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Background Obstructive sleep apnoea (OSA) is a well-known cardiovascular risk factor and is frequently associated with hypertension. The treatment of OSA with continuous positive airway pressure (CPAP) can resolve apnoeas, hypoxia, and sympathetic hyperactivation. Meta-analyses of randomised controlled trials (RCTs) show that CPAP treatment modestly reduces blood pressure (BP) with a pronounced heterogeneity among different OSA patient subgroups. Purpose To study the effects of CPAP treatment on BP changes, and to identify predictors of BP response to CPAP through analysis of individual patient data from published RCTs. Methods Study groups who had published RCTs on the effect of CPAP therapy on BP in OSA were invited to share the individual patient data (i.e. BP values, history of hypertension and antihypertensive drugs use). The outcomes of interest were the group-difference (BP at follow-up – BP at baseline) in office and out-of-office BP. Data analysis was performed with a one-step approach using a linear regression model, with treatment as covariate, including a random effect. An additional analysis was performed by stratifying patients in three subgroups: normotension, controlled hypertension and uncontrolled hypertension, based on BP at baseline, history of hypertension or treatment with antihypertensive drugs. Lastly, we evaluated the determinants of CPAP associated BP changes. Results Individual patient data from 34 parallel-group RCTs (n=7,456, 72% males, body mass index, BMI 31.9±14.8 kg/m2, age 58.6±10.9 years, apnoea-hypopnoea index, AHI 35.5±20.6 /hour) were analysed. The overall CPAP effect was larger for 24-BP compared to office BP measurements (Table 1), the highest reductions being observed for nocturnal BP. The stratified analysis showed a consistent BP lowering effect in the group of patients with uncontrolled hypertension whereas there was no significant BP change in those with controlled hypertension or in normotensives (figure 1). Higher BP levels at baseline and history of hypertension were independent predictors of BP reduction by CPAP for office and 24-BP measurements. Younger age and more severe nocturnal oxygen desaturations predicted a larger treatment effect on office BP only. Conclusions BP response to CPAP in OSA patients varies in different patient groups as a function of baseline BP, the greatest reduction being observed in younger patients with uncontrolled BP. Thus, our individual patient data meta-analysis indicates that younger patients with uncontrolled hypertension and more severe nocturnal oxygen desaturations measured by minimum SpO2 are likely to benefit the most from CPAP treatment in terms of BP reduction. Funding Acknowledgement Type of funding sources: None.

Fifty-one mother-toddler (15 to 31 months) dyads participated in a study on the predictors of compliance. Mothers completed two questionnaires: the Multidimensional Personality Questionnaire (Tellegen, 1982), a measure of maternal personality, and the Toddler Behavior Assessment Questionnaire (Goldsmith, 1987), a measure of child temperament. A free play period in the laboratory provided the observations for scoring the quality of the mother-toddler interactions with the Emotional Availability Scales (Biringen, Robinson, and Emde, 1993). The following clean-up task in which children were asked to help put the toys in the basket provided the observations for scoring compliance with maternal directives. Emotional availability was the strongest predictor of compliance, especially the maternal variables of sensitivity and structuring. Child temperament was also implicated, with high compliance toddlers perceived by their mothers to be less socially fearful and less prone to anger than their less compliant pee...

Introduction and objectives Graphic Health Warning Labels (GHWL) assist in primary and secondary smoking prevention. A lack of evidence exists regarding their desensitisation with increased exposure. Investigating knowledge and attitudes around GHWL may allow better implementation of future public health policies. Singapore introduced GHWL in 2004, five years before they were introduced in the UK; this study aims to investigate any potential desensitisation effect by direct comparison. Methods Data were collected from 266 smokers and non-smokers, 163 from London (54.6% smokers, 54.0% male, mean age 52.4 (17.8)) and 103 from Singapore (47.6% smokers, 77.7% male, mean age 57.7 (14.5)) between 2011 and 2013. A structured interview with fifty items, showing ten different GHWL, recorded demographics, smoking history, plans to quit and knowledge about the health-related consequences of smoking, as well as the emotional response, processing and impact of GHWL on behaviour. Participants further ranked hypothetical conditions that they could develop in terms of prevention and treatment. Results The London cohort experienced significantly higher levels of ‘disgust’ when viewing GHWL than their Singapore counterparts (smokers 74.1% vs 49.0%, p = 0.003; non-smokers 83.8% vs 57.4%, p Conclusion A desensitisation effect of GHWL is observed in cohorts with an increased length of exposure, both in smokers and non-smokers. The socio-cultural background needs to be considered when running public health campaigns due to differences in perception and responses to GHWL. Investigating the awareness of risks such as blindness, that have a low knowledge score but a high deterring impact, provides the chance to create a tailored approach when addressing this desensitisation.

Guidelines on the use of prophylaxis in venous thromboembolism (VTE) are poorly implemented in clinical practice.To evaluate the extent to which the American College of Chest Physicians (ACCP) 2001 guidelines on VTE prophylaxis are adhered to in clinical practice by determining whether patients admitted to a medical center with an objective diagnosis of VTE had received adequate prophylaxis.The medical records of medical and surgery patients with an objective diagnosis of VTE were reviewed. Patients were classified as having either preventable or nonpreventable VTE according to indication for prophylaxis, VTE risk, and adequacy of prophylaxis if administered. Adequacy was determined by adherence to the ACCP 2001 guidelines.Of 44 patients, 17 (38.6%) had not received adequate prophylaxis and were classified as having potentially preventable VTE. Venous thromboembolism developed in the remaining 27 (61.4%) patients despite adequate prophylaxis. In general, adequate prophylaxis rates were lower among surgery patients compared with medical patients. Four (80%) of the very-high-risk surgery patients received inadequate prophylaxis. The most common VTE risk factor in both categories was immobility.Adherence to the ACCP guidelines is suboptimal, with a substantial proportion of patients with VTE receiving inadequate prophylaxis. The additional finding that the incidence of VTE is high despite adequate prophylaxis indicates that the guidelines may need to be reevaluated.

Maternal practices, attitudes, and beliefs about children's attachments to soft objects were investigated via questionnaires and interviews completed by mothers of 58 children with such attachments, present or previous, and of 24 children who had never been thus attached. Mothers in the former group were generally more accurate and positive about the attachments and the characteristics of children with them than were mothers in the latter group. The role of parents in the development of soft-object attachments is discussed.

Blastomycosis has a wide spectrum of clinical presentations. When a patient presents with chronic pneumonia, especially coexisting with cutaneous lesions, blastomycosis infection needs to be considered in the differential diagnosis. Erythema nodosum can rarely be associated with pulmonary blastomycosis. A positive culture is the gold standard of diagnosis; occasionally, the organism can be identified by its typical "shoe print" morphology with periodic acid-Schiff (PAS) stain. The Gen-Probe technique may be required to confirm the uncertain culture results. The preferred treatment for blastomycosis in less severe cases is oral itraconazole, with amphotericin B in disseminated cases.

Since May 1993, 26 people have died of a ''unique, previously unknown" viral illness that presents with flu-like symptoms and progresses rapidly to respiratory failure and death. Originally isolated in the four-corners region of the Southwest, the hantavirus responsible has now been isolated from patients in several other areas. In this article, we describe our experience with ''the most puzzling case so far," an infection by a "cousin" of the Southwest hantaviral strain in a Louisiana bridgeworker. This case is unique not only because of the slightly different makeup of the virus, but also because of the absence of deer mice, the suspected carrier of the hantavirus, in the Louisiana region.

A young man with recurrent cough and hemoptysis was found at thoracotomy to have benign intrapulmonary cystic teratoma. Although benign cystic teratomas are a common mediastinal neoplasm, they rarely occur within the lung parenchyma. Fewer than 30 cases have been reported in the literature. Occasionally, patients present with bronchiectasis, abscess, or pneumonia in addition to cough and hemoptysis. The patient in this report had little evidence of infection and recovered rapidly following surgical excision of the mass.