Decrease In Days Research Articles

Healthcare-Associated Bloodstream Infections in a Neonatal Intensive Care Unit over a 20-Year Period (1992–2011): Trends in Incidence, Pathogens, and Mortality

To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992-2011). Historical cohort study. Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital. Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD). A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition-days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis. In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2-3.9). A significant increasing time trend in incidence density was observed for the period 1995-2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001). An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care.

Coupling of winter climate transitions to snow and clouds over the Prairies

AbstractUsing data from 13 climate stations on the Canadian Prairies, together with opaque cloud cover and daily snow depth, to analyze the winter climate transitions with snow, we find that a snow cover acts as a fast climate switch. Surface temperature falls by about 10 K with fresh snowfall and rises by a similar amount with snowmelt, while the daily range of relative humidity falls to around 5–15% with snow cover. These are robust climate signals. For every 10% decrease in days with snow cover over the Canadian Prairies, the mean October to April climate is warmer by about 1.4 K. Stratifying by daily mean opaque cloud cover across snow transitions shows the rapid shift within 5 days from a diurnal cycle dominated by shortwave cloud forcing to one dominated by longwave cloud forcing. We calculate the change in the surface radiative budget with snow using surface albedo data from the Moderate Resolution Imaging Spectroradiometer and station longwave data. We find that with the fall‐winter snow transitions, the surface radiative heating is reduced by 50 Wm−2, with 69% coming from the reduced net shortwave flux, resulting from the increased surface albedo and a small increase in effective cloud albedo, and 31% from a reduced incoming longwave flux. This drop in surface radiative heating is sufficient to produce a drop in the surface radiometric skin temperature of 11 K. We find that in winter, the monthly mean diurnal climate is more closely coupled to the diurnal shortwave forcing than the mean diurnal climate.

Detection of variations in precipitation at different time scales of twentieth century at three locations of Italy

In continuation of efforts to contribute to the studies on climatic change, 120 years time series precipitation of Firenze, Pisa and Palermo of Italy was analyzed over two time scales (10 and 60 years). Within the long (60 years) time scale, patterns of annual, seasonal, and monthly precipitation were studied. Mean annual precipitation decreased by 50, 148 and 84mm, and annual rainy days decreased by 8, 12 and 3 days respectively, at Firenze, Pisa and Palermo in 2nd half than in 1st half of the century. Precipitation in spring season at Firenze and Pisa and in winter at Palermo showed highly significant decline in 2nd half of the century compared to the 1st half. Decline in rainy days was also higher in spring season (by 4 days per year) at Firenze and Pisa and in winter (by 3 days per year) at Palermo in 2nd half of the century. Monthly precipitation means in 2nd half, however, depicted increase of precipitation across all the three locations (non-significant) only in August and September. Long-term (120 years) trend over 20th century reveals highly significant negative trend in rainy days at Firenze and Pisa and in precipitation at Pisa and Palermo. Most interesting observation from this study is the highly significant increase in the days with low (< 1mm) precipitation at all the locations and decrease of days of frequently occurring precipitation amounts (5 to 15mm) by 4 and 6 days per year at Pisa and Palermo, in the later half than in 1st half. Long-term standardized precipitation indices depicted downward trend in precipitation and increase in dry years with longer duration and higher intensity in the later half at all three locations. Decline in the precipitation and rainy days, increased precipitation extremes and intensities noticed in this study are similar to the globally observed signals of Green House Gases induced climate change.

EFFECT OF HUMIC ACID AND MICRONUTRIENTS FOLIAR FERTILIZATION ON YIELD, YIELD COMPONENTS AND NUTRIENTS UPTAKE OF MAIZE IN CALCAREOUS SOILS

Two field trials were conducted in calcareous soils at Nubaria Agriculture Research Station in 2011 and 2012 summer seasons. The objectives of this investigation was aimed to study the response of maize plants to humic acid and micronutrient foliar fertilization. This study was implemented in newly reclaimed lands at Nubaria region representing calcareous soils under surface irrigation system.Treatments were two humic acid levels (0 and 1000 ppm) and five micronutrient elements (Fe, Zn, Mn and mixture of Fe+Zn+Mn and control). Experimental design was split-plot with four replications. Humic acid was randomly assigned to the main plots, while micronutrients were arranged at random in sub-plots. Results showed that humic acid application resulted in significant decrease in days to 50% tasseling and silking but did not affect plant height and ear height. Spraying of FZM significantly increased weight of 100-kernel and grain yield. Macro- and micro-nutrients concentration in maize leaves and grains and also grain nutrients uptake were affected significantly by spraying humic acid and/or micronutrients comparing with control treatments. Spraying FZM recorded the highest nutrients concentrations and uptake in leaves. Interaction effects between humic acid and MN indicated that treatments of humic acid and micronutrients were superior to excluding humic acid. Nearly all prominent increases were obtained when a mixture of micronutrients and humic acid was used followed by humic acid, Fe, and Zn in the both growing seasons. Regression relation between grain yield (GY) and 18 independnt varibles showed that there is a highly significant relation between grain yield and twelve of the independnt varibles. The regressing between GY and the most effective parameters indicated that there were a statistical model contains all the eighteen independnt varibles explain 78% of grain yield differences at the same time there were four varibles explained 72% of yield variations including (Puptake leaf fe content Nuptake and grain Mn concentration ) under the experiment conditions.

Treatment and outcome in medication overuse headache patients

Results One hundred forty six patients (29 males and 117 females) with MOH were evaluated (mean age 38.5 ±12.7 years; mean body mass index 26.1±4.44). Patients overused triptans (38.9%), analgesics (61.1%), NDAIDs (48.4%), codein plus paracetamol (77.6%), bezodiazepines (2.3%), or ergotamine (17.5%). Scores for Hamilton scale for anxiety and depression were 23.9±5.6 and 18.8±6.5, respectively. Prophylactic treatment consisted of naproxen 1000mg (plus gastroproplylaxis), SNRI (venlafaxine 150-300mg/d, or mirtazapine 45-90mg/d) and one of three agents: propranolol (160-320mg/d), topiramate (100mg) or valproate (500-1500mg/d). In cases of anxiety disorder comorbidity (HAM-A score>18) prazepam was added (10-20mg/d). All patients were advised to withdraw immediately the substance overused. After one to three months treatment 37% and 45.6% of patients reported a greater of 50% or 75% decrease of days with headache per month, respectively. The 17.3% of the patient population did not respond to treatment. Conclusion Immediate withdraw of substance overused combined with a strong prophylactic treatment, which included naproxen, SNRIs and preventative antimigraine agents is efficient to decrease headache impact in most patients with MOH.

A select issue in the postpartum period: contraception

A select issue in the postpartum period: contraception

Therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding

Aspiration pneumonia is an emerging problem in patients receiving gastrostomy feeding. This study is designed to clarify the therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding. The study subjects were 119 patients with dysphasia who required gastrostomy feeding. They were randomly assigned to the control (without medication), lansoprazole (15mg, 1/day), and mosapride (5mg, 3/day) groups. The number of days with fever (≥37.8°C), vomiting, and antibiotics administration, as well as the occurrence of pneumonia were investigated during the 6-month observation period. The incidence of pneumonia during the observation period was significantly lower in the mosapride group as compared to the control (7/38 vs. 16/40, p=0.038) and lansoprazole (vs. 20/41, p=0.005) groups. The mosapride group also showed a significant decrease in days with fever and antibiotics administration as compared to the other groups. Multivariate analysis revealed that the presence of hiatal hernia was a significant risk factor and administration of mosapride was a significant preventive factor for pneumonia. Mosapride has a preventive effect on occurrence of pneumonia in patients receiving gastrostomy feeding.

Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function.

The role of endoscopic sinus surgery (ESS) in patients with cystic fibrosis (CF) is not clearly defined. TO perform a systematic review of subjective and objective outcomes of ESS in CF. A systematic review was performed using the keywords 'sinusitis,' 'sinus surgery,' 'nasal polyps' and 'cystic fibrosis.' The quality of papers was assessed using the NICE scoring scale. Outcomes included safety, subjective symptoms, objective endoscopy scores, days spent in hospital, courses of antibiotics, and pulmonary function tests (PFTs). Nineteen studies involving 586 patients were included in the review. There were four prospective cohort trials, and three were rated as good quality. There were no major complications attributable to ESS. There was consistent evidence in four cohort studies of improved sinonasal symptoms, including nasal obstruction, facial pain, headaches, rhinorrhea and olfaction. Three studies reported conflicting results in post-operative endoscopy scores. Three studies showed a decrease in days spent in hospital, and two showed a significant decrease in courses of intravenous antibiotics. A recent study, however, did not show a difference in either days spent in hospital or courses of antibiotics. Pulmonary function tests were not improved by ESS in six cohort trials, and one small study found significant improvement. A meta-analysis of FEV1 scores confirmed no significant difference. THE most consistent findings of this review were that ESS in patients with CF is safe, produces symptomatic benefit, and does not consistently improve PFTs. There were more conflicting results with regards to endoscopy scores, days spent in hospital, and courses of intravenous antibiotics. Future prospective studies, utilizing validated quality of life, symptom and endoscopy scales, are needed to further elucidate the role of ESS in the management of chronic rhinosinusitis in CF patients.

Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function

The role of endoscopic sinus surgery (ESS) in patients with cystic fibrosis (CF) is not clearly defined. TO perform a systematic review of subjective and objective outcomes of ESS in CF. A systematic review was performed using the keywords 'sinusitis,' 'sinus surgery,' 'nasal polyps' and 'cystic fibrosis.' The quality of papers was assessed using the NICE scoring scale. Outcomes included safety, subjective symptoms, objective endoscopy scores, days spent in hospital, courses of antibiotics, and pulmonary function tests (PFTs). Nineteen studies involving 586 patients were included in the review. There were four prospective cohort trials, and three were rated as good quality. There were no major complications attributable to ESS. There was consistent evidence in four cohort studies of improved sinonasal symptoms, including nasal obstruction, facial pain, headaches, rhinorrhea and olfaction. Three studies reported conflicting results in post-operative endoscopy scores. Three studies showed a decrease in days spent in hospital, and two showed a significant decrease in courses of intravenous antibiotics. A recent study, however, did not show a difference in either days spent in hospital or courses of antibiotics. Pulmonary function tests were not improved by ESS in six cohort trials, and one small study found significant improvement. A meta-analysis of FEV1 scores confirmed no significant difference. THE most consistent findings of this review were that ESS in patients with CF is safe, produces symptomatic benefit, and does not consistently improve PFTs. There were more conflicting results with regards to endoscopy scores, days spent in hospital, and courses of intravenous antibiotics. Future prospective studies, utilizing validated quality of life, symptom and endoscopy scales, are needed to further elucidate the role of ESS in the management of chronic rhinosinusitis in CF patients.

Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function

Introduction: The role of endoscopic sinus surgery (ESS) in patients with cystic fibrosis (CF) is not clearly defined. Objective: TO perform a systematic review of subjective and objective outcomes of ESS in CF. Methods: A systematic review was performed using the keywords 'sinusitis,' 'sinus surgery,' 'nasal polyps' and 'cystic fibrosis.' The quality of papers was assessed using the NICE scoring scale. Outcomes included safety, subjective symptoms, objective endoscopy scores, days spent in hospital, courses of antibiotics, and pulmonary function tests (PFTs). Results: Nineteen studies involving 586 patients were included in the review. There were four prospective cohort trials, and three were rated as good quality. There were no major complications attributable to ESS. There was consistent evidence in four cohort studies of improved sinonasal symptoms, including nasal obstruction, facial pain, headaches, rhinorrhea and olfaction. Three studies reported conflicting results in post-operative endoscopy scores. Three studies showed a decrease in days spent in hospital, and two showed a significant decrease in courses of intravenous antibiotics. A recent study, however, did not show a difference in either days spent in hospital or courses of antibiotics. Pulmonary function tests were not improved by ESS in six cohort trials, and one small study found significant improvement. A meta-analysis of FEV1 scores confirmed no significant difference. Conclusion: THE most consistent findings of this review were that ESS in patients with CF is safe, produces symptomatic benefit, and does not consistently improve PFTs. There were more conflicting results with regards to endoscopy scores, days spent in hospital, and courses of intravenous antibiotics. Future prospective studies, utilizing validated quality of life, symptom and endoscopy scales, are needed to further elucidate the role of ESS in the management of chronic rhinosinusitis in CF patients.

Quality of life and costs of conventional therapy in patients treated by catheter ablation for atrial fibrillation

AimsThe purpose of the study was to assess quality of life, socioeconomic parameters, and costs of conventional therapy in patients treated by catheter ablation for atrial fibrillation (AF). MethodsThe study included 160 patients treated by catheter ablation for AF who fulfilled a minimum of 2-year follow-up. Quality of life using EQ-5D questionnaire, and days of hospitalization and working incapacity were evaluated before ablation and every 6 months after ablation. Further, one-year costs of conventional therapy for AF were assessed before and after ablation. ResultsQuality of life was significantly improved at each post-ablation stage. EQ-5D index increased from baseline 68±14 to 76±17 after 2 years (p<0.001), and EQ-VAS score from baseline 65±17 to 71±15 after 2 years (p=0.01). Significant reduction was further observed in the count of hospitalization days and days of working incapacity (both p<0.01). The cost of conventional therapy per patient per year decreased from 49,337 Czech Crowns (1974€) before ablation to 16.504 (660€) and 13.576 CZC (543€) in the first and second post-ablation year, respectively. ConclusionAF ablation was associated with significant improvement in quality of life, and decrease in days of hospitalization and working incapacity. There was more than three-fold reduction in the costs of conventional therapy observed in the first two years after ablation.

The application of human engineering interventions reduces ventilator-associated pneumonia in trauma patients

Ventilator-associated pneumonia (VAP) increases mortality and length of stay and escalates the cost of care. Our institution embarked on a project to eradicate VAP. We compared the outcome of trauma patients admitted in period 1 (P1) (January 2005 to December 2006) and period 2 (P2) (January 2006 to December 2009). Team building, culture change, and the ventilator bundle were introduced and modified during P1 and were fully implemented in P2. Outcome data were calculated for both periods. The Center for Disease Control VAP definition was used. The VAP rate was calculated as VAP/1,000 ventilator days. Chi-square and t test statistics were used as appropriate. Data were considered statistically significant if p ≤ 0.05. In total, 299 trauma patients were admitted in P1 and 655 in P2. The two groups were identical in age, Injury Severity Score, mortality, and non-VAP. There was a trend toward a shorter length of stay in P2 (p = 0.06). The days on ventilator was significantly shorter in P2 compared with P1 (p = 0.05). The VAP rate dropped significantly from 7.9/1,000 in P1 to 1.0/1,000 in P2 (p = 0.04). The Appropriate Care Measure score increased from 45% in early P1 to 91% in late P2 (p = 0.0001). The application of the VAP bundle, a checklist, and the multidisciplinary team approach resulted in significant improvement of VAP in all trauma patients admitted to the shock trauma unit and to the decrease in days on ventilator in the trauma patients. This intervention did not affect mortality or the rate of non-VAP in the trauma patients. Therapeutic study, level IV.

Pressure Overload Induces Early Morphological Changes in the Heart

Cardiac hypertrophy, whether pathological or physiological, induces a variety of additional morphological and physiological changes in the heart, including altered contractility and hemodynamics. Events exacerbating these changes are documented during later stages of hypertrophy (usually termed pathological hypertrophy). Few studies document the morphological and physiological changes during early physiological hypertrophy. We define acute cardiac remodeling events in response to transverse aortic constriction (TAC), including temporal changes in hypertrophy, collagen deposition, capillary density, and the cell populations responsible for these changes. Cardiac hypertrophy induced by TAC in mice was detected 2 days after surgery (as measured by heart weight, myocyte width, and wall thickness) and peaked by day 7. Picrosirius staining revealed increased collagen deposition 7 days after TAC; immunostaining and flow cytometry indicated a concurrent increase in fibroblasts. The findings correlated with angiogenesis in TAC hearts; a decrease in capillary density was observed at day 2, with recovery to sham-surgery levels by day 7. Increased pericyte levels, which were observed 2 days after TAC, may mediate this angiogenic transition. Gene expression suggests a coordinated response in growth, extracellular matrix, and angiogenic factors to mediate the observed morphological changes. Our data demonstrate that morphological changes in response to cardiovascular injury occur rapidly, and the present findings allow correlation of specific events that facilitate these changes.

Cerebrovascular Response in Migraineurs During Prophylactic Treatment with Acupuncture: A Randomized Controlled Trial

The study objective was to evaluate the effect of acupuncture on cerebrovascular response in migraineurs by transcranial Doppler ultrasound. This study was a randomized, quasi double-blinded, placebo-controlled study. Thirty-five (35) migraineurs were diagnosed according to the International Headache Society criteria. The stimulus paradigm was performed in 18 verum and 17 placebo acupuncture patients. Participants were treated with acupuncture according to Traditional Chinese Medicine recommendations. All patients received one session of acupuncture each week for 8 weeks. To evaluate the clinical effect of acupuncture treatment, headache frequency and intensity was monitored by a headache diary. Cerebral blood flow velocity data were analyzed with a validated technique based on automated stimulus-related averaging. Vasotonus was determined by systolic and mean flow velocities and pulsality index in right and left middle cerebral arteries during rest. Cerebrovascular response was evaluated by detecting the cerebrovascular Valsalva ratio by maximum end-diastolic flow velocity acceleration during the straining phase of a Valsalva maneuver. Additionally, the centroperipheral Valsalva ratio was determined by the quotient of the cerebrovascular ratio to the corresponding blood pressure acceleration. Pre-/post-acupuncture treatment comparisons between verum- and placebo- acupuncture groups demonstrated a significant decrease of days with migraine headache in the verum group (-52.5%; p<0.001), whereas placebo-acupuncture patients profited to a smaller extent and the duration of headache attack (hours/month) did not decrease significantly. Pretreatment recordings showed increased vasotonus and exaggerated cerebrovascular response in migraineurs. Pre-/post-treatment comparisons demonstrated no significant differences in vasotonus between groups, while cerebrovascular response patterns to Valsalva stimulus were significantly (p<0.001) diminished in verum-acupuncture patients, but not in the placebo group. The findings indicate that prophylactic treatment of migraineurs by standardized acupuncture might positively influence the dysfunction of the cerebrovascular response to autonomic stimuli, but not the cerebral vasotonus during rest.

Protein and Starch Content of 20 Wheat (&lt;i&gt;Triticum aestivum&lt;/i&gt; L.) Genotypes Exposed to High Temperature Under Late Sowing Conditions

A total of 20 spring wheat genotypes were evaluated under three growing conditions (optimum, late and very late) at the research farm of the Wheat Research Center, Bangladesh to assess the variation in grain yield, protein and starch content under heat stress. All genotypes were significantly affected by high temperature stress in late and very late sowing conditions, resulting in a decrease in days to heading and maturity, ultimately affecting yield, protein and starch content. Considering yield performance, genotype ‘E-8’ was best under optimum (6245 kg ha-1), late (5220 kg ha-1) and very late sowing (4657 kg ha-1) conditions while ‘E-40’ was the worst. With respect to yield reduction, genotype ‘E-72’ was heat-tolerant (13% yield reduction) while ‘Prodip’ (49% yield reduction) was heat-susceptible. On the other hand, it was found that the percentage protein increased as heat stress increased. Under heat stress, genotype ‘E-65’ and ‘E-60’ had the highest and lowest protein content (15.5% and 12%), respectively. With respect to starch content, ‘Prodip’ and ‘E-37’ had the highest while ‘E-14’ and ‘E-72’ had the lowest content (64.8% vs. 62.9%), respectively in all sowing conditions. Keywords: Yield; Protein; Starch; Wheat. © 2012 JSR Publications. ISSN: 2070-0237 (Print); 2070-0245 (Online). All rights reserved. doi: http://dx.doi.org/10.3329/jsr.v4i2.8679 J. Sci. Res. 4 (2), 477-489 (2012)

Detection of recent climate change using daily ­temperature extremes in Khorasan Province, Iran

CR Climate Research Contact the journal Facebook Twitter RSS Mailing List Subscribe to our mailing list via Mailchimp HomeLatest VolumeAbout the JournalEditorsSpecials CR 49:247-254 (2011) - DOI: https://doi.org/10.3354/cr01031 Detection of recent climate change using daily ­temperature extremes in Khorasan Province, Iran Sara Sanjani, Mohammad Bannayan*, Mohsen Kamyabnejad Faculty of Agriculture, Ferdowsi University of Mashhad, PO Box 91775-1163, Mashhad, Iran *Email: banayan@um.ac.ir ABSTRACT: Climate change is considered one of the main environmental concerns of the 21st century. Increased variation and changes in mean temperature and precipitation are expected to dominate future changes in climate and affect crop productivity. It is highly important to identify regions vulnerable to climate change and to identify suitable adaptation practices that can sustain productivity to some extent. In the present study, an iterative χ2 method was applied to detect recent possible climate change in extreme daily minimum and maximum temperatures for 5 different regions (Birjand, Boujnord, Mashhad, Sabzevar and Torbat Heydarieh) in Khorasan Province, Iran, during a recent 15 yr period and a prior 30 yr period. The method determines the values of extreme daily temperature that are most significantly different between the prior and recent periods and gives a measure of the weekly significance of that difference. We determined the percentage change in the frequency of the number of extreme days for each period of continuous significant weeks. In all 5 regions, a few days of extreme low minimum temperature (especially in Mashhad and Sabzevar) were experienced during the recent period. The major changes in climate for minimum temperature were determined in Mashhad. In this region the highest percentage change of climate (min. temperature) occurred during Week 33, when a 41% decrease of extreme low minimum temperatures occurred. In Mashhad the highest warming (decrease in days of min. temperature) occurred during late March to late December. Among 5 regions during the recent period some weeks experienced a greater number of days of extreme high maximum temperature (except Torbat Heydarieh and Birjand). In Torbat Heydarieh, the highest percentage change occurred during Week 24, when a 26% decrease of extreme high maximum temperatures was detected. In ­Torbat Heydarieh, the highest cooling occurred from April to early December. KEY WORDS: Global climate change · Daily minimum and maximum temperature · Temperature variability Full text in pdf format PreviousCite this article as: Sanjani S, Bannayan M, Kamyabnejad M (2011) Detection of recent climate change using daily ­temperature extremes in Khorasan Province, Iran. Clim Res 49:247-254. https://doi.org/10.3354/cr01031 Export citation RSS - Facebook - Tweet - linkedIn Cited by Published in CR Vol. 49, No. 3. Online publication date: November 21, 2011 Print ISSN: 0936-577X; Online ISSN: 1616-1572 Copyright © 2011 Inter-Research.

Mesalazine (5‐aminosalicylic acid) alters faecal bacterial profiles, but not mucosal proteolytic activity in diarrhoea‐predominant irritable bowel syndrome

Imbalances in gut luminal bacteria may contribute to the pathogenesis of irritable bowel syndrome (IBS). To explore select bacteriological and anti-inflammatory effects of mesalazine (mesalamine; 5-aminosalicylic acid or 5ASA) and their relation to potential therapeutic effects in IBS. Prospective pilot study of 12 women with diarrhoea-predominant IBS. Patients received oral mesalazine (1.5 g b.d.) for 4 weeks followed by a 4-week washout phase. Molecular profiling of stool bacterial communities and IBS symptoms were assessed before, during and after mesalazine treatment. Colonic mucosal biopsies were assessed for proteolytic activity. Qualitative and quantitative effects of mesalazine on stool microbiota, mucosal proteolytic activity and IBS symptoms were assessed. Faecal bacteria decreased by 46% on mesalazine treatment (P = 0.014), but returned to baseline during washout. Firmicutes and Bacteroidetes represented 95% of identified phylotypes, with a trend towards an increase in the proportion of Firmicutes at week 4 in symptomatic responders [median (IQR) 14% (49) increase] compared with nonresponders [median 5% (11) decrease, P = 0.088]. Rectosigmoid mucosal proteolytic activity did not change between baseline and treatment [median 23.2 (17.9) vs. 19.5 (46.7) mU activity/mg tissue, P = 0.433]. Eight of 12 (67%) patients responded favourably to mesalazine based on a global relief questionnaire, with significant decreases in days with discomfort and increases in bowel movement satisfaction. Mesalazine treatment is associated with a decrease in faecal bacteria abundance and rebalancing of the major constituents of the microbiota. Further study of the bacteriological and anti-inflammatory properties of mesalazine in IBS is warranted.

Is blunted heart rate decrease at night associated with prevalent organ damage in essential hypertension?

The association between a blunted decrease in day–night heart rate and subclinical organ damage has not been investigated earlier in human hypertension. Therefore, we assessed such an association in a cohort of 658 untreated essential hypertensive patients. All patients underwent procedures including cardiac and carotid ultrasonography, 24-h urine collection for microalbuminuria, ambulatory blood pressure monitoring with simultaneous assessment of heart rate over two 24-h periods within 4 weeks. Nondipping heart rate was defined as a mean heart rate reduction at night lower than 10% compared with daytime values. A reproducible nocturnal dipping (heart rate decrease >10% in both the ambulatory blood pressure monitoring periods) and nondipping profile was found in 513 (78%) and 76 patients (12%), respectively; 69 hypertensive patients (10%) had a variable dipping profile. The three groups did not differ with regard to age, sex, body size, metabolic variables, office and ambulatory blood pressures, left ventricular mass, carotid intima-media thickness, carotid plaque and microalbuminuria. In a univariate analysis, the decrease in nocturnal heart rate did not correlate with any parameter of subclinical organ damage. Our findings from a cross-sectional study do not support the view that a flattened heart rate circadian rhythm is related to a prevalent organ damage in essential hypertension and that this altered pattern is a marker for subclinical cardiovascular disease. The prognostic significance of this finding should be defined by prospective studies.

‘The Impact of SIGN guidelines on Carotid Endarterectomy in South-East Scotland’

‘The Impact of SIGN guidelines on Carotid Endarterectomy in South-East Scotland’

Older Women in a State-Wide, Evidence-Based Falls Prevention Program: Who Enrolls and What Benefits Are Obtained?

Background Older women who are vulnerable to falls and their negative consequences have been shown, in controlled randomized clinical trials, to benefit from fall prevention programs. The purpose of this study was to identify personal characteristics of female participants enrolled in a falls prevention program, the effectiveness of the program for female participants, and whether personal characteristics indicate which women might benefit most from programs delivered in real-world settings. Methods Data were collected from seniors enrolled in A Matter of Balance/Voluntary Lay Leader (AMOB/VLL) program sessions conducted in Texas over the 2-year period from 2007 to 2009. Baseline and postintervention data from 1,101 female participants were drawn from a larger, state-wide dataset and analyzed using structural equation modeling to identify relationships between variables of interest. Findings Analyses revealed that women who attended AMOB/VLL significantly increased falls efficacy from baseline to postintervention ( t = 1.680; p < .05; d = 0.143) and reduced the number of times fallen ( t = 3.790; p < .01; d = 0.313). Further, participants reported decreases in days of physical ( t = 3.810; p < .01; d = 0.323) and mental health ( t = 1.850; p < .05; d = 0.156) reported as not good. Conclusion Findings from this study support the effectiveness of evidence-based programs for reducing falls-related risks in older women. Identifying the characteristics of female participants enrolled in AMOB/VLL can enable public health professionals to better target and meet the health demands of the aging female population. Such translational research can help to guide the dissemination of additional state-wide health promotion programs for older women.