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A 12-year-old boy suddenly collapsed while playing and was brought to the emergency department, where he was declared dead. The child had no prior medical illness. On autopsy examination, a dumbbell shaped mass was found in the right atrioventricular sulcus on the anterior and posterior aspects. Microscopic examination of the mass revealed a thrombus within the wall of right coronary artery. Careful examination of the epicardial tissue close to the thrombus revealed a granulomatous vasculitis of the right coronary artery, with involvement of the root of aorta. A possible diagnosis of Takayasu's arteritis was rendered. Vasculitis is the inflammation of the blood vessels. Kawasaki's and Takayasu's arteritis are the most common ones affecting the vessels of the heart. Takayasu's arteritis or "pulseless" disease is a rare, idiopathic, chronic granulomatous vasculitis that affects aorta and its major branches. The rarity of its occurrence and clinical presentation as a thrombus masquerading as cardiac tumour is unusual and hence reported. [ABSTRACT FROM AUTHOR]

This paper provides a broad overview of hormesis, a specific type of biphasic dose response, its historical and scientific foundations as well as its biomedical applications, especially with respect to aging. Hormesis is a fundamental component of adaptability, neutralizing many endogenous and environmental challenges by toxic agents, thereby enhancing survival. Hormesis is highly conserved, broadly generalizable, and pleiotrophic, being independent of biological model, endpoint measured, inducing agent, level of biological organization and mechanism. The low dose stimulatory hormetic response has specific characteristics which defines both the quantitative features of biological plasticity and the potential for maximum biological performance, thereby estimating the limits to which numerous medical and pharmacological interventions may affect humans. The substantial degrading of some hormetic processes in the aged may profoundly reduce the capacity to respond effectively to numerous environmental/ischemic and other stressors leading to compromised health, disease and, ultimately, defining the bounds of longevity. [ABSTRACT FROM AUTHOR]

Obesity is one of today's most diffused and severe public health problems worldwide. It affects both adults and children with critical physical, social, and psychological consequences. The aim of this review is to appraise the studies that investigated the effects of motivational interviewing techniques in treating overweight and obese children. The electronic databases PubMed and PsychINFO were searched for articles meeting inclusion criteria. The review included studies based on the application of motivational interviewing (MI) components and having the objective of changing body mass index (BMI) in overweight or obese children from age 2 to age 11. Six articles have been selected and included in this review. Three studies reported that MI had a statistically significant positive effect on BMI and on secondary obesity-related behavior outcomes. MI can be applicable in the treatment of overweight and obese children, but its efficacy cannot be proved given the lack of studies carried out on this specific sample. [ABSTRACT FROM AUTHOR]

The objectives were to quantify gastrointestinal tolerance, total tract nutrient digestibility, and serum lipid profiles of dogs as affected by α-cyclodextrin (ACD) supplementation and to validate the accuracy of fat analyses techniques using novel ACD-fat complexes. The ACD was hydrolyzed and free sugars and hydrolyzed monosaccharides were quantified using high performance liquid chromatography. Known amount of fats were complexed with ACD, and fat content of complexes were determined using the ether extraction and acid-hydrolyzed fat methods. Nine mixed-breed hounds were used in a crossover design with 3 periods of 10 d each, including 6 d for diet adaptation and 4 d for fecal collection. Dogs were fed twice daily a diet with poultry byproduct meal and brewer's rice as the main ingredients, and chromic oxide (0.2%) was included as a digestion marker. Dogs were supplemented with either 0, 3, or 6 g of ACD diluted in 15 mL of water twice per day for a total of 0, 6, and 12 g ACD per day. The ACD had a very low free sugar concentration and, once hydrolyzed, released only glucose, as expected. Average daily food intake, fecal output (DM basis), and fecal scores were not significantly different among treatments. Body weight and condition score and serum triglycerides and cholesterol concentrations remained unaltered throughout the duration of the experiment. Dry matter, OM, and fat digestibility coefficients were lower (P < 0.05) for both treatment groups compared to the control. The acid-hydrolyzed fat method was valid to measure fat that was bound to ACD. Intake of ACD lowered fat digestibility somewhat but not to the extent previously reported, without affecting serum lipid concentrations or outcomes related to tolerance. Therefore, ACD supplementation resulted in a small decrease in fat digestibility, but ACD supplementation might have potential in modifying serum lipid profiles. [ABSTRACT FROM AUTHOR]

Background Adherence is a challenge in obesity treatment. Motivational interviewing ( MI) may promote patient adherence. MI Values is a randomized controlled trial of MI implemented as an adjunct to an adolescent obesity treatment [Teaching Encouragement Exercise Nutrition Support ( T.E.E.N.S.)]. Objective Assess effects of MI Values on T.E.E.N.S. attrition and adherence. Methods Participants were randomized to MI ( n = 58) or control ( n = 41). At weeks 1 and 10, MI participants had brief MI sessions; controls viewed health education videos. All participants continued with T.E.E.N.S. (biweekly dietitian and behavioural support visits; 3 times per week supervised physical activity). Assessments were repeated at baseline, 3 and 6 months. T-tests and chi-square analyses examined T.E.E.N.S. attrition and adherence by group. Results Adolescents ( N = 99) were primarily African-American (73%) females (74%); age = 13.8 ± 1.8 years, body mass index percentile = 98.0 ± 1.2. Compared with controls, MI participants had greater 3-month adherence overall (89.2% vs. 81.0%, P = 0.040), and to dietitian (91.3% vs. 84.0%; P = 0.046) and behavioural support (92.9% vs. 85.2%; P = 0.041) visits, and greater 6-month adherence overall (84.4% vs. 76.2%, P = 0.026) and to behavioural support visits (87.5% vs. 78.8%, P = 0.011). Conclusions MI enhanced adherence to this obesity intervention. MI Values is the first study to examine the impact of MI on treatment adherence among obese, primarily African-American adolescents. [ABSTRACT FROM AUTHOR]

The Health Research Engagement Intervention (HREI) aims to reduce information and access disparities for breast cancer research opportunities among low-socioeconomic status (SES) and limited English proficient (LEP) breast cancer survivors by providing neutral, non-trial-specific information about health research via a trusted patient navigator. Qualitative methods in the context of a community-based participatory research design were used to iteratively design the HREI in collaboration with community-based care navigators from a trusted community organization, Shanti Project, and to locate appropriate research studies in collaboration with a web-based trial-matching service, BreastCancerTrials.org (BCT). Navigators were first trained in clinical trials and health research and then to deliver the HREI, providing feedback that was incorporated into both the HREI design and BCT's interface. Our intervention pilot with low SES and LEP survivors ( n = 12) demonstrated interest in learning about 'health research.' All 12 participants opted to obtain more information when offered the opportunity. Post-intervention questionnaires showed that three of 11 (27 %) participants independently pursued additional information about research opportunities either online or by phone in the week following the intervention. Post-intervention navigator questionnaires indicated that navigators could confidently and efficiently deliver the intervention. LEP patients who pursued information independently faced language barriers. The HREI is a promising and potentially scalable intervention to increase access to neutral information about breast cancer research opportunities for low-SES and LEP individuals. However, in order for it to be effective, systems barriers to participation such as language accessibility at sources of health research information must be addressed. [ABSTRACT FROM AUTHOR]

Suboptimal regimen adherence among youth with type 1 diabetes (T1D) is a common challenge for patients, families, and providers. Motivational interviewing (MI) is a brief communication style designed to elicit intrinsic motivation and strengthen commitment to behavior change goals. As pediatric MI research expands, a critical review of its evidence base and applicability to promote adherence behaviors for youth with T1D is needed. This review introduces the core tenets of MI and clinical applications in T1D, synthesizes the existing MI research in T1D, and discusses the next steps in MI research. Overall, mixed results for MI interventions in T1D reflect variations in research study design and clinical implementation. Targeting adherence rather than glycemic outcomes typically demonstrates greater results, highlighting the promise of MI to facilitate meaningful and enduring improvements in youths' T1D adherence behaviors. [ABSTRACT FROM AUTHOR]

Purpose: There is growing evidence supporting minimally invasive surgical (MIS) techniques for correction of symptomatic hallux valgus. The aim of this study was to present a hybrid third-generation technique and assess the safety and efficacy from the first 45 procedures. Methods: Forty-five consecutive feet underwent a third-generation MIS distal chevron osteotomy with a minimum six month follow-up (range six to 17 months). This technique uses both first- and second-generation techniques plus a distal chevron osteotomy and screw for improved control and stabilisation of the metatarsal head. All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsal length and overall toe length. Results: There were significant improvements in all three domains of the MOXFQ ( p <0.001). There was also significant improvement in all radiographic parameters ( p < 0.001). Mean HVA decreased from 30.54° to 10.41°, and the mean IMA decreased from 14.55° to 7.11°. Shortening of the first metatarsal had no effect on clinical outcomes. There was a very low rate of complications. Conclusion: The short-term results of this third-generation technique show that it is a safe procedure with good clinical outcomes and compares favourably with earlier techniques. [ABSTRACT FROM AUTHOR]

Objectives: To describe the development of a peer support intervention and test an enhanced version compared to a standard protocol. Methods: Participants (N = 36 females) were assigned to an Enhanced Peer Support (PS) vs Standard weight loss group for 4 months. The PS component consisted of skills training and practice between sessions using social networking. Results: The PS group perceived significantly more peer support and experienced higher levels of social interaction. When meeting frequency decreased, the PS group showed an increase in overall types of support from group members. Conclusions: Findings suggest that an intervention targeting peer support skills results in greater feelings of peer support. [ABSTRACT FROM AUTHOR]

Having good intentions to engage in healthy behaviours, to change our lives in a positive direction and make substantial, lasting changes may not always translate into actions or behaviour that is maintained. Motivational Interviewing is a directive person-centred approach designed to explore ambivalence and activate motivation for change [Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behaviour. London: Guilford Press, 1991]. A key component of a motivational interviewing conversation is to acknowledge that clients have every right to make no change. It uses a guiding communication style which invites people to consider their own situation and find their own solutions to situations that they identify as problematic that are preventing change. Motivational Interviewing was first introduced in adult health addiction services in the early 1980s. It has developed in the physical health specialties, and in the last 20 years or so attention has turned to the potential of Motivational Interviewing in the paediatric setting and the challenges of using it in families with children at differing ages and developmental stages. This article summarizes studies published from 2006 to 2011 of Motivational Interviewing in individuals across the lifespan with type 1 and type 2 diabetes and obesity. [ABSTRACT FROM AUTHOR]

BACKGROUND Patient navigation programs are emerging that aim to address disparities in clinical trial participation among medically underserved populations, including racial/ethnic minorities. However, there is a lack of consensus on the role of patient navigators within the clinical trial process as well as outcome measures to evaluate program effectiveness. METHODS A review of the literature was conducted of PubMed, Medline, CINHAL, and other sources to identify qualitative and quantitative studies on patient navigation in clinical trials. The search yielded 212 studies, of which only 12 were eligible for this review. RESULTS The eligible studies reported on the development of programs for patient navigation in cancer clinical trials, including training and implementation among African Americans, American Indians, and Native Hawaiians. A low rate of clinical trial refusal (range, 4%-6%) was reported among patients enrolled in patient navigation programs. However, few studies reported on the efficacy of patient navigation in increasing clinical treatment trial enrollment. CONCLUSIONS Outcome measures are proposed to assist in developing and evaluating the efficacy and/or effectiveness of patient navigation programs that aim to increase participation in cancer clinical trials. Future research is needed to evaluate the efficacy of patient navigators in addressing barriers to clinical trial participation and increasing enrollment among medically underserved cancer patients. Cancer 2014;120(7 suppl):1122-30. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]

Using self-determination theory (SDT) as an explanatory framework, this randomised-controlled study evaluates the effect of a motivational interviewing (MI)-based intervention as an addition to a standard weight loss programme (SWLP) on physical activity (PA) practice in obese adolescents over a six-month period. Fifty-four obese adolescents (mean age = 13 years, mean BMI = 29.57 kg/m²) were randomly assigned to an SWLP group (n = 28) or SWLP + MI group (n = 26). Both groups received two SWLP sessions, supplemented for the SWLP + MI group, by six MI sessions. Perceived autonomy support, perceived competence, motivational regulations, PA and BMI were assessed at baseline, three and six months (i.e. the end of the programme). MLM analyses revealed that compared to SWLP, the SWLP + MI group had a greater BMI decrease and a greater PA practice increase over time. Moreover, the SWLP + MI group reported greater autonomy support from medical staff at the end of the programme, greater increase in integrated and identified regulations and a stronger decrease in amotivation. MI appears as an efficient counselling method as an addition to an SWLP to promote PA in the context of pediatric obesity. [ABSTRACT FROM PUBLISHER]

Objective To evaluate the efficacy of Motivational Interviewing (MI) as an intervention for promoting self-efficacy and weight loss in a sample of overweight and obese youth. Methods/Design 40 participants (aged 10–18 years) were randomly assigned to control (social skills training) or treatment (MI) group. Both groups received individual therapy (∼30 min/month) in addition to usual care of diet/exercise counseling. Pre- and post- (at 6 months follow-up) variables included measures of self-efficacy and anthropometrics. Results Although significant between-group differences were not found, individuals in the MI group attended more sessions. Overall, participants in both groups showed significant increases in self-efficacy and a trend of decreased body mass index z-scores. Conclusions Health benefits from participation in individual therapy may have been accrued; however, specific benefits attributable to MI were limited. Findings suggest that more than one type of counseling intervention (i.e., MI and social skills training) may be beneficial when providing integrative treatment for obese youth. [ABSTRACT FROM AUTHOR]

Objective To examine the efficacy of an adjunct motivational and autonomy-enhancing intervention (self-directed) for behavioral family-based pediatric obesity relative to the standard prescription of uniform behavioral skills use and interventionist goal assignment (prescribed). Methods In this randomized clinical trial, 72 overweight/obese children and their parents/caregivers were assigned to either self-directed or prescribed intervention for 20 weeks, with approaches diverging after week 5. Anthropometric measurements from child and participating parent at baseline, posttreatment, and 3-month, 6-month, 1-year, and 2-year follow-ups were evaluated for change (n = 59 in follow-up analyses). Results The approaches demonstrated similar child body mass index (BMI) z-score and parent BMI change from baseline to posttreatment and throughout follow-up, with child and parent weight status lower than baseline at 2 years after treatment cessation. Conclusions An adjunct motivational and autonomy-enhancing approach to behavioral family-based pediatric obesity treatment is a viable alternative to the standard intervention approach. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess the effects of motivational interviewing for obese children and telephone consultation for parents to promote weight loss in obese children. Background Childhood obesity is a worldwide health problem that leads to serious metabolic and physiological consequences. An effective intervention to manage obesity is essential. Motivational interviewing is designed to resolve ambivalence, enhance intrinsic motivation and promote confidence in a person's ability to make behaviour changes. It has shown promise in the adult obesity literature as effecting positive health behaviour changes. Motivational interviewing has also been proposed as an effective method for improving the weight loss of obese children. Design A pre-post quasi-experimental design with repeated measures was used. Methods The study was conducted in four primary schools over an 11-month period in 2010-2011. Obese children ( n = 185) were screened from 791 school children studying the equivalent to UK grades 5 and 6 and were divided into three groups: motivational interviewing, motivational interviewing+ and a control group. The motivational interviewing group ( n = 70) children were provided with motivational interviewing counselling; the motivational interviewing+ group ( n = 66) children were provided with motivational interviewing counselling while telephone consultation was provided for their parents; and the control group did not receive any intervention ( n = 49). Results Children in both the motivational interviewing and motivational interviewing+ groups showed significant improvement in their weight-related behaviour and obesity-related anthropometric measures from the baseline to the end of the 14-week intervention, while the control group had significant deterioration in their anthropometric measures. Conclusion Motivational interviewing appears to be a promising intervention for promoting weight loss in obese children. Motivational interviewing counselling may be extended to obese children of different age groups. Relevance to clinical practice This study indicates that motivational interviewing is a useful method for improving behaviour changes in eating, physical activity and weight loss for obese children, suggesting the benefits of such intervention. [ABSTRACT FROM AUTHOR]

Despite advances in science, the prevalence of childhood obesity persists and outcomes remain inconsistent. An event history calendar (EHC) is a tool to facilitate understanding of family life dynamics influencing eating and activity choices. This tool uses reflection to assess temporally linked behavior in the context of life events so that choices related to eating and activity are more explicit. Fourteen parent–child (6-14 years) dyads completed an EHC and interview 2 months following a healthy eating/activity intervention. Phenomenological analysis revealed themes including “awareness” of activity/eating behaviors, “healthy lessons,” “family time,” and “barriers” to change. The EHC facilitated participant communication and understanding by making connections between behaviors, habits, and events in family context, so that eating and activity behaviors could be realistically reviewed. This tool has potential to guide development of individualized interventions through barrier identification and goal establishment in research and clinical settings to help counteract childhood obesity over time. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics including the type IV reactions to latex and synthetic medical gloves, pimonidazole as a tumour hypoxia marker in gastro-oesophageal adenocarcinoma, and the early occurrence of methicillin-resistant staphylococcus aureus in Australia.

Objective This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income). Methods Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI). Results Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores. Conclusions A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediathc obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change. [ABSTRACT FROM AUTHOR]

Objective: An overweight prevention protocol was used in the ‘Be active, eat right’ study; parents of overweight children (5 years) were offered healthy lifestyle counseling by youth health care professionals. Effects of the protocol on child BMI and waist circumference at age 7 years were evaluated. Methods: A cluster RCT was conducted among nine youth health care centers in the Netherlands. Parents of overweight, not obese, children received lifestyle counseling and motivational interviewing according to the overweight prevention protocol in the intervention condition (n = 349) and usual care in the control condition (n = 288). Measurements were made of child height, weight and waist circumference at baseline and at a two-year follow-up; parents completed questionnaires regarding demographic characteristics. Linear mixed models were applied; interaction terms were explored. Results: The analyzed population consisted of 38.1% boys; mean age 5.7 [sd: 0.4] years; mean BMI 18.1 [sd: 0.6], the median number of counseling sessions in the intervention condition was 2. The regression model showed no significant difference in BMI increase between the research conditions at follow-up (beta −0.16; 95% CI:−0.60 to 0.27; p = 0.463). There was a significant interaction between baseline BMI and research condition; children with a baseline BMI of 17.25 and 17.50 had a smaller increase in BMI at follow-up when allocated to the intervention condition compared to control condition (estimated adjusted mean difference −0.67 [se: 0.30] and −0.52 [se: 0.36]). Conclusion: Mildly overweight children (baseline BMI 17.25 and 17.50) in the intervention condition showed a significantly smaller increase in BMI at follow-up compared to the control condition; there was no overall difference between intervention and control condition. Future research may explore and evaluate improvements of the prevention protocol. Trial Registration: Current Controlled Trials ISRCTN04965410 [ABSTRACT FROM AUTHOR]

The article discusses the symptoms, causes and diagnosis of acute non-degenerative neck pain. The five specific spinal chord injury syndromes which include Central cord syndrome, Anterior cord syndrome, Brown-Séquard syndrome, Root compression, and Root compression are included. The different treatment methodologies and management regime for acute non-degenerative neck pain are described. Referral to appropriate clinicians is essential whether non-operative or operative intervention is needed. INSET: KEY POINTS.

lodewijckx c., sermeus w., panella m., deneckere s., leigheb f., troosters t., boto p.a., mendes r.v., decramer m. & vanhaecht k. (2012) Quality indicators for in-hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study. Journal of Advanced Nursing 69(2), 348-362. doi: 10.1111/j.1365-2648.2012.06013.x Abstract Aim. To report a Delphi study that was conducted to select process and outcome indicators that are relevant to study quality of care and impact of care pathways for patients hospitalized with exacerbation of chronic obstructive pulmonary disease. Background. Management of patients hospitalized with exacerbation of chronic obstructive pulmonary disease is suboptimal and outcomes are poor. To evaluate the impact of care pathways properly, relevant indicators need to be selected. Design. Delphi study. Methods. The study was conducted over 4 months in 2008, with 35 experts out of 15 countries, including 19 medical doctors, 8 nurses and 8 physiotherapists. Participants were asked to rate, for 72 process and 21 outcome indicators, the relevance for follow-up in care pathways for in-hospital management of exacerbation of chronic obstructive pulmonary disease. Consensus (agreement by at least 75% of the participants) that an indicator is relevant for follow-up was sought in two rounds. Results. Consensus was reached for 26 of 72 process indicators (36·1%) and 10 of 21 outcome indicators (47·6%). Highest consensus levels were found for the process indicators regarding oxygen therapy (100%), pulmonary rehabilitation (100%) and patient education (94·5-88·6%) and for the outcome indicators concerning understanding of therapy (91·4-85·7%) and self-management (88·6-88·2%). Conclusion. The selected indicators appear to be sensitive for improvement. Therefore, researchers and clinicians that want to study and improve the care for patients hospitalized with exacerbation of chronic obstructive pulmonary disease should primarily focus on these indicators. [ABSTRACT FROM AUTHOR]

Obesity interventions that involve family members may be effective with racial/ethnic minority youth. This review assessed the nature and effectiveness of family involvement in obesity interventions among African- American girls aged 5-18 years, a population group with high rates of obesity. Twenty-six databases were searched between January 2011 and March 2012, yielding 27 obesity pilot or full-length prevention or treatment studies with some degree of family involvement and data specific to African- American girls. Interventions varied in type and level of family involvement, cultural adaptation, delivery format and behaviour change intervention strategies; most targeted parent-child dyads. Some similarities in approach based on family involvement were identified. The use of theoretical perspectives specific to African- American family dynamics was absent. Across all studies, effects on weight-related behaviours were generally promising but often non-significant. Similar conclusions were drawn for weight-related outcomes among the full-length randomized controlled trials. Many strategies appeared promising on face value, but available data did not permit inferences about whether or how best to involve family members in obesity prevention and treatment interventions with African- American girls. Study designs that directly compare different types and levels of family involvement and incorporate relevant theoretical elements may be an important next step. [ABSTRACT FROM AUTHOR]

Analysis of the proteomic profile of pressure ulcers over time is a critical step in the identification of biomarkers of healing or nonhealing in pressure ulcers. The wound fluid from 32 subjects with 42 pressure ulcers was evaluated over 6 weeks at 15 time points. Samples specific to both the interior and the periphery of the wound bed were collected. Antibody screening arrays, isobaric tags for relative and absolute quantitation with mass spectrometry and multiplexed microarrays were used to characterize wound fluid and results were correlated with clinical outcome. Twenty-one proteins were found to distinguish between healed and chronic wounds and 19 proteins were differentially expressed between the interior and periphery of wounds. Four proteins, pyruvate kinase isozymes M1/ M2, profilin-1, Ig lambda-1 chain C regions, and Ig gamma-1 chain C region, were present in lower levels for periphery samples when compared to interior samples and six proteins, keratin, type II cytoskeletal 6 A ( KRT6A), keratin, type I cytoskeletal 14, S100 calcium binding proteins A7, alpha-1-antitrypsin precursor, hemoglobin subunit alpha, and hemoglobin subunit beta, were present in higher levels in periphery samples when compared with interior samples. S100 calcium binding protein A6, S100 calcium binding protein A7, and soluble receptor for advanced glycation end-products had higher levels in the periphery of chronic wounds vs. the interior in planar arrays. A significant temporal trend was noted for monokine induced by gamma interferon (MIG), synonomous with chemokine (C-X-C motif) ligand 9 (CXCL9), which increased as wounds healed and remained nearly constant for ulcers that were not approaching closure. [ABSTRACT FROM AUTHOR]

yi m. & park e.y. (2011) Effects of breast health education conducted by trained breast cancer survivors. Journal of Advanced Nursing 68(5), 1100-1110. Abstract Aims. This article is a report on a study of the effectiveness of breast health education provided by trained breast cancer survivors on knowledge, skills, performance and self-efficacy. Background. Numerous studies have been performed to assess the effects of breast health education provided by health professionals, but few studies have examined the effects of education provided by lay persons, such as breast cancer survivors. This study focused on the role of breast cancer survivors as breast health educators. Methods. A pretest and post-test quasi-experimental design was used. Trained breast cancer survivors conducted a 60-minute breast health class that was guided by self-efficacy theory to young healthy women. The data were collected in 2008 from 22 young healthy women who participated in the class. Self-report questionnaires were used to measure the breast cancer and breast self-examinations knowledge, skills, performance and self-efficacy at pre-education, and at 1 month and 3 months post-education. Results. The scores on knowledge, skills, performance and self-efficacy before breast health education were significantly increased after 1 month and 3 months post-education. Conclusion. The results of this study demonstrate that a one-time breast health class provided by trained breast cancer survivors can be useful in motivating young women to adopt behaviours that help to prevent breast cancer morbidity and mortality. [ABSTRACT FROM AUTHOR]

The primary systemic vasculitides in childhood are quite rare except for Henoch-Schönlein purpura and Kawasaki disease. These are usually self-limited diseases. The etiopathogenesis for most of them is not clearly understood. However, it is usually thought that environmental triggers (mostly infectious) evoke an aggravated inflammatory response in susceptible individuals. The classification criteria for most of them were recently validated for children. Clinical manifestations are determined by the organs affected, reflecting the involved vessels on a background of constitutional symptoms. For treatment, the main data are adapted from adult studies, especially for rarer vasculitides in childhood. In this review, the recent classification criteria, current pathophysiologic pathways, and treatment protocols are summarized. [ABSTRACT FROM AUTHOR]

Bioelectrical impedance analysis (BIA) is a simple, inexpensive, quick and non-invasive technique for measuring body composition. The clinical benefit of BIA can be further enhanced by combining it with bioelectrical impedance vector analysis (BIVA). However, there is a substantial lack of information on the practical aspects of BIA/BIVA for those primarily interested in learning how to use and interpret this method in practice. The purpose of this article is to provide some guidance on the use of BIA/BIVA with special attention to practical considerations.This report reflects the authors' practical experience with the use of single-frequency BIA in combination with BIVA, particularly in COPD patients. First, the method and principles of BIA/BIVA are briefly described. Then, a practice-oriented approach to the interpretation and analysis of characteristic examples of altered nutritional and fluid status as seen with BIA/BIVA in COPD patients (e.g. malnutrition in obese and underweight patients with COPD, water retention) is presented.As our examples show BIA/BIVA is an attractive and easy-to-learn tool for quick nutritional assessment and is therefore of great clinical benefit in daily practice. [ABSTRACT FROM AUTHOR]

The article provides an overview of degenerative neck pain, focusing on the clinical aspects of diagnosis and management. It considers the symptoms and signs to formulate a differential diagnosis. It recommends the use of x-ray and magnetic resonance imaging to investigate degenerative neck pain. It suggests that operative intervention can be beneficial for radiculopathy and may be considered for myelopathy. INSET: KEY POINTS.

The incidence rate of pressure ulcers in the USA ranges from 0·4% to 38% in acute care settings and from 2·2% to 23·9% in long-term care settings, and their treatment costs are in the billions of dollars yearly. The proteome of wound fluid may contain early indicators or biomarkers associated with healing in pressure ulcers that would enable treatment regimes to be optimised for each individual. Wound fluid was collected from the interior and periphery of 19 chronic pressure ulcers at 15 time points during 42 days for an analysis of protein expression. Proteins were fractionated using two-dimensional polyacrylamide gel electrophoresis. A comparison of the spot distributions indicates a biochemical difference between the interior and the periphery of wounds. Pressure ulcers that healed show a greater number of spots for interior and peripheral locations combined over time when compared with wounds that did not heal. Using this technique, protein S100A9 was identified as a potential biomarker of wound healing. The identification of differences within the proteome of healing versus non healing pressure ulcers could have great significance in the use of current treatments, as well as the development of new therapeutic interventions. [ABSTRACT FROM AUTHOR]

To evaluate the effects of dietary hemi- cellulose from corn on growth and metabolic measures, female pigs (n = 48; initial BW 30.8 kg) were fed diets containing 0 to 38.6% solvent-extracted corn germ meal for 28 d. Increasing the hemicellulose level had no impact on ADG or ADFI, but resulted in a quadratic response (P < 0.03) on G:F. To investigate physiological changes that occur with increased dietary hemicellulose, blood, colon contents, and tissue samples from the liver and intestine were obtained from a subset (n = 16; 8 pigs/treatment) of pigs fed the least and greatest hemicellulose levels. The abundance of phosphoadenosine monophosphate-activated protein kinase (AMPK) and the mitochondrial respiratory protein, cytochrome C oxidase II (COXII) were determined in liver, jejunum, ileum, and colon by Western blotting. The mRNA expression levels of AMPKα1, AMPKα2, PPAR coactivator 1α (PGC1-α), PPAR γ2,.and sirtuin 1 (Sirt1) were determined in liver and intestinal tis- sues. When compared with pigs fed the control diet, pigs fed the high hemicellulose diet had increased (P < 0.02) plasma triglycerides, but there was no differ- ence in plasma cholesterol, glucose, or insulin. Absolute and relative liver weights were decreased (P < 0.03) in pigs consuming the high hemicellulose diet. The high-fiber diet led to a tendency (P < 0.12) for decreased liver triglyceride content. In pigs fed the high hemicellulose diet, ileal mucosal alkaline phosphatase activity was increased (P < 0.08) and sucrase activity tended (P < 0.12) to be increased. The high hemicellulose diet had no effect on phospho-AMPK, AMPK mRNA, or colonic VFA, but in pigs consuming the high fiber diet there was a greater (P < 0.05) abundance of COXII in colon tissue. The expression of PGC1-α, PPARγ, or Sirt1 mRNA was not altered by dietary fiber in liver, jejunum, or ileum tissue. In colon tissue from pigs fed the high fiber diet there was an increase (P < 0.09) in Sirt1 mRNA and a trend (P < 0.12) toward increased of PGC1-α mRNA. These data suggest that alterations in metabolism involved in adaptation to a diet high in hemicellulose are associated with increased colonic Sirti mRNA and COXII expression, indicating an increased propensity for oxidative metabolism by the intestine. [ABSTRACT FROM AUTHOR]

Purpose: To review the identification of patients at risk of secondary ischemic events, discuss the therapies available for their medical management, and identify the role of the nurse practitioner (NP) in their primary and long-term care. Data sources: ACC/AHA 2007 guidelines for the management of patients with unstable angina and non-ST-elevation myocardial infarction, ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease, AHA/ASA 2006 guidelines for patients with ischemic stroke, AHA/ACC 2006 guidelines update for patients with coronary and other atherosclerotic vascular disease, and selected clinical articles identified through PubMed. Conclusions: Preventive therapy in patients with atherothrombotic vascular disease is critical for reducing the risk of recurrent events. Almost all patients with atherosclerotic disease will benefit from general lifestyle modifications, and most will also benefit from appropriate pharmacotherapies targeting dyslipidemia, diabetes, hypertension, and platelet function. However, evidence suggests that secondary prevention strategies may not be utilized effectively. Implications for practice: Increased awareness and implementation of clinical practice guidelines can reduce the risk of recurrent atherothrombotic events. NPs in primary care settings or in long-term care facilities are well placed to determine whether patients are receiving appropriate preventive care and to implement improvements in their management. [ABSTRACT FROM AUTHOR]

During the Bronze Age in Crete, agriculture, pottery production, metallurgy, textiles, architectural feats, trade, and other specializations flourished. Throughout habitation on Crete, pottery production was an area of craftsmanship and practicality from the end of the Neolithic to Mycenean and Iron Age. This experiment, however, relates to the Late Minoan I period in the geographical region of Mochlos. The Artisan's Quarter is a building that contains various rooms that have been tied to craftsmanship and workshops. Once connected by a land bridge to the ancient site of Mochlos, this particular building would have been the place of vast amounts of pottery production. Activities would have ranged from the clay preparation to forming the vessels by hand or wheel to the decoration choices to the firing, and then finally to the exportation. For this experiment, the construction of the kiln was based on the research of two kilns of differing sizes and characteristics in this area, combined with other Late Minoan sites on Crete, to understand firing techniques and building aspects. Chalinomouri was another place of specialization. It was a small habitation that seemed to concentrate on agriculture. The pottery collected from this site varies in date and function, which is similar to that of the Artisan's Quarter. As seen in the excavations at Mochlos, the scored basins were discovered fragmented within various rooms of different activities, suggesting their fabrication and possible function. [ABSTRACT FROM AUTHOR]

Exacerbations of chronic obstructive pulmonary disease (COPD) may lead to a rapid decline in health and subsequent death, an unfortunate tyranny of having COPD—an irreversible health condition of 16 million individuals in the USA totaling 60 million in the world. While COPD is the third largest leading cause of death, causing 3.23 million deaths worldwide in 2019 (according to the WHO), most patients with COPD do not receive adequate treatment at the end stages of life. Although death is inevitable, the trajectory towards end-of-life is less predictable in severe COPD. Thus, clinician-patient discussion for end-of-life and palliative care could bring a meaningful life-prospective to patients with advanced COPD. Here, we summarized the current understanding and treatment of COPD. This review also highlights the importance of patient-centered discussion and summarizes current status of managing patients with advanced COPD. [ABSTRACT FROM AUTHOR]

Aims. To describe alcohol use, and the prevalence and predictors of hazardous drinking, among hospital doctors. Methods. Data were collected by anonymous mail survey in 2006, from a representative national sample of 1917 (58% response rate) hospital doctors in Germany. Alcohol use was measured using the AUDIT-C, scores of 5 or more for males and females indicating "hazardous drinking." Results. There were 9.5% abstainers, 70.7% moderate drinkers, and 19.8% hazardous drinkers. The majority of doctors (90.5%) used alcohol—mainly at a sensible level, e.g., 2-4 times a month (32%) or 2-3 times a week (29%), and 1-2 glasses on one occasion (83%). Binge drinking was common (53%), but for most occurred less than once in a month (39%). When hazardous drinking was controlled for certain confounders, being male (OR 4.7; 95% CI 3.4-6.5) and having a surgical specialty (OR 1.4; 1.1-1.8) were significantly correlated to hazardous drinking. Age had no influence on this model. By contrast, the age group 40 years and younger (OR 2.1; 1.4-3.0) was a significant predictor of abstinence. Conclusions. There is a higher rate of abstainers and a lower rate of binge drinkers among hospital doctors in Germany than in the general population. However, some hospital doctors drink hazardously, the risk being greater among males and among surgeons, which should be paid due attention in the interest of their health and their function as doctors. [ABSTRACT FROM AUTHOR]

Background: Kenyatta National Hospital (KNH) is the main public hospital in Kenya delivering comprehensive cancer care and receives patients from throughout the country. The patient navigation program, established in 2017, addresses barriers to accessing timely care at the Cancer Treatment Centre (CTC) and several clinics. The COVID-19 pandemic disrupted cancer healthcare systems worldwide and posed additional challenges to cancer patients in Kenya. In March 2020, the government instituted control measures, including a travel ban that along with other factors led to a 50% reduction in the number of patients able to access care at the CTC. In response, patient navigators expanded use of mobile phone calls to support cancer patients and ensure continuity of care. Objective: This presentation provides a summary of the challenges cancer patients encountered with accessing care during the COVID-19 pandemic identified through mobile phone calls and describes how the use of telephone navigation addressed them. Methodology: From March to April 2020, navigators called patients to check in on them and also received calls from patients and caregivers. Call date, reason for the call, and other comments about the discussion were recorded in paper phone call logs. Data from 230 calls with cancer patients were reviewed. Call reasons and support provided were grouped into themes and summarized using descriptive statistics. Results: In 39% (n = 89) of the calls, patients were afraid or worried that traveling to KNH was going to expose them to COVID-19. More than a quarter (28%, n = 63) were to attend a follow-up clinic and shared that they were not planning to come out of fear of contracting COVID-19, whereas in 13% (n = 29) of the calls, patients said they thought that the cancer services had been suspended. Patients were informed that preventive measures were in place, and that the services were continuing. Forty-four percent (n = 101) reported challenges in accessing services at KNH due to imposed movement restrictions and the inability to afford transportation costs. Navigators assisted by rescheduling nonurgent appointments or by providing letters explaining their medical need for clearance to travel. Seventeen percent (n = 40) reported experiencing pain but being unable to access their usual pain medication because of travel restrictions. They were linked to the nearest health facility for pain management, and those near Nairobi were assisted to access KNH. Thirteen percent (n = 31) reported experiencing other symptoms or side effects and were advised on their management. Those needing medical attention were advised to come to KNH or were linked to the nearest health facilities. Conclusion: The COVID-19 pandemic significantly affected cancer patients' ability to access cancer care. Phone calls have been instrumental in ensuring cancer care continuity by addressing patients' unique needs due to the pandemic in addition to the usual barriers. Mobile calls enabled navigators to optimize their provision of quality patient-centered care, and they can continue to leverage this resource for enhanced patient support. [ABSTRACT FROM AUTHOR]

Background: Low enrollment rates for cancer clinical trials have been an ongoing barrier to scientific advances in oncology care. Average clinical trial participation rates are estimated to be as low as 8% nationally, with great variability based on demographics.1 Whereas studies have explored the benefit of patient navigation in improving trial enrollment and completion at an institutional and statewide level,2,3 the impact of an advanced practice clinical trial nurse navigation program on trial enrollment from a national vantage point has not yet been discussed in the literature. With more than 178,520 new cases of leukemia, lymphoma, and myeloma anticipated to be diagnosed in 2020, clinical trial participation in studies investigating new treatments for hematologic malignancies are more important than ever.4 Objective: To determine the impact of the Leukemia & Lymphoma Society (LLS) Clinical Trial Support Center (CTSC) nurse navigation services on clinical trial enrollment for adult and pediatric patients with hematologic malignancies and the perceived helpfulness of the service. Methods: LLS created the CTSC in 2016 and expanded the advanced practice nursing (APN) staff in 2019. The CTSC is charged with providing a personalized, patient-centered navigation service to identify and connect patients with potential clinical trials while addressing barriers to enrollment and educating patients about clinical trials. The APN staff assesses the patient's preferences, physical condition, medical history, insurance coverage, ability to travel, and financial barriers to provide an individualized list of appropriate clinical trials. A retrospective online survey of 474 patients and caregivers who utilized the CTSC from May 2018 to April 2019 was conducted by RTI International on behalf of LLS from July 2019 to August 2019 utilizing a standardized tool. Results: A 30% response rate for the online survey provided 142 partially or fully completed surveys. A majority of respondents were white (92%, n = 114/124) and reported having at least a 4-year college degree (71%, n = 89/126). Of patients and caregivers surveyed, 29.8% (n = 39/131) enrolled in a clinical trial after receiving assistance from the CTSC APN. Over half of the participants who enrolled in a trial noted the CTSC nurse navigator helped them find the trial in which they enrolled (55.9%, n = 19/34). Further, 99.2% (n = 130/131) of respondents found the conversation(s) with the CTSC nurse navigator to be helpful, and 98.5% (n = 128/130) reported the CTSC nurse navigator's ability to answer questions as great or excellent. Conclusion: Use of a nationally focused, advanced practice clinical trial nurse navigation program for hematologic malignancies facilitated clinical trial enrollment of 21%, well above the national estimate of trial participation of 8%. The vast majority of those who utilized the service found it helpful. Similar to noted disparities in nationwide clinical trial participation, there is lack of diversity among those historically served by the CTSC. LLS is actively working to improve the reach of this service into racially, ethnically, and socioeconomically diverse communities. [ABSTRACT FROM AUTHOR]

Background: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide information on cancer rates and trends in the United States. This year's report updates statistics on the 15 most common cancers in the five major racial/ethnic populations in the United States for 1992–2002 and features population-based trends in cancer treatment. Methods: The NCI, the CDC, and the NAACCR provided information on cancer cases, and the CDC provided information on cancer deaths. Reported incidence and death rates were age-adjusted to the 2000 U.S. standard population, annual percent change in rates for fixed intervals was estimated by linear regression, and annual percent change in trends was estimated with join-point regression analysis. Population-based treatment data were derived from the Surveillance, Epidemiology, and End Results (SEER) Program registries, SEER-Medicare linked databases, and NCI Patterns of Care/Quality of Care studies. Results: Among men, the incidence rates for all cancer sites combined were stable from 1995 through 2002. Among women, the incidence rates increased by 0.3% annually from 1987 through 2002. Death rates in men and women combined decreased by 1.1% annually from 1993 through 2002 for all cancer sites combined and also for many of the 15 most common cancers. Among women, lung cancer death rates increased from 1995 through 2002, but lung cancer incidence rates stabilized from 1998 through 2002. Although results of cancer treatment studies suggest that much of contemporary cancer treatment for selected cancers is consistent with evidence-based guidelines, they also point to geographic, racial, economic, and age-related disparities in cancer treatment. Conclusions: Cancer death rates for all cancer sites combined and for many common cancers have declined at the same time as the dissemination of guideline-based treatment into the community has increased, although this progress is not shared equally across all racial and ethnic populations. Data from population-based cancer registries, supplemented by linkage with administrative databases, are an important resource for monitoring the quality of cancer treatment. Use of this cancer surveillance system, along with new developments in medical informatics and electronic medical records, may facilitate monitoring of the translation of basic science and clinical advances to cancer prevention, detection, and uniformly high quality of care in all areas and populations of the United States. [ABSTRACT FROM AUTHOR]

Aims: This study was designed to describe the alcohol use by female surgeons and the hazards of their drinking habits for them compared with the habits of female doctors from non-surgical specialities, and with those of their male colleagues in surgery, and to identify the variables associated with hazardous drinking. Methods: The data were collected in 2000 from a representative national sample of 1120 Norwegian doctors. Alcohol use was measured using a modified version of the Alcohol Use Disorders Identification Test A score of 9 or more was used as an indicator of hazardous drinking. Results: Female surgeons compared with female non-surgeons had tendencies for more frequent moderate alcohol consumption accompanied by more frequent consumption of larger amounts of alcohol, and a significantly higher rate of hazardous drinking (18 vs 7.6%). Being a surgeon (OR = 1.7, 95% CI 1.2-2.4), male (OR = 2.7, 1.7-4.1) and aged 45 years or over (OR = 1.5, 1.1-2.2) were significant predictors of hazardous drinking. With separate gender analyses, being a surgeon was a significant predictor for both females (OR = 2.8, 1.2-6.6) and males (OR = 1.5, 1.0-2.3). Conclusion: Female surgeons practising in Norway drink more frequently and more hazardously than other female doctors. There are a number of possible explanations for this. Surgical culture may be an important factor. [ABSTRACT FROM AUTHOR]

Objectives To assess the effectiveness of combined ultrasound and biochemical (CUB) screening for chromosome abnormalities in singleton pregnancies in a routine antenatal clinic and laboratory setting. Methods Women whose pregnancies fell within the gestational age range of 11 to 14 weeks by ultrasound assessment were offered CUB screening on the basis of measurement of nuchal translucency (NT), maternal serum free beta-human chorionic gonadotrophin (FβhCG) and pregnancy-associated plasma protein A (PAPP-A). NT measurements were obtained using a standardised method defined by the Fetal Medicine Foundation and FβhCG, and PAPP-A were measured using the DELFIA immunoassay system. Each screening marker measurement was converted to a multiple of the appropriate gestational median and a risk was derived using previously published parameters for each marker in chromosomally abnormal and unaffected pregnancies. A combined risk of Down syndrome and of trisomy 18/13, incorporating the maternal age risk, was calculated for all women. Invasive diagnostic testing was offered to women whose combined risk exceeded the cut-off risk of 1 in 250 (term). Results Five thousand and eighty-four women accepted a first-trimester screening test for Down syndrome, representing 75% of the eligible booking population. Out of the population eligible for CUB screening at the time of booking, NT measurements were obtained from 93% at the first clinic visit and 7% had to return for a second attempt. After excluding women who defaulted on a return visit, satisfactory NT measurements were obtained in 99.5% of pregnancies. Fifteen cases of Down syndrome and eleven pregnancies with other chromosome abnormalities were ascertained. The detection rate for Down syndrome was 93% (14/15) at a false-positive rate of 5.9% and for all chromosome abnormalities it was 96% (25/26) at an overall false-positive rate of 6.3%. Conclusions CUB screening offers a significant improvement in sensitivity over second-trimester biochemical screening and is deliverable within a routine prenatal clinical setting. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents abstracts of medical research. They include "Combined ultrasound and magnetic resonance imaging approach in the antenatal diagnosis of arachnoid cysts: three case reports," "Fetal MRI of the CNS: Technique, MRI-anatomy and pathological images interpretation," and "Ultrasonographic indicators in predicting postnatal outcomes of antenatally detected ventriculomegaly."