Factors influencing online health information seeking behaviour among patients in Kwahu West Municipal, Nkawkaw, Ghana.

Over the years, health care delivery and ways of accessing health information have transformed rapidly through the use of technology. The internet has played a key role in this advancement by serving as an important source of health information to people regardless of their location, language or condition. This cross sectional study was conducted in the Kwahu West Municipal to determine factors influencing online health information seeking behaviours among patients. Three hospitals in the municipality were purposively selected for the study. Outpatients attending these facilities were systematically selected and data was collected using structured interviewer administered questionnaire. The study findings revealed that internet usage rate among patients was 85.8%. However, only 35.7% of patients ever used the internet to access health information. Sex, education and average monthly income were significant factors associated with online health information seeking. The study also showed that, computer and internet experience factors increased the probability of using internet for health information. After adjusting for confounding factors; being employed, earning higher income and owning a computer were positive predictors of online health information seeking. It is important to explore other means of reducing the disparity in information access by improving skill and health literacy among the low social class who cannot afford internet ready devices. Health care providers should recognize that patients are seeking health information from the internet and should be prepared to assist and promote internet user skills among their patients.

Effectiveness of CT for the detection of glenoid bone graft resorption following reverse shoulder arthroplasty.

INTRODUCTION: Glenoid bone grafting is often used in cases of reverse shoulder arthroplasty (RSA) with glenoid deficiency. Additionally, bony increased-offset RSA (BIO-RSA) uses a cylindrical bonegraft harvested from the humeral head and is positioned beneath the glenoid baseplate to increase lateralization. Postoperative computed tomography (CT) has been used to detect glenoid bonegraft resorption, which is typically identified by a gap between the bonegraft and baseplate; however, CT images are often degraded by implant metal artifact. The purpose of this CT imaging study was to determine if a simulated bonegraft resorption gap is detectable following RSA with glenoid bone grafting. HYPOTHESIS: CT is unable to detect bone graft resorption following reverse shoulder arthroplasty conducted with bone grafting beneath the glenoid baseplate. MATERIALS AND METHODS: RSA with glenoid bone grafting was performed on four cadaver shoulders. Glenoid bonegraft resorption gaps were simulated by fixing the implant at six different gap widths (0, 1, 2, 4, 6 and 8mm). Clinical CT scans were acquired for each gap resulting in 6 scans per specimen. Two experienced observers (blinded) analyzed DICOM images in the axial and coronal directions, and measured gap widths using Mimics(®) software. Each observer had access to approximately 200 images per condition per specimen. RESULTS: The sensitivity of CT imaging to positively identify bonegraft resorption was 38%, with an accuracy of 46%. Inter-observer agreement was 92%. Observers tended to visualize no-gap for most conditions. Resorption gap width measurements were consistently underestimated. DISCUSSION: Metal artifact prevented identification of simulated bonegraft resorption gaps and observers most often determined that there was bonegraft-to-implant "healing" on CT, when in fact a gap was clinically present. This study illustrates the need for more effective imaging techniques to determine if bonegraft resorption has occurred following RSA.

Improving the diagnosis of LV non-compaction with cardiac magnetic resonance imaging.

BACKGROUND: Current diagnostic criteria for left ventricular non-compaction (LVNC) poorly correlate with clinical outcomes. We aimed to develop a cardiac magnetic resonance (CMR) based semi-automated technique for quantification of non-compacted (NC) and compacted (C) masses and to ascertain their relationships to global and regional LV function. METHODS: We analysed CMR data from 30 adults with isolated LVNC and 20 controls. NC and C masses were measured using relative signal intensities of myocardium and blood pool. Global and regional LVNC masses was calculated and correlated with both global and regional LV systolic function as well as occurrence of arrhythmia. RESULTS: LVNC patients had significantly higher end-systolic (ES) and end-diastolic (ED) NC:C ratios compared to controls (ES 0.21 [SD 0.09] vs. 0.12 [SD 0.02], p<0.001; ED 0.39 [SD 0.08] vs. 0.26 [SD 0.05], p<0.001). NC:C ratios correlated inversely with global ejection fraction, with a stronger correlation in ES vs. ED (r=-0.58, p<0.001 vs. r=-0.30, p=0.03). ES basal, mid and apical NC:C ratios also showed a significant inverse correlation with global LV ejection fraction (ES basal r=-0.29, p=0.04; mid-ventricular r=-0.50, p<0.001 and apical r=-0.71, p<0.001). Upon ROC testing, an ES NC:C ratio of 0.16 had a sensitivity of 70% and a specificity of 95% for detection of significant LVNC. Patients with sustained ventricular tachycardia had a significantly higher ES NC:C ratio (0.31 [SD 0.18] vs. 0.20 [SD 0.06], p=0.02). CONCLUSIONS: The NC:C ratio derived from relative signal intensities of myocardium and blood pool improves the ability to detect clinically relevant NC compared to previous CMR techniques.

Barriers to cancer screening for people with disabilities: a literature review.

BACKGROUND: Over 50 million Americans are currently living with some form of disability. Studies have shown that people with disabilities are underinsured, have less access to health care, and are more likely to engage in risky health behavior. Routine preventive screenings for breast, cervical and colorectal cancer are recommended for all adults to improve early detection and treatment of cancer. Although early detection of cancer offers the best chances for treatment and survival, cancer screening has been limited for many people with disabilities. OBJECTIVE: To present results of a scoping review of studies focused on barriers to cancer screening for people with disabilities. METHODS: Online databases were searched for research articles on barriers to cancer screening (breast, cervical, prostate, and colorectal) in people with disabilities. RESULTS: Thirty-five peer-reviewed articles met inclusion criteria. Existing research on cancer screenings, particularly prostate cancer, among people with disabilities is limited. Current studies suggest that those with advanced disabilities are not being screened for cancer as often as the able-bodied population with the exception of military veterans. Education, income, age, employment, screening history, tobacco use, activity level, disability level, and geography affected screening rates. CONCLUSIONS: Barriers include cost, access, health care provider discomfort, and physical and cognitive restraints. Future interventions to improve routine preventive cancer screenings rates could include specialized health care provider training, community interventions, emphasis on the value of health promotion and the specific health care needs of people with disabilities.

Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study.

OBJECTIVE: To investigate, among women who have had a third- or fourth-degree perineal tear, the mode of delivery in subsequent pregnancies as well as the recurrence rate of third- or fourth-degree tears. DESIGN: A retrospective cohort study of deliveries using a national administrative database. SETTING: The English National Health Service between 1 April 2004 and 31 March 2012. POPULATION: A total of 639,402 primiparous women who had a singleton, term, vaginal live birth between April 2004 and March 2011, and a second birth before April 2012. METHODS: Multivariable logistic regression models were used to estimate odds ratios, adjusted for other risk factors. MAIN OUTCOME MEASURES: Mode of delivery and recurrence of tears at second birth. RESULTS: The rate of elective caesarean at second birth was 24.2% for women with a third- or fourth-degree tear at first birth, and 1.5% for women without (adjusted odds ratio, aOR 18.3, 95% confidence interval, 95% CI 16.4-20.4). Among women who had a vaginal delivery at second birth, the rate of third- or fourth-degree tears was 7.2% for women with a third- or fourth-degree tear at first birth, compared with 1.3% for women without (aOR 5.5, 95% CI 5.2-5.9). CONCLUSIONS: The risk of a severe perineal tear is increased five-fold in women who had a third- or fourth-degree tear in their first delivery. This increased risk should be taken into account when decisions about mode of delivery are made.

Vaginal birth after caesarean section: a cohort study investigating factors associated with its uptake and success.

OBJECTIVES: To investigate the demographic and obstetric factors associated with the uptake and success rate of vaginal birth after caesarean section (VBAC). DESIGN: Cohort study using data from Hospital Episode Statistics. SETTING: English National Health Service. POPULATION: Women whose first birth resulted in a live singleton delivery by caesarean section between 1 April 2004 and 31 March 2011, and who had a second birth before 31 March 2012. METHODS: Logistic regression to estimate adjusted odds ratios (OR). MAIN OUTCOME MEASURES: Attempted and successful VBAC. RESULTS: Among the 143,970 women in the cohort, 75,086 (52.2%) attempted a VBAC for their second birth. Younger women, those of non-white ethnicity and those living in a more deprived area had higher rates of attempted VBAC. Overall, 47,602 women (63.4%) who attempted a VBAC had a successful vaginal birth. Younger women and women of white ethnicity had higher success rates. Black women had a particularly low success rate (OR, 0.54; 95% confidence interval [CI], 0.50-0.57). Women who had an emergency caesarean section in their first birth also had a lower VBAC success rate, particularly those with a history of failed induction of labour (OR, 0.59; 95% CI, 0.53-0.67). CONCLUSION: In this national cohort, just over one-half of women with a primary caesarean section who were eligible for a trial of labour attempted a VBAC for their second birth. Of these, almost two-thirds successfully achieved a vaginal delivery.

Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors.

OBJECTIVE: To describe the trends of severe perineal tears in England and to investigate to what extent the changes in related risk factors could explain the observed trends. DESIGN: A retrospective cohort study of singleton deliveries from a national administrative database. SETTING: The English National Health Service between 1 April 2000 and 31 March 2012. POPULATION: A cohort of 1 035 253 primiparous women who had a singleton, term, cephalic, vaginal birth. METHODS: Multivariable logistic regression was used to estimate the impact of financial year of birth (labelled by starting year), adjusting for major risk factors. MAIN OUTCOME MEASURE: The rate of third-degree (anal sphincter is torn) or fourth-degree (anal sphincter as well as rectal mucosa are torn) perineal tears. RESULTS: The rate of reported third- or fourth-degree perineal tears tripled from 1.8 to 5.9% during the study period. The rate of episiotomy varied between 30 and 36%. An increasing proportion of ventouse deliveries (from 67.8 to 78.6%) and non-instrumental deliveries (from 15.1 to 19.1%) were assisted by an episiotomy. A higher risk of third- or fourth-degree perineal tears was associated with a maternal age above 25 years, instrumental delivery (forceps and ventouse), especially without episiotomy, Asian ethnicity, a more affluent socio-economic status, higher birthweight, and shoulder dystocia. CONCLUSIONS: Changes in major risk factors are unlikely explanations for the observed increase in the rate of third- or fourth-degree tears. The improved recognition of tears following the implementation of a standardised classification of perineal tears is the most likely explanation.

Severe neurological decompression sickness in a U-2 pilot.

Severe neurological decompression sickness (DCS) has been a rare entity in the U.S. Air Force, including the U-2 community. In over 50 yr of operation, few U-2 pilots reported severe neurological DCS in flight despite the extreme altitudes at which they operate. This article describes a near-fatal case of neurological DCS that occurred during a combat mission. The injury left the pilot with permanent cognitive deficits that correlated with focal lesions present on magnetic resonance imaging of his brain. To our knowledge, the images presented herein are the first to show radiological evidence of brain injury induced by altitude DCS. Though only a single case, the objective and clinical findings in the case pilot are similar to results documented in divers suffering DCS with central nervous system injury and victims of traumatic brain injury. DCS will remain a potentially serious threat to current and future air and space operations.

Variation in endophyte-plant associations influence black cutworm (Lepidoptera: Noctuidae) performance and susceptibility to the parasitic nematode Steinernema carpocapsae.

This study examined how variability in Neotyphodium endophyte-grass associations influences black cutworm Agrotis ipsilon Hufnagel performance and susceptibility to the entomopathogenic nematode Steinernema carpocapsae (Weiser). Second-instar cutworm larvae were confined to greenhouse pots containing four different tall fescue Schedonorus phoenix (Scop.) Holub cultivars. After 1 wk, larvae were recovered from the pots, weighed, and individually exposed to 20 infective juvenile nematodes. Nematode-induced mortality was monitored for 72 h after exposure. Endophyte infection levels and ergot alkaloid concentrations varied between tall fescue cultivars, but endophyte infection level was not a significant predictor of ergot alkaloid concentrations in above-ground plant tissue. Larval survival also varied between cultivars, but neither endophyte infection level nor ergot alkaloid concentration was a significant covariate. Larval susceptibility to the entomopathogenic nematode varied between cultivars at 48 and 72 h after exposure. In all but one cultivar (Plantation), cumulative mortality at 72 h decreased significantly as ergot alkaloid concentrations increased. Neither larval biomass nor endophyte infection levels in tall fescue were significant predictors of larval susceptibility to the nematode. Results show that variation in endophyte-plant associations can influence black cutworm performance and susceptibility to entomopathogenic nematodes and that susceptibility to the nematode H. bacteriophora may be partially tied to ergot alkaloid levels in the insects' food. Findings further support the assertion that black cutworm may use certain endophyte-mediated toxins, particularly ergot alkaloids, as a form of acquired chemical defense against nematode-induced septicaemia.

Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasound.

OBJECTIVE: To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter. DESIGN: A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed. METHODS: To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test-retest analysis. Kappa agreement was calculated to assess intra-observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans. MAIN OUTCOME MEASURES: Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra-observer and gold standard versus observer kappa values of experienced clinicians (A-E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations. CONCLUSIONS: LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms.

Case reports: cutaneous small vessel vasculitis due to famciclovir therapy.

Cutaneous hypersensitivity vasculitis is often idiopathic, but may be the result of therapeutic drugs. It is important to be aware of previously unreported drugs that may be associated with this complication. We report a case of cutaneous hypersensitivity vasculitis due to famciclovir therapy. To our knowledge, this is the first report of this interaction in the medical literature in English.

Denaturing high performance liquid chromatography: high throughput mutation screening in familial hypertrophic cardiomyopathy and SNP genotyping in motor neurone disease.

AIMS: To evaluate the usefulness of denaturing high performance liquid chromatography (DHPLC) as a high throughput tool in: (1) DNA mutation detection in familial hypertrophic cardiomyopathy (FHC), and (2) single nucleotide polymorphism (SNP) discovery and validation in sporadic motor neurone disease (MND). METHODS: The coding sequence and intron-exon boundaries of the cardiac beta myosin heavy chain gene (MYH7) were screened by DHPLC for mutation identification in 150 unrelated patients diagnosed with FHC. One hundred and forty patients with sporadic MND were genotyped for the A67T SNP in the poliovirus receptor gene. All DHPLC positive signals were confirmed by conventional methods. RESULTS: Mutation screening of MYH7 covered 10 kb with a total of 5700 amplicons, and more than 6750 DHPLC injections were completed within 35 days. The causative mutation was identified in 14% of FHC cases, including seven novel missense mutations (L227V, E328G, K351E, V411I, M435T, E894G, and E927K). Genotyping of the A67T SNP was performed at two different temperatures both in MND cases and 280 controls. This coding SNP was found more frequently in MND cases (13.6%) than in controls (6.8%). Furthermore, 19 and two SNPs were identified in MYH7 and the poliovirus receptor gene, respectively, during DHPLC screening. CONCLUSIONS: DHPLC is a high throughput, sensitive, specific, and robust platform for the detection of DNA variants, such as disease causing mutations or SNPs. It enables rapid and accurate screening of large genomic regions.

National audit of incontinence surgery in the United Kingdom.

The aim of the study was to describe the experience, current trends and management of incontinence surgery for urodynamic stress incontinence (USI) in the United Kingdom. The study was a postal questionnaire survey that was sent to a cohort of surgeons known to be performing continence surgery. The subjects addressed included the considered role of the surgeon, the total number and type of operations performed in the last year, urodynamics and physiotherapy prior to incontinence surgery, operative complications, postoperative advice and follow-up (lengths and methods). The response rate was 54%. Large variations were found in all areas. The survey provides evidence of the number of incontinence operations performed, potentially important trends and differences in the practice and management of incontinence in the United Kingdom. This survey may be helpful in making guidelines and standards for audit at regional, local and individual levels as well as recommendations for strategies to enhance professional expertise in urogynaecology in the United Kingdom.

Tension-free vaginal tape (TVT) in the United Kingdom.

Four hundred and twenty-six surgeons identified as performing TVT in the United Kingdom in the year ended 1 January 2002 were sent a postal questionnaire to identify the technique employed and the complications encountered. An 81% response rate was achieved. Over 7000 TVT operations were reported. Large numbers of surgeons perform a small number of operations each year. A variety of different surgical techniques and anaesthetics are used. Bladder perforations have been reported by 44% and de novo bladder overactivity by 37% of surgeons. Tape erosion is seen in 0.33%. Twenty-eight per cent of surgeons have seen voiding abnormalities that persist for more than 6 weeks. Fifty-seven per cent of surgeons perform short-term follow-up only. The operation is performed in a variety of different ways, by surgeons with variable experience and volumes of work. The different surgical techniques have not been evaluated prospectively and complications are seen more commonly than originally reported.

Knowledge of female bladder care among medical staff, nurses and midwives: results of a questionnaire survey.

OBJECTIVE: To determine knowledge about bladder care among junior medical staff and allied health professionals, and to examine any difference in knowledge among the subgroups. SUBJECTS AND METHODS: Using a single-questionnaire survey in a large obstetrics and gynaecology Hospital Trust in an inner city setting, midwives, nurses and medical staff (not consultants) were asked eight questions about different aspects of female bladder physiology and care. The differences in responses among the professional groups were assessed. RESULTS: In all, 120 completed questionnaires were returned (32 doctors, 40 nurses, and 48 midwives). Knowledge was similar on urethral length, bladder capacity, daily fluid intake, ideal size of catheter, catheter balloon size, and the maximum time of use of a short-term catheter. Correct responses for normal daily fluid intake, duration of both short and long-term catheterization were given by fewer than half the respondents. There were significant differences among the professional groups in the correct response rate for long-term catheter duration (P = 0.031) and the normal time interval between voids (P = 0.038). CONCLUSION: There were significant differences in the knowledge of all subgroups about bladder care, and poor levels of knowledge in several areas. This is a potentially serious problem for women at risk of bladder complications after gynaecological surgery and childbirth. All staff involved in managing women after childbirth and gynaecological surgery should have formal training in bladder care, to optimize patient care.

Black cutworm (Lepidoptera: Noctuidae) larval emigration and biomass in mixtures of endophytic perennial ryegrass and Kentucky bluegrass.

Studies examined the possibility that mixtures of endophytic perennial ryegrass and Kentucky bluegrass provide resistance against larvae of the black cutworm, Agrotis ipsilon (Hufnagel). We hypothesized that resistance against A. ipsilon in such stands would stem from the influence of Kentucky bluegrass on A. ipsilon growth and behavior rather than the influence of endophytic perennial rvegrass. In replicated greenhouse experiments, black cutworm larvae initially emigrated more quickly from pots containing monocultures of endophytic perennial ryegrass than from Kentucky bluegrass monocultures or polycultures of Kentucky bluegrass and endophytic perennial ryegrass. However, biomass of emigrating larvae decreased linearly as the proportion of Kentucky bluegrass increased. Turfgrass mixtures containing endophytic perennial ryegrass and Kentucky bluegrass may provide resistance against A. ipsilon mainly through the physiological effects of Kentucky bluegrass on A. ipsilon growth and development, but possibly through the influence of endophytic perennial ryegrass on A. ipsilon movement and foraging behavior as well.

Contraception. Myths, facts and methods.

OBJECTIVES: After reading this article, the reader should be able to: 1. Recognize the mechanism of action, side effects, contraindications, precautions and instructions for use of a variety of contraceptive methods. 2. Understand the advantages and disadvantages of the various contraceptive methods. 3. List the common myths and misconceptions about conception and contraception, and recognize how they can influence contraceptive decisions. Unintended pregnancy is a serious problem in the United States. Counseling a patient about conception and contraception involves more than simply imparting information and answering questions. Clinicians should actively detect and correct any myths and misapprehensions on the patient's part. These myths are quite common and can interfere with treatment if not attended to. This article summarizes common myths about pregnancy and contraception and reviews the key facts about both.

Hairy chinch bug (Hemiptera: Lygaeidae) damage, population density, and movement in relation to the incidence of perennial ryegrass infected by Neotyphodium endophytes.

Studies examined hairy chinch bug, Blissus leucopterus hirtus Montandon, damage, population density, and movement in stands of perennial ryegrass, Lolium perenne L., containing various proportions of endophyte infected plants (E+). Our main objective was to determine the utility of mixtures containing E+ for management of chinch bugs. Chinch bug damage and population density decreased linearly as the proportion of E+ increased. This trend held true even when chinch bug populations were extremely high. Chinch bug nymphs emigrated more quickly from stands containing 100% E+ than they did from stands containing 50 or 0% E+, whereas adult chinch bug emigration was relatively unaffected by the proportion of E+. Our results indicate that turfgrass mixtures containing E+ can reduce chinch bug damage and population density.

Role of mitotic control in spermatogenesis.

OBJECTIVE: To study the correlation between the incidence of sex chromosome aneuploidies in the somatic cells and spermatozoa in karyotypically normal infertile men and fertile donors. DESIGN: A prospective, phase two, controlled study. SETTING: A teaching Hospital Reproductive Medicine and Medical Genetics Units. PATIENT(S): Ten patients with idiopathic oligozoospermia and 10 sperm donors with proven fertility, all with a normal karyotype 46, XY. INTERVENTION(S): Multicolor fluorescence in situ hybridization (FISH) of peripheral blood lymphocytes and spermatozoa using a probe cocktail containing the alpha satellite DXZ1 for the X centromere, DYZ1 for the heterochromatic region of the long arm of the Y, and cosmids D21S259, D21S341, and D21S342 for Down syndrome critical region of chromosome 21. MAIN OUTCOME MEASURE(S): The incidence of chromosome X, Y, and 21 aneuploidies in peripheral lymphocytes and spermatozoa in both groups. RESULT(S): The incidence of aneuploidies related to chromosomes X, Y, and 21 were significantly higher in peripheral lymphocytes and spermatozoa of infertile men compared with donors. There was a positive correlation between the incidence of chromosome aneuploidies in the somatic cells and sperm in all men. CONCLUSION(S): These findings provide suggestive evidence for the importance of mitosis in spermatogenesis and the role of mitotic instability in unexplained oligozoospermia.