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Although both obesity and ageing are risk factors for cognitive impairment, there is no evidence in Chile on how obesity levels are associated with cognitive function. Therefore, the aim of the present study was to investigate the association between adiposity levels and cognitive impairment in older Chilean adults. This cross-sectional study includes 1384 participants, over 60 years of age, from the Chilean National Health Survey 2009–2010. Cognitive impairment was evaluated using the Mini-Mental State Examination. BMI and waist circumference (WC) were used as measures of adiposity. Compared with people with a normal BMI, the odds of cognitive impairment were higher in participants who were underweight (OR 4·44; 95 % CI 2·43, 6·45; P < 0·0001), overweight (OR 1·86; 95 % CI 1·06, 2·66; P = 0·031) and obese (OR 2·26; 95 % CI 1·31, 3·21; P = 0·003). The associations were robust after adjustment for confounding variables. Similar results were observed for WC. Low and high levels of adiposity are associated with an increased likelihood of cognitive impairment in older adults in Chile.
Enteric illness outbreaks are complex events, therefore, outbreak investigators use many different hypothesis generation methods depending on the situation. This scoping review was conducted to describe methods used to generate a hypothesis during enteric illness outbreak investigations. The search included five databases and grey literature for articles published between 1 January 2000 and 2 May 2015. Relevance screening and article characterisation were conducted by two independent reviewers using pretested forms. There were 903 outbreaks that described hypothesis generation methods and 33 papers which focused on the evaluation of hypothesis generation methods. Common hypothesis generation methods described are analytic studies (64.8%), descriptive epidemiology (33.7%), food or environmental sampling (32.8%) and facility inspections (27.9%). The least common methods included the use of a single interviewer (0.4%) and investigation of outliers (0.4%). Most studies reported using two or more methods to generate hypotheses (81.2%), with 29.2% of studies reporting using four or more. The use of multiple different hypothesis generation methods both within and between outbreaks highlights the complexity of enteric illness outbreak investigations. Future research should examine the effectiveness of each method and the contexts for which each is most effective in efficiently leading to source identification.
The need for assistive technologies in Canada is increasing, but access is inconsistent and fragmented which can result in unmet needs. We aimed to identify citizens’ values and preferences for how to enhance equitable access to assistive technologies and to engage policymakers, stakeholders, and researchers in deliberations to spark action. In spring 2017, we convened three citizen panels and a stakeholder dialogue. Key panel findings were included in an evidence brief that informed dialogue participants. Thirty-seven citizens participated in panels and emphasized the need for access to reliable information, equitable access to assistive technologies regardless of ability to pay, and the need for collaboration. Twenty-two dialogue participants focused on the need for a guiding framework that supports fundamental change across the country. The proposed policy framework can enhance access to assistive technologies through enabling simplified policies and programs, along with fostering robust data collection and evaluation to support countrywide innovation and accountability.
Too many children face disadvantages that negatively impact their health, happiness and future life chances. Adverse Childhood Experiences (ACEs) represent a particularly traumatic set of circumstances that have been found through research to dramatically increase the likelihood of poor adult physical and mental health outcomes. While we do not view ACEs to represent the only or necessarily the most serious risks to children’s development, we do recognise them to pose a substantial threat. This article identifies twenty-four interventions with causal evidence of preventing or reducing ACE-related trauma and considers how they could be offered through system-wide strategies aimed at improving the lives of children who are at the greatest risk. While we are not suggesting that these interventions – on their own or in combination – represent a magic solution to ACEs, or the wider societal issues that contribute to them, we do propose that knowledge about their effectiveness can improve the quality of services that support the needs of highly vulnerable children.
Patulous Eustachian tube is a benign but notoriously difficult condition to treat successfully. Symptoms include autophony of voice and breathing, and aural fullness.
This paper presents a series of 8 patients (12 ears) for whom a novel computed tomography guided injection of silicone elastomer suspension implant (Vox) was used to treat patulous Eustachian tube. This is the largest and only series in the current literature using this technique.
The combined complete and partial symptom resolution rate was 91 per cent. Complications related to the procedure are described. The pros and cons of this novel approach are also discussed in relation to traditional endoscopic transnasal techniques.
Computed tomography guided injection of Vox for the treatment of patulous Eustachian tube is suggested to be a feasible alternative to endoscopic transnasal approaches, particularly for refractory cases.
Urbanisation and climate change are altering the pattern of California serogroup viruses in North America. As La Crosse virus (LACV) is the most pathogenic of the California serogroup, it is important to identify changes in distribution, transmission and pathogenesis. A scoping review (ScR) was prioritised to summarise the global evidence on LACV. A comprehensive search strategy was used, identified references were screened for relevance and relevant articles were characterised. Each step was conducted by two independent reviewers using pre-tested forms. Analysis identified areas of research saturation and gaps. The ScR included 481 research articles that were mostly journal articles (78.2%) conducted in North America (90.9%) from 1969 to 2016. Most evidence focused on epidemiology (44.9%), virus characteristics (25.8%), transmission conditions (18.7%) and pathogenesis of LACV in hosts (18.3%). Fewer studies evaluated the accuracy of diagnostic tests (8.7%), the efficacy of treatments (3.5%), prevention and control strategies (3.1%), the economic burden of infection (0.6%) and social impact (0.2%) of LACV. None of the literature predicted the impact of climate change on LACV, nor were any cases reported in Canada. These findings are intended to guide research to close knowledge gaps and inform evidence-based decisions surrounding activities for the prevention and control of LACV.
‘It is the hour of the stranger. Let the stranger now enter the soul.’
– D. H. Lawrence (1923)
It is over 90 years since D. H. Lawrence gave this eloquent evocation of the ordinary, yet extraordinary, impact of puberty on the personality and the ensuing course of adolescence. Yet adolescence remains the ‘hour of the stranger’, when the personality painfully develops into its adult self. Lawrence does not make gender distinctions, but there are significant differences between growing up female and growing up male. Below are some comments from girls attending a specialist adolescent clinic.
• ‘I cannot bear mental pain.’
A 17-year-old, whose left arm, covered with scratches and scars, told a desperate story, physical evidence of her inner psychological pain that she needed to inscribe on her own body in an attempt to get rid of inner, unbearable tension.
• ‘I feel depressed and unlikeable. Basically, I hate my looks. I'm fat and ugly. I don't smile anymore – only when I puff or get drunk.’
A 14-year-old with anorexia.
• ‘I didn't feel wanted at home. I was always rowing with my mum and her new boyfriend. I suppose I just wanted someone to love me unconditionally – someone I could love too.’
A pregnant 15-year-old.
• ‘I wake up in a panic most nights. The exam pressure is impossible. I just want to cry all the time. It's hopeless.’ An 18-year-old.
Each of these statements is a powerful expression of the intensities of adolescent pain and confusion, and of the often unstoppable urge to act, or act out – that is, to attempt to manage internal conflict by action, rather than by thinking or feeling. Girls tend to act against themselves, as a result of intellectual pressure, depression, poor body image, lack of self-esteem and separation anxiety (this last taking the form of a fear of rejection). The statements describe responses to unmanageable states of mind, and the problems they describe will be familiar to many.
What happens in the mind (the internal world) cannot be separated from what happens in the body and external world.
Many have been deeply critical of the Church of England’s response to the First World War, which has been seen as insufficiently critical of Government policy and too influenced by the war spirit. Charles Gore (Bishop of Oxford, 1911–19) provides a fascinating case study of how one independently minded Anglican thinker arrived at swift and unwavering support for the war, while simultaneously trying to mount a ‘counterpoise’ to some elements of the war mentality. This article describes and evaluates Gore’s use of the just war tradition, and the efficacy of the counterpoise he attempted. Analysis of his thought reveals a curious mix of hard-headed strategic realism about what would secure a just and lasting peace, and striking naiveté about what war actually entailed.
Epidemiology formed the basis of ‘the Barker hypothesis’, the concept of ‘developmental programming’ and today’s discipline of the Developmental Origins of Health and Disease (DOHaD). Animal experimentation provided proof of the underlying concepts, and continues to generate knowledge of underlying mechanisms. Interventions in humans, based on DOHaD principles, will be informed by experiments in animals. As knowledge in this discipline has accumulated, from studies of humans and other animals, the complexity of interactions between genome, environment and epigenetics, has been revealed. The vast nature of programming stimuli and breadth of effects is becoming known. As a result of our accumulating knowledge we now appreciate the impact of many variables that contribute to programmed outcomes. To guide further animal research in this field, the Australia and New Zealand DOHaD society (ANZ DOHaD) Animals Models of DOHaD Research Working Group convened at the 2nd Annual ANZ DOHaD Congress in Melbourne, Australia in April 2015. This review summarizes the contributions of animal research to the understanding of DOHaD, and makes recommendations for the design and conduct of animal experiments to maximize relevance, reproducibility and translation of knowledge into improving health and well-being.
We present the results of a multi-wavelength investigation of the dwarf galaxy populations in three interacting galaxy groups: NGC 871/6/7, NGC 3166/9, NGC 4725/47. Using degree-scale Giant Metrewave Radio Telescope Hi mosaics and deep optical photometry from the Canada-France-Hawaii Telescope, we measured the Hi and stellar properties of the gas-rich low-mass group members to classify each one as a classical dwarf galaxy, a short-lived tidal knot or a tidal dwarf galaxy (TDG). Our observations detect several dwarf irregulars and various tidal knots. We identify four potentially long-lived tidal objects in the three groups, implying that TDGs are not readily produced. The tidal objects examined in this small survey also appear to have a wider variety of properties than TDGs formed in current simulations.
Coverage of Scotland's referendum in Canada's English-language media highlights all the shortcomings that have come to dominate the performance of the Canadian media in the last decade as a result of the online revolution, the dramatic decline in advertising revenue and massive layoffs and cost-cutting across reporting and editing ranks in all the country's mainstream print, broadcast and online media.
Canadian news organisations reported on the referendum campaign in a largely episodic fashion that reflected the cutbacks in foreign correspondents employed by the Canadian media. Much of the time the story was simply ignored. When it appeared possible that Scots would vote for independence, there was a rush of last-minute coverage with all the contextual shortcomings that are integral parts of parachute journalism by foreign correspondents.
At least, however, in the last days before the vote, major Canadian news organisations sent their own reporters to Scotland from Canada so Canadian audiences would get the story through Canadian eyes. For almost all the preceding year that simply did not happen, largely due to the decline in the number of foreign correspondents. Even the remaining few Canadian correspondents based in London rarely ventured north during the year before the vote, as they were often preoccupied by whatever major international stories were underway in Europe or the Middle East at the time. That meant for much of the year before the referendum, any knowledge of the campaign Canadians received from their media came from reporters working for international news wire services such as Bloomberg and Associated Press or the syndicated service of Britain's Daily Telegraph or the Washington Post in the United States. Canadians were not told most of the story through Canadian eyes.
There were two other common features of coverage during the year before 18 September 2014. Much of the material published and broadcast did not emanate from Scotland but instead came from Toronto, London, Montreal and Ottawa. There is rarely, if ever, a situation where either reporting or commenting is better done from a distance than from on the ground where events are taking place. But in an era of squeezed financial resources and cutbacks, that long-distance reporting is now commonplace, frequently to the detriment of audiences’ understanding of the stories presented to them.
The co-occurring development of internalizing and externalizing problems were examined in an inception cohort of 392 children diagnosed with autism spectrum disorder at age 3 who were assessed on four occasions. Results indicated that internalizing and externalizing problems were stable over time and highly comorbid. Joint trajectory analysis suggested that 13% of the sample followed a dual high-risk trajectory. High risk was not found to be associated with intellectual ability or autism spectrum disorder symptom severity but was linked to lower income and gender: more girls than boys were found in the high/stable internalizing problems trajectory. The results suggest that 1 in 4 preschoolers followed a trajectory of internalizing or externalizing problems (or a combination of the two) that could be characterized as clinically elevated.
Phase maps of Co–Cr alloys bonded to dental porcelain cycled through an incremental number of porcelain firings at two separate thicknesses (0.5 and 1 mm) were analyzed. Bulk hexagonal close-packed (hcp) phase vol% of the alloy was found to increase with the number of porcelain firings for both 0.5 and 1 mm specimens. At the metal-porcelain interface, a uniform fine-grained hcp phase was observed. The depth and grain size of this hcp layer increased with the number of porcelain firings with the thicker specimens undergoing more substantial growth and transformation. Simple heat transfer modeling of the specimens during heat treatment cycles indicated that the thicker specimen had more time at high temperature to affect the face-centered cubic to hcp phase transformation. Therefore, the amount of porcelain firings and the thickness of the alloy should be considered and kept to a minimal when manufacturing metal-porcelain restoration.
This systematic review–meta-analysis appraises and summarizes all the available research (128 papers) on the zoonotic potential of Mycobacterium avium ssp. paratuberculosis. The latter has been debated for a century due to pathogenic and clinical similarities between Johne's disease in ruminants and Crohn's disease (108 studies) in humans and recently for involvement in other human diseases; human immunodeficiency virus (HIV) infection (2), sarcoidosis (3), diabetes mellitus type 1 (T1DM) (7) and type 2 (3), multiple sclerosis (5) and Hashimoto's thyroiditis (2). Meta-analytical results indicated a significant positive association, consistently across different laboratory methods for Crohn's disease [odds ratio (OR) range 4·26–8·44], T1DM (OR range 2·91–9·95) and multiple sclerosis (OR range 6·5–7·99). The latter two and the thyroiditis hypothesis require further investigation to confirm the association. Meta-regression of Crohn's disease studies using DNA detection methods indicated that choice of primers and sampling frame (e.g. general population vs. hospital-based sample) explained a significant proportion of heterogeneity. Other epidemiological studies demonstrated a lack of association between high-risk occupations and development of Crohn's disease. Due to knowledge gaps in understanding the role of M. paratuberculosis in the development or progression of human disease, the evidence at present is not strong enough to inform the potential public health impact of M. paratuberculosis exposure.