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This chapter begins by providing an overview of current philosophies relevant to equine pain management. Objective and subjective techniques for assessing pain and the limitations of these are then described in depth. The conclusion emphasizes the need for an evidence based approach to managing pain in the horse and sets the stage for subsequent chapters in this edition.
In this edition of Public Health, McClure and colleagues report on research that considered the criterion validity of indicators based on serious long bone fracture and length of stay in hospital. They found that neither were sensitive or specific indicators for serious injury as defined by an Injury Severity Score (ISS) of 16 or more. They contend that their study findings ' em leader strongly support a return to a measure similar in intent to that encapsulated in the original UK Green Paper em leader '. We contend that their analysis does not provide any empirical evidence to support their view that there should be a return to the Green Paper: Our Healthier Nation indicator. Furthermore, we consider the analyses that they carry out to validate both the Saving Lives: Our Healthier Nation and the serious long bone fracture indicators are flawed. We agree that national (or state) indicators are very influential. They encourage preventive action and resource use aimed at producing favourable changes to these indicators. However, each of the four non-fatal indicators considered in their analysis have problems. Formal validation of existing indicators is necessary and the following aspects of validity should be addressed: face; criterion; consistency; and completeness and accuracy of the source date. Taking into account the current national data systems in England, possible options for one or more national non-fatal unintentional injury indicators have been proposed in our paper. Furthermore, the International Collaborative Effort on Injury Statistics (ICE) Injury Indicators Group is about to embark on the development of a strategic framework for the development of valid indicators of non-fatal injury occurrence.
BACKGROUND: This paper outlines the ways in which a little-used archive of early public health records may throw light on longer-term trends in international epidemic behaviour and serve as a major source of epidemiological information for historians of urbanization and public health. The Weekly Abstract of Sanitary Reports was the official disease surveillance report of the US Public Health Service and its predecessors, and began to publish urban mortality statistics on a regular basis in 1888. Here, the authors describe the first 25 years of continuous reporting (1888-1912), when the Reports contained not only disease data for US cities, but also records sent back by US consuls based in some 250 cities in many parts of the world. METHODS: The content of the weekly editions of the Reports was systematically sampled and analysed using graphical techniques and the simple statistical method of running means. RESULTS: Relatively complete weekly series of mortality from all causes, and six infectious diseases (diphtheria, enteric or typhoid fever, measles, scarlet fever, tuberculosis and whooping cough) were identified for a total of 100 cities world-wide. CONCLUSION: Reporting coverage for these cities is sufficiently complete that multivariate analysis should be possible to obtain a comparative picture of mortality for many parts of the world. Despite limitations of the data, sources of the type described in this paper form an important comparative database for studying international patterns of mortality.
OBJECTIVE: The objective of this study was to examine the relationship between healthcare use and children's healthcare needs as assessed from the perspectives of children themselves, parents, and healthcare practitioners. RESEARCH DESIGN: We conducted a prospective cohort study in which service use was monitored for the 12 months before and after administration of a health survey. SUBJECTS: We studied 384 parents and children aged 6 to 11 years enrolled for 2 years in a northern California health maintenance organization or a Medicaid managed care program in Rhode Island. MEASURES: Child and parent perspectives on needs were determined using the Child Health and Illness Profile, Child Edition (CHIP-CE). Plan administrative data were used to develop a treated morbidity index, which was based on diagnosis codes recorded by practitioners during the year before the survey and to obtain prospective measures of service use. RESULTS: For both child- and parent-respondents, low satisfaction and comfort scale scores from the CHIP-CE were significant predictors of number of visits. CHIP-CE domain scales unrelated to future use were risk avoidance, resilience, and achievement. Multivariable regression using CHIP-CE information collected from children explained more variation in total physician visits than models that used parent-respondent data. The treated morbidity index was a weaker predictor of physician visits than the CHIP-CE scale scores. None of the domain scales were significant predictors of any emergency department use or any specialist use; however, the treated morbidity index was associated with any specialist use. CONCLUSIONS: A child's sense of well-being and burden of symptoms predict future use. Perceived healthcare needs, as assessed by the CHIP-CE, is a better predictor of children's service use than evaluated needs as assessed by physician-diagnosed disorders. Our results support the validity of using the responses of children aged 6 to 11 years as a measure of need for future health care.
The International World Health Organisation (WHO) classification of central nervous system tumours does not give an extensive classification of germ cell tumours and other malformative tumours and tumour-like lesions. In the same way, no consistent classification of dysontogenetic brain tumours can be found in the classical handbooks. For an eventual new edition of the WHO classification, it is proposed to reconsider and improve the classification of these tumours, based on their ontogenetic relations.
This study evaluated the accuracy of home care nurses' ratings of the Outcome and Assessment Information Set (OASIS) depression items. The accuracy of home care nurses' depression assessments was studied by comparing nurse ratings of OASIS depression items with a research diagnostic assessment based on the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). The setting for this study was a nonprofit, Medicare-certified, voluntary home healthcare agency. Sixty-four home care nurses assessed 220 patients aged 65 and older with the OASIS upon admission. Of the 220 patients, using standard SCID criteria, 35 cases of major or minor depression were identified. The home care nurses accurately documented the presence of depression in 13 of 35 cases (sensitivity=37.1%; positive predictive value=0.56). Of the 220 patients, 185 had no SCID-identified major or minor depression. The nurses agreed on the absence of depression in 175 of 185 cases (specificity=94.6%; negative predictive value=88.8%). This study indicates that home care nurses often do not accurately rate OASIS depression items for older adult patients.
OBJECTIVE: The aim of this study was to systematically review published literature about the prevalence, incidence, and natural history of irritable bowel syndrome (IBS) in North America. METHODS: A computer-assisted search of MEDLINE, EMBASE, and Current Contents/Science Edition databases was performed independently by two investigators. Study selection criteria included: 1) North American population-based sample of adults; 2) objective diagnostic criteria for IBS (i.e., Rome or Manning criteria); and 3) publication in full manuscript form in English. Eligible articles were reviewed in a duplicate and independent manner. Data extracted were converted into individual tables and presented in descriptive form. RESULTS: The prevalence of IBS in North America ranges from 3% to 20%, with most prevalence estimates ranging from 10% to 15%. The prevalences of diarrhea-predominant and constipation-predominant IBS are both approximately 5%. Published prevalence estimates by gender range from 2:1 female predominance to a ratio of 1:1. Constipation-predominant IBS is more common in female individuals. The prevalence of IBS varies minimally with age. No true population-based incidence studies or natural history studies were found. In one cohort surveyed on two occasions 1 yr apart, 9% of subjects who were free of IBS at baseline reported IBS at follow-up producing an onset rate of 67 per 1000 person-years. In all, 38% of patients meeting criteria for IBS did not meet IBS criteria at 1-yr follow-up. CONCLUSION: Approximately 30 million people in North America meet the diagnostic criteria for IBS. However, data about the natural history of IBS is quite sparse and renewed efforts should be focused at developing appropriately designed trials of the epidemiology of IBS.
OBJECTIVE: Recurrent abdominal pain (RAP) of childhood is a common problem encountered by clinicians. The aim of this study was to systematically review published literature about the prevalence, incidence, natural history, and co-morbid conditions of childhood RAP in western countries. METHODS: A computer-assisted search of MEDLINE, EMBASE, and Current Contents/Science Edition databases was performed. Study selection criteria included: (1) United States and European population and school-based samples of children; (2) diagnostic criteria of RAP; and (3) published in full manuscript form in English. Data were extracted, tabulated, and presented in descriptive form. RESULT: The prevalence of RAP ranged from 0.3 to 19% (median 8.4; IQR 2.3-14.7). Published studies in children demonstrate a higher prevalence of RAP in females, with the highest prevalence of symptoms between 4 and 6 yr and early adolescence. Identified studies demonstrated associations between RAP and the child's familial and socioeconomic environment. In addition, childhood RAP was reported to be associated with psychological co-morbidity in childhood and adulthood. Population/school-based studies have not, however, established the incidence of this disorder, what features predict long-standing symptoms, or whether RAP is a risk factor for adult functional bowel disorders. CONCLUSION: RAP is a common complaint of childhood with associated familial, psychological, and co-morbid conditions. Epidemiologic studies of RAP in children may offer information on the evolution of functional bowel disorders through the lifespan.
The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that the methods offered for specification and balancing of principles are inadequate.
A number of knowledge management systems have been developed to allow users to have access to large quantity of neuroanatomical data. The advent of three-dimensional (3D) visualization techniques allows users to interact with complex 3D object. In order to better understand the structural and functional organization of the brain, we present Neuroanatomical Affiliations Visualization-Interface System (NAVIS) as the original software to see brain structures and neuroanatomical affiliations in 3D. This version of NAVIS has made use of the fifth edition of "The Rat Brain in Stereotaxic coordinates" (Paxinos and Watson, 2005). The NAVIS development environment was based on the scripting language name Python, using visualization toolkit (VTK) as 3D-library and wxPython for the graphic user interface. The following manuscript is focused on the nucleus of the solitary tract (Sol) and the set of affiliated structures in the brain to illustrate the functionality of NAVIS. The nucleus of the Sol is the primary relay center of visceral and taste information, and consists of 14 distinct subnuclei that differ in cytoarchitecture, chemoarchitecture, connections, and function. In the present study, neuroanatomical projection data of the rat Sol were collected from selected literature in PubMed since 1975. Forty-nine identified projection data of Sol were inserted in NAVIS. The standard XML format used as an input for affiliation data allows NAVIS to update data online and/or allows users to manually change or update affiliation data. NAVIS can be extended to nuclei other than Sol.
Thirty-five patients suffering from schizophrenia, as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were preselected from 7 clinical trials according to a priori criteria of catatonic signs and symptoms based on 3 Positive and Negative Syndrome Scale (PANSS) items: scores for PANSS item 19 (mannerism and posturing) and either item 4 (excitement) or item 21 (motor retardation) had to exceed or equal 4 at baseline. This particular patient population represents a severely psychotic sample: mean +/- SD PANSS total scores at baseline were 129.26 +/- 19.76. After I week of olanzapine treatment, mean PANSS total score was decreased significantly (-13.14; p < .001), as was mean PANSS total score after 6 weeks of olanzapine treatment (-45.16; p < .001); additionally, the positive subscale, negative subscale, and mood scores improved significantly. A significant improvement in the catatonic signs and symptoms composite score was also observed at week 6 (-4.96; p < .001). The mean +/- SD daily dose of olanzapine was 18.00 +/- 2.89 mg after 6 weeks of treatment. The present data analysis suggests the efficacy of olanzapine in the treatment of severely ill schizophrenic patients with nonspecified catatonic signs and symptoms.
The new entities of cysts and odontogenic tumors of the second edition of WHO "Histological Typing of Odontogenic Tumors" (Kramer et al., 1992) are presented. The classification is based on tumor behavior. The benign epithelial odontogenic tumors are classified in relation to tooth development. The malignant odontogenic tumors are subdivided in carcinomas, sarcomas and carcinosarcomas, which are very rare. This international classification has the purpose to make rare cases comparable, so that more detailed knowledge of their characteristics can be achieved. Types of bone tumor that also occur in other parts of the skeleton are not discussed here.
OBJECTIVE: To determine the self-perceived continuing education needs of current certified athletic trainers and the factors that affect those needs. DESIGN AND SETTING: Self-reporting surveys using a Likert-type scale were sent to 2000 certified athletic trainers. SUBJECTS: All subjects were certified athletic trainers working in the United States. MEASUREMENTS: A 3-part survey of continuing education participation, continuing education needs, and demographic data was developed. Continuing education items were based on the domains of athletic training as defined by the Athletic Training Role Delineation Study, 3rd edition. RESULTS: The response rate was 52% (1040/2000). Athletic trainers in this study perceived "some to moderate need" for continuing education within each of the domains. Rehabilitation of Athletic Injuries (domain 3) was the area in which athletic trainers saw the most need for continuing education. The back and neck were specific anatomical areas perceived by the athletic trainers as needing the highest level of continuing education. Sex was a significant factor in the perceived importance of continuing education within all but domain 5, Professional Development and Responsibility. Other factors included employment setting and years of experience. CONCLUSIONS: Athletic trainers in this study perceived each of the tasks within the domains to be at least "somewhat important," with rehabilitation and specific continuing education programs for the back and neck being the most important. Sex, employment setting, and years of experience may influence what athletic trainers think is important. Therefore, continuing education providers should attempt to vary programs and tailor them to various audiences.
UNLABELLED: This study evaluates the mucociliary transport system in patients with diffuse panbronchiolitis using aerosol inhalation cine-scintigraphy (AICS). METHODS: Forty-one subjects, 10 healthy controls and 31 patients with diffuse panbronchiolitis, were studied. In addition, the mucociliary transport system was evaluated in 11 patients who had received erythromycin therapy for 3-8.3 yr. Following inhalation of 99mTc-human serum albumin aerosol for 3-5 min in a sitting position, the subjects were placed on the imaging table in the supine position and posterior images were obtained dynamically for 20 sec/frame over 2 hr with a gamma camera linked to a digital computer. The 360 20-sec serial frames were edited into a cinematographic presentation at 200-msec intervals. Clinical evaluation of the mucociliary transport system was based on the bolus movement of radioactive aerosol from the main bronchi to the trachea and the movement patterns, which were divided into four types using the movement in the controls as a standard (type I): type I, rapid and smooth movement; type II, slow movement; type III, stagnation at the carina; and type IV, complete stasis. RESULTS: All patients with diffuse panbronchiolitis had types III and IV, indicating that mucociliary transport system was severely impaired. Of the 11 patients on erythromycin therapy, 8 had movement pattern type IV and 3 had movement pattern type III before erythromycin therapy. In eight patients (72.7%), movement pattern was improved to type I or II after therapy. CONCLUSION: Aerosol inhalation cine-scintigraphy helps evaluate the clinical usefulness of erythromycin therapy in diffuse panbronchiolitis.
This is an edited version of the evidence from The Medical Council on Alcoholism (MCA) on 'Sensible Drinking', which is based on the collective views of the Education and Public Health Committee and of The MCA Regional Advisers in medical schools throughout the UK. The contributors are not only university teachers, but also clinicians and health service providers in touch with patients and the public. On one aspect there is total unanimity. On no account should the 21/14 units per week figures for men and women, respectively, be changed: the evidence indicates that this could only lead to increased harm. There seems to be some scope for restatement of the significance of the benchmark such as that 'below 21/14 units per week is a sensible level, and that, at twice this level, there is an appreciable increase in risk of harm which continues to increase as consumption rises'. Drink-free days are recommended, but the need to suggest an additional curb on intake on any given occasion is also emphasized, since heavy consumption of this sort is that which is particularly associated with behavioural and psychosocial problems, notably in the young. Driving is an obvious example where any drinking could be dangerous. A simple statement such as 'avoid intoxication and do not exceed 6/4 units in a day, while maintaining the weekly guidelines as at present and bearing in mind the circumstances' is proposed.
Myelokathexis is a rare from of neutropenia that is probably congenital, characterized by severe noncyclic neutropenia, recurrent infections, granulocytic hyperplasia of the bone marrow, and degenerative changes in mature neutrophils. The cause remains uncertain. A case of myelokathexis was reported in a father and two daughters, and based on this, myelokathexis was given an autosomal-dominant inheritance in Mendelian Inheritance in Man (11th edition, 1994). We present the case of a 12-month-old male with chronic neutropenia and the morphologic features of myelokathexis whose mother carries the same diagnosis, providing additional evidence in favor of dominant transmission.
A lactonohydrolase from Fusarium oxysporum AKU 3702 is an enzyme catalyzing the hydrolysis of aldonate lactones to the corresponding aldonic acids. The amino acid sequences of the NH2 terminus and internal peptide fragments of the enzyme were determined to prepare synthetic oligonucleotides as primers for the PCR. An approximate 1, 000-base genomic DNA fragment thus amplified was used as the probe to clone both genomic DNA and cDNA for the enzyme. The lactonohydrolase genomic gene consists of six exons separated by five short introns. A novel type of RNA editing, in which lactonohydrolase mRNA included the insertion of guanosine and cytidine residues, was observed. The predicted amino acid sequence of the cloned lactonohydrolase cDNA showed significant similarity to those of the gluconolactonase from Zymomonas mobilis, and paraoxonases from human and rabbit, forming a unique superfamily consisting of C-O cleaving enzymes and P-O cleaving enzymes. Lactonohydrolase was expressed under the control of the lac promoter in Escherichia coli.
The mitochondrial gene coding for subunit 4 of the NADH dehydrogenase complex I (nad4) has been isolated and characterized from lettuce, Lactuca sativa. Analysis of nad4 genes in a number of plants by Southern hybridization had previously suggested that the intron content varied between species. Characterization of the lettuce gene confirms this observation. Lettuce nad4 contains two exons and one group IIA intron, whereas previously sequenced nad4 genes from turnip and wheat contain three group IIA introns. Northern analysis identified a transcript of 1600 nucleotides, which represents the mature nad4 mRNA and a primary transcript of 3200 nucleotides. Sequence analysis of lettuce and turnip nad4 cDNAs was used to confirm the intron/exon border sequences and to examine RNA editing patterns. Editing is observed at the 5' and 3' ends of the lettuce transcript, but is absent from sequences that correspond to exons two, three and the 5' end of exon four in turnip and wheat. In contrast, turnip transcripts are highly edited in this region, suggesting that homologous recombination of an edited and spliced cDNA intermediate was involved in the loss of introns two and three from an ancestral lettuce nad4 gene.