PRIME: impact of previous mental health problems on health-related quality of life in women with childbirth trauma

We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n?=?137) or parenting support (n?=?125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06; 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08; 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.     

Skeletal muscle microvascular exchange capacity is associated with hyperglycaemia in subjects with central obesity

Aims Poor glycaemic control is associated with increased risk of microvascular disease in various organs including the eye and kidney, but the relationship between glycated haemoglobin (HbA_1c) and microvascular function in skeletal muscle has not been described. We tested the association between HbA_1c and a measure of microvascular exchange capacity (K_f) in skeletal muscle in people with central obesity at risk of developing Type 2 diabetes. Methods Microvascular function was measured in 28 women and 19 men [mean (± sd ) age 51 ± 9 years] with central obesity who did not have diabetes. We estimated insulin sensitivity by hyperinsulinaemic–euglycaemic clamp, visceral and total fatness by magnetic resonance imaging, fitness (VO₂ max by treadmill testing), physical activity energy expenditure [metabolic equivalents of tasks (METS) by use of the SenseWear Pro armband] and skeletal muscle microvascular exchange capacity (K_f) by venous occlusion plethysmography. Results In regression modelling, age, sex and fasting plasma glucose accounted for 30.5% of the variance in HbA_1c (r² = 0.31, P = 0.001). Adding K_f to this model explained an additional 26.5% of the variance in HbA_1c (r² = 0.57, P = 0.0001 and K_f was strongly and independently associated with HbA_1c (standardized B coefficient ?0.45 (95% confidence interval ?0.19, ?0.06), P = 0.001). Conclusions We found a strong negative independent association between a measure of skeletal muscle microvascular exchange capacity (K_f) and HbA_1c. K_f was associated with almost as much of the variance in HbA_1c as fasting plasma glucose.     

Low-level hydrocarbon solvent exposure and neurobehavioural effects

Studies of workers exposed to hydrocarbon solvents are reviewed in order to address the question, 'Does long-term human exposure to hydrocarbon solvents at concentrations around occupational exposure limits result in clinically important neurobehavioural effects?' Studies selected evaluated exposure-response (E-R) trends with some control of potential confounders. Tests of neurobehavioural performance were classified into specific functional categories, within those of cognitive, psychomotor and sensory functions to increase specificity and power to detect patterns of effect. The weight-of-evidence was evaluated with respect to criteria for determining causality. The temporality criterion was met as latency was adequate for the occurrence of chronic effects. There were few significant associations, and when present, were consistently weak even in the most-exposed workers. Exposure response showed no consistent or significant pattern for any tests of functional mortality. The weight of evidence suggests that exposure to hydrocarbon solvents at current limits does not appear to cause adverse neurobehavioural effects.     

Integrating HIV prevention and care services: the Seattle "Collaboration Project".

The "Collaboration Project" explored whether human immunodeficiency virus (HIV) prevention providers in Seattle-King County refer their HIV+ clients into care services and whether HIV care service providers discuss sex and drug use risk reduction or make referrals for clients with ongoing risk reduction needs. Data uncovered demographic disparities between provider populations that may impact cross-system collaboration, particularly regarding provider demographic reflectiveness of the consumers being served. Ninety percent of prevention providers referred clients to care services; only one quarter discussed sexual risk reduction, while half discussed drug use risk reduction. Knowledge of cross-system resources was generally high, although gaps emerged between providers in several resource areas. Based on these findings, several key changes have been implemented.     

Porphyrinogenic xenobiotic-induced N-alkylprotoporphyrin IX formation: a bioassay utilizing chick embryo hepatic ferrochelatase

INTRODUCTION: The porphyrinogenicity of some xenobiotics results from mechanism-based inactivation of selected cytochrome P450 (CYP) enzymes accompanied by conversion of prosthetic heme groups to N-alkylprotoporphyrins (N-alkylPPs), some of which inhibit ferrochelatase (FC). Problems have arisen in extrapolating xenobiotic porphyrinogenicity observed in test animals to humans, due in part to differences among CYP enzymes. Our goal was to develop a bioassay to detect N-alkylPPs formed following interaction of porphyrinogenic xenobiotics with rat liver microsomal CYP. METHODS: Seventeen-day-old chick embryo livers were homogenized, and the mitochondrial fraction was isolated. The FC activity of this fraction was determined by means of the pyridine hemochromogen method. Inhibition of FC was used to detect N-alkylPP formation following interaction of porphyrinogenic xenobiotics with rat liver microsomes. RESULTS: The 17-day-old chick embryo hepatic mitochondrial preparation served as a stable source of FC activity, which was linear with respect to time and protein concentration. FC activity was higher than previously reported in a homogenate of 17-day-old chick embryo hepatocytes in culture and in an aqueous extract of 17-day-old chick embryo mitochondria. The EC(50) of N-methylprotoporphyrin IX in the chick embryo liver mitochondrial preparation was similar to that in the homogenate of chick embryo liver cell culture. The FC bioassay could detect N-alkylPPs formed following the interaction of porphyrinogenic xenobiotics with rat liver microsomes containing 2.4-9.0 nmol of CYP. DISCUSSION: In future studies investigating N-alkylPP formation following interaction of xenobiotics with CYP enzymes, we recommend using a combination of a fluorescence technique and the chick embryo hepatic mitochondrial FC assay. This would provide information both on the formation of N-alkylPPs and distinguish between those N-alkylPPs that produced porphyrin accumulation via FC inhibition and those that do not.     

Assessing patient satisfaction and quality of care through observation and interview

The purpose of this study was to investigate patient satisfaction using an in-depth approach rather than the more common patient survey method. The authors conducted patient interviews and participant-oriented observations between patients, family members, and medical staff in a large teaching hospital to assess patients' perceptions of the quality of care provided on a medical-surgical unit. The observations were classified according to the Donabedian model of quality of care: technical care, interpersonal care, and amenities of care. Technical interactions (92.5%, or n = 123) were most common, followed by interpersonal interactions (5%, or n = 7) and interactions related to amenities of care (2%, or n = 3). Of the patients interviewed, 89% (n = 40) were satisfied with the treatment and quality of care they received. Of the 10% (n = 9) of patients who reported dissatisfaction with the hospitalization, most of the complaints were related to surgical procedures. Observations and patient interviews may provide a more informative and accurate assessment of patient satisfaction than a reliance on patient surveys as the sole measure.