Autonomous circadian rhythms in the human hepatocyte regulate hepatic drug metabolism and inflammatory responses

Critical aspects of physiology and cell function exhibit self-sustained ~24-hour variations termed circadian rhythms. In the liver, circadian rhythms play fundamental roles in maintaining organ homeostasis. Here, we established and characterized an in vitro liver experimental system in which primary human hepatocytes display self-sustained oscillations. By generating gene expression profiles of these hepatocytes over time, we demonstrated that their transcriptional state is dynamic across 24 hours and identified a set of cycling genes with functions related to inflammation, drug metabolism, and energy homeostasis. We designed and tested a treatment protocol to minimize atorvastatin- and acetaminophen-induced hepatotoxicity. Last, we documented circadian-dependent induction of pro-inflammatory cytokines when triggered by LPS, IFN-β, or Plasmodium infection in human hepatocytes. Collectively, our findings emphasize that the phase of the circadian cycle has a robust impact on the efficacy and toxicity of drugs, and we provide a test bed to study the timing and magnitude of inflammatory responses over the course of infection in human liver.

[Skin cancer screening in the aging population in Saxony-Anhalt : Utilization, facilitating, and hindering factors]

BACKGROUND

Statutory skin cancer screening (gHKS) can counteract severe courses of various types of skin cancer. The example of malignant melanoma shows that screening is important for older adults in view of the average age of onset of this disease: 62 (women) and 68 years (men). For Saxony-Anhalt (ST), as a state particularly affected by demographic change, little gHKS data are available regarding its usage.

OBJECTIVES

For the study, gHKS participation rates for persons aged 55 and older are presented for ST in comparison to the rest of Germany. Reasons for and barriers to participation from those eligible as well as possible fields of action are shown.

MATERIALS AND METHODS

For the target group, outpatient billing data from the Central Institute for Statutory Health Insurance Physicians in Germany (Zi) on gHKS from 2011-2020 are cross-sectionally and longitudinally analysed. Guideline-based telephone interviews with 18 residents using qualitative content analysis according to Kuckartz serve to identify reasons for and barriers to the use of gHKS.

RESULTS

The gHKS was rarely and irregularly used in ST and other federal states of Germany from 2011-2020; the annual utilisation rate was about 8.0% (national average: 8.4%). Between 2011 and 2020, 50% of eligible people aged 55 years and older did not participate in the gHKS. The highest utilisation rates were among men aged 70-79 years. In addition to district-specific differences, which indicate possible gaps in care, information deficits appear to be the main reason for low participation.

CONCLUSION

The low utilisation of gHKS, partly due to a lack of information among those entitled to it, requires target group-specific information services.

Positive impacts of oral health services provision by a student-led primary care clinic to an Australian rural indigenous community

BACKGROUND

This study aimed to determine whether oral health services provision by a dental student clinical outplacement embedded within a Community Controlled Health Service positively impacted a rural Indigenous community and to explore the nature of these benefits.

METHODS

Aggregated and de-identified 2017, 2018 and 2019 student-led clinic services provision data were retrospectively analysed. The change in services mix over time was measured. Rural outplacement clinic operational costs to the university were estimated. Government-funded local public dental clinic waiting list and services provision data were used to identify any student clinic establishment effect.

RESULTS

The student-led clinic services mix shifted over time from mainly acute care for toothache towards prevention of disease and tooth restoration, indicating an improvement in patient oral health and correspondingly reduced system costs. Imputed value of 2017-2019 student-led clinic services provision totalled almost AUD$1 million. Government public clinic waiting list times decreased after full establishment of the student-led clinic, indicating decreased pressure on the public system.

CONCLUSION

The Community Controlled Health Service and university partnership improved community oral health care access, its timely delivery and simultaneously provided valuable human capital development from the student training experience. The student-led clinic's targeted Indigenous community showed oral health improvement over time. © 2023 Australian Dental Association.

Positive oral health outcomes: A partnership model improves care in a rural Indigenous community

OBJECTIVE

The purpose of this study was to explore the benefits of a partnership between a university dental school and a Community Controlled Health Service, specifically in relation to improving the oral health of an underserved rural Indigenous community. We sought community opinions on health and social outcomes arising from the service provided by the dental student clinical outplacement.

SETTING

In Dalby, Queensland.

PARTICIPANTS

In total, 38 participants in five focus groups were representative of local Indigenous community Elders, community health support group members and management and staff.

DESIGN

A descriptive qualitative study employing semi-structured audio-recorded focus group discussions conducted with purposefully selected Indigenous community groups to explore participant views and experience of the partnership model. Qualitative data were analysed using thematic content analysis.

RESULTS

The Indigenous community representatives expressed positive benefit in both their general and oral health awareness, in improved access to dental care provided in their own safe space, while they were pleased to assist with students' learning. They viewed the partnership as mutually beneficial. Suggestions for enhancement of the oral health service were also offered.

CONCLUSION

This partnership between a university and a Community Controlled Health Service provides sustainable positive social and health benefits for the targeted Indigenous community and for the wider local population, while simultaneously providing enhanced educational benefits for students on clinical outplacement. Translation and uptake of this successful model of care would benefit both underserved communities and dental and other health care professional educators worldwide.

Assisted Reproductive Technology: Gaps in young adults’ perceptions and information from clinics

Background

Around 186 million individuals are facing infertility worldwide, with a huge impact on their wellbeing. Fertility care is considered a key element to promote reproductive health. This study aims to explore young adults’ knowledge, perceptions and concerns about infertility and Assisted Reproductive Technology (ART), and to contrast it with the information provided by ART clinics.

Methods

A multi-country qualitative study was conducted in Albania, Belgium, Slovenia, Spain, Italy, Kosovo, North Macedonia and Switzerland within the H2020 B2-INF project (Grant Agreement 872706). In 2021, 10-15 semi-structured interviews were conducted in each country with participants aged 18-30, childless and non-ART users. Additionally, 3-5 clinics’ websites in each country were explored. Data was collected in native languages and translated into English. A thematic analysis was carried out.

Results

In total, 98 interviews were conducted and 38 clinics’ websites were explored. Three themes emerged from the analysis of the interviews: 1. Parenthood and (in)fertility; 2. Young people's perception on ART; 3. Information and publicity of ART. Parenthood was described as a relationship beyond biological ties and infertility as a social taboo. Most participants perceived ART positively and would use it if needed, although knowledge on ART was low. Participants considered information on ART as scarce and suggested that government-led information campaigns should be launched to raise awareness on it. Concerning clinics, the websites provided information on infertility and exhaustive technical descriptions of ART techniques, although it may be difficult for the general population to understand. Data offered on success rates were unclear and heterogeneous.

Conclusions

Gaps in citizens’ expectations and needs and the information provided by ART clinics were identified. Awareness campaigns are needed to diminish social taboo on infertility and ART and to promote reproductive health.

Key messages

• Assisted Reproductive Technology is positively perceived by young adults, though their knowledge of it and infertility is low. Information campaigns are thus needed to raise awareness among the young.

• ART clinics have room for improvement in aligning the information provided on their websites with young people's perceptions and needs, and to show it in a more accessible and understandable way.

O-201 B2-INF: Giving voice to citizens towards improving assisted reproduction technologies for society. Gaps between young people’s perceptions and the information offered by ART providers

Study question

Are the young citizens’ perceptions and expectations on Assisted Reproduction Technologies (ART) aligned with the information that ART clinics offer to citizens?

Summary answer

There is a gap between young citizen’s perceptions and expectations and the information offered by ART providers taking into account gender, sociocultural, and legal perspectives.

What is known already

Studies investigating young people’s opinions, concerns, and expectations in relation to ART are scarce. Some studies have highlighted that young adults reported low general knowledge about ART and overestimated its success rates. In addition, gaps in knowledge about fertility and the potential of ART have been described among this population. To our knowledge, there are no studies that compare young people’s perceptions with the information offered by ART providers.

Study design, size, duration

B2-Inf is funded by the European Union’s Horizon 2020 research and innovation programme (Grant Agreement No 872706), to be executed in 36 months. B2-InF contrasts ART perceptions of young population from 8 countries (Spain, Belgium, Italy, Switzerland, Kosovo, Albania, Macedonia, Slovenia) with the information provided by ART clinics to society in the same countries. To reach this objective, a descriptive multicentre qualitative study was designed through semi-structured interviews and documentary data collection from ART clinics

Participants/materials, setting, methods

From March to December 2021, 10-15 semi-structured interviews were conducted in each country. Participants were men and women aged 18 to 30 years old, childless and non-ART users. Additionally, 3-5 clinics’ websites from each country were planned to be explored and clinics’ ‘physical information’, such as consent forms, were requested. All the information was collected and transcribed verbatim in the native language and afterwards translated into English. A thematic analysis was conducted using Atlas.ti V9.

Main results and the role of chance

In total, 98 interviews were conducted: 15 in Spain, 14 in Belgium, 13 in Italy, 10 in Switzerland, 15 in Kosovo, 11 in Albania, 10 in North Macedonia and 10 in Slovenia; and 33 clinics were explored: 5 in Spain, 5 in Belgium, 5 in Italy, 5 in Switzerland, 5 in Kosovo, 5 in Albania, 5 in North Macedonia and 3 in Slovenia.

The themes that emerged in the analysis of interviews were: 1. Social perceptions of parenthood and fertility; 2. Young people’s perceptions on ART; 3. Information and publicity of ART. Participants described parenthood as a relationship beyond biological ties and identified infertility as a social taboo. Young’s perceptions on ART techniques were positive and most would use it in case of need, but the knowledge related to ART was limited. Most participants suggested that trustworthy national information campaigns led by Governments should be implemented to raise awareness of ART.

Regarding clinics, information on websites addressed risk factors and prevalence of infertility. It included description of ART techniques with unclear data about success rates, economic information and clinics human resources and facilities. Gaps were identified between citizens’ expectations and needs and the online information provided by ART clinics.

Limitations, reasons for caution

This is a first thematic analysis that provides an overview of the possible gaps between young citizen’s expectations and the information provided by ART clinics. In next steps of B2-InF project, an in-depth qualitative analysis will be conducted considering gender, sociocultural, and legal perspectives.

Wider implications of the findings

This is the first systematic multinational study that compare young people’s perceptions about ART and information provided by ART clinics. Although this is a preliminary analysis, the results will be used to develop national guidelines to inform policies on ART services with potential impact on European citizens and ART providers.

Trial registration number

European Union’s Horizon 2020 Research and Innovation Programme (Grant Agreement No 872706)

A single-cell liver atlas of Plasmodium vivax infection

Malaria-causing Plasmodium vivax parasites can linger in the human liver for weeks to years and reactivate to cause recurrent blood-stage infection. Although they are an important target for malaria eradication, little is known about the molecular features of replicative and non-replicative intracellular liver-stage parasites and their host cell dependence. Here, we leverage a bioengineered human microliver platform to culture patient-derived P. vivax parasites for transcriptional profiling. Coupling enrichment strategies with bulk and single-cell analyses, we capture both parasite and host transcripts in individual hepatocytes throughout the course of infection. We define host- and state-dependent transcriptional signatures and identify unappreciated populations of replicative and non-replicative parasites that share features with sexual transmissive forms. We find that infection suppresses the transcription of key hepatocyte function genes and elicits an anti-parasite innate immune response. Our work provides a foundation for understanding host-parasite interactions and reveals insights into the biology of P. vivax dormancy and transmission.

The effects of farming systems (organic vs. conventional) on dairy cow welfare, based on the Welfare Quality® protocol

Animal welfare in livestock production is of great interest to consumers. The organic farming approach strives to ensure animal welfare based on preventive measures, but there are very few scientific studies that compare the actual differences in animal welfare between organic and conventional farms. Those studies that have been carried out frequently focus on specific aspects of animal welfare, mostly health issues. The aim of the present study, therefore, was to investigate the effects of the farming system on the welfare of dairy cows in a more holistic way. Although this study was carried out in just two federal states of Germany, the results could serve as a suitable model for the whole country. We used the Welfare Quality assessment protocol to measure welfare for dairy cattle (Welfare Quality®, 2009) and the results showed significant differences (P < 0.05) between organic and conventional farms, but there was also considerable variance between individual farms of the same farming system. Organic farms scored higher in all four Welfare Quality® principles: "Good Feeding", "Good Housing", "Good Health" and "Appropriate Behavior" compared to conventional farms. In particular, organic farms obtained higher scores with respect to Welfare Quality® measures of resting comfort, which contributes to a lower percentage of lameness; organic farms also implemented less painful methods for disbudding, or indeed carried out no disbudding, and provided access to pasture and outdoor exercise. However, organic farms still have room for improvement, especially with respect to animal health. Therefore, outcome-based specifications should be included in the current (purely action-oriented) European regulation of organic production (EC, 2008; EU, 2018) to safeguard the health-related aspects of animal welfare.

Mapping functional humoral correlates of protection against malaria challenge following RTS,S/AS01 vaccination

Vaccine development has the potential to be accelerated by coupling tools such as systems immunology analyses and controlled human infection models to define the protective efficacy of prospective immunogens without expensive and slow phase 2b/3 vaccine studies. Among human challenge models, controlled human malaria infection trials have long been used to evaluate candidate vaccines, and RTS,S/AS01 is the most advanced malaria vaccine candidate, reproducibly demonstrating 40 to 80% protection in human challenge studies in malaria-naïve individuals. Although antibodies are critical for protection after RTS,S/AS01 vaccination, antibody concentrations are inconsistently associated with protection across studies, and the precise mechanism(s) by which vaccine-induced antibodies provide protection remains enigmatic. Using a comprehensive systems serological profiling platform, the humoral correlates of protection against malaria were identified and validated across multiple challenge studies. Rather than antibody concentration, qualitative functional humoral features robustly predicted protection from infection across vaccine regimens. Despite the functional diversity of vaccine-induced immune responses across additional RTS,S/AS01 vaccine studies, the same antibody features, antibody-mediated phagocytosis and engagement of Fc gamma receptor 3A (FCGR3A), were able to predict protection across two additional human challenge studies. Functional validation using monoclonal antibodies confirmed the protective role of Fc-mediated antibody functions in restricting parasite infection both in vitro and in vivo, suggesting that these correlates may mechanistically contribute to parasite restriction and can be used to guide the rational design of an improved vaccine against malaria.

Antimalarial activity of primaquine operates via a two-step biochemical relay

Primaquine (PQ) is an essential antimalarial drug but despite being developed over 70 years ago, its mode of action is unclear. Here, we demonstrate that hydroxylated-PQ metabolites (OH-PQm) are responsible for efficacy against liver and sexual transmission stages of Plasmodium falciparum. The antimalarial activity of PQ against liver stages depends on host CYP2D6 status, whilst OH-PQm display direct, CYP2D6-independent, activity. PQ requires hepatic metabolism to exert activity against gametocyte stages. OH-PQm exert modest antimalarial efficacy against parasite gametocytes; however, potency is enhanced ca.1000 fold in the presence of cytochrome P450 NADPH:oxidoreductase (CPR) from the liver and bone marrow. Enhancement of OH-PQm efficacy is due to the direct reduction of quinoneimine metabolites by CPR with the concomitant and excessive generation of H₂O₂, leading to parasite killing. This detailed understanding of the mechanism paves the way to rationally re-designed 8-aminoquinolines with improved pharmacological profiles.

Primaquine (PQ) is a widely used anti-malaria drug, but its mechanism of action is unclear. Here, Camarda et al. show that PQ’s activity against liver and sexual Plasmodium stages depends on generation of hydroxylated-PQ metabolites (OH-PQm), which, undergoing further reactions, results in production of H₂O₂.

Steroid Hormone Function Controls Non-competitive Plasmodium Development in Anopheles

Transmission of malaria parasites occurs when a female Anopheles mosquito feeds on an infected host to acquire nutrients for egg development. How parasites are affected by oogenetic processes, principally orchestrated by the steroid hormone 20-hydroxyecdysone (20E), remains largely unknown. Here we show that Plasmodium falciparum development is intimately but not competitively linked to processes shaping Anopheles gambiae reproduction. We unveil a 20E-mediated positive correlation between egg and oocyst numbers; impairing oogenesis by multiple 20E manipulations decreases parasite intensities. These manipulations, however, accelerate Plasmodium growth rates, allowing sporozoites to become infectious sooner. Parasites exploit mosquito lipids for faster growth, but they do so without further affecting egg development. These results suggest that P. falciparum has adopted a non-competitive evolutionary strategy of resource exploitation to optimize transmission while minimizing fitness costs to its mosquito vector. Our findings have profound implications for currently proposed control strategies aimed at suppressing mosquito populations.

Emergency contraception and risk habits in a university population

OBJECTIVE

The aim of our study was to determine the self-reported prevalence of use of emergency contraception (EC), identify factors associated with EC use, and measure the prevalence in university students of pregnancy and abortion among users and non-users of EC.

METHODS

A cross-sectional descriptive study of university students using a self-administered questionnaire was carried out in 2016. The main dependent variable was EC use at any time. Independent variables included sociodemographic factors and factors related to harmful habits and sexual behaviour.

RESULTS

The study sample consisted of 1309 students (median age 20 years). Forty per cent of participants reported using EC; condom failure was given as the main reason. Variables associated with EC use in both men and women were illegal drug consumption and having had more than 10 sexual partners. In women, other factors associated with EC use were age at first coitus and non-centrist political views. The prevalence of pregnancy was 6.5% and the prevalence of voluntary abortion was 2.9%. This prevalence was similar for men and women and for EC users and non-users.

CONCLUSION

EC use in university students was more likely in those who experienced contraceptive failure or used no contraception. There were differences between men and women. Those at higher risk of unplanned pregnancy were more likely to report EC use, which may explain why there was no difference in the rates of unwanted pregnancies between EC users and non-users.

Geographical Variations in the Clinical Management of Colorectal Cancer in Australia: A Systematic Review

Background: Colorectal cancer (CRC) presents considerable health, economic, and societal burden, and Australia has one of the highest incidence rates of this disease. Over a third of the Australian population live in nonmetropolitan areas and research has shown that they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. One of the main contributors of poorer CRC outcomes in rural Australia may be limited access to treatment facilities and optimal care; however, the extent to which geographical disparities exist in CRC management has not been systematically explored. Aim: To understand the nature of geographical variations in the clinical management and treatment of CRC (including surgery, chemotherapy, and radiotherapy) in Australia, incorporating clinical reports as well as peer-reviewed literature. Methods: A systematic review of published and gray literature was conducted. Five databases (CINAHL, PubMed, Embase, ProQuest, and Informit) were searched for articles published in English from 1990 to 2018. Studies were included if they assessed differences in clinical management according to geographical location; focused on CRC patients; and were conducted in Australia. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. PRISMA systematic review reporting methods were applied. Results: Only 17 articles met inclusion criteria. All were of high (53%) or moderate (47%) quality. The evidence available may suggest that patients in nonmetropolitan areas are more likely to experience delays in surgery and are less likely to receive chemotherapy for stage III colon cancer and adjuvant radiotherapy for rectal cancer. Conclusion: The present review found limited information on clinical management across geographic regions in Australia and the synthesis highlights significant issues both for data collection and reporting at the population level. Where geographical disparities exist, these may be due to a combination of patient and system factors reflective of location. Population-level data regarding clinical management and treatment of CRC needs to be routinely collected to better understand geographical variations and inform future guidelines and policy.

Challenges and Opportunities for Cancer Care in Regional Australia: The Health Professional´s Perspective

Background: Cancer specialists working in rural and regional Australia may experience unique difficulties when compared with their metropolitan counterparts, as they often have higher workloads, spend longer hours in clinical practice, and experience professional and social isolation. Previous research has identified accessibility and distance from services, a shortage of workforce, limited availability of specialists and allied health providers, suboptimal chemotherapy administration, and reduced availability of radiotherapy services as predictors of poorer outcomes in regional areas. Yet to date, limited research has focused on the perspective of the regional healthcare professionals. Aim: This study aimed to identify the factors which health professionals believe influence clinical care and outcomes for people with cancer in regional areas of Australia, to confirm existing barriers and identify any new insights specific to the health professional perspective. Methods: Semistructured interviews were conducted with regional oncology health professionals of varying backgrounds. Interview questions explored health professional´s perspectives on barriers to cancer care for patients, factors which influence clinical care, and access to support in regional areas. Data were interpreted using an inductive thematic analysis approach. Results: Two global themes were identified: rural culture and the health system. Within these global themes, health professionals discussed barriers to cancer care in regional areas, predominantly associated with travel, limited workforce, and poor communication within the health system. Participants also noted many positive aspects of cancer care in regional areas, including more personalised care for the patients and faster career progression for professionals. Conclusion: Despite recent innovations aimed at improving rural cancer care, including innovative models of care and increased infrastructure, regional health professionals still perceive many barriers to cancer care in regional Australia. These are predominantly associated with patient demographics, travel difficulties, and inadequate governance. However, there are also many notable benefits to receiving care in regional areas which have been absent from previous literature. These positive factors should be incorporated in efforts to enhance regional cancer care through the recruitment of health professionals to regional areas and development of regional community support networks. An understanding of the experiences of health professionals working in oncology settings in regional areas is a key step toward improving care and providing recommendations to health services and policymakers, particularly regarding recruitment and retention.

Geographic Variation in Compliance With FOBT Colorectal Cancer Screening Programs: The Role of Attitudes Toward Health and Help Seeking

Background: Utilization of health services is thought to vary between urban and nonurban residents. In Australia, colorectal cancer (CRC) patients in peri-urban and rural areas tend to be diagnosed at a more advanced stage than their urban counterparts and have poorer 5 year survival rates. Aim: In this study, we investigate the effect that attitudes toward health and health related help-seeking have on compliance with population CRC screening programs and whether this varied among varied locations. We also examined the rate of recipients complying with overall program guidelines as opposed to the commonly reported participation rates in mail-out screening programs. Methods: A cross-section of recipients (n=371) who reported receiving a mail-out fecal occult blood test (FOBT) as part of the National Bowel Cancer Screening Program (NBCSP) in Australia were surveyed in 2017 regarding compliance. Attitudinal constructs including fatalism, stoicism and consideration of future consequences known to impact health-related help seeking were also measured. Logistic regression models were tested to assess the attitudinal predictors of program compliance in urban, peri-urban and rural groups. Results: Program participation (% returning kits) was relatively even across geographical locations, however, compliance with overall screening guidelines (returning kit or engaging in suitable alternative) was significantly lower in peri-urban, compared with urban, areas. Higher levels of stoicism and lower levels of consideration for future consequences were associated with lower NBCSP compliance in rural and peri-urban, but not urban areas. Fatalism was not associated with NBCSP compliance. Conclusion: Attempts to increase compliance with mail-out CRC screening program guidelines need to consider the use of appropriately tailored interventions that reflect the different ways in which socio-cultural and psychological factors impact cancer screening practices in geographically diverse communities. Interventions to enhance compliance in nonurban areas should promote the consideration of one's future, and discourage stoic attitudes to health.

Strategies for Increasing Participation in Mail-out Colorectal Cancer Screening Programs. A Systematic Review and Meta-Analysis

Background: Population mail-out bowel screening programs are a convenient, cost-effective and sensitive method of detecting colorectal cancer (CRC). Despite increased survival rates associated with early detection of CRC, in many countries 50% or more of eligible individuals do not participate in such programs, resulting in a substantial amount of cancers progressing undetected and wasted public health resources. Aim: The current study aimed to systematically review all of the interventions that have been applied internationally to increase fecal occult blood test (FOBT) kit return, specifically in population mail-out programs, to make recommendations to policy makers and program organizers as to the most effective methods of increasing uptake. Method: Six electronic databases (PubMed, PsycINFO, Scopus, InformIT, CINAHL, and ProQuest Dissertations and Theses) were searched for articles published in English before 10th of March 2018. Studies were included if they reported the results of an intervention designed to increase the return of FOBT kits that had been mailed to individuals' homes. Results: PRISMA systematic review reporting methods were applied and each study was assessed using Cochrane's risk of bias tool. The quality of evidence was assessed using GRADE guidelines. The review identified 53 interventions from 30 published studies. Nine distinct intervention strategy types were identified and pooled risk ratios and confidence intervals were estimated for each intervention type. Four key effective intervention strategies were identified including telephone contact, GP endorsement, simplified test procedures, and advance notification with small to moderate effect sizes. Conclusions: Interventions that combine program-level changes incorporating the issue of advance notification and alternative screening tools with the involvement of primary health professionals through endorsement letters and telephone contact should lead to increases in kit return in mail-out CRC screening programs. Future research should examine the benefit of combining intervention strategies and tailoring to specific populations.

Discourses on the postcoital pill in young women

BACKGROUND

Emergency contraception (EC) is an effective postcoital contraceptive method for reducing the risk of unwanted pregnancy after unprotected intercourse. The estimated effectiveness of EC is between 70 and 89% if taken within 72 h following intercourse. Most of the studies carried out in Spain are quantitative and from the perspective of health professionals. In this study, we intend to explore the knowledge of, attitudes towards and discourse regarding the use of EC in women aged 15 to 25 years.

METHODS

Sample: A qualitative study including in-depth interviews with 19 women between 15 and 25 years of age was performed.

INCLUSION CRITERIA

Participants were natives of Spain or of a Latin American country. Segmentation criteria: Participants had experience in the use of EC.

DATA COLLECTION

Participants were selected by health care informants and by the snowball technique among university students.

DATA ANALYSIS

A thematic analysis was performed. Preliminary analyses were made during the course of the field work to adapt the script and to assess data saturation. A preliminary code tree was developed by two researchers, and the coding of the text was done with the Atlas.ti 5.0 software.

RESULTS

EC is perceived positively by women. They do not express issues with taking it, although some feel guilty. The reason for taking EC is to avoid unwanted pregnancy and abortion. Women also feel that EC should be used in moderation. False beliefs and misconceptions regarding EC are held: EC delivers an excess of hormones, induces abortion and causes severe side effects. Women mention that the health professionals who provide EC have moral beliefs. Women use it because of condom breakage associated with their first coital relations.

CONCLUSIONS

The results of this study have public health implications: The sexual-affective health education received by young people should incorporate clear information about the mechanism of action of the EC pill and its side effects together with empowerment strategies addressing guilt and moralistic messages. Programmes and training activities for health professionals must be designed to prevent the communication of inappropriate messages such as those that exaggerate the side effects of EC and those that promote fear and guilt, because they represent a barrier to the responsible use of this medication.

Gastric Emptying Procedures in the Self-Poisoned Patient: Are we Forcing Gastric Content beyond the Pylorus?

A prospective, randomized, single-blind study was carried out to determine whether gastric content is forced into the small bowel when gastric-emptying procedures are employed in self-poisoned patients. They were asked to swallow barium-impregnated polythene pellets, immediately prior to either gastric lavage or ipecacuanha-induced emesis. A second group of patients, who did not require treatment, were used as controls. Sixty patients were recruited to the study. The data show a significant difference in the number of residual pellets in the small bowel of the treated group (n=40), when compared with the control group (P < 0.0001). There was no statistical difference in the number of pellets in the small bowel when the treated groups were compared with each other. In addition, the inefficiency of gastric-emptying procedures is highlighted; 58.5% of the total number of pellets ingested were retained in the gastrointestinal tract of the ipecacuanha-treated group, while 51.8% of total pellets ingested were retained in the gastric lavage-treated group.

In Vitro Culture, Drug Sensitivity, and Transcriptome of Plasmodium Vivax Hypnozoites

The unique relapsing nature of Plasmodium vivax infection is a major barrier to malaria eradication. Upon infection, dormant liver-stage forms, hypnozoites, linger for weeks to months and then relapse to cause recurrent blood-stage infection. Very little is known about hypnozoite biology; definitive biomarkers are lacking and in vitro platforms that support phenotypic studies are needed. Here, we recapitulate the entire liver stage of P. vivax in vitro, using a multiwell format that incorporates micropatterned primary human hepatocyte co-cultures (MPCCs). MPCCs feature key aspects of P. vivax biology, including establishment of persistent small forms and growing schizonts, merosome release, and subsequent infection of reticulocytes. We find that the small forms exhibit previously described hallmarks of hypnozoites, and we pilot MPCCs as a tool for testing candidate anti-hypnozoite drugs. Finally, we employ a hybrid capture strategy and RNA sequencing to describe the hypnozoite transcriptome and gain insight into its biology.

Linking primary study data with administrative and claims data in a German cohort study on work, age, health and work participation: is there a consent bias?

OBJECTIVES

We analysed the degree and impact of consent bias in the prospective study 'leben in der Arbeit (lidA)' after linking primary interview data with claims data from German statutory health insurance funds as well as with administrative data provided by the German Federal Employment Agency.

STUDY DESIGN

Prospective cohort study.

METHODS

Within two study waves (2011, 2014) primary data were collected based on computer-assisted personal interviews. During interview informed consent to data linkage was obtained. We used binary logistic regression analyses with participants' consent for record linkage as the dependent variable calculating odds ratios (ORs) and 95% confidence intervals (95% CIs) for independent variables. Several sociodemographic, socio-economic and work-related factors were modelled as potential determinants of consent.

RESULTS

A total of 4244 participants took part in both waves. After excluding invalid consent, 4178 participants were included in the analysis. About 3918 (93.8%) of these participants gave their consent to link their primary data with data from at least one source. Within regression analyses only moderate bias was found due to region of residence, apprenticeship, professional affiliations, income and number of diseases. Participants from former West Germany were less likely to have their study data linked with both data sources (OR 0.63 [95% CI 0.42-0.96]) than those from the former East Germany. Participants with no information on income were more likely to refuse consent to both data sources compared to the reference group (net income: under EUR 1000; OR 0.15 [95% CI 0.08-0.30]). Respondents with two (OR 1.37 [95% CI 1.06-1.77]) or three and more diseases (OR 1.30 [95% CI 1.02-1.66]) diagnosed by a doctor agreed more frequently to linking both data sources than participants without disease. There is just a small proportion of variance in consenting explained by the models (R²: 0.063-0.085). Also, only small changes of factors' prevalence were observed in consenters.

CONCLUSIONS

For the first time in Germany, the lidA-study links primary survey data with health claims and administrative employment data. We conclude that there is only a minor relation between the analysed factors and consent behaviour of the participants. A linked data set may be used in further analyses without substantial biases.