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PubMed2001

Challenges to vaccine safety.

The end of the 20th century saw the realization of a goal that was previously only dreamed about: the near elimination of many deadly infectious diseases through universal vaccination. As one disease after another has been driven from memory, it is vaccination programs themselves that have come to occupy the public's mind. With increased scrutiny comes the promise that vaccines will become even safer, but there is also the threat that ill-founded concerns will result in reduced immunization rates, and diseases will resurge. This article reviews scientific data relating to current vaccine safety concerns.

Attitude to Health↗
PubMed2003

The beginning of human life and its modern scientific assessment.

One of the most controversial topics in modern bioethics, science, and philosophy is the beginning of individual human life. In the seemingly endless debate, strongly stimulated, by recent technologic advances in human reproduction, a synthesis between scientific data and hypothesis, philosophical thought, and issues of humanities has become a necessity to deal with ethical, juridical, and social problems. Furthermore, in this field there is a temptation to ask science to choose between opinions and beliefs, which neutralize one another. The question of when human life begins requires the essential aid of different forms of knowledge. Here we become involved in the juncture between science and religion, which needs to be carefully explored.

Beginning of Human Life↗
PubMed2006

Secret science: tobacco industry research on smoking behaviour and cigarette toxicity.

A lack of scientific data remains the principal obstacle to regulating cigarette toxicity. In particular, there is an immediate need to improve our understanding of the interaction between smoking behaviour and product design, and its influence on cigarette deliveries. This article reviews internal tobacco industry documents on smoking behaviour research undertaken by Imperial Tobacco Limited (ITL) and British-American Tobacco (BAT). BAT documents indicate that smokers vary their puffing behaviour to regulate nicotine levels and compensate for low-yield cigarettes by smoking them more intensely. BAT research also shows that the tar and nicotine delivered to smokers is substantially greater than the machine-smoked yields reported to consumers and regulators. Internal documents describe a strategy to maximise this discrepancy through product design. In particular, BAT developed elastic cigarettes that produced low yields under standard testing protocols, whereas in consumers' hands they elicited more intensive smoking and provided higher concentrations of tar and nicotine to smokers. Documents also show that BAT pursued this product strategy despite the health risks to consumers and ethical concerns raised by senior scientists, and paired it with an equally successful marketing campaign that promoted these cigarettes as low-tar alternatives for health-concerned smokers. Overall, the documents seem to reveal a product strategy intended to exploit the limitations of the testing protocols and to intentionally conceal from consumers and regulators the potential toxicity of BAT products revealed by BAT's own research. Tobacco industry research underscores the serious limitations of the current cigarette testing protocols and the documents describe deceptive business practices that remain in place.

Advertising↗
PubMed1989

Should all pregnant women be screened for gestational glucose intolerance?

Although gestational glucose intolerance is associated with the remote development of diabetes mellitus, the risk to the mother during the index pregnancy and the risk to her fetus remain uncertain. Nevertheless, universal screening for gestational glucose intolerance has many strong advocates. The scientific data supporting a universal screening programme--showing that treatment of gestational glucose intolerance does more good than harm--are limited. Until the evidence can be extended beyond that on infant birthweight, a more restrained approach than universal screening may be appropriate.

Birth Weight↗
PubMed2001

A database generator for human brain imaging.

Sharing scientific data containing complex information requires new concepts and new technology. NEUROGENERATOR is a database generator for the neuroimaging community. A database generator is a database that generates new databases. The scientists submit raw PET and fMRI data to NEUROGENERATOR, which then processes the data in a uniform way to create databases of homogeneous data suitable for data sharing, met-analysis and modelling the human brain at the systems level. These databases are then distributed to the scientists.

Brain↗
PubMed2000

Risk assessment of Listeria monocytogenes in fish products: some general principles, mechanism of infection and the use of performance standards to control human exposure.

Risk assessment is increasingly used as a scientific process to assess the potential for adverse health effects to occur and as a basis for management of unacceptable risks. For each risk assessment activity, the purpose of the assessment should be clearly stated. For Listeria monocytogenes, the purpose of risk assessment may be providing information on the relative contribution of listeriosis to infectious diseases. For control purposes, the emphasis may be put on factors contributing to the risk of occurrence in a food or to inform risk managers that they should be setting food safety objectives. For an adequate risk assessment of L. monocytogenes, sound scientific data are necessary. This especially applies both to exposure assessment and hazard characterisation. Surveillance data indicates that cold storage to prolongs product shelf-life has opened an ecological window for the growth of L. monocytogenes. Assessment of dose-response relationship is often regarded as a key element in risk characterisation. Due to the large variability of the current assessed dose-response data, their contribution to assessing risks is low. The use of epidemiological data on incidence rate, types of food involved in listeriosis, etc. may be good alternatives. The use of performance standards or criteria, such as inactivation by heat or by fermentation, combined with processes that prevent outgrowth of the organism should be reconsidered. Presently, performance standards can simply be assessed since mathematical tools for their calculations are becoming increasingly available.

Animals↗
PubMed2001

A Chinese fermented soybean food.

Sufu or furu is a fermented soybean product originating in China. It is a cheese-like product with a spreadable creamy consistency and a pronounced flavour. Sufu is a popular side dish consumed mainly with breakfast rice or steamed bread. It has a long history and written records date back to the Wei Dynasty (220-265 AD). Sufu is made by fungal solid state fermentation of tofu (soybean curd) followed by aging in brine containing salt and alcohol. The present review is based on scientific data published in Chinese and international sources. Several types of sufu can be distinguished, according to processing method or according to colour and flavour. Choice of processing can result in mould fermented sufu, naturally fermented sufu, bacterial fermented sufu, or enzymatically ripened sufu. Depending on the choice of dressing mixture, red, white or grey sufu may be obtained. The stages of the process are discussed and include the preparation of tofu, the preparation of pehtze, salting and ripening. Fungal starters include Actinomucor spp., Mucor spp. and Rhizopus spp. The chemical composition is discussed with particular reference to the proximate composition, the amino acid content and profile, as well as the volatile flavour components of various types of sufu.

Biotechnology↗
PubMed1997

Transmission of urinary bacterial strains between patients with indwelling catheters--nursing in the same room and in separate rooms compared.

Despite lack of supporting scientific data it has been suggested that patients with an indwelling urinary catheter (IUC) should be nursed in separate rooms to reduce the risk of cross-infection. We conducted a one-month case-control study of nursing home patients with an IUC and bacteriuria, 20 nursed together pairwise and 20 in separate rooms, by weekly urine cultures and typing of the bacterial isolates. The transmission rate of urinary strains between patients was three times higher within rooms (5/9 possible transmissions) than between rooms (9/53 possible transmissions, P = 0.02). The study thus supported nursing IUC patients in separate rooms.

Aged↗
PubMed1988

Controversies in antibiotic choices for bite wounds.

In the last decade much progress has been made in our understanding of animal bites. Two major areas of remaining controversy are discussed. Recent study of human bites has shown that the early literature depicting all human bites as having an extraordinarily high infection and complication rate was biased by its emphasis on human bites of the hand that presented late with infection already present. These bites, the so-called closed-fist injuries (CFI), do indeed have a poor prognosis, but it may be as much due to their location and initial neglect as to the source of the injury. Human bites elsewhere do not seem to have any higher risk than animal bites, which have an infection rate of about 10%. Human bites of the face, lips, and ears are at very low risk for infection (less than 3%) if properly treated. The CFI should be identified early and aggressively irrigated and debrided (if possible). CFI wounds can be treated on an outpatient basis if uninfected and less than 24 hours old. The economical outpatient antibiotics of choice for CFI are penicillin plus dicloxacillin; the former is needed to cover Eikenella corrodens and the latter to cover Staphylococcus aureus, both common in these wounds. Diabetics with hand infection frequently have Gram-negative infection and may warrant parenteral aminoglycosides. Second- and third-generation cephalosporins are very effective but should be reserved for special situations due to their expense. Prophylactic antibiotics are not indicated for typical bite wounds, which are low risk. The choice of antibiotic (when needed) in other bite wounds is a matter of confusion, because the only scientific data available are in vitro sensitivities, which are a very poor and crude reflection of the clinical reality. Antibiotic effectiveness in vivo is dependent on a complex summation of absorption, tissue levels (not just serum levels), host immune defenses, and the interrelationships between bacterial species present. For dog bite wounds, dicloxacillin and cephalexin are both good choices because they cover most of the broad spectrum of infecting pathogens; dicloxacillin is significantly cheaper.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMedDate not supplied

Care of patients with leg ulcers: a nursing perspective.

Care of patients with leg ulcers is challenging as well as rewarding. Recent advances in scientific knowledge about healing should be incorporated in the nursing care of leg ulcer patients. This article provides an update on the state of the science in the care of leg ulcers in geriatric patients, and focuses on assessment and local care of such ulcers. Ulcer assessment provides the basis for selecting therapies to maximize healing. Wound cleansing and appropriate dressings are essential to good patient outcomes. Furthermore, healing is enhanced when these interventions are combined with strategies that maximize oxygen to the ulcer, promote appropriate levels of activity, optimize perfusion through physiological positioning, and reduce mechanical shear through selection of proper footwear. Care of patients with leg ulcers provides the nurse an opportunity to apply pathophysiology, utilize scientific data, and function as an integral player on the wound care team.

Aged↗
PubMed2006

[Thrombolysis in cardiac arrest].

Both acute myocardial infarction and pulmonary thromboembolism are responsible for a great number of cardiac arrests. Both present high rates of mortality. Thrombolysis has proved to be an effective treatment for acute myocardial infarction and pulmonary thromboembolism with shock. It would be worth considering whether thrombolysis could be effective and safe during or after cardiopulmonary resuscitation (CPR). Unfortunately, too few clinical studies presenting sufficient scientific data exist in order to respond adequately to this question. However, most studies they show that thrombolysis applied during and after CPR is a therapeutic option that is not associated with greater risk of serious hemorrhaging and could possibly have beneficial effects. On the other hand, experimental data exists which show that thrombolytics can attenuate neurological damage produced after CPR. Nevertheless, clinical trials would be necessary in order to adequately establish the effectiveness and safety of thrombolysis in patients who require CPR.

Cardiopulmonary Resuscitation↗
PubMed2004

[Program to improve care in chronic illnesses: application of the model of care in chronic illness].

INTRODUCTION: Chronic diseases have become more central to Primary Care due to their greater prevalence and the difficulties of monitoring them. This complex problem requires a many-sided solution that affects patients' behaviour, health workers' approach and changes in how the health service is organised. OBJECTIVES: The Chronic Diseases Care Model aims to empower the patient to manage his/her own disease and to encourage doctors to take a proactive approach. PROGRAMME: The model proposed has six interlinked components, focusing on the patient. A personalized care plan, based on the scientific data, is worked out. All patients are followed up, including those not attending for consultations. The model possesses a specific tool for exploring possibilities of improvement and incorporates the P-D-C-A cycles in order to make changes in activities. DISCUSSION: The Health Service's emphasis on resolving acute problems is the biggest barrier to the Model's introduction. Selection of those patients who will most benefit and the visible support of system leaders are key elements for the Model's success.

Chronic Disease↗
PubMed2005

[Risk from prenatal exposure to ionizing radiation].

Exposure to ionizing radiation during pregnancy always is a worrisome event. Knowledge of teratogenic and carcinogenic mechanisms based on reliable scientific data (ICRP 84) allows appropriate management of patients following exposure to ionizing radiation. Radiation exposure in the setting of diagnostic imaging studies is not associated with an increased risk of fetal malformation; however, the risk of childhood malignancy is minimally increased. This information must be provided to parents so they may reach an informed decision with regards to the outcome of the pregnancy. The analysis of the quality and quantity of exposure should be limited to imaging examinations where the abdomen was exposed. Management will be based on the type of exposure. Guidelines are provided for various exposure situations and all radiologists must be able to manage such situations.

Female↗
PubMed1999

[Normal pressure hydrocephalus in an elderly patient].

INTRODUCTION: Idiopathic normal pressure hydrocephalus is a disease that most frequently concerns subjects of an advanced age. It is not easy to establish a definitive diagnosis, and the practitioner frequently encounters decision-making problems regarding the following question: should a shunt be performed, or not? Opinions remain contradictory, even though the available scientific data is increasingly precise. The aim of this review is to analyze the physiopathogenic, clinical, paraclinical and therapeutic data associated with this type of hydrocephalus. CURRENT KNOWLEDGE AND KEY POINTS: If the clinical triad is determinant, no other investigation is in fact necessary to confirm the diagnosis, although it should always be questioned in the case of ventricular enlargement determined by tomodensitometry. The decision to perform the only efficient procedure, i.e., a ventricular shunt operation, depends upon a number of established arguments in favor of that procedure. Clinical improvement, which is often spectacular, can then confirm the diagnosis. FUTURE PROSPECTS AND PROJECTS: The efficacy of surgical treatment has been confirmed by clinical studies, and there is a reduced tendency as regards post-operative complications. However, each case should be considered individually and with the cooperation of and coordination between the family, the physician and the neurosurgeon.

Aged↗
PubMed2001

[Risk factors and incidence of venous thromboembolic disease in internal medicine: prospective descriptive study on 947 hospitalized patients].

PURPOSE: The thromboembolic risk is difficult to evaluate in medical inpatients because of the multiplicity of risk factors. The lack of scientific data leads to a certain empiricism in selection of patients who need a preventive treatment. METHODS: All patients hospitalised in an internal medicine department were included during 34 months. The pathogenic mechanism of risk factors (venous stasis or hypercoagulability) was analysed as well as their progress (transient or permanent risk factors) and their pathogenic weight (major risk factor or not). Three levels of embolic risk (high, intermediate, low) were identified. A preventive treatment was initiated only for patients at high or intermediate risk. A clinical screening for thromboembolic events was performed daily. Therefore, we have excluded patients who needed a hypocoagulant treatment. RESULTS: Nine hundred and forty-seven patients were included. Age (over 60) was the most frequent permanent risk factor (70%). Bed rest was the most frequent transient risk factor responsible for venous stasis. Fifty percent of patients had a transient and permanent risk factor and needed a preventive treatment according to our selection criteria. The incidence of thromboembolic events was 0.4% in the high-risk treated group and 0.2% in the low-risk non-treated group. CONCLUSIONS: Venous stasis factors are the more frequent risk factor in internal medicine, perhaps because of the increasing number of geriatric patients. The incidence of thromboembolic disease is low in high-risk inpatients when a preventive treatment is performed.

Aged↗
PubMed2002

[Risk factors for venous thromboembolism in hospitalized patients in internal medicine: case-control study of 150 patients].

BACKGROUND: Risk factors for the thrombo-embolic disease are not yet completely validated in medical setting. Indeed, there is a lack of scientific data concerning their prevalence and their thrombogenic weight. METHODS: We carried out a prospective case-control study in an internal medicine unit where general acute pathologies are recruited. We have included two patients without thrombosis for each patient admitted for a thrombo-embolic event. In all patients, at admission, clinical and biological risk factors for thromboembolism were systematically analysed in a physiopathological and chronological way. RESULTS: 450 patients were included during the 27 months period of the study. Among these patients, 150 were hospitalised for a deep venous thrombosis of the leg or/and a pulmonary embolism. Height risk factors have demonstrated their high thrombogenic potential: paralysis of the legs (OR = 13; 95% CI: 1.4 to 5.1), post-thrombotic syndromes (OR = 13; CI: 1.7 to 4.3), extrinsic compressions (OR = 8; CI: 1.3 to 5.4), pregnancy (OR = 6; CI: 1.2 to 6), malignancy occurred one year before (OR = 4; CI: 1.1 to 6.7), personal history of deep vein thrombosis (OR = 3; CI: 1.6 to 4.5), varicosity (OR = 2.5; CI: 1.2 to 6.1) and venous insufficiency (OR = 1.7; CI: 1 to 7.4). Four parameters, generally considered as risk factors, didn't prove here their pathogenic power: the age over 60, obesity (BMI > 27), bedrest and the presence of an on-going malignancy. CONCLUSIONS: Only risk factors with high thrombogenic power (as paralysis or extrinsic compression for example) could be identified by this kind of study performed in polypathological patients. In this particular population, usually recognised risk factors as age, obesity and bedrest are not determinant parameters for the thomboembolic risk evaluation.

Acute Disease↗
PubMed2000

Is there a causal link between hepatitis B vaccination and multiple sclerosis?

After the publication of case reports of hepatitis B vaccinees with onset or relapse of multiple sclerosis (MS), followed by a media-driven scare campaign in France, the perception that hepatitis B vaccine causes MS has developed. This has led to a fall in the acceptance of hepatitis B vaccination particularly in French-speaking communities which was accelerated by court decisions in favour of vaccination "victims" and the suspension of routine vaccination of pre-adolescents in French schools as a "precautionary measure". This situation has arisen in spite of the absence of scientific data to support a causal link between vaccination and multiple sclerosis. In this article, initially written to inform and reassure employees of one of the vaccine manufacturers, the epidemiological importance of hepatitis B and current knowledge on the aetiology of MS are described. All available data that may throw light on the hypothesis that hepatitis B vaccination is causally linked to MS was reviewed. The conclusion reached on the basis of available data is that the most plausible explanation for the observed temporal association between vaccination and MS is that it is a coincidental association. It is now important to rebuild public confidence in hepatitis B vaccine as well as in vaccination in general.

Adolescent↗
PubMed1990

Crystalline silica and lung cancer: a review of recent experimental evidence.

The International Agency for Research in Cancer (IARC) has recently stated that crystalline silica should be regarded as a potential carcinogen. The IARC bases this statement on a finding that there is limited evidence of carcinogenicity in humans and sufficient evidence for carcinogenicity in animals. Recent laboratory animal experiments demonstrating a carcinogenic response to silica exposure have intensified scientific and regulatory concern for crystalline silica as a respiratory carcinogen. Studies of human populations have been contradictory in demonstrating a causal relationship between crystalline silica exposure and lung cancer. This paper reviews recent experimental evidence and attempts to identify the gaps and inconsistencies in our understanding of the relationship between exposure to crystalline silica and the two diseases of concern: silicosis and pulmonary neoplasia. Given our current level of understanding and the need for more scientific data it seems premature to initiate changes in exposure regulations at this time.

Animals↗