Prevalence of complementary/alternative medicines (CAMs) in a cancer population in northern Italy receiving antineoplastic treatments and relationship with quality of life and psychometric features

Purpose

To explore the use of CAM (Complementary/Alternative Medicine) in a population of cancer patients undergoing antineoplastic therapy, and to compare differences in sociodemographics, quality of life, and psychological features between CAM users and non-users.

Methods

The study population was consecutive cancer patients undergoing antineoplastic treatment in three Piedmont cancer centers. Data were collected from anonymous questionnaires investigating CAM use or not, and what type if used, and sociodemographics, and through validated psychometric instruments to assess psychological features: Functional Assessment of Cancer Therapy-General, the Hospital Anxiety and Depression Scale, and the Mini Mental Adjustment to Cancer Scale.

Results

Of the 288 evaluable patients, 52 (18.1%) reported using one or more types of CAM; the most often cited were herbs, special diets and body-based practices, such as plantar reflexology, chiropractic application, and massage. On quality of life assessment, CAM users scored lower than CAM non-users for physical wellbeing (P = 0.006); no significant differences emerged for anxiety and depression and coping styles.

Conclusions

CAM use is less prevalent in northern Italy than in most other European countries. CAM users were found to have a lower quality of life than CAM non-users.     

Fatigue interference with daily living among patients with inflammatory bowel disease

Purpose

The purpose of the study was to examine fatigue interference with daily living in patients with inflammatory bowel disease (IBD) and to explore relationships between severe fatigue interference and socio-demographic and clinical variables, including use of complementary and alternative medicine (CAM).

Methods

Data were collected using self-report questionnaires from adult IBD outpatients. Fatigue interference was assessed with the 5-item Fatigue Severity Scale, and scores ≥5 were defined as severe fatigue interference. CAM use was assessed with the International CAM Questionnaire. Multivariate logistic regression analysis was used to examine associations between severe fatigue interference and socio-demographic factors, clinical factors, and CAM use.

Results

In total, 428 patients had evaluable questionnaires (response rate 93 %). Severe fatigue interference was reported by 39 % of the total sample. Patients with Crohn’s disease (CD) (n = 238) were more likely than patients with ulcerative colitis (UC) (n = 190) to report severe fatigue interference (43 and 33 %, respectively, p = 0.003). In addition, patients reporting severe fatigue interference were more likely to have active disease than patients without severe fatigue interference (p < 0.001 for both diagnoses). Patients with inactive disease had scores comparable to the general population. Factors independently associated with severe fatigue interference in UC included disease activity and CAM use, while in CD they included disease activity and current smoking.

Conclusions

Severe fatigue interference is common among IBD patients with active disease. Among patients with UC, but not CD, CAM use was associated with severe fatigue interference. The relationship between fatigue interference and personal factors should be considered further in subsequent studies.     

Promotion of physical activity in primary care: knowledge and practice of general practitioners and physiotherapists

Aim

Being physically active has many proven health benefits and promoting physical activity to patients in primary care is an important component of public health programmes. This study examined the knowledge and practices of general practitioners and physiotherapists in the promotion of physical activity in primary care.

Subject and methods

A cross-sectional population survey was conducted in Ireland to establish participants’ knowledge of physical activity guidelines and current practice in the promotion of physical activity. A total of 342 general practitioners (response rate 65 %; n?=?543) and 89 physiotherapists (response rate 88 %; n?=?101) responded to the survey.

Results

More physiotherapists (50.5 %; n?=?45) than general practitioners (28 %; n?=?97) correctly reported the minimal physical activity guidelines (X²?=?16.56, p?<?.005, df?=?1). General practitioners reported screening physical activity opportunistically (41 %; n?=?139) and when related to a patient’s presenting complaint (37 %; n?=?126). Physiotherapists reported screening physical activity routinely (34 %; n?=?30) and when related to the presenting complaint (28 %; n?=?25). With the exception of overweight patients, general practitioners were more likely than physiotherapists to promote physical activity to patients with known cardiovascular risk factors such as hypertension (X²?=?49.65, p?<?.001, df?=?2) and hypercholesterolemia (X²?=?32.58, p?<?.001, df?=?2). Physiotherapists, however, were more likely to promote physical activity to healthy populations (X²?=?9.91; p?<?.01, df?=?2). Education and advice was the intervention most frequently used (general practitioners 76 %; n?=?258, physiotherapists 97 %; n?=?86).

Conclusion

Despite high levels of awareness of physical activity promotion amongst general practitioners and physiotherapists, there is scope to improve physical activity promotion particularly to healthy populations and ongoing challenges to incorporate evidence based interventions into routine care.     

Use and understanding of nutrition information on food labels in six European countries

Aim

The goal of the study was to investigate the use of nutrition information on food labels and understanding of guideline daily amount (GDA) front-of-pack nutrition labels in six European countries.

Subjects and methods

In-store observations and in-store interviews were conducted in major retailers in the UK (n?=?2019), Sweden (n?=?1858), France (n?=?2337), Germany (n?=?1963), Poland (n?=?1800) and Hungary (n?=?1804), supplemented by questionnaires filled out at home and returned (overall response rate 50.3%). Use of labels was measured by combining in-store observations and in-store interviews on concrete purchases in six product categories. Understanding of GDA front-of-pack nutrition labels was measured by a variety of tasks dealing with conceptual understanding, substantial understanding and health inferences. Demographics, nutrition knowledge and interest in healthy eating were measured as potential determinants.

Results

Across six product categories, 16.8% of shoppers were found to have looked for nutrition information on the label, with the nutrition grid (table or list), GDA labels and the ingredients list as the main sources consulted and calories, fat and sugar the information most often looked for. Understanding of GDA labels was high in the UK, Sweden and Germany, and more limited in the other countries. Regression analysis showed that, in addition to country-specific differences, use and understanding are also affected by differences in interest in healthy eating and in nutrition knowledge and by social grade.

Conclusion

Understanding of nutrition information seems to be more widespread than use, suggesting that lack of use is a question of not only understanding, but also motivation. Considerable national differences exist in both understanding and use, some of which may be attributed to different histories of the role of nutrition in the public debate.     

Isolation of a novel amylase and lipase-producing Pseudomonas luteola strain: study of amylase production conditions

Background

Patients with mixed hyperlipidemia usually are in need of combination therapy to achieve low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) target values for reduction of cardiovascular risk. This study investigated the efficacy and safety of adding a new hypolipidemic agent, coenzyme A (CoA) to stable statin therapy in patients with mixed hyperlipidemia.

Methods

In this multi-center, 8-week, double-blind study, adults who had received ≥8 weeks of stable statin therapy and had hypertriglyceridemia (TG level at 2.3-6.5 mmol/L) were randomized to receive CoA 400 U/d or placebo plus stable dosage of statin. Efficacy was assessed by the changes in the levels and patterns of lipoproteins. Tolerability was assessed by the incidence and severity of adverse events (AEs).

Results

A total of 304 patients with mixed hyperlipidemia were randomized to receive CoA 400 U/d plus statin or placebo plus statin (n?=?152, each group). After treatment for 8 weeks, the mean percent change in TG was significantly greater with CoA plus statin compared with placebo plus statin (-25.9% vs -4.9%, respectively; p?=?0.0003). CoA plus statin was associated with significant reductions in TC (-9.1% vs -3.1%; p?=?0.0033), LDL-C (-9.9% vs 0.1%; p?=?0.003), and non- high-density lipoprotein cholesterol (-13.5% vs -5.7%; p?=?0.0039). There was no significant difference in the frequency of AEs between groups. No serious AEs were considered treatment related.

Conclusions

In these adult patients with persistent hypertriglyceridemia, CoA plus statin therapy improved TG and other lipoprotein parameters to a greater extent than statin alone and has no obviously adverse effect.

Trial registration

Current Controlled Trials ClinicalTrials.gov ID NCT01928342.     

‘It helps me make sense of the world’: the role of an art intervention for promoting health and wellbeing in primary care—perspectives of patients, health professionals and artists

Background

Art interventions are increasingly used in public health for the enhancement of patients’ health and wellbeing. The present study investigated perceived outcomes and role of an art intervention from the collective perspectives of participants (patients who took part), deliverers (artists) and referrers (general practitioners and practice nurses).

Methods

A qualitative methodology, using interviews and focus groups, allowed investigation of participants (n?=?18) perceived outcomes and role of the intervention. Participants included patients (n?=?10), artists (n?=?5), and referring health professionals (n?=?3).

Results

Themes that emerged from the analysis included perceived benefits, role and value of the intervention, and setting and referral process. Central to these themes were psychological and mental health benefits, an appreciated holistic treatment option and the merits of the intervention being situated in the surgery setting.

Conclusions

The study showed that art interventions within primary care are valuable in the promotion of public health, and in particular, patients’ mental health. Interactions between other participants and the artist were central to achieving patients’ perceived health improvement. Locating the intervention in primary care facilitated patient participation and provided health professionals with a holistic treatment alternative. There is also some evidence that participation in the intervention encourages less dependence on the health professional.     

Reliability of adverse symptom event reporting by clinicians

Purpose

Adverse symptom event reporting is vital as part of clinical trials and drug labeling to ensure patient safety and inform risk?Cbenefit decision making. The purpose of this study was to assess the reliability of adverse event reporting of different clinicians for the same patient for the same visit.

Methods

A retrospective reliability analysis was completed for a sample of 393 cancer patients (42.8% men; age 26?C91, M?=?62.39) from lung (n?=?134), prostate (n?=?113), and Ob/Gyn (n?=?146) clinics. These patients were each seen by two clinicians who independently rated seven Common Terminology Criteria for Adverse Events (CTCAE) symptoms. Twenty-three percent of patients were enrolled in therapeutic clinical trials.

Results

The average time between rater evaluations was 68?min. Intraclass correlation coefficients were moderate for constipation (0.50), diarrhea (0.58), dyspnea (0.69), fatigue (0.50), nausea (0.52), neuropathy (0.71), and vomiting (0.46). These values demonstrated stability over follow-up visits. Two-point differences, which would likely affect treatment decisions, were most frequently seen among symptomatic patients for constipation (18%), vomiting (15%), and nausea (8%).

Conclusion

Agreement between different clinicians when reporting adverse symptom events is moderate at best. Modification of approaches to adverse symptom reporting, such as patient self-reporting, should be considered.     

Common tongue conditions affect quality of life: an issue to be recognized

Introduction

There is an increasing recognition that oral disorders might cause significant impact on life of patients. To date, there has been less focus on oral health?Crelated quality of life (OHR-QoL) measures in outpatient clinics for oral diseases.

Aim

This study was carried out to test the assumption that patients with common tongue conditions would report a worse OHR-QoL than controls.

Method

A total of 59 oral subjects with various tongue conditions and 44 controls were enrolled in this prospective study. Demographic, clinic, and laboratory findings of oral subjects were recorded, and an OHR-QoL questionnaire, named 14-item oral health impact profile (OHIP-14), was completed by oral subjects and controls at the outpatient clinics of four centers.

Results

Median of OHIP-14 total scores of the oral subjects with common tongue conditions was 11 and that of controls was 4 (P?=?0.00) indicating that OHR-QoL was worse in oral subjects than in controls. Most (n?=?39, 66%) of the oral subjects had mild to distressing pain. Eating was the most commonly affected function. Oral subjects were arbitrarily divided into two groups. Group 1 (n?=?22) included patients with tongue conditions which were associated with candidal infections and the other patients formed Group 2 (n?=?34). A significant difference between Group 1 and Group 2 was observed only with respect to functional limitation (P?=?0.027), indicating that oral subjects of Group 1 had more functional limitation.

Conclusion

Common tongue disorders were believed to be innocuous by most. When the influence of one of the most common form of oral disease (tongue conditions) on OHR-QoL was taken into consideration, OHR-QoL will provide an additional dimension and may help to improve the impact of a disease on an individual??s life. Moreover, we also encourage more extensive use of these OHR-QoL instruments for oral diseases at outpatient clinics.     

The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain

Background

Chronic musculoskeletal pain is the single most cited reason for use of complementary and alternative medicine (CAM). Primary care is the most frequent conventional medical service used by patients with pain in the UK. We are unaware, however, of a direct evidence of the extent of CAM use by primary care patients, and how successful they perceive it to be.

Methods

Aims and objectives

To determine CAM use among patients with chronic musculoskeletal pain who have consulted about their pain in primary care.

Study design

Face-to-face interview-based survey.

Setting

Three general practices in North Staffordshire.

Participants

Respondents to a population pain survey who had reported having musculoskeletal pain in the survey and who had consulted about their pain in primary care in the previous 12 months as well as consenting to further research and agreeing to an interview. Information was gathered about their pain and the use of all treatments for pain, including CAM, in the previous year.

Results

138 interviews were completed. 116 participants (84%) had used at least one CAM treatment for pain in the previous year. 65% were current users of CAM. The ratio of over-the-counter CAM use to care from a CAM provider was 3:2. 111 participants (80%) had used conventional treatment. 95 (69%) were using a combination of CAM and conventional treatment. Glucosamine and fish oil were the most commonly used CAM treatments (38%, 35% respectively). Most CAM treatments were scored on average as being helpful, and users indicated that they intended to use again 87% of the CAM treatments they had already used.

Conclusion

We provide direct evidence that most primary care consulters with chronic musculoskeletal pain have used CAM in the previous year, usually in combination with conventional treatments. The high prevalence and wide range of users experiences of benefit and harm from CAM strengthen the argument for more research into this type of medicine to quantify benefit and assess safety. The observation that most users of conventional medicine also used CAM suggests a continuing need for more investigation of effective pain management in primary care.     

Health and well-being benefits of spending time in forests: systematic review

Background

Numerous studies have reported that spending time in nature is associated with the improvement of various health outcomes and well-being. This review evaluated the physical and psychological benefits of a specific type of exposure to nature, forest therapy.

Method

A literature search was carried out using MEDLINE, PubMed, ScienceDirect, EMBASE, and ProQuest databases and manual searches from inception up to December 2016. Key words: “Forest” or “Shinrin -Yoku” or “Forest bath” AND “Health” or “Wellbeing”. The methodological quality of each randomized controlled trials (RCTs) was assessed according to the Cochrane risk of bias (ROB) tool.

Results

Six RCTs met the inclusion criteria. Participants’ ages ranged from 20 to 79 years. Sample size ranged from 18 to 99. Populations studied varied from young healthy university students to elderly people with chronic disease. Studies reported the positive impact of forest therapy on hypertension (n?=?2), cardiac and pulmonary function (n?=?1), immune function (n?=?2), inflammation (n?=?3), oxidative stress (n?=?1), stress (n?=?1), stress hormone (n?=?1), anxiety (n?=?1), depression (n?=?2), and emotional response (n?=?3). The quality of all studies included in this review had a high ROB.

Conclusion

Forest therapy may play an important role in health promotion and disease prevention. However, the lack of high-quality studies limits the strength of results, rendering the evidence insufficient to establish clinical practice guidelines for its use. More robust RCTs are warranted.

     

A comparative analysis of TLR5 polymorphism and clinical parameters in typhoid patients and asymptomatic typhoid carriers

Aim

Typhoid fever is a serious health problem in tropical and developing countries. Although asymptomatic typhoid carriers show no clinical signs, they can spread infection to others. This study investigated the Toll like receptor 5 (TLR5) polymorphism and various clinical parameters in typhoid patients and asymptomatic typhoid carriers.

Subjects and methods

TLR5 gene was amplified in typhoid patients (n?=?15), asymptomatic carriers (n?=?10) and healthy control subjects (n?=?10) by polymerase chain reaction (PCR). A restriction fragment length polymorphism (RFLP) analysis of TLR5 gene was performed with restriction enzyme (Ddel). Clinical parameters such as total leukocyte, platelets, C-reactive protein (CRP), and adenosine de-aminase (ADA) were estimated. A correlative analysis of TLR5 gene polymorphism and clinical parameters was performed.

Results

Typhoid fever patients had significantly (p?<?0.05) reduced total leukocyte and platelet counts when compared to asymptomatic carriers and control subjects. Typhoid patients showed significantly (p?<?0.05) reduced ADA activity, while elevated CRP level when compared to carriers and controls. TLR5 gene was amplified in all individuals, but only two typhoid patients showed TLR5 gene polymorphism (TLR5 ^392STOP). There was no significant correlation between TLR5 gene polymorphism and clinical parameters studied in typhoid patients.

Conclusion

The TLR5 gene polymorphism seems to be not associated with susceptibility to typhoid fever.     

Testing Skype as an interview method in epidemiologic research: response and feasibility

Introduction

Despite its popularity, Skype has not been tested as a tool for epidemiologic research. We examined its feasibility in Germany.

Methods

A population-based sample of young adults was randomly invited to a Skype (n?=?150) or a phone interview (n?=?150). Response and duration of interviews were analysed to evaluate the feasibility of Skype interviews.

Results

Response was low and, with 10 % (95 % CI 5–15 %), even worse among Skype candidates, compared to 22 % (15–28 %) in the phone group. A third of the Skype group asked for being interviewed by phone. Median duration was 34.0 minutes for Skype interviews and 37.0 minutes for phone interviews.

Conclusions

Skype is not yet a feasible tool for data collection in Germany.     

Prevalence of hypersensitivity reactions against drugs among adult population in Turkey: a self-reported survey

Aim

There is currently no data available regarding hypersensitivity reactions to drugs in an adult population in Turkey. The aim of this study was to determine the prevalence of self-reported drug hypersensitivity reactions among adults in Turkey and related factors.

Subjects and methods

A structured self-administered questionnaire was sent to the parents of 6th grade elementary students who represented different socioeconomic levels of populations in Ankara/Turkey.

Results

A total of 1,370 adults (mean age: 23.88?±?6.48?years, female/male: 710/660) responded to the survey. The prevalence of self-reported drug hypersensitivity was 13.4% (183/1,370). The most frequently drugs involved were beta-lactams (n?=?63, 34.4%), followed by nonsteroidal anti-inflammatory drugs (n?=?52, 28.4%), general anesthetics (n?=?29, 15.8%) and radio contrast media (n?=?25, 13.7%). Factors related with reported reactions were age (p?<?0.0001, odds ratio: 2.27); personal history of allergic (p: 0.001, odds ratio: 7.32), nonallergic diseases (p?<?0.0001, odds ratio: 39.93), and family history of drug hypersensitivity (p?<?0.0001, odds ratio: 17.00). Less than half of the subjects had solicited medical assistance during the acute stages of a reaction and 9.7% of them had been referred to an allergist for further evaluation of a drug allergy.

Conclusion

This survey showed that self-reported hypersensitivity reactions to drugs are highly prevalent among parents of elementary students and its prevalence seems to be affected by age, personal allergic and nonallergic diseases, and family history of drug hypersensitivity.     

The effectiveness of psychosocial interventions designed to improve health-related quality of life (HRQOL) amongst asthmatic children and their families: a systematic review

Purpose

Asthmatic children are at risk of compromised health-related quality of life (HRQOL) compared with their healthy peers. This systematic review reports the range and effectiveness of psychosocial interventions designed to improve HRQOL amongst asthmatic children, adolescents, and their families.

Method

Data sources included The Cochrane Airways Group Trials Register of trials, PubMed database, and reference lists from review articles.

Results

Eighteen studies of psychosocial interventions were identified. Interventions were designed to improve HRQOL amongst a range of psychosocial, health care, school-related and clinical outcomes, and were delivered in numerous settings and formats. Four studies reported that interventions were effective for significant improvements in child overall HRQOL scores. These include asthma education (n?=?2), asthma education plus problem solving (n?=?1), and art therapy (n?=?1).

Conclusions

Most interventions focussed on the delivery of asthma education to children, with the purpose of improving knowledge about asthma and disease management. There is limited evidence to suggest that interventions currently available are effective for significantly improving HRQOL amongst asthmatic children, adolescents, and their families. Most interventions lacked a theoretical basis and did not focus on family functioning variables. Multi-component interventions that incorporate asthma education along with strategies to assist families with implementing behaviour change towards improved asthma management are required. Future interventions should also attempt to address the wider context of family functioning likely to contribute to the family??s ability to engage in successful asthma management in order to improve HRQOL.     

Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised,double-blind,placebo-controlled trial

Background

This multicentre, randomised, double-blind, placebo-controlled trial was performed to determine whether the use of oral probiotic preparation (prOVag®) containing three Lactobacillus strains together with standard metronidazole treatment and also targeted antibiotic treatment (following the failure of metronidazole therapy) could reduce the recurrence rates of bacterial vaginosis (BV) and aerobic vaginitis (AV).

Methods

Patients at private gynaecological clinics in Poland with histories of recurrent BV/AV and current symptoms were randomly allocated to receive metronidazole and probiotic or placebo, and assessed monthly on visits II and III-V. The total number of study visits was 5–6 (I, II, II bis – if applicable, III, IV, V). One probiotic or placebo capsule was administered with metronidazole/targeted antibiotic twice daily for 10 days; during follow up, patients took one capsule daily for 10 days perimenstrually. Clinical examination and vaginal swabbing were performed at each visit. Primary outcomes were clinical or microbiological BV/AV recurrence and probiotic safety. Secondary outcomes were vaginal pH, Nugent score, and Lactobacillus counts in the vaginal microbiota. Safety analysis was performed in 578 (probiotic, n?=?285; placebo, n?=?293) 18–50-year-old women who were randomised.

Results

BV/AV was confirmed microbiologically in 241 (probiotic, n?=?118; placebo, n?=?123) participants, who continued the trial. Data from 154 (probiotic, n?=?73; placebo, n?=?81) participants who completed the study were analysed to determine the efficacy of prOVag. Additional analyses included 37 (probiotic, n?=?22; placebo, n?=?15) participants who received targeted antibiotics and probiotics or placebo. prOVag lengthened the time to clinical relapse of BV/AV symptoms up to 51 % (p?<?0.05) compared with placebo; AV relapse was delayed by up to 76 % (p?<?0.05). Probiotic use also reduced and maintained low vaginal pH and Nugent score, and increased vaginal Lactobacillus counts following standard treatment.

Conclusion

This study demonstrated that oral probiotics lengthened remission in patients with recurrent BV/AV and improved clinical and microbiological parameters.

Trial registration

NCT01993524; 20 November 2013.

     

Prospective predictors of actual research participation among African-American adults

Aim

Although several variables appear to be associated with reluctance of African Americans to participate in research, most research on this topic has utilized hypothetical study scenarios, and there is a need for empirical studies of factors that predict actual study participation. The purpose of the present paper was to assess five potential predictors of participation in an actual study of psychological stress and health.

Subjects and methods

African American adults (n?=?236) completed the Barriers to Research Participation Questionnaire (BRPQ), which assesses attitudes toward research participation, and indicated whether they were willing to be contacted for involvement in a study of psychological stress and health.

Results

Respondents who declined to be contacted for further involvement (n?=?191) scored significantly lower (less willingness/greater barriers) on the overall BRPQ, and on the health beliefs/fears, role overload/time demands, and perceived benefits subscales than respondents who were enrolled in the study (n?=?45).

Conclusion

Investigators might enhance enrollment of African American adults by ameliorating health-related fears, increasing accessibility, or communicating benefits of the research.     

Work-related behavior and experience patterns of entrepreneurs compared to teachers and physicians

Purpose

This study examined the status of health-related behavior and experience patterns of entrepreneurs in comparison with teachers and physicians to identify specific health risks and resources.

Methods

Entrepreneurs (n?=?632), teachers (n?=?5,196), and physicians (n?=?549) were surveyed in a cross-sectional design. The questionnaire Work-related Behavior and Experience Patterns (AVEM) was used for all professions and, in addition, two scales (health prevention and self-confidence) from the Checklist for Entrepreneurs in the sample of entrepreneurs.

Results

The largest proportion of the entrepreneurs (45%) presented with a healthy pattern (compared with 18.4% teachers and 18.3% physicians). Thirty-eight percent of entrepreneurs showed a risk pattern of overexertion and stress, followed by teachers (28.9%) and physicians (20.6%). Unambitious or burnout patterns were seen in only 9.3/8.2% of entrepreneurs, respectively, and 25.3/27.3% of teachers, and 39.6/21.5% of physicians. While the distribution of patterns in teachers and physicians differed significantly between genders, a gender difference was not found among entrepreneurs. Entrepreneurs with the risk pattern of overexertion scored significantly (P?Conclusions The development of a successful enterprise depends, in part, on the health of the entrepreneur. The large proportion of entrepreneurs with the healthy pattern irrespective of gender may support the notion that self-selection effects of healthy individuals in this special career might be important. At the same time, a large proportion was at risk for overexertion and might benefit from measures to cope with professional demands and stress and promote a healthy behavior pattern.     

Bibliometric analysis of peer-reviewed literature on Syrian refugees and displaced people (2011–2017)

Background

The Syrian conflict has created the worst humanitarian crisis of our time with approximately half of Syria’s pre-war population killed or forced to flee their homes. The current study aimed to analyze peer-reviewed literature published on Syrian refugees and displaced people.

Methods

A bibliometric methodology was implemented using Scopus database after retrieving documents relevant to Syrian refugees and displaced people.

Findings

In total, 323 documents were retrieved. Research articles constituted 71.2% (n?=?230) of the retrieved documents. The bulk (61.6%; n?=?199) of the retrieved documents were in health-related fields. Research domains of the retrieved health-related documents were mainly in the field of mental and psychosocial (17.3%; n?=?56), infectious diseases (15.2%; n?=?49), health policy and systems (16.4%; n?=?53), maternal and reproductive health (15.2%; n?=?49), and non-communicable diseases (NCD) (7.4%; n?=?24). Authors from research institutions in the United States produced the highest number of publications (24.5%; n?=?79), followed by Turkey (21.4%; n?=?69) and Lebanon (10.2%; n?=?33). The American University of Beirut was the most active (5.6%; n?=?18) research institution. Aside from Lebanon and Jordan, there was very little contribution from other Arab states. Conflict and Health was the most active journal (5.3%; n?=?17) in publishing on Syrian refugees and displaced people.

Conclusion

The study highlighted some particular research gaps – most notably the limited research on NCDs. There was also modest international research collaboration and engagement from Arab countries aside from Lebanon and Jordan.

     

The impact of a recent relapse on patient-reported outcomes in subjects with multiple sclerosis

Purpose

In this study, we estimate the impact of a recent relapse on physical and mental health in subjects with relapsing-remitting multiple sclerosis (RRMS) using validated patient-reported outcome (PRO) measures.

Methods

Subjects enrolled in the Comprehensive Longitudinal Investigation of MS at the Brigham and Women??s Hospital with RRMS were eligible for enrollment. Subjects with a clinical visit within 45?days of a relapse were identified and divided into groups based on whether the relapse occurred before (recent relapse) (n?=?59) or after the visit (pre-relapse) (n?=?31). A group of subjects with no relapses was also identified (remission) (n?=?336). PRO measures in these three groups were compared. All outcomes were compared using a t test and linear regression controlling for age, disease duration, sex, and EDSS.

Results

Subjects with a recent relapse had significantly worse functioning on several physical and mental health scales compared to subjects in remission even after adjusting for potential confounders. Subjects with a recent relapse also showed significant deterioration on PRO measures over 1?year compared to subjects in remission (P?<?0.05 for each comparison). Subjects in the pre-relapse group were not significantly different than subjects in remission.

Conclusions

Clinical relapses have a measurable effect on PRO in subjects with RRMS.     

Cytological evaluation of breast lesions in symptomatic patients presenting to Kenyatta National Hospital,Kenya: a retrospective study

Background

Palpable breast lump, breast pain, and nipple discharge are common symptoms of breast disease. Breast cytology (fine-needle aspiration, nipple discharge smear, and touch preparation) accurately identifies benign, atypical, and malignant pathological changes in breast specimens. This study aims to determine the types of breast lesions diagnosed by breast cytology and assess the clinical adequacy of narrative reporting of breast cytology results.

Methods

Medical records of 390 patients presenting to breast or general surgery clinics in Kenyatta National Hospital, Nairobi, Kenya, between January 2010 and March 2014 were evaluated retrospectively.

Results

Of the 390 diagnosed breast lesions, 89.7 % (n?=?350) occurred in females, while 10.3 % (n?=?40) occurred in males, giving rise to a female-to-male ratio of 8.8:1. Neoplastic breast lesions (n?=?296) comprised 75.9 %, while non-neoplastic breast lesions (n?=?94) comprised 24.1 % of all diagnosed breast lesions. The neoplastic lesions were classified as 72.3 % (n?=?214) benign and 27.7 % (n?=?82) malignant, resulting in a benign-to-malignant ratio of 2.6:1. Fibroadenoma (n?=?136) and gynecomastia (n?=?33) were the most frequently diagnosed breast lesions for women and men, respectively.

Conclusions

Breast cytology effectively diagnosed neoplastic and non-neoplastic breast lesions. Neoplastic breast lesions occurred more frequently in women whereas non-neoplastic lesions occurred more frequently in men. To address the limitations associated with narrative reporting of breast cytology results, a synoptic reporting format incorporating the United Kingdom’s National Health Service Breast Screening Programme’s diagnostic categories (C1 to C5) is recommended for adoption by this hospital.