Focusing on customer service.
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Americas↗
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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.
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ICMR's multicentre study on comprehensive MCH care.
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Child↗
Training folk practitioners as PHWs in rural India.
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Adult↗
Analytical resources for assessment of clinical genetics services in public health: current status and future prospects.
CONTEXT: Genetics services are not well integrated into the public health programs of most states, nor has there been effective use of clinical and program databases in the design, evaluation, and monitoring of public health genetics services at the state level. OBJECTIVE: To evaluate the availability and current use of population-based clinical genetics databases, including birth defects surveillance programs, in state-level public health genetics programs. DESIGN: Mail survey to state genetics coordinators in 50 states and 3 territories during 1996 with an update in 1997. RESULTS: Thirty states had birth defects surveillance programs; data from these resources were used in public health genetics program planning and management in only 15 states. Thirty states or territories had clinical genetics services databases. Most states had newborn screening program databases; few linked these records to vital statistics for programmatic purposes. Only 24 states had individual record databases for the Children with Special Health Care Needs program; 8 states had databases for maternal serum alpha-fetoprotein screening, and 7 had statewide cytogenetics registries. CONCLUSION: Population-based databases concerning aspects of public health genetics are largely unavailable at the state level. Where these databases exist, they are poorly integrated into state public health genetics program activities. More attention should be paid to the development and use of clinical data programs for the assessment, monitoring, and assurance of genetics issues with relevance to population health.
Child↗
Prevention of dopamine-induced cell death by thiol antioxidants: possible implications for treatment of Parkinson's disease.
We have recently shown that dopamine (DA) can trigger apoptosis, an active program of cellular self-destruction, in various neuronal cultures and proposed that inappropriate activation of apoptosis by DA and or its oxidation products may initiate nigral cell loss in Parkinson's disease (PD). Since DA toxicity may be mediated via generation of oxygen-free radical species, we examined whether DA-induced cell death in PC12 cells may be inhibited by antioxidants. We have found that the thiol containing compounds, reduced glutathione (GSH), N-acetyl-cysteine (NAC), and dithiothreitol (DTT) were markedly protective, while vitamins C and E had lesser or no effect. The thiol antioxidants and vitamin C but not vitamin E, prevented dopamine autooxidation and production of dopamine-melanin. Their protective effect has also manifested by inhibiting DA-induced apoptosis; DNA fragmentation was prevented as was shown histochemically by the in situ end-labeled DNA technique (TUNEL). Intracellular GSH and other thiols constitute an important natural defense against oxidative stress. We have found that depletion of cellular GSH by the addition of phoron, a substrate of glutathione transferase, and buthionine sulfoximine (BSO), an inhibitor of gamma-glutamyl transpeptidase, significantly enhanced DA toxicity. Cotreatment with NAC rescued the cells from the toxic effect of BSO+DA, and phoron+ DA, while addition of GSH provided only partial protection from BSO+DA toxicity. Our data indicate that the thiol family of antioxidants, but not vitamins C and E, are highly effective in rescuing cells from DA-induced apoptosis. Further study of the mechanisms underlying the unique protective capacity of thiol antioxidants may lead to the development of new neuroprotective therapeutic strategies for PD.
Acetylcysteine↗
A survey of consultation-liaison psychiatry program characteristics and functions.
A survey of medical school affiliated consultation-liaison psychiatry programs has provided useful information on several aspects of current C-L program activity, including: (a) patients seen and treatments provided; (b) C-L training; (c) program structure (and fiscal operations); and (d) subjective appraisal by program directors. Data on patients, diagnostic categories, and treatments support the findings of similar, previous studies. Training and research appear to be continuing at past levels rather than increasing. Limited information on fiscal operations and program structure preclude adequate assessment of their strengths and vulnerabilities. Recording of better data and the development of more aggressive management techniques are proposed as appropriate foci of attention for C-L program leaders.
Education, Medical↗
Hepatitis C virus infection and lung transplantation: a survey of practices.
BACKGROUND: Approximately 4 million persons in the United States are chronically infected with hepatitis C and morbidity due to this disease is increasingly observed in transplant recipients. While knowledge of hepatitis C in liver and kidney transplantation is advancing, little information is available concerning hepatitis C and lung transplantation. We surveyed lung transplant programs about policies regarding testing for hepatitis C, transplantation of hepatitis C-infected candidates, and the use of organs from seropositive donors. METHODS: A written questionnaire was sent to all United Network of Organ Sharing (UNOS) approved lung transplant programs. RESULTS: Fifty-nine of 89 (66%) surveys were returned, including 49 from active programs, capturing 81% of lung transplants performed within UNOS prior to January 1998. All programs screen candidates for hepatitis C. The estimated median seropositivity rate among candidates was 1.9%. Thirty-three of 46 (72%) programs consider seropositive patients for transplantation and most use virologic and/or histologic data to determine candidacy. All donors are screened for hepatitis C. Twenty-six of 47 (55%) programs accept lungs from seropositive donors and many restrict the use of organs from seropositive donors to infected recipients. Few programs routinely test recipients for hepatitis C, and policies for monitoring those with known infection are variable. CONCLUSIONS: Lung transplant candidates and donors are tested routinely for hepatitis C. The majority of programs are willing to accept infected candidates and seropositive donors. Post-transplant follow-up of hepatitis C is variable and prospective studies are needed to evaluate the impact of hepatitis C on lung transplant recipients.
Disease Transmission, Infectious↗
Characterization and expression kinetics of an endothelial cell activation antigen present in vivo only in acute inflammatory tissues.
Endothelial cell activation by endotoxin (LPS), tumor necrosis factor (TNF), Interleukin-1-alpha, beta (IL-1-alpha, beta) and phorbolesters (TPA) results in increased monocyte adhesion. Examination of kinetics of monocyte adhesion shows that the onset of adherence enhancement (AE) is similar in all five agents (about 300% AE at 6 h), while its decrease is delayed in LPS/TNF versus IL-1-alpha, beta/TPA-induced activation (LPS versus IL-1-beta:260% versus 60% at 18 h). Monoclonal antibody (4D10), raised against 24 h LPS-stimulated endothelial cells detects an endothelial cell-specific activation antigen at Mr 81,000 that is induced by LPS, TNF, IL-1-alpha, beta and TPA (within 6 h about 100% positive cells). Decrease in antigen-positive cells is delayed in LPS/TNF versus IL-1-alpha, beta/TPA-induced antigen expression (LPS vs. IL-1-beta: 60% vs. 5% at 24 h). In situ the antigen is not expressed in normal and chronic inflammatory tissues. Acute inflammatory tissues, including contact and atopic dermatitis, psoriasis and periodontitis, however, show endothelial cells staining strongly positive. In contact eczemas at different times after elicitation (0, 6, 24, 72, 96 h), expression of the antigen is first seen after 24 h and is still strong at 96 h. These data indicate that LPS/TNF conduct an endothelial cell activation program in vitro, showing the same prolonged kinetics that is found for endothelial cell activation in the acute inflammatory process in vivo.
Antibodies, Monoclonal↗
Computer-assisted rapid surveys in developing countries.
Health surveys are an important source of population-based data in much of the developing world. Unfortunately, sample surveys often take more time to plan, process, and analyze than is practical, given the information needs of the local decision-makers. Rapid survey methodology (RSM) has been developed to permit health professionals to answer quickly questions about the health status and activities of people at the community level. These answers may be necessary for determining program priorities or for monitoring program activities. Rapid surveys are meant to supplement, rather than replace, information derived from existing sources of vital and health statistics data. RSM combines sample survey methods with contemporary software used in portable, battery-powered microcomputers. The ability to do rapid surveys in developing countries also requires knowledge of how to use appropriate computer hardware and software and how to apply cluster sampling theory in the local environment. RSM was used for the first time in Hlegu Township, Burma, to conduct a health survey of young children. The survey team started the field work on May 4, 1987. Four days later, while still in the field, the data were processed and rapidly analyzed by portable microcomputers for presentation to the local township medical officer and his staff. Within 10 days of starting the field work, we issued a detailed 50-page report of the study findings. This paper provides (a) a description of the components of rapid survey methodology, including the sample survey method, computer hardware, and computer software; (b) the general requirements for portable computer hardware in less developed regions of the world; (c) the procedures for doing a rapid survey; and (d) a summary of our experiences with RSM in Burma.
Developing Countries↗
Traditional midwives, tetanus immunization, and infant mortality in rural Haiti.
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Haiti↗
[Lung transplantation at the Barnes Hospital in 1992].
Lung transplantation is a constantly changing form of therapy. The St. Louis Work Group is known for its contributions in the area of single lung transplant, with two highly active programs running at present, one for adults and one for children. The Group is also active in research, in the development of various methods for lung preservation, and in medium-and long-term studies. Finally, this team writes and updates the International Register of Lung Transplants, which brings together the vast majority of operations of this type done worldwide. The Register permits control of results of lung transplant operations as well as the assessment of future alternatives.
Contraindications↗
Molecular events in the induction of a nonresponsive state in interleukin 2-producing helper T-lymphocyte clones.
Exposure of normal interleukin 2 (IL-2)-producing helper T-cell clones to antigen and 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide-treated antigen-presenting cells results in proliferative unresponsiveness to subsequent stimulation with antigen and normal antigen-presenting cells. In the present study, we have examined the molecular events that accompany the induction of this unresponsive state. T cells stimulated in this manner failed to produce IL-2, but interleukin 3, interferon-gamma, and IL-2 receptors were partially induced and T-cell receptor beta mRNA was fully induced. Although T-cell unresponsiveness correlated with an IL-2 production defect, addition of IL-2 during the induction phase failed to prevent development of the unresponsive state. The critical biochemical event appeared to be an increase in intracellular calcium. Removal of calcium from the medium prevented induction of the unresponsive state, whereas addition of the calcium ionophore ionomycin induced unresponsiveness as well as all of the related partial activation events. Thus, an increase in intracellular calcium under nonmitogenic conditions appears to initiate an alternative activation program that prevents the T cell from producing IL-2 in response to subsequent normal activation signals. The significance of this in vitro model for tolerance induction in vivo is discussed.
Animals↗
Nerve growth factor activation of nuclear factor kappaB through its p75 receptor is an anti-apoptotic signal in RN22 schwannoma cells.
Recent evidence indicates that nerve growth factor (NGF) produces its effects through signaling contributions from both TrkA and the p75 receptor. In contrast to its trophic actions through TrkA, NGF binding to p75 has been shown to activate programmed cell death through a mechanism involving the stress kinase JNK. However, this receptor also activates nuclear factor kappaB (NF-kappaB), the role of which has yet to be determined. We investigated the function of p75-mediated NF-kappaB stimulation in regulating cell survival in the rat schwannoma cell line RN22, which expresses p75, but not TrkA. Gel shift assays demonstrated activation of NF-kappaB in response to NGF within 30 min and lasting at least 4 h. NGF also stimulated JNK in the cells (detected by in vitro kinase assays) with a similar time course. Preventing activation of NF-kappaB with the specific inhibitor SN50 resulted in NGF-induced cell loss. Similarly, transfection of the cells with a mutant form of the endogenous NF-kappaB inhibitor (IkappaBalphaDeltaN), which cannot be degraded and therefore remains bound to NF-kappaB, preventing its activation, resulted in a significant increase in the number of apoptotic cells following NGF treatment. These results suggest that NGF activation of NF-kappaB through the p75 receptor promotes survival, counterbalancing the pro-apoptotic signal.
Animals↗
The industrial hygiene audit: purposes and implementation.
The increased implementation of industrial hygiene programs in industry, with the associated increase in funds allocated to safety and health programs, has introduced the concept of evaluative measures for program performance. The audit is a frequently used and valuable tool for the safety specialist, but it has been infrequently used by the hygienist. We differentiate the audit from 1) program guidelines and 2) program evaluation. The latter implies relating program activities to articulated measures of effectiveness. The audit, in contrast, utilizes widely accepted industrial hygiene program structural elements. In an audit a qualitative or numerical rating scale is assigned each audit program element to indicate the extent to which the element is present. The audit is an essential tool for the manager of an industrial hygiene program. Audits are not a substitute for program evaluation, but program evaluation is a very uncertain matter because the industrial hygiene profession has yet to focus on measures of program progress in terms similar to those of the safety field, i.e. accident frequencies and severities. Program elements and qualitative and quantitative rating scales are described. Preparation, conduct and reporting of the audit are discussed.
Accident Prevention↗
Institutionalized elderly. Relaxation, locus of control, self-esteem.
Progressive relaxation significantly moved elders toward a perception of internal locus of control. Progressive relaxation and activity programs significantly increased elders' self-esteem. Progressive relaxation was significantly more effective than the activity group in increasing self-esteem. Changes in locus of control and self-esteem were not correlated.
Aged↗
Progress toward poliomyelitis eradication--Nigeria, January 2000-March 2002.
Since 1988, when the World Health Assembly of the World Health Organization (WHO) resolved to eradicate poliomyelitis globally, the annual estimated incidence of polio has declined 99%. Nigeria is the most populous country in Africa (estimated 2000 population: 127 million) and a major poliovirus reservoir. This report summarizes the progress toward polio eradication in Nigeria during January 2000-March 2002, highlighting achievements in acute flaccid paralysis (AFP) surveillance and evidence indicating reduced poliovirus transmission. The findings underscore the importance of ensuring a rapid flow of surveillance information to guide program activities.
Humans↗
Cardiac rehabilitation: a patient education program.
Hospitalized cardiac patients were given an education program that covered, in five 45-minute discussion sessions, anatomy and physiology, dietary management, appropriate activity programs, the adjustment process, risk factors, and signs and symptoms of complications of therapy. A sample of 36 patients was given pre- and posttests and followed at six weeks and three months postdischarge. Significant (p less than .05) increases in knowledge were found among study subjects which resulted in improved conditions for the subjects.
Adolescent↗
Flexor tendon injuries. Treatment of the acute problem.
The management of flexor tendon injuries continues to evolve as our knowledge of tendon biology and physiology improves. The concept of early motion after tendon repair is a key part of this evolutionary process. This section has provided a brief review of the history of early motion and presented a postoperative therapy program for flexor tendon repairs. Patient education, splinting (protective and corrective) and an exercise and activity program have been stressed. It must be emphasized that if early motion is used postoperatively, it must be done in conjunction with a closely supervised hand therapy program.
Adult↗