Determinants of use of care provided by complementary and alternative health care practitioners to pregnant women in primary midwifery care:A prospective cohort study

Background: Pregnant women visit complementary/alternative health care practitioners in addition to regular maternal health care practitioners. A wide variation has been reported with regard to rates and determinants of use of complementary/alternative medicine (CAM), which may be due to heterogeneous populations. The aim of this study was to examine the prevalence and determinants of use of CAM practitioners by a homogeneous population of low-risk pregnant women in the Netherlands. Methods: Data from the population-based DELIVER study was used, concerning 1500 clients from twenty midwifery practices across the Netherlands in 2009 and 2010. CAM use was measured based on patient reports. Potential determinants were derived from Andersen's behavioural model of health care utilization. Results: The prevalence of CAM practitioner use by low-risk pregnant women was 9.4 %. Women were more likely to use CAM if they had supplementary health care insurance (OR 3.11; CI 1.41-6.85), rated their health as 'bad/fair' (OR 2.63; CI 1.65-4.21), reported a chronic illness or handicap (OR 1.93; CI 1.14-3.27), smoked during pregnancy (OR 1.88; CI 1.06-3.33), or used alcohol during pregnancy (OR 2.30; CI 1.46-3.63). Conclusions: CAM is relatively frequently used by low-risk pregnant women. Determinants revealed in this study diverge from other studies using heterogeneous populations. Maternal health care practitioners must be aware of CAM use by low-risk pregnant women and incorporate this knowledge into daily practice by actively discussing this subject with pregnant women

Serious game-based word-to-text integration intervention effects in English as a second language

Word-to-text integration (WTI) is the ability to integrate words into a mental representation of the text and is important for reading comprehension, but challenging in English as a second language (ESL). However, it remains unclear whether WTI can be trained in seventh grade ESL learners, who often struggle with reading comprehension and display large individual differences. To pay attention to individual differences, the present study examined an adaptive computer game-based WTI-intervention. The intervention, replacing 50 min of ESL classroom instruction, comprized a 12-week program in which students had to complete WTI-based assignments within four serious games, targeting morphosyntactic awareness, translation of words within sentences, recognizing idioms from words in contexts, and a filler game targeting dictation. The intervention group (n = 164) was compared to a control group (n = 166), who only received regular ESL classroom instruction. Both groups completed the following reading measures: decoding, morphological, and syntactic awareness, WTI (argument and anomaly reading speed and processing), and reading comprehension tasks at the beginning (T1) of the school year and at the end (T2) of the school year. Results demonstrated an intervention effect on decoding and anomaly processing as reflected by an interaction between time (T1 vs. T2) and group (intervention vs. control) in a repeated measures MANOVA. Follow-up mediation analyses for the intervention group only - with game performance as mediators between reading measures at T1 and T2 - indicated that students with better T1 scores on reading measures showed more growth in performance within games. More performance growth within the translation game and the idiom recognition game was related to better reading scores at T2. Both high-achieving and low-achieving students displayed performance growth within games, indicating that a WTI intervention yields promising results for a broad variety of ESL readers

Behavior and complications of hepatocellular adenoma during pregnancy and puerperium:a retrospective study and systematic review

BACKGROUND: Hepatocellular adenomas (HCA) are benign liver tumors at risk of hemorrhage. The influence of pregnancy on HCA growth and potential bleeding remains unclear. This study investigates HCA-associated behavior and bleeding complications during or shortly after pregnancy. METHODS: (I) Single center retrospective cohort study of HCA during and after pregnancy (II) Systematic literature review. RESULTS: The retrospective study included 11 patients, of which 4 with HCA ≥5 cm. In only two patients HCA showed growth during pregnancy. In this local cohort, no HCA-related hemorrhages occurred during median follow-up of 34 months (interquartile range 19-58 months). The systematic review yielded 33 studies, totaling 90 patients with 99 pregnancies. Of 73 pregnancies without prior HCA-related intervention, 39 HCA remained stable (53.4%), 11 regressed (15.1%), and 23 (31.5%) progressed. Fifteen HCA-related hemorrhages occurred in HCA measuring 6.5-17.0 cm. Eight patients experienced bleeding during pregnancy, two during labor and five postpartum. CONCLUSION: Although hemorrhage of HCA during or shortly after pregnancy is rare and only reported in HCA ≥6.5 cm, it can be fatal. Pregnancy in women with HCA, regardless of size, warrant a close surveillance strategy. Observational studies on behavior and management of HCA ≥5 cm during and immediately after pregnancy are needed

Eczema phenotypes and risk of allergic and respiratory conditions in school age children

Background: Eczema phenotypes based on eczema onset and persistence might better identify groups prone to allergic and respiratory conditions than a binary definition of eczema. We examined the associations of childhood eczema phenotypes with allergic sensitization, allergy, asthma and lung function at school age. Methods: This study among 4277 children was embedded in a multi-ethnic population-based prospective cohort study. Five eczema phenotypes (never, early transient, mid-transient, late transient, persistent) based on parental-reported physician-diagnosed eczema from age 6 months until 10 years were identified. At age 10 years, allergic sensitization was measured by skin prick tests, physician-diagnosed allergy and asthma by parent-reported questionnaires, and lung function by spirometry. Adjusted linear, logistic and multinomial regression models were applied. Results: Compared with never eczema, all eczema phenotypes were associated with increased risks of asthma (odds ratios (OR) range (95% confidence interval): 2.68 (1.58, 4.57) to 11.53 (6.65, 20.01)), food and inhalant allergic sensitization (1.72 (1.25, 2.36) to 12.64 (7.20, 22.18)), and physician-diagnosed inhalant allergy (1.92 (1.34, 2.74) to 11.91 (7.52, 18.86)). Strongest effect estimates were observed of early and persistent eczema with the risk of physician-diagnosed food allergy (OR 6.95 (3.76, 12.84) and 35.05 (18.33, 70.00), respectively) and combined asthma and physician-diagnosed allergy (7.11 (4.33, 11.67) and 29.03 (15.27, 55.22), respectively). Eczema phenotypes were not associated with lung function measures. Conclusion: Eczema phenotypes were differentially associated with risks of respiratory and allergic conditions in school-aged children. Children with early transient and persistent eczema might benefit from more intense follow-up for early identification and treatment of asthma and allergies

Impact of word-to-text integration processes on reading comprehension development in English as a second language

Background: Word-to-text integration (WTI) can be challenging for second-language (L2) learners, although it can positively contribute to reading comprehension. The present study examined the role of WTI, after controlling for decoding, vocabulary and morphosyntactic awareness, in predicting English as an L2 reading comprehension development in 441 Dutch seventh-grade students. Methods: At the beginning (Time 1 [T1]) and the end (Time 2 [T2]) of the school year, students were tested on their English decoding, vocabulary, morphological and syntactic awareness and reading comprehension with paper-and-pencil tasks and on WTI with a self-paced reading task with reading times being compared on passages with unknown versus known words and passages with and without anomalies. Results: Mediation analyses showed small indirect effects of processing argument overlap and anomalies on T2 reading comprehension, via T1 reading comprehension. Conclusions: WTI explained unique variance in reading comprehension at T2 via reading comprehension at T1, suggesting that it moderately impacts initial stages of reading comprehension in English as a second language (ESL)

Relationships between Serotonin Transporter Binding in the Raphe Nuclei, Basal Ganglia, and Hippocampus with Clinical Symptoms in Cervical Dystonia:A [C]DASB Positron Emission Tomography Study

PurposeAlterations of the central serotonergic system have been implicated in the pathophysiology of dystonia. In this molecular imaging study, we assessed whether altered presynaptic serotonin transporter (SERT) binding contributes to the pathophysiology of cervical dystonia (CD), concerning both motor and non-motor symptoms (NMS).MethodsWe assessed the non-displaceable binding potential (BPND) using the selective SERT tracer [11C]DASB and positron emission tomography (PET) in 14 CD patients and 12 age- and gender-matched controls. Severity of motor symptoms was scored using the Toronto Western Spasmodic Torticollis Rating Scale and Clinical Global Impression jerks/tremor scale. NMS for depressive symptoms, anxiety, fatigue, and sleep disturbances were assessed with quantitative rating scales. The relationship between SERT binding and clinical patient characteristics was analyzed with the Spearman’s rho test and multiple regression.ResultsWhen comparing the CD patients with controls, no significant differences in BPND were found. Higher BPND in the dorsal raphe nucleus was statistically significantly correlated (p < 0.001) with motor symptom severity (rs = 0.65), pain (rs = 0.73), and sleep disturbances (rs = 0.73), with motor symptom severity being the most important predictor of SERT binding. Furthermore, fatigue was negatively associated with the BPND in the medial raphe nucleus (rs = −0.61, p = 0.045), and sleep disorders were positively associated with the BPND in the caudate nucleus (rs = 0.58, p = 0.03) and the hippocampus (rs = 0.56, p = 0.02).ConclusionMotor symptoms, as well as pain, sleep disturbances, and fatigue in CD showed a significant relationship with SERT binding in the raphe nuclei. Moreover, fatigue showed a significant relationship with the medial raphe nucleus and sleep disorders with the caudate nucleus and hippocampus. These findings suggest that an altered serotonergic signaling in different brain areas in CD is related to different motor as well as NMS, which will further stimulate research on the role of serotonin in the pathogenesis of dystonia

Amount and Distribution of Intracranial Calcification in Symptomatic and Asymptomatic Primary Familial Brain Calcification

BACKGROUND AND OBJECTIVES: In clinical practice, it can be difficult to differentiate between intracranial calcifications related to primary familial brain calcification (PFBC) or aging. Also, little is known about the consequences of the amount of intracranial calcifications in patients with PFBC. Therefore, we aimed to compare the amount and distribution of intracranial calcifications in persons with PFBC with controls and between asymptomatic and symptomatic PFBC cases. METHODS: This was a case-control study including patients with PFBC and controls. Controls received a CT of the brain because of a trauma and had at least some basal ganglia calcification. The Nicolas score and volume of calcification were used to quantify intracranial calcifications on the CT scans. Receiver operating characteristic curves were obtained to calculate optimal cutoff points to discriminate between cases and controls. Mann-Whitney U tests and logistic regression, adjusted for age and sex, were used to compare the amount of calcification. RESULTS: Twenty-eight cases (median age 65 years, 50.0% male) and 90 controls (median age 74 years, 46.1% male) were included. Calcification scores were higher in cases (median volume: 4.91 cm 3 against 0.03 cm 3, p < 0.001, median Nicolas score: 26.5 against 2.0, p < 0.001) than controls. Calcifications were also more diffusely distributed in cases. To differentiate between cases and controls, optimal cutoff points were ≥0.2 cm 3 for the calcification volume and ≥6.0 for the Nicolas score. Calcification was higher for symptomatic than asymptomatic cases (calcification volume: 13.62 cm 3 against 1.61 cm 3, p = 0.01, Nicolas score: 39.0 against 15.5, p = 0.02). After adjustment for age and sex, the Nicolas score remained significantly higher in symptomatic patients, and the calcification volume did not. DISCUSSION: Patients with PFBC had more severe intracranial calcifications, and these calcifications were more diffusely distributed through the brain compared with controls. Symptomatic patients with PFBC might have more intracranial calcifications than asymptomatic persons

Maternal and neonatal 25-hydroxyvitamin D concentrations and school-age lung function, asthma and allergy. The Generation R Study

Background: Vitamin D deficiency in early life might affect the developing lung and immune system, and subsequently influence the risk of asthma and allergy in later life. Objective: We examined the associations of 25‐hydroxyvitamin D concentrations in mid‐gestation and at birth with lung function, asthma, inhalant allergic sensitization and inhalant allergy at school‐age. Methods: This study among 4951 children and their mothers was embedded in a population‐based prospective cohort in Rotterdam, the Netherlands. Maternal ve‐ nous blood samples in mid‐gestation and umbilical cord blood samples at birth were used to determine 25‐hydroxyvitamin D concentrations. At age 10 years, lung func‐ tion was measured by spirometry, current asthma and physician‐diagnosed inhalant allergy by questionnaire, and inhalant allergic sensitization by skin prick tests. We used multivariable regression models to examine associations. Results: Higher 25‐hydroxyvitamin D concentrations in mid‐gestation were associ‐ ated with a higher forced vital capacity (FVC), but a lower forced expiratory volume in 1 second/FVC (FEV1/FVC) and a lower forced expiratory flow after exhaling 75% of FVC (FEF75) (Z‐score differences [95% CI] 0.02 [0.00, 0.03], −0.02 [−0.03, −0.01] and −0.01 [‐0.03, −0.00], respectively, per 10 nmol/L 25‐hydroxyvitamin D), but not with asthma. Furthermore, higher 25‐hydroxyvitamin D concentrations in mid‐gesta‐ tion were associated with an increased risk of inhalant allergy (Odds Ratio [95% CI] 1.07 [1.02, 1.12]), but not with inhalant allergic sensitization. After additional adjust‐ ment for child's 25‐hydroxyvitamin D concentrations at the age of 6 years, only the associations of 25‐hydroxyvitamin D concentrations in mid‐gestation with FEV1