Effect of personality traits on rehabilitation effect after anterior cruciate ligament reconstruction: An observational study

BackgroundAnterior cruciate ligament (ACL) reconstruction requires an extended period of postoperative rehabilitation. Psychological factors can affect recovery after surgery. Study of psychological factors is still limited to self-motivation, fear and pain. Study of personality traits associated with early rehabilitation outcome after ACL reconstruction is scarce.ObjectiveWe aimed to explore the effect of personality traits on early rehabilitation after ACL reconstruction and provide a reference for clinicians in designing a personalized rehabilitation plan.MethodsThis prospective analysis investigated 155 patients at 3 and 6 months after ACL reconstruction. Follow-up involved administration of a general data questionnaire, the Chinese Big Five Personality Inventory Brief Version, the Tegner activity score, the International Knee Documentation Committee Subjective Knee Score, the Knee injury and Osteoarthritis Outcome Score, the Lysholm Score and a balance test.ResultsAmong the 155 patients included (124 males), Neuroticism was negatively correlated with subjective knee scores at 3 and 6 months after surgery (p<0.001). The odds of a poor balance test result was increased for each 1-point increase in Neuroticism score (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.28–2.36, p<0.001). We found a positive correlation between Conscientiousness score and subjective knee scores at 3 and 6 months after surgery (p<0.001). For every 1-point increase in Conscientiousness score, the odds of a poor balance test result were decreased (OR 0.29, 95% CI 0.16–0.54, p<0.001). Agreeableness and Openness to experience scores were positively correlated with subjective knee scores at 3 and 6 months after surgery (p<0.001). We found no correlation between Extraversion and subjective knee scores at 3 and 6 months after surgery (p>0.05) but a positive correlation with the Tegner activity score at 3 and 6 months after surgery (p<0.05).ConclusionWe found a significant correlation between the Big Five personality dimensions and the early rehabilitation effect after ACL reconstruction, which can provide a reference for clinicians in designing a personalized rehabilitation plan.     

Biological variability of blood omega-3 biomarkers

ObjectivesWe conducted a pilot study to estimate the biological variability and effects of a prior meal on the omega-3 fatty acid (FA) content of 3 blood FA pools.Design and methodsWe measured FA levels in red blood cells (RBCs), plasma and plasma phospholipids (PL) obtained from 20 healthy volunteers tested weekly over 6 weeks.ResultsThe within-subject coefficients of variation were 4.1% ± 1.9%, 15.9% ± 6.4%, and 14.5% ± 8.4%, respectively (RBC vs. others, p < 0.001). RBC omega-3 FA content had the lowest biological variability and was not altered in the fed state.ConclusionsFrom the perspective of variability and of the sample types tested, RBCs may be the preferred sample type for assessing omega-3 FA status.     

Prevalence,Severity, and Correlates of Sleep-Wake Disturbances in Long-Term Breast Cancer Survivors

ContextCurrent evidence shows that sleep-wake disturbances are a persistent problem linked to poor quality of life in women surviving breast cancer. Information regarding correlates of sleep-wake disturbances in long-term survivors is sparse.ObjectivesThe objective of this study was to refine knowledge regarding prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors (BCS) compared with age-matched women without breast cancer (WWC).MethodsThe cross-sectional convenience sample included 246 BCS and 246 WWC who completed a quality-of-life study and were matched within ±5 years of age.ResultsBCS were a mean of 5.6 years beyond completion of cancer treatment (range = 5.6–10.0 years). Based on Pittsburgh Sleep Quality Index (PSQI) scores, BCS had significantly more prevalent sleep-wake disturbances (65%) compared with WWC (55%) (P < 0.05). BCS also had significantly higher PSQI global scores indicating poorer sleep quality compared with WWC (P < 0.05). Significant correlates of prevalence of poor sleep for BCS included hot flashes, poor physical functioning, depressive symptoms, and distress, and for WWC, these included hot flashes, poor physical functioning, and depressive symptoms. Significant correlates (P < 0.05) of severity of poor sleep for BCS included presence of noncancer comorbidities, hot flashes, depressive symptoms, and residual effects of cancer treatment. For WWC, these included hot flashes, poor physical functioning, depressive symptoms, and impact of a life event.ConclusionKnowledge of prevalence, severity, and correlates of sleep-wake disturbances provides useful information to health care providers during clinical evaluations for treatment of sleep-wake disturbances in BCS.     

Efficacy of low‐calorie,partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: a double‐blind,randomised controlled trial of two diet plans – one high in protein and one nutritionally balanced

Background: Little is known about the relative efficacy of high‐protein vs. conventional diet plans that include partial meal replacements on body fat loss in obese subjects with metabolic syndrome. Objective: We aimed to evaluate the efficacy of two low‐calorie diets with partial meal replacement plans–a high‐protein plan (HP) and a nutritionally balanced conventional (C) plan–on reducing obesity in obese subjects with metabolic syndrome. Design: In a 12‐week, double‐blind study, we randomised 75 participants to either the HP‐ or the C‐plan group. We recorded key metrics at 0 and 12 weeks. Results: The overall mean weight loss was 5 kg in the HP‐plan group and 4.9 kg in the C‐plan group (p = 0.72). Truncal fat mass decreased 1.6 kg in the HP‐plan group (p < 0.05) and 1.5 kg in the C‐plan group (p < 0.05), while whole body fat mass decreased 2.5 kg in the HP‐plan group (p < 0.05) and 2.3 kg in the C‐plan group (p < 0.05). Between‐group losses did not differ significantly for truncal (p = 0.52) or whole body (p = 0.77) fat mass. Among subjects with ≥ 70% dietary compliance, however, truncal and whole body fat mass decreased more in the HP‐plan group (Δ2.2 kg and Δ3.5 kg respectively) than in the C‐plan group (Δ1.5 kg and Δ1.9 kg respectively) (p < 0.05). Conclusion: The HP‐ and C‐plans had a similar effect on weight and abdominal fat reduction, but the HP‐plan was more effective in reducing body fat among compliant subjects.     

Impact of radiotherapy and chemotherapy on biomarkers of oxidative DNA damage in lung cancer patients

ObjectivesTo assess oxidative damage to DNA during lung cancer (LC) treatments.Design and methodsUrinary levels of 8-oxoguanine (8-oxoGua) and levels of 8-oxo-2′-deoxyguanosine (8-oxodG) from urine and whole blood were determined in 36 non-cancer controls and 65 LC patients before any treatments. Samples were also obtained of LC patients during and after radiotherapy (RT, n = 33) and chemotherapy (CT, n = 16).ResultsStage IV LC patients had higher urinary 8-oxoGua and 8-oxodG levels than patients with stage I–III disease (p = 0.044 and p = 0.034, respectively). Urinary 8-oxodG levels increased during the first week of RT (p < 0.001). Nuclear 8-oxodG increased during RT and 3 months after start of RT. Nuclear 8-oxodG levels also rose between the first two CT cycles (p = 0.043), and urinary 8-oxodG levels during the sixth CT cycle (p = 0.009).ConclusionsUrinary DNA damage biomarker levels may be associated with LC stage. Both RT and CT increase the parameters of DNA oxidation.     

Efectividad de un programa de mejora para la calidad de los registros enfermeros en ginecología y obstetricia

ObjectivesTo evaluate the effect of a program to improve nursing documentation on the quality and quantity of the nursing records in the Obstetrics and Gynecology Units of the Hospital Clínico San Carlos (Madrid, Spain).MethodA quasi-experimental, pretest-posttest study was performed. The medical records of patients in the Obstetrics and Gynecology Unit were analyzed. The intervention was developed from January to May, 2005. The medical records of discharged patients were evaluated from January to December 2004 and from January to May 2005. In addition, the medical records of 50% of the patients admitted in December 2004 and June 2005 were randomly selected and audited. The variables analyzed were: 1) the number of records with a nursing discharge report, nursing care plan, and evaluation of the aims set, and 2) the number of nursing care plans and the coherence of these plans.ResultsStatistically significant differences were found in obstetrics (OBS) and gynecology (GYN) in the following variables: “discharge with evaluation of the aims set”: OBS, 2004 (20.6%), 2005 (57.6%), p < 0.001; GYN, 2004 (14.4%) and 2005 (54.6%), p < 0.001; “patients discharged with nursing care plans”: OBS, 2004 (95.5%), 2005 (98.8%), p < 0.001; GYN, 2004 (84.2%), 2005 (88.8%), p < 0.001; “coherence of the nursing care plan”: OBS, December 2004 (15.4%), June 2005 (93.7%), p < 0.001; GYN, December 2004 (28,6%), June 2005 (73%) p < 0.02.ConclusionsThe intervention was effective. Variables indicating quality (discharge with evaluation of the aims set and coherence of the nursing care plan) were significantly increased. The number of patients discharged with a nursing care plan also increased.     

Does Omega-3 Fatty Acid Supplementation Have Favorable Effects on the Lipid Profile in Postmenopausal Women? A Systematic Review and Dose–response Meta-analysis of Randomized Controlled Trials

PurposeMenopause is associated with disturbances in the metabolism of lipids. Moreover, during the postmenopausal period, female subjects are more prone to develop dyslipidemia. Omega-3 fatty acids, which exert cardioprotective, anti-inflammatory, and lipid-lowering actions, are commonly recommended in postmenopausal women. However, their effect on serum lipids in this population remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to clarify this research question.MethodsWe systematically searched the Web of Science, Scopus, PubMed/MEDLINE, and EMBASE databases from their inception until January 3, 2022. The DerSimonian and Laird random-effects model was used to combine effect sizes.FindingsOmega-3 fatty acid supplementation resulted in a decrease in triglyceride concentrations (weighted mean difference [WMD], –17.8 mg/dL; 95% CI, –26 to –9.6; P < 0.001), particularly in the RCTs that lasted ≤16 weeks (WMD, –18.6 mg/dL), when the baseline triglyceride concentrations were ≥150 mg/dL (WMD, –22.8 mg/dL), in individuals with a body mass index ≥30 kg/m² (WMD, –19.3 mg/dL), and when the dose of omega-3 fatty acids was ≥1 g/d (WMD, –21.10 mg/dL). LDL-C (WMD, 4.1 mg/dL; 95% CI, 1.80 to 6.36; P < 0.001) and HDL-C (WMD, 2.1 mg/dL; 95% CI, 0.97 to 3.2; P < 0.001) values increased. Total cholesterol levels (WMD, –0.15 mg/dL; 95% CI, –4 to 3.74; P = 0.94) remained unchanged after administration of omega-3 fatty acids.ImplicationsIn postmenopausal women, supplementation with omega-3 fatty acids resulted in a significant reduction in triglyceride concentrations and a modest elevation in HDL-C and LDL-C levels, whereas this intervention did not affect total cholesterol values.     

Intra- and Inter-Examiner Reliability of the Viladot Method in Children

ObjectiveThe aim of this study was to evaluate the interexaminer and intraexaminer reliability of classification with the Viladot method of plantar impression obtained by means of a footprinting mat.MethodsFootprints were taken from 40 participants using a footprinting mat. The images were subjected to analysis by 3 independent examiners. To investigate intraexaminer reliability, the analysis was repeated by 1 of the examiners 1 week later.ResultsExcellent intraexaminer reliability was found (κ = 1.0; 95% confidence interval [CI], 0.77-1.0; P < .00). For interexaminer reliability, in the right foot high concordance was found for typical feet (κ_p = 0.76; 95% CI, 0.58-0.93; P < .00) and excellent concordance for cavus feet and flat feet (respectively: κ_p = 0.86; 95% CI, 0.68-1.0; P < .00; and κ_p = 0.81; 95% CI, = 0.63-0.99; P < .00). In the left foot high concordance was observed between the 3 evaluators for typical feet and cavus feet (respectively: κ_p = 0.75; 95% CI, 0.57-0.93; P < .00; and κ_p = 0.69; 95% CI, 0.51-0.87; P < .00) and excellent concordance for flat feet (κ_p = 1.0; 95% CI, 0.82-1.0; P < .00).ConclusionThe Viladot method is reliable for analyses involving 1 or more examiners, presenting excellent intraexaminer reliability and high to excellent interexaminer reliability. The Viladot method is a reliable (replicable and consistent) instrument, that is, its repeated application to the same subject produces similar results.     

Impact of chronic liver disease in intensive care unit acquired pneumonia: a prospective study

Purpose

To assess the impact of chronic liver disease (CLD) on ICU-acquired pneumonia.

Methods

This was a prospective, observational study of the characteristics, microbiology, and outcomes of 343 consecutive patients with ICU-acquired pneumonia clustered according to the presence of CLD.

Results

Sixty-seven (20 %) patients had CLD (67 % had liver cirrhosis, LC), MELD score 26 ± 9, 20 % Child–Pugh class C). They presented higher severity scores than patients without CLD both on admission to the ICU (APACHE II, LC 19 ± 6 vs. other CLD 18 ± 6 vs. no CLD 16 ± 6; p < 0.001; SOFA, 10 ± 3 vs. 8 ± 4 vs. 7 ± 3; p < 0.001) and at onset of pneumonia (APACHE II, 19 ± 6 vs. 17 ± 6 vs. 16 ± 5; p = 0.001; SOFA, 11 ± 4 vs. 9 ± 4 vs. 7 ± 3; p < 0.001). Levels of CRP were lower in patients with LC than in the other two groups (day 1, 6.5 [2.5–11.5] vs. 13 [6–23] vs. 15.5 [8–24], p < 0.001, day 3, 6 [3–12] vs. 16 [9–21] vs. 11 [5–20], p = 0.001); all the other biomarkers were higher in LC and other CLD patients. LC patients had higher 28- and 90-day mortality (63 vs. 28 %, p < 0.001; 72 vs. 38 %, p < 0.001, respectively) than non-CLD patients. Presence of LC was independently associated with decreased 28- and 90-day survival (95 % confidence interval [CI], 1.982–17.250; p = 0.001; 95 % confidence interval [CI], 2.915–20.699, p = 0.001, respectively).

Conclusions

In critically ill patients with ICU-acquired pneumonia, CLD is associated with a more severe clinical presentation and poor clinical outcomes. Moreover, LC is independently associated with 28- and 90-day mortality. The results of this study are important for future trials focused on mortality.     

Physical training combined with dietary measures in the treatment of adult obesity. A comparison of two protocols

ObjectiveOur objective was to study the effects of physical training combined with dietary measures in obese adults. In a second step, we sought to compare two training protocols and establish the additional contribution of strength training.MethodsWe performed a randomized, prospective survey from July 2004 to November 2007. Included patients were randomized into three groups: a control group (G1), a group (G2) performing dietary measures and a programme of treadmill training at 60% of each individual's maximum heart rate (HR_max) and a group (G3) who followed the G2 programme supplemented with strength training. All patients underwent an initial and final assessment of anthropometric & cardiovascular parameters, muscle strength, dyspnoea during activities of daily living, metabolic disorders, psychological status and quality of life.ResultsThe greatest weight loss (7.24%) was observed in G3. Reduction in waistline measurement (WL) of 4.3% and 10.26% were noted in G2 and G3, respectively (p < 0.001). The percentage fat body mass fell by 10.4% in G3 (p < 0.001) and 8.6% in G2 (p = 0.03). We particularly noted an improvement in physical condition in groups 2 and 3, with lower HR and blood pressure values at rest and at maximum effort. The overall improvement in both arm and leg muscle strength was greater for G3 than for G2. Likewise, we noted an improvement in the metabolic parameters and depression & anxiety scores for the trained groups (G2, G3), relative to the control group (G1). We also noted improvements in the total impact of weight on quality of life (IWQOL) lite score of 15.2% in G2 and 18% in G3.ConclusionOur survey demonstrated the beneficial effect of combining dietary measures and physical training in obese patients. In addition to weight loss, the programme enabled a reduction in the patients’ body fat mass and abdominal obesity, a correction of metabolic disorders and an improvement in aerobic capacity. The improvement in all these parameters also enhanced the patients’ psychological status and quality of life. The addition of strength training produced notable improvements in weight loss, arm muscle strength and abdominal obesity.     

Effect of omega-3 supplements on plasma apolipoprotein C-III concentrations: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Apolipoprotein C-III (apo C-III) is a key regulator of triglycerides metabolism. The aim of this meta-analysis was to assess the effect of fish omega-3 polyunsaturated fatty acids (PUFAs) on apo C-III levels.

Methods: Randomized placebo-controlled trials investigating the impact of omega-3 on apo C-III levels were searched in PubMed-Medline, SCOPUS, Web of Science and Google Scholar. A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate the impact of potential confounders on glycemic parameters.

Results: This meta-analysis comprising 2062 subjects showed a significant reduction of apo C-III concentrations following treatment with omega-3 (WMD: ?22.18?mg/L, 95% confidence interval: ?31.61, ?12.75, p?<?.001; I²: 88.24%). Subgroup analysis showed a significant reduction of plasma apo C-III concentrations by eicosapentaenoic acid (EPA) ethyl esters but not omega-3 carboxylic acids or omega-3 ethyl esters. There was a greater apo C-III reduction with only EPA as compared with supplements containing EPA and docosahexaenoic acid (DHA) or only DHA. A positive association between the apo C-III-lowering effect of omega-3 with baseline apo C-III concentrations and treatment duration was found.

Conclusions: This meta-analysis has shown that omega-3 PUFAs might significantly decrease apo C-III.

• Key messages

• Omega-3 PUFA supplements significantly reduce apo C-III plasma levels, particularly in hypertriglyceridemic patients when applied in appropriate dose (more than 2?g/day)

• Triglyceride (TG)-lowering effect is achieved via peroxisome proliferator-activated receptors α

• Further studies should address the effect of omega-3 PUFAs alone or with other lipid-lowering drugs in order to provide a final answer whether apo C-III could be an important target for prevention of cardiovascular disease

• New apo C-III antisense oligonucleotide drug (Volanesorsen) showed to be promising in decreasing elevated TGs by reducing levels of apo C-III mRNA

     

Evolution of practice patterns in the management of acute respiratory distress syndrome: A secondary analysis of two successive randomized controlled trials

PurposeWe sought to examine changes in acute respiratory distress syndrome (ARDS) management over a 12-year period of two successive randomized trials.MethodsAnalyses included baseline data, from eligible patients, prior to influence of trial protocols, and daily study data, from randomized patients, of variables not determined by trial protocols. Mixed linear regressions examined changes in practice year-on-year.ResultsA total of 2376 patients met the inclusion criteria. Over the 12-year period, baseline tidal volume index decreased (9.0 to 7.0 ml/kg, p < 0.001), plateau pressures decreased (30.8 to 29.0 cmH₂O, p < 0.05), and baseline positive end-expiratory pressures increased (10.8 to 13.2 cmH₂O, p < 0.001). Volume-controlled ventilation declined from 29.4 to 14.0% (p < 0.01). Use of corticosteroids increased (baseline: 7.7 to 30.3%; on study: 32.6 to 61.2%; both p < 0.001), as did neuromuscular blockade (baseline: 12.3 to 24.5%; on study: 55.5 to 70.0%; both p < 0.01). Inhaled nitric oxide use increased (24.9 to 65.8%, p < 0.05). We observed no significant change in prone positioning (16.2 to 18.9%, p = 0.70).ConclusionsClear trends were apparent in tidal volume, airway pressures, ventilator modes, adjuncts and rescue therapies. With the exception of prone positioning, and outside the context of rescue therapy, these trends appear consistent with the evolving literature on ARDS management.     

Genetic signature of CTLA-4, BTLA,TIM-3 and LAG-3 molecular expression in colorectal cancer patients: Implications in diagnosis and survival outcomes

ObjectiveAccumulating evidences suggest that immune checkpoints (ICs) inhibit immune response against cancerous cells and promote tumor cell survival. Up-regulation of ICs in tumor microenvironment is reported in patients with colorectal cancer (CRC). Thus, evaluating the peripheral blood expression of ICs may be used as non-invasive biomarkers for diagnosis and prognosis of CRC.MethodsThis study included 60 primary and treatment naïve CRC patients along with 15 age and sex matched healthy volunteers as a control group. Total RNA was extracted from peripheral blood samples and gene expression of cytotoxic T lymphocyte antigen-4 (CTLA-4), B and T lymphocyte attenuator (BTLA), T-cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), and Lymphocyte activation gene-3 (LAG-3) was measured by quantitative real time polymerase chain reaction (qRT-PCR). All patients were followed for 12 months to correlate the measured ICs to patients’ survival.ResultsThe gene expression of CTLA-4, BTLA, TIM-3 and LAG-3 was significantly up-regulated in CRC patients compared to the control group (p < 0.001). Individually, CTLA-4 and BTLA showed 85% sensitivity in discriminating CRC patients from control group (p < 0.001). On the other hand, TIM-3 and LAG-3 expression showed higher sensitivity (93%) for diagnosis of CRC (p < 0.001). Conversely, CTLA-4 or BTLA strongly predicted CRC patients’ survival (p < 0.001) compared to TIM-3 (p = 0.018) or LAG-3 (p = 0.035). CTLA-4, BTLA, TIM-3 and LAG-3 were independent prognostic factors of survival after adjustment for age and gender.ConclusionThe current study provided evidence that blood gene expression of ICs was up-regulated in CRC patients and associated with cancer stage and patients’ survival, which highlights the diagnostic and prognostic values of ICs expression in CRC. Further investigations and validations in larger cohorts are required.     

Low-dose hip abductor-adductor power training improves neuromechanical weight-transfer control during lateral balance recovery in older adults

BackgroundAge-related neuromuscular changes in the hip abductor-adductor muscles lead to reduced performance, especially in the rate of force development and power production. These alterations may impair weight transfer control and lateral balance recovery through protective stepping. This study compared the effects of eight weeks of low-dose hip abductor-adductor power and strength training on the performance of isometric maximal voluntary contractions, and lateral balance recovery at different initial weight-bearing conditions in older individuals.MethodsEighteen healthy older adults (71.3 (0.9) years) underwent eight weeks of low-dose hip abductor-adductor exercise training involving either power training (n = 10) or lower velocity strength training (n = 8). Outcomes were assessed for hip abductor-adductor isometric maximal voluntary contractions and lateral waist-pull balance perturbations with three initial stepping limb-load conditions (50%, 65%, or 80% body mass).FindingsPower training increased isometric maximal voluntary contractions abductor-adductor peak torque (14%–18%, p < 0.05), rate of torque development (31%–39%, p < 0.05) and rate of neuromuscular activation (37%–81%, p < 0.05). During lateral balance recovery, power training increased the incidence of stabilizing single lateral steps at 80% body mass pre-load (by 43%, p < 0.05), reduced step lift-off time by 27 ms at 50% body mass (p < 0.05) and decreased downward momentum of the body center of mass at 80% body mass (32%, p < 0.05). Power training also increased in task hip abductor net joint torque (49%–61%, p < 0.05), power (21%–54%, p < 0.05), and abductor-adductor rate of neuromuscular activation (17%–62%, p < 0.05).InterpretationLow-dose hip abductor-adductor power training was more effective than strength training at eliciting improvements in maximal neuromuscular performance and enhanced medio-lateral balance recovery.     

Nutritional status survey of aplastic anemia patients - a single center experience in China

AimsTo analyze the nutritional status of aplastic anemia (AA) patients.MethodsThe nutrition-related anthropometric indicators and blood biochemical index of 622 newly-diagnosed AA patients were retrospectively analyzed.ResultsOf the cohort of AA patients, body mass index of non-severe AA (NSAA) patients were higher than those of severe AA (SAA) (p < 0.05). The serum total protein and albumin protein levels of SAA patients differed from those of NSAA, and lower hemoglobin was correlated with lower serum albumin protein concentration (p < 0.01). The concentration of B vitamins (folic acid and vitamin B₁₂) of urban patients significantly differed from rural ones (P < 0.01). Of the 97 cases of iron overload (15.6% of the entire patient group), the iron overload rate of SAA patients (19.1%) was much higher than that of NSAA (8.1%).ConclusionsAA patients exhibited malnutrition conditions; it would be helpful to conduct individualized dietary guidance and health education for patients.     

Activity of paraoxonase 1 (PON1) on HDL2 and HDL3 subclasses in renal disease

IntroductionCardiovascular complications, as the main cause of mortality in renal patients, are followed with altered lipoproteins composition. Considering that paraoxonase-1 (PON1) is an anti-oxidative enzyme located mainly on HDL particles, the current study has aim to investigate whether failure of kidney function leads to changes in the distribution of PON1 activity between different HDL subclasses.Materials and methodsIn 77 renal patients (21 chronic kidney disease (CKD) and 56 end stage renal disease (ESRD) patients on dialysis) and 20 healthy subjects PON1 activity on HDL₂ and HDL₃ subclasses was determined by zymogram method that combines gradient gel electrophoresis separation of HDL subclasses and measurement of PON1 activity in the same gel.ResultsSerum paraoxonase (p<0.01) and arylesterase activity (p<0.001) of PON1 as well as its concentration (p<0.01) were significantly lower in CKD and ESRD patients compared to controls. Relative proportion of HDL₃ subclasses was higher in ESRD patients than in healthy participants, while HDL₂ subclasses was significantly decreased in CKD (p<0.05) and ESRD (p<0.001) patients, as compared to controls. Furthermore, control subjects had higher PON1 activity on HDL₂ (CKD and ESRD patients p<0.001) and HDL₃ (CKD p<0.05; ESRD patients p<0.001) subclasses in comparison with the both patients groups. Also, significant negative correlation was found between paraoxonase activity of PON1 in serum and creatinine concentration (ρ=‐0.373, p<0.01).ConclusionsThis study showed that altered HDL subclasses distribution, changed PON1 activities on different HDL subclasses as well as diminished anti-oxidative protection could be important factors in atherosclerosis development in CKD and ESRD patients.     

Implementing and evaluating the effectiveness of an oral health module for the bachelor of midwifery program at an Australian university

ObjectiveAlthough guidelines recommend antenatal care providers such as midwives promote oral health during pregnancy, oral health training is not routinely provided in undergraduate midwifery curricula. The aim of this study was to implement an oral health module into an Australian undergraduate midwifery program, and evaluate its effectiveness in improving the oral health knowledge and confidence of midwifery students.DesignPre-test post-test study (2015–2017).SettingAn undergraduate midwifery program within an Australian university.ParticipantsAll first-year undergraduate midwifery students enrolled in two core units at the above university (N = 56).MethodsOral health modules were implemented into each of the two core units within the first year of the Bachelor of Midwifery course. Changes in knowledge and confidence were measured using a standardised questionnaire, administered at baseline, immediately following module completion, and at 2 and 3 years following module completion.Results44 students participated in the baseline survey (79% response rate), of which 41 completed the first post-module questionnaire, 21 completed the second post-questionnaire, and 24 completed the third post-questionnaire. Knowledge scores significantly increased from baseline (mean 13.12) to follow-up (mean 17.78, p < 0.001), with increases being retained through to the 3-year mark (mean 18.29, p < 0.001). Confidence scores also showed a sustained increase following the module, particularly regarding introducing oral health in the first antenatal appointment (62.1% increase, p < 0.001) and referring pregnant women to a dentist (48.2% increase, p < 0.001). However, the 48.2% increase (p < 0.001) in confidence in conducting a visual mouth check on a pregnant woman following the module was not sustained at subsequent time points, reducing to a 31.5% increase (p = 0.118) by the third year post-module.ConclusionsThe module is effective in improving and sustaining the knowledge and confidence of midwifery students to promote maternal oral health. Ongoing updates may be required to keep confidence high regarding visual mouth checks.