Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair: a prospective randomized study

INTRODUCTION

Rehabilitation programs after rotator cuff repair should allow recovery of shoulder function without preventing tendon healing. The aim of this randomized prospective study was to compare the clinical results after two types of postoperative management: immediate passive motion versus immobilization.

PATIENTS AND METHODS

We followed 100 patients, mean age 55 years old, who underwent arthroscopic repair of a non-retracted supraspinatus tear. Patients were randomized to receive postoperative management of immediate passive motion or strict immobilization for 6 weeks. A clinical evaluation was performed in 92 patients, and CT arthrography in 82. Mean follow-up was 15 months.

RESULTS

The mean preoperative Constant score improved significantly from 46.1 points to 73.9 at the final follow-up. The rate of intact cuffs was 58.5%. Functional results were statistically better after immediate passive motion with a mean passive external rotation of 58.7° at the final follow-up versus 49.1° after immobilization (P=0.011), a passive anterior elevation of 172.4° versus 163.3° (P=0.094) respectively, a Constant score of 77.6 points versus 69.7 (P=0.045) respectively, and a lower rate of adhesive capsulitis and complex regional pain syndrome. Results for healing seemed to be slightly better with immobilization, but this was not statistically significant: the cuff had a normal appearance in 35.9% of cases after immobilization compared to 25.6% after passive motion, an image of intratendinous addition was found in 25.6% versus 30.2%, punctiform leaks in 23.1% versus 20.9%, and recurrent tears in 15.4% versus 23.3% respectively.

DISCUSSION

The rehabilitation program that results in better tendon healing by preventing postoperative stiffness has not yet been identified. Our results suggest that early passive motion should be authorized: the functional results were better with no significant difference in healing.

Effectiveness of rotavirus vaccination in prevention of hospital admissions for rotavirus gastroenteritis among young children in Belgium: case-control study

OBJECTIVE

To evaluate the effectiveness of rotavirus vaccination among young children in Belgium.

DESIGN

Prospective case-control study.

SETTING

Random sample of 39 Belgian hospitals, February 2008 to June 2010.

PARTICIPANTS

215 children admitted to hospital with rotavirus gastroenteritis confirmed by polymerase chain reaction and 276 age and hospital matched controls. All children were of an eligible age to have received rotavirus vaccination (that is, born after 1 October 2006 and aged ≥ 14 weeks).

MAIN OUTCOME MEASURE

Vaccination status of children admitted to hospital with rotavirus gastroenteritis and matched controls.

RESULTS

99 children (48%) admitted with rotavirus gastroenteritis and 244 (91%) controls had received at least one dose of any rotavirus vaccine (P<0.001). The monovalent rotavirus vaccine accounted for 92% (n=594) of all rotavirus vaccine doses. With hospital admission as the outcome, the unadjusted effectiveness of two doses of the monovalent rotavirus vaccine was 90% (95% confidence interval 81% to 95%) overall, 91% (75% to 97%) in children aged 3-11 months, and 90% (76% to 96%) in those aged ≥ 12 months. The G2P[4] genotype accounted for 52% of cases confirmed by polymerase chain reaction with eligible matched controls. Vaccine effectiveness was 85% (64% to 94%) against G2P[4] and 95% (78% to 99%) against G1P[8]. In 25% of cases confirmed by polymerase chain reaction with eligible matched controls, there was reported co-infection with adenovirus, astrovirus and/or norovirus. Vaccine effectiveness against co-infected cases was 86% (52% to 96%). Effectiveness of at least one dose of any rotavirus vaccine (intention to vaccinate analysis) was 91% (82% to 95%).

CONCLUSIONS

Rotavirus vaccination is effective for the prevention of admission to hospital for rotavirus gastroenteritis among young children in Belgium, despite the high prevalence of G2P[4] and viral co-infection.

Search for charged Higgs bosons in e+e- collisions at [Formula: see text]

A search is made for charged Higgs bosons predicted by Two-Higgs-Doublet extensions of the Standard Model (2HDM) using electron-positron collision data collected by the OPAL experiment at [Formula: see text], corresponding to an integrated luminosity of approximately 600 pb-1. Charged Higgs bosons are assumed to be pair-produced and to decay into [Formula: see text], τντ or AW±. No signal is observed. Model-independent limits on the charged Higgs-boson production cross section are derived by combining these results with previous searches at lower energies. Under the assumption [Formula: see text], motivated by general 2HDM type II models, excluded areas on the [Formula: see text] plane are presented and charged Higgs bosons are excluded up to a mass of 76.3 GeV at 95 % confidence level, independent of the branching ratio BR(H±→τντ ). A scan of the 2HDM type I model parameter space is performed and limits on the Higgs-boson masses [Formula: see text] and mA are presented for different choices of tanβ.

Regulation and expression of IL-32 in chronic rhinosinusitis

BACKGROUND

Activated T lymphocytes and their interaction with resident tissue cells, particularly epithelium, play important roles in inflammatory processes in chronic rhinosinusitis (CRS). IL-32 is a recently described cytokine, which is expressed in a variety of tissue cells and involved in the pathogenesis of several chronic inflammatory diseases.

METHODS

Human sinus epithelial cells were isolated from biopsies and stimulated with different cytokines, which play a role in the pathogenesis of CRS. IL-32 mRNA expression was analyzed using real-time-PCR, IL-32 protein was determined by Western blot and flow cytometry as well as immunofluorescent staining in primary sinus epithelial cells and nasal biopsies from patients with CRS and healthy controls.

RESULTS

IL-32 mRNA was upregulated by TNF-α and IFN-γ in primary sinus epithelial cells, whereas IL-1 β, IL-4, IL-13, and IL-17 did not influence IL-32 expression. IL-32 mRNA expression was significantly higher in human primary sinonasal epithelial cells (HSECs) cocultured with Th1 cells compared with HSECs cocultured with Th0 or Th2 cells. IL-32 mRNA expression was significantly higher in biopsies from sinus epithelial tissue of CRS patients with nasal polyps compared with healthy subjects (P = 0.01). IL-32 was detected in biopsies from patients with CRS, whereas it was scarcely present in control tissues.

CONCLUSION

The induction of IL-32 by TNF-α, IFN-γ and Th1 cells as well as its increased expression in sinus tissues from CRS patients with nasal polyps demonstrated a potential role for IL-32 in the pathogenesis of CRS.

The impact of childhood acute rotavirus gastroenteritis on the parents' quality of life: prospective observational study in European primary care medical practices

Background

Rotavirus (RV) is the commonest cause of acute gastroenteritis in infants and young children worldwide. A Quality of Life study was conducted in primary care in three European countries as part of a larger epidemiological study (SPRIK) to investigate the impact of paediatric rotavirus gastroenteritis (RVGE) on affected children and their parents.

Methods

A self-administered questionnaire was linguistically validated in Spanish, Italian and Polish. The questionnaire was included in an observational multicentre prospective study of 302 children aged <5 years presenting to a general practitioner or paediatrician for RVGE at centres in Spain, Italy or Poland. RV infection was confirmed by polymerase chain reaction (PCR) testing (n = 264). The questionnaire was validated and used to assess the emotional impact of paediatric RVGE on the parents.

Results

Questionnaire responses showed that acute RVGE in a child adversely affects the parents’ daily life as well as the child. Parents of children with RVGE experience worry, distress and impact on their daily activities. RVGE of greater clinical severity (assessed by the Vesikari scale) was associated with higher parental worries due to symptoms and greater changes in the child’s behaviour, and a trend to higher impact on parents’ daily activities and higher parental distress, together with a higher score on the symptom severity scale of the questionnaire.

Conclusions

Parents of a child with acute RVGE presenting to primary care experience worry, distress and disruptions to daily life as a result of the child’s illness. Prevention of this disease through prophylactic vaccination will improve the daily lives of parents and children.

Hormone-sensitive lipase protein expression and extent of phosphorylation in subcutaneous and retroperitoneal adipose tissues in the periparturient dairy cow

Lipomobilization is essential for dairy cows to balance the energy requirement for milk production in early lactation. This study aimed to determine the role of hormone-sensitive lipase (HSL) and its activation by phosphorylation at Ser 660 (HSLp660) and 563 (HSLp563) in different adipose tissue depots as influenced by time and postpartum diet in dairy cows. Biopsy samples were obtained from s.c. (SCAT) and retroperitoneal (RPAT) adipose tissues of 20 Holstein cows 21 d prepartum, and 1 and 21 d postpartum. After d 1 postpartum, cows were randomly assigned to 2 groups (n=10). Groups received diets with either a concentrate-to-roughage ratio on a dry matter basis of 30:70% (low-concentrate, LC, group) or 60:40% (high-concentrate group), fed until the third biopsy sampling 21 d postpartum. Dry matter intake, milk yield, and milk composition were recorded. Blood samples were taken weekly, starting 21 d prepartum and analyzed for nonesterified fatty acids, β-hydroxybutyrate (BHBA), glucose, and insulin. Protein expression of HSL and its extent of phosphorylation in adipose tissue were measured by semiquantitative Western blotting. Total HSL expression was lower in both adipose tissues 1 d after calving compared with prepartum sampling (SCAT: 4.10±0.5 vs. 2.4±0.3; RPAT: 11.1±1.3 vs. 6.6±1.1). Phosphorylation at Ser 660 was higher 21 d postpartum compared with 21 d prepartum in RPAT (2.9±0.3 vs. 4.6±0.6). Phosphorylation at Ser 563 was higher 21 d postpartum than 21 d prepartum in SCAT (0.6±0.1 vs. 3.9±1.1), and in RPAT a difference was observed between 21 d prepartum and 1 d postpartum (1.0±0.1 vs. 3.3. ± 0.6). On d 21 postpartum, the LC group showed a lower extent of Ser 563 phosphorylation in RPAT (3.9±0.8 vs.10.0±1.9) and a higher concentration of serum BHBA (0.77±0.05 vs. 0.47±0.11) than did the high-concentrate group. An inhibitory influence of higher BHBA concentrations on HSL phosphorylation in the LC group could be a possible explanation. On comparing RPAT to SCAT, HSL expression and the extent of Ser 660 and 563 phosphorylation was higher in RPAT at 21 d prepartum (HSL: 4.1±0.5 vs. 11.1±1.2; HSLp660 1.3±0.2 vs. 2.9±0.3; HSLp563: 0.6±0.1 vs. 1.0±0.1). In conclusion, the postpartum feeding regimen influenced the phosphorylation pattern, especially in RPAT, implying a regulatory role for different phosphorylation sites in adaptive lipolysis of dairy cows. It is suggested that RPAT is more sensitive to periparturient challenges than is SCAT.

[Physicians' knowledge on cancer pain therapy : Comparison of palliative care and prehospital emergency physicians in training]

BACKGROUND

Palliative care needs a high level of expertise. In particular, there are some potential difficulties in the treatment of patients with the symptom cancer pain (for example lack of education). In Germany, various physicians are involved in cancer pain treatment but in general palliative care patients are treated by a physician who is educated in palliative medicine. In special circumstances prehospital emergency physicians and other physicians are involved in therapy decisions in palliative care patients as well. The authors surveyed different groups of physicians in Germany about their specific knowledge of cancer pain management.

MATERIAL AND METHODS

A self-designed, standardized questionnaire (50 items) was given to palliative physicians in training (PP). The survey asked prospectively for knowledge on the World Health Organization (WHO) step ladder of cancer pain therapy. The results were retrolectively compared with an earlier investigation with the same background (emergency physicians in training EP).

RESULTS

There was a 99.5% response rate with a total of 654 respondents (PP 185, EP 469) and 461 (70.5%) of the respondents had knowledge of the WHO step ladder for the treatment of cancer pain [PP 164/185 (88.6%), EP 297/469 (63.3%), PP versus EP p < 0.001)]. The correct numbers of therapeutic levels were known by 361/461 participants [PP 151/164 (92.1%), EP 210/297 (70.7%), p < 0.001].The EPs with a professional experience less than 5 years answered statistically significantly more questions correctly (p = 0.004). Concerning the defined parameters knowledge and professional experience, there was no statistically significant difference in the group of PP.

CONCLUSIONS

The results of this study verified that the highest knowledge scores were achieved by PPs and overall, the knowledge scores showed an improvement in comparison to previous investigations. In recent years there seems to have been an improvement in education on pain treatment,for example during medical school. Whether this also leads to an improvement of patient care and the relevance of these data for the clinical practice needs to be investigated in further studies.

[Anti-p200 pemphigoid: a spectacular response to dapsone]

BACKGROUND

Types of subepidermal autoimmune bullous dermatosis (AIBD) are classified by anatomoclinical picture and target antigen. A new entity has recently been identified: anti-p200 pemphigoid.

PATIENTS AND METHODS

An 82-year-old man consulted for a profuse pruritic bullous eruption refractory to the standard treatments for bullous pemphigoid (BP). Direct immunofluorescence examination of a skin biopsy revealed linear deposits of IgG and of C3 at the dermal-epidermal junction, but Elisa screening for circulating anti-BP180 and anti-BP230 antibodies was negative. Indirect immunofluorescence (IIF) testing of cleaved skin revealed a deposit of IgG4 antibodies on the dermal side. Immunoblotting was negative for a dermal extract but showed an antibody directed against a 200-kD epidermal antigen. A diagnosis of anti-p200 pemphigoid was eventually made and the patient was successfully treated with dapsone.

DISCUSSION

The diagnosis of anti-p200 pemphigoid was made in this case in spite of discrepancy between the IIF and immunoblotting results, and despite the fact that the target antigen in this disease is considered as being restricted to dermal sites. Anti-p200 pemphigoid usually begins in the second part of life and differs from standard bullous pemphigoid in terms of more frequent mucous membrane and cephalic involvement, as well as a greater degree of miliary scarring. This disease appears more prominent in males and is associated with psoriasis in around one third of cases. Autoantibodies recognize laminin gamma-1, an extra-desmosomal protein that contributes to dermal-epidermal adhesion.

CONCLUSION

This recently described disease as probably under-diagnosed in France. It should be considered in atypical presentations of bullous disease. Diagnosis is confirmed by immunoblotting detection of autoantibodies directed against a 200-kD antigen normally present in the extract. Dapsone appears to be the most effective treatment.

[Preventive crisis management in general outpatient palliative care - prospectively cross-sectional study of General Practitioners in Eastern Bavaria]

BACKGROUND

General out-patient palliative care (GOPC) must be integrated into the care of patients with life-limiting diseases. Aim of the study was to evaluate experiences of general practitioners concerning advance directives and palliative emergency sheets.

METHODS

A self-provided survey was mailed to all general practitioners in Regensburg (cross-sectional study). Main outcome measures included responses regarding a palliative emergency sheet (PES) and a palliative emergency plan (PEP). The investigation period was four months. The analysis was performed using defined criteria (e. g. professional experience concerning palliative care patients, patients treated in nursing homes, patients with dementia).

RESULTS

Sixty-nine questionnaires from 259 were analysed (response rate 27 %). 86 % of respondents named practical experience in the care of palliative patients, 46 % named theoretical knowledge in this field. 41 % and 40 % consider creating an advance directive for their practical work as important/very important (p = 0.004 concerning the treatment of more than five palliative care patients per three months). 52 % and 49 % regard a PES or a PEP to be relevant (PES median: 6.5, SD ± 2.7; PEP median: 6.5 SD ± 2.9; inter-group analysis p < 0.05). 94 % of respondents name the general practitioner to be suitable for creating an advance directive.

CONCLUSION

In Germany, GOPC in end-of-life care is very important. This study shows that advance directives were declared as an important instrument for patients? autonomy. The sense of PES and PEP to ensure patients? autonomy, especially for acute emergency medical palliative care, must be better recognized. However, the increase in acceptance in the GOPC for such instruments must be disclosed. Further studies to investigate this problem are necessary.

Are we giving patients enough information on how to use topical treatments? Analysis of 767 prescriptions in psoriasis

BACKGROUND

Unclear instructions probably contribute to the suboptimal efficacy and adherence to topical agents in psoriasis.

OBJECTIVES

To analyse the quality of prescriptions for topical therapy in psoriasis and to determine factors associated with high-quality prescription writing.

METHODS

We made a systematic analysis of 767 topical prescriptions written by dermatologists and general practitioners (GPs). The following parameters were recorded: writing mode (electronic vs. hand written), indication of formulation, frequency of administration, duration of treatment, indication of areas to be treated, and indication of amount of product to be used. We considered prescriptions of high quality to be those including at least four of the five prospectively defined quality parameters.

RESULTS

Only 35·7% of prescriptions fulfilled the definition of a high-quality prescription. Quality of prescription writing was significantly influenced by two factors: electronic writing [odds ratio (OR) 3·04, 95% confidence interval (CI) 2·2-4·21; P < 10(-4) ] and specialty of the prescriber, dermatologists writing higher quality prescriptions compared with GPs (OR 1·61, 95% CI 1·54-2·14; P < 10(-4) ).

CONCLUSIONS

Almost two-thirds of topical prescriptions are not adequately written and do not include the required information to help patients manage their topical treatment in psoriasis correctly. The quality of topical prescriptions could be improved by making the use of electronic prescriptions widespread and by the development of aids for easy evaluation of the right amount of topical treatment to be applied according to body surface area involved.

Improvement of Rat Islet Viability during Transplantation: Validation of Pharmacological Approach to Induce VEGF Overexpression

Delayed and insufficient revascularization during islet transplantation deprives islets of oxygen and nutrients, resulting in graft failure. Vascular endothelial growth factor (VEGF) could play a critical role in islet revascularization. We aimed to develop pharmacological strategies for VEGF overexpression in pancreatic islets using the iron chelator deferoxamine (DFO), thus avoiding obstacles or safety risks associated with gene therapy. Rat pancreatic islets were infected in vivo using an adenovirus (ADE) encoding human VEGF gene (4.108 pfu/pancreas) or were incubated in the presence of DFO (10 μmol/L). In vitro viability, functionality, and the secretion of VEGF were evaluated in islets 1 and 3 days after treatment. Infected islets or islets incubated with DFO were transplanted into the liver of syngenic diabetic rats and the graft efficiency was estimated in vivo by measuring body weight, glycemia, C-peptide secretion, and animal survival over a period of 2 months. DFO induced transient VEGF overexpression over 3 days, whereas infection with ADE resulted in prolonged VEGF overexpression lasting 14 days; however, this was toxic and decreased islet viability and functionality. The in vivo study showed a decrease in rat deaths after the transplantation of islets treated with DFO or ADE compared with the sham and control group. ADE treatment improved body weight and C-peptide levels. Gene therapy and DFO improved metabolic control in diabetic rats after transplantation, but this effect was limited in the presence of DFO. The pharmacological approach is an interesting strategy for improving graft efficiency during transplantation, but this approach needs to be improved with drugs that are more specific.

[Anesthesiology and palliative medicine. Structured results of a prospective questionnaire-based survey in German hospitals]

BACKGROUND

Anesthesiology departments were often integrated into the primary formation of palliative activities in Germany. The aim of this study was to present the current integration of anesthesiology departments into palliative care activities in Germany.

METHODS

The objective was to determine current activities of anesthesiology departments in in-hospital palliative care. A quantitative study was carried out based on a self-administered structured questionnaire used during telephone interviews.

RESULTS

A total of 168 out of 244 hospitals consented to participate in the study and the response rate was 69%. In-hospital palliative care activities were reported for most of the surveyed hospitals. Only two hospitals in the maximum level of care reported no activities. Participation in these activities by anesthesiology departments was described in up to 92%. Historically, most activities are due to the commitment of individuals, whereas the development of palliative care of cancer pain services and hospital support teams took place in the university hospitals by 2005.

CONCLUSIONS

Until 2005 many university palliative care activities had their origins in cancer pain services. These were often integrated into anesthesiology departments. Currently, anesthesiology departments work as an integrative part of palliative medicine. However, it appears from the present results that there is a domination of internal medicine (especially hematology and oncology) in palliative activities in German hospitals. This allows the focus of palliative activities to be formed by subjective specialist interests. Such a state seems to be reduced by the integration of anesthesiology departments because of their neutrality with respect to faculty-specific medical interests. Advantages or disadvantages of these circumstances are not considered by the present investigation.

Fluorodeoxyglucose positron emission tomography fails to detect distant metastases at initial staging of melanoma patients with metastatic involvement of sentinel lymph node

BACKGROUND

Positron emission tomography (PET) using fluorodeoxyglucose (FDG) has proven to be more sensitive and accurate than other imaging modalities for the detection of distant metastases in patients with melanoma. Sentinel lymph node (SLN) status is the most important prognostic factor in melanoma patients with no evidence of distant metastasis.

OBJECTIVES

To assess the rate of distant metastases in patients with a positive SLN biopsy (SLNB).

METHODS

Forty-six consecutive patients with a positive SLNB underwent PET or PET-computed tomography within 6 weeks of the SLNB procedure. The patients did not present any clinical sign of nodal involvement or of distant metastasis. PET findings were classified as positive, negative or nonconclusive.

RESULTS

No patient had a positive PET scan for distant metastasis. Six patients (13%) had a nonconclusive PET scan; none of them presented distant metastasis within 12 months. Forty patients (87%) had a negative PET scan; among them five (12%) presented with distant metastasis within 12 months.

CONCLUSIONS

Fluorodeoxyglucose positron emission tomography failed to detect distant metastases at initial staging in patients with a positive SLNB, even in patients who presented with distant metastases within 12 months after the FDG PET scan. These results could be explained by the low prevalence of macroscopic metastatic disease at this stage and by the important delay between the onset of the spread of microscopic metastatic disease and the identification by PET scan of macroscopic metastatic disease.

Primary care-based surveillance to estimate the burden of rotavirus gastroenteritis among children aged less than 5 years in six European countries

This observational, prospective study was undertaken to estimate the burden of rotavirus (RV) gastroenteritis (GE) leading to general practitioner (GP)/family paediatrician (FP) visits among children aged <5 years in Czech Republic, Germany, Italy, Poland, Spain and the UK. Children aged <5 years presenting with acute GE provided stool samples for rapid RV testing. RV+ samples were confirmed and typed by RT-PCR. Demographic and clinical data were collected for all RVGE episodes. Transmission patterns among other household children aged <5 years were also assessed. From November 2005 to May 2007, excluding data from the UK, 497/3,813 (13.0%) children aged <5 years presenting with acute GE to GP/FP and tested were RV+ by PCR. Most RVGE cases (69.1%) occurred in children aged <2 years, occurred between December and May (93.1%) and were moderate or severe by Vesikari score (92.9%). RV strain distribution varied between countries: G9P[8] was the most common type in Poland (54/76) and Spain (172/196), G1P[8] was predominant in the Czech Republic (56/64) and Italy (46/107), and G4P[8] and G1P[8] both prevailed in Germany (17/54 and 13/54, respectively). A total of 24/122 (19.7%) children aged <5 years resident in the same household as a PCR+ study participant also developed RVGE. Conclusion. This multinational epidemiological study in Europe shows that RV is easily transmitted among household children, with RVGE burden highest among children aged <2 years accessing primary healthcare for acute GE.

[Breast-feeding training programme as intervention approach at the hospital level: results of evaluation of the first phase of the STELLA study]

BACKGROUND

The health-promoting short- and long-term effects of breast-feeding are supported by a vast scientific literature. The Bavarian prospective cohort study 2005/2006 showed regional variations of breast-feeding rates. Furthermore, improvement in counselling mothers, particularly with regard to prevention and handling of breast-feeding problems, has a great potential for health promotion. The objective of this study is to promote breast-feeding in maternity clinics by improving the surrounding conditions.

STUDY DESIGN

A clinic-based and community-related intervention trial was carried out in Lower Bavaria as a model region with below average breast-feeding rates. (1) INTERVENTION: an advanced training of maternity ward professionals of 10 hospitals and after-care midwives was performed from May until December 2008. The training programme was based on the WHO/UNICEF criteria of the "Ten Steps to Successful Breastfeeding" to deepen the breast-feeding knowledge and to improve the breast-feeding management. (2) EVALUATION: A singular assessment of the advanced training programme was undertaken concerning an increase of knowledge and the practicability in clinical everyday life by participants; improvements of the maternity wards were assessed via structural interviews with maternity ward staff before and after intervention.

RESULTS

Approximately 85% (n=378) of the staff of the 10 maternity clinics attended the training course. The survey after the training programme (response rate 83%) indicated that more than 80% of the participants stated to have learned something new and to be able to use the knowledge acquired for their own practice. Results of the clinic interviews showed a transfer of training contents into clinical work routines. Improvements at interview date were shown best for bonding (all 10 maternity clinics), for additional feeding (8 maternity clinics) as well as for 24-h rooming-in and mother counselling (7 maternal clinics each).

CONCLUSION

Training of maternity ward professionals accounts for baby-friendly conditions in maternity clinics. Most willingness for improvements was shown by maternity ward staff particularly for bonding between mother and child as well as for additional feeding. Considerable differences between the hospitals were observed for the promotion of infant formulas before and after the intervention.

Joint clinical and pathological review meetings improve patient care: a prospective evaluation in dermatology

BACKGROUND

Joint clinical and pathological review meeting exists in most academic dermatology departments.

OBJECTIVE

The primary objective of the study was to assess the impact of the joint clinical and pathological review meeting in dermatology on patient care.

METHODS

Prospective descriptive study over 6 months (May to October 2008) on all clinical cases of dermatology reviewed at the joint clinical and pathological review meeting in our University Hospital.

RESULTS

A total of 139 cases were reviewed during the 6-month period. In 97 cases (69.8%), the joint clinical and pathological review meeting had a positive impact on final diagnosis and/or on patient management. For 27 cases, a consensus diagnosis different from the initial proposal was established. In 21 cases, the joint clinical and pathological review meeting led to additional investigations or therapeutic proposals. The impact of the joint clinical and pathological review meeting was highest for inflammatory skin diseases.

CONCLUSIONS

The joint clinical and pathological review meeting is a useful procedure to improve diagnostic accuracy in difficult cases.

[Psychosocial aspects and body pain: results from an employee survey in the frame of the MAF-project "integrated health management in companies: employee survey about working conditions as management tool"]

INTRODUCTION

The aim of the study is to present a compact employee attitude survey for companies within a health care management tool. Beside body pains work-related psychosocial risk factors as well as further influencing factors, are taken into consideration. The questionnaire was evaluated by 6 Bavarian companies.

METHOD

Potential influencing factors on physical problems like back pain, neck- and shoulder tension, gastro-intestinal diseases and headache were examined by multiple analysis. Dissatisfaction with working conditions was also examined in the same way. All analyses were carried out age and sex adjusted.

RESULTS

Statistical analyses are based on 3,720 employees of 3 companies out of a total of 6 companies who answered the questionnaires. Response rates of the different companies ranged from 34 to 60%. Psychomental demands and psychosocial strains were found to be the strongest predictors for body pains as well as for dissatisfaction with working conditions.

CONCLUSIONS

The introduced questionnaire is easy to implement within the framework of a company health care management. It has an holistic approach. We could demonstrate that this instrument is able to reveal multiple aspects of work-related body pain as well as multiple aspects of dissatisfaction with working conditions. Thus it is a starting point for the development of necessary measures for health promotion.

Surveillance to estimate the burden of rotavirus gastroenteritis in children aged less than 3 years attending day care centers in Paris, France

Between December 2006-May 2007, 371 children aged <3 years attending 15 day care centers (DCCs) in Paris, France were actively followed for acute gastroenteritis [GE; diarrhea (≥3 loose stools/24 hours with or without vomiting) for <14 days] and outbreaks of acute GE (≥3 cases in a DCC with onset within 11 days). Demographic, clinical and cost-related information was collected for all acute GE episodes. All children with acute GE and all participating attendees at affected DCC s during an outbreak (irrespective of symptoms) provided stool samples for rotavirus (RV) testing (RotaStrip™). RV-positive samples were typed by polymerase chain reaction (PCR). Overall incidence of RVGE among DCC attendees <3 years was 46.7 cases/100,000 person-days (95% CI: 26.7, 75.8) and was highest among children aged 5-11 months [139.2 cases/100,000 person-days (95% CI: 60.1, 274.2)]. 16/69 (23.2%) GE episodes were RV-positive by PCR, with 50% of RV-positive episodes occurring in children aged <1 year. G1P[8] was the most common RV type (12/16). Over half of the RVGE episodes that could be evaluated scored severe on the Vesikari scale and most RVGE episodes resulted in parents/guardians accessing health care services. We found 10 children with RVGE to be the likely origin of outbreaks in 3 DCCs, in which 5/10 (50.0%), 6/21 (28.6%) and 7/23 (30.4%) children tested RV-positive. One in 25 DCC attendees exposed to RVGE developed RVGE and 1 in 9 contracted asymptomatic RV infection. RV-positive episodes had higher mean total costs than RV-negative episodes (€484.00 versus €182.80, respectively). Results highlight the ease with which RV can spread in a day care setting and the resulting burden on DCC attendees and their families. The introduction of new RV vaccines into national immunization programs should help prevent similar outbreaks and protect DCC attendees.

Psoriasis: an epidemiological evaluation of disease burden in 590 patients

BACKGROUND

There are limited data available on the economical burden of psoriasis and its impact on everyday life.

OBJECTIVE

The aim of this study was to evaluate the impact of psoriasis on personal and professional life, and to evaluate the cost of psoriasis for the patient.

METHODS

We performed a cross-sectional study in psoriasis patients. All patients aged >or=18 years with a diagnosis of plaque-psoriasis confirmed by a physician were included. A self-administered questionnaire evaluating everyday life was constructed with members of the French association of psoriasis patients. In addition, the Dermatology Life Quality Index (DLQI), Working Productivity and Activity Impairment and individual costs were assessed.

RESULTS

A total of 590 patients completed the study. Mean age of the responders was 56 years. The mean DLQI score was 8.5 for patients with severe psoriasis vs. 6.4 for mild psoriasis. Global loss of productivity was 10.7% without significant difference according to the disease severity. Daily activities alteration was most important in patients with severe psoriasis. In this study, 36.8% of patients with severe psoriasis reported a negative impact on their professional life vs. 19.6% for patients with mild psoriasis (P = 0.002). Time devoted to phototherapy was on average 33 h/year/patient and the application of emollients took 25 h/year/patient; 47.3% of patients had a feeling to clean the house more often, in correlation with the severity of the disease. Mean out-of-pocket expenses for the disease was estimated to be 543 euro/year/patient. High impact of psoriasis on quality of life (DLQI >10), age <40 years and joint involvement were significantly associated with an increased risk of loss of work productivity.

CONCLUSION

Psoriasis, particularly severe psoriasis, is a true burden for patients and impacts significantly everyday life and patient's economical resources.

[Can medical treatment be the first-line treatment for most ectopic pregnancies? A series of 202 patients]

OBJECTIVES

To assess the efficacy and safety of a liberal policy of medical treatment for ectopic pregnancies (EUP).

MATERIAL AND METHODS

Retrospective study of EUP that received active management between January 1999 and December 2003. Patients with rupture or near-rupture and those who refused medical treatment received surgical treatment. Other patients were treated by methotrexate.

RESULTS

Two hundred and two EUP were managed; 26 % were treated surgically, 74 % medically. The success rate of medical treatment was 83 %. A ss-hCG threshold of 2526 IU/l was selected. Under this level, the success rate was 90.7 % compared with 68 % when it was higher (p=0.001). Cardiac activity tripled the failure rate. Morbidity with medical treatment consisted of an augmentation in transaminases in 18.8 % and one case of severe dermatosis (0.7 %). Almost half of the patients treated medically required hospitalizations.

CONCLUSION

The extension of medical treatment in our population to 74 % of all EUP yielded a high success rate, 83 %.

The effect of pinholes of different sizes on visual acuity under different refracting states and ambient lighting conditions*

Purpose: The purpose of this pilot study was to investigate the effect of different size pinholes on visual acuity (VA) at near (0.4 m) while various factors were altered. The alterations made involved accommodation and illumination.Method: Four subjects were selected and their ages ranged from 7 to 14 years. Subjective refractions were performed and then near visual acuities were measured at 0.4 m under two different lighting conditions (460 lux and 1 lux) by adding stigmatic (or spherical) lenses of positive and negative powers in front of pinholes of diameters 1.5 mm and 2 mm.Results: The results showed that there was an improvement in VA in most, however, the size of the pinhole played a minor role. Low illumination did have a drastic effect on our results not only by decreasing the amount of lenses used for near that gave more positive results, but also when the pinhole was placed in front of the subjects. According to Borish, the pinhole does improve VA by a straight forward process of elimination produced by spherical aberrations of the eye. However, this did not seem to be the case in this study under conditions of low illumination.Conclusion: The pinhole effect offers improvement in VA at near by reducing the amount of blupresented to the retina. This study showed that alsubjects had an improvement in VA of at least twolines in high illumination. Pinhole size did not alte the results sufficiently thus suggesting that a pinhole, no matter the size, should increase the VA. However this was not the case when illumination was decreased.

Geoepidemiologic considerations of auto-immune pemphigus

Sporadic and endemic forms of pemphigus foliaceus exist. Incidences of the various forms of pemphigus vary from country to country: pemphigus vulgaris is most common in Europe and the USA, whereas pemphigus foliaceus is more prevalent in Northern Africa, Turkey and Southern America. Endemic pemphigus foliaceus (also known as fogo selvagem and Brazilian pemphigus foliaceus) is a variant of the disease that is frequently diagnosed in some areas of Brazil and other underdeveloped areas of the world, including Tunisia and Colombia. Both genetic and environmental factors have been associated with the occurrence of auto-immune pemphigus and endemic pemphigus is very interesting from this point of view. Most of the patients with auto-immune pemphigus are aged 40-60 years at the onset of the disease. The incidence and prevalence of pemphigus are low. The demonstration of association of pemphigus vulgaris with HLA class II alleles is supported by various studies.

CONSORT adoption and quality of reporting of randomized controlled trials: a systematic analysis in two dermatology journals

BACKGROUND

CONSORT (Consolidated Standards for Reporting Trials) guidelines were constructed to ensure optimal reporting quality of randomized controlled trials (RCTs).

OBJECTIVES

To determine the effect of the adoption of CONSORT on the reporting quality of RCTs, we performed a systematic evaluation of RCTs published in two dermatology journals pre- and post-CONSORT adoption.

METHODS

The journals selected for the study were the Journal of the American Academy of Dermatology and the British Journal of Dermatology. We selected RCTs published in 1997 and 2006 using both Medline and hand searching. The following critical CONSORT criteria were recorded: sample size, type of disease studied, type of control, single-centre or multicentre study, type of funding, blinding, methods and type of randomization, definition of a primary endpoint, justification for sample size selection and power calculation, population for analysis, and adequacy of group comparison. A multivariable analysis was conducted to determine factors associated with optimal reporting quality.

RESULTS

In total, 98 studies were included. Improvement in reporting quality was evident for the specification of the randomization method (20% in 1997 vs. 45% in 2006, P < 0.01) and for the justification of sample size (22% in 1997 vs. 43% in 2006, P = 0.027). The percentage of studies with optimal reporting quality increased from 11% in 1997 to 28% in 2006 (P = 0.03). Factors significantly associated with a good methodological quality were pharmaceutical industry funding and publication in 2006 vs. 1997.

CONCLUSIONS

There is a need to improve the reporting quality of RCTs published in dermatology journals.

Particle and gaseous emissions from compressed natural gas and ultralow sulphur diesel-fuelled buses at four steady engine loads

Exhaust emissions from thirteen compressed natural gas (CNG) and nine ultralow sulphur diesel in-service transport buses were monitored on a chassis dynamometer. Measurements were carried out at idle and at three steady engine loads of 25%, 50% and 100% of maximum power at a fixed speed of 60 km h(-1). Emission factors were estimated for particle mass and number, carbon dioxide and oxides of nitrogen for two types of CNG buses (Scania and MAN, compatible with Euro 2 and 3 emission standards, respectively) and two types of diesel buses (Volvo Pre-Euro/Euro1 and Mercedez OC500 Euro3). All emission factors increased with load. The median particle mass emission factor for the CNG buses was less than 1% of that from the diesel buses at all loads. However, the particle number emission factors did not show a statistically significant difference between buses operating on the two types of fuel. In this paper, for the very first time, particle number emission factors are presented at four steady state engine loads for CNG buses. Median values ranged from the order of 10(12) particles min(-)(1) at idle to 10(15) particles km(-)(1) at full power. Most of the particles observed in the CNG emissions were in the nanoparticle size range and likely to be composed of volatile organic compounds The CO2 emission factors were about 20% to 30% greater for the diesel buses over the CNG buses, while the oxides of nitrogen emission factors did not show any difference due to the large variation between buses.

Hospital-based surveillance to estimate the burden of rotavirus gastroenteritis among European children younger than 5 years of age

OBJECTIVES

Rotavirus is the leading cause of acute gastroenteritis requiring hospitalization in young children. Data on the burden of rotavirus gastroenteritis are needed to guide recommendations for rotavirus vaccine use. This study was undertaken to estimate the burden of rotavirus gastroenteritis in European children <5 years of age.

METHODS

This prospective, study was conducted in 12 hospitals in France, Germany, Italy, Spain, and the United Kingdom. A sample of all children aged <5 years presenting to emergency departments or hospitalized because of community-acquired acute gastroenteritis was enrolled for parental interview and stool collection. Acute gastroenteritis was defined as diarrhea (>/=3 loose stools per 24 hours) for <14 days. Rotavirus was detected by enzyme-linked immunosorbent assay and typed by reverse-transcriptase polymerase chain reaction.

RESULTS

Between February 2005 and August 2006, 3734 children with community-acquired acute gastroenteritis were recruited and retained for analysis (55.9% via the emergency department, 41.8% hospitalized). Of the 2928 community-acquired acute gastroenteritis cases for which stool samples were available, 43.4% were rotavirus-positive by enzyme-linked immunosorbent assay (32.8% emergency department, 56.2% hospitalized). Of these rotavirus gastroenteritis cases 80.9% occurred in children aged <2 years and 15.9% among infants aged <6 months. Acute gastroenteritis was more severe in rotavirus-positive subjects (Vesikari score >/= 11 in 53.3% compared with 31.0% of rotavirus-negative subjects). All 1271 rotavirus-positive strains were genotyped (G1P[8]: 40.3%; G9P[8]: 31.2%; G4P[8]: 13.5%; G3P[8]: 7.1%).

CONCLUSIONS

Rotavirus gastroenteritis places high demands on European health care systems, accounting for 56.2% of hospitalizations and 32.8% of emergency department visits because of community-acquired acute gastroenteritis in children aged <5 years. Most community-acquired rotavirus gastroenteritis occurs in children aged <2 years, and a high proportion occurs in infants aged <6 months. Cases were also observed among very young infants <2 months of age. Rotavirus vaccination is expected to have a major impact in reducing morbidity and the pressure on hospital services in Europe.