Oral versus intravenous hypertonic saline for exercise-associated hyponatraemia.

Exercise-associated hyponatraemia is a potentially serious acute condition that may present early as asymptomatic or mildly symptomatic. Standard treatment is intravenous hypertonic saline, which can be challenging and carries some risk. An alternative may be oral therapy. We undertook a review of existing literature to assess whether paediatric populations should receive oral or intravenous hypertonic saline solutions. One study addressed our question but was aimed at a presumably adult population of runners. That study found that intravenous and oral solutions provide similar effects on biochemistry, but intravenous hypertonic saline provides superior effects on subjective relief and plasma volume.

Fluoroquinolone-Associated Tendinopathy of the Hand and Wrist: A Systematic Review and Case Report.

BACKGROUND: Fluoroquinolone use has been known to be associated with tendinopathy and tendon rupture for over 30 years. Hand and wrist involvement has been reported rarely, yet without early recognition and withdrawal of the fluoroquinolone, there is potential for significant morbidity. METHODS: We searched Medline using a comprehensive search strategy for fluoroquinolones and tendinopathy of the hand and wrist, and provide a case report of a possible levofloxacin-related tendon rupture in a patient with a previous mutilating hand injury. RESULTS: We located 10 previously reported cases of fluoroquinolone-associated tendinopathy in the hand or wrist ranging from 1983 to 2015. Unlike Achilles tendinopathy, women were no more likely than men to have tendon rupture affecting the hands or wrists. Our patient was a 59-year-old man with prior tendon repair but otherwise noncontributory medical history who experienced spontaneous tendon rupture on an extended course of levofloxacin and required extensive pulley and boutonnière repair. CONCLUSIONS: Given the extensive damage that may be caused to weakened tissue, clinicians should maintain a high index of suspicion of tendinopathy in patients taking fluoroquinolones who have had previous tendon repairs, particularly in the setting of unexplained changes in recovery trajectory.

Risk and blood-borne virus testing among men who inject image and performance enhancing drugs, Sydney, Australia.

INTRODUCTION AND AIMS: Needle and syringe program (NSP) workers have highlighted that people who inject image and performance enhancing drugs (IPED) in Australia are a younger and more culturally and linguistically diverse (CALD) group compared with other groups who inject drugs. Previous research has found riskier injecting practices and faster Hepatitis C acquisition rates among people who are new to injecting drugs and self-identify with CALD backgrounds, compared with their Anglo-Australian counterparts. Given recent indications of increasing IPED prevalence in Australia and elsewhere, this study sought to update knowledge of infection risk among a large group of IPED injectors, as well as explore sub-group differences. DESIGN AND METHODS: A cross-sectional survey of men who inject IPEDs was conducted from September 2014 to January 2015 at nine NSP sites, across five local health districts in Sydney, Australia. RESULTS: Six hundred and five people participated. Small proportions reported previous 12month needle or syringe sharing (2.3%), sharing vials (4.6%), injecting psychostimulants (5.1%) or personal needle or syringe reuse (5.2%). Participants from CALD backgrounds were more likely to report sharing needles or syringes (P = 0.004), and participants from Middle Eastern and North African backgrounds were less likely to have ever been tested for blood-borne viruses, compared with Anglo-Australian participants (P = 0.04). DISCUSSION AND CONCLUSIONS: The findings show that some groups who inject IPEDs may be more vulnerable to blood-borne virus transmission and/or less likely to know their blood-borne virus status. From design to delivery, IPED harm minimisation strategies should pay attention to the needs of CALD groups.

Smoking Cessation Programs for Lesbian, Gay, Bisexual, Transgender, and Intersex People: A Content-Based Systematic Review.

INTRODUCTION: Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and aging. Despite associations between smoking and noncommunicable diseases relevant to aging and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalized populations without modification and evaluation may fail and exacerbate inequities. AIMS: To assess outcomes and characterize the populations served, cultural modifications, and behavior change techniques (BCTs) of interventions to reduce LGBTI smoking. METHODS: We searched MEDLINE, six additional databases, and contacted authors to retrieve published and unpublished program evaluations. RESULTS: We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 included lesbians, 13 "LGBT," 12 bisexual people, five transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences. CONCLUSIONS: Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men. IMPLICATIONS: This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions' success.

Cognition in chronic kidney disease: a systematic review and meta-analysis.

BACKGROUND: Cognitive impairment is common in people with chronic kidney disease (CKD) and associated with increased morbidity and mortality. Subtle changes can impact engagement with healthcare, comprehension, decision-making, and medication adherence. We aimed to systematically summarise evidence of cognitive changes in CKD. METHODS: We searched MEDLINE (March 2016) for cross-sectional, cohort or randomised studies that measured cognitive function in people with CKD (PROSPERO, registration number CRD42014015226). The CKD population included people with eGFR < 60 mL/min/1.73 m2, not receiving renal replacement therapy, in any research setting. We conducted a meta-analysis using random effects, expressed as standardised mean differences (SMD) with 95% confidence intervals (CI). Outcomes were performance in eight cognitive domains. Bias was assessed with the Newcastle-Ottawa Scale (NOS). RESULTS: We identified 44 studies reporting sufficient data for synthesis (51,575 participants). Mean NOS score for cohort studies was 5.8/9 and for cross-sectional 5.4/10. Studies were deficient in NOS outcome and selection due to poor methods reporting and in comparison group validity of demographics and chronic disease status. CKD patients (eGFR < 60 mL/min/1.73 m2) performed worse than control groups (eGFR ≥ 60 mL/min/1.73 m2) on Orientation & Attention (SMD -0.79, 95% CI, -1.44 to -0.13), Language (SMD -0.63, 95% CI, -0.85 to -0.41), Concept Formation & Reasoning (SMD -0.63, 95% CI, -1.07 to -0.18), Executive Function (SMD -0.53, 95% CI, -0.85 to -0.21), Memory (SMD -0.48, 95% CI, -0.79 to -0.18), and Global Cognition (SMD -0.48, 95% CI, -0.72 to -0.24). Construction & Motor Praxis and Perception were unaffected (SMD -0.29, 95% CI, -0.90 to 0.32; SMD -1.12, 95% CI, -4.35 to 2.12). Language scores dropped with eGFR (<45 mL/min/1.73 m2 SMD -0.86, 95% CI, -1.25 to -46; 30 mL/min/1.73 m2 SMD -1.56, 95% CI, -2.27 to -0.84). Differences in Orientation & Attention were greatest at eGFR < 45 mL/min/1.73 m2 (SMD -4.62, 95% CI, -4.68 to -4.55). Concept Formation & Reasoning differences were greatest at eGFR < 45 mL/min/1.73 m2 (SMD -4.27, 95% CI, -4.23 to -4.27). Differences in Executive Functions were greatest at eGFR < 30 mL/min/1.73 m2 (SMD -0.54, 95% CI, -1.00 to -0.08). CONCLUSIONS: Cognitive changes occur early in CKD, and skills decline at different rates. Orientation & Attention and Language are particularly affected. The cognitive impact of CKD is likely to diminish patients' capacity to engage with healthcare decisions. An individual's cognitive trajectory may deviate from average.

Global Distribution of Businesses Marketing Stem Cell-Based Interventions.

A structured search reveals that online marketing of stem-cell-based interventions is skewed toward developed economies including the United States, Ireland, Australia, and Germany. Websites made broad, imprecise therapeutic claims and frequently failed to detail procedures. Widespread marketing poses challenges to regulators, bioethicists, and those seeking realistic hope from therapies.

Interventions to reduce sexual prejudice: a study-space analysis and meta-analytic review.

Sexual prejudice is an important threat to the physical and mental well-being of lesbians, gay men, and bisexual people. Therefore, we reviewed the effectiveness of interventions designed to reduce such prejudice. A study-space analysis was performed on published and unpublished papers from all over the world to identify well-studied and underexplored issues. Most studies were conducted with North American undergraduates and were educational in nature. Dissertations were often innovative and well designed but were rarely published. We then performed meta-analyses on sets of comparable studies. Education, contact with gay people, and combining contact with education had a medium-size effect on several measures of sexual prejudice. The manipulation of social norms was effective in reducing antigay behavior. Other promising interventions, such as the use of entertainment media to promote tolerance, need further investigation. More research is also needed on populations other than American students, particularly groups who may have higher levels of sexual prejudice.

[Profile of a medical auditing group in the state of Rio Grande do Sul]. / Perfil dos médicos auditores no estado do Rio Grande do Sul.

BACKGROUND: This paper aims to determine the profile of the medical auditor in the State of Rio Grande do Sul, Brazil, based upon a group of physicians who participated in the post-graduation courses of Unimed Foundation Health Auditing, in the cities of Porto Alegre and Caxias do Sul, together with other professionals performing the same activity in the State of Rio Grande do Sul. METHODS: A historical review, a study of the laws and norms that guide the role of the Medical Auditor is presented as well as a review of the literature on medical auditing in Brazil. A non identifiable questionnaire was administered, where questions on personal data and professional training were made, as well as others related to personal satisfaction, health and well-being. RESULTS: The questionnaire was answered by 71 Medical Auditors, with a total of 85 positions in medical auditing at several workplaces. 83.8% are male, ages ranging from 41 to 50 years (38%), on the average they had been graduated for 21.96 +/- 7.68 years, performing medical auditing activities for 7.24 +/- 6.62 years and 88.7% hold a medical academic title and/or medical specialization courses in several areas. In the group researched, 25.37% are formally employed 60% are personally and professionally satisfied and are physically well. In the interviewed group, there are no physicians under 33 years of age nor any graduated for less than 7 years. CONCLUSIONS: A high level of medical education, specialization and updating is evident among the Medical Auditors that were interviewed. Data from the present study will contribute for the definition of the Brazilian Medical Auditor's Profile.

Perfil dos médicos auditores no estado do Rio Grande do Sul / Profile of a medical auditing group in the state of Rio Grande do Sul

OBJETIVO: O presente artigo analisa o perfil do médico auditor no Estado do Rio Grande do Sul, tomando por base o grupo de médicos que participou dos cursos de pós-graduação em Auditoria em Saúde, Fundação Unimed, nas cidades de Porto Alegre e Caxias do Sul. MÉTODOS: Apresentamos uma revisão histórica, estudo das leis e normas que regem a função de médico auditor e uma revisão bibliográfica sobre a auditoria médica no Brasil. Foi aplicado um instrumento fechado, no qual constavam dados pessoais e de formação profissional, assim como relativos à satisfação pessoal, saúde e bem-estar do entrevistado. RESULTADOS: Responderam ao questionário 71 médicos auditores com um total de 85 funções de auditoria médica em locais diversos de trabalho: 83,8 por cento do sexo masculino, com faixa de idade preponderante de 41 a 50 anos (38 por cento), formados em média há 21,96 +/- 7,68 anos, com tempo de atuação em auditoria médica de 7,24 +/- 6,62 anos, e 88,7 por cento possuem títulos universitários e/ou cursos de especialização médica nas mais diversas áreas de atuação. Do grupo pesquisado, 25,37 por cento têm relação formal de emprego, 60 por cento encontram-se satisfeitos como pessoa e como profissional, estando bem fisicamente. No grupo entrevistado, não existem médicos com menos de 33 anos de idade nem formados há menos de 7 anos. CONCLUSÕES: Fica evidente o alto grau de formação, especialização e de atualização dos médicos auditores entrevistados. O presente estudo contribuirá para que se possa estabelecer o perfil do médico auditor brasileiro.