Institutional care for the insane and idiots in Scotland before 1820: part 2.
Explore the source record for details and available documents.
History, 18th Century↗
Biomedical subjects
R Houston
Publications and source records attributed to R Houston.
A computerised database system for bovine traceability.
A computerised database system to record the details of all individual cattle, cattle holdings, cattle movements and cattle tests has been in use in Northern Ireland since 1988. This system was originally used purely to administer official tuberculosis and brucellosis eradication schemes, but subsequent developments have employed the traceability function to extend the use of the system to quality assurance, public health and marketing of beef and beef products. The database has evolved into the current, second generation system and this case study details that evolution from a manual system and describes potential future developments of the system.
Animal Identification Systems↗
A community-based trial for the control of lymphatic filariasis and iodine deficiency using salt fortified with diethylcarbamazine and iodine.
To evaluate the effectiveness of salt fortified with diethylcarbamazine (DEC) and iodine for elimination of Bancroftian filariasis and iodine deficiency, all consenting residents of Miton, Haiti (n = 1,932) were given salt fortified with 0.25% diethylcarbamazine and 25 ppm of iodine for one year. Wuchereria bancrofti microfilaria prevalence and intensity, antigenemia, and urinary iodine were measured before and one year after salt distribution began. To measure the effect of DEC-fortified salt on adult worm motility, 15 microfilaria-positive men were examined by ultrasound of the scrotal area. Entomologic surveys were conducted to determine the proportion of W. bancrofti-infected Culex quinquefasciatus. After one year of treatment, the prevalence and intensity of microfilaremia were both reduced by more than 95%, while antigenemia levels were reduced by 60%. The motility of adult worms, as detected by ultrasound, was decreased, but not significantly, by DEC-fortified salt. The proportion of vector mosquitoes carrying infective stage larvae decreased significantly from 2.3% in the nine months before the intervention to 0.2% in the last three-month follow-up period. Iodine deficiency, which had been moderate to severe, was eliminated after one year of iodized salt consumption. The DEC-fortified salt was well accepted by the community and reduced microfilaremia and transmission to low levels in the absence of reported side effects. Based on these results, salt cofortified with DEC and iodine should be considered as a concurrent intervention for lymphatic filariasis and iodine deficiency elimination programs.
Adolescent↗
Salt fortified with diethylcarbamazine (DEC) as an effective intervention for lymphatic filariasis, with lessons learned from salt iodization programmes.
DEC-fortified salt has been used successfully as a principal public health tool to eliminate lymphatic filariasis (LF) in China and, less extensively, in several other countries. Studies from 1967 to the present conducted in Brazil, Japan, Tanzania, India, China, and Taiwan involving administration of DEC salt for 18 days to 1 year, have shown this intervention to be effective for both bancroftian and brugian filariasis, as measured by reductions in both microfilarial density and positivity, and in some studies through reduction in mosquito positivity rates as well. Furthermore, studies suggest specific advantages from using DEC salt, including lack of side effects, particularly for bancroftian filariasis, and ability to reduce prevalence below 1% when used in conjunction with standard regimens of DEC tablets. However, use of DEC salt as a control tool suffers from a concern that health authorities might find it difficult to manage a programme involving a commodity such as salt. In the past decade, the very successful global efforts to eliminate iodine deficiency through universal salt iodization have demonstrated that partnership with the salt industry can be both successful and effective as a public health tool. Use of DEC salt can be most successfully implemented in areas in which (a) there is adequate governmental support for its use and for elimination of filariasis, (b) filariasis-endemic areas are clearly defined, (c) political leaders, health officials and the salt industry agree that DEC salt is an appropriate intervention, (d) the salt industry is well-organized and has known distribution patterns, (e) a successful national salt iodization effort exists, (f) a monitoring system exists that ensures adequacy of salt iodine content during production and that can also measure household coverage, and (g) measurement of impact on transmission of LF with the new antigen or filarial DNA detection methods can be established. There are advantages and disadvantages of using DEC-fortified salt compared with other interventions for LF elimination programmes, but rather than being considered as a 'competing' intervention, DEC salt should be seen as an additional option. Indeed, it is likely that many countries will derive maximal benefit from the synergistic effects of combining different intervention strategies in their national programmes to eliminate lymphatic filariasis.
Diethylcarbamazine↗
Thyroid volumes in US and Bangladeshi schoolchildren: comparison with European schoolchildren.
OBJECTIVE: The World Health Organization (WHO) recently adopted thyroid volume ultrasonography results from European schoolchildren as the international reference for assessing iodine deficiency disorders. Our objective was to describe thyroid volumes measured by ultrasonography in US and Bangladeshi schoolchildren and compare these with European schoolchildren. METHODS: Cross-sectional studies were performed in schoolchildren in the US (n=302) and Bangladesh (n=398). Data were collected on the following: thyroid size by palpation and ultrasonography; urinary iodine; age; sex; weight; and height. RESULTS: Applying the new WHO thyroid volume references to the Bangladeshi children resulted in prevalence estimates of enlarged thyroid of 26% based on body surface area (BSA) and 7% based on age. In contrast, in the US children, the prevalence estimates were less than 1% for each reference. In the US children, the best single predictor of thyroid volume was BSA (R2=0.32), followed by weight (R2=0.31). Using linear regression, upper normal limits (97th percentile) of thyroid volume from US children were calculated for BSA, weight and age, and were found to be lower than the corresponding references based on BSA and age from European schoolchildren. CONCLUSIONS: In areas with malnutrition, such as Bangladesh, the BSA reference should be preferred to the reference based on age. Results from the US children indicated that a thyroid volume reference based on weight alone would perform as well as the one based on BSA. European schoolchildren had larger thyroids than US children, perhaps due to a residual effect of iodine deficiency in the recent past in some areas in Europe.
Age Factors↗
Flexible nasolaryngoscopy. A low-risk, high-yield procedure.
Flexible nasolaryngoscopy can be a valuable tool in the primary care physician's office. It is nearly painless for the patient and can yield valuable information about common patient complaints. The equipment is relatively inexpensive, and its use can be easily learned. The procedure is also well tolerated by patients. With proper patient selection, it can clarify otherwise confusing causes of nasopharyngeal or laryngeal disease.
Endoscopy↗
Use of thyroid stimulating hormone testing in newborns to identify iodine deficiency.
Iodine deficiency has traditionally been associated with goiter and cretinism. More recently, iodine deficiency has been recognized as the leading worldwide cause of preventable intellectual impairment. Intellectual and neurologic deficits occur because of a lack of thyroid hormone during critical phases of brain development. More sensitive biologic tests may be useful in determining the true extent of iodine deficiency in populations. Thyroid stimulating hormone (TSH) levels among urban newborns from countries with known iodine deficiency problems were determined using a sensitive whole-blood spot assay. Results found prevalences of high TSH (> 5 mU/L whole blood units using a sensitive monoclonal assay) ranging from 32-80% compared with a prevalence of 3% usually found in iodine-replete areas. These findings suggest that developing brains of newborns are at risk from the detrimental effects of iodine deficiency in these urban areas. The results presented suggest the need for effective intervention programs in urban areas as well.
Developing Countries↗
Socioeconomic circumstances and the risk of bowel cancer in Northern Ireland.
OBJECTIVE: To describe the variation in the incidence of colorectal cancer across Northern Ireland and relate it to factors associated with community deprivation. DESIGN: This was a cross sectional descriptive study. SETTING: Incidence data were obtained from a population based register for the period 1990-91. Small areas were characterised by their "affluence", or lack of it, by deriving a Townsend deprivation score for each electoral ward, using information from the 1991 census. PARTICIPANTS, MAIN OUTCOME MEASURES, AND STATISTICAL METHODS: The age standardised incidence was calculated for all colorectal cancer cases diagnosed histologically in 1990-91. Electoral wards were grouped into quintiles of the population after ranking of their Townsend scores and the association with incidence was studied using Poisson regression. RESULTS: The age standardised colorectal cancer incidence ranged from 22.5 (for quintile 1) to 29.9/100,000 (quintile 5) for men but the trend for women was less regular and rates were 18.4, 23.8, 27.3, 26.5, and 23.9/100,000 for quintiles 1-5 respectively (that is, from the most "affluent" to the most "deprived" fifths of the population). After adjusting for age and sex in Poisson regression, there was a significant association between the total colorectal cancer incidence and levels of community deprivation. The rate ratio for the most deprived quintile of the population (compared with the least) was 1.28 (95% CI 1.06,1.53). The effect was stronger for rectal cancer than for colonic cancer. There was no association between community deprivation and the cancer stage at diagnosis. CONCLUSIONS: In this population, the colorectal cancer incidence is associated with the level of material deprivation. The disease stages at the time of diagnosis in patients from more deprived areas seem to be comparable with those of patients from affluent areas. As others have shown, associations such as these are not explicable entirely on the basis of the distribution of known risk factors. Further research is needed to determine plausible mechanisms for the association.
Adolescent↗
Meconium drug screening to detect prenatal substance abuse.
Explore the source record for details and available documents.
Female↗
Integrating CQI into performance appraisals.
A formal, systematic method of judging produces fair, impartial performance appraisals. Integrating continuous quality improvement concepts into employee evaluations enables these outcomes to be met. Investigate currently used rating scales and appraisal systems, then take constructive steps to produce an evaluation that encourages continuous improvement.
Clinical Competence↗
Older Alabamians System of Information and Services (OASIS): a model Title VII chapter 2 low vision rehabilitation program.
BACKGROUND: Little attention has been paid in the ophthalmic literature to programmatic issues of low vision rehabilitation services delivery. The Older Alabamians System of Information and Services (Project OASIS) is a model low vision rehabilitation program functioning within the state of Alabama. This program is funded through Title VII, chapter 2 of the Rehabilitation Act, Independent Living Services for Older Blind Individuals. The program provides a comprehensive array of independent living services, including optometric low vision evaluation and low vision devices, to persons who are older and blind. Through intergency agreements between various state agencies and private entities, OASIS is able to maximize limited resources and reduce service redundancies. METHODS: Components of the OASIS consortium are reviewed along with outcomes of participants in fiscal year 1993-94. RESULTS: In fiscal year 1993-94 1,114 persons were entered into Project OASIS. Over half (569/1,114) of individuals accepted into the program received traditional optometric low vision rehabilitation services. More than 80% (586/717) of persons were able to achieve their independent living goals. CONCLUSIONS: Through a consortium effort between aging and rehabilitative services, minimal resources have been maximized to allow older visually impaired adults to benefit from comprehensive low vision rehabilitation services.
Activities of Daily Living↗
A non-invasive optical technique for intrapartum fetal monitoring: preliminary clinical studies.
A relatively new optical method based on near infra-red spectroscopy was evaluated in preliminary clinical trials for noninvasive intrapartum fetal monitoring. The measurements were performed using mainly the light reflection mode of monitoring. Continuous monitoring of changes in the concentrations of oxygenated and deoxygenated haemoglobin and thus changes in total haemoglobin concentration in the fetal brain was achieved. It was found that uterine contractions can influence in a distinctive manner the near infra-red derived cerebral haemoglobin concentration changes in the fetus. The results indicate that near infra-red spectroscopy could offer a non-invasive real-time monitoring method for in vivo monitoring of blood oxygenation in the fetal brain. We conclude that this technique may be useful for intrapartum fetal monitoring and in predicting fetal cerebral hypoxia.
Brain Chemistry↗
Near infrared spectroscopy used to observe changes in fetal cerebral haemodynamics during labour.
Near Infrared Spectroscopy (NIRS) has been used in the neonate to observe changes in the cerebral haemodynamics and concentration of oxygenated haemoglobin. Specific changes have been demonstrated in response to spontaneous bradycardias and alterations in the inspired oxygen concentration. We report here changes in fetal cerebral haemodynamics using NIRS in response to rapid spontaneous delivery and the "topping up" of a maternal epidural with bupivacaine. NIRS offers a new way of observing changes in cerebral haemodynamics in the fetus during labour.
Brain Chemistry↗
Effect of fetal hemoglobin on the determination of neonatal cerebral oxygenation by near-infrared spectroscopy.
Near-infrared spectroscopy has been applied to the study of cerebral oxygenation and hemodynamics in the newborn. Fetal Hb is present in high concentrations in these infants. Because spectral absorption curves in the near-infrared range for fetal Hb are not identical to those for adult Hb, there is a potential for the measurements to be affected. This possibility has not previously been investigated. A quantitative analysis of cerebral oxygenation was undertaken in six newborn infants. The analysis used near-infrared spectroscopy multiplier coefficients derived from the absorption coefficients of both fetal and adult deoxygenated and oxygenated Hb. The results of both analyses were compared. It was concluded that the error in near-infrared spectroscopy analysis of neonatal cerebral oxygenation arising from the use of absorption coefficients derived from adult Hb is inconsequential, even in the presence of high concentrations of fetal Hb.
Adult↗
The thyroid status of the Yanomamö Indians of southern Venezuela: 1992 update.
Previous reports described an apparent paradox in the clinical expression of endemic iodine deficiency in Amazonian Indians, who were severely iodine deficient but had no goiter and were clinically euthyroid. To confirm and explain this unique observation, we estimated the iodine intake and evaluated the functional and structural thyroid status of an isolated population of Yanomamö Indians (n = 104) in southern Venezuela. Twenty-six children, 32 adolescents, and 46 adults were studied with serum thyroid function tests, spot urinary iodide concentration determinations, and sonographic measurement of thyroid gland volume. A subset of adolescents and adults (n = 35) had 24-h fractional thyroidal 131I uptake determinations. No individual with goiter, clinical hypothyroidism, or cretinism was observed. Children had higher mean serum T4 (114.5 vs. 102.9 nmol/L; P < 0.02) and serum T3 (2.96 vs. 2.46 nmol/L; P < 0.02) concentrations than adults, with 2% and 50%, respectively, of children having levels more than 2 SD above the mean for a North American reference population. Serum TSH concentrations were also higher in children than adults (3.3 vs. 2.3 mU/L; P < 0.02), with 25% of the subjects above the reference range. Mean urinary iodide was 61 +/- 29 micrograms/L (range, 10-178 micrograms/L), reflecting borderline iodine sufficiency. Thyroidal 131I uptake values were 28 +/- 7%, with 33% above the upper limit of normal (30%). Compared to an iodine-replete Swedish population, the thyroid gland volume was above normal (> mean + 2 SD) in 71% of the study children. We conclude that the Yanomamö have borderline iodine deficiency, associated in children with predictably higher serum T3 and TSH concentrations and a high prevalence of small goiters. The basis for the apparent change in their dietary iodide intake over the past 30 yr is unclear, as is the explanation for their previously postulated resistance to goitrogenesis with more profound iodine deficiency.
Adolescent↗
Effect of co-trimoxazole on stool recovery of Blastocystis hominis.
Explore the source record for details and available documents.
Animals↗
Non-invasive optical monitoring of cerebral blood oxygenation in the foetus and newborn: preliminary investigation.
Near infra-red spectroscopy was applied as a non-invasive and continuous technique for the in vivo monitoring of blood and tissue oxygenation in human neonates. Monitoring of cerebral blood oxygenation in the wavelength range 775-904 nm was carried out on preterm infants after inducing a transient mild hypoxic change; the measurements were performed either by the transmission or reflection (backscattering) mode of monitoring. The results of these investigations were used to assess the application of the technique to foetal monitoring. A series of foetal monitoring studies was performed to investigate the influence of maternal contractions on foetal cerebral blood oxygenation. Although only changes in haemoglobin concentration can be monitored at present, the results suggest that near infra-red monitoring could provide a non-invasive, real-time monitoring method in intensive neonatal and intrapartum care.
Brain↗
Near infra-red reflection measurements and the applicability of the absorption law.
Explore the source record for details and available documents.
Adult↗