Effects of the PREMIER Interventions on Health-Related Quality of Life

Background  

Health-related quality of life (HRQOL) is an important aspect of well-being that may improve with health behavior interventions. However, health behavior change is difficult with pressure to maintain status quo.     

Patients’ preferences for enrolment into critical-care trials

Background  

Most critically ill patients are incapable of providing informed consent for research.     

Evaluation of the Food And Nutrient Database for Dietary Studies for use with a mobile telephone food record

The development of a mobile telephone food record (mpFR) in which image analysis and volume estimation data can be indexed with the Food and Nutrient Database for Dietary Studies (FNDDS) has the potential to improve the accuracy of dietary assessment. To validate the mpFR for use with adolescents, a convenience sample of adolescents, aged 11–18 years, was recruited to eat all meals and snacks in a controlled feeding environment over a 24-h period. Each food item matched a food code in the FNDDS 3.0. The objective of this analysis was to compare the measured energy and protein content of foods to the published values in the FNDDS. Duplicate plates of all meals and snacks were prepared, and samples of 20 foods were individually weighed, homogenized, freeze dried, and analyzed for energy with a bomb calorimeter and for protein with a Dumas nitrogen analyzer. Eleven of the twenty food items had energy values in the FNDDS within ±10% of the measured energy value. The measured energy and protein values from all foods correlated significantly with the energy (r = 0.981, P < 0.01) and protein (r = 0.911, P < 0.01) values in the FNDDS. These results support the use of the FNDDS with the mpFR.     

A Review of the Clinical Presentation of Dientamoebiasis

Among 750 symptomatic and asymptomatic patients, Dientamoeba fragilis was detected at a prevalence of 5.2% and more common than Giardia intestinalis. Most infected patients presented with diarrhea and abdominal pain with symptoms greater than 2 weeks duration being common. Bacterial and viral causes of infection were excluded by routine microbiological techniques. Treatment of D. fragilis infection with either iodoquinol, paromomycin, or combination therapy resulted in the eradication of the parasite and complete resolution of symptoms. Treatment failure/relapses were associated only with the use of metronidazole. Nineteen patients were examined for pin worm, no Enterobius vermicularis, a proposed vector of transmission, were detected. Intermittent shedding of D. fragilis was found to be highly variable. These studies confirm the pathogenic nature of D. fragilis and we recommend laboratories routinely test for the organism.     

Early Pleural Effusions Related to the Myocardial Injury after Open-heart Surgery for Congenital Heart Disease

Objectives. The degree of effusion immediately after cardiopulmonary bypass (CPB) can vary and may reflect several factors including the degree of myocardial injury. We compared the degree of pleural effusions after CPB to the overall myocardial injury as determined by serum cardiac troponin I (cTnI) levels after elective repair of a variety of congenital heart defects, including univentricular surgeries via cavopulmonary shunts. Methods. Serum was collected pre-CPB, post-CPB, and daily after that and cTnI level measured. The postoperative pleural effusion was measured each day until the chest tube was removed. Results. The 21 study patients were of average age of 5.5 years (±5.6). The duration of chest-tube drainage after open-heart surgery was 4.3 days (±3.5) and the amount was 2.4 mL/kg/hour (±2.9). For the biventricular repairs, cTnI levels on the postoperative day (POD) 1 best correlated with amount of effusion (n = 16, r = 0.5, P = 0.02) and the average (POD 0–3) cTnI levels with the total duration (n = 16, r = 0.4, P = 0.01) and also the amount (n = 16, r = 0.5, P = 0.02) of effusions. For the cavopulmonary shunts, the post-CBP cTnI level best correlated with the duration (n = 5, r = 0.8, P = 0.02) and amount (n = 5, r = 0.9, P = 0.02) of effusions. A cTnI level on the first postoperative day ≥15 µg/L was associated with effusions >2 days (sensitivity of 81% and specificity of 80%). Conclusion. We found that higher the cTnI released, especially ≥15 µg/L, longer the duration and greater the amount of early pleural effusions for a variety of congenital heart surgeries including cavopulmonary shunts. A number of factors may lead to excessive pleural effusions and the degree of myocardial injury may be one of them.     

Capacity for Freedom—A New Way of Measuring Poverty Amongst Australian Children

A little over 200 000 children and youths in Australia between the ages of 5 and 19 years were in Freedom poverty in 2003—they had low family income, and either poor health or an insufficient level of education. These individuals are some of the most disadvantaged in society due to their multiple capability restrictions. Current political rhetoric focused on increasing the education opportunities of children and youth to maximise their labour force participation in the future and thus improve their living standards may offer a means of improving the lives of these most disadvantaged children. However, half of these children have poor health and this may act as a barrier to their future labour force participation. It is shown that when looking at the health, education and labour force status of adults, amongst those with and without a disability those with a higher education had a greater likelihood of participating in the labour force—indicating policies to promote education amongst children are justified. However, it was also shown that regardless of education attainment those with a disability still had lower labour force participation rates than those without a disability. As such, efforts to increase children’s future labour force participation rates as a means of improving their living standards should also focus on improving childhood health, as well as education. Political promises to improve the lives of children should take a holistic view of the lives of individuals taking note in particular of how health may be restraining their quality of life.     

Alloantibodies against low-frequency human platelet antigens do not account for a significant proportion of cases of fetomaternal alloimmune thrombocytopenia: evidence from 1054 cases

BACKGROUND: Maternal alloantibodies against the five common human platelet antigen (HPA) systems (HPA-1 to -3, -5, and -15) are found in only 20% of cases referred for fetal and neonatal thrombocytopenia (FMAIT) investigations. The question asked was whether mismatches for the remaining 11 low-frequency HPAs (HPA-4 and -6bw to -17bw) might in part explain the remaining 80% of cases.
STUDY DESIGN AND METHODS: A total of 1054 paternal DNA samples from referred FMAIT cases (among which 223 cases where antibodies against a common HPA were found) were genotyped for 11 low-frequency HPAs as well as a recently discovered polymorphism ( ITGA2B -C2320T). The initial genotyping was carried out by TaqMan and potential heterozygotes were confirmed by DNA sequencing. Clinical and serologic data were collected for each case with a heterozygote father.
RESULTS: In total, eight heterozygous fathers were identified: four for HPA-6w, one each for HPA-10w and -11w, and two for HPA-12w. Maternal antibodies against the corresponding antigen were identified in four of the eight cases. In two of these cases, antibodies against HPA-1a and HPA-1b were also found.
CONCLUSION: It was concluded that the minor alleles of HPA-4 and -6bw to -17bw are exceptionally rare in the Caucasian population and therefore do not explain the large number of FMAIT referrals which test negative for the common HPA antibodies.