Health-related Complaints Research Articles

Knowledge and Awareness of Medical Students on Orthodontics: A Cross Sectional Study

Healthcare providers are the primary caregivers for a variety of health-related complaints. If they areunaware of the relationship between the malocclusion and orthodontics on general well-being of the patient,they may not educate, motivate and refer patients for orthodontic care. Considering that the present-daymedical students are the future healthcare providers; we have assessed their level of orthodontic awareness.This cross sectional survey was conducted in Sree Balaji Medical College & Hospital, Bharath Instituteof Higher Education & Research. The total sample size includes 375 male and female medical studentsselected by simple random sampling technique. A pre-piloted validated self-administered questionnaire wasused and the collected data was subjected to statistical analysis using SPSS software version 24.0. Responserate was 70.4% (n=264) of which 49.2% were males (n=130) and the rest others were females. Half ofthe respondents (50.1%, (n=131) know the term ‘orthodontics’. 31.4% (n=81) knew that orthodontics isrelated to correcting malocclusion. 40.1% (n=106) had received orthodontic treatment. Around half of therespondents (54.5%, (n=144) have relatives who are undergoing orthodontic treatment during the studyperiod and 47.4% (n=125) felt aesthetics is the most important criteria affected by malocclusion. Similarly,56% (n=148) would make referrals and 38.6% (n=102) cited duration of treatment as a discouraging factor.The medical students surveyed had only less awareness of orthodontics as a separate speciality. The femalestudents showed a higher level of awareness towards oral health, aesthetics and orthodontics as compared tothe male students. So a basic introduction to the dental sub-specialties, especially orthodontics would enablethem to identify and educate on malocclusions and make informed referrals appropriately.

Explantation of Silicone Breast Implants Ameliorates Gel Bleed Related Health Complaints in Women with Breast Implant Illness

In a retrospective study, women with silicone breast implants, who consulted plastic surgeons for a variety of reasons, were requested to fill out a questionnaire, which was aimed at an evaluation of health complaints. In total, 101 questionnaires of the women with silicone breast implants and 34 questionnaires filled out by female hospital workers without breast implants, who served as a reference group, were evaluated. The women with silicone breast implants comprised 39 women who retained their silicone breast implants and 62 women who had explantation surgery.

Characterization of Young Children Presenting to the Emergency Department for Mental Health Complaints.

From 2011 to 2015, psychiatric emergency department visits among youth in the United States increased 28% and psychiatric visits made up 10% of all pediatric emergency department (ED) visits. Previous research has focused on adolescent mental health, with little characterization of children 10 years of age and younger with mental health complaints. The primary objective of this study was to describe these children who presented to a pediatric ED for mental health complaints in terms of demographics and psychosocial factors. One researcher reviewed medical records of children 10 years and younger who presented to the Children's of Alabama ED between January 1, 2016 and May 31, 2016 with a mental health-related chief complaint. Patient data were then categorized based on demographic information, characteristics of the ED visit, and medical and social history. Descriptive analyses were run using SAS version 9.4. In total, 222 patients 10 years and younger were seen between January 1 and May 31, 2016. This age group makes up 20% of all of the children seen in the ED for mental health-related complaints. Patients were 73% male (n = 162) and ages 3 to 10 years, with a mean age of 7.8 years. Patients were 55% white (n = 122), 42% African American (n = 94), 1% Hispanic (n = 2), and 1% other ethnicity (n = 3). Patients' insurance coverage was 76% Medicaid (n = 168), 18% private insurance (n = 39), and 6% uninsured (n = 14). Of the 219 patients treated in the ED (3 left without treatment), 45% of patients were admitted (n = 100). Univariate analyses showed increased odds of admission for children with 3 or more prior psychiatric diagnoses (odds ratio [OR] 2.33, P = 0.03), a family history of psychiatric illness (OR 2.53, P < 0.01), history of any previous psychiatric care (OR 2.61, P = 0.01), a history of trauma (OR 1.84, P = 0.03), and a chief complaint of suicidal ideation (OR 1.54, P < 0.01). Analyses showed a decreased odds of admission for children referred to the ED by their school (OR -1.12, P < 0.01). The pediatric ED sees a significant number of children ages 10 years and younger for mental health-related complaints. Nearly half of these children were admitted for psychiatric care. Several factors were found to predict admission, which reflect psychosocial influences. These psychosocial factors are important targets for intervention both in the ED and in the community.

Circulating Extracellular Vesicles from Patients with Sickle Cell Disease Progressively Disrupt Different Types of Endothelial Intercellular Junctions

Introduction: Aberrant cell-cell interactions involving the endothelium are central to the pathophysiology of crises in sickle cell disease (SCD), including acute chest syndrome (ACS). We previously demonstrated that the plasma of SCD patients contains circulating small extracellular vesicles (EVs) and that those vesicles can disrupt endothelial integrity in vitro, including a decrease in VE-cadherin. The current study was designed to examine the effects of those EVs on additional components of the endothelial junctions including tight (zonula occludens 1, ZO-1) and gap junctions (connexin43, Cx43) and to test the hypothesis that the junctions would be more severely affected by EVs isolated from patients during an episode of ACS than by those isolated from the same patient at baseline. Methods: We identified subjects with SCD in our biobank who had plasma isolated at baseline and at the beginning of an admission for ACS (prior to transfusion). Samples were considered baseline if the patient was more than 4 weeks since transfusion and had no new health-related complaints. ACS was defined by the presence of an infiltrate on chest x-ray combined with fever, pain, hypoxia or cough. EVs were isolated from plasma using established methodologies. To determine the effects on endothelium, cultures of human microvascular endothelial cells were treated with EVs for 48 h. Cells were fixed and studied by fluorescence microscopy (after immunolocalization of Cx43, ZO-1 and/or VE-cadherin and staining of nuclei with DAPI). Proteins were detected and quantified by immunoblotting. mRNA expression was determined by RT-qPCR. Gap junction mediated intercellular communication was assessed following microinjection of Lucifer yellow and neurobiotin. Results: Microscopy confirmed our previous observation that EVs isolated from subjects with SCD caused in vitro disruption of endothelial monolayers and that damage is significantly worse when EVs are isolated during an episode of ACS. The distribution and abundance of VE-cadherin and ZO-1 at the plasma membrane of undisturbed cells were minimally affected by SCD EVs. While baseline EVs did not detectably affect the distribution of Cx43, EVs isolated during ACS caused a loss of Cx43 from the plasma membrane. The integrated intensity of Cx43 membrane staining was decreased by ~20% following treatment with ACS EVs. Cx43 protein decreased on average by 32 % and Cx43 mRNA levels by 21% in cells treated with ACS EVs compared to baseline from the same patient. EVs isolated during ACS caused significant disruption in intercellular transfer compared to EVs isolated at baseline (67-94% reduction) (Figure 1). Conclusions: Our results show that subjects with SCD produce small EVs that cause disruption of the endothelial monolayer in vitro. Gap junctions composed of Cx43 are the most sensitive of the cell-cell junctions in this setting, since their abundance and function are reduced by ACS EVs even when the endothelial monolayer appears intact. Disruption of endothelial intercellular communication mediated by Cx43 appears to be an early and sensitive event in the endothelial disturbance caused by EVs in SCD patients. Disclosures No relevant conflicts of interest to declare.

Interventions to Mitigate Fatigue Induced by Physical Work: A Systematic Review of Research Quality and Levels of Evidence for Intervention Efficacy.

We present a literature review on workplace physical fatigue interventions, focusing on evaluating the methodological quality and strength of evidence. Physical fatigue is a recognized workplace problem, with negative effects on performance and health-related complaints. Although many studies have focused on the mechanisms and consequences of fatigue, few have considered the effectiveness of interventions to mitigate fatigue. A systematic review of the workplace safety literature for controlled trials of physical fatigue interventions was conducted. Data on intervention type, subject characteristics, targeted tasks and body locations, outcome measures, and study design were extracted. The methodological quality for each study was evaluated using the PEDro scale, and the level of evidence was based on quality, amount, and consistency. Forty-five controlled trials were reviewed, examining 18 interventions. We categorized those interventions into individual-focused (N = 28 studies, nine interventions), workplace-focused (N = 12 studies, five interventions), and multiple interventions (N = 5 studies, four interventions). We identified moderate evidence for interventions related to assistive devices and task variation. There was moderate evidence supporting no fatigue attenuation for the garment change category of interventions. The interventions in the remaining categories had limited to minimal evidence of efficacy. The heterogeneity of the included trials precludes the determination of effect size. This review showed a lack of high levels of evidence for the effectiveness of most physical fatigue interventions. Due to a lack of high levels of evidence for any category of reviewed physical fatigue interventions, further high-quality studies are needed to establish the efficacy of others.

Risk Factors Associated With Health And Wellness of Professional Automobile Drivers Of Karachi, Pakistan

Objective: To identify the health status and well-being of the professional automobile drivers and associated risk factors that affect their health. Study Design and Setting: A cross-sectional study was conducted among 350 professional automobile drivers operating on local and long routes in Karachi, Pakistan Methodology: The study was done at various locations in the city of Karachi from September to November 2017. The subjects were asked for their personal health related complaints and medical illnesses. Further, this research also has the complimentary purpose to measure anxiety and depression among professional drivers. Anxiety was measured using the Generalized Anxiety Disorder-2 Item Scale (GAD-2) and Patient Health Questionnaire2-Item Depression Module (PHQ- 2) was used to measure, depression. SPSS version 21.0 was used for data entry and its analysis. A written informed consent about the study was provided to the subjects with questionnaire. This study was approved by the Institutional/Ethical review board of Karachi Institute of Medical Sciences (KIMS). Results: Amongst the 350 participants 48% were long route and 52% were local route automobile drivers. The result indicate that professional automobile drivers were suffering from backache (56%), Joint pain (36%), Hypertension (44%), Diabetes Mellitus (21%), Anxiety (87%) and Depression (38%). Tobacco addiction was found in (94%) of total respondents. Conclusion: Health status of the professional drivers and their well-being was found unsatisfactory. Multiple factors such as working environment and sociodemographic factors are inevitably linked to their health status and wellbeing

Patient perspectives on employment participation in the “hypermobile Ehlers–Danlos syndrome”

Background “Ehlers–Danlos syndrome” (EDS) is a heritable connective disorder influencing multiple aspects of daily life. Most studies have focused on describing the physical symptoms and level of disability, but little knowledge exists about the psychosocial effects of the pathology. Participation in employment is an aspect that strongly influences quality of life of patients with chronic pathologies. This study, therefore, aimed to explore the lived experiences in employment participation of patients diagnosed with “hypermobile EDS”. Methods An inductive thematic analysis, using semi-structured interviews was used. Nine patients, purposively selected by a continuum sampling strategy, were included. Interviews were audio-recorded and transcribed verbatim. Results Data analysis resulted in three main themes: (1) elements assisting participation in employment, (2) limitations in employment participation, and (3) unemployment due to the “hypermobile EDS”. On the one hand, the results show that related health complaints can impede employment participation to an important extent. On the other hand, patients also report several aspects of work that can affect their well-being in a positive way. Conclusion There are specific reasons for a person with “hypermobile EDS” to participate in employment. These reasons are different for each person and may even vary in time. Implications for rehabilitation “Hypermobile EDS” greatly impacts activities and participation in daily life. “Living with limitations” is the central theme in the lives of “Hypermobile EDS” patients. Various aspects influence work participation in people with “Hypermobile EDS”, such as work pressure, tasks, and transport to work. Work has positive effects in the lives of people with “Hypermobile EDS.” Work can create difficulties when the job requirements and tasks do not match the functional abilities of a person with “Hypermobile EDS.”

Circulating Exosomes Isolated during Acute Chest Syndrome Disrupt Endothelial Integrity

Introduction: Acute chest syndrome (ACS) is a leading cause of morbidity and death among children with sickle cell disease (SCD). Aberrant cell-cell interactions involving the endothelium are central to the pathophysiology of ACS. Endothelial integrity is partially regulated by circulating cell-derived extracellular vesicles (exosomes). We previously demonstrated that (even when at a healthy baseline) patients with SCD have increased numbers of circulating exosomes, and exosomes from SCD patients with a history of ACS cause increased disruption of endothelial integrity in vitro. The current study was designed to test the hypothesis that exosomes isolated from patients during an episode of ACS would induce much greater endothelial damage than those isolated from the same patient at their baseline.Methods: We identified 9 patients with SCD included in our biobank who had plasma isolated at baseline and at the beginning of an admission for ACS (prior to transfusion). Samples were considered baseline if the patient was more than 4 weeks since transfusion and had no new health-related complaints. ACS was defined by the presence of an infiltrate on chest x-ray combined with fever, pain, hypoxia or cough. Control plasma samples were obtained from children without SCD or known medical problems and a BMI < 95%ile. Exosomes were isolated from plasma using established methodologies. Assessment of vesicle size was performed by nanoparticle tracking analysis. To determine the effects on endothelium, exosomes were added to cultures of human microvascular endothelial cells (HMVEC), which were subsequently studied by fluorescence microscopy (after immunolocalization of VE-cadherin, reaction with TRITC-conjugated phalloidin and treatment with DAPI). Protein components of exosomes and cells were detected and quantified by immunoblotting. VE-cadherin mRNA expression was determined by qRT-PCR. Free heme was quantified using a colorimetric assay.Results: Nanoparticle tracking analysis showed that all exosome preparations (regardless of patient or disease status) had a size distribution with a sharp peak of between 90 - 100 nm. Immunoblotting showed the presence of exosomal marker proteins (CD63 and flotillin) in all samples. The abundance of these proteins was increased by 50% (on average) in the samples obtained during ACS. Immunoblots showed that the exosomes also contained hemoglobin, glycophorin A, and ferritin; of these, only hemoglobin was increased in patients with SCD (2-fold greater in SCD than control) and ACS (4-fold greater in ACS than control). Heme concentration in the exosome preparations was below the assay detection limit. Microscopy showed that application of exosomes to endothelial monolayers caused no immediate damage; in addition, most samples showed no significant damage after 24 hr. However, after 48 hr, ACS-exosomes caused alterations of the localization of VE-cadherin (with opening of gaps between cells) and of actin microfilaments (as detected by phalloidin staining) consistent with cell retraction. ACS exosomes caused significantly more disruption of the monolayers than baseline-exosomes (baseline: 0.36 ± 0.07 % cell-free space vs. ACS: 5.81±0.65 % cell-free space, p < 0.01). DAPI staining showed no differences in numbers of nuclei excluding cell death or detachment. Although VE-cadherin mRNA levels were unchanged, immunoblots showed a dramatic decrease (by 62%) in VE-cadherin protein (p <0.01), in cells treated with ACS-exosomes vs. baseline-exosomes.Conclusions: These results confirm and extend on our prior observations that circulating exosomes in SCD patients affect endothelial integrity. We confirmed that these patients have circulating vesicles consistent with designation as exosomes, based on size and the presence of marker proteins. Their composition shows that many of these exosomes must derive from red cell precursors, but they are not simply red cell-derived vesicles. ACS exosomes cause a disruption of endothelial monolayer integrity that involves rearrangement of the actin cytoskeleton and degradation of cadherin-based intercellular junctions. The time course suggests that it requires cellular signaling and perhaps new RNA/protein synthesis. We speculate that exosomes are central to the vascular pathology in all SCD patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Hygienic assessment of handicapped adolescents vocational training conditions: problems and optimization opportunities

In a number of occupations, there is a shortage of labor force that can be filled with economically active part of the population, including people with disabilities (handicapped, HC). Unfortunately, observance of hygienic requirements in the context of HP adolescents vocational training has not been studied sufficiently: most scholars have researched only the conditions of teaching healthy adolescents. This study aimed to examine the HC adolescents vocational training conditions and develop measures to improve their working conditions with pathologies factored in. We examined adaptation potential, anxiety level, mental efficiency, sick rate and personal well-being assessment in HC adolescents (n = 120) aged 16–18, not impaired intellectually, studying sewing equipment operation, shoe repairs in the boarding scool. In the context of the study, we applied Smirnov hygiene criteria, Giessen Symptom Questionnaire, Spielberger's Test Anxiety Questionnaire, Sivkov scale, correction tables, Baevsky adaptation index. For the purposes of statistical analysis, we used parametric (Student t-test) and non- parametric (Mann–Whitney) criteria. The Spearman's correlation coefficient helped determine interrelationship of the studied parameters. We identified the following key adverse hygienic factors that have a significant impact on the students' health: intense character of labor performed, insufficient artificial lighting, noise level above the norm, high content of organic solvents and dust in the workshop's air. The timetable of the boarding school was also found to be inefficient. The results of this study allowed developing and introducing a software program to automatically compile the school's timetable with the aim to improve psychosomatic health of the students and halve the number of health-related complaints.

3.37 Education, Stat!: Evaluating the Impact of a University-Based Curriculum in Emergency Psychiatry and Telepsychiatry on Trainees

Child psychiatry has struggled with a workforce shortage crisis for many years. In addition, there has been an increased use of the emergency department (ED) for behavioral health-related complaints. Telepsychiatry has emerged in recent years as a potential solution to the escalating workforce crisis as well as managing mental health emergencies efficiently, yet there has been no guidance on structured curricula in these areas. There is no known research to date evaluating the impact of a specific curriculum on the child and adolescent psychiatry trainee’s perception of these models of care. We sought to prepare a pediatric emergency psychiatry curriculum and clinical experience and to demonstrate its effectiveness in preparing our trainees to practice in these areas.

DREAMeR: Drug use Reconsidered in the Elderly using goal Attainment scales during Medication Review; study protocol of a randomised controlled trial

BackgroundClinical medication reviews (CMR) are increasingly performed in older patients with polypharmacy. Studies have shown positive effects of CMR on process- and intermediate outcomes, like drug-related problems (DRPs). Little effect has been shown on clinical outcomes, like hospital admissions or health-related quality of life (HR-QoL). In particular, HR-QoL is related to the individual health-related goals and complaints of patients. The aim of this study is to investigate the effects of a CMR focused on personal goals on HR-QoL and health-related complaints in older patients with polypharmacy.MethodsA randomised controlled trial will be performed in 35 Dutch community pharmacies aiming to include 630 patients aged 70 years and older using seven or more chronic drugs. Patients will be randomly assigned to control or intervention group by block-randomisation per pharmacy. Patients in the intervention group receive a CMR focused on patients’ preferences, personal goals and health-related complaints. With every goal a goal attainment scale (GAS) will be proposed. Primary outcome measures are HR-QoL, measured with the EQ-5D-5L and EQ-VAS and the number of health-related complaints per patient measured with a written questionnaire, during a follow-up period of six months. Secondary outcomes are healthcare utilisation, number and type of drug changes, number and type of health-related goals, scores on GAS and number and type of DRPs and interventions.DiscussionThis study is expected to add evidence on the effects of a CMR on HR-QoL and health-related complaints in older patients with polypharmacy. New in this study is the use of personal goals measured with GAS and health-related complaints as patient-related outcome measures.Trial registrationNetherlands Trial Register; NTR5713.

Long-term health complications following snake envenoming.

BackgroundSnakebite is an important public health problem in tropical regions of the world. Although devastating effects of envenoming such as kidney failure, tissue necrosis, bleeding diathesis, and neurotoxicity are well known in the acute stage following a snakebite, the long-term effects of snake envenoming have not been adequately studied.Materials and methodsA population-based study was conducted among 8707 residents in a rural district in Sri Lanka to assess the long-term sequelae following snakebite. Health-related complaints that snakebite victims had developed immediately or within 4 weeks of the bite and persisted for more than 3 months, were assessed by interviewer-administered questionnaire and in-depth interviews, and further evaluated by physical examination and relevant investigations.ResultsOf the 816 participants who were identified as ever snakebite victims, 112 (13.7%) presented with at least one snakebite-related long-term health complication. Among them, “migraine-like-syndrome” characterized by headache vertigo, and photosensitivity to sunlight was found in 46 (5.6%); musculoskeletal disorders such as pain, local swelling, muscle weakness, deformities, contractures, and amputations were found in 26 (3.2%); visual impairment in 21 (2.6%); acute kidney injury in 4 (0.5%); skin blisters at the bite site in 5 (0.6%); psychological distress in 2 (0.2%); hemiplegia in 1 (0.1%); right-side facial nerve palsy in 1 (0.1%); paresthesia over bite site in 1 (0.1%); generalized shivering in 1 (0.1%); and chronic nonhealing ulcer in 1 (0.1%). Interestingly, 31 (3.8%) reported nonspecific somatic symptoms such as abdominal colic, chest tightness, wheezing, receding gums, excessive hair loss, and lassitude with body aches following the bite. The average duration of symptoms since snakebite was 12.7 years (SD=11.7).ConclusionThis study highlights that a significant proportion of snakebite victims suffer disabling chronic health sequelae. There is a need to place systems to address these unmet health needs.

Social determinants of health and well-being among municipal school children in Mumbai

Background: HBSC seeks to identify and explore the extent of the inequalities related to socioeconomic status (SES), age and gender among the younger age group, and highlight the need for preventive action. Hence, this study was carried out, to find out the social context as a determinant of their health and well-being. The objectives of the study were to study the socio-demographic characteristics of the students; to find the social determinants and its association with their perceived health outcomes.Methods: The study was carried out among 426 Municipal school students in Mumbai. They were enquired about their socio demographic characteristics, their personal habits and behaviour, relationship with their parents, siblings and friends, performance in school, academic pressures, and also about any health related complaints if they had. Results: The study shows less communication of students with their parents, more so with their fathers’. Students were seen to have more friends and would also spend more time with them, especially boys. Academic achievement was better among girls and those from less affluent families and it also showed a dip in the higher age groups. Regular consumption of breakfast, fruits, vegetables was seen less among girls and older students. Boys and those from less affluent families were seen to be more involved in high risk behaviour. Conclusions: All the factors mentioned in the study are shown to have adverse effects on the perceived health outcome of the students. These social factors need to be addressed to improve the health and well-being of the younger generations.

Exosomes contribute to endothelial integrity and acute chest syndrome risk: Preliminary findings.

Acute Chest Syndrome (ACS) is one of the leading causes of death among children with Sickle Cell Disease (SCD). Disruption of microvascular integrity is critical to the pathophysiology of ACS, but the factors governing its phenotypic variability are incompletely understood. Because circulating exosomes have been implicated in vascular dysfunction in various diseases, we hypothesized that exosomes induce endothelial dysfunction in patients who experience ACS. Cross-sectional cohort study including 33 outpatients with SCD (without new health-related complaints or recent transfusions) and a cohort of control patients. Exosomes were isolated from platelet-free plasma. ImageStream showed that exosome counts were greatly increased in patients with SCD compared with controls, but there were few differences in the concentrations of exosomes between patients who had experienced ACS (ACS(+)) and those who had not (ACS(-)). Exosomes were added to human microvascular endothelial cells, and the exosomal effects on monolayer integrity was determined using Electric Cell-substrate Impedance Sensing (ECIS). Exosomes from SCD patients without ACS differed minimally from control patients; however, exosomes from ACS(+) decreased endothelial cell resistance compared to ACS(-), (Relative resistance: ACS(+): 0.981 ± 0.055 vs ACS(-): 1.124 ± 0.042; P = 0.006). Treatment of endothelial cultures with exosomes from ACS(-) patients increased endothelial Nitric Oxide Synthase (eNOS) mRNA expression, while ACS(+)-derived exosomes were not able to increase eNOS expression above that of controls. These findings demonstrate that patients with SCD have circulating exosomes that produce differential effects that may contribute to the pathophysiology of ACS and may serve as risk-related biomarkers.

P119: Health care utilization by patients presenting to the emergency department with mental health complaints

Introduction: Emergency department (ED) visits for mental health and addiction related complaints are common and appear to be increasing. It is believed these patients come to the ED requiring urgent assessment either because they do not have a primary care or psychiatric healthcare provider or access to their provider is not available in a timely fashion. The objective of this study was to describe healthcare utilization in the previous 12 months by patients presenting to the ED with a mental health complaint. Methods: Between April-November 2016, a convenience sample of adult (≥18 years) patients presenting to an academic ED (annual census 65,000) with a mental health and/or addictions complaint were invited to complete a paper-based survey to determine their usage of ten different mental healthcare resources over the previous 12 months. The questionnaire was pilot-tested and peer-reviewed for feasibility and comprehension. Results: Of the 134 patients who completed the survey, mean (SD) age was 37.9 (15.7) years and 64 (47.8%) were male. Only 7 (5.2%) patients did not access any mental health resource in the previous 12 months, and the most commonly accessed resource was hospital EDs (102, 76.1%), with 24 (23.5%) of these patients using the ED at least 6 times. Patients also accessed a variety of other mental health resources, with 28 (20.9%) seeing their family physician, 20 (14.9%) seeing their psychiatrist/psychologist, and 61 (45.5%) seeing both in the previous 12 months. Only 6 (5.9%) patients used the ED exclusively for a mental health related complaint. By comparison, respondents accessed other specific mental health resources such as crisis centres (19, 14.2%), helplines (34, 25.4%), and peer-support groups (24, 17.9%) less often. Conclusion: These findings suggest that the ED is the most commonly used mental health resource for this population. However, these patients also frequently access family physicians and psychiatrists/psychologists, with community resources such as crisis centres, helplines, and peer-support being used less often. This suggests that lack of timely access to other mental health resources may be the primary motivation for accessing the ED.

Exosomes from Patients with Sickle Cell Disease and History of Acute Chest Syndrome Alter Endothelial Integrity In Vitro

Introduction: Acute Chest Syndrome (ACS) is the leading cause of death among children with sickle cell disease (SCD). While the phenotypic variability of ACS is incompletely understood, aberrant cell-cell interactions involving the endothelium are central to the pathophysiology. Recent studies suggest that circulating cell-derived extracellular vesicles, termed exosomes, can regulate endothelial integrity. We and others recently demonstrated that exosomes from SCD patients differentially affect endothelial integrity in vitro, but the relationship to specific complications of SCD, such as ACS, are unknown. Given the critical role of the endothelium in ACS, we hypothesized that exosomes from patients with a history of ACS induce increased endothelial damage compared to those without a previous ACS episodes.Methods: Plasma was isolated from 33 patients with SCD. Patients were >4 weeks since transfusion and had no new health-related complaints. Control plasma samples were from children without SCD or known medical problems, who had a BMI < 95%ile. Exosomes were isolated from plasma using established methodologies. The cellular origin of exosomes was determined using Image Stream flow cytometry. To determine the effects on endothelium, exosomes were added to cultures of human microvascular endothelial cells (HMVEC-D). Intercellular junctions were visualized by immunofluorescent microscopy for VE-cadherin. To quantify effects on endothelial barrier integrity, HMVEC-D endothelial cells were grown to confluence on an Electric Cell-substrate Impedance Sensing (ECIS) array, treated with exosomes and then continuously monitored for 36 hours. Endothelial Nitric Oxide Synthase (eNOS) mRNA expression was assessed in HMVEC-D cells 24 hours post-exposure by qRT-PCR.Results/Discussion: Flow cytometry demonstrated that the absolute exosome number was greatly increased in patients with SCD compared with controls. In contrast, no significant differences in total exosome numbers emerged between SCD patients based on ACS history. The origin of theexosomes was mainly erythroid (controls:9,661 ± 3,195 /100 uL vs. SCD: 31,338 ± 5,323 /100 uL, p<0.007), but significantly increased numbers of endothelial-, CD34+, lymphocyte-, and monocyte- derived exosomes were also detected. Although a minor population, ACS(+) patients had significantly more monocyte-derived exosomes than ACS(-) patients (monocyte exosomes ACS(-):45.89 ± 22.41 /100 uL vs. ACS(+): 477.4 ± 173.7 /100 uL, p=0.0218); exosomes from other sources did not differ. Immunolocalization of VE-cadherin showed that exosomes from SCD patients (especially ACS(+)) led to the formation of increased gaps between HMVECs as compared to untreated cells or cells treated with exosomes from control patients. ECIS recordings showed that samples from ACS(-) patients differed minimally from control patients, but exosomes from ACS(+)-patients greatly decreased monolayer resistance (relative resistance: ACS(+): 0.981±0.055 vs. ACS(-): 1.124±0.042; p = 0.006). Given its role in pulmonary endothelial dysfunction in ACS, we evaluated the ability of exosomes to induce eNOS expression. ACS(-) samples induced a ~50% increase in eNOS expression when compared to controls (controls;1.01± 0.00 versus ACS(-); 1.61 ± 0.06; p = 0.01) while ACS(+)-derived exosomes failed to induce any significant changes (ACS(+): 0.99 ± 0.05; p < 0.0001 vs. ACS(-)).Conclusions: The results confirm and expand on our prior observations that circulating exosomes are increased in patients with SCD and contribute to the maintenance of endothelial integrity. Exosomes from ACS(+) patients disrupt the endothelial monolayer in vitro (unlike exosomes from SCD patients who never experienced ACS). We speculate that the increased exosomes contribute to the vascular pathology in all SCD patients. However, some SCD patients are protected by specific exosome cargoes, as in the ACS(-) patients whose exosomes induced eNOS expression by the cultured endothelial cells in vitro, which plays a critical role in endothelial health. Together, the current findings suggest that exosomes are differentially generated based on ACS history, and that their function/cargo (as opposed to their number), modulates endothelial function. Thus, SCD exosomes that induce endothelial dysfunction likely contribute to the pathophysiology of ACS, and may serve as risk-related biomarkers. DisclosuresNo relevant conflicts of interest to declare.

The Safety of CT-Guided Epidural Steroid Injections in an Older Patient Cohort

Background: Epidural steroid injections (ESIs) are a common method for treating lower back pain, which is one of the most prevalent health-related complaints in the adult U.S. population. Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data concerning the procedure’s safety profile in an older patient population. Objective: This retrospective study analyzed safety data among a single-center cohort of patients &gt; 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015. Study Design: An Institutional Review Board (IRB)-approved retrospective chart review. Setting: University hospital center. Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis was conducted to examine the relationship between dose length product (DLP), body mass index (BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of long procedure time, average-DLP and high-DLP procedures. Results: Average age was 75.77 years, with 44% having a BMI &gt; 30. The mean DLP was 55.58 mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically successful and no complications were observed during or after any of the procedures, including at one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP, followed by procedure time. The high-DLP cases had a greater number of needle placement series, more intervertebral disc spaces included in each planning series and higher machine settings (kVp 120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9). Limitations: This study is limited by its retrospective design. Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times, relatively low DLP’s and without complications in an older patient population. Key words: Epidural steroid injection, interlaminar approach, CT-guidance, older adults, back pain, lumbar spine, thoracic spine, cervical spine, dose length product, radiation exposure

A descriptive analysis of medical health services utilization of Veterans living in Ontario: a retrospective cohort study using administrative healthcare data

BackgroundHealth services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system.MethodsThis is a retrospective cohort study designed to use Ontario’s provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release.ResultsThe cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1–83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0–61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2–41.5) went to the emergency department in that same time period and 9.9 % (9.5–10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity.ConclusionThis study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1596-y) contains supplementary material, which is available to authorized users.

“Aging males” symptoms and general health of adult males: a cross-sectional study

A cross-sectional study was conducted to explore the prevalence and severity of health-related complaints perceived by adult males of Hong Kong by using the Hong Kong Traditional Chinese versions of the Aging males’ symptoms (AMS) scale and the 5-dimensional and 3-level European Quality of life (EQ-5D-3L) questionnaire. A total of 825 adult males aged 40 years or above were surveyed, and observed that 80% of the population was living with little-to-mild levels of aging symptoms with mean total scores ranged between 26.02 ± 7.91 and 32.99 ± 7.91 in different age groups. Such symptoms were correlated with age, especially for the somato-vegetative and sexual symptoms. The most severe AMS symptoms were observed in the oldest age group at 70 years or above, with 76%, 34% and 70% living with moderate-to-severe levels of somato-vegetative, psychological and sexual symptoms, respectively. The result was highly correlated with the EQ-5D-3L questionnaire. Secondly, the Hong Kong Aging males’ symptoms (AMS) scale was shown to have good reliability with test–retest coefficient at 0.79 (ranged 0.66–0.87) and Cronbach’s alpha coefficient at 0.88 (ranged 0.70–0.84). In summary, the population of Hong Kong male adults was commonly living with little-to-mild levels of aging symptoms, whereas their severity was correlated with age.

Occupational stress and its associated health disorders among bus drivers

Background: Bus drivers as compared to workers in other jobs, are more likely to experience cardiovascular diseases, gastrointestinal disorders and musculoskeletal disorders. Occupational stress is believed to play a significant role in causing these problems. The objective of this study is to assess the occupational stress and to find the prevalence of cardiovascular, gastrointestinal and musculoskeletal disorders among bus drivers and its association if any, with occupational stress . Methods: Cross sectional study was conducted from June 2004 -May 2005 among bus drivers of a Bus terminal of Mumbai city. 210 bus drivers were included in the study. Occupational stress was assessed by using Stress- related health complaints questionnaire. Results: Hypertension was seen among 24%, Dyspepsia, regurgitation among 52%, lower back among 79% of bus drivers. Morbidities were significantly high among the drivers who had high occupational stress score . Conclusions: Occupational stress is associated with hypertension, gastrointestinal and musculoskeletal problems among bus drivers.