Low Uptake Rates Research Articles

The Place of Pharmacotherapy in Alcohol Use Disorder Management in Family Practice - A Systematic Review.

Alcohol use disorders (AUD) are among the most prevalent mental disorders around the world, yet still remain the most undertreated. Many studies report the low rate of treatment uptake, less than 20%, among people with AUD. Among those accessing care, a large majority only approach their GP for help. Therefore, primary care is a strategic setting for the identification and the management of AUD. International recommendations stress AUD pharmacotherapy for withdrawal and craving management, but very few studies have shown interest in the management of AUDs in primary care. The main objective of this study was to analyse pharmacotherapy in AUD management in primary care by means of a systematic literature review. A systematic literature review (PRISMA) was carried out. 5 databases were screened: PUBMED via MEDLINE, LiSSa, the SUDOC catalogue, PASCAL and EMBASE. Search algorithms were used integrating the concepts of pharmacotherapy management, alcohol use disorders and primary care, only in the English language. 296 studies were selected and 10 were included. One was a follow-up study on the national prescription database, while four were cross-sectional studies with an auto-questionnaire survey. Of the 10 studies included, two were conducted in Europe, five in North America, two in Australia and one in South Africa. These pharmacotherapy studies were concerned with the anti-craving treatment, and 3 types of medications were used: Disulfiram, Acamprosate and Naltrexone. Factors identified as limiting or facilitating prescriptions concerned cost, indications, efficacy, training and adjuncts to pharmacotherapy. Knowledge and prescription of pharmacotherapy for AUD, more specifically, anti-craving treatment, is insufficient in primary care. There is a lack of data and studies on the efficacy of anti-craving treatment in primary care. Guidelines for AUD management, including psychological and medical management and pharmacotherapy, do exist but have not been adapted to primary care practice. Barriers and facilitators of pharmacotherapy prescription in AUD in primary care were identified in this study.

Effects of Drought and Heat on Photosynthetic Performance, Water Use and Yield of Two Selected Fiber Hemp Cultivars at a Poor-Soil Site in Brandenburg (Germany)

Hemp currently regains certain importance as fiber, oil and medical crop not least because of its modest requirements of biocides, fertilizer and water. During recent years, crops were exposed to a combination of drought and heat, even in northern Central-Europe. Dynamic responses of photosynthesis and stomatal conductance to these stresses and their persistent effects had been studied, if at all, in controlled environment experiments. Comprehensive field studies on diurnal and long-term net photosynthesis and gas exchange, and yield properties of hemp during a drought prone, high-temperature season in northern Central-Europe are obviously missing. Thus, in whole season field trails, the essential actual physiological (rates of net photosynthesis and transpiration, stomatal conductance, water use efficiencies, ambient and internal CO2 concentrations) and the yield performance of modern high-yielding multi-purpose hemp cultivars, ‘Ivory’ and ‘Santhica 27’, were evaluated under extreme environmental conditions and highly limited soil water supply. This provides comprehensive information on the usability of these cultivars under potential future harsh production conditions. Plants of both cultivars differentially cope with the prevailing climatic and soil water conditions. While ‘Ivory’ plants developed high rates of CO2 gain and established large leaf area per plant in the mid-season, those of ‘Santhica 27’ utilized lower CO2 uptake rates at lower leaf area per plant most time. This and the higher germination success of ‘Santhica 27’ resulted in nearly twice the yield compared to ‘Ivory’. Although stomatal control of CO2 gain was pronounced in both cultivars, higher stomatal limitations in ‘Ivory’ plants resulted in higher overall intrinsic water use efficiency. Cultivation of both hemp cultivars with only basic irrigation during seed germination was successful and without large effects on yield and quality. This was valid even under extremely hot and dry climatic conditions in northern Central Europe.

The effects of implementation barriers in virtually proctored examination: A randomised field experiment in Dutch higher education

AbstractVirtual proctoring technology is credited with increasing the accessibility of exams by enabling students to participate in exams at any time and place. In this field experiment, students were randomly assigned to virtual proctoring or traditional on‐campus examination to evaluate the effect, nature and timing of implementation barriers for online proctoring in higher education. The results show that the uptake in the traditional examination setting in this study was six times higher due to technical hurdles that students experienced with the virtual proctoring software. When alleviating these implementation barriers by offering all students the chance to participate in an unproctored retake, students initially assigned to virtual proctoring still showed a significantly lower uptake rate. Uptake could not be related to student characteristics, such as performance levels and motivation.

Low benthic mineralization and nutrient fluxes in the continental shelf sediment of the northern East China Sea

The sediment oxygen uptake rate, vertical distributions of organic carbon content, sedimentation rate, and benthic nutrient flux were measured from May 29 to June 9, 2015, to evaluate the partitioned organic carbon and nutrient cycles in the sediment of northern part of East China Sea. The sediment oxygen uptake rate, measured by in situ and/or ex situ incubation methods were ranged from 5.81 ± 0.08 to 16.36 ± 0.08 mmol O2 m−2 d−1. The fauna mediated oxygen uptake rate were ranged from 5.80 ± 0.04 to 8.09 ± 1.52 mmol O2 m−2 d−1, showing a strong relationship with the benthic macrofauna biomass and density. The burial flux of organic carbon into sediment layer ranged from 0.26 to 2.04 mmol C m−2 d−1 (average: 0.92 ± 0.64 mmol C m−2 d−1), which comprised 0.5–4.2% (average: 1.9 ± 1.3%) of primary production. Burial efficiency ranged from 2.0 to 22.4% (average: 11.1 ± 7.0%). Low sediment oxygen uptake rate caused low effluxes of dissolved inorganic nitrogen (0.19 ± 0.03–0.73 ± 0.04 mmol N m−2 d−1), phosphate (−0.034 ± 0.004–0.016 ± 0.005 mmol P m−2 d−1), and silicate (0.30 ± 0.03–1.61 ± 0.06 mmol Si m−2 d−1), which accounted for less than 10% of the nutrients required for primary production in the water column.

Determinants of intention-to-use first-/last-mile automated bus service

The successful adoption of a product or service by its target market or users relies on delivering a product or service in line with their needs and expectations. Failure to do so will likely result in a low rate of uptake or use of the product or service. This study sought to identify the criteria by which potential users of a first-/last-mile automated bus (AB) service would evaluate the service, and accordingly decide whether to use or disregard the service. This research investigated various explanatory factors affecting users’ perceptions of the service’s quality and utility, and which enhanced or diminished their intentions to use it. The data analysed in this study was collected from a survey conducted in February and March of 2018 in Stockholm, Sweden, during a trial operation of a first-/last-mile AB service. Three-factor theory analysis, commonly used to analyse services, was applied to this data in order to identify users’ core perceptions about the service, which in turn influence their intention-to-use the service. Structural equation modelling was used to identify the significant factors that influence the identified perceptions influencing the intention-to-use the service. This study found that different subgroups of users prioritised different attributes. Prospective users (with no prior experience with the service) were most concerned with the frequency of service. Their intention-to-use the service greatly increased when the service frequency is comparable to the service frequency of a regular public bus service. Experienced users’ intentions to continue using the service greatly increased when the buses were made more comfortable. This study additionally found that users’ perceptions of the service’s quality were also influenced by numerous factors including the passenger’s age, income level, preferred mode of travel for daily trips, preferred mode of travel for first-/last-mile trips, being tech-savvy or not, and their level of familiarity with automated driving technology.

Traumatic Brain Injury-Induced Sex-Dependent Changes in Late-Onset Sensory Hypersensitivity and Glutamate Neurotransmission.

Women approximate one-third of the annual 2.8 million people in the United States who sustain traumatic brain injury (TBI). Several clinical reports support or refute that menstrual cycle-dependent fluctuations in sex hormones are associated with severity of persisting post-TBI symptoms. Previously, we reported late-onset sensory hypersensitivity to whisker stimulation that corresponded with changes in glutamate neurotransmission at 1-month following diffuse TBI in male rats. Here, we incorporated intact age-matched naturally cycling females into the experimental design while monitoring daily estrous cycle. We hypothesized that sex would not influence late-onset sensory hypersensitivity and associated in vivo amperometric extracellular recordings of glutamate neurotransmission within the behaviorally relevant thalamocortical circuit. At 28 days following midline fluid percussion injury (FPI) or sham surgery, young adult Sprague-Dawley rats were tested for hypersensitivity to whisker stimulation using the whisker nuisance task (WNT). As predicted, both male and female rats showed significantly increased sensory hypersensitivity to whisker stimulation after FPI, with females having an overall decrease in whisker nuisance scores (sex effect), but no injury and sex interaction. In males, FPI increased potassium chloride (KCl)-evoked glutamate overflow in primary somatosensory barrel cortex (S1BF) and ventral posteromedial nucleus of the thalamus (VPM), while in females the FPI effect was discernible only within the VPM. Similar to our previous report, we found the glutamate clearance parameters were not influenced by FPI, while a sex-specific effect was evident with female rats showing a lower uptake rate constant both in S1BF and VPM and longer clearance time (in S1BF) in comparison to male rats. Fluctuations in estrous cycle were evident among brain-injured females with longer diestrus (low circulating hormone) phase of the cycle over 28 days post-TBI. Together, these findings add to growing evidence indicating both similarities and differences between sexes in a chronic response to TBI. A better understanding of the influence of gonadal hormones on behavior, neurotransmission, secondary injury and repair processes after TBI is needed both clinically and translationally, with potential impact on acute treatment, rehabilitation, and symptom management.

Advance care planning in Australia during the COVID-19 outbreak: now more important than ever.

The novel Coronavirus disease 2019 (COVID‐19) outbreak has led to rapid and profound changes in healthcare system delivery and society more broadly. Older adults, and those living with chronic or life‐limiting conditions, are at increased risk of experiencing severe or critical symptoms associated with COVID‐19 infection and are more likely to die. They may also experience non‐COVID‐19 related deterioration in their health status during this period. Advance care planning (ACP) is critical for this cohort, yet there is no coordinated strategy for increasing the low rates of ACP uptake in these groups, or more broadly. This paper outlines a number of key reasons why ACP is an urgent priority, and should form a part of the health system's COVID‐19 response strategy. These include reducing the need for rationing, planning for surges in healthcare demand, respecting human rights, enabling proactive care coordination and leveraging societal change. We conclude with key recommendations for policy and practice in the system‐wide implementation of ACP, to enable a more ethical, coordinated and person‐centred response in the COVID‐19 context.

Understanding barriers to treatment and treatment delivery preferences for individuals with symptoms of hoarding disorder: A preliminary study

Hoarding Disorder (HD) is a common and debilitating mental health condition that is characterized by low treatment uptake and high drop-out rates. The aim of the present study was to 1) provide a preliminary evaluation of the barriers to psychological help-seeking and 2) understand psychological treatment preferences of individuals with clinically significant symptoms of HD. Fifty participants (82% female; M age = 47.82, SD = 12.92) completed the study. The most frequently cited barriers to treatment were related to cost (66%), self-reliance (58%), and lack of knowledge about treatment options (42%). Likelihood of seeking treatment for HD symptoms was low and past-treatment predicted treatment-seeking intention, while symptom severity, depression, and internalized stigma were non-significant predictors (F(4, 44) = 9.40, p < .001; R2 = 0.49). Participants indicated a preference for individually-administered treatment (41.3%) or remote low intensity treatments (30.4%), over accelerated or group therapy approaches. The study highlights that individuals with HD experience significant barriers to accessing psychological treatment for HD and providing a variety of low cost, evidence-based treatment approaches may enhance treatment uptake for this population.

Production of Active Recombinant Hyaluronidase Inclusion Bodies from Apis mellifera in E. coli Bl21(DE3) and characterization by FT-IR Spectroscopy.

The bacterium E. coli is one of the most important hosts for recombinant protein production. The benefits are high growth rates, inexpensive media, and high protein titers. However, complex proteins with high molecular weight and many disulfide bonds are expressed as inclusion bodies (IBs). In the last decade, the overall perception of these IBs being not functional proteins changed, as enzyme activity was found within IBs. Several applications for direct use of IBs are already reported in literature. While fluorescent proteins or protein tags are used for determination of IB activity to date, direct measurements of IB protein activity are scacre. The expression of recombinant hyaluronidase from Apis mellifera in E. coli BL21(DE3) was analyzed using a face centered design of experiment approach. Hyaluronidase is a hard to express protein and imposes a high metabolic burden to the host. Conditions giving a high specific IB titer were found at 25 °C at low specific substrate uptake rates and induction times of 2 to 4 h. The protein activity of hyaluronidase IBs was verified using (Fourier transform) FT-IR spectroscopy. Degradation of the substrate hyaluronan occurred at increased rates with higher IB concentrations. Active recombinant hyaluronidase IBs can be immediately used for direct degradation of hyaluronan without further down streaming steps. FT-IR spectroscopy was introduced as a method for tracking IB activity and showed differences in degradation behavior of hyaluronan dependent on the applied active IB concentration.

Consanguinity rates among Syrian refugees in Lebanon: a study on genetic awareness.

Consanguineous marriage is a deeply rooted tradition in the Arab world. Such marriages are linked to higher rates of recessive genetic diseases. During the Syrian conflict, which started in 2011, around one million Syrian individuals became refugees in Lebanon. This study assessed the consanguinity rates among Syrian refugees living in Lebanon up to three successive consanguineous generations, and examined refugees' awareness of the possible consequences of consanguineous marriage and their attitudes towards consanguinity. Their knowledge of, and access to, premarital screening was also assessed. The study was conducted between January and May 2018. Several study sites representing refugees' distribution within the country were chosen. The study sample included 1008 interviewees from different families. Of those interviewed, 51.9% were in a consanguineous marriage. Interestingly, 23.9% were the product of consanguineous marriages themselves, and 17.9% were consanguineous for three successive generations. The interviewees generally knew about premarital screening, but the majority (61.9%) had not had the screening. The high rates of consanguinity in these Syrian refugees call for immediate action, including raising genetic awareness and providing appropriate genetic counselling. Despite the respondents' familiarity with premarital screening, there was a low rate of uptake of the test, underscoring the importance of providing better education to these refugees.

Tackling the energy efficiency gap in the Irish residential sector

The residential sector holds significant potential for improvements in energy efficiency in Ireland. Retrofit activity, however, can be difficult to instigate despite the presence of government incentives and cost-effective investment opportunities. The failure of individuals and organisations to invest in cost-effective energy efficiency measures is often referred to as ‘the energy efficiency gap’. Here, two separate, but not mutually exclusive, potential contributing factors for this phenomenon are discussed in detail: behavioural anomalies and modelling miscalculations. The relevance of these factors in the context of the Irish residential sector is introduced, and this is followed by a review of intervention literature seeking to increase energy efficiency programme adoption rates by addressing behavioural failures. An examination of domestic and international evidence shows a consistent overestimation by ex-ante models of energy-saving benefits. The paper concludes that addressing behavioural and informational factors can have a positive influence on energy efficiency adoption, but this needs to be complemented with additional policy measures to sufficiently rectify current low rates of uptake in the Irish residential sector. Simultaneously, further action will be needed to better calibrate engineering models using data gathered from ex-post field experiments.

Silver nanoparticles stabilized by humic substances adversely affect wheat plants and soil

More than 50% of engineered nanomaterials released into the environment contain silver nanoparticles (Ag-NPs). The mobility, bioavailability, and toxicity of engineered Ag-NPs are known to depend on their properties and the environmental conditions. However, almost nothing is known about the fate of naturally occurring Ag-NPs, which are formed during the reduction of Ag+ by natural organic matter, primarily humic substances (HSs). The aim of this work was to study the interaction of soils and plants with simulated natural Ag-NPs, i.e., Ag-NPs stabilized with HSs (Ag-HS-NPs). To reach this goal, Ag-HS-NPs were synthesized, and their sorption-desorption behavior on two contrasting soils (a mineral soil and one rich in organic matter) was evaluated, including alterations in the mineral composition of the soil solution. In parallel, the influence of Ag-HS-NPs on wheat seedling growth was estimated. Introduction of Ag-HS-NPs into the soils resulted in a 1.3- to 2-fold or greater increase in the concentration of many elements in the soil solution (Al, Cr, Cu, Fe, etc.), and this effect was more pronounced for the organic soil than for the mineral soil. To explain this effect, we hypothesized that this phenomenon was due to the partial dissolution of Ag-HS-NPs leading to the production of Ag+ that could be further reduced by soil organic matter, which was correspondingly oxidized. Therefore, the partial breaking of soil aggregates because of the decomposition of soil organic matter in the presence of Ag-HS-NPs could be expected. Plants treated with Ag-HS-NPs demonstrated a lower rate of water uptake, which decreased by over 81%. The shoot and root biomass decreased by 15–17% and by 13–15%, respectively. This study clearly demonstrates an underestimated hazard of Ag-NPs formed in nature in terms of their ability to adversely affect the environment.

Feasibility of Plasma-Methylated SFRP2 for Early Detection of Gastric Cancer.

Gastric cancer (GC) is fifth most frequently diagnosed cancer and second leading cause of cancer in China. More than 80% of GC are diagnosed at an advanced stage due to low uptake rate of invasive screening method. The performance of methylated SFRP2 test was evaluated in 236 plasma samples, including 92 patients with GC, 16 intestinal metaplasia patients, 26 gastric fundic gland polyp patients, 13 small adenoma patients, 39 hyperplastic polyp patients, and 50 control patients. The sensitivity of plasma methylated SFRP2 was compared to serum CEA, CA72-4, CA19-9, and CA242 results in 79 patients with GC. The sensitivities for detecting GC and gastric intestinal metaplasia by methylated SFRP2 test were 60.9% and 56.3% with a specificity of 86.0%. Methylated SFRP2 test had significantly higher positive detection rate for patients with GC than gastric fundic gland polyp, small adenoma, and hyperplastic polyp patients. In 79 patients with GC, the sensitivities of CEA, CA72-4, CA19-9, and CA242 for detecting GC were 22.8%, 16.5%, 12.7%, and 11.4%. In comparison, the sensitivity of methylated SFRP2 test for detecting GC was 58.2%. Plasma methylated SFRP2 test may become a valuable tool for the noninvasive detection of GC and precursor lesions and showed higher sensitivity than serum tumor markers.

Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial

RationalePulmonary rehabilitation (PR) is an effective, key standard treatment for people with COPD. Nevertheless, low participant uptake, insufficient attendance and high drop-out rates are reported. Investigation is warranted of the...

Low rates of influenza vaccination uptake among healthcare workers: Distinguishing barriers between occupational groups

To gain further insights into health care workers (HCWs) attitudes toward influenza vaccination to guide future interventions to increase vaccination rates. A standardized anonymous questionnaire was sent to all employees of the University Hospital Basel, Switzerland following the influenza season 2013/2014. We collected information regarding HCW's demographics, experiences with flu vaccinations, and reasons for nonvaccination. Vaccination rates ranged from 14.7% to 31% from 2007 to 2019. A total of 1,454 HCW participated in the survey, of which 62% reported being vaccinated. HCW not vaccinated were more commonly female and differed by occupational group and department. The main reasons for nonvaccination were fear of short-term adverse reactions, followed by assessing the evidence regarding vaccination-benefits as insufficient and fears of violation of the right to self-determination. Fear of long-term sequela and violation of the right of self-determination differed between the 4 professional groups, both being most commonly indicated by nurses and at least indicated by physicians. This study provides some insight into differences regarding barriers to vaccination between different occupational groups, which might not have been adequately addressed so far. Policy makers should consider such differences when designing campaigns to raise acceptance of influenza vaccine among HCWs.

Drivers of short-term variability in phytoplankton production in an embayment of the southern Benguela upwelling system

St Helena Bay (SHB), a retention zone in the southern Benguela upwelling system, supports 40–50% of the region's primary productivity. It also experiences harmful algal blooms (HABs) and hypoxic conditions that are difficult to predict given the high sub-seasonal variability. To better understand this variability, net primary production (NPP), nitrate and ammonium uptake, and phytoplankton community composition were monitored for ten days in SHB during summer, the season of enhanced upwelling. A period of active upwelling (days 1–5) was followed by one of relaxation (days 6–10). During upwelling, the mixed layer was deeper than the euphotic zone and phytoplankton were light-limited, evidenced by high ambient nitrate concentrations and low rates of NPP and nitrate uptake. During relaxation, stratification increased, restricting phytoplankton production to a shallow euphotic zone in which nitrate was exhausted after three days; the subsequent decline in NPP and nitrate uptake rates confirm that nutrient availability rapidly succeeded light as the dominant control on productivity. Nanophytoplankton (mainly the small diatoms, Chaetoceros spp. and Skeletonema costatum) dominated the biomass, NPP, and nitrate uptake throughout the experiment. We attribute this to their ability to respond quickly to newly-upwelled nitrate and to sustain elevated nitrate uptake rates for longer than pico- and microphytoplankton. They may also engage in luxury nitrate uptake, storing nitrate intracellularly under high-nutrient conditions and assimilating it later when nutrients are depleted. Additionally, Chaetoceros spp. and S. costatum are chain-formers, benefitting from the advantages of being small (i.e., as individual cells) and large (i.e., when aggregated into chains). A weakening of surface stratification late in the experiment may have prevented dinoflagellates, some of which are HAB species, from succeeding the diatoms. One implication of this is that understanding the rapid cycling between light and nutrient limitation of SHB phytoplankton, induced by an actively-upwelling versus stratified water column, may improve our capacity to anticipate HABs and the associated hypoxic events.

Barriers and Enablers to Intervention Uptake and Health Reporting in a Water Intervention Trial in Rural India: A Qualitative Explanatory Study.

Consumption of unsafe drinking water contributes to the global disease burden, necessitating identification and implementation of effective, acceptable, and sustainable water interventions in resource-limited settings. In a quantitative stepped-wedge cluster randomized trial of a community-based water intervention in rural India, we identified low rates of intervention uptake and reported diarrhea. To better understand and explain these findings, we performed a qualitative study examining barriers and enablers to intervention uptake and health reporting using the COM-B model, where capabilities, opportunities, and motivators interact to generate behavior. We conducted 20 focus groups and one semi-structured interview with participants and four focus groups with data collectors. Multifactorial barriers to intervention uptake included distorted perceptions of water-related health effects, implementation issues that reduced treated water availability; convenience of, and preference for, alternative drinking water sources; delivery of water to plastic storage tanks (perceived as affecting water quality and taste); and resistance to change. Enablers included knowledge of water-related health risks, proximity to tanks, and social opportunity. Barriers to health reporting included variability in interpretation of illness, suspicion regarding the consequences of reporting disease, weariness with repeated questions, and perceived inaction on health data already provided; low survey implementation fidelity was also important. Enablers included surveyor initiatives to encourage reporting and a sense of social responsibility. This qualitative explanatory study allowed better understanding of our quantitative results. It also identified obstacles and facilitators to implementing and evaluating community water interventions, providing insight on how to achieve better intervention uptake and health reporting in future studies.

Nutrient uptake of different contingent crops under delayed sowings in changed climate in rainfed agriculture

A field experiment was conducted during kharif 2018 at Dryland Agriculture Project, All India Coordinated Research Project (AICRP) on Dryland Agriculture, University of Agricultural Sciences, GKVK, Bengaluru, Karnataka. The experiment comprised of two factors laid out in Factorial Randomized Complete Block Design (FRCBD) with three replications. Treatments consist of three sowing windows viz., August 2nd fortnight, September 1st fortnight and September 2nd fortnight and five crops viz foxtail millet, finger millet, field bean, french bean and quiona. Delayed dates of sowing caused drop in growth parameters which may be due to unfavorable weather conditions to the plants as well as high temperature which might have caused in lower rate of photosynthesis and lower uptake of nutrients led to reduced accumulation of food materials. Among the contingent crops and delayed sowings in kharif season under dryland condition, August 2nd fortnight sowing recorded significantly higher availability of nitrogen, phosphorous and potassium by crops and it was decreasing with delayed sowing of contingent crops. Field bean and french bean were improved the availability of nutrients in the soil after the harvest of crops than remaining crops.

Reconstruction of residents\u2019 thyroid equivalent doses from internal radionuclides after the Fukushima Daiichi nuclear power station accident

There is concern among residents that their children might suffer from thyroid cancer in the near future after the Fukushima Daiichi nuclear power station (FDNPS) accident. However, the demographic and geographical distribution of thyroid equivalent doses was not thoroughly evaluated, and direct thyroid measurements were conducted only for 1,200 children, whose individual thyroid doses were assessed on the basis of those measurements accounting for the dynamics of radioiodine intake. We conducted hierarchical clustering analyses of 100 or 300 randomly sampled behavioural questionnaire sheets of children from each of seven municipalities in the evacuation area to reconstruct evacuation scenarios associated with high or low exposures to plumes. In total 896 behaviour records in the Fukushima Health Management Survey were analysed to estimate thyroid equivalent doses via inhalation, using a spatiotemporal radionuclides concentration database constructed by atmospheric dispersion simulations. After a decontamination factor for sheltering and a modifying factor for the dose coefficient—to reflect lower iodine uptake rate in Japanese—were applied, estimated thyroid equivalent doses were close to those estimated from direct thyroid measurement. The median and 95th percentile of thyroid equivalent doses of 1-year-old children ranged from 0.6 to 16 mSv and from 7.5 to 30 mSv, respectively. These results are useful for future epidemiological studies of thyroid cancer in Fukushima.

Interest in expanded carrier screening among individuals and couples in the general population: systematic review of the literature.

Through carrier screening, prospective parents can acquire information about whether they have an increased risk of conceiving a child affected with an autosomal recessive or X-linked condition. Within the last decade, advances in genomic technologies have facilitated a shift from condition-directed carrier screening to expanded carrier screening (ECS). Following the introduction of ECS, several studies have been performed to gauge the interest in this new technology among individuals and couples in the general population. The aim of this systematic review was to synthesize evidence from empirical studies that assess the interest in ECS among individuals and couples in the general population. As the availability and accessibility of ECS grow, more couples who are a priori not at risk based on their personal or family history will be presented with the choice to accept or decline such an offer. Their attitudes and beliefs, as well as the perceived usefulness of this screening modality, will likely determine whether ECS is to become a widespread reproductive genetic test. Four databases (Pubmed, Web of Science, CINAHL, Cochrane Library) were systematically searched to identify English language studies performed between January 2009 and January 2019 using the following search terms: carrier screening, carrier testing, attitudes, intention, interest, views, opinions, perspectives and uptake. Studies were eligible for inclusion if they reported on intentions to undergo a (hypothetical) ECS test, uptake of an actual ECS offer or both. Two researchers performed a multistep selection process independently for validation purposes. Twelve empirical studies performed between 2015 and 2019 were included for analysis. The studies originated from the USA (n= 6), the Netherlands (n= 3), Belgium (n= 1), Sweden (n= 1) and Australia (n= 1). The sample size of the studies varied from 80 to 1669. In the included studies, 32%-76% of respondents were interested in a (hypothetical) ECS test, while uptake rates for actual ECS offers ranged from 8% to 50%. The highest overall uptake was observed when ECS was offered to pregnant women (50%). By contrast, studies focusing on the preconception population reported lower overall uptake rates (8-34%) with the exception of one study where women were counseled preconception in preparation for IVF (68.7%). Our findings suggest that there may be discrepancies between prospective parents' reported intentions to undergo ECS and their actual uptake, particularly during the preconception period. As ECS is a new and relatively unknown test for most future parents, the awareness and comprehension within the general population could be rather limited. Adequate pre- and post-test counseling services should be made available to couples offered ECS to ensure informed reproductive decision-making, together with guidelines for primary health care professionals. Due to restricted nature of the samples and methods of the underlying primary studies, some of the reported results might not be transferable to a broader population. More research is needed to see if the observed trends also apply to a broader and more diverse population.