Migration and Maternity: Insights of Context,Health Policy,and Research Evidence on Experiences and Outcomes From a Three Country Preliminary Study Across Germany,Canada, and the United Kingdom

A group from Germany, Canada, and the United Kingdom undertook country-specific scoping reviews and stakeholder consultations before joining to holistically compare migration and maternity in all three countries. We examined four interlinking dimensions to understand how international migrant/minority maternal health might be improved upon using transnational research: (a) wider sociopolitical context, (b) health policy arena, (c) constellation, outcomes, and experiences of maternity services, and (d) existing research contexts. There was clear evidence that the constellation and delivery of services may undermine good experiences and outcomes. Interventions to improve access and quality of care remain small scale, short term, and lacking in rigorous evaluation.     

Analyses of welfare-state reform policies towards long-term senior care in a cross-European perspective

The aim of this article is to introduce a systematic, structured conceptual framework for the comparative analysis of welfare-state reform policies towards long-term senior care and the care structures in a cross-European perspective. A welfare state’s policies on the long-term care of senior citizens frame the different aspects of their care: the care options of the older people, the employment situation of the different types of caregivers and the care quality. The actual structure of senior care is mainly based on the specific care-provision mix in a welfare state and on the main types of care employment. It is should not, however, be treated as a direct outcome of care policies in analyses of welfare-state policies, since the care recipients and care givers all act within the broader framework of the complex and often contradictory cultural, institutional, social and economic context—the specific ‘care arrangement’ of a country.     

Familial acquired thrombotic thrombocytopenic purpura in siblings – no immunogenetic link with associated human leucocyte antigens

Acquired immunoglobulin G (IgG)‐mediated thrombotic thrombocytopenic purpura (TTP) has not yet been described in non‐twin siblings. We report two cases of acquired TTP in Caucasian sisters with inactive ADAMTS13 metalloprotease due to ADAMTS13 autoantibodies suggesting a role of genetic determinants in this life‐threatening disease. However, human leucocyte antigen (HLA) class II types presumably associated with acquired TTP were not identified in the patients, indicating that HLA class II typing may not be useful in acquired TTP risk assessment of family members.     

Hepatitis C-associated autoimmunity in patients coinfected with HIV.

Background: Hepatitis C virus (HCV) infection is associated with multiple extrahepatic manifestations. It is unclear to what extent extrahepatic manifestations occur in HIV/HCV coinfection. Methods: We prospectively assessed cross-sectional frequencies of autoimmune manifestations in HIV/HCV-coinfected patients (n=98), HIV-mono-infected (n=45) and HCV-mono-infected patients (n=78). Diagnostic vasculitis scores, HCV and HIV loads, CD4 cell counts, thyroid-, cardiolipin-, non-organ-specific tissue antibodies (nuclear, smooth muscle, anti-liver-kidney-microsome, neutrophil-cytoplasmic) and cryoglobulins were determined. Results: Synergistic effects of HCV and HIV infection were observed with respect to the prevalence of antibodies against thyroglobulin (HCV infection 15.4%, HIV infection 8.8%, HIV/HCV coinfection 30.6%; P<0.001) and cardiolipin antibodies (HCV infection 9.0%, HIV infection 31%, HIV/HCV coinfection 46%; P<0.001). Cryoglobulinemia type III, was significantly associated with HCV infection (HCV, 25.6%; HIV/HCV, 20.4%) but not with HIV infection (4.4%, P<0.05). Rheumatoid factor was commonly detected in patients with HCV infection (48%), but occurred considerably less frequently in patients with HIV infection (4.4%) or HIV/HCV coinfection (9.5%, P<0.01). Conclusion: HIV coinfection appears to differentially modulate the frequency of HCV-related autoimmunity. However, autoimmunity is rarely accompanied by clinical manifestations.     

Too little aspirin for secondary prevention after acute myocardial infarction in patients at high risk for cardiovascular events: Results from the MITRA study

Background

A meta-analysis of randomized trials has shown a significant reduction of mortality rate in patients receiving aspirin for secondary prevention after acute myocardial infarction (AMI). However, a significant number of patients do not receive aspirin after AMI. Little is known about why aspirin is withheld or the long-term outcome of these patients today.

Methods

The Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) registry is a multicenter registry of patients with AMI in Germany.

Results

Of 4902 patients, 509 (10%) did not receive aspirin at the time of discharge from the hospital. The mean follow-up period for these patients was 17 months. Relative contraindications to aspirin were significantly associated with the withholding of aspirin (in-hospital bleeding: odds ratio [OR], 3.56; 95% CI, 1.86-6.80; history of peptic ulcer: OR, 2.49; 95% CI, 1.62-3.83). Absolute contraindications to aspirin were rare (2.2%). Other medications of proven benefit were also given less often in these patients (β-blockers: 49.0% vs 61.9%, P <.001; angiotensin-converting enzyme inhibitors: 65.6% vs 70.2%, P = .06; statins: 12.2% vs 15.1%, P = .10). Patients who were not given aspirin were at high risk for vascular events. They were more likely to have a history of prior AMI (OR, 1.34; 95% CI, 1.02-1.79), were in critical clinical condition at admission more often (cardiogenic shock: OR, 1.98; 95% CI, 1.09-3.56; overt heart failure: OR, 1.6; 95% CI, 1.05-2.3), and received acute revascularization less often (OR, 1.32; 95% CI, 1.05-1.67). The 1-year mortality was 2-times higher in patients who did not receive aspirin than in patients who did receive aspirin (16.5% vs 8.3%, P <.001). A significant association of withheld aspirin at discharge with a higher long-term mortality rate was confirmed with multivariate analysis (OR, 1.62; 95% CI, 1.15-2.29).

Conclusions

Ten percent of patients who sustained an AMI did not receive aspirin at the time of hospital discharge. Most of these patients were at high risk for cardiovascular events. Withheld aspirin was significantly associated with higher mortality rate during follow up.     

Efficacy of sulbactam in an in vitro model of mixed aerobic/anaerobic infections

Summary Bacterial interactions in mixed infections may interfere with antimicrobial therapy. Thein-vitro efficacy of ampicillin alone, combination sulbactam/ampicillin, and metronidazole was studied. Strains ofBacteroides fragilis, Escherichia coli, andEnterococcus faecalis, alone and in association, were tested by means of a broth dilution method. Minimal bactericidal concentrations (MBC) of ampicillin forB. fragilis 74 in association withE. coli 68 were up to 16-fold higher than forB. fragilis 74 alone (256 compared to 16 mg/l), but only 2-fold higher for sulbacta(5 mg/l)/ampicillin (0.5 and 0.25 g/l). Association ofB. fragilis 45 andE. faecalis 186 increased ampicillin MBC ofE. faecalis 186 from 2 to 16 mg/l, but the combination sulbactam/ampicillin restored activity of ampicillin. In association withE. faecalis, metronidazole MBCs ofB. fragilis increased up to 64-fold. Strains ofE. faecalis andE. coli were able to destroy 10 mg/l metronidazole within 8 to 20 h. The present experiments demonstrated effectiveness of sulbactam/ampicillin to inhibit -lactamases of associated pathogens. Destruction of metronidazole byE. faecalis lends additional support to the use of the combination in aerobic/anaerobic infections includingE. faecalis.

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In vitro-Wirksamkeit von Sulbactam in einem Modell für aerob/anaerobe Mischinfektionen

Zusammenfassung Bakterielle Interaktionen in Mischinfektionen können die Wirksamkeit einer antibiotischen Therapie beeinflussen. DieIn-vitro-Wirksamkeit von Ampicillin, Sulbactam/Ampicillin sowie von Metronidazol wurde mit Stämmen vonBacteroides fragilis, Escherichia coli undEnterococcus faecalis einzeln und in Association mittels einer Bouillonverdünnungsmethode getestet. Die minimale bakterizide Konzentration (MBK) von Ampicillin fürB. fragilis 74 in Association mitE. coli 68 war bis zu 16 mal höher als bei der Testung vonB. fragilis 74 alleine (256 mg/l bzw. 16 mg/l), zweimal höher mit Sulbactam (5 mg/l)/Ampicillin (0,5 und 25 mg/l). In Assoziation mitB. fragilis 45 und erhöhte sich die Ampicillin-MBK fürE. faecalis 186 von 2 auf 16 mg/l, die Kombination mit Sulbactam stellte die Wirksamkeit von Ampicillin wieder her. Die Metronidazol-MBK-Werte fürB. fragilis stiegen in Assoziation mitE. faecalis um das bis zu 64fache an.E. faecalis- undE. coli-Stämme waren in der Lage, 10 mg/l Metronidazol innerhalb von 8 bis 20 h abzubauen. Die vorliegenden Experimente demonstrierten die Wirksamkeit von Sulbactam/Ampicillin bei der Hemmung von -Laktamasen assoziierter Erreger. Auch bei aerob/anaeroben Infektionen mit Beteiligung vonE. faecalis kann diese Kombination vorteilhaft sein.

     

Cardiac hypertrophy is enhanced in PPAR alpha-/- mice in response to chronic pressure overload

AIMS: Peroxisome proliferator-activated receptor-alpha (PPARalpha) is a nuclear receptor regulating cardiac metabolism that also has anti-inflammatory properties. Since the activation of inflammatory signalling pathways is considered to be important in cardiac hypertrophy and fibrosis, it is anticipated that PPARalpha modulates cardiac remodelling. Accordingly, in this study the hypothesis was tested that the absence of PPARalpha aggravates the cardiac hypertrophic response to pressure overload. METHODS AND RESULTS: Male PPARalpha-/- and wild-type mice were subjected to transverse aortic constriction (TAC) for 28 days. TAC resulted in a more pronounced increase in ventricular weight and left ventricular (LV) wall thickness in PPARalpha-/- than in wild-type mice. Compared with sham-operated mice, TAC did not affect cardiac function in wild-type mice, but significantly depressed LV ejection fraction and LV contractility in PPARalpha-/- mice. Moreover, after TAC mRNA levels of hypertrophic (atrial natriuretic factor, alpha-skeletal actin), fibrotic (collagen 1, matrix metalloproteinase-2), and inflammatory (interleukin-6, tumour necrosis factor-alpha, cyclo-oxygenase-2) marker genes were higher in PPARalpha-/- than in wild-type mice. The mRNA levels of genes involved in fatty acid metabolism (long-chain acyl-CoA synthetase, hydroxyacyl-CoA dehydrogenase) were decreased in PPARalpha-/- mice, but were not further compromised by TAC. CONCLUSION: The present findings show that the absence of PPARalpha results in a more pronounced hypertrophic growth response and cardiac dysfunction that are associated with an enhanced expression of markers of inflammation and extracellular matrix remodelling. These findings indicate that PPARalpha exerts salutary effects during cardiac hypertrophy.