The future of work and health.
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Employment↗
Biomedical subjects
R Anderson
Publications and source records attributed to R Anderson.
Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry.
The outcome for children with deep vein thrombosis (DVT) and pulmonary embolism (PE) is unknown. An understanding of morbidity and mortality of DVT/PE is crucial to the development of rational treatment protocols. The Canadian Childhood Thrombophilia Registry has followed 405 children aged 1 mo to 18 y with DVT/PE for a mean of 2.86 y (range, 2 wk to 6 y) to assess outcome. The all-cause mortality was 65 of 405 children (16%). Mortality directly attributable to DVT/PE occurred in nine children (2.2%), all of whom had central venous line-associated thrombosis. Morbidity was substantial, with 33 children (8.1%) having recurrent thrombosis, and 50 children (12.4%) having postphlebitic syndrome. Recurrent thrombosis and postphlebitic syndrome were more common in older children, although deaths occurred equally in all age groups. The incidence of recurrent thrombosis and postphlebitic syndrome are likely underestimated because of difficulties in diagnosis, especially in younger children. The significant mortality and morbidity found in our study supports the need for international multicenter randomized clinical trials to determine optimal prophylactic and therapeutic treatment for children with DVT/PE.
Adolescent↗
The relationship of tamoxifen with dementia, depression, and dependence in activities of daily living in elderly nursing home residents.
OBJECTIVES: To evaluate the association between tamoxifen treatment and the prevalence of Alzheimer's disease, other dementias, depression, and the levels of dependence in activities of daily living (ADL) in elderly, nursing home residents. PARTICIPANTS: 93,031 women, at least 65 years old, whose data were part of the 1993 New York State MDS, and for whom there was documentation of treatment with at least one medication. SETTING: New York State long-term care facilities. DESIGN: Cross-sectional study via secondary analysis of 1,385 matched sets of residents. Each set included one resident who received tamoxifen treatment and up to four residents who did not. MEASUREMENTS: Included age, ethnicity, tamoxifen treatment, hormone replacement therapy, depression, levels of dependence in ADL and in cognitive skills for daily decision-making, and documentation of Alzheimer's disease and other dementias. RESULTS: Women receiving tamoxifen were less likely to have a diagnosis of Alzheimer's disease documented on the MDS (odds ratio: 0.674; 95% confidence interval: 0.551-0.823), were significantly more independent in bed mobility, eating, toileting (in each case P < 0.0001), personal hygiene (P = 0.0155), dressing (P = 0.0015), transferring (P = 0.0006), locomotion (P = 0.0016), and they had better cognitive skills for daily decision-making (P < 0.0001). They were, however, 42% more likely to have a MDS diagnosis of depression (P < 0.0001). All tests of statistical significance are two-sided. CONCLUSION: In this population, tamoxifen was associated with a higher level of independence in ADL and decision-making. While the MDS also suggested a relationship of tamoxifen with a lower prevalence of Alzheimer's disease, there seemed to be an increased prevalence of depression among treated women. The findings of this cross-sectional study could be evaluated in the randomized clinical trial that has just begun, and that will compare tamoxifen and raloxifene treatments.
Activities of Daily Living↗
Using the WWW to supply the molecular biology lab.
The World Wide Web is changing the face of business today and will continue to reshape it in the coming years. Nonvalue-added processes are being eliminated as organizations reengineer their internal ways of doing business in a continual effort to reduce costs and remain competitive. Current electronic market followers claim that gateways, or portals, of information will be the wave of the future. This does not mean that individual suppliers' websites will become extinct. It means that content will continue to change and adapt so that sites will continue to be more useful. If gateways do turn out to be the user's choice for product information presentation in the future, expect more consolidated sites devoted to specific product categories, such as chemicals, molecular biology supplies, and the like.
Commerce↗
Patient beliefs about the characteristics, causes, and care of the common cold: an update.
BACKGROUND: Many people seek medical care for cold symptoms. The cold-related knowledge and beliefs of adults seeking medical care for themselves or their children may not correspond with current medical opinion. METHODS: A total of 249 parents of symptomatic children and 257 symptomatic adults who sought medical advice in the spring of 1997 from 1 of 3 primary care clinics in the Minneapolis-St. Paul, Minnesota, area were surveyed by telephone 48 to 96 hours after contact with the medical system. RESULTS: Of the adults seeking care for a child or themselves, 44% believed viruses alone cause the common cold: an additional 42% believed both viruses and bacteria play a role. Most thought rest (97%) and nonprescription medications (63%) were helpful for colds, which was consistent with published reports. Contrary to medical reports, however, most felt vitamin C (67%) and the inhalation of steam (70%) reduced cold symptoms, and 44% believed antibiotics help colds (chi2=19.57; P=.0002). But 85% believed colds could resolve on their own. CONCLUSIONS: Those adults seeking medical care for uncomplicated colds are misinformed about the primary cause of the common cold, the use of prescription medications for treating cold symptoms, and the effectiveness of some palliative care techniques. Care providers should address these perceptions rather than enabling overuse of antibiotics.
Adolescent↗
The mother-child interaction and clinical judgment during acute pediatric illnesses.
OBJECTIVES: For acutely ill children living in less than optimal environments, mothers and pediatricians may have a heightened perception of illness severity, a lower specificity of clinical judgments, and a tendency to over-utilize resources. We examined the mother-child interaction in order to understand the relation of less optimal environments to clinical judgment and resource use. STUDY DESIGN: At the 2-week and 6-, 15-, and 24-month well child visits of 316 children, the mother-well child interaction was assessed by using the Biringen's Emotional Availability Scales (EAS). Data were gathered regarding maternal depression and sense of competence, infant temperament, maternal social support, life events, the home environment, and demographics. At ill visits, the mother-ill child interaction was assessed by using the EAS, and mothers and pediatricians independently assessed illness severity using the Acute Illness Observation Scales. Resource use during the illness was evaluated. RESULTS: One thousand nine hundred eight-three acute illnesses were assessed. A less optimal mother-child interaction was significantly (P <.05 for all comparisons) associated with poorer reliability of mothers' judgments, lower specificity of mothers' judgments (71% vs 85%) and pediatricians' judgments (92% vs 97%), and greater use of resources (eg, for hospitalizations, 2.6% of visits vs 0.7%). Adverse maternal, infant, and demographic characteristics were associated with a less optimal mother-well child (r = 0.68) and mother-ill child (r = 0.80) interaction, a heightened perception of illness severity, and greater resource use. CONCLUSION: Less optimal environments adversely affect the mother-child interaction; a poor mother-child interaction is correlated with low specificity of clinical judgment and over-utilization of resources.
Acute Disease↗
Castless ambulatory method of treating fractures. 1942.
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Fracture Fixation↗
DNA-based vaccines for malaria: a heterologous prime-boost immunisation strategy.
A generic approach to inducing high level CD8+ T cell responses would be of value for prophylactic and therapeutic immunisation against several infectious diseases. However, it has been very difficult to achieve such immune responses using available vaccination strategies. Malaria is one of several diseases against which a new generation of better CD8+ T cell-inducing vaccines might be useful and is unusual in that it allows assessment of vaccine efficacy in small numbers of volunteers in carefully controlled challenge studies. Here we review the identification of a heterologous prime-boost regime using DNA priming and recombinant modified vaccinia Ankara (MVA) boosting that induces high level T cell responses in both mice and non-human primates. Clinical trials to determine whether this prime-boost approach is immunogenic in humans are in progress.
Adjuvants, Immunologic↗
Working with youth brings rewards.
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Adolescent↗
NHS direct and access to dental care.
NHS Direct - the nurse-led 24-hour telephone helpline - is the flagship initiative of the 'New NHS'. The scheme is already available to over 19 million people, and is planned to serve 60% of England by the end of 1999 and the whole of the country by the end of 2000. It is intended to revolutionise how and when people access the NHS, particularly out-of-hours. The present government has recently also signalled that NHS Direct should play a key role in rebuilding accessibility to NHS dentistry. Yet many dentists are unaware of its existence, and within the profession there has been little debate regarding its actual or likely future impact on how people access dental care. This article briefly describes the concept and early experiences of NHS Direct, and speculates about its potential impact on how people access dental care.
Community-Institutional Relations↗
Iceland's medical database is insecure.
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Computer Security↗
Particle size separation via soil washing to obtain volume reduction.
A pilot-plant study was performed using a soil washing pilot plant originally designed by the Environmental Protection Agency (EPA) to demonstrate scale-up and potential full-scale remediation. This pilot plant named VORCE (Volume Reduction/Chemical Extraction) was modified to meet the specific requirements for treatment of the Formerly Utilized Sites Remedial Action Program (FUSRAP) and a Department of Energy site soils. After a series of tests on clean soils to develop operating parameters and system performance, the machine was used to treat soils, one contaminated with Thorium-232 and the other with Cesium-137. All indicate that soil washing is very promising for volume reduction treatment. In addition, cost data was generated and is given herein.
Cesium Radioisotopes↗
Patient presentation at medical practices with dental problems: an analysis of the 1996 General Practice Morbidity Database for Wales.
OBJECTIVE: To describe the characteristics of attendances and patients who present to family medical practitioners with oral or dental problems. DESIGN: Secondary analysis of standard consultation data. SETTING: 30 family medical practices in the General Practice Morbidity Database for Wales. SUBJECTS: All patients who presented at the practices with an oral or dental complaint during 1996. RESULTS: Of the 1,650,882 patient attendances at the 30 medical practices in the study year, 4,891 (0.3%) were for oral/dental problems. The frequency of these attendances varied considerably between practices (ranging from 0.02 to 0.67% of all attendances); 44.2% of the attendances included tooth-related problems, and 42.3% were for diseases of soft tissue, salivary glands or the tongue. On average patients with dental problems attended their doctor twice as frequently as other patients. The majority (75%) of oral/dental attendances were related solely to these problems. Patients with tooth-related dental problems were three times more likely to seek treatment at weekends than patients attending for other reasons. CONCLUSIONS: The rate of attendance for oral/dental problems varies substantially between practices, but is generally low. The higher rate of attendance for tooth-related problems at weekends suggests that some of the attendances for oral problems might be related to a perceived or actual lack of dental services at these times.
Adolescent↗
A mutational analysis of the transforming functions of the E8 protein of bovine papillomavirus type 4.
The E8 protein of BPV-4 contributes to transformation of primary bovine cells (PalFs) by inducing anchorage-independent growth and by down-regulating gap junction intercellular communication, likely due to its binding to 16K ductin. We show here that, in addition, E8 confers on PalF cells the ability to grow in low serum and to escape from contact inhibition (focus formation). E8 also transactivates an exogenous human cyclin A gene promoter, suggesting that overexpression of cyclin A is responsible for the transformed phenotype. Mutant forms of E8 were generated to establish whether the transforming functions of the protein could be segregated. Mutations were introduced both in the hydrophobic domain and in the hydrophilic C-terminal "tail", and chimeras with BPV-1 E5 were constructed. Cells expressing either wild-type E8 or mutant forms were analyzed for their ability to grow in low serum and in suspension and to form foci. Wild-type E8 and its mutants were also analyzed for their ability to transactivate the cyclin A promoter. We show here that the transforming functions of E8 can be segregated and that both the hydrophilic C-terminal tail and the residue at position 17 in the hydrophobic domain are crucial for E8 functions and for the transactivation of the cyclin A promoter. These results support the hypothesis that the different aspects of cellular transformation brought about by E8 might be due to interaction with different cellular targets. They suggest that E8 might function differently from BPV-1 E5 and demonstrate that the separate domains of E5 and E8 are not functionally interchangeable.
Animals↗
Behavioural analysis and susceptibility to CNS injury of four inbred strains of mice.
Interpretation of data from gene targeting studies can be confounded by the inherent traits of the background inbred strains used in the generation of transgenic and null mutant mice. We have therefore compared the behaviour and response to CNS injury of four inbred strains commonly used in molecular genetic studies to produce models of neurological disease. Adult, male 129/Ola, BALB/c, C57BL/6 and FVB/N mice (2-4 months) were initially subjected to behavioural tests that comprised a neurological examination, determination of motor function and cognitive testing in the Morris water maze. Also the response to CNS injury following an acute kainic acid (KA) challenge (30 mg kg-1, i.p.) was determined. The 129/Ola and BALB/c strains showed significant motor deficits when compared with the C57BL/6 and FVB/N strains. In contrast, only the FVB/N strain showed evidence of apparent cognitive impairments in the water maze as evidenced by increased pathlengths to locate the escape platforms and impaired performance in a probe trial. In addition, the FVB/N strain showed the most severe seizure response and mortality rate (62%) following administration of KA (30 mg kg-1, i.p.). These behavioural changes were also associated with a greater degree of cell body and synaptophysin loss in the pyramidal CA3 hippocampal cell layer and astrogliosis 72-h post-dose. These data suggest that the FVB/N strain may not be the most suitable background strain for the development of new transgenic mice for the study of genes implicated in the learning and memory process.
Analysis of Variance↗