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PubMedDate not supplied

Medical supplies for travelers to developing countries.

BACKGROUND: There has been little research to date on the use of medicines and first aid supplies by travelers. In some developing countries such products may be difficult to obtain, and there is the danger that substandard medicines may be purchased. As space for medical supplies in the luggage of many individuals, particularly backpackers, may be restricted, it is important to identify correctly those items most likely to be needed. OBJECTIVES: The aim of this study was to survey a cohort of travelers from the UK visiting a variety of destinations in developing countries, regarding the medical supplies taken and used during their trip. METHOD: Travelers visiting a specialist travel pharmacy in London, UK were recruited consecutively into the study. Only those planning to visit destinations in South America, Asia, Africa or the Middle East for < or = 2 weeks and returning to the UK were included. Participants were handed a questionnaire to be posted back when they returned to the UK, asking them to note those items that they included in the kit, those actually used, and any others obtained while they were away. All subjects had consulted the pharmacist concerning the medical kit appropriate for their trip. RESULTS: Two hundred and ninety-nine travelers volunteered to take part, of whom 127 returned the postal questionnaire. Analgesics and medication for the treatment of diarrhea were most likely to be used, but many types of wound dressing were unlikely to be required. Twenty individuals (16%) required antibiotics, with eight people purchasing them while they were away. Thirty-two (31%) individuals did not use insect repellents despite traveling to potentially malaria-endemic countries. Only seven subjects purchased any other items while they were away. CONCLUSION: The items most likely to be required by travelers to developing countries are analgesics, treatments for diarrhea, antiseptics and sticking plasters. The provision of antibiotics to certain travelers is probably justified.

Adolescent↗
PubMed2000

Lost letter returns on five topics from urban waterfront, and smaller rural communities.

Of 850 letters "lost" in Florida, 339 (39.9%) were returned in the mail and indicated across 5 addressees, 2 sizes of community, and 2 destinations, community size and addressees' affiliations were associated with returned responses, but not destinations. These findings seem to indicate that there was no bias in the willingness of people to help some strangers with a mailing address in another Florida county. The similarities of our findings with other measures of public response were discussed.

Helping Behavior↗
PubMed1991

Classification of the abdominal splanchnic nerves--a preliminary attempt to re-evaluate their nomenclatures.

The abdominal splanchnic nerves were observed in 22 cadavers (41 sides). The purpose of the study is to give more accurate definition to each nerve, for there are uncertainties in the nomenclature of these nerves. According to PNA, the abdominal splanchnic nerves are classified into three categories, on the basis of their sizes and their levels, namely Nn. splanchnici major, minor, and imus. Although Mitchell (1935) had already claimed that more attention should be given to the levels of ganglia which gave rise to these nerves, no revision has ever been made. Moreover, there still remains the matter of their destinations, which are more significant in defining them. Therefore, in addition to the conventional criteria for the classification, destinations of the nerves were taken into consideration. In the present study, 36 out of 41 sides were grouped into four types according to the said criteria. 5 exceptional cases were interpreted as results of minor modifications of these four types. Naturally, what is important in describing these nerves is to give clear idea about the actual condition of them. It is expected to give more reasonable nomenclature to these nerves based on the present result.

Abdomen↗
PubMed1985

Epidemiological aspects of acute viral hepatitis A in Swedish travellers to endemic areas.

A decreased incidence of hepatitis A (HA) in Swedish travellers to the northern part of the Mediterranean area was observed after 1972, from 1/3 000 travellers who did not receive gammaglobulin in the period 1970-72 to 1/14 200 travellers between 1979 and 1981 and 1/20 000 travellers in 1982. No such decrease in incidence was observed in travellers going to the southern part of the Mediterranean area. Differences in the incidences of HA in travellers to individual countries in southern Europe were also noticed. The risk of Swedish travellers to remote destinations, such as tropical Africa and Asia, contracting HA is still very high, being 1/150-100 travellers not receiving gammaglobulin. It was observed that years with high incidences of HA in travellers to certain destinations also saw increased incidences of HA in Sweden.

Adolescent↗
PubMed1999

Expression of the elastin promoter in novel tissue sites in transgenic mouse embryos.

We have previously shown in a transgenic mouse line, in which 5.2 kb of the elastin promoter was linked to the reporter enzyme chloramphenicol acetyltransferase (CAT), that the highest levels of expression were found in embryonic lungs and aorta, while lower levels were detected in other elastin-containing tissues. Furthermore, in general, expression of the transgene showed developmental regulation similar to that of the endogenous gene. However, the precise location of cellular expression could not be determined in this model. To overcome this limitation, we have developed a similar model, but replaced CAT with the reporter enzyme beta-galactosidase. Enzyme activity was readily detected in the transgenic mouse embryos in expected regions of tissue forming elastic fibers, including the dermis and elastic cartilage. Of considerable interest, however, was the novel finding of expression in specific areas of neuroepithelium of the brain and in the perichondrium surrounding areas destined to form hyaline cartilage in endochondral bone formation. These latter areas included all the bones of the limbs, the spine and rib cage. It appeared that these segments of elastin expression demarcated the border between the developing cartilage and the surrounding mesenchymal tissue. Elastin promoter expression was also found in developing somites, in the mesenchymal layer of the forming cornea of the eye, in the genital tubercle and in the epithelium destined to form the olfactory epithelium. These findings indicate that the elastin promoter is activated during embryonic development in a variety of tissues, suggesting that elastin gene expression may play a role in organizing cutaneous, skeletal and neural structures.

Animals↗
PubMed1994

High juvenile body weight and low insulin levels as markers preceding early diabetes in the BB rat.

Diabetes incidence in BB rats is 60-80% and our aim was to investigate whether it is possible to characterize those rats destined to develop diabetes. While the genetic background as well as the environmental factors affecting BB-rat littermates are very similar, body weight reflects some existing variance. The study involved 151 BB rats, and the body weight of each animal was measured daily from birth. Thirty-four animals became diabetic before 100 days of age, and their body weight showed a 5-10% increase compared to the non-diabetic animals for each day of life from day 1 to day 45 (p values 0.0001 to 0.05). This increased body weight in individuals destined for diabetes was seen in both sexes. When investigating whether juvenile body weight has any predictive value, we found that the incidence of diabetes at 100 days of age increased from 22.5% to 46.7% (p < 0.01) when the heaviest animals in each litter were selected. Insulin content in pancreas was examined at day 10 and 20, and was found to be significantly reduced in the BB rats with highest body weight compared with rest of the litter (p = 0.02 and p = 0.0005, respectively). The insulin concentration in peripheral blood was significantly reduced in the BB rats with highest body weight at 20 days of age (p = 0.002). When early and late diabetic BB rats were compared at time of diagnosis regarding blood glucose, degree of insulitis and number of small and large islets, no significant differences were found between the groups.

Age of Onset↗
PubMed1996

The role of follicle-stimulating hormone in the selection of follicles in human ovaries: a survey of the literature and a proposed model.

A review of the literature resulted in a model consisting of three follicle-stimulating hormone (FSH)-related mechanisms of follicle selection in the human ovarian cycle. The FSH-dependent selection of dominant follicles is the result of varying FSH serum levels on the one hand, and a varying follicular sensitivity to FSH on the other hand. The first FSH-related mechanism of follicle selection is the intercycle rise of FSH which induces the ongoing development of a reasonable number of follicles during the early follicular phase. The intercycle FSH level should surpass the FSH threshold of the follicles with the highest FSH sensitivity, but the FSH level should not be too high because many other less sensitive follicles might also be stimulated to develop. The second and third mechanisms act together during the mid- to late follicular phase. During the mid- and late follicular phases, the number of dominant follicles is reduced by the synergistic actions of a decreasing FSH level and the differentiation of the follicular sensitivity to FSH. Follicles destined to become dominant gain sensitivity to FSH, whereas follicles destined to become atretic lose their sensitivity to FSH. This differentiation of follicular sensitivity to FSH is the result of several endo-, para- and autocrine factors which modulate the effect of FSH on the growing follicle. The differentiation of follicular sensitivity to FSH supports the effect of the decreasing FSH level. Only the most sensitive follicle will become dominant. The other follicles will become atretic. The presented model may be of use not only for interpretation of the results of ovarian stimulation, but also to put the growing amount of data on growth factors and other substances which modulate the effects of FSH in the dynamic context of follicle selection.

Female↗
PubMed1992

A numerical prognostic index for clinical use in identification of poor-risk patients with Hodgkin's disease at diagnosis. The Scotland and Newcastle Lymphoma Group (SNLG) Therapy Working Party.

The aim of this study was to assess the feasibility of using objective data obtained at the time of diagnosis of Hodgkin's disease to predict those patients who were likely to die of progressive disease within four years. Ninety-two consecutive patients from one centre (Newcastle upon Tyne) were used to construct a numerical index based on disease stage (Ann Arbor), age, haemoglobin and absolute lymphocyte count. Weight was assigned according to a predictive value from univariate and multivariate analyses based on survival. The index produced was then validated on a separate patient set (455) from other centres within the Scotland and Newcastle Lymphoma Group (SNLG) on whom the same prospective information was available. The index produced provided a useful separation of those patients destined to die of disease. In 101 patients with index > 0.5, 62 (61.4%) were dead at four years, whereas with index < 0.5, 61 (18%) of 336 patients were dead at four years. The index includes Ann Arbor stage but possesses additional practical prognostic value which allows identification of patients with early stage destined to die of disease. Of 149 patients with Stage IA and IIA disease 15 patients had index > 0.5, and 10 (60%) have died, whereas the remaining patients had survival of 90% and 85% respectively. This numerical index has now been strengthened by an added factor for bulk disease > 10 cms and in the SNLG it has replaced Ann Arbor staging for selection of patients requiring aggressive therapy. A randomized study of chemotherapy versus chemotherapy plus autotransplant in first remission using high dose melphalan and VP16 is currently in progress.

Bone Marrow Transplantation↗
PubMed1983

The relationship between posture and plasma catecholamines in the pregnant woman.

The response of endogenous norepinephrine levels (NE) to changes in body posture, lateral to supine, was investigated in a prospective study of 46 primigravid patients during the last half of pregnancy. Blood samples were obtained in the lateral and supine positions. The mean supine NE levels were not significantly higher in those patients destined to develop pregnancy-induced hypertension (PIH) than in those who remained normotensive. The mean percent relative change of NE in the patients destined to develop PIH and in those who remained normotensive was not significantly different.

Blood Pressure Determination↗
PubMed1999

[Factors influencing clients' return home on discharge from geriatric intermediate care facilities in a metropolitan suburb].

The present study investigated factors influencing the destination following discharge from geriatric intermediate care facilities (GICF) located in a suburb of a metropolis. A set of questionnaires was prepared, and a survey was conducted involving 204 subjects (46 men, 158 women, average age 84 years) of three GICFs and their families. Seventy-two percent of clients were termed bedridden and 84% as having dementia. Furthermore, 63% of them were admitted to GICFs from hospitals, and about half used the GICFs more than twice. Most families cared for the subjects before admission into the GICFs, and were feeling the burden of daily care. The families desired them to stay in the GICFs for as long as possible. Forty-five percent of the families wanted the subject to go back home after discharge. About 30% of subjects returned home, 31% were admitted to a hospital and 40% were placed in GICFs. The following factors were related to discharge and return home: the family wanted the subject to return home, subjects admitted to GICFs from home could return home, good ability to walk, families consulted subjects about the destination following discharge, the cost of staying at the GICF was covered by the subjects' pension, and confirmed administration of drugs was not necessary. These findings suggest that in order for clients at GICFs to successfully return home, the facilities should consider where the family wants the clients to go.

Aged↗
PubMed2006

Invited review: Culling: nomenclature, definitions, and recommendations.

Replacing cows on a dairy is a major cost of operation. There is a need for the industry to adopt a more standardized approach to reporting the rate at which cows exit from the dairy, and to reporting the reasons why cows are replaced and their destination as they exit the dairy. Herd turnover rate is recommended as the preferred term for characterizing the cows exiting a dairy, in preference to herd replacement rate, culling rate, or percent exiting, all of which have served as synonyms. Herd turnover rate should be calculated as the number of cows that exit in a defined period divided by the animal time at risk for the population being characterized. The terms voluntary and involuntary culling suffer from problems of definition and their use should be discouraged. Destination should be recorded for all cows that exit the dairy and opportunities to record one or more reasons for exiting should be provided by management systems. Comparing reported reasons between dairies requires considerable caution because of differences in case definitions and recording methods. Relying upon culling records to monitor disease has been and will always be an ineffective management strategy. Dairies are encouraged to record and monitor disease events and reproductive performance and use this information as the basis for management efforts aimed at reducing the need to replace cows.

Abattoirs↗
PubMed2006

Stochastic simulation of live salmonid movement in England and Wales to predict potential spread of exotic pathogens.

The anthropogenic movement of live fish has been identified as the most important route for the transmission of disease between river catchments. To assist in contingency planning for exotic salmonid disease outbreaks, a stochastic model was developed to assess the potential geographic distribution of an introduced pathogen with time to first detection. The Live Fish Movement Database (a resource funded by the UK Department for Environment, Food and Rural Affairs [Defra] and managed by the Centre for Environment, Fisheries and Aquaculture Science [CEFAS] and the Environment Agency [EA]) was used to establish details of live fish movement in England and Wales. A contact network was created for farm to farm and farm to non-farm (fishery) movements of rainbow trout Oncorhynchus mykiss, brown trout Salmo trutta and Atlantic salmon Salmo salar, and probability functions were used to model the timing and destination of movements from farm sites, based on these trading activities. Monte Carlo simulations were run to track the progression of potential disease transmission from single index farm inputs through river catchments with time. Two hundred farms exported fish to 1653 destinations in 147 of the total 198 river catchments. The median number of catchments contacted after 3 and 12 mo were 3 and 6, respectively. In 5% of simulations 63 or more catchments were contacted, and in 1% of simulations 75 or more catchments were contacted after 12 mo. These results may be used to underpin the development of contingency plans for exotic disease outbreaks.

Animals↗
PubMed1997

Pediatric malaria in Houston, Texas.

We retrospectively reviewed the medical records of all infants and children (< 18 years of age) with the discharge diagnosis of malaria who were admitted to the four major pediatric teaching hospitals in Houston, Texas from January 1988 through December 1993. Thirty-four cases of pediatric malaria were identified in three newborns, 22 travelers, and nine recent immigrants. The travel destination was West Africa in 68%, Central America in 14%, India in 14%, and unknown in 4%. The location of the child's and parents' birthplace was available in 77% of the travel-related cases and in all cases the destination of travel was the parents' country of origin. The peak incident of the travel-related cases was late summer and early January corresponding to return from summer or Christmas vacation. Sixteen (75%) of the 22 travel-related cases had received either no prophylaxis (12 of 22) or inadequate (4 of 22) chemoprophylaxis. Half of the patients who were given appropriate chemoprophylaxis admitted to poor compliance. The clinical presentation was usually nonspecific. Fever was the most common symptom (97%) and was paroxysmal in one-third. Splenomegaly was the most common physical finding (68%). The malaria species identified included Plasmodium falciparum (56%), P. vivax (23%), P. malariae (3%), and unidentified (18%). Moderate anemia (hemoglobin level = 7.0-10 g/dL) occurred in 38% and severe anemia (hemoglobin level < 7.0 g/dL) in 29%. Three patients required transfusion. There were no end-organ complications. In summary, pediatric malaria in Houston was primarily seen in immigrants or children of immigrants who returned to their native country. Education and preventive strategies should target these families and should be part of the routine well child care of these children.

Adolescent↗
PubMed2000

Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries.

There is little information available regarding traveler's diarrhea that affects a large number of Americans who differ widely in age and travel destination, and little or no information exists on self-treatment. This paper describes the clinical features, self-treatment, and outcome of diarrhea in 784 (95% follow-up) Americans who traveled for < or = 90 days, and who received detailed pre-travel advice. Diarrhea was reported by 46%. Of these, 34% (n = 270) had traveler's diarrhea (TD) defined as > or = 3 unformed stools/day +/- enteric symptoms or < 3 stools/day with > or = 1 enteric symptom, and 11% (n = 88) had loose motions (LM). Diarrhea was often severe and nearly a quarter of people with TD experienced fever and vomiting and 35% were required to alter their plans. The duration of travel and the destination itself were the strongest influences on diarrhea. Most travelers treated the illness themselves, whether or not they had LM (72%) or TD (83%). Those with LM took an antimotility agent or bismuth subsalicylate alone more frequently than those with TD (71% versus 48%, P < 0.002). Conversely, antibiotics were taken more frequently by those with TD (47% versus 27%, P < 0.03). Overall, 83% indicated self-treatment was effective (91% with LM and 80% with TD). Diarrhea is common despite pre-travel advice. Because travelers usually treat themselves, they should be provided with clear instructions on appropriate self-treatment.

Adolescent↗
PubMedDate not supplied

Walking and bicycling: an evaluation of environmental audit instruments.

PURPOSE: This paper reviews existing environmental audit instruments used to capture the walkability and bikability of environments. The review inventories and evaluates individual measures of environmental factors used in these instruments. It synthesizes the current state of knowledge in quantifying the built environment. The paper provides health promotion professionals an understanding of the essential aspects of environments influencing walking and bicycling for both recreational and transportation purposes. It serves as a basis to develop valid and efficient tools to create activity-friendly communities. DATA SOURCES: Keyword searches identified journal articles from the computer-based Academic Citation Databases, including the National Transportation Library, the Web of Science Citation Database, and MEDLINE. Governmental publications and conference proceedings were also searched. STUDY INCLUSION AND EXCLUSION CRITERIA: All instruments to audit physical environments have been included in this review, considering both recreation- and transportation related walking and bicycling. Excluded are general methods devised to estimate walking and cycling trips, those used in empirical studies on land use and transportation, and research on walking inside buildings. DATA EXTRACTION METHODS: Data have been extracted from each instrument using a template of key items developed for this review. The data were examined for quality assurance among three experienced researchers. DATA SYNTHESIS: A behavioral model of the built environment guides the synthesis according to three components: the origin and destination of the walk or bike trip, the characteristics of the road traveled, and the characteristics of the areas surrounding the trip's origin and destination. These components, combined with the characteristics of the instruments themselves, lead to a classification of the instruments into the four categories of inventory, route quality assessment, area quality assessment, and approaches to estimating latent demand for walking and bicycling. Furthermore, individual variables used in each instrument to measure the environment are grouped into four classes: spatiophysical, spatiobehavioral, spatiopsychosocial, and policy-based. MAJOR CONCLUSIONS: Individually, existing instruments rely on selective classes of variables and therefore assess only parts of built environments that affect walking and bicycling. Most of the instruments and individual measures have not been rigorously tested because of a lack of available data on walking and bicycling and because of limited research budgets. Future instrument development will depend on the acquisition of empirical data on walking and bicycling, on inclusion of all three components of the behavioral model, and on consideration of all classes of variables identified.

Bicycling↗
PubMed1999

Clinical pathways in hip and knee arthroplasty: a prospective randomised controlled study.

OBJECTIVE: To ascertain the effectiveness of clinical pathways for improving patient outcomes and decreasing lengths of stay after hip and knee arthroplasty. DESIGN AND SETTING: Twelve-month randomised prospective trial comparing patients treated through a clinical pathway with those treated by an established standard of care at a single tertiary referral university hospital. PARTICIPANTS: 163 patients (56 men and 107 women; mean age, 66 years) undergoing primary hip or knee arthroplasty, and randomly allocated to the clinical pathway (92 patients) and the control group (71 patients). MAIN OUTCOME MEASURES: Time to sitting out of bed and walking; rates of complications and readmissions; match to planned discharge destination; and length of hospital stay. RESULTS: Clinical pathway patients had a shorter mean length of stay (P = 0.011), earlier ambulation (P = 0.001), a lower readmission rate (P = 0.06) and closer matching of discharge destination. There were beneficial effects of attending patient seminars and preadmission clinics for both pathway and control patients. CONCLUSION: Clinical pathway is an effective method of improving patient outcomes and decreasing length of stay following hip and knee arthroplasty.

Activities of Daily Living↗
PubMed2003

Urinary incontinence in subacute care--a retrospective analysis of clinical outcomes and costs.

OBJECTIVE: To investigate the effect of incontinence on clinical outcomes and costs for patients in subacute care. DESIGN: Retrospective analysis of data collected over a 3-month period in 1996. SETTING: 54 medical facilities in Australia and New Zealand providing subacute care in an inpatient setting. PATIENTS: 6773 episodes of care provided to 6455 rehabilitation and geriatric evaluation and management patients. MAIN OUTCOME MEASURES: Urinary continence status, treatment outcomes, length of stay, discharge destination, and nursing and allied healthcare costs. RESULTS: Discharge destination differed between incontinent and continent patients (57% compared with 82%, respectively, discharged home, and 29% compared with 12%, respectively, discharged to a nursing home or to further care). There was a difference in cost between patients who were continent and those who were incontinent throughout their episode of care (rehabilitation: $185.60 [95% CI, $181-$190] per day for incontinent and $156.82 [95% CI, $153-$160] for continent patients; and geriatric evaluation and management: $164.62 [95% CI, $157-$172] for incontinent and $121.40 [95% CI, $114-$129] for continent patients). However, multilevel analyses showed that, after allowing for age and level of functional independence, the contribution of continence status to the cost of care depended on the functional independence of the patient (cognitive function for orthopaedic patients [P < 0.01] and motor function for stroke patients [P = 0.04]). CONCLUSION: The relationship between continence status and cost of care is complex. However, the cost differences found in our study need to be considered in payment systems, allocation of staff levels on wards and in development of casemix classifications.

Aged↗
PubMed1999

Autopsy result utilization: a College of American Pathologists Q-probes study of 256 laboratories.

OBJECTIVES: To document the level of involvement and communication with nonpathology clinical personnel regarding autopsies and to document the destination of autopsy reports. DESIGN: The College of American Pathologists Q-Probes format was used to collect information on 15 consecutively performed autopsies per institution or for 6 months, whichever occurred first. The following information was recorded for each autopsy: decedent's age, hospital service, length of hospital stay, whether organs were donated, who was present at autopsy, methods of communicating preliminary and final autopsy results, special techniques used to arrive at a preliminary diagnosis, activities for which the autopsy was used, and destination of final report. PARTICIPANTS: Two hundred fifty-six laboratories collected information on 2755 autopsies. RESULTS: The aggregate autopsy rate was 12.4% (median 8.5%). Nonpathology clinical personnel attended 35.8% of all autopsies. A clinical physician was more likely to attend an autopsy if the patient was from a surgical service. Three primary methods were used to communicate preliminary autopsy results, namely, written reports (82.5%), telephone calls (50.6%), and meetings (11.5%). The primary care physician was sent the autopsy report in 91.1% of cases. Approximately half of the autopsy cases were used in both pathology departmental and extradepartmental activities. Aggregate autopsy data were distributed in the majority of cases to various departmental chairpersons and institutional quality assurance committees. CONCLUSIONS: This study provides a comparative multiinstitutional database for the utilization of autopsy results by clinicians and clinical departments. Although autopsy rates are low, autopsy results are routinely being used for hospital quality assurance activities and for educational purposes.

Autopsy↗