A prospective randomized pilot study on intermittent post-dialysis dosing of cinacalcet.

BACKGROUND: Treatment of secondary hyperparathyroidism (SHPT) is important in management of patients with end-stage renal disease on hemodialysis (HD). Calcimimetic agent, cinacalcet provides an option for control of SHPT in patients who fail traditional therapy. It may not have optimal results in non-compliant patients. To enhance compliance, we evaluated effectiveness of post-dialysis dosing of cinacalcet (group AD) as compared to daily home administration (group D) in a prospective randomized trial of HD patients with refractory SHPT. METHODS: After 2-week run-in phase, patients were randomly assigned to two treatment groups. In group AD (N = 12), patients were administered cinacalcet on the day of dialysis (3 times/week) by dialysis staff, while in control group D (N = 11), cinacalcet was prescribed daily to be taken by patients at home. Intact parathyroid hormone (i-PTH), serum calcium, phosphorus, and alkaline phosphatase were followed for 16 weeks and compared to baseline in both groups. Data were analyzed using between-groups linear regression for repeated measures. RESULTS: No significant decline in i-PTH occurred in group AD at 16 weeks as compared to a significant drop in group D (p = 0.006). However, subgroup analysis showed effectiveness of post-dialysis dosing in patients with less severe SHPT (p = 0.04). CONCLUSION: Although daily dosing overall was more effective for treatment of SHPT, dialysis dosing was effective in patients with less severe SHPT. This warrants a larger study considering the limitations of this pilot trial. In the meantime, dialysis dosing can be considered in non-compliant patients with less severe SHPT.

Outcome of patients with acute lymphoblastic leukemia (ALL) following induction therapy with a modified (pulsed dexamethasone rather than continuous prednisone) UKALL XII/ECOG E2993 protocol at Tawam Hospital, United Arab Emirates (UAE).

This retrospective data analysis examined the outcome of 99 acute lymphoblastic leukemia (ALL) patients treated at Tawam Hospital between January 2000 and December 2009. Sixteen patients were treated before June 2002, and 83 patients were treated from June 2002. A modified form of UKALL XII/ECOG E2993 with pulsed dexamethasone in induction phase one (modified UKALL) was the main therapy from June 2002 (71/83). The median age was 28 years. Fifty-eight percent had pre-B ALL where 36 % of them were Philadelphia chromosome-positive (Ph+). Overall, complete remission (CR) rate was 86.7 % which was significantly inferior for patients with white blood cell count 30-100 × 109/l (p = 0.009), therapy before June 2002 (p = 0.02), pregnancy (p = 0.005), CNS leukemia (p = 0.028), and unknown karyotype (p = 0.004). With a median follow-up of 11.8 months (0.49-126 months), the estimated overall survival (OS) and event-free survival (EFS) at 3 years were 50.6 and 28.7 %, respectively. OS and EFS were significantly inferior for patients not in CR after induction, age >20 years, Ph+, unknown karyotype and therapy before June 2002. In addition, CR, OS and EFS were significantly superior (p = 0.004, p < 0.001 and p = 0.001, respectively) for therapy with our modified UKALL protocol compared to Tawam protocol (main therapy before June 2002). In conclusion, the outcome of treatment for ALL at our institute is encouraging with significant improvement in the outcome of older adolescents and young adults when using high-intensity chemotherapy. This suggests that such an approach is feasible in developing countries in spite of some limitations including lack of stem cell transplantation service.

Vitamin D supplementation for nonspecific musculoskeletal pain in non-Western immigrants: a randomized controlled trial.

PURPOSE: Many non-Western immigrants report musculoskeletal pains that are hard to treat. We studied the effect of high-dose vitamin D(3) on nonspecific persistent musculoskeletal complaints in vitamin D-deficient non-Western immigrants and assessed correlation of pain patterns with benefit. METHODS: We conducted a semi-crossover randomized controlled trial between February 2008 and February 2010 in primary care in 84 non-Western immigrants visiting their general practitioner for nonspecific musculoskeletal pain. At baseline, patients were randomized to placebo or vitamin D (150,000 IU vitamin D(3) orally); at week 6, patients in the original vitamin D group were randomized a second time to receive vitamin D (again) or to switch to placebo, whereas patients in the original placebo group were all switched to vitamin D. The main outcome was self-assessed change in pain after the first 6 weeks. RESULTS: Patients in the vitamin D group were significantly more likely than their counterparts in the placebo group to report pain relief 6 weeks after treatment (34.9% vs 19.5%, P = .04). The former were also more likely to report an improved ability to walk stairs (21.0% vs 8.4%, P = .008). Pain pattern was not correlated with the success of treatment. In a nonsignificant trend, patients receiving vitamin D over 12 weeks were more likely to have an improvement than patients receiving it over 6 weeks. CONCLUSIONS: There is a small positive effect 6 weeks after high-dose vitamin D(3) on persistent nonspecific musculoskeletal pain. Future research should focus on longer follow-up, higher supplementation doses, and mental health.

Muslim women's physician preference: beyond obstetrics and gynecology.

When Emirati (Muslim) women (n = 218) were asked about their preferred physician (in terms of gender, religion, and nationality) for three personal clinical scenarios, a female was almost exclusively preferred for the gynecological (96.8%) and "stomach" (94.5%) scenarios, while ±46% of the women also preferred a female physician for the facial allergy scenario. Only 17% considered physician gender important for the prepubertal child scenario. Just over half of the women preferred a Muslim physician for personal examinations (vs. 37.6% for the child). Being less educated and having a lower literacy level were significant predictors of preferred physician religion for some personal scenarios, whereas a higher education level was a significant predictor for physician gender not mattering for the facial allergy scenario. Muslim women's preference for same gender physicians, and to a lesser extent religion, has implications for health care services beyond obstetrics and gynecology.

Muslim women and medical students in the clinical encounter.

CONTEXT: Increasingly, male medical students report being refused by female patients, particularly in obstetrics and gynaecology, which is impacting on recruitment into the discipline. However, little has been documented in terms of Muslim patients and medical students in the clinical consultation. METHODS: Female Emirati nationals (n = 218) attending out-patient clinics at a public hospital in Al Ain, United Arab Emirates (UAE), were interviewed by medical students. Participants were provided with four hypothetical clinical scenarios (three personal, one concerning a pre-pubertal child) and asked whether they would allow male and female students to be present at a consultation, take a history or perform an examination. They were also canvassed about their past experiences with medical students and their social responsibility to contribute towards the training of Emirati doctors. RESULTS: Significant differences were recorded in terms of female versus male student involvement for all activities (P < 0.05-0.0005). For gynaecological and abdominal problems, patients would generally refuse male students. More than 50% of interviewees would not allow a male student to examine their face. Students of either gender could, however, examine their 8-year-old child. Although 47% of the women had had previous clinical encounters with students, in only 58% of consultations had the attending doctor asked their permission. Despite this, the women had generally felt comfortable, although satisfaction decreased with increasing age (P = 0.088). Almost 90% of the women believed that Emiratis had a social responsibility to contribute towards the training of Emirati doctors, but this decreased with increasing income (P = 0.004). CONCLUSIONS: As many medical students will encounter Muslim patients during their training, they need to be sensitive to religious and cultural issues, particularly for personal examinations. In contexts where most patients are Muslim, alternative options (e.g. manikins, international rotations) may be required for male students. In the UAE, patient education may improve history-taking opportunities but will probably not transcend religious and cultural beliefs without intervention from religious leaders.

Allergic rhinitis and asthma: a large cross-sectional study in the United Arab Emirates.

BACKGROUND: Studies on comorbidity of allergic rhinitis (AR) and asthma have been carried out in developed countries; however, data from countries in development transition are lacking. METHODS: In a randomly selected, age-stratified cohort of adolescent school children and their caretakers in the United Arab Emirates (UAE), comorbidity of AR and asthma was calculated using multinomial regression to determine independent risk factors. RESULTS: A total of 6,543 subjects were included in the study; the median age was 30 years (range 8-93), and 52% were males. The standardized prevalence of concomitant asthma and AR was 7.3%. AR subjects had a 3-fold increased risk of asthma compared to subjects without AR (23.8 and 7.5%, respectively). Immigrants had a significantly lower prevalence of comorbidity of AR and asthma [adjusted odds ratio (OR) 0.53, 95% confidence interval (CI) 0.33-0.85] compared to UAE nationals, while greater age carried a lower risk (adjusted OR 0.58, 95% CI 0.44-0.78), but a family history of both AR (adjusted OR 3.03, 95% CI 2.31-3.98) and asthma (adjusted OR 4.65, 95% CI 3.53-6.12) was strongly associated with the co-occurrence of these 2 conditions, while gender and education were not. Asthma patients with AR had more severe symptoms than those without, i.e. 'dry cough at night' in 65 versus 36%, ß-mimeticum use in 42 versus 30%, and steroid use in 25 versus 13%, respectively. CONCLUSION: Comorbidity of asthma and AR in the UAE is high, with a prevalence of 7.3%. Both the underlying reasons and possibilities for better prevention now need to be focused on in future research.

Barriers and facilitators of weight management: perspectives of Arab women at risk for type 2 diabetes.

Obesity and associated chronic diseases, such as type 2 diabetes, are highly prevalent in the United Arab Emirates (UAE). This qualitative study explored weight management behaviours and perceptions of women who are at increased risk for type 2 diabetes through focus group interviews. A total of 75 Emirati national women (age, 20-60 years) considered high risk for type 2 diabetes participated in eight focus groups. Purposive sampling was used to recruit women from primary healthcare centres (PHCs) in Al Ain, UAE. Qualitative research methodology involving a modified approach to grounded theory was used to guide data collection and analysis. Focus group interviews transcripts were thematically analyzed using NVivo software. A number of personal, social and physical environmental themes emerged as both barriers and enablers that are consistent with the social ecological model of health promotion. Low motivation, lack of social support, competing demands, lack of culturally-sensitive exercise facilities and sociocultural norms that restrict outdoor physical activities were the main barriers cited by the participants. On the other hand, social support, such as having other women to walk with, helped them stay physically active. Suggestions from the participants included enhancing social support for women, greater access to dietitians and nutrition information, and increasing availability of culturally-sensitive exercise facilities. This study provides valuable information in the development of culturally congruent healthy weight promotion programmes for women at risk for type 2 diabetes in the UAE and has implications for obesity intervention programmes for women in other Arabian Gulf countries.

Prevalence and risk factors of asthma among adolescents and their parents in Al-Ain (United Arab Emirates).

BACKGROUND: Evidence indicates that the prevalence of asthma tends to increase in the developed world. However, little is known about current prevalence rates and risk factors of asthma in countries in transition, e.g. the United Arab Emirates (UAE). OBJECTIVES: We investigated the prevalence of asthma and its independent risk factors among adolescents and adults in Al-Ain, UAE. METHODS: For a two-stage, randomly selected survey, 10,000 questionnaires were distributed to adolescents and their parents. Logistic regression was applied to assess asthma prevalence and independent associations with age, gender, education, nationality and family history. RESULTS: In total, 6,543 subjects were included in the final analysis. Median age was 30 years (range: 8-93 years); 53% were male. The overall self-reported prevalence of asthma was 13%. Direct standardization with the UAE population as the reference yielded a prevalence of 12%. Logistic regression revealed family history and UAE nationality (about 50% of nationals were of Bedouin origin) as the main risk factors for asthma, and a significant (p = 0.001) interaction between gender and age: in the group aged 13-19 years, males had a significantly higher prevalence of asthma [17 and 14%; adjusted odds ratio (OR): 1.45; 95% confidence interval (CI): 1.10-1.90]; in the group aged >19 years, males had a significantly lower prevalence of asthma (11 and 13%; adjusted OR: 0.77; 95% CI: 0.60-0.95) than females. CONCLUSIONS: The prevalence of asthma is comparable to findings of earlier studies. The higher prevalence in adolescent males compared to females may possibly be due to sex-specific lifestyle factors. Strong predictors of asthma such as family history and UAE nationality may indicate modernization and possible genetic susceptibility, warranting further studies in this population.

Management decisions in nontraumatic complaints of arm, neck, and shoulder in general practice.

UNLABELLED: OBJECTIVE We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. METHODS: We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. RESULTS: Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently. CONCLUSIONS: Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well.

A safety and feasibility study comparing an intermittent high dose with a daily standard dose of liposomal amphotericin B for persistent neutropenic fever.

A high intermittent dose regimen (group A: 10 mg kg(-1) on day 1, 5 mg kg(-1) on days 3 and 6) was compared with standard dosing (group B: 3 mg kg(-1) per day for 14 days) of liposomal amphotericin B (LAB) for empirical treatment of persistent febrile neutropenia. A total cumulative dose of 1275 mg (group A) and 2800 mg (group B) was administered. Infusion-related adverse drug events, mainly rigors/chills, occurred more frequently with group A (11/45, 24 % infusions) than with group B (12/201, 6 % infusions) (P=0.002), which extended the mean infusion time by 20 min (P=0.001). Creatinine levels were similar in the two regimens: the A : B ratio of the area under the curve for creatinine (AUC(CREATININE)) for days 2-7 was 1.09 (P=0.27) and for days 2-14 was 1.05 (P=0.51). Rises in creatinine were mild (clinical toxicity criteria 1) in all patients with elevations. Hypokalaemia tended to be less severe in group A with a lower proportion of hypokalaemic days [57/143 (39 %) vs 80/137 (58 %), P=0.21], a higher AUC(POTASSIUM) (A : B ratio of 1.06, P=0.12), a lower proportion of patients with hypokalaemia at the end of study (10 vs 61 %, P=0.01) and fewer potassium-supplemented days [12/210 (6 %) vs 41/210 (19.5 %), P<0.1]. There were mildly elevated median levels of serum bilirubin, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase, which were similar for the two regimens and were usually associated with other co-existing co-morbid conditions. The AUC for these enzymes was also similar in the two groups. No patient had discontinuation of the study drug due to toxicity. Composite success was identical for each regimen (11/15 patients, 73 %). Three of the fifteen patients in group B and none in group A developed invasive fungal infections (IFIs). Beta-D-Glucan levels were similar in both groups for patients without an IFI [AUC(GLUCAN) of 362 and 683 (P=0.36) for groups A and B, respectively]. The rate of defervescence was similar for each regimen (P=0.75). This feasibility study suggests that a short intermittent high-dose course of 10/5/5 mg LAB kg(-1) on days 1, 3 and 6 may be as safe and effective as a standard 14 day course of 3 mg kg(-1) per day, with drug-acquisition cost savings and reduced drug exposure. A larger study is indicated for confirmation of this.

Effects of a rapid peer-based HIV/AIDS educational intervention on knowledge and attitudes of high school students in a high-income Arab country.

INTRODUCTION: In response to low knowledge about HIV and intolerant attitudes toward persons living with HIV among Arab university students, a peer-based educational intervention was developed and impact evaluated on knowledge and attitudes of high school students in 2 of 4 main cities of United Arab Emirates. METHODS: Four small teams of final year medical students, 3 female and 1 male, were trained. Multistage random sampling selected 14 female and 5 male Arab schools, then 56 female and 14 male grade 12 classes in Al Ain and Abu Dhabi. The 90-minute intervention included a factual presentation and 3 attitude workshops. Baseline and postintervention knowledge and attitudes were assessed. Significance was tested by McNemar, Wilcoxon signed rank, and multilevel regression tests. RESULTS: Response was 99.6%, 1398 females and 505 males. Misconceptions about modes of transmission and intolerant attitudes were evident. Mean knowledge score improved from 65% to 82% and attitude 51% to 64%, that is, relative increase 26% (P < 0.0005). Females had slightly lower baseline knowledge than males but showed greater improvement in knowledge and attitudes (P < 0.0005) CONCLUSIONS: Grade 12 students' knowledge about HIV/AIDS was inadequate and attitudes stigmatizing. Peer-based knowledge workshops were effective, especially among females. Concise integrated teaching and workshops designed to address key knowledge and attitudinal deficiencies can be highly effective.

Prospective evaluation of mannan and anti-mannan antibodies for diagnosis of invasive Candida infections in patients with neutropenic fever.

The diagnostic performance and usefulness of the Platelia antigen and antibody test (Bio-Rad) was investigated in a prospective study of haematological patients at risk for invasive Candida infections. Among 100 patients, 86 were eligible, of whom invasive candidiasis (IC) occurred in 12 (14%), according to the criteria of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. These included candidaemia due to Candida albicans (one patient) or Candida tropicalis (four patients), and hepatosplenic candidiasis (seven patients). The comparator group of 74 patients included 50 with febrile neutropenia alone and 24 with mould infections. A strategy was developed to determine diagnostic cut-offs from receiver operating characteristic curves with maximal sensitivity and, given this sensitivity, maximal specificity, both being greater than 0. In this patient population, these values were 0.25 ng ml(-1) for mannan (M) and 2.6 arbitrary units ml(-1) for anti-mannan (AM), which are lower than those recommended by the manufacturer. All patients developed at least one positive diagnostic M or AM result during the 10 days of persistent febrile neutropenia (PFN). The optimal overall performance was found when two consecutive positive tests for both M and AM were used [sensitivity, specificity, positive predictive value and negative predictive value (NPV) (95 % confidence intervals) of 0.73 (0.39-0.94), 0.80 (0.69-0.89), 0.36 (0.17-0.59) and 0.95 (0.86-0.99), respectively]. There was a positive correlation of M with beta-D-glucan (r=0.28, P=0.01). The first positive M test was found up to a mean+/-sd of 8.8+/-8.5 (range 2-23) days prior to a clinical/mycological diagnosis of IC. Day-to-day variation in quantitative M levels was high. High-level AM responses were delayed until leucopenia resolved. The low specificities of the test performance may have been due to some of the comparator patients having subclinical Candida infections as evidenced by the high incidence of colonization among them (60% had a colonization index of >or=0.5). The high NPVs suggest that the tests may be particularly useful in excluding IC. It is feasible to explore the use of serial measurements of M and AM as part of a broader diagnostic strategy for selecting PFN patients to receive antifungal drug therapy.

HER-2/neu Ile655Val polymorphism and the risk of breast cancer.

Genetic alterations of the proto-oncogene human epidermal growth factor receptor (HER-2/neu) have been shown to induce malignant transformation and metastasis. Genotyping studies have addressed the association of codon 655 isoleucine to valine polymorphism located in the transmembrane coding region and the risk of breast cancer, but the results are inconsistent. In this study, we investigated the association of HER-2/neu Ile655Val polymorphism and the risk of breast cancer in a Sudanese population. In addition, the joint effects of HER-2/neu variants and our previously reported ESR1C325G polymorphism were tested for their association with breast cancer risk. Candidate single nucleotide polymorphism (SNP) in HER-2/neu Ile655Val [db SNP rs1136200] was genotyped in breast cancer patients and in healthy controls that were randomly selected from the same age group as the patients. Genotyping was performed using a high-throughput allelic discrimination method using real-time PCR, and data on clinical features and demographic details were collected. Associations between genotype and breast cancer were assessed by means of logistic regression. The prevalence of Val/Val genotype was similar in patients of breast cancer and control subjects. In comparison with the Ile/Ile genotype, the Ile/Val had a borderline significantly (P= 0.06) higher risk of breast cancer (OR = 2.95, 95% CI: 0.97-8.96). Regarding the genotypic and allelic frequencies stratified by age and menopausal status, there were no significant associations. A significantly higher risk of breast cancer was observed among homozygous carriers of ESR1325 CC genotype and heterozygous carriers of HER-2/neu655 Ile/Val genotype (P= 0.05; adjusted OR = 4.9, 95% CI: 1.0-24). The association of HER-2/neu Ile655Val polymorphism and the risk of breast cancer was borderline significant with the heterozygous carrier being at higher risk. However, the frequency of different polymorphic variants varies with ethnicity. The results of this study suggest that a significant gene-gene interaction between ESR1325C (previously reported) and HER-2/neu Ile655Val variants may jointly contribute to a higher risk of breast cancer.

Estrogen receptor alpha gene polymorphism and breast cancer.

Estrogen and estrogen receptors play important roles in the proliferation and development of breast cancer. Several genetic alterations identified in the estrogen receptor alpha gene (ESR1) are thought to influence the expression or function of this protein, and many have been evaluated for their role in breast cancer predisposition. The aim of this study was to evaluate the role of the C325G single nucleotide polymorphism (SNP) in the ESR1 in predisposition to breast cancer. The candidate SNP C325G in ESR1, exon 4 was genotyped in breast cancer patients and in healthy controls that were age and sex matched. Genotyping was performed using both single-stranded conformational polymorphism (SSCP) and a higher throughput allelic discrimination method using real-time PCR. Data on clinical features and demographic details were collected. Significant association of breast cancer risk was shown in the subgroup of women 50 years and younger who had the C allele (OR: 2.28, 95% CI: 1.10-4.72) (P= 0.03). However, the overall susceptibility to breast cancer was not significant, although all estimates were in the direction of a higher risk in women with CC genotypes. This study found significant evidence that polymorphism within the low penetrance ESR1 is associated with breast cancer susceptibility in women of 50 years or younger. There is also an indication that G allele is protective (compared to C allele).

Inhaled sodium cromoglycate for asthma in children.

BACKGROUND: Sodium cromoglycate has been recommended as maintenance treatment for childhood asthma for many years. Its use has decreased since 1990, when inhaled corticosteroids became popular, but it is still used in many countries. OBJECTIVES: To determine the efficacy of sodium cromoglycate compared to placebo in the prophylactic treatment of children with asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group Trials Register (October 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2007), MEDLINE (January 1966 to November 2007), EMBASE (January 1985 to November 2007) and reference lists of articles. We also contacted the pharmaceutical company manufacturing sodium cromoglycate. In 2007 we updated the review. SELECTION CRITERIA: All double-blind, placebo-controlled randomised trials, which addressed the effectiveness of inhaled sodium cromoglycate as maintenance therapy, studying children aged 0 up to 18 years with asthma. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We pooled study results. MAIN RESULTS: Of 3500 titles retrieved from the literature, 24 papers reporting on 23 studies could be included in the review. The studies were published between 1970 and 1997 and together included 1026 participants. Most were cross-over studies. Few studies provided sufficient information to judge the concealment of allocation. Four studies provided results for the percentage of symptom-free days. Pooling the results did not reveal a statistically significant difference between sodium cromoglycate and placebo. For the other pooled outcomes, most of the symptom-related outcomes and bronchodilator use showed statistically significant results, but treatment effects were small. Considering the confidence intervals of the outcome measures, a clinically relevant effect of sodium cromoglycate cannot be excluded. The funnel plot showed an under-representation of small studies with negative results, suggesting publication bias. AUTHORS' CONCLUSIONS: There is insufficient evidence to be sure about the efficacy of sodium cromoglycate over placebo. Publication bias is likely to have overestimated the beneficial effects of sodium cromoglycate as maintenance therapy in childhood asthma.

Combined sensory impairment (deaf-blindness) in five percent of adults with intellectual disabilities.

Our purpose in this cross-sectional study with 1,598 adult clients who had intellectual disabilities was to obtain valid prevalences of sensory impairments and to identify associations. The diagnoses were made through ophthalmologic and audiometric assessments, applying WHO/IASSID definitions. Re-weighted prevalences were 5.0% (95% CI 3.9- 6.2%) for the total adult population; 2.9% (1.9-4.1), less than 50 years; and 11.0% (7.9- 14.7), 50 years and over. Apart from being 50 years of age and over, p = .000, risk factors were more severe intellectual disability, p = .0001, and Down syndrome, p = .001. Results show that the risk of combined sensory impairment in this population is considerably increased compared with the general population. Part of the underlying conditions are treatable or can be rehabilitated. However, the complete diagnosis had been identified in only 12%.

What is the clinical course of acute ankle sprains? A systematic literature review.

BACKGROUND: Ankle sprains are one of the most common musculoskeletal injuries. In order to evaluate the effectiveness of therapeutic interventions and to guide management decisions, it is important to have clear insight of the course of recovery after an acute lateral ankle injury and to evaluate potential factors for nonrecovery and re-sprains. METHODS: A database search was conducted in MEDLINE, CINAHL, PEDro, EMBASE, and the Cochrane Controlled trial register. Included were observational studies and controlled trials with adult subjects who suffered from an acute lateral ankle sprain that was conventionally treated. One of the following outcomes had to be described: pain, re-sprains, instability, or recovery. Two reviewers independently assessed the methodological quality of each included study. One reviewer extracted relevant data. RESULTS: In total, 31 studies were included, from which 24 studies were of high quality. There was a rapid decrease in pain reporting within the first 2 weeks. Five percent to 33% of patients still experienced pain after 1 year, while 36% to 85% reported full recovery within a period of 3 years. The risk of re-sprains ranged from 3% to 34% of the patients, and re-sprain was registered in periods ranging from 2 weeks to 96 months postinjury. There was a wide variation in subjective instability, ranging from 0% to 33% in the high-quality studies and from 7% to 53% in the low-quality studies. One study described prognostic factors and indicated that training more than 3 times a week is a prognostic factor for residual symptoms. CONCLUSIONS: After 1 year of follow-up, a high percentage of patients still experienced pain and subjective instability, while within a period of 3 years, as much as 34% of the patients reported at least 1 re-sprain. From 36% up to 85% of the patients reported full recovery within a period of 3 years.

Measles, mumps and rubella infections and atopic disorders in MMR-unvaccinated and MMR-vaccinated children.

Vaccinations have been incriminated in the increase of atopic disorders. Especially the measles-mumps-rubella (MMR) vaccination is often refused by people having a notion that these infectious diseases are beneficial for a healthy development of a child's immune system. This practice endangers herd immunity and is the cause of repeated outbreaks. As the clinical course of infections and also its possible impact on the development of atopy may be different in vaccinated and unvaccinated individuals, we explored in vaccinated and unvaccinated children associations of MMR infection with atopic disorders. Using data from a previously conducted study on the relationship between the diphtheria-tetanus-pertussis-(inactivated) poliomyelitis vaccination in the first year of life and atopic disorders, the study population of 1872 8-12-yr-old was divided as children MMR-unvaccinated and children MMR-vaccinated in the first year of life. Within each group the association between MMR infections and atopic disorders (both as reported by the parents) was assessed. We found a statistically significant positive association between measles infection and 'any atopic disorder' [adjusted odds ratio, OR (95% confidence interval, CI): 1.77 (1.20-2.61)] in the MMR-vaccinated group, mainly because of the relationship with eczema. For rubella there was a negative association with eczema and food allergy in the unvaccinated group: adjusted OR (95% CI): 0.57 (0.38-0.85) and 0.23 (0.07-0.76), respectively. All other associations were not statistically significant. We found a positive relationship between measles infection and any atopy in a group of MMR-vaccinated children and a negative association between rubella infection and eczema and food allergy in unvaccinated children. However, we cannot conclude that these relationships are causal. The negative association with rubella may be an artefact. This study shows no evidence for any protective effects from MMR diseases for the development of atopy and therefore supports conclusions found elsewhere that childhood vaccinations do not cause atopy.