Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “harmful working position”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

270 records · Page 15Linked to original sources
PubMed2003

[Use of methadone therapy at the Institute for Alcoholism and Drug Addiction in the Canton of Sarajevo].

INTRODUCTION: Number of addicts increased in our country, especially after the war, and needed adequate solution of the problem as well as use of the experiences from the other countries that faced before us "epidemy" of addictions. One of the solutions for harm reduction caused by use of opioid substances, primarily heroin, is use of methadone (heptanone), which is a good pharmacological replacement. METHODS: In this paper we have presented one-year experience in application of methadone for detoxification or substitution among the patients in our Institute. This retrospective-prospective study included 104 patients treated by methadone detoxification therapy and 59 patients included in the program of methadone substitution. This study involves analyses of the applied therapy compared to age, gender, profession, and duration of addiction, employment status and other social and demographic indicators. RESULTS: Methadone detoxification therapy. Among all age groups most dominant are addicts age 21-30 years (71%), and some in the age group 30-35 years (18%). Lack of adequate treatment programs, as well as break in continuity of treatment due to the war in our country, caused that we have in our sample 10% patients older than 36 years. Few patients younger than 20 years of age, we can explain with short working age of your department, but even now we can notice the incensement of young addicts number. First contact with the drug our addicts usually have between 13 and 18 years of age (61%), while earliest age of contact was 11. Duration of addiction is usually from 1 up to 9 years (65%), although we cannot neglect the number of addicts who are using the drug more than 10 years (35%). During our work, up to now, we did not have neither one case of HIV infection, which does not means that this disease is not present in the addicts population that we have not tested yet. Number of Hepatitis B and C positive addicts in our sample is in accordance with epidemiological data from other countries. There was 32% Hepatitis B positive, 58% Hepatitis C positive, and 23% Hepatitis B and C positive. Methadone substitution therapy. Among those included in the MST, male patients are most dominant, with average age of 31.4 years. Majority of patients has finished high school, they are unemployed, single, and living with their parents. First contact with drugs they had in average age of 16.4 years, while the duration of use had mean value of 10 years. Initial maintenance doses were between 10 and 50 mg, mean 36.1 mg, and maintenance doses after the two months had mean value of 61.6 mg. Among patients involved in MST, we have noted one HIV positive case, and significantly larger number of patients that are positive on Hepatitis: Hepatitis C 33%, and Hepatitis B and C (34%). CONCLUSIONS: Our experience during the application of both treatment types is positive. This treatment is well accepted by the addicts. The MDT and MST methods provides better functioning, easier follow up and better participation in the social and psychological therapeutic processes, which are conducted at our department. Positive improvement in social functioning. Better motivation for the continuation of treatment in the other institutions (therapeutic community). We did not have any side effects of the treatment in order to stop the therapeutic process. We need continuous education and sensibility of the whole society and political community in order to accept, finance and maintain methadone programs.

Adolescent↗
PubMed2004

Why do animal models (sometimes) fail to mimic human sepsis?

OBJECTIVE: To describe potential mechanisms that may account for the observation that drugs that work in treating sepsis in animal models often fail in sepsis trials in patients. DATA SOURCE: MEDLINE searches were used to provide the key information. DATA SUMMARY: Most animal studies are performed acutely in young healthy animals, whereas a significant percentage of the clinical population is elderly with many secondary complications (e.g., diabetes, systemic vascular disease, high blood pressure, immune suppression, cancer). Furthermore, unlike the acute challenge presented in most animal studies, many of the septic patients' clinical histories indicate a relatively slow onset of the disease. In many animal studies, intervention occurs before or during the very early stages of sepsis, when inflammatory cytokine levels are still rising and both organ damage and vascular leakage are minimal. In contrast, current treatment strategies are started when many (probably most) patients are switching from a proinflammatory cytokine response to an anti-inflammatory response and organ damage is already apparent. Patients are also generally receiving some form of supportive therapy (e.g., fluids, vasopressors, ventilators). Because these are seldom used in the animal model, their effect on a particular drug response is difficult to assess. In the animal model, a well-defined bacterial strain, endotoxin challenge, or, in the most complex case, cecal ligation puncture at a defined site is employed to bring about the onset of sepsis. Generally, bacterial proliferation can be controlled in these situations by selecting the appropriate antibiotic (if desired). In human sepsis, the pathogenic bacteria are often not known, mixed infections involving both Gram-negative and Gram-positive bacteria are common, and antibiotic treatment is incomplete or ineffective. Anti-inflammatory strategies that impair bacterial killing may be helpful in cases in which antibiotics were effective and harmful when they were not. Thus, an intervention in human sepsis is attempted at a later stage and under very different conditions than it is during efficacy testing in animal models. CONCLUSIONS: Differences in the nature of the initiating agent causing sepsis and the lack of co-morbidities in the animal models probably contribute to some of the differences in animal studies and clinical trials in sepsis.

Age Factors↗
PubMed2005

Patients with extreme obesity: change in mental symptoms three years after gastric banding.

OBJECTIVE: Extreme obesity causes grave psychosocial and psychopathological problems in addition to somatic morbidity. One possible treatment is gastric banding, a surgical reduction of stomach volume. The aim of this study was to investigate whether gastric banding leads to lasting change in: 1) the Body Mass Index (BMI); 2) social factors such as work and partnerships, eating behavior, anxiety and depression symptoms; and 3) health related quality of life. METHOD: We surveyed a sample of 50 adipose women (BMI > 40 kg/m2). Primary outcome measures were self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), the Hospital Anxiety and Depression Scale (HADS-D), and the Health Survey (SF-36). RESULTS: In comparison with the control group, we observed significant changes in BMI (p < 0.01) and the existence of a partnership (p < 0.01), on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression:p < 0.01), and on all scales of the SF-36 Health Survey (p between < 0.05 and < 0.01 in every case). The most marked changes in all the qualities investigated occurred within the first 12 months of surgery. CONCLUSIONS: Three years after gastric banding, positive changes in BMI reduction, partnership, eating behavior, anxiety, depressive symptomatology, and health related quality of life could be observed. There was also a significant correlation between BMI reduction and reduction firstly on the depression scale (HADS-D) and secondly on the SF-36 scales for physical functioning (PHFU), role physical (ROPH), mental health (PSYC), and vitality (VITA).

Adult↗
PubMedDate not supplied

Drug use and risk of bloodborne infections: a survey of female prisoners in British Columbia.

BACKGROUND: Clinicians working in a women's prison in British Columbia observed hepatitis C sero-conversion among inmates, prompting this study to determine: the characteristics of women who do and do not report illicit drug use in prison; patterns of drug use inside prison; factors associated with illicit drug use that might contribute to bloodborne transmission inside prison. METHODS: A cross-sectional observational data set was created using an anonymous 61-item self-administered survey. RESULTS: Eighty-three percent (104/126) of eligible inmates participated. Seventy-four percent (77/104) reported their current prison sentence was related to illicit drug use and 25% (26/104) reported their ethnicity as Aboriginal. Ninety-three percent (97/104) reported a prior history of illicit drug use, of whom 70% (68/97) reported a history of injection drug use. Thirty-six percent (37/104) reported illicit drug use in prison, and 21% (22/104) reported injection drug use in prison. Fifty-two percent (54/104) reported hepatitis C sero-positivity, and 8% (8/104) reported HIV sero-positivity. Of the 22 women who reported prison injection drug use, 91% (20/22) reported hepatitis C infection and 86% (19/22) reported injecting with shared needles inside prison, with or without bleach cleaning. Women were more likely to report illicit drug use in prison if they had had illegal sources of income prior to incarceration (p=0.0081, OR 3.19), had previously injected drugs (p=0.036, OR 2.97), and had first injected drugs at a friend's house (p=0.066, OR 2.70). INTERPRETATION: The majority of women reporting prison injection drug use also reported hepatitis C sero-positivity and shared needle use. Canadian prisons are risk situations for transmission of bloodborne pathogens, and provide opportunities for harm reduction strategies.

Adult↗
PubMed2006

Psychiatric wards with locked doors--advantages and disadvantages according to nurses and mental health nurse assistants.

AIMS AND OBJECTIVE: To describe nurses' and mental health nurse assistants' perceptions of advantages and disadvantages about working on a psychiatric ward with a locked entrance door. BACKGROUND: Psychiatric staff sometimes needs to protect patients from harming themselves or others. To keep the entrance door locked may help staff to achieve this goal. How locked entrance doors at psychiatric wards are experienced by staff, working on these wards, has been investigated to a very limited extent. DESIGN: The study was explorative and descriptive. METHOD: Audio taped, semi-structured interviews with open-ended questions about advantages and disadvantages about working on a psychiatric ward with a locked entrance door, were conducted with 20 nurses and 20 mental health nurse assistants. Data were analyzed with content analysis. RESULTS: A content analysis revealed eight categories of advantages and 18 categories of disadvantages. Most advantages mentioned by nurses and mental health nurse assistants were categorized as providing staff with control over patients, providing patients with a secure and efficient care and protecting patients and staff against 'the outside'. Most disadvantages mentioned by nurses were categorized as causing extra work for staff, making patients feel confined, making patients feel dependent and creating a non-caring environment. Most disadvantages mentioned by mental health nurse assistants were categorized as causing extra work for staff, making patients feel confined, causing emotional problems for patients, making staff's power obvious and forcing patients to adapt to other patients' needs. Nurses and mental health nurse assistants mentioned more disadvantages than advantages and nurses mentioned more disadvantages than mental health nurse assistants. CONCLUSION: Nurses and mental health nurse assistants perceive a number of advantages and disadvantages for themselves, patients and significant others with a locked door at a psychiatric ward. Most of these concern patients' experiences. RELEVANCE TO CLINICAL PRACTICE: It is important for staff working within psychiatric care to reflect upon the fact that a locked entrance door is connected with a range of negative as well as positive perceptions and to minimize patient and own concerns connected to the locked door.

Adult↗
PubMed1975

Hormology with inorganic compounds.

Three components of the dose-response reaction, usually seen as three separate curves, are reviewed as a single continuum of the effect of the dose of any agent upon an organism. The usual considerations of any agent in toxicology are the harmful actions. The individual considerations of an essential nutrient or of a hormone usually suggests a positive action. The third component is the stimulatory action as understood in hormone research and as seen in many studies with minute doses of toxic materials. The coelescence of these concepts into one continuum gives a broad viewpoint which is helpful to understand the biologic implications of any toxic, nutritious or stimulating material under a variety of conditions. Such a view is useful in predicting results and in understanding the reaction of living organisms to their environments; when small amounts of a chemical are added to a biologic system, one parameter may be affected in one way and another parameter in the opposite manner. Consideration of the complete dose-response curve led to the concept of hormology, the sutdy of excitation. The thesis of hormology is that any harmful agent may be stimulatory for any parameter when it is administered in subharmful quantities to an organism existing in a suboptimum environment. Concepts fro hormology allow the suggestion that the zero equivalent point (zep) could be used to replace zero tolerance as a practical, legislative concept for dangerous chemicals in our environment. A reivew of three pharmacology texts revealed four types of dose-response curves. The alpha curve demonstrated a simple toxicity, the beta curve exhibited a single stimulation peak followed by a toxicity as more material was added; the gamma curve showed an initial harmful reaction followed by a stimulatory reaction which, in turn, was followed by a toxic reaction as the quantity of material administered was increased; and the delta curve was essentially a sign wave in which two peaks of stimulation were separated by a "harmful valley", then, as greater concentrations of material were administered, toxicity was noted. A brief review of agents which are stimulatory in minute doses showed that a considerable amount of work had been done with radiation and late work has established emf as a stimulatory vehicle. Little work is done with other physical agents. Organic chemical compounds are known to be stimulatory in small quantities; e.g. dietary antibiotics. The fact that antibiotics stimulate growth in germfree animals and the fact that nongermicides stimulate classic animals proves their direct effect on the animal tissues.

Animals↗
PubMed2005

Detection of age-dependent brain injury in a mouse model of brain amyloidosis associated with Alzheimer's disease using magnetic resonance diffusion tensor imaging.

Using magnetic resonance diffusion tensor imaging (DTI), the present study investigates changes in both gray and white matter in the APPsw transgenic mouse (Tg2576), a model of beta-amyloid plaque deposition associated with Alzheimer's disease (AD). DTI analyses were performed in cross-sectional groups of transgene-positive and -negative mice at 8, 12, 16, and 18 months of age to assess the magnitude of water diffusion in gray matter (i.e., Tr(D)) and changes in diffusion in white matter that may be indicative of axonal degeneration (i.e., reduced water diffusion parallel to axonal tracts, lambda(||)) and myelin degradation (i.e., increased water diffusion perpendicular to axonal tracts, lambda(perpendicular)). No appreciable changes in gray or white matter were observed between the APPsw and the age-matched control mice at 8 months of age. Reduced Tr(D) and lambda(||) were observed in gray and white matter, respectively, for the APPsw mice at ages greater than 8 months, which coincides with the time period when appreciable amyloid plaque accumulation was confirmed by ex vivo histopathological studies. The decreases in lambda(||) suggest the presence of axonal injury in multiple white matter tracts of APPsw mice. Unlike lambda(||), lambda(perpendicular) was unaltered between control and APPsw mice in most white matter tracts. However, in the corpus collosum (CC), lambda(perpendicular) increased at 16 and 18 months of age, suggesting the possibility of myelin damage in the CC at these later ages. This work demonstrates the potential for DTI as a noninvasive modality to detect evolving pathology associated with changes in tissue water diffusion properties in brain tissues.

Aging↗
PubMed1997

Enzymatic midchain branching of polylactosamine backbones is restricted in a site-specific manner in alpha 1,3-fucosylated chains.

Branched polylactosamines on animal cell surfaces are believed to contribute to multivalent interactions in cell adhesion and cell signalling. Their biosynthesis proceeds via linear precursors that become branched by beta1,6-GlcNAc transferases (IGnT6, GlcNAc to Gal). Previous work has identified the tetrasaccharide Galbeta1-4GlcNAcbeta1-3Galbeta1-4GlcNAc (1) and the hexasaccharide Galbeta1-4GlcNAcbeta1-3Galbeta1-4GlcNAcbeta1- 3Galbeta1-4GlcNAc (4) as acceptors for a rat serum enzyme activity (cIGnT6), which transfers GlcNAcbeta1-6 units to the midchain galactose residues. Thereby, 1 is converted to the branched pentasaccharide Galbeta1-4GlcNAcbeta1-3(GlcNAcbeta1-6)Galbeta1-4 GlcNAc and 4 to the doubly branched octasaccharide Galbeta1-4GlcNAcbeta1-3(GlcNAcbeta1-6)Galbeta1-+ ++4GlcNAcbeta1-3(GlcNAcb eta1-6)Galbeta1-4GlcNAc [Leppänen, A., Salminen, H., Zhu, Y., Maaheimo, H., Helin, J., Costello, C. E., & Renkonen, O. (1997) Biochemistry 36, 7026-7036]. Here we report that neither the alpha1, 3-fucose-containing derivatives of 1 [Galbeta1-4GlcNAcbeta1-3Galbeta1-4(Fucalpha1-3)G lcNAc and Galbeta1-4(Fucalpha1-3)GlcNAcbeta1-3Galbeta1-4Gl cNAc] nor a similar derivative of 4 [Galbeta1-4GlcNAcbeta1-3Galbeta1-4(Fucalpha1-3)+ ++GlcNAcbeta1-3Galbeta1- 4GlcNAc] were acceptors for the rat serum cIGnT6 activity. Hence, the enzyme's branch-forming action was completely prevented at sites in the immediate neighborhood of the fucosylated loci of the polylactosamines. In Galbeta1-4GlcNAcbeta1-3Galbeta1-4GlcNAcbeta1- 3Galbeta1-4(Fucalpha1-3) GlcNAc, the inhibition of the branch-forming reaction was restricted to the fucose-carrying LacNAc unit; at the middle LacNAc, the branching proceeded normally. However, in the isomeric Galbeta1-4(Fucalpha1-3)GlcNAcbeta1-3Galbeta1- 4GlcNAcbeta1-3Galbeta1-4 GlcNAc, the fucose residue prevented branching completely at the middle LacNAc and almost completely at the reducing end LacNAc. In summary, alpha1,3-fucose residues in polylactosamine chains inhibited the cIGnT6 reaction in a site-specific manner, at the fucosylated LacNAc unit itself and also at sites one and two LacNAc units upstream, but not at the LacNAc units downstream from the fucosylated locus. These data imply that site-directed branching in polylactosamines is possible in vitro with the aid of specifically positioned alpha1,3-fucosyl units, that can be removed afterward without harming the branched backbones.

Acetylglucosamine↗
PubMed2004

Frameless image guidance improves accuracy in three-dimensional interstitial brachytherapy needle placement.

PURPOSE: The aim of this work was to adapt a computer-assisted real-time three-dimensional (3D) navigation system for interstitial brachytherapy procedures. METHODS AND MATERIALS: The 3-D navigation system Surgical Planning and Orientation Computer System (SPOCS; Aesculap, Tuttlingen, Germany) was adapted for use in interstitial brachytherapy. A special needle holder with mounted infrared-emitting diodes (IRED) for 3D navigation-based needle implantation was developed. Measurements were made on a series of different phantoms to study the feasibility and the overall accuracy and precision of the navigation system with regard to single-needle application and volume implants (multiple-needle implantations). In all, 250 single implants and 20 volume implants were performed. Accuracy was measured as the target registration error (TRE) between the preoperatively defined and the achieved target position. RESULTS: Analyses of the 250 different targets showed a mean TRE for single-needle applications of 1.1 mm (SD +/- 0.4 mm), 0.9 mm (SD +/- 0.3 mm), and 0.7 mm (SD +/- 0.3 mm) in the x, y, and z direction, respectively. The maximal deviation was 2.3 mm. The corresponding TRE in the x, y, and z direction for volume implants was 1.6 mm (SD +/- 0.4 mm), 1.9 mm (SD +/- 0.6 mm), and 1.0 mm (SD +/- 0.4 mm), respectively. The maximum deviation was 2.9 mm. CONCLUSIONS: The adaptation of a commercially available surgical planning and navigation system to interstitial brachytherapy is feasible. It enables virtual planning and improved accuracy in 3D interstitial needle implantation.

Brachytherapy↗
PubMed1998

Posture, locomotion, spatial orientation, and motion sickness as a function of space flight.

This article summarizes a variety of newly published findings obtained by the Neuroscience Laboratory, Johnson Space Center, and attempts to place this work within a historical framework of previous results on posture, locomotion, motion sickness, and perceptual responses that have been observed in conjunction with space flight. In this context, we have taken the view that correct transduction and integration of signals from all sensory systems is essential to maintaining stable vision, postural and locomotor control, and eye-hand coordination as components of spatial orientation. The plasticity of the human central nervous system allows individuals to adapt to altered stimulus conditions encountered in a microgravity environment. However, until some level of adaptation is achieved, astronauts and cosmonauts often experience space motion sickness, disturbances in motion control and eye-hand coordination, unstable vision, and illusory motion of the self, the visual scene, or both. Many of the same types of disturbances encountered in space flight reappear immediately after crew members return to earth. The magnitude of these neurosensory, sensory-motor and perceptual disturbances, and the time needed to recover from them, tend to vary as a function of mission duration and the space travelers prior experience with the stimulus rearrangement of space flight. To adequately chart the development of neurosensory changes associated with space flight, we recommend development of enhanced eye movement systems and body position measurement. We also advocate the use of a human small radius centrifuge as both a research tool and as a means of providing on-orbit countermeasures that will lessen the impact of living for long periods of time with out exposure to altering gravito-inertial forces.

Humans↗
PubMed2006

Pathogen inactivation techniques.

The desire to rid the blood supply of pathogens of all types has led to the development of many technologies aimed at the same goal--eradication of the pathogen(s) without harming the blood cells or generating toxic chemical agents. This is a very ambitious goal, and one that has yet to be achieved. One approach is to shun the 'one size fits all' concept and to target pathogen-reduction agents at the Individual component types. This permits the development of technologies that might be compatible with, for example, plasma products but that would be cytocidal and thus incompatible with platelet concentrates or red blood cell units. The technologies to be discussed include solvent detergent and methylene blue treatments--designed to inactivate plasma components and derivatives; psoralens (S-59--amotosalen) designed to pathogen-reduce units of platelets; and two products aimed at red blood cells, S-303 (a Frale--frangible anchor-linker effector compound) and Inactine (a binary ethyleneimine). A final pathogen-reduction material that might actually allow one material to inactivate all three blood components--riboflavin (vitamin B2)--is also under development. The sites of action of the amotosalen (S-59), the S-303 Frale, Inactine, and riboflavin are all localized in the nucleic acid part of the pathogen. Solvent detergent materials act by dissolving the plasma envelope, thus compromising the integrity of the pathogen membrane and rendering it non-infectious. By disrupting the pathogen's ability to replicate or survive, its infectivity is removed. The degree to which bacteria and viruses are affected by a particular pathogen-reducing technology relates to its Gram-positive or Gram-negative status, to the sporulation characteristics for bacteria, and the presence of lipid or protein envelopes for viruses. Concerns related to photoproducts and other breakdown products of these technologies remain, and the toxicology of pathogen-reduction treatments is a major ongoing area of investigation. Clearly, regulatory agencies have a major role to play in the evaluation of these new technologies. This chapter will cover the several types of pathogen-reduction systems, mechanisms of action, the inactivation efficacy for specific types of pathogens, toxicology of the various systems and the published research and clinical trial data supporting their potential usefulness. Due to the nature of the field, pathogen reduction is a work in progress and this review should be considered as a snapshot in time rather than a clear picture of what the future will bring.

Anti-Infective Agents↗
PubMed2002

The ecology of fish parasites with particular reference to helminth parasites and their salmonid fish hosts in Welsh rivers: a review of some of the central questions.

Ecological studies carried out in Welsh rivers on the feeding behaviour of salmonid fish, their helminth parasites and intermediate hosts in the early 1950s and in 1998 have been used as a basis to review the literature dealing with the following questions. First, how are the helminth populations dispersed in space-time? Second, to what extent are the distributional patterns and the life history strategies of the parasites influenced by physicochemical factors? Third, to what extent are populations of helmith parasites in salmonid fish influenced by host characteristics including the genome, sex, age, size, social position and Feeding behaviour? Fourth, are the populations of parasites regulated in a density-dependent manner? Fifth, do the parasites influence the survival and wellbeing of their salmonid hosts and the evolution of sex? Sixth, to what extent is the parasite community influenced by environmental changes including those of an anthropogenic nature and can the parasites be used as bioindicators of pollution? As with most parasites the helminth species found were highly overdispersed thus making it necessary to undertake a log10 (1 + x) conversion for statistical analyses. Statistical analyses confirm that the genome, age and sex of salmonid fish hosts, the station and seasonal change in radiation levels were significant factors in predicting the number of parasites. The evidence given supports the hypothesis that the feeding behaviour and habitat selection by the host fish, their position in the social hierarchy and the overdispersed nature of the transmission sites are the key factors in causing differences in the parasitic fauna related to host species, age, size and sex. Differences in the helminth parasite community related to station can be explained on the basis of differences in water types, sediments and chemistry. Although the evidence presented is in accord with the consensus view that temperature is correlated with seasonal changes in the abundance of many species of helminth parasites, it is argued that it may not be the direct causative mechanism. It is postulated that the life history strategy that results in a decline in abundance of the more vulnerable adult parasites in the gut of the salmonid hosts during the summer has arisen as a result of evolutionary pressures. At this time, the gut environment is particularly inhospitable because of the temperature-related enhancement of the host's immune mechanism and the increased gut turnover rate. In contrast, the larval stages in the immunologically and metabolically more benign intermediate host would be under less intensive selective pressures. It is postulated therefore that evolutionary pressures have caused the parasites to leave the definitive host and concentrate their reproductive efforts in the intermediate hosts during the warmer months. Evidence is given in support of the hypothesis that the parasite populations are regulated in a density-dependent manner and that the regulatory mechanisms may involve the host's immune mechanisms and intraspecies competition and interspecies competition of an exploitative or interference nature. Quantitative studies using 'K' factor analysis and biochemical research to elucidate the nature of the interference mechanisms are required to test this hypothesis. The absence of age-related resistance indicates an old and stable relationship in which the immunosuppressive and immunoavoidance mechanisms of the parasites and hosts, respectively, are in balance. This indicates that the introduction of novel parasites or new genetic strains of host fish could result in harmful epidemics. Despite causing tissue damage, there was no evidence of parasite-induced mortality among the salmonids in the Teifi. This finding is in accord with the generally accepted view that most freshwaters are not troubled by parasite problems. although parasites are present in abundance. In fact, parasite abundance in the salmonid fish in the Teifi was positively correlated with the condition factor and the adipose index. Two testable hypotheses were advanced to explain these observations. First, the more dominant well-conditioned fish in the hierarchy are more likely to acquire parasites because they ingest more food items and spend more time in sheltered habitats with depositing sediments where transmission mainly occurs. Second, the parasites may release factors that stimulate the host's immune and endocrinological systems to produce factors that enhance somatic growth and inhibit reproduction of the host. This benign relationship is considered to be indicative of long-term coevolution. The sex of the fish had a significant influence on the abundance of the parasites in total and also on particular species with the bias in all cases being in favour of the female fish. This review shows that sex bias in parasitism is generally not strong and that male bias in parasitism is not a general rule. Taken as a whole, the results fail to support most of the predictions based on the Hamilton-Zuk and the immunocompetence hypotheses. Possible hypotheses to explain why parasitism tends to be higher in female than in male trout include testosterone immunosuppression, corticosteroid-based immune suppression and differences between the size and behaviour of the sexes. However, the latter two hypotheses have more credence, although testosterone levels are higher in female than male trout. Between the early 1950s and 1998 there has been a marked decline in the prevalence, abundance and diversity of the helminth parasite communities in salmonid fish as well as their intermediate hosts. Possible reasons for these declines include heavy metal pollution, increased acidity and habitat degradation linked to changes in land use. It is concluded that although helminth parasites can provide supplementary information on pollution. the use of biotic indices based on the Biological monitoring working party (BMWP) or River invertebrate prediction and classification system (RIVPACS) methods are preferable. However, as these methods were designed to measure the impact of organic pollution they lack the sensitivity for measuring metal pollution. It is advocated therefore that new biomonitoring methods should be developed to measure the impact of heavy metal pollution using biotic indices based on the sampling of the susceptible invertebrate communities inhabiting depositing sediments in the transmission sites of helminth parasites.

Animals↗
PubMed2006

Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment.

A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear--and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.

Journal Article↗
PubMed2004

The Sit & Stand chair. A revolutionary advance in adaptive seating systems.

A major factor governing independence for the elderly and persons with disabilities is the ability to stand from a chair. Factors such as pain, reduced joint range of motion, stiffness, and muscle weakness frequently limit the ability to stand. Sit-to-stand position is even further reduced in patients whose hands and shoulders are afflicted with rheumatoid arthritis. When achieving a sit-to-stand position in the elderly and persons with disabilities, there is considerable risk of the individual falling and sustaining bone fracture. The purposes of this scientific report are to achieve the following goals: (1) to provide a narrative discussion of the senior author's contributions to furniture manufacturing as well as his successful patent application for the SIT & STAND chair, (2) to describe the steps involved in the development of the SIT & STAND prototype, and (3) to examine the performance of the SIT & STAND chair in assisting the elderly or persons with disabilities in achieving a sit-to-stand position. The invention of the SIT & STAND chair by the senior author, Michael Galumbeck, was a culmination of his lifelong interest in adaptive seating systems. His electrically operated chair has the unique ability to assist the occupant to achieve safely a sit-to-stand position. The rear portion of his chair remains in a fixed position to support the buttocks of the user during mechanical lift. The front portion of the seat folds down incrementally as the chair rises to allow the feet of the user to be positioned in a more posterior position firmly on the floor. Using its actuator, the height that the chair rises will vary with the length of the legs of the occupant. Using the drawing program Solid Works (Solid Works, Concord, Massachusetts), drawings of the chair were made. To visualize the operation and performance of the chair, separate drawings were made in the lateral position. The prototype of the SIT & STAND chair was manufactured with an electric actuator that allows elevation of the back portion of the seat. The design of this chair ensured that there were no pinch points that could endanger the user or assistant. Its framework ensured that it was stable and did not tip over. After the prototype chair is manufactured, it is being sent to Underwriters Laboratory Inc. (Los Angeles, California) for review and certification. The performance of the SIT & STAND chair was determined in a clinical study involving seven elderly or disabled individuals who complained of difficulty in rising from a chair from a seated position. During each performance evaluation, a mechanical chest and shoulder harness attached to an overhead sling encircled the individual to ensure that he/she would not fall. In the first part of the evaluation, these individuals were asked to achieve a standing position after being seated in the SIT & STAND chair without the use of the actuator. Three individuals were unable to achieve a standing position, while four achieved this standing position with considerable difficulty and potential instability. When these participants used the SIT & STAND chair with the use of the electrical actuator, all individuals achieved a standing position without difficulty or instability. All individuals expressed disappointment that the SIT & STAND chair was not commercially available for them to purchase and use in their homes. Because the SIT & STAND chair allows the individual to achieve a standing position without assistance, the SIT & STAND chair has other potential benefits not evaluated in this study. The beneficial effects of standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased bladder pressure, enhanced circulatory regulation, reduction in muscular tone, decrease in upper extremity muscle stress, and participation in activities of daily living. Another irrefutable benefit of the SIT & STAND chair is that the chair eliminates the need for physical assistance from family members or health care personnel, preventing the development of disabling back injuries in personal care assistants. In addition, the SIT & STAND chair entirely removes the risk of pain or harm to the individual, which sometimes occurs with manual assist to stand, such as dislocation or fracture of frail shoulders with the under-axilla lift. Realizing the medical benefits of the SIT & STAND chair, Aetna completed a clinical policy bulletin that states that the seat lift mechanism is a medically necessary durable medical product. On the basis of this extensive product and performance evaluation, we recommend the SIT & STAND chair for the elderly as well as persons with disability to safely achieve a sit-to-stand position.

Activities of Daily Living↗
PubMed2006

Drugs for preventing malaria in pregnant women.

BACKGROUND: Malaria contributes to maternal illness and anaemia in pregnancy, especially in first-time mothers, and can harm the mother and the baby. Drugs given routinely to prevent or mitigate the effects of malaria during pregnancy are often recommended. OBJECTIVES: To assess drugs given to prevent malaria infection and its consequences in pregnant women living in malarial areas. This includes prophylaxis and intermittent preventive treatment (IPT). SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (March 2006), CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE (1966 to March 2006), EMBASE (1974 to March 2006), LILACS (1982 to March 2006), and reference lists. We also contacted researchers working in the field. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials comparing antimalarial drugs given regularly with no antimalarial drugs for preventing malaria in pregnant women living in malaria-endemic areas. DATA COLLECTION AND ANALYSIS: Both authors extracted data and assessed methodological quality. Dichotomous variables were combined using relative risks (RR) and weighted mean differences (WMD) for mean values, both with 95% confidence intervals (CI). MAIN RESULTS: Sixteen trials (12,638 participants) met the inclusion criteria; two used adequate methods to conceal allocation. Antimalarials reduced antenatal parasitaemia when given to all pregnant women (RR 0.53, 95% CI 0.33 to 0.86; 328 participants, 2 trials), placental malaria (RR 0.34, 95% CI 0.26 to 0.45; 1236 participants, 3 trials), but no effect was detected with perinatal deaths (2890 participants, 4 trials). In women in their first or second pregnancy, antimalarial drugs reduced severe antenatal anaemia (RR 0.62, 95% CI 0.50 to 0.78; 2809 participants, 1 prophylaxis and 2 IPT trials), antenatal parasitaemia (RR 0.27, 95% CI 0.17 to 0.44, random-effects model; 2906 participants, 6 trials), and perinatal deaths (RR 0.73, 95% CI 0.53 to 0.99; 1986 participants, 2 prophylaxis and 1 IPT trial; mean birthweight was higher (WMD 126.70 g, 95% CI 88.64 to 164.75 g; 2648 participants, 8 trials), and low birthweight less frequent (RR 0.57, 95% CI 0.46 to 0.72; 2350 participants, 6 trials). Proguanil performed better than chloroquine in one trial of women of all parities in relation to maternal fever episodes. Sulfadoxine-pyrimethamine performed better than chloroquine in two trials of low-parity women. AUTHORS' CONCLUSIONS: Chemoprophylaxis or IPT reduces antenatal parasite prevalence and placental malaria when given to women in all parity groups. They also have positive effects on birthweight and possibly on perinatal death in low-parity women.

Antimalarials↗
PubMed2005

Analytical investigations on a releasing agent application in aluminium diecasting.

BACKGROUND, AIMS AND SCOPE: Releasing agents, applied in the aluminium diecasting process, usually consist of water, oils, waxes, polysiloxanes, as well as of a set of additives like emulsifiers, corrosion inhibitors, and biocides. During spray application and part release, gases and aerosols are emitted into workplace air. The chemical compositions of these emissions are determined by the components of the releasing agents and their reaction products formed during thermal stress of more than 700 degrees C. In the frame of the joint project, the analytical tasks were to develop an appropriate sampling strategy for this production environment, to draw conclusions about the occurrence of hazardous chemicals from production plant studies and from laboratory-scale thermolysis experiments, and to determine the biodegradability of customary releasing agents. METHODS: During realistic test production, active air sampling was performed in a production hall using different adsorption materials. Cotton fabric sheets were positioned in the production area as passive samplers. Thermolysis experiments were performed at 600 degrees C with sealed quartz ampoules. The biodegradability of different releasing agents was determined according to German industry standard DIN 51828 (2000). For analyses, GC/MS (headspace), FTIR, HPLC, IC, and ICP-OES techniques were applied. RESULTS AND DISCUSSION: The substance spectrum, which was found in workplace air, was dominated by saturated and nonsaturated aliphatic hydrocarbons. Besides these, alcohols, alkyl phenols, xylenes and other benzene derivatives, aldehydes, glycols, carboxylic acid esters, and amides were present. The German limiting value of 40 mg/m3 of complex hydrocarbon mixtures in a diecasting workplace atmosphere was clearly under-run. Total hydrocarbon contents ranged between 2.7 and 6.3 mg/m3. Five different PAH were found in the air close to the diecasting machine, with maximum concentrations between 0.05 and 3.06 microg/m3. Concentrations of nonylphenols ranged from 10 to 200 microg/m3, and those of triethanolamine from 20 to 30 microg/m3. From 17 elements analyzed, only B, Fe, P, S, Si, and Ti were emitted in small amounts. It was striking that the PAH patterns resulting from thermolysis experiments were quite the same compared to those determined during the diecasting process. An influence of water and of Fe/Al on the composition of the thermolysis products could mostly be shown. The degrees of biodegradation of three releasing agent extracts after 21 days were 21%, 29%, and 55%, respectively. CONCLUSION: A sampling strategy was developed, which allows an emission assessment for the industrial process of aluminium diecasting. It enabled one to control limiting values, to characterize a wide variety of compounds emitted, and to identify and quantify relevant pollutants. Only a few hazardous substances could be detected during the exemplary use of one releasing agent within the compounds emitted into workplace air. Indications were found, that the prediction of the formation of harmful substances from releasing agent components should be possible via thermolysis experiments. The biodegradability test can serve to assess the expenditure of disposal of the usual leakage run-off of excess agent during production. RECOMMENDATION AND OUTLOOK: Investigations on further differently composed releasing agents, e.g. powders, would be desirable. A substitution of nonylphenol ethoxylates by less harmful components would surely be an improvement of a releasing agent with regard to work safety and health care, because of avoiding the emission of toxic and endocrine active nonylphenols. The surprisingly wide range of biodegradability of the investigated releasing agents points to an optimization potential, that has obviously not yet been considered.

Air Pollutants, Occupational↗
PubMed1998

[The status of neurologic intensive care in Germany. Current data].

In 1994 this journal published the results of a survey undertaken on behalf of the Working Association for Neurological Intensive Care Medicine (ANIM) in the winter of 1992/93. In the winter of 1996/97 a continuation of this analysis was performed. With the help of a questionnaire the data of 62 intensive care units with a total of 420 beds were established. This is 11 intensive care units and 83 beds more than 1992/93. The intensive care units were again classified into three groups (ventilation units, monitoring units, interdisciplinary units) relating to their equipment and structure. The questions concerned structural organisation, such as the number of beds, type of clinic, number and training of physicians and nurses, technical equipment and availability of large and high-tech apparatus or access to other facilities, such as neurosurgery. Of great interest were data about whether and to what extent special measures of intensive medicine can be taken on the one hand and performance parameter data e.g. days of ventilation and duration of in-patient treatment on the other hand. Detailed data were provided concerning the frequency of each diagnosis of patients treated in those intensive care units. Evaluating the data a positive development in the last four years of the neurological intensive care can be found in most of the areas investigated. It has also been found that neurological intensive care in the new lander has reached equal standard both in quality and quantity. Now a single physician is responsible for 2,3 beds compared to 3,6. Today 78 per cent of the beds in ventilation units are equipped with a ventilator. The overall time of ventilation increased to 48 per cent. Overall there are, however, considerable differences between individual units as well as regions. The data presented can serve as a means to monitor the quality of neurological intensive care.

Equipment and Supplies, Hospital↗
PubMed1999

[Man and his fellow-creatures under ethical aspects]

Preliminary remarks Preceding the detailed literary review, here a few events, topics and publications for the busy reader including * The decision of the Bundesverfassungsgericht (Federal Constitutional Court) to declare unconstitutional and invalid chicken owner ordinances permitting caging * The decision of the German parliament to declare animal protection a national goal * Publication of a number of books which are likely to influence discussions for years to come since they bring to a close developments having emerged over an extended period of time. Without claiming to be exhaustive the following should be mentioned: Marc Bekoff and Carron A. Meany, ed.: "Encyclopedia of animal rights and animal welfare", an extensive work being reviewed by Peter Thornton in chapter 3.6 of this report. For the first time, animal protection of the Anglo-American tradition is being summarised, in theory as well as in practice, and, on high standards: "The list of contributors reads like a Who"s Who of experts in their chosen fields and includes philosophers such as Peter Singer, Tom Regan, Tom Beauchamp and Bernard Rollin and welfare scientists such as Don Broom, David Fraser, Temple Grandin. Others involved in examining the role of animals in society and our relationship with them, such as Andrew Linzey, Richard Ryder, James Serpell and David Morton (to name just a few), have also provided entries" (Peter Thornton). The comprehensive monograph by Johannes Caspar: "Tierschutz im Recht der modernen Industriegesellschaft. Eine rechtliche Neukonstruktion auf philosophischer und historischer Grundlage" (Animal Protection in the Law of modern industrial Society. A new legal Construct on a philosophical and historical Base) represents an extensive critical incorporation of animal protection in Germany under legal and ethical aspects including a detailed rendering of the actual treatment of animals. The term "critical incorporation" was used on purpose since never before was cruelty to animals presented in such completeness and thoroughness, together with the distance and objectivity originating in the legal stance. The book is of invaluable significance in particular for the commentators of the German animal protection law as amended in 1998: For the first time, they are now in a position to draw from an abundance of facts and evaluations relevant to animal protection. It appears as a fortunate circumstance in this context, that not only the traditional Lorz-commentary is being continued (Albert Lorz and Ernst Metzger: "Tierschutzgesetz" [Animal Protection Law], commentary, 5th edition) but also a completely new commentary is being developed by the team of Hans Georg Kluge, ed., Antoine F. Goetschel, Jörg Hartung, Eisenhart von Loeper, Jost Dietrich Ort and Kerstin Reckwell: "Kommentar zum Tierschutzgesetz" (Commentary to the Animal Protection Law). "Moral Status" is not only the title of an important investigation by Mary Anne Warren (in the introductory chapter she describes and evaluates the basics of the Status-discussion to date) but also a topic singularly dominating the scientific discourse. Out of rejection or reservation regarding the biocentrical position of Albert Schweitzer or Paul W. Taylor, time after time new restricting concepts have been introduced. In the same way, the criterion of the ability to suffer as developed by Bentham was considered by some as too far reaching. In considering animals ethically the line can be drawn so tightly that, aside from apes and maybe some large marine mammals, the whole of the animal kingdom can be degraded to at best, the ecological worthy resources of man; and all this without being suspected of an adversary position to animal protection. At times, the impression arises that science is seeking and finding ever new hurdles in order to keep the number of morally considered fellow-creatures as small as possible. Following common opinion, even animals with moral status are only entitled to protection from pain or suffering but not from being killed, as long as it is performed without causing fear or pain. In the prevailing opinion, only animals demonstrating a conscious will to live have the right to be protected and not the host of "lower" animals who are granted only a kind of life-impulse. But why is a life-impulse so much less powerful, so much less worthy? Does not even an oyster summon up all of it"s force to defend itself, instinctively? However, it is true that we cannot protect all of life or all animals to the same degree. But there is no sufficient reason to exclude this multitude of fellow-creatures from any consideration at all just because they are only demonstrating a life-impulse. Maybe, it would be meaningful to adopt a gradually increasing moral status, granted any living creature by virtue of it"s being alive. This would mean a protection from thoughtless and random harm and annihilation. This "biophilia", regarding all life as valuable (even if it"s protection varies in range), could reconcile two formally differing ethical positions: * pathocentrism, which presumes the ability to feel in all of life, and * biocentrism, intending to do justice to each life-form according to it"s abundance and intensity.

Journal Article↗