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Aim: Documentation is a critical element in the function of the nursing team, and cannot be separated from high-quality, patient-centered care. The aim of this study was to compare the quality of nursing documentation in electronic and paper-based systems.Method: A retrospective descriptive study was designed to compare the quality of nursing documentation in electronic health records (EHR) versus paper-based documentation systems before and after the application of the electronic system.Results: Analysis of data found a significant difference in the quality of nursing documentation in the two hospitals both before and after the implementation of an EHR system (p < 0.001).Quality of nursing documentation in the electronic system was significantly better than that of paper-based documentation systems.Conclusion: Vocal-electronic systems help to improve quality of nursing documentation, suggesting this aspect may be essential to implementing a successful system in local settings. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the ocular surface characteristics based on Schirmer's test, tear break-up time (TBUT), and conjunctival impression cytology (CIC) in children with Hashimoto's thyroiditis (HT).Methods: This study included 51 children with HT and 53 control subjects. The ocular surface characteristics of participants were assessed via Schirmer's test, TBUT, and CIC. Conjunctival samples were examined cytologically according to the Nelson grading system.Results: Schirmer's and TBUT results were significantly lower in HT group (p < .05). All samples in both the study and control groups were evaluated as grade 0 according to the Nelson classification (p = .841), however, goblet cell density (GCD) was significantly lower in HT group (p = .001). Schirmer test results were significantly associated with the duration of HT (p = .025, r = -0.311).Conclusion: Hashimoto's thyroiditis without any ocular complaints may cause ocular surface changes with TBUT and Schirmer's. Although CIC analysis showed similar grading results, GCD was significantly decreased in HT group. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to examine if people with protein C deficiency, which is a natural anticoagulant and also an endogenous acyl ghrelin peptidase, have elevated circulating levels of acyl ghrelin. The clinical trial was conducted in a university hospital setting. People with protein C deficiency were identified and invited to participate by a specialized coagulation outpatient clinic. People with protein C deficiency were examined and compared to age, sex, and body mass index matched healthy controls with regards to acyl ghrelin, unacylated ghrelin, growth hormone (GH) and insulin-like growth-factor I (IGF-I) in a cross-sectional case-control study. Systemic levels of acyl ghrelin, desacyl ghrelin, acyl-to-desacyl ghrelin ratio, GH and IGF-I were similar in people with protein C deficiency and healthy controls. Despite a significant reduction of protein C in people with protein C deficiency, there was no difference in acyl ghrelin or the secondary end points unacylated ghrelin, GH, or IGF-I in people with protein C deficiency. [ABSTRACT FROM AUTHOR]

Purpose: To compare differences in infertility-related stress and quality of life (QOL) among women with infertility and concurrent reproductive trauma, defined as pregnancy loss during the infertility experience.Materials and Methods: We used a descriptive, cross-sectional study design to recruit 205 women who underwent infertility treatments from infertility-related Facebook support groups and pages. Participants completed the Copenhagen Multi-center Psychosocial Infertility Fertility Problem Stress Scale, the Fertility Quality of Life tool, and a supplemental infertility demographic form. Statistical analyses included descriptive statistics, Pearson correlations, multivariate analysis of variance (MANOVA), univariate ANOVA, and eta squared. Statistical significance was evaluated using a Bonferroni adjusted alpha = .05/7 = .007.Results: Participants with concurrent reproductive trauma had significantly higher social stress (p < .001), and significantly lower emotional QOL (p = .003) than women with infertility alone. Although not statistically significant, participants with concurrent reproductive trauma reported higher personal and marital stress scores and lower mind/body, relational, and social QOL scores than women with infertility alone.Conclusions: Women with concurrent reproductive trauma may need psychological support to combat the emotional distress of pregnancy loss during infertility treatment. [ABSTRACT FROM AUTHOR]

Background: Students of medicine in India tend to follow textbooks from western authors for rural pathologies, zoonosis, and this geographical disconnect leads to gaps in familiarity with local diseases.Aim: This study aims to assess knowledge, practices, and attitudes on leptospirosis among undergraduate and postgraduate medical students.Methods: A cross-sectional, self-administered questionnaire study was performed from June 2018 to May 2019 among 778 undergraduate students from six medical colleges of Tamil Nadu and 446 postgraduate students from two postgraduate institutions.Results: The survey of 1224 medical students revealed that the postgraduate medical students' knowledge of leptospirosis was better than undergraduates; however, there were important knowledge gaps in risk factors and management of leptospiral infection.Conclusions: Although the results of the study are encouraging, poor knowledge of risk factors and of diagnosis of leptospirosis can significantly affect the quality of patient care. This calls for multifaceted interventions to improve the medical curriculum. [ABSTRACT FROM AUTHOR]

Background: There have been various articles reporting relationship between Vitamin D (VitD) and celiac disease (CeD), but results remain controversial. This study aimed to conduct a meta-analysis to systematically review and quantify the relationship between VitD and CeD. Moreover, difference in Vitamin D Receptor (VDR) genotypes between CeD patients and controls was also analyzed.Methods: Articles published until July 20, 2019 in the PubMed, MEDLINE, and EMBASE databases were searched. According to the inclusion and exclusion criteria, relevant statistical data were collated and extracted, which were finally analyzed by STATA15.1.Results: 27 articles and 28 sets of data were included. It showed that average 25(OH)D level in CeD patients was 8.36 nmol/L lower than controls (Weighted Mean Difference (WMD) = -8.36, 95% CI = [-14.63, -2.09] nmol/L). After gluten-free diet treatment, we found that average 25(OH)D level in treated patients was 15.6 nmol/L higher than untreated patients (WMD = 15.6, 95% CI = [5.96, 25.23] nmol/L). In addition, 25(OH)D level in treated patients was close to healthy controls (WMD = -2.82, 95% CI = [-6.45, 0.73] nmol/L). However, genetic polymorphism analysis showed that there is no difference in VDR genotypes between CeD and control.Conclusions: CeD had decreased serum 25(OH)D levels, which returned to normal after treatment, suggesting that VitD may play a role in the development of CeD. The directionality of this association cannot be confirmed from cross-sectional studies. Demonstration of a causal role of VitD deficiency in CeD development in future studies could have important therapeutic implications. [ABSTRACT FROM AUTHOR]

Objectives: Misuse of antibiotics, especially in low-and-middle-income countries is a major contributor to antimicrobial resistance. Medical students are antibiotic consumers and prescribers in the future. This study aimed to assess antibiotic knowledge and utilization among medical students in the Republic of Mali, and to determine the relationship between knowledge and health-seeking behavior in relation to antibiotic use.Methods: A cross-sectional survey was conducted in the only public medical university in Mali. The questionnaire explored knowledge about antibiotics of medical students, and health behaviors for self-limiting illness. Data were analyzed in SPSS.Results: A total of 446 medical students completed the questionnaire. The average knowledge score was 4.12 out of 10. Students with clinical experience performed higher (4.79 vs 3.74, p< 0.01); 391(87.7%) medical students reported experience of self-limiting diseases in the past year. Of these 197(50.4%) went to see a doctor, 160 (81.2%) of whom were prescribed antibiotics: 151 medical students self-treated, with 121(80.1%) using antibiotics.Conclusions: This study shows poor knowledge and massive misuse of antibiotics among medical students in Mali. Promoting education on the mechanism of antibiotics, antimicrobial resistance and rational antibiotic use among medical students should be a priority in the medical school curriculum. [ABSTRACT FROM AUTHOR]

In working memory (WM), successful maintenance of information is affected by interference. Older adults may be especially susceptible to the effects of interference, which may cause age-related cognitive impairments. A relative score of IC was derived from cross-sectional (n = 869) and longitudinal (n = 443) data to investigate (1) if IC is reduced in normal aging, (2) if individual differences in IC related to individual performance in other cognitive domains, and (3) if 5-year change in IC is related to change in general cognition. Older age was associated with reduced IC, but no decline in IC occurred over 5 years. Also, the ability to control interference in WM was related to performance in episodic memory, verbal fluency, and block design. We also found that IC mediates the relationship between age and cognition, suggesting that age-related cognitive decline is linked to IC. Finally, we demonstrate that change in IC was related to decline in episodic memory. [ABSTRACT FROM AUTHOR]

Purpose: To study macular microvascular changes in ocular Behçet disease (OBD) using optical coherence tomography angiography (OCTA).Methods: Quantitative and qualitative analyses of OCTA were performed on 23 OBD patients with active or inactive uveitis and compared with healthy controls.Results: Deep capillary plexus (DCP) is the most frequently involved in OBD (p < 0.001). Its vessel density (VD) is reduced compared with controls in both active (p < 0.007) and inactive uveitis (p = 0.03). In inactive uveitis, VD is inversely related to the number of uveitis relapses (superficial capillary plexus: r = -0.694, p = 0.004; DCP: r = -0.541, p = 0.037) and it is significantly reduced in patients with a uveitis-free period ≥5 years compared with healthy controls (p < 0.038).Conclusions: Macular VD is reduced in Behçet patients with active and inactive uveitis, especially in DCP. In inactive uveitis, VD is inversely related to the number of ocular relapses and cannot be restored during time. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore whether abstinent patients on recent opioid detoxification or on opioid maintenance treatment suffer from sleeping problems. 199 patients on opioid maintenance treatment (methadone, diacetylmorphine and buprenorphine) or recent opioid detoxification were included in this exploratory cross-sectional study. We used the Pittsburgh Sleep Quality Index (PSQI) and the Regensburger Insomnia Scale (RIS) in order to assess potential sleeping problems. There was a significant effect of the condition "opioid maintenance" or "recent opioid detoxification" on the total score of PSQI and RIS. All opioid maintenance drugs used by the study population were associated with more sleeping problems compared to the detoxification group when calculated with RIS values. Recently abstinent patients (opioid detoxification) displayed significantly fewer sleep disturbances than opioid-maintained patients. Since sleeping problems can seriously impair treatment success and quality of life, screening for sleep disturbances and their subsequent treatment is of pronounced relevance. [ABSTRACT FROM AUTHOR]

Kratom (Mitragyna speciosa), an indigenous medicinal plant of Southeast Asia, is believed to be harmful. We compared the perceptions toward kratom use among kratom users and non-users in Malaysia. 356 respondents (137 kratom users and 219 non-users) were recruited for this cross-sectional study. The majority of respondents were male (60%, n = 212/356), Malays (88%), and 51% were ≥37 years old. Non-users showed higher unadjusted odds of reporting a perception that kratom use can cause addiction (OR = 6.72, CI: 3.91-11.54, p < .0001), withdrawal symptoms (OR = 7.58, CI: 4.62-12.42, p < .0001), illicit drug use problems (OR = 10.12, CI: 6.14-16.68, p < .0001), impaired social-functioning (OR = 12.05, CI: 7.24-20.05, p < .0001), and health problems (OR = 10.44, CI: 6.32-17.24, p < .0001). Similarly, non-users viewed kratom policies differently from kratom users, displaying increased odds of reporting the belief that kratom use and sales must be regulated with stringent laws (OR = 5.75, CI: 3.61-9.18, p < .0001), and kratom should be regulated instead under the Dangerous Drugs Act 1952 to overcome kratom use problems (OR = 8.26, CI: 4.94-13.82, p < .0001). Because of the disconnect in kratom use perceptions and personal experiences between kratom users and non-users, hastily criminalizing kratom without investigating carefully its scientific merits can significantly impede future kratom research. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to provide insights into the impact of organizational family-centered care characteristics at German neonatal intensive care units (NICUs) on the satisfaction of parents of very low birthweight (VLBW) infants.Materials and methods: Using multilevel modeling, this study analyzed whether organizational characteristics of NICUs fostering parent-infant interaction (by way of the existence of a recreation room, possibility of rooming in, existence of unrestricted visiting hours for parents, existence of parental classes, and the connection to parent associations as well as the existence of standards on developmentally supportive care) increase the satisfaction of parents after the infants' high-intensive care phase within the NICU.Results: Nine hundred and twenty-three VLBW infants from 66 NICUs in Germany born between May and October 2013 were enrolled in this multicenter study. We retrieved 1493 questionnaires completed by 1277 parents. The existence of unrestricted visiting hours (adjusted odds ratio (AOR): 1.967; 95% CI [1.118, 3.459]) and standardized procedures for developmentally supportive care (AOR: 1.775; 95% CI [1.166, 2.704]) were positively associated with parental satisfaction.Conclusions: Fostering the parent-infant interaction through the provision of developmentally supportive care and unrestricted visiting hours for parents whose infants are hospitalized within an NICU significantly contributes to the satisfaction of parents. [ABSTRACT FROM AUTHOR]

Background and objectives: Social anxiety disorder is a common comorbidity in psychotic disorders and impacts significantly on functioning and recovery. Conflicting theories and evidence exist on its relationship with other psychopathologies. This study examined this complex network of relationship using path analysis.Design: Clinical assessment and self-report in a cross-sectional consecutive outpatient sample.Methods: Face-to-face interviews were conducted in 137 outpatients with early psychosis. A theoretical model of relationship between social anxiety, insight, persecutory delusions, ideas of reference, negative symptoms, and depression was tested using path analysis.Results: Clinically significant social anxiety was observed in 45% of this sample. The final model suggested a direct link between ideas of reference (standardized path coefficient, β = 0.26, p < 0.002) and negative symptoms (β = 0.29, p < 0.001) to social anxiety. Insight was related to both persecutory delusions and negative symptoms but had no direct relationship with social anxiety. The model has excellent goodness-of-fit (Chi-square 6.62, comparative fit index 1.00, root mean square error of approximation 0.00).Conclusions: This model provided a new framework for understanding the complex interplay between psychosis symptoms and social anxiety, which may be unique to outpatients with early psychosis and require further confirmatory research and targeted intervention strategies. [ABSTRACT FROM AUTHOR]

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The Suicide Competency Assessment Form (SCAF) provides a framework for suicide prevention skills training. This study assessed SCAF psychometric properties in a sample of behavioral health staff. A cross-sectional survey of National Health Services (NHS) staff from varying disciplines (N = 170) was conducted. The SCAF yielded a 1-factor structure with high internal consistency. Nursing assistants reported lower SCAF scores compared to other professionals. SCAF scores demonstrated positive associations with prior suicide prevention training, job enthusiasm, and several suicide/self-injury prevention outcome expectations (i.e., optimism working with self-harming patients and perceived ability to help self-harming patients). SCAF scores further demonstrated incremental validity in the form of multivariate model associations with suicide/self-injury prevention outcome expectations. Improved job satisfaction mediated the pathway from SCAF scores to perceived ability to help self-harming patients. The SCAF can be utilized in suicide prevention training and clinical supervision. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate corneal parameters in patients with polymyositis (PM) and dermatomyositis (DM) and compare them with those of healthy controls.Methods: A total of 43 PM and 32 DM patients and 93 controls were enrolled in this cross-sectional, observational, case-control study. Corneal parameters were evaluated by Pentacam. Objective clinical tests of dry eye disease (DED) were also performed.Results: All pachymetric measurements and corneal volumes (CVs) proved to be significantly lower both in PM and DM patients. The values of DM patients were closer to control values than those of the PM patients. For tear break-up time and Schirmer-I test values significant differences were observed between patients and controls, with values decreased both in PM and DM patients.Conclusions: PM patients rather than DM patients tend to develop thinner and low-volume corneas as compared to controls. Additionally, a high prevalence of DED among both PM and DM patients was also detected. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the opinions of Brazilian medical residents in Obstetrics and Gynaecology on abortion legislation according to their personal beliefs.Material and methods: A multicentre cross-sectional study. Residents at 21 university teaching hospitals completed a self-report questionnaire on their opinions in abstract terms, and about punishing women who abort in general and women they know.Results: In abstract terms, 8% favoured allowing abortion under any circumstances (fully liberal); 36% under socioeconomic or psychological constraints (broadly liberal); 75.3% opposed punishing a woman who has aborted (liberal in general practice); and 90.2% opposed punishing women they knew personally (liberal in personal practice). Not having a stable partner and not being influenced by religion were factors associated with liberal opinions. In personal practice, however, 80% of those who are influenced by religion were liberal. The percentage of respondents whose opinions were liberal was significantly greater among those who believed that abortion rates would remain the same or decrease following liberalisation.Conclusions: Judgements regarding the penalisation of women who abort are strongly influenced by how close the respondent is to the problem. Accurate information on abortion needs to be provided. Although about one third of the respondents were broadly liberal, the majority oppose punishment. [ABSTRACT FROM AUTHOR]

Background: The SF-36v2 is commonly used instrument worldwide. Nevertheless, it lacks the evidence of psychometric testing and health-related quality of life (HRQoL) level among the general Thai population. Therefore, this study aimed to investigate the psychometric performance and to evaluate the HRQoL level and the factors associated with it in the general Thai population.Methods: Cross-sectional research was conducted with 600 Thai subjects. Various psychometric properties were investigated including ceiling/floor effects, item-scale and scale levels validity using correlations, principal component analysis (PCA), and internal consistency. Multiple regression was used to assess the impact of demographic factors on the HRQoL level.Results: Cronbach's alpha ranged from 0.703 to 0.858. These eight SF-36v2 scales had a high ceiling effect while no floor effects were observed except for Bodily pain and General health. Correlations between the eight scales and two summary components, and item-scale correlations supported the hypotheses. Physical and Mental Health components were identified by PCA. Multiple regression revealed that having chronic diseases diminished HRQoL level.Conclusions: These preliminary results confirmed that the Thai SF-36v2 was a valid and reliable instrument. Having chronic diseases diminished the HRQoL level. Further study investigating subjects in different severity and impact of other factors on HRQoL level is encouraged. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery.Materials and Methods: A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery.Results: A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 ± 6.0 years versus 25.9 ± 6.5 years, p < .0001) as was the mean Body Mass Index (25.2 ± 5.3 kg/m2 versus 23.8 ± 4.5 kg/m2, p < .0001). CS was related to higher education, employment, white skin color, planned pregnancy, antenatal care in a private service, and primiparity.Conclusions: The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services. [ABSTRACT FROM AUTHOR]

Objective: This study addresses the need to measure and monitor objective, real-world driver safety behavior in at-risk drivers with age-related dysfunction. Older drivers are at risk for age-related cognitive and visual dysfunction, which may reduce mobility and increase errors that lead to crashes. Understanding patterns of real-world behavior, exposure, and cognitive-perceptual processes underlying risk in environmental context and in older drivers requires new approaches.Methods: We assessed patterns of objective, real-world driver risk exposure and vehicle control related to steering, braking, and accelerating in older adults with a range of cognitive and visual functional abilities. Real-world driver behavior was collected from passive-monitoring systems installed in 77 drivers' vehicles and analyzed across 242,153 km (150,467 miles) driven. Driver behavior was assessed cross-sectionally in relationship to driver functional abilities and safety-critical environmental contexts (roadway type and visibility condition).Results: Results suggest that cognitive dysfunction impairs vehicle control across wide-ranging environments. Drivers with greater cognitive dysfunction showed more erratic braking and accelerating during daytime commercial and interstate driving. Drivers with less cognitive dysfunction showed more erratic braking and accelerating on residential roadways regardless of visibility condition. Greater cognitive dysfunction predicted more erratic steering on commercial and interstate roadways and less erratic steering on residential roadways. Greater visual dysfunction impaired braking and accelerating during nighttime and interstate driving, but not on residential or commercial roadways. Steering behavior was unaffected by visual abilities. Drivers with greater cognitive dysfunction did not appear to reduce driving frequency in higher-risk environments. Visually impaired drivers drove more on residential roadways and less on commercial roadways, but did not reduce driving on interstates, where they showed the greatest risk per mile driven.Conclusions: Results successfully mapped driver cognitive and visual profiles onto contemporaneous, real-world behavior and risk loci. Results link age-related dysfunction to real-world vehicle control and show that drivers may not sufficiently reduce exposure to higher-risk driving environments. Employing naturalistic observation to monitor and measure patterns of driver behavior can inform methods for early detection of age-related risk, fitness-to-drive assessments, and interventions to preserve safety, mobility, and quality of life in aging or other at-risk populations. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to understand the awareness, riding behaviors, and legislative attitudes of electric bike (e-bike) users and non-e-bike road users toward e-bikes in Tianjin, a municipality in China.Methods: This cross-sectional investigation included 2 components. The field survey was conducted in 9 districts (4 urban and 5 rural) from 2015 to 2017. Adult participants were interviewed using a street intercept method. The online survey was conducted using the WeChat social platform. A series of questions related to awareness and practice of e-bike safety-related issues was asked.Results: A total of 16,859 interviews were completed, including 1,653 (794 e-bike users and 859 other road users) in-person interviews by field survey and 15,206 (4,426 e-bike users and 10,780 other road users) by online survey. Except for ignoring a red light when making a left turn (P = .000) and waiting across the white line at a red light (P = .000), which e-bike users were lower than other road users, there were no significant differences between e-bike users and other road users in regards to the correct awareness rate of riding in the opposite direction, riding in a motor vehicle lane, running red lights, jaywalking, speeding, carrying adult passengers, and riding on the expressway (P > .05). In addition, 74.2% of e-bike users considered helmet use necessary (P = .000) and 54.7% thought that installing a windshield is wrong (P = .000), which was higher than other road users (49.1 and 48.4%, respectively). Other road users had greater awareness than e-bike users regarding whether turning left at a red light is wrong (91.7 vs. 85.1%), waiting across the white line when the light is red is wrong (86.6 vs. 75.9%), lighs should be turned on at night (94.8 vs. 90.3%). Correct practices were far behind awareness in all kinds of violation behaviors (P = .000) among e-bike users in the field survey. The rate of public support for legislation including those who very much support and support legislation was 93.34% in the field survey and 87.68% in the online survey.Conclusions: E-bike users had lower correct awareness rate than other road users regarding e-bike violation behaviors but were more concerned about safety protection than other road users. E-bike users' correct practices were far behind their awareness for all kinds of violation behaviors. Public education on the traffic law needs to be strengthened among e-bike users. The public strongly supported special regulations for e-bike use, such as helmet use. [ABSTRACT FROM AUTHOR]

Background: The consumption of psychotropic drugs (PD) is increasing worldwide with a significant variation between countries. Croatia and Sweden have similar health and pharmaceutical systems; however, Sweden is a high-income country with developed medical care, registries, and prescribing guidelines. We sought to compare the utilization of PD between Croatia and Sweden to identify areas for improvement in rational use of drugs.Methods: This was a cross-sectional study using national databases to assess utilization of PD (ATC N05, N06) in Croatia and Sweden in 2014 and 2015.Results: Prescribing of PD in Croatia increased from 127 DDD/TID (defined daily dose/1000 inhabitants) in 2014 to 131 DDD/TID in 2015. In Sweden, the total utilization was higher with an increase from 183 DDD/TID in 2014 to 188 DDD/TID in 2015. There were substantial differences. In Croatia, the utilization of benzodiazepine derivatives (N05BA) was 72.5 DDD/TID in 2014 and increased to 74.4 DDD/TID, in 2015. In Sweden, the utilization was only 11.2 DDD/TID for benzodiazepine derivatives in both years.Conclusions: There were substantial differences in utilization of PD between Croatia and Sweden. Highlighting the problem of inappropriate benzodiazepine utilization in Croatia can help to introduce measures to change prescribing habits and improve prescribing quality. [ABSTRACT FROM AUTHOR]

Assessments of gay and bisexual men's substance use often obscures salient sociocultural and identity-related experiences related to how they use drugs. Latent class analysis was used to examine how patterns of substance use represent the social, economic and identity-related experiences of this population. Participants were sexually active gay and bisexual men (including other men who have sex with men), aged ≥ 16 years, living in Metro Vancouver (n = 774). LCA indicators included all substances used in the past six months self-reported by more than 30 men. Model selection was made with consideration to model parsimony, interpretability and optimisation of statistical criteria. Multinomial regression identified factors associated with class membership. A six-class solution was identified representing: 'assorted drug use' (4.5%); 'club drug use' (9.5%); 'street drug use' (12.1%); 'sex drug use' (11.4%); 'conventional drug use' (i.e. tobacco, alcohol, marijuana; 25.9%); and 'limited drug use' (36.7%). Factors associated with class membership included age, sexual orientation, annual income, occupation, income from drug sales, housing stability, group sex event participation, gay bars/clubs attendance, sensation seeking and escape motivation. These results highlight the need for programmes and policies that seek to lessen social disparities and account for social distinctions among this population. [ABSTRACT FROM AUTHOR]

The need for early prevention approaches to improve young people's sexual and reproductive health is gaining attention, yet little is known about the sexual experiences of early adolescents aged 10-14 years. Drawing on cross-sectional survey data collected from 365 early adolescents in a Nairobi slum, we used latent class analysis to identify subgroups based on self-reported awareness about sex and involvement in romantic and sexual activities. Multivariate regression models were fitted to examine the characteristics of each subgroup. Results revealed three subgroups: Involved (12%, high probability of being aware of sex and to have engaged in romantic/sexual activities); Observant (48%, high awareness but little own experience); and Naïve (40%, little awareness or personal experience). Being in the Involved group was associated with older age, having commenced puberty/orphanhood, and living in the least poor households. Findings suggest that while most early adolescents in this setting have not initiated romantic and sexual activities, there are distinct subgroups of who would not be captured by looking only at the prevalence of sexual intercourse. Understanding the characteristics and needs of specific subgroups may help to strengthen efforts to improve young people's sexual and reproductive health in urban poor environments. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to further understanding of the relationship between social support, internalized and perceived stigma, and mental health among women who experienced sexual violence in the eastern Democratic Republic of Congo (DRC).Methods: Drawing from baseline survey data collected in eastern DRC, researchers conducted a secondary cross-sectional analysis using data from 744 participants. Regression and moderation analyses were conducted to examine associations between social support variables, felt stigma, and depression, anxiety and posttraumatic stress disorder (PTSD).Results: Emotional support seeking and felt stigma were positively associated with increased symptom severity across all three mental health variables. Stigma modified associations between emotional support seeking and depression (t = -2.49, p = .013), anxiety (t = -3.08, p = .002), and PTSD (t = -2.94, p = .003). Increased frequency of emotional support seeking was associated with higher mental health symptoms of anxiety and PTSD among women experiencing all levels of stigma.Conclusions: Enhancing understanding of social support and stigma may inform research and intervention among Congolese forced migrant populations across circumstances and geographic locations. Implications for practice and research are discussed. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the performance of a neurologic assessment protocol among jaundiced infants requiring exchange transfusion (ET).Methods: We identified infants in a referral children's hospital who received ET and those who met the American Academy of Pediatrics (AAP) criteria for ET based on total serum bilirubin (TSB) levels. The performance of a bilirubin-induced neurologic dysfunction (BIND-M) scoring protocol for acute bilirubin encephalopathy (ABE) in detecting infants treated with ET in both groups was investigated by logistic regression analysis and c-statistic.Results: A total of 438 late-preterm and term infants were enrolled, out of which 141 (32.2%) received ET, and 155 (35.4%) met AAP criteria for ET. Infants with BIND-M scores of 3-6 (intermediate ABE) or 7-12 (advanced ABE) were significantly associated with ET in both groups, but not scores of 1-2 (mild ABE), with or without adjustment for confounding neurotoxicity risk factors. However, the discriminatory ability of BIND-M regression models was modestly satisfactory (c-statistic range: 0.693-0.791).Conclusions: Our findings suggest that BIND-M is a potentially useful decision-making tool for ET and support current recommendation for immediate ET for infants with intermediate-to-advanced stages of ABE regardless of the TSB levels. [ABSTRACT FROM AUTHOR]

Background: Rotavirus diarrhea is a major health problem among young children worldwide with potential negative impacts on health-related quality of life (HRQoL). This study assessed the impact of rotavirus diarrhea on HRQoL of children and their caregivers.Methods: We performed a cross-sectional study among 460 hospitalized children with diarrhea aged under 5 years and their family caregivers at three hospitals in Phetchabun province, Thailand during May 2013 and February 2014. The severity of diarrhea was assessed using the Vesikari severity scoring system while the HRQoL was assessed using the EQ-5D-3L.Results: The mean EQ-5D utility of children with all-causes diarrhea was 0.604. The utility of the rotavirus diarrhea group was significantly lower than that of the non-rotavirus diarrhea group (0.593 vs. 0.612; p-value = 0.040). The family caregiver's utility was 0.964 at baseline and significantly decreased to 0.620 (p-value = 0.041) when their children were hospitalized with diarrhea. In multiple regression analyses, severity but not rotavirus infection had significant negative impacts on the utility of both the children and their caregivers.Conclusion: Diarrhea, either caused by rotavirus or non-rotavirus infection, resulted in substantial negative impacts on the quality of life of both the children and their caregivers. [ABSTRACT FROM AUTHOR]

Objective: Crash and injury surveillance studies have identified a range of rider-related factors, including age, sex, licensure, training and experience, as being associated with motorcycle crash risk. The aim of this study was to establish whether these previously identified factors were associated with crash involvement in an Australian-based population.Methods: Data obtained from motorcyclists recruited from road authority licensing offices in a population-based survey design were analyzed. In addition to descriptive analysis, survey logistic regression was used to examine predictors of self-reported motorcycle crashes. A statewide population prevalence study of motorcyclists in New South Wales, Australia, was conducted using a multistage stratified random sampling plan. Participants (n = 503) represented 47% of eligible riders invited to participate. The distribution of responses was weighted to represent the population based on motorcycle registrations as a proxy for active motorcyclists, adjusted for age, sex, and variations in sample size and population density between survey sites.Results: This analysis investigated factors associated with having crashed in the past 12 months. The key predictors of increased crash risk included frequent near-crash experiences (6-10) in the past year (adjusted odds ratio [ORadj] = 5.3; 95% confidence interval [CI], 1.3-21.8), having 4 or more riding demerit points (ORadj = 4.1; 95% CI, 1.1-14.7), and motorcycle type and riding purpose. Sports (ORadj = 2.8; 95% CI, 1.1-7.3) and commuter motorcycles (ORadj = 4.0; 95% CI, 1.1-15.3) were associated with higher odds of crashes compared to cruiser/touring motorcycles. Those whose purpose for riding frequently involved commuting, high-speed roads, or motorcycle sports had higher odds of being involved in a crash compared to riders who rarely took part in such activities. Rider age, license type, and time holding a motorcycle license were not predictive of crash involvement when other factors were taken into account.Conclusions: These findings provide important population-level information and insights about risk exposure for motorcyclists. Taking a more tailored approach to data collection meant that factors associated with crash involvement were identified that are not commonly observed in studies relying on administrative data. In particular, the study highlights the importance of near-crash experiences as warnings to riders and the need to use such experiences as learning opportunities to improve their riding style and safety. [ABSTRACT FROM AUTHOR]

Background: Non-prescription use of antibiotics in children is an important public health problem. We aimed to investigate primary caregivers' knowledge, attitudes, and practices of antibiotics use among children in urban China.Methods: Knowledge, attitudes, and practices regarding antibiotics use in children were assessed through a cross-sectional questionnaire survey of 4200 caregivers of children under-7 years from three cities in China. Data were analyzed using descriptive statistics and multivariate analysis.Results: Caregivers' knowledge gaps and undesirables attitudes regarding appropriate use of antibiotics were identified. 48.2% of respondents reported non-prescription use of antibiotics for children in the past 6 months. The most common sources of antibiotics used without a prescription are community pharmacies and leftovers. Storing antibiotics at home and caregivers' supportive attitude were positively and significantly associated with non-prescription use of antibiotics in children, while significant inverse associations were found for caregiver's knowledge of prescription-only regulation on antibiotics sales at community pharmacies.Conclusions: There was a high proportion of primary caregivers self-medicate antibiotics for children in urban China, despite their insufficient knowledge about antibiotic use. Public health initiatives are needed such as public education campaigns and stricter government regulation of antibiotic use and availability in community pharmacies. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the correlation between clinical features of ankylosing spondylitis (AS) and different human leukocyte antigen (HLA)-B27 subtypes.Methods: We conducted a cross-sectional study of 216 patients with AS. HLA-B27 and its subtypes were detected by polymerase chain reaction with sequence specific primer (PCR-SSP). Clinical features were compared between the different HLA-B27 subtypes. A meta-analysis on uveitis frequencies in AS patients with HLA-B*2705 vs 2704 was performed.Results: The most prevalent subtypes of HLA-B27 were HLA-B*2704 (66.1%) and HLA-B*2705 (32.2%). There were 57 HLA-B27-positive AS patients with the history of uveitis; 45 were B*2704 and 12 were B*2705. Patients with B*2704 had more uveitis than B*2705 (p = 0.021). After meta-analysis, there was no significant difference in the presence of uveitis between HLA-B*2704 and HLA-B*2705.Conclusions: AS patients with B*2704 have a higher risk of uveitis than AS with B*2705 in a north Chinese people. [ABSTRACT FROM AUTHOR]

Background: Hemodynamic responses to exercise are used as markers of diagnosis for cardiac diseases, systolic blood pressure (SBP) especially. However, the reference values for SBP in children at peak exertion level are outdated. This study aimed to establish current reference values for SBP, rate pressure product (RPP), and circulatory power (CircP).Methods: Data from children who previously underwent cardiopulmonary exercise testing were categorized as healthy (N = 184; age 12.6 ± 2.9 years), and CoA patients (N = 25; age 13.0 ± 3.2 years). With the Lambda-Mu-Sigma (LMS) method, percentile curves were made for SBP, CircP, and RPP in function of peak work rate (Wpeak). Data of CoA patients were used to validate the reference values.Results: Wpeak was the best predictor of peak SBP during exercise. The prediction equations for SBP, CircP and RPP were: (0.2853 x Wpeak) + 111.46; (10.56 x Wpeak) + 2550.2 and (61.879 x Wpeak) + 19.887, respectively. CoA patients showed significantly increased values for peak SBP (Z-score 1.063 ± 1.347).Conclusion: This study provides reference values for SBP, RPP, and CircP at peak exercise. These values can be used for objective evaluation of participants 6-18 years of age in a Dutch population. [ABSTRACT FROM AUTHOR]

The use of performance and image enhancing drugs (PIEDs) is not uncommon in athletes and appears to be associated with several psychopathological disorders of unclear prevalence. In this multicenter, cross-sectional study, we aimed to evaluate the prevalence of body image disorders (BIDs) and eating disorders (EDs) in PIED-using athletes vs. PIED nonusers. We enrolled 84 consecutive professional and amateur athletes training in sport centers in Italy, who underwent semi-structured interviews (SCID-I, SCID-II) and completed the Body Image Concern Inventory (BICI) and the Sick, Control, One, Fat, Food Eating Disorder Screening Test (SCOFF). PIEDs were searched for in participants’ blood, urine, and hair. Of these, 18 (21.4%) used PIEDs, the most common being anabolic androgenic steroids, amphetamine-like substances, coffee and caffeine derivatives, synthetic cathinones, and ephedrine. PIED users and nonusers did not differ in socio-demographic characteristics, but differed in clinical and psychopathological features, with PIED users being characterized by higher physical activity levels, higher daily coffee and psychotropic medication use (e.g., benzodiazepines), more SCID diagnoses of psychiatric disorders, especially substance use disorder, body dysmorphic disorder (BDD), EDs, and general anxiety disorder, higher BICI scores (indicating higher risk of BDD), and higher SCOFF scores (suggesting higher risks for BIDs and EDs). [ABSTRACT FROM PUBLISHER]

Objectives: Cardiovascular function generally decreases with age, but whether this decrease differs between men and women is unclear. Our aims were twofold: (1) to investigate age-related sex differences in left ventricular (LV) structure, function and mechanics, and (2) to compare these measures between pre- and postmenopausal women in the middle-aged group.Methods: Resting echocardiography was performed in a cross-sectional sample of 82 healthy adults (14 young men, 19 middle-aged men, 15 young women, 34 middle-aged women: 15 premenopausal and 19 postmenopausal). Two-way ANOVAs were used to examine sex × age interactions, and t-tests to compare pre- and postmenopausal women (α < 0.1).Results: Normalized LV mass, stroke volume and end-diastolic volume were significantly lower in middle-aged than young men, but this difference was smaller between middle-aged and young women. Peak systolic apical mechanics were significantly greater in middle-aged men than in middle-aged women, but not between young men and women. Postmenopausal women had significantly lower LV relaxation and mechanics (torsion, twisting velocity and apical circumferential strain rates) compared with middle-aged premenopausal women.Conclusion: Our cross-sectional findings suggest that the hearts of men and women may age differently, with men displaying greater differences in LV volumes accompanied by differences in apical mechanics. [ABSTRACT FROM AUTHOR]

Objective: Limited research has evaluated the individual and combined associations of physical activity (PA), cardiorespiratory fitness (CRF) and muscle strengthening activities (MSA) on generalized anxiety, panic and depressive symptoms. We evaluated this topic in a representative sample of young (20-39 years) adults, with considerations by sex.Methods: Data from the 1999-2004 National Health and Nutrition Examination Survey (N = 2088) were used. Generalized anxiety, panic and depressive symptoms were assessed via self-report as well as using the Generalized Anxiety Disorder, Panic Disorder, and Depressive Disorders modules of the automated version of the World Health Organization Composite International Diagnostic Interview (CIDI-Auto 2.1). PA and MSA were assessed via validated self-report questionnaires and CRF was determined via a submaximal treadmill-based test. An index variable was created summing the number (range = 0-3) of these parameters for each participant. For example, those meeting PA guidelines, MSA guidelines and having moderate-to-high CRF were classified as having an index score of 3.Results: MSA was not independently associated with generalized anxiety, panic and depressive symptoms, but those with higher levels of PA and CRF had a reduced odds of these symptoms (ranging from 40 to 46% reduced odds). Compared to those with an index score of 0, those with an index score of 1, 2, and 3, respectively, had a 39%, 54% and 71% reduced odds of having generalized anxiety, panic and depressive symptoms. Results were consistent across both sexes.Conclusion: PA and CRF, but not MSA, were independently associated with generalized anxiety, panic and depressive symptoms. There was evidence of an additive association between PA, CRF, and MSA on these symptoms. [ABSTRACT FROM AUTHOR]

There is a need for validated measures of attention for use in longitudinal studies of older populations. We studied 249 participants aged 80 to 101 years using the population-based MOBILIZE Boston Study. Four subscales of the Test of Everyday Attention (TEA) were included, measuring attention switching, selective, sustained and divided attention and a neuropsychological battery including validated measures of multiple cognitive domains measuring attention, executive function and memory. The TEA previously has not been validated in persons aged 80 and older. Among participants who completed the TEA, scores on other attentional measures strongly with TEA domains (R=.60-.70). Proportions of participants with incomplete TEA subscales ranged from 8% (selective attention) to 19% (attentional switching). Reasons for not completing TEA tests included failure to comprehend test instructions despite repetition and practice. These results demonstrate the challenges and potential value of the Test of Everyday Attention in studies of very old populations. [ABSTRACT FROM AUTHOR]

This study compared knowledge and compliance with traffic signs among young commercial motorcyclists in rural and urban communities in Oyo state, Nigeria. Information on knowledge and compliance with 10 common traffic signs was obtained from 149 rural and 113 urban commercial motorcyclists aged 18–35 years. Aggregate knowledge scores were computed and categorized as good (≥5) and poor (<5) knowledge. Overall, 98.7% rural versus 61.1% urban motorcyclists had poor knowledge of traffic signs (p< 0.05). After controlling for age, level of education and years of commercial riding, motorcyclists in the rural areas were more likely to have poor knowledge of the traffic signs (OR = 58.15; 95% CI = 11.96–282.79). A higher proportion of rural than urban motorcyclists never obeyed any of the traffic signs. Young rural commercial motorcyclists' knowledge and compliance with the road signs was poorer than their urban counterparts. Interventions to improve the rural motorcyclists' knowledge and ultimately compliance with road signs are urgently required. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate the effect of rheumatoid arthritis (RA) on choroid, retinal nerve fiber layer (RNFL), and foveal thickness using spectral domain optical coherence tomography (OCT).Methods: Fifty patients with RA and forty-one healthy volunteers were enrolled in this study. The subfoveal, perifoveal choroidal, RNFL, and foveal thicknesses were measured by spectral domain OCT.Results: The mean subfoveal, nasal, and temporal choroidal thicknesses in RA individuals were significantly higher than those in the control group (p ˂ 0.05). However, there was no significant difference between the RA and healthy group regarding RNFL and foveal thickness (p ˃ 0.05). A significant correlation was found between rheumatoid factor (RF) and the subfoveal temporal choroidal thickness.Conclusion: Choroidal thickness in RA patients was higher than that in healthy participants. Choroidal thickening showed a positive correlation with RF, which may be an indicator for systemic vasculitis. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop a theory-based questionnaire to measure road crossing attitudes and potentially risky pedestrian behavior.Methods: A cross-sectional validation study was carried out on a total sample of 380 young adults aged 18 to 25 years who live in Tehran, Iran. Data were collected from January 27 to May 20, 2015, using a self-administered structured pool of 76 items that was developed from research on the theory of planned behavior. A panel of subject-matter experts evaluated the items for content validity index and content validity ratio, and the questionnaire was pretested. Exploratory factor analysis (EFA) was performed to test construct validity. The Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) analyses were done to assess internal consistency and stability of the scale.Results: From the initial 76 items, 38 items were found to be appropriate for assessing the pedestrian road crossing behavior (PEROB) of young adults in Tehran. A 9-factor solution revealed an exploratory factor analysis that jointly accounted for 63.8% of the variance observed. Additional analyses also indicated acceptable results for the internal consistency with Cronbach's alpha value ranging from 0.67 to 0.88 and ICC values ranging from 0.64 to 0.96.Conclusions: This psychometric evaluation of a self-administered instrument resulted in a reliable and valid instrument to assess young adult pedestrians' self-reported road crossing attitudes and behaviors in Tehran. Further development of the instrument is needed to assess its applicability to other road users, particularly older pedestrians. [ABSTRACT FROM AUTHOR]

Given the role of the intestinal microbiota in obesity and related disease, strategies to modulate the composition of the intestinal microbiota may augment traditional weight-management approaches. Here, we examined the safety and tolerability of 28 days of supplementation with bovine whey-derived lactoferrin and immunoglobulin supplements in a cross-sectional cohort of free-living adults. Participants (n = 20 each group) received enteric-coated whey-derived bovine lactoferrin (200 mg), immunoglobulin (200 mg or 800 mg), combination lactoferrin/immunoglobuiln supplements (200 mg/200 mg, 200 mg/800 mg) or placebo in a double-blind design. Supplement use was generally well tolerated and routine haematology, and clinical chemistry measures were largely unchanged following supplementation. Measures of body composition remained stable and indices of glycaemic control and blood lipids revealed fluctuations of <5% but were not significantly different between groups. Overall, short-term lactoferrin/immunoglobulin supplementation was well tolerated in this cohort; use of these types of supplements to enhance other weight management strategies should be investigated over extended periods. [ABSTRACT FROM PUBLISHER]

Background: Predicting time to relapse provides an opportunity for the development of relapse prevention interventions in drug users.Objectives: The aim of the present study was to describe the development of the Persian version of the 9-item Time to Relapse Questionnaire (TRQ) and to evaluate its psychometric properties in an Iranian sample of treatment-seeking individuals with substance dependence (n = 150).Methods: The forward-backward method was used to translate the TRQ scale from English into Persian. After linguistic validation and a pilot check, a cross-sectional study was performed, and psychometric properties of the Iranian version of the questionnaire were assessed. The reliability was evaluated by Cronbach's alpha and test-retest analyses. In addition, the factor structure of the scale was extracted by applying confirmatory factor analysis.Results: The mean age of participants was 40.52 (SD = 11.30) years. The mean scores for the content validity index (CVI) and the content validity ratio (CVR) were 0.93 and 0.81, respectively. A confirmatory factor analysis (CFA) demonstrated that the three-factor model of the TRQ was a good fit for the data and thus replicated the factor structure of the original English language TRQ. Cronbach's alpha presented good internal consistency (alpha = 0.76), and test-retest reliability of the TRQ instrument with 2-week intervals was appropriate (ICC = 0.84).Conclusion: The findings demonstrate that the Persian version of the TRQ is a reliable and valid scale for measuring time to relapse in Iranian drug users. The TRQ can be applied at the start of treatment so that clinical interventions can be targeted toward the different relapse styles. [ABSTRACT FROM AUTHOR]

Purpose: To compare corneal biomechanics, intraocular pressure (IOP) and central corneal thickness (CCT) of 38 patients with unilateral Fuchs' uveitis (FU) with 42 healthy controls.Methods: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated IOP (IOPg and IOPcc, respectively) and CCT were measured.Results: The mean CH, CRF, and IOPg of the involved FU eyes were significantly lower (9.5 ± 1.6, 9.0 ± 1.9 and 13.1 ± 4.3 mmHg) than contralateral eyes (10.1 ± 1.7, 9.9 ± 1.7 and 14.6 ± 3.4 mmHg), and controls (10.5 ± 1.5, 10.3 ± 1.5 and 14.8 ± 2.5 mmHg), respectively. There was no significant difference for mean IOPcc between involved FU or contralateral eyes and controls (14.8 ± 4.1, 15.5 ± 3.4 and 15.0 ± 2.7 mmHg). The CCT values correlated with CH and CRF in the involved and contralateral eyes.Conclusions: Involved FU eyes had lower CH, CRF, and IOPg than contralateral eyes and controls, with no difference regarding IOPcc. [ABSTRACT FROM AUTHOR]

Objective: To investigate attitudes towards schizophrenia and people with schizophrenia presented in YouTube videos. Methods: We searched YouTube using the search terms “schizophrenia” and “psychosis” in Finnish and Greek language on April 3rd, 2013. The first 20 videos from each search (N = 80) were retrieved. Deductive content analysis was first applied for coding and data interpretation and it was followed by descriptive statistical analysis. Results: A total of 52 videos were analyzed (65%). The majority of the videos were in the “Music” category (50%,n = 26). Most of the videos (83%,n = 43) tended to present schizophrenia in a negative way, while less than a fifth (17%,n = 9) presented schizophrenia in a positive or neutral way. Specifically, the most common negative attitude towards schizophrenia was dangerousness (29%,n = 15), while the most often identified positive attitude was objective, medically appropriate beliefs (21%,n = 11). All attitudes identified were similarly present in the Finnish and Greek videos, without any statistically significant difference. Conclusions: Negative presentations of schizophrenia are most likely to be accessed when searching YouTube for schizophrenia in Finnish and Greek language. More research is needed to investigate to what extent, if any, YouTube viewers’ attitudes are affected by the videos they watch. [ABSTRACT FROM PUBLISHER]

Background: E-mental health interventions can have a positive impact on patient-reported and clinical outcomes. The purpose of this project was to develop a user-centered e-mental health portal.Methods: The development of the portal www.psychenet.de included mixed-methods techniques for needs assessment to identify user-relevant content. Furthermore, user-centered design techniques were applied by utilizing individual usability testing with cognitive task analysis. First, a basic version of the portal was created and introduced to the public by means of a media campaign. After the development of module-specific content, exposure and use of the portal was investigated as part of a process evaluation.Results: Relevant content identified by needs assessment covered both, overarching and diagnosis-specific topics. Results of the process evaluation showed a highly accessed website. During the first 18 months, 119,423 visits were tracked. The portal was predominantly accessed by Google searches (73.9%), while 17.6% of visits were related to direct traffic.Discussion: Serving as a complement to face-to-face consultations, www.psychenet.de attempts to inform about mental disorders, and engage patients in the course of their treatment. Results of the process evaluation confirm the high relevance and potential of the portal and can be used for further improvements and extensions in the future. [ABSTRACT FROM AUTHOR]

The ratio of cystatin C to creatinine (cysC/crea) is regarded as a marker of glomerular filtration quality and predicts mortality. It has been hypothesized that increased mortality may be mediated by the retention of biologically active substances due to shrinking glomerular pores. The present study investigated whether cysC/crea is independently associated with the levels of two renally cleared hormones, which have been linked to increased mortality. We conducted a multicenter, cross-sectional study with a random selection of general practitioners (GPs) from all GP offices in seven Swiss cantons. Markers of glomerular filtration quality were investigated together with estimated glomerular filtration rate (eGFR), albuminuria and urinary neutrophil gelatinase associated lipocalin (uNGAL) as well as two renally cleared low-molecular-weight protein hormones (i.e. BNP and PTH), Morbidity was assessed with the Charlson Comorbidity Index (CCI). A total of 1000 patients (433 males; mean age 57 ± 17 years) were included. There was a significant univariate association of BNP (r = 0.36,p < 0.001) and PTH (r = 0.18,p < 0.001) with cysC/crea. An adjusted model that accounted for kidney function (eGFR), altered glomerular structure (albuminuria), renal stress (uNGAL), and CCI showed that BNP and PTH were independently associated with cysC/crea as well as with the ratio of cystatin C-based to creatinine-based eGFR. In conclusion, in primary care patients, BNP and PTH are independently associated both with markers of glomerular filtration quality and eGFR regardless of structural kidney damage or renal stress. These findings offer an explanation, how altered glomerular filtration quality could contribute to increased mortality. [ABSTRACT FROM PUBLISHER]

Background: The role of adiponectin in arterial stiffness and its relationship to cardiovascular disease is not fully demonstrated and needs further elaboration. In this study, the association between adiponectin level and arterial stiffness is studied among kidney transplant patients.Material and Methods: Anthropometric data and biochemical data including fasting glucose, lipid profile, renal function and serum adiponectin were determined in 55 kidney transplant patients. Central arterial stiffness was measured and presented by carotid-femoral pulse wave velocity.Results: Univariate linear analysis showed that body weight, waist circumference, brachial pulse pressure and body mass index were correlated positively with carotid-femoral pulse wave velocity in this patient group. However, logarithmically transformed adiponectin level (log-adiponectin) correlated negatively with carotid-femoral pulse wave velocity. In multivariate regression analysis of factors significantly associated with carotid-femoral pulse wave velocity, it showed that both log-adiponectin (β = -0.427; R(2) = 0.205, p = 0.001) and body weight (β = 0.327; R(2 )=( )0.106, p = 0.007) were independently predictive of central arterial stiffness.Conclusion: Our study suggests that fasting serum adiponectin is negatively associated with carotid-femoral pulse wave velocity, hence arterial stiffness, in kidney transplant patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate expression of glucocorticoid-induced tumor necrosis factor receptor (GITR), cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and IL-10 in peripheral blood mononuclear cells (PBMCs) of 20 women with unexplained recurrent spontaneous abortion (URSA) compared to 20 normal non-pregnant women (NNP) during luteal phase in the window of implantation. Methods: Quantitative real-time PCR (qRT-PCR) was performed using the Taqman method for expression of GITR and SYBR Green method for expression of CTLA-4 and IL-10. Results: Expression of CTLA-4 in the NNPs (median; interquartile range; 3; 1.8–10) was significantly higher than the URSAs (0.72; 0.26–3.81,p = 0.015). Expression of GITR in the NNPs (53; 10–139) was significantly higher than the URSAs (6; 3–27,p = 0.005). However, IL-10 expression in the URSAs was significantly higher than the NNPs, did not meet a significant value. A significant correlation was found between CTLA-4 and GITR expression in the study population (p = 0.0001). Conclusions: Expression of CTLA-4 and GITR were significantly down-regulated in the URSAs compared to NNPs at the window of implantation, which shows the essential role of Treg cells in creating an immunological privileged site for fetus as an allograft at the maternal–fetal interface by high expression levels of CTLA-4 and GITR during a normal pregnancy. [ABSTRACT FROM PUBLISHER]

Objectives: Carotid artery calcifications (CAC) and high carotid artery intima-media thickness (cIMT) are associated with low bone mineral density (BMD) by unknown mechanisms in postmenopausal women. Leptin, adiponectin and estradiol may mediate these associations. Our aim was to study the relationships of the aforementioned factors to bone health (BMD) and carotid atherosclerosis (CAC and cIMT).Method: Participants (n = 290, mean age 73.6 years) for this cross-sectional OSTPRE-BBA study (Kuopio Osteoporosis Risk Factor and Prevention - Bone, Brain and Atherosclerosis) were randomly selected from the OSTPRE cohort in 2009. Femoral neck and total body BMDs, trunk and total body fat mass were measured with dual-energy X-ray absorptiometry, and cIMT (mm) and CAC (no/yes) were measured with B-type ultrasound. Free estradiol, adiponectin and leptin were measured from serum samples.Results: Circulating estradiol levels were associated with leptin (β = 0.131, p < 0.001), but not with adiponectin (p > 0.05), when adjusted for total body fat mass. There were no associations between estradiol tertiles and BMDs, or with cIMT or CAC. Adiponectin levels were inversely associated with femoral neck BMD (p = 0.019, β = -0.138) and total body BMD (p = 0.009, β = -0.142), adjusted for total body fat mass, age, current smoking and estradiol, but showed no relationship with CAC or cIMT. Leptin levels were not associated with BMDs or cIMT; but the odds ratio was 1.5 between the CAC and leptin quartiles (p = 0.014), adjusted for total body fat mass, age, statin use and calcium intake.Conclusion: The adipokines are associated with vascular calcification and low BMD. Moreover, estradiol was not independently associated with BMD or CAC. [ABSTRACT FROM AUTHOR]

Introduction: Hypoglycemia is an acute complication of diabetes that increases morbidity, mortality and disease costs. We aim to estimate healthcare resource consumption and costs associated with severe hypoglycemia using the societal perspective.Methods: A cross-sectional, observational, nationwide, multicenter, hospital-based study was conducted in seven centers of Portuguese mainland with a 1-year enrolment period. Unit costs were extracted from official/public data sources. Patient-level data were used to quantify healthcare resource use related to emergency transportation, emergency-department care and hospitalization. Productivity loss was calculated based on the Human Capital Approach.Results: The study enrolled 238 Type-2 diabetic patients and the proportion of hypoglycemic episodes among all emergency events during the study period was 0.075% (95% CI: 0.067-0.083%). Mean patient age was 76 years and 57.6% were female. At time of the emergency department admission, 55% of patients were using insulin, 31.5% were being treated with secretagogues, 6.7% were on a combination of both, and 6.7% were on other oral antihyperglycemic agents. Estimated mean costs in the emergency department were: emergency transportation €33, medication €4, laboratory workup €56, other exams €72, physician and nurse time €30 and €13, respectively. Mean hospitalization cost was €1271. Indirect cost averaged €15. Overall cost per hypoglycemic episode averaged €1493 (standard deviation: €2962; range: €34-26,818). Patients treated with secretagogues had the highest rates of hospitalizations and mean costs.Conclusion: We conclude that severe hypoglycemic events represent a substantial cost for society and in particular for the hospitals of the National Health Service. [ABSTRACT FROM AUTHOR]

Objectives: This project aims to identify socio-demographic, medical and psychosocial factors (study factors) associated with coronary risk control and prognosis, and to test their impact in a representative sample of coronary heart disease (CHD) patients.Design: The first phase includes a cross-sectional study designed to explore the association between the study factors and coronary risk factor control in CHD patients. Data from hospital records, a questionnaire, clinical examination and blood samples were collected. The independent effects of study factors on subsequent coronary events will be explored prospectively by controlling for baseline coronary risk factors. In the second phase, we will test the effect of tailored interventions to modify the study factors associated with unfavourable risk profile in phase I.Results: In all 1366 patients (21% women), aged 18-80 years with a coronary event on average 17 (2-38) months prior to study participation were identified (83% participation rate). Of the 239 patients who refused participation, 229 patients consented to analysis of hospital record data (non- participants).Conclusions: If the study variables contribute to CHD risk factors and prognosis, the present project may be important for the development of prevention programs by tailoring these to the patients perceived needs and behaviour profiles. [ABSTRACT FROM AUTHOR]

Background: While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection.Objectives: To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission.Methods: A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping.Results: Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT.Conclusion: Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women. [ABSTRACT FROM AUTHOR]