Congenital thumb anomalies and the consequences for daily life : patients’ long-term experience after corrective surgery. A qualitative study

Purpose: The aim of the study was to explore patients’ long-term experience of a congenital hand problem, and the consequences for daily life. Method: Fifteen participants with a median age 24 years (17–55 years), born with thumb hypoplasia/aplasia or thumb duplication were interviewed using a semi-structured interview guide. The interviews were subjected to qualitative content analysis. Results: Although the mobility and strength in the thumb/hand(s) varied within the group, hand function was generally described as good. Compensatory strategies were used to overcome practical obstacles. The emotional reactions to being visibly different from peers in early life varied from total acceptance and a sense of pride in being special, to deep distress and social withdrawal. Support from parents, teachers and others was important in facing emotional challenges and practical consequences. Conclusion: The present study highlights the importance of healthcare professionals addressing appearance-related concerns which may have long-term emotional and social consequences for patients born with a thumb anomaly. Implications for RehabilitationAppearance-related concerns and need for emotional support should be fully considered throughout the rehabilitation process to prevent distress and social withdrawal.Effective problem-solving strategies, such as compensation, change in occupational performance and support from others may reduce activity limitations and participation restriction

Mental distress, alcohol use and help-seeking among medical and business students: a cross-sectional comparative study

<p>Abstract</p> <p>Background</p> <p>Stress and distress among medical students are thoroughly studied and presumed to be particularly high, but comparative studies including other student groups are rare.</p> <p>Methods</p> <p>A web-based survey was distributed to 500 medical students and 500 business students. We compared levels of study stress (HESI), burnout (OLBI), alcohol habits (AUDIT) and depression (MDI), and analysed their relationship with self-assessed mental health problems by logistic regression, with respect to gender.</p> <p>Results</p> <p>Medical students' response rate was 81.6% and that of business students 69.4%. Business students scored higher on several study stress factors and on disengagement. Depression (OR 0.61, CI₉₅0.37;0.98) and harmful alcohol use (OR 0.55, CI₉₅0.37; 0.75) were both less common among medical students. However, harmful alcohol use was highly prevalent among male students in both groups (medical students 28.0%, business students 35.4%), and among female business students (25.0%). Mental health problems in need of treatment were equally common in both groups; 22.1% and 19.3%, respectively, and was associated with female sex (OR 2.01, CI₉₅1.32;3.04), exhaustion (OR 2.56, CI₉₅1.60;4.10), lower commitment to studies (OR 1.95, CI₉₅1.09;3.51) and financial concerns (OR 1.81 CI₉₅1.18;2.80)</p> <p>Conclusions</p> <p>Medical students may not be more stressed than other high achieving student populations. The more cohesive structure of medical school and a higher awareness of a healthy lifestyle may be beneficial factors.</p

Kafirin structure and functionality

The structural and functional properties of kafirins are reviewed. Three classes of kafirin: the a, ß and ? forms have been identified at the protein level and one, the d, has been identified only at the gene and transcript levels. All forms show high homology with the equivalent zein proteins. By analogy with the zeins it is believed that the a-kafirins probably have an extended hairpin structure in solution, comprising elements of a-helix, ß-sheet and turns folded back on itself. Kafirins are the most hydrophobic of the prolamins as shown by their solubility, and calculated hydration free energies. The proteins exhibit extensive cross-linking by disulphide bonds and on cooking form indigestible aggregates which are not solubilised by reduction of disulphide bonds. In spite of continuing studies, the reasons for the low digestibility of the protein remain uncertain and there may be several factors involved. Other research has shown that kafirins may have non-food uses and may be used to form films

Effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures: Consensus report of group 2 of the SEPA/DGI/OF workshop

OBJECTIVES: The aim of this study was to comprehensively assess the literature in terms of the effect of peri‐implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures to increase the mucosal thickness with autogenous grafts or soft tissue substitutes. MATERIAL AND METHODS: Two systematic reviews (SR) were performed prior to the consensus meeting to assess the following questions. Review 1, focused question: In systemically healthy patients with an implant‐supported fixed prosthesis, what is the influence of thin as compared to thick peri‐implant mucosa on esthetic outcomes? Review 2, focused question 1: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of connective tissue graft (CTG), as compared to absence of a soft tissue grafting procedure, in terms of gain in peri‐implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? Review 2, focused question 2: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri‐implant STT reported by RCTs or CCTs? The outcomes of the two SRs, the consensus statements, the clinical implications, and the research recommendations were discussed and subsequently approved at the consensus meeting during the group and plenary sessions. CONCLUSIONS: There was a tendency of superior esthetic outcomes in the presence of a thick mucosa. The connective tissue graft remains the standard of care in terms of increasing mucosa thickness

For whom is a health-promoting intervention effective? Predictive factors for performing activities of daily living independently

BACKGROUND: Health-promoting interventions tailored to support older persons to remain in their homes, so-called "ageing in place" is important for supporting or improving their health. The health-promoting programme "Elderly Persons in the Risk Zone," (EPRZ) was set up for this purpose and has shown positive results for maintaining independence in activities of daily living for older persons 80 years and above at 1- and 2 year follow-ups. The aim of this study was to explore factors for maintaining independence in the EPRZ health-promoting programme.METHODS: Total of 459 participants in the original trial was included in the analysis; 345 in the programme arm and 114 in the control arm. Thirteen variables, including demographic, health, and programme-specific indicators, were chosen as predictors for independence of activities of daily living. Logistic regression was performed separately for participants in the health promotion programme and in the control arm.RESULTS: In the programme arm, being younger, living alone and self-rated lack of tiredness in performing mobility activities predicted a positive effect of independence in activities of daily living at 1-year follow-up (odds ratio [OR] 1.18, 1.73, 3.02) and 2-year, (OR 1.13, 2.01, 2.02). In the control arm, being less frail was the only predictor at 1-year follow up (OR 1.6 1.09, 2.4); no variables predicted the outcome at the 2-year follow-up.CONCLUSIONS: Older persons living alone - as a risk of ill health - should be especially recognized and offered an opportunity to participate in health-promoting programmes such as "Elderly Persons in the Risk Zone". Further, screening for subjective frailty could form an advantageous guiding principle to target the right population when deciding to whom health-promoting intervention should be offered.TRIAL REGISTRATION: The original clinical trial was registered at ClinicalTrials.gov. Identifier: NCT00877058 , April 6, 2009

Grain legumes and dryland cereals for enhancing carbon sequestration in semi-arid and sub-humid agro-ecologies of Africa and South Asia

Sorghum, millets (pearl and finger millet) and grain legumes (chickpea, common bean, cowpea, lentils, pigeon pea and soybean), collectively referred to as GLDC under the CGIAR research program on Grain Legumes and Dryland Cereals, are commonly grown, eaten and traded by small holder farmers in Africa and South Asia. These crops contribute to food and nutritional security, environmental sustainability, and economic growth in the region. However, their possible contribution to carbon sequestration through biomass production and accumulation of soil organic carbon (SOC) is not known. To find out more about their contribution, and how to increase SOC, this study reviewed the evidence of carbon sequestration in farming systems that integrate GLDC in Africa and South Asia. A total of 437 publications reporting SOC and its proxies across 32 countries in Africa (N=250 studies) and South Asia (N=187) were identified as sources of evidence for carbon sequestration. Among these, 179 publications provided appropriate control groups for evaluating changes in aboveground carbon when GLDC were integrated under intercrop (n=38), crop rotation (n=8) or agroforestry (n=13), or when improved varieties of GLDC were compared with local varieties (n=14). A further 81 publications compared SOC content at the start and the end of the experiment while 43 publications compared SOC between farms growing GLDC and those which did not. Aboveground carbon of GLDC was found to be 1.51±0.05 Mg/ha in Africa and 2.29±0.10 Mg/ha in South Asia. Absolute SOC concentration in the topsoil (0-30 cm) was 0.96±0.06% in Africa and 0.58±0.04 in South Asia. It was observed that GLDC produced more aboveground carbon and significantly increased SOC when grown as intercrops and in crop rotations. The increase, however, depended on the species and whether the crop was a legume or a cereal. The largest amount of aboveground carbon (>2 Mg/ha) was found in cereals (and pigeon pea) while the largest increase in SOC was found in farming systems that included legumes. Aboveground carbon of improved varieties of GLDC was lower compared to local varieties. Soils which had low initial (32%) showed the greatest potential for carbon sequestration when GLDC were grown. Among the GLDC crops, pigeon pea which is a perennial grain legume showed the highest biomass production and carbon sequestration in the soil when integrated into farming systems in Africa and South Asia. Findings from this study underscore the importance of aboveground residues in regulating the addition of carbon to the soil, and the role of legumes in the enhancement of SOC