Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D.

BACKGROUND: Hypovitaminosis D is well known in different populations, but may be under diagnosed in certain populations. We aim to determine the first diagnosis considered, the duration and resolution of symptoms, and the predictors of response to treatment in female asylum seekers suffering from hypovitaminosis D. METHODS: Design: A pre- and post-intervention observational study. Setting: A network comprising an academic primary care centre and nurse practitioners. Participants: Consecutive records of 33 female asylum seekers with complaints compatible with osteomalacia and with hypovitaminosis D (serum 25-(OH) vitamin D < 21 nmol/l). Treatment intervention: The patients received either two doses of 300,000 IU intramuscular cholecalciferol as well as 800 IU of cholecalciferol with 1000 mg of calcium orally, or the oral treatment only. Main outcome measures: We recorded the first diagnosis made by the physicians before the correct diagnosis of hypovitaminosis D, the duration of symptoms before diagnosis, the responders and non-responders to treatment, the duration of symptoms after treatment, and the number of medical visits and analgesic drugs prescribed 6 months before and 6 months after diagnosis. Tests: Two-sample t-tests, chi-squared tests, and logistic regression analyses were performed. Analyses were performed using SPSS 10.0. RESULTS: Prior to the discovery of hypovitaminosis D, diagnoses related to somatisation were evoked in 30 patients (90.9%). The mean duration of symptoms before diagnosis was 2.53 years (SD 3.20). Twenty-two patients (66.7%) responded completely to treatment; the remaining patients were considered to be non-responders. After treatment was initiated, the responders' symptoms disappeared completely after 2.84 months. The mean number of emergency medical visits fell from 0.88 (SD 1.08) six months before diagnosis to 0.39 (SD 0.83) after (P = 0.027). The mean number of analgesic drugs that were prescribed also decreased from 1.67 (SD 1.5) to 0.85 (SD 1) (P = 0.001). CONCLUSION: Hypovitaminosis D in female asylum seekers may remain undiagnosed, with a prolonged duration of chronic symptoms. The potential pitfall is a diagnosis of somatisation. Treatment leads to a rapid resolution of symptoms, a reduction in the use of medical services, and the prescription of analgesic drugs in this vulnerable population.

Vom Finanz- zum Wissenschaftsbetrug : Methode, den Irrungen in der medizinischen Literatur beizukommen [From financial to scientific fraud : Methods to detect discrepancies in the medical literature].

Fraud is as old as Mankind. There are an enormous number of historical documents which show the interaction between truth and untruth; therefore it is not really surprising that the prevalence of publication discrepancies is increasing. More surprising is that new cases especially in the medical field generate such a huge astonishment. In financial mathematics a statistical tool for detection of fraud is known which uses the knowledge of Newcomb and Benford regarding the distribution of natural numbers. This distribution is not equal and lower numbers are more likely to be detected compared to higher ones. In this investigation all numbers contained in the blinded abstracts of the 2009 annual meeting of the Swiss Society of Anesthesia and Resuscitation (SGAR) were recorded and analyzed regarding the distribution. A manipulated abstract was also included in the investigation. The χ(2)-test was used to determine statistical differences between expected and observed counts of numbers. There was also a faked abstract integrated in the investigation. A p<0.05 was considered significant. The distribution of the 1,800 numbers in the 77 submitted abstracts followed Benford's law. The manipulated abstract was detected by statistical means (difference in expected versus observed p<0.05). Statistics cannot prove whether the content is true or not but can give some serious hints to look into the details in such conspicuous material. These are the first results of a test for the distribution of numbers presented in medical research.

Environmental effects of Deccan volcanism across the Cretaceous-Tertiary transition in Meghalaya, India

The Urn Sohryngkew section of Meghalaya, NE India, located 800-1000 km from the Deccan volcanic province, is one of the most complete Cretaceous-Tertiary boundary (KTB) transitions worldwide with all defining and supporting criteria present: mass extinction of planktic foraminifera, first appearance of Danian species, delta(13)C shift, Ir anomaly (12 ppb) and KTB red layer. The geochemical signature of the KTB layer indicates not only an extraterrestrial signal (Ni and all Platinum Group Elements (PGEs)) of a second impact that postdates Chicxulub, but also a significant component resulting from condensed sedimentation (P), redox fluctuations (As, Co, Fe, Pb, Zn, and to a lesser extent Ni and Cu) and volcanism. From the late Maastrichtian C29r into the early Danian, a humid climate prevailed (kaolinite: 40-60%, detrital minerals: 50-80%). During the latest Maastrichtian, periodic acid rains (carbonate dissolution; CIA index: 70-80) associated with pulsed Deccan eruptions and strong continental weathering resulted in mesotrophic waters. The resulting super-stressed environmental conditions led to the demise of nearly all planktic foraminiferal species and blooms (>95%) of the disaster opportunist Guembelitria cretacea. These data reveal that detrimental marine conditions prevailed surrounding the Deccan volcanic province during the main phase of eruptions in C29r below the KTB. Ultimately these environmental conditions led to regionally early extinctions followed by global extinctions at the KTB. (C) 2011 Elsevier B.V. All rights reserved.

Dispersal of Aedes aegypti and Aedes albopictus (Diptera: Culicidae) in an urban endemic dengue area in the State of Rio de Janeiro, Brazil

Experimental releases of female Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus were performed in August and September 1999, in an urban area of Nova Iguaçu, State of Rio de Janeiro, Brazil, to estimate their flight range in a circular area of 1,600 m where 1,472 ovitraps were set. Releases of 3,055 Ae. aegypti and 2,225 Ae. albopictus females, fed with rubidium (Rb)-marked blood and surgically prevented from subsequent blood-feeding, were separated by 11 days. Rb was detected in ovitrap-collected eggs by atomic emission spectrophotometry. Rb-marked eggs of both species were detected up to 800 m from the release point. Eggs of Ae. albopictus were more numerous and more heterogeneously distributed in the area than those of Ae. aegypti. Eggs positively marked for Rb were found at all borders of the study area, suggesting that egg laying also occurred beyond these limits. Results from this study suggest that females can fly at least 800 m in 6 days and, if infected, potentially spread virus rapidly.

Strategic Review of Medical Training and Career Structures Report on Medical Career Structures and Pathways following completion of Specialist Training

The Minister for Health decided, in July 2013, to establish a Working Group, chaired by Professor Brian MacCraith, President of DCU, to carry out a strategic review of medical training and career structure. The Working Group will examine and make high-level recommendations relating to training and career pathways for doctors with a view to: From January-April 2014, the Working Group prioritised work on career structures and pathways following completion of specialist training in order to report to the Minister for Health on these issues in this report. Download the Report (PDF, 800 kb)  

Macrophage migration inhibitory factor: a regulator of innate immunity.

For more than a quarter of a century, macrophage migration inhibitory factor (MIF) has been a mysterious cytokine. In recent years, MIF has assumed an important role as a pivotal regulator of innate immunity. MIF is an integral component of the host antimicrobial alarm system and stress response that promotes the pro-inflammatory functions of immune cells. A rapidly increasing amount of literature indicates that MIF is implicated in the pathogenesis of sepsis, and inflammatory and autoimmune diseases, suggesting that MIF-directed therapies might offer new treatment opportunities for human diseases in the future.

Personality factors and alcohol use: a mediator analysis of drinking motives.

Current evidence on the association between personality factors, drinking motives, and alcohol use comes exclusively from North America. The present study, however, is based on a sample of 2090 Swiss college students (mean age 23.5, SD = 2,9) and investigates by means of structural equation modeling whether drinking motives mediate the association between personality factors and alcohol use. The results revealed that extraversion was positively related to drinking for enhancement motives; conscientiousness was negatively related to both enhancement and coping motives; and neuroticism was positively related to drinking for coping motives. The association between extraversion and alcohol use was mediated by enhancement motives, while the negative association between conscientiousness and alcohol use was partially mediated by both enhancement and coping motives. This concurs with the findings of North American studies. However, in contrast to these findings, our study finds that coping motives attenuate the "protective" effect of neuroticism with regard to alcohol use. Taken together, the study indicates that alcohol use serves specific purposes depending on particular personality traits. The finding that personality-related effects are partially mediated by motives increases the likelihood that motive-based preventive efforts will help reduce alcohol use among young adults who display particular personality traits.

Deaths in Northern Ireland, 2008

The number of deaths registered in Northern Ireland in 2008 was 14,900, a small increase on the 14,600 deaths registered in 2007. Cancer continues to be the most common cause of death with nearly 4,000 cancer deaths last year.These findings are contained in provisional 2008 mortality figures released by the Northern Ireland Statistics and Research Agency (NISRA).In 2008, over half of all deaths were caused by three main diseases; cancer (4,000 deaths), ischaemic heart disease (2,400 deaths) and stroke (1,300 deaths). Whilst ischaemic heart disease deaths halved from 4,800 in 1978 to 2,400 last year; cancer deaths have risen from 2,900 in 1978 to 4,000 last year.Over the last few years we have seen marked increases in deaths recorded due to Alzheimer's and other dementia related illnesses; conditions largely associated with the elderly. In 2008, there were 290 deaths due to Alzheimer's disease and a further 520 deaths due to other forms of dementia. Deaths related to healthcare-associated infection also increased last year.

Configuració d'un equip eficient per a projectes informàtics

En els estudis d'enginyeria superior d'informàtica fets s'estudien els aspectes tècnics i metodològics de gestió de projectes informàtics. Ara bé, s'aborda breument un dels factors més importants i més determinants dels projectes: el factor humà. Aquest projecte complementa els coneixements sobre la gestió de projectes mitjançant un estudi sobre com el vessant humà afecta el desenvolupament d'un projecte informàtic. El projecte serveix de manual per a conèixer el funcionament d'un equip de projecte informàtic i de guia per a poder dirigir un equip d'aquestes característiques. Aquest treball permet saber per què pot funcionar un equip de projecte informàtic, quins factors individuals i de grup hi ha, quins són els seus participants i quines són les seves funcions, com s'organitzen, els problemes que hi poden aparèixer, i consells i estratègies per a aconseguir un equip eficient. Alhora, el projecte es complementa amb una sèrie d'experiències de persones que desenvolupen o han desenvolupat diferents rols dins equips de diferents projectes informàtics, que ajuden a entendre i identificar l'objectiu estudiat.

Le "Protévangile de Jacques" en latin. Etat de la question et perspectives nouvelles

Dans la première partie, on décrit et classifie les témoins qui contribuent à la connaissance du Protévangile de Jacques (PJ) en latin : 23 mss latins, les évangiles irlandais de l'enfance du Liber Flavus Fergusiorum (LFF) et du Leabhar Breac (LB). On clarifie dans une seconde partie plusieurs questions touchant à la diversité des formes textuelles du PJ en Occident, démontrant l'existence d'au moins deux traductions latines indépendantes. (I) L'une, plutôt littérale, est conservée en partie dans Montpellier 55 (M2) et Paris, n.a.l. 718 (S). (II) L'autre, caractérisée par des amplifications, est représentée par 4 témoins : Sainte-Geneviève 2787 (G; texte presque complet); l'homélie Inquirendum est (ch. 1-8, mss KPRBDO); l'Evangile latin de l'enfance combinant une partie du PJ, le Pseudo-Matthieu et une source inconnue, de coloration docète (compilation J, 8 témoins); le récit du LFF (ch. 1-16). Une troisième traduction indépendante est peut-être attestée (mss TUE). On montre ainsi l'existence de deux étapes successives d'amplification de la traduction II (IIa et IIb), illustrant le besoin d'expliciter la narration concise du PJ original. Cette traduction amplifiée a servi de modèle à l'auteur du remaniement latin du Pseudo-Matthieu. On éclaire enfin les antécédents, les caractéristiques et l'évolution de J, qui a vu le jour avant 800. La présente étude trouvera son prolongement dans l'édition critique des diverses formes du Protévangile latin

ICT Skills Action Plan 2014-2018

In January 2012, in a direct response to specific skills shortages for people with high-level ICT skills, the Department of Education and Skills published a joint Government–industry ICT Action Plan aimed at building the supply of high-level ICT graduates. One of the key measures in the Plan was the roll-out, from March 2012, of more than 800 places on intensive NFQ level 8 higher diploma ICT skills conversion programmes by higher education providers in partnership with industry. In recognition of the ICT and software development skills shortages that continue to exist, a second phase of the ICT Skills Programme was rolled-out in late 2012, with the Higher Education Authority requesting proposals from higher education providers for a further round of specialist programmes aimed at addressing identified ICT and software development skills gaps. From spring 2013, a number of higher education providers are again offering a number of Level 8 Conversion Programmes, in collaboration with industry partners, which will provide graduates from other skills areas with the opportunity to up-skill or re-skill through a 1 year full-time HDip Conversion Programme in core computing/programming, software and data analysis.

Taeniasis-cysticercosis in Southern Ecuador: assessment of infection status using multiple laboratory diagnostic tools

Taenia solium-taeniasis and cysticercosis were studied in the human and porcine populations of a rural community in the Southern Ecuadorian Andes. From the 1059 inhabitants, 800 serum samples and 958 stool samples could be collected. In addition, 646 from the estimated 1148 pigs were tongue inspected. Circulating antigen was detected by enzyme linked immunosorbent assay (Ag-ELISA) in 2.25% of the human population, whereas intestinal taeniasis was detected in 1.46% by the formalin-ether technique. Following treatment and recovery of tapeworm fragments these were all identified as T. solium. Porcine cysticercosis was diagnosed in 3.56% of the pigs by tongue inspection. In addition, enzyme linked immunoelectrotransfer blot (EITB) was performed on a subset group of 100 humans to confirm the results of the Ag-ELISA. One hundred serum samples from pigs were also analysed by EITB. It appeared that 43 and 74% of humans and pigs had antibodies against T. solium cysticerci, respectively. It is concluded that contrary to the high exposure of the human population to T. solium that is suggested by EITB, the number of active cysticercosis cases, diagnosed by Ag-ELISA, was low, which may indicate endemic stability. The further use of complementary diagnostic methods for a better understanding of the epidemiology of T. solium is suggested.

A single high dose of oral vitamin D3 is insufficient to correct a deficiency in a rheumatologic population

Introduction Vitamin D plays a major role in bone metabolismand neuromuscular function. Supplementation with vitamin D iseffective to reduce the risk of fall and of fracture. However adherenceto oral daily vitamin D is low. Screening and correcting vitamin Dinsufficiency in a rheumatologic population could improve bothmorbidity and quality of life. After determining the prevalence ofvitamin D deficiency in this population, we evaluated if supplementationwith a single high dose of oral 25-OH vitamin D3 wassufficient to correct this abnormality.Methods During one month (November 2009), levels of 25-OHvitamin D were systematically determined in our rheumatology outpatientclinic and classified in: vitamin D deficiency (< 10 μg/l),vitamin D insufficiency (10 to 30 μg/l) or normal vitamin D (> 30 μg/l).Patients with insufficiency or deficiency received respectively a singlehigh dose of 300'000 IU or 600'000 IU oral vitamin D3. In addition,all patients with osteoporosis were prescribed daily supplement ofcalcium (1 g) and vitamin D (800 IU). 25-OH vitamin D levels werereevaluated after 3 months.Results Vitamin D levels were initially determined in 292 patients(mean age 53, 211 women, 87 % Caucasian). 77 % had inflammatoryrheumatologic disease (IRD), 20 % osteoporosis (OP) and 12 %degenerative disease (DD). Vitamin D deficiency was present in 20(6.8 %), while 225 (77.1 %) had insufficiency. Of the 245 patientswith levels < 30μg/l, a new determination of vitamin D level wasavailable in 173 (71 %) at 3 months.Conclusion Vitamin D insufficiency is highly prevalent in ourrheumatologic population (84 %), and is not adequately correctedby a single high dose of oral vitamin D3 in > 50 % of the patientswith IRD and DD. In patients with OP, despite association of asingle high dose with daily oral vitamin D supplementation, 40 %of patients are still deficient when reevaluated at 3 months.

Capillostrongyloides arapaimae sp. n. (Nematoda: Capillariidae), a new intestinal parasite of the arapaima Arapaima gigas from the Brazilian Amazon

A new nematode species, Capillostrongyloides arapaimae sp. n., is described from the intestine and pyloric caeca of the arapaima, Arapaima gigas (Schinz), from the Mexiana Island, Amazon river delta, Brazil. It is characterized mainly by the length of the spicule (779-1,800 µm), the large size of the body (males and gravid females 9.39-21.25 and 13.54-27.70 mm long, respectively) and by the markedly broad caudal lateral lobes in the male. It is the third species of genus Capillostrongyloides reported to parasitize Neotropical freshwater fishes.