Association between cognitive performance and self-reported glaucoma in middle-aged and older adults: a cross-sectional analysis of ELSA-Brasil

Recent evidence suggests that glaucoma and Alzheimer's disease are neurodegenerative diseases sharing common pathophysiological and etiological features, although findings are inconclusive. We sought to investigate whether self-reported glaucoma patients without dementia present poorer cognitive performance, an issue that has been less investigated. We employed cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and included participants ≥50 years of age without a known diagnosis of dementia and a self-reported glaucoma diagnosis. We excluded those with previous stroke, other eye conditions, and using drugs that could impair cognition. We evaluated cognition using delayed word recall, phonemic verbal fluency, and trail making (version B) tests. We used multinomial linear regression models to investigate associations between self-reported glaucoma with cognition, adjusted by several sociodemographic and clinical variables. Out of 4,331 participants, 139 reported glaucoma. Fully-adjusted models showed that self-reported glaucoma patients presented poorer performance in the verbal fluency test (β=-0.39, 95%CI=-0.64 to -0.14, P=0.002), but not in the other cognitive assessments. Thus, our results support the hypothesis that self-reported glaucoma is associated with poor cognitive performance; however, longitudinal data are necessary to corroborate our findings.

Independent or simultaneous lowering of core and skin temperature has no impact on self-paced intermittent running performance in hot conditions

Purpose

To investigate the effects of lowering core (T_gi) and mean skin temperature (T_sk) concomitantly and independently on self-paced intermittent running in the heat.

Methods

10 males (30.5 ± 5.8 years, 73.2 ± 14.5 kg, 176.9 ± 8.0 cm, 56.2 ± 6.6 ml/kg/min) completed four randomised 46-min self-paced intermittent protocols on a non-motorised treadmill in 34.4 ± 1.4 °C, 36.3 ± 4.6% relative humidity. 30-min prior to exercise, participants were cooled via either ice slurry ingestion (INT); a cooling garment (EXT); mixed-cooling (ice slurry and cooling garment concurrently) (MIX); or no-cooling (CON).

Results

At the end of pre-cooling and the start of exercise T_gi were lower during MIX (36.11 ± 1.3 °C) compared to CON (37.6 ± 0.5 °C) and EXT (36.9 ± 0.5 °C, p < 0.05). Throughout pre-cooling T_sk and thermal sensation were lower in MIX compared to CON and INT, but not EXT (p < 0.05). The reductions in thermophysiological responses diminished within 10–20 min of exercise. Despite lowering T_gi, T_sk, body temperature (T_b), and thermal sensation prior to exercise, the distances covered were similar (CON: 6.69 ± 1.08 km, INT: 6.96 ± 0.81 km, EXT: 6.76 ± 0.65 km, MIX 6.87 ± 0.70 km) (p > 0.05). Peak sprint speeds were also similar between conditions (CON: 25.6 ± 4.48 km/h, INT: 25.4 ± 3.6 km/h, EXT: 26.0 ± 4.94 km/h, MIX: 25.6 ± 3.58 km/h) (p > 0.05). Blood lactate, heart rate and RPE were similar between conditions (p > 0.05).

Conclusion

Lowering T_gi and T_sk prior to self-paced intermittent exercise did not improve sprint, or submaximal running performance.

Electronic supplementary material

The online version of this article (10.1007/s00421-019-04173-y) contains supplementary material, which is available to authorized users.

Re-appraising HIV Testing among Scottish Gay Men: The Impact of New HIV Treatments

This paper explores Scottish gay men's understandings of HIV testing within the context of changes stemming from the availability of new treatments for HIV. Transcripts of one-toone interviews with 18 gay men were analysed together with those from four focus groups (n= 19) concerning HIV testing, HIV status and HIV risk management. Interpretative Phenomenological Analysis was employed to identify recurrent themes. We focus upon a rise of HIV-optimism, risk-complacency and HIV fatigue and chart the apparent transformation of HIV diagnosis from 'death sentence' to 'life sentence'. In turn, we explore how these changes have impacted upon HIV testing. As HIV management becomes increasingly medicalized, we highlight the ongoing need to attend to psychological and social issues.

Subcostal transversus abdominis plane block for postoperative analgesia in liver transplant recipients

BACKGROUND

Postoperative pain treatment in orthotopic liver transplant (OLT) patients is a challenge. We performed a pilot study on ultrasound-guided transversus abdominis plane (TAP) block in OLT patients. To test the efficacy of this technique, which is noveI to OLT patients, we compared morphine consumption, pain scores, and time to extubation with a matching control group.

METHODS

Seventeen patients who underwent OLT underwent bilateral ultrasound-guided TAP block using a subcostal approach with levobupivacaine (0.5%; 20 mL each) followed by postoperative morphine patient-controlled analgesia (PCA). The control group of 17 patients had only morphine PCA. We recorded the total morphine consumption, postoperative pain, and time to extubation.

RESULTS

The total amount of morphine consumption over 24 hours was 45.9 ± 33.9 mg in the TAP group and 71.8 ± 39.9 mg in the control group (P < .005). Median pain scores were 1 in the TAP group and 2 in the control group (not significant [NS]). Median time to extubation was 60 minutes in the TAP group and 97 minutes in the control group (P = NS).

CONCLUSION

Initial evaluation of subcostal TAP block after OLT showed significant reduction in postoperative morphine consumption.

Comparison of the GMFM-66 and the PEDI Functional Skills Mobility domain in a group of Chinese children with cerebral palsy

BACKGROUND

Previous research has suggested there is a high level of comparability between the Gross Motor Function Measure-66 (GMFM-66) and the Pediatric Evaluation of Disability Inventory (PEDI) Functional Skills Mobility domain. However, there are only a few studies that have examined the correlations between these instruments. The purpose of this study was to determine the correlation between the GMFM-66 and the PEDI Functional Skills Mobility domain scaled scores in a group of Chinese children with spastic cerebral palsy, at the ages of 12-70 months, in order to explore the feasibility of using them interchangeably.

METHODS

Secondary data analysis was conducted of data collected during a prospective international collaborative study that used the GMFM-66 and the PEDI to examine the impact of treatment. This study examined the Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain at six time points over the course of 28 consecutive weeks for 115 Chinese children who participated at baseline.

RESULTS

Pearson correlations between the GMFM-66 and the PEDI Functional Skills Mobility domain ranged from 0.83 to 0.90 for the six time points of data collection, with statistically significant P-values <0.0001 for each correlation.

CONCLUSIONS

These results support previous research that the GMFM-66 and the PEDI Functional Skills Mobility domain are complementary assessments that may be used interchangeably when it is not possible to administer both.

Choice for periodic schedules of reinforcement

Pigeons' responses in the presence of two concurrently available (initial-link) stimuli produced one of two different (terminal-link) stimuli according to identical but independent variable-interval schedules. Responding in the mutually exclusive terminal links was reinforced with food according to fixed-ratio schedules for six pigeons and according to fixed-interval schedules for two pigeons. None of the pigeons matched the proportion of (choice) responses in the initial links to the proportion of the rates of reinforcement obtained during the terminal links. Instead, as the values of each of the terminal-link schedules were increased by a constant amount, the choice proportions for the stimulus associated with the smaller of the two values increased, even though the relative rates of reinforcement during the terminal links decreased. These results are incompatible with those from previous studies with aperiodic (variable-interval or variable-ratio) schedules. The present results do suggest, however, that in transforming aperiodic schedules into their periodic equivalents, it may be necessary to consider the size of the smallest interreinforcement interval comprising the terminal-link schedules.

Some effects of interreinforcement time upon choice

Pigeons' responses were reinforced on two identical and concurrently available chain variable-interval-schedules. Unlike the typical concurrent chains procedure, both links were operative throughout, thus producing three types of concurrency: (1) concurrent initial links; (2) concurrent initial and terminal links; (3) concurrent terminal links. Choice proportions in each of these three states suggested that the pigeons were sensitive to momentary likelihoods of reinforcement: choice proportions for a schedule were higher when the schedule had been operative for some time, resulting in a higher probability of reinforcement. The study also showed that the relative rates of responding did not match the relative rates of reinforcement in any of the three states of concurrency. Instead, the choice proportions in both the concurrent initial and in the concurrent terminal links were intermediate between the scheduled and the obtained relative rates of reinforcement, while the choice proportions for a terminal link concurrent with an initial link consistently overmatched the relative interreinforcement times (and were typically 1.00). These data indicate that an accurate characterization of choice may not be obtained by considering only the relative interreinforcement interval where one interreinforcement interval is segmented into a chain. Instead, the organism's choice for a schedule will be substantially lowered by the chaining operation.

The psychological distance to reward

Pigeons' responses in the presence of two concurrently available (initial-link) stimuli produced entry into one of two different and mutually exclusive terminal link stimuli according to identical but independent variable-interval schedules. In one experiment, a two-component chained fixed-interval schedule produced food in one terminal link while a simple fixed-interval schedule produced food in the other terminal link. When the interreinforcement intervals were equal in the two terminal links (i.e., the simple fixed-interval was twice the size of each of the components in the chained schedule) pigeons preferred the simple fixed-interval as measured by their relative rates of responding in the concurrently available initial links. This preference increased as the duration of the terminal links increased. The preference could be reversed by making the simple fixed-interval schedule sufficiently longer than the chained schedule. In the second experiment, the terminal links consisted of two- vs three-component chained fixed-intervals, again with equal interreinforcement intervals. Pigeons preferred the two-component chain to the three-component chain, although these results were less consistent and less dramatic than those in the first experiment. Again, preference increased as the duration of the terminal links increased. The results show that an organism's choice for a schedule will be substantially lowered by the chaining operation even when the interreinforcement interval remains constant.

How the media reported the first days of the pandemic (H1N1) 2009: results of EU-wide media analysis

The European Centre for Disease Prevention and Control (ECDC) commissioned an in-depth review of European media coverage of the opening days of the pandemic (H1N1) 2009. A total of 3,979 articles were collected from 31 European countries in the period 27 April until 3 May 2009. National and international public health authorities were by far the leading source of information on the new virus. They were identified as the main source of information in 75% of the articles analysed. 94% of the articles were either neutral, relaying factual information (70%), or expressing support for the authorities handling of the situation (24%). These results seem to vindicate the communication strategy adopted by the public health authorities.

Arterial calcification in race horses

Calcification of large arteries has been sporadically reported in horses. The pathogenesis is still unknown, but recent studies in humans suggest that this is a regulated biomineralizing process. This study surveyed the prevalence, distribution, and severity of vascular calcification in Thoroughbred and Standardbred racehorses. Histopathologic, ultrastructural imaging, and energy dispersive X-ray elemental analyses were used to examine the lesions. Calcification of the tunica media, predominantly the pulmonary artery, was found in 82% of horses (83/101). Young adult horses (mean [SD] age in years, 4.44 +/- 2.17) of both breeds and sexes were similarly affected. Lesions appeared as white-to-yellowish, hard, and gritty plaques of variable size. On microscopic examination, elastic fibers within the tunica media were thinned, fragmented, and calcified, and surrounded by dense collagen matrix. Elemental analysis showed distinct peaks for calcium and phosphorus, consistent with hydroxyapatite mineral. The frequent occurrence of calcification in the tunica media of large pulmonary arteries of young racing horses indicates the need to investigate its pathogenesis and potential clinical implications.

Successful outcome after a technically challenging liver transplant during pregnancy

Little is known about the implications of liver transplantation (OLT) during pregnancy. We report the case of a 26-year-old woman with cryptogenic familial biliary cirrhosis that decompensated rapidly. OLT was performed using the donor iliac vein for a retrogastric portal vein conduit to the superior mesenteric vein and the donor iliac artery for an infrarenal aortic conduit. During the latter anastomosis, a viable fetus was noticed. Both donor and recipient were cytomegalovirus positive. Postoperative ultrasound revealed a 13.5-week-old viable fetus. The patient received tacrolimus, azathioprine, and prednisolone. The pregnancy progressed normally with the vaginal delivery of a healthy male infant after 36 weeks gestation. Nineteen months later, both the mother and child were well. This case demonstrated that even technically difficult OLT during pregnancy can have a successful outcome, raising the question of whether transplant patients of childbearing age should be routinely tested for pregnancy.

New Health Communication Unit in ECDC

From 1 May, a new Health Communication Unit (HCU) has been established in the European Centre for Disease Prevention and Control (ECDC).

Parental perceptions of the therapeutic effect from osteopathic manipulation or acupuncture in children with spastic cerebral palsy

Fifty children were involved in a randomized, controlled trial to evaluate the effectiveness of either osteopathic manipulation or acupuncture as a 6-month therapeutic adjunct for children with spastic cerebral palsy. Exit interviews were used to obtain parental perceptions and form the basis of this report. Only 2 of 17 parents reported positive gains while their child was in a wait-list control period but all 17 reported gains while in the treatment phase of the study. Ninety-six percent (48 of 50) of the parents reported some improvement while their child was receiving treatments but the gains varied from child to child. The most frequent gains were seen in improvement in the use of arms or legs (61% and 68%) and more restful sleep (39% and 68%) in the osteopathic and the acupuncture groups, respectively. Improvement in mood and improved bowel function were also very common benefits noted by the parents in both groups.

"That sort of place...where filthy men go...": a qualitative study of women's perceptions of genitourinary medicine services

BACKGROUND

A stigma is a pejorative social label. Stigmatisation is a process by which individuals are made to experience isolation and reduced opportunities in life. Some diseases are particularly associated with stigmatising attitudes; this applies particularly to sexually transmitted infections. Although several studies report the effects of stigma, no study to date has attempted to investigate its nature, which is a prerequisite to designing health interventions.

METHODS

This qualitative, exploratory study investigated the experience of stigma among young women recently diagnosed with an STI and considered the implications of these experiences in terms of maximising access to GUM clinics.

RESULTS

Three themes were identified from interviews undertaken with women recruited in family planning and genitourinary medicine (GUM) clinics: the perception of STIs as a condition of "others," the threatening nature of the GUM clinic, and the evolution of the experience of stigma within the GUM clinic.

CONCLUSION

More open discussion and education about sexual health services and STIs should take place at a general population level; awareness of sexual health services should be raised in inclusive ways, which are seen as relevant to the needs of a wide range of individuals; medical, nursing, and counselling staff in GUM clinics should be supported in their efforts to reduce the experience of stigma. Finally, future interventions designed to improve access to sexual health services should formally assess their impact on stigma.

A pilot study of donepezil for memory problems in epilepsy

We performed a pilot 3-month, open-label study of 5-10 mg donepezil, an anticholinesterase inhibitor, as treatment for memory problems in people with epilepsy. The Buschke Selective Reminding Test was administered at baseline and after 3 months of donepezil. In 18 completing patients, the total number of words recalled across learning trials was greater on donepezil (P = 0.4). No change was noted in attention, visual sequencing, mental flexibility, psychomotor speed, or reported quality-of-life scores. Mean 3-month seizure frequency at baseline was 2.70 ± 4.60, and during treatment, 3.06 ± 4.52 (P = 0.19, not significant). Two patients experienced increased tonic-clonic seizures. Side effects included diarrhea, stomach cramps, insomnia, depression, and blurred vision. Cholinergic medication is worthy of investigation as treatment for memory problems in people with epilepsy, but attention must be paid to possible exacerbation of seizures.

Cost-effectiveness of a trial of labor after previous cesarean

OBJECTIVE

To determine the cost-effective method of delivery, from society's perspective, in patients who have had a previous cesarean.

METHODS

We completed an incremental cost-effectiveness analysis of a trial of labor relative to cesarean using a computerized model for a hypothetical 30-year old parturient. The model incorporated data from peer-reviewed studies, actual hospital costs, and utilities to quantify health-related quality of life. A threshold of $50,000 per quality-adjusted life-years was used to define cost-effective.

RESULTS

The model was most sensitive to the probability of successful vaginal delivery. If the probability of successful vaginal birth after cesarean (VBAC) was less than 0.65, elective repeat cesarean was both less costly and more effective than a trial of labor. Between 0.65 and 0.74, elective repeat cesarean was cost-effective (the cost-effectiveness ratio was less than $50,000 per quality-adjusted life-years), because, although it cost more than VBAC, it was offset by improved outcomes. Between 0.74 and 0.76, trial of labor was cost-effective. If the probability of successful vaginal delivery exceeded 0.76, trial of labor became less costly and more effective. Costs associated with a moderately morbid neonatal outcome, as well as the probabilities of infant morbidity occurring, heavily impacted our results.

CONCLUSION

The cost-effectiveness of VBAC depends on the likelihood of successful trial of labor. Our modeling suggests that a trial of labor is cost-effective if the probability of successful vaginal delivery is greater than 0.74. Improved algorithms are needed to more precisely estimate the likelihood that a patient with a previous cesarean will have a successful vaginal delivery.

Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening

OBJECTIVES

To investigate the psychosocial impact for women of a diagnosis of Chlamydia trachomatis and discuss the implications for the proposed UK chlamydia screening programme.

DESIGN

Qualitative study with semistructured interviews. Interview transcripts analysed to identify recurrent themes.

PARTICIPANTS

Seventeen women with a current or recent diagnosis of chlamydia.

SETTING

A family planning clinic and a genitourinary medicine clinic in Glasgow.

RESULTS

Three themes were identified: perceptions of stigma associated with sexually transmitted infection, uncertainty about reproductive health after diagnosis, and anxieties regarding partner's reaction to diagnosis. Most women had not previously perceived sexually transmitted infections as personally relevant; this was a function of stereotypical beliefs about who was "at risk" of sexually transmitted infection. These beliefs were pervasive and negatively affected reactions to diagnosis and produced anxiety about disclosure of the condition to others (particularly sexual partners) and future reproductive morbidity. This anxiety, given the uncertain natural history of chlamydia, may prove difficult to dispel.

CONCLUSIONS

There are three primary areas of concern for women after a diagnosis of chlamydia which need to be examined in the proposed screening programme. Information provided should normalise and destigmatise chlamydial infection and positively promote genitourinary medicine services. Support services should be available because notification of partner can cause anxiety. Uncertainty about future reproductive morbidity may be inevitable; staff providing screening will require guidance in providing advice under such conditions.

Treatment of chronic hypertension with intravenous enalaprilat and transdermal clonidine

We report an 11-year-old boy with hypertension and chronic intestinal pseudo-obstruction, which renders him totally dependent on parenteral nutrition and prevents the use of oral medications. Here we report the feasibility of utilizing chronic i.v. enalaprilat and transdermal clonidine on a chronic basis to control hypertension. Over the last 10 months, the patient's hypertension has been well controlled by 1.25 mg i.v. enalaprilat every 8 h and a 0.2-mg clonidine patch every 6 days, with no apparent side-effects. There are no reports of i.v. enalaprilat usage exceeding 3 weeks' duration. Therefore we believe that it is possible to effect reasonable management of chronic hypertension with the use of chronic i.v. enalaprilat and transdermal clonidine therapy.

A new, simple, inexpensive means of testing functional vitamin A status: the night vision threshold test (NVTT). A preliminary field-test report

Vitamin A deficiency is the leading cause of preventable childhood blindness in developing countries. Each year, an estimated 13.5 million children world-wide are unable to adapt to the dark and half a million children progress to complete blindness annually from lack of vitamin A. Most of the currently available methods for assessing vitamin A status are expensive, require sophisticated instrumentation and are not efficacious in field conditions. A simple, inexpensive method was developed to identify children with defective dark-adaptability, thereby providing a reflection of marginal vitamin A stores. The purpose of this preliminary study was to test the field-efficacy of the Night Vision Threshold Tester (NVTT). Thirty-nine middle-school children with a mean age of 13.5 +/- 1.37 years were initially tested for their ability to adapt to the dark using the

The impact of a structured programme of asthma care in general practice

The impact of a new GP programme of asthma care was examined using: a) a retrospective pre- and post-casenote survey of 400 asthma patients, comparing patients in practices using the health board programme (HBP) and other programmes (OP); and b) a patient satisfaction questionnaire, completed by 532 people on asthma clinic lists in HBP and OP practices. Outcomes assessed were health service use, perceived change in symptoms and asthma self-management. The casenote survey indicated improved health service use by patients in HBP practices, with fewer patient-initiated (p < 0.05), emergency (p < 0.05) and other chest-related attendances (p < 0.01) and increased clinic attendance (p < 0.05) post intervention. OP practices also showed reduced patient-initiated (p < 0.01) and increased asthma clinic use (p < 0.01). Increased use of management plans (p < 0.01) and peak flow diaries (p < 0.01) was noted post intervention for HBP practices. Responders to the questionnaire survey perceived that clinic attendance improved asthma symptoms, including severity and control, sleep disturbance and early morning wheeze. People in HBP practices were more likely than those in OP practices to possess a peak flow meter, a diary and a personal management plan (all p < 0.01 or above) but were not more likely to use a peak flow diary. Notwithstanding methodological difficulties in the selection of practices, both studies showed trends towards improvement in health service use and asthma self-management. The HBP was associated with greater improvement in self-management processes and outcomes, and greater patient satisfaction with asthma care.

The Night Vision Threshold Test (NVTT): a simple instrument for testing dark adaptation in young children

It is estimated that 41 per cent of the population aged under 5 in the developing world has an inadequate vitamin A dietary intake resulting in increased morbidity and mortality. Half a million children go blind each year as a result of vitamin A deficiency. Thirteen and a half million have night blindness, the first sign of vitamin A deficiency. Unfortunately, there is no simple, sensitive and inexpensive means to identify the child who has marginal levels of vitamin A and thus institute means to prevent their development of severe deficiency. A low cost, simple, easy-to-use instrument designed to detect a young child's ability to adapt to darkness was tested in children admitted to the Mwanamugimu Nutrition Unit at Makerere Medical School in Kampala, Uganda. Despite the severe degree of malnutrition found in these children, Night Vision Threshold Test results and serum retinol levels were related (r = 0.41, p < 0.05). Further efficacy trials for this instrument are planned at community sites in Nepal.

Evaluation of an alternative model of anticoagulant care

BACKGROUND

Alternative models for the delivery of anticoagulant care are required in view of an estimated increase of 20% per annum in patients requiring treatment, and an inability for the present service to deal with this increase. This led to a restructuring of the anticoagulant service, which included the appointment of a nurse specialist and the implementation of a computer-assisted warfarin dosing system.

AIM

To assess the impact of changes in the delivery of anticoagulant care in one unit.

METHODS

A previous consultant-led delivery service of anticoagulant care was compared with the current nurse-led service. Two six month periods was compared. The end points of the study were INR control, appointment intervals and clinic size. A patient questionnaire was completed to assess patient satisfaction and education.

RESULTS

In two years, attendance at walk-in clinics increased by 43% but the number attending anticoagulant clinics decreased by 50%. There was a parallel increase in the number of patients presenting on a flexible 'walk-in' basis for phlebotomy with postal dosing with 76% of patients now being managed on a flexible postal system. Anticoagulant control and reattendance intervals compare favourably, the percentage of patients attending at the maximal reattendance interval of eight weeks has increased from 3% to 15%. Patient knowledge and satisfaction scores were high on the questionnaire. Financially, this model of care is more cost effective than employing further doctors.

CONCLUSION

The introduction of a nurse specialist managed service has allowed us to accommodate a 21% annual increase in patient numbers while improving the overall quality, efficiency and cost-effectiveness of the service and patient care.