BACKGROUND: Improvement of sex education in schools is a key part of the UK government's strategy to reduce teenage pregnancy in England. We examined the effectiveness of one form of peer-led sex education in a school-based randomised trial of over 8000 pupils. METHODS: 29 schools were randomised to either peer-led sex education (intervention) or to continue their usual teacher-led sex education (control). In intervention schools, peer educators aged 16-17 years delivered three sessions of sex education to 13-14 year-old pupils from the same schools. Primary outcome was unprotected (without condom) first heterosexual intercourse by age 16 years. Analysis was by intention to treat. FINDINGS: By age 16 years, significantly fewer girls reported intercourse in the peer-led arm than in the control arm, but proportions were similar for boys. The proportions of pupils reporting unprotected first sex did not differ for girls (8.4% intervention vs 8.3% control) or for boys (6.2% vs 4.7%). Stratified estimates of the difference between arms were -0.4% (95% CI -3.7% to 2.8%, p=0.79) for girls and -1.4% (-4.4% to 1.6%, p=0.36) for boys. At follow-up (mean age 16.0 years [SD 0.32]), girls in the intervention arm reported fewer unintended pregnancies, although the difference was borderline (2.3% vs 3.3%, p=0.07). Girls and boys were more satisfied with peer-led than teacher-led sex education, but 57% of girls and 32% of boys wanted sex education in single-sex groups. INTERPRETATION: Peer-led sex education was effective in some ways, but broader strategies are needed to improve young people's sexual health. The role of single-sex sessions should be investigated further.

Adolescent↗

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Evaluation of retention of safety and survival training content versus industry standard for training.

INTRODUCTION: The accepted standard in the industry for survival and safety training is annual recurrent educational programs. The industry has never looked at nor tested content comprehension or retention on this subject. We decided to conduct a sample testing of crews' ability to understand and retain survival training material. METHODS: This study solicited the participation of four program crews that had received previous training in safety and survival. A test on safety and survival training content was administrated to nurses and paramedics before a refresher course (test 1), then immediately after the course (test 2), and again 6 months later (test 3). Ninety-six crew members took tests 1 and 2, and 79 (82%) took test 3. RESULTS: The average time since any crew member participating in this study had attended a survival course was 1 to 1.5 years. The pretraining test mean score was 60 (60%); the posttraining average score was 92 (92%); and the 6-month mean score was 65 (65%). CONCLUSION: Flight crews do not retain a safe level of survival skill knowledge with annual recurrent training. Therefore the industry needs to reevaluate its position on this standard of annual recurrent training. Survival training is too important for flight crews to undertake only once per year. Rescuer care is as important as patient care.

Air Ambulances↗

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Hypoxia favours necrotic versus apoptotic shedding of placental syncytiotrophoblast into the maternal circulation.

In the third trimester of normal pregnancy, the mother tolerates daily shedding of several grams of dying placental trophoblast into the maternal circulation. The balance between apoptotic and necrotic shedding is presently unknown. Since pre-eclampsia is characterized by an altered placental oxygenation and increased trophoblast shedding, we investigated the role of oxygen on the balance of apoptotic versus necrotic trophoblast shedding in vitro. We studied human trophoblast turnover in explanted villi from late first and third trimester placentas in low oxygen (2 per cent) and higher oxygen tensions (6 per cent and 18 per cent) for up to 72h. Trophoblast turnover including apoptosis and necrosis were assessed by histology, immunolocalization of Mib-1 (proliferation marker), Bcl-2 (apoptosis inhibitor), activated caspase 3 (apoptosis promoter), cytokeratin 18 neo-epitope formation (M30 antibody), TUNEL test (DNA degradation), and (3)H-cytidine and(3) H-uridine incorporations. Culture in 2 per cent oxygen increased cytotrophoblast proliferation and syncytiotrophoblast shedding by necrosis. The proteins necessary for execution of apoptosis were mostly retained in the cytotrophoblast due to lack of syncytial fusion. Culture in 6 per cent and 18 per cent oxygen reduced cytotrophoblast proliferation. Syncytial fusion occurred and activity of caspase 3 was found in the syncytiotrophoblast; the latter remained intact demonstrating physiologic turnover, including apoptotic shedding. We conclude that severe placental hypoxia favours necrotic rather than apoptotic shedding of syncytial fragments into the maternal circulation. Since uteroplacental ischaemia is a significant risk factor for pre-eclampsia, these findings may explain the link between reduced uteroplacental blood flow and the systemic clinical manifestations of this disease.

Adult↗

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Orbitofrontal function, object alternation and perseveration.

Object alternation (OA) is a well-established measure of perseveration and orbitofrontal function in non-human primates. Although several studies have used OA to examine orbitofrontal system dysfunction in humans with neurological and psychiatric disease, this task itself has not been validated as a bona fide measure of frontal dysfunction in humans. To address this issue, six patients with bilateral frontal lobe lesions documented by computerized tomography (CT) or magnetic resonance imaging (MRI) and 15 healthy controls were given OA, as well as other measures of frontal system dysfunction, delayed alternation (DA), delayed response (DR), and the Wisconsin Card Sorting Test (WCST). The CT and MRI scans were interpreted blindly. The patients with bilateral frontal lesions were significantly impaired on OA, DA, DR and the WCST. Analyses of the CT/MRI lesions suggest that the neuroanatomical regions involved in the deficits on OA include Brodmann areas 10, 24, 32 and 47, as well as possibly 11, and that OA is a sensitive measure of ventrolateral-orbitofrontal and medial frontal dysfunction in humans. Our findings lend further support for the use of experimental paradigms adopted from animal models to study the functional neuroanatomy and neuropsychological mechanisms underlying cognitive functions in humans with neurological and psychiatric disease.

Cognition↗

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Otomastoiditis caused by Mycobacterium avium-intracellulare.

Explore the source record for details and available documents.

Female↗

PubMedDate not supplied

Impact of duration in a cardiac rehabilitation program on coronary risk profile and health-related quality of life outcomes.

BACKGROUND: Optimal cardiac rehabilitation (CR) program length and the time course of changes in relevant outcomes are unknown. The purpose of this study was to assess changes in coronary risk factors and health-related quality of life (HRQoL) after 3 months and 6 months of cardiac rehabilitation. METHODS: This is an observational study of a cohort of 126 consecutive cardiac rehabilitation patients who completed baseline, 3-month, and 6-month evaluations of coronary risk factors and HRQoL. The coronary risk factors included lipid profile, blood pressure, body mass index (BMI), and physical activity level. HRQoL was assessed using the Short Form-36 questionnaire (SF-36) comprising eight health concepts and two component scales (physical [PCS] and mental [MCS]). RESULTS: There was significant improvement in all coronary risk factors and HRQoL measures, except BMI, over the 6-month period (P < 0.001). Significant changes in blood pressure, physical activity, PCS, and high-density lipoprotein cholesterol (HDL-C) were apparent at 3 months, and no additional significant changes in these variables occurred between 3 and 6 months. For total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and MCS, significant change was achieved between 3 and 6 months but not between baseline and 3 months. CONCLUSIONS: Secondary prevention and HRQoL outcomes improved at variable rates. Physical activity and physical function peaked at 3 months and were maintained at program completion. Significant improvements occurred in mental health recovery beyond the traditional 12-week CR program length. Outcomes furthest from normative values showed the most rapid improvement. Optimal duration of participation may vary according to the outcome of interest.

Blood Pressure↗