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Competing Interests: Competing interests: None declared.

Objective: Evaluate a method for the estimation of the nocturnal systolic blood pressure (SBP) dip from 24 h blood pressure trends using a wrist-worn photoplethysmography (PPG) sensor and a deep neural network in free-living individuals, comparing the deep neural network to traditional machine learning and non-machine learning baselines., Approach: A wrist-worn PPG sensor was worn by 106 healthy individuals for 226 d during which 5111 reference values for blood pressure (BP) were obtained with a 24 h ambulatory BP monitor and matched with the PPG sensor data. Features based on heart rate variability and pulse morphology were extracted from the PPG waveforms. Long- and short term memory (LSTM) networks, dense networks, random forests and linear regression models were trained and evaluated in their capability of tracking trends in BP, as well as the estimation of the SBP dip., Main Results: Best performance for estimating the SBP dip were obtained with a deep LSTM neural network with a root mean squared error (RMSE) of 3.12 [Formula: see text] 2.20 [Formula: see text] mmHg and a correlation of 0.69 [Formula: see text]. This dip was derived from trend estimates of BP which had an RMSE of 8.22 [Formula: see text] 1.49 mmHg for systolic and 6.55 [Formula: see text] 1.39 mmHg for diastolic BP (DBP). While other models had similar performance for the tracking of relative BP, they did not perform as well as the LSTM for the SBP dip., Significance: The work provides first evidence for the unobtrusive estimation of the nocturnal SBP dip, a highly prognostic clinical parameter. It is also the first to evaluate unobtrusive BP measurement in a large data set of unconstrained 24 h measurements in free-living individuals and provides evidence for the utility of LSTM models in this domain.

Background: The recession has increased job insecurity in the European Union (EU) which may result in higher levels of psychological distress, burnout and anxiety., Aims: To investigate the association of job insecurity and financial difficulties with mental health in 27 member states of the EU and to explore the moderating effect of having financial difficulties on the relationship between job insecurity and mental health., Methods: The sample consisted of employed people from 27 European countries where the Eurobarometer survey (73.2 wave, 2010) was administered by the European Commission. Mental well-being and psychological distress were measured using the Vitality and Mental Health Index (MHI-5) subscales from the Short-Form 36-item health survey (SF-36v2). Linear regression including an interaction term was used to test the underlying factors in this study., Results: Among the 12594 respondents, experiencing job insecurity was associated with lower Vitality [β = -3.82, 95% confidence interval (CI) -5.29 to -2.36] and MHI-5 (β = -3.48, 95% CI -4.91 to -2.04). Similarly, having financial difficulties was significantly correlated with lower Vitality (β = -8.65, 95% CI -12.07 to -5.24) and MHI-5 (β = -11.51, 95% CI -15.08 to -7.94). However, having financial difficulties did not moderate the relationship between job insecurity and both mental health scales., Conclusions: This study highlights the negative effect of job insecurity and financial difficulties on mental health in the EU. Support to employees facing job security issues should be a priority regardless of the financial circumstances., (© The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Bispectral index (BIS) monitor is a neurophysiological monitoring device which continually analyses a patient's electroencephalogram during sedation and general anaesthesia to assess the level of consciousness and depth of anaesthesia. BIS monitoring, whilst performing sleep nasendoscopy (using midazolam and propofol), has helped validate depth of sedation and allowed comparison with levels of sedation of control patients during natural sleep. A prospective study of 30 patients with snoring undergoing sleep nasendoscopy with BIS monitoring was conducted. BIS monitoring was recorded throughout the procedure and assessment of snoring was made at the appropriate level of sedation and snoring. BIS values were compared with control patients. The 30 patients undergoing sleep nasendoscopy had average BIS values ranging from 50.72 to 61.2. Similar results were seen with BIS and oxygen saturation in the control group. BIS monitoring provides an adjunct to the assessment of sleep nasendoscopy in determining the level of sedation required for snoring assessment. Comparable BIS values and oxygen saturation levels were obtained between controls and patients during sedation-induced sleep, thus validating the role of sleep nasendoscopy.

Aims: To determine the recurrent convulsion rate using low-dose magnesium sulphate regime in eclampsia and to identify toxicity and complications with clinical parameters., Methods: Prospective study with two different magnesium sulphate regimes in two slightly clinically different subgroups. Group A that came directly to our hospital and group B who had already received an injection of diazepam or Phenergan at the referring hospital. Group A received 10 g and group B 6 g loading dose of magnesium sulphate. Both groups received 4 g maintenance dose every 4 h., Results: Out of 95 eclamptic patients, only one woman in group B had recurrent convulsion. All women maintained normal respiratory rates. 39 (41.1%) women had absent knee jerks on at least one occasion when the maintenance dose was omitted. Urinary output was more than 30 ml/h in 92 (96.8%) women. In 5 women, maintenance dose had to be augmented to 5 g as reflexes were exaggerated., Conclusion: The low-dose regime appears to control and prevent convulsions effectively in Indian women. Clinical monitoring appears to be sufficient. We hope to be able to reassure health professionals at primary and secondary level hospitals about the safety of magnesium.

Many countries have now adopted fortification, where folic acid is added to flour and intended to benefit all with rise in blood folate level. During many transformations of folate from one form to another, a proportion is accidentally converted to N(5)-methyl-THF, an inactive metabolite, the so-called "folate trap". Consideration should be given to including B(12) as well as folic acid in any program of supplementation or food fortification to prevent NTDs. This is especially applicable to developing countries like India where the majority of women are vegetarians and have borderline levels of vitamin B(12). Administration of [6S]-5-MTHF is more effective than is folic acid supplementation at improving folate status. Therefore, we urge to reconsider the "folate trap" in folic acid fortification programs.

Half of all new human immunodeficiency virus (HIV) infections in the United States and two thirds of all sexually transmitted diseases (STD) occur among young people under the age of 25. It is estimated that by the end of high school, nearly two thirds of American youth are sexually active, and one in five has had four or more sexual partners. Despite these alarming statistics, less than half of all public schools in the United States offer information on how to obtain contraceptives and most schools increasingly teach abstinence-only-until-marriage (or "abstinence-only") education. There is little evidence that abstinence-only programs are successful in encouraging teenagers from delaying sexuality activity until marriage, and consequently, avoiding pregnancy, or STD or HIV infection. Comprehensive sex education, which emphasizes the benefits of abstinence while also teaching about contraception and disease-prevention methods, has been proven to reduce rates of teen pregnancy and STD infection.

A total of 112 male patients presenting with acute gonococcal urethritis were admitted to the hospital. The diagnosis was confirmed by smear, culture, oxidase reaction and sugar fermentation tests. The patients were treated with a single 300 mg capsule of rosoxacin. All patients except one showed adequate response to rosoxacin.

During the immediate postoperative course after upper abdominal surgery, pulmonary complications often occur, caused, inter alia, by reduced regional ventilation and by atelectases as a result of: (1) narrowing of the small peripheral bronchi, and (2) impaired respiratory function. Based on these pathophysiological mechanisms, an instrument (Bartlett-Edwards Incentive Spirometer) has been devised, which aims at giving the patient an opportunity of sustained maximal inspiration under standardized and controlled conditions. The use of this instrument has been followed by reports of a considerable reduction in postoperative pulmonary complications. In a controlled clinical investigation of the pre- and postoperative condition of the lungs, we were unable to show any beneficial effect of the instrument. In general, we have a low frequency of severe postoperative pulmonary complications, as compared with the results reported in the literature. We ascribe this to our very effective pre- and postoperative respiratory therapy.