Sex and Care: The Evolutionary Psychological Explanations for Sex Differences in Formal Care Occupations

Men and women exhibit clear differences in occupational choices. The present article elucidates sex differences in terms of formal care occupational choices and care styles based on evolutionary psychological perspectives. Broadly (1) the motivation to attain social status drives male preference for occupations that signals prestige and the desire to form interpersonal affiliation underlies female preference for occupations that involve psychosocial care for people in need; (2) ancestral sex roles leading to sexually differentiated cognitive and behavioral phenotypic profiles underlie present day sex differences in care styles where men are things-oriented, focusing on disease management while women are people-oriented, focusing on psychosocial management. The implications for healthcare and social care are discussed and recommendations for future studies are presented

Comparing quality of life and treatment satisfaction between patients on warfarin and direct oral anticoagulants : a cross-sectional study

Introduction and aim: Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC). Methods: This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2). Results: A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, P=0.083; mental QOL, P=0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 (P=0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, P=0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, P=0.069). Conclusion: Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Optimizing the use of local muscle flaps for knee megaprosthesis coverage

Primary muscle flap cover of megaprostheses following limb salvage surgery for tumors around the knee serves to decrease infection rates, provide additional soft tissue cover over the implant, and act as a bed for split-skin grafting. The purpose of this study is to demonstrate the role of supplementary muscle flaps such as the hemisoleus, gracilis, and semimembranosus in augmenting coverage provided by gastrocnemius muscle flaps. Between August 1999 and August 2006, 10 patients underwent resection of distal femur (n = 5) or proximal tibia (n = 5) sarcomas, followed by bone reconstruction with a modular megaprosthesis and soft tissue coverage with local pedicled flaps. The average age was 31 years (range, 13 to 47), with pathologic diagnoses inclusive of osteosarcoma (n = 7), chondrosarcoma (n = 2), and recurrent giant cell tumor (n = 1). For proximal tibial tumors, both bellies of the gastrocnemius with hemisoleus for additional soft tissue cover were used. For distal femoral tumors, 1 gastrocnemius belly sutured to the extensor mechanism and gracilis or semimembranosus provided adequate soft tissue cover. All flaps survived without complications, all wounds healed well, and all patients were ambulant after surgery. The role of supplementary muscle flaps was demonstrated in specific situations, where coverage of the subcutaneous area of the midtibia was deficient and where a significant amount of the vastus medialis or gastrocnemius has been resected. Technical refinements included primary skin grafting to relieve tension during skin closure and excision of the aponeurosis over the gastrocnemius and hemisoleus to increase the reach and surface area of the muscle flap

Membrane lipid binding molecules for the isolation of bona fide extracellular vesicle types and associated biomarkers in liquid biopsy

Cancer exacts a heavy socioeconomic cost. Earlier detection and treatment are likely to mitigate this cost. Unfortunately, conventional tissue biopsy, the gold standard in cancer diagnosis cannot fulfill the goal of earlier detection. While liquid biopsy is a promising alternative to tissue biopsy, it has its challenges and limitations. A major challenge is the isolation of bona fide lipid membrane vesicles from biological fluids. In this review, we presented a new perspective of isolating different types of extracellular vesicles (EVs) by their affinity for membrane lipid binding ligands for liquid biopsy. EVs are lipid membrane particles naturally released by almost all cells and are found in almost all biological fluids suitable for liquid biopsy. They carry materials from the secreting cells that could affect the biology of the recipient cells and could thus inform on the state and progress of the disease. However, isolating bona fide EVs is a technical challenge as biological fluids have a complex composition and contain particles or aggregates that are physically similar to EVs. Here we review the use of membrane lipid-binding ligands to isolate different bona fide EV subtypes, and to circumvent the problem of co-isolating physically similar non-EV complexes in current EV isolation protocols. We will discuss the advantages of this technique and its potential for accelerated biomarker discovery and validation through examples of pre-clinical studies. We propose that isolating EV subtypes is a technically viable and robust strategy to overcome the current bottleneck of isolating EVs for liquid biopsy

Quantifying the impact of inhalational burns: a prospective study

Abstract Background Inhalational injury is a major cause of morbidity and mortality in burns patients. This study aims to analyse the clinical outcomes, complications and bacteriology of inhalational burn patients. Methods A prospective study was done on consecutive admissions to Burn Department, Singapore General Hospital over 15 months from January 2015 to March 2016. Presence of inhalational injury, demographics, complications and outcomes was recorded. Diagnosis of inhalational injury was based on history, symptoms and nasoendoscopy. Diagnosis of acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and infective complications were according to the Berlin criteria, acute kidney injury network (AKIN) classification stage 2 and above and the American Burns Association guidelines. Results Thirty-five patients (17.3%) had inhalational burns out of 202 patients (63.4% male, 57.4% Chinese population). The average age was 43 ± 16.7 years (range 16–86), and percentage of total body surface area (%TBSA) was 12.1 ± 18.0 (range 0–88). In patients with inhalational injury, age was 38.9 ± 17.2 years and %TBSA was 30.3 ± 32.3. In patients without inhalational injury, age was 44.1 ± 12.8  years and %TBSA was 8.3 ± 9.59. Compared to patients with cutaneous injury alone, patients with inhalational burns had more surgeries (3 ± 7.07 vs 1 ± 1.54, p = 0.003), increased length of stay (21 days vs 8 days, p = 0.004) and higher in-hospital mortality rate (17.1% vs 0.6%, p < 0.001). Incidence of ARDS and AKI was 48.6% and 37.1%, respectively, compared to 0.6% and 1.2% in the patients without inhalational injury (p < 0.001). Patients with inhalational injury had increased incidence of bacteraemia (31.4% vs 2.4%, p < 0.001), pneumonia (37.1% vs 1.2%, p < 0.001) and burn wound infection (51.4% vs 25.1%, p = 0.004). Inhalational injury predicted AKI with an adjusted odds ratio (OR) of 17.43 (95% confidence interval (CI) 3.07–98.87, p < 0.001); ARDS, OR = 106.71 (95% CI 12.73–894.53, p < 0.001) and pneumonia, OR = 13.87 (95% CI 2.32–82.94, p = 0.004). Acinetobacter baumannii was the most frequently cultured bacteria in sputum, blood and tissue cultures with inhalational injury. Gram-negative bacteria were predominantly cultured from tissue in patients with inhalational injury, whereas gram-positive bacteria were predominantly cultured from tissue in patients without inhalational injury. Conclusions Inhalational injury accompanying burns significantly increases the length of stay, mortality and complications including AKI, ARDS, infection and sepsis

A preliminary report: The new protocol of managing acute partial-thickness hand burns

Background: Optimal hand function recovery is the key to the successful management of hand burns. It starts with a timely burns coverage in the acute setting. A new hand burns protocol has been introduced to cover hand burn wounds within 24 hours after admission. Biobrane TM and split skin graft (SSG) are the coverage methods for partial-thickness burns. A three-year prospective study is being carried out to evaluate the short- and long-term clinical and functional outcomes of the two treatment modalities. This paper reports the preliminary short-term results of the first 34 hand burns of the study. Methodology: This report includes consecutive hand burns patients admitted between September 2014 and May 2015. The recruited hand burns patients underwent clinical and functional assessments seven days after the coverage with either SSG or Biobrane TM . Statistical analysis was performed to evaluate the outcomes. Results and discussion: Eleven burnt hands were treated with SSG and 23 with Biobrane TM . The clinical and functional outcomes, including range of motion, power and sensitivity, were similar in both treatment groups. Further study to recruit more patients is necessary to ascertain the significance of the above findings. More importantly, long-term functional outcomes have to be assessed to conclude the treatment efficacy of early hand burns coverage with Biobrane TM or SSG