Proximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the best treatment is still lacking. ...The primary aim of this multicenter, randomized 3-arm superiority, open-label trial was to assess the results of nonoperative treatment and operative treatment either with locking plate (LP) or hemiarthroplasty (HA) of 3- and 4-part PHF with the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) at 2-year follow-up. In this study, no benefit was observed between operative treatment with LP or HA and nonoperative treatment in displaced 3- and 4-part PHFs in patients aged 60 years and older. Further, we observed a high rate of complications related to operative treatments.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A meta-analysis can help inform the debate about the epidemiological evidence on dairy intake and development of acne. A systematic literature search of PubMed from inception to 11 December 2017 was ...performed to estimate the association of dairy intake and acne in children, adolescents, and young adults in observational studies. We estimated the pooled random effects odds ratio (OR) (95% CI), heterogeneity (
²-statistics,
-statistics), and publication bias. We included 14 studies (
= 78,529; 23,046 acne-cases/55,483 controls) aged 7⁻30 years. ORs for acne were 1.25 (95% CI: 1.15⁻1.36;
6.13 × 10
) for any dairy, 1.22 (1.08⁻1.38;
1.62 × 10
) for full-fat dairy, 1.28 (1.13⁻1.44;
8.23 × 10
) for any milk, 1.22 (1.06⁻1.41;
6.66 × 10
) for whole milk, 1.32 (1.16⁻1.52;
4.33 × 10
) for low-fat/skim milk, 1.22 (1.00⁻1.50;
5.21 × 10
) for cheese, and 1.36 (1.05⁻1.77;
2.21 × 10
) for yogurt compared to no intake. ORs per frequency of any milk intake were 1.24 (0.95⁻1.62) by 2⁻6 glasses per week, 1.41 (1.05⁻1.90) by 1 glass per day, and 1.43 (1.09⁻1.88) by ≥2 glasses per day compared to intake less than weekly. Adjusted results were attenuated and compared unadjusted. There was publication bias (
4.71 × 10
), and heterogeneity in the meta-analyses were explained by dairy and study characteristics. In conclusion, any dairy, such as milk, yogurt, and cheese, was associated with an increased OR for acne in individuals aged 7⁻30 years. However, results should be interpreted with caution due to heterogeneity and bias across studies.
Visual impairments (VIs) have a negative impact on life and affect up to 60% of stroke survivors. Despite this, VIs are often overlooked. This paper explores how persons with VIs experience vision ...care within stroke health services and how VIs impact everyday life the first 3 months post stroke.
Individual semi-structured interviews were conducted with 10 stroke survivors 3 months post stroke, and analyzed using qualitative content analysis.
The main theme, "Invisible" visual impairments, represents how participants experience VIs as an unknown and difficult symptom of stroke and that the lack of attention and appropriate visual care leads to uncertainty about the future. VIs were highlighted as a main factor hindering the participants living life as before. The lack of acknowledgement, information, and systematic vision rehabilitation leads to feelings of being unsupported in the process of coping with VIs.
VIs are unknown symptoms pre stroke and sequelas after stroke that significantly affect everyday life. VIs and vision rehabilitation needs more attention through all phases of stroke health services. We request a greater awareness of VIs as a presenting symptom of stroke, and that visual symptoms should be included in stroke awareness campaigns. Further, we suggest increased competence and standardized evidence-based clinical pathways for VIs to advance all stroke health services including rehabilitation in order to improve outcomes and adaptation to future life for stroke survivors with VIs.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Lumbar puncture is generally performed in stroke settings when infectious or inflammatory diseases are suspected to be the etiology. This review aimed to assess the prevalence of pleocytosis in the ...cerebrospinal fluid following ischemic stroke without inflammatory or infectious etiology.
We searched PubMed for studies with mentions of “ischemic stroke AND cerebrospinal fluid”. We included only studies written in English, including patients with a primary diagnosis of either ischemic stroke or transient ischemic attack (TIA), and where white blood cell count in the spinal fluid was presented. Studies investigating common etiologies for pleocytosis, was excluded. Study and patient characteristics, white blood cell count and time to lumbar puncture were presented in tables, and the prevalence of pleocytosis were reported and plotted graphically.
We included 15 studies with 1607 patients, 1522 with ischemic stroke and 85 with TIA. The prevalence of pleocytosis was between 0% to 28,6% and a mean of 11.8%. The highest white blood cell count found with common etiologies for pleocytosis ruled out was 56 cells/mm3. A mean white blood cell count of 4.0 was based on the three studies where this was available.
The included studies were methodologically heterogenous and few had pleocytosis as primary outcome. Pleocytosis following ischemic stroke is uncommon and should prompt further investigations
•Pleocytosis in cerebrospinal fluid after ischemic stroke is uncommon.•Findings of pleocytosis in CSF after ischemic stroke should lead to further investigations.•Pleocytosis is more common in settings of neuroinflammation or infection.•The studies identified in this review where heterogenous in design.
•Global radial optic flow sensitivity varies with age and dot speed.•Performance improves gradually but is still immature at 16years of age.•Both children and adults showed better sensitivity to ...faster than slower speed.
The development of sensitivity to radial optic flow discrimination was investigated by measuring motion coherence thresholds (MCTs) in school-aged children at two speeds. A total of 119 child observers aged 6–16years and 24 young adult observers (23.66+/−2.74years) participated. In a 2AFC task observers identified the direction of motion of a 5° radial (expanding vs. contracting) optic flow pattern containing 100 dots with 75% Michelson contrast moving at 1.6°/s and 5.5°/s and. The direction of each dot was drawn from a Gaussian distribution whose standard deviation was either low (similar directions) or high (different directions). Adult observers also identified the direction of motion for translational (rightward vs. leftward) and rotational (clockwise vs. anticlockwise) patterns. Motion coherence thresholds to radial optic flow improved gradually with age (linear regression, p<0.05), with different rates of development at the two speeds. Even at 16years MCTs were higher than that for adults (independent t-tests, p<0.05). Both children and adults had higher sensitivity at 5.5°/s compared to 1.6°/s (paired t-tests, p<0.05). Sensitivity to radial optic flow is still immature at 16years of age, indicating late maturation of higher cortical areas. Differences in sensitivity and rate of development of radial optic flow at the different speeds, suggest that different motion processing mechanisms are involved in processing slow and fast speeds.
► This study examines how organizations handle the internal dimension of crisis management and crisis communication before, during and after a crisis. ► During a crisis, employees typically produce ...more informal communication, lack information, and feel frustrated and insecure. ► The larger the organization the more crisis-prepared. ► The employees are communicatively active in a crisis situation. ► Public organizations have their own approach to internal crisis management and crisis communication.
The aim of this paper is to present and discuss some of the main findings from a large survey of internal crisis management and crisis communication conducted in the spring of 2011 among public and private organizations in Denmark (the ICMCC survey). The survey was conducted among the 367 largest private companies (selected from DK 1000, established by Børsen business magasin) and among 98 public organizations (municipalities). The overall goal was to get a preliminary idea of how these companies or organizations perceive, plan, coordinate and implement internal crisis management and crisis communication activities before, during and after a crisis. The survey questionnaire comprised 36 questions and was sent to respondents who typically are responsible for the crisis-preparedness of their organizations. The results from the survey show that the vast majority of organizations have a crisis or contingency plan, and most of these plans contain an internal dimension relating to the management and communication with the internal stakeholders during a crisis. Thus, the study shows a rather professional and formalized behavior towards crisis management in general, but also when it comes to managing a crisis in relation to the internal organizational stakeholders in specific. In addition, the results clearly indicate a strong relation between organizational size and crisis management; the larger the organization the more likely to have a crisis plan. This particularly pertained to the private organizations. The ICMCC survey forms part of a major collaborative research project, financed by the Danish Council for Independent Research/Social Sciences (2011–2014), entitled Internal Crisis Management and Crisis Communication in Danish Organizations. The purpose of this three-year long project is to shed light upon the role of internal crisis management and crisis communication before, during and after an organizational crisis and/or a societal crisis leading to downsizing or major changes within an organization or an organizational field.
To explore current hospital practice in relation to the assessment of vision problems in patients with acquired brain injury.
A survey study.
A total of 143 respondents from hospital settings, with ...background in occupational therapy and physical therapy, participated in the survey.
The survey questionnaire, developed collaboratively by Danish and Norwegian research groups, encompassed 22 items categorically covering "Background information", "Clinical experience and current practice", "Vision assessment tools and protocols", and "Assessment barriers". It was sent out online, to 29 different hospital departments and 18 separate units for occupational therapists and physiotherapists treating patients with acquired brain injury.
Most respondents worked in acute or subacute hospital settings. Few departments had an interdisciplinary vision team, and very few therapists had formal education in visual problems after acquired brain injury. Visual assessment practices varied, and there was limited use of standardized tests. Barriers to identifying visual problems included patient-related challenges, knowledge gaps, and resource limitations.
The study emphasized the need for enhanced interdisciplinary collaboration, formal education, and standardized assessments to address visual problems after acquired brain injury. Overcoming these challenges may improve identification and management, ultimately contributing to better patient care and outcomes in the future.
Melatonin plays an important role in regulation and maintaining of the circadian rhythm. In the elderly population, an array of disturbances of circadian rhythm and sleep can be observed; however the ...current knowledge within the group of healthy, elderly is scarce. This systematic literature review of studies on the melatonin profile measured in the blood of healthy, elderly individuals included 519 studies, found in the primary search on PubMed. After reviewing the title and abstract, 47 studies were found eligible for full text review. The inclusion criteria were defined as follows: healthy, elderly individuals, with a mean or average age over 65 years and analysis done in blood or plasma. In addition to the primary search, three studies were directly identified by the reference lists of already included studies. A final total of 23 studies were included in the systematic literature review. In reviewing the literature, a clear circadian melatonin profile with a nocturnal peak at 3 am and lower daytime levels was observed in the healthy, elderly population. In elderly over 75 years of age, the nocturnal level of melatonin may be lower; however, the circadian rhythmicity is maintained. In the comparison of elderly, independently living individuals and individuals living in care facilities, the latter group had lower levels of nocturnal melatonin peak as well as higher daytime levels; however one can wonder if elderly in care facilities are healthy. The 23 included studies in the systematic literature review had varying primary objectives and generally the term "healthy" within this population group proves difficult to clearly define. As a result of this, an obvious interstudy variability existed, which is a limitation of this systematic literature review. However, the graphs depicted represent the best possible estimation of the melatonin profile in a healthy, elderly population. Future research in the melatonin profile within this population should focus on clearly defined healthy elderly to ensure a valid normal material in this age group.
Bacterial airway infections, predominantly caused by
P. aeruginosa
, are a major cause of mortality and morbidity of CF patients. While short insertions and deletions as well as point mutations ...occurring during infection are well studied, there is a lack of understanding of how gene loss and acquisition play roles in bacterial adaptation to the human airways. Here, we investigated
P. aeruginosa
within-host evolution with regard to gene loss and acquisition. We show that during long-term infection
P. aeruginosa
genomes tend to lose genes, in particular, genes related to virulence. This adaptive strategy allows reduction of the genome size and evasion of the host’s immune response. This knowledge is crucial to understand the basic mutational steps that, on the timescale of years, diversify lineages and adds to the identification of bacterial genetic determinants that have implications for CF disease.
ABSTRACT
Genome analyses have documented that there are differences in gene repertoire between evolutionary distant lineages of the same bacterial species; however, less is known about microevolutionary dynamics of gene loss and acquisition within bacterial lineages as they evolve over years. Here, we analyzed the genomes of 45
Pseudomonas aeruginosa
lineages evolving in the lungs of cystic fibrosis (CF) patients to identify genes that are lost or acquired during the first years of infection. On average, lineage genome content changed by 88 genes (range, 0 to 473). Genes were more often lost than acquired, and prophage genes were more variable than bacterial genes. We identified convergent loss or acquisition of the same genes across lineages, suggesting selection for loss and acquisition of certain genes in the host environment. We found that a notable proportion of such genes are associated with virulence; a trait previously shown to be important for adaptation. Furthermore, we also compared the genomes across lineages to show that the within-lineage variable genes (i.e., genes that had been lost or acquired during the infection) often belonged to genomic content not shared across all lineages. In sum, our analysis adds to the knowledge on the pace and drivers of gene loss and acquisition in bacteria evolving over years in a human host environment and provides a basis to further understand how gene loss and acquisition play roles in lineage differentiation and host adaptation.
IMPORTANCE
Bacterial airway infections, predominantly caused by
P. aeruginosa
, are a major cause of mortality and morbidity of CF patients. While short insertions and deletions as well as point mutations occurring during infection are well studied, there is a lack of understanding of how gene loss and acquisition play roles in bacterial adaptation to the human airways. Here, we investigated
P. aeruginosa
within-host evolution with regard to gene loss and acquisition. We show that during long-term infection
P. aeruginosa
genomes tend to lose genes, in particular, genes related to virulence. This adaptive strategy allows reduction of the genome size and evasion of the host’s immune response. This knowledge is crucial to understand the basic mutational steps that, on the timescale of years, diversify lineages and adds to the identification of bacterial genetic determinants that have implications for CF disease.
Visual impairments (VIs) affect 60% of stroke survivors and have negative consequences for rehabilitation and quality of life poststroke. Symptoms of VIs post stroke are difficult to identify for ...stroke survivors and health care professionals without using a structured vision assessment. In this study, we qualitatively evaluate the implementation outcomes after implementing a structured visual assessment with the Competence, Rehabilitation of Sight after Stroke Vision (KROSS) assessment tool in stroke care services.
This is a qualitative study comprising four focus group interviews. The health care personnel (HCP) involved in the implementation or with experience using the KROSS assessment tool in practice were invited to participate. We used Proctor et al.'s definitions of implementation outcomes as a framework, which informed the interview guide and analysis. We used a deductive - inductive content analysis, as described by Elo and Kyngäs.
The participants found the structured vision assessment with the KROSS tool as being acceptable; they expressed a motivation and intention to use the new routine in practice. They believed it was important to assess their patient's visual function because it influenced other rehabilitation activities and activities of daily living. Most of the participants reported having adopted the vision assessment in their practice, except for those participants from the home care services who experienced that they have few stroke survivors to follow up on. The assessment was believed to be more appropriate to perform within the rehabilitation services where there is more of a focus on functional assessments. Although vision assessment was new to all the participants, they felt that they improved their vision assessment skills by regularly using the assessment tool. Together with sufficient instructions and supervision, they believed that vison assessment was feasible for their practise. Including the vison assessment in the existing routines and systems was important to promote sustainable implementation.
Implementing a structured vision assessment with the KROSS tool in health care services was experienced as acceptable and feasible. The new routine led to increased attention towards poststroke VIs and increased collaboration with vision experts. Tailoring the routine to each practice and how they organise their work can support the integration of a vision assessment in their routines. To promote better vision care poststroke vision assessment and follow up should be included in the stroke care pathways.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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