We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Pharyngocutaneous fistula is a troublesome complication. Recently, synthetic materials such as fibrin sealant have been used as a secondary measure to treat fistula. This work assessed whether the primary use of fibrin sealant can reduce the rate of fistula.
Method
A retrospective review of 50 cases from 2 centres was completed. Tisseel was an adjunct to primary closure in all cases.
Results
In the first centre, 3 out of 34 cases developed pharyngocutaneous fistula (fistula rate of 9 per cent). All three were salvage cases. In the second centre, 0 out of 16 cases developed a fistula.
Conclusion
The incidence of pharyngocutaneous fistula post-radiation and post-chemoradiotherapy in laryngectomy cases has been quoted as 23 per cent and 34 per cent respectively. This study represents the first patient series on the use of fibrin sealant as an adjunct in primary closure following laryngectomy. The results are promising, encouraging the use of Tisseel as an adjunct to meticulous closure.
The impact of Idiopathic Parkinson Disease (IPD) in patient’s sexual health is still a matter of debate. Clinicians should have a concern about the sexual function of their patients with IPD.
Aims
To evaluate sexual health of patients with IPD.
Methods
We randomly select a group of IPD patients and a group of healthy controls. We used the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) to assess sexual function. To evaluate depression and anxiety we used Brief Symptom Inventory (BSI) and Beck Depression Index (BDI).
Results
We had 83 IPD patients, and 69 controls. Male patients had lower total IIEF scores than controls (p< 0,001). The analysis of linear regression shows a relationship between the IIFE and the duration of the disease, the patient age and the BDI score (R=0,72; Adjusted R square=0,49, p< 0,001) when adjusted to the variables: realization of deep brain cirurgy of subthalamic nucleus (DBS-STN) stage of the disease, BSI score, dopaminergic treatment, treatment with antidepressives and antipsychotics. The IFSF didn’t show differences between the cases and the controls. Patients had higher BSI and BDI scores than controls (p< 0,001).
Conclusions
Male IPD patients had an impairment of sexual function predicted by disease duration, patient age and BDI scores. Sexual function should be assessed in these patients
The changes in sexual health of patients with Parkinson's disease must be a concern to the clinicians. The effects in sexual health of patients submitted to functional cirurgy is still a matter of debate.
Objectives:
To describe and evaluate the sexual health of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).
Methods:
Patients with Parkinson's disease bilaterally implanted for DBS of STN and those only pharmacologically treated, will be evaluated. Sexual functioning will be assessed using the international erectile function indices (IEFI) and the female sexual function indices (FSFI). Depression and anxiety will be evaluated using the Beck depression inventory and the brief symptom indices. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease will be analyzed.
Results and conlusions:
We expect to find positive changes in the sexual health of these patients, given the fact of the procedure improve the overall burden of the disease by reduction of medication and motor symptoms.
The Psychiatric Emergency Service (PES) is an important part of the mental health care system for the management of acute conditions requiring prompt intervention representing also a significant part of workload of specialists and trainees. The objective of this study was to characterize the clinical features of patients observed in PES of Coimbra University Hospitals.
Method:
During the first 6 months of 2008, demographic and clinical data were obtained for all patients observed by the first author of the study, together with a specialist in Psychiatry.
Results:
The sample consisted of 159 patients, 103 females and 56 males. Mean age was 45,9 ± 18,367 years. The majority of patients presented in the emergency room either alone (56,6%) or with a first degree relative (34,6%) by self-initiative and having a past psychiatric history (71,1%). Disturbing mood symptoms (depression, anxiety or both) were the motive of assessment in 58% of patients but several other causes were reported including behavioural symptoms, agitation, psychosis, drug or alcohol related disorders, sleep and cognitive disorders. Average Clinical Global Impression was 4,12 ± 1,177. After the psychiatric assessment, several diagnosis were made namely Major Depressive Episode (14,5%), Adaptation Disorders (13,9%), Schizophrenia and related disorders (13,8%), Anxiety Disorder Not Otherwise Specified (11,9%) and Drug or Alcohol related disorders (8,2%). Most patients were discharged without referral (50,3%).
Conclusion:
A significant percentage of patients went to the PES for conditions that could have been treated by a primary care physician or in an outpatient clinic setting.
Steady Boussinesq flow in a weakly curved channel driven by a horizontal temperature gradient is considered. Linear variation in the transverse direction is assumed so that the problem reduces to a system of ordinary differential equations. A series expansion in
$G$
, a parameter proportional to the Grashof number and the square root of the curvature, reveals a real singularity and anticipates hysteresis. Numerical solutions are found using path continuation and the bifurcation diagrams for different parameter values are obtained. Multivalued solutions are observed as
$G$
and the Prandtl number vary. Often fields with the imposed structure that satisfy all the governing equations are insensitive to the boundary conditions and can be regarded as perturbations of the homogeneous (or ‘unforced’) problem. Four such unforced solutions are found. In two of these the velocity remains coupled with temperature which, formally, scales as
$1/G$
as
$G\rightarrow 0$
. The other two are purely hydrodynamic. The existence of such solutions is due to the unbounded nature of the domain. It is shown that these occur not only for the Dean equations, but constitute previously unreported solutions of the full Navier–Stokes equations in an annulus of arbitrary curvature. Two additional unforced solutions are found for large curvature.
The functional composition of plant communities in montane regions has been studied for decades, and most recent analyses find that environmentally favourable landscapes at lower altitudes tend to be dominated by species with resource-acquisitive traits, while more resource-conservative taxa dominate higher-altitude communities. However, it is unclear the extent to which this pattern is driven by co-gradient variation within clades or changes in clade representation across the gradient. To test for co-gradient variation, species composition, phylogenetic structure and functional traits were quantified for 97 species within the plant family Melastomataceae at five locations across a 2500-m altitudinal gradient along Volcán Barva in Costa Rica. Average melastome leaf force to punch, specific leaf area and leaf size vary with altitude, while four other functional traits do not. Taxonomic dissimilarity between communities was correlated with altitudinal difference, while phylogenetic dissimilarity was correlated with altitudinal dissimilarity only when measured with a metric that emphasizes shallow turnover of the tips of the phylogeny. These results highlight how species turnover may be more pronounced than functional or phylogenetic variation along altitudinal gradients. In addition, these results highlight the conservation value of lowland tropical forests, which here harbour a disproportionate amount of phylogenetic and functional diversity.
The Total Solar Irradiance (TSI), which is the total radiation arriving at Earth's atmosphere from the Sun, is one of the most important forcing of the Earths climate. Measurements of the TSI have been made employing instruments on board several space-based platforms during the last four solar cycles. However, combining these measurements is still challenging due to the degradation of the sensor elements and the long-term stability of the electronics. Here we describe the preliminary efforts to design an absolute radiometer based on the principle of electrical substitution that is under development at Brazilian's National Institute for Space Research (INPE).
N-3 polyunsaturated fatty acids (PUFAs) have been hypothesised to be protective for depression during pregnancy. However, there are few data and no consensus regarding this association. In this line, we aim to evaluate if the concentration of n-3 and n-6 PUFAs, and their ratio, are associated with depressive symptoms throughout pregnancy.
Method.
A prospective cohort of 172 Brazilian women was followed at 5–13th, 20–26th and 30–36th weeks of gestation. The presence of depressive symptoms was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) at each pregnancy trimester. Depression was defined as an EPDS score ≥11. The concentrations of n-3 [α-linolenic acid; eicosapentaenoic acid (EPA); docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA)] and n-6 PUFAs [linoleic acid; γ linolenic acid; eicosadienoic acid; eicosatrienoic acid; arachidonic acid; docosatetraenoic acid and docosapentaenoic acid] were expressed as absolute (μg/ml) values. The total n-6/n-3 ratio was calculated. Statistical analyses were performed using univariate and adjusted random intercept logistic model for each fatty acid (FA) considering the longitudinal nature of data. Covariates were selected as potential confounders based on their biological plausibility of having an association with the concentration of FA and depressive symptoms during pregnancy.
Results.
The prevalence of depressive symptoms was high in all pregnancy trimesters (1st = 33.7%; 2nd = 18.9%; 3rd = 17.4%). We did not find differences in means FA concentrations by depressive symptom classification, for each follow-up visit. The women presented a 5% decrease in the odds of having depressive symptoms for each one-week increase in the gestational age. As individual women progressed through pregnancy, higher concentrations of EPA (odds ratio (OR) = 0.92; 95% CI: 0.86–0.99), DHA (OR = 0.96; 95% CI: 0.93–0.99), DPA (OR = 0.87; 95% CI: 0.77–0.99) and total n-3 (OR = 0.98; 95% CI: 0.96–0.99) were associated with a lower odds of depressive symptoms, while higher total n-6/n-3 ratio were associated with greater odds of depressive symptoms (OR = 1.40; 95% CI: 1.09–1.79). We detected a decrease in the probability of depressive symptoms as concentrations of total n-3 FA, α-linolenic acid, DPA, and DHA increased. We also observed a sharper decline for women with initial greater chance of depressive symptoms compared with those with lower chance of having these symptoms.
Conclusions.
We found a high prevalence of depressive symptoms in low-income Brazilian pregnant women and no significant associations between n-6 FA and depressive symptoms. Lower serum concentrations of DHA, EPA and DPA and a higher n-6/n-3 ratio at each pregnancy trimester were associated with higher odds of depressive symptoms throughout pregnancy.
Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.
OBJECTIVE
To determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non–safety net hospitals.
DESIGN
Interrupted time-series design.
SETTING AND PARTICIPANTS
Nonfederal acute care hospitals that reported central line–associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention’s National Health Safety Network from July 1, 2007, through December 31, 2013.
RESULTS
We did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84–1.09]) or non–safety net (0.99 [0.90–1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non–safety net hospitals (P for 2-way interaction, .87).
CONCLUSIONS
The Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line–associated bloodstream infection in safety net or non–safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States.
The notion of educating the public through generic healthy eating messages has pervaded dietary health promotion efforts over the years and continues to do so through various media, despite little evidence for any enduring impact upon eating behaviour. There is growing evidence, however, that tailored interventions such as those that could be delivered online can be effective in bringing about healthy dietary behaviour change. The present paper brings together evidence from qualitative and quantitative studies that have considered the public perspective of genomics, nutrigenomics and personalised nutrition, including those conducted as part of the EU-funded Food4Me project. Such studies have consistently indicated that although the public hold positive views about nutrigenomics and personalised nutrition, they have reservations about the service providers’ ability to ensure the secure handling of health data. Technological innovation has driven the concept of personalised nutrition forward and now a further technological leap is required to ensure the privacy of online service delivery systems and to protect data gathered in the process of designing personalised nutrition therapies.
To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines.
Design
Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol.
Setting
Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries.
Subjects
A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project.
Results
The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8–37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded).
Conclusions
Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group.
Family meals have been negatively associated with overweight in children, while television (TV) viewing during meals has been associated with a poorer diet. The aim of the present study was to assess the association of eating family breakfast and dinner, and having a TV on during dinner, with overweight in nine European countries and whether these associations differed between Northern and Southern & Eastern Europe.
Design
Cross-sectional data. Schoolchildren reported family meals and TV viewing. BMI was based on parental reports on height and weight of their children. Cut-off points for overweight by the International Obesity Task Force were used. Logistic regressions were performed adjusted by age, gender and parental education.
Setting
Schools in Northern European (Sweden, the Netherlands, Iceland, Germany and Finland) and Southern & Eastern European (Portugal, Greece, Bulgaria and Slovenia) countries, participating in the PRO GREENS project.
Subjects
Children aged 10–12 years in (n 6316).
Results
In the sample, 21 % of the children were overweight, from 35 % in Greece to 10 % in the Netherlands. Only a few associations were found between family meals and TV viewing during dinner with overweight in the nine countries. Northern European children, compared with other regions, were significantly more likely to be overweight if they had fewer family breakfasts and more often viewed TV during dinner.
Conclusions
The associations between family meals and TV viewing during dinner with overweight were few and showed significance only in Northern Europe. Differences in foods consumed during family meals and in health-related lifestyles between Northern and Southern & Eastern Europe may explain these discrepancies.
Major vascular complications in patients with head and neck cancer have previously been thought of as terminal events. However, it is now possible to intervene in many situations, with benefits for quality of life as well as survival. Endovascular techniques have reduced morbidity and mortality in many situations, both emergency and elective.
Method:
We describe the techniques that can be employed in such situations, and present illustrative case reports. Life-threatening haemorrhage, carotid compression and radiation-induced carotid stenosis are all discussed.
Conclusion:
It is possible to predict where complications may arise, and to take prophylactic steps to allow treatment to continue. Early intervention can reduce both morbidity and mortality in this high-risk patient group.
Where very young children come into contact with water containing schistosome cercariae, infections occur and schistosomiasis can be found. In high transmission environments, where mothers daily bathe their children with environmentally drawn water, many infants and preschool-aged children have schistosomiasis. This ‘new’ burden, inclusive of co-infections with Schistosoma haematobium and Schistosoma mansoni, is being formally explored as infected children are not presently targeted to receive praziquantel (PZQ) within current preventive chemotherapy campaigns. Thus an important PZQ treatment gap exists whereby infected children might wait up to 4–5 years before receiving first treatment in school. International treatment guidelines, set within national treatment platforms, are presently being modified to provide earlier access to medication(s). Although detailed pharmacokinetic studies are needed, to facilitate pragmatic dosing in the field, an extended ‘dose pole’ has been devised and epidemiological monitoring has shown that administration of PZQ (40 mg/kg), in either crushed tablet or liquid suspension, is both safe and effective in this younger age-class; drug efficacy, however, against S. mansoni appears to diminish after repeated rounds of treatment. Thus use of PZQ should be combined with appropriate health education/water hygiene improvements for both child and mother to bring forth a more enduring solution.
The eastern English Channel, the narrow channel of water separating northern
France and southeast England is an area of intense human use of the array of
resources concentrated into its relative small area. The vulnerability of
living resources and their habitats brought together French and British
maritime experts within a common project (called CHARM): to create an atlas
of marine resource habitats in the eastern English Channel so as to provide
planners and decision-makers with the necessary information to help managing
the use of its living and non-living resources. This multidisciplinary and
richly illustrated atlas provides abundant information on the legal
framework and physical environment; benthic invertebrates, fish and their
habitats; fishing activities; and a first attempt at developing a trophic
network model (using ECOPATH software) and a marine conservation planning
exercise (using MARXAN software, at a spatial resolution of 25 km$^{2})$.
Although most of the data used were collected elsewhere, some were collected
especially for the project. Similarly, most of the analyses performed on the
data where entirely original for this geographical area. The CHARM atlas has
significantly improved the knowledge about the eastern Channel while
contributing to the recognition that such holistic or multidisciplinary
approaches to exploited marine systems are necessary to efficiently and
durably manage their resources use.
Seroprevalence of Toxocara and Taenia solium and risk factors for infection with these parasites were explored in a long-term rural settlement in São Paulo state, Brazil. An ELISA for the detection of anti-Toxocara IgG and IgE and anti-T. solium cysticerci was standardized using Toxocara excretory-secretory antigens (TES) obtained from the cultured second-stage larvae of T. canis and by vesicular fluid antigen from Taenia crassiceps cysticerci (VF). For cysticercosis, the reactive ELISA samples were assayed by Western blot using 18 kDa and 14 kDa proteins purified from VF. Out of 182 subjects, 25 (13·7%) presented anti-Toxocara IgG and a positive correlation between total IgE and the reactive index of specific anti-TES IgE (P=0·0265) was found amongst the subjects found seropositive for anti-Toxocara IgG. In these individuals 38·0% showed ocular manifestations. The frequency of anti-T. solium cysticerci confirmed by Western blot was 0·6%. Seropositivity for Toxocara was correlated with low educational levels and the owning of dogs. Embryonated eggs of Toxocara spp. were found in 43·3% of the analysed areas.
Phenotypical Down syndrome includes pharyngeal and maxillary hypoplasia and, frequently, constricted maxillary arch with nasal obstruction.
Study design:
This clinical trial assessed the effects of rapid maxillary expansion on ENT disorders in 24 children with Down syndrome randomly allocated to receive either rapid maxillary expansion or not. Each group received ENT and speech therapy assessments before expansion and after the device had been removed.
Results:
In the rapid maxillary expansion group, the yearly ENT infection rate was reduced when assessed after device removal (p < 0.01). The parents of rapid maxillary expansion children reported a reduction in respiratory obstruction symptoms. Audiological assessment revealed improvements in the rapid maxillary expansion group (p < 0.01). Cephalometry showed increased maxillary width in the rapid maxillary expansion group.
Conclusions:
Rapid maxillary expansion resulted in a reduction in hearing loss, yearly rate of ENT infections and parentally assessed symptoms of upper airway obstruction, compared with no treatment. These findings are probably related to expanded oronasal space, due to rapid maxillary expansion.
Several studies have implied that patients' quality of life stabilises six months after undergoing total laryngectomy. However, these studies may well have overlooked persistent short term variations in patients' quality of life. The aim of this study was to assess the impact of seasonal change (i.e. summer vs winter) on the quality of life of patients following total laryngectomy.
Methods:
A prospective, cross-sectional study of recurrence-free laryngectomy patients was performed, using the European Organization for Research and Treatment of Cancer (version three) QLQ-C30 questionnaires (EORTC QLQ-C30), during January 2004 (i.e. winter), August 2004 (summer) and January 2005 (winter).
Results:
Thirty-six patients were entered into the study. The response rate was 70.3 per cent. Patient's time elapsed since surgery varied from six months to 12 years. In all questionnaire domains, responses seemed remarkably consistent over time.
Conclusion:
No statistically significant differences were found between summer and winter scores in all the domains analysed by the EORTC QLQ-C30.
The effects of graded levels (0 %, 0·5 %, 0·75 and 1 %) of dietary conjugated linoleic acid (CLA) were assessed on 97 g rainbow trout. Fish were fed to satiation twice a day for 12 weeks. At the end of the experiment, all groups of fish weighed more than 250 g and no significant differences were detected in growth performance, feed conversion, nutrient or energy utilisation or body composition between treatments. A decrease in liver lipid content resulted from including CLA and was accompanied by a reduction in malic enzyme activity. The muscle saturated acid and PUFA content did not vary between dietary treatments, despite the increasing concentration of stearic acid and CLA. In the liver, however, both fractions increased significantly with dietary CLA. Moreover, the MUFA decreased significantly in both muscle and liver. CLA was incorporated into tissue lipids, with levels in flesh (2·1–4·2 %) being 2-fold higher than in liver (0·8–1·9 %). In muscle, the percentage of cis-9, trans-11 isomer ranged from 39·5 % to 41·8 % and that of trans-10, cis-12 isomer from 31·4 % to 33·4 % of total CLA. The incorporation of CLA isomers in the liver varied with dietary treatment, and the cis-9, trans-11 isomer seemed to be more efficiently incorporated than trans-10, cis-12. Sensory data indicated slight-to-moderate differences between the trout fed with and without CLA. The present results suggest that 250 g rainbow trout can incorporate CLA in both muscle and liver, contributing to the production of a functional food.
The tick Boophilus microplus is a 1-host tick that causes important losses to bovine herds, and protective antigens are being investigated in order to develop vaccines that avoid the use of acaricides. Paramyosins are multi-functional invertebrate muscle proteins, whose roles may include host immunomodulation, and seem to be a prominent candidate in a schistosomiasis vaccine. We report here the cloning, expression and characterization of a B. microplus paramyosin (BmPRM). Sequence analysis of the full length coding sequence cDNA shows high identity to other arthropod paramyosin sequences, and the predicted molecular weight, pI and secondary structure are consistent with a typical paramyosin. Western-blot expression analysis indicates the presence of BmPRM in all tissues and developmental stages tested, but not in saliva. The recombinant protein (rBmPRM) was shown to bind both IgG and collagen. Possible implications of these activities with host evasion mechanisms are discussed.