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TAVI (transcatheter aortic valve implantation) is the gold standard treatment for aortic stenosis in the elderly. Prior identification of patients likely to benefit from this procedure remains crucial. A standardised geriatric assessment is used to identify the main geriatric syndromes likely to influence postoperative results. The primary objective is to identify factors associated with non-treatment with TAVI. The secondary objective of this study is to compare the one-year survival of TAVI and non-TAVI patients and to estimate the prognostic factors for death after TAVI. This was a single-centre, retrospective, observational study conducted at the Arras Hospital between 2016 and 2020. Patients aged 70 years and older with symptomatic severe aortic stenosis who had undergone a geriatric assessment were included. Following this pre-TAVI assessment, 2 groups were defined: – TAVI group: eligible patients who underwent percutaneous valve replacement; – non-TAVI group: patients who were not eligible after the pre-TAVI assessment or who refused the procedure. A total of 192 patients, mean age 82.3 years. The 1-year mortality rate was 18% in the TAVI group and 44% in the non-TAVI group (P < 0.001). Confers (Fig. 1). Parameters associated with non-TAVI were Euroscore 1 (19.6 ± 10.9 vs. 23.2 ± 13.5 P = 0.020), malnutrition (14% vs. 35%, P = 0.004), slowed walking speed < 0.8 m/s (39% vs. 75%, P = 0.001), functional dependence with ADL score (5.4 ± 1 vs. 4.2 ± 1.6, P < 0.001) and IADL (2.6 ± 1.2 vs. 1.8 ± 1.4, P = 0.002), thymic disorders with mini-GDS > 1 (16% vs. 38%, P = 0.045) and cognitive dysfunction with MMSE score (25.1 ± 3.5 vs. 21.6 ± 4.3 < 0.001). Geriatric syndromes are important determinants of eligibility for TAVI. Cardiac surgical risk scores are not effective in discriminating between patients. Coordinated assessment may optimise selection. Therefore, geriatric assessment should be systematically performed as part of the pre-TAVI evaluation. [ABSTRACT FROM AUTHOR]

Despite the large amount of research on the existence and the negative consequences of stigmatization of clients of mental health services, little is known about the differences between services. Using data from 520 clients of 47 rehabilitation centers in a multilevel design, we studied organizational and individual characteristics explaining variation in social rejection and self-rejection. The results reveal that only a very small percentage of variance in stigmatization is explained by organizational features, such as size, composition of the client population and the kind of supplied activities. Client level characteristics affecting stigmatization are current mental health status, former mental hospitalization, and participation in psychotherapeutic activities. [ABSTRACT FROM AUTHOR]

Background: A cross-national comparison of Belgian and Dutch childbearing women allows us to gain insight into the relative importance of pain acceptance and personal control in pain relief in 2 maternity care models. Although Belgium and the Netherlands are neighbouring countries sharing the same language, political system and geography, they are characterised by a different organisation of health care, particularly in maternity care. In Belgium the medical risks of childbirth are emphasised but neutralised by a strong belief in the merits of the medical model. Labour pain is perceived as a needless inconvenience easily resolved by means of pain medication. In the Netherlands the midwifery model of care defines childbirth as a normal physiological process and family event. Labour pain is perceived as an ally in the birth process.Methods: Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Two questionnaires were filled out by 611 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. However, only women having a hospital birth without obstetric intervention (N = 327) were included in this analysis. A logistic regression analysis has been performed.Results: Labour pain acceptance and personal control in pain relief render pain medication use during labour less likely, especially if they occur together. Apart from this general result, we also find large country differences. Dutch women with a normal hospital birth are six times less likely to use pain medication during labour, compared to their Belgian counterparts. This country difference cannot be explained by labour pain acceptance, since - in contrast to our working hypothesis - Dutch and Belgian women giving birth in a hospital setting are characterised by a similar labour pain acceptance. Our findings suggest that personal control in pain relief can partially explain the country differences in coping with labour pain. For Dutch women we find that the use of pain medication is lowest if women experience control over the reception of pain medication and have a positive attitude towards labour pain. In Belgium however, not personal control over the use of pain relief predicts the use of pain medication, but negative attitudes towards labour.Conclusions: Apart from individual level determinants, such as length of labour or pain acceptance, our findings suggest that the maternity care context is of major importance in the study of the management of labour pain. The pain medication use in Belgian hospital maternity care is high and is very sensitive to negative attitudes towards labour pain. In the Netherlands, on the contrary, pain medication use is already low. This can partially be explained by a low degree of personal control in pain relief, especially when co-occurring with positive pain attitudes. [ABSTRACT FROM AUTHOR]

Background: Because numerous studies have revealed the negative consequences of stigmatisation, this study explores the determinants of stigma experiences. In particular, it examines whether or not part-time hospitalisation in contemporary psychiatric hospitals is associated with less stigma experiences than full-time hospitalisation.Methods: Survey data on 378 clients of 42 wards from 8 psychiatric hospitals are used to compare full-time clients, part-time clients and clients receiving part-time care as aftercare on three dimensions of stigma experiences, while controlling for symptoms, diagnosis and clients' background characteristics.Results: The results reveal that part-time clients without previous full-time hospitalisation report less social rejection than clients who receive full-time hospitalisation. In contrast, clients receiving part-time treatment as aftercare do not differ significantly from full-time clients concerning social rejection. No significant results for the other stigma dimensions were found.Conclusion: Concerning social rejection, immediate part-time hospitalisation could be recommended as a means of destigmatisation for clients of contemporary psychiatric hospitals. [ABSTRACT FROM AUTHOR]

Acute Hepatopancreatic Necrosis Disease (AHPND), a highly destructive shrimp disease, has inflicted severe setbacks on the shrimp farming industry worldwide. As the use of antibiotics is discouraged due to emerging antibiotic-resistant bacteria and the pollution of ecosystems, there is a pressing demand for novel, sustainable alternatives. Hence, the influence of bovine lactoferrin (bLF) and hen ovotransferrin (OT), two natural antimicrobial proteins, on the growth of three AHPND-causing Vibrio parahaemolyticus ( Vp ) strains (M0904, TW01 and PV1) was examined. Additionally, we explored their potential to affect selected Vp virulence factors such as biofilm formation, swimming and swarming, cell surface hydrophobicity, and activity of released lipases and caseinases. Lag phases of all bacterial growth curves were significantly prolonged in the presence of bLF or OT (1, 5 and 10 mg/mL), and bLF (5 and 10 mg/mL) completely inhibited growth of all strains. In addition, bLF or OT significantly reduced biofilm formation (all tested bLF and OT concentrations for Vp M0904 and Vp PV1), bacterial swimming motility (0.5 mg/mL bLF and OT for Vp M0904 and Vp TW01; 1 mg/mL bLF and OT for all strains), cell surface hydrophobicity (for all strains, all bLF and OT concentrations tested except for 0.125 mg/mL OT for Vp PV1) and lipase activity (1 mg/mL bLF and OT for all strains and 0.5 mg/mL bLF and OT for Vp PV1). These promising in vitro results suggest that bLF and/or OT might be used as novel agents for combating AHPND and warrant further research to elucidate the underlying mechanisms of action to fully unlock their potential for AHPND disease management.

Background: Vaccine hesitancy for COVID-19 is a major obstacle to achieving high vaccine coverage. Low vaccine confidence among college students is one factor fueling the COVID-19 pandemic in the U.S., Objective: The purpose of this study was to evaluate COVID-19 vaccine hesitancy and barriers to vaccine uptake among students, faculty, and staff at a rural public university., Method: We used the Barrier Analysis (BA) mixed-methods approach, which explores determinants of the desired behavior using the Health Belief Model and Theory of Reasoned Action. We developed a BA questionnaire and distributed it through Qualtrics to 4,600 randomly selected students ( n  = 4,000), faculty ( n  = 300), and staff ( n  = 300) from March 11 to April 1, 2021. We defined Acceptors as those who were willing to be vaccinated and Non-acceptors as those who were not., Results: Our analysis found that among Non-acceptors, perceived social norms, perceived negative consequences, and trust had the highest association with COVID-19 vaccine hesitancy among students, faculty, and staff., Conclusion: These findings illustrate the need to develop effective behavior change strategies for COVID-19 vaccines uptake that identify sources of trusted information among vaccine-hesitant college students, faculty, and staff, while leveraging enablers to increase COVID-19 vaccination coverage on university campuses., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Optical tracking systems (OTSs) are essential components of many modern computer assisted orthopaedic surgery (CAOS) systems but patient movement is often neglected in the evaluation of the accuracy. The aim of this study was to develop a representative test to assess the accuracy of OTSs including patient movement and demonstrate the effect of pointer design and OTS choice., Method: A mobile phantom with dynamic reference base (DRB) attached was designed and constructed. The point registration trueness and precision were evaluated for measurements with both a static and moving phantom., Results: The trueness of the total target registration error (TTRE) was 1.4 to 2.7 times worse with a moving phantom compared to a static phantom., Conclusion: The accuracy of OTSs for CAOS applications should be evaluated by measurements with a moving phantom as the evaluation of the TTRE with a static frame significantly underestimates the measurement error., (© 2021 John Wiley & Sons Ltd.)

Aims: Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon's experience level., Methods: A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB)., Results: The mean 75 th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents., Conclusion: This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324-1330.

Objective : Blood lactate concentration (L) and lactate kinetic (LK) over time might be a helpful marker of the shock severity. The purpose of this study is to analyze whether the L and LK could correlate with the outcome and the therapy of patients with different types of shock. Methods : Design : A 3.5-year retrospective observational study. Patients : Eighteen years of age or older, diagnosed with shock were included. Arterial L measurements were performed upon admission and approximatively 3 and 6 h later. The evolution of lactate over this period of time was correlated with the outcome and therapy. Interventions : Univariate and multivariable statistical tests were performed to examine the relation between the initial L/LK and the in-hospital mortality, total mortality, length of stay (LOS), the LOS at the intensive care unit and the administered therapy. The optimal cut-off point of the LK over time to predict the mortality was calculated. Results : The initial L and the 6 h LK were significantly associated with the outcome. The higher the initial L and lower the LK, the higher the risk of mortality in the hospital or within 6 months. Moreover, the higher the initial L and lower the 6 h LK, the longer was the LOS. A relation between the initial L/LK and the required therapy was found. The optimal cut-off for the 6-h LK is 38.1%. Patients with a 6 h LK >38.1% had a significantly higher chance of survival. Conclusions : A significant relationship between the L/6-h LK and the outcome and treatment was found. The optimal survival cut-off point of 6 h LK in our study was 38.1%.

Purpose: The detrimental impact of stigma on the utilization of mental health services is a well-established finding. Nevertheless, most studies consider only the personal or interactional dimensions of stigma. This contribution makes a distinction between the dominant beliefs about stigma within a culture and the personal beliefs of individuals with regard to stigma. We hypothesize that both have an impact on professional-care seeking within the field of mental health. Methods: A multi-level research design is used to estimate the effects of both types of stigma beliefs on the likelihood of consulting general and specialized health professionals about mental health problems in 28 European countries (N of individuals = 24,881, Eurobarometer 248, 2005-2006). Results: In countries where stigmatizing beliefs are dominant, the likelihood of seeking help from specialized mental health professionals is constrained, and individuals refrain from contacting general practitioners when in need of formal support, regardless of their own personal stigma beliefs. Conclusion: The present study signals the importance of stigma beliefs as shared cultural phenomena, and of personal stigma beliefs to the likelihood of seeking professional care for mental health problems. We therefore propose that most studies on stigma and formal-care seeking underestimate the pervasive effects of stigma beliefs, due to methodological individualism., (Copyright © 2019 Bracke, Delaruelle and Verhaeghe.)

The purpose of this study is to evaluate the possible use of four "FSA" thin and flexible resistive pressure mapping systems, designed by Vista Medical (Winnipeg, Manitoba, Canada), for the measurement of interface pressure exerted by lumbar belts onto the trunk. These sensors were originally designed for the measurement of low pressure applied by medical devices on the skin. Two types of tests were performed: standard metrology tests such as linearity, hysteresis, repeatability, reproducibility and drift, and specific tests for this application such as curvature, surface condition and mapping system superposition. The linear regression coefficient is between 0.86 and 0.98; hysteresis is between 6.29% and 9.41%. Measurements are repeatable. The location, time and operator, measurement surface condition and mapping system superposition have a statistically significant influence on the results. A stable measure is verified over the period defined in the calibration procedure, but unacceptable drift is observed afterward. The measurement stays suitable on a curved surface for an applied pressure above 50 mmHg. To conclude, the sensor has acceptable linearity, hysteresis and repeatability. Calibration must be adapted to avoid drift. Moreover, when comparing different measurements with this sensor, the location, the time, the operator and the measurement surface condition should not change; the mapping system must not be superimposed., (© IMechE 2014.)

Objective: Individuals in need of psychiatric treatment often avoid seeking help because of stigma. This study examined the impact of two stigma dimensions on help-seeking attitudes. Perceived public stigma refers to discrimination and devaluation by others, and anticipated self-stigma refers to internalization of negative stereotypes about people who seek help., Methods: Data were from the 2009 Stigma in a Global Context-Belgian Mental Health Study, in which face-to-face interviews were conducted with a representative sample of the general Belgian population. The study reported here included 728 respondents who received a vignette depicting major depression or schizophrenia. Perceived public stigma and anticipated self-stigma were measured with validated instruments. Respondents' attitudes toward help seeking were measured by the importance they assigned to care from formal and informal providers: general practitioners, psychiatrists, psychologists, family members, or friends. Multiple linear regression models were estimated., Results: Respondents with higher levels of anticipated self-stigma attached less importance to care provided by general practitioners or psychiatrists, and those with higher levels of perceived public stigma rated informal help seeking as less important. The gender and the ethnicity of the person and respondents' sociodemographic characteristics had relatively little effect on help-seeking attitudes., Conclusions: Anticipated self-stigma and perceived public stigma appeared to have a differential impact on attitudes toward formal and informal help seeking. Internalization of negative stereotypes was negatively associated with the perceived importance of care from medical providers (general practitioners and psychiatrists). Awareness of stereotypes held by others deterred respondents from acknowledging the importance of informal care.

Background: Stigmatizing attitudes can impair the quality of life of people with mental health problems. Psychiatric hospitalization can generate stigma. Are some approaches to care less stigmatizing than others?, Aims: This study was designed to replicate findings from Flanders, Belgium in an English context, investigating how ward size and treatment approach affected service users' expectations and experiences of stigma., Methods: The translated Belgian questionnaire was administered to 70 service users in 15 inpatient adult mental health settings in central England. Adjustments were made to the multivariate analysis in light of the smaller sample size, in order to replicate the original equation as closely as possible., Results: Neither ward size nor individualized care proved significant in the smaller English sample, which was subject to the risk of type II error. Across two models, self-rejection correlated with age (negatively), social rejection and stigma expectations., Conclusions: This analysis shows that attempts to translate evidence about psychiatric inpatient services must take into account differences between the settings, populations and models of care. Expectations as well as outcomes of stigma may be relevant when assessing the impact of psychiatric hospital treatment on individual patients.

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.

This study examines whether there is an association between network social capital and self-rated health after controlling for social support. Moreover, we distinguish between network social capital that emerges from strong ties and weak ties. We used a cross-sectional representative sample of 815 adults from the Belgian population. Social capital is measured with the position generator and perceived social support with the MOS Social Support-scale. Results suggest that network social capital is associated with self-rated health after adjustment for social support. Because different social classes have access to different sets of resources, resources of friends and family from the intermediate and higher service classes are beneficial for self-rated health, whereas resources of friends and family from the working class appear to be rather detrimental for self-rated health. From a health-promoting perspective, these findings indicate that policy makers should deal with the root causes of socioeconomic disadvantages in society., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aim: Recently, interest has grown in the association between contextual factors and health outcomes. This study questions whether mental health complaints vary according to the socio-economic characteristics of the residential area where people live. The gender-specific patterns are studied., Methods: Complaints of depression and generalized anxiety were measured by means of the relevant subscales of the Symptoms Checklist 90-Revised. Multilevel models were estimated with PASW statistics 18, based on a unique dataset, constructed by merging data from the Belgian Health Interview Surveys from 2001 and 2004 with data from 264 municipalities derived from Statistics Belgium and the General Socio-Economic Survey., Main Findings: The results of this exploratory study indicate that the local unemployment rate is associated with complaints of depression among women., Conclusion: This study suggests that policy should approach the male and female population differently when implementing mental health prevention campaigns.

This article investigates whether and how the stigma experiences of mental health service users relate to trust in the professionals caring for them, and how both stigma and trust relate to service user satisfaction. The study uses survey data gathered from mental health service users (N = 650 service users from 36 organizations) and applies multilevel regression analyses. The results show that service users with more stigma experiences report less trust and are, partially for that reason, less satisfied with the services. Furthermore, service users with more severe symptoms and those with a psychotic disorder seem the most vulnerable ones for the processes occurring., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Clinical manual tests refer to increased ankle stiffness in children immobilized due to hip osteochondritis. The aim of the present study was to investigate musculo-articular stiffness via different techniques in immobilized children to confirm or not and quantify these observations. Ankle stiffness was quantified monthly during the long immobilization period in three diseased children and compared to healthy age-matched children. Sinusoidal perturbations were used to evaluate musculo-articular (MA) stiffness of the ankle plantar-flexors. The stiffness index (SI(MA-EMG)) was the slope of the linear relationship between angular stiffness and plantar-flexion torque normalized with electromyographic activity of the triceps surae (TS). The stiffness of the ankle plantar-flexors was also indirectly evaluated using the TS electromechanical delay (EMD). SI(MA-EMG) was greater for diseased children, and this higher stiffness was confirmed by the higher EMD values found in these immobilized children. Furthermore, both parameters indicated that ankle stiffness continues to increase through immobilization period. This study gives a quantitative evaluation of ankle stiffness changes through the immobilization period imposed to children treated for hip osteochondritis. The use of EMD measurement to indirectly evaluate these stiffness changes is also validated. This study shed for the first time some light into the patterns of muscle modifications following immobilization in children., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

The hepatitis C virus (HCV) envelope glycoprotein E1 has been widely employed as a potential vaccine antigen in clinical research. A truncated form (amino acids 192-326) of the E1 protein (E1y) was expressed in the yeast Hansenula polymorpha and purified from the cell lysate. E1y forms protein particles in the absence of detergent and remains monomeric when detergent concentration is high. In this work, a variety of spectroscopic and hydrodynamic techniques including circular dichroism, intrinsic and ANS fluorescence as well as static and dynamic light scattering are employed to evaluate E1y structural stability. The effect of two dissociative detergents, Empigen BB and Zwittergent 3-12 on E1y stability, is investigated and the results are summarized using the empirical phase diagram (EPD)-based approach. The EPDs reveal that when temperature is increased, E1y particles are more thermally stable than monomers at both pH 5 and 7. A more detailed biophysical characterization of the E1y particles is also performed including pH and temperature as variables. The EPD indicates that E1y particles are most stable at pH 7 and 8 under the given experimental conditions. The results from this study provide detailed information that will help guide the future development of E1-based HCV vaccines.

Background: Persons with mental health problems often experience stigmatization, which can have detrimental consequences for their objective and subjective quality of life. Previous research seeking for elements buffering this negative association focused on coping strategies and revealed that none of the most often used strategies is successful., Aims: This article studies whether peer support among clients can moderate this negative link, and to what extent. Following the buffering hypothesis on stress and social support, it was expected that the association between stigmatization and self-esteem would be less among persons experiencing greater peer support., Methods: This research problem was studied by means of ordinary least squares regression analysis using quantitative data from structured questionnaires completed by 595 clients of rehabilitation centres., Results and Conclusions: The results confirm that stigmatization is negatively related to self-esteem, while peer support is positively linked with it. Furthermore, they show that peer support moderates the negative association between stigmatization and self-esteem, but not in the expected way. These findings suggest that peer support can only have positive outcomes among clients with few stigma experiences, and that stigmatization itself could impede the formation and beneficial consequences of constructive peer relationships among persons receiving professional mental healthcare.

Background: Various studies have revealed the existence and negative consequences of stigmatization of persons receiving professional mental health care. Less attention is generally paid to factors affecting these stigma experiences. The influence of the immediate treatment context, especially, is largely neglected., Objective: In this article, a multilevel design is used to explore the link between characteristics of the treatment context and stigma experiences, controlling for client characteristics., Method: Data of 366 clients from 42 wards in psychiatric hospitals are used to investigate the relationship of individualized treatment, group atmosphere and ward size to self-rejection., Results: The results reveal significant differences in self-rejection between the wards. Furthermore, they show that individualized treatment in a ward is related to less self-rejection, but only if it does not worsen the group atmosphere. A positive group atmosphere seems to reduce self-rejection. Finally, clients of larger wards report more self-rejection., Conclusion: The connection between ward characteristics and stigma experiences has important research and policy implications. It brings together the domains of stigma research and mental health services research, which have mostly been developed on a separate basis. In terms of policy, this kind of study could highlight factors in the immediate treatment that could be changed to reduce stigma experiences for clients of mental health services.