Sparrows use a medicinal herb to defend against parasites and increase offspring condition.

The incorporation of aromatic plants into nests by birds is suspected to constitute an example of preventative medicine use, whereby the phytochemical compounds within plants reduce infestation by parasites and increase offspring condition [1,2]. In China, russet sparrows (Passer cinnamomeus) incorporate wormwood (Artemisia verlotorum) leaves into their nests around the same time that local people hang wormwood from their doors as a traditional custom during the Dragon Boat Festival. The belief that this behaviour confers protection against ill health [3] is supported by the description of anti-parasite compounds in wormwood [4]. It has been suggested that the incorporation of fresh wormwood leaves into nests may serve a similar function for sparrows. Here we show that sparrows choose nest location and resupply established nests with fresh wormwood leaves using olfactory cues, that nests containing wormwood leaves have lower ectoparasite loads, and that nests with more wormwood leaves produce heavier chicks. Our results indicate that sparrows use wormwood as a preventative medicine to control ectoparasites and improve the body mass of their offspring.

24-hour access outpatient clinic for patients with exacerbation of chronic disease: a before-after cohort study of differences in acute healthcare utilisation.

BACKGROUND: Chronic diseases are becoming more common due to an increasing ageing population. Patients with chronic conditions managed in outpatient clinics account for a large share of healthcare costs. We developed a 24-h access outpatient clinic offering 24-h telephone support and triaged access to the hospital for patients with acute exacerbation of four selected chronic diseases. The aim of this study was to conduct a 1-year before-after study of the acute healthcare utilisation in patients offered the 24-h access outpatient clinic intervention. METHODS: The study was conducted as an observational register-based cohort study. Data from the patient administrative register and the Danish National Health Service Register were extracted 12 months before and 12 months after implementation of the 24-h access intervention. Patients with chronic obstructive pulmonary disease, chronic liver disease, inflammatory bowel disease and heart failure managed in hospital outpatient clinics were enrolled in the study. Differences in healthcare utilisation were analysed for all patients, including the subgroup of high-risk patients with at least one acute admission in the year before enrolment. RESULTS: Length-of-stay remained unchanged for all diagnostic groups, except for patients with heart failure in whom a statistically significant reduction was observed. Statistically significant reductions of length of stay and acute admissions were observed in all high-risk groups, except for patients with chronic liver disease. A statistically significant reduction in the number of contacts to out-of-hours primary care was seen in patients with chronic obstructive pulmonary disease, whereas the level remained unchanged in the other diagnostic groups. Similar patterns were also seen in high-risk patients. CONCLUSIONS: The 24-h access outpatient clinic did not increase the use of acute healthcare services inpatients with chronic disease. Significant reductions in hospital utilisation were seen in high-risk patients. These preliminary results should be interpreted with caution due to the observational before-after design of the study.

Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam in Patients with Moderate-to-Severe Psoriasis: Sub-Group Analysis of the PSO-ABLE Study.

BACKGROUND: Fixed-combination calcipotriol 50 µg/g plus betamethasone 0.5 mg/g (Cal/BD) aerosol foam is a new topical treatment for psoriasis. Although moderate-to-severe psoriasis is typically treated with systemic/biologic therapies, a topical treatment that is efficacious in these patients may be a significant cost-saving alternative to systemic therapy. OBJECTIVE: The objective of this study was to assess the response to Cal/BD foam and gel in patients with moderate-to-severe psoriasis enrolled in the phase III, 12-week PSO-ABLE study. METHODS: Patients eligible for this analysis had moderate-to-severe psoriasis, defined by the 'Rule of Tens': body surface area ≥10% or Psoriasis Area and Severity Index (PASI) [excluding head; modified PASI (mPASI)] >10 or Dermatology Life-Quality Index >10. Endpoints included: proportion of patients achieving mPASI75 or mPASI90; change in body surface area; proportion of patients clear/almost clear with a ≥2 grade improvement (i.e., treatment success); change in Dermatology Life-Quality Index. RESULTS: Seventy-seven Cal/BD foam patients and 82 gel patients had moderate-to-severe psoriasis. A greater proportion achieved mPASI75 and mPASI90 with Cal/BD foam than gel at weeks 4, 8, and 12 (57.1 vs. 35.4%; p = 0.006 and 15.6 vs. 12.2% at week 12, respectively); overall reduction in mPASI from baseline to week 12 was 64% with the foam vs. 51% with the gel. Overall reduction in body surface area at week 12 was 50% with the foam and 39% with the gel. Treatment success rates were higher with the Cal/BD foam than the gel at weeks 1, 2, 4, 8 (p = 0.0089), and 12, and a greater proportion of foam patients achieved a Dermatology Life-Quality Index score of 0/1 at weeks 4 (p = 0.004), 8, and 12 (p = 0.001). CONCLUSION: Cal/BD foam can be considered as a treatment option in some patients with moderate-to-severe psoriasis who are potential candidates for systemic therapy. CLINICALTRIALS. GOV IDENTIFIER: NCT02132936.

Characterisation of cancer support and rehabilitation programmes: a Swedish multiple case study.

Cancer support and rehabilitation are suggested to be an integral part of cancer care strategies. This study focuses on comparativeness of cancer support and rehabilitation programmes. The aim of this study was to analyse available cancer support and rehabilitation programmes in Sweden presented as complementary to cancer rehabilitation at cancer clinics. A multiple case study design was chosen in order to inquire the small number of existing supportive and rehabilitative cancer programmes. Based on the structures, processes and outcomes of the nine included programmes, three types of cancer support and rehabilitation programmes were identified: multimodal rehabilitation, comprehensive cancer support and art therapy. Cancer support and rehabilitation programmes offer a variety of activities and therapies which are highly valuable and relevant for people with cancer. The typology of cancer support and rehabilitation programmes and comparability between programmes need further inquiry.

Host-parasite relationship between colonial terns and bacteria is modified by a mutualism with a plant with antibacterial defenses.

Predator-prey and host-parasite interactions and mutualisms are common and may have profound effects on ecosystems. Here we analyze the parasitic and mutualistic associations between three groups of organisms: the plant Artemisia maritima, bacteria, and a colonial seabird (the sandwich tern Sterna sandvicensis) that breeds in dense colonies covered in feces produced by both adults and chicks. A disproportionately large fraction of colonies of the sandwich tern in Denmark were located in patches covered by A. maritima. This association was specific for the densely colonial sandwich tern, but was not present for four other sympatric species of terns that breed in much less dense colonies. A. maritima reduced the abundance of pathogenic Staphylococcus on chicken eggshells in a field experiment. Recruitment by sandwich terns breeding in patches of A. maritima was 18 % higher than for sandwich terns breeding in the absence of A. maritima. A. maritima benefitted from the association with sandwich terns due to the supply of nutrients from feces and uneaten food lost by young. These findings are consistent with sandwich terns exploiting the association with A. maritima and its antimicrobial properties to improve their reproductive success, while sandwich terns and A. maritima are involved in a mutualistic interaction.

'I want a choice, but I don't want to decide'--a qualitative study of pregnant women's experiences regarding early ultrasound risk assessment for chromosomal anomalies.

OBJECTIVE: To increase our understanding of how pregnant women experience early ultrasound examination that includes a risk assessment for chromosomal anomalies and how such women perceive the test results. DESIGN/SETTING: Qualitative study at St. Olavs Hospital in Norway. Both pre- and post-examination interviews were conducted with ten pregnant women who underwent risk assessment for chromosomal anomalies. Grounded theory was used to analyse the results. FINDINGS: The study generated a core category (I want a choice, but I don't want to decide), which related to the conflict between choice and decision making. There were also five main categories (existential choices, search for knowledge, anxiety, feeling of guilt and counselling and care). The main categories describe the complex feelings experienced by the women regarding the risk assessment. Factors contributing to the difficulty of choice included loss of control and coping, emotional connection to the fetus and social pressure. As the women sought independent choices without any external influence, they also felt greater responsibility. The women's understanding of the actual risk varied, and they used different types of logic and methods to evaluate the risk and reach a decision. CONCLUSIONS: The pregnant women in this study wanted prenatal diagnostic information and easy access to specialty services. Stress-related feelings and non-transparent information about the actual and perceived risks as well as personal moral judgments made the decision-making process complicated. Improved distribution of information and frequent contact with health professionals may help such women to make informed choices in accordance with their values and beliefs.

Workplace interventions for neck pain in workers.

BACKGROUND: Musculoskeletal disorders are the most common cause of disability in many industrial countries. Recurrent and chronic pain accounts for a substantial portion of workers' absenteeism. Neck pain seems to be more prominent in the general population than previously known. OBJECTIVES: To determine the effectiveness of workplace interventions (WIs) in adult workers with neck pain. SEARCH STRATEGY: We searched: CENTRAL (The Cochrane Library 2009, issue 3), and MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, OTseeker, PEDro to July 2009, with no language limitations;screened reference lists; and contacted experts in the field.   SELECTION CRITERIA: We included randomised controlled trials (RCT), in which at least 50% of the participants had neck pain at baseline and received interventions conducted at the workplace. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. Authors were contacted for missing information. Since the interventions varied to a large extend, International Classification of Functioning, Disability and Health (ICF) terminology was used to classify the intervention components. This heterogeneity restricted pooling of data to only one meta-analysis of two studies. MAIN RESULTS: We identified 1995 references and included10 RCTs (2745 workers). Two studies were assessed with low risk of bias. Most trials (N = 8) examined office workers. Few workers were sick-listed. Thus, WIs were seldom designed to improve return-to-work. Overall, there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity. If present, significant results in favour of WIs were not sustained across follow-up times. There was moderate quality evidence (1 study, 415 workers) that a four-component WI was significantly more effective in reducing sick leave in the intermediate-term (OR 0.56, 95% CI 0.33 to 0.95), but not in the short- (OR 0.83, 95% CI 0.52 to 1.34) or long-term (OR 1.28, 95% CI 0.73 to 2.26). These findings might be because only a small proportion of the workers were sick-listed. AUTHORS' CONCLUSIONS: Overall, this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term, which was not sustained over time. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There is an urgent need for high quality RCTs with well designed WIs.

Sperm of colourful males are better protected against oxidative stress.

Sperm cells are highly vulnerable to free radicals, and sperm quality and male fertility are critically affected by oxidative stress. Recently, sexual ornaments, particularly carotenoid-based colourful traits, have been proposed to depend on a male's capacity to resist oxidative stress, and thus to signal sperm quality. We conducted an experimental test of this hypothesis on great tits Parus major, in which adults are sexually dichromatic in carotenoid-based breast plumage. We report the first evidence that ornaments and sperm quality may be linked through oxidative stress. When experimentally subjected to oxidative stress resulting from increased workload, less colourful males suffered a greater reduction in sperm motility and swimming ability, and increased levels of sperm lipid peroxidation compared to more colourful males. Moreover, the level of sperm lipid peroxidation was negatively correlated with sperm quality. Finally, carotenoid supplementation increased sperm quality of less colourful males, suggesting that pale males are deficient in carotenoid antioxidants.

Antioxidants in eggs of great tits Parus major from Chernobyl and hatching success.

Antioxidants are powerful protectors against the damaging effects of free radicals that constitute the inevitable by-products of aerobic metabolism. Growing embryos are particularly susceptible to the damaging effects of free radicals produced during rapid growth, and mothers of many species provide protection against such damage by allocating antioxidants to their eggs. Birds living in radioactively contaminated areas use dietary antioxidants to cope with the damaging effects of radiation, but females also allocate dietary antioxidants to eggs, potentially enforcing a physiological trade-off between self-maintenance and reproductive investment. Here we tested whether female great tits Parus major breeding in radioactively contaminated study areas near Chernobyl allocated less dietary antioxidants to eggs, and whether such reduced allocation of dietary antioxidants to eggs had fitness consequences. Concentrations of total yolk carotenoids and vitamins A and E were depressed near Chernobyl compared to concentrations in a less contaminated Ukrainian study area and a French control study area, and all antioxidants showed dose-dependent relationships with all three dietary antioxidants decreasing with increasing level of radiation at nest boxes. These effects held even when controlling statistically for potentially confounding habitat variables and covariation among antioxidants. Laying date was advanced and clutch size increased at nest boxes with high dose rates. Hatching success increased with increasing concentration of vitamin E, implying that hatching success decreased at boxes with high levels of radiation, eventually eliminating and even reversing the higher potential reproductive output associated with early reproduction and large clutch size. These findings are consistent with the hypothesis that radioactive contamination reduced levels of dietary antioxidants in yolks, with negative consequences for hatching success and reproductive success.

Carotenoid availability in diet and phenotype of blue and great tit nestlings.

Carotenoids are biologically active pigments of crucial importance for the development of avian embryos and nestlings. Thus parental ability to provide nestlings with a carotenoid-rich diet may enhance offspring fitness. However, very little is known about the possible effects of carotenoid availability in the diet on growing nestlings in natural populations. We experimentally manipulated dietary intake of carotenoids by nestlings of two closely related passerine species, the great tit Parus major and the blue tit Parus caeruleus, and measured nestling antioxidants, body condition, immunity and plumage colour. There was no detectable increase in plasma carotenoids after treatment in carotenoid-fed nestlings of either species despite regular supply of dietary carotenoids. However, in carotenoid-fed blue tit nestlings, plasma vitamin E concentration increased with plasma carotenoid concentration, while that was not the case for control nestlings. In both species, there was no significant effect of carotenoid supply on immune function. Carotenoid supplementation enhanced yellow feather colour in great tit nestlings only. In both species a strong effect of carotenoid supply was found on body condition with an increase in body mass for small carotenoid-fed nestlings compared to similarly sized control nestlings. Dietary availability of carotenoids may thus have important fitness consequences for tits. We hypothesise that the difference in effect of dietary carotenoids on the two species is due to relatively larger clutch size and higher growth rates of blue tits compared to great tits, leading to blue tit nestlings being more in need of carotenoids for antioxidant function than great tit nestlings.

Effects of carotenoid availability during laying on reproduction in the blue tit.

Carotenoids are antioxidant pigments involved in several physiological processes and signalling in animals that cannot synthesise them and therefore must acquire them from food. We experimentally investigated the effects of carotenoid availability in the diet during egg laying on antioxidant deposition in egg yolk and the related effects on nestling condition, female body condition and parental investment in the blue tit (Parus caeruleus). Carotenoid supplementation of egg-laying females resulted in a significant increase in carotenoid concentration in egg yolk, but not in vitamin E or A concentration. There was no relationship between yellow plumage colour of adult females and carotenoid deposition in eggs, and no differential effect of feeding treatment depending on female colour. Nestlings from eggs laid by carotenoid supplemented females had longer tarsi, had faster development of the immune system as reflected by leukocyte concentration in blood, and grew brighter yellow feathers than nestlings from control females. However, nestlings from the two groups did not differ significantly in body mass, plasma antioxidants or plumage colour hue. At the time of chick rearing, carotenoid-fed females had increased plasma vitamin E levels compared to controls. However, females from the two treatment groups did not differ significantly in body condition or feeding rate. These results suggest that carotenoid availability is limiting during egg laying, and that females may have to balance the benefits of investing in egg quality against the potential costs of impairing their own future antioxidant protection. In addition, there may be considerable variation in carotenoid availability not only across seasons, but also among different stages of the breeding season.

Electro-acupuncture versus conventional analgesia: a comparison of pain levels during oocyte aspiration and patients' experiences of well-being after surgery.

BACKGROUND: The primary aims were to compare the pain-relieving effect and post-operative well-being between electro-acupuncture analgesia (EA) and conventional analgesia (CA) comprising opiates. Further aims were to compare time for mobilization, and costs for time and drug consumption. METHODS: In all, 160 women undergoing IVF were randomized, according to a computer-generated list, to EA or CA. Well-being was evaluated with the State Trait Anxiety Inventory (STAI). Pain and subjective expectations and experiences were recorded on a visual analogue scale (VAS). Time and drug consumption were recorded. RESULTS: Although VAS pain ratings were significantly higher at oocyte aspiration (P < 0.0001) and after retrieval (P < 0.01) in the EA than in the CA group, they were similar 60 min after surgery. Both groups had similar STAI well-being scores. The EA group was significantly less tired and confused than the CA group after oocyte aspiration. No significant differences in time and costs for drug consumption were noted. CONCLUSION: EA cannot generally be recommended as a pain-relieving method at oocyte aspiration but might be an alternative for women desiring a non-pharmacological method. An advantage of EA is less post-operative tiredness and confusion compared with CA.

Carotenoids and egg quality in the lesser blackbacked gull Larus fuscus: a supplemental feeding study of maternal effects.

Egg quality is a phenotype of, and can profoundly influence fitness in, both mother and offspring. However, the physiological mechanisms that underlie this maternal effect are poorly understood. Carotenoids are hypothesized to enhance antioxidant activity and immune function, and are responsible for the pigmentation of egg yolk. The proximate basis and consequences of this maternal investment, however, have not previously been studied in wild birds. In this supplemental feeding study of lesser black-backed gulls, Larus fuscus, carotenoid-fed females are shown to have increased integument pigmentation, higher plasma concentrations of carotenoids and antioxidant activity, and lower plasma concentrations of immunoglobulins (Igs) in comparison with controls. In turn, carotenoid-fed females produced eggs containing high carotenoid but low Ig concentrations (i.e. passive immunity), whereas control females produced eggs containing low carotenoid but high Ig concentrations. Within-clutch patterns of these resources varied over the laying sequence in a similar manner in both carotenoid-fed and control nests. Our results suggest that carotenoids could be one resource responsible for egg quality maternal effects in birds. We discuss the possible implications of carotenoid-mediated effects on phenotype for fitness in mothers and their offspring.