Is treatment adherence associated with better quality of life in children with sickle cell disease?

The association of treatment adherence with quality of life (QOL) and the role of sickle cell disease complications were explored in children with sickle cell disease. Primary caregivers of 43 children, ages 5 years and older, and 21 children, ages 8 years and older, completed a standardized measure of QOL during an admission for pain or fever to the hematology acute care unit. Adherence was measured through medical staff ratings, caregiver-report of sickle cell disease-related care activities, and matching of medical staff standard recommendations for treatment of pain and fever with sickle cell disease-related care activities. Sickle cell disease complications were assessed via medical file review. Pearson correlation coefficients indicated that better adherence was associated with poorer overall QOL. In follow-up analyses, although sickle cell disease complications were associated with adherence, it did not explain the negative correlation of adherence with QOL. Higher treatment adherence may interfere with activities that contribute to QOL for some children. Further research to investigate the role of sickle cell disease complications, as well as psychosocial factors, in determining both treatment adherence and QOL is suggested.     

Does race influence the provision of care to persons with sickle cell disease? Perceptions of multidisciplinary providers

This study examined whether multidisciplinary health care providers (HCPs) perceived race of persons with sickle cell disease (SCD) as an influence in the delivery of health care. A total of 227 multidisciplinary HCPs completed the three-item Influence of Patient Race on Provision of Health Care Services Index (Cronbach's alpha = 0.77). Results suggest that African American HCPs were more likely to perceive race as an influence along all scale items, whereas Caucasian and other race HCPs did not. Female HCPs and those who serve adults were more likely than male HCPs and those who serve children to perceive race as having an influence on the quality of health care. Findings suggest a need for the examination of the health care delivery systems in which persons with SCD receive care to determine if race does, in fact, affect the delivery of health care and to explain the discrepancies in the perceptions of the HCPs.     

Assessing responsiveness over time of the PROMIS® pediatric symptom and function measures in cancer,nephrotic syndrome,and sickle cell disease

Quality of Life Research - Previous studies provided evidence for the validity of the PROMIS Pediatric measures in cross-sectional studies. This study evaluated the ability of the PROMIS Pediatric...     

A stem cell ... is stem cell?

We are used to associate stem cells with renewable tissues such as blood, gut and skin. But some cells in the adult central nervous system have the capacity to generate new neurons and glial cells as well and as such, they are considered to be neural stem cell. Yet their ability to generate neurons and glia, and their presence in the central nervous system throughout life, suggests new, intriguing possibilities for recovery and repair after damage to the central nervous system--and unexpectedly, the regeneration of blood tissues. After transplantation into irradiated hosts, neural stem cells were found to produce a variety of blood cell types including myeloid and lymphoid cells as well as early hematopoietic cells. Therefore, the developmental potential of stem cells is not restricted to the differentiated elements of the tissue in which they reside. Multipotential stem cells can persist in an undifferentiated state, and depending on specific environmental conditions function as a stem cell for many different tissues.     

The readiness of German GPs to recommend and conduct cancer screening is associated with patient–physician gender concordance. Results of a survey

Background: Cancer screening participation rates in Germany differ depending on patients’ gender. International studies have found that patient–physician gender concordance fosters recommendation and conducting of cancer screening, and especially cancer screening for women.

Objectives: We aimed to ascertain whether gender concordance influences general practitioners' (GPs’) rating of the usefulness of cancer screening, as well as their recommendations and readiness to conduct cancer screening in general practice in Germany.

Methods: For an exploratory cross-sectional survey, 500 randomly selected GPs from all over Germany were asked to fill in a questionnaire on cancer screening in general practice between March and June 2015. We asked them to rate the usefulness of each cancer screening examination, how frequently they recommended and conducted them and whether they viewed GPs or specialists as responsible for carrying them out. We used multiple logistic regression to analyse gender effect size by calculating odds ratios.

Results: Our study sample consisted of 139 GPs of which 65% were male. Male and female GPs did not differ significantly in their rating of the general usefulness of any of the specified cancer screening examinations. Male GPs were 2.9 to 6.8 times as likely to consider GPs responsible for recommending and conducting PSA testing and digital rectal examinations and were 3.7 to 7.9 times as likely to recommend and conduct these examinations on a regular basis.

Conclusion: Patient–physician gender concordance made it more likely that male-specific cancer screenings would be recommended and conducted, but not female-specific screenings.

KEY MESSAGES

• Male GPs are more likely than female GPs to view GPs as responsible for recommending and conducting male-specific cancer screening.

• Men consult urologists less frequently than women consult gynaecologists, so male GPs seem to take on the role of ‘doctor for men’.

     

Occupational imbalance and the role of perceived stress in predicting stress-related disorders

Background: Stress-related disorders are the main reason for sick leave in many European countries. The aim of the present study was to explore whether perceived occupational imbalance predicts stress-related disorders, potential gender differences, and to explore the mediating role of perceived stress.

Method: Longitudinal data on 2223 employees in a public organization in Sweden were collected by surveys, and analyzed by logistic regression.

Results: Occupational imbalance predicted stress-related disorders among both women and men. However, what aspects of occupational imbalance which predicted stress-related disorders differ by gender. Perceived stress was not a mediator in these associations.

Conclusion and significance: How women and men perceived their occupational balance affected the risk of stress-related disorders. The results may be used to develop effective strategies to decrease stress-related disorders.     

Ethnicity questions and antenatal screening for sickle cell/thalassaemia [EQUANS] in England: a randomised controlled trial of two questionnaires

Concepts allied to ethnicity are increasingly coming under question as legitimate variables for use in health research. A randomised controlled trial of two ethnicity screening questions for ascertaining risk of carrying genes associated with sickle cell and thalassaemia illustrates the challenges and limitations of assessing an association of social constructs and genetic statuses.

Objectives . To evaluate two candidate ethnicity screening questions in antenatal screening programmes in low, mixed and high sickle cell prevalence areas, and to identify time taken in administration of the questions by use of the following measures:

1. Proportions of respondents with missing ethnicity data and/or significant changes in ethnic/family origins upon re-interview.

2. Numbers of carriers of clinically significant haemoglobin disorders missed by ethnicity screening questions.

3. Time taken to explain screening question for sickle cell disease (SCD)/thalassaemia and obtain ethnic/family origins.

4. Proportion of clients providing usable ethnic/family origins data.

5. Reported ethnic/family origins in pregnant women at first booking with midwife.

Design . Ten-month (September 2002–June 2003) questionnaire study with random allocation to two self-administered ethnicity questions, comparison with laboratory results and results from re-interview. The settings were antenatal booking clinics in four geographical areas of England of varying expected foetal prevalence of SCD: very high (29.75 per 10,000 pregnancies); high (8.2); mixed high and low (1.29); and low (0.18). The subjects were 4,559 pregnant women at first booking with midwife.

Results . Proportions of respondents with missing ethnicity data and/or significant changes in ethnic/family origins upon re-interview were 4.33% (CI 2.63–6.68%) for a category-based question and 9.45% (CI 6.86–12.61%) for a binary plus open-ended question. Proportions of carriers missed were 5.74% (CI 2.34–11.46%) and 9.71% (CI 4.75–17.13%) by category-based and binary plus open-ended questions, respectively. Average time taken to ascertain ethnic/family origins for screening was between 2.17 and 5.12 minutes in different areas, and up to 15 minutes at the 95th centile. Usable ethnicity screening data was missing in 2.94% of instances. Errors in interpretation or missing data were 3.2% for a category-based question and 4.71% for a binary plus open-ended ethnicity question. Ethnicity Question A produces fewer cases of missing or misinterpreted data (p < 0.001).

Conclusions . A category-based ethnicity screening question was more effective than a binary plus open-ended question. Using the more effective question, 5.74% (CI 2.34–11.46%) of significant haemoglobinopathies will be missed in a selective screening programme, and 4.33% (CI 2.63–6.68%) of replies to an ethnicity screening question will be unreliable when compared to information given upon re-interview. In specific carefully circumscribed situations, namely, in antenatal screening for sickle cell and thalassaemia, it is possible to measure the degree of association between social constructs of ethnicity and health status in a manner that may help in effecting policy decisions.     

Rodent control in urban communities in Johannesburg,South Africa: from research to action

Introduction:

Rodents are troublesome urban pests, with potentially serious health implications. Preventive efforts require greater understanding of social contexts in which they are prevalent. This study aimed to determine rodent prevalence and identify factors associated with rodent infestations in urban residential settings.

Methods:

The Health, Environment and Development study is a longitudinal panel study conducted in five settlements across Johannesburg. Data on socio-economic status, domestic behaviour and housing quality are collected annually. Logistic regression revealed risk factors for rodent prevalence at household level.

Results:

Rodents are a major household problem in all study areas (prevalence 54%). Factors associated with increased prevalence of rats included lower income, living in informal areas, overcrowding, cracks in dwelling walls and internal damp.

Conclusion:

Socio-economic status, housing quality, domestic behaviour and environmental health services are associated with exposure to rodents in urban Johannesburg communities. This information served as a platform to launch rodent awareness campaigns at study sites.     

Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women

Objective. To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.

Design. Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.

Participants. A total of 70 married Somali women aged 18–50 and mother of 2–10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.

Settings. Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.

Results. Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.

Conclusions. The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.     

Acute toxicological effects of zinc oxide nanoparticles in mice after intratracheal instillation

Background: Zinc oxide nanoparticles (ZnO NPs) are increasingly being used in industry.

Objective: To evaluate the acute toxicology of ZnO NPs in Mice.

Methods: ZnO NPs were intratracheally instilled into mice at different dose (200, 400, 800 μg/kg), which was 1, 2, or 4 times of accumulative intake in one week according to the threshold limit value. Acute toxicity was assessed by animal mortality, organ/body weight ratios, hematology, blood biochemistry, and histopathology as well as by the determination of cells, proteins, and lactate dehydrogenase activity in bronchoalveolar lavage fluid.

Results: Exposure to ZnO NPs also resulted in bodyweight loss and a higher level of total cell number, total protein, and hydroxyproline content in BALF. Nitric oxide and malondialdehyde levels in the lung homogenates were also increased. In addition, inflammatory and hyperplastic changes in the lungs were observed.

Conclusion: Threshold limit value (5 mg/m³) may unfit for ZnO NPs.     

Ethnicity, genetics, and breast cancer: media portrayal of disease identities

Design

Results

Conclusions

To describe, compare, and analyze how the risk of breast cancer is framed in newspapers directed towards an ethnic minority population (Jewish) with higher risk of inherited breast cancer compared with newspaper coverage for the general population (Anglo-Canadian) without this risk.

This investigation utilized a mixed methods (quantitative and qualitative) approach. The design emphasized a content analysis conducted on ethnically specific and non-ethnic newspaper articles.

It is noteworthy that the ‘Jewish’ newspapers devote a substantially larger proportion of articles on breast cancer to genetic risk as the key risk factor for this disease. Articles in the Jewish newspapers tend to link being a Jewish woman with being at risk for a diagnosis of breast cancer. This ethnic ‘identity’ is reinforced through the repeated association of Jewish heritage and genetic breast cancer risk at the exclusion of other known risk factors. This isolated genetic link to breast cancer is not a message that is replicated within the provincial newsprint articles.

These findings assist in the facilitation of prevention and treatment of those with or at risk of breast cancer. The health policy implications of this portrayal as well as suggestions for change are considered.     

Effect of Different Obesity Phenotypes on Incidence of Chronic Kidney Disease in Tehranian Adults

Background: The aim of this community-based study is to ascertain the effect of different obesity phenotypes on the incidence of chronic kidney disease in Iranian adults.

Study Design: A prospective cohort study, the Tehran Lipid Glucose Study (TLGS).

Setting and Participants: Adults aged ≥ 20 years with a mean age of 40.38 years (54.8% female) who were free from chronic kidney disease (CKD) at baseline (phase 1) and were followed up at 3 time stages (phases 2, 3, and 4) for a mean duration of 9.4 years to assess the risk for CKD.

Predictor: Obesity phenotypes.

Outcome: Incidence of chronic kidney disease.

Measurements: Glomerular filtration rate (GFR) was estimated from the simplified equation developed using data from the Modification of Diet in Renal Disease (MDRD) Study.

Results: CKD events occurred in 1162 participants. The prevalence of the 2 known obesity phenotypes (metabolically obese normal weight [MONW] and metabolically healthy but obese [MHO]) in the overall population was 3.5% and 8.8%, respectively. According to Kaplan-Meier curves, rates of freedom from CKD in the MHO and MONW obesity phenotypes were 75.3% and 60.6%, respectively (p < 0.0001). Age- and sex-adjusted (model 1) hazard ratios for participants with MHO or MONW obesity phenotype were 1.14 (95% confidence interval [CI], 0.91–1.43) and 1.43 (95% CI, 1.09–1.88), respectively. After further adjustment for confounder variables (model 2), multivariate-adjusted hazard ratios for CKD for participants with MHO or MONW obesity phenotypes were 1.23 (95% CI, 0.93–1.62) and 1.43 (95% CI, 1.08–1.90), respectively.

Conclusion: Adults with the MONW obesity phenotype compared to those with MHO obesity phenotype have a higher risk for incidence of CKD. The results indicate that having a normal weight is not the only factor to protect against incidence of CKD.