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PubMed1995

[Immobility syndrome in patients being care for in a home care unit].

OBJECTIVES: to asses in a group of elderly patients included in a Home Care Unit, the level of immobility, the functional status based on the Katz's index and the Red Cross scale, and their medical, psychological and social consequences. METHODS: assessment of elderly patients visited during three consecutive months, through and standardized protocol with 14 items related with the previous aspects. RESULTS: 114 elderly patients (71% females) were visited during this time. The mean age was 82.4 years. 71 patients (65.7%) had immobility, with a mean age of 83.4 years and females predominance. Based on the level of immobility, 24 patients were in bed and 44 patients were able to be in bed-armchair. 74% of the patients were severely disabled on the activities daily living (Katz G); 85% of the patients had a severe physical disability (Red Cross scale 4-5), whereas a lower percentage (36%) had severe mental disability (Red Cross scale 4-5). Neurological disorders were the most frequent etiology of immobility (72%), with only one cause in 27 patients, two causes in 20 patients and more than three causes in 24 patients. Medical consequences were the most frequent, mainly urinary and chest infections, pressure sores and constipation. CONCLUSIONS: Immobility's syndrome represents a common medical problem in the geriatric care, related specially with the neurological and osteo-articular disorders, conditioning a high mobility.

Aged↗
PubMedDate not supplied

Different efficacy of alcohol education tools among trainee nurses.

BACKGROUND/AIMS: The evaluation of the efficacy of two different forms of scientific information concerning alcohol-related problems (ARP), among Italian trainee nurses. METHODOLOGY: A specific questionnaire, investigating the awareness of ARP, was distributed to 193 trainee nurses, 158 enrolled in the Italian Red Cross School for Professional Nurses at S. Orsola-Malpighi Hospital in Bologna and 35 enrolled in the Professional Nursing School at the Social Security Institute in the Republic of San Marino, who had attended a scientific meeting on ARP in the last year. Eighty-one nurses (62 belonging to the Red Cross School of Bologna and 19 to the Professional Nursing School of San Marino), had previously been given an information package on ARP (Group A). One hundred twelve subjects (96 belonging to the Red Cross School of Bologna and 16 to the Professional Nursing School of San Marino) did not read the specialized material (Group B). RESULTS: The results showed a statistically significant difference in the percentage of correct answers between Group A (25.98%) and Group B (21.80%). The percentage of correct answers among the Bologna trainee nurses were always significantly lower than that of the San Marino nurses. CONCLUSIONS: These results suggest a scant awareness and interest in ARP among trainee nurses and show that courses and lectures are more effective than scientific printed material.

Adolescent↗
PubMed2000

[Hypersensitivity pneumonitis caused by Lyophyllum aggregatum in two sisters].

We encountered two sisters with hypersensitivity pneumonitis caused by Lyophyllum aggregatum. In Case 1, the patient was a 47-year-old woman who consulted Iiyama Red Cross Hospital because of a non-productive cough. She had worked with Lyophyllum aggregatum cultures for 7 years. In 1996, she complained of a dry cough, and had had a severe cough in November 1998. She was admitted to Iiyama Red Cross Hospital because of dyspnea on effort. Laboratory data revealed a high level of C-reactive protein. Chest radiography and CT scanning showed ground glass opacities in both lower lobes, and centrilobular nodules. Bronchoalveolar lavage fluid revealed a decrease in the CD4/CD8 ratio, and the lymphocyte fraction was very high. Transbronchial lung biopsy revealed lymphocytic granuloma and interstitial thickening, and the lymphocyte stimulation test was positive for Lyophyllum aggregatum. Case 2 occurred in the 51-year-old sister of Patient 1. She had worked with Lyophyllum aggregatum cultures for 10 years. In 1994, she had experienced dyspnea and a dry cough while working. In January 1999, she was admitted to Iiyama Red Cross Hospital because of a dry cough, sputum and chest oppression. Chest radiography and CT scanning revealed ground glass opacities in both lower lobes and centrilobular nodules. The CD4/CD8 ratio in the bronchoalveolar lavage fluid was low, and the lymphocyte fraction conspicuously high. The transbronchial lung biopsy revealed lymphocytic granuloma and interstitial thickening. The lymphocyte stimulation test was negative for Lyophyllum aggregatum. She was discharged and returned to work, but the dry cough and low-grade fever recurred. However, the occupational provocation test is not regarded as positive because chest radiography, laboratory examinations, and a pulmonary function test were not performed. The symptoms of both cases were eliminated only on isolation of the antigen. There has not been any previous report of hypersensitivity pneumonitis caused by Lyophyllum aggregatum.

Agaricales↗
PubMedDate not supplied

Eligibility and exclusion of hemochromatosis patients as voluntary blood donors.

BACKGROUND: Hereditary hemochromatosis patients are excluded in many countries as voluntary blood donors. In 1991, changes in the Canadian Red Cross policy allowed healthy hemochromatosis patients to become voluntary donors. STUDY DESIGN AND METHODS: The medical histories of 208 hemochromatosis patients were evaluated for eligibility for blood donation from a large prospective database of hemochromatosis patients. A survey that determined the success or exclusion of 81 patients for blood donation and the reasons for their exclusion based on Canadian Red Cross donor exclusion criteria was analyzed. RESULTS: Of 208 hemochromatosis patients, 140 (67%) were eligible for blood donation. Criteria for exclusion were other illnesses excluded by Canadian Red Cross criteria and the use of contraindicated medications. Fifty-one per cent of patients had attempted to donate blood, with only 7% being successful. CONCLUSIONS: A large number of potential blood donors are excluded from blood donation inappropriately despite changes in eligibility criteria to the contrary. Further public and health education is needed to increase awareness and, thus, increase blood donation by potential donors.

Blood Donors↗
PubMed1996

Prognostic validity of different classifications in assessment of war inflicted nerve injury.

In this study, the relation of postoperative peripheral nerve recovery following war inflicted nerve injuries and the injury classification according to the projectile energy, Abbreviated Injuries Scale, 1985 revision, as well as the fracture and metallic bodies criteria (Red Cross Wound Classification), was investigated. During the war against Croatia, the authors followed-up 137 wounded people, suffering a total of 147 various war nerve injuries that were surgically treated. The prospective classification of all wounded based on the projectile energy data and retrospective classification based on the Abbreviated Injury Scale and Red Cross Wound Classification were performed. The recovery was independently evaluated by a neurologist according to the British Medical Research Council for arm and Millesi scale for leg nerve injuries. A statistically significant relation was obtained between the peripheral nerve function recovery, Abbreviated Injury Scale and fracture criteria from the Red Cross Wound Classification. There was no significant influence on the projectile energy and presence of metallic body criteria on the nerve function recovery. The Abbreviated Injury Scale was concluded to be the most valid prognostic classification in the assessment of war inflicted peripheral nerve injuries. The fracture criteria were also found to be an additional valuable source of information.

Abbreviated Injury Scale↗
PubMed1999

The risk of occupational HIV exposure among Thai healthcare workers.

To analyze the incidence of occupational exposure to HIV in a large group of healthcare workers at the 2 Thai Red Cross hospitals, prospectively collected during a seven-year period in order to find out the causes and circumstances that prone to exposure, the interventions that may minimize the exposure and the consequences of the accidents. The first 200 incident reports from 198 hospital workers of the Thai Red Cross Society who had occupational exposure to HIV-infected blood and body fluids during 1991-1997 were analyzed. We analyzed the demographic data, the timing and place of exposure, the nature and cause of exposure, HIV status at baseline and at follow-up at 3, 6 and 12 months as well as the received antiretroviral prophylaxis. All of the 198 HCW had negative anti-HIV at baseline and remained negative throughout the one-year follow-up although only 55% submitted the results of their anti-HIV testing at 6 months. However, none claimed for work-related life insurance against HIV during those 7 years indicating that nosocomial rate of transmission is less than 1 in 200 or less than 0.5%. Analysis of the incidents indicated that the risk group was the 20-40 years old nursing personnel who worked in the medical wards during the regular working hours. The procedures that were responsible for most of the injuries were venepuncture, intravenous access, injection and waste collection. Most of the injuries could be prevented if the work place safety guidelines were strictly followed and if personnel were more careful at work. The results can be used to implement more effective preventive measures for hospitals in Thailand. Postexposure management at the Thai Red Cross hospitals conformed with the international guidelines. However, only 78% of those who should receive postexposure prophylaxis were recommended for treatment and only 69% of those recommended actually took the treatment. This emphasizes the need to educate clinicians involved in postexposure care as well as to ensure them and the injured subjects about the safety of the antiretroviral prophylaxis.

Adult↗
PubMed2003

Melatonin and N-acetyl-serotonin cross the red blood cell membrane and evoke calcium mobilization in malarial parasites.

The duration of the intraerythrocytic cycle of Plasmodium is a key factor in the pathogenicity of this parasite. The simultaneous attack of the host red blood cells by the parasites depends on the synchronicity of their development. Unraveling the signals at the basis of this synchronicity represents a challenging biological question and may be very important to develop alternative strategies for therapeutic approaches. Recently, we reported that the synchrony of Plasmodium is modulated by melatonin, a host hormone that is synthesized only during the dark phases. Here we report that N-acetyl-serotonin, a melatonin precursor, also releases Ca2+ from isolated P. chabaudi parasites at micro- and nanomolar concentrations and that the release is blocked by 250 mM luzindole, an antagonist of melatonin receptors, and 20 mM U73122, a phospholipase C inhibitor. On the basis of confocal microscopy, we also report the ability of 0.1 microM melatonin and 0.1 microM N-acetyl-serotonin to cross the red blood cell membrane and to mobilize intracellular calcium in parasites previously loaded with the fluorescent calcium indicator Fluo-3 AM. The present data represent a step forward into the understanding of the signal transduction process in the host-parasite relationship by supporting the idea that the host hormone melatonin and N-acetyl-serotonin generate IP3 and therefore mobilize intracellular Ca2+ in Plasmodium inside red blood cells.

Animals↗
PubMed1996

[Collection and utilization of plasma in Austria: on the way to national self-sufficiency].

Self-sufficiency for plasma and plasma products on the basis of voluntary non-remunerated donation is more than guaranteed in Austria. Historically commercial enterprises are co-operating with the non profit sector of the Austrian Red Cross in an ideal way since more than 30 years. Austria needs about 16 millions IE of factor VIII yearly to treat the haemophilia patients as it should be. About 100,000 1 source plasma (FFP) coming from the industry and some 50,000 1 of frozen plasma per year being given for fractionation by the Red Cross Blood Transfusion Services seem to be sufficient for preparing the amount of factor VIII needed. Austria feels furthermore responsible to also fulfill its part as a member of the European Community in order to reach the common European goal of self-sufficiency in due time. As for the term "non remunerated' it is our strong concern that to compensate the plasma donor's time- and work-spending by reinbursement does not mean any sort of "payment'. We agree herewith with the opinion of the "Arbeitskreis Blut' in Germany. To change the successful way of having enough raw material to treat all our haemophilia patients with the necessary amounts of factor VIII by abruptly and artificially pressing for unpaid plasma donations would be a bad decision. By certainly not getting enough plasma by using such an unusual way this idea would not be successful. Austrian Red Cross does not intend to create own plasmapheresis-centres.

Austria↗
PubMed1982

Labor room and laboratory: clinical validation of the cold pressor as a means of testing preparation for childbirth strategies.

Annually, numerous couples prepare for childbirth through Lamaze childbirth education classes. Research on various portions of the Lamaze method has used the cold pressor as an analogue for labor. In this experiment, pregnant women who had attended either (a) Lamaze classes which taught pain control methods (n = 22), or (b) Red Cross parenting classes which did not teach pain control methods (n = 7), and students who received either (c) brief Lamaze training (n = 10), or (d) no training (n = 10), were tested on the cold pressor. Pregnant women were also interviewed after the delivery of their children. On the cold pressor, clinically trained Lamaze women were superior (longer tolerance, less pain and/or distress) to clinical control (Red Cross) women, which were equal to student Lamaze trained women. All groups performed better than student controls. Post hoc analyses showed that women who managed labor pain well performed better on the cold pressor task than women who did not manage labor pain well. This experiment established some limits for applying analogue results to childbirth. Moreover, it showed that women who attended Lamaze classes received less medication during labor than women who attended Red Cross classes; however, it was not clear whether this difference was due to the Lamaze classes per se, or to other uncontrolled variables.

Adaptation, Psychological↗
PubMed1995

Estimated risk of transmission of the human immunodeficiency virus by screened blood in the United States.

BACKGROUND: In the United States, transmission of the human immunodeficiency virus (HIV) by blood transfusion occurs almost exclusively when a recently infected blood donor is infectious but before antibodies to HIV become detectable (during the "window period"). We estimated the risk of HIV transmission caused by transfusion on the basis of the window period associated with the use of current, sensitive enzyme immunosorbent assays and recent data on HIV incidence among blood donors. METHODS: We analyzed demographic and laboratory data on more than 4.1 million blood donations obtained in 1992 and 1993 in 19 regions served by the American National Red Cross, as well as the results of HIV-antibody tests of 4.9 million donations obtained in an additional 23 regions. RESULTS: We estimated that, in the 19 study regions, 1 donation in every 360,000 (95 percent confidence interval, 210,000 to 1,140,000) was made during the window period. In addition, it is estimated that 1 in 2,600,000 donations was HIV-seropositive but was not identified as such because of an error in the laboratory. We estimated that 15 to 42 percent of window-period donations were discarded because they were seropositive on laboratory tests other than the HIV-antibody test. When these results were extrapolated to include the additional 23 Red Cross service regions, there was a risk of one case of HIV transmission for every 450,000 to 660,000 donations of screened blood. If the Red Cross centers are assumed to be representative of all U.S. blood centers, among the 12 million donations collected nationally each year an estimated 18 to 27 infectious donations are available for transfusion. CONCLUSIONS: The estimated risk of transmitting HIV by the transfusion of screened blood is very small and nearly half that estimated previously, primarily because the sensitivity of enzyme immunosorbent assays has been improved.

Blood Banks↗
PubMed1988

Immune response in shipyard workers with x ray abnormalities consistent with asbestos exposure.

The association of cellular and humoral immune responses with asbestos exposure was studied in two groups of 150 workers each from a shipyard population and compared with a population of Red Cross blood donors. One of the shipyard groups had both chest x ray evidence of asbestos exposure and work assignments that necessitated direct handling of asbestos. The other shipyard group had normal chest x ray films and no job assignments involving the direct handling of asbestos. Cellular immune responses studied were mitogen activation and measures of T helper and T suppressor cells. Humoral immune measures were IgG, IgA, and IgM. In shipyard workers with asbestos related x ray abnormalities there was a significant increase in pokeweed mitogen stimulation. In both shipyard groups compared with Red Cross blood donors were found (1) significantly higher IgG and IgA levels and (2) greater numbers of T helper and T suppressor cells; because of the disproportionately large number of T suppressor cells, Th/Ts ratios were lower than in the Red Cross controls. Observations of differences in humoral and cellular immune response may point the way to the early diagnosis of the clinical manifestation of asbestos related disease.

Asbestos↗
PubMed1995

Sexual risk behaviour reduction associated with voluntary HIV counselling and testing in HIV infected patients in Thailand.

Sexual risk behaviour, measured by anonymously self-reported sexual activity, number of sexual partners, and condom use rates, was studied in age- and gender-matched HIV-1 positive consecutive patients from the Thai Red Cross Immune Clinic (IC) (study group, questioned after voluntary HIV counselling and testing) and the Thai Red Cross Anonymous Clinic (AC) (control group, questioned before voluntary HIV counselling and testing) in Bangkok, Thailand in 1993/94. More than 80% of study patients reported having decreased their sexual activity and their number of sexual partners since receipt of the positive HIV test result. Compared to control patients, study patients reported more often abstaining from sex (42% vs 14%), and more often using condoms during all their last three incidences of sexual intercourse (44% vs 14%). These findings give evidence for the value of voluntary HIV counselling and testing in contributing to the reduction of HIV transmission in Asia.

Adolescent↗
PubMedDate not supplied

False-positive hepatitis B surface antigen screening test results in patients receiving granulocyte-colony-stimulating factor.

BACKGROUND: Granulocyte-colony-stimulating factor (G-CSF) is used for the mobilization of progenitor cells and granulocytes. False-positive hepatitis B surface antigen (HBsAg) enzyme-linked immunosorbent assays (ELISAs) (NML) from one manufacturer in individuals receiving G-CSF have been observed. STUDY DESIGN AND METHODS: Sixty-six autologous peripheral blood progenitor cell donors from 1994 were retrospectively reviewed. Donors typically received 5 to 10 micrograms of G-CSF per kg subcutaneously for 5 days before collection. Additional ELISA dilutional studies (1-in-10, 1-in-100, 1-in-1000) with known HBsAg-negative serum were made with G-CSF. Testing was performed by the University of North Carolina, the American Red Cross in Charlotte, NC, or the National American Red Cross, Washington, DC. RESULTS: Of the 66 patients, none reacted for antibody to hepatitis B core antigen, and 30 (45%) had a positive reaction in the ELISA. Surface antigen positivity was "confirmed" on 6 of the 30 patients by neutralizing ELISA reactivity with an antibody to HBsAg test from the same manufacturer. In all cases, the clinical presentation was not suggestive of hepatitis, and these individuals were not at high risk for hepatitis B. Twenty-seven of the 30 cases were tested with a monoclonal HBsAg ELISA (AUSZYME) from another manufacturer in the peridonation period and did not react. In 1994, 256 autologous whole-blood donors not receiving G-CSF were similarly tested and only 1 (0.4%) had a positive reaction with the second manufacturer's HBsAg ELISA (p < 0.001). Of this group, 41 patients with histories of malignancy were identified, which is comparable to the history of the peripheral blood progenitor cell donors in this study, and none of these blood donors tested positive for HBsAg (p < 0.001). Dilutional studies with G-CSF produced no reactions. CONCLUSION: The NML HBsAg ELISA studied has an unacceptably high false-positive rate in patients or donors receiving G-CSF. The false reactivity of this assay appears to be an indirect consequence of G-CSF administration, which can also lead to spurious confirmation by the HBsAg neutralization assay from the same manufacturer.

Adolescent↗
PubMed2003

Elimination of human rabies in a canine endemic province in Thailand: five-year programme.

A five-year project to prevent human deaths from rabies in Phetchabun Province, Thailand involved increasing accessibility of post-exposure treatment with the Thai Red Cross intradermal (2-2-2-0-1-1) regimen for humans exposed to potentially and confirmed rabid animals; intensifying documentation of post-exposure treatment; increasing educational awareness through advocacy in provincial schools, television programmes, and newspapers; reducing canine rabies by monitoring the dog population and implementing vaccination and sterilization programmes; increasing the cooperation between the Ministries of Public Health, Agriculture, and Education on a provincial level; and assessing the impact of the programme through intensified follow-up of patients exposed to suspected and laboratory-confirmed rabid animals. Between 1996 and 2001, 10350 patients received post-exposure treatment; 7227 of these received the Thai Red Cross intradermal regimen. Fewer than 3% of exposed patients received rabies immunoglobulin. Seventy-three percent of all patients presented with WHO category III exposures. In a retrospective study, 188 patients exposed to laboratory-confirmed rabid animals were followed to determine their health status. Of these patients, 20 received the intramuscular Essen regimen and 168 the Thai Red Cross intradermal regimen (148 received 0.1 ml purified chick embryo cell rabies vaccine, 10 received 0.1 ml purified vero cell rabies vaccine, and 10 received 0.2 ml purified duck embryo cell rabies vaccine). All patients were alive one year after exposure. Two human deaths occurred in the first two years of the programme - neither patient had received vaccine or rabies immunoglobulin after exposure. No deaths occurred during the last three years of the programme, which indicated that the programme was successful.

Animals↗
PubMed1998

Suitability of casemix classification for output funding of blood services in Victoria. Victorian Blood Users Group.

OBJECTIVE: To study the suitability of diagnosis-related groups (DRGs) to quantify blood use in order to fund hospitals directly for fresh blood components. DESIGN: (i) Retrospective empirical analysis of hospital inpatient separation data, matching DRG classification with blood usage. (ii) Prediction of blood usage based on actual DRGs and comparison with actual blood products issued from the blood service. SETTING: Eight large public hospitals, April 1994-March 1995, the Department of Human Services and the Australian Red Cross Blood Service in Victoria, 1994-1997. MAIN OUTCOME MEASURES: Requirement for transfusion according to DRG; quantity of blood or blood products transfused; and statistical reliability of measuring blood component usage by DRG. RESULTS: A match between patient records and transfusion records for 287,117 patient separations showed that the patients had received 51,115 units of red cells, 30,451 units of platelet concentrates, 9043 units of fresh frozen plasma and 1273 units of cryoprecipitate. Ten per cent of DRGs (527) accounted for over 70% of blood product usage. The numbers of DRGs in which blood products were used for at least 30 separations (with a relative SEM [for units of blood used per separations using blood] of up to 20% at a 95% confidence level) were 56 for red cells, 8 for platelets and 4 for fresh frozen plasma. Estimates of red cell usage calculated from actual DRGs for three consecutive years (1994-1997) showed that DRGs predicted aggregate issues of red cells by the Red Cross Blood Service (ratio of actual red cells issued to red cell usage estimates were 1.036 for 1994-95, 0.994 for 1995-96, and 1.021 for 1996-97, respectively). CONCLUSION: DRGs are moderately good predictors of blood product usage, and could be used to allocate funds for blood products to hospitals instead of to the blood service. However, DRG data are not designed to manage blood issue policies, because DRGs do not represent single diagnoses or procedures and some are surrogate descriptions of procedures.

Australia↗
PubMed1992

Assessment of bullet disruption in armed conflicts.

Under international humanitarian law, the Hague Declaration of 1899 forbids the use of small arms ammunition that disrupts in the body after impact. However, assessment of whether bullets have undergone disruption is subjective and accusations that one or both sides of a conflict have used such ammunition cannot be substantiated. We describe a method by which disruption of bullets after impact can be assessed objectively. We reviewed 1287 wound radiographs of 1201 patients in four International Committee of the Red Cross hospitals. Radiographs were scored according to the F (fracture) and M (presence of metallic bodies) variables of the Red Cross wound classification; bullet disruption is evidenced by metallic fragments on the radiograph. One hospital had a significantly higher proportion of patients wounded by bullets that disrupted after impact; these wounds were associated with comminuted fractures. The findings show that the presence of metallic fragments on a radiograph is a reliable indicator of wound severity and bullet disruption. The study has important implications for the upholding of international humanitarian law, because with our method the use and manufacture of bullets that contravene the Hague Declaration can be identified.

Foreign Bodies↗
PubMed1998

Concern mounts as transfusion medicine loses its lustre.

Transfusion medicine is in trouble. Several factors, ranging from the tainted-blood scandal to changes in the way the system operates, mean that young physicians are avoiding the specialty. Dr. Antonio Giulivi of the Red Cross says the issue is serious because these specialists act as the system's overseers, and this fact won't change when the Red Cross gets out of the blood business in September.

Blood Banks↗
PubMed1999

Clinical and legal significance of fragmentation of bullets in relation to size of wounds: retrospective analysis.

OBJECTIVE: To examine the relation between fragmentation of bullets and size of wounds clinically and in the context of the Hague Declaration of 1899. DESIGN: Retrospective analysis of prospectively collected data on hospital admissions. SETTING: Hospitals of the International Committee of the Red Cross. SUBJECTS: 5215 people wounded by bullets in armed conflicts (5933 wounds). MAIN OUTCOME MEASURES: Grade of wound computed from the Red Cross wound classification and presence of bullet fragments on radiography. RESULTS: Of the 347 wounds with fragmentation of bullets, 251 (72%) were large wounds (grade 2 or 3)-that is, those with a clinically detectable cavity. Of the 5586 wounds without fragmentation of bullets, 2915 (52.1%) were large wounds. Only 7.9% (251/3166) of large wounds were associated with fragmentation of bullets. CONCLUSIONS: Fragmentation of bullets is associated with large wounds, but most large wounds do not contain bullet fragments. In addition, bullet fragments may occur in wounds that are not defined as large. Fragmentation of bullets is neither a necessary nor sufficient cause of large wounds, and surgeons should not diagnose extensive tissue damage because of the presence of fragments on radiography. Such findings also do not necessarily represent the use of bullets which contravene the law of war. Future legislation should take into account not only the construction of bullets but also their potential to transfer energy to the human body.

Humans↗