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PubMed2004

Establishing the compliance in elderly women for use of a low level mechanical stress device in a clinical osteoporosis study.

Non-pharmacologic approaches to prevent bone loss are well suited for elderly patients to avoid polypharmacy and medication side effects. One potential treatment is a vibrating platform that delivers low-level mechanical loading stimulating bone remodeling. However, compliance is a major concern with any daily treatment, and is unknown for an elderly group using this device. Thus we assessed compliance with standing 10 min/day on a vibrating platform device in elderly women, the target population for osteoporosis therapy. We also assessed satisfaction with daily use of the device. We conducted a randomized, placebo-controlled, double-blinded 6-month study for daily use of a 10-min vibrating platform treatment in elderly women who were residents of a Continuing Care Retirement community. Compliance for each subject was calculated as the number of days attended divided by the 182 days in the 6-month trial. The 24 elderly women (mean age 86, range 79-92 years) had 83% compliance (95% CI: 70.5, 94.5) for daily treatment over 6 months. Excluding three study drop-outs, the 21 women had 93% compliance (95% CI: 89.8, 95.6), with no difference in compliance between active and placebo treatment. Main reasons for missing treatment days over the 6 months were vacation (54% of missed days) and illness (29%). Three adverse events occurred; one (syncope) was possibly related to device use, whereas the other two were not related to device use. Among participants, 95% reported overall satisfaction with daily use of the vibrating platform, and 57% preferred the platform versus daily oral medications for prevention of bone loss. Elderly women showed high compliance, high satisfaction and few adverse experiences with a daily non-pharmacological treatment designed to inhibit bone loss. Larger randomized controlled trials should evaluate the long-term efficacy of vibrating platform devices for treatment of low bone mass and osteoporosis in elderly individuals.

Aged↗
PubMed2003

Milk composition and growth in wild and captive Tasmanian bettongs, Bettongia gaimardi (Marsupialia).

Changes in milk composition (total solids, carbohydrate, protein, lipid and calculated gross energy content) during lactation in three groups of Tasmanian bettongs ( Bettongia gaimardi): free-living animals (wild group), captive animals offered a diet of dry dog food and apples ad libitum (ad lib group), and captive animals fed restricted amounts of the same diet (maintenance group) were related to growth rates (measured as body mass and head length) of their young. There were no significant differences in the concentration of milk solids among the three groups, but the wild group had higher lipid concentrations and the maintenance group had higher carbohydrate but lower protein concentrations. For all three groups, milk total solids increased through lactation from ca. 25% to ca. 45% and carbohydrate concentrations decreased from ca. 18% to about 3%. Protein concentrations increased from ca. 5% to ca. 10% in the wild and ad lib groups, but only from 4% to 8% in the maintenance group. Lipid concentrations increased in the wild and ad lib groups from ca. 4% to ca. 18%, but in the maintenance group only to ca. 7%. Calculated gross energy content of milk increased through lactation in the wild and ad lib groups (from ca. 500 kJ.100 ml(-1) to ca. 1,000 kJ.100 ml(-1)), but there was no significant increase in the maintenance group. The volume of milk produced increased to a peak just prior to permanent pouch vacation by the young, when the gross energy output in milk was 120-150 kJ.3 h(-1) in the wild and ad lib groups. On a daily basis this is equivalent to the milk energy output of larger wallabies, and helps to explain the relatively high growth rates of young Tasmanian bettongs. There were significant differences in growth rates among the groups, with the heaviest young always in the ad lib group. Thus differences in milk composition resulting from different planes of nutrition can lead to differences in growth rates of marsupial young.

Animal Nutritional Physiological Phenomena↗
PubMed1998

[Therapy of refractory chronic polyarthritis with tumor necrosis factor alpha receptor fusion protein (TNFR55-IgG1)--long term follow-up of 80 personal cases].

AIM OF THE STUDY: To investigate the long-term effect of TNFR55-IgG1 in patients with severe rheumatoid arthritis refractory to multiple previous DMARD treatments. METHODS: Between 1994 and 1995 we recruited 80 patients for two double blind, placebo-controlled multicenter trials. All patients were treated for 2-30 months with a glycosylated fused protein consisting of two human p55 TNF receptors linked to a human IgG1-Fc. The dose range was 2.5-100 mg/month given i.v. with cumulative doses from 40-940 mg. All patients were followed-up prospectively for 24-36 months after initiation of therapy. The evaluations included a 48 swollen and tender joint count, ESR. CRP, RF, ANA, ENA, and safety parameters at 6 month intervals. In addition, pharmacokinetics, TNF, and anti-TNFR55-IgG1 antibody levels were available after the first and third injection. RESULTS: Data from 80 patients are available representing an experience of more than 170 patient years; 11 patients are still being treated. Predominant reasons for treatment withdrawal were restrictions in treatment protocol. Six patients died (1 during treatment, 5 in the post-treatment follow-up). All deaths were related to preexisting cardiovascular disease except one post-surgery septic arthritis 6 months after the last dosing (during vacation in another country). No malignancies were detected. Anti-TNFR55-IgG1 antibodies correlated with a decrease in drug half-time. Shifts in the TNFR55-IgG1 glycosylation pattern affected pharmacokinetics and efficacy. A lupus nephritis occurred 18 months after the last dosing in one patient with erosive RA (ANA and dsDNS positive already before TNFR55-IgG1 initiation). Continued treatment for 3 years in 11 patients resulted in an 81% reduction in swollen joint count, less morning stiffness, less pain, and a reduction in steroids. CONCLUSION: Treatment with TNFR55-IgG1 is safe and efficacious over the long-term in patients with severe refractory RA.

Adult↗
PubMed2004

Seasonality of alcohol-related phenomena in Estonia.

We studied alcohol consumption and its consequences as a seasonal phenomenon in Estonia and analysed the social and environmental factors that may cause its seasonal rhythm. There are two important questions when researching the seasonality of human activities: (1) whether it is caused by natural or social factors, and (2) whether the impact of the factors is direct or indirect. Often the seasonality of social phenomena is caused by social factors, but the triggering mechanisms are related to environmental factors like temperature, precipitation, and radiation via the circannual calendar. The indicators of alcohol consumption in the current paper are grouped as: (1) pre-consumption phenomena, i.e. production, tax and excise, sales (beer, wine and vodka are analysed separately), and (2) post-consumption phenomena, i.e. alcohol-related crime and traffic accidents and the number of people detained in lockups and admitted to alcohol treatment clinics. In addition, seasonal variability in the amount of alcohol advertising has been studied, and a survey has been carried out among 87 students of Tartu University. The analysis shows that different phenomena related to alcohol have a clear seasonal rhythm in Estonia. The peak period of phenomena related to beer is in the summer, from June to August and the low point is during the first months of the year. Beer consumption correlates well with air temperature. The consumption of vodka increases sharply at the end of the year and in June; the production of vodka does not have a significant correlation with negative temperatures. The consumption of wine increases during summer and in December. The consequences of alcohol consumption, expressed as the rate of traffic accidents or the frequency of medical treatment, also show seasonal variability. Seasonal variability of alcohol consumption in Estonia is influenced by natural factors (temperature, humidity, etc.) and by social factors (celebrations, vacations, etc.). However, distinguishing between impacts of direct and indirect relationships is complicated, as they are interlinked.

Accidents, Traffic↗
PubMed2005

Adding problem-based learning tutorials to a traditional lecture-based curriculum: a pilot study in a dental school.

This article reports on the implementation of a problem-based learning (PBL) tutorial in our advanced program for second year students within an existing curriculum. The program was opened on the last 5 days of the summer vacation and students could volunteer to be part of the group. Students separated themselves into small groups by random sampling. The PBL tutorials were done during the first 3 days for medical problems according to our original scenarios (based on medical cases), and during the last 2 days, students made presentations of their learning outcomes, using information technology (IT) by themselves. Throughout this program, students were expected to engage in self-learning, except for a 1(1/2)-h group session with a tutor. Assessment was done by attendance at a group session and by portfolio analysis. Following the portfolio analysis, students identified the number of learning issues (group A, 26 +/- 7 issues; group B, 20 +/- 3 issues; group C, 21 +/- 7 issues). Research, by questionnaire, revealed that 84% of the students were strongly interested in each scenario and 95% of the students felt familiar with each scenario. The levels of satisfaction with the tutor were different in the three groups. All of the students were comfortable in the discussion room and IT center. These results suggested that PBL tutorials are supported by the scenario, the tutor, and the location of the group session, as well as by self-learning. Moreover, one of the most important factors for a PBL tutorial that the student is ready for the free discussions and has enough time for individual self-learning.

Computer-Assisted Instruction↗
PubMed2004

[Empowerment, quality of life and participation in neurological rehabilitation. Empirical study with stroke patients and their relatives].

The active role (participation) that patients with chronic conditions are able to achieve has increasingly been recognised as a measure for the effectiveness of prevention- and rehabilitation strategies. An empowerment scale is an especially effective instrument for measuring social participation, and was applied to stroke patients in neurological rehabilitation for the first time. 26 stroke survivors and 26 informal carers, who participated in self-help groups in Lower Austria, were surveyed. The mean age was 63.9 (+/- 10.4) (stroke survivors) and 61.9 (+/- 9.6) years (informal carers). The mean duration of disease was 7.3 (+/- 3.2) years and the mean length of self-help group participation approximately 4 years. Every other stroke survivor and every fifth informal carer had to give up their professional life because of the stroke. Financial burden, reduction of vacations and social activities was found for both groups. Informal carers more frequently reported an increased fear of a relapse and generally of the future. One third of the stroke survivors had insomnia, depression, and nervousness. Reduced mobility, memory impairment, and increased sensitivity to temperature-changes were seen as the largest burdens. In spite of the large overlap in many domains of empowerment- and quality-of-life measures, empowerment measures also seem to reflect aspects of social participation. Therefore, measures of empowerment should be included in long-term outcome measurements following stroke.

Activities of Daily Living↗
PubMed2005

Sexual risk behavior of men who have sex with men: comparison of behavior at home and at a gay resort.

This study compared sexual behavior of gay and bisexual men (N = 551) while at their primary residence to their behavior while vacationing at a gay resort community. Participants reported behavior for the days they spent in the resort and for their last 60 days in their home residences. Overall, 11 times more non-main partners were reported for unprotected anal intercourse (UAI) per day while in the resort as for the "at home" period. Regression analysis identified negative attitudes toward condoms, less concern about AIDS, and daily number of non-main, male partners at home with whom UAI occurred as significant predictors of the daily number of non-main male partners with whom holidaymakers engaged in UAI while in the resort area. The results suggest that sexual risk taking by men who have sex with men (MSM) while on holiday may be elevated over that at home and that prevention efforts need to be promoted in gay resorts. Behavioral surveillance research would be helpful in better characterizing the current social contexts of sexual risk taking by MSM. Theory-based studies of the nature of risk-taking and sexual decision-making on "gay holiday" could inform the development of empirically proven and conceptually grounded interventions.

Adult↗
PubMed2007

Ambient UV, personal sun exposure and risk of multiple primary melanomas.

OBJECTIVE: Sun exposure is the main cause of melanoma in populations of European origin. No previous study has examined the effect of sun exposure on risk of multiple primary melanomas compared with people who have one melanoma. METHODS: We identified and enrolled 2,023 people with a first primary melanoma (controls) and 1,125 with multiple primary melanomas (cases) in seven centers in four countries, recorded their residential history to assign ambient UV and interviewed them about their sun exposure. RESULTS: Risk of multiple primary melanomas increased significantly (P<0.05) to OR=2.10 for the highest exposure quarter of ambient UV irradiance at birth and 10 years of age, to OR=1.38 for lifetime recreational sun exposure, to OR=1.85 for beach and waterside activities, to OR=1.57 for vacations in a sunnier climate, to OR=1.50 for sunburns. Occupational sun exposure did not increase risk (OR=1.03 for highest exposure). Recreational exposure at any age increased risk and appeared to add to risk from ambient UV in early life. CONCLUSIONS: People who have had a melanoma can expect to reduce their risk of a further melanoma by reducing recreational sun exposure whatever their age. The same is probably true for a person who has never had a melanoma.

Adolescent↗
PubMed2006

Science or practice? UK undergraduate experiences and attitudes to the MPharm degree.

OBJECTIVE: The debate surrounding the science/practice balance in the teaching of undergraduate pharmacy has been played out in the professional literature for years. The objective of this work was to explore the attitudes of pharmacy undergraduates on the practice-science debate. SETTING: The study was undertaken as part of a national study of teaching, learning and assessment methods in United Kingdom (UK) schools of pharmacy. METHOD: Six focus groups were carried out. The sample was 44 volunteer students from nine UK schools of pharmacy, representing all 4 years of the MPharm programme. Groups were tape recorded and transcribed. Analysis of the transcripts was theme based by topic. MAIN OUTCOME MEASURE: Qualitative data on student attitudes and experiences. RESULTS: Most students thought that there was too strong an emphasis placed on the science components of the course in the early part of their studies. Later in the course they realised that the majority of the science was necessary; it just had not been apparent to them at the time. There were strongly held attitudes across all 4 years that it would be beneficial to include more practice-related material at the beginning of their studies. This would be beneficial for three reasons: to make the course more interesting, to aid in the contextualisation of the science component and to assist the students in any early placement or vacational work. CONCLUSION: Internationally, changes to the role of the pharmacist from a traditional supply function to a more clinical role has resulted in differing educational needs for the pharmacist of the future. Pharmacy will remain a degree built on a strong scientific background, but students advise that the contextualisation and sequencing of material within the degree could make a considerable improvement to their learning. Consulting students helps us to understand the teaching, learning and assessment experience better by giving insights into ways of improving the delivery. In the case of the UK, there are legislative changes impending which may provide an opportunity to review the balance of practice-and science in the curriculum.

Attitude↗
PubMed2006

Social participation and employment status after kidney transplantation: a systematic review.

OBJECTIVE: To summarize and assess literature regarding social participation of recipients after successful kidney transplantation. METHODS: A systematic review including a literature search in Medline (1980-2003) and five other databases, and assessment of methodological quality of selected studies by two reviewers applying a checklist of twelve criteria. RESULTS: Seventeen studies out of 1443 identified references were selected. Quality scores for internal validity ranged from 0% to 50% (median 20%). Employment was the most used indicator of social participation and two studies briefly reported on vacation and recreation. Employment rate ranged from 18% to 82%, however differences in defining categories of employment or lack of description were present. Study populations were heterogeneous with regard to demographic and clinical characteristics. Three studies identified pre-transplant employment status as predictor of post-transplant employment. Other potential risk factors were not consistent across studies. CONCLUSION: Measurement of social participation focuses mainly on employment status. Quality assessment revealed shortcomings in reporting and validity of studies, whereby valid conclusions regarding the degree of social participation after kidney transplantation cannot be drawn. Future research should supplement the focus on employment status by examining other aspects of social participation as well as potential risk factors.

Employment↗
PubMed2006

Norovirus gastroenteritis.

Recent epidemiologic studies have shown that norovirus is one of the most frequent causes of acute nonbacterial gastroenteritis. Reverse-transcription polymerase chain reaction and nucleotide sequencing are the means by which the hundreds of norovirus strains have been identified, named, and classified into genogroups and genetic clusters. They are also the means by which a particular strain is traced from the source of an outbreak throughout its spread. These molecular techniques have been combined with classic epidemiology to investigate norovirus outbreaks in diverse settings, including hospitals, nursing homes, dining locations, schools, daycare centers, and vacation venues. Outbreaks are difficult to control because of the apparent ease of transmission through food, water, person-to-person contact, and environmental surfaces. Almost all patients with norovirus gastroenteritis recover completely, but hospital and nursing home outbreaks have been associated with morbidity and mortality. The diagnostic and management approach to an individual patient is to use clinical and epidemiologic findings to rule out "not norovirus." At the first sign that there is an outbreak, strict compliance with cleaning, disinfection, and work release guidelines is important to prevent further spread.

Caliciviridae Infections↗
PubMed2006

Skin and soft tissue infections and envenomations acquired at the beach.

Millions of people spend vacation and leisure time on the shores of the lakes and oceans of North America. Many others are employed in water-related industries. In doing so, they potentially expose themselves to infections and envenomations that other people do not even consider when making their plans for leisure time activities or in going to work each day. This article reviews some common and uncommon beach-related infections and envenomations that can affect the skin and soft tissues of people frequenting the shores and beaches of North America. Physicians are thereby provided with a guide to such skin and soft tissue injuries and infections and will be better able to recognize and treat these maladies associated with recreational and occupational activities.

Journal Article↗
PubMed1994

The disposition of antiparasitic drugs in relation to the development of resistance by parasites of livestock.

The kinetic and dynamic disposition of endo- and ectoparasiticides in livestock in relation to development of resistance is examined. Based on the modes of action of antiparasitic drugs, maximum activity necessitates that the parasite be exposed to 'toxic' concentrations for as great a duration as possible. In contrast, exposure to non-lethal discriminating drug concentrations has a significant potential to promote the development of resistance. Orally administered anthelmintics quickly associate with particulate digesta in the rumen; their subsequent desorption from particulate matter as it vacates the rumen maintains the duration of metabolite availability. The flow rate of digesta increases with feed intake and the presence of gastrointestinal parasites, and together with other parasite-induced physiological changes to the gut, contributes to reduced duration of drug availability. The potential for orally administered drugs to bypass the rumen, due to closure of the oesophageal groove, exacerbates the effect. Once absorbed, the metabolite concentration with time profile progressively decreases, the rate depending upon the chemical nature of the drug and the type and condition of the host into which it was administered. The greater hepatic activity of goats speeds drug elimination, the lower dose equivalent availability increases the potential for generation of drug resistance in parasites of goats as compared to sheep. Parasites whose resistance is generated in goats may be then transferred to sheep. Similar distribution/elimination kinetics apply to topically administered insecticides of sheep. The progressively reducing concentrations expose ectoparasites to discriminating drug levels, again contributing to the development of resistance. It is anticipated that a greater understanding of the physiological/pharmacological effects which are described in this review will permit the more efficient use of existing and future antiparasitic drugs.

Administration, Oral↗
PubMed1984

Parathyroid hyperplasia and carcinoma within one gland.

A 47-year-old Scottish woman vacationing in the United States presented with a serum calcium level greater than 20 mg/dl and a parathyroid hormone level 16 times greater than normal after a one-week history of severe vomiting and unrelenting abdominal pain. Surgical exploration of the thymus revealed the very rare association of a large (7 by 4 by 0.8 cm) parathyroid carcinoma adjacent to apparently normal parathyroid tissue, separated by a thin fibrous band. Two other hyperplastic and one normal parathyroid glands were also identified. Postoperatively, the patient became hypocalcemic and, for the past nine months, has received maintenance 1-alpha-hydroxycholecalciferol therapy (1 microgram per day) with normal calcium and barely detectable parathyroid hormone levels.

Carcinoma↗
PubMed1993

Practice activities and career satisfaction among fellows of the South Atlantic Association of Obstetricians and Gynecologists.

OBJECTIVE: The practice activities and career satisfaction of obstetricians and gynecologists in private practice were compared with those in a teaching faculty setting. STUDY DESIGN: The 475 fellows of the South Atlantic Association of Obstetricians and Gynecologists were surveyed; 314 responses (66.1%) were received. Private practice and teaching faculty respondents were compared regarding practice description, factors influencing choice of practice type, practice activities, and career satisfaction. Data were examined by chi 2 testing and analysis of variance. RESULTS: Patient care involvement was the primary influence in practice choice by 86.0% of private practitioners; interest in teaching was the most important single factor for 58.2% of the teaching faculty. Significantly more teaching faculty than private practitioners had done research work during residency (81.2% vs 53.4%, p < 0.001). There were no differences regarding presentations at medical meetings during residency or publications from work performed during residency. The private practice group recorded more nights on call and more scheduled time off. The teaching faculty showed more publications, continuing medical education credits, hours worked per week, and medical meeting attendance. There were no differences in vacation days, malpractice charges, or expert witness appearances. The group showed no significant differences in their ratings of career satisfaction, but more of the teaching faculty group would elect again to enter obstetrics and gynecology if completing school today (82.4% vs 55.3%, p < 0.001). CONCLUSION: Professional activities of private practice physicians differ from those of teaching faculty physicians. The great majority of both groups are satisfied with their careers.

Adult↗
PubMed1991

Adenosine-5'-phosphosulfate kinase from Penicillium chrysogenum: ligand binding properties and the mechanism of substrate inhibition.

[35S]Adenosine-5'-phosphosulfate (APS) binding to Penicillium chrysogenum APS kinase was measured by centrifugal ultrafiltration. APS did not bind to the free enzyme with a measurable affinity even at low ionic strength where substrate inhibition by APS is quite marked. However, APS bound with an apparent Kd of 0.54 microM in the presence of 5 mM MgADP. In the presence of 0.1 M (NH4)2SO4, Kd,app was increased to 2.1 +/- 0.7 microM. Bound [35S]APS was displaced by low concentrations of 3'-phosphoadenosine-5'-phosphosulfate (PAPS), or iso-(2') PAPS, or (less efficiently) by adenosine-3,5'-diphosphate (PAP) or adenosine-5'-monosulfate (AMS). The results support our conclusion that substrate inhibition of the fungal enzyme by APS results from the formation of a dead end E. MgADP.APS complex. That is, APS binds to the subsite vacated by PAPS in the compulsory (or predominately) ordered product release sequence (PAPS before MgADP). Radioligand displacement was used to verify the Kd for APS dissociation from E.MgADP.APS and to determine the Kd values for the dissociation of iso-PAPS (13 +/- 5 microM), PAP (4.8 mM), or AMS (5.2 mM) from their respective ternary enzyme.MgADP.ligand complexes. Incubation of the fungal enzyme with [gamma-32P]MgATP did not yield a phosphoenzyme that survives gel filtration or gel electrophoresis.

Adenosine Diphosphate↗
PubMed1994

Studies of a neurochemical link between depression, anxiety, and stress from [3H]imipramine and [3H]paroxetine binding on human platelets.

We measured platelet [3H]imipramine and [3H]paroxetine binding in patients with major depression (n = 11), dysthymia (n = 9), generalized anxiety (n = 18) and panic disorder (n = 10), and in healthy controls (n = 13). The [3H]imipramine binding capacity (Bmax) was lower in all patient groups; [3H]paroxetine binding was reduced in anxiety disorders, however, decreases in depression and dysthymia were not significant. There were no differences in the affinity constant (Kd) for either radioligand. We also examined the effects of examination stress on platelet binding in medical students. Compared to after vacation, when binding was similar to controls, [3H]imipramine (n = 19) and [3H]paroxetine (n = 14) Bmax values were significantly decreased during examinations and similar to patient values. Examinations were also associated with an increase in plasma cortisol levels. These findings suggest that there is a neurochemical link between depression, anxiety, and stress, and that disturbances in neurochemical functioning may be associated with specific symptomatology, independent of psychiatric diagnosis.

Adult↗
PubMed1979

The regression of synapses formed by a foreign nerve in a mature axolotl striated muscle.

A study has been made of the factors which determine that the terminals of a foreign flexor nerve at synaptic sites in a unrodele extensor muscle regress on return of the original extensor nerve. The quantal content (m) of the endplate potential (EPP) at flexor nerve terminal synapses, during innervation of a previously denervated extensor muscle, increased in about 8 weeks to reach the same size as at normal extensor nerve terminals; the same time was taken for m to reach normal size at extensor nerve terminals when these reinnervated their own muscle. At flexor nerve terminals, m decreased eventually to zero if the extensor nerve terminals returned within about 6 weeks of synapse formation by the flexor nerve terminals to the same or an immediately adjacent synaptic site to that occupied by these terminals. During this decrease in m at flexor nerve terminals, stimulation of the flexor nerves in the presence of horseradish peroxidase (HRP) showed HRP-labelled flexor nerve terminals present only in those regions of the extensor muscle in which the electrical signs of flexor nerve terminals were observed, indicating that the decrease in m at regressing flexor terminals was accompanied by their vacating synaptic sites. However, flexor nerve terminals failed to regress from the extensor muscle on return of the original nerve supply if the flexor nerve allowed to form synapses for more than about 10 weeks before the return of the extensor nerve.

Ambystoma↗