Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study.

BACKGROUND: There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies. METHODS: We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding. RESULTS: We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication. CONCLUSIONS: Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.

Effects of a modified clinoptilolite zeolite on growth performance, health status and detoxification of aflatoxin B1 and ochratoxin A in male broiler chickens.

1. The aim of the present study was to test the ability of an in-feed modified clinoptilolite zeolite-based mycotoxin binding substance (Minazel® Plus, Patent Co, Misicevo, Serbia; MP) to prevent gastrointestinal absorption of aflatoxin B1 (AFB1) and ochratoxin A (OTA) and its effects on health status and performance parameters of broilers.2. A total of 375, 1 d old male broiler chickens (Cobb 500) were used for a total trial period of 42 d (from hatch to 42 d of age). Animals were randomly allocated to five treatment groups (T1-T5), in 25 pens (15 male broilers per pen, five pens per treatment). T1 was the control maize-based diet without the addition of mycotoxins, or the test product. T2 and T3 groups received contaminated maize in the diet containing 0.02 mg AFB1/kg feed and 0.1 mg OTA/kg feed, whereas T4 and T5 groups received 0.05 mg AFB1/kg feed and 0.5 mg OTA/kg feed. The MP was added to T3 (1 g/kg feed), and T5 (2 g/kg feed) groups.3. Results showed that exposure to AFB1 and OTA at low or moderate levels, as used in this study, did not markedly affect growth performance, blood profile or organ weights. Improvements in feed conversion ratio (FCR) were observed in birds receiving MP, whereby FCR of T3 group was improved in comparison with T2 group, although there was no significant difference between T5 and T4 groups. However, average body weight gain (ABWG) was improved in the T5 group compared to T4, but not in the T3 versus T2 group comparison.4. For serum biochemical parameters, glutamate-dehydrogenase (GLDH) was significantly improved in T5 birds in comparison with T4. The addition of MP significantly decreased residue levels of AFB1 in liver and OTA in the spleen of the treated groups.5. The improvements in productive performance and reduction of mycotoxin residue levels in tissues demonstrated a beneficial effect of MP in cases of concurrent AFB1 and OTA ingestion by broilers.

Obstetric and neonatal outcomes in women aged 40 years or older after in vitro fertilization.

PURPOSE OF INVESTIGATION: The aim of this study was to determine the rate of complications in pregnancy and during delivery, as well as neonatal outcomes, in women who underwent in vitro fertilization (IVF) and who are 40 years of age or older. MATERIALS AND METHODS: This was a prospective study. The study group consisted of 29 women who underwent IVF. The control group consisted of women who had a spontaneous pregnancy. RESULTS: Pregnancy complications occurred in 86.21% of women in the study group, an 46.87% of women in the control group. The proportion of cesarean sections (CS) was 84.62% in the study group, and 21.87% in control group. Birth weight < 1,500 grams and < 2,500 grams was present in 17.16% and 22.86% of newborns in the study group, spectively. In the control group, birth weight < 1,500 grams and < 2,500 grams was present in 5.55% and 8.33% of newborns, respectively. Neonatal intensive care unit admissions included 22.86% newborns from the study group and 8.33% from the control group. CONCLUSION: Pregnancy, delivery, and neonatal complications were more frequent in the study (IVF) group.

Knowledge about cervical cancer, Pap test, and barriers to women's participation in screening in Belgrade, Serbia.

INTRODUCTION: Cervical cancer (CC) is a serious public health concern in Serbia, due to opportunistic screening still being in force, which led to twice higher than the average incidence rate of cervical cancer in Europe. Despite the fact that early detection and treatment services of CC are available at no additional cost, majority of women use inadequate screening services in Serbia. OBJECTIVE: This study aimed to examine the link between the knowledge about CC and Papanicolaou (Pap) test and perception of barriers to women's participation in CC screening. MATERIALS AND METHODS: The study included 300 women aged 21 to 69, with a place of residence in the city of Belgrade (Serbia), who were attending for their medical examination to the University Clinic of Gynecology and Obstetrics - "Narodni front", from June through December 2014. A survey instrument to collect data was an adapted questionnaire for the assessment of knowledge about and barriers to CC and Pap test. Patients were divided into three groups: a study group consisted of women attending irregularly (over three years), women who never participated in screening, and a control group that included women regularly participating in screening. RESULTS: Women regularly participating in screening (52.7%) had adequate knowledge about CC and Pap test, while women who irregularly (79.4%) or never participated (71.9%) did not have any adequate knowledge. There was a significant statistical difference between the CC and Pap test awareness in a group of respondents who regularly participated in comparison to respondents who irregularly or never participated in screening (x²= 27.772, p = 0.000). Regarding knowledge about human papillomavirus (HPV), 80% of women did not know that Pap test cannot be used for detection of HPV, as well as that abnormal Pap test result may be due to HPV (61.7%). Majority of women (93.7%) had poor knowledge about Pap test role in CC early detection and considered Pap test to be used to diagnose CC. The authors found a significant statistical correlation between participation of women in screening and barriers. Women who were irregular or never participated, had barriers such as: lack of time (F = 9.51; p = 0,000), difficult access to Healthcare facilities (F = 11.29; p = 0.000), lack of knowledge about the Pap test procedure (F = 21.27,p = 0.000), discomfort (F = 9.36; p = 0.000), and anxiety of Pap test results (F = 3.35; p = 0.036). Women who regularly participated did not have prejudice when choosing a gynecologist, unlike the other two groups that preferred a female gynecologist (F = 3.61; p = 0.028). CONCLUSION: This study showed that the level of knowledge about CC and Pap test in women is an important factor associated with regular participation in screening. It is necessary to take educational measures in order to raise awareness of women regarding risk factors, as well as to overcome fear and shame, with the ultimate aim to reduce frequency and mortality rate caused by CC in Serbia.

What is the impact of e-cigarette adverts on children's perceptions of tobacco smoking? An experimental study.

OBJECTIVE: Exposure to e-cigarette adverts increases children's positive attitudes towards using them. Given the similarity in appearance between e-cigarettes and tobacco cigarettes, we examined whether exposure to e-cigarette adverts has a cross-product impact on perceptions and attitudes towards smoking tobacco cigarettes. METHODS: Children aged 11-16 (n=564) were interviewed in their homes and randomised to one of three groups: two groups saw different sets of 10 images of e-cigarette adverts and one group saw no adverts. Of the 20 e-cigarette adverts, 10 depicted the product as glamorous and 10 depicted it as healthy. The children then self-completed a questionnaire assessing perceived appeal, harms and benefits of smoking tobacco cigarettes. RESULTS: The analyses were conducted on 411 children who reported never having smoked tobacco cigarettes or used e-cigarettes. Exposure to the adverts had no impact on the appeal or perceived benefits of smoking tobacco cigarettes. While the perceived harm of smoking more than 10 cigarettes per day was similar across groups, those exposed to either set of adverts perceived the harms of smoking one or two tobacco cigarettes occasionally to be lower than those in the control group. CONCLUSIONS: This study provides the first evidence that exposure to e-cigarette adverts might influence children's perceptions of smoking tobacco cigarettes, reducing their perceived harm of occasional smoking. These results suggest the potential for e-cigarette adverts to undermine tobacco control efforts by reducing a potential barrier (ie, beliefs about harm) to occasional smoking.

Predictive value of transvaginal ultrasound score for detection of endometrial malignancy.

PURPOSE: The aim of this study was to assess the accuracy of transvaginal ultrasound in detecting endometrial malignancy in peri-menopausal women. MATERIAL AND METHODS: The cross-sectional study included 100 perimenopausal women who had changes on the endometrium discovered through a regular ultrasound check-up and were referred to Clinic of Gynecology and Obstetrics "Narodni Front" in Belgrade during the period from September 1, 2012 to September 1, 2013. Transvaginal ultrasound was performed on each participant in the study. Parameters of the ultrasound examination composed a score system. RESULT: The results of regression analysis showed that this transvaginal ultrasound score have independent prognostic value for detection of endometrial malignancy. Score system showed that the value 8 had the best validity for the detection of endometrial malignity, with the sensitivity of 0.857 ind specificity of 0.785. CONCLUSION: The collected transvaginal ultrasound sample had high predictive value for the discovery of malign changes on endometrium.

Recurrence rate of ovarian endometriosis in patients treated with laparoscopic surgery and postoperative suppressive therapy.

INTRODUCTION: The testing represented a prospective study that was performed at the Gynaecology and Obstetrics Clinic "Narodni Front" in Belgrade during a two-year period. The study encompassed female patients with ovarian endometrioma operated with laparoscopic surgery. The research objective was to determine the percentage of occurrence of relapses in patients operated for endometriosis of the ovary in relation to the stage of the disease and the type of performed operation, and which were receiving suppressive therapy with gonadotropin-releasing hormone (GnRH) analogues after the surgery compared to those who were not receiving suppressive therapy after the operation. MATERIALS AND METHODS: The recurrence of endometriosis on the ovary of the test and control groups was monitored during the first year after surgery. In all patients ultrasound checks were done every month during the first six months after surgery, and then every three months for the next six months. In all patients in whom the recurrence, i.e. endometrioma on the ovary larger than three cm was revealed postoperatively by ultrasound, the laparoscopic removal of the endometrioma was performed again as well as the histopathological examination of the material. RESULTS AND CONCLUSION: There was no statistically significant difference in the distribution of recurrence of endometriosis between the groups formed according to the type of surgical technique (cystectomy or cystotomy). The recurrence of endometriosis occurred later in the group of patients in which the treatment GnRH analogues was applied after the surgical treatment. The recurrence of endometriosis in more severe stages (Stage III and IV) occurs later in the group of patients in which the treatment GnRH analogues is applied after the surgical treatment.

Adalimumab in the treatment of moderate-to-severe chronic plaque psoriasis in patients switching from other biologics.

BACKGROUND: Ample evidence shows that switching from one biological agent to another may prove effective when response to the first one is inadequate. Nevertheless, there are little data so far showing the efficacy and safety of adalimumab in patients with plaque psoriasis who previously received another biologic agent. OBJECTIVE: We evaluated the 1-year effectiveness, safety and quality-of-life outcomes patients with psoriasis who had switched to adalimumab from other biologic therapies. METHODS: Forty-two patients who participated in this Austrian multicenter study were treated with adalimumab over a 1-year period, after switching from efalizumab, infliximab or etanercept. Effectiveness was assessed using standardized tools for measurement of disease severity [Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI)] and quality of life [Dermatology Life Quality Index (DLQI)]. The study endpoints were evaluated using the all-treated population. RESULTS: The mean percentage of improvement at the end of the study was 74.3% for PASI, 81.6% for DLQI and 83.6% for NAPSI, demonstrating a considerable benefit of treatment with adalimumab. The safety profile observed was consistent with previous clinical trials for adalimumab, and no new safety signals were observed. CONCLUSION: Adalimumab therapy in patients with plaque psoriasis previously treated with other biologic agents demonstrates effectiveness, safety and improvement in quality of life.

Ectopic pregnancy and laparoscopy.

PURPOSE: The aim of this study was to compare the success of surgical procedures performed by laparoscopy and laparotomy in the treatment of tubal ectopic pregnancy. MATERIALS AND METHODS: In this prospective study, there were 57 women who were operated due to tubal ectopic pregnancy. Laparoscopic surgery was performed in 36 women (study group). Conventional abdominal surgical treatment was performed in 21 women (control group). RESULTS: Among 36 women from study group, a laparoscopic linear salpingotomy was performed in 69.44% cases, salpingectomy in 13.88% cases, and milking of tube in 16.66% cases. In the control group, linear salpingotomy was performed in 57.14% cases, salpingectomy in 28.57% cases, and milking of tube in 14.28% cases. Patent ipsilateral fallopian tube at three months after surgery was 66.66% in the study group and 52.38% in the control group. The intrauterine pregnancy rate was 19.44% in the study group and 19.05% in the control group. CONCLUSION: The percentage of tubal patency and intrauterine pregnancies after laparoscopical surgical treatment was not higher than after conventional surgical treatment by laparotomy.

Laparoscopic management of ovarian benign masses.

PURPOSE: To determine whether the presence of normal ovarian tissue could assist in the diagnosis of large benign ovarian neoplasms in young females and in choosing the laparoscopic treatment. MATERIALS AND METHODS: A prospective study of 25 patients treated surgically for a cystic ovarian neoplasm measuring diameter more than ten cm or volume more than 500 ml and having normal ovarian tissue or ovarian crescent sign (OCS). Ultrasonography was performed at six weeks, then at three, six, nine, and 12 months postoperatively. RESULTS: The mean age of patients was 15.3 +/- 3.6 years, ranging between 6.5 and 19 years. The mean preoperative volume of the ovarian neoplasm was 1,686 +/- 1,380 cm3, ranging between 550 and 6,000 cm3. The presence of OCS was visualized by ultrasonography in all 25 patients and serum tumor markers were negative in 22. No borderline tumors or malignancies were identified. There was a statistically significant difference between the volume of the affected ovary and the contralateral ovary during the first six weeks follow-up, but without significant difference after three months. CONCLUSIONS: Postoperative ultrasound revealed that the affected ovary resumed its normal volume within three months after surgery, despite the thinned appearance of the ovarian cortex present on ultrasound as the OCS. Laparoscopic ovarian preservation should be the preferred surgical approach for adolescents to ensure the conservation of the entire ovarian tissue.

Ovary-preserving tumorectomy for immature teratoma in an adolescent--case report.

The authors present a case of a 14-year-old premenarchal girl with a large solid tumor of the left ovary. The rim of normal ovarian tissue was visible around the tumor on ultrasonography scan. Although the levels of two tumor markers, LDH and CA125, were elevated, the authors performed an organ-sparing tumorectomy. The final pathology report revealed foci of immature neural tissue, with a final diagnosis immature teratoma Stage Ia.

Simultaneous dermoid cyst and endometriosis in the same ovary: a case report.

The authors present a case of a 33-year-old infertile woman with coincidental dermoid cyst and ovarian endometriosis in the same ovary. She was admitted to the Clinic because of cystic tumor of the left adnexa. Transvaginal ultrasound (TVUS) examination found a bilocular tumor of complex structure on the left ovary. Video-laparoscopy was also performed. On the left ovary, two adjacent cystic formations were found. Laparoscopic ovarian cystectomy was performed and a surgical specimen was sent for histopathologic analysis. The diagnosis was a dermoid cyst and ovarian endometriosis. Without complications, the patient was released from the hospital. The patient was treated with an analogue of gonadotropin releasing hormone (GnRH) for three months as a preparation for in vitro fertilization (IVF).

The parvalbumin-positive interneurons in the mouse dentate gyrus express GABAA receptor subunits α1, ß2, and δ along their extrasynaptic cell membrane.

Neuronal circuitries in the hippocampus are involved in navigation and memory and are controlled by major networks of GABAergic interneurons. Parvalbumin (PV)-expressing interneurons in the dentate gyrus (DG) are identified as fast-spiking cells, playing a crucial role in network oscillation and synchrony. The inhibitory modulation of these interneurons is thought to be mediated mainly through GABAA receptors, the major inhibitory neurotransmitter receptors in the brain. Here we show that all PV-positive interneurons in the granular/subgranular layer (GL/SGL) of the mouse DG express high levels of the GABAA receptor δ subunit. PV-containing interneurons in the hilus and the molecular layer, however, express the δ subunit to a lower extent. Only 8% of the somatostatin-containing interneurons express the δ subunit, whereas calbindin- or calretinin-containing interneurons in the DG seem not to express the GABAA receptor δ subunit at all. Hence, these cells receive a GABAergic control different from that of PV-containing interneurons in the GL/SGL. Experiments investigating a possible co-expression of GABAA receptor α1, α2, α3, α4, α5, ß1, ß2, ß3, or γ2 subunits with PV and δ subunits indicated that α1 and ß2 subunits are co-expressed with δ subunits along the extrasynaptic membranes of PV-interneurons. These results suggest a robust tonic GABAergic control of PV-containing interneurons in the GL/SGL of the DG via δ subunit-containing receptors. Our data are important for better understanding of the neuronal circuitries in the DG and the role of specific cell types under pathological conditions.

Carcinosarcoma of the uterus in advanced stage: a case report.

This is the case of an advanced stage carcinosarcoma uteri, in a patient with limited therapy options. Carcinosarcomas (malignant mixed Müllerian tumors) are histologically composed of malignant epithelial and mesenchymal components. Sarcomatous component of this mixed tumor in the present patient was of heterologous-type chondrosarcoma. The primary treatment option for uterine carcinosarcomas is surgery, but adjuvant therapy is always necessary. The optimal treatment is still uncertain, as the histogenesis of this tumor remains controversial.

Comparison of hysterosonography and hysteroscopy for diagnosing perimenopausal bleeding.

This investigation was a prospective study performed at the Gynecological Clinic "Narodni Front" in Belgrade. In the investigated group, endometrial hyperplasia, endometrial polyp, and myoma were diagnosed as the most frequent causes of bleeding during perimenopause. The test group of patients was then subjected to hysterosonography in order to diagnose bleeding etiology, followed by hysteroscopy to confirm its etiology based on hysterosonography. Material was sent for histopathological analysis to definitely confirm the diagnosis. The aim of this study was to the compare the findings of hysterosonography and hysteroscopy to evaluate the sensitivity and efficacy of hysterosonography for diagnosing the etiology of uterine bleeding in perimenopausal women. In the diagnostics of submucosal myoma, endometrial hyperplasia, and endometrial polyps, hysterosonography has proven to be a good screening method. By its use for diagnosing intracavitary uterine pathology, and thus also the pathology of bleeding in perimenopausal women, in many cases hysteroscopy can be avoided. This is a method that is easy to perform, less invasive, less costly to perform, and is well-tolerated.

Doppler parameters of maternal renal blood flow in normal pregnancy.

UNLABELLED: The purpose of this investigation was to evaluate changes in maternal renal arterial blood flow during pregnancy. MATERIALS AND METHODS: The study included 40 non-pregnant, 200 pregnant, and 30 women after delivery. The authors measured pulsatility index (Pi) and resistance index (Ri) in the right and left renal arteries in the hilus. The authors compared the values between non-pregnant and women during first, second, and third trimester and post-partum period and tested correlation with gestational age. RESULTS: The authors did not find a statistical difference in Pi and Ri between the right and left kidneys. There was no difference in Pi and Ri in pregnancy trimester compared to the non-pregnant state. There was no correlation between the values of Pi and Ri and gestational weeks. CONCLUSION: During pregnancy there are no changes in the values of maternal renal Pi and renal Ri. Unchanged total vascular resistance may result from physiological changes of the glomerular filtration rate.

The management of fusion of the labia minora pudendi in adult women using a radiosurgical knife.

Fusion of the labia minora is a rare event in adult women and rarely seen as a clinical entity. We present a case of a 30-year-old woman with labial fusion, unmarried, a virgin, and sexually inactive with the complaint of discomfort during menstruation and difficulty in micturition since her puberty. The labia minora were fused in the midline with a pinpoint aperture for draining urine, while the clitoris could not be visualized. Previous history regarding a causal factor was perineal trauma in childhood. Effective surgical resection to separate the fusion was done by a radio frequency surgical knife. After the surgical separation, it was possible to expose the normal hymen behind the previously fused labia. We have shown that the separation of labial fusion in adult women with a radio frequency surgical knife, associated with topical application of estrogen cream, prevents re-fusion of the labia and leads to healing without scarring of the vulva.

Adenosarcoma ovarii in a 51-year-old woman: case report.

This case report presents a 51-year-old woman with an adenosarcoma of ovarian origin which is a very rare tumor. She came for consultation due to abnormal vaginal bleeding. The case also illustrates the difficulty of its correct diagnosis and discusses the possible reasons of wrong preoperative and intraoperative diagnosis.

Treatment of early heterotopic interstitial (cornual) gestation with subsequent delivery of an intrauterine pregnancy--case report.

We present the case of a 38-year-old woman who was treated for a heterotopic interstitial (cornual) pregnancy diagnosed at the 7th week of gestation. The intervention was performed via transvaginal ultrasound-guided aspiration and instillation of a hypertonic solution of sodium chloride into the cornual sac. The heterotopic comrnual pregnancy was successfully aborted, and the intrauterine pregnancy was successfully maintained with delivery of a healthy newborn.

Evaluation of utero-ovarian hemodynamics in relation to fertility and stage of endometriosis.

OBJECTIVE: The aim of this study was to compare hemodynamic changes in the uterine and ovarian arteries between infertile women with moderate and/or severe endometriosis and healthy women. In this prospective study, 99 women in their generative age were subjected to color Doppler ultrasonography to measure hemodynamic parameters from July 2010 to January 2011. The examination was performed during the proliferative or ovulatory phase of the natural menstrual cycle in a random sample of 54 women treated for endometriosis-induced infertility and 45 healthy women were included in control examination procedure. Irrespective of considered stage, endometriosis was most often found in the ovaries, in the sacro-uterine ligaments, peritoneum, and rectovaginally. Resistance to blood flow expressed as the resistance index (RI) in the measured arteries, was significantly higher in severe endometriosis compared to moderate form. Average values of pulsation index (PI) and RI are significantly higher, in both endometriosis stages, compared to measured values in healthy women.