Long-term association of pregnancy and maternal brain structure: the Rotterdam Study

European Journal of Epidemiology - The peripartum period is the highest risk interval for the onset or exacerbation of psychiatric illness in women’s lives. Notably, pregnancy and childbirth...     

The presence of hepatitis C virus (HCV) antibody in human immunodeficiency virus-positive hemophilic men undergoing HCV "seroreversion"

Hepatitis C virus (HCV) is a major cause of transfusion-induced chronic liver disease in hemophiliacs, with 70% to 90% being anti-HCV positive. Seroreversion or loss of antibody response to HCV has been observed in a small proportion of human immunodeficiency virus-positive [HIV(+)] anti-HCV(+) hemophilic men. Despite the seroreversion to an anti-HCV- negative state, such patients continue to show serum alanine aminotransferase (ALT) elevations and biopsy evidence of cirrhosis and/or chronic active hepatitis. To determine the cause for the loss of anti-HCV antibody, we compared first- and second-generation anti-HCV enzyme immunosorbent assay (EIA 1.0 and 2.0), second-generation recombinant immunoblot (RIBA 2.0), and HCV-RNA amplification using polymerase chain reaction (PCR) in 19 "seroreverters" before and after seroreversion. There was no difference between 19 seroreverters and 59 persistently anti-HCV-positive hemophiliacs in mean ALT (1.1 +/- 0.1 XUL v 2.0 +/- 0.2 XUL; chi 2 = 1.80, P > .05), in mean CD4 (188 +/- 36/microL v 232 +/- 28/microL; t = 0.965, P > .05), or in the rate of progression to acquired immunodeficiency syndrome (13 of 19 [68.4%] v 30 of 59 [50.9%]; chi 2 = .987, P > .05, respectively). Before seroreversion, all 19 seroreverters (100%) were positive for EIA 1.0 and 2.0 and PCR, and all but 2 of 19 (89.5%) were RIBA 2.0 positive, whereas, after seroreversion, none were positive for EIA 1.0, 15 of 19 (78.9%) were positive for EIA 2.0, 8 of 18 (44.4%) were positive for RIBA 2.0, and 18 of 19 (94.7%) were positive for PCR. There was a lower CD4 lymphocyte number after seroreversion in those who were RIBA 2.0 negative as compared with those who were RIBA 2.0 positive (32 +/- 10/microL v 171 +/- 52/microL; t = 2.638, P > .05). These results indicate that HIV(+) anti-HCV(+) hemophilic men who undergo "HCV seroreversion" are truly infectious and anti-HCV positive by second- generation tests. Anti-HCV detection in immunosuppressed hosts is significantly improved by second-generation EIA and RIBA assays.     

Evaluation of Natural Change of Skin Function in Split-Thickness Skin Grafts by Noninvasive Bioengineering Methods

BACKGROUND: Autologous split-thickness skin grafts (STSGs) are considered the mainstay for the treatment of large full-thickness wounds. There have been few studies reporting the natural change of the skin function in STSGs after procedure, however. OBJECTIVE: The objective was to evaluate the natural change of the skin function in STSG using noninvasive bioengineering methods. METHODS: Eighteen patients were eligible for the study. The skin functions of the graft and the control site were evaluated by an evaporimeter, corneometer, mexameter, and cutometer at Postoperation Days 0.5, 1, 2, 3, 6, 9, and 12 months. RESULTS: Transepidermal water loss (TEWL) of the graft was maintained around that of the normal skin. The values of the skin hydration testing generally decreased during the follow-up period. Erythema was highly maintained for the whole period. For the pigmentation, the ratio tended to increase after 6 months. The skin pliability of the graft was abruptly decreased at 0.5 month, and it recovered from 3 to 12 months. The value did not reach that of the normal skin, however. CONCLUSION: Our results showed that the STSGs had changed within the frame of the skin function, including the TEWL, epidermal hydration, color, and pliability, throughout 1 year after surgery. The authors have indicated no significant interest with commercial supporters.     

The dignity in advanced dementia (diadem) study: Developing an integrated geriatric palliative homecare program

Background: The prevalence of dementia is rising globally. Many patients suffer from the burdensome complications of advanced dementia as they are still poorly addressed. Aims: To describe the development of an interdisciplinary palliative homecare program for patients with advanced dementia and to develop a workflow that delineates the seamless continuation of care between the hospital and community with the homecare program. Design: Palliative care needs of patients and caregivers were established through a qualitative review of the literature. Appraisal tools were chosen based on their validity and feasibility in the homecare setting. Gaps in the healthcare system were identified and addressed as part of the integration of care between the hospital and the community. Setting/participants: Patients at Functional Assessment Staging (FAST) 7 with pneumonia, albumin level <35?g/L and/or enteral feeding were enrolled from a tertiary care hospital into the homecare program. Results: Patients’ symptom burden and quality of life were assessed. Caregivers were engaged in the planning of patients’ care. With the homecare program, patients and caregivers received support at home. Two physicians, seven nurses, and three social work professionals were educated about advanced dementia palliative care and medical information was communicated between different healthcare sites. Preliminary analysis of 306 patients revealed the presence of pain and neuropsychiatric behaviors. Impact of caregiving was mild to moderately severe. Conclusion: Advanced dementia is under-recognized as a terminal illness requiring specialized palliative intervention. Integrating a homecare palliative program into advanced dementia care is the first step towards palliating suffering at the end-of-life.     

The effect of costal cartilage resection on the chest wall development: a morphometric evaluation.

OBJECTIVE: In repair of thoracic wall deformities, there is a debate in the literature regarding the optimal age and the type and number of costal cartilage resections. We evaluated the effect of costal cartilage resections on the chest wall development in young rabbits. METHODS: Fifty apparently healthy, 6 weeks of age, male New Zealand white rabbits were evaluated in five groups, each including 10 subjects. Group 1 served as control for the observation of normal thoracic development. Rabbits in group 2 underwent partial and rabbits in group 3 underwent total resections of the right third and fourth costal cartilages; those in group 4 underwent partial and rabbits in group 5 underwent total resections of the right third to sixth costal cartilages. Anteroposterior, horizontal and vertical diameters of the chest were measured before operation and repeated at 24 weeks of age. RESULTS: Upper and lower anteroposterior diameters of the thoracic wall and horizontal diameters of the left hemithorax differed significantly among groups (p=0.011, p=0.004, and p=0.002, respectively). Upper anteroposterior diameter was 49 mm in group 1 and 44 mm in group 3 (p=0.009). Lower anteroposterior diameter in group 5 (66 mm) was significantly less than that in group 1 (70 mm) (p=0.039) and there was also a statistically significant difference between group 4 (71 mm) and group 5 (66 mm) (p=0.002). Horizontal diameters of the left hemithorax in group 3 (32 mm; p=0.005) and 5 (32 mm; p=0.008) were significantly different when compared to group 1 (26 mm). Growth in right hemithorax was statistically less than that in left side in all operated groups except in group 2. CONCLUSIONS: Thoracic resections in young rabbits have demonstrated that the costal cartilage resection is not an innocent procedure as it severely affects the chest wall development especially in anteroposterior direction and the thoracic growth is markedly retarded when growth centers of the ribs are not preserved and/or four or more ribs are resected.     

Factorial structure of the Chinese version of the 12‐item General Health Questionnaire in adolescents

Aims. To evaluate the underlying factor structure of the Chinese version of General Health Questionnaire‐12 using exploratory and confirmatory factor analyses in Chinese adolescents and find out which factor model proposed by previous empirical research is the best‐fit model. Background. The 12‐item General Health Questionnaire has been extensively used with adolescents in the West. Yet, it has not been used with adolescents in a Hong Kong Chinese context. Design. A cross‐sectional study was employed. Method. Chinese students between the ages of 12–19 from four secondary schools were invited to participate in the study using the multiple‐stage stratified random sampling method during the period from December 2007–February, 2008. The total sample size included in the final analysed was 1883. Results. The General Health Questionnaire‐12 was found to be internally consistent. The results of exploratory factor analysis showed that there are two factors underlying the General Health Questionnaire‐12. Of nine factor models were tested by means of confirmatory factor analysis, only three factor model: the eight‐item two‐factor model, 12‐item three‐factor model and 10‐item two‐factor model, demonstrated good model fit across all model fit indices. Conclusion. This study addressed a gap in the literature by evaluating the factorial structure of the Chinese version of General Health Questionnaire‐12 using exploratory and confirmatory factor analyses in Chinese adolescents. The findings revealed that the eight‐item two‐factor model is the best‐fit model. Relevance to clinical practice. The adolescent mental health problem is alarming and aggravating and warrants special attention. It is essential for community nurses to differentiate psychological distress in adolescents and to identify those adolescents who are at a higher risk of suffering from mental health problems. The availability of a valid and reliable instrument that measures adolescents’ psychological distress is crucial before any nursing interventions to promote their mental health can be appropriately planned, implemented and evaluated.     

Diet and Respiratory Health in Children from 11 Latin American Countries: Evidence from ISAAC Phase III

Background and Aim

The burden of childhood asthma and its risk factors is an important but neglected public health challenge in Latin America. We investigated the association between allergic symptoms and dietary intake in children from this region.

Methods

As part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III, questionnaire collected dietary intake was investigated in relation to risk of parental/child reported current wheeze (primary outcome) and rhino-conjunctivitis and eczema. Per-country adjusted logistic regressions were performed, and combined effect sizes were calculated with meta-analyses.

Results

143,967 children from 11 countries had complete data. In children aged 6–7 years, current wheeze was negatively associated with higher fruit intake (adjusted odds ratio [aOR] 0.65; 95% CI 0.74, 0.97). Current rhino-conjunctivitis and eczema were statistically negatively associated with fruit intake (aOR 0.72; 95% CI 0.64, 0.82; and OR 0.64, 95% CI 0.56, 0.74, respectively). Vegetable intake was negatively associated with risk of symptoms in younger children, but these associations were attenuated in the 13–14 years old group. Fastfood/burger intake was positively associated with all three outcomes in the older children.

Conclusion

A higher intake of fruits and vegetables was associated with a lower prevalence of allergic symptoms in Latin American children. Conversely, intake of fastfood was positively associated with a higher prevalence of wheeze in adolescents. Improved dietary habits in children might help reduce the epidemic of allergic symptoms in Latin America. Food interventions in asthmatic children are needed to evaluate the possible public health impact of a better diet on respiratory health.