Open pilot trial of an interactive digital application for campus sexual violence prevention.

Digital applications, or "serious games" for health address learning goals in a cognitively active, interactive manner, with the potential for widespread dissemination. This study used a mixed methods approach to develop and conduct a formative evaluation of a digital application for sexual assault prevention. Make a change is a digital application that uses the principles of games for health to foster learning, engagement, and skill-building around risk and protective factors for sexual victimization, sexual aggression, and bystander intervention. The digital application includes four narrative chapters, six embedded activities, as well as a user-derived change plan in which individuals establish goals for behavior change following program completion. This multisite study at a 2- and a 4-year college utilized student interviews (n = 14), stakeholder interviews (n = 10), and focus groups with students (n = 40) to inform intervention development. A total of 41 college students then participated in an open trial and completed self-report surveys (pre, post, and 1-month follow-up) to evaluate the feasibility, acceptability, utility, and preliminary outcomes. Most of the sample reported enjoyment, usefulness, and perceived competence after completing the application. Data evidenced a trend to reduce the frequency of heavy drinking, and perceptions of social norms evidenced change over time. Findings support the feasibility and effectiveness of this novel format for the delivery of sexual assault prevention programming.

Managing challenges in congenital CMV: current thinking.

Congenital human cytomegalovirus (CMV) infection is the most common congenital infection, affecting around 1 in 200 infants in high-income settings. It can have life-long consequences for up to one in four children, including sensorineural hearing loss and neurodisability. Despite the frequency of congenital CMV and the severity for some children, it is a little-known condition by pregnant women, families and healthcare providers. Timely diagnosis of CMV infection in pregnancy is important to facilitate consideration of treatment with valaciclovir, which may reduce the risk of transmission to the fetus or reduce the severity of the outcomes for infected infants. Recognition of features of congenital CMV is important for neonatologists, paediatricians and audiologists to prompt testing for congenital CMV within the first 21 days of life. Early diagnosis gives the opportunity for valganciclovir treatment, where appropriate, to improve outcomes for affected infants. Further research is urgently needed to inform decisions about antenatal and neonatal screening, long-term outcomes for asymptomatic and symptomatic infants, predictors of these outcomes and optimal treatment for women and infants.

Paediatric health-related quality of life in congenital cytomegalovirus.

OBJECTIVE: Congenital cytomegalovirus (cCMV) is the most common congenital infection globally. This cross-sectional study aimed to describe the health-related quality of life (HRQoL) of children with cCMV and that of their parents. METHODS: Families of children with cCMV in the UK were approached through the charity CMV Action. Parents completed questionnaires about their own HRQoL and that of their child. Children who were able to self-report completed questionnaires about their own HRQoL. Demographic characteristics of the sample were described using descriptive statistics. Questionnaire responses were scored, and domain and summary scores were calculated and compared with UK population norms, where available. RESULTS: Seventy families participated, with children aged between 5 months and 18 years. Children with cCMV had poorer HRQoL compared with children from UK population data. HRQoL of children whose health was more severely affected by cCMV was poorer than that of children whose health was less severely affected. Parents of children whose health was moderately or severely affected had greater psychological morbidity and poorer HRQoL in physical, emotional, social, and cognitive functioning domains than parents of less severely affected children. CONCLUSIONS: cCMV has a significant effect on the HRQoL of children with cCMV and their parents, with the children with the most significant health needs having the lowest HRQoL compared with those children with little or no effects on their health. This data could contribute to health economic analyses, informing resource allocation to potential interventions for the prevention and treatment of cCMV.

Changing knowledge, attitudes and behaviours towards cytomegalovirus in pregnancy through film-based antenatal education: a feasibility randomised controlled trial of a digital educational intervention.

BACKGROUND: Congenital cytomegalovirus (CMV) is the most common congenital infection globally, however information about CMV is not routinely included in antenatal education in the United Kingdom. This feasibility study aimed to gather the essential data needed to design and power a large randomised controlled trial (RCT) to investigate the efficacy of a digital intervention in reducing the risk of CMV acquisition in pregnancy. In order to do this, we carried out a single-centre RCT, which explored the knowledge, attitudes and risk reduction behaviours in women in the intervention and treatment as usual groups, pre- and post-intervention. METHODS: CMV seronegative women living with a child less than four years old, receiving antenatal care at a single UK tertiary centre, were randomised to the digital intervention or 'treatment as usual' groups. Participants completed questionnaires before the digital intervention and after and at 34 gestational weeks, and responses within groups and between groups were compared using tailored randomisation tests. CMV serology was tested in the first trimester and at the end of pregnancy. RESULTS: Of the 878 women screened, 865 samples were analysed with 43% (n = 372) being CMV seronegative and therefore eligible to take part in the RCT; of these, 103 (27.7%) women were enrolled and 87 (84%) of these completed the study. Most participants (n = 66; 64%) were unfamiliar with CMV at enrolment, however at 34 gestational weeks, women in the intervention group (n = 51) were more knowledgeable about CMV compared to the treatment as usual group (n = 52) and reported engaging in activities that may increase the risk of CMV transmission less frequently. The digital intervention was highly acceptable to pregnant women. Overall, four participants seroconverted over the course of the study: two from each study group. CONCLUSIONS: A large multi-centre RCT investigating the efficacy of a CMV digital intervention is feasible in the United Kingdom; this study has generated essential data upon which to power such a study. This single-centre feasibility RCT demonstrates that a digital educational intervention is associated with increase in knowledge about CMV and can result in behaviour change which may reduce the risk of CMV acquisition in pregnancy. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03511274 , Registered 27.04.18, http://www.Clinicaltrials.gov.

The nutritional and cardiovascular health benefits of rapeseed oil-fed farmed salmon in humans are not decreased compared with those of traditionally farmed salmon: a randomized controlled trial.

PURPOSE: Farmed fish are increasingly raised on feeds containing vegetable oils, which affects their composition and possibly health properties. We investigated the effects of consuming farmed salmon, raised on different feeding regimes, on nutrient status and health outcomes in healthy subjects. METHODS: Salmon were grown on feeds containing mainly fish oil (FO) or rapeseed oil (RO), resulting in an eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) content of fillets of 2.1 or 0.9 g/100 g, respectively. In a randomized parallel controlled trial, 51 healthy subjects were allocated to consume 2 portions/week of FO salmon (n = 17), RO salmon (n = 17) or no additional salmon (Control, n = 17) as part of their habitual diet, for 18 weeks. We collected blood at 0, 9 and 18 weeks to measure omega-3 index (O3I) in red blood cells, plasma markers of cardiovascular risk, serum 25(OH)-vitamin D3 (25(OH)D3) and plasma trace elements. RESULTS: After 18 weeks, O3I was similarly increased in subjects consuming 2 portions/week of FO or RO salmon compared to control (both p < 0.05). Serum 25(OH)D3 was significantly higher, whereas plasma triacylglycerols were significantly lower in subjects consuming RO salmon compared to control (both p < 0.05). Heart rate was significantly lower in subjects consuming FO salmon after 9 weeks, compared to control (p < 0.01). Salmon consumption did not affect other markers. CONCLUSION: Consuming two portions/week of salmon raised on rapeseed oil rather than fish oil increased the O3I and vitamin D status, and decreased plasma triacylglycerols. These outcomes endorse opportunities for developing more sustainable feeds within aquaculture food systems. CLINICAL TRIAL REGISTRY: This trial was registered at clinicaltrials.gov as NCT01916434.

Economic cost of congenital CMV in the UK.

OBJECTIVE: Congenital cytomegalovirus (cCMV) is the most common infectious cause of congenital disability. It can disrupt neurodevelopment, causing lifelong impairments including sensorineural hearing loss and developmental delay. This study aimed, for the first time, to estimate the annual economic burden of managing cCMV and its sequelae in the UK. DESIGN: The study collated available secondary data to develop a static cost model. SETTING: The model aimed to estimate costs of cCMV in the UK for the year 2016. PATIENTS: Individuals of all ages with cCMV. MAIN OUTCOME MEASURES: Direct (incurred by the public sector) and indirect (incurred personally or by society) costs associated with management of cCMV and its sequelae. RESULTS: The model estimated that the total cost of cCMV to the UK in 2016 was £732 million (lower and upper estimates were between £495 and £942 million). Approximately 40% of the costs were directly incurred by the public sector, with the remaining 60% being indirect costs, including lost productivity. Long-term impairments caused by the virus had a higher financial burden than the acute management of cCMV. CONCLUSIONS: The cost of cCMV is substantial, predominantly stemming from long-term impairments. Costs should be compared against investment in educational strategies and vaccine development programmes that aim to prevent virus transmission, as well as the value of introducing universal screening for cCMV to both increase detection of children who would benefit from treatment, and to build a more robust evidence base for future research.

The colonic metabolites dihydrocaffeic acid and dihydroferulic acid are more effective inhibitors of in vitro platelet activation than their phenolic precursors.

Cardiovascular disease (CVD) is the major cause of morbidity and mortality worldwide. The consumption of a healthy diet rich in polyphenols has been inversely associated with the development of CVD. This study evaluated the effects of green coffee bean extract (GCBE) and yerba mate phenolic extract (YMPE), the main phenolic and methylxanthine constituents (5-caffeoylquinic acid, 3,5-dicaffeoylquinic acid, caffeine, and theobromine), and their main metabolites (caffeic acid, ferulic acid, dihydrocaffeic acid (DHCA) and dihydroferulic acid (DHFA)) on platelet activation in vitro. Upon incubation with different doses (0.01-100 µg mL-1 or µM) of each compound, adenosine 5'-diphosphate-induced P-selectin expression and fibrinogen binding were determined using whole blood flow cytometry. Platelet P-selectin expression was significantly decreased by YMPE and all phenolic and methylxanthine constituents at physiological concentrations, compared with control, whereas fibrinogen binding on platelets was significantly increased. The colonic metabolites (DHCA and DHFA) had stronger inhibitory effects on P-selectin expression than their phenolic precursors, suggesting an increase in the efficacy to modulate platelet activation with the metabolism of the phenolic compounds.

A Home Visit Checklist to Reduce Rehospitalizations.

Hospital readmission rates have become the subject of national attention among healthcare providers. Home healthcare agencies work to bridge the gap between hospital and home/community, and share a vested interest in reducing hospital readmissions. Evidence supports the use of checklists to improve safety and decrease risk by reducing errors of omission, facilitating communication and improving clinician accountability. This article proposes that the use of checklists in home healthcare agencies may reduce rehospitalizations, and presents the experience of a large home healthcare agency's creation and implementation of a pilot study to introduce a home visit checklist.

Supplementation with a 9c,11t-rich conjugated linoleic acid blend shows no clear inhibitory effects on platelet function in healthy subjects at low and moderate cardiovascular risk: a randomized controlled trial.

SCOPE: The 9cis,11trans-conjugated linoleic acid (9c,11t-CLA) is reported to have anti-atherogenic properties in animal models and to modulate protein expression in unstimulated human platelets in vivo. Platelet function was therefore investigated after dietary supplementation with 9c,11t-CLA enriched oil (CLA80:20) in a randomized, baseline-controlled cross-over trial. METHODS AND RESULTS: Forty-three healthy adults at low to moderate risk of cardiovascular disease received 4 g/day of CLA80:20 or placebo for two weeks each. Platelet function, inflammation, and endothelial activation were assessed before and after each phase. Compared with placebo, supplementation had no significant effects on platelet function measured by Platelet Function Analyzer-100. Inhibitory effects on collagen-induced aggregation were sex-dependent (p = 0.005) that reached significance only in women (p = 0.045). Thrombin receptor-activating peptide (TRAP)-induced P-selectin expression was higher after supplementation in all subjects (p = 0.017). TRAP-induced platelet fibrinogen binding was also dependent on sex (p = 0.015), with fibrinogen binding after CLA80:20 being higher in males (p = 0.035). Plasma monocyte chemoattractant protein-1 was higher (p = 0.041) after CLA80:20. CONCLUSION: No clear evidence was found for inhibition or activation of platelet function as well as inflammation by CLA80:20 in a low to moderate cardiovascular risk group.

Effectiveness of A-CRA/ACC in treating adolescents with cannabis-use disorders.

An evidence-based treatment for adolescent cannabis users, Adolescent Community Reinforcement Approach with Assertive Continuing Care, was implemented in a rural county and small city in the USA. A total of 147 adolescents, ages 12-18, were enrolled and assessed at baseline and three time points: 3, 6, and 12 months using the Global Appraisal of Individual Needs and related measures. Program effectiveness was confirmed. The treatment was equally effective for youth from the city versus the county. More than two-thirds (68.7%) of the adolescents reported quitting use of cannabis by 12 months. The days of cannabis use in the last 90 days decreased significantly from the first follow-up, controlling for age (p value < .01), and shows consistent decline until the end of the treatment. In addition to reduction in substance use, the average number of days missing school and expelled from school decreased significantly from baseline to the end of the treatment.

Calculating alcohol risk in a visualization tool for promoting healthy behavior.

OBJECTIVE: To investigate effective methods for communicating the personalized risks of alcohol consumption, particularly to young people. METHODS: An interactive computerized blood alcohol content calculator was implemented in Flash based on literature findings for effectively communicating risk. Young people were consulted on attitudes to the animation features and visualization techniques used to display personalized risk based on disclosed alcohol consumption. RESULTS: Preliminary findings reveal the calculator is relatively enjoyable to use for its genre. However, the primary aims of the visualization tool to effectively communicate personalized risk were undermined for some users by technical language. Transparency of risk calculations might further enhance the tool for others. Worryingly, user feedback revealed a tension between accurate presentation of risk and its consequent lack of sensationalism in terms of personal risk to the individual. CONCLUSION: Initial findings suggest the tool may provide a relatively engaging vehicle for exploring the link between action choices and risk outcomes. Suggestions for enhancing risk communication include using intelligent techniques for selecting data presentation formats and for demonstrating the effects of sustained risky behavior. PRACTICE IMPLICATIONS: Effective communication of risk contributes only partially to effecting behavior change; the role of the tool in influencing contributing attitudinal factors is also discussed.

Flavan-3-ol-enriched dark chocolate and white chocolate improve acute measures of platelet function in a gender-specific way--a randomized-controlled human intervention trial.

SCOPE: We examined whether flavan-3-ol-enriched dark chocolate, compared with standard dark and white chocolate, beneficially affects platelet function in healthy subjects, and whether this relates to flavan-3-ol bioavailability. METHODS AND RESULTS: A total of 42 healthy subjects received an acute dose of flavan-3-ol-enriched dark, standard dark or white chocolate, in random order. Blood and urine samples were obtained just before and 2 and 6 h after consumption for measurements of platelet function, and bioavailability and excretion of flavan-3-ols. Flavan-3-ol-enriched dark chocolate significantly decreased adenosine diphosphate-induced platelet aggregation and P-selectin expression in men (all p ≤ 0.020), decreased thrombin receptor-activating peptide-induced platelet aggregation and increased thrombin receptor-activating peptide-induced fibrinogen binding in women (both p ≤ 0.041), and increased collagen/epinephrine-induced ex vivo bleeding time in men and women (p ≤ 0.042). White chocolate significantly decreased adenosine diphosphate-induced platelet P-selectin expression (p = 0.002) and increased collagen/epinephrine-induced ex vivo bleeding time (p = 0.042) in men only. Differences in efficacy by which flavan-3-ols affect platelet function were only partially explained by concentrations of flavan-3-ols and their metabolites in plasma or urine. CONCLUSION: Flavan-3-ols in dark chocolate, but also compounds in white chocolate, can improve platelet function, dependent on gender, and may thus beneficially affect atherogenesis.

Alperujo extract, hydroxytyrosol, and 3,4-dihydroxyphenylglycol are bioavailable and have antioxidant properties in vitamin E-deficient rats--a proteomics and network analysis approach.

SCOPE: Olive products are rich in phenolic compounds, which are natural antioxidants in vitro. We tested the in vivo effects of alperujo, an olive production by-product, as well as hydroxytyrosol and 3,4-dihydroxyphenylglycol (DHPG) isolated from alperujo, on indices and pathways of oxidative and metabolic stress in a vitamin E-deficient rat model. METHODS AND RESULTS: Rats were fed a vitamin E-deficient diet for 10 weeks, followed by this diet supplemented with either 100 mg/kg diet dα-tocopherol, alperujo extract, hydroxytyrosol, or 10 mg/kg diet DHPG, for a further 2 weeks. We detected alperujo phenolics in tissues and blood, indicating they are bioavailable. Alperujo extract partially ameliorated elevated plasma levels of thiobarbituric acid reactive substances and also lowered plasma cholesterol levels, whereas hydroxytyrosol increased plasma triglyceride levels. Proteomics and subsequent network analysis revealed that hepatic mitochondrial aldehyde dehydrogenase (ALDH2), of which protein and activity levels were regulated by dα-tocopherol and olive phenolics, represents a novel central regulatory protein hub affected by the dietary interventions. CONCLUSION: The in vivo free radical scavenging properties of olive phenolics appear relatively modest in our model. But alternative mechanisms, including regulation of ALDH2, may represent relevant antioxidant mechanisms by which dietary olive phenolics could have beneficial impact on cardiovascular health.

A high intake of industrial or ruminant trans fatty acids does not affect the plasma proteome in healthy men.

Consumption of industrial trans fat raises the risk of cardiovascular disease, but it is unclear whether cis9,trans11-conjugated linoleic acid (CLA)--a trans fatty acid in dairy products--modulates disease development. We investigated the effects of complete diets providing 7% of energy as industrial trans fat or cis9, trans11 CLA, compared with oleic acid, on regulation of plasma proteins in 12 healthy men. Diets were provided for 3 wk each, in random order. Plasma was collected at the end of each 3 wk intervention period, depleted of its 12 most abundant proteins and analyzed by 2-DE. Principal component analysis of protein spot intensity values revealed that the nature of the dietary intervention did not significantly affect the plasma proteome. The intervention provided in the 1st period produced a significant treatment effect compared with the interventions provided in the other two periods, and there was a significant subject effect. In conclusion, the nature of an extreme dietary intervention, i.e. 7% of energy provided by industrial trans fat or cis9,trans11 CLA, did not markedly affect the plasma proteome. Thus plasma proteomics using 2-DE appears, by and large, an unsuitable approach to detect regulation of plasma proteins due to changes in the diet.

Dealing with phantom limb pain after amputation.

Patients usually experience phantom limb pain after amputation but it may also occur following resection of other parts of the body, such as the breast and internal organs like the rectum. The causes are complex and patients require careful assessment to ensure they receive appropriate care. This article describes the causes of phantom limb pain and discusses assessment strategies.

Anti-platelet effects of olive oil extract: in vitro functional and proteomic studies.

PURPOSE: Platelets play a key role in haemostasis and wound healing, contributing to formation of vascular plugs. They are also involved in formation of atherosclerosic plaques. Some traditional diets, like the Mediterranean diet, are associated with a lower risk of cardiovascular disease. Components in these diets may have anti-platelet functions contributing to their health benefits. METHODS: We studied the effects of alperujo extract, an olive oil production waste product containing the majority of polyphenols found in olive fruits, through measurement of effects on platelet aggregation and activation in isolated human platelets, and through identification of changes in the platelet proteome. RESULTS: Alperujo extract (40 mg/L) significantly decreased in vitro ADP- (p = 0.002) and TRAP- (p = 0.02) induced platelet activation as measured by the flow cytometry using the antibody for p-selectin (CD62p), but it did not affect the conformation of the fibrinogen receptor as measured by flow cytometry using the antibodies for anti-fibrinogen, CD42a and CD42b. Alperujo extract (100 mg/L) inhibited both collagen- and TRAP-induced platelet aggregation by 5% (p < 0.05), and a combination of hydroxytyrosol and 3,4-dihydroxyphenylglycol were, at least partly, responsible for this effect. Proteomic analysis identified nine proteins that were differentially regulated by the alperujo extract upon ADP-induced platelet aggregation. These proteins represent important mechanisms that may underlie the anti-platelet effects of this extract: regulation of platelet structure and aggregation, coagulation and apoptosis, and signalling by integrin αIIb/ß3. CONCLUSIONS: Alperujo extract may protect against platelet activation, platelet adhesion and possibly have anti-inflammatory properties.

Determination of 3,4-dihydroxyphenylglycol, hydroxytyrosol and tyrosol purified from olive oil by-products with HPLC in animal plasma and tissues.

A simple, fast and reliable method to quantify, simultaneously, 3,4-dihydroxyphenylglycol (DHPG), hydroxytyrosol (HT) and tyrosol (Ty) extracted and purified successfully from olive oil by-product, called alperujo, in animal plasma and tissues samples has been developed using a high-performance liquid chromatographic (HPLC) method with UV-Vis detection. Extraction of compounds is based on solid-phase extraction for plasma and homogenisation with zirconia beads and centrifugation for tissues. Calibration curves were linear for all three phenols at a relatively low concentration range (0.05-50µg/mL). This method has acceptable accuracy (91-95% in plasma and 63-100% in tissues), precision (1.11-8.26% intra-day and 0.32-9.5% inter-day) and sensitivity for detecting low concentrations of these phenols in small plasma volumes and several animal tissues such as liver, heart, kidney, muscle, testes, white adipose tissue (WAT) and brain.

Postoperative pain 1: understanding the factors affecting patients' experiences of pain.

Management of postoperative pain is complex and multidimensionalandits effective management presents challenges to nurses. Failure to control pain can result in long term complications, including chronic post surgical pain. This first article, in a two part series, explores the physiological mechanism involved in the perception of pain and the role of psychological and environmental influences on how patients respond to it. Part 2, to be published next week, explores the principles of patient assessment and management of postoperative pain.

Postoperative pain 2: patient education, assessment and management.

Postoperative pain is poorly managed, with up to 67% of patients in the U.K. experiencing unnecessary moderate to severe pain. Part 1 of this two part series explored physiological mechanisms involved in the perception of pain and the role of psychological and environmental influences on how patients respond to it. This second part explores the principles of patient assessment and management of postoperative pain, and discusses acute pain analgesic guides.