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.     

Health-related quality of life changes associated with buprenorphine treatment for opioid dependence

Background

Few studies have described improvement in health-related quality of life (HRQOL) associated with opioid dependence treatment with buprenorphine (ODT-B).

Objective

To evaluate HRQOL changes in domain scores, physical and mental component summaries, and health utilities (HUs) associated with ODT-B using the Short Form 36 (SF-36).

Methods

We assessed HRQOL changes in a substudy of a pharmacokinetic study that compared buprenorphine oral tablet and liquid dosage formulations over 16?weeks. Individuals, aged 18?C65?years, were screened for opioid dependence. They were excluded if they would not agree to birth control or had a serious medical condition. Subjects received psychosocial counseling and weekly group therapy. The SF-36 was administered upon enrollment and at 4-week intervals. We used the SF-6D to estimate HUs. We performed intention to treat (ITT) analyses based on the last observation available for each subject. Paired t tests of each domain and HU, limited to remaining patients at each 4-week interval, were also conducted.

Results

Of 96 subjects enrolled, cumulative dropouts over time resulted in 80, 69, 59, and 44 subjects remaining at 4, 8, 12, and 16?weeks. There were no significant differences in opioid-positive urines, dropout rates, or dosage changes between formulations. In the ITT analyses, HRQOL improvements over time were bodily pain (62.1 vs. 69.1, P?=?0.017), vitality (49.8 vs. 56.5, P?=?0.001), mental health (59.9 vs. 66.0, P?=?0.001), social function (66.4 vs. 74.7, P?=?0.001), role emotional (59.4 vs. 71.9, P?=?0.003), role physical (60.9 vs. 70.6, P?=?0.005), and mental component summary (41.9 vs. 45.4, P<0.001). HU scores also improved (0.674 vs. 0.715, P?=?0.001). Results from paired t tests, with only concurrently enrolled patients, showed similar improvements from baseline to 4, 8, 12, or 16?weeks.

Conclusion

Buprenorphine, accompanied with psychosocial counseling, was associated with improved HRQOL and HUs.     

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.     

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.     

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.     

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.

     

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.     

Serum and lipoprotein sitostanol and non-cholesterol sterols after an acute dose of plant stanol ester on its long-term consumption

Purpose

Chronic inhibition of cholesterol absorption with large doses of plant stanol esters (staest) alters profoundly cholesterol metabolism, but it is unknown how an acute inhibition with a large staest dose alters the postprandial serum and lipoprotein cholesterol precursor, plant sterol, and sitostanol contents.

Methods

Hypercholesterolemic subjects, randomly and double-blind divided into control (n?=?18) and intervention groups (n?=?20), consumed experimental diet without and with staest (plant stanols 8.8?g/day) for 10?weeks. Next morning after a fasting blood sample (0 h), the subjects had a breakfast without or with staest (4.5?g of plant stanols). Blood sampling was repeated 4?h later. Lipoproteins were separated with ultracentrifugation, and sterols were measured with gas–liquid chromatography.

Results

In 0-h chylomicrons and VLDL, plant sterols were lower in staest than in controls. Postprandially, cholestenol (cholesterol synthesis marker) was reduced in chylomicrons in staest compared with controls (?0.13?±?0.04?μg/dL vs. 0.01?±?0.08?μg/dL, P?P?Conclusions Chronic cholesterol absorption inhibition with large amount of plant stanol esters decreases plant sterols in triglyceride-rich lipoproteins. Acute plant stanol ester consumption increases sitostanol content in triglyceride-rich lipoproteins but suggests to decrease the risk of plant sterol and plant stanol accumulation into vascular wall by chylomicrons.     

What level of IBS symptoms drives impairment in health-related quality of life in community subjects with irritable bowel syndrome?

Background

Quality of life is impaired in some people with IBS, but the level of symptoms that may drive this impairment is unclear.

Aims

We aimed to identify whether current frequency and severity cut-offs for IBS-type symptoms are associated with a clinically meaningful impairment of quality of life in the community.

Methods

People who met modified Rome III criteria for IBS (n?=?201) and controls (n?=?1,904) were assessed. Frequency of IBS symptoms was grouped a priori into ??less frequent?? (not at all and sometimes) and ??more?? frequent (often, very often and almost always). Severity of abdominal pain was grouped into ??mild?? (very mild and mild) and severe (moderate, severe and very severe). Mental and physical functioning was measured using the valid SF-12, with ??normal?? functioning (defined as a score of >43 and >48) and ??impaired?? functioning (defined as a score of ??43 and ??48), respectively. Psychological variables were assessed via valid self-report.

Results

Having ??more?? versus ??less?? severe abdominal pain (OR?=?9.41; 95% CI 1.17?C75.43, P?=?0.03) and ??more?? versus ??less?? frequent diarrhoea (OR?=?2.19; 95% CI 1.13?C4.26, P?=?0.02) along with increasing age (OR?=?1.03; 95% CI 1.01?C1.05, P?=?0.003) were significant independent predictors of having impairment in physical functioning. In terms of psychological factors, having higher levels of depression (OR?=?1.61; 95% CI 1.36?C1.91) and somatic distress (OR?=?1.17; 95% CI 1.09?C1.27) were independently associated with mental and physical impairment, respectively.

Conclusion

The current frequency and severity threshold cut-offs for IBS symptoms in the Rome III criteria are associated with a clinically meaningful impairment of quality of life in community subjects with IBS.     

Validation of the Swedish translation of the general self-efficacy scale

Purpose

To study the internal consistency, factorial structure, and convergent validity of the Swedish translation of the General Self-Efficacy scale (S-GSE).

Methods

The S-GSE and two items on mental and physical work capacity were completed by a randomized population cohort (n?=?4,027) and two cohorts (n?=?3,310 and n?=?498) of incident cases of sick-leave (>14?days).

Results

S-GSE means were higher among men than women in two of the cohorts and higher in the randomized population cohort than in the two sick-leave cohorts. Internal consistency was high with ???=?.90. Unidimensionality was indicated and factor loadings ranged between .64 and .80. Moderate correlations (.35?C.38) between the S-GSE and mental work capacity were found in all cohorts. Yet, the correlation between S-GSE and physical work capacity was weaker in the sick-leave cohorts. The psychometric properties showed similar patterns across gender.

Conclusions

Across three cohorts, additionally stratified by gender, the S-GSE comprised one single latent factor and showed high internal consistency. However, since S-GSE was more strongly related to self-assessments of mental work capacity than physical work capacity regardless of sick-leave status, the S-GSE may not be a strong predictor of beliefs about physical work capacity across all populations.     

‘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.     

A maternal erythrocyte DHA content of approximately 6?g% is the DHA status at which intrauterine DHA biomagnifications turns into bioattenuation and postnatal infant DHA equilibrium is reached

Purpose

Higher long-chain polyunsaturated fatty acids (LCP) in infant compared with maternal lipids at delivery is named biomagnification. The decline of infant and maternal docosahexaenoic acid (DHA) status during lactation in Western countries suggests maternal depletion. We investigated whether biomagnification persists at lifelong high fish intakes and whether the latter prevents a postpartum decline of infant and/or maternal DHA status.

Methods

We studied 3 Tanzanian tribes with low (Maasai: 0/week), intermediate (Pare: 2–3/week), and high (Sengerema: 4–5/week) fish intakes. DHA and arachidonic acid (AA) were determined in maternal (m) and infant (i) erythrocytes (RBC) during pregnancy (1st trimester n?=?14, 2nd?=?103, 3rd?=?88), and in mother–infant pairs at delivery (n?=?63) and at 3?months postpartum (n?=?104).

Results

At delivery, infants of all tribes had similar iRBC-AA which was higher than, and unrelated to, mRBC-AA. Transplacental DHA biomagnification occurred up to 5.6?g% mRBC-DHA; higher mRBC-DHA was associated with “bioattenuation” (i.e., iRBC-DHA?Conclusion Uniform high iRBC-AA at delivery might indicate the importance of intrauterine infant AA status. Biomagnification reflects low maternal DHA status, and bioattenuation may prevent intrauterine competition of DHA with AA. A mRBC-DHA of about 6?g% during pregnancy predicts maternal–fetal equilibrium at delivery, postnatal iRBC-DHA equilibrium, but is unable to prevent a postnatal mRBC-DHA decline.     

On-site screening of farming-induced chronic obstructive pulmonary disease with the use of an electronic mini-spirometer: results of a pilot study in Brittany, France

Purpose

Dairy farming is a risk factor for the development of chronic obstructive pulmonary disease (COPD). We assessed the prevalence of farming-induced COPD (FI-COPD) using a new screening device, and we analyzed symptoms and occupational risk factors.

Methods

We performed on-site screening study of bronchial obstruction using an electronic mini-spirometer (EMS) on an entire population of dairy farmers (n?=?147) from two villages in Brittany, France. Suspected bronchial obstruction (FEV1/FEV6 <0.8) was confirmed with standardized lung function tests (FEV1/FVC ≤0.7). We assessed past medical histories, respiratory symptoms, and occupational tasks of subjects with bronchial obstruction; asthmatics were defined as atopic and/or reversible; smoking-induced COPD patients were defined as non-reversible, non-atopic with smoking histories (≥5 PY); and FI-COPD patients were defined as non-reversible, non-atopic, and non-smokers.

Results

Using the EMS, 30.6% (n?=?45) of dairy farmers were suspected of bronchial obstruction and underwent standardized spirometry. The FEV1/FEV6 ratio and FEV1/FVC ratio were in good agreement (r2?=?0.66, P?<?0.0001). The prevalence of confirmed bronchial obstruction was 9.5% (n?=?14), which included 4 asthmatics, 3 smoking-induced COPD subjects, and 7 FI-COPD subjects. All the COPD patients were GOLD Stage II, and none were aware of their respiratory disease. Foddering duration was significantly higher in FI-COPD subjects compared with non-obstructive subjects, with 44 versus 17?min/day, respectively.

Conclusions

The EMS was a convenient mean of screening for bronchial obstruction, especially in on-site settings, and allowed us to diagnose FI-COPD in a non-spontaneously complaining dairy farmer population. Foddering was considered a significant risk factor.     

Longitudinal changes in social functioning in mildly disabled patients with relapsing–remitting multiple sclerosis receiving subcutaneous interferon β-1a: results from the COGIMUS (COGnitive Impairment in MUltiple Sclerosis) study (II)

Purpose

To report longitudinal changes in and explore the influence of cognition on social functioning in mildly disabled patients with relapsing?Cremitting multiple sclerosis (RRMS).

Methods

Italian patients (18?C50?years) with RRMS and Expanded Disability Status Scale (EDSS) score ??4.0 were assigned to interferon ??-1a, 44 or 22???g subcutaneously three times weekly, and underwent annual assessments for social functioning (Environmental Status Scale [ESS]) over 3?years.

Results

Baseline total ESS score did not differ between patients with and without cognitive impairment (P?=?0.505). Total ESS score remained low (<2.0) and stable over 3?years in the whole study population, but worsened slightly when assessed by assigned treatment or treatment and baseline cognitive status (both P?=?0.004), driven mostly by changes in the ??transportation?? and ??financial/economic status?? subscales. The strongest independent predictor of worsening ESS score was baseline EDSS score. Test?Cretest analyses confirmed that total ESS score and most subscales changed little over 3?years.

Conclusion

ESS scores remained low and changed minimally over 3?years, reflecting the mild physical disability and good cognitive performance in this patient population. Determining the influence of cognitive function and treatment on longitudinal changes in social functioning requires further studies.     

Methods for interpreting change over time in patient-reported outcome measures

Purpose

Interpretation guidelines are needed for patient-reported outcome (PRO) measures’ change scores to evaluate efficacy of an intervention and to communicate PRO results to regulators, patients, physicians, and providers. The 2009 Food and Drug Administration (FDA) Guidance for Industry Patient-Reported Outcomes (PRO) Measures: Use in Medical Product Development to Support Labeling Claims (hereafter referred to as the final FDA PRO Guidance) provides some recommendations for the interpretation of change in PRO scores as evidence of treatment efficacy.

Methods

This article reviews the evolution of the methods and the terminology used to describe and aid in the communication of meaningful PRO change score thresholds.

Results

Anchor- and distribution-based methods have played important roles, and the FDA has recently stressed the importance of cross-sectional patient global assessments of concept as anchor-based methods for estimation of the responder definition, which describes an individual-level treatment benefit. The final FDA PRO Guidance proposes the cumulative distribution function (CDF) of responses as a useful method to depict the effect of treatments across the study population.

Conclusions

While CDFs serve an important role, they should not be a replacement for the careful investigation of a PRO’s relevant responder definition using anchor-based methods and providing stakeholders with a relevant threshold for the interpretation of change over time.     

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.     

Utility of a patient-reported outcome in measuring functional impairment during autologous stem cell transplant in patients with multiple myeloma

Background

We aimed to determine the utility of a patient-reported outcome (PRO) as it relates to patient performed testing (PPT) for measuring functional status in multiple myeloma patients after autologous hematopoietic stem cell transplantation (auto-HCT).

Methods

Symptom interference on walking (a PRO) was measured by the MD Anderson Symptom Inventory (MDASI). PPT was assessed via 6-min walk test (6MWT). Mixed effects modeling was used to examine (1) the longitudinal relationship between the MDASI score and 6MWT distance and (2) the MDASI scores between patients who did or did not complete the 6WMT. Receiver operating characteristic (ROC) curve analysis was performed to quantify the construct validity of the PRO by differentiating performance status.

Results

Seventy-nine patients were included. Mean 6MWT distance significantly correlated with MDASI-walking interference score (PRO) over the first month of auto-HCT (est?=?6.09, p?=?0.006). There was a significantly higher completion rate for MDASI versus 6MWT at each time point (p?<?0.01). Patients who completed the 6MWT reported less interference on walking during the study period (est?=?1.61, p?<?0.0001). Finally, the PRO demonstrated significant construct validity for measuring functioning status with MDASI-walking against ECOG-PS as the anchor (AUC?=?0.77, 95% CI 0.60–0.94, p?=?0.003).

Conclusion

The PRO of MDASI-walking interference is a valid physical functioning measure, correlating with an objective functional measure (6MWT) in MM patients undergoing auto-HCT. As patients with poorer functional status during therapy are less likely to complete PPT, this PRO may offer a more practical quantitative measure of functioning in patients.

     

Childhood Haemophilus influenzae related deaths in England and Wales

Aims

This study aimed to assess the contribution of Haemophilus influenzae disease to childhood deaths in England and Wales using national death registrations data.

Subjects and Methods

The Health Protection Agency (HPA) routinely receives national electronic death registrations data for public health purposes. Records of children aged < 15 years who died in 2009 were scrutinised for any mention of: “Haemophilus”, “influenzae”, “Hia/b/c/d/e/f” or “non‐typeable/non‐encapsulated H. influenzae”.

Results

Of the 4,436 children who died, only one death certificate recorded “Haemophilus bronchopneumonia” secondary to influenza virus infection. Follow-up revealed the Haemophilus species was isolated from post-mortem lung biopsy but had not been submitted to the HPA for identification and serotyping. During the same period, there were 126 children with invasive H. influenzae reported to the HPA, including 22 who were notified to have died. Most deaths (17/22, 77 %) were reported in neonates (n?=?7) or 1–11 month-old infants (n?=?10) and none had H. influenzae recorded as a cause of death on their death certificate.

Conclusions

Death registrations data do not accurately capture the contribution of H. influenzae disease to childhood deaths. This finding emphasises the need for detailed clinical follow-up of reported cases in order to develop evidence‐based strategies for preventing invasive H. influenzae infections in children.     

Greater adherence to the dietary approaches to stop hypertension (DASH) dietary pattern is associated with lower blood pressure in healthy Iranian primary school children

Purpose

The dietary determinants of children blood pressure (BP) are poorly understood. We examined the association between adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and BP in healthy Iranian primary school children.

Methods

This cross-sectional study was conducted among a representative sample (n?=?407) of healthy Shirazi students aged 6–12 years. Subjects’ systolic and diastolic BP were measured by a validated oscillometric BP monitor. Usual dietary intakes over the past 12 months were assessed using a valid and reproducible 168-item semi-quantitative food frequency questionnaire via face-to-face interviews. A DASH score was calculated for each subject based on his/her energy-adjusted intakes of 8 major dietary components emphasized or minimized in the DASH dietary pattern. The higher the DASH score of a subject, the more his/her adherence to the DASH dietary pattern.

Results

After controlling for several potential confounders in the analysis of covariance models, multivariable-adjusted means of systolic and mean BP of subjects in the highest tertile of DASH score were significantly lower than those in the lowest tertile (for systolic BP: mean difference ?6.2 mmHg, P?=?0.010; and for mean BP: mean difference ?5.4 mmHg, P?=?0.013). Furthermore, a similar but statistically insignificant difference was found in terms of multivariable-adjusted means of diastolic BP (mean difference ?3.9 mmHg, P?=?0.146).

Conclusions

The findings suggest that greater adherence to the DASH dietary pattern is associated with lower BP in healthy Iranian primary school children. However, future prospective studies of adequate methodological quality are warranted to confirm these findings.