Health assessments and screening tools for adults experiencing homelessness: a systematic review.

BACKGROUND: Homelessness is increasing globally. It results in poorer physical and mental health than age matched people living in permanent housing. Better information on the health needs of people experiencing homelessness is needed to inform effective resourcing, planning and service delivery by government and care organisations. The aim of this review was to identify assessment tools that are valid, reliable and appropriate to measure the health status of people who are homeless. METHODS: Data sources: A systematic literature search was conducted in PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC from database inception until September 2018. Key words used were homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. The protocol was registered with PROSPERO. The National Health and Medical Research Council of Australia (NHMRC) hierarchy of evidence was applied; methodological quality of included articles was assessed using the McMaster critical appraisal tools and psychometric properties of the tools were appraised using the International Centre for Allied Health Evidence Ready Reckoner. RESULTS: Diverse tools and measures (N = 71) were administered within, and across the reviewed studies (N = 37), with the main focus being on general health, oral health and nutrition. Eleven assessment tools in 13 studies had evidence of appropriate psychometric testing for the target population in domains of quality of life and health status, injury, substance use, mental health, psychological and cognitive function. Methodological quality of articles and tools were assessed as moderate to good. No validated tools were identified to assess oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. However, assessments of physical constructs (such as oral health, anthropometry, vision and hearing) could be applied to homeless people on a presumption of validity, because the constructs would be measured with clinical indicators in the same manner as people living in permanent dwellings. CONCLUSIONS: This review highlighted the need to develop consistent and comprehensive health assessment tools validated with, and tailored for, adults experiencing homelessness.

Mathematical accuracy of Aztec land surveys assessed from records in the Codex Vergara.

Land surveying in ancient states is documented not only for Eurasia but also for the Americas, amply attested by two Acolhua-Aztec pictorial manuscripts from the Valley of Mexico. The Codex Vergara and the Códice de Santa María Asunción consist of hundreds of drawings of agricultural fields that uniquely record surface areas as well as perimeter measurements. A previous study of the Codex Vergara examines how Acolhua-Aztecs determined field area by reconstructing their calculation procedures. Here we evaluate the accuracy of their area values using modern mathematics. The findings verify the overall mathematical validity of the codex records. Three-quarters of the areas are within 5% of the maximum possible value, and 85% are within 10%, which compares well with reported errors by Western surveyors that postdate Aztec-Acolhua work by several centuries.

What helps children to be more active and less sedentary? Perceptions of mothers living in disadvantaged neighbourhoods.

BACKGROUND: Increasing children's participation in physical activity and decreasing time spent in sedentary behaviours is of great importance to public health. Despite living in disadvantaged neighbourhoods, some children manage to engage in health-promoting physical activity and avoid high levels of screen-based activities (i.e. watching TV, computer use and playing electronic games). Understanding how these children manage to do well and whether there are unique features of their home or neighbourhood that explain their success is important for informing strategies targeting less active and more sedentary children. The aim of this qualitative study was to gain in-depth insights from mothers regarding their child's resilience to low physical activity and high screen-time. METHODS: Semi-structured face-to-face interviews were conducted with 38 mothers of children who lived in disadvantaged neighbourhoods in urban and rural areas of Victoria, Australia. The interviews were designed to gain in-depth insights about perceived individual, social and physical environmental factors influencing resilience to low physical activity and high screen-time. RESULTS: Themes relating to physical activity that emerged from the interviews included: parental encouragement, support and modelling; sports culture in a rural town; the physical home and neighbourhood environment; child's individual personality; and dog ownership. Themes relating to screen-time behaviours encompassed: parental control; and child's individual preferences. CONCLUSIONS: The results offer important insights into potential avenues for developing 'resilience' and increasing physical activity and reducing screen-time among children living in disadvantaged neighbourhoods. In light of the negative effects of low physical activity and high levels of screen-time on children's health, this evidence is urgently needed.

Fuelling the athlete with type 1 diabetes.

People with type 1 diabetes (T1DM) want to enjoy the benefits of sport and exercise, but management of diabetes in this context is complex. An understanding of the physiology of exercise in health, and particularly the control of fuel mobilization and metabolism, gives an idea of problems which may arise in managing diabetes for sport and exercise. Athletes with diabetes need to be advised on appropriate diet to maximize performance and reduce fatigue. Exercise in diabetes is complicated both by hypoglycaemia and hyperglycaemia in particular circumstances and explanations are advanced which can provide a theoretical underpinning for possible management strategies. Management strategies are proposed to improve glycaemic control and performance.

A service evaluation of an intervention to increase application of topical fluoride varnish in general dental practice in South Yorkshire.

PURPOSE: Dental caries is still common in children in the UK despite many available preventative interventions. Application of topical fluoride varnish can reduce caries experience. National and international guidance recommends at least twice-yearly application of topical fluoride varnish, however guidance is not always followed. This project aimed to first identify the proportion of patients receiving fluoride varnish by their primary care dental practitioner prior to their referral to a secondary care service and subsequently increase this rate by introducing an intervention. METHODS: The intervention required the referring practitioner to document the date of which topical fluoride was applied prior to referral. Referrals without this information were rejected. Data were collected pre and post this change in policy to ascertain fluoride application rates. Parents and children were questioned about the frequency of application, and referral forms were reviewed for practitioner-reported application. RESULTS: Topical fluoride application rates improved by 19% points for patient-reported application, and 31% points for practitioner-reported application. The biggest increase in application rate was in the cohort of patients receiving 6-monthly fluoride application. CONCLUSION: This study demonstrated that a simple intervention, mandating that primary care dental practitioners record the most recent application of topical fluoride before referring a patient to secondary care, can improve the rates of topical fluoride varnish application in the UK.

Effects of strategies to promote children's physical activity on potential mediators.

The aim of this paper is to review evidence of the effectiveness of interventions that present physical activity outcomes and potential mediators of behavioural change among 4-12-year-old children. A systematic search of electronic databases for original research articles published in peer-review journals between January 1985 and the end of June 2006 was carried out. A total of 19 studies that reported intervention effects on physical activity and mediators of behavioural change were identified. The most common mediators reported included physical activity knowledge or beliefs (11 studies); self-efficacy (8 studies); and enjoyment or preference for physical activity (6 studies). Less frequently reported mediators included attitudes, behavioural capability, intentions, outcome expectancies, social norms, social support and self-concept. Seven of the 11 interventions that reported intervention effects on knowledge/beliefs stated positive changes in this mediator. Four of the eight studies that reported intervention effects on self-efficacy had significant improvements; however, only two out of six interventions reported significant improvements in physical activity enjoyment or preference. None of the studies reviewed reported whether changes in these constructs mediated changes in children's physical activity behaviours. Although more than half of the studies reviewed reported a positive intervention effect on children's physical activity, no study carried out a mediating analysis to attempt to identify the mechanisms of change. Future research should more clearly identify the mediators of behavioural change that are being targeted and whether this explains intervention effects.

Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children: switch-play.

OBJECTIVES: To evaluate the effectiveness of an intervention to prevent excess weight gain, reduce time spent in screen behaviours, promote participation in and enjoyment of physical activity (PA), and improve fundamental movement skills among children. PARTICIPANTS: In 2002, 311 children (78% response; 49% boys), average age 10 years 8 months, were recruited from three government schools in low socioeconomic areas of Melbourne, Australia. DESIGN: Group-randomized controlled trial. Children were randomized by class to one of the four conditions: a behavioural modification group (BM; n=66); a fundamental movement skills group (FMS; n=74); a combined BM/FMS group (BM/FMS; n=93); and a control (usual curriculum) group (n=62). Data were collected at baseline, post intervention, 6- and 12-month follow-up periods. RESULTS: BMI data were available for 295 children at baseline and 268 at 12-month follow-up. After adjusting for food intake and PA, there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls (-1.88 kg m(-2), P<0.01), which was maintained at 6- and 12-month follow-up periods (-1.53 kg m(-2), P<0.05). Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention (adjusted odds ratio (AOR)=0.36, P<0.05); also maintained at 12-month follow-up (AOR=0.38, P<0.05). Compared with controls, FMS group children recorded higher levels and greater enjoyment of PA; and BM children recorded higher levels of PA and TV viewing across all four time points. Gender moderated the intervention effects for participation in and enjoyment of PA, and fundamental movement skills. CONCLUSION: This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA. Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required.

A prospective examination of children's time spent outdoors, objectively measured physical activity and overweight.

OBJECTIVE: This study aimed to determine whether time spent outdoors was associated with objectively measured physical activity, body mass index (BMI) z-score and overweight in elementary-school aged children, cross-sectionally and prospectively over 3 years. METHODS: Three-year cohort study with data collected during 2001 and 2004. Nineteen randomly selected state elementary schools across Melbourne, Australia. One hundred and eighty eight 5-6-year-old and 360 10-12-year-old children. Baseline parent reports of children's time spent outdoors during warmer and cooler months, on weekdays and weekends. At baseline and follow-up, children's moderate and vigorous physical activity (MVPA) was objectively assessed by accelerometry, and BMI z-score and overweight was calculated from measured height and weight. RESULTS: Cross-sectionally, each additional hour outdoors on weekdays and weekend days during the cooler months was associated with an extra 27 min week(-1) MVPA among older girls, and with an extra 20 min week(-1) MVPA among older boys. Longitudinally, more time outdoors on weekends predicted higher MVPA on weekends among older girls and boys (5 min week(-1)). The prevalence of overweight among older children at follow-up was 27-41% lower among those spending more time outdoors at baseline. CONCLUSION: Encouraging 10-12-year-old children to spend more time outdoors may be an effective strategy for increasing physical activity and preventing increases in overweight and obesity. Intervention research investigating the effect of increasing time outdoors on children's physical activity and overweight is warranted.

Constitutive c-myc expression enhances the response of murine mast cells to IL-3, but does not eliminate their requirement for growth factors.

An interleukin-3 (IL-3) dependent mast cell line (MC) was infected with a recombinant retrovirus expressing the proto-oncogene c-myc and the drug selectable marker neo. Cells containing the transcriptionally activated c-myc gene displayed an increased growth rate in liquid culture and a higher cloning efficiency in soft agar when compared to control virus infected cells. All infected cells remained absolutely dependent on IL-3 for growth and were not tumorigenic in nude mice. Similar results were obtained with two additional IL-3 dependent cell lines, the mast cell 32D and the pre-B-cell Ea3. Thus, while constitutive expression of c-myc potentiates the response of mast cells to IL-3, it is not sufficient to eliminate their requirement for growth factors.

Coordinate regulation of HLA class II genes: a novel DNA binding complex.

We have characterized a nuclear protein complex from B lymphoblastoid cell lines that binds to HLA class II promoters as detected by electrophoretic gel mobility shift assays (EMSA). This complex (C1) binds to three independent sites in the proximal DRA promoter which have not been identified previously as cis-acting elements. C1 is very abundant in Burkitt's lymphoma cell lines, but less abundant in "normal" B lymphoblastoid cell lines. The binding specificity of the C1 complex was analysed using competition experiments and chemical footprinting methods. Complexes with specificity similar to C1 also bind the DPA and DQA promoters. Though mutation of the sequences in the DRA promoter that severely reduced binding of the C1 complex had no effect on the ability of the DRA fragment to drive transcription of the reporter gene in transient expression or in vitro transcription assays, this conservation of binding sites among all class II promoters tested suggests functional relevance in transcription. In addition, complexes similar to C1 were observed in nuclear extracts from all cell lines examined, but minor differences in mobility appeared to correlate with class II expression. Thus, the C1 complex may act as a trans-acting factor in MHC class II expression.

Evaluation of histological grade and histologically tumour-free margins as predictors of local recurrence in completely excised canine mast cell tumours.

Completeness of mast cell tumour (MCT) excision is determined by assessment of histologically tumour-free margins (HTFM). The HTFM width necessary to prevent local recurrence (LR), recognized as histologic safety margin (HSM) in human oncology, has not been defined. We hypothesized that HTFM width would correlate with risk for LR and high-grade tumours would require wider HTFM than low-grade tumours. Records of dogs with completely excised MCTs were included. Signalment, two-tier tumour grade, tumour size, HTFM width, recurrence and therapy data was collected. High-grade (n = 39) tumours were more likely to recur than low-grade (n = 51) tumours (35.9% versus 3.9%), P < 0.0001, with no association between HTFM width and LR. Twenty-nine percent of low-grade tumours had HTFM less than 3 mm; none recurred. Narrow (≤3 mm) histologic margins are likely adequate to prevent LR of low-grade tumours. High-grade tumours have significant risk of LR regardless of HTFM width.

Congenital immunodeficiencies associated with absence of HLA class II antigens on lymphocytes result from distinct mutations in trans-acting factors.

Coordinate regulation of HLA class II gene expression during development and coinduction of class II genes by soluble factors suggests that common trans-acting factor(s) control expression of these genes. In B-lymphoblastoid cell lines derived from two independent class II-deficient bare lymphocyte syndrome patients, we observed a drastic decrease in transcription rates of the class II genes. When these cell lines are fused, class II genes are reexpressed, indicating that immunodeficiencies in bare lymphocyte syndrome patients are the result of two distinct mutations. Further studies show that genes governing the expression of class II antigens fall into at least three complementation groups; two of these were previously unidentified in mutant cell lines generated in vitro. In addition, we report the identification of two discrete complexes, NFX1.1 and NFX1.2, that bind to the DRA X consensus element. Though the mutation in at least one mutant line generated in vitro (RJ2.2.5) affects products functioning via interaction with the X box, clear alterations in either NFX1.1 or NFX1.2 are not found in any of the mutant cell lines.

Bare lymphocyte syndrome: altered HLA class II expression in B cell lines derived from two patients.

Types II and III bare lymphocyte syndrome (BLS) are severe or lethal congenital immunodeficiencies characterized by defective cell surface expression of HLA class II antigens. We have analyzed by Southern and Northern blotting B-lymphoblastoid cell lines derived by Epstein-Barr virus (EBV) transformation from peripheral blood lymphocytes of two unrelated BLS patients and their families. While DNA analyses of both families showed no indication of rearrangement or alteration of HLA region genes, class II mRNAs were virtually absent in the patients' cell lines (BLS-1 and BLS-2). This is consistent with previous observations of different BLS patients and their families. An exception to the absence of class II mRNAs in BLS was the detection of low quantities of HLA-DQ alpha transcripts in the cell lines BLS-1. This finding provides further evidence that factors regulating HLA-DQ expression may differ from those governing expression of the other class II genes.

Cancer of the external auditory canal and temporal bone.

Malignant tumors involving the structures of the temporal bone represent formidable diagnostic and therapeutic challenges for clinicians involved in the treatment of otologic disease. This article offers a perspective on the current understanding of the biology of malignancies involving the external auditory canal, middle ear space, and temporal bone, and reviews the often confusing and contradictory literature on this topic.

Predictors of time spent outdoors among children: 5-year longitudinal findings.

BACKGROUND: Given the importance of physical activity for health and age-related declines in physical activity, understanding influences on related behaviours, such as time outdoors, is crucial. This study aimed to understand individual, social and physical environmental influences on longitudinal changes in urban children's time outdoors. METHODS: The time children spent outdoors in 2001, 2004 and 2006 (aged 5-6 and 10-12 years at baseline) was reported by their parents (n=421). In 2001, individual, social and physical environmental factors were self-reported by parents. Generalized estimating equations examined longitudinal relationships between baseline predictors and average change in time outdoors over 5 years. RESULTS: Children's time outdoors significantly declined over time. "Indoor tendencies" inversely predicted time outdoors among younger and older boys, and younger girls. Social opportunities positively predicted time outdoors among younger boys, while "outdoor tendencies" positively predicted time outdoors among older boys. Parental encouragement for activity positively predicted time outdoors among younger and older girls, while lack of adult supervision for active play outdoors after school inversely predicted time outdoors among older girls and older boys. CONCLUSION: Individual (indoor and outdoor tendencies) and social factors (social opportunities, parental encouragement and parental supervision) predicted children's time outdoors over 5 years. Interventions targeting reduced indoor tendencies, increased outdoor play with others, and increased parental encouragement and supervision are warranted.

Cystosonographic measurements of canine bladder tumours.

The purpose of this study was to evaluate the variability of cystosonographic bladder tumor measurements with both operator and bladder volume changes. Ten dogs with bladder tumors were included. In each dog, three operators determined tumor dimensions for three different bladder volumes. Intraclass correlation coefficient was used to assess operator reliability. Response Evaluation Criteria in Solid Tumors (RECIST) and greater than or equal to 50% differences in tumor measurements were used as guidelines. Poor to fair correlations between operators were found for the different tumor dimensions (r(I) = 0.4 - 0.7). The percent differences in tumor dimensions with operator and bladder volume changes were significant enough to misclassify the tumors into the categories of partial response (PR) or progressive disease (PD). These results suggest that cystosonographic measurements of bladder tumors are affected by both changes in operator and bladder volume, and the discrepancies are significant enough to change response classification.

Planar soap bubble clusters with a cavity.

We construct local energy-minimizing bubble clusters in the plane that are not simply-connected. Numerical evidence suggests that these minima are not isolated.