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Abstract:Congenital adrenal hyperplasia (CAH) encompasses a range of inherited autosomal recessive enzyme conditions that impact steroid hormone production. This lifelong condition has associated health risks for some individuals, including adrenal crisis, and menstruation and fertility issues. Health literacy materials focused on the physical and pharmacological aspects of managing menstruation (i.e., treatment to initiate or maintain menses for those with CAH) are scarce. This article addresses this gap by exploring menses patterns in people with CAH. An integrative literature review searched articles published between 2005 and 2020, and 30 articles met inclusion criteria. Study findings indicated that while menarche seems to occur at an average age for people with CAH, menstruation is commonly disrupted and irregular. Several studies reported individuals achieving regular menses and pregnancy, while others noted individuals consistently showing poor control, irregular menses, and infertility despite ongoing treatment. A few studies reported such individuals as “non-adherent” or worse “non-compliant” with their medication regimens when health outcomes were lower than expected. We emphasize that such fault finding by health service providers around adherence acts as a barrier to communication with people with CAH. We argue that a sustained and coordinated person-centred approach focusing on communication and education across situational, developmental, and organizational transitions, can promote health literacy, foregrounding individuals’ health and bodily autonomy across their life span. Future research needs to address gaps in knowledge translation that supports menstrual education for individuals with CAH. Studies should also address how medication management is assessed and adherence negotiated with individuals with CAH.

The views of contributors to 'Building' magazine on their most and least favorite buildings are presented. A selection of choices from 1994 to 2000 is shown, with the most liked buildings emerging as the Houses of Parliament and Stansted Airport.

Building Conservation Consultant Brian Ridout uses his expertise in entomology to study living organisms in buildings. Ridout often works in historical buildings trying to discover why they decaying and suggesting ways of correcting the damage, without major reconstruction work or the excessive use of chemicals. Abseiling Engineer Chris Flewitt is an engineering geologist who uses his skills as a climber to examine parts of buildings which have difficult access, such as lighthouses. Ecologist John Newton advises the construction industry on ecological issues.

Citrobacter rodentiumis an extracellular enteric mouse-specific pathogen used to model infections with human pathogenic Escherichia coliand inflammatory bowel disease. C. rodentiuminjects type III secretion system effectors into intestinal epithelial cells (IECs) to target inflammatory, metabolic and cell survival pathways and establish infection. While the host responds to infection by activating innate and adaptive immune signalling, required for clearance, the IECs respond by rapidly shifting bioenergetics to aerobic glycolysis, which leads to oxygenation of the epithelium, an instant expansion of mucosal-associated commensal Enterobacteriaceae and a decline of obligate anaerobes. Moreover, infected IECs reprogramme intracellular metabolic pathways, characterized by simultaneous activation of cholesterol biogenesis, import and efflux, leading to increased serum and faecal cholesterol levels. In this Review we summarize recent advances highlighting the intimate relationship between C. rodentiumpathogenesis, metabolism and the gut microbiota.

Chemoradiotherapy is the primary treatment for patients with squamous cell carcinoma of the anus, but variations in the reported outcomes have restricted between-study comparisons. Treatment-related morbidity is considerable; however, no trial has comprehensively quantified long-term side-effects or quality of life. Therefore, we established the first international health-care professional and patient consensus to develop a core outcome set, using the Core Outcome Measures in Effectiveness Trials method. We used the results from our previous systematic review and combined them in this Review with patient interviews to derive a comprehensive list of outcomes, followed by a two-round Delphi survey completed by 149 participants (55 patients and 94 health-care professionals) from 11 countries. The Delphi results were discussed at a consensus meeting of health-care professionals and patients. Agreement was reached on 19 outcomes across four domains: disease activity, survival, toxicity, and life impact. Implementation of the Core Outcome Research Measures in Anal Cancer (CORMAC) set in future trials will serve as a framework to achieve standardisation, facilitate selection of health-area-specific evaluation tools, reduce redundancy of outcome lists, allow between-study comparisons, and ultimately enhance the relevance of trial findings to health-care professionals, trialists, and patients.

We investigated the role of commensals at the peak of infection with the colonic mouse pathogen Citrobacter rodentium.Bioluminescent and kanamycin (Kan)-resistant C. rodentiumpersisted avirulently in the cecal lumen of mice continuously treated with Kan. A single Kan treatment was sufficient to displace C. rodentiumfrom the colonic mucosa, a phenomenon not observed following treatment with vancomycin (Van) or metronidazole (Met). Kan, Van, and Met induce distinct dysbiosis, suggesting C. rodentiumrelies on specific commensals for colonic colonization. Expression of the master virulence regulator leris induced in germ-free mice, yet C. rodentiumis only seen in the cecal lumen. Moreover, in conventional mice, a single Kan treatment was sufficient to displace C. rodentiumconstitutively expressing Ler from the colonic mucosa. These results show that expression of virulence genes is not sufficient for colonization of the colonic mucosa and that commensals are essential for a physiological infection course.

Forty young professionals of the construction industry talk about their heros, the worst thing about construction and their hopes for the future.

Introduction Quality of life has become an accepted end point in clinical research trials in recent years, as interest in patients' experiences and preferences has grown.[1] Quality of life is [...]

Rectal irrigation is increasingly being used as an early intervention for children with faecal incontinence resulting from injury or disease. Caroline Sandersand Lucy Braydiscuss how it works and the impact it can have on young people and their families.

Faecal incontinence can have a serious impact on the emotional wellbeing of children and young people. The school nurse is ideally placed to help support them and their families to manage and cope with the complex issues related to soiling.

The article evaluates STA-LITE® Polydextrose and TEAWELL™ Green tea polyphenols, two beverage ingredients from Tate & Lyle Ingredients.

The article offers information on the Health & Wellness Innovation Centre in Lille, France, a brand-new facility of Tate & Lyle Ingredients, a world leader in food and industrial ingredients. The facility opened in September 2008 and leads the research and development of functional ingredients and foods. It is open to the company's customers and are designed to accommodate customer project teams working on food propositions or optimizing existing brands.

Aim:To develop and evaluate an education programme to help older people find out about treatment and care choices at the end of life.Design:An action research approach was used to develop an education booklet about end-of-life care. A programme of qualitative evaluation ran alongside the project. It comprised a combination of methods, including face-to-face and telephone interviews and questionnaires with those who took part in the small group discussions.Sample:The research team consisted of five academic researchers and eight people recruited from voluntary groups representing older adults to act as community advisors in developing the programme. The booklet was tested in small group discussions with members of the general public. Five community advisors volunteered to act as ‘peer educators’ and helped to lead the small group discussions after receiving a 3-day training course to prepare them for their role. The project took place in Sheffield.Results:The education discussions and the related booklet were perceived as acceptable in providing information about a sensitive issue. Peer educators felt that the training course prepared them well. Community advisors felt that they were treated as equal members of the research team. This project has served as a useful pilot study of the education programme that has now been extended to other areas of the UK.

Hypospadias occurs when the urethral folds fail to fuse on the ventral aspect of the penis (Thomas and Barker, 1997). Surgical repair is often warranted and standard postoperative practice in the UK often includes the application of a dressing around the penis. This article reports the outcome of a small randomized controlled feasibility study to compare two methods of dressing removal following hypospadias repair. The same dressing was used throughout the study — a control group used a standard method of dressing removal, while an experimental group had an additional barrier film applied before the dressing was attached to the wound. The primary outcome measure was the time taken to remove the dressing. The time interval between starting the process of dressing removal and having no dressing left in place was used for statistical analysis. Secondary measures included assessment of the child's pain at different intervals by the parents and by an independent nurse observer. General discussion took place with the parents regarding any experience of anxiety. This was to assess whether parental anxiety should be measured in a future randomized controlled trial (RCT). There appeared to be implications with regard to time savings with the new method of dressing removal. Issues about the most suitable environment to remove dressings and differences between pain assessments of nurse and parent are noted. This was only a small-scale study. To investigate these issues more fully, a RCT has since been developed, has gained ethical approval and is due to start in August 2003.

The aim of this article was to examine an area from clinical practice, in this instance, paediatric urology and to look at the information needs of families prior to their young sons' having surgery to correct a hypospadias. Involving families and promoting informed decision-making with families prior to hypospadias repair for their child is important. To be able to facilitate real involvement the information has to be shared and parents and families given adequate support and opportunity to seek answers to questions. Providing an environment to undertake this, to then learn from the families for the future and to support the development of a National Support group, www.hypospadias.co.uk have been outcomes from setting up a pre-admission clinic. Literature in respect of after-care is very sparse. It became evident from clinical practice that the rationale for applying a dressing post-operatively needed to be explored. Furthermore limited evidence about dressing removal, coupled with the anxiety and upset this caused parents, identified the need to consider two issues (i) a better method of removal of dressings and (ii) the effects on pain scores. A blinded randomized controlled feasibility study was developed and implemented, with completion due at the end of 2001.

The mouse pathogen C. rodentiumis a widely used model for colonic infection and has been a major tool in fundamental discoveries in the fields of bacterial pathogenesis and mucosal immunology. Despite extensive studies probing acute C. rodentiuminfection, our understanding of the early stages preceding the infection climax remains relatively undetailed. To this end, we apply a multiomics approach to resolve temporal changes to the host and microbiome during early infection. Unexpectedly, we found immediate and dramatic responses occurring on the day of colonic infection, both in the host intestinal epithelial cells and in the microbiome. Our study suggests changes in cholesterol and carbon metabolism in epithelial cells are instantly induced upon pathogen detection in the colon, corresponding with a shift to primarily facultative anaerobes constituting the microbiome. This study contributes to our knowledge of disease pathogenesis and mechanisms of barrier regulation, which is required for development of novel therapeutics targeting the intestinal epithelium.

ObjectiveTo assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions. DesignA study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care. Data were collected at baseline, four months (short term), and 12 months (long term). Primary intention to treat analyses tested treatment effectiveness; multilevel models controlled for clustering by general practice and a range of covariates. Analyses were conducted for 759 participants who completed questionnaire measures at all three time points (complete case cohort) and 1201 who completed the baseline assessment plus at least one other assessment (available case cohort). Secondary per protocol analyses tested treatment efficacy and included 633 and 1108 participants in the complete case and available case cohorts, respectively.SettingProvision of primary and secondary care via general practices, specialist nurses, and hospital clinics in three diverse regions of England (Cornwall, Kent, and Newham), with established integrated health and social care systems.Participants Patients with chronic obstructive pulmonary disease (COPD), diabetes, or heart failure recruited between May 2008 and December 2009.Main outcome measuresGeneric, health related quality of life (assessed by physical and mental health component scores of the SF-12, and the EQ-5D), anxiety (assessed by the six item Brief State-Trait Anxiety Inventory), and depressive symptoms (assessed by the 10 item Centre for Epidemiological Studies Depression Scale). ResultsIn the intention to treat analyses, differences between treatment groups were small and non-significant for all outcomes in the complete case (0.480≤P≤0.904) or available case (0.181≤P≤0.905) cohorts. The magnitude of differences between trial arms did not reach the trial defined, minimal clinically important difference (0.3 standardised mean difference) for any outcome in either cohort at four or 12 months. Per protocol analyses replicated the primary analyses; the main effect of trial arm (telehealth vusual care) was non-significant for any outcome (complete case cohort 0.273≤P≤0.761; available case cohort 0.145≤P≤0.696).ConclusionsSecond generation, home based telehealth as implemented in the Whole Systems Demonstrator Evaluation was not effective or efficacious compared with usual care only. Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients.Trial Registration ISRCTN43002091.

Several letters to the editor are presented in response to the articles in previous issues including "Chemicals in clothing recall" in the June 2014 issue, one on Telstra's policy on extending due dates and another on the service received from a rooftop solar hot water system provider.

ObjectiveTo determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care.DesignPragmatic, two arm, cluster randomised controlled trial.SettingGeneral practices, serving a population in northwest England with high levels of deprivation.Participants5599 patients with a diagnosis of diabetes (n=2546), chronic obstructive pulmonary disease (n=1634), and irritable bowel syndrome (n=1419) from 43 practices (19 intervention and 22 control practices).InterventionPractice level training in a whole systems approach to self management support. Practices were trained to use a range of resources: a tool to assess the support needs of patients, guidebooks on self management, and a web based directory of local self management resources. Training facilitators were employed by the health management organisation.Main outcome measuresPrimary outcomes were shared decision making, self efficacy, and generic health related quality of life measured at 12 months. Secondary outcomes were general health, social or role limitations, energy and vitality, psychological wellbeing, self care activity, and enablement.ResultsWe randomised 44 practices and recruited 5599 patients, representing 43% of the eligible population on the practice lists. 4533 patients (81.0%) completed the six month follow-up and 4076 (72.8%) the 12 month follow-up. No statistically significant differences were found between patients attending trained practices and those attending control practices on any of the primary or secondary outcomes. All effect size estimates were well below the prespecified threshold of clinically important difference.ConclusionsAn intervention to enhance self management support in routine primary care did not add noticeable value to existing care for long term conditions. The active components required for effective self management support need to be better understood, both within primary care and in patients’ everyday lives.Trial registrationCurrent Controlled Trials ISRCTN90940049.