Aetiology and risk factors of musculoskeletal disorders in physically active conscripts: a follow-up study in the Finnish Defence Forces

<p>Abstract</p> <p>Background</p> <p>Musculoskeletal disorders (MSDs) are the main reason for morbidity during military training. MSDs commonly result in functional impairment leading to premature discharge from military service and disabilities requiring long-term rehabilitation. The purpose of the study was to examine associations between various risk factors and MSDs with special attention to the physical fitness of the conscripts.</p> <p>Methods</p> <p>Two successive cohorts of 18 to 28-year-old male conscripts (<it>N </it>= 944, median age 19) were followed for six months. MSDs, including overuse and acute injuries, treated at the garrison clinic were identified and analysed. Associations between MSDs and risk factors were examined by multivariate Cox's proportional hazard models.</p> <p>Results</p> <p>During the six-month follow-up of two successive cohorts there were 1629 MSDs and 2879 health clinic visits due to MSDs in 944 persons. The event-based incidence rate for MSD was 10.5 (95% confidence interval (CI): 10.0-11.1) per 1000 person-days. Most MSDs were in the lower extremities (65%) followed by the back (18%). The strongest baseline factors associated with MSDs were poor result in the combined outcome of a 12-minute running test and back lift test (hazard ratio (HR) 2.9; 95% CI: 1.9-4.6), high waist circumference (HR 1.7; 95% CI: 1.3-2.2), high body mass index (HR 1.8; 95% CI: 1.3-2.4), poor result in a 12-minute running test (HR 1.6; 95% CI: 1.2-2.2), earlier musculoskeletal symptoms (HR 1.7; 95% CI: 1.3-2.1) and poor school success (educational level and grades combined; HR 2.0; 95% CI: 1.3-3.0). In addition, risk factors of long-term MSDs (≥10 service days lost due to one or several MSDs) were analysed: poor result in a 12-minute running test, earlier musculoskeletal symptoms, high waist circumference, high body mass index, not belonging to a sports club and poor result in the combined outcome of the 12-minute running test and standing long jump test were strongly associated with long-term MSDs.</p> <p>Conclusions</p> <p>The majority of the observed risk factors are modifiable and favourable for future interventions. An appropriate intervention based on the present study would improve both aerobic and muscular fitness prior to conscript training. Attention to appropriate waist circumference and body mass index would strengthen the intervention. Effective results from well-planned randomised controlled studies are needed before initiating large-scale prevention programmes in a military environment.</p

The cost of promiscuity: sexual transmission of Nosema microsporidian parasites in polyandrous honey bees

Multiple mating (and insemination) by females with different males, polyandry, is widespread across animals, due to material and/or genetic benefits for females. It reaches particularly high levels in some social insects, in which queens can produce significantly fitter colonies by being polyandrous. It is therefore a paradox that two thirds of eusocial hymenopteran insects appear to be exclusively monandrous, in spite of the fitness benefits that polyandry could provide. One possible cost of polyandry could be sexually transmitted parasites, but evidence for these in social insects is extremely limited. Here we show that two different species of Nosema microsporidian parasites can transmit sexually in the honey bee Apis mellifera. Honey bee males that are infected by the parasite have Nosema spores in their semen, and queens artificially inseminated with either Nosema spores or the semen of Nosema-infected males became infected by the parasite. The emergent and more virulent N. ceranae achieved much higher rates of infection following insemination than did N. apis. The results provide the first quantitative evidence of a sexually transmitted disease (STD) in social insects, indicating that STDs may represent a potential cost of polyandry in social insects

Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

<p>Abstract</p> <p>Background</p> <p>Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland.</p> <p>Methods</p> <p>The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital). A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse). The introduction of this triage system was combined with information to the public on the "correct" use of emergency services.</p> <p>Results</p> <p>After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month) as compared to the three previous years in the EDs. The Number of visits to public sector GPs during office hours did not alter. Implementation of ABCDE-triage combined with public guidance was associated with decreased total number of doctor visits in public health care. During same period, the number of patient visits in the private health care increased. Simultaneously, the number of doctor visits in secondary health care ED did not alter.</p> <p>Conclusions</p> <p>The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the secondary health care EDs. Limiting the access of less urgent patients to ED may redirect the demands of patients to private sector rather than office hours GP services.</p

The Cosmic Infrared Background: Measurements and Implications

The cosmic infrared background records much of the radiant energy released by processes of structure formation that have occurred since the decoupling of matter and radiation following the Big Bang. In the past few years, data from the Cosmic Background Explorer mission provided the first measurements of this background, with additional constraints coming from studies of the attenuation of TeV gamma-rays. At the same time there has been rapid progress in resolving a significant fraction of this background with the deep galaxy counts at infrared wavelengths from the Infrared Space Observatory instruments and at submillimeter wavelengths from the Submillimeter Common User Bolometer Array instrument. This article reviews the measurements of the infrared background and sources contributing to it, and discusses the implications for past and present cosmic processes.Comment: 61 pages, incl. 9 figures, to be published in Annual Reviews of Astronomy and Astrophysics, 2001, Vol. 3

Early Childhood Caries among a Bedouin community residing in the eastern outskirts of Jerusalem

<p>Abstract</p> <p>Background</p> <p>ECC is commonly prevalent among underprivileged populations. The Jahalin Bedouin are a severely deprived, previously nomadic tribe, dwelling on the eastern outskirts of Jerusalem. The aim of this study was to assess ECC prevalence and potentially associated variables.</p> <p>Methods</p> <p>102 children aged 12–36 months were visually examined for caries, mothers' anterior dentition was visually subjectively appraised, demographic and health behavior data were collected by interview.</p> <p>Results</p> <p>Among children, 17.6% demonstrated ECC, among mothers, 37.3% revealed "fairly bad" anterior teeth. Among children drinking bottles there was about twice the level of ECC (20.3%) than those breast-fed (13.2%). ECC was found only among children aged more than one year (p < 0.001); more prevalent ECC (55.6%) was found among large (10–13 children) families than among smaller families (1–5 children: 13.5%, 6–9 children: 15.6%) (p = 0.009); ECC was more prevalent among children of less educated mothers (p = 0.037); ECC was more prevalent among mothers with "fairly poor" anterior dentition (p = 0.04). Oral hygiene practices were poor.</p> <p>Conclusion</p> <p>ECC levels in this community were not very high but neither low. This changing population might be on the verge of a wider dental disease "epidemic". Public health efforts clearly need to be invested towards the oral health and general welfare of this community.</p

Low-luminosity Type II supernovae - III. SN 2018hwm, a faint event with an unusually long plateau

In this work, we present photometric and spectroscopic data of the low-luminosity (LL) Type IIP supernova (SN) 2018hwm. The object shows a faint (Mr = -15 mag) and very long (~ 130 d) plateau, followed by a 2.7 mag drop in the r band to the radioactive tail. The first spectrum shows a blue continuum with narrow Balmer lines, while during the plateau the spectra show numerous metal lines, all with strong and narrow P-Cygni profiles. The expansion velocities are low, in the 1000-1400 km s-1 range. The nebular spectrum, dominated by H α in emission, reveals weak emission from [O I] and [Ca II] doublets. The absolute light curve and spectra at different phases are similar to those of LL SNe IIP. We estimate that 0.002 M⊙ of 56Ni mass were ejected, through hydrodynamical simulations. The best fit of the model to the observed data is found for an extremely low explosion energy of 0.055 foe, a progenitor radius of 215 R⊙, and a final progenitor mass of 9-10 M⊙. Finally, we performed a modelling of the nebular spectrum, to establish the amount of oxygen and calcium ejected. We found a low M(16O)≈ 0.02M⊙, but a high M(40Ca) of 0.3 M⊙. The inferred low explosion energy, the low ejected 56Ni mass, and the progenitor parameters, along with peculiar features observed in the nebular spectrum, are consistent with both an electron-capture SN explosion of a superasymptotic giant branch star and with a low-energy, Ni-poor iron core-collapse SN from a 10-12 M⊙ red supergiant.</p

Garden and landscape-scale correlates of moths of differing conservation status: significant effects of urbanization and habitat diversity

Moths are abundant and ubiquitous in vegetated terrestrial environments and are pollinators, important herbivores of wild plants, and food for birds, bats and rodents. In recent years, many once abundant and widespread species have shown sharp declines that have been cited by some as indicative of a widespread insect biodiversity crisis. Likely causes of these declines include agricultural intensification, light pollution, climate change, and urbanization; however, the real underlying cause(s) is still open to conjecture. We used data collected from the citizen science Garden Moth Scheme (GMS) to explore the spatial association between the abundance of 195 widespread British species of moth, and garden habitat and landscape features, to see if spatial habitat and landscape associations varied for species of differing conservation status. We found that associations with habitat and landscape composition were species-specific, but that there were consistent trends in species richness and total moth abundance. Gardens with more diverse and extensive microhabitats were associated with higher species richness and moth abundance; gardens near to the coast were associated with higher richness and moth abundance; and gardens in more urbanized locations were associated with lower species richness and moth abundance. The same trends were also found for species classified as increasing, declining and vulnerable under IUCN (World Conservation Union) criteria

Low-luminosity Type II supernovae - III. SN 2018hwm, a faint event with an unusually long plateau

In this work, we present photometric and spectroscopic data of the low-luminosity (LL) Type IIP supernova (SN) 2018hwm. The object shows a faint (Mr = -15 mag) and very long (∼130 d) plateau, followed by a 2.7 mag drop in the r band to the radioactive tail. The first spectrum shows a blue continuum with narrow Balmer lines, while during the plateau the spectra show numerous metal lines, all with strong and narrow P-Cygni profiles. The expansion velocities are low, in the 1000-1400 km s-1 range. The nebular spectrum, dominated by H α in emission, reveals weak emission from [O i] and [Ca ii] doublets. The absolute light curve and spectra at different phases are similar to those of LL SNe IIP. We estimate that 0.002 M of 56Ni mass were ejected, through hydrodynamical simulations. The best fit of the model to the observed data is found for an extremely low explosion energy of 0.055 foe, a progenitor radius of 215 R, and a final progenitor mass of 9-10 M. Finally, we performed a modelling of the nebular spectrum, to establish the amount of oxygen and calcium ejected. We found a low M(16O)$\approx 0.02\, \mathrm{ M}_{\odot }$, but a high M(40Ca) of 0.3 M. The inferred low explosion energy, the low ejected 56Ni mass, and the progenitor parameters, along with peculiar features observed in the nebular spectrum, are consistent with both an electron-capture SN explosion of a superasymptotic giant branch star and with a low-energy, Ni-poor iron core-collapse SN from a 10-12 M red supergiant

Multifractal tubes

Tube formulas refer to the study of volumes of $r$ neighbourhoods of sets. For sets satisfying some (possible very weak) convexity conditions, this has a long history. However, within the past 20 years Lapidus has initiated and pioneered a systematic study of tube formulas for fractal sets. Following this, it is natural to ask to what extend it is possible to develop a theory of multifractal tube formulas for multifractal measures. In this paper we propose and develop a framework for such a theory. Firstly, we define multifractal tube formulas and, more generally, multifractal tube measures for general multifractal measures. Secondly, we introduce and develop two approaches for analysing these concepts for self-similar multifractal measures, namely: (1) Multifractal tubes of self-similar measures and renewal theory. Using techniques from renewal theory we give a complete description of the asymptotic behaviour of the multifractal tube formulas and tube measures of self-similar measures satisfying the Open Set Condition. (2) Multifractal tubes of self-similar measures and zeta-functions. Unfortunately, renewal theory techniques do not yield "explicit" expressions for the functions describing the asymptotic behaviour of the multifractal tube formulas and tube measures of self-similar measures. This is clearly undesirable. For this reason, we introduce and develop a second framework for studying multifractal tube formulas of self-similar measures. This approach is based on multifractal zeta-functions and allow us obtain "explicit" expressions for the multifractal tube formulas of self-similar measures, namely, using the Mellin transform and the residue theorem, we are able to express the multifractal tube formulas as sums involving the residues of the zeta-function.Comment: 122 page

Reporting of Adverse Events in Published and Unpublished Studies of Health Care Interventions : A Systematic Review

BACKGROUND: We performed a systematic review to assess whether we can quantify the underreporting of adverse events (AEs) in the published medical literature documenting the results of clinical trials as compared with other nonpublished sources, and whether we can measure the impact this underreporting has on systematic reviews of adverse events. METHODS AND FINDINGS: Studies were identified from 15 databases (including MEDLINE and Embase) and by handsearching, reference checking, internet searches, and contacting experts. The last database searches were conducted in July 2016. There were 28 methodological evaluations that met the inclusion criteria. Of these, 9 studies compared the proportion of trials reporting adverse events by publication status. The median percentage of published documents with adverse events information was 46% compared to 95% in the corresponding unpublished documents. There was a similar pattern with unmatched studies, for which 43% of published studies contained adverse events information compared to 83% of unpublished studies. A total of 11 studies compared the numbers of adverse events in matched published and unpublished documents. The percentage of adverse events that would have been missed had each analysis relied only on the published versions varied between 43% and 100%, with a median of 64%. Within these 11 studies, 24 comparisons of named adverse events such as death, suicide, or respiratory adverse events were undertaken. In 18 of the 24 comparisons, the number of named adverse events was higher in unpublished than published documents. Additionally, 2 other studies demonstrated that there are substantially more types of adverse events reported in matched unpublished than published documents. There were 20 meta-analyses that reported the odds ratios (ORs) and/or risk ratios (RRs) for adverse events with and without unpublished data. Inclusion of unpublished data increased the precision of the pooled estimates (narrower 95% confidence intervals) in 15 of the 20 pooled analyses, but did not markedly change the direction or statistical significance of the risk in most cases. The main limitations of this review are that the included case examples represent only a small number amongst thousands of meta-analyses of harms and that the included studies may suffer from publication bias, whereby substantial differences between published and unpublished data are more likely to be published. CONCLUSIONS: There is strong evidence that much of the information on adverse events remains unpublished and that the number and range of adverse events is higher in unpublished than in published versions of the same study. The inclusion of unpublished data can also reduce the imprecision of pooled effect estimates during meta-analysis of adverse events