Aktive Mobilität und Gesundheit : Hintergrundbericht für den nationalen Gesundheitsbericht 2015

Zu Fuss gehen und Velofahren tragen viel zu einer gesundheitsfördernden Bewegung bei. Die vielfältigen positiven Gesundheitseffekte regelmässiger Bewegung sind heute umfassend belegt. Ob in der Freizeit oder im Alltag, zu Fuss gehen und Velofahren - so genannte aktive Mobilität - können viel zu einer gesundheitsfördernden Bewegung beitragen. Zahlreiche Faktoren beeinflussen indessen die Neigung, zu Fuss zu gehen oder mit dem Velo zu fahren, darunter Wegeigenschaften, Alter, Fitness, aber auch Verkehrssicherheit und ganz allgemein die Merkmale von Quartieren und Städten. Die veränderbaren strukturellen Faktoren, insbesondere die Verkehrsinfrastruktur und -Sicherheit stehen im Zentrum zeitgemässer Förderung der aktiven Mobilität. Aus Sicht der Gesundheitspolitik ist eine intersektorielle Zusammenarbeit zwischen Gesundheitssektor und Verkehrs- und Städteplanung erstrebenswert. Bei den Überlegungen werden dadurch auch Gesundheitsfolgen fokussiert

Current trends in highly active anti-retroviral therapy in an anti-retroviral therapy centre attached to a remote government medical college of Maharashtra, India: a retrospective study

Background: Highly active anti-retroviral therapy (HAART) became the keystone of national AIDS program. There is lack of awareness and inadequate training about drug safety monitoring among health care professionals in India. Hence, the present study was carried out to study current trends in HAART and pattern of associated adverse drug reactions.Methods: A retrospective observational study was conducted at an anti-retroviral therapy (ART) Centre. A total of 151 HIV/AIDS Patients (old and new cases) receiving HAART during July 2015 to December 2015 were randomly included in the study. Causality and severity assessment of adverse drug reactions (ADRs) was done by using Naranjo’s ADR causality scale and modified Hartwig and Siegel scale respectively. The data was computed using MS Excel and descriptive results were expressed as counts and percentages. The study was approved by institutional ethics committee.Results: The prevalence of HIV/AIDS infection was higher in adult males (51.66%). Zidovudine+lamivudine+nevirapine (ZLN) was the most commonly prescribed HAART combination. Out of 132 ADRs reported, 76.52% of the ADRs were related to haematological system and ZLN was the commonest combination causing ADRs. 90.91% ADRs belong to possible category on causality assessment and 68.94% of the ADRs were of moderate severity. Tuberculosis (28.47%) was the commonest diagnosed opportunistic infection among the HIV/AIDS patients.Conclusions: The prescribing pattern of HAART regimens was in accordance with national guidelines for antiretroviral therapy. We recommend a pharmacovigilance system for sustainable management of ADRs in HIV/AIDS patients as we found under reporting of ADRs

Clinical recognition of symptomatic midfoot osteoarthritis: findings from the clinical assessment study of the foot

Purpose: Osteoarthritis (OA) is a common yet poorly understood cause of disabling foot pain. In the absence of radiographic confirmation of OA, clinical diagnosis in primary care is inhibited by lack of evidence informing clinical examination. This study aimed to determine whether the presence of symptomatic midfoot OA (SMOA) can be clinically identified in older adults with midfoot pain presenting to primary care.Methods: A diagnostic model using brief clinical assessments was developed using cross-sectional data from 274 adults aged ≥50 years who had self-reported midfoot pain in the last month and attended a research assessment clinic between 2010-2011. All clinical assessment data were collected by trained physiotherapy or podiatry assessors adhering to a standardised, quality-controlled protocol. Presence of radiographic midfoot OA in at least one of four scored joints (1st and 2nd cuneo-metatarsal joint, navicular-first cuneiform joint, and talo-navicular joint) was ascertained by a single reader using a validated atlas and scoring system, and who was blinded to the clinical assessment data. Radiographic OA was defined as a score of ≥2 for osteophytes or joint space narrowing on either weight-bearing dorso-plantar or lateral views. SMOA was defined as co-occuring radiographic OA and midfoot pain. One foot per participant was entered into the analysis. The selection of predictor variables was based on known associations with OA or mechanically-driven putative links to SMOA. Significant predictor variables (p<0.25 from likelihood ratio tests) from univariable analyses were simultaneously entered into a multivariable logistic regression model and backward elimination (p=0.05) was performed. The Hosmer-Lemeshow statistic assessed the calibration of the refitted model and the area under the curve (AUC) evaluated discrimination. Histograms visually summarised discrimination. Internal validation of the model was performed using 1000 bias-corrected bootstrap samples with replacement.Results: 274 participants without inflammatory disease comprised 125 men and 149 women (mean age 65 yrs, SD 9). Of these 155 had midfoot pain and 119 had SMOA. 16 univariable analyses identified 9 significant predictors and no collinearity was observed. In addition to force-entered variables (age, gender, body mass index (BMI)), only two independent predictors of SMOA were retained in the multivariable analysis: (i) reduced ankle dorsiflexion with the knee flexed and (ii) absence of a midfoot exostosis. Based on the strength of univariable association, the Foot Posture Index, subtalar inversion and ankle dorsiflexion with the knee extended appeared too weak to contribute to the final model, whereas the removal of the Arch Index and foot length-corrected navicular height was due to the stronger influence of age explaining these relationships. The final fitted model was well calibrated (p=0.79) but discrimination was poor (AUC, 0.69; 95%CI: 0.62, 0.75). Bootstrapping revealed a small degree of overfitting. The use of categorical predictor variables in continuous form did not identify any other predictors, nor did it improve model performance.Conclusions: Brief clinical assessments offer only marginal improvement to age, gender and BMI for identifying SMOA. Milder severity in a population sample, random and systematic error in the clinical assessment, and variable expression of SMOA disease manifestation may have contributed to poor diagnostic accuracy. A clinically defined SMOA phenotype based on modifiable joint loading characteristics may offer an alternative approach to facilitating the development of more targeted biomechanical interventions

Study of current prescribing pattern of antimicrobial drugs in indoor cases of enteric fever in a tertiary care hospital

Background: Rational antibiotic prescription is very important to prevent antimicrobial resistance. Hence the present study was conducted to evaluate the prescribing pattern of antimicrobial drugs in indoor enteric fever patients of medicine and paediatric department of a tertiary care hospital.Methods: A retrospective study of 2 months duration was undertaken during July and August of 2015. A total number of 97 enteric fever patients’ case sheets were utilized for our study from medicine and paediatric in-patients department of a tertiary care hospital. The data was analysed and results were expressed as percentage.Results: Out of 97 enteric fever patients, 54.64% were females. 13.4% of paediatric population were suffered because of enteric fever. The incidence of enteric fever was 74.23% in 13-40 years. Most commonly prescribed antimicrobials were 3rd generation cephalosporins and fluoroquinolones. 43.30% patients received more than one antibiotic. Antimalarials chloroquine, artemisinin derivatives and metronidazole were other drugs prescribed to enteric fever patients concurrently for associated clinical conditions.Conclusions: Interventional programme should focus on the use of rational antibiotic prescription aimed at minimizing unnecessary cost, adverse drug reactions and emergence of bacterial resistance

Prescription pattern in indoor patients of cardiovascular diseases: a descriptive study in a tertiary care hospital attached to a government medical college

Background: In India, one of the leading causes of death is cardiovascular diseases (CVDs). The study of prescription pattern ensures rational pharmacotherapy and assures quality medical care to the patients. Hence the present study was conducted to observe the prescription pattern of drugs among the indoor patients of cardiovascular diseases in a tertiary care hospital attached to a Government Medical college.Methods: A retrospective observational study of 9 month duration was undertaken from January- September 2015. A total number of 113 indoor cardiovascular disease patients’ case sheets were utilized for our study from medicine and ICCU department of a tertiary care hospital. The data was analysed and the results were expressed as counts and percentage.Results: Of 113 patients, most of the patients were of the age group of 56-65 years (40.71%). The prevalence of CVDs was higher in females (56.64%) than males (43.36%). Hypertension (58.41%) and Ischemic heart disease (41.59%) were found to be predominant CVDs. Nifedipine (53.10%), Atenolol (31.86%), Isosorbide dinitrate (40.71%), Atorvastatin (53.10%) were the most commonly prescribed cardiovascular drugs. Aspirin and Clopidogrel combination was prescribed in 46.90% of CVD patients. The average number of drugs per prescription was 6.53.Conclusions: The present study shows that most of drugs were prescribed rationally according to the current treatment guidelines except the under use of ACEIs and ARBs in hypertensive diabetes mellitus patients. Standard treatment guidelines should be circulated among practicing physicians to encourage rational prescription

Evaluation of efficacy of whatsapp messenger application in medical research education

Background: There is lack of knowledge regarding research amongst medical students as it is not included in the present curriculum of MBBS. Hence authors have selected ‘Medical Research’ as a topic to evaluate the efficacy of WhatsApp messenger application as a teaching-learning tool. There is very limited research on impact of technological modalities like WhatsApp on education. Authors undertook this study to evaluate its efficacy as a tool to supplement medical research education and assess the perception of students about e-learning via WhatsApp messenger application.Methods: A prospective analytical interventional study was conducted after obtaining ethical approval from the Institutional Ethics Committee. A self-designed comprehensive questionnaire was used to test the knowledge of medical students. A series of modules were sent and discussed on the WhatsApp study groups followed by assessment in change of the level of knowledge amongst the participants post intervention.Results: Applying the paired t-test, the scores of the study participants showed a statistically significant increase in the post- intervention evaluation (Mean=10.13, Median=10, Range=0-21) as compared to the baseline knowledge regarding medical research as reflected in the pre intervention evaluation (Mean=6.76, Median=7, Range=0-16). Conclusions: Growing availability of economical and user friendly smart phones in every generation has promoted use of WhatsApp by teachers as well as students. WhatsApp has the potential to supplement academic learning and become a natural educational modality. Necessary precautions could be taken to minimize the drawbacks expressed by the students to make it a more enjoyable and acceptable tool for teaching and learning

Observational methods for COVID-19 vaccine effectiveness research:an empirical evaluation and target trial emulation

Background:There are scarce data on best practices to control for confounding in observational studies assessing vaccine effectiveness to prevent COVID-19. We compared the performance of three well-established methods [overlap weighting, inverse probability treatment weighting and propensity score (PS) matching] to minimize confounding when comparing vaccinated and unvaccinated people. Subsequently, we conducted a target trial emulation to study the ability of these methods to replicate COVID-19 vaccine trials.Methods:We included all individuals aged ≥75 from primary care records from the UK [Clinical Practice Research Datalink (CPRD) AURUM], who were not infected with or vaccinated against SARS-CoV-2 as of 4 January 2021. Vaccination status was then defined based on first COVID-19 vaccine dose exposure between 4 January 2021 and 28 January 2021. Lasso regression was used to calculate PS. Location, age, prior observation time, regional vaccination rates, testing effort and COVID-19 incidence rates at index date were forced into the PS. Following PS weighting and matching, the three methods were compared for remaining covariate imbalance and residual confounding. Last, a target trial emulation comparing COVID-19 at 3 and 12 weeks after first vaccine dose vs unvaccinated was conducted.Results:Vaccinated and unvaccinated cohorts comprised 583 813 and 332 315 individuals for weighting, respectively, and 459 000 individuals in the matched cohorts. Overlap weighting performed best in terms of minimizing confounding and systematic error. Overlap weighting successfully replicated estimates from clinical trials for vaccine effectiveness for ChAdOx1 (57%) and BNT162b2 (75%) at 12 weeks.Conclusion:Overlap weighting performed best in our setting. Our results based on overlap weighting replicate previous pivotal trials for the two first COVID-19 vaccines approved in Europe

Natural mutations of human XDH promote the nitrite (NO2 −)-reductase capacity of xanthine oxidoreductase: A novel mechanism to promote redox health?

Several rare genetic variations of human XDH have been shown to alter xanthine oxidoreductase (XOR) activity leading to impaired purine catabolism. However, XOR is a multi-functional enzyme that depending upon the environmental conditions also expresses oxidase activity leading to both O2·- and H2O2 and nitrite (NO2−) reductase activity leading to nitric oxide (·NO). Since these products express important, and often diametrically opposite, biological activity, consideration of the impact of XOR mutations in the context of each aspect of the biochemical activity of the enzyme is needed to determine the potential full impact of these variants. Herein, we show that known naturally occurring hXDH mutations do not have a uniform impact upon the biochemical activity of the enzyme in terms of uric acid (UA), reactive oxygen species (ROS) and nitric oxide ·NO formation. We show that the His1221Arg mutant, in the presence of xanthine, increases UA, O2·- and NO generation compared to the WT, whilst the Ile703Val increases UA and ·NO formation, but not O2·-. We speculate that this change in the balance of activity of the enzyme is likely to endow those carrying these mutations with a harmful or protective influence over health that may explain the current equipoise underlying the perceived importance of XDH mutations. We also show that, in presence of inorganic NO2−, XOR-driven O2·- production is substantially reduced. We suggest that targeting enzyme activity to enhance the NO2−-reductase profile in those carrying such mutations may provide novel therapeutic options, particularly in cardiovascular disease

p53Psi is a transcriptionally inactive p53 isoform able to reprogram cells toward a metastatic-like state

Although much is known about the underlying mechanisms of p53 activity and regulation, the factors that influence the diversity and duration of p53 responses are not well understood. Here we describe a unique mode of p53 regulation involving alternative splicing of the TP53 gene. We found that the use of an alternative 3' splice site in intron 6 generates a unique p53 isoform, dubbed p53Psi. At the molecular level, p53Psi is unable to bind to DNA and does not transactivate canonical p53 target genes. However, like certain p53 gain-of-function mutants, p53Psi attenuates the expression of E-cadherin, induces expression of markers of the epithelial-mesenchymal transition, and enhances the motility and invasive capacity of cells through a unique mechanism involving the regulation of cyclophilin D activity, a component of the mitochondrial inner pore permeability. Hence, we propose that p53Psi encodes a separation-of-function isoform that, although lacking canonical p53 tumor suppressor/transcriptional activities, is able to induce a prometastatic program in a transcriptionally independent manner