Age Factors

Previous work has demonstrated marked changes in inpatient mental health service use by children and adolescents in the 1980s and early 1990s, but more recent, comprehensive, nationally representative data have not been reported. Objective: To describe trends in inpatient treatment of children and adolescents with mental disorders between 1990 and 2000. Design and Setting: Analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a nationally representative sample of discharges from US community hospitals sponsored by the Agency for Healthcare Research and Quality. Patients: Patients aged 17 years and younger discharged from US community hospitals with a principal diagnosis of a mental disorder. Main Outcome Measures: Changes in the number and population-based rate of discharges, total inpatient days and average length of stay, charges, diagnoses, dispositions, and patient demographic and hospital characteristics. Results: Although the total number of discharges, population-based discharge rate, and daily charges did not significantly change between 1990 and 2000, the total number of inpatient days and mean charges per visit each fell by approximately one half. Median length of stay declined 63% over the decade from 12.2 days to 4.5 days. Declines in median and mean lengths of stay were observed for most diagnostic categories and remained significant after controlling for changes in background patient and hospital characteristics. Discharge rates for psychotic and mood disorders as well as intentional selfinjuries increased while rates for adjustment disorders fell. Discharges to short-term, nursing, and other inpatient facilities declined. The period between 1990 and 2000 was characterized by a transformation in the length of inpatient mental health treatment for young people. Community hospitals evaluated, treated, and discharged mentally ill children and adolescents far more quickly than 10 years earlier despite higher apparent rates of serious illness and self-harm and fewer transfers to intermediate and inpatient care.

IMPORTANCE Keratinization is a histologic feature on hematoxylin-eosin staining associated with adverse outcomes in head and neck cancer, particularly oral cavity squamous cell carcinoma. However, the prognostic value of keratinization has not been demonstrated in oropharyngeal squamous cell carcinoma (OPSCC) in a large cohort of patients. OBJECTIVE To quantify the prognostic value of keratinization in a large cohort of patients with OPSCC with subgroup analysis based on p16 status, basaloid differentiation, and smoking status. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional study using a prospectively collected database that identified 208 patients with OPSCC diagnosed and treated at a single tertiary cancer center from 2002 to 2009. Tissue microarrays (TMAs) were generated from 208 patient specimens stained with hematoxylin-eosin and immunohistochemical markers. Digital images from stained TMAs were scored for the presence of keratinization and/or basaloid differentiation and for p16 status. INTERVENTIONS Patients were treated with curative intent with surgery, radiation, and/or chemotherapy. The primary outcome measure was 5-year disease-specific survival (DSS) in OPSCC according to keratinization. Univariate and multivariate survival analyses were performed to estimate survival according to histopathologic profile and smoking status. In the 208 samples, 96 were keratinizing and 112 were nonkeratinizing. Patients with keratinizing tumors were more likely to have advanced-stage disease and be p16 negative. Keratinization was independently associated with adverse outcomes. The 5-year DSS was significantly higher for nonkeratinizing tumors (63.3%) compared with keratinizing tumors (44.8%; P = .007). In subgroup analysis, nonkeratinization was associated with improved DSS in those with nonbasaloid and p16-negative tumors and in patients who were smokers. When stratifying patients based on keratinization, p16-status, and smoking status, patients with p16-negative keratinizing tumors who were smokers had the lowest 5-year DSS (26.7%). Patients with nonkeratinized OPSCC have improved survival compared with those with keratinizing tumors. Information on keratinization is most useful prognostically in those who have p16-negative and nonbasaloid tumors and in patients who are smokers. Survival can be stratified using keratinization, p16 status, and smoking status.

Studies have shown that protein synthesis in skeletal muscle of neonatal pigs is uniquely sensitive to a physiological rise in both insulin and amino acids. Protein synthesis in cardiac muscle, skin, and spleen is responsive to insulin but not amino acid stimulation, whereas in the liver, protein synthesis responds to amino acids but not insulin. To determine the response of protein synthesis to insulin-like growth factor I (IGF-I) in this model, overnight-fasted 7- and 26-day-old pigs were infused with IGF-I (0, 20, or 50 μg · kg−1 · h−1) to achieve levels within the physiological range, while amino acids and glucose were clamped at fasting levels. Because IGF-I infusion lowers circulating insulin levels, an additional group of high-dose IGF-I-infused pigs was also provided replacement insulin (10 ng · kg−0.66 · min−1). Tissue protein synthesis was measured using a flooding dose ofl-[4-3H]phenylalanine. In 7-day-old pigs, low-dose IGF-I increased protein synthesis by 25–60% in vari...

The present study examined age differences in the discrimination between anxiety and depressive symptoms in a community sample of 374 adults, ages 18-93. Older adults were less accurate and more likely than younger adults to label symptoms as neither anxiety nor depression. Both older and younger adults were more accurate in their classification of depressive than anxiety symptoms. These findings suggest that additional efforts are needed to educate the general public, particularly older adults, about anxiety and its symptoms.

This research used a mixed methods intervention design. The research aimed to: 1) study the perspectives of diabetic adults and 2) investigate the effectiveness of health literacy through transformative learning of glycemic control. In study 1, through qualitative research, the perspectives of 13 diabetic adults in Bangkok, Thailand, were examined using in-depth interviews. The findings were divided into three themes that reflected the beliefs of the patients: 1) the serious nature of the disease; 2) that made life difficult; and 3) that the glycemic control relied on patients’ sense of self-reliance and efficacy. The perspectives towards health literacy consisted of two themes: 1) information must be analyzed and evaluated before usage; and 2) hierarchical relationship influences the communication between providers and patients. The study 2 was an experimental research, in which consisted of 40 diabetic adults, divided equally into 2 groups; the experimental (20 participants) and c...

Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) usually emerges after a viral infection and causes severe disease in immunocompetent individuals. Concurrent infection with tuberculosis (TB) is generally very rare.Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen. Indiscriminate and increased use of systemic antibiotics is the reason for emergence of MRSA. Tuberculosis is the major infectious disease found in India and is still in phase to be eliminated. Concurrent infection of Tuberculosis with MRSA strain is rare to found in clinical settings. Here we report three cases of coinfection of MRSA in tuberculosis patients in different clinical samples and having different case history.

Background: the numbers with dementia are projected to double between 2001 and 2040, in line with continued increases in life expectancy. Projections have failed to account for the impact of changing risk factors on future numbers with dementia or disability. Objective: to estimate the size of the disabled population over the next 20 years and explore the impact of treatments that delay onset of cognitive impairment and associated disability. Methods: a dynamic macro-simulation projection model was used to calculate the numbers of older people with disability to 2026. Transition rates to disability and death conditional on a range of conditions, calculated from the MRC Cognitive Function and Ageing Study, were applied to the 1992 England and Wales population. Scenarios for trends in dementia incidence, risk factors and treatment were devised from a systematic review and applied. Findings: population ageing alone resulted in 39% more older people between 2006 and 2026 and 82% more with disability. A combination of reduced incidence of cognitive impairment and disabling consequences alongside improved survival provided the largest reductions in the disabled population (15,000) and the numbers cognitively impaired (302,000) compared with ageing of the population alone. Interpretation: population ageing alone will increase the disabled older population by over 80% and the numbers cognitively impaired by almost 50% over the next 20 years with serious implications for the provision of care. Research priorities should focus on earlier detection of dementia and its risk factors, thereby allowing earlier and more targeted treatment to alleviate its associated disability.

Objective Assess sociodemographic disparities in attention-deficit hyperactivity disorder (ADHD) diagnoses and determine whether England's universal assessment of 'school readiness' could provide a signal for ADHDrelated educational needs. Design Population-based cohort study. Setting Bradford, UK. Method Education and health records were linked using the Connected Bradford database for individuals who completed their first year of compulsory schooling (age 4-5 years) between the 2006/2007 and 2018/2019 academic years (n=1 25 330). School readiness was indexed by the 'good level of development' threshold within the Early Years Foundation Stage Profile. Primary healthcare records were used to identify individuals with clinical codes recorded that indicate ADHD diagnosis. Regression analyses allowed controlling for covariates, including sex, ethnicity, free school meals receipt and local area deprivation. Results Male and White British heritage individuals were more likely to have received a diagnosis for ADHD than females and those of South Asian heritage or other ethnicities, with the lowest diagnosis rates among South Asian girls. Those who attained a 'good level of development' were also less likely to have received a diagnosis for ADHD (attained: 1.0%; not attained: 2.6%, OR=0.40, 95% CI (0.35, 0.45)), even after controlling for covariates (OR=0.42, 95% CI (0.37, 0.48)). Conclusions There are structural inequalities in ADHD diagnosis, particularly across sex and ethnicity. Universal school readiness assessments, such as the Early Years Foundation Stage Profile used in England, could act as a signal of ADHD-related educational needs and aid more equitable pathways for ADHD identification and support. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ⇒ School entry assessments could be used to facilitate earlier identification of ADHD need and reduce inequalities in the identification and support of neurodevelopmental conditions. Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies.

Endurance refers to an individual’s capacity to sustain a submaximal power output or speed for the duration of an exercise bout or athletic event (>30 min). This, in turn, depends on the integration of several key physiological determinants of endurance including an individual’s maximal oxygen uptake (
O2max), the fractional utilization of
O2max (i.e., the percentage of
O2max sustainable, which is related to individual lactate threshold or critical power), and exercise economy [1]. In response to repeated bouts of exercise, termed physical training, there are whole-body and tissue-specific adaptations that lead to improvements in endurance capacity. As such, after just several weeks of training, previously sedentary individual can engage in prolonged exercise at absolute intensities that were unattainable or only tolerated for short periods prior to training. Physical training induces adaptations in multiple organs and tissues, notably in the cardiorespiratory system, vasculature and skeletal muscle, collectively contributing to enhanced endurance.
O2max functions as a surrogate marker for an individual’s endurance capacity but also serves as a strong predictive indicator for metabolic health status. Of note,
O2max, originally proposed by Nobel Prize Winner A.V. Hill [2] as a marker for athletic potential, is now acknowledged as a superior predictor of mortality compared to any other established risk factor or biomarker for cardiovascular disease (CVD) [3, 4]. This chapter provides an overview of the adaptive responses to endurance exercise training and explores their implications for athletic performance and metabolic health.

Objectives: Early childhood caries (ECC) is very prevalent among young Hispanic children. ECC is amenable to a variety of preventive procedures, yet many Hispanic families underutilize dental services. Acceptability research may assist in health care planning and resource allocation by identifying patient preferences among efficacious treatments with the goal of improving their utilization. The purposes of this study were (a) to develop a culturally competent acceptability assessment instrument, directed toward the caregivers of young Hispanic children, for five preventive dental treatments for ECC and (b) to test the instrument's reliability and validity. Methods: An instrument of five standard treatments known to prevent ECC was developed, translated, reviewed by focus groups, and pilot tested, then tested for reliability. The instrument included illustrated cards, brief video clips, and samples of the treatments and was culturally appropriate for low‐income Hispanic caregiver...

Since cardiotoxicity is a life threatening late effect, a reduction of cardiotoxicity in the treatment of acute myeloid leukaemia (AML) is essential. This review is a compilation of the current knowledge about cardiotoxicity after AML treatment and of how future directions in treatment may affect its incidence. A total of six studies concerning AML and cardiotoxicity were identified. The incidence of late subclinical cardiotoxicity varied between 1Á3 and 15Á3%, and late clinical cardiotoxicity varied between 1Á3 and 9Á3%. Cumulative dose of anthracyclines (ACs) and history of relapse were the most common risk factors identified. No conclusions could be drawn about new, potentially less toxic ACs. Differences in treatment data and variations in study populations made comparisons uncertain. The echocardiographic techniques used in the majority of the studies are inferior to more modern echocardiographic methods. This decreases reproducibility and may increase the risk of overestimation of cardiotoxicity. In summary, AML cannot be cured today without ACs. However, some ACs may cause less cardiotoxicity than others. Furthermore there is currently no consensus on equipotent doses of ACs and risk factors for cardiotoxicity. Further research including randomized trials is needed to evaluate whether or not the potentially less cardiotoxic agents fulfil their promise.

Background-The interpretation of an adequate response to the unconjugated 23-valent pneumococcal vaccine for serotypes having high preimmunization titers remains challenging. Objectives-We sought to determine whether high preimmunization titers preclude a 4-fold or greater response to vaccination. Moreover, we sought to determine the effect of the following covariates on this response: absolute preimmunization titer value, age, sex, serum IgG level, and serum IgG subclasses. Methods-We conducted a retrospective analysis of patients who were seen in our immune disorders clinic between 2001 and 2007 who had received the unconjugated 23-valent pneumococcal vaccine. Logistic regression was used to estimate the effect of different covariates, including preimmunization titer values, age, sex, IgG levels, and IgG subclass values, on the odds of a 4-fold or greater antibody response. Results-Per serotype, 10% to 40% of subjects with a high preimmunization titer attained at least a 4-fold response to vaccination. However, the odds of a 4-fold or greater response were found to decrease as a function of the absolute preimmunization titer value with an absolute value for each serotype beyond which the odds ratio approached zero. Conclusion-High pneumococcal preimmunization titers do not necessarily preclude a 4-fold or greater response to vaccination. However, there appear to be serotype-specific preimmunization titer values, ranging from 4.4 to 10.3 μg/mL, above which a 4-fold or greater response would not be expected. This response does not seem to be significantly affected by age, sex, IgG level, or IgG subclass value.

This study examines contextual and community-level characteristics associated with youth access to tobacco through commercial sources in 50 non-contiguous mid-sized California communities. The study is based on data from access surveys conducted by four confederate buyers (two men and two women) in 997 tobacco outlets. City demographics, adult smoking prevalence, and measures of tobacco outlet density, local tobacco retailer licencing and cigarette tax were included. Multilevel regression analyses indicated that buyer's actual age, a male clerk and asking young buyers about their age were related to successful cigarette purchases. Buyer's actual age and minimum age signs increased the likelihood that clerks will request an identification (ID). At the community level, a higher percentage of minors, higher education, and a greater percentage of African-Americans were associated with an increased likelihood of a successful purchase. Lower percentage of minors, lower education, ...

This article examines prevalence of non-medical use of prescription drugs (NMUPD) in a sample of elementary and high school students in an Appalachian Tennessee county. We found that lifetime prevalence of NMUPD (35%) was higher than prevalence of cigarette use (28%) and marijuana use (17%), but lower than lifetime prevalence of alcohol use (46%). We examined characteristics, as well as risk and protective factors in several domains, as predictors of NMUPD. For comparison, we also examined these characteristics and factors as predictors of alcohol, cigarette, and marijuana use. Using survey data from a sample of late elementary school and high school students (grades 5, 7, 9, and 11), logistic regression analyses showed that the risk factors of friends' non-medical use and perceived availability, and the protective factors of perceived risk, parents' disapproval, school commitment, and community norms against youth NMUPD were significant predictors of lifetime prevalence of ...

Objective. Accelerated atherosclerosis and premature coronary heart disease (CHD) are recognized complications of systemic lupus erythematosus (SLE), but the exact etiology remains unclear and is likely to be multifactorial. We hypothesized that SLE patients with CHD have increased exposure to traditional risk factors as well as differing disease phenotype and therapy-related factors compared to SLE patients free of CHD. Our aim was to examine risk factors for development of clinical CHD in SLE in the clinical setting.Methods. In a UK-wide multicenter retrospective case-control study we recruited 53 SLE patients with verified clinical CHD (myocardial infarction or angina pectoris) and 96 SLE patients without clinical CHD. Controls were recruited from the same center as the case and matched by disease duration. Charts were reviewed up to time of event for cases, or the same “dummy-date” in controls.Results. SLE patients with clinical CHD were older at the time of event [mean (SD) 53 ...

The gene for myotonic dystrophy (DM) has recently been isolated and amplifica- tion of an unstable CTG trinucleotide repeat, located within the DM gene, has been identified in virtually all patients studied to date. A high proportion of DM families who are studied show a progressively earlier age of onset with succeeding generations and, in the few pedigrees reported so far, an increasing degree of amplification of the CTG re- peat has been noted to parallel this trend. It has been implicit in several of the original reports on the nature of the changes in the DM gene that knowledge of CTG amplification status at the DM locus of a person will provide useful in- formation concerning prognosis. How- ever, no studies of genotype-phenotype correlation have been reported and there are no specific data on which to base such counsel. In this paper we report the cor- relation between the degree of CTG amplification and age of onset in 109 DM gene carriers from 17 families. Included are parent-child and sib-sib comparisons which provide a framework in which to incorporate DNA diagnostic studies when counselling subjects and families at risk for DM.

It is hoped that the guidelines will improve clinical practice in the use of nebulized therapy throughout Europe. The most important considerations should be ef® cacy and patient safety. The guidelines will also serve as an educational and scienti® c resource for clinicians and scientists with an interest in inhaled therapy. These guidelines are aimed at a wide group of healthcare professionals practising in very different healthcare systems throughout Europe. The immediate target audience for the guidelines will be pulmonary physicians, but it is hoped that the messages will be communicated to all healthcare workers who are involved in treating patients with nebulized medica- tion (doctors, nurses, pharmacists, paramedics, phy- siotherapists etc.). The ERS Guidelines will provide recommendations based on scienti® c and clinical evidence, as described in the next section, and they will provide practical advice for the majority of nebulizer users. The guidelines will also identify ar...

To evaluate the extent of variability in functional responses among participants in the LIFE study, and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability. Secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) study. Multicenter U.S. institutions participating in the LIFE study. A volunteer sample of 1635 sedentary men and women aged 70 to 89 years who were able to walk 400 m, but had physical limitations, defined as a score on the Short Physical Performance Battery (SPPB) of ≤9. Moderate-intensity physical activity (PA, n=818) consisting of aerobic, resistance and flexibility exercises performed both center-based (twice/wk) and in or around the home environment (3-4 times/wk) or health education (HE, n=817) consisting of weekly to monthly workshops covering relevant health information. Physical function: gait speed over 400-m and lower extremity function (...

The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury-related death. Fall-related fractures among older women are more than twice as frequent as those for men. Gender-specific evidence-based fall prevention strategy and intervention studies show that improved patient-centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus-based priority research agenda is presented in this article.

Background: Wyburn-Mason syndrome (WMS), historically termed racemose angioma or Bonnet-Dechaume-Blanc syndrome, represents a rare, congenital, nonhereditary neurocutaneous disorder characterized by high-flow arteriovenous malformations (AVMs) involving the retina, midbrain, and facial structures. Unlike other phakomatoses, WMS lacks significant cutaneous manifestations, reflecting a unique embryologic vascular derangement confined primarily to cerebrofacial metameres. Objective: To provide a professor-level synthesis of the current understanding of the etiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of Wyburn-Mason syndrome, integrating historical perspectives and modern imaging-based insights. Methods: A comprehensive analysis of literature on Wyburn-Mason syndrome was undertaken, integrating data from neuroophthalmology, interventional neuroradiology, and embryologic vascular development. Emphasis was placed on the conceptual framework of Cerebrofacial Arteriovenous Metameric Syndrome (CAMS), the role of advanced imaging modalities, and the evolving conservative-to-interventional therapeutic paradigm. Findings: WMS arises from an embryonic failure of normal capillary bed formation between arteries and veins within defined cerebrofacial vascular segments, resulting in persistent arteriovenous communications. The syndrome's hallmark is the coexistence of unilateral retinal and midbrain AVMs. Ophthalmic manifestations vary from asymptomatic vascular tortuosity to profound vision loss, while intracranial lesions may provoke seizures, hemiparesis, or catastrophic hemorrhage. Diagnosis hinges upon ophthalmoscopic recognition of the racemose vascular pattern, supplemented by MRI, MRA, and digital subtraction angiography to delineate the extent of vascular involvement. Management is largely conservative, with observation warranted for stable lesions. Interventions-including embolization, radiosurgery, or microsurgical resection-are reserved for symptomatic or hemorrhagic lesions. Ocular complications such as macular edema, vitreous hemorrhage, and neovascular glaucoma are managed through contemporary ophthalmic strategies including intravitreal anti-VEGF therapy and laser photocoagulation. Conclusion: Wyburn-Mason syndrome exemplifies a developmental vascular anomaly that bridges embryology, neuroophthalmology, and interventional neuroscience. Given its potential for severe visual and neurological sequelae, lifelong surveillance by an interprofessional team is essential. Early recognition through retinal findings and vigilant neuroimaging can mitigate complications and improve quality of life, even though definitive cure remains elusive.

Background: Although non-steroidal anti-inflammatory drug hypersensitivity (NSAID-H) has been widely studied in adults, there is still a lack of data regarding the features and phenotypes of NSAID-H in children. Our aim was to define risk factors and different phenotypes according to clinical patterns. Methods: Patients with a history of reaction to any NSAIDs referred between January 2012 and October 2014 were included. After completing a European Network for Drug Allergy (ENDA) questionnaire, initial skin and/or oral provocation tests (OPTs) were performed for the offending drug. Additional OPTs were done with aspirin in case of NSAID-H to determine cross-reactivity. NSAID-hypersensitive patients were defined as being either a selective responder (SR) or cross-intolerant (CI) and further categorized according to either the ENDA/GA2LEN classification or an alternative scheme by Caimmi et al. [Int Arch Allergy Immunol 2012;159:306-312]. Results: Among 121 patients [58.7% male, avera...

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

OBJECTIVES. Cleft lip palate is congenital growth disease with unknown etiology, probably linked to both genetically and external causes. The aim of this work consists in presenting the effects of these diseases on cranio facial growth and the surgical protocols described in literature. MATERIALS AND METHODS. The literature review articles conducted by Medline ranged from 1998 to 2011 have been selected. The key words of the research were "cleft lip palate", "cleft lip palate facial growth", "cleft lip palate surgery". The inclusion criteria were articles that analyzed surgical protocols and the growth of unilateral lip and palate clefts, the timing repair of lip, palate and alveolus. We excluded case reports, studies without control group in the sample and the other types of publication as thesis or conference presentation. 60 articles had the selection criteria of the research. RESULTS. The cleft lip and palate is one of the most common birth defects ...

Background: in a previous study, we showed that the ability to detect a rise in airflow resistance at rest was reduced in some non-asthmatic subjects in old age. Objective: to determine whether airflow resistance detection is attenuated in elderly subjects with asthma. Methods: we studied 60 adult subjects with stable asthma (age range 20-88). Progressive external airflow resistance loading was used to measure the inspiratory load detection threshold (LDT) during tidal breathing at rest. Results: the mean inspiratory LDT was 5.57 (4.33 SD) kPa.s/l in the 20-64 age group (n = 32) and 15.6 (10.1 SD) kPa.s/l in those aged 65 and above (n = 28) (P < 0.0001). The inspiratory LDT was significantly correlated with age (r = 0.5246, P < 0.00008), mainly due to the effect of higher LDTs in about half of the subjects above the age of 65 years. Expiratory LDT values and correlations were very similar to inspiratory values. Conclusions: the threshold for detecting external resistive loads during tidal breathing rises in old age in some, but not all, asthmatic patients as was observed in non-asthmatic subjects. The finding has implications for treatment guidelines because some elderly subjects are likely to have reduced awareness of worsening airflow obstruction, and consequently delay their use of rescue treatments.

Background: Toxoplasma gondii infections during pregnancy can result in abortion or congenital defects. Prevalence and risk factors of toxoplasmosis in women of child-bearing age in Ethiopia are unknown. The current study was conducted with the objectives of estimating the seroprevalence and potential risk factors in acquiring T. gondii infection by women of child-bearing age in Central Ethiopia. Methods: A cross-sectional study was conducted from March 2011 to September 2011. Sera of 425 women were analyzed by indirect enzyme linked immunosorbent assay (ELISA). A questionnaire survey was administered for all study participants to gather information on risk factors. The study revealed that anti-T. gondii IgG antibodies were detected in 81.4% of the samples of which 78.4% were positive for only IgG and 3.06% positive for both IgG and IgM antibodies. Seroprevalence of IgM antibodies to T. gondii (4.0%, 95% CI: 2.14, 5.86) was suggestive of recent infections. Of the 213 pregnant women 9 (4.2 %) were IgM reactive. Out of 17 potential risk factors investigated, univariate logistic regression showed significant association of T. gondii infection with study area, age, pregnancy status, raw vegetable consumption, source of water, presence of cats at home, contact with cats, HIV status and precaution during cats' feces cleaning (P ≤ 0.05). The final logistic regression model revealed that: the probability of acquiring T. gondii infection by women of Debre-Zeit was 4.46 times (95% CI of adjusted odds ratio [aOR]: 1.67, 11.89; P =0.003) higher compared to women of Ambo, pregnant women were twice (95% CI aOR: 1.13, 3.59; P = 0.018) more likely to be seropositive than non-pregnant women and women who consume raw vegetable were at increased risk of infection (aOR = 2.21, 95% CI: 1.03, 4.78; P = 0.043) than women who didn't consume. The seroprevalence of T. gondii infection in women of child-bearing age in Central Ethiopia is high. Study area, pregnancy and raw vegetable consumption are risk factors to acquire T. gondii infection. Educational program, antenatal screening of pregnant women and further epidemiological studies to uncover the economic and health impact of toxoplasmosis are suggested.

Population control of the dengue vector mosquito, Aedes aegypti, is difficult due to many reasons, one being the development of resistance to neurotoxic insecticides employed. The biosynthesis of chitin, a major constituent of insect cuticle, is a novel target for population control. Novaluron is a benzoylphenylurea (BPU) that acts as a chitin synthesis inhibitor, already used against mosquitoes. However, information regarding BPU effects on immature mosquito stages and physiological parameters related with mosquito larval development are scarce. A set of physiological parameters were recorded in control developing larvae and novaluron was administered continuously to Ae. aegypti larvae, since early third instar. Larval instar period duration was recorded from third instar until pupation. Chitin content was measured during third and fourth instars. Fourth instars were processed histochemically at the mesothorax region, stained with hematoxylin and eosin (HE) for assessment of internal tissues, and labeled with WGA-FITC to reveal chitinized structures. In control larvae: i) there is a chitin content increase during both third and fourth instars where late third instars contain more chitin than early fourth instars; ii) thoracic organs and a continuous cuticle, closely associated with the underlying epidermis were observed; iii) chitin was continuously present throughout integument cuticle. Novaluron treatment inhibited adult emergence, induced immature mortality, altered adult sex ratio and caused delay in larval development. Moreover, novaluron: i) significantly affected chitin content during larval development; ii) induced a discontinuous and altered cuticle in some regions while epidermis was often thinner or missing; iii) rendered chitin cuticle presence discontinuous and less evident. In both control and novaluron larvae, chitin was present in the peritrophic matrix. This study showed quantitatively and qualitatively evidences of novaluron effects on Ae. aegypti larval development. To our knowledge, this is the first report describing histological alterations produced by a BPU in immature vector mosquitoes.

Researchers have studied whether some youth are "addicted" to video games, but previous studies have been based on regional convenience samples. Using a national sample, this study gathered information about video-gaming habits and parental involvement in gaming, to determine the percentage of youth who meet clinical-style criteria for pathological gaming. A Harris poll surveyed a randomly selected sample of 1,178 American youth ages 8 to 18. About 8% of video-game players in this sample exhibited pathological patterns of play. Several indicators documented convergent and divergent validity of the results: Pathological gamers spent twice as much time playing as nonpathological gamers and received poorer grades in school; pathological gaming also showed comorbidity with attention problems. Pathological status significantly predicted poorer school performance even after controlling for sex, age, and weekly amount of video-game play. These results confirm that pathological gaming can be measured reliably, that the construct demonstrates validity, and that it is not simply isomorphic with a high amount of play.

The incidence of obesity is increasing rapidly all over the world and results in numerous health detriments, including disruptions in reproduction. However, the mechanisms by which excess body fat interferes with reproductive functions are still not fully understood. After weaning, female rats were treated with a cafeteria diet or a chow diet (control group). Biometric and metabolic parameters were evaluated in adulthood. Reproductive parameters, including estradiol, progesterone, LH and prolactin during the proestrus afternoon, sexual behavior, ovulation rates and histological analysis of ovaries were also evaluated. Cafeteria diet was able to induce obesity in female rats by increasing body and fat pad weight, which resulted in increased levels of triglycerides, total cholesterol, LDL and induced insulin resistance. The cafeteria diet also negatively affected female reproduction by reducing the number of oocytes and preantral follicles, as well as the thickness of the follicular layer. Obese females did not show preovulatory progesterone and LH surges, though plasma estradiol and prolactin showed preovulatory surges similar to control rats. Nevertheless, sexual receptiveness was not altered by cafeteria diet. Taken together, our results suggest that the cafeteria diet administered from weaning age was able to induce obesity and reduce the reproductive capability in adult female rats, indicating that this obesity model can be used to better understand the mechanisms underlying reproductive dysfunction in obese subjects.

Purpose Quantitative estimates of dopamine transporter availability, determined with [ 123 I]FP-CIT SPECT, depend on the SPECT equipment, including both hardware and (reconstruction) software, which limits their use in multicentre research and clinical routine. This study tested a dedicated re-construction algorithm for its ability to reduce camera-specific intersubject variability in [ 123 I]FP-CIT SPECT. The secondary aim was to evaluate binding in whole brain (excluding striatum) as a reference for quantitative analysis. Methods Of 73 healthy subjects from the European Normal Control Database of [ 123 I]FP-CIT recruited at six centres, 70 Ralph Buchert and Andreas Kluge contributed equally to this work.

Background.-Sensation seeking has been implicated as a major risk factor for underage alcohol use, however little research into this personality trait has been conducted among children. Methods.-A latent state-trait (LST) analysis was conducted among 552 individuals (54.3% female; age range 8-13; mean age 9.3) to determine the state or trait-based aspects of sensation seeking, and if this state or trait predicted future alcohol use. Sensation seeking behavior and lifetime alcohol use were assessed at four time points using two previously validated measures. Results.-Between 49.4% and 95.3% of individual differences in sensation seeking could be attributed to a stable underlying sensation seeking trait. Further, logistic regression of the stable trait of sensation seeking predicted future alcohol use. A one unit increase in the latent trait increased the odds a student would try alcohol by 7.83 times (95% CI = 1.49-41.11, p = .015). Standardized regression coefficients revealed that an increase of one standard deviation in the latent trait of sensation seeking increased the odds of experimentation with alcohol by 1.29 times (95% CI = 1.11-1.49, p = .001). Conclusion.-Findings suggest sensation seeking presents as a stable trait during childhood, which can cause children to seek out novel or exciting behaviors such as alcohol use. Future substance use interventions may need to account for the influence of the underlying trait.

This systematic review examined the health risk assessment methods of studies of wholebody vibration exposure from occupational vehicles or machines utilizing the International Standard ISO 2631-1 (1997) and/or the European Machine Directive 2002/44. This review found inconsistent reporting of measurement parameters in studies on wholebody vibration (WBV) exposure. Although many authors treat the ISO 2631-1 HGCZ as a medical health standard with defined threshold levels, the epidemiological evidence for these limits is unclear. Similarly, the EU Directive offers more comprehensive risk management guidance, but the numeric limits are equal without supporting scientific evidence. Both guidelines likely represent the prevailing societal and interdisciplinary consensus at the time. Authors note discrepancies between international and national standards and adverse WBV exposure outcomes are reported below given boundaries. Future publications should report all relevant parameters from ISO 2631-1 and clearly state study limitations, exercising caution when applying ISO 2631-1 HGCZ in health and safety assessments and considering different susceptibility of diverse populations. We advise reducing WBV exposure to the lowest technically feasible limits wherever possible and applying the precautionary principle with attention to individual differences, instead of depending solely on numeric limits.

Background Exhaled breath temperature has been suggested as a new method to detect and monitor pathological processes in the respiratory system. The putative mechanism of this approach is based upon changes in the blood flow. So far potential factors that influence breath temperature have not been studied in the general population. Methods The exhaled breath temperature was measured in 151 healthy non-smoking elderly (aged: 60–80 years) at room temperature with the X-halo device with an accuracy of 0.03°C. We related exhaled breath temperature by use of regression models with potential predictors including: host factors (sex, age) and environmental factors (BMI, physical activity, and traffic indicators). Results Exhaled breath temperature was lower in women than in men and was inversely associated with age, physical activity. BMI and daily average ambient temperature were positively associated with exhaled breath temperature. Independent of the aforementioned covariates, exhaled br...

Objective: The aim of the study was to analyze the effectiveness of the day 3 ET strategy, and the morphology of the transferred embryos, in patients from POSEIDON and non-POSEIDON groups. Methods: 600 cycles of patients meeting the POSEIDON criteria and 600 non-POSEIDON cycles were analyzed to determine the proportion of cycles with an ET on days 3 or 5, or FET. Then we reviewed 330 day 3 ETs to compared the developmental stage, morphology, zona pellucida thickness and implantation potential of embryos transferred on day 3 from POSEIDON and non-POSEIDON patients. Results: Most cycles of POSEIDON patients end with ET on day 3 (42%) or without transfer (37%). In contrast, most cycle of non-POSEIDON patients end with FET (44%) and just 9% is canceled. The lowest percentage of embryos at the morula stage was recorded in POSEIDON groups III (10%) and IV (9%). The average number of cells in embryos was comparable in all groups. The largest percentage of top-quality embryos (grade A) were in POSEIDON group I (47%) .The highest implantation potential were observed in the non-POSEIDON group <35Y (28%), and in POSEIDON groups I (28%) and III (26%). The highest incidence of miscarriage was recorded in all POSEIDON and non-POSEIDON groups that included patients who were ≥35 years of age. Conclusions: The day 3 ET strategy still seems optimal for POSEIDON patients. The prognosis depends on which Poseidon group the patient is in. The best prognosis is for group I and the worst for group IV.

Objectives: Because the autonomic nervous system is an important determinant in the appearance of atrial fibrillation, we have assessed the role of ventral cardiac denervation for its prevention. Methods: Patients undergoing low-risk coronary artery surgery were enrolled. No routine antiarrhythmic drugs were administered before or after the operation. Ventral cardiac denervation was performed in 207 patients, and 219 patients were used as control subjects. Denervation was performed before cardiopulmonary bypass. The groups were comparable regarding demographic, clinical, and operative variables. The additional time for the denervation was 5 Ϯ 2 minutes, and there were no associated complications. Postoperative atrial fibrillation was present in 15 (7%) patients undergoing ventral cardiac denervation (95% confidence interval, 4%-12%) and in 56 (27%) control subjects (95% confidence interval, 18%-35%). Patients submitted to ventral cardiac denervation had fewer and less severe episodes of atrial fibrillation, and no patient had atrial fibrillation after discharge. Ventral cardiac denervation was the most significant predictor of postoperative atrial fibrillation (odds ratio, 0.42; confidence interval, 0.23-0.78; P ϭ .006). Age of greater than 65 years (odds ratio, 1.67; confidence interval, 0.96-2.9; P ϭ .067) was a highly suggestive predictor. The analysis of the effect of ventral cardiac denervation correlated with the patient's age showed a more pronounced effect in patients younger than 70 years (odds ratio, 0.43; confidence interval, 0.22-0.86; P ϭ .022) Conclusions: Ventral cardiac denervation is a fast and low-risk procedure. Its use significantly reduces the incidence and severity of atrial fibrillation after routine coronary artery bypass surgery. Patients younger than 70 years of age are expected to have a higher success rate than those older than 70 years.

Background Cow&#39;s milk is the most common food allergen in infants and the diagnosis of cow&#39;s milk allergy is difficult, even with the use of several diagnostic tests. Therefore, elimination diets and challenge tests are essential for the diagnosis and treatment of this disorder. The aim of this study is to report the clinical presentation and nutritional status of children evaluated by pediatric gastroenterologists for the assessment of symptoms suggestive of cow&#39;s milk allergy. Methods An observational cross-sectional study was performed among 9,478 patients evaluated by 30 pediatric gastroenterologists for 40 days in 5 different geographical regions in Brazil. Clinical data were collected from patients with symptoms suggestive of cow&#39;s milk allergy. The nutritional status of infants (age ≤ 24 months) seen for the first time was evaluated according to z-scores for weight-for-age, weight-for-height, and height-for-age. Epi-Info (CDC-NCHS, 2000) software was used to c...

We have reviewed the results of 106 intertrochanteric osteotomies performed for osteonecrosis of the femoral head. The average age at operation was 47.5 years. At two years from operation 71% of the hips had a clinically satisfactory result and at final follow-up, an average of 8.2 years after operation, 58% continued to have excellent or good rating. Twenty-four hips had needed total replacement or arthrodesis because of pain. Patients aged less than 55 did better than those operated on after that age, and hips with an idiopathic or post-traumatic aetiology did considerably better than alcohol-induced or steroid-induced cases. In view of these findings we believe that in the younger adult, in the absence of metabolic bone disease or advanced joint destruction, intertrochanteric osteotomy should be considered for the treatment of osteonecrosis.

Sex effect on the incubation period of variant Creutzfeldt-Jakob disease (vCJD) disease in human and ME-7 murine models was investigated. In the 167 vCJD cases reported in the United Kingdom as of January 2009, age at onset was significantly lower in female patients (by 2 years) than in male patients after stratification on birth cohort. In C57/Bl6N mice infected with ME-7 scrapie strain, incubation was shorter in female than in male mice. The incubation period increased in castrated male mice after intraperitoneal infection but not after intracerebral inoculation. In the absence of androgen receptors, the incubation period for prion disease increased after intraperitoneal inoculation. In ovariectomized or estrogen receptor a-defective female mice, no effect was observed on the incubation period of mouse prion disease. These results show that androgens influence the prion diseases incubation period after inoculation at a peripheral site.

Feline immunodeficiency virus is a lentivirus of domestic cats that causes significant lifelong infection. Infection with this or similar lentiviruses has been detected in several non-domestic feline species, including African lions (Panthera leo). Although lion lentivirus (FIVple) infection is endemic in certain lion populations in eastern and southern Africa, little is known about its pathogenic effects or its epidemiological impact in free-ranging lions. This report describes the epidemiological investigation of lentivirus positivity of free-ranging lions in the Kruger National Park, South Africa. A nested polymerase chain reaction assay for virus detection was performed on all whole blood samples collected. In addition, serum samples were tested for cross-reactive antibodies to domestic feline lentivirus antigens and to puma lentivirus synthetic envelope peptide antigen. The results were analysed in conjunction with epidemiological data to provide a descriptive epidemiological s...

In a previous survey of Columbia University Public Psychiatry Fellowship alumni, medical directors reported experiencing higher job satisfaction compared to staff psychiatrists. To further this inquiry, the authors conducted an expanded survey among the membership of the American Association of Community Psychiatrists (AACP). We mailed a questionnaire to all AACP members. Respondents categorized their positions as staff psychiatrist, program medical director or agency medical director, and rated their overall job satisfaction. The form also included a number of demographic and job characteristic items. Of 479 questionnaires mailed, a total of 286 individuals returned questionnaires (61%-12 forms were undeliverable). As in our previous survey, medical directors experience significantly higher job satisfaction compared to staff psychiatrists. Program and agency medical directors do not differ significantly. In addition, job satisfaction is strongly and negatively correlated with age f...

and colleagues added the use of CPAP to long-term oxygen therapy and observed differences in long term survival of 71% versus 26%. Recently, Marin et al. have shown that hospitalization rates and mortality from COPD can be mitigated if CPAP is prescribed, compared to those with COPD alone, 6 but the amount of use of CPAP required to achieve optimal outcomes remains unknown. In the present study we reviewed records from a large community-based sample of patients with OSA, COPD, and overlap syndrome to assess the impact of CPAP use and other risk factors on mortality. We hypothesized greater CPAP adherence would reduce mortality in the overlap syndrome. Background: The overlap syndrome, defi ned by concurrent existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), is associated with poor outcomes. From a large outpatient cohort we aimed to defi ne better the risk factors for increased mortality in the overlap syndrome and hypothesized that CPAP adherence would be associated with improved survival in patients with overlap syndrome. Methods: A post hoc analysis from an outpatient database of 10,272 patients from 2007-2010, identifi ed 3,396 patients which were classifi ed in 6 groups; patients both alive or deceased, with the known diagnosis of COPD, OSA, and the overlap of COPD plus OSA. Information regarding their gender, age, pulmonary function, obstructive sleep apnea parameters, and CPAP compliance was collected. A multivariate Cox proportional hazards model was generated for the determinants of mortality. Results: 1,112 COPD patients and 2,284 OSA patients were identifi ed by diagnostic coding and then comprehensive chart review. Of these, 227 patients were identifi ed with the overlap syndrome. From this group, 17 patients (7.4%) died. Multivariate analysis revealed hours of CPAP use and age as independent predictors of mortality (HR 0.71 and 1.14, p < 0.001, 0.002). Greater time on CPAP was associated with reduced mortality; although age did not correlate with CPAP use (p = 0.2), mean age of those with CPAP use < 2 hours per night was signifi cantly higher than those using CPAP > 2 hours per night. Conclusions: From this observational cohort, mortality in the overlap syndrome is impacted by CPAP use. Age is also an independent factor which has a negative association with survival and CPAP usage.

We tested the hypothesis that dopamine D1 and D2 receptor gene (DRD1 and DRD2, respectively) polymorphisms and the development of working memory skills can interact to influence symptom change over 10 years in children with attention‐deficit/hyperactivity disorder (ADHD). Specifically, we examined whether improvements in working memory maintenance and manipulation from childhood to early adulthood predicted the reduction of ADHD symptoms as a function of allelic variation in DRD1 and DRD2. Participants were 76 7–11‐year‐old children with ADHD who were genotyped and prospectively followed for almost 10 years. ADHD symptoms were rated using the Attention Problems scale on the Child Behavior Checklist, and verbal working memory maintenance and manipulation, measured by Digit Span forward and backward, respectively, were assessed at baseline and follow‐up. After correction for multiple testing, improvements in working memory manipulation, not maintenance, predicted reduction of symptoma...