Urinary tract infections in healthy women: a revolution in management?

<p>Abstract</p> <p>Background</p> <p>Urinary infection in otherwise healthy women has largely been a straightforward matter of diagnosis by identifying bacteria in the urine, and then cure by appropriate antibiotics. Recent research has shown this to be over-simplified. Evaluation of methods of self-management of symptoms has been neglected.</p> <p>Discussion</p> <p>Firstly trial data show that women with what used to called 'urethral syndrome' (urinary symptoms but sterile urine) obtain relief from antibiotics. Other trial data have shown a surprisingly large placebo effect from the resolution of symptoms among women who feel their care has been 'positive'. In addition, data published this month in <it>BMC Medicine </it>show that non-steroidal anti-inflammatory (NSAID) drugs provide symptom relief to women with conventional infections (positive urine bacteriology) as much as antibiotics.</p> <p>Conclusions</p> <p>These recent findings provide an opportunity to consider how clinicians might change practice, and sets a new research agenda. We need to know (1) whether the effect of NSAIDs is replicable; (2) why some women in previous trials have had more symptoms if not treated with antibiotics sooner; (3) whether NSAIDs and antibiotics have an additive effect on relieving symptoms; (4) how we can harness the placebo effect better to assist out patients with this distressing and common complaint.</p> <p>See research article <url>http://www.biomedcentral.com/1741-7015/8/30</url></p

Avoiding catastrophic failure in correlated networks of networks

Networks in nature do not act in isolation but instead exchange information, and depend on each other to function properly. An incipient theory of Networks of Networks have shown that connected random networks may very easily result in abrupt failures. This theoretical finding bares an intrinsic paradox: If natural systems organize in interconnected networks, how can they be so stable? Here we provide a solution to this conundrum, showing that the stability of a system of networks relies on the relation between the internal structure of a network and its pattern of connections to other networks. Specifically, we demonstrate that if network inter-connections are provided by hubs of the network and if there is a moderate degree of convergence of inter-network connection the systems of network are stable and robust to failure. We test this theoretical prediction in two independent experiments of functional brain networks (in task- and resting states) which show that brain networks are connected with a topology that maximizes stability according to the theory.Comment: 40 pages, 7 figure

Measurement of Alcohol Use and Misuse in a Cohort of Students Followed from Grade 6 Through Grade 12

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66189/1/j.1530-0277.1994.tb00938.x.pd

Why Moral Expertise Needs Moral Theory

Discussions of the nature or possibility of moral expertise have largely proceeded in atheoretical terms, with little attention paid to whether moral expertise depends on theoretical knowledge of morality. Here I argue that moral expertise is more theory-dependent than is commonly recognized: Moral expertise consists, at least in part, in knowledge of the correct or best moral theory, and second, that knowledge of moral theory is essential to moral experts dispensing expert counsel to non-experts. Moral experts would not be moral experts absent knowledge of moral theory, nor could they play the testimonial role we would expect them to play in moral inquiry and deliberation absent such knowledg

Health differentials in the older population of England: An empirical comparison of the materialist, lifestyle and psychosocial hypotheses

BACKGROUND: In developed countries with old age structures most deaths occur at older ages and older people account for the majority of those in poor health, which suggests a particular need to investigate health inequalities in the older population. METHODS: We empirically compared the materialist, psychosocial and lifestyle/behavioural theoretical mechanisms of explanation for socio-economic variation in health using data from two waves of the English Longitudinal Study of Ageing (ELSA), a nationally representative multi-purpose sample of the population aged 50 and over living in England. Three dimensions of health were examined: somatic health, depression and well-being. RESULTS: The materialist and lifestyle/behavioural paths had the most prominent mediating role in the association between socio-economic position and health in the older population, whereas the psychosocial pathway was less influential and exerted most of its influence on depression and well-being, with part of its effect being due to the availability of material resources. CONCLUSIONS: From a policy perspective there is therefore an indication that population interventions to reduce health differentials and thus improve the overall health of the older population should focus on material circumstances and population based interventions to promote healthy lifestyles

Interventions to Influence Consulting and Antibiotic Use for Acute Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

BACKGROUND: Respiratory tract infections (RTIs) are common in children and generally self-limiting, yet often result in consultations to primary care. Frequent consultations divert resources from care for potentially more serious conditions and increase the opportunity for antibiotic overuse. Overuse of antibiotics is associated with adverse effects and antimicrobial resistance, and has been shown to influence how patients seek care in ensuing illness episodes. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a systematic review and meta-analysis to assess the effectiveness of interventions directed towards parents or caregivers which were designed to influence consulting and antibiotic use for respiratory tract infections (RTIs) in children in primary care. Main outcomes were parental consulting rate, parental knowledge, and proportion of children subsequently consuming antibiotics. Of 5,714 references, 23 studies (representing 20 interventions) met inclusion criteria. Materials designed to engage children in addition to parents were effective in modifying parental knowledge and behaviour, resulting in reductions in consulting rates ranging from 13 to 40%. Providing parents with delayed prescriptions significantly decreased reported antibiotic use (Risk Ratio (RR) 0.46 (0.40, 0.54); moreover, a delayed or no prescribing approach did not diminish parental satisfaction. CONCLUSIONS: IN ORDER TO BE MOST EFFECTIVE, INTERVENTIONS TO INFLUENCE PARENTAL CONSULTING AND ANTIBIOTIC USE SHOULD: engage children, occur prior to an illness episode, employ delayed prescribing, and provide guidance on specific symptoms. These results support the wider implementation of interventions to reduce inappropriate antibiotic use in children

Comparison of imputation methods for handling missing covariate data when fitting a Cox proportional hazards model: a resampling study

<p>Abstract</p> <p>Background</p> <p>The appropriate handling of missing covariate data in prognostic modelling studies is yet to be conclusively determined. A resampling study was performed to investigate the effects of different missing data methods on the performance of a prognostic model.</p> <p>Methods</p> <p>Observed data for 1000 cases were sampled with replacement from a large complete dataset of 7507 patients to obtain 500 replications. Five levels of missingness (ranging from 5% to 75%) were imposed on three covariates using a missing at random (MAR) mechanism. Five missing data methods were applied; a) complete case analysis (CC) b) single imputation using regression switching with predictive mean matching (SI), c) multiple imputation using regression switching imputation, d) multiple imputation using regression switching with predictive mean matching (MICE-PMM) and e) multiple imputation using flexible additive imputation models. A Cox proportional hazards model was fitted to each dataset and estimates for the regression coefficients and model performance measures obtained.</p> <p>Results</p> <p>CC produced biased regression coefficient estimates and inflated standard errors (SEs) with 25% or more missingness. The underestimated SE after SI resulted in poor coverage with 25% or more missingness. Of the MI approaches investigated, MI using MICE-PMM produced the least biased estimates and better model performance measures. However, this MI approach still produced biased regression coefficient estimates with 75% missingness.</p> <p>Conclusions</p> <p>Very few differences were seen between the results from all missing data approaches with 5% missingness. However, performing MI using MICE-PMM may be the preferred missing data approach for handling between 10% and 50% MAR missingness.</p