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Using data collected from a Community Assessment for Public Health Emergency Response (CASPER) conducted in Fairfax Health District, Virginia, in 2016, we sought to assess the relationship between household-level perceived preparedness and self-reported preparedness behaviors.
Weighted population estimates and 95% confidence intervals were reported, and Pearson’s chi-squared test was used to investigate differences by group.
Examining responses to how prepared respondents felt their household was to handle a large-scale emergency or disaster, an estimated 7.4% of respondents (95% CI: 4.3–12.3) reported that their household was “completely prepared,” 37.3% (95% CI: 31.4–43.7) were “moderately prepared,” 38.2% (95% CI: 31.6–45.2) were “somewhat prepared,” and 14.4% (95% CI: 10.2–20.0) were “unprepared.” A greater proportion of respondents who said that their household was “completely” or “moderately” prepared for an emergency reported engaging in several behaviors related to preparedness. However, for several preparedness behaviors, there were gaps between perceived preparedness and self-reported readiness.
Community assessments for public health preparedness can provide valuable data about groups who may be at risk during an emergency due to a lack of planning and practice, despite feeling prepared to handle a large-scale emergency or disaster.
Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken.
Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance.
Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa–Hunt syndrome cases.
A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.
Background: It is unclear as to the extent to which psychological interventions focusing specifically on depression and anxiety are helpful for people with physical health conditions, with respect to mood and condition management. Aims: To evaluate the effectiveness of a modified evidence-based psychological intervention focusing on depression and anxiety for people with type 2 diabetes mellitus (T2DM), compared with a control intervention. Method: Clients (n = 140) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM were allocated to either diabetes specific treatment condition (n = 52) or standard intervention (control condition, n = 63), which were run in parallel. Each condition received a group intervention offering evidence-based psychological interventions for people with depression and anxiety. Those running the diabetes specific treatment group received additional training and supervision on working with people with T2DM from a clinical health psychologist and a general practitioner. The diabetes specific treatment intervention helped patients to link mood with management of T2DM. Results: Both conditions demonstrated improvements in primary outcomes of mood and secondary outcome of adjustment [95% confidence interval (CI) between 0.25 and 5.06; p < 0.05 in all cases]. The diabetes specific treatment condition also demonstrated improvements in secondary outcomes of self-report management of T2DM for diet, checking blood and checking feet, compared with the control condition (95% CIs between 0.04 and 2.05; p < 0.05 in all cases) and in glycaemic control (95% CI: 0.67 to 8.22). The findings also suggested a non-significant reduction in NHS resources in the diabetes specific treatment condition. These changes appeared to be maintained in the diabetes specific treatment condition. Conclusions: It is concluded that a modified intervention, with input from specialist services, may offer additional benefits in terms of improved diabetic self-management and tighter glycaemic control.
Background: The proposal of a 4-year plan to integrate treatment of people with long term medical conditions (LTCs) into the IAPT service (Department of Health, 2011) seeks for research to understand the effectiveness of IAPT interventions for this patient group. Aim: The aim of this service development pilot work was to develop an intervention that is effective for people with Type 2 Diabetes Mellitus (T2DM). It was hypothesized that the standard IAPT intervention would not be effective, but that it can be adapted so that it is effective both in terms of mood and self-management of T2DM. Method: Clients (n = 95) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM opted to attend. The intervention was adapted over a series of cohorts from a standard Step 2 intervention. A team of Psychological Wellbeing Practitioners (PWPs), a Clinical Health Psychologist and a General Practitioner worked in collaboration, using outcomes measures and feedback from service users and facilitators. Results: The standard IAPT Step 2 intervention met with challenges when specifically targeting this client group. Using paired t-tests, the modified Step 2 intervention demonstrated significant improvements from pre- to postintervention measures both in terms of psychological (n = 17) and physical (n = 9) outcomes. Conclusion: It is concluded that it may be possible to modify a generic Step 2 IAPT intervention to demonstrate improvements both in terms of psychological wellbeing and self-management of T2DM. The main adaptations were related to more targeted recruitment and linking of diabetes specifically into the CBT model.
We report an extremely rare case of laryngeal lichen planus.
A case report and literature review of the aetiopathogenesis, clinical features and management of laryngeal lichen planus are presented.
A male patient presented with hoarseness and a history suggestive of squamous cell carcinoma of the larynx. However, characteristic histopathological findings demonstrated lichen planus. The patient responded very well to oral steroids, and at the time of writing had remained symptom-free for two years.
This is the first English language report of laryngeal lichen planus. Lichen planus is a diagnosis of exclusion and responds well to steroids. However, patients should be followed up regularly as malignant change is known to occur.
The aim of this study was to demonstrate the epidemiological use of multiple correspondence analysis (MCA), as applied to tuberculosis (TB) data from North East London. Data for TB notifications in North East London primary care trusts (PCTs) between the years 2002 and 2007 were used. TB notification data were entered for MCA allowing display of graphical data output (n=4947); MCA analyses were performed on the whole dataset, by PCT, and by year of notification. Graphical MCA output displayed variance of data categories; clustering of variable categories in MCA output signified association. Clustering patterns in MCA output demonstrated different associations by year of notification, within PCTs and between PCTs. MCA is a useful technique for displaying association of variable categories used in TB epidemiology. Results suggest that MCA could be a useful tool in informing commissioning of TB services.
Since disinfectants containing hypochlorites have been used for the sterilisation of dairy utensils, and it has been claimed that such disinfectants are more efficient than steam sterilisation, it seemed advisable to study the question in the interests of the Milk Industry. The efficiency of three proprietary disinfectants (A, B and C) has, therefore, been investigated.
Large food portions may be facilitating excess energy intake (EI) and adiposity among adults. The present study aimed to assess the extent to which EI and amounts of foods consumed are influenced by the availability of different-sized food portions. A randomised within-subject cross-over, fully residential design was used, where forty-three (twenty-one men and twenty-two women) normal-weight and overweight adults were randomly allocated to two separate 4 d periods where they were presented with either ‘standard’ or ‘large’ food portions of the same foods and beverages. The main outcome measures were the amount of food (g) and EI (MJ) consumed throughout each study period. Mean EI over 4 d was significantly higher on the large portion condition compared with the standard condition in the total group (59·1 (sd 6·6) v. 52·2 (sd 14·3) MJ; P = 0·020); men and women increased their EI by 17 % (10 (sd 6·5) MJ; P < 0·001) and 10 % (4 (sd 6·5) MJ; P = 0·005) respectively when served the large food portions relative to the standard food portions. The increased intakes were sustained over the 4 d in the large portion condition with little evidence of down-regulation of EI and food intake being made by subjects. Increased food portion size resulted in significant and sustained increases in EI in men and women over 4 d under fully residential conditions. The availability and consumption of larger portions of food may be a significant factor contributing to excess EI and adiposity.
The objective of the present study was to examine the associations between the portion sizes of food groups consumed with measures of adiposity using data from the National Diet and Nutrition Survey of British adults. Seven-day weighed dietary records, physical activity diaries and anthropometric measurements were used. Foods eaten were assigned to thirty different food groups and analyses were undertaken separately for men and women. The median daily portion size of each food group consumed was calculated. The potential misreporting of dietary energy intake (EI) was identified using the following equation: EI − estimated energy requirements × 100 = percentage of under-reporting (UR) of energy needs. Multinomial logistic regression (adjusted for age, social class, physical activity level and UR) was used to determine the portion sizes of food groups most strongly associated with obesity status. Few positive associations between the portion sizes of food groups consumed and obesity status were found. However, UR was prevalent, with a median UR of predicted energy needs of 34 and 33 % in men and women, respectively. After the adjustment was made for UR, more associations between the food groups and obesity status became apparent in both sexes. The present study suggests that the true effect of increased portion size of foods on obesity status may be masked by high levels of UR. Alternatively, these data may indicate that an increased risk of obesity is not associated with specific foods/food groups but rather with an overall increase in the range of foods and food groups being consumed.
Despite the potential link between snack food intake and obesity and the reportedly high prevalence of snacking among adolescents, adolescent snack food patterns (types of foods consumed, frequency and portion size) have not been extensively examined. This study examines these issues using data on the snacking patterns of adolescents aged 13–16 years who took part in the 1997 National Diet and Nutrition Survey (NDNS) and that from a Northern Irish (NI) cohort of adolescents collected 8 years later, in 2005. Overall energy intake was significantly higher in the NI adolescents in 2005 compared with the NDNS adolescents in 1997 (P < 0·01). Consequently, energy intake from snacks was significantly higher in the NI cohort (P < 0·01) and a trend for a higher % energy intake from snacks compared with the NDNS group was observed (median 32·5 % v. 29·8 %, respectively). Sugar-sweetened carbonated and soft drinks remained the most popular choice of snack over this 8-year period; however, both the portion size consumed and frequency of consumption were significantly higher among the adolescents in 2005 compared with those in 1997 (P = 0·022 and P = 0·014, respectively). Despite the lower popularity, and correspondingly lower frequency of milks and beverages, the portion size of both food groups was significantly higher among the adolescents in 2005 compared with those in 1997 (P < 0·001 and P = 0·007, respectively). These findings may provide scope for policy interventions to place particular emphasis on reducing typical portion sizes consumed of popular snack choices, in particular high-energy carbonated and soft drinks, among UK adolescents.
National survey data show that reported energy intake has decreased in recent decades despite a rise in the prevalence of obesity. This disparity may be due to a secular increase in under-reporting or a quantitatively greater decrease in energy expenditure. This study examines the extent of under-reporting of energy intake in the National Diet and Nutrition Survey (NDNS) in young people aged 4–18 years in 1997 using published equations to calculate estimated energy requirements. It explores secular changes by comparison with the Diets of British School Children (DBSC) survey in 10–11- and 14–15-year-olds in 1983. In the NDNS, under-reporting (estimated energy requirements – energy intake) represented 21 % of energy needs in girls and 20 % in boys. The magnitude of under-reporting increased significantly with age (P<0·001) and was higher in overweight than lean individuals over 7 years of age. To compare reported energy intake in DBSC and NDNS, the estimated physical activity level from dietary records (dPAL=reported energy intake/predicted BMR) was calculated. If there were no under-reporting, dPAL would represent the subject's true activity level. However, dPAL from the NDNS was significantly lower than that from the DBSC by 8 % and 9 % in boys and girls for those aged 10–11 years, and by 14 % and 11 % for 14–15-year-olds respectively, reaching physiologically implausible levels in the 14–15-year-old girls (dPAL=1·17). If activity levels have remained constant between the two surveys, under-reporting has increased by 8–14 %. The evidence supports a secular trend towards increased under-reporting between the two surveys, but the precise magnitude cannot be quantified in the absence of historical measures of energy expenditure.
To assess the validity and repeatability of a simple index designed to rank participants according to their energy expenditure estimated by self-report, by comparison with objectively measured energy expenditure assessed by heart-rate monitoring with individual calibration.
Energy expenditure was assessed over one year by four separate episodes of 4-day heart-rate monitoring, a method previously validated against whole-body calorimetry and doubly labelled water. Cardio-respiratory fitness was assessed by four repeated measures of sub-maximum oxygen uptake. At the end of the 12-month period, participants completed a physical activity questionnaire that assessed past-year activity. A simple four-level physical activity index was derived by combining occupational physical activity together with time participating in cycling and other physical exercise (such as keep fit, aerobics, swimming and jogging).
One hundred and seventy-three randomly selected men and women aged 40 to 65 years.
The repeatability of the physical activity index was high (weighted kappa = 0.6, P < 0.0001). There were positive associations between the physical activity index from the questionnaire and the objective measures of the ratio of daytime energy expenditure to resting metabolic rate (P = 0.003) and cardio-respiratory fitness (P = 0.001). As an indirect test of validity, there was a positive association between the physical activity index and the ratio of energy intake, assessed by 7-day food diaries, to predicted basal metabolic rate.
The summary index of physical activity derived from the questions used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study suggest it is useful for ranking participants in terms of their physical activity in large epidemiological studies. The index is simple and easy to comprehend, which may make it suitable for situations that require a concise, global index of activity.
The speech perception and speech production performance following cochlear implantation of congenitally deaf children and children deafened by meningitis were analysed. Three groups consisting of 70 congenitally deaf children, 22 children deafened by meningitis before two years of age and 14 children deafened by meningitis after two years of age were compared. The group deafened by meningitis after two years of age demonstrated significantly better speech perception than the other two groups. Their speech production appeared better but did not achieve statistical significance compared with the other two groups. There was no significant difference in either speech perception or speech production between the congenitally deaf group and the group deafened by meningitis before two years of age.
Studies of concurrent central, and autonomic activity
using a conventional event-related potential (ERP) oddball
paradigms, are considered useful in elucidating the relationship
between central and autonomic responses, but the autonomic
response tends to overlap. A new method was used to decompose
and score overlapping skin conductance responses (SCR).
This method enabled examination of dynamic relationships
of phasic SCR, prestimulus electroencephalogram (EEG),
and ERP to auditory target stimuli in 50 normal adults.
SCR amplitude was negatively correlated to EEG and N200
amplitude. The SCR amplitude changes over time exhibited
an exponential decline opposite to those of N200,
alpha, and beta. All the fitted exponential functions had
a time constant of 1–2 min. The findings suggest
that a N200 component, active in the auditory sensory discrimination,
is concomitant with the SCR. The narrow range of the time
constant may provide a clue to the conjoint processes underlying
central and autonomic adaptive functions.
To identify factors associated with an increased occurrence of Klebsiella pneumoniae isolation in urine cultures and infected wounds on a rehabilitation unit and to compare typing methods for K pneumoniae isolates.
Retrospective review of laboratory reports and patient records with case-control study. Analysis of K pneumoniae isolates using capsular serotyping, enzyme electrophoretic typing, ribotyping, and DNA typing.
48-bed rehabilitation unit in an 1,100-bed tertiary care teaching hospital in Winnipeg, Manitoba.
In 1988, 20 (19%) of 106 patients admitted to the rehabilitation unit had K pneumoniae isolated from urine or wound, and in 1989 31 (28%) of 111 patients had Klebsiella isolated. Review of ward practices revealed appropriate written policies but evidence of failure in execution leading to multiple opportunities for transmission among patients. Substantial environmental contamination was not identified, although a common urine graduate may have contributed to some transmission. Individuals with K pneumoniae isolated had a significantly longer duration of stay. Many of these were spinal cord-injured patients and were maintained on intermittent catheterization.
One outbreak strain was identified in epidemiologic typing. Other strains were generally identified in individuals with nonnosocomial acquisition of infection. Comparison of epidemiologic typing methods suggests ribotyping may be the optimal method for typing K pneumoniae strains.
K pneumoniae was acquired frequently by spinal cord-injured patients with extended admissions, re-emphasizing the importance of both patients and stalf following appropriate infection control practices on rehabilitation wards. Ribotyping was the optimal method for typing K pneumoniae isolates.
The effects of supplementary feeding of licks containing non-protein nitrogen on the reproductive performance of beef breeding cows and on the live-weight gain of growing stock in Botswana is described. The trials involved 1375 breeding cows at five artificial insemination centres, and 360 breeding cows and 269 growing stock under ranch conditions. These licks increased the percentage of pregnancies in cows under lactation stress by up to 20%, but had no effect on the reproductive performance of dry cows or cows with a calf older than 5 mo. In growing animals the provision of rumen stimulatory licks increased live-weight gain by an average of 12%, but was of doubtful economic value.
The three indigenous beef cattle breeds in Botswana, the Tswana, Africander and Tuli, were evaluated for reproductive performance, viability and growth. Over 3 yr the calving percentages of 1389 Africander cows, 305 Tswanas and 357 Tulis were 64·5, 70·6 and 85 respectively. These differences were significant (P<0·05). Mortality of the Africander calves was higher to 2 yr of age, being 11% compared with 7-5% for Tswana calves and 7·4% for Tulis. The 18 mo weight of 219 Tuli cattle was 284 kg, and of 454 Tswanas 279 kg, both superior to the 270 kg for the 786 Africanders. Productivity estimates combining these three traits demonstrate the value of the Tuli breed for Botswana conditions.
Comparisons of the crossbreds produced by the use of Simmental, Brahman, Bonsmara and Tuli sires on Tswana cows showed an advantage in growth to 18 mo through crossbreeding. The 18 mo weights of Simmental and Brahman crosses at 324 and 304 kg respectively were significantly different, and superior to the weight of pure Tswana at 279 kg. Bonsmara and Tuli crosses at 294 and 290 kg also showed a significant increase over the pure Tswana. The use of the Simmental is now recommended for better management conditions, with Brahman crossbreeding on a wider scale.