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PubMed2001

The performance and utility of rapid diagnostic assays for Plasmodium falciparum malaria in a field setting in the Lao People's Democratic Republic.

Rapid diagnostic assays for malaria have the potential to improve the management and control of the disease in developing countries. The objectives of the present study were to evaluate, in a field setting, the performance of several such assays for Plasmodium falciparum infection and to examine the usefulness of these assays in identifying subjects for treatment trials in rural field sites. Residents of 12 villages in Laos who presented with fever were eligible for inclusion. Blood was collected by fingerprick for a dipstick assay, developed by the Program for Appropriate Technology in Health (PATH), performed and interpreted in the field by local healthcare workers. Compared with 'blinded' reference microscopy (N =196), the sensitivity and specificity of the PATH assay were 96.2% and 93.0%, respectively. Two rapid diagnostic assays (PATH and OptiMAL) were also performed on the subset of subjects eligible to participate in an in-vivo treatment trial (N = 97), and the results again compared with those of 'blinded' reference microscopy. In this subset, a subject was considered a 'true positive' if found positive by microscopy or the alternate rapid assay. Using this modified reference standard, the sensitivity and specificity of the PATH assay were 96.7% and 94.4%, and those of the OptiMAL assay were 91.8% and 100%, respectively. Both of the rapid assays tested therefore appear suitable for use in rural field settings by local healthcare providers and can accurately identify participants for treatment trials.

Developing Countries↗
PubMed1997

The Specificity of Motor Skill and Manual Asymmetry: A Review of the Evidence and Its Implications.

Results of investigations on gaining control of limb movements are reviewed, and their contribution to understanding the development of manual asymmetries is discussed in relation to the discrimination and programming of appropriate neuromuscular resources. An examination of the relevant evidence on number and types of manual asymmetries recorded provides strong grounds for concluding that where asymmetries occur, they simply represent a further example of the well-documented activity-specific nature of motor skills and of the extremely lengthy periods of learning or experience needed for their acquisition and perfection. This specificity of motor skill and manual asymmetry also readily accounts for most of the discrepancy usually reported between assessments of hand preference and performance differences between hands, because these alternative measures of handedness have rarely employed the same range or variety of tasks.

handedness↗
PubMed1984

Hyperlipidemia. What is 'normal,' who should be treated and how.

Considering that over half of Americans will die from cardiovascular disease, the over-whelming majority of those deaths being from atherosclerosis, we need to accept and act on the vast body of information derived from investigation of coronary risk factors. Identification of persons at risk needs to be done early--when the patient is in his or her 20s or 30s--not after an infarction has occurred or an angiogram indicates a problem. Although high serum lipid levels are obviously not the only factor involved in development of atherosclerosis, their early identification is a simple, cost-effective way to start preventive care. The concept of "normal" levels of cholesterol and triglyceride must be revised, and that of "safe" levels should be adopted instead. Patients with abnormal electrophoretic patterns should not be the only target; they are only the tip of the iceberg. A typical workup in a young patient consists merely of measurement of cholesterol and triglyceride levels. Further evaluation is necessary if the levels are high or the family history suggests a problem. Lipoprotein electrophoresis and computation of the ratio of high-density lipoprotein to low-density lipoprotein are then used not just as predictors but as a guide to therapy. Basic therapy begins with a change in life-style to incorporate dietary reduction of saturated fats and cholesterol and substitution of polyunsaturated fats. Other measures such as cessation of cigarette smoking, introduction of an appropriate exercise program and, most importantly, reduction of body weight complete the game plan.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol↗
PubMed1986

Stroke rehabilitation. A problem-oriented approach.

Optimal rehabilitation of stroke disability depends on a detailed analysis of neurologic impairments, associated medical conditions, psychosocial status, activities of daily living, and environmental barriers. Such analysis will permit design of the most appropriate management program, aimed at minimizing disability, maximizing function, and returning the stroke patient to a gratifying existence in spite of residual impairment and disability.

Activities of Daily Living↗
PubMed1995

Wrist pain in adult athletes.

As more and more adults become physically active, primary care physicians are seeing an increasing number of wrist injuries. Effective treatment is based on (1) accurate diagnosis, (2) maintenance of bone and joint-surface alignment until healing of bone, soft tissue, or both occurs, and (3) institution of an appropriate rehabilitation program. After symptoms have subsided, patients can gradually return to athletic participation. The long-term sequelae of wrist injuries are yet to be determined. If it is assumed that such injury causes a form of joint trauma, then analogies may be drawn to other types of musculoskeletal trauma, in which such factors as joint-surface and bone malalignment can lead to abnormal cartilage wear, predisposing patients to degenerative arthritis. Similarly, untreated ligament injuries may alter joint biomechanics, which can also lead to joint-surface trauma. Further clinical study should clarify the long-term effects of wrist injury.

Adult↗
PubMedDate not supplied

The argument for HIV-antibody testing in chemical dependence treatment programs.

Controversy surrounds the issue of human immunodeficiency virus (HIV) antibody testing in chemically dependent patients. However, HIV testing can be clinically and therapeutically useful in chemical dependence treatment programs. Prerequisites for HIV testing include: staff education, high-quality pre- and posttest counseling for patients, assurance of confidentiality of results, and the use of accurate screening and confirmatory tests. Reasons to offer voluntary HIV testing in chemical dependence treatment programs include: appropriate medical evaluation and treatment, prevention of the spread of HIV infection, and support for working through the crisis of a positive diagnosis. Voluntary informed consent should be obtained prior to HIV testing; involuntary testing and mass screening are not justified. Testing decisions should be individualized, with the focus on the patient's participation based on treatment- and health-related decisions.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The need for empirically derived permeation data for personal protective equipment: the death of Dr. Karen E. Wetterhahn.

Personal protective equipment (PPE) is an essential component in any occupational health and safety program. The appropriate selection and use of PPE can help prevent or limit exposure to hazardous materials. The inappropriate selection or use of PPE can lead to unnecessary exposure or --with extremely hazardous materials--serious harm including death. In 1997, Dr. Karen E. Wetterhahn died from mercury poisoning resulting from a single exposure to dimethylmercury almost a year before. Her death raised numerous questions as to how this tragedy occurred and what could be done to protect against a chemical as dangerous as dimethylmercury. This article provides a brief review of the case and discusses the glove permeation testing done during the course of the accident investigation. Using this case as an example, the author argues that all recommendations for PPE be based on empirical testing using accepted methods and that this information be readily available.

Accidents, Occupational↗
PubMed2000

Focus groups: a qualitative method complementing quantitative research for studying culturally diverse groups.

CONTEXT: Focus groups are becoming an important method for conducting qualitative research in health care. This strategy enables information to be gathered on the perceptions, beliefs, and values of a group's participants and is particularly well suited to addressing cultural characteristics that impact on a population's health status. As nations become more culturally diverse, qualitative research will likely play a growing role in helping health professions educators develop appropriate educational programs and in helping researchers better understand the needs of minorities and other vulnerable populations who are experiencing disparities in health care. OBJECTIVES: The purposes of this paper are to introduce the usefulness of a qualitative research strategy as an adjunct to quantitative survey research, and to describe briefly how researchers and educators at the Charles R. Drew University of Medicine and Science (Drew) have utilized this strategy when conducting combined qualitative and quantitative research. DISCUSSION: Focus group research has been successfully used to develop culturally adapted surveys, to develop educational programs, and to conduct needs assessments at Drew, which serves a culturally diverse urban population.

Journal Article↗
PubMedDate not supplied

Mate selection and its impact on female marriage age, pregnancy wastages, and first child survival in Tamil Nadu, India.

Marriage in Indian society is a religious duty. Consanguineous marriage is common, where individuals prefer to marry within their clan (a unilateral kin group based on either matrilineal or patrilineal descent). Keeping in mind that this form of marriage has certain disadvantages for social and biological as well as demographic aspects of individuals and families, the present study examines the influence of mate selection (i.e., close relatives, distant relatives, not related) on female age at marriage, pregnancy wastages, and survival status of the first child. The study was designed based on the information collected on a sample size of 3,948 married women aged 13-49 in Tamil Nadu, India, by the National Family Health Survey (NFHS), 1992. Results suggest that 48 per cent of women in Tamil Nadu marry their relatives. This practice of marrying relatives is high in rural areas, among Hindus, Scheduled Castes/tribes, and illiterate women as compared to urban areas, among non-Hindus, non-SC/ST, and educated women, respectively. The bivariate analysis reveals that women marrying their close relatives had low age at marriage and experienced a higher per cent of pregnancy wastage and child loss (first child) as compared to those women marrying their distant relatives or nonrelatives. The result is found to be consistent even after controlling for selected background variables through multivariate techniques (applied separately for age at marriage, pregnancy wastages, and the survival status of first child). Hence, this study suggests that steps should be taken to inform people about the problems of marrying close relatives through appropriate IEC programs in Tamil Nadu.

Abortion, Spontaneous↗
PubMed2003

Cognitive and behavioral change in health care professionals after training in the treatment of injection drug users.

A training program was implemented for 56 health care professionals who work with injection drug users (IDUs) in Spain. The aims were to change health care professionals' concepts of drug treatment for IDUs and increase the knowledge required to implement effective drug treatment programs and train professionals who would in turn train other professionals, thus creating a network. Follow-up was carried out at 8 months. All of the professionals had little prior experience in designing and implementing risk reduction programs. At the end of the training program, all thought that they had increased their knowledge; had gained the skills required to design, implement, and evaluate harm reduction programs for IDUs; and felt qualified to train colleagues from other treatment centers. After 1 year, they had trained 676 health care professionals. The program is appropriate with regard to the aims sought and the target population for which it was designed. The effectiveness of a network-building strategy was also validated.

Adult↗
PubMedDate not supplied

Interdisciplinary research is key to understanding sex differences: report from the Society for Women's Health Research Meeting on understanding the biology of sex differences.

Progress in sex-based biology, the study of biological and behavioral differences between males and females, and the impact of those differences on health and disease will require collaboration across research disciplines and medical specialties and among all research approaches, from molecular biology to epidemiology. The importance of sex-based biology to healthcare necessitates a bench-to-bedside approach that is built on integration of research findings from studies at the cellular level, in animals, and in human subjects. Barriers to interdisciplinary collaborations are being addressed in a variety of ways by public and private funders. The J.D. and C.T. MacArthur Foundation supports interdisciplinary research networks that address broad questions in health and behavior. The National Institute of Mental Health supports cross-disciplinary research networks investigating the hypothalamic-pituitary-adrenal network. The National Institute of Child Health and Human Development offers grants for Building Interdisciplinary Research Careers in Women's Health. The National Science Foundation Directorate for Biological Sciences sponsors Research Coordination Networks in Biological Sciences. Among the challenges faced by interdisciplinary research programs are appropriate peer review, career advancement for young investigators with interdisciplinary training, and acceptance of interdisciplinary research reports by high-quality scientific publications.

Female↗
PubMed1999

Megestrol acetate: promises and pitfalls.

Recent reports suggest that effective antiretroviral therapy, resulting in a plasma HIV load that has been reduced to undetectable levels, may itself prevent HIV- and opportunistic infection-associated weight loss and lead to substantial weight gain. Although these data are encouraging, it is clear that a significant proportion of patients will require, in addition, specific treatment for HIV-associated wasting. Megestrol acetate, in the dosage range of 400 to 800 mg/day, is a useful appetite stimulant for the prevention and treatment of HIV-associated wasting, particularly in women. Patients need to be advised of possible adverse effects and monitored closely. Megestrol acetate stimulates weight gain mostly through an increase in body fat and is therefore most effective in combination with a muscle-building exercise program, where appropriate, and an anabolic agent (steroid or growth hormone) to maintain or increase lean body mass.

Appetite Stimulants↗
PubMed1992

Use of the Terumo SteriCell for the processing of bone marrow and peripheral blood stem cells.

The SteriCell cell processing instrument is a good choice for a stem cell processing laboratory that is of sufficient size that they cannot share an apheresis machine with the blood bank. It is a laboratory instrument, with no facility for patient connection. Because of its minimal size and weight, it is easily stored in a cramped laboratory. Its automated programs are appropriate for processing of bone marrow and peripheral blood stem cells, and it is quite easy to learn how to use (in our laboratory, most individuals have been completely facile with the SteriCell after fewer than six processings). Based on reported results from other instruments, the SteriCell provides cell yields that are comparable to competing instruments. Service (provided by Haemonetics) has been satisfactory, and support from Terumo has been excellent. We can recommend this instrument to any other laboratory.

Automation↗
PubMed2002

Justifying high-cost anticoagulant therapy.

The application of pharmacoeconomics for choosing low-molecular-weight heparins (LMWHs) to facilitate better clinical and economic outcomes is examined. Today's pharmacy paradigm challenges pharmacists to weigh budgetary concerns with optimal patient outcomes to ensure medication-use practices represent the interests of both the health care system and the patient. Pharmacy is attempting to apply pharmacoeconomics to daily practice to influence these outcomes. By using pharmacoeconomic principles, methods, and data, pharmacists can project the impact of a new drug, such as LMWHs, on a pharmacy budget or overall hospital expenditures. LMWHs have demonstrated superior clinical outcomes and overall cost-of-care advantages over traditional anticoagulant agents. Although LMWHs are more expensive than unfractionated heparins, the costs are partially offset by reductions of hospital length of stay, rates of heparin-induced thrombocytopenia, and the monitoring of certain laboratory test values. LMWHs also facilitate the use of bridge therapy for patients with venous thromboembolism, atrial fibrillation, or prosthetic-valve replacements, allowing drastic cost savings for health systems that far offset their acquisition costs. LMWHs can also provide health care systems the opportunity to implement targeted dose-reduction and rounding programs and appropriate dosing guidelines. Pharmacoeconomics provides pharmacy professionals a method to document potential cost savings, cost avoidances, and costs offsets as well as a means to justify additional pharmacy staff. Applying pharmacoeconomics when choosing LMWHs for anticoagulant therapy can assist pharmacy practitioners in facilitating better clinical and economic outcomes.

Anticoagulants↗
PubMedDate not supplied

Control of acute lower respiratory illness in the developing world: an assessment of vaccine intervention.

The major bacterial and viral causes of morbidity and death due to acute lower respiratory infection (ALRI) in the developing world are amenable to control by vaccines. Initially, full use of measles, pertussis, and diphtheria vaccines, in appropriately scheduled programs, can make an immediate contribution to the reduction of severe respiratory infection. Emerging technologies offer the promise of vaccines against bacterial and viral respiratory pathogens that are suitable for infants and children in developing countries. These technologic advances include the use of protein-polysaccharide conjugates of endemic serotypes for Haemophilus influenzae and Streptococcus pneumoniae vaccines and new approaches to the use of purified protein components or attenuated live virus with respiratory syncytial virus and paramyxovirus vaccines. Such vaccines should soon be available for evaluation in developing countries. It is timely to embark upon a program of development, evaluation, and worldwide deployment of vaccines for the control of ALRI.

Acute Disease↗
PubMed2001

A method applicable to effective dose rate estimates for aircrew dosimetry.

The inclusion of cosmic radiation as occupational exposure under ICRP Publication 60 and the European Union Council Directive 96/29/Euratom has highlighted the need to estimate the exposure of aircrew. According to a report of the Group of Experts established under the terms of Article 31 of the European Treaty, the individual estimates of dose for flights below 15 km may be done using an appropriate computer program. In order to calculate the radiation exposure at aircraft altitudes, calculations have been performed by means of the Monte Carlo transport code FLUKA. On the basis of the calculated results, a simple method is proposed for the individual evaluation of effective dose rate due to the galactic component of cosmic radiation as a function of latitude and altitude.

Air Pollution, Radioactive↗
PubMed1995

Considerations when testing and training the respiratory muscles.

The purpose of this review is to describe the muscles of respiration, mechanisms that lead to their dysfunction, and unique features of the respiratory muscles that should be considered when designing testing and training protocols for patients with respiratory compromise. The diaphragm's unique shape is an important determinant of its function. Respiratory pathophysiology combined with systemic abnormalities may result in inspiratory muscle weakness, fatigue, and injury. The specificity of training principle, as it applies to respiratory muscle training in patients with respiratory compromise, will be described. Precautions related to this type of training will also be outlined. In conclusion, a better understanding of the mechanisms contributing to inspiratory muscle dysfunction will assist physical therapists in designing the most appropriate training programs. This article, along with the other articles in this focus on respiratory muscle training, will provide therapists with scientifically based guidelines for rehabilitation of patients with impaired respiratory muscle function.

Breathing Exercises↗