'I think we just do it once and leave it ' The collection and utility of family health history in general practice in Aotearoa New Zealand: a qualitative study.

Introduction The value of family health history as a means to understanding health risk has been long known. Its value in a precision medicine context is also now becoming apparent. General practitioners (GPs) are considered to play a key role in the collection, and investigation, of family health history, but it remains widely reported as being both poorly and infrequently undertaken. Little is known about this practice in Aotearoa New Zealand (NZ). Aim This study aimed to explore current practices in relation to the ascertainment of family health history, with a view towards precision medicine. Methods Semi-structured interviews were conducted with 10 GPs recruited from one urban area of NZ. The interviews were subjected to a thematic analysis. Results Family health history information was used to varying degrees in four areas - risk ascertainment, patient engagement with a diagnosis, social context and building relationships. Patient cultural considerations were rarely mentioned. Reliability of information provided by patients, resource constraints, context driven consults and electronic health record limitations are potential indicators of current limits of family health history. Discussion Our findings present a baseline of current practice and echo larger studies from overseas. As precision medicine is not yet routine, a unique opportunity exists for consideration to be given to establishing specific roles within the NZ health system to enable equitable practice of, and subsequent health gains from, the use of family/whanau health history information as part of precision medicine.

Seroprevalence and risk factors of Toxoplasma gondii infection in invasive raccoons (Procyon lotor) in Central Europe.

Toxoplasma gondii is an obligate intracellular protozoan that causes toxoplasmosis in warm-blooded animals. Most mammals, including humans, can become intermediate host, resulting in subclinical infection or even death. Generally, there is limited information on the epidemiology of T. gondii of game species in Germany. As omnivores, raccoons, which are particularly widespread and abundant in Germany, are particularly exposed to infection the parasite. Here, we report the seroprevalence of T. gondii antibodies from 15 study sites located in Luxembourg and Germany. Using the indirect modified agglutination test (MAT), 170 (37.4%; 95% CI: 33.0-41.9) out of 454 raccoons were surveyed to be T. gondii seropositive. While values ranged from 19.0% to 53.3%, there was no significant difference in seroprevalence between study areas. Animal weight had a strong influence on the presence of T. gondii antibodies in raccoon sera, with heavier animals more likely to be seropositive. Our results show that T. gondii infection is widespread in central European raccoons, suggesting a high degree of ecosystem circulation of the parasite.

[Cervical cancer in Mecklenburg-Western Pomerania. Tumor stage, histological tumor type, age and screening participation of 985 patients]. / Zervixkarzinome in Mecklenburg-Vorpommern. Tumorstadium, histologischer Tumortyp, Alter und Screeningteilnahme von 985 Patientinnen.

BACKGROUND: In view of the discussion on primary human papillomavirus (HPV) screening it was necessary to evaluate recent and reliable data from the current cytology-based screening program. METHODS: Since the year 2004 all cases of cervical cancer must be reported to the Joint State Quality Control Commission in Mecklenburg-Western Pomerania, corrected and supplemented by data of the State Cancer Registry. The screening histories of all patients, age, tumor stages and histological tumor types were analyzed. RESULTS: Over a 10-year period (2004-2013) 985 women with invasive cervical cancer and complete data were identified, of whom 573 patients (58 %) had not had a cervical smear within the past 5 years, an irregular screening history was found in 312 patients (32 %) and 100 patients (10 %) had cervical cancer despite regular participation. In women who did not participate in the screening program, tumor stages T1b and higher were found in 85 %. In the group of women with regular screening 53 % were diagnosed with microinvasive cancer and in 38 % of women with irregular screening. The age distribution showed a peak for cervical cancer in the age group of 40-54 years. Squamous cell carcinoma dominated and adenocarcinoma was found in 17 % which showed a tendency to increase over the investigation time period. CONCLUSION: Most cervical cancers and the advanced stages were found in women who did not participate in the screening program.

Accessing primary care Big Data: the development of a software algorithm to explore the rich content of consultation records.

OBJECTIVE: To develop a natural language processing software inference algorithm to classify the content of primary care consultations using electronic health record Big Data and subsequently test the algorithm's ability to estimate the prevalence and burden of childhood respiratory illness in primary care. DESIGN: Algorithm development and validation study. To classify consultations, the algorithm is designed to interrogate clinical narrative entered as free text, diagnostic (Read) codes created and medications prescribed on the day of the consultation. SETTING: Thirty-six consenting primary care practices from a mixed urban and semirural region of New Zealand. Three independent sets of 1200 child consultation records were randomly extracted from a data set of all general practitioner consultations in participating practices between 1 January 2008-31 December 2013 for children under 18 years of age (n=754,242). Each consultation record within these sets was independently classified by two expert clinicians as respiratory or non-respiratory, and subclassified according to respiratory diagnostic categories to create three 'gold standard' sets of classified records. These three gold standard record sets were used to train, test and validate the algorithm. OUTCOME MEASURES: Sensitivity, specificity, positive predictive value and F-measure were calculated to illustrate the algorithm's ability to replicate judgements of expert clinicians within the 1200 record gold standard validation set. RESULTS: The algorithm was able to identify respiratory consultations in the 1200 record validation set with a sensitivity of 0.72 (95% CI 0.67 to 0.78) and a specificity of 0.95 (95% CI 0.93 to 0.98). The positive predictive value of algorithm respiratory classification was 0.93 (95% CI 0.89 to 0.97). The positive predictive value of the algorithm classifying consultations as being related to specific respiratory diagnostic categories ranged from 0.68 (95% CI 0.40 to 1.00; other respiratory conditions) to 0.91 (95% CI 0.79 to 1.00; throat infections). CONCLUSIONS: A software inference algorithm that uses primary care Big Data can accurately classify the content of clinical consultations. This algorithm will enable accurate estimation of the prevalence of childhood respiratory illness in primary care and resultant service utilisation. The methodology can also be applied to other areas of clinical care.

Revisiting the phylogeography and demography of European badgers (Meles meles) based on broad sampling, multiple markers and simulations.

Although the phylogeography of European mammals has been extensively investigated since the 1990s, many studies were limited in terms of sampling distribution, the number of molecular markers used and the analytical techniques employed, frequently leading to incomplete postglacial recolonisation scenarios. The broad-scale genetic structure of the European badger (Meles meles) is of interest as it may result from historic restriction to glacial refugia and/or recent anthropogenic impact. However, previous studies were based mostly on samples from western Europe, making it difficult to draw robust conclusions about the location of refugia, patterns of postglacial expansion and recent demography. In the present study, continent-wide sampling and analyses with multiple markers provided evidence for two glacial refugia (Iberia and southeast Europe) that contributed to the genetic variation observed in badgers in Europe today. Approximate Bayesian computation provided support for a colonisation of Scandinavia from both Iberian and southeastern refugia. In the whole of Europe, we observed a decline in genetic diversity with increasing latitude, suggesting that the reduced diversity in the peripheral populations resulted from a postglacial expansion processes. Although MSVAR v.1.3 also provided evidence for recent genetic bottlenecks in some of these peripheral populations, the simulations performed to estimate the method's power to correctly infer the past demography of our empirical populations suggested that the timing and severity of bottlenecks could not be established with certainty. We urge caution against trying to relate demographic declines inferred using MSVAR with particular historic or climatological events.

A decrease of intracellular ATP is compensated by increased respiration and acidification at sub-lethal parathion concentrations in murine embryonic neuronal cells: measurements in metabolic cell-culture chips.

We present a label-free in vitro method for testing the toxic potentials of chemical substances using primary neuronal cells. The cells were prepared from 16-day-old NMRI mouse embryos and cultured on silicon chips (www.bionas.de) under the influence of different parathion concentrations with sensors for respiration (Clark-type oxygen electrodes), acidification (pH-ISFETs) and cell adhesion (interdigitated electrode structures, IDES). After 12 days in vitro, the sensor readouts were simultaneously recorded for 350 min in the presence of parathion applying a serial 1:3 dilution. The parathion-dependent data was fitted by logistic functions. IC(50) values of approximately 105 µM, 65 µM, and 54 µM were found for respiration, acidification, and adhesion, respectively. An IC(50) value of approximately 36 µM was determined from the intracellular ATP-levels of cells, which were detected by an ATP-luminescence assay using micro-well plates. While the intracellular ATP level and cell adhesion showed no deviation from a simple logistic decay, increases of approximately 29% in the respiration and 15% in the acidification rates above the control values were found at low parathion concentrations, indicating hormesis. These increases could be fitted by a modified logistic function. We believe that the label-free, continuous, multi-parametric monitoring of cell-metabolic processes may have applications in systems-biology and biomedical research, as well as in environmental monitoring. The parallel characterization of IC(50) values and hormetic effects may provide new insights into the metabolic mechanisms of toxic challenges to the cell.

A red face in a lupus patient: thinking beyond lupus rash.

A 61-year-old woman with a history of systemic lupus erythematosus presented with a facial rash followed by fever. The diagnosis of lupus flare was made by the general practioner who prescribed corticosteroids. The evolution was unfavorable and the patient was hospitalized. On admission, she presented with high fever and a sharply demarcated papular erythema overlying her cheeks. Biology was inflammatory with elevated C-reactive protein, sedimentation rate and leucocyte count. The diagnosis of erysipelas of the face was made on the basis of the malar and non pruritic papular erythema, fever, the high C-reactive protein levels and the absence of response to corticosteroids. The evolution was favorable under intravenous antibiotics and rapid tapering of the corticosteroids. To our knowledge, this is the first report of facial erysipelas in a patient with a history of systemic lupus erythematosus. This coincidence is a rare condition which may lead to erroneous diagnosis and inappropriate therapy.

[Transmyocardial laser revascularization--the initial experiences of imaging in MRT]. / Transmyokardiale Laserrevaskularisation--erste Erfahrungen der Bildgebung in der MRT.

PURPOSE: Imaging of myocardial signal alteration and perfusion differences after transmyocardial laser revascularization (TMLR). METHODS AND MATERIAL: 5 patients suffering from coronary vessel disease underwent MRI (0.5 T) pre- and 4-7 d post-TMLR. T1-weighted spin echo sequences were acquired ECG-triggered native and after injection of gadolinium. Qualitative analysis was performed on both native and contrast-enhanced images. Myocardial signal alterations and wall changes were evaluated. Qualitative and quantitative analyses of contrast-enhanced images were performed with regard of post-therapeutic perfusion differences. Analysis was based on contrast-to-noise (C/N) data obtained from operator defined "regions of interest". RESULTS: Visualization of laser-induced channels was not possible. Native scans obtained before and after TMLR revealed no significant change with regard to the qualitative analysis. Both qualitative and quantitative analyses demonstrated a posttherapeutic increase of C/N in both the left ventricular myocardium (64.4 pre-TMLR; 89.1 post-TMLR; p = 0.06) and the septum in the majority of cases. No significant difference between laser-treated left myocardium and untreated septum was observed (p > 0.05). DISCUSSION: Single myocardial laser channels could not be visualized with a 0.5-T MRI. However, visualization of increased myocardial contrast enhancement in laser-treated left ventricular myocardium was evident in the majority of cases on the basis of qualitative and quantitative analyses. CONCLUSIONS: The MRI technique used enabled a first, limited depiction of TMLR-induced myocardial changes. The clinical value and impact still have to be defined.

[Successful operation of right ventricular cardiac fibroma in an infant]. / Erfolgreiche Operation eines rechtsventrikulären kardialen Fibroms bei einem Säugling.

Cardiac tumors are rare in infants. We describe the diagnostic procedure and the good postoperative outcome despite the very large cardiac fibroma.

[The parasite fauna of East Germany. 9. The helminth fauna of Lutra lutra]. / Beiträge zur Parasitenfauna der DDR. 9. Mitteilung: Zur Helminthenfauna von Lutra lutra.

Alimentary tract, liver, kidneys and lungs of 25 otters, died of several causes during 1982-1987 in GDR were included in helminthological investigations. Parasites were detected in 8 animals. One cestode: Taenia martis and 3 trematodes: Isthmiophora melis, Opisthorchis felineus and Pseudamphistomum truncatum are regarded to be certain parasites of this host. Other findings like Ligula intestinalis, Azygia luccii and Piscicola geometra and the fragment of a pseudophyllidean enter the alimentary tract with the food and pass through it.