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PubMedDate not supplied

Moderate disaccharide malabsorption does not affect weight gain and cecal cell proliferation in piglets.

BACKGROUND: Intestinal malabsorption of disaccharides or oligosaccharides occurs normally in preterm infants, the majority of the world's adult population when ingesting dairy products, and in sick patients with abnormal intestinal motility or intestinal damage. Although there may be benefit to colonic fermentation, there also could be mucosal damage from excessive fermentation. Moreover, excess fluid in the colon also may impair fermentation. There are few data that address the effects of moderate amounts of carbohydrate, such as 50% of intake, reaching the colon. We addressed the hypothesis that normal weight gain and stool characteristics would occur during disaccharide malabsorption approximating 50% of intake. METHODS: Twelve piglets (aged 17 days) were randomized to receive control sow milk replacement formula (CON; lactose 60 g/L) or CON modified so that lactulose replaced 50% of the lactose (LAC). During a 5- to 7-day period, weight gain and fecal characteristics were observed before autopsy for cecal histology and determination of cecal cell proliferation using bromodeoxyuridine. RESULTS: Neither group developed diarrhea. In LAC and CON, formula intakes (g/kg/d) were similar (279 +/- 30 and 280 +/- 35), as were the ratios of weight gain:formula intake (g/mL): 0.23 +/- 0.04 and 0.22 +/- 0.04. Mean cecal cell proliferation was not diminished in the group receiving lactulose (p > .05). CONCLUSION: These data suggest that moderate (50%) disaccharide malabsorption per se does not cause diarrhea and does not impair dietary energy use or colonic cell proliferation.

Animals↗
PubMed2004

An evaluation of collaborative interventions to improve chronic illness care. Framework and study design.

The author's dual-purpose evaluation assesses the effectiveness of formal collaboratives in stimulating organizational changes to improve chronic illness care (the chronic care model or CCM). Intervention and comparison sites are compared before and after introduction of the CCM. Multiple data sources are used to measure the degree of implementation, patient-level processes and outcomes, and organizational and team factors associated with success. Despite challenges in timely recruitment of sites and patients, data collection on 37 participating organizations, 22 control sites, and more than 4,000 patients with diabetes, congestive heart failure, asthma, or depression is nearing completion. When analyzed, these data will shed new light on the effectiveness of collaborative improvement methods and the CCM.

Chronic Disease↗
PubMedDate not supplied

Trials on trial.

Explore the source record for details and available documents.

Centers for Disease Control and Prevention, U.S.↗
PubMed1990

[Dementia in the elderly. A 3-year project].

In order to meet the need of proper examination and treatment of memory problems in the elderly a specialized unit of psychogeriatrics has been established as a pilot project. In the period from September 1986 to April 1988, 146 persons were examined, 42% as outpatients and 58% as inpatients. The average age was 75.3 years. 54% had dementia senilis and 16% other sorts of dementia. 30% were not demented: 14% had a psychiatric illness, 8% organic damage or illness of the brain and 7% were confused. Overdose or wrong use of psychopharmacological drugs was a frequent problem, and cutting out the medication, regulating the dose, or changing to another medicine had surprising consequences. The further treatment was planned in cooperation with the patient's family and the community health service. A follow-up after nine months indicated that this was a positive procedure for the patients, and that the unit was a professional resource to the local health services in the whole district. The hospital has now been allocated funds from the Government to function as a competence centre for part of Eastern Norway.

Aged↗
PubMed1998

The refugee crisis in Africa and implications for health and disease: a political ecology approach.

Political violence in civil war and ethnic conflicts has generated millions of refugees across the African continent with unbelievable pictures of suffering and unnecessary death. Using a political ecology framework, this paper examines the geographies of exile and refugee movements and the associated implications for re-emerging and newly emerging infectious diseases in great detail. It examines how the political ecologic circumstances underlying the refugee crisis influences health services delivery and the problems of disease and health in refugee camps. It has four main themes, namely, an examination of the geography of the refugee crisis: the disruption of health services due to political ecologic forces that produce refugees; the breeding of disease in refugee camps due to the prevailing desperation and destitution; and the creation of an optimal environment for emergence and spread of disease due to the chaotic nature of war and violence that produces refugees. We argue in this paper that there is great potential of something more virulent than cholera and Ebola emerging and taking a big toll before being identified and controlled. We conclude by noting that once such a disease is out in the public rapid diffusion despite political boundaries is likely, a fact that has a direct bearing on global health. The extensive evidence presented in this paper of the overriding role of political factors in the refugee health problem calls for political reform and peace accords, engagement and empowerment of Pan-African organizations, foreign policy changes by Western governments and greater vigilance of non-governmental organizations (NGOs) in the allocation and distribution of relief aid.

Africa↗
PubMed2000

From the Hawaii Declaration to the Declaration of Madrid.

The Declaration of Hawaii, adopted by the World Psychiatric Association (WPA) in 1977, was a significant event. But the needs and new ethical dilemmas of the 1990s led WPA to develop new recommendations on the duties of psychiatrists resulting in the Declaration of Madrid, adopted by WPA in 1996. It outlines the framework of ethical conduct of psychiatrists, formulates seven general guidelines with an increased emphasis on research and resource allocation, and gives five specific guidelines on euthanasia, torture, the death penalty, selection of sex, and organ transplantation.

Capital Punishment↗
PubMedDate not supplied

Role of carotid endarterectomy in asymptomatic carotid stenosis. A Veterans Administration Cooperative Study.

A multi-centered cooperative study is being undertaken to determine the role of carotid endarterectomy in the treatment of asymptomatic carotid stenosis. The primary objective is to compare the incidence of transient ischemic attacks, stroke, and death in previously asymptomatic patients with arteriographically confirmed internal carotid stenoses (greater than or equal to 50%) randomly allocated to carotid endarterectomy and aspirin therapy versus aspirin therapy alone. Ten Veterans Administration Medical Centers (VAMC) in the United States are participating. The study will be conducted over a period of eight years. The first three years will be devoted to acquiring and randomizing patients, after which all patients will be followed clinically for a minimum of five years. It is anticipated that approximately 500 patients will be recruited into the study.

Arterial Occlusive Diseases↗
PubMed1992

A randomized study of the efficacy of postconsolidation therapy in adult acute nonlymphocytic leukemia: a report of the Italian Cooperative Group GIMEMA.

The Italian Co-operative Group GIMEMA conducted a randomized trial in adult acute nonlymphocytic leukemia (ANLL) to assess the role of postconsolidation treatment. Of 448 evaluable patients entered into the study, 305 (68%) achieved a complete remission after a standard induction with daunorubicin and cytosine arabinoside (3 + 7; 2 + 5). Those in remission after a consolidation therapy including 4 courses of daunorubicin, cytosine arabinoside, and 6-thioguanine (DAT) were allocated to one of three arms: no treatment, conventional maintenance, or intensive postconsolidation therapy. The median disease-free survival (DFS) was 13 months, and the median survival was 14 months, with 26% surviving at 6.5 years. There was no difference in survival and in disease-free survival among the three postconsolidation arms. In conclusion our study, as others, suggests that the critical period of ANLL treatment is within the first 5-6 months.

Adolescent↗
PubMed2000

Adjuvant active specific immunotherapy for stage II and III colon cancer with an autologous tumor cell vaccine: Eastern Cooperative Oncology Group Study E5283.

PURPOSE: A randomized phase III clinical trial of adjuvant active specific immunotherapy (ASI) with an autologous tumor cell-bacillus Calmette-Guérin (BCG) vaccine was conducted to determine whether surgical resection plus ASI was more beneficial than resection alone in stage II and III colon cancer patients. PATIENTS AND METHODS: Patients (n = 412) with colon cancer (297 with stage II disease, 115 with stage III disease) were randomly allocated to an observation arm or to a treatment arm in which they received three weekly intradermal vaccine injections of 10(7) irradiated autologous tumor cells beginning approximately 4 weeks after surgery. The first two weekly injections also contained 10(7) BCG organisms. Patients were observed for determination of time to recurrence and disease-free and overall survival. RESULTS: This was a negative study in that after a 7.6-year median follow-up period, there were no statistically significant differences in clinical outcomes between the treatment arms. However, there were disease-free survival (P =.078) and overall survival (P =.12) trends in favor of ASI when treatment compliance was evaluated, ie, patients who received the intended treatment had a delayed cutaneous hypersensitivity (DCH) response to the third vaccination (induration >/=5 mm). Also, the magnitude of the DCH response correlated with improved prognosis. The 5-year survival proportion was 84.6% for those with indurations greater than 10 mm, compared with 45.0% for those with indurations less than 5 mm. CONCLUSIONS: When all randomized patients were evaluated, no significant clinical benefit was seen with ASI in surgically resected colon cancer patients with stage II or III colon cancer. However, there was an indication that treatment compliance with effective immunization results in disease-free and overall survival benefits.

Adjuvants, Immunologic↗
PubMed1997

Prospective and randomized trial of lipiodol-transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma: a comparison of epirubicin and doxorubicin (second cooperative study). The Cooperative Study Group for Liver Cancer Treatment of Japan.

A randomized, controlled clinical trial was conducted to compare the use of epirubicin (EPI) and doxorubicin (DOX) in Lipiodol (Laboratoire Guerbet, Roissy-Charles-de-Gaulle Cedex, France)-transcatheter arterial chemoembolization as a treatment of hepatocellular carcinoma. One hundred ninety-two hospitals participated, and 415 patients were enrolled in the study during the period between October 1989 and December 1990. The patients were randomly allocated to group A (EPI) or group B (DOX) by a centralized telephone registration. The actual doses of EPI and DOX were 72 mg/body and 48 mg/body, respectively. The 1-, 2-, and 3-year survival rates were, respectively, 69%, 44%, and 33% for group A and 73%, 54%, and 37% for group B. There were no statistically significant differences (P = .2296, log-rank test). When each group of patients was classified retrospectively into high-risk and low-risk subgroups based on the severity index calculated by the Cox regression model from the significant prognostic factors (the pretreatment tumor size, the pretreatment serum alpha-fetoprotein level, tumor encroachment, and Child's classification), the survival curve of the low-risk DOX subgroup was significantly superior to that of the low-risk EPI subgroup (P = .0182). However, there was no significant difference between the high-risk subgroups (P = .4606). The change in the serum alpha-fetoprotein level, the extent of Lipiodol accumulation in the tumor, and the extent of tumor reduction after the treatment did not show any significant differences between the groups. The white blood cell count in group B showed a tendency to decrease slightly more than in group A at 3 weeks after Lipiodol-transcatheter arterial chemoembolization. In conclusion, there was no statistically significant difference between the survival curves of the EPI and DOX groups in Lipiodol-transcatheter arterial embolization treatment of hepatocellular carcinoma.

Adult↗
PubMed1988

Tyramine sulfate excretion may be a better predictor of antidepressant response than monoamine oxidase activity.

The tyramine sulfate excretion test was performed on 62 nonmelancholic depressed outpatients who then took part in a 6-week double-blind trial comparing imipramine, phenelzine, and placebo. In a double-blind design, nonresponders were switched to one of the active medications. Tyramine sulfate excretion failed to differentiate response from nonresponse to placebo. By contrast, phenelzine responders excreted significantly less tyramine sulfate than did phenelzine nonresponders, while there was a trend in the same direction for imipramine-treated patients. The presence of only eight phenelzine nonresponders dictates caution in interpreting these results. Baseline monoamine oxidase (MAO) activity did not distinguish responders from nonresponders or correlate with tyramine sulfate excretion. Although males had significantly lower MAO activity than females, controlling for sex did not alter these negative findings. These results fail to confirm a previous report of a significant correlation between MAO activity and treatment response in older, mainly melancholic patients.

Adult↗