Incidence and public health burden of sunburn among beachgoers in the United States.

The beach environment creates many barriers to effective sun protection, putting beachgoers at risk for sunburn, a well-established risk factor for skin cancer. Our objective was to estimate incidence of sunburn among beachgoers and evaluate the relationship between sunburn incidence and sun-protective behaviors. A secondary analysis, of prospective cohorts at 12 locations within the U.S. from 2003 to 2009 (n = 75,614), were pooled to evaluate sunburn incidence 10-12 days after the beach visit. Behavioral and environmental conditions were cross-tabulated with sunburn incidence. Multivariable logistic regression was used to estimate the association between new sunburn and sun-protective behaviors. Overall, 13.1% of beachgoers reported sunburn. Those aged 13-18 years (16.5%), whites (16.0%), and those at beach locations along the Eastern Seaboard (16.1%), had the highest incidence of sunburn. For those spending ≥5 h in the sun, the use of multiple types of sun protection reduced odds of sunburn by 55% relative to those who used no sun protection (Odds Ratio = 0.45 (95% Confidence Interval:0.27-0.77)) after adjusting for skin type, age, and race. Acute health effects of sunburn tend to be mild and self-limiting, but potential long-term health consequences are more serious and costly. Efforts to encourage and support proper sun-protective behaviors, and increase access to shade, protective clothing, and sunscreen, can help prevent sunburn and reduce skin cancer risk among beachgoers

The motor and cognitive features of Parkinson's disease in patients with concurrent Gaucher disease over 2 years: a case series.

We report the cognitive features and progression of Parkinson's disease (PD) in five patients with concurrent Gaucher disease. The patients presented at an earlier age than patients with sporadic PD, as previously noted by others; but in contrast to many previous reports, our patients followed a variable clinical course. While two patients developed early cognitive deficits and dementia, three others remained cognitively intact over the follow-up period. Thus, in this small case series, PD in the context of GD more closely resembles idiopathic PD in terms of its clinical heterogeneity in contrast to PD associated with GBA heterozygote mutations.NIHR BRC and NIHR Senior Investigator, Rosetrees fundin

Medicaid savings from the Contraceptive CHOICE Project: a cost-savings analysis

Background Forty-five percent of births in the United States are unintended, and the costs of unintended pregnancy and birth are substantial. Clinical and policy interventions that increase access to the most effective reversible contraceptive methods (intrauterine devices and contraceptive implants) have potential to generate significant cost savings. Evidence of cost savings for these interventions is needed. Objective The purpose of this study was to conduct a cost-savings analysis of the Contraceptive CHOICE Project, which provided counseling and no-cost contraception, to demonstrate the value of investment in enhanced contraceptive care to the Missouri Medicaid program. Study Design The Contraceptive CHOICE Project was a prospective cohort study of 9256 reproductive-age women who were enrolled between 2007 and 2011. Study follow-up was completed October 2013. This analysis includes 5061 Contraceptive CHOICE Project participants who were current Missouri Medicaid beneficiaries or were uninsured and reported household incomes <201% of the federal poverty line. We created a simulated comparison group of women who were receiving care through the Missouri Title X program and modeled the contraception and pregnancy outcomes that would have occurred in the absence of the Contraceptive CHOICE Project. Data about contraceptive use for the comparison group (N=5061) were obtained from the Missouri Title X program and adjusted based on age, race, ethnicity, and income. To make an accurate comparison that would account for the difference in the 2 populations, we used our simulation model to estimate total Contraceptive CHOICE Project costs and total comparison group costs. We reported all costs in 2013 dollars to account for inflation. Results Among the Contraceptive CHOICE Project participants who were included, the uptake of intrauterine devices and implants was 76.1% compared with 4.8% among the comparison group. The estimated contraceptive cost for the simulated Contraceptive CHOICE Project group was $4.0 million vs$2.3 million for the comparison group. The estimated numbers of unintended pregnancies and births averted among the simulated Contraceptive CHOICE Project group compared with the comparison group were 927 and 483, respectively, which represented a savings in pregnancy and maternity care of $6.7 million. We estimated that the total cost savings for the state of Missouri attributable to the Contraceptive CHOICE Project was$5.0 million (40.7%) over the project duration. Conclusion A program providing counseling and no-cost contraception yields substantial cost savings because of the increased uptake of highly effective contraception and consequent averted unintended pregnancy and birth

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

BACKGROUND: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. OBJECTIVE: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. METHODS: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. RESULTS: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. CONCLUSIONS: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members

Placental adaptations in growth restriction

The placenta is the primary interface between the fetus and mother and plays an important role in maintaining fetal development and growth by facilitating the transfer of substrates and participating in modulating the maternal immune response to prevent immunological rejection of the conceptus. The major substrates required for fetal growth include oxygen, glucose, amino acids and fatty acids, and their transport processes depend on morphological characteristics of the placenta, such as placental size, morphology, blood flow and vascularity. Other factors including insulin-like growth factors, apoptosis, autophagy and glucocorticoid exposure also affect placental growth and substrate transport capacity. Intrauterine growth restriction (IUGR) is often a consequence of insufficiency, and is associated with a high incidence of perinatal morbidity and mortality, as well as increased risk of cardiovascular and metabolic diseases in later life. Several different experimental methods have been used to induce placental insufficiency and IUGR in animal models and a range of factors that regulate placental growth and substrate transport capacity have been demonstrated. While no model system completely recapitulates human IUGR, these animal models allow us to carefully dissect cellular and molecular mechanisms to improve our understanding and facilitate development of therapeutic interventions

The Effects Of Acute Resistance Exercise On Bioelectrical Impedance Analysis Measures Of Body Composition

Bioelectrical Impedance Analysis (BIA) is a popular method of body composition assessment; however, validity of BIA is thought to be highly dependent on adhering to pre-test criteria, including the abstinence from exercise prior to testing. PURPOSE: The purpose of this study was to determine if acute, localized resistance exercise (RE) compromises the validity of BIA total body composition estimates. METHODS: In a crossover design, 16 healthy, resistance trained adults, including 7 females (age: 22.7 ± 1.9 y; height: 165.4 ± 8.4 cm; body mass: 62.1 ± 10.9 kg; body fat: 25.9 ± 7.3%) and 9 males (age: 24.3 ± 3.6 y; height: 179.1 ± 5.1 cm; body mass: 88.0 ± 7.6 kg; body fat: 18.4 ± 6.6%) completed three conditions in a randomized order: lower-body resistance exercise (RELOWER), upper-body resistance exercise (REUPPER), and rest (REST). The RE protocol consisted of a warm-up consisting of 2 sets of 12-15 repetitions of 3 upper-body exercises (upper) or 3 lower-body exercises (lower), followed by 5 sets of 10 repetitions per exercise, with 1-minute rest intervals. The REST condition involved no exercise. BIA (InBody 770) was completed immediately pre and post-exercise and at 15-, 30-, and 60-minutes post-exercise. BIA estimates of fat mass (FM) and fat-free mass (FFM) were analyzed using 3 x 5 (condition x time) analysis of variance with repeated measures, follow-up pairwise comparisons, and evaluation of the partial eta-squared (ηp2) effect sizes. RESULTS: Pre-exercise FM and FFM did not differ between conditions (0.1 to 0.4 kg; p \u3e 0.4 for all). Condition x time interactions were present for both FM (pp2 =0.48) and FFM (pp2 =0.45). Pairwise comparisons indicated that FM was lower in the REUPPER condition as compared to both REST (1.5 kg; pLOWER (1.3 kg; pUPPER condition as compared to both REST (1.3 kg; pLOWER (0.9 kg; pUPPER as compared to REST (1.0 kg; p=0.005) but no longer differed between REUPPER and RELOWER (0.4 kg; p=0.44). CONCLUSION: These data indicate that acute upper-body RE compromises the validity of BIA total body composition estimates compared to REST and lower-body RE and reinforces exercise abstinence as a pre-test consideration. Further exploration of the effects on segmental body composition data is warranted

The Effects Of Acute Resistance Exercise On Dual-Energy X-Ray Absorptiometry Measure Of Body Composition

Dual Energy X-Ray Absorptiometry (DXA) is a reference laboratory method for estimating body composition but there are questions concerning the pre-testing guidelines that should be followed to increase validity and reliability of this methodology. PURPOSE: The purpose of this study was to determine if acute, localized resistance exercise disrupts the validity of DXA total body composition estimates. METHODS: In a crossover design, 18 healthy, resistance-trained, college-aged adults, including 7 females (age: 22.7 ± 1.9 y; height: 165.4 ± 8.4 cm; body mass: 62.1 ± 10.9 kg; body fat: 25.9 ± 7.3%) and 11 males (age: 24.2 ± 4.1 y; height: 180.0 ± 5.1 cm; body mass: 90.2 ± 9.5 kg; body fat: 18.7 ± 7.2%) completed three conditions in a randomized order: lower-body resistance exercise (RELOWER), upper-body resistance exercise (REUPPER), and rest (REST). The resistance exercise (RE) protocol consisted of a RE warm-up consisting of 2 sets of 12-15 repetitions of 3 upper-body exercises (upper), or 3 lower-body exercises (lower) or nothing (rest). The RE circuit consisted of 5 sets of 10 repetitions per exercise, with 1-minute rest intervals between circuits. A DXA scan was performed immediately before exercise and at 60 minutes post exercise. DXA estimates of fat mass (FM) and fat-free mass (FFM; calculated as lean soft tissue plus bone mineral content) were analyzed using 3 x 2 (condition x time) analysis of variance with repeated measures, follow-up pairwise comparisons, and evaluation of the partial eta-squared (ηp2) effect sizes. RESULTS: Pre-exercise FM and FFM did not differ between conditions (0.2 to 0.4 kg; p \u3e 0.14 for all). For FM, no statistically significant interaction or main effects were present (interaction: p=0.80, ηp2=0.01; time main effect: p=0.14, ηp2=0.12; condition main effect: p=0.92, ηp2=0.01). For FFM, no statistically significant interaction (p=0.13, ηp2=0.12) or condition main effect (p=0.56, ηp2=0.03) was present. However, a statistically significant time main effect was present (p=0.009, ηp2=0.34). Pairwise comparisons indicated that post-condition FFM estimates were 0.20 ± 0.07 kg lower than pre-condition values in all conditions combined. CONCLUSION: No differences were seen among conditions, indicating that DXA total body composition estimates may be relatively robust to the effects of acute, localized RE. However, investigation of segmental estimates is warranted due to RE-induced blood flow redistributio

Predatory journals and their practices present a conundrum for systematic reviewers and evidence synthesisers of health research: A qualitative descriptive study

Predatory journals are a blemish on scholarly publishing and academia and the studies published within them are more likely to contain data that is false. The inclusion of studies from predatory journals in evidence syntheses is potentially problematic due to this propensity for false data to be included. To date, there has been little exploration of the opinions and experiences of evidence synthesisers when dealing with predatory journals in the conduct of their evidence synthesis. In this paper, the thoughts, opinions, and attitudes of evidence synthesisers towards predatory journals and the inclusion of studies published within these journals in evidence syntheses were sought. Focus groups were held with participants who were experienced evidence synthesisers from JBI (previously the Joanna Briggs Institute) collaboration. Utilising qualitative content analysis, two generic categories were identified: predatory journals within evidence synthesis, and predatory journals within academia. Our findings suggest that evidence synthesisers believe predatory journals are hard to identify and that there is no current consensus on the management of these studies if they have been included in an evidence synthesis. There is a critical need for further research, education, guidance, and development of clear processes to assist evidence synthesisers in the management of studies from predatory journals.</p