From problem people to addictive products: a qualitative study on rethinking gambling policy from the perspective of lived experience

BACKGROUND

Previous research has shown that government and industry discussions of gambling may focus on personal responsibility for gambling harm. In Australia, these discussions have largely excluded people with lived experience of problem gambling, including those involved in peer support and advocacy.

METHODS

We conducted 26 in-depth interviews with people with current or previous problem gambling on electronic gaming machines (EGMs) involved in peer support and advocacy activities, using an approach informed by Interpretive Policy Analysis and Constructivist Grounded Theory.

RESULTS

Participants perceived that government and industry discussed gambling as safe and entertaining with a focus on personal responsibility for problem gambling. This focus on personal responsibility was perceived to increase stigma associated with problem gambling. In contrast, they described gambling as risky, addictive and harmful, with problem gambling resulting from the design of EGMs. As a result of their different perspectives, participants proposed different interventions to reduce gambling harm, including reducing accessibility and making products safer.

CONCLUSIONS

Challenging the discourses used by governments and industry to describe gambling, using the lived experience of people with experience of gambling harm, may result in reduced stigma associated with problem gambling, and more effective public policy approaches to reducing harm.

The impact of sexual orientation on body image, self-esteem, urinary and sexual functions in the experience of prostate cancer

Prostate cancer (PCa) poses a large health burden globally. Research indicates that men experience a range of psychological challenges associated with PCa including changes to identity, self-esteem and body image. The ways in which sexual orientation plays a role in the experience of PCa, and the subsequent impact on quality of life (QoL), body image and self-esteem have only recently been addressed. By addressing treatment modality, where participant numbers were sufficient, we also sought to explore whether gay (homosexual) men diagnosed with PCa (PCaDx) and with a primary treatment modality of surgery would report differences in body image and self-esteem compared with straight (heterosexual) men with PCaDx with a primary treatment modality of surgery, compared with gay and straight men without PCaDx. The results of our study identified overall differences with respect to PCaDx (related to urinary function, sexual function and health evaluation), and sexual orientation (related to self-esteem), rather than interactions between sexual orientation and PCaDx. Gay men with PCaDx exhibited higher levels of urinary functioning than straight men with PCaDx, the difference being reversed for gay and straight men without PCaDx; but this result narrowly failed to achieve statistical significance, suggesting a need for further research, with larger samples.

Dramatic Increase in Incidence of Ulcerative Colitis and Crohn's Disease (1988-2011): A Population-Based Study of French Adolescents

OBJECTIVES

Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period.

METHODS

Pediatric-onset IBD (<17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification.

RESULTS

1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/10⁵ for IBD overall (3.2 for CD, 1.1 for UC and 0.1 for IBDU). From 1988-1990 to 2009-2011, a dramatic increase in incidences of both CD and UC were observed in adolescents (10-16 years): for CD from 4.2 to 9.5/10⁵ (+126%; P<0.001) and for UC, from 1.6 to 4.1/10⁵ (+156%; P<0.001). No modification in age or location at diagnosis was observed in either CD or UC.

CONCLUSIONS

In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

3D kinematics of the interphalangeal joints in the forelimb of walking and trotting horses

The objective was to measure 3D rotations of the distal (DIP) and proximal (PIP) interphalangeal joints at walk and trot. 3D trajectories of markers fixed to the proximal phalanx, middle phalanx and the hoof wall of the right forelimb of four sound horses were recorded at 120 Hz. Joint kinematics were calculated in terms of anatomically-based joint coordinate systems between the bone segments. Ranges of motion were similar at walk and trot. Values for the DIP joint were: flexion/extension: 46 ± 3° at walk, 47 ± 4° at trot; internal/ external rotation: 5 ± 1° at walk, 6 ± 3° at trot; and adduction/abduction: 5 ± 2° at walk, 5 ± 3° at trot. Within each gait, kinematic profiles at the DIP joint were similar between horses with the exception of adduction/abduction during breakover, which may vary depending on the direction of hoof rotation over the toe. Knowledge of the types and amounts of motion at the DIP joint will be useful in understanding the aetiology and treatment of injuries to the soft tissues, which are being recognized more frequently through the use of sensitive imaging techniques. Ranges of motion for the PIP joint were: flexion/extension: 13 ± 4° at walk, 14 ± 4° at trot; adduction/abduction: 3 ± 1° at walk, 3 ± 1° at trot; and internal/external rotation: 3 ± 1° at walk, 4 ± 1° at trot. The PIP joint made a significant contribution to flexion/extension of the digit. During surgical arthrodesis, the angle of fusion may be important since loss of PIP joint extension in late stance is likely to be accommodated by increased extension of the DIP joint.

Do ultrasound guided trochanteric bursa injections of corticosteroid for greater trochanteric pain syndrome provide sustained benefit and are imaging features associated with treatment response?

AIM

To assess intra-bursal corticosteroid injections (ICSI) efficacy and duration of action in the management of greater trochanteric pain syndrome (GTPS). The secondary aim was to identify patient and ultrasound (US) features predictive of treatment response.

MATERIALS AND METHODS

Consecutive prospectively recruited patients undergoing US-guided ICSI therapy for GTPS received baseline pre-injection questionnaires assessing pain at rest and activity, demographics and comorbidities. Baseline US and radiography findings were reported prospectively. Follow-up was performed at 6 weeks and 6 and 12 months, and change in pain scores assessed using the Wilcoxon signed rank test. Logistic regression examined associations between demographics, US findings, and a clinically significant reduction in pain score (≥50%).

RESULTS

Over 6 months, 127 patients were recruited with a median age of 63.5 years and 90% were female. The greatest pain reduction was between baseline and 6 weeks at activity (median 8 versus 5, p<0.001). The majority of patients noted a reduction in pain score, but the percentage of patients receiving a ≥50% reduction at 6 weeks, 6 months, and 12 months for pain at rest was 41%, 37%, and 36%, respectively. Regression models suggested only gluteus medius bursitis was weakly associated with pain reduction.

CONCLUSION

ICSIs confer a benefit in pain reduction to a large proportion of patients in the short term, but this may not be reduced by a clinically significant amount. This small effect size and lack of predictive imaging features suggests initial management including subsequent steroid injection could be provided without imaging guidance in the majority of cases.

Extra-intestinal Manifestations at Diagnosis in Paediatric- and Elderly-onset Ulcerative Colitis are Associated With a More Severe Disease Outcome: A Population-based Study

BACKGROUND AND AIMS

Data on extra-intestinal manifestations [EIM] and their impact on the disease course of ulcerative colitis [UC] in population-based cohorts are scarce, particularly in paediatric- and elderly-onset UC patients. The aims of this population-based study were to assess: 1] the occurrence of EIM in paediatric- and elderly-onset UC; 2] the factors associated with EIM; and 3] their impact on long-term disease outcome.

METHODS

Paediatric-onset [< 17 years at diagnosis] and elderly-onset UC patients [> 60 years at diagnosis] from a French prospective population-based registry [EPIMAD] were included. Data on EIM and other clinical factors at diagnosis and at maximal follow-up were collected.

RESULTS

In all, 158 paediatric- and 470 elderly-onset patients were included [median age at diagnosis 14.5 and 68.8 years, median follow-up 11.2 and 6.2 years, respectively]. EIM occurred in 8.9% of childhood- and 3% of elderly-onset patients at diagnosis and in 16.7% and 2.2% of individuals during follow-up [p < 0.01], respectively. The most frequent EIM was joint involvement [15.8% of paediatric onset and 2.6% of elderly-onset]. Presence of EIM at diagnosis was associated with more severe disease course [need for immunosuppressants or biologic therapy or colectomy] in both paediatric- and elderly-onset UC (hazard ratio [HR] = 2.0, 95% confidence interval [CI]: 1.0-4.2; and HR = 2.8, 0.9-7.9, respectively). Extensive colitis was another independent risk factor in both age groups.

CONCLUSIONS

Elderly-onset UC patients had lower risk of EIM either at diagnosis or during follow-up than paediatric-onset individuals. EIM at diagnosis predicted more severe disease outcome, including need for immunosuppressive or biologic therapy or surgery, in both paediatric- and elderly-onset UC.

Effectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry

BACKGROUND

Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway; however, effectiveness data in a population with significant comorbidities are limited.

AIMS

To describe severe allergic asthma, omalizumab treatment outcomes and predictors of response among the Australian Xolair Registry participants.

METHODS

A web-based post-marketing surveillance registry was established to characterise the use, effectiveness and adverse effects of omalizumab (Xolair) for severe allergic asthma.

RESULTS

Participants (n = 192) (mean age 51 years, 118 female) with severe allergic asthma from 21 clinics in Australia were assessed, and 180 received omalizumab therapy. They had poor asthma control (Asthma Control Questionnaire, ACQ-5, mean score 3.56) and significant quality of life impairment (Asthma-related Quality of Life Questionnaire score 3.57), and 52% were using daily oral corticosteroid (OCS). Overall, 95% had one or more comorbidities (rhinitis 48%, obesity 45%, cardiovascular disease 23%). The omalizumab responder rate, assessed by an improvement of at least 0.5 in ACQ-5, was high at 83%. OCS use was significantly reduced. The response in participants with comorbid obesity and cardiovascular disease was similar to those without these conditions. Baseline ACQ-5 ≥ 2.0 (P = 0.002) and older age (P = 0.05) predicted the magnitude of change in ACQ-5 in response to omalizumab. Drug-related adverse events included anaphylactoid reactions (n = 4), headache (n = 2) and chest pains (n = 1).

CONCLUSION

Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.

Men's weight loss stories: How personal confession, responsibility and transformation work as social control

Obesity is considered a public health concern. In Australia, there are a greater number of overweight or obese men compared with women. The media is an important source of information about body weight and weight management. We undertook a qualitative study to analyse men's weight loss stories in a popular men's magazine. Between January 2009 and December 2012, we collected 47 men's weight loss stories from the Australian edition of Men's Health magazine. We undertook thematic analysis to examine the stories. Confession, personal responsibility, appearance and transformation were key themes. The stories describe the men's self-discipline and their monitoring and tracking of their behaviours as activities which supported their weight loss. In this way, the stories promote the importance of such panoptic self-surveillance and self-discipline to the readers. We consider how such stories contribute to the wider synoptic system of media messages about body weight.

Women's experiences of, and attitudes to, maternity education across the perinatal period in Victoria, Australia: A mixed-methods approach

BACKGROUND

While the provision of maternity education across the perinatal period can increase the confidence and self-efficacy in childbearing women, there is still thought to be a lack of effective educational resources for parenthood. This study, conducted in Victoria, Australia, investigated women's experiences of, and attitudes to education communicated in maternity service provision.

METHODS

189 women were recruited from a variety of settings to participate in a mixed-methods survey about their experiences of perinatal health service education.

FINDINGS

Of the sample of childbearing women, 153 (81%) reported attending antenatal classes. Women perceived their antenatal education as beneficial, though many women still felt unprepared beyond labour and birth. With respect to the hospital postnatal stay, findings suggested a variation among the content imparted to women across different Victorian maternity services, (e.g. rural women tended to be more dissatisfied with information received in relation to maternal emotional and physical health). Overall, women wished they had been more informed about breastfeeding and settling techniques, while a lack of information relating to social support initiatives for the postnatal period was also indicated. Women reported that they were missing educational and practical reinforcement of mothercraft skills.

CONCLUSIONS

There is a need for a reorientation of perinatal health service education. A health promotion approach is suggested as it extends beyond the physical recovery from birth to encompass psychosocial factors; including perinatal morbidities that can disrupt the quality and experience of the transition to parenthood.

Simultaneous loss of interlayer coherence and long-range magnetism in quasi-two-dimensional PdCrO2

In many layered metals, coherent propagation of electronic excitations is often confined to the highly conducting planes. While strong electron correlations and/or proximity to an ordered phase are believed to be the drivers of this electron confinement, it is still not known what triggers the loss of interlayer coherence in a number of layered systems with strong magnetic fluctuations, such as cuprates. Here, we show that a definitive signature of interlayer coherence in the metallic-layered triangular antiferromagnet PdCrO₂ vanishes at the Néel transition temperature. Comparison with the relevant energy scales and with the isostructural non-magnetic PdCoO₂ reveals that the interlayer incoherence is driven by the growth of short-range magnetic fluctuations. This establishes a connection between long-range order and interlayer coherence in PdCrO₂ and suggests that in many other low-dimensional conductors, incoherent interlayer transport also arises from the strong interaction between the (tunnelling) electrons and fluctuations of some underlying order.

Incoherent transport is an important feature of many anisotropic quantum materials but often its origin is not well understood. Here, the authors show that in a layered quantum magnet, incoherence is driven by the interaction of electrons with spin fluctuations after the melting of magnetic order.

Real-life effectiveness of omalizumab in severe allergic asthma above the recommended dosing range criteria

BACKGROUND

Omalizumab (Xolair) dosing in severe allergic asthma is based on serum IgE and bodyweight. In Australia, patients eligible for omalizumab but exceeding recommended ranges for IgE (30-1500 IU/mL) and bodyweight (30-150 kg) may still receive a ceiling dose of 750 mg/4 weeks. About 62% of patients receiving government-subsidized omalizumab are enrolled in the Australian Xolair Registry (AXR).

OBJECTIVES

To determine whether AXR participants above the recommended dosing ranges benefit from omalizumab and to compare their response to within-range participants.

METHODS

Data were stratified according to dose range status (above-range or within-range). Further sub-analyses were conducted according to the reason for being above the dosing range (IgE only vs. IgE and weight).

RESULTS

Data for 179 participants were analysed. About 55 (31%) were above recommended dosing criteria; other characteristics were similar to within-range participants. Above-range participants had higher baseline IgE [812 (IQR 632, 1747) IU/mL vs. 209 (IQR 134, 306) IU/mL] and received higher doses of omalizumab [750 (IQR 650, 750) mg] compared to within-range participants [450 (IQR, 300, 600) mg]. At 6 months, improvements in Juniper 5-item Asthma Control Questionnaire (ACQ-5, 3.61 down to 2.01 for above-range, 3.47 down to 1.93 for within-range, P < 0.0001 for both) and Asthma Quality of Life Questionnaire (AQLQ mean score (3.22 up to 4.41 for above-range, 3.71 up to 4.88 for within-range, P < 0.0001) were observed in both groups. Forced expiratory volume in one second (FEV₁ ) improved among above-range participants. There was no difference in response between above-range and within-range participants. Above-range participants due to either IgE alone or IgE and weight had similar improvements in ACQ-5, AQLQ and FEV₁ .

CONCLUSIONS AND CLINICAL RELEVANCE

Patients with severe allergic asthma above recommended dosing criteria for omalizumab have significantly improved symptom control, quality of life and lung function to a similar degree to within-range participants, achieved without dose escalation above 750 mg.

Do quantitative and qualitative shear wave elastography have a role in evaluating musculoskeletal soft tissue masses?

Objectives

To determine if quantitative and qualitative shear wave elastography have roles in evaluating musculoskeletal masses.

Methods

105 consecutive patients, prospectively referred for biopsy within a specialist sarcoma centre, underwent B-mode, quantitative (m/s) and qualitative (colour map) shear wave elastography. Reference was histology from subsequent biopsy or excision where possible. Statistical modelling was performed to test elastography data and/or B-mode imaging in predicting malignancy.

Results

Of 105 masses, 39 were malignant and 6 had no histology but benign characteristics at 12 months. Radiologist agreement for B-mode and elastography was moderate to excellent Kw 0.52-0.64; PABAKw 0.85-0.90). B-Mode imaging had 78.8% specificity, 76.9% sensitivity for malignancy. Quantitatively, adjusting for age, B-mode and lesion volume there was no statistically significant association between longitudinal velocity and malignancy (OR [95% CI] 0.40[0.10, 1.60], p=0.193), but some evidence that higher transverse velocity was associated with decreased odds of malignancy (0.28[0.06, 1.28], p=0.101). Qualitatively malignant masses tended to be towards the blue spectrum (lower velocities); 39.5% (17/43) of predominantly blue masses were malignant, compared to 14.3% (1/7) of red lesions.

Conclusions

Quantitatively and qualitatively there is no statistically significant association between shear wave velocity and malignancy. There is no clear additional role to B-mode imaging currently.

Key Points

• Correlation between shear wave velocity and soft tissue malignancy was statistically insignificant

• B-mode ultrasound is 76.9 % sensitive and 78.8 % specific

• Statistical models show elastography does not significantly add to lesion assessment

Primary ciliary dyskinesia in two English Cocker Spaniels

BACKGROUND

Primary ciliary dyskinesia (PCD) is an inherited condition characterised by structural and functional defects of ciliated cells. Ciliated cells are present in several different anatomic locations and PCD can thus cause a variety of clinical signs; however, the predominant clinical signs in dogs are respiratory in nature, most commonly chronic nasal discharge and recurrent lower respiratory tract infections commencing in the neonatal period.

CASE REPORT AND CONCLUSION

This report describes two cases of PCD in English Cocker Spaniel puppies presenting with chronic nasal discharge and bronchopneumonia. We describe the use of a minimally invasive technique to collect samples suitable for cilial studies for its diagnosis.

The burden of illness in patients with hyponatraemia in Sweden: a population-based registry study

BACKGROUND

Hyponatraemia (HN; serum sodium level < 135 mmol/l) is the most common electrolyte disturbance seen in clinical practice, and is associated with varying spectrum of symptoms. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common aetiology in hospitalised patients, and can be caused by several different underlying conditions.

AIMS

The objectives of this study were to retrospectively examine the baseline characteristics, clinical outcomes and hospital resource utilisation of patients with HN and/or SIADH in Sweden over a 10-year period from 2001 to 2011. Additional analysis was performed on subpopulations of patients with hip fracture, pneumonia and small cell lung cancer (SCLC) to see if trends in outcomes were consistent across a broad range of aetiologies commonly associated with the condition.

METHODS

Patient information was taken from the Swedish National Patient Registry, the Swedish Cancer Registry, the Swedish Cause of Death Register and the Swedish Prescribed Drug Register. A total of 34,537 patients (4.38%) were identified with HN and/or SIADH, with the incidence and prevalence rising over the 10-year study period.

RESULTS

Of the 34,537 patients identified, 841 had hip fracture, 2635 had pneumonia and 106 had SCLC. Compared with matched control patients, those with HN and/or SIADH had a longer length of hospital stay, a higher re-admission rate and a shorter time to re-admission.

CONCLUSIONS

This study showed that HN and/or SIADH negatively impact patient outcomes and healthcare resources related to hospital stay irrespective of the underlying cause. The impact of HN is not confined to the initial hospitalisation, as re-admission rates are also affected.

Hospital capacity and management preparedness for pandemic influenza in Victoria

OBJECTIVE

This study was designed to investigate acute hospital pandemic influenza preparedness in Victoria, Australia, particularly focussing on planning and management efforts.

METHODS

A prospective study was conducted by questionnaire and semi-structured interview of health managers across the Victorian hospital system from July to October 2011. Participants with responsibility for emergency management, planning and operations were selected from every hospital in Victoria with an emergency department to complete a questionnaire (response rate 22/43 = 51%). Each respondent was invited to participate in a phone-based semi-structured interview (response rate 11/22 = 50%).

RESULTS

Rural/regional hospitals demonstrated higher levels of clinical (86%) and non-clinical (86%) staff contingency planning than metropolitan hospitals (60% and 40% respectively). Pandemic plans were not being sufficiently tested in exercises or drills, which is likely to undermine their effectiveness. All respondents reported hand hygiene and standard precautions programs in place, although only one-third (33%) of metropolitan respondents and no rural/regional respondents reported being able to meet patient needs with high levels of staff absenteeism. Almost half Victoria's healthcare workers were unvaccinated against influenza.

CONCLUSIONS AND IMPLICATIONS

Hospitals across Victoria demonstrated different levels of influenza pandemic preparedness and planning. If a more severe influenza pandemic than that of 2009 arose, Victorian hospitals would struggle with workforce and infrastructure problems, particularly in rural/regional areas. Staff absenteeism threatens to undermine hospital pandemic responses. Various strategies, including education and communication, should be included with in-service training to provide staff with confidence in their ability to work safely during a future pandemic.

Efficacy and safety of iota-carrageenan nasal spray versus placebo in early treatment of the common cold in adults: the ICICC trial

Abstract

Iota-carrageenan (I-C) is active against respiratory viruses in vitro and was effective as nasal spray in three previous clinical trials. The current trial served to further investigate I-C in patients with early common cold symptoms.

Methods

This randomized, placebo-controlled, double-blind phase IV trial was conducted in 200 adult patients with self-diagnosed colds of <48 h’ duration that were confirmed by baseline cold symptom scores. Patients were to self-administer 0.12 % I-C or placebo spray (NaCl 0.5 %) four times daily for four to ten days and record symptom information for ten days. Common respiratory viruses were quantified by RT-PCR during pretreatment and on Day 3 or 4. The primary endpoint was the mean total symptom score (TSS) of eight cold symptoms on Days 2–4 (TSS_2–4).

Results

Patients in both treatment groups had similar baseline TSSs (mean TSS: 6.75 for I-C and 6.79 for placebo). Viruses were detected in baseline samples from 53 of 98 I-C patients (54.1 %) and 54 of 97 placebo patients (55.7 %). Mean ± SE for TSS_2–4 was 5.78 ± 0.25 for I-C patients and 6.39 ± 0.25 for placebo (p = 0.0895). Exploratory analyses after unblinding (TSS_2–4 excluding a patient with aberrantly high symptom scores [TSS_{2–4, ex 1pt}]; mean of TSS over Days 1–4 [TSS_1–4]; change in TSS_1–4 relative to baseline [TSS_{1–4, rel}]) demonstrated treatment differences in favor of I-C (p = 0.0364, p = 0.0495 and p = 0.0421, respectively). For patients with quantifiable rhinovirus/enterovirus at baseline, there was a trend towards greater reduction of virus load at Day 3 or 4 (p = 0.0958; I-C: 90.2 % reduction in viral load; placebo: 72.0 %). Treatments were well tolerated with no differences in adverse event rates.

Conclusions

The primary endpoint did not demonstrate a statistically significant difference between I-C and placebo but showed a trend towards I-C benefit. Exploratory analyses indicated significant reduction of cold symptoms in the I-C group relative to placebo during the first four days when symptoms were most severe, and also substantiated I-C’s activity against rhinovirus/enterovirus.

Trial registration

NCT01944631 (clinicaltrials.gov)

Effect of parasitic infection on dopamine biosynthesis in dopaminergic cells

Infection by the neurotropic agent Toxoplasma gondii alters rodent behavior and can result in neuropsychiatric symptoms in humans. Little is understood regarding the effects of infection on host neural processes but alterations to dopaminergic neurotransmission are implicated. We have previously reported elevated levels of dopamine (DA) in infected dopaminergic cells however the involvement of the host enzymes and fate of the produced DA were not defined. In order to clarify the effects of infection on host DA biosynthetic enzymes and DA packaging we examined enzyme levels and activity and DA accumulation and release in T. gondii-infected neurosecretory cells. Although the levels of the host tyrosine hydroxylase (TH) and DOPA decarboxylase and AADC (DDC) did not change significantly in infected cultures, DDC was found within the parasitophorous vacuole (PV), the vacuolar compartment where the parasites reside, as well as in the host cytosol in infected dopaminergic cells. Strikingly, DDC was found within the intracellular parasite cysts in infected brain tissue. This finding could provide some explanation for observations of DA within tissue cysts in infected brain as a parasite-encoded enzyme with TH activity was also localized within tissue cysts. In contrast, cellular DA packaging appeared unchanged in single-cell microamperometry experiments and only a fraction of the increased DA was accessible to high potassium-induced release. This study provides some understanding of how this parasite produces elevated DA within dopaminergic cells without the toxic ramifications of free cytosolic DA. The mechanism for synthesis and packaging of DA by T. gondii-infected dopaminergic cells may have important implications for the effects of chronic T. gondii infection on humans and animals.

Can a single isotropic 3D fast spin echo sequence replace three-plane standard proton density fat-saturated knee MRI at 1.5 T?

OBJECTIVE

To assess whether a single isotropic three-dimensional (3D) fast spin echo (FSE) proton density fat-saturated (PD FS) sequence reconstructed in three planes could replace the three PD (FS) sequences in our standard protocol at 1.5 T (Siemens Avanto, Erlangen, Germany).

METHODS

A 3D FSE PD water excitation sequence was included in the protocol for 95 consecutive patients referred for routine knee MRI. This was used to produce offline reconstructions in axial, sagittal and coronal planes. Two radiologists independently assessed each case twice, once using the standard MRI protocol and once replacing the standard PD (FS) sequences with reconstructions from the 3D data set. Following scoring, the observer reviewed the 3D data set and performed multiplanar reformats to see if this altered confidence. The menisci, ligaments and cartilage were assessed, and statistical analysis was performed using the standard sequence as the reference standard.

RESULTS

The reporting accuracy was as follows: medial meniscus (MM) = 90.9%, lateral meniscus (LM) = 93.7%, anterior cruciate ligament (ACL) = 98.9% and cartilage surfaces = 85.8%. Agreement among the readers was for the standard protocol: MM kappa = 0.91, LM = 0.89, ACL = 0.98 and cartilage = 0.84; and for the 3D protocol: MM = 0.86, LM = 0.77, ACL = 0.94 and cartilage = 0.64.

CONCLUSION

A 3D PD FSE sequence reconstructed in three planes gives reduced accuracy and decreased concordance among readers compared with conventional sequences when evaluating the menisci and cartilage with a 1.5-T MRI scanner.

ADVANCES IN KNOWLEDGE

Using the existing 1.5-T MR systems, a 3D FSE sequence should not replace two-dimensional sequences.

Contrasting brain patterns of writing-related DTI parameters, fMRI connectivity, and DTI-fMRI connectivity correlations in children with and without dysgraphia or dyslexia

Based on comprehensive testing and educational history, children in grades 4-9 (on average 12 years) were diagnosed with dysgraphia (persisting handwriting impairment) or dyslexia (persisting word spelling/reading impairment) or as typical writers and readers (controls). The dysgraphia group (n = 14) and dyslexia group (n = 17) were each compared to the control group (n = 9) and to each other in separate analyses. Four brain region seed points (left occipital temporal gyrus, supramarginal gyrus, precuneus, and inferior frontal gyrus) were used in these analyses which were shown in a metaanalysis to be related to written word production on four indicators of white matter integrity and fMRI functional connectivity for four tasks (self-guided mind wandering during resting state, writing letter that follows a visually displayed letter in alphabet, writing missing letter to create a correctly spelled real word, and planning for composing after scanning on topic specified by researcher). For those DTI indicators on which the dysgraphic group or dyslexic group differed from the control group (fractional anisotropy, relative anisotropy, axial diffusivity but not radial diffusivity), correlations were computed between the DTI parameter and fMRI functional connectivity for the two writing tasks (alphabet and spelling) by seed points. Analyses, controlled for multiple comparisons, showed that (a) the control group exhibited more white matter integrity than either the dysgraphic or dyslexic group; (b) the dysgraphic and dyslexic groups showed more functional connectivity than the control group but differed in patterns of functional connectivity for task and seed point; and (c) the dysgraphic and dyslexic groups showed different patterns of significant DTI-fMRI connectivity correlations for specific seed points and written language tasks. Thus, dysgraphia and dyslexia differ in white matter integrity, fMRI functional connectivity, and white matter-gray matter correlations. Of clinical relevance, brain differences were observed in dysgraphia and dyslexia on written language tasks yoked to their defining behavioral impairments in handwriting and/or in word spelling and on the cognitive mind wandering rest condition and composition planning.

The Men's Shed: providing biopsychosocial and spiritual support

Community Men's Sheds (CMS) have been a unique approach within Australia for addressing and promoting men's health and well-being issues by providing biopsychosocial support. Given the decline of traditional religious influence, and the contemporary understanding of 'spirituality', it can be argued that CMS may also develop and demonstrate characteristics of a communal spirituality. This research aimed to explore the individual and community contribution of CMS in terms of men's health and well-being and subsequently whether CMS programmes satisfied the contemporary and consensus understanding of spirituality. A qualitative case study was undertaken combining both participant observation over a 6-month period and semi-structured in-depth interviews with 21 men of varying ages and occupations attending a Melbourne suburban CMS (Victoria, Australia). Thematic analysis indicated that the CMS provided a number of health and well-being benefits at individual, family, community and public health levels. These included increased self-esteem and empowerment, respite from families, a sense of belonging in the community and the opportunity to exchange ideas relating to personal, family, communal and public health issues. It is concluded that CMS, through the provision of an appropriate spatial context and organizational activities, encourage intra-personal and inter-personal reflection and interaction that subsequently results in men meaningfully, purposefully and significantly connecting with the moment, to self, to others and to their environment-and thus, CMS not only provides biopsychosocial support but can also deliver spiritual support.

Contrasting brain patterns of writing-related DTI parameters, fMRI connectivity, and DTI-fMRI connectivity correlations in children with and without dysgraphia or dyslexia

Based on comprehensive testing and educational history, children in grades 4-9 (on average 12 years) were diagnosed with dysgraphia (persisting handwriting impairment) or dyslexia (persisting word spelling/reading impairment) or as typical writers and readers (controls). The dysgraphia group (n = 14) and dyslexia group (n = 17) were each compared to the control group (n = 9) and to each other in separate analyses. Four brain region seed points (left occipital temporal gyrus, supramarginal gyrus, precuneus, and inferior frontal gyrus) were used in these analyses which were shown in a metaanalysis to be related to written word production on four indicators of white matter integrity and fMRI functional connectivity for four tasks (self-guided mind wandering during resting state, writing letter that follows a visually displayed letter in alphabet, writing missing letter to create a correctly spelled real word, and planning for composing after scanning on topic specified by researcher). For those DTI indicators on which the dysgraphic group or dyslexic group differed from the control group (fractional anisotropy, relative anisotropy, axial diffusivity but not radial diffusivity), correlations were computed between the DTI parameter and fMRI functional connectivity for the two writing tasks (alphabet and spelling) by seed points. Analyses, controlled for multiple comparisons, showed that (a) the control group exhibited more white matter integrity than either the dysgraphic or dyslexic group; (b) the dysgraphic and dyslexic groups showed more functional connectivity than the control group but differed in patterns of functional connectivity for task and seed point; and (c) the dysgraphic and dyslexic groups showed different patterns of significant DTI-fMRI connectivity correlations for specific seed points and written language tasks. Thus, dysgraphia and dyslexia differ in white matter integrity, fMRI functional connectivity, and white matter-gray matter correlations. Of clinical relevance, brain differences were observed in dysgraphia and dyslexia on written language tasks yoked to their defining behavioral impairments in handwriting and/or in word spelling and on the cognitive mind wandering rest condition and composition planning.

A pilot study on using acupunture and core stability exercises to treat non-specific acute low back paun among industrial workers

To explore the effects of using acupunture and core stability experiences to treat acute low back pain among industrial workers at an Occupational health department in the UK.

Parkinson's disease incidence and prevalence assessment in France using the national healthcare insurance database

BACKGROUND AND PURPOSE

The incidence and prevalence of Parkinson's disease are important for public health planning yet there is a lack of representative, up-to-date estimations for France.

METHODS

For this cross-sectional study, subjects with suspected Parkinson's were identified in the EGB database, a 1/97 random sample of the national healthcare insurance database, linked to the national hospital-discharge summary database. Incidence and prevalence were estimated using a specific definition that included those with a diagnosis (hospitalization or listed as a long-term chronic disease for full reimbursement) and a sensitive definition that also included those with an indicative drug reimbursement profile. Estimations were extrapolated to the national population, standardizing on age and gender.

RESULTS

According to either the specific or the sensitive definitions, the annual incidence of Parkinson's disease during the study period was respectively 36 and 49 per 100,000 person-years and prevalence in 2010 was 308-410 per 100,000 persons in the population as a whole. According to the age groups 55-64, 65-74, 75-84 and ≥85 years incidence was respectively 33-46, 139-172, 301-363 and 442-560 per 100,000 person-years amongst men and 32-55, 81-117, 203-270 and 251-313 per 100,000 person-years amongst women. The 2010 prevalence stratified by the same age groups was 293-376, 898-1161, 2524-3011 and 3760-4578 per 100,000 persons amongst men and 199-351, 618-889, 1910-2433 and 2504-3263 per 100,000 persons amongst women.

CONCLUSIONS

The specific and sensitive definitions of disease bracket the true values; the relatively small range indicates that the current study provides good estimations of incidence and prevalence of Parkinson's disease for recent years in France.