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Sample records for recommended intermittent preventive

  1. Intermittent preventive treatment of malaria in pregnancy

    DEFF Research Database (Denmark)

    Mbonye, A.K.; Hansen, Kristian Schultz; Bygbjerg, Ib Christian

    2008-01-01

    The main objective of this study was to assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilisers could administer intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) to pregnant women. The study w...

  2. Monitoring antifolate resistance in intermittent preventive therapy for malaria

    DEFF Research Database (Denmark)

    Venkatesan, Meera; Alifrangis, Michael; Roper, Cally

    2013-01-01

    Mutations in the Plasmodium falciparum genes Pfdhfr and Pfdhps have rendered sulfadoxine-pyrimethamine (SP) ineffective for malaria treatment in most regions of the world. Yet, SP is efficacious as intermittent preventive therapy in pregnant women (IPTp) and infants (IPTi) and as seasonal malaria...... control in children (SMC). SP-IPTp is being widely implemented in sub-Saharan Africa. SP-IPTi is recommended where the prevalence of SP-resistant malaria parasites is low, whereas SMC is recommended for areas of intense seasonal malaria transmission. The continuing success of these interventions depends...

  3. Intermittent preventive treatment of malaria in pregnancy

    DEFF Research Database (Denmark)

    Mbonye, A.K.; Bygbjerg, Ib Christian; Magnussen, Pascal

    2008-01-01

    OBJECTIVE: To assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. METHODS: A non-randomized comm......OBJECTIVE: To assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. METHODS: A non......-randomized community trial was implemented in 21 community clusters (intervention) and four clusters where health units provided routine IPTp (control). The primary outcome measures were access and adherence to IPTp, number of malaria episodes, prevalence of anaemia, and birth weight. Numbers of live births, abortions......, still births, and maternal and child deaths were secondary endpoints. FINDINGS: 1404 (67.5%) of 2081 with the new delivery system received two doses of sulfadoxine-pyrimethamine versus 281 (39.9%) of 704 with health units (P malaria episodes decreased from 906 (49...

  4. Implementing intermittent preventive treatment for malaria in pregnancy

    DEFF Research Database (Denmark)

    Mubyazi, Godfrey Martin; Magnussen, Pascal; Goodman, Catherine

    2011-01-01

    Introduction Implementing Intermittent Preventive Treatment for malaria in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) through antenatal care (ANC) clinics is recommended for malaria endemic countries. The vast biomedical literature on malaria prevention focuses more on the epidemiological...... of the recommended interventions. Objective To review literature on policy advances, achievements, constraints and challenges to malaria IPTp implementation, emphasising its operational feasibility in the context of health-care financing, provision and uptake, resource constraints and psychosocial factors in Africa...... discriminatory socio-cultural values on and attitudes towards SP, malaria, and quality of ANC; supply and cost of SP at health facilities; understaffing and demoralised staff; ambiguity and impracticability of user-fee exemption policy guidelines on essential ANC services; implementing IPTp, bednets, HIV...

  5. Preventive Care Recommendations for Adults with MS

    Science.gov (United States)

    ... risk factors including prolonged use of steroids or anticonvulsants, a family history of osteoporosis, and a sedentary ... care provider. Yearly. Monthly. The American Academy of Pediatrics recommends starting at age eighteen. Preventive Care Recommendations | ...

  6. Carotid body denervation prevents fasting hyperglycemia during chronic intermittent hypoxia.

    Science.gov (United States)

    Shin, Mi-Kyung; Yao, Qiaoling; Jun, Jonathan C; Bevans-Fonti, Shannon; Yoo, Doo-Young; Han, Woobum; Mesarwi, Omar; Richardson, Ria; Fu, Ya-Yuan; Pasricha, Pankaj J; Schwartz, Alan R; Shirahata, Machiko; Polotsky, Vsevolod Y

    2014-10-01

    Obstructive sleep apnea causes chronic intermittent hypoxia (IH) and is associated with impaired glucose metabolism, but mechanisms are unknown. Carotid bodies orchestrate physiological responses to hypoxemia by activating the sympathetic nervous system. Therefore, we hypothesized that carotid body denervation would abolish glucose intolerance and insulin resistance induced by chronic IH. Male C57BL/6J mice underwent carotid sinus nerve dissection (CSND) or sham surgery and then were exposed to IH or intermittent air (IA) for 4 or 6 wk. Hypoxia was administered by decreasing a fraction of inspired oxygen from 20.9% to 6.5% once per minute, during the 12-h light phase (9 a.m.-9 p.m.). As expected, denervated mice exhibited blunted hypoxic ventilatory responses. In sham-operated mice, IH increased fasting blood glucose, baseline hepatic glucose output (HGO), and expression of a rate-liming hepatic enzyme of gluconeogenesis phosphoenolpyruvate carboxykinase (PEPCK), whereas the whole body glucose flux during hyperinsulinemic euglycemic clamp was not changed. IH did not affect glucose tolerance after adjustment for fasting hyperglycemia in the intraperitoneal glucose tolerance test. CSND prevented IH-induced fasting hyperglycemia and increases in baseline HGO and liver PEPCK expression. CSND trended to augment the insulin-stimulated glucose flux and enhanced liver Akt phosphorylation at both hypoxic and normoxic conditions. IH increased serum epinephrine levels and liver sympathetic innervation, and both increases were abolished by CSND. We conclude that chronic IH induces fasting hyperglycemia increasing baseline HGO via the CSN sympathetic output from carotid body chemoreceptors, but does not significantly impair whole body insulin sensitivity. Copyright © 2014 the American Physiological Society.

  7. Cancer Prevention Recommendations: Impact of Adherence.

    Science.gov (United States)

    Maresso, Karen Colbert; Hawk, Ernest

    2016-08-01

    To review the relationship between adherence to cancer prevention guidelines published by the American Cancer Society and the World Cancer Research Fund/American Institute for Cancer Research and reductions in cancer incidence, cancer mortality, cardiovascular mortality, and overall mortality. Current cancer prevention guidelines published by the American Cancer Society and the American Institute for Cancer Research, journal articles published between 2004 and 2016, and internet resources. Evidence from a number of large observational studies indicates that following current cancer prevention recommendations in a comprehensive manner results in significant reductions in both cancer risk and cancer mortality, as well as in cardiovascular mortality and overall mortality. Nurses can take the lead in familiarizing patients and families with established cancer prevention recommendations and resources that may assist patients in implementing them comprehensively in their daily lives, as well as in discussing the substantial health benefits of adhering to the recommendations. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas

    Directory of Open Access Journals (Sweden)

    Massougbodji Achille

    2007-12-01

    Full Text Available Abstract Malaria in pregnancy is one of the major causes of maternal morbidity and adverse birth outcomes. In high transmission areas, its prevention has recently changed, moving from a weekly or bimonthly chemoprophylaxis to intermittent preventive treatment (IPTp. IPTp consists in the administration of a single curative dose of an efficacious anti-malarial drug at least twice during pregnancy – regardless of whether the woman is infected or not. The drug is administered under supervision during antenatal care visits. Sulphadoxine-pyrimethamine (SP is the drug currently recommended by the WHO. While SP-IPTp seems an adequate strategy, there are many issues still to be explored to optimize it. This paper reviewed data on IPTp efficacy and discussed how to improve it. In particular, the determination of both the optimal number of doses and time of administration of the drug is essential, and this has not yet been done. As both foetal growth and deleterious effects of malaria are maximum in late pregnancy women should particularly be protected during this period. Monitoring of IPTp efficacy should be applied to all women, and not only to primi- and secondigravidae, as it has not been definitively established that multigravidae are not at risk for malaria morbidity and mortality. In HIV-positive women, there is an urgent need for specific information on drug administration patterns (need for higher doses, possible interference with sulpha-based prophylaxis of opportunistic infections. Because of the growing level of resistance of parasites to SP, alternative drugs for IPTp are urgently needed. Mefloquine is presently one of the most attractive options because of its long half life, high efficacy in sub-Saharan Africa and safety during pregnancy. Also, efforts should be made to increase IPTp coverage by improving the practices of health care workers, the motivation of women and their perception of malaria complications in pregnancy. Because IPTp

  9. Multiplicity of Plasmodium falciparum infection following intermittent preventive treatment in infants

    NARCIS (Netherlands)

    Buchholz, Ulrike; Kobbe, Robin; Danquah, Ina; Zanger, Philipp; Reither, Klaus; Abruquah, Harry H.; Grobusch, Martin P.; Ziniel, Peter; May, Jürgen; Mockenhaupt, Frank P.

    2010-01-01

    Intermittent preventive treatment in infants with sulphadoxine-pyrimethamine (IPTi-SP) reduces malaria morbidity by 20% to 33%. Potentially, however, this intervention may compromise the acquisition of immunity, including the tolerance towards multiple infections with Plasmodium falciparum.

  10. Multiplicity of Plasmodium falciparum infection following intermittent preventive treatment in infants

    NARCIS (Netherlands)

    Buchholz, U.; Kobbe, R.; Danquah, I.; Zanger, P.; Reither, K.; Abruquah, H.H.; Grobusch, M.P.; Ziniel, P.; May, J.; Mockenhaupt, F.P.

    2010-01-01

    Background: Intermittent preventive treatment in infants with sulphadoxine-pyrimethamine (IPTi-SP) reduces malaria morbidity by 20% to 33%. Potentially, however, this intervention may compromise the acquisition of immunity, including the tolerance towards multiple infections with Plasmodium

  11. Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa

    DEFF Research Database (Denmark)

    Fernandes, Silke; Sicuri, Elisa; Halimatou, Diawara

    2016-01-01

    $/DALY averted. Simulations show that cost-effectiveness of ISTp-AL increases as the efficacy of IPTp-SP decreases, though the specific threshold at which ISTp-AL becomes cost-effective depends on assumptions about the contribution of bed nets to malaria control, bed net coverage and the willingness......-to-pay threshold used.  Conclusions: At SP efficacy levels currently observed in the trial settings it would not be cost-effective to switch from IPTp-SP to ISTp-AL, mainly due to the substantially higher costs of ISTp-AL and limited difference in outcomes. The modelling results indicate thresholds below which IPT......Background: Emergence of high-grade sulfadoxine-pyrimethamine (SP) resistance in parts of Africa has led to growing concerns about the efficacy of intermittent preventive treatment of malaria during pregnancy (IPTp) with SP. The incremental cost-effectiveness of intermittent screening and treatment...

  12. Native Teen Voices: adolescent pregnancy prevention recommendations.

    Science.gov (United States)

    Garwick, Ann W; Rhodes, Kristine L; Peterson-Hickey, Melanie; Hellerstedt, Wendy L

    2008-01-01

    American Indian adolescent pregnancy rates are high, yet little is known about how Native youth view primary pregnancy prevention. The aim was to identify pregnancy prevention strategies from the perspectives of both male and female urban Native youth to inform program development. Native Teen Voices (NTV) was a community-based participatory action research study in Minneapolis and St. Paul, Minnesota. Twenty focus groups were held with 148 Native youth who had never been involved in a pregnancy. Groups were stratified by age (13-15 and 16-18 years) and sex. Participants were asked what they would do to prevent adolescent pregnancy if they were in charge of programs for Native youth. Content analyses were used to identify and categorize the range and types of participants' recommendations within and across the age and sex cohorts. Participants in all cohorts emphasized the following themes: show the consequences of adolescent pregnancy; enhance and develop more pregnancy prevention programs for Native youth in schools and community-based organizations; improve access to contraceptives; discuss teen pregnancy with Native youth; and use key messages and media to reach Native youth. Native youth perceived limited access to comprehensive pregnancy prevention education, community-based programs and contraceptives. They suggested a variety of venues and mechanisms to address gaps in sexual health services and emphasized enhancing school-based resources and involving knowledgeable Native peers and elders in school and community-based adolescent pregnancy prevention initiatives. A few recommendations varied by age and sex, consistent with differences in cognitive and emotional development.

  13. [Recommendations for the prevention of drowning].

    Science.gov (United States)

    Rubio, B; Yagüe, F; Benítez, M T; Esparza, M J; González, J C; Sánchez, F; Vila, J J; Mintegi, S

    2015-01-01

    Drowning is the second leading cause of non-intentional death in children under the age of 19 in Europe. Weather conditions in Spain allow an extended period of contact with water, therefore increasing the risk of drowning (due to the increased exposure), and constitutes the second leading cause of accidental death in children less than 14 years of age. In children younger than 5 years, drowning occurs mostly in pools belonging to private homes or communities, while in older children, drowning is often linked to aquatic recreational activities in lakes, sea, rivers and canals, and at times associated with alcohol consumption. In this article, the Committee on Safety and Non-Intentional Injury Prevention in Childhood of the Spanish Association of Pediatrics provides a series of architectonic, educational and legislative recommendations to prevent such incidents. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  14. [Recommendations for the prevention of poisoning].

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    Mintegi, S; Esparza, M J; González, J C; Rubio, B; Sánchez, F; Vila, J J; Yagüe, F; Benítez, M T

    2015-12-01

    Poisoning is the fifth leading cause of death from unintentional injury in the WHO European region, while Spain is in the group with a lower rate. Most involuntary poisonings occur in young children while they are at the home, due to unintentional ingestion of therapeutic drugs or household products. Of these, a large percentage is stored in non-original containers and/or within reach of children. In this article, the Committee on Safety and Non-Intentional Injury Prevention in Childhood of the Spanish Association of Pediatrics provides a series of recommendations, educational as well as legal, to prevent such cases. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  15. User and Provider Acceptability of Intermittent Screening and Treatment and Intermittent Preventive Treatment with Dihydroartemisinin-Piperaquine to Prevent Malaria in Pregnancy in Western Kenya.

    Directory of Open Access Journals (Sweden)

    Jenny Hill

    Full Text Available The World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp with sulphadoxine-pyrimethamine (SP alongside long-lasting insecticide-treated nets (LLIN and case management for reducing the risks associated with malaria in pregnancy in areas of moderate-to-high transmission in sub-Saharan Africa. Due to increasing Plasmodium falciparum resistance to SP, the search for alternative drugs or strategies to control malaria in pregnancy is a priority. We assessed the acceptability among pregnant women and health providers of intermittent screening and treatment (ISTp and IPTp with dihydroartemisinin-piperaquine (DP as alternative strategies in the context of an un-blinded clinical trial.Qualitative data were collected through ten focus group discussions with women participating in a randomized controlled trial to evaluate ISTp or IPTp with DP (multi-day regimen versus IPTp with SP (single dose in western Kenya. Individual in-depth interviews were conducted with 26 health providers working in the trial facilities and trial staff.Women appreciated the advantages of being tested with a rapid diagnostic test (RDT at every ANC visit (although a few women disliked finger pricks and accepted that they would not receive any antimalarial when tested RDT-negative. There were differences in women's experiences of the efficacy of antimalarials between the trial arms, with more women in the IPTp-SP arm reporting they had experienced malaria episodes. Side effects were experienced among women taking DP and SP. Although women and trial staff reported adherence to the full DP regimen within the trial, health providers were not confident that women would adhere to multi-day regimens in non-trial settings. Health providers recognized the advantages of ISTp in reducing unnecessary exposure to drugs, but lacked confidence in the reliability of RDTs compared to microscopy.Our findings indicate that, within a trial context, ISTp-DP and IPTp

  16. An audit of pressure sores caused by intermittent compression devices used to prevent venous thromboembolism.

    Science.gov (United States)

    Skillman, Joanna; Thomas, Sunil

    2011-12-01

    When intermittent compression devices (ICDs) are used to prevent venous thromboembolism (VTE) they can cause pressure sores in a selected group of women, undergoing long operations. A prospective audit pre and post intervention showed a reduced risk with an alternative device, without increasing the risk of VTE.

  17. Decline of placental malaria in southern Ghana after the implementation of intermittent preventive treatment in pregnancy

    NARCIS (Netherlands)

    Hommerich, Lena; von Oertzen, Christa; Bedu-Addo, George; Holmberg, Ville; Acquah, Patrick A.; Eggelte, Teunis A.; Bienzle, Ulrich; Mockenhaupt, Frank P.

    2007-01-01

    Intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) has been adopted as policy by many countries in sub-Saharan Africa. However, data on the post-implementation effectiveness of this measure are scarce. Clinical and parasitological parameters were assessed among

  18. Augmented surgical amounts for intermittent exotropia to prevent recurrence

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    Hatice Arda

    2014-01-01

    Full Text Available Purpose: The purpose was to evaluate the results of bilateral lateral rectus (BLR recession which is based on augmented surgical amounts of classical surgical table of Parks′ for basic and pseudo-divergence excess type intermittent exotropia [X(T]. Materials and Methods: Patients with X(T operated by the same surgeon and followed-up for at least 6 months were included. Patients with prior surgery, neurobehavioral and musculoskeletal conditions, strabismus different from that mentioned above X(T were excluded. All the patients received BLR only. The amount of the recession was increased by the amount needed to correct 5 prism diopters (PD more X(T than what was measured. After the operation, 1 st week, 2 nd and 6 months measurements were recorded. The patients were grouped according to their 1 st week (3-7 days postoperative examination as: >10 PD esotropia (Group 1, ≤10 PD esotropia (Group 2, exotropia (Group 3, and orthotropic (Group 4, respectively. Final surgical outcomes were classified as "good" (≤10 PD exotropia and ≤5 PD esotropia, "recurrence" (>10 PD exotropia and "overcorrected" (>5 esotropia. Results: Thirty-seven patients were included. The mean age was 6.78 ± 2.87 years (range: 2-12 years. Mean preoperative deviation was 29.72 ± 8.07 PD (range: 15-45 PD at distance and 20.94 ± 11.65 PD (range: 10-45 PD at near (P < 0.0001. There were 21 (56.8% patients in Group 1, 9 (24.3% patients in Group 2, 1 (2.7% patient in Group 3 and 6 (16.2% patients in Group 4. Initial esotropia was achieved in 30 (30/37 of the patients. Twenty-eight of them had good results at the end of the 6 months. Overall "motor surgical" success rate was found to be 89.2% (33/37 patients, with 1 (2.7% overcorrection and 3 (8.1% recurrences at the end of the 6 months. Conclusion: This study demonstrated that early overcorrection of 10-20 PD after X(T surgery can achieve acceptable motor outcomes in the first 6 months postoperative period.

  19. Decline of placental malaria in southern Ghana after the implementation of intermittent preventive treatment in pregnancy

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    Eggelte Teunis A

    2007-11-01

    Full Text Available Abstract Background Intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP has been adopted as policy by many countries in sub-Saharan Africa. However, data on the post-implementation effectiveness of this measure are scarce. Methods Clinical and parasitological parameters were assessed among women delivering at a district hospital in rural southern Ghana in the year 2000 when pyrimethamine chemoprophylaxis was recommended (n = 839 and in 2006 (n = 226, approximately one year after the implementation of IPTp-SP. Examinations were performed in an identical manner in 2000 and 2006 including the detection of placental Plasmodium falciparum infection by microscopy, histidine-rich protein 2, and PCR. Results In 2006, 77% of the women reported to have taken IPTp-SP at least once (26%, twice; 24%, thrice. In 2006 as compared to 2000, placental P. falciparum infection was reduced by 43–57% (P P = 0.0009, and median birth weight was 130 g higher (P = 0.02. In 2006, likewise, women who had taken ≥ 1 dose of IPTp-SP revealed less infection and anaemia and their children tended to have higher birth weights as compared to women who had not used IPTp-SP. However, placental P. falciparum infection was still observed in 11% (microscopy to 26% (PCR of those women who had taken three doses of IPTp-SP. Conclusion In southern Ghana, placental malaria and maternal anaemia have declined substantially and birth weight has increased after the implementation of IPTp-SP. Likely, these effects can further be increased by improving IPTp-SP coverage and adherence. However, the remnant prevalence of infection in women having taken three doses of IPTp-SP suggests that additional antimalarial measures are needed to prevent malaria in pregnancy in this region.

  20. Implementing intermittent preventive treatment for malaria in pregnancy

    DEFF Research Database (Denmark)

    Mubyazi, Godfrey Martin; Magnussen, Pascal; Goodman, Catherine

    2008-01-01

    and other discriminatory socio-cultural values on pregnancy; target users, perceptions and attitudes towards SP, malaria, and quality of ANC; supply and cost of SP at health facilities; understaffing and demoralised staff; ambiguity and impracticability of user-fee exemption policy guidelines on essential...... and cost-effectiveness analyses of the randomised controlled trials carried out in selected geographical settings. Such studies fail to elucidate the economic, psychosocial, managerial, organization and other contextual systemic factors influencing the operational effectiveness, compliance and coverage...... in Africa. RESULTS: The importance of IPTp in preventing unnecessary anaemia, morbidity and mortality in pregnancy and improving childbirth outcomes is highly acknowledged, although the following factors appear to be the main constraints to IPTp service delivery and uptake: cost of accessing ANC; myths...

  1. Coverage of intermittent preventive treatment and insecticide-treated nets for the control of malaria during pregnancy in sub-Saharan Africa: a synthesis and meta-analysis of national survey data, 2009-11

    NARCIS (Netherlands)

    van Eijk, Anna Maria; Hill, Jenny; Larsen, David A.; Webster, Jayne; Steketee, Richard W.; Eisele, Thomas P.; ter Kuile, Feiko O.

    2013-01-01

    Pregnant women in malaria-endemic countries in sub-Saharan Africa are especially vulnerable to malaria. Recommended prevention strategies include intermittent preventive treatment with two doses of sulfadoxine-pyrimethamine and the use of insecticide-treated nets. However, progress with

  2. Influence of intermittent preventive treatment on antibodies to VAR2CSA in pregnant Cameroonian women

    DEFF Research Database (Denmark)

    Babakhanyan, Anna; Tutterrow, Yeung L; Bobbili, Naveen

    2016-01-01

    Intermittent preventive treatment (IPT) and insecticide-treated bed nets are the standard of care for preventing malaria in pregnant women. Since these preventive measures reduce exposure to malaria, their influence on the antibody (Ab) response to the parasite antigen VAR2CSA was evaluated...... in pregnant Cameroonian women exposed to holoendemic malaria. Ab levels to full-length VAR2CSA (FV2), variants of the six Duffy binding like (DBL) domains, and proportion of high avidity Ab to FV2 were measured longitudinally in 92 women before and 147 women after IPT. As predicted, reduced exposure...

  3. Selective Intermittent Preventive Treatment of Vivax Malaria: Reduction of Malaria Incidence in an Open Cohort Study in Brazilian Amazon

    Science.gov (United States)

    Gil, Luiz Herman Soares; de Lima, Alzemar Alves; Freitag, Elci Marlei; dos Santos, Tatiana Marcondes; do Nascimento Filha, Maria Teixeira; dos Santos Júnior, Alcides Procópio Justiniano; da Silva, Josiane Mendes; Rodrigues, Aline de Freitas; Tada, Mauro Shugiro; Fontes, Cor Jesus Fernandes; Pereira da Silva, Luiz Hildebrando

    2013-01-01

    In children, the Intermittent Preventive Treatment (IPTc), currently called Seasonal Malaria Chemoprevention (SMC), was considered effective on malaria control due to the reduction of its incidence in Papua New Guinea and in some areas with seasonal malaria in Africa. However, the IPT has not been indicated because of its association with drug resistance and for hindering natural immunity development. Thus, we evaluated the alternative IPT impact on malaria incidence in three riverside communities on Madeira River, in the municipality of Porto Velho, RO. We denominate this scheme Selective Intermittent Preventive Treatment (SIPT). The SIPT consists in a weekly dose of two 150 mg chloroquine tablets for 12 weeks, for adults, and an equivalent dose for children, after complete supervised treatment for P. vivax infection. This scheme is recommend by Brazilian Health Ministry to avoid frequent relapses. The clinic parasitological and epidemiological surveillance showed a significant reduction on vivax malaria incidence. The results showed a reduction on relapses and recurrence of malaria after SIPT implementation. The SIPT can be effective on vivax malaria control in localities with high transmission risk in the Brazilian Amazon. PMID:23577276

  4. Selective Intermittent Preventive Treatment of Vivax Malaria: Reduction of Malaria Incidence in an Open Cohort Study in Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    Tony Hiroshi Katsuragawa

    2013-01-01

    Full Text Available In children, the Intermittent Preventive Treatment (IPTc, currently called Seasonal Malaria Chemoprevention (SMC, was considered effective on malaria control due to the reduction of its incidence in Papua New Guinea and in some areas with seasonal malaria in Africa. However, the IPT has not been indicated because of its association with drug resistance and for hindering natural immunity development. Thus, we evaluated the alternative IPT impact on malaria incidence in three riverside communities on Madeira River, in the municipality of Porto Velho, RO. We denominate this scheme Selective Intermittent Preventive Treatment (SIPT. The SIPT consists in a weekly dose of two 150 mg chloroquine tablets for 12 weeks, for adults, and an equivalent dose for children, after complete supervised treatment for P. vivax infection. This scheme is recommend by Brazilian Health Ministry to avoid frequent relapses. The clinic parasitological and epidemiological surveillance showed a significant reduction on vivax malaria incidence. The results showed a reduction on relapses and recurrence of malaria after SIPT implementation. The SIPT can be effective on vivax malaria control in localities with high transmission risk in the Brazilian Amazon.

  5. Parasite clearance following treatment with sulphadoxine-pyrimethamine for intermittent preventive treatment in Burkina-Faso and Mali

    DEFF Research Database (Denmark)

    Coulibaly, Sheick O; Kayentao, Kassoum; Taylor, Steve

    2014-01-01

    Intermittent Preventive Treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is widely used for the control of malaria in pregnancy in Africa. The emergence of resistance to SP is a concern requiring monitoring the effectiveness of SP for IPTp....

  6. Preventing Childhood obesity. EPODE European Network Recommendations

    NARCIS (Netherlands)

    Borys, J.M.; Le Bodo, Y.; De Henauw, S.; Moreno, L.A.; Romon, M.; Seidell, J.C.; Visscher, T.L.S.

    2011-01-01

    Childhood obesity is a complex issue and needs multistakeholder involvement at all levels to foster healthier lifestyles in a sustainable way. 'Ensemble Prévenons l'ObésitéDes Enfants' (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for

  7. Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: a randomised controlled non-inferiority trial.

    Directory of Open Access Journals (Sweden)

    Harry Tagbor

    2010-12-01

    Full Text Available The effectiveness of intermittent preventive treatment of malaria in pregnancy (IPTp may be compromised by the spread of resistance to sulphadoxine/pyrimethamine (SP across Africa. But little information exists on alternative drugs for IPTp or alternative strategies for the prevention of malaria in pregnancy. Therefore, we have investigated whether screening with a rapid diagnostic test and treatment of those who are positive (IST at routine antenatal clinic attendances is as effective and as safe as SP-IPTp in pregnant women.During antenatal clinic sessions in six health facilities in Ghana held between March 2007 and September 2007, 3333 pregnant women who satisfied inclusion criteria were randomised into three intervention arms (1 standard SP-IPTp, (2 IST and treatment with SP or (3 IST and treatment with amodiaquine+artesunate (AQ+AS. All women received a long-lasting insecticide treated net. Study women had a maximum of three scheduled follow-up visits following enrollment. Haemoglobin concentration and peripheral parasitaemia were assessed between 36 and 40 weeks of gestation. Birth weight was measured at delivery or within 72 hours for babies delivered at home. Parasite prevalence at enrollment in primigravidae and in multigravidae was 29.6% and 10.2% respectively. At 36-40 weeks of gestation the prevalence of asymptomatic parasitaemia was 12.1% in study women overall and was very similar in all treatment groups. The risk of third trimester severe anaemia or low birth weight did not differ significantly between the three treatment groups regardless of gravidity. IST with AQ+AS or SP was not inferior to SP-IPTp in reducing the risk of low birth weight (RD  =  -1.17[95%CI; -4.39-1.02] for IST-SP vs. SP-IPTp and RD = 0.78[95%CI; -2.11-3.68] for IST-AQAS vs. SP-IPTp; third trimester severe anaemia (RD = 0.29[95%CI; -0.69-1.30] for IST-SP vs. SP-IPTp and RD  =  -0.36[95%CI;-1.12-0.44] for IST-AQAS vs. SP-IPTp.The results of this study

  8. Nutritional recommendations for cardiovascular disease prevention.

    Science.gov (United States)

    Eilat-Adar, Sigal; Sinai, Tali; Yosefy, Chaim; Henkin, Yaakov

    2013-09-17

    Lifestyle factors, including nutrition, play an important role in the etiology of Cardiovascular Disease (CVD). This position paper, written by collaboration between the Israel Heart Association and the Israel Dietetic Association, summarizes the current, preferably latest, literature on the association of nutrition and CVD with emphasis on the level of evidence and practical recommendations. The nutritional information is divided into three main sections: dietary patterns, individual food items, and nutritional supplements. The dietary patterns reviewed include low carbohydrate diet, low-fat diet, Mediterranean diet, and the DASH diet. Foods reviewed in the second section include: whole grains and dietary fiber, vegetables and fruits, nuts, soy, dairy products, alcoholic drinks, coffee and caffeine, tea, chocolate, garlic, and eggs. Supplements reviewed in the third section include salt and sodium, omega-3 and fish oil, phytosterols, antioxidants, vitamin D, magnesium, homocysteine-reducing agents, and coenzyme Q10.

  9. Nutritional Recommendations for Cardiovascular Disease Prevention

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    Yaakov Henkin

    2013-09-01

    Full Text Available Lifestyle factors, including nutrition, play an important role in the etiology of Cardiovascular Disease (CVD. This position paper, written by collaboration between the Israel Heart Association and the Israel Dietetic Association, summarizes the current, preferably latest, literature on the association of nutrition and CVD with emphasis on the level of evidence and practical recommendations. The nutritional information is divided into three main sections: dietary patterns, individual food items, and nutritional supplements. The dietary patterns reviewed include low carbohydrate diet, low-fat diet, Mediterranean diet, and the DASH diet. Foods reviewed in the second section include: whole grains and dietary fiber, vegetables and fruits, nuts, soy, dairy products, alcoholic drinks, coffee and caffeine, tea, chocolate, garlic, and eggs. Supplements reviewed in the third section include salt and sodium, omega-3 and fish oil, phytosterols, antioxidants, vitamin D, magnesium, homocysteine-reducing agents, and coenzyme Q10.

  10. Nutritional Recommendations for Cardiovascular Disease Prevention

    Science.gov (United States)

    Eilat-Adar, Sigal; Sinai, Tali; Yosefy, Chaim; Henkin, Yaakov

    2013-01-01

    Lifestyle factors, including nutrition, play an important role in the etiology of Cardiovascular Disease (CVD). This position paper, written by collaboration between the Israel Heart Association and the Israel Dietetic Association, summarizes the current, preferably latest, literature on the association of nutrition and CVD with emphasis on the level of evidence and practical recommendations. The nutritional information is divided into three main sections: dietary patterns, individual food items, and nutritional supplements. The dietary patterns reviewed include low carbohydrate diet, low-fat diet, Mediterranean diet, and the DASH diet. Foods reviewed in the second section include: whole grains and dietary fiber, vegetables and fruits, nuts, soy, dairy products, alcoholic drinks, coffee and caffeine, tea, chocolate, garlic, and eggs. Supplements reviewed in the third section include salt and sodium, omega-3 and fish oil, phytosterols, antioxidants, vitamin D, magnesium, homocysteine-reducing agents, and coenzyme Q10. PMID:24067391

  11. Folic Acid for the Prevention of Neural Tube Defects : US Preventive Services Task Force Recommendation Statement

    NARCIS (Netherlands)

    Calonge, Ned; Petitti, Diana B.; DeWitt, Thomas G.; Dietrich, Allen J.; Gregory, Kimberly D.; Grossman, David; Isham, George; LeFevre, Michael L.; Leipzig, Rosanne M.; Marion, Lucy N.; Melnyk, Bernadette; Moyer, Virginia A.; Ockene, Judith K.; Sawaya, George F.; Schwartz, J. Sanford; Wilt, Timothy

    2009-01-01

    Description: In 1996, the U. S. Preventive Services Task Force (USPSTF) recommended that all women planning or capable of pregnancy take a multivitamin supplement containing folic acid for the prevention of neural tube defects. This recommendation is an update of the 1996 USPSTF recommendation.

  12. A non-inferiority, individually randomized trial of intermittent screening and treatment versus intermittent preventive treatment in the control of malaria in pregnancy

    DEFF Research Database (Denmark)

    Tagbor, Harry; Cairns, Matthew; Bojang, Kalifa

    2015-01-01

    BACKGROUND: The efficacy of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine (IPTp-SP) in pregnancy is threatened in parts of Africa by the emergence and spread of resistance to SP. Intermittent screening with a rapid diagnostic test (RDT) and treatment of positive women...... with malaria parasitemia between routine antenatal clinics (310 vs 182 episodes, rate difference: 49.4 per 1,000 pregnancies [95% CI 30.5, 68.3], but the number of hospital admissions for malaria was similar in the two groups. CONCLUSIONS: Despite low levels of resistance to SP in the study areas, ISTp......-AL performed as well as IPTp-SP. In the absence of an effective alternative medication to SP for IPTp, ISTp-AL is a potential alternative to IPTp in areas where SP resistance is high. It may also have a role in areas where malaria transmission is low and for the prevention of malaria in HIV positive women...

  13. IntermIttent PreventIve treatment and Bed nets uPtake among ...

    African Journals Online (AJOL)

    2015, in the number of pregnant women in Kenya receiving recommended malaria prophylaxis in the ... recommended that at least three IPtp doses be provided to pregnant ..... operational research and training Initiative (sort. It), a global ...

  14. The management of patients with peripheral arterial disease and intermittent claudication. Actual recommendations.

    Science.gov (United States)

    Tîrziu, Cristina; Bădilă, Elisabeta; Mehic, Florentina; Ghiorghe, S; Bartoş, Daniela

    2010-01-01

    In the general context of increasing prevalence of cardiovascular risk factors in European population, we face with a significant rise of the incidence of atherothrombotic diseases. Peripheral arterial disease (PAD) represented for a long time a peripheral interest for cardiologist. The epidemiological studies in the latest years determine a reconsideration of the medical attitude in respect of PAD, motivated by an increase in its prevalence and, on the other hand, by the significant cardiovascular risk this disease carries with. Taking into account that fact and aiming at a better medical approach of these patients, we realized a review regarding therapeutic methods in patients with PAD and intermittent claudication based on the latest medical publications and in accord with the guide in force at the moment.

  15. [Access to intermittent preventive treatment (IPt) in a situation of abolition of user's fee: role of economic welfare].

    Science.gov (United States)

    Faye, A; Manga, N M; Seck, I; Niang, K; Leye, M M; Diagne-Camara, M; Diongue, M; Ba, M; Ndiaye, P; Tal-Dia, A

    2012-08-01

    In Senegal, the free distribution of sulfadoxine pyrimethamine during antenatal care is recommended to remove the disparity in the context of intermittent preventive treatment against malaria. The objective of this study was thus to identify factors influencing access to treatment in a situation of abolition of user fees. It was a cross-sectional and analytical study. It covered a sample of 1906 women aged 15-49 years randomly selected during the national survey on malaria in Senegal. Data were collected during a personal interview. The economic well-being was measured from the characteristics of housing and durable goods. The multivariate analysis was performed using logistic regression. The average age was 27.94 ± 5.34, 64.27% resided in rural area and 71.8% had received no schooling. Among the surveyed women, 23% were in the poorest quintile, while 16.3% were in the richest. Intermittent preventive treatment was performed in 49.3%. IPt were made more in urban areas (OR 1.45 95% [1.17 to 1.72]). It increased with the level of education with an OR of 1.5 and 1.68 in primary and secondary. The completion of the IPt increased with economic welfare. The OR ranged from 1.44 to 2.95 in the second quintile to the richest. Free medication does not necessarily benefit poor people. Other accompanying measures must be developed to facilitate the distribution of drugs particularly at community level with the involvement of people.

  16. Factors influencing dropout rate of intermittent preventive treatment of malaria during pregnancy.

    Science.gov (United States)

    Doku, David Teye; Zankawah, Mumuni Mukaila; Adu-Gyamfi, Addae Boateng

    2016-10-10

    The burden of malaria in terms of morbidity and mortality is huge is Sub-Saharan Africa, particularly among pregnant women. Among the measures to curb down this burden include intermittent preventive treatment (IPT) and effective case management. These strategies were adopted by Ghana and implemented since 2003; however, there is still high dropout rate in IPT coverage. This study sought to investigate factors contributing to high dropout rate between IPT1 and IPT3 in the Tamale Metropolis, one of the health facilities with the highest IPT dropout rates in Ghana. Survey, in-depth interviews and short ethnographic techniques were conducted among pregnant women, antenatal care (ANC) health workers and heads of health facilities to investigate factors which account for dropout rate of intermittent treatment of malaria. Shortage of sulphadoxine pyrimethamine (SP), inadequate supply of portable water for administration of SP, unavailability of IPT during outreach services, lack of knowledge by ANC staff about the dropout rate in their area of jurisdiction and poor attitude of some health workers were identified as barriers to achieving high IPT3 coverage. Late ANC visit, provider and logistical barriers account for the women's missed opportunities to prevent malaria in pregnancy through IPT. Addressing the above barriers will contribute to saving lives and ensuring progress towards the goal of combating malaria as well as reducing maternal, neonatal and child mortalities.

  17. Intermittent preventive treatment with sulphadoxine-pyrimethamine is effective in preventing maternal and placental malaria in Ibadan, south-western Nigeria

    Directory of Open Access Journals (Sweden)

    Mokuolu Olugbenga A

    2007-07-01

    Full Text Available Abstract Background Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP is currently the recommended regimen for prevention of malaria in pregnancy in endemic areas. This study sets out to evaluate the effectiveness of IPT-SP in the prevention of maternal and placental malaria in parturient mothers in Ibadan, Nigeria, where the risk of malaria is present all year round. Method During a larger study evaluating the epidemiology of congenital malaria, the effect of malaria prophylaxis was examined in 983 parturient mothers. Five hundred and ninety eight mothers (60.8% received IPT-SP, 214 (21.8% received pyrimethamine (PYR and 171 (17.4% did not take any chemoprophylactic agent (NC. Results The prevalence of maternal parasitaemia in the IPT-SP, PYR and NC groups was 10.4%, 15.9% and 17% respectively (p = 0.021. The prevalence of placental parasitaemia was 10.5% in the IPT-SP, 16.8% PYR and 17% NC groups, respectively (p = 0.015. The prevalence of maternal anaemia (haematocrit Conclusion IPT-SP is effective in preventing maternal and placental malaria as well as improving pregnancy outcomes among parturient women in Ibadan, Nigeria. The implementation of the recently adopted IPT-SP strategy should be pursued with vigour as it holds great promise for reducing the burden of malaria in pregnancy in Nigeria.

  18. Community-Based Promotional Campaign to Improve Uptake of Intermittent Preventive Antimalarial Treatment in Pregnancy in Burkina Faso

    NARCIS (Netherlands)

    Gies, Sabine; Coulibaly, Sheick O.; Ky, Clotilde; Ouattara, Florence T.; Brabin, Bernard J.; d'Alessandro, Umberto

    2009-01-01

    Malaria preventive strategies in pregnancy were assessed in a health center randomized trial comparing intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) with and without community based promotional activities in rural Burkina Faso. The study involved 2,240 secundigravidae

  19. Intra-accumbens Raclopride Administration Prevents Behavioral Changes Induced by Intermittent Access to Sucrose Solution

    Directory of Open Access Journals (Sweden)

    Josué O. Suárez-Ortiz

    2018-02-01

    Full Text Available Overeating is one of the most relevant clinical features in Binge Eating Disorder and in some obesity patients. According to several studies, alterations in the mesolimbic dopaminergic transmission produced by non-homeostatic feeding behavior may be associated with changes in the reward system similar to those produced by drugs of abuse. Although it is known that binge-eating is related with changes in dopaminergic transmission mediated by D2 receptors in the nucleus accumbens shell (NAcS, it has not been determined whether these receptors may be a potential target for the treatment of eating pathology with binge-eating. Accordingly, the aim of the present study was to evaluate whether sugar binging induced by intermittent access to a sucrose solution produced changes in the structure of feeding behavior and whether blocking D2 receptors prevented these changes. We used the intermittent access model to a 10% sucrose solution (2 h/day for 4 weeks to induce sugar binging in Sprague Dawley female rats. Experimental subjects consumed in a 2-h period more than 50% of the caloric intake consumed by the subjects with ad-lib access to the sweetened solution without any increase in body weight or fat accumulation. Furthermore, we evaluated whether sugar binging was associated to the estrous cycle and we did not find differences in caloric intake (estrous vs. diestrus. Subsequently, we characterized the structure of feeding behavior (microstructural analysis and the motivation for palatable food (breakpoints of the subjects with sugar binging and found that feeding episodes had short latencies, high frequencies, as well as short durations and inter-episode intervals. The intermittent access model did not increase breakpoints, as occurred in subjects with ad-lib access to the sucrose. Finally, we evaluated the effects of D2 receptor blockade in the NAcS, and found that raclopride (18 nM prevented the observed changes in the frequency and duration of

  20. The effects of Ramadan intermittent fasting on athletic performance: recommendations for the maintenance of physical fitness.

    Science.gov (United States)

    Chaouachi, Anis; Leiper, John B; Chtourou, Hamdi; Aziz, Abdul Rashid; Chamari, Karim

    2012-01-01

    The behavioural modifications that accompany Ramadan intermittent fasting (RIF) are usually associated with some alterations in the metabolic, physiological, and psychological responses of athletes that may affect sport performance. Muslim athletes who are required to train and/or compete during the month-long, diurnal fast must adopt coping strategies that allow them to maintain physical fitness and motivation if they are to perform at the highest level. This updated review aims to present the current state of knowledge of the effects of RIF on training and performance, focusing on key-factors that contribute to the effects of Ramadan on exercise performance: energy restriction, sleep deprivation, circadian rhythm perturbation, dehydration, and alterations in the training load. The available literature contain few studies that have examined the effects of RIF on physical performance in athletes and, to date, the results are inconclusive, so the effects of RIF on competition outcomes are not at present wholly understood. The diverse findings probably indicate individual differences in the adaptability and self-generated coping strategies of athletes during fasting and training. However, the results of the small number of well-controlled studies that have examined the effects of Ramadan on athletic performance suggest that few aspects of physical fitness are negatively affected, and where decrements are observed these are usually modest. Subjective feelings of fatigue and other mood indicators are often cited as implying additional stress on the athlete throughout Ramadan, but most studies show that these factors may not result in decreases in performance and that perceived exercise intensity is unlikely to increase to any significant degree. Current evidence from good, well-controlled research supports the conclusion that athletes who maintain their total energy and macronutrient intake, training load, body composition, and sleep length and quality are unlikely to

  1. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets.

    Science.gov (United States)

    Munns, Craig F; Shaw, Nick; Kiely, Mairead; Specker, Bonny L; Thacher, Tom D; Ozono, Keiichi; Michigami, Toshimi; Tiosano, Dov; Mughal, M Zulf; Mäkitie, Outi; Ramos-Abad, Lorna; Ward, Leanne; DiMeglio, Linda A; Atapattu, Navoda; Cassinelli, Hamilton; Braegger, Christian; Pettifor, John M; Seth, Anju; Idris, Hafsatu Wasagu; Bhatia, Vijayalakshmi; Fu, Junfen; Goldberg, Gail; Sävendahl, Lars; Khadgawat, Rajesh; Pludowski, Pawel; Maddock, Jane; Hyppönen, Elina; Oduwole, Abiola; Frew, Emma; Aguiar, Magda; Tulchinsky, Ted; Butler, Gary; Högler, Wolfgang

    2016-02-01

    Vitamin D and calcium deficiencies are common worldwide, causing nutritional rickets and osteomalacia, which have a major impact on health, growth, and development of infants, children, and adolescents; the consequences can be lethal or can last into adulthood. The goals of this evidence-based consensus document are to provide health care professionals with guidance for prevention, diagnosis, and management of nutritional rickets and to provide policy makers with a framework to work toward its eradication. A systematic literature search examining the definition, diagnosis, treatment, and prevention of nutritional rickets in children was conducted. Evidence-based recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system that describe the strength of the recommendation and the quality of supporting evidence. Thirty-three nominated experts in pediatric endocrinology, pediatrics, nutrition, epidemiology, public health, and health economics evaluated the evidence on specific questions within five working groups. The consensus group, representing 11 international scientific organizations, participated in a multiday conference in May 2014 to reach a global evidence-based consensus. This consensus document defines nutritional rickets and its diagnostic criteria and describes the clinical management of rickets and osteomalacia. Risk factors, particularly in mothers and infants, are ranked, and specific prevention recommendations including food fortification and supplementation are offered for both the clinical and public health contexts. Rickets, osteomalacia, and vitamin D and calcium deficiencies are preventable global public health problems in infants, children, and adolescents. Implementation of international rickets prevention programs, including supplementation and food fortification, is urgently required.

  2. Prevention of rectal SHIV transmission in macaques by daily or intermittent prophylaxis with emtricitabine and tenofovir.

    Directory of Open Access Journals (Sweden)

    J Gerardo García-Lerma

    2008-02-01

    Full Text Available In the absence of an effective vaccine, HIV continues to spread globally, emphasizing the need for novel strategies to limit its transmission. Pre-exposure prophylaxis (PrEP with antiretroviral drugs could prove to be an effective intervention strategy if highly efficacious and cost-effective PrEP modalities are identified. We evaluated daily and intermittent PrEP regimens of increasing antiviral activity in a macaque model that closely resembles human transmission.We used a repeat-exposure macaque model with 14 weekly rectal virus challenges. Three drug treatments were given once daily, each to a different group of six rhesus macaques. Group 1 was treated subcutaneously with a human-equivalent dose of emtricitabine (FTC, group 2 received orally the human-equivalent dosing of both FTC and tenofovir-disoproxil fumarate (TDF, and group 3 received subcutaneously a similar dosing of FTC and a higher dose of tenofovir. A fourth group of six rhesus macaques (group 4 received intermittently a PrEP regimen similar to group 3 only 2 h before and 24 h after each weekly virus challenge. Results were compared to 18 control macaques that did not receive any drug treatment. The risk of infection in macaques treated in groups 1 and 2 was 3.8- and 7.8-fold lower than in untreated macaques (p = 0.02 and p = 0.008, respectively. All six macaques in group 3 were protected. Breakthrough infections had blunted acute viremias; drug resistance was seen in two of six animals. All six animals in group 4 that received intermittent PrEP were protected.This model suggests that single drugs for daily PrEP can be protective but a combination of antiretroviral drugs may be required to increase the level of protection. Short but potent intermittent PrEP can provide protection comparable to that of daily PrEP in this SHIV/macaque model. These findings support PrEP trials for HIV prevention in humans and identify promising PrEP modalities.

  3. Prevention of urethral stricture recurrence using clean intermittent self-catheterization

    DEFF Research Database (Denmark)

    Kjaergaard, B; Walter, S; Bartholin, J

    1994-01-01

    OBJECTIVE: To investigate the effect of clean intermittent catheterization (CIC) on prevention of urethral stricture recurrence after internal urethrotomy. PATIENTS AND METHODS: Of 55 men who were randomly selected, 43 completed the investigation. Of these, 21 patients performed CIC weekly for 1...... year following Sachse's operation for urethral stricture and 22 patients formed the control group after the same operation. All had an objective examination for urethral stricture every 2 months after surgery. RESULTS: Significantly fewer (P urethral stricture...... within the first postoperative year in the CIC group (n = 4) compared with the control group (n = 15). No CIC complications were seen, and patients who completed the CIC programme considered the method fully acceptable. CONCLUSION: Weekly CIC is a simple method of reducing the frequency of urethral...

  4. Efficacy and safety of intermittent preventive treatment for malaria in schoolchildren: a systematic review.

    Science.gov (United States)

    Matangila, Junior R; Mitashi, Patrick; Inocêncio da Luz, Raquel A; Lutumba, Pascal T; Van Geertruyden, Jean-Pierre

    2015-11-14

    Intermittent preventive treatment (IPT) is a proven malaria control strategy in infants and pregnancy. School-aged children represent 26 % of the African population, and an increasing percentage of them are scholarized. Malaria is causing 50 % of deaths in this age group and malaria control efforts may shift the malaria burden to older age groups. Schools have been suggested as a platform for health interventions delivery (deworming, iron-folic acid, nutrients supplementation, (boost-)immunization) and as a possible delivery system for IPT in schoolchildren (IPTsc). However, the current evidence on the efficacy and safety of IPTsc is limited and the optimal therapeutic regimen remains controversial. A systematic search for studies reporting efficacy and safety of IPT in schoolchildren was conducted using PubMed, Web of Science, Clinicaltrials and WHO/ICTRP database, and abstracts from congresses with the following key words: intermittent, preventive treatment AND malaria OR Plasmodium falciparum AND schoolchildren NOT infant NOT pregnancy. Five studies were identified. Most IPTsc regimes demonstrated substantial protection against malaria parasitaemia, with dihydroartemisinin-piperaquine (DP) given monthly having the highest protective effect (PE) (94 %; 95 % CI 93-96). Contrarily, SP did not provide any PE against parasitaemia. However, no IPT regimen provided a PE above 50 % in regard to anaemia, and highest protection was provided by SP+ amodiaquine (AQ) given four-monthly (50 %; 95 % CI 41-53). The best protection against clinical malaria was observed in children monthly treated with DP (97 %; 95 % CI 87-98). However, there was no protection when the drug was given three-monthly. No severe adverse events were associated with the drugs used for IPTsc. IPTsc may reduce the malaria-related burden in schoolchildren. However, more studies assessing efficacy of IPT in particular against malaria-related anaemia and clinical malaria in schoolchildren must be conducted.

  5. Air pollution prevention at the Hanford Site: Status and recommendations

    International Nuclear Information System (INIS)

    Engel, J.A.

    1995-08-01

    With the introduction of the Clean Air Act Amendments of 1990 and other air and pollution prevention regulations, there has been increased focus on both pollution prevention and air emissions at US DOE sites. The Pollution Prevention (P2) Group of WHC reviewed the status of air pollution prevention with the goal of making recommendations on how to address air emissions at Hanford through pollution prevention. Using the air emissions inventory from Hanford's Title V permit, the P2 Group was able to identify major and significant air sources. By reviewing the literature and benchmarking two other DOE Sites, two major activities were recommended to reduce air pollution and reduce costs at the Hanford Site. First, a pollution prevention opportunity assessment (P2OA) should be conducted on the significant painting sources in the Maintenance group and credit should be taken for reducing the burning of tumbleweeds, another significant source of air pollution. Since they are significant sources, reducing these emissions will reduce air emission fees, as well as have the potential to reduce material and labor costs, and increase worker safety. Second, a P2OA should be conducted on alternatives to the three coal-fired powerhouses (steam plants) on-site, including a significant costs analysis of alternatives. This analysis could be of significant value to other DOE sites. Overall, these two activities would reduce pollution, ease regulatory requirements and fees, save money, and help Hanford take a leadership role in air pollution prevention

  6. Community response to intermittent preventive treatment of malaria in infants (IPTi in Papua New Guinea

    Directory of Open Access Journals (Sweden)

    Senn Nicolas

    2010-12-01

    Full Text Available Abstract Background Building on previous acceptability research undertaken in sub-Saharan Africa this article aims to investigate the acceptability of intermittent preventive treatment of malaria in infants (IPTi in Papua New Guinea (PNG. Methods A questionnaire was administered to mothers whose infants participated in the randomised placebo controlled trial of IPTi. Mothers whose infants participated and who refused to participate in the trial, health workers, community reporters and opinion leaders were interviewed. Men and women from the local community also participated in focus group discussions. Results Respondents viewed IPTi as acceptable in light of wider concern for infant health and the advantages of trial participation. Mothers reported complying with at-home administration of IPTi due to perceived benefits of IPTi and pressure from health workers. In spite of patchy knowledge, respondents also demonstrated a demand for infant vaccinations and considered non-vaccination to be neglect. There is little evidence that IPTi has negative impacts on attitudes to EPI, EPI adherence or existing malaria prevention practices. Conclusion The degree of similarity between findings from the acceptability studies undertaken in sub-Saharan Africa and PNG allows some generalization relating to the implementation of IPTi outside of Africa: IPTi fits well with local health cultures, appears to be accepted easily and has little impact on attitudes towards EPI or malaria prevention. The study adds to the evidence indicating that IPTi could be rolled out in a range of social and cultural contexts.

  7. Implementation of intermittent preventive treatment with sulphadoxine-pyrimethamine for control of malaria in pregnancy in Kisumu, western Kenya

    NARCIS (Netherlands)

    van Eijk, Anna M.; Ayisi, John G.; ter Kuile, Feiko O.; Slutsker, L.; Otieno, Juliana A.; Misore, Ambrose O.; Odondi, J. O.; Rosen, Daniel H.; Kager, Piet A.; Steketee, Rick W.; Nahlen, Bernard L.

    2004-01-01

    OBJECTIVE In 1998, the Kenyan Ministry of Health introduced intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP), one treatment dose in the second trimester (16-27 weeks) and one treatment dose between 28 and 34 weeks of gestational age, for the control of malaria in

  8. A new strategy and its effect on adherence to intermittent preventive treatment of malaria in pregnancy in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Yanow, Stephanie; Birungi, Josephine

    2013-01-01

    Few women in Uganda access intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP). Previous studies have shown that high costs, frequent stock-out of drugs, supplies and poor quality of care are the greatest hindrance for women to access health services...

  9. The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa

    NARCIS (Netherlands)

    Conteh, Lesong; Sicuri, Elisa; Manzi, Fatuma; Hutton, Guy; Obonyo, Benson; Tediosi, Fabrizio; Biao, Prosper; Masika, Paul; Matovu, Fred; Otieno, Peter; Gosling, Roly D.; Hamel, Mary; Odhiambo, Frank O.; Grobusch, Martin P.; Kremsner, Peter G.; Chandramohan, Daniel; Aponte, John J.; Egan, Andrea; Schellenberg, David; Macete, Eusebio; Slutsker, Laurence; Newman, Robert D.; Alonso, Pedro; Menéndez, Clara; Tanner, Marcel

    2010-01-01

    BACKGROUND: Intermittent preventive treatment in infants (IPTi) has been shown to decrease clinical malaria by approximately 30% in the first year of life and is a promising malaria control strategy for Sub-Saharan Africa which can be delivered alongside the Expanded Programme on Immunisation (EPI).

  10. Recommendations for prevention of radiation accident in industrial gammagraphy

    International Nuclear Information System (INIS)

    Souza, L.S.; Silva, F.C.A. da

    2017-01-01

    Industrial Gammagraphy plays an important role in the quality control of various materials and components. It is classified by the International Atomic Energy Agency - IAEA as Category 2, due to its radiation risk caused by the use of high activity radioactive sources. This risk is based on the harmful consequences of human health, described in some accidents in the world, due to failures. In 2012, the 'Brazilian National Workshop on Accident Prevention in Industrial Gammagraphy' was carried out by DIAPI/CNEN, with the objective of disseminating knowledge about radiation accidents. At the time, the IRD/CNEN-RJ carried out a survey with the 75 participants using a form with 22 recommendations to prevent radiological accidents, in order to select the 10 most voted. A statistical study, using the 'Frequency Distribution' method, was performed to define 10 recommendations. The percentage and vote results were obtained by category of the participants and the 10 most important recommendations were defined to prevent radiation accidents. The recommendation that came in first place was 'Always use an individual monitor with alarm during all work'

  11. Selection of antimalarial drug resistance after intermittent preventive treatment of infants and children (IPTi/c) in Senegal.

    Science.gov (United States)

    Ndiaye, Magatte; Tine, Roger; Faye, Babacar; Ndiaye, Jean L; Diouf, Ibrahima; Lo, Aminata C; Sylla, Khadime; Dieng, Yemou; Hallett, Rachel; Alifrangis, Michael; Gaye, Oumar

    2013-01-01

    Senegal has since 2003 used sulphadoxine-pyrimethamine (SP) for Intermittent Preventive Treatment (IPT) of malaria in risk groups. However, the large-scale IPT strategy may result in increasing drug resistance. Our study investigated the possible impact of SP-IPT given to infants and children on the prevalence of SP-resistant haplotypes in the Plasmodium falciparum genes Pfdhfr and Pfdhps, comparing sites with and without IPTi/c. P. falciparum positives samples (n=352) were collected from children under 5years of age during two cross-sectional surveys in 2010 and 2011 in three health districts (two on IPTi/c and one without IPTi/c intervention) located in the southern part of Senegal. The prevalence of SP-resistance-related haplotypes in Pfdhfr and Pfdhps was determined by nested PCR followed by sequence-specific oligonucleotide probe (SSOP)-ELISA. The prevalence of the Pfdhfr double mutant haplotypes (CNRN and CICN) was stable between years atSenegal according to WHO recommendations. Copyright © 2013 Académie des sciences. Published by Elsevier SAS. All rights reserved.

  12. Intermittent warming of 'Tahiti' lime to prevent chilling injury during cold storage

    Directory of Open Access Journals (Sweden)

    Kluge Ricardo Alfredo

    2003-01-01

    Full Text Available Storage of 'Tahiti' limes (Citrus latifolia at low temperature allows the marketing period to be extended. However, the loss of the green skin color and the occurrence of chilling injury (CI prevent this extension. The purpose of this work was to verify the efficiency of intermittent warming (IW in 'Tahiti' lime quality maintenance during cold storage. Fruit were submitted to IW (20ºC for 48 hours every 7 or 14 days or 38ºC for 24 hours every 14 days during cold storage at 5ºC. Fruit were also stored at 5 and 10ºC continuously. The evaluations were carried out after 30 and 60 days of storage (+ 3 days of simulated marketing at 20ºC. CI occurrence on fruit was not verified after 30 days of storage. However, after 60 days of storage 60% of the fruit kept continuously at 5ºC presented CI, while fruit intermittently warmed had 10 to 12.5% CI. Fruit stored at 10ºC did not present CI, but they showed high degreening after 30 days of storage. Fruit warmed at 38ºC for 24 hours every 14 days developed rot, loss of green skin color and vitamin C, high respiratory rates, as well as high levels of ethanol and acetaldehyde in the juice. Fruit can be stored at 5ºC during 30 days, without risk of CI, while IW can be used to reduce CI after 60 days of storage.

  13. Azithromycin-chloroquine and the intermittent preventive treatment of malaria in pregnancy

    Directory of Open Access Journals (Sweden)

    Greenwood Brian

    2008-12-01

    Full Text Available Abstract In the high malaria-transmission settings of sub-Saharan Africa, malaria in pregnancy is an important cause of maternal, perinatal and neonatal morbidity. Intermittent preventive treatment of malaria in pregnancy (IPTp with sulphadoxine-pyrimethamine (SP reduces the incidence of low birth-weight, pre-term delivery, intrauterine growth-retardation and maternal anaemia. However, the public health benefits of IPTp are declining due to SP resistance. The combination of azithromycin and chloroquine is a potential alternative to SP for IPTp. This review summarizes key in vitro and in vivo evidence of azithromycin and chloroquine activity against Plasmodium falciparum and Plasmodium vivax, as well as the anticipated secondary benefits that may result from their combined use in IPTp, including the cure and prevention of many sexually transmitted diseases. Drug costs and the necessity for external financing are discussed along with a range of issues related to drug resistance and surveillance. Several scientific and programmatic questions of interest to policymakers and programme managers are also presented that would need to be addressed before azithromycin-chloroquine could be adopted for use in IPTp.

  14. Randomized controlled trial of enoxaparin versus intermittent pneumatic compression for venous thromboembolism prevention in Japanese surgical patients with gynecologic malignancy.

    Science.gov (United States)

    Nagata, Chie; Tanabe, Hiroshi; Takakura, Satoshi; Narui, Chikage; Saito, Motoaki; Yanaihara, Nozomu; Okamoto, Aikou

    2015-09-01

    The aim of this study was to compare the efficacy and safety of enoxaparin and intermittent pneumatic compression (IPC) for venous thromboembolism (VTE) prevention in Japanese surgical patients with gynecologic malignancy. Patients ≥ 40 years old undergoing major surgery for gynecologic malignancy without preoperative VTE were included. Written informed consent was obtained. Enrolled patients received IPC immediately before surgery. After surgery, they were randomly assigned to either an enoxaparin group or an IPC-alone group. The enoxaparin group received enoxaparin injection (20 mg, subcutaneous, every 12 h) from postoperative day 2 to 8. IPC was discontinued after the first injection. In the IPC-alone group, IPC was continued until full ambulation. The primary end-point was incidence of VTE, including pulmonary embolism and deep vein thrombosis, regardless of symptoms. An interim analysis was to be conducted when the first 30 patients had completed the study protocol. A Data and Safety Monitoring Board was established for making recommendation on the continuation or termination of the study based on the interim results. At the time of the interim analysis, six cases of VTE were found: five in the IPC-alone group and one in the enoxaparin group (Fisher's exact test, P = 0.08). Three patients in the IPC-alone group developed pulmonary embolism, but none in the enoxaparin group did so (Fisher's exact test, P = 0.10). The study was terminated following the Data and Safety Monitoring Board's recommendation. Enoxaparin might have lowered the risk of VTE among surgical patients with gynecologic malignancy. Further studies are necessary to confirm this. © 2015 Japan Society of Obstetrics and Gynecology.

  15. Exercise for prevention of cardiovascular disease: Evidence-based recommendations

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    Geevar Zachariah

    2017-01-01

    Full Text Available Sedentary lifestyle is one of the major risk factors for cardiovascular disease (CVD. In India, a large percentage of the people are physically inactive with fewer than 10% engaging in recreational physical activity. Physical activity has many beneficial effects on the risk factors for CVD. Apart from improving fitness level, it decreases myocardial oxygen demand and improves myocardial perfusion. There is an inverse association between physical activity and all-cause mortality. In primary prevention, physical inactivity is associated with a two-fold increase in the risk for coronary events. In secondary prevention, data confirm the existence of an inverse dose–response relationship between cardiovascular fitness and the all-cause mortality in large populations of cardiovascular patients. Guidelines from the American authorities as well as the European Society of Cardiology provide specific recommendations for exercise depending on the clinical setting (primary or secondary prevention of CVD and the patient-specific factors (the patient's physical activity level and the perceived CVD risk. The present review summarizes the clinical evidence regarding the role of exercise in CVD prevention and the exercise recommendations from the leading Cardiac societies.

  16. Cost-effectiveness of intermittent preventive treatment of malaria in pregnancy in southern Mozambique.

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    Elisa Sicuri

    2010-10-01

    Full Text Available Malaria in pregnancy is a public health problem for endemic countries. Economic evaluations of malaria preventive strategies in pregnancy are needed to guide health policies.This analysis was carried out in the context of a trial of malaria intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP, where both intervention groups received an insecticide treated net through the antenatal clinic (ANC in Mozambique. The cost-effectiveness of IPTp-SP on maternal clinical malaria and neonatal survival was estimated. Correlation and threshold analyses were undertaken to assess the main factors affecting the economic outcomes and the cut-off values beyond which the intervention is no longer cost-effective. In 2007 US$, the incremental cost-effectiveness ratio (ICER for maternal malaria was 41.46 US$ (95% CI 20.5, 96.7 per disability-adjusted life-year (DALY averted. The ICER per DALY averted due to the reduction in neonatal mortality was 1.08 US$ (95% CI 0.43, 3.48. The ICER including both the effect on the mother and on the newborn was 1.02 US$ (95% CI 0.42, 3.21 per DALY averted. Efficacy was the main factor affecting the economic evaluation of IPTp-SP. The intervention remained cost-effective with an increase in drug cost per dose up to 11 times in the case of maternal malaria and 183 times in the case of neonatal mortality.IPTp-SP was highly cost-effective for both prevention of maternal malaria and reduction of neonatal mortality in Mozambique. These findings are likely to hold for other settings where IPTp-SP is implemented through ANC visits. The intervention remained cost-effective even with a significant increase in drug and other intervention costs. Improvements in the protective efficacy of the intervention would increase its cost-effectiveness. Provision of IPTp with a more effective, although more expensive drug than SP may still remain a cost-effective public health measure to prevent malaria in pregnancy

  17. Stroke Prevention in Atrial Fibrillation: Current Strategies and Recommendations

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    Gerald V. Naccarelli, MD

    2016-02-01

    Full Text Available Stroke is the most common complication of atrial fibrillation (AF. Guidelines recommend anticoagulant treatment in patients with CHA2DS2VASc scores of >2. Registry data suggests that almost half of patients who should be on therapeutic anticoagulation for stroke prevention in AF (SPAF are not. Warfarin and more recently developed agents, the “novel anticoagulants” (NOACs reduce the risk of embolic strokes. In addition, the NOACs also reduce intracranial hemorrhage (ICH by over 50% compared to warfarin. Anticoagulation and bridging strategies involving cardioversion, catheter ablation, and invasive/surgical procedures are reviewed. The development of reversal agents for NOACs and the introduction of left atrial appendage occluding devices will evolve the use of newer strategies for preventing stroke in high risk AF patients.

  18. Pollution prevention opportunity assessment benchmarking: Recommendations for Hanford

    Energy Technology Data Exchange (ETDEWEB)

    Engel, J.A.

    1994-05-01

    Pollution Prevention Opportunity Assessments (P2OAs) are an important first step in any pollution prevention program. While P2OAs have been and are being conducted at Hanford, there exists no standard guidance, training, tracking, or systematic approach to identifying and addressing the most important waste streams. The purpose of this paper then is to serve as a guide to the Pollution Prevention group at Westinghouse Hanford in developing and implementing P2OAs at Hanford. By searching the literature and benchmarks other sites and agencies, the best elements from those programs can be incorporated and pitfalls more easily avoided. This search began with the 1988 document that introduces P2OAs (then called Process Waste Assessments, PWAS) by the Environmental Protection Agency. This important document presented the basic framework of P20A features which appeared in almost all later programs. Major Department of Energy programs were also examined, with particular attention to the Defense Programs P20A method of a graded approach, as presented at the Kansas City Plant. The graded approach is a system of conducting P2OAs of varying levels of detail depending on the size and importance of the waste stream. Finally, private industry programs were examined briefly. While all the benchmarked programs had excellent features, it was determined that the size and mission of Hanford precluded lifting any one program for use. Thus, a series of recommendations were made, based on the literature review, in order to begin an extensive program of P2OAs at Hanford. These recommendations are in the areas of: facility Pollution Prevention teams, P20A scope and methodology, guidance documents, training for facilities (and management), technical and informational support, tracking and measuring success, and incentives.

  19. The combined effect of determinants on coverage of intermittent preventive treatment of malaria during pregnancy in the Kilombero Valley, Tanzania

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    Schellenberg Joanna

    2011-05-01

    Full Text Available Abstract Background Intermittent preventive treatment during pregnancy (IPTp at routine antenatal care (ANC clinics is an important and efficacious intervention to reduce adverse health outcomes of malaria infections during pregnancy. However, coverage for the recommended two IPTp doses is still far below the 80% target in Tanzania. This paper investigates the combined impact of pregnant women's timing of ANC attendance, health workers' IPTp delivery and different delivery schedules of national IPTp guidelines on IPTp coverage. Methods Data on pregnant women's ANC attendance and health workers' IPTp delivery were collected from ANC card records during structured exit interviews with ANC attendees and through semi-structured interviews with health workers in south-eastern Tanzania. Women's timing of ANC visits and health worker's timing of IPTp delivery were analyzed in relation to the different national IPTp schedules and the outcome on IPTp coverage was modelled. Results Among all women eligible for IPTp, 79% received a first dose of IPTp and 27% were given a second dose. Although pregnant women initiated ANC attendance late, their timing was in line with the national guidelines recommending IPTp delivery between 20-24 weeks and 28-32 weeks of gestation. Only 15% of the women delayed to the extent of being too late to be eligible for a first dose of IPTp. Less than 1% of women started ANC attendance after 32 weeks of gestation. During the second IPTp delivery period health workers delivered IPTp to significantly less women than during the first one (55% vs. 73% contributing to low second dose coverage. Simplified IPTp guidelines for front-line health workers as recommended by WHO could lead to a 20 percentage point increase in IPTp coverage. Conclusions This study suggests that facility and policy factors are greater barriers to IPTp coverage than women's timing of ANC attendance. To maximize the benefit of the IPTp intervention, revision of

  20. Intermittent Fasting with or without Exercise Prevents Weight Gain and Improves Lipids in Diet-Induced Obese Mice

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    Robin A. Wilson

    2018-03-01

    Full Text Available Intermittent fasting (IF and high intensity interval training (HIIT are effective lifestyle interventions for improving body composition and overall health. However, the long-term effects of IF and potential synergistic effects of combining IF with exercise are unclear. The purpose of the study was to investigate the long-term effects of IF, with or without HIIT, on body composition and markers of metabolic health in diet-induced obese mice. In a randosmised, controlled design, 8-week-old C57BL/6 mice (males (n = 39 and females (n = 49 were fed a high fat (HF and sugar (S water diet (30% (w/v for 24-weeks but were separated into five groups at 12-weeks: (1 ‘obese’ baseline control (OBC; (2 no intervention (CON; (3 intermittent fasting (IF; (4 high intensity intermittent exercise (HIIT and (5 combination of dietary and exercise intervention (IF + HIIT. Body composition, strength and blood variables were measured at 0, 10 and/or 12-weeks. Intermittent fasting with or without HIIT resulted in significantly less weight gain, fat mass accumulation and reduced serum low density lipoproteins (LDL levels compared to HIIT and CON male mice (p < 0.05. The results suggest that IF, with or without HIIT, can be an effective strategy for weight gain prevention despite concurrently consuming a high fat and sugar diet.

  1. Intermittent Fasting with or without Exercise Prevents Weight Gain and Improves Lipids in Diet-Induced Obese Mice.

    Science.gov (United States)

    Wilson, Robin A; Deasy, William; Stathis, Christos G; Hayes, Alan; Cooke, Matthew B

    2018-03-12

    Intermittent fasting (IF) and high intensity interval training (HIIT) are effective lifestyle interventions for improving body composition and overall health. However, the long-term effects of IF and potential synergistic effects of combining IF with exercise are unclear. The purpose of the study was to investigate the long-term effects of IF, with or without HIIT, on body composition and markers of metabolic health in diet-induced obese mice. In a randosmised, controlled design, 8-week-old C57BL/6 mice (males ( n = 39) and females ( n = 49)) were fed a high fat (HF) and sugar (S) water diet (30% ( w / v )) for 24-weeks but were separated into five groups at 12-weeks: (1) 'obese' baseline control (OBC); (2) no intervention (CON); (3) intermittent fasting (IF); (4) high intensity intermittent exercise (HIIT) and (5) combination of dietary and exercise intervention (IF + HIIT). Body composition, strength and blood variables were measured at 0, 10 and/or 12-weeks. Intermittent fasting with or without HIIT resulted in significantly less weight gain, fat mass accumulation and reduced serum low density lipoproteins (LDL) levels compared to HIIT and CON male mice ( p < 0.05). The results suggest that IF, with or without HIIT, can be an effective strategy for weight gain prevention despite concurrently consuming a high fat and sugar diet.

  2. Intermittent Fasting with or without Exercise Prevents Weight Gain and Improves Lipids in Diet-Induced Obese Mice

    Science.gov (United States)

    Wilson, Robin A.; Deasy, William; Stathis, Christos G.; Hayes, Alan; Cooke, Matthew B.

    2018-01-01

    Intermittent fasting (IF) and high intensity interval training (HIIT) are effective lifestyle interventions for improving body composition and overall health. However, the long-term effects of IF and potential synergistic effects of combining IF with exercise are unclear. The purpose of the study was to investigate the long-term effects of IF, with or without HIIT, on body composition and markers of metabolic health in diet-induced obese mice. In a randosmised, controlled design, 8-week-old C57BL/6 mice (males (n = 39) and females (n = 49)) were fed a high fat (HF) and sugar (S) water diet (30% (w/v)) for 24-weeks but were separated into five groups at 12-weeks: (1) ‘obese’ baseline control (OBC); (2) no intervention (CON); (3) intermittent fasting (IF); (4) high intensity intermittent exercise (HIIT) and (5) combination of dietary and exercise intervention (IF + HIIT). Body composition, strength and blood variables were measured at 0, 10 and/or 12-weeks. Intermittent fasting with or without HIIT resulted in significantly less weight gain, fat mass accumulation and reduced serum low density lipoproteins (LDL) levels compared to HIIT and CON male mice (p HIIT, can be an effective strategy for weight gain prevention despite concurrently consuming a high fat and sugar diet. PMID:29534545

  3. Modelling the epidemiological impact of intermittent preventive treatment against malaria in infants.

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    Amanda Ross

    Full Text Available BACKGROUND: Trials of intermittent preventive treatment against malaria in infants (IPTi using sulphadoxine-pyrimethamine (SP have shown a positive, albeit variable, protective efficacy against clinical malaria episodes. The impact of IPTi in different epidemiological settings and over time is unknown and predictions are hampered by the lack of knowledge about how IPTi works. We investigated mechanisms proposed for the action of IPTi and made predictions of the likely impact on morbidity and mortality. METHODS/PRINCIPAL FINDINGS: We used a comprehensive, individual-based, stochastic model of malaria epidemiology to simulate recently published trials of IPTi using SP with site-specific characteristics as inputs. This baseline model was then modified to represent hypotheses concerning the duration of action of SP, the temporal pattern of fevers caused by individual infections, potential benefits of avoiding fevers on immunity and the effect of sub-therapeutic levels of SP on parasite dynamics. The baseline model reproduced the pattern of results reasonably well. None of the models based on alternative hypotheses improved the fit between the model predictions and observed data. Predictions suggest that IPTi would have a beneficial effect across a range of transmission intensities. IPTi was predicted to avert a greater number of episodes where IPTi coverage was higher, the health system treatment coverage lower, and for drugs which were more efficacious and had longer prophylactic periods. The predicted cumulative benefits were proportionately slightly greater for severe malaria episodes and malaria-attributable mortality than for acute episodes in the settings modelled. Modest increased susceptibility was predicted between doses and following the last dose, but these were outweighed by the cumulative benefits. The impact on transmission intensity was negligible. CONCLUSIONS: The pattern of trial results can be accounted for by differences between

  4. Intermittent Preventive Treatment for Malaria in Pregnancy: Optimization of Target Concentrations of Dihydroartemisinin-Piperaquine.

    Science.gov (United States)

    Savic, Rada M; Jagannathan, Prasanna; Kajubi, Richard; Huang, Liusheng; Zhang, Nan; Were, Moses; Kakuru, Abel; Muhindo, Mary K; Mwebaza, Norah; Wallender, Erika; Clark, Tamara D; Opira, Bishop; Kamya, Moses; Havlir, Diane V; Rosenthal, Philip J; Dorsey, Grant; Aweeka, Francesca T

    2018-03-14

    Dihydroartemsinin-piperaquine is highly efficacious as intermittent preventive therapy for malaria during pregnancy (IPTp). Determining associations between piperaquine exposure, malaria risk, and adverse birth outcomes informs optimal dosing strategies. HIV-uninfected pregnant women were enrolled in a placebo-controlled trial of IPTp at 12-20 weeks gestation and randomized to: sulfadoxine-pyrimethamine every 8 weeks (n=106), dihydroartemsinin-piperaquine every 8 weeks (n=94), or dihydroartemsinin-piperaquine every 4 weeks (n=100) during pregnancy. Pharmacokinetic sampling for piperaquine was performed every 4 weeks, and an intensive pharmacokinetic sub-study was performed in 30 women at 28 weeks gestation. Concentration-effect relationships were assessed between exposure to piperaquine; the prevalence of P. falciparum infection during pregnancy; outcomes at delivery including placental malaria, low birthweight, and preterm birth; and risks for toxicity. Simulations of new dosing scenarios were performed. Model-defined piperaquine target venous plasma concentrations of 13.9 ng/ml provided 99% protection from P. falciparum infection during pregnancy. Each 10 day increase in time>target piperaquine concentrations was associated with reduced odds of placental parasitemia (0∙67, P<0.0001), preterm birth (0.74, P<0.01), and low birthweight (0.74, P<0.05), though increases in piperaquine concentrations were associated with QTc prolongation (5 msec increase per 100 ng/ml). Modeling suggests that daily or weekly administration of lower dosages of piperaquine, compared to standard dosing, will maintain piperaquine trough levels above target concentrations with reduced piperaquine peak levels, potentially limiting toxicity. The protective efficacy of IPTp with dihydroartemsinin-piperaquine was strongly associated with higher drug exposure. Studies of the efficacy and safety of alternative dihydroartemsinin-piperaquine IPTp dosing strategies are warranted. NCT02163447.

  5. Intermittent Fasting Pretreatment Prevents Cognitive Impairment in a Rat Model of Chronic Cerebral Hypoperfusion.

    Science.gov (United States)

    Hu, Yuan; Yang, Ying; Zhang, Miao; Deng, Min; Zhang, Jun-Jian

    2017-07-01

    Background: Whether intermittent fasting (IF) pretreatment can prevent vascular cognitive dysfunction remains unknown to our knowledge. Objective: We investigated the effects and underlying mechanisms of IF pretreatment on cognitive dysfunction in a permanent 2-vessel occlusion (2VO) vascular dementia rat model. Methods: Male Wistar rats weighing 200 g were subjected to either IF or ad libitum feeding for 12 wk before 2VO surgery. Rats in the IF protocol underwent alternative-day feed deprivation (FD). Memory of the animals was assessed by using the Morris water maze (MWM) and the novel object recognition (NOR) test 6 wk after the surgery. After behavioral testing, malondialdehyde and glutathione concentrations, superoxide dismutase (SOD) activity, gene expression of antioxidative enzymes, inflammatory protein concentrations, and microglia density were determined in the hippocampus of rats. Results: 2-vessel occlusion operation ad libitum (2VO-AL) rats had significantly longer escape latencies on day 4 of the training phase and spent a lower percentage of time in the target quadrant (25% compared with 38% and 41%) in the MWM, and had lower discrimination ratios (47% compared with 65% and 67%) in the NOR test than 2-vessel operation and alternate-day feed deprivation (2VO-FD) and sham operation ad libitum (Sham-AL) rats, respectively ( P < 0.05). This indicates that IF helps to prevent vascular cognitive deficits. 2VO-AL rats also had higher malondialdehyde (3.54 compared with 2.15 and 1.66 nmol/mg protein) and lower glutathione concentrations (53.25 compared with 66.41 and 91.71 nmol/mg protein), lower SOD activity (100.1 compared with 133.3 and 138.5 U/mg protein), lower gene expression of antioxidative enzymes, higher expression of inflammatory proteins, and higher microglia density in the hippocampus than 2VO-FD and Sham-AL rats, respectively ( P < 0.05). This suggests that IF has antioxidative and anti-inflammatory effects. Conclusions: IF pretreatment provided

  6. Intermittent preventive treatment of malaria in pregnancy: a community-based delivery system and its effect on parasitemia, anemia and low birth weight in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Bygbjerg, Ib; Magnussen, Pascal

    2008-01-01

    OBJECTIVE: The main objective of the study was to assess the impact of a community-based delivery system of intermittent preventive treatment (IPT) for malaria in pregnancy with sulfadoxine-pyrimethamine (SP) on access, parasitemia, anemia and low birth weight as primary outcome measures. METHODS.......0001). At both health units and the community-based approaches, IPT increased mean hemoglobin by 6.7% (panemia from 5.7% to 3.1% (p.... This intervention was acceptable to 89.6% of the women at the community-based approaches intending to use IPT in the future, while 48.1% of them had recommended it to other women. CONCLUSIONS: The community-based approaches increased access and adherence to IPT with an effect on anemia, severe anemia, parasitemia...

  7. Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned.

    Science.gov (United States)

    Coldiron, Matthew E; Lasry, Estrella; Bouhenia, Malika; Das, Debashish; Okui, Peter; Nyehangane, Dan; Mwanga, Juliet; Langendorf, Celine; Elder, Greg; Salumu, Léon; Grais, Rebecca F

    2017-05-23

    Northern Uganda hosts a large population of refugees from South Sudan, and malaria is one of the major health problems in the area. In 2015, intermittent preventive treatment for malaria (IPTc) was implemented in two refugee camps among children aged 6 months to 14 years. Three distributions of dihydroartemisinin-piperaquine (DP) were conducted at 8-week intervals. The first dose was directly administered at IPTc distribution sites and the second and third doses were given to caregivers to administer at home. A multi-faceted evaluation was implemented, including coverage surveys, malaria prevalence surveys, reinforced surveillance, and pharmacovigilance. Programme coverage exceeded 90% during all three distributions with a total of 40,611 participants. Compared to same period during the previous year (only available data), the incidence of malaria in the target populations was reduced (IRR 0.73, 95% CI 0.69-0.77 among children under 5 years old; IRR 0.70, 95% CI 0.67-0.72 among children aged 5-14 years). Among those not targeted for intervention, the incidence between the 2 years increased (IRR 1.49, 95% CI 1.42-1.56). Cross-sectional surveys showed a prevalence of parasitaemia (microscopy or PCR) of 12.9-16.4% (95% CI 12.6-19.3) during the intervention, with the highest prevalence among children aged 5-14 years, but with a large increase 8 weeks after the final distribution. A total of 57 adverse events were reported during the intervention period, including one severe adverse event (death from varicella). Adverse events were of mild to moderate severity, and were mainly dermatologic and gastrointestinal. This is the first documentation of an IPTc programme in a refugee camp. The positive impact of DP on the incidence of malaria, together with its favourable safety profile, should lead to further use of IPTc in similar settings. Expanding coverage groups and decreasing intervals between distributions might provide more benefit, but would need to be balanced

  8. Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya

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    Jukes Matthew CH

    2008-09-01

    Full Text Available Abstract Background Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT as delivered by teachers in schools in western Kenya. Methods Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly. Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness. Results The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year. The estimated cost per anaemia case averted was US$ 29.84 and the cost per case of Plasmodium falciparum parasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively. Conclusion This

  9. Intermittent Preventive Therapy for Malaria During Pregnancy Using 2 vs 3 or More Doses of Sulfadoxine-Pyrimethamine and Risk of Low Birth Weight in Africa

    Science.gov (United States)

    Kayentao, Kassoum; Garner, Paul; van Eijk, Anne Maria; Naidoo, Inbarani; Roper, Cally; Mulokozi, Abdunoor; MacArthur, John R.; Luntamo, Mari; Ashorn, Per; Doumbo, Ogobara K.; ter Kuile, Feiko O.

    2015-01-01

    less placental malaria (RR,0.51; 95% CI, 0.38–0.68; I2=0%, in 6 trials, 63 vs 32 per 1000; absolute risk reduction,31 per 1000 [95% CI, 20–39]). In primigravid plus secundigravid women, the risk of moderate to severe maternal anemia was lower in the ≥3-dose group (RR,0.60; 95% CI, 0.36–0.99; I2=20%; in 6 trials, 36 vs 22 per 1000; absolute risk reduction,14 per 1000 [95% CI, 0.4–23]). There were no differences in rates of serious adverse events. Conclusions and Relevance Among pregnant women in sub-Saharan Africa, intermittent preventive therapy with 3 or more doses of sulfadoxine-pyrimethamine was associated with a higher birth weight and lower risk of LBW than the standard 2-dose regimens. These data provide support for the new WHO recommendations to provide at least 3 doses of intermittent preventive therapy during pregnancy at each scheduled antenatal care visit in the second and third trimester. PMID:23403684

  10. High rates of parasite recrudescence following intermittent preventive treatment with sulphadoxine-pyrimethamine during pregnancy in Benin

    DEFF Research Database (Denmark)

    Moussiliou, Azizath; Sissinto-Savi De Tove, Yolande; Doritchamou, Justin

    2013-01-01

    the second dose. Women with persistent parasitaemia had an increased prevalence of anaemia (P = 0.03). CONCLUSION: The data presented here, highlight the inability of SP to ensure optimal antiplasmodial protection in late pregnancy, and invite urgent consideration of an alternative drug or strategy.......BACKGROUND: Despite widespread parasite resistance to sulphadoxine-pyrimethamine (SP) its use for intermittent preventative treatment during pregnancy remains the policy in Benin and throughout most of sub-Saharan Africa. METHODS: In a prospective study, 982 pregnant women were recruited in Benin...

  11. Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation: A single-center randomized controlled trial.

    Science.gov (United States)

    Fujimoto, Hiroko; Yamaguchi, Osamu; Hayami, Hajime; Shimosaka, Mika; Tsuboi, Sayaka; Sato, Mitsunori; Takebayashi, Shigeo; Morita, Satoshi; Saito, Mari; Goto, Takahisa; Kurahashi, Kiyoyasu

    2018-03-23

    Aspiration of subglottic secretion is a widely used intervention to prevent ventilator-associated pneumonia (VAP). This study aimed to compare the efficacy of continuous and intermittent subglottic secretion drainage (SSD) in preventing VAP. A single-center randomized controlled trial was conducted on adult postoperative patients who were expected to undergo mechanical ventilation for more than 48 hours. Primary outcome measure was incidence of VAP and secondary outcome measures were length of mechanical ventilation and intensive-care unit (ICU) stay. Fifty-nine patients received continuous SSD, while 60 patients received intermittent SSD. Of these 119 patients, 88 (74%) were excluded and 15 and 16 patients were allocated to receive continuous and intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7 (43.8%) patients in the continuous and intermittent groups, respectively, (p=0.320). The length of mechanical ventilation was significantly shorter (p=0.034) in the continuous group (99.5±47.1 h) than in the intermittent group (159.9±94.5 h). The length of ICU stay was also shorter (p=0.0097) in the continuous group (6.3±2.1 days) than the intermittent group (9.8±4.8 days). Although continuous SSD did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and ICU stay when compared to intermittent SSD.

  12. Sub-optimal delivery of intermittent preventive treatment for malaria in pregnancy in Nigeria: influence of provider factors

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    Onoka Chima A

    2012-09-01

    Full Text Available Abstract Background The level of access to intermittent preventive treatment for malaria in pregnancy (IPTp in Nigeria is still low despite relatively high antenatal care coverage in the study area. This paper presents information on provider factors that affect the delivery of IPTp in Nigeria. Methods Data were collected from heads of maternal health units of 28 public and six private health facilities offering antenatal care (ANC services in two districts in Enugu State, south-east Nigeria. Provider knowledge of guidelines for IPTp was assessed with regard to four components: the drug used for IPTp, time of first dose administration, of second dose administration, and the strategy for sulphadoxine-pyrimethamine (SP administration (directly observed treatment, DOT. Provider practices regarding IPTp and facility-related factors that may explain observations such as availability of SP and water were also examined. Results Only five (14.7% of all 34 providers had correct knowledge of all four recommendations for provision of IPTp. None of them was a private provider. DOT strategy was practiced in only one and six private and public providers respectively. Overall, 22 providers supplied women with SP in the facility and women were allowed to take it at home. The most common reason for doing so amongst public providers was that women were required to come for antenatal care on empty stomachs to enhance the validity of manual fundal height estimation. Two private providers did not think it was necessary to use the DOT strategy because they assumed that women would take their drugs at home. Availability of SP and water in the facility, and concerns about side effects were not considered impediments to delivery of IPTp. Conclusion There was low level of knowledge of the guidelines for implementation of IPTp by all providers, especially those in the private sector. This had negative effects such as non-practice of DOT strategy by most of the providers

  13. Effectiveness of Intermittent Preventive Treatment in Pregnancy with Sulphadoxine-Pyrimethamine against Submicroscopic falciparum Malaria in Central Region, Ghana

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    Ekene K. Nwaefuna

    2015-01-01

    Full Text Available Malaria infections undetectable by microscopy but detectable by Polymerase Chain Reaction (PCR (submicroscopic malaria are common in endemic areas like Ghana. Submicroscopic malaria has been linked with severe pregnancy outcomes as well as contributing to malaria transmission. In this cross-sectional study 872 consenting pregnant women (gestation ≥ 20 weeks were recruited from 8 hospitals in Central Region, Ghana, between July and December 2009. Malaria infection was detected by microscopy and PCR. Haemoglobin was measured and anaemia was defined as haemoglobin lower than 11 g/dL. Majority of the women, 555 (63.6%, were Intermittent Preventive Treatment in Pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP users while 234 (36.4% were nonusers. The prevalence of malaria by microscopy was 20.9% (182/872 and 9.7% (67/688 of microscopy negative women had submicroscopic malaria. IPTp-SP usage significantly (odds ratio = 0.13, 95% confidence interval = 0.07–0.23, p=0.005 reduced the prevalence of submicroscopic malaria as more nonusers (51/234 than users (16/454 were PCR positive. After controlling for other variables the effect of IPTp-SP remained statistically significant (odds ratio = 0.11, 95% confidence interval = 0.02–0.22, p=0.006. These results suggest that Intermittent Preventive Treatment with Sulphadoxine-Pyrimethamine is useful in the reduction of submicroscopic malaria in pregnancy.

  14. Effectiveness of antenatal clinics to deliver intermittent preventive treatment and insecticide treated nets for the control of malaria in pregnancy in Kenya

    NARCIS (Netherlands)

    Hill, Jenny; Dellicour, Stephanie; Bruce, Jane; Ouma, Peter; Smedley, James; Otieno, Peter; Ombock, Maurice; Kariuki, Simon; Desai, Meghna; Hamel, Mary J.; ter Kuile, Feiko O.; Webster, Jayne

    2013-01-01

    Malaria in pregnancy can have devastating consequences for mother and baby. Coverage with the WHO prevention strategy for sub-Saharan Africa of intermittent-preventive-treatment (IPTp) with two doses of sulphadoxine-pyrimethamine (SP) and insecticide-treated-nets (ITNs) in pregnancy is low. We

  15. Effect of sulfadoxine-pyrimethamine resistance on the efficacy of intermittent preventive therapy for malaria control during pregnancy: a systematic review

    NARCIS (Netherlands)

    ter Kuile, Feiko O.; van Eijk, Annemieke M.; Filler, Scott J.

    2007-01-01

    In malaria-endemic regions, strategies to control malaria during pregnancy rely on case management of malaria illness and anemia, and preventive measures such as insecticide-treated nets and intermittent preventive therapy (IPT). To determine the effect of increasing resistance to

  16. Organizational factors in fire prevention: roles, obstacles, and recommendations

    Science.gov (United States)

    John R. Christiansen; William S. Folkman; Keith W. Warner; Michael L. Woolcott

    1976-01-01

    Problems being encountered in implementing fire prevention programs were explored by studying the organization for fire prevention at the Fish Lake, Uinta, and Wasatch National Forests in Utah. The study focused on role congruency in fire prevention activities and on the social and organizational obstacles to effective programs. The problems identified included lack of...

  17. Intermittent preventive treatment of malaria in pregnancy with mefloquine in HIV-negative women: a multicentre randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Raquel González

    2014-09-01

    Full Text Available Intermittent preventive treatment in pregnancy (IPTp with sulfadoxine-pyrimethamine (SP is recommended by WHO to prevent malaria in African pregnant women. The spread of SP parasite resistance has raised concerns regarding long-term use for IPT. Mefloquine (MQ is the most promising of available alternatives to SP based on safety profile, long half-life, and high efficacy in Africa. We evaluated the safety and efficacy of MQ for IPTp compared to those of SP in HIV-negative women.A total of 4,749 pregnant women were enrolled in an open-label randomized clinical trial conducted in Benin, Gabon, Mozambique, and Tanzania comparing two-dose MQ or SP for IPTp and MQ tolerability of two different regimens. The study arms were: (1 SP, (2 single dose MQ (15 mg/kg, and (3 split-dose MQ in the context of long lasting insecticide treated nets. There was no difference on low birth weight prevalence (primary study outcome between groups (360/2,778 [13.0%] for MQ group and 177/1,398 (12.7% for SP group; risk ratio [RR], 1.02 (95% CI 0.86-1.22; p=0.80 in the ITT analysis. Women receiving MQ had reduced risks of parasitemia (63/1,372 [4.6%] in the SP group and 88/2,737 [3.2%] in the MQ group; RR, 0.70 [95% CI 0.51-0.96]; p=0.03 and anemia at delivery (609/1,380 [44.1%] in the SP group and 1,110/2743 [40.5%] in the MQ group; RR, 0.92 [95% CI 0.85-0.99]; p=0.03, and reduced incidence of clinical malaria (96/551.8 malaria episodes person/year [PYAR] in the SP group and 130/1,103.2 episodes PYAR in the MQ group; RR, 0.67 [95% CI 0.52-0.88]; p=0.004 and all-cause outpatient attendances during pregnancy (850/557.8 outpatients visits PYAR in the SP group and 1,480/1,110.1 visits PYAR in the MQ group; RR, 0.86 [0.78-0.95]; p=0.003. There were no differences in the prevalence of placental infection and adverse pregnancy outcomes between groups. Tolerability was poorer in the two MQ groups compared to SP. The most frequently reported related adverse events were dizziness

  18. Intermittent pneumatic compression to prevent venous thromboembolism in patients with high risk of bleeding hospitalized in intensive care units: the CIREA1 randomized trial.

    Science.gov (United States)

    Vignon, Philippe; Dequin, Pierre-François; Renault, Anne; Mathonnet, Armelle; Paleiron, Nicolas; Imbert, Audrey; Chatellier, Delphine; Gissot, Valérie; Lhéritier, Gwenaelle; Aboyans, Victor; Prat, Gwenael; Garot, Denis; Boulain, Thierry; Diehl, Jean-Luc; Bressollette, Luc; Delluc, Aurélien; Lacut, Karine

    2013-05-01

    Venous thromboembolism (VTE) is a frequent and serious problem in intensive care units (ICU). Anticoagulant treatments have demonstrated their efficacy in preventing VTE. However, when the bleeding risk is high, they are contraindicated, and mechanical devices are recommended. To date, mechanical prophylaxis has not been rigorously evaluated in any trials in ICU patients. In this multicenter, open-label, randomized trial with blinded evaluation of endpoints, we randomly assigned 407 patients with a high risk of bleeding to receive intermittent pneumatic compression (IPC) associated with graduated compression stockings (GCS) or GCS alone for 6 days during their ICU stay. The primary endpoint was the occurrence of a VTE between days 1 and 6, including nonfatal symptomatic documented VTE, or death due to a pulmonary embolism, or asymptomatic deep vein thrombosis detected by ultrasonography systematically performed on day 6. The primary outcome was assessed in 363 patients (89.2%). By day 6, the incidence of the primary outcome was 5.6% (10 of 179 patients) in the IPC + GCS group and 9.2% (17 of 184 patients) in the GCS group (relative risk 0.60; 95% confidence interval 0.28-1.28; p = 0.19). Tolerance of IPC was poor in only 12 patients (6.0%). No intergroup difference in mortality rate was observed. With the limitation of a low statistical power, our results do not support the superiority of the combination of IPC + GCS compared to GCS alone to prevent VTE in ICU patients at high risk of bleeding.

  19. Anti-bacterial activity of intermittent preventive treatment of malaria in pregnancy: comparative in vitro study of sulphadoxine-pyrimethamine, mefloquine, and azithromycin

    Directory of Open Access Journals (Sweden)

    Mombo-Ngoma Ghyslain

    2010-10-01

    Full Text Available Abstract Background Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine (SP is recommended for the prevention of malaria in pregnancy in sub-Saharan Africa. Increasing drug resistance necessitates the urgent evaluation of alternative drugs. Currently, the most promising candidates in clinical development are mefloquine and azithromycin. Besides the anti-malarial activity, SP is also a potent antibiotic and incurs significant anti-microbial activity when given as IPTp - though systematic clinical evaluation of this action is still lacking. Methods In this study, the intrinsic anti-bacterial activity of mefloquine and azithromycin was assessed in comparison to sulphadoxine-pyrimethamine against bacterial pathogens with clinical importance in pregnancy in a standard microdilution assay. Results SP was highly active against Staphylococcus aureus and Streptococcus pneumoniae. All tested Gram-positive bacteria, except Enterococcus faecalis, were sensitive to azithromycin. Additionally, azithromycin was active against Neisseria gonorrhoeae. Mefloquine showed good activity against pneumococci but lower in vitro action against all other tested pathogens. Conclusion These data indicate important differences in the spectrum of anti-bacterial activity for the evaluated anti-malarial drugs. Given the large scale use of IPTp in Africa, the need for prospective clinical trials evaluating the impact of antibiotic activity of anti-malarials on maternal and foetal health and on the risk of promoting specific drug resistance of bacterial pathogens is discussed.

  20. Role of clean intermittent self catheterisation (CICS) in the prevention of recurrent urethral strictures after internal optical urethrotomy

    International Nuclear Information System (INIS)

    Khan, S.; Khan, R.A.; Ullah, A.; Haq, F.U.; Rahman, A.U.; Durrani, S.N.; Khan, M.K.

    2011-01-01

    Background: Urethral stricture is one of the oldest diseases Urethral dilatation Internal optical urethrotomy, were the only treatment. Clean Intermittent Self Catheterisation was introduced by Lapides has greatly decreased the recurrence of stricture. Objectives were to determine the role of Clean Intermittent Self Catheterisation (CISC) in the prevention of recurrence of urethral strictures after Internal Optical Urethrotomy and to study the frequency of any postoperative complications and tolerability for the patients associated with this procedure. Methods: A randomised controlled study conducted in the department of urology and renal transplantation, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar from June 2007 to June 2010. Total of 60 patients with mean age 48 years (range 20-73) were selected and randomly divided into Treatment Group (30 patients) and Control Group (30 Patients). Eight 'drop out' occurred in the treatment group and four 'drop out' occurred in the controlled group. All the patients were treated with Internal Optical Urethrotomy using Sachse method followed by indwelling catheter for 5 days. The treatment group was then taught to perform Clean Intermittent Self Catheterisation by inserting a Classic Neleton Catheter (No. 16 or 18) twice a day for 1 week, then once a day for another 4 weeks and then once weekly continued for one year. All the patients were followed up regularly at 1 month intervals during the first 6 months and then every 2 months for the next 6 months. Results: Total of 48 patients completed the study, 22 in the treatment group and 26 in the control group. Within the first year, 4 patients (22%) in the treatment group developed urethral stricture. In the control group, 12 patients (46%) developed urethral stricture within the first year, showing a significant difference (p<0.01). In the treatment group four patients developed simple UTIs while in the control group three patients developed UTIs, one with

  1. Metallothionein as a compensatory component prevents intermittent hypoxia-induced cardiomyopathy in mice

    International Nuclear Information System (INIS)

    Yin, Xia; Zhou, Shanshan; Zheng, Yang; Tan, Yi; Kong, Maiying; Wang, Bo; Feng, Wenke; Epstein, Paul N.; Cai, Jun; Cai, Lu

    2014-01-01

    Obstructive sleep apnea (OSA) causes chronic intermittent hypoxia (IH) to induce cardiovascular disease, which may be related to oxidative damage. Metallothionein (MT) has been extensively proved to be an endogenous and highly inducible antioxidant protein expressed in the heart. Therefore, we tested the hypotheses that oxidative stress plays a critical role in OSA induced cardiac damage and MT protects the heart from OSA-induced cardiomyopathy. To mimic hypoxia/reoxygenation events that occur in adult OSA patients, mice were exposed to IH for 3 days to 8 weeks. The IH paradigm consisted of alternating cycles of 20.9% O 2 /8% O 2 F I O 2 (30 episodes per hour) with 20 s at the nadir F I O 2 for 12 h a day during daylight. IH significantly increased the ratio of heart weight to tibia length at 4 weeks with a decrease in cardiac function from 4 to 8 weeks. Cardiac oxidative damage and fibrosis were observed after 4 and 8 weeks of IH exposures. Endogenous MT expression was up-regulated in response to 3-day IH, but significantly decreased at 4 and 8 weeks of IH. In support of MT as a major compensatory component, mice with cardiac overexpression of MT gene and mice with global MT gene deletion were completely resistant, and highly sensitive, respectively, to chronic IH induced cardiac effects. These findings suggest that chronic IH induces cardiomyopathy characterized by oxidative stress-mediated cardiac damage and the antioxidant MT protects the heart from such pathological and functional changes. - Highlights: • The effect of intermittent hypoxia (IH) on cardiac metallothionein (MT) • Cardiac MT expression was up-regulated in response to 3-day IH. • Exposure to 4- or 8-week IH downregulated cardiac MT expression. • Overexpression of cardiac MT protects from IH-induced cardiac damage. • Global deletion of MT gene made the heart more sensitive to IH damage

  2. Selection of antimalarial drug resistance after intermittent preventive treatment of infants and children (IPTi/c) in Senegal

    DEFF Research Database (Denmark)

    Ndiaye, Magatte; Tine, Roger; Faye, Babacar

    2013-01-01

    Senegal has since 2003 used sulphadoxine-pyrimethamine (SP) for Intermittent Preventive Treatment (IPT) of malaria in risk groups. However, the large-scale IPT strategy may result in increasing drug resistance. Our study investigated the possible impact of SP-IPT given to infants and children...... on the prevalence of SP-resistant haplotypes in the Plasmodium falciparum genes Pfdhfr and Pfdhps, comparing sites with and without IPTi/c. P. falciparum positives samples (n=352) were collected from children under 5years of age during two cross-sectional surveys in 2010 and 2011 in three health districts (two...... on IPTi/c and one without IPTi/c intervention) located in the southern part of Senegal. The prevalence of SP-resistance-related haplotypes in Pfdhfr and Pfdhps was determined by nested PCR followed by sequence-specific oligonucleotide probe (SSOP)-ELISA. The prevalence of the Pfdhfr double mutant...

  3. Scheduled Intermittent Screening with Rapid Diagnostic Tests and Treatment with Dihydroartemisinin-Piperaquine versus Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine for Malaria in Pregnancy in Malawi: An Open-Label Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Mwayiwawo Madanitsa

    2016-09-01

    Full Text Available In Africa, most plasmodium infections during pregnancy remain asymptomatic, yet are associated with maternal anemia and low birthweight. WHO recommends intermittent preventive therapy in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP. However, sulfadoxine-pyrimethamine (SP efficacy is threatened by high-level parasite resistance. We conducted a trial to evaluate the efficacy and safety of scheduled intermittent screening with malaria rapid diagnostic tests (RDTs and treatment of RDT-positive women with dihydroartemisinin-piperaquine (DP as an alternative strategy to IPTp-SP.This was an open-label, two-arm individually randomized superiority trial among HIV-seronegative women at three sites in Malawi with high SP resistance. The intervention consisted of three or four scheduled visits in the second and third trimester, 4 to 6 wk apart. Women in the IPTp-SP arm received SP at each visit. Women in the intermittent screening and treatment in pregnancy with DP (ISTp-DP arm were screened for malaria at every visit and treated with DP if RDT-positive. The primary outcomes were adverse live birth outcome (composite of small for gestational age, low birthweight [<2,500 g], or preterm birth [<37 wk] in paucigravidae (first or second pregnancy and maternal or placental plasmodium infection at delivery in multigravidae (third pregnancy or higher. Analysis was by intention to treat. Between 21 July 2011 and 18 March 2013, 1,873 women were recruited (1,155 paucigravidae and 718 multigravidae. The prevalence of adverse live birth outcome was similar in the ISTp-DP (29.9% and IPTp-SP (28.8% arms (risk difference = 1.08% [95% CI -3.25% to 5.41%]; all women: relative risk [RR] = 1.04 [95% CI 0.90-1.20], p = 0.625; paucigravidae: RR = 1.10 [95% CI 0.92-1.31], p = 0.282; multigravidae: RR = 0.92 [95% CI 0.71-1.20], p = 0.543. The prevalence of malaria at delivery was higher in the ISTp-DP arm (48.7% versus 40.8%; risk difference = 7.85%, [95% CI 3

  4. Intermittent Administration of Parathyroid Hormone [1-34] Prevents Particle-Induced Periprosthetic Osteolysis in a Rat Model.

    Directory of Open Access Journals (Sweden)

    Fanggang Bi

    Full Text Available We examined whether intermittent administration of parathyroid hormone [1-34] (PTH[1-34]; 60 μg/kg/day can prevent the negative effects of titanium (Ti particles on implant fixation and periprosthetic osteolysis in a rat model. Eighteen adult male rats (12 weeks old, bones still growing received intramedullary Ti implants in their bilateral femurs; 6 rats from the blank group received vehicle injections, and 12 rats from the control group and PTH treatment group received Ti particle injections at the time of operation and intra-articular injections 2 and 4 weeks postoperatively. Six of the rats that received Ti particles from the PTH group also received PTH[1-34] treatment. Six weeks postoperatively, all specimens were collected for assessment by X-ray, micro-CT, biomechanical, scanning electron microscopy (SEM, and dynamic histomorphometry. A lower BMD, BV/TV, Tb.N, maximal fixation strength, and mineral apposition rate were observed in the control group compared to the blank group, demonstrating that a periprosthetic osteolysis model had been successfully established. Administration of PTH[1-34] significantly increased the bone mineral density of the distal femur, BV/TV, Tb.N, Tb.Th, Tb.Sp, Con.D, SMI, and maximal fixation strength in the PTH group compared to that in the control group. SEM revealed higher bone-implant contact, thicker lamellar bone, and larger trabecular bone area in the PTH group than in the control group. A higher mineral apposition rate was observed in the PTH group compared to both the blank and control groups. These findings imply that intermittent administration of PTH[1-34] prevents periprosthetic osteolysis by promoting bone formation. The effects of PTH[1-34] were evaluated at a suprapharmacological dosage to the human equivalent in rats; therefore, additional studies are required to demonstrate its therapeutic potential in periprosthetic osteolysis.

  5. Metallothionein as a compensatory component prevents intermittent hypoxia-induced cardiomyopathy in mice

    Energy Technology Data Exchange (ETDEWEB)

    Yin, Xia; Zhou, Shanshan [The First Hospital of Jilin University, Changchun, 130021 (China); KCHRI at the Department of Pediatrics, School of Medicine, University of Louisville, Louisville, 40202 (United States); Zheng, Yang, E-mail: zhengyang@jlu.edu.cn [The First Hospital of Jilin University, Changchun, 130021 (China); Tan, Yi [KCHRI at the Department of Pediatrics, School of Medicine, University of Louisville, Louisville, 40202 (United States); Chinese–American Research Institute for Diabetic Complications, Wenzhou Medical College School of Pharmacy, Wenzhou, 325035 (China); Kong, Maiying [Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40202 (United States); Wang, Bo [KCHRI at the Department of Pediatrics, School of Medicine, University of Louisville, Louisville, 40202 (United States); Department of Pathology, Inner Mongolia Forestry General Hospital, Yakeshi, 022150 (China); Feng, Wenke [Department of Medicine, School of Medicine, University of Louisville, Louisville, 40202 (United States); Epstein, Paul N. [KCHRI at the Department of Pediatrics, School of Medicine, University of Louisville, Louisville, 40202 (United States); Cai, Jun, E-mail: j0cai002@louisville.edu [KCHRI at the Department of Pediatrics, School of Medicine, University of Louisville, Louisville, 40202 (United States); Cai, Lu [KCHRI at the Department of Pediatrics, School of Medicine, University of Louisville, Louisville, 40202 (United States); Chinese–American Research Institute for Diabetic Complications, Wenzhou Medical College School of Pharmacy, Wenzhou, 325035 (China); Department of Medicine, School of Medicine, University of Louisville, Louisville, 40202 (United States)

    2014-05-15

    Obstructive sleep apnea (OSA) causes chronic intermittent hypoxia (IH) to induce cardiovascular disease, which may be related to oxidative damage. Metallothionein (MT) has been extensively proved to be an endogenous and highly inducible antioxidant protein expressed in the heart. Therefore, we tested the hypotheses that oxidative stress plays a critical role in OSA induced cardiac damage and MT protects the heart from OSA-induced cardiomyopathy. To mimic hypoxia/reoxygenation events that occur in adult OSA patients, mice were exposed to IH for 3 days to 8 weeks. The IH paradigm consisted of alternating cycles of 20.9% O{sub 2}/8% O{sub 2} F{sub I}O{sub 2} (30 episodes per hour) with 20 s at the nadir F{sub I}O{sub 2} for 12 h a day during daylight. IH significantly increased the ratio of heart weight to tibia length at 4 weeks with a decrease in cardiac function from 4 to 8 weeks. Cardiac oxidative damage and fibrosis were observed after 4 and 8 weeks of IH exposures. Endogenous MT expression was up-regulated in response to 3-day IH, but significantly decreased at 4 and 8 weeks of IH. In support of MT as a major compensatory component, mice with cardiac overexpression of MT gene and mice with global MT gene deletion were completely resistant, and highly sensitive, respectively, to chronic IH induced cardiac effects. These findings suggest that chronic IH induces cardiomyopathy characterized by oxidative stress-mediated cardiac damage and the antioxidant MT protects the heart from such pathological and functional changes. - Highlights: • The effect of intermittent hypoxia (IH) on cardiac metallothionein (MT) • Cardiac MT expression was up-regulated in response to 3-day IH. • Exposure to 4- or 8-week IH downregulated cardiac MT expression. • Overexpression of cardiac MT protects from IH-induced cardiac damage. • Global deletion of MT gene made the heart more sensitive to IH damage.

  6. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings.

    Science.gov (United States)

    Barnosky, Adrienne R; Hoddy, Kristin K; Unterman, Terry G; Varady, Krista A

    2014-10-01

    Intermittent fasting (IF) regimens have gained considerable popularity in recent years, as some people find these diets easier to follow than traditional calorie restriction (CR) approaches. IF involves restricting energy intake on 1-3 d/wk, and eating freely on the nonrestriction days. Alternate day fasting (ADF) is a subclass of IF, which consists of a "fast day" (75% energy restriction) alternating with a "feed day" (ad libitum food consumption). Recent findings suggest that IF and ADF are equally as effective as CR for weight loss and cardioprotection. What remains unclear, however, is whether IF/ADF elicits comparable improvements in diabetes risk indicators, when compared with CR. Accordingly, the goal of this review was to compare the effects of IF and ADF with daily CR on body weight, fasting glucose, fasting insulin, and insulin sensitivity in overweight and obese adults. Results reveal superior decreases in body weight by CR vs IF/ADF regimens, yet comparable reductions in visceral fat mass, fasting insulin, and insulin resistance. None of the interventions produced clinically meaningful reductions in glucose concentrations. Taken together, these preliminary findings show promise for the use of IF and ADF as alternatives to CR for weight loss and type 2 diabetes risk reduction in overweight and obese populations, but more research is required before solid conclusions can be reached. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. A community-based delivery system of intermittent preventive treatment of malaria in pregnancy and its effect on use of essential maternity care at health units in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Bygbjerg, I C; Magnussen, Pascal

    2007-01-01

    Community delivery of intermittent preventive treatment of malaria in pregnancy (IPTp) is one potential option that could mitigate malaria in pregnancy. However, there is concern that this approach may lead to complacency among women with low access to essential care at health units. A non-random...

  8. In a Randomized Controlled Trial of Iron Fortification, Anthelmintic Treatment, and Intermittent Preventive Treatment of Malaria for Anemia Control in Ivorian Children, only Anthelmintic Treatment Shows Modest Benefit

    NARCIS (Netherlands)

    Rohner, F.; Zimmermann, M.B.; Amon, R.J.; Vounatsou, P.; Tschannen, A.B.; N'goran, E.K.; Nindjin, C.; Cacou, M.C.; Té-Bonlé, D.; Aka, H.; Sess, D.E.; Utzinger, J.; Hurrell, R.F.

    2010-01-01

    Anemia is common among children in sub-Saharan Africa and its etiology is multifactorial. Likely causes of anemia are low bioavailability of dietary iron, malaria, and helminth infection. In this study, we aimed to assess the effect of iron fortification, intermittent preventive treatment (IPT) of

  9. Community-based distribution of sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy improved coverage but reduced antenatal attendance in southern Malawi

    NARCIS (Netherlands)

    Msyamboza, K. P.; Savage, E. J.; Kazembe, P. N.; Gies, S.; Kalanda, G.; D'Alessandro, U.; Brabin, B. J.

    2009-01-01

    To evaluate the impact of a 2-year programme for community-based delivery of sulfadoxine-pyremethamine (SP) on intermittent preventive treatment during pregnancy coverage, antenatal clinic attendance and pregnancy outcome. Fourteen intervention and 12 control villages in the catchment areas of

  10. Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials

    NARCIS (Netherlands)

    Aponte, John J.; Schellenberg, David; Egan, Andrea; Breckenridge, Alasdair; Carneiro, Ilona; Critchley, Julia; Danquah, Ina; Dodoo, Alexander; Kobbe, Robin; Lell, Bertrand; May, Jürgen; Premji, Zul; Sanz, Sergi; Sevene, Esperanza; Soulaymani-Becheikh, Rachida; Winstanley, Peter; Adjei, Samuel; Anemana, Sylvester; Chandramohan, Daniel; Issifou, Saadou; Mockenhaupt, Frank; Owusu-Agyei, Seth; Greenwood, Brian; Grobusch, Martin P.; Kremsner, Peter G.; Macete, Eusebio; Mshinda, Hassan; Newman, Robert D.; Slutsker, Laurence; Tanner, Marcel; Alonso, Pedro; Menendez, Clara

    2009-01-01

    BACKGROUND: Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. METHODS: We pooled data from six double-blind, randomised,

  11. Evaluation of the effectiveness and compliance of intermittent preventive treatment (IPT) in the control of malaria in pregnant women in south eastern Nigeria

    Science.gov (United States)

    Nduka, F O; Nwosu, E; Oguariri, R M

    2011-01-01

    Controlling malaria in pregnancy has been an important component of the millennium development goal and intermittent preventive treatment (IPT) is considered an important tool in controlling malaria among pregnant women. In this study, we evaluated the level of compliance to IPT use as well as its effect on malaria infection among pregnant women attending antenatal clinic in south eastern Nigeria. Peripheral blood smears and placental histology were used as diagnostic tools to determine infection rate. Our data show that compliance to IPT use was poor (33%) when compared with non-compliance (67%). Infection rate was significantly lower among IPT users (39%) than in non-users (71%) (X2 = 39.95; P<0.05). Maternal anaemia was also lower in IPT users (4%) than in non-users (18%). Taken together, IPT use appears to be important in reducing infection rate and maternal anaemia. Therefore, its adoption is highly recommended and this could be improved through public enlightenment campaign and adequate funding. PMID:22325819

  12. A bacterial interference strategy for prevention of UTI in persons practicing intermittent catheterization.

    Science.gov (United States)

    Prasad, A; Cevallos, M E; Riosa, S; Darouiche, R O; Trautner, B W

    2009-07-01

    Non-randomized pilot trial. To determine whether Escherichia coli 83972-coated urinary catheters in persons with spinal cord injury (SCI) practicing an intermittent catheterization program (ICP) could (1) achieve bladder colonization with this benign organism and (2) decrease the rate of symptomatic urinary tract infection (UTI). Outpatient SCI clinic in a Veterans Affairs hospital (USA). Participants had neurogenic bladders secondary to SCI, were practicing ICP, had experienced at least one UTI and had documented bacteruria within the past year. All participants received a urinary catheter that had been pre-inoculated with E. coli 83972. The catheter was left in place for 3 days and then removed. Participants were followed with urine cultures and telephone calls weekly for 28 days and then monthly until E. coli 83972 was lost from the urine. Outcome measures were (1) the rate of successful bladder colonization, defined as the detection (>or=10(2) cfu ml(-1)) of E. coli 83972 in urine cultures for >3 days after catheter removal and (2) the rate of symptomatic UTI during colonization with E. coli 83972. Thirteen participants underwent 19 insertions of study catheters. Eight participants (62%) became successfully colonized for >3 days after catheter removal. In these 8 participants, the rate of UTI during colonization was 0.77 per patient-year, in comparison with the rate of 2.27 UTI per patient-year before enrollment. E. coli 83972-coated urinary catheters are a viable means of achieving bladder colonization with this potentially protective strain in persons practicing ICP.

  13. Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- A preliminary study of 100 patients

    Directory of Open Access Journals (Sweden)

    M N Vijai

    2016-01-01

    Full Text Available Background and Aims: Oropharyngeal colonisation followed by aspiration of contaminated secretions is the major cause for ventilator-associated pneumonia (VAP. Pooled secretions present in the sub-glottic area above inflated endotracheal tube cuff may be aspirated into the lower airways. It was hypothesised that intermittent suctioning of sub-glottic secretions would prevent VAP. Methods: Group I (n = 50 patients were intubated with HiLo Evac™ endotracheal (ET tube with facility for sub-glottic suctioning, and Group II (n = 50 patients were intubated with HiLo Contour™ ET tube without such facility. In the Group I, sub-glottic suctioning was performed every 2 h. Incidence of VAP, mean ventilator days, Intensive Care Unit (ICU stay and mortality were compared. Qualitative variables were reported as percentages and were compared by Chi-square test or unpaired two-tailed, Fisher′s exact test, as appropriate, to analyse the significance of difference between the two groups. Results: The two groups were similar with respect to demographic characteristics. VAP was seen in 6% of patients in Group I and 22% of patients in Group II (P = 0.021. Both early- and late-onset VAPs were significantly reduced in Group I. Both ventilator days (8.0 vs. 6.45; P = 0.001 and ICU stay (8.33 vs. 6.33; P = 0.001 on the day of onset of VAP were significantly more in the Group I. Total ventilator days were significantly less (6.52 vs. 8.32; P = 0.006 with lower incidence of mortality (36% vs. 48%; P = 0.224 in the Group I. Conclusion: Intermittent sub-glottic suctioning reduces the incidence of VAP including late-onset VAP.

  14. Efficacy of intermittent sub-glottic suctioning in prevention of ventilator-associated pneumonia- A preliminary study of 100 patients.

    Science.gov (United States)

    Vijai, M N; Ravi, Parli R; Setlur, Rangaraj; Vardhan, Harsh

    2016-05-01

    Oropharyngeal colonisation followed by aspiration of contaminated secretions is the major cause for ventilator-associated pneumonia (VAP). Pooled secretions present in the sub-glottic area above inflated endotracheal tube cuff may be aspirated into the lower airways. It was hypothesised that intermittent suctioning of sub-glottic secretions would prevent VAP. Group I (n = 50) patients were intubated with HiLo Evac™ endotracheal (ET) tube with facility for sub-glottic suctioning, and Group II (n = 50) patients were intubated with HiLo Contour™ ET tube without such facility. In the Group I, sub-glottic suctioning was performed every 2 h. Incidence of VAP, mean ventilator days, Intensive Care Unit (ICU) stay and mortality were compared. Qualitative variables were reported as percentages and were compared by Chi-square test or unpaired two-tailed, Fisher's exact test, as appropriate, to analyse the significance of difference between the two groups. The two groups were similar with respect to demographic characteristics. VAP was seen in 6% of patients in Group I and 22% of patients in Group II (P = 0.021). Both early- and late-onset VAPs were significantly reduced in Group I. Both ventilator days (8.0 vs. 6.45; P = 0.001) and ICU stay (8.33 vs. 6.33; P = 0.001) on the day of onset of VAP were significantly more in the Group I. Total ventilator days were significantly less (6.52 vs. 8.32; P = 0.006) with lower incidence of mortality (36% vs. 48%; P = 0.224) in the Group I. Intermittent sub-glottic suctioning reduces the incidence of VAP including late-onset VAP.

  15. Recommended method to prevent leakage of titanium tube in condenser

    International Nuclear Information System (INIS)

    Wang Jun

    2010-01-01

    Qinshan Phase III is located at the estuary area of Qiantang River, where contains much slit and sand in the seawater. Since the units were put into operation, tube bundles in the condenser have been scratched, damaged or blocked by hard foreign materials, and outside wall thickness reduced and broken due to various reasons. Many tube bundles are discarded. In order to effectively prevent the re-occurrence of such problem and eliminate the existing defects, equipment management personnels of Qinshan Phase III work together with experts both from home and abroad, and perfom root-analysis for various cause of defects. After the problem root is identified, a serious of specific and effective measures are taken to prevent and eliminate the problem and reached a good effect. This paper herein is written for comments and reference. (authors)

  16. Randomized trial of piperaquine with sulfadoxine-pyrimethamine or dihydroartemisinin for malaria intermittent preventive treatment in children.

    Directory of Open Access Journals (Sweden)

    Badara Cisse

    Full Text Available BACKGROUND: The long terminal half life of piperaquine makes it suitable for intermittent preventive treatment for malaria but no studies of its use for prevention have been done in Africa. We did a cluster randomized trial to determine whether piperaquine in combination with either dihydroartemisin (DHA or sulfadoxine-pyrimethamine (SP is as effective, and better tolerated, than SP plus amodiaquine (AQ, when used for intermittent preventive treatment in children delivered by community health workers in a rural area of Senegal. METHODS: Treatments were delivered to children 3-59 months of age in their homes once per month during the transmission season by community health workers. 33 health workers, each covering about 60 children, were randomized to deliver either SP+AQ, DHA+PQ or SP+PQ. Primary endpoints were the incidence of attacks of clinical malaria, and the incidence of adverse events. RESULTS: 1893 children were enrolled. Coverage of monthly rounds and compliance with daily doses was similar in all groups; 90% of children received at least 2 monthly doses. Piperaquine combinations were better tolerated than SP+AQ with a significantly lower risk of common, mild adverse events. 103 episodes of clinical malaria were recorded during the course of the trial. 68 children had malaria with parasitaemia >3000/microL, 29/671 (4.3% in the SP+AQ group, compared with 22/604 (3.6% in the DHA+PQ group (risk difference 0.47%, 95%CI -2.3%,+3.3%, and 17/618 (2.8% in the SP+PQ group (risk difference 1.2%, 95%CI -1.3%,+3.6%. Prevalences of parasitaemia and the proportion of children carrying Pfdhfr and Pfdhps mutations associated with resistance to SP were very low in all groups at the end of the transmission season. CONCLUSIONS: Seasonal IPT with SP+PQ in children is highly effective and well tolerated; the combination of two long-acting drugs is likely to impede the emergence of resistant parasites. TRIAL REGISTRATION: ClinicalTrials.gov NCT00529620.

  17. Restructuring of the Gut Microbiome by Intermittent Fasting Prevents Retinopathy and Prolongs Survival in db/db Mice.

    Science.gov (United States)

    Beli, Eleni; Yan, Yuanqing; Moldovan, Leni; Vieira, Cristiano P; Gao, Ruli; Duan, Yaqian; Prasad, Ram; Bhatwadekar, Ashay; White, Fletcher A; Townsend, Steven; Chan, Luisa; Ryan, Caitlin N; Morton, Daniel; Moldovan, Emil G; Chu, Fang-I; Oudit, Gavin Y; Derendorf, Hartmut; Adorini, Luciano; Wang, Xiaoxin X; Evans-Molina, Carmella; Mirmira, Raghavendra G; Boulton, Michael E; Yoder, Mervin C; Li, Qiuhong; Levi, Moshe; Busik, Julia V; Grant, Maria B

    2018-04-30

    Intermittent fasting (IF) protects against the development of metabolic diseases and cancer, but whether it can prevent diabetic microvascular complications is not known. In db/db mice, we examined the impact of long-term IF on diabetic retinopathy (DR). Despite no change in glycated hemoglobin, db/db mice on the IF regimen displayed significantly longer survival and a reduction in DR endpoints, including acellular capillaries and leukocyte infiltration. We hypothesized that IF mediated changes in the gut microbiota would produce beneficial metabolites and prevent the development of DR. Microbiome analysis revealed increased levels of Firmicutes and decreased Bacteroidetes and Verrucomicrobia Compared to db/db mice on ad-libitum (AL) feeding, changes in the microbiome of the db/db mice on IF were associated with increases in gut mucin, goblet cell number and villi length and reductions in plasma peptidoglycan. Consistent with the known modulatory effects of Firmicutes on bile acid (BA) metabolism, measurement of BAs demonstrated a significant increase of tauroursodeoxycholate (TUDCA), a neuroprotective BA, in db/db on IF but not in db/db on AL feeding. TGR-5, the TUDCA receptor, was found in neural cells of the retina primary ganglion cells. Expression of TGR5 did not change with IF or diabetes. However, IF reduced retinal TNF-α mRNA, which is a key downstream target of TGR-5 activation. Pharmacological activation of TGR5 using INT-767 prevented DR in a second diabetic mouse model. These findings support the concept that IF prevents DR by restructuring the microbiota towards species producing TUDCA and subsequent retinal protection by TGR5 activation. © 2018 by the American Diabetes Association.

  18. A randomized placebo-controlled trial of intermittent preventive treatment in pregnant women in the context of insecticide treated nets delivered through the antenatal clinic.

    Directory of Open Access Journals (Sweden)

    Clara Menéndez

    2008-04-01

    Full Text Available Current recommendations to prevent malaria in African pregnant women rely on insecticide treated nets (ITNs and intermittent preventive treatment (IPTp. However, there is no information on the safety and efficacy of their combined use.1030 pregnant Mozambican women of all gravidities received a long-lasting ITN during antenatal clinic (ANC visits and, irrespective of HIV status, were enrolled in a randomised, double blind, placebo-controlled trial, to assess the safety and efficacy of 2-dose sulphadoxine-pyrimethamine (SP. The main outcome was the reduction in low birth weight.Two-dose SP was safe and well tolerated, but was not associated with reductions in anaemia prevalence at delivery (RR, 0.92 [95% CI, 0.79-1.08], low birth weight (RR, 0.99 [95% CI, 0.70-1.39], or overall placental infection (p = 0.964. However, the SP group showed a 40% reduction (95% CI, 7.40-61.20]; p = 0.020 in the incidence of clinical malaria during pregnancy, and reductions in the prevalence of peripheral parasitaemia (7.10% vs 15.15% (p<0.001, and of actively infected placentas (7.04% vs 13.60% (p = 0.002. There was a reduction in severe anaemia at delivery of borderline statistical significance (p = 0.055. These effects were not modified by gravidity or HIV status. Reported ITN's use was more than 90% in both groups.Two-dose SP was associated with a reduction in some indicators, but these were not translated to significant improvement in other maternal or birth outcomes. The use of ITNs during pregnancy may reduce the need to administer IPTp. ITNs should be part of the ANC package in sub-Saharan Africa.ClinicalTrials.gov NCT00209781.

  19. Assessing supply-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study and document and record review in two regions of Uganda.

    Science.gov (United States)

    Rassi, Christian; Graham, Kirstie; Mufubenga, Patrobas; King, Rebecca; Meier, Joslyn; Gudoi, Sam Siduda

    2016-07-04

    Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), provided as part of routine antenatal care (ANC), is one of three malaria-in-pregnancy prevention and control mechanisms recommended by the World Health Organization (WHO). However, despite high ANC attendance and increased efforts to address known obstacles, IPTp uptake figures have remained low. This study aimed to identify and assess barriers that continue to impede IPTp uptake in Uganda, in particular for women who attend ANC. The paper focuses on supply-side barriers, i.e., challenges relating to the health service provider. In-depth interviews were conducted in two regions of Uganda in November 2013 and April/May 2014 with four different target audiences: seven district health officials, 15 health workers, 19 women who had attended ANC, and five opinion leaders. In addition, a document and record review was carried out at four health facilities. Guidelines with regard to IPTp provision in Uganda have been shown to be inconsistent and, at the time of the research, did not reflect the most recent WHO policy recommendation. There is a lack of training and supervision opportunities for health workers, resulting in poor knowledge of IPTp guidelines and uncertainty about the safety and efficacy of SP. ANC is not consistently offered in health facilities, leading to some women being denied services. While strengthening of the supply chain appears to have reduced the occurrence of stock-outs of SP in public facilities, stock-outs reportedly continue to occur in the private sector. There are also sources of data inaccuracy along the data recording and reporting chain, limiting policy makers' ability to react adequately to trends and challenges. Given the high ANC attendance rates in Uganda, supply-side barriers are likely to account for many missed opportunities for the provision of IPTp in Uganda. Improvements will require consistent provision of ANC, implementation of current

  20. Energy intermittency

    CERN Document Server

    Sorensen, Bent

    2014-01-01

    The first book to consider intermittency as a key point of an energy system, Energy Intermittency describes different levels of variability for traditional and renewable energy sources, presenting detailed solutions for handling energy intermittency through trade, collaboration, demand management, and active energy storage. Addressing energy supply intermittency systematically, this practical text:Analyzes typical time-distributions and intervals between episodes of demand-supply mismatch and explores their dependence on system layouts and energy source characteristicsSimulates scenarios regar

  1. Common rugby league injuries. Recommendations for treatment and preventative measures.

    Science.gov (United States)

    Gibbs, N

    1994-12-01

    Rugby league is the main professional team sport played in Eastern Australia. It is also very popular at a junior and amateur level. However, injuries are common because of the amount of body contact that occurs and the amount of running that is required to participate in the game. Injuries to the lower limbs account for over 50% of all injuries. The most common specific injuries are ankle lateral ligament tears, knee medial collateral and anterior cruciate ligament tears, groin musculotendinous tears, hamstring and calf muscle tears, and quadriceps muscle contusions. Head injuries are common and consist of varying degrees of concussion as well as lacerations and facial fractures. Serious head injury is rare. Some of the more common upper limb injuries are to the acromioclavicular and glenohumeral joints. Accurate diagnosis of these common injuries using appropriate history, examination and investigations is critical in organising a treatment and rehabilitation plan that will return the player to competition as soon as possible. An understanding of the mechanism of injury is also important in order to develop preventative strategies.

  2. Screening for gestational diabetes mellitus : US preventive services task force recommendation statement

    NARCIS (Netherlands)

    Calonge, Ned; Petitti, Diana B.; DeWitt, Thomas G.; Gordis, Leon; Gregory, Kimberly D.; Harris, Russell; Isham, George; LeFevre, Michael L.; Loveland-Cherry, Carol; Marion, Lucy N.; Moyer, Virginia A.; Ockene, Judith K.; Sawaya, George F.; Siu, Albert L.; Teutsch, Steven M.; Yawn, Barbara P.

    2008-01-01

    Description: Update of 2003 U. S. Preventive Services Task Force (USPSTF) recommendation about screening for gestational diabetes. Methods: The USPSTF weighed the evidence on maternal and neonatal benefits (reduction in preeclampsia, mortality, brachial plexus injury, clavicular fractures, admission

  3. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: US Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Grossman, David C; Curry, Susan J; Owens, Douglas K; Barry, Michael J; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Landefeld, C Seth; Mangione, Carol M; Phipps, Maureen G; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen

    2017-12-12

    Menopause occurs at a median age of 51.3 years, and the average US woman who reaches menopause is expected to live another 30 years. The prevalence and incidence of most chronic conditions, such as coronary heart disease, dementia, stroke, fractures, and breast cancer, increase with age; however, the excess risk for these conditions that can be attributed to menopause alone is uncertain. Since the publication of findings from the Women's Health Initiative that hormone therapy use is associated with serious adverse health effects in postmenopausal women, use of menopausal hormone therapy has declined. To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on the use of menopausal hormone therapy for the primary prevention of chronic conditions. The USPSTF reviewed the evidence on the benefits and harms of systemic (ie, oral or transdermal) hormone therapy for the prevention of chronic conditions in postmenopausal women and whether outcomes vary among women in different subgroups or by timing of intervention after menopause. The review did not address hormone therapy for preventing or treating menopausal symptoms. Although the use of hormone therapy to prevent chronic conditions in postmenopausal women is associated with some benefits, there are also well-documented harms. The USPSTF determined that the magnitude of both the benefits and the harms of hormone therapy in postmenopausal women is small to moderate. Therefore, the USPSTF concluded with moderate certainty that combined estrogen and progestin has no net benefit for the primary prevention of chronic conditions for most postmenopausal women with an intact uterus and that estrogen alone has no net benefit for the primary prevention of chronic conditions for most postmenopausal women who have had a hysterectomy. The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal women. (D recommendation) The USPSTF

  4. A Community-Driven Approach to Generate Urban Policy Recommendations for Obesity Prevention

    Directory of Open Access Journals (Sweden)

    Julia Díez

    2018-03-01

    Full Text Available There is an increasing research interest in targeting interventions at the neighborhood level to prevent obesity. Healthy urban environments require including residents’ perspectives to help understanding how urban environments relate to residents’ food choices and physical activity levels. We describe an innovative community-driven process aimed to develop environmental recommendations for obesity prevention. We conducted this study in a low-income area in Madrid (Spain, using a collaborative citizen science approach. First, 36 participants of two previous Photovoice projects translated their findings into policy recommendations, using an adapted logical framework approach. Second, the research team grouped these recommendations into strategies for obesity prevention, using the deductive analytical strategy of successive approximation. Third, through a nominal group session including participants, researchers, public health practitioners and local policy-makers, we discussed and prioritized the obesity prevention recommendations. Participants identified 12 policy recommendations related to their food choices and 18 related to their physical activity. The research team grouped these into 11 concrete recommendations for obesity prevention. The ‘top-three’ ranked recommendations were: (1 to adequate and increase the number of public open spaces; (2 to improve the access and cost of existing sports facilities and (3 to reduce the cost of gluten-free and diabetic products.

  5. Middle age onset short-term intermittent fasting dietary restriction prevents brain function impairments in male Wistar rats.

    Science.gov (United States)

    Singh, Rumani; Manchanda, Shaffi; Kaur, Taranjeet; Kumar, Sushil; Lakhanpal, Dinesh; Lakhman, Sukhwinder S; Kaur, Gurcharan

    2015-12-01

    Intermittent fasting dietary restriction (IF-DR) is recently reported to be an effective intervention to retard age associated disease load and to promote healthy aging. Since sustaining long term caloric restriction regimen is not practically feasible in humans, so use of alternate approach such as late onset short term IF-DR regimen which is reported to trigger similar biological pathways is gaining scientific interest. The current study was designed to investigate the effect of IF-DR regimen implemented for 12 weeks in middle age rats on their motor coordination skills and protein and DNA damage in different brain regions. Further, the effect of IF-DR regimen was also studied on expression of energy regulators, cell survival pathways and synaptic plasticity marker proteins. Our data demonstrate that there was an improvement in motor coordination and learning response with decline in protein oxidative damage and recovery in expression of energy regulating neuropeptides. We further observed significant downregulation in nuclear factor kappa B (NF-κB) and cytochrome c (Cyt c) levels and moderate upregulation of mortalin and synaptophysin expression. The present data may provide an insight on how a modest level of short term IF-DR, imposed in middle age, can slow down or prevent the age-associated impairment of brain functions and promote healthy aging by involving multiple regulatory pathways aimed at maintaining energy homeostasis.

  6. Burden of Placental Malaria among Pregnant Women Who Use or Do Not Use Intermittent Preventive Treatment at Mulago Hospital, Kampala

    Directory of Open Access Journals (Sweden)

    Charles Okot Odongo

    2016-01-01

    Full Text Available Intermittent preventive treatment of malaria in pregnancy with sulphadoxine-pyrimethamine (SP-IPTp is widely used to reduce the incidence of adverse pregnancy outcomes. As a monitor for continued effectiveness of this intervention amidst SP resistance, we aimed to assess malaria burden among pregnant women who use or do not use SP-IPTp. In a descriptive cohort study at Mulago Hospital, Kampala, 87 women who received two supervised doses of SP-IPTp were followed up until delivery. Controls were pregnant women presenting in early labour without history of SP-IPTp. Histopathological investigation for placental malaria (PM was performed using the Bulmer classification criterion. Thirty-eight of the 87 women returned for delivery and 33 placentas were successfully collected and processed along with 33 placentas from SP nonusers. Overall, 12% (4/33 of the users had evidence of PM compared to 48% (16/33 of nonusers. Among nonusers, 17/33, 8/33, 2/33, and 6/33 had no placental infection, active infection, active-chronic infection, and past-chronic infection, respectively. Among users, respective proportions were 29/33, 2/33, 0/33, and 2/33. No difference in birth weights was apparent between the two groups, probably due to a higher proportion of infections occurring later in pregnancy. Histological evidence here suggests that SP continues to offer substantial benefit as IPTp.

  7. A Review of Eating Disorders in Athletes: Recommendations for Secondary School Prevention and Intervention Programs

    Science.gov (United States)

    Hildebrandt, Tom

    2005-01-01

    The current review aims to evaluate the literature on eating disorders and athletes with the purpose of making recommendations for sport psychologists and other relevant personnel on how to proceed in identifying, managing, and preventing eating disorders in school settings. Whereas the intention of this review is to make recommendations for…

  8. Determinants of adherence to recommendations for cancer prevention among Lynch Syndrome mutation carriers : A qualitative exploration

    NARCIS (Netherlands)

    Visser, Annemiek; Vrieling, Alina; Murugesu, Laxsini; Hoogerbrugge, Nicoline; Kampman, Ellen; Hoedjes, Meeke

    2017-01-01

    Background: Lynch Syndrome (LS) mutation carriers are at high risk for various cancer types, particularly colorectal cancer. Adherence to lifestyle and body weight recommendations for cancer prevention may lower this risk. To promote adherence to these recommendations, knowledge on determinants of

  9. Determinants of adherence to recommendations for cancer prevention among Lynch Syndrome mutation carriers: a qualitative exploration.

    NARCIS (Netherlands)

    Visser, A.; Vrieling, A.; Murugesu, L.; Hoogerbrugge, N.; Kampman, E.; Hoedjes, M.

    2017-01-01

    Background: Lynch Syndrome (LS) mutation carriers are at high risk for various cancer types, particularly colorectal cancer. Adherence to lifestyle and body weight recommendations for cancer prevention may lower this risk. To promote adherence to these recommendations, knowledge on determinants of

  10. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement.

    Science.gov (United States)

    Moyer, Virginia A

    2014-06-01

    Update of the 2004 US Preventive Services Task Force (USPSTF) recommendation on prevention of dental caries in preschool-aged children. The USPSTF reviewed the evidence on prevention of dental caries by primary care clinicians in children 5 years and younger, focusing on screening for caries, assessment of risk for future caries, and the effectiveness of various interventions that have possible benefits in preventing caries. This recommendation applies to children age 5 years and younger. The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. (B recommendation) The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by primary care clinicians in children from birth to age 5 years. (I Statement). Copyright © 2014 by the American Academy of Pediatrics.

  11. Postoperative intermittent fasting prevents hippocampal oxidative stress and memory deficits in a rat model of chronic cerebral hypoperfusion.

    Science.gov (United States)

    Hu, Yuan; Zhang, Miao; Chen, Yunyun; Yang, Ying; Zhang, Jun-Jian

    2018-01-11

    Whether intermittent fasting (IF) treatment after stroke can prevent its long-term detrimental effects remains unknown. Here, we investigate the effects of postoperative IF on cognitive deficits and its underlying mechanisms in a permanent two-vessel occlusion (2VO) vascular dementia rat model. Rats were subjected to either IF or ad libitum feeding 1 week after 2VO surgery. The cognition of rats was assessed using the novel object recognition (NOR) task and Morris water maze (MWM) 8 weeks after surgery. After behavioral testing, hippocampal malondialdehyde (MDA) and glutathione (GSH) concentrations, superoxide dismutase (SOD) activity, gene expression of antioxidative enzymes, inflammatory protein levels, and microglia density were determined. Postoperative IF significantly ameliorated the cognitive performance of 2VO rats in the NOR and MWM tests. Cognitive enhancement paralleled preservation of the PSD95 and BDNF levels in the 2VO rat hippocampus. Mechanistically, postoperative IF mitigated hippocampal oxidative stress in 2VO rats, as indicated by the reduced MDA concentration and mRNA and the protein levels of the reactive oxygen species-generating enzyme nicotinamide adenine dinucleotide phosphate oxidase 1. IF treatment also preserved the GSH level and SOD activity, as well as the levels of their upstream regulating enzymes, resulting in preserved antioxidative capability. In addition, postoperative IF prevented hippocampal microglial activation and elevation of sphingosine 1-phosphate receptor 1 and inflammatory cytokines in 2VO rats. Our results suggest that postoperative IF suppresses neuroinflammation and oxidative stress induced by chronic cerebral ischemia, thereby preserving cognitive function in a vascular dementia rat model.

  12. Dressings as an adjunct to pressure ulcer prevention: consensus panel recommendations.

    Science.gov (United States)

    Black, Joyce; Clark, Michael; Dealey, Carol; Brindle, Christopher T; Alves, Paulo; Santamaria, Nick; Call, Evan

    2015-08-01

    The formulation of recommendations on the use of wound dressings in pressure ulcer prevention was undertaken by a group of experts in pressure ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings (Mepilex Border Sacrum(®) and 3 layer Mepilex Heel(®) dressings by Mölnlycke Health Care, Gothenburg, Sweden) for pressure ulcer prevention in the sacrum, buttocks and heels in high-risk patients, those in Emergency Department (ED), intensive care unit (ICU) and operating room (OR). Literature on which this recommendation is based includes one prospective randomised control trial, three cohort studies and two case series. Recommendations for dressing use in patients at high risk for pressure injury and shear injury were also provided. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  13. Youth injury prevention in Canada: use of the Delphi method to develop recommendations.

    Science.gov (United States)

    Pike, Ian; Piedt, Shannon; Davison, Colleen M; Russell, Kelly; Macpherson, Alison K; Pickett, William

    2015-12-22

    The Health Behaviour in School-aged Children Survey is one of very few cross-national health surveys that includes information on injury occurrence and prevention within adolescent populations. A collaboration to develop a Canadian youth injury report using these data resulted in, Injury among Young Canadians: A national study of contextual determinants. The objective of this study was to develop specific evidence-based, policy-oriented recommendations arising from the national report, using a modified-Delphi process with a panel of expert stakeholders. Eight injury prevention experts and a 3-person youth advisory team associated with a Canadian injury prevention organization (Parachute Canada) reviewed, edited and commented on report recommendations through a three-stage iterative modified-Delphi process. From an initial list of 27 draft recommendations, the modified-Delphi process resulted in a final list of 19 specific recommendations, worded to resonate with the group(s) responsible to lead or take the recommended action. Two recommendations were rated as "extremely important" or "very important" by 100 % of the expert panel, two were deleted, a further two recommendations were deleted but the content included as text in the report, and four were merged with other existing recommendations. The modified-Delphi process was an appropriate method to achieve agreement on 19 specific evidence-based, policy-oriented recommendations to complement the national youth injury report. In providing their input, it is noted that the injury stakeholders each acted as individual experts, unattached to any organizational position or policy. These recommendations will require multidisciplinary collaborations in order to support the proposed policy development, additional research, programming and clear decision-making for youth injury prevention.

  14. Implications of the 2015 World Health Organization isoniazid preventive therapy recommendations on tuberculosis prevention efforts in Namibia.

    Science.gov (United States)

    Oloo, Stella Anne

    2016-07-01

    The World Health Organization recently released guidelines recommending 36-month use of isoniazid preventive therapy in adults and adolescents living with HIV in resource-limited settings. Namibia continues to grapple with one of the highest incidences of tuberculosis (TB) worldwide. Implementation of these guidelines requires considerations of TB epidemiology, health infrastructure, programmatic priorities and patient adherence. This article explores the challenges Namibia currently faces in its fight against TB and the implications of the new guidelines on Namibian TB prevention efforts.

  15. Intermittent preventive treatment of malaria in pregnancy with mefloquine in HIV-infected women receiving cotrimoxazole prophylaxis: a multicenter randomized placebo-controlled trial.

    Directory of Open Access Journals (Sweden)

    Raquel González

    2014-09-01

    Full Text Available BACKGROUND: Intermittent preventive treatment in pregnancy (IPTp with sulfadoxine-pyrimethamine (SP is recommended for malaria prevention in HIV-negative pregnant women, but it is contraindicated in HIV-infected women taking daily cotrimoxazole prophylaxis (CTXp because of potential added risk of adverse effects associated with taking two antifolate drugs simultaneously. We studied the safety and efficacy of mefloquine (MQ in women receiving CTXp and long-lasting insecticide treated nets (LLITNs. METHODS AND FINDINGS: A total of 1,071 HIV-infected women from Kenya, Mozambique, and Tanzania were randomized to receive either three doses of IPTp-MQ (15 mg/kg or placebo given at least one month apart; all received CTXp and a LLITN. IPTp-MQ was associated with reduced rates of maternal parasitemia (risk ratio [RR], 0.47 [95% CI 0.27-0.82]; p=0.008, placental malaria (RR, 0.52 [95% CI 0.29-0.90]; p=0.021, and reduced incidence of non-obstetric hospital admissions (RR, 0.59 [95% CI 0.37-0.95]; p=0.031 in the intention to treat (ITT analysis. There were no differences in the prevalence of adverse pregnancy outcomes between groups. Drug tolerability was poorer in the MQ group compared to the control group (29.6% referred dizziness and 23.9% vomiting after the first IPTp-MQ administration. HIV viral load at delivery was higher in the MQ group compared to the control group (p=0.048 in the ATP analysis. The frequency of perinatal mother to child transmission of HIV was increased in women who received MQ (RR, 1.95 [95% CI 1.14-3.33]; p=0.015. The main limitation of the latter finding relates to the exploratory nature of this part of the analysis. CONCLUSIONS: An effective antimalarial added to CTXp and LLITNs in HIV-infected pregnant women can improve malaria prevention, as well as maternal health through reduction in hospital admissions. However, MQ was not well tolerated, limiting its potential for IPTp and indicating the need to find alternatives with

  16. Therapeutic and prophylactic effect of intermittent preventive anti-malarial treatment in infants (IPTi from Ghana and Gabon

    Directory of Open Access Journals (Sweden)

    Kreuels Benno

    2008-10-01

    Full Text Available Abstract Background Intermittent preventive treatment in infants (IPTi with sulphadoxine-pyrimethamine (SP reduces the incidence of malaria episodes in young children. The exact mechanism by which the protective effect is mediated needs to be defined. This study aimed to investigate therapeutic, prophylactic, and possible exceeding effects of SP-based IPTi in two clinical trials. Methods Protective efficacies from two IPTi trials performed in Kumasi, Ghana, and Lambaréné, Gabon, were assessed for overlapping time series of 61 days. For six-months periods after each of three IPTi doses a multivariate Poisson regression model with the respective cohort as co-variate was generated and effect modification of protective efficacy with time strata was evaluated by log-likelihood tests. Results Protective efficacies were not significantly different between the two study cohorts. Study-cohort corrected protective efficacy was highest for the first 61 days after each IPTi application and decreased continuously. For the first 61 days after IPTi-1, IPTi-2, and IPTi-3 the protective efficacy was 71%, 44%, and 43%, respectively. A reduction of the malaria incidence rate was detectable for the first 60, 30 and 40 days after IPTi-1, IPTi-2 and IPTi-3 drug application, respectively. After IPTi-3 a higher risk for malaria could be seen after day 60. This effect was mainly based on the overwhelming influence of the Kumasi cohort. Conclusion The results suggest that SP-based IPTi mainly works through a therapeutic and prophylactic effect over 30 to 60 days after drug application and that a sustained effect beyond post-treatment prophylaxis might be very low. Trial registration Data analysis from clinical trials NCT ID # 00206739 (Kumasi Trial and NCT ID # 00167843 (Lambaréné Trial, http://www.clinicaltrials.gov.

  17. Are we having fun yet? Fostering adherence to injury preventive exercise recommendations in young athletes.

    Science.gov (United States)

    Keats, Melanie R; Emery, Carolyn A; Finch, Caroline F

    2012-03-01

    Sport and recreational activities are the leading cause of injury in youth, yet there is increasing evidence that many sport-related injuries are preventable. For injury prevention strategies to be effective, individuals must understand, adopt and adhere to the recommended prevention strategy or programme. Despite the recognized importance of a behavioural approach, the inclusion of behavioural change strategies in sport injury prevention has been historically neglected. The purpose of this commentary is to outline the rationale for the inclusion and application of behavioural science in reducing the burden of injury by increasing adherence to proven prevention strategies. In an effort to provide an illustrative example of a behavioural change approach, the authors suggest a specific plan for the implementation of a neuromuscular training strategy to reduce the risk of lower limb injury in youth sport. Given the paucity of evidence in the sport injury prevention setting, and the lack of application of theoretical frameworks to predicting adoption and adherence to injury preventive exercise recommendations in youth sport, data from the related physical activity promotion domain is utilized to describe how sound, theory-based injury prevention exercise interventions in youth may be developed. While the question of how to facilitate behavioural change and optimize adherence to preventive exercise recommendations remains an ongoing challenge, the authors detail several strategies based on two prominent behavioural theories to aid the reader in conceptualizing, designing and implementing effective interventions. Despite the minimal application of behavioural theory within the field of sport injury prevention in youth, behavioural science has the potential to make a significant impact on the understanding and prevention of youth sport injury. Appropriate evaluation of adherence and maintenance components based on models of behavioural change should be a critical

  18. Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study.

    Science.gov (United States)

    Barker, Anna Lucia; Kamar, Jeannette; Tyndall, Tamara Jane; White, Lyn; Hutchinson, Anastasia; Klopfer, Nicole; Weller, Carolina

    2013-06-01

    Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

  19. Adherence of preventive oral care products in the Syrian market to evidence-based international recommendations.

    Science.gov (United States)

    Habes, D; Mahzia, R; Nakhleh, K; Joury, E

    2016-09-25

    No study has investigated the availability and adherence of preventive oral care products on the Syrian market to evidence-based international recommendations. Data were collected in 2012, and updated in 2016, in terms of availability, characteristics and adherence to evidence-based international recommendations. Few preventive products adhered to the recommendations. Despite the large decrease in the number of oral care products on the Syrian market, due to the Syrian crisis, nonadherence of some of the available products is still present. A multisectorial approach at a policy level is needed to address such important limitations. The Syrian Ministry of Health should reform regulations for fluoride products to become subject to drug monitoring systems; the Syrian Arab Committee for Measurements and Standards needs to update its standards; and the Syrian General Dental Association should distribute a preventive booklet to dental practitioners.

  20. Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia.

    Science.gov (United States)

    Tolcher, Mary Catherine; Chu, Derrick M; Hollier, Lisa M; Mastrobattista, Joan M; Racusin, Diana A; Ramin, Susan M; Sangi-Haghpeykar, Haleh; Aagaard, Kjersti M

    2017-09-01

    The US Preventive Services Task Force recommends low-dose aspirin for the prevention of preeclampsia among women at high risk for primary occurrence or recurrence of disease. Recommendations for the use of aspirin for preeclampsia prevention were issued by the US Preventive Services Task Force in September 2014. The objective of the study was to evaluate the incidence of recurrent preeclampsia in our cohort before and after the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention. This was a retrospective cohort study designed to evaluate the rates of recurrent preeclampsia among women with a history of preeclampsia. We utilized a 2-hospital, single academic institution database from August 2011 through June 2016. We excluded multiple gestations and included only the first delivery for women with multiple deliveries during the study period. The cohort of women with a history of preeclampsia were divided into 2 groups, before and after the release of the US Preventive Services Task Force 2014 recommendations. Potential confounders were accounted for in multivariate analyses, and relative risk and adjusted relative risk were calculated. A total of 17,256 deliveries occurred during the study period. A total of 417 women had a documented history of prior preeclampsia: 284 women before and 133 women after the US Preventive Services Task Force recommendation. Comparing the before and after groups, the proportion of Hispanic women in the after group was lower and the method of payment differed between the groups (P .05]). Risk factors for recurrent preeclampsia included maternal age >35 years (relative risk, 1.83; 95% confidence interval, 1.34-2.48), Medicaid insurance (relative risk, 2.08; 95% confidence interval, 1.15-3.78), type 2 diabetes (relative risk, 2.13; 95% confidence interval, 1.37-3.33), and chronic hypertension (relative risk, 1.96; 95% confidence interval, 1.44-2.66). The risk of recurrent preeclampsia was decreased by

  1. Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines.

    Science.gov (United States)

    Frame, P S; Sawai, R; Bowen, W H; Meyerowitz, C

    2000-02-01

    The purpose of this article is to compare published evidence supporting procedures to prevent dental caries and periodontal disease, in low-risk patients, with the actual preventive recommendations of practicing dentists. Methods included (1) a survey questionnaire of general dentists practicing in western New York State concerning the preventive procedures they would recommend and at what intervals for low-risk children, young adults, and older adults; and (2) review of the published, English-language literature for evidence supporting preventive dental interventions. The majority of dentists surveyed recommended semiannual visits for visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk patients of all ages. Bite-wing radiographs were recommended for all age groups at annual or semiannual intervals. In-office fluoride applications were recommended for low-risk children at intervals of 6 to 12 months by 73% of dentists but were recommended for low-risk older persons by only 22% of dentists. Application of sealants to prevent pit and fissure caries was recommended for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of dental examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and polishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reason for the decline in the prevalence of dental caries, there are no studies of the incremental benefit of in-office fluoride treatments for low-risk patients exposed to fluoridated water and using fluoridated toothpaste. Comparative studies using outcome end points are needed to determine the optimal frequency of dental examinations and bite-wing radiographs for the early detection of caries, and of scaling

  2. Recommendations of the IOM clinical preventive services for women committee: implications for obstetricians and gynecologists.

    Science.gov (United States)

    Gee, Rebekah E; Brindis, Claire D; Diaz, Angela; Garcia, Francisco; Gregory, Kimberly; Peck, Magda G; Reece, E Albert

    2011-12-01

    In July 2011, in response to language in the Affordable Care Act (ACA) the Office of the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services (HHS) tasked the Institute of Medicine (IOM) to develop a report on the clinical preventive services necessary for women. The committee proposed eight new clinical preventive service recommendations aimed at closing significant gaps in preventive healthcare. This article reviews the process, findings, and the implications for obstetrician gynecologists and other primary care clinicians. Obstetricians and gynecologists play a major role in delivering primary care to women and many of the services recommended by the Committee are part of the core set of obstetrics and gynecology services. The women's health amendment to the ACA (Federal Register, 2010) requires that new private health plans cover - with no cost-sharing requirements - preventive healthcare services for women. Congress requested that a review be conducted to ascertain whether there were any additional needed preventive services specific to women's health that should be included. The IOM Committee on Preventive Services for Women recommended eight clinical measures specific to women's health that should be considered for coverage without co-payment. The US Department of HHS reviewed and adopted these recommendations, and, as a result, new health plans will need to include these services as part of insurance policies with plan years beginning on or after 1 August 2012. The authors discuss the implications of the IOM recommendations on practicing clinicians and on their potential impact on women's health and well being.

  3. Coverage, adherence and costs of intermittent preventive treatment of malaria in children employing different delivery strategies in Jasikan, Ghana.

    Directory of Open Access Journals (Sweden)

    Edith Patouillard

    Full Text Available Intermittent preventive treatment of malaria in children (IPTc involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxine-pyrimethamine plus amodiaquine (SP&AQ and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy.A community randomized trial was undertaken in Jasikan district, Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways. Twelve villages were randomly selected to receive IPTc from village health workers (VHWs or facility-based nurses working at health centres' outpatient departments (OPD or EPI outreach clinics. Children aged 3 to 59 months-old received one IPT course (three doses in May, June, September and October. Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective.The economic cost per child receiving at least the first dose of all 4 courses was US$4.58 when IPTc was delivered by VHWs, US$4.93 by OPD nurses and US$ 5.65 by EPI nurses. The unit economic cost of receiving all 3 doses of all 4 courses was US$7.56 and US$8.51 when IPTc was delivered by VHWs or facility-based nurses respectively. The main cost driver for the VHW delivery was supervision, reflecting resources used for travelling to more remote communities rather than more intense supervision, and for OPD and EPI delivery, it was the opportunity cost of the time spent by nurses in dispensing IPTc.VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district, Ghana.ClinicalTrials.gov NCT00119132.

  4. The Cost-Effectiveness of Intermittent Preventive Treatment for Malaria in Infants in Sub-Saharan Africa

    Science.gov (United States)

    Conteh, Lesong; Sicuri, Elisa; Manzi, Fatuma; Hutton, Guy; Obonyo, Benson; Tediosi, Fabrizio; Biao, Prosper; Masika, Paul; Matovu, Fred; Otieno, Peter; Gosling, Roly D.; Hamel, Mary; Odhiambo, Frank O.; Grobusch, Martin P.; Kremsner, Peter G.; Chandramohan, Daniel; Aponte, John J.; Egan, Andrea; Schellenberg, David; Macete, Eusebio; Slutsker, Laurence; Newman, Robert D.; Alonso, Pedro; Menéndez, Clara; Tanner, Marcel

    2010-01-01

    Background Intermittent preventive treatment in infants (IPTi) has been shown to decrease clinical malaria by approximately 30% in the first year of life and is a promising malaria control strategy for Sub-Saharan Africa which can be delivered alongside the Expanded Programme on Immunisation (EPI). To date, there have been limited data on the cost-effectiveness of this strategy using sulfadoxine pyrimethamine (SP) and no published data on cost-effectiveness using other antimalarials. Methods We analysed data from 5 countries in sub-Saharan Africa using a total of 5 different IPTi drug regimens; SP, mefloquine (MQ), 3 days of chlorproguanil-dapsone (CD), SP plus 3 days of artesunate (SP-AS3) and 3 days of amodiaquine-artesunate (AQ3-AS3).The cost per malaria episode averted and cost per Disability-Adjusted Life-Year (DALY) averted were modeled using both trial specific protective efficacy (PE) for all IPTi drugs and a pooled PE for IPTi with SP, malaria incidence, an estimated malaria case fatality rate of 1.57%, IPTi delivery costs and country specific provider and household malaria treatment costs. Findings In sites where IPTi had a significant effect on reducing malaria, the cost per episode averted for IPTi-SP was very low, USD 1.36–4.03 based on trial specific data and USD 0.68–2.27 based on the pooled analysis. For IPTi using alternative antimalarials, the lowest cost per case averted was for AQ3-AS3 in western Kenya (USD 4.62) and the highest was for MQ in Korowge, Tanzania (USD 18.56). Where efficacious, based only on intervention costs, IPTi was shown to be cost effective in all the sites and highly cost-effective in all but one of the sites, ranging from USD 2.90 (Ifakara, Tanzania with SP) to USD 39.63 (Korogwe, Tanzania with MQ) per DALY averted. In addition, IPTi reduced health system costs and showed significant savings to households from malaria cases averted. A threshold analysis showed that there is room for the IPTi-efficacy to fall and still

  5. From strategy development to routine implementation: the cost of Intermittent Preventive Treatment in Infants for malaria control

    Directory of Open Access Journals (Sweden)

    Tanner Marcel

    2008-07-01

    Full Text Available Abstract Background Achieving the Millennium Development Goals for health requires a massive scaling-up of interventions in Sub Saharan Africa. Intermittent Preventive Treatment in infants (IPTi is a promising new tool for malaria control. Although efficacy information is available for many interventions, there is a dearth of data on the resources required for scaling up of health interventions. Method We worked in partnership with the Ministry of Health and Social Welfare (MoHSW to develop an IPTi strategy that could be implemented and managed by routine health services. We tracked health system and other costs of (1 developing the strategy and (2 maintaining routine implementation of the strategy in five districts in southern Tanzania. Financial costs were extracted and summarized from a costing template and semi-structured interviews were conducted with key informants to record time and resources spent on IPTi activities. Results The estimated financial cost to start-up and run IPTi in the whole of Tanzania in 2005 was US$1,486,284. Start-up costs of US$36,363 were incurred at the national level, mainly on the development of Behaviour Change Communication (BCC materials, stakeholders' meetings and other consultations. The annual running cost at national level for intervention management and monitoring and drug purchase was estimated at US$459,096. Start-up costs at the district level were US$7,885 per district, mainly expenditure on training. Annual running costs were US$170 per district, mainly for printing of BCC materials. There was no incremental financial expenditure needed to deliver the intervention in health facilities as supplies were delivered alongside routine vaccinations and available health workers performed the activities without working overtime. The economic cost was estimated at 23 US cents per IPTi dose delivered. Conclusion The costs presented here show the order of magnitude of expenditures needed to initiate and to

  6. Surfing the web during pandemic flu: availability of World Health Organization recommendations on prevention.

    Science.gov (United States)

    Gesualdo, Francesco; Romano, Mariateresa; Pandolfi, Elisabetta; Rizzo, Caterina; Ravà, Lucilla; Lucente, Daniela; Tozzi, Alberto E

    2010-09-20

    People often search for information on influenza A(H1N1)v prevention on the web. The extent to which information found on the Internet is consistent with recommendations issued by the World Health Organization is unknown. We conducted a search for "swine flu" accessing 3 of the most popular search engines through different proxy servers located in 4 English-speaking countries (Australia, Canada, UK, USA). We explored each site resulting from the searches, up to 4 clicks starting from the search engine page, analyzing availability of World Health Organization recommendations for swine flu prevention. Information on hand cleaning was reported on 79% of the 147 websites analyzed; staying home when sick was reported on 77.5% of the websites; disposing tissues after sneezing on 75.5% of the websites. Availability of other recommendations was lower. The probability of finding preventative recommendations consistent with World Health Organization varied by country, type of website, and search engine. Despite media coverage on H1N1 influenza, relevant information for prevention is not easily found on the web. Strategies to improve information delivery to the general public through this channel should be improved.

  7. Surfing the web during pandemic flu: availability of World Health Organization recommendations on prevention

    Directory of Open Access Journals (Sweden)

    Ravà Lucilla

    2010-09-01

    Full Text Available Abstract Background People often search for information on influenza A(H1N1v prevention on the web. The extent to which information found on the Internet is consistent with recommendations issued by the World Health Organization is unknown. Methods We conducted a search for "swine flu" accessing 3 of the most popular search engines through different proxy servers located in 4 English-speaking countries (Australia, Canada, UK, USA. We explored each site resulting from the searches, up to 4 clicks starting from the search engine page, analyzing availability of World Health Organization recommendations for swine flu prevention. Results Information on hand cleaning was reported on 79% of the 147 websites analyzed; staying home when sick was reported on 77.5% of the websites; disposing tissues after sneezing on 75.5% of the websites. Availability of other recommendations was lower. The probability of finding preventative recommendations consistent with World Health Organization varied by country, type of website, and search engine. Conclusions Despite media coverage on H1N1 influenza, relevant information for prevention is not easily found on the web. Strategies to improve information delivery to the general public through this channel should be improved.

  8. Increasing awareness and knowledge of lifestyle recommendations for cancer prevention in Lynch syndrome carriers

    NARCIS (Netherlands)

    Vrieling, A.; Visser, A.; Hoedjes, Meeke; Hurks, H.M.H.; Gómez García, E.; Hoogerbrugge, N.; Kampman, E.

    2018-01-01

    Lynch syndrome (LS) mutation carriers may reduce their cancer risk by adhering to lifestyle recommendations for cancer prevention. This study tested the effect of providing LS mutation carriers with World Cancer Research Fund-the Netherlands (WCRF-NL) health promotion materials on awareness and

  9. Effectiveness of recommended drug classes in secondary prevention of acute coronary syndrome in France

    NARCIS (Netherlands)

    Bezin, Julien; Groenwold, Rolf; Ali, Sanni; Lassalle, Régis; De Boer, Anthonius; Moore, Nicholas; Klungel, Olaf; Pariente, Antoine

    Background: Guidelines for cardiovascular secondary prevention are based on evidence from relatively old clinical trials and need to be evaluated in daily clinical practice. Objectives: To evaluate effectiveness of the recommended drug classes after an acute coronary syndrome (ACS) for secondary

  10. U.S. Preventive Services Task Force recommendations and cancer screening among female Medicare beneficiaries.

    Science.gov (United States)

    Salloum, Ramzi G; Kohler, Racquel E; Jensen, Gail A; Sheridan, Stacey L; Carpenter, William R; Biddle, Andrea K

    2014-03-01

    Medicare covers several cancer screening tests not currently recommended by the U.S. Preventive Services Task Force (Task Force). In September 2002, the Task Force relaxed the upper age limit of 70 years for breast cancer screening recommendations, and in March 2003 an upper age limit of 65 years was introduced for cervical cancer screening recommendations. We assessed whether mammogram and Pap test utilization among women with Medicare coverage is influenced by changes in the Task Force's recommendations for screening. We identified female Medicare beneficiaries aged 66-80 years and used bivariate probit regression to examine the receipt of breast (mammogram) and cervical (Pap test) cancer screening reflecting changes in the Task Force recommendations. We analyzed 9,760 Medicare Current Beneficiary Survey responses from 2001 to 2007. More than two-thirds reported receiving a mammogram and more than one-third a Pap test in the previous 2 years. Lack of recommendation was given as a reason for not getting screened among the majority (51% for mammogram and 75% for Pap). After controlling for beneficiary-level socioeconomic characteristics and access to care factors, we did not observe a significant change in breast and cervical cancer screening patterns following the changes in Task Force recommendations. Although there is evidence that many Medicare beneficiaries adhere to screening guidelines, some women may be receiving non-recommended screening services covered by Medicare.

  11. Adherence to WCRF/AICR cancer prevention recommendations and metabolic syndrome in breast cancer patients.

    Science.gov (United States)

    Bruno, Eleonora; Gargano, Giuliana; Villarini, Anna; Traina, Adele; Johansson, Harriet; Mano, Maria Piera; Santucci De Magistris, Maria; Simeoni, Milena; Consolaro, Elena; Mercandino, Angelica; Barbero, Maggiorino; Galasso, Rocco; Bassi, Maria Chiara; Zarcone, Maurizio; Zagallo, Emanuela; Venturelli, Elisabetta; Bellegotti, Manuela; Berrino, Franco; Pasanisi, Patrizia

    2016-01-01

    Metabolic syndrome (MetS), conventionally defined by the presence of at least three out of five dismetabolic traits (abdominal obesity, hypertension, low plasma HDL-cholesterol and high plasma glucose and triglycerides), has been associated with both breast cancer (BC) incidence and prognosis. We investigated the association between the prevalence of MetS and a score of adherence to the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) recommendations for the prevention of cancer in a cross-sectional study of BC patients. The DIet and ANdrogen-5 study (DIANA-5) for the prevention of BC recurrences recruited 2092 early stage BC survivors aged 35-70. At recruitment, all women completed a 24-hour food frequency and physical activity diary on their consumption and activity of the previous day. Using these diaries we created a score of adherence to five relevant WCRF/AICR recommendations. The prevalence ratios (PRs) and 95% confidence intervals (CIs) of MetS associated with the number of recommendations met were estimated using a binomial regression model. The adjusted PRs of MetS decreased with increasing number of recommendations met (p < 0.001). Meeting all the five recommendations versus meeting none or only one was significantly associated with a 57% lower MetS prevalence (95% CI 0.35-0.73). Our results suggest that adherence to WCRF/AICR recommendations is a major determinant of MetS and may have a clinical impact. © 2015 UICC.

  12. The 10 recommendations for prevention of radiation accidents in industrial gamma radiography

    International Nuclear Information System (INIS)

    Souza, Luana Silva de

    2015-01-01

    The Industrial Gamma Radiography, as part of Industrial Radiography, stands out as the most widespread and plays an important role in the quality control of different materials and devices. However, IAEA classifies industrial gamma radiography in the Category 2 as very dangerous due to the radiological risk caused by the use of high activity radioactive sources. In March, 2012, a Brazilian Workshop on Prevention of Industrial Gamma Radiography Accident was performed by DIAPI/CNEN with the objective of disseminating knowledge about radiological accidents with radioactive sources in this application. During this Workshop, IRD/CNEN conducted a survey with 75 participants using a form with 22 recommendations to prevent radiological accidents, aiming to select the most voted. This present work aims to perform a detailed statistical study to define the Top 10 Recommendations for industrial gamma radiography operator avoids radiological accidents and to prepare a brochure with these top 10 recommendations to be distributed to all industrial gamma radiography radiation workers. Data analysis was performed using the statistical method 'Frequency Distribution', among the 75 participants categorized as General, RPO, and Other Workers of the area. The results were obtained for each category, accounting for the total of 22 recommendations in its percentage and number of votes, and the top 10 recommendations were defined to prevent radiological accidents. The first place and most important recommendation is 'Always use a personal alarm monitor throughout the work'. One of the conclusions is that the brochure with the Top 10 Recommendations shows to be understandable and useful for dissemination and training of radiation workers to avoid radiological accidents in industrial gamma radiography. (author)

  13. Use of Intermittent Preventive Treatment among Pregnant Women in Sub-Saharan Africa: Evidence from Malaria Indicator Surveys

    Directory of Open Access Journals (Sweden)

    Sanni Yaya

    2018-02-01

    Full Text Available Uptake of intermittent preventive therapy in pregnancy (IPTp with sulfadoxine-pyrimethamine (IPTp-SP is a clinically-proven method to prevent the adverse outcomes of malaria in pregnancy (MiP for the mother, her foetus, and the neonates. The majority of countries in sub-Saharan Africa have introduced IPTp policies for pregnant women during the past decade. Nonetheless, progress towards improving IPTp coverage remains dismal, with widespread regional and socioeconomic disparities in the utilisation of this highly cost-effective service. In the present study, our main objective was to measure the prevalence of IPTp uptake in selected malaria-endemic countries in sub-Saharan Africa, and to investigate the patterns of IPTp uptake among different educational and wealth categories adjusted for relevant sociodemographic factors. For this study, cross-sectional data on 18,603 women aged between 15 and 49 years were collected from the Malaria Indicator Surveys (MIS conducted in Burkina Faso, Ghana, Mali, Malawi, Kenya, Nigeria, Sierra Leone, and Uganda. The outcome variable was taking three doses of IPTp-SP in the last pregnancy, defined as adequate by the WHO. According to the analysis, the overall prevalence of taking three doses of IPTp-SP in the latest pregnancy was 29.5% (95% CI = 28.2–30.5, with the prevalence being highest for Ghana (60%, 95% CI = 57.1–62.8, followed by Kenya (37%, 95% CI = 35.3–39.2 and Sierra Leone (31%, 95% CI = 29.2–33.4. Women from non-poor households (richer—20.7%, middle—21.2%, richest—18.1% had a slightly higher proportion of taking three doses of IPTp-SP compared with those from poorest (19.0% and poorer (21.1% households. Regression analysis revealed an inverse association between uptake of IPTp-SP and educational level. With regard to wealth status, compared with women living in the richest households, those in the poorest, poorer, middle, and richer households had significantly higher odds of not taking

  14. Two-year evaluation of Intermittent Preventive Treatment for Children (IPTc combined with timely home treatment for malaria control in Ghana

    Directory of Open Access Journals (Sweden)

    Seake-Kwawu Atsu

    2011-05-01

    Full Text Available Abstract Background Intermittent preventive treatment (IPT has recently been accepted as an important component of the malaria control strategy. Intermittent preventive treatment for children (IPTc combined with timely treatment of malaria related febrile illness at home to reduce parasite prevalence and malaria morbidity in children aged between six and 60 months in a coastal community in Ghana. This paper reports persistence of reduced parasitaemia two years into the intervention. The baseline and year-one-evaluation findings were published earlier. Objective The main objective in the second year was to demonstrate whether the two interventions would further reduce parasite prevalence and malaria-related febrile illness in the study population. Methods This was an intervention study designed to compare baseline and evaluation findings without a control group. The study combined home-based delivery of intermittent preventive treatment for children (IPTc aged 6 - 60 months and home treatment of suspected febrile malaria-related illness within 24 hours. All children aged 6 - 60 months received home-based delivery of intermittent preventive treatment using amodiaquine + artesunate, delivered at home by community assistants every four months (6 times in 24 months. Malaria parasite prevalence surveys were conducted before the first and after the third and sixth IPTc to the children. The evaluation surveys were done four months after the third and sixth IPTc was given. Results Parasite prevalence which reduced from 25% to 3.0% at year-one evaluation had reduced further from 3% to 1% at year-two-evaluation. At baseline, 13.8% of the children were febrile (axilary temperature of ≥37.5°C compared to 2.2% at year-one-evaluation while 2.1% were febrile at year-two-evaluation. Conclusion The year-two-evaluation result indicates that IPTc given three times in a year (every four months combined with timely treatment of febrile malaria illness, is

  15. Two-year evaluation of Intermittent Preventive Treatment for Children (IPTc) combined with timely home treatment for malaria control in Ghana.

    Science.gov (United States)

    Ahorlu, Collins K; Koram, Kwadwo A; Seake-Kwawu, Atsu; Weiss, Mitchell G

    2011-05-15

    Intermittent preventive treatment (IPT) has recently been accepted as an important component of the malaria control strategy. Intermittent preventive treatment for children (IPTc) combined with timely treatment of malaria related febrile illness at home to reduce parasite prevalence and malaria morbidity in children aged between six and 60 months in a coastal community in Ghana. This paper reports persistence of reduced parasitaemia two years into the intervention. The baseline and year-one-evaluation findings were published earlier. The main objective in the second year was to demonstrate whether the two interventions would further reduce parasite prevalence and malaria-related febrile illness in the study population. This was an intervention study designed to compare baseline and evaluation findings without a control group. The study combined home-based delivery of intermittent preventive treatment for children (IPTc) aged 6 - 60 months and home treatment of suspected febrile malaria-related illness within 24 hours. All children aged 6-60 months received home-based delivery of intermittent preventive treatment using amodiaquine + artesunate, delivered at home by community assistants every four months (6 times in 24 months). Malaria parasite prevalence surveys were conducted before the first and after the third and sixth IPTc to the children. The evaluation surveys were done four months after the third and sixth IPTc was given. Parasite prevalence which reduced from 25% to 3.0% at year-one evaluation had reduced further from 3% to 1% at year-two-evaluation. At baseline, 13.8% of the children were febrile (axilary temperature of ≥ 37.5 °C) compared to 2.2% at year-one-evaluation while 2.1% were febrile at year-two-evaluation. The year-two-evaluation result indicates that IPTc given three times in a year (every four months) combined with timely treatment of febrile malaria illness, is effective to reduce malaria parasite prevalence in children aged 6 to 60 months

  16. Respiratory Synchronized Versus Intermittent Pneumatic Compression in Prevention of Venous Thromboembolism After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Elbuluk, Ameer M; Kim, Kelvin Y; Chen, Kevin K; Anoushiravani, Afshin A; Schwarzkopf, Ran; Iorio, Richard

    2018-04-01

    The objective of this study was to evaluate the efficacy of respiratory synchronized compression devices (RSCDs) versus nonsynchronized intermittent pneumatic compression devices (NSIPCDs) in preventing venous thromboembolism (VTE) after total joint arthroplasty. A systematic literature review was conducted. Data regarding surgical procedure, deep vein thrombosis, pulmonary embolism, mortality, and adverse events were abstracted. Compared with control groups, the risk ratio of deep vein thrombosis development was 0.51 with NSIPCDs and 0.47 with RSCDs. This review demonstrates that RSCDs may be marginally more effective at preventing VTE events than NSIPCDs. Furthermore, the addition of mechanical prophylaxis to any chemoprophylactic regimen increases VTE prevention. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures.

    Science.gov (United States)

    Marques, Andréa; Rodrigues, Ana M; Romeu, José Carlos; Ruano, Afonso; Barbosa, Ana Paula; Simões, Eugénia; Águas, Fernanda; Canhão, Helena; Alves, José Delgado; Lucas, Raquel; Branco, Jaime Cunha; Laíns, Jorge; Mascarenhas, Mário; Simões, Susete; Tavares, Viviana; Lourenço, Oscar; da Silva, José António Pereira

    2016-01-01

    To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures. A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions. 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible. Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.

  18. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy.

    Science.gov (United States)

    Rawlinson, William D; Boppana, Suresh B; Fowler, Karen B; Kimberlin, David W; Lazzarotto, Tiziana; Alain, Sophie; Daly, Kate; Doutré, Sara; Gibson, Laura; Giles, Michelle L; Greenlee, Janelle; Hamilton, Stuart T; Harrison, Gail J; Hui, Lisa; Jones, Cheryl A; Palasanthiran, Pamela; Schleiss, Mark R; Shand, Antonia W; van Zuylen, Wendy J

    2017-06-01

    Congenital cytomegalovirus is the most frequent, yet under-recognised, infectious cause of newborn malformation in developed countries. Despite its clinical and public health importance, questions remain regarding the best diagnostic methods for identifying maternal and neonatal infection, and regarding optimal prevention and therapeutic strategies for infected mothers and neonates. The absence of guidelines impairs global efforts to decrease the effect of congenital cytomegalovirus. Data in the literature suggest that congenital cytomegalovirus infection remains a research priority, but data are yet to be translated into clinical practice. An informal International Congenital Cytomegalovirus Recommendations Group was convened in 2015 to address these questions and to provide recommendations for prevention, diagnosis, and treatment. On the basis of consensus discussions and a review of the literature, we do not support universal screening of mothers and the routine use of cytomegalovirus immunoglobulin for prophylaxis or treatment of infected mothers. However, treatment guidelines for infected neonates were recommended. Consideration must be given to universal neonatal screening for cytomegalovirus to facilitate early detection and intervention for sensorineural hearing loss and developmental delay, where appropriate. The group agreed that education and prevention strategies for mothers were beneficial, and that recommendations will need continual updating as further data become available. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Timing of intermittent preventive treatment for malaria during pregnancy and the implications of current policy on early uptake in north-east Tanzania

    Directory of Open Access Journals (Sweden)

    Chambo Pili

    2008-05-01

    Full Text Available Abstract Background Intermittent preventive treatment (IPTp is efficacious in reducing the adverse outcomes associated with pregnancy-associated malaria, however uptake of the recommended two doses is low in Tanzania, and little is known of the timepoint during pregnancy at which it is delivered. This study investigated the timing of delivery of IPTp to pregnant women attending antenatal clinics (ANC, and the potential determinants of timely uptake. Methods Structured interviews were conducted with staff and pregnant women at antenatal clinics in northeast Tanzania, and antenatal consultations were observed. Facility-based and individual factors were analysed for any correlation with timing of IPTp uptake. Results Almost half the women interviewed first attended ANC during or before the fourth month of gestation, however 86% of these early attendees did not receive IPTp on their first visit. The timing of IPTp delivery complied closely with the national guidelines which stipulate giving the first dose at 20–24 weeks gestation. Uptake of at least one dose of IPTp among women who had reached this gestation age was 67%, although this varied considerably between clinics. At one facility, IPTp was not delivered because SP was out of stock. Conclusion Early uptake of IPTp was found to be hampered by factors external to health worker performance or women's individual preferences. These include insufficient drug stocks and an apparent lack of information to health workers on the reasoning for continued use of SP for IPTp when it has been replaced as a first-line treatment. In addition, an unexpectedly high proportion of women attend antenatal clinics before 20 weeks of pregnancy. While current policy denies the use of IPTp at this time, there is emerging, but incomplete, evidence that malaria in early pregnancy may contribute considerably to the burden of pregnancy-related malaria. Current policy may thus result in a missed opportunity for maximising

  20. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

    Directory of Open Access Journals (Sweden)

    Mubyazi Godfrey M

    2012-02-01

    Full Text Available Abstract Background Since its introduction in the national antenatal care (ANC system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment

  1. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

    Science.gov (United States)

    2012-01-01

    Background Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Methods Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. Results In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water

  2. Implementation of intermittent preventive treatment in pregnancy with sulphadoxine/pyrimethamine (IPTp-SP at a district health centre in rural Senegal

    Directory of Open Access Journals (Sweden)

    Vaillant Michel

    2008-11-01

    Full Text Available Abstract Background Intermittent preventive treatment with sulphadoxine-pyrimethamine (SP is recommended for reducing the risk of malaria in pregnancy and its consequences on mothers and babies (IPTp-SP. Indicators of implementation and effects of IPTp-SP were collected in a rural clinic in Southern Senegal. Methods Women seen routinely at the antenatal clinic (ANC of a rural dispensary during 2000–2007. Deployment of IPTp-SP started in January 2004. Inspection of antenatal and outpatient clinic registries of the corresponding period. Results Between 1st January 2000 and 30th April 2007, 1,781 women of all gravitidities and parities attended the ANC with 965 deliveries (606 and 398 respectively since 1st January 2004, when IPTp-SP was started. 69% of women were seen ≥ 3 times; 95% received at least one dose and 70% two doses of SP (from 61% in 2004 to 86% in 2007. The first visit, first and second dose of SP occurred at a median week 20, 22 and 31. The probability of receiving two doses was > 80% with ≥ 3 antenatal visits and a first dose of SP by week 20. The prevalence of maternal malaria was low and similar pre- (0.7% and during IPTp (0.8%. Effects on of low birth weight (LBW, Unfavourable pregnancy outcomes numbered 72 (7.5% of pregnancies with known outcome, including 30 abortions and 42 later deaths (late foetal deaths, stillbirth, peri-natal of which 13 with one or more malformations (1.35% of all recorded deliveries. Conclusion The implementation of IPTp-SP was high. Early attendance to ANC favours completion of IPTp-SP. The record keeping system in place is amenable to data extraction and linkage. A model was developed that predicts optimal compliance to two SP doses, and could be tested in other settings. Maternal malaria was infrequent and unaffected by IPTp-SP. The risk of LBW was lower during IPT implementation but the difference was non-significant and could have other explanations.

  3. Glucose-6-Phosphate Dehydrogenase Deficiency and Haemoglobin Drop after Sulphadoxine-Pyrimethamine Use for Intermittent Preventive Treatment of Malaria during Pregnancy in Ghana - A Cohort Study.

    Directory of Open Access Journals (Sweden)

    Ruth Owusu

    Full Text Available Sulphadoxine-Pyrimethamine (SP is still the only recommended antimalarial for use in intermittent preventive treatment of malaria during pregnancy (IPTp in some malaria endemic countries including Ghana. SP has the potential to cause acute haemolysis in G6PD deficient people resulting in significant haemoglobin (Hb drop but there is limited data on post SP-IPTp Hb drop. This study determined the difference, if any in proportions of women with significant acute haemoglobin drop between G6PD normal, partial deficient and full deficient women after SP-IPTp.Prospectively, 1518 pregnant women who received SP for IPTp as part of their normal antenatal care were enrolled. Their G6PD status were determined at enrollment followed by assessments on days 3, 7,14 and 28 to document any adverse effects and changes in post-IPTp haemoglobin (Hb levels. The three groups were comparable at baseline except for their mean Hb (10.3 g/dL for G6PD normal, 10.8 g/dL for G6PD partial deficient and 10.8 g/dL for G6PD full defect women.The prevalence of G6PD full defect was 2.3% and 17.0% for G6PD partial defect. There was no difference in the proportions with fractional Hb drop ≥ 20% as compared to their baseline value post SP-IPTp among the 3 groups on days 3, 7, 14. The G6PD full defect group had the highest median fractional drop at day 7. There was a weak negative correlation between G6PD activity and fractional Hb drop. There was no statistical difference between the three groups in the proportions of those who started the study with Hb ≥ 8g/dl whose Hb level subsequently fell below 8g/dl post-SP IPTp. No study participant required transfusion or hospitalization for severe anaemia.There was no significant difference between G6PD normal and deficient women in proportions with significant acute haemoglobin drop post SP-IPTp and lower G6PD enzyme activity was not strongly associated with significant acute drug-induced haemoglobin drop post SP-IPTp but a larger

  4. Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts.

    Science.gov (United States)

    Mubyazi, Godfrey M; Bloch, Paul; Byskov, Jens; Magnussen, Pascal; Bygbjerg, Ib C; Hansen, Kristian S

    2012-02-18

    Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts. Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively. In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for

  5. Shilling Attack Prevention for Recommender Systems Using Social-based Clustering

    KAUST Repository

    Lee, Tak

    2011-06-06

    A Recommender System (RS) is a system that utilizes user and item information to predict the feeling of users towards unfamiliar items. Recommender Systems have become popular tools for online stores due to their usefulness in confidently recommending items to users. A popular algorithm for recommender system is Collaborative Filtering (CF). CF uses other users\\' profiles to predict whether a user is interested in a particular object. This system, however, is vulnerable to malicious users seeking to promote items by manipulating rating predictions with fake user profiles. Profiles with behaviors similar to "victim" users alter the prediction of a Recommender System. Manipulating rating predictions through injected profiles is referred to as a shilling attack. It is important to develop shilling attack prevention frameworks for to protect the trustworthiness of Recommender Systems. In this thesis, we will demonstrate a new methodology that utilizes social information to prevent malicious users from manipulating the prediction system. The key element in our new methodology rests upon the concept of trust among real users, an element we claim absent among malicious profiles. In order to use trust information for shilling attack prevention, we first develop a weighting system which makes the system rely more on trustworthy users when making predictions. We then use this trust information to cluster out untrustworthy users to improve rating robustness. The robustness of the new and classic systems is then evaluated with data from a public commercial consumer RS, Epinions.com. Several complexity reduction procedures are also introduced to make implementing the algorithms mentioned possible for a huge commercial database.

  6. Intermittent sequential pneumatic compression of the legs and thromboembolism-deterrent stockings in the prevention of postoperative deep venous thrombosis

    International Nuclear Information System (INIS)

    Nicolaides, A.N.; Miles, C.; Hoare, M.; Jury, P.; Helmis, E.; Venniker, R.

    1983-01-01

    One hundred fifty patients over the age of 30 who had undergone major abdominal operations were stratified according to the risk of deep venous thrombosis and randomized into three groups to receive different prophylactic regimens: group A, electrical calf stimulation; group B, low-dose subcutaneous heparin; group C, intermittent sequential compression and thromboembolism-deterrent (TED) stockings. All the patients were scanned with the 125 I-fibrinogen test for the whole stay in hospital. The incidence of 125 I-fibrinogen detected deep venous thrombi was 18% in group A, 9% in group B, and 4% in group C. The results indicate that the regimen of intermittent sequential compression and TED stockings is as effective as low-dose subcutaneous heparin. Electrical calf stimulation is less effective

  7. Intermittent Fasting with or without Exercise Prevents Weight Gain and Improves Lipids in Diet-Induced Obese Mice

    OpenAIRE

    Robin A. Wilson; William Deasy; Christos G. Stathis; Alan Hayes; Matthew B. Cooke

    2018-01-01

    Intermittent fasting (IF) and high intensity interval training (HIIT) are effective lifestyle interventions for improving body composition and overall health. However, the long-term effects of IF and potential synergistic effects of combining IF with exercise are unclear. The purpose of the study was to investigate the long-term effects of IF, with or without HIIT, on body composition and markers of metabolic health in diet-induced obese mice. In a randosmised, controlled design, 8-week-old C...

  8. A new strategy and its effect on adherence to intermittent preventive treatment of malaria in pregnancy in Uganda.

    Science.gov (United States)

    Mbonye, Anthony K; Yanow, Stephanie; Birungi, Josephine; Magnussen, Pascal

    2013-09-21

    Few women in Uganda access intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP). Previous studies have shown that high costs, frequent stock-out of drugs, supplies and poor quality of care are the greatest hindrance for women to access health services. In order to increase adherence to IPTp, we conceptualised an intervention that offset delivery care costs through providing a mama kit, created awareness on health benefits of IPTp and built trust between the provider and the client. The new strategy was conceived along four constructs namely: 1) creating awareness by training midwives to explain the benefits of SP and the importance of adhering to the two doses of SP as IPTp to all pregnant women who attended ANC and consented to the study. Midwives were trained for two days in customer care and to provide a friendly environment. The pregnant women were also informed of the benefits of attending ANC and delivering at health facilities. 2) Each woman was promised a mama kit during ANC; 3) trust was built by showing the mama kit to each woman and branding it with her name; 4) keeping the promise by providing the mama kit when women came to deliver. The strategy to increase adherence to two doses of SP and encourage women to deliver at health facilities was implemented at two health facilities in Mukono district (Kawolo hospital and Mukono health centre IV). The inclusion criteria were women who: i) consented to the study and ii) were in the second trimester of pregnancy. All pregnant women in the second trimester (4-6 months gestation) who attended ANC and consented to participate in the study were informed of the benefits of SP, the importance of delivering at health facilities, were advised to attend the scheduled visits, promised a mama kit and ensured the kit was available at delivery. The primary outcome was the proportion of pregnant women adhering to a two dose SP regimen. A total of 2,276 women received the first

  9. Internal Medicine Hospitalists' Perceived Barriers and Recommendations for Optimizing Secondary Prevention of Osteoporotic Hip Fractures.

    Science.gov (United States)

    Tan, Eng Keong; Loh, Kah Poh; Goff, Sarah L

    2017-12-01

    Osteoporosis is a major public health concern affecting an estimated 10 million people in the United States. To the best of our knowledge, no qualitative study has explored barriers perceived by medicine hospitalists to secondary prevention of osteoporotic hip fractures. We aimed to describe these perceived barriers and recommendations regarding how to optimize secondary prevention of osteoporotic hip fracture. In-depth, semistructured interviews were performed with 15 internal medicine hospitalists in a tertiary-care referral medical center. The interviews were analyzed with directed content analysis. Internal medicine hospitalists consider secondary osteoporotic hip fracture prevention as the responsibility of outpatient physicians. Identified barriers were stratified based on themes including physicians' perception, patients' characteristics, risks and benefits of osteoporosis treatment, healthcare delivery system, and patient care transition from the inpatient to the outpatient setting. Some of the recommendations include building an integrated system that involves a multidisciplinary team such as the fracture liaison service, initiating a change to the hospital policy to facilitate inpatient care and management of osteoporosis, and creating a smooth patient care transition to the outpatient setting. Our study highlighted how internal medicine hospitalists perceive their role in the secondary prevention of osteoporotic hip fractures and what they perceive as barriers to initiating preventive measures in the hospital. Inconsistency in patient care transition and the fragmented nature of the existing healthcare system were identified as major barriers. A fracture liaison service could remove some of these barriers.

  10. Obesity prevention, screening, and treatment: practices of pediatric providers since the 2007 expert committee recommendations.

    Science.gov (United States)

    Rausch, John Conrad; Perito, Emily Rothbaum; Hametz, Patricia

    2011-05-01

    This study surveyed pediatric primary care providers at a major academic center regarding their attitudes and practices of obesity screening, prevention, and treatment. The authors compared the care providers' reported practices to the 2007 American Medical Association and Centers for Disease Control and Prevention Expert Committee Recommendations to evaluate their adherence to the guidelines and differences based on level of training and specialty. Of 96 providers surveyed, less than half used the currently recommended criteria for identifying children who are overweight (24.7%) and obese (34.4%), with attendings more likely to use the correct criteria than residents (P obesity, the majority felt their counseling was not effective. There was considerable variability in reported practices of lab screening and referral patterns of overweight and obese children. More efforts are needed to standardize providers' approach to overweight and obese children.

  11. Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: Conflicting recommendations

    OpenAIRE

    Burk, Ruth Srednicki; Jo Grap, Mary

    2012-01-01

    Pressure ulcers and ventilator-associated pneumonia (VAP) are both common in acute and critical care settings and are considerable sources of morbidity, mortality, and health care costs. To prevent pressure ulcers, guidelines limit bed backrest elevation to less than 30 degrees, whereas recommendations to reduce VAP include use of backrest elevations of 30 degrees or more. Although a variety of risk factors beyond patient position have been identified for both pressure ulcers and VAP, this ar...

  12. Teen Pregnancy Prevention Program Recommendations from Urban and Reservation Northern Plains American Indian Community Members

    OpenAIRE

    McMahon, Tracey R.; Hanson, Jessica D.; Griese, Emily R.; Kenyon, DenYelle Baete

    2015-01-01

    Despite declines over the past few decades, the United States has one of the highest rates of teen pregnancy compared to other industrialized nations. American Indian youth have experienced higher rates of teen pregnancy compared to the overall population for decades. Although it's known that community and cultural adaptation enhance program effectiveness, few teen pregnancy prevention programs have published on recommendations for adapting these programs to address the specific needs of Nort...

  13. The use of guideline recommended beta-blocker therapy in primary prevention implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Ruwald, Anne Christine; Gislason, Gunnar Hilmar; Vinther, Michael

    2017-01-01

    Aims: We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a 'real-life' setting. Methods and results: From the Danish Pacemaker and ICD Registry we identified all 1st-time prim......Aims: We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a 'real-life' setting. Methods and results: From the Danish Pacemaker and ICD Registry we identified all 1st......-time primary prevention ICD and cardiac resynchronization therapy defibrillator (CRT-D) implantations in Denmark from 2007-12 (n = 2935). Use of beta-blocker, type and dose was acquired through the Danish Prescription Registry. According to guideline recommendations, we defined target daily doses as ≥50 mg...... carvedilol and ≥200 mg metoprolol. Prior to implantation 2427 of 2935 (83%) patients received beta-blocker therapy, with 2166 patients (89%) having initiated treatment 3 months or more prior to implantation. The majority of patients was prescribed carvedilol (52%) or metoprolol (41%). Patients on carvedilol...

  14. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

    Directory of Open Access Journals (Sweden)

    Julie Storr

    2017-01-01

    Full Text Available Abstract Health care-associated infections (HAI are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.

  15. Utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in health facilities of Cross River State, Nigeria

    Directory of Open Access Journals (Sweden)

    Esu E

    2013-09-01

    Full Text Available Ekpereonne Esu,1,2 Emmanuel Effa,1,2 Ekong Udoh,1,2 Olabisi Oduwole,1,2 Friday Odey,1,2 Moriam Chibuzor,1 Angela Oyo-Ita,1,2 Martin Meremikwu1,2 1Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria; 2College of Medical Sciences, University of Calabar, Calabar, Nigeria Objective: This study assessed the utilization of intermittent preventive treatment with sulfadoxine–pyrimethamine for the prevention of malaria in pregnancy against the national treatment policy among women attending health care facilities in Cross River State, Nigeria. Methods: A clinical audit was carried out between January 2012 and March 2012 using case records of pregnant women who received antenatal care in health facilities in the state. Facilities were selected by simple random sampling. Information on the frequency of antenatal clinic (ANC visits by the women, as well as parity, age, and adherence to intermittent preventive treatment (IPTp doses was obtained using an audit checklist. Results: A total of 322 pregnant women were assessed across 36 health care facilities. In addition, 246 (76% of them attended the ANC in public health facilities. Age, parity, and gestational age at booking were recorded in more than 95% of the cases evaluated. The audit showed that 13.7% of the women did not utilize IPTp, 53.1% had one dose of IPTp (IPTp1, 24.2% had two doses of IPTp (IPTp2, while 3.1% had three doses of IPTp (IPTp3. The overall utilization of two doses or more of IPTp (IPTp2+ was 30.7%. Conclusion: There was good documentation of the basic obstetric information of pregnant women in the health care facilities examined in this study, but the overall utilization of IPTp was very low. Efforts at ensuring early ANC booking and regular visits may be a potential means of increasing IPTp utilization in health care facilities in the state. Keywords: intermittent preventive treatment, malaria, pregnancy, clinical

  16. Intermittent preventive sulfadoxine-pyrimethamine treatment of primigravidae reduces levels of plasma immunoglobulin G, which protects against pregnancy-associated Plasmodium falciparum malaria

    DEFF Research Database (Denmark)

    Staalsoe, Trine; Shulman, Caroline E; Dorman, Edgar K

    2004-01-01

    Pregnancy-associated malaria (PAM) is an important cause of maternal and neonatal suffering. It is caused by Plasmodium falciparum capable of inhabiting the placenta through expression of particular variant surface antigens (VSA) with affinity for proteoglycans such as chondroitin sulfate A....... Protective immunity to PAM develops following exposure to parasites inhabiting the placenta, and primigravidae are therefore particularly susceptible to PAM. The adverse consequences of PAM in primigravidae are preventable by intermittent preventive treatment (IPTp), where women are given antimalarials...... at specified intervals during pregnancy, but this may interfere with acquisition of protective PAM immunity. We found that Kenyan primigravidae receiving sulfadoxine-pyrimethamine IPTp had significantly lower levels of immunoglobulin G (IgG) with specificity for the type of parasite-encoded VSA-called VSA(PAM...

  17. Developing a matrix to identify and prioritise research recommendations in HIV Prevention

    Directory of Open Access Journals (Sweden)

    Coates Bob

    2011-05-01

    Full Text Available Abstract Background HIV prevention continues to be problematic in the UK, as it does globally. The UK Department of Health has a strategic direction with greater focus on prevention as part of its World Class Commissioning Programme. There is a need for targeted evidence-based prevention initiatives. This is an exploratory study to develop an evidence mapping tool in the form of a matrix: this will be used to identify important gaps in contemporary HIV prevention evidence relevant to the UK. It has the potential to aid prioritisation in future research. Methods Categories for prevention and risk groups were developed for HIV prevention in consultation with external experts. These were used as axes on a matrix tool to map evidence. Systematic searches for publications on HIV prevention were undertaken using electronic databases for primary and secondary research undertaken mainly in UK, USA, Canada, Australia and New Zealand, 2006-9. Each publication was screened for inclusion then coded. The risk groups and prevention areas in each paper were counted: several publications addressed multiple risk groups. The counts were exported to the matrix and clearly illustrate the concentrations and gaps of literature in HIV prevention. Results 716 systematic reviews, randomised control trials and other primary research met the inclusion criteria for HIV prevention. The matrix identified several under researched areas in HIV prevention. Conclusions This is the first categorisation system for HIV prevention and the matrix is a novel tool for evidence mapping. Some important yet under-researched areas have been identified in HIV prevention evidence: identifying the undiagnosed population; international adaptation; education; intervention combinations; transgender; sex-workers; heterosexuals and older age groups. Other research recommendations: develop the classification system further and investigate transferability of the matrix to other prevention areas

  18. Language of Uncertainty: the Expression of Decisional Conflict Related to Skin Cancer Prevention Recommendations.

    Science.gov (United States)

    Strekalova, Yulia A; James, Vaughan S

    2017-09-01

    User-generated information on the Internet provides opportunities for the monitoring of health information consumer attitudes. For example, information about cancer prevention may cause decisional conflict. Yet posts and conversations shared by health information consumers online are often not readily actionable for interpretation and decision-making due to their unstandardized format. This study extends prior research on the use of natural language as a predictor of consumer attitudes and provides a link to decision-making by evaluating the predictive role of uncertainty indicators expressed in natural language. Analyzed data included free-text comments and structured scale responses related to information about skin cancer prevention options. The study identified natural language indicators of uncertainty and showed that it can serve as a predictor of decisional conflict. The natural indicators of uncertainty reported here can facilitate the monitoring of health consumer perceptions about cancer prevention recommendations and inform education and communication campaign planning and evaluation.

  19. Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update.

    Science.gov (United States)

    Rodrigues, A M; Canhão, H; Marques, A; Ambrósio, C; Borges, J; Coelho, P; Costa, L; Fernandes, S; Gonçalves, I; Gonçalves, M; Guerra, M; Marques, M L; Pimenta, S; Pinto, P; Sequeira, G; Simões, E; Teixeira, L; Vaz, C; Vieira-Sousa, E; Vieira, R; Alvarenga, F; Araújo, F; Barcelos, A; Barcelos, F; Barros, R; Bernardes, M; Canas da Silva, J; Cordeiro, A; Costa, M; Cunha-Miranda, L; Cruz, M; Duarte, A C; Duarte, C; Faustino, A; Figueiredo, G; Fonseca, J E; Furtado, C; Gomes, J; Lopes, C; Mourão, A F; Oliveira, M; Pimentel-Santos, F M; Ribeiro, A; Sampaio da Nóvoa, T; Santiago, M; Silva, C; Silva-Dinis, A; Sousa, S; Tavares-Costa, J; Terroso, G; Vilar, A; Branco, J C; Tavares, V; Romeu, J C; da Silva, Jap

    2018-01-01

    Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey. The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with

  20. Estimated impact on birth weight of scaling up intermittent preventive treatment of malaria in pregnancy given sulphadoxine-pyrimethamine resistance in Africa: A mathematical model.

    Directory of Open Access Journals (Sweden)

    Patrick G T Walker

    2017-02-01

    Full Text Available Malaria transmission has declined substantially in the 21st century, but pregnant women in areas of sustained transmission still require protection to prevent the adverse pregnancy and birth outcomes associated with malaria in pregnancy (MiP. A recent call to action has been issued to address the continuing low coverage of intermittent preventive treatment of malaria in pregnancy (IPTp. This call has, however, been questioned by some, in part due to concerns about resistance to sulphadoxine-pyrimethamine (SP, the only drug currently recommended for IPTp.Using an existing mathematical model of MiP, we combined estimates of the changing endemicity of malaria across Africa with maps of SP resistance mutations and current coverage of antenatal access and IPTp with SP (IPTp-SP across Africa. Using estimates of the relationship between SP resistance mutations and the parasitological efficacy of SP during pregnancy, we estimated the varying impact of IPTp-SP across Africa and the incremental value of enhancing IPTp-SP uptake to match current antenatal care (ANC coverage. The risks of MiP and malaria-attributable low birthweight (mLBW in unprotected pregnancies (i.e., those not using insecticide-treated nets [ITNs] leading to live births fell by 37% (33%-41% 95% credible interval [crI] and 31% (27%-34% 95% crI, respectively, from 2000 to 2015 across endemic areas in sub-Saharan Africa. However, these gains are fragile, and coverage is far from optimal. In 2015, 9.5 million (8.3 million-10.4 million 95% crI of 30.6 million pregnancies in these areas would still have been infected with Plasmodium falciparum without intervention, leading to 750,000 (390,000-1.1 million 95% crI mLBW deliveries. In all, 6.6 million (5.6 million-7.3 million 95% crI of these 9.5 million (69.3% pregnancies at risk of infection (and 53.4% [16.3 million/30.6 million] of all pregnancies occurred in settings with near-perfect SP curative efficacy (>99% based on the most recent

  1. SGLT2 Inhibitor-associated Diabetic Ketoacidosis: Clinical Review and Recommendations for Prevention and Diagnosis.

    Science.gov (United States)

    Goldenberg, Ronald M; Berard, Lori D; Cheng, Alice Y Y; Gilbert, Jeremy D; Verma, Subodh; Woo, Vincent C; Yale, Jean-François

    2016-12-01

    Sodium-glucose cotransporter 2 (SGLT2) inhibitors are the newest class of antihyperglycemic agents available on the market. Regulator warnings and concerns regarding the risk of developing diabetic ketoacidosis (DKA), however, have dampened enthusiasm for the class despite the combined glycemic, blood pressure, and occasional weight benefits of SGLT2 inhibitors. With the goal of improving patient safety, a cross-Canada expert panel and writing group were convened to review the evidence to-date on reported SGLT2 inhibitor-related DKA incidents and to offer recommendations for preventing and recognizing patients with SGLT2 inhibitor-associated DKA. Reports covering DKA events in subjects taking SGLT2 inhibitors that were published in PubMed, presented at professional conferences, or in the public domain from January 2013 to mid-August 2016 were reviewed by the group independently and collectively. Practical recommendations for diagnosis and prevention were established by the panel. DKA is rarely associated with SGLT2 inhibitor therapy. Patients with SGLT2 inhibitor-associated DKA may be euglycemic (plasma glucose level SGLT2 inhibitor-associated DKA may be prevented by withholding SGLT2 inhibitors when precipitants develop, avoiding insulin omission or inappropriate insulin dose reduction, and by following sick day protocols as recommended. Preventive strategies should help avoid SGLT2 inhibitor-associated DKA. All SGLT2 inhibitor-treated patients presenting with signs or symptoms of DKA should be suspected to have DKA and be investigated for DKA, especially euglycemic patients. If DKA is diagnosed, SGLT2 inhibitor treatment should be stopped, and the DKA should be treated with a traditional treatment protocol. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.

  2. Alberta's Tomorrow Project: adherence to cancer prevention recommendations pertaining to diet, physical activity and body size.

    Science.gov (United States)

    Whelan, Heather K; Xu, Jian-Yi; Vaseghi, Sanaz; Lo Siou, Geraldine; McGregor, S Elizabeth; Robson, Paula J

    2017-05-01

    To explore cross-sectional adherence to cancer prevention recommendations by adults enrolled in a prospective cohort in Alberta, Canada. Questionnaire data were used to construct a composite cancer prevention adherence score for each participant, based on selected personal recommendations published by the World Cancer Research Fund/American Institute for Cancer Research (2007). Data were self-reported on health and lifestyle, past-year physical activity and past-year FFQ. The scores accounted for physical activity, dietary supplement use, body size, and intakes of alcohol, fruit, vegetables and red meat. Tobacco exposure was also included. Scores ranged from 0 (least adherent) to 7 (most adherent). Alberta's Tomorrow Project; a research platform based on a prospective cohort. Adult men and women (n 24 988) aged 35-69 years recruited by random digit dialling and enrolled in Alberta's Tomorrow Project between 2001 and 2009. Of the cohort, 14 % achieved adherence scores ≥5 and 60 % had scores ≤3. Overall adherence scores were higher in women (mean (sd): 3·4 (1·1)) than in men (3·0 (1·2)). The extent of overall adherence was also associated with level of education, employment status, annual household income, personal history of chronic disease, family history of chronic disease and age. Reported adherence to selected personal recommendations for cancer prevention was low in this cohort of adults. In the short to medium term, these results suggest that more work is required to identify behaviours to target with cancer prevention strategies at a population level. Future work will explore the associations between adherence scores and cancer risk in this cohort.

  3. Prevention of Backover Fatalities in Highway Work Zones: A Synthesis of Current Practices and Recommendations

    Directory of Open Access Journals (Sweden)

    Wei Fan

    2014-12-01

    Full Text Available The purpose of this paper is to synthesize current practices and procedures on the prevention of backing fatalities in highway work zones. First, general work zone safety hazards are reviewed, particularly blind areas are identified. Second, engineering controls currently in use are examined and explained to help understand what steps can be taken to prevent future backing fatalities. Third, administrative controls (including signalers, drivers, and workers-on-foot training are also discussed. Fourth, existing technology controls are reviewed for use in aiding equipment operators in identifying when pedestrian personnel are in dangerous areas around their equipment (i.e., back-up camera, radar. Fifth, recommendations are made based on the comprehensive review of the backover fatality prevention techniques in construction work zones and the conducted testing results of several commercially available systems. Recommendations on engineering and technology controls are discussed, with detailed information such as improving internal traffic control plans, and integrating technology with traffic control plans. Information and drawings are provided to illustrate how to design work zones, and the internal traffic flow diagrams are created using the integrated technology available, and site specific characteristics. The drawings represent examples of using different types of technology, in different scenarios using the proper legend, as well as using the proper general and technology notes to help explain the traffic control plan, ensuring that full comprehension is made. Recommendations on administrative controls are also given such as how to conduct safety meetings, electing safety officers, how to set regulations and guidelines for workers, and how to handle training. Training should be used as a backover fatality prevention method for pedestrian workers, flaggers, spotters, and equipment operators. Finally, a summary and discussion of future research

  4. Physical activity and cancer prevention: awareness and meeting the recommendations among adult Saudis.

    Science.gov (United States)

    Amin, Tarek Tawfik; Al-Hammam, Abudllah Mohammed; AlMulhim, Nasser Abdullah; Al-Hayan, Mohammed Ibrahim; Al-Mulhim, Mona Mohammed; Al-Mosabeh, Modhahir Jawad; Al-Subaie, Mohammed Ali; Al-Hmmad, Qassem Ahmed; Al-Omran, Ahmed Adi

    2014-01-01

    There is a scarcity of information about the proportion of the adult Saudi population that meet the recommended guidelines of physical activity (PA) to reduce cancer risk. Moreover, their awareness about the role of PA in cancer prevention is unclear. This cross-sectional study aimed at estimating the proportion of adult Saudis meeting the PA guidelines, specifically those recommended by American Cancer Society (ACS) for cancer prevention, and to assess the public awareness about the role of PA in cancer prevention. Using a multistage sampling method, 2,127 adult Saudis of both genders were recruited from 6 urban and 4 rural primary health care centers in Al Hassa, Saudi Arabia. Participants were personally interviewed to gather information about their sociodemographic characteristics, searching activity about PA and cancer, and the time spent in leisure time PA (moderate and vigorous)/week using the Global Physical Activity Questionnaire with show cards. Finally, items about the role of PA in cancer risk reduction were inquired. Of the included participants, 11.6% met the recommendations for cancer prevention (≥ 45 minutes of moderate-vigorous PA activity/≥ 5 days/week or 225 minutes/week). Multivariate regression showed that being male (AOR=1.49, CI=1.09-2.06), cancer prevention. Only 11.4% of the sample indicated correctly the frequency and duration of PA required for an average adult to be physically active and while >70% of them indicated the role of PA in prevention of hypertension, coronary heart disease and lowering elevated blood cholesterol, only 18.6% and 21.7% correctly mentioned the role of PA in reducing colon and breast cancer risk, respectively. Poor knowledge was found among those with less than college education and aged ≥ 50 years. The level of knowledge was significantly positively correlated with total leisure time PA of the participants. A minority of adult Saudis in Al Hassa was aware about the role of PA in cancer prevention and

  5. Intermittent hydronephrosis

    International Nuclear Information System (INIS)

    Knop, J.; Vogel, H.; Hupe, W.

    1981-01-01

    An intermittent hydronephrosis was observed in a 40-year old patient. This disease pattern is due to an incongruity between the formation of urine and the transport capacity in the ureteropelvic junction. The latent impediment of flow becomes manifest with increased urine secretion. Irreversible renal damage can be the result of the repeatedly occurring hydronephrotic crises. (orig.) [de

  6. Serologic Screening for Genital Herpes Infection: US Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Bibbins-Domingo, Kirsten; Grossman, David C; Curry, Susan J; Davidson, Karina W; Epling, John W; García, Francisco A R; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Landefeld, C Seth; Mangione, Carol M; Phillips, William R; Phipps, Maureen G; Pignone, Michael P; Silverstein, Michael; Tseng, Chien-Wen

    2016-12-20

    Genital herpes is a prevalent sexually transmitted infection in the United States, occurring in almost 1 in 6 persons aged 14 to 49 years. Infection is caused by 2 subtypes of the herpes simplex virus (HSV), HSV-1 and HSV-2. Antiviral medications may provide symptomatic relief from outbreaks but do not cure HSV infection. Neonatal herpes infection, while uncommon, can result in substantial morbidity and mortality. To update the 2005 US Preventive Services Task Force (USPSTF) recommendation on screening for genital herpes. The USPSTF reviewed the evidence on the accuracy, benefits, and harms of serologic screening for HSV-2 infection in asymptomatic persons, including those who are pregnant, as well as the effectiveness and harms of preventive medications and behavioral counseling interventions to reduce future symptomatic episodes and transmission to others. Based on the natural history of HSV infection, its epidemiology, and the available evidence on the accuracy of serologic screening tests, the USPSTF concluded that the harms outweigh the benefits of serologic screening for genital HSV infection in asymptomatic adolescents and adults, including those who are pregnant. The USPSTF recommends against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including those who are pregnant. (D recommendation).

  7. Caloric restriction and intermittent fasting alter hepatic lipid droplet proteome and diacylglycerol species and prevent diabetes in NZO mice.

    Science.gov (United States)

    Baumeier, Christian; Kaiser, Daniel; Heeren, Jörg; Scheja, Ludger; John, Clara; Weise, Christoph; Eravci, Murat; Lagerpusch, Merit; Schulze, Gunnar; Joost, Hans-Georg; Schwenk, Robert Wolfgang; Schürmann, Annette

    2015-05-01

    Caloric restriction and intermittent fasting are known to improve glucose homeostasis and insulin resistance in several species including humans. The aim of this study was to unravel potential mechanisms by which these interventions improve insulin sensitivity and protect from type 2 diabetes. Diabetes-susceptible New Zealand Obese mice were either 10% calorie restricted (CR) or fasted every other day (IF), and compared to ad libitum (AL) fed control mice. AL mice showed a diabetes prevalence of 43%, whereas mice under CR and IF were completely protected against hyperglycemia. Proteomic analysis of hepatic lipid droplets revealed significantly higher levels of PSMD9 (co-activator Bridge-1), MIF (macrophage migration inhibitor factor), TCEB2 (transcription elongation factor B (SIII), polypeptide 2), ACY1 (aminoacylase 1) and FABP5 (fatty acid binding protein 5), and a marked reduction of GSTA3 (glutathione S-transferase alpha 3) in samples of CR and IF mice. In addition, accumulation of diacylglycerols (DAGs) was significantly reduced in livers of IF mice (P=0.045) while CR mice showed a similar tendency (P=0.062). In particular, 9 DAG species were significantly reduced in response to IF, of which DAG-40:4 and DAG-40:7 also showed significant effects after CR. This was associated with a decreased PKCε activation and might explain the improved insulin sensitivity. In conclusion, our data indicate that protection against diabetes upon caloric restriction and intermittent fasting associates with a modulation of lipid droplet protein composition and reduction of intracellular DAG species. Copyright © 2015. Published by Elsevier B.V.

  8. Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations.

    Science.gov (United States)

    Balsells, Evelyn; Filipescu, Teodora; Kyaw, Moe H; Wiuff, Camilla; Campbell, Harry; Nair, Harish

    2016-12-01

    Clostridium difficile is the leading cause of health care-associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance. We identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI-targeted IPC recommendations and describe the assessment of evidence in available guidelines. We identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long-term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported "strong" recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality. Our review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations.

  9. Achievement of public health recommendations for physical activity and prevention of gains in adiposity in adults

    DEFF Research Database (Denmark)

    Grøntved, A.

    2013-01-01

    Physical activity (PA) is considered a cornerstone in weight control and public health guidelines recommend regular participation to prevent gains in adiposity. It may therefore come as a surprise that the cumulative evidence from observational studies to support this is not strong. A weakness...... of many published observational studies on this topic has been a reliance on a single baseline assessment of PA. Using only the baseline information on PA in a prospective study cause misclassification because of participants often change activity level during follow-up. In turn this causes regression...

  10. Surfing the web during pandemic flu: availability of World Health Organization recommendations on prevention

    OpenAIRE

    Gesualdo, Francesco; Romano, Mariateresa; Pandolfi, Elisabetta; Rizzo, Caterina; Rav?, Lucilla; Lucente, Daniela; Tozzi, Alberto E

    2010-01-01

    Abstract Background People often search for information on influenza A(H1N1)v prevention on the web. The extent to which information found on the Internet is consistent with recommendations issued by the World Health Organization is unknown. Methods We conducted a search for "swine flu" accessing 3 of the most popular search engines through different proxy servers located in 4 English-speaking countries (Australia, Canada, UK, USA). We explored each site resulting from the searches, up to 4 c...

  11. [FEDERAL CLINICAL RECOMMENDATIONS IN DIAGNOSIS, TREATMENT AND PREVENTION OF HEARING LOSS DUE TO NOISE].

    Science.gov (United States)

    Adeninskaya, E E; Bukhtiarov, I V; Bushmanov, A Iu; Dayhes, N A; Denisov, E I; Izmerov, N F; Mazitova, N N; Pankova, V B; Preobrazhenskaya, E A; Prokopenko, L V; Simonova, N I; Tavartkiladze, G A; Fedina, I N

    2016-01-01

    Noise induced hearing loss is a slowly developing hearing impairment, caused by occupational exposure to excessive noise levels, constitutes a lesion of the auditory analyzer and clinically manifested as chronic bilateral sensorineural hearing loss. Currently, there is not a treatment that provide a cure of sensorineural hearing loss. Regular, individually tailored treatment should be directed to the pathogenic mechanisms and specific clinical symptoms of hearing loss, as well as the prevention of complications. We recommend using non-drug therapies that can improve blood flow in labyrinth, tissue and cellular metabolism.

  12. Pediatric heat-related illness: recommendations for prevention and management [digest].

    Science.gov (United States)

    Dunn, Roberta J; Kim, Tommy Y; Chaudhari, Pradip

    2017-08-22

    Infants, children, and adolescents are at increased risk for heat-related illness due to their inability to remove themselves from dangerous environments. Evidence shows that morbidity and mortality from heat illness is related to the length of time core temperature is elevated, so rapid reduction and accurate serial measurements are crucial to prevention of organ system damage and death. The primary methods of patient cooling are conduction (ice-water immersion, cold packs) and convection (moisture and moving air). The choice of method used may depend on availability of equipment, but there is evidence that can guide optimal use of resources. This issue presents evidence-based recommendations and best practices in heat-illness resuscitation, including managing children who are obese, have special needs or take medications, and advocacy for prevention strategies. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  13. Prevalence of Plasmodium falciparum resistance markers to sulfadoxine-pyrimethamine among pregnant women receiving intermittent preventive treatment for malaria in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Birungi, Josephine; Yanow, Stephanie K

    2015-01-01

    The aim of this study was to assess the prevalence of mutations in Plasmodium falciparum dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes among pregnant women using sulfadoxine-pyrimethamine (SP) as an intermittent preventive treatment (IPTp). A molecular epidemiological...... in the Pfdhfr and Pfdhps genes that are associated with SP resistance. The prevalence of the single-nucleotide mutations in Pfdhfr at codons 51I, 59R, and 108N and in Pfdhps at codons 437G and 540E was high (>98%), reaching 100% fixation after one dose of SP, while the prevalence of 581G was 3.3% at baseline...... and anemia. However, women infected with P. falciparum had 1.3-g/dl-lower hemoglobin levels (P = 0.001) and delivered babies with a 400-g-lower birth weight (P = 0.001) compared to nonparasitemic women. Despite this, 44 women who were P. falciparum positive at baseline became negative after one or two doses...

  14. Intermittent preventive treatment of malaria in pregnancy: evaluation of a new delivery approach and the policy implications for malaria control in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Bygbjerg, Ib; Magnussen, Pascal

    2007-01-01

    The impact of intermittent preventive treatment (IPT) on malaria in pregnancy is well known. In countries where this policy is implemented, poor access and low compliance to this intervention has been widely reported. A study was designed to assess a new approach to deliver IPT to pregnant women...... through traditional birth attendants (TBAs), drug-shop vendors (DSVs), community reproductive health workers (CRHWs) and adolescent peer mobilisers (APMs); and compared this approach with IPT at health units. We evaluated this approach to assess user perceptions, its acceptability and sustainability....... Results show that the new approach increased access and compliance to IPT. Mean gestational age at first dose of IPT was 21.0 weeks with the community approaches versus 23.1 weeks at health units, P>0.0001. Health units accessed a high proportion of adolescents, 28.4%, versus 25.0% at the new approaches...

  15. Appraisal on the prevalence of malaria and anaemia in pregnancy and factors influencing uptake of intermittent preventive therapy with sulfadoxine-pyrimethamine in Kibaha district, Tanzania.

    Science.gov (United States)

    Tarimo, S Donath

    2007-10-01

    To appraise the prevalence of malaria and anaemia in antenatal mothers; and explore the factors influencing coverage of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) under operational conditions in the national programme for malaria control in pregnancy. Descriptive cross-sectional survey. The reproductive and child health clinic in Kibaha district hospital, Tanzania SUBECTS: Pregnant mothers on routine antenatal visits Prevalence of malaria (peripheral parasitaemia) and anaemia, coverage of IPT with SP and the factors influencing coverage. A total of 395 mothers were recruited; 27.3% had malaria. Moderate anaemia i.e. haemoglobin (Hb) level 8. -10.9 g/dl was detected in 56.7% of mothers; 34.2% had severe anaemia (Hb 8.0 g/dl was strongly associated with negative parasitaemia while Hb < 8.0 gidl was strongly associated with positive parasitaemia. About a third (40.0%) of the mothers did not receive SP for IPT

  16. Adherence to recommendations for primary prevention of atopic disease in neonatology clinical practice.

    Science.gov (United States)

    Passariello, Annalisa; Terrin, Gianluca; Baldassarre, Maria E; Bisceglia, Massimo; Ruotolo, Serena; Berni Canani, Roberto

    2010-08-01

    The prevalence and severity of atopic manifestations in children are increasing in western countries in the last decades. Specific nutritional intervention may prevent or delay the onset of atopic diseases in infants at high risk of developing allergy. These nutritional interventions should be applied early in the perinatal period to have a chance of success. Thus, we assessed adherence to the dietary management recommendations of the Committee on Nutrition and Section on Allergy and Immunology of the American Academy of Pediatrics (AAP) for the prevention of atopic diseases in neonatal age through an audit study. Questionnaire was administered to the chiefs of 30 maternity units (MU) with more than 1500 live births/yr to report the policy applied in their MU. Twenty-two MU returned the questionnaire. Identification of high-risk newborns was routinely performed only in 7/22 MU (31.8%). High-risk newborns were identified by the presence of at least two or one first-degree relative (parent or sibling) with documented allergic disease by 18.2% and 45.5% of MU, respectively. Specific maternal dietary restrictions during lactation were adopted in 7/22 MU (31.8%). Extensively or partially hydrolyzed formula was prescribed for bottle-fed high-risk infants in 22.7% of MU. Only 2/22 MU have a policy in complete agreement with the nutritional intervention proposed by the AAP. Our study suggest a poor adherence to dietary recommendations for primary prevention of atopic disease in neonatology clinical practice. Further efforts should be planned to improve the knowledge and the application of these preventive strategies.

  17. Recommendations for Methicillin-Resistant Staphylococcus aureus Prevention in Adult ICUs: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Whittington, Melanie D; Atherly, Adam J; Curtis, Donna J; Lindrooth, Richard C; Bradley, Cathy J; Campbell, Jonathan D

    2017-08-01

    Patients in the ICU are at the greatest risk of contracting healthcare-associated infections like methicillin-resistant Staphylococcus aureus. This study calculates the cost-effectiveness of methicillin-resistant S aureus prevention strategies and recommends specific strategies based on screening test implementation. A cost-effectiveness analysis using a Markov model from the hospital perspective was conducted to determine if the implementation costs of methicillin-resistant S aureus prevention strategies are justified by associated reductions in methicillin-resistant S aureus infections and improvements in quality-adjusted life years. Univariate and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. ICU. Hypothetical cohort of adults admitted to the ICU. Three prevention strategies were evaluated, including universal decolonization, targeted decolonization, and screening and isolation. Because prevention strategies have a screening component, the screening test in the model was varied to reflect commonly used screening test categories, including conventional culture, chromogenic agar, and polymerase chain reaction. Universal and targeted decolonization are less costly and more effective than screening and isolation. This is consistent for all screening tests. When compared with targeted decolonization, universal decolonization is cost-saving to cost-effective, with maximum cost savings occurring when a hospital uses more expensive screening tests like polymerase chain reaction. Results were robust to sensitivity analyses. As compared with screening and isolation, the current standard practice in ICUs, targeted decolonization, and universal decolonization are less costly and more effective. This supports updating the standard practice to a decolonization approach.

  18. Intermittency '93

    International Nuclear Information System (INIS)

    Bialas, A.

    1993-01-01

    The existing data definitely indicate the existence of intermittency, i.e. of self similar structures in the systems of particles created in high-energy collisions. The effect seems universal: it was found in most of the processes investigated and its measures parameters depend only weakly (if at all) on the process in question. Strong HBT effect was found, suggesting that intermittency is related to space-time structure of the pion source rather than to detailed momentum structure of the production amplitudes. There are indications that this space time structure may be fractal, but more data is needed to establish this. The theoretical explanation remains obscure: it seems that both parton cascade and hadronization play an important role. Their interrelation, however, remains a mystery. 5 figs., 19 refs

  19. Allocating HIV prevention funds in the United States: recommendations from an optimization model.

    Directory of Open Access Journals (Sweden)

    Arielle Lasry

    Full Text Available The Centers for Disease Control and Prevention (CDC had an annual budget of approximately $327 million to fund health departments and community-based organizations for core HIV testing and prevention programs domestically between 2001 and 2006. Annual HIV incidence has been relatively stable since the year 2000 and was estimated at 48,600 cases in 2006 and 48,100 in 2009. Using estimates on HIV incidence, prevalence, prevention program costs and benefits, and current spending, we created an HIV resource allocation model that can generate a mathematically optimal allocation of the Division of HIV/AIDS Prevention's extramural budget for HIV testing, and counseling and education programs. The model's data inputs and methods were reviewed by subject matter experts internal and external to the CDC via an extensive validation process. The model projects the HIV epidemic for the United States under different allocation strategies under a fixed budget. Our objective is to support national HIV prevention planning efforts and inform the decision-making process for HIV resource allocation. Model results can be summarized into three main recommendations. First, more funds should be allocated to testing and these should further target men who have sex with men and injecting drug users. Second, counseling and education interventions ought to provide a greater focus on HIV positive persons who are aware of their status. And lastly, interventions should target those at high risk for transmitting or acquiring HIV, rather than lower-risk members of the general population. The main conclusions of the HIV resource allocation model have played a role in the introduction of new programs and provide valuable guidance to target resources and improve the impact of HIV prevention efforts in the United States.

  20. Decrease in Prostate Cancer Testing Following the US Preventive Services Task Force (USPSTF) Recommendations.

    Science.gov (United States)

    Li, Jun; Berkowitz, Zahava; Hall, Ingrid J

    2015-01-01

    To assess changes of prostate-specific antigen (PSA) testing following recent US Preventive Services Task Force (USPSTF) prostate cancer screening recommendations using 2005 to 2013 National Health Interview Survey data. We calculated the percentage of PSA testing among men ≥40 years by age group and age-adjusted race for each survey year. Differences between years were assessed with linear contrasts after combining all years' data. The overall percentage of PSA testing was highest in 2008 and decreased significantly in 2013. Compared with 2008, each age group had significantly lower screening percentages in 2013, especially men ≥75 years old (-14.0% points; P testing percentages were highest in 2008 and decreased significantly in 2013. Only white men had a significantly lower percentage in 2013 than in 2010. Significant declines in PSA testing from 2008 to 2013 in men ≥75 years old may reflect the impact of the 2008 USPSTF recommendations. While the cause of the decreases in PSA testing between 2010 and 2013 among men aged 50 to 74 years old and white men is unknown, the decreases may suggest the early effects of the 2012 recommendations. © Copyright 2015 by the American Board of Family Medicine.

  1. Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

    Directory of Open Access Journals (Sweden)

    Murphy Donald R

    2009-08-01

    Full Text Available Abstract Background It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with information upon which to base advice to patients. The evidence behind claims of increased risk is investigated as well as the evidence regarding the risk of decompression surgery. Methods A literature search was conducted on the risk of spinal cord injury in individuals with asymptomatic cord encroachment and the risk and benefit of preventive decompression surgery. Results Three studies on the risk of spinal cord injury in this population met the inclusion criteria. All reported increased risk. However, none were prospective cohort studies or case-control studies, so the designs did not allow firm conclusions to be drawn. A number of studies and reviews of the risks and benefits of decompression surgery in patients with cervical myelopathy were found, but no studies were found that addressed surgery in asymptomatic individuals thought to be at risk. The complications of decompression surgery range from transient hoarseness to spinal cord injury, with rates ranging from 0.3% to 60%. Conclusion There is insufficient evidence that individuals with spondylotic spinal cord encroachment are at increased risk of spinal cord injury from minor trauma. Prospective cohort or case-control studies are needed to assess this risk. There is no evidence that prophylactic decompression surgery is helpful in this patient population. Decompression surgery appears to be helpful in patients with cervical myelopathy, but the significant risks may outweigh the unknown benefit in asymptomatic individuals. Thus, broad recommendations for decompression surgery in suspected at-risk individuals cannot be made

  2. A comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urological surgery.

    Science.gov (United States)

    Soderdahl, D W; Henderson, S R; Hansberry, K L

    1997-05-01

    Intermittent pneumatic compression of the calf and/or thigh effectively decreases the incidence of deep venous thrombosis and other thrombotic sequelae but clinical data comparing these modalities are currently lacking. A total of 90 patients undergoing major urological surgery was randomly assigned to receive calf length or thigh length pneumatic compression for antithrombotic prophylaxis. Duplex ultrasound of the lower extremities was performed preoperatively and twice postoperatively to evaluate for deep venous thrombosis. Health care providers in the operating room, recovery room and ward were asked to compare the compression systems, and a cost analysis was performed. A total of 47 patients wore the thigh length sequential pneumatic sleeves and 43 wore calf length uniform compression systems. A pulmonary embolus without evidence of deep venous thrombosis was detected in 1 patient (2%) using the thigh length system. A thrombus was detected in the common femoral vein by duplex ultrasonography in 1 patient (2%) with the calf length system. Nursing personnel found the calf length sleeves easier to apply and more comfortable by patient account but they were satisfied with both systems. There was a significant cost savings with the calf length pneumatic compression system. Calf and thigh length pneumatic compression systems similarly decrease the risk of deep venous thrombosis in patients undergoing urological surgery. The calf length system has the added advantage of being less expensive and easier to use.

  3. Practical Dietary Recommendations for the Prevention and Management of Nonalcoholic Fatty Liver Disease in Adults.

    Science.gov (United States)

    George, Elena S; Forsyth, Adrienne; Itsiopoulos, Catherine; Nicoll, Amanda J; Ryan, Marno; Sood, Siddharth; Roberts, Stuart K; Tierney, Audrey C

    2018-01-01

    Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide. In the absence of effective pharmacotherapies, clinical guidelines focus primarily on weight loss to treat this condition. Established consensus, evidence-based, and clinical dietary recommendations for NAFLD are currently lacking. The aim of this paper is to provide evidence-based practical dietary recommendations for the prevention and management of NAFLD in adults. A literature review focusing on established principles for the development of clinical practice recommendations was employed using the following criteria: based on substantial evidence, ensures risk minimization, is flexible for an individual patient approach, and is open to further modification as evidence emerges. The Practice-based Evidence in Nutrition classification system was used to grade these principles. Five key dietary recommendations were developed: 1) follow traditional dietary patterns, such as the Mediterranean diet; 2) limit excess fructose consumption and avoid processed foods and beverages with added fructose; 3) PUFAs, especially long-chain omega-3 rich foods and MUFAs, should replace SFAs in the diet; 4) replace processed food, fast food, commercial bakery goods, and sweets with unprocessed foods high in fiber, including whole grains, vegetables, fruits, legumes, nuts, and seeds; and 5) avoid excess alcohol consumption. Improving diet quality may reduce the incidence and progression of NAFLD and associated risk factors. Many of the benefits are likely to result from the collective effect of dietary patterns. High-quality research-in particular, randomized clinical trials assessing dietary interventions that focus on liver-specific endpoints-are needed as a priority. © 2018 American Society for Nutrition. All rights reserved.

  4. Marked reduction in prevalence of malaria parasitemia and anemia in HIV-infected pregnant women taking cotrimoxazole with or without sulfadoxine-pyrimethamine intermittent preventive therapy during pregnancy in Malawi

    NARCIS (Netherlands)

    Kapito-Tembo, Atupele; Meshnick, Steven R.; van Hensbroek, Michaël Boele; Phiri, Kamija; Fitzgerald, Margaret; Mwapasa, Victor

    2011-01-01

    Effectiveness of cotrimoxazole (CTX) compared with sulfadoxine-pyrimethamine (SP) intermittent-preventive-therapy (IPTp) for malaria in HIV-infected pregnant women is unknown. We examined effectiveness of CTX with or without SP-IPTp versus SP-IPTp at reducing malaria parasitemia and anemia. From

  5. Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: systematic review and meta-analysis

    NARCIS (Netherlands)

    Kayentao, Kassoum; Garner, Paul; van Eijk, Anne Maria; Naidoo, Inbarani; Roper, Cally; Mulokozi, Abdunoor; MacArthur, John R.; Luntamo, Mari; Ashorn, Per; Doumbo, Ogobara K.; ter Kuile, Feiko O.

    2013-01-01

    Intermittent preventive therapy with sulfadoxine-pyrimethamine to control malaria during pregnancy is used in 37 countries in sub-Saharan Africa, and 31 of those countries use the standard 2-dose regimen. However, 2 doses may not provide protection during the last 4 to 10 weeks of pregnancy, a

  6. The first Iranian recommendations on prevention, evaluation and management of high blood pressure

    Directory of Open Access Journals (Sweden)

    Feridoun Noohi

    2012-10-01

    Full Text Available This paper presents the complete report of the first Iranian Recommendations on Prevention, Evaluation and Management of High Blood Pressure. The purpose is to provide an evidence-based approach to the prevention, management and control of hypertension (HTN by adapting the most internationally known and used guidelines to the local health care status with consideration of the currently available data and based on the locally conducted researches on HTN as well as social and health care requirements. A working group of national and international experts participated in discussions and collaborated in decision-making, writing and reviewing the whole report. Multiple subcommittees worked together to review the recent national and international literature on HTN in different areas. We used the evaluation tool that is called “AGREE” and considered a score of > 60% as a high score. We adapted the Canadian Hypertension Education Program (CHEP, the United Kingdom’s National Institute for Health and Clinical Excellence (NICE and the US-based joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7. The key topics that are highlighted in this report include: The importance of ambulatory and self-measurement of blood pressure, evaluation of cardiovascular risk in HTN patients, the role of lifestyle modification in the prevention of HTN and its control with more emphasis on salt intake reduction and weight control, introducing pharmacotherapy suitable for uncomplicated HTN or specific situations and the available drugs in Iran, highlighting the importance of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers and calcium channel blockers as the first line therapy in many situations, the non-use of beta blockers as the first time treatment except in specific conditions, treating HTN in women, children, obese and elderly patients, the patient compliance to improve HTN control, practical

  7. Adherence to intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine and outcome of pregnancy among parturients in South East Nigeria

    Directory of Open Access Journals (Sweden)

    Onyebuchi AK

    2014-04-01

    Full Text Available Azubike Kanario Onyebuchi,1 Lucky Osaheni Lawani,2 Chukwuemeka Anthony Iyoke,3 Chukwudi Robinson Onoh,1 Nwabunike Ekene Okeke4 1Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria; 2School of Postgraduate Studies, Department of Community Medicine, University of Nigeria; 3Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria; 4Department of Obstetrics and Gynecology, Mile Four Catholic Hospital, Abakaliki, Nigeria Background: Intermittent preventive treatment of malaria for pregnant women (IPTp is a very important strategy for the control of malaria in pregnancy in malaria-endemic tropical countries, where mosquito bites easily occur during evening outdoor activities. Issues related to provision, cost, and acceptability may affect the use of IPTp in some developing countries. The aim of the study was to assess the uptake and adherence to sulphadoxine-pyrimethamine-based intermittent preventive treatment of malaria during pregnancy and the relationship of IPTp use to pregnancy outcomes in two major obstetric centers in South East Nigeria. Methods: This was a prospective descriptive study involving women who received antenatal and delivery services. All recruited women were followed-up from booking until delivery, and statistical analysis was done with Epi Info version 7. Results: A total of 516 parturients were studied. The mean gestational age at booking was 21.8±6.9 weeks while the mean number of antenatal visits throughout the pregnancy was 5.5±3.1. The rate of uptake of at least one dose of prescribed IPTp was 72.1% (367/516. Of the 367 who took prescribed IPTp, adherence to second doses of IPTp was 59.7% (219/367, and only 4.9% (18/367 took a third dose. Clinical malaria occurred in 85% (127/149 of women who did not receive IPTp at all compared to 20.5% of those who received at least one dose of IPTp. All those who had clinical malaria despite IPTp had only one

  8. Dietary behaviors related to cancer prevention among pre-adolescents and adolescents: the gap between recommendations and reality

    Directory of Open Access Journals (Sweden)

    White Mary C

    2011-06-01

    Full Text Available Abstract Background Diet is thought to play an important role in cancer risk. This paper summarizes dietary recommendations for cancer prevention and compares these recommendations to the dietary behaviors of U.S. youth ages 8-18. Methods We identified cancer prevention-related dietary recommendations from key health organizations and assessed dietary consumption patterns among youth using published statistics from the National Health and Nutrition Examination Survey, the national Youth Risk Behavior Survey, and other supplemental sources. Results Cancer prevention guidelines recommend a diet rich in fruits, vegetables, and whole grains, recommend limiting sugary foods and beverages, red and processed meats, sodium, and alcohol, and recommend avoiding foods contaminated with carcinogens. However, youth typically do not meet the daily recommendations for fruit, vegetable, or whole grain consumption and are over-consuming energy-dense, sugary and salty foods. Conclusions A large discrepancy exists between expert recommendations about diet and cancer and actual dietary practices among young people and points to the need for more research to better promote the translation of science into practice. Future research should focus on developing and evaluating policies and interventions at the community, state and national levels for aligning the diets of youth with the evolving scientific evidence regarding cancer prevention.

  9. The first Iranian recommendations on prevention, evaluation and management of high blood pressure.

    Science.gov (United States)

    Noohi, Feridoun; Sarrafzadegan, Nizal; Khosravi, Alireza; Andalib, Elham

    2012-01-01

    This paper presents the complete report of the first Iranian Recommendations on Prevention, Evaluation and Management of High Blood Pressure. The purpose is to provide an evidence-based approach to the prevention, management and control of hypertension (HTN) by adapting the most internationally known and used guidelines to the local health care status with consideration of the currently available data and based on the locally conducted researches on HTN as well as social and health care requirements. A working group of national and international experts participated in discussions and collaborated in decision-making, writing and reviewing the whole report. Multiple subcommittees worked together to review the recent national and international literature on HTN in different areas. We used the evaluation tool that is called "AGREE" and considered a score of > 60% as a high score. We adapted the Canadian Hypertension Education Program (CHEP), the United Kingdom's National Institute for Health and Clinical Excellence (NICE) and the US-based joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). The key topics that are highlighted in this report include: The importance of ambulatory and self-measurement of blood pressure, evaluation of cardiovascular risk in HTN patients, the role of lifestyle modification in the prevention of HTN and its control with more emphasis on salt intake reduction and weight control, introducing pharmacotherapy suitable for uncomplicated HTN or specific situations and the available drugs in Iran, highlighting the importance of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers and calcium channel blockers as the first line therapy in many situations, the non-use of beta blockers as the first time treatment except in specific conditions, treating HTN in women, children, obese and elderly patients, the patient compliance to improve HTN control, practical guidelines to improve

  10. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Siu, Albert L

    2016-02-16

    Update of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for breast cancer. The USPSTF reviewed the evidence on the following: effectiveness of breast cancer screening in reducing breast cancer-specific and all-cause mortality, as well as the incidence of advanced breast cancer and treatment-related morbidity; harms of breast cancer screening; test performance characteristics of digital breast tomosynthesis as a primary screening strategy; and adjunctive screening in women with increased breast density. In addition, the USPSTF reviewed comparative decision models on optimal starting and stopping ages and intervals for screening mammography; how breast density, breast cancer risk, and comorbidity level affect the balance of benefit and harms of screening mammography; and the number of radiation-induced breast cancer cases and deaths associated with different screening mammography strategies over the course of a woman's lifetime. This recommendation applies to asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. (B recommendation) The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years. (C recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to

  11. Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: conflicting recommendations.

    Science.gov (United States)

    Burk, Ruth Srednicki; Grap, Mary Jo

    2012-01-01

    Pressure ulcers and ventilator-associated pneumonia (VAP) are both common in acute and critical care settings and are considerable sources of morbidity, mortality, and health care costs. To prevent pressure ulcers, guidelines limit bed backrest elevation to less than 30 degrees, whereas recommendations to reduce VAP include use of backrest elevations of 30 degrees or more. Although a variety of risk factors beyond patient position have been identified for both pressure ulcers and VAP, this article will focus on summarizing the major evidence for each of these apparently conflicting positioning strategies and discuss implications for practice in managing mechanically ventilated patients with risk factors for both pressure ulcers and VAP. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Consensus recommendation for meningococcal disease prevention for Hajj and Umra pilgrimage/travel medicine.

    Science.gov (United States)

    Shibl, A; Tufenkeji, H; Khalil, M; Memish, Z

    2013-04-01

    The Islamic Hajj to Makkah (Mecca) has been associated with outbreaks of invasive meningococcal disease and the global spread of Neisseria meningitidis serogroup W-135. For Hajj pilgrims the quadrivalent vaccination against serogroups A, C, W-135 and Y is a mandatory requirement. Novel conjugate vaccines may provide benefits for the community by reduction of carriage. With the introduction of the new generation of quadrivalent meningococcal conjugate vaccines (Menveo, Menactra, and others pending license) and their recent implementation in Saudi Arabia, experts from 11 countries in the Middle East region met at a Meningococcal Leadership Forum (MLF), in Dubai in May 2010 to exchange opinions on meningococcal disease and prevention strategies. These experts discussed the importance of introducing conjugate vaccines for pilgrims and travellers, and elaborated a consensus recommendation to support healthcare professionals and decision-makers.

  13. Prevention of deep vein thrombosis in potential neurosurgical patients. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control

    International Nuclear Information System (INIS)

    Turpie, A.G.; Hirsh, J.; Gent, M.; Julian, D.; Johnson, J.

    1989-01-01

    In a randomized trial of neurosurgical patients, groups wearing graduated compression stockings alone (group 1) or graduated compression stockings plus intermittent pneumatic compression (IPC) (group 2) were compared with an untreated control group in the prevention of deep vein thrombosis (DVT). In both active treatment groups, the graduated compression stockings were continued for 14 days or until hospital discharge, if earlier. In group 2, IPC was continued for seven days. All patients underwent DVT surveillance with iodine 125-labeled fibrinogen leg scanning and impedance plethysmography. Venography was carried out if either test became abnormal. Deep vein thrombosis occurred in seven (8.8%) of 80 patients in group 1, in seven (9.0%) of 78 patients in group 2, and in 16 (19.8%) of 81 patients in the control group. The observed differences among these rates are statistically significant. The results of this study indicate that graduated compression stockings alone or in combination with IPC are effective methods of preventing DVT in neurosurgical patients

  14. Intermittent hyperthyreosis

    International Nuclear Information System (INIS)

    Sulman, F.G.; Tal, E.; Pfeifer, Y.; Superstine, E.

    1975-01-01

    Intermittent hyperthyreosis occurs under various forms of stress, especially heat stress. The clinician may diagnose such cases as masked or apathetic hyperthyroidism or 'forme fruste' hyperthyreosis or thyroid autonomy. As most routine and standard tests may here yield inconsistent results, it is the patients' anamnesis which may provide the clue. Our Bioclimatology Unit has now seen over 100 cases in which thyroid hypersensitivity towards heat was the most prominent syndrome: 10-15% of weather-sensitive patients are affected. The patients complain before or during heat spells of such contradictory symptoms as insomnia, irritability, tension, tachycardia, palpitations, precordial pain, dyspnoe, flushes with sweating or chills, tremor, abdominal pain or diarrhea, polyuria or pollakisuria, weight loss in spite of ravenous appetite, fatigue, exhaustion, depression, adynamia, lack of concentration and confusion. Determination of urinary neurohormones allows a differential diagnosis, intermittent hyperthyreosis being characterized by three cardinal symptoms: tachycardia - every case with more than 80 pulse beats being suspect (not specific); urinary histamine - every case excreting more than 90 μg/day being suspect. Again the drawback of this test is its lack of specificity, as histamine may also be increased in cases of allergy and spondylitis; urinary thyroxine - every case excreting more than 20 μg/day T-4 being suspect. This is the only specific test. Therapy should make use of lithium carbonate and betablockers. Propyl thiouracil is rarely required. (orig.) [de

  15. Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Grossman, David C; Bibbins-Domingo, Kirsten; Curry, Susan J; Barry, Michael J; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Landefeld, C Seth; Mangione, Carol M; Phipps, Maureen G; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen

    2017-06-20

    Based on year 2000 Centers for Disease Control and Prevention growth charts, approximately 17% of children and adolescents aged 2 to 19 years in the United States have obesity, and almost 32% of children and adolescents are overweight or have obesity. Obesity in children and adolescents is associated with morbidity such as mental health and psychological issues, asthma, obstructive sleep apnea, orthopedic problems, and adverse cardiovascular and metabolic outcomes (eg, high blood pressure, abnormal lipid levels, and insulin resistance). Children and adolescents may also experience teasing and bullying behaviors based on their weight. Obesity in childhood and adolescence may continue into adulthood and lead to adverse cardiovascular outcomes or other obesity-related morbidity, such as type 2 diabetes. Although the overall rate of child and adolescent obesity has stabilized over the last decade after increasing steadily for 3 decades, obesity rates continue to increase in certain populations, such as African American girls and Hispanic boys. These racial/ethnic differences in obesity prevalence are likely a result of both genetic and nongenetic factors (eg, socioeconomic status, intake of sugar-sweetened beverages and fast food, and having a television in the bedroom). To update the 2010 US Preventive Services Task Force (USPSTF) recommendation on screening for obesity in children 6 years and older. The USPSTF reviewed the evidence on screening for obesity in children and adolescents and the benefits and harms of weight management interventions. Comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older who have obesity can result in improvements in weight status for up to 12 months; there is inadequate evidence regarding the effectiveness of less intensive interventions. The harms of behavioral interventions can be bounded as small to none, and the harms of screening are minimal. Therefore, the USPSTF

  16. Fiscal policy to improve diets and prevent noncommunicable diseases: from recommendations to action.

    Science.gov (United States)

    Thow, Anne Marie; Downs, Shauna M; Mayes, Christopher; Trevena, Helen; Waqanivalu, Temo; Cawley, John

    2018-03-01

    The World Health Organization has recommended that Member States consider taxing energy-dense beverages and foods and/or subsidizing nutrient-rich foods to improve diets and prevent noncommunicable diseases. Numerous countries have either implemented taxes on energy-dense beverages and foods or are considering the implementation of such taxes. However, several major challenges to the implementation of fiscal policies to improve diets and prevent noncommunicable diseases remain. Some of these challenges relate to the cross-sectoral nature of the relevant interventions. For example, as health and economic policy-makers have different administrative concerns, performance indicators and priorities, they often consider different forms of evidence in their decision-making. In this paper, we describe the evidence base for diet-related interventions based on fiscal policies and consider the key questions that need to be asked by both health and economic policy-makers. From the health sector's perspective, there is most evidence for the impact of taxes and subsidies on diets, with less evidence on their impacts on body weight or health. We highlight the importance of scope, the role of industry, the use of revenue and regressive taxes in informing policy decisions.

  17. [Compliance with recommendations in secondary prevention of stroke in primary care].

    Science.gov (United States)

    Tamayo-Ojeda, Carmen; Parellada-Esquius, Neus; Salvador-González, Betlem; Oriol-Torón, Pilar Ángeles; Rodríguez-Garrido, M Dolores; Muñoz-Segura, Dolores

    Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. Multi-centre cross-sectional. Health primary care centres in a metropolitan area (944,280 inhabitants). Patients aged 18years and over with ischemic brain disease diagnosis prior to 6months before the study. Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP <140/90 mmHg, LDL-cholesterol <100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18months. A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP <140/90 in 65.7% and LDL <100 mg/dL in 41.0%. 86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79years aged and lower in 18-40years aged. The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. Environmental components of OCS policy committee recommendations regarding national oil spill prevention and response program

    International Nuclear Information System (INIS)

    Groat, C.G.; Thorman, J.

    1991-01-01

    The Exxon Valdez oil spill of March 24, 1989 resulted in thousands of pages of analytical reports assessing the environmental, organizational, legal, procedural, social, economic, and political aspects of the event. Even though the accident was a transportation incident, it had a major impact on the public and political perception of offshore oil operations. This caused the OCS Policy Committee, which advises the Secretary of the Interior and the Minerals Management Service on Outer Continental Shelf resource development and environmental matters, to undertake a review of the reports for the purpose of developing recommendations to the secretary for improvements in OCS operations that would insure maximum efforts to prevent spills and optimal ability to deal with any that occur. The Committee felt strongly that 'a credible national spill prevention and response program from both OCS and non-OCS oil spills in the marine environment is needed to create the political climate for a viable OCS program.' The report of the Committee described eight essential elements of this program; four of these focused on the environmental aspects of oil spills, calling for (1) adequate characterization of the marine and coastal environment, including both information and analysis, accessible to decision makers, (2) the capacity to restore economic and environmental resources as quickly as possible if damage occurs, (3) a mechanism for research on oil spill impacts, and (4) a meaningful role for all interested and responsible parties, including the public, in as many of these activities as possible, from spill prevention and contingency planning to environmental oversight of ongoing operations and participation in clean-up and restoration activities

  19. Intermittent versus every-day mesalazine therapy in preventing complications of diverticular disease: a long-term follow-up study.

    Science.gov (United States)

    Tursi, A; Di Mario, F; Brandimarte, G; Elisei, W; Picchio, M; Loperfido, S; Dal Bo', N; Ferrara, F; Marcello, R; Heras Salvat, H; Scarpignato, C

    2013-12-01

    Mesalazine seems to be effective in preventing recurrence of acute uncomplicated diverticulitis (AUD), but the optimal mesalazine scheme to achieve these results is still debated. To assess the effectiveness of two different mesalazine-based treatments in preventing recurrence of AUD and the occurrence of other complications of diverticular disease (DD) during a long-term follow-up. We reviewed 311 patients suffer from recent episode of AUD and undergoing to mesalazine treatment: 207 (group A, 105 males, median age 63 years, range 47-74 years) were treated with mesalazine 1.6 g for 10 days each month, whilst 104 (group B, 55 males, median age 65 years, range 50-72 years) were treated with mesalazine 1.6 g every day. Patients were followed-up every 6 months (median 7.5 months, range 5-13 months). Patients were followed-up for a mean time of 3 years (range 12-72 months). Overall, occurrence of complication recurred more frequently in group A than in group B (p = 0.030, log-rank test). Acute diverticulitis recurred in 17 (8.2%) patients in group A and in 3 (2.9%) in group B; diverticular bleeding occurred in 4 (1.9%) patients in group A and in 1 (0.96%) patient in group B; surgery was required in 3 (1.4%) patients in group A and in no (0%) patient in group B. This is the first study showing that long-term mesalazine treatment is significantly better that intermittent mesalazine treatment in preventing occurrence of DD complications after an attack of acute diverticulitis.

  20. Intermittent preventive treatment of malaria in pregnancy: the effect of new delivery approaches on access and compliance rates in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Magnussen, Pascal; Bygbjerg, Ib Christian

    2007-01-01

    and increase access and compliance to it. METHODS: The study was designed to assess new approaches of delivering IPT through these groups and compare it with IPT at health units. The primary outcome measures were: the proportion of adolescents and primigravidae accessed; gestational age at recruitment...... and the proportion of women who completed two doses of sulfadoxine-pyremethamine. RESULTS: Two thousand seven hundred and eighty-five pregnant women (78% of those in the study area) participated. With new approaches, 92.4% of the women received IPT during the second trimester as recommended by the policy, vs. 76.......1% at health units, P approaches (P approaches also accessed IPT early: the mean gestational age when receiving the first dose of sulfadoxine...

  1. Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive services Task Force recommendation statement.

    Science.gov (United States)

    Moyer, Virginia A

    2014-04-15

    Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on vitamin supplementation to prevent cardiovascular disease and cancer. The USPSTF reviewed the evidence on the efficacy of multivitamin or mineral supplements in the general adult population for the prevention of cardiovascular disease and cancer. This recommendation applies to healthy adults without special nutritional needs (typically aged 50 years or older). It does not apply to children, women who are pregnant or may become pregnant, or persons who are chronically ill or hospitalized or have a known nutritional deficiency. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of multivitamins for the prevention of cardiovascular disease or cancer. (I statement). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of single- or paired-nutrient supplements (except β-carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement). The USPSTF recommends against β-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation).

  2. Prevention and treatment of skin lesions associated with non-invasive mechanical ventilation. Recommendations of experts.

    Science.gov (United States)

    Raurell-Torredà, M; Romero-Collado, A; Rodríguez-Palma, M; Farrés-Tarafa, M; Martí, J D; Hurtado-Pardos, B; Peñarrubia-San Florencio, L; Saez-Paredes, P; Esquinas, A M

    In the last two decades, non-invasive mechanical ventilation (NIV) has been consolidated as an initial strategy for the management of respiratory failure in critical adult and paediatric patients. To identify risk factors and preventive strategies to reduce the incidence of skin lesions associated with clinical devices (LESADIC) related to NIV, as well as the most effective treatment for injuries that cannot be avoided. Review in the MEDLINE, CINAHL and Cochrane databases of studies published in the last 10years to reach consensus through an expert panel. Knowledge about how to measure correct mask size and protection of the skin with foam or hydrocolloids dressings are factors related to the incidence of LESADIC, as it conditions the degree of pressure-friction and shear that the interface exerts on the skin. The interface that causes fewer LESADIC and is better tolerated is the face mask. When there are injuries, the first thing is to remove the interface that causes pressure on damaged skin, recommending a Helmet ® hood as an alternative, treating the infection, managing the exudate and stimulating perilesional skin. The mask of choice is the facial, always using foam or hydrocolloid dressings on the nasal bridge. Evaluate the condition of the skin under the interface and harness every 4hours (recommended) and 11hours (maximum). Evaluate the rotation strategy of the interface at 24hours if the NIV is still needed on an ongoing basis. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Control Cross-sectional Study Evaluating an Antibiotic Prevention Strategy in 30 Pregnancies Under Clean Intermittent Self-catheterization and Review of Literature.

    Science.gov (United States)

    Michau, Adélie; Dinh, Aurélien; Denys, Pierre; Levy, Jonathan; Chartier-Kastler, Emmanuel; Bernard, Louis; Dommergues, Marc; Nizard, Jacky

    2016-05-01

    To assess the efficacy and safety of a weekly oral cycling antibiotic (WOCA) strategy to prevent UTI in women. We performed a monocentric, comparative, retrospective, cross-sectional study on pregnant women under clean intermittent self catheterization between January 2008 and December 2014. WOCA consisted the administration of a single-dose antibiotic, alternating antibiotic A and B once every 2 weeks, according to previous urine cultures. Twenty-five women carried out 30 pregnancies. Thirteen pregnancies (43.3%) were in the WOCA group (WCG) strategy and 17 were in the non-WOCA group (NWCG) (56.7%). In the 19 (63.3%) pregnancies with urinary tract infection (UTI), 5 (38.4%) were in WCG, 14 (82.3%) were not (P = .023). There were more cystitis in NWCG (76.5% vs 23.1% P = .009) but more colonization in WCG (46.2% vs 5.8% P = .025). UTIs were due to Escherichia coli, Enterobacter cloacae, and Klebsiella pneumoniae. There was a nonsignificant increase in preterm birth in NWCG (35.3% vs 7.7% P = .10), no small for gestational age neonates, and no significant difference for the mode of delivery, birthweight, and neonatal outcome. According to our result, WOCA seems safe and effective on symptomatic UTI frequency and could be promoted to help physicians to manage specific risks in pregnancy. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Screening for Obstructive Sleep Apnea in Adults: US Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Bibbins-Domingo, Kirsten; Grossman, David C; Curry, Susan J; Davidson, Karina W; Epling, John W; García, Francisco A R; Herzstein, Jessica; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Landefeld, C Seth; Mangione, Carol M; Phillips, William R; Phipps, Maureen G; Pignone, Michael P; Silverstein, Michael; Tseng, Chien-Wen

    2017-01-24

    Based on data from the 1990s, estimated prevalence of obstructive sleep apnea (OSA) in the United States is 10% for mild OSA and 3.8% to 6.5% for moderate to severe OSA; current prevalence may be higher, given the increasing prevalence of obesity. Severe OSA is associated with increased all-cause mortality, cardiovascular disease and cerebrovascular events, diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes. To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for OSA in asymptomatic adults. The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of screening for OSA in asymptomatic adults seen in primary care, including those with unrecognized symptoms. The USPSTF also evaluated the evidence on the benefits and harms of treatment of OSA on intermediate and final health outcomes. The USPSTF found insufficient evidence on screening for or treatment of OSA in asymptomatic adults or adults with unrecognized symptoms. Therefore, the USPSTF was unable to determine the magnitude of the benefits or harms of screening for OSA or whether there is a net benefit or harm to screening. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults. (I statement).

  5. Fires in Indian hospitals: root cause analysis and recommendations for their prevention.

    Science.gov (United States)

    Chowdhury, Kanchan

    2014-08-01

    There is an increase in the incidence of intraoperative fire in Indian hospitals. It is hypothesized that oxygen (O2) enrichment of air, is primarily responsible for most of the fires, particularly in intensive care units. As the amount of ignition energy needed to initiate fire reduces in the presence of higher O2 concentration, any heat or spark, may be the source of ignition when the air is O2-rich. The split air conditioner is the source of many such fires in the ICU, neonatal intensive care unit (NICU), and operating room (OR), though several other types of equipment used in hospitals have similar vulnerability. Indian hospitals need to make several changes in the arrangement of equipment and practice of handling O2 gas, as well as create awareness among hospital staff, doctors, and administrators. Recommendations for changes in system practice, which are in conformity with the National Fire Protection Association USA, are likely to be applicable in preventing fires at hospitals in all developing countries of the world with warm climates. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. The VCU Pressure Ulcer Summit: Collaboration to Operationalize Hospital-Acquired Pressure Ulcer Prevention Best Practice Recommendations.

    Science.gov (United States)

    Brindle, C Tod; Creehan, Sue; Black, Joyce; Zimmermann, Deb

    2015-01-01

    This executive summary reports outcomes of an interprofessional collaboration between experts in pressure ulcer prevention, bedside clinicians, regulatory agencies, quality improvement, informatics experts, and professional nursing organizations. The goal of the collaboration was to develop a framework to assist facilities to operationalize best practice recommendations to sustain organizational culture change in hospital-acquired pressure ulcer prevention, to develop a hospital-acquired pressure ulcer severity score, and to address topics related to the unavoidable pressure ulcer.

  7. A trial of intermittent preventive treatment and home-based management of malaria in a rural area of The Gambia

    Directory of Open Access Journals (Sweden)

    Webb Emily L

    2011-01-01

    conclusion can be drawn on the added benefit of IPTc in preventing clinical episodes of malaria among children who had access to HMM in The Gambia. However, the study showed that VHWs can successfully combine provision of HMM with provision of IPTc. Trial Registration ClinicalTrials.gov NCT00944840

  8. Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents

    Directory of Open Access Journals (Sweden)

    Taveras Elsie M

    2009-12-01

    Full Text Available Abstract Background Parents are integral to the implementation of obesity prevention and management recommendations for children. Exploration of barriers to and facilitators of parental decisions to adopt obesity prevention recommendations will inform future efforts to reduce childhood obesity. Methods We conducted 4 focus groups (2 English, 2 Spanish among a total of 19 parents of overweight (BMI ≥ 85th percentile children aged 5-17 years. The main discussion focused on 7 common obesity prevention recommendations: reducing television (TV watching, removing TV from child's bedroom, increasing physically active games, participating in community or school-based athletics, walking to school, walking more in general, and eating less fast food. Parents were asked to discuss what factors would make each recommendation more difficult (barriers or easier (facilitators to follow. Participants were also asked about the relative importance of economic (time and dollar costs/savings barriers and facilitators if these were not brought into the discussion unprompted. Results Parents identified many barriers but few facilitators to adopting obesity prevention recommendations for their children. Members of all groups identified economic barriers (time and dollar costs among a variety of pertinent barriers, although the discussion of dollar costs often required prompting. Parents cited other barriers including child preference, difficulty with changing habits, lack of information, lack of transportation, difficulty with monitoring child behavior, need for assistance from family members, parity with other family members, and neighborhood walking safety. Facilitators identified included access to physical activity programs, availability of alternatives to fast food and TV which are acceptable to the child, enlisting outside support, dietary information, involving the child, setting limits, making behavior changes gradually, and parental change in shopping

  9. Conflict between Supermarkets and Wet-Markets in Ghana: Early Warning Signals and Preventive Policy Recommendations

    Directory of Open Access Journals (Sweden)

    Etornam Kosi Anku

    2017-10-01

    Full Text Available The source of conflict between Supermarkets and Wet-markets arise from the use of market power and economies of scale by one group against the other. This study explores the tensions that exist between modern retailers and their traditional counterparts as a result of the influx of supermarkets in Ghana. The main objective of the study is to compare attributes related to the control of access to consumers by the Supermarket and the Wet-market. In this study, the dot-survey approach of Rapid Market Assessment Technique was used to elicit information from 438 respondents at the Madina market (wet-market and Melcom (supermarket over a period of two weeks and Wilcoxon-Mann-Whitney (WMW comparison test and descriptive statistics were employed for the analysis. The results revealed that consumers patronise the supermarkets for convenience and the wet-market for freshness of product. Their purchasing decisions were affected by their level of education and product selections of the retailer. The highly educated preferred to shop at the Supermarket instead of the Wet-market; however, over 50% of respondents preferred the wet-market for fresh food products and the supermarket for non-food items. Each retailer receives its fair share of purchases from its loyal customers, therefore the revolution arising from the supermarket influx in Ghana has not yet resulted into conflict between supermarkets and their traditional counterparts, though it is inevitable if nothing is done to prevent it from happening. To avoid the conflict, it is recommended that policies should be instituted to (i improve the market infrastructures and shopping environment in the Wet-markets, (ii give tax concession to modern retailers who source products from local farmers and small-scale processors, (iii enable traditional retailers position themselves on the fringe and co-exist with modern retailers and (iv enforce public standards with regards to food safety laws in the traditional

  10. Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Dat, Vu Quoc; Geskus, Ronald B; Wolbers, Marcel; Loan, Huynh Thi; Yen, Lam Minh; Binh, Nguyen Thien; Chien, Le Thanh; Mai, Nguyen Thi Hoang; Phu, Nguyen Hoan; Lan, Nguyen Phu Huong; Hao, Nguyen Van; Long, Hoang Bao; Thuy, Tran Phuong; Kinh, Nguyen Van; Trung, Nguyen Vu; Phu, Vu Dinh; Cap, Nguyen Trung; Trinh, Dao Tuyet; Campbell, James; Kestelyn, Evelyne; Wertheim, Heiman F L; Wyncoll, Duncan; Thwaites, Guy Edward; van Doorn, H Rogier; Thwaites, C Louise; Nadjm, Behzad

    2018-04-04

    Ventilator-associated respiratory infection (VARI) comprises ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). Although their diagnostic criteria vary, together these are the most common hospital-acquired infections in intensive care units (ICUs) worldwide, responsible for a large proportion of antibiotic use within ICUs. Evidence-based strategies for the prevention of VARI in resource-limited settings are lacking. Preventing the leakage of oropharyngeal secretions into the lung using continuous endotracheal cuff pressure control is a promising strategy. The aim of this study is to investigate the efficacy of automated, continuous endotracheal cuff pressure control in preventing the development of VARI and reducing antibiotic use in ICUs in Vietnam. This is an open-label randomised controlled multicentre trial. We will enrol 600 adult patients intubated for ≤ 24 h at the time of enrolment. Eligible patients will be stratified according to admission diagnosis (180 tetanus, 420 non-tetanus) and site and will be randomised in a 1:1 ratio to receive either (1) automated, continuous control of endotracheal cuff pressure or (2) intermittent measurement and control of endotracheal cuff pressure using a manual cuff pressure meter. The primary outcome is the occurrence of VARI, defined as either VAP or VAT during the ICU admission up to a maximum of 90 days after randomisation. Patients in both groups who are at risk for VARI will receive a standardised battery of investigations if their treating physician feels a new infection has occurred, the results of which will be used by an endpoint review committee, blinded to the allocated arm and independent of patient care, to determine the primary outcome. All enrolled patients will be followed for mortality and endotracheal tube cuff-related complications at 28 days and 90 days after randomisation. Other secondary outcomes include antibiotic use; days ventilated, in ICU and in hospital

  11. 2016 updated MASCC/ESMO consensus recommendations : Prevention of acute chemotherapy-induced nausea and vomiting in children

    NARCIS (Netherlands)

    Dupuis, L. Lee; Sung, Lillian; Molassiotis, Alexander; Orsey, Andrea D.; Tissing, Wim; van de Wetering, Marianne

    To update the 2009 recommendations for the prevention of acute chemotherapy-induced emesis in children. We updated the original systematic literature search. Randomized studies were included in the evidence to support this guideline if they were primary studies fully published in full text in

  12. Preventing Suicide in Prisons, Part I Recommendations fromthe International Association for Suicide Prevention Task Force on Suicide in Prisons

    NARCIS (Netherlands)

    Konrad, N.; Daigle, M.S.; Daniel, A.E.; Dear, G.E.; Frottier, P.; Hayes, L.M.; Kerkhof, A.J.F.M.; Liebling, A.; Sarchiapone, M.

    2007-01-01

    In 2000 the Department of Mental Health of the World Health Organization (WHO) published a guide named Preventing Suicide. A Resource for Prison Officers as part of the WHO worldwide initiative for the prevention of suicide. In 2007 there are new epidemiological data on prison suicide, a more

  13. Cluster-randomized study of intermittent preventive treatment for malaria in infants (IPTi in southern Tanzania: evaluation of impact on survival

    Directory of Open Access Journals (Sweden)

    Schellenberg Joanna

    2011-12-01

    Full Text Available Abstract Background Intermittent Preventive Treatment for malaria control in infants (IPTi consists of the administration of a treatment dose of an anti-malarial drug, usually sulphadoxine-pyrimethamine, at scheduled intervals, regardless of the presence of Plasmodium falciparum infection. A pooled analysis of individually randomized trials reported that IPTi reduced clinical episodes by 30%. This study evaluated the effect of IPTi on child survival in the context of a five-district implementation project in southern Tanzania. [Trial registration: clinical trials.gov NCT00152204]. Methods After baseline household and health facility surveys in 2004, five districts comprising 24 divisions were randomly assigned either to receive IPTi (n = 12 or not (n = 12. Implementation started in March 2005, led by routine health services with support from the research team. In 2007, a large household survey was undertaken to assess the impact of IPTi on survival in infants aged two-11 months through birth history interviews with all women aged 13-49 years. The analysis is based on an "intention-to-treat" ecological design, with survival outcomes analysed according to the cluster in which the mothers lived. Results Survival in infants aged two-11 months was comparable in IPTi and comparison areas at baseline. In intervention areas in 2007, 48% of children aged 12-23 months had documented evidence of receiving three doses of IPTi, compared to 2% in comparison areas (P P = 0.31. Conclusion The lack of evidence of an effect of IPTi on survival could be a false negative result due to a lack of power or imbalance of unmeasured confounders. Alternatively, there could be no mortality impact of IPTi due to low coverage, late administration, drug resistance, decreased malaria transmission or improvements in vector control and case management. This study raises important questions for programme evaluation design.

  14. Pharmacokinetics of mefloquine and its effect on sulfamethoxazole and trimethoprim steady-state blood levels in intermittent preventive treatment (IPTp) of pregnant HIV-infected women in Kenya.

    Science.gov (United States)

    Green, Michael; Otieno, Kephas; Katana, Abraham; Slutsker, Laurence; Kariuki, Simon; Ouma, Peter; González, Raquel; Menendez, Clara; ter Kuile, Feiko; Desai, Meghna

    2016-01-05

    Intermittent preventive treatment in pregnancy with sulfadoxine/pyrimethamine is contra-indicated in HIV-positive pregnant women receiving sulfamethoxazole/trimethoprim prophylaxis. Since mefloquine is being considered as a replacement for sulfadoxine/pyrimethamine in this vulnerable population, an investigation on the pharmacokinetic interactions of mefloquine, sulfamethoxazole and trimethoprim in pregnant, HIV-infected women was performed. A double-blinded, placebo-controlled study was conducted with 124 HIV-infected, pregnant women on a standard regimen of sulfamethoxazole/trimethoprim prophylaxis. Seventy-two subjects received three doses of mefloquine (15 mg/kg) at monthly intervals. Dried blood spots were collected from both placebo and mefloquine arms four to 672 h post-administration and on day 7 following a second monthly dose of mefloquine. A novel high-performance liquid chromatographic method was developed to simultaneously measure mefloquine, sulfamethoxazole and trimethoprim from each blood spot. Non-compartmental methods using a naïve-pooled data approach were used to determine mefloquine pharmacokinetic parameters. Sulfamethoxazole/trimethoprim prophylaxis did not noticeably influence mefloquine pharmacokinetics relative to reported values. The mefloquine half-life, observed clearance (CL/f), and area-under-the-curve (AUC0→∞) were 12.0 days, 0.035 l/h/kg and 431 µg-h/ml, respectively. Although trimethoprim steady-state levels were not significantly different between arms, sulfamethoxazole levels showed a significant 53% decrease after mefloquine administration relative to the placebo group and returning to pre-dose levels at 28 days. Although a transient decrease in sulfamethoxazole levels was observed, there was no change in hospital admissions due to secondary bacterial infections, implying that mefloquine may have provided antimicrobial protection.

  15. Clustering of unhealthy lifestyle behaviors is associated with a low adherence to recommended preventive practices among COPD patients in Spain.

    Science.gov (United States)

    de Miguel-Díez, Javier; Jiménez-García, Rodrigo; Hernández-Barrera, Valentín; Maestu, Luis Puente; Aparicio, Irene Jarana; Ramos, Alicia Oliva; López de Andrés, Ana; Carrasco-Garrido, Pilar

    2014-08-01

    To analyze clustering of unhealthy lifestyle behavior and its relationship with non-adherence to recommended clinical preventive care services among Spanish COPD patients. Cross-sectional study including 2,575 COPD subjects from the 2006 Spanish National Health Survey (NHS) and 2009 European Health Survey for Spain (EHISS). Subjects were asked about the following recommended preventive practices: uptake of blood pressure (BP) measurement, lipid profile, influenza vaccination and dental examination. Lifestyle behaviors included: smoking status, physical activity, alcohol consumption and obesity. Logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of preventive activities. Blood pressure measurement in the previous 6 months and a blood lipid test in the last year had not been taken by 11.74% and 23.26% of the subjects, respectively, in 2006 NHS and by 11.16% and 16.33% of the subjects, respectively, in EHISS 2009. Then, 36.36% percent had not been vaccinated and 70.61% had not received dental examination in 2006 NHS and these percentages decreased to 27.33% and 66.22%, respectively, in 2009 EHISS. A higher number of unhealthy lifestyle behaviors increased the probability of not being vaccinated and not having a dental examination. Clustering of unhealthy lifestyle behaviors is linearly associated with a greater number of preventive measures unfulfilled. Compliance with healthy lifestyles and adherence to recommended clinical preventive services is under desirable levels among Spanish COPD patients. Patients with lifestyles considered as "worse" are those who also have lower uptake of recommended preventive activities.

  16. 76 FR 2383 - Proposed HHS Recommendation for Fluoride Concentration in Drinking Water for Prevention of Dental...

    Science.gov (United States)

    2011-01-13

    ... Prevention, CWF Comments, Division of Oral Health, National Center for Chronic Disease Prevention and Health... , Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP... prevalence of dental fluorosis come from the National Health and Nutrition Examination Survey (NHANES), 1999...

  17. The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting.

    Science.gov (United States)

    Ahmed, Sara; Ware, Patrick; Visca, Regina; Bareil, Celine; Chouinard, Maud-Christine; Desforges, Johanne; Finlayson, Roderick; Fortin, Martin; Gauthier, Josée; Grimard, Dominique; Guay, Maryse; Hudon, Catherine; Lalonde, Lyne; Lévesque, Lise; Michaud, Cecile; Provost, Sylvie; Sutton, Tim; Tousignant, Pierre; Travers, Stella; Ware, Mark; Gogovor, Amede

    2015-10-15

    Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of

  18. Cost-effectiveness of two versus three or more doses of intermittent preventive treatment for malaria during pregnancy in sub-Saharan Africa: a modelling study of meta-analysis and cost data.

    Science.gov (United States)

    Fernandes, Silke; Sicuri, Elisa; Kayentao, Kassoum; van Eijk, Anne Maria; Hill, Jenny; Webster, Jayne; Were, Vincent; Akazili, James; Madanitsa, Mwayi; ter Kuile, Feiko O; Hanson, Kara

    2015-03-01

    In 2012, WHO changed its recommendation for intermittent preventive treatment of malaria during pregnancy (IPTp) from two doses to monthly doses of sulfadoxine-pyrimethamine during the second and third trimesters, but noted the importance of a cost-effectiveness analysis to lend support to the decision of policy makers. We therefore estimated the incremental cost-effectiveness of IPTp with three or more (IPTp-SP3+) versus two doses of sulfadoxine-pyrimethamine (IPTp-SP2). For this analysis, we used data from a 2013 meta-analysis of seven studies in sub-Saharan Africa. We developed a decision tree model with a lifetime horizon. We analysed the base case from a societal perspective. We did deterministic and probabilistic sensitivity analyses with appropriate parameter ranges and distributions for settings with low, moderate, and high background risk of low birthweight, and did a separate analysis for HIV-negative women. Parameters in the model were obtained for all countries included in the original meta-analysis. We did simulations in hypothetical cohorts of 1000 pregnant women receiving either IPTp-SP3+ or IPTp-SP2. We calculated disability-adjusted life-years (DALYs) for low birthweight, severe to moderate anaemia, and clinical malaria. We calculated cost estimates from data obtained in observational studies, exit surveys, and from public procurement databases. We give financial and economic costs in constant 2012 US$. The main outcome measure was the incremental cost per DALY averted. The delivery of IPTp-SP3+ to 1000 pregnant women averted 113·4 DALYs at an incremental cost of $825·67 producing an incremental cost-effectiveness ratio (ICER) of $7·28 per DALY averted. The results remained robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analyses, the ICER was $7·7 per DALY averted for moderate risk of low birthweight, $19·4 per DALY averted for low risk, and $4·0 per DALY averted for high risk. The ICER for HIV

  19. [Prevention of Neonatal Group B Sreptococcal Infection. Spanish Recommendations. Update 2012. SEIMC/SEGO/SEN/SEQ/SEMFYC Consensus Document].

    Science.gov (United States)

    Alós Cortés, Juan Ignacio; Andreu Domingo, Antonia; Arribas Mir, Lorenzo; Cabero Roura, Luis; de Cueto López, Marina; López Sastre, José; Melchor Marcos, Juan Carlos; Puertas Prieto, Alberto; de la Rosa Fraile, Manuel; Salcedo Abizanda, Salvador; Sánchez Luna, Manuel; Sanchez Pérez, María José; Torrejon Cardoso, Rafael

    2013-03-01

    Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including criteria for the diagnosis of UTI and asymptomatic bacteriuria in pregnancy are clarified; IAP in preterm labour and premature rupture of membranes, and the management of the newborn in relation to GBS carrier status of the mother are also revised. These recommendations are only addressed to the prevention of GBS early neonatal infection, are not effective against late neonatal infection. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  20. Impact of intermittent fasting on glucose homeostasis.

    Science.gov (United States)

    Varady, Krista A

    2016-07-01

    This article provides an overview of the most recent human trials that have examined the impact of intermittent fasting on glucose homeostasis. Our literature search retrieved one human trial of alternate day fasting, and three trials of Ramadan fasting published in the past 12 months. Current evidence suggests that 8 weeks of alternate day fasting that produces mild weight loss (4% from baseline) has no effect on glucose homeostasis. As for Ramadan fasting, decreases in fasting glucose, insulin, and insulin resistance have been noted after 4 weeks in healthy normal weight individuals with mild weight loss (1-2% from baseline). However, Ramadan fasting may have little impact on glucoregulatory parameters in women with polycystic ovarian syndrome who failed to observe weight loss. Whether intermittent fasting is an effective means of regulating glucose homeostasis remains unclear because of the scarcity of studies in this area. Large-scale, longer-term randomized controlled trials will be required before the use of fasting can be recommended for the prevention and treatment of metabolic diseases.

  1. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Grossman, David C; Curry, Susan J; Owens, Douglas K; Barry, Michael J; Caughey, Aaron B; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Krist, Alex H; Kubik, Martha; Landefeld, Seth; Mangione, Carol M; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen

    2018-04-17

    Because of the aging population, osteoporotic fractures are an increasingly important cause of morbidity and mortality in the United States. Approximately 2 million osteoporotic fractures occurred in the United States in 2005, and annual incidence is projected to increase to more than 3 million fractures by 2025. Within 1 year of experiencing a hip fracture, many patients are unable to walk independently, more than half require assistance with activities of daily living, and 20% to 30% of patients will die. To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on vitamin D supplementation, with or without calcium, to prevent fractures. The USPSTF reviewed the evidence on vitamin D, calcium, and combined supplementation for the primary prevention of fractures in community-dwelling adults (defined as not living in a nursing home or other institutional care setting). The review excluded studies conducted in populations with a known disorder related to bone metabolism (eg, osteoporosis or vitamin D deficiency), taking medications known to be associated with osteoporosis (eg, long-term steroids), or with a previous fracture. The USPSTF found inadequate evidence to estimate the benefits of vitamin D, calcium, or combined supplementation to prevent fractures in community-dwelling men and premenopausal women. The USPSTF found adequate evidence that daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium has no benefit for the primary prevention of fractures in community-dwelling, postmenopausal women. The USPSTF found inadequate evidence to estimate the benefits of doses greater than 400 IU of vitamin D or greater than 1000 mg of calcium to prevent fractures in community-dwelling postmenopausal women. The USPSTF found adequate evidence that supplementation with vitamin D and calcium increases the incidence of kidney stones. The USPSTF concludes that the current evidence is insufficient to assess the balance of the

  2. Disparity in cancer prevention and screening in aboriginal populations: recommendations for action

    OpenAIRE

    Ahmed, S.; Shahid, R.K.; Episkenew, J.A.

    2015-01-01

    Historically, cancer has occurred at a lower rate in aboriginal populations; however, it is now dramatically increasing. Unless preventive measures are taken, cancer rates among aboriginal peoples are expected to soon surpass those in non-aboriginal populations. Because a large proportion of malignant disorders are preventable, primary prevention through socioeconomic interventions, environmental changes, and lifestyle modification might provide the best option for reducing the increasing bur...

  3. Shilling Attack Prevention for Recommender Systems Using Social-based Clustering

    KAUST Repository

    Lee, Tak

    2011-01-01

    to promote items by manipulating rating predictions with fake user profiles. Profiles with behaviors similar to "victim" users alter the prediction of a Recommender System. Manipulating rating predictions through injected profiles is referred to as a shilling

  4. Improving preventive service delivery at adult complete health check-ups: the Preventive health Evidence-based Recommendation Form (PERFORM cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Moineddin Rahim

    2006-07-01

    Full Text Available Abstract Background To determine the effectiveness of a single checklist reminder form to improve the delivery of preventive health services at adult health check-ups in a family practice setting. Methods A prospective cluster randomized controlled trial was conducted at four urban family practice clinics among 38 primary care physicians affiliated with the University of Toronto. Preventive Care Checklist Forms© were created to be used by family physicians at adult health check-ups over a five-month period. The sex-specific forms incorporate evidence-based recommendations on preventive health services and documentation space for routine procedures such as physical examination. The forms were used in two intervention clinics and two control clinics. Rates and relative risks (RR of the performance of 13 preventive health maneuvers at baseline and post-intervention and the percentage of up-to-date preventive health services delivered per patient were compared between the two groups. Results Randomly-selected charts were reviewed at baseline (n = 509 and post-intervention (n = 608. Baseline rates for provision of preventive health services ranged from 3% (fecal occult blood testing to 93% (blood pressure measurement, similar to other settings. The percentage of up-to-date preventive health services delivered per patient at the end of the intervention was 48.9% in the control group and 71.7% in the intervention group. This is an overall 22.8% absolute increase (p = 0.0001, and 46.6% relative increase in the delivery of preventive health services per patient in the intervention group compared to controls. Eight of thirteen preventive health services showed a statistically significant change (p Conclusion This simple, low cost, clinically relevant intervention improves the delivery of preventive health services by prompting physicians of evidence-based recommendations in a checklist format that incorporates existing practice patterns. Periodic updates

  5. Research design considerations for chronic pain prevention clinical trials: IMMPACT recommendations.

    Science.gov (United States)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C; Farrar, John T; Fillingim, Roger B; Gilron, Ian; Markman, John D; Oaklander, Anne Louise; Polydefkis, Michael J; Raja, Srinivasa N; Robinson, James P; Woolf, Clifford J; Ziegler, Dan; Ashburn, Michael A; Burke, Laurie B; Cowan, Penney; George, Steven Z; Goli, Veeraindar; Graff, Ole X; Iyengar, Smriti; Jay, Gary W; Katz, Joel; Kehlet, Henrik; Kitt, Rachel A; Kopecky, Ernest A; Malamut, Richard; McDermott, Michael P; Palmer, Pamela; Rappaport, Bob A; Rauschkolb, Christine; Steigerwald, Ilona; Tobias, Jeffrey; Walco, Gary A

    2015-07-01

    Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (ie, surgery, viral infection, injury, and toxic or noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

  6. Prevention and control of tuberculosis in correctional and detention facilities: recommendations from the CDC

    CSIR Research Space (South Africa)

    Parsons, S

    2006-07-01

    Full Text Available and Detention Facilities: Recommendations from CDC Endorsed by the Advisory Council for the Elimination of Tuberculosis, the National Commission on Correctional Health Care, and the American Correctional Association MMWR CONTENTS Introduction... in Correctional and Detention Facilities: Recommendations from CDC Endorsed by the Advisory Council for the Elimination of Tuberculosis, the National Commission on Correctional Health Care, and the American Correctional Association Summary Tuberculosis (TB...

  7. Screening for Syphilis Infection in Pregnancy : US Preventive Services Task Force Reaffirmation Recommendation Statement

    NARCIS (Netherlands)

    Calonge, Ned; Petitti, Diana B.; DeWitt, Thomas G.; Dietrich, Allen; Gregory, Kimberly D.; Grossman, David; Isham, George; LeFevre, Michael L.; Leipzig, Rosanne; Marion, Lucy N.; Melnyk, Bernadette; Moyer, Virginia A.; Ockene, Judith K.; Sawaya, George F.; Schwartz, J. Sanford; Wilt, Timothy

    2009-01-01

    Description: Update of the 2004 U. S. Preventive Services Task Force statement about screening for syphilis in pregnancy. Methods: The U. S. Preventive Services Task Force did a targeted literature search for evidence on the benefits of screening, the harms of screening, and the harms of treatment

  8. Impact of recommended changes in labor management for prevention of the primary cesarean delivery.

    Science.gov (United States)

    Thuillier, Claire; Roy, Sophie; Peyronnet, Violaine; Quibel, Thibaud; Nlandu, Aurélie; Rozenberg, Patrick

    2018-03-01

    The dramatic rise in cesarean delivery rates worldwide in recent decades, without evidence of a concomitant decrease in cerebral palsy rates, has raised concerns about its potential negative consequences for maternal and infant health. In 2014, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine jointly published an Obstetric Care Consensus for safe prevention of the primary cesarean delivery. We sought to assess whether modification of our protocol to implement these recommendations helped to decrease our primary cesarean delivery rate safely. This is a before-and-after retrospective cohort study at a university referral hospital. In March 2014, the threshold for defining active labor changed from 4 to >6 cm and arrest of first-stage labor from lack of cervical change despite regular contractions after 3 hours of oxytocin administration with amniotomy and epidural anesthesia to no change after 4 hours of adequate or 6 hours of inadequate contractions in women with an epidural. The definition of second-stage arrest of labor changed simultaneously from lack of progress for 3 hours with adequate contractions in women with epidural anesthesia to no progress for ≥4 hours in nulliparas or 3 hours in multiparas with an epidural. We compared maternal and neonatal outcomes over two 1 year periods: from March 2013 to February 2014 (before, preguideline) and from June 2014 to May 2015 (after, postguideline). We included all women with singleton pregnancies at ≥37 weeks' gestation, in vertex presentation, in spontaneous or induced labor, and with epidural anesthesia. We excluded women with an elective or previous cesarean delivery and those with obstetric or fetal complications. This study included 3283 and 3068 women in the before and after periods, respectively. The groups had similar general and obstetric characteristics. The global cesarean delivery rate decreased significantly from 9.4% in the preguideline to 6.9% in

  9. Assessment of community-level effects of intermittent preventive treatment for malaria in schoolchildren in Jinja, Uganda (START-IPT trial): a cluster-randomised trial.

    Science.gov (United States)

    Staedke, Sarah G; Maiteki-Sebuguzi, Catherine; Rehman, Andrea M; Kigozi, Simon P; Gonahasa, Samuel; Okiring, Jaffer; Lindsay, Steve W; Kamya, Moses R; Chandler, Clare I R; Dorsey, Grant; Drakeley, Chris

    2018-06-01

    Intermittent preventive treatment (IPT) is a well established malaria control intervention. Evidence that delivering IPT to schoolchildren could provide community-level benefits is limited. We did a cluster-randomised controlled trial to assess the effect of IPT of primary schoolchildren with dihydroartemisinin-piperaquine (DP) on indicators of malaria transmission in the community, in Jinja, Uganda. We included 84 clusters, each comprising one primary school and the 100 closest available households. The clusters were randomly assigned 1:1 to receive IPT with DP or standard care (control) by restricted randomisation to ensure balance by geography and school type. Children in intervention schools received IPT monthly for up to six rounds (June to December, 2014). We did cross-sectional community surveys in randomly selected households at baseline and in January to April, 2015, during which we measured participants' temperatures and obtained finger-prick blood smears for measurement of parasite prevalence by microscopy. We also did entomological surveys 1 night per month in households from 20 randomly selected IPT and 20 control clusters. The primary trial outcome was parasite prevalence in the final community survey. The primary entomological survey outcome was the annual entomological inoculation rate (aEIR) from July, 2014, to April, 2015. This trial is registered at ClinicalTrials.gov, number NCT02009215. Among 23 280 students registered in the 42 intervention schools, 10 079 (43%) aged 5-20 years were enrolled and received at least one dose of DP. 9286 (92%) of 10 079 received at least one full course of DP (three doses). Community-level parasite prevalence was lower in the intervention clusters than in the control clusters (19% vs 23%, adjusted risk ratio 0·85, 95% CI 0·73-1·00, p=0·05). The aEIR was lower in the intervention group than in the control group, but not significantly so (10·1 vs 15·2 infective bites per person, adjusted incidence rate

  10. β2-Adrenergic receptor-dependent attenuation of hypoxic pulmonary vasoconstriction prevents progression of pulmonary arterial hypertension in intermittent hypoxic rats.

    Directory of Open Access Journals (Sweden)

    Hisashi Nagai

    Full Text Available In sleep apnea syndrome (SAS, intermittent hypoxia (IH induces repeated episodes of hypoxic pulmonary vasoconstriction (HPV during sleep, which presumably contribute to pulmonary arterial hypertension (PAH. However, the prevalence of PAH was low and severity is mostly mild in SAS patients, and mild or no right ventricular hypertrophy (RVH was reported in IH-exposed animals. The question then arises as to why PAH is not a universal finding in SAS if repeated hypoxia of sufficient duration causes cycling HPV. In the present study, rats underwent IH at a rate of 3 min cycles of 4-21% O2 for 8 h/d for 6 w. Assessment of diameter changes in small pulmonary arteries in response to acute hypoxia and drugs were performed using synchrotron radiation microangiography on anesthetized rats. In IH-rats, neither PAH nor RVH was observed and HPV was strongly reversed. Nadolol (a hydrophilic β(1, 2-blocker augmented the attenuated HPV to almost the same level as that in N-rats, but atenolol (a hydrophilic β1-blocker had no effect on the HPV in IH. These β-blockers had almost no effect on the HPV in N-rats. Chronic administration of nadolol during 6 weeks of IH exposure induced PAH and RVH in IH-rats, but did not in N-rats. Meanwhile, atenolol had no effect on morphometric and hemodynamic changes in N and IH-rats. Protein expression of the β1-adrenergic receptor (AR was down-regulated while that of β2AR was preserved in pulmonary arteries of IH-rats. Phosphorylation of p85 (chief component of phosphoinositide 3-kinase (PI3K, protein kinase B (Akt, and endothelial nitric oxide synthase (eNOS were abrogated by chronic administration of nadolol in the lung tissue of IH-rats. We conclude that IH-derived activation of β2AR in the pulmonary arteries attenuates the HPV, thereby preventing progression of IH-induced PAH. This protective effect may depend on the β2AR-Gi mediated PI3K/Akt/eNOS signaling pathway.

  11. The New World Health Organization Recommendations on Perioperative Administration of Oxygen to Prevent Surgical Site Infections: A Dangerous Reductionist Approach?

    Science.gov (United States)

    Wenk, Manuel; Van Aken, Hugo; Zarbock, Alexander

    2017-08-01

    In October 2016, the World Health Organization (WHO) published recommendations for preventing surgical site infections (SSIs). Among those measures is a recommendation to administer oxygen at an inspired fraction of 80% intra- and postoperatively for up to 6 hours. SSIs have been identified as a global health problem, and the WHO should be commended for their efforts. However, this recommendation focuses only on the patient's "wound," ignores other organ systems potentially affected by hyperoxia, and may ultimately worsen patient outcomes.The WHO advances a "strong recommendation" for the use of a high inspired oxygen fraction even though the quality of evidence is only moderate. However, achieving this goal by disregarding other potentially lethal complications seems inappropriate, particularly in light of the weak evidence underpinning the use of high fractions of oxygen to prevent SSI. Use of such a strategy thus should be intensely discussed by anesthesiologists and perioperative physicians.Normovolemia, normotension, normoglycemia, normothermia, and normoventilation can clearly be safely applied to most patients in most clinical scenarios. But the liberal application of hyperoxemia intraoperatively and up to 6 hours postoperatively, as suggested by the WHO, is questionable from the viewpoint of anesthesia and perioperative medicine, and its effects will be discussed in this article.

  12. Development and psychometric validation of a questionnaire to evaluate nurses' adherence to recommendations for preventing pressure ulcers (QARPPU).

    Science.gov (United States)

    Moya-Suárez, Ana Belén; Morales-Asencio, José Miguel; Aranda-Gallardo, Marta; Enríquez de Luna-Rodríguez, Margarita; Canca-Sánchez, José Carlos

    2017-11-01

    The main objective of this work is the development and psychometric validation of an instrument to evaluate nurses' adherence to the main recommendations issued for preventing pressure ulcers. An instrument was designed based on the main recommendations for the prevention of pressure ulcers published in various clinical practice guides. Subsequently, it was proceeded to evaluate the face and content validity of the instrument by an expert group. It has been applied to 249 Spanish nurses took part in a cross-sectional study to obtain a psychometric evaluation (reliability and construct validity) of the instrument. The study data were compiled from June 2015 to July 2016. From the results of the psychometric analysis, a final 18-item, 4-factor questionnaire was derived, which explained 60.5% of the variance and presented the following optimal indices of fit (CMIN/DF: 1.40 p < 0.001; GFI: 0.93; NFI: 0.92; CFI: 0.98; TLI: 0.97; RMSEA: 0.04 (90% CI 0.025-0.054). The results obtained show that the instrument presents suitable psychometric properties for evaluating nurses' adherence to recommendations for the prevention of pressure ulcers. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  13. Continuous infusion versus intermittent flushing to prevent loss of function of peripheral intravenous catheters used for drug administration in newborn infants.

    Science.gov (United States)

    Flint, A; McIntosh, D; Davies, M W

    2005-10-19

    The use of peripheral intravenous cannulae is common in newborn babies. Many of them require an intravenous line only for medications and not for fluid. Currently there is little uniformity in methods used to maintain cannula patency. The object of this review was to determine which method was better for maintaining intravenous lines used in neonates for intravenous medication only: intermittent flushing or continuous infusion We searched The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), CINAHL (from 1982 to June 2004) and MEDLINE (from 1966 to June 2004) . Randomised controlled trials comparing continuous infusion to intermittent flushing to maintain patency of intravenous cannulas. Units of randomisation might include individual catheters or individual babies. Three reviewers independently assessed trial quality and extracted data. Two studies were eligible for inclusion. In one study only one of our primary outcomes was available: the duration of cannula patency for the first cannula used per infant was slightly longer in the continuous infusion group, but not significantly so, with a mean difference of -4.3 hours (95% CI -18.2 to 9.7). In the second study, only one of our primary outcomes was available: the mean (SD) number cannulas used per infant in the first 48 hours was less in the intermittent flush group with a mean difference of -0.76 cannulas (95% CI -1.37 to -0.15). No results were available for any of our other primary outcomes: in the published report, results were reported per catheter rather than per infant, a number of infants received more than one intravenous catheter (39 infants received an unknown number of catheters). The overall duration of cannula patency was significantly longer in the intermittent flush group with a mean duration of patency in the intermittent flush group of 2.1 days (SD 1.0) compared with the continuous infusion group where the mean duration of patency was 1.0 days (SD 0

  14. Recommended industry best management practices for the prevention of Phytophthora ramorum introduction in nursery operations

    Science.gov (United States)

    Karen Suslow

    2008-01-01

    The following industry recommended best management practices (BMPs), designed for growers and/or interstate shippers of host and associated host plants of Phytophthora ramorum, consists of biosecurity guidelines created by and for nursery growers in order to reduce the risks associated with P. ramorum. The control of P....

  15. Preventing dental caries in children <5 years: systematic review updating USPSTF recommendation.

    Science.gov (United States)

    Chou, Roger; Cantor, Amy; Zakher, Bernadette; Mitchell, Jennifer Priest; Pappas, Miranda

    2013-08-01

    Screening and preventive interventions by primary care providers could improve outcomes related to early childhood caries. The objective of this study was to update the 2004 US Preventive Services Task Force systematic review on prevention of caries in children younger than 5 years of age. Searching Medline and the Cochrane Library (through March 2013) and reference lists, we included trials and controlled observational studies on the effectiveness and harms of screening and treatments. One author extracted study characteristics and results, which were checked for accuracy by a second author. Two authors independently assessed study quality. No study evaluated effects of screening by primary care providers on clinical outcomes. One good-quality cohort study found pediatrician examination associated with a sensitivity of 0.76 for identifying a child with cavities. No new trials evaluated oral fluoride supplementation. Three new randomized trials were consistent with previous studies in finding fluoride varnish more effective than no varnish (reduction in caries increment 18% to 59%). Three trials of xylitol were inconclusive regarding effects on caries. New observational studies were consistent with previous evidence showing an association between early childhood fluoride use and enamel fluorosis. Evidence on the accuracy of risk prediction instruments in primary care settings is not available. There is no direct evidence that screening by primary care clinicians reduces early childhood caries. Evidence previously reviewed by the US Preventive Services Task Force found oral fluoride supplementation effective at reducing caries incidence, and new evidence supports the effectiveness of fluoride varnish in higher-risk children.

  16. The Role of the Coroner in School Bus Accident Prevention: Some Recommendations.

    Science.gov (United States)

    Fox, Michael

    1995-01-01

    Following the deaths of two elementary school students in bus-related accidents in 1992, the Coroner of Quebec held extensive hearings investigating school bus safety and accident prevention. A subsequent report addressed responsibilities of government and school board officials to correct deficiencies in school bus services and provided…

  17. GST – the idea and recommendations for the prevention of criminal behaviour

    Directory of Open Access Journals (Sweden)

    Robert Agnew

    2011-12-01

    Full Text Available The article is a presentation of the main assumptions of the General Strain Theory (GST and the possibility to put theory into practice in the field of prevention of criminal behaviour. The GST was created in the ‘90s by Robert Agnew as a continuation of previous structural theories (Merton, Cloward – Ohlin, Cohen. Up to this day it has been widely verified empirically and along with other criminology theories (the theory of social learning/theory of different relations, theory of social control, theories of interaction is both a fundamental but also alternative ground for interpreting social behaviour. Due to its universal assumptions, GST is now being developed also by Polish researchers. In the article are presented the fundamental strategies of prevention of criminal behaviour based on GST and examples of particular programs being carried out in the US and Poland. Pilot studies on building in Poland a pioneer local system of prevention, based on GST, are presented. In the conclusions the authors stress the importance of GST in the genesis of criminal behaviour. The content of this article is therefore a result of an American-Polish cooperation in the field of prevention of criminal behaviour. It seems that international and based on mutual partnership approach is the hallmark of the current stage of the Polish resocialization system development.

  18. Comparative effectiveness of recommended versus less intensive drug combinations in secondary prevention of acute coronary syndrome

    NARCIS (Netherlands)

    Bezin, Julien; Groenwold, Rolf; Ali, M Sanni; Lassalle, Régis; Robinson, Philip; de Boer, Anthonius; Moore, Nicholas; Klungel, Olaf H; Pariente, Antoine

    2017-01-01

    PURPOSE: The secondary prevention treatment for acute coronary syndrome (ACS) is based on the combined use of drugs from four therapeutic classes (beta-blockers, antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). The objective of this study

  19. Comparative effectiveness of recommended versus less intensive drug combinations in secondary prevention of acute coronary syndrome

    NARCIS (Netherlands)

    Bezin, Julien; Groenwold, Rolf H H; Ali, M. Sanni; Lassalle, Régis; Robinson, Philip; de Boer, A.; Moore, Nicholas; Klungel, Olaf H.; Pariente, Antoine

    Purpose: The secondary prevention treatment for acute coronary syndrome (ACS) is based on the combined use of drugs from four therapeutic classes (beta-blockers, antiplatelet agents, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). The objective of this study

  20. Recommendations for the diagnosis, treatment and prevention of the pneumonia acquired in the community in adults

    International Nuclear Information System (INIS)

    2003-01-01

    The pneumonia acquired in the community in adults, is the acute infection of the pulmonary parenchyma that is developed away from the hospital environment, it is manifested in the first 48 hours from the entrance to the hospital or after seven days of having left. The supplement includes clinical square, epidemiology, etiology classification, diagnostic, treatment and prevention among others

  1. Routine Immunization of Adults in Canada: Review of the Epidemiology of Vaccine-Preventable Diseases and Current Recommendations for Primary Prevention

    Directory of Open Access Journals (Sweden)

    Michael D Parkins

    2009-01-01

    Full Text Available Vaccination is one of the greatest achievements in public health of the 20th century. However, the success of vaccine uptake and adherence to immunization guidelines seen in pediatric populations has not been observed among adult Canadians. As a result of the disparity in susceptibility to vaccine-preventable disease, there has been an increasing shift of vaccine-preventable childhood diseases into adult populations. Accordingly, morbidity and mortality due to vaccine-preventable illnesses now occur disproportionately in adults. All Canadians, irrespective of age, should have immunity to measles, mumps, rubella, tetanus, diphtheria, pertussis and varicella. All adult Canadians with significant medical comorbidities or those older than 65 years of age should receive the pneumococcal polysaccharide vaccine and yearly trivalent inactivate influenza vaccines. The present review summarizes the burden of illness of these vaccine-preventable diseases in the Canadian adult population and reviews the current immunization recommendations. Vaccination of all Canadians to these common agents remains a vital tool to decrease individual morbidity and mortality and reduce the overall burden of preventable disease in Canada.

  2. Clustering of unhealthy lifestyle behaviors is associated with nonadherence to clinical preventive recommendations among adults with diabetes.

    Science.gov (United States)

    Jiménez-García, Rodrigo; Esteban-Hernández, Jesus; Hernández-Barrera, Valentín; Jimenez-Trujillo, Isabel; López-de-Andrés, Ana; Carrasco Garrido, Pilar

    2011-01-01

    Analyze clustering of unhealthy lifestyle behavior and its relationship with nonadherence to clinical preventive care services among Spanish diabetic adults. Cross-sectional study including 2156 diabetic adults from the 2006 Spanish National Health Survey. Subjects were asked about their uptake of BP measurement, lipid profile, influenza vaccination, and dental examination. Lifestyle behaviors included smoking status, physical activity, alcohol consumption, and dieting. Binary logistic regression models were built to assess the association between clustering of unhealthy lifestyle and the uptake of each preventive activity. Almost 16% and 36% of the subjects had not undergone blood pressure (BP) and blood lipids measurements, respectively. Forty percent had not been vaccinated and 72% had not received dental examination. Fourteen percent of the subjects had three to four unhealthy behaviors and this increased the probability of not having BP check-up (OR 2.32, 95% CI 1.38-3.91), blood lipids testing (OR 1.63, 95% CI 1.14-2.33), and not being vaccinated (OR 1.99, 95% CI 1.37-2.89). Number of unhealthy lifestyle behaviors is linearly associated with number of preventive measures unfulfilled. Adherence to recommended clinical preventive services is under desirable levels among Spanish diabetes sufferers. These preventive services are provided neither equitably nor efficiently, since subjects with unhealthier lifestyles are less likely to receive them. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. A community effectiveness trial of strategies promoting intermittent preventive treatment with sulphadoxine-pyrimethamine in pregnant women in rural Burkina Faso

    Directory of Open Access Journals (Sweden)

    Brabin Bernard

    2008-09-01

    Full Text Available Abstract Background Intermittent preventive treatment with sulphadoxine-pyrimethamine for pregnant women (IPTp-SP is currently being scaled up in many countries in sub-Saharan Africa. Despite high antenatal clinic (ANC attendance, coverage with the required two doses of SP remains low. The study investigated whether a targeted community-based promotion campaign to increase ANC attendance and SP uptake could effectively improve pregnancy outcomes in the community. Methods Between 2004 and 2006 twelve health centres in Boromo Health District, Burkina Faso were involved in this study. Four were strategically assigned to community promotion in addition to IPTp-SP (Intervention A and eight were randomly allocated to either IPTp-SP (Intervention B or weekly chloroquine (Control. Primi- and secundigravidae were enrolled at village level and thick films and packed cell volume (PCV taken at 32 weeks gestation and at delivery. Placental smears were prepared and newborns weighed. Primary outcomes were peripheral parasitaemia during pregnancy and at delivery, placental malaria, maternal anaemia, mean and low birth weight. Secondary outcomes were the proportion of women with ≥ 3 ANC visits and ≥ 2 doses of SP. Intervention groups were compared using logistic and linear regression with linearized variance estimations to correct for the cluster-randomized design. Results SP uptake (≥ 2 doses was higher with (Intervention A: 70% than without promotion (Intervention B: 49% (OR 2.45 95%CI 1.25–4.82 p = 0.014. Peripheral (33.3% and placental (30.3% parasite rates were significantly higher in the control arm compared to Intervention B (peripheral: 20.1% OR 0.50 95%CI 0.37–0.69 p = 0.001; placental: 20.5% OR 0.59 95%CI 0.44–0.78 p = 0.002 but did not differ between Intervention A (17.4%; 18.1% and Intervention B (20.1; 20.5% (peripheral: OR 0.84 95%CI 0.60–1.18 p = 0.280; placental: OR 0.86 95%CI 0.58–1.29 p = 0.430. Mean PCV and birth weight and

  4. Mammography use among women ages 40-49 after the 2009 U.S. Preventive Services Task Force recommendation.

    Science.gov (United States)

    Block, Lauren D; Jarlenski, Marian P; Wu, Albert W; Bennett, Wendy L

    2013-11-01

    In 2009, the U.S. Preventive Service Task Force changed its recommendation regarding screening mammography in average-risk women aged 40-49 years. To evaluate the effects of the 2009 recommendation on reported mammogram use in a population-based survey. Secondary data analysis of data collected in the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System surveys. Women ages 40-74 years in the 50 states and Washington, DC who were not pregnant at time of survey and reported data on mammogram use during the 2006, 2008, or 2010 survey. Mammogram use was compared between women ages 40-49 and women ages 50-74 before and after the recommendation. We performed a difference-in-difference estimation adjusted for access to care, education, race, and health status, and stratified analyses by whether women reported having a routine checkup in the prior year. Reported prevalence of mammogram use in the past year among women ages 40-49 and 50-74 was 53.2 % and 65.2 %, respectively in 2008, and 51.7 % and 62.4 % in 2010. In 2010, mammography use did not significantly decline from 2006-2008 in women ages 40-49 relative to women ages 50-74. There was no reduction in mammography use among younger women in 2010 compared to older women and previous years. Patients and providers may have been hesitant to comply with the 2009 recommendation.

  5. Barriers to prostate cancer prevention and community recommended health education strategies in an urban African American community in Jackson, Mississippi.

    Science.gov (United States)

    Ekúndayò, Olúgbémiga T; Tataw, David B

    2013-01-01

    This article describes the use of survey research in collaboration with the African American urban community of Georgetown, Jackson, Mississippi to identify and understand prostate cancer knowledge, resource utilization, and health education strategies considered most effective in reaching the community with prostate cancer prevention messages. The study revealed profound needs in disease identification and resources awareness and utilization. Barriers to utilization were identified by participants to include lack of self-efficacy, low self-esteem, lack of trust in the health care system, limited knowledge of prostate pathology, and limited ability to pay. Participants' recommended strategies for reaching the community with prostate cancer education include traditional and nontraditional strategies. The list of recommendations exclude modern-day outlets such as handheld devices, Twitter, Facebook, blogs, wikis, and other Internet-based outlets. The findings provide a road map for program development and an intervention research agenda custom-tailored to the Georgetown community of Jackson, Mississippi.

  6. Intermittent search strategies

    Science.gov (United States)

    Bénichou, O.; Loverdo, C.; Moreau, M.; Voituriez, R.

    2011-01-01

    This review examines intermittent target search strategies, which combine phases of slow motion, allowing the searcher to detect the target, and phases of fast motion during which targets cannot be detected. It is first shown that intermittent search strategies are actually widely observed at various scales. At the macroscopic scale, this is, for example, the case of animals looking for food; at the microscopic scale, intermittent transport patterns are involved in a reaction pathway of DNA-binding proteins as well as in intracellular transport. Second, generic stochastic models are introduced, which show that intermittent strategies are efficient strategies that enable the minimization of search time. This suggests that the intrinsic efficiency of intermittent search strategies could justify their frequent observation in nature. Last, beyond these modeling aspects, it is proposed that intermittent strategies could also be used in a broader context to design and accelerate search processes.

  7. Recommendations concerning the prevention of radiation-induced health hazards through the application of soft and MID lasers

    Energy Technology Data Exchange (ETDEWEB)

    1987-01-01

    The Federal Health Office (BGA) recommends observation of the following practical hints: The application of soft lasers or MID lasers for cosmetic treatment or acupuncture represents a danger to the eye. Instructions for use of laser equipment have to indicate this danger. Appropriate use of the equipment will prevent damage. Any person applying soft lasers or MID lasers for treatment of customers or patients near the eye are required to give proof of a special training assuring appropriate handling, and of instructions in laser radiation protection.

  8. Recommendations concerning the prevention of radiation-induced health hazards through the application of soft and MID lasers

    International Nuclear Information System (INIS)

    Anon.

    1987-01-01

    The Federal Health Office (BGA) recommends observation of the following practical hints: The application of soft lasers or MID lasers for cosmetic treatment or acupuncture represents a danger to the eye. Instructions for use of laser equipment have to indicate this danger. Appropriate use of the equipment will prevent damage. Any person applying soft lasers or MID lasers for treatment of customers or patients near the eye are required to give proof of a special training assuring appropriate handling, and of instructions in laser radiation protection. (orig./PW) [de

  9. Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007-2015: A Serial, Cross-sectional Study.

    Science.gov (United States)

    Van't Hof, Jeremy R; Duval, Sue; Walts, Adrienne; Kopecky, Stephen L; Luepker, Russell V; Hirsch, Alan T

    2017-10-03

    No previous study has evaluated the impact of past US Preventive Services Task Force statements on primary prevention (PP) aspirin use in a primary care setting. The aim of this study was to evaluate temporal changes in PP aspirin use in a primary care population, stratifying patients by their 10-year global cardiovascular disease risk, in response to the 2009 statement. This study estimated biannual aspirin use prevalence using electronic health record data from primary care clinics within the Fairview Health System (Minnesota) from 2007 to 2015. A total of 94 270 patient encounters had complete data to estimate a 10-year cardiovascular disease risk score using the 2013 American College of Cardiology/American Heart Association global risk estimator. Patients were stratified into low- (aspirin use averaged 43%. When stratified by low, intermediate and high risk, average PP aspirin use was 41%, 63%, and 73%, respectively. Average PP aspirin use decreased after the publication of the 2009 US Preventive Services Task Force recommendation statement: from 45% to 40% in the low-risk group; from 66% to 62% in the intermediate-risk group; and from 76% to 73% in the high-risk group, before and after the guideline. Publication of the 2009 US Preventive Services Task Force recommendation was not associated with an increase in aspirin use. High risk PP patients utilized aspirin at high rates. Patients at intermediate risk were less intensively treated, and patients at low risk used aspirin at relatively high rates. These data may inform future aspirin guideline dissemination. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  10. Lifestyle intervention to prevent obesity during pregnancy: Implications and recommendations for research and implementation.

    Science.gov (United States)

    Hill, Briony; McPhie, Skye; Moran, Lisa J; Harrison, Paul; Huang, Terry T-K; Teede, Helena; Skouteris, Helen

    2017-06-01

    Maternal obesity and excessive gestational weight gain (GWG) are significant contributors to the global obesity epidemic. However, isolated lifestyle interventions to address this in pregnancy appear to have only modest benefit and responses can be variable. This paper aims to address the question of why the success of lifestyle interventions to prevent excessive GWG is suboptimal and variable. We suggest that there are inherent barriers to lifestyle change within pregnancy as a life stage, including the short window available for habit formation; the choice for women not to prioritise their weight; competing demands including physiological, financial, relationship, and social situations; and lack of self-efficacy among healthcare professionals on this topic. In order to address this problem, we propose that just like all successful public health approaches seeking to change behaviour, individual lifestyle interventions must be provided in the context of a supportive environment that enables, incentivises and rewards healthy changes. Future research should focus on a systems approach that integrates the needs of individuals with the context within which they exist. Borrowing from the social marketing principle of 'audience segmentation', we also need to truly understand the needs of individuals to design appropriately tailored interventions. This approach should also be applied to the preconception period for comprehensive prevention approaches. Additionally, relevant policy needs to reflect the changing evidence-based climate. Interventions in the clinical setting need to be integrally linked to multipronged obesity prevention efforts in the community, so that healthy weight goals are reinforced throughout the system. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Recommendations for cervical cancer prevention in Latin America and the Caribbean.

    Science.gov (United States)

    Muñoz, Nubia; Franco, Eduardo L; Herrero, Rolando; Andrus, Jon Kim; de Quadros, Ciro; Goldie, Sue J; Bosch, F Xavier

    2008-08-19

    Cervical cancer control in the Latin America and Caribbean (LAC) region has been, and remains, a priority and a major public health challenge. It also provides the opportunity for the advancement of research into novel cervical cancer preventative tools including the use of prophylactic human papillomavirus (HPV) vaccines, HPV-based screening options and low technology visual inspection methods. The challenges for prevention are compounded because cervical cancer cases continue to cluster in the low socio-economic and rural populations, thus requiring strong political and social commitments to ensure effective implementation in the region. Although cytology-based screening activities exist in the majority of LAC countries, these have been largely based on opportunistic screening services. Evaluation of the impact of screening is often focused on assessing coverage of the population with Pap smears. However, regardless of the chosen technology a screening program requires a complex set of activities that must also be of high quality such us ensuring access of the underserved populations to the program, maintaining routine quality controls of the screening procedures and organizing the proper follow-up of women with abnormal screening results. The cost of the HPV vaccine and of the delivery infrastructure required is currently a significant obstacle for widespread introduction that will require collaborative resolve between public health organizations, governments and vaccine manufacturers. It is important to ensure that HPV vaccines are made available to the wider public, not only to those who can afford it. This monograph and the associated regional reports have carefully identified and discussed the many challenges and opportunities to be considered for policy decisions, in particular the complex interplay between vaccination strategies and subsequent screening requirements. An advanced cost-benefit analysis, using models calibrated to specific countries in the

  12. Secondary prevention of work-related upper extremity disorders: recommendations from the Annapolis conference.

    Science.gov (United States)

    Feuerstein, Michael; Harrington, Cherise B

    2006-09-01

    Efforts to improve the secondary prevention of work-related upper extremity (WRUE) symptoms continue to present a challenge. As with many occupational musculoskeletal pain disorders no single, direct cause-effect relationship exists among specific exposures, pathologic processes, and symptoms. The field has yet to create truly effective and efficient interventions for these problems that are based on current epidemiological and clinical knowledge. A working conference was held in Annapolis, Maryland on September 23rd and 24th, 2005 with leaders in research and application related to upper extremity disorders to address this challenge. The intent of the meeting was to review "state of the art" evidence in epidemiology and intervention research in order to develop suggestions regarding next steps in intervention research and application. On day 2 a number of stakeholders were present to discuss what they perceived as the missing pieces in both epidemiological research and applied intervention research in order to generate more effective workplace interventions. The papers in this series of the Journal of Occupational Rehabilitation indicate that scientifically sound progress has been made over the past decade in identifying ergonomic, workplace psychosocial, and individual factors in both the etiology and exacerbation of these symptoms/disorders. However, there is a gap between this knowledge and the development and practical implementation of comprehensive interventions for these problems. The conference also highlighted the paucity of economic analyses of the impact of these disorders as well as the economic study of the impact of intervention. Approaches for such evaluations were presented and are included in this special section of the journal. This series of papers and the summary of the invited group's discussions provided in this paper clearly emphasize the need for innovative ways to think about these problems and specific research topics that can help

  13. Conclusions and recommendations from the symposium, Beyond Cholesterol: Prevention and Treatment of Coronary Heart Disease with n-3 Fatty Acids.

    Science.gov (United States)

    Deckelbaum, Richard J; Leaf, Alexander; Mozaffarian, Dariush; Jacobson, Terry A; Harris, William S; Akabas, Sharon R

    2008-06-01

    After the symposium "Beyond Cholesterol: Prevention and Treatment of Coronary Heart Disease with n-3 Fatty Acids," faculty who presented at the conference submitted manuscripts relating to their conference topics, and these are presented in this supplement. The content of these manuscripts was reviewed, and 2 conference calls were convened. The objective was to summarize existing evidence, gaps in evidence, and future research needed to strengthen recommendations for specific intakes of n-3 fatty acids for different conditions relating to cardiovascular disease. The following 2 questions were the main items discussed. What are the roles of n-3 fatty acids in primary versus secondary prevention of coronary heart disease? What are the roles of n-3 fatty acids in hypertriglyceridemia, in the metabolic syndrome and type 2 diabetes, and in sudden cardiac death, cardiac arrhythmias, and vulnerable plaque? Each area was summarized by using 2 general categories: 1) current knowledge for which general consensus exists, and 2) recommendations for research and policy. Additional references for these conclusions can be found in the articles included in the supplement.

  14. Consensus recommendations for preventing and managing bleeding complications associated with novel oral anticoagulants in singapore.

    Science.gov (United States)

    Ng, Heng Joo; Chee, Yen Lin; Ponnudurai, Kuperan; Lim, Lay Cheng; Tan, Daryl; Tay, Jam Chin; Handa, Pankaj Kumar; Akbar Ali, Mufeedha; Lee, Lai Heng

    2013-11-01

    Novel oral anticoagulants (NOACs) have at least equivalent efficacy compared to standard anticoagulants with similar bleeding risk. Optimal management strategies for bleeding complications associated with NOACs are currently unestablished. A working group comprising haematologists and vascular medicine specialists representing the major institutions in Singapore was convened to produce this consensus recommendation. A Medline and EMBASE search was conducted for articles related to the 3 available NOACs (dabigatran, rivaroxaban, apixaban), bleeding and its management. Additional information was obtained from the product monographs and bibliographic search of articles identified. The NOACs still has substantial interactions with a number of drugs for which concomitant administration should best be avoided. As they are renally excreted, albeit to different degrees, NOACs should not be prescribed to patients with creatinine clearance of factor VIIa and prothrombin complex may be considered although their effectiveness is currently unsupported by firm clinical evidence. The NOACs have varying effect on the prothrombin time and activated partial thromboplastin time which has to be interpreted with caution. Routine monitoring of drug level is not usually required. NOACs are an important advancement in antithrombotic management and careful patient selection and monitoring will permit optimisation of their potential and limit bleeding events.

  15. [Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group].

    Science.gov (United States)

    Campins, Magda; Moreno-Pérez, David; Gil-de Miguel, Angel; González-Romo, Fernando; Moraga-Llop, Fernando A; Arístegui-Fernández, Javier; Goncé-Mellgren, Anna; Bayas, José M; Salleras-Sanmartí, Lluís

    2013-04-01

    A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  16. Meeting Recommended Levels of Physical Activity in Relation to Preventive Health Behavior and Health Status Among Adults

    Directory of Open Access Journals (Sweden)

    Peter D. Hart

    2017-01-01

    Full Text Available Objectives The purpose of this study was to examine the relationship of meeting the recommended levels of physical activity (PA with health status and preventive health behavior in adults. Methods A total of 5630 adults 18 years of age or older were included in this study. PA was assessed using a series of questions that categorized activities based on their metabolic equivalent values and then categorized individuals based on the reported frequency and duration of such activities. Participants reporting 150 minutes or more of moderate-intensity PA per week were considered to have met the PA guidelines. Multiple logistic regression was used to model the relationships between meeting PA guidelines and health status and preventive health behavior, while controlling for confounding variables. Results Overall, 53.9% (95% confidence interval [CI], 51.9 to 55.9% of adults reported meeting the recommended levels of PA. Among adults with good general health, 56.9% (95% CI, 54.7 to 59.1% reported meeting the recommended levels of PA versus 43.1% (95% CI, 40.9 to 45.3% who did not. Adults who met the PA guidelines were significantly more likely not to report high cholesterol, diabetes, chronic obstructive pulmonary disease, arthritis, asthma, depression, or overweight. Furthermore, adults meeting the PA guidelines were significantly more likely to report having health insurance, consuming fruits daily, consuming vegetables daily, and not being a current cigarette smoker. Conclusions In this study, we found meeting the current guidelines for PA to have a protective relationship with both health status and health behavior in adults. Health promotion programs should focus on strategies that help individuals meet the current guidelines of at least 150 minutes per week of moderate-intensity PA.

  17. Identifying environmental, social, and psychological correlates of meeting the recommended physical activity levels for colon cancer prevention among Japanese adults.

    Science.gov (United States)

    Ishii, Kaori; Shibata, Ai; Oka, Koichiro

    2013-11-01

    Although physical activity reduces the risk of diseases such as cancer, diabetes and cardiovascular disease, a large proportion of the population is not sufficiently physically active. Therefore, the present study examined the environmental, social, and psychological correlates for meeting the 2 recommended physical activity criteria: ≥420 min per week of at least moderate-intensity activity (MPA criterion) and ≥210 min per week of vigorous activity (VPA criterion) for colon cancer prevention among Japanese adults. Cross-sectional study. The sample included 2000 Japanese adults aged 20-79 years. An Internet-based survey was used to assess seven sociodemographic variables (e.g., education level, employment status), environmental variables (home fitness equipment, access to facilities, neighborhood safety, aesthetic sensibilities, and frequency of observing others exercising, residential area), social variables (social support), psychological variables (self-efficacy, perceived positive (pros) and negative (cons) aspects of exercise), and physical activity. The adjusted odds of meeting each physical activity criterion by these variables were calculated. Overall, 22.3% of the study population met the criterion of MPA, and 7.3% met the criterion of VPA. Having high self-efficacy, fewer perceived cons, possessing home fitness equipment, reporting enjoyable scenery, and living in a rural area were significantly associated with meeting the recommended criteria. Participants who met the 2 activity recommendations differed by self-efficacy, cons, possession of home fitness equipment, reporting of enjoyable scenery, and residential area. These findings imply that strategies to promote more intense physical activities specifically in terms of these variables may be necessary for colon cancer prevention. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  18. The prevention and management of congenital syphilis: an overview and recommendations.

    Science.gov (United States)

    Saloojee, Haroon; Velaphi, Sithembiso; Goga, Yasmin; Afadapa, Nike; Steen, Richard; Lincetto, Ornella

    2004-01-01

    The continued occurrence of congenital syphilis is an indictment of the inadequate antenatal care services and poor quality of programmes to control sexually transmitted infections. More than 1 million infants are born with congenital syphilis each year. Despite national policies on antenatal testing and the widespread use of antenatal services, syphilis screening is still implemented only sporadically in many countries, leaving the disease undetected and untreated among many pregnant women. The weak organization of services and the costs of screening are the principal obstacles facing programmes. Decentralization of antenatal syphilis screening programmes, on-site testing and immediate treatment can reduce the number of cases of congenital syphilis. Antenatal syphilis screening and treatment programmes are as cost effective as many existing public health programmes, e.g. measles immunization. Diagnosis of congenital syphilis is problematic since more than half of all infants are asymptomatic, and signs in symptomatic infants may be subtle and nonspecific. Newer diagnostic tests such as enzyme immunoassays, polymerase chain reaction and immunoblotting have made diagnosis more sensitive and specific but are largely unavailable in the settings where they are most needed. Guidelines developed for better-resourced settings are conservative and err on the side of overtreatment. They are difficult to implement in, or inappropriate for, poorly-resourced settings because of the lack of investigative ability and the pressure on health facilities to discharge infants early. This paper offers recommendations for treating infants, including an approach based solely on maternal serological status and clinical signs of syphilis in the infant. PMID:15356934

  19. Intermittency in branching models

    International Nuclear Information System (INIS)

    Chiu, C.B.; Texas Univ., Austin; Hwa, R.C.; Oregon Univ., Eugene

    1990-01-01

    The intermittency properties of three branching models have been investigated. The factorial moments show power-law behavior as function of small rapidity width. The slopes and energy dependences reveal different characteristics of the models. The gluon model has the weakest intermittency. (orig.)

  20. Needle stick injuries among dental students: risk factors and recommendations for prevention

    Science.gov (United States)

    Gaballah, Kamis; Warbuton, Dorothy; Sihmbly, Kamal; Renton, Tara

    2012-01-01

    Aim To evaluate the risk factors of needle stick injuries (NSIs) sustained by undergraduate dental students and nurse students at the King's College London (KCL) Dental Institute. Materials and methods A retrospective study evaluated the incident reports relating to NSIs reported over a period of 2 years. Factors including the dental department, study year, and when the injury took place during administration of local anaesthesia (LA) and recapping conventional syringe or clearing work surface or during disposal. Results This report showed that students are at the highest risk of NSIs at the fourth year of their 5-year BDS course. About one-third of injuries were reported among this group of students followed by year 5 students (25%). Oral surgery clinics were the major source of incident reporting when compared with other specialised dental clinics within the institute. The left hands of the students were the most frequently affected by such injuries and then the right hands of student dental nurses. The attempt of needle recapping of conventional syringes was the least reported mechanism of injuries and constituted only 15% of the total injuries and mainly occurred in third year students. The most frequent injuries among student nurses were during disposal of the needle. Conclusion Less NSIs occur when using safety syringes. A non-recapping policy with immediate disposal of either the conventional or safety syringe systems after injection would prevent all clearance-related NSIs sustained by nurses. To avoid NSIs, education plays a vital role particularly with effective implementation of the change to safety syringes with appropriate training. PMID:22741025

  1. Needle stick injuries among dental students: risk factors and recommendations for prevention

    Directory of Open Access Journals (Sweden)

    Kamis Gaballah

    2012-06-01

    Full Text Available Aim: To evaluate the risk factors of needle stick injuries (NSIs sustained by undergraduate dental students and nurse students at the King's College London (KCL Dental Institute. Materials and methods: A retrospective study evaluated the incident reports relating to NSIs reported over a period of 2 years. Factors including the dental department, study year, and when the injury took place during administration of local anaesthesia (LA and recapping conventional syringe or clearing work surface or during disposal. Results: This report showed that students are at the highest risk of NSIs at the fourth year of their 5-year BDS course. About one-third of injuries were reported among this group of students followed by year 5 students (25%. Oral surgery clinics were the major source of incident reporting when compared with other specialised dental clinics within the institute. The left hands of the students were the most frequently affected by such injuries and then the right hands of student dental nurses. The attempt of needle recapping of conventional syringes was the least reported mechanism of injuries and constituted only 15% of the total injuries and mainly occurred in third year students. The most frequent injuries among student nurses were during disposal of the needle. Conclusion: Less NSIs occur when using safety syringes. A non-recapping policy with immediate disposal of either the conventional or safety syringe systems after injection would prevent all clearance-related NSIs sustained by nurses. To avoid NSIs, education plays a vital role particularly with effective implementation of the change to safety syringes with appropriate training.

  2. Intermittent fasting and cardiovascular disease: current evidence and unresolved questions.

    Science.gov (United States)

    Tinsley, Grant M; Horne, Benjamin D

    2018-01-01

    Intermittent fasting has produced a variety of beneficial health effects in animal models, although high-quality research in humans has been limited. This special report examines current evidences for intermittent fasting in humans, discusses issues that require further examination, and recommends new research that can improve the knowledge base in this emerging research area. While potentially useful for health improvement, intermittent fasting requires further study prior to widespread implementation for health purposes. Randomized, longer-term studies are needed to determine whether using intermittent fasting as a lifestyle rather than a diet is feasible and beneficial for the health of some members of the human population.

  3. Infection prevention behaviour and infectious disease modelling: a review of the literature and recommendations for the future.

    Science.gov (United States)

    Weston, Dale; Hauck, Katharina; Amlôt, Richard

    2018-03-09

    Given the importance of person to person transmission in the spread of infectious diseases, it is critically important to ensure that human behaviour with respect to infection prevention is appropriately represented within infectious disease models. This paper presents a large scale scoping review regarding the incorporation of infection prevention behaviour in infectious disease models. The outcomes of this review are contextualised within the psychological literature concerning health behaviour and behaviour change, resulting in a series of key recommendations for the incorporation of human behaviour in future infectious disease models. The search strategy focused on terms relating to behaviour, infectious disease and mathematical modelling. The selection criteria were developed iteratively to focus on original research articles that present an infectious disease model with human-human spread, in which individuals' self-protective health behaviour varied endogenously within the model. Data extracted included: the behaviour that is modelled; how this behaviour is modelled; any theoretical background for the modelling of behaviour, and; any behavioural data used to parameterise the models. Forty-two papers from an initial total of 2987 were retained for inclusion in the final review. All of these papers were published between 2002 and 2015. Many of the included papers employed a multiple, linked models to incorporate infection prevention behaviour. Both cognitive constructs (e.g., perceived risk) and, to a lesser extent, social constructs (e.g., social norms) were identified in the included papers. However, only five papers made explicit reference to psychological health behaviour change theories. Finally, just under half of the included papers incorporated behavioural data in their modelling. By contextualising the review outcomes within the psychological literature on health behaviour and behaviour change, three key recommendations for future behavioural

  4. Naftidrofuryl for intermittent claudication.

    Science.gov (United States)

    De Backer, T L M; Vander Stichele, R; Lehert, P; Van Bortel, L

    2008-04-16

    Lifestyle changes and cardiovascular prevention measures are a primary treatment for intermittent claudication (IC). Symptomatic treatment with vasoactive agents (Anatomic Therapeutic Chemical Classification (ATC) for medicines from the World Health Organisation class CO4A) is controversial. To evaluate evidence on the efficacy and safety of oral naftidrofuryl (ATC CO4 21) versus placebo on the pain-free walking distance (PFWD) of people with IC by using a meta-analysis based on individual patient data (IPD). The Cochrane Peripheral Vascular Diseases Group searched their Trials Register (last searched December 2007) and CENTRAL (last searched 2007, Issue 4). We searched MEDLINE, EMBASE, International Pharmaceutical Abstracts, the Science Citation Index and contacted the authors and checked the reference lists of retrieved articles. We asked the manufacturing company for IPD. We included only randomized controlled trials (RCTs) with low or moderate risk of bias for which the IPD were available. We collected data from the electronic data file or from the case report form and checked the data by a statistical quality control procedure. All randomized patients were analyzed following the intention-to-treat (ITT) principle. The geometric mean of the relative improvement in PFWD was calculated for both treatment groups in all identified studies. The effect of the drug was assessed compared with placebo on final walking distance (WDf) using multilevel and random-effect models and adjusting for baseline walking distance (WD0). For the responder analysis, therapeutic success was defined as an improvement of walking distance of at least 50%. We included seven studies in the IPD (n = 1266 patients). One of these studies (n = 183) was only used in the sensitivity analysis so that the main analysis included 1083 patients. The ratio of the relative improvement in PFWD (naftidrofuryl compared with placebo) was 1.37 (95% confidence interval (CI) 1.32 to 1.51, P < 0.001). The

  5. Intermittent degradation and schizotypy

    Directory of Open Access Journals (Sweden)

    Matthew W. Roché

    2015-06-01

    Full Text Available Intermittent degradation refers to transient detrimental disruptions in task performance. This phenomenon has been repeatedly observed in the performance data of patients with schizophrenia. Whether intermittent degradation is a feature of the liability for schizophrenia (i.e., schizotypy is an open question. Further, the specificity of intermittent degradation to schizotypy has yet to be investigated. To address these questions, 92 undergraduate participants completed a battery of self-report questionnaires assessing schizotypy and psychological state variables (e.g., anxiety, depression, and their reaction times were recorded as they did so. Intermittent degradation was defined as the number of times a subject’s reaction time for questionnaire items met or exceeded three standard deviations from his or her mean reaction time after controlling for each item’s information processing load. Intermittent degradation scores were correlated with questionnaire scores. Our results indicate that intermittent degradation is associated with total scores on measures of positive and disorganized schizotypy, but unrelated to total scores on measures of negative schizotypy and psychological state variables. Intermittent degradation is interpreted as potentially derivative of schizotypy and a candidate endophenotypic marker worthy of continued research.

  6. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel.

    Science.gov (United States)

    Günthard, Huldrych F; Saag, Michael S; Benson, Constance A; del Rio, Carlos; Eron, Joseph J; Gallant, Joel E; Hoy, Jennifer F; Mugavero, Michael J; Sax, Paul E; Thompson, Melanie A; Gandhi, Rajesh T; Landovitz, Raphael J; Smith, Davey M; Jacobsen, Donna M; Volberding, Paul A

    2016-07-12

    New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and

  7. Development of case-based medication alerting and recommender system: a new approach to prevention for medication error.

    Science.gov (United States)

    Miyo, Kengo; Nittami, Yuki S; Kitagawa, Yoichiro; Ohe, Kazuhiko

    2007-01-01

    The purpose of this study was to develop a new alerting and recommender system for preventing medication errors. In recent years, alerting systems have been widely implemented, but because these systems apply a same static threshold for all patients in all cases, they produce excessive alerts and subject physicians to "alert fatigue". We believe that the most commonly-written prescription for a patient's status is the safest one. From this standpoint, we developed a real-time case-based medication alerting and recommender system linked to a database of past prescriptions. When a physician issues his or her prescription, our system dynamically compares it with past ones for similar patients in the database. An analysis of the 10 most frequently-used drugs in the University of Tokyo Hospital revealed that our system reduced the number of false alerts compared to the traditional static alert method. Our system contributes to the creation of alerts that are appropriate for patients' clinical conditions and based on physicians' empirical discretion.

  8. Prevention

    DEFF Research Database (Denmark)

    Halken, S; Høst, A

    2001-01-01

    , breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....

  9. European recommendations for primary prevention of congenital anomalies: a joined effort of EUROCAT and EUROPLAN projects to facilitate inclusion of this topic in the National Rare Disease Plans.

    Science.gov (United States)

    Taruscio, Domenica; Arriola, Larraitz; Baldi, Francesca; Barisic, Ingeborg; Bermejo-Sánchez, Eva; Bianchi, Fabrizio; Calzolari, Elisa; Carbone, Pietro; Curran, Rhonda; Garne, Ester; Gatt, Miriam; Latos-Bieleńska, Anna; Khoshnood, Babak; Irgens, Lorentz; Mantovani, Alberto; Martínez-Frías, Maria Luisa; Neville, Amanda; Rißmann, Anke; Ruggeri, Stefania; Wellesley, Diana; Dolk, Helen

    2014-01-01

    Congenital anomalies (CA) are the paradigm example of rare diseases liable to primary prevention actions due to the multifactorial etiology of many of them, involving a number of environmental factors together with genetic predispositions. Yet despite the preventive potential, lack of attention to an integrated preventive strategy has led to the prevalence of CA remaining relatively stable in recent decades. The 2 European projects, EUROCAT and EUROPLAN, have joined efforts to provide the first science-based and comprehensive set of recommendations for the primary prevention of CA in the European Union. The resulting EUROCAT-EUROPLAN 'Recommendations on Policies to Be Considered for the Primary Prevention of Congenital Anomalies in National Plans and Strategies on Rare Diseases' were issued in 2012 and endorsed by EUCERD (European Union Committee of Experts on Rare Diseases) in 2013. The recommendations exploit interdisciplinary expertise encompassing drugs, diet, lifestyles, maternal health status, and the environment. The recommendations include evidence-based actions aimed at reducing risk factors and at increasing protective factors and behaviors at both individual and population level. Moreover, consideration is given to topics specifically related to CA (e.g. folate status, teratogens) as well as of broad public health impact (e.g. obesity, smoking) which call for specific attention to their relevance in the pre- and periconceptional period. The recommendations, reported entirely in this paper, are a comprehensive tool to implement primary prevention into national policies on rare diseases in Europe. © 2014 S. Karger AG, Basel.

  10. Vision Screening in Children Aged 6 Months to 5 Years: US Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Grossman, David C; Curry, Susan J; Owens, Douglas K; Barry, Michael J; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Landefeld, C Seth; Mangione, Carol M; Phipps, Maureen G; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen

    2017-09-05

    One of the most important causes of vision abnormalities in children is amblyopia (also known as "lazy eye"). Amblyopia is an alteration in the visual neural pathway in a child's developing brain that can lead to permanent vision loss in the affected eye. Among children younger than 6 years, 1% to 6% have amblyopia or its risk factors (strabismus, anisometropia, or both). Early identification of vision abnormalities could prevent the development of amblyopia. Studies show that screening rates among children vary by race/ethnicity and family income. Data based on parent reports from 2009-2010 indicated identical screening rates among black non-Hispanic children and white non-Hispanic children (80.7%); however, Hispanic children were less likely than non-Hispanic children to report vision screening (69.8%). Children whose families earned 200% or more above the federal poverty level were more likely to report vision screening than families with lower incomes. To update the 2011 US Preventive Services Task Force (USPSTF) recommendation on screening for amblyopia and its risk factors in children. The USPSTF reviewed the evidence on the accuracy of vision screening tests and the benefits and harms of vision screening and treatment. Surgical interventions were considered to be out of scope for this review. Treatment of amblyopia is associated with moderate improvements in visual acuity in children aged 3 to 5 years, which are likely to result in permanent improvements in vision throughout life. The USPSTF concluded that the benefits are moderate because untreated amblyopia results in permanent, uncorrectable vision loss, and the benefits of screening and treatment potentially can be experienced over a child's lifetime. The USPSTF found adequate evidence to bound the potential harms of treatment (ie, higher false-positive rates in low-prevalence populations) as small. Therefore, the USPSTF concluded with moderate certainty that the overall net benefit is moderate for

  11. Efficacy and Safety of Azithromycin-Chloroquine versus Sulfadoxine-Pyrimethamine for Intermittent Preventive Treatment of Plasmodium falciparum Malaria Infection in Pregnant Women in Africa: An Open-Label, Randomized Trial.

    Directory of Open Access Journals (Sweden)

    Joshua Kimani

    Full Text Available The World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp with sulfadoxine-pyrimethamine (SP in African regions with moderate to high malaria transmission. However, growing resistance to SP threatens the effectiveness of IPTp-SP, and alternative drugs are needed. This study tested the efficacy, tolerability, and safety of a fixed-dose combination azithromycin-chloroquine (AZCQ; 250 mg AZ/155 mg CQ base for IPTp relative to IPTp-SP.A randomized, Phase 3, open-label, multi-center study was conducted in sub-Saharan Africa (Benin, Kenya, Malawi, Tanzania, and Uganda between October 2010 and November 2013. Pregnant women received 3 IPTp courses with AZCQ (each course: 1,000/620 mg AZCQ QD for 3 days or SP (each course 1,500/75 mg SP QD for 1 day at 4- to 8-week intervals during the second and third trimester. Long-lasting insecticide-treated bednets were also provided at enrollment. Study participants were followed up until day 28 post delivery (time window: day 28-42. The primary endpoint was the proportion of participants with sub-optimal pregnancy outcomes (a composite endpoint comprising live-borne neonates with low birth weight [LBW, 28 weeks], abortion [≤28 weeks], lost to follow-up prior to observation of pregnancy outcome, or missing birth weight. The study was terminated early after recruitment of 2,891 of the planned 5,044 participants, due to futility observed in a pre-specified 35% interim analysis. In the final intent-to-treat dataset, 378/1,445 (26.2% participants in the AZCQ and 342/1,445 (23.7% in the SP group had sub-optimal pregnancy outcomes, with an estimated risk ratio (RR of 1.11 (95% CI: 0.97, 1.25; p = 0.12. There was no significant difference in the incidence of LBW between treatment groups (57/1138 [5.0%] in the AZCQ group, 68/1188 [5.7%] in the SP group, RR 0.87 [95% CI: 0.62, 1.23]; p = 0.44. IPTp-AZCQ was less well-tolerated in mothers than IPTp-SP. Occurrences of congenital anomalies

  12. Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer

    Science.gov (United States)

    Lawler, Mark; Alsina, Deborah; Adams, Richard A; Anderson, Annie S; Brown, Gina; Fearnhead, Nicola S; Fenwick, Stephen W; Hochhauser, Daniel; Koelzer, Viktor H; McNair, Angus G K; Norton, Christine; Novelli, Marco R; Steele, Robert J C; Thomas, Anne L; Wilde, Lisa M; Wilson, Richard H

    2018-01-01

    Objective Colorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes. Design RG analysis was conducted by a multidisciplinary panel of patients, clinicians and researchers (n=71). Eight working groups (WG) were constituted: discovery science; risk; prevention; early diagnosis and screening; pathology; curative treatment; stage IV disease; and living with and beyond CRC. A series of discussions led to development of draft papers by each WG, which were evaluated by a 20-strong patient panel. A final list of RGs and research recommendations (RR) was endorsed by all participants. Results Fifteen critical RGs are summarised below: RG1: Lack of realistic models that recapitulate tumour/tumour micro/macroenvironment; RG2: Insufficient evidence on precise contributions of genetic/environmental/lifestyle factors to CRC risk; RG3: Pressing need for prevention trials; RG4: Lack of integration of different prevention approaches; RG5: Lack of optimal strategies for CRC screening; RG6: Lack of effective triage systems for invasive investigations; RG7: Imprecise pathological assessment of CRC; RG8: Lack of qualified personnel in genomics, data sciences and digital pathology; RG9: Inadequate assessment/communication of risk, benefit and uncertainty of treatment choices; RG10: Need for novel technologies/interventions to improve curative outcomes; RG11: Lack of approaches that recognise molecular interplay between metastasising tumours and their microenvironment; RG12: Lack of reliable biomarkers to guide stage IV treatment; RG13: Need to increase understanding of health related quality of life (HRQOL) and promote residual symptom resolution; RG14: Lack of coordination of CRC research/funding; RG15: Lack of effective communication between relevant stakeholders. Conclusion Prioritising research activity and funding could have a significant impact on reducing CRC

  13. Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer.

    Science.gov (United States)

    Lawler, Mark; Alsina, Deborah; Adams, Richard A; Anderson, Annie S; Brown, Gina; Fearnhead, Nicola S; Fenwick, Stephen W; Halloran, Stephen P; Hochhauser, Daniel; Hull, Mark A; Koelzer, Viktor H; McNair, Angus G K; Monahan, Kevin J; Näthke, Inke; Norton, Christine; Novelli, Marco R; Steele, Robert J C; Thomas, Anne L; Wilde, Lisa M; Wilson, Richard H; Tomlinson, Ian

    2018-01-01

    Colorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes. RG analysis was conducted by a multidisciplinary panel of patients, clinicians and researchers (n=71). Eight working groups (WG) were constituted: discovery science; risk; prevention; early diagnosis and screening; pathology; curative treatment; stage IV disease; and living with and beyond CRC. A series of discussions led to development of draft papers by each WG, which were evaluated by a 20-strong patient panel. A final list of RGs and research recommendations (RR) was endorsed by all participants. Fifteen critical RGs are summarised below: RG1 : Lack of realistic models that recapitulate tumour/tumour micro/macroenvironment; RG2 : Insufficient evidence on precise contributions of genetic/environmental/lifestyle factors to CRC risk; RG3 : Pressing need for prevention trials; RG4 : Lack of integration of different prevention approaches; RG5 : Lack of optimal strategies for CRC screening; RG6 : Lack of effective triage systems for invasive investigations; RG7 : Imprecise pathological assessment of CRC; RG8 : Lack of qualified personnel in genomics, data sciences and digital pathology; RG9 : Inadequate assessment/communication of risk, benefit and uncertainty of treatment choices; RG10 : Need for novel technologies/interventions to improve curative outcomes; RG11 : Lack of approaches that recognise molecular interplay between metastasising tumours and their microenvironment; RG12 : Lack of reliable biomarkers to guide stage IV treatment; RG13 : Need to increase understanding of health related quality of life (HRQOL) and promote residual symptom resolution; RG14 : Lack of coordination of CRC research/funding; RG15 : Lack of effective communication between relevant stakeholders. Prioritising research activity and funding could have a significant impact on reducing CRC disease burden over

  14. Intermittent Explosive Disorder

    Directory of Open Access Journals (Sweden)

    Lut Tamam

    2011-09-01

    Full Text Available Intermittent explosive disorder is an impulse control disorder characterized by the occurrence of discrete episodes of failure to resist aggressive impulses that result in violent assault or destruction of property. Though the prevalence intermittent explosive disorder has been reported to be relatively rare in frontier studies on the field, it is now common opinion that intermittent explosive disorder is far more common than previously thought especially in clinical psychiatry settings. Etiological studies displayed the role of both psychosocial factors like childhood traumas and biological factors like dysfunctional neurotransmitter systems and genetics. In differential diagnosis of the disorder, disorders involving agression as a symptom such as alcohol and drug intoxication, antisocial and borderline personality disorders, personality changes due to general medical conditions and behavioral disorder should be considered. A combination of pharmacological and psychotherapeutic approaches are suggested in the treatment of the disorder. This article briefly reviews the historical background, diagnostic criteria, epidemiology, etiology and treatment of intermittent explosive disorder.

  15. Intermittent heating of buildings

    Energy Technology Data Exchange (ETDEWEB)

    Kohonen, K

    1983-02-01

    Conditions for intermittent heating of buildings are considered both theoretically and experimentally. Thermal behaviour of buildings adn rooms in intermittent heating is simulated by a program based on the convective heat balance equation and by simplified RC-models. The preheat times and the heating energy savings compared with continuous heating are presented for typical lightweight, mediumweight and heavyweight classroom and office modules. Formulaes for estimating the oversizing of the radiator network, the maximum heat output of heat exchangers in district heating and the efficiency of heating boilers in intermittent heating are presented. The preheat times and heating energy savings with different heating control systems are determined also experimentally in eight existing buildings. In addition some principles for the planning and application of intermittent heating systems are suggested.

  16. Optimal intermittent search strategies

    International Nuclear Information System (INIS)

    Rojo, F; Budde, C E; Wio, H S

    2009-01-01

    We study the search kinetics of a single fixed target by a set of searchers performing an intermittent random walk, jumping between different internal states. Exploiting concepts of multi-state and continuous-time random walks we have calculated the survival probability of a target up to time t, and have 'optimized' (minimized) it with regard to the transition probability among internal states. Our model shows that intermittent strategies always improve target detection, even for simple diffusion states of motion

  17. Intermittent Theta Burst Over M1 May Increase Peak Power of a Wingate Anaerobic Test and Prevent the Reduction of Voluntary Activation Measured with Transcranial Magnetic Stimulation.

    Science.gov (United States)

    Giboin, Louis-Solal; Thumm, Patrick; Bertschinger, Raphael; Gruber, Markus

    2016-01-01

    Despite the potential of repetitive transcranial magnetic stimulation (rTMS) to improve performances in patients suffering from motor neuronal afflictions, its effect on motor performance enhancement in healthy subjects during a specific sport task is still unknown. We hypothesized that after an intermittent theta burst (iTBS) treatment, performance during the Wingate Anaerobic Test (WAnT) will increase and supraspinal fatigue following the exercise will be lower in comparison to a control treatment. Ten subjects participated in two randomized experiments consisting of a WAnT 5 min after either an iTBS or a control treatment. We determined voluntary activation (VA) of the right knee extensors with TMS (VATMS) and with peripheral nerve stimulation (VAPNS) of the femoral nerve, before and after the WAnT. T-tests were applied to the WAnT results and a two way within subject ANOVA was applied to VA results. The iTBS treatment increased the peak power and the maximum pedalling cadence and suppressed the reduction of VATMS following the WAnT compared to the control treatment. No behavioral changes related to fatigue (mean power and fatigue index) were observed. These results indicate for the first time that iTBS could be used as a potential intervention to improve anaerobic performance in a sport specific task.

  18. Intermittent theta burst over M1 may increase peak power of a Wingate anaerobic test and prevent the reduction of voluntary activation measured with transcranial magnetic stimulation

    Directory of Open Access Journals (Sweden)

    Louis-Solal Giboin

    2016-07-01

    Full Text Available Despite the potential of repetitive transcranial magnetic stimulation (rTMS to improve performances in patients suffering from motor neuronal afflictions, its effect on motor performance enhancement in healthy subjects during a specific sport task is still unknown. We hypothesised that after an intermittent theta burst (iTBS treatment, performance during the Wingate Anaerobic Test (WAnT, will increase and supraspinal fatigue following the exercise will be lower in comparison to a control treatment.Ten subjects participated in two randomised experiments consisting of a WAnT 5 minutes after either an iTBS or a control treatment. We determined voluntary activation (VA of the right knee extensors with TMS (VATMS and with peripheral nerve stimulation (VAPNS of the femoral nerve, before and after the WAnT. T-tests were applied to the WAnT results and a 2 way within subject ANOVA was applied to VA results. The iTBS treatment increased the peak power and the maximum pedalling cadence and suppressed the reduction of VATMS following the WAnT compared to the control treatment. No behavioural changes related to fatigue (mean power and fatigue index were observed.These results indicate for the first time that iTBS could be used as a potential intervention to improve anaerobic performance in a sport specific task.

  19. Is adherence to diet, physical activity, and body weight cancer prevention recommendations associated with colorectal cancer incidence in African American women?

    Science.gov (United States)

    Nomura, Sarah J O; Dash, Chiranjeev; Rosenberg, Lynn; Yu, Jeffrey; Palmer, Julie R; Adams-Campbell, Lucile L

    2016-07-01

    The purpose of this study was to evaluate whether adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations was associated with colorectal cancer incidence in the Black Women's Health Study (BWHS). In this ongoing prospective cohort of African American women (analytic cohort n = 49,103), 354 incident colorectal cancers were diagnosed between baseline (1995) and 2011. Adherence scores for seven WCRF/AICR recommendations (adherent = 1 point, non-adherent level 1 = 0.5 points, non-adherent level 2 = 0 points) were created using questionnaire data and summed to an overall adherence score (maximum = 7). Recommendation adherence and colorectal cancer incidence were evaluated using baseline and time-varying data in Cox regression models. At baseline, 8.5 % of women adhered >4 recommendations. In time-varying analyses, the HR was 0.98 (95 % CI 0.84-1.15) per 0.5 point higher score and 0.51 (95 % CI 0.23-1.10) for adherence to >4 compared to <3 recommendations. Adherence to individual recommendations was not associated with colorectal cancer risk. Results were similar in models that considered baseline exposures only. Adherence to cancer prevention recommendations was low and not associated with colorectal cancer risk among women in the BWHS. Research in diverse populations is essential to evaluate the validity of existing recommendations, and assess whether there are alternative recommendations that are more beneficial for cancer prevention in specific populations.

  20. [The modern principles of management of intermittent claudication].

    Science.gov (United States)

    Gamzatov, T H; Svetlikov, A V

    2016-01-01

    Number of patients with peripheral arterial disease, despite various national public health programs, remains high and has no steady downward trend over the past few decades. Despite recent advances in drug therapy, сonservative approach in the management of peripheral arterial disease is often neglected by vascular surgeons. However, vast majority of patients with intermittent claudication, who receive comprehensive conservative treatment, including risk factor modification, exercise and drug therapy, may get significant improvement in quality of life by partial or complete relief of symptoms related to the disease. Patients strictly adhering to medical recommendations has favorable prognosis and progression of disease to the stage of critical limb ischemia is very unlikely. Noncompliant patients and those who continue smoking in particular, often experience progression of symptoms related to the disease. That may result in the need for surgical intervention aiming to prevent or delay the onset of critical limb ischemia.

  1. Optimal intermittent search strategies

    Energy Technology Data Exchange (ETDEWEB)

    Rojo, F; Budde, C E [FaMAF, Universidad Nacional de Cordoba, Ciudad Universitaria, X5000HUA Cordoba (Argentina); Wio, H S [Instituto de Fisica de Cantabria, Universidad de Cantabria and CSIC E-39005 Santander (Spain)

    2009-03-27

    We study the search kinetics of a single fixed target by a set of searchers performing an intermittent random walk, jumping between different internal states. Exploiting concepts of multi-state and continuous-time random walks we have calculated the survival probability of a target up to time t, and have 'optimized' (minimized) it with regard to the transition probability among internal states. Our model shows that intermittent strategies always improve target detection, even for simple diffusion states of motion.

  2. Intermittency and random matrices

    Science.gov (United States)

    Sokoloff, Dmitry; Illarionov, E. A.

    2015-08-01

    A spectacular phenomenon of intermittency, i.e. a progressive growth of higher statistical moments of a physical field excited by an instability in a random medium, attracted the attention of Zeldovich in the last years of his life. At that time, the mathematical aspects underlying the physical description of this phenomenon were still under development and relations between various findings in the field remained obscure. Contemporary results from the theory of the product of independent random matrices (the Furstenberg theory) allowed the elaboration of the phenomenon of intermittency in a systematic way. We consider applications of the Furstenberg theory to some problems in cosmology and dynamo theory.

  3. Menopausal hormone therapy for the primary prevention of chronic conditions: a systematic review to update the U.S. Preventive Services Task Force recommendations.

    Science.gov (United States)

    Nelson, Heidi D; Walker, Miranda; Zakher, Bernadette; Mitchell, Jennifer

    2012-07-17

    Menopausal hormone therapy to prevent chronic conditions is currently not recommended because of its adverse effects. To update evidence about the effectiveness of hormone therapy in reducing risk for chronic conditions and adverse effects, and to examine whether outcomes vary among women in different subgroups. MEDLINE (January 2002 to November 2011), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the 3rd quarter of 2011), Scopus, and reference lists. Randomized, placebo-controlled trials of menopausal hormone therapy published in English since 2002 that assessed primary prevention of chronic conditions. Investigators extracted data on participants, study design, analysis, follow-up, and results; 2 investigators independently rated study quality by using established criteria. 9 fair-quality trials met the inclusion criteria. The Women's Health Initiative reported most of the results, had 11 years of follow-up, and had data most applicable to postmenopausal women in the United States. It showed that estrogen plus progestin therapy reduced fractures (46 fewer per 10 000 woman-years) and increased invasive breast cancer (8 more per 10 000 woman-years), stroke (9 more per 10 000 woman-years), deep venous thrombosis (12 more per 10 000 woman-years), pulmonary embolism (9 more per 10 000 woman-years), lung cancer death (5 more per 10 000 woman-years), gallbladder disease (20 more per 10 000 woman-years), dementia (22 more per 10 000 woman-years), and urinary incontinence (872 more per 10 000 woman-years). Estrogen-only therapy reduced fractures (56 fewer per 10 000 woman-years), invasive breast cancer (8 fewer per 10 000 woman-years), and death (2 fewer per 10 000 woman-years) and increased stroke (11 more per 10 000 woman-years), deep venous thrombosis (7 more per 10 000 woman-years), gallbladder disease (33 more per 10 000 woman-years), and urinary incontinence (1271 more per 10 000 woman-years). Outcomes did not

  4. The Development and Implementation of a Public Health Strategy:Cost and Health System Analysis of Intermittent Preventive Treatment in Infants

    OpenAIRE

    Manzi, Fatuma

    2010-01-01

    The achievements of the health Millennium Development Goal of reducing child mortality (MDG 4) depend on the massive scaling-up of new and available health interventions. Evidence shows that effective interventions to attain MDG 4 are available; however coverage rates are currently low. The health systems in developing countries lack the necessary capacity to deliver the interventions to those in need. These factors among others are the cause of millions of preventable child...

  5. Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force.

    Science.gov (United States)

    Thombs, Brett D; Saadat, Nazanin; Riehm, Kira E; Karter, Justin Michael; Vaswani, Akansha; Andrews, Bonnie K; Simons, Peter; Cosgrove, Lisa

    2017-08-09

    Recently, health screening recommendations have gone beyond screening for early-stage, asymptomatic disease to include "screening" for presently experienced health problems and symptoms using self-report questionnaires. We examined recommendations from three major national guideline organizations to determine the consistency of recommendations, identify sources of divergent recommendations, and determine if guideline organizations have identified any direct randomized controlled trial (RCT) evidence for the effectiveness of questionnaire-based screening. We reviewed recommendation statements listed by the Canadian Task Force on Preventive Health Care (CTFPHC), the United Kingdom National Screening Committee (UKNSC), and the United States Preventive Services Task Force (USPSTF) as of 5 September 2016. Eligible recommendations focused on using self-report questionnaires to identify patients with presently experienced health problems or symptoms. Within each recommendation and accompanying evidence review we identified screening RCTs. We identified 22 separate recommendations on questionnaire-based screening, including three CTFPHC recommendations against screening, eight UKNSC recommendations against screening, four USPSTF recommendations in favor of screening (alcohol misuse, adolescent depression, adult depression, intimate partner violence), and seven USPSTF recommendations that did not recommend for or against screening. In the four cases where the USPSTF recommended screening, either the CTFPHC, the UKNSC, or both recommended against. When recommendations diverged, the USPSTF expressed confidence in benefits based on indirect evidence, evaluated potential harms as minimal, and did not consider cost or resource use. CTFPHC and UKNSC recommendations against screening, on the other hand, focused on the lack of direct evidence of benefit and raised concerns about harms to patients and resource use. Of six RCTs that directly evaluated screening interventions, five

  6. Sustainable prevention of resource conflicts. Policy and research recommendations (report 5); Rohstoffkonflikte nachhaltig vermeiden. Forschungs- und Handlungsempfehlungen (Teilbericht 5)

    Energy Technology Data Exchange (ETDEWEB)

    Taenzler, Dennis; Westerkamp, Meike [Adelphi Research, Berlin (Germany); Supersberger, Nikolaus; Ritthoff, Michael; Bleischwitz, Raimund [Wuppertal Institut (Germany)

    2011-04-15

    Raw material conflict occurs in various forms: in the form of supply bottlenecks and crises, violent disputes, or even war; as well as due to the effects of environmental destruction, whereby the sources of people's livelihood are lost. Raw material conflict is a reality in many instances, but in others is merely postulated. On the one hand, the nature, strategic importance and price of raw materials influence potential conflict constellations. On the other hand, much depends on the management and governance of raw material resources and production, material flows, value creation chains and sources of financing, across a variety of levels. Existing research into raw material conflict in the field of oil, gas and valuable minerals reveals the multi-layered complexity of the issue as well as the necessity and possibilities of avoiding such conflict in a sustainable manner over the long term. This research landscape was the starting point for the study by adelphi and the Wuppertal Institute titled ''Sustainable Prevention of Resource Conflicts: Identifying and reducing international conflict risk relating to access to and use of raw materials''. The project has added to existing research and delivered new perspectives in relation to lithium and rare earths - resources which are of special relevance for future energy supply and planning - with a view to developing renewable energy sources and meeting ambitious climate protection goals. This report summarises the results of the research project and sets out recommendations. The project was sponsored by the German Federal Environmental Agency, and was conducted in the period between July 2008 and September 2010. The results are published in a total of eight reports which are briefly summarised here. (orig.)

  7. Toward a new philosophy of preventive nutrition: from a reductionist to a holistic paradigm to improve nutritional recommendations.

    Science.gov (United States)

    Fardet, Anthony; Rock, Edmond

    2014-07-01

    The reductionist approach has been predominant to date in human nutrition research and has unraveled some of the fundamental mechanisms at the basis of food nutrients (e.g., those that involve deficiency diseases). In Western countries, along with progress in medicine and pharmacology, the reductionist approach helped to increase life expectancy. However, despite 40 y of research in nutrition, epidemics of obesity and diabetes are growing each year worldwide, both in developed and developing countries, leading to a decrease in healthy life years. Yet, interactions between nutrition-health relations cannot be modeled on the basis of a linear cause-effect relation between 1 food compound and 1 physiologic effect but rather from multicausal nonlinear relations. In other words, explaining the whole from the specific by a bottom-up reductionist approach has its limits. A top-down approach becomes necessary to investigate complex issues through a holistic view before addressing any specific question to explain the whole. However, it appears that both approaches are necessary and mutually reinforcing. In this review, Eastern and Western research perspectives are first presented, laying out bases for what could be the consequences of applying a reductionist versus holistic approach to research in nutrition vis-à-vis public health, environmental sustainability, breeding, biodiversity, food science and processing, and physiology for improving nutritional recommendations. Therefore, research that replaces reductionism with a more holistic approach will reveal global and efficient solutions to the problems encountered from the field to the plate. Preventive human nutrition can no longer be considered as "pharmacology" or foods as "drugs." © 2014 American Society for Nutrition.

  8. Toward a New Philosophy of Preventive Nutrition: From a Reductionist to a Holistic Paradigm to Improve Nutritional Recommendations1

    Science.gov (United States)

    Fardet, Anthony; Rock, Edmond

    2014-01-01

    The reductionist approach has been predominant to date in human nutrition research and has unraveled some of the fundamental mechanisms at the basis of food nutrients (e.g., those that involve deficiency diseases). In Western countries, along with progress in medicine and pharmacology, the reductionist approach helped to increase life expectancy. However, despite 40 y of research in nutrition, epidemics of obesity and diabetes are growing each year worldwide, both in developed and developing countries, leading to a decrease in healthy life years. Yet, interactions between nutrition-health relations cannot be modeled on the basis of a linear cause-effect relation between 1 food compound and 1 physiologic effect but rather from multicausal nonlinear relations. In other words, explaining the whole from the specific by a bottom-up reductionist approach has its limits. A top-down approach becomes necessary to investigate complex issues through a holistic view before addressing any specific question to explain the whole. However, it appears that both approaches are necessary and mutually reinforcing. In this review, Eastern and Western research perspectives are first presented, laying out bases for what could be the consequences of applying a reductionist versus holistic approach to research in nutrition vis-à-vis public health, environmental sustainability, breeding, biodiversity, food science and processing, and physiology for improving nutritional recommendations. Therefore, research that replaces reductionism with a more holistic approach will reveal global and efficient solutions to the problems encountered from the field to the plate. Preventive human nutrition can no longer be considered as “pharmacology” or foods as “drugs.” PMID:25022992

  9. Acute Effects of Carbohydrate Supplementation on Intermittent Sports Performance.

    Science.gov (United States)

    Baker, Lindsay B; Rollo, Ian; Stein, Kimberly W; Jeukendrup, Asker E

    2015-07-14

    Intermittent sports (e.g., team sports) are diverse in their rules and regulations but similar in the pattern of play; that is, intermittent high-intensity movements and the execution of sport-specific skills over a prolonged period of time (~1-2 h). Performance during intermittent sports is dependent upon a combination of anaerobic and aerobic energy systems, both of which rely on muscle glycogen and/or blood glucose as an important substrate for energy production. The aims of this paper are to review: (1) potential biological mechanisms by which carbohydrate may impact intermittent sport performance; (2) the acute effects of carbohydrate ingestion on intermittent sport performance, including intermittent high-intensity exercise capacity, sprinting, jumping, skill, change of direction speed, and cognition; and (3) what recommendations can be derived for carbohydrate intake before/during exercise in intermittent sports based on the available evidence. The most researched intermittent sport is soccer but some sport-specific studies have also been conducted in other sports (e.g., rugby, field hockey, basketball, American football, and racquet sports). Carbohydrate ingestion before/during exercise has been shown in most studies to enhance intermittent high-intensity exercise capacity. However, studies have shown mixed results with regards to the acute effects of carbohydrate intake on sprinting, jumping, skill, change of direction speed, and cognition. In most of these studies the amount of carbohydrate consumed was ~30-60 g/h in the form of a 6%-7% carbohydrate solution comprised of sucrose, glucose, and/or maltodextrin. The magnitude of the impact that carbohydrate ingestion has on intermittent sport performance is likely dependent on the carbohydrate status of the individual; that is, carbohydrate ingestion has the greatest impact on performance under circumstances eliciting fatigue and/or hypoglycemia. Accordingly, carbohydrate ingestion before and during a game

  10. Acute Effects of Carbohydrate Supplementation on Intermittent Sports Performance

    Directory of Open Access Journals (Sweden)

    Lindsay B. Baker

    2015-07-01

    Full Text Available Intermittent sports (e.g., team sports are diverse in their rules and regulations but similar in the pattern of play; that is, intermittent high-intensity movements and the execution of sport-specific skills over a prolonged period of time (~1–2 h. Performance during intermittent sports is dependent upon a combination of anaerobic and aerobic energy systems, both of which rely on muscle glycogen and/or blood glucose as an important substrate for energy production. The aims of this paper are to review: (1 potential biological mechanisms by which carbohydrate may impact intermittent sport performance; (2 the acute effects of carbohydrate ingestion on intermittent sport performance, including intermittent high-intensity exercise capacity, sprinting, jumping, skill, change of direction speed, and cognition; and (3 what recommendations can be derived for carbohydrate intake before/during exercise in intermittent sports based on the available evidence. The most researched intermittent sport is soccer but some sport-specific studies have also been conducted in other sports (e.g., rugby, field hockey, basketball, American football, and racquet sports. Carbohydrate ingestion before/during exercise has been shown in most studies to enhance intermittent high-intensity exercise capacity. However, studies have shown mixed results with regards to the acute effects of carbohydrate intake on sprinting, jumping, skill, change of direction speed, and cognition. In most of these studies the amount of carbohydrate consumed was ~30–60 g/h in the form of a 6%–7% carbohydrate solution comprised of sucrose, glucose, and/or maltodextrin. The magnitude of the impact that carbohydrate ingestion has on intermittent sport performance is likely dependent on the carbohydrate status of the individual; that is, carbohydrate ingestion has the greatest impact on performance under circumstances eliciting fatigue and/or hypoglycemia. Accordingly, carbohydrate ingestion before

  11. Recommendations for sampling for prevention of hazards in civil defense. On analytics of chemical, biological and radioactive contaminations. Brief instruction for the CBRN (chemical, biological, radioactive, nuclear) sampling

    International Nuclear Information System (INIS)

    Bachmann, Udo; Biederbick, Walter; Derakshani, Nahid

    2010-01-01

    The recommendation for sampling for prevention of hazards in civil defense is describing the analytics of chemical, biological and radioactive contaminations and includes detail information on the sampling, protocol preparation and documentation procedures. The volume includes a separate brief instruction for the CBRN (chemical, biological, radioactive, nuclear) sampling.

  12. Intermittent Testicular Torsion

    African Journals Online (AJOL)

    2017-06-02

    Jun 2, 2017 ... had prior episodes of testicular pain, suggesting that they may have had intermittent torsion before .... None of the patients had antecedent history of sexual exposure, fever, or urinary tract infection .... torsion of the spermatic cord portends an increased risk of acute testicular infarction. J Urol 2008;180 4 ...

  13. The 10 recommendations for prevention of radiation accidents in industrial gamma radiography; As 10 recomendacoes mais importantes para prevencao de acidentes radiologicos em gamagrafia industrial

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Luana Silva de

    2015-07-01

    The Industrial Gamma Radiography, as part of Industrial Radiography, stands out as the most widespread and plays an important role in the quality control of different materials and devices. However, IAEA classifies industrial gamma radiography in the Category 2 as very dangerous due to the radiological risk caused by the use of high activity radioactive sources. In March, 2012, a Brazilian Workshop on Prevention of Industrial Gamma Radiography Accident was performed by DIAPI/CNEN with the objective of disseminating knowledge about radiological accidents with radioactive sources in this application. During this Workshop, IRD/CNEN conducted a survey with 75 participants using a form with 22 recommendations to prevent radiological accidents, aiming to select the most voted. This present work aims to perform a detailed statistical study to define the Top 10 Recommendations for industrial gamma radiography operator avoids radiological accidents and to prepare a brochure with these top 10 recommendations to be distributed to all industrial gamma radiography radiation workers. Data analysis was performed using the statistical method 'Frequency Distribution', among the 75 participants categorized as General, RPO, and Other Workers of the area. The results were obtained for each category, accounting for the total of 22 recommendations in its percentage and number of votes, and the top 10 recommendations were defined to prevent radiological accidents. The first place and most important recommendation is 'Always use a personal alarm monitor throughout the work'. One of the conclusions is that the brochure with the Top 10 Recommendations shows to be understandable and useful for dissemination and training of radiation workers to avoid radiological accidents in industrial gamma radiography. (author)

  14. Prevention and treatment of pressure ulcers by newest recommendations from European Pressure Ulcer Advisory Panel (EPUAP: practical reference guide for GPs

    Directory of Open Access Journals (Sweden)

    Jakub Taradaj

    2017-03-01

    Full Text Available The guideline titled “Prevention and treatment of pressure ulcers: clinical practice guideline” is the result of a collaborative effort between the National Pressure Ulcer Advisory Panel (NPUAP, European Pressure Ulcer Advisory Panel (EPUAP and Pan Pacific Pressure Injury Alliance (PPPIA. A comprehensive literature review was conducted on pressure ulcer prevention and treatment. Rigorous scientific methodology was used to appraise available research and make evidence-based recommendations for the prevention and treatment of pressure ulcers. Draft guidelines were made available to 986 invited individual stakeholders and organizations or societies, and the feedback of the stakeholders was taken under consideration by the developers of the guideline. The guideline includes 575 explicit recommendations and/or research summaries for multidisciplinary pressure ulcer topics.

  15. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper

    DEFF Research Database (Denmark)

    Grimshaw, K.E.C.; Allen, K.; Edwards, C.A.

    2009-01-01

    of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy......The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack...... prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised...

  16. Infant feeding and allergy prevention: a review of current knowledge and recommendations. A EuroPrevall state of the art paper.

    LENUS (Irish Health Repository)

    Grimshaw, K E C

    2009-10-01

    The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies.

  17. Adherence to the WCRF/AICR Dietary Recommendations for Cancer Prevention and Risk of Cancer in Elderly from Europe and the United States: A Meta-Analysis within the CHANCES Project.

    NARCIS (Netherlands)

    Jankovic, Nicole; Geelen, Anouk; Winkels, Renate M; Mwungura, Blaise; Fedirko, Veronika; Jenab, Mazda; Illner, Anne K; Brenner, Hermann; Ordóñez-Mena, José M; Kiefte de Jong, Jessica C; Franco, Oscar H; Orfanos, Philippos; Trichopoulou, Antonia; Boffetta, Paolo; Agudo, Antonio; Peeters, Petra H; Tjønneland, Anne; Hallmans, Göran; Bueno-de-Mesquita, H Bas; Park, Yikyung; Feskens, Edith J; de Groot, Lisette C; Kampman, Ellen

    2017-01-01

    It is unknown whether dietary recommendations for cancer prevention are applicable to the elderly. We analyzed WCRF/AICR recommendations in cohorts of European and U.S. adults ages 60 years and above.

  18. Harms of Breast Cancer Screening: Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation.

    Science.gov (United States)

    Nelson, Heidi D; Pappas, Miranda; Cantor, Amy; Griffin, Jessica; Daeges, Monica; Humphrey, Linda

    2016-02-16

    In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years. To review studies of screening in average-risk women with mammography, magnetic resonance imaging, or ultrasonography that reported on false-positive results, overdiagnosis, anxiety, pain, and radiation exposure. MEDLINE and Cochrane databases through December 2014. English-language systematic reviews, randomized trials, and observational studies of screening. Investigators extracted and confirmed data from studies and dual-rated study quality. Discrepancies were resolved through consensus. Based on 2 studies of U.S. data, 10-year cumulative rates of false-positive mammography results and biopsies were higher with annual than biennial screening (61% vs. 42% and 7% vs. 5%, respectively) and for women aged 40 to 49 years, those with dense breasts, and those using combination hormone therapy. Twenty-nine studies using different methods reported overdiagnosis rates of 0% to 54%; rates from randomized trials were 11% to 22%. Women with false-positive results reported more anxiety, distress, and breast cancer-specific worry, although results varied across 80 observational studies. Thirty-nine observational studies indicated that some women reported pain during mammography (1% to 77%); of these, 11% to 46% declined future screening. Models estimated 2 to 11 screening-related deaths from radiation-induced cancer per 100,000 women using digital mammography, depending on age and screening interval. Five observational studies of tomosynthesis and mammography indicated increased biopsies but reduced recalls compared with mammography alone. Studies of overdiagnosis were highly heterogeneous, and estimates varied depending on the analytic approach. Studies of anxiety and pain used different outcome measures. Radiation exposure was based on models. False-positive results are common and are higher for

  19. Recommendations for prevention of radiation accident in industrial gammagraphy; Recomendações para prevenção de acidentes radiológicos em gamagrafia industrial

    Energy Technology Data Exchange (ETDEWEB)

    Souza, L.S.; Silva, F.C.A. da [Instituto de Radioproteção e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil)

    2017-07-01

    Industrial Gammagraphy plays an important role in the quality control of various materials and components. It is classified by the International Atomic Energy Agency - IAEA as Category 2, due to its radiation risk caused by the use of high activity radioactive sources. This risk is based on the harmful consequences of human health, described in some accidents in the world, due to failures. In 2012, the 'Brazilian National Workshop on Accident Prevention in Industrial Gammagraphy' was carried out by DIAPI/CNEN, with the objective of disseminating knowledge about radiation accidents. At the time, the IRD/CNEN-RJ carried out a survey with the 75 participants using a form with 22 recommendations to prevent radiological accidents, in order to select the 10 most voted. A statistical study, using the 'Frequency Distribution' method, was performed to define 10 recommendations. The percentage and vote results were obtained by category of the participants and the 10 most important recommendations were defined to prevent radiation accidents. The recommendation that came in first place was 'Always use an individual monitor with alarm during all work'.

  20. Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Hill, Jenny; Hoyt, Jenna; van Eijk, Anna Maria; D'Mello-Guyett, Lauren; ter Kuile, Feiko O.; Steketee, Rick; Smith, Helen; Webster, Jayne

    2013-01-01

    Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted

  1. Quasistatic Dynamics with Intermittency

    International Nuclear Information System (INIS)

    Leppänen, Juho; Stenlund, Mikko

    2016-01-01

    We study an intermittent quasistatic dynamical system composed of nonuniformly hyperbolic Pomeau–Manneville maps with time-dependent parameters. We prove an ergodic theorem which shows almost sure convergence of time averages in a certain parameter range, and identify the unique physical family of measures. The theorem also shows convergence in probability in a larger parameter range. In the process, we establish other results that will be useful for further analysis of the statistical properties of the model.

  2. Quasistatic Dynamics with Intermittency

    Energy Technology Data Exchange (ETDEWEB)

    Leppänen, Juho; Stenlund, Mikko, E-mail: mikko.stenlund@helsinki.fi [University of Helsinki, Department of Mathematics and Statistics (Finland)

    2016-06-15

    We study an intermittent quasistatic dynamical system composed of nonuniformly hyperbolic Pomeau–Manneville maps with time-dependent parameters. We prove an ergodic theorem which shows almost sure convergence of time averages in a certain parameter range, and identify the unique physical family of measures. The theorem also shows convergence in probability in a larger parameter range. In the process, we establish other results that will be useful for further analysis of the statistical properties of the model.

  3. Implementation of the updated 2015 Commission for Hospital Hygiene and Infection Prevention (KRINKO recommendationsPrevention and control of catheter-associated urinary tract infections” in the hospitals in Frankfurt/Main, Germany

    Directory of Open Access Journals (Sweden)

    Heudorf, Ursel

    2016-06-01

    Full Text Available Aim: The Commission for Hospital Hygiene and Infection Prevention (KRINKO updated the recommendations for the prevention of catheter-associated urinary tract infections in 2015. This article will describe the implementation of these recommendations in Frankfurt’s hospitals in autumn, 2015.Material and methods: In two non-ICU wards of each of Frankfurt’s , inspections were performed using a checklist based on the new KRINKO recommendations. In one large hospital, a total of were inspected. The inspections covered the structure and process quality (operating instructions, training, indication, the placement and maintenance of catheters and the demonstration of the preparation for insertion of a catheter using an empty bed and an imaginary patient, or insertion in a model.Results: Operating instructions were available in all hospital wards; approximately half of the wards regularly performed training sessions. The indications were largely in line with the recommendations of the KRINKO. Alternatives to urinary tract catheters were available and were used more often than the urinary tract catheters themselves (15.9% vs. 13.5%. In accordance with the recommendations, catheters were placed without antibiotic prophylaxis or the instillation of antiseptic or antimicrobial substances or catheter flushing solutions. The demonstration of catheter placement was conscientiously performed. Need for improvement was seen in the daily documentation and the regular verification of continuing indication for a urinary catheter, as well as the omission of regular catheter change.Conclusion: Overall, the recommendations of the KRINKO on the prevention of catheter-associated urinary tract infections were adequately implemented. However, it cannot be ruled out that in situations with time pressure and staff shortage, the handling of urinary tract catheters may be of lower quality than that observed during the inspections, when catheter insertion was done by two

  4. Implementation of the updated 2015 Commission for Hospital Hygiene and Infection Prevention (KRINKO) recommendations "Prevention and control of catheter-associated urinary tract infections" in the hospitals in Frankfurt/Main, Germany.

    Science.gov (United States)

    Heudorf, Ursel; Grünewald, Miriam; Otto, Ulla

    2016-01-01

    The Commission for Hospital Hygiene and Infection Prevention (KRINKO) updated the recommendations for the prevention of catheter-associated urinary tract infections in 2015. This article will describe the implementation of these recommendations in Frankfurt's hospitals in autumn, 2015. In two non-ICU wards of each of Frankfurt's 17 hospitals, inspections were performed using a checklist based on the new KRINKO recommendations. In one large hospital, a total of 5 wards were inspected. The inspections covered the structure and process quality (operating instructions, training, indication, the placement and maintenance of catheters) and the demonstration of the preparation for insertion of a catheter using an empty bed and an imaginary patient, or insertion in a model. Operating instructions were available in all hospital wards; approximately half of the wards regularly performed training sessions. The indications were largely in line with the recommendations of the KRINKO. Alternatives to urinary tract catheters were available and were used more often than the urinary tract catheters themselves (15.9% vs. 13.5%). In accordance with the recommendations, catheters were placed without antibiotic prophylaxis or the instillation of antiseptic or antimicrobial substances or catheter flushing solutions. The demonstration of catheter placement was conscientiously performed. Need for improvement was seen in the daily documentation and the regular verification of continuing indication for a urinary catheter, as well as the omission of regular catheter change. Overall, the recommendations of the KRINKO on the prevention of catheter-associated urinary tract infections were adequately implemented. However, it cannot be ruled out that in situations with time pressure and staff shortage, the handling of urinary tract catheters may be of lower quality than that observed during the inspections, when catheter insertion was done by two nurses. Against this background, a sufficient

  5. Reshaping Time: Recommendations for Suicide Prevention in LBGT Populations. Reflections on "Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations" from Journal of Homosexuality 58(1).

    Science.gov (United States)

    Mullaney, Clare

    2016-01-01

    This article serves as one of the supplementary pieces of this special issue on "Mapping Queer Bioethics," in which we take a solipsistic turn to "map" the Journal of Homosexuality itself. Here, the author examines the journal's 2011 consensus recommendations for the prevention of LGBT suicide. Invoking the axiom approach of Eve Kosovsky Sedgwick's seminal Epistemology of the Closet, the author argues that merely offering practical guidelines at the level of the demonstrative and the instructive may not be sufficient models to address the urgency of suicide rates in LGBTQ youth populations.

  6. Malaria prevention strategies and recommendations, from chemoprophylaxis to stand-by emergency treatment: a 10-year prospective study in a Swiss Travel Clinic.

    Science.gov (United States)

    Boubaker, Rim; Hérard Fossati, Annie; Meige, Pierrette; Mialet, Catherine; Ngarambe Buffat, Chantal; Rochat, Jacynthe; Souvannaraj-Blanchant, Manisinh; Uwanyiligira, Mediatrice; Widmer, Francine; Payot, Sylvie; Rochat, Laurence; de Vallière, Serge; D'Acremont, Valérie; Genton, Blaise

    2017-09-01

    There are several possible malaria prevention strategies for travellers. In Switzerland, chemoprophylaxis (CP) is recommended for persons visiting areas highly endemic for malaria and stand-by emergency treatment (SBET) for areas with moderate to low risk. To describe the type of malaria prevention prescribed to travel clinic attendees with a specific focus on changes over time following adaptation of recommendations. All pre-travel first consultation data recorded between November 2002 and December 2012 were included. Country-specific malaria preventive recommendations provided and medicines prescribed over time were analysed. In total, 64 858 client-trips were recorded. 91% of travellers planned to visit a malaria endemic country. Among those clients, 42% were prescribed an antimalarial medicine as CP only, 36% as SBET only, and 3% both. Between 2002 and 2012, there was a 16% drop of CP prescription ( P  travellers receiving CP, the proportion of those prescribed mefloquine dropped from 82% in 2002 to 46% in 2012 while those prescribed atovaquone-proguanil (AP) increased from 7% to 39%. For those prescribed SBET, the proportion dropped from 46% to 30% for AP and increased from 2% to 61% for artemether-lumefantrine. CP prescription for travellers to India fell from 62% to 5% and SBET prescription increased from 40% to 88% after the change of recommendation from CP to SBET in 2005 for this country. Comparatively, CP prescription for travellers to Senegal, for which no change of recommendation occurred, remained relatively stable between 88% in 2002 and 89% in 2012. This study shows the considerable decline of antimalarial prescription for chemoprophylaxis that occurred over the 10-year period in favour of SBET. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  7. Definition and recommendations for the convention on the prevention of marine pollution by dumping of wastes and other matter, 1972. 1986 ed.

    International Nuclear Information System (INIS)

    1986-01-01

    Under the terms of the Convention on the Prevention of Marine Pollution by Dumping of Wastes and Other Matter, the IAEA is the organization with the responsibility for defining high level radioactive wastes or other high level radioactive matter which is unsuitable for dumping at sea, and for making recommendations to Contracting Parties about the issue of permits for dumping radioactive waste or other radioactive matter. The IAEA established a provisional Definition and Recommendations in 1974 and a revised version in 1978. This Safety Series document contains the second revised Definition and Recommendations, which were established in 1985. The Annexes to the document contain a description of the calculations which form the basis of the quantitative Definition, a comparison between the new and the previous version and a list of all the meetings held during the process of establishing the new document

  8. Putting intelligent structured intermittent auscultation (ISIA) into practice.

    Science.gov (United States)

    Maude, Robyn M; Skinner, Joan P; Foureur, Maralyn J

    2016-06-01

    Fetal monitoring guidelines recommend intermittent auscultation for the monitoring of fetal wellbeing during labour for low-risk women. However, these guidelines are not being translated into practice and low-risk women birthing in institutional maternity units are increasingly exposed to continuous cardiotocographic monitoring, both on admission to hospital and during labour. When continuous fetal monitoring becomes routinised, midwives and obstetricians lose practical skills around intermittent auscultation. To support clinical practice and decision-making around auscultation modality, the intelligent structured intermittent auscultation (ISIA) framework was developed. The purpose of this discussion paper is to describe the application of intelligent structured intermittent auscultation in practice. The intelligent structured intermittent auscultation decision-making framework is a knowledge translation tool that supports the implementation of evidence into practice around the use of intermittent auscultation for fetal heart monitoring for low-risk women during labour. An understanding of the physiology of the materno-utero-placental unit and control of the fetal heart underpin the development of the framework. Intelligent structured intermittent auscultation provides midwives with a robust means of demonstrating their critical thinking and clinical reasoning and supports their understanding of normal physiological birth. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. "Every day they keep adding new tools but they don't take any away": Producing indicators for intermittent preventive treatment for malaria in pregnancy (IPTp) from routine data in Kenya.

    Science.gov (United States)

    Okello, George; Gerrets, Rene; Zakayo, Scholastica; Molyneux, Sassy; Jones, Caroline

    2018-01-01

    Intermittent preventive treatment for malaria in pregnancy (IPTp) is part of a multi-pronged strategy aimed at preventing malaria in pregnancy in areas of moderate to high transmission in sub-Saharan Africa. Despite being formally adopted as a malaria prevention policy over a decade ago, IPTp coverage has remained low. Recent demands for action have incorporated calls to strengthen IPTp monitoring and evaluation systems, including the use of routine data, to measure coverage, track implementation and identify roadblocks to improving uptake. Concerns about the quality of malaria indicators reported through routine information systems are well recognized, but there are few data on the realities of IPTp recording practices in frontline facilities or their entry into District Health Information Software (DHIS2). Drawing on fieldwork conducted in two malaria endemic sub-counties in Kenya, we explore how local adaptations and innovations employed by health workers and sub-country managers to cope with a range of health system constraints, shape recording practices and in turn, the measurement of IPTp. Data were collected through observations, interviews, and document reviews. Data analysis and interpretation was guided by thematic analysis approach. Measurement of IPTp was undermined by health system constraints such as stock-out of drugs and human resource shortages. Coping strategies adopted by health workers to address these challenges ensured continuity in service delivery and IPTp data generation but had variable consequences on IPTp data quality. Unclear recording and reporting instructions also led to lack of standardization in IPTp data generation. The use of redundant tools created significant data burdens which undermined service delivery in general. There is need to integrate monthly reporting forms so as to remove redundancies which exacerbates workload for health workers and disrupts service delivery. Similarly, data collection instructions in registers and

  10. Prevention of Mental Health Disorders Using Internet- and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research

    Directory of Open Access Journals (Sweden)

    David Daniel Ebert

    2017-08-01

    Full Text Available Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD, their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en masse due to limited health care resources and the limited availability of evidence-based interventions and clinicians in routine practice, especially in rural areas. Therefore, new approaches are needed to maximize the impact of psychological preventive interventions. Limitations of traditional prevention programs could potentially be overcome by providing Internet- and mobile-based interventions (IMIs. This relatively new medium for promoting mental health and preventing MHD introduces a fresh array of possibilities, including the provision of evidence-based psychological interventions that are free from the restraints of travel and time and allow reaching participants for whom traditional opportunities are not an option. This article provides an introduction to the subject and narratively reviews the available evidence for the effectiveness of IMIs with regard to the prevention of MHD onsets. The number of randomized controlled trials that have been conducted to date is very limited and so far it is not possible to draw definite conclusions about the potential of IMIs for the prevention of MHD for specific disorders. Only for the indicated prevention of depression there is consistent evidence across four different randomized trial trials. The only trial on the prevention of general anxiety did not result in positive findings in terms of eating disorders (EDs, effects were only found in post hoc subgroup analyses, indicating that it might be possible to prevent ED onset for subpopulations of people at risk of developing EDs. Future studies need to identify those subpopulations likely to profit from preventive. Disorders not examined so far include

  11. Prevention of Mental Health Disorders Using Internet- and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research.

    Science.gov (United States)

    Ebert, David Daniel; Cuijpers, Pim; Muñoz, Ricardo F; Baumeister, Harald

    2017-01-01

    Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en masse due to limited health care resources and the limited availability of evidence-based interventions and clinicians in routine practice, especially in rural areas. Therefore, new approaches are needed to maximize the impact of psychological preventive interventions. Limitations of traditional prevention programs could potentially be overcome by providing Internet- and mobile-based interventions (IMIs). This relatively new medium for promoting mental health and preventing MHD introduces a fresh array of possibilities, including the provision of evidence-based psychological interventions that are free from the restraints of travel and time and allow reaching participants for whom traditional opportunities are not an option. This article provides an introduction to the subject and narratively reviews the available evidence for the effectiveness of IMIs with regard to the prevention of MHD onsets. The number of randomized controlled trials that have been conducted to date is very limited and so far it is not possible to draw definite conclusions about the potential of IMIs for the prevention of MHD for specific disorders. Only for the indicated prevention of depression there is consistent evidence across four different randomized trial trials. The only trial on the prevention of general anxiety did not result in positive findings in terms of eating disorders (EDs), effects were only found in post hoc subgroup analyses, indicating that it might be possible to prevent ED onset for subpopulations of people at risk of developing EDs. Future studies need to identify those subpopulations likely to profit from preventive. Disorders not examined so far include substance use

  12. Male circumcision for HIV prevention in Papua New Guinea: a summary of research evidence and recommendations for public health following a national policy forum.

    Science.gov (United States)

    Vallely, A; MacLaren, D J; Kaleva, W; Millan, J; Tommbe, R; Marape, W; Manineng, C; Buchanan, H; Amos, A; Frank, R; Kelly, A; Kupul, M; Aeno, H; Trowalle, E; John, L N; Redman-Maclaren, M L; Ryan, C; Browne, K; Tynan, A; Hill, P S; Gray, R T; Murray, J; Wilson, D P; Law, G; Siba, P; McBride, W J H; Farley, T; Kaldor, J M

    2011-01-01

    In 2005, a clinical trial in South Africa found that circumcision of young men could reduce their risk of acquiring HIV (human immunodeficiency virus) infection by over 60%. In the following year, two more trials in Africa confirmed this finding, leading the World Health Organization to recommend male circumcision as a public health strategy for HIV prevention in high-incidence countries. In order to inform public health policy in Papua New Guinea (PNG), two major research projects were initiated with the goals of investigating the status of penile cutting practices and assessing understandings, acceptability, feasibility and cost-effectiveness of male circumcision for HIV prevention. In addition, behavioural surveillance surveys systematically asked questions on penile cutting practices and an ethnographic literature review informed historical perspectives of penile cutting in PNG. Key findings from these research activities were presented at a National Policy Forum on Male Circumcision for HIV Prevention held in Port Moresby in November 2011. The Forum made three key recommendations: (1) the formation of a joint National Department of HealthlNational AIDS Council Secretariat Policy Committee on male circumcision; (2) the establishment of an integrated harm reduction program; and (3) that future policy on wide-scale roll-out of male circumcision for HIV prevention in PNG be informed by a combination of data from (a) male circumcision intervention pilot programs and (b) research on the potential protective effect of other forms of penile cutting.

  13. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement.

    Science.gov (United States)

    Moyer, Virginia A

    2013-08-06

    Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening and behavioral counseling interventions in primary care to reduce alcohol misuse. The USPSTF reviewed new evidence on the effectiveness of screening for alcohol misuse for improving health outcomes, the accuracy of various screening approaches, the effectiveness of various behavioral counseling interventions for improving intermediate or long-term health outcomes, the harms of screening and behavioral counseling interventions, and influences from the health care system that promote or detract from effective screening and counseling interventions for alcohol misuse. These recommendations apply to adolescents aged 12 to 17 years and adults aged 18 years or older. These recommendations do not apply to persons who are actively seeking evaluation or treatment of alcohol misuse. The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. (Grade B recommendation)The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse in adolescents. (I statement)

  14. [Prevention of medical device-related adverse events in hospitals: Specifying the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment].

    Science.gov (United States)

    Bohnet-Joschko, Sabine; Zippel, Claus; Siebert, Hartmut

    2015-01-01

    The use and organisation of medical technology has an important role to play for patient and user safety in anaesthesia. Specification of the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment, explore opportunities and challenges for the safe use and organisation of anaesthesia devices. We conducted a literature search in Medline/PubMed for studies dealing with the APS recommendations for the prevention of medical device-related risks in the context of anaesthesia. In addition, we performed an internet search for reports and recommendations focusing on the use and organisation of medical devices in anaesthesia. Identified studies were grouped and assigned to the recommendations. The division into users and operators was maintained. Instruction and training in anaesthesia machines is sometimes of minor importance. Failure to perform functional testing seems to be a common cause of critical incidents in anaesthesia. There is a potential for reporting to the federal authority. Starting points for the safe operation of anaesthetic devices can be identified, in particular, at the interface of staff, organisation, and (anaesthesia) technology. The APS recommendations provide valuable information on promoting the safe use of medical devices and organisation in anaesthesia. The focus will be on risks relating to the application as well as on principles and materials for the safe operation of anaesthesia equipment. Copyright © 2015. Published by Elsevier GmbH.

  15. Intermittency in Complex Flows

    Science.gov (United States)

    Ben Mahjoub, Otman; Redondo, Jose M.

    2017-04-01

    Experimental results of the complex turbulent wake of a cilinder in 2D [1] and 3D flows [2] were used to investigate the scaling of structure functions, similar research was also performed on wave propagation and breaking in the Ocean [3], in the the stratified Atmosphere (ABL) [4] and in a 100large flume (UPC) for both regular and irregular waves, where long time series of waves propagating and generating breaking turbulence velocity rms and higher order measurements were taken in depth. [3,5] by means of a velocimeter SONTEK3-D. The probability distribution functions of the velocity differences and their non Gaussian distribution related to the energy spectrum indicate that irregularity is an important source of turbulence. From Kolmogorov's K41 and K61 intermittency correction: the p th-order longitudinal velocity structure function δul at scale l in the inertial range of three-dimensional fully developed turbulence is related by ⟨δup⟩ = ⟨(u(x+ l)- u(x))p⟩ ˜ ɛp0/3lp/3 l where ⟨...⟩ represents the spatial average over flow domain, with ɛ0 the mean energy dissipation per unit mass and l is the separation distance. The importance of the random nature of the energy dissipation led to the K62 theory of intermittency, but locality and non-homogeneity are key issues. p p/3 p/3 ξd ⟨δul⟩ ˜ ⟨ɛl ⟩l ˜ l and ξp = p 3 + τp/3 , where now ɛl is a fractal energy dissipation at scale l, τp/3 is the scaling of and ξp is the scaling exponent of the velocity structure function of order p. Both in K41 and K62, the structure functions of third order related to skewness is ξ3 = 1. But this is not true either. We show that scaling exponents ξp do deviate from early studies that only investigated homogeneous turbulence, where a large inertial range dominates. The use of multi-fractal analysis and improvements on Structure function calculations on standard Enhanced mixing is an essential property of turbulence and efforts to alter and to control

  16. Intermittency in nuclear multifragmentation

    International Nuclear Information System (INIS)

    Ploszajczak, M.; Tucholski, A.

    1990-07-01

    Fluctuations of the fragment size distribution in a percolation model and in nuclear multifragmentation following the breakup of high energy nuclei in the nuclear emulsion are studied using the method of scaled factorial moments. An intermittent patern of fluctuations is found in the data as well as in the percolation lattice calculation. This is a consequence of both a self-similarity in the fragment size distribution and a random character for the scaling law. These fluctuations are in general well-described by percolation model. The multifractal dimensions are calculated and their relevance to the study of possible critical behaviour is pointed out. (orig.)

  17. Multidimensional intermittency in hadronic collisions

    International Nuclear Information System (INIS)

    Pan, J.; Hwa, R.C.

    1992-06-01

    The study of intermittency in high-energy hadronic collisions by the Monte Carlo code ECCO is extended to 3-dimensional phase space. Strong intermittency is found in agreement with the data. Fluctuation in the impact parameter is responsible for the intermittency in lnp T , and the transverse-momentum conservation leads to negative intermittency slopes in the azimuthal angle φ. The Ochs-Wosiek plots are linear in all dimensions having universal slopes. An exponent ν = 1.448 emerges to characterize multiparticle production in pp collisions. The properties of G moments are also examined, and the fractal dimensions determined

  18. Knowledge and utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in primary health care centers in rural southwest, Nigeria: a cross-sectional study.

    Science.gov (United States)

    Akinleye, Stella O; Falade, Catherine O; Ajayi, Ikeoluwapo O

    2009-07-09

    Intermittent preventive treatment for prevention of malaria in pregnancy (IPTp) is a key component of malaria control strategy in Nigeria and sulfadoxine-pyrimethamine (SP) is the drug of choice. Despite the evidence of the effectiveness of IPTp strategy using SP in reducing the adverse effects of malaria during pregnancy the uptake and coverage in Nigeria is low. This study set out to assess the use of IPTp among pregnant women attending primary health centres in the rural area and determine factors that influence the uptake. A cross-sectional study was carried out between July and August 2007 among 209 pregnant women selected by systematic random sampling from antenatal care attendees at primary health care in a rural Local Government Area of Ekiti State, Nigeria. Information on knowledge of IPT, delivery, adherence and acceptability was obtained using an interviewer administered questionnaire. Descriptive statistics such as means, range, proportions were used. Chi-square test was used to examine association between categorical variables. All analyses were performed at 5% level of significance. One hundred and nine of 209 (52.2%) respondents have heard about IPTp but only 26 (23.9%) were able to define it. Fifty seven (27.3%) reported to have received at least one dose of IPTp during the index pregnancy and all were among those who have heard of IPTp (52.3%). Twenty one of the 57 (36.8%) took the SP in the clinic. Only three of the twenty-one (14.3%) were supervised by a health worker. Twenty two of the 36 women (61.1%) who did not take their drugs in the clinic would have liked to do so if allowed to bring their own drinking cups. Almost half (43.9%) of those who had used IPTp during the index pregnancy expressed concern about possible adverse effect of SP on their pregnancies. Periodic shortages of SP in the clinics were also reported. In this study, IPTp use among pregnant women was very low and there was poor adherence to the Directly Observed Therapy (DOT

  19. Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine during pregnancy in Burkina Faso: effect of adding a third dose to the standard two-dose regimen on low birth weight, anaemia and pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Roberfroid Dominique

    2010-11-01

    Full Text Available Abstract Background Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW and the prevalence of maternal anaemia. Nevertheless, where the risk of infection close to delivery is high because of intense transmission, a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome. Methods Pregnant women in the 2nd or 3rd trimester were randomized to receive either 2 (SP2 or 3 doses (SP3 of SP. Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule. Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed. The prevalence of LBW ( Results Data from 1274 singleton pregnancies were analysed (641 in the SP3 and 633 in the SP2 group. The uptake of the intervention appeared to be low. Though the prevalence of LBW in both intervention groups was similar (adjusted Incident Rate Ratio, AIRR = 0.92, 95%CI: 0.69-1.24 in the ITT analysis, the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group (AIRR = 0.38, 95%CI: 0.16 - 0.90. The PP analysis showed a trend of reduced risk of LBW, severe anaemia and premature delivery in the SP3 group, albeit the difference between two and three IPTp-SP did not reach statistical significance. Conclusion The risk of LBW and severe anaemia tended to be lower in the SP3 group, though this was not statistically significant, probably due to the low uptake of the intervention which reduced the power of the study. Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings where transmission is markedly seasonal.

  20. Intermittent preventive treatment of malaria with sulphadoxine-pyrimethamine during pregnancy in Burkina Faso: effect of adding a third dose to the standard two-dose regimen on low birth weight, anaemia and pregnancy outcomes.

    Science.gov (United States)

    Valea, Innocent; Tinto, Halidou; Drabo, Maxime K; Huybregts, Lieven; Henry, Marie-Claire; Roberfroid, Dominique; Guiguemde, Robert T; Kolsteren, Patrick; D'Alessandro, Umberto

    2010-11-12

    Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight (LBW) and the prevalence of maternal anaemia. Nevertheless, where the risk of infection close to delivery is high because of intense transmission, a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome. Pregnant women in the 2nd or 3rd trimester were randomized to receive either 2 (SP2) or 3 doses (SP3) of SP. Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule. Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed. The prevalence of LBW (anaemia (Hb pregnancies were analysed (641 in the SP3 and 633 in the SP2 group). The uptake of the intervention appeared to be low. Though the prevalence of LBW in both intervention groups was similar (adjusted Incident Rate Ratio, AIRR = 0.92, 95%CI: 0.69-1.24) in the ITT analysis, the risk of severe anaemia was significantly lower in the SP3 group compared to the SP2 group (AIRR = 0.38, 95%CI: 0.16 - 0.90). The PP analysis showed a trend of reduced risk of LBW, severe anaemia and premature delivery in the SP3 group, albeit the difference between two and three IPTp-SP did not reach statistical significance. The risk of LBW and severe anaemia tended to be lower in the SP3 group, though this was not statistically significant, probably due to the low uptake of the intervention which reduced the power of the study. Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings where transmission is markedly seasonal.

  1. Prevalence of intermittent preventive treatment with sulphadoxine ...

    African Journals Online (AJOL)

    by the national diagnostic algorithm of two rapid antibody test and western blot confirmation. Results: Of ... problem, affecting nearly half of all pregnant women .... bottle and temporarily stored in an ice chest and were ... copy of the concentrated sediments in urine. ..... cacy and cost effectiveness of IPTp-SP, SP drug resist-.

  2. HIV Prevention Service Utilization in the Los Angeles House and Ball Communities: Past Experiences and Recommendations for the Future

    Science.gov (United States)

    Holloway, Ian W.; Traube, Dorian E.; Kubicek, Katrina; Supan, Jocelyn; Weiss, George; Kipke, Michele D.

    2012-01-01

    African-American young men who have sex with men and transgender persons are at elevated risk for HIV infection. House and Ball communities, networks of mostly African-American gay, bisexual, and transgender individuals who compete in modeling and dance, represent a prime venue for HIV prevention with these difficult-to-reach populations; however,…

  3. Design and Implementation of a Pilot Obesity Prevention Program in a Low-Resource School: Lessons Learned and Research Recommendations

    Science.gov (United States)

    Baskin, Monica L.; Zunker, Christie; Worley, Courtney B.; Dial, Brenda; Kimbrough, Linda

    2009-01-01

    Purpose: This paper seeks to describe the design, implementation, and lessons learned from an obesity prevention pilot program delivered in a low resource school in the USA. Design/methodology/approach: A planned program evaluation was conducted to: document explicitly the process of designing and implementing the program; and assess the…

  4. Prevention of Mental Health Disorders using Internet and mobile-based Interventions: a narrative review and recommendations for future research.

    NARCIS (Netherlands)

    Ebert, David Daniel; Cuijpers, Pim; Muñoz, Ricardo F.; Baumeister, Harald

    2017-01-01

    Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en

  5. Prevention of mental health disorders using internet- and mobile-based interventions : A narrative review and recommendations for future research

    NARCIS (Netherlands)

    Ebert, David Daniel; Cuijpers, Pim; Muñoz, Ricardo F.; Baumeister, Harald

    2017-01-01

    Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en

  6. The health beliefs of mothers about preventing cervical cancer and their intention to recommend the Pap test to their daughters: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Hae Won Kim

    2016-05-01

    Full Text Available Abstract Background Mothers have a primary role in the prevention of cervical cancer in Korea. This study aimed to determine the awareness and health beliefs of mothers about preventing cervical cancer in their daughters, their intention to recommend the Pap test to their daughters, and the factors influencing this intention. Methods A cross-sectional survey design was employed, and the study enrolled mothers (n = 1,581 of pubescent girls aged 13 to 18 years who were living nationwide in Korea. The six health-beliefs variables related to preventing cervical cancer in their daughters, awareness of the importance of cervical cancer prevention methods, and the intention to recommend the Pap test to daughters were investigated. The impacts of these health beliefs of the mothers and the sociodemographic factors influencing their intention to recommend the Pap test to their daughters were assessed using multiple logistic regression analysis. Results Almost one-quarter (23.7 % of the mothers had talked about the Pap test, 69.2 % were intending to recommend the Pap test to their daughters, and 38.5 % considered that the Pap test could be necessary if their daughters became sexually active. The significant health beliefs influencing the intention to recommend the Pap test were the perceived barriers [odds ratio (OR = 1.47, 95 % confidence interval (95 % CI = 1.03–2.11] and benefits (OR = 2.25, 95 % CI = 1.55–3.25. The significant sociodemographic factors of mothers were their education (OR = 1.52, 95 % CI = 1.08–2.13, their experience of talking about the Pap test with their daughters (OR = 2.11, 95 % CI = 1.23–3.64, their regularity of undergoing the Pap test themselves (OR = 1.98, 95 % CI = 1.30–3.03, and their age when they first underwent the Pap test (OR = 1.60, 95 % CI = 1.43–0.82. Conclusions The mothers perceived HPV vaccination as the most important of the five methods

  7. Metabolic Effects of Intermittent Fasting.

    Science.gov (United States)

    Patterson, Ruth E; Sears, Dorothy D

    2017-08-21

    The objective of this review is to provide an overview of intermittent fasting regimens, summarize the evidence on the health benefits of intermittent fasting, and discuss physiological mechanisms by which intermittent fasting might lead to improved health outcomes. A MEDLINE search was performed using PubMed and the terms "intermittent fasting," "fasting," "time-restricted feeding," and "food timing." Modified fasting regimens appear to promote weight loss and may improve metabolic health. Several lines of evidence also support the hypothesis that eating patterns that reduce or eliminate nighttime eating and prolong nightly fasting intervals may result in sustained improvements in human health. Intermittent fasting regimens are hypothesized to influence metabolic regulation via effects on (a) circadian biology, (b) the gut microbiome, and (c) modifiable lifestyle behaviors, such as sleep. If proven to be efficacious, these eating regimens offer promising nonpharmacological approaches to improving health at the population level, with multiple public health benefits.

  8. Evaluation of evidence-based literature and formulation of recommendations for the clinical preventive guidelines for immigrants and refugees in Canada.

    Science.gov (United States)

    Tugwell, Peter; Pottie, Kevin; Welch, Vivian; Ueffing, Erin; Chambers, Andrea; Feightner, John

    2011-09-06

    This article describes the evidence review and guideline development method developed for the Clinical Preventive Guidelines for Immigrants and Refugees in Canada by the Canadian Collaboration for Immigrant and Refugee Health Guideline Committee. The Appraisal of Guidelines for Research and Evaluation (AGREE) best-practice framework was combined with the recently developed Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to produce evidence-based clinical guidelines for immigrants and refugees in Canada. A systematic approach was designed to produce the evidence reviews and apply the GRADE approach, including building on evidence from previous systematic reviews, searching for and comparing evidence between general and specific immigrant populations, and applying the GRADE criteria for making recommendations. This method was used for priority health conditions that had been selected by practitioners caring for immigrants and refugees in Canada. This article outlines the 14-step method that was defined to standardize the guideline development process for each priority health condition.

  9. Barriers and facilitators to implementation of the institute of medicine recommendations on preventing mental, emotional, and behavioral disorders among young people.

    Science.gov (United States)

    Evans, Mary E

    2012-05-01

    The purpose of this study was to gain an understanding of the barriers and facilitators to implementation of the five overarching recommendations of the Institute of Medicine report and to consider the implications for nursing. Data were collected through use of a semi-structured interview of purposive sample of 22 key informants regarding the barriers and facilitators to implementation of the report's five major recommendations. The major barriers were competing priorities, lack of infrastructure for implementation, lack of public education regarding mental health and the effectiveness of prevention, stigma, and a paucity of facilitating factors. The facilitators were leadership, flexible resources, linkage to healthcare reform or other legislation, coordination across agencies and governmental levels, and additional research. The discussion focuses on ways of promoting facilitating factors and consideration of nursing's potential contributions in the areas of education, practice, and research. © 2012 Wiley Periodicals, Inc.

  10. Traditional Dietary Recommendations for the Prevention of Cardiovascular Disease: Do They Meet the Needs of Our Patients?

    Directory of Open Access Journals (Sweden)

    Johannes Scholl

    2012-01-01

    Full Text Available The characteristics of patients with CVD have changed: whereas smoking prevalence declines, obesity and metabolic syndrome are on the rise. Unfortunately, the traditional low-fat diet for the prevention of cardiovascular disease (CVD still seems to be the “mainstream knowledge” despite contradicting evidence. But lowering LDL-cholesterol by the wrong diet even may be counterproductive, if sd-LDL is raised and HDL is lowered. New insights into the pathophysiology of insulin resistance and its influence on the effects of dietary changes have led to a better approach: (1 the higher a patient's insulin resistance, the more important is the glycemic load of the diet. (2 Fat quality is much more important than fat quantity. (3 The best principle for a reduced calorie intake is not fat counting, but a high volume diet with low energy density, which means fibre rich vegetables and fruits. (4 And finally, satiation and palatability of a diet is very important: there is no success without the patient's compliance. Thus, the best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly.

  11. Easier said than done: World Health Organization recommendations for prevention of mother-to-child transmission of HIV-areas of concern.

    Science.gov (United States)

    Palombi, Leonardo; Nielsen-Saines, Karin; Giuliano, Marina; Marazzi, Maria Cristina

    2011-08-01

    The World Health Organization released recommendations on treatment, prevention, and infant feeding practices within the context of HIV infection based on the "latest scientific evidence" available. The "Rapid Advice" document anticipates the release of official HIV Prevention-of-Mother-to-Child Transmission guidelines. As investigators involved in public health programs providing HIV care in sub-Saharan Africa, we are concerned about the ramifications of specific recommendations, often viewed as dogma by policy makers in this setting. The recommendation that CD4 cell counts be available antenatally so that decisions can be made regarding maternal antiretroviral eligibility is problematic because the ability to measure CD4 cells is nonexistent in many African health centers. As a result, antiretroviral treatment initiation in pregnancy will either be unnecessarily delayed or patients in need of treatment may receive prolonged courses of monotherapy. It is critical that exceptions be made for populations without access to flow cytometry. Another point of concern is that the massive unrestricted use of efavirenz during pregnancy is encouraged. Given that surveillance of pregnancy outcomes is not routinely performed in such settings and in light of the teratogenic potential of efavirenz (contraindicated during the first trimester in developed countries), we are concerned that its indiscriminate use will lead to further problems in vulnerable populations. Another premature recommendation is the use of daily administration of nevirapine to HIV-exposed infants throughout the entire duration of breastfeeding. Results of clinical trials documenting the efficacy of this approach for extended periods of time are not yet available. Single dose nevirapine has been shown to compromise future treatment options in HIV-infected women and infants. In addition, the long-term safety profile of this agent in immune-competent infants has not been established. In summary, although the

  12. Fate in intermittent claudication

    DEFF Research Database (Denmark)

    Jelnes, Rolf; Gaardsting, O; Hougaard Jensen, K

    1986-01-01

    , or an ankle/arm pressure index below 50% were individually significantly associated with progression of the arteriosclerotic disease. These findings show the importance of peripheral blood pressure measurements in the management of patients with intermittent claudication due to arteriosclerotic disease........ The rate of clinical progression of the arteriosclerotic disease (that is, rest pain or gangrene) of the worst affected leg was 7.5% in the first year after referral. Thereafter the rate was 2.2% a year. An ankle systolic blood pressure below 70 mm Hg, a toe systolic blood pressure below 40 mm Hg...... 113 of the patients (44%) had died. Causes of death were no different from those in the general population. Mortality was twice that of the general population matched for age and sex. Mortality among the men was twice that among the women. In men under 60 mortality was four times that expected...

  13. Adherence to the cancer prevention recommendations of the World Cancer Research Fund/American Institute for Cancer Research and mortality: a census-linked cohort.

    Science.gov (United States)

    Lohse, Tina; Faeh, David; Bopp, Matthias; Rohrmann, Sabine

    2016-09-01

    Modifiable lifestyle factors linked to cancer offer great potential for prevention. Previous studies suggest an association between adherence to recommendations on healthy lifestyle and cancer mortality. The aim of this study was to examine whether adherence to the cancer prevention recommendations of the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) is associated with reduced all-cause, total cancer, and specific cancer type mortality. We built a lifestyle score that included 3 categories, based on the recommendations of the WCRF/AICR. Applying Cox regression models, we investigated the association with all-cause, total cancer, and specific cancer type mortality; in addition, we included cardiovascular disease (CVD) mortality. We used census- and death registry-linked survey data allowing a mortality follow-up for ≤32 y. Our analysis included 16,722 participants. Information on lifestyle score components and confounders was collected at baseline. Over a mean follow-up of 21.7 y, 3730 deaths were observed (1332 cancer deaths). Comparing best with poorest category of the lifestyle score showed an inverse association with all-cause (HR: 0.82; 95% CI: 0.75, 0.89) and total cancer (men only, HR: 0.69; 95% CI: 0.57, 0.84) mortality. We estimated that ∼13% of premature cancer deaths in men would have been preventable if lifestyle score levels had been high. Inverse associations were observed for lung, upper aerodigestive tract, stomach, and prostate cancer mortality [men and women combined, HR: 0.72; 95% CI: 0.51, 0.99; HR: 0.49; 95% CI: 0.26, 0.92; HR: 0.34; 95% CI: 0.14, 0.83; HR: 0.48; 95% CI: 0.28, 0.82 (men only), respectively]. CVD mortality was not associated with the lifestyle score (men and women combined, HR: 0.96; 95% CI: 0.82, 1.13). Our results support the importance of adhering to recommendations for a healthy lifestyle with regard to all-cause and cancer mortality. To reduce the burden of cancer in the

  14. Recommendations to ECE governments on the prevention of water pollution from hazardous substances as adopted by the Committee on Environmental Policy at its first session (1994)

    International Nuclear Information System (INIS)

    1995-01-01

    With a view to preventing, controlling and reducing the release of pollutants into the aquatic environment, thus promoting the implementation of the Convention on the Protection and Use of Transboundary Watercourses and International Lakes, pending its entry into force, it is recommended that ECE Governments, taking into account, inter alia, current water quality, water-quality requirements of present and future water users in the relevant catchments, requirements of aquatic and riparian flora and fauna, assessments of the risks involved, the urgency of control measures, and the economic feasibility

  15. Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study.

    Directory of Open Access Journals (Sweden)

    María Rupérez

    2016-02-01

    Full Text Available Little is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ compared to sulfadoxine-pyrimethamine (SP for important infant health and developmental outcomes.In the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania, 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age. Anthropometric parameters and psychomotor development were assessed at 1, 9, and 12 mo of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 mo of age. No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 9, and 12 mo of age between infants born to women who were on IPTp with MQ versus SP. Except for three items evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Information on the outcomes at 12 mo of age was unavailable in 26% of the infants, 761 (27% from the MQ group and 377 (26% from the SP group. Reasons for not completing the study were death (4% of total study population, study withdrawal (6%, migration (8%, and loss to follow-up (9%.No significant differences were found between IPTp with MQ and SP administered in pregnancy on infant mortality, morbidity, and nutritional outcomes. The poorer performance on certain psychomotor development milestones at 9 mo of age in children born to women in the MQ group compared to those in the SP group may deserve

  16. Feasibility and coverage of implementing intermittent preventive treatment of malaria in pregnant women contacting private or public clinics in Tanzania: experience-based viewpoints of health managers in Mkuranga and Mufindi districts.

    Science.gov (United States)

    Mubyazi, Godfrey M; Magnussen, Pascal; Byskov, Jens; Bloch, Paul

    2013-10-01

    Evidence on healthcare managers' experience on operational feasibility of malaria intermittent preventive treatment for malaria during pregnancy (IPTp) using sulphadoxine-pyrimethamine (SP) in Africa is systematically inadequate. This paper elucidates the perspectives of District Council Health Management Team (CHMT)s regarding the feasibility of IPTp with SP strategy, including its acceptability and ability of district health care systems to cope with the contemporary and potential challenges. The study was conducted in Mkuranga and Mufindi districts. Data were collected between November 2005 and December 2007, involving focus group discussion (FGD) with Mufindi CHMT and in-depth interviews were conducted with few CHMT members in Mkuranga where it was difficult to summon all members for FGD. Participants in both districts acknowledged the IPTp strategy, considering the seriousness of malaria in pregnancy problem; government allocation of funds to support healthcare staff training programmes in focused antenatal care (fANC) issues, procuring essential drugs distributed to districts, staff remuneration, distribution of fANC guidelines, and administrative activities performed by CHMTs. The identified weaknesses include late arrival of funds from central level weakening CHMT's performance in health supervision, organising outreach clinics, distributing essential supplies, and delivery of IPTp services. Participants anticipated the public losing confidence in SP for IPTp after government announced artemither-lumefantrine (ALu) as the new first-line drug for uncomplicated malaria replacing SP. Role of private healthcare staff in IPTp services was acknowledged cautiously because CHMTs rarely supplied private clinics with SP for free delivery in fear that clients would be required to pay for the SP contrary to government policy. In Mufindi, the District Council showed a strong political support by supplementing ANC clinics with bottled water; in Mkuranga such support was

  17. [Assessment and training of strength and balance for fall prevention in the elderly: recommendations of an interdisciplinary expert panel].

    Science.gov (United States)

    Granacher, U; Muehlbauer, T; Gschwind, Y J; Pfenninger, B; Kressig, R W

    2014-08-01

    The proportion of elderly people in societies of western industrialized countries is continuously rising. Biologic aging induces deficits in balance and muscle strength/power in old age, which is responsible for an increased prevalence of falls. Therefore, nationwide and easy-to-administer fall prevention programs have to be developed in order to contribute to the autonomy and quality of life in old age and to help reduce the financial burden on the public health care system due to the treatment of fall-related injuries. This narrative (qualitative) literature review deals with a) the reasons for an increased prevalence of falls in old age, b) important clinical tests for fall-risk assessment, and c) evidence-based intervention/training programs for fall prevention in old age. The findings of this literature review are based on a cost-free practice guide that is available to the public (via the internet) and that was created by an expert panel (i.e., geriatricians, exercise scientists, physiotherapists, geriatric therapists). The present review provides the scientific foundation of the practice guide.

  18. Hot Idea or Hot Air: A Systematic Review of Evidence for Two Widely Marketed Youth Suicide Prevention Programs and Recommendations for Implementation

    Science.gov (United States)

    Wei, Yifeng; Kutcher, Stan; LeBlanc, John C.

    2015-01-01

    Introduction: Youth suicide is highly related to mental disorders. While communities and schools are marketed to with a plethora of suicide prevention programs, they often lack the capacity to choose evidence-based programs. Methods: We conducted a systematic review of two youth suicide prevention programs to help determine if the quality of evidence available justifies their wide spread dissemination. We searched Medline, PsycINFO, EMBASE, CINAHL, the Cochrane Library, Campbell Collaboration SPECTR database, SocIndex, Sociological Abstracts, Social Services Abstracts, ERIC, Social Work Abstracts, Research Library, and Web of Science, for relevant studies. We included studies/systematic reviews/meta-analysis that evaluated the effectiveness, cost-effectiveness, and/or safety of Signs of Suicide (SOS) and Yellow Ribbon (YR) suicide prevention programs that target adolescents. We applied the Office of Justice Program What Works Repository (OJP-R) to evaluate the quality of the included studies as effective, effective with reservation, promising, inconclusive evidence, insufficient evidence, and ineffective. Two SOS studies were ranked as “inconclusive evidence” based on the OJP-R. One SOS study was ranked as having “insufficient evidence” on OJP-R. The YR study was ranked as “ineffective” using OJP-R. We only included studies in peer-reviewed journals in English and therefore may have missed reports in grey literature or non-English publications. Results: We cannot recommend that schools and communities implement either the SOS or YR suicide prevention programs. Purchasers of these programs should be aware that there is no evidence that their use prevents suicide. Conclusions: Academics and organizations should not overstate the positive impacts of suicide prevention interventions when the evidence is lacking. PMID:26336375

  19. What not to do in acute otitis media: the top five recommendations proposed by the Italian Society of Preventive and Social Pediatrics.

    Science.gov (United States)

    Chiappini, Elena; Bortone, Barbara; Doria, Mattia; Landi, Massimo; Di Mauro, Giuseppe; Marchisio, Paola

    2017-10-01

    With the aim to reduce inappropriate procedures and antibiotic therapy in the management of acute otitis media (AOM) in children, the Italian Society of Preventive and Social Pediatrics (SIPPS) proposed a top five list of recommendations for clinical practice. Areas covered: AOM is one of the most frequent reasons for antibiotic prescription in pediatric age. The over-estimation of AOM is associated with inappropriate treatment, increased costs, adverse events and spread of antibiotic resistance. Thus, the most recent guidelines provided stringent diagnostic criteria and considered the 'watchful waiting' approach, limiting the immediate antibiotic therapy to a well-characterized subgroup of children. Expert commentary: The five recommendations proposed are: 1) Do not diagnose AOM without having documented the presence of middle ear effusion 2) Do not diagnose AOM without examining the entire tympanic membrane; 3) Do not treat immediately all cases of AOM with antibiotics; 4) Do not administer ear analgesic drops until examining the whole tympanic membrane 5) Do not use macrolides in the AOM therapy. This list of top five recommendations could be a novel tool to spread the key messages on the guidelines and to promote the correct diagnostic procedures as well as a rational use of antibiotics in children.

  20. Quality of life and functional status after revascularization or conservative treatment in patients with intermittent claudication

    DEFF Research Database (Denmark)

    Hedeager Momsen, Anne-Mette; Bach Jensen, Martin; Norager, Charlotte Buchard

    2011-01-01

    Revascularization of patients with intermittent claudication (IC) is recommended only for selected patients who have chronic pain or disabling disease. However, improvement in the quality of life (QoL) could justify more widespread use.......Revascularization of patients with intermittent claudication (IC) is recommended only for selected patients who have chronic pain or disabling disease. However, improvement in the quality of life (QoL) could justify more widespread use....

  1. The effect of iron-fortified complementary food and intermittent preventive treatment of malaria on anaemia in 12- to 36-month-old children: a cluster-randomised controlled trial.

    Science.gov (United States)

    Glinz, Dominik; Hurrell, Richard F; Ouattara, Mamadou; Zimmermann, Michael B; Brittenham, Gary M; Adiossan, Lukas G; Righetti, Aurélie A; Seifert, Burkhardt; Diakité, Victorine G; Utzinger, Jürg; N'Goran, Eliézer K; Wegmüller, Rita

    2015-09-17

    Iron deficiency (ID) and malaria co-exist in tropical regions and both contribute to high rates of anaemia in young children. It is unclear whether iron fortification combined with intermittent preventive treatment (IPT) of malaria would be an efficacious strategy for reducing anaemia in young children. A 9-month cluster-randomised, single-blinded, placebo-controlled intervention trial was carried out in children aged 12-36 months in south-central Côte d'Ivoire, an area of intense and perennial malaria transmission. The study groups were: group 1: normal diet and IPT-placebo (n = 125); group 2: consumption of porridge, an iron-fortified complementary food (CF) with optimised composition providing 2 mg iron as NaFeEDTA and 3.8 mg iron as ferrous fumarate 6 days per week (CF-FeFum) and IPT-placebo (n = 126); group 3: IPT of malaria at 3-month intervals, using sulfadoxine-pyrimethamine and amodiaquine and no dietary intervention (n = 127); group 4: both CF-FeFum and IPT (n = 124); and group 5: consumption of porridge, an iron-fortified CF with the composition currently on the Ivorian market providing 2 mg iron as NaFeEDTA and 3.8 mg iron as ferric pyrophosphate 6 days per week (CF-FePP) and IPT-placebo (n = 127). The primary outcome was haemoglobin (Hb) concentration. Linear and logistic regression mixed-effect models were used for the comparison of the five study groups, and a 2 × 2 factorial analysis was used to assess treatment interactions of CF-FeFum and IPT (study groups 1-4). After 9 months, the Hb concentration increased in all groups to a similar extent with no statistically significant difference between groups. In the 2 × 2 factorial analysis after 9 months, no treatment interaction was found on Hb (P = 0.89). The adjusted differences in Hb were 0.24 g/dl (95 % CI -0.10 to 0.59; P = 0.16) in children receiving IPT and -0.08 g/dl (95 % CI -0.42 to 0.26; P = 0.65) in children receiving CF-FeFum. At baseline, anaemia (Hb

  2. The impact of intermittent or sustained carbon dioxide on intermittent hypoxia initiated respiratory plasticity. What is the effect of these combined stimuli on apnea severity?

    Science.gov (United States)

    Mateika, Jason H; Panza, Gino; Alex, Raichel; El-Chami, Mohamad

    2017-10-31

    The following review explores the effect that intermittent or sustained hypercapnia coupled to intermittent hypoxia has on respiratory plasticity. The review explores published work which suggests that intermittent hypercapnia leads to long-term depression of respiration when administered in isolation and prevents the initiation of long-term facilitation when administered in combination with intermittent hypoxia. The review also explores the impact that sustained hypercapnia alone and in combination with intermittent hypoxia has on the magnitude of long-term facilitation. After exploring the outcomes linked to intermittent hypoxia/hypercapnia and intermittent hypoxia/sustained hypercapnia the translational relevance of the outcomes as it relates to breathing stability during sleep is addressed. The likelihood that naturally induced cycles of intermittent hypoxia, coupled to oscillations in carbon dioxide that range between hypocapnia and hypercapnia, do not initiate long-term facilitation is addressed. Moreover, the conditions under which intermittent hypoxia/sustained hypercapnia could serve to improve breathing stability and mitigate co-morbidities associated with sleep apnea are considered. Published by Elsevier B.V.

  3. Contextualizing willingness to participate: recommendations for engagement, recruitment & enrolment of Kenyan MSM in future HIV prevention trials

    Directory of Open Access Journals (Sweden)

    Monika Doshi

    2017-05-01

    Full Text Available Abstract Background The HIV epidemic among men who have sex with men (MSM continues to expand globally. The addition of an efficacious, prophylactic vaccine to combination prevention offers immense hope, particularly in low- and middle- income countries which bear the greatest global impact. However, in these settings, there is a paucity of vaccine preparedness studies that specifically pertain to MSM. Our study is the first vaccine preparedness study among MSM and female sex workers (FSWs in Kenya. In this paper, we explore willingness of Kenyan MSM to participate in HIV vaccine efficacy trials. In addition to individual and socio-cultural motivators and barriers that influence willingness to participate (WTP, we explore the associations or linkages that participants draw between their experiences with or knowledge of medical research both generally and within the context of HIV/AIDS, their perceptions of a future HIV vaccine and their willingness to participate in HIV vaccine trials. Methods Using a social network-based approach, we employed snowball sampling to recruit MSM into the study from Kisumu, Mombasa, and Nairobi. A field team consisting of seven community researchers conducted in-depth interviews with a total of 70 study participants. A coding scheme for transcribed and translated data was developed and the data was then analysed thematically. Results Most participants felt that an HIV vaccine would bring a number of benefits to self, as well as to MSM communities, including quelling personal fears related to HIV acquisition and reducing/eliminating stigma and discrimination shouldered by their community. Willingness to participate in HIV vaccine efficacy trials was highly motivated by various forms of altruism. Specific researcher responsibilities centred on safe-guarding the rights and well-being of participants were also found to govern WTP, as were reflections on the acceptability of a future preventive HIV vaccine. Conclusion

  4. Intermedia and Intermittency

    Directory of Open Access Journals (Sweden)

    Veres Bálint

    2014-12-01

    Full Text Available It is commonly known that medial reflections have been initiated by attempts to secure the borders of discrete medial forms and to define the modus operandi of each essentialized medial area. Later on, the focus of study has shifted to plurimedial formations and the interactions between predefined medial genres. In the last few decades, taxonomic approaches to various multi-, inter-, and transmedial phenomena dominated the discussions, which offered invaluable support in mapping the terrain, but at the same time hindered the analysis of the ephemeral, time-dependent aspects of plurimedial operations. While we explore the properties of each medial configuration, we lose sight of the actual historical drivers that produce ever-new configurations. My thesis is that any discourse on intermediality should be paralleled by a discourse on cultural intermittency, and consequently, media studies should involve an approach that focuses on the “ecosystem” of the constantly renewing media configurations from the point of view of their vitalizing potential and capability to trigger heightened experiences. This approach draws much inspiration from K. Ludwig Pfeiffer’s media anthropology that gives orientation in my paper.

  5. Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers.

    Science.gov (United States)

    Arnold, J Malcom O; Howlett, Jonathan G; Dorian, Paul; Ducharme, Anique; Giannetti, Nadia; Haddad, Haissam; Heckman, George A; Ignaszewski, Andrew; Isaac, Debra; Jong, Philip; Liu, Peter; Mann, Elizabeth; McKelvie, Robert S; Moe, Gordon W; Parker, John D; Svendsen, Anna M; Tsuyuki, Ross T; O'Halloran, Kelly; Ross, Heather J; Rao, Vivek; Sequeira, Errol J; White, Michel

    2007-01-01

    Heart failure is common, yet it is difficult to treat. It presents in many different guises and circumstances in which therapy needs to be individualized. The Canadian Cardiovascular Society published a comprehensive set of recommendations in January 2006 on the diagnosis and management of heart failure, and the present update builds on those core recommendations. Based on feedback obtained through a national program of heart failure workshops during 2006, several topics were identified as priorities because of the challenges they pose to health care professionals. New evidence-based recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. Specific recommendations and practical tips were written for the prevention of heart failure, the management of heart failure during intercurrent illness, the treatment of acute heart failure, and the current and future roles of biomarkers in heart failure care. Specific clinical questions that are addressed include: which patients should be identified as being at high risk of developing heart failure and which interventions should be used? What complications can occur in heart failure patients during an intercurrent illness, how should these patients be monitored and which medications may require a dose adjustment or discontinuation? What are the best therapeutic, both drug and nondrug, strategies for patients with acute heart failure? How can new biomarkers help in the treatment of heart failure, and when and how should BNP be measured in heart failure patients? The goals of the present update are to translate best evidence into practice, to apply clinical wisdom where evidence for specific strategies is weaker, and to aid physicians and other health care providers to optimally treat heart failure patients to result in a measurable impact on patient health and clinical outcomes in Canada.

  6. Chronic Intermittent Hypoxia Induces Atherosclerosis

    OpenAIRE

    Savransky, Vladimir; Nanayakkara, Ashika; Li, Jianguo; Bevans, Shannon; Smith, Philip L.; Rodriguez, Annabelle; Polotsky, Vsevolod Y.

    2007-01-01

    Rationale: Obstructive sleep apnea, a condition leading to chronic intermittent hypoxia (CIH), is associated with hyperlipidemia, atherosclerosis, and a high cardiovascular risk. A causal link between obstructive sleep apnea and atherosclerosis has not been established.

  7. Client-Focused Security Assessment of mHealth Apps and Recommended Practices to Prevent or Mitigate Transport Security Issues.

    Science.gov (United States)

    Müthing, Jannis; Jäschke, Thomas; Friedrich, Christoph M

    2017-10-18

    Mobile health (mHealth) apps show a growing importance for patients and health care professionals. Apps in this category are diverse. Some display important information (ie, drug interactions), whereas others help patients to keep track of their health. However, insufficient transport security can lead to confidentiality issues for patients and medical professionals, as well as safety issues regarding data integrity. mHealth apps should therefore deploy intensified vigilance to protect their data and integrity. This paper analyzes the state of security in mHealth apps. The objectives of this study were as follows: (1) identification of relevant transport issues in mHealth apps, (2) development of a platform for test purposes, and (3) recommendation of practices to mitigate them. Security characteristics relevant to the transport security of mHealth apps were assessed, presented, and discussed. These characteristics were used in the development of a prototypical platform facilitating streamlined tests of apps. For the tests, six lists of the 10 most downloaded free apps from three countries and two stores were selected. As some apps were part of these top 10 lists in more than one country, 53 unique apps were tested. Out of the 53 apps tested from three European App Stores for Android and iOS, 21/53 (40%) showed critical results. All 21 apps failed to guarantee the integrity of data displayed. A total of 18 apps leaked private data or were observable in a way that compromised confidentiality between apps and their servers; 17 apps used unprotected connections; and two apps failed to validate certificates correctly. None of the apps tested utilized certificate pinning. Many apps employed analytics or ad providers, undermining user privacy. The tests show that many mHealth apps do not apply sufficient transport security measures. The most common security issue was the use of any kind of unprotected connection. Some apps used secure connections only for selected tasks

  8. Client-Focused Security Assessment of mHealth Apps and Recommended Practices to Prevent or Mitigate Transport Security Issues

    Science.gov (United States)

    Müthing, Jannis; Jäschke, Thomas

    2017-01-01

    Background Mobile health (mHealth) apps show a growing importance for patients and health care professionals. Apps in this category are diverse. Some display important information (ie, drug interactions), whereas others help patients to keep track of their health. However, insufficient transport security can lead to confidentiality issues for patients and medical professionals, as well as safety issues regarding data integrity. mHealth apps should therefore deploy intensified vigilance to protect their data and integrity. This paper analyzes the state of security in mHealth apps. Objective The objectives of this study were as follows: (1) identification of relevant transport issues in mHealth apps, (2) development of a platform for test purposes, and (3) recommendation of practices to mitigate them. Methods Security characteristics relevant to the transport security of mHealth apps were assessed, presented, and discussed. These characteristics were used in the development of a prototypical platform facilitating streamlined tests of apps. For the tests, six lists of the 10 most downloaded free apps from three countries and two stores were selected. As some apps were part of these top 10 lists in more than one country, 53 unique apps were tested. Results Out of the 53 apps tested from three European App Stores for Android and iOS, 21/53 (40%) showed critical results. All 21 apps failed to guarantee the integrity of data displayed. A total of 18 apps leaked private data or were observable in a way that compromised confidentiality between apps and their servers; 17 apps used unprotected connections; and two apps failed to validate certificates correctly. None of the apps tested utilized certificate pinning. Many apps employed analytics or ad providers, undermining user privacy. Conclusions The tests show that many mHealth apps do not apply sufficient transport security measures. The most common security issue was the use of any kind of unprotected connection. Some apps

  9. Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement.

    Science.gov (United States)

    Lin, Kenneth; Fajardo, Kevin

    2008-07-01

    Asymptomatic bacteriuria is common, and screening for this condition in pregnant women is a well-established, evidence-based standard of current medical practice. Screening other groups of adults has not been shown to improve outcomes. To review new and substantial evidence on screening for asymptomatic bacteriuria, to support the work of the U.S. Preventive Services Task Force. English-language studies of adults (age >18 years) indexed in PubMed and the Cochrane Library and published from 1 January 2002 through 30 April 2007. For benefits of screening or treatment for screened populations, systematic reviews; meta-analyses; and randomized, controlled trials were included. For harms of screening, systematic reviews; meta-analyses; randomized, controlled trials; cohort studies; case-control studies; and case series of large multisite databases were included. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion. Two reviewers extracted data from studies on benefits of screening and treatment (including decreases in the incidence of adverse maternal and fetal outcomes, symptomatic urinary tract infections, hypertension, and renal function decline). An updated Cochrane systematic review of 14 randomized, controlled trials of treatment supports screening for asymptomatic bacteriuria in pregnant women. A randomized, controlled trial and a prospective cohort study show that screening nonpregnant women with diabetes for asymptomatic bacteriuria is unlikely to produce benefits. No new evidence on screening men for asymptomatic bacteriuria or on harms of screening was found. The focused search strategy may have missed some smaller studies on the benefits and harms of screening for asymptomatic bacteriuria. The available evidence continues to support screening for asymptomatic bacteriuria in pregnant women, but not in other groups of adults.

  10. The De Novo Synthesis of Horsepox Virus: Implications for Biosecurity and Recommendations for Preventing the Reemergence of Smallpox.

    Science.gov (United States)

    Koblentz, Gregory D

    In March 2017, the American biotech company Tonix announced that a Canadian scientist had synthesized horsepox virus as part of a project to develop a safer vaccine against smallpox. The first de novo synthesis of an orthopoxvirus, a closely related group of viruses that includes horsepox and the variola virus that causes smallpox, crosses an important Rubicon in the field of biosecurity. The synthesis of horsepox virus takes the world one step closer to the reemergence of smallpox as a threat to global health security. That threat has been held at bay for the past 40 years by the extreme difficulty of obtaining variola virus and the availability of effective medical countermeasures. The techniques demonstrated by the synthesis of horsepox have the potential to erase both of these barriers. The primary risk posed by this research is that it will open the door to the routine and widespread synthesis of other orthopoxviruses, such as vaccinia, for use in research, public health, and medicine. The normalization and globalization of orthopoxvirus synthesis for these beneficial applications will create a cadre of laboratories and scientists that will also have the capability and expertise to create infectious variola virus from synthetic DNA. Unless the safeguards against the synthesis of variola virus are strengthened, the capability to reintroduce smallpox into the human population will be globally distributed and either loosely or completely unregulated, providing the foundation for a disgruntled or radicalized scientist, sophisticated terrorist group, unscrupulous company, or rogue state to recreate one of humanity's most feared microbial enemies. The reemergence of smallpox-because of a laboratory accident or an intentional release-would be a global health disaster. International organizations, national governments, the DNA synthesis industry, and the synthetic biology community all have a role to play in devising new approaches to preventing the reemergence of

  11. Hyponatremic hypochloremic dehydration in children with cystic fibrosis in Slovenia; the incidence and recommendations for prevention and treatment

    Directory of Open Access Journals (Sweden)

    Marina Praprotnik

    2015-05-01

    Full Text Available Background: Young children and rarely adolescents with cystic fibrosis can develop hyponatremic hypochloremic dehydration with metabolic alkalosis. The purpose of this article was to review the incidence of this metabolic disorder in our CF patients.Methods: We investigated the medical records of all children diagnosed with cystic fibrosis who are under follow-up in the CF center at the University Childrenʹs Hospital Ljubljana, and were hospitalised or treated on an outpatient basis due to hyponatremic, hypochloremic dehydration in the period from 2007–2012. Data analysis included clinical and laboratory findings.Results: A total of 4 children (7.2 % from Ljubljana CF center (55 patients under the age of 19 years were enrolled in the study. We observed 5 episodes of hyponatremic hypochloremic dehydration in 4 patients (one boy had two episodes. All were homozigous for ΔF 508 mutation. Two had episodes in summer and two in autumn, so that no season prevalence of its occurence was found. Median age at admission to the hospital due to hyponatremic hypochloremic dehydration was 7 months (range 4–34. One boy had a hypovolemic shock at the time of admission to the hospital.Conclusions: The results of our study show that dehydration with hypoelectrolytaemia is a rare complication in children with CF in Slovenia, but due to the severity of clinical signs it is an important disorder. Vomiting and fatigue are the warning signs that should alert parents and physicians to consider the possibility of this complication which can be prevented by proper hydration and salt replacement. If left untreated, it can cause seizures, arrhythmias and even death.

  12. Dynamic characterizers of spatiotemporal intermittency

    OpenAIRE

    Gupte, Neelima; Jabeen, Zahera

    2006-01-01

    Systems of coupled sine circle maps show regimes of spatiotemporally intermittent behaviour with associated scaling exponents which belong to the DP class, as well as regimes of spatially intermittent behaviour (with associated regular dynamical behaviour) which do not belong to the DP class. Both types of behaviour are seen along the bifurcation boundaries of the synchronized solutions, and contribute distinct signatures to the dynamical characterizers of the system, viz. the distribution of...

  13. Helping Clinicians Prevent Pregnancy among Sexually Active Adolescents: U.S. Medical Eligibility Criteria for Contraceptive Use and U.S. Selected Practice Recommendations for Contraceptive Use.

    Science.gov (United States)

    Godfrey, Emily M

    2015-08-01

    The United States has made substantial progress in reducing teenage birth rates in recent decades, but rates remain high. Teen pregnancy can increase the risk of poor health outcomes and lead to decreased educational attainment, increased poverty, and welfare use, as well as increased cost to taxpayers. One of the most effective ways to prevent teenage pregnancy is through the use of effective birth control methods. The Centers for Disease Control (CDC) and Prevention has made the prevention of teenage pregnancy 1 of its 10 winnable battles. The CDC has released 2 evidence-based clinical guideline documents regarding contraceptive use for adolescents and adults. The first guideline, US Medical Eligibility Criteria for Contraceptive Use, 2010, helps clinicians recognize when a contraceptive method may not be safe to use for a particular adolescent but also when not to withhold a contraceptive method that is safe to use. The second document, US Selected Practice Recommendations for Contraceptive Use, 2013, provides guidance for how to use contraceptive methods safely and effectively once they are deemed safe. Health care providers are encouraged to use these documents to provide safe and effective contraceptive care to patients seeking family planning, including adolescents. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. All rights reserved.

  14. [Individual prevention of occupational contact dermatitis: protective gloves and skin protection recommendations as part of the patient management scheme by the public statutory employers' liability insurance].

    Science.gov (United States)

    Wilke, A; Skudlik, C; Sonsmann, F K

    2018-05-02

    The dermatologist's procedure is a pivotal tool for early recognition of occupational contact dermatitis (OCD), for reporting OCD cases to the statutory accident insurance and for treating the diseases. The employer is in charge of implementing skin protection measures at the workplace. However, in terms of an individual prevention approach it may be necessary to propose targeted skin protection recommendations in specific patient cases. The patient's own skin protection behavior significantly contributes to regenerating and maintaining healthy skin. This behavior includes the use of occupational skin products, and in particular the correct use of appropriately selected protective gloves. Protective gloves are the most important personal protective measure in the prevention of OCD. Prevention services, occupational health and safety specialists, occupational physicians and centers specialized in occupational dermatology can support the identification of suitable protective measures. Nowadays, suitable protective gloves exist for (almost) every occupational activity and exposure. However, improper use in practice can become a risk factor by itself for the skin (e. g., incorrectly used gloves). Therefore, it is of utmost importance to identify application errors, to educate patients in terms of skin protection and to motivate them to perform an appropriate skin protection behavior. With particular focus on protective gloves, this article gives an overview of various types, materials and potentially glove-related allergens, presents strategies for reducing occlusion effects and discusses some typical application errors and solutions.

  15. Prevention and control of catheter-associated urinary tract infections – implementation of the recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO in nursing homes for the elderly in Frankfurt am Main, Germany

    Directory of Open Access Journals (Sweden)

    Heudorf, Ursel

    2016-06-01

    Full Text Available Introduction: Urinary tract infections range among the most frequent infections not only in hospital patients but also in residents of long-term care facilities for the elderly. Urinary catheters are the greatest risk factor for urinary tract infections. In the guidance paper on the “prevention of infections in nursing homes” (2005 as well as in the updated recommendations for the “prevention and control of catheter-associated urinary tract infections” (2015, the Commission for Hospital Hygiene and Infection Prevention (KRINKO has recommended adequate preventive measures. In 2015, the implementation of these KRINKO recommendations was investigated.Method: All of Frankfurt’s 40 nursing homes were evaluated using a checklist based on the KRINKO recommendations. The evaluation included assessing the availability of operating instructions, appropriate indications for the placement of catheters etc. Age, sex and duration of catheterization, as well as current and previous infections within the past 6 months were documented for every resident with a catheter.Results: In 35 (87.5% of the nursing homes, operating instructions for the handling of urinary tract catheters were available. The decision as to whether a catheter is indicated is made by physicians, while its placement is often delegated to the nursing service. Typically, silicon catheters are used. In three-quarters of the nursing homes, regular intervals of 4–6 weeks for changing catheters were reported. On the respective survey day, 7.3% of the residents were catheterized. On the survey day, 3.6% (4.2% and in the previous 6 months a total of 28% (28.9% of the residents had a urinary tract infection (prevalence of antibiotic therapy in parentheses. Ciprofloxacin was used most often followed by cefuroxime and cotrimoxazole.Discussion: In the current evaluation, fewer nursing home residents were catheterized than in previous years and the rate of urinary tract infections was low

  16. Prevention and control of catheter-associated urinary tract infections - implementation of the recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) in nursing homes for the elderly in Frankfurt am Main, Germany.

    Science.gov (United States)

    Heudorf, Ursel; Gasteyer, Stefanie; Müller, Maria; Samoiski, Yvonne; Serra, Nicole; Westphal, Tim

    2016-01-01

    Urinary tract infections range among the most frequent infections not only in hospital patients but also in residents of long-term care facilities for the elderly. Urinary catheters are the greatest risk factor for urinary tract infections. In the guidance paper on the "prevention of infections in nursing homes" (2005) as well as in the updated recommendations for the "prevention and control of catheter-associated urinary tract infections" (2015), the Commission for Hospital Hygiene and Infection Prevention (KRINKO) has recommended adequate preventive measures. In 2015, the implementation of these KRINKO recommendations was investigated. All of Frankfurt's 40 nursing homes were evaluated using a checklist based on the KRINKO recommendations. The evaluation included assessing the availability of operating instructions, appropriate indications for the placement of catheters etc. Age, sex and duration of catheterization, as well as current and previous infections within the past 6 months were documented for every resident with a catheter. In 35 (87.5%) of the nursing homes, operating instructions for the handling of urinary tract catheters were available. The decision as to whether a catheter is indicated is made by physicians, while its placement is often delegated to the nursing service. Typically, silicon catheters are used. In three-quarters of the nursing homes, regular intervals of 4-6 weeks for changing catheters were reported. On the respective survey day, 7.3% of the residents were catheterized. On the survey day, 3.6% (4.2%) and in the previous 6 months a total of 28% (28.9%) of the residents had a urinary tract infection (prevalence of antibiotic therapy in parentheses). Ciprofloxacin was used most often followed by cefuroxime and cotrimoxazole. In the current evaluation, fewer nursing home residents were catheterized than in previous years and the rate of urinary tract infections was low. This indicates an increasingly cautious and apparently appropriate

  17. 4Ps medicine of the fatty liver: the research model of predictive, preventive, personalized and participatory medicine-recommendations for facing obesity, fatty liver and fibrosis epidemics.

    Science.gov (United States)

    Trovato, Francesca Maria; Catalano, Daniela; Musumeci, Giuseppe; Trovato, Guglielmo M

    2014-01-01

    Relationship between adipose tissue and fatty liver, and its possible evolution in fibrosis, is supported by clinical and research experience. Given the multifactorial pathogenesis of non-alcoholic fatty liver disease (NAFLD), treatments for various contributory risk factors have been proposed; however, there is no single validated therapy or drug association recommended for all cases which can stand alone. Mechanisms, diagnostics, prevention and treatment of obesity, fatty liver and insulin resistance are displayed along with recommendations and position points. Evidences and practice can get sustainable and cost-benefit valuable outcomes by participatory interventions. These recommendations can be enhanced by comprehensive research projects, addressed to societal issues and innovation, market appeal and industry development, cultural acceptance and sustainability. The basis of participatory medicine is a greater widespread awareness of a condition which is both a disease and an easy documented and inclusive clue for associated diseases and unhealthy lifestyle. This model is suitable for addressing prevention and useful for monitoring improvement, worsening and adherence with non-invasive imaging tools which allow targeted approaches. The latter include health psychology and nutritional and physical exercise prescription expertise disseminated by continuous medical education but, more important, by concrete curricula for training undergraduate and postgraduate students. It is possible and recommended to do it by early formal teaching of ultrasound imaging procedures and of practical lifestyle intervention strategies, including approaches aimed to healthier fashion suggestions. Guidelines and requirements of research project funding calls should be addressed also to NAFLD and allied conditions and should encompass the goal of training by research and the inclusion of participatory medicine topics. A deeper awareness of ethics of competences in health professionals

  18. Prevention

    Science.gov (United States)

    ... Recommend on Facebook Tweet Share Compartir Practice good hand hygiene after contact with infected animals or humans. There ... could be at risk for infection. Practice good hand hygiene after contact with infected animals or humans. For ...

  19. [Recommendation for the prevention and treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal ulcers and its complications].

    Science.gov (United States)

    2017-01-01

    Non-steroidal anti-inflammatory drugs (NSAIDs) are a broad class of non glucocorticoid drugs which are extensively used in anti-inflammatory, analgesic, and antipyretic therapies. However, NSAIDs may cause many side effects, most commonly in gastrointestinal(GI) tract. Cardiovascular system, kidney, liver, central nervous system and hematopoietic system are also involved. NSAID-induced GI side effects not only endanger the patients' health, increase mortality, but also greatly increase the cost of medical care. Therefore, how to reduce GI side effects is of particular concern to clinicians. The Chinese Rheumatism Data Center(CRDC) and Chinese Systemic Lupus Erythematosus Treatment and Research Group(CSTAR) compose a "Recommendation for the prevention and treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal ulcers and its complications" , as following: (1) GI lesions are the most common side effects of NSAIDs. (2) NSAID-induced GI side effects include gastritis, esophagitis, gastric and duodenal ulcers, bleeding, perforation and obstruction. (3) With the application of capsule endoscopy and small intestinal endoscopy, growing attention is being paid to the NASID-induced small intestine mucosa damage, which is mainly erosion and ulcer. (4) Risk factors related to NSAID-induced GI ulcers include: Helicobacter pylori (Hp) infection, age> 65 years, past history of GI ulcers, high doses of NSAIDs, multiple-drug combination therapy, and comorbidities, such as cardiovascular disease and nephropathy.(5) GI and cardiovascular function should be evaluated before using NSAIDs and gastric mucosal protective agents. (6) The risk of GI ulcers and complications caused by selective cyclooxygenase-2 (COX-2) inhibitors is less than that of non-selective COX-2 inhibitors. (7)Hp eradication therapy helps to cure GI ulcers and prevent recurrence when Hp infection is positive in NSAID-induced ulcers. (8) Proton pump inhibitor (PPI) is the first choice for the

  20. Comparing ELISA test-positive prevalence, risk factors and management recommendations for Johne's disease prevention between organic and conventional dairy farms in Ontario, Canada.

    Science.gov (United States)

    Pieper, Laura; Sorge, Ulrike S; DeVries, Trevor; Godkin, Ann; Lissemore, Kerry; Kelton, David

    2015-11-01

    Johne's disease (JD) is a chronic, infectious disease in cattle. Between 2010 and 2013, a voluntary JD control program was successfully launched in Ontario, Canada, including a Risk Assessment and Management Plan (RAMP) and JD ELISA testing of the entire milking herd. Over the last decade, the organic dairy sector has been growing. However, organic farming regulations and philosophies may influence the risk for JD transmission on Ontario organic dairy farms. The aim of this cross-sectional study was to investigate differences in JD ELISA test positive prevalence, risk factors for JD and recommendations for JD prevention between organic and conventional dairy herds in Ontario. RAMP results (i.e. RAMP scores and recommendations) and ELISA results were available for 2103 dairy herds, including 42 organic herds. If available, additional data on milk production, milk quality, and herd characteristics were gathered. Organic and conventional herds had a similar herd-level JD ELISA test-positive prevalence (26.2% and 27.2%, respectively). Organic herds (4.2%) had a higher within-herd JD ELISA test-positive prevalence compared to conventional herds (2.3%) if they had at least one JD test-positive animal on the farm. Organic farms had lower risk scores for biosecurity (9 points lower), and higher scores in the calving (7 points higher) and the calf-rearing management areas (4 points higher). After accounting for RAMP score, organic farms received fewer recommendations for the calving management area (Odds Ratio=0.41) and more recommendations in the adult cow management area (Odds Ratio=2.70). A zero-inflated negative binomial model was built with purchase of animals and the herd size included in the logistic portion of the model. Herd type (organic or conventional), colostrum and milk feeding practices, average bulk tank somatic cell count, and presence of non-Holstein breeds were included in the negative binomial portion of the model. Organic farms had a higher number of

  1. [Recommendations of the Spanish Paediatric Endocrinology Society Working Group on Obesity on eating habits for the prevention of obesity and cardiovascular risk factors in childhood].

    Science.gov (United States)

    Palomo Atance, E; Bahíllo Curieses, P; Bueno Lozano, G; Feliu Rovira, A; Gil-Campos, M; Lechuga-Sancho, A M; Ruiz Cano, R; Vela Desojo, A

    2016-03-01

    Childhood obesity is associated with a high risk of cardiovascular disease and early mortality. This paper summarises the currently available evidence on the implications of dietary factors on the development and prevention of obesity in paediatric patients. Evidence-based recommendations are: promote the consumption of slowly absorbed carbohydrates and reduce those with a high-glycaemic-index, avoid intake of sugar-sweetened beverages. Fat may provide up to 30-35% of the daily energy intake and saturated fat should provide no more than 10% of daily energy intake; reduce cholesterol intake, avoid formula milk with a high protein content during the first year; promote higher fibre content in the diet, reduce sodium intake, and have at least four meals a day, avoiding regular consumption of fast food and snacks. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  2. Removing a broken guidewire in the hip joint: treatment options and recommendations for preventing an avoidable surgical catastrophe. A case report

    Directory of Open Access Journals (Sweden)

    Abhijeet Ashok Salunke

    Full Text Available ABSTRACT CONTEXT: Hardware breakage during hip surgery can pose challenging and difficult problems for orthopedic surgeons. Apart from technical difficulties relating to retrieval of the broken hardware, complications such as adjacent joint arthritis and damage to neurovascular structures and major viscera can occur. Complications occurring during the perioperative period must be informed to the patient and proper documentation is essential. The treatment options must be discussed with the patient and relatives and the implant company must be informed about this untoward incident. CASE REPORT: We report a case of complete removal of the implant and then removal of the broken guidewire using a combination of techniques, including a cannulated drill bit, pituitary forceps and Kerrison rongeur. CONCLUSIONS: We suggest some treatment options and recommendations for preventing an avoidable surgical catastrophe.

  3. Output capabilities of personal music players and assessment of preferred listening levels of test subjects: outlining recommendations for preventing music-induced hearing loss.

    Science.gov (United States)

    Breinbauer, Hayo A; Anabalón, Jose L; Gutierrez, Daniela; Cárcamo, Rodrigo; Olivares, Carla; Caro, Jorge

    2012-11-01

    Our goal was to assess the impact of personal music players, earphones, and music styles on output, the subject's preferred listening levels, and outline recommendations for the prevention of music-induced hearing loss. Experimental study. Personal music players' output capabilities and volunteers' preferred output levels were assessed in different settings. Based on current noise-induced hearing loss exposure limits, recommendations were outlined. On three different devices and earphone types and 10 music styles, free field equivalent sound pressure output levels were assessed by applying a microphone probe inside the auditory canal. Forty-five hearing-healthy volunteers were asked to select preferred listening levels in different background noise scenarios. Sound pressure output reached 126 dB. No difference was found between device types, whereas earbud and supra-aural earphones showed significantly lower outputs than in-ear earphones (P music style groups were identified with as much as 14.4 dB difference between them. In silence, 17.8% of volunteers spontaneously selected a listening level above 85 dB. With 90 dB background noise, 40% selected a level above 94 dB. Earphone attenuation capability was found to correlate significantly with preferred level reductions (r = 0.585, P < .001). In-ear and especially supra-aural earphones reduced preferred listening levels the most. Safe-use recommendations were outlined, whereas selecting the lowest volume setting comfortable remained the main suggestion. High background noise attenuating earphones may help in reducing comfortable listening levels and should be preferred. A risk table was elaborated, presenting time limits before reaching a risky exposure. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  4. Supplements in pregnancy: the latest recommendations

    Science.gov (United States)

    Martínez García, Rosa María

    2016-07-12

    Pregnancy is a challenge from the nutritional point of view, because nutrient requirements are increased and alter its intake can affect maternal and fetal health. Micronutrient defi ciency states are related to preeclampsia, intrauterine growth restriction, abortion and congenital anomalies. Currently, the diet of many expectant mothers is insufficient in micronutrients, in this cases supplementation is necessary. It is recommended supplementation with folic acid in doses of 400 mcg / day and 5 mg/day in risk pregnant, and should begin at least one month before conception and during the first 12 weeks gestation, and extend it throughout pregnancy in mothers with nutritional risk. It is important to keep watch the proper dose of folic acid to prevent possible adverse effects of unmetabolized accumulation in plasma. A high percentage of pregnant women presented iron deficiency anemia, being recommended intermittent use of iron supplements (with lower gastrointestinal alteration and oxidative stress); not recommended for mothers without anemia (hemoglobin> 13.5 g / L). Since calcium absorption is increased up to 40% in gestation, its supplementation is not recommended for mothers with adequate intakes (3 dairy / day), and its use must be reserved to women with inadequate intakes and / or high risk of preeclampsia. Regarding the iodine, there are confl icting positions by different working groups established potassium iodide supplementation in women who do not reach their recommended intake (3 servings of milk and dairy products + 2 g of iodized salt), with their diets. Given that vitamin A and D can be toxic to mother and fetus, it is not recommended its supplementation except in cases of deficiency. Although the use of multiple micronutrients supplements may favorably impact the outcome of pregnancy, more scientific evidence is needed to establish the replacement of iron and folic acid with a multiple micronutrient supplement.

  5. Intermittency in 197Au fragmentation

    International Nuclear Information System (INIS)

    Dabrowska, A.; Holynski, R.; Olszewski, A.; Szarska, M.; Wilczynska, B.; Wolter, W.; Wosiek, B.; Cherry, M.L.; Deines-Jones, P.; Jones, W.V.; Sengupta, K.; Wefel, B.

    1995-07-01

    The concept of factorial moments was applied to an analysis of the dynamical fluctuations in the charge distributions of the fragments emitted from gold nuclei with energies 10.6 and < 1.0 GeV/n interacting with emulsion nuclei. Clear evidence for intermittent fluctuations has been found in an analysis using all the particles released from the gold projectile, with a stronger effect observed below 1 GeV/n than at 10.6 GeV/n. For the full data sets, however, the intermittency effect was found to be very sensitive to the singly charged particles, and neglecting these particles strongly reduces the intermittency signal. When the analysis is restricted to the multiply charged fragments, an intermittency effect is revealed only for multifragmentation events, although one that is enhanced as compared to the analysis of all, singly and multiply charged, particles. The properties of the anomalous fractal dimensions suggest a sequential decay mechanism, rather than the existence of possible critical behaviour in the process of nuclear fragmentation. The likely influence of the charge conservation effects and the finite size of decaying systems on the observed intermittency signals was pointed out. (author). 37 refs, 9 figs, 5 tabs

  6. Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 U.S. Preventive Services Task Force Recommendation.

    Science.gov (United States)

    Nelson, Heidi D; Fu, Rochelle; Cantor, Amy; Pappas, Miranda; Daeges, Monica; Humphrey, Linda

    2016-02-16

    In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years. To review studies of the effectiveness of breast cancer screening in average-risk women. MEDLINE and Cochrane databases to 4 June 2015. English-language randomized, controlled trials and observational studies of screening with mammography, magnetic resonance imaging, and ultrasonography that reported breast cancer mortality, all-cause mortality, or advanced breast cancer outcomes. Investigators extracted and confirmed data and dual rated study quality; discrepancies were resolved through consensus. Fair-quality evidence from a meta-analysis of mammography trials indicated relative risks (RRs) for breast cancer mortality of 0.92 for women aged 39 to 49 years (95% CI, 0.75 to 1.02) (9 trials; 3 deaths prevented per 10,000 women over 10 years); 0.86 for those aged 50 to 59 years (CI, 0.68 to 0.97) (7 trials; 8 deaths prevented per 10,000 women over 10 years); 0.67 for those aged 60 to 69 years (CI, 0.54 to 0.83) (5 trials; 21 deaths prevented per 10,000 women over 10 years); and 0.80 for those aged 70 to 74 years (CI, 0.51 to 1.28) (3 trials; 13 deaths prevented per 10,000 women over 10 years). Risk reduction was 25% to 31% for women aged 50 to 69 years in observational studies of mammography screening. All-cause mortality was not reduced with screening. Advanced breast cancer was reduced for women aged 50 years or older (RR, 0.62 [CI, 0.46 to 0.83]) (3 trials) but not those aged 39 to 49 years (RR, 0.98 [CI, 0.74 to 1.37]) (4 trials); less evidence supported this outcome. Most trials used imaging technologies and treatments that are now outdated, and definitions of advanced breast cancer were heterogeneous. Studies of effectiveness based on risk factors, intervals, or other modalities were unavailable or methodologically limited. Breast cancer mortality is generally reduced with mammography

  7. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    Emery, C. A.; Roos, Ewa M.; Verhagen, E.

    2015-01-01

    The risk of post-traumatic osteoarthritis (PTOA) substantially increases following joint injury. Research efforts should focus on investigating the efficacy of preventative strategies in high quality randomized controlled trials (RCT). The objective of these OARSI RCT recommendations is to inform...... the design, conduct and analytical approaches to RCTs evaluating the preventative effect of joint injury prevention strategies. Recommendations regarding the design, conduct, and reporting of RCTs evaluating injury prevention interventions were established based on the consensus of nine researchers...... internationally with expertise in epidemiology, injury prevention and/or osteoarthritis (OA). Input and resultant consensus was established through teleconference, face to face and email correspondence over a 1 year period. Recommendations for injury prevention RCTs include context specific considerations...

  8. Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance: American College of Nurse-Midwives.

    Science.gov (United States)

    2015-01-01

    Fetal heart rate surveillance is a standard component of intrapartum care. The fetal heart rate can be evaluated using intermittent auscultation or electronic fetal monitoring. Research that has compared these 2 strategies found them to be equivalent with respect to long-term neonatal outcomes. The purpose of this clinical bulletin by the American College of Nurse-Midwives is to review the evidence for use of intermittent auscultation and provide recommendations for intermittent auscultation technique, interpretation, and documentation. © 2015 by the American College of Nurse-Midwives.

  9. Intermittent Fasting Modulation of the Diabetic Syndrome in Streptozotocin-Injected Rats

    Directory of Open Access Journals (Sweden)

    Louiza Belkacemi

    2012-01-01

    Full Text Available This study investigates the effects of intermittent overnight fasting in streptozotocin-induced diabetic rats (STZ rats. Over 30 days, groups of 5-6 control or STZ rats were allowed free food access, starved overnight, or exposed to a restricted food supply comparable to that ingested by the intermittently fasting animals. Intermittent fasting improved glucose tolerance, increased plasma insulin, and lowered Homeostatis Model Assessment index. Caloric restriction failed to cause such beneficial effects. The β-cell mass, as well as individual β-cell and islet area, was higher in intermittently fasting than in nonfasting STZ rats, whilst the percentage of apoptotic β-cells appeared lower in the former than latter STZ rats. In the calorie-restricted STZ rats, comparable findings were restricted to individual islet area and percentage of apoptotic cells. Hence, it is proposed that intermittent fasting could represent a possible approach to prevent or minimize disturbances of glucose homeostasis in human subjects.

  10. The Indian National Association for Study of the Liver (INASL) Consensus on Prevention, Diagnosis and Management of Hepatocellular Carcinoma in India: The Puri Recommendations.

    Science.gov (United States)

    Kumar, Ashish; Acharya, Subrat K; Singh, Shivaram P; Saraswat, Vivek A; Arora, Anil; Duseja, Ajay; Goenka, Mahesh K; Jain, Deepali; Kar, Premashish; Kumar, Manoj; Kumaran, Vinay; Mohandas, Kunisshery M; Panda, Dipanjan; Paul, Shashi B; Ramachandran, Jeyamani; Ramesh, Hariharan; Rao, Padaki N; Shah, Samir R; Sharma, Hanish; Thandassery, Ragesh B

    2014-08-01

    Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality and healthcare expenditure in patients with chronic liver disease. There are no consensus guidelines on diagnosis and management of HCC in India. The Indian National Association for Study of the Liver (INASL) set up a Task-Force on HCC in 2011, with a mandate to develop consensus guidelines for diagnosis and management of HCC, relevant to disease patterns and clinical practices in India. The Task-Force first identified various contentious issues on various aspects of HCC and these issues were allotted to individual members of the Task-Force who reviewed them in detail. The Task-Force used the Oxford Center for Evidence Based Medicine-Levels of Evidence of 2009 for developing an evidence-based approach. A 2-day round table discussion was held on 9th and 10th February, 2013 at Puri, Odisha, to discuss, debate, and finalize the consensus statements. The members of the Task-Force reviewed and discussed the existing literature at this meeting and formulated the INASL consensus statements for each of the issues. We present here the INASL consensus guidelines (The Puri Recommendations) on prevention, diagnosis and management of HCC in India.

  11. Knowledge of HIV Testing Guidelines Among US Internal Medicine Residents: A Decade After the Centers for Disease Control and Prevention's Routine HIV Testing Recommendations.

    Science.gov (United States)

    Dandachi, Dima; Dang, Bich N; Wilson Dib, Rita; Friedman, Harvey; Giordano, Thomas

    2018-05-01

    Ten years after the Centers for Disease Control and Prevention recommended universal HIV screening, rates remain low. Internal medicine residents are the front-line medical providers for large groups of patients. We evaluated the knowledge of internal medicine residents about HIV testing guidelines and examined adherence to universal HIV testing in an outpatient setting. A cross-sectional survey of internal medicine residents at four residency programs in Chicago was conducted from January to March 2016. Aggregate data on HIV screening were collected from 35 federally qualified community health centers in the Chicago area after inclusion of an HIV testing best practice alert in patients' electronic medical records. Of the 192 residents surveyed, 130 (68%) completed the survey. Only 58% were aware of universal HIV screening and 49% were aware that Illinois law allows for an opt-out HIV testing strategy. Most of the residents (64%) ordered no more than 10 HIV tests in 6 months. The most frequently reported barriers to HIV testing were deferral because of urgent care issues, lack of time, and the perception that patients were uncomfortable discussing HIV testing. From July 2015 to February 2016, the average HIV testing adherence rate in the 35 health centers was 18.2%. More effort is needed to change HIV testing practices among internal medicine residents so that they will adopt this approach in their future clinical practice. Improving knowledge about HIV testing and addressing other HIV testing barriers are essential for such a successful change.

  12. Physical examination instead of laboratory tests for most infants born to mothers colonized with group B Streptococcus: support for the Centers for Disease Control and Prevention's 2010 recommendations.

    Science.gov (United States)

    Cantoni, Luigi; Ronfani, Luca; Da Riol, Rosalia; Demarini, Sergio

    2013-08-01

    To compare 2 approaches in the management of neonates at risk for group B Streptococcus early-onset sepsis: laboratory tests plus standardized physical examination and standardized physical examination alone. Prospective, sequential study over 2 consecutive 12-month periods, carried out in the maternity hospitals of the region Friuli-Venezia Giulia (north-eastern Italy). All term infants were included (7628 in the first period, 7611 in the second). In the first period, complete blood count and blood culture were required for all infants at risk, followed by a 48-hour period of observation with a standardized physical examination. In the second period, only standardized physical examination was performed. Study outcomes were: (1) number of neonates treated with antibiotics; and (2) time between onset of signs of possible sepsis and beginning of treatment. There was no difference between the 2 periods in the rate of maternal colonization (19.7% vs 19.8%, P = .8), or in other risk factors. The interval between onset of signs of sepsis and starting of antibiotics was not different in the 2 periods. Significantly fewer infants were treated with antibiotics in the second period (0.5% vs 1.2%, P examination seem to offer no advantage over standardized physical examination alone; the latter was associated with fewer antibiotic treatments. Our results are in agreement with the Center for Disease Control and Prevention's 2010 recommendations. Copyright © 2013 Mosby, Inc. All rights reserved.

  13. [Occupational skin cancer : Prevention and recommendations for UV protection as part of the treatment approved by the public statutory employers' liability insurance].

    Science.gov (United States)

    Rocholl, M; Ludewig, M; Skudlik, C; Wilke, A

    2018-04-27

    In Germany, approximately 2 to 3 million employees work in outdoor professions. They are exceptionally exposed to solar ultraviolet (UV) radiation for a large part of their daily working time. Cumulative UV exposure is associated with a significantly increased risk of skin cancer for outdoor workers from various occupational groups (e. g. landscape and horticulture, agriculture and forestry, fisheries and seafaring, construction and trade, as well as sports teachers, lifeguards and mountain guides). Since 1 January 2015, squamous cell carcinoma and multiple actinic keratosis due to natural UV radiation can be recognised as occupational disease No. 5103 by the German statutory social accident insurance. Reducing cumulative UV exposure is the main prevention aspect of this type of skin damage. Therefore, technical, organisational and personal UV protection measures should be implemented in the professional and private environment. Moreover, they have to be regularly used in an appropriate way. In addition to guideline-oriented therapy, training and counselling of patients with already existing actinic skin damage or a recognised occupational disease No. 5103 is therefore of particular importance. The focus should be on improving the individual UV protection behaviour. This article gives an overview of current recommendations for UV protection in the professional environment. It outlines possible solutions for patient counselling in terms of UV protection in everyday practice.

  14. Effect of prolonged and intermittent treatment on the clinical course of peptic ulcer.

    Science.gov (United States)

    Chornenka, Zhanetta A; Yasinska, Elvira Ts; Grytsiuk, Mariana I

    2018-01-01

    Introduction: The number of patients with peptic ulcer increases annually. According to published data, patients with peptic ulcer constitute about 15% of those hospitalized with gastrointestinal diseases. The aim: That is why we set the task to evaluate the methods of preventive treatment and to choose the most effective one. Materials and methods: For this purpose, we selected 103 patients with peptic ulcer without severe exacerbations and complications from one region (main group) and 101 patients from another region (control group) for observations. Making diagnosis was based on the study of complaints, anamnestic data, physical examination of the patient, evaluation of the functional state of the gastroduodenal system, as well as the X-ray and endoscopic examination. The sources of the study were medical records of outpatients, control cards for dispensary surveillance, registers of temporary disability records, sick leave records and others. Results: Most patients, from both the main and control groups, who were on prophylactic treatment, noticed that they had an increased working capacity, normalized sleep, better appetite and fewer dyspeptic disorders. Patients in the main group for two years were on prolonged prophylactic treatment according to the method that we had developed. by us. Patients in the control group received an intermittent preventive treatment twice a year (in spring and autumn). In the complex of therapeutic measures the following were used: dietary recommendations, antacids, cholinolytics, multivitamins, etc. Conclusions: Prolonged prophylactic treatment is an effective means to combat exacerbations and complications of peptic ulcer and can be recommended for implementation in practice.

  15. Intermittent oral iron supplementation during pregnancy (Review)

    Science.gov (United States)

    Peña-Rosas, Juan Pablo; De-Regil, Luz Maria; Dowswell, Therese; Viteri, Fernando E

    2014-01-01

    Background Anaemia is a frequent condition during pregnancy, particularly among women from developing countries who have insufficient iron intake to meet increased iron needs of both the mother and the fetus. Traditionally, gestational anaemia has been prevented with the provision of daily iron supplements throughout pregnancy, but adherence to this regimen due to side effects, interrupted supply of the supplements, and concerns about safety among women with an adequate iron intake, have limited the use of this intervention. Intermittent (i.e. one, two or three times a week on non-consecutive days) supplementation with iron alone or in combination with folic acid or other vitamins and minerals has recently been proposed as an alternative to daily supplementation. Objectives To assess the benefits and harms of intermittent supplementation with iron alone or in combination with folic acid or other vitamins and minerals to pregnant women on neonatal and pregnancy outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (23 March 2012). We also searched the WHO International Clinical Trials Registry Platform (ICTRP) for ongoing studies and contacted relevant organisations for the identification of ongoing and unpublished studies (23 March 2012). Selection criteria Randomised or quasi-randomised trials. Data collection and analysis We assessed the methodological quality of trials using standard Cochrane criteria. Two review authors independently assessed trial eligibility, extracted data and conducted checks for accuracy. Main results This review includes 21 trials from 13 different countries, but only 18 trials (with 4072 women) reported on our outcomes of interest and contributed data to the review. All of these studies compared daily versus intermittent iron supplementation. Three studies provided iron alone, 12 iron+folic acid and three more iron plus multiple vitamins and minerals. Their methodological quality was mixed

  16. Adequacy in dialysis: intermittent versus continuous therapies.

    Science.gov (United States)

    Misra, M; Nolph, K D

    2000-01-01

    relationship between outcome and dialysis dose needs to be better defined. Data relating adequacy of dialysis to outcome in a pediatric population is not available. In dialysis therapy, the Risk/Dose (R/D) function does not bear a linear relationship. This together with a lack of proof equating peritoneal to renal clearance lends some uncertainty to the validity of the recommendation that there is a linear and constant decrease in RR for std (Kt/V) [equivalent standardized Kt/V calculated from average predialysis BUN for any frequency and/or combination of intermittent and continuous dialysis ref] up to 2.3 as reported in the CANUSA study. Due to the complex nature of this problem it may be prudent to undertake a multi-center trial with std (Kt/V) prospectively randomized to either 2.0 or 2.4. This would provide a reliable database to evaluate the R/D function over this critical range of normalized peritoneal urea clearance. Likewise in PD, the postulated linearity between dialysis dose and outcome needs to be studied in a prospective randomized manner. The amount of dialysis dose required for malnourished patients, diabetic and pediatric patients needs to be better defined. The role of aggressive dialysis in reversing malnutrition needs to be studied and studies need to be done to identify the most scientific use of V in malnourished patients. Justification of a healthy start/incremental dialysis based on outcome measures needs to be established and it's cost effectiveness validated by clinical trials. Again, a prospective randomized controlled trial comparing incremental dialysis with dietary protein restriction in patients with GFR < or = 10.5 ml/min/1.73 m2 with properly defined outcome measures like morbidity, mortality, decline of GFR and quality of life needs to be conducted. Comparisons of incremental hemodialysis and incremental peritoneal dialysis need to be made especially with regard to technique survival and preservation of residual renal function (RRF). (ABSTR

  17. Perioperative corticosteroids for intermittent and mild persistent asthma

    OpenAIRE

    Hiroto Matsuse; Terufumi Shimoda; Ikuko Machida; Yuki Kondo; Tetsuya Kawano; Sachiko Saeki; Shinya Tomari; Kazuko Mitsuta; Chizu Fukushima; Yasushi Obase; Shigeru Kohno

    2002-01-01

    Objectives: Asthmatics are considered to be at high risk for pulmonary complications during general anesthesia with tracheal intubation. The purpose of the present study was to determine the usefulness of perioperative corticosteroids for mild asthmatics in preventing perioperative exacerbation of asthma. Methods: Airway hyperresponsiveness to inhaled methacholine was determined in patients with intermittent (n = 27) and mild persistent (n = 48) asthma before general anesthesia who underwe...

  18. Comprehensive review of methicillin-resistant Staphylococcus aureus: screening and preventive recommendations for plastic surgeons and other surgical health care providers.

    Science.gov (United States)

    O'Reilly, Eamon B; Johnson, Mark D; Rohrich, Rod J

    2014-11-01

    Up to 2.3 million people are colonized with methicillin-resistant Staphylococcus aureus in the United States, causing well-documented morbidity and mortality. Although the association of clinical outcomes with community and hospital carriage rates is increasingly defined, less is reported about asymptomatic colonization prevalence among physicians, and specifically plastic surgeons and the subsequent association with the incidence of patient surgical-site infection. A review of the literature using the PubMed and Cochrane databases analyzing provider screening, transmission, and prevalence was undertaken. In addition, a search was completed for current screening and decontamination guidelines and outcomes. The methicillin-resistant S. aureus carriage prevalence of surgical staff is 4.5 percent. No prospective data exist regarding transmission and interventions for plastic surgeons. No studies were found specifically looking at prevalence or treatment of plastic surgeons. Current recommendations by national organizations focus on patient-oriented point-of-care testing and intervention, largely ignoring the role of the health care provider. Excellent guidelines exist regarding screening, transmission prevention, and treatment both in the workplace and in the community. No current such guidelines exist for plastic surgeons. No Level I or II evidence was found regarding physician screening, treatment, or transmission. Current expert opinion, however, indicates that plastic surgeons and their staff should be vigilant for methicillin-resistant S. aureus transmission, and once a sentinel cluster of skin and soft-tissue infections is identified, systematic screening and decontamination should be considered. If positive, topical decolonization therapy should be offered. In refractory cases, oral antibiotic therapy may be required, but this should not be used as a first-line strategy.

  19. [Recommendations of the European Society of Cardiology and the European Atherosclerosis Society on Cardiovascular Disease Prevention and Management of Dyslipidemias. for the Diagnosis of Atherosclerosis and Dyslipidemia Treatment (2016): Basic S.G.

    Science.gov (United States)

    Bubnova, M G; Kukharchuk, V V

    2017-03-01

    This review summarizes the main provisions of the new, issued in 2016, recommendations of the European Society of Cardiology and Atherosclerosis Society in cooperation with the European Association on Cardiovascular Prevention and Rehabilitation on Cardiovascular disease prevention and Management of dyslipidemia. In these recommendations, the following trends can be traced distinctly: priority in primary prevention is given to non-drug methods of influence; targets of hypolipidemic therapy are identified not only for low density lipoprotein (LDL) cholesterol (CH), but also for non-high density lipoprotein (HDL) CH, especially in cases of concomitant hypertriglyceridemia. In the field of therapy, in which statins remain the main tool of correction of hyperlipidemia, it is recommended to more widely resort to the use of combination therapy, especially in cases of familial hypercholesterolemia or intolerance to statins; introduction of a new class of drugs- inhibitors of proprotein convertase subtilisin/kexin type 9 makes it possible to further reduce the level of LDLCH, lipoprotein(a) more than 60%. Regarding the wider application of these drugs there are issues related to the relatively limited experience of their use and the lack of data on long-term results and the incidence of side effects. Much attention is paid to more active correction of dyslipidemia in elderly patients, patients with chronic renal failure, diabetes, and several other diseases. The emergence of new European recommendations will undoubtedly serve as a stimulus to the revision of the Russian recommendations, which remain unchanged from 2012.

  20. Recommendations for sampling for prevention of hazards in civil defense. On analytics of chemical, biological and radioactive contaminations. 2. ed.; Empfehlungen fuer die Probenahme zur Gefahrenabwehr im Bevoelkerungsschutz. Zur Analytik von chemischen, biologischen und radioaktiven Kontaminationen

    Energy Technology Data Exchange (ETDEWEB)

    Bachmann, Udo; Derakshani, Nahid; Drobig, Matthias; Koenig, Mario; Mentfewitz, Joachim; Prast, Hartmut; Uelpenich, Gerhard; Vidmayer, Marc; Wilbert, Stefan; Wolf, Manfred

    2016-07-01

    The recommendations for sampling for prevention of hazards in civil defense (analytics of chemical, biological and radioactive contaminations) cover the following topics: Requirements for sampling, description of the materials (chemical, biological and radioactive contaminated materials), decontamination, sample transport and protocol documents.

  1. Intermittent hypoxic episodes in preterm infants: do they matter?

    Science.gov (United States)

    Martin, Richard J; Wang, Katherine; Köroğlu, Ozge; Di Fiore, Juliann; Kc, Prabha

    2011-01-01

    Intermittent hypoxic episodes are typically a consequence of immature respiratory control and remain a troublesome challenge for the neonatologist. Furthermore, their frequency and magnitude are underestimated by clinically employed pulse oximeter settings. In extremely low birth weight infants the incidence of intermittent hypoxia progressively increases over the first 4 weeks of postnatal life, with a subsequent plateau followed by a slow decline beginning at weeks 6-8. Such episodic hypoxia/reoxygenation has the potential to sustain a proinflammatory cascade with resultant multisystem morbidity. This morbidity includes retinopathy of prematurity and impaired growth, as well as possible longer-term cardiorespiratory instability and poor neurodevelopmental outcome. Therapeutic approaches for intermittent hypoxic episodes comprise determination of optimal baseline saturation and careful titration of supplemental inspired oxygen, as well as xanthine therapy to prevent apnea of prematurity. In conclusion, characterization of the pathophysiologic basis for such intermittent hypoxic episodes and their consequences during early life is necessary to provide an evidence-based approach to their management. Copyright © 2011 S. Karger AG, Basel.

  2. Physiologic basis for intermittent hypoxic episodes in preterm infants.

    Science.gov (United States)

    Martin, R J; Di Fiore, J M; Macfarlane, P M; Wilson, C G

    2012-01-01

    Intermittent hypoxic episodes are typically a consequence of immature respiratory control and remain a troublesome challenge for the neonatologist. Furthermore, their frequency and magnitude are commonly underestimated by clinically employed pulse oximeter settings. In extremely low birth weight infants the incidence of intermittent hypoxia [IH] progressively increases over the first 4 weeks of postnatal life, with a subsequent plateau followed by a slow decline beginning at weeks six to eight. Over this period of unstable respiratory control, increased oxygen-sensitive peripheral chemoreceptor activity has been associated with a higher incidence of apnea of prematurity. In contrast, infants with bronchopulmonary dysplasia [chronic neonatal lung disease] exhibit decreased peripheral chemosensitivity, although the effect on respiratory stability in this population is unclear. Such episodic hypoxia/reoxygenation in early life has the potential to sustain a proinflammatory cascade with resultant multisystem, including respiratory, morbidity. Therapeutic approaches for intermittent hypoxic episodes comprise careful titration of baseline or supplemental inspired oxygen as well as xanthine therapy to prevent apnea of prematurity. Characterization of the pathophysiologic basis for such intermittent hypoxic episodes and their consequences during early life is necessary to provide an evidence-based approach to their management.

  3. The influence of continuous and intermittent traffic noise on sleep

    Science.gov (United States)

    Eberhardt, J. L.; Stråle, L.-O.; Berlin, M. H.

    1987-08-01

    The effects of road traffic noise on sleep were studied in the laboratory using nine young male adults (aged 20-26). The subjects were exposed to noise with different temporal characteristics: (i) continuous traffic noise of 36 dB(A) or 45 dB(A), (ii) intermittent noise of 50 truck passages with L pmax = 45 dB(A) ( L eq = 29 dB(A)) or L pmax = 55 dB(A) ( L eq = 36 dB(A)), and (iii) a combination of continuous (45 dB(A)) and intermittent ( L pmax = 55 dB(A)) traffic noise. For one noise condition (intermittent 55 dB(A)) the effect of the use of ear plugs was also studied. The intermittent noise of L pmax = 45 dB(A) caused transitions towards lighter sleep, whereas 55 dB(A) was needed to induce awakening effects. It could be shown that the probability for arousal reactions depends on the emergence of the noise peaks from the background, rather than the absolute noise peak level. Continuous traffic noise of 45 dB(A) caused REM sleep deficits, while intermittent traffic noise of L pmax = 45 dB(A) caused stage III+IV deficits. The night with ear plugs was virtually undisturbed. After nights with REM sleep deficits the subjective sleep quality was rated lower and mood was influenced adversely. For the types of exposure used in the present investigation L eq alone is not an adequate descriptor of the noise dose, relating to the sleep disturbances observed. From the present experiment, together with other existing data, it might be concluded that the WHO recommendation of L eq = 35 dB(A) is adequate, but should be supplemented with a maximum noise level, as expressed for example in L pmax or LI, that should not be exceeded.

  4. After the flood is before the next flood - post event review of the Central European Floods of June 2013. Insights, recommendations and next steps for future flood prevention

    Science.gov (United States)

    Szoenyi, Michael; Mechler, Reinhard; McCallum, Ian

    2015-04-01

    In early June 2013, severe flooding hit Central and Eastern Europe, causing extensive damage, in particular along the Danube and Elbe main watersheds. The situation was particularly severe in Eastern Germany, Austria, Hungary and the Czech Republic. Based on the Post Event Review Capability (PERC) approach, developed by Zurich Insurance's Flood Resilience Program to provide independent review of large flood events, we examine what has worked well (best practice) and opportunities for further improvement. The PERC overall aims to thoroughly examine aspects of flood resilience, flood risk management and catastrophe intervention in order to help build back better after events and learn for future events. As our research from post event analyses shows a lot of losses are in fact avoidable by taking the right measures pre-event and these measures are economically - efficient with a return of 4 Euro on losses saved for every Euro invested in prevention on average (Wharton/IIASA flood resilience alliance paper on cost benefit analysis, Mechler et al. 2014) and up to 10 Euros for certain countries. For the 2013 flood events we provide analysis on the following aspects and in general identify a number of factors that worked in terms of reducing the loss and risk burden. 1. Understanding risk factors of the Central European Floods 2013 We review the precursors leading up to the floods in June, with an extremely wet May 2013 and an atypical V-b weather pattern that brought immense precipitation in a very short period to the watersheds of Elbe, Donau and partially the Rhine in the D-A-CH countries and researched what happened during the flood and why. Key questions we asked revolve around which protection and risk reduction approaches worked well and which did not, and why. 2. Insights and recommendations from the post event review The PERC identified a number of risk factors, which need attention if risk is to be reduced over time. • Yet another "100-year flood" - risk

  5. Recommender systems

    OpenAIRE

    Lu L.; Medo M.; Yeung C.H.; Zhang Y.-C.; Zhang Z.-K.; Zhou T.

    2012-01-01

    The ongoing rapid expansion of the Internet greatly increases the necessity of effective recommender systems for filtering the abundant information. Extensive research for recommender systems is conducted by a broad range of communities including social and computer scientists, physicists, and interdisciplinary researchers. Despite substantial theoretical and practical achievements, unification and comparison of different approaches are lacking, which impedes further advances. In this article...

  6. European recommendations for primary prevention of congenital anomalies: A joined effort of EUROCAT and EUROPLAN projects to facilitate inclusion of this topic in the National Rare Disease Plans

    DEFF Research Database (Denmark)

    Taruscio, Domenica; Arriola, Larraitz; Baldi, Francesca

    2014-01-01

    Congenital anomalies (CA) are the paradigm example of rare diseases liable to primary prevention actions due to the multifactorial etiology of many of them, involving a number of environmental factors together with genetic predispositions. Yet despite the preventive potential, lack of attention t...

  7. Chronic stress in adulthood followed by intermittent stress impairs spatial memory and the survival of newborn hippocampal cells in aging animals: prevention by FGL, a peptide mimetic of neural cell adhesion molecule

    DEFF Research Database (Denmark)

    Borcel, Erika; Pérez-Alvarez, Laura; Herrero, Ana Isabel

    2008-01-01

    In this study, we examined whether chronic stress in adulthood can exert long-term effects on spatial-cognitive abilities and on the survival of newborn hippocampal cells in aging animals. Male Wistar rats were subjected to chronic unpredictable stress at midlife (12 months old) and then reexposed...... in the hippocampus. Interestingly, spatial-memory performance in the Morris water maze was positively correlated with the number of newborn cells that survived in the dentate gyrus: better spatial memory in the water maze was associated with more 5-bromo-2-deoxyuridine (BrdU)-labeled cells. Administration of FGL......, a peptide mimetic of neural cell adhesion molecule, during the 4 weeks of continuous stress not only prevented the deleterious effects of chronic stress on spatial memory, but also reduced the survival of the newly generated hippocampal cells in aging animals. FGL treatment did not, however, prevent...

  8. The Yo-Yo intermittent recovery test

    DEFF Research Database (Denmark)

    Bangsbo, Jens; Iaia, F. Marcello; Krustrup, Peter

    2008-01-01

    The two Yo-Yo intermittent recovery (IR) tests evaluate an individual's ability to repeatedly perform intense exercise. The Yo-Yo IR level 1 (Yo-Yo IR1) test focuses on the capacity to carry out intermittent exercise leading to a maximal activation of the aerobic system, whereas Yo-Yo IR level 2...

  9. Intermittent behavior of the logistic system

    Science.gov (United States)

    Mayer-Kress, G.; Haken, H.

    1981-03-01

    In the discrete logistic model a transition to chaotic behavior via intermittency occurs in a neighborhood of periodic bands. Intermittent behavior is also induced if a stable periodic orbit is perturbed by low-level external noise, whereas alterations due to computer digitalisation produce remarkable periodicities. We compare our numerical results with the predictions of Pomeau and Manneville for the Lorenz system.

  10. Recommender systems

    CERN Document Server

    Kembellec, Gérald; Saleh, Imad

    2014-01-01

    Acclaimed by various content platforms (books, music, movies) and auction sites online, recommendation systems are key elements of digital strategies. If development was originally intended for the performance of information systems, the issues are now massively moved on logical optimization of the customer relationship, with the main objective to maximize potential sales. On the transdisciplinary approach, engines and recommender systems brings together contributions linking information science and communications, marketing, sociology, mathematics and computing. It deals with the understan

  11. Gaps in the prevention of perinatal transmission of hepatitis B virus between recommendations and routine practices in a highly endemic region: a provincial population-based study in China

    Directory of Open Access Journals (Sweden)

    Hu Yali

    2012-09-01

    Full Text Available Abstract Background Hepatitis B virus (HBV infection is endemic in China; perinatal transmission is the main source of chronic HBV infection. Simultaneous administration of hepatitis B immune globulin (HBIG and hepatitis B vaccine is highly effective to prevent perinatal transmission of HBV; however, the effectiveness also depends on full adherence to the recommended protocols in daily practice. In the present investigation, we aimed to identify gaps in immunoprophylaxis of perinatal transmission of HBV between recommendations and routine practices in Jiangsu Province, China. Methods Totally 626 children from 6 cities and 8 rural areas across Jiangsu Province, China, born from February 2003 to December 2004, were enrolled; 298 were born to mothers with positive hepatitis B surface antigen (HBsAg and 328 were born to HBsAg-negative mothers. Immunoprophylactic measures against hepatitis B were retrospectively reviewed for about half of the children by checking medical records or vaccination cards and the vaccine status was validated for most of children. Results Of 298 children born to HBV carrier mothers, 11 (3.7% were HBsAg positive, while none of 328 children born to non-carrier mothers was HBsAg positive (P  Conclusions There are substantial gaps in the prevention of perinatal HBV infection between the recommendations and routine practices in China, which highlights the importance of full adherence to the recommendations to eliminate perinatal HBV infection in the endemic regions.

  12. Cosmic Rays in Intermittent Magnetic Fields

    International Nuclear Information System (INIS)

    Shukurov, Anvar; Seta, Amit; Bushby, Paul J.; Wood, Toby S.; Snodin, Andrew P.

    2017-01-01

    The propagation of cosmic rays in turbulent magnetic fields is a diffusive process driven by the scattering of the charged particles by random magnetic fluctuations. Such fields are usually highly intermittent, consisting of intense magnetic filaments and ribbons surrounded by weaker, unstructured fluctuations. Studies of cosmic-ray propagation have largely overlooked intermittency, instead adopting Gaussian random magnetic fields. Using test particle simulations, we calculate cosmic-ray diffusivity in intermittent, dynamo-generated magnetic fields. The results are compared with those obtained from non-intermittent magnetic fields having identical power spectra. The presence of magnetic intermittency significantly enhances cosmic-ray diffusion over a wide range of particle energies. We demonstrate that the results can be interpreted in terms of a correlated random walk.

  13. Cosmic Rays in Intermittent Magnetic Fields

    Energy Technology Data Exchange (ETDEWEB)

    Shukurov, Anvar; Seta, Amit; Bushby, Paul J.; Wood, Toby S. [School of Mathematics and Statistics, Newcastle University, Newcastle Upon Tyne NE1 7RU (United Kingdom); Snodin, Andrew P., E-mail: a.seta1@ncl.ac.uk, E-mail: amitseta90@gmail.com [Department of Mathematics, Faculty of Applied Science, King Mongkut’s University of Technology North Bangkok, Bangkok 10800 (Thailand)

    2017-04-10

    The propagation of cosmic rays in turbulent magnetic fields is a diffusive process driven by the scattering of the charged particles by random magnetic fluctuations. Such fields are usually highly intermittent, consisting of intense magnetic filaments and ribbons surrounded by weaker, unstructured fluctuations. Studies of cosmic-ray propagation have largely overlooked intermittency, instead adopting Gaussian random magnetic fields. Using test particle simulations, we calculate cosmic-ray diffusivity in intermittent, dynamo-generated magnetic fields. The results are compared with those obtained from non-intermittent magnetic fields having identical power spectra. The presence of magnetic intermittency significantly enhances cosmic-ray diffusion over a wide range of particle energies. We demonstrate that the results can be interpreted in terms of a correlated random walk.

  14. ANISOTROPIC INTERMITTENCY OF MAGNETOHYDRODYNAMIC TURBULENCE

    International Nuclear Information System (INIS)

    Osman, K. T.; Kiyani, K. H.; Chapman, S. C.; Hnat, B.

    2014-01-01

    A higher-order multiscale analysis of spatial anisotropy in inertial range magnetohydrodynamic turbulence is presented using measurements from the STEREO spacecraft in fast ambient solar wind. We show for the first time that, when measuring parallel to the local magnetic field direction, the full statistical signature of the magnetic and Elsässer field fluctuations is that of a non-Gaussian globally scale-invariant process. This is distinct from the classic multiexponent statistics observed when the local magnetic field is perpendicular to the flow direction. These observations are interpreted as evidence for the weakness, or absence, of a parallel magnetofluid turbulence energy cascade. As such, these results present strong observational constraints on the statistical nature of intermittency in turbulent plasmas

  15. Prolonged Intermittent Renal Replacement Therapy.

    Science.gov (United States)

    Edrees, Fahad; Li, Tingting; Vijayan, Anitha

    2016-05-01

    Prolonged intermittent renal replacement therapy (PIRRT) is becoming an increasingly popular alternative to continuous renal replacement therapy in critically ill patients with acute kidney injury. There are significant practice variations in the provision of PIRRT across institutions, with respect to prescription, technology, and delivery of therapy. Clinical trials have generally demonstrated that PIRRT is non-inferior to continuous renal replacement therapy regarding patient outcomes. PIRRT offers cost-effective renal replacement therapy along with other advantages such as early patient mobilization and decreased nursing time. However, due to lack of standardization of the procedure, PIRRT still poses significant challenges, especially pertaining to appropriate drug dosing. Future guidelines and clinical trials should work toward developing consensus definitions for PIRRT and ensure optimal delivery of therapy. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  16. Are the current recommendations for the use of aspirin in primary prevention of cardiovascular disease applicable in low-income countries?

    Directory of Open Access Journals (Sweden)

    Noubiap JJ

    2015-08-01

    Full Text Available Jean Jacques N Noubiap,1,2 Jobert Richie N Nansseu3,41Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; 2Medical Diagnostic Center, Yaoundé, Cameroon; 3Sickle Cell Disease Unit, Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon; 4Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, CameroonAbstract: Although evidence has accumulated that long-term aspirin therapy is beneficial in secondary prevention of cardiovascular disease (CVD, a lot of controversies persist regarding the benefit of aspirin use in primary prevention of CVD. In low-income countries (LIC specifically, the decision to prescribe aspirin for primary CVD prevention is more problematic, as there is a dearth of evidence in this regard. Aspirin has been shown to have relative beneficial effects in preventing a first myocardial infarction, but not stroke. However, as stroke is the prevailing CVD in many LIC, especially in Africa, the benefit of aspirin in these settings is therefore questionable. Indeed, there is no published trial that has evaluated the benefits and risks of continuous aspirin therapy in populations of LIC. Furthermore, though cardiovascular risk assessment is crucial in decision-making for the use of aspirin in primary prevention of CVD, there are no risk assessment tools that have been validated in African populations. Studies are urgently warranted, to determine the usefulness of aspirin in primary prevention of CVD in low-income settings where the drug is highly available and affordable, as CVD is becoming the leading cause of deaths in LIC.Keywords: aspirin, cardiovascular disease, primary prevention, low-income countries

  17. Cholera Prevention and Control

    Science.gov (United States)

    ... name=”commit” type=”submit” value=”Submit” /> Prevention & Control Recommend on Facebook Tweet Share Compartir Prevention of ... of cholera and other diarrheal disease prevention. Prevention & Control Topics Ending Cholera: The Global Roadmap to 2030 ...

  18. Intermittent hypoxia in childhood: the harmful consequences versus potential benefits of therapeutic uses

    Directory of Open Access Journals (Sweden)

    Tatiana V. Serebrovskaya

    2015-05-01

    Full Text Available Intermittent hypoxia often occurs in early infancy in both preterm and term infants and especially at 36 to 44 weeks postmenstrual age. These episodes of intermittent hypoxia could result from sleep-disordered breathing or may be temporally unrelated to apnea or bradycardia events. There are numerous reports indicating adverse effects of intermittent hypoxia on development, behavior, academic achievement and cognition in children with sleep apnea syndrome. It remains uncertain the exact causative relationship between the neurocognitive and behavioral morbidities and intermittent hypoxia and/or its associated sleep fragmentation. On the other hand, well-controlled and moderate intermittent hypoxia conditioning/training has been used in sick children for treating their various forms of bronchial asthma, allergic dermatoses, autoimmune thyroiditis, cerebral palsy, and obesity. This review article provides an updated and impartial analysis on the currently available evidence in supporting either side of the seemingly contradictory scenarios. We wish to stimulate a comprehensive understanding of such a complex physiological phenomenon as intermittent hypoxia, which may be accompanied by other confounding factors (e.g. hypercapnia, polycythemia, in order to prevent or reduce its harmful consequences, while maximize its potential utility as an effective therapeutic tool in pediatric patients.

  19. Intermittent cranial lung herniation in two dogs.

    Science.gov (United States)

    Guglielmini, Carlo; De Simone, Antonio; Valbonetti, Luca; Diana, Alessia

    2007-01-01

    Two aged dogs with chronic obstructive airway disease were evaluated because of intermittent swelling of the ventral cervical region. Radiographs made at expiration and caudal positioning of the forelimbs allowed identification of intermittent cervical lung herniation of the left and right cranial lung lobe in both dogs. Pulmonary hyperinflation, increased expiratory effort, and chronic coughing were considered responsible for the lung herniation. Cervical lung hernia should be included in the differential diagnoses of intermittent cervical swelling in dogs with chronic respiratory disorders associated with increased expiratory effort and chronic coughing.

  20. Screening Mammography for Women in Their 40s: The Potential Impact of the American Cancer Society and U.S. Preventive Services Task Force Breast Cancer Screening Recommendations.

    Science.gov (United States)

    Pitman, Jenifer A; McGinty, Geraldine B; Soman, Rohan R; Drotman, Michele B; Reichman, Melissa B; Arleo, Elizabeth Kagan

    2017-09-01

    The purpose of this study was to review screening mammograms obtained in one practice with the primary endpoint of determining the rate of detection of breast cancer and associated prognostic features in women 40-44 and 45-49 years old. The retrospective cohort study included women in their 40s with breast cancer detected at screening from June 2014 through May 2016. The focus was on cancer detection rate, pathologic findings, and risk factors. A total of 32,762 screens were performed, and 808 biopsies were recommended. These biopsies yielded 224 breast cancers (cancer detection rate, 6.84 per 1000 screens). Women 40-49 years old had 18.8% of cancers detected; 50-59 years, 21.8%; 60-69 years, 32.6%; and 70-79 years, 21.4%. Among the 40- to 49-year-old women, women 40-44 years old underwent 5481 (16.7%) screens, had 132 biopsies recommended, and had 20 breast cancers detected (cancer detection rate, 3.6/1000). Women 45-49 years old underwent 5319 (16.2%) screens, had 108 biopsies recommended, and had 22 breast cancers detected (cancer detection rate, 4.1/1000). Thus, women 40-44 years old had 8.9% and women 45-49 years old had 9.8% of all screen-detected breast cancers. Of these only a small percentage of women with detected cancers had a first-degree relative with breast cancer (40-44 years, 15%; 45-49 years, 32%) or a BRCA mutation (40-44 years, 5%; 45-49 years, 5%), and over 60% of the cancers were invasive. Women 40-49 years old had 18.8% of all screen-detected breast cancers. The two cohorts (40-44 and 45-49 years old) had similar incidences of screen-detected breast cancer (8.9%, 9.8%) and cancer detection rates within performance benchmark standards, supporting a similar recommendation for both cohorts and the American College of Radiology recommendation of annual screening mammography starting at age 40.

  1. Pressure Ulcer in Norway—A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care

    Science.gov (United States)

    Johansen, Edda; Bakken, Linda N.; Moore, Zena

    2015-01-01

    Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured. PMID:27417771

  2. Pressure Ulcer in Norway—A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care

    Directory of Open Access Journals (Sweden)

    Edda Johansen

    2015-06-01

    Full Text Available Pressure ulcers (PU are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU, however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured.

  3. Knockdown of angiopoietin-like 2 mimics the benefits of intermittent fasting on insulin responsiveness and weight loss.

    Science.gov (United States)

    Martel, Cécile; Pinçon, Anthony; Bélanger, Alexandre Maxime; Luo, Xiaoyan; Gillis, Marc-Antoine; de Montgolfier, Olivia; Thorin-Trescases, Nathalie; Thorin, Éric

    2018-01-01

    Angiopoietin-like 2 (ANGPTL2) is an inflammatory adipokine linking obesity to insulin resistance. Intermittent fasting, on the other hand, is a lifestyle intervention able to prevent obesity and diabetes but difficult to implement and maintain. Our objectives were to characterize a link between ANGPTL2 and intermittent fasting and to investigate whether the knockdown of ANGPTL2 reproduces the benefits of intermittent fasting on weight gain and insulin responsiveness in knockdown and wild-type littermates mice. Intermittent fasting, access to food ad libitum once every other day, was initiated at the age of three months and maintained for four months. Intermittent fasting decreased by 63% (p < 0.05) gene expression of angptl2 in adipose tissue of wild-type mice. As expected, intermittent fasting improved insulin sensitivity (p < 0.05) and limited weight gain (p < 0.05) in wild-type mice. Knockdown mice fed ad libitum, however, were comparable to wild-type mice following the intermittent fasting regimen: insulin sensitivity and weight gain were identical, while intermittent fasting had no additional impact on these parameters in knockdown mice. Energy intake was similar between both wild-type fed intermittent fasting and ANGPTL2 knockdown mice fed ad libitum, suggesting that intermittent fasting and knockdown of ANGPTL2 equally lower feeding efficiency. These results suggest that the reduction of ANGPTL2 could be a useful and promising strategy to prevent obesity and insulin resistance, although further investigation of the mechanisms linking ANGPTL2 and intermittent fasting is warranted. Impact statement Intermittent fasting is an efficient diet pattern to prevent weight gain and improve insulin sensitivity. It is, however, a difficult regimen to follow and compliance is expected to be very low. In this work, we demonstrate that knockdown of ANGPTL2 in mice fed ad libitum mimics the beneficial effects of intermittent fasting on weight gain and insulin

  4. Intermittent pneumatic compression of legs increases microcirculation in distant skeletal muscle.

    Science.gov (United States)

    Liu, K; Chen, L E; Seaber, A V; Johnson, G W; Urbaniak, J R

    1999-01-01

    Intermittent pneumatic compression has been established as a method of clinically preventing deep vein thrombosis, but the mechanism has not been documented. This study observed the effects of intermittent pneumatic compression of legs on the microcirculation of distant skeletal muscle. The cremaster muscles of 80 male rats were exposed, a specially designed intermittent pneumatic-compression device was applied to both legs for 60 minutes, and the microcirculation of the muscles was assessed by measurement of the vessel diameter in three categories (10-20, 21-40, and 41-70 microm) for 120 minutes. The results showed significant vasodilation in arterial and venous vessels during the application of intermittent pneumatic compression, which disappeared after termination of the compression. The vasodilation reached a maximum 30 minutes after initiation of the compression and could be completely blocked by an inhibitor of nitric oxide synthase, NG-monomethyl-L-arginine (10 micromol/min). A 120-minute infusion of NG-monomethyl-L-arginine, beginning coincident with 60 minutes of intermittent pneumatic compression, resulted in a significant decrease in arterial diameter that remained at almost the same level after termination of the compression. The magnitude of the decrease in diameter in the group treated with intermittent pneumatic compression and NG-monomethyl-L-arginine was comparable with that in the group treated with NG-monomethyl-L-arginine alone. The results imply that the production of nitric oxide is involved in the positive influence of intermittent pneumatic compression on circulation. It is postulated that the rapid increase in venous velocity induced by intermittent pneumatic compression produces strong shear stress on the vascular endothelium, which stimulates an increased release of nitric oxide and thereby causes systemic vasodilation.

  5. Intermittent sea-level acceleration

    Science.gov (United States)

    Olivieri, M.; Spada, G.

    2013-10-01

    Using instrumental observations from the Permanent Service for Mean Sea Level (PSMSL), we provide a new assessment of the global sea-level acceleration for the last ~ 2 centuries (1820-2010). Our results, obtained by a stack of tide gauge time series, confirm the existence of a global sea-level acceleration (GSLA) and, coherently with independent assessments so far, they point to a value close to 0.01 mm/yr2. However, differently from previous studies, we discuss how change points or abrupt inflections in individual sea-level time series have contributed to the GSLA. Our analysis, based on methods borrowed from econometrics, suggests the existence of two distinct driving mechanisms for the GSLA, both involving a minority of tide gauges globally. The first effectively implies a gradual increase in the rate of sea-level rise at individual tide gauges, while the second is manifest through a sequence of catastrophic variations of the sea-level trend. These occurred intermittently since the end of the 19th century and became more frequent during the last four decades.

  6. Social Smoking among Intermittent Smokers

    Science.gov (United States)

    Shiffman, Saul; Li, Xiaoxue; Dunbar, Michael S.; Ferguson, Stuart G.; Tindle, Hilary A.; Scholl, Sarah M.

    2015-01-01

    Background “Social smoking” - smoking mostly or even only with others – may be an important pattern that implies smoking motivated extrinsically by social influences. Non-daily smokers (intermittent smokers; ITS) are often assumed to be social smokers, with some authors even assuming that all ITS are social smokers (SS+). We sought to identify and characterize social smokers in a sample of ITS. Methods 204 adult ITS (smoking 4–27 days/month) recorded the circumstances of smoking in their natural settings using Ecological Momentary Assessment, while also recording their circumstances in nonsmoking moments. SS+ were defined as ITS who were with others when they smoked most of their cigarettes, and who were ≥ 50% more likely to be with others when smoking than when not. Results Only 13% of ITS were SS+. Although defined solely on the basis of presence of others, SS+ showed a distinct pattern of smoking across multiple dimensions: Compared to other ITS (who were significantly less likely to smoke when with others), SS+ smoking was more associated with socializing, being with friends and acquaintances, drinking alcohol, weekends, evening or nighttime, being in other people’s homes, but not their own home. SS+ smoking was low in the morning and increased in the evening. SS+ smoked fewer days/week and were less dependent, but did not differ demographically. Conclusions Social smoking does constitute a highly distinct smoking pattern, but is not common among adult ITS. PMID:26205313

  7. Intermittent ileocoecal intususception in adult

    International Nuclear Information System (INIS)

    Cambal, M.; Zonca, P.; Maly, T.

    2013-01-01

    Aim: Aim of our paper is to present a case-report of chronic invagination in adult patient. Material: 28-years old woman with one year history of intermittent abdominal pain with symptoms of subileus state. She has underwent abdominal ultrasonography, abdominal X-ray, colonoscopy, irigography and abdominal CT. Appendectomy indicated for diagnosis of chronic appendicitis did not improve symptoms. Consecutively during acute problems were irigography and CT performed and diagnosis of an incomplete colon transversum obstruction of uncertain origin was established. There was stated suspicion of an intususception and patient was due to a repeated gastrointestinal passage indicated for an explorative laparotomy. During operation there was identified threefold invagination – colo-colonic, ileo-colonic and ileo-ileal. As a leading point of invagination was found in terminal ileum intraluminal polypous tumor 5 cm in diameter. Because of the secondary chronic changes of right colon wall and terminal ileum wall, after partial desinvagination right hemicolectomy was performed. Results: Patient was primary healed and now is without any subjective problems. Conclusion: Invagination is an acute abdominal event of obturative-strangulative type and it mainly occurs in infantile age. It is astonishing how long were patient´s difficulties lasting without obvious acute ileus. It is necessary in clinical practice to think on these rare reasons of gastrointestinal passage disorders. (author)

  8. Effectiveness of intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy on placental malaria, maternal anaemia and birthweight in areas with high and low malaria transmission intensity in Tanzania.

    Science.gov (United States)

    Mosha, Dominic; Chilongola, Jaffu; Ndeserua, Rabi; Mwingira, Felista; Genton, Blaise

    2014-09-01

    To assess the effectiveness of IPTp in two areas with different malaria transmission intensities. Prospective observational study recruiting pregnant women in two health facilities in areas with high and low malaria transmission intensities. A structured questionnaire was used for interview. Maternal clinic cards and medical logs were assessed to determine drug intake. Placental parasitaemia was screened using both light microscopy and real-time quantitative PCR. Of 350 pregnant women were recruited and screened for placental parasitaemia, 175 from each area. Prevalence of placental parasitaemia was 16.6% (CI 11.4-22.9) in the high transmission area and 2.3% (CI 0.6-5.7) in the low transmission area. Being primigravida and residing in a high transmission area were significant risk factors for placental malaria (OR 2.4; CI 1.1-5.0; P = 0.025) and (OR 9.4; CI 3.2-27.7; P anaemia or low birthweight, regardless of transmission intensity. The number needed to treat (NNT) was four (CI 2-6) women in the high transmission area and 33 (20-50) in the low transmission area to prevent one case of placental malaria. IPTp may have an effect on lowering the risk of placental malaria in areas of high transmission, but this effect did not translate into a benefit on risks of maternal anaemia or low birthweight. The NNT needs to be considered, and weighted against that of other protective measures, eventually targeting areas which are above a certain threshold of malaria transmission to maximise the benefit. © 2014 John Wiley & Sons Ltd.

  9. White adipose tissue coloring by intermittent fasting.

    Science.gov (United States)

    Kivelä, Riikka; Alitalo, Kari

    2017-11-01

    Intermittent fasting (IF) has been shown to promote metabolic health in several organisms. Two recent papers show that IF induces white adipose tissue beiging and increases thermogenesis, which improves metabolic health in mice.

  10. On-line intermittent connector anomaly detection

    Data.gov (United States)

    National Aeronautics and Space Administration — This paper investigates a non-traditional use of differential current sensor and current sensor to detect intermittent disconnection problems in connectors. An...

  11. Intermittent chaotic chimeras for coupled rotators

    DEFF Research Database (Denmark)

    Olmi, Simona; Martens, Erik Andreas; Thutupalli, Shashi

    2015-01-01

    Two symmetrically coupled populations of N oscillators with inertia m display chaotic solutions with broken symmetry similar to experimental observations with mechanical pendulums. In particular, we report evidence of intermittent chaotic chimeras, where one population is synchronized and the other...

  12. Feigenbaum attractor and intermittency in particle collisions

    International Nuclear Information System (INIS)

    Batunin, A.V.

    1992-01-01

    The hypothesis is proposed that the Feigenbaum attractor arising as a limit set in an infinite pichfork bifurcation sequence for unimodal one-dimensional maps underlies the intermittency phenomena in particle collisions. 23 refs.; 8 figs

  13. Developing a Research Strategy for Suicide Prevention in the Department of Defense: Status of Current Research, Prioritizing Areas of Need, and Recommendations for Moving Forward

    Science.gov (United States)

    2014-01-01

    practice. Websites, brochures , pamphlets , and marketing campaigns can help translate “jargon-y” academic research ndings into layman’s terms for...websites, brochures , pamphlets , and marketing campaigns, among other approaches. Careful attention should be paid to the media portrayal of new practices...cide prevention every three to six months from the Chief of Sta of the Air Force. As stated in Air Force Pamphlet 44-160: “It is encouraging that

  14. Current food classifications in epidemiological studies do not enable solid nutritional recommendations for preventing diet-related chronic diseases: the impact of food processing.

    Science.gov (United States)

    Fardet, Anthony; Rock, Edmond; Bassama, Joseph; Bohuon, Philippe; Prabhasankar, Pichan; Monteiro, Carlos; Moubarac, Jean-Claude; Achir, Nawel

    2015-11-01

    To date, observational studies in nutrition have categorized foods into groups such as dairy, cereals, fruits, and vegetables. However, the strength of the association between food groups and chronic diseases is far from convincing. In most international expert surveys, risks are most commonly scored as probable, limited, or insufficient rather than convincing. In this position paper, we hypothesize that current food classifications based on botanical or animal origins can be improved to yield solid recommendations. We propose using a food classification that employs food processes to rank foods in epidemiological studies. Indeed, food health potential results from both nutrient density and food structure (i.e., the matrix effect), both of which can potentially be positively or negatively modified by processing. For example, cereal-based foods may be more or less refined, fractionated, and recombined with added salt, sugars, and fats, yielding a panoply of products with very different nutritional values. The same is true for other food groups. Finally, we propose that from a nutritional perspective, food processing will be an important issue to consider in the coming years, particularly in terms of strengthening the links between food and health and for proposing improved nutritional recommendations or actions. © 2015 American Society for Nutrition.

  15. Current Food Classifications in Epidemiological Studies Do Not Enable Solid Nutritional Recommendations for Preventing Diet-Related Chronic Diseases: The Impact of Food Processing12

    Science.gov (United States)

    Fardet, Anthony; Rock, Edmond; Bassama, Joseph; Bohuon, Philippe; Prabhasankar, Pichan; Monteiro, Carlos; Moubarac, Jean-Claude; Achir, Nawel

    2015-01-01

    To date, observational studies in nutrition have categorized foods into groups such as dairy, cereals, fruits, and vegetables. However, the strength of the association between food groups and chronic diseases is far from convincing. In most international expert surveys, risks are most commonly scored as probable, limited, or insufficient rather than convincing. In this position paper, we hypothesize that current food classifications based on botanical or animal origins can be improved to yield solid recommendations. We propose using a food classification that employs food processes to rank foods in epidemiological studies. Indeed, food health potential results from both nutrient density and food structure (i.e., the matrix effect), both of which can potentially be positively or negatively modified by processing. For example, cereal-based foods may be more or less refined, fractionated, and recombined with added salt, sugars, and fats, yielding a panoply of products with very different nutritional values. The same is true for other food groups. Finally, we propose that from a nutritional perspective, food processing will be an important issue to consider in the coming years, particularly in terms of strengthening the links between food and health and for proposing improved nutritional recommendations or actions. PMID:26567188

  16. Convention on the Prevention of Marine Pollution by Dumping of Wastes and other Matter. The Definition Required by Annex I, paragraph 6 to the Convention and the Recommendations Required by Annex II, Section D

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1975-01-10

    Paragraph 6 of Annex I to the Convention on the Prevention of Marine Pollution by Dumping of Wastes and Other Matter provides for the Agency to define high-level radioactive wastes or other high-level radioactive matter as unsuitable for dumping at sea, and section D of Annex II provides for the Agency to make recommendations which the Contracting Parties to the Convention should take fully into account in issuing permits for the dumping at sea of radioactive wastes or other radioactive matter ''not included in Annex I''.

  17. Convention on the Prevention of Marine Pollution by Dumping of Wastes and other Matter. The Definition Required by Annex I, paragraph 6 to the Convention and the Recommendations Required by Annex II, Section D

    International Nuclear Information System (INIS)

    1975-01-01

    Paragraph 6 of Annex I to the Convention on the Prevention of Marine Pollution by Dumping of Wastes and Other Matter provides for the Agency to define high-level radioactive wastes or other high-level radioactive matter as unsuitable for dumping at sea, and section D of Annex II provides for the Agency to make recommendations which the Contracting Parties to the Convention should take fully into account in issuing permits for the dumping at sea of radioactive wastes or other radioactive matter ''not included in Annex I''.

  18. Montelukast reduces asthma exacerbations in 2- to 5-year-old children with intermittent asthma

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Zielen, Stefen; Garcia-Garcia, María Luz

    2005-01-01

    The PREVIA study was designed to investigate the role of montelukast, a leukotriene receptor antagonist, in the prevention of viral-induced asthma exacerbations in children aged 2 to 5 years with a history of intermittent asthma symptoms. The study was a 12-month multicenter, double-blind, parall...

  19. Core outcome measures for interventions to prevent or slow the progress of dementia for people living with mild to moderate dementia: Systematic review and consensus recommendations.

    Directory of Open Access Journals (Sweden)

    Lucy Webster

    Full Text Available There are no disease-modifying treatments for dementia. There is also no consensus on disease modifying outcomes. We aimed to produce the first evidence-based consensus on core outcome measures for trials of disease modification in mild-to-moderate dementia.We defined disease-modification interventions as those aiming to change the underlying pathology. We systematically searched electronic databases and previous systematic reviews for published and ongoing trials of disease-modifying treatments in mild-to-moderate dementia. We included 149/22,918 of the references found; with 81 outcome measures from 125 trials. Trials involved participants with Alzheimer's disease (AD alone (n = 111, or AD and mild cognitive impairment (n = 8 and three vascular dementia. We divided outcomes by the domain measured (cognition, activities of daily living, biological markers, neuropsychiatric symptoms, quality of life, global. We calculated the number of trials and of participants using each outcome. We detailed psychometric properties of each outcome. We sought the views of people living with dementia and family carers in three cities through Alzheimer's society focus groups. Attendees at a consensus conference (experts in dementia research, disease-modification and harmonisation measures decided on the core set of outcomes using these results. Recommended core outcomes were cognition as the fundamental deficit in dementia and to indicate disease modification, serial structural MRIs. Cognition should be measured by Mini Mental State Examination or Alzheimer's Disease Assessment Scale-Cognitive Subscale. MRIs would be optional for patients. We also made recommendations for measuring important, but non-core domains which may not change despite disease modification.Most trials were about AD. Specific instruments may be superseded. We searched one database for psychometric properties.This is the first review to identify the 81 outcome measures the research community

  20. International recommendations

    International Nuclear Information System (INIS)

    Lindell, Bo

    1986-01-01

    Full text: This short presentation will indicate the general radiation protection background to protective measures against foodstuffs contaminated with radioactive substances. A number of international organizations are involved in various aspects of radiation protection, for example, the International Atomic Energy Agency (IAEA), the United Nations Food and Agriculture Organization (FAO), the United Nations Environment Programme (UNEP), and the World Health Organization (WHO). Two international organizations, however, provide the basic background. These are the International Commission on Radiological Protection (ICRP) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). UNSCEAR provides the scientific information on radiation levels and effects. It consists of 21 member countries, with truly international coverage. It issues reports to the UN General Assembly, including comprehensive scientific annexes. Its latest comprehensive report was issued in 1982, the next is expected to be published in 1988. That report will include an assessment of the radiological consequences of the Chernobyl accident. The ICRP is a non-governmental organization. It has issued recommendations on radiation protection since 1928. The postulated biological basis for radiation protection recommendations involves two types of biological effects. The so-called non-stochastic effects, mainly due to cell death, appear only when the radiation doses exceed a certain threshold value. These effects, therefore, can only appear after high accidental exposures. After the Chernobyl accident, they only affected about 200 individuals involved in fire extinction and rescue work at the damaged nuclear power plant. Stochastic effects, with some simplification, may be seen as the result of initial changes in the genetic code of some surviving cells. If these cells are germ cells, this may lead to hereditary harm. If they are somatic cells, the result could be cancer

  1. Human and behavioral factors contributing to spine-based neurological cockpit injuries in pilots of high-performance aircraft: recommendations for management and prevention

    Science.gov (United States)

    Jones, J. A.; Hart, S. F.; Baskin, D. S.; Effenhauser, R.; Johnson, S. L.; Novas, M. A.; Jennings, R.; Davis, J.

    2000-01-01

    In high-performance aircraft, the need for total environmental awareness coupled with high-g loading (often with abrupt onset) creates a predilection for cervical spine injury while the pilot is performing routine movements within the cockpit. In this study, the prevalence and severity of cervical spine injury are assessed via a modified cross-sectional survey of pilots of multiple aircraft types (T-38 and F-14, F-16, and F/A-18 fighters). Ninety-five surveys were administered, with 58 full responses. Fifty percent of all pilots reported in-flight or immediate post-flight spine-based pain, and 90% of fighter pilots reported at least one event, most commonly (> 90%) occurring during high-g (> 5 g) turns of the aircraft with the head deviated from the anatomical neutral position. Pre-flight stretching was not associated with a statistically significant reduction in neck pain episodes in this evaluation, whereas a regular weight training program in the F/A-18 group approached a significant reduction (mean = 2.492; p < 0.064). Different cockpit ergonomics may vary the predisposition to cervical injury from airframe to airframe. Several strategies for prevention are possible from both an aircraft design and a preventive medicine standpoint. Countermeasure strategies against spine injury in pilots of high-performance aircraft require additional research, so that future aircraft will not be limited by the human in control.

  2. Eye problems in mountain and remote areas: prevention and onsite treatment--official recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM.

    Science.gov (United States)

    Ellerton, John A; Zuljan, Igor; Agazzi, Giancelso; Boyd, Jeffrey J

    2009-01-01

    Although eyes are not frequently injured in the mountains, they are exposed to many adverse factors from the environment. This article, intended for first responders, paramedics, physicians, and mountaineers, is the consensus opinion of the International Commission for Mountain Emergency Medicine (ICAR-MEDCOM). Its aim is to give practical advice on the management of eye problems in mountainous and remote areas. Snow blindness and minor injuries, such as conjunctival and corneal foreign bodies, could immobilize a person and put him or her at risk of other injuries. Blunt or penetrating trauma can result in the loss of sight in the eye; this may be preventable if the injury is managed properly. In almost all cases of severe eye trauma, protecting the eye and arranging an immediate evacuation are necessary. The most common eye problems, however, are due to ultraviolet light and high altitude. People wearing contact lenses and with previous history of eye diseases are more vulnerable. Any sight-threatening eye problem or unexplained visual loss at high altitude necessitates descent. Wearing appropriate eye protection, such as sunglasses with sidepieces and goggles with polarized or photochromic lenses, could prevent most of the common eye problems in mountaineering.

  3. Evaluation of community-based oral health promotion and oral disease prevention--WHO recommendations for improved evidence in public health practice

    DEFF Research Database (Denmark)

    Petersen, Poul Erik; Kwan, Stella

    2004-01-01

    Systematic evaluation is an integral part of the organisation and delivery of community oral health care programmes, ensuring the effectiveness of these community-based interventions. As for general health promotion programmes the common problems from effectiveness reviews of oral health...... a challenge to oral health professionals to integrate community oral health programmes into a wider health agenda. Public health research focusing on the development of evaluation methodologies has identified a variety of issues including the importance of using pluralistic evaluation approaches (quantitative...... of the evaluation of oral health promotion and oral disease prevention programmes. The aims of the workshop were to: (1) identify common problems and challenges in evaluating community-based oral health interventions; (2) explore developments in the evaluation approaches in public health; (3) share experiences...

  4. Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs.

    Science.gov (United States)

    Hellstein, John W; Adler, Robert A; Edwards, Beatrice; Jacobsen, Peter L; Kalmar, John R; Koka, Sreenivas; Migliorati, Cesar A; Ristic, Helen

    2011-11-01

    This narrative review of osteonecrosis of the jaw in patients with low bone mass receiving treatment with antiresorptive agents is based on an appraisal of the literature by an advisory committee of the American Dental Association Council on Scientific Affairs. It updates the committee's 2008 advisory statement. The authors searched MEDLINE for literature published between May 2008 (the end date of the last search) and February 2011. This report contains recommendations based on the findings of the literature search and on expert opinion that relate to general dentistry; periodontal disease management; implant placement and maintenance; oral and maxillofacial surgery; endodontics; restorative dentistry and prosthodontics; orthodontics; and C-terminal telopeptide testing and drug holidays. The highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) prevalence is approximately 0.10 percent. Osteoporosis is responsible for considerable morbidity and mortality. Therefore, the benefit provided by antiresorptive therapy outweighs the low risk of developing osteonecrosis of the jaw. An oral health program consisting of sound hygiene practices and regular dental care may be the optimal approach for lowering ARONJ risk. No validated diagnostic technique exists to determine which patients are at increased risk of developing ARONJ. Discontinuing bisphosphonate therapy may not lower the risk but may have a negative effect on low-bone-mass-treatment outcomes.

  5. Intermittent ephemeral river-breaching

    Science.gov (United States)

    Reniers, A. J.; MacMahan, J. H.; Gallagher, E. L.; Shanks, A.; Morgan, S.; Jarvis, M.; Thornton, E. B.; Brown, J.; Fujimura, A.

    2012-12-01

    In the summer of 2011 we performed a field experiment in Carmel River State Beach, CA, at a time when the intermittent natural breaching of the ephemeral Carmel River occurred due to an unusually rainy period prior to the experiment associated with El Nino. At this time the river would fill the lagoon over the period of a number of days after which a breach would occur. This allowed us to document a number of breaches with unique pre- and post-breach topographic surveys, accompanying ocean and lagoon water elevations as well as extremely high flow (4m/s) velocities in the river mouth during the breaching event. The topographic surveys were obtained with a GPS-equipped backpack mounted on a walking human and show the evolution of the river breaching with a gradually widening and deepening river channel that cuts through the pre-existing beach and berm. The beach face is qualified as a steep with an average beach slope of 1:10 with significant reflection of the incident waves (MacMahan et al., 2012). The wave directions are generally shore normal as the waves refract over the deep canyon that is located offshore of the beach. The tide is mixed semi-diurnal with a range on the order of one meter. Breaching typically occurred during the low-low tide. Grain size is highly variable along the beach with layers of alternating fine and coarse material that could clearly be observed as the river exit channel was cutting through the beach. Large rocky outcroppings buried under the beach sand are also present along certain stretches of the beach controlling the depth of the breaching channel. The changes in the water level measured within the lagoon and the ocean side allows for an estimate of the volume flux associated with the breach as function of morphology, tidal elevation and wave conditions as well as an assessment of the conditions and mechanisms of breach closure, which occurred on the time scale of O(0.5 days). Exploratory model simulations will be presented at the

  6. Coherent Structures and Intermittency in Plasma Turbulence

    International Nuclear Information System (INIS)

    Das, Amita; Kaw, Predhiman; Sen, Abhijit

    2008-01-01

    The paper discusses some fundamental issues related to the phenomenon of intermittency in plasma turbulence with particular reference to experimental observations in fusion devices. Intermittency is typically associated with the presence of coherent structures in turbulence. Since coherent structures can play an important role in governing the transport properties of a system they have received a great deal of attention in fusion research. We review some of the experimental measurements and numerical simulation studies on the presence and formation of coherent structures in plasmas and discuss their relevance to intermittency. Intermittency, as widely discussed in the context of neutral fluid turbulence, implies multiscaling behaviour in contrast to self-similar scaling patterns observed in self organized criticality (SOC) phenomenon. The experimental evidence from plasma turbulence measurements reveal a mixed picture--while some observations support the SOC model description others indicate the presence of multiscaling behaviour. We discuss these results in the light of our present understanding of plasma turbulence and in terms of certain unique aspects of intermittency as revealed by fluid models of plasmas.

  7. Intermittency in {sup 197}Au fragmentation

    Energy Technology Data Exchange (ETDEWEB)

    Dabrowska, A; Holynski, R; Olszewski, A; Szarska, M; Wilczynska, B; Wolter, W; Wosiek, B [Institute of Nuclear Physics, Cracow (Poland); Cherry, M L; Deines-Jones, P; Jones, W V; Sengupta, K; Wefel, B [Louisiana State Univ., Baton Rouge, LA (United States). Dept. of Physics and Astronomy; Waddington, C J [Minnesota Univ., Minneapolis, MN (United States). School of Physics and Astronomy; Pozharova, E A; Skorodko, T Yu [Inst. of Theoretical and Experimental Physics, Moscow (Russian Federation); KLMM Collaboration

    1995-07-01

    The concept of factorial moments was applied to an analysis of the dynamical fluctuations in the charge distributions of the fragments emitted from gold nuclei with energies 10.6 and < 1.0 GeV/n interacting with emulsion nuclei. Clear evidence for intermittent fluctuations has been found in an analysis using all the particles released from the gold projectile, with a stronger effect observed below 1 GeV/n than at 10.6 GeV/n. For the full data sets, however, the intermittency effect was found to be very sensitive to the singly charged particles, and neglecting these particles strongly reduces the intermittency signal. When the analysis is restricted to the multiply charged fragments, an intermittency effect is revealed only for multifragmentation events, although one that is enhanced as compared to the analysis of all, singly and multiply charged, particles. The properties of the anomalous fractal dimensions suggest a sequential decay mechanism, rather than the existence of possible critical behaviour in the process of nuclear fragmentation. The likely influence of the charge conservation effects and the finite size of decaying systems on the observed intermittency signals was pointed out. (author). 37 refs, 9 figs, 5 tabs.

  8. Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial.

    Science.gov (United States)

    Savolainen-Kopra, Carita; Haapakoski, Jaason; Peltola, Piia A; Ziegler, Thedi; Korpela, Terttu; Anttila, Pirjo; Amiryousefi, Ali; Huovinen, Pentti; Huvinen, Markku; Noronen, Heikki; Riikkala, Pia; Roivainen, Merja; Ruutu, Petri; Teirilä, Juha; Vartiainen, Erkki; Hovi, Tapani

    2012-01-16

    Hand hygiene is considered as an important means of infection control. We explored whether guided hand hygiene together with transmission-limiting behaviour reduces infection episodes and lost days of work in a common work environment in an open cluster-randomized 3-arm intervention trial. A total of 21 clusters (683 persons) were randomized to implement hand hygiene with soap and water (257 persons), with alcohol-based hand rub (202 persons), or to serve as a control (224 persons). Participants in both intervention arms also received standardized instructions on how to limit the transmission of infections. The intervention period (16 months) included the emergence of the 2009 influenza pandemic and the subsequent national hand hygiene campaign influencing also the control arm. In the total follow-up period there was a 6.7% reduction of infection episodes in the soap-and water arm (p = 0.04). Before the onset of the anti-pandemic campaign, a statistically significant (p = 0.002) difference in the mean occurrence of infection episodes was observed between the control (6.0 per year) and the soap-and-water arm (5.0 per year) but not between the control and the alcohol-rub arm (5.6 per year). Neither intervention had a decreasing effect on absence from work. We conclude that intensified hand hygiene using water and soap together with behavioural recommendations can reduce the occurrence of self-reported acute illnesses in common work environment. Surprisingly, the occurrence of reported sick leaves also increased in the soap-and water-arm. ClinicalTrials.gov: NCT00981877 The Finnish Work Environment Fund and the National Institute for Health and Welfare.

  9. Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial

    Directory of Open Access Journals (Sweden)

    Savolainen-Kopra Carita

    2012-01-01

    Full Text Available Abstract Background Hand hygiene is considered as an important means of infection control. We explored whether guided hand hygiene together with transmission-limiting behaviour reduces infection episodes and lost days of work in a common work environment in an open cluster-randomized 3-arm intervention trial. Methods A total of 21 clusters (683 persons were randomized to implement hand hygiene with soap and water (257 persons, with alcohol-based hand rub (202 persons, or to serve as a control (224 persons. Participants in both intervention arms also received standardized instructions on how to limit the transmission of infections. The intervention period (16 months included the emergence of the 2009 influenza pandemic and the subsequent national hand hygiene campaign influencing also the control arm. Results In the total follow-up period there was a 6.7% reduction of infection episodes in the soap-and water arm (p = 0.04. Before the onset of the anti-pandemic campaign, a statistically significant (p = 0.002 difference in the mean occurrence of infection episodes was observed between the control (6.0 per year and the soap-and-water arm (5.0 per year but not between the control and the alcohol-rub arm (5.6 per year. Neither intervention had a decreasing effect on absence from work. Conclusions We conclude that intensified hand hygiene using water and soap together with behavioural recommendations can reduce the occurrence of self-reported acute illnesses in common work environment. Surprisingly, the occurrence of reported sick leaves also increased in the soap-and water-arm. Trial Registration ClinicalTrials.gov: NCT00981877 Source of funding The Finnish Work Environment Fund and the National Institute for Health and Welfare.

  10. A review of highly pathogenic avian influenza in birds, with an emphasis on Asian H5N1 and recommendations for prevention and control.

    Science.gov (United States)

    Kelly, Terra R; Hawkins, Michelle G; Sandrock, Christian E; Boyce, Walter M

    2008-03-01

    Avian influenza is a disease of both veterinary and public health importance. Influenza A viruses infect a range of hosts, including humans, and can cause significant morbidity and mortality. These viruses have high genetic variability, and new strains develop through both mutation and reassortment. Modes of transmission as well as the location of viral shedding may differ both by host species and by viral strain. Clinical signs of influenza A virus infection in birds vary considerably depending on the viral subtype, environmental factors, and age, health status, and species of the bird and range from decreased egg production and gastrointestinal manifestations to nervous system disorders and respiratory signs. Most commonly, peracute death with minimal clinical disease is observed in poultry infected with a highly pathogenic avian influenza virus. There are various prevention and control strategies for avian influenza, including education, biosecurity, surveillance, culling of infected animals, and vaccination. These strategies will differ by institution and current federal regulations. Each institution should have an established biosecurity protocol that can be properly instituted. Lastly, human health precautions, such as proper hand hygiene, personal protective equipment, and employee health monitoring, are imperative for at-risk individuals.

  11. [Recommendations for the diagnosis and prevention of infectious diseases in pediatric and adolescent refugees in Germany : Statement of the German Society of Pediatric Infectious Diseases, the Society of Tropical Pediatrics and International Child Health, and the Professional Association of Pediatricians].

    Science.gov (United States)

    Pfeil, J; Kobbe, R; Trapp, S; Kitz, C; Hufnagel, M

    2016-05-01

    Child and adolescent refugees in Germany represent a particularly vulnerable social group and treating infectious diseases forms a crucial part of providing their medical care. From an infectious diseases perspective, refugees themselves, as a result of their difficult personal circumstances, are the ones at highest risk. Even in crisis situations, medical practitioners are medically and ethically obliged to provide a high standard of care. The guidelines presented here propose recommendations for diagnosing and preventing infectious diseases among refugees under 18 in Germany. The guidelines are intended to assist in optimizing vaccine protection and treatment of diseases while taking into consideration factors such as refugees' challenging living conditions, cultural differences and potential language barriers.Upon refugees' arrival at the first housing sites, it is recommended that a basic clinical screening (and not just a brief visual inspection) be provided in order to identify and initiate treatment for acute medical problems and potentially contagious diseases (including tuberculosis), as well as to close gaps in vaccination coverage. Documentation of the clinical findings is critical, both to avoid redundant investigations and to optimize individual medical care. For this, an effective communication system must be established.Once refugees have been transferred into their destination community, outpatient and inpatient care providers should collaborate to bring refugees up-to-date with all vaccines recommended by STIKO (German Standing Committee on Vaccination). The same high standard of medical care should be delivered to refugees as would be to the general population. Due to the high prevalence of multi-resistant organisms (MRO) in the refugees' countries of origin, MRO screening is recommended for most patients receiving inpatient care.

  12. the role of community participation in intermittent preventive

    African Journals Online (AJOL)

    2014-06-01

    Jun 1, 2014 ... paid to community participation in malaria control in the past and this ... current Artemisinin Combination Therapy (ACT)for malaria treatment is ..... Malaria Journal. 2009; 8:292. . 2. Ghana Health Service: Final draft antimalarial drug policy for Ghana, Accra. 2004. 3. Keta District Report. Keta, 2001. 4. Pitt C ...

  13. Intermittent Preventive Therapy and Treatment of Malaria during ...

    African Journals Online (AJOL)

    (FGDs) were also conducted with 46 pregnant women at the health facilities in the district. Results: More than half ... (76.6 %) did not know the use of SP for IPT in relationship with gestation age. Overall, the .... provide adequate information about the use and benefits of ... random sample of 8 dispensaries was selected using ...

  14. missed opportunities for intermittent preventive treatment for malaria

    African Journals Online (AJOL)

    is a general risk for malaria within the population, there is an increased vulnerability ... optimal IPTp-SP uptake within the context of high ... in Sub- Saharan African countries in 2010, the average coverage of at ... three step stratified sampling method. Stratification ... estimates were independently observed from recent births ...

  15. Recommendations for the Development of a Mobile HIV Prevention Intervention for Men Who Have Sex With Men and Hijras in Mumbai: Qualitative Study.

    Science.gov (United States)

    Rawat, Shruta; Wilkerson, J Michael; Lawler, Sylvia M; Patankar, Pallav; Rosser, B R Simon; Shukla, Kanjani; Butame, Seyram; Ekstrand, Maria L

    2018-05-03

    As Internet and mobile phone use expands in India, there is an opportunity to develop mobile health (mHealth) interventions for marginalized populations, including men who have sex with men (MSM) and hijras (transgender women), hesitant to access traditional health care systems. The purpose of this study was to determine if an mHealth intervention was acceptable to MSM and hijras living in Mumbai, and if so, what features would be useful in targeting the prevention of HIV acquisition and to increase the quality of life among persons living with HIV/AIDS. Data from 4 focus groups with MSM and interviews with 4 hijras, 10 health service providers, and 8 mHealth developers were thematically analyzed. Once the need for an mHealth intervention was confirmed, comments about features were organized into 3 themes: content, interface, and retention. Content subthemes included providing sex education for younger community members, providing information about STIs, and providing information and social support for persons living with HIV. Interface subthemes included presenting content using pictures; using videos to present stories of role models; using push notifications for testing, appointment, and medication reminders; using geolocation to link to just-in-time services; and using telemedicine to increase access to health service providers and community services. The 5 retention subthemes included keeping it fun, using gaming mechanics, developing content in regional languages, protecting confidentiality, and linking to social networking apps. These findings may help inform mHealth development in India. ©Shruta Rawat, J Michael Wilkerson, Sylvia M Lawler, Pallav Patankar, BR Simon Rosser, Kanjani Shukla, Seyram Butame, Maria L Ekstrand. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 03.05.2018.

  16. Forces and energetics of intermittent swimming

    Science.gov (United States)

    Floryan, Daniel; Van Buren, Tyler; Smits, Alexander J.

    2017-08-01

    Experiments are reported on intermittent swimming motions. Water tunnel experiments on a nominally two-dimensional pitching foil show that the mean thrust and power scale linearly with the duty cycle, from a value of 0.2 all the way up to continuous motions, indicating that individual bursts of activity in intermittent motions are independent of each other. This conclusion is corroborated by particle image velocimetry (PIV) flow visualizations, which show that the main vortical structures in the wake do not change with duty cycle. The experimental data also demonstrate that intermittent motions are generally energetically advantageous over continuous motions. When metabolic energy losses are taken into account, this conclusion is maintained for metabolic power fractions less than 1.

  17. Chaos synchronization based on intermittent state observer

    Institute of Scientific and Technical Information of China (English)

    Li Guo-Hui; Zhou Shi-Ping; Xu De-Ming

    2004-01-01

    This paper describes the method of synchronizing slave to the master trajectory using an intermittent state observer by constructing a synchronizer which drives the response system globally tracing the driving system asymptotically. It has been shown from the theory of synchronization error-analysis that a satisfactory result of chaos synchronization is expected under an appropriate intermittent period and state observer. Compared with continuous control method,the proposed intermittent method can target the desired orbit more efficiently. The application of the method is demonstrated on the hyperchaotic Rossler systems. Numerical simulations show that the length of the synchronization interval rs is of crucial importance for our scheme, and the method is robust with respect to parameter mismatch.

  18. Intermittent fasting modulation of the diabetic syndrome in sand rats. II. In vivo investigations.

    Science.gov (United States)

    Belkacemi, Louiza; Selselet-Attou, Ghalem; Louchami, Karim; Sener, Abdullah; Malaisse, Willy J

    2010-11-01

    This study deals with the effects of daily intermittent fasting for 15 h upon the development of diabetes in sand rats exposed to a hypercaloric diet. The same pattern of daily intermittent fasting was imposed on sand rats maintained on a purely vegetal diet (control animals). Over the last 30 days of the present experiments, non-fasting animals gained weight, whilst intermittently fasting sand rats lost weight. In this respect, there was no significant difference between control animals and either diabetic or non-diabetic sand rats exposed to the hypercaloric diet. The postprandial glycemia remained fairly stable in the control animals. During a 3-week transition period from a purely vegetal to a hypercaloric diet, the post-prandial glycemia increased by 5.95 ± 1.26 mM (n=6) in diabetic sand rats, as distinct from an increase of only 0.45 ± 0.56 mM (n=6) in the non-diabetic animals. During the intermittent fasting period, the postprandial glycemia decreased significantly in the diabetic animals, but not so in the non-diabetic sand rats. Before the switch in food intake, the peak glycemia at the 30th min of an intraperitoneal glucose tolerance test was already higher in the diabetic than non-diabetic rats. In both the non-diabetic and diabetic sand rats, intermittent fasting prevented the progressive deterioration of glucose tolerance otherwise observed in non-fasting animals. These findings reveal that, at least in sand rats, intermittent daily fasting prevents the progressive deterioration of glucose tolerance otherwise taking place when these animals are exposed to a hypercaloric diet.

  19. Unsteady propulsion by an intermittent swimming gait

    Science.gov (United States)

    Akoz, Emre; Moored, Keith W.

    2018-01-01

    Inviscid computational results are presented on a self-propelled swimmer modeled as a virtual body combined with a two-dimensional hydrofoil pitching intermittently about its leading edge. Lighthill (1971) originally proposed that this burst-and-coast behavior can save fish energy during swimming by taking advantage of the viscous Bone-Lighthill boundary layer thinning mechanism. Here, an additional inviscid Garrick mechanism is discovered that allows swimmers to control the ratio of their added mass thrust-producing forces to their circulatory drag-inducing forces by decreasing their duty cycle, DC, of locomotion. This mechanism can save intermittent swimmers as much as 60% of the energy it takes to swim continuously at the same speed. The inviscid energy savings are shown to increase with increasing amplitude of motion, increase with decreasing Lighthill number, Li, and switch to an energetic cost above continuous swimming for sufficiently low DC. Intermittent swimmers are observed to shed four vortices per cycle that form into groups that are self-similar with the DC. In addition, previous thrust and power scaling laws of continuous self-propelled swimming are further generalized to include intermittent swimming. The key is that by averaging the thrust and power coefficients over only the bursting period then the intermittent problem can be transformed into a continuous one. Furthermore, the intermittent thrust and power scaling relations are extended to predict the mean speed and cost of transport of swimmers. By tuning a few coefficients with a handful of simulations these self-propelled relations can become predictive. In the current study, the mean speed and cost of transport are predicted to within 3% and 18% of their full-scale values by using these relations.

  20. Shape of power spectrum of intermittent chaos

    International Nuclear Information System (INIS)

    So, B.C.; Mori, H.

    1984-01-01

    Power spectra of intermittent chaos are calculated analytically. It is found that the power spectrum near onset point consists of a large number of Lorentzian lines with two peaks around frequencies ω = 0 and ω = ω 0 , where ω 0 is a fundamental frequency of a periodic orbit before the onset point, and furthermore the envelope of lines around ω = 0 obeys the power law 1/ + ω +2 , whereas the envelope around ω 0 obeys 1/ + ω-ω 0 +4 . The universality of these power law dependence in a certain class of intermittent chaos are clarified from a phenomenological view point. (author)

  1. Intermittent fasting protects against the deterioration of cognitive function, energy metabolism and dyslipidemia in Alzheimer's disease-induced estrogen deficient rats.

    Science.gov (United States)

    Shin, Bae Kun; Kang, Suna; Kim, Da Sol; Park, Sunmin

    2018-02-01

    Intermittent fasting may be an effective intervention to protect against age-related metabolic disturbances, although it is still controversial. Here, we investigated the effect of intermittent fasting on the deterioration of the metabolism and cognitive functions in rats with estrogen deficiency and its mechanism was also explored. Ovariectomized rats were infused with β-amyloid (25-35; Alzheimer's disease) or β-amyloid (35-25, Non-Alzheimer's disease; normal cognitive function) into the hippocampus. Each group was randomly divided into two sub-groups: one with intermittent fasting and the other fed ad libitum: Alzheimer's disease-ad libitum, Alzheimer's disease-intermittent fasting, Non-Alzheimer's disease-ad libitum, and Non-Alzheimer's disease-intermittent fasting. Rats in the intermittent fasting groups had a restriction of food consumption to a 3-h period every day. Each group included 10 rats and all rats fed a high-fat diet for four weeks. Interestingly, Alzheimer's disease increased tail skin temperature more than Non-Alzheimer's disease and intermittent fasting prevented the increase. Alzheimer's disease reduced bone mineral density in the spine and femur compared to the Non-Alzheimer's disease, whereas bone mineral density in the hip and leg was reduced by intermittent fasting. Fat mass only in the abdomen was decreased by intermittent fasting. Intermittent fasting decreased food intake without changing energy expenditure. Alzheimer's disease increased glucose oxidation, whereas intermittent fasting elevated fat oxidation as a fuel source. Alzheimer's disease and intermittent fasting deteriorated insulin resistance in the fasting state but intermittent fasting decreased serum glucose levels after oral glucose challenge by increasing insulin secretion. Alzheimer's disease deteriorated short and spatial memory function compared to the Non-Alzheimer's disease, whereas intermittent fasting prevented memory loss in comparison to ad libitum. Unexpectedly

  2. New Insulin Delivery Recommendations.

    Science.gov (United States)

    Frid, Anders H; Kreugel, Gillian; Grassi, Giorgio; Halimi, Serge; Hicks, Debbie; Hirsch, Laurence J; Smith, Mike J; Wellhoener, Regine; Bode, Bruce W; Hirsch, Irl B; Kalra, Sanjay; Ji, Linong; Strauss, Kenneth W

    2016-09-01

    Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  3. Intermittent hypoxia in obese Zucker rats: cardiometabolic and inflammatory effects.

    Science.gov (United States)

    Briançon-Marjollet, Anne; Monneret, Denis; Henri, Marion; Joyeux-Faure, Marie; Totoson, Perle; Cachot, Sandrine; Faure, Patrice; Godin-Ribuot, Diane

    2016-11-01

    What is the central question of this study? This study addresses the relative impact of obesity and intermittent hypoxia in the pathophysiological process of obstructive sleep apnoea by investigating the metabolic, inflammatory and cardiovascular consequences of intermittent hypoxia in lean and obese Zucker rats. What is the main finding and its importance? We found that obesity and intermittent hypoxia have mainly distinct consequences on the investigated inflammatory and cardiometabolic parameters in Zucker rats. This suggests that, for a given severity of sleep apnea, the association of obesity and obstructive sleep apnoea may not necessarily be deleterious. Obstructive sleep apnoea is associated with obesity with a high prevalence, and both co-morbidities are independent cardiovascular risk factors. Intermittent hypoxia (IH) is thought to be the main factor responsible for the obstructive sleep apnoea-related cardiometabolic alterations. The aim of this study was to assess the respective impact of obesity and IH on the inflammatory and cardiometabolic state in rats. Lean and obese Zucker rats were exposed to normoxia or chronic IH, and we assessed metabolic and inflammatory parameters, such as plasma lipids and glucose, serum leptin and adiponectin, liver cytokines, nuclear factor-κB activity and cardiac endothelin-1 levels. Myocardial infarct size was also evaluated following in vitro ischaemia-reperfusion. Circulating lipids, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), leptin and adiponectin levels were higher in obese versus lean rats. Chronic IH did not have a significant impact on metabolic parameters in lean rats. In obese rats, IH increased glycaemia and HOMA-IR. Liver interleukin-6 and tumour necrosis factor-α levels were elevated in lean rats exposed to IH; obesity prevented the increase in interleukin-6 but not in tumour necrosis factor-α. Finally, IH exposure enhanced myocardial sensitivity to infarction in both lean and

  4. Which factors make clean intermittent (self) catheterisation successful?

    NARCIS (Netherlands)

    Cobussen-Boekhorst, H.; Beekman, J.; Wijlick, E. van; Schaafstra, J.; Kuppevelt, D. van; Heesakkers, J.P.

    2016-01-01

    AIMS AND OBJECTIVES: To explore which factors determine successful intermittent catheterisation. BACKGROUND: Intermittent catheterisation is a safe, effective treatment and is associated with improved quality of life, although negative issues are reported. Factors which determine adherence are

  5. Fractal structures and intermittency in QCD

    International Nuclear Information System (INIS)

    Gustafson, Goesta.

    1990-04-01

    New results are presented for fractal structures and intermittency in QCD parton showers. A geometrical interpretation of the anomalous dimension in QCD is given. It is shown that model predications for factorial moments in the PEP-PETRA energy range are increased. if the properties of directly produced pions are more carefully taken into account

  6. Intermittent demand : Linking forecasting to inventory obsolescence

    NARCIS (Netherlands)

    Teunter, Ruud H.; Syntetos, Aris A.; Babai, M. Zied

    2011-01-01

    The standard method to forecast intermittent demand is that by Croston. This method is available in ERP-type solutions such as SAP and specialised forecasting software packages (e.g. Forecast Pro), and often applied in practice. It uses exponential smoothing to separately update the estimated demand

  7. Acute intermittent porphyria presenting as progressive muscular ...

    African Journals Online (AJOL)

    Acute intermittent porphyria, the most common porphyria affecting the nervous system, typically presents with neurovisceral crises followed by a motor neuropathy. We describe a 23-year-old black South African man presenting with a progressive stuttering, lower motor neuron syndrome developing over months. He had not ...

  8. Cooling tower modification for intermittent operation

    International Nuclear Information System (INIS)

    Midkiff, W.S.

    1975-03-01

    One of the cooling towers at Los Alamos Scientific Laboratory is being operated intermittently. The cooling tower has been modified to restrict air flow and to keep the tower from drying out. The modifications are relatively inexpensive, simple to operate, and have proved effective. (U.S.)

  9. Management of patients with intermittent claudication

    NARCIS (Netherlands)

    S. Spronk (Sandra)

    2008-01-01

    textabstractIntermittent claudication is the first and mildest manifestation of peripheral arterial disease, caused by the atherosclerotic process of progressive narrowing of one or more of the arteries of the peripheral circulation.1 If the arterial system fails, it results in a progressive oxygen

  10. Intermittent resistive faults in digital cmos circuits

    NARCIS (Netherlands)

    Kerkhoff, Hans G.; Ebrahimi, Hassan

    2015-01-01

    A major threat in extremely dependable high-end process node integrated systems in e.g. Avionics are no failures found (NFF). One category of NFFs is the intermittent resistive fault, often originating from bad (e.g. Via or TSV-based) interconnections. This paper will show the impact of these faults

  11. Intermittent and global transitions in plasma turbulence

    International Nuclear Information System (INIS)

    Vlad, M.; Spineanu, F.; Itoh, K.; Itoh, S.-I.

    2003-07-01

    The dynamics of the transition processes in plasma turbulence described by the nonlinear Langevin equation (1) is studied. We show that intermittent or global transitions between metastable states can appear. The conditions for the generation of these transitions and their statistical characteristics are determined. (author)

  12. Infection prevention during anaesthesia ventilation by the use of breathing system filters (BSF): Joint recommendation by German Society of Hospital Hygiene (DGKH) and German Society for Anaesthesiology and Intensive Care (DGAI).

    Science.gov (United States)

    Kramer, Axel; Kranabetter, Rainer; Rathgeber, Jörg; Züchner, Klaus; Assadian, Ojan; Daeschlein, Georg; Hübner, Nils-Olaf; Dietlein, Edeltrut; Exner, Martin; Gründling, Matthias; Lehmann, Christian; Wendt, Michael; Graf, Bernhard Martin; Holst, Dietmar; Jatzwauk, Lutz; Puhlmann, Birgit; Welte, Thomas; Wilkes, Antony R

    2010-09-21

    An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use.THE BREATHING SYSTEM AND THE MANUAL VENTILATION BAG ARE CHANGED IMMEDIATELY AFTER THE RESPECTIVE ANAESTHESIA IF THE FOLLOWING SITUATION HAS OCCURRED OR IT IS SUSPECTED TO HAVE OCCURRED: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonisation with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anaesthesia breathing system is changed and the breathing gas conducting parts of the anaesthesia ventilator are hygienically reprocessed.Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case.

  13. Intermittency in the particle production and in the nuclear multifragmentation

    International Nuclear Information System (INIS)

    Bozek, P.; Ploszajczak, M.

    1991-01-01

    Intermittency is a manifestation of scale invariance and randomness in physical systems. Intermittency in relativistic heavy-ion collisions and, in particular, the projectile dependence, multiplicity dependence and source-size dependence are discussed in the frame of the model of spatio-temporal intermittency. Moreover, recent theoretical results in intermittency studies of the nuclear multifragmentation are presented. (author) 35 refs., 4 figs., 1 tab

  14. Suppressing methane emission and global warming potential from rice fields through intermittent drainage and green biomass amendment

    NARCIS (Netherlands)

    Haque, Md. M.; Biswas, J. C.; Kim, S. Y.; Kim, P. J.

    Winter cover crops are recommended to improve soil quality and carbon sequestration, although their use as green manure can significantly increase methane (CH4) emission from paddy soils. Soil management practices can be used to reduce CH4 emission from paddy soils, but intermittent drainage is

  15. Intermittent Rivers and Biodiversity. Large scale analyses between hydrology and ecology in intermittent rivers

    OpenAIRE

    Blanchard, Q.

    2014-01-01

    Intermittent rivers are characterized by a temporary interruption of their flow which can manifest in a variety of ways, as much on a spatial scale as on a temporal one. This particular aspect of intermittent river hydrology gives rise to unique ecosystems, combining both aquatic and terrestrial habitats. Neglected for a long time by scientists and once considered biologically depauperate and ecologically unimportant, these fragile habitats are nowadays acknowledged for their rendered service...

  16. High-Intensity Intermittent Exercise and Fat Loss

    Directory of Open Access Journals (Sweden)

    Stephen H. Boutcher

    2011-01-01

    Full Text Available The effect of regular aerobic exercise on body fat is negligible; however, other forms of exercise may have a greater impact on body composition. For example, emerging research examining high-intensity intermittent exercise (HIIE indicates that it may be more effective at reducing subcutaneous and abdominal body fat than other types of exercise. The mechanisms underlying the fat reduction induced by HIIE, however, are undetermined. Regular HIIE has been shown to significantly increase both aerobic and anaerobic fitness. HIIE also significantly lowers insulin resistance and results in a number of skeletal muscle adaptations that result in enhanced skeletal muscle fat oxidation and improved glucose tolerance. This review summarizes the results of HIIE studies on fat loss, fitness, insulin resistance, and skeletal muscle. Possible mechanisms underlying HIIE-induced fat loss and implications for the use of HIIE in the treatment and prevention of obesity are also discussed.

  17. Preventing Diabetic Foot Complications : Strategic Recommendations

    African Journals Online (AJOL)

    The diabetic foot is the commonest cause of non-traumatic lower extremity amputation in the developed and developing nations. Several risk factors predispose the diabetic patient to foot ulceration and peripheral neuropathy, with peripheral vascular disease are the commonest risk factors. Clinical examination for these risk ...

  18. Intermittent control: a computational theory of human control.

    Science.gov (United States)

    Gawthrop, Peter; Loram, Ian; Lakie, Martin; Gollee, Henrik

    2011-02-01

    The paradigm of continuous control using internal models has advanced understanding of human motor control. However, this paradigm ignores some aspects of human control, including intermittent feedback, serial ballistic control, triggered responses and refractory periods. It is shown that event-driven intermittent control provides a framework to explain the behaviour of the human operator under a wider range of conditions than continuous control. Continuous control is included as a special case, but sampling, system matched hold, an intermittent predictor and an event trigger allow serial open-loop trajectories using intermittent feedback. The implementation here may be described as "continuous observation, intermittent action". Beyond explaining unimodal regulation distributions in common with continuous control, these features naturally explain refractoriness and bimodal stabilisation distributions observed in double stimulus tracking experiments and quiet standing, respectively. Moreover, given that human control systems contain significant time delays, a biological-cybernetic rationale favours intermittent over continuous control: intermittent predictive control is computationally less demanding than continuous predictive control. A standard continuous-time predictive control model of the human operator is used as the underlying design method for an event-driven intermittent controller. It is shown that when event thresholds are small and sampling is regular, the intermittent controller can masquerade as the underlying continuous-time controller and thus, under these conditions, the continuous-time and intermittent controller cannot be distinguished. This explains why the intermittent control hypothesis is consistent with the continuous control hypothesis for certain experimental conditions.

  19. CONDITIONED ANALYSIS OF HIGH-LATITUDE SOLAR WIND INTERMITTENCY

    International Nuclear Information System (INIS)

    D'Amicis, R.; Consolini, G.; Bavassano, B.; Bruno, R.

    2012-01-01

    The solar wind is a turbulent medium displaying intermittency. Its intermittent features have been widely documented and studied, showing how the intermittent character is different in fast and slow wind. In this paper, a statistical conditioned analysis of the solar wind intermittency for a period of high-latitude fast solar wind is presented. In particular, the intermittent features are investigated as a function of the Alfvénic degree of fluctuations at a given scale. The results show that the main contribution to solar wind intermittency is due to non-Alfvénic structures, while Alfvénic increments are found to be characterized by a smaller level of intermittency than the previous ones. Furthermore, the lifetime statistics of Alfvénic periods are discussed in terms of a multiscale texture of randomly oriented flux tubes.

  20. Intermittent character of interplanetary magnetic field fluctuations

    International Nuclear Information System (INIS)

    Bruno, Roberto; Carbone, Vincenzo; Chapman, Sandra; Hnat, Bogdan; Noullez, Alain; Sorriso-Valvo, Luca

    2007-01-01

    Interplanetary magnetic field magnitude fluctuations are notoriously more intermittent than velocity fluctuations in both fast and slow wind. This behavior has been interpreted in terms of the anomalous scaling observed in passive scalars in fully developed hydrodynamic turbulence. In this paper, the strong intermittent nature of the interplanetary magnetic field is briefly discussed comparing results performed during different phases of the solar cycle. The scaling properties of the interplanetary magnetic field magnitude show solar cycle variation that can be distinguished in the scaling exponents revealed by structure functions. The scaling exponents observed around the solar maximum coincide, within the errors, to those measured for passive scalars in hydrodynamic turbulence. However, it is also found that the values are not universal in the sense that the solar cycle variation may be reflected in dependence on the structure of the velocity field

  1. Intermittency exponent of the turbulent energy cascade

    International Nuclear Information System (INIS)

    Cleve, J.; Greiner, M.; Pearson, B.R.; Sreenivasan, K.R.

    2006-12-01

    We consider the turbulent energy dissipation from one-dimensional records in experiments using air and gaseous helium at cryogenic temperatures, and obtain the intermittency exponent via the two-point correlation function of the energy dissipation. The air data are obtained in a number of flows in a wind tunnel and the atmospheric boundary layer at a height of about 35 m above the ground. The helium data correspond to the centerline of a jet exhausting into a container. The air data on the intermittency exponent are consistent with each other and with a trend that increases with the Taylor microscale Reynolds number, R λ , of up to about 1000 and saturates thereafter. On the other hand, the helium data cluster around a constant value at nearly all R λ , this being about half of the asymptotic value for the air data. Some possible explanation is offered for this anomaly. (author)

  2. Effects of intermittent hypoxia on running economy.

    Science.gov (United States)

    Burtscher, M; Gatterer, H; Faulhaber, M; Gerstgrasser, W; Schenk, K

    2010-09-01

    We investigated the effects of two 5-wk periods of intermittent hypoxia on running economy (RE). 11 male and female middle-distance runners were randomly assigned to the intermittent hypoxia group (IHG) or to the control group (CG). All athletes trained for a 13-wk period starting at pre-season until the competition season. The IHG spent additionally 2 h at rest on 3 days/wk for the first and the last 5 weeks in normobaric hypoxia (15-11% FiO2). RE, haematological parameters and body composition were determined at low altitude (600 m) at baseline, after the 5 (th), the 8 (th) and the 13 (th) week of training. RE, determined by the relative oxygen consumption during submaximal running, (-2.3+/-1.2 vs. -0.3+/-0.7 ml/min/kg, Ptraining phase. Georg Thieme Verlag KG Stuttgart . New York.

  3. Optimal intermittent search strategies: smelling the prey

    International Nuclear Information System (INIS)

    Revelli, J A; Wio, H S; Rojo, F; Budde, C E

    2010-01-01

    We study the kinetics of the search of a single fixed target by a searcher/walker that performs an intermittent random walk, characterized by different states of motion. In addition, we assume that the walker has the ability to detect the scent left by the prey/target in its surroundings. Our results, in agreement with intuition, indicate that the prey's survival probability could be strongly reduced (increased) if the predator is attracted (or repelled) by the trace left by the prey. We have also found that, for a positive trace (the predator is guided towards the prey), increasing the inhomogeneity's size reduces the prey's survival probability, while the optimal value of α (the parameter that regulates intermittency) ceases to exist. The agreement between theory and numerical simulations is excellent.

  4. Optimal intermittent search strategies: smelling the prey

    Energy Technology Data Exchange (ETDEWEB)

    Revelli, J A; Wio, H S [Instituto de Fisica de Cantabria, Universidad de Cantabria and CSIC, E-39005 Santander (Spain); Rojo, F; Budde, C E [Fa.M.A.F., Universidad Nacional de Cordoba, Ciudad Universitaria, X5000HUA Cordoba (Argentina)

    2010-05-14

    We study the kinetics of the search of a single fixed target by a searcher/walker that performs an intermittent random walk, characterized by different states of motion. In addition, we assume that the walker has the ability to detect the scent left by the prey/target in its surroundings. Our results, in agreement with intuition, indicate that the prey's survival probability could be strongly reduced (increased) if the predator is attracted (or repelled) by the trace left by the prey. We have also found that, for a positive trace (the predator is guided towards the prey), increasing the inhomogeneity's size reduces the prey's survival probability, while the optimal value of {alpha} (the parameter that regulates intermittency) ceases to exist. The agreement between theory and numerical simulations is excellent.

  5. Optimal Dynamics of Intermittent Water Supply

    Science.gov (United States)

    Lieb, Anna; Wilkening, Jon; Rycroft, Chris

    2014-11-01

    In many urban areas of the developing world, piped water is supplied only intermittently, as valves direct water to different parts of the water distribution system at different times. The flow is transient, and may transition between free-surface and pressurized, resulting in complex dynamical features with important consequences for water suppliers and users. These consequences include degradation of distribution system components, compromised water quality, and inequitable water availability. The goal of this work is to model the important dynamics and identify operating conditions that mitigate certain negative effects of intermittent water supply. Specifically, we will look at valve parameters occurring as boundary conditions in a network model of transient, transition flow through closed pipes. Optimization will be used to find boundary values to minimize pressure gradients and ensure equitable water availability.

  6. AN ELDERLY WOMAN WITH INTERMITTENT CLAUDICATION

    Directory of Open Access Journals (Sweden)

    Nayyer Naveed Wazir

    2006-01-01

    Full Text Available This case report illustrates the misdiagnosis of intermittent claudication in an elderly with multiple cardiac risk factors. Careful clinical evaluation and imaging shifts the diagnosis from peripheral vascular disease to spinal stenosis. The decision whether to offer conservative therapy or proceed to spinal surgery requires an accurate assessment of the severity of the symptoms without ignoring the important role of patient preferences.

  7. Long-range forecasting of intermittent streamflow

    OpenAIRE

    F. F. van Ogtrop; R. W. Vervoort; G. Z. Heller; D. M. Stasinopoulos; R. A. Rigby

    2011-01-01

    Long-range forecasting of intermittent streamflow in semi-arid Australia poses a number of major challenges. One of the challenges relates to modelling zero, skewed, non-stationary, and non-linear data. To address this, a statistical model to forecast streamflow up to 12 months ahead is applied to five semi-arid catchments in South Western Queensland. The model uses logistic regression through Generalised Additive Models for Location, Scale and Shape (GAMLSS) to determine th...

  8. Long-range forecasting of intermittent streamflow

    OpenAIRE

    F. F. van Ogtrop; R. W. Vervoort; G. Z. Heller; D. M. Stasinopoulos; R. A. Rigby

    2011-01-01

    Long-range forecasting of intermittent streamflow in semi-arid Australia poses a number of major challenges. One of the challenges relates to modelling zero, skewed, non-stationary, and non-linear data. To address this, a probabilistic statistical model to forecast streamflow 12 months ahead is applied to five semi-arid catchments in South Western Queensland. The model uses logistic regression through Generalised Additive Models for Location, Scale and Shape (GAMLSS) to determine the probabil...

  9. Efficient search by optimized intermittent random walks

    International Nuclear Information System (INIS)

    Oshanin, Gleb; Lindenberg, Katja; Wio, Horacio S; Burlatsky, Sergei

    2009-01-01

    We study the kinetics for the search of an immobile target by randomly moving searchers that detect it only upon encounter. The searchers perform intermittent random walks on a one-dimensional lattice. Each searcher can step on a nearest neighbor site with probability α or go off lattice with probability 1 - α to move in a random direction until it lands back on the lattice at a fixed distance L away from the departure point. Considering α and L as optimization parameters, we seek to enhance the chances of successful detection by minimizing the probability P N that the target remains undetected up to the maximal search time N. We show that even in this simple model, a number of very efficient search strategies can lead to a decrease of P N by orders of magnitude upon appropriate choices of α and L. We demonstrate that, in general, such optimal intermittent strategies are much more efficient than Brownian searches and are as efficient as search algorithms based on random walks with heavy-tailed Cauchy jump-length distributions. In addition, such intermittent strategies appear to be more advantageous than Levy-based ones in that they lead to more thorough exploration of visited regions in space and thus lend themselves to parallelization of the search processes.

  10. Allergy prevention.

    Science.gov (United States)

    Muche-Borowski, Cathleen; Kopp, Matthias; Reese, Imke; Sitter, Helmut; Werfel, Thomas; Schäfer, Torsten

    2010-09-01

    The further increase of allergies i