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PubMed1988

Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction.

STUDY OBJECTIVE: To assess effect of intravenous recombinant tissue type plasminogen activator on size of infarct, left ventricular function, and survival in acute myocardial infarction. DESIGN: Double blind, randomised, placebo controlled prospective trial of patients with acute myocardial infarction within five hours after onset of symptoms. SETTING: Twenty six referral centres participating in European cooperative study for recombinant tissue type plasminogen activator. PATIENTS: Treatment group of 355 patients with acute myocardial infarction allocated to receive intravenous recombinant plasminogen activator. Controls comprised 366 similar patients allocated to receive placebo. INTERVENTION: All patients were given aspirin 250 mg and bolus injection of 5000 IU heparin immediately before start of trial. Patients in treatment group were given 100 mg recombinant tissue plasminogen activator over three hours (10 mg intravenous bolus, 50 mg during one hour, and 40 mg during next two hours) by infusion. Controls were given placebo by same method. Full anticoagulation treatment and aspirin were given to both groups until angiography (10-22 days after admission). beta Blockers were given at discharge. END POINT: Left ventricular function at 10-22 days, enzymatic infarct size, clinical course, and survival to three month follow up. MEASUREMENTS AND MAIN RESULTS: Mortality was reduced by 51% (95% confidence interval -76 to 1) in treated patients at 14 days after start of treatment and by 36% (-63 to 13) at three months. For treatment within three hours after myocardial infarction mortality was reduced by 82% (-95 to -31) at 14 days and by 59% (-83 to -2) at three months. During 14 days in hospital incidence of cardiac complications was lower in treated patients than controls (cardiogenic shock, 2.5% v 6.0%; ventricular fibrillation, 3.4% v 6.3%; and pericarditis, 6.2% v 11.0% respectively), but that of angioplasty or artery bypass, or both was higher (15.8% v 9.6%) during the first three months. Bleeding complications were commoner in treated than untreated patients. Most were minor, but 1.4% of treated patients had intracranial haemorrhage within three days after start of infusion. Enzymatic size of infarct, determined by alpha hydroxybutyrate dehydrogenase concentrations, was less (20%, 2p = 0.0018) in treated patients than in controls. Left ventricular ejection fraction was 2.2% higher (0.3 to 4.0) and end diastolic and end systolic volumes smaller by 6.0 ml (-0.2 to -11.9) and 5.8 ml (-0.9 to -10.6), respectively, in treated patients. CONCLUSION: Recombinant tissue type plasminogen activator with heparin and aspirin reduces size of infarct, preserves left ventricular function, and reduces complications and death from cardiac causes but at increased risk of bleeding complications4+

Adult↗
PubMed1993

Medical ethics in the European Community.

Increasing European co-operation must take place in many areas, including medical ethics. Against the background of common cultural norms and pluralistic variation within political traditions, religion and lifestyles, Europe will have to converge towards unity within the field of medical ethics. This article examines how such convergence might develop with respect to four major areas: European research ethics committees, democratic health systems, the human genome project and rules for stopping futile treatments.

Bioethical Issues↗
PubMed1987

The establishment of the embryonic-abembryonic axis in the mouse embryo.

The influence of cell division order on the establishment of the embryonic-abembryonic axis (EA axis) of the mouse embryo was investigated. Aggregate embryos were constructed in which a labelled cell (or pair of cells) was combined with a group of unlabelled cells all of which were up to one cell cycle earlier or later in their progress through development to the blastocyst stage. The aggregates were cultured first to the nascent blastocyst stage and then to the expanded blastocyst stage. The positions of the progeny of the labelled cells in relation to the nascent blastocoel and to the orientation of the embryonic-abembryonic axis were recorded. It was concluded that cell division order does influence the establishment of the EA axis, early dividing cells tending to be associated with the nascent blastocoel and the site of the nascent blastocoel tending to mark the site of the abembryonic pole. However, the influence of division order was diminished by a requirement for intercellular cooperation during blastocoel formation and by a counteracting influence of division order arising from its effects on the allocation of cells to the inner cell mass.

Animals↗
PubMedDate not supplied

[The goals and tasks of the Roll Back Malaria WHO Cabinet Project].

WHO's Roll Back Malaria Cabinet Project (RBM) has been initiated by WHO Director-General Dr. G. Brundtland in 1998. The World Health Organization, The United Nation's Children's Fund, the United Nation's Development Programme and World Bank have joined forces to fight malaria, which kills more than one million people a year. RBM is being launched at time of growing and investment in malaria, which still remains grossly underfunded. RBM is different from previous efforts to fight malaria. The project is working not only through new tools for controlling the disease but also by involving and strengthening the health services to affected population. This pattern of activities is close to Russian version of malaria eradication programme that had been carried out with the success in the former Soviet Union in the 1950s. RBM seeks to reduce substantially the human suffering and economic losses due one of the most costly diseases. Malaria causes an estimated 300 to 500 million acute cases per year. Malaria is a disease of young and the poor, many of them children who live with no easy access to health service. RBM goal is a significant reduction--ideally halving within ten years--in the global burden of disease associated with malaria. RBM purpose is to create an environment that helps countries develop policies and implement relevant elements of RBM strategy. There are six elements to roll back malaria. They are: early detection of malaria illness; rapid treatment of those who are ill; multiple means for preventing infection; strengthening of health sector and intersectoral activities; a powerful sustained social involvement and movement; focused research for new tools and better implementation. New tools are available to combat malaria. They include among others: rapid diagnostics; new drugs (artesunates) and new means for delivery; impregnated bednets; new means for predicting epidemics (satellite mapping). WHO will be coordinating the RBM project. Endemic countries and affected populations have identified malaria as a priority health issue. Activities will cut across WHO programmes and regions to support government, to improve technical efficiency and capacity, to optimize resource allocation, utilization and mobilization.

Disease Outbreaks↗
PubMed1974

Population 1974.

Explore the source record for details and available documents.

Catholicism↗
PubMed1992

We must tackle population problems.

Thank you Mr. Chairman, for the opportunity to speak out not only as a Japanese parliamentarian, but also as a member of GLOBE International, Global Legislators Organization for a Balanced Environment, consisting of legislators from the US Congress, EC Parliament, USSR Assembly and Japanese Diet who have joined together to compare, improve and coordinate our respective legislative activities in an effort to effectively address the complex issues surrounding environment and development. Mr. Chairman, world population--which reached 5.4 billion in mid-1991--is growing exponentially. According to 1 UNFPA report 3 people are born every second, a total of 250,000 people every day or 95-100 million people every year. At this rate, world population will reach 6.4 billion by year 2001, and if this rate continues to go unchecked, world population will reach 14-15 billion by the end of the 21st century. GLOBE is highly aware of the relationship between rapidly growing human populations, environmental degradation and sustainable development. We urge UNCED negotiators to address population growth rates and the integrally linked concerns of resource consumption levels, particularly in the industrialized world, in their search for solutions to the conflict between environment and development. Negotiators should also seriously consider ways in which to broaden educational and economic opportunities for women to ease population growth rates, and to alleviate poverty and stresses on the environment that result from population pressures. Social and economic factors must be integrated into population planning. It is saddening to note that almost 40,000 children die every day due to malnutrition, lack of fresh water and access to resources. Over 100 million children do not receive a primary education. Mr. Chairman, worldwide demand for a range of family planning services is increasing faster than supply. Recent studies indicate that if quality family planning information, training and services were made readily available by government and other groups, population rates would drop to manageable levels. Widespread access to family planning services is essential to population stabilization. The health of mothers, children and general quality of life is also improved through the implementation of family planning programs. At the present time many women cannot make use of the limited available services because of cultural constraints, lack of status and self-confidence. Unless complementary efforts are made to expand economic and educational opportunities for women, family planning and other reproductive health services will not reach their full potential for stabilizing population. Although family planning is an individual decision, and implementation of population programs is a sovereign matter in each country, I would urge developed countries to help their neighbors in developing countries who are in need of support for family planning and health services. Investment in family planning programs is 1 of the best ways to contribute to environmental protection and improvement. A greater portion of our foreign aid monies should be allocated for direct population assistance programs that will reach people at the grassroots level. To achieve this, a cooperative working relationship with local nongovernmental organization (NGOs) is essential. The members of GLOBE hope to facilitate cooperation between NGOs and governments so that we might stabilize human population.

Conservation of Natural Resources↗
PubMed1992

World blindness and the medical profession: conflicting medical cultures and the ethical dilemmas of helping.

This is an account of a thwarted humanitarian effort and the strategic and ethical issues that is raised. Between 14 and 17 million people in the world are blind with cataract, a condition readily corrected by surgery. In 1989 a proposal was developed to attack this problem by supplying volunteer ophthalmologists to the world's leading private voluntary organizations that carry out programs in less developed countries. The proposal was rejected. This article describes the proposal and the issues on which it foundered: cost effectiveness, appropriate technology, changing ideologies of assistance, and conflict between the cultures of medicine and public health. The account illustrates the far-flung consequences of technological change in medicine, as well as the practical and ethical questions facing organizations that carry out overseas assistance programs.

Altruism↗
PubMed1990

[The sick leave notification II system. From the project Evaluation of follow-up of long-term sick leave patients].

In 1988 the National Insurance Administration in Norway introduced a compulsory sickness certificate to be issued by the doctor after eight weeks of incapacity of work (sickness certificate II). The form contains 25 specified items to be filled in by the doctor. We registered and analysed the sickness certificates received by the local National Insurance offices in five municipalities during the last three months of 1988 (n = 735). The patients included a slight majority of males. 1/3 of the patients were younger than 30 years old and 2/3 younger than 50. 1/4 of the items had not been filled in by the doctors. The most frequent diagnostic groups were musculo-skeletal/connective tissue diseases (46.4%), mental disorders (11.2%), and complications related to pregnancy and birth (9.6%). Sickness certificate II included a five-level prognosis scheme. 68.3% of the patients were allocated to prognosis A, i.e. full recovery as a result of medical treatment only. Few doctors noted that cooperation with other health and social welfare personnel was desirable. The level of unemployment was reported as being higher in patients who were certified sick for greater than or equal to 8 weeks than in the general population of the countries included in the study. The extra costs of introducing sickness certificate II are estimated to equal one day's sickness allowance for each of the 735 patients.

Absenteeism↗