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Recent research implicates antibiotic use as a potential contributor to child obesity risk. In this narrative review, we examine current observational evidence on the relation between antibiotic use in early childhood and subsequent measures of child body mass.
We searched PubMed, Web of Science and the Cochrane Library to identify studies that assessed antibiotic exposure before 3 years of age and subsequent measures of body mass or risk of overweight or obesity in childhood.
We identified 13 studies published before October 2017, based on a total of 6 81 332 individuals, which examined the relation between early life antibiotic exposure and measures of child body mass. Most studies did not appropriately account for confounding by indication for antibiotic use. Overall, we found no consistent and conclusive evidence of associations between early life antibiotic use and later child body mass [minimum overall adjusted odds ratio (aOR) reported: 1.01, 95% confidence interval (95% CI) 0.98–1.04, N = 2 60 556; maximum overall aOR reported: 2.56, 95% CI 1.36–4.79, N = 616], with no clinically meaningful increases in weight reported (maximum increase: 1.50 kg at 15 years of age). Notable methodological differences between studies, including variable measures of association and inclusion of confounders, limited more comprehensive interpretations.
Evidence to date is insufficient to indicate that antibiotic use is an important risk factor for child obesity, or leads to clinically important differences in weight. Further comparable studies using routine clinical data may help clarify this association.
Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.
A retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.
A range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.
Neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.
WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments. Prehosp Disaster Med. 2016;31(6):675–679.
The discovery of Neolithic houses at Durrington Walls that are contemporary with the main construction phase of Stonehenge raised questions as to their interrelationship. Was Durrington Walls the residence of the builders of Stonehenge? Were the activities there more significant than simply domestic subsistence? Using lipid residue analysis, this paper identifies the preferential use of certain pottery types for the preparation of particular food groups and differential consumption of dairy and meat products between monumental and domestic areas of the site. Supported by the analysis of faunal remains, the results suggest seasonal feasting and perhaps organised culinary unification of a diverse community.
Antimicrobial stewardship programs are increasingly recognized as critical in optimizing the use of antimicrobials. Consequently, more physicians, pharmacists, and other healthcare providers are developing and implementing such programs in a variety of healthcare settings. The purpose of this guidance document is to outline the knowledge and skills that are needed to lead an antimicrobial stewardship program. It was developed by antimicrobial stewardship experts from organizations that are engaged in advancing the field of antimicrobial stewardship.
Infect Control Hosp Epidemiol 2014;35(12):1444–1451
Objective: The Cities Readiness Initiative is a federally funded program designed to assist 72 metropolitan statistical areas (MSAs) in preparing to dispense life-saving medical countermeasures within 48 hours of a public health emergency. Beginning in 2008, the 72 MSAs were required to conduct 3 drills related to the distribution and dispensing of emergency medical countermeasures. The report describes the results of the first year of pilot data for medical countermeasure drills conducted by the MSAs.
Methods: The MSAs were provided templates with key metrics for 5 functional elements critical for a successful dispensing campaign: personnel call down, site activation, facility setup, pick-list generation, and dispensing throughput. Drill submissions were compiled into single data sets for each of the 5 drills. Analyses were conducted to determine whether the measures were comparable across business and non-business hours. Descriptive statistics were computed for each of the key metrics identified in the 5 drills.
Results: Most drills were conducted on Mondays and Wednesdays during business hours (8:00 am-5:00 pm). The median completion time for the personnel call-down drill was 1 hour during business hours (n = 287) and 55 minutes during non-business hours (n = 136). Site-activation drills were completed in a median of 30 minutes during business hours and 5 minutes during non-business hours. Facility setup drills were completed more rapidly during business hours (75 minutes) compared with non-business hours (96 minutes). During business hours, pick lists were generated in a median of 3 minutes compared with 5 minutes during non-business hours. Aggregate results from the dispensing throughput drills demonstrated that the median observed throughput during business hours (60 people/h) was higher than that during non-business hours (43 people/h).
Conclusion: The results of the analyses from this pilot sample of drill submissions provide a baseline for the determination of a national standard in operational capabilities for local jurisdictions to achieve in their planning efforts for a mass dispensing campaign during an emergency.
(Disaster Med Public Health Preparedness. 2012;6:357–362)
Background: While smoking rates in the United States have decreased, some population subgroups have smoking rates that exceed national and state averages. These higher rates often are associated with higher incidence rates of tobacco-associated cancers. Over time, a decrease in smoking rates leads to lower cancer incidence. Methods: Using spatial modelling techniques, we identified an underserved geographic locale in South Florida with higher than expected incidence rates of tobacco-associated cancers. We then used a community-based participatory research (CBPR) design to conduct focus groups in 2011 to elicit information about the acceptability of a smoking cessation intervention delivered by trained former smokers from within peer networks. Results: A variety of smoking cessation strategies was presented and discussed in separate, gender-stratified focus groups comprised of former and current smokers (n = 39). Focus group findings consistently indicated that support groups were the preferred cessation mechanism in this community. Based on this finding, we changed our initially proposed cessation approach to one which employed support groups as a quit method. Conclusions: Currently, we are collecting pilot data to test this intervention and to reach smokers who might not otherwise be directly targeted with cessation messaging from larger tobacco control initiatives. If successful, this strategy can be adapted to effect other important changes in health behaviours in at-risk populations.
Multiple silicon nanowires were synthesized using large gallium pools and microwave plasma. Results showed that nanowires growing out of different sized large gallium drops show little variation in diameters, suggesting that our non-traditional technique can be used to synthesize bulk amounts of monodispersed nanowires out of thin films of molten gallium.
We report the development of oxygen sensors using polymer photonic bandgap structure and CMOS chips. These integrated sensors provide a new platform for the development of low cost, low (battery) powered, light weight, robust, fast and small sensors. We demonstrate an approach to encapsulation of chemical and biological recognition elements within the porous structures. This sensing platform is built on our recently demonstrated nanofabrication technique using holographic interferometry of a photo-activated mixture that includes a volatile solvent as well as monomers, photoinitiators, and co-initiators. Resulting structure is nanoporous polymer 1D photonic bandgap structures that has reflection grating property and can be directly integrated into optical sensor systems that we have previously developed. For optical sensor system, CMOS (Complementary Metal Oxide Semiconductor) detectors that include phototransistors, trans impedance amplifier, and other signal processing units are used. Combining CMOS chip and nano-porous polymer reflection grating, we demonstrate an oxygen sensor as a prototype by encapsulating the fluorophore (tris(4,7-diphenyl-1,10-phenathroline)ruthenium(II) using fluorescence intensity.
The human dimension of weed management is most evident when farmers make decisions contrary to science-based recommendations. Why do farmers resist adopting practices that will delay herbicide resistance, or seem to ignore new weed species or biotypes until it is too late? Weed scientists for the most part have ignored such questions or considered them beyond their domain and expertise, continuing to focus instead on fundamental weed science and technology. Recent pressing concerns about widespread failure of herbicide-based weed management and acceptability of emerging technologies necessitates a closer look at farmer decision making and the role of weed scientists in that process. Here we present a circular risk-analysis framework characterized by regular interaction with and input from farmers to inform both research and on-farm risk-management decisions. The framework utilizes mental models to probe the deeply held beliefs of farmers regarding weeds and weed management. A mental model is a complex, often hidden web of perceptions and attitudes that govern how we understand and respond to the world. One's mental model may limit ability to develop new insights and adopt new ways of management, and is best assessed through structured, open-ended interviews that enable the investigator to exhaust the subjects inherent to a particular risk. Our assessment of farmer mental models demonstrated the fundamental attribution error whereby farmers attributed problems with weed management primarily to factors outside of their control, such as uncontrolled weed growth on neighboring properties and environmental factors. Farmers also identified specific processes that contribute to weed problems that were not identified by experts; specifically, the importance of floods and faulty herbicide applications in the spread of weeds. Conventional farmers expressed an overwhelming preference for controlling weeds with herbicides, a preference that was reinforced by their extreme dislike for weeds. These preferences reflect a typical inverse relationship between perceived risk and benefit, where an activity or entity we perceive as beneficial is by default perceived as low risk. This preference diminishes the ability of farmers to appreciate the risks associated with overreliance on herbicides. Likewise, conventional farmers saw great risk and little benefit in preventive measures for weed control. We expect that thorough two-way communication and a deeper understanding of farmer belief systems will facilitate the development of audience-specific outreach programs with an enhanced probability of affecting better weed management decisions.
A log-coffin excavated in the early nineteenth century proved to be well enough preserved in the early twenty-first century for the full armoury of modern scientific investigation to give its occupants and contents new identity, new origins and a new date. In many ways the interpretation is much the same as before: a local big man buried looking out to sea. Modern analytical techniques can create a person more real, more human and more securely anchored in history. This research team shows how.
To analyse the experience of a pilot programme designed to shift care from hospital to the community.
The white paper, Our Health, Our Care, Our Say, published in England in 2006, set out a vision for the future of primary care and community services. A key component of this vision is to provide care closer to home. The NHS Institute for Innovation and Improvement established a pilot programme in five field test sites to explore the scope for bringing about shifts in care from hospital to the community. This paper reports the results of the evaluation of the programme.
A comparative case study design was used including interviews with key stakeholders at different points during the pilot programme, participation in discussion groups, documentary analysis, and collation of activity and output statistics. By comparing evidence drawn from 14 projects in the five field test sites, the evaluation was able to identify the impact of different factors on the progress of the projects.
All of the projects made some progress in taking forward their plans to shift care, although there were wide variations in what had been achieved at the end of the test and learn phase. Key factors influencing progress were the existence of a receptive context for change, project focus, organisational leadership, project management, stakeholder analysis, clinical engagement and leadership, overcoming barriers to change, aligned incentives, training and support, measuring and monitoring progress, and the timescale for change. A critical requirement in programmes of this kind is ‘getting the basics right’ through dogged attention to project and change management. Also important is ensuring that the evidence on change management and quality improvement is acted on by those leading change programmes.
W. Parker Frisbie, Population Research Center and Department of Sociology, College of Liberal Arts, University of Texas at Austin, 1, University Station A1700, Austin, TX 78712-0543, USA,
Robert A. Hummer, The University of Texas at Austin, Population Research Center, 1, University Station G1800, Austin, TX 78712-0543, USA,
T. Elizabeth Durden, Department of Sociology and Anthropology, Bucknell University, Lewisburg, PA 17837,
Youngtae Cho, School of Public Health, Seoul National University, Seoul Korea
Any analysis of the health of the Asian and Pacific Islander (API) populations in the United States immediately confronts the obstacle that, as late as the year 2000, ‘Asian and Native Hawaiian/Pacific Islanders have to a large degree been “invisible” in public health debates’, and that there are large gaps in our understanding of the ‘factors that influence their health and quality of life’ (Srinivasan and Guillermo 2000: 1731). A major reason for such gaps is that the comparatively small size of many API subpopulations results in data sets with an insufficient number of cases to allow stable and reliable statistical estimates. Assessing API health in the United States requires drawing on a number of different data sources across which information is not always fully consistent. With the partial exception of Hawaiians, information on specific Pacific Islander populations is especially scarce, so that it is often necessary to assess the health of this group as if it were an undifferentiated whole. In fact, much more often than is desirable, Pacific Islanders are subsumed within a combined Asian and Pacific Islander category. Nevertheless, by employing information from a number of different sources, including our own analyses, we believe a useful assessment of the physical health of the API population in the United States can be achieved.
Demographic and socioeconomic characteristics
The API population is quite heterogeneous in demographic, socioeconomic status (SES) and cultural terms, as well as in length of settlement (Srinivasan and Guillermo 2000; Barnes and Bennett 2002; Ro 2002; Reeves and Bennett 2003).
Hippocampal volume reduction has been reported inconsistently in people with major depression.
To evaluate the interrelationships between hippocampal volumes, memory and key clinical, vascular and genetic risk factors.
Totals of 66 people with depression and 20 control participants underwent magnetic resonance imaging and clinical assessment. Measures of depression severity, psychomotor retardation, verbal and visual memory and vascular and specific genetic risk factors were collected.
Reduced hippocampal volumes occurred in older people with depression, those with both early-onset and late-onset disorders and those with the melancholic subtype. Reduced hippocampal volumes were associated with deficits in visual and verbal memory performance.
Although reduced hippocampal volumes are most pronounced in late-onset depression, older people with early-onset disorders also display volume changes and memory loss. No clear vascular or genetic risk factors explain these findings. Hippocampal volume changes may explain how depression emerges as a risk factor to dementia.