Search for teratogenic risks with the aid of malformation registries

A summary is given of experiences in the use of the Swedish registries of birth defects for causal epidemiological studies. Case-control studies and cohort studies are described and exemplified. The application of case-control techniques to cohorts of women selected for probable or possible exposure is also described. The importance of using large-scale registry studies in the search for common but low-risk teratogens is stressed.     

An interactive internet-based continuing education course on sexually transmitted diseases for physicians and midwives in Peru

Background

Clinicians in developing countries have had limited access to continuing education (CE) outside major cities, and CE strategies have had limited impact on sustainable change in performance. New educational tools could improve CE accessibility and effectiveness.

Methodology/Principal Findings

The objective of this study was to evaluate an interactive Internet-based CE course on Sexually Transmitted Diseases (STDs) management for clinicians in Peru. Participants included physicians and midwives in private practice drawn from a census of 10 Peruvian cities. The CE included a three-hour workshop for improving Internet skills, followed by a 22-hour online course on STD-syndrome-management, with subsequent educational support. The course used case-based clinical vignettes tailored to local STD problems. Knowledge and reported practices on STD management were assessed before, immediately after and at four months after completion of the course. Statistical analysis included parametric tests-linear regression multivariate analysis, paired t-test and repeated measures ANOVA using SPSS 14.0. Of 1,071 eligible clinicians, 510 agreed to participate, as did an additional 132 public sector clinicians. Of these 642 participants, 619 (96.4%) completed the course, and 596 (96.3%) took the four-month follow-up evaluation. Physician and midwife scores improved from 64.2% correct answers on the pre-test to 77.9% correct on the four-month follow-up test (p<0.001). Most participants (95%) found the online course useful for their work needs. Self reported STD management practices did not change.

Conclusions/Significance

Among physicians and midwives in Peru, an Internet-based CE course was feasible, acceptable with high participation rates, and led to sustained improvement in knowledge at four months. Further studies are needed to test it as a model for improving the training of physicians, midwives, and other health care providers.     

The acceptability of Internet-based treatment and characteristics of an adult sample with obsessive compulsive disorder: an Internet survey

Background

Obsessive-compulsive disorder (OCD) is a disabling anxiety disorder, but most individuals delay seeking treatment. Internet-based cognitive behavioural therapy (iCBT) is an innovative service delivery method that may help to improve access to care, but the acceptability to consumers of such programs has not yet been established.

Methodology

People with symptoms of OCD were invited to complete an online survey enquiring about demographic characteristics, symptom severity, and acceptability of Internet-based treatment. Demographic and symptom severity data were compared with people with OCD identified in a national epidemiological survey and with a sample of patients with OCD from a specialist outpatient anxiety clinic.

Participants

129 volunteers to an online Internet survey, 135 patients at a specialist anxiety disorders outpatient clinic, and 297 cases identified in a national epidemiological survey.

Main Measures

Demographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale, the 12-item World Health Organisation Disability Assessment Schedule - Second Edition and the Yale Brown Obsessive Compulsive Scale - Self Report Version.

Principal Findings

The Internet sample was similar demographically but reported more severe symptoms than the comparison groups, although had similar severity of symptoms of OCD compared with other clinical samples reported in the literature. Participants reported Internet-based treatment for OCD would be highly acceptable.

Conclusions

Internet-based treatment may reduce barriers to accessing treatment to people with OCD. Individuals in this study were similar demographically to other samples and had similar severity of symptoms as those identified in other clinical samples, suggesting that Internet-based treatment using techniques employed in face-to-face treatment may be effective in this group. Internet-based treatments for OCD need to be developed and evaluated.     

Are all born equal? Incidence of febrile convulsions by seasons of birth.

To test whether the seasons of birth had an effect on subsequent experience of illness, details were obtained of all Sheffield children born between 1973 and 1977 who were admitted to hospital before their second birthday with a first febrile convulsion. Analysis by date of birth in consecutive 28-day cohorts showed that the incidence of febrile convulsions ranged from 2.5 per thousand live births to 30.2 per thousand in different "month" cohorts. Statistically significant variations were noted in the incidence rates in relation to season and year of birth. The implication is that even large scale epidemiological studies which have been confined to children born in a particular week or month may not be representative of the whole child population.     

Information that should be given to HIV cohort participants during ongoing research: the viewpoints of patient representatives and research professionals

While investigators have a duty to provide research participants with summary findings at the end of a study, providing general information during the course of research is rarely considered. However, this raises an important ethical issue in the context of long-term studies such as cohorts or biobanks. We investigated this issue in the context of two ANRS cohorts of HIV-infected patients, AQUITAINE and COPILOTE. Face-to-face interviews were conducted with HIV patient representatives and research professionals concerning the delivery of information in the course of the research. Respondents stated that participants wish to be informed of research results (both aggregate and individual) but also expect general information about the cohort itself, research progression, and what their participation may provide. It was concluded that information provided during the course of the research may help participants to distinguish between care and research. The essential role of clinicians-investigators in providing information was emphasized.     

Factors Associated with Participation and Attrition in a Longitudinal Study of Bacterial Vaginosis in Australian Women Who Have Sex with Women

Objective

A number of social and sexual risk factors for bacterial vaginosis (BV) have been described. It is important to understand whether these factors are associated with non-participation or attrition of participants from longitudinal studies in order to examine potential for recruitment or attrition bias. We describe factors associated with participation and attrition in a 24-month prospective cohort study, investigating incident BV among Australian women who have sex with women.

Study Design and Setting

Participants negative for prevalent BV were offered enrolment in a longitudinal cohort study. Participants self-collected vaginal samples and completed questionnaires 3-monthly to endpoint (BV-positive/BV-negative by 24 months). Factors associated with participation in the cohort study were examined by logistic regression and factors associated with attrition from the cohort were examined by Cox regression.

Results

The cross-sectional study recruited 457 women. 334 BV-negative women were eligible for the cohort and 298 (89%, 95%CI 85, 92) enrolled. Lower educational levels (aOR 2.72, 95%CI 1.09, 6.83), smoking (aOR 2.44, 95%CI 1.13, 5.27), past BV symptoms (aOR 3.42, 95%CI 1.16, 10.10) and prior genital warts (aOR 2.71, 95%CI 1.14, 6.46) were associated with non-participation; a partner co-enrolling increased participation (aOR 3.73, 95%CI 1.43, 9.70). 248 participants (83%, 95%CI 78, 87) were retained to study endpoint (BV-negative at 24 months or BV-positive at any stage). Attrition was associated being <30 yrs (aHR 2.15, 95%CI 1.13, 4.10) and a male partner at enrolment (aHR 6.12, 95%CI 1.99, 18.82).

Conclusion

We achieved high participation and retention levels in a prospective cohort study and report factors influencing participation and retention of participants over a 24-month study period, which will assist in the design and implementation of future cohort studies in sexual health and disease.     

Effects of different forms of physiology instruction on the development of students' conceptions of and approaches to science learning

The purpose of this study was to investigate students' conceptions of and approaches to learning science in two different forms: internet-assisted instruction and traditional (face-to-face only) instruction. The participants who took part in the study were 79 college students enrolled in a physiology class in north Taiwan. In all, 46 of the participants were from one class and 33 were from another class. Using a quasi-experimental research approach, the class of 46 students was assigned to be the "internet-assisted instruction group," whereas the class of 33 students was assigned to be the "traditional instruction group." The treatment consisted of a series of online inquiry activities. To explore the effects of different forms of instruction on students' conceptions of and approaches to learning science, two questionnaires were administered before and after the instruction: the Conceptions of Learning Science Questionnaire and the Approaches to Learning Science Questionnaire. Analysis of covariance results revealed that the students in the internet-assisted instruction group showed less agreement than the traditional instruction group in the less advanced conceptions of learning science (such as learning as memorizing and testing). In addition, the internet-assisted instruction group displayed significantly more agreement than the traditional instruction group in more sophisticated conceptions (such as learning as seeing in a new way). Moreover, the internet-assisted instruction group expressed more orientation toward the approaches of deep motive and deep strategy than the traditional instruction group. However, the students in the internet-assisted instruction group also showed more surface motive than the traditional instruction group did.     

Expanding the traditional physiology class with asynchronous online discussions and collaborative projects

Discussion and writing are very powerful ways to support learning. This article describes the use of a free, asynchronous online forum to expand student-teacher discussions beyond the time/place constraints of the physical physiology classroom. The main participants were medical students enrolled in physiology class at the University of Zagreb Medical School and their teachers. The assessment data were collected by the electronic administration of the software, by anonymous paper questionnaires, and by the results of the final examination in physiology. During one academic year, 25% (n = 55) of 220 students enrolled in a traditional physiology course participated in online discussions. Physiology teachers and other faculty also joined the forum. All forum members (n = 99) posted 395 messages. Nine documents were published by six students who participated in two online collaborative projects. The difference in the mean grade of the final examination in physiology between student members and nonmembers was statistically significant (P = 0.0328, t = 2.1526). Students who participated in Web discussions were self-selected. Likely, they are the most motivated students, who would perform better on the final examination with or without this resource. Nevertheless, using an online forum could be very successful in teaching critical thinking in physiology because the Internet removes traditional time/place barriers. However, new barriers related to technology and behavioral changes are created. For most teachers and students, the main obstacles to information technology implementation are lack of motivation and lack of professional incentives. To overcome these barriers, institutional support is needed for both students and teachers.     

Harnessing the Medicaid Analytic eXtract (MAX) to Evaluate Medications in Pregnancy: Design Considerations

Background

In the absence of clinical trial data, large post-marketing observational studies are essential to evaluate the safety and effectiveness of medications during pregnancy. We identified a cohort of pregnancies ending in live birth within the 2000–2007 Medicaid Analytic eXtract (MAX). Herein, we provide a blueprint to guide investigators who wish to create similar cohorts from healthcare utilization data and we describe the limitations in detail.

Methods

Among females ages 12–55, we identified pregnancies using delivery-related codes from healthcare utilization claims. We linked women with pregnancies to their offspring by state, Medicaid Case Number (family identifier) and delivery/birth dates. Then we removed inaccurate linkages and duplicate records and implemented cohort eligibility criteria (i.e., continuous and appropriate enrollment type, no private insurance, no restricted benefits) for claim information completeness.

Results

From 13,460,273 deliveries and 22,408,810 child observations, 6,107,572 pregnancies ending in live birth were available after linkage, cleaning, and removal of duplicate records. The percentage of linked deliveries varied greatly by state, from 0 to 96%. The cohort size was reduced to 1,248,875 pregnancies after requiring maternal eligibility criteria throughout pregnancy and to 1,173,280 pregnancies after further applying infant eligibility criteria. Ninety-one percent of women were dispensed at least one medication during pregnancy.

Conclusions

Mother-infant linkage is feasible and yields a large pregnancy cohort, although the size decreases with increasing eligibility requirements. MAX is a useful resource for studying medications in pregnancy and a spectrum of maternal and infant outcomes within the indigent population of women and their infants enrolled in Medicaid. It may also be used to study maternal characteristics, the impact of Medicaid policy, and healthcare utilization during pregnancy. However, careful attention to the limitations of these data is necessary to reduce biases.     

Cancer incidence rate ratios of Turkish immigrants in Hamburg,Germany: A registry based study

The aim of this study was to estimate cancer incidence rate ratios for Turkish migrants in Hamburg, Germany. We used a name-based approach and identified 1346 cases with Turkish names (as a proxy of Turkish origin) among 140,249 cases of cancer registered in the cancer registry Hamburg during 1990–2005. To estimate the size of the denominator population, we applied the name-based approach to the population of Hamburg as well. The cancer incidence of specific cancer sites was compared between Turkish and non-Turkish cases using incidence rate ratios (IRR), stratified by gender and birth cohort. Our main findings are that cancer of the respiratory organs is diagnosed less frequent among Turkish men in older birth cohorts but with higher frequency in the younger birth cohorts. Malignant neoplasms of lymphoid, haematopoietic and related tissues are slightly higher in most male Turkish men birth cohorts, and even considerably higher for the birth cohort 1961 to <1971 (IRR = 1.8). Among women, incidence rates for Turkish women are lower than for non-Turkish women for cancer of the respiratory system, skin cancer and cancer of genital organs. Also, breast cancer incidence rates of Turkish women are lower than for non-Turkish women, especially in older birth cohorts. Incidence rate ratios of neoplasms of lymphoid, haematopoietic and related tissues are low in the 1931 to <1941 cohort (IRR = 0.71) but increase in younger birth cohorts. In conclusion, we found differences in cancer risks between cases with and without Turkish names for specific cancer sites. These results are consistent with the findings of studies from other countries.     

Associations of Aging and Birth Cohort with Body Mass Index in a Biethnic Cohort

Objective: To examine associations of aging and birth cohort with body mass index (BMI) in a biethnic cohort. Research Methods and Procedures: This was a longitudinal closed cohort study of 14, 500 white and African‐American men and women, 45 to 64 years of age, followed for 9 years. Aging was defined as the length of the interval in years between baseline and following visits. Birth cohort was defined by the year in which participants were born. Mixed model analyses were used to examine associations of aging, birth cohort, and BMI in four ethnicity‐gender groups. Results: We found that aging was associated with an increase in BMI in white and African‐American men and women. The associations between aging and BMI were stronger in the younger birth cohorts. Except for white women, younger birth cohort was associated with a higher BMI. After adjusting for aging, birth cohort was associated with an increase in BMI of 0.1 kg/m² [95% confidence interval (95% CI): ?0.1, 0.3] among white women. The corresponding values for African‐American women, white men, and African‐American men are 0.5 kg/m² (95% CI: 0.1, 0.9), 0.6 kg/m² (95% CI: 0.4, 0.8), and 0.6 kg/m² (95% CI: 0.2, 1.0), respectively. Discussion: Our analyses show that, in all except white women, people in this age range who were born later have a higher BMI at the same attained age. In all groups, people who are born later gained more weight as they aged. In general, subjects ages 45 to 64 years gained weight as they aged 9 years.     

Changes in Sibling configurations for American preschool children

Abstract

This paper uses data drawn from the 1940 through 1980 Public Use Microdata Samples of the U.S. Census of Population to document sibling configurations from the child's perspective. Changes in four aspects of siblings are examined for five cohorts of white and black preschool‐aged children: number, birth order distributions, spacing intervals, and sex composition. Changes in fertility behavior of adults in the post‐war era had a profound effect on the structure of sibling systems experienced by children. Successive cohorts of preschool children show a rise in number of siblings through the early post‐war years before showing sharp declines in number of siblings through the 1960's and 1970's. These shifts in size of sibling sets are reflected in changes in the proportion of each cohorts who are first born and only children, both of which have increased substantially by the 1980 cohort. The 1940 and 1980 cohorts have similar proportions of children with short intervals. However, the middle cohorts show the effects of the quickened pace of fertility with substantial proportions of children with comparatively short birth intervals. Finally, substantial shifts across cohorts in several measures of sex composition of children are observed. Most significantly, there is a marked decline in the proportion of children experiencing an opposite‐sex older sibling.     

Duration of obesity exposure between ages 10 and 40 years and its relationship with cardiometabolic disease risk factors: A cohort study

BackgroundIndividuals with obesity do not represent a homogeneous group in terms of cardiometabolic risk. Using 3 nationally representative British birth cohorts, we investigated whether the duration of obesity was related to heterogeneity in cardiometabolic risk.Methods and findingsWe used harmonised body mass index (BMI) and cardiometabolic disease risk factor data from 20,746 participants (49.1% male and 97.2% white British) enrolled in 3 British birth cohort studies: the 1946 National Survey of Health and Development (NSHD), the 1958 National Child Development Study (NCDS), and the 1970 British Cohort Study (BCS70). Within each cohort, individual life course BMI trajectories were created between 10 and 40 years of age, and from these, age of obesity onset, duration spent obese (range 0 to 30 years), and cumulative obesity severity were derived. Obesity duration was examined in relation to a number of cardiometabolic disease risk factors collected in mid-adulthood: systolic (SBP) and diastolic blood pressure (DBP), high-density-lipoprotein cholesterol (HDL-C), and glycated haemoglobin (HbA1c).A greater obesity duration was associated with worse values for all cardiometabolic disease risk factors. The strongest association with obesity duration was for HbA1c: HbA1c levels in those with obesity for <5 years were relatively higher by 5% (95% CI: 4, 6), compared with never obese, increasing to 20% (95% CI: 17, 23) higher in those with obesity for 20 to 30 years. When adjustment was made for obesity severity, the association with obesity duration was largely attenuated for SBP, DBP, and HDL-C. For HbA1c, however, the association with obesity duration persisted, independent of obesity severity. Due to pooling of 3 cohorts and thus the availability of only a limited number harmonised variables across cohorts, our models included adjustment for only a small number of potential confounding variables, meaning there is a possibility of residual confounding.ConclusionsGiven that the obesity epidemic is characterised by a much earlier onset of obesity and consequently a greater lifetime exposure, our findings suggest that health policy recommendations aimed at preventing early obesity onset, and therefore reducing lifetime exposure, may help reduce the risk of diabetes, independently of obesity severity. However, to test the robustness of our observed associations, triangulation of evidence from different epidemiological approaches (e.g., mendelian randomization and negative control studies) should be obtained.

Tom Norris and colleagues investigate how obesity duration and obesity severity throughout a person''s lifetime may affect cardiometabolic risk factors such as blood pressure, cholesterol, and glycated haemoglobin.     

基于BOPPPS+翻转课堂的“蛋白质工程”线上线下混合式教学模式探索

“蛋白质工程”是山西省一流本科专业建设点生物技术专业的核心必修课程。为了解决“蛋白质工程”课堂教学模式单一、传授式教学学生参与度不够、听课不认真、授课时间缩短、实验价格昂贵等问题,课程团队进行了“蛋白质工程”课程教学模式改革与实践,提出了适合生物技术专业的“蛋白质工程”教学新策略:构建了基于BOPPPS+翻转课堂的教学模式,线下课堂讲授与学生在线自主学习与完成作业、章节测验和讨论等相结合,全面融入翻转课堂;特别是在“金课”两性一度标准的指导下,课程团队自建慕课(massive open online courses,MOOC)课程资源,利用超星泛雅网络教学平台开展BOPPPS+翻转课堂的“蛋白质工程”线上线下混合式教学工作,构建了全面、系统及动态的“蛋白质工程”课程新教学体系。经过3轮的教学实践表明,课程团队在“蛋白质工程”课程资源建设、探究性实验辅导、课堂研讨设计,以及课程成绩评定方式等方面形成了一套完整、可复制、科学、合理的线上线下混合式教学模式。基于BOPPPS+翻转课堂的“蛋白质工程”线上线下混合式教学模式有助于提高学生的自主学习能力,使学生深度参与到教学的全过程,对“蛋白质工程”有了全面深刻的认识,提高了“蛋白质工程”的教学质量,为后续学生学习其他专业课程奠定了基础,也为课程教学改革提供了参考。     

Steeling Ourselves: Intragroup Communication while Anticipating Intergroup Contact Evokes Defensive Intergroup Perceptions

Two experiments investigated the role of intragroup communication in intergroup conflict (de-)escalation. Experiment 1 examined the effects of intragroup communication (vs. individual thought) and anticipated face-to-face intergroup contact (vs. no anticipated face-to-face intergroup contact). The group discussions of stigmatized group members who anticipated face-to-face intergroup contact revolved more around intergroup hostility. This boosted ingroup identification and increased social creativity but also led to steeling (a hardening of perceived intergroup relations). In Experiment 2, new participants listened to the taped group discussions. The discussions of groups anticipating face-to-face intergroup contact evoked more intergroup anxiety-related discomfort than discussions of groups not anticipating face-to-face intergroup encounters. Together, these results support the idea that steeling is a defensive reaction to prepare for an anxiety-arousing intergroup confrontation. Although steeling is also associated with positive consequences such as increased ingroup solidarity and social creativity, this hardened stance may be an obstacle to conflict de-escalation.     

“分子与细胞”翻转课堂教学模式在临床专业教学中的探究

提高医学创新人才培养手段是医学教育改革的重点内容之一。"分子与细胞"是临床医学教育改革的重点专业基础课,也是一门全新的整合课程,具有学时多、难度大且要求和临床专业紧密结合的特点。如何转变临床专业课程的传统教学模式,是临床专业课程改革创新的焦点。该研究通过基于嵌入式文献阅读和临床案例式的翻转课堂教学模式,将传统的面对面授课转化为以学生为中心的授课方式,将课堂主阵地由线下转移至线上,为线下课堂提供了更多创新融合的方式,同时增强了医学生对于生命学基本原理的理解,为培养具有精准医学专业背景的医学生提供了理论基础。通过三年的翻转课堂实施,临床专业卓越医生试点班学生对教学满意度以及学生成绩显著提升,说明在临床专业整合课程开展翻转课堂教学具有积极意义。     

Rapid Emergence of Free-Riding Behavior in New Pediatric Immunization Programs

Background

Mathematical models have formalized how free-rider effects can threaten the stability of high vaccine coverage levels under established voluntary vaccination programs. However, little research has addressed the question of when free-riding begins to develop when a new vaccine is first introduced in a population.

Methodology/Principal Findings

Here, we combine a game theoretical model of vaccinating behavior with an age-structured compartmental model to analyze rational vaccinating behavior in the first years of a universal immunization program, where a new vaccine is free to all children of a specified age. The model captures how successive birth cohorts face different epidemiological landscapes that have been shaped by the vaccinating decisions of previous birth cohorts, resulting in a strategic interaction between individuals in different birth cohorts. The model predicts a Nash equilibrium coverage level of for the first few birth cohorts under the new program. However, free-riding behavior emerges very quickly, with the Nash equilibrium vaccine coverage dropping significantly within 2-5 years after program initiation. Subsequently, a rich set of coupled dynamics between infection prevalence and vaccinating behaviors is possible, ranging from relatively stable (but reduced) coverage in later birth cohorts to wide fluctuations in vaccine coverage from one birth cohort to the next. Individual tolerance for vaccine risk also starts out at relatively high levels before dropping significantly within a few years.

Conclusions/Significance

These results suggest that even relatively new immunization programs can be vulnerable to drops in vaccine coverage caused by vaccine scares and exacerbated by herd immunity effects, necessitating vigilance from the start.