Emerging clinical perspectives in cystic fibrosis liver disease.

PURPOSE OF REVIEW: Liver disease (CFLD) as a complication of cystic fibrosis is recognized as a more severe disease phenotype in both children and adults. We review recent advances in understanding the disease mechanism and consider the implications of new strategies for the diagnosis and management of cystic fibrosis in those with evidence of clinically significant liver disease. RECENT FINDINGS: Evidence suggests that the prevalence of CFLD has not declined with the introduction of newborn screening. Furthermore, children with CFLD, who have been diagnosed with cystic fibrosis following newborn screening continue to have a much higher mortality rate compared with those with no liver disease. There is further data suggesting noncirrhotic obliterative portal venopathy as the predominant pathological mechanism in the majority of children and young adults receiving a liver transplantation. Little progress has been made in developing an accurate noninvasive test for early diagnosis or monitoring disease progression in CFLD. The benefit of new modulator therapies is not well understood in those with established CFLD, whereas the risk of hepatotoxicity as a complication of treatment must be carefully monitored. SUMMARY: Better understanding of the pathophysiology of CFLD would allow a standardized approach to diagnosis, with the potential to improve outcomes for those with CFLD.

The Alzheimer's-related amyloid beta peptide is internalised by R28 neuroretinal cells and disrupts the microtubule associated protein 2 (MAP-2).

Age-related Macular Degeneration (AMD) is a common, irreversible blinding condition that leads to the loss of central vision. AMD has a complex aetiology with both genetic as well as environmental risks factors, and share many similarities with Alzheimer's disease. Recent findings have contributed significantly to unravelling its genetic architecture that is yet to be matched by molecular insights. Studies are made more challenging by observations that aged and AMD retinas accumulate the highly pathogenic Alzheimer's-related Amyloid beta (Aß) group of peptides, for which there appears to be no clear genetic basis. Analyses of human donor and animal eyes have identified retinal Aß aggregates in retinal ganglion cells (RGC), the inner nuclear layer, photoreceptors as well as the retinal pigment epithelium. Aß is also a major drusen constituent; found correlated with elevated drusen-load and age, with a propensity to aggregate in retinas of advanced AMD. Despite this evidence, how such a potent driver of neurodegeneration might impair the neuroretina remains incompletely understood, and studies into this important aspect of retinopathy remains limited. In order to address this we exploited R28 rat retinal cells which due to its heterogeneous nature, offers diverse neuroretinal cell-types in which to study the molecular pathology of Aß. R28 cells are also unaffected by problems associated with the commonly used RGC-5 immortalised cell-line, thus providing a well-established model in which to study dynamic Aß effects at single-cell resolution. Our findings show that R28 cells express key neuronal markers calbindin, protein kinase C and the microtubule associated protein-2 (MAP-2) by confocal immunofluorescence which has not been shown before, but also calretinin which has not been reported previously. For the first time, we reveal that retinal neurons rapidly internalised Aß1-42, the most cytotoxic and aggregate-prone amongst the Aß family. Furthermore, exposure to physiological amounts of Aß1-42 for 24 h correlated with impairment to neuronal MAP-2, a cytoskeletal protein which regulates microtubule dynamics in axons and dendrites. Disruption to MAP-2 was transient, and had recovered by 48 h, although internalised Aß persisted as discrete puncta for as long as 72 h. To assess whether Aß could realistically localise to living retinas to mediate such effects, we subretinally injected nanomolar levels of oligomeric Aß1-42 into wildtype mice. Confocal microscopy revealed the presence of focal Aß deposits in RGC, the inner nuclear and the outer plexiform layers 8 days later, recapitulating naturally-occurring patterns of Aß aggregation in aged retinas. Our novel findings describe how retinal neurons internalise Aß to transiently impair MAP-2 in a hitherto unreported manner. MAP-2 dysfunction is reported in AMD retinas, and is thought to be involved in remodelling and plasticity of post-mitotic neurons. Our insights suggest a molecular pathway by which this could occur in the senescent eye leading to complex diseases such as AMD.

Improving detection of cystic fibrosis related liver disease using liver fibrosis assessment tools.

Background & aims: Cystic Fibrosis related liver disease (CFLD) is the 3rd largest cause of death in Cystic Fibrosis (CF). As advances in pulmonary therapies have increased life-expectancy, CFLD has become more prevalent. Current guidelines may underdiagnose liver fibrosis, particularly in its early stages. Newer modalities for the assessment of fibrosis may provide a more accurate assessment. FibroScan is validated in assessing fibrosis for several aetiologies including alcohol and fatty liver, the CFLD cohort have an entirely different phenotype so the cut off values are not transferrable. We appraised fibrosis assessment tools to improve diagnosis of CFLD. Methods: A prospective cohort (n = 114) of patients from the Manchester Adult Cystic Fibrosis Centre, UK were identified at annual assessment. Demographic data including co-morbidity, CFTR genotyping, biochemistry and imaging were used alongside current guidelines to group into CFLD and CF without evidence of liver disease. All patients underwent liver stiffness measurement (LSM) and assessment of serum-based fibrosis biomarker panels. A new diagnostic criterion was created and validated in a second, independent cohort. Results: 12 of 114 patient classified as CFLD according to the European Cystic Fibrosis Society best practice guidelines. No specific risk factors for development of CFLD were identified. Liver enzymes were elevated in patients with CFLD. Serum biomarker panels did not improve diagnostic criteria. LSM accurately predicted CFLD. A new diagnostic criterion was proposed and validated in a separate cohort, accurately predicating CFLD in 10 of 32 patients (31 %). Conclusion: We present a cohort of patients with CF assessed for the presence of liver fibrosis using blood biomarkers and LSM based platforms. We propose a new, simplified diagnostic criteria, capable of accurately predicting liver disease in patients with CF.Clinical trials number: NCT04277819.

A laser-induced mouse model of progressive retinal degeneration with central sparing displays features of parafoveal geographic atrophy.

There are no disease-modifying treatments available for geographic atrophy (GA), the advanced form of dry age-related macular degeneration. Current murine models fail to fully recapitulate the features of GA and thus hinder drug discovery. Here we describe a novel mouse model of retinal degeneration with hallmark features of GA. We used an 810 nm laser to create a retinal lesion with central sparing (RLCS), simulating parafoveal atrophy observed in patients with progressive GA. Laser-induced RLCS resulted in progressive GA-like pathology with the development of a confluent atrophic lesion. We demonstrate significant changes to the retinal structure and thickness in the central unaffected retina over a 24-week post-laser period, confirmed by longitudinal optical coherence tomography scans. We further show characteristic features of progressive GA, including a gradual reduction in the thickness of the central, unaffected retina and of total retinal thickness. Histological changes observed in the RLCS correspond to GA pathology, which includes the collapse of the outer nuclear layer, increased numbers of GFAP + , CD11b + and FcγRI + cells, and damage to cone and rod photoreceptors. We demonstrate a laser-induced mouse model of parafoveal GA progression, starting at 2 weeks post-laser and reaching confluence at 24 weeks post-laser. This 24-week time-frame in which GA pathology develops, provides an extended window of opportunity for proof-of-concept evaluation of drugs targeting GA. This time period is an added advantage compared to several existing models of geographic atrophy.

Human equivalent doses of L-DOPA rescues retinal morphology and visual function in a murine model of albinism.

L-DOPA is deficient in the developing albino eye, resulting in abnormalities of retinal development and visual impairment. Ongoing retinal development after birth has also been demonstrated in the developing albino eye offering a potential therapeutic window in humans. To study whether human equivalent doses of L-DOPA/Carbidopa administered during the crucial postnatal period of neuroplasticity can rescue visual function, OCA C57BL/6 J-c2J OCA1 mice were treated with a 28-day course of oral L-DOPA/Carbidopa at 3 different doses from 15 to 43 days postnatal age (PNA) and for 3 different lengths of treatment, to identify optimum dosage and treatment length. Visual electrophysiology, acuity, and retinal morphology were measured at 4, 5, 6, 12 and 16 weeks PNA and compared to untreated C57BL/6 J (WT) and OCA1 mice. Quantification of PEDF, ßIII-tubulin and syntaxin-3 expression was also performed. Our data showed impaired retinal morphology, decreased retinal function and lower visual acuity in untreated OCA1 mice compared to WT mice. These changes were diminished or eliminated when treated with higher doses of L-DOPA/Carbidopa. Our results demonstrate that oral L-DOPA/Carbidopa supplementation at human equivalent doses during the postnatal critical period of retinal neuroplasticity can rescue visual retinal morphology and retinal function, via PEDF upregulation and modulation of retinal synaptogenesis, providing a further step towards developing an effective treatment for albinism patients.

Sexual violence trends between 2004 and 2008 in South Kivu, Democratic Republic of Congo.

INTRODUCTION: For more than a decade, conflict in the Eastern Democratic Republic of Congo (DRC) has been claiming lives. Within that conflict, sexual violence has been used by militia groups to intimidate and punish communities, and to control territory. This study aimed to: (1) investigate overall frequency in number of Eastern DRC sexual assaults from 2004 to 2008 inclusive; (2) determine if peaks in sexual violence coincide with known military campaigns in Eastern DRC; and (3) study the types of violence and types of perpetrators as a function of time. METHODS: This study was a retrospective, descriptive, registry-based evaluation of sexual violence survivors presenting to Panzi Hospital between 2004 and 2008. RESULTS: A total of 4,311 records were reviewed. Throughout the five-year study period, the highest number of reported sexual assaults occurred in 2004, with a steady decrease in the total number of incidents reported at Panzi Hospital from 2004 through 2008. The highest peak of reported sexual assaults coincided with a known militant attack on the city of Bukavu. A smaller sexual violence peak in April 2004 coincided with a known military clash near Bukavu. Over the five-year period, the number of sexual assaults reportedly perpetrated by armed combatants decreased by 77% (p = 0.086) and the number of assaults reportedly perpetrated by non-specified perpetrators decreased by 92% (p < 0.0001). At the same time, according to the hospital registry, the number of sexual assaults reportedly perpetrated by civilians increased 17-fold (p < 0.0001). This study was limited by its retrospective nature, by the inherent selection bias of studying only survivors presenting to Panzi Hospital, and by the use of a convenience sample within Panzi Hospital. CONCLUSIONS: After years of military rape in South Kivu Province, civilian adoption of sexual violence may be a growing phenomenon. If this is the case, the social mechanisms that prevent sexual violence will have to be rebuilt and sexual violence laws will have to be fully enforced to bring all perpetrators to justice. Proper rehabilitation and reintegration of ex-combatants may also be an important step towards reducing civilian rape in Eastern DRC.

Characterization of the Frmd7 Knock-Out Mice Generated by the EUCOMM/COMP Repository as a Model for Idiopathic Infantile Nystagmus (IIN).

In this study, we seek to exclude other pathophysiological mechanisms by which Frmd7 knock-down may cause Idiopathic Infantile Nystagmus (IIN) using the Frmd7.tm1a and Frmd7.tm1b murine models. We used a combination of genetic, histological and visual function techniques to characterize the role of Frmd7 gene in IIN using a novel murine model for the disease. We demonstrate that the Frmd7.tm1b allele represents a more robust model of Frmd7 knock-out at the mRNA level. The expression of Frmd7 was investigated using both antibody staining and X-gal staining confirming previous reports that Frmd7 expression in the retina is restricted to starburst amacrine cells and demonstrating that X-gal staining recapitulates the expression pattern in this model. Thus, it offers a useful tool for further expression studies. We also show that gross retinal morphology and electrophysiology are unchanged in these Frmd7 mutant models when compared with wild-type mice. High-speed eye-tracking recordings of Frmd7 mutant mice confirm a specific horizontal optokinetic reflex defect. In summary, our study confirms the likely role for Frmd7 in the optokinetic reflex in mice mediated by starburst amacrine cells. We show that the Frmd7.tm1b model provides a more robust knock-out than the Frmd7.tm1a model at the mRNA level, although the functional consequence is unchanged. Finally, we establish a robust eye-tracking technique in mice that can be used in a variety of future studies using this model and others. Although our data highlight a deficit in the optiokinetic reflex as a result of the starburst amacrine cells in the retina, this does not rule out the involvement of other cells, in the brain or the retina where Frmd7 is expressed, in the pathophysiology of IIN.

AAV2/8 Anti-angiogenic Gene Therapy Using Single-Chain Antibodies Inhibits Murine Choroidal Neovascularization.

While anti-angiogenic therapies for wet age-related macular degeneration (AMD) are effective for many patients, they require multiple injections and are expensive and prone to complications. Gene therapy could be an elegant solution for this problem by providing a long-term source of anti-angiogenic proteins after a single administration. Another potential issue with current therapeutic proteins containing a fragment crystallizable (Fc) domain (such as whole antibodies like bevacizumab) is the induction of an unwanted immune response. In wet AMD, a low level of inflammation is already present, so to avoid exacerbation of disease by the therapeutic protein, we propose single-chain fragment variable (scFv) antibodies, which lack the Fc domain, as a safer alternative. To investigate the feasibility of this, anti-vascular endothelial growth factor (VEGF)-blocking antibodies in two formats were produced and tested in vitro and in vivo. The scFv transgene was then cloned into an adeno-associated virus (AAV) vector. A therapeutic effect in a mouse model of choroidal neovascularization (CNV) was demonstrated with antibodies in both scFv and immunoglobulin G1 (IgG1) formats (p < 0.04). Importantly, the scFv anti-VEGF antibody expressed from an AAV vector also had a significant beneficial effect (p = 0.02), providing valuable preclinical data for future translation to the clinic.

Self-efficacy correlates with leg muscle pain during maximal and submaximal cycling exercise.

UNLABELLED: Quadriceps muscle pain is a naturally occurring consequence of moderate- to high-intensity cycle ergometry. The present study involved an examination of self-efficacy for tolerating muscle pain during exercise as a correlate of muscle pain during maximal and submaximal cycle ergometry. Young adult females (n=16) who were healthy and regularly physically active completed a measure of self-efficacy for tolerating moderate to strong pain in the legs and then undertook a maximal incremental exercise test on a cycle ergometer. Within 1 week, participants completed a 30-minute bout of submaximal exercise (80% VO2peak) on a cycle ergometer. Ratings of quadriceps muscle pain intensity were recorded every minute during the maximal incremental exercise test and every 5 minutes during the submaximal exercise session. Self-efficacy for tolerating pain was moderately inversely correlated with ratings of peak muscle pain during the maximal incremental exercise test (r=-.45) and pain ratings averaged across the submaximal session (r=-.49). Our results are consistent with social-cognitive theory and indicate that self-efficacy for tolerating pain is inversely associated with ratings of muscle pain during maximal and submaximal exercise in healthy and regularly active young adult females. Such findings support a possible examination of strategies for manipulating self-efficacy for tolerating pain and thereby reducing muscle pain during exercise. PERSPECTIVE: Our data provided evidence that self-efficacy for tolerating moderate to strong muscle pain during exercise correlates with muscle pain intensity ratings during bouts of maximal and submaximal exercise. Future research could identify methods of manipulating self-efficacy as a means of decreasing muscle pain during exercise and ultimately enhancing physical activity participation.

Demographic correlates of physical activity in individuals with multiple sclerosis.

PURPOSE: There is limited information about the demographic characteristics associated with participation in physical activity among those with multiple sclerosis (MS). Hence, the present study examined 12 demographic variables in association with physical activity in a sample of individuals with MS. METHOD: Participants were 196 individuals with MS from the Midwestern portion of the United States. The participants provided demographic information and then wore a pedometer for a seven-day period. RESULTS: Analyses indicated that increasing age, use of a cane for ambulation, unemployment, and primary and secondary progressive MS were independently associated with less physical activity participation in this sample of MS patients. CONCLUSION: Individuals with those characteristics are likely to be inactive and in need of a targeted intervention for increasing their participation in physical activity.

Validity of physical activity measures in ambulatory individuals with multiple sclerosis.

PURPOSE: The literature suggests that individuals with multiple sclerosis (MS) engage in less physical activity than non-diseased individuals. That conclusion, however, depends upon the validity of scores from measures of physical activity among the MS population. This study evaluated the validity of scores from two self-report surveys, a pedometer, and an accelerometer and during seven days of free-living conditions among individuals with MS. METHOD: Participants were 30 individuals (28 females, two males) with an established definite diagnosis of MS. The participants wore a pedometer and a single-axis accelerometer during the waking hours of a 7-day period. After the 7-day period, participants returned to the lab and completed a self-administered physical activity questionnaire and then underwent a 7-day physical activity recall. RESULTS: There were strong correlations (a) between scores from the two self-report measures of physical activity and (b) between scores from the two objective measures of physical activity, and (c) weaker, but moderate-to-strong correlations between scores from the self-report and objective measures of physical activity. CONCLUSION: Our results support the quantification of physical activity among those with MS using validated self-report and objective measures.

The influence of organisational climate on care of patients with schizophrenia: a qualitative analysis of health care professionals' views.

BACKGROUND: Organizational climate relates to how employees perceive and describe the characteristics of their employing organization. It has been found to have an impact on healthcare professionals' and patients' experiences of healthcare (e.g. job satisfaction, patient satisfaction), as well as organizational outcomes (e.g. employee productivity). This research used organizational theory to explore dynamics between health care professionals (pharmacists, doctors and nurses) in mental health outpatients' services for patients taking clozapine, and the perceived influence on patient care. SETTING: Seven clozapine clinics (from one NHS mental health Trust in the UK) which provided care for people with treatment resistant schizophrenia. METHODS: This study used qualitative methods to identify organizational climate factors such as deep structures, micro-climates and climates of conflict that might inhibit change and affect patient care. Using Interpretative Phenomenological Analysis, semistructured interviews were conducted with 10 healthcare professionals working in the clinics to explore their experiences of working in these clinics and the NHS mental health Trust the clinics were part of. MAIN OUTCOME MEASURE: Health Care Professionals' perceptions of the care of patients with treatment resistant schizophrenia. RESULTS: Three superordinate themes emerged from the data: philosophy of care, need for change and role ambiguity. Participants found it difficult to articulate what a philosophy of care was and in spite of expressing the need for change in the way the clinics were run, could not see how 'changing things would work'. There was considerable role ambiguity with some 'blurring of the boundaries between roles'. Factors associated with organizational climate (role conflict; job satisfaction) were inhibiting team working and preventing staff from identifying the patients' health requirements and care delivery through innovation in skill mix. There were mixed attitudes towards the pharmacist's inclusion as a team member. CONCLUSIONS: Our findings suggest deficiencies within the clinics that may be manifestations of the wider culture of the NHS. The implications for mental health outpatient clinics are that local initiatives are crucial to the implementation of recovery models; clear guidance should be provided on the skill mix required in clozapine clinics and interprofessional learning should be encouraged to reduce role conflict.

Influences of weather on Ixodes scapularis nymphal densities at long-term study sites in Connecticut.

Tick species worldwide are implicated in transmission of pathogens that cause mild to severe diseases in humans and livestock. Although tick population densities are often highly correlated with tick-borne disease rates, we currently know little about which factors underlie annual changes in those tick population densities. We used a 25-year dataset of Ixodes scapularis drag-sampling surveys at two locations in CT, USA, to investigate the relationship between average nymphal density from mid-May to mid-August and monthly, lagged regional weather variables. The dataset was randomly split into two data subsets, one for hypothesis development and one for hypothesis testing. Nymphal density showed the strongest association with the Standardized Precipitation Index for January of the same year that density data were collected in the analysis based on the hypothesis development data subset. This association was positive; nymphal tick density increased with regional winter precipitation. Nymphal density was positively associated with this same weather variable in the hypothesis testing data subset. Weather conditions during the coldest months of the year may serve as a bottleneck to tick populations, thereby functioning as an important correlate of not only annual blacklegged tick nymphal densities the following summer, but also entomological risk associated with tick-borne pathogens transmitted by this species.

Prevalence of organic neuro-ophthalmologic disease in patients with functional visual loss.

PURPOSE: To determine the concurrence of various patterns of functional visual loss (FVL) and organic disease. DESIGN: A retrospective case series in a university neuro-ophthalmology practice. METHODS: A retrospective case series in which we reviewed the clinical histories and neuro-ophthalmologic examinations of 133 consecutive patients diagnosed with FVL between July 1999 and August 2001. Functional visual loss was defined as an apparent afferent or efferent dysfunction that was unassociated with or far out of proportion with an identifiable lesion of the visual pathways. RESULTS: A total of 133 patients were identified. Nineteen were pediatric, and 76 were female. Fifty-six had concurrent head or eye pain. Nineteen had a recent history of trauma, and 17 had a recent surgical procedure. The most common pattern of FVL was a normal visual field in the presence of reduced visual acuity. Seventy-one patients (53%) with FVL presented with abnormal neuro-ophthalmologic examinations. Thirteen patients had central scotomata, and all had concurrent retinal or optic nerve pathology. Only 18 patients had a known disability claim pending. CONCLUSION: Although FVL was found in patients with no pathology, it was more common to find objective abnormalities on examination. This concurrence rate underscores the clinical necessity for following patients closely despite the diagnosis of FVL. No pattern of visual field constriction was routinely predictive of ophthalmologic or neurologic pathology except the presence of a central scotoma. The presence of a central scotoma in a nonorganic visual field should alert the practitioner to search for organic pathology.

Improving cellular adhesion on scaffolds for transplantation: synthesising a poly(MMA-co-PEGM) network.

Electrospun fibrous matrices prepared from methacrylate-based copolymers are investigated as a tool for retinal pigment epithelium (RPE) transplantation in the treatment of degenerative retinal diseases. Human RPE cells were used to probe the cell-surface interactions on these copolymer matrices. For the first time, simple changes in chemical functionality have been found to induce gel formation of these methacrylate backbone copolymers in vitro. This effect is shown to significantly improve RPE cell adhesion and survival.

Reliability and validity of instruments for assessing perinatal depression in African settings: systematic review and meta-analysis.

BACKGROUND: A major barrier to improving perinatal mental health in Africa is the lack of locally validated tools for identifying probable cases of perinatal depression or for measuring changes in depression symptom severity. We systematically reviewed the evidence on the reliability and validity of instruments to assess perinatal depression in African settings. METHODS AND FINDINGS: Of 1,027 records identified through searching 7 electronic databases, we reviewed 126 full-text reports. We included 25 unique studies, which were disseminated in 26 journal articles and 1 doctoral dissertation. These enrolled 12,544 women living in nine different North and sub-Saharan African countries. Only three studies (12%) used instruments developed specifically for use in a given cultural setting. Most studies provided evidence of criterion-related validity (20 [80%]) or reliability (15 [60%]), while fewer studies provided evidence of construct validity, content validity, or internal structure. The Edinburgh postnatal depression scale (EPDS), assessed in 16 studies (64%), was the most frequently used instrument in our sample. Ten studies estimated the internal consistency of the EPDS (median estimated coefficient alpha, 0.84; interquartile range, 0.71-0.87). For the 14 studies that estimated sensitivity and specificity for the EPDS, we constructed 2 x 2 tables for each cut-off score. Using a bivariate random-effects model, we estimated a pooled sensitivity of 0.94 (95% confidence interval [CI], 0.68-0.99) and a pooled specificity of 0.77 (95% CI, 0.59-0.88) at a cut-off score of ≥ 9, with higher cut-off scores yielding greater specificity at the cost of lower sensitivity. CONCLUSIONS: The EPDS can reliably and validly measure perinatal depression symptom severity or screen for probable postnatal depression in African countries, but more validation studies on other instruments are needed. In addition, more qualitative research is needed to adequately characterize local understandings of perinatal depression-like syndromes in different African contexts.

Demographics and care-seeking behaviors of sexual violence survivors in South Kivu province, Democratic Republic of Congo.

OBJECTIVES: One of the most striking features of the ongoing conflict in the Democratic Republic of Congo (DRC) is the use of sexual violence. In spite of the brutality of these crimes, the experiences of women affected by sexual violence in Eastern DRC remain poorly characterized. This analysis aimed to (1) provide detailed demographics of sexual violence survivors presenting to Panzi Hospital; (2) examine how demographic factors might impact patterns of sexual violence; and (3) describe care-seeking behavior among sexual violence survivors. METHODS: The demographics and care-seeking behavior of sexual violence survivors in South Kivu Province were described from a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital (2004-2008). RESULTS: A total of 4311 records were reviewed. The mean age of survivors was 35 years. Most women (53%) were married, self-identified with the Bashi tribe (65%), and reported agriculture as their livelihood (74%). The mean time delay between sexual assault and seeking care was 10.4 months. Five reasons were identified to help explain the lengthy delays to seeking care: waiting for physical symptoms to develop or worsen before seeking medical attention, lack of means to access medical care, concerns that family would find out about the sexual assault, stigma surrounding sexual violence, and being abducted into sexual slavery for prolonged periods of time. CONCLUSIONS: Many sexual assault survivors have very delayed presentations to medical attention. Promoting timely access of medical care may best be facilitated by reducing stigma and by educating women about the benefits of early medical care, even in the absence of injuries or symptoms.

Patterns of sexual violence in Eastern Democratic Republic of Congo: reports from survivors presenting to Panzi Hospital in 2006.

BACKGROUND: Despite the signing of international peace agreements, a deadly war continues in the Democratic Republic of Congo (DRC) and sexual violence is a prominent modus operandi of many military groups operating in the region. METHODS: Retrospective cohort study of women who presented to Panzi Hospital in 2006 requesting post-sexual violence care. Data was extracted and analyzed to describe the patterns of sexual violence. RESULTS: A total of 1,021 medical records were reviewed. A majority of attacks occurred in individual homes (56.5%), with the fields (18.4%) and the forest (14.3%) also being frequent locations of attack. In total, 58.9% of all attacks occurred at night. Of the four primary types of sexual violence, gang rape predominated (59.3%) and rape Not Otherwise Specified (NOS) was also common (21.5%). Sexual slavery was described by 4.9% of the survivors and a combination of gang rape and sexual slavery was described by 11.7%. The mean number of assailants per attack was 2.5 with a range of one to > 15. There were several demographic predictors for sexual slavery. Controlling for age, education level and occupation, a marital status of "single" increased the risk of sexual slavery (OR = 2.97, 95% CI = 1.12-7.85). Similarly, after controlling for other variables, age was a significant predictor of sexual slavery with older women being at a slightly reduced risk (OR = 0.96, 95% CI = 0.92-0.99). Women who experienced sexual slavery were 37 times more likely to have a resultant pregnancy in comparison to those who reported other types of sexual violence (OR = 37.50, 95% CI = 14.57-99.33). CONCLUSIONS: Among sexual violence survivors presenting to Panzi Hospital in 2006, the majority of attacks occurred in women's own homes, often at night. This represents a pattern of violence that differs from other conflict settings and has important implications regarding protection strategies. Sexual violence in South Kivu was also marked with a predominance of gang rape, thus increasing the risk of serious injury as well as the likelihood of an individual woman contracting a sexually transmitted infection (STI). Sexual slavery was noted to be more common among young, single women and was found to have a high rate of resultant pregnancy.

Physical activity and multiple sclerosis: validity of self-report and objective measures.

This study examined the validity of scores from measures of physical activity among individuals with multiple sclerosis. Participants (N = 196) completed 2 self-report measures of physical activity, and wore a pedometer and an accelerometer for a 7-day period. There was a large correlation between scores from the objective devices (r = 0.82) and a moderate correlation between scores from the self-report surveys (r = 0.37). The correlations across measurement methods were moderate-to-large in magnitude (range of r = 0.32-0.53). Our results provide a stronger and more compelling basis for the validity of scores from measures of physical activity among individuals with multiple sclerosis.