Computed Tomography Perfusion Can Guide Endovascular Therapy in Bilateral Carotid Artery Dissection

Carotid artery dissection (CAD) is a major cause of stroke in those under age 45, accounting for around 20% of ischaemic events[1,2]. In the absence of known connective tissue disorders, most dissections are traumatic[2]. First-line management is comprised of antiplatelet or anticoagulation therapy, but many traumatic dissections progress despite this and carry the risk of long-term complications from embolism or stenosis[3]. We report a case of traumatic bilateral carotid dissection leading to progressive neurological symptoms and hypoperfusion on computed tomography perfusion (CTP), despite escalation in anticoagulation, which led to emergency carotid stenting.

A comparison of risky sexual behaviours between circumcised and uncircumcised men aged 30-44 years in Botswana.

Background: The principal mode of HIV transmission in Southern Africa is through sexual intercourse, and this has prompted uptake of safe male circumcision. Engaging in risky sexual behaviour by circumcised men increases the risks of acquiring HIV, though male circumcision coupled with preventive behaviour reduces this risk. Objective: To compare the factors associated with risky sexual behaviour among circumcised and uncircumcised men in Botswana. Methods: Nationally representative data from the Botswana AIDS Impact Survey III were used. A sample of 313 sexually active men was used. The data was analysed by cross-tabulation and logistic regression. Results: The study revealed that uncircumcised men (odds ratio, 5.711) were more likely to have sex while intoxicated with alcohol compared to circumcised men. Low levels of education (odds ratio, 8.736), urban residency (city/town: odds ratio, 1.238 and urban village: odds ratio, 1.098) were more likely to influence risky behaviour (more than one sexual partner) for circumcised men. The results also show that marital status (never married) (odds ratio, 1.947) influences risky behaviour (having sex while intoxicated with alcohol) among uncircumcised men. Conclusion: Low level of education, place of residence and alcohol consumption influences risky sexual behaviour for both circumcised and uncircumcised men. Policies and programmes should thus focus on the attitudes underlying sexual behaviour.

Empathy in the field: towards a taxonomy of empathic communication in information gathering interviews with suspected sex offenders

Research suggests that those suspected of sexual offending might be more willing to reveal information about their crimes if interviewers display empathic behaviour. However, the literature concerning investigative empathy is in its infancy, and so as yet is not well understood. This study explores empathy in a sample of real-life interviews conducted by police officers in England with suspected sex offenders. Using qualitative methodology, the presence and type of empathic verbal behaviours displayed was examined. Resulting categories were quantitatively analysed to investigate their occurrence overall, and across interviewer gender. We identified four distinct types of empathy, some of which were used significantly more often than others. Female interviewers displayed more empathic behaviour per se by a considerable margin.

The Impact of Childhood Sexual Abuse on Later Parenting Self-Perceptions: The Moderating Effect of Family Support

Childhood sexual abuse has been found to be a risk factor for developing negative parenting self-perceptions later in life. Given this established relationship, it is crucial to investigate factors that may mitigate negative outcomes, such as family support. The present study used secondary analysis of a dataset of 265 predominantly African-American and low-income mothers. This study examined differences in parenting self-perceptions among mothers who experienced childhood sexual abuse and those who did not. Analyses revealed that mothers who experienced childhood sexual abuse did not differ in terms of parenting self-perceptions from non-sexually-abused mothers. After controlling for depression, there was no moderating effect of family support; however, a main effect for family support was observed. The results indicate that depression plays a larger role in mothers’ parenting self-perceptions than childhood sexual abuse, and that family support is beneficial for all mothers, regardless of sexual abuse status. Clinical implications are discussed.

Job-related strain and sexual health difficulties among heterosexual men from three european countries: The role of culture and emotional support

Introduction. Epidemiological evidence for the association between job-related stress and sexual difficulties in men is largely lacking. Little is known about the factors that may mediate or moderate this relationship. Aim. This study analyzes the association between job-related difficulties and men’s sexual difficulties. Main Outcome Measures. Job-related difficulties were measured by 10 yes/no questions that addressed a range of adverse workplace situations. The experience of sexual difficulties in the past 12 months was assessed by using seven dichotomous indicators developed in the National Study of Sexual Attitudes and Lifestyles (NATSAL) 2000. Method. Analyses were carried out using data from a 2011 online study of Portuguese, Croatian, and Norwegian men (N = 2,112). Multivariate logistic regression and mediation analysis were used to test the hypothesized association. Results. Men with job-related concerns reported lower sexual satisfaction than men without such concerns did (F = 7.53, P < 0.001). Multivariate analysis confirmed the association between job-related and sexual health concerns. The odds of experiencing one or more sexual health difficulties in the past 12 months were about 1.8 times higher among men who reported the highest levels of workplace difficulties than among men who experienced no such difficulties. The odds of reporting sexual health difficulties were significantly reduced by a higher income (adjusted odds ratio [AOR] = 0.87, P < 0.01), emotional intimacy with one’s partner (AOR = 0.93, P < 0.001), having children (AOR = 0.62–0.66, P < 0.01), and country-specific effects (AOR = 1.98–2.22, P < 0.001). In all three countries, the relationship between job-related and sexual health difficulties was mediated by anxiety and depression. Conclusions. The findings suggest that negative mood is the mechanism behind the association between workplace strain and sexual difficulties. Emotional support, such as couple intimacy and fatherhood, can reduce—independently from sociocultural and socioeconomic factors—the risk of sexual health concerns.

Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation: A Single Technology Appraisal. Evidence Review Group Report to NICE

1.1 Edoxaban is recommended, within its marketing authorisation, as an option for preventing stroke and systemic embolism in adults with non-valvular atrial fibrillation with one or more risk factors, including: congestive heart failure hypertension diabetes prior stroke or transient ischaemic attack age 75 years or older

Comportamiento sexual y reproductivo de los estudiantes de la carrera de Medicina, Facultad de Ciencias Médicas, Universidad de Cuenca, en el año 2015, Cuenca

La salud sexual y reproductiva es fundamental en el desarrollo biológico, psicológico y social del ser humano, el desconocimiento y la falta de información ponen en riesgo el correcto desenvolvimiento del ser humano en la sociedad, limita sus aspiraciones y metas y favorece la desestructuración familiar. OBJETIVO: Identificar el comportamiento sexual y reproductivo de los estudiantes de la carrera de medicina de la Universidad de Cuenca, para proporcionar una realidad y analizar posibles soluciones respecto a los resultados obtenidos. MATERIALES Y MÉTODOS: Es un estudio descriptivo en el año 2015. La muestra se obtuvo mediante aleatorización por conglomerados, constituido por hombres y mujeres. Para obtener la información se aplicó un cuestionario. La muestra estuvo conformada por 179 estudiantes, el nivel de confianza del 95% y un error estándar de 5%. Los datos fueron ingresados y analizados en el programa estadístico Epi Info 7. RESULTADOS: La población estudiantil con un 24,14% inició su vida sexual a los 18 años. El 48,6% refirió haber tenido relaciones sexuales. El 82,76% afirma haber utilizado un método anticonceptivo. CONCLUSIONES: Se evidencia que a pesar de disponer de recursos para acceder a servicios de salud, tener conocimientos sobre prevención de embarazo y que el uso de anticoncepción es frecuente, existen todavía estudiantes que necesitan capacitación en esta temática

Erectile dysfunction: prevalence, risk factors and involvement of antihypertensive drugs intervention

Purpose: To explore the literature regarding prevalance, risk factors and the involvement of antihypertensive drugs in erectile dysfunction (ED). Methods: Original research articles, reviews, editorials and case reports published in English language on the prevalence of sexual/erectile dysfunction in hypertensive men taking antihypertensive drugs and risk factors were identified through a search of four bibliographic databases, namely, PubMed, EMBASE, CINAHL and EBSCO Health. Results: Recent analyses suggest that hypertensive men of almost all age groups suffer from ED but it is more prevalent in elderly male patients. The involvement of β-blockers was found to be controversial. Nevertheless, some evidence had been found regarding the use of propranolol in high doses. Conclusion: The present review indicates the need for research to unravel the role of β-blockers in the manifestation of ED in hypertensive males, whom there are no contributory factors such as sedentary lifestyle, aging, stress and anxiety, etc.

Prosecutors' perspectives on clarifying sexual acts in child abuse interviews

For the successful prosecution of child sexual abuse offences, investigative interviews of alleged victims must establish beyond reasonable doubt the nature of each sexual offence alleged. One limitation of interviews from an evidential (prosecution) perspective is that they often include unnecessary questions about sexual acts, which risk damaging the witness's credibility in the eyes of the jury. The aim of this study, using focus group methodology, was to elicit further guidance from prosecutors about when, and how, interviewers should clarify details about sexual acts. Overall, the prosecutors advised that three factors need to be considered before asking clarifying questions: whether the detail already provided by the witness would be clear to juries; the developmental age of the child; and the strength of the evidence available to support the allegations. These findings and their implications for investigative interviewers are discussed.

Interventions for reducing extinction risk in chytridiomycosis-threatened amphibians

Wildlife diseases pose an increasing threat to biodiversity and are a major management challenge. A striking example of this threat is the emergence of chytridiomycosis. Despite diagnosis of chytridiomycosis as an important driver of global amphibian declines 15 years ago, researchers have yet to devise effective large-scale management responses other than biosecurity measures to mitigate disease spread and the establishment of disease-free captive assurance colonies prior to or during disease outbreaks. We examined the development of management actions that can be implemented after an epidemic in surviving populations. We developed a conceptual framework with clear interventions to guide experimental management and applied research so that further extinctions of amphibian species threatened by chytridiomycosis might be prevented. Within our framework, there are 2 management approaches: reducing Batrachochytrium dendrobatidis (the fungus that causes chytridiomycosis) in the environment or on amphibians and increasing the capacity of populations to persist despite increased mortality from disease. The latter approach emphasizes that mitigation does not necessarily need to focus on reducing disease-associated mortality. We propose promising management actions that can be implemented and tested based on current knowledge and that include habitat manipulation, antifungal treatments, animal translocation, bioaugmentation, head starting, and selection for resistance. Case studies where these strategies are being implemented will demonstrate their potential to save critically endangered species.

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

Background

Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed.

Methods

The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.

Results

The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.

Conclusion

The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.

Sexual behaviour in early adolescence: a cross-national comparison of Australian and United States youth

Objective: This study used matched samples from schools in the states of Victoria and Washington to compare sexual behaviour in early adolescence. It was hypothesised that the contrasting dominant policy objectives of harm minimisation in Australia and abstinence in the USA would result in state differences for markers of sexual risk, mirroring prior cross-national findings in substance use. Method: A two-stage cluster sampling approach was used to recruit students from the two states. Self-reported sexual behaviour was examined for 1,596 students in annual surveys from Grade 7 in 2002 to Grade 9 in 2004. Prevalence estimates were derived for each measure of sexual behaviour, and comparisons were made between gender groups in each state. Results: State differences were found for girls' first sex, with significantly more girls in Washington than Victoria having had sex by Grade 7. By Grade 9, significantly more girls in Victoria reported sex in the last year and more sexual partners than girls in Washington. A large proportion of Grade 9 students across both states reported inconsistent contraception use. Conclusions: Contradicting the abstinence policy objective, first sex by Grade 7 was more prevalent in Washington than in Victoria. While sexual behaviour was more prevalent in Grade 9 in Victoria, the sexually active showed no clear cross-national differences in markers of risk such as contraception use and pregnancy outcomes. Findings demonstrate few cross-national differences in adolescent sexual behaviour despite the different policy contexts of Victoria and Washington.

Metals in the environment as risk factors for infectious diseases: gaps and opportunities

Many parts of the world in which common infectious diseases are endemic also have the highest prevalence of trace metal deficiencies or rising rates of trace metal pollution. Infectious diseases can increase human susceptibility to adverse effects of metal exposure (at suboptimal or toxic levels), and metal excess or deficiency can increase the incidence or severity of infectious diseases. The co-clustering of major infectious diseases with trace metal deficiency or toxicity has created a complex web of interactions with serious but poorly understood health repercussions, yet has been largely overlooked in animal and human studies. This book focuses on the distribution, trafficking, fate, and effects of trace metals in biological systems. Its goal is to enhance our understanding of the relationships between homeostatic mechanisms of trace metals and the pathogenesis of infectious diseases. Drawing on expertise from a range of fields, the book offers a comprehensive review of current knowledge on vertebrate metal-withholding mechanisms and the strategies employed by different microbes to avoid starvation (or poisoning). Chapters summarize current, state-of-the-art techniques for investigating pathogen-metal interactions and highlight open question to guide future research. The book makes clear that improving knowledge in this area will be instrumental to the development of novel therapeutic measures against infectious diseases. ContributorsM. Leigh Ackland, Vahid Fa Andisi, Angele L. Arrieta, Michael A. Bachman, J. Sabine Becker, Robert E. Black, Julia Bornhorst, Sascha Brunke, Joseph A. Caruso, Jennifer S. Cavet, Anson C. K. Chan, Christopher H. Contag, Heran Darwin, George V. Dedoussis, Rodney R. Dietert, Victor J. DiRita, Carol A. Fierke, Tamara Garcia-Barrera, David P. Giedroc, Peter-Leon Hagedoorn, James A. Imlay, Marek J. Kobylarz, Joseph Lemire, Wenwen Liu, Slade A. Loutet, Wolfgang Maret, Andreas Matusch, Trevor F. Moraes, Michael E. P. Murphy, Maribel Navarro, Jerome O. Nriagu, Ana-Maria Oros-Peusquens, Elisabeth G. Pacyna, Jozef M. Pacyna, Robert D. Perry, John M. Pettifor, Stephanie Pfaffen, Dieter Rehder, Lothar Rink, Anthony B. Schryvers, Ellen K. Silbergeld, Eric P. Skaar, Miguel C. P. Soares, Kyrre Sundseth, Dennis J. Thiele, Richard B. Thompson, Meghan M. Verstraete, Gonzalo Visbal, Fudi Wang, Mian Wang, Thomas J. Webster, Jeffrey N. Weiser, Günter Weiss, Inga Wessels, Bin Ye, Judith T. Zelikoff, Lihong Zhang

A rational (unapologetically pragmatic) approach to dealing with the irrational - the setencing of offenders with mental disorders

People with mental impairment are so heavily over-represented in prisons and jails that jails have been labeled “warehouses for the mentally ill.” In many parts of the United States, there are more mentally impaired offenders in prisons than in hospitals for the mentally unwell. Offenders laboring with impaired mental functioning are often regarded as being less morally culpable for their crimes and hence less deserving of punishment. However, the reduced mental functioning of offenders does not diminish the harm caused to victims. People are no less dead if mentally unwell offenders kill them rather than offenders who are mentally sound. This tension has proven an intractable problem for sentencing law and practice. There are no clear, fair, and effective principles or processes for accommodating impaired mental functioning in the sentencing inquiry. It is an under-researched area of the law. In this Article, I explore this tension. Key to ascertaining the proper manner in which to incorporate mental illness into the sentencing system is clarity regarding the importance of consequences to the offender, as opposed to moral culpability. I analyze current approaches to sentencing offenders with mental health problems in both the United States and Australia. Despite the vastly different sentencing regimes in these countries, both systems are deficient in dealing with mentally ill offenders, but for different reasons. I propose a solution to administering sentences to offenders with a mental disorder that is equally applicable to both sentencing systems. Mental impairment should mitigate penalty. However, in determining the extent and circumstances in which it should do so, it is cardinal not to lose sight of the fact that those who are sentenced for a crime are not insane, and they were aware that their acts were wrong--otherwise they would not have been found guilty in the first instance. I argue that a standard ten percent sentencing discount should be accorded to offenders who were mentally disordered at the time of sentencing. There should be an even more substantial discount when it is likely that offenders will find the sanction--in particular imprisonment--more burdensome due to their mental state. This difference would ensure some recognition of the reduced blameworthiness of mentally impaired offenders and the extra hardship that some forms of punishment inflict on mentally *2 ill offenders, while not compromising the important objectives of proportionality and community protection. The only situations when mental disorder should not mitigate penalty are when the offender is a recidivist, serious sexual or violent offender. In these circumstances, the interests of the community are the paramount consideration. The analysis in this paper applies most directly when a term of imprisonment is imposed. However, the reasoning also extends to the threshold decision of whether or not a term of imprisonment should be imposed in the first place.

Exposure to Stressful Life Events and Lung Cancer Risk

Objectif: Examiner l’association entre l'exposition aux évènements stressants de la vie et le cancer du poumon. Méthodes: Les données proviennent d’une étude cas-témoins, menée chez les hommes et les femmes vivant dans la région métropolitaine de Montréal entre 1996 et 2001. Le cancer du poumon d’un cas éligible devait être confirmé histologiquement à l’un des 18 hôpitaux de cette région. Les témoins ont été sélectionnés aléatoirement de la liste électorale du Québec et ont été appariés au cas par fréquence de groupes d'âge et par sexe. Un questionnaire a été administré en entrevue pour recueillir les données, dont l’évaluation de huit évènements stressants de la vie par le participant. Si le participant avait vécu un évènement stressant ciblé durant les six dernières années, il devait aussi coter cet évènement sur une échelle de trois points. La régression logistique non conditionnelle a été utilisée pour estimer les rapports de cotes ainsi que leurs intervalles de confiance à 95%. Des analyses par sexe, niveau de tabagisme et par type histologique ont été réalisées. Nous avons aussi analysé l’association entre le cancer du poumon et le nombre total d'évènements, les évènements de perte et les évènements socioéconomiques, ainsi que chaque évènement individuellement. Les analyses des scores d'impact autoévalués et avec un score externe de perception, ont également été menées. Résultats: La population de ce projet comprend 1061 cas et 1422 témoins, âgés de 35 à 70 ans. Les participants inclus avaient répondu aux sections du questionnaire portant sur les facteurs de style de vie et sur l'historique de tabagisme. Dans l'ensemble, nous n’avons pas observé d’association entre le cancer du poumon et l'exposition aux évènements stressants de la vie. Nous avons observé une diminution du risque pour les évènements socioéconomiques autoévalués comme peu stressants (RC=0,50; IC 95%= 0,31 - 0,81). Conclusion: Nos résultats suggèrent que les évènements socioéconomiques sont associées à un risque réduit si ces évènements sont considérés comme peu stressant.