Journals
2012 EN
Evgeniya Antonova · Catherine Rycroft · Christopher S. Ambrose
+2 more
Background Influenza illness in children causes significant clinical and economic burden. Although some European countries have adopted influenza immunisation policies for healthy children, the debate about paediatric influenza vaccination in most countries of the European Union is ongoing. Our aim was to summarise influenza burden (in terms of health outcomes and economic burden) in children in Western Europe via a systematic literature review. Methods We conducted a systematic literature search of PubMed, EMBASE, and the Cochrane Library (1970-April 2011) and extracted data on influenza burden in children (defined as aged ≤ 18 years) from 50 publications (13 reporting laboratory-confirmed influenza; 37 reporting influenza-like illness). Results Children with laboratory-confirmed influenza experienced hospitalisations (0.3%-20%), medical visits (1.7-2.8 visits per case), antibiotic prescriptions (7%-55%), and antipyretic or other medications for symptomatic relief (76%-99%); young children and those with severe illness had the highest rates of health care use. Influenza in children also led to absenteeism from day care, school, or work for the children, their siblings, and their parents. Average (mean or median) length of absence from school or day care associated with confirmed influenza ranged from 2.8 to 12.0 days for the children, from 1.3 to 6.0 days for their siblings, and from 1.3 to 6.3 days for their parents. Influenza negatively affected health-related quality of life in children with asthma, including symptoms and activities; this negative effect was smaller in vaccinated children than in non-vaccinated children. Conclusions Influenza burden in children is substantial and has a significant direct impact on the ill children and an indirect impact on their siblings and parents. The identified evidence regarding the burden of influenza may help inform both influenza antiviral use in children and paediatric immunisation policies in European countries.
Journals
2012 EN
Yan S Kim · Irawan Susanto · Catherine Lazar
+5 more
Background Hepatic hydrothorax is a major pulmonary complication of liver disease occurring in up to 5-10% of patients with cirrhosis. Case presentation We report four observations of the development of pneumothorax ex-vacuo or trapped lung in the setting of hepatic hydrothorax. The diagnosis of trapped lung was made based on the presence of a hydropneumothorax after evacuation of a longstanding hepatic hydrothorax with failure of the lung to re-expand after chest tube placement in three of the four cases. Two patients underwent surgical decortication with one subsequent death from post-operative bleeding. The other two patients remarkably had spontaneous improvement of their “trapped lung” without surgical intervention. Conclusions While pneumothorax ex-vacuo is a known phenomenon in malignant effusions, to our knowledge, it has never been described in association with hepatic hydrothoraces. The pathophysiology of this phenomenon remains unclear but could be related to chronic inflammation with development of a fibrous layer along the visceral pleura.
Journals
2012 EN
Elsa ParotSchinkel · Alexis Descatha · Catherine Ha
+3 more
Background The musculoskeletal disorders in working population represent one of the most worrying work-related health issues at the present time and although the very great majority of available data on the subject focus on musculoskeletal disorders defined by anatomical site, a growing number of studies indicate the low prevalence of disorders strictly confined to a specific anatomical site. The objective of this study was to describe the prevalence and characteristics of multisite musculoskeletal symptoms (multisite MS) in a large French working population. Methods This study was performed on surveillance data of the cross-sectional survey (2002–2005) conducted by a network of occupational physicians in the working population of the Loire Valley region (from 20 to 59 years old). Data concerning MS were collected in the waiting room of the occupational physicians by means of the self-administrated standardized NORDIC questionnaire. Results The study population comprised 3,710 workers (2,162 men (58%) and 1,548 women (42%)) with a mean age of 38.4 years (standard deviation: 10.4 years). The prevalence of MS during the past 12 months was 83.8% with 95% confidence interval of [82.8-85.3] for men and 83.9% [82.0-85.7] for women. The prevalence of subacute MS (lasting at least 30 days) over the past 12 months was 32.8% [30.9-34.8] for men and 37.3% [34.9-39.7] for women. Two-thirds of workers reported MS in more than one anatomical site and about 20% reported MS lasting at least 30 days in more than one anatomical site. The anatomical sites most frequently associated with other MS were the upper back, hip, elbow and neck. The majority of these multisite MS were widespread, involving at least two of the three anatomical regions (upper limb, axial region and lower limb). Conclusions The frequency and extent of multisite MS reported by workers are considerable. Further research must be conducted in this field in order to provide a better understanding of the characteristics and determinants of these multisite MS.
Journals
2012 EN
Kelli D. Allen · Hayden B. Bosworth · Dorothea S Brock
+16 more
Background Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care. Methods / Design One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n = 300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n = 560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed. Discussion Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings. Trial registration NCT01130740 (VA); NCT 01435109 (NIH)
Journals
2012 EN
Pedro Da Silva · Vanessa Eyraud · Maïté Carre-Pierrat
+4 more
Background Because of the increasingly concern of consumers and public policy about problems for environment and for public health due to chemical pesticides, the search for molecules more safe is currently of great importance. Particularly, plants are able to fight the pathogens as insects, bacteria or fungi; so that plants could represent a valuable source of new molecules. Results It was observed that Medicago truncatul a seed flour displayed a strong toxic activity towards the adults of the rice weevil Sitophilus oryzae (Coleoptera), a major pest of stored cereals. The molecule responsible for toxicity was purified, by solvent extraction and HPLC, and identified as a saponin, namely 3-GlcA-28-AraRhaxyl-medicagenate. Saponins are detergents, and the CMC of this molecule was found to be 0.65 mg per mL. Neither the worm Caenorhabditis elegans nor the bacteria E. coli were found to be sensitive to this saponin, but growth of the yeast Saccharomyces cerevisiae was inhibited at concentrations higher than 100 μg per mL. The purified molecule is toxic for the adults of the rice weevils at concentrations down to 100 μg per g of food, but this does not apply to the others insects tested, including the coleopteran Tribolium castaneum and the Sf9 insect cultured cells. Conclusions This specificity for the weevil led us to investigate this saponin potential for pest control and to propose the hypothesis that this saponin has a specific mode of action, rather than acting via its non-specific detergent properties.
British Motor Corporation
Journals
2012 EN
A. Chaikuad · Ewa S. Pilka · Antonio De Riso
+5 more
Backround Aspartyl aminopeptidase (DNPEP), with specificity towards an acidic amino acid at the N-terminus, is the only mammalian member among the poorly understood M18 peptidases. DNPEP has implicated roles in protein and peptide metabolism, as well as the renin-angiotensin system in blood pressure regulation. Despite previous enzyme and substrate characterization, structural details of DNPEP regarding ligand recognition and catalytic mechanism remain to be delineated. Results The crystal structure of human DNPEP complexed with zinc and a substrate analogue aspartate-β-hydroxamate reveals a dodecameric machinery built by domain-swapped dimers, in agreement with electron microscopy data. A structural comparison with bacterial homologues identifies unifying catalytic features among the poorly understood M18 enzymes. The bound ligands in the active site also reveal the coordination mode of the binuclear zinc centre and a substrate specificity pocket for acidic amino acids. Conclusions The DNPEP structure provides a molecular framework to understand its catalysis that is mediated by active site loop swapping, a mechanism likely adopted in other M18 and M42 metallopeptidases that form dodecameric complexes as a self-compartmentalization strategy. Small differences in the substrate binding pocket such as shape and positive charges, the latter conferred by a basic lysine residue, further provide the key to distinguishing substrate preference. Together, the structural knowledge will aid in the development of enzyme-/family-specific aminopeptidase inhibitors.
Journals
2012 EN
Janine Gray · Nuria Navarro-Coy · Sue Pavitt
+13 more
Background According to the UK Adult Dental Health Survey (2009) 15% of adults aged 65–74, 30% aged 75–84 and 47% aged >85 years are edentulous and require complete dentures. Patients’ quality of life and nutrition status are affected by poor dentures. The quality of the dental impression is the most important issue for improving the fit and comfort of new dentures. There is paucity of RCT evidence for which impression material is best for complete dentures construction. This study aims to compare two impression materials for effectiveness and cost effectiveness. Methods/Design IMPROVDENT is a double-blind crossover trial comparing the use of alginate and silicone, two commonly used denture impression materials, in terms of patient preference and cost-effectiveness. Eighty five edentulous patients will be recruited and provided with two sets of dentures, similar in all aspects except for the impression material used (alginate or silicone). Patients will try both sets of dentures for a two-week period, unadjusted, to become accustomed to the feel of the new dentures (habituation period). Patients will then wear each set of dentures for a period of 8 weeks (in random order) during which time the dentures will be adjusted for optimum comfort. Finally, patients will be given both sets of dentures for a further two weeks to wear whichever denture they prefer (confirmation period). Patients will be asked about quality of life and to rate dentures on function and comfort at the end of each trial period and asked which set they prefer at the end of the habituation period (unadjusted denture preference) and confirmation period (adjusted denture preference). A health economic evaluation will estimate incremental cost-effectiveness ratios of producing dentures from the two materials. A qualitative study will investigate the impact of dentures on behaviour and quality of life. Funding: IMPROVDENT is funded by NIHR RfPB (PB-PG-0408-16300). Discussion This trial aims to provide evidence on the costs and quality of dentures cast from two different commonly used impression materials; the intention is to significantly impact on the quality of denture production within NHS dentistry. Trial Registration ISRCTN Register: ISRCTN01528038 UKCRN Portfolio ID: 8305
Journals
2012 EN
Elizabeth A Kandel · Jenna M Richards · Catherine J. Binkley
Background Untreated dental caries afflicts almost one third of school-aged children in the United States and many of them are from disadvantaged families. This cross-sectional study was undertaken to investigate the prevalence of untreated caries in north central Kentucky, USA and to examine the relationships between the available demographic variables and untreated childhood caries as reported on the forms from the Smile Kentucky! program. Methods During the fall of 2008, caries status was assessed during the visual oral screening examination component of “SmileKentucky!”– a model of the American Dental Association’s Give Kids A Smile program. Parents had completed brief surveys concerning 3,488 elementary school children aged 5 to 13 years who participated in the program. A secondary analysis was conducted using univariate, bivariate and multivariate statistical methods. Results Untreated caries was reported in 33% of children. Bivariate and logistic regression analyses found that the most significant risk factors for having untreated caries were living in the metropolitan Louisville, Kentucky area, not having had a dental visit in the previous 3 years and not having any form of dental insurance. Conclusions Untreated caries in elementary school children is prevalent in north-central Kentucky despite efforts to improve access to care. The results suggest that additional family and community preventive initiatives are needed to reduce the development of childhood caries in this area of the United States.
Journals
2012 EN
Ivor G. Chestnutt · Barbara Chadwick · Simon Hutchings
+14 more
Background Dental caries remains a significant public health problem, prevalence being linked to social and economic deprivation. Occlusal surfaces of first permanent molars are the most susceptible site in the developing permanent dentition. Cochrane reviews have shown pit and fissure sealants (PFS) and fluoride varnish (FV) to be effective over no intervention in preventing caries. However, the comparative cost and effectiveness of these treatments is uncertain. The primary aim of the trial described in this protocol is to compare the clinical effectiveness of PFS and FV in preventing dental caries in first permanent molars in 6-7 year-olds. Secondary aims include: establishing the costs and the relative cost-effectiveness of PFS and FV delivered in a community/school setting; examining the impact of PFS and FV on children and their parents/carers in terms of quality of life/treatment acceptability measures; and examining the implementation of treatment in a community setting. Methods/design The trial design comprises a randomised, assessor-blinded, two-arm, parallel group trial in 6–7 year old schoolchildren. Clinical procedures and assessments will be performed at 66 primary schools, in deprived areas in South Wales. Treatments will be delivered via a mobile dental clinic. In total, 920 children will be recruited (460 per trial arm). At baseline and annually for 36 months dental caries will be recorded using the International Caries Detection and Assessment System (ICDAS) by trained and calibrated dentists. PFS and FV will be applied by trained dental hygienists. The FV will be applied at baseline, 6, 12, 18, 24 and 30 months. The PFS will be applied at baseline and re-examined at 6, 12, 18, 24, and 30 months, and will be re-applied if the existing sealant has become detached/is insufficient. The economic analysis will estimate the costs of providing the PFS versus FV. The process evaluation will assess implementation and acceptability through acceptability scales, a schools questionnaire and interviews with children, parents, dentists, dental nurses and school staff. The primary outcome measure will be the proportion of children developing new caries on any one of up to four treated first permanent molars. Discussion The objectives of this study have been identified by the National Institute for Health Research as one of importance to the National Health Service in the UK. The results of this trial will provide guidance on which of these technologies should be adopted for the prevention of dental decay in the most susceptible tooth-surface in the most at risk children. Trial registrations ISRCTN ref: ISRCTN17029222 EudraCT: 2010-023476-23 UKCRN ref: 9273
Journals
2012 EN
Lesley Braun · Catherine Stanguts · Lisa Casanelia
+4 more
Purpose The primary aim of the study was to determine the effects of massage therapy, delivered to post-surgery cardiothoracic patients, on pain, anxiety, relaxation and muscular tension at two different time points and compare it to an equivalent period of rest time. The secondary aims were to explore the effects of massage on heart rate, respiratory rate and blood pressure, feasibility of treatment delivery in a busy ward and staff acceptance of the new therapy and therapists. Methods A randomised study conducted at the Alfred hospital compared massage therapy to an equivalent period of rest time. Visual analogue scales measured pain, anxiety, relaxation, muscular tension and satisfaction. Heart rate, respiratory rate and blood pressure were measured preand post-treatment by a cardiac nurse. Focus groups, staff and therapist feedback were utilised to collect qualitative data about clinical significance and feasibility of delivering the treatment. Results One hundred and fifty-two (99% response rate) patients participated. Compared to rest time, massage therapy produced a significantly greater reduction in pain (p=0.001), anxiety (p<0.0001), muscular tension (p=0.002) and increases in relaxation (p<0.0001) and satisfaction (p=0.016). No significant differences were seen for heart rate, respiratory rate and blood pressure. The effects at different time points were also compared between the groups. Pain significantly reduced after massage on day 3/4 (p<0.0001) and day 5/6 (p=0.003) whereas controls experienced no significant change at either time point. At both time points, massage significantly reduced anxiety (p<0.0001) and muscular tension (p<0.0001). Relaxation significantly improved on day 3/4 for both groups (massage p<0.0001; rest time p=0.006) but only massage was effective on day 5/6 (p<0.0001). Nurses and physiotherapists confirmed patient improvements and helped facilitate delivery of the treatment. Conclusion Post-surgery massage therapy significantly improved pain, anxiety, muscular tension and relaxation amongst cardiothoracic surgery patients, was well accepted and feasible to deliver.