False-negative dual-energy computed tomography in a patient with acute gout

Gout is a painful inflammatory arthropathy caused by crystallization of monosodium urate within the joints. We present the case of a patient with primary gout who had positive results of joint aspiration and synovial biopsy for monosodium urate crystals in the third metacarpophalangeal joint but false-negative results of dual-energy computed tomography.     

The cooling effect of tubular liquid flow during radiofrequency heating: the "rind" survival hypothesis

The influence of flowing blood on temperatures reached in nearby tumor cells during localized radiofrequency (RF) hyperthermia may be critical for tumor cell survival. We have investigated the effect on the temperatures nearby of blood flowing in a vessel. Using 13.56 MHz capacitive RF, we heated gel phantoms containing a tube through which cooling solution could flow. Our results demonstrated a reduction in temperature of the order of 3 degrees C around the tube when coolant was flowing, and the cooling pattern correlated with theoretical mathematical predictions. Up to 564 joules per minute could be removed from the system. Our results suggest the improbability of uniform tumor cell killing by RF heating. A scheme for integrating the concepts of physical cell damage, biochemical cell damage and peripheral cell survival in a tumor nodule is presented.     

Impact of a multiple, IVF birth on post-partum mental health: a composite analysis

BACKGROUND: This study explored the impact of a multiple IVF birth on maternal mental health in the early post-partum period. METHODS: A prospective study of 207 women who had conceived following IVF treatment and followed up at 6 weeks post-partum. Mothers rated their mood using the Edinburgh postnatal depression scale (EPDS) and their baby's behaviour using the Unsettled and Irregular Behaviour scale. Mothers' emotional well-being was explored using theme analysis of semi-structured telephone interviews. RESULTS: Of the 175 (84.5%) followed up post-partum, 56 (32%) had a multiple birth (7 triplets, 49 twins). Nearly 16% of mothers in the multiple group scored>12 on the EPDS indicating clinically significant symptoms, which represented a 3-fold increased risk compared to mothers of singletons (Odds ratio=3.4, Confidence Interval=1.011-11.618, P=0.048). Unsettled and irregular infant behaviour was another independent risk factor. Qualitative analysis of interviews identified 12 themes. Mothers of multiples were more likely to express negative themes including 'tiredness' (P<0.01), 'feelings of stress/depression' (P<0.05) and 'questioning parenthood' (P<0.05). Mothers of singletons were more likely to be 'feeling wonderful', reflecting their delight in parenthood (P<0.05). CONCLUSIONS: Mothers of multiples are at increased risk of poorer emotional well-being. Clinicians should focus on the psychological benefits of a singleton birth.     

Mental health and disclosure of HIV status in Zambian adolescents with HIV infection: implications for peer-support programs

OBJECTIVES: To examine emotional and behavioural difficulties in HIV positive Zambian adolescents and to determine the relationship between disclosure of HIV status and mental health. DESIGN: A cross-sectional survey. METHODS: Participants were 127 HIV positive adolescents aged 11 to 15 years recruited through clinics in the Lusaka region. Mental health was assessed using the youth report version of the Strengths and Difficulties Questionnaire (SDQ). Caregivers completed the parent SDQ. Sixty-two participants were invited for a semi-structured interview which probed views on attending a peer support group. RESULTS: Compared to a British community sample participants had increased mental health problems (OR, 2.1), particularly emotional symptoms (OR = 3.6) and peer problems (OR = 7.1). The majority of children (n = 94) were receiving antiretroviral (ARV) treatment, but only 48 children (37.8%) had their HIV status disclosed. Those who had not had their HIV status disclosed were younger (P < 0.001) and less likely to be receiving ARV treatment (P < 0.001). Controlling for these factors they were also more likely to score in the abnormal range of the emotional difficulties subscale (OR = 2.63, 95% CI: 1.11 to 6.26). Of 38 interviews transcribed, content analysis showed that only 3 children were opposed to participation in a peer-group program, with the majority (23/38) expressing reasoned and positive responses, regardless of disclosure status. CONCLUSION: High rates of emotional and peer problems were found in this sample but disclosure of HIV status did not have a negative effect on mental health. Interventions to promote disclosure could facilitate access to emotional and peer support.     

The asthma files: evaluation of a multimedia package for children's asthma education

Children's knowledge of asthma triggers and the impact on children's knowledge of using 'The Asthma Files', an interactive, educational computer program, were evaluated in this pilot study. Thirty-one children aged between seven and 14 years and diagnosed with asthma were recruited to the study. Ten boys participated in evaluating the triggers section and a questionnaire was used to determine their feelings about the program and retention of information. Children enjoyed using the package and knowledge about asthma triggers increased significantly. 'The Asthma Files' shows promise as an additional tool to augment existing education.     

UK health visitors' role in identifying and intervening with infants at risk of developing obesity

Childhood obesity is associated with a number of modifiable risk factors that can be identified during infancy or earlier. In the UK, health visitors advise parents about infant feeding, but little is known about their role in obesity prevention. The aim of this study was to investigate the beliefs and current practices of UK health visitors in relation to recognising and intervening with infants at risk of developing obesity. Thirty members of the health visiting team were interviewed. The interviews were audio‐recorded and transcribed verbatim. Thematic analysis was applied using an interpretative, inductive approach. Health visitors were aware of some of the modifiable risk factors for childhood obesity such as infant feeding practices. They felt they had a role in advising parents about diet but did not formally identify and/or intervene with larger infants. Infant overweight was considered a sensitive issue that was difficult to raise with parents. They believed some parents preferred larger infants and were unaware that their feeding practices might be contributing to obesity risk. A need for training and guidance was identified together with strategies to overcome system barriers. Health visitors do not currently target parents of infants at risk of obesity largely because they do not perceive they have appropriate guidance and skills to enable them to do so. There is an urgent need for tools and training to enable all health care professionals to recognise and manage infants at risk of developing obesity without creating a sense of blame.     

Breast cancer risk factors in Queensland women attending population-based mammography screening

Objective

To investigate the prevalence of established modifiable and non-modifiable risk factors associated with breast cancer in Queensland (Australia) women.

Study design

Cross-sectional prevalence study of 9792 women (58% of women sent the questionnaire) attending BreastScreen Queensland Screening and Assessment Services between November 2008 and February 2009. Prevalence and 95% confidence intervals were calculated for each risk factor, stratified by age-group (45–49 years, 50–59 years, 60–69 years, ≥70 years).

Main outcome measures

First-degree family history (FH) of breast cancer (mother, sister, daughter), reproductive history, behavioural factors, co-morbidities, use of hormone replacement therapy (HRT) and alternatives, and socio-demographic factors.

Results

The prevalence of first-degree FH of breast cancer was 16% and a previous diagnosis of breast cancer was 3.5%; both are considered major risk factors for breast cancer. The prevalence of modifiable breast cancer risk factors of moderate risk were: current HRT use (12%), HRT use within the past 5 years (7%), overweight [body mass index 25–29] (33%) or obesity [BMI > 30] (27%), alcohol consumption [≥11 drinks/week] (10%), sedentary behaviour (70%), and low fruit (34%) and vegetable consumption (69%). These risk factors tended to be higher in younger women (45–49 years) compared to older women (>50 years).

Conclusion

Prevalence of risk factors in Queensland women were largely consistent with other Australian and international studies. Hormone therapy use is lower than previously reported estimates in Australia and internationally. The comparatively high prevalence of modifiable lifestyle factors which have been shown to be moderately associated with breast cancer are potential targets for reducing the public health burden of breast cancer.