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At least 397 records · Page 22Linked to original sources
PubMed1996

Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services.

OBJECTIVE: The study examined whether the prescription practices of clinicians in psychiatric emergency services differed for African-American patients. Prescription of antipsychotic medications and its relation to quality of care was a particular focus. METHODS: Data from 442 independently observed evaluations of patients in psychiatric emergency services were examined using multivariate analyses. The observations were made during a five-year period at four urban general hospitals in California. RESULTS: Clinicians in the four emergency services, most of whom were Caucasian, prescribed more psychiatric medications to African Americans than to other patients and devoted significantly less time to their evaluations. African Americans received more oral doses and more injections of antipsychotic medications, and the mean 24-hour dosage of antipsychotics (1,321 milligrams) was significantly higher than for other patients (825 milligrams). The tendency to overmedicate African-American patients was lower when clinicians' efforts to engage the patients in treatment were rated higher. CONCLUSIONS: The results highlight the importance of efforts to engage African Americans in the treatment process and the need for clinical skills and training to help bridge cultural distances.

Adult↗
PubMed1989

The effects of bilirubin on brain energy metabolism during hyperosmolar opening of the blood-brain barrier: an in vivo study using 31P nuclear magnetic resonance spectroscopy.

Despite intensive investigation it remains uncertain how bilirubin enters the brain and how it exerts a toxic effect on neurones. Studies of induced hyperbilirubinemia in animal models in vivo have failed to reproduce bilirubin encephalopathy without additional factors such as hypoxia, asphyxia, hypercapnia, and disruption of the blood-brain barrier. The aim of this study was to investigate, using 31P NMRS, whether hyperbilirubinemia alone or in association with hyperosmolar opening of the blood-brain barrier caused any disturbance of cerebral energy metabolism in vivo. Spectra were acquired using a surface coil positioned over the right cerebral hemisphere of anaesthetized adult rats placed in the bore of a 1.9 Tesla magnet. Hyperbilirubinemia alone at a maximum mean serum concentration of 1063 +/- 175 mumol/L (mean +/- SD, n = 7) caused no apparent disruption in brain energy metabolism. However, in combination with hyperosmolar blood-brain barrier opening a serum bilirubin concentration of 483 +/- 52 mumol/L (mean +/- SD, n = 9) was associated with a reduction in PCr/(PCr + Pi) ratio from 0.68 +/- 0.06 to 0.44 +/- 0.14 (mean +/- SD, p less than 0.001). A significant correlation was demonstrated between cerebral hemisphere bilirubin content and the reduction in PCr/(PCr + Pi) (r = 0.84, n = 9, p less than 0.01). These results demonstrate in vivo a disruptive effect of bilirubin on cerebral energy metabolism in the presence of an open BBB. This mode of entry and mechanism of toxicity may be factors in the pathophysiology of bilirubin encephalopathy in the newborn infant.

Animals↗
PubMed1994

EFFECTS OF BARIUM CHLORIDE ON ELECTROLYTE TRANSPORT ACROSS ISOLATED COLONS FROM NORMAL AND ALDOSTERONE-TREATED LIZARDS (GALLOTIA GALLOTI)

Addition of BaCl2 to the solution bathing colons of normal lizards did not alter the absorptive Na+ flux, but did reverse the net absorption of Cl- to become net secretion. Cl- secretion resulted from an increase in its serosal-to-mucosal movement and was positively correlated to an increase in short-circuit current. Ba2+-induced short-circuit current was dependent on the presence of both Na+ and Cl- in the serosal medium. Ba2+-induced Cl- secretion could be reversed by serosal amiloride (10(­4) mmol l-1). Colons from acutely or chronically aldosterone-treated lizards exhibited a considerably higher short-circuit current, potential difference and net Na+ absorption than did untreated colons. Net Cl- transport was unaltered by acute treatment, but was totally abolished after chronic treatment. BaCl2 rapidly decreased the potential difference, short-circuit current and tissue conductance across colons from aldosterone-treated lizards. Net Na+ transport was markedly inhibited by Ba2+ in both acutely and chronically treated tissues, but barium did not change unidirectional or net Cl- fluxes in these. The present results support the following hypotheses: (1) that BaCl2 inhibits electrogenic Na+ absorption induced by acute or chronic aldosterone treatment and (2) that Ba2+ induces an electrogenic Cl- secretion by stimulating a basolateral Na+-dependent Cl- intake in normal but not in aldosterone-treated colons. This also suggests that aldosterone could exert an antisecretory influence in colonic epithelia.

Journal Article↗
PubMed2000

Dynamics of the IgG3 responses following immunisation of BALB/c mice with somatic and excretory/secretory antigens from various Trichinella species.

Comparison of the dynamics and antigen recognition profiles of IgG3 following immunisation with larval crude extracts (LCE) and excretory-secretory (ES) products from muscle larvae of different species of Trichinella (T. spiralis, T. nativa, T. britovi, T. nelsoni and genotype T6) was made in BALB/c mice. High levels of gG3 response were obtained in ELISA following immunisation with LCE from all species with maximum levels achieved between days 59 and 64 post-immunisation (p.i.) and maintained up to the limit of the observation (day 164). Antigen recognition profiles as measured by western-blot showed dense and numerous bands in the range 45-64 kDa that were consistent from week 5th with variation in epitope recognition among the different species. Following immunisation with ES antigens a significant decrease in IgG3 response was observed for all species especially for T. nativa in comparison to LCE. Antigen recognition on ES antigens showed three main bands in the range of 45-60 kDa for all species excepting T. nelsoni and T. britovi where an additional band was also present. These results clearly show that IgG3 epitopes are more abundant in somatic (LCE) than in ES products of Trichinella muscle larvae and that quantitative as well as qualitative variations exist among different species.

Animals↗
PubMed2002

Opinion on the diagnosis and treatment of human trichinellosis.

The clinical diagnosis of trichinellosis is difficult because there are no pathogenic signs or symptoms and in diagnosing the infection epidemiological data are of great importance. Trichinellosis usually begins with a sensation of general discomfort and headache, increasing fever, chills and sometimes diarrhoea and/or abdominal pain. Pyrexia, eyelid or facial oedema and myalgia represent the principal syndrome of the acute stage, which can be complicated by myocarditis, thromboembolic disease and encephalitis. High eosinophilia and increased creatine phosphokinase activity are the most frequently observed laboratory features and the parasitological examination of a muscle biopsy and the detection of specific circulating antibodies will confirm the diagnosis. The medical treatment includes anthelmintics (mebendazole or albendazole) and glucocorticosteroids. Mebendazole is usually administered at a daily dose of 5 mg/kg but higher doses (up to 20 - 25 mg/kg/day) are recommended in some countries. Albendazole is used at 800 mg/day (15 mg/kg/day) administered in two doses. These drugs should be taken for 10 - 15 days. The use of mebendazole or albendazole is contraindicated during pregnancy and not recommended in children aged < 2 years. The most commonly used steroid is prednisolone, which may alleviate the general symptoms of the disease. It is administered at a dose of 30 - 60 mg/day for 10 - 15 days.

Adult↗
PubMed1996

Sick building syndrome, work factors and occupational stress.

The sick building syndrome has been associated with certain buildings and environmental characteristics and is estimated to affect up to 30% of new or renovated buildings. Investigations have concentrated on physical factors, and it is only recently that psychological factors have been examined. Work and personal factors have also been considered. Occupational stress has been found to be correlated with symptoms of the sick building syndrome, but much of the research has been of a cross-sectional nature, and it does not indicate whether stress is an active element or an outcome. There is a clear need for further research in this area to examine stress, personality and physical factors associated with the sick building syndrome longitudinally. There is also a clear need to assess the validity of the historical and self-report methods used to assess the sick building syndrome.

Causality↗
PubMedDate not supplied

Trichinella antigens: a review.

This paper presents a review of the Trichinella antigens within the context of species variation. As with other parasites, Trichinella antigens can be classified according to their localisation as surface, excretory/secretory (ES) and somatic components. Surface antigens are mainly constituents of the outer cuticle although secretions from inner parts of the body wall as well as from the oesophagus can temporarily accumulate in the surface. ES antigens come mainly from the excretory granules of the stichosome, whereas somatic constitutive antigens come from the internal parts of the worms. ES products are considered very important from an immunological point of view as they are easily targeted by the immune system, whereas parasite death is required for exposure of somatic products. Some of the antigenic components have been characterised chemically. Phosphorylcholine is an important hapten that modulates the immune responses in Trichinella infections. Glycoproteins are the major components of surface and excretory/secretory products. A 43-kDa glycoprotein has been regarded as a good candidate for diagnosis and vaccination purposes. Recently some glycans have received special attention either as relevant epitopes or as parasite evasion strategies.

Animals↗
PubMed2000

Comparison of IgG3 responses to carbohydrates following mouse infection or immunization with six species of Trichinella.

The IgG3 antibody responses to carbohydrate epitopes were compared in BALB/c mice infected or immunized with six species of Trichinella: T. spiralis (T1), T. nativa (T2), T. britovi (T3), T6, T. nelsoni (T7), and T8. The dynamics of IgG3 responses and antigen recognition following infection or immunization were measured by ELISA and Western blot respectively, using glycosylated and deglycosylated larval crude extracts (LCE) prepared from homologous isolates. A high degree of protein glycosylation was found in all species and with similar profiles. Deglycosylation was completely achieved only in LCE from T1 and T6 isolates. The dynamics of IgG3 responses following infection or immunization significantly differed whereas the antigen recognition profiles appeared similar. Variations in the levels and antigen recognition patterns of IgG3 among the different species were apparent. The highest IgG3 levels were recorded in infections by the T8 isolate and the lowest in infections by the T6 isolate, whereas for immunization the highest IgG3 response was induced by T7 and the lowest by T8. Following antigen deglycosylation, the IgG3 responses were significantly reduced or abrogated and the recognition patterns markedly modified or suppressed in the different species of Trichinella.

Animals↗
PubMed2002

Parental characteristics and adolescent sexual behaviour in Bida Local Government Area of Niger State, Nigeria.

This study was conducted in Bida Local Government Area of Niger State, Nigeria, to examine how parental attributes influence adolescent sexual activity. Data were gathered through structured interview with 400 adolescents aged 12-24 years using a three-stage random sampling procedure. Findings show that more than one third of the adolescents interviewed had sexual intercourse in the month proceeding the survey. Less than one fifth of the sexually active adolescents were using a method of contraception to either prevent infections or avoid unwanted pregnancy. Further analysis confirmed the fact that adolescents with whom parents had discussed family life issues were less likely to be sexually active than those with whom parents had never discussed family life issues. The study also found a negative effect of family instability on adolescent sexuality. These findings call for the need for family-sensitive programs that will enhance family stability especially economically. The need for parental empowerment to be able to cope with the challenges of adolescent life in Nigeria is also stressed since adolescents who have family life education from parents are less likely to be sexually active.

Adolescent↗
PubMed2003

Adjunctive sympathoplegic therapy to ACE inhibition in Blacks with congestive heart failure: a comparison of alpha-1 with beta-1 blockade on exercise tolerance and cardiac sympathovagal reflex activity.

OBJECTIVES: Congestive heart failure (CHF) is characterized by an initial compensatory, but subsequently deleterious, activation of both the renin-angiotensin (RAS) and the sympathetic nervous system (SNS). Incomplete suppression of the SNS may contribute to the residual mortality during optimal ACE inhibitor therapy in CHF. Carvedilol, a mixed alpha and beta-blocker with antioxidant properties, and other pure beta-adrenoceptor blockers reduce morbidity and mortality in Caucasians with CHF. However, beta-blocker monotherapy is of poor efficacy in Blacks with essential hypertension or in the treatment of glaucoma. The efficacy of beta-blockers in the treatment of African Americans with congestive heart failure is a controversial issue with conflicting findings. The aims of the present study were to examine and compare the cardiovascular, autonomic, and clinical effects of additional alpha-1, or beta-1 blockade in ACE-inhibitor treated Black patients with moderate to severe CHF. METHODS: Twenty-eight Nigerian patients with chronic CHF stabilized on digoxin and diuretics, were randomized to 3 groups of similar demographics according to a single blind, parallel group design. The patients were aged 53 +/- 6 years, and comprised 14 men and 14 women, with a mean cardiothoracic ratio of 0.66 +/- 0.03, and ejection fraction of 0.38 +/- 0.10, 60% hypertensive etiology. Group 1 patients received 5 mg enalapril alone, group 2 received 5 mg enalapril + 1 mg prazosin, and group 3 received 5 mg enalapril + 50 mg atenolol. All medication was taken daily for 4 weeks. Blood pressure, heart rate, pressure rate product, 6-minute walk test, NYHA class, and cardiac autonomic reflexes were measured at baseline and again at 2 and 4 weeks of treatment. Two-way repeated measures ANOVA, and a one-way ANOVA were used in data analysis. RESULTS: The 3 treatments caused significant (P<.001 ANOVA) and similar improvements for the NYHA class (-1.0 to -1.6), and increased the 6-minute distance covered (+130 m to +205 m). Although no treatment differences were observed, a trend suggesting a greater improvement with enalapril + atenolol became apparent. By the fourth week, the sympathoplegic treatments, enalapril + atenolol, and enalapril + prazosin, caused significant reductions in the pressure rate product (-3726 +/- 1885 mm Hg x beats/min; -3498 +/- 396 mm Hg beats/min, respectively), (compared to enalapril alone (-1349 +/- 894 mm Hg x beats/min) (P<.001 ANOVA). During the Valsalva maneuver, the phase IV bradycardia were significantly greater after treatment with enalapril + atenolol (944 +/- 66 msec) or with enalapril + prazosin (825 +/- 48 msec), compared to enalapril alone (760 +/- 45 msec) (P<.001 ANOVA). The phase II Valsalva tachycardia were similar between treatments. The respiratory sinus arrhythmia ratio increased significantly (P<.005 ANOVA) and equally on all treatments. However, the pressor and chronotropic responses to forearm isometric handgrip increased significantly on the enalapril + prazosin combination (P<.02), compared to the other treatments. CONCLUSIONS: Our findings demonstrated not only the safety of providing additional therapy with alpha-1 or beta-1 receptor blockade concurrent with ACE inhibition in Blacks with CHF, but also the resultant improvement in exercise tolerance and NYHA class. Compared to using ACE inhibition alone, the combined therapies caused a marked reduction in the pressure rate product, an index of myocardial oxygen consumption, and a greater enhancement of cardiac parasympathetic activity. Selective beta-1 blockade caused a greater enhancement of central baroreceptor vagal activity compared to alpha-1 blockade. Conversely, the pressor and chronotropic abnormalities during forearm isometric handgrip in CHF, were normalized by alpha-1, but not beta-1, blockade. Thus, the combined reflex cardiac vagal augmentation following selective beta-1 blockade, and the hemodynamic effects of alpha-1 antagonism with concurrent ACE inhibition, may be of major therapeutic and prognostic benefit in Blacks with non-ischemic (hypertensive) CHF stabilized on digoxin and diuretics.

Adrenergic alpha-Antagonists↗
PubMed2003

Microalbuminuria in pregnancy as a predictor of preeclampsia and eclampsia.

INTRODUCTION: Hypertensive disorders of pregnancy are common major complications of pregnancy and are responsible for significant morbidity and mortality in the fetus, the newborn infant and the mother. OBJECTIVES: To access if a single estimation of urinary microalbumin at booking would be of value in the prediction of subsequent development of preeclampsia or eclampsia METHODS: We studied at booking urinary microalbumin excretion in one hundred healthy normotensive Nigerian pregnant women attending the antenatal clinic and followed them till delivery. The women were grouped into 3 i.e. those with normal, micro and macro albumin excretion during analysis. RESULTS: Ninety-three of these patients delivered at UCII, 2 had spontaneous abortions and five delivered elsewhere. At booking, 57 patients (61.3%) had normal albumin excretion and 22 (23.7%) and 14(15%) had microalbuminuria and gross albuminuria respectively. The men urinary albumin excretions for the normal, micro and gross albuminuria groups were 10.2 +/- 8.4, 67.0 +/- 55.2 and 321.4 +/- 14.0 mg/24 hours respectively. There was increased incidence of preeclampsia with an increase in albumin excretion and this was statistically significant (P value < 0.05). No patient developed eclampsia. With single urinary microalbumin excretion estimation at booking, the sensitivity, specificity, positive and negative predictive values of albuminuria were 88.9%, 67.9%, 22.2% and 98.3% respectively. CONCLUSION: Urinary microalbumin excretion when used as a single test at booking appeared to predict preeclampsia with a high sensitivity but a low positive predictive value.

Adult↗
PubMed2005

Opportunities for new research using the post-2001 ONS Longitudinal Study.

The addition of 2001 Census data to the ONS Longitudinal Study extends the range of research topics that this unique data resource can support. Census questions on religion, care-giving and self-rated health that were asked for the first time in 2001 and the repetition of 1991 questions on limiting long-standing illness and ethnicity raise opportunities for new longitudinal investigation in these areas. This article describes how new 2001 methodologies including data imputation, the One Number Census and de jure enumeration affect the LS database. The support service for existing and prospective LS users is described.

Adult↗
PubMed2005

Stability and change in ethnic groups in England and Wales.

The Office for National Statistics (ONS) Longitudinal Study (LS) is an exceptional resource for exploring dynamic processes in individuals' lives for a representative sample of the population of England and Wales and across a thirty year period, including how those processes vary by ethnic group. However, analyses tend to assume a certain stability in the meaning of the ethnic group being studied: the insights into ethnic group differentiation are premised on the fact that the group has the same meaning over time. Here we show how the LS allows us to challenge such notions of group stability. This has practical implications for the ways we measure and conceive of Britain's minority ethnic groups. We illustrate this point with two examples: one exploring the change in ethnic group identification by the same individuals between 1991 and 2001, and the second exploring how loss to follow up is differentially experienced according to ethnic group. We provide some suggestions on the implications of this ethnic group instability for other research.

Censuses↗