Knowledge of pelvic floor disorders amongst immigrant women in Canada.

INTRODUCTION AND HYPOTHESIS: Pelvic floor disorders (PFD) have a detrimental effect on quality of life. Despite the available treatments, women often do not seek medical care. Patient knowledge has been identified as a major barrier to accessing care. The objective of this study was to assess knowledge on PFD amongst women in Edmonton, hypothesizing that immigrant women are less knowledgeable about PFD than Canadian-born women. METHODS: A cross-sectional study of immigrant women and Canadian-born women was conducted. Immigrant women were recruited at the Multi-Cultural Health Brokers Co-op (MCHB) and Canadian-born women at a colposcopy clinic. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) was administered. Scores for UI and POP were calculated and compared using a Mann-Whitney U test and a t test. A subgroup analysis of immigrants was carried out according to length of stay in Canada and ethnicity. Ethics approval was obtained from the University of Alberta Human Research Ethics Office. RESULTS: A total of 106 immigrants and 102 Canadian-born women completed the PIKQ. The overall PIKQ scores were 12.7 for immigrant women and 14.4 for Canadian-born women (p = 0.04). Immigrant women who had lived in Canada for >10 years had higher scores (mean = 13.2) compared with women with less than 10 years in Canada (mean = 11.8). Women from South Asia had higher overall PIKQ scores (mean = 14.6) whereas women from sub-Saharan Africa had the lowest scores (mean = 12.1). CONCLUSIONS: Immigrant women in Edmonton were found to have less knowledge on PFD than Canadian-born women.

The physiological roles of tau and Aß: implications for Alzheimer's disease pathology and therapeutics.

Tau and amyloid beta (Aß) are the prime suspects for driving pathology in Alzheimer's disease (AD) and, as such, have become the focus of therapeutic development. Recent research, however, shows that these proteins have been highly conserved throughout evolution and may have crucial, physiological roles. Such functions may be lost during AD progression or be unintentionally disrupted by tau- or Aß-targeting therapies. Tau has been revealed to be more than a simple stabiliser of microtubules, reported to play a role in a range of biological processes including myelination, glucose metabolism, axonal transport, microtubule dynamics, iron homeostasis, neurogenesis, motor function, learning and memory, neuronal excitability, and DNA protection. Aß is similarly multifunctional, and is proposed to regulate learning and memory, angiogenesis, neurogenesis, repair leaks in the blood-brain barrier, promote recovery from injury, and act as an antimicrobial peptide and tumour suppressor. This review will discuss potential physiological roles of tau and Aß, highlighting how changes to these functions may contribute to pathology, as well as the implications for therapeutic development. We propose that a balanced consideration of both the physiological and pathological roles of tau and Aß will be essential for the design of safe and effective therapeutics.

Microglia regulation of central nervous system myelin health and regeneration.

Microglia are resident macrophages of the central nervous system that have key functions in its development, homeostasis and response to damage and infection. Although microglia have been increasingly implicated in contributing to the pathology that underpins neurological dysfunction and disease, they also have crucial roles in neurological homeostasis and regeneration. This includes regulation of the maintenance and regeneration of myelin, the membrane that surrounds neuronal axons, which is required for axonal health and function. Myelin is damaged with normal ageing and in several neurodegenerative diseases, such as multiple sclerosis and Alzheimer disease. Given the lack of approved therapies targeting myelin maintenance or regeneration, it is imperative to understand the mechanisms by which microglia support and restore myelin health to identify potential therapeutic approaches. However, the mechanisms by which microglia regulate myelin loss or integrity are still being uncovered. In this Review, we discuss recent work that reveals the changes in white matter with ageing and neurodegenerative disease, how this relates to microglia dynamics during myelin damage and regeneration, and factors that influence the regenerative functions of microglia.

Astrocyte-oligodendrocyte interaction regulates central nervous system regeneration.

Failed regeneration of myelin around neuronal axons following central nervous system damage contributes to nerve dysfunction and clinical decline in various neurological conditions, for which there is an unmet therapeutic demand. Here, we show that interaction between glial cells - astrocytes and mature myelin-forming oligodendrocytes - is a determinant of remyelination. Using in vivo/ ex vivo/ in vitro rodent models, unbiased RNA sequencing, functional manipulation, and human brain lesion analyses, we discover that astrocytes support the survival of regenerating oligodendrocytes, via downregulation of the Nrf2 pathway associated with increased astrocytic cholesterol biosynthesis pathway activation. Remyelination fails following sustained astrocytic Nrf2 activation in focally-lesioned male mice yet is restored by either cholesterol biosynthesis/efflux stimulation, or Nrf2 inhibition using the existing therapeutic Luteolin. We identify that astrocyte-oligodendrocyte interaction regulates remyelination, and reveal a drug strategy for central nervous system regeneration centred on targeting this interaction.

The Nature and Extent of Component Analyses for Improving or Mitigating Behavior: A Systematic Review.

A component analysis is an approach where two or more independent variables are evaluated as a package and independently. The approach is used to assess and identify which component of a treatment package is the most effective. The purpose of this review is to document the application of component analyses to improve or mitigate non-academic behaviors with individuals with disabilities. We identified 21 research articles that used a component analysis to evaluate treatment packages with students who were identified as having or at-risk for a disability in classroom and/or alternative settings. Results from reviewing 21 articles (22 cases) indicate that 11 intervention packages had a single component that was critical for successful behavior change. Two articles suggested the entire intervention package was necessary while nine articles did not report a critical component or had variable results pertaining to critical components. The benefits and drawbacks of using component analyses for single case research are discussed. Implications for future research are also presented.

Digital Intervention for Problematic Smartphone Use.

Smartphones have become the primary devices for accessing the online world. The potential for smartphone use to become problematic has come into increasing focus. Students and young adults have been shown to use their smartphones at high rates and may be at risk for problematic use. There is limited research evaluating interventions for problematic smartphone use. The present research aimed to develop and evaluate a digital intervention for problematic smartphone use in a student population. A mixed-method case series design was used. The participants were 10 students with mild-moderate dependency on the online world (measured via a self-report questionnaire). An intervention comprising goal setting, personalised feedback, mindfulness, and behavioural suggestions was delivered via a smartphone application. Time spent on smartphones was measured objectively through the same application. Changes in problematic technology use, wellbeing, mindfulness, and sleep were also evaluated. The findings indicate that the intervention resulted in a reduction in self-reported problematic smartphone use, but not screen time. The findings also indicate that over the course of participation, there was a positive influence on wellbeing, online dependency, mindfulness, and sleep. However, the mechanisms of change could not be determined. The study provides preliminary evidence that a light-touch, smartphone-delivered package is an acceptable and effective intervention for students wishing to better manage their problematic smartphone use.

When Does a Lot Become Too Much? A Q Methodological Investigation of UK Student Perceptions of Digital Addiction.

Despite the benefits of the internet and other digital technology, the online world has been associated with a negative impact on university student wellbeing. Many university students report symptoms of pathological internet use. Internationally, further research is needed to understand what student users of technology perceive to be problematic internet and/or digital use. The current study explores the range of perceptions that university students hold about 'digital addiction'. We recruited 33 participants from a UK university into a Q-methodology study. Participants sorted, ranked, and commented on fifty-two statements representing the concourse of 'things written or said about digital addiction'. The statements were identified from a comprehensive search of a wide variety of sources (e.g., newspapers, academic articles, blogs, and YouTube). Principal Component Analysis was used to identify four distinct viewpoints of 'digital addiction': (I) digital addiction is differentiated by the negative consequences experienced by addicted individuals; (II) digital addiction comes from our fascination with the online world; (III) digital addiction is an attempt to escape real world problems and impacts on mental health and relationships; (IV) digital addiction is defined by the amount of time we spend online. All four viewpoints share the perception that people do not realize they are digitally addicted because using and having digital devices on you at all times has become the social norm. There was also overall agreement that that those with 'addictive personalities' were more likely to be 'digitally addicted'. Despite these similarities, complexity and contradictions within the viewpoints surrounding what digital addiction is and how it might be defined are apparent. The information found in this study provides important suggestions of how we might frame prevention and early intervention messages to engage students and ensure they develop the skills necessary to successfully manage their digital lives.

Social identity in eating disorders.

This qualitative study examines social identity in eating disorders. Semi-structured interviews were conducted with eight females with an eating disorder diagnosis. Interpretative phenomenological analysis (IPA) was used to analyse the data. Three superordinate themes emerged from participants' accounts: (1) Shifts in social identity; (2) Outgroup perceptions and influences and (3) Eating disorders as an ingroup. The findings suggested that a person's social identity can change during the course of having an eating disorder, and an interaction between social identity and a person's recovery from an eating disorder was proposed. Clinical implications, methodological issues, and directions for future research were discussed.

Hyperandrogenism and hyperinsulinism in children of women with polycystic ovary syndrome: a controlled study.

OBJECTIVE: Hyperandrogenia and insulin resistance are heritable family traits, likely to cluster in children of polycystic ovary syndrome (PCOS) mothers. DESIGN: We performed a case control study of PCOS children (n = 32) compared with children from control women (n = 38) for reproductive and metabolic abnormalities, stratifying results by three Tanner stage groupings. The children underwent history and physical examinations, a 3-h timed urine collection, a 2-h oral glucose tolerance test, and abdominal ultrasound examination (females only). Serum was obtained in older children (age > 8 yr) who consented. RESULTS: Urine LH levels were significantly lower in the Tanner IV-V PCOS girls compared with controls (P = 0.04). Urine testosterone levels were significantly elevated in Tanner II-III PCOS boys compared with controls (P = 0.007). There were no significant differences in dehydroepiandrosterone levels. We validated the correlation between salivary and serum levels of insulin (insulin areas under the curve) in an adult population [n =30, Pearson correlation coefficient (r) = 0.67; P < 0.0001], which also replicated in the children (2-h insulin r = 0.57; P = 0.0004). Mean area under the curve salivary insulin levels were significantly higher in the Tanner IV-V PCOS girls in the later stages of puberty when compared with controls (3625 +/- 1372 vs. 1766 +/- 621 min x muU/ml, 95% confidence interval 475-3242; P < 0.02). CONCLUSIONS: Hyperinsulinism may be a familial characteristic of PCOS children (or at least girls) but does not appear until the later stages of puberty. Other reproductive abnormalities that characterize PCOS may develop later.

Factors that influence improvement for patients with poorly controlled type 2 diabetes.

OBJECTIVE: Assess reasons for improved control for patients with initially poorly controlled diabetes. RESEARCH DESIGN AND METHODS: Patients in seven practices with type 2 diabetes were selected if within a 6-month period they had two glycosylated hemoglobin (HbA1c) levels of at least 8.0%. Patient factors that may influence control were compared for patients grouped according to their last two HbA1c levels. RESULTS: Review of 643 medical records of diabetic patients treated by 29 clinicians identified 69 study patients. After at least 1 year of follow-up 26 patients became well controlled, 14 had intermediate control, and 29 remained in poor control. Becoming controlled was not significantly associated with gender, age, duration of diabetes, BMI, or HbA1c levels prior to baseline. It was inversely associated with greater use of medications (P = 0.04), and positively associated with understanding of diabetes (P = 0.03), adherence to recommendations for meal plan (P = 0.001), and glucose monitoring (P = 0.02). Thirty-one percent of patients who became controlled had a change in life circumstances. Reasons for not advancing medications were probably justified for 69% of patients who remained uncontrolled. CONCLUSION: Improved control depends largely on patient self-care behaviors.

Selective dorsal rhizotomy in children: comparison of outcomes after single-level versus multi-level laminectomy technique.

Children with cerebral palsy may experience spasticity, which may negatively impact their quality of life. One proven treatment for such spasticity is selective dorsal rhizotomy (SDR), whereby a partial sectioning of the dorsal roots from L2 to S1 is performed. SDR can be performed where the nerve root exits the intervertebral foramina via multi-level laminectomies, or at the level of the conus via a single-level laminectomy. At British Columbia Children's Hospital (BCCH), SDRs were performed via multi-level laminectomies until 2005, when the single-level technique was adopted. The single-level procedure is technically more challenging and takes longer, but requires a smaller incision and involves less muscle dissection. Functional outcomes at one-year follow-up are similar for the two methods of surgery. It was hypothesized that post-operative pain would be less, mobilization faster and hospital stay shorter using the single-level technique. Using a retrospective case series analysis, we compared nine patients who had had single-level SDR to 18 matched controls who had undergone SDR using the multi-level technique. There were no significant differences in post-operative pain, duration of opioid infusion, or time to mobilization. Length of hospital stay was significantly decreased after the single level procedure: 3.4 versus 5.2 days (p = 0.01).

Morphine infusions after pediatric cranial surgery: a retrospective analysis of safety and efficacy.

INTRODUCTION: Morphine infusions are avoided after cranial surgery in children due to concerns of masking neurological deterioration and because cranial surgery is considered less painful than other surgical procedures. Studies indicate that up to 60% of patients experience moderate to severe pain after craniotomies. Morphine has demonstrated efficacy in the treatment of acute postoperative pain, yet codeine phosphate is commonly preferred as the standard treatment. We assessed the efficacy and safety of intravenous morphine use outside the intensive care unit (ICU) following cranial surgery in children. METHODS: A retrospective case series analysis was conducted of medical records for 71 children. The patients underwent either cranial reconstruction (2002-2007) or supratentorial/infratentorial craniotomies (2005-2007) at British Columbia Children's Hospital. Comparison was made between patients receiving a continuous morphine infusion (CMI) and patients receiving acetaminophen and codeine. Patients were assessed for pain control and adverse events. RESULTS: Thirty-seven children received CMI on the unit (30 cranial reconstruction and seven craniotomy), while 34 (10 cranial reconstruction and 24 craniotomy) received acetaminophen and codeine. There was no statistical difference in pain control. There was a statistically significant difference in nausea on postoperative day one (p = 0.002). CONCLUSIONS: These findings suggest that CMI is as safe a treatment option as acetaminophen and codeine. Careful observation enables nurses to safely administer a CMI for children following cranial surgery on a surgical unit setting.

A computer-aided drug discovery system for chemistry teaching.

The Schools Malaria Project (http://emalaria.soton.ac.uk/) brings together school students with university researchers in the hunt for a new antimalaria drug. The design challenge being offered to students is to use a distributed drug search and selection system to design potential antimalaria drugs. The system is accessed via a Web interface. This e-science project displays the results of the trials in an accessible manner, giving students an opportunity for discussion and debate both with peers and with the university contacts. The project has been implemented by using distributed computing techniques, spreading computer load over a network of machines that cross institutional boundaries, forming a grid. This provides access to greater computing power and allows a much more complex and detailed formulation of the drug design problem to be tackled for research, teaching, and learning.

Polycystic ovary syndrome in adolescents.

Recent findings suggest substantial metabolic sequelae to polycystic ovary syndrome (PCOS), including risk of diabetes and cardiovascular disease. Primary treatment of the metabolic sequelae should be the focus of the clinician. The definition of PCOS has been expanded from a disorder that presents at menarche and ends at menopause to a disorder that may be present from birth to senescence. The earliest recognized PCOS phenotype to date is premature pubarche characterized by excessively elevated levels of dehydroepiandosterone sulfate and hyperinsulinemia. Such girls are at high risk to develop the full PCOS phenotype, including ovarian hyperandrogenism and chronic anovulation. A fasting glucose-to-insulin ratio of < 7 is a useful index of insulin resistance in adolescents. However, each patient should be evaluated for glucose intolerance and lipid abnormalities on a regular basis by completing a 2-hour oral glucose tolerance test and a fasting lipid profile. Primary prevention of diabetes and cardiovascular disease by lifestyle modifications, regular exercise, and a balanced diet are of utmost importance, especially in adolescents who have the opportunity to establish healthy habits before entering adulthood. The role of insulin-sensitizing medications is still under study. Although no clinical trials over 6 months in duration have assessed the long-term efficacy of metformin use in adolescents, short-term trials have shown promising effects in lowering insulin secretion, improving insulin sensitivity, restoring normal menstrual cycles, and correcting lipid abnormalities.