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PubMed2001

[Antibiotic treatment of travellers' diarrhea].

UNLABELLED: This review should be cited as: De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoea (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software. A substantive amendment to this systematic review was last made on 21 May 2000. Cochrane reviews are regularly checked and updated if necessary. BACKGROUND: Traveller's diarrhoea is a syndrome frequently encountered in persons crossing an international boundary. Diarrhoea can lead to significant discomfort and interference with travel plans. Bacterial pathogens are a frequent course of this syndrome. Several antibiotics have been tested for efficacy in reducing the duration and severity of the illness. OBJECTIVES: The aims of the review were to access the effects of antibiotics on traveller's diarrhoea in relation to the duration of illness, severity of illness, and adverse effects of medications. SEARCH STRATEGY: The Cochrane Collaboration Trials Register, MEDLINE, and EMBASE were searched. Additional trials were identified by hand searching. Content experts were contacted. SELECTION CRITERIA: All trials in any language in which travellers older than five years were randomly allocated to treatment for acute non-bloody diarrhoea with antibiotics and where the causative organism is not known at allocation. DATA COLLECTION AND ANALYSIS: Two reviewers assessed trial quality and extracted data. MAIN RESULTS: Twenty published studies met inclusion and quality criteria for inclusion. Twelve studies were placebo-controlled. A meta-analysis for the primary outcome was not feasible. All of the ten trials reported a significant reduction in duration of diarrhoea in participants treated with antibiotics compared with placebo. Data from two trials demonstrated a small reduction for antibiotic treated patients in the number of unformed stools passed per each 24 hour period from randomisation up to 72 hours. Data from six trials demonstrated a greater number of participants being cured of diarrhoea by 72 hours (odds ratio [OR] 5.9, 95% confidence interval [CI] 4.06 to 8.57). Data regarding side effects were available from five trials. There was wide variation in the prevalence of side effects reported in different trials. Persons taking antibiotics experienced more side effects than those taking placebo (OR 2.37, 95% CI 1.5 to 3.75). REVIEWERS' CONCLUSION: Antibiotic treatment is associated with shorter duration of diarrhoea but higher incidence of side effects. Trials generally do not report duration of post-treatment diarrhoea using time-to-event analyses, and should do.

Anti-Bacterial Agents↗
PubMed2002

Design of the Brazilian BCG-REVAC trial against tuberculosis: a large, simple randomized community trial to evaluate the impact on tuberculosis of BCG revaccination at school age.

This paper describes the design and baseline results of a large and simple randomized controlled trial of the protection against tuberculosis of a dose of Bacillus Calmette Guerin (BCG) vaccination given to school children in a population with a high coverage of neonatal BCG (The Brazilian BCG-REVAC trial). The study started in 1996 and is a pair-matched and stratified-cluster randomized controlled trial with no placebo. The study population consists of children aged 7-14 years enrolled in 763 state schools from the cities of Salvador and Manaus, Brazil. Schools were the unit of randomization. Identifying information was collected for 354,708 school children. The final study population, after exclusions on the basis of age, BCG scar readings and absence from school on the day of the study visit, consists of 242,401 children, of whom 125,403 are in intervention schools. Follow-up relies on ascertainment of cases diagnosed at the health services and notified to the tuberculosis control program surveillance system. Blindness is guaranteed during linkage and validation of cases. Analysis is planned for the next 12 months, where efficacy will be estimated by calculating incidence of tuberculosis in the vaccine and control groups, taking into consideration the cluster design. The intervention studied, a second BCG vaccination, is widely used, although the World Health Organization does not recommend it on the basis of absence of evidence of protection or lack of protection. The results of the trial will make it possible for BCG revaccination practice to be informed by evidence. This is an example of a large simple and relatively inexpensive effectiveness trial, resulting from good collaboration between academia and health and education services enabling developing countries to define policies that are relevant for their reality.

Adolescent↗
PubMed1994

Preventing the Spread of Vancomycin Resistance--A Report from the Hospital Infection Control Practices Advisory Committee prepared by the Subcommittee on Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals; comment period and public meeting--CDC. Notice.

This notice is a request for review and comment of the draft document, Preventing the Spread of Vancomycin Resistance--A Report From the Hospital Infection Control Practices Advisory Committee (HICPAC) Prepared by the Subcommittee on Prevention and Control of Antimicrobial-Resistant Microorganisms in Hospitals. The draft document was prepared in collaboration with the National Center for Infectious Diseases (NCID), CDC, and representatives of the American Hospital Association, American Society for Microbiology, Association for Professionals in Infection Control and Epidemiology, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, and Surgical Infection Society.

Centers for Disease Control and Prevention, U.S.↗
PubMed2004

The creation of a large UK-based multicentre cohort of HIV-infected individuals: The UK Collaborative HIV Cohort (UK CHIC) Study.

OBJECTIVES: This paper describes the development of the UK Collaborative HIV Cohort (CHIC) Study. The aim of the study is to collate routinely collected data on HIV-infected individuals attending one of seven clinical centres in the UK since 1 January 1996, with the objectives of describing changes over time in the frequency of AIDS-defining illnesses, describing the uptake of and response to highly active antiretroviral therapy (HAART), and identifying factors associated with virological and immunological responses to HAART. METHODS: By December 2002, demographic, clinical and laboratory data had been collected on HIV-positive patients seen at six of the seven HIV centres. Missing and inconsistent data had been investigated and the datasets audited. Records identified as relating to the same patient had been merged, and cross-checks made with UK death registers to improve the accuracy of death reporting. RESULTS: The cohort currently contains information on 13,833 individuals. Eighty-two per cent of the cohort are male, and the median age was 34 years at first follow-up. The main risk factors for HIV infection have been determined as sex between men (63%) and sex between men and women (24%). Twenty-five per cent of the cohort are known to have developed AIDS, and 8% have died. CONCLUSIONS: The UK CHIC Study provides important information on the status of individuals infected with HIV in the UK, and provides a means to study the response to HAART and to monitor changes in the clinical event and death rates that have occurred since the introduction of HAART in the UK.

Adult↗
PubMed2001

Classroom strategies used by teachers of students with attention deficit hyperactivity disorder.

Pediatric therapists working in schools commonly function as consultants to assist teachers to develop strategies to help promote the classroom performance of students with attention deficit hyperactivity disorders (ADHD). This study surveyed general education teachers in northern New England to determine the classroom strategies teachers commonly use and perceive as being effective for improving the performance of children with ADHD. The strategies receiving the highest frequency and effectiveness ratings were enforcing routine and structure, frequent contact, preferential seating, use of motor breaks, and teaching self-monitoring of behaviors. The strategies receiving the lowest effectiveness ratings were peer tutoring, timeout, and giving assistance during transitions. Cross tabulations with chi-square analysis of the effectiveness ratings by grade level indicated the ratings for 3 of the 15 strategies, use of a designated quiet space, use of motor breaks, and sensory modulation techniques, were dependent on grade level. Qualitative analysis of teacher responses to open-ended questions provided recommendations for improving the education of children with ADHD, including: increasing special education support in the classroom, smaller class sizes, frequent parent-teacher collaboration, and more hands-on learning experiences. Implications of the results of the study for therapists working with students with ADHD and their teachers are discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed1992

Occupancy of CD72 (the CD5 counterstructure) enhances interleukin-4-dependent CD23 expression in resting B lymphocytes.

CD72, the human homologue of murine Lyb-2, was recently identified as a counterstructure to CD5. An antibody to CD72 (BU40) has been found to mimic interleukin-4 (IL-4) both in its ability to activate resting B cells into the early G1 phase of cell cycle and to augment the expression of major histocompatibility complex (MHC) class II antigen; unlike IL-4, the CD72-clustered antibody fails to induce the expression of CD23. We now report that engagement of CD72 by the IgG monoclonal antibody BU40 potentiates the capacity of IL-4--when used at optimal concentrations--to promote CD23 production in human B cells. The degree of enhancement arising from occupancy of CD72 ranged from two- to fivefold. Importantly, antibody to CD72 was also found to diminish the concentration required for IL-4 to promote CD23 expression to a level equivalent to that maximally achieved when using IL-4 alone. Engagement of CD72 by BU40 not only increased the amount of cell-associated CD23 induced by IL-4 but also led to augmented release of soluble material into the culture medium. Monovalent Fab fragments of BU40 antibody were as efficient as intact antibodies at synergizing with IL-4 for enhanced expression and release of CD23: thus simple tethering without the need for receptor cross-linking was sufficient to invoke change through CD72. Enhancement of CD23 expression via CD72 appeared to be selective for IL-4-dependent induction: the turn on of CD23 by tumour-promoting phorbol ester was left unaltered on the addition of BU40 antibody. Engagement of CD72 had no effect on the IL-4-promoted hyperexpression of surface IgM. The findings are discussed within the context of the molecular and functional interactions occurring during T-B collaboration.

Antibodies, Monoclonal↗
PubMed2004

Indianapolis I3: the third generation Integrated Advanced Information Management Systems.

In 2001, the Regenstrief Institute for Health Care and the Indiana University School of Medicine (IUSM) began an IAIMS planning effort to create a vision and a tactical plan for the first Integrated Advanced Information Management Systems (IAIMS) implementation to cross a large area and include unaffiliated institutions. A number of elements made this planning effort unique. Among these elements were the existence of a network infrastructure that supported the Indianapolis Network for Patient Care, the existence of a mature medical informatics program at the Regenstrief Institute, and the existence of a wide-area knowledge network fostered by the IUSM libraries. However, the leadership for a strong information technology role in the IUSM that could promote collaboration in support of education and research across the diverse Indianapolis hospital systems had been lacking. By bringing together various groups, each with a commitment to improve health care quality and public health across the Indianapolis metropolitan area, regardless of individual institutional affiliation, the strategic directions for I3-Indianapolis IAIMS Initiative have been defined and the foundations for a third generation IAIMS construct have been laid in Indianapolis, Indiana.

Academic Medical Centers↗
PubMed1984

Antigen-specific T helper clones in a nonresponder strain require augmentation for expression of helper activity. Evidence for a possible antigen presentation defect in B cells.

Hen egg-white lysozyme (HEL)-specific Thy-1+, Lyt-1+2- T cell lines and clones were derived from the nonresponder C57BL/6 strain. Although the antigen-specific proliferative response of these T cells in the presence of syngeneic irradiated spleen cells as a source of antigen-presenting cells (APC) was normal, the same cells were incapable of stimulating B cells to secrete antibody in vitro. This deficiency could, however, be corrected by the addition of an excess of normal T cells or a supernatant from concanavalin A-stimulated rat spleen cells. Alternatively, the use of highly cross-reactive ring-necked pheasant lysozyme in the cultures allowed expression of efficient help, ruling out any inherent deficiency in the T cells. The antibody response was specific and required MHC compatibility between the T lines and responding B cells. By using (H-2b X H-2d)F1 B cells and another H-2d-restricted HEL-specific T line, it was shown that only the H-2b-restricted T-B collaboration required exogenous factors, and the H-2d-restricted collaboration did not. Because both proliferative and helper responses are dependent upon MHC-restricted antigen presentation by macrophage-APC and B cells, respectively, these results suggest that the defect in the nonresponder H-2b-restricted T-B collaborative pathway may relate to the inability of B cells to adequately process and present HEL to clonal T cells.

Animals↗
PubMed2000

Functional recognition of 5' splice site by U4/U6.U5 tri-snRNP defines a novel ATP-dependent step in early spliceosome assembly.

A sensitive assay based on competition between cis-and trans-splicing suggested that factors in addition to U1 snRNP were important for early 5' splice site recognition. Cross-linking and physical protection experiments revealed a functionally important interaction between U4/U6.U5 tri-snRNP and the 5' splice site, which unexpectedly was not dependent upon prior binding of U2 snRNP to the branch point. The early 5' splice site/tri-snRNP interaction requires ATP, occurs in both nematode and HeLa cell extracts, and involves sequence-specific interactions between the highly conserved splicing factor Prp8 and the 5' splice site. We propose that U1 and U5 snRNPs functionally collaborate to recognize and define the 5' splice site prior to establishment of communication with the 3' splice site.

Adenosine Triphosphate↗
PubMedDate not supplied

Public health nursing directors' perceptions regarding interagency collaboration with community mental health agencies.

Involvement in collaborative interagency relationships is crucial to the future of public health nursing and public health agencies. The purpose of this study was to describe public health nursing directors' perceptions regarding relationships between public health agencies and mental health agencies in their communities. A secondary analysis was conducted of textual responses to open-ended questions and unsolicited comments from 71 (55%) the of respondents to a larger survey of nursing directors of all public health agencies in Ohio. Data were analyzed inductively using content analysis for emergent themes and patterns, which were organized and classified deductively according to a community interagency collaboration framework. Public health nursing directors described environmental, situational, task, and interagency factors that impact collaboration between their agencies and local community mental health agencies. These descriptions provide a context for understanding impediments to collaboration between these two types of agencies, and have implications for designing interventions to enhance public health nursing directors' skills at marketing both their profession and their agencies. Collaborative relationships between public health and mental health agencies could improve care for community-dwelling persons with severe mental disabilities and enhance the future of public health nursing in a changing, competitive health care system.

Community Mental Health Services↗
PubMedDate not supplied

Congenital erythrocytosis and polycythemia vera in childhood and adolescence.

Polycythemia vera - the most frequent form of a primary erythrocytosis in adult patients - represents an extremely rare disease in pediatric and juvenile patients as do congenital primary and secondary erythrocytoses. Frequently, in patients with these diseases clinical problems do not occur before adulthood. Systematic data on clinical and laboratory evaluations as well as on treatment regimens are sparse. In addition, in the majority of cases with congenital erythrocytosis, the etiology is unknown. For those reasons, a protocol (PV-ERY-KA 03) for the systematic collection of clinical, hematological, biochemical, biological as well as treatment data of children and adolescents with polycythemia vera or congenital erythrocytosis including the hemoglobinopathies with high affinity hemoglobin, familial 2,3-BPG deficiencies, and those of unknown origin, has been developed. These data are combined with molecular analyses which focus initially on EPO-receptor and vHL-gene examination, but will later be extended into presently unexplored pathophysiologic regulatory circuits. In addition, pathophysiologic changes due to the erythrocytosis will be studied. The co-ordinated medical care for patients with those rare diseases within a collaborative trial accompanied by scientific projects is aimed at the improvement of the treatment of these patients as well as to a better understanding of the underlying biological processes.

2,3-Diphosphoglycerate↗
PubMed2006

EMBL Nucleotide Sequence Database in 2006.

The EMBL Nucleotide Sequence Database (http://www.ebi.ac.uk/embl) at the EMBL European Bioinformatics Institute, UK, offers a large and freely accessible collection of nucleotide sequences and accompanying annotation. The database is maintained in collaboration with DDBJ and GenBank. Data are exchanged between the collaborating databases on a daily basis to achieve optimal synchrony. Webin is the preferred tool for individual submissions of nucleotide sequences, including Third Party Annotation, alignments and bulk data. Automated procedures are provided for submissions from large-scale sequencing projects and data from the European Patent Office. In 2006, the volume of data has continued to grow exponentially. Access to the data is provided via SRS, ftp and variety of other methods. Extensive external and internal cross-references enable users to search for related information across other databases and within the database. All available resources can be accessed via the EBI home page at http://www.ebi.ac.uk/. Changes over the past year include changes to the file format, further development of the EMBLCDS dataset and developments to the XML format.

Base Sequence↗
PubMed2005

The systemic lupus erythematosus tri-nation study: longitudinal changes in physical and mental well-being.

OBJECTIVE: We have shown that SLE patients in Canada and the UK incurred 20% and 13% lower health costs than those in the US, respectively, but did not experience worse outcomes as expressed by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. We now compare change in quality of life in these patients. PATIENTS AND METHODS: Seven hundred and fifteen SLE patients (Canada 231, US 269, UK 215) completed the SF-36 annually over four years. The annual change in the SF-36 Physical and Mental Component Summary (PCS and MCS) scores over the course of the study were summarized by estimating a linear trend for each individual patient using hierarchical modelling. Cross-country comparison of the slopes in the PCS and MCS scores was then performed using simultaneous regressions. RESULTS: The estimated mean annual changes (95% credible interval [CrI]) in the PCS scores in Canada, the US, and the UK were 0.18 (-0.07, 0.43), -0.05 (-0.27, 0.17), and 0.03 (-0.20, 0.27), respectively; the mean annual changes in the MCS scores were 0.15 (-0.04, 0.34), 0.23 (0.09, 0.37), and 0.08 (-0.10, 0.27), respectively. Regression results showed that the mean annual changes in PCS and MCS scores did not substantially differ across countries. CONCLUSION: Quality of life remained stable across countries. Despite Canadian and British patients incurring lower health costs, on average, patients experienced similar changes in physical and mental well-being.

Adult↗
PubMedDate not supplied

Review: neurotoxicity of lead.

'Lead and its compounds are potentially toxic; the element has no known physiological function; it is widely distributed in nature and as a result of man's activities' (Lawther Report: DHSS 1980). Concern grew in the late 1970s that even low levels of exposure to lead caused adverse changes in children's adjustment and academic attainment. This paper traces the rapid developments of the past decade in investigating the relationship between body lead burden and relevant outcome measures. Research strategies moved from small-scale, clinical-descriptive studies to large-scale epidemiological studies; from cross-sectional studies to longitudinal ones. Agreement had to be reached on how to measure body lead burden. Decisions had to be made on which outcome measures to use. Measures of global intelligence were complemented by measures of academic attainment, emotional adjustment and hyperactivity, as well as by experimental measures of more basic psychophysiological functioning. Ways had to be found of dealing experimentally and statistically with socioeconomic factors which acted as confounds. The investigations were marked by tremendous collaboration between investigators, between national agencies and across countries. The methodological issues are relevant to the investigation of other toxins and they define a field of developmental behavioural toxicology. This case study can act as a model for investigating the effects of other environmental toxins and hazards.

Child↗
PubMed2001

Implementation of strategies to control antimicrobial resistance.

Antimicrobial resistance has emerged as a major public health issue in recent years. A steady increase in resistance continues despite the introduction of new antibiotics, and resistant bacteria have been associated with increased patient morbidity and mortality as well as with increased costs. Addressing the problem of antimicrobial resistance requires both infection control and regulation of antibiotic use; addressing either alone is insufficient. Mounting evidence shows that control of the use of broad-spectrum antibiotics (especially vancomycin and third-generation cephalosporins) and implementation of infection control measures can result in decreased incidence of antibiotic-resistant bacteria such as vancomycin-resistant enterococci and extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella. Recent reports from professional organizations and a consensus of experts have outlined strategies for the control of resistance in hospitals, with specific measures identified for antibiotic control and infection control. These reports have emphasized the importance of a multidisciplinary approach in tackling this problem in hospitals and have suggested that a quality-improvement model be used to address antimicrobial resistance. A close collaboration among the disciplines of infectious diseases, microbiology, hospital epidemiology, pharmacy, and nursing, with particular emphasis in ICUs, and with strong support from hospital leadership, can result in an effective program that can be readily incorporated into the quality-improvement goals of any health-care organization.

Bacterial Infections↗
PubMed2003

Update: Outbreak of severe acute respiratory syndrome--worldwide, 2003.

CDC continues to support the World Health Organization (WHO) in the investigation of a multicountry outbreak of unexplained atypical pneumonia referred to as severe acute respiratory syndrome (SARS). This report includes summaries of the epidemiologic investigations and public health responses in several affected locations where CDC is collaborating with international and national health authorities. This report also describes an unusual cluster of cases associated with a hotel in Hong Kong and identifies the potential etiologic agent of SARS. Epidemiologic and laboratory investigations of SAPS are ongoing.

Communicable Diseases, Emerging↗
PubMed2004

The collaborative method. A strategy for improving Australian general practice.

BACKGROUND: The United Kingdom National Primary Care Collaborative (NPCC) is said to be the largest health service improvement project in the world. The 2000 practices participating serve 11.5 million patients throughout the UK. Improvements such as a 60% reduction in waiting times to see a general practitioner and a four-fold reduction in coronary heart disease mortality have drawn the attention of policy makers in Australia. In 2003, I accompanied a group of Australians to Manchester in the UK to participate in an international training course in collaboratives hosted by the NPCC. The Australian government has recently called for tenders to run the Australian Primary Care Collaborative (APCC) program. OBJECTIVE: To describe the NPCC and discuss how the methodology could be adapted and applied to Australia. DISCUSSION: The Australian primary health care system faces challenges in application of evidence to patient care. Collaborative methodology warrants consideration to address these. Differences including distance, business issues, remuneration mechanisms, infrastructure deficiencies and clinician cynicism present challenges in adaptation and application to Australia. Given adequate support, an APCC could empower general practices to continue to make improvements in many areas of activity.

Australia↗
PubMedDate not supplied

The utility of ethnographic methods in medical research: experience with substance use disorders.

Ethnographic research methodology provides investigators with the opportunity to explore various ways in which culture affects and modulates human behaviour and beliefs. These methods, even though commonly used in medical anthropology, are often neglected in the main-stream of medical research, possibly as a result of relative unfamiliarity with their principles and techniques. Drawing on experience gained in Ibadan during a WHO collaborative study in nine different countries, we demonstrate the use of key informants interview and focus group techniques. We conclude that the methods are easy to learn and apply, and have potentials for helping researchers in many areas of medicine to address important questions.

Anthropology, Cultural↗