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26.  Test-retest reliability of a new questionnaire on the diet and eating behavior of one year old children 
BMC Research Notes  2015;8:16.
As part of a sub-study in the ongoing Norwegian RCT ‘Fit for Delivery’, a new questionnaire, using a combination of food frequency, scale, and categorical questions to gather data on the diets and eating patterns of one year olds, was developed and tested for reliability by test-retest.
Of 102 parents recruited to the study, 94 completed both test and retest. Correlation coefficients (Spearman’s r, and/or Cohen’s kappa, where applicable) were high for all categories of question, with a mean value of 0.72 for Spearman’s r for food frequency variables, and a mean value of 0.75 for Cohen’s kappa for non-numeric variables such as breast feeding status, showing very high test-retest reliability.
This newly developed diet and eating habit questionnaire had strong test-retest reliability in a test population similar to the study population, for which it was developed. This indicates that the questionnaire is reliable in this population.
Electronic supplementary material
The online version of this article (doi:10.1186/s13104-014-0966-y) contains supplementary material, which is available to authorized users.
PMCID: PMC4320631  PMID: 25616767
Infant/child nutrition; Eating behavior; Breastfeeding; Diet questionnaire; Reliability testing
27.  Biosecurity measures to reduce influenza infections in military barracks in Ghana 
BMC Research Notes  2015;8:14.
Military barracks in Ghana have backyard poultry populations but the methods used here involve low biosecurity measures and high risk zoonosis such as avian influenza A viruses or Newcastle disease. We assessed biosecurity measures intended to minimize the risk of influenza virus infection among troops and poultry keepers in military barracks.
We educated troops and used a questionnaire to collect information on animal populations and handling practices from 168 individuals within 203 households in military barracks. Cloacal and tracheal samples were taken from 892 healthy domestic and domesticated wild birds, 91 sick birds and 6 water samples for analysis using molecular techniques for the detection of influenza A virus. Of the 1090 participants educated and 168 that responded to a questionnaire, 818 (75%) and 129 (76.8%) respectively have heard of pandemic avian influenza and the risks associated with its infection. Even though no evidence of the presence of avian influenza infection was found in the 985 birds sampled, only 19.5% of responders indicated they disinfect their coops regularly and 28% wash their hands after handling their birds. Vaccination of birds and use of personal protective clothing while handling the birds were low putting the people at risk.
Though some efforts have been made to improve biosecurity practices, interventions that help to protect the poultry flock from direct contact have to be practiced. Basic hygiene like washing of hands with soap and running water and regular cleaning of chicken coops are needed to prevent the spread of diseases among birds and between birds and humans.
PMCID: PMC4316646  PMID: 25612659
Backyard poultry; Pandemic avian influenza; Biosecurity; Education; Military; Ghana
28.  Effectiveness of monetary incentives to recruit family physicians as study subjects: a randomized controlled trial 
BMC Research Notes  2015;8:15.
Recruiting family physicians to participate as subjects of clinical studies is challenging. Monetary incentives are often used to increase enrolment, but few studies have measured the impact of doing so. As part of a trial seeking to compare two formats of interactive activities within an online continuing medical education (CME) program, we compared family physicians’ recruitment rates with and without a monetary incentive. Recruitment took place by email.
Family physicians listed in the directory of the College of Physicians of the Province of Quebec (Canada) were emailed a one-page letter inviting them to participate in a randomized trial designed to evaluate a three-hour online CME program on rheumatology. Half of physicians were randomly allocated to receive a version of the letter that offered them $300 to participate (incentive group); the other half was not offered compensation (no-incentive group).
A total of 1314 (91%) physicians had a valid email address as listed in the directory. The response rate was 7.5% (54/724) in the incentive group and 2.6% (19/724) in the no-incentive group (absolute difference [AD] 4.8%, 95% confidence interval [95% CI] = 2.6 – 7.2%; risk ratio [RR] 2.8, 95% CI = 1.7 - 4.7). Recruitment rates were 3.5% (25/724) in the incentive group and 0.6% (4/724) in the no-incentive group (AD 2.9%, 95% CI = 1.5 - 4.5%; RR 6.3, 95% CI = 2.2 - 17.9).
Monetary incentives significantly increased recruitment, which nonetheless remained low. To reach recruitment targets, researchers are advised to plan for an extensive list of email contacts and to minimize restrictive eligibility criteria.
PMCID: PMC4318443  PMID: 25612788
Continuing medical education; e-learning; Compensation; Medical research methodology
29.  The strategic role of competency based medical education in health care reform: a case report from a small scale, resource limited, Caribbean setting 
BMC Research Notes  2015;8:13.
Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care environment that is conducive for change and capable of facilitating the smooth migration of existent services into an effective and sustainable VBHC system.
Our findings revealed that our chosen approach was well accepted by the stakeholders. We discovered that in order to achieve a new value based health care system based on a reliable and well-organized system, the competencies of health care providers and the quality of the health care system needs to be assured. For this, extra focus needs to be given to improving service and manpower development both during and after formal training.
In order to achieve a VBHC system in a resource-limited environment, the standard of physicians’ competencies and of the health care system need to be guaranteed. The quality of the educational process needs to be maintained and safeguarded within an integrated health care delivery system that offers support to all care delivery and teaching institutions within the community. Finally, collaborative efforts with international medical institutions are recommended.
PMCID: PMC4305231  PMID: 25605271
Competency; Resource-limited; Health care; Caribbean; Medical education
30.  Cyborg beast: a low-cost 3d-printed prosthetic hand for children with upper-limb differences 
BMC Research Notes  2015;8:10.
There is an increasing number of children with traumatic and congenital hand amputations or reductions. Children's prosthetic needs are complex due to their small size, constant growth, and psychosocial development. Families’ financial resources play a crucial role in the prescription of prostheses for their children, especially when private insurance and public funding are insufficient. Electric-powered (i.e., myoelectric) and body-powered (i.e., mechanical) devices have been developed to accommodate children’s needs, but the cost of maintenance and replacement represents an obstacle for many families. Due to the complexity and high cost of these prosthetic hands, they are not accessible to children from low-income, uninsured families or to children from developing countries. Advancements in computer-aided design (CAD) programs, additive manufacturing, and image editing software offer the possibility of designing, printing, and fitting prosthetic hands devices at a distance and at very low cost. The purpose of this preliminary investigation was to describe a low-cost three-dimensional (3D)-printed prosthetic hand for children with upper-limb reductions and to propose a prosthesis fitting methodology that can be performed at a distance.
No significant mean differences were found between the anthropometric and range of motion measurements taken directly from the upper limbs of subjects versus those extracted from photographs. The Bland and Altman plots show no major bias and narrow limits of agreements for lengths and widths and small bias and wider limits of agreements for the range of motion measurements. The main finding of the survey was that our prosthetic device may have a significant potential to positively impact quality of life and daily usage, and can be incorporated in several activities at home and in school.
This investigation describes a low-cost 3D-printed prosthetic hand for children and proposes a distance fitting procedure. The Cyborg Beast prosthetic hand and the proposed distance-fitting procedures may represent a possible low-cost alternative for children in developing countries and those who have limited access to health care providers. Further studies should examine the functionality, validity, durability, benefits, and rejection rate of this type of low-cost 3D-printed prosthetic device.
PMCID: PMC4304188  PMID: 25601104
3D printing; Computer-aided design; Low-cost prosthesis; Custom-made prosthesis; Prosthesis for children
31.  Measuring social capital through multivariate analyses for the IQ-SC 
BMC Research Notes  2015;8:11.
Social capital can be viewed as a societal process that works toward the common good as well as toward the good of the collective based on trust, reciprocity, and solidarity.
Our study aimed to present two multivariate statistical analyses to examine the formation of latent classes of social capital using the IQ-SC and to identify the most important factors in building an indicator of individual social capital.
A cross-sectional study was conducted in 2009 among working adolescents supported by a Brazilian NGO. The sample consisted of 363 individuals, and data were collected using the World Bank Questionnaire for measuring social capital. First, the participants were grouped by a segmentation analysis using the Two Step Cluster method based on the Euclidian distance and the centroid criteria as the criteria for aggregate answers. Using specific weights for each item, discriminant analysis was used to validate the cluster analysis in an attempt to maximize the variance among the groups with respect to the variance within the clusters. “Community participation” and “trust in one’s neighbors” contributed significantly to the development of the model with two distinct discriminant functions (p < 0.001). The majority of cases (95.0%) and non-cases (93.1%) were correctly classified by discriminant analysis.
The two multivariate analyses (segmentation analysis and canonical discriminant analysis), used together, can be considered good choices for measuring social capital. Our results indicate that it is possible to form three social capital groups (low, medium and high) using the IQ-SC.
Electronic supplementary material
The online version of this article (doi:10.1186/s13104-015-0978-2) contains supplementary material, which is available to authorized users.
PMCID: PMC4304630  PMID: 25601219
Social capital; Statistical analysis; Adolescent
32.  Physical education or playtime: which is more effective at promoting physical activity in primary school children? 
BMC Research Notes  2015;8:12.
School physical education (PE) and playtime provide important opportunities for physical activity (PA). However, little research has assessed PA during primary school PE using accelerometry or compared PA during different lesson types. There is also a lack of research comparing PA during PE and playtime, despite suggestions that playtime promotes more PA. The primary aim of this study was to determine which types of PE lesson are most facilitative of PA. The secondary aim was to determine whether children are more active during PE or playtime.
Descriptive and fitness data were assessed in 20 children aged 8-9years from a single school. Over eight consecutive weeks PA was assessed during PE lessons, which were classified as either team games or movement activities. At the mid-week of data collection playtime PA was also assessed. PA was assessed using accelerometry and the percentage of time spent in moderate to vigorous PA (MVPA) calculated. Paired t-tests were used to compare MVPA during movement lessons and team games lessons and during PE and playtime.
Children spent 9.5% of PE lessons in MVPA and engaged in significantly more MVPA during team games (P < 0.001). MVPA was also significantly higher during PE than playtime (P < 0.01).
Children do not engage in sufficient PA during PE, but are most active during team games lessons; whilst PA during playtime is lower than PE. Interventions to increase PA during both PE and playtime are therefore required. PE interventions should target games lessons as they dominate the curriculum, encourage most PA and present the greatest potential for change. Playtime interventions should encourage participation in active games through the provision of playground equipment and markings.
PMCID: PMC4307686  PMID: 25601324
Physical activity; Playtime; Physical education; Team games
33.  Performance of the ActiGraph accelerometer using a national population-based sample of youth and adults 
BMC Research Notes  2015;8:7.
Accelerometer output may be semi-continuous or continuous in nature, which has implications on discerning non-wear and defining physical activity intensity levels. This study described field-based accelerometer performance from a surveillance sample of youth and adults.
Using 2003–2006 National Health and Nutrition Examination Survey data, 4,028 youth ages 6 to 17 years and 7,931 adults age > =18 years wore an ActiGraph AM7164 accelerometer for one week, providing at least 3 days of wear for > =8 hours/day. Accelerometer performance was assessed by exploring the number of different values of accelerometer counts/minute for each participant.
On average, youth participants had 1381 different counts/minute over 7 days (median 1360, interquartile range 1127–1623) and adult participants had 1101 different counts/minute over 7 days (median 1085, interquartile range 874–1313). For both youth and adults, when restricting to counts/minute between 0 to 4999, every possible value (in counts/minute) occurred at least once.
The field-based data confirmed that the accelerometer used in this study allowed for continuous counts/minute through which all but the most vigorous activities would usually occur.
PMCID: PMC4304161  PMID: 25595702
ActiGraph; Intensity; Missingness; Non-wear; Physical activity; Sample weights; Sedentary behavior
34.  Reproductive health services utilization and its associated factors among Madawalabu University students, Southeast Ethiopia: cross-sectional study 
BMC Research Notes  2015;8:8.
Youths in Sub-Saharan region including Ethiopia account for higher proportion of new HIV infections, maternal mortality ratios, and unmet need for reproductive health information and services. This study assessed reproductive health services utilization and its associated factors among Madawalabu University Students, Southeast Ethiopia.
Institutional-based cross-sectional study was conducted among regular under graduate Madawalabu University students in May 2014. Data were collected from randomly selected students through self-administered pre-tested structured questionnaire. Data were entered in to EpiData 3.1 and exported to SPSS-16.0 for analysis. Descriptive, bivariate and multivariate analyses were employed.
From the total 568 respondents 507(89.3%) of them knew modern family planning. 457(80.5%) of them had ever utilized at least one reproductive health services. Students who ever made discussion on VCT with health profession utilized the VCT two times than those hadn’t made discussion (AOR 2.06, 95% CI 1.21-3.48). Discussion also triple reproductive health services utilization (AOR 3.76, CI 1.55-9.11).
Utilization of reproductive health services for the three indexed variables namely: modern contraceptives, STI diagnosis and treatment, and VCT is fair. But utilization of specific reproductive health services is under expectation. Discussion on reproductive health services between health worker and students, and focusing other identified factors are the way of reproductive health problems intervention in the University.
PMCID: PMC4304627  PMID: 25595848
University students; Reproductive health services; Modern contraceptives; VCT and sexually transmitted infection diagnosis and treatment
35.  Lifestyle factors associated with childhood obesity: a cross-sectional study in Shanghai, China 
BMC Research Notes  2015;8:6.
Limited research has been conducted to investigate factors associated with overweight and obesity of children in China, where obesity has been increasing. This study investigated associations of lifestyle factors with overweight or obesity among Chinese primary school-aged children.
A cross-sectional survey was conducted with 2400 children aged 6–12 from 11 primary schools. Children completed a self-administered questionnaire assisted by their parents at home. The survey included questions on self-reported height and weight, screen time, physical activity, modes of travel to/from school, and dietary habits. Multilevel models were conducted to examine factors associated with overweight or obesity.
15.6% of children were overweight and 11.2% were obese; nearly 80% of children spent ≤2 hrs./day either on physical activities or screen time. Compared with those spent >3 hrs./day on screen time, children who spent ≤2 hrs./day or between 2-3 hrs./day were significantly less likely to be obese after adjusting for other variables (AOR = 0.34, 95% CI: 0.20-0.60, P < 0.01; or AOR = 0.41, 95% CI: 0.20-0.84, P = 0.02 respectively). Children spent ≤2 hrs./day on screen time were less likely to become overweight or obesity, compared with >3 hrs./day (AOR = 0.62, 95% CI: 0.38-0.99, P < 0.05).
Screen time is independently associated with childhood obesity, and needs be focused for obesity prevention in school-aged children in China.
PMCID: PMC4305265  PMID: 25595610
Obesity; Screen time; Physical activity; Sugar-sweetened beverage
36.  Computational identification and binding analysis of orphan human cytochrome P450 4X1 enzyme with substrates 
BMC Research Notes  2015;8:9.
Cytochrome P450s (CYPs) are important heme-containing proteins, well known for their monooxygenase reaction. The human cytochrome P450 4X1 (CYP4X1) is categorized as “orphan” CYP because of its unknown function. In recent studies it is found that this enzyme is expressed in neurovascular functions of the brain. Also, various studies have found the expression and activity of orphan human cytochrome P450 4X1 in cancer. It is found to be a potential drug target for cancer therapy. However, three-dimensional structure, the active site topology and substrate specificity of CYP4X1 remain unclear.
In the present study, the three-dimensional structure of orphan human cytochrome P450 4X1 was generated by homology modeling using Modeller 9v8. The generated structure was accessed for geometrical errors and energy stability using PROCHECK, VERFIY 3D and PROSA. A molecular docking analysis was carried out against substrates arachidonic acid and anandamide and the docked substrates were predicted for drug-likeness, ADME-Tox parameters and biological spectrum activity.
The three-dimensional model of orphan human cytochrome P450 4X1 was generated and assessed with various structural validation programmes. Docking of orphan human cytochrome P450 4X1 with arachidonic acid revealed that TYR 112, ALA 126, ILE 222, ILE 223, THR 312, LEU 315, ALA 316, ASP 319, THR 320, PHE 491 and ILE 492 residues were actively participating in the interaction, while docking of CYP4X1 with anandamide showed that TYR 112, GLN 114, PRO 118, ALA 126, ILE 222, ILE 223, SER 251, LEU 315, ALA 316 and PHE 491 key residues were involved in strong interaction.
From this study, several key residues were identified to be responsible for the binding of arachidonic acid and anandamide with orphan human cytochrome P450 4X1. Both substrates obeyed Lipinski rule of five in drug-likeness test and biological spectrum prediction showed anticarcinogenic activity. Compared to anandamide, arachidonic acid showed strong interaction with cytochrome P450 4X1 and also less health effect in certain human system in ADME-Tox prediction. These findings provide useful information on the biological role and structure-based drug design of orphan human cytochrome P450 4X1.
PMCID: PMC4322450  PMID: 25595103
Homology modeling; Human cytochrome; CYP4X1; Molecular docking; Arachidonic acid; Anandamide
37.  Effects of photobleaching on selected advanced glycation end products in the human lens 
BMC Research Notes  2015;8:5.
Cataract is the leading cause of blindness, especially in the developing world. To ease access to treatment, we have proposed that cataract could be treated non-invasively by photobleaching of the chemically modified proteins responsible for cataract formation. The present study was aimed at examining the optical and biochemical effects of the proposed treatment.
Human donor lenses were photobleaced using a 445 nm cw laser. Lens optical quality was assessed before and after photobleaching by light transmission and scattering. The concentration of the advanced glycation end products (AGEs) pentosidine, argpyrimidine, carboxymethyllysine, hydroimidazolone was measured.
Transmission increased and AGE-related fluorescence decreased significantly after photobleaching but no changes were observed in the concentration of the measured AGEs.
We found a significant effect of the photobleaching treatment on lens optical parameters but we could not associate the optical findings to a change in the concentration of the AGEs we measured. This finding suggests that other AGEs were responsible for the observed photobleaching of the human lens after laser treatment. The biochemical nature of the photochemical reactions associated with photobleaching remains to be elucidated.
PMCID: PMC4302587  PMID: 25592966
Advanced glycation end products; Cataract; Laser; Treatment
38.  Melanoma characteristics in Brazil: demographics, treatment, and survival analysis 
BMC Research Notes  2015;8:4.
The incidence of melanoma, one of the most aggressive of the skin cancers, has been increasing worldwide in the last few decades. Data from Latin America and Brazil remain scarce. We aimed to describe the demographic, clinical, and histopathological data; therapy characteristics; and survival rates of the Brazilian melanoma patient population.
We collected and analysed retrospective data from 15 years at a tertiary cancer centre. We describe patient characteristics and treatment. We calculated survival, and identified the main prognostic factors through univariate and multivariate analysis. We analysed a total of 1073 patients, with a mean age of 56.7 years. Men and women experienced similar prevalence, and 91.2% of patients had white skin. The most prevalent subtype was superficial spreading, and the most prevalent anatomic location was the trunk (32.2%), followed by the lower extremities (28%). Of all cases, 567 (52.9%) were assigned to clinical stages I and II, while 382 (32.6%) were stages III and IV. Surgery was the main treatment. Sentinel node biopsy was performed in 373 patients, with 23.8% positivity. Overall actuarial 5-year survival was 67.6%. Multivariate analysis showed that gender, serum lactate dehydrogenase (LDH) levels at diagnosis; anatomic location, TNM stage, and local recurrence were significant prognostic factors.
Overall survival was lower than worldwide rates. The main factors influencing survival were similar to those in other populations. Local recurrence was independently associated with lower survival rates. The high prevalence of advanced cases reinforces the importance of strategies to diagnose melanomas in the early stages. There is a need for future multi-institutional prospective studies to attain a better understanding of possible socioeconomic and other influences on survival among melanoma populations in Brazil and Latin America.
PMCID: PMC4302717  PMID: 25592837
Brazil; Melanoma; Cutaneous malignant; Latin America; Prognosis; Sentinel lymph node biopsy; Skin neoplasms
39.  Concurrent occurrence of renal cell carcinoma with rhabdoid features in a married couple: a case report 
BMC Research Notes  2015;8:3.
Renal cell carcinoma (RCC) with rhabdoid features is a rare histology and exhibits clinically aggressive behavior. We report a case of a married couple in whom RCC with rhabdoid features concurrently occurred. The rarity of this event suggests that environmental factors may contribute to the etiology of RCC with rhabdoid features.
Case presentation
A 76-year-old Japanese woman was diagnosed with a hypervascular mass in the right kidney and tumor thrombus extending into the right atrium by enhanced computed tomography (CT). She underwent radical nephrectomy and tumor thrombectomy following systemic therapy with the tyrosine kinase inhibitor sunitinib. The histological evaluation denoted clear cell RCC with rhabdoid features. The patient died of cancer 12 months postoperatively. A 76-year-old man, her husband, presented with gross hematuria 2 weeks after his wife had undergone surgery. He had a long history of asbestos exposure. An abdominal CT scan revealed a hypervascular mass in the right kidney and tumor thrombus extending into the inferior vena cava. He also underwent radical nephrectomy and tumor thrombectomy. The histological evaluation also showed clear cell RCC with rhabdoid features. Bone metastasis occurred 12 months postoperatively, but he died of an unrelated cause 18 months after surgery.
Concurrent occurrence of RCC with rhabdoid features may not to be coincidental. Although further studies are warranted, asbestos exposure may contribute to the etiology of clear cell RCC with rhabdoid features.
PMCID: PMC4302605  PMID: 25588411
Renal cell carcinoma; Rhabdoid features; Married couple; Asbestos
40.  Knowledge, attitudes and practices regarding rabies and exposure to bats in two rural communities in Guatemala 
BMC Research Notes  2015;8:955.
Rabies is a fatal encephalitis caused by rabies virus, of the genus Lyssavirus. The principal reservoir for rabies in Latin America is the common vampire bat (Desmodus rotundus), which feeds routinely on the blood of cattle, and when livestock are scarce, may prey on other mammals, including humans. Although rabies is endemic in common vampire bat populations in Guatemala, there is limited research on the extent of exposure to bats among human populations living near bat refuges.
A random sample of 270 of 473 households (57%) in two communities located within 2 Km of a known bat roost was selected and one adult from each household was interviewed. Exposure to bats (bites, scratches or bare skin contact) was reported by 96 (6%) of the 1,721 residents among the selected households. Of those exposed, 40% received rabies post-exposure prophylaxis. Four percent of household respondents reported that they would seek rabies post exposure prophylaxis if they were bitten by a bat.
These findings demonstrate that exposure to bats in communities near bat roosts is common but recognition of the potential for rabies transmission from bats is low. There is a need for educational outreach to raise awareness of bat-associated rabies, prevent exposures to bats and ensure appropriate health-seeking behaviours for bat-inflicted wounds, particularly among communities living near bat roosts in Guatemala.
PMCID: PMC4302579  PMID: 25576098
Rabies; Bat bite; Health practices; Post-exposure prophylaxis; Guatemala; Rabies prevention; Vampire bat
41.  Genetic relatedness among indigenous rice varieties in the Eastern Himalayan region based on nucleotide sequences of the Waxy gene 
BMC Research Notes  2014;7:953.
Indigenous rice varieties in the Eastern Himalayan region of Northeast India are traditionally classified into sali, boro and jum ecotypes based on geographical locality and the season of cultivation. In this study, we used DNA sequence data from the Waxy (Wx) gene to infer the genetic relatedness among indigenous rice varieties in Northeast India and to assess the genetic distinctiveness of ecotypes.
The results of all three analyses (Bayesian, Maximum Parsimony and Neighbor Joining) were congruent and revealed two genetically distinct clusters of rice varieties in the region. The large group comprised several varieties of sali and boro ecotypes, and all agronomically improved varieties. The small group consisted of only traditionally cultivated indigenous rice varieties, which included one boro, few sali and all jum varieties. The fixation index analysis revealed a very low level of differentiation between sali and boro (FST = 0.005), moderate differentiation between sali and jum (FST = 0.108) and high differentiation between jum and boro (FST = 0.230) ecotypes.
The genetic relatedness analyses revealed that sali, boro and jum ecotypes are genetically heterogeneous, and the current classification based on cultivation type is not congruent with the genetic background of rice varieties. Indigenous rice varieties chosen from genetically distinct clusters could be used in breeding programs to improve genetic gain through heterosis, while maintaining high genetic diversity.
Electronic supplementary material
The online version of this article (doi:10.1186/1756-0500-7-953) contains supplementary material, which is available to authorized users.
PMCID: PMC4320456  PMID: 25547027
Boro; Ecotype; Genetic relatedness; Indigenous rice varieties; Jum; Sali
42.  Assessing the application of non-pharmacological interventions for people with dementia in German nursing homes: feasibility and content validity of the dementia care questionnaire (DemCare-Q) 
BMC Research Notes  2014;7(1):950.
Non-pharmacological interventions are guideline-recommended as initial treatment for people with dementia in nursing homes. In Germany, there is no instrument available to collect standardized data on the application of all of these interventions; an investigation of their use in large-scale samples is not currently possible. This article describes the development and initial testing of a questionnaire (Dementia Care Questionnaire (DemCare-Q)) to assess provided non-pharmacological interventions in residents with dementia in nursing homes that can be completed by nurses.
The questionnaire development comprised the following steps to achieve content validity and feasibility: a structured content analysis of the German guideline for the care of people with dementia and challenging behavior in nursing homes and a systematic literature review of projects that implemented these; quantitative expert ratings and calculation of content validity indices; qualitative pre-test with future users using cognitive techniques; quantitative pre-test using frequency analysis of item non-response.
The developed questionnaire covers seven dementia-specific non-pharmacological interventions in nursing homes. Problematic items could be improved by revising them successively, bringing forth a feasible and content valid version of the DemCare-Q. The DemCare-Q enables researchers to collect data on the application of dementia interventions in German nursing homes in large-scale studies.
A literature review, expert rating and multi-method pre-test are important steps of questionnaire development. The applied methods ensure content validity and the practicability of the instrument. The publication of this process enhances the transparency of questionnaire design and supports researchers in solving problems in developing questions to assess the application of interventions. Since these are initial steps of questionnaire development, further testing of its reliability is needed.
PMCID: PMC4307140  PMID: 25539580
Questionnaires; Feasibility studies; Health care surveys; Data collection; Non-pharmacological interventions; Nursing home; Dementia
43.  The validation of Fibit Zip™ physical activity monitor as a measure of free-living physical activity 
BMC Research Notes  2014;7(1):952.
The new generation of activity monitors allow users to upload their data to the internet and review progress. The aim of this study is to validate the Fitbit Zip as a measure of free-living physical activity.
Participants wore a Fitbit Zip, ActiGraph GT3X accelerometer and a Yamax CW700 pedometer for seven days. Participants were asked their opinion on the utility of the Fitbit Zip. Validity was assessed by comparing the output using Spearman’s rank correlation coefficients, Wilcoxon signed rank tests and Bland-Altman plots. 59.5% (25/47) of the cohort were female. There was a high correlation in steps/day between the Fitbit Zip and the two reference devices (r = 0.91, p < 0.001). No statistically significant difference between the Fitbit and Yamax steps/day was observed (Median (IQR) 7477 (3597) vs 6774 (3851); p = 0.11). The Fitbit measured significantly more steps/day than the Actigraph (7477 (3597) vs 6774 (3851); p < 0.001). Bland-Altman plots revealed no systematic differences between the devices.
Given the high level of correlation and no apparent systematic biases in the Bland Altman plots, the use of Fitbit Zip as a measure of physical activity. However the Fitbit Zip recorded a significantly higher number of steps per day than the Actigraph.
PMCID: PMC4307145  PMID: 25539733
Physical activity; Pedometer; Accelerometer; Validation
44.  Demyelinating disease and anti-N-methyl-D-aspartate receptor immunoglobulin G antibodies: a case report 
BMC Research Notes  2014;7(1):948.
Anti–N-methyl-D-aspartate receptor immunoglobulin G antibodies directed against the GluN1 subunit are considered highly specific for anti-N-methyl-D-aspartate receptor encephalitis, a severe clinical syndrome characterized by seizures, psychiatric symptoms, orofacial dyskinesia and autonomic dysfunction.
Case presentation
Here we report a 33 year old Caucasian male patient with clinically definite multiple sclerosis who was found to be positive for anti-N-methyl-D-aspartate receptor antibodies. Rituximab therapy was initiated. On the 18 months follow-up visit the patient was found to be clinically stable, without typical signs of anti-N-methyl-D-aspartate receptor encephalitis.
Our findings add to the growing evidence for a possible association between anti-N-methyl-D-aspartate receptor encephalitis and demyelinating diseases.
PMCID: PMC4307172  PMID: 25539977
Multiple Sclerosis; NMDA receptor antibody; Encephalitis; Demyelinating disease; Anti-neuronal antibodies; Neuroinflammation
45.  Dental caries and associated factors among primary school children in Bahir Dar city: a cross-sectional study 
BMC Research Notes  2014;7(1):949.
Dental caries is the most common chronic infectious disease of childhood caused by the interaction of bacteria, mainly Streptococcus mutans and sugary foods on tooth enamel. This study aimed at determining the prevalence and associated factors of dental caries among primary school children at Bahir Dar city.
A school based cross-sectional study was conducted at Bahir Dar city from October 2013 to January 2014. Systematic random sampling technique was used to select the children. Structured questionnaire was used to interview children and/or parents to collect socio demographic variables. Clinical dental information obtained by experienced dentist using dental caries criteria set by World Health Organization. Binary and multiple logistic regression analysis were computed to investigate factors associated with dental caries.
Of the 147 children, 82 (55.4%) were girls. Majority of the children (67.6%) cleaned their teeth using traditional method (small stick of wood made of a special type of plant). The proportion of children having dental caries was 32 (21.8%). Primary tooth decay accounted for 24 (75%) of dental caries. The proportion of missed teeth was 7 (4.8%). The overall proportion of toothache and dental plaque among school children were 40 (27.2%) and 99 (67.3%), respectively. Grade level of 1–4 (AOR = 3.9, CI = 1.49 -10.4), poor habit of tooth cleaning (AOR = 2.6, CI = 1.08 - 6.2), dental plaque (AOR = 5.3, CI = 1.6 - 17.7) and toothache (AOR = 6.3, CI = 2.4 – 15.4) were significantly associated with dental caries.
Dental caries is a common public health problem in school children associated with poor oral hygiene, dietary and dental visit habits. Therefore, prevention measures such as health education on oral hygiene, dietary habits and importance of dental visit are obligatory for children.
PMCID: PMC4307198  PMID: 25540044
Dental caries; Dental plaque; Children
46.  Cervical Ectropion and Intra-Uterine Contraceptive Device (IUCD): a five-year retrospective study of family planning clients of a tertiary health institution in Lagos Nigeria 
BMC Research Notes  2014;7(1):946.
Cervical ectropion (also known as cervical erosion) is a common finding on routine pelvic examination during the fertile years. The decision to treat or not remains controversial. According to studies in support of routine treatment of cervical erosion, there is a possible relationship between squamous metaplasia and squamous cell carcinoma of the cervix. To determine the prevalence of cervical ectropion and associated risk factors among clients with intra-uterine contraceptive devices (IUCDs) attending a family planning clinic of a tertiary health institution in Lagos, Nigeria.
A 5-year retrospective study was conducted by assessing existing clinic records from years 2007–2011. Clients with IUCDs undergo routine pelvic examination during check-up visits. A total of 628 clients’ records were seen within the stated time frame. This study was approved by the ethical committee of the Lagos State University Teaching Hospital (LASUTH) and the collected data were analyzed using SPSS version 19.0.
The mean age of the IUCD users was 34.7 ± 6.52 years, while 517 (82.3%) had secondary education. On routine pelvic examination, seventy-nine clients (12.6%) had cervical ectropion. Thirty-nine (6.2%) clients had presented with a history of abnormal vaginal bleeding while 12.1% had vaginal discharge. Treatments offered to cases of cervical ectropion include cervical painting with gentian violet (89.9%) and antibiotics prescription (58.2%). On bivariate analysis, previous hormonal contraceptive use (P = 0.041) and vaginal discharge (P < 0.001) were significantly associated with developing cervical ectropion. Clients with ectropion were significantly more likely to receive prescriptions for antibiotics (P < 0.001).
Less than one fifth of the clients had cervical erosion. However, routine pelvic examination could aid the detection and control of latent reproductive health problems such as cervical ectropion which may require further investigations for example, pap smears, to exclude potentially lethal conditions and to determine appropriate treatment modality.
PMCID: PMC4307624  PMID: 25539789
Cervical; Ectropion; Intra-uterine contraceptive device
47.  Through the lens of the clinician: autopsy services and utilization in a large teaching hospital in Ghana 
BMC Research Notes  2014;7(1):943.
Declining hospital autopsy rates in many countries have generated considerable concern. The survey determined challenges of the autopsy service in a large Teaching Hospital in Ghana, from the perspective of clinicians.
This was a cross-sectional study of doctors at the Korle-Bu Teaching Hospital (KBTH) over in 2012. The data was collected using a 69 item self-administered structured questionnaire. In all a total of 215 questionnaires were sent out and 119 doctors responded. Data was collected on the challenges of the autopsy services and barriers to autopsy request from the perspectives of clinicians. Survey data were analyzed by simple descriptive statistics (i.e. proportions, ratios and percentages. Data from survey was analyzed with SPSS version 21.
The most common reasons for requesting autopsies were to answer clinical questions, 55 (46.2%) and in cases of uncertain diagnosis, 54 (45.4%). Main demand side barriers to the use of autopsy services by clinicians were reluctance of family to give consent for autopsy 100 (84%), due to cultural and religious objections 89 (74.8%), extra funeral cost to family53 (44.5%) and increased duration of stay of body in the morgue 19 (16%). Health system barriers included delayed feedback from autopsy service 54 (45.4%), difficulties following up the autopsy process 40 (33.6%) due to uncertainties in the timing of particular events in the autopsy process, and long waiting time for autopsy reports 81 (68.1%). More than a third of clinicians 43 (36.2%), received full autopsy report beyond three weeks and 75 (63.1%) clinicians had concerns with the validity of reports issued by the autopsy service (i.e. reports lack specificity or at variance with clinical diagnosis, no toxicological, histological or tissue diagnoses are performed).
The autopsy service should restructure itself efficiently and management should support the provision of histological and toxicological services. Strengthening internal and external quality improvement and control of autopsies in the Hospital are essential.
PMCID: PMC4307638  PMID: 25533037
Autopsy service; Barriers to autopsies; Clinicians; Teaching hospital; Ghana
48.  Clinical and pathological features of Nerium oleander extract toxicosis in wistar rats 
BMC Research Notes  2014;7(1):947.
Nerium oleander has been widely studied for medicinal purposes for variety of maladies. N. oleander has also been reported having noxious effects because of its number of components that may show signs of toxicity by inhibiting plasma lemma Na+, K+-ATPase. The present study was performed to scrutinize the toxic effect of N. oleander leaves extract and its clinical and pathological features in wistar rats.
Hematological analysis showed significant variations in RBCs count (P = 0.01), Hb (P = 0.001), Hct (P = 0.0003), MCV (P = 0.013), lymphocyte count (P = 0.015), neutrophil count (P = 0.003), monocyte count (P = 0.012) and eosinophil count (P = 0.006). Histopathological studies have shown that in T1 group noticeable infiltration of inflammatory cells was found with low level of vascular damage. In T2 group, increased proportion of binucleated and inflammatory cells, hepatic necrosis, widening of sinusoidal spaces and mild level of vascular damage was observed.
Taken together these findings we can conclude that N. oleander leaves extract significantly affects on experimental animals due to its toxicity. Efforts must be exerted to purify different chemical components from extract with no inflammation as this plant is utilized in folk medicine with narrow therapeutic indices.
PMCID: PMC4308011  PMID: 25539875
Histopathology; Inflammation; Toxicity; Polycythemia; Macrocytosis; Neutrophilia
49.  Validation of miRNA genes suitable as reference genes in qPCR analyses of miRNA gene expression in Atlantic salmon (Salmo salar) 
BMC Research Notes  2014;7(1):945.
MicroRNAs (miRNAs) are an abundant class of endogenous small RNA molecules that downregulate gene expression at the post-transcriptional level. They play important roles by regulating genes that control multiple biological processes, and recent years there has been an increased interest in studying miRNA genes and miRNA gene expression. The most common method applied to study gene expression of single genes is quantitative PCR (qPCR). However, before expression of mature miRNAs can be studied robust qPCR methods (miRNA-qPCR) must be developed. This includes identification and validation of suitable reference genes. We are particularly interested in Atlantic salmon (Salmo salar). This is an economically important aquaculture species, but no reference genes dedicated for use in miRNA-qPCR methods has been validated for this species. Our aim was, therefore, to identify suitable reference genes for miRNA-qPCR methods in Salmo salar.
We used a systematic approach where we utilized similar studies in other species, some biological criteria, results from deep sequencing of small RNAs and, finally, experimental validation of candidate reference genes by qPCR to identify the most suitable reference genes. Ssa-miR-25-3p was identified as most suitable single reference gene. The best combinations of two reference genes were ssa-miR-25-3p and ssa-miR-455-5p. These two genes were constitutively and stably expressed across many different tissues. Furthermore, infectious salmon anaemia did not seem to affect their expression levels. These genes were amplified with high specificity, good efficiency and the qPCR assays showed a good linearity when applying a simple cybergreen miRNA-PCR method using miRNA gene specific forward primers.
We have identified suitable reference genes for miRNA-qPCR in Atlantic salmon. These results will greatly facilitate further studies on miRNA genes in this species. The reference genes identified are conserved genes that are identical in their mature sequence in many aquaculture species. Therefore, they may also be suitable as reference genes in other teleosts. Finally, the systematic approach used in our study successfully identified suitable reference genes, suggesting that this may be a useful strategy to apply in similar validation studies in other aquaculture species.
Electronic supplementary material
The online version of this article (doi:10.1186/1756-0500-7-945) contains supplementary material, which is available to authorized users.
PMCID: PMC4308020  PMID: 25533334
50.  Amino acid substitutions in hemagglutinin of the 2009 pandemic influenza A(H1N1) viruses that might affect the viral antigenicity 
BMC Research Notes  2014;7(1):951.
During 2009 to 2012, Thailand had encountered 4 distinctive waves of the 2009 pandemic influenza A(H1N1) (H1N1pdm) outbreaks. Considering the RNA nature of the influenza viral genome, a mutation in hemagglutinin (HA) gene which led to change in antigenicity of the strains circulating during those epidemic periods is anticipated. It is also uncertain whether the A/California/07/2009 (H1N1) (CA/07) vaccine strain still confers protective immunity against those evolved viruses, the causative agents of the later epidemic waves.
HA gene segments of 10 H1N1pdm isolates obtained during 2009 to 2012 were sequenced and phylogenetically analysed using ClustalW and MEGA5 programs. A total of 124 convalescent serum samples collected from patients naturally infected during 3 epidemic waves were employed as tools to investigate for antigenic change in HA of these 10 circulating H1N1pdm viruses by hemagglutination inhibition (HI) assay.
A phylogenetic analysis showed that the 10 virus isolates were grouped into 4 clusters corresponding to the time of 4 consecutive outbreaks. An accumulation of amino acid substitutions in HA was observed in viruses derived from the late epidemic waves. Significantly lower antibody titers were observed when CA/07 was tested against convalescent sera collected from the 3 waves (p < 0.05) compared to most of Thai isolates; and significantly lower antibody titers were also obtained when virus isolates, retrieved from the third epidemic wave were tested against convalescent sera collected during the first and second wave. These results were suggestive of change in antigenicity of the evolved viruses. Our results also showed some mutation position residing outside the previously reported antigenic site that may involve in an alteration of the viral antigenicity.
Our study demonstrated that convalescent sera collected from individuals naturally infected with H1N1pdm virus were successfully used to reveal a statistically significant change in antibody titers against the currently evolved H1N1pdm viruses as determined by HI assay. Nevertheless, the antibody titers of individual serum against various viruses were less than 4-folded difference as compared to that against the CA/07 vaccine strain. Therefore, CA/07 is still a potent vaccine strain for those evolved H1N1pdm viruses.
PMCID: PMC4308064  PMID: 25539651
2009 pandemic influenza A(H1N1) virus; Hemagglutinin; Hemagglutination inhibition assay; Nucleotide sequencing; Thailand

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