for improvement have been chosen. These functions are then subjected to a simple, but, rigorous RCA to get to the root cause of their deficiencies, whether it is high cost/poor value, poor quality, or poor reliability. Once the most probable causes for these problems have been arrived at, better solutions for improvement can bemore » developed in the creativity phase because the team better understands the problems associated with these functions.« less

A new definition of maternal depletion syndrome.

PubMed Central

Winkvist, A; Rasmussen, K M; Habicht, J P

1992-01-01

BACKGROUND. Although the term "maternal depletion syndrome" has been commonly used to explain poor maternal and infant health, whether such a syndrome actually exists remains unclear. This uncertainty may be due to the lack of a clear definition of the syndrome and the absence of theoretical frameworks that account for the many factors related to reproductive nutrition. METHODS. We propose a new definition of maternal depletion syndrome within a framework that accounts for potential confounding factors. RESULTS. Our conceptual framework distinguishes between childbearing pattern and inadequate diet as causes of poor maternal health; hence, our definition of maternal depletion syndrome has both biological and practical meaning. The new definition is based on overall change in maternal nutritional status over one reproductive cycle in relation to possible depletion and repletion phases and in relation to initial nutritional status. CONCLUSIONS. The empirical application of this approach should permit the testing of the existence of maternal depletion syndrome in the developing world, and the distinction between populations where family planning will alleviate maternal depletion and those in which an improved diet is also necessary. PMID:1566948

The Role of Tobacco-Derived Carcinogens in Pancreas Cancer

PubMed Central

Lochan, Rajiv; Reeves, Helen L.; Daly, Anne K.; Charnley, Richard M.

2011-01-01

The extremely poor outcome from pancreas cancer is well known. However, its aetiology less well appreciated, and the molecular mechanisms underlying this are poorly understood. Tobacco usage is one of the strongest risk factors for this disease, and this is a completely avoidable hazard. In addition, there are well described hereditary diseases which predispose, and familial pancreas cancer. We have sought here to summarise the role of tobacco-derived carcinogens and the mode of their tumorigenic action on the pancreas. There is compelling evidence from animal and human studies (laboratory including cell line studies and epidemiologic) that tobacco derived carcinogens cause pancreas cancer. However, the manner in which they do so is not entirely apparent. There is also compelling evidence that synergism with genetic and other life-style factors—like diet obesity—results in a multifactorial causation of the disease. Ascertaining the role of tobacco carcinogens in the development of this cancer and their interaction with other risk factors will enable novel therapeutic and preventative strategies to improve outcome from this appalling malignancy. PMID:22084727

A classification of psychological factors leading to violent behavior in posttraumatic stress disorder.

PubMed

Silva, J A; Derecho, D V; Leong, G B; Weinstock, R; Ferrari, M M

2001-03-01

Posttraumatic stress disorder has long been linked to violent behavior. However, the exact nature of that association remains poorly characterized due to the limitations of knowledge in the area of phenomenology, contextual factors, the biology, and the nature of the aggression involved in the disorder. A clear understanding of the genesis of violence in posttraumatic stress disorder can be helpful to those involved in assessing psychiatric-legal issues relevant to the disorder and in its therapeutic management. In this article, we review the potential psychological links between posttraumatic stress disorder secondary to combat exposure and violent behavior and suggest a tentative classification of the main psychological causes of violence in that syndrome.

[Occupation-specific illnesses in musicians].

PubMed

Schuppert, M; Altenmüller, E

1999-12-01

Performance-related disorders in musicians are most often caused by multiple risk factors. They are based on the chronic complex, rapid and forceful work that requires highest precision, as well as on poor ergonomic conditions and psychological strain. Predominantly, the musculo-skeletal system of the upper extremity and the spine is affected by acute or chronic pain syndromes and neurological disorders. Stage fright and psychological tension frequently generate somatoform disorders and may contribute to the chronification of physical disabilities in musicians. Depending on the individual characteristics, the actual professional activity and the specific instrument, the performance-related risk factors and disorders differ widely. Early and regular prevention clearly contributes to a reduction of medical problems in musicians.

Fifty years of stroke researches in India

PubMed Central

Banerjee, Tapas Kumar; Das, Shyamal Kumar

2016-01-01

Currently, the stroke incidence in India is much higher than Western industrialized countries. Large vessel intracranial atherosclerosis is the commonest cause of ischemic stroke in India. The common risk factors, that is, hypertension, diabetes, smoking, and dyslipidemia are quite prevalent and inadequately controlled; mainly because of poor public awareness and inadequate infrastructure. Only a small number of ischemic stroke cases are able to have the benefit of thrombolytic therapy. Benefits from stem cell therapy in established stroke cases are under evaluation. Presently, prevention of stroke is the best option considering the Indian scenario through control and/or avoiding risk factors of stroke. Interventional studies are an important need for this scenario. PMID:27011621

Fasting blood glucose level and prognosis in non-small cell lung cancer (NSCLC) patients.

PubMed

Luo, Juhua; Chen, Yea-Jyh; Chang, Li-Jung

2012-05-01

Diabetes has been consistently linked to many forms of cancers, such as liver, colorectal, pancreatic, and breast cancer, however, the role of diabetes in outcome among cancer patients remains unclear. In this study, we retrospectively reviewed electronic medical records of 342 inpatients newly diagnosed with NSCLC referred by a teaching hospital cancer center in southern Taiwan between 2005 and 2007 to examine the effects of fasting glucose levels at time of cancer diagnosis on overall survival in patients with non-small cell lung cancer (NSCLC). All patients were followed up until the end of 2010. The Kaplan-Meier method was used to compare survival curves for patients with and without diabetes. The Cox proportional hazards model was used to estimate hazard ratios for the association between diabetes, other prognostic factors and patient survival. We observed that significant prognostic factors for poor overall survival in patients with NSCLC included older age, smoking, poor performance status, advanced stage (stage IIIB or IV), and no cancer-directed surgery treatment. Particularly, we identified that diabetic state defined by fasting blood glucose level ≥126 mg/dl was another independent prognostic factor for these patients. Compared with those who had normal range of fasting glucose level (70-99 mg/dl), patients with high fasting glucose level (≥126 mg/dl) had 69% excess risk of all-cause mortality in patients with NSCLC. Diabetes as indicated by elevated fasting blood glucose was independently associated with a significantly higher risk of all-cause mortality in patients with NSCLC, indicating that diabetes or hyperglycemia effectively controlled may present an opportunity for improving prognosis in NSCLS patients with abnormal glucose level. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Long-term outcome and prognostic factors after C2 ganglion decompression in 68 consecutive patients with intractable occipital neuralgia.

PubMed

Choi, Kyu-Sun; Ko, Yong; Kim, Young-Soo; Yi, Hyeong-Joong

2015-01-01

Occipital neuralgia is a rare cause of severe headache characterized by paroxysmal shooting or stabbing pain in the distribution of the greater occipital or lesser occipital nerve. In cases of intractable occipital neuralgia, a definite cause has not been uncovered, so various types of treatment have been applied. The aim of this study is to evaluate the prognostic factors, safety, and long-term clinical efficacy of second cervical (C2) ganglion decompression for intractable occipital neuralgia. Retrospective analysis was performed in 68 patients with medically refractory occipital neuralgia who underwent C2 ganglion decompression. Factors based on patients' demography, pre- and postoperative headache severity/characteristics, medication use, and postoperative complications were investigated. Therapeutic success was defined as pain relief by at least 50 % without ongoing medication. The visual analog scale (VAS) score was significantly reduced between the preoperative and most recent follow-up period. One year later, excellent or good results were achieved in 57 patients (83.9 %), but poor in 11 patients (16.1 %). The long-term outcome after 5 years was only slightly less than the 1-year outcome; 47 of the 68 patients (69.1 %) obtained therapeutic success. Longer duration of headache (over 13 years; p = 0.029) and presence of retro-orbital/frontal radiation (p = 0.040) were significantly associated with poor prognosis. In the current study, C2 ganglion decompression provided durable, adequate pain relief with minimal complications in patients suffering from intractable occipital neuralgia. Due to the minimally invasive and nondestructive nature of this surgical procedure, C2 ganglion decompression is recommended as an initial surgical treatment option for intractable occipital neuralgia before attempting occipital nerve stimulation. However, further study is required to manage the pain recurrence associated with longstanding nerve injury.

Poverty and health sector inequalities.

PubMed Central

Wagstaff, Adam

2002-01-01

Poverty and ill-health are intertwined. Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. This association reflects causality running in both directions: poverty breeds ill-health, and ill-health keeps poor people poor. The evidence on inequalities in health between the poor and non-poor and on the consequences for impoverishment and income inequality associated with health care expenses is discussed in this article. An outline is given of what is known about the causes of inequalities and about the effectiveness of policies intended to combat them. It is argued that too little is known about the impacts of such policies, notwithstanding a wealth of measurement techniques and considerable evidence on the extent and causes of inequalities. PMID:11953787

An investigation into the causes of low calving percentage in communally grazed cattle in Jericho, North West Province.

PubMed

Mokantla, E; McCrindle, C M E; Sebei, J P; Owen, R

2004-03-01

The communal grazing system is generally understood to have a low input, low output type of management. However, the actual inputs and outputs of the farmers are not well known and the farmers are often unaware of their problems. Although the causes of low calving percentage are well understood in commercial beef farming enterprises in South Africa, the same is not true for communal farming systems. The aim of this study was to determine the reproductive performance of beef cattle on a communal farming system in Jericho, North West Province. Ten farmers from five villages with a total of 265 cows and 13 bulls were purposively selected. The selection criteria were that each farmer had to have a minimum of 10 breeding cows and a bull and be willing to participate in the study. This was followed by a 12-month longitudinal study with monthly herd visits where cows were examined rectally and bulls (n = 13) were subjected to a single breeding soundness evaluation. The calving percentage was found to be 37.7%. This is lower than the recorded percentages for commercial beef cattle on extensive grazing. The factors playing a role in low calving percentage were ranked using field data. From this it appeared that failure of cows to become pregnant was the main cause of poor calving percentage as opposed of loss of calves through abortion or resorption. Sub-fertility of the bulls was found to be of great significance and it is proposed that this be included in extension messages and that bulls be fertility tested routinely. Poor body condition score of cows, mainly caused by poor management, was also considered to play a major role in reducing pregnancy rates. Infectious diseases like trichomonosis, campylobacteriosis and brucellosis played a much leser role than anticipated.

Perceptions and concerns of women undergoing Pap smear examination in a tertiary care hospital of India.

PubMed

Tiwari, A; Kishore, J; Tiwari, A

2011-01-01

Cervical cancer is one of the major causes of deaths due to cancer among women in India. Pap smear is one of the best methods to detect early changes in cervix. However, there is lack of data on awareness level of women about Pap smear and various risk factors for cervical cancer. To study the awareness about various risk factors for cervical cancer, health-seeking behavior and hygienic practices among women and to assess the distress experienced by these women before the Pap smear examination. This cross-sectional study was carried out on women coming for a Pap smear examination in a tertiary teaching hospital in New Delhi. A pretested interview schedule was used to get information after obtaining their informed consent. Fifty-seven percent stated that they did not consult a doctor when they noticed the symptoms the first time. Sixty-one percent did not know what a cervical cancer is and a same percentage of women did not know what a Pap smear examination was. Older age group, Muslim and literate women had higher number of abnormal Pap smear results. Women who reported being stressed in their lives had higher number of abnormal smears as compared to women who claimed to lead a stress free life. Poor hygienic practices among these women from urban areas were also associated with abnormal Pap smear results. The study concluded that factors such as poor awareness, shyness, poor hygiene, and old age could be responsible for abnormal Pap smears and this needs special attention in cancer prevention activities of the government.

Glomerular Immune Deposits Are Predictive of Poor Long-Term Outcome in Patients with Adult Biopsy-Proven Minimal Change Disease: A Cohort Study in Korea.

PubMed

Lee, Sung Woo; Yu, Mi-Yeon; Baek, Seon Ha; Ahn, Shin-Young; Kim, Sejoong; Na, Ki Young; Chae, Dong-Wan; Chin, Ho Jun

2016-01-01

There has been little published information on risk factors for poor long-term outcome in adult biopsy-proven minimal change disease (MCD). Data from sixty-three adult, biopsy-proven primary MCD patients treated at a tertiary university hospital between 2003 and 2013 were analyzed. Baseline clinical and pathologic factors were assessed for the associations with composite outcome of creatinine doubling, end stage renal disease, or all-cause mortality. During a median (interquartile) 5.0 (2.8-5.0) years, the composite outcome occurred in 11.1% (7/63) of patients. The rate of glomerular immune deposits was 23.8% (15/63). Patients with glomerular immune deposits showed a significantly lower urine protein creatinine ratio than those without deposits (P = 0.033). The rate of non-responders was significantly higher in patients with glomerular immune deposits than in those without deposits (P = 0.033). In patients with deposits, 26.7% (4/15) developed the composite outcome, while only 6.3% (3/48) developed the composite outcome among those without deposits (P = 0.049). In multivariate Cox proportional hazards regression analysis, the presence of glomerular immune deposits was the only factor associated with development of the composite outcome (hazard ratio: 2.310, 95% confidence interval: 1.031-98.579, P = 0.047). Glomerular immune deposits were associated with increased risk of a composite outcome in adult MCD patients. The higher rate of non-responders in patients with deposits might be related to the poor outcome. Future study is needed.

Species decline: Contaminants and other contributing factors

USGS Publications Warehouse

Pattee, O.H.; Rattner, B.A.; Eisler, R.

1998-01-01

Members of over 1,200 taxa have been listed as Threatened or Endangered, and over 4,000 additional organisms have been identified as Candidate Species or Species of Concern. Identification of critical limiting factors may result in management actions that stabilize vulnerable populations and insure their perpetuation. Both naturally-occurring and anthropogenic activities (e.g., environmental contaminants and pollution) have been demonstrated to be a significant factor in depressing populations or catalyzing the final crash of some species. The objective of this project is to develop a synthesis document and database that lists and ranks the presumed causes of decline, with special emphasis on contaminants and pollutant-related situations. This will be accomplished by synoptic review of all recovery plans (n=479) with listing packages (n=1134) serving as a secondary source of information, followed by itemization, cross-referencing, enumeration, and ranking of contributing and limiting factors. To date we have analyzed all of the recovery plans for reptiles (n=26) and amphibians (n=6). 188 causes are defined, falling into 6 major categories: habitat alteration/availability (47.8%); exploitation/harvest (19.7%); introduction of exotic species (10.1%); contaminants (9.0%); miscellaneous others (6.9%); pollution (6.4%). The applicability of these data are extensive, including facilitating reviews of Section 7 consultations and Environmental Impact Statements, reviewing permit applications, conducting environmental contaminant risk assessments, identifying specific data gaps and research needs, selecting potential management actions, and establishing priorities for broad-based research on limiting factors applicable to groups of species rather than the current species-by-species approach. However. caution must be exercised in the use of this data because of the speculative nature of the causes; most of the causes (69.7%) are based on poorly documented expert opinion and/or guesswork. This is particularly true of the contaminant/pollution categories where only 13.8% of the incidents are documented in the literature as true causes of decline.

Performance Metrics for Monitoring Parallel Program Executions

NASA Technical Reports Server (NTRS)

Sarukkai, Sekkar R.; Gotwais, Jacob K.; Yan, Jerry; Lum, Henry, Jr. (Technical Monitor)

1994-01-01

Existing tools for debugging performance of parallel programs either provide graphical representations of program execution or profiles of program executions. However, for performance debugging tools to be useful, such information has to be augmented with information that highlights the cause of poor program performance. Identifying the cause of poor performance necessitates the need for not only determining the significance of various performance problems on the execution time of the program, but also needs to consider the effect of interprocessor communications of individual source level data structures. In this paper, we present a suite of normalized indices which provide a convenient mechanism for focusing on a region of code with poor performance and highlights the cause of the problem in terms of processors, procedures and data structure interactions. All the indices are generated from trace files augmented with data structure information.. Further, we show with the help of examples from the NAS benchmark suite that the indices help in detecting potential cause of poor performance, based on augmented execution traces obtained by monitoring the program.

Surgeons' Perceptions of the Causes of Preventable Harm in Arterial Surgery: A Mixed-Methods Study.

PubMed

Lear, Rachael; Godfrey, Anthony D; Riga, Celia; Norton, Christine; Vincent, Charles; Bicknell, Colin D

2017-12-01

System factors contributing to preventable harm in vascular patients have not been previously reported in detail. The aim of this exploratory mixed-methods study was to describe vascular surgeons' perceptions of factors contributing to adverse events (AEs) in arterial surgery. A secondary aim was to report recommendations to improve patient safety. Vascular consultants/registrars working in the British National Health Service were questioned about the causes of preventable AEs through survey and semi-structured interview (response rates 77% and 83%, respectively). Survey respondents considered a recent AE, indicating on a 5 point Likert scale the extent to which various factors from a validated framework contributed toward the incident. Semi-structured interviews were conducted to obtain detailed accounts of contributory factors, and to elicit recommendations to improve safety. Seventy-seven surgeons completed the survey on 77 separate AEs occurring during open surgery (n = 41) and in endovascular procedures (n = 36). Ten interviewees described 15 AEs. The causes of AEs were multifactorial (median number of factors/AE = 5, IQR 3-9, range 0-25). Factors frequently reported by survey respondents were communication failures (36.4%; n = 28/77); inadequate staffing levels/skill mix (32.5%; n = 25/77); lack of knowledge/skill (37.3%; n = 28/75). Themes emerging from interviews were team factors (communication failure, lack of team continuity, lack of clarity over roles/responsibilities); work environment factors (poor staffing levels, equipment problems, distractions); inadequate training/supervision. Knowledge/skill (p = .034) and competence (p = .018) appeared to be more prominent in causing AEs in open procedures compared with endovascular procedures; organisational structure was more frequently implicated in AEs occurring in endovascular procedures (p = .017). To improve safety, interviewees proposed team training programmes (5/10 interviewees); additional protocols/checklists (4/10); improved escalation procedures (3/10). Vascular surgeons believe that AEs in arterial operations are caused by multiple, modifiable system factors. Larger studies are needed to establish the relative importance of these factors and to determine strategies that can effectively address system failures. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

An epidemiological study of temporomandibular joint ankylosis

PubMed Central

Gupta, Vinay Kumar; Mehrotra, Divya; Malhotra, Seema; Kumar, Sandeep; Agarwal, Girdhar Gopal; Pal, Uma Shanker

2012-01-01

Introduction: The temporomandibular joint (TMJ) forms the very cornerstone of craniofacial integrity and its ankylosis in a growing child may cause problems in daily food intake, speech, appearance, and oral hygiene is affected to a major extent. It is one of the common acquired pathologies afflicting the skeleton. It is also the most overlooked and under-managed problem in children. Materials and Methods: A house to house survey was conducted between 2010 and 2011 in rural and urban areas of Lucknow. A total of 21,720 children aged between 3-15 years from 9090 houses comprising a representative sample were included. Results: Ten TMJ ankylosis cases were identified in 21,720 children. Of these, six were bilateral and four were unilateral. Male to female ratio was 1:9, with most patients (70.0%) being in the 10-15 years’ age group (mean age was 11.1 years ± 3.34). The most common cause of ankylosis was trauma for 90.0% of cases. The majority of patients (70%) were reporting the condition for the first time, with 30% patients having had previous treatment. Conclusion: TMJ ankylosis is an acquired condition in most of the cases. Birth/childhood trauma would be the major causative factor. Knowledge amongst parents, providers of health about this entity was poor. Initial management of the causative factor was poor. Mere knowledge among the general population and healthcare providers can result in primary prevention and also secondary prevention along with its successful definitive treatment. PMID:23251054

CXCR1-mediated Neutrophil Degranulation and Fungal Killing Promotes Candida Clearance and Host Survival

PubMed Central

Swamydas, Muthulekha; Gao, Ji-Liang; Break, Timothy J.; Johnson, Melissa D.; Jaeger, Martin; Rodriguez, Carlos A.; Lim, Jean K.; Green, Nathaniel M.; Collar, Amanda L.; Fischer, Brett G.; Lee, Chyi-Chia Richard; Perfect, John R.; Alexander, Barbara D.; Kullberg, Bart-Jan; Netea, Mihai G.; Murphy, Philip M.; Lionakis, Michail S.

2016-01-01

Systemic Candida albicans infection causes high morbidity and mortality and is now the leading cause of nosocomial bloodstream infection in the US. Neutropenia is a major risk factor for poor outcome in infected patients; however, the molecular factors that mediate neutrophil trafficking and effector function during infection are poorly defined. Here, using a mouse model of systemic candidiasis, we found that the neutrophil-selective CXC chemokine receptor Cxcr1 and its ligand, Cxcl5, are highly induced in the Candida-infected kidney, the target organ in the model. To investigate the role of Cxcr1 in antifungal host defense in vivo, we generated Cxcr1−/− mice and analyzed their immune response to Candida. Mice lacking Cxcr1 exhibited decreased survival with enhanced Candida growth in the kidney and renal failure. Surprisingly, increased susceptibility of Cxcr1−/− mice to systemic candidiasis was not due to impaired neutrophil trafficking from the blood into the infected kidney but was the result of defective killing of the fungus by neutrophils that exhibited a cell-intrinsic decrease in degranulation. In humans, the mutant CXCR1 allele CXCR1-T276 results in impaired neutrophil degranulation and fungal killing and was associated with increased risk of disseminated candidiasis in infected patients. Together, our data demonstrate a biological function for mouse Cxcr1 in vivo and indicate that CXCR1-dependent neutrophil effector function is a critical innate protective mechanism of fungal clearance and host survival in systemic candidiasis. PMID:26791948

On the causes of persistent apical periodontitis: a review.

PubMed

Nair, P N R

2006-04-01

Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not adequately eliminated intraradicular infection. Problems that lead to persistent apical periodontitis include: inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Even when the most stringent procedures are followed, apical periodontitis may still persist as asymptomatic radiolucencies, because of the complexity of the root canal system formed by the main and accessory canals, their ramifications and anastomoses where residual infection can persist. Further, there are extraradicular factors -- located within the inflamed periapical tissue -- that can interfere with post-treatment healing of apical periodontitis. The causes of apical periodontitis persisting after root canal treatment have not been well characterized. During the 1990s, a series of investigations have shown that there are six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment. These are: (i) intraradicular infection persisting in the complex apical root canal system; (ii) extraradicular infection, generally in the form of periapical actinomycosis; (iii) extruded root canal filling or other exogenous materials that cause a foreign body reaction; (iv) accumulation of endogenous cholesterol crystals that irritate periapical tissues; (v) true cystic lesions, and (vi) scar tissue healing of the lesion. This article provides a comprehensive overview of the causative factors of non-resolving periapical lesions that are seen as asymptomatic radiolucencies post-treatment.

Virulence properties of asymptomatic bacteriuria Escherichia coli.

PubMed

Mabbett, Amanda N; Ulett, Glen C; Watts, Rebecca E; Tree, Jai J; Totsika, Makrina; Ong, Cheryl-lynn Y; Wood, Jacqueline M; Monaghan, Wayne; Looke, David F; Nimmo, Graeme R; Svanborg, Catharina; Schembri, Mark A

2009-01-01

In asymptomatic bacteriuria (ABU), bacteria colonize the urinary tract without provoking symptoms. Here, we compared the virulence properties of a collection of ABU Escherichia coli strains to cystitis and pyelonephritis strains. Specific urinary tract infection (UTI)-associated virulence genes, hemagglutination characteristics, siderophore production, hemolysis, biofilm formation, and the ability of strains to adhere to and induce cytokine responses in epithelial cells were analyzed. ABU strains were phylogenetically related to strains that cause symptomatic UTI. However, the virulence properties of the ABU strains were variable and dependent on a combination of genotypic and phenotypic factors. Most ABU strains adhered poorly to epithelial cells; however, we also identified a subgroup of strongly adherent strains that were unable to stimulate an epithelial cell IL-6 cytokine response. Poor immune activation may represent one mechanism whereby ABU E. coli evade immune detection after the establishment of bacteriuria.

Impact of computer use on children's vision.

PubMed

Kozeis, N

2009-10-01

Today, millions of children use computers on a daily basis. Extensive viewing of the computer screen can lead to eye discomfort, fatigue, blurred vision and headaches, dry eyes and other symptoms of eyestrain. These symptoms may be caused by poor lighting, glare, an improper work station set-up, vision problems of which the person was not previously aware, or a combination of these factors. Children can experience many of the same symptoms related to computer use as adults. However, some unique aspects of how children use computers may make them more susceptible than adults to the development of these problems. In this study, the most common eye symptoms related to computer use in childhood, the possible causes and ways to avoid them are reviewed.

Connecting the Lines between Hypogonadism and Atherosclerosis

PubMed Central

Fahed, Akl C.; Gholmieh, Joanna M.; Azar, Sami T.

2012-01-01

Epidemiological studies show that atherosclerotic cardiovascular disease is a leading cause of morbidity and mortality worldwide and point to gender differences with ageing males being at highest risk. Atherosclerosis is a complex process that has several risk factors and mediators. Hypogonadism is a commonly undiagnosed disease that has been associated with many of the events, and risk factors leading to atherosclerosis. The mechanistic relations between testosterone levels, atherosclerotic events, and risk factors are poorly understood in many instances, but the links are clear. In this paper, we summarize the research journey that explains the link between hypogonadism, each of the atherosclerotic events, and risk factors. We look into the different areas from which lessons could be learned, including epidemiological studies, animal and laboratory experiments, studies on androgen deprivation therapy patients, and studies on testosterone-treated patients. We finish by providing recommendations for the clinician and needs for future research. PMID:22518131

A classification on human factor accident/incident of China civil aviation in recent twelve years.

PubMed

Luo, Xiao-li

2004-10-01

To study human factor accident/incident occurred during 1990-2001 using new classification standard. The human factor accident/incident classification standard is developed on the basis of Reason's Model, combining with CAAC's traditional classifying method, and applied to the classified statistical analysis for 361 flying incidents and 35 flight accidents of China civil aviation, which is induced by human factors and occurred from 1990 to 2001. 1) the incident percentage of taxi and cruise is higher than that of takeoff, climb and descent. 2) The dominating type of flight incidents is diverging of runway, overrunning, near-miss, tail/wingtip/engine strike and ground obstacle impacting. 3) The top three accidents are out of control caused by crew, mountain collision and over runway. 4) Crew's basic operating skill is lower than what we imagined, the mostly representation is poor correcting ability when flight error happened. 5) Crew errors can be represented by incorrect control, regulation and procedure violation, disorientation and diverging percentage of correct flight level. The poor CRM skill is the dominant factor impacting China civil aviation safety, this result has a coincidence with previous study, but there is much difference and distinct characteristic in top incident phase, the type of crew error and behavior performance compared with that of advanced countries. We should strengthen CRM training for all of pilots aiming at the Chinese pilot behavior characteristic in order to improve the safety level of China civil aviation.

Risk factors associated with infectious bursal disease vaccination failures in broiler farms in Kenya.

PubMed

Mutinda, Wanzila Usyu; Nyaga, Philip Njeru; Mbuthia, Paul Gichohi; Bebora, Lilly Caroline; Muchemi, Gerald

2014-04-01

Immunization together with application of biosecurity measures are the principal methods of preventing infectious bursal disease outbreaks in high-risk areas. However, outbreaks in vaccinated chicken flocks have been reported in many parts of the world as a result of factors of vaccine virus, animal, or vaccine handler. In Kenya, such outbreaks have been reported, but the causes have not been studied. This study aimed at determining the risk factors associated with vaccine handling leading to vaccine failure in broiler flocks in Kwale County, Kenya. Structured questionnaires and visual observations were used to collect data from 83 broiler farms, 6 breeding farms, and 17 vaccine outlets. Relative risk (RR) analysis was used to determine the association between identified potential risk factors and vaccination failure. Results show that vaccines were properly handled in all vaccine outlet shops. Breeding farms maintained high levels of biosecurity and employed standard vaccine handling practices. Basic biosecurity practices were poor in broiler farms. Broiler farms failed to meet all the recommended standard procedures for vaccine storage, reconstitution, and administration. Risk factors included poor vaccine storage (RR = 8.7) and use of few drinkers to administer vaccine (RR = 5.8); traces of disinfectants in drinkers used to administer live vaccine (RR = 2.8); use of wrong vaccine-infectious bronchitis instead of infectious bursal disease vaccine (RR = 2.1); and use of improper diluents (RR = 1.6). Broiler farmers need training on basic farm biosecurity measures and standard vaccine handling practices.

Study on the quality of FRP fishing vessel based on improved Fishbone Chart

NASA Astrophysics Data System (ADS)

Sui, J. H.; Yu, Y. F.; Du, Q. F.; Jiang, D. W.

2018-01-01

The construction quality of FRP fishing vessels influences their production, use and industry development. In order to explore the factors that affect the construction quality of FRP fishing vessels, key factors affecting the construction quality of FRP fishing vessels are determined based on the quality problems of FRP fishing vessels constructed. The improved Fishbone Chart is used to analyze the eight factors of “human, machine, material, process, environment, inspection, design and information”. Taking the factors that affect the construction quality of FRP fishing vessels as the central target, the eight influencing factors were condensed into five aspects and a composite Fishbone Chart is drawn. The Fishbone Chart is used as the basic model, the influencing factors are sorted, screened and discriminated, and the system model convenient for construction site management and control is established. Finally, the causes of poor construction of FRP fishing vessels are analyzed and discussed, and relevant suggestions are put forward.

Categorization of potential project cost overrun factors in construction industry

NASA Astrophysics Data System (ADS)

Karunakaran, P.; Abdullah, A. H.; Nagapan, S.; Sohu, S.; Kasvar, K. K.

2018-04-01

Cost overrun has been severely hit down the economy and reputations for many construction industry around the world. Many project management tools developed to control the budget of a project. However, the cost management is still considered poor as there are many cost overrun issues occurred in the construction industry. Thus, this paper aims to identify and cluster the potential construction project cost overrun factors according to their originating groups using the thematic approach. Basically, through literature review, all the potential factors that may cause cost overrun were screened thoroughly before they were clustered into seven (7) groups of the originating factors, namely project, contract, client, contractor, consultant, labour and external. Each potential factor was explained clearly with some examples based on the Malaysian case studies to illustrate the cost overrun scenario. These findings may aid in the future to highlight on how to mitigate the critical potential factors of cost overrun to reduce or overcome its impact on all the stakeholders involved.

Retinopathy of prematurity

PubMed Central

Hellström, Ann; Smith, Lois E H; Dammann, Olaf

2015-01-01

The immature retinas of preterm neonates are susceptible to insults that disrupt neurovascular growth, leading to retinopathy of prematurity. Suppression of growth factors due to hyperoxia and loss of the maternal–fetal interaction result in an arrest of retinal vascularisation (phase 1). Subsequently, the increasingly metabolically active, yet poorly vascularised, retina becomes hypoxic, stimulating growth factor-induced vasoproliferation (phase 2), which can cause retinal detachment. In very premature infants, controlled oxygen administration reduces but does not eliminate retinopathy of prematurity. Identification and control of factors that contribute to development of retinopathy of prematurity is essential to prevent progression to severe sight-threatening disease and to limit comorbidities with which the disease shares modifiable risk factors. Strategies to prevent retinopathy of prematurity will depend on optimisation of oxygen saturation, nutrition, and normalisation of concentrations of essential factors such as insulin-like growth factor 1 and ω-3 polyunsaturated fatty acids, as well as curbing of the effects of infection and inflammation to promote normal growth and limit suppression of neurovascular development. PMID:23782686

Magnitude and associated factors of aggressive behaviour among patients with bipolar disorder at Amanual Mental Specialized Hospital, outpatient department, Addis Ababa, Ethiopia: cross-sectional study.

PubMed

Belete, Habte; Mulat, Haregwoin; Fanta, Tolesa; Yimer, Solomon; Shimelash, Takele; Ali, Tilahun; Tewabe, Tilahun

2016-12-12

Aggressive behavior is a challenging behavior among bipolar patients that causes poor social interaction and hospitalization. But, there is no information regards of the magnitude and contributing factors for aggressive behaviour among bipolar patients in Ethiopia. Therefore, this study was designed to assess the prevalence and associated factors of aggressive behaviour among patients with bipolar disorder. An institutional based cross sectional study was conducted at Amanual Mental Specialized Hospital from May 1 to June 1, 2015 among 411 participants who were selected by systematic random sampling technique. Data was collected by interview technique by using Modified Overt Aggression Scale, entered and analyzed by using Epi Data 3.1 and Statistical Package for Social Science version 20, respectively. Adjusted Odd Ratio (AOR) with 95% Confidence Interval (CI) were used to show the odd and P-value <0.05 was considered as statistically significant. A total of 411 bipolar patients were included in the study and the prevalence of aggressive behaviour was 29.4%. Significant associated factors for aggression were, having two or more episode [AOR = 2.35 95% CI (1.18, 4.69)], previous history of aggression, [AOR = 3.72, 95% CI (1.54, 8.98)], depressive symptoms [AOR = 3.63, 95% CI (1.89, 6.96)], psychotic symptoms [AOR = 5.41,95% CI (2.88, 10.1)], manic symptoms [AOR = 3.85,95% CI (2.06, 7.19)], poor medication adherence [AOR = 3.73 95% CI (1.71, 8.13)], poor social support [AOR = 2.99 95% CI (1.30, 6.91)] and current use of substance[AOR = 2.17 95% CI (1.16, 4.06)]. Prevalence of aggression is high among bipolar patients and associated with many factors. So it needs public health attention to decrease aggression among bipolar patients.

Functional contributors to poor movement and balance control in patients with low back pain: A descriptive analysis.

PubMed

Ayhan, Cigdem; Bilgin, Sevil; Aksoy, Songul; Yakut, Yavuz

2016-08-10

Automatic and voluntary body position control is essential for postural stability; however, little is known about individual factors that impair the sensorimotor system associated with low back pain (LBP). To evaluate automatic and voluntary motor control impairments causing postural instability in patients with LBP. Motor control impairments associated with poor movement and balance control were analyzed prospectively in 32 patients with LBP. Numeric Rating Scale (NRS) for pain assessment, Oswestry Disability Index (ODI) for disability measurement, and computerized dynamic posturography (CDP) for analysis of postural responses were used to measure outcomes of all patients. Computerized dynamic posturography tests including Sensory organization test (SOT), limits of stability test (movement velocity, directional control, endpoint, and maximum excursion), rhythmic weight shift (rhythmic movement speed and directional control), and adaptation test (toes-up and toes-down tests) were performed and the results compared with NeuroCom normative data. The mean age of the patients was 40.50 ± 12.28 years. Lower equilibrium scores were observed in SOT (p < 0.05). There was a significant increase in reaction time and decrease in movement velocity, directional control, and endpoint excursion (p < 0.05). Speed of rhythmic movement along the anteroposterior direction decreased, while speed increased along the lateral direction (p < 0.05). Poor directional control was recorded in the anteroposterior direction (p < 0.05). Toes-down test showed an increased COG sway in patients compared with that in the controls (p < 0.05). LBP causes poor voluntary control of body positioning, a reduction in movement control, delays in movement initiation, and a difficulty to adapt to sudden surface changes.

Prevalence and Visual Outcomes of Cataract Surgery in Rural South India: A Cross-Sectional Study.

PubMed

Paul, P; Kuriakose, T; John, J; Raju, R; George, K; Amritanand, A; Doss, P A; Muliyil, J

2016-10-01

To determine the prevalence of cataract surgery and postoperative vision-related outcomes, especially with respect to sex, socioeconomic status (SES) and site of first contact with eye care, in a rural area of South India. In a population-based cross-sectional survey of 5530 individuals aged 50 years or older from 10 villages selected by cluster sampling, individuals who had undergone cataract surgery in one or both eyes were identified. Consenting participants were administered a questionnaire, underwent vision assessment and ophthalmic examination. Outcomes were classified as good if visual acuity of the operated eye was 6/18 or better, fair if worse than 6/18 but better than or equal to 6/60, and poor if worse than 6/60. Prevalence of cataract surgery in this age group (771 persons) was 13.9% (95% confidence interval, CI, 13.0-14.9%). In the 1112 eyes of 749 persons studied, at presentation, 53.1% (95% CI 50.1-56.1%) of operated eyes had good, 38.1% (95% CI 35.2-41.0%) had fair, and 8.8% (95% CI 7.1-10.5%) had poor outcomes. With pinhole, 75.2% (95% CI 72.6-77.8%) had good, 17.2% (95% CI 14.9-19.5%) had fair, and 7.4% (95% CI 5.8-9.0%) had poor outcomes. In 76.3% of eyes with fair and poor presenting outcomes we detected an avoidable cause for the suboptimal visual acuity. Place of surgery and duration since surgery of 3 years or more were risk factors for blindness, while SES, sex and site of first eye care contact were not. The high prevalence of avoidable causes of visual impairment in this rural setting indicates the scope for preventive strategies.

iPSC-derived cardiomyocytes reveal abnormal TGFβ signaling in left ventricular non-compaction cardiomyopathy

PubMed Central

Kodo, Kazuki; Ong, Sang-Ging; Jahanbani, Fereshteh; Termglinchan, Vittavat; Hirono, Keiichi; InanlooRahatloo, Kolsoum; Ebert, Antje D.; Shukla, Praveen; Abilez, Oscar J.; Churko, Jared M.; Karakikes, Ioannis; Jung, Gwanghyun; Ichida, Fukiko; Wu, Sean M.; Snyder, Michael P.; Bernstein, Daniel; Wu, Joseph C.

2016-01-01

Left ventricular non-compaction (LVNC) is the third most prevalent cardiomyopathy in children and its pathogenesis has been associated with the developmental defect of the embryonic myocardium. We show that patient-specific induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) generated from LVNC patients carrying a mutation in the cardiac transcription factor TBX20 recapitulate a key aspect of the pathological phenotype at the single-cell level and was associated with perturbed transforming growth factor beta (TGFβ) signaling. LVNC iPSC-CMs have decreased proliferative capacity due to abnormal activation of TGFβ signaling. TBX20 regulates the expression of TGFβ signaling modifiers including a known genetic cause of LVNC, PRDM16, and genome editing of PRDM16 caused proliferation defects in iPSC-CMs. Inhibition of TGFβ signaling and genome correction of the TBX20 mutation were sufficient to reverse the disease phenotype. Our study demonstrates that iPSC-CMs are a useful tool for the exploration of pathological mechanisms underlying poorly understood cardiomyopathies including LVNC. PMID:27642787

Sudden cardiac death in haemodialysis: clinical epidemiology and mechanisms.

PubMed

Banerjee, Debasish

Sudden cardiac death, which causes premature loss of lives on haemodialysis of the elderly, youths and even children; cannot be prevented, because the aetiology is poorly understood and effective interventions are yet unknown. Improving our knowledge of mechanisms causing sudden cardiac death in haemodialysis patients may help us to design better interventions; and clinical epidemiology of sudden cardiac death could be an important tool to further guide human and animal studies. This review researches the clinical epidemiology of sudden cardiac death to suggest possible mechanisms, although they require further studies. The research shows how traditional cardiovascular risk factors such as age, diabetes and smoking have an impact; non-traditional risk factors such as inflammation, mineral-bone disease and even uraemia itself have higher impact; and how cardiac structural, functional and electrocardiographic markers predict sudden cardiac death in dialysis patients. More in-depth human and animal studies, guided with existing knowledge, are necessary to better understand the mechanisms and design successful interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

The Effects of Diesel Exhaust Pollution on Floral Volatiles and the Consequences for Honey Bee Olfaction.

PubMed

Lusebrink, Inka; Girling, Robbie D; Farthing, Emily; Newman, Tracey A; Jackson, Chris W; Poppy, Guy M

2015-10-01

There is growing evidence of a substantial decline in pollinators within Europe and North America, most likely caused by multiple factors such as diseases, poor nutrition, habitat loss, insecticides, and environmental pollution. Diesel exhaust could be a contributing factor to this decline, since we found that diesel exhaust rapidly degrades floral volatiles, which honey bees require for flower recognition. In this study, we exposed eight of the most common floral volatiles to diesel exhaust in order to investigate whether it can affect volatile mediated plant-pollinator interaction. Exposure to diesel exhaust altered the blend of common flower volatiles significantly: myrcene was considerably reduced, β-ocimene became undetectable, and β-caryophyllene was transformed into its cis-isomer isocaryophyllene. Proboscis extension response (PER) assays showed that the alterations of the blend reduced the ability of honey bees to recognize it. The chemically reactive nitrogen oxides fraction of diesel exhaust gas was identified as capable of causing degradation of floral volatiles.

Time Overrun in Construction Project

NASA Astrophysics Data System (ADS)

Othman, I.; Shafiq, Nasir; Nuruddin, M. F.

2017-12-01

Timely completion is the key criteria to achieve success in any project despite the industry. Unfortunately construction industry in Malaysia has been labelled as industry facing poor performance leading to failure in achieving effective time management. As the consequence most of the project face huge amount of time overrun. This study assesses the causes of construction projects time overrun in Malaysia using structured questionnaire survey. Each respondent is asked to assign a one-to-five rating for each of the 18 time factors identified from literature review. Out of the 50 questionnaires sent out, 33 were received back representing 68% of the response rate. Data received from the questionnaires were analysed and processed using the descriptive statistics procedures. Findings from the study revealed that design and documentation issues, project management and contract administration, ineffective project planning and scheduling, contractor’s site management, financial resource management were the major factors that cause the time overrun. This study is hoped to help the practitioners to implement the mitigation measure at planning stage in order to achieve successful construction projects.

VEGF and Ki-67 Overexpression in Predicting Poor Overall Survival in Adenoid Cystic Carcinoma.

PubMed

Park, Seongyeol; Nam, Soo Jeong; Keam, Bhumsuk; Kim, Tae Min; Jeon, Yoon Kyung; Lee, Se-Hoon; Hah, J Hun; Kwon, Tack-Kyun; Kim, Dong-Wan; Sung, Myung-Whun; Heo, Dae Seog; Bang, Yung-Jue

2016-04-01

The purpose of this study was to evaluate potential prognostic factors in patients with adenoid cystic carcinoma (ACC). A total of 68 patients who underwent curative surgery and had available tissue were enrolled in this study. Their medical records and pathologic slides were reviewed and immunohistochemistry for basic fibroblast growth factor, fibroblast growth factor receptor (FGFR) 2, FGFR3, c-kit, Myb proto-oncogene protein, platelet-derived growth factor receptor beta, vascular endothelial growth factor (VEGF), and Ki-67 was performed. Univariate and multivariate analysis was performed for determination of disease-free survival (DFS) and overall survival (OS). In univariate analyses, primary site of nasal cavity and paranasal sinus (p=0.022) and Ki-67 expression of more than 7% (p=0.001) were statistically significant factors for poor DFS. Regarding OS, perineural invasion (p=0.032), high expression of VEGF (p=0.033), and high expression of Ki-67 (p=0.007) were poor prognostic factors. In multivariate analyses, primary site of nasal cavity and paranasal sinus (p=0.028) and high expression of Ki-67 (p=0.004) were independent risk factors for poor DFS, and high expression of VEGF (p=0.011) and Ki-67 (p=0.011) showed independent association with poor OS. High expression of VEGF and Ki-67 were independent poor prognostic factors for OS in ACC.

Single and Cumulative Relations of Social Risk Factors with Children's Dental Health and Care-Utilization Within Regions of the United States.

PubMed

Yang, Alyssa J; Gromoske, Andrea N; Olson, Melissa A; Chaffin, Jeffrey G

2016-03-01

The purpose is to examine the relation of social risk factors, and the cumulative burden of social risk factors, on parent-reported dental health and dental care-seeking behavior. National Survey of Children's Health data (2011-2012) were analyzed for US children by Title V Block Grant regions. Multivariate logistic regressions were estimated for ten social risk factors, as well as a cumulative risk index, to find any associations with poor condition of teeth, presence of dental caries, and no dental care visits. Almost all of the risk factors were significantly associated with poor condition of teeth and presence of dental caries for the US. Models associating no dental care visits suggested that low family income (OR 1.58), poor maternal mental health (OR 1.54), high school education or less (OR 1.34), and multi-racial/other race (OR 1.18) were significant factors for the US. Regional variation existed for those risk factors and their association with the outcomes, but income, education, and poor maternal mental health consistently played a significant role in adverse outcomes. The cumulative risk index was strongly related to poor oral health outcomes, with a weaker relationship to dental care utilization. US children experiencing certain social risk factors, such as low family income, high school education or less, and poor maternal mental health, are likely to be at greater risk for poor dental health and low levels of dental-care seeking behavior. Children experiencing multiple social risks are at greater risk for poor oral outcomes than children who experience fewer social risks. An approach that involves the social determinants of health is needed to address these issues.

Social determinants of cardiovascular disease outcomes in Indians.

PubMed

Jeemon, Panniyammakal; Reddy, K S

2010-11-01

Cardiovascular diseases (CVD) are the leading cause of death and disability in both developed and developing countries. In developed countries socio-economic mortality differentials have been studied extensively showing that the low socio-economic group suffers the highest mortality. As the epidemiological transition is taking place against a background of economic globalization, CVD risk factors among the urban poor and middle class are rapidly increasing in India. Recent evidences from India also suggest reversal of social gradient with excess burden of CVD morbidity in the low socio-economic group. Understanding the social determinants of environmental and behavioural exposures, in determining the risk factors for cardiovascular disease is an important challenge for public health professionals as well as communities. Socio-economic disadvantage is not simply a proxy for poor cardiovascular risk factor status, but also an indication of the likely trajectory that an individual or a community may follow in the course of their life. The paucity of intervention research seeking to address the role of social determinants in shaping lifestyle practices among individuals in culturally and socially diverse population groups within India is definitely a measure of inadequacy in public health research. This review article provides an overview of the role of social determinants of CVD and its possible conceptual pathways with special focus on acute coronary syndrome (ACS) outcomes among Indians.

Chemical abundances in the globular clusters M3, M13, and NGC 6752

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bell, R.A.; Dickens, R.J.

The abundances of iron, carbon, nitrogen, and oxygen have been investigated in red giant stars in the globular clusters M3, M13, and NGC 6752. The results are based on application of spectrum synthesis and theoretical colors to observed spectra, DDO colors, and infrared CO measurements. Carbon is depleted by a factor of about 3 relative to other metals in most giants studied, with no evidence for the discontinuity along the giant branch at M/sub v/approx. =-0.7 found for more metal-poor clusters. This contrasts with the greater depletion of about a factor of 6 for the more metal-poor cluster stars, amore » difference which is expected if meridional mixing is responsible for the carbon depletion. The spectroscopic results for nitrogen are imprecise, but the colors suggest enhancements of a factor of 3. The iron abundances for M3 and M13 stars have been determined from published equivalent widths, yielding (Fe/H) close to -1.4 for both clusters. The uncertainties in M3 and M13 CO colors and (O I) equivalent widths make it impossible to derive accurate oxygen abundances, but the depletion of carbon is real and is not caused by an overabundance of oxygen.« less

Prevalence and Risk Factors of Poor Sleep Quality among Chinese Elderly in an Urban Community: Results from the Shanghai Aging Study

PubMed Central

Zhao, Qianhua; Guo, Qihao; Meng, Haijiao; Hong, Zhen; Ding, Ding

2013-01-01

Background Sleep disorders causes a significant negative effect on mental and physical health, particularly among the elderly. The disease burden and risk factors of poor sleep quality of the elderly need to be verified using a validated form of measurement in urban mainland China. Methods This study included 1086 community residents aged ≥60 years who completed the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Poor sleeper was defined by a CPSQI global score of >5. Subjects also accepted the neurological and neuropsychological assessments, including the Mini-Mental State Examination, Center for Epidemiological Studies Depression Scale, and Zung Self-Rating Anxiety Scale (ZSAS). A history of chronic diseases was confirmed by the medical records of each participant. Results The prevalence of poor sleep quality in this population was 41.5% (95% confidence interval (CI) = 38.6–44.5%), with a higher rate observed in elderly females (45.8% [95% CI = 41.9–49.7%]) than that in elderly males (35.8% [95% CI = 31.4–40.1%]). The prevalence rate increased with age, from 32.1% (95% CI = 27.8–36.4%) in those aged 60–69 years to 52.5% (95% CI = 45.9–59.1%) in those aged ≥80 years (p value for trend<0.001). Multivariate logistic regression analysis indicated that age (OR = 1.03[95% CI = 1.01–1.05], p<0.001), less education duration (OR = 1.04 [95% CI = 1.01–1.08, p = 0.014), living alone (OR = 1.62 [95% CI = 1.02–2.58], p = 0.04), anxiety (ZSAS score: OR = 1.09 [95% CI = 1.05–1.12], p<0.001), number of chronic disease (OR = 1.18 [95% CI = 1.07–1.30], p = 0.14) and arthritis (OR = 1.45[95% CI = 1.05–2.01], p = 0.025) were risk factors of poor sleep quality. Conclusions Poor sleep quality is highly prevalent among elderly Chinese residents in urban Shanghai. Growing attention and comprehensive countermeasures involving psycho-social and personal activities might alleviate the sleep problem in the elderly. PMID:24282576

Knowledge of type 2 diabetic patients about their condition in Kimpese Hospital diabetic clinic, Democratic Republic of the Congo

PubMed Central

Fina, Jean-Pierre L.; Kintaudi, Léon N.M.

2017-01-01

Background Diabetes mellitus is a worldwide increasing health problem of which type 2 diabetes is the most prevalent. Previously considered as a problem of industrialised countries, diabetes is currently a huge concern in developing countries and the Democratic Republic of the Congo (DRC) is one of the sub-Saharan countries with a high prevalence rate of diabetes. Deficit of knowledge has already been shown to be one of the barriers preventing diabetic patients from controlling their disease. Objectives This study aimed to assess the knowledge of type 2 diabetic patients seen at the Institut Médical Evangélique (IME) Kimpese Hospital diabetic clinic, DRC, and the factors associated with their knowledge. Methods A cross-sectional study involving 184 respondents was conducted at the diabetic clinic of the IME Kimpese Hospital, DRC. We administered a pre-tested questionnaire. Out of a total of 10, scores of < 5, 5 to < 7, and ≥ 7 were classified as ‘poor knowledge’, ‘moderate knowledge’ and ‘good knowledge’, respectively, according to expert consensus. All statistical tests were performed using p < 0.05 as the level of statistical significance. Results The mean age of respondents was 57.5 years (s.d. ± 1.4, ranging from 40 to 83 years), with 56% being male. The mean diabetes knowledge score was poor: 3.2 out of a total of 10 (s.d. ± 1.7), with the range between 0.2 and 7.7. The majority of respondents (72.3%) had poor general knowledge about diabetes mellitus. Respondents also scored poorly in areas of the causes (35.6%), risk factors (39.3%), clinical features (34.9%), complications (20.5%) and management (42.4%) of diabetes mellitus. Using the student t-test analysis, it was found that age (p = 0.001), gender (p = 0.002), educational level (p = 0.007) and duration of disease (p = 0.032) were significantly associated with poor knowledge of diabetes mellitus. Conclusions Knowledge of diabetes mellitus among type 2 diabetic patients seen at our setting was poor. Areas of deficiency and factors associated with knowledge of diabetes were identified. Our findings suggest the need for a health education intervention programme for our diabetic patients. PMID:29041795

Celecoxib restores angiogenic factor expression at the maternal-fetal interface in the BPH/5 mouse model of preeclampsia.

PubMed

Reijnders, Dorien; Liu, Chin-Chi; Xu, Xinjing; Zhao, Anna M; Olson, Kelsey N; Butler, Scott D; Douglas, Nataki C; Sones, Jenny L

2018-05-01

Preeclampsia (PE), a hypertensive disease of pregnancy, is a leading cause of fetal and maternal morbidity/mortality. Early angiogenic and inflammatory disturbances within the placenta are thought to underlie the development of the maternal PE syndrome and poor pregnancy outcomes. However, the exact etiology remains largely unknown. Here, we use the BPH/5 mouse model of PE to elucidate the way in which inflammation early in pregnancy contributes to abnormal expression of angiogenic factors at the maternal-fetal interface. We have previously described improvement in maternal hypertension and fetal growth restriction in this model after treatment with the anti-inflammatory cyclooxygenase-2 (Cox2) specific inhibitor celecoxib. To further characterize the mechanisms by which celecoxib improves poor pregnancy outcomes in BPH/5 mice, we determined expression of angiogenic factors and complement pathway components after celecoxib. In BPH/5 implantation sites there was increased hypoxia inducible factor-1α ( Hif1α), heme oxygenase-1 ( Ho-1), and stem cell factor ( Scf) mRNA concomitant with elevated prostaglandin synthase 2 ( Ptgs2), encoding Cox2, and elevated VEGF protein. Angiopoietin 1 ( Ang1), tunica interna endothelial cell kinase-2 receptor ( Tie2), complement factor 3 ( C3), and complement factor B ( CfB) were increased in midgestation BPH/5 placentae. Whereas BPH/5 expression levels of VEGF, Ang1, and Tie2 normalized after celecoxib, placental C3 and CfB mRNA remained unchanged. However, celecoxib did reduce the pregnancy-specific circulating soluble fms-like tyrosine kinase-1 (sFlt-1) rise in BPH/5 mice at midgestation. These data show that elevated Cox2 during implantation contributes to placental angiogenic factor imbalances in the BPH/5 mouse model of PE.

A Culture in Transition: Poor Reading and Writing Ability among Children in South African Townships.

ERIC Educational Resources Information Center

Pretorius, E.; Naude, H.

2002-01-01

This study examined factors contributing to poor literacy and numeracy development among black South African children ages 5.5 to 7 years. Findings pointed to a conglomerate of factors, namely inadequate visual-motor integration, poor visual analysis and synthesis, poor fine motor development, and inadequate exposure to mediated reading and…

Characterizing and Mitigating Work Time Inflation in Task Parallel Programs

DOE PAGES

Olivier, Stephen L.; de Supinski, Bronis R.; Schulz, Martin; ...

2013-01-01

Task parallelism raises the level of abstraction in shared memory parallel programming to simplify the development of complex applications. However, task parallel applications can exhibit poor performance due to thread idleness, scheduling overheads, and work time inflation – additional time spent by threads in a multithreaded computation beyond the time required to perform the same work in a sequential computation. We identify the contributions of each factor to lost efficiency in various task parallel OpenMP applications and diagnose the causes of work time inflation in those applications. Increased data access latency can cause significant work time inflation in NUMA systems.more » Our locality framework for task parallel OpenMP programs mitigates this cause of work time inflation. Our extensions to the Qthreads library demonstrate that locality-aware scheduling can improve performance up to 3X compared to the Intel OpenMP task scheduler.« less

Chronic sublethal stress causes bee colony failure.

PubMed

Bryden, John; Gill, Richard J; Mitton, Robert A A; Raine, Nigel E; Jansen, Vincent A A

2013-12-01

Current bee population declines and colony failures are well documented yet poorly understood and no single factor has been identified as a leading cause. The evidence is equivocal and puzzling: for instance, many pathogens and parasites can be found in both failing and surviving colonies and field pesticide exposure is typically sublethal. Here, we investigate how these results can be due to sublethal stress impairing colony function. We mathematically modelled stress on individual bees which impairs colony function and found how positive density dependence can cause multiple dynamic outcomes: some colonies fail while others thrive. We then exposed bumblebee colonies to sublethal levels of a neonicotinoid pesticide. The dynamics of colony failure, which we observed, were most accurately described by our model. We argue that our model can explain the enigmatic aspects of bee colony failures, highlighting an important role for sublethal stress in colony declines. © 2013 The Authors. Ecology Letters published by John Wiley & Sons Ltd and CNRS.

Chronic sublethal stress causes bee colony failure

PubMed Central

Bryden, John; Gill, Richard J; Mitton, Robert A A; Raine, Nigel E; Jansen, Vincent A A; Hodgson, David

2013-01-01

Current bee population declines and colony failures are well documented yet poorly understood and no single factor has been identified as a leading cause. The evidence is equivocal and puzzling: for instance, many pathogens and parasites can be found in both failing and surviving colonies and field pesticide exposure is typically sublethal. Here, we investigate how these results can be due to sublethal stress impairing colony function. We mathematically modelled stress on individual bees which impairs colony function and found how positive density dependence can cause multiple dynamic outcomes: some colonies fail while others thrive. We then exposed bumblebee colonies to sublethal levels of a neonicotinoid pesticide. The dynamics of colony failure, which we observed, were most accurately described by our model. We argue that our model can explain the enigmatic aspects of bee colony failures, highlighting an important role for sublethal stress in colony declines. PMID:24112478

Poor Performance Among Trainees in a Dutch Postgraduate GP Training Program.

PubMed

Vermeulen, Margit I; Kuyvenhoven, Marijke M; de Groot, Esther; Zuithoff, Nicolaas Pa; Pieters, Honore M; van der Graaf, Yolanda; Damoiseaux, Roger Amj

2016-06-01

Poor performance among trainees is an important issue, for patient safety and economic reasons. While early identification might enhance remediation measures, we explored the frequency, nature, and risk factors of poor performance in a Dutch postgraduate general practitioner (GP) training program. All trainees who started the GP training between 2005 and 2007 were included. Multivariate logistic regression analysis was applied to examine associations between individual characteristics; early assessments of competencies and knowledge, training process characteristics (eg, illness, maternal leave), and the outcome poor performance; sub-analyses were performed for each year. A total of 215 trainees started the 3-year GP program, and 49 (22.8%) exhibited poor performance (in one or more years). In the first and second years, problem areas among poor performers were equally distributed across the roles of "medical expert," "communicator," and "professional." In the third year, shortcomings in "professionalism" were the most common problem. Increasing age was a risk factor for poor performance as were insufficient scores in communication and knowledge. Poor performance in the previous year was a risk factor for poor performance in the second and third years; OR=4.20 (CI=1.31--13.47) and OR=5.40 (CI=1.58--18.47), respectively. Poor performance is prevalent but primarily occurring within a single training year. This finding suggests that trainees are capable of solving trainee problems. Increasing age, insufficient assessment scores early in the training, and poor performance in a previous year constitute risk factors for poor performance.

Maternal Conditions and Perinatal Characteristics Associated with Autism Spectrum Disorder and Intellectual Disability

PubMed Central

Langridge, Amanda T.; Glasson, Emma J.; Nassar, Natasha; Jacoby, Peter; Pennell, Craig; Hagan, Ronald; Bourke, Jenny; Leonard, Helen; Stanley, Fiona J.

2013-01-01

Background As well as being highly comorbid conditions, autism spectrum disorders (ASD) and intellectual disability (ID) share a number of clinically-relevant phenomena. This raises questions about similarities and overlap in diagnosis and aetiological pathways that may exist for both conditions. Aims To examine maternal conditions and perinatal factors for children diagnosed with an ASD, with or without ID, and children with ID of unknown cause, compared with unaffected children. Methods The study population comprised all live singleton births in Western Australia (WA) between January 1984 and December 1999 (N = 383,153). Univariate and multivariate multinomial logistic regression models were applied using a blocked modelling approach to assess the effect of maternal conditions, sociodemographic factors, labour and delivery characteristics and neonatal outcomes. Results In univariate analyses mild-moderate ID was associated with pregnancy hypertension, asthma, urinary tract infection, some types of ante-partum haemorrhage, any type of preterm birth, elective C-sections, breech presentation, poor fetal growth and need for resuscitation at birth, with all factors showing an increased risk. Severe ID was positively associated with poor fetal growth and need for resuscitation, as well as any labour or delivery complication. In the multivariate analysis no maternal conditions or perinatal factors were associated with an increased risk of ASD without ID. However, pregnancy hypertension and small head circumference were associated with a reduced risk (OR = 0.64, 95% CI: 0.43, 0.94; OR = 0.58, 95% CI: 0.34, 0.96, respectively). For ASD with ID, threatened abortion before 20 weeks gestation and poor fetal growth were associated with an increased risk. Conclusion Findings show that indicators of a poor intrauterine environment are associated with an elevated risk of ID, while for ASD, and particularly ASD without ID, the associations are much weaker. As such, these findings highlight the importance of accounting for the absence or presence of ID when examining ASD, if we are to improve our understanding of the causal pathways associated with these conditions. PMID:23308096

Low sensitivity of the metabolic syndrome to identify adolescents with impaired glucose tolerance: an analysis of NHANES 1999-2010.

PubMed

DeBoer, Mark D; Gurka, Matthew J

2014-04-23

The presence of impaired glucose tolerance (IGT) and metabolic syndrome (MetS) are two risk factors for Type 2 diabetes. The inter-relatedness of these factors among adolescents is unclear. We evaluated the sensitivity and specificity of MetS for identifying IGT in an unselected group of adolescents undergoing oral glucose tolerance tests (OGTT) in the National Health and Nutrition Evaluation Survey 1999-2010. We characterized IGT as a 2-hour glucose ≥140 mg/dL and MetS using ATP-III-based criteria and a continuous sex- and race/ethnicity-specific MetS Z-score at cut-offs of +1.0 and +0.75 standard deviations (SD) above the mean. Among 1513 adolescents, IGT was present in 4.8%, while ATP-III-MetS was present in 7.9%. MetS performed poorly in identifying adolescents with IGT with a sensitivity/specificity of 23.7%/92.9% for ATP-III-MetS, 23.6%/90.8% for the MetS Z-score at +1.0 SD and 35.8%/85.0 for the MetS Z-score at +0.75 SD. Sensitivity was higher (and specificity lower) but was still overall poor among overweight/obese adolescents: 44.7%/83.0% for ATP-III-MetS, 43.1%/77.1% for the MetS Z-score at +1.0 SD and 64.3%/64.3% for MetS Z-score at +0.75 SD. This lack of overlap between MetS and IGT may indicate that assessment of MetS is not likely to be a good indicator of which adolescents to screen using OGTT. These data further underscore the importance of other potential contributors to IGT, including Type 1 diabetes and genetic causes of poor beta-cell function. Practitioners should keep these potential causes of IGT in mind, even when evaluating obese adolescents with IGT.

Regulation of insulin-like growth factor I receptors on vascular smooth muscle cells by growth factors and phorbol esters.

PubMed

Ververis, J J; Ku, L; Delafontaine, P

1993-06-01

Insulin-like growth factor I (IGF I) is an important mitogen for vascular smooth muscle cells. To characterize regulation of vascular IGF I receptors, we performed radioligand displacement experiments using rat aortic smooth muscle cells (RASMs). Serum deprivation for 48 hours caused a 40% decrease in IGF I receptor number. Exposure of quiescent RASMs to platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), or angiotensin II (Ang II) caused a 1.5-2.0-fold increase in IGF I receptors per cell. After FGF exposure, there was a marked increase in the mitogenic response to IGF I. IGF I downregulated its receptors in the presence of platelet-poor plasma. Stimulation of protein kinase C (PKC) by exposure of quiescent RASMs to phorbol 12-myristate 13-acetate caused a biphasic response in IGF I binding; there was a 42% decrease in receptor number at 45 minutes and a 238% increase at 24 hours. To determine the role of PKC in growth factor-induced regulation of IGF I receptors, we downregulated PKC by exposing RASMs to phorbol 12,13-dibutyrate (PDBu) for 48 hours. PDGF- and FGF- but not Ang II-mediated upregulation of IGF I receptors was completely inhibited in PDBu-treated cells. Thus, acute PKC activation by phorbol esters inhibits IGF I binding, whereas chronic PKC activation increases IGF I binding. PDGF and FGF but not Ang II regulate vascular IGF I receptors through a PKC-dependent pathway. These data provide new insights into the regulation of vascular smooth muscle cell IGF I receptors in vitro and are of potential importance in characterizing vascular proliferative responses in vivo.

Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness.

PubMed

Buckley, Peter F

2006-01-01

The co-occurrence of a severe mental illness and a substance use or abuse disorder is common in the United States as well as internationally and could be considered as more the expectation than the exception when assessing patients with serious mental illness. Substance use disorders can occur at any phase of the mental illness, perhaps even inducing psychosis. Causes of this comorbidity may include self-medication, genetic vulnerability, environment or lifestyle, underlying shared origins, and/or a common neural substrate. The consequences of dual diagnosis include poor medication compliance, physical comorbidities and poor health, poor self-care, increased suicide risk or aggression, increased sexual behavior, and possible incarceration. All of these factors contribute to a greater health burden, which reduces the health care system's capacity to adequately treat patients. Therefore, screening, assessment, and integrated treatment plans for dual diagnosis that can address both the addiction disorder and the mental illness are recommended in order to provide accurate treatment, after-care, and other health care to accommodate patients' social and vocational needs.

Hypomagnesemia and Chemotherapy, Diagnostic Dilemma, and Treatment Challenge: Case Report and Literature Review.

PubMed

Haroon, Nivin; Raza, Syed M; Bhat, Zeenat Y

2016-01-01

Magnesium is the second most common intracellular cation after potassium and plays pivotal role in the majority of metabolic process. Several studies have shown the prevalence of hypomagnesemia ranging from 2.5% to 12% in general population and even up to 60% in intensive care unit patients. Hypomagnesemia might be more prevalent in patients with cancer owing to a combination of several factors such as gastrointestinal loss, renal loss, poor intake, and use of certain chemotherapeutic drugs. It is imperative that we identify the exact cause of hypomagnesemia to aid and guide treatment. We report a case of a 63-year-old white woman with hypomagnesemia who was undergoing treatment for metastatic colon cancer. The chemotherapy regimen was with FOLFIRI (folinic acid, 5-fluorouracil, and irinotecan) and bevacizumab. This was followed by maintenance therapy with Xeloda (capecitabine). Her hypomagnesium was attributed to her chemotherapy. During our workup, the renal fractional excretion of magnesium was found to be low excluding the cause as renal wasting. This patient's hypomagnesemia could very well be explained by gastrointestinal losses (diarrhea) from short bowel after colectomy, her chemotherapeutic agents and metformin, as well as poor oral intake from medications, or malignancy itself.

Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression

PubMed Central

Eberhart, Michael G.; Yehia, Baligh R.; Hillier, Amy; Voytek, Chelsea D.; Fiore, Danielle J.; Blank, Michael; Frank, Ian; Metzger, David S.; Brady, Kathleen A.

2015-01-01

Background Previous analyses identified specific geographic areas in Philadelphia (hotspots) associated with negative outcomes along the HIV care continuum. We examined individual and community factors associated with residing in these hotspots. Methods Retrospective cohort of 1,404 persons newly diagnosed with HIV in 2008–2009 followed for 24 months after linkage to care. Multivariable regression examined associations between individual (age, sex, race/ethnicity, HIV transmission risk, and insurance status) and community (economic deprivation, distance to care, access to public transit, and access to pharmacy services) factors and the outcomes: residence in a hotspot associated with poor retention in care and residence in a hotspot associated with poor viral suppression. Results 24.4% and 13.7% of persons resided in hotspots associated with poor retention and poor viral suppression, respectively. For persons residing in poor retention hotspots, 28.3% were retained in care compared to 40.4% of those residing outside hotspots (p<0.05). Similarly, for persons residing in poor viral suppression hotspots, 51.4% achieved viral suppression compared to 75.3% of those outside hotspots (p<.0.05). Factors significantly associated with residence in a poor retention hotspots included: female sex, lower economic deprivation, greater access to public transit, shorter distance to medical care, and longer distance to pharmacies. Factors significantly associated with residence in a poor viral suppression hotspots included; female sex, higher economic deprivation, and shorter distance to pharmacies. Conclusions Individual and community-level associations with geographic hotspots may inform both content and delivery strategies for interventions designed to improve retention in care and viral suppression. PMID:25867777

Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression.

PubMed

Eberhart, Michael G; Yehia, Baligh R; Hillier, Amy; Voytek, Chelsea D; Fiore, Danielle J; Blank, Michael; Frank, Ian; Metzger, David S; Brady, Kathleen A

2015-05-01

Previous analyses identified specific geographic areas in Philadelphia (hotspots) associated with negative outcomes along the HIV care continuum. We examined individual and community factors associated with residing in these hotspots. Retrospective cohort of 1404 persons newly diagnosed with HIV in 2008-2009 followed for 24 months after linkage to care. Multivariable regression examined associations between individual (age, sex, race/ethnicity, HIV transmission risk, and insurance status) and community (economic deprivation, distance to care, access to public transit, and access to pharmacy services) factors and the outcomes: residence in a hotspot associated with poor retention-in-care and residence in a hotspot associated with poor viral suppression. In total, 24.4% and 13.7% of persons resided in hotspots associated with poor retention and poor viral suppression, respectively. For persons residing in poor retention hotspots, 28.3% were retained in care compared with 40.4% of those residing outside hotspots (P < 0.05). Similarly, for persons residing in poor viral suppression hotspots, 51.4% achieved viral suppression compared with 75.3% of those outside hotspots (P < 0.0.05). Factors significantly associated with residence in poor retention hotspots included female sex, lower economic deprivation, greater access to public transit, shorter distance to medical care, and longer distance to pharmacies. Factors significantly associated with residence in poor viral suppression hotspots included female sex, higher economic deprivation, and shorter distance to pharmacies. Individual and community-level associations with geographic hotspots may inform both content and delivery strategies for interventions designed to improve retention-in-care and viral suppression.

Viridans streptococcal bacteraemia in patients with haematological and solid malignancies.

PubMed

Burden, A D; Oppenheim, B A; Crowther, D; Howell, A; Morgenstern, G R; Scarffe, J H; Thatcher, N

1991-01-01

Thirty-three episodes of septicaemia caused by viridans streptococci are reported in 32 adults under treatment for malignant diseases. The underlying diseases were acute leukaemia (17), lymphoma (4), myeloma (1), small cell carcinoma of the bronchus (6), carcinoma of the breast (2) and carcinoma of the stomach (2). Important predisposing factors included severe neutropenia and oral mucositis due to intensive chemotherapeutic regimens. There was a poor response to standard empirical antibiotics and a mortality of 12%. A role for prophylactic penicillin in high risk groups is suggested.

Winter losses of Canada geese at Pea Island, North Carolina

USGS Publications Warehouse

Cowan, A.B.; Herman, C.M.

1955-01-01

Report of research and findings to date. Topics discussed include: studies on life history and biology of gizzard worm; results of autopsies; experiments on survival and transmission of gizzard worm eggs and larvae in both field and laboratory; persistence of infections; and results of infections in geese of different ages. Cause of deaths has not been finally determined, but indications are that gizzard worm is an important contributing factor and that poor physical condition, brought about at least partially by malnutrition, also contributes to the losses.

The application of dummy noise adaptive Kalman filter in underwater navigation

NASA Astrophysics Data System (ADS)

Li, Song; Zhang, Chun-Hua; Luan, Jingde

2011-10-01

The track of underwater target is easy to be affected by the various by the various factors, which will cause poor performance in Kalman filter with the error in the state and measure model. In order to solve the situation, a method is provided with dummy noise compensative technology. Dummy noise is added to state and measure model artificially, and then the question can be solved by the adaptive Kalman filter with unknown time-changed statistical character. The simulation result of underwater navigation proves the algorithm is effective.

Geographic Variations in Cardiovascular Health in the United States: Contributions of State- and Individual-Level Factors

PubMed Central

Gebreab, Samson Y; Davis, Sharon K; Symanzik, Jürgen; Mensah, George A; Gibbons, Gary H; Diez-Roux, Ana V

2015-01-01

Background Improving cardiovascular health (CVH) of all Americans by 2020 is a strategic goal of the American Heart Association. Understanding the sources of variation and identifying contextual factors associated with poor CVH may suggest important avenues for prevention. Methods and Results Cross-sectional data from the Behavioral Risk Factor Surveillance System for the year 2011 were linked to state-level coronary heart disease and stroke mortality data from the National Vital Statistics System and to state-level measures of median household income, income inequality, taxes on soda drinks and cigarettes, and food and physical activity environments from various administrative sources. Poor CVH was defined according to the American Heart Association definition using 7 self-reported CVH metrics (current smoking, physical inactivity, obesity, poor diet, hypertension, diabetes, and high cholesterol). Linked micromap plots and multilevel logistic models were used to examine state variation in poor CVH and to investigate the contributions of individual- and state-level factors to this variation. We found significant state-level variation in the prevalence of poor CVH (median odds ratio 1.32, P<0.001). Higher rates of poor CVH and cardiovascular disease mortality were clustered in the southern states. Minority and low socioeconomic groups were strongly associated with poor CVH and explained 51% of the state-level variation in poor CVH; state-level factors explained an additional 28%. State-level median household income (odds ratio 0.89; 95% CI 0.84–0.94), taxes on soda drinks (odds ratio 0.94; 95% CI 0.89–0.99), farmers markets (odds ratio 0.91; 95% CI 0.85–0.98), and convenience stores (odds ratio 1.09; 95% CI 1.01–1.17) were predictive of poor CVH even after accounting for individual-level factors. Conclusions There is significant state-level variation in poor CVH that is partly explained by individual- and state-level factors. Additional longitudinal research is warranted to examine the influence of state-level policies and food and physical activity environments on poor CVH. PMID:26019131

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wixson, J. R.

Root cause analysis (RCA) is an important methodology that can be integrated with the VE Job Plan to generate superior results from the VE Methodology. The point at which RCA is most appropriate is after the function analysis and FAST Model have been built and functions for improvement have been chosen. These functions are then subjected to a simple, but, rigorous RCA to get to the root cause of their deficiencies, whether it is high cost/poor value, poor quality, or poor reliability. Once the most probable causes for these problems have been arrived at, better solutions for improvement can bemore » developed in the creativity phase because the team better understands the problems associated with these functions.« less

Urban Mexican-American mothers’ beliefs about caries etiology in children

PubMed Central

HOEFT, Kristin S.; BARKER, Judith C.; MASTERSON, Erin E.

2012-01-01

Objectives Caries is a severe condition which disproportionately affects Latino children in the U.S. This study sought contextual understanding of urban, low-income Mexican-American mothers’ beliefs, perceptions, knowledge and behavior surrounding causes of caries. Methods In urban San José, CA, a qualitative study was conducted with a convenience sample of Mexican-American mothers of young children about their beliefs and knowledge about the causes of caries. Audio-taped in-depth interviews with open-ended questions, primarily in Spanish, were translated to English and then transcribed verbatim. Texts were independently read and thematically analyzed by two researchers. Results Even while expressing uncertainty, all 48 mothers mentioned specific causes of caries, most frequently citing candy or juice consumption (85%), poor oral hygiene (65%) and use of the bottle (52%). Mothers rarely recognized cariogenic foods beyond candy, did not know or perform recommended oral hygiene routines, and demonstrated confusion and uncertainty about exactly how baby bottles are detrimental to teeth. Nearly half of these mothers also mentioned secondary cavity causes, such as genetics, lack of calcium, not going to the dentist, or lack of fluoride. Mothers did not mention the role of bacteria. While mothers recognize that oral hygiene can counteract the detrimental effects of candy consumption, they did not recognize its beneficial effects in other contexts. Nor did they know about other preventive activities. Conclusions Mothers recognized the three major important factors causing caries: sugar consumption, poor oral hygiene, and bottle use. However, their knowledge is limited in depth and specificity which restricts development of caries prevention behaviors. More comprehensive education is needed, including on caries prevention (oral hygiene) behaviors, which could lead to an increased sense of self-efficacy with respect to their children’s oral health. PMID:20156233

Ophthalmologic outcome after third cranial nerve palsy or paresis in childhood.

PubMed

Mudgil, A V; Repka, M X

1999-02-01

The purpose of this study was to evaluate the causes and ophthalmologic outcome of oculomotor nerve palsy or paresis in children younger than 8 years of age. Patients evaluated between 1985 and 1997 were retrospectively reviewed. Data analyzed included vision, residual strabismus after surgery, aberrant reinnervation, binocular function, and anisometropia. Long-term outcome was assessed in patients followed-up longer than 6 months. Forty-one patients were identified. The most frequent causes were congenital (39%), traumatic (37%), and neoplastic (17%). Visual acuities were reduced in 71% of patients at the time of the initial visit. Long-term outcome could be assessed in 20 of the 41 patients (49%), with a mean follow-up of 3.6 years (range, 0.5 to 13 years). Visual acuities were reduced because of amblyopia in 35% and nonamblyopic factors in 25% of patients in the long-term outcome group at last follow-up. The best response to amblyopia therapy was in the congenital group, in which all patients improved to normal visual acuity. Strabismus surgery was performed on 8 of 20 children (40%) followed-up, none of whom demonstrated measurable stereopsis after operation despite improved alignment. Aberrant reinnervation was present in 9 of 20 patients (45%). Only 3 patients fully recovered from their oculomotor nerve injuries, and these were the only patients to regain measurable stereopsis. The causes in those 3 patients were congenital, traumatic, and neoplastic. Oculomotor nerve palsy/paresis is associated with poor visual and sensorimotor outcome in children younger than 8 years of age. The best ophthalmologic outcome was in the resolved cases (3 of 20; 15%). Amblyopia therapy was most effective with congenital causes, but treatment results were poor with other causes. Young children with posttraumatic and postneoplastic oculomotor nerve injuries demonstrated the worst ophthalmologic outcomes.

Molecular Mechanisms of Cutaneous Inflammatory Disorder: Atopic Dermatitis

PubMed Central

Kim, Jung Eun; Kim, Jong Sic; Cho, Dae Ho; Park, Hyun Jeong

2016-01-01

Atopic dermatitis (AD) is a multifactorial inflammatory skin disease resulting from interactions between genetic susceptibility and environmental factors. The pathogenesis of AD is poorly understood, and the treatment of recalcitrant AD is still challenging. There is accumulating evidence for new gene polymorphisms related to the epidermal barrier function and innate and adaptive immunity in patients with AD. Newly-found T cells and dendritic cell subsets, cytokines, chemokines and signaling pathways have extended our understanding of the molecular pathomechanism underlying AD. Genetic changes caused by environmental factors have been shown to contribute to the pathogenesis of AD. We herein present a review of the genetics, epigenetics, barrier dysfunction and immunological abnormalities in AD with a focus on updated molecular biology. PMID:27483258

[Asthma and metabolic syndrome: Clinical and pathogenetic relationships].

PubMed

Budnevsky, A V; Malysh, E Yu; Ovsyannikov, E S; Drobysheva, E S

2015-01-01

Asthma and metabolic syndrome (MS) are common and social diseases. External and internal factors influencing the development and manifestations of asthma are identified; among which there is obesity that is a major risk factor for MS. Accordingly, the concurrence of asthma and MS and to study their clinical and pathogenetic relationships are a topical problem. There is a tendency to identify a particular asthma phenotype that is characterized by later-onset disease in the presence of obesity; the low prevalence of atopy, low serum level of IgE, and a poorly-controlled course with a trend of standard therapy resistance. It is necessary to understand the essence of asthma cause-effect relationships in the presence of obesity for defining management tactics for this group of patients.

Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints.

PubMed

Wilder, Robert P; Sethi, Shikha

2004-01-01

Approximately 50% of all sports injuries are secondary to overuse and result from repetitive microtrauma that causes local tissue damage. Injuries are most likely with changes in mode, intensity, or duration of training and can accumulate before symptoms appear. Intrinsic factors contributing to injuries are individual bio-mechanical abnormalities such as malalignments, muscle imbalance, inflexibility, weakness, and instability. Contributing extrinsic (avoidable) factors include poor technique, improper equipment, and improper changes in duration or frequency of activity. Injuries are often related to biomechanical abnormalities removed from the specific injury site, requiring evaluation of the entire kinetic chain. This article discusses common overuse injuries of the lower leg, ankle, and foot: tendinopathies, stress fractures, chronic exertional compartment syndrome, and shin splints.

Global challenges of graduate level Ayurvedic education: A survey

PubMed Central

Patwardhan, Kishor; Gehlot, Sangeeta; Singh, Girish; Rathore, H.C.S.

2010-01-01

In the present day scenario, Ayurveda is globally being perceived in several contradictory ways. Poor quality of Ayurveda graduates produced as a result of poorly structured and poorly regulated education system is at least one of the important factors responsible for this scenario. The present study was carried out to evaluate the ‘Global challenges of graduate level Ayurvedic education’ and is based on the responses of Ayurvedic students and Ayurvedic teachers from various educational institutions of India to a methodically validated questionnaire. As the study indicates, the poor standard of Ayurvedic education in India is definitely a cause of concern. The curriculum of Bachelor of Ayurvedic Medicine and Surgery (BAMS) course of studies is required to be reviewed and restructured. The syllabi are required to be updated with certain relevant topics like laws governing the intellectual property rights, basic procedures of standardization of medicinal products, fundamental methods of evaluating the toxicity of the medicinal products, essentials of healthcare management and the basics of cultivation and marketing of medicinal plants. Furthermore, the study suggests that the Ayurvedic academicians are required to be trained in standard methods of research and documentation skills, and the educational institutions are required to be encouraged to contribute their share in building up the evidence base for Ayurveda in the form of quality education and research. PMID:20532099

Management of asthma: the essentials of good clinical practice.

PubMed

Aït-Khaled, N; Enarson, D A

2006-02-01

Asthma is a condition that affects all countries worldwide. It is a chronic, disabling condition that diminishes the quality of life and the economic prosperity of those who live with it. The majority of persons living with asthma are from developing countries. Asthma management necessitates long-term treatment that is expensive, making it less accessible to poor people. The cost of medications is the key factor preventing people living with asthma from having access to care that has the potential to relieve their suffering, improve their quality of life and enhance their economic status. Asthma is a disease caused by environmental exposures. Genetic factors predispose certain people to developing asthma once they are exposed to the causative agents, and certain factors can trigger symptomatic episodes of asthma in those who have already developed the disease. Certain clinical characteristics differentiate asthma from other chronic lung conditions. The most important of these is that the symptoms and functional disability caused by asthma vary from one occasion to another. In those with less severe asthma, they may be present on some occasions and not others; in those with more severe asthma, their degree of severity varies from one time to another.

Community-acquired acute kidney injury in Asia.

PubMed

Jha, Vivekanand; Chugh, Kirpal S

2008-07-01

Asia, the largest continent in the world, is heterogeneous in the ethnic, socioeconomic, and developmental status of its populations. A vast majority of it is poor with no adequate access to modern health care, making an accurate estimation of the nature and extent of acute kidney injury (AKI) difficult. Community-acquired AKI in otherwise healthy individuals is common, and the population developing AKI is younger compared with its counterparts in Europe or North America. The etiologic spectrum varies in different geographic regions of Asia depending on environmental, cultural, and socioeconomic factors. Some of the etiologic factors include AKI in relation to infectious diseases, intravascular hemolysis caused by glucose 6-phosphate dehydrogenase deficiency, poisonings caused by industrial chemicals or copper sulphate, animal venoms, natural medicines, heat stroke, and after complications of pregnancy. Preventive opportunities are missed because of failure to recognize the risk factors and early signs of AKI. Patients often present late for treatment, leading to multi-organ involvement and increased mortality. The exact etiologic diagnosis cannot be established in many instances because of a lack of appropriate laboratory support. Modern methods of renal replacement therapy are not universally available; and intermittent peritoneal dialysis is still widely practiced in many areas.

Perfectionism related to self-reported insomnia severity, but not when controlled for stress and emotion regulation.

PubMed

Brand, Serge; Kirov, Roumen; Kalak, Nadeem; Gerber, Markus; Pühse, Uwe; Lemola, Sakari; Correll, Christoph U; Cortese, Samuele; Meyer, Till; Holsboer-Trachsler, Edith

2015-01-01

Perfectionism is understood as a set of personality traits such as unrealistically high and rigid standards for performance, fear of failure, and excessive self-criticism. Previous studies showed a direct association between increased perfectionism and poor sleep, though without taking into account possible mediating factors. Here, we tested the hypothesis that perfectionism was directly associated with poor sleep, and that this association collapsed, if mediating factors such as stress and poor emotion regulation were taken into account. Three hundred and forty six young adult students (M=23.87 years) completed questionnaires relating to perfectionism traits, sleep, and psychological functioning such as stress perception, coping with stress, emotion regulation, and mental toughness. Perfectionism was directly associated with poor sleep and poor psychological functioning. When stress, poor coping, and poor emotion regulation were entered in the equation, perfectionism traits no longer contributed substantively to the explanation of poor sleep. Though perfectionism traits seem associated with poor sleep, the direct role of such traits seemed small, when mediating factors such as stress perception and emotion regulation were taken into account.

Perfectionism related to self-reported insomnia severity, but not when controlled for stress and emotion regulation

PubMed Central

Brand, Serge; Kirov, Roumen; Kalak, Nadeem; Gerber, Markus; Pühse, Uwe; Lemola, Sakari; Correll, Christoph U; Cortese, Samuele; Meyer, Till; Holsboer-Trachsler, Edith

2015-01-01

Background Perfectionism is understood as a set of personality traits such as unrealistically high and rigid standards for performance, fear of failure, and excessive self-criticism. Previous studies showed a direct association between increased perfectionism and poor sleep, though without taking into account possible mediating factors. Here, we tested the hypothesis that perfectionism was directly associated with poor sleep, and that this association collapsed, if mediating factors such as stress and poor emotion regulation were taken into account. Methods Three hundred and forty six young adult students (M=23.87 years) completed questionnaires relating to perfectionism traits, sleep, and psychological functioning such as stress perception, coping with stress, emotion regulation, and mental toughness. Results Perfectionism was directly associated with poor sleep and poor psychological functioning. When stress, poor coping, and poor emotion regulation were entered in the equation, perfectionism traits no longer contributed substantively to the explanation of poor sleep. Conclusion Though perfectionism traits seem associated with poor sleep, the direct role of such traits seemed small, when mediating factors such as stress perception and emotion regulation were taken into account. PMID:25678791

Urinary tract infection in infants caused by extended-spectrum beta-lactamase-producing Escherichia coli: comparison between urban and rural hospitals.

PubMed

Cheng, Ming-Fang; Chen, Wan-Ling; Huang, I-Fei; Chen, Jung-Ren; Chiou, Yee-Hsuan; Chen, Yao-Shen; Lee, Susan Shin-Jung; Hung, Wan-Yu; Hung, Chih-Hsin; Wang, Jiun-Ling

2016-08-01

Community-acquired urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an emerging problem. Compared with urban infants, rural infants may encounter different distributions of community-acquired resistant strains and various barriers to efficient management. A retrospective survey and comparison was conducted for infants with UTI caused by ESBL-producing E. coli admitted to an urban hospital (n = 111) and a rural hospital (n = 48) in southern Taiwan from 2009 to 2012. Compared with 2009 and 2010, the total number of cases at both hospitals significantly increased in 2011 and 2012 (p < 0.001). Compared with the rural patients, the urban patients were significantly younger, and they had fewer days of fever before and after admission, fewer presentations of poor activity and poor appetite, and a lower serum creatinine level. Most of the patients had no prior history of illness, and we could not identify any significant different risk factors for acquiring ESBL-producing E. coli, such as past antimicrobial use, hospitalization, UTI, and underlying renal diseases, between the urban and rural populations. The increase in community-acquired UTI in infants caused by ESBL-producing E. coli was similar between the urban and rural populations. Our preliminary data suggest that the rural-urban disparities were probably related to easy access to health care by the urban population. ESBL complicates disease management, and the increase in the prevalence of ESBL producers is a major health concern and requires further healthy carrier and environmental surveillance.

Factors associated with poor control of 9/11-related asthma 10–11 years after the 2001 World Trade Center terrorist attacks

PubMed Central

Jordan, Hannah T.; Stellman, Steven D.; Reibman, Joan; Farfel, Mark R.; Brackbill, Robert M.; Friedman, Stephen M.; Li, Jiehui; Cone, James E.

2015-01-01

Abstract Objective: To identify key factors associated with poor asthma control among adults in the World Trade Center (WTC) Health Registry, a longitudinal study of rescue/recovery workers and community members who were directly exposed to the 2001 WTC terrorist attacks and their aftermath. Methods: We studied incident asthma diagnosed by a physician from 12 September 2001 through 31 December 2003 among participants aged ≥18 on 11 September 2001, as reported on an enrollment (2003–2004) or follow-up questionnaire. Based on modified National Asthma Education and Prevention Program criteria, asthma was considered controlled, poorly-controlled, or very poorly-controlled at the time of a 2011–2012 follow-up questionnaire. Probable post-traumatic stress disorder, depression, and generalized anxiety disorder were defined using validated scales. Self-reported gastroesophageal reflux symptoms (GERS) and obstructive sleep apnea (OSA) were obtained from questionnaire responses. Multinomial logistic regression was used to examine factors associated with poor or very poor asthma control. Results: Among 2445 participants, 33.7% had poorly-controlled symptoms and 34.6% had very poorly-controlled symptoms in 2011–2012. Accounting for factors including age, education, body mass index, and smoking, there was a dose–response relationship between the number of mental health conditions and poorer asthma control. Participants with three mental health conditions had five times the odds of poor control and 13 times the odds of very poor control compared to participants without mental health comorbidities. GERS and OSA were significantly associated with poor or very poor control. Conclusions: Rates of poor asthma control were very high in this group with post-9/11 diagnosed asthma. Comprehensive care of 9/11-related asthma should include management of mental and physical health comorbidities. PMID:25539137

Scabies.

PubMed

Hicks, Maria I; Elston, Dirk M

2009-01-01

Scabies is an ectoparasite caused by the mite Sarcoptes scabiei var hominis, an obligate human parasite. There are about 300 million cases of scabies in the world each year. Common predisposing factors are overcrowding, immigration, poor hygiene, poor nutritional status, homelessness, dementia, and sexual contact. Direct skin-to-skin contact between 15 and 20 minutes is needed to transfer the mites from one person to another. The diagnosis suspected with a clinical history of itch, worse at night, affecting other family members, clinical distribution, and appearance. Definite diagnosis relies on microscopic identification of the mites, eggs, or fecal pellets with 10% potassium hydroxide, ink enhancement, tetracycline fluorescence tests, or mineral oil; other methods include: epiluminescence light microscopy and S. scabiei DNA. The most commonly used treatment modalities are permethrin and ivermectin. Persistence of symptoms for 2-6 weeks after successful treatment is common. Most recurrences are because of reinfection from untreated contacts.

The indoor air we breathe.

PubMed Central

Oliver, L C; Shackleton, B W

1998-01-01

Increasingly recognized as a potential public health problem since the outbreak of Legionnaire's disease in Philadelphia in 1976, polluted indoor air has been associated with health problems that include asthma, sick building syndrome, multiple chemical sensitivity, and hypersensitivity pneumonitis. Symptoms are often nonspecific and include headache, eye and throat irritation, chest tightness and shortness of breath, and fatigue. Air-borne contaminants include commonly used chemicals, vehicular exhaust, microbial organisms, fibrous glass particles, and dust. Identified causes include defective building design and construction, aging of buildings and their ventilation systems, poor climate control, inattention to building maintenance. A major contributory factor is the explosion in the use of chemicals in building construction and furnishing materials over the past four decades. Organizational issues and psychological variables often contribute to the problem and hinder its resolution. This article describes the health problems related to poor indoor air quality and offers solutions. Images p398-a p399-a PMID:9769764

Sleep disorders in pregnancy

PubMed Central

Bourjeily, Ghada

2009-01-01

Sleep complaints are a common occurrence in pregnancy that are in part due to pregnancy-associated anatomic and physiological changes but may also be due to pathological causes. In the non-pregnant population, sleep deprivation has been associated with physical and cognitive issues; poor sleep may even be associated with adverse maternal outcomes. Maternal obesity, one of the most prevalent risk factors in obstetric practices, together with physiologic changes of pregnancy predispose to the development of sleep disordered breathing. Symptoms of sleep disordered breathing have also been associated with poor maternal outcomes. Management options of restless legs syndrome and narcolepsy pose a challenge in pregnancy; benefits of therapy need to be weighed against the potential harm to the fetus. This article briefly reviews the normal changes in pregnancy affecting sleep, gives an overview of certain sleep disorders occurring in pregnancy, and suggests management options specific for this population. PMID:27582822

Welcoming Home the Patient with a New Ostomy.

PubMed

Walker, Cynthia A; Rau, Lou Ann; Green, Mary Phyllis

2015-01-01

The 5-day average inpatient hospital length-of-stay postostomy limits opportunities for patients and family members to master self-care of the new ostomy prior to discharge. The literature suggests premature discharge, poor care coordination, lack of symptom reporting and follow-up as the primary factors supporting causes of readmissions. Home care nurses are faced with failed handoffs, limited resources, poor care coordination, payor restrictions, and knowledge and skill deficits that negatively impact safe and effective discharge practices of patients with a new ostomy. This article describes an evolving community standard related to nursing care of the patient with a new ostomy as identified by the Baltimore Wound, Ostomy, Continence (WOC) Nursing Affiliate. Case managers, discharge planners, intake team members, and home care nurses benefit from ongoing education from WOC nurse experts to master the skills needed to care for patients with ostomies.

Poor wound healing after pial synangiosis in 2 children with moyamoya vasculopathy associated with neurofibromatosis type 1.

PubMed

Golomb, Meredith R; Smith, Jodi L

2014-10-01

Wound healing is a key component of recovery for children with neurologic conditions undergoing neurosurgical procedures. Understanding factors that can impair wound healing aids in planning long-term clinical care. Children with neurofibromatosis type 1 are at risk for vasculopathies in the brain (including moyamoya vasculopathy) and in other organs, including the heart, lung, and skin. Neurofibromatosis 1 is caused by mutations in the gene for neurofibromin, a protein that plays a role in tissue maintenance and repair as well as tumor suppression. The authors report 2 children with neurofibromatosis 1-associated moyamoya vasculopathy who developed significant wound healing complications after pial synangiosis surgery. They discuss possible contributors to these complications, including the role of neurofibromin and the possibility of vasculopathy affecting the skin, and the implications of poor wound healing in pediatric neurology patients. © The Author(s) 2013.

The human spermatozoon--not waving but drowning.

PubMed

Aitken, R John; Sawyer, Dennis

2003-01-01

The poor quality of the human ejaculate sets man apart from all other mammalian species. Even in normal fertile men the ejaculate may contain up to 85% abnormal forms according to the World Heath Organization (1999). In the wake of this poor semen quality comes extremely poor fertility (Hull et al, 1985) and the highest rates of aneuploidy, pregnancy loss and birth defects in viviparous vertebrates. Thus, the poor quality of human spermatozoa is reflected in both their capacity for fertilization and their genetic integrity. The ultimate cause of defective sperm function is unknown. In certain patients a genetic basis for male infertility has been identified involving DNA deletions on the long arm of the Y chromosome. Such deletions might explain the impoverished semen quality seen in about 10-14% of men with severely impaired spermatogenesis, but fail to explain the infertility seen in most (>85%) cases of male infertility. One of the key attributes and probable causes of defective sperm function is oxidative stress created by excessive ROS generation by the spermatozoa and/or the disruption of antioxidant defence systems in the male reproductive tract. Excess free radical generation frequently involves an error in spermiogenesis resulting in the release of spermatozoa from the germinal epithelium exhibiting abnormally high levels of cytoplasmic retention. The excess cytoplasm contains enzymes that fuel the generation of ROS by the spermatozoa's plasma membrane redox systems. The consequences of such oxidative stress include a loss of motility and fertilizing potential and the induction of DNA damage in the sperm nucleus. The loss of sperm function is due to the peroxidation of unsaturated fatty acids in the sperm plasma membrane as a consequence of which the latter loses its fluidity and the cells lose their function. The causes and consequences of oxidative damage to the DNA in the sperm nucleus are still not known with certainty. The available evidence suggests that early pregnancy loss and morbidity in the offspring, including childhood cancer, are associated with such damage. Developing animal models with which to establish the validity of these relationships and identifying the environmental factors associated with the proposed 'testicular dysgenesis syndrome' will clearly be important tasks for the future.

Women's knowledge, attitudes and practice about breast cancer screening in the region of Monastir (Tunisia).

PubMed

El Mhamdi, Sana; Bouanene, Ines; Mhirsi, Amel; Sriha, Asma; Ben Salem, Kamel; Soltani, Mohamed Soussi

2013-01-01

Breast cancer remains a worldwide public health problem. In Tunisia, it is considered to be the primary women's cancer and causes high morbidity and mortality. This study aimed to investigate female knowledge, attitudes and practice of breast cancer screening in the region of Monastir (Tunisia). We conducted a descriptive cross-sectional design exploring knowledge, attitudes and practices of women in the region of Monastir on breast cancer screening. The study was conducted in health centres of this region from 1 March 2009 to 30 June 2009. Data were collected via a structured questionnaire containing 15 items on demographic status, knowledge of risk factors and screening methods and attitudes towards the relevance and effectiveness of breast cancer screening. A scoring scheme was used to score women's responses. A total of 900 women agreed to take part in the study. Their mean age was 41.6±12.4 years and 64% did not exceed the primary level of education. According to the constructed scores, 92% of participants had poor knowledge of the specific risk factors for breast cancer and 63.2% had poor knowledge of the screening methods. Proper practice of breast cancer screening was observed in 14.3% of cases. Multiple logistic regression analysis showed that good knowledge of risk factors and screening methods, higher level of education and positive family history of breast cancer were independently correlated with breast cancer screening practice. This study revealed poor knowledge of breast cancer and the screening methods as well as low levels of practice of breast cancer screening among women in the region of Monastir. Results justify educational programs to raise women's adherence to breast cancer screening programs in Tunisia.

Glomerular Immune Deposits Are Predictive of Poor Long-Term Outcome in Patients with Adult Biopsy-Proven Minimal Change Disease: A Cohort Study in Korea

PubMed Central

Lee, Sung Woo; YU, Mi-Yeon; Baek, Seon Ha; Ahn, Shin-Young; Kim, Sejoong; Na, Ki Young; Chae, Dong-Wan; Chin, Ho Jun

2016-01-01

Background and Objectives There has been little published information on risk factors for poor long-term outcome in adult biopsy-proven minimal change disease (MCD). Methods Data from sixty-three adult, biopsy-proven primary MCD patients treated at a tertiary university hospital between 2003 and 2013 were analyzed. Baseline clinical and pathologic factors were assessed for the associations with composite outcome of creatinine doubling, end stage renal disease, or all-cause mortality. Results During a median (interquartile) 5.0 (2.8–5.0) years, the composite outcome occurred in 11.1% (7/63) of patients. The rate of glomerular immune deposits was 23.8% (15/63). Patients with glomerular immune deposits showed a significantly lower urine protein creatinine ratio than those without deposits (P = 0.033). The rate of non-responders was significantly higher in patients with glomerular immune deposits than in those without deposits (P = 0.033). In patients with deposits, 26.7% (4/15) developed the composite outcome, while only 6.3% (3/48) developed the composite outcome among those without deposits (P = 0.049). In multivariate Cox proportional hazards regression analysis, the presence of glomerular immune deposits was the only factor associated with development of the composite outcome (hazard ratio: 2.310, 95% confidence interval: 1.031–98.579, P = 0.047). Conclusion Glomerular immune deposits were associated with increased risk of a composite outcome in adult MCD patients. The higher rate of non-responders in patients with deposits might be related to the poor outcome. Future study is needed. PMID:26799663

Exploring Gender Difference in Sleep Quality of Young Adults: Findings from a Large Population Study

PubMed Central

Fatima, Yaqoot; Doi, Suhail A.R.; Najman, Jake M.; Mamun, Abdullah Al

2016-01-01

Objectives To explore if gender difference in sleep quality is due to higher prevalence of depression in females, and whether socio-demographic and lifestyle factors have a differential effect on sleep quality in males and females. Methods Youth self-reports and the Pittsburgh Sleep Quality Index were used to assess sleep quality and associated risk factors. Logistic regression analyses were used to analyze the association between various risk factors and poor sleep quality. Results Reports from 3,778 young adults (20.6±0.86 years) indicate a higher prevalence of poor sleep quality in females than males (65.1% vs. 49.8%). It seems that gender difference in poor sleep is independent of depression, socio-demographics, and lifestyle factors, since the higher odds of poor sleep quality in females was robust to adjust for depression, socio-demographics, and lifestyle factors (OR: 1.53, 95% CI: 1.23–1.90). Lifestyle factors (eg, smoking) (OR 1.91; 95% CI 1.05–3.46) were associated with sleep quality in only males. Conclusion Our findings indicate that female vulnerability to poor sleep quality should be explored beyond psycho-social disparities. Perhaps, exploring if the female predisposition to poor sleep quality originates at the biological level could lead to the answer. PMID:28188139

Prevention of preterm birth: harnessing science to address the global epidemic.

PubMed

Rubens, Craig E; Sadovsky, Yoel; Muglia, Louis; Gravett, Michael G; Lackritz, Eve; Gravett, Courtney

2014-11-12

Preterm birth is a leading cause of infant morbidity and mortality worldwide, but current interventions to prevent prematurity are largely ineffective. Preterm birth is increasingly recognized as an outcome that can result from a variety of pathological processes. Despite current research efforts, the mechanisms underlying these processes remain poorly understood and are influenced by a range of biological and environmental factors. Research with modern techniques is needed to understand the mechanisms responsible for preterm labor and birth and identify targets for diagnostic and therapeutic solutions. This review evaluates the state of reproductive science relevant to understanding the causes of preterm birth, identifies potential targets for prevention, and outlines challenges and opportunities for translating research findings into effective interventions. Copyright © 2014, American Association for the Advancement of Science.

Genetics of Congenital Heart Disease: Past and Present.

PubMed

Muntean, Iolanda; Togănel, Rodica; Benedek, Theodora

2017-04-01

Congenital heart disease is the most common congenital anomaly, representing an important cause of infant morbidity and mortality. Congenital heart disease represents a group of heart anomalies that include septal defects, valve defects, and outflow tract anomalies. The exact genetic, epigenetic, or environmental basis of congenital heart disease remains poorly understood, although the exact mechanism is likely multifactorial. However, the development of new technologies including copy number variants, single-nucleotide polymorphism, next-generation sequencing are accelerating the detection of genetic causes of heart anomalies. Recent studies suggest a role of small non-coding RNAs, micro RNA, in congenital heart disease. The recently described epigenetic factors have also been found to contribute to cardiac morphogenesis. In this review, we present past and recent genetic discoveries in congenital heart disease.

Poor periodontal health: A cancer risk?

PubMed

Rajesh, K S; Thomas, Deepak; Hegde, Shashikanth; Kumar, M S Arun

2013-11-01

Evidence indicates that chronic infections and inflammation are associated with increased risk of cancer development. There has also been considerable evidence that proves the interrelationship between bacterial and viral infections and carcinogenesis. Periodontitis is a chronic oral infection thought to be caused by gram-negative anaerobic bacteria in the dental biofilm. Periodontal bacteria and viruses may act synergistically to cause periodontitis. Many studies have shown that periodontal pockets may act as reservoirs for human papilloma virus, cytomegalovirus, Epstein Barr virus, and suspected agents associated with oral cancer. Periodontitis, characterized by epithelial proliferation and migration, results in a chronic release of inflammatory cytokines, chemokines, growth factors, prostaglandins, and enzymes, all of which are associated with cancer development. This review article intends to shed light on the association between periodontal health and carcinogenesis.

Impact of combined lifestyle factors on metabolic syndrome in Korean men.

PubMed

Lee, Jung Ah; Cha, Young Hwa; Kim, Sun Hee; Park, Hye Soon

2017-03-01

The purpose of this study was to determine the relationship between combined poor lifestyle factors and metabolic syndrome (MetS) in Korean men. Data from the Korean National Health and Nutrition Examination Survey 2010 were classified according to the number and combination patterns of poor lifestyle factors, namely, current smoking, high-risk alcohol use, low physical activity and poor dietary habits. We analyzed the association between the combined poor lifestyle factors and MetS. The definition of MetS was based on the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention in 2009. A total of 1408 men aged 20-75 were included in this study. Approximately one-third of the 30-49 age group had ≥3 combined poor lifestyle factors. Compared with those with no poor lifestyle factors, the ORs for MetS were 3.57 (95% CI 1.16-11.02), 3.62 (95% CI 1.18-11.08) and 6.31 (95% CI 2.08-19.26) in subjects with one, two and three or more poor lifestyle factors, respectively. When current smoking, high-risk alcohol use and low physical activity were concurrently present, the ORs for MetS, hyperglycemia, and hypertriglyceridemia were 14.32 (95% CI 3.64-56.30), 4.49 (95% CI 1.62-12.40), and 5.07 (95% CI 2.18-11.81), respectively. Comprehensive lifestyle modifications need to be stressed in public health programs. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study

PubMed Central

Lassale, Camille; Gunter, Marc J.; Romaguera, Dora; Peelen, Linda M.; Van der Schouw, Yvonne T.; Beulens, Joline W. J.; Freisling, Heinz; Muller, David C.; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C.; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K.; Katzke, Verena A.; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J.; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H. Bas; Boer, Jolanda M. A.; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G. M.; Riboli, Elio; Tzoulaki, Ioanna

2016-01-01

Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72–0.79) to 0.88 (0.84–0.92) for all-cause, 0.76 (0.69–0.83) to 0.84 (0.76–0.92) for CVD and 0.78 (0.73–0.83) to 0.91 (0.85–0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors. PMID:27409582

Mediterranean diet adherence and synergy with acute myocardial infarction and its determinants: A multicenter case-control study in Italy.

PubMed

La Torre, Giuseppe; Saulle, Rosella; Di Murro, Francesca; Siliquini, Roberta; Firenze, Alberto; Maurici, Massimo; Mannocci, Alice; Colamesta, Vittoria; Barillà, Francesco; Ferrante, Fabio; Agati, Luciano

2018-01-01

Cardiovascular diseases are the leading causes of mortality and morbidity in Western countries. The possible synergistic effect of poor adherence to a Mediterranean diet (MD) and other risk factors for acute myocardial infarction (AMI) such as hypertension, cholesterol, ever smoker, BMI> 25, diabetes, has not been deeply studied. Case-control study. Patients with first AMI and controls from four tertiary referral Italian centers were screened for enrolment. Dietary information was collected through a questionnaire and a MD adherence score was calculated. Physical activity and smoking habits were also registered. The Synergy Index was calculated according to Rothman. 127 cases and 173 controls were enrolled. The analysis was conducted using a dichotomous variable for the MD score with values ≥7 representing good adherence. Multivariate analysis showed the following variables associated to AMI: ever smoker (OR = 2.08), diabetes (OR = 1.42), hypertension (OR = 2.08), hypercholesterolemia (OR = 2.47), BMI> 25 (OR = 1.99), while a protective effect emerged both in subjects scoring > 7 on the MD score (OR = 0.55) and in subjects resident of Southern Italy (OR = 0.38). A synergistic effect does exist between poor adherence to the MD and the following risk factors: hypertension, hypercholesterolemia, BMI >25, diabetes and being a resident in central and northern Italy. Synergy between heart disease risk factors and MD underlines the need to enlarge the list of known modifiable cardiovascular risk factors to include and promote adherence to Mediterranean dietary habits.

Survival rate and prognostic factors of conventional osteosarcoma in Northern Thailand: A series from Chiang Mai University Hospital.

PubMed

Pruksakorn, Dumnoensun; Phanphaisarn, Areerak; Arpornchayanon, Olarn; Uttamo, Nantawat; Leerapun, Taninnit; Settakorn, Jongkolnee

2015-12-01

Osteosarcoma is a common and aggressive primary malignant bone tumor occurring in children and adolescents. It is one of the most aggressive human cancers and the most common cause of cancer-associated limb loss. As treatment in Thailand has produced a lower survival rate than in developed countries; therefore, this study identified survival rate and the poor prognostic factors of osteosarcoma in Northern Thailand. The retrospective cases of osteosarcoma, diagnosis between 1 January 1996 and 31 December 2013, were evaluated. Five and ten year overall survival rates were analyzed using time-to-event analysis. Potential prognostic factors were identified by multivariate regression analysis. There were 208 newly diagnosed osteosarcomas during that period, and 144 cases met the criteria for analysis. The majority of the osteosarcoma cases (78.5%) were aged 0-24 years. The overall 5- and 10-year survival rates were 37.9% and 33.6%, respectively. Presence of metastasis at initial examination, delayed and against treatment co-operation, and axial skeletal location were identified as independent prognostic factors for survival, with hazard ratios of 4.3, 2.5 and 3.8, and 3.1, respectively. This osteosarcoma cohort had a relatively poor overall survival rate. The prognostic factors identified would play a critical role in modifying survival rates of osteosarcoma patients; as rapid disease recognition, a better treatment counselling, as well as improving of chemotherapeutic regimens were found to be important in improving the overall survival rate in Thailand. Copyright © 2015 Elsevier Ltd. All rights reserved.

Heregulin/ErbB3 Signaling Enhances CXCR4-Driven Rac1 Activation and Breast Cancer Cell Motility via Hypoxia-Inducible Factor 1α

PubMed Central

Lopez-Haber, Cynthia; Barrio-Real, Laura; Casado-Medrano, Victoria

2016-01-01

The growth factor heregulin (HRG), a ligand of ErbB3 and ErbB4 receptors, contributes to breast cancer development and the promotion of metastatic disease, and its expression in breast tumors has been associated with poor clinical outcome and resistance to therapy. In this study, we found that breast cancer cells exposed to sustained HRG treatment show markedly enhanced Rac1 activation and migratory activity in response to the CXCR4 ligand SDF-1/CXCL12, effects mediated by P-Rex1, a Rac-guanine nucleotide exchange factor (GEF) aberrantly expressed in breast cancer. Notably, HRG treatment upregulates surface expression levels of CXCR4, a G protein-coupled receptor (GPCR) implicated in breast cancer metastasis and an indicator of poor prognosis in breast cancer patients. A detailed mechanistic analysis revealed that CXCR4 upregulation and sensitization of the Rac response/motility by HRG are mediated by the transcription factor hypoxia-inducible factor 1α (HIF-1α) via ErbB3 and independently of ErbB4. HRG caused prominent induction in the nuclear expression of HIF-1α, which transcriptionally activates the CXCR4 gene via binding to a responsive element located in positions −1376 to −1372 in the CXCR4 promoter, as revealed by mutagenesis analysis and chromatin immunoprecipitation (ChIP). Our results uncovered a novel function for ErbB3 in enhancing breast cancer cell motility and sensitization of the P-Rex1/Rac1 pathway through HIF-1α-mediated transcriptional induction of CXCR4. PMID:27185877

Pseudomonas fluorescens NZI7 repels grazing by C. elegans, a natural predator.

PubMed

Burlinson, Peter; Studholme, David; Cambray-Young, Joanna; Heavens, Darren; Rathjen, John; Hodgkin, Jonathan; Preston, Gail M

2013-06-01

The bacteriovorous nematode Caenorhabditis elegans has been used to investigate many aspects of animal biology, including interactions with pathogenic bacteria. However, studies examining C. elegans interactions with bacteria isolated from environments in which it is found naturally are relatively scarce. C. elegans is frequently associated with cultivation of the edible mushroom Agaricus bisporus, and has been reported to increase the severity of bacterial blotch of mushrooms, a disease caused by bacteria from the Pseudomonas fluorescens complex. We observed that pseudomonads isolated from mushroom farms showed differential resistance to nematode predation. Under nutrient poor conditions, in which most pseudomonads were consumed, the mushroom pathogenic isolate P. fluorescens NZI7 was able to repel C. elegans without causing nematode death. A draft genome sequence of NZI7 showed it to be related to the biocontrol strain P. protegens Pf-5. To identify the genetic basis of nematode repellence in NZI7, we developed a grid-based screen for mutants that lacked the ability to repel C. elegans. The mutants isolated in this screen included strains with insertions in the global regulator GacS and in a previously undescribed GacS-regulated gene cluster, 'EDB' ('edible'). Our results suggest that the product of the EDB cluster is a poorly diffusible or cell-associated factor that acts together with other features of NZI7 to provide a novel mechanism to deter nematode grazing. As nematodes interact with NZI7 colonies before being repelled, the EDB factor may enable NZI7 to come into contact with and be disseminated by C. elegans without being subject to intensive predation.

Non-compliance to the continuous ambulatory peritoneal dialysis procedure increases the risk of peritonitis.

PubMed

Mawar, Shashi; Gupta, Sanjay; Mahajan, Sandeep

2012-08-01

Peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) is the leading cause of technique failure. Information on the impact of non-compliance in performing CAPD exchange on peritonitis is limited. We aimed to find the prevalence of non-compliance to the CAPD procedure and its influence on the incidence of peritonitis. This observational study included 30 adult patients undergoing CAPD. The CAPD exchange procedure was observed at home and assessed as per the structured checklist and categorized into poor, average and good compliance. The compliance was correlated with the episodes of peritonitis in previous 1 year. The patients' mean age was 52 ± 13 years and the mean duration of CAPD was 2.1 ± 0.9 years. Only 16.5% of patients were good performers, while 67% were average performers, and 16.5% were poor performers. The technique skill was similar across all the steps of the procedure. The most common improperly performed steps were: not putting on a face mask in 68%, not flushing the tubing system in 60%, and not washing hands in 24%. Poor adherence to procedure was independent of age, gender, education and duration of dialysis. Ten episodes of peritonitis occurred in 5 patients over 1-year period. Peritonitis occurred in 60% of poor performers, whereas fully compliant patients had no peritonitis. Also 40% of the poorly compliant patients had multiple episodes of peritonitis. Poor compliance in performing the CAPD procedure is a modifiable risk factor for peritonitis. Adherence to recommended aseptic technique is the cornerstone of peritonitis prevention.

Size and Placement of Metal Culverts Critical on Peatland Woods Roads

Treesearch

J.H. Stoeckeler

1967-01-01

Culverts too small in diameter or poorly placed were major causes of timber flooding and tree damage. Placement problems were poor culvert slope, poor hydraulic approach, lack of gravel bedding, and too little soil covering the culverts.

Transcriptional markers of sub-optimal nutrition in developing Apis mellifera nurse workers

PubMed Central

2014-01-01

Background Honey bees (Apis mellifera) contribute substantially to the worldwide economy and ecosystem health as pollinators. Pollen is essential to the bee’s diet, providing protein, lipids, and micronutrients. The dramatic shifts in physiology, anatomy, and behavior that accompany normal worker development are highly plastic and recent work demonstrates that development, particularly the transition from nurse to foraging roles, is greatly impacted by diet. However, the role that diet plays in the developmental transition of newly eclosed bees to nurse workers is poorly understood. To further understand honey bee nutrition and the role of diet in nurse development, we used a high-throughput screen of the transcriptome of 3 day and 8 day old worker bees fed either honey and stored pollen (rich diet) or honey alone (poor diet) within the hive. We employed a three factor (age, diet, age x diet) analysis of the transcriptome to determine whether diet affected nurse worker physiology and whether poor diet altered the developmental processes normally associated with aging. Results Substantial changes in gene expression occurred due to starvation. Diet-induced changes in gene transcription occurring in younger bees were largely a subset of those occurring in older bees, but certain signatures of starvation were only evident 8 day old workers. Of the 18,542 annotated transcripts in the A. mellifera genome, 150 transcripts exhibited differential expression due to poor diet at 3d of age compared with 17,226 transcripts that differed due to poor diet at 8d of age, and poor diet caused more frequent down-regulation of gene expression in younger bees compared to older bees. In addition, the age-related physiological changes that accompanied early adult development differed due to the diet these young adult bees were fed. More frequent down-regulation of gene expression was observed in developing bees fed a poor diet compared to those fed an adequate diet. Functional analyses also suggest that the physiological and developmental processes occurring in well-fed bees are vastly different than those occurring in pollen deprived bees. Our data support the hypothesis that poor diet causes normal age-related development to go awry. Conclusion Poor nutrition has major consequences for the expression of genes underlying the physiology and age-related development of nurse worker bees. More work is certainly needed to fully understand the consequences of starvation and the complex biology of nutrition and development in this system, but the genes identified in the present study provide a starting point for understanding the consequences of poor diet and for mitigating the economic costs of colony starvation. PMID:24529032

Laboratory environmental factors and pain behavior: the relevance of unknown unknowns to reproducibility and translation.

PubMed

Mogil, Jeffrey S

2017-03-22

The poor record of basic-to-clinical translation in recent decades has led to speculation that preclinical research is "irreproducible", and this irreproducibility in turn has largely been attributed to deficiencies in reporting and statistical practices. There are, however, a number of other reasonable explanations of both poor translation and difficulties in one laboratory replicating the results of another. This article examines these explanations as they pertain to preclinical pain research. I submit that many instances of apparent irreproducibility are actually attributable to interactions between the phenomena and interventions under study and "latent" environmental factors affecting the rodent subjects. These environmental variables-often causing stress, and related to both animal husbandry and the specific testing context-differ greatly between labs, and continue to be identified, suggesting that our knowledge of their existence is far from complete. In pain research in particular, laboratory stressors can produce great variability of unpredictable direction, as stress is known to produce increases (stress-induced hyperalgesia) or decreases (stress-induced analgesia) in pain depending on its parameters. Much greater attention needs to be paid to the study of the laboratory environment if replication and translation are to be improved.

Obesity and Its Potential Effects on Antidepressant Treatment Outcomes in Patients with Depressive Disorders: A Literature Review

PubMed Central

Woo, Young Sup; Seo, Hye-Jin; McIntyre, Roger S.; Bahk, Won-Myong

2016-01-01

Accumulating evidence regarding clinical, neurobiological, genetic, and environmental factors suggests a bidirectional link between obesity and depressive disorders. Although a few studies have investigated the link between obesity/excess body weight and the response to antidepressants in depressive disorders, the effect of weight on treatment response remains poorly understood. In this review, we summarized recent data regarding the relationship between the response to antidepressants and obesity/excess body weight in clinical studies of patients with depressive disorders. Although several studies indicated an association between obesity/excess body weight and poor antidepressant responses, it is difficult to draw definitive conclusions due to the variability of subject composition and methodological differences among studies. Especially, differences in sex, age and menopausal status, depressive symptom subtypes, and antidepressants administered may have caused inconsistencies in the results among studies. The relationship between obesity/excess body weight and antidepressant responses should be investigated further in high-powered studies addressing the differential effects on subject characteristics and treatment. Moreover, future research should focus on the roles of mediating factors, such as inflammatory markers and neurocognitive performance, which may alter the antidepressant treatment outcome in patients with comorbid obesity and depressive disorder. PMID:26771598

Factors related to outcome in heart failure with a preserved (or normal) left ventricular ejection fraction.

PubMed

Sanderson, John E

2016-07-01

Heart failure with a preserved ejection faction (HFpEF) is a growing and expensive cause of heart failure (HF) affecting particularly the elderly. It differs in substantial ways in addition to the normal left ventricular ejection fraction, from the more easily recognized form of heart failure with a reduced ejection fraction (HFrEF or 'systolic heart failure') and unlike HFrEF there have been little advances in treatment. In part, this relates to the complexity of the pathophysiology and identifying the correct targets. In HFpEF, there appears to be widespread stiffening of the vasculature and the myocardium affecting ventricular function (both systolic and diastolic), impeding ventricular suction, and thus early diastolic filling leading to breathlessness on exertion and later atrial failure and fibrillation. Left ventricular ejection fraction tends to gradually decline and some evolve into HFrEF. Most patients also have a mixture of several co-morbidities including hypertension, diabetes, obesity, poor renal function, lack of fitness, and often poor social conditions. Therefore, many factors may influence outcome in an individual patient. In this review, the epidemiology, possible causation, pathophysiology, the influence of co-morbidities and some of the many potential predictors of outcome will be considered.

Validation of the English and Spanish Mammography Beliefs and Attitudes Questionnaire.

PubMed

Lopez-McKee, Gloria; Bader, Julia

2011-03-21

Breast cancer is the leading cause of cancer deaths among Hispanic women in the United States. Unfortunately Hispanic women exhibit poor mammography screening participation, are diagnosed at later stages of the disease, and have lower survival rates than non-Hispanic white women. Several cultural and psycho-social factors have been found to influence mammography screening participation among Hispanic women. We will begin by presenting the theoretical framework that grounded this research program to develop an instrument to assess factors contributing to poor mammography participation among Hispanic women. We will also summarize the early stages in the development of the English and Spanish Mammography Beliefs and Attitudes Questionnaire (MBAQ and SMBAQ) for use with low-health-literacy Mexican-American women. Next we will describe the initial psychometric testing of the MBAQ/SMBAQ, after which we will present the psychometric testing of the SMBAQ with low-health-literacy women. This will be followed by a discussion of the modification of the MBAQ and SMBAQ subscales. We'll conclude with a discussion of the instruments and share our assessment regarding the limitations of this research program, where the program stands to date, and the implications for practice and future research.

Nutritional and socioeconomic status in cognitive development of Santal children of Purulia district, India.

PubMed

Chowdhury, Sutanu Dutta; Ghosh, Tusharkanti

2011-03-01

Cognitive development of children depends on nutritional and socioeconomic factors. The objectives of the present study were to assess the cognitive development and to investigate the relationship of nutritional and socioeconomic status (SES) to cognitive development in 5-12 year old Santal children of Purulia district of West Bengal, India. The nutritional status of each child was assessed by z-score of height-for-age, weight-for-height and weight-for-age parameters. SES was measured using the updated Kuppusswami scale. Cognitive development was measured by Raven's Coloured Progressive Matrices (RCPM). The growth curve of RCPM scores of Santal children remained around the 5(th) percentile values of British children. The RCPM scores of the adequately nourished children and upper-lower SES were significantly higher (p < 0.05) than the children with lower SES and nutritional status. About 42.96% and 27.69% of Santal children were found to be in the intellectually deficient and below average groups, respectively. RCPM scores of Santal children were significantly correlated with nutritional status and socioeconomic factors (p < 0.01). The surveyed children showed poor cognitive functions. The vulnerable nutritional and socioeconomic statuses of Santal children are the major causes for their poor cognitive development.

The Influence of SAND’s Gradation and Clay Content of Direct Sheart Test on Clayey Sand

NASA Astrophysics Data System (ADS)

Wibisono, Gunawan; Agus Nugroho, Soewignjo; Umam, Khairul

2018-03-01

The shear strength of clayey-sand can be affected by several factors, e.g. gradation, density, moisture content, and the percentage of clay and sand fraction. The same percentage of clay and sand fraction in clayey-sand mixtures may have different shear strengths due to those factors. This research aims to study the effect of clay content on sand that cause the change of its shear strength. Samples consisted of different clay and sand fractions were reconstituted at a certain moisture content. Sand fractions varied from well-graded to poorly-graded sand. Shear strength was measured in terms of the direct shear test. Prior to the test, surcharge loads were applied to represent overburden pressures. Shear strength results and their components (i.e. Cohesion and internal angle of friction) were correlated with physical properties of samples (i.e. grading coefficient of curvature, coefficient of uniformity, and density). Results showed that samples classified as well-graded and dense sand had higher shear strength. In the other hand, the shear strengths decreased when the mixtures became poorly-graded and less dense. The inclusion of the clay fraction increased cohesion component and decreased internal angle of friction.

Global biogeography of human infectious diseases.

PubMed

Murray, Kris A; Preston, Nicholas; Allen, Toph; Zambrana-Torrelio, Carlos; Hosseini, Parviez R; Daszak, Peter

2015-10-13

The distributions of most infectious agents causing disease in humans are poorly resolved or unknown. However, poorly known and unknown agents contribute to the global burden of disease and will underlie many future disease risks. Existing patterns of infectious disease co-occurrence could thus play a critical role in resolving or anticipating current and future disease threats. We analyzed the global occurrence patterns of 187 human infectious diseases across 225 countries and seven epidemiological classes (human-specific, zoonotic, vector-borne, non-vector-borne, bacterial, viral, and parasitic) to show that human infectious diseases exhibit distinct spatial grouping patterns at a global scale. We demonstrate, using outbreaks of Ebola virus as a test case, that this spatial structuring provides an untapped source of prior information that could be used to tighten the focus of a range of health-related research and management activities at early stages or in data-poor settings, including disease surveillance, outbreak responses, or optimizing pathogen discovery. In examining the correlates of these spatial patterns, among a range of geographic, epidemiological, environmental, and social factors, mammalian biodiversity was the strongest predictor of infectious disease co-occurrence overall and for six of the seven disease classes examined, giving rise to a striking congruence between global pathogeographic and "Wallacean" zoogeographic patterns. This clear biogeographic signal suggests that infectious disease assemblages remain fundamentally constrained in their distributions by ecological barriers to dispersal or establishment, despite the homogenizing forces of globalization. Pathogeography thus provides an overarching context in which other factors promoting infectious disease emergence and spread are set.

Probabilistic Reversal Learning in Schizophrenia: Stability of Deficits and Potential Causal Mechanisms.

PubMed

Reddy, Lena Felice; Waltz, James A; Green, Michael F; Wynn, Jonathan K; Horan, William P

2016-07-01

Although individuals with schizophrenia show impaired feedback-driven learning on probabilistic reversal learning (PRL) tasks, the specific factors that contribute to these deficits remain unknown. Recent work has suggested several potential causes including neurocognitive impairments, clinical symptoms, and specific types of feedback-related errors. To examine this issue, we administered a PRL task to 126 stable schizophrenia outpatients and 72 matched controls, and patients were retested 4 weeks later. The task involved an initial probabilistic discrimination learning phase and subsequent reversal phases in which subjects had to adjust their responses to sudden shifts in the reinforcement contingencies. Patients showed poorer performance than controls for both the initial discrimination and reversal learning phases of the task, and performance overall showed good test-retest reliability among patients. A subgroup analysis of patients (n = 64) and controls (n = 49) with good initial discrimination learning revealed no between-group differences in reversal learning, indicating that the patients who were able to achieve all of the initial probabilistic discriminations were not impaired in reversal learning. Regarding potential contributors to impaired discrimination learning, several factors were associated with poor PRL, including higher levels of neurocognitive impairment, poor learning from both positive and negative feedback, and higher levels of indiscriminate response shifting. The results suggest that poor PRL performance in schizophrenia can be the product of multiple mechanisms. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Fibromyalgia as a cause of uncontrolled asthma: a case-control multicenter study.

PubMed

Martinez-Moragon, Eva; Plaza, Vicente; Torres, Isabel; Rosado, Ana; Urrutia, Isabel; Casas, Xavier; Hinojosa, Belen; Blanco-Aparicio, Marina; Delgado, Julio; Quirce, Santiago; Sabadell, Carles; Cebollero, Pilar; Muñoz-Fernández, Ana

2017-12-01

Fibromyalgia can affect the control of asthma when both diseases are present in a single patient. To characterize asthma in patients with concomitant fibromyalgia to assess whether fibromyalgia is an independent factor of asthma severity that influences poor asthma control. We also evaluated how dyspnea is perceived by patients in order to demonstrate that alterations in the perception of airway obstruction may be responsible for poor asthma control. This was a cross-sectional case-control multicenter study, in which 56 patients in the asthma and fibromyalgia group were matched to 36 asthmatics by sex, approximate age, and asthma severity level. All patients were women. Study variables included the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), the Nijmegen hyperventilation syndrome questionnaire, the Hospital Anxiety and Depression Scale, and perception of dyspnea after acute bronchoconstriction. Although patients in both study groups showed similar asthma severity and use of anti-asthmatic drugs, patients in the asthma and fibromyalgia group showed lower scores on the ACT and MiniAQLQ questionnaires, and higher scores of anxiety and depression as well as hyperventilation compared to asthma patients without fibromyalgia. All these differences were statistically significant. Fibromyalgia in patients with asthma influences poor control of the respiratory disease and is associated with altered perception of dyspnea, hyperventilation syndrome, high prevalence of depression and anxiety, and impaired quality of life. Fibromyalgia may be considered a risk factor for uncontrolled asthma in patients suffering from asthma and fibromyalgia concomitantly.

Analysis of agency relationships in the design and implementation process of the equity fund in Madagascar.

PubMed

Honda, Ayako

2015-02-04

There are large gaps in the literature relating to the implementation of user fee policy and fee exemption measures for the poor, particularly on how such schemes are implemented and why many have not produced expected outcomes. In October 2003, Madagascar instituted a user fee exemption policy which established "equity funds" at public health centres, and used medicine sales revenue to subsidise the cost of medicine for the poor. This study examines the policy design and implementation process of the equity fund in Madagascar in an attempt to explore factors influencing the poor equity outcomes of the scheme. This study applied an agency-incentive framework to investigate the equity fund policy design and implementation practices. It analysed agency relationships established during implementation; examined incentive structures given to the agency relationships in the policy design; and considered how incentive structures were shaped and how agents responded in practice. The study employed a case-study approach with in-depth analysis of three equity fund cases in Madagascar's Boeny region. Policy design problems, triggering implementation problems, caused poor equity performance. These problems were compounded by the re-direction of policy objectives by health administrators and strong involvement of the administrators in the implementation of policy. The source of the policy design and implementation failure was identified as a set of principal-agent problems concerning: monitoring mechanisms; facility-based fund management; and the nature and level of community participation. These factors all contributed to the financial performance of the fund receiving greater attention than its ability to financially protect the poor. The ability of exemption policies to protect the poor from user fees can be found in the details of the policy design and implementation; and implications of the policy design and implementation in a specific context determine whether a policy can realise its objectives. The equity fund experience in Madagascar, which illustrates the challenges of beneficiary identification, casts doubts on the application of the 'targeting' approach in health financing and raises issues to be considered in universal health policy formulation. The agency framework provides a useful lens through which to examine policy process issues.

MITOCHONDRIAL DISEASES PART II: MOUSE MODELS OF OXPHOS DEFICIENCIES CAUSED BY DEFECTS IN REGULATORY FACTORS AND OTHER COMPONENTS REQUIRED FOR MITOCHONDRIAL FUNCTION

PubMed Central

Iommarini, Luisa; Peralta, Susana; Torraco, Alessandra; Diaz, Francisca

2015-01-01

Mitochondrial disorders are defined as defects that affect the oxidative phosphorylation system (OXPHOS). They are characterized by a heterogeneous array of clinical presentations due in part to a wide variety of factors required for proper function of the components of the OXPHOS system. There is no cure for these disorders owing our poor knowledge of the pathogenic mechanisms of disease. To understand the mechanisms of human disease numerous mouse models have been developed in recent years. Here we summarize the features of several mouse models of mitochondrial diseases directly related to those factors affecting mtDNA maintenance, replication, transcription, translation as well to other proteins that are involved in mitochondrial dynamics and quality control which affect mitochondrial OXPHOS function without been intrinsic components of the system. We discuss how these models have contributed to our understanding of mitochondrial diseases and their pathogenic mechanisms. PMID:25640959

Factors Influencing Attitude, Safety Behavior, and Knowledge regarding Household Waste Management in Guinea: A Cross-Sectional Study

PubMed Central

Mamady, Keita

2016-01-01

Waste indiscriminate disposal is recognized as an important cause of environmental pollution and is associated with health problems. Safe management and disposal of household waste are an important problem to the capital city of Guinea (Conakry). The objective of this study was to identify socioeconomic and demographic factors associated with practice, knowledge, and safety behavior of family members regarding household waste management and to produce a remedial action plan. I found that no education background, income, and female individuals were independently associated with indiscriminate waste disposal. Unplanned residential area was an additional factor associated with indiscriminate waste disposal. I also found that the community residents had poor knowledge and unsafe behavior in relation to waste management. The promotion of environmental information and public education and implementation of community action programs on disease prevention and health promotion will enhance environmental friendliness and safety of the community. PMID:27092183

Factors Influencing Attitude, Safety Behavior, and Knowledge regarding Household Waste Management in Guinea: A Cross-Sectional Study.

PubMed

Mamady, Keita

2016-01-01

Waste indiscriminate disposal is recognized as an important cause of environmental pollution and is associated with health problems. Safe management and disposal of household waste are an important problem to the capital city of Guinea (Conakry). The objective of this study was to identify socioeconomic and demographic factors associated with practice, knowledge, and safety behavior of family members regarding household waste management and to produce a remedial action plan. I found that no education background, income, and female individuals were independently associated with indiscriminate waste disposal. Unplanned residential area was an additional factor associated with indiscriminate waste disposal. I also found that the community residents had poor knowledge and unsafe behavior in relation to waste management. The promotion of environmental information and public education and implementation of community action programs on disease prevention and health promotion will enhance environmental friendliness and safety of the community.

Comorbidities and risk factors among patients with schizophrenia.

PubMed

Harrison, Christopher; Charles, Janice; Britt, Helena

2015-01-01

General practitioners (GPs) are charged with maintaining a holistic approach to their patients' health. While most patients with schizophrenia attend public mental health services and/or non-government organisations supporting people with mental illness, 88.2% of people with a psychotic illness (the majority being schizophrenia or schizoaffective disorder) had visited a GP in the previous year. For at least 30-40% of people living with schizophrenia in Australia, ongoing management is provided by their GP alone. Moreover, there is evidence that patients with schizophrenia value the help provided by GPs. Patients with schizophrenia have reduced life expectancy. Overseas research (primarily from the UK and US) has found that the poor physical health of patients with schizophrenia can be attributed to a number of factors such as modifiable lifestyle risk factors and side effects of medication, compounded by causes intrinsic to the illness such as mental stress and loss of initiative.

Whiplash and the compensation hypothesis.

PubMed

Spearing, Natalie M; Connelly, Luke B

2011-12-01

Review article. To explain why the evidence that compensation-related factors lead to worse health outcomes is not compelling, either in general, or in the specific case of whiplash. There is a common view that compensation-related factors lead to worse health outcomes ("the compensation hypothesis"), despite the presence of important, and unresolved sources of bias. The empirical evidence on this question has ramifications for the design of compensation schemes. Using studies on whiplash, this article outlines the methodological problems that impede attempts to confirm or refute the compensation hypothesis. Compensation studies are prone to measurement bias, reverse causation bias, and selection bias. Errors in measurement are largely due to the latent nature of whiplash injuries and health itself, a lack of clarity over the unit of measurement (specific factors, or "compensation"), and a lack of appreciation for the heterogeneous qualities of compensation-related factors and schemes. There has been a failure to acknowledge and empirically address reverse causation bias, or the likelihood that poor health influences the decision to pursue compensation: it is unclear if compensation is a cause or a consequence of poor health, or both. Finally, unresolved selection bias (and hence, confounding) is evident in longitudinal studies and natural experiments. In both cases, between-group differences have not been addressed convincingly. The nature of the relationship between compensation-related factors and health is unclear. Current approaches to testing the compensation hypothesis are prone to several important sources of bias, which compromise the validity of their results. Methods that explicitly test the hypothesis and establish whether or not a causal relationship exists between compensation factors and prolonged whiplash symptoms are needed in future studies.

Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis.

PubMed

Bouzid, Maha; Kintz, Erica; Hunter, Paul R

2018-06-07

Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries. We sought to conduct a systematic review and meta-analysis to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs). Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure. The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11-3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13-3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19-2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77-1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13-1.22), which was not statistically significant. Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.

Design of maintainable drains for earth retaining structures : final report and design guide.

DOT National Transportation Integrated Search

2017-04-01

Poor drainage is by far the most common cause of poor performance for earth retention systems. Poor performance includes burdensome serviceability problems that can progress to outright failure of the earth retention system if not addressed. : A comm...

Decline in snail abundance due to soil acidification causes eggshell defects in forest passerines.

PubMed

Graveland, J; van der Wal, R

1996-02-01

On poor soils in the Netherlands an increasing number of great tits, Parus major, and of other forest passerines produce eggs with defective shells and have low reproductive success as a result of calcium deficiency. A similar increase in eggshell defects has been observed in Germany and Sweden. Snail shells are the main calcium source for tits in forests where defective eggshells do not occur, but are very little taken in forests where tits often have eggshell defects. We investigated whether a decrease in snail abundance on poor soils could be responsible for the decline in eggshell quality, and if so, what caused this decrease. Snail density in forests where tits have eggshell defects was much lower than in forests where tits do not have such defects. Snail density correlated with the calcium content and to a lesser extent with pH of the litter layer. Liming of a calciumpoor forest soil with few snails resulted in snail densities comparable to those on calcium-rich soils after 4 years. Snail density has declined on calcium-poor soils over the last two decades, but not on calcium-rich soils. Acid deposition has caused a decline of soil calcium on poor soils. We conclude, therefore, that anthropogenic acidification has caused a decline in snail populations, resulting in an increase in eggshell defects in birds in forests on poor soils.

Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa

PubMed Central

Kariuki, Symon M; Matuja, William; Akpalu, Albert; Kakooza-Mwesige, Angelina; Chabi, Martin; Wagner, Ryan G; Connor, Myles; Chengo, Eddie; Ngugi, Anthony K; Odhiambo, Rachael; Bottomley, Christian; White, Steven; Sander, Josemir W; Neville, Brian G R; Newton, Charles R J C

2014-01-01

Purpose Epilepsy is common in sub-Saharan Africa (SSA), but the clinical features and consequences are poorly characterized. Most studies are hospital-based, and few studies have compared different ecological sites in SSA. We described active convulsive epilepsy (ACE) identified in cross-sectional community-based surveys in SSA, to understand the proximate causes, features, and consequences. Methods We performed a detailed clinical and neurophysiologic description of ACE cases identified from a community survey of 584,586 people using medical history, neurologic examination, and electroencephalography (EEG) data from five sites in Africa: South Africa; Tanzania; Uganda; Kenya; and Ghana. The cases were examined by clinicians to discover risk factors, clinical features, and consequences of epilepsy. We used logistic regression to determine the epilepsy factors associated with medical comorbidities. Key Findings Half (51%) of the 2,170 people with ACE were children and 69% of seizures began in childhood. Focal features (EEG, seizure types, and neurologic deficits) were present in 58% of ACE cases, and these varied significantly with site. Status epilepticus occurred in 25% of people with ACE. Only 36% received antiepileptic drugs (phenobarbital was the most common drug [95%]), and the proportion varied significantly with the site. Proximate causes of ACE were adverse perinatal events (11%) for onset of seizures before 18 years; and acute encephalopathy (10%) and head injury prior to seizure onset (3%). Important comorbidities were malnutrition (15%), cognitive impairment (23%), and neurologic deficits (15%). The consequences of ACE were burns (16%), head injuries (postseizure) (1%), lack of education (43%), and being unmarried (67%) or unemployed (57%) in adults, all significantly more common than in those without epilepsy. Significance There were significant differences in the comorbidities across sites. Focal features are common in ACE, suggesting identifiable and preventable causes. Malnutrition and cognitive and neurologic deficits are common in people with ACE and should be integrated into the management of epilepsy in this region. Consequences of epilepsy such as burns, lack of education, poor marriage prospects, and unemployment need to be addressed. PMID:24116877

Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa.

PubMed

Kariuki, Symon M; Matuja, William; Akpalu, Albert; Kakooza-Mwesige, Angelina; Chabi, Martin; Wagner, Ryan G; Connor, Myles; Chengo, Eddie; Ngugi, Anthony K; Odhiambo, Rachael; Bottomley, Christian; White, Steven; Sander, Josemir W; Neville, Brian G R; Newton, Charles R J C; Twine, Rhian; Gómez Olivé, F Xavier; Collinson, Mark; Kahn, Kathleen; Tollman, Stephen; Masanja, Honratio; Mathew, Alexander; Pariyo, George; Peterson, Stefan; Ndyomughenyi, Donald; Bauni, Evasius; Kamuyu, Gathoni; Odera, Victor Mung'ala; Mageto, James O; Ae-Ngibise, Ken; Akpalu, Bright; Agbokey, Francis; Adjei, Patrick; Owusu-Agyei, Seth; Kleinschmidt, Immo; Doku, Victor C K; Odermatt, Peter; Nutman, Thomas; Wilkins, Patricia; Noh, John

2014-01-01

Epilepsy is common in sub-Saharan Africa (SSA), but the clinical features and consequences are poorly characterized. Most studies are hospital-based, and few studies have compared different ecological sites in SSA. We described active convulsive epilepsy (ACE) identified in cross-sectional community-based surveys in SSA, to understand the proximate causes, features, and consequences. We performed a detailed clinical and neurophysiologic description of ACE cases identified from a community survey of 584,586 people using medical history, neurologic examination, and electroencephalography (EEG) data from five sites in Africa: South Africa; Tanzania; Uganda; Kenya; and Ghana. The cases were examined by clinicians to discover risk factors, clinical features, and consequences of epilepsy. We used logistic regression to determine the epilepsy factors associated with medical comorbidities. Half (51%) of the 2,170 people with ACE were children and 69% of seizures began in childhood. Focal features (EEG, seizure types, and neurologic deficits) were present in 58% of ACE cases, and these varied significantly with site. Status epilepticus occurred in 25% of people with ACE. Only 36% received antiepileptic drugs (phenobarbital was the most common drug [95%]), and the proportion varied significantly with the site. Proximate causes of ACE were adverse perinatal events (11%) for onset of seizures before 18 years; and acute encephalopathy (10%) and head injury prior to seizure onset (3%). Important comorbidities were malnutrition (15%), cognitive impairment (23%), and neurologic deficits (15%). The consequences of ACE were burns (16%), head injuries (postseizure) (1%), lack of education (43%), and being unmarried (67%) or unemployed (57%) in adults, all significantly more common than in those without epilepsy. There were significant differences in the comorbidities across sites. Focal features are common in ACE, suggesting identifiable and preventable causes. Malnutrition and cognitive and neurologic deficits are common in people with ACE and should be integrated into the management of epilepsy in this region. Consequences of epilepsy such as burns, lack of education, poor marriage prospects, and unemployment need to be addressed. Wiley Periodicals, Inc. © 2013 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of the International League Against Epilepsy.

Social determinants of cardiovascular disease outcomes in Indians

PubMed Central

Jeemon, Panniyammakal; Reddy, K.S.

2010-01-01

Cardiovascular diseases (CVD) are the leading cause of death and disability in both developed and developing countries. In developed countries socio-economic mortality differentials have been studied extensively showing that the low socio-economic group suffers the highest mortality. As the epidemiological transition is taking place against a background of economic globalization, CVD risk factors among the urban poor and middle class are rapidly increasing in India. Recent evidences from India also suggest reversal of social gradient with excess burden of CVD morbidity in the low socio-economic group. Understanding the social determinants of environmental and behavioural exposures, in determining the risk factors for cardiovascular disease is an important challenge for public health professionals as well as communities. Socio-economic disadvantage is not simply a proxy for poor cardiovascular risk factor status, but also an indication of the likely trajectory that an individual or a community may follow in the course of their life. The paucity of intervention research seeking to address the role of social determinants in shaping lifestyle practices among individuals in culturally and socially diverse population groups within India is definitely a measure of inadequacy in public health research. This review article provides an overview of the role of social determinants of CVD and its possible conceptual pathways with special focus on acute coronary syndrome (ACS) outcomes among Indians. PMID:21150014

Place of Death in Patients with Lung Cancer: A Retrospective Cohort Study from 2004-2013.

PubMed

O'Dowd, Emma L; McKeever, Tricia M; Baldwin, David R; Hubbard, Richard B

2016-01-01

Many patients with cancer die in an acute hospital bed, which has been frequently identified as the least preferred location, with psychological and financial implications. This study looks at place and cause of death in patients with lung cancer and identifies which factors are associated with dying in an acute hospital bed versus at home. We used the National Lung Cancer Audit linked to Hospital Episode Statistics and Office for National Statistics data to determine cause and place of death in those with lung cancer; both overall and by cancer Network. We used multivariate logistic regression to compare features of those who died in an acute hospital versus those who died at home. Of 143627 patients identified 40% (57678) died in an acute hospital, 29% (41957) died at home and 17% (24108) died in a hospice. Individual factors associated with death in an acute hospital bed compared to home were male sex, increasing age, poor performance status, social deprivation and diagnosis via an emergency route. There was marked variation between cancer Networks in place of death. The proportion of patients dying in an acute hospital ranged from 28% to 48%, with variation most notable in provision of hospice care (9% versus 33%). Cause of death in the majority was lung cancer (86%), with other malignancies, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) comprising 9% collectively. A substantial proportion of patients with lung cancer die in acute hospital beds and this is more likely with increasing age, male sex, social deprivation and in those with poor performance status. There is marked variation between Networks, suggesting a need to improve end-of-life planning in those at greatest risk, and to review the allocation of resources to provide more hospice beds, enhanced community support and ensure equal access.

[Devaluation of the African Financial Community franc and the dietary strategies of families in Bamako (Mali)].

PubMed

Ag Bendech, M; Chauliac, M; Gerbouin-Rerolle, P; Kante, N; Malvy, D J

1997-01-01

This survey, conducted in 1996, evaluated changes in the way families feed themselves caused by the effects of devaluation of the CFA franc. It involved semi-directed interviews with 64 subjects from various socio-economic backgrounds (affluent, middle-class, poor). The subjects spoke of the difficulties of daily life, lack of money and rapid, unpredictable rises in the prices of essential goods caused by the devaluation. They did not understand the reasons for the devaluation, which has caused rapid changes in the social conditions and nutrition of urban families and has exacerbated the inequality of access to foodstuffs. Affluent families have adopted strategies that increase the family food budget, compensating for price increases. The meals of poor and middle-class families have been directly affected in both structure and content. Poor families have been particularly badly affected. All the changes in strategy, and substitutions of one product for another described by middle-class families were already being used by the poor families before devaluation.

Inequalities in health and health risk factors in the Southern African Development Community: evidence from World Health Surveys.

PubMed

Umuhoza, Stella M; Ataguba, John E

2018-04-27

Socioeconomic inequalities in health have been documented in many countries including those in the Southern African Development Community (SADC). However, a comprehensive assessment of health inequalities and inequalities in the distribution of health risk factors is scarce. This study specifically investigates inequalities both in poor self-assessed health (SAH) and in the distribution of selected risk factors of ill-health among the adult populations in six SADC countries. Data come from the 2002/04 World Health Survey (WHS) using six SADC countries (Malawi, Mauritius, South Africa, Swaziland, Zambia and Zimbabwe) where the WHS was conducted. Poor SAH is reporting bad or very bad health status. Risk factors such as smoking, heavy drinking, low fruit and vegetable consumption and physical inactivity were considered. Other environmental factors were also considered. Socioeconomic status was assessed using household expenditures. Standardised and normalised concentration indices (CIs) were used to assess socioeconomic inequalities. A positive (negative) concentration index means a pro-rich (pro-poor) distribution where the variable is reported more among the rich (poor). Generally, a pro-poor socioeconomic inequality exists in poor SAH in the six countries. However, this is only significant for South Africa (CI = - 0.0573; p < 0.05), and marginally significant for Zambia (CI = - 0.0341; P < 0.1) and Zimbabwe (CI = - 0.0357; p < 0.1). Smoking and inadequate fruit and vegetable consumption were significantly concentrated among the poor. Similarly, the use of biomass energy, unimproved water and sanitation were significantly concentrated among the poor. However, inequalities in heavy drinking and physical inactivity are mixed. Overall, a positive relationship exists between inequalities in ill-health and inequalities in risk factors of ill-health. There is a need for concerted efforts to tackle the significant socioeconomic inequalities in ill-health and health risk factors in the region. Because some of the determinants of ill-health lie outside the health sector, inter-sectoral action is required.

Can verbal working memory training improve reading?

PubMed

Banales, Erin; Kohnen, Saskia; McArthur, Genevieve

2015-01-01

The aim of the current study was to determine whether poor verbal working memory is associated with poor word reading accuracy because the former causes the latter, or the latter causes the former. To this end, we tested whether (a) verbal working memory training improves poor verbal working memory or poor word reading accuracy, and whether (b) reading training improves poor reading accuracy or verbal working memory in a case series of four children with poor word reading accuracy and verbal working memory. Each child completed 8 weeks of verbal working memory training and 8 weeks of reading training. Verbal working memory training improved verbal working memory in two of the four children, but did not improve their reading accuracy. Similarly, reading training improved word reading accuracy in all children, but did not improve their verbal working memory. These results suggest that the causal links between verbal working memory and reading accuracy may not be as direct as has been assumed.

Blocked, delayed, or obstructed: What causes poor white matter development in intrauterine growth restricted infants?

PubMed

Tolcos, Mary; Petratos, Steven; Hirst, Jonathan J; Wong, Flora; Spencer, Sarah J; Azhan, Aminath; Emery, Ben; Walker, David W

2017-07-01

Poor white matter development in intrauterine growth restricted (IUGR) babies remains a major, untreated problem in neonatology. New therapies, guided by an understanding of the mechanisms that underlie normal and abnormal oligodendrocyte development and myelin formation, are required. Much of our knowledge of the mechanisms that underlie impaired myelination come from studies in adult demyelinating disease, preterm brain injury, or experimental models of hypoxia-ischemia. However, relatively less is known for IUGR which is surprising because IUGR is a leading cause of perinatal mortality and morbidity, second only to premature birth. IUGR is also a significant risk factor for the later development of cerebral palsy, and is a greater risk compared to some of the more traditionally researched antecedents - asphyxia and inflammation. Recent evidence suggests that the white matter injury and reduced myelination in the brains of some preterm babies is due to impaired maturation of oligodendrocytes thereby resulting in the reduced capacity to synthesize myelin. Therefore, it is not surprising that the hypomyelination observable in the central nervous system of IUGR infants has similarly lead to investigations identifying a delay or blockade in the progress of maturation of oligodendrocytes in these infants. This review will discuss current ideas thought to account for the poor myelination often present in the neonate's brain following IUGR, and discuss novel interventions that are promising as treatments that promote oligodendrocyte maturation, and thereby repair the myelination deficits that otherwise persist into infancy and childhood and lead to neurodevelopmental abnormalities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future.

PubMed

Schultz, Marcus J; Dunser, Martin W; Dondorp, Arjen M; Adhikari, Neill K J; Iyer, Shivakumar; Kwizera, Arthur; Lubell, Yoel; Papali, Alfred; Pisani, Luigi; Riviello, Beth D; Angus, Derek C; Azevedo, Luciano C; Baker, Tim; Diaz, Janet V; Festic, Emir; Haniffa, Rashan; Jawa, Randeep; Jacob, Shevin T; Kissoon, Niranjan; Lodha, Rakesh; Martin-Loeches, Ignacio; Lundeg, Ganbold; Misango, David; Mer, Mervyn; Mohanty, Sanjib; Murthy, Srinivas; Musa, Ndidiamaka; Nakibuuka, Jane; Serpa Neto, Ary; Nguyen Thi Hoang, Mai; Nguyen Thien, Binh; Pattnaik, Rajyabardhan; Phua, Jason; Preller, Jacobus; Povoa, Pedro; Ranjit, Suchitra; Talmor, Daniel; Thevanayagam, Jonarthan; Thwaites, C Louise

2017-05-01

Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

The epidemiology of bovine respiratory disease: What is the evidence for predisposing factors?

PubMed Central

Taylor, Jared D.; Fulton, Robert W.; Lehenbauer, Terry W.; Step, Douglas L.; Confer, Anthony W.

2010-01-01

Bovine respiratory disease (BRD) is the most costly disease of beef cattle in North America. It is multi-factorial, with a variety of physical and physiological stressors combining to predispose cattle to pneumonia. However, efforts to discern which factors are most important have frequently failed to establish definitive answers. Calves are at highest risk shortly after transport. Risk factors include purchasing from sale barns and commingling. It is unclear whether or not these practices increase susceptibility, increase exposure, or are proxies for poor management. Lighter-weight calves appear to be at greater risk, although this has not been consistent. Persistent infection (PI) with bovine virus diarrhea virus increases BRD occurrence, but it is unclear if PI calves affect other cattle in the feedlot. The complexity of BRD has made it difficult to define involvement of individual factors. Stressors may play a role as “necessary but not sufficient” components, requiring additive effects to cause disease. PMID:21197200

Etiopathogenesis of cataract: An appraisal

PubMed Central

Gupta, Varun B; Rajagopala, Manjusha; Ravishankar, Basavaiah

2014-01-01

Natural eye lens is a crystalline substance to produce a clear passage for light. Cataract is opacity within the clear lens of the eye and is the dominant cause of socio-medical problem i.e., blindness worldwide. The only available treatment of cataract is surgery. However, insufficient surgical facilities in poor and developing countries and post-operative complications inspire researchers to find out other modes of treatment for cataract. In this review, an attempt has been made to appraise various etiological factors of cataract to make their perception clear to build up counterpart treatment. Present study is an assortment of various available literatures and electronic information in view of cataract etiopathogenesis. Various risk factors have been identified in development of cataracts. They can be classified in to genetic factors, ageing (systemic diseases, nutritional and trace metals deficiencies, smoking, oxidative stress etc.), traumatic, complicated (inflammatory and degenerative diseases of eye), metabolic (diabetes, galactosemia etc.), toxic substances including drugs abuses, alcohol etc., radiation (ultraviolet, electromagnetic waves etc.) are implicated as significant risk factors in the development of cataract. PMID:24618482

Commonsense illness beliefs, adherence behaviors, and hypertension control among African Americans.

PubMed

Hekler, Eric B; Lambert, Jennifer; Leventhal, Elaine; Leventhal, Howard; Jahn, Eric; Contrada, Richard J

2008-10-01

Hypertension, particularly among African Americans, has been increasing in importance in the past 10 years. One aspect of this problem is poor disease management. This study examined illness beliefs, behaviors, and hypertension control among 102 African American outpatients. Participants were interviewed about their commonsense beliefs concerning hypertension and its management in accordance with Leventhal's commonsense model of self-regulation (CSM). Also assessed were medication adherence, stress-reducing behaviors, and lifestyle behaviors recommended for blood pressure control. Blood pressure was measured at about the time of interviewing. Results indicated that endorsement of a medical belief model of hypertension (i.e., caused and controlled by factors such as diet, age, and weight) was cross-sectionally associated with lower systolic blood pressure, a relationship that was statistically mediated by lifestyle behaviors (e.g., cut down salt, exercise). Endorsement of a stress belief model (i.e., stress is the main factor in hypertension cause and control) was associated with engagement in stress-related behaviors but not with blood pressure. These results further support the utility of the CSM for understanding patients' disease management behaviors.

Population growth and consumption.

PubMed

Chalkley, K

1997-04-01

The relationship between population growth, resource consumption, and environmental degradation is complex. The rise in "greenhouse gases" that will cause climatic change is clearly due to human activity, and pollutants are often concentrated in densely populated areas. However, even an area with a negative population growth, such as Russia, can experience severe environmental degradation due to poor management. Consumption patterns have the most effect on ozone depletion, while population growth threatens biodiversity of and within species through the destruction of ecosystems. Migration joins population growth and social factors, such as land inequality, as major causes of deforestation, and global demand for water is expected to increase faster than the rate of population growth. Coastal development and over-fishing threaten to deplete the oceans, while soil quality is threatened by inappropriate land use. Estimates of the earth's carrying capacity range from less than 3 billion to more than 44 billion people, indicating how difficult it is to assess this figure. Development efforts throughout the world may lead to human gains that will ultimately be negated by environmental losses. These factors have led to growing support for environmentally sustainable development.

Roles of lignin biosynthesis and regulatory genes in plant development

PubMed Central

Yoon, Jinmi; Choi, Heebak

2015-01-01

Abstract Lignin is an important factor affecting agricultural traits, biofuel production, and the pulping industry. Most lignin biosynthesis genes and their regulatory genes are expressed mainly in the vascular bundles of stems and leaves, preferentially in tissues undergoing lignification. Other genes are poorly expressed during normal stages of development, but are strongly induced by abiotic or biotic stresses. Some are expressed in non‐lignifying tissues such as the shoot apical meristem. Alterations in lignin levels affect plant development. Suppression of lignin biosynthesis genes causes abnormal phenotypes such as collapsed xylem, bending stems, and growth retardation. The loss of expression by genes that function early in the lignin biosynthesis pathway results in more severe developmental phenotypes when compared with plants that have mutations in later genes. Defective lignin deposition is also associated with phenotypes of seed shattering or brittle culm. MYB and NAC transcriptional factors function as switches, and some homeobox proteins negatively control lignin biosynthesis genes. Ectopic deposition caused by overexpression of lignin biosynthesis genes or master switch genes induces curly leaf formation and dwarfism. PMID:26297385

Update on causes of premature death in people with convulsive epilepsy in rural West China.

PubMed

Si, Yang; Chen, Deng; Tian, Linyu; Mu, Jie; Chen, Tao; Liu, Ling; Deng, Ying; He, Jun; Li, You; He, Li; Zhou, Dong

2016-06-01

This longitudinal prospective study updated a previous report on premature mortality and focused on the risk factors among patients with convulsive epilepsy in resource-poor settings. The present cohort size (7,231) and follow-up (mean 33.4 months) were expanded. The basic epidemiologic aspects of this cohort were similar to the original report (case fatality: 3.26% vs. 2.97%, respectively; injury contributed more than half of the deaths). Cox regression analysis suggested that male patients, late ages of onset (>45 years old), short duration of epilepsy (<10 years), and high convulsive seizure frequency (>2 per month) were independent risk factors for overall premature death. Male patients with late ages of onset and high seizure frequency had a higher risk of injury-specific death. This study emphasizes the preventable nature of injuries that are leading putative causes of death among people with convulsive epilepsy in rural West China. Education on specific populations and efficient seizure control are of paramount importance in reducing the risk of premature mortality. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Stress perceived by houseman in a hospital in northern Malaysia.

PubMed

Gopalakrishnan, V; Umabalan, T; Affan, M; Zamri, A A; Kamal, A; Sandheep, S

2016-02-01

Being a houseman in Malaysian hospitals can be very stressful. Stress can affect decision making to a great extent while addressing the needs of the patient in an emergency setting. This necessitated a study to find out the main sources of stress among housemen. This was a cross-sectional descriptive study carried out among 55 housemen using a questionnaire on sources of stress. The data was analysed using SPSS version 17. A total of 16 factors leading to stress were studied among the housemen. Poor work and social life balance, annoying non-clinical personnel and medico-legal threats were among the top causes of stress. The factors leading to stress among housemen should be considered for effective working of the hospital and improving the workplace atmosphere for the housemen.

Extra-hepatic hepatocellular carcinoma presenting as obstructive jaundice.

PubMed

Batsis, J A; Halfdanarson, T R; Pitot, H

2006-10-01

Hepatocellular carcinoma is a neoplasm with a uniformly poor prognosis. Risk factors for its development include chronic hepatitis B or C infection, haemochromatosis and alpha-1-antitrypsin deficiency, but individuals with any type of chronic liver disease are predisposed. The incidence is significantly higher in Asia and Africa although it has been noted to be increasing in the United States. We present a patient with notable atypical clinical features for hepatocellular carcinoma. The patient had neither predisposing risk factors nor a primary liver lesion causing obstructive jaundice. After multiple tissue specimens were obtained, the final pathological diagnosis was established. Hepatocellular carcinoma generally requires a surgical cure, but patients who are icteric often portend poorer prognoses. For those at high risk, screening may be indicated to identify early curative treatment.

Examining the influence of health insurance literacy and perception on the people preference to purchase private voluntary health insurance.

PubMed

Mathur, Tanuj; Das, Gurudas; Gupta, Hemendra

2018-01-01

Most studies have associated "un-affordability" as a plausible cause for the lower take-up of private voluntary health insurance plans. However, others refuted this claim on the pretext that when people can afford "inpatient-care" from pocket then insurance premium cost is far less than those payments. Thus, economic factors remain insufficient in clearly explaining the reason for poor private voluntary health insurance take-up. An attempt is being made by shifting the focus towards non-economic factors and understanding the role of perception and health insurance literacy in transforming people preferences to invest in private voluntary health insurance plans. The study findings will conspicuously support decision-makers in developing strategy to increase the private voluntary health insurance take-up.

Cardiovascular Risk Factors in Patients with Poorly Controlled Diabetes Mellitus.

PubMed

Dizdarevic-Bostandzic, Amela; Begovic, Ermin; Burekovic, Azra; Velija-Asimi, Zelija; Godinjak, Amina; Karlovic, Vanja

2018-02-01

Diabetes mellitus(DM) is considered an independent cardiovascular risk factor. Having in mind concomitant occurence of diabetes and other cardiovascular risk factors, it is expected that patients with poor glucoregulation will have more cardiovascular risk factors and higher cardiovascular risk than patients with good glucoregulation. To compare cardiovascular risk and cardiovascular risk factors between patients with poorly controlled and patients with well-controlled Diabetes mellitus. Hundered ten patients aged 40-70 years suffering from Diabetes mellitus type 2 were included. Research is designed as a retrospective, descriptive study. Patients with glycosylated hemoglobin (HbA1c) > 7% were considered to have poorly controlled diabetes. The following data and parameters were monitored: age,sex, family history, data on smoking and alcohol consumption, BMI (body mass index), blood pressure, blood glucose, total cholesterol, triglycerides, LDL, HDL, fibrinogen, uric acid. For the assessment of cardiovascular risk, the WHO / ISH (World Health Organization/International Society of hypertension) tables of the 10-year risk were used, and due to the assessment of the risk factors prevalence, the optimal values of individual numerical variables were defined. Differences in the mean values of systolic, diastolic blood pressure, fasting glucose, total cholesterol, LDL cholesterol are statistically significant higher in patients with poorly controlled diabetes. Hypertension more frequently occurre in patients with poorly controlled DM. The majority of patients with well-controlled DM belong to the group of low and medium cardiovascular risk, while the majority of patients with poorly controlled DM belong to the group of high and very high cardiovascular risk. In our research, there was a significant difference in cardiovascular risk in relation to the degree of DM regulation, and HbA1c proved to be an important indicator for the emergence of the CVD. There are significant differences in certain risk factors between patients with poorly controlled and well controlled DM. Patients with poorly controlled diabetes mellitus have a higher cardiovascular risk than patients with well controlled diabetes. The value of HbA1c should be considered when assessing cardiovascular risk.

Determinants of quality of life in children with psychiatric disorders.

PubMed

Bastiaansen, Dennis; Koot, Hans M; Ferdinand, Robert F

2005-08-01

To assess factors that, in addition to childhood psychopathology, are associated with Quality of Life (QoL) in children with psychiatric problems. In a referred sample of 252 8 to 18-year-olds, information concerning QoL, psychopathology and a broad range of child, parent, and family/ social network factors was obtained from children, parents, teachers and clinicians. Poor child, parent, and clinician reported QoL was associated with child psychopathology, but given the presence of psychopathology, also with child factors, such as low self-esteem, and poor social skills, and family/social network factors, such as poor family functioning, and poor social support. In multiple linear regression analyses the importance of parent factors, such as parenting stress, was almost negligible. To increase QoL of children with psychiatric problems, treatment of symptoms is important, but outcome might improve if treatment is also focussed on other factors that may affect QoL. Results are discussed in relation to current treatment programs.

Seborrheic dermatitis: an update.

PubMed

Bukvić Mokos, Zrinka; Kralj, Martina; Basta-Juzbašić, Aleksandra; Lakoš Jukić, Ines

2012-01-01

Seborrheic dermatitis is a chronic relapsing inflammatory skin disorder clinically characterized by scaling and poorly defined erythematous patches. The prevalence of adult seborrheic dermatitis is estimated at 5%. Although the exact cause of seborrheic dermatitis has yet to be understood, Malassezia yeasts, hormones (androgens), sebum levels and immune response are known to play important roles in its development. Additional factors including drugs, winter temperatures and stress may exacerbate seborrheic dermatitis. A variety of treatment modalities are available, including antifungal agents, topical low-potency steroids and calcineurin inhibitors (immunomodulators). This review summarizes current knowledge on the etiopathogenesis and therapy of adult seborrheic dermatitis.

SHOULDER DISORDERS AND OCCUPATION

PubMed Central

Linaker, CH; Walker-Bone, K

2016-01-01

Shoulder pain is very common and causes substantial morbidity. Standardised classification systems based upon presumed patho-anatomical origins have proved poorly reproducible and hampered epidemiological research. Despite this, there is evidence that exposure to combinations of physical workplace strains such as overhead working, heavy lifting and forceful work as well as working in an awkward posture increase the risk of shoulder disorders. Psychosocial risk factors are also associated. There is currently little evidence to suggest that either primary prevention or treatment strategies in the workplace are very effective and more research is required, particularly around the cost-effectiveness of different strategies. PMID:26612238

Poverty, social stress & mental health.

PubMed

Kuruvilla, A; Jacob, K S

2007-10-01

While there is increasing evidence of an association between poor mental health and the experience of poverty and deprivation, the relationship is complex. We discuss the epidemiological data on mental illness among the different socio-economic groups, look at the cause -effect debate on poverty and mental illness and the nature of mental distress and disorders related to poverty. Issues related to individual versus area-based poverty, relative poverty and the impact of poverty on woman's and child mental health are presented. This review also addresses factors associated with poverty and the difficulties in the measurement of mental health and illness and levels/impact of poverty.

Developmental dysgraphia with profound hearing impairment: intervention by auditory methods enabled by cochlear implant.

PubMed

Fukushima, Kunihiro; Kawasaki, Akihiro; Nagayasu, Rie; Kunisue, Kazuya; Maeda, Yukihide; Kariya, Shin; Kataoka, Yuko; Nishizaki, Kazunori

2008-06-01

Learning disability combined with hearing impairment (LDHI) is a poor prognostic factor for the language development of hearing impaired children after educational intervention. A typical example of a child with LDHI and effective interventions provided by cochlear implants are presented in this report. A case of congenital cytomegaloviral infection that showed dysgraphia as well as profound deafness was reported and an underlying visual processing problem diagnosed in the present case caused the patient's dysgraphia. The dysgraphia could be circumvented by the use of auditory memory fairly established by a cochlear implant.

Clinical and Polysomnographic Predictors of the Natural History of Poor Sleep in the General Population

PubMed Central

Fernandez-Mendoza, Julio; Vgontzas, Alexandros N.; Bixler, Edward O.; Singareddy, Ravi; Shaffer, Michele L.; Calhoun, Susan L.; Karataraki, Maria; Vela-Bueno, Antonio; Liao, Duanping

2012-01-01

Study Objectives: Approximately 8-10% of the general population suffers from chronic insomnia, whereas another 20-30% of the population has insomnia symptoms at any given time (i.e., poor sleep). However, few longitudinal studies have examined risk factors of the natural history of poor sleep, and none have examined the role of polysomnographic (PSG) variables. Design: Representative longitudinal study. Setting: Sleep laboratory. Participants: From a random, general population sample of 1,741 individuals of the adult Penn State Cohort, 1,395 were followed up after 7.5 yr. Measurements: Full medical evaluation and 1-night PSG at baseline and telephone interview at follow-up. Results: The rate of incident poor sleep was 18.4%. Physical (e.g., obesity, sleep apnea, and ulcer) and mental (e.g., depression) health conditions and behavioral factors (e.g., smoking and alcohol consumption) increased the odds of incident poor sleep as compared to normal sleep. The rates of persistent, remitted, and poor sleepers who developed chronic insomnia were 39%, 44%, and 17%, respectively. Risk factors for persistent poor sleep were physical health conditions combined with psychologic distress. Shorter objective sleep duration and a family history of sleep problems were risk factors for poor sleep evolving into chronic insomnia. Conclusions: Poor sleep appears to be primarily a symptom of physical and mental health conditions, whereas the persistence of poor sleep is associated with psychologic distress. Importantly, sleep apnea appears to be associated with incident poor sleep but not with chronic insomnia. Finally, this study suggests that objective short sleep duration in poor sleepers is a biologic marker of genetic predisposition to chronic insomnia. Citation: Fernandez-Mendoza J; Vgontzas AN; Bixler EO; Singareddy R; Shaffer ML; Calhoun SL; Karataraki M; Vela-Bueno A; Liao D. Clinical and polysomnographic predictors of the natural history of poor sleep in the general population. SLEEP 2012;35(5):689-697. PMID:22547895

Risks of neonicotinoid insecticides to honeybees

PubMed Central

Fairbrother, Anne; Purdy, John; Anderson, Troy; Fell, Richard

2014-01-01

The European honeybee, Apis mellifera, is an important pollinator of agricultural crops. Since 2006, when unexpectedly high colony losses were first reported, articles have proliferated in the popular press suggesting a range of possible causes and raising alarm over the general decline of bees. Suggested causes include pesticides, genetically modified crops, habitat fragmentation, and introduced diseases and parasites. Scientists have concluded that multiple factors in various combinations—including mites, fungi, viruses, and pesticides, as well as other factors such as reduction in forage, poor nutrition, and queen failure—are the most probable cause of elevated colony loss rates. Investigators and regulators continue to focus on the possible role that insecticides, particularly the neonicotinoids, may play in honeybee health. Neonicotinoid insecticides are insect neurotoxicants with desirable features such as broad-spectrum activity, low application rates, low mammalian toxicity, upward systemic movement in plants, and versatile application methods. Their distribution throughout the plant, including pollen, nectar, and guttation fluids, poses particular concern for exposure to pollinators. The authors describe how neonicotinoids interact with the nervous system of honeybees and affect individual honeybees in laboratory situations. Because honeybees are social insects, colony effects in semifield and field studies are discussed. The authors conclude with a review of current and proposed guidance in the United States and Europe for assessing the risks of pesticides to honeybees. PMID:24692231

Rapamycin reduces fibroblast proliferation without causing quiescence and induces STAT5A/B-mediated cytokine production

PubMed Central

Gillespie, Zoe E; MacKay, Kimberly; Sander, Michelle; Trost, Brett; Dawicki, Wojciech; Wickramarathna, Aruna; Gordon, John; Eramian, Mark; Kill, Ian R; Bridger, Joanna M; Kusalik, Anthony; Mitchell, Jennifer A; Eskiw, Christopher H

2015-01-01

Rapamycin is a well-known inhibitor of the Target of Rapamycin (TOR) signaling cascade; however, the impact of this drug on global genome function and organization in normal primary cells is poorly understood. To explore this impact, we treated primary human foreskin fibroblasts with rapamycin and observed a decrease in cell proliferation without causing cell death. Upon rapamycin treatment chromosomes 18 and 10 were repositioned to a location similar to that of fibroblasts induced into quiescence by serum reduction. Although similar changes in positioning occurred, comparative transcriptome analyses demonstrated significant divergence in gene expression patterns between rapamycin-treated and quiescence-induced fibroblasts. Rapamycin treatment induced the upregulation of cytokine genes, including those from the Interleukin (IL)-6 signaling network, such as IL-8 and the Leukemia Inhibitory Factor (LIF), while quiescent fibroblasts demonstrated up-regulation of genes involved in the complement and coagulation cascade. In addition, genes significantly up-regulated by rapamycin treatment demonstrated increased promoter occupancy of the transcription factor Signal Transducer and Activator of Transcription 5A/B (STAT5A/B). In summary, we demonstrated that the treatment of fibroblasts with rapamycin decreased proliferation, caused chromosome territory repositioning and induced STAT5A/B-mediated changes in gene expression enriched for cytokines. PMID:26652669

Traumatic injuries in developing countries: report from a nationwide cross-sectional survey of Sierra Leone.

PubMed

Stewart, Kerry-Ann A; Groen, Reinou S; Kamara, Thaim B; Farahzad, Mina M; Samai, Mohamed; Cassidy, Laura D; Kushner, Adam L; Wren, Sherry M

2013-05-01

To use a nationwide household survey tool to provide an estimate of injury prevalence, mechanisms of traumatic injuries, and number of injury-related deaths in a low-income country. A randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool was conducted in 2012. Sierra Leone, Africa. Three thousand seven hundred fifty randomly selected participants throughout Sierra Leone. Mechanisms of injury based on age, sex, anatomic location, cause, and sociodemographic factors as well as mechanisms of injury-related deaths in the previous year were the primary outcome measures. Data were collected and analyzed from 1843 households and 3645 respondents (98% response rate). Four hundred fifty-two respondents (12%) reported at least 1 traumatic injury in the preceding year. Falls were the most common cause of nonfatal injuries (40%). The extremities were the most common injury site regardless of age or sex. Traffic injuries were the leading cause of injury-related deaths (32% of fatal injuries). This study provides baseline data on the mechanisms of traumatic injuries as well as the sociodemographic factors affecting injury prevalence in one of the world's poorest nations. It is anticipated that these data will provide an impetus for further studies to determine injury severity, associated disability, and barriers to accessing care in these resource-poor areas.

An Update on Oxidative Damage to Spermatozoa and Oocytes.

PubMed

Opuwari, Chinyerum S; Henkel, Ralf R

2016-01-01

On the one hand, reactive oxygen species (ROS) are mandatory mediators for essential cellular functions including the function of germ cells (oocytes and spermatozoa) and thereby the fertilization process. However, the exposure of these cells to excessive levels of oxidative stress by too high levels of ROS or too low levels of antioxidative protection will render these cells dysfunctional thereby failing the fertilization process and causing couples to be infertile. Numerous causes are responsible for the delicate bodily redox system being out of balance and causing disease and infertility. Many of these causes are modifiable such as lifestyle factors like obesity, poor nutrition, heat stress, smoking, or alcohol abuse. Possible correctable measures include foremost lifestyle changes, but also supplementation with antioxidants to scavenge excessive ROS. However, this should only be done after careful examination of the patient and establishment of the individual bodily antioxidant needs. In addition, other corrective measures include sperm separation for assisted reproductive techniques. However, these techniques have to be carried out very carefully as they, if applied wrongly, bear risks of generating ROS damaging the germ cells and preventing fertilization.

An Update on Oxidative Damage to Spermatozoa and Oocytes

PubMed Central

Opuwari, Chinyerum S.; Henkel, Ralf R.

2016-01-01

On the one hand, reactive oxygen species (ROS) are mandatory mediators for essential cellular functions including the function of germ cells (oocytes and spermatozoa) and thereby the fertilization process. However, the exposure of these cells to excessive levels of oxidative stress by too high levels of ROS or too low levels of antioxidative protection will render these cells dysfunctional thereby failing the fertilization process and causing couples to be infertile. Numerous causes are responsible for the delicate bodily redox system being out of balance and causing disease and infertility. Many of these causes are modifiable such as lifestyle factors like obesity, poor nutrition, heat stress, smoking, or alcohol abuse. Possible correctable measures include foremost lifestyle changes, but also supplementation with antioxidants to scavenge excessive ROS. However, this should only be done after careful examination of the patient and establishment of the individual bodily antioxidant needs. In addition, other corrective measures include sperm separation for assisted reproductive techniques. However, these techniques have to be carried out very carefully as they, if applied wrongly, bear risks of generating ROS damaging the germ cells and preventing fertilization. PMID:26942204

Environmental determinants of severity in sickle cell disease

PubMed Central

Tewari, Sanjay; Brousse, Valentine; Piel, Frédéric B.; Menzel, Stephan; Rees, David C.

2015-01-01

Sickle cell disease causes acute and chronic illness, and median life expectancy is reduced by at least 30 years in all countries, with greater reductions in low-income countries. There is a wide spectrum of severity, with some patients having no symptoms and others suffering frequent, life-changing complications. Much of this variability is unexplained, despite increasingly sophisticated genetic studies. Environmental factors, including climate, air quality, socio-economics, exercise and infection, are likely to be important, as demonstrated by the stark differences in outcomes between patients in Africa and USA/Europe. The effects of weather vary with geography, although most studies show that exposure to cold or wind increases hospital attendance with acute pain. Most of the different air pollutants are closely intercorrelated, and increasing overall levels seem to correlate with increased hospital attendance, although higher concentrations of atmospheric carbon monoxide may offer some benefit for patients with sickle cell disease. Exercise causes some adverse physiological changes, although this may be off-set by improvements in cardiovascular health. Most sickle cell disease patients live in low-income countries and socioeconomic factors are undoubtedly important, but little studied beyond documenting that sickle cell disease is associated with decreases in some measures of social status. Infections cause many of the differences in outcomes seen across the world, but again these effects are relatively poorly understood. All the above factors are likely to account for much of the pathology and variability of sickle cell disease, and large prospective studies are needed to understand these effects better. PMID:26341524

Prognostic factors for return-to-work following surgery for carpal tunnel syndrome: a systematic review.

PubMed

Peters, Susan; Johnston, Venerina; Hines, Sonia; Ross, Mark; Coppieters, Michel

2016-09-01

Carpal tunnel syndrome (CTS) is a common problem, that can be effectively managed by surgery. Screening for prognostic factors is important to identify workers who are at a greater risk of a poor work outcome in order to implement tailored interventions to facilitate their return-to-work. To synthesize the best available evidence on the association of preoperative prognostic factors with work-related outcomes in people who have undergone carpal tunnel surgery. Participants included those who were employed at the time of surgery, underwent carpal tunnel surgery and planned to return-to-work. The primary outcome was return-to-work. Quantitative studies investigating at least one prognostic factor for a work-related outcome in studies of workers who had carpal tunnel surgery were considered. Eleven electronic databases were searched from their respective inception date up to July 2015. A total of 3893 publications were reviewed. The quality of the included studies was assessed by two reviewers using a modified version of an appraisal tool (Joanna Briggs Institute Meta-analysis of Statistical Assessment and Review Instrument [JBI-MAStARI]). The following criteria were evaluated: study population representativeness, clearly defined prognostic factors and outcomes, potential confounding variables and appropriate statistical analysis. Data extraction was performed using a modified version of the standardized extraction tool from JBI-MAStARI. Statistical pooling was not possible. Findings are presented in tables and narrative format. Eleven studies (13 publications) investigating 93 prognostic factors for delayed return-to-work or prolonged work disability outcomes and 27 prognostic factors for work role functioning in 4187 participants were identified.Prognostic factors associated with workers' increased likelihood of an earlier return-to-work in a moderate-to-high-quality study included worker expected or desired fewer days off work, occupation, lower pain anxiety and if CTS had not altered their work role.Prognostic factors for a poorer work-related outcome included older age, lower household income, greater upper extremity functional limitation, greater than two musculoskeletal pain sites, lower recovery expectations, worse mental health status, job accommodation availability, high job strain, high job demands with high job control, poor co-worker relationships, poor baseline work role functioning, less-supportive workplace policies, preoperative work absence due to CTS or work disability of any cause, workers' compensation status, attorney involvement, and post-diagnosis surgical wait time. For workers who have had carpal tunnel surgery, there are a number of factors which may be modified in order to improve return-to-work times.

Phelligridin D-loaded oral nanotube titanium implant enhances osseointegration and prevents osteolysis in rat mandible.

PubMed

Kim, Ji-Eun; Takanche, Jyoti Shrestha; Kim, Jeong-Seok; Lee, Min-Ho; Jeon, Jae-Gyu; Park, Il-Song; Yi, Ho-Keun

2018-04-12

Poor bone quality and osteolysis are the major causes of implant failure in dentistry. Here, this study tested the effect of phelligridin D-loaded nanotubes titanium (Ti) for bone formation around the dental implants. The purpose of this study was to enhance osseointegration of phelligridin D-loaded implant into the bone for bone formation and prevention of osteolysis. Cell viability, crystal violet staining, Western blot, alizarin red S staining, alkaline phosphatase activity, tartrate-resistant acid phosphatase staining, micro-computed tromography (μ-CT), hematoxylin and eosin (H&E) and immunohistochemical staining were used in vitro and in vivo to test the biocompatibility of phelligridin D. Phelligridin D enhanced osteoblast differentiation and mineralization by increasing bone morphogenic protein-2/7 (BMP-2/7), Osterix, Runx-2, osteoprotegerin (OPG), alkaline phosphatase and inhibited osteoclast differentiation by decreasing receptor activator of nuclear factor kappa-B ligand (RANKL) in MC-3T3 E1 cells. Further, phelligridin D promoted bone regeneration around nanotube Ti implant surface by increasing the levels of BMP-2/7 and OPG in a rat model. Phelligridin D also inhibited osteolysis by suppressing the expression of RANKL. These findings strongly suggest that phelligridin D is a new compound representing a potential therapeutic candidate for implant failure caused by osteolysis and poor bone quality of teeth.

Impact of antinutritional factors in food proteins on the digestibility of protein and the bioavailability of amino acids and on protein quality.

PubMed

Sarwar Gilani, G; Wu Xiao, Chao; Cockell, Kevin A

2012-08-01

Dietary antinutritional factors have been reported to adversely affect the digestibility of protein, bioavailability of amino acids and protein quality of foods. Published data on these negative effects of major dietary antinutritional factors are summarized in this manuscript. Digestibility and the quality of mixed diets in developing countries are considerably lower than of those in developed regions. For example, the digestibility of protein in traditional diets from developing countries such as India, Guatemala and Brazil is considerably lower compared to that of protein in typical North American diets (54-78 versus 88-94 %). Poor digestibility of protein in the diets of developing countries, which are based on less refined cereals and grain legumes as major sources of protein, is due to the presence of less digestible protein fractions, high levels of insoluble fibre, and/or high concentrations of antinutritional factors present endogenously or formed during processing. Examples of naturally occurring antinutritional factors include glucosinolates in mustard and canola protein products, trypsin inhibitors and haemagglutinins in legumes, tannins in legumes and cereals, gossypol in cottonseed protein products, and uricogenic nucleobases in yeast protein products. Heat/alkaline treatments of protein products may yield Maillard reaction compounds, oxidized forms of sulphur amino acids, D-amino acids and lysinoalanine (LAL, an unnatural nephrotoxic amino acid derivative). Among common food and feed protein products, soyabeans are the most concentrated source of trypsin inhibitors. The presence of high levels of dietary trypsin inhibitors from soyabeans, kidney beans or other grain legumes have been reported to cause substantial reductions in protein and amino acid digestibility (up to 50 %) and protein quality (up to 100 %) in rats and/or pigs. Similarly, the presence of high levels of tannins in sorghum and other cereals, fababean and other grain legumes can cause significant reductions (up to 23 %) in protein and amino acid digestibility in rats, poultry, and pigs. Normally encountered levels of phytates in cereals and legumes can reduce protein and amino acid digestibility by up to 10 %. D-amino acids and LAL formed during alkaline/heat treatment of lactalbumin, casein, soya protein or wheat protein are poorly digestible (less than 40 %), and their presence can reduce protein digestibility by up to 28 % in rats and pigs, and can cause a drastic reduction (100 %) in protein quality, as measured by rat growth methods. The adverse effects of antinutritional factors on protein digestibility and protein quality have been reported to be more pronounced in elderly rats (20-months old) compared to young (5-weeks old) rats, suggesting the use of old rats as a model for assessing the protein digestibility of products intended for the elderly.

Downregulation of tumor suppressor QKI in gastric cancer and its implication in cancer prognosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bian, Yongqian; Wang, Li; Lu, Huanyu

2012-05-25

Highlights: Black-Right-Pointing-Pointer QKI expression is decreased in gastric cancer samples. Black-Right-Pointing-Pointer Promoter hyper methylation contributes to the downregulation of QKI. Black-Right-Pointing-Pointer QKI inhibits the growth of gastric cancer cells. Black-Right-Pointing-Pointer Decreased QKI expression predicts poor survival. -- Abstract: Gastric cancer (GC) is the fourth most common cancer and second leading cause of cancer-related death worldwide. RNA-binding protein Quaking (QKI) is a newly identified tumor suppressor in multiple cancers, while its role in GC is largely unknown. Our study here aimed to clarify the relationship between QKI expression with the clinicopathologic characteristics and the prognosis of GC. In the 222 GCmore » patients' specimens, QKI expression was found to be significantly decreased in most of the GC tissues, which was largely due to promoter hypermethylation. QKI overexpression reduced the proliferation ability of GC cell line in vitro study. In addition, the reduced QKI expression correlated well with poor differentiation status, depth of invasion, gastric lymph node metastasis, distant metastasis, advanced TNM stage, and poor survival. Multivariate analysis showed QKI expression was an independent prognostic factor for patient survival.« less

Tail biting in pigs--causes and management intervention strategies to reduce the behavioural disorder. A review.

PubMed

Sonoda, Lilia Thays; Fels, Michaela; Oczak, Maciej; Vranken, Erik; Ismayilova, Gunel; Guarino, Marcella; Viazzi, Stefano; Bahr, Claudia; Berckmans, Daniel; Hartung, Jörg

2013-01-01

One of the largest animal welfare problems in modern pig production is tail biting. This abnormal behaviour compromises the well-being of the animals, can seriously impair animal health and can cause considerable economic losses. Tail biting has a multifactorial origin and occurs mainly in fattening pigs. High stocking densities, poor environment and bad air quality are seen as important factors. However, it is presumed that a plurality of internal and external motivators in intensive pig production can trigger this behaviour which is not reported in sounders of wild boars. The aim of this review is to summarize the causes and the effects of tail biting in pigs and present management strategies that are likely to reduce its incidence. In particular, management strategies by applying Precision Livestock Farming (PLF) technologies to monitor and control the behaviour of the pigs may be suitable to detect the outbreaks of tail biting at an early stage so that counter measures can be taken in time.

Adolescents’ and Young Adults' Naïve Understandings of the Economic Crisis

PubMed Central

Berti, Anna Emilia; Ajello, Anna Maria; Aprea, Carmela; Castelli, Ilaria; Lombardi, Elisabetta; Marchetti, Antonella; Massaro, Davide; Sappa, Viviana; Valle, Annalisa

2017-01-01

Over the last decade, Financial Literacy (FL) and interventions aimed at improving it, that is Financial Education (FE), have been the focus of increased attention from economists, governments, and international organizations such as the world Bank and OECD, but much less by scholars in the fields of Learning and Instruction. We examined open-ended written answers on the causes of the economic crisis that started in 2007-2008, as given by 381 Italian secondary school and university students, and 268 Swiss Italian-speaking secondary school students. Most Italian students mentioned internal political causes (i.e., corrupt politicians or inefficiency of the government), whereas Swiss students mentioned banks more often. International factors were rarely mentioned by either group, and explanations were generally very poor, listing a few causes without making connections between them. These findings indicate the need for economics education aimed at making people more knowledgeable of the workings of the economic system and the effects of financial systems on the real economy. PMID:28344680

Adolescents' and Young Adults' Naïve Understandings of the Economic Crisis.

PubMed

Berti, Anna Emilia; Ajello, Anna Maria; Aprea, Carmela; Castelli, Ilaria; Lombardi, Elisabetta; Marchetti, Antonella; Massaro, Davide; Sappa, Viviana; Valle, Annalisa

2017-03-01

Over the last decade, Financial Literacy (FL) and interventions aimed at improving it, that is Financial Education (FE), have been the focus of increased attention from economists, governments, and international organizations such as the world Bank and OECD, but much less by scholars in the fields of Learning and Instruction. We examined open-ended written answers on the causes of the economic crisis that started in 2007-2008, as given by 381 Italian secondary school and university students, and 268 Swiss Italian-speaking secondary school students. Most Italian students mentioned internal political causes (i.e., corrupt politicians or inefficiency of the government), whereas Swiss students mentioned banks more often. International factors were rarely mentioned by either group, and explanations were generally very poor, listing a few causes without making connections between them. These findings indicate the need for economics education aimed at making people more knowledgeable of the workings of the economic system and the effects of financial systems on the real economy.

Blast vibration damage to water supply well - water quality and quantity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matheson, G.M.; Miller, D.K.

1997-05-01

Possible impacts to the water quality and production capacity of ground water supply wells by blasting is a common cause of complaints for blasting contractors, mining companies, and local regulatory authorities. The major complaints of changes in well water quality include; turbidity; discolored water (red, brown, black, yellow and milky water), and nitrate and/or coliform contamination. The major complaints for changes in well water production capacity include: loss of quantity production, air in water and/or water lines, damage to pump, and damage to well screen or borehole. The review of research and common causes of these problems indicates that mostmore » of these complaints are not related to blasting and can be shown to be related to either environmental factors, poor well construction, or wells whose elements required repair or replacement prior to blasting. The paper reviews each of the complaints cited and provides the probable causes of the observed condition and discusses their relation to blasting.« less

Factors associated with poor satisfaction with treatment and trial discontinuation in chronic schizophrenia.

PubMed

Schoemaker, Joep H; Vingerhoets, Ad J J M; Emsley, Robin A

2018-06-05

IntroductionDespite consistently high discontinuation rates due to withdrawal of consent (WOC) and insufficient therapeutic effect (ITE) in schizophrenia trials, insight into the underlying factors contributing to poor satisfaction with treatment and dropout is limited. A better understanding of these factors could help to improve trial design and completion rates. Using data from 1,136 trial participants with schizophrenia or schizoaffective disorder, we explored associations between predictor variables with (1) dropout due to WOC and ITE and (2) satisfaction with treatment among patients and investigators by means of hierarchic multiple regression analyses. ITE was associated with poor clinical improvement, poor investigator satisfaction with treatment, and poor patient insight into their own disease, whereas WOC only showed a meaningful association with poor patient satisfaction with treatment. Investigator satisfaction with treatment appeared most strongly associated with Positive and Negative Syndrome Scale (PANSS) positive factor endpoint scores, whereas patient satisfaction with treatment was best predicted by the endpoint score on the PANSS emotional distress factor. The occurrence of severe side effects showed no meaningful association to satisfaction with treatment among investigators and patients, and neither did a patient's experienced psychopathology, nor their self-rating of functional impairment. Whereas trial discontinuation due to ITE is associated with poor treatment effectiveness, a patient's decision to withdraw from an antipsychotic trial remains unpredictable and may occur even when the investigator observes a global clinical improvement and is satisfied with the treatment.

Medication errors: an overview for clinicians.

PubMed

Wittich, Christopher M; Burkle, Christopher M; Lanier, William L

2014-08-01

Medication error is an important cause of patient morbidity and mortality, yet it can be a confusing and underappreciated concept. This article provides a review for practicing physicians that focuses on medication error (1) terminology and definitions, (2) incidence, (3) risk factors, (4) avoidance strategies, and (5) disclosure and legal consequences. A medication error is any error that occurs at any point in the medication use process. It has been estimated by the Institute of Medicine that medication errors cause 1 of 131 outpatient and 1 of 854 inpatient deaths. Medication factors (eg, similar sounding names, low therapeutic index), patient factors (eg, poor renal or hepatic function, impaired cognition, polypharmacy), and health care professional factors (eg, use of abbreviations in prescriptions and other communications, cognitive biases) can precipitate medication errors. Consequences faced by physicians after medication errors can include loss of patient trust, civil actions, criminal charges, and medical board discipline. Methods to prevent medication errors from occurring (eg, use of information technology, better drug labeling, and medication reconciliation) have been used with varying success. When an error is discovered, patients expect disclosure that is timely, given in person, and accompanied with an apology and communication of efforts to prevent future errors. Learning more about medication errors may enhance health care professionals' ability to provide safe care to their patients. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Clinical and mycological study of scalp white piedra in the State of Paraíba, Brazil.

PubMed

Pontes, Zélia Braz Vieira da Silva; Ramos, Adriano Lira; Lima, Edeltrudes de Oliveira; Guerra, Maria de Fátima de Lacerda; Oliveira, Neuza Maria Cavalcante; Santos, Jozemar Pereira dos

2002-07-01

White piedra is a superficial mycoses characterized by nodules on the hair shaft, caused by the basidiomycetous yeasts. In the present study, clinical and mycological findings of scalp white piedra caused by Trichosporon spp. are related. Twenty three cases of scalp white piedra were observed with a high incidence in women (87%) and preschool children from 2 to 6 (74%) years old. These groups presented a relationship of dependence with this infection. Despite the low socio-economic status, poor standards of hygiene, (48% of the patients) as well as the fact that 30.4% of the children shared the same nursery, these factors were not significant for the transmission of the mycosis. These were the first reports of scalp white piedra in João Pessoa city, Paraíba, Brazil.

Murine Typhus

PubMed Central

Dzul-Rosado, Karla R; Zavala Velázquez, Jorge Ernesto; Zavala-Castro, Jorge

2012-01-01

Rickettsia typhi: is an intracellular bacteria who causes murine typhus. His importance is reflected in the high frequency founding specific antibodies against Rickettsia typhi in several worldwide seroepidemiological studies, the seroprevalence ranging between 3-36%. Natural reservoirs of R. typhi are rats (some species belonging the Rattus Genus) and fleas (Xenopsylla cheopis) are his vector. This infection is associated with overcrowding, pollution and poor hygiene. Typically presents fever, headache, rash on trunk and extremities, in some cases may occur organ-specific complications, affecting liver, kidney, lung or brain. Initially the disease is very similar to other diseases, is very common to confuse the murine typhus with Dengue fever, therefore, ignorance of the disease is a factor related to complications or non-specific treatments for the resolution of this infection. This paper presents the most relevant information to consider about the rickettsiosis caused by Rickettsia typhi. PMID:24893060

Personalizing behavioral interventions: the case of late-life depression

PubMed Central

Arean, Patricia A

2013-01-01

SUMMARY This article reviews the potential utility of behavioral interventions in personalized depression treatment. The paper begins with a definition of personalized treatment, moves to current thinking regarding the various causes of depression, and proposes how those causes can be used to inform the selection of behavioral interventions. Two examples from the late-life depression field will illustrate how a team of researchers at Cornell University (NY, USA) and University of California, San Francisco (CA, USA) created a research partnership to select and study behavioral interventions for older adults with risk factors associated with poor response to selective serotonin reuptake inhibitor medications. The paper ends with a discussion of how the process used by the Cornell University–University of California, San Francisco team can be applied to the selection and development of behavioral interventions for other psychiatric disorders. PMID:23646065

Transmission of Hepatitis E Virus in Developing Countries

PubMed Central

Khuroo, Mohammad S.; Khuroo, Mehnaaz S.; Khuroo, Naira S.

2016-01-01

Hepatitis E virus (HEV), an RNA virus of the Hepeviridae family, has marked heterogeneity. While all five HEV genotypes can cause human infections, genotypes HEV-1 and -2 infect humans alone, genotypes HEV-3 and -4 primarily infect pigs, boars and deer, and genotype HEV-7 primarily infects dromedaries. The global distribution of HEV has distinct epidemiological patterns based on ecology and socioeconomic factors. In resource-poor countries, disease presents as large-scale waterborne epidemics, and few epidemics have spread through person-to-person contact; however, endemic diseases within these countries can potentially spread through person-to-person contact or fecally contaminated water and foods. Vertical transmission of HEV from infected mother to fetus causes high fetal and perinatal mortality. Other means of transmission, such as zoonotic transmission, can fluctuate depending upon the region and strain of the virus. For instance, zoonotic transmission can sometimes play an insignificant role in human infections, such as in India, where human and pig HEV infections are unrelated. However, recently China and Southeast Asia have experienced a zoonotic spread of HEV-4 from pigs to humans and this has become the dominant mode of transmission of hepatitis E in eastern China. Zoonotic HEV infections in humans occur by eating undercooked pig flesh, raw liver, and sausages; through vocational contact; or via pig slurry, which leads to environmental contamination of agricultural products and seafood. Lastly, blood transfusion-associated HEV infections occur in many countries and screening of donors for HEV RNA is currently under serious consideration. To summarize, HEV genotypes 1 and 2 cause epidemic and endemic diseases in resource poor countries, primarily spreading through contaminated drinking water. HEV genotypes 3 and 4 on the other hand, cause autochthonous infections in developed, and many developing countries, by means of a unique zoonotic food-borne transmission. PMID:27657112

Frostbite

MedlinePlus

... to frostbite. These include extreme: Wet clothes High winds Poor blood circulation. Poor circulation can be caused ... areas. In cold weather, wear mittens (not gloves); wind-proof, water-resistant, layered clothing; 2 pairs of ...

Improving the quality of obstetric care for women with obstructed labour in the national referral hospital in Uganda: lessons learnt from criteria based audit.

PubMed

Kayiga, Herbert; Ajeani, Judith; Kiondo, Paul; Kaye, Dan K

2016-07-11

Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 patients was conducted in September/October 2013. The Audit results were shared with key stakeholders. Gaps in patient management were identified and recommendations for improving obstetric care initiated. Six standards of care (intravenous fluids, intravenous antibiotics, monitoring of maternal vital signs, bladder catheterization, delivery within two hours, and blood grouping and cross matching) were implemented. A re-audit of 180 patients with obstructed labour was conducted four months later to evaluate the impact of these recommendations. The results of the two audits were compared. In-depth interviews and focus group discussions were conducted among healthcare providers to identify factors that could have influenced the audit results. There was improvement in two standards of care (intravenous fluids and intravenous antibiotic administration) 58.9 % vs. 86.1 %; p < 0.001 and 21.7 % vs. 50.5 %; P < 0.001 respectively after the second audit. There was no improvement in vital sign monitoring, delivery within two hours or blood grouping and cross matching. There was a decline in bladder catheterization (94 % vs. 68.9 %; p < 0.001. The overall mean care score in the first and second audits was 55.1 and 48.2 % respectively, p = 0.19. Healthcare factors (negative attitude, low numbers, poor team work, low motivation), facility factors (poor supervision, stock-outs of essential supplies, absence of protocols) and patient factors (high patient load, poor compliance to instructions) contributed to poor quality of care. Introduction of criteria based audit in the management of obstructed labour led to measurable improvements in only two out of six standards of care. The extent to which criteria based audit may improve quality of obstetric care depends on having basic effective healthcare systems in place.

Double jeopardy: interaction effects of marital and poverty status on the risk of mortality.

PubMed

Smith, K R; Waitzman, N J

1994-08-01

The purpose of this paper is to examine the hypothesis that marital and poverty status interact in their effects on mortality risks beyond their main effects. This study examines the epidemiological bases for applying an additive rather than a multiplicative specification when testing for interaction between two discrete risk factors. We specifically predict that risks associated with being nonmarried and with being poor interact to produce mortality risks that are greater than each risk acting independently. The analysis is based on men and women who were ages 25-74 during the 1971-1975 National Health and Nutrition Examination Survey I (NHANES I) and who were traced successfully in the NHANES I Epidemiologic Follow-Up Study in 1982-1984. Overall, being both poor and nonmarried places nonelderly (ages 25-64) men, but not women, at risk of mortality greater than that expected from the main effects. This study shows that for all-cause mortality, marital and poverty status interact for men but less so for women; these findings exist when interaction is assessed with either a multiplicative or an additive standard. This difference is most pronounced for poor, widowed men and (to a lesser degree) poor, divorced men. For violent/accidental deaths among men, the interaction effects are large on the basis of an additive model. Weak main and interaction effects were detected for the elderly (age 65+).

Conventional MRI features for predicting the clinical outcome of patients with invasive placenta

PubMed Central

Chen, Ting; Xu, Xiao-Quan; Shi, Hai-Bin; Yang, Zheng-Qiang; Zhou, Xin; Pan, Yi

2017-01-01

PURPOSE We aimed to evaluate whether morphologic magnetic resonance imaging (MRI) features could help to predict the maternal outcome after uterine artery embolization (UAE)-assisted cesarean section (CS) in patients with invasive placenta previa. METHODS We retrospectively reviewed the MRI data of 40 pregnant women who have undergone UAE-assisted cesarean section due to suspected high risk of massive hemorrhage caused by invasive placenta previa. Patients were divided into two groups based on the maternal outcome (good-outcome group: minor hemorrhage and uterus preserved; poor-outcome group: significant hemorrhage or emergency hysterectomy). Morphologic MRI features were compared between the two groups. Multivariate logistic regression analysis was used to identify the most valuable variables, and predictive value of the identified risk factor was determined. RESULTS Low signal intensity bands on T2-weighted imaging (P < 0.001), placenta percreta (P = 0.011), and placental cervical protrusion sign (P = 0.002) were more frequently observed in patients with poor outcome. Low signal intensity bands on T2-weighted imaging was the only significant predictor of poor maternal outcome in multivariate analysis (P = 0.020; odds ratio, 14.79), with 81.3% sensitivity and 84.3% specificity. CONCLUSION Low signal intensity bands on T2-weighted imaging might be a predictor of poor maternal outcome after UAE-assisted cesarean section in patients with invasive placenta previa. PMID:28345524

The Unhealthy Lifestyle Factors Associated with an Increased Risk of Poor Nutrition among the Elderly Population in China.

PubMed

Lin, W-Q; Wang, H H X; Yuan, L-X; Li, B; Jing, M-J; Luo, J-L; Tang, J; Ye, B-K; Wang, P-X

2017-01-01

The associations between nutritional status and lifestyle factors have not been well established. This study aimed to investigate the prevalence of poor nutrition and to examine the relationships between nutritional status and unhealthy lifestyle and other related factors among the elderly. This cross-sectional study was conducted in Liaobu Town, Dongguan city, China. A total of 708 community-dwelling older adults aged ≥60 years were recruited by stratified random sampling. Data on sociodemographic characteristics, health and lifestyle factors, and the Mini Nutritional Assessment (MNA) scores were collected using structured questionnaires via face-to-face interviews. A multivariate logistic regression model was constructed to identify the risk factors of poor nutrition. The prevalence of malnutrition among the elderly adults in this study was 1.3%, and 24.4% were at risk of malnutrition (RM). Poor nutrition was significantly associated with female gender, older age, lower education, a high number of self-reported chronic diseases, and hospitalization in the last year. Unhealthy lifestyle factors associated with poor nutrition included current smoking status, higher alcohol consumption, lack of physical activity, longer duration of sitting, negative attitude towards life, and a poor family relationship. While the prevalence of malnutrition was low, RM was high in the elderly population in China. The determinants of malnutrition were explored and the relationships between nutritional status and unhealthy lifestyle factors were examined. The results of this study provide information for future longitudinal studies with multi-factorial interventional design in order to determine the effects of the causal relationships.

Outcomes of UTI and bacteriuria caused by ESBL vs. non-ESBL Enterobacteriaceae isolates in pregnancy: a matched case-control study.

PubMed

Yagel, Y; Nativ, H; Riesenberg, K; Nesher, L; Saidel-Odes, L; Smolyakov, R

2018-04-01

Infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) have become increasingly prevalent, posing a serious public threat worldwide. It is commonly believed that untreated urinary tract infections (UTI) and asymptomatic bacteriuria (ABU) during pregnancy are associated with poor obstetric outcomes. Currently, there is a paucity of data regarding the outcomes or risk factors of such ESBL-E infections in pregnant women. We conducted a retrospective 1:2 matched case-control study of hospitalised pregnant women with ESBL-E- vs. non-ESBL-producing Enterobacteriaceae-positive urine cultures obtained between 2004 and 2015, and compared risk factors for the development of resistant bacteria, clinical course and outcomes. In total, 87 pregnant women with ESBL-E-positive urine cultures were matched to 174 controls by decade of age, ethnicity and pregnancy trimester. Significant risk factors for acquisition of ESBL-E included prior UTI/ABU episodes (50.6% vs. 26.3%, P < 0.001), previous isolation of ESBL-E in urine cultures (12.6% vs. 0.6%, P < 0.001) and prior antibiotic exposure (71.3% vs. 54%, P = 0.002). Previous hospitalisation, however, was not found to be a risk factor. No significant difference was found in adverse obstetric outcomes. We conclude that prior urinary infections and antibiotic exposure were significant risk factors for the isolation of ESBL-E pathogens from the urine of pregnant women; however, this was not associated with worse obstetric outcomes compared with non-ESBL-E pathogens.

Biochars impact on soil moisture storage in an Ultisol and two Aridisols

USDA-ARS?s Scientific Manuscript database

Droughts associated with low or erratic rainfall distribution can cause detrimental crop moisture stress. This problem is exacerbated in the USA’s arid western and southeastern Coastal Plain due to poor rainfall distribution, poor soil water storage, or poorly-aggregated, subsurface hard layers that...

Where Have All the Mathematics Teachers Gone?

ERIC Educational Resources Information Center

Clever, George

Three basic causes for the general decline in mathematics achievement among high school graduates nationally are poor motivation to learn math, poor math curriculum, and poor or no mathematics instruction. Many Native Americans drop mathematics because of lack of challenging courses or interesting teachers in their high schools. Since American…

Semantic and Phonological Coding in Poor and Normal Readers.

ERIC Educational Resources Information Center

Vellutino, Frank R.; And Others

1995-01-01

Using poor and normal readers, three studies evaluated semantic coding and phonological coding deficits as explanations for reading disability. It was concluded that semantic coding deficits are unlikely causes of difficulties in poor readers in early stages but accrue with prolonged reading difficulties in older readers. Phonological coding…

Traumatic brain injury due to gunshot wounds: a single institution's experience with 442 consecutive patients.

PubMed

Solmaz, Ilker; Kural, Cahit; Temiz, Cağlar; Seçer, Halil Ibrahim; Düz, Bülent; Gönül, Engin; Izci, Yusuf

2009-07-01

Traumatic brain injury (TBI) caused by a gunshot wound is a complex injury with a broad spectrum of symptoms and high rates of mortality and morbidity. This study presents an evaluation of TBI caused by gunshot wounds presenting at a single institution and discusses possible predictive factors for the outcome of surgical intervention. The study sample consisted of 442 patients who underwent surgery for TBI over a 16-year period. All injuries were caused by gunshot wounds, such as bullets and shrapnel. All patients underwent surgical intervention. Almost all patients (99.3%) were male, and the mean patient age was 22.3 years. Wounds were caused by shrapnel in 68 percent of patients. The Glasgow Coma Scale (GCS) score at admission was below 8 in 116 patients (26.2%) and above 8 in 326 patients (73.8%). In total, 47 patients (10.6%) died despite surgical management, with diffuse brain injury the most common cause of death. Low GCS scores, ventricular injuries and bihemispheric injuries are correlated with poor prognosis. Early and less invasive surgery in conjunction with short transportation time to the hospital could decrease mortality rates.

Alignment between Chronic Disease Policy and Practice: Case Study at a Primary Care Facility

PubMed Central

Draper, Claire A.; Draper, Catherine E.; Bresick, Graham F.

2014-01-01

Background Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. Methods One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. Results The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Conclusions Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting. PMID:25141191

Alignment between chronic disease policy and practice: case study at a primary care facility.

PubMed

Draper, Claire A; Draper, Catherine E; Bresick, Graham F

2014-01-01

Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting.

Association of sociodemographic, lifestyle, and health factors with sleep quality and daytime sleepiness in women: findings from the 2007 National Sleep Foundation "Sleep in America Poll".

PubMed

Baker, Fiona C; Wolfson, Amy R; Lee, Kathryn A

2009-06-01

To investigate factors associated with poor sleep quality and daytime sleepiness in women living in the United States. Data are presented from the National Sleep Foundation's 2007 Sleep in America Poll that included 959 women (18-64 years of age) surveyed by telephone about their sleep quality, daytime sleepiness, and sociodemographic, health, and lifestyle factors. Poor sleep quality was reported by 27% and daytime sleepiness was reported by 21% of respondents. Logistic multivariate regression analyses revealed that poor sleep quality and daytime sleepiness were both independently associated with poor health, having a sleep disorder, and psychological distress. Also, multivariate analyses showed that women who consumed more caffeinated beverages and those who had more than one job were more likely to report poor sleep quality but not daytime sleepiness. Daytime sleepiness, on the other hand, was independently associated with being black/African American, younger, disabled, having less education, and daytime napping. Poor sleep quality and daytime sleepiness are common in American women and are associated with health-related, as well as sociodemographic, factors. Addressing sleep-related complaints in women is important to improve their daytime functioning and quality of life.

Imperatorin ameliorates lipopolysaccharide induced memory deficit by mitigating proinflammatory cytokines, oxidative stress and modulating brain-derived neurotropic factor.

PubMed

Chowdhury, Amrita A; Gawali, Nitin B; Shinde, Prashant; Munshi, Renuka; Juvekar, Archana R

2018-04-26

Lipopolysaccharide (LPS), an endotoxin from the outer membrane of Gram negative bacteria has been reported to cause neuroinflammation and learning and memory deficits. There are reports describing the beneficial effects of Imperatorin (IMP), a naturally occurring furanocoumarin in central nervous system (CNS) disorders such as anxiety and epilepsy. In the current study, we investigated whether IMP protects against LPS mediated memory deficits and neuroinflammation. Mice pretreated with IMP (5, 10 mg/kg po) were administered LPS (250 μg/kg ip) for 7 days. Memory was evaluated in the Morris water maze (MWM) and Y maze. The mice were euthanised and different biochemical assessments were carried out to measure oxidative stress and acetyl choline esterase (AChE). Further, evaluation of proinflammatory cytokines such as tumor necrosis factor (TNF-α) and interleukin-6 (IL-6) levels and brain derived neurotrophic factor (BDNF) in hippocampus and cortex of brain were performed. LPS administration caused poor memory retention in both, MWM and Y maze, and caused distinct oxidative stress since decrease in superoxide dismutase (SOD), reduced glutathione (GSH) levels and increased lipid peroxidation were observed. Also, a significant rise was observed in the levels of AChE. Moreover, a rise in TNF-α and IL-6 levels and depleted levels of BDNF were noted. IMP pretreatment reversed LPS induced behavioral and memory disturbances and significantly decreased the oxidative stress and AChE levels. It also reduced TNF-α and IL-6 levels and caused a significant upregulation of BDNF levels. Present study highlights the potential neuroprotective role of IMP against LPS mediated cognitive impairment and neuroinflammation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Association between response to ovarian stimulation and miscarriage following IVF: an analysis of 124 351 IVF pregnancies.

PubMed

Sunkara, Sesh Kamal; Khalaf, Yacoub; Maheshwari, Abha; Seed, Paul; Coomarasamy, Arri

2014-06-01

Is there a relationship between ovarian reserve, quantified as ovarian response to stimulation, and miscarriage rate following IVF treatment? There is a strong association between the number of oocytes retrieved and miscarriage rate following IVF treatment, with the miscarriage rate decreasing with an increasing number of oocytes and then levelling off: poor responders have a higher miscarriage rate across all age groups. Poor ovarian response is a manifestation of a decline in the quantity of the primordial follicle pool. Whether poor ovarian response is associated with a decline in oocyte quality contributing to miscarriage is however debated. Anonymous data were obtained from the Human Fertilization and Embryology Authority (HFEA), the statutory regulator of assisted reproduction treatment (ART) in the UK. The HFEA has collected data on all ART performed in the UK since 1991. Data from 1991 to June 2008 involving 402 185 stimulated fresh IVF cycles and 124 351 pregnancy outcomes were analysed. Data on all women undergoing a stimulated fresh IVF treatment cycle with at least one oocyte retrieved during the period from 1991 to June 2008 were analysed for their early pregnancy outcomes. There was a strong association between the number of oocytes retrieved and the clinical miscarriage rate. The miscarriage rate fell from 20 to 13% with an increasing number of oocytes before levelling off. Stepwise logistic regression identified three cut-off points (4, 10 and 15 oocytes) at or beyond which the probability of clinical miscarriage fell. There was no increase in miscarriage rate with very high oocyte numbers (>20 oocytes). The lowest risk of miscarriage (9.9%) was for women under 38 years of age, with primary infertility without a female cause and producing more than three oocytes. Although the analysis was performed only on stimulated IVF cycles (excluding unstimulated cycles), the data had the limitation that there was no information on the total gonadotrophin consumption. The model was adjusted for age and type of infertility, but the dataset contained no information on other confounders such as body mass index (BMI) of the women to allow adjustment. Analysis of this extensive dataset suggests that poor responders have a higher risk of clinical miscarriage, indicating that poor ovarian response is associated with a parallel decline in both oocyte quantity and quality. The miscarriage rate is also higher with advanced age, secondary infertility and a female cause of infertility compared with a younger age, male factor infertility and unexplained cause.

Preoperative and perioperative factors effect on adolescent idiopathic scoliosis surgical outcomes.

PubMed

Sanders, James O; Carreon, Leah Y; Sucato, Daniel J; Sturm, Peter F; Diab, Mohammad

2010-09-15

Prospective multicenter database. To identify factors associated with outcomes from adolescent idiopathic scoliosis (AIS) surgery outcomes and especially poor results. Because AIS is rarely symptomatic during adolescence, excellent surgical results are expected. However, some patients have poor outcomes. This study seeks to identify factors correlating with results and especially those making poor outcomes more likely. Demographic, surgical, and radiographic parameters were compared to 2-year postoperative Scoliosis Research Society (SRS) scores in 477 AIS surgical patients using stepwise linear regression to identify factors predictive of 2-year domain and total scores. Poor postoperative score patients (>2 SD below mean) were compared using t tests to those with better results. The SRS instrument exhibited a strong ceiling effect. Two-year scores showed more improvement with greater curve correction (self-image, pain, and total), and were worse with larger body mass index (pain, mental, total), larger preoperative trunk shift (mental and total), larger preoperative Cobb (self-image), and preoperative symptoms (function). Poor results were more common in those with Lenke 3 curve pattern (pain), less preoperative coronal imbalance, trunk shift and rib prominence (function), preoperative bracing (self-image), and anterior procedures (mental). Poor results also had slightly less average curve correction (50% vs. 60%) and larger curve residuals (31° vs. 23°). Complications, postoperative curve magnitude, and instrumentation type did not significantly contribute to postoperative scores, and no identifiable factors contributed to satisfaction. Curve correction improves patient's self-image whereas pain and poor function before surgery carry over after surgery. Patients with less spinal appearance issues (higher body mass index, Lenke 3 curves) are less happy with their results. Except in surgical patient selection, many of these factors are beyond physician control.

Defective ribosome assembly in Shwachman-Diamond syndrome.

PubMed

Wong, Chi C; Traynor, David; Basse, Nicolas; Kay, Robert R; Warren, Alan J

2011-10-20

Shwachman-Diamond syndrome (SDS), a recessive leukemia predisposition disorder characterized by bone marrow failure, exocrine pancreatic insufficiency, skeletal abnormalities and poor growth, is caused by mutations in the highly conserved SBDS gene. Here, we test the hypothesis that defective ribosome biogenesis underlies the pathogenesis of SDS. We create conditional mutants in the essential SBDS ortholog of the ancient eukaryote Dictyostelium discoideum using temperature-sensitive, self-splicing inteins, showing that mutant cells fail to grow at the restrictive temperature because ribosomal subunit joining is markedly impaired. Remarkably, wild type human SBDS complements the growth and ribosome assembly defects in mutant Dictyostelium cells, but disease-associated human SBDS variants are defective. SBDS directly interacts with the GTPase elongation factor-like 1 (EFL1) on nascent 60S subunits in vivo and together they catalyze eviction of the ribosome antiassociation factor eukaryotic initiation factor 6 (eIF6), a prerequisite for the translational activation of ribosomes. Importantly, lymphoblasts from SDS patients harbor a striking defect in ribosomal subunit joining whose magnitude is inversely proportional to the level of SBDS protein. These findings in Dictyostelium and SDS patient cells provide compelling support for the hypothesis that SDS is a ribosomopathy caused by corruption of an essential cytoplasmic step in 60S subunit maturation.

Examining Delay Intervals in the Diagnosis and Treatment of Primary Open Angle Glaucoma in an Egyptian Population and Its Impact on Lifestyle

PubMed Central

Abu Hussein, Nahla B.; Habib, Ahmed E.; El Sayed, Yasmine M.

2016-01-01

Purpose. To examine causes as well as extent of delay in diagnosis and treatment of primary open angle glaucoma patients in a sample of Egyptians. Patients and Methods. 440 patients with primary open angle glaucoma were interviewed to evaluate delay in their diagnosis and treatment. The extent and cause of delay were investigated. The total delay interval, if any, was correlated with socioeconomic and other factors. Results. The median total delay was one year, with 50% of patients having a total delay of 1 year or less, of which 25% exhibited zero total delay. 25% of patients had a delay ranging from 1 to 3 years, and 25% had a total delay ranging from 3 to 27 years. Diagnostic delay accounted for 43.03% of cases. Longer delays were met in patients with certain socioeconomic factors. Patients with a positive family history of glaucoma displayed shorter delay periods. Conclusion. Significant delay in the diagnosis and treatment of glaucoma was found. Poor socioeconomic status seems to hinder timely diagnosis and treatment of POAG. Certain socioeconomic factors seem to correlate with the extent of delay. More effort is thus needed to subsidize the cost of investigations and treatment for glaucoma patients. PMID:28116140

Cerebrovascular Complications After Heart Transplantation

PubMed Central

Alejaldre, Aída; Delgado-Mederos, Raquel; Santos, Miguel Ángel; Martí-Fàbregas, Joan

2010-01-01

Neurological complications in orthotopic heart transplantation represent a major cause of morbidity and mortality despite successful transplantation. The most frequent perioperative neurological complications are delirium or encephalopathy. In this period cerebrovascular complication ranges between 5-11%. After the perioperative period, the 5-year stroke risk after cardiac transplantation is 4.1%. In a retrospective study conducted with 314 patients who underwent cardiac transplantation, it was found that 20% of cerebrovascular complications occurred within the first two weeks after transplantation, while 80% occurred in the late postoperative phase. Of these, ischemic stroke is the most common subtype. In the perioperative periode, hemodynamic instability, cardiac arrest, extracorporeal circulation over 2 hours, prior history of stroke, and carotid stenosis greater than 50% have been reported to be risk factors for the occurrence of cerebrovascular complications. Perioperative cerebrovascular complications are associated with higher mortality and poor functional outcome at one year follow-up. After the perioperative period, the only factor that has been significantly associated with an increased risk of cerebrovascular complications is a history of prior stroke, either ischemic or hemorrhagic. Other associated factors include unknown atrial fibrillation, septic emboli from endocarditis, cardiac catheterization and perioperative hemodynamic shock. According to the TOAST etiologic classification, the most prevalent etiologic subtype of ischemic stroke is undetermined cause. PMID:21804780

Epidemiology and Individual, Household and Geographical Risk Factors of Podoconiosis in Ethiopia: Results from the First Nationwide Mapping

PubMed Central

Deribe, Kebede; Brooker, Simon J.; Pullan, Rachel L.; Sime, Heven; Gebretsadik, Abeba; Assefa, Ashenafi; Kebede, Amha; Hailu, Asrat; Rebollo, Maria P.; Shafi, Oumer; Bockarie, Moses J.; Aseffa, Abraham; Reithinger, Richard; Cano, Jorge; Enquselassie, Fikre; Newport, Melanie J.; Davey, Gail

2015-01-01

Although podoconiosis is one of the major causes of tropical lymphoedema and is endemic in Ethiopia its epidemiology and risk factors are poorly understood. Individual-level data for 129,959 individuals from 1,315 communities in 659 woreda (districts) were collected for a nationwide integrated survey of lymphatic filariasis and podoconiosis. Blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests. A clinical algorithm was used to reach a diagnosis of podoconiosis by excluding other potential causes of lymphoedema of the lower limb. Bayesian multilevel models were used to identify individual and environmental risk factors. Overall, 8,110 of 129,959 (6.2%, 95% confidence interval [CI] 6.1–6.4%) surveyed individuals were identified with lymphoedema of the lower limb, of whom 5,253 (4.0%, 95% CI 3.9–4.1%) were confirmed to be podoconiosis cases. In multivariable analysis, being female, older, unmarried, washing the feet less frequently than daily, and being semiskilled or unemployed were significantly associated with increased risk of podoconiosis. Attending formal education and living in a house with a covered floor were associated with decreased risk of podoconiosis. Podoconiosis exhibits marked geographical variation across Ethiopia, with variation in risk associated with variation in rainfall, enhanced vegetation index, and altitude. PMID:25404069

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India.

PubMed

Saito, K; Korzenik, J R; Jekel, J F; Bhattacharji, S

1997-01-01

In India, approximately 20 percent of children under the age of four suffer from severe malnutrition, while half of all the children suffer from undernutrition. The contributions of knowledge and attitudes of nutrition-conscious behaviors of the mothers to childhood malnutrition has been unclear. The purpose of this study was to explore maternal knowledge of the causes of malnutrition, health-care-seeking attitudes and socioeconomic risk factors in relation to children's nutritional status in rural south India. A case-controlled study was conducted in a rural area in Tamil Nadu, India. Thirty-four cases and 34 controls were selected from the population of approximately 97,000 by using the local hospital's list of young children. A case was defined as a mother of a severely malnourished child under four years of age. Severe malnutrition was defined as having less than 60 percent of expected median weight-for-age. A control had a well-nourished child and was matched by the location and the age of the child. Interviews obtained: (1) socioeconomic information on the family, (2) knowledge of the cause of malnutrition and (3) health-care-seeking attitudes for common childhood illnesses, including malnutrition. Poor nutritional status was associated with socioeconomic variables such as sex of the child and father's occupation. Female gender (OR = 3.44, p = .02) and father's occupation as a laborer (OR = 2.98, p = .05) were significant risk factors for severe malnutrition. The two groups showed a significant difference in nutrition-related knowledge of mild mixed malnutrition (OR = 2.62, p = .05). No significant difference was apparent in health-care-seeking attitudes. Based on their traditional beliefs, the mothers did not believe that medical care was an appropriate intervention for childhood illnesses such as malnutrition or measles. The results suggested that the gender of the child and socioeconomic factors were stronger risk factors for malnutrition than health-care availability and health-care-seeking attitudes. The father's occupation was a more accurate indicator for malnutrition than household income. These results suggest a need for intensive nutritional programs targeted toward poor female children and their mothers.

Five-year Prognosis after Mild to Moderate Ischemic Stroke by Stroke Subtype: A Multi-Clinic Registry Study

PubMed Central

Lv, Yumei; Fang, Xianghua; Asmaro, Karam; Liu, Hongjun; Zhang, Xinqing; Zhang, Hongmei; Qin, Xiaoming; Ji, Xunming

2013-01-01

Background and Purpose Mild to moderate ischemic stroke is a common presentation in the outpatient setting. Among the various subtypes of stroke, lacunar infarction (LI) is generally very common. Currently, little is known about the long-term prognosis and factors associated with the prognosis between LI and non-LI. This study aims to compare the risk of death and acute cardiovascular events between patients with LI and non-LI, and identify potential risk factors associated with these outcomes. Methods A total of 710 first-ever ischemic stroke patients (LI: 474, non-LI: 263) from 18 clinics were recruited consecutively from 2003 to 2004. They were prospectively followed-up until the end of 2008. Hazard ratios and 95% confidence intervals were calculated using multivariable Cox proportional hazards regression. Results After a 5-year follow up, 54 deaths and 96 acute cardiovascular events occurred. Recurrent stroke was the most common cause of death (19 cases, 35.18%) and new acute cardiovascular events (75 cases, 78.13%). There were no significant differences between patients with LI and non-LI in their risks of death, new cardiovascular events, and recurrent stroke after adjusting for age, sex, hypertension, diabetes, cardiac diseases, body mass index, dyslipidemia, smoking, alcohol consumption, ADL dependence, and depressive symptoms. Among the modifiable risk factors, diabetes, hypertension, ADL dependency, and symptoms of depression were independent predictors of poor outcomes in patients with LI. In non-LI patients, however, no modifiable risk factors were detected for poor outcomes. Conclusion Long-term outcomes did not differ significantly between LI and non-LI patients. Detecting and managing vascular risk factors and depression as well as functional rehabilitation may improve the prognoses of LI patients. PMID:24223696

Patient Characteristics Associated with Tuberculosis Treatment Default: A Cohort Study in a High-Incidence Area of Lima, Peru

PubMed Central

Lackey, Brian; Seas, Carlos; Van der Stuyft, Patrick; Otero, Larissa

2015-01-01

Background Although tuberculosis (TB) is usually curable with antibiotics, poor adherence to medication can lead to increased transmission, drug resistance, and death. Prior research has shown several factors to be associated with poor adherence, but this problem remains a substantial barrier to global TB control. We studied patients in a high-incidence district of Lima, Peru to identify factors associated with premature termination of treatment (treatment default). Methods We conducted a prospective cohort study of adult smear-positive TB patients enrolled between January 2010 and December 2011 with no history of TB disease. Descriptive statistics and multivariable logistic regression analyses were performed to determine risk factors associated with treatment default. Results Of the 1233 patients studied, 127 (10%) defaulted from treatment. Patients who defaulted were more likely to have used illegal drugs (OR = 4.78, 95% CI: 3.05-7.49), have multidrug-resistant TB (OR = 3.04, 95% CI: 1.58-5.85), not have been tested for HIV (OR = 2.30, 95% CI: 1.50-3.54), drink alcohol at least weekly (OR = 2.22, 95% CI: 1.40-3.52), be underweight (OR = 2.08, 95% CI: 1.21-3.56), or not have completed secondary education (OR = 1.55, 95% CI: 1.03-2.33). Conclusions Our study identified several factors associated with defaulting from treatment, suggesting a complex set of causes that might lead to default. Addressing these factors individually would be difficult, but they might help to identify certain high-risk patients for supplemental intervention prior to treatment interruption. Treatment adherence remains a barrier to successful TB care and reducing the frequency of default is important for both the patients’ health and the health of the community. PMID:26046766

Patient Characteristics Associated with Tuberculosis Treatment Default: A Cohort Study in a High-Incidence Area of Lima, Peru.

PubMed

Lackey, Brian; Seas, Carlos; Van der Stuyft, Patrick; Otero, Larissa

2015-01-01

Although tuberculosis (TB) is usually curable with antibiotics, poor adherence to medication can lead to increased transmission, drug resistance, and death. Prior research has shown several factors to be associated with poor adherence, but this problem remains a substantial barrier to global TB control. We studied patients in a high-incidence district of Lima, Peru to identify factors associated with premature termination of treatment (treatment default). We conducted a prospective cohort study of adult smear-positive TB patients enrolled between January 2010 and December 2011 with no history of TB disease. Descriptive statistics and multivariable logistic regression analyses were performed to determine risk factors associated with treatment default. Of the 1233 patients studied, 127 (10%) defaulted from treatment. Patients who defaulted were more likely to have used illegal drugs (OR = 4.78, 95% CI: 3.05-7.49), have multidrug-resistant TB (OR = 3.04, 95% CI: 1.58-5.85), not have been tested for HIV (OR = 2.30, 95% CI: 1.50-3.54), drink alcohol at least weekly (OR = 2.22, 95% CI: 1.40-3.52), be underweight (OR = 2.08, 95% CI: 1.21-3.56), or not have completed secondary education (OR = 1.55, 95% CI: 1.03-2.33). Our study identified several factors associated with defaulting from treatment, suggesting a complex set of causes that might lead to default. Addressing these factors individually would be difficult, but they might help to identify certain high-risk patients for supplemental intervention prior to treatment interruption. Treatment adherence remains a barrier to successful TB care and reducing the frequency of default is important for both the patients' health and the health of the community.

Clinical Manifestations and Prognostic Factors of Pneumocystis jirovecii Pneumonia without HIV.

PubMed

Asai, Nobuhiro; Motojima, Shinji; Ohkuni, Yoshihiro; Matsunuma, Ryo; Iwasaki, Takuya; Nakashima, Kei; Sogawa, Keiji; Nakashita, Tamao; Kaneko, Norihiro

2017-01-01

Pneumocystis jirovecii pneumonia (PCP) can occur in HIV patients but also in those without HIV (non-HIV PCP) but with other causes of immunodeficiency including malignancy or rheumatic diseases. To evaluate the clinical presentation and prognostic factors of non-HIV PCP, we retrospectively reviewed all patients diagnosed as having PCP without HIV at Kameda Medical Center, Chiba, Japan, from January 2005 until June 2012. For the purpose of examining a prognostic factor for non-HIV PCP with 30-day mortality, we compared the characteristics of patients, clinical symptoms, radiological images, Eastern Cooperative Oncology Group performance status (PS), and the time from the onset of respiratory symptoms to the start of therapy, in both survival and fatality groups. A total of 38 patients were eligible in this study. Twenty-five survived and 13 had died. The non-HIV PCP patients in the survivor group had a better PS and received anti-PCP therapy earlier than those in the nonsurvivor group. Rales upon auscultation and respiratory failure at initial visits were seen more frequently in the nonsurvivor group than in the survivor group. Lactate dehydrogenase and C-reactive protein values tended to be higher in the nonsurvivor group, but this was not statistically significant. Multivariate analyses using 5 variables showed that a poor PS of 2-4 was an independent risk factor for non-HIV PCP patients and resulted in death (odds ratio 15.24; 95% confidence interval 1.72-135.21). We suggest that poor PS is an independent risk factor in non-HIV PCP, and a patient's PS and disease activity may correlate with outcome. © 2017 S. Karger AG, Basel.

Mediterranean diet adherence and synergy with acute myocardial infarction and its determinants: A multicenter case-control study in Italy

PubMed Central

Saulle, Rosella; Di Murro, Francesca; Siliquini, Roberta; Firenze, Alberto; Maurici, Massimo; Mannocci, Alice; Colamesta, Vittoria; Barillà, Francesco; Ferrante, Fabio; Agati, Luciano

2018-01-01

Background Cardiovascular diseases are the leading causes of mortality and morbidity in Western countries. The possible synergistic effect of poor adherence to a Mediterranean diet (MD) and other risk factors for acute myocardial infarction (AMI) such as hypertension, cholesterol, ever smoker, BMI> 25, diabetes, has not been deeply studied. Design Case-control study. Methods Patients with first AMI and controls from four tertiary referral Italian centers were screened for enrolment. Dietary information was collected through a questionnaire and a MD adherence score was calculated. Physical activity and smoking habits were also registered. The Synergy Index was calculated according to Rothman. Results 127 cases and 173 controls were enrolled. The analysis was conducted using a dichotomous variable for the MD score with values ≥7 representing good adherence. Multivariate analysis showed the following variables associated to AMI: ever smoker (OR = 2.08), diabetes (OR = 1.42), hypertension (OR = 2.08), hypercholesterolemia (OR = 2.47), BMI> 25 (OR = 1.99), while a protective effect emerged both in subjects scoring > 7 on the MD score (OR = 0.55) and in subjects resident of Southern Italy (OR = 0.38). A synergistic effect does exist between poor adherence to the MD and the following risk factors: hypertension, hypercholesterolemia, BMI >25, diabetes and being a resident in central and northern Italy. Conclusion Synergy between heart disease risk factors and MD underlines the need to enlarge the list of known modifiable cardiovascular risk factors to include and promote adherence to Mediterranean dietary habits. PMID:29543823

Child labour in low- and middle-income countries and its consequences for mental health: a systematic literature review of epidemiologic studies.

PubMed

Sturrock, Sarah; Hodes, Matthew

2016-12-01

In low- and middle-income countries, large numbers of children are involved in work. Whilst studies have shown that child labour may be harmful to children's physical health, little is known about child labour's effects on mental health. It is important to understand the relationship between work and mental health problems during childhood, and identify possible risk factors for poorer mental health. A systematic literature review was conducted. Published papers in any language that compared the mental health of children (<18 years) who had been exposed to work with those who had not been exposed to work were included. Twelve published observational studies on the association between child labour and general psychopathology, internalising and externalising problems were identified. Child labour was found to be strongly associated with poor mental health outcomes in seven studies. More significant associations were found between child labour and internalising problems than externalising problems. The burden of poor mental health as a result of child labour is significant given the numbers of children in work. Risk factors for poorer mental health were involvement in domestic labour, younger age, and greater intensity of work, which could be due to the potential of child labour to cause isolation, low self-esteem, and perception of an external locus of control. The risk factors suggested by this review will have implications for policy makers. Additional research is needed in low-income countries, risk factors and also into the potential psychological benefits of low levels of work.

Causes and outcomes of emergency presentation of rectal cancer.

PubMed

Comber, Harry; Sharp, Linda; de Camargo Cancela, Marianna; Haase, Trutz; Johnson, Howard; Pratschke, Jonathan

2016-09-01

Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004-2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete-time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter-relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio-economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation. © 2016 UICC.

Positive affect moderates the effect of negative affect on cardiovascular disease-related hospitalizations and all-cause mortality after cardiac rehabilitation.

PubMed

Meyer, Fiorenza Angela; von Känel, Roland; Saner, Hugo; Schmid, Jean-Paul; Stauber, Stefanie

2015-10-01

Little is known as to whether negative emotions adversely impact the prognosis of patients who undergo cardiac rehabilitation. We prospectively investigated the predictive value of state negative affect (NA) assessed at discharge from cardiac rehabilitation for prognosis and the moderating role of positive affect (PA) on the effect of NA on outcomes. A total of 564 cardiac patients (62.49 ± 11.51) completed a comprehensive three-month outpatient cardiac rehabilitation program, filling in the Global Mood Scale (GMS) at discharge. The combined endpoint was cardiovascular disease (CVD)-related hospitalizations plus all-cause mortality at follow-up. Cox regression models estimated the predictive value of NA, as well as the moderating influence of PA on outcomes. Survival models were adjusted for sociodemographic factors, traditional cardiovascular risk factors, and severity of disease. During a mean follow-up period of 3.4 years, 71 patients were hospitalized for a CVD-related event and 15 patients died. NA score (range 0-20) was a significant and independent predictor (hazard ratio (HR) 1.091, 95% confidence interval (CI) 1.012-1.175; p = 0.023) with a three-point higher level in NA increasing the relative risk by 9.1%. Furthermore, PA interacted significantly with NA (p < 0.001). The relative risk of poor prognosis with NA was increased in patients with low PA (p = 0.012) but remained unchanged in combination with high PA (p = 0.12). The combination of NA with low PA was particularly predictive of poor prognosis. Whether reduction of NA and increase of PA, particularly in those with high NA, improves outcome needs to be tested. © The European Society of Cardiology 2014.

[Peritonitis in pediatric patients receiving peritoneal dialysis].

PubMed

Jellouli, Manel; Ferjani, Meriem; Abidi, Kamel; Hammi, Yosra; Boutiba, Ilhem; Naija, Ouns; Zarrouk, Chokri; Ben Abdallah, Taieb; Gargah, Tahar

2015-12-01

Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments

PubMed Central

Tangcharoensathien, Viroj; Srisookwatana, Orapan; Pinprateep, Poldej; Posayanonda, Tipicha; Patcharanarumol, Walaiporn

2017-01-01

Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs) and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA) and United Nations General Assembly (UNGA) resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors. Capacity development at individual, institutional and system level to generate evidence and ensure it is used by multisectoral agencies is as critical as strengthening the health literacy of people and the overall good governance of a country. PMID:28812831

Review: Fuel Volatility Standards and Spark-Ignition Vehicle Driveability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yanowitz, Janet; McCormick, Robert L.

2016-03-14

We've put spark-ignition engine fuel standards in place in order to ensure acceptable hot and cold weather driveability (HWD and CWD). Vehicle manufacturers and fuel suppliers have developed systems that meet our driveability requirements so effectively that drivers overwhelmingly find that their vehicles reliably start up and operate smoothly and consistently throughout the year. For HWD, fuels that are too volatile perform more poorly than those that are less volatile. Vapor lock is the apparent cause of poor HWD, but there is conflicting evidence in the literature as to where in the fuel system it occurs. Most studies have foundmore » a correlation between degraded driveability and higher dry vapor pressure equivalent or lower TV/L = 20, and less consistently with a minimum T50. For CWD, fuels with inadequate volatility can cause difficulty in starting and rough operation during engine warmup. The Driveability Index (DI)-a function of T10, T50, and T90-is well correlated with CWD in hydrocarbon fuels. For ethanol-containing fuels, a correction factor to the DI equation improves the correlation with CWD, although the best value for that factor has still not been determined. Ethanol increases the heat of vaporization. But, this is likely insignificant for E15 and lower concentration fuels. The impact of ethanol on driveability is likely due to its direct effect on vapor pressure at cold temperatures. For E51-E83 or flex-fuel blends, ASTM sets a minimum vapor pressure; however, published data suggest that a correction for the amount of ethanol in the fuel is needed to accurately predict CWD, possibly because ethanol has a higher lower-flammability limit.« less

Perception of Students on Causes of Poor Performance in Chemistry in External Examinations in Umuahia North Local Government of Abia State

ERIC Educational Resources Information Center

Ojukwu, M. O.

2016-01-01

The aim of this study was to investigate the perception of students on the causes of their poor performance in external chemistry examinations in Umuahia North Local Government Area of Abia State. Descriptive survey design was used for the study. Two hundred and forty (240) students were selected through simple random sampling for the study. A…

The Earth Sciences, Human Well-Being, and the Reduction of Global Poverty

NASA Astrophysics Data System (ADS)

Mutter, John C.

2005-04-01

Poverty is not solely a social or political matter, nor is it caused simply by population pressures as Thomas Malthus postulated in 1798. A new understanding of poverty is emerging in which natural and environmental drivers, together with social, political, and demographic causes, underpin livelihoods. The Earth sciences, therefore, play a critical role in identifying the deep causes of human suffering and in identifying solutions. The State of the Planet: Why Are So Many So Poor? For far too many, the state of human well-being is bleak. Around one in six human beings-1 billion people-live in extreme poverty, struggling to survive on less than $1 a day; another one sixth of humanity ekes out existence on $2 per day (U.N. Development Programme (UNDP) Human Development Report, 2004; http://hdr.undp.org/2004/). The extreme poor lack all normal attributes of a decent, dignified life: adequate food, housing, sanitation, health care, education, and employment. Some 800 million people lack sufficient nourishment almost every day. It stunts their mental and physical development and shortens their lives, making them susceptible to common illnesses that attack their hunger-weakened bodies. Poor nutrition in mothers and infants is the leading cause of reduced disability-adjusted life years in poor countries [ Economist, 2004].

The incidence of bent dorsal fins in free-ranging cetaceans.

PubMed

Alves, F; Towers, J R; Baird, R W; Bearzi, G; Bonizzoni, S; Ferreira, R; Halicka, Z; Alessandrini, A; Kopelman, A H; Yzoard, C; Rasmussen, M H; Bertulli, C G; Jourdain, E; Gullan, A; Rocha, D; Hupman, K; Mrusczok, M-T; Samarra, F I P; Magalhães, S; Weir, C R; Ford, J K B; Dinis, A

2018-02-01

Laterally bent dorsal fins are rarely observed in free-ranging populations of cetaceans, contrary to captivity, where most killer whale Orcinus orca adult males have laterally collapsed fins. This topic has been poorly explored, and data/information on its occurrence and possible causes are limited. The present study: (i) undertakes a review of the available information on bent dorsal fins in free-ranging cetaceans, and updates it with new records, (ii) reports on the proportion of bent fins in different study populations, and (iii) discusses possible causes. An empirical approach based on bibliographic research and compilation of 52 new records collected worldwide resulted in a total of 17 species of cetaceans displaying bent dorsal fins. The species with the highest number of records (64%) and from most locations was O. orca. On average, individuals with bent dorsal fins represent < 1% of their populations, with the exception of false killer whales Pseudorca crassidens and O. orca. While line injuries associated with fisheries interactions may be the main cause for P. crassidens, and the vulnerability to health issues caused by the evolutionary enlargement of the fin may be the cause for O. orca adult males, factors contributing to this abnormality for other species are still unclear. The occurrence of bent dorsals could be influenced by a set of variables rather than by a single factor but, irrespective of the cause, it is suggested that it does not directly affect the animals' survivorship. While still rare in nature, this incident is more common (at least 101 known cases) and widespread (geographically and in species diversity) than hypothesized, and is not confined only to animals in captive environments. Investigation into the occurrence of bent fins may be an interesting avenue of research. © 2017 Anatomical Society.

Clinical, epidemiological and socio-cultural aspects of infertility in resource-poor settings. Evidence from Rwanda

PubMed Central

Dhont, N.

2011-01-01

Infertility is a serious but entirely neglected public health problem in resource-poor countries. Most of the infertility is caused by infections and therefore potentially preventable. The problem of infertility in Rwanda has not been researched so far. We examined predictors for infertility and treatment-seeking behaviour in an unmatched case-control. We performed infertility investigations in all infertile couples and discussed consequences of infertility in focus group discussions. HSV-2 and HIV infection and sexual violence were the most important determinants of infertility. We found a higher HIV prevalence among couples in secondary and not primary infertile relationships with at least one HIV infected partner in 45% of these couples. Men in infertile relationships reported more frequently concurrent partners over the last year than fertile men. We found a high prevalence of tubal factor (70%) and male factor infertility (64%). Pregnancy rates (16%) were low after conventional therapy. Both men and women are unlikely to attribute infertility to the male partner. Participants reported a wide array of treatments they received in the past, often including ineffective or even harmful interventions. We demonstrated severe suffering as a consequence of infertility for both men and women but with women carrying the largest burden, similar to what is reported in other resource-poor countries. Overall, we can conclude that there is an urgent need for a more holistic approach towards reproductive health services in SSA, one that recognises the importance of reproductive failure. The link with HIV has important consequences for both HIV and reproductive health programs. PMID:24753853

Sociodemographic features and risk factor profile of keratomalacia in early infancy.

PubMed

Gupta, Noopur; Tandon, Radhika

2012-08-01

To study the clinical spectrum and etiopathogenesis of keratomalacia in infants younger than 6 months. Case records of children younger than 6 months presenting with keratomalacia to cornea services of a tertiary care ophthalmic center in India from June 2007 through April 2010 were reviewed. The parameters evaluated were age, sex, anthropometry, nutritional status, socioeconomic status, antenatal history, maternal nutrition, systemic associations, immunization, and dietary history. Comprehensive ocular examination with emphasis on ocular adnexa, conjunctiva, cornea, and anterior chamber was performed. Overall, 33 infants (24 male and 9 female) with mean age of 2.8 ± 1.3 months (range = 1-6 months) were included. Eighty-eight percent (29 of 33) had associated protein energy malnutrition. A total of 31 of 33 children (94%) belonged to poor families, and nearly, three fourth of the children were not fully immunized as recommended for their age. Inadequate breastfeeding was the precipitating cause in 100%. Maternal nutritional status was poor in 82% of the cases. The reason for not breastfeeding the infant was inadequate milk production in 89.4% of mothers, 64.7% were ill informed, and 1 mother had adopted a child. Feeding practices included diluted cow's milk (1:1-1:5) in 21 infants (63.6%), toned dairy milk in 9 infants (27.3%), infant lactogen in 2 infants (6.1%), and skimmed milk powder in 1 infant (3.0%). Keratomalacia in early infancy can be attributed to inadequate breastfeeding. Important contributory risk factors include lower socioeconomic status, poor maternal nutrition, and lack of knowledge about recommended feeding guidelines.

Causes of prolonged hospitalization among general internal medicine patients of a tertiary care center.

PubMed

Ruangkriengsin, Darat; Phisalprapa, Pochamana

2014-03-01

Unnecessary days of prolonged hospitalization may lead to the increase in hospital-related complications and costs, especially in tertiary care center Currently, there have not been many studies about the causes of prolonged hospitalization. Some identified causes could, however, be prevented and improved. To identify the prevalence, causes, predictive factors, prognosis, and economic burden of prolonged hospitalization in patients who had been in general internal medicine wards of the tertiary care center for 7 days or more. Retrospective chart review study was conducted among all patients who were admitted for 7 days or more in general internal medicine wards of Siriraj Hospital, the largest tertiary care center in Thailand. The period of this study was from 1 August 2012 to 30 September 2012. Demographic data, principle diagnosis, comorbid diseases, complications, discharge status, total costs of admission and percentage of reimbursement were collected. The causes of prolonged hospitalization at day 7, 14, 30, and 90 were assessed. Five hundred and sixty-two charts were reviewed. The average length of stay was 25.9 days. The two most common causes of prolonged admission at day 7 were treatment of main diagnosed disease with stable condition (27.6%) and waiting for completion of intravenous antibiotics administration with stable condition (19.5%). The causes of prolonged hospitalization at day 14 were unstable condition from complications (22.6%) and those waiting for completion of intravenous antibiotics administration with stable condition (15.8%). The causes of prolonged admission at day 30 were unstable conditions from complications (25.6%), difficulty weaning or ventilator dependence (17.6%), and caregiver problems (15.2%). The causes of prolonged hospitalization at day 90 were unstable condition from complications (30.0%), caregiver problems (30.0%), and palliative care (25.0%). Poor outcomes were shown in the patients admitted more than 90 days. Percentage of death, being bedridden, and re-admission were 55, 40, and 22, respectively. The goal of treatment was only palliative care in 80 percent of this patient group. Respiratory failure among the hospitalized was the strongest predictive factors of death (Odds ratio = 7.5, p < 0.001). The average costs of admission per patient was 163,870 THB and the percentage of reimbursement was only 72%. For total costs of admission in these two months, Siriraj Hospital lost a large amount of money (about 26 million THB) for patients admitted for 7 days or more and almost 50% of this was spent on the patients admitted for 90 days or more. The average cost of admission per patient in the latter group was 1,073,004 THB. Prolonged hospitalization had adverse outcomes for the patients and the hospital, such as high complications, poor outcomes, high costs of treatment and low reimbursement ratio that created an enormous economic burden for the hospital. Therefore possible preventable causes of prolonged admission must be identified, prevented and managed by improving quality of multidisciplinary health care system and ancillary services.

Children's school performance: impact of general and oral health.

PubMed

Blumenshine, Stephanie L; Vann, William F; Gizlice, Ziya; Lee, Jessica Y

2008-01-01

The purpose of this study was to examine: a) the sociodemographic and health factors associated with poor school performance among North Carolina children; and b) the impact of poor oral health status on school performance while controlling for other health and sociodemographic factors. We used data from the 2005 Child Health Assessment and Monitoring Program, a follow-back telephone survey to the Behavioral Risk Factor Surveillance System involving parents/guardians of children 0 to 17. This project includes sections on oral health and school performance. Our principal outcome variable was school performance and our major explanatory variable was children's oral health status, based upon parental report. Our sample consisted of 2,871 school children, weighted to reflect the North Carolina census. Bivariate analysis revealed that sex, race, parental education, low socioeconomic status, poor general health, poor oral health, and the interaction of poor oral health and general health were significantly related to school performance (P < 0.05). Logistic regression analysis demonstrates the effects of poor oral health and general health on school performance. Children with both poor oral health and general health were 2.3 times more likely to report poor school performance. Children with either poor oral health or general health were only 1.4 times more likely to report poor school performance. Our results show that children who have both poor oral health and general health are more likely to have poor school performance. Our findings suggest that the improvement of children's oral health may be a vehicle to improve their educational experience.

The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms.

PubMed

Andrade, Jason; Khairy, Paul; Dobrev, Dobromir; Nattel, Stanley

2014-04-25

Atrial fibrillation (AF) is the most common arrhythmia (estimated lifetime risk, 22%-26%). The aim of this article is to review the clinical epidemiological features of AF and to relate them to underlying mechanisms. Long-established risk factors for AF include aging, male sex, hypertension, valve disease, left ventricular dysfunction, obesity, and alcohol consumption. Emerging risk factors include prehypertension, increased pulse pressure, obstructive sleep apnea, high-level physical training, diastolic dysfunction, predisposing gene variants, hypertrophic cardiomyopathy, and congenital heart disease. Potential risk factors are coronary artery disease, kidney disease, systemic inflammation, pericardial fat, and tobacco use. AF has substantial population health consequences, including impaired quality of life, increased hospitalization rates, stroke occurrence, and increased medical costs. The pathophysiology of AF centers around 4 general types of disturbances that promote ectopic firing and reentrant mechanisms, and include the following: (1) ion channel dysfunction, (2) Ca(2+)-handling abnormalities, (3) structural remodeling, and (4) autonomic neural dysregulation. Aging, hypertension, valve disease, heart failure, myocardial infarction, obesity, smoking, diabetes mellitus, thyroid dysfunction, and endurance exercise training all cause structural remodeling. Heart failure and prior atrial infarction also cause Ca(2+)-handling abnormalities that lead to focal ectopic firing via delayed afterdepolarizations/triggered activity. Neural dysregulation is central to atrial arrhythmogenesis associated with endurance exercise training and occlusive coronary artery disease. Monogenic causes of AF typically promote the arrhythmia via ion channel dysfunction, but the mechanisms of the more common polygenic risk factors are still poorly understood and under intense investigation. Better recognition of the clinical epidemiology of AF, as well as an improved appreciation of the underlying mechanisms, is needed to develop improved methods for AF prevention and management.

Poor School Satisfaction and Number of Cannabis Using Peers within School Classes as Individual Risk Factors for Cannabis Use among Adolescents

ERIC Educational Resources Information Center

Hoff, Dominic A.; Andersen, Anette; Holstein, Bjorn E.

2010-01-01

There is little information available on the topic of poor school satisfaction as a risk factor for cannabis use among adolescents. We examined if there was an association between poor school satisfaction, school class cannabis use and individual cannabis use. Further, we investigated if many cannabis users within the school class statistically…

Factors associated with poor academic achievement among urban primary school children in Malaysia.

PubMed

Ong, L C; Chandran, V; Lim, Y Y; Chen, A H; Poh, B K

2010-03-01

The aim of this study was to identify factors associated with poor academic achievement during the early school years. This was a cross-sectional study of urban Primary Two children. Sociodemographic and medical data were obtained from questionnaires and interviews. Achievement was based on marks obtained in the core subjects of the Primary One examination. All students underwent the Raven's Standard Progressive Matrices test as a general measure of cognitive ability, audiometry and visual tests, and standardised measurements of weight and height. Out of 1,470 eligible children, 206 (14 percent) had poor academic achievement. Of the 919 children who participated in the study, 111 (12.1 percent) had poor achievement compared with 95 (17.2 percent) of the 551 non-participants. Using logistic regression analysis, the factors that were found to be independently associated with poor academic achievement were lower mean Raven scores (p-value is less than 0.001), lower mean socioeconomic status scores (p-value is less than 0.001), larger sibship size (p-value is 0.031), male gender (odds ratio [OR] 1.7; 95 percent confidence interval [CI] 1.1-2.65) and a history of prematurity (OR 14; 95 percent CI 2-97.8). Cognitive ability, gender, prematurity and social factors contribute to poor academic achievement during the early school years. The higher proportion of poor achievers among non-participants warrants further attention.

Estimated Under-Five Deaths Associated with Poor-Quality Antimalarials in Sub-Saharan Africa

PubMed Central

Renschler, John P.; Walters, Kelsey M.; Newton, Paul N.; Laxminarayan, Ramanan

2015-01-01

Many antimalarials sold in sub-Saharan Africa are poor-quality (falsified, substandard, or degraded), and the burden of disease caused by this problem is inadequately quantified. In this article, we estimate the number of under-five deaths caused by ineffective treatment of malaria associated with consumption of poor-quality antimalarials in 39 sub-Saharan countries. Using Latin hypercube sampling our estimates were calculated as the product of the number of private sector antimalarials consumed by malaria-positive children in 2013; the proportion of private sector antimalarials consumed that were of poor-quality; and the case fatality rate (CFR) of under-five malaria-positive children who did not receive appropriate treatment. An estimated 122,350 (interquartile range [IQR]: 91,577–154,736) under-five malaria deaths were associated with consumption of poor-quality antimalarials, representing 3.75% (IQR: 2.81–4.75%) of all under-five deaths in our sample of 39 countries. There is considerable uncertainty surrounding our results because of gaps in data on case fatality rates and prevalence of poor-quality antimalarials. Our analysis highlights the need for further investigation into the distribution of poor-quality antimalarials and the need for stronger surveillance and regulatory efforts to prevent the sale of poor-quality antimalarials. PMID:25897068

Timing and teamwork--an observational pilot study of patients referred to a Rapid Response Team with the aim of identifying factors amenable to re-design of a Rapid Response System.

PubMed

Peebles, Emma; Subbe, Christian P; Hughes, Paul; Gemmell, Les

2012-06-01

Rapid Response Teams aim to accelerate recognition and treatment of acutely unwell patients. Delays in delivery might undermine efficiency of the intervention. Our understanding of the causes of these delays is, as yet, incomplete. To identify modifiable causes of delays in the treatment of critically ill patients outside intensive care with a focus on factors amenable to system design. Review of care records and direct observation with process mapping of care delivered to 17 acutely unwell patients attended by a Rapid Response Team in a District General Hospital in the United Kingdom. Delays were defined as processes with no added value for patient care. Essential diagnostic and therapeutic procedures accounted for only 31% of time of care processes. Causes for delays could be classified into themes as (1) delays in call-out of the Rapid Response Team, (2) problems with team cohesion including poor communication and team efficiency and (3) lack of resources including lack of first line antibiotics, essential equipment, experienced staff and critical care beds. We identified a number of potentially modifiable causes for delays in care of acutely ill patients. Improved process design could include automated call-outs, a dedicated kit for emergency treatment in relevant clinical areas, increased usage of standard operating procedures and staff training using crew resource management techniques. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Impact of functional status on 6-month mortality in elderly patients with acute venous thromboembolism: results from a prospective cohort.

PubMed

Gómez-Cuervo, Covadonga; Díaz-Pedroche, Carmen; Pérez-Jacoiste Asín, María Asunción; Lalueza, Antonio; Del Pozo, Roberto; Díaz-Simón, Raquel; Trapiello, Francisco; Paredes, Diana; Lumbreras, Carlos

2018-06-05

Functional status linked to a poor outcome in a broad spectrum of medical disorders. Barthel Activities of Daily Life Index (BADLI) is one of the most extended tools to quantify functional dependence. Whether BADLI can help to predict outcomes in elderly patients with acute venous thromboembolism (VTE) is unknown. The current study aimed to ascertain the influence of BADLI on 6-month all-cause mortality in aged patients with VTE. This is a prospective observational study. We included consecutive patients older than 75-year-old with an acute VTE between April 2015 and April 2017. We analyzed several variables as mortality predictors, including BADLI-measured functional status. Afterward, we performed a multivariate analysis, using logistic regression, to identify all-cause mortality independent predictive factors. Two hundred and two subjects were included. Thirty-five (17%) patients died in the first 6 months. The leading cause of death was cancer (59%). After multivariable logistic regression, we identified BADLI and Charlson index as independent predictors for 6-months mortality [BADLI (every decrease of 10 points) OR 1.21 95% CI (1.03-1.42) and Charlson index OR 1.71 95% CI (1.21-2.43)]. Body mass index (BMI) values were inversely related to mortality [OR 0.85 95% CI (0.75-0.95)]. In conclusion, BADLI, BMI, and Charlson index scores are independent predictive factors for 6-month all-cause mortality in old patients with VTE.

Self-disorders and schizophrenia: a phenomenological reappraisal of poor insight and noncompliance.

PubMed

Henriksen, Mads G; Parnas, Josef

2014-05-01

Poor insight into illness is considered the primary cause of treatment noncompliance in schizophrenia. In this article, we critically discuss the predominant conceptual accounts of poor insight, which consider it as an ineffective self-reflection, caused either by psychological defenses or impaired metacognition. We argue that these accounts are at odds with the phenomenology of schizophrenia, and we propose a novel account of poor insight. We suggest that the reason why schizophrenia patients have no or only partial insight and consequently do not comply with treatment is rooted in the nature of their anomalous self-experiences (ie, self- disorders) and the related articulation of their psychotic symptoms. We argue that self-disorders destabilize the patients' experiential framework, thereby weakening their basic sense of reality (natural attitude) and enabling another sense of reality (solipsistic attitude) to emerge and coexist. This coexistence of attitudes, which Bleuler termed "double bookkeeping," is, in our view, central to understanding what poor insight in schizophrenia really is. We suggest that our phenomenologically informed account of poor insight may have important implications for early intervention, psychoeducation, and psychotherapy for schizophrenia.

Self-disorders and Schizophrenia: A Phenomenological Reappraisal of Poor Insight and Noncompliance

PubMed Central

Henriksen, Mads G.

2014-01-01

Poor insight into illness is considered the primary cause of treatment noncompliance in schizophrenia. In this article, we critically discuss the predominant conceptual accounts of poor insight, which consider it as an ineffective self-reflection, caused either by psychological defenses or impaired metacognition. We argue that these accounts are at odds with the phenomenology of schizophrenia, and we propose a novel account of poor insight. We suggest that the reason why schizophrenia patients have no or only partial insight and consequently do not comply with treatment is rooted in the nature of their anomalous self-experiences (ie, self- disorders) and the related articulation of their psychotic symptoms. We argue that self-disorders destabilize the patients’ experiential framework, thereby weakening their basic sense of reality (natural attitude) and enabling another sense of reality (solipsistic attitude) to emerge and coexist. This coexistence of attitudes, which Bleuler termed “double bookkeeping,” is, in our view, central to understanding what poor insight in schizophrenia really is. We suggest that our phenomenologically informed account of poor insight may have important implications for early intervention, psychoeducation, and psychotherapy for schizophrenia. PMID:23798710

Independence and mobility after infrainguinal lower limb bypass surgery for critical limb ischemia.

PubMed

Ambler, Graeme K; Dapaah, Andrew; Al Zuhir, Naail; Hayes, Paul D; Gohel, Manjit S; Boyle, Jonathan R; Varty, Kevin; Coughlin, Patrick A

2014-04-01

Critical limb ischemia (CLI) is a common condition associated with high levels of morbidity and mortality. Most work to date has focused on surgeon-oriented outcomes such as patency, but there is increasing interest in patient-oriented outcomes such as mobility and independence. This study was conducted to determine the effect of infrainguinal lower limb bypass surgery (LLBS) on postoperative mobility in a United Kingdom tertiary vascular surgery unit and to investigate causes and consequences of poor postoperative mobility. We collected data on all patients undergoing LLBS for CLI at our institution during a 3-year period and analyzed potential factors that correlated with poor postoperative mobility. During the study period, 93 index LLBS procedures were performed for patients with CLI. Median length of stay was 11 days (interquartile range, 11 days). The 12-month rates of graft patency, major amputation, and mortality were 75%, 9%, and 6%, respectively. Rates of dependence increased fourfold during the first postoperative year, from 5% preoperatively to 21% at 12 months. Predictors of poor postoperative mobility were female sex (P = .04) and poor postoperative mobility (P < .001), initially and at the 12-month follow-up. Patients with poor postoperative mobility had significantly prolonged hospital length of stay (15 vs 8 days; P < .001). Patients undergoing LLBS for CLI suffer significantly impaired postoperative mobility, and this is associated with prolonged hospital stay, irrespective of successful revascularization. Further work is needed to better predict patients who will benefit from revascularization and in whom a nonoperative strategy is optimal. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Are we doing enough to prevent poor-quality antimalarial medicines in the developing world?

PubMed

Walker, Erin J; Peterson, Gregory M; Grech, James; Paragalli, Evie; Thomas, Jackson

2018-05-15

Malaria is a deadly parasitic disease that affects more than 3 billion people worldwide, in predominantly resource-poor countries. Despite malaria being preventable and treatable, a large number of adults and children, mostly in Africa, die from this disease each year. One contributor to needless morbidity and mortality is the production and distribution of poor-quality antimalarial medicines; indeed, it is estimated that over 122,000 deaths of children under 5 years of age in sub-Saharan countries were caused by poor-quality antimalarial medicines, in 2013 alone. Poor-quality medicines include those that are deliberately falsified for monetary gain and may contain incorrect amounts or even no active ingredients at all, as well as products that are inadequate due to poor compliance to conventional quality standards and medicines that have degraded over time. Across a number of studies it has been reported that 4-92% of antimalarials tested are poor quality. This represents a massive risk to the population subjected to the use of these medicines, in the form of more severe and prolonged illness, additional costs to individuals who already have very little money, and lack of confidence in treatments. The continuing circulation of poor-quality medicines results from a number of factors, including insufficient regulatory capacity in susceptible countries, inadequate funding to perform regulatory functions, poor coordination between regulatory authorities, and inefficient import/export control systems. To combat the distribution of poor-quality medicines a number of organisations have developed guidelines for the procurement of antimalarials, and programs to educate consumers about the risks of poor-quality medicines and incentivise retailers to identify and report falsified medicines. The development of new technologies to quickly identify poor-quality medicines in the field is also essential, and some significant advances have been made. There has been considerable improvement in the delivery of high-quality antimalarials to those who need them; however, there is still an urgent need for a collective response by the international community, political leaders, regulatory bodies, and pharmaceutical companies. This should include political commitment for enhanced research and development funding, such as for new innovative track-and-trace field devices, and international efforts to strengthen and harmonise drug regulation practices.

The Science of Reading and Its Educational Implications

PubMed Central

Seidenberg, Mark S.

2013-01-01

Research in cognitive science and neuroscience has made enormous progress toward understanding skilled reading, the acquisition of reading skill, the brain bases of reading, the causes of developmental reading impairments and how such impairments can be treated. My question is: if the science is so good, why do so many people read so poorly? I mainly focus on the United States, which fares poorly on cross-national comparisons of literacy, with about 25-30% of the population exhibiting literacy skills that are low by standard metrics. I consider three possible contributing factors, all of which turn on issues concerning the relationships between written and spoken language. They are: the fact that English has a deep alphabetic orthography; how reading is taught; and the impact of linguistic variability as manifested in the Black-White “achievement gap”. I conclude that there are opportunities to increase literacy levels by making better use of what we have learned about reading and language, but also institutional obstacles and understudied issues for which more evidence is badly needed. PMID:24839408

The potential for short rotation energy forestry on restored landfill caps.

PubMed

Nixon, D J; Stephens, W; Tyrrel, S F; Brierley, E D

2001-05-01

This review examines the potential for producing biomass on restored landfills using willow and poplar species in short rotation energy forestry. In southern England, the potential production may be about 20 t ha(-1) of dry stem wood annually. However, actual yields are likely to be constrained by detrimental soil conditions, including shallow depth, compaction, low water holding capacity and poor nutritional status. These factors will affect plant growth by causing drought, waterlogging, poor soil aeration and nutritional deficiencies. Practical solutions to these problems include the correct placement and handling of the agricultural cap material, soil amelioration using tillage and the addition of organic matter (such as sewage sludge), irrigation (possibly using landfill leachate), the installation of drainage and the application of inorganic fertilizers. The correct choice of species and clone, along with good site management are also essential if economically viable yields are to be obtained. Further investigations are required to determine the actual yields that can be obtained on landfill sites using a range of management inputs.

Origins and consequences of DNA damage in male germ cells.

PubMed

Aitken, R John; De Iuliis, Geoffry N

2007-06-01

DNA damage in the male germline is associated with poor fertilization rates following IVF, defective preimplantation embryonic development, and high rates of miscarriage and morbidity in the offspring, including childhood cancer. This damage is poorly characterized, but is known to involve hypomethylation of key genes, oxidative base damage, endonuclease-mediated cleavage and the formation of adducts with xenobiotics and the products of lipid peroxidation. There are many possible causes of such DNA damage, including abortive apoptosis, the oxidative stress associated with male genital tract infection, exposure to redox cycling chemicals, and defects of spermiogenesis associated with the retention of excess residual cytoplasm. Physical factors such as exposure to radiofrequency electromagnetic radiation or mild scrotal heating can also induce DNA damage in mammalian spermatozoa, although the underlying mechanisms are unclear. Ultimately, resolving the precise nature of the DNA lesions present in the spermatozoa of infertile men will be an important step towards uncovering the aetiology of this damage and developing strategies for its clinical management.

The relationship between risk factors and aeronautical decision making in the flight training environment

NASA Astrophysics Data System (ADS)

Wetmore, Michael J.

The purpose of this applied dissertation was to investigate the relationship between risk factors and aeronautical decision making in the flight training environment using a quantitative, non-experimental, ex post facto research design. All 75 of the flight training accidents that involved a fatality from the years 2001-2003 were selected for study from the National Transportation Safety Board (NTSB) aviation accident database. Objective evidence from the Factual Reports was used to construct accident chains and to code and quantify total risk factors and total poor aeronautical decisions. The data were processed using correlational statistical tests at the 1% significance level. There was a statistically significant relationship between total risk factors per flight and poor decisions per flight. Liveware risks were the most prevalent risk factor category. More poor decisions were made during preflight than any other phase of flight. Pilots who made multiple poor decisions per flight had significantly higher risk factors per flight. A risk factor threat to decision making chart is presented for use by flight instructors and/or flight training organizations. The main threat to validity of this study was the NTSB accident investigation team investigative equality assumption.

Avian colibacillosis: still many black holes.

PubMed

Guabiraba, Rodrigo; Schouler, Catherine

2015-08-01

Avian pathogenic Escherichia coli (APEC) strains cause severe respiratory and systemic diseases, threatening food security and avian welfare worldwide. Intensification of poultry production and the quick expansion of free-range production systems will increase the incidence of colibacillosis through greater exposure of birds to pathogens and stress. Therapy is mainly based on antibiotherapy and current vaccines have poor efficacy. Serotyping remains the most frequently used diagnostic method, only allowing the identification of a limited number of APEC strains. Several studies have demonstrated that the most common virulence factors studied in APEC are all rarely present in the same isolate, showing that APEC strains constitute a heterogeneous group. Different isolates may harbor different associations of virulence factors, each one able to induce colibacillosis. Despite its economical relevance, pathogenesis of colibacillosis is poorly understood. Our knowledge on the host response to APEC is based on very descriptive studies, mostly restricted to bacteriological and histopathological analysis of infected organs such as lungs. Furthermore, only a small number of APEC isolates have been used in experimental studies. In the present review, we discuss current knowledge on APEC diversity and virulence, including host response to infection and the associated inflammatory response with a focus on pulmonary colibacillosis. © FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Sonic hedgehog (SHH) and glioblastoma-2 (Gli-2) expressions are associated with poor jaundice-free survival in biliary atresia.

PubMed

Jung, Hae Yoen; Jing, Jin; Lee, Kyoung Bun; Jang, Ja-June

2015-03-01

Biliary atresia (BA) causes biliary obstruction in neonates. Although the Kasai operation can successfully treat certain BA cases, many patients exhibit recurrent jaundice and secondary biliary cirrhosis requiring liver transplantation. Consequently, studies of the prognostic factors of the Kasai operation are needed. Accordingly, sonic hedgehog (SHH) pathway expression at the extrahepatic bile duct (EHBD), an important bile duct repair mechanism, will be investigated via immunohistochemistry in patients with BA to examine the association with post-Kasai operation prognosis. Fifty-seven EHBD specimens were obtained during Kasai operations from 1992 to 2009. The SHH, patched (PTCH), and glioblastoma-2 (Gli-2) immunohistochemical staining results were analyzed quantitatively. Overall, 57.9% of patients had bile flow normalization after the Kasai operation; 43.1% did not. High preoperative serum total bilirubin, direct bilirubin, and aspartate aminotransferase levels were associated with sustained jaundice post-Kasai operation, as was an age ≥65days at the time of surgery (all p<0.05). High Gli-2 and SHH expression rates were significantly associated with early post-Kasai operation jaundice relapse. Strong Gli-2 and SHH expression in the EHBD might be a poor prognostic factor in Kasai operation-treated patients with BA. Copyright © 2015 Elsevier Inc. All rights reserved.

Poor drug adherence and lack of awareness of hypertension among hypertensive stroke patients in Kampala, Uganda: a cross sectional study.

PubMed

Mugwano, Isaac; Kaddumukasa, Mark; Mugenyi, Levi; Kayima, James; Ddumba, Edward; Sajatovic, Martha; Sila, Cathy; DeGeorgia, Michael; Katabira, Elly

2016-01-02

Raised blood pressure (BP) remains an important risk factor for cardiovascular diseases such as stroke. Adherence to therapeutic recommendations especially antihypertensive drugs is important in BP control. The aim of the study was to assess the stroke risk factors and levels of adherence among hypertensive patients with stroke in Kampala Uganda. In a cross-sectional study we describe 112 hypertensive subjects with stroke from two Kampala city hospitals. A standardized pre-tested questionnaire was used to collect medical history, clinical details, radiological findings and laboratory data. A total of 112 hypertensive subjects with stroke were enrolled between May 2013 and April 2014. The median ages were 63.5 years (52.5-75.0) for the cases. Seventy percent (78/112) of the study participants had ischemic strokes. Only 17% were adherent to anti-hypertensive medications. The main cause of non-adherence appears to be lack of knowledge. Poor adherence of anti-hypertensive medications among hypertensive patients remains a big challenge in our setting. This has been attributed to lack of adequate knowledge and cost of the prescribed drugs. There is therefore an urgent need to promptly diagnose and educate hypertensive patients with emphasis on adherence to anti hypertensive drugs.

Drinking Water from Dug Wells in Rural Ghana — Salmonella Contamination, Environmental Factors, and Genotypes

PubMed Central

Dekker, Denise Myriam; Krumkamp, Ralf; Sarpong, Nimako; Frickmann, Hagen; Boahen, Kennedy Gyau; Frimpong, Michael; Asare, Renate; Larbi, Richard; Hagen, Ralf Matthias; Poppert, Sven; Rabsch, Wolfgang; Marks, Florian; Adu-Sarkodie, Yaw; May, Jürgen

2015-01-01

Salmonellosis is an important but neglected disease in sub-Saharan Africa. Food or fecal-oral associated transmissions are the primary cause of infections, while the role of waterborne transmission is unclear. Samples were collected from different dug wells in a rural area of Ghana and analyzed for contamination with bacteria, and with Salmonella in particular. In addition, temporal dynamics and riks factors for contamination were investigated in 16 wells. For all Salmonella isolates antibiotic susceptibility testing was performed, serovars were determined and strains from the same well with the same serovar were genotyped. The frequency of well water contamination with Gram-negative rod-shaped bacteria was 99.2% (n = 395). Out of 398 samples, 26 (6.5%) tested positive for Salmonella spp. The serovar distribution was diverse including strains not commonly isolated from clinical samples. Resistance to locally applied antibiotics or resistance to fluoroquinolones was not seen in the Salmonella isolates. The risk of Salmonella contamination was lower in wells surrounded by a frame and higher during the rainy season. The study confirms the overall poor microbiological quality of well water in a resource-poor area of Ghana. Well contamination with Salmonella poses a potential threat of infection, thus highlighting the important role of drinking water safety in infectious disease control. PMID:25826395

Synthesis of a Nano-Silver Metal Ink for Use in Thick Conductive Film Fabrication Applied on a Semiconductor Package

PubMed Central

Yung, Lai Chin; Fei, Cheong Choke; Mandeep, JS; Binti Abdullah, Huda; Wee, Lai Khin

2014-01-01

The success of printing technology in the electronics industry primarily depends on the availability of metal printing ink. Various types of commercially available metal ink are widely used in different industries such as the solar cell, radio frequency identification (RFID) and light emitting diode (LED) industries, with limited usage in semiconductor packaging. The use of printed ink in semiconductor IC packaging is limited by several factors such as poor electrical performance and mechanical strength. Poor adhesion of the printed metal track to the epoxy molding compound is another critical factor that has caused a decline in interest in the application of printing technology to the semiconductor industry. In this study, two different groups of adhesion promoters, based on metal and polymer groups, were used to promote adhesion between the printed ink and the epoxy molding substrate. The experimental data show that silver ink with a metal oxide adhesion promoter adheres better than silver ink with a polymer adhesion promoter. This result can be explained by the hydroxyl bonding between the metal oxide promoter and the silane grouping agent on the epoxy substrate, which contributes a greater adhesion strength compared to the polymer adhesion promoter. Hypotheses of the physical and chemical functions of both adhesion promoters are described in detail. PMID:24830317

[Health status, use of health services and reported morbidity: application of correspondence analysis].

PubMed

Espinàs, J A; Riba, M D; Borràs, J M; Sánchez, V

1995-01-01

The study of the relationship between self-reported morbidity, health status and health care utilization presents methodological problems due to the variety of illnesses and medical conditions that one individual may report. In this article, correspondence analysis was use to analyse these relationships. Data from the Spanish National Health Survey pertaining to the region of Catalonia was studied. Statistical analysis included multi-way correspondence analysis (MCA) followed by cluster analysis. The first factor extracted is defined by self-assessed health perception; the second, by limitation of activities, and the third is related to self-reported morbidity caused by chronic and acute health problems. Fourth and fifth factors, capture residual variability and missing values. Acute problems are more related to perception of poor health while chronic problems are related to perception of fair health. Also, it may be possible to distinguish self-reported morbidity due to relapses of chronic diseases from true acute health problems. Cluster analysis classified individuals into four groups: 1) healthy people; 2) people who assess their health as being poor and those with acute health problems; 3) people with chronic health problems, limited activity and a perception of fair health; and 4) missing values. Correspondence analysis is a useful tool when analyzing qualitative variables like those in a health survey.

Drinking water from dug wells in rural ghana--salmonella contamination, environmental factors, and genotypes.

PubMed

Dekker, Denise Myriam; Krumkamp, Ralf; Sarpong, Nimako; Frickmann, Hagen; Boahen, Kennedy Gyau; Frimpong, Michael; Asare, Renate; Larbi, Richard; Hagen, Ralf Matthias; Poppert, Sven; Rabsch, Wolfgang; Marks, Florian; Adu-Sarkodie, Yaw; May, Jürgen

2015-03-27

Salmonellosis is an important but neglected disease in sub-Saharan Africa. Food or fecal-oral associated transmissions are the primary cause of infections, while the role of waterborne transmission is unclear. Samples were collected from different dug wells in a rural area of Ghana and analyzed for contamination with bacteria, and with Salmonella in particular. In addition, temporal dynamics and riks factors for contamination were investigated in 16 wells. For all Salmonella isolates antibiotic susceptibility testing was performed, serovars were determined and strains from the same well with the same serovar were genotyped. The frequency of well water contamination with Gram-negative rod-shaped bacteria was 99.2% (n = 395). Out of 398 samples, 26 (6.5%) tested positive for Salmonella spp. The serovar distribution was diverse including strains not commonly isolated from clinical samples. Resistance to locally applied antibiotics or resistance to fluoroquinolones was not seen in the Salmonella isolates. The risk of Salmonella contamination was lower in wells surrounded by a frame and higher during the rainy season. The study confirms the overall poor microbiological quality of well water in a resource-poor area of Ghana. Well contamination with Salmonella poses a potential threat of infection, thus highlighting the important role of drinking water safety in infectious disease control.

Epilepsy coexisting with depression.

PubMed

Błaszczyk, Barbara; Czuczwar, Stanisław J

2016-10-01

Depression episodes in epilepsy is the most common commorbidity, affecting between 11% and 62% of patients with epilepsy. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. The manifestation of depression in epilepsy is a complex issue having many interacting neurobiological and psychosocial determinants, including clinical features of epilepsy (seizure frequency, type, foci, or lateralization of foci) and neurochemical or iatrogenic mechanisms. Other risk factors are a family history of psychiatric illness, particularly depression, a lack of control over the seizures and iatrogenic causes (pharmacologic and surgical). In addition, treatment with antiepileptic drugs (AEDs) as well as social coping and adaptation skills have also been recognised as risk factors of depression associated with epilepsy. Epilepsy may foster the development of depression through being exposed to chronic stress. The uncertainty and unpredictability of seizures may instigate sadness, loneliness, despair, low self-esteem, and self-reproach in patients with epilepsy and lead to social isolation, stigmatization, or disability. Often, depression is viewed as a reaction to epilepsy's stigma and the associated poor quality of life. Moreover, patients with epilepsy display a 4-5 higher rate of depression and suicide compared with healthy population. Copyright © 2016. Published by Elsevier Urban & Partner Sp. z o.o.

Synthesis of a nano-silver metal ink for use in thick conductive film fabrication applied on a semiconductor package.

PubMed

Yung, Lai Chin; Fei, Cheong Choke; Mandeep, Js; Binti Abdullah, Huda; Wee, Lai Khin

2014-01-01

The success of printing technology in the electronics industry primarily depends on the availability of metal printing ink. Various types of commercially available metal ink are widely used in different industries such as the solar cell, radio frequency identification (RFID) and light emitting diode (LED) industries, with limited usage in semiconductor packaging. The use of printed ink in semiconductor IC packaging is limited by several factors such as poor electrical performance and mechanical strength. Poor adhesion of the printed metal track to the epoxy molding compound is another critical factor that has caused a decline in interest in the application of printing technology to the semiconductor industry. In this study, two different groups of adhesion promoters, based on metal and polymer groups, were used to promote adhesion between the printed ink and the epoxy molding substrate. The experimental data show that silver ink with a metal oxide adhesion promoter adheres better than silver ink with a polymer adhesion promoter. This result can be explained by the hydroxyl bonding between the metal oxide promoter and the silane grouping agent on the epoxy substrate, which contributes a greater adhesion strength compared to the polymer adhesion promoter. Hypotheses of the physical and chemical functions of both adhesion promoters are described in detail.

Strategy to identify the causes and to solve a sludge granulation problem in methanogenic reactors: application to a full-scale plant treating cheese wastewater.

PubMed

Macarie, Hervé; Esquivel, Maricela; Laguna, Acela; Baron, Olivier; El Mamouni, Rachid; Guiot, Serge R; Monroy, Oscar

2017-08-26

Granulation of biomass is at the basis of the operation of the most successful anaerobic systems (UASB, EGSB and IC reactors) applied worldwide for wastewater treatment. Despite of decades of studies of the biomass granulation process, it is still not fully understood and controlled. "Degranulation/lack of granulation" is a problem that occurs sometimes in anaerobic systems resulting often in heavy loss of biomass and poor treatment efficiencies or even complete reactor failure. Such a problem occurred in Mexico in two full-scale UASB reactors treating cheese wastewater. A close follow-up of the plant was performed to try to identify the factors responsible for the phenomenon. Basically, the list of possible causes to a granulation problem that were investigated can be classified amongst nutritional, i.e. related to wastewater composition (e.g. deficiency or excess of macronutrients or micronutrients, too high COD proportion due to proteins or volatile fatty acids, high ammonium, sulphate or fat concentrations), operational (excessive loading rate, sub- or over-optimal water upflow velocity) and structural (poor hydraulic design of the plant). Despite of an intensive search, the causes of the granulation problems could not be identified. The present case remains however an example of the strategy that must be followed to identify these causes and could be used as a guide for plant operators or consultants who are confronted with a similar situation independently of the type of wastewater. According to a large literature based on successful experiments at lab scale, an attempt to artificially granulate the industrial reactor biomass through the dosage of a cationic polymer was also tested but equally failed. Instead of promoting granulation, the dosage caused a heavy sludge flotation. This shows that the scaling of such a procedure from lab to real scale cannot be advised right away unless its operability at such a scale can be demonstrated.

Acute liver failure caused by hepatitis E virus genotype 3 and 4: A systematic review and pooled analysis.

PubMed

Haffar, Samir; Shalimar; Kaur, Ravinder J; Wang, Zhen; Prokop, Larry J; Murad, Mohammad H; Bazerbachi, Fateh

2018-04-19

Acute liver failure caused by hepatitis E virus genotype 3 and 4 has been rarely described. Because of the presence of a short golden therapeutic window in patients with viral acute liver failure from other causes, it is possible that early recognition and treatment might reduce the morbidity and mortality. We performed a systematic review and pooled analysis of acute liver failure caused by hepatitis E virus genotype 3 and 4. Two reviewers appraised studies after searching multiple databases on June 12th, 2017. Appropriate tests were used to compare hepatitis E virus genotype 3 vs 4, suspected vs confirmed genotypes, hepatitis E virus-RNA positive vs negative, and to discern important mortality risk factors. We identified 65 patients, with median age 58 years (range: 3-79), and a male to female ratio of 1.2:1. The median bilirubin, ALT, AST and alkaline phosphatase (expressed by multiplication of the upper limit of normal) levels were 14.8, 45.3, 34.8 and 1.63 respectively. Antihepatitis E virus IgG, antihepatitis E virus IgM and hepatitis E virus-RNA were positive in 84%, 91% and 86% of patients respectively. The median interval from symptoms onset to acute liver failure was 23 days, and 16 patients underwent liver transplantation. Final outcome was reported in 58 patients and mortality was 46%. Age was a predictor of poor prognosis in multivariate analysis. No important differences were found between patients infected with genotype 3 vs 4, patients with confirmed vs suspected genotypes, or patients with positive vs negative RNA. Acute liver failure caused by hepatitis E virus genotype 3 and 4 is rare, similar between genotypes, occurs commonly in middle-aged/elderly patients and has a very high mortality. Age is predictive of poor prognosis in multivariate analysis. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[ANALYSIS OF BACKGROUNDS AND LEVEL OF UNDERSTANDING OF TREATMENT OF POOR ADHERENCE AND DROPOUT CASES ON SUBLINGUAL IMMUNOTHERAPY FOR JAPANESE CEDAR POLLINOSIS IN THE FIRST FOLLOW-UP YEAR].

PubMed

Kikkawa, Sayaka; Kamijo, Atsushi; Nakagome, Kazuyuki; Soma, Tomoyuki; Kobayashi, Takehito; Uchida, Yoshitaka; Morita, Eiji; Nagata, Makoto; Inoue, Tomoe; Kase, Yasuhiro

We considered the factors of poor adherence to and dropout from sublingual immunotherapy (SLIT) by verifying patient backgrounds 1 year after start of treatment. We recruited 38 patients who began SLIT between November 2014 and September 2015. We analyzed their attributes and level of understanding of the treatment, and conducted a self-reported survey on factors behind dropout cases and poor adherence cases. Four patients dropped out 1 year after start of treatment. Three left for reasons related to anxiety about side effects. There were five cases of poor adherence. There was no significant difference between good adherence, poor adherence, and dropout regarding level of understanding of the treatment (p=0.59). In the comparison between good and poor adherence groups, except four dropout patients, the adherence tended to be poor in patients with short duration of disease, smoking patients, and young patients. Continuous rate of SLIT achieved about 90%, suggesting relatively high level of adherence. It appears possible that anxiety related to side effects could be a factor affecting dropout from SLIT. There was no significant difference regarding level of understanding of the treatment. The adherence tended to be poor in patients with short duration of disease, smoking patients, and young patients.

China's water scarcity.

PubMed

Jiang, Yong

2009-08-01

China has been facing increasingly severe water scarcity, especially in the northern part of the country. China's water scarcity is characterized by insufficient local water resources as well as reduced water quality due to increasing pollution, both of which have caused serious impacts on society and the environment. Three factors contribute to China's water scarcity: uneven spatial distribution of water resources; rapid economic development and urbanization with a large and growing population; and poor water resource management. While it is nearly impossible to adjust the first two factors, improving water resource management represents a cost-effective option that can alleviate China's vulnerability to the issue. Improving water resource management is a long-term task requiring a holistic approach with constant effort. Water right institutions, market-based approaches, and capacity building should be the government's top priority to address the water scarcity issue.

Contributory factors in herb-induced fatal aconite poisoning.

PubMed

Chan, Thomas Y K

2012-11-30

Detailed investigations of all reported cases of herb-induced aconite poisoning are necessary to identify the major contributory causes so that preventive measures can be formulated. In the present review of 12 fatal cases that were published in the medical journals during 1992 and 2011, the available clinical data and forensic toxicological analyses indicated that poor post-harvest processing of aconite roots, use of greater than the recommended doses and inadequate boiling of processed aconite roots during decoction preparation were important contributory factors in herb-induced aconite poisoning. Under such circumstances, the actual amount of Aconitum alkaloids ingested was much larger than intended. Good manufacturing practice to ensure adequate processing of aconite roots, use of the recommended doses, clear instructions for the patients and their compliance during decoction preparation are important preventive measures. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Predictive factors for lymph node metastasis in poorly differentiated early gastric cancer and their impact on the surgical strategy

PubMed Central

Li, Hua; Lu, Ping; Lu, Yang; Liu, Cai-Gang; Xu, Hui-Mian; Wang, Shu-Bao; Chen, Jun-Qing

2008-01-01

AIM: To identify the predictive clinicopathological factors for lymph node metastasis (LNM) in poorly differentiated early gastric cancer (EGC) and to further expand the possibility of using endoscopic mucosal resection (EMR) for the treatment of poorly differentiated EGC. METHODS: Data were collected from 85 poorly-differentiated EGC patients who were surgically treated. Association between the clinicopathological factors and the presence of LNM was retrospectively analyzed by univariate and multivariate logistic regression analyses. RESULTS: Univariate analysis showed that tumor size (OR = 5.814, 95% CI = 1.050 - 32.172, P = 0.044), depth of invasion (OR = 10.763, 95% CI = 1.259 - 92.026, P = 0.030) and lymphatic vessel involvement (OR = 61.697, 95% CI = 2.144 - 175.485, P = 0.007) were the significant and independent risk factors for LNM. The LNM rate was 5.4%, 42.9% and 50%, respectively, in poorly differentiated EGC patients with one, two and three of the risk factors, respectively. No LNM was found in 25 patients without the three risk factors. Forty-four lymph nodes were found to have metastasis, 29 (65.9%) and 15 (34.1%) of the lymph nodes involved were within N1 and beyond N1, respectively, in 12 patients with LNM. CONCLUSION: Endoscopic mucosal resection alone may be sufficient to treat poorly differentiated intramucosal EGC (≤ 2.0 cm in diameter) with no histologically-confirmed lymphatic vessel involvement. When lymphatic vessels are involved, lymph node dissection beyond limited (D1) dissection or D1+ lymph node dissection should be performed depending on the tumor location. PMID:18636670

Poverty and stroke in India: a time to act.

PubMed

Pandian, Jeyaraj D; Srikanth, Velandai; Read, Stephen J; Thrift, Amanda G

2007-11-01

In developed countries, the predominant health problems are those lifestyle-related illnesses associated with increased wealth. In contrast, diseases occurring in developing countries can largely be attributed to poverty, poor healthcare infrastructure, and limited access to care. However, many developing countries such as India have undergone economic and demographic growth in recent years resulting in a transition from diseases caused by poverty toward chronic, noncommunicable, lifestyle-related diseases. Despite this recent rapid economic growth, a large proportion of the Indian population lives in poverty. Although risk factors for stroke in urban Indian populations are similar to developed nations, it is likely that they may be quite different among those afflicted by poverty. Furthermore, treatment options for stroke are fewer in developing countries like India. Well-organized stroke services and emergency transport services are lacking, many treatments are unaffordable, and sociocultural factors may influence access to medical care for many stroke victims. Most stroke centers are currently in the private sector and establishing such centers in the public sector will require enormous capital investment. Given the limited resources available for hospital treatments, it would be logical to place a greater emphasis on effective populationwide interventions to control or reduce exposure to leading stroke risk factors. There also needs to be a concerted effort to ensure access to stroke care programs that are tailored to suit Indian communities and are accessible to the large majority of the population, namely the poor.

National Institutes of Health funding for behavioral interventions to prevent chronic diseases.

PubMed

Calitz, Chris; Pollack, Keshia M; Millard, Chris; Yach, Derek

2015-04-01

Chronic non-communicable diseases (NCDs) cause the majority of premature deaths, disability, and healthcare expenditures in the U.S. Six largely modifiable risk behaviors and factors (tobacco use, poor nutrition, physical inactivity, alcohol abuse, drug abuse, and poor mental health) account for more than 50% of premature mortality and considerably more morbidity and disability. The IOM proposed that population burden of disease and preventability should be major determinants of the amount of research funding provided by the U.S. NIH. Data on NIH prevention funding between fiscal years 2010 and 2012 for human behavioral interventions that target the modifiable risk factors of NCDs were analyzed during 2013-2014. The NIH prevention portfolio comprises approximately 37% human behavioral studies and 63% basic biomedical, genetic, and animal studies. Approximately 65% of studies were secondary prevention versus 23% for primary prevention, and 71% of studies intervened at the individual and family levels. Diet and exercise were the most-studied risk factors (41%), and few studies conducted economic analyses (12%). NIH spends an estimated $2.2-$2.6 billion annually (7%-9% of the total of $30 billion) on human behavioral interventions to prevent NCDs. Although NIH prevention funding broadly aligns with the current burden of disease, overall funding remains low compared to funding for treatment, which suggests funding misalignment with the preventability of chronic diseases. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The limits of low-temperature performance of Li-ion cells

NASA Technical Reports Server (NTRS)

Huang, C.; Sakamoto, J.; Wolfenstine, J.; Surampudi, S.

2000-01-01

The results of electrode and electrolyte studies reveal that the poor low-temperature (<-30 degrees C) performance of Li-ion cells is mainly caused by the carbon electrodes and not the organic electrolytes and solid electrolyte interphase, as previously suggested. It is suggested that the main causes for the poor performance in the carbon electrodes are (i) the low value and concentration depedence of the Li diffusivity and (ii) limited Li capacity.

An adaptive optics imaging system designed for clinical use.

PubMed

Zhang, Jie; Yang, Qiang; Saito, Kenichi; Nozato, Koji; Williams, David R; Rossi, Ethan A

2015-06-01

Here we demonstrate a new imaging system that addresses several major problems limiting the clinical utility of conventional adaptive optics scanning light ophthalmoscopy (AOSLO), including its small field of view (FOV), reliance on patient fixation for targeting imaging, and substantial post-processing time. We previously showed an efficient image based eye tracking method for real-time optical stabilization and image registration in AOSLO. However, in patients with poor fixation, eye motion causes the FOV to drift substantially, causing this approach to fail. We solve that problem here by tracking eye motion at multiple spatial scales simultaneously by optically and electronically integrating a wide FOV SLO (WFSLO) with an AOSLO. This multi-scale approach, implemented with fast tip/tilt mirrors, has a large stabilization range of ± 5.6°. Our method consists of three stages implemented in parallel: 1) coarse optical stabilization driven by a WFSLO image, 2) fine optical stabilization driven by an AOSLO image, and 3) sub-pixel digital registration of the AOSLO image. We evaluated system performance in normal eyes and diseased eyes with poor fixation. Residual image motion with incremental compensation after each stage was: 1) ~2-3 arc minutes, (arcmin) 2) ~0.5-0.8 arcmin and, 3) ~0.05-0.07 arcmin, for normal eyes. Performance in eyes with poor fixation was: 1) ~3-5 arcmin, 2) ~0.7-1.1 arcmin and 3) ~0.07-0.14 arcmin. We demonstrate that this system is capable of reducing image motion by a factor of ~400, on average. This new optical design provides additional benefits for clinical imaging, including a steering subsystem for AOSLO that can be guided by the WFSLO to target specific regions of interest such as retinal pathology and real-time averaging of registered images to eliminate image post-processing.

Limitation of Unloading in the Developing Grains Is a Possible Cause Responsible for Low Stem Non-structural Carbohydrate Translocation and Poor Grain Yield Formation in Rice through Verification of Recombinant Inbred Lines

PubMed Central

Li, Guohui; Pan, Junfeng; Cui, Kehui; Yuan, Musong; Hu, Qiuqian; Wang, Wencheng; Mohapatra, Pravat K.; Nie, Lixiao; Huang, Jianliang; Peng, Shaobing

2017-01-01

Remobilisation of non-structural carbohydrates (NSC) from leaves and stems and unloading into developing grains are essential for yield formation of rice. In present study, three recombinant inbred lines of rice, R91, R156 and R201 have been tested for source-flow-sink related attributes determining the nature of NSC accumulation and translocation at two nitrogen levels in the field. Compared to R91 and R156, R201 had lower grain filling percentage, harvest index, and grain yield. Meanwhile, R201 had significantly lower stem NSC translocation during grain filling stage. Grain filling percentage, harvest index, and grain yield showed the consistent trend with stem NSC translocation among the three lines. In comparison with R91 and R156, R201 had similarity in leaf area index, specific leaf weight, stem NSC concentration at heading, biomass, panicles m-2, spikelets per panicle, remobilization capability of assimilation in stems, sink capacity, sink activity, number and cross sectional area of small vascular bundles, greater number and cross sectional area of large vascular bundles, and higher SPAD, suggesting that source, flow, and sink were not the limiting factors for low stem NSC translocation and grain filling percentage of R201. However, R201 had significant higher stem and rachis NSC concentrations at maturity, which implied that unloading in the developing grains might result in low NSC translocation in R201. The results indicate that stem NSC translocation could be beneficial for enhancement of grain yield potential, and poor unloading into caryopsis may be the possible cause of low stem NSC translocation, poor grain filling and yield formation in R201. PMID:28848573

Association between Household Air Pollution Exposure and Chronic Obstructive Pulmonary Disease Outcomes in 13 Low- and Middle-Income Country Settings.

PubMed

Siddharthan, Trishul; Grigsby, Matthew R; Goodman, Dina; Chowdhury, Muhammad; Rubinstein, Adolfo; Irazola, Vilma; Gutierrez, Laura; Miranda, J Jaime; Bernabe-Ortiz, Antonio; Alam, Dewan; Kirenga, Bruce; Jones, Rupert; van Gemert, Frederick; Wise, Robert A; Checkley, William

2018-03-01

Forty percent of households worldwide burn biomass fuels for energy, which may be the most important contributor to household air pollution. To examine the association between household air pollution exposure and chronic obstructive pulmonary disease (COPD) outcomes in 13 resource-poor settings. We analyzed data from 12,396 adult participants living in 13 resource-poor, population-based settings. Household air pollution exposure was defined as using biomass materials as the primary fuel source in the home. We used multivariable regressions to assess the relationship between household air pollution exposure and COPD outcomes, evaluated for interactions, and conducted sensitivity analyses to test the robustness of our findings. Average age was 54.9 years (44.2-59.6 yr across settings), 48.5% were women (38.3-54.5%), prevalence of household air pollution exposure was 38% (0.5-99.6%), and 8.8% (1.7-15.5%) had COPD. Participants with household air pollution exposure were 41% more likely to have COPD (adjusted odds ratio, 1.41; 95% confidence interval, 1.18-1.68) than those without the exposure, and 13.5% (6.4-20.6%) of COPD prevalence may be caused by household air pollution exposure, compared with 12.4% caused by cigarette smoking. The association between household air pollution exposure and COPD was stronger in women (1.70; 1.24-2.32) than in men (1.21; 0.92-1.58). Household air pollution exposure was associated with a higher prevalence of COPD, particularly among women, and it is likely a leading population-attributable risk factor for COPD in resource-poor settings.

Lay theories of obesity predict actual body mass.

PubMed

McFerran, Brent; Mukhopadhyay, Anirban

2013-08-01

Obesity is a major public health problem, but despite much research into its causes, scientists have largely neglected to examine laypeople's personal beliefs about it. Such naive beliefs are important because they guide actual goal-directed behaviors. In a series of studies across five countries on three continents, we found that people mainly believed either that obesity is caused by a lack of exercise or that it is caused by a poor diet. Moreover, laypeople who indicted a lack of exercise were more likely to actually be overweight than were those who implicated a poor diet. This effect held even after controlling for several known correlates of body mass index (BMI), thereby explaining previously unexplained variance. We also experimentally demonstrated the mechanism underlying this effect: People who implicated insufficient exercise tended to consume more food than did those who indicted a poor diet. These results suggest that obesity has an important, pervasive, and hitherto overlooked psychological antecedent.

[Healing status of surgical incisions in human immunodeficiency virus-positive patients with fractures].

PubMed

Li, Xin; Zhang, Qiang; Zhao, Changsong; Sun, Sheng; Cai, Juan

2014-09-09

To observe the healing status of surgical incisions in human immunodeficiency virus (HIV)-positive patients with fractures and explore the factors related with poor wound healing, treatment and preventive measures. Retrospective analyses were performed for the clinical data of 61 HIV-positive patients with fractures. And the influencing factors, treatment and outcomes of poor wound healing were analyzed. Among them, the healing status was good (n = 50) and poor (n = 11). And the outcomes included redness (n = 10), oozing (n = 8), split (n = 3), infection (n = 2), hematoma (n = 1), fat liquefaction (n = 2) and delayed healing (n = 2). All healed well after treatment. There was no infection or death during the follow-up period. Compared with HIV-negative patients, it was not statistically significant in wound infection. However, poor healing rates were significantly different (P < 0.05). The risk factors included advanced age, low body mass index, low albumin, low hemoglobin, low total lymphocyte count, low CD4⁺ T lymphocyte count, high HIV infection clinical stage, long operative duration, emergency surgery and incision contamination. In HIV-positive patients with fractures, the healing of surgical incision is generally good. However few have poor wound healing due to multiple factors. If poor healing is identified early and handled timely and correctly, good healing ensues.

Reversal of experimental Laron Syndrome by xenotransplantation of microencapsulated porcine Sertoli cells.

PubMed

Luca, Giovanni; Calvitti, Mario; Mancuso, Francesca; Falabella, Giulia; Arato, Iva; Bellucci, Catia; List, Edward O; Bellezza, Enrico; Angeli, Giovanni; Lilli, Cinzia; Bodo, Maria; Becchetti, Ennio; Kopchick, John J; Cameron, Don F; Baroni, Tiziano; Calafiore, Riccardo

2013-01-10

Recombinant human IGF-1 currently represents the only available treatment option for the Laron Syndrome, a rare human disorder caused by defects in the gene encoding growth hormone receptor, resulting in irreversibly retarded growth. Unfortunately, this treatment therapy, poorly impacts longitudinal growth (13% in females and 19% in males), while burdening the patients with severe side effects, including hypoglycemia, in association with the unfair chore of taking multiple daily injections that cause local intense pain. In this study, we have demonstrated that a single intraperitoneal graft of microencapsulated pig Sertoli cells, producing pig insulin-like growth factor-1, successfully promoted significant proportional growth in the Laron mouse, a unique animal model of the human Laron Syndrome. These findings indicate a novel, simply, safe and successful method for the cell therapy-based cure of the Laron Syndrome, potentially applicable to humans. Copyright © 2012 Elsevier B.V. All rights reserved.

[Non-Helicobacter pylori, Non-nonsteroidal Anti-inflammatory Drug Peptic Ulcer Disease].

PubMed

Chang, Young Woon

2016-06-25

Non-Helicobacter pylori, non-NSAID peptic ulcer disease (PUD), termed idiopathic PUD, is increasing in Korea. Diagnosis is based on exclusion of common causes such as H. pylori infection, infection with other pathogens, surreptitious ulcerogenic drugs, malignancy, and uncommon systemic diseases with upper gastrointestinal manifestations. The clinical course of idiopathic PUD is delayed ulcer healing, higher recurrence, higher re-bleeding after initial ulcer healing, and higher mortality than the other types of PUD. Genetic predisposition, older age, chronic mesenteric ischemia, cigarette smoking, concomitant systemic diseases, and psychological stress are considered risk factors for idiopathic PUD. Diagnosis of idiopathic PUD should systematically explore all possible causes. Management of this disease is to treat underlying disease followed by regular endoscopic surveillance to confirm ulcer healing. Continuous proton pump inhibitor therapy is an option for patients who respond poorly to the standard ulcer regimen.

Repletion of TNFα or leptin in calorically restricted mice suppresses post-restriction hyperphagia

PubMed Central

Hambly, Catherine; Duncan, Jacqueline S.; Archer, Zoë A.; Moar, Kim M.; Mercer, Julian G.; Speakman, John R.

2012-01-01

SUMMARY The causes of post-restriction hyperphagia (PRH) represent a target for drug-based therapies to prevent obesity. However, the factors causing PRH are poorly understood. We show that, in mice, the extent of PRH was independent of the time under restriction, but depended on its severity, suggesting that PRH was driven by signals from altered body composition. Signals related to fat mass were important drivers. Circulating levels of leptin and TNFα were significantly depleted following caloric restriction (CR). We experimentally repleted their levels to match those of controls, and found that in both treatment groups the level of PRH was significantly blunted. These data establish a role for TNFα and leptin in the non-pathological regulation of energy homeostasis. Signals from adipose tissue, including but not limited to leptin and TNFα, regulate PRH and might be targets for therapies that support people engaged in CR to reduce obesity. PMID:21954068

Delayed Consequences of Acute Kidney Injury

PubMed Central

Parr, Sharidan K; Siew, Edward D

2016-01-01

Acute kidney injury (AKI) is an increasingly common complication of hospitalization and acute illness. Experimental data indicate that AKI may cause permanent kidney damage through tubulointerstitial fibrosis and progressive nephron loss, while also lowering the threshold for subsequent injury. Furthermore, preclinical data suggest that AKI may also cause distant organ dysfunction. The extension of these findings to human studies suggests long-term consequences of AKI including, but not limited to recurrent AKI, progressive kidney disease, elevated blood pressure, cardiovascular events, and mortality. As the number of AKI survivors increases, the need to better understand the mechanisms driving these processes becomes paramount. Optimizing care for AKI survivors will require understanding the short- and long-term risks associated with AKI, identifying patients at highest risk for poor outcomes, and testing interventions that target modifiable risk factors. In this review, we examine the literature describing the association between AKI and long-term outcomes and highlight opportunities for further research and potential intervention. PMID:27113695

A historical and socioeconomic analysis of occupational safety and health in India.

PubMed

Vilanilam, J V

1980-01-01

Workers in poor countries of the so-called Third World are more likely to be affected by the dangers of high technology than their counterparts in wealthier countries. Owing to their lack of education, most workers in the "developing" world are unaware of the hazards of their occupations. Moreover, their general backwardness in sanitation and nutrition and climatic proneness of their geographic region to epidemics cause diseases contracted from the work environment to be aggravated. occupational diseases are often misconstrued as diseases resulting from the general environment. Since unemployment in underdeveloped countries is of a very high order, workers are prepared to accept any job, irrespective of the dangers involved. Labor is cheap and easily replaceable, so employers see no need for improving occupational safety and health. Labor unions are mostly controlled by full-time politicians who consider health a political issue, especially when their party controls the country's government. The seriousness of all these factors is heightened by the existing socioeconomic order in poor countries, in which national medievalism and multinational modernism play a crucial role. In order to understand the prevailing socioeconomic order, one has to analyze the social structures of poor countries in the context of today's world economic structure. India is taken as an example of a "developing" country where all the above-mentioned factors and many others are in operation: backwardness of the worker; poor nutrition; lack of concern for public health; proneness to epidemics; and indifference on the part of employers, politicians, and unions toward occupational health; high unemployment, control of the local economy by multinational corporations; and control of the mass media by feudalistic vested interests. This article attempts to analyze the occupational health and safety issue in India from a historical perspective, and stresses the vital need of structural changes in various fields so that workers can have a safe and healthy working environment.

Sleep patterns as predictors for disability pension due to low back diagnoses: a 23-year longitudinal study of Finnish twins.

PubMed

Ropponen, Annina; Silventoinen, Karri; Hublin, Christer; Svedberg, Pia; Koskenvuo, Markku; Kaprio, Jaakko

2013-06-01

Impaired sleep patterns are known to be associated with many chronic conditions and ultimately they may lead to permanent work incapacity. Less is known about the associations between sleep patterns and cause-specific disability pensions, such as low back diagnoses, or whether familial factors (genetics and family environment) can affect the associations. The objective of this study was to investigate sleep patterns as predictors of disability pension due to low back diagnoses with a 23-year follow-up. A prospective cohort study with comprehensive mailed questionnaires about sleep patterns, e.g., quality and length of sleep in 1975 and 1981. Follow-up from the national disability pension register data until 2004. Not applicable. There were 18,979 individuals (7,722 complete twin pairs) born before 1958. Cox proportional hazards regression was used to calculate hazard ratios (HR) with 95% confidence intervals (95% CI). Disability pension due to low back diagnoses had been granted to 467 individuals during the follow-up. Sleeping moderately well (HR 1.25; 95% CI 1.02, 1.53), or fairly poorly/poorly (HR 2.05; 95% CI 1.53, 2.73) at baseline predicted a significantly higher risk for disability pension. Stable patterns of sleeping either fairly well (HR 1.29; 95% CI 1.01, 1.64), or stably fairly poorly/poorly (HR 2.29; 95% CI 1.49, 3.52) between 1975 and 1981 were associated with a higher risk as compared to a stable pattern of sleeping well. Furthermore, a decrease in quality of sleep from 1975 to 1981 was associated (HR 1.34; 95% CI 1.03, 1.76) with an increased risk of disability pension. Sleep quality and changes in sleep quality appear to be early predictors for disability pension due to low back diagnoses independently from other confounding factors.

[Factors associated with poor sleep quality in the Brazilian population ≥ 40 years of age: VIGICARDIO Study].

PubMed

Muñoz-Pareja, Maritza; Loch, Mathias Roberto; Dos Santos, Hellen Geremias; Sakay Bortoletto, Maira Sayuri; Durán González, Alberto; Maffei de Andrade, Selma

The prevalence of poor sleep quality in men and women ≥ 40 years old from the VIGICARDIO Study was determined, and sociodemographic, health, lifestyle and social capital factors associated with poor sleep quality were identified. A population-based study conducted in 2011 among 1,058 non-institutionalised individuals randomly selected from Cambé, Paraná State, Brazil. Logistic regression was used to evaluate the association between sleep quality and sociodemographic, health, lifestyle and social capital factors in men and women. The prevalence of poor sleep quality was 34% in men and 44% in women. Having bad/regular self-rated health status was a factor associated with poor sleep quality in men (OR: 1.79; 95% CI: 1.17-2.72) and women (OR: 2.43; 95% CI: 1.68-3.53). Being obese (OR: 1.67; 95% CI: 1.13-2.46), having depression (OR: 2.09; 95% CI: 1.41-3.13) and presenting temporal orientation difficulties (OR: 1.95; 95% CI: 1.08-3.52) were associated factors in women. Difficulty to understand what is explained (OR: 2.18; 95% CI: 1.16-4.09) and alcohol abuse (OR: 1.85; 95% CI: 1.21-2.83) were associated factors in men. Factors affecting sleep quality are different for men and for women. These factors should be taken into consideration when devising activities that promote good sleep quality, with a view to improving their effectiveness. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Stroke Epidemiology and Risk Factor Management.

PubMed

Guzik, Amy; Bushnell, Cheryl

2017-02-01

Death from stroke has decreased over the past decade, with stroke now the fifth leading cause of death in the United States. In addition, the incidence of new and recurrent stroke is declining, likely because of the increased use of specific prevention medications, such as statins and antihypertensives. Despite these positive trends in incidence and mortality, many strokes remain preventable. The major modifiable risk factors are hypertension, diabetes mellitus, tobacco smoking, and hyperlipidemia, as well as lifestyle factors, such as obesity, poor diet/nutrition, and physical inactivity. This article reviews the current recommendations for the management of each of these modifiable risk factors. It has been documented that some blood pressure medications may increase variability of blood pressure and ultimately increase the risk for stroke. Stroke prevention typically includes antiplatelet therapy (unless an indication for anticoagulation exists), so the most recent evidence supporting use of these drugs is reviewed. In addition, emerging risk factors, such as obstructive sleep apnea, electronic cigarettes, and elevated lipoprotein (a), are discussed. Overall, secondary stroke prevention includes a multifactorial approach. This article incorporates evidence from guidelines and published studies and uses an illustrative case study throughout the article to provide examples of secondary prevention management of stroke risk factors.

Pathologizing the Language and Culture of Poor Children

ERIC Educational Resources Information Center

Dudley-Marling, Curt; Lucas, Krista

2009-01-01

There has been a resurgence of deficit discourses that implicate deficiencies in the language and culture of poor students as the cause of their academic failures. An influential study by Betty Hart and Todd Risley concludes that high levels of academic failure among poor children can be linked to the quantity and quality of language interactions…

Understanding the cause of an unreadable nuclear medicine image: a case of unexpected results with 123I whole-body scintigraphy.

PubMed

Skweres, Justin; Yang, Zhiyun; Gonzalez-Toledo, Eduardo

2014-12-01

When unexpected results are obtained with standard image collection, the nuclear medicine physician must consider many technical factors that may have contributed. When image quality is poor, prior radiotracer administration, among other things, should always be considered. Our case demonstrates how knowledge of patient history and basic principles of nuclear medicine physics allows recognition of the septal penetration artifact. This allows the nuclear medicine physician to tailor the exam to an individual patient and obtain the most useful diagnostic information for the clinician. © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Hypocalcaemia following thyroidectomy unresponsive to oral therapy.

PubMed

Etheridge, Zac C; Schofield, Christopher; Prinsloo, Peter J J; Sturrock, Nigel D C

2014-01-01

Hypocalcaemia due to hypoparathyroidism following thyroidectomy is a relatively common occurrence. Standard treatment is with oral calcium and vitamin D replacement therapy; lack of response to oral therapy is rare. Herein we describe a case of hypoparathyroidism following thyroidectomy unresponsive to oral therapy in a patient with a complex medical history. We consider the potential causes in the context of calcium metabolism including: poor adherence, hungry bone syndrome, malabsorption, vitamin D resistance, bisphosphonate use and functional hypoparathyroidism secondary to magnesium deficiency. Malabsorption due to intestinal hurry was likely to be a contributory factor in this case and very large doses of oral therapy were required to avoid symptomatic hypocalcaemia.

[Selective mutism].

PubMed

Lämsä, Teemu; Erkolahti, Ritva

2013-01-01

Selective mutism is a disorder closely linked to anxiety disorders in particular social phobia. Heightened sensitivity to emotional stress factors and coping with social anxiety may be part of the causes leading to the failure to speak. Follow-up studies confirm the fact that selective mutism is a very persistent disorder with a general tendency of poor outcome in particular if not intensively treated. Current treatment combines different modalities of cognitive-behavioural therapies which are aimed to reduce anxiety symptoms and to improve verbal communication. Enhancing of parent-child interaction is often needed to improve the child's emotion regulation skills. SSRI medication, especially fluoxetine, may improve outcome when combined with therapy.

Primary and Secondary Prevention of Acute Coronary Syndromes: The Role of the Statins.

PubMed

Diamantis, Evangelos; Troupis, Theodoros; Mazarakis, Antonios; Kyriakos, Giorgos; Diamanti, S; Troupis, Georgios; Skandalakis, Panagiotis

2014-01-01

Poor prognosis is strongly associated with Acute Coronary Syndrome (ACS) and, even though a number of treatment strategies are available, the incidence of subsequent serious complications after an acute event is still high. Statins are hypolipidemic factors and recent studies have demonstrated that they have a protective role during the process of atherogenesis and that they reduce mortality caused by cardiovascular diseases. This review tries to reveal the function of the statins as a component of the primary and secondary action of acute coronary syndrome and to describe the lifestyle changes that have the same effect as the use of statins.

[Eating disorders in childhood and adolescence. Anorexia nervosa, bulimia nervosa, binge eating disorder].

PubMed

Gerlinghoff, M; Backmund, H

2004-03-01

The most important eating disorders are anorexia and bulimia, which most frequently occur for the first time during adolescence and continue into adulthood. Medical complications and accompanying psychological disturbances cause a significant mortality rate of up to 6% in anorexia and up to 3% in bulimia. The pathogenesis of eating disorders is still unclear. Current etiological concepts are multidimensional including biological, individual, familial, and sociocultural factors. In spite of a great variety of therapeutic possibilities, the prognosis for eating disorders is quite poor. In the long term, only about 50% of the persons affected overcome their illness. Preventive measures are therefore indispensable.

Diabetic Complications and Amputation Prevention

MedlinePlus

... because of two complications of diabetes: nerve damage (neuropathy) and poor circulation. Neuropathy causes loss of feeling in your feet, taking ... to the bone. Because of poor circulation and neuropathy in the feet, cuts or blisters can easily ...

Analysis of SEER Adenosquamous Carcinoma Data to Identify Cause Specific Survival Predictors and Socioeconomic Disparities.

PubMed

Cheung, Rex

2016-01-01

This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) adenosquamous carcinoma data to identify predictive models and potential disparities in outcome. This study analyzed socio-economic, staging and treatment factors available in the SEER database for adenosquamous carcinoma. For the risk modeling, each factor was fitted by a generalized linear model to predict the cause specific survival. An area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. A total of 20,712 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 54.2 (78.4) months. Some 2/3 of the patients were female. The mean (S.D.) age was 63 (13.8) years. SEER stage was the most predictive factor of outcome (ROC area of 0.71). 13.9% of the patients were un-staged and had risk of cause specific death of 61.3% that was higher than the 45.3% risk for the regional disease and lower than the 70.3% for metastatic disease. Sex, site, radiotherapy, and surgery had ROC areas of about 0.55-0.65. Rural residence and race contributed to socioeconomic disparity for treatment outcome. Radiotherapy was underused even with localized and regional stages when the intent was curative. This under use was most pronounced in older patients. Anatomic stage was predictive and useful in treatment selection. Under-staging may have contributed to poor outcome.

Increased SST and Frequent Occurrence of Rough Sea Events in the Bay of Bengal: Implications for livelihoods of Coastal Populace in Bangladesh (Invited)

NASA Astrophysics Data System (ADS)

Ahmed, A. U.

2010-12-01

Bangladesh is a densely populated low-lying deltaic country, widely known to be highly vulnerable to climate change. High vulnerability is caused mainly by geophysical factors, compounded by a number of social and economic factors such as large population, high incidence of poverty and malnutrition, glaring social inequity, and poor governance. The coastal zone facing the Bay of Bengal is particularly vulnerable to hazards such as sea level rise, salinity intrusion, high wave interaction and erosion, saline water-logging, and cyclonic storm surges. The sea surface temperature (SST) in the northern Indian Ocean has recently been exhibiting a general increasing trend, with a net rise of about 0.45°C over the past four decades. This has been attributed to climate change. The warming, identified by marked increase in SST, has been causing a significant increase in the formation of ‘low pressures’ to ‘deep depressions’ in the bay. Consequently, the tidal activities on the surface have become rough and turbulent, triggering a number of problems for the livelihoods of coastal population of Bangladesh. The coastal fisherfolk communities represent poorest of the poor, who can hardly earn a livelihood from traditional fishing practices. Their prime fishing period coincides with Monsoon and post-monsoon seasons combined, when the bay becomes rough, turbulent, and unsuitable for artisanal fishing. With increasing frequency of occurrence of ‘rough sea events’, the coastal fishermen are forced to stay out of action in anticipation of complete loss of investment made for fishing trips or forced to abandon incomplete fishing trips - the latter causing heavy financial losses. As a consequence of too many incomplete fishing trips and scanty return from subsequent investments, livelihoods of coastal fisherfolk have been devastated. Coastal farmers have been maintaining their livelihoods, where the state invested for building surge protecting embankments to offer ‘safe cultivation’ opportunities since the 1960s. With the increased frequency of rough sea events and high energy wave interactions, combined with poor management of embankments, there have been repeated incidences of embankment failure, erosion and subsequent saline inundation. Such events generally wreck havoc in the affected areas, while crop lands suddenly become unsuitable for cropping, thereby devastating farming-based livelihoods. Climate change and sea level rise have already posed significant risks to coastal livelihoods in Bangladesh. Farming and capture fisheries are the two most dominant forms of livelihoods along the coastal zone. Both forms of livelihoods are now facing tremendous challenges. Due to successive crop loss and losses incurred from abandoned fishing trips, not only that people has become significantly indebted to local money-lenders, a social survey revealed that the poor in general are contemplating out migration to find alternative livelihoods in urban areas. Meanwhile the government has been investing large amounts to run social safety net programs. The economic and social toll of adapting to climate change is becoming much higher than estimated earlier.

Chronic periodontitis among diabetics and nondiabetics aged 35-65 years, in a rural block in Vellore, Tamil Nadu: A cross-sectional study.

PubMed

Nand, Khushboo Yamima; Oommen, Anu Mary; Chacko, Rabin Kurudamannil; Abraham, Vinod Joseph

2017-01-01

Chronic periodontitis is a common cause of poor oral health globally. Those at higher risk of this preventable and easily treatable condition need to be identified so that efforts can be taken to decrease disease burden and subsequent consequences. The aims of the study were (1) To compare the prevalence of chronic periodontitis among individuals with and without type 2 diabetes, aged 35-65 years from a rural block in Vellore, Tamil Nadu and (2) to assess risk factors for chronic periodontitis among individuals with diabetes. A cross-sectional study was done in nine villages of Kaniyambadi block, Vellore, between October 2015 and July 2016 among participants aged 35-65 years of a previous cross-sectional survey which had identified individuals with and without type 2 diabetes. Chronic periodontitis was assessed using the Community Periodontal Index and Treatment Needs index. Oral hygiene was assessed clinically using the Simplified Oral Hygiene Index. Diabetes was defined as on medication for type 2 diabetes or detected to have fasting blood glucose ≥126 mg/dl (in a previous survey). Chi-square test and odds ratios (adjusted using logistic regression) were used to study risk factors for periodontitis among those with diabetes. Prevalence of chronic periodontitis was 45.9% (95% confidence interval [CI]: 40.88%-50.9%) among 98 individuals with diabetes and 35.6% (95% CI: 30.91-40.29%) among 104 individuals without diabetes. Poor oral hygiene (odds ratio: 8.33, 95% CI: 3.33-25.00), low socioeconomic status (odds ratio: 3.19, 95% CI: 1.00-10.12), and smoking (odds ratio: 3.51, 95% CI: 1.17-10.51) were associated with periodontitis among diabetics. Individuals with type 2 diabetes have a higher prevalence of periodontitis. As poor oral hygiene is a strong risk factor for periodontitis, there is a need for targeted education regarding dental hygiene to reduce this preventable condition.

How reliable are clinical systems in the UK NHS? A study of seven NHS organisations

PubMed Central

Franklin, Bryony Dean; Moorthy, Krishna; Cooke, Matthew W; Vincent, Charles

2012-01-01

Background It is well known that many healthcare systems have poor reliability; however, the size and pervasiveness of this problem and its impact has not been systematically established in the UK. The authors studied four clinical systems: clinical information in surgical outpatient clinics, prescribing for hospital inpatients, equipment in theatres, and insertion of peripheral intravenous lines. The aim was to describe the nature, extent and variation in reliability of these four systems in a sample of UK hospitals, and to explore the reasons for poor reliability. Methods Seven UK hospital organisations were involved; each system was studied in three of these. The authors took delivery of the systems' intended outputs to be a proxy for the reliability of the system as a whole. For example, for clinical information, 100% reliability was defined as all patients having an agreed list of clinical information available when needed during their appointment. Systems factors were explored using semi-structured interviews with key informants. Common themes across the systems were identified. Results Overall reliability was found to be between 81% and 87% for the systems studied, with significant variation between organisations for some systems: clinical information in outpatient clinics ranged from 73% to 96%; prescribing for hospital inpatients 82–88%; equipment availability in theatres 63–88%; and availability of equipment for insertion of peripheral intravenous lines 80–88%. One in five reliability failures were associated with perceived threats to patient safety. Common factors causing poor reliability included lack of feedback, lack of standardisation, and issues such as access to information out of working hours. Conclusions Reported reliability was low for the four systems studied, with some common factors behind each. However, this hides significant variation between organisations for some processes, suggesting that some organisations have managed to create more reliable systems. Standardisation of processes would be expected to have significant benefit. PMID:22495099

Host cell interactions of outer membrane vesicle-associated virulence factors of enterohemorrhagic Escherichia coli O157: Intracellular delivery, trafficking and mechanisms of cell injury

PubMed Central

Greune, Lilo; Jarosch, Kevin-André; Steil, Daniel; Zhang, Wenlan; He, Xiaohua; Lloubes, Roland; Fruth, Angelika; Kim, Kwang Sik; Schmidt, M. Alexander; Dobrindt, Ulrich; Mellmann, Alexander; Karch, Helge

2017-01-01

Outer membrane vesicles (OMVs) are important tools in bacterial virulence but their role in the pathogenesis of infections caused by enterohemorrhagic Escherichia coli (EHEC) O157, the leading cause of life-threatening hemolytic uremic syndrome, is poorly understood. Using proteomics, electron and confocal laser scanning microscopy, immunoblotting, and bioassays, we investigated OMVs secreted by EHEC O157 clinical isolates for virulence factors cargoes, interactions with pathogenetically relevant human cells, and mechanisms of cell injury. We demonstrate that O157 OMVs carry a cocktail of key virulence factors of EHEC O157 including Shiga toxin 2a (Stx2a), cytolethal distending toxin V (CdtV), EHEC hemolysin, and flagellin. The toxins are internalized by cells via dynamin-dependent endocytosis of OMVs and differentially separate from vesicles during intracellular trafficking. Stx2a and CdtV-B, the DNase-like CdtV subunit, separate from OMVs in early endosomes. Stx2a is trafficked, in association with its receptor globotriaosylceramide within detergent-resistant membranes, to the Golgi complex and the endoplasmic reticulum from where the catalytic Stx2a A1 fragment is translocated to the cytosol. CdtV-B is, after its retrograde transport to the endoplasmic reticulum, translocated to the nucleus to reach DNA. CdtV-A and CdtV-C subunits remain OMV-associated and are sorted with OMVs to lysosomes. EHEC hemolysin separates from OMVs in lysosomes and targets mitochondria. The OMV-delivered CdtV-B causes cellular DNA damage, which activates DNA damage responses leading to G2 cell cycle arrest. The arrested cells ultimately die of apoptosis induced by Stx2a and CdtV via caspase-9 activation. By demonstrating that naturally secreted EHEC O157 OMVs carry and deliver into cells a cocktail of biologically active virulence factors, thereby causing cell death, and by performing first comprehensive analysis of intracellular trafficking of OMVs and OMV-delivered virulence factors, we provide new insights into the pathogenesis of EHEC O157 infections. Our data have implications for considering O157 OMVs as vaccine candidates. PMID:28158302

Disparities in Prevalence of Cardiometablic Risk Factors in Rural, Urban-Poor, and Urban-Middle Class Women in India.

PubMed

Mohan, Indu; Gupta, Rajeev; Misra, Anoop; Sharma, Krishna Kumar; Agrawal, Aachu; Vikram, Naval K; Sharma, Vinita; Shrivastava, Usha; Pandey, Ravindra M

2016-01-01

Urbanization is an important determinant of cardiovascular disease (CVD) risk. To determine location-based differences in CVD risk factors in India we performed studies among women in rural, urban-poor and urban middle-class locations. Population-based cross-sectional studies in rural, urban-poor, and urban-middle class women (35-70 y) were performed at multiple sites. We evaluated 6853 women (rural 2616, 5 sites; urban-poor 2008, 4 sites; urban middle-class 2229, 11 sites) for socioeconomic, lifestyle, anthropometric and biochemical risk factors. Descriptive statistics are reported. Mean levels of body mass index (BMI), waist circumference, waist-hip ratio (WHR), systolic BP, fasting glucose and cholesterol in rural, urban-poor and urban-middle class women showed significantly increasing trends (ANOVAtrend, p <0.001). Age-adjusted prevalence of diabetes and risk factors among rural, urban-poor and urban-middle class women, respectively was, diabetes (2.2, 9.3, 17.7%), overweight BMI ≥25 kg/m2 (22.5, 45.6, 57.4%), waist >80 cm (28.3, 63.4, 61.9%), waist >90 cm (8.4, 31.4, 38.2%), waist hip ratio (WHR) >0.8 (60.4, 90.7, 88.5), WHR>0.9 (13.0, 44.3, 56.1%), hypertension (31.6, 48.2, 59.0%) and hypercholesterolemia (13.5, 27.7, 37.4%) (Mantel Haenszel X2 ptrend <0.01). Inverse trend was observed for tobacco use (41.6, 19.6, 9.4%). There was significant association of hypertension, hypercholesterolemia and diabetes with overweight and obesity (adjusted R2 0.89-0.99). There are significant location based differences in cardiometabolic risk factors in India. The urban-middle class women have the highest risk compared to urban-poor and rural.

Disparities in Prevalence of Cardiometablic Risk Factors in Rural, Urban-Poor, and Urban-Middle Class Women in India

PubMed Central

Mohan, Indu; Gupta, Rajeev; Misra, Anoop; Sharma, Krishna Kumar; Agrawal, Aachu; Vikram, Naval K.; Sharma, Vinita; Shrivastava, Usha; Pandey, Ravindra M.

2016-01-01

Objective Urbanization is an important determinant of cardiovascular disease (CVD) risk. To determine location-based differences in CVD risk factors in India we performed studies among women in rural, urban-poor and urban middle-class locations. Methods Population-based cross-sectional studies in rural, urban-poor, and urban-middle class women (35–70y) were performed at multiple sites. We evaluated 6853 women (rural 2616, 5 sites; urban-poor 2008, 4 sites; urban middle-class 2229, 11 sites) for socioeconomic, lifestyle, anthropometric and biochemical risk factors. Descriptive statistics are reported. Results Mean levels of body mass index (BMI), waist circumference, waist-hip ratio (WHR), systolic BP, fasting glucose and cholesterol in rural, urban-poor and urban-middle class women showed significantly increasing trends (ANOVAtrend, p <0.001). Age-adjusted prevalence of diabetes and risk factors among rural, urban-poor and urban-middle class women, respectively was, diabetes (2.2, 9.3, 17.7%), overweight BMI ≥25 kg/m2 (22.5, 45.6, 57.4%), waist >80 cm (28.3, 63.4, 61.9%), waist >90 cm (8.4, 31.4, 38.2%), waist hip ratio (WHR) >0.8 (60.4, 90.7, 88.5), WHR>0.9 (13.0, 44.3, 56.1%), hypertension (31.6, 48.2, 59.0%) and hypercholesterolemia (13.5, 27.7, 37.4%) (Mantel Haenszel X2 ptrend <0.01). Inverse trend was observed for tobacco use (41.6, 19.6, 9.4%). There was significant association of hypertension, hypercholesterolemia and diabetes with overweight and obesity (adjusted R2 0.89–0.99). Conclusions There are significant location based differences in cardiometabolic risk factors in India. The urban-middle class women have the highest risk compared to urban-poor and rural. PMID:26881429

Factors Influencing The Six-Month Mortality Rate In Patients With A Hip Fracture

PubMed Central

Ristic, Branko; Rancic, Nemanja; Bukumiric, Zoran; Zeljko, Stepanovic; Ignjatovic-Ristic, Dragana

2016-01-01

Abstract Background There are several potential risk factors in patients with a hip fracture for a higher rate of mortality that include: comorbid disorders, poor general health, age, male gender, poor mobility prior to injury, type of fracture, poor cognitive status, place of residence. The aim of this study was to assess the influence of potential risk factors for six-month mortality in hip fracture patients. Methods The study included all patients with a hip fracture older than 65 who had been admitted to the Clinic for orthopaedic surgery during one year. One hundred and ninety-two patients were included in the study. Results Six months after admission due to a hip fracture, 48 patients had died (6-month mortality rate was 25%). The deceased were statistically older than the patients who had survived. Univariate regression analysis indicated that six variables had a significant effect on hip fracture patients’ survival: age, mobility prior to the fracture, poor cognitive status, activity of daily living, comorbidities and the place where they had fallen. Multivariate regression modelling showed that the following factors were independently associated with mortality at 6 months post fracture: poor cognitive status, poor mobility prior to the fracture, comorbid disease. Conclusion Poor cognitive status appeared to be the strongest mortality predictor. The employment of brief tests for cognitive status evaluation would enable orthopaedists to have good criteria for the choice of treatment for each patient screened. PMID:27284379

Quality of Vitamin K Antagonist Anticoagulation in Spain: Prevalence of Poor Control and Associated Factors.

PubMed

Anguita Sánchez, Manuel; Bertomeu Martínez, Vicente; Cequier Fillat, Ángel

2015-09-01

To study the prevalence of poorly controlled vitamin K antagonist anticoagulation in Spain in patients with nonvalvular atrial fibrillation, and to identify associated factors. We studied 1056 consecutive patients seen at 120 cardiology clinics in Spain between November 2013 and March 2014. We analyzed the international normalized ratio from the 6 months prior to the patient's visit, calculating the prevalence of poorly controlled anticoagulation, defined as < 65% time in therapeutic range using the Rosendaal method. Mean age was 73.6 years (standard deviation, 9.8 years); women accounted for 42% of patients. The prevalence of poorly controlled anticoagulation was 47.3%. Mean time in therapeutic range was 63.8% (25.9%). The following factors were independently associated with poorly controlled anticoagulation: kidney disease (odds ratio = 1.53; 95% confidence interval, 1.08-2.18; P = .018), routine nonsteroidal anti-inflammatory drugs (odds ratio = 1.79; 95% confidence interval, 1.20-2.79; P = .004), antiplatelet therapy (odds ratio = 2.16; 95% confidence interval, 1.49-3.12; P < .0001) and absence of angiotensin receptor blockers (odds ratio = 1.39; 95% confidence interval, 1.08-1.79; P = .011). There is a high prevalence of poorly controlled vitamin K antagonist anticoagulation in Spain. Factors associated with poor control are kidney disease, routine nonsteroidal anti-inflammatory drugs, antiplatelet use, and absence of angiotensin receptor blockers. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Prevalence and Predictive Factors of Chronic Postsurgical Pain and Poor Global Recovery 1 Year After Outpatient Surgery.

PubMed

Hoofwijk, Daisy M N; Fiddelers, Audrey A A; Peters, Madelon L; Stessel, Björn; Kessels, Alfons G H; Joosten, Elbert A; Gramke, Hans-Fritz; Marcus, Marco A E

2015-12-01

To prospectively describe the prevalence and predictive factors of chronic postsurgical pain (CPSP) and poor global recovery in a large outpatient population at a university hospital, 1 year after outpatient surgery. A prospective longitudinal cohort study was performed. During 18 months, patients presenting for preoperative assessment were invited to participate. Outcome parameters were measured by using questionnaires at 3 timepoints: 1 week preoperatively, 4 days postoperatively, and 1 year postoperatively. A value of >3 on an 11-point numeric rating scale was considered to indicate moderate to severe pain. A score of ≤80% on the Global Surgical Recovery Index was defined as poor global recovery. A total of 908 patients were included. The prevalence of moderate to severe preoperative pain was 37.7%, acute postsurgical pain 26.7%, and CPSP 15.3%. Risk factors for the development of CPSP were surgical specialty, preoperative pain, preoperative analgesic use, acute postoperative pain, surgical fear, lack of optimism, and poor preoperative quality of life. The prevalence of poor global recovery was 22.3%. Risk factors for poor global recovery were recurrent surgery because of the same pathology, preoperative pain, preoperative analgesic use, surgical fear, lack of optimism, poor preoperative and acute postoperative quality of life, and follow-up surgery during the first postoperative year. Moderate to severe CPSP after outpatient surgery is common, and should not be underestimated. Patients at risk for developing CPSP can be identified during the preoperative phase.

Wound Healing Problems in the Mouth

PubMed Central

Politis, Constantinus; Schoenaers, Joseph; Jacobs, Reinhilde; Agbaje, Jimoh O.

2016-01-01

Wound healing is a primary survival mechanism that is largely taken for granted. The literature includes relatively little information about disturbed wound healing, and there is no acceptable classification describing wound healing process in the oral region. Wound healing comprises a sequence of complex biological processes. All tissues follow an essentially identical pattern to complete the healing process with minimal scar formation. The oral cavity is a remarkable environment in which wound healing occurs in warm oral fluid containing millions of microorganisms. The present review provides a basic overview of the wound healing process and with a discussion of the local and general factors that play roles in achieving efficient would healing. Results of oral cavity wound healing can vary from a clinically healed wound without scar formation and with histologically normal connective tissue under epithelial cells to extreme forms of trismus caused by fibrosis. Many local and general factors affect oral wound healing, and an improved understanding of these factors will help to address issues that lead to poor oral wound healing. PMID:27853435

Is Perineural Invasion of Head and Neck Squamous Cell Carcinomas Linked to Tobacco Consumption?

PubMed

Baumeister, Philipp; Welz, Christian; Jacobi, Christian; Reiter, Maximilian

2018-05-01

Perineural invasion (PNI) is an underrecognized path of cancer spread, and its causes and mechanisms are poorly understood. Recent research indicates a mutual attraction of neuronal and cancer cells, largely dependent on neurotrophic factors and their receptors. Interestingly, the release of neurotrophic factors occurs upon cigarette smoke/nicotine exposure in a dose-dependent manner, and serum levels correlate with current smoking, number of smoking years, and smoking severity. Among cell types capable of neurotrophic factors secretion are lung and oral fibroblasts. In our study of 178 patients with head and neck squamous cell carcinoma, tumors of current and former smokers showed PNI significantly more often than tumors of never smokers. Moreover, PNI was a marker for aggressive tumor growth. Surprisingly, PNI was more significant for survival than p16 status. Our study warrants further research on PNI in head and neck squamous cell carcinoma with special emphasis on the impact of tobacco consumption to identify suitable candidates for therapeutic interventions.

Childhood functional abdominal pain: mechanisms and management.

PubMed

Korterink, Judith; Devanarayana, Niranga Manjuri; Rajindrajith, Shaman; Vlieger, Arine; Benninga, Marc A

2015-03-01

Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing, predisposing factors are poorly understood and the pathophysiological mechanisms are not clear. The prevailing viewpoint in the pathogenesis involves the inter-relationship between changes in hypersensitivity and altered motility, to which several risk factors have been linked. Making a diagnosis of functional abdominal pain can be a challenge, as it is unclear which further diagnostic tests are necessary to exclude an organic cause. Moreover, large, well-performed, high-quality clinical trials for effective agents are lacking, which undermines evidence-based treatment. This Review summarizes current knowledge regarding the epidemiology, pathophysiology, risk factors and diagnostic work-up of functional abdominal pain. Finally, management options for children with functional abdominal pain are discussed including medications, dietary interventions, probiotics and psychological and complementary therapies, to improve understanding and to maximize the quality of care for children with this condition.

Study of the various factors influencing deposit formation and operation of gasoline engine injection systems

NASA Astrophysics Data System (ADS)

Stepien, Z.

2016-09-01

Generally, ethanol fuel emits less pollutants than gasoline, it is completely renewable product and has the potential to reduce greenhouse gases emission but, at the same time can present a multitude of technical challenges to engine operation conditions including creation of very adverse engine deposits. These deposits increasing fuel consumption and cause higher exhaust emissions as well as poor performance in drivability. This paper describes results of research and determination the various factors influencing injector deposits build-up of ethanol-gasoline blends operated engine. The relationship between ethanol-gasoline fuel blends composition, their treatment, engine construction as well as its operation conditions and fuel injectors deposit formation has been investigated. Simulation studies of the deposit formation endanger proper functioning of fuel injection system were carried out at dynamometer engine testing. As a result various, important factors influencing the deposit creation process and speed formation were determined. The ability to control of injector deposits by multifunctional detergent-dispersant additives package fit for ethanol-gasoline blends requirements was also investigated.

Chronic intermittent hypoxia activates nuclear factor-{kappa}B in cardiovascular tissues in vivo

DOE Office of Scientific and Technical Information (OSTI.GOV)

Greenberg, Harly; Ye Xiaobing; Wilson, David

2006-05-05

Obstructive sleep apnea (OSA) is an important risk factor for cardiovascular morbidity and mortality. The mechanisms through which OSA promotes the development of cardiovascular disease are poorly understood. In this study, we tested the hypotheses that chronic exposure to intermittent hypoxia and reoxygenation (CIH) is a major pathologic factor causing cardiovascular inflammation, and that CIH-induces cardiovascular inflammation and pathology by activating the NF-{kappa}B pathway. We demonstrated that exposure of mice to CIH activated NF-{kappa}B in cardiovascular tissues, and that OSA patients had markedly elevated monocyte NF-{kappa}B activity, which was significantly decreased when obstructive apneas and their resultant CIH were eliminatedmore » by nocturnal CPAP therapy. The elevated NF-{kappa}B activity induced by CIH is accompanied by and temporally correlated to the increased expression of iNOS protein, a putative and important NF-{kappa}B-dependent gene product. Thus, CIH-mediated NF-{kappa}B activation may be a molecular mechanism linking OSA and cardiovascular pathologies seen in OSA patients.« less

Modifiable Risk Factors for West Nile Virus Infection during an Outbreak—Arizona, 2010

PubMed Central

Gibney, Katherine B.; Colborn, James; Baty, Steven; Bunko Patterson, Andrean M.; Sylvester, Tammy; Briggs, Graham; Stewart, Tasha; Levy, Craig; Komatsu, Ken; MacMillan, Katherine; Delorey, Mark J.; Mutebi, John-Paul; Fischer, Marc; Staples, J. Erin

2012-01-01

West Nile virus (WNV) is the leading cause of mosquito-borne disease in the United States; however, risk factors for infection are poorly defined. We performed a case-control study to identify modifiable risk factors for WNV infection. Case-patients (N = 49) had laboratory evidence of recent WNV infection, whereas control-subjects (N = 74) had negative WNV serology. We interviewed participants, surveyed households, and assessed environmental data. WNV infection was associated with living in or near Water District X within Gilbert Township (adjusted odds ratio [aOR] 5.2; 95% confidence interval [95% CI] = 1.5–18.1), having water-holding containers in their yard (aOR 5.0; 95% CI = 1.5–17.3), and not working or attending school outside the home (aOR 2.4; 95% CI = 1.1–5.5). During this outbreak, WNV infection was likely primarily acquired peri-domestically with increased risk associated with potential mosquito larval habitats around the home and neighborhood. PMID:22556093

The confounding factors leading to plagiarism in academic writing and some suggested remedies: A systematic review.

PubMed

Guraya, Salman Yousuf; Guraya, Shaista Salman

2017-05-01

There is a staggering upsurge in the incidence of plagiarism of scientific literature. Literature shows divergent views about the factors that make plagiarism reprehensible. This review explores the causes and remedies for the perennial academic problem of plagiarism. Data sources were searched for full text English language articles published from 2000 to 2015. Data selection was done using medical subject headline (MeSH) terms plagiarism, unethical writing, academic theft, retraction, medical field, and plagiarism detection software. Data extraction was undertaken by selecting titles from retrieved references and data synthesis identified key factors leading to plagiarism such as unawareness of research ethics, poor writing skills and pressure or publish mantra. Plagiarism can be managed by a balance among its prevention, detection by plagiarism detection software, and institutional sanctions against proven plagiarists. Educating researchers about ethical principles of academic writing and institutional support in training writers about academic integrity and ethical publications can curtail plagiarism.

Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract

PubMed Central

Jaquiery, A; Stylianopoulos, A; Hogg, G; Grover, S

1999-01-01

AIM—To clarify the contribution of clinical and environmental factors and infection to the aetiology of vulvovaginitis in premenarchal girls, and to determine clinical indicators of an infectious cause.
DESIGN—It was necessary first to define normal vaginal flora. Cases were 50 premenarchal girls > 2 years old with symptoms of vulvovaginitis; 50 controls were recruited from girls in the same age group undergoing minor or elective surgery.
RESULTS—Interview questionnaire showed no difference between cases and controls in regards to hygiene practices, exposure to specific irritants, or history of possible sexual abuse. Normal vaginal flora was similar to that described in previous studies, with the exception of organisms likely to be associated with sexual activity. 80% of cases had no evidence of an infectious cause. In the 10 cases in whom an infectious cause was found, there was significantly more visible discharge and distinct redness of the genital area on examination compared with other cases.
CONCLUSIONS— The findings suggest that vulvovaginitis in this age group is not usually infectious or necessarily related to poor hygiene, specific irritants or sexual abuse, although any of these can present with genital irritation. The possibility of sexual abuse should always be considered when a child presents with genital symptoms, but our data indicate it is not a common contributing factor. Infection is generally associated with vaginal discharge and moderate or severe inflammation.

 PMID:10373139

Is expert opinion enough? A critical assessment of the evidence for potential impacts of climate change on tick-borne diseases.

PubMed

Randolph, Sarah E

2013-12-01

Before attributing cause and consequence to climate change, the precise patterns of change must be known. Ground records across much of Europe show a 1-2 °C rise in temperatures in 1989 with no significant rise since then. The timing and spatial uniformity of this pattern, relative to changes in the distribution and incidence of many vector-borne diseases, are sufficient to falsify most simple claims that climate change is the principal cause of disease emergence. Furthermore, age-specific increases in incidence indicate causes other than, or in addition to, climate change. Unfortunately, many public health professionals repeat the received wisdom that climate change is worsening the burden of indirectly transmitted infections; this 'expert opinion' soon becomes consensus dogma divorced from quantitative evidence. The pressing need is to gather appropriate data to test the simple concept that the composition and relative importance of disparate multifactorial factors, commonly integrated within a causal nexus, will inevitably vary with the geographical, cultural, socio-economical, wildlife, etc. context. The greatest impact of warming occurs at the geographical limits of current distributions, where low temperatures limit the hazard of infected vectors. Within core endemic regions, changing exposure of humans to this hazard, through changing socio-economic factors is evidently more important amongst both the poor and the wealthy.

Balanitis

MedlinePlus

Balanitis is most often caused by poor hygiene in uncircumcised men. Other possible causes include: Diseases, such as reactive arthritis and lichen sclerosus atrophicus Infection Harsh soaps Not rinsing soap off ...

The aetiology of dento-alveolar injuries and factors influencing attendance for emergency care of adolescents in the north west of England.

PubMed

Blinkhorn, F A

2000-08-01

The aims of the study were to determine the main aetiological factors involved in injuries to anterior teeth and to identify factors influencing the attendance for emergency care. This information is essential, first, for planning dental health education programmes aimed at reducing the incidence of dental trauma and, second, to devise strategies for its effective treatment. Of 2022 schoolchildren examined for evidence of dental trauma, 696 (34%) had experienced injury and were interviewed regarding this injury. Of these, 403 knew about their damaged front tooth, but only 330 recollected the incident causing the injury. Over one third of accidents occurred at home and a further 25% at school. The most common cause of injury was falling onto a hard surface or object (34%) with accidents involving bicycles or other sporting activities accounting for a further 30%. Factors found to be significantly related to attendance for emergency care were experience of pain, unattractive appearance of the injured tooth and social classification, with children from higher income, more affluent areas being more likely to seek treatment. The majority of dental injuries were the result of genuine accidents which were almost impossible to prevent. This study highlighted the need for attention to be brought to parents, children, lay people and health care professionals that all dental injuries should be examined by a dentist, not just those injuries resulting in pain or poor aesthetics.

Risk factors for atopic and non-atopic asthma in a rural area of Ecuador.

PubMed

Moncayo, Ana Lucia; Vaca, Maritza; Oviedo, Gisela; Erazo, Silvia; Quinzo, Isabel; Fiaccone, Rosemeire L; Chico, Martha E; Barreto, Mauricio L; Cooper, Philip J

2010-05-01

BACKGROUND Asthma has emerged as an important public health problem of urban populations in Latin America. Epidemiological data suggest that a minority of asthma cases in Latin America may be associated with allergic sensitisation and that other mechanisms causing asthma have been overlooked. The aim of the present study was to investigate risk factors for atopic and non-atopic asthma in school-age children. METHODS A cross-sectional study was conducted among 3960 children aged 6-16 years living in Afro-Ecuadorian rural communities in Esmeraldas province in Ecuador. Allergic diseases and risk factors were assessed by questionnaire and allergic sensitisation by allergen skin prick reactivity. RESULTS A total of 390 (10.5%) children had wheeze within the previous 12 months, of whom 14.4% had at least one positive skin test. The population-attributable fraction for recent wheeze associated with atopy was 2.4%. Heavy Trichuris trichiura infections were strongly inversely associated with atopic wheeze. Non-atopic wheeze was positively associated with maternal allergic symptoms and sedentarism (watching television (>3 h/day)) but inversely associated with age and birth order. CONCLUSIONS The present study showed a predominance of non-atopic compared with atopic wheeze among schoolchildren living in a poor rural region of tropical Latin America. Distinct risk factors were associated with the two wheeze phenotypes and may indicate different causal mechanisms. Future preventive strategies in such populations may need to be targeted at the causes of non-atopic wheeze.

An Effective Programme Is Not Enough: A Review of Factors Associated with Poor Attendance and Engagement with Parenting Support Programmes

ERIC Educational Resources Information Center

Whittaker, Karen A.; Cowley, Sarah

2012-01-01

The provision of parenting support is a key feature of wealthier nations' health and social care services. However, attendance and engagement by the neediest parents remains poor. Barriers experienced by parents include personal life factors (beliefs, lifestyles and limited resources) and programme-specific factors (delivery, content and support…

A murine model of acute myeloid leukemia with Evi1 overexpression and autocrine stimulation by an intracellular form of GM-CSF in DA-3 cells.

PubMed

Cardona, Maria E; Simonson, Oscar E; Oprea, Iulian I; Moreno, Pedro M D; Silva-Lara, Maria F; Mohamed, Abdalla J; Christensson, Birger; Gahrton, Gösta; Dilber, M Sirac; Smith, C I Edvard; Arteaga, H Jose

2016-01-01

The poor treatment response of acute myeloid leukemia (AML) overexpressing high-risk oncogenes such as EVI1, demands specific animal models for new treatment evaluations. Evi1 is a common site of activating integrations in murine leukemia virus (MLV)-induced AML and in retroviral and lentiviral gene-modified HCS. Still, a model of overt AML induced by Evi1 has not been generated. Cell lines from MLV-induced AML are growth factor-dependent and non-transplantable. Hence, for the leukemia maintenance in the infected animals, a growth factor source such as chronic immune response has been suggested. We have investigated whether these leukemias are transplantable if provided with growth factors. We show that the Evi1(+)DA-3 cells modified to express an intracellular form of GM-CSF, acquired growth factor independence and transplantability and caused an overt leukemia in syngeneic hosts, without increasing serum GM-CSF levels. We propose this as a general approach for modeling different forms of high-risk human AML using similar cell lines.

Poor oral intake causes enteral nutrition dependency after concomitant chemoradiotherapy for pharyngeal cancers.

PubMed

Ishii, Ryo; Kato, Kengo; Ogawa, Takenori; Sato, Takeshi; Nakanome, Ayako; Ohkoshi, Akira; Kawamoto-Hirano, Ai; Shirakura, Masayuki; Hidaka, Hiroshi; Katori, Yukio

2018-06-01

To identify precipitating factors responsible for enteral nutrition (EN) dependency after concomitant chemoradiotherapy (CCRT) of head and neck cancers and to examine their statistical correlations. Factors related to feeding condition, nutritional status, disease, and treatment of 26 oropharyngeal and hypopharyngeal cancer patients who received definitive CCRT were retrospectively investigated by examining their medical records. The days of no oral intake (NOI) during hospitalization and the months using enteral nutrition after CCRT were counted as representing the feeding condition, and the changes in body weight (BW) were examined as reflecting nutritional status. The factors related to EN dependency after CCRT were analyzed. Long duration of total NOI (≥ 30 days) and maximum NOI ≥ 14 days were significant predictors of EN dependency. Decreased BW (≥ 7.5 kg) was the next predictor identified, but it was not significant. Multivariate analysis showed that the total duration of NOI was more correlated with EN dependency than changes in BW. A long duration of NOI was more strongly related to EN dependency than nutritional factors.

Socioeconomic, Family, and Pediatric Practice Factors Affecting the Level of Asthma Control

PubMed Central

Bloomberg, Gordon R; Banister, Christina; Sterkel, Randall; Epstein, Jay; Bruns, Julie; Swerczek, Lisa; Wells, Suzanne; Yan, Yan; Garbutt, Jane M

2008-01-01

Background Multiple issues bear on effective control of childhood asthma. Objective To identify factors related to the level of asthma control in children receiving asthma care from community pediatricians. Patients and Methods Data for 362 children participating in an intervention study to reduce asthma morbidity were collected by telephone administered questionnaire. Level of asthma control (“well controlled,” partially controlled,” or “poorly controlled”) was derived from measures of recent impairment (symptoms, activity limitations, albuterol use) and the number of exacerbations in a 12 month period. Data also included demographic characteristics, asthma-related quality of life, pediatric management practices, and medication usage. Univariable and multivariable analyses were used to identify factors associated with poor asthma control and to explore the relationship between control and use of daily controller medications. Results Asthma was “well controlled” for 24% of children, “partially controlled” for 20%, and “poorly controlled” for 56%. Medicaid insurance (p=0.016), the presence of another family member with asthma (p=0.0168), and outside the home maternal employment, (p=0.025), were significant univariable factors associated with poor asthma control. Medicaid insurance had an independent association with poor control (OR 0.49, 95% CI 0.28-0.9). Seventy-six percent of children were reported by parents as receiving a daily controller medication. Comparison of guidelines recommended controller medication with level of control indicated that a higher step level of medication would have been appropriate for 74% of these children. Significantly lower overall quality of life scores were observed in both parents and children with poor control. (ANOVA, p<0.05) Conclusion Despite substantial use of daily controller medication, children with asthma continue to experience poorly controlled asthma and reduced quality of life. While Medicaid insurance and aspects of family structure are significant factors associated with poorly controlled asthma, attention to medication use and quality of life indicators may further reduce morbidity. PMID:19255010

Poor school performance.

PubMed

Karande, Sunil; Kulkarni, Madhuri

2005-11-01

Education is one of the most important aspects of human resource development. Poor school performance not only results in the child having a low self-esteem, but also causes significant stress to the parents. There are many reasons for children to under perform at school, such as, medical problems, below average intelligence, specific learning disability, attention deficit hyperactivity disorder, emotional problems, poor socio-cultural home environment, psychiatric disorders and even environmental causes. The information provided by the parents, classroom teacher and school counselor about the child's academic difficulties guides the pediatrician to form an initial diagnosis. However, a multidisciplinary evaluation by an ophthalmologist, otolaryngologist, counselor, clinical psychologist, special educator, and child psychiatrist is usually necessary before making the final diagnosis. It is important to find the reason(s) for a child's poor school performance and come up with a treatment plan early so that the child can perform up to full potential.

Significance chasing in research practice: causes, consequences and possible solutions.

PubMed

Ware, Jennifer J; Munafò, Marcus R

2015-01-01

The low reproducibility of findings within the scientific literature is a growing concern. This may be due to many findings being false positives which, in turn, can misdirect research effort and waste money. We review factors that may contribute to poor study reproducibility and an excess of 'significant' findings within the published literature. Specifically, we consider the influence of current incentive structures and the impact of these on research practices. The prevalence of false positives within the literature may be attributable to a number of questionable research practices, ranging from the relatively innocent and minor (e.g. unplanned post-hoc tests) to the calculated and serious (e.g. fabrication of data). These practices may be driven by current incentive structures (e.g. pressure to publish), alongside the preferential emphasis placed by journals on novelty over veracity. There are a number of potential solutions to poor reproducibility, such as new publishing formats that emphasize the research question and study design, rather than the results obtained. This has the potential to minimize significance chasing and non-publication of null findings. Significance chasing, questionable research practices and poor study reproducibility are the unfortunate consequence of a 'publish or perish' culture and a preference among journals for novel findings. It is likely that top-down change implemented by those with the ability to modify current incentive structure (e.g. funders and journals) will be required to address problems of poor reproducibility. © 2014 Society for the Study of Addiction.

Significance chasing in research practice: Causes, consequences, and possible solutions

PubMed Central

Ware, Jennifer J.; Munafò, Marcus R.

2016-01-01

Background and Aims The low reproducibility of findings within the scientific literature is a growing concern. This may be due to many findings being false positives, which in turn can misdirect research effort and waste money. Methods We review factors that may contribute to poor study reproducibility and an excess of ‘significant’ findings within the published literature. Specifically, we consider the influence of current incentive structures, and the impact of these on research practices. Results The prevalence of false positives within the literature may be attributable to a number of questionable research practices, ranging from the relatively innocent and minor (e.g., unplanned post hoc tests), to the calculated and serious (e.g., fabrication of data). These practices may be driven by current incentive structures (e.g. pressure to publish), alongside the preferential emphasis placed by journals on novelty over veracity. There are a number of potential solutions to poor reproducibility, such as new publishing formats that emphasise the research question and study design, rather than the results obtained. This has the potential to minimise significance chasing and non-publication of null findings. Conclusions Significance chasing, questionable research practices, and poor study reproducibility are the unfortunate consequence of a “publish or perish” culture and a preference among journals for novel findings. It is likely that top-down change implemented by those with the ability to modify current incentive structure (e.g., funders and journals) will be required to address problems of poor reproducibility. PMID:25040652

Dietary sugar and artificial sweetener intake and chronic kidney disease: a review.

PubMed

Karalius, Vytas P; Shoham, David A

2013-03-01

Sugar consumption, especially in the form of fructose, has been hypothesized to cause kidney disease. This review provides an overview of the epidemiologic evidence that sugar consumption increases CKD risk. Research supports a causal role of sugar in several kidney disease risk factors, including increasing serum uric acid levels, diabetes, and obesity. Sugar may also harm the kidney via other mechanisms. There is no evidence that sucrose is any safer for the kidney than high fructose corn syrup (HFCS) because both are similar in composition. To date, 5 epidemiologic studies have directly evaluated the relationship between sugar consumption (in the form of sugar-sweetened beverages) and CKD. Although most studies suggest that the risk of CKD is elevated among consumers of sugar-sweetened beverages, only 2 studies report statistically significant associations. Three studies have also examined diet soda consumption, with two reporting positive and significant associations. Confounding by unmeasured lifestyle factors may play a role in the positive results whereas poor measurement of sugar and artificial sweetener intake could explain null results. Nevertheless, the hypothesis that sugar causes kidney disease remains plausible, and alternative research designs may be needed. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Diabetes mellitus, part 1: physiology and complications.

PubMed

Nair, Muralitharan

In part 1 of this 2-part article the author discusses the physiology and complications of diabetes mellitus (DM), a chronic and progressive disorder which affects all ages of the population. The number of people diagnosed with diabetes is approximately 1.8 million and an estimated further 1 million are undiagnosed (Department of Health, 2005). In the UK, 1-2% of the population have diabetes and among school children this is approximately 2 in 1000 (Watkins, 1996). There are two main types of diabetes--type 1 and type 2 (Porth, 2005). The aetiology of DM is unknown; however, genetic and environmental factors have been linked to its development. Type 1 results from the loss of insulin production in the beta cells of the pancreas, and type 2 from a lack of serum insulin or poor uptake of glucose into the cells. Diabetes causes disease in many organs in the body, which may be life-threatening if untreated. Complications such as heart disease, vascular disease, renal failure and blindness (Roberts, 2005) have all been reported. The increased prevalence may be caused by factors such as environmental aspects, diet, an ageing population and low levels of physical exercise.