Prevalence Rates Range Research Articles

Identifying Autism Spectrum Disorder (Level 1) in Adults

Autistic Spectrum Disorder (ASD) is a neurodevelopmental disorder that is present from childhood. Prevalence rates range from 1% to 1.5%. Males are more likely to be diagnosed with ASD than females. A review of childhood and current behavior and social functioning is critical to accurate diagnosis. Listening to the description of problems from the perspective of the patient, building the treatment alliance, and processing the details of problematic social interactions are essential to successful outcomes. Coaching and role-playing can also be useful techniques.

Bioelectrical impedance analysis in the assessment of sarcopenia.

Bioelectrical impedance analysis (BIA) is an accepted technique to estimate low muscle mass for sarcopenia diagnosis. However, muscularity assessment from BIA relies on prediction equations, estimating different compartments according to the calibration method. Low muscle mass can be defined using different approaches. There is a lack of standardization on how low muscularity is defined in the context of sarcopenia. Recent studies have shown discrepant results for the estimation of low muscle mass when different prediction equations are used in the same BIA device. Different sarcopenia prevalence rates are observed if different definitions are used to identify low muscle mass. Most of the studies using BIA for diagnosing sarcopenia use the incorrect combination of specific population cut-off or a different device from the original equation. The lack of standardization of BIA use for assessing muscularity results in a wide range of sarcopenia prevalence rates among studies, even when conducted in the same population. As BIA equations and cut-off values are population and device-specific, results should be interpreted with caution when data from different devices are applied in equations or using cut-off values from a different population.

Abstract B080: Update on the NCI-Molecular Analysis for Therapy Choice (NCI-MATCH/EAY131) precision medicine trial

Abstract Purpose: NCI-Molecular Analysis for Therapy Choice (NCI-MATCH/EAY131), by ECOG-ACRIN (EA) and NCI, is the first national signal-finding trial to incorporate centralized NGS testing to direct patients (pts) to molecularly targeted parallel phase 2 treatment arms. We report status of accrual from opening on 08/12/15 thru 07/16/17 and future plans. Methods: Eligible pts have advanced/refractory solid tumors, lymphoma, or myeloma. Drug treatments and molecular targets require stringent levels of evidence (LOE). Each arm (N-35) has a phase 2 dose, a molecular abnormality believed to predict response, and evidence of clinical activity. Pts must have enrolled by 05/22/17 with intent to submit fresh tissue or recent clinical biopsy. Tumor cores are shipped to the EA Central Biorepository & Pathology Facility at MD Anderson Cancer Center for evaluation of histopathology and % tumor; PTEN, MLH1, and MSH2 IHC; and RNA/DNA extraction. NGS is performed in one of 4 CLIA-accredited laboratories using the NCI-MATCH adapted Oncomine™ panel (Version 1.0; 143 genes with >4000 reported variants including SNVs, indels, amplifications, and gene fusions). When an actionable mutation of interest (aMOI) or relevant IHC result is identified, the pt is assigned to treatment by a custom-designed informatics system (MATCHbox). If >1 aMOI present, the pt is assigned by the variant with the highest LOE. Results: As of 07/16/17, 5963 tumors were screened for 30 treatment arms. The assay success rate is 93%; median turnaround is 15 days (from sample receipt to return of results). 38.2% of pts have common cancers: colorectum (15.4%), breast (12.8%), lung (7.4%), and prostate (2.6%); 61.8% have less common tumors. The current overall match rate to aMOI’s is 18% (95% CI 17%, 19%); aMOI prevalence rates range from 3.47% to zero. The match rate also varies across tumor types: <10% in pancreatic & SCLC; >30% in bladder/urinary tract, uterine, and head/neck cancer. 998 pts have been assigned to Rx; 69% have enrolled. Of 30 arms, 8 have enrolled ≥ 35 pts; some arms with higher prevalence rates have been expanded to N=70 to accommodate pts with matching aMOIs. Arms with less frequent aMOIs will not complete accrual within the 6,000-pt central screening goal, leading to identification of pts for screening based on approved high-volume NGS labs’ assay results, verified centrally. Conclusions: NCI-MATCH screened ~6000 pts at a rate that far exceeded expectations, and with acceptable toxicity; NGS was successful in 93%, well above the industry average of ~80%. The pace of enrollment, along with the trial’s availability at 1100+ sites, reflects the broad interest in the promise of genomics and the ability of such a trial to deliver on that promise. Lower accrual to "rare variant" arms led to use of high-volume NGS laboratories to complete the study. Follow-up will determine whether matching drugs to molecular targets results in meaningful response rates and improved patient outcome. Citation Format: Lyndsay Harris, Alice Chen, Peter O'Dwyer, Keith Flaherty, Stanley Hamilton, Lisa McShane, Robert Gray, Shuli Li, Edith Mitchell, Diane Dragaud, Mickey Williams, Jeffrey Sklar, A. John Iafrate, David Patton, Richard F. Little, James Zweibel, Jeffrey Abrams, James Doroshow, Barbara Conley. Update on the NCI-Molecular Analysis for Therapy Choice (NCI-MATCH/EAY131) precision medicine trial [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr B080.

Internet Gaming Disorder in Children and Adolescents.

The American Psychiatric Association recently included Internet gaming disorder (IGD) as a potential diagnosis, recommending that further study be conducted to help illuminate it more clearly. This paper is a summary of the review undertaken by the IGD Working Group as part of the 2015 National Academy of Sciences Sackler Colloquium on Digital Media and Developing Minds. By using measures based on or similar to the IGD definition, we found that prevalence rates range between ∼1% and 9%, depending on age, country, and other sample characteristics. The etiology of IGD is not well-understood at this time, although it appears that impulsiveness and high amounts of time gaming may be risk factors. Estimates for the length of time the disorder can last vary widely, but it is unclear why. Although the authors of several studies have demonstrated that IGD can be treated, no randomized controlled trials have yet been published, making any definitive statements about treatment impossible. IGD does, therefore, appear to be an area in which additional research is clearly needed. We discuss several of the critical questions that future research should address and provide recommendations for clinicians, policy makers, and educators on the basis of what we know at this time.

Cri-du-Chat syndrome diagnosed in a 21-year-old woman by means of comparative genomic hybridization

El síndrome de cri du chat o del maullido de gato es causado por una deleción en el brazo corto del cromosoma 5; el tamaño de la pérdida de material genético varía desde solo la región 5p15.2 hasta el brazo entero. La prevalencia va desde 1 por 15 000 habitantes hasta 1 por 50 000 habitantes. Su diagnóstico se puede confirmar con cariotipo con bandas G de alta resolución, hibridación fluorescente in situ o hibridación genómica comparativa por microarreglos (HGCm); este se sospecha en infantes con un llanto similar al maullido de un gato, fascies dismórficas, hipotonía y retardo del desarrollo psicomotor; sin embargo, en los adultos afectados los hallazgos fenotípicos son menos específicos.Se presenta el caso de una mujer de 21 años con retardo mental severo y tricotilomanía, que no controla esfínteres y no se baña ni come sola; solo emite ruidos y tiene facies dismórficas. El cariotipo de bandas G es reportado 46, XX y la HGCm muestra microdeleción de 18.583Mb en 5p15.33p14.3, incluyendo región crítica de cri du chat. En pacientes de este tipo se debe realizar HGCm para hacer un diagnóstico etiológico, establecer un pronóstico, ordenar pruebas médicas adicionales y tratamientos específicos y realizar la adecuada asesoría genética.

Chronic pain in multiple sclerosis: A 10-year longitudinal study

Background and purposePain is a common symptom associated with multiple sclerosis (MS), and has lasting effects on an individual's functional capacity and quality of life. A wide range of prevalence rates of pain (between 23% and 90%)have been reported in MS and this is mainly due to the methodological differences amongst the studies such as variability in patient sources, method of sampling and the definition of pain used. Chronic pain in MS, defined as pain lasting for greater than 3–6 months, can have a significant impact on their biopsychosocial health, including negative impact on activities of daily living, relationships and social participation. The long-term course of MS-related pain and its impact in an Australian cohort over a 7-year period has been investigated earlier. The aim of this longitudinal study was to describe the impact of chronic pain, pain-related disability and carer burden in persons with MS over a 10-year period. The aim of this longitudinal study was to describe the impact of chronic pain, pain-related disability and carer burden in persons with MS over a 10-year period. MethodsThis was a prospective longitudinal study conducted at the Rehabilitation Department of Royal Melbourne Hospital (RMH), a tertiary referral hospital in Victoria and Australia. The source of participants was from the RMH MS database and contains detailed MS patient information including demographic data, diagnosis details (using McDonald's criteria), pain characteristics. Structured face-face interviews and validated measures were used, which include the visual analogue scale (VAS); chronic pain grade (CPG); the assessment of quality of life (AQoL) and the carer strain index (CSI). The mean age of the participants (n=70) was 55.3 years and majority (70%) were female. ResultsThe mean age of the participants (n=70) was 55.3 years and majority (70%) were female. The findings show that over time (10 years), participants report having greater bilateral bodily pain and greater description of pain as ‘worse as it could be’. Pain types were similar to 7-years follow-up but remained higher than baseline. There was a significant deterioration in quality of life in those with more severe CPG over time. Almost half of the participants 31 (44%) required care either from a private carer, institution or from a family member. Although fear of taking medications and side effects were common barriers to treatment for pain, there was an increase in the use of pharmacological treatment over time and an increase in the use of healthcare services, mainly neurologists and general practitioners. ConclusionsThe pain measures reported by the participants were similar to those at the 7-year follow-up except there was a greater representation of bilateral pain locations (limb, trunk and facial pain) compared to baseline and 7-year follow-up. At 10-year follow-up, more participants used medications compared to 7-year follow-up and there was an increase in the use of health professionals at the 10-year follow-up. At the 10-year follow up QoL of the participants deteriorated significantly and more participants had progressed to higher CPG III and CPG IV. This study demonstrates that chronic pain is a significant issue over time in MS, with clinical and health implications, impact on quality of life, disability and healthcare utilization. ImplicationsGreater awareness of chronic pain in pwMS, cognitive classifications and an interdisciplinary approach is required to improve long-term patient outcomes and well-being.

The prevalence and nature of sexual harassment and assault against women and girls on public transport: an international review

PurposeThe purpose of this paper is to report on the findings from a study commissioned by the British Transport Police and the Department for Transport for England and Wales concerning sexual offences and harassment on public transport worldwide. Specifically, it aims to explore the prevalence of such behaviours, through a review of existing survey and interview data regarding women and girls’ experiences.Design/methodology/approachA rapid evidence assessment (REA) was used, the function of which is to: search the literature as comprehensively as possible within given time constraints; collate descriptive outlines of the available evidence on a topic and critically appraise it; sift out studies of poor quality; and provide an overview of the evidence.FindingsIt was found that prevalence rates range from 15 to 95 per cent, with the UK having the lowest rates. Emerging economies had higher rates of harassment and assault, which may relate to differing cultural and gender norms, where public space is regarded as a male domain.Research limitations/implicationsA REA is not a full systematic review, differing in the scope and depth of the searches and depending almost exclusively on electronic databases, not accompanied by searching journals by hand.Practical implicationsMore research of high methodological rigour needs to be carried out on prevalence rates of sexual harassment and offending on public transport worldwide. The high prevalence rates found suggest the need for more work around the area of interventions to curtail offending in this setting. The findings suggest that emerging economies, in particular, need to do more to address the problem of sexual harassment and assault on public transport. More fundamentally, cultural norms around women’s roles in society need to be addressed and challenged.Originality/valueWomen may become “transit captive” and socially excluded if they are afraid to travel on public transport and do not have access to private transport. This would be an unacceptable situation which must be addressed by transport authorities and police.

Role of UCP1 Gene Variants in Interethnic Differences in the Development of Cardio-Metabolic Diseases.

Cardio-metabolic diseases (CMDs) comprise a cluster of risk factors that contribute to chronic pathological conditions with adverse consequences for cardiovascular function and metabolic processes. A wide range of CMD prevalence rates among different ethnic groups has been documented. In view of accumulated evidence, there is a trend toward increasing CMD prevalence rates in Eastern Europe and Western Asia. Numerous studies have revealed an association between uncoupling protein 1 (UCP1) gene variants and CMDs. UCP1 activity is essential for brown adipose tissue (BAT)-mediated thermogenesis. Experimental animal studies and epidemiological studies in humans highlight the significance of BAT-mediated thermogenesis in protecting against obesity and maintaining a lean phenotype. We hypothesize that the genetic variation in UCP1 gene expression observed among different ethnic groups could contribute to the ethnic-specific predisposition to CMD development. Constructing such prevalence maps of UCP1 gene variants could contribute significantly into identifying high-risk ethnic groups predisposed to the development of CMDs, and further shaping public health policies by the improvement of existing preventive and management strategies.

Adolescent-to-Parent Violence: Translating Research into Effective Practice

Adolescent-to-parent violence is an increasingly recognized family and societal problem. Documented prevalence rates range between 5 and 22% of the population; however, researchers speculate that this is a gross underestimate. Parents and caregivers are hesitant to report adolescent-to-parent violence because, in large part, there are no standardized protocols for police response and evidence-based treatment practices are nonexistent. This article offers an updated narrative review of existing literature on adolescent-to-parent violence found through word searches in the databases Google Scholar and PsychInfo followed by additional review of cited literature in all articles located. We review extant theoretical frameworks that guide research and practice, discuss the impact of inconsistent research methods on the current state of knowledge, integrate new empirical data on risk and protective factors and assessment procedures, and detail existing intervention approaches. There are substantial detrimental consequences of adolescent-to-parent violence for families and current research, assessment, and intervention practices have fallen short of fully addressing these needs. A collective, collaborative, and interdisciplinary effort by clinical scientists, mental health practitioners, and the legal community is greatly needed to develop a more comprehensive and integrated literature that can then inform policy and practice.

The prevalence of urinary tract infection in children with severe acute malnutrition: a narrative review.

This article aims to review the current evidence which shows that the prevalence of urinary tract infection (UTI) has been increasing in children with severe acute malnutrition (SAM). UTI remains one of the most common causes of febrile illness in pediatric practice. Most studies conducted among hospitalized children with complicated SAM have reported high prevalence rates of UTI. Clearly, the knowledge of baseline risk of UTI can help clinicians to make informed diagnostic and therapeutic decisions in these children. From the global reports reviewed in this article, UTI prevalence rates range from as low as 6% to as high as 37% in developing countries, while the most common bacterial isolates from urine cultures are Gram-negative coliform organisms such as Escherichia coli and Klebsiella species. These findings form the basis for the current diagnostic and therapeutic guidelines for clinicians managing children with complicated SAM. With the reported high prevalence of UTI among these children and concerns over antibiotic resistance, more extensive data are required using standardized microbiological methods. Thus, the assessment of the performance of urine dipsticks and microscopy against the gold standard urine culture is an important step toward strengthening the evidence for the therapeutic guidelines for UTI in children with SAM.

Methodological Moderators in Prevalence Studies on Child Maltreatment: Review of a Series of Meta‐Analyses

Insight into the effects of methodological characteristics on reported child maltreatment prevalence rates can facilitate the interpretation of results of previous studies and improve the design of future prevalence studies. We reviewed findings from four previous meta‐analyses (Stoltenborgh et al., , , , ) on methodological moderators in self‐report prevalence studies on child sexual (k = 323, N = 410,951), physical (k = 157, N = 250,167) and emotional abuse (k = 42, N = 76,586), and physical (k = 13, N = 59 406) and emotional neglect (k = 16, N = 59 655). We provide an overview of the moderating effects of participant characteristics (e.g. age), the sampling method and measurement characteristics (e.g. validation). No characteristic was without influence, but specific characteristics were significant moderators for certain types of abuse and not for others. This implies that the wide range of lifetime prevalence rates reported in the literature can partly be explained by methodological differences. Our best‐evidence synthesis (sexual abuse: k = 4, N = 52 749; physical abuse: k = 2, N = 40 341; emotional abuse: k = 6, N = 4029; emotional neglect: k = 3, N = 3226) suggests that depending on the methodological characteristic under consideration a certain prevalence rate can be an over‐ or underestimation of the actual prevalence. Taking methodological characteristics' influence into consideration and choosing a sound methodology can help to get as close as possible to the actual child maltreatment prevalence. Copyright © 2016 John Wiley & Sons, Ltd.‘We reviewed findings from four previous meta‐analyses on methodological moderators in self‐report prevalence studies on child sexual, physical and emotional abuse, and physical and emotional neglect’Key Practitioner Messages The methodological quality of studies affects the reported lifetime prevalence rates of child maltreatment, but the direction of this effect depends on the indicator of methodological quality. A higher response rate is related to a higher reported lifetime prevalence of child maltreatment for all maltreatment types except physical abuse. A sound study design and methodology can help researchers to get as close as possible to the actual lifetime prevalence of child maltreatment.

Pharmacological Neuroenhancement: teachers' knowledge and attitudes-Results from a survey study among teachers in Germany.

BackgroundPharmacological neuroenhancement (PN) is a topic of increasing importance. Its prevalence rates range from 1 % to more than 20 %. Students are a group that shows exceptionally high prevalence rates. However, little is known about teachers’ knowledge, management, attitudes and ethical judgements regarding PN.MethodsA web-based survey containing 40 closed questions was developed. All teachers working at all private and public schools in Mecklenburg-Vorpommern, a state in northeastern Germany, were invited to participate after their respective school offices were contacted by telephone, email and mail.ResultsIn total, 255 teachers participated in the survey. Of those, 73.3 % had already heard about PN in general, and 68.2 % had heard about PN in students. Their sources of knowledge were digital media such as TV (73.8 %) and the internet (40.6 %) and print media (64.7 %); their own students informed 29.9 % of the teachers about PN in general and 35.6 % of them about PN among students. Furthermore, 34.9 % of the surveyed teachers were convinced that PN substance use was ineffective in general, and 51.8 % of the surveyed teachers believed that PN substances were ineffective in achieving better grades. Only 1.2 % thought that none of the so-called PN substances could lead to addiction, and 37.6 % would classify PN substance use as general drug misuse. The highest values regarding risk of addiction were observed for illicit drugs. The prevalence of PN substance use was evaluated to be very low and to be significantly higher in male, highly skilled and college/university students. In total, 1.6 school lessons per year were used to discuss PN. Finally, 55.7 % of the surveyed teachers believed that performance-enhancing substances should be forbidden at schools.ConclusionTeachers, as an integral part of the education of children and adolescents, often know about PN substances and mostly refuse their use being afraid about the risk of addiction. However, regarding effects as well as side effects of PN substances, teachers have very different opinions. Furthermore, they seem to underestimate the prevalence among their students and broach the topic infrequently. Teachers should be sensitized for high prevalence rates and should broach the topic of PN more frequently to their students to prevent potential misuse of PN substances.

How older persons explain why they became victims of abuse.

elder abuse greatly impacts the quality of life of older individuals. Prevalence rates range from 3 to 30% depending on the definition used. Only about a dozen studies have explored how older victims themselves experience and explain abuse. It is essential that healthcare professionals understand the perceptions of older victims as they are among the most important groups to handle and report abuse. a qualitative study on the perceptions and experiences of victims of elder abuse was conducted using in-depth semi-structured interviews. abused individuals living independently, in residential care facilities and nursing homes. six males and 11 females aged 63-90 years. the main causes of abuse identified by older victims themselves were mutual dependency between victim and perpetrator, power and control imbalances, loneliness and a marginalised social position of older persons. Effects of abuse included negative feelings, physical and psychological distress, a change of personal norms and values, changed perspectives on money and low self-efficacy. These differential effects depended upon the types of abuse experienced and the relationship with the perpetrator. Coping strategies mentioned by victims were seeking informal or professional help and using self-help strategies. older victims perceive abuse differently depending on the expected acceptability of the type(s) of abuse experienced and the anticipated stigma associated with the perpetrator involved. The effects and chosen coping strategies are influenced by these considerations and therewith also influence their help-seeking behaviour. Healthcare professionals are encouraged to use these findings in practice to prevent, detect and intervene in elder abuse.

Pharmacological Neuroenhancement in the Field of Economics-Poll Results from an Online Survey.

Introduction: The use of over-the-counter, prescription, and illicit drugs to increase attention, concentration, or memory—often called (pharmacological) neuroenhancement—shows a broad range of prevalence rates among students. However, very little data is available on neuroenhancement among employed persons. The aim of this study was to provide first data on substance use for neuroenhancement among readers of the German “Handelsblatt” coming from the field of economics.Methods: Readers of the online edition of the Handelsblatt, a leading print and online medium for the field of economics, were invited to participate in a survey via a link on the journal homepage to complete a web-based questionnaire. Within the questionnaire, participants were asked for their gender, current age, current professional status, hours of work per week, prevalence rates of substance use for the purpose of neuroenhancement as well as for reasons of its use. Binary regression analyses with stepwise forward selection were used to predict the dependent variables “use of illicit and prescription drugs for neuroenhancement” (yes/no), “use of over-the-counter drugs for neuroenhancement” (yes/no), and “use of any drug for neuroenhancement” (yes/no).Results: A total of 1021 participants completed the anonymous survey. Lifetime prevalence for the use of any drug for neuroenhancement was 88.0% and for the use of illicit and prescription drugs for neuroenhancement 19.0%. Reasons and situations that predicted neuroenhancement with illicit and prescription drugs were “curiosity,” “to enhance mood,” ”for a confident appearance,” “stress/pressure to perform,” and “deadline pressure.”Discussion: The study shows that neuroenhancement with drugs is a widespread and frequent phenomenon among people belonging to the professional field of economics. Given in the literature that the use of drugs, especially prescription, and illicit drugs, may be associated with side effects, the high epidemic of drug use for neuroenhancement also shown in the present paper underlines the new public health concern of neuroenhancement.

Odontogenic myxoma: a clinicopathological study in a South African population.

Odontogenic myxoma is a benign, locally aggressive neoplasm of the jaws. Prevalence rates range between 0.5% and 17.7% of odontogenic tumours. There are few reports in the literature on this lesion in African populations, and therefore, this study aimed to report on odontogenic myxoma in a South African population over a 40-year period. The clinical records and orthopantomograms of 29 histopathologically diagnosed odontogenic myxoma were retrospectively analysed. Details of age, gender, ethnic origin and clinical, histological as well as radiological features were recorded. The ages of patients ranged from 7 to 44 years with a mean of 21.3 years. The male-to-female ratio was 1:2.6 with the majority of patients being of mixed race and Africans. Clinically, 31% complained of pain while 58.6% had a history of swelling. The majority of odongenic myxomas (62.1%) were located in the mandible with the posterior region being most commonly affected. Multilocular lesions (69.2%) were more common and were significantly larger than unilocular lesions (P < 0.05). The outline of these tumours was mostly well-defined (84.6%) with different degrees of cortication. Only one tumour caused tooth resorption, while 20 cases (76.9%) caused tooth displacement. Six tumours expanded into the maxillary sinus, and 14 tumours caused expansion of the mandible. Odontogenic myxomas have variable clinical, radiological and histological features. Most of these features in this population were similar to other populations. It is mandatory to use conventional radiographs along with histopathological examination to aid in arriving at an accurate diagnosis.

Low Back Pain in Student Nurses: Literature Review and Prospective Cohort Study.

There is consensus that registered nurses worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Patient handling activities such as lifting present the highest risk of injury, activities that begin in nursing school. A literature review identified 21 studies of back pain in nursing students, indicating a wide range of prevalence rates. A prospective cohort study of nursing students in a United States baccalaureate program followed 119 students who completed the Nordic Musculoskeletal Questionnaire upon beginning the 16 month upper division major and then a year later. There was no statistically significant change in low back pain prevalence over time. While nursing students have intermittent and brief exposure to patient handling activities, nursing schools must nevertheless protect them before they enter the high risk profession of nursing by teaching evidence-based safe patient handling techniques, empowering students to refuse unsafe manual lifts, and ensuring that the clinical settings with which they affiliate have adequate mechanical equipment available.

Bestiality: An Overview and Analytic Discussion

Individuals who experience sexual and emotional attractions to animals are widely considered deviant in American society. Such a condition is frequently referred to as bestiality and zoophilia, which in fact describe two separate types of sexual behaviors. A multitude of studies have uncovered a range of prevalence rates across different demographic groups, which may vary due to the terminology and the type of data collection methods utilized. Dogs and horses are consistently chosen as the preferred animal to engage in sexual activities by humans, while male animals have been presented as the heavily favored sex of animal. It is questionable whether one's sexual orientation corresponds with the preference of the sex of the animal. Those engaged in human–animal sexual contacts vary in their reasoning behind their sexual behavior with animals, which are generally environmentally or belief based, and reinforce certain myths. Since the development of the Internet not only has it promoted an enhanced research perspective of the sexual behaviors of bestialists and zoophiles, but they have also found an environment populated by like-minded individuals with similar sexual behaviors/interests.

Renal Biopsy Diagnosis of IGA Nephropathy in Chin Refugees Living in the United States

IgA nephropathy (IgAN) is a common diagnosis in patients undergoing renal biopsy for hematuria and proteinuria, but histopathology may vary widely among affected patients. Worldwide, IgAN is the most common form of primary glomerulonephritis and is a leading cause of end-stage renal failure in patients presenting for renal replacement therapy. In the United States, prevalence rates of IgA nephropathy are only 2 to 10 percent while in Asia prevalence rates range from 20 to 40%. In Chin refugees relocated from Myanmar (formerly Burma) to a geographic area near our laboratory in the Midwestern United States (U.S.), IgAN was the most frequently encountered glomerulopathy detected in needle biopsy specimens. We report our biopsy experience with this small but unique cohort, many of whom have had little to no previous access to medical care.

A Vaginal Bowel-Control System for the Treatment of Fecal Incontinence

Fecal incontinence is a common problem in community-dwelling women. Prevalence rates range from 12% to 25%. The average age at onset is between 47 and 55 years. This condition is debilitating and emotionally devastating. Most women with fecal incontinence are socially isolated and do not seek care. Although the cause of fecal incontinence is multifactorial, there is often a history of damage to the pelvic region caused by pregnancy and childbirth, Contributory causes include congenital, neurologic, functional, and traumatic alterations of the continence mechanism. Current nonsurgical treatment options for fecal incontinence include antidiarrheal agents, fiber supplements, biofeedback therapy, passive anal barriers, and injectable agents. All have shortcomings in efficacy, morbidity, cost, and/or patient compliance. Surgical options such as anal sphincteroplasty, dynamic graciloplasty, and the artificial anal sphincter have higher morbidity than noninvasive treatments, and long-term results are disappointing. A nonsurgical vaginal bowel-control system (Eclipse System) was recently approved by the Food and Drug administration and is now available. The Eclipse System provides a low-risk, effective, and easily reversible treatment for fecal incontinence. This device consists of a vaginal insert and pressure-regulated pump that reversibly occludes the distal rectum, allowing the patient to control her own bowel movements. The aim of this prospective, open-label trial was to assess the effectiveness and safety of the Eclipse system in women with fecal incontinence. Women with a history of fecal incontinence for at least 6 months and a minimum of 4 incontinence episodes over 2 weeks were fitted with the device. Patients served as their own controls. The primary efficacy outcome was defined as a 50% or greater reduction in fecal incontinence episodes at 1 month and was assessed using a bowel diary. Participants successfully completing 1 month of use were invited into an optional extended-wear period of another 2 months. Secondary outcomes were validated measures of symptom improvement: the Fecal Incontinence Quality of Life scale, the Modified Manchester Health Questionnaire, and the Patient Global Impression of Improvement. Device-related adverse events were recorded. The intention-to-treat population was defined as all participants successfully fitted with the device. The per-protocol population included intention-to-treat participants with a valid 1-month treatment diary. A total of 110 participants from 6 clinical sites entered the fitting assessment. Of these, 61 (55.5%) were successfully fit and underwent treatment. At 1 month, treatment success was demonstrated in 78.7% (48/61) of participants in the intention-to-treat population and 85.7 (48/56) of those in the per-protocol population (both comparisons, P < 0.001). More than 85% of patients considered bowel symptoms to be very much better (57.1%) or much better (28.6%). There was also significant improvement at 1 month in all Fecal Incontinence Quality of Life (P < 0.001) and Modified Manchester (P ≤ 0.007) subscales. Nearly 90% of participants were satisfied with the device, and 98.2% would recommend it to others. There were no serious device-related adverse events; the most common study-wide event reported by 22.7% of women was pelvic cramping or discomfort. The majority (64%) of adverse events occurred during the fitting period. This nonsurgical bowel-control device offers a completely new treatment option for women with fecal incontinence. Women successfully fitted and treated with the device show significant improvement in fecal incontinence symptoms assessed by objective and subjective measures. The device is effective in most patients and has no serious adverse effects. Patient acceptance and satisfaction are high. A longer-term outcome study is being designed to provide additional information on potential adverse effects and tolerability as well as efficacy.

Female genital mutilation – why does it still exist in Africa?

Abstract Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the external female genitalia for non-medical reasons. FGM is practised in many parts of the world – including 28 African countries, some countries in the Middle East and Asia, and some population groups in Central and South America. Its prevalence rates range from 0.6% up to 97.9%, and it has been classified as a violation of human and children’s rights. Consequently, several countries have passed laws against the practice and many international programmes have been implemented to abandon it. Yet, FGM still prevails in many countries. This literature review aimed at identifying the underlying reasons for the perpetuation of FGM, ascertaining forces that foster its promotion and persistence and who is responsible for pushing its continuation. The main goal was to try to understand the underlying causes that make FGM resistant against initiatives and campaigns targeting its elimination. A literature search was carried out using several databases. All sources that approached the topic of FGM were incorporated including literature reviews, systematic reviews, qualitative and quantitative as well as mixed-method studies that described attitudes towards FGM and factors associated with its practice. Different factors that were interlinked could be identified at the individual, interpersonal, organisational/institutional as well as the community/societal level as the underlying causes of the perpetuation for FGM. These factors varied within and between different settings, and include individual characteristics such as parents’ level of education, place of residence, personal beliefs (aesthetics, health benefits, hygiene) about FGM as well as the medicalisation of FGM and the involvement of health care professionals at the institutional level. Cultural factors like gender inequality, social norms and pressure also played an important role. Surprisingly, no evidence that supported religious motives could be found in any of the three monotheistic religions. This review suggests that the reasons behind the performance of FGM differ between and within countries and contexts, but cannot be found in the scriptures even though it is mainly practiced by Muslims. Girls with low education living in small Muslim communities, in rural areas in Africa and whose parents especially the mother had a low educational level, were at increased risk of undergoing FGM. Successful actions to eliminate this practice require a balance between respect of culture and human rights. Practising communities should be involved in each step of every programme. Finally, it is crucial to target the young generations through education, women empowerment and reduction of gender inequality.