Calcium absorption, assessed by a double isotope method, was found to be impaired in postmenopausal women with rheumatoid arthritis of recent onset (mean 14.2 months) compared with controls. Circulating levels of 1,25-dihydroxyvitamin D (calcitriol) were higher than in controls, suggesting a primary malabsorption of calcium in these patients. The reduction in calcium absorption correlated with several measures of disease activity, suggesting that the disease process was responsible for the intestinal defect, but an effect from non-steroidal anti-inflammatory agents cannot be excluded. A primary reduction in calcium absorption may increase the risk of osteoporosis in women with rheumatoid arthritis.,Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception (LARC) methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted.
While abortion has been legal in most developed countries for many years, the topic remains controversial. A major area of controversy concerns women’s rights vis-a-vis the rights of health professionals to opt out of providing the service on conscience grounds. Although scholars from various disciplines have addressed this issue in the literature, there is a lack of empirical research on the topic. This paper provides a documentary analysis of three examples of conscientious objection on religious grounds to performing abortion-related care by midwives in different Member States of the European Union, two of which have resulted in legal action. These examples show that as well as the laws of the respective countries and the European Union, professional and church law each played a part in the decisions made. However, support from both professional and religious sources was inconsistent both within and between the examples. The authors conclude that there is a need for clear guidelines at both local and pan-European level for health professionals and recommend a European-wide forum to develop and test them.,The relationship between serum acid-labile alpha interferon and tubuloreticular inclusions within the cytoplasm of circulating lymphocytes was studied in 46 patients with systemic lupus erythematosus. Elevated levels of interferon (greater than or equal to 8 IU/ml) were found in 17 patients and lymphocyte inclusions in 35. The mean serum interferon concentration in patients with lymphocyte inclusions was significantly higher than in patients without inclusions (17.2 versus 2.4 IU/ml, p less than 0.01). Inclusions were found in 16 of 17 patients with elevated interferon and also in 19 of 29 patients without interferon (p = 0.026). In lupus, serum interferon appears to be a sufficient though not an essential marker for the presence of lymphocyte inclusions.
BackgroundThere is an ongoing debate about harm and benefit of e-cigarettes, usage of which has rapidly increased in recent years. By separating non-commercial (organic) tweets from commercial tweets, we seek to evaluate the general public's attitudes towards e-cigarettes.MethodsWe collected tweets containing the words ‘e-cig’, ‘e-cigarette’, ‘e-liquid’, ‘vape’, ‘vaping’, ‘vapor’ and ‘vaporizer’ from 23 July to 14 October 2015 (n=757 167). A multilabel Naïve Bayes model was constructed to classify tweets into 5 polarities (against, support, neutral, commercial, irrelevant). We further analysed the prevalence of e-cigarette tweets, geographic variations in these tweets and the impact of socioeconomic factors on the public attitudes towards e-cigarettes.ResultsOpinions from organic tweets about e-cigarettes were mixed (against 17.7%, support 10.8% and neutral 19.4%). The organic—against tweets delivered strong educational information about the risks of e-cigarette use and advocated for the general public, especially youth, to stop vaping. However, the organic—against tweets were outnumbered by commercial tweets and organic—support tweets by a ratio of over 1 to 3. Higher prevalence of organic tweets was associated with states with higher education rates (r=0.60, p<0.0001), higher percentage of black and African-American population (r=0.34, p=0.01), and higher median household income (r=0.33, p=0.02). The support rates for e-cigarettes were associated with states with fewer persons under 18 years old (r=−0.33, p=0.02) and a higher percentage of female population (r=0.3, p=0.02).ConclusionsThe organic—against tweets raised public awareness of potential health risks and could aid in preventing non-smokers, adolescents and young adults from using e-cigarettes. Opinion polarities about e-cigarettes from social networks could be highly influential to the general public, especially youth. Further educational campaigns should include measuring their effectiveness.,Examination of Coeliac Society records from eight areas of England has shown that the number of members rose with birth dates from 1900 to 1972, apart from a decline between 1941 to 1962, and then fell steeply. The steep decline in the number of members with birth dates after 1972 is unexplained, and is unlikely to be accounted for by change in diagnostic practice or registration and may reflect a true fall in disease incidence; but the fall in numbers of members with birth dates from 1941 to 1962 is explainable by a tendency for the disease to remit in adolescence or early adult life.
Two cases of acute myocardial infarction occurred in association with myocarditis, which was confirmed by biopsy. The first patient suffered an anteroseptal and the second patient an inferior wall myocardial infarction shortly after an acute viral illness. In both patients, coronary angiography showed normal coronary arteries, and right ventricular endomyocardial biopsy confirmed myocarditis. Histological abnormalities attributable to ischaemic heart disease were absent. The first patient's condition became stable after immunosuppressive treatment. Myocarditis resolved spontaneously within three months in the second patient. Coronary artery spasm and myocardial involvement with a systemic disease were unlikely. Endomyocardial biopsy in patients with acute myocardial infarction and normal coronary arteries may be useful in identifying myocarditis associated with myocardial necrosis. Myocarditis in acute myocardial infarction in the absence of coronary artery obstruction has not previously been documented during life.,OBJECTIVESThe objective of this study was to investigate the mortality of electrical utility workers exposed to electric and magnetic fields. METHODSA historical cohort mortality study was carried out on 21,744 workers who were employed in an electrical company in the province of Québec between 1970 and 1988. The last job held by each study subject was coded. A job exposure matrix (JEM) was used to estimate the exposure to 60 Hz electric and magnetic fields, and pulsed electromagnetic fields (as recorded by the PEMF (POSITRON) meter) in this job. Standardised mortality ratios (SMRs) were calculated relative to Québec men. Because the exposure was exclusively among blue collar workers, the remainder of the analyses by exposure were restricted to them. Rate ratios (RRs) in the exposed groups relative to the background groups were estimated with Poisson regression. There were 1582 deaths by the end of follow up. RESULTSSMRs were almost all below one and never substantially increased, although there were a few increased rate ratios (RRs). There was a significant RR of 2.00 (95% confidence interval (95% CI) 1.37-2.93) for deaths caused by accidents and violence in workers exposed to magnetic fields, RR of 1.82 (95% CI 1.25-2.65) for electric fields, and RR of 1.62 (95% CI 1.13-2.32) for pulsed electromagnetic fields. Occupational accidents related to power lines explain some of the excess of deaths from accidents and violence. Some association was found between magnetic fields and leukaemia, brain cancer, and suicide, between electric fields and brain cancer and suicide, and between pulsed electromagnetic fields and lung cancer, but these were not significant. CONCLUSIONThese results are broadly reassuring that major causes of death are not strongly associated with exposure to electric and magnetic fields, but small numbers and approximate exposure assessments preclude the denial of any risk, in particular if it were to affect a rare cause of death.,ObjectiveTo analyse injuries of water polo players reported during four Summer Olympic Games (2004, 2008, 2012, 2016) and four Federation Internationale de Natation World Championships (2009, 2013, 2015, 2017).MethodsInjuries during training and matches were reported daily by the team physicians and the local medical staff at the sports venues using an established surveillance system.ResultsA total of 381 injuries were reported, equivalent to 14.1 injuries per 100 players (95% CI ±1.42). The most frequent diagnoses were laceration (12.7%) and contusion (10.9%) of head, followed by (sub-)luxation/sprain of hand (9.5%) and contusion of trunk (6.5%) or hand (6.2%). More than half of the injuries (57.0%) occurred due to contact with another player. A quarter of the injuries (25.4%) were expected to result in absence from training or match; 10 (2.9%) resulted in an estimated time-loss of 3 or more weeks. About three-quarters of injuries (75.6%) occurred during matches, 86 during training. The incidence of match injuries was on average 56.2 injuries per 1000 match hours (95% CI ±6.74). The incidence of time-loss match injuries (14.7; 95% CI ±3.44) was significantly higher in men than in women.ConclusionsA critical review of water polo in-competition rules and the implementation of a Fair Play programme may help to mitigate the high incidence of contact injuries incurred during matches. A water polo-specific concussion education programme including recognition, treatment and return to play is recommended. Finally, a prospective injury surveillance programme would help to better define water polo injuries outside of the competition period.
The assumption of upright posture by patients with liver cirrhosis leads to striking activation of adrenergic and renin-angiotensin systems. The tilting-induced modifications in renal function of eight healthy controls and 14 untreated patients with liver cirrhosis and ascites were related to plasma concentrations of noradrenaline, renin activity and aldosterone. All patients had preserved renal blood perfusion. All parameters were evaluated during bed rest for two hours and in the sitting posture for one hour. Basal plasma renin activity (0.1 greater than p greater than 0.05), aldosterone and noradrenaline concentrations (p less than or equal to 0.01) were raised in cirrhotics. The renal function tests (creatinine clearance, filtered sodium, tubular rejection fraction, urinary sodium excretion) were significantly reduced in cirrhosis. Under basal conditions, in cirrhotic patients tubular rejection fraction and urinary sodium excretion were inversely related to both noradrenaline and aldosterone concentrations. After tilting, the noradrenaline and aldosterone integrated outputs (sigma delta) were significantly greater in cirrhosis. All renal function tests significantly decreased in cirrhotics, whereas creatinine clearance only significantly decreased in controls. Patient's tubular rejection fraction of sodium and sodium excretion were related to sigma delta aldosteronaemia (r = -0.72; p less than 0.01), but no longer to sigma delta plasma noradrenaline.,BackgroundThe tobacco industry routinely opposes tobacco control policies, often using a standard repertoire of arguments. Following proposals to introduce standardised packaging in New Zealand (NZ), British American Tobacco New Zealand (BATNZ) launched the ‘Agree–Disagree’ mass media campaign, which coincided with the NZ government's standardised packaging consultations. This study examined the logic of the arguments presented and rhetorical strategies employed in the campaign.MethodsWe analysed each advertisement to identify key messages, arguments and rhetorical devices, then examined the arguments' structure and assessed their logical soundness and validity.ResultsAll advertisements attempted to frame BATNZ as reasonable, and each contained flawed arguments that were either unsound or based on logical fallacies. Flawed arguments included misrepresenting the intent of the proposed legislation (straw man), claiming standardised packaging would harm all NZ brands (false dilemma), warning NZ not to adopt standardised packaging because of its Australian origins (an unsound argument) or using vague premises as a basis for claiming negative outcomes (equivocation).ConclusionsBATNZ's Agree–Disagree campaign relied on unsound arguments, logical fallacies and rhetorical devices. Given the industry's frequent recourse to these tactics, we propose strategies based on our study findings that can be used to assist the tobacco control community to counter industry opposition to standardised packaging. Greater recognition of logical fallacies and rhetorical devices employed by the tobacco industry will help maintain focus on the health benefits proposed policies will deliver.
IntroductionUnsafe abortion past the first trimester disproportionately accounts for the majority of global abortion-related morbidity and mortality; research that documents the safety, feasibility and acceptability of existing models for providing information and support to women who self-manage outside of formal clinic settings is needed.MethodsThis study is a retrospective analysis of anonymised electronic client records from callers to a safe abortion hotline in Indonesia. Between July 2012 and October 2016, a total of 96 women contacted the hotline for information on medication abortion beyond 12 weeks' gestation and are included in this study. Descriptive statistics were calculated regarding pregnancy termination status, client experience with warning signs of potential complications, and medical care seeking and treatment.ResultsNinety-six women with pregnancies beyond the first trimester called the hotline for information on medication abortion; 91 women received counselling support from the hotline. Eighty-three women (91.2%) successfully terminated their pregnancies using medication and did not seek medical care. Five women exhibited warning signs of potential complications and sought medical care; one woman sought care after a failed abortion. Two women were lost to follow-up and the outcomes of their pregnancies are unknown.ConclusionsEvidence from our analysis suggests that a model of remote provision of support for abortions later in pregnancy by non-medically trained, skilled abortion counsellors could be a safe alternative for women in need of abortions beyond 12 weeks' gestation in a legally restrictive context. Further examination and documentation of the model is warranted.,STUDY OBJECTIVEThe aim was to investigate risk factors for cancer of the buccal and labial mucosa in Kerala, southern India. DESIGNThe investigation was a case-control study. SETTINGRegional Cancer Centre, Trivandrum, Kerala, and local teaching hospitals. PARTICIPANTSCases were all those registered with oral cancers at the Regional Cancer Centre during 1983 and 1984 (n = 414). Controls (n = 895) were selected from admissions to the cancer centre who were found to have non-malignant conditions, or from patients attending outpatients in teaching hospitals of Trivandrum medical college with non-malignant conditions. MEASUREMENTS AND MAIN RESULTSThe risk in males of the following habits was investigated: pan (betel)-tobacco chewing, bidi and cigarette smoking, drinking alcohol, and taking snuff. Only pan-tobacco chewing was investigated in females as very few indulged in other habits. Among males predisposing effects were found for pan-tobacco chewing (p less than 0.001), bidi smoking (p less than 0.001), drinking alcohol (p less than 0.001), and taking snuff (p less than 0.01). As in males, pan-tobacco chewing also had a predisposing effect in females (p less than 0.001). Duration of use was a better predictor of risk than either daily frequency of use or total lifetime exposure, both for pan-tobacco chewing (especially if the habit started before age 21 years) and bidi smoking. However, there were also very high risks associated with the current occasional use of both factors. Pan-tobacco chewing was the most important risk factor, with relative risk of 13.24 with 31-40 years' use, and 37.75 with greater than 40 years' use among males. Corresponding relative risks in females were 21.30 and 54.93. No effect of cigarette smoking was observed (relative risk 0.64, p greater than 0.1). CONCLUSIONSA substantial majority of cases of buccal and labial cancers are attributable to chewing pan-tobacco. This has obvious implications for instituting preventive measures.