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A systematic review of research on psychiatric mother-baby units
Get PDF© 2017 Springer. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/Psychiatric mother-baby units (MBUs) are currently viewed as best practice, particularly in the UK, Australia and France, for improving outcomes for mothers and babies when the former are experiencing severe forms of mental illness. A growing number of publications have examined MBUs, but to date, there has not been a comprehensive review of these studies. As such, the systematic review reported in this paper sought to address this gap. A systematic search was conducted for peer-reviewed research and grey literature published in English between 2000 and 2015. A final sample of 44 publications were identified that reported on empirical findings with regard to MBUs. Three quarters of the studies focused on individual MBUs and most studies were quantitative. A thematic analysis of the studies identified three major themes: (1) admissions data, (2) outcomes for mothers, and (3) programmes and interventions. The analysis also identified four secondary themes: (i) follow-up after discharge, (ii) separation of mothers and babies after discharge, (iii) client satisfaction with MBUs, and (iv) partners of women admitted to MBUs. The findings of the review highlight gaps in knowledge about MBUs and provide suggestions for future research.This study was funded by an internal research development grant from the Department of Education Arts and Social Sciences at the University of South Australia
Addition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: A pilot double-blind randomized trial
Get PDFThis article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.Aims: Does the addition of botulinum toxin type A increase the effect of casting for improving wrist extension after stroke in people with upper limb spasticity?
Methods: Randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis which was part of a larger trial included 18 adults with upper limb spasticity two years after stroke (89%) or stroke-like conditions (11%). The experimental group (n=7) received botulinum toxin type A injections to upper limb muscles for spasticity management followed by two weeks of wrist casting into maximum extension. The control group (n=11) received two weeks of casting only. Range of motion (goniometry) measured at baseline and after two weeks of casting. Results: Passive wrist extension for the experimental group improved over two weeks from 22 degrees (SD 16) to 54 degrees (SD 16), while the control group improved from 21 degrees (SD 29) to 43 degrees (SD 26). The experimental group increased passive wrist extension 13 degrees (95% CI 4 to 31) more than the control group which was not statistically significant.
Conclusion: Joint range of motion improved over a two-week period for both groups. Botulinum toxin type A injection followed-by casting produced a mean, clinically greater range of motion than casting alone, therefore, a fully-powered trial is warranted.Non
Choice of Health Options in Prevention of Cardiovascular Events (CHOICE) Replication Study
Get PDFThis manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits use, distribution and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 24 month embargo from date of publication (Sept 2017) in accordance with the publisher’s archiving policy.Background
Globally, attendance at cardiac rehabilitation (CR) is between 15 and 30%. Alternative models of individualised care are recommended to promote participation in CR, however there has been no prospective testing of different durations of such models. We aimed to replicate the previously proven Choice of Health Options In prevention of Cardiovascular Events (CHOICE) intervention, and to determine if an extended version (CHOICEplus) would confer additional benefits.
Methods
Acute coronary syndrome (ACS) survivors not accessing centre-based CR (n = 203) were randomised to CHOICE for 3 months (n = 100) or CHOICEplus for 24 months (n = 103) at four urban hospitals. The program comprised telephone-based tailored risk-factor reduction.
Results
CHOICE and CHOICEplus were equivalent demographically and in risk profile at baseline. At 24 months, lipid profiles improved significantly and fewer patients had ≥3 risk factors above target compared to baseline in both groups. There were no significant differences between groups.
Conclusions
The 24-month CHOICEplus program did not confer additional benefit above the brief 3-month CHOICE intervention. However, participation in either CHOICE and CHOICEplus significantly improved cardiovascular risk profile in ACS survivors. Importantly, the study was feasible, and the intervention translated readily across four hospitals. Overall, this study adds to the existing evidence for brief individualised approaches to CR.This work was supported by a Hospital Contributions Fund (HCF) Foundation Grant. LN was funded by an NHMRC Early Career Fellowship (APP1036763). JR is funded by an NHMRC Career Development Fellowship (1061793) co-funded with a National Heart Foundation Future Leader Fellowship (G160523). KH is supported by an Australian Postgraduate Award. NL was funded by a National Heart Foundation Postgraduate Scholarship (PP12S6990)
Promotility Action of the Probiotic Bifidobacterium lactis HN019 Extract Compared with Prucalopride in Isolated Rat Large Intestine
No full textCopyright © 2017 Dalziel, Anderson, Peters, Lynch, Spencer, Dekker and Roy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Attention is increasingly being focussed on probiotics as potential agents to restore or improve gastrointestinal (GI) transit. Determining mechanism of action would support robust health claims. The probiotic bacterium Bifidobacterium lactis HN019 reduces transit time, but its mechanisms of action and effects on motility patterns are poorly understood. The aim of this study was to investigate changes in GI motility induced by an extract of HN019 on distinct patterns of colonic motility in isolated rat large intestine, compared with a known promotility modulator, prucalopride. The large intestines from male Sprague Dawley rats (3–6 months) were perfused with Kreb's buffer at 37°C in an oxygenated tissue bath. Isometric force transducers recorded changes in circular muscle activity at four independent locations assessing contractile propagation between the proximal colon and the rectum. HN019 extract was perfused through the tissue bath and differences in tension and frequency quantified relative to pre-treatment controls. Prucalopride (1 μM) increased the frequency of propagating contractions (by 75 ± 26%) in the majority of preparations studied (10/12), concurrently decreasing the frequency of non-propagating contractions (by 50 ± 11%). HN019 extract had no effect on contractile activity during exposure (n = 8). However, following wash out, contraction amplitude of propagating contractions increased (by 55 ± 18%) in the distal colon, while the frequency of non-propagating proximal contractions decreased by 57 ± 7%. The prokinetic action of prucalopride increased the frequency of synchronous contractions along the length of colon, likely explaining increased colonic rate of transit in vivo. HN019 extract modified motility patterns in a different manner by promoting propagating contractile amplitude and inhibiting non-propagations, also demonstrating prokinetic activity consistent with the reduction of constipation by B. lactis HN019 in humans
Regional differences in nutrient-induced secretion of gut serotonin
No full textThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Enterochromaffin (EC) cells located in the gastrointestinal (GI) tract provide the vast majority of serotonin (5‐HT) in the body and constitute half of all enteroendocrine cells. EC cells respond to an array of stimuli, including various ingested nutrients. Ensuing 5‐HT release from these cells plays a diverse role in regulating gut motility as well as other important responses to nutrient ingestion such as glucose absorption and fluid balance. Recent data also highlight the role of peripheral 5‐HT in various pathways related to metabolic control. Details related to the manner by which EC cells respond to ingested nutrients are scarce and as that the nutrient environment changes along the length of the gut, it is unknown whether the response of EC cells to nutrients is dependent on their GI location. The aim of the present study was to identify whether regional differences in nutrient sensing capability exist in mouse EC cells. We isolated mouse EC cells from duodenum and colon to demonstrate differential responses to sugars depending on location. Measurements of intracellular calcium concentration and 5‐HT secretion demonstrated that colonic EC cells are more sensitive to glucose, while duodenal EC cells are more sensitive to fructose and sucrose. Short‐chain fatty acids (SCFAs), which are predominantly synthesized by intestinal bacteria, have been previously associated with an increase in circulating 5‐HT; however, we find that SCFAs do not acutely stimulate EC cell 5‐HT release. Thus, we highlight that EC cell physiology is dictated by regional location within the GI tract, and identify differences in the regional responsiveness of EC cells to dietary sugars
A Short Non-Saline Sprinkling Increases the Tuber Weights of Saline Sprinkler Irrigated Potatoes
No full text© 2017 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).Previous work has shown that a short non-saline sprinkling, following saline sprinkling, increased crop growth. We incorporated this finding into an investigation of two approaches to the conjunctive use of saline and non-saline water sources for sprinkler irrigation of potatoes viz., (i) mixing waters prior to application, and (ii) keeping waters temporally separate, that is commencing each irrigation with saline water and finishing it with non-saline sprinkling. The latter approach delayed canopy senescence and increased tuber weight by at least 150%. Under both approaches, soil salinities and leaf and tuber concentrations of Na+ and Cl− were similar. Thus, the advantages of a non-saline sprinkling cannot be explained in terms of its effect on either soil osmotic potential or bulk tissue concentrations of putatively toxic ions Na+ and Cl−. We propose that the positive effect of finishing irrigations with a non-saline sprinkling may be attributed to either dilution, and hence increase in osmotic potential, of the water film that remains on the leaf after each irrigation or its effect on the distribution of the putatively toxic ions Na+ and Cl− within tissue. View Full-Tex
New insights into the genetics of primary open-angle glaucoma based on meta-analyses of intraocular pressure and optic disc characteristics.
Get PDFPre-copyedited author-produced manuscript made available following 12 month embargo from date of publication in accordance with publisher copyright policy.Primary open-angle glaucoma (POAG), the most common optic neuropathy, is a heritable disease. Siblings of POAG cases have a ten-fold increase risk of developing the disease. Intraocular pressure (IOP) and optic nerve head characteristics are used clinically to predict POAG risk. We conducted a genome-wide association meta-analysis of IOP and optic disc parameters and validated our findings in multiple sets of POAG cases and controls. Using imputation to the 1000 genomes (1000G) reference set, we identified 9 new genomic regions associated with vertical cup disc ratio (VCDR) and 1 new region associated with IOP. Additionally, we found 5 novel loci for optic nerve cup area and 6 for disc area. Previously it was assumed that genetic variation influenced POAG either through IOP or via changes to the optic nerve head; here we present evidence that some genomic regions affect both IOP and the disc parameters. We characterized the effect of the novel loci through pathway analysis and found that pathways involved are not entirely distinct as assumed so far. Further, we identified a novel association between CDKN1A and POAG. Using a zebrafish model we show that six6b (associated with POAG and optic nerve head variation) alters the expression of cdkn1a In summary, we have identified several novel genes influencing the major clinical risk predictors of POAG and showed that genetic variation in CDKN1A is important in POAG risk
Is task-shifting a solution to the health workers’ shortage in Northern Ghana?
Get PDFThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Objective
To explore the experiences and perceptions of health workers and implementers of task-shifting in rural health facilities in Upper East Region, Ghana.
Methods
Data was collected through field interviews. A total of sixty eight (68) in-depth interviews were conducted with health workers’ in primary health care facilities (health centres); Four in-depth interviews with key persons involved in staff management was conducted to understand how task-shifting is organised including its strengths and challenges. The health workers interview guide was designed with the aim of getting data on official tasks of health workers, additional tasks assigned to them, how they perceive these tasks, and the challenges associated with the practice of task-shifting.
Findings
Task-shifting is a practice being used across the health facilities in the study area to help reduce the impact of insufficient health workers. Generally, health workers had a comprehensive training that supported the organisation of task-shifting. However, staff members’ are sometimes engaged in tasks above their level of training and beyond their actual job descriptions. Adequate training is usually not provided before additional tasks are assigned to staff members. Whilst some health workers perceived the additional tasks they performed as an opportunity to learn new skills, others described these as stressful and overburdening.
Conclusion
Task-shifting has the potential to contribute to addressing the insufficient health workforce, and thereby improving health delivery system where the procedures are well defined and staff members work in a coordinated and organised manner. The provision of adequate training and supervision for health workers is important in order to improve their expertise before additional tasks are assigned to them so that the quality of care would not be compromised
Review of The Child Savage, 1890-2010: From Comics to Games edited by Elizabeth Wesseling
Get PDFReview of The Child Savage, 1890-2010: From Comics to Games edited by Elizabeth Wesselin