Interventions to increase influenza vaccination rates in children with high-risk conditions--a systematic review

BACKGROUND

Influenza is a common cause of morbidity and mortality, especially among the elderly and those with certain chronic diseases. Annual influenza vaccination is recommended for individuals in at-risk groups, but rates of vaccination are particularly low in children with high-risk conditions (HRCs).

OBJECTIVE

To conduct a systematic review of studies that have examined interventions aimed at improving influenza vaccination in children with HRCs.

METHODS

Two databases - PubMed and SCOPUS - were searched (with no time or language restrictions) using a combination of keywords - Influenza AND vaccination OR immunization OR children AND asthma OR malignancy OR high-risk AND reminder. Duplicates were removed, and abstracts of relevant articles were screened using specific inclusion/exclusion criteria. Thirteen articles were selected, and five additional studies were identified following a review of the reference lists of the initial thirteen articles, bringing the total number to eighteen.

RESULTS

Most studies were conducted in the United States. Among the 18 studies, there was one systematic review of a specific intervention in asthmatic children, seven randomized controlled trials (RCTs), six before-and-after studies, one non-randomized controlled trial, one retrospective cohort study, one quasi-experimental post-test study, and one letter to editors. Interventions reported include multi-component strategies, letter reminders, telephone recall, letters plus telephone calls, an asthma education tool and year-round scheduling for influenza vaccination, amongst others.

CONCLUSION

There is good evidence that reminder letters will improve influenza vaccination uptake in children with HRCs, but the evidence that telephone recall or a combination of letter reminder and telephone recall will improve uptake is weak. It is not known if multiple reminder letters are more effective than single letters or if multi-component strategies are more effective than single or dual component strategies. There is a need for further research of these interventions, possibly outside the United States.

Health risk estimates for groundwater and soil contamination in the Slovak Republic: a convenient tool for identification and mapping of risk areas

We undertook a quantitative estimation of health risks to residents living in the Slovak Republic and exposed to contaminated groundwater (ingestion by adult population) and/or soils (ingestion by adult and child population). Potential risk areas were mapped to give a visual presentation at basic administrative units of the country (municipalities, districts, regions) for easy discussion with policy and decision-makers. The health risk estimates were calculated by US EPA methods, applying threshold values for chronic risk and non-threshold values for cancer risk. The potential health risk was evaluated for As, Ba, Cd, Cu, F, Hg, Mn, NO3 (-), Pb, Sb, Se and Zn for groundwater and As, B, Ba, Be, Cd, Cu, F, Hg, Mn, Mo, Ni, Pb, Sb, Se and Zn for soils. An increased health risk was identified mainly in historical mining areas highly contaminated by geogenic-anthropogenic sources (ore deposit occurrence, mining, metallurgy). Arsenic and antimony were the most significant elements in relation to health risks from groundwater and soil contamination in the Slovak Republic contributing a significant part of total chronic risk levels. Health risk estimation for soil contamination has highlighted the significance of exposure through soil ingestion in children. Increased cancer risks from groundwater and soil contamination by arsenic were noted in several municipalities and districts throughout the country in areas with significantly high arsenic levels in the environment. This approach to health risk estimations and visualization represents a fast, clear and convenient tool for delineation of risk areas at national and local levels.

AKT inhibition synergistically enhances growth-inhibitory effects of gefitinib and increases apoptosis in non-small cell lung cancer cell lines

OBJECTIVES

EGFR inhibitors are ineffective against most EGFR wild-type non-small cell lung cancer, for which novel treatment strategies are needed. AKT signalling is essential for mediating EGFR survival signals in NSCLC. We evaluated the combination of gefitinib and two different AKT inhibitors, the allosteric inhibitor AKTi-1/2 and the ATP-competitive pan-AKT inhibitor AZD5363, in EGFR-mutant (HCC-827 and PC-9) and -wild-type (NCI-H522, NCI-H1651), non-small cell lung cancer cell lines.

MATERIALS AND METHODS

Drug interaction was studied in two EGFR mutant and two EGFR wild-type non-small cell lung cancer cell lines by calculating combination index (CI) using median effect analysis. The effects on p-EGFR, p-ERK, p-AKT, p-S6 and apoptosis were studied by Western blot analysis.

RESULTS

The combination of gefitinib and AKTi-1/2 or AZD5363 showed synergistic growth inhibition in all cell lines. CI values for the combination of gefitinib and AKTi-1/2 were 0.35 (p=0.0048), 0.56 (p=0.036), 0.75 (p=0.13) and 0.64 (p=0.0003) in NCI-H522, NCI-H1651, HCC-827 and PC-9 cell lines, respectively; CI values of 0.45 (p=0.0087) and 0.22 (p<0.0001) were observed in NCI-H522 and PC-9 cells, respectively, when gefitinib was combined with AZD5363. Additive inhibition of signalling output through AKT and key downstream proteins (S6) and increased apoptosis were demonstrated.

CONCLUSION

Dual inhibition of EGFR and AKT may be a useful up-front strategy for patients with EGFR-mutant and -wild-type non-small cell lung cancer.

Over-reported peripheral neuropathy symptoms in a cohort of HIV infected and uninfected Rwandan women: the need for validated locally appropriate questionnaires

BACKGROUND

Peripheral neuropathy symptoms (PNS) are commonly manifested in HIV-infected (HIV+) individuals, although data are limited on the prevalence and predictors of PNS in HIV+ patients from sub-Saharan Africa.

OBJECTIVE

To determine the prevalence and predictors of PNS in HIV+ and HIV-uninfected (HIV-) Rwandan women.

METHODS

Data were analysed from 936 (710 HIV+ and 226 HIV-) women from the Rwanda Women Interassociation Study and Assessment (RWISA), an observational prospective cohort study investigating the effectiveness and toxicity of ART in HIV+ women.

RESULTS

Of 936 enrolled, 920 (98.3%) were included in this analysis with 44% of HIV- and 52% of the HIV+ women reporting PNS (p=0.06). CD4+ count was not associated with PNS, although there was a non-significant trend towards higher prevalence in those with lower CD4+ counts. For the HIV- women, only alcohol and co-trimoxazole use were independently associated with PNS. WHO HIV stage IV illness and albumin ≤ 3.5 were associated with PNS in HIV+ women.

CONCLUSIONS

The rate of peripheral neuropathy symptoms reported in this cohort of HIV-infected African women seems implausible, and rather suggests that the screening tool for peripheral neuropathy in culturally diverse African settings be locally validated.

A Toolkit to assess health needs for congenital disorders in low- and middle-income countries: an instrument for public health action

BACKGROUND

In 2010 the World Health Assembly called for action to improve the care and prevention of congenital disorders, noting that technical guidance would be required for this task, especially in low- and middle-income countries. Responding to this call, we have developed a freely available web-accessible Toolkit for assessing health needs for congenital disorders.

METHODS

Materials for the Toolkit website (http://toolkit.phgfoundation.org) were prepared by an iterative process of writing, discussion and modification by the project team, with advice from external experts. A customized database was developed using epidemiological, demographic, socio-economic and health-services data from a range of validated sources. Document-processing and data integration software combines data from the database with a template to generate topic- and country-specific Calculator documents for quantitative analysis.

RESULTS

The Toolkit guides users through selection of topics (including both clinical conditions and relevant health services), assembly and evaluation of qualitative and quantitative information, assessment of the potential effects of selected interventions, and planning and prioritization of actions to reduce the risk or prevalence of congenital disorders.

CONCLUSIONS

The Toolkit enables users without epidemiological or public health expertise to undertake health needs assessment as a prerequisite for strategic planning in relation to congenital disorders in their country or region.

Influence of the ABCG2 gout risk 141 K allele on urate metabolism during a fructose challenge

INTRODUCTION

Both genetic variation in ATP-binding cassette sub-family G member 2 (ABCG2) and intake of fructose-containing beverages are major risk factors for hyperuricemia and gout. This study aimed to test the hypothesis that the ABCG2 gout risk allele 141 K promotes the hyperuricaemic response to fructose loading.

METHODS

Healthy volunteers (n = 74) provided serum and urine samples immediately before and 30, 60, 120 and 180 minutes after ingesting a 64 g fructose solution. Data were analyzed based on the presence or absence of the ABCG2 141 K gout risk allele.

RESULTS

The 141 K risk allele was present in 23 participants (31%). Overall, serum urate (SU) concentrations during the fructose load were similar in those with and without the 141 K allele (PSNP = 0.15). However, the 141 K allele was associated with a smaller increase in SU following fructose intake (PSNP <0.0001). Those with the 141 K allele also had a smaller increase in serum glucose following the fructose load (PSNP = 0.002). Higher fractional excretion of uric acid (FEUA) at baseline and throughout the fructose load was observed in those with the 141 K risk allele (PSNP <0.0001). However, the change in FEUA in response to fructose was not different in those with and without the 141 K risk allele (PSNP = 0.39). The 141 K allele effects on serum urate and glucose were more pronounced in Polynesian participants and in those with a body mass index ≥25 kg/m².

CONCLUSIONS

In contrast to the predicted responses for a hyperuricemia/gout risk allele, the 141 K allele is associated with smaller increases in SU and higher FEUA following a fructose load. The results suggest that ABCG2 interacts with extra-renal metabolic pathways in a complex manner to regulate SU and gout risk.

CLINICAL TRIALS REGISTRATION

The study was registered by the Australian Clinical Trials Registry (ACTRN12610001036000).

The reliability of the modified lower extremity functional scale among adults living with HIV on antiretroviral therapy, in Rwanda, Africa

Peripheral neuropathy (PN) is common among people living with HIV (PLHIV) on antiretroviral therapy (ART), and affects their daily functional ability and quality of life. Lower extremity functional ability, which is most commonly compromised in patients with PN, has not been clearly evaluated in an African setting, with regard to functional limitations. The lower extremity functional scale (LEFS) was originally developed and validated among elderly people in the USA, where the environment and activities of daily life are very different from those in Rwanda. The purpose of this study was to adapt and establish the reliability of LEFS, among adults living with HIV on ART, in a Rwandan environment. The study translated LEFS from English to Kinyarwanda, the local language spoken in Rwanda, the LEFS was then modified accordingly, and tested for test-retest reliability among 50 adult PLHIV on ART. An average Spearman rank order correlation coefficient, ρ ≥ 0.7, was considered optimal for reliability. Prior to the modification of the LEFS and in the initial testing of the translated LEFS, none of the activities was strongly correlated (ρ ≥ 0.8); most of the activities (90%, 18/20) were moderately correlated (ρ ≥ 0.5) and 10% (2/20) were weakly correlated (ρ ≤ 0.5). The ρ of most of the functional activities improved after modification by an expert group to ρ ≥ 0.7, establishing reliability and validity of LEFS among PLHIV on ART with lower extremity functional limitations, in this environment. In conclusion, this study demonstrated the importance of modifying and establishing test - retest reliability of tools derived from developed world contexts to local conditions in developing countries, such as in Rwanda. The modified LEFS in this study can be used in Rwanda by clinicians, specifically at ART clinics to screen and identify people with functional limitations at an early stage of the limitations, for treatment, rehabilitation and/or referral to appropriate health care services.

RGS6 suppresses Ras-induced cellular transformation by facilitating Tip60-mediated Dnmt1 degradation and promoting apoptosis

The RAS protooncogene has a central role in regulation of cell proliferation, and point mutations leading to oncogenic activation of Ras occur in a large number of human cancers. Silencing of tumor-suppressor genes by DNA methyltransferase 1 (Dnmt1) is essential for oncogenic cellular transformation by Ras, and Dnmt1 is overexpressed in numerous human cancers. Here we provide new evidence that the pleiotropic regulator of G protein signaling (RGS) family member RGS6 suppresses Ras-induced cellular transformation by facilitating Tip60-mediated degradation of Dmnt1 and promoting apoptosis. Employing mouse embryonic fibroblasts from wild-type and RGS6(-/-) mice, we found that oncogenic Ras induced upregulation of RGS6, which in turn blocked Ras-induced cellular transformation. RGS6 functions to suppress cellular transformation in response to oncogenic Ras by downregulating Dnmt1 protein expression leading to inhibition of Dnmt1-mediated anti-apoptotic activity. Further experiments showed that RGS6 functions as a scaffolding protein for both Dnmt1 and Tip60 and is required for Tip60-mediated acetylation of Dnmt1 and subsequent Dnmt1 ubiquitylation and degradation. The RGS domain of RGS6, known only for its GTPase-activating protein activity toward Gα subunits, was sufficient to mediate Tip60 association with RGS6. This work demonstrates a novel signaling action for RGS6 in negative regulation of oncogene-induced transformation and provides new insights into our understanding of the mechanisms underlying Ras-induced oncogenic transformation and regulation of Dnmt1 expression. Importantly, these findings identify RGS6 as an essential cellular defender against oncogenic stress and a potential therapeutic target for developing new cancer treatments.

The prevalence of clinical signs of ankle instability in club rugby players

Background. Ankle injuries are one of the most common injuries in sport and have a high recurrence rate.Aim. To determine the prevalence of clinical signs of ankle injuries in club rugby players in South Gauteng.Methods. Institutional ethical clearance was obtained for the study. Of the 180 players from 9 clubs who were eligible for participation in thestudy, 76% (n=137) were recuited. Informed consent was obtained before players were asked to complete a battery of tests. Each player wasasked to complete a demographic questionnaire and the Olerud and Molander questionnaire to determine the prevalence of clinical signs ofperceived instability. The prevalence of clinical signs of mechanical instability was determined by the anterior drawer test (ADT) and talartilt test (TTT). Balance and proprioception were assessed by the Balance Error Scoring System (BESS) and this was used to determine theprevalence of clinical signs of functional instability.Results. The prevalence of perceived instability was 44%. The prevalence of clinical signs of mechanical ankle instability was 33%. There was anincreased prevalence of mechanical instability in players who had a history of previous ankle injuries: ADT left (p=0.003); ADT right (p=0.01);TTT left (p=0.001); TTT right (p=0.08), both tests positive left (p=0.001) and both tests positive right (p=0.03). The prevalence of clinical signsof functional ankle instability depended on the surface and visual input, and was greater as the challenge or perturbation increased.Conclusion. There was a high prevalence of clinical signs of ankle instability in club rugby players for perceived, mechanical and functionalinstability. Those with previously injured ankles were more likely to have unstable ankles.

The prevalence of clinical signs of ankle instability in club rugby players

Background. Ankle injuries are one of the most common injuries in sport and have a high recurrence rate.Aim. To determine the prevalence of clinical signs of ankle injuries in club rugby players in South Gauteng.Methods. Institutional ethical clearance was obtained for the study. Of the 180 players from 9 clubs who were eligible for participation in thestudy, 76% (n=137) were recuited. Informed consent was obtained before players were asked to complete a battery of tests. Each player wasasked to complete a demographic questionnaire and the Olerud and Molander questionnaire to determine the prevalence of clinical signs ofperceived instability. The prevalence of clinical signs of mechanical instability was determined by the anterior drawer test (ADT) and talartilt test (TTT). Balance and proprioception were assessed by the Balance Error Scoring System (BESS) and this was used to determine theprevalence of clinical signs of functional instability.Results. The prevalence of perceived instability was 44%. The prevalence of clinical signs of mechanical ankle instability was 33%. There was anincreased prevalence of mechanical instability in players who had a history of previous ankle injuries: ADT left (p=0.003); ADT right (p=0.01);TTT left (p=0.001); TTT right (p=0.08), both tests positive left (p=0.001) and both tests positive right (p=0.03). The prevalence of clinical signsof functional ankle instability depended on the surface and visual input, and was greater as the challenge or perturbation increased.Conclusion. There was a high prevalence of clinical signs of ankle instability in club rugby players for perceived, mechanical and functionalinstability. Those with previously injured ankles were more likely to have unstable ankles.

The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis

This ISAAC Phase Three synthesis provides summarised information on the main findings of the study, regional tables and figures related to the prevalence and severity of current symptoms of asthma, rhinoconjunctivitis and eczema in the main regions of the world. The large number of surveyed children (≈1,200,000), the large number of centres (233) and countries (98) that participated in ISAAC Phase Three makes this study the most comprehensive survey of these diseases ever undertaken. Globally, the prevalence for current asthma, rhinoconjunctivitis and eczema in the 13-14-year age group was 14.1%, 14.6% and 7.3%, respectively. In the 6-7-year age group the prevalence for current asthma, rhinoconjunctivitis and eczema was 11.7%, 8.5% and 7.9%, respectively. The study shows a wide variability in the prevalence and severity of asthma, rhinoconjunctivitis and eczema which occurs not just between regions and countries but between centres in the same country and centres in the same city. This study definitively establishes that the prevalence of those diseases can be very high in non-affluent centres with low socioeconomic conditions. The large variability also suggests a crucial role of local environment characteristics to determine the differences in prevalence between one place and another. Thus, ISAAC Phase Three has provided a large body of epidemiological information on asthma, rhinoconjunctivitis and eczema in childhood from contrasting environments which is expected to yield new clues about the aetiology of those conditions and reasons for their marked global variability.

Reliability and Validity of the Dyadic Observed Communication Scale (DOCS)

We evaluated the reliability and validity of the Dyadic Observed Communication Scale (DOCS) coding scheme, which was developed to capture a range of communication components between parents and adolescents. Adolescents and their caregivers were recruited from mental health facilities for participation in a large, multi-site family-based HIV prevention intervention study. Seventy-one dyads were randomly selected from the larger study sample and coded using the DOCS at baseline. Preliminary validity and reliability of the DOCS was examined using various methods, such as comparing results to self-report measures and examining interrater reliability. Results suggest that the DOCS is a reliable and valid measure of observed communication among parent-adolescent dyads that captures both verbal and nonverbal communication behaviors that are typical intervention targets. The DOCS is a viable coding scheme for use by researchers and clinicians examining parent-adolescent communication. Coders can be trained to reliably capture individual and dyadic components of communication for parents and adolescents and this complex information can be obtained relatively quickly.

The impact of lower limb amputation on community reintegration of a population in Johannesburg: A Qualitative perspective

Aim: To explore the experiences and perceptions of people with lower limb amputations from the Johannesburg metropolitan area on the impact that their amputations had on their lives and their return to their communities. Methods: Semi-structured audio-taped in-depth interviews were used to collect data on 12 purposively selected participants. Ethical clearance was obtained. A General Inductive Approach was used to generate or discover themes within the data using a process of systematic coding. Results: Emerging from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hopes of obtaining prostheses were reported. Some reported poor social involvement due to mobility problems and employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their communities of origin three months postoperatively with both functional and psychosocial challenges.

Inter-examiner reliability when using the Objective Structured Practical Examination (OSPE) mark sheet for physiotherapy practical

The Objective Structured Practical Examination (OSPE) format is used during practical examinations as part of the physiotherapy undergraduate curriculum at the University of the Witwatersrand. Various factors influence inter-examiner reliability and investigating the inter-examiner reliability when using the OSPE can lead to improvement of the examination process. The aim of this study was to establish inter-examiner reliability when using the OSPE mark sheet. Methods: Twelve examiners participated in this study. Thirty-three second year PT students were examined at six stations and by two examiners at each station. The Spearman’s correlation test was used to establish inter-examiner reliability. Results: The general inter-examiner reliability of the OSPE mark sheet was high. There was a high correlation between examiners who had the same level of experience (r=0.79 to r=0.93; p<0.001). The background knowledge section of the OSPE mark sheet showed the greatest inter-examiner reliability (r=0.75 to r=0.91; p<0.001). Discussion: In general, a high inter-examiner reliability was found. Examiners with the same level of experience seemed to generally have better inter-examiner reliability when using the OSPE mark sheet. Furthermore, a well-described, operationalised list of micro-skills also improved inter-examiner reliability. Conclusion: The OSPE mark sheet aids inter-examiner reliability. The use of this method of examination should be encouraged.

Paediatric HIV - Looking beyond CD4 Counts

Paediatric HIV remains a significant health and social challenge in sub-Saharan Africa despite many countries gaining improved access to antiretroviral treatment. Paediatric HIV affects multiple body systems and has the potential to cause wide ranging impairments as well as activity and participation limitations. The aim of this paper is to highlight some of the impairments that remain, despite the children having access to better medical care, in order to establish a possible role for physiotherapists. Nine studies conducted through the department of physiotherapy at the University of the Witwatersrand, South Africa are presented. The results of these studies demonstrate the neurodevelopmental, musculoskeletal, respiratory and quality of life challenges which children infected with HIV as well as their caregivers continue to face. The need for long term, multidisciplinary follow up of children infected with HIV is emphasized.

No reduction in circulating preosteoclasts 18 months after treatment with zoledronate: analysis from a randomized placebo controlled trial

The conventional model that bisphosphonates bind to the bone surface and inhibit mature osteoclasts does not convincingly explain the prolonged duration of action of zoledronate. We hypothesized that zoledronate on the bone surface adjacent to marrow cells impairs osteoclastogenesis, contributing to sustained inhibition of resorption. In this case, numbers of circulating preosteoclasts may be reduced after zoledronate treatment. This study assessed this possibility in subjects from a clinical trial. Twenty-two osteopenic women participating in a randomized, controlled trial comparing zoledronate 5 mg with placebo were recruited, 18 months after administration of study drug. Peripheral blood mononuclear cells were analyzed for the presence of osteoclast precursors using flow cytometry for preosteoclast markers and the ability to form osteoclast-like cells in culture with RANKL and M-CSF. There was no difference in the percentage of CD14(+)/CD11b(+) cells in peripheral blood between the two groups. The numbers of TRAP(+) multinucleated cells in cultures in the absence of RANKL and M-CSF were very low in both groups, but a significantly higher number of these cells was observed in the zoledronate group compared with the placebo group (p = 0.01). The number of TRAP(+) multinucleated cells and resorption pits following culture with RANKL and M-CSF did not differ between the two groups. Serum P1NP was reduced 53 % at 18 months in the zoledronate group but unchanged in the placebo group. These results do not support the hypothesis that the inhibitory action of zoledronate contributes to its prolonged action on preosteoclasts within bone marrow.

Quality of life following a major lower limb ampu tation in Johann esburg, South Africa

To determine the impact of lower limb amputation on qualityof life in people in the Johannesburg metropolitan area of South Africa, duringtheir reintegration to their society/community of origin.A longitudinal pre- test- post test design was utilized. Consecutive samplingwas used to recruit and interview participants (n=73) who met the inclusioncriteria. Ethical clearance was obtained. The hospitals and participants gaveinformed consent.The EQ-5D, Barthel Index, and Modified Household Economic andSocial Status Index were used to collect data. Participants were interviewed preoperatively and then followed upthree months post-operatively. Data were analysed using STATA version 10. Categorical data were analysedusing Chi-square/Fischer’s exact test and continuous data were analysed using Wilcoxon signed rank and medianregression.Most (n=21, 52.5 %) participants had no income. One participant was homeless, 17.5% (n=7) lived in shacks.The preoperative and postoperative median VAS of the EQ-5D was 60 and 70 respectively showing no significantimprovement in QOL (median EQ-5D VAS). The preoperative and postoperative median total BI score was 20 and 19respectively, showing a significant reduction in function (median total BI) three months postoperatively (p<0.001).Preoperative mobility was a predictor of postoperative quality of life. Being female was a predictor of higher qualityof life.The average EQ-5D VAS score and overall function (total BI) were generally scored high both preoperativelyand postoperatively but there was no significant improvement in EQ-5D VAS score and there was a significant reductionin function after three months. Higher scores in mobility preoperatively is a predictor of higher quality of lifepostoperatively.

HIV/AIDS in Physiotherapy Education – Mainstreaming Using UN Principles

HIV /AID S remains at epidemic levels in South Africa with onein ten people affected by the HI virus. The United Nations program for AID S(UNAID S) has defined five principles that can be used to mainstream HIV .The five key principles are: the development of a clearly defined entry point;use of existing policies, structures and frameworks; advocacy sensitizationand capacity building; distinguishing between the external (institutionalinterventions) and internal (staff risks and vulnerability) domain; and developingstrategic partnerships. A proposed HIV curriculum for physiotherapists wasbeen developed from a series of studies undertaken to understand the issues related to HIV using the principles ofmainstreaming.The purpose of this paper is to explore how each principle of mainstreaming can be applied in physiotherapyeducation and curricula.Each mainstreaming principle was considered and ways in which it could be mainstreamed into physiotherapytraining and practice, using data from the patients’, academics’ and clinicians’ experience were proposed.The five principles can be used in South African settings. In principle one the aetiology, approaches to treatment,management of conditions and symptoms are used to identify entry points for introducing HIV teaching. Relevantexamples of conditions associated with HIV include pain, stroke, specific muscle weakness patterns, fatigue andcardiopulmonary system problems (e.g. breathlessness). The role of physiotherapy in HIV management is also a goodentry point.For principle two, policies were considered. Pertinent areas such as antiretroviral use, frameworks such as theInternational Classification of Function (ICF), Worthington’s rehabilitation framework and CBR can also be integratedwith HIV physiotherapy curriculum and practice. Sensitised and aware staff as promoted in principle three,can advocate for affected patients and role model appropriate practice and attitudes in HIV management thuscontributing to reducing stigma and burnout. Integrating policies with the need to avoid risks and correct inappropriateattitudes of staff is promoted and promoting strategic partnerships and collaborative work will help provideappropriate services.Using the mainstreaming principles allows for the inclusion of HIV content in physiotherapy education and practice.Both physiotherapy curriculum and continuous professional development may use this information to respondappropriately.

Parenting stress of caregivers of young children who are HIV Positive

OBJECTIVE

Paediatric HIV remains a major challenge in Sub-Saharan Africa. Paediatric HIV is a multi-generational disorder with far-reaching implications for the whole family. Parenting stress in caregivers of HIV infected children has been studied in developed countries but never in South Africa. The aim of this study was to determine the extent of parenting stress in caregivers of children infected with HIV in South Africa. Further objectives were to monitor the levels of stress over one year after caregivers started attending a paediatric HIV clinic and to ascertain what factors were predictive of a decrease in parenting stress over that time.

METHOD

One hundred and twenty two caregiver and children dyads were recruited into this study. Caregivers completed the Parenting Stress Index/ Short form at baseline and after six and 12 months. Demographic information was collected and the children's heights, weights and CD4 counts were recorded at each visit.

RESULTS

The families that participated in this study came from very poor socio-economic backgrounds. Eighty five percent of the children were still being cared for by their biological mothers. The parenting stress levels of the caregivers in this study were extremely high at baseline. Although the parenting stress levels did come down significantly over the study period (p< 0.001) they remained high and warrant further investigation and management. A better level of education, better housing facilities and fewer adults living in the household were the three most important factors predicting a decrease in parenting stress over a one year period.

CONCLUSION

Parenting stress of caregivers of young children infected with HIV is extremely high and warrants further investigation and long term management.

An ongoing large outbreak of measles in Merseyside, England, January to June 2012

From 1 January to 30 June 2012, 359 confirmed and 157 probable cases of measles were reported in Merseyside, England. The most affected age groups were children under five years and young adults from 15 years of age. Most cases have been sporadic. There have been few outbreaks in nurseries; however, no outbreaks have been reported in schools. Of the cases eligible for vaccination, only 3% of the confirmed cases were fully immunised.

An ongoing large outbreak of measles in Merseyside, England, January to June 2012

From 1 January to 30 June 2012, 359 confirmed and 157 probable cases of measles were reported in Merseyside, England. The most affected age groups were children under five years and young adults from 15 years of age. Most cases have been sporadic. There have been few outbreaks in nurseries; however, no outbreaks have been reported in schools. Of the cases eligible for vaccination, only 3% of the confirmed cases were fully immunised.

Methods of weaning preterm babies <30 weeks gestation off CPAP: a multicentre randomised controlled trial

BACKGROUND

Controversy exists whether different continuous positive airway pressure (CPAP) weaning methods influence time to wean off CPAP, CPAP duration, oxygen duration, Bronchopulmonary Dysplasia (BPD) or length of admission.

AIMS

In a multicentre randomised controlled trial, the authors have primarily compared CPAP weaning methods impact on time to wean off CPAP and CPAP duration and secondarily their effect on oxygen duration, BPD and time of admission.

METHODS

Between April 2006 and October 2009, 177 infants <30 weeks gestational age (GA) who fulfilled stability criteria on CPAP were randomised to one of the three CPAP weaning methods (M). M1: Taken 'OFF' CPAP with the view to stay 'OFF'. M2: Cycled on and off CPAP with incremental time 'OFF'. M3: As with m(2), cycled on and off CPAP but during 'OFF' periods were supported by 2 mm nasal cannula at a flow of 0.5 l/min.

RESULTS

Based on intention to treat analysis, there was no significant difference in mean GA or birthweight between the groups (27.1 ± 1.4, 26.9 ± 1.6 and 27.3 ± 1.5 (weeks ± 1SD) and 988 ± 247, 987 ± 249 and 1015 ± 257 (grams ± 1SD), respectively). Primary outcomes showed M1 produced a significantly shorter time to wean from CPAP (11.3 ± 0.8, 16.8 ± 1.0, 19.4 ± 1.3 (days ± 1SE) p<0.0001, respectively) and CPAP duration (24.4 ± 0.1, 38.6 ± 0.1, 30.5 ± 0.1 (days ± 1SE) p<0.0001, respectively). All the secondary outcomes were significantly shorter with M1, (oxygen duration: 24.1 ± 1.5, 45.8 ± 2.2, 34.1 ± 2.0 (days ± 1SE) p<0.0001, BPD: 7/56 (12.5%), 29/69 (42%), 10/52 (19%) p=0.011 and length of admission: 58.5 ± 0.1, 73.8 ± 0.1 69.5 ± 0.1 (days ± 1SE) p<0.0001, respectively).

CONCLUSION

Method 1 significantly shortens CPAP weaning time, CPAP duration, oxygen duration, BPD and admission time.

Monitoring indicates greater resilience for birds than for mammals in Kakadu National Park, northern Australia

Context A previous study reported major declines for native mammal species from Kakadu National Park, over the period 2001–09. The extent to which this result may be symptomatic of more pervasive biodiversity decline was unknown. Aims Our primary aim was to describe trends in the abundance of birds in Kakadu over the period 2001–09. We assessed whether any change in bird abundance was related to the arrival of invading cane toads (Rhinella marina), and to fire regimes. Methods Birds were monitored at 136 1-ha plots in Kakadu, during the period 2001–04 and again in 2007–09. This program complemented sampling of the same plots over the same period for native mammals. Key results In contrast to the decline reported for native mammals, the richness and total abundance of birds increased over this period, and far more individual bird species increased than decreased. Fire history in the between-sampling period had little influence on trends for individual species. Interpretation of the overall positive trends for bird species in Kakadu over this period should be tempered by recognition that most of the threatened bird species present in Kakadu were unrecorded in this monitoring program, and the two threatened species for which there were sufficient records to assess trends – partridge pigeon (Geophaps smithii) and white-throated grass-wren (Amytornis woodwardi) – both declined significantly. Conclusions The current decline of the mammal fauna in this region is not reflected in trends for the region’s bird fauna. Some of the observed changes (mostly increases) in the abundance of bird species may be due to the arrival of cane toads, and some may be due to local or regional-scale climatic variation or variation in the amount of flowering. The present study provides no assurance about threatened bird species, given that most were inadequately recorded in the study (perhaps because their decline pre-dated the present study). Implications These contrasting trends between mammals and birds demonstrate the need for biodiversity monitoring programs to be broadly based. The declines of two threatened bird species over this period indicate the need for more management focus for these species.

Investigation of a neuropsychological screen for chemo-fog

Research on chemotherapy-induced cognitive impairment (the term ‘‘chemo-fog’’ is used by many investigators) supports the occurrence of subtle declines in function for a subset of recipients. Identification of vulnerable individuals via comprehensive neuropsychological batteries is complicated due to their lack of clinical utility and increased risk of misclassification. The goal of this paper was to evaluate the ability of a reduced battery to detect chemotherapy-related cognitive impairments. Data from our previous study (Ouimet et al. J Clin Exp Neuropsychol 31:73–89, 2009) were used to compare a comprehensive neuropsychological test battery comprising 23 tests with a reduced battery consisting of a subset of nine tests. A standardized regression-based approach revealed that a comparable numbers of participants were identified by both batteries, suggesting that individuals vulnerable to chemotherapy-induced cognitive impairment can be identified by a more selective battery. Further work is needed to clarify the neuropsychological tests most sensitive to detecting impairments associated with chemotherapy so that assessment batteries can be limited to these tests.

Investigation of a neuropsychological screen for chemo-fog

Research on chemotherapy-induced cognitive impairment (the term ‘‘chemo-fog’’ is used by many investigators) supports the occurrence of subtle declines in function for a subset of recipients. Identification of vulnerable individuals via comprehensive neuropsychological batteries is complicated due to their lack of clinical utility and increased risk of misclassification. The goal of this paper was to evaluate the ability of a reduced battery to detect chemotherapy-related cognitive impairments. Data from our previous study (Ouimet et al. J Clin Exp Neuropsychol 31:73–89, 2009) were used to compare a comprehensive neuropsychological test battery comprising 23 tests with a reduced battery consisting of a subset of nine tests. A standardized regression-based approach revealed that a comparable numbers of participants were identified by both batteries, suggesting that individuals vulnerable to chemotherapy-induced cognitive impairment can be identified by a more selective battery. Further work is needed to clarify the neuropsychological tests most sensitive to detecting impairments associated with chemotherapy so that assessment batteries can be limited to these tests.

Changes in cerebral oximetry during peritoneal insufflation for laparoscopic procedures

Background:

Changes in cardiac output may occur during insufflation for laparoscopic procedures. However, there are limited data regarding its potential effects on cerebral oxygenation.

Materials and Methods:

Cerebral oxygenation (ScO₂), end tidal CO₂, heart rate, blood pressure and oxygen saturation by pulse oximetry were recorded every 5 minutes prior to insufflation, during insufflation and after desufflation. Minute ventilation was increased to maintain normocapnia and the depth of anesthesia was adjusted or fluids/phenylephrine administered to maintain the blood pressure within 20% of the baseline.

Results:

The cohort for the study included 70 adults for laparoscopic herniorrhaphy, gastric bypass or cholecystectomy. A total of 1004 ScO₂ values were obtained during laparoscopy. The ScO₂ decreased from the baseline in 758 of the 1004 data points. The ScO₂ was 0–9 less than the baseline in 47.8% of the values, 10–19 less than the baseline in 24.9% of the values and 20–29 less than the baseline in 26 values (2.6%). Eighty-two (8.2%) of the values were less than 80% of the baseline value, while 25 values (2.5%) were less than 75% of the baseline value. Twelve patients had at least one ScO₂ value that was less than 80% of the baseline and 6 had at least one ScO₂ value that was less than 75% of the baseline. Four patients of the cohort had ScO₂ values less than 80% of the baseline for more than 50% of the laparoscopic procedure.

Conclusions:

Although relatively uncommon, significant changes in cerebral oxygenation do occur in some patients during insufflation for laparoscopic surgery.