LXVII. On the chemical composition of the substances employed in pottery

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Iron deficiency in children: food for thought

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Iron deficiency has a high incidence in Australian children of Arabic background. It is recommended that medical practitioners improve the iron status of booth Australian mothers and children.Richard TL Couper, Karen N Simme

Prospective study of lung function and abdominal aortic aneurysm risk: The Atherosclerosis Risk in Communities study

Abstract Background and aims No prospective study has investigated whether individuals with respiratory impairments, including chronic obstructive pulmonary disease (COPD) and restrictive lung disease (RLD), are at increased risk of abdominal aortic aneurysm (AAA). We aimed to prospectively investigate whether those respiratory impairments are associated with increased AAA risk. Methods In 1987–1989, the Atherosclerosis Risk in Communities (ARIC) study followed 14,269 participants aged 45–64 years, without a history of AAA surgery, through 2011. Participants were classified into four groups, “COPD” [forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <lower limit of normal (LLN)], “RLD” (FEV1/FVC ≥ LLN and FVC < LLN), “respiratory symptoms with normal spirometry” (without RLD or COPD), and “normal” (without respiratory symptoms, RLD or COPD, reference group). Results During the 284,969 person-years of follow-up, 534 incident AAA events were documented. In an age, sex, and race-adjusted proportional hazards model, individuals with respiratory impairments had a significantly higher risk of AAA than the normal reference group. After adjustment for AAA risk factors, including smoking status and pack-years of smoking, AAA risk was no longer significant in the respiratory symptoms with normal spirometry group [HR (95% CI), 1.25 (0.98–1.60)], but was still increased in the other two groups [RLD: 1.45 (1.04–2.02) and COPD: 1.66 (1.34–2.05)]. Moreover, continuous measures of FEV1/FVC, FEV1 and FVC were associated inversely with risk of AAA. Conclusions In the prospective population-based cohort study, obstructive and restrictive spirometric patterns were associated with increased risk of AAA independent of smoking, suggesting that COPD and RLD may increase the risk of AAA. Highlights • No prospective study has examined the association between lung function and abdominal aortic aneurysm (AAA). • We examined this association using a prospective population-based study in the US. • Chronic obstructive pulmonary disease (COPD) and restrictive diseases patterns were associated with increased AAA risk. • This study suggested COPD and restrictive lung diseases may increase AAA risk

Speaking up during the COVID-19 pandemic: Nurses' experiences of organizational disregard and silence.

AIM: To critically examine nurses' experiences of speaking up during COVID-19 and the consequences of doing so. DESIGN: Longitudinal qualitative study. METHODS: Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. RESULTS: Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. CONCLUSION: Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a 'deaf' or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. IMPACT: Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. PATIENT OR PUBLIC CONTRIBUTION: Nurses working clinically during COVID-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design

Cromwell's Edinburgh press and the development of print culture in Scotland

Alasdair Mann, the noted scholar of book culture in early modern Scotland, has suggested that a significant change had occurred in Scotland's relationship with the printed word by the late seventeenth century. This study sets out to explain how the interregnum served as a ‘watershed’ during which a consumer demand was created for popular print and how this in turn necessitated a significant increase in the production and distribution of printed material. Beginning with the sale of the press and patent of Evan Tyler to the London Stationers’ Company in 1647, the article charts the key factors that transformed Scotland's printing industry from the production of official declarations and works for foreign markets to the production of polemical texts for a Scottish audience. These developments also witnessed publication of the first serial news journal and the growth of a competitive market for up-to-date printed news. More than just an anomaly that flourished during a decade of occupation, these fundamental changes altered Scotland by introducing the large-scale consumption of chapbooks and printed ephemera, thereby initiating the nation's enduring print culture

A typology of longitudinal integrated clerkships

Context Longitudinal integrated clerkships (LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time‐limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution‐specific studies. Objectives This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. Methods Data on all LIC and LIC‐like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student‐years of LIC‐like curricula. Results Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC‐like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. Conclusions Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context

Television, physical activity, diet, and body weight status: the ARIC cohort

<p>Abstract</p> <p>Background</p> <p>Television (TV) watching is the most common leisure activity in the United States. Few studies of adults have described the relationship between TV and health behaviors such as physical activity, diet, and body weight status.</p> <p>Methods</p> <p>Extant data from the Atherosclerosis Risk in Communities (ARIC) Study were analyzed to assess the association of TV with physical activity, diet, and body mass index (BMI) among 15,574 adults at baseline (1986–89) and 12,678 adults six years later. Television, physical activity, and diet were collected with questionnaires and BMI was measured at both time points. Based on baseline TV exposure, adults were categorized into high, medium, and low TV exposure. Linear and logistic regression models were adjusted for gender, age, race-center, smoking, education, and general health.</p> <p>Results</p> <p>Relative to participants who had low TV exposure, those with high TV exposure were more likely to be less physically active and have a poorer dietary profile at baseline and six-years later. Participants with high TV exposure at baseline had a 40% and 31% greater odds of being considered insufficiently active at baseline (1.40, 95% CI 1.26, 1.55), and six years later (1.31, 95% CI 1.18, 1.46). At baseline, high TV exposure was also associated with a 20% to 30% greater odds of being above the median for servings of salty snacks (1.37, 95% CI 1.24, 1.51), sweets (1.26, 95% CI 1.15, 1.38), and sweetened drinks (1.29, 95% CI 1.17, 1.42), and below the median for fruit and vegetable servings (1.36, 95% CI 1.24, 1.50). Higher TV exposure was also cross-sectionally associated with a greater odds for being overweight or obese (1.43, 95% CI 1.29, 1.58). Similar associations were observed between baseline TV exposure and six-year physical activity and diet, but were not observed with BMI after six years follow-up.</p> <p>Conclusion</p> <p>These results support the hypothesis that time spent watching TV is associated with deleterious effects on physical activity, diet, and BMI.</p

Does metformin improve vascular health in children with Type 1 diabetes? Protocol for a one year, double blind, randomised, placebo controlled trial

Background: Cardiovascular disease is the leading cause of mortality in Type 1 diabetes (T1D). Vascular dysfunction is an early and critical event in the development of cardiovascular disease. Children with T1D have vascular dysfunction therefore early interventions to improve vascular health are essential to reduce cardiovascular mortality in T1D. Metformin is an insulin sensitising agent which is known to improve vascular health outcomes in type 2 diabetes (T2D) and other individuals with insulin resistance. It has been used safely in children and adolescents with T2D for over 10 years. This study aims to assess the effect of metformin on vascular health in children with T1D. Methods/Design: This study is a 12 month, double blind, randomised, placebo controlled trial to determine the effect of metformin on vascular health in children (age 8–18) with T1D. The sample size is 76 with 38 children in the metformin group and 38 children in the placebo group. Vascular health and biochemical markers will be measured at baseline, 3, 6 and 12 months. Vascular function will be measured using flow mediated dilatation and glyceryl trinitrate mediated dilatation of the brachial artery and vascular structure will be measured with carotid and aortic intima media thickness, using standardised protocols. Discussion: This study will be the first to investigate the effect of metformin on vascular health in children with T1D. It will provide important information on a potential intervention to improve cardiovascular morbidity and mortality in this population at high risk from cardiovascular disease.Jemma Anderson, Alexia S Peña, Thomas Sullivan, Roger Gent, Bronwen D’Arcy, Timothy Olds, Brian Coppin and Jennifer Coupe

Investigating competencies needed by European-trained doctors in rural South African hospitals

Barnacle JR, Johnson O,Couper I. Investigating competencies needed by European-trained doctors in rural South African hospitals.Afr J Prm Health Care Fam Med. 2020;12(1), a2322. https://doi.org/10.4102/phcfm.v12i1.2322Barnacle JR, Johnson O, Couper I. Investigating competencies needed by European-trained doctors in rural South African hospitals. Afr J Prm Health Care Fam Med. 2020;12(1), a2322. https://doi.org/10.4102/ phcfm.v12i1.2322The original publication is available at http://www.phcfm.orgBackground: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work