GPs' awareness of pregnancy:trends and association with hazardous medication use

BACKGROUND: GPs have been shown to be important providers of medical care during pregnancy, however, little evidence exists on their awareness of pregnancy when prescribing medication to women. AIM: To assess GPs' awareness of pregnancy and its association with prescribing medication with potential safety risks. DESIGN AND SETTING: Population-based study using confirmed pregnancy records linked to GP records from the PHARMO Perinatal Research Network. METHOD: GPs' awareness of pregnancy, defined as the presence of a pregnancy confirmation in the GP information system during pregnancy, was assessed from 2004 to 2020. GP prescriptions of medication with potential safety risks were selected during pregnancy and its association with GPs' awareness of pregnancy was assessed using multivariable logistic regression. RESULTS: A pregnancy confirmation was present in the GP records for 48% (n = 67 496/140 976) of selected pregnancies, increasing from 28% (n = 34/121) in 2004 to 63% in 2020 (n = 5763/9124). During 3% (n = 4489/140 976) of all pregnancies, the GP prescribed highly hazardous medication with teratogenic effects that should have been (temporarily) avoided. Pregnancy was GP confirmed for only 13% (n = 585/4489) at the first occurrence of such a prescription. Comparative analyses showed that women without a pregnancy confirmation were 59% more likely to be prescribed this highly hazardous medication (odds ratio [OR] 1.59, 95% confidence interval [CI] = 1.49 to 1.70) compared with those with a confirmed pregnancy. CONCLUSION: Results of this study indicate a potential issue with GP awareness about pregnancy status at the time medication with potential safety risks is prescribed. Although pregnancy registration by GPs improved over the years, inadequate use still seems to be made of the available information systems for appropriate drug surveillance.</p

Streptococcus pneumoniae enhances human respiratory syncytial virus infection in vitro and in vivo

Human respiratory syncytial virus (HRSV) and Streptococcus pneumoniae are important causative agents of respiratory tract infections. Both pathogens are associated with seasonal disease outbreaks in the pediatric population, and can often be detected simultaneously in infants hospitalized with bronchiolitis or pneumonia. It has been described that respiratory virus infections may predispose for bacterial superinfections, resulting in severe disease. However, studies on the influence of bacterial colonization of the upper respiratory tract on the pathogenesis of subsequent respiratory virus infections are scarce. Here, we have investigated whether pneumococcal colonization enhances subsequent HRSV infection. We used a newly generated recombinant subgroup B HRSV strain that expresses enhanced green fluorescent protein and pneumococcal isolates obtained from healthy children in disease-relevant in vitro and in vivo model systems. Three pneumococcal strains specifically enhanced in vitro HRSV infection of primary well-differentiated normal human bronchial epithelial cells grown at air-liquid interface, whereas two other strains did not. Since previous studies reported that bacterial neuraminidase enhanced HRSV infection in vitro, we measured pneumococcal neuraminidase activity in these cultures but found no correlation with the observed infection enhancement in our model. Subsequently, a selection of pneumococcal strains was used to induce nasal colonization of cotton rats, the best available small animal model for HRSV. Intranasal HRSV infection three days later resulted in strain-specific enhancement of HRSV replication in vivo. One S. pneumoniae strain enhanced HRSV both in vitro and in vivo, and was also associated with enhanced syncytium formation in vivo. However, neither pneumococci nor HRSV were found to spread from the upper to the lower respiratory tract, and neither pathogen was transmitted to naive cage mates by direct contact. These results demonstrate that pneumococcal colonization can enhance subsequent HRSV infection, and provide tools for additional mechanistic and intervention studies

Life cycle informed restoration:Engineering settlement substrate material characteristics and structural complexity for reef formation

Ecosystems are degrading world-wide, with severe ecological and economic consequences. Restoration is becoming an important tool to regain ecosystem services and preserve biodiversity. However, in harsh ecosystems dominated by habitat-modifying organisms, restoration is often expensive and failure prone. Establishment of such habitat modifiers often hinges on self-facilitation feedbacks generated by traits that emerge when individuals aggregate, causing density- or patch size-dependent establishment thresholds. To overcome these thresholds, adult or juvenile habitat-forming species are often transplanted in clumped designs, or stress-mitigating structures are deployed. However, current restoration approaches focus on introducing or facilitating a single life stage, while many habitat modifiers experience multiple bottlenecks throughout their life as they transition through sequential life stages. Here, we define and experimentally test ‘life cycle informed restoration’, a restoration concept that focuses on overcoming multiple bottlenecks throughout the target species’ lifetime. To provide proof of concept, and show its general applicability, we carried out complementary experiments in intertidal soft-sediment systems in Florida and the Netherlands where oysters and mussels act as reef-building habitat modifiers. We used biodegradable structures designed to facilitate bivalve reef recovery by both stimulating settlement with hard and fibrous substrates and post-settlement survival by reducing predation. Our trans-Atlantic experiments demonstrate that these structures enabled bivalve reef formation by: (a) facilitating larval recruitment via species-specific settlement substrates, and (b) enhancing post-settlement survival by lowering predation. In the Netherlands, structures with coir rope most strongly facilitated mussels by providing fibrous settlement substrate, and predation-lowering spatially complex hard attachment substrate. In Florida, oysters were greatly facilitated by hard substrates, while coir rope proved unbeneficial. Synthesis and applications. Our findings demonstrate that artificial biodegradable reefs can enhance bivalve reef restoration across the Atlantic by mimicking emergent traits that ameliorate multiple bottlenecks over the reef-forming organism’ life cycle. This highlights the potential of our approach as a cost-effective and practical tool for nature managers to restore systems dominated by habitat modifiers whose natural recovery is hampered by multiple life stage-dependent bottlenecks. Therefore, investment in understanding how to achieve life cycle informed restoration on larger scales and whether the method it is applicable to restore other ecosystems is now required

Physical activity resource needs of occupational therapists in primary public health care in Gauteng, South Africa

DATA AVAILABILITY : Upon reasonable request from the corresponding author.INTRODUCTION : Resource constraints in primary health care settings in South Africa give rise to challenges for occupational therapists. This study aimed to determine the physical activity resource needs (including objects used and space demands) of occupational therapists in the primary health care context of Gauteng, South Africa. METHOD : A qualitative, descriptive research design was used. The participants were occupational therapists working in primary health care settings in Gauteng. Convenience and snowball sampling were used. Data were collected through two online asynchronised focus groups, conducted over three days each. Thematic analysis was used to analyse the data. FINDINGS : Findings included the resource constraints experienced by occupational therapists and how the occupational therapists' adaptability helped them overcome these constraints. Space, resources for basic and instrumental activities of daily living, assistive devices, Bobath plinths and recyclable and low-cost materials were identified as being particularly useful physical activity resource needs. CONCLUSION : Although limited physical activity resources were available in the settings, therapists' skills in adaptability proved useful in using unconventional resources instead. This study's results identify physical resources deemed as most useful to provide occupational therapy services in primary health care. Furthermore, the results provide information to the education faculty in order to adapt the undergraduate curriculum to better prepare occupational therapy students for practice in primary health care. IMPLICATIONS FOR PRACTICE : • The findings can be communicated to management of primary health care facilities in order to procure or advocate for the procurement of resources deemed as essential in primary health care practice contexts. • Innovation, problem-solving and adaptability can be valuable characteristics used in professional reasoning that may enable occupational therapists to overcome physical resource barriers. • Faculty at tertiary educational institutions may utilise the findings in order to adapt curriculums to better prepare occupational therapists for work in the South African primary health care context. • Occupational therapy students should gain experience in developing and adapting activities using recyclable and reusable materials for diverse clients, including children and adults.http://www.sajot.co.za/index.php/sajothj2023Occupational Therap

Evaluating the Effectiveness of Complex, Multi-component, Dynamic, Community Based Injury Prevention Interventions: A Statistical Framework

Dynamic violence and injury prevention interventions located within community settings raise evaluation challenges by virtue of their complex structure, focus, and aims. They try to address many risk factors simulta neously, are often overlapped in their implementation, and their imple mentation may be phased over time. This article proposes a statistical and analytic framework for evaluating the effectiveness of multilevel, multi system, multi-component, community-driven, dynamic interventions. The proposed framework builds on meta regression methodology and recently proposed approaches for pooling results from multi-component interven tion studies. The methodology is applied to the evaluation of the effec tiveness of South African community-centered injury prevention and safety promotion interventions. The proposed framework allows for complex interventions to be disaggregated into their constituent parts in order to extract their specific effects. The potential utility of the framework is suc cessfully illustrated using contact crime data from select police stations in Johannesburg. The proposed framework and statistical guidelines proved to be useful to study the effectiveness of complex, dynamic, community-based interventions as a whole and of their components. The framework may help researchers and policy makers to adopt and study a specific methodology for evaluating the effectiveness of complex intervention programs.Institute for Social and Health Studies (ISHS

Withdrawing biologics in non-systemic JIA:what matters to pediatric rheumatologists?

Abstract Objective Approximately one third of children with JIA receive biologic therapy, but evidence on biologic therapy withdrawal is lacking. This study aims to increase our understanding of whether and when pediatric rheumatologists postpone a decision to withdraw biologic therapy in children with clinically inactive non-systemic JIA. Methods A survey containing questions about background characteristics, treatment patterns, minimum treatment time with biologic therapy, and 16 different patient vignettes, was distributed among 83 pediatric rheumatologists in Canada and the Netherlands. For each vignette, respondents were asked whether they would withdraw biologic therapy at their minimum treatment time, and if not, how long they would continue biologic therapy. Statistical analysis included descriptive statistics, logistic and interval regression analysis. Results Thirty-three pediatric rheumatologists completed the survey (40% response rate). Pediatric rheumatologists are most likely to postpone the decision to withdraw biologic therapy when the child and/or parents express a preference for continuation (OR 6.3; p < 0.001), in case of a flare in the current treatment period (OR 3.9; p = 0.001), and in case of uveitis in the current treatment period (OR 3.9; p < 0.001). On average, biologic therapy withdrawal is initiated 6.7 months later when the child or parent prefer to continue treatment. Conclusion Patient’s and parents' preferences were the strongest driver of a decision to postpone biologic therapy withdrawal in children with clinically inactive non-systemic JIA and prolongs treatment duration. These findings highlight the potential benefit of a tool to support pediatric rheumatologists, patients and parents in decision making, and can help inform its design

Evaluating the Effectiveness of Complex, Multi-component, Dynamic, Community Based Injury Prevention Interventions: A Statistical Framework

Dynamic violence and injury prevention interventions located within community settings raise evaluation challenges by virtue of their complex structure, focus, and aims. They try to address many risk factors simulta neously, are often overlapped in their implementation, and their imple mentation may be phased over time. This article proposes a statistical and analytic framework for evaluating the effectiveness of multilevel, multi system, multi-component, community-driven, dynamic interventions. The proposed framework builds on meta regression methodology and recently proposed approaches for pooling results from multi-component interven tion studies. The methodology is applied to the evaluation of the effec tiveness of South African community-centered injury prevention and safety promotion interventions. The proposed framework allows for complex interventions to be disaggregated into their constituent parts in order to extract their specific effects. The potential utility of the framework is suc cessfully illustrated using contact crime data from select police stations in Johannesburg. The proposed framework and statistical guidelines proved to be useful to study the effectiveness of complex, dynamic, community-based interventions as a whole and of their components. The framework may help researchers and policy makers to adopt and study a specific methodology for evaluating the effectiveness of complex intervention programs.Institute for Social and Health Studies (ISHS

A Randomized Controlled Trial to Examine the Effect of 2-Year Vitamin B12 and Folic Acid Supplementation on Physical Performance, Strength, and Falling: Additional Findings from the B-PROOF Study

Elevated homocysteine concentrations are associated with a decline in physical function in elderly persons. Homocysteine-lowering therapy may slow down this decline. This study aimed to examine the effect of a 2-year intervention of vitamin B12 and folic acid supplementation on physical performance, handgrip strength, and risk of falling in elderly subjects in a double-blind, randomized placebo-controlled trial. Participants aged ≥65 years with elevated plasma homocysteine concentrations [12–50 µmol/L (n = 2919)] were randomly assigned to daily supplementation of 500 µg vitamin B12, 400 µg folic acid, and 600 I

Low vitamin D status is associated with more depressive symptoms in Dutch older adults

Purpose: The existence of vitamin D receptors in the brain points to a possible role of vitamin D in brain function. We examined the association of vitamin D status and vitamin D-related genetic make-up with depressive symptoms amongst 2839 Dutch older adults aged ≥65 years. Methods: 25-Hydroxyvitamin D (25(OH)D) was measured, and five ‘vitamin D-related genes’ were selected. Depressive symptoms were measured with the 15-point Geriatric Depression Scale. Results were expressed as the relative risk of the score of depressive symptoms by quartiles of 25(OH)D concentration or number of affected alleles, using the lowest quartile or minor allele group as reference. Results: A clear cross-sectional and pr