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PubMed1995

[Transmission and prevention of viral hepatitis].

The ways of transmission of hepatotropic viruses are now fairly known. Populations at risk for these infections are precisely identified and preventive measures are efficient. Safe hygiene for oro-fecal as well as for sexual or blood transmission is accurately determined. Vaccines exist against some viruses. In the future, efforts will have to be made in several directions: a) education of individuals at risk, in order to further diminish the transmission of the viruses in these groups; b) identification of the mode of transmission of sporadic hepatitis which, so far, has escaped any prevention; c) design of a vaccine against virus C, which will make mass prevention possible.

Hepatitis A↗
PubMed1993

Work-related chronic injuries of the forearm and hand: their specific diagnosis and management.

Work-related chronic injuries occur in muscles, tendons, and nerves. Epidemiological, histological, and physiological data confirm their often disputed physical basis. Terms such as repetitive strain injury and cumulative trauma disorder, when used as a diagnosis, have obscured the issue for they are really statements of causation. Definitive diagnosis is required both to treat and prevent such injuries. Precise terminology that identifies the tissue and its pathology is required. A detailed assessment methodology is described that allows a precise diagnosis. A clear relationship to work stress is necessary both to establish the cause and formulate prevention strategies. Treatment must begin early and be appropriate to the tissue and the nature of the injury. Examples are presented and discussed. Early treatment begins before too much damage has been done and yields better results.

Cumulative Trauma Disorders↗
PubMed2026

A hybrid effectiveness-implementation trial to integrate precision skin cancer risk feedback in federally qualified health centers.

BACKGROUND: Skin cancers are the most common type of cancer in the United States, occur in all segments of the population, and are preventable. Our previous research with primary care patients' demonstrated interest in and efficacy of a precision prevention intervention providing feedback on MC1R risk level (higher versus average) in combination with prevention education materials relative to a standard educational intervention. Our current study is a hybrid type 1 effectiveness-implementation trial deployed at six federally-qualified health centers. This paper presents the study protocol. METHODS: A community advisory panel will guide development of study materials and measures. Staff training at each clinic will be completed in-person. Patients will be approached and screened in-person. Those completing genetic testing and the baseline survey will be randomized to the precision versus standard intervention for each risk level with a target sample size of 286 for each combination. Primary outcomes of effectiveness, assessed at 6 and 12 months, include a tanning score (5 items assessing intentional and unintentional tanning), number of sunburns, conduct of a skin self-examination, and electronic health record documentation of clinician-patient communication about skin cancer prevention. Effectiveness comparisons will focus on the precision relative to the standard intervention among higher risk participants. Implementation data will be collected to identify barriers and facilitators. RESULTS: Effectiveness and implementation outcomes will be evaluated following study completion. CONCLUSIONS: Results will guide subsequent scale-up of the precision intervention, including modifications of the intervention as well as methods for implementation. CLINICAL TRIALS IDENTIFIER: NCT07222995.

Humans↗
PubMed2004

Injury prevention and control: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan.

The National Action Plan for Non-communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) incorporates prevention of injuries into a comprehensive NCD prevention effort. This encompasses the prevention of road traffic crashes (RTC)s, occupational injuries, falls, burns and other injuries. In this programme, surveillance of injuries--as part of comprehensive population-based NCD surveillance system, supplemented by multiple data sources--has been stipulated as an entry point, to injury prevention and control efforts. Actions areas for preventing RTCs include interventions to improve road safety education, identification and implementation of safety measures for traffic black-spots, enforcement of seatbelt and helmet laws and the development and implementation of highway ordinances. Recommendations have also been made to establish a road safety committee and to facilitate inter-sectoral action. It has also been deemed essential to enact and enforce legislation on locally manufactured vehicles, regulate drivers' training and licensing and evaluation of Highway Police Force from a performance and fiscal perspective. To prevent worksite injuries, a national consensus has been achieved to develop a comprehensive policy and to enact and enforce legislation for occupational health and safety; to include preventive health in the mandate of organizations dealing with worksite safety and to study patterns of occupational injuries and their determinants with a view to defining precise targets for preventive interventions. In addition NAP-NCD makes a strong case for the establishment of a National Safety Commission, the development of product safety standards for household usage, enforcement of legislation on building safety, and efforts to improve trauma care to the extent that a credible, cost-effective analysis suggests. It also calls for the need to formally evaluate interventions to reduce all forms of violence in Pakistan. Building capacity in the health system for injury prevention and building partnerships for sustainable outcomes in injury prevention have also been defined as priority areas.

Accidental Falls↗
PubMed1990

Dietary intervention in the clinical prevention of ischemic heart disease.

While some scientific doubt lingers with regard to the validity of minimizing mortality rates attributable to ischemic heart disease via nutritional strategies targeted at coronary risk factors, popular consensus is committed to such intervention. Chiropractic respondents largely support the notion that nutritional intervention can indeed facilitate prevention of ischemic heart disease. The precise strategies whereby such disease prevention may be achieved have proven problematic; even respondents who conceptually supported particular intervention strategies demonstrated some hesitation in clinically implementing their beliefs.

Australia↗
PubMed1990

Gastroduodenal ulcers: causes, diagnosis, prevention, and treatment.

The precise diagnosis and duration of peptic ulcer disease can now be made endoscopically. Numerous effective medical therapies are available to treat these disorders. While the vast majority of patients respond to medical therapy with complete healing of ulcers within 4 to 6 weeks, a small percentage require longer and probably more intense treatment. A total assessment of the patient's lifestyle is important in order to achieve the best therapeutic response. Cigarette smoking is a potent negative factor for both healing and ulcer recurrence. The question of who should continue on maintenance therapy and for how long has not been answered. Certainly, the first-time ulcer patient who smokes and becomes asymptomatic on treatment requires nothing more than standard 4- to 6-week therapy and discontinuation of smoking. Patients with recurrent disease and those who have sustained complications such as bleeding or perforation probably warrant 6 to 12 months of maintenance therapy, with close follow-up thereafter. Some patients will require continuous maintenance therapy in order to remain asymptomatic. In such patients it is important to determine that the problem is, in fact, "routine" peptic ulcer disease. Ulcers associated with NSAIDs are unique in that their cause is known and, at present, their treatment is specific. Studies to date indicate that the only appropriate therapy to prevent NSAID ulcers is misoprostol, and that this drug is also effective in healing such ulcers while NSAID treatment is continued. Except for complications, few patients now need to be referred for surgical intervention. Those who are should receive the least destructive procedure possible. The efficacy of medical therapy is generally enhanced following selective and highly selective vagotomy. No patient should be referred electively to surgery without the Zollinger-Ellison syndrome being ruled out.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

A substrate variant as a high-affinity, reversible inhibitor: insight from the X-ray structure of cilastatin bound to membrane dipeptidase.

An analysis of the X-ray structure of cilastatin bound to membrane dipeptidase, together with docking studies, is presented here to reveal how a simple amide may act as a high-affinity, reversible, amidase inhibitor. Cilastatin binds as a normal substrate and is orientated in a perfect near-attack conformer for formation of a tetrahedral intermediate with the zinc-bound water/hydroxide. This intermediate is fated, however, only to revert to its starting components as scission of the amide bond is prevented by the precise fit of cilastatin within the active site. The cilastatin alkyl end groups that are tightly buttressed against amino acid residues on opposite sides of the active site, are aligned along the C-N reaction coordinate axis thereby preventing collapse of the intermediate via rupture of the C-N bond. Such a feature could have more general applicability in the explicit design of substrate variants as selective, tight-binding, and reversible inhibitors.

Amidohydrolases↗
PubMed2004

Prevention and control of cancers: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan.

The National Action Plan for Non-communicable Diseases Prevention, Control and Health Promotion in Pakistan (NAP-NCD) integrates prevention and control of cancers with a comprehensive NCD prevention framework with a specific emphasis on tobacco, diet and physical activity as cross-cutting risks. The programme prioritizes on sustainable institutional support for mature cancer registries in order to facilitate cancer surveillance; prevention of cancers and early detection as part of an integrated NCD behavioural change communication strategy and building capacity in the health system for cancer prevention and control. The programme's research agenda also includes appropriate studies to bridge critical gaps in evidence relating to appropriate and cost-effective strategies for preventing common cancers in Pakistan. To contain exposure to carcinogenic agents in the environment and in worksites, NAP-NCD stresses on the transparent enforcement of National Environmental Quality Standards; the institution to take proactive measures to contain potential risks to cancers in industrial settings; stricter enforcement of labour laws, stringent regulations governing chemical handling and the active incorporation of preventive health in the mandate of organizations providing health coverage for the labour workforce. It has also been deemed essential to study cancer trends in defined industrial settings at high-risk and to identify causal associations in order to delineate precise targets for preventive interventions in the native setting. NAP-NCD stresses on the development of institutional mechanisms with a regulatory function for cancer control; these include a National Cancer Control Council, with the mandate to uphold ethics and principles and guidelines on technical matters and a National Occupational Safety and Health Association. The Plan also prioritizes on pain relief and palliative care alongside prevention and control efforts and stresses on the need to integrate prevention efforts into health services as a sustainable and evidence-based activity.

Breast Neoplasms↗
PubMed1995

'Spirituality as integrative energy': a philosophical analysis as requisite precursor to holistic nursing practice.

Spirituality is a universal human phenomenon, yet conceptual confusion, ambiguity and scientific scepticism have prevented adequate investigation into its potential healing effects. A recent resurgence of interest in non-medical sources of healing and holistic medical practices is causing increased speculation regarding the nature of spirituality. The lack of conceptual clarity, and absence of a precise theoretical definition, prevent recognition of spiritual distress and, hence, appropriate nursing intervention. In this paper, current usage and definitions of spirituality are discussed and a philosophical definition of 'spirituality as integrative energy' is proposed. The metaphysical nature of this phenomenon makes it the proper concern of philosophy; consequently, a philosophical analysis of the aforestated proposition was completed using the five predicables of logic theory: species, genus, differentia, logical property and logical accident. Implications of this definition for providing holistic nursing care are also presented.

Curriculum↗
PubMed2005

Epidemiology and treatment of psychiatric conditions that develop after critical illness.

PURPOSE: As a greater number of patients survive critical illness, there is increasing interest in accelerating patients' recovery after intensive care unit discharge. There is compelling evidence that psychiatric illnesses such as depression impair functional status in patients with chronic medical illnesses. Therefore, psychiatric conditions that develop after critical illness are a logical target for treatment or prevention strategies to improve recovery after critical illness. RECENT FINDINGS: This is a new area of investigation for intensive care unit researchers. To date, most studies have focused on descriptive epidemiology of psychiatric conditions at varying times after intensive care unit discharge. Small randomized trials have shown that depression and posttraumatic stress symptoms can be reduced by interventions during or after mechanical ventilation, although the causal mechanisms leading to these improved outcomes are obscure. Promising results must be confirmed in additional trials. After acute myocardial infarction, large trials have found that psychosocial interventions started after hospital discharge are ineffective at preventing psychosocial impairment. SUMMARY: Psychiatric symptoms and disorders affect 15%-35% of patients months after intensive care unit discharge. There is no consistent evidence that antidepressant medications are safe or effective in critically ill patients. Understanding the causal pathways that lead from acute medical stress to neuronal alterations and subsequent psychiatric symptoms will allow more precise targeting of preventive interventions.

Comorbidity↗
PubMed1993

[Medical, psychosocial rehabilitation and prevention in patients with epilepsy].

Patients suffering from epilepsy and quite frequently reversible impairment of personality and individual development are in need of specific, disease-related measures of rehabilitation. Particularly, the complexity of the disorder prevents from a responsible and successful self-management. In order to obtain effective rehabilitation and reintegration into all aspects of social life it is essential to initiate a comprehensive treatment plan for the patients at the earliest possible stage considering personality, the distinct form of seizures, education and training as well as the condition of the environment. It requires various programs of precise examination and preventive treatment at specific facilities to ensure the desired success of rehabilitation. Thus multiple social disadvantages as well as unnecessary longterm costs may be avoided and mainly that kind of therapy will result in a better life quality and prolonged life expectancy for the epileptic patients.

Adaptation, Psychological↗
PubMed1980

Assessing root caries in populations: the evolution of the root caries index.

This paper traces the history of the epidemiologic assessment of root caries over the past 30 years. This history clearly points out that a critical junction has been reached between the state-of-the art for the reporting of root caries and the demand placed on research and service components of the oral health system. If progress is to be made, it is imperative that a uniform reporting method for root caries be adopted. This paper introduces the Root Caries Index (RCI) as an index that should prove to be a feasible and utilitarian method for reporting root caries data in descriptive and analytic epidemiologic studies as well as assessing the results of preventive and treatment agents, clinical trials. The Root Caries Index represents, in the evolution of a root caries measurement method, a refinement of the delineation of the true intraoral "population at risk" to the disease process. The resulting index is a true attack rate for supragingival root caries lesions. This development should permit more meaningful comparison of populations, clearer interpretations regarding risk factors, and more precise assessment of preventive and treatment agents.

Adolescent↗
PubMed2001

Diagnosis of occlusal caries: Part I. Conventional methods.

Accurate diagnosis of the presence or absence of disease is a fundamental requirement in health care. The diagnosis of non-overt occlusal decay is challenging and can be highly subjective, and its inherent uncertainties can lead to widely differing treatment decisions. The development of more sensitive, specific and reproducible diagnostic tools for occlusal surfaces would contribute greatly to more precise planning of preventive and operative therapy. The purpose of this 2-part paper is to review current knowledge concerning conventional and new diagnostic methods for occlusal caries. Part I looks at established diagnostic methods for occlusal surfaces. Conventional visual, tactile and radiographic examinations provide less-than-ideal diagnostic sensitivity. Neither fissure discolouration (black or brown) nor the use of an explorer has been shown to improve diagnostic accuracy. However, the combination of careful visual examination with optimal radiographic examination affords better diagnostic performance. The best visual indicators involve precise features associated with the presence of disease, such as opaque fissure demineralization and the presence and extent of localized breakdown of the enamel. For best results, teeth should be clean, thoroughly dry and well illuminated. Part II will examine new and emerging technologies, including the DIAGNOdent laser fluorescence device, which are being developed for the diagnosis of occlusal decay.

Dental Caries↗
PubMed1998

Can primary prevention or selective screening for melanoma be more precisely targeted through general practice? A prospective study to validate a self administered risk score.

OBJECTIVES: To establish whether a questionnaire incorporating MacKie's risk factor flow chart can identify patients at high risk for melanoma so that they can be targeted for primary and secondary prevention. To validate the risk score derived from the questionnaire and test the feasibility of self completion by comparing patients' self reported skin characteristics with a skin examination performed by an experienced general practitioner. DESIGN: Prospective questionnaire survey followed by a comparative study. SETTING: 16 randomly selected group practices in a health district in Cheshire, United Kingdom. SUBJECTS: Questionnaire survey--3105 consecutive patients aged 16 years and over attending for a primary care consultation; comparative study--a self selected subsample of 388 of the 3,105 patients. MAIN OUTCOME MEASURES: MacKie risk group for melanoma. Comparison of high risk skin characteristics reported by patients and those noted during a skin examination by a doctor (kappa statistic). RESULTS: 4.3% of patients (87% women) were in the highest risk group and 4.4% (79% men) were in the second highest risk group, as defined by the MacKie score. Agreement between patients' self appraisal of skin characteristics and clinical skin examinations was reflected in kappa values of 0.67 for freckles, 0.60 for moles, and 0.43 for atypical naevi. CONCLUSION: This questionnaire helped to identify a group at high risk for melanoma. Furthermore, good agreement was found when the patient's risk scores were compared with results of the clinical skin examination. This risk score is potentially useful in targeting primary and secondary prevention of melanoma through general practice.

Age Distribution↗
PubMed2003

Risky, aggressive, or emotional driving: addressing the need for consistent communication in research.

PROBLEM: Researchers agree that a consistent definition for aggressive driving is lacking. Such definitional ambiguity in the literature impedes the accumulation of accurate and precise information, and prevents researchers from communicating clearly about findings and implications for future research directions. This dramatically slows progress in understanding the causes and maintenance factors of aggressive driving. SUMMARY: This article critiques prevailing definitions of driver aggression and generates a definition that, if used consistently, can improve the utility of future research. Pertinent driving behaviors have been variably labeled in the literature as risky, aggressive, or road rage. The authors suggest that the term "road rage" be eliminated from research because it has been used inconsistently and has little probability of being clarified and applied consistently. Instead, driving behaviors that endanger or have the potential to endanger others should be considered as lying on a behavioral spectrum of dangerous driving. Three dimensions of dangerous driving are delineated: (a). intentional acts of aggression toward others, (b). negative emotions experienced while driving, and (c). risk-taking. IMPACT ON INDUSTRY: The adoption of a standardized definition for aggressive driving should spark researchers to use more explicit operational definitions that are consistent with theoretical foundations. The use of consistent and unambiguous operational definitions will increase the precision of measurement in research and enhance authors' ability to communicate clearly about findings and conclusions. As this occurs over time, industry will reap benefits from more carefully conducted research. Such benefits may include the development of more valid and reliable means of selecting safe professional drivers, conducting accurate risk assessments, and creating preventative and remedial dangerous driving safety programs.

Accidents, Traffic↗
PubMed1993

Efficacy of different doses of immune serum globulin in the prevention of hepatitis A: a three-year prospective study.

Previous studies have shown that the administration of immune serum globulin (ISG) before exposure to hepatitis A virus prevents infection. The precise dose needed and the duration of the protection conferred are unclear, however. In this study, ISG doses of 2 mL and 5 mL were used for preexposure prophylaxis, and their efficacies in reducing the attack rate of hepatitis A among Israel Defence Forces troops serving in field units were compared. The attack rate during the first 4 months of follow-up was low and was similar regardless of the dose administered (0.11/10,000 and 0.15/10,000 for 2 mL and 5 mL, respectively; P = 1.0). In the second and third 4-month intervals after immunization, attack rates were higher (but not significantly so) among soldiers given 2 mL than among those given 5 mL. Twelve months after immunization, the cumulative attack rate for hepatitis A was significantly different for the two groups (2.78/10,000 vs. 1.30/10,000; P < .05). Our data suggest that preexposure immunization with 2 mL of ISG is as effective as that with 5 mL in preventing hepatitis A for 4 months. The advantage of the 5-mL dose is evident 5-12 months after administration.

Dose-Response Relationship, Immunologic↗
PubMed1996

Time course analysis of alpha+ beta+ T cell clones during normal pregnancy.

During normal pregnancy, the fetus continues to mature inside the uterus without rejection. Inherited paternal antigens could be targeted by the maternal immune system. These reactions are believed to play a role in a number of habitual abortions. However, the precise maternal mechanisms preventing fetal tissue rejection are not well understood. Maternal T cells should recognize fetal antigens, so it is conceivable that antigen-specific T cell response to fetal antigens would occur by proliferation and accumulation of certain T cell clones in the pregnant mother. To elucidate the maternal immune response to the fetus we investigated the clonality of expanded T cells in peripheral blood lymphocytes in ten normal pregnant women. We employed reverse transcriptase-polymerase chain reaction for T cell receptor beta chain gene and subsequently analyzed the PCR product by single-strand conformation polymorphism analysis. A large number of distinctly expanded T cell clones were detected during pregnancy. These accumulations were observed as early as the ninth to tenth week post-conception and reached a maximum during the second trimester, suggesting the existence of dynamic antigen-specific T cell responses in the pregnant mother. However, after the 30th week of gestation, nearly all expanded T cell clones disappeared before parturition and the degree of clonality reached almost normal levels. Our results clearly indicate the existence of dynamic maternal T cell responses during pregnancy.

Adult↗
PubMed1986

[Difficulties in the recognition and evaluation of injuries of the anterior cervical spine].

The difficulties encountered in diagnosis, course and medical opinion are shown by two cases concerning the upper cervical spine. One of them was a condyle of the third occipital bone due to predisposition, the other a splintered fracture of the lateral mass of the atlas. A definitive medical opinion can only be established on the basis of an analysis of symptoms and findings, an objective assessment of the course and a precise diagnosis. This prevents disappointment and helps to avoid a lot of paperwork and protracted procedures.

Adult↗