Activity

on of sterility protocol with anti-malaria prophylaxis led to improvements in our centre’s outcomes.

The management of POF in the cardiac ICU was complicated by the requirement of co-operation from a larger number of specialties than is usually required in advanced centres with special expertise in malaria confirmation. We, therefore, introduced structured clinical, laboratory, and appropriate interventions to treat POF more aggressively. We found that more careful attention to peri-operative details to ensure strict observation of sterility protocol with anti-malaria prophylaxis led to improvements in our centre’s outcomes.

Self-harm is a major health concern, not only as a signal of distress but also as a strong predictor of later suicide. Self-harm can be further refined into suicidal self-harm (SSH, i.e. suicide attempt) and non-suicidal self-harm (NSSH). Understanding the aetiologies of NSSH and SSH can help inform suicide prevention strategies. Using a twin design, we investigated the phenotypic and aetiological relationships between NSSH and SSH, and their aetiological overlap with mental health problems.

We analysed data from the Twins Early Development Study using structural equation modelling. JHU395 clinical trial At age 21 years, 9063 twins (62.4% female) answered questions related to self-harm. At age 16 years, 19 self- or parent-reported mental health measures were administered, including measures of internalising and externalising problems, psychotic-like experiences and substance abuse.

Prevalences for NSSH and SSH were 21.9% and 10.5%, respectively. Additive genetic factors explained half of the variance in NSSH (55%) and SSH (50%), with the rest explained by non-shared environmental factors. Phenotypically, NSSH and SSH were strongly correlated (r = 0.87) with their correlation explained by genetic (57%) and non-shared environmental (43%) factors. We found no evidence that NSSH and SSH differed in their phenotypic and aetiological relationships with mental health measures.

Our findings suggest no aetiological difference between NSSH and SSH. NSSH and SSH should be regarded as two different ends of a continuum, rather than as two distinct categories.

Our findings suggest no aetiological difference between NSSH and SSH. NSSH and SSH should be regarded as two different ends of a continuum, rather than as two distinct categories.How do experts judge the legitimacy of technical policy processes, and do their ideas change as these processes are opened to other stakeholders and the public? This research examines the adoption of public and patient involvement in pharmaceutical assessment in Canada. It finds tensions between scientific legitimacy that prioritizes rigor and objectivity, and democratic legitimacy that values inclusion and a broader range of evidence. In response to policy change, experts incorporate new ideas about democratic inputs and processes, while maintaining scientific policy goals. The research responds to calls for more precise measurement of ideas and ideational change and more evaluation of public and patient involvement in health policy. It helps us understand the significance of, and limits to, ideational change among experts in health policy domains that are highly technical and publicly salient. Understanding the way democratic and scientific legitimacy are negotiated in policy decisions has a wide applicability in health, but is particularly relevant during a global pandemic when evidence is being generated rapidly, decisions must be made quickly, and these decisions have a significant, immediate effect on the lives of all citizens.Following hurricanes, there can be increases in exacerbations of chronic diseases, such as asthma. Asthma is common among children, and many asthma exacerbations can be prevented. This systematic literature review assessed literature describing the impact of hurricanes on children with asthma in the United States. Medline, Embase, Global Health, PubMed, and Scopus databases were searched for peer-reviewed, English-language articles published January 1990 to June 2019 that described the effect of a hurricane on children with asthma. This search identified 212 articles; 8 met inclusion criteria. All 8 were related to Hurricane Katrina, but research questions and study design varied. Articles included information on asthma after hurricanes from cross-sectional surveys, retrospective chart review, and objective clinical testing. Four articles described discontinuity in health insurance, asthma-related health care, or asthma medication use; and 3 articles examined the relationship between mold exposure and asthma symptoms and reported varying results. The eighth study quantified the burden of asthma among people visiting mobile medical units but did not describe factors associated with asthma symptoms. These results highlight opportunities for future research (eg, on more recent hurricanes) and disaster preparedness planning (eg, strategies to prevent health-care discontinuity among children with asthma).This study examined the roles of parental gender and context in the communicative functions of parents’ child-directed speech. Seventy three families with toddlers participated in the study. Dyadic and triadic parent-toddler interactions were videotaped during structured play activities. Results indicated context-dependent variability in parents’ facilitative speech and gentle guidance. Parental gender effects were observed in parents’ directive speech but no gender or contextual effects were observed in parents’ referential speech. Results suggest the need for a closer examination of parental gender and contextual factors related to parents’ speech functions.

Mandatory fortification of bread flour with folic acid has helped to reduce the incidence of neural tube defects in several countries. However, it has been suggested that folic acid may have potential adenoma-promoting effects, and reports from some countries have suggested that mandatory folic acid food fortification programmes have increased the incidence of colorectal cancer. The objective of this study was to evaluate colorectal cancer incidence patterns before and after introduction of mandatory folic acid fortification of bread flour in Australia in 2009.

Data from the Australian Cancer Database were used to plot age-standardised incidence of colorectal cancer. We calculated age-adjusted rate ratios with 95 % CIs.

Australia.

We used population-level aggregate data obtained from cancer registries.

Age-standardised colorectal cancer incidence generally decreased between 1999 and 2016. Although there was a slight increase in rates in 2010 compared with 2009 (62·8 v. 61·6 cases per 100 000, age-adjusted rate ratio 1·02 (95 % CI 0·99, 1·04), joinpoint regression indicated decreases of -0·4 % (95 % CI -0·7, 0·0) per year from 1999 to 2010 and -2·2 % (95 % CI -3·1, -1·3) per year from 2010 to 2016.