Cost-effectiveness of a clinical medication review in vulnerable older patients at hospital discharge,a randomized controlled trial

International Journal of Clinical Pharmacy - Background Drug-related problems (DRP) following hospital discharge may cause morbidity, mortality and hospital re-admissions. It is unclear whether a...     

Application of the adverse outcome pathway framework to genotoxic modes of action

In May 2017, the Health and Environmental Sciences Institute's Genetic Toxicology Technical Committee hosted a workshop to discuss whether mode of action (MOA) investigation is enhanced through the application of the adverse outcome pathway (AOP) framework. As AOPs are a relatively new approach in genetic toxicology, this report describes how AOPs could be harnessed to advance MOA analysis of genotoxicity pathways using five example case studies. Each of these genetic toxicology AOPs proposed for further development includes the relevant molecular initiating events, key events, and adverse outcomes (AOs), identification and/or further development of the appropriate assays to link an agent to these events, and discussion regarding the biological plausibility of the proposed AOP. A key difference between these proposed genetic toxicology AOPs versus traditional AOPs is that the AO is a genetic toxicology endpoint of potential significance in risk characterization, in contrast to an adverse state of an organism or a population. The first two detailed case studies describe provisional AOPs for aurora kinase inhibition and tubulin binding, leading to the common AO of aneuploidy. The remaining three case studies highlight provisional AOPs that lead to chromosome breakage or mutation via indirect DNA interaction (inhibition of topoisomerase II, production of cellular reactive oxygen species, and inhibition of DNA synthesis). These case studies serve as starting points for genotoxicity AOPs that could ultimately be published and utilized by the broader toxicology community and illustrate the practical considerations and evidence required to formalize such AOPs so that they may be applied to genetic toxicity evaluation schemes. Environ. Mol. Mutagen. 61:114–134, 2020. © 2019 Wiley Periodicals, Inc.     

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study

Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.     

Ethnic differences in risk of acute compulsory admission in Amsterdam, 1996–2005

Purpose  

Several European studies have shown that migrants from non-western countries are at increased risk of psychotic disorders. This study examines how this is reflected in the risk of acute compulsory admission (ACA).     

Albuminuria, but not estimated glomerular filtration rate, is associated with maladaptive arterial remodeling: the Hoorn Study

OBJECTIVE: Arterial remodeling aims to maintain a constant circumferential wall stress (sigmac). A failing remodeling process is associated with stroke. Data on the relationship between chronic kidney disease and arterial remodeling are scarce. METHODS: We investigated the association between a lower glomerular filtration rate (GFR) and microalbuminuria with arterial remodeling of the common carotid artery (CCA) in a population-based study of 806 patients. CCA properties including intima-media thickness and interadventitial diameter (IAD) were assessed. Lumen diameter, circumferential wall tension (CWT), and circumferential wall stress (sigmac) were calculated. GFR was estimated (eGFR) by the Modification of Diet in Renal Disease formula. Albuminuria was expressed as urinary albumin/creatinine ratio. RESULTS: Mean eGFR was 60.3 (+/-10.8) ml/min/1.73 m2; median urinary albumin/creatinine ratio was 0.57 (range 0.10-26.6 mg/mmol). After adjustment for age, sex, glucose tolerance status, and prevalent cardiovascular disease, eGFR was not independently associated with CCA properties. A greater urinary albumin/creatinine ratio (per quartile) was associated with a greater lumen diameter [regression coefficient beta with 95% confidence interval, 0.14 (0.08-0.20; P < 0.01)], IAD [0.15 (0.09-0.21; P < 0.01)], CWT [0.95 (0.52-1.38; P < 0.01)], and sigmac [1.7 (0.5-2.9; P < 0.01)] but not with a greater IMT [0.01 (-0.002-0.02; P = 0.12)]. Additional adjustments for mean arterial pressure, pulse pressure, and eGFR did not change the results. CONCLUSION: Greater albuminuria is independently associated with an increase in lumen diameter and IAD of the CCA. In addition, greater albuminuria is associated with a maladaptive carotid remodeling process as shown by an increase in CWT and sigmac. These findings may explain, why microalbuminuria is associated with a greater risk of cardiovascular disease and especially stroke.     

Diagnostic value of echocardiographic markers for diastolic dysfunction and heart failure with preserved ejection fraction

Heart Failure Reviews - This study aimed to evaluate the diagnostic performance of echocardiographic markers of heart failure with preserved ejection fraction (HFpEF) and left ventricular diastolic...     

Museum specimens reveal loss of pollen host plants as key factor driving wild bee decline in The Netherlands

Evidence for declining populations of both wild and managed bees has raised concern about a potential global pollination crisis. Strategies to mitigate bee loss generally aim to enhance floral resources. However, we do not really know whether loss of preferred floral resources is the key driver of bee decline because accurate assessment of host plant preferences is difficult, particularly for species that have become rare. Here we examine whether population trends of wild bees in The Netherlands can be explained by trends in host plants, and how this relates to other factors such as climate change. We determined host plant preference of bee species using pollen loads on specimens in entomological collections that were collected before the onset of their decline, and used atlas data to quantify population trends of bee species and their host plants. We show that decline of preferred host plant species was one of two main factors associated with bee decline. Bee body size, the other main factor, was negatively related to population trend, which, because larger bee species have larger pollen requirements than smaller species, may also point toward food limitation as a key factor driving wild bee loss. Diet breadth and other potential factors such as length of flight period or climate change sensitivity were not important in explaining twentieth century bee population trends. These results highlight the species-specific nature of wild bee decline and indicate that mitigation strategies will only be effective if they target the specific host plants of declining species.Pollinating insects such as bees play an essential role in the pollination of wild plants (1) and crops (2). However, reported population declines in both wild and managed bees (3–5) have raised concerns about loss of pollination services and triggered interest in identifying the underlying causes for bee decline (6). Land use change and agricultural intensification are major drivers of biodiversity loss in general (7, 8) and are considered the most important environmental drivers of loss of wild bee diversity in particular (6, 9). It is generally believed that these drivers affect bees, which depend on floral resources in both their larval and adult life stages, through repercussions on the availability of floral resources in contemporary anthropogenic landscapes (9–11), but, so far, scientific evidence that loss of floral resources is driving bee decline is lacking. Nevertheless, current strategies to mitigate bee decline focus primarily on enhancing floral resources (12). To prioritize and develop effective mitigation strategies, it is essential to identify the mechanisms underlying bee population trends and assess whether these are mediated by floral resources.Although bees as a group are declining, individual species show more variable responses, with some species declining sharply while others remain stable or even increase under current land use change and agricultural intensification (3, 4, 13). These differential responses can be used to disentangle the effects of floral resource availability from those of other potential factors affecting bee population trends. The proportion of the floral resources in contemporary anthropogenic landscapes that can be used for forage by a bee species depends on its diet breadth and host plant preference, and it may be expected that species that have declined have a narrower diet breadth and prefer host plants that have declined (14, 15). However, diet breadth and host plant preference of bee species is difficult to assess. Presently observed host plant use does not necessarily reflect actual preference, as preferred host plants may have gone locally extinct and bees that have declined may have become restricted in their food choice in their remaining habitats (15). In addition, if host plant use is measured for more individuals of abundant, widespread species than for rare ones, an apparent link between diet breadth and population trend may simply arise as a sampling artifact (16). Furthermore, the relationship between host plant use and population trend may be confounded by species’ rarity prior to the onset of major environmental changes (17), as rarity in itself increases susceptibility to stochastic events (18) and has been shown to be one of the most important factors predicting population decline in various taxa (19–21). Surprisingly, to our knowledge, none of the studies that have so far examined the relationship between diet breadth and/or host plant preference and bee population trends have taken species’ initial rarity into account (e.g., refs. 3, 4, 15, and 22). Other factors, such as body size (4, 23), phenology (4, 22), and sensitivity to climate change (4, 24, 25) may be associated with bee decline as well, and, to date, the relative importance of diet breadth and pollen host plant preference in explaining bee population trends remains unclear.Here we solve this problem by analyzing historical pollen preferences of wild bees (15). Bees are generally more selective in their choice of food plants when foraging for pollen (source of protein and minerals for both larvae and adults) than nectar (source of energy) (26, 27). Distributional changes in plant species from which pollen is collected therefore probably exerts a larger influence on bee populations than changes in nectar plants. We investigate whether and to what extent loss of preferred floral resources drives bee population trends in The Netherlands, one of the most human-modified and intensively farmed countries in the world. Over the course of the twentieth century, agriculture has intensified in The Netherlands (Fig. S1) and the area of seminatural habitat preferred by bees has diminished to only one-fifth of the area at the beginning of the twentieth century (Fig. S2). More than half of the bee species are currently on the national Red List (28). As such, this country is a particularly suitable study area to identify critical factors associated with bee population decline.We assessed pollen host plant use of bee species independently from their population trends by analyzing pollen loads on the bodies of bee specimens that were collected before 1950 (15), before the onset of agricultural intensification in The Netherlands. Altogether, our analysis included trend and trait data of 57 bee species in 10 genera and 4 subfamilies (Table S1). We calculated population trend indices for bee species and their host plants (period 1902–1949 vs. 1975–1999) using extensive national species distribution datasets (13, 29). Linear mixed models, with bee subfamily as a random factor to account for phylogeny, and a multimodel inference approach were used to examine the relationship between bee population trends and pollen host plant use, simultaneously taking into account differences in species’ rarity before the onset of agricultural intensification and other factors that have been proposed to explain bee population trends.