Post-stroke Cognition is Associated with Stroke Survivor Quality of Life and Caregiver Outcomes: A Systematic Review and Meta-analysis

Disability arising from post-stroke cognitive impairment is a likely contributor to the poor quality of life (QoL) stroke survivors and their carers frequently experience, but this has not been summarily quantified. A systematic literature review and meta-analysis was completed examining the association between general and domain-specific post-stroke cognitive functioning and adult stroke survivor QoL, caregiver QoL, and caregiver burden. Five databases were systematically searched, and eligibility for inclusion, data extraction, and study quality were evaluated by two reviewers using a standardised protocol. Effects sizes (r) were estimated using a random effects model. Thirty-eight studies were identified, generating a sample of 7365 stroke survivors (median age 63.02 years, range 25-93) followed for 3 to 132 months post-stroke. Overall cognition (all domains combined) demonstrated a significant small to medium association with QoL, r = 0.23 (95% CI 0.18-0.28), p < 0.001. The cognitive domains of speed, attention, visuospatial, memory, and executive skills, but not language, also demonstrated a significant relationship with QoL. Regarding caregiver outcomes, 15 studies were identified resulting in a sample of 2421 caregivers (median age 58.12 years, range 18-82) followed for 3 to 84 months post-stroke. Stroke survivor overall cognitive ability again demonstrated a significant small to medium association with caregiver outcomes (QoL and burden combined), r = 0.17 (95% CI 0.10-0.24), p < 0.001. In conclusion, lower post-stroke cognitive performance is associated with significant reductions in stroke survivor QoL and poorer caregiver outcomes. Cognitive assessment is recommended early to identify those at risk and implement timely interventions to support both stroke survivors and their caregivers.

A - 121 Psychosocial and Neurocognitive Correlates of Suicidal Thoughts and Behaviours Amongst Siblings of Persons with and without Neurodevelopmental Conditions

OBJECTIVE

Siblings of individuals with neurodevelopmental conditions (NDCs) have greater incidence of psychiatric diagnoses and neurocognitive difficulties compared to siblings of persons without NDCs. Despite suicidality being labelled a global health crisis, and NDC siblings experiencing risk factors implicated in suicidality, no previous studies examined suicidality amongst adolescent and young adult siblings of persons with NDCs. Our study aimed to bridge this gap.

METHOD

The present study used Bayesian analyses and risk classification models to examine individual and environmental risk factors associated with suicidal thoughts and behaviour amongst siblings of persons with and without NDCs (n = 267; 132 NDC, 135 control group, mean age 20.61, range 14-27, 76.40% female, 76.78% White Caucasian), as measured using self-report survey data and remote self-administered cognitive tests.

RESULTS

NDC siblings had higher rates of current nonsuicidal self-injury (NSSI; 18.94% versus 14.07%, δ = -0.32), suicidal ideation (25.76% versus 8.89%, δ = -0.40) and history of suicide attempts (18.18% versus 4.44%, δ = -0.43) compared to controls. Classification models using boosting and random forest demonstrated adequate performance: positive predictive value 0.86-0.91, negative predictive value 0.81-0.90, false negative rates 0.11-0.24. Cognitive inflexibility, alexithymia, inattention, bullying, depression, NSSI, and eating or psychotic disorder history had the highest relative importance in predicting lifetime suicidality. Poorer executive functioning (measured by the Wisconsin Card Sorting Task, Sustained Attention to Response Task, Stop Signal Task, and N-Back 2-back task) was strongly correlated with suicidality.

CONCLUSIONS

Screening for proximal and modifiable risk factors is critical to inform suicidal behaviour intervention and prevention programs for at-risk siblings.

B - 71 Neurocognitive and Self-Reported Psychosocial and Behavioural Functioning in Siblings of Individuals with Neurodevelopmental Conditions: a Study Using Remote Self-Administered Testing

OBJECTIVE

This study compared and explored the neurocognitive profiles of siblings of persons with and without neurodevelopmental conditions (NDCs), and associations between objective test performance and self-reported psychosocial functioning.

METHOD

Siblings of persons with and without NDCs (64 NDC and 64 control siblings; mean age 19.88 years, range 11-27 years, 73.44% female, 75.78% White Caucasian) completed self-report questionnaires and self-administered computerized neurocognitive tests of executive functioning (EF). Using Bayesian analyses, we examined cross-sectional associations between self-reported psychosocial functioning and cognitive test performance, and predictors of EF over 15 months.

RESULTS

NDC siblings had poorer working memory, inhibition, attention, and shifting compared to controls, as measured by experimental paradigms on the backward Corsi span, N-Back 2-back task, Stop Signal Task, Sustained Attention to Response Task, and the Wisconsin Card Sorting Test (effect size δ ranging 0.49 to 0.64). Bayesian cross-sectional networks revealed negative emotion reactivity and working memory difficulties were central to the NDC sibling network. Over 15 months, poorer EF (k low test scores) was predicted by negative emotion reactivity, sleep problems, and anxiety, over and above effects of age and subclinical autistic and ADHD traits. Siblings of autistic individuals and persons with fetal alcohol spectrum disorder had higher rates of neurocognitive and psychiatric difficulties than other NDCs and controls (Bayes factors >20).

CONCLUSION

Neurocognitive difficulties were associated with transdiagnostic vulnerability to poorer wellbeing in NDC siblings. These findings demonstrate the feasibility of remote online cognitive testing and highlight the importance of individualised prevention and intervention for NDC siblings.

Neurocognitive and self-reported psychosocial and behavioral functioning in siblings of individuals with neurodevelopmental conditions: a study using remote self-administered testing

OBJECTIVE

This study compared and explored the neurocognitive profiles of siblings of persons with and without neurodevelopmental conditions (NDCs) and associations between objective test performance and self-reported psychosocial functioning.

METHODS

Siblings of persons with and without NDCs (64 NDC and 64 control siblings; mean age 19.88 years, range 11-27 years, 73.44% female, 75.78% White Caucasian) completed self-report questionnaires and self-administered computerized neurocognitive tests of executive functioning (EF). Using Bayesian analyses, we examined cross-sectional associations between self-reported psychosocial functioning and cognitive test performance, and predictors of EF over 15 months.

RESULTS

NDC siblings had poorer working memory, inhibition, attention, and shifting compared to controls, as measured by experimental paradigms on the backward Corsi span, N-Back 2-back task, Stop Signal Task, Sustained Attention to Response Task, and the Wisconsin Card Sorting Test (effect size δ ranging 0.49 to 0.64). Bayesian cross-sectional networks revealed negative emotion reactivity and working memory difficulties were central to the NDC sibling network. Over 15 months, poorer EF (k low test scores) was predicted by negative emotion reactivity, sleep problems, and anxiety, over and above effects of age and subclinical autistic and ADHD traits. Siblings of autistic individuals and persons with fetal alcohol spectrum disorder had higher rates of neurocognitive and psychiatric difficulties than other NDCs and controls (Bayes factors >20).

CONCLUSIONS

Neurocognitive difficulties were associated with transdiagnostic vulnerability to poorer wellbeing in NDC siblings. These findings demonstrate the feasibility of remote online cognitive testing and highlight the importance of individualized prevention and intervention for NDC siblings.

Psychosocial and neurocognitive correlates of suicidal thoughts and behaviours amongst siblings of persons with and without neurodevelopmental conditions

OBJECTIVE

Siblings of individuals with neurodevelopmental conditions (NDCs) have greater incidence of neuropsychiatric diagnoses and neurocognitive difficulties compared to siblings of persons without NDCs. Despite suicidality being labelled a global health crisis (WHO, 2014) and NDC siblings experiencing risk factors implicated in suicidality, no previous studies examined suicidality amongst adolescent and young adult siblings of persons with NDCs. Our study aimed to bridge this gap.

METHOD

The present study used Bayesian analyses and risk classification models to examine individual and environmental risk factors associated with suicidal thoughts and behaviours amongst siblings of persons with and without NDCs (n = 267; 132 NDC, 135 control group, mean age 20.61, range 14-27, 76.40% female, 76.78% White Caucasian), as measured using self-report survey data and remote self-administered cognitive tests.

RESULTS

NDC siblings had higher rates of current nonsuicidal self-injury (NSSI; 18.94% versus 14.07%, δ = -0.32), suicidal ideation (25.76% versus 8.89%, δ = -0.40) and history of suicide attempts (18.18% versus 4.44%, δ = -0.43) compared to controls. Classification models using boosting and random forest demonstrated adequate performance: positive predictive value 0.86-0.91, negative predictive value 0.81-0.90, false negative rates 0.11-0.24. Cognitive inflexibility, alexithymia, inattention, bullying, depression, NSSI, and eating or psychotic disorder history had the highest relative importance in predicting lifetime suicidality. Poorer executive functioning (measured by the Wisconsin Card Sorting Task, Sustained Attention to Response Task, Stop Signal Task, and N-Back 2-back task) was strongly correlated with suicidality.

CONCLUSIONS

Screening for proximal and modifiable risk factors is critical to inform suicidal behaviour intervention and prevention programs for at-risk siblings.

Individual-Level Risk and Resilience Factors Associated with Mental Health in Siblings of Individuals with Neurodevelopmental Conditions: A Network Analysis

Siblings of individuals with neurodevelopmental conditions (NDCs) are exposed to unique family environments and experience a range of psychosocial risk and resilience factors. Networks of self-reported risk, resilience, and neuropsychiatric variables were estimated for siblings of individuals with (n = 235) and without (n = 480) NDCs (N = 715, mean age 22.40 years, 76% female, 74% White Caucasian). The NDC group reported more depressive (g = 0.39) and anxious (g = 0.43) symptoms than controls, and 71.5% of the NDC group reported at least one neuropsychiatric diagnosis compared to 36.9% of controls. Self-reported sleep and post-traumatic stress disorders were high amongst NDC siblings. Everyday executive functioning difficulties (cognitive inflexibility, hyperactivity/impulsivity) and emotion dysregulation were the most influential transdiagnostic risk factors for poorer functioning within the NDC group network.

Twelve Tips for Inclusive Practice in Healthcare Settings

This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association's diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.

Psychosocial Interventions and Support Groups for Siblings of Individuals with Neurodevelopmental Conditions: A Mixed Methods Systematic Review of Sibling Self-reported Mental Health and Wellbeing Outcomes

Siblings of persons with neurodevelopmental conditions (NDCs) have increased risk of poorer psychosocial functioning. This systematic review evaluated quantitative and qualitative evidence on sibling mental health and wellbeing outcomes following psychosocial interventions and the risk and protective factors associated with post-intervention outcomes. From 2025 identified studies published from 1991 to 2022 across ten databases, 24 studies were included. The largest immediate post-intervention improvements were in self-esteem, social wellbeing and knowledge of NDCs. The most sustained improvements in intervention groups at follow-up periods were in emotional and behavioural adjustment and NDC knowledge. There were positive, but small, differences in favour of the intervention groups on knowledge of NDCs, self-esteem, coping and the sibling relationship as compared to waitlist control groups. Psychosocial interventions for siblings are heterogeneous, and more data, including consideration of unique family circumstances, are needed to improve reporting and replicability, to measure effectiveness and tailor necessary supports.

Risk and resilience factors impacting the mental health and wellbeing of siblings of individuals with neurodevelopmental conditions: A mixed methods systematic review

OBJECTIVE

This pre-registered systematic review synthesised and evaluated the existing literature on self-reported mental health and wellbeing of siblings of individuals with neurodevelopmental conditions (NDCs).

METHODS

From 2437 identified studies published 2000-2022, 81 studies were included: 14 population- or cohort-based, 39 quantitative, 7 mixed method, and 21 qualitative outcome studies.

RESULTS

Seven sibling mental health (any psychiatric disorder, anxiety, depression, bipolar disorder, schizophrenia, internalising and externalising difficulties) and five wellbeing indicators were identified (quality of life, emotional adjustment, social wellbeing, somatic/physical wellbeing, and resilience/growth). Overall, siblings had increased risk of any psychiatric disorder, but they also reported experiences of growth and resilience, primarily in qualitative studies. 41 risk factors and 24 resilience factors associated with these outcomes were identified; the most frequently cited risk factor was symptom severity of the NDC sibling, while the most common resilience factor was adaptive/active coping at the individual sibling level. Studies showed high methodological heterogeneity and 90 different self-report measures were used.

CONCLUSIONS

Sibling mental health indictors are heterogeneous and cumulative risk factors may result in poorer wellbeing. There is a need for consistent reporting of family and sibling characteristics, a strengths-based approach to assessment, and identification of protective and resilience-promoting factors.

Child protection involvement of children of mothers with intellectual disability

BACKGROUND

Children born to parents with intellectual disability (ID) have been shown as disproportionally represented in child protection services however with limited population-based research.

OBJECTIVES

To investigate child protection involvement for children born to mothers with ID in Western Australia using linked administrative data.

PARTICIPANTS AND SETTING

A cohort of 1106 children born to a mother with ID and a comparison group of 9796 children of mothers without ID were identified in Western Australia.

METHODS

Cox regression analyses stratified by maternal Aboriginal status were conducted to investigate risk of child involvement with child protection services and care placement. Interaction with child age, intellectual disability status, and maternal mental health and substance use was investigated.

RESULTS

Children born to a mother with ID were both at higher risk of having contact with child protection services (HR: 4.35 (3.70-5.12)) and placement in out-of-home care (HR: 6.21 (4.73-8.17)). For non-Aboriginal children, the risks of child protection involvement and placement for those born to mothers with ID were 7 times and 12 times higher than those of mothers without ID. The risk was lower for Aboriginal children, at 1.8 and 1.9 times, respectively. Infants born to mothers with ID were at higher risk of child protection involvement compared to other age groups. Maternal mental health and substance use moderated the increased risk.

CONCLUSIONS

Intellectual disability alone is not sufficient justification for removal of children from their parents. The challenge for family services is ensuring that resources are adequate to meet the family's needs.

A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents

AIM

This systematic review aimed to identify the most important social, environmental, biological, and/or genetic risk factors for intellectual disability (ID).

METHODS

Eligible were published prospective or retrospective comparative studies investigating risk factors for ID in children 4-18 years. Exclusions were single group studies with no comparator without ID and a sample size <100. Electronic databases (Medline, Cochrane Library, EMBASE, PsycInfo, Campbell Collaboration, and CINAHL) were searched for eligible publications from 1980 to 2020. Joanna Briggs Institute critical appraisal instruments, appropriate for study type, were used to assess study quality and risk of bias. Descriptive characteristics and individual study results were presented followed by the synthesis for individual risk factors, also assessed using GRADE.

RESULTS

Fifty-eight individual eligible studies were grouped into six exposure topics: sociodemographic; antenatal and perinatal; maternal physical health; maternal mental health; environmental; genetic or biological studies. There were few eligible genetic studies. For half the topics, the certainty of evidence (GRADE) was moderate or high.

CONCLUSION

Multiple studies have examined individual potential determinants of ID, but few have investigated holistically to identify those populations most at risk. Our review would indicate that there are vulnerable groups where risk factors we identified, such as low socioeconomic status, minority ethnicity, teenage motherhood, maternal mental illness, and alcohol abuse, may cluster, highlighting a target for preventive strategies. At-risk populations need to be identified and monitored so that interventions can be implemented when appropriate, at preconception, during pregnancy, or after birth. This could reduce the likelihood of ID and provide optimal opportunities for vulnerable infants.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=120032], identifier [CRD42019120032].

The Role of Sleep in the Relationship Between ADHD Symptoms and Stop Signal Task Performance

Background: ADHD commonly occurs with sleep problems and secondary cognitive impairments such as inhibitory control. Sleep problems may explain attentional lapses and inhibition performance variability in children with ADHD. This study applied Bayesian analyses to examine the relationship between ADHD symptoms, sleep problems, and inhibition. Methods: Participants included 73 children with ADHD and 73 non-ADHD controls, aged 10.5 to 13.5 years. The Stop Signal Task measured inhibition. Sleep problems were measured with the Adolescent Sleep Wake Scale and parent-report. Results: ADHD symptoms are associated with sleep problems and reaction time variability, however, sleep problems accounted for more variance in inhibition performance than both hyperactive and inattentive symptoms. Conclusion: Sleep problems account for inhibition performance over and above ADHD symptom severity in children with and without ADHD diagnoses. This suggests clinical utility in assessing sleep in children with manifestations of ADHD, and interventions targeting sleep problems concurrently with behavioral symptoms. This further adds to the discussion on overdiagnosis of ADHD due to behavioral presentations of underlying sleep disorders. Treatment for phenotypes of ADHD could be enhanced by targeting sleep problems, in addition to inhibition deficits and attentional lapses.

[Update from France Macula Federation: Diagnosis of wet AMD]

PURPOSE

To update the recommendations of the France Macula Federation for the diagnosis of wet age-related macular degeneration (AMD).

METHODS

Analysis of literature and expert opinion.

RESULTS

The FMF recommends diagnosing wet AMD by combining the results of fundus examination (or color or monochromatic fundus photographs), optical coherence tomography (OCT) showing exudative signs, and morphological visualization of the neovascular membrane, which may be obtained non-invasively (OCT-angiography) or invasively (fluorescein and/or indocyanine green angiography). Under optimal conditions in which all these tools are available, the FMF recommends using non-invasive methods as first-line tools and resorting to dye angiography if diagnostic doubt remains.

CONCLUSION

As observed in other fields of medical imaging, non-invasive methods are preferred to invasive methods for the diagnosis of wet AMD, while the latter are reserved for more difficult cases.

[Management of wet AMD in France in 2015]

PURPOSE AND CONTEXT

Intravitreal administration of anti-VEGF agents, available in France since 2007, allows stabilization and improvement in visual acuity in wet age-related macular degeneration (AMD). In the past few years, the management of this disease has evolved in terms of both diagnostic methods and treatment schedules, which have been adapted to the pathophysiology of AMD. The goal of this survey, performed in a representative sample of French ophthalmologists, was to describe the evolution of medical practices one year after a similar survey (Massé et al., J Fr Ophtalmol 2016; 39: 40-7).

METHOD

The survey was performed from December, 2014 to March, 2015 in 191 ophthalmologists (53 general ophthalmologists and 98 retina specialists) with an on-line questionnaire. This questionnaire was designed by a committee of ophthalmologists to describe practices concerning screening, diagnosis, treatment and follow-up of wet AMD.

RESULTS

An initial intravitreal injection of an anti-VEGF agent was usually performed within 10 days after the diagnosis of wet AMD by 98% of ophthalmologists and within 5 days by 63%. The treatment protocols favored by retina specialists were pro re nata (PRN) for 58%, Observe and Plan for 25% and Treat and Extend for 17%. Bilateral intravitreal injections were performed on the same day by 46% of retina specialists, mostly for the convenience of the patient and because of the low infectious risk. The initial protocol was maintained by one third of retina specialists throughout the course of treatment, while two thirds of them reported that they reassessed the protocol on average after 5 months.

CONCLUSION

This survey on the practices of the ophthalmologists in wet AMD highlights an improvement in the time course of patient management and an evolution of treatment schedules toward individualized protocols.

Use of Rheumatic Scores to Guide Therapeutic Decisions in Patients with Ankylosing Spondylitis: Results of a Multicentre Study in Germany

Summary Background Rheumatology practice has seen an increasing development and use of scores to assess disease activity, loss of physical function, quality of life and radiographic damage. Study results, in particular for rheumatoid arthritis, demonstrate that target-oriented treatment concepts using scores lead to improved treatment results (Treat-to-Target).

Objective To review how frequently scores are used in daily rheumatological practice to assess disease activity, loss of physical function and treatment response in patients with ankylosing spondylitis and how much treatment decisions are influenced by the use of these scores.

Methods A Germany-wide prospective multicentre study 74 sites (61 rheumatologists in private practice and 13 hospital-based rheumatologists) documented the use of scores for assessing disease activity, treatment response, quality of life and imaging results in patients with ankylosing spondylitis (AS) (18–83 years) over 3 consecutive visits. A total of 1 476 fully evaluable visits of 492 patients [326 (66.26%) men and 166 (33.74%) women] were recorded.

Results The most commonly used scores were BASDAI (n=1.134, 84% of all visits) and BASFI (n=500, 37.5%). At least one score was calculated in 1.335 visits (90.45%); a combination of several scores was calculated in 748 visits (50.68%). Only in 141 visits (9.55%) no scores were calculated at all. Scores were used independently of patients’ age, duration of treatment, medication, and treatment changes and region of the participating rheumatologist. Scores recording treatment response (ASAS response) or quality of life were recorded in a few cases only. The average influence of a score on a treatment decision was 5.67 on a scale from 0 to 10.

[Functional outcomes obtained after vesicoureteral reimplantation surgery in adults: A review]

OBJECTIVES

Vesico-ureteral reimplantations (VUR) for adults are complex procedures, often practicing for distal ureteral lesions. Our goal was to synthesis the main indications for VUR, different techniques and their functional outcomes.

MATERIAL AND METHODS

A literature review in English by Medline, Embase and Google scholar was performed using the following keywords: ureter; laparoscopy; robotics, reimplantation; surgery; obstruction; morbidity; complications; psoas hitch; Boari flap; ureteroneocystostomy.

RESULTS

In more than half of the cases, aetiology was a iatrogenic ureteral lesion. When the ureteral defect was less than 2 cm, direct or non-refluxing VUR was the technique of choice. If defect was superior than 2 cm the Boari flap or vesicopsoas hitch were preferred. Several surgical approaches were feasible: open, laparoscopic only, robot assisted laparoscopic. Estimated blood loss, pain and mean hospital stay seemed better with conventional or robotic coelioscopy. Nevertheless, complications, pre-/post-operative renal function and mean operative time seemed similar. The most frequent major complication was the anastomotic urine leakage.

CONCLUSIONS

The VUR techniques are well codified now even if it's a rare procedure. Functional outcomes are satisfied according to literature and morbidity is more and more decreasing but the level of evidence of the studies is low.

Human endothelial lecitin-like oxLDL receptor-1 (LOX-1) expression is not associated with impairment of endothelium-dependent vasoreactivity in conduit vessels

The cellular uptake of oxidized low density lipoprotein (LDL) is mediated through the oxidized LDL receptor-1, LOX-1. We investigated whether circulating factors link LOX-1 expression in endothelial cells and impaired endothelium-dependent vasoreactivity (EDVR) as functional indicator of atherogenesis. EDVR was measured as flow-mediated dilation (FMD) of the brachial artery in 27 patients with a known history of cardiovascular disease. Human umbilical vein endothelial cells (HUVEC) were incubated with bradykinin or prostacyclin in the presence of tumour necrosis factor-alpha (TNF-α) or with serum of each patient for four hours. Total mRNA and protein extracts were analysed for LOX-1 and eNOS expression relative to the expression in medium-treated cells and corrected for GAPDH expression.

RESULTS

Prostacyclin and bradykinin did not modulate LOX-1 basal expression but were able to prevent significantly the up-regulation of LOX-1 expression by TNF-α, in HUVEC in vitro. Impaired EDVR was associated significantly with reduced endothelial nitric oxide synthase (eNOS) protein expression in HUVEC (r=0.788, P<0.001), diabetes (P=0.024), and smoking status (yes/no, P=0.047). In contrast, no such association was established with LOX-1 mRNA (r=0.292, P=0.138) or with LOX-1 protein expression in HUVEC (r=0.201, P=0.312).

CONCLUSIONS

Using a combination of in vitro experiments with in vivo measurements, we found no evidence that endothelial LOX-1 expression and EDVR mediated through circulating factors were associated.

Bacterial biofilm composition in caries and caries-free subjects

BACKGROUND

Certain major pathogens such as Streptococcus mutans, Lactobacillus spp. and others have been reported to be involved in caries initiation and progression. Yet, in addition to those leading pathogens, microbial communities seem to be much more diverse and individually differing. The aim of this study, therefore, was to analyze the bacterial composition of carious dentin and the plaque of caries-free patients by using a custom-made, real-time quantitative polymerase chain reaction assay (RQ-PCR).

METHODS

The study included 26 patients with caries and 28 caries-free controls. Decayed tooth substance and plaque samples were harvested. Bacterial DNA was extracted and tested for the presence of 43 bacterial species or species groups using RQ-PCR.

RESULTS

Relative quantification revealed that Propionibacterium acidifaciens was significantly more abundant in caries samples than were other microorganisms (fold change 169.12, p = 0.023). In the caries-free samples, typical health-associated species were significantly more prevalent. Unsupervised hierarchical cluster analysis showed a high abundance of P. acidifaciens in caries subjects and distinct but individually differing bacterial clusters in the caries-free subjects. The distribution of 11 bacteria allowed full discrimination between caries and caries-free subjects.

CONCLUSION

Within the investigated cohort, P. acidifaciens was the only pathogen significantly more abundant in caries subjects. Cluster analysis yielded a diverse flora in caries-free subjects, whereas it was narrowed down to a small range of a few outcompeting members in caries subjects.

The experience of "medicine companions" to support adherence to antiretroviral therapy: quantitative and qualitative data from a trial population in Uganda

Good adherence is critical for antiretroviral therapy (ART) in sub-Saharan Africa. We report on the characteristics of medicine companions (MCs) chosen by Ugandan patients enrolling on ART, and on how MCs were chosen, and what roles they played. Baseline data on MCs of 1453 participants in a randomized controlled trial comparing facility and home-based delivery of ART in Jinja, Uganda were analyzed. Textual data on experience with MCs were collected through in-depth interviews among a subsample of 40 trial participants equally divided by sex and trial arm. Significantly more women (71%) than men (29%) were recruited. The majority (75%) of women participants were either widowed (51%) or separated or divorced (24%), whereas most of the men (66%) were married. Women were most likely to choose a child as their MC while men were most likely to choose their spouse; 41% of women chose an MC under 21 compared with only 14% of men. Only 31% of married women chose their husband, compared with 66% of married men who chose their wife. Qualitative interviews suggested MCs proved useful for reminding and other supportive tasks in the first three months but were generally less essential by six months and beyond. Convenience, reliability, and trust were key considerations in choosing an MC. Children provided the only alternative for many unmarried women, but even some married women felt children made more reliable MCs than husbands. Participants who had disclosed their serostatus usually received drug-taking reminders from multiple household members. One participant in the qualitative sample with poor family relations delayed starting treatment due to unwillingness to identify an MC. MCs were generally welcome and useful in supporting early adherence. However, disclosure to an MC should not be a condition of obtaining treatment.

Amplification of minute amounts of oral bacterial DNA for real-time quantitative PCR analysis

BACKGROUND

High-throughput technologies for typing caries or health-associated bacterial populations including PCR, DNA microarrays and next-generation sequencing techniques require significant amounts of bacterial DNA. In clinical settings, the amount of sampled DNA is often limited and amplification is therefore essential. Protocols should be able to reproducibly amplify sequences in order to maintain initial sequence ratios and should not bias the representation of particular DNA sequence types.

METHODS

A linear amplification protocol using DNA polymerase I was modified to permit the amplification and subsequent analysis of small amounts of bacterial DNA. The protocol was tested on human oral bacterial biofilms from different sources, including carious dentine and plaque, and compared to amplification by degenerate PCR of 16S rDNA sequences. Real-time quantitative PCR of 24 bacterial species was used as a readout system to test amplified DNA against unamplified DNA.

RESULTS

The amplification protocol reliably yielded 5-10 μg DNA from as little as 12.5 ng of template DNA. Correlation coefficients between real-time quantitative PCR results from amplified and unamplified DNA were between 0.78 and 0.98.

CONCLUSION

The optimized protocol consistently produced amplification products from minute amounts of bacterial DNA from caries and plaque; the amplification products are suitable for downstream genetic analyses.