Proscriptive vs. Prescriptive Health Recommendations to Drink Alcohol Within Recommended Limits: Effects on Moral Norms, Reactance, Attitudes, Intentions and Behaviour Change.

AIMS: Health advice can be framed in terms of prescriptive rules (what people should do, e.g. you should drink alcohol within recommended limits) or proscriptive rules (what people should not do, e.g. you should not drink alcohol above recommended limits). The current research examines the differing effect that these two types of injunction have on participants' moral norms, reactance, attitudes and intentions to consume alcohol within moderation, and their subsequent alcohol consumption. METHODS: Participants (N = 529) completed an online questionnaire which asked them to report their previous 7 days' alcohol consumption. They then read either a proscriptive or a prescriptive health message and completed measures of moral norms, reactance, attitudes and intentions to drink alcohol only within recommended limits. Subsequent alcohol consumption was reported 7 days later. RESULTS: The results showed that across all participants, the proscriptive message elicited stronger moral norms than did the prescriptive message, which in turn were associated with more positive attitudes and intentions to drink within recommended limits. For male participants who reported drinking more alcohol than recommended at baseline, the proscriptive message elicited more reported alcohol consumption over the subsequent 7 days. CONCLUSIONS: Proscriptive messages may be effective at eliciting stronger moral norms to drink within government recommended guidelines. However, reactance may occur for high relevance groups. Practical and theoretical implications are discussed.

Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system.

Previous studies suggested that risk for Autism Spectrum Disorder (ASD) may be increased in children exposed to antidepressants during the prenatal period. The disease specificity of this risk has not been addressed and the possibility of confounding has not been excluded. Children with ASD or attention-deficit hyperactivity disorder (ADHD) delivered in a large New England health-care system were identified from electronic health records (EHR), and each diagnostic group was matched 1:3 with children without ASD or ADHD. All children were linked with maternal health data using birth certificates and EHRs to determine prenatal medication exposures. Multiple logistic regression was used to examine association between prenatal antidepressant exposures and ASD or ADHD risk. A total of 1377 children diagnosed with ASD and 2243 with ADHD were matched with healthy controls. In models adjusted for sociodemographic features, antidepressant exposure prior to and during pregnancy was associated with ASD risk, but risk associated with exposure during pregnancy was no longer significant after controlling for maternal major depression (odds ratio (OR) 1.10 (0.70-1.70)). Conversely, antidepressant exposure during but not prior to pregnancy was associated with ADHD risk, even after adjustment for maternal depression (OR 1.81 (1.22-2.70)). These results suggest that the risk of autism observed with prenatal antidepressant exposure is likely confounded by severity of maternal illness, but further indicate that such exposure may still be associated with ADHD risk. This risk, modest in absolute terms, may still be a result of residual confounding and must be balanced against the substantial consequences of untreated maternal depression.

Force production during maximal effort bend sprinting: Theory vs reality.

This study investigated whether the "constant limb force" hypothesis can be applied to bend sprinting on an athletics track and to understand how force production influences performance on the bend compared with the straight. Force and three-dimensional video analyses were conducted on seven competitive athletes during maximal effort sprinting on the bend (radius 37.72 m) and straight. Left step mean peak vertical and resultant force decreased significantly by 0.37 body weight (BW) and 0.21 BW, respectively, on the bend compared with the straight. Right step force production was not compromised in the same way, and some athletes demonstrated substantial increases in these variables on the bend. More inward impulse during left (39.9 ± 6.5 Ns) than right foot contact (24.7 ± 5.8 Ns) resulted in 1.6° more turning during the left step on the bend. There was a 2.3% decrease in velocity from straight to bend for both steps. The constant limb force hypothesis is not entirely valid for maximal effort sprinting on the bend. Also, the force requirements of bend sprinting are considerably different to straight-line sprinting and are asymmetrical in nature. Overall, bend-specific strength and technique training may improve performance during this portion of 200- and 400-m races.

Using electronic medical records to enable large-scale studies in psychiatry: treatment resistant depression as a model.

BACKGROUND: Electronic medical records (EMR) provide a unique opportunity for efficient, large-scale clinical investigation in psychiatry. However, such studies will require development of tools to define treatment outcome. METHOD: Natural language processing (NLP) was applied to classify notes from 127 504 patients with a billing diagnosis of major depressive disorder, drawn from out-patient psychiatry practices affiliated with multiple, large New England hospitals. Classifications were compared with results using billing data (ICD-9 codes) alone and to a clinical gold standard based on chart review by a panel of senior clinicians. These cross-sectional classifications were then used to define longitudinal treatment outcomes, which were compared with a clinician-rated gold standard. RESULTS: Models incorporating NLP were superior to those relying on billing data alone for classifying current mood state (area under receiver operating characteristic curve of 0.85-0.88 v. 0.54-0.55). When these cross-sectional visits were integrated to define longitudinal outcomes and incorporate treatment data, 15% of the cohort remitted with a single antidepressant treatment, while 13% were identified as failing to remit despite at least two antidepressant trials. Non-remitting patients were more likely to be non-Caucasian (p<0.001). CONCLUSIONS: The application of bioinformatics tools such as NLP should enable accurate and efficient determination of longitudinal outcomes, enabling existing EMR data to be applied to clinical research, including biomarker investigations. Continued development will be required to better address moderators of outcome such as adherence and co-morbidity.

Pregnancy after heterotopic heart transplant removal.

Heterotopic heart transplants were introduced in 1974. The technique allows the patient's native heart to be preserved in situ, alongside the transplanted heterotopic donor heart. We present the case of a nulliparous woman who underwent heterotopic heart transplant in infancy, and subsequent explantation of the donor heart eleven years later, when her native heart function recovered. In adulthood the patient attended pre-pregnancy counselling and was awaiting cardiac magnetic resonance imaging when she presented pregnant at 6 weeks-of-gestation. She attended the joint cardiac obstetric and anaesthetic clinic, where she was reviewed monthly and had bi-monthly echocardiograms. At 35 weeks-of-gestation she was admitted to hospital with preeclampsia. After blood pressure control and steroid administration, a category 3 caesarean delivery under spinal anaesthesia was performed. To our knowledge this is the first case report describing pregnancy in a patient with a removed heterotopic heart transplant.

Alcohol and depression: Evidence from the 2014 health survey for England.

BACKGROUND: A relatively large body of literature examines the association between depression and alcohol consumption, with evidence suggesting a bidirectional causal relationship. However, the endogeneity arising from this reverse causation has not been addressed in the literature. METHODS: Using data on 5828 respondents from the Health Survey for England (HSE), this study revisits the relationship between alcohol and depression and addresses the endogenous nature of this relationship. We use information on self-assessed depression, and control for endogeneity using the Lewbel two-staged least square (2SLS) estimation technique. RESULTS: We find that drinking alcohol promotes depression, and this is consistent across several measures of drinking behaviour including the amount of alcohol consumed, consumption intensity, alcohol dependence and risk of dependence. CONCLUSION: While drinking may be generally accepted and in the case of England, part of the culture, this has costs in terms of both physical and mental health that ought not to be ignored. While public policy has predominantly focused on the physical aspects of excessive alcohol consumption it is possible that these policies will also have a direct positive spillover in terms of the mental health costs, through the impact of lower alcohol consumption on quality of life and wellbeing.

Hypoxemia with air breathing periods in U.S. NAVY Treatment Table 6.

Air breathing is used to lessen hyperbaric oxygen (HBO2) toxicity. Hypoxemia could occur during hyperbaric air breathing in patients with lung dysfunction, although this has not been previously reported. We report two cases of hypoxemia during air breathing with two patients treated with the US Navy Table 6. Patient 1 was an 11-year-old male with cerebral gas embolism (during cardiac transplantation), patient 2 was a 66-year-old female with cerebral gas embolism from a central venous catheter accident. Both were mechanically ventilated. We monitored arterial blood gas (ABG) during therapy. In both patients, ABG measurements showed hypoxia during the first air breathing period at 1.9 atm abs (192.5 kPa). If patients require > or = 40% inspired oxygen before HBO2 therapy, oxygenation monitoring is advisable during air breathing periods, especially at lower chamber pressures (< or = 2.0 atm abs).

Regulation of D-beta-hydroxybutyrate dehydrogenase in rat hepatoma cell lines.

Quantitation of D-beta-hydroxybutyrate dehydrogenase (BDH) in normal rat hepatocytes was compared with that in two rat hepatoma cell lines, H4-II-EC3 and RLT-3C. BDH activity in normal rat hepatocyte mitochondria was 321 nmol/min/mg, which was greatly reduced to 10.7 nmol/min/mg and 1.7 nmol/min/mg in H4-II-EC3 and RLT-3C cell mitochondria, respectively. The cell growth rate and L-[35S]methionine incorporation rate showed that RLT-3C cells had the highest growth rate (32.4-h doubling time) and the fastest protein biosynthesis rate (2.65 x 10(5) cpm/min/10(6) cells). The H4-II-EC3 cell line grew more slowly (48.5-h doubling time) and had lower protein biosynthesis rate (1.46 x 10(5) cpm/min/10(6) cells). The protein synthesis rate in hepatocytes was 1.25 x 10(5) cpm/min/10(6) cells. These results suggest that there is a reciprocal correlation between BDH activity and cell growth and protein synthesis rates. Immunochemical quantitation of BDH showed the amount of BDH in H4-II-EC3 and RLT-3C cells was about 4.8 and 0.5% of that in normal rat hepatocytes, respectively. Quantitation of BDH by biosynthesis indicated that BDH content in H4-II-EC3 cells and RLT-3C cells was 9.3 and 4.0% of that of normal hepatocytes, respectively. Precursor BDH synthesized by in vitro translation primed with RNA of H4-II-EC3 cells or RLT-3C cells was 3.0 and 1.1% of that translated from normal rat hepatocyte RNA. These results suggest that the decrease in BDH content in hepatoma cells results from a decrease in functional BDH-mRNA. The coupling of a decrease in BDH activity with an increase in activity of succinyl-CoA: acetoacetyl-CoA transferase in hepatoma cells may play a role in generating additional energy required for the rapid growth of tumor cells.

Absence of evidence for increase in risk for autism or attention-deficit hyperactivity disorder following antidepressant exposure during pregnancy: a replication study.

Multiple studies have examined the risk of prenatal antidepressant exposure and risk for autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD), with inconsistent results. Precisely estimating such risk, if any, is of great importance in light of the need to balance such risk with the benefit of depression and anxiety treatment. We developed a method to integrate data from multiple New England health systems, matching offspring and maternal health data in electronic health records to characterize diagnoses and medication exposure. Children with ASD or ADHD were matched 1:3 with children without neurodevelopmental disorders. Association between maternal antidepressant exposure and ASD or ADHD liability was examined using logistic regression, adjusting for potential sociodemographic and psychiatric confounding variables. In new cohorts of 1245 ASD cases and 1701 ADHD cases, along with age-, sex- and socioeconomic status matched controls, neither disorder was significantly associated with prenatal antidepressant exposure in crude or adjusted models (adjusted odds ratio 0.90, 95% confidence interval 0.50-1.54 for ASD; 0.97, 95% confidence interval 0.53-1.69 for ADHD). Pre-pregnancy antidepressant exposure significantly increased risk for both disorders. These results suggest that prior reports of association between prenatal antidepressant exposure and neurodevelopmental disease are likely to represent a false-positive finding, which may arise in part through confounding by indication. They further demonstrate the potential to integrate data across electronic health records studies spanning multiple health systems to enable efficient pharmacovigilance investigation.

Metabolic consequences of polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women and the leading cause of anovulatory infertility. The prevalence of the syndrome ranges between 6 to 15% based on broader Rotterdam diagnostic criteria verses strict NIH diagnostic criteria.1 The condition is characterized by a combination of ovulatory dysfunction, hyperandrogenism and the presence of polycystic ovaries. PCOS has been associated with multiple metabolic alterations and consequences including impaired glucose tolerance, insulin resistance, hyperinsulinemia, type II diabetes, dyslipidemia, metabolic syndrome, obesity and subclinical cardiovascular disease. It remains unclear however if these associations lead to an increased risk of clinically significant long-term cardiovascular disease. Large prospective studies to date have not detected significant differences in overall cardiovascular morbidity and mortality in PCOS. The phenotypical variability in PCOS has made researching each of these associations challenging as different aspects of the syndrome may be contributing, opposing or confounding factors. The ability to detect significant differences in long-term cardiovascular outcomes may also be due to the variable nature of the syndrome. In this review, we attempt to describe a summary of the current literature concerning the metabolic alterations and cardiovascular consequences of polycystic ovary syndrome.

Diabetes and the risk of infections with immunomodulator therapy in inflammatory bowel diseases.

BACKGROUND: Infections are an important concern in patients using immunosuppressive therapy for their inflammatory bowel disease (IBD). Diabetes affects nearly 10% of Americans. Whether it confers an additional risk with immunosuppression in IBD has not been examined previously. AIM: To examine the association between diabetes and infections with immunomodulator use in IBD METHODS: Using a validated, multi-institutional IBD cohort, we identified all patients who received at least one prescription for immunomodulators (thiopurines, methotrexate). Our primary outcome was infection within 1 year of the prescription of the immunomodulator. Multivariable logistic regression adjusting for relevant confounders was used to estimate the independent association with diabetes. RESULTS: Our study included 2766 patients receiving at least one prescription for immunomodulators among whom 210 (8%) developed an infection within 1 year. Patients who developed an infection were likely to be older, have more comorbidities, more likely to have received a prescription for steroids but similar in initiation of anti-TNF therapy within that year. Only 8% of those without an infection had diabetes compared to 19% of those who developed an infection within 1 year [odds ratio (OR) 2.74, 95% confidence interval (CI) 1.88-3.98, P < 0.001]. On multivariate analysis, diabetes was independently associated with a nearly two-fold increase in risk of infections (OR: 1.80, 95% CI: 1.20-2.68). There was no increase in risk of infections with addition of anti-TNF therapy (OR: 1.14, 95% CI: 0.80-1.63). CONCLUSION: Diabetes is an independent risk factor for infection in IBD patients using immunomodulator therapy.

The foot of Homo naledi.

Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo.

Characterization of purified rabbit uterine renin: influence of pregnancy on uterine inactive renin.

Using specific antibody raised against renal renin, we have documented that the majority of the uterine renin-like activity in gravid and nongravid uteri is immunoreactive renin. To characterize its physiochemical properties, we obtained highly purified uterine renin by two affinity chromatographic steps, pepstatin and antirenin. Uterine renin has a pH optimum of 6, an apparent mol wt of 38K, and a Km of 1.7 microM for homologous substrate. These properties are identical to those of renal renin and are not influenced by the pregnant state. In the basal state, an inactive form of the uterine enzyme constitute 55 +/- 10% of the total uterine renin. During pregnancy, active renin increased 40-fold as inactive renin fell to 4 +/- 3% of the total renin concentration. The renal renin concentration fell as plasma renin increased during pregnancy. These data suggest that the increased uterine renin concentrations during pregnancy are probably due to increased local production and conversion of renin precursor to the active enzyme. This stimulation of the uterine renin level appears to be independent of renal renin.

Developmental regulation of D-beta-hydroxybutyrate dehydrogenase in rat liver and brain.

The activities of ketone-metabolizing enzymes in rat brain increase 3- to 5-fold during the suckling period before decreasing to the adult level after weaning. We have observed that a similar developmental pattern also exists for D-beta-hydroxybutyrate dehydrogenase (BDH) in rat liver. Utilizing antibodies prepared against the purified protein we determined that the changes in BDH activities in both brain and liver are due to changes in the amount of BDH in the mitochondria. In vitro translations of isolated RNA followed by immunoprecipitation revealed that the increase in BDH activity and content was correlated with an increase in the level of functional BDH-mRNA in both liver and brain.

Minority recruitment in clinical trials: a conference at Tuskegee, researchers and the community.

PURPOSE: This article describes the planning, implementation, and evaluation of a 2-day conference designed to examine the factors related to the participation of African Americans in cancer clinical trials. METHODS: Pre-conference formative evaluations (e.g., focus group discussions and key informant interviews with community leaders and health providers) were conducted in several rural and urban counties in the state of Alabama to determine African Americans' perceptions of participation in clinical research. The findings from these evaluations were used to develop a conference format and agenda. The 2-day conference included: (i) a pretest of African Americans' perceptions of cancer research, participation factors, and communication and recruitment issues; (ii) individual presentations high-lighting community leaders, church leaders, and researchers' perspectives regarding minority participation in research; (iii) working group discussions regarding the barriers and solutions to minority participation in research; and (iv) a posttest evaluation to measure changes in African Americans' perceptions of research. RESULTS: Several recruitment barriers and solutions were identified and reported by the working groups. Comparisons of the pretest and posttest measures showed significant (p > .05) and favorable shifts in the areas of perceptions of cancer research, participation factors, communication issues, and recruitment issues. Participation in the conference reflected a positive change in attitudes on these measures. However, the theme, "barriers that contributed to nonparticipation," did not show any significant changes during the two testing periods. The most critical lesson that resulted from this conference was the need for researchers and community members to have open dialogue about participation in research. CONCLUSIONS: This conference demonstrated that progress can be made when all parties are at the "table" and can be heard. In this model, community members proved to be valuable resources in providing researchers with information that was vital to the success of recruitment and retention studies and trials.

Pulmonary edema associated with hyperbaric oxygen therapy.

We report three cases of pulmonary edema associated with hyperbaric oxygen therapy, including one fatality. All three patients had cardiac disease and reduced left ventricular (LV) ejection fractions (EFs). Two patients had diabetes, and one patient had severe aortic stenosis. Hyperbaric oxygen therapy may contribute to pulmonary edema by increasing LV afterload, increasing LV filling pressures, increasing oxidative myocardial stress, decreasing LV compliance by oxygen radical-mediated reduction in nitric oxide, altering cardiac output between the right and left hearts, inducing bradycardia with concomitant LV dysfunction, increasing pulmonary capillary permeability, or by causing pulmonary oxygen toxicity. We advise caution in the use of hyperbaric oxygen therapy in patients with heart failure or in patients with reduced cardiac EFs.

Identification of Euro-Americans, Afro-Americans, and Amerindians from palatal dimensions.

Seven measurements were taken on 414 Euro-American, Afro-American, and Amerindian palates in an attempt to evaluate differences in dental arcade shape among these three groups. Width measurements across the palate at the first incisor, canine, second premolar, and second molar were taken directly on the dental arcade. The distances along the sagittal plane from the front of the palate to the level of these teeth were calculated from measurements taken between the right central incisor and the canine, second premolar and second molar. Discriminant functions computed from the measurements properly classified palates by group 66.0% of the time if sex is unknown. If sex is known to be male, other functions properly classified 65.7% of the sample; for sex known to be female 72.0% correct classification was achieved. Because these percentage are more than twice that expected from probability theory alone, it is concluded that the seven measurements are useful in determining ethnic group.

Performance of the Baxter Flo-Gard 6201 volumetric infusion pump for monoplace chamber applications.

For non-hyperbaric purposes, the Baxter Flo-Gard 6201 volumetric pump is capable of infusing multiple types of fluids at rates of 1-1,999 ml x h(-1). We designed a study to determine flow accuracy of this pump at variable rates, fluid viscosities, and volumes over a range of chamber pressures. For hyperbaric use, the pump pressure sensor was adjusted. Sodium chloride solution 0.9% (NS), enteral formula, and packed red blood cells (PRBC) were infused at varying rates from 86.1 to 304 kPa (0.85 to 3.0 atm abs). For NS, measured compared to set flow rates ranged from 12.5% to -7.5% at settings of 1 and 5 ml x h(-1) from 86.1 to 304 kPa (0.85 to 3.0 atm abs) pressures, respectively. For NS infusions at a set rate of 100 ml x h(-1), the measured flow was identical to the set rate at all pressures. At flow settings of 1,999 ml x h(-1), the measured flow varied from the set flow by +/-4.9% Enteral infusion at 100 ml x h(-1) showed approximately a 3% increase in the measured vs. set flow rate. PRBC measured flow rates ranged from -0.4 to 6% of the set rate. During chamber compression and decompression, with set flow rates from 1 to 10 ml x h(-1), the measured flow was considerably less than expected during compression and more than expected during decompression. In conclusion, the Baxter Flo-Gard 6201 infusion pump demonstrated acceptable performance for infusing saline, enteral formula, and PRBC at low and high infusion rates into the pressurized monoplace hyperbaric chamber up to 304 kPa (3 atm abs), with the exception of low rates during compression and decompression.