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Just under 2.5 million people die annually due to alcohol use. This global estimate, however, excludes most of the health burden borne by others than the alcohol user. Alcohol's harm to others includes a multitude of conditions, such as trauma from traffic crashes, fetal disorders due to prenatal exposure to alcohol, as well as interpersonal and intimate partner violence. While alcohol's causal role in these conditions is well-established, alcohol's harm to others' contribution to the overall health burden of alcohol remains unknown. This knowledge gap leads to a situation in which alcohol policy and prevention strategies largely focus on the reduction of alcohol's detrimental health harms on the alcohol users, neglecting affected others and population groups most vulnerable to these harms, including women and children. In this article, we seek to elucidate why estimates for alcohol's harm to others are lacking and offer guidance for future research. We also argue that a full assessment of the alcohol health burden that includes the harm caused by others' alcohol use would enhance the visibility and public awareness of such harms, and advancing the evaluation of policy interventions to mitigate them. Chaque annee, un peu moins de 2,5 millions de deces sont lies a la consommation d'alcool. Cette estimation globale ne tient cependant pas compte de l'impact sur la sante de l'entourage des consommateurs d'alcool. Les mefaits de l'alcool sur les autres ont une multitude de consequences, parmi lesquelles des traumatismes dus aux accidents de la circulation, des anomalies fatales liees a une exposition prenatale a l'alcool, ainsi que des actes de violence interpersonnelle et entre partenaires. Bien que le role causal de l'alcool dans ces problematiques soit bien etabli, les repercussions de tels mefaits sur la sante dans son ensemble restent a determiner. Des lacunes qui aboutissent souvent a une situation dans laquelle les politiques et strategies de prevention se concentrent principalement sur la diminution des effets nefastes de l'alcool sur la sante des consommateurs eux-memes, negligeant les personnes qui les entourent et les categories de population les plus vulnerables, en particulier les femmes et les enfants. Dans cet article, nous tentons d'expliquer pourquoi il n'existe aucune estimation concernant les mefaits de l'alcool sur les autres et prodiguons des conseils pour de futures recherches. Nous plaidons aussi pour une analyse complete de la charge sanitaire imputable a l'alcool incluant les mefaits de l'alcool sur les autres, afin d'ameliorer la visibility et de mieux sensibiliser l'opinion publique a ces problematiques, mais aussi de faire progresser l'evaluation des interventions politiques entreprises pour y remedier. Cerca de 2,5 millones de personas mueren cada ano por el consumo de alcohol. Sin embargo, esta estimacion global excluye la mayor parte de la carga sanitaria que soportan personas que no son consumidores de alcohol. Los danos del alcohol a terceros incluyen multitud de afecciones, como los traumatismos por accidentes de trafico, los trastornos fetales debidos a la exposicion prenatal al alcohol, y la violencia interpersonal y de pareja. Aunque se sabe que el alcohol influye en estas afecciones, se desconoce la contribucion de los danos del alcohol a terceros a la carga sanitaria global que supone el alcohol. Esta falta de conocimiento conduce a una situacion en la que las estrategias de politica y de prevencion del alcohol se centran en gran medida en la reduccion de los danos perjudiciales del alcohol para la salud de los consumidores de alcohol, dejando de lado a los demas afectados y a los grupos de poblacion mas vulnerables a estos danos, incluidas las mujeres y los ninos. En este articulo, tratamos de dilucidar por que faltan estimaciones sobre los danos del alcohol en otras personas y ofrecemos orientaciones para futuras investigaciones. Tambien argumentamos que una evaluacion completa de la carga sanitaria del alcohol que incluya los danos causados por el consumo de alcohol de otras personas mejoraria la visibilidad y la concienciacion publica de esos danos, y haria avanzar la evaluacion de las intervenciones politicas para mitigarlos. [phrase omitted], Introduction Just under 2.5 million people die annually due to alcohol use. (1) This global estimate, however, excludes most of the health burden borne by others than the alcohol user. [...]

Shiga toxin-producing Escherichia coli (STEC) bacteria are responsible for a spectrum of disease, ranging from simple to bloody diarrhea, and pose increased risk for severe complications, including hemolytic uremic syndrome [...]

Background Predicting disease severity can be informative for management of HUS. Dialysis requirement, volume depletion, elevated white blood cell counts, very young age, and use of antimotility agents are known factors associated with severe HUS. Methods A retrospective cohort analysis was performed to identify factors associated with dialysis duration using electronic medical record and chart review of 76 children [less than or equal to] 18 years of age at presentation with STEC-HUS identified through billing data from July 2008 to April 2020 at James Whitcomb Riley Hospital for Children, Indiana University, Indiana. Results Novel findings associated with prolonged dialysis duration were age [greater than or equal to] 6 years old at presentation (p = 0.041) and lack of drop in platelets below 60,000/mm.sup.3 anytime during the illness (p = 0.015). In addition, children with NSAID exposure trended longer on dialysis: 15 days with vs. 10 days without (p = 0.117). Known risk factors for severe disease including elevated peak white blood cell (WBC) count and higher hematocrit at presentation were also associated with longer dialysis duration: children with peak WBC > 20,000/mm.sup.3 were on dialysis for 15 vs. 9.5 days (p = 0.002) and in children on dialysis [greater than or equal to] 14 days hematocrit at presentation was 29.6% vs. 24.2% (p = 0.03). Children requiring dialysis for 20 days or longer were more likely to be on anti-hypertensive medications (p = 0.025) and have chronic kidney disease at 12-month follow up (p = 0.044). Conclusions Age [greater than or equal to] 6, elevated WBC count > 20,000/mm.sup.3, higher hematocrit at presentation, lack of drop in platelets to < 60,000/mm.sup.3, and possibly NSAID exposure during illness are associated with longer dialysis duration in STEC-HUS. Graphical abstract, Author(s): Myda Khalid [sup.1] , Chloe Miller [sup.1] , Netsanet Gebregziabher [sup.2] , Zoe Guckien [sup.1] , Shrea Goswami [sup.1] , Anthony Perkins [sup.2] , Sharon Phillips Andreoli [sup.1] Author [...]

African horse sickness (AHS) is a fatal vector-borne disease affecting all species of equids. The disease has major economic consequences for the equine industry. The World Organisation for Animal Health [...]

Perceived personal wellbeing tends to be lower in individuals with autism spectrum disorders (ASD), especially in the case of women. To develop the present study, the Personal Wellbeing Index (PWI-A) was administered to a Spanish-speaking sample of women with ASD (N = 401) and self-diagnosed ASD (N = 343), women without ASD (N = 373) and men with ASD (N = 65) to compare their self-perceptions. Women with ASD showed significantly lower wellbeing rates than women in the control group for the total PWI-A and across all the domains, and there were no significant differences when compared with self-diagnosed women with ASD and men with ASD. Autism explained between 24 and 26% of the decline in the PWI-A total score, with life achievement, future security, safety and relationships being the domains most highly correlated with the total. These findings are an effective contribution to improving diagnosis and professional intervention in women with ASD., Author(s): Paula Morales Hidalgo [sup.1] [sup.2] [sup.13] , María Merino Martínez [sup.3] [sup.4] [sup.13] , Angélica Gutiérrez González [sup.5] [sup.6] [sup.13] , Lola Garrote Petisco [sup.7] [sup.13] , Carol Amat [...]

Shiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen that causes illness ranging from mild diarrhea to hemolytic uremic syndrome and death. During 2011, an exceptionally large outbreak caused by [...]

Introduction: Despite the rising availability and use of medical marijuana (MM) in the USA, little is known about the demographics, clinical characteristics, or quality of life of MM patients. This study describes the demographic characteristics and health-related quality of life (HRQoL) of MM patients who are initiating treatment in Pennsylvania. Methods: Two-hundred adults naive to MM and referred for any of the 23 state-approved qualifying conditions were recruited at three MM dispensaries in Pennsylvania between September 2020 and March 2021. All participants consented to the study; completed semi-structured interviews that included demographic questionnaires, the Short Form-36 (SF-36), and Generalized Anxiety Disorder-7 (GAD-7); provided height and weight measurements; and allowed access their dispensary medical records. Results: Participants had a mean age of 48.5 ± 15.6 years, predominantly identified as female (67.5%), and were most commonly referred for chronic pain (63.5%) and/or anxiety (58.5%). Additionally, 46.0% were living with obesity as determined by BMI. Relative to a normative sample, participants reported diminished HRQoL in several domains, most notably in role limitations due to physical health (M = 46.0 ± 42.0), role limitations due to emotional problems (M = 52.5 ± 42.3), energy and fatigue (M = 39.8 ± 20.2), and pain (M = 49.4 ± 26.0). Discussion/Conclusion: Patients initiating MM treatment experienced low HRQoL in multiple domains. Future studies could evaluate the relationship between HRQoL and patients' decisions to pursue MM treatment, as well as changes in HRQoL with MM use over time. Keywords: Medical marijuana, Health-related quality of life, Clinical characteristics, Author(s): Lydia S. Buonomano [a]; Matthew M. Mitnick [a]; Thomas R. McCalmont [a]; Paulina Syracuse [a]; Karen L. Dugosh [b]; David S. Festinger [a]; Michelle R. Lent [a] Introduction Medical [...]

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions. Keywords: Medical marijuana, Cannabis, Cannabinoids, Cannabidiol, Marijuana efficacy, Commonly recommended conditions for marijuana treatment, Marijuana clinical outcomes, Author(s): Sebastian Jugl [a,b]; Aimalohi Okpeku [a,b]; Brianna Costales [a,b]; Earl J. Morris [a,b]; Golnoosh Alipour-Haris [a,b]; Juan M. Hincapie-Castillo [a,b]; Nichole E. Stetten [c]; Ruba Sajdeya [d]; Shailina Keshwani [...]

: Objective: To undertake a census of the healthfulness of food venues providing lunch or dinner meals in a rural Australian setting and compare healthfulness by remoteness, using two measurement tools. Methods: A census of the rural local government area food venues was undertaken using two validated tools: the Healthfulness Rating Classification System (HRCS) and the Nutrition Environment Measures Survey (NEMS‐R). Data were collected covering an area of 3,438 square kilometres in Victoria, Australia, with a population of >21,000. Healthfulness by remoteness was described and variability between tools was explored. Results: Data were collected from all 95 eligible food venues. Both tools classified the food venues as relatively unhealthy. The mean HRCS score was ‐2.9 (unhealthy) and the mean NEMS‐R score was 10.8 (SD 7.0; possible range ‐27 to 64). There were no significant differences in healthiness of venues by remoteness (as measured by the Modified Monash Model), although the outer‐rural region had lower scores. Conclusions: This census of a rural food retail environment showed low access to healthy menu options along with minimal provision of nutrition information and promotion of healthy food in food venues. This environment has the potential to affect the dietary intake of more than 21,000 rural‐dwelling Australians and action to improve rural food environments is desperately needed. Implications for public health: If unhealthful rural food environments are not addressed, inequalities in the diet‐related disease burden for rural Australians will continue to persist. This study shows that interventions are needed for independent venues that could be targeted by researchers, local health promotion officers, community nutritionists or community education programs., Unhealthy diets, particularly those with an excessive intake of over‐processed foods and low intake of fruits and vegetables,[sup.1] have been acknowledged as a major driver of global increases in preventable [...]

Background Fifty percent of patients with typical diarrhea-associated hemolytic uremic syndrome (D+HUS) require kidney replacement therapy (KRT). In these patients, dehydration worsens disease prognosis. We evaluated dialysis requirement, presence of seizures, and mortality rate among patients diagnosed with D+HUS treated with volume expansion (VE) versus fluid restriction (FR). Methods Thirty-five patients with D+HUS were enrolled; 16 received VE and 19 were historical patients who received conventional FR. Results Upon admission or during treatment, neither group presented evidence of fluid overload. The VE group received higher volumes of saline (VE 27 ml/kg [10-30] over a 3-h period vs. FR 0 ml), had higher urine output after 12 h (VE vs. FR: OR 6.2 [1.2-41.6], P = 0.03), and required less dialysis (VE 2 [12.5%, CI 95% 0-29] vs. FR 9 [47.4%, CI 95% 24-70], P = 0.035). The VE group had an absolute risk reduction of 0.34 (CI 95% 0.07-0.63); hence, three patients treated with VE were required to avoid one KRT. VE also corrected initial hyponatremia and maintained serum sodium within normal ranges. No statistical differences were observed regarding number of patients with seizures (P = 0.08) or mortality (P = 1.0). Conclusions VE markedly reduces the number of patients requiring KRT and keeps serum sodium within a normal range. We propose to initially hydrate every patient with D+HUS and without signs of fluid overload, with 10 ml/kg/h 0.9% saline solution IV, over a 3-h period. Afterwards, if urine output is [greater than or equal to] 0.5 ml/kg/h, it is recommended to not dialyze and continue IV hydration schedule with isotonic (D5) saline solution, according to their needs., Author(s): Pablo Bonany [sup.1] , Manuel D. Bilkis [sup.2] , Guillermo Iglesias [sup.1] , Amalia Braun [sup.1] , Juliana Tello [sup.1] , Viviana Ratto [sup.3] , Ana Vargas [sup.4] , [...]

Background Hemolytic uremic syndrome (HUS) is a multisystemic disease. In a nationwide study, we characterized the incidence, clinical course, and prognosis of HUS caused by Shiga toxin (Stx)-producing Escherichia coli (STEC) strains with emphasis on risk factors, disease severity, and long-term outcome. Methods The data on pediatric HUS patients from 2000 to 2016 were collected from the medical records. STEC isolates from fecal cultures of HUS and non-HUS patients were collected from the same time period and characterized by whole genome sequencing analysis. Results Fifty-eight out of 262 culture-positive cases developed verified (n = 58, 22%) STEC-HUS. Another 29 cases had probable STEC-HUS, the annual incidence of STEC-HUS being 0.5 per 100,000 children. Eleven different serogroups were detected, O157 being the most common (n = 37, 66%). Age under 3 years (OR 2.4), stx2 (OR 9.7), and stx2a (OR 16.6) were found to be risk factors for HUS. Fifty-five patients (63%) needed dialysis. Twenty-nine patients (33%) developed major neurological symptoms. Complete renal recovery was observed in 57 patients after a median 4.0 years of follow-up. Age under 3 years, leukocyte count over 20 x 10.sup.9/L, and need for dialysis were predictive factors for poor renal outcome. Conclusions Age under 3 years, stx2, and stx2a were risk factors for HUS in STEC-positive children. However, serogroup or stx types did not predict the renal outcome or major CNS symptoms., Author(s): Elisa Ylinen [sup.1] , Saara Salmenlinna [sup.2] , Jani Halkilahti [sup.2] , Timo Jahnukainen [sup.1] , Linda Korhonen [sup.3] [sup.4] , Tiia Virkkala [sup.1] , Ruska Rimhanen-Finne [sup.2] , [...]

Listeriosis is a severe, mainly foodborne, human infection associated with higher casefatality and hospitalization rates than other bacterial gastrointestinal pathogens (1). The causative agent, Listeria monocytogenes, occurs ubiquitously in the [...]

BRCA1 and BRCA2 mutation carriers face an elevated lifetime risk of developing ovarian cancer. Oral contraceptives have been shown to significantly decrease the risk of ovarian cancer by approximately 50% in this high-risk population. Changes in contraceptive formulations and patterns of use over time have introduced lower hormonal dosages, different steroid types and non-oral routes of administration. Specifically, there has been a considerable shift in patterns of contraceptive use and the increase in the uptake of non-oral, long-acting, reversible contraception (e.g., intrauterine devices, implants, injections) has corresponded to a decline in oral contraceptive pill use. Whether or not these other methods confer a protective effect against ovarian cancer in the general population is not clear. To our knowledge, there have been no such studies conducted among BRCA mutation carriers. Furthermore, the impact of these changes on the risk of developing ovarian cancer is not known. In this article, we will review the existing epidemiologic evidence regarding the role of contraceptives and the risk of ovarian cancer with a focus on women with a BRCA1 or BRCA2 mutation. We will discuss recent findings and gaps in the knowledge while extrapolating from studies conducted among women from the noncarrier population. Keywords: BRCA, Ovarian cancer, Contraception, Intrauterine device, Case-control, Author(s): Yue Yin Xia[sup.1,2] and Joanne Kotsopoulos[sup.1,3] Background The BRCA1 and BRCA2 tumour suppressor genes encode nuclear protein products that maintain genome integrity through various roles, including DNA repair, cell-cycle [...]

Background Hemolytic uremic syndrome (HUS) is a leading cause of acute kidney injury in children. Although international guidelines emphasize comprehensive evaluation and treatment with eculizumab, access to diagnostic and therapeutic facilities is limited in most developing countries. The burden of Shiga toxin-associated HUS in India is unclear; school-going children show high prevalence of anti-factor H (FH) antibodies. The aim of the consensus meeting was to formulate guidelines for the diagnosis and management of HUS in children, specific to the needs of the country. Methods Four workgroups performed literature review and graded research studies addressing (i) investigations, biopsy, genetics, and differential diagnosis; (ii) Shiga toxin, pneumococcal, and infection-associated HUS; (iii) atypical HUS; and (iv) complement blockade. Consensus statements developed by the workgroups were discussed during a consensus meeting in March 2017. Results An algorithm for classification and evaluation was developed. The management of Shiga toxin-associated HUS is supportive; prompt plasma exchanges (PEX) is the chief therapy in patients with atypical HUS. Experts recommend that patients with anti-FH-associated HUS be managed with a combination of PEX and immunosuppressive medications. Indications for eculizumab include incomplete remission with plasma therapy, life-threatening features, complications of PEX or vascular access, inherited defects in complement regulation, and recurrence of HUS in allografts. Priorities for capacity building in regional and national laboratories are highlighted. Conclusions Limited diagnostic capabilities and lack of access to eculizumab prevent the implementation of international guidelines for HUS in most developing countries. We propose practice guidelines for India, which will perhaps be applicable to other developing countries., Author(s): Arvind Bagga [sup.1] , Priyanka Khandelwal [sup.1] , Kirtisudha Mishra [sup.2] , Ranjeet Thergaonkar [sup.3] , Anil Vasudevan [sup.4] , Jyoti Sharma [sup.5] , Saroj Kumar Patnaik [sup.6] , [...]

Shiga toxin (Stx)-producing Escherichia coli (STEC) is the offending agent in post-diarrhea-associated hemolytic uremic syndrome (HUS), a disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney failure, with thrombi occluding the renal microvasculature. Endothelial dysfunction has been recognized as the trigger event in the development of microangiopathic processes. Glomerular endothelial cells are susceptible to the toxic effects of Stxs that, via nuclear factor kappa B (NF-[kappa]B) activation, induce the expression of genes encoding for adhesion molecules and chemokines, culminating in leukocyte adhesion and platelet thrombus formation on the activated endothelium. Complement activation via the alternative pathway has been seen in patients during the acute phase of STEC-associated HUS. Experimental evidence has highlighted the role of complement proteins in driving glomerular endothelium toward a thrombogenic phenotype. At the glomerular level, podocytes are also an important target of Stx-induced complement activation. Glomerular injury as a consequence of podocyte dysfunction and loss is thus a mechanism that might affect long-term renal outcomes in the disease. New approaches to targeting the complement system may be useful therapeutic options for patients with STEC-HUS., Author(s): Carlamaria Zoja [sup.1] , Simona Buelli [sup.1] , Marina Morigi [sup.1] Author Affiliations: (Aff1) 0000000106678902, grid.4527.4, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, IRCCS - Istituto [...]

Background This study aims to identify epidemiological and clinical characteristics of patients and report our experience with eculizumab treatment during an outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing Escherichia coli (STEC) in Istanbul in 2015. Methods Thirty-two children (21 females, median age 3.25 years) were included in this study. Demographic, clinical and laboratory data, and treatment details were retrospectively collected. Renal outcomes were assessed at last follow-up visit. To assess the effect of eculizumab on prognosis of STEC-HUS, subgroup analysis was performed on patients who required dialysis. Results A high number of cases occurred within a certain region of Istanbul. Stool samples were cultured from 21 patients (65%), and enteroaggregative E. coli (EAEC; n = 7) and enterohemorrhagic E. coli (EHEC; n = 3) strains were detected. Rates of dialysis treatment, neurological manifestations, and death were 59%, 25%, and 3%, respectively. Mean follow-up duration was 8.6 ± 2.6 months (range 3-12 months). None of the patients (n = 25) was on dialysis at the final visit. The complete renal recovery rate was 54%. Nine patients were treated with eculizumab. At final follow-up visit, no differences in estimated glomerular filtration rate, proteinuria level, or hypertension incidence were observed between patients treated with eculizumab and those not treated with eculizumab. Conclusions An outbreak of EAEC occurred in a specific region of Istanbul. Livestock markets were suspected as the source. Evidence for beneficial effects of eculizumab on renal outcome was not clear in this cohort., Author(s): Ayse Agbas [sup.1] , Nilüfer Göknar [sup.2] , Nurver Akinci [sup.3] , Zeynep Yürük Yildirim [sup.4] , Mehmet Tasdemir [sup.5] , Meryem Benzer [sup.6] , Ibrahim Gökçe [sup.7] , [...]

Introduction Post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur. In the general population, approximately one-third of individuals with lifetime PTSD also meet criteria for lifetime AUD. (1) [...]

Introduction The harmful use of alcohol has been of interest to doctors for centuries, and minimizing the harm caused by alcohol use disorder (AUD) has been a priority of psychiatrists [...]

Children with autism spectrum disorder (ASD) are at high risk for being overweight and obese. Little is known about how obesity in children with ASD is being addressed in primary care. This article reports findings from a survey completed by 327 general pediatricians, which included a fictional clinical vignette and Likert-scales assessing attitudes, practices, self-efficacy, and barriers to obesity management. Although the majority of respondents agreed pediatricians should be the main providers to manage obesity in children with ASD, few reported receiving adequate training to do so. Pediatricians were more likely to refer to developmental-behavioral pediatricians and dietitians for a child with ASD compared to a child without ASD. Higher self-efficacy was associated with increased weight-related counseling frequency by pediatricians., Author(s): Morgan Walls [sup.1] [sup.2] , Sarabeth Broder-Fingert [sup.1] , Emily Feinberg [sup.3] [sup.4] , Mari-Lynn Drainoni [sup.5] [sup.6] , Megan Bair-Merritt [sup.1] Author Affiliations: (Aff1) 0000 0001 2183 6745, [...]

Foodborne pathogens are of public health concern worldwide (/). Estimates of the total number of foodborne illnesses and associated hospitalizations and deaths are needed to assess their effect on health [...]

Whole slide imaging (WSI) offers a convenient, tractable platform for measuring features of routine and special-stain histology or in immunohistochemistry staining by using digital image analysis (IA). We now routinely use IA for quantitative and qualitative analysis of theranostic markers such as human epidermal growth factor 2 (HER2/neu), estrogen and progesterone receptors, and Ki-67. Quantitative IA requires extensive validation, however, and may not always be the best approach, with pancreatic neuroendocrine tumors being one example in which a semiautomated approach may be preferable for patient care. We find that IA has great utility for objective assessment of gastrointestinal tract dysplasia, microvessel density in hepatocellular carcinoma, hepatic fibrosis and steatosis, renal fibrosis, and general quality analysis/quality control, although the applications of these to daily practice are still in development. Collaborations with bioinformatics specialists have explored novel applications to gliomas, including in silico approaches for mining histologic data and correlating with molecular and radiologic findings. We and many others are using WSI for rapid, remote-access slide reviews (telepathology), though technical factors currently limit its utility for routine, high-volume diagnostics. In our experience, the greatest current practical impact of WSI lies in facilitating long-term storage and retrieval of images while obviating the need to keep slides on site. Once the existing barriers of capital cost, validation, operator training, software design, and storage/back-up concerns are overcome, these technologies appear destined to be a cornerstone of precision medicine and personalized patient care, and to become a routine part of pathology practice. (doi: 10.5858/arpa.2016-0265-SA), Pathologists make crucial diagnoses and issue reports that directly affect patient care, primarily using microscopes and hematoxylin-eosin (H&E)-stained tissue with techniques that have not changed since the 19th century (1,2) [...]

OBJECTIVES: 1) To examine associations between racial discrimination and drug problems among urban-based Aboriginal adults; and 2) to determine whether these associations are best explained by symptoms of psychological stress, distress or post-traumatic stress disorder (PTSD). METHODS: Data were collected through in-person surveys with a community-based sample of Aboriginal adults (N = 372) living in a mid-sized city in western Canada in 2010. Associations were examined using bootstrapped linear regression models adjusted for confounders, with continuous prescription and illicit drug problem scores as outcomes. Mediation was examined using the cross-products of coefficients method. RESULTS: More than 80% of Aboriginal adults had experienced racial discrimination in the past year, with the majority reporting high levels in that period. Past-year discrimination was a risk factor for PTSD symptoms and prescription drug problems in models adjusted for confounders and other forms of psychological trauma. In mediation models, PTSD symptoms explained the association between discrimination and prescription drug problems; psychological stress and distress did not. PTSD symptoms also explained this association when the covariance between mediators was controlled. The results also indicate that participation in Aboriginal cultural traditions was associated with increased discrimination. CONCLUSIONS: Most efforts to address Aboriginal health inequities in Canada have focused on the role Aboriginal people play in these disparities. The current findings combine with others to call for an expanded focus. Non-Aboriginal Canadians may also play a role in the health inequities observed. The findings of this study suggest efforts to reduce discrimination experienced by Aboriginal adults in cities may reduce PTSD symptomology and prescription drug problems in these populations. Key words: Aboriginal; racial discrimination; prescription drugs; posttraumatic stress; Canada Can J Public Health 2015;106(6):e382-e387 doi: 10.17269/CJPH.106.4979 OBJECTIFS: 1) Examiner les associations entre la discrimination raciale et les problemes de toxicomanie chez les adultes autochtones en milieu urbain; et 2) determiner si ces associations s'expliquent mieux par les symptomes du stress psychologique, de la detresse ou de l'etat de stress post-traumatique (ESPT). METHODE: Les donnees ont ete recueillies au moyen de questionnaires administres en personne aupres d'un echantillon communautaire d'adultes autochtones (N = 371) vivant dans une ville de taille moyenne de l'Ouest canadien en 2010. Les associations ont ete examinees a l'aide de modeles de regression lineaire avec reechantillonnage (bootstrap) ajustes en fonction de facteurs confusionnels, les resultats etant les notes obtenues par rapport aux ordonnances continues de medicaments et aux abus de drogues illicites. Nous avons examine la mediation a l'aide des produits croises de la methode des coefficients. RESULTATS: Plus de 80 % des adultes autochtones avaient subi de la discrimination raciale au cours de l'annee anterieure, la majorite indiquant des niveaux eleves de discrimination durant cette periode. La discrimination au cours de l'annee anterieure etait un facteur de risque pour les symptomes d'ESPT et les abus de medicaments sur ordonnance dans les modeles ajustes en fonction des facteurs confusionnels et d'autres formes de traumatisme psychologique. Dans les modeles de mediation, les symptomes d'ESPT expliquaient l'association entre la discrimination et l'abus de medicaments sur ordonnance; le stress psychologique et la detresse ne l'expliquaient pas. Les symptomes d'ESPT expliquaient aussi cette association apres ajustement pour tenir compte de la covariance entre les mediateurs. Les resultats montrent egalement que la participation aux traditions culturelles autochtones etait associee a une discrimination accrue. CONCLUSION: La plupart des efforts pour aborder les iniquites en sante chez les Autochtones du Canada portent sur le role joue par les Autochtones dans ces disparites. Nos constatations, combinees a celles d'autres chercheurs, justifient un elargissement de cette perspective. Les Canadiens non autochtones pourraient aussi jouer un role dans les iniquites en sante observees. Les constatations de notre etude indiquent que des efforts pour reduire la discrimination vecue par les adultes autochtones dans les villes pourraient reduire les symptomes d'ESPT et les abus de medicaments sur ordonnance dans ces populations. MOTS CLES: Indiens d'Amerique nord; discrimination raciale; medicaments sur ordonnance; stress post-traumatique; Canada, Aboriginal peoples experience a disproportionate burden of drug problems with serious implications for health. (1,2) To date, we do not have a common understanding of the determinants underlying these disparities. [...]

Objective To assess relationships between the perception of radiation risks and psychological distress among evacuees from the Fukushima nuclear power plant disaster. Methods We analysed cross-sectional data from a survey of evacuees conducted in 2012. Psychological distress was classified as present or absent based on the K6 scale. Respondents recorded their views about the health risks of exposure to ionizing radiation, including immediate, delayed and genetic (inherited) health effects, on a four-point Likert scale. We examined associations between psychological distress and risk perception in logistic regression models. Age, gender, educational attainment, history of mental illness and the consequences of the disaster for employment and living conditions were potential confounders. Findings Out of the 180604 people who received the questionnaire, we included 59807 responses in our sample. There were 8717 respondents reporting psychological distress. Respondents who believed that radiation exposure was very likely to cause health effects were significantly more likely to be psychologically distressed than other respondents: odds ratio (OR) 1.64 (99.9% confidence interval, Cl: 1.42-1.89) for immediate effects; OR: 1.48 (99.9% Cl: 1.32-1.67) for delayed effects and OR: 2.17 (99.9% Cl: 1.94-2.42) for genetic (inherited) effects. Similar results were obtained after controlling for individual characteristics and disaster-related stressors. Conclusion Among evacuees of the Fukushima nuclear disaster, concern about radiation risks was associated with psychological distress. Objectif Evaluer les liens entre la perception des risques lies aux rayonnements et la detresse psychologique chez des personnes evacuees suite a la catastrophe survenue a la centrale nucleaire de Fukushima. Methodes Nous avons analyse des donnees transversales tirees d'une enquete realisee en 2012 aupres des personnes evacuees. La detresse psychologique a ete classee comme presente ou absente en utilisant l'echelle K6. Dans l'enquete, les repondants avaient evalue leur perception des risques sanitaires lies a l'exposition a des rayonnements onisants -effets sur la sante immediats, differes et genetiques (herites)sur une echelle de Likert a quatre points. Nous avons etudie les associations entre detresse psychologique et perception des risques a l'aide de modeles de regression logistique. L'age, le sexe, le niveau d'etudes, les antecedents de maladies mentales et les consequences de la catastrophe sur l'emploi et les conditions de vie ont ete identifies comme des facteurs de confusion potentiels. Resultats 180 604 personnes avaient recu le questionnaire. Dans notre echantillon, nous avons inclus 59 807 reponses. Pour 8 717 personnes, les reponses traduisent la presence d'une detresse psychologique. Les repondants qui estimaient que l'exposition aux rayonnements etait tres susceptible d'avoir des effets sur la sante ont ete largement plus enclins a souffrir de detresse psychologique comparativement aux autres repondants: rapport des cotes (RC) 1,64 (intervalle de confiance (IC) de 99,9%: 1,42-1,89) pour les effets immediats; RC: 1,48 (IC 99,9%: 1,32-1,67) pour les effets differes et RC: 2,17 (IC 99,9%: 1,94-2,42) pour les effets genetiques (herites). Des resultats similaires ont ete obtenus apres controle des caracteristiques individuelles et des facteurs de stress lies a la catastrophe. Conclusion Chez les personnes evacuees suite a la catastrophe nucleaire de Fukushima, les inquietudes concernant les risques lies aux rayonnements ont ete assodees a une detresse psychologique. Objetivo Evaluar la relacion entre la percepcion de los riesgos de radiacion y la angustia psicologica entre los evacuados del desastre de la central nuclear de Fukushima. Metodos Se analizaron los datos transversales de una encuesta realizada a los evacuados en 2012. La angustia psicologica se clasifico en terminos de presente o ausente en base a la escala K6. Los encuestados registraron sus opiniones sobre los riesgos sanitarios de la exposicion a la radiacion ionizante, incluyendo los efectos inmediatos, tardios o geneticos (heredados) en la salud en una escala Likert de cuatro puntos. Se examinaron las asociaciones entre la angustia psicologica y la percepcion de los riesgos en modelos logisticos de regresion. La edad, el genero, el nivel educativo, el historial de enfermedades mentalesy las consecuencias del desastre en cuanto a empleo y vida fueron factores potenciales de confusion. Resultados En nuestra muestra se incluyeron 59.807 respuestas de las 180.604 personas que realizaron el cuestionario. Hubo 8.717 encuestados que registraron angustia psicologica. Aquellos encuestados que creian que la exposicion a la radiacion muy probablemente causaria efectos sobre la salud tenian mas posibilidades de estar psicologicamente angustiados que otros encuestados: cociente de posibilidades (CP) de 1,64 (intervalo de confianza, IC, del 99,9%: 1,42-1,89) para efectos inmediatos; CP: 1,48 (IC del 99,9%: 1,32-1,67) para efectos tardios, y CP: 2,17 (IC del 99,9%: 1,94-2,42) para efectos geneticos (heredados). Se obtuvieron resultados parecidos tras controlar las caracteristicas individuales y los agentes de estres relacionados con desastres. Conclusion En los evacuados del desastre nuclear de Fukushima, la preocupacion en relacion con los riesgos de radiacion estaba asociada con la angustia psicologica., Introduction The Tohoku earthquake in Japan on 11 March 2011 was a triple disaster --earthquake, tsunami and nuclear incident--that had major health effects. The Chernobyl nuclear disaster in the former [...]

Two studies examine the role of compassionate and self-image parenting goals in the experience of mothers of children with autism. In Study 1, a comparison sample was included. Study 1 included measures of parenting goals, life satisfaction, family life satisfaction, parenting satisfaction, and meaning in life. Study 2 incorporated a measure of parenting efficacy. Study 1 showed that mothers of children with autism were higher than comparison mothers in compassionate parenting goals. In both studies, compassionate parenting predicted positive outcomes including higher parenting satisfaction (both studies), family life satisfaction, meaning in life (Study 1) and higher parenting efficacy (Study 2). These studies support the notion that compassionate parenting is a key to satisfaction for mothers of children with autism., Author(s): Regina Conti[sup.1] Author Affiliations: (1) Department of Psychology, Colgate University, 13346, Hamilton, NY, USA Introduction Parents of children with autism experience significant stress (Hayes and Watson 2013; Huang et [...]

Background The aim of this study was to analyze the neurological involvement and outcome in pediatric patients with hemolytic uremic syndrome (HUS) during the 2011 epidemic caused by Escherichia coli O104:H4. Methods Clinical data and data from magnetic resonance imaging (MRI) scans and electroencephalography (EEG) during the acute phase of the disease and during follow-up at 3 and 6 months were analyzed in 50 patients. Twenty-five of these patients underwent neuropsychological testing (WISC IV) during follow-up. Results Neurological involvement (stupor or coma, seizures, visual disturbances, paresis, myocloni) was initially observed in 14/50 (28%) patients. One patient died. EEG abnormalities were more frequent in patients with neurological involvement than in those without (12/14 vs. 13/25, respectively). Cranial MRI scans were analyzed in nine patients with neurological involvement, of whom five showed abnormal findings. At the 3- and 6-month follow-ups, EEG abnormalities were found in 14/40 (35%) and 7/36 (19%) patients, respectively, whereas 28/42 (67%) and 17/39 (44%) patients, respectively, complained about on-going reduced performance. Neuropsychological testing showed a slightly lower global intelligence quotient in patients with neurological involvement versus those without (113.4 ± 2.8 vs. 119.4 ± 1.8, respectively). Conclusions Neurological involvement was frequent in our cohort. Accordingly, the incidence of pathological EEG findings was high, even in patients without clinical signs of neurological involvement. Nevertheless, major neurological sequelae were rare, and neuropsychological outcome was favorable after 6 months. Keywords Hemolytic uremic syndrome * E. coli 0104:H4 * Children * Neurology * Outcome, Introduction Hemolytic uremic syndrome (HUS) is defined by the triad of hemolytic anemia, thrombocytopenia and acute kidney injury [1]. It is the most common cause of acute kidney injury during [...]

Accurate assessment of renal function is critical for appropriate drug dosing of renally excreted compounds. Glomerular filtration rate (GFR) is considered the best marker of kidney function. Inulin clearance forms the gold standard for measuring GFR, both in adults and in children. The method is invasive, cumbersome, and smaller children require urinary catheterization for accurate timed urine collections. Nuclear medicine methods replaced inulin clearance in the 1970s after [sup.51]Cr EDTA clearance was introduced. Inulin has no plasma protein binding, whereas all commonly used radioisotopes have a small amount of plasma protein binding that leads to lower values. Only iohexol does not have significant plasma protein binding. The underestimation due to plasma protein binding is partially offset by overestimation due to the use of non-compartmental pharmacokinetic modeling of the plasma disappearance of the radioisotope. The problem could be overcome with a urinary nuclear medicine clearance method, but these have not been validated in children. Endogenous markers of GFR include serum creatinine and low molecular weight proteins such as cystatin C and beta-trace protein. Of these, estimation of GFR using cystatin C appears to be the most promising, although its accuracy in pregnancy and in the neonatal period may be limited. Keywords Inulin * Nuclear medicine * Cystatin C * eGFR * Creatinine * Chronic kidney disease, Introduction Adequate measurement of kidney function is important for the management of all children and adolescents. In the neonatal period, there is considerable ontogeny of drug disposition, largely due to [...]

Infectious disease outbreaks in which most or all persons are exposed to the same potential source of infection, so-called universal exposure, are common. They can occur in a range of [...]

Measles is a highly contagious disease that causes illness and death in developing and industrialized countries. Measles has an estimated basic reproduction number ([R.sub.0]) range of 12-40 (1-5), meaning that [...]