Pre-dilution haemofiltration--the Sardinian multicentre studies: present and future. The Sardinian Collaborative Study Group on Haemofiltration On-Line.
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Adult↗
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Cardiovascular risk factors and dietary habits in secondary school children in southern Italy.
Interest in research on atherosclerosis involving children has been the consequence of confluent evidence that atherogenic process begins in early life and grows silently until the occurrence of clinical events in middle-age or later. We carried out a cross-study in the Mediterranean area on a random sample of a secondary school of Casteldaccia (a farming and fishing village located on the Northern coast of Sicily, East of Palermo), consisting of 186 teen-agers (103 males and 83 females) aged between 10 and 13 years (average age: 11.3 +/- 0.2 years). We determined: total cholesterol, triglycerides, HDL-cholesterol, LDL-Cholesterol, apolipoproteins A1 and B, glycaemia, body mass index (BMI), systolic and diastolic blood pressure. Dietary habits were recorded on two occasions by a weekly diary (of the 7 days food record type) with the collaboration of dieticians. The prevalence of plasma cholesterol levels between 170-200 mg% and exceeding 200 mg% was 24.2% and 12.4% respectively, of overweight (BMI > 25) was 9.7% and of hypertension (SBP > 125 and/or DBP > 85 mmHg) was 8.6%. In comparison with Mediterranean diet according to Euratom study (1969), the following are the most impressive findings: an increase of cholesterol (+54%) and fat intake (+2% of total calories), a reduction of fibre intake (-32%) and an increase of 2S-P difference (+27%) and of total fats/fibre ratio (+53%).
Adolescent↗
Kinesthetic stimulation versus theophylline for apnea in preterm infants.
BACKGROUND: Apnea of prematurity may lead to hypoxemia and bradycardia requiring resuscitative measures being instituted. Many treatments have been used in infants with apnea of prematurity, such as theophylline. Kinesthetic stimulation, which uses various forms of oscillating mattress, might also prevent apnea without using a standard drug such as theophylline. OBJECTIVES: Main question: in preterm infants, how does kinesthetic stimulation compare with methylxanthine therapy in the treatment of apnea of prematurity. SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants and journal handsearching mainly in the English language. SELECTION CRITERIA: All trials using random or quasi-random patient allocation, in which kinesthetic stimulation was compared to methylxanthine therapy for apnea of prematurity, were eligible. No trials were excluded from the review that met these criteria. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration and its Neonatal Review Group were used with separate evaluation of trial quality, data extraction by both authors and synthesis of data using relative risk and weighted mean difference. MAIN RESULTS: A single small study of 20 infants (Saigal 1986) demonstrated a significant benefit to the infants receiving theophylline compared to those on an oscillating water bed in terms of mean rates of clinically important apnea (apnea > 14 seconds and bradycardia < 100, and cyanosis or receiving stimulation). There were no significant differences in adverse effects (death, sleep states, the Albert Einstein Neurobehavioural Index, adverse neurological outcomes, and the Bayley Mental Development Index at six and 12 months), although the infants on the OWB had a higher psychomotor index at six but not 12 months. There were some differences between the groups in incidence and severity of respiratory distress syndrome, and baseline apnea rates. REVIEWER'S CONCLUSIONS: The results of this review should be treated with caution. Theophylline has been shown in one small study to be superior to kinesthetic stimulation at treating clinically important apnea of prematurity. There are currently no clear research questions regarding the comparison of methylxanthines and kinesthetic stimulation to treat apnea of prematurity.
Apnea↗
A collaborative study on the first international standard of Dermatophagoides pteronyssinus (house dust mite) extract.
A collaborative study was carried out to assess the suitability of a preparation to serve as the International Standard for Dermatophagoides pteronyssinus (house dust mite) extract. The proposed international standard of D. pteronyssinus, two additional freeze-dried extracts, and a commercially available skin testing solution were tested in the study. Nineteen laboratories in 11 different countries participated. The assay methods used included RAST inhibition, crossed immunoelectrophoresis/crossed radioimmunoelectrophoresis, isoelectric focusing, quantitative skin testing, and various other methods for assessing total allergenic activity. In addition, six laboratories measured the quantity of antigen P1, and three laboratories measured antigen DpX in each of the preparations. On the basis of the results from this study, the World Health Organization established the preparation as the International Standard for D. pteronyssinus extract with an assigned unitage of 100,000 IU per ampule. The units refer both to the total allergenic activity of the ampule and to that of the individual allergens, such as P1 and DpX.
Allergens↗
Review article: Intestinal epithelia and barrier functions.
The mucosal epithelia of the digestive tract acts as a selective barrier, permeable to ions, small molecules and macromolecules. These epithelial cells aid the digestion of food and absorption of nutrients. They contribute to the protection against pathogens and undergo continuous cell renewal which facilitates the elimination of damaged cells. Both innate and adaptive defence mechanisms protect the gastrointestinal-mucosal surfaces against pathogens. Interaction of microorganisms with epithelial cells triggers a host response by activating specific transcription factors which control the expression of chemokines and cytokines. This host response is characterized by the recruitment of macrophages and neutrophils at the site of infection. Disruption of epithelial signalling pathways that recruit migratory immune cells results in a chronic inflammatory response. The adaptive defence mechanism relies on the collaboration of epithelial cells (resident sampling system) with antigen-presenting and lymphoid cells (migratory sampling system); in order to obtain samples of foreign antigen, these samples must be transported across the barriers without affecting the integrity of the barrier. These sampling systems are regulated by both environmental and host factors. Fates of the antigen may differ depending on the way in which they cross the epithelial barrier, i.e. via interaction with motile dendritic cells or epithelial M cells in the follicle-associated epithelium.
Adaptation, Physiological↗
[Exanthema during frequent use of antibiotics and antibacterial drugs (penicillin, especially aminopenicillin, cephalosporin and cotrimoxazole) as well as allopurinol. Results of The Berne Comprehensive Hospital Drug Monitoring Program].
Of 19,653 patients hospitalized in the medical divisions of two teaching hospitals, 3980 were treated with an aminopenicillin, 808 with other penicillins, 427 with a cephalosporin, 2619 with cotrimoxazole and 846 with allopurinol. The first part of the study deals only with the incidence of exanthemas definitely or probably due to a specific drug on the basis of clinical considerations. The exanthema incidence is 8.0% for aminopenicillins, 4.7% for other penicillins, 1.9% for cephalosporins and 2.8% for cotrimoxazole. The second part of the study employs a cross-tabulation to determine the incidence of exanthemas definitely and probably drug-induced, and the temporal relationship of these reactions to aminopenicillin and allopurinol exposure. The observed risks of developing an exanthema are as follows: aminopenicillin without allopurinol 10.1%, aminopenicillin combined with allopurinol 7.2%, allopurinol without aminopenicillin 3.0%, neither of the two drugs 1.5%. The increased incidence of exanthemas observed by the Boston Collaborative Drug Surveillance Program (BCDSP) in patients concomitantly treated with aminopenicillin and allopurinol was not confirmed by our results. Our hypothesis is that the time of exposure to aminopenicillins might have been shorter for patients of the BCDSP who were not treated in connection with neoplastic disease and did not receive allopurinol. The incidence of aminopenicillin induced exanthemas increases severalfold with the duration of exposure time during the first 2-3 weeks. In the CHDMB, on the other hand, exposure time does not differ between the patients treated with aminopenicillin alone or in combination with allopurinol.
Allopurinol↗
The physical, developmental, and mental health needs of young children in child welfare by initial placement type.
The American Academy of Pediatrics recommends comprehensive assessments for children entering foster care. These children may be placed with biological parents, kin, or in nonrelative foster care. It is not known whether health-related needs differ by placement. Chart abstractions were conducted of child welfare and medical records of 1542 children, ages 3 months to 5 years 11 months, admitted to San Diego's sole emergency shelter/receiving facility from April 1, 1998, through June 30, 1999, for investigation of alleged maltreatment. Children were discharged to three placement types: biological parents (28.5%), kinship caregivers (28.4%), or nonrelative foster parents (43.1%). Overall, 86.7% of children studied demonstrated physical, developmental, or mental health needs, with more than half displaying two or more problems. More than half of the children had a "Suspect" score on the Denver-II; 70.3% of children with "Suspect" scores were found to have delay on a developmental evaluation. Almost one tenth of the sample were diagnosed with one or more mental health conditions. Few differences were found for physical, developmental, or mental health concerns by placement. Results suggest that young children placed with biological parents or in kinship care have similar needs to those of children placed with foster parents. This study confirms the importance of comprehensive assessments for young children removed from their homes, regardless of placement. It also illustrates a need for standardized assessment criteria, particularly for developmental and mental health status, and for collaborative care models for all young children entering the child welfare system, regardless of their placement following investigation.
Caregivers↗
Measuring community/environmental interventions: the Child Pedestrian Injury Prevention Project.
OBJECTIVES: To assess the effectiveness of community/environmental interventions undertaken as part of the Child Pedestrian Injury Prevention Project (CPIPP). SETTING: Three communities (local government areas) in the Perth metropolitan area, Western Australia. METHODS: A quasiexperimental community intervention trial was undertaken over three years (1995-97). Three communities were assigned to either: a community/environmental road safety intervention and a school based road/pedestrian safety education program (intervention group 1); a school based road/pedestrian safety education program only (intervention group 2); or to no road safety intervention (comparison group). Quantification of the various road safety community/environmental activities undertaken in each community during the trial was measured, and a cumulative community activity index developed. Estimates of the volume and speed of vehicular traffic were monitored over a two year period. RESULTS: Greater road safety activity was observed in intervention group 1 compared with the other groups. A significant reduction in the volume of traffic on local access roads was also observed over the period of the trial in intervention group 1, but not in the remaining groups. CONCLUSIONS: The findings indicate that the various community/environmental interventions initiated in collaboration with CPIPP in intervention group 1 contributed, in part, to the observed reduction in the volume of traffic. A combination of community/environmental interventions and education are likely to reduce the rate of childhood pedestrian injury.
Accidents, Traffic↗
Recruiting a community sample in collaboration with farmworkers.
Few studies have examined health effects of pesticides in farmworkers, possibly because researchers perceive this population to be relatively inaccessible. We conducted an epidemiologic study of health effects among farmworkers in two towns in central Florida--Apopka and Pierson. Apopka is a suburb of Orlando with a diffuse farmworker community working in many crops, whereas Pierson is a small rural town with a tightly knit farmworker community working mainly in ferns. We collaborated with the Farmworker Association of Florida, a grassroots organization representing 6,700 farmworker families. We identified potential participants using membership lists of the Community Trust Federal Credit Union. Members of the Farmworker Association served as recruiters for the study, locating randomly selected Credit Union members and administering a screening interview to determine eligibility. In Apopka 90% of contacted workers were screened, and 79% of eligible workers participated in the study; corresponding proportions in Pierson were 94 and 85%. Farmworkers who had worked for 6-15 years and those who worked in a defined type of agriculture (nursery, citrus, or ferns) were more likely to enroll than others. Thus, while the response rate was good for a multistage recruiting process, study participants had a slightly different work history from those who chose not to enroll. We conclude that it is possible to conduct a study of health outcomes in farmworkers with a defined population and good response rates. Collaboration with the community is essential to the success of such a project, and community characteristics can affect response rates.
Adult↗
A staff nurse's perspective of infection control problems.
Earlier this month astonishing figures causing major concern were released from the Department of Health (DoH) showing the number of cases of Clostridium difficile in the over 65s in hospitals in England. This article focuses upon what is already known about infection control and concludes that a greater collaborative approach to infection control is needed, with a prudent use of broad spectrum antibiotics and a greater use of precautionary isolation measures based on patient symptoms, if infection rates are to fall.
Anti-Bacterial Agents↗
Continuing the debate on a separate adolescent psychiatry.
OBJECTIVE: This paper continues the debate, started by George Patton, that a separate adolescent psychiatry is required since many psychotic illnesses begin in late adolescence, and adolescent mental health needs have not been well met by child or adult psychiatry. METHOD: Epidemiological studies are used to illustrate that there are many continuities, as well as discontinuities, in the natural history of psychiatric disorders throughout the life cycle. The paper comments on rational service planning, which requires data on the outcomes of different treatment approaches. It goes on to explore the implications of a separate adolescent psychiatry for service delivery, including how current service boundaries and the training of psychiatrists might need to change. RESULTS AND CONCLUSIONS: An argument is mounted that psychiatrists should take a whole life perspective, rather than further fragment the specialty. In most Australian States, recent reviews of child and adolescent mental health services are likely to result in increased funding for services to adolescents. Adult psychiatry needs to attend more to the requirements of older adolescents, and greater collaboration is recommended between psychiatry services for children and adults. The authors argue for diversity of approaches, and consider that moves towards separate adolescent mental health services may not always be appropriate.
Adolescent↗
Survey of veterinary extension in the United States.
OBJECTIVE: To assess veterinary extension in the United States as perceived by veterinary extension personnel. DESIGN: Cross-sectional survey. SAMPLE POPULATION: Extension veterinarians in the United States. PROCEDURE: 2 surveys were designed and mailed to extension veterinarians listed by the USDA and the American Association of Extension Veterinarians. RESULTS: 34 states had > or = 1 extension veterinarian. The majority (> 60%) of extension veterinarians did not commit time to resident education and were not involved in research activities. Paradoxically, 23% of responding extension veterinarians did not report extension work. Programs for food animal producers, horse owners, and companion animal owners were provided by 100, 63, and 37% of states, respectively. Continuing education (CE) programs were provided for food animal veterinarians, equine veterinarians, and companion animal veterinarians by 96, 63, and 52% of states, respectively. Challenges facing veterinary extension included limited recognition of veterinary extension activities by universities, lack of university personnel to support CE programs, and decreased support for companion animal extension programs. CONCLUSIONS AND CLINICAL RELEVANCE: Extension veterinarians need to identify and clearly articulate the mission of veterinary extension, develop more collaborative programs across regions, and continue to serve as catalysts to bring diverse constituents together. Extension veterinarians must distinguish their mission not solely as information transfer, which can be accomplished in a variety of ways outside of extension, but as a coherent and consistent program of education and policy developed on a national level and distributed locally.
Agriculture↗
Ecuadorian adolescents and cigarette smoking: a cross-sectional survey.
This study investigates adolescents' attitudes and behaviors toward cigarette smoking in Ecuador. Using social cognitive theory as a basis, the cross-sectional survey focuses attention on such social influences as the smoking habits of family members and peers, as well as on the role of cigarette advertisements. Data on prevalence of actual use, access to cigarettes, and knowledge and attitudes about smoking are also obtained. The survey was conducted during the summer of 1994 in both urban and rural areas. Fifty schools in 40 different communities participated, resulting in a sample of 2,625 adolescents aged 9 to 15 years who completed the self-administered questionnaire. This study was conducted in collaboration with Amigos de las Américas (AMIGOS), an international health organization. Staff and volunteers who participated in projects conducted by AMIGOS in Ecuador worked with local health and education officials to implement the survey. Nearly 9% of students identified themselves as current smokers, 24.5% had experimented with smoking, and 61.1% had never smoked. The results varied significantly by age and gender, with older students and boys smoking at the highest rate. The smoking status of family members and peers also significantly predicted student smoking status. The results from this sample replicate findings from North American samples. Although Ecuadorian students smoke somewhat less than their American counterparts, cigarette smoking in Ecuador is a significant public health problem and clearly warrants a coordinated response. The present study points to several strategies for preventing smoking among youth.
Adolescent↗
Brucellosis: the situation in Western Nigeria.
Over 55% of 7161 people examined in different parts of Western Nigeria have positive Brucella abortus-antibodies in their sera. Higher incidence of titres were found among dairy farmers and slaughtermen than in the general population. The rates of infection among the human and the cattle populations in two farms studied were very similar. There was evidence of high rate of cross-infections going on in one of these farms: more than 63% of the herd in this farm showed serological evidence of active brucellosis. The socio-economic implications of high incidence of bovine brucellosis in a rapidly developing country, like Nigeria, are outlined. The need for the establishment of public health laboratories to facilitate early diagnosis of active disease and the necessity for full collaboration between the medical and veterinary professions for the proper control (and eradication) of brucellosis in Nigeria are discussed.
Agricultural Workers' Diseases↗
Perceptions of physician order entry: results of a cross-site qualitative study.
OBJECTIVE: To identify perspectives of success factors for implementing computerized physician order entry (POE) in the inpatient setting. DESIGN: Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes. RESULTS: A taxonomy of ten high level themes was developed, including 1) separating POE from other processes, 2) terms, concepts, and connotations, 3) context, 4) tradeoffs, 5) conflicts and contradictions, 6) collaboration and trust, 7) leaders and bridgers, 8) the organization of information, 9) the ongoing nature of implementation, and 10) temporal concerns. CONCLUSION: The identified success factors indicate that POE implementation is an iterative and difficult process, but informants perceive it is worth the effort.
Attitude to Computers↗
Making youth tobacco control programs more ecological: organizational and professional profiles.
PURPOSE: To identify the organizational and professional correlates of the integration of the ecological approach in Canadian public health organizations' tobacco control programs for youth. DESIGN: Cross-sectional survey. SETTING: Canadian public health organizations. SUBJECTS: One hundred and ten tobacco control programs implemented in 90 organizations. The response rate for the organizations was 87%. MEASURES: Descriptions of programs were obtained by telephone interviews. An analytical procedure was applied to the program data to identify intervention settings, targets and strategies for each program. Using this information, a summary score of the integration of the ecological approach was estimated for each program. Organizational and professional variables were assessed by self-administered questionnaires to managers and professionals involved in these programs. RESULTS: The level of integration of the ecological approach in programs was related to organizational (frequency of contacts and collaborations with external partners, team composition) and extraorganizational factors (size of the city in which the public health unit is located). Cognitive attributes of the practitioners (knowledge and beliefs) also emerged as significant predictors. Finally, positive associations were observed between practitioners' personal characteristics (educational achievement, working status in health promotion [full vs. part-time], previous experience, gender, and disciplinary/professional background) and cognitive predictors. CONCLUSIONS: Organizational environment and staff preparation play a critical role in the adoption of the ecological approach in tobacco control programs.
Access to Information↗
Organizational climate and intensive care unit nurses' intention to leave.
OBJECTIVE: The purposes of this study were to a) estimate the incidence of intensive care units nurses' intention to leave due to working conditions; and b) identify factors predicting this phenomenon. DESIGN: Cross-sectional design. SETTING: Hospitals and critical care units. SUBJECTS: Registered nurses (RNs) employed in adult intensive care units. INTERVENTIONS: Organizational climate, nurse demographics, intention to leave, and reason for intending to leave were collected using a self-report survey. MEASUREMENTS AND MAIN RESULTS: Nurses were categorized into two groups: a) those intending to leave due to working conditions; and b) others (e.g., those not leaving or retirees). The measure of organizational climate had seven subscales: professional practice, staffing/resource adequacy, nurse management, nursing process, nurse/physician collaboration, nurse competence, and positive scheduling climate. Setting characteristics came from American Hospital Association data and a survey of chief nursing officers. RESULTS: A total of 2,323 RNs from 66 hospitals and 110 critical care units were surveyed across the nation. On average, the RN was 39.5 yrs old (SD = 9.40), had 15.6 yrs (SD = 9.20) experience in health care, and had worked in his or her current position for 8.0 yrs (SD = 7.50). Seventeen percent (n = 391) of the respondents indicated intending to leave their position in the coming year. Of those, 52% (n = 202) reported that the reason was due to working conditions. Organizational climate factors that had an independent effect on intensive care unit nurse intention to leave due to working conditions were professional practice, nurse competence, and tenure (p < .05). CONCLUSIONS: Improving professional practice in the work environment and clinical competence of the nurses as well as supporting new hires may reduce turnover and help ensure a stable and qualified workforce.
Adult↗
Epidemiology in the pharmaceutical industry: a perspective for infectious diseases.
As access to observational data and databases expands so does the need for epidemiologists in industry. As an example, in the U.K. arm of the Department of Epidemiology at GlaxoWellcome Research and Development, the number of PhD-trained epidemiologists increased from zero in 1996 to eight in 1999. Their remit is often broad, including designing and co-ordinating, pharmacoepidemiologic research, studies of risk factors for disease and disease progression and pregnancy registries. Where appropriate, existing data sources, such as research databases, are employed for studies. Otherwise, primary data collection is pursued using standard methodology, for example, cross-sectional, case-control and cohort studies. This paper describes a structure for epidemiologic research in the pharmaceutical industry, the role of the industry epidemiologist and the scope of epidemiological studies. Two examples of observational studies of HSV-2/HIV interactions are given, and implications for research agendas discussed. The pharmaceutical industry is becoming increasingly committed to epidemiological research, and research agendas often involve extensive collaboration with leading external academic and public health groups.
Adolescent↗