#20 [updated] Community wide interventions for increasing physical activity - Clinical Version

People who are physically active have higher levels of health related fitness, and a lower risk profile for developing a number of disabling medical conditions and chronic diseases. However, despite considerable evidence of the benefits of regular physical activity, global levels of physical inactivity remain stubbornly high. In response, governments are looking to find ways to increase the physical activity of their populations.

Assessment of the underreporting rate of death cause data in Shandong province using capture-mark-recapture method [应用捕获再捕获方法评估山东省死因登记漏报率水平]

To evaluate the underreporting rate of death -cause data in Shandong province during 2012 to 2013 by capture -mark -recapture method and to provide the base for health strategy. Methods All counties were divided into 5 stratifications according the death rates of 2012, and 14 counties were selected, then 3 towns or streets were selected in each country, 10 villages or neighborhood committees were selected in each town （street）. The death data collected from security bureau and civil affairs bureau were compared with the reporting death data from the National Cause of Death Surveillance, and the underreporting rate was calculated. Results In present study, 6 929 death cases were collected, it was found that 1 556 cases were underreported. The death cases estimated by CMR method were 6 227 cases （95%CI: 7 593-7 651）, and the average underreporting rate was 23.15%. There were significantly differences between different stratifications （P<0.01）. The underreporting rate in 0-4 years old group was 56.93%, the male underreporting rate was 22.31% and the female underreporting rate was 24.09%. There was no significant difference between male and female groups （P>0.05）. Conclusion There is an obvious underreport in the cause of death surveillance of Shandong province, and the underreporting rates are different among the 5 stratifications. The underreporting rate is higher in 0-4 years old group, and the investigation of the death cause surveillance for young residents is not perfect in some countries. The investigation quality of the death cause surveillance should be improved, increasing the integrity of the report data and adjusting the mortalities in different stratifications for obtaining a accurate mortality in Shandong province.

Attributes of clinical role models as described by senior veterinary students in Australia

Role models incite admiration and provide inspiration, contributing to learning as students aspire to emulate their example. The attributes of physician role models for medical trainees are well documented, but they remain largely unexplored in the context of veterinary medical training. The aim of the current study was to describe the attributes that final-year veterinary students (N=213) at the University of Queensland identified when reflecting on their clinical role models. Clinical role model descriptions provided by students were analyzed using concept-mapping software (Leximancer v. 2.25). The most frequent and highly connected concepts used by students when describing their role model(s) included clients, vet, and animal. Role models were described as good communicators who were skilled at managing relationships with clients, patients, and staff. They had exemplary knowledge, skills, and abilities, and they were methodical and conducted well-structured consultations. They were well respected and, in turn, demonstrated respect for clients, colleagues, staff, and students alike. They were also good teachers and able to tailor explanations to suit both clients and students. Findings from this study may serve to assist with faculty development and as a basis for further research in this area.

Clinical Escherichia coli isolates utilize alpha-hemolysin to inhibit in vitro epithelial cytokine production

Uropathogenic Escherichia coli is the primary cause of urinary tract infections, which affects over 60% of women during their lifetime. UPEC exhibits a number of virulence traits that facilitate colonization of the bladder, including inhibition of cytokine production by bladder epithelial cells. The goal of this study was to identify the mechanism of this inhibition. We observed that cytokine suppression was associated with rapid cytotoxicity toward epithelial cells. We found that cytotoxicity, cytokine suppression and alpha-hemolysin production were all tightly linked in clinical isolates. We screened a UPEC fosmid library and identified clones that gained the cytotoxicity and cytokine-suppression phenotypes. Both clones contained fosmids encoding a PAI II(J96)-like domain and expressed the alpha-hemolysin (hlyA) encoded therein. Mutation of the fosmid-encoded hly operon abolished cytotoxicity and cytokine suppression. Similarly, mutation of the chromosomal hlyCABD operon of UPEC isolate F11 also abolished these phenotypes, and they could be restored by introducing the PAI II(J96)-like domain-encoding fosmid. We also examined the role of alpha-hemolysin in cytokine production both in the murine UTI model as well as patient specimens. We conclude that E. coli utilizes alpha-hemolysin to inhibit epithelial cytokine production in vitro. Its contribution to inflammation during infection requires further study.

Integration of clinical information systems in Saudi Arabian health care contexts: A grounded theory exploration

This research examined the implementation of clinical information system technology in a large Saudi Arabian health care organisation. The research was underpinned by symbolic interactionism and grounded theory methods informed data collection and analysis. Observations, a review of policy documents and 38 interviews with registered nurses produced in-depth data. Analysis generated three abstracted concepts that explained how imported technology increased practice and health care complexity rather than enhance quality patient care. The core category, Disseminating Change, also depicted a hierarchical and patriarchal culture that shaped the implementation process at the levels of government, organisation and the individual.

Amber teething necklaces: Is there any basis to their use in teething infants?

Introduction. Baltic amber-bead necklaces or bracelets are commonly used for managing teething symptoms in infants. The effectiveness of these beads is claimed to be from succinic acid release (a compound said to have analgesic and anti-inflammatory properties), which is then absorbed through the skin. Aims. To investigate whether succinic acid is contained in Baltic amber teething necklaces purchased in Australia, whether it can be released from the beads, and whether it has anti-inflammatory activity. Methods. Infrared spectroscopy was used to confirm that the teething necklaces were made of Baltic amber. The amount of succinic acid contained within the beads was quantified, and succinic acid release from intact beads was measured in phosphate buffered saline (PBS) pH 5.5 or octanol. Anti-inflammatory activity of succinic acid was compared with ibuprofen, paracetamol and hydrocortisone in vitro using THP-1 human macrophages stimulated with LPS. Secretion of the cytokines IL-1a, IL-1b, IL-8 and TNF-α were determined by ELISA. Results. Each necklace (33 beads in length) contained 19.17 ± 4.89 mg of succinic acid (mean ± se). Over a 6-month period, no succinic acid was detected in PBS. While 0.13 ± 0.09 mg of succinic acid per necklace was released in octanol, this was due to only one replicate of amber beads which had fragmented into shards free-floating in the solvent. Succinic acid had no effect on cytokine secretion unless extremely high concentrations were used and changes were likely to be associated with cell apoptosis and death. Discussion. No evidence for anti-inflammatory activity was found in the cytokines studied. It is possible that succinic acid could exert an effect via some other mechanism, but while the teething necklaces do contain small quantities of succinic acid, it is highly unlikely to be released from intact beads.

Clinical tips: Bowel cancer screening

So, when was the last time you checked your poo? Checking your poo – it probably is not a conversation many patients want to have with their pharmacists. But bowel cancer screening remains an important tool in cancer detection...

Clinical tips: Treating addiction explained

Helping treat and manage addiction through pharmacotherapy is part of a complex process, write Dr Esther Lau and Professor Lisa Nissen, from the School of Clinical Sciences, Queensland University of Technology...

AJP clinical update: Eye health

For most people our eyes provide around 80% of the information from our surroundings, and pharmacists are perfectly placed to help consumers maintain good eye health.

Clinical tips: Diabetes explained

For many people, diabetes can start insidiously, without people knowing or being aware that they have diabetes. Signs and symptoms can just start with something very benign, such as feeling more thirsty than usual, or that they are going to the bathroom more because they are drinking more fluids from being thirsty...

Clinical tips: Mental health and Christmas explained

Christmas is usually a time for celebration, being with family and friends, opening presents, stuffing yourself silly with food at Christmas lunch – then doing it all over again at dinner. However, this may not be the case for some people. Relationships with family may be strained, or there may have been the loss of a loved one or significant other...

Feedback and clinical practice improvement: A tool to assist workplace supervisors and students

In work integrated learning, students may report difficulties applying theory learned at university to clinical practice. One contributing factor may be students' inability to engage in meaningful reflection and self-correcting behaviours. This paper reports the evaluation of a tool, process and resources developed to assist students to reflect on feedback and engage in self-assessment. Students were assisted to develop self-assessment skills by reflecting on, and engaging with feedback from previous workplace experiences to develop goals, learning outcomes and strategies to improve performance with mostly positive results. A secondary aim was to identify common learning strategies or barriers that impacted on student outcomes. Four themes emerged from the qualitative data: 1) preparing for clinical learning; 2) relationships and engagement levels; 3) shared awareness, and; 4) developing clinical practice. Overall students felt the tool assisted them to narrow their attention on what needed to be improved. While supervisors believed the tool helped them to focus on specific needs of each student. Common barriers to clinical practice improvement related to a lack of opportunity in some settings, and lack of staff willingness to support students to achieve identified goals. Students and supervisors found the use of the tools beneficial and assisted students to demonstrate a greater understanding of how to apply feedback received to support their learning in the clinical environment.

Pro-apoptotic NOXA is implicated in atmospheric-pressure plasma-induced melanoma cell death

Atmospheric-pressure plasma (APP) has been successfully used to treat several types of cancers in vivo and in vitro, with the effect being primarily attributed to the generation of reactive oxygen species (ROS). However, the mechanisms by which APP induces apoptosis in cancer cells require further elucidation. In this study, the effects of APP on the expression of 500 genes in melanoma Mel007 cancer cells were examined. Pro-apoptotic phorbol-12-myristate-13-acetate-induced protein (PMAIP1), also known as NOXA, was highly expressed as a result of APP treatment in a dose-dependent manner. Blocking of ROS using scavenger NAC or silencing of NOXA gene by RNA interference inhibited the APP-induced NOXA genes upregulation and impaired caspases 3/7 mediated apoptosis, confirming the important role plasma-generated ROS species and pro-apoptotic NOXA play in APP-induced cancer cell death.

Clinical Tips: Crohn's and Colitis

Inflammatory bowel disease (IBD) describes a group of chronic relapsing inflammatory conditions of the gastrointestinal tract (GIT), with Crohn’s disease and ulcerative colitis being the two most common. Ulcerative colitis affects the colon, with the inflammation limited to the colonic mucosal layers. In contrast, the full thickness of the gut wall can be inflamed in Crohn’s disease, and any part of the GIT can be affected – from the mouth to the anus, though the small and large intestine are most commonly involved...

Clinical tips: Food poisoning

Food poisoning is used to describe a range of illnesses caused by drinking or eating contaminated drink or food. Infectious pathogens include bacteria, viruses, parasites, or their toxins, though food poisoning can also be a result of eating poisonous plants e.g. some mushrooms, or animals e.g. puffer fish. Common symptoms include nausea, vomiting, watery diarrhoea, abdominal pain and cramps, and fevers, though these will vary depending on the causative pathogen or toxin. Symptoms can start within hours of eating contaminated food, or may begin days or weeks later. Most food poisoning is mild in nature, lasts for several hours to a few days, and generally resolves without treatment. However, some cases of food poisoning can also be extremely severe, with people requiring medical attention or admission to hospital...