Perinatal mental disorders in Switzerland : prevalence estimates and use of mental-health services

Background: Perinatal mental disorders (PMDs) are the most common complication of pregnancy and the first postpartum year. Since PMD prevalence and use of mental-health services by perinatal women in Switzerland are unknown, we analysed existing health statistics. Methods: We used statistics from a large health insurance company, hospitals and freelance midwives. We assessed the annual rates of mental healthcare use in perinatal women (n = 13 969). We ascertained the annual rates of PMD treatment in obstetric inpatients (n = 89 699), and annual rates of PMD records by freelance midwives (n = 57 951). In 15 104 women who gave birth in 2012 or 2013, we assessed use of mental-healthcare before and during pregnancy, and in the postpartum year. For the same sample, we determined proportions of medication and consultation treatments. We used multiple regression analysis to estimate the influence of PMD on overall healthcare costs of mandatory health insurance. Results: The annual rate of mental-healthcare use by perinatal women was 16.7%. The annual rate of PMD treatment in obstetric inpatients was 1.1%. The annual rate of PMD records in the midwifery care setting was 2.9%. Women with PMD use mental health services mainly in non-obstetric outpatient settings. Medication was the most frequent treatment. Primary care providers and mental health specialists contributed almost equally to consultation treatments. PMD during pregnancy raised overall costs of healthcare in the postpartum year by 1214 Swiss francs. Conclusions: Health-system research and perinatal healthcare should take into consideration the high prevalence of PMD. Real PMD prevalence may be even higher than our data suggest and could be assessed with a survey using our model of PMD prevalence

Dedicated Spiral Breast Computed Tomography With a Single Photon-Counting Detector: Initial Results of the First 300 Women

OBJECTIVES The aim of this study was to describe our initial clinical experiences using a dedicated spiral breast computed tomography (B-CT) with a single photon-counting detector. MATERIALS AND METHODS This retrospective study was approved by the institutional review board. Examinations of 300 consecutive women undergoing B-CT were evaluated on reason of assignment for B-CT instead of mammography, detection rate of breast cancer, and quality criteria of data acquisition. Further evaluated performance indicators were the number of additional ultrasounds examinations due to unclear findings or dense breast tissue and reliability of the technical data acquisition. RESULTS Five hundred ninety-one B-CT acquisitions in 300 women were performed. The main reason for preference of B-CT over mammography was the lack of breast compression (254 of 300, 84.7%), which was desired due to personal reasons or mastodynia, whereas 10 patients (0.3%) had implants hampering mammography. One hundred two possible lesions were detected in B-CT including 4 cases of breast cancer (1.3% of all patients). Additional ultrasound was performed in 226 patients (102 due to detected lesions and 124 due to dense breast tissue). Three malignant lesions were only detected in an additional ultrasound (1% of all patients). As a quality criterion, the pectoralis muscle was included in 341 of 591 examinations, but complete assessment of breast tissue was only possible in 149, respectively 140 examinations. No movement artifacts were noted. In 99% of all women, the examination could be realized. CONCLUSIONS The dedicated B-CT provides high-quality images. It can be used as alternative particularly in those patients not otherwise willing to perform mammography because of the breast compression

Memoryless Worker-Task Assignment with Polylogarithmic Switching Cost

We study the basic problem of assigning memoryless workers to tasks with dynamically changing demands. Given a set of $w$ workers and a multiset $T \subseteq[t]$ of $|T|=w$ tasks, a memoryless worker-task assignment function is any function $\phi$ that assigns the workers $[w]$ to the tasks $T$ based only on the current value of $T$. The assignment function $\phi$ is said to have switching cost at most $k$ if, for every task multiset $T$, changing the contents of $T$ by one task changes $\phi(T)$ by at most $k$ worker assignments. The goal of memoryless worker task assignment is to construct an assignment function with the smallest possible switching cost. In past work, the problem of determining the optimal switching cost has been posed as an open question. There are no known sub-linear upper bounds, and after considerable effort, the best known lower bound remains 4 (ICALP 2020). We show that it is possible to achieve polylogarithmic switching cost. We give a construction via the probabilistic method that achieves switching cost $O(\log w \log (wt))$ and an explicit construction that achieves switching cost $\operatorname{polylog} (wt)$. We also prove a super-constant lower bound on switching cost: we show that for any value of $w$, there exists a value of $t$ for which the optimal switching cost is $w$. Thus it is not possible to achieve a switching cost that is sublinear strictly as a function of $w$. Finally, we present an application of the worker-task assignment problem to a metric embeddings problem. In particular, we use our results to give the first low-distortion embedding from sparse binary vectors into low-dimensional Hamming space.Comment: ICALP 202

Nonpharmacologic Treatments for Childhood Constipation:Systematic Review

OBJECTIVE: To summarize the evidence and assess the reported quality of studies concerning nonpharmacologic treatments for childhood constipation, including fiber, fluid, physical movement, prebiotics, probiotics, behavioral therapy, multidisciplinary treatment, and forms of alternative medicine. METHODS: We systematically searched 3 major electronic databases and reference lists of existing reviews. We included systematic reviews and randomized controlled trials (RCTs) that reported on nonpharmacologic treatments. Two reviewers rated the methodologic quality independently. RESULTS: We included 9 studies with 640 children. Considerable heterogeneity across studies precluded meta-analysis. We found no RCTs for physical movement, multidisciplinary treatment, or alternative medicine. Some evidence shows that fiber may be more effective than placebo in improving both the frequency and consistency of stools and in reducing abdominal pain. Compared with normal fluid intake, we found no evidence that water intake increases or that hyperosmolar fluid treatment is more effective in increasing stool frequency or decreasing difficulty in passing stools. We found no evidence to recommend the use of prebiotics or probiotics. Behavioral therapy with laxatives is not more effective than laxatives alone. CONCLUSIONS: There is some evidence that fiber supplements are more effective than placebo. No evidence for any effect was found for fluid supplements, prebiotics, probiotics, or behavioral intervention. There is a lack of well-designed RCTs of high quality concerning nonpharmacologic treatments for children with functional constipation. Pediatrics 2011;128:753-76

Facilitating Effective Communication Between First Responders and Older Adults During Fall Incidents

PURPOSE. The purpose of this project was to provide first responders with communication strategies for older adults that may help when responding to fall- related calls. General information was also provided to First Responders on working with older adults with a focus on the aging process, fall risk factors, and communications strategies. METHODS. A series of educational sessions to first responders at a local fire district were developed and presented by occupational therapy students. Materials were developed by presenters from evidence-based resources and tailored to the target population. Each presentation focused on statistics about older adults, the aging process, fall risk factors, and effective communication strategies for older adults. Each two hour presentation consisted of a lecture, role play, and a discussion period. RESULTS. Evaluations were completed by participants upon the conclusion of each educational presentation. Evaluations included rating the quality and information provided, and whether participants recommend this training to other first responders. The average rating was 92-98% which indicated participants strongly agree and the training was useful and would recommend it to other first responders. CONCLUSION. As the older adult population increases, more individuals wish to “age in place”, leading to an increased number of falls among older adults, and requiring emergency care from first responders. Information and communication strategies provided through educational presentations to first responders may help facilitate effective communication during an emergency call with an older adult and also prevent future falls. Collaboration with first responders can help occupational therapists develop new role regarding fall prevention and communication with older adults.https://scholar.dominican.edu/ug-student-posters/1019/thumbnail.jp

Impact of elosulfase alfa in patients with morquio A syndrome who have limited ambulation: An open-label, phase 2 study.

Efficacy and safety of elosulfase alfa enzyme replacement therapy (ERT) were assessed in an open-label, phase 2, multi-national study in Morquio A patients aged ≥5 years unable to walk ≥30 meters in the 6-min walk test. Patients received elosulfase alfa 2.0 mg/kg/week intravenously for 48 weeks. Efficacy measures were functional dexterity, pinch/grip strength, mobility in a modified timed 25-foot walk, pain, quality of life, respiratory function, and urine keratan sulfate (KS). Safety/tolerability was also assessed. Fifteen patients received elosulfase alfa, three patients discontinued ERT due to adverse events (two were grade 3 drug-related adverse events, the other was not drug-related), and two patients missed >20% of planned infusions; 10 completed treatment through 48 weeks and received ≥80% of planned infusions (Modified Per Protocol [MPP] population). The study population had more advanced disease than that enrolled in other trials. From baseline to week 48, MPP data showed biochemical efficacy (urine KS decreased 52.4%). The remaining efficacy results were highly variable due to challenges in test execution because of severe skeletal and joint abnormalities, small sample sizes, and clinical heterogeneity among patients. Eight patients showed improvements in one or more outcome measures; several patients indicated improvements not captured by the study assessments (e.g., increased energy, functional ability). The nature of adverse events was similar to other elosulfase alfa studies. This study illustrates the considerable challenges in objectively measuring impact of ERT in very disabled Morquio A patients and highlights the need to examine results on an individual basis. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc

Systematic analysis on the relationship between luminal enhancement, convolution kernel, plaque density, and luminal diameter of coronary artery stenosis: a CT phantom study

To systematically investigate into the relationships between luminal enhancement, convolution kernel, plaque density, and stenosis severity in coronary computed tomography (CT) angiography. A coronary phantom including 63 stenoses (stenosis severity, 10-90%; plaque densities, −100 to 1,000HU) was loaded with increasing solutions of contrast material (luminal enhancement, 0-700HU) and scanned in an anthropomorphic chest. CT data was acquired with prospective triggering using 64-section dual-source CT; reconstructions were performed with soft-tissue (B26f) and sharp convolution kernels (B46f). Two blinded and independent readers quantitatively assessed luminal diameter and CT number of plaque using electronic calipers. Measurement bias between phantom dimensions and CT measurements were calculated. Multivariate linear regression models identified predictors of bias. Inter- and intra-reader agreements of luminal diameter and CT number measurements were excellent (ICCs>0.91, p200HU. Measurement bias was significantly (p<0.01, each) correlated (ρ=0.37-55 and ρ=−0.70-85) with the differences between luminal enhancement and plaque density. In multivariate models, bias of luminal diameter assessment with CT was correlated with plaque density (β=0.09, p<0.05). Convolution kernel (β=−0.29 and −0.38), stenosis severity (β=−0.45 and −0.38), and luminal enhancement (β=−0.11 and −0.29) represented independent (p<0.05,each) predictors of measurement bias of luminal diameter and plaque number, respectively. Significant independent relationships exist between luminal enhancement, convolution kernel, plaque density, and luminal diameter, which have to be taken into account when performing, evaluating, and interpreting coronary CT angiograph

New Signal of Atmospheric Tau Neutrino Appearance: Sub-GeV Neutral-Current Interactions in JUNO

We propose the first practical method to detect atmospheric tau neutrino appearance at sub-GeV energies, which would be an important test of $\nu_\mu \rightarrow \nu_\tau$ oscillations and of new-physics scenarios. In the Jiangmen Underground Neutrino Observatory (JUNO; starts in 2024), active-flavor neutrinos eject neutrons from carbon via neutral-current quasielastic scattering. This produces a two-part signal: the prompt part is caused by the scattering of the neutron in the scintillator, and the delayed part by its radiative capture. Such events have been observed in KamLAND, but only in small numbers and were treated as a background. With $\nu_\mu \rightarrow \nu_\tau$ oscillations, JUNO should measure a clean sample of 55 events/yr; with simple $\nu_\mu$ disappearance, this would instead be 41 events/yr, where the latter is determined from Super-Kamiokande charged-current measurements at similar neutrino energies. Implementing this method will require precise laboratory measurements of neutrino-nucleus cross sections or other developments. With those, JUNO will have $5\sigma$ sensitivity to tau-neutrino appearance in 5 years exposure, and likely sooner.Comment: 12 pages, 8 figure

Value of Abdominal Radiography, Colonic Transit Time, and Rectal Ultrasound Scanning in the Diagnosis of Idiopathic Constipation in Children:A Systematic Review

Objective To perform a systematic review evaluating the value of abdominal radiography, colonic transit time (CTT), and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children. Study design Eligible studies were those assessing diagnostic accuracy of abdominal radiography, CTT, or rectal ultrasound scanning in children suspected for idiopathic constipation. Methodological quality of the included studies was assessed with the Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews checklist. Results One systematic review summarized 6 studies on abdominal radiography until 2004. The additional 9 studies evaluated abdominal radiography (n = 2), CTT (n = 3), and ultrasound scanning (n = 4). All studies except two used a case-control study design, which will lead to overestimation of test accuracy. Furthermore, none of the studies interpreted the results of the abdominal radiography, ultrasound scanning, or CTT without knowledge of the clinical diagnosis of constipation. The sensitivity of abdominal radiography, as studied in 6 studies, ranged from 80% (95% CI, 65-90) to 60%(95% CI, 46-72), and its specificity ranged from 99%(95% CI, 95-100) to 43%(95% CI, 18-71). Only one study presented test characteristics of CTT, and two studies presented test characteristics of ultrasonography. Conclusion We found insufficient evidence for a diagnostic association between clinical symptoms of constipation and fecal loading on abdominal radiographs, CTT, and rectal diameter on ultrasound scanning in children. (J Pediatr 2012; 161: 44-50)