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Lazarus Naturals Review: Costs

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09.06.2018

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    Z-Freeze 400mg review Pain for Rub 1 Zuri

    Therefore, early diagnosis and management of the problem become essential to avoid later sequalae on reproductive and sexual life. However, early diagnosis may be challenged by many factors. For example, many patients will be preoccupied by the newborn or embarrassed of talking about sexual matters after delivery, which makes it very important for the midwifery, medical, or other staff to raise the issue during the postnatal care sessions.

    The staff, on the other hand, might feel uncomfortable to discuss the sexual function with the client, or even may lack the knowledge and skills required for sexual health counselling. In addition to the client-service gap, there are gaps between different sexual service providers. There are many types of postnatal sexual disorders. These types can differ widely in clinical features and management. In the last three decades there has been an increase in caesarean section rate in the developed world due to many maternal and fetal indications, especially with the significant improvement in surgical and postoperative care.

    Recently, more attention has been paid to the positive role the caesarean section may play in protecting the female pelvic floor from birth trauma. Perineal birth trauma has been accused by many authors of adversely affecting the female sexual well being. This problem might become more difficult to solve if the woman already suffers from a sexual disorder for example: Female sexual dysfunction is impaired or inadequate ability of a woman to engage in or enjoy satisfactory sexual intercourse and orgasm.

    This could be related to fluctuations in gonadal hormone secretion, making women more vulnerable to sexual symptoms. To help in understanding this classification better, it is important to refer to the early research done in this field by Masters and Johnson in One of the most interesting findings of the latter has been the four stage model of sexual response, which they described as the human sexual response cycle.

    Excitement phase initial arousal , Plateau phase at full arousal, but not yet at orgasm , Orgasm, and Resolution phase after orgasm. Although it is normal to have hypoactive sexual desire loss of libido in the first weeks after giving birth, this becomes abnormal when the desire for sexual activity is persistently reduced or absent causing distress in the relationship. Sexual desire disorder after delivery may be due to the mother being preoccupied with the neonate or postpartum complications e.

    It can often be associated with sexual pain disorder as well. Solana-Arellano et al reported an incidence of Moreover, dyspareunia might be caused by psychosocial factors like problems in relationship with the partner, work stress, financial crisis, depression, and anxiety.

    Dyspareunia, in many cases, can occur as a result of a combination of medical and psychosocial factors. Although, vaginismus is recognised as a different identity, it is usually associated with dyspareunia when it happens in the Puerperium. Sexual desire disorders, Isolated postpartum sexual arousal and orgasmic disorder are rarely seen in postnatal clinics as when they occur they tend to be part of other PPFSDs.

    Effect of Mode of Delivery: Searching the Cochrane library databases has shown no review related to the subject. New MESH words were used, related to comparison between different modes of delivery Caesarean section, vaginal birth, modes of delivery, sexual dysfunction, sexual disorder, dyspareunia.

    Additional studies from the reference lists were obtained. Only studies directly compared between caesarean section and vaginal birth in term of assessing the PPFSD were included. The Cochrane library database review did not have related articles. It is worth mentioning, however, that there was a Cochrane review on postpartum perineal short term pain, not related to sexual activity. Therefore, it was excluded from this review. The systematic review included in this list of literature studies is the Langer and Minetti review on the complications of episiotomy.

    Only eight studies fulfilled the criteria. Full papers were retrieved. There was one randomised controlled trial, one prospective cohort study, one cross-sectional study, and the other 5 were performed retrospectively 4 questionnaire surveys, and 1 interview survey. The total pool sample of patients studied included cases Caesarean sections vs.

    Four studies aimed to compare PPFSD aspects within other variants, such as pelvic floor morbidity, urinary incontinence, and faecal or flatus incontinence. However, in long term i. Forest plot of comparison between studies. Studies to left of the midline were in favour of less long term PPFSD symptoms with caesarean section compared to vaginal delivery. Therefore it is a logic presumption to think that avoiding pelvic floor injury by performing a caesarean section especially as an elective mode of delivery may alleviate PPFSD.

    This presumption, if true, will have very significant clinical and financial implications in practice especially with a pre-existing problem of increasing caesarean section rate in many parts of the developed world. So what research evidence in the literature is available to support or overrule this presumption?. Griffiths et al in their questionnaire survey of a women from the Cardiff Birth Survey Database have showed a significant increase in the prevalence of dyspareunia two years after vaginal birth compared to caesarean section.

    In their paper they did not mention if vaginal birth with no tears or complications was associated with a higher incidence of dyspareunia. In contrast, Klein et al concluded that women who had intact perineum after vaginal birth had less dyspareunia than those underwent caesarean section. Moreover, as a previous caesarean section will increase the operative risk of the successive caesarean sections or will add more risk to the trial of labour if this is opted for in the future, we can expect a higher increased of sexual disorders in the following pregnancies.

    From previous discussion we found insufficient evidence to advocate a decision of performing a caesarean section on basis of alleviating PPFSD. This evidence is outweighed by the higher risk of caesarean section including bleeding, infection, anaesthesia risk, deep vein thrombosis, pulmonary embolism, impairment of future fertility, risk of scar dehiscence in next labour, injury to bladder and bowels and risk of fetal laceration.

    In this review, there is good evidence to suggest that episiotomy is an important risk factor for short term PPFSD. However, there is little evidence to support a possible long term effect especially if other complications to episiotomy occurred later. Breastfeeding, and the use of progestogen-only pill as contraceptive are other risk factors identified by other studies.

    Awareness of the problem makes half of the solution. Episiotomy and severe obstetric traumas are the main risk factors. Restricted use of episiotomy and early management of episiotomy complications can play an important role in preventing persistent PPFSD. There is insufficient evidence to suggest caesarean section as a better mode of delivery in term of preventing or alleviating PPFSD.

    Women's dyspareunia after childbirth: Y, Su L, et al. Women's sexual health after delivery and its related influential factors. Reproductive life events and sexual functioning in women: Diagnostic and Statistical Manual for Mental Disorders, 4th ed.

    Human Sexual Response, 1st ed. Postpartum sexual functioning and method of delivery: Immediate and long term complications of episiotomy.

    Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. Sexuality after delivery with episiotomy: Gynecologic and Obstetric Investigation. Female genital tract morbidity and sexual function following vaginal delivery or lower segment caesarean section. Pelvic floor morbidity up to one year after difficult instrumental delivery and cesarean section in the second stage of labour: Post-cesarean pelvic floor dysfunction contributes to undisclosed psychosocial morbidity. Journal of Reproductive Medicine.

    A comparison of urinary and sexual outcomes in women experiencing vaginal and Caesarean births. Does the mode of delivery influence sexual function after childbirth?. Journal of Women's Health. Cesarean section and postnatal sexual health. Rate of dyspareunia after delivery in primiparae according to mode of delivery.

    The effect of the mode of delivery on the quality of life, sexual function, and sexual satisfaction in primiparous women and their husbands. Journal of Sexual Medicine. Sexual health in postnatal women: Revista de Psiquiatria Consiliar e de Ligacao. Women's sexual health after childbirth British Journal of Obstetrics and Gynaecology. Journal of Reproductive Medicine for the Obstetrician and Gynecologist ; 44 Women's sexuality after childbirth: Archives of Sexual Behavior. Headaches and sexual activity are often treated with humour as a typical way for women to reject male advances.

    However, headaches associated with sexual activity can be anything but a joke. HSA headaches associated with sexual activity are by definition benign conditions but the symptoms can be the same as in serious life threatening cerebral conditions and these need to be quickly excluded at the first presentation. Most sexual headaches are of a benign nature. However, the first time an HSA occurs it can be a traumatic, frightening occurrence for the patient. HSA are capricious in nature with poorly understood pathophysiology and uncertain course of the condition.

    Patients need to have the situation clearly explained to them so that management can be optimal. However, good overall management of a patient with HSA should also include discussions about possible negative sexual consequences of the HSA experience. Sexuality can be affected by HSA both during the active condition and subsequently.

    Headaches associated with or occurring around sexual activity have been recognized since the time of Hippocrates [1, 2]. Wolff [3] discussed headache during sexual activity in However, these headaches started to be formally reported in the s, first by Kitz in [4] and then Paulson [5] and Martin [6] in Johnson, Human sexual response.

    Cesk Neurol Neurochir, Klawans, Benign orgasmic cephalgia. Ir J Med Sci, J Neurol Neurosurg Psychiatry, Boes, Cough, exertional and sex headaches. Neurol Clin N Am, Frese, Comorbidity of migraine and headache associated with sexual activity. Olesen, Symptomatic and non-symptomatic headaches in a general population. Kraft, Natural course of benign coital headache. An analysis of 72 benign and symptomatic cases.

    Demography, clinical features and comorbidity. Primary headache attributed to sexual activity. Silbert, Sequential benign sexual headaches and exertional headaches. Steiner, Coital headaches induced by amiodarone. Jankovic, Benign coital cephalalgia. Villaverde, Sexual headache and stroke in a heavy cannabis smoker. Int J of Impotence Research, Lopez-Valdez, Benign Valsalva's maneuver-related headaches: An MRI study of 6 cases.

    Exertional and sexual headaches. Curr Pain Headache Rep, A disorder of myogenic cerebrovascular autoregulation? Evers, A patient with orgasmic headaches converting to concurrent orgasmic and benign exertional headaches. Ostermann, The benign and malignant forms of orgasmic cephalgia. Arboix, Complicated coital cephalalgia, three cases with benign evolution.

    Caplan, Avoiding pitfalls in the diagnosis of subarachnoid haemorrhage. N Engl J Med, Wijdicks, Pituitary apoplexy presenting as a thunderclap headache. Kappelle, Thunderclap headache as first symptom of cerebral venous sinus thrombosis. Zochodne, Recurrent coital 'thunderclap' headache associated with ischaemic stroke.

    Hinterberger, Symptoms of phaeochromocytoma, with particular reference to headache, correlated with catecholamine production. Prophylactic treatment and course of the disease in headache associated with sexual activity.

    Preventative Pharmacotherapy of Headache Disorders, ed. Harding, Headache and Sexual Activity: American Headache Society, Clinical features, diagnosis and management. Med Clin North Am, Husstedt, Alternatives in drug treatment of chronic paroxysmal hemicrania. Br Med J, J Indiana State Med Assoc, J Korean Med Sci, Reported prevalence of physical restraint varies from 7.

    Use of restraints often has an effect opposite of the intended purpose, which is to protect the patient. The risk of using a restraint must be weighed against the risk of not using one, and informed consent with proxy decision makers should occur. Comprehensive nursing assessment of problem behaviours, a physician order when instituting restraints, and documentation of failure of alternatives to restraint is required. Steps can be taken to reduce restraints before the need for restraints arises, when the need for restraints finally does arise, and while the use of restraints is ongoing.

    Complications of restraints can be serious including death resulting from both medications and devices. Use of restraints should be reserved for documented indications, should be time limited, and there should be frequent re-evaluation of their indications, effectiveness, and side effects in each patient. Analysis of environmental and patient specific root causes of potentially self-injurious behavior can lead to reduction in the use of restraints.

    Education of the patients, families, and the health care team can increase the use of less restrictive alternatives. Review of the use of physical restraints and lap belts with wheelchair users. Influence of physical restraint on unplanned extubation of adult intensive care patients: Am J Crit Care.

    Risk of death in elderly users of conventional vs. Dec 1 ; Conditions and circumstances predisposing to death from positional asphyxia in adults. J Forensic Leg Med. Elderly patients with dementia-related symptoms of severe agitation and aggression: Accessed August 13, Case study approach to removing physical restraint.

    International Journal of Nursing Practice. Use of physical and chemical restraints in medical teaching units. Feb 8 ; 3: J Am Geriatr Soc.

    A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents. Administrative initiatives for reducing inappropriate prescribing of psychotropic drugs in nursing homes: Snowden M, Roy-Byrne P. Mental illness and nursing home reform: OBRA ten years later.

    Omnibus Budget Reconciliation Act. Use of physical restraints and psychotropic medications in Alzheimer special care units in nursing homes. Am J Public Health.

    Patient injury and physical restraint devices: Safety and efficacy of physical restraints for the elderly. Review of the evidence. Physical restraint initiation in nursing homes and subsequent resident health. Medicare nonpayment, hospital falls, and unintended consequences. Jun 4 ; Fatalities related to medical restraint devices-asphyxia is a common finding. Jul 4 ; Atypical antipsychotics in the elderly with Parkinson disease and the "black box" warning.

    Aug 22 ;67 4: Jusic N, Lader M. Post-mortem antipsychotic drug concentrations and unexplained deaths. Guideline for the prevention of falls in older persons. Omnibus Budget Reconciliation Act of and its implications for the medical director. Elon R, Pawlson LG. The impact of OBRA on medical practice within nursing facilities. Accessed July 17, Moore K, Haralambous B. Barriers to reducing the use of restraints in residential elder care facilities.

    Effective assessment of use of sitters by nurses in inpatient care settings. J Nurs Care Qual. Developing a perspective on restraint and the least intrusive intervention. Dec Jan 10 ;15 Chronically ill patients with neurodegenerative and neurobehavioural and psychiatric diseases commonly have systemic and central nervous system bacterial and viral infections.

    Evidence of Mycoplasma species, Chlamydia pneumoniae , Borrelia burgdorferi , human herpesvirus-1, -6 and -7 and other bacterial and viral infections revealed high infection rates in the above illnesses that were not found in controls. Nicolson GL, Haier J. Role of chronic bacterial and viral infections in neurodegenerative, neurobehavioral, psychiatric, autoimmune and fatiguing illnesses: Br J Med Practit ; 2 4: Psychiatric manifestations of Lyme borreliosis.

    J Clin Psychiatry ; Role of psychiatric co-morbidity in chronic Lyme disease. Severity of Lyme disease with persistent symptoms. Insights from a double-blind placebo-controlled clinical trial. Dementia associated with infectious diseases. Psychiatric comorbidity and other psychological factors in patients with "chronic Lyme disease". Higher prevalence of antibodies to Borrelia burgdorferi in psychiatric patients than in healthy subjects.

    Screening for Lyme disease in hospitalized psychiatric patients: Mt Sinai J Med. Clinical and demographic characteristics of psychiatric patients seropositive for Borrelia burgdorferi. No association of seropositivity for anti-Borrelia IgG antibody with mental and physical complaints. Relations among indexes of memory disturbance and depression in patients with Lyme borreliosis.

    Psychological states and neuropsychological performances in chronic Lyme disease. Selected infectious agents and risk of schizophrenia among U. High risk of schizophrenia and other mental disorders associated with chlamydial infections: Antistreptococcal, neuronal and nuclear antibodies in Tourette syndrome. The catechol O-methyltransferase ValMet polymorphism and herpes simplex virus type 1 infection are risk factors for cognitive impairment in bipolar disorder: Infection with herpes simplex virus type 1 is associated with cognitive deficits in bipolar disorder.

    Association of serum antibodies to herpes simplex virus 1 with cognitive deficits in individuals with schizophrenia. Maternal exposure to herpes simplex virus and risk of psychosis among adult offspring. No evidence of relation between maternal exposure to herpes simplex virus type 2 and risk of schizophrenia? No changes in paired viral antibody titers during the course of acute schizophrenia. Search for evidence of herpes simplex virus, type 1, or varicella-zoster virus infection in postmortem brain tissue from schizophrenic patients.

    Decreased serum levels of interleukin-2 and interleukin-6 in Indian Bengalee schizophrenic patients. Increased serum interleukin-1beta and interleukin-6 in elderly, chronic schizophrenic patients on stable antipsychotic medication. Eur Arch Psychiatry Clin Neurosci. The value of interleukinB p40 gene promoter polymorphism in patients with schizophrenia in a region of East Turkey.

    Interleukin gene promoter polymorphism in patients with schizophrenia in a region of East Turkey. World J Biol Psychiatry.

    Microglia hypothesis of schizophrenia. Clinical analysis of Gilles de la Tourette syndrome based on cases. Tics in children and adolescents: Autoimmune neuropsychiatric disorders associated to infection by streptococcus in the paediatric age: Mycoplasma pneumoniae infection and Tourette's syndrome. Obsessive-compulsive disorder and acquired toxoplasmosis in two children.

    Eur Child Adolesc Psychiatry. Bacterial triggers and autoimmune rheumatic diseases. Clin Exptl Rheumatol ; Bacterial infections and the pathogenesis of autoimmune conditions. Br J Med Practit ; 2 1: Infections and autoimmune diseases. J Autoimmun ; 25 suppl: Serological evidence for infection with Campylobacter jujuni in patients with multifocal motor neuropathy. J Clin Neurosci ; 5: Reactivity of serum anti-GM1 ganglioside antibodies with the lipopolysaccharide fractions of Campylobacter jejuni isolates from patients with Guillain-Barre syndrome GBS.

    J Neuroimmunol ; Natl Med India Komagamine T, Yuki N. J Peripher Nerv Syst ; Brannagan TH, Zhou Y. J Neurol Sci ; Saraf S, Singh RK. GB syndrome with herpes simplex infection. Indian J Pediatr ; J Clin Virol ; Neuropsychiatric disorders associated with Streptococcal infection: Pediatric autoimmune neuropsychiatric disorders associated with streptococcus: Association between streptococcal infection and obsessive-compulsive disorder, Tourette's syndrome, and tic disorder.

    Increased anti-streptococcal antibodies in patients with Tourette's syndrome. Curr Treat Options Neurol. Is Tourette's syndrome an autoimmune disease? Tourette Syndrome Study Group. Serial immune markers do not correlate with clinical exacerbations in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.

    Streptococcal infection and exacerbations of childhood tics and obsessive-compulsive symptoms: The Chronic Fatigue Syndrome, a comprehensive approach to its definition and study. Ann Internal Med ; Neural correlates of the chronic fatigue syndrome—an fMRI study. Relationship of brain MRI abnormalities and physicial functional status in chronic fatigue syndrome.

    Intern J Neurosci ; Natural Killer cell function in chronic fatigue syndrome. Clin Appl Immunol Rev ; 2: Nijs J, Fremont M. Expert Opin Ther Targets ; High levels of type 2 cytokine-producing cells in chronic fatigue syndrome, Clin Exp Immunol ; Cytokines and chronic fatigue syndrome. Ann New York Acad Sci ; The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome. Mycoplasmal infections in chronic illnesses: J Chronic Fatigue Syndr ; 6 3: Evidence for bacterial Mycoplasma, Chlamydia and viral HHV-6 co-infections in chronic fatigue syndrome patients.

    J Chronic Fatigue Syndr ; 11 2: Multiple co-infections Mycoplasma, Chlamydia, human herpesvirus-6 in blood of chronic fatigue syndrome patients: Chronic fatigue syndrome after human parvovirus B19 infection without persistent viremia. Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach. J Clin Pathol ; J Chronic Fatigue Syndr ; 15 4: Absence of Mycoplasma species DNA in chronic fatigue syndrome.

    J Med Microbiol ; High prevalence of mycoplasmal infections among European Chronic Fatigue Syndrome patients. Examination of four Mycoplasma species in Chronic Fatigue Syndrome patients. Chronic Chlamydia pneumoniae infection: Clin Infect Dis ; Immunossay with cytomegalovirus early antigens from gene products p52 and CM2 UL44 and UL57 detects active infection in patients with chronic fatigue syndrome.

    Antibody responses to Epstein-Bar virus, human herpesvirus 6 and human herpesvirus 7 in patients with chronic fatigue syndrome. Prevalence of IgM antibodies to human herpesvirus-6 early antigen in patients with chronic fatigue syndrome. J Infect Dis ; Chronic fatigue syndrome CFS: J Chronic Fatigue Syndr ; 5: Detection of a retrovirus, XMRV, in blood cells of patients with chronic fatigue syndrome.

    Science ; online J Chronic Fatigue Syndr ; 11 1: High prevalence of mycoplasmal infections in symptomatic Chronic Fatigue Syndrome family members of mycoplasma-positive Gulf War Illness patients. Baumzweiger WE, Grove R. Brainstem-Limbic immune dysregulation in Gulf War veterans: Intern J Med ; 1: Vojdani A, Franco AR.

    Lyme disease — a tick-borne spirochetosis? Med Hypotheses ; Borrelia burgdorferi migrates into joint capsules and causes an upregulation of interleukin-8 in synovial membranes of dogs experimentally infected with ticks, Infection and Immunity,. Gale A, Ringdahl E. Am Fam Physician ; Chronic fatigue syndrome in patients with Lyme borrellosis. Eur Neurol ; Borrelia burgdorferi reactivity in patients with severe persistent fatigue who are from a region in which Lyme disease is endemic.

    Clin Infect Dis ; 18 suppl 1: Diagnosis and therapy of chronic systemic co-infections in Lyme Disease and other tick-borne infectious diseases. Townsend Lett ; Recognition and management of Lyme Disease. Am Family Physician ; ALS-like sequelae in chronic neuroborreliosis. Wien Med Wochensch ; Lebech AM, Hansen K.

    Detection of Borrelia burgdorferi DNA in urine samples and cerebrospinal fluid samples from patients with early and late Lyme neuroborreliosis by polymerase chain reaction.

    J Clin Microbiol ; Evidence for disseminated Mycoplasma fermentans in New Jersey residents with antecedent tick attachment and subsequent musculoskeletal symptoms, J Clin Rheumatol ; 9: Immunoserologic evidence of coinfection to tick-borne pathogens of babesiosis, ehrlichiosis and Lyme borrelosis in human sera. Diagnostic hints and treatment guidelines for Lyme and other tick-borne diseases.

    Clinical and epidemiological features of early Lyme Disease and human granulocytic ehrlichiosis in Wisconsin. Rao R-V, and E. Concurrent infection of the central nervous system byBorrelia burgdorferi and Bartonella henselae.

    Arch Neurol ; When to suspect and how to monitor Babesiosis. Am Fam Physican ; J Pediatr ; Krakowian 1 , M. Napora-Rutkowska 1 , J. Faron 1 , K. Gruszka 1 , M. Mrzyk 1 , A. Paleczny 1 , H. The study was an attempt of use of Hydra attenuata and Brachydanio rerio embryos in teratogenic studies. The aim was to determine the suitability of these species in a such type of researches. Eleven active substances with different degree of influence on prenatal development were used in experiment: Acute toxicity and regeneration test were performed for each substance.

    Tests were performed to obtain LC50 value for acute and for regeneration test. The teratogenic index was estimated. Depending on the size of the index, the appropriate point value was assigned: Different concentrations of substances were used in the study to observe the concentration with toxic effects and lethal effects.

    The occurrence of changes and lethal effects in the embryos was marked as an appropriate point values. Lack of changes was valued as 0. The maximum point value for changes and lethal effects could be 4. Study reveals usefulness of these animals as indicators for strong teratogenic. The final grade for each substance was the sum of the points in the study on hydra and embryos. All used in experiment strong teratogenic reached the highest value of points 5 to 6 and are clearly higher then values of substances defined as not teratogenic 0 to 4.

    Regola 1 , R. Vicini 1 , A. Buzzella 1, 2 , F. Riva 3 , M. Mori 1 , S. Giorgetti 4 , C. Angelinetta 1 , O. The moisturization of the skin is regulated by the balance between transepidermic water loss and skin ability to retain water.

    This function is supported by the presence of specifical structures: Occludin which play a key role in maintaining the cutaneous barrier integrity in thight junctions, and Aquaporins AQPs , transmembrane proteins that facilitate the transport of water and, in some cases, small solutes across cells membrane.

    According to the results of in vivo moisturizing tests currently used, the aim of this study was to develop an in vitro moisturizing test based on the evaluation of expression of Occludin and AQP3. Topical products, tested in vivo and in vitro, were divided into 3 different categories based on the active moisturizing ingredients: For the in vivo study the products were applied on 20 female subjects and the instrumental measurements of moisturization was performed before the beginning of treatment T 0 , basal value and after min for short-term evaluations or after several days of continuous use for long-term evaluations.

    The cells were treated for hours with concentrations of products choosen after a preliminary cytotoxicity test MTT: We observed an increase in skin moisturization in vivo for all tested products particularly evident for category A and B products.

    The slowest in vitro action of category B products reflects the long-term effects obtained following in vivo treatment for 7 days. The moisturizing power of category C products was observed only in vivo, probably due to the humectant characteristics of glycerol present in them rather than to the increase of the expression of specific moisturizing markers. Iskandar 1 , S. Sandro 1 , M. Shoaib 1 , A. Kondylis 1 , Y. Xiang 1 , F. Zanetti 1 , S.

    Frentzel 1 , F. Martin 1 , N. Ivanov 1 , M. Peitsch 1 , U. Doshi 2 , W. McKinney 2 , M. Considerable attention has been given toward the potential reduced harm of e-cigarettes e-cigs. Most in vitro studies have focused on testing e-liquid formulations directly on submerged 2D cultures. Here, we examined the effects of exposure to whole e-cig aerosols compared with mainstream cigarette smoke CS using human 3D organotypic cultures.

    Nine independent exposures were conducted for a robust assessment. Concentrations of the deposited nicotine and carbonyls in the exposure chamber were measured each time as markers of exposure. Biological endpoints investigated include histology, cytotoxicity, inflammatory mediators, and gene microarray.

    Alterations in morphology and cytotoxicity were not observed in buccal cultures exposed to undiluted e-cig aerosols despite the two-fold nicotine deposition compared with the deposition following exposure to diluted CS.

    Similarly, morphological changes and cytotoxicity were not observed in small airway cultures following e-cig aerosol exposure despite the fold nicotine deposition compared with the deposition after exposure to diluted CS. In both cultures, many more inflammatory mediators in the media were altered following exposure to CS than were altered following exposure to e-cig aerosols.

    In addition, compared with exposure to e-cig aerosols, CS exposure showed greater biological impact in global gene expression, including mechanisms of cell fate, proliferation, stress, and inflammatory response.

    In small airway cultures, these impacts reverted to the levels of the air-exposed cultures after 24 hours. In small airway and buccal cultures, e-cig aerosols caused significantly less impact than CS.

    Ploem 1 , A. Wouters 1 , M. Willems 1 , T. Artois 1 , K. Biodiversity and Toxicology, Diepenbeek, Limburg, Belgium. The need for accurate and reliable carcinogenicity assays poses an important issue within the field of toxicology.

    Cancer risks are directly associated with the underlying mechanism of action of the carcinogenic compound e. The presented assay provides a simple, rapid and inexpensive alternative method to predict genotoxicity, but also has the potential to identify non-genotoxic compounds. Our methodology entails the exposure to carcinogens during the early stages of the regeneration process of a flatworm species: During this regeneration period, the tested compounds induced unique stem cell responses for the different types of carcinogens non-genotoxic vs genotoxic.

    We are currently assessing more compounds to further validate the concept, i. In addition, we focused on direct and indirect DNA damage and the activated repair mechanisms of the pluripotent stem cells.

    Here we observed differences, between genotoxic and non-genotoxic exposure, in the type and regulation of the activated repair gene groups, e. The ability to discriminate between genotoxic and non-genotoxic compounds in an in vivo alternative model, makes this approach unique and with significant added value to current research and drug development.

    Van Mulders 1, 2 , B. Mertens 1 , V. Over the last years, many valuable in chemico, in silico and in vitro methods have been developed as alternatives to animal testing. Unfortunately, expertise on these alternative methods is scattered and communication on the topic between experts from different domains is often limited. In order to enhance the use of alternative methods to animal testing, knowledge sharing needs to be facilitated between the different parties involved e.

    In , the RE-Place project was initiated by the Flemish and Brussels government with the aim to centralize the existing knowledge and increase its accessibility.

    The RE-Place project is performed in close collaboration with the members of the RE-Place steering committee, which consists of experts from academia, industry and government institutions, all with extensive know-how in the field of alternative methods to animal testing. Since the online tool is publicly accessible, experts from different fields will be able to connect with peers and engage in new collaborations.

    Centralization of the information will also allow to identify the gaps in the field of alternative methods to animal testing. Importantly, in a later stage, the RE-Place database can be further extended to a broader platform, stimulating the development of new techniques, methods and strategies and supporting education and training. Bars 1 , E. Verbueken 1 , J. Vergauwen 2 , E. Michiels 2 , E. Stinckens 2 , I. Knapen 2 , C. Van Ginneken 1 , S. However, the biotransformation capacity at such an early stage of development embryonic and larval stage remains a point of debate.

    This is important for a correct interpretation of toxicity data and especially when these data are used for human risk assessment.

    We, therefore, thoroughly characterized the transcript profiling of enzymes involved in the metabolism of xenobiotics, i. Generally, low CYP expression was noted during zebrafish organogenesis until 3 dpf, followed by an increase of expression after this stage of development.

    An interesting pattern of expression of the CYP enzymes was also observed between 6 and 10 dpf. The expression of the phase II enzymes and the drug transporter seemed to be low as well until 3 dpf, highly increased from 3 dpf until 5 dpf and then stabilized. The correlation of the gene expression data with the activity of these proteins, in both the early phase of development and the adult stage of the zebrafish, will allow for a better interpretation of toxicity studies in this model.

    Bressers 1 , M. Tobor-Kaplon 2 , M. The methodology of these reproductive toxicity assessments used by different groups varies greatly. To set a first step in implementation of the C. A thorough analysis of published peer-reviewed manuscripts on the use of C. Test conditions such as selection of nematode strain, culture media liquid or agar , temperature, developmental stage at the start of exposure, use of solvent, method of exposure agar vs liquid medium; in presence or absence of bacteria , exposure length, type of test chamber, availability of food alive, inactivated or in absence of food and study endpoints were reviewed.

    Based on the outcome of this literature review and based on in-house experimental data, the most optimal study design regarding these test conditions is proposed.

    Hessel 1 , Y. Staal 1 , A. Developmental neurotoxicity entails one of the most complex areas in toxicology. Development of the central nervous system involves many different events within strictly controlled timeframes creating a different windows of vulnerability to chemical exposure.

    OECD test guidelines for DNT TG and are only occasionally carried out and the predictivity of these in vivo animal tests for human health effects may be limited.

    A multitude of alternative models have been developed over the years, providing insights into mechanisms of action. The development and application of mechanistically driven in vitro tests in relation to human brain development may facilitate a better prediction of DNT in the future.

    Given the impressive progress in mechanistic knowledge of human biology and toxicology, the time is right for a conceptual approach for designing testing strategies that cover the integral mechanistic landscape of developmental neurotoxicity. The ontology approach provides a framework for defining this landscape, upon which an integral in silico model for predicting toxicity can be built.

    It subsequently directs the selection of in vitro assays for rate-limiting events in the biological network, to feed parameter tuning in the model, leading to prediction of the toxicological outcome. Therefore, we generated an overview of fundamental processes of neurodevelopment based on existing knowledge of the biology of neural tube formation, brain development and neural specification.

    In parallel, we made an inventory of the wealth of alternative methods in this area and matched them to biological processes that need assessment for chemical perturbation. This inventory will feed into an ontology approach towards building comprehensive testing strategies for developmental neurotoxicity. Teles 1, 2 , F. Balasch 2 , L. Tort 2 , M. The transcriptional profile was complemented with outcomes at higher levels of biological organization, including biotransformation, antioxidant response, hepatic health indicators, and oxidative damage indicators.

    Chemical quantification of AuNP was carried out in water samples and in S. The overall genetic response showed a differential hepatic transcriptional profile both in the number and intensity of differentially expressed genes DEG.

    Concerning the functional pathways affected, main changes were found for genes encoding proteins involved in the response to xenobiotics, oxidoreductase activity, immunomodulation, DNA repair and programmed cell death types I and II. In light of results obtained for all the organizational levels of response assessed, we conclude that short-term waterborne AuNP exposure has a direct effect on gene expression modulation in S. Erkens 1 , J. Boonen 1 , N. Goeminne 1 , A. Kegels 1 , L. Van den Sande 1 , D.

    Marien 1 , M. Cardiotoxicity is a major concern during drug development and is a major factor contributing to the high attrition rates. Therefore, it is important to detect cardiac toxicity early in the development process. The objective of our study was to evaluate both the analytical and biological performance of a number of safety biomarkers related to cardiotoxicity in a preclinical setting.

    Serum samples were collected from male Sprague-Dawley rats prior to treatment, and 6 and 24 hours after subcutaneous single dose administration of 0. Parallelism was observed, although the minimum required dilution varied with parameter in the multiplex panel. Histopathology confirmed the presence of heart damage in the treated rats. Except for FSTL1, increases were detected in all parameters from the cardiac multiplex panel and myoglobin, with fold changes ranging between 2- and more than fold, depending on the biomarker.

    In addition, an increase in a number of miRNAs was observed, such as miRa-3p, b-3p, p and a-3p. Although our experience with the FirePlex platform at this stage is limited and the data in this study are based on a small sample size, results indicated that the evaluated assays are able to detect biomarker changes in rats with cardiac injury. Therefore, these safety biomarker assays could be of added value in preclinical toxicity studies in the rat.

    This study aimed to investigate under laboratory conditions the chronic effects of Acer 35EC on Nile tilapia Oreochromis niloticus using a multi-biomarker approach. The results showed that Acer 35EC reduced cholinesterase activity in muscle of treated fish of both sexes.

    Females displayed high levels of testosterone and Keto-testosterone after 56 days of exposure. Regarding immune biomarkers, intracellular superoxide anion production decreased in both sexes after 56 days of exposure. Oxidative stress biomarkers were not influenced by AcerEC exposure, regardless of sex and concentration. After 28 and 56 days of exposure, significant differences in the ovarian development were observed as the diameter of vitellogenic oocytes in exposed females differed from the one of the control females, indicating an increase in oocyte growth during the 1 st month of exposure to AcerEC, followed by a regression during the 2 nd exposure period.

    No differences were recorded in male gonads. Based on a large set of biomarkers, the insecticide AcerEC seems to impair different physiological functions in Nile tilapia juveniles on a time-dependent manner, with a stronger impact on females than in males.

    Ungurianu 1 , O. The objective of our study was to compare the antioxidant capacity and redox alterations of serum samples and isolated lipoproteins from type 2 diabetes mellitus T2DM rats treated with either metformin, gliclazide or Retinofort — a plant-based antidiabetic dietary supplement. T2DM were split into 4 groups which received different treatment: Rats were sacrificed and serum was separated. High and low density lipoproteins were isolated from serum with the heparin-citrate method and, respectively, the phosphotungstic acid-MgCl 2 one.

    Antioxidant capacity was determined with a ABTS based method and lipid peoxidation was assessed with a previousely optimised Amplex Red assay, on both serum and lipoprotein preparations. As for the serum lipid peroxidation, compared to control, the mean values were lower for Metformin and Retinofort groups and higher for Gliclazide. Regarding LDL peroxidation there was no significant differences between the four groups, however a strong positive correlation of this marker with glycemia throughout the treatment period was observed.

    Retinofort treated rats exhibited superior antioxidant defence of serum and LDL compared to the other groups, accompanied by similar lipid peroxidation versus the Metformin one.

    Lipid peroxidation of HDL in Retinofort rats was significantly higher compared to Metformin, but the antioxidant capacity was similar. Miyajima-Tabata 1 , K. Komoriya 1 , M. Tanaka 2 , H. Hiruma 1 , R. Kato 1 , Y. Haemocompatibility is a major concern associated with using medical devices or materials that contact with blood; it is greatly influenced by the physical properties of the material surface.

    Although some representative evaluation methods are established in ISO , appropriate biomarkers for the evaluation of haemocompatibility have not yet been identified. In this study, we evaluated the biomarkers for haemocompatibility of these biomaterials.

    Both sides of a polycarbonate PC sheet were coated with the biomaterials. Heparinized human whole blood was incubated with polymer-coated and uncoated PC sheets for hours in various testing tubes with gentle shaking. The effects of priming and air contact were also compared. No haemolysis was observed in all cases. Priming and air contact did not affect the assessment of the haemocompatibility of these biomaterials.

    The levels of these biomarkers increased after incubation with uncoated PC sheets. There was no remarkable difference of the levels of C3a, C5a, and SC5b-9 in all sheets. Krauskopf 1 , F. Caiment 1 , K.

    Chadeau-Hyam 2 , R. Sinharay 3 , K. Fan Chung 3 , P. Cullinan 3 , P. Collins 3 , B. Barratt 4 , F. Kelly 4 , R. Vermeulen 5 , T. Motor vehicles emit large quantities of a complex mixture of harmful pollutants including several species of particulate matter PM as well as gaseous pollutants such as nitrogen dioxide NO2.

    These traffic-related emissions have been linked to the pathogenesis of several diseases including multiple types of cancer, pulmonary and cardiovascular diseases and more recently also to neurodegenerative diseases. In search of an early diagnostic biomarker for improved air pollution related health risk assessment, recent studies have shown that certain circulating miRNAs are altered upon e.

    PM exposure in humans. In this study we assessed real-time personal exposure to vehicle-emitted air pollutants of a human population walking at a high and low traffic site, and consequently analyzed the global plasma circulating miRNA genome of all participants by next-generation sequencing. The study revealed a profile of circulating miRNAs to be dose- and pollutant species-dependently associated with multiple ambient vehicle-emitted pollutant species including PM10, PM2.

    Our bioinformatics analysis suggests that the signature of circulating miRNAs reflect the consequences of motor vehicle emission-induced toxicity in target tissues such as the lung, heart and brain already after 2 hours. Shestakova 1 , N.

    The model of adaptive potential reduction was tested on male Wistar rats in the days experiment with carbon tetrachloride CCl4 intoxication. Animals with an initial body weight of Besides similar diets O, O and O , the test group rats were intraperitoneally administered CCl4 once a week throughout the experiment 8 injections.

    In total each animal received CCl4 in the amount of 6. In addition to a standard for toxicological research set of hematological, biochemical and morphological parameters, there was also used single-cell gel electrophoresis DNA-comet method to study the apoptosis activity in the liver, whereby the apoptotic index AI, the number of apoptotic cells per liver cells.

    The analysis of the data revealed a significant increase in apoptosis activity correlated to the level of nutrient deficiency, with AI values in control groups K, K and K of 2. The test group animals demonstrated the similar dynamics in programmed cell death intensity increasing amid the vitamins and minerals decline: It worth noting that the deepening nutrients shortage led to decrease difference between the test and control groups.

    According to the research results, it can be concluded that the apoptosis activity indicators, which are sensitive biomarkers of toxic effects, appear to be inappropriate for application on alimentary deficiency models. Diabetic kidney disease DKD is the leading of chronic and end-stage-renal disease worldwide. After development of overt diabetic nephropathy, patients will progress to end-stage renal disease ESRD , which is associated with high morbidity and mortality, and high treatment costs.

    Recently, microalbumin has historically been measured as an early marker for advanced CKD. In this study, we identified reliable on non-invasive urinary biomarkers for early detecting DKD.

    We identified protein-based new biomarkers in the kidney of high fat diet-induced ZDF rats. These biomarkers were validated in urine of diabetic patients. Our results indicated that the marked increases in SBP-1 and PKM2 levels were observed in the urine of diabetic patients. Thus, these new biomarkers may have potential as alternatives to traditional biomarkers for the efficient and sensitive assessment of DKD.

    Further, novel biomarkers can be used as sensitive diagnostic kits in diabetic patients for early time prevention of ESRD. Silvano 1 , P. Ancian 1 , C. Bansard 1 , J. Boje Nielsen 2 , P. Singh 1 , R. Phenobarbital is a widely used anti-seizure medication. Treatment of laboratory animals with PB results in hepatomegaly and induction of CYP xenobiotic metabolizing enzymes, and long term treatment of rats and mice results in hepatic tumours.

    While PB has been extensively studied in rodents, little is known about the impact of PB treatment on the gene expression profile in minipig liver. On day 7, animals were euthanized and an 80 mg section of liver was snap frozen in liquid nitrogen. The differentially expressed genes were filtered using an absolute fold-change threshold at 1.

    A total of and probesets were found to be significantly down and upregulated in minipig liver by PB treatment, respectively. These data will be correlated with additional analyses such as CYPs and UGT expression and ex-vivo enzyme activities in liver microsomes.

    Ruiz 2 , T. Calcium Ca may have a protective effect against metal toxicity by modulating metal-induced oxidative stress. The goal of this study is to assess the effects of Ca availability and metal pollution on oxidative stress biomarkers in adult female pied flycatchers Ficedula hypoleuca. We performed a Ca-supplementation experiment in in a Ca-poor and metal-polluted area in SW Finland. Pied flycatcher females showed higher metal concentrations in feces in the polluted zone.

    The Ca supplementation and zone had no effect on the oxidative stress biomarkers. Generalized linear models were also performed by choosing fecal metal concentrations as a proxy of dietary levels and Ca levels in plasma instead of pollution zone and treatment in an effort to investigate more accurately associations between metal exposure and Ca levels in the organism. GSSG ratio decreased with increasing metal concentrations.

    This suggests that birds are able to upregulate their antioxidant capacity to cope with higher metal exposure from a certain level of Ca concentrations in plasma. Thus, Ca concentrations in plasma may have a protective effect against metal-related oxidative stress.

    However, Ca could also be involved in lipid damage in a context of increased metal concentrations. Further studies are needed to better understand this mechanism.

    This study was financed by the Academy of Finland project to T. Ancian 1 , E. Grosdidier 1 , A. Decheix-Nguyen 1 , S. Sarlang 1 , J. Inconsistent delayed-type hypersensitivity DTH responses have been reported in non-human primates, hence the need to study alternative endpoints. DTH was induced by an intradermal challenge of tetanus toxoid TTx and aluminum hydroxide on days 28 and Injection sites were observed before challenge and after 24, 48 and 72 hours.

    No clinical signs were noted. Hematological findings were consistent with known effects of RPM. No clear trend in any cytokine level was noted after the first DTH response, but all levels declined after RPM treatment. Silva 1 , J. Madureira 1, 2 , A. Esteves 1, 2 , F. Teixeira 1, 2 , C. Genetic and epigenetic effects , aims to analyse both genetic damage and DNA methylation of mothers and their newborns exposed to environmental tobacco smoke ETS taking into consideration other possible co-exposures relevant to genetic and epigenetic alterations, namely PAHs, phthalates, brominated polyphenylene and metals.

    At birth, maternal blood and urine, umbilical cord blood and placenta samples have been collected. In addition, each participant provided information on demographics, clinical history, lifestyles and exposures, including exposure to ETS before and during pregnancy, through an individual questionnaire. Cotinine concentrations were determined in maternal urine as it was found to be more sensitive than the remaining samples to second hand exposure paired samples of 15 participants were analysed to confirm matrix selection.

    A comparison between urinary nicotine concentrations and quantitative measurement of ETS exposure measured through questionnaire was also performed to identify possible underreport of smoking and exposure behaviors.

    Smoking cessation during pregnancy has for long been an international priority to protect the health of the developing fetus. Moreover, tobacco control policies have been implemented in many countries to promote health, save healthcare costs and generate revenues for government services. Accurate assessment of fetal exposure to smoking through the objective measure of a biomarker is essential in this project, as the ultimate goal is the investigation of the effects of prenatal exposures to pollutants, including tobacco smoke, in genetic and epigenetic alterations.

    Schmidt 1 , A. Steinhilber 1 , H. Hammer 3 , A. Mentz 4 , J. Kalinowski 4 , D. Lichtenstein 2 , A. Braeuning 2 , P.

    Marx-Stoelting 2 , A. Lampen 2 , T. Joos 1 , O. Consumers are exposed to multiple residues of different pesticides via their diet. The toxicological properties of these substances are generally determined individually, hence there is not much data available on potential mixture effects.

    Due to the increasing number of available substances and thus the increase of potential multiple residues in food, analysis of mixture effects by traditional toxicological methodology would increase animal testing. Therefore, it is important to develop in vitro methods for the assessment of pesticide combinations to reduce animal experiments. We developed mass spectrometry- MS based immunoassays to investigate the influence of single substances and combinations at the protein level of toxicologically relevant biomarkers.

    In this approach peptides are analyzed as surrogates for the protein that can be identified and quantified via MS.

    HepaRG are a well-established human cell model system for human hepatocytes. We used this cell system to analyze the protein profile after pesticide treatment. Cells were perturbated for 24h with single pesticides and combinations thereof. We analyzed 24 proteins quantitatively and six of these proteins showed induction effects depending on the applied pesticide. In summary, we developed a very robust and accurate platform for the analysis of toxicological effects in HepaRG cells.

    Karzi 1, 2 , I. Katsikantami 1, 2 , M. Tzatzarakis 1 , E. Vakonaki 1 , P. Xezonaki 3 , A. Stratidakis 1 , E. Iliaki 1 , S. Sifakis 3 , A. Rizos 2 , A. The growing need of producing longer lasting and better quality products has led to the increasing use of antimicrobial agents like triclosan TCS and parabens PBs. These compounds are mainly used in pharmaceutical products, make up and personal care products, like toothpastes, shampoos, deodorants and baby wipes.

    It is recorded that TCS and PBs affect the reproductive system of males and females, the thyroid gland and other tissues like the liver. Analytes were extracted by liquid-liquid extraction with ethyl acetate and determined using liquid chromatography— APCI —mass spectrometry. The LOD was 0. MePB was present in Median concentrations were 9. This work is one of the very few monitoring studies of triclosan and parabens in amniotic fluid. Low detection frequencies and concentration levels of all agents in amniotic fluid samples were in agreement with data provided from the recent literature.

    Concentration levels were also below the corresponding levels reported for urine samples which is attributed to possible low tranfer or rapid clearance of the compounds in amniotic fluid. Wang 2 , C. Several studies have shown that polymethoxyflavones PMFs are effective in preventing carcinogen-induced colorectal cancer CRC or colitis. Polycyclic aromatic hydrocarbons PAHs are widespread environmental carcinogenic pollutants and they have become an important issue in food contamination.

    Dietary intake of PAHs has been recognized as a major route of human exposure. Additionally, consumption of PMF extracts also altered the composition of gut microbiota and made it similar to that in the control group by increasing butyrate-producing probiotics and decreasing CRC-related bacteria. B a P in combination with DSS significantly induced colorectal tumorigenesis through induced DNA adduct formation, abnormal gene expression, and imbalanced gut microbiota composition.

    Miret 1 , D. Zappia 2 , L. Pontillo 1 , F. Chiappini 1 , M. Lasagna 3 , C. Cocca 3 , F. Monczor 2 , A. Breast cancer is the most common cancer worldwide in women and different studies link pesticide exposure to the risk of developing this disease.

    The pesticides hexachlorobenzene HCB and chlorpyrifos CPF are weak ligands of the aryl hydrocarbon receptor AhR , a transcription factor involved in apoptosis and proliferation.

    Epigenetic changes include retrotransposons like the long interspersed nuclear element 1 LINE-1 , which is activated in mammary tumors. We have reported that HCB 0. On the other hand, CPF increased c-Src phosphorylation after 5 and 15 min at 0. These findings could be linked to alterations previously observed in process like breast cancer cell migration, invasion or metastasis. Pontillo 1 , A. Miret 1 , F. Chiappini 1 , C. Cocca 3 , L. Alvarez 1 , D. Kleiman de Pisarev 1 , M.

    Sales 2 , A. Breast cancer is by far the most frequently diagnosed cancer in women. In addition, HCB 0. Our results demonstrate that both pesticides increase angiogenesis and VEGF expression in vivo and in vitro. Abdul Fattah 1, 2. Breast cancer BC is the most common cancer affecting women worldwide and has been associated with active tobacco smoking. Low levels of nitrosamine carcinogens, including nicotine and 4- methylnitrosamino 3-pyridyl butanone NNK , have been detected in the second hand smoke SHS.

    In this study, we investigated whether nicotine and NNK act together to induce breast carcinogenesis using an in-vitro breast cell carcinogenesis model. Immortalized non-tumorigenic breast epithelial cell line, HBL, was used for a time course assay exposed to either a very low level of nicotine or NNK, or both. British Journal of Psychiatry.

    Determinants of burden in caregivers of patients with exacerbating schizophrenia. Caregiver Burden in Mental Illness: Review of Measurement, Findings and Interventions, Current Opinion in Psychiatry. The relationship between caregiver burden, caregivers' perceived health and their sense of coherence in caring for elders with dementia.

    Journal of Clinical Nursing,;vol. The schizophrenic patient and his effect on the household. International Journal of Social Psychiatry.

    Appraisal of caregiving, burden and psychological distress in relatives of psychiatric inpatients. Family burden in long-term diseases: Social Science and Medicine. The social readjustment rating scale.

    Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. Role strains and personal stress. Stress, Appraisal and Coping. A comparison of spouse and adult child caregivers in shared and seperate households.

    Journal of Ageing and health. Caregiver stress and noncaregiver stress: Exploring the pathways of psychiatric morbidity. Do behavioural disturbances in persons with Alzheimer's disease predict caregiver depression over time? What do carers of people with psychosis need from mental health services? Exploring the views of carers, service users and professionals. Journal of Family Therapy. Canadian Study of Health and Aging: Study methods and prevalence of dementia.

    Canadian Medical Association Journal. J Am Psychiatr Nurses Assoc, ; 11 4 , Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses. Journal of Aging and Health. Prevalence of depression in family caregivers. Anxiety and depressive disorders in adult children caring for demented parents. Prevalence and predictors of carer burden and depression in carers of patients referred to an old age psychiatric service. Caring for relatives with Alzheimers Disease: Depression among Alzheimer's caregivers: Journal of the American Geriatrics Society.

    The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy. Synthesizing the family caregiving studies: Positive aspects of caregiving: International Journal of Geriatric Psychiatry.

    Psychologie et Neuropsychiatre Vieilissement. Depressive disorders in spouses of mentally ill patients. Social Psychiatry and Psychiatric Epidemiology. Impact of family burden and patient symptom status on clinical outcome in bipolar affective disorder. Journal of Nervous Mental Disorders.

    The economic and social burden of depression. Journal of Clinical Psychiatry. Family caregiving in depression: Journal of Affective Disorders. Use of mental health and primary care services by caregivers of patients with bipolar disorder: Family distress and involvement in relatives of obsessive-compulsive disorder patients. Journal of Anxiety Disorders. The experience of caregiving for severe mental illness: A qualitative study of the experience of caring for a person with bulimia nervosa.

    The emotional impact of caring. International Journal of Eating Disorders. A Caregiver's Guide and Sourcebook. A Two-year longitudinal study of depression among Alzheimer's caregivers. Predicting participation and adherence to a home environmental intervention among family caregivers of persons with dementia. The dynamics of caregiving for a demented elder among Black and White families. The Psychological and Physical health of family members caring for an elderly person with dementia. Journal of Clinical Epidemiology.

    Longitudinal analysis of multiple indicators of health decline among spousal caregivers. Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes. The costs of caring: Impact of dementia on family caregivers.

    Journal of Geriatric Psychiatry and Neurology. Results of a qualitative study. Journal of Gerontological Social Work. Race, finding meaning, and caregiver distress. Depression symptomatology in the first-degree family caregivers of Alzheimer disease patients: Predict depression in caregiver burden and in Alzheimer's disease.

    Coping with specific stressors in Alzheimer's Disease caregiving. Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's disease and matched controls: A diathesis-stress model of psychopathology,Journal of abnormal psychology.

    Burden in Schizophrenia Caregivers: Impact of cognitive and physical impairment on carer burden and quality of life. Quality of Life Research: Coping wih the caregiving role. Internal resourcefulness, task demands, coping, and dysphoric affect among caregivers of the frail elderly. Support in the community for people with dementia and their carers: The prevalence and Phenomenology of psychotic symptoms in dementia sufferers.

    Relationships of cognitions associated with coping reactions to depression in spousal caregivers of Alzheimer's disease patients.

    Coping in the Carers of dementia sufferes. Past influences on current caregiving. Interventions in Dementia Care: Toward Improving Quality of Caregiving. Religious effects on health status and life satisfaction among Black Americans. Religiosity and perceived rewards of Black and Anglo caregivers. Issues of race , ethnicity, and culture in caregiving research: A year review Well-being, appraisel, and coping in Latina and Caucasian female dementia caregivers: Aging and Mental Health.

    Stress appraisal, coping and social support as predictors of adptational outcome among dementia caregivers. Gain in the caregiving experience: Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: Well-being, appraisal, and coping in African- American and Cuacasian dementia caregivers: Comparing the experience of Black and White Caregivers of dementia patients.

    Racial variations in caregiver stress and burden among informal caregivers of impaired elderly persons. University of Florida, Gainesville. Quality of life of Australian family carers: Implications for research, policy, and practice. Journal of Policy and Practice in Intellectual Disabilities. Modifying repetitive verbalizations of community-dwelling patients with AD. Psychotherapeutic work with people with dementia: British Journal of Medical Psychology. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease,British Journal of Psychiatry.

    Burden or significant experience? Efficacy of interventions aimed at the main carers of dependent individuals aged more than 65 years old.

    Revista Espanola de Geriatria y Gerontologia. African-American and white caregivers of older adults with Dementia: Kales, MD, Frederic C. Blow, PhD, Deborah E. Welsh, MS, and Alan M. Herbal products and other Supplements: J Geriatr Psychiatry Neurol ; Effect of respite care on dementia and nondementia patients in caregiver', Psychology and Aging. A review of instruments developed to measure outcomes for carers of people with mental health problems.

    Acute lung injury is a syndrome with a diagnostic criteria base on hypoxaemia and a classical radiological appearance, with acute respiratory distress syndrome at the severe end of the disease spectrum. Its incidence is common, it is likely to exist outside the intensive care setting and therefore is a condition relevant to all clinicians.

    Genetically predisposed individuals are subject to environmental triggers which can be intra or extrapulmonary in nature. An inflammatory response causes damage to alveolar epithelial cells and vasculature, impairing gas exchange and can lead to multiple organ failure.

    Management centres around supportive care and treating the cause, but evidence supports use of low tidal volume ventilatory settings and conservative intravenous fluid strategies. Long term outcomes are related to neuromuscular, cognitive and psychological issues rather than pulmonary, and rehabilitation during recovery needs to focus on this.

    Acute Lung Injury ALI is a continuum of clinical and radiographic changes affecting the lungs, characterised by acute onset severe hypoxaemia, not related to left atrial hypertension, occurring at any age. It was first described by Ashbaugh in the Lancet in Computer tomography of the chest can show the heterogeneous nature of ALI, with dependent areas of the lung showing patchy consolidation with air bronchograms, atelectasis and fibrosis.

    As with plain radiography there may be pneumothoraces present. Acute Respiratory Distress in Adults. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. Definitions, mechanisms, relevant outcomes and clinical trial coordination. Epidemiology and Outcomes of Acute Lung Injury. Epidemiology of Acute Lung Injury. Current Opinion in Critical Care. Incidence and outcomes of acute lung injury.

    N Engl J Med ; Acute lung injury outside the ICU: Clinical risks for development of the acute respiratory distress syndrome. Proc Am Thorac Soci. Diabetic patients have a decreased incidence of acute respiratory distress syndrome. Critical Care Medicine ; Late adult respiratory distress syndrome. New Horiz ; 1: Lung parenchyma remodelling in acute respiratory distress syndrome.

    Gattinoni L, Pesenti A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.

    Higher versus lower positive end-expiratory pressures in patients with acute respiratory distress syndrome. N Engl J Med. Ventilation strategy using low tidal volumes, recruitment manoeuvres and high positive end expiratory pressure for acute lung injury and acute respiratory distress syndrome: J Am Med Assoc; Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: Efficacy and economic assessment of conventional ventilator support versus extracorporeal membrane oxygenation for severe adult respiratory failure CESAR: Prone positioning improves survival in severe ARDS: Cochrane Database Syst Rev; Apr; 15; 2: Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure.

    Prognostic value of extravascular lung water in critically ill patients. New Engl J Med. Review of a large clinical series: Journal of Intensive Care Medicine. Cepkova M, Matthay MA. Pharmacotherapy of acute lung injury and the acute respiratory distress syndrome. J Intensive Care Med. Nonventilatory treatments for acute lung injury and ARDS.

    Chest ; 3: Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. Mechanisms of beta-receptor stimulation-induced improvement of acute lung injury and pulmonary oedema. Critical Care ; 8 4: Acute Lung Injury — affecting many lives.

    Has mortality from acute respiratory distress syndrome decreased over time?: Causing and timing of death in patients with ARDS. Moss M, Manniono DM. Race and gender differences in acute respiratory distress syndrome deaths in the United States: Body Mass Index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury.

    Education and support needs during recovery in acute respiratory distress syndrome survivors. Critical Care ; 13 5: Female sexual dysfunction FSD is a serious morbidity which could occur postnatally. It is important for different members of staff GP, midwife, obstetrician, nurse, psychosexual therapist to be aware of this problem and its various implementations.

    Objectives of the review: Perineal pain as a complication after episiotomy or tears was differentiated from dyspareunia, and studies on perineal pain after delivery were excluded from the review if they did not discuss the effect of the pain on sexual activity.

    A meta-analysis was performed to summarise the outcome of the different studies comparing the effect of modes of delivery on PPFSD. However, there is little evidence to support a possible long term effect.

    Breastfeeding, use of progestogen-only pill and the lack of postpartum sexual health counselling and treatment are other significant risk factors for PPFSD. There is insufficient evidence to advocate a decision of performing a caesarean section on basis of alleviating PPFSD. It may lead to a variety of physical, psychological, and social adverse effects on the patient. Moreover, the consequent cycle of fear might compound the initial sexual disorder and makes it more difficult to treat.

    Therefore, early diagnosis and management of the problem become essential to avoid later sequalae on reproductive and sexual life.

    However, early diagnosis may be challenged by many factors. For example, many patients will be preoccupied by the newborn or embarrassed of talking about sexual matters after delivery, which makes it very important for the midwifery, medical, or other staff to raise the issue during the postnatal care sessions.

    The staff, on the other hand, might feel uncomfortable to discuss the sexual function with the client, or even may lack the knowledge and skills required for sexual health counselling. In addition to the client-service gap, there are gaps between different sexual service providers. There are many types of postnatal sexual disorders. These types can differ widely in clinical features and management.

    In the last three decades there has been an increase in caesarean section rate in the developed world due to many maternal and fetal indications, especially with the significant improvement in surgical and postoperative care. Recently, more attention has been paid to the positive role the caesarean section may play in protecting the female pelvic floor from birth trauma. Perineal birth trauma has been accused by many authors of adversely affecting the female sexual well being.

    This problem might become more difficult to solve if the woman already suffers from a sexual disorder for example: Female sexual dysfunction is impaired or inadequate ability of a woman to engage in or enjoy satisfactory sexual intercourse and orgasm.

    This could be related to fluctuations in gonadal hormone secretion, making women more vulnerable to sexual symptoms. To help in understanding this classification better, it is important to refer to the early research done in this field by Masters and Johnson in One of the most interesting findings of the latter has been the four stage model of sexual response, which they described as the human sexual response cycle.

    Excitement phase initial arousal , Plateau phase at full arousal, but not yet at orgasm , Orgasm, and Resolution phase after orgasm. Although it is normal to have hypoactive sexual desire loss of libido in the first weeks after giving birth, this becomes abnormal when the desire for sexual activity is persistently reduced or absent causing distress in the relationship.

    Sexual desire disorder after delivery may be due to the mother being preoccupied with the neonate or postpartum complications e. It can often be associated with sexual pain disorder as well. Solana-Arellano et al reported an incidence of Moreover, dyspareunia might be caused by psychosocial factors like problems in relationship with the partner, work stress, financial crisis, depression, and anxiety.

    Dyspareunia, in many cases, can occur as a result of a combination of medical and psychosocial factors. Although, vaginismus is recognised as a different identity, it is usually associated with dyspareunia when it happens in the Puerperium. Sexual desire disorders, Isolated postpartum sexual arousal and orgasmic disorder are rarely seen in postnatal clinics as when they occur they tend to be part of other PPFSDs. Effect of Mode of Delivery: Searching the Cochrane library databases has shown no review related to the subject.

    New MESH words were used, related to comparison between different modes of delivery Caesarean section, vaginal birth, modes of delivery, sexual dysfunction, sexual disorder, dyspareunia. Additional studies from the reference lists were obtained. Only studies directly compared between caesarean section and vaginal birth in term of assessing the PPFSD were included.

    The Cochrane library database review did not have related articles. It is worth mentioning, however, that there was a Cochrane review on postpartum perineal short term pain, not related to sexual activity. Therefore, it was excluded from this review. The systematic review included in this list of literature studies is the Langer and Minetti review on the complications of episiotomy.

    Only eight studies fulfilled the criteria. Full papers were retrieved. There was one randomised controlled trial, one prospective cohort study, one cross-sectional study, and the other 5 were performed retrospectively 4 questionnaire surveys, and 1 interview survey. The total pool sample of patients studied included cases Caesarean sections vs. Four studies aimed to compare PPFSD aspects within other variants, such as pelvic floor morbidity, urinary incontinence, and faecal or flatus incontinence.

    However, in long term i. Forest plot of comparison between studies. Studies to left of the midline were in favour of less long term PPFSD symptoms with caesarean section compared to vaginal delivery. Therefore it is a logic presumption to think that avoiding pelvic floor injury by performing a caesarean section especially as an elective mode of delivery may alleviate PPFSD.

    This presumption, if true, will have very significant clinical and financial implications in practice especially with a pre-existing problem of increasing caesarean section rate in many parts of the developed world. So what research evidence in the literature is available to support or overrule this presumption?. Griffiths et al in their questionnaire survey of a women from the Cardiff Birth Survey Database have showed a significant increase in the prevalence of dyspareunia two years after vaginal birth compared to caesarean section.

    In their paper they did not mention if vaginal birth with no tears or complications was associated with a higher incidence of dyspareunia. In contrast, Klein et al concluded that women who had intact perineum after vaginal birth had less dyspareunia than those underwent caesarean section.

    Moreover, as a previous caesarean section will increase the operative risk of the successive caesarean sections or will add more risk to the trial of labour if this is opted for in the future, we can expect a higher increased of sexual disorders in the following pregnancies. From previous discussion we found insufficient evidence to advocate a decision of performing a caesarean section on basis of alleviating PPFSD. This evidence is outweighed by the higher risk of caesarean section including bleeding, infection, anaesthesia risk, deep vein thrombosis, pulmonary embolism, impairment of future fertility, risk of scar dehiscence in next labour, injury to bladder and bowels and risk of fetal laceration.

    In this review, there is good evidence to suggest that episiotomy is an important risk factor for short term PPFSD. However, there is little evidence to support a possible long term effect especially if other complications to episiotomy occurred later.

    Breastfeeding, and the use of progestogen-only pill as contraceptive are other risk factors identified by other studies. Awareness of the problem makes half of the solution. Episiotomy and severe obstetric traumas are the main risk factors. Restricted use of episiotomy and early management of episiotomy complications can play an important role in preventing persistent PPFSD. There is insufficient evidence to suggest caesarean section as a better mode of delivery in term of preventing or alleviating PPFSD.

    Women's dyspareunia after childbirth: Y, Su L, et al. Women's sexual health after delivery and its related influential factors. Reproductive life events and sexual functioning in women: Diagnostic and Statistical Manual for Mental Disorders, 4th ed.

    Human Sexual Response, 1st ed. Postpartum sexual functioning and method of delivery: Immediate and long term complications of episiotomy.

    Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. Sexuality after delivery with episiotomy: Gynecologic and Obstetric Investigation.

    Female genital tract morbidity and sexual function following vaginal delivery or lower segment caesarean section. Pelvic floor morbidity up to one year after difficult instrumental delivery and cesarean section in the second stage of labour: Post-cesarean pelvic floor dysfunction contributes to undisclosed psychosocial morbidity.

    Journal of Reproductive Medicine. A comparison of urinary and sexual outcomes in women experiencing vaginal and Caesarean births. Does the mode of delivery influence sexual function after childbirth?. Journal of Women's Health. Cesarean section and postnatal sexual health. Rate of dyspareunia after delivery in primiparae according to mode of delivery. The effect of the mode of delivery on the quality of life, sexual function, and sexual satisfaction in primiparous women and their husbands.

    Journal of Sexual Medicine. Sexual health in postnatal women: Revista de Psiquiatria Consiliar e de Ligacao. Women's sexual health after childbirth British Journal of Obstetrics and Gynaecology. Journal of Reproductive Medicine for the Obstetrician and Gynecologist ; 44 Women's sexuality after childbirth: Archives of Sexual Behavior.

    Headaches and sexual activity are often treated with humour as a typical way for women to reject male advances. However, headaches associated with sexual activity can be anything but a joke.

    HSA headaches associated with sexual activity are by definition benign conditions but the symptoms can be the same as in serious life threatening cerebral conditions and these need to be quickly excluded at the first presentation. Most sexual headaches are of a benign nature. However, the first time an HSA occurs it can be a traumatic, frightening occurrence for the patient. HSA are capricious in nature with poorly understood pathophysiology and uncertain course of the condition. Patients need to have the situation clearly explained to them so that management can be optimal.

    However, good overall management of a patient with HSA should also include discussions about possible negative sexual consequences of the HSA experience. Sexuality can be affected by HSA both during the active condition and subsequently. Headaches associated with or occurring around sexual activity have been recognized since the time of Hippocrates [1, 2]. Wolff [3] discussed headache during sexual activity in However, these headaches started to be formally reported in the s, first by Kitz in [4] and then Paulson [5] and Martin [6] in Johnson, Human sexual response.

    Cesk Neurol Neurochir, Klawans, Benign orgasmic cephalgia. Ir J Med Sci, J Neurol Neurosurg Psychiatry, Boes, Cough, exertional and sex headaches. Neurol Clin N Am, Frese, Comorbidity of migraine and headache associated with sexual activity. Olesen, Symptomatic and non-symptomatic headaches in a general population. Kraft, Natural course of benign coital headache. An analysis of 72 benign and symptomatic cases. Demography, clinical features and comorbidity.

    Primary headache attributed to sexual activity. Silbert, Sequential benign sexual headaches and exertional headaches. Steiner, Coital headaches induced by amiodarone. Jankovic, Benign coital cephalalgia. Villaverde, Sexual headache and stroke in a heavy cannabis smoker. Int J of Impotence Research, Lopez-Valdez, Benign Valsalva's maneuver-related headaches: An MRI study of 6 cases.

    Exertional and sexual headaches. Curr Pain Headache Rep, A disorder of myogenic cerebrovascular autoregulation? Evers, A patient with orgasmic headaches converting to concurrent orgasmic and benign exertional headaches. Ostermann, The benign and malignant forms of orgasmic cephalgia. Arboix, Complicated coital cephalalgia, three cases with benign evolution. Caplan, Avoiding pitfalls in the diagnosis of subarachnoid haemorrhage.

    N Engl J Med, Wijdicks, Pituitary apoplexy presenting as a thunderclap headache. Kappelle, Thunderclap headache as first symptom of cerebral venous sinus thrombosis.

    Zochodne, Recurrent coital 'thunderclap' headache associated with ischaemic stroke. Hinterberger, Symptoms of phaeochromocytoma, with particular reference to headache, correlated with catecholamine production.

    Prophylactic treatment and course of the disease in headache associated with sexual activity. Preventative Pharmacotherapy of Headache Disorders, ed. Harding, Headache and Sexual Activity: American Headache Society, Clinical features, diagnosis and management. Med Clin North Am, Husstedt, Alternatives in drug treatment of chronic paroxysmal hemicrania. Br Med J, J Indiana State Med Assoc, J Korean Med Sci, Reported prevalence of physical restraint varies from 7. Use of restraints often has an effect opposite of the intended purpose, which is to protect the patient.

    The risk of using a restraint must be weighed against the risk of not using one, and informed consent with proxy decision makers should occur. Comprehensive nursing assessment of problem behaviours, a physician order when instituting restraints, and documentation of failure of alternatives to restraint is required. Steps can be taken to reduce restraints before the need for restraints arises, when the need for restraints finally does arise, and while the use of restraints is ongoing.

    Complications of restraints can be serious including death resulting from both medications and devices.

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