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PubMed2004

People with learning disabilities in a low secure in-patient unit: comparison of offenders and non-offenders.

BACKGROUND: People with learning disability who exhibit challenging behaviour are frequently segregated from services and local teams are often reluctant to receive them back into their care. This situation is worse in those whose challenging behaviour includes a forensic history, but the difference between those labelled as challenging and those treated as offenders is not clear, and there is a lack of evidence about treatment effectiveness. AIMS: To test between-group differences in aggression and treatment outcome in people with learning disability and challenging behaviour, with and without a forensic history. METHOD: Clinical records of 86 former in-patients (45 offenders and 41 non-offenders) of a specialist unit were compared on measures of behavioural disturbance and placement outcome. RESULTS: People in the offenders group were significantly less likely to be aggressive to others and to use weapons, but significantly more likely to harm themselves compared with the non-offenders group. Both groups had a significant reduction in their challenging behaviour during admission, and there was no significant difference in treatment outcome. CONCLUSIONS: The negative reputation of people with learning disabilities who offend needs to be reconsidered.

Adolescent↗
PubMed1991

Twenty-four-hour profile of plasma glucose and glucoregulatory hormones during normal living conditions in trained and untrained men.

Compared with untrained (UT) subjects, in trained (T) subjects the increased insulin sensitivity and decreased glucose induced insulin secretion would tend to promote health by decreasing glucose levels and insulin secretion whereas the increased food intake would tend to increase these variables. To study the net effect of training, blood was sampled from seven T and eight UT young men [VO2max: 76 +/- 2 (T) vs. 48 +/- 1 (UT) mL.kg-1.min-1] for 24 h during ordinary living conditions. Athletes exercised 204 +/- 20 min and ate 50% more calories and 130% more carbohydrate than UT subjects (P less than 0.05). However, 24-h integrated plasma concentrations of glucose, C-peptide, glucagon, free fatty acids, and glycerol as well as glycosylated hemoglobin levels were identical in T and UT subjects. Mean insulin concentration was 41% lower in T than in UT but levels differed significantly (P less than 0.05) only late during the night. Urinary excretion of pancreatic peptides paralleled plasma concentrations. In conclusion, during training adaptations in pancreas- and insulin-sensitive tissues allow the necessary increase in food intake without harmful hyperglycemia and overloading of beta-cells, but sparing of insulin secretion and reductions in glucose levels are only relative to food intake. However, training may be wholesome by increasing hepatic insulin extraction and thereby decreasing arterial insulin levels. Training-induced beta-cell adaptation is not caused by diminished average glucose levels. Finally, renal handling of insulin, C-peptide, and glucagon is not influenced by training.

Adult↗
PubMed2000

Stigma reduction through group counselling of persons affected by leprosy--a pilot study.

Stigmatization of persons with leprosy causes the emotional harm of social, economic and spiritual deprivation. Individual counselling has benefits in addressing these psychosocial problems but is a slow process and effects few people at any one time. Our experience of group counselling of stigmatized persons achieved the following: addressing common issues to more than one person at a time, encouraging the unity of sufferers, developing compassion for others, understanding the common effects of stigmatization, and beginning to overcome its harmful effects.

Adaptation, Psychological↗
PubMed2004

[Risk and prevention in cardiovascular diseases].

The RCTs are the most important sources of drug therapy related scientific evidence (RCT--Randomised Controlled clinical Trials). In most cases RCTs studying identical or similar clinical issues are slightly or considerably varied. However, for such cases we have the appropriate methodology to compare the more or less different RCT results. This publication was written to provide a general overview of this methodology such as relative and absolute risk reduction (RRR, ARR), odd ratio (OR), number needed to treat and number needed to harm (NNT, NNH).

Cardiovascular Diseases↗
PubMedDate not supplied

Firearms injuries and deaths: a critical public health issue. American Medical Association Council on Scientific Affairs.

The prevention of firearm deaths and injuries is one of the most complex and controversial issues facing the public health profession in recent years. Laws have been enacted to control or discourage private gun ownership, and especially to eliminate guns from the hands of criminals, but the laws' effects in reducing crime and firearm-related injuries and deaths have been disappointing. Gunshot wounds are the 12th leading cause of death in the United States and more than half of all suicides are committed with guns. There are virtually no reliable data on the number of nonfatal firearm injuries. One of the most troubling aspects of handgun violence is that children often are the victims. Educational efforts have been attempted to promote the safer use of firearms, but they have not led to a significant reduction in the number of fatalities, since most firearm incidents are intended to do harm.

Adolescent↗
PubMed1994

[Complications of eating disorders].

Among eating disorders, the incidence and prevalence of anorexia nervosa and bulimia nervosa are reported to be on the increase. The diverse--and possibly fatal--consequences of these disorders are reviewed by the authors. The process of fasting-dieting, the bingeing episode or the methods applied for weight reduction (self-vomiting, use of laxatives, diuretics, diet pills, extreme exercise) can be harmful to the organism, either alone, or in combination. After reviewing the gastrointestinal, cardiovascular, pulmonary, renal, hematological, gynecological, endocrine, neurological, orthopedic, dermatologic, laryngologic and dental complications, the authors high-light anamnestic data and clinical signs on the basis of which eating disorders can be diagnosed.

Adolescent↗
PubMed1993

Effectiveness of general practice interventions for patients with harmful alcohol consumption.

Harmful alcohol consumption can have severe consequences for both the individual and society. A review of the six published studies on the effectiveness of general practitioner interventions for individuals with harmful alcohol consumption suggests that between five and 10 minutes of advice leads to reductions of alcohol consumption of around 25-35% at follow up six months or one year later. Two of the three studies which failed to demonstrate an intervention effect had inadequate sample sizes and in two of the studies the control group was a comparison group which received minimal advice to reduce alcohol consumption. There was greater evidence for an intervention effect among men than women. The methodological problems of the studies are discussed.

Alcohol Drinking↗
PubMed1998

In vivo dynamic stiffness of the porcine lumbar spine exposed to cyclic loading: influence of load and degeneration.

The dynamic axial stiffness of the L2-3 motion segment subjected to vibratory loading under intact and injured states of the intervertebral disc was studied using an in vivo porcine model. Three groups of animals with the following states of the intervertebral discs were studied: intact disc, acutely injured disc, and degenerated disc. A miniaturized servo-hydraulic exciter was used to sinusoidally vibrate the motion segment from 0.05 to 25 Hz under a compressive load with a peak value of either 100 or 200 N. The dynamic axial stiffness of the intervertebral disc was calculated at 1-Hz intervals over the frequency range. The results showed that the dynamic axial stiffness was frequency dependent. A positive relationship was found between an increase in mean dynamic stiffness and load magnitude. An increase in mean stiffness with successive exposures at the same load magnitude was observed, despite the allowance of a recovery period between loading. The greatest difference was noted between the first and second load sets. No significant change in stiffness was found due to an acute disc injury, whereas a significant increase in mean stiffness was found for the degenerated disc group as compared with the intact group. The form of the frequency response curve, however, remained relatively unaltered regardless of the degenerated state of the disc. With heavier loads, repeated loading, and/or disc degeneration, the stiffness of the intervertebral disc increases. An increase in stiffness can mean a reduction in the amount of allowable motion within the motion segment or a potentially harmful increase in force to obtain the desired motion. This may locally result in greater stresses due to an altered ability of the disc to distribute loads.

Animals↗
PubMed2005

1,2,4,5-Tetra([5]trovacenyl)benzene: an organometallic tetraradical displaying pronounced electro- and magnetocommunication.

The organometallic tetraradical 1,2,4,5-[(eta)7-C7H7)V(all eta]5-C5H4)]4C6H2 has been prepared and structurally characterized. The isotropic EPR spectrum displays 29 a(51V) hyperfine lines, the intensity distribution slightly deviating from binomial. Exchange coupling therefore approaches the strong exchange limit, J(ortho) not equal to J(meta) not equal to J(para) greater or approximately 50 a(51V) with a(51V)= 0.0067 cm(-1). According to magnetic susceptometry, the interaction is antiferromagnetic. While redox splittings deltaE(1/2) are resolved for the four reduction steps this is not the case for oxidation.

Electrochemistry↗
PubMed1995

Hemophilia and von Willebrand's disease: 2. Management. Association of Hemophilia Clinic Directors of Canada.

OBJECTIVE: To present current strategies for the treatment of hemophilia and von Willebrand's disease. OPTIONS: Prophylactic and corrective therapy with hemostatic and adjunctive agents: DDAVP (1-desamino-8-D-arginine vasopressin [desmopressin acetate]), recombinant coagulation products (human Factor VIII and human Factor VIIa) or virally inactivated plasma-derived products (high- or ultra-high-purity human Factor VIII or human Factor VIII concentrate containing von Willebrand factor activity, porcine Factor VIII, high-purity human Factor IX, human prothrombin-complex concentrate, human activated prothrombin-complex concentrate), adjunctive antifibrinolytic agents, topical thrombin and fibrin sealant. The induction of immune tolerance in patients in whom inhibitors develop should also be considered. OUTCOMES: Morbidity and quality of life associated with bleeding and treatment. EVIDENCE: Relevant clinical studies and reports published from 1974 to 1994 were examined. A search was conducted of our reprint files, MEDLINE, citations in the articles reviewed and references provided by colleagues. In the MEDLINE search the following terms were used singly or in combination: "hemophilia," "von Willebrand's disease," "Factor VIII," "Factor IX," "von Willebrand factor," "diagnosis," "management," "home care," "comprehensive care," "inhibitor," "AIDS," "hepatitis," "life expectancy," "complications," "practice guidelines," "consensus statement" and "controlled trial." The in-depth review included only articles written in English from North America and Europe that were relevant to human disease and pertinent to a predetermined outline. The availability of treatment products in Canada was also considered. VALUES: Minimizing morbidity and maximizing functional status and quality of life were given a high value. BENEFITS, HARMS AND COSTS: Proper prophylactic or early treatment with appropriate hemostatic agents minimizes morbidity and functional disability and improves quality of life. Economic gains are realized through the reduction of mortality and morbidity and their associated costs. The patient has a better opportunity to contribute to society through gainful employment and the fulfillment of social roles. Potential harms include HIV infection, hepatitis B, hepatitis C and the development of inhibitor antibodies to clotting-factor concentrates. The risk of viral transmission has been minimized through the development of procedures for the viral inactivation of plasma-derived clotting-factor concentrates and through the use of recombinant coagulation-factor concentrates and other non-plasma-derived hemostatic agents. RECOMMENDATIONS: DDAVP is the drug of choice for patients with mild hemophilia or type 1 or 2 (except 2B) von Willebrand's disease whose response to DDAVP in previous testing has been found to be adequate. Therapeutic blood components of choice include recombinant products and virally inactivated plasma-derived products. In Canada the recommended products are recombinant Factor VIII for hemophilia A, high-purity plasma-derived Factor IX for hemophilia B and plasma-derived Factor VIII concentrates containing adequate von Willebrand factor (e.g., Haemate P) for von Willebrand's disease. Dosages vary according to specific indications. Adjunctive antifibrinolytic agents, topical thrombin and fibrin sealant are useful for the treatment of oral or dental bleeds and localized bleeds in accessible sites. In patients with inhibitor antibodies, high-dose human or porcine Factor VIII is usually effective when the inhibitor titre is less than 5 Bethesda units/mL. In nonresponsive patients, or in those whose inhibitor titre is higher, "bypassing" agents (e.g., activated prothrombin-complex concentrate and recombinant Factor VIIa) are useful. Long-term management may include immune-tolerance induction. VALIDATION: These recommendations were reviewed and approved by the Association of Hemophilia Clinic Directors of Canada (AHCDC) and the Medical and Scientific Advisory Committee of the Canadian Hemophilia Society. No similar consensus statements or practice guidelines are available for comparison. SPONSORS: These recommendations were developed at the request of the Canadian Blood Agency, which funds the provision of all coagulation-factor concentrates for people with congenital bleeding disorders, and were developed and endorsed by the AHCDC and the Medical and Scientific Advisory Committee of the Canadian Hemophilia Society.

Antifibrinolytic Agents↗
PubMed2004

Arterial hyperoxia in severe head injury: a useful or harmful option?

There is mounting evidence both from experimental and clinical studies that traumatic brain injury (TBI) is associated with a reduction of aerobic metabolism. This results from a variable combination of impaired substrate delivery and mitochondrial failure. Mitochondria, which are responsible for the production of 95% of cell adenosine triphosphate (ATP), may become compromised after TBI. On the other hand, in the very early period after the primary injury, oxygen delivery may be impaired due to arterial hypoxia and/or to a reduction of cerebral blood flow (CBF). As a consequence, 80-90% of patients who die of head injury show ischemia on histo-pathological examination of the brain tissue. In the absence of an appropriate treatment for TBI, these observations favored the hypothesis that manipulation of brain oxygen delivery could be a therapeutic tool to improve aerobic metabolism. Several strategies were developed, including the increase of cerebral perfusion pressure (CPP) using amines or the increase of arterial partial pressure of oxygen (PaO(2)) through hyperbaric oxygen (HBO) or normobaric hyperoxia. Several experimental and clinical studies, using normobaric hyperoxia, demonstrated an increase in brain tissue oxygen tension and a reduction of brain extracellular lactate levels, but there is no consensus about the biological meaning of these findings. For some authors, they translate an improvement of brain oxidative metabolism, while for others they represent only biological epiphenomena. The current review addresses the rational behind normobaric hyperoxia as a therapeutic application and discusses the experimental and clinical results achieved so far.

Animals↗
PubMed2001

Effects of elevated CO2 and O3 on aspen clones varying in O3 sensitivity: can CO2 ameliorate the harmful effects of O3?

To determine whether elevated CO2 reduces or exacerbates the detrimental effects of O3 on aspen (Populus tremuloides Michx.). aspen clones 216 and 271 (O3 tolerant), and 259 (O3 sensitive) were exposed to ambient levels of CO2 and O3 or elevated levels of CO2, O3, or CO2 + O3 in the FACTS II (Aspen FACE) experiment, and physiological and molecular responses were measured and compared. Clone 259. the most O3-sensitive clone, showed the greatest amount of visible foliar symptoms as well as significant decreases in chlorophyll, carotenoid, starch, and ribulose-1, 5-bisphosphate carboxylase/oxygenase (Rubisco) concentrations and transcription levels for the Rubisco small subunit. Generally, the constitutive (basic) transcript levels for phenylalanine ammonialyase (PAL) and chalcone synthase (CHS) and the average antioxidant activities were lower for the ozone sensitive clone 259 as compared to the more tolerant 216 and 271 clones. A significant decrease in chlorophyll a, b and total (a + b) concentrations in CO2, O3, and CO2 + O3 plants was observed for all clones. Carotenoid concentrations were also significantly lower in all clones; however. CHS transcript levels were not significantly affected, suggesting a possible degradation of carotenoid pigments in O3-stressed plants. Antioxidant activities and PAL and 1-aminocyclopropane-l-carboxylic acid (ACC)-oxidase transcript levels showed a general increase in all O3 treated clones, while remaining low in CO2 and CO2 + O3 plants (although not all differences were significant). Our results suggest that the ascorbate-glutathione and phenylpropanoid pathways were activated under ozone stress and suppressed during exposure to elevated CO2. Although CO2 + O2 treatment resulted in a slight reduction of O3-induced leaf injury, it did not appear to ameliorate all of the harmful affects of O3 and, in fact. may have contributed to an increase in chloroplast damage in all three aspen clones.

Air Pollutants↗
PubMed2005

Psychosocial assessment of patients who attend an accident and emergency department with self-harm.

It has been recommended that all patients attending hospital accident and emergency departments in the United Kingdom (UK) with self-harm should be offered adequate psychosocial assessment to identify those at risk of completed suicide or repeated self-harm. This paper focuses on the extent to which this recommendation has been implemented in a large district general hospital in Wales, and compares the characteristics and hospital management of patients who received no specialist assessment with those who were assessed by a psychiatric liaison nurse or a psychiatrist. Data were routinely collected as part of the hospital annual audit procedure and confirm previous findings that guidelines for the general hospital management of self-harm patients have not been well implemented. Whilst we found some evidence that certain high risk patient groups were more likely to receive specialist assessment, this was far from universal. We conclude that if there is to be a reduction in the rate of suicide in Wales and the UK as a whole, it is crucial that services for people who self-harm are more appropriately targeted on patients who are at greatest risk.

Adolescent↗
PubMed1976

Deleterious effects of copulation in Drosophila females as a function of growth temperature of both sexes.

In Drosophila females, copulation always results in a reduction of longevity but the gravity of the phenomenon varies according to growth temperature. The harmful effect of adult males, or aggressiveness, is maximum when growth took place at a middle temperature. Female sensitivity, on the other hand, is at a maximum when larvae were reared at exteme, low or high, temperatures.

Aggression↗
PubMed1990

A hospital quit-smoking consult service: clinical report and intervention guidelines.

A minimal-contact quit-smoking consult service was established to treat hospital inpatients and outpatients referred for behavioral smoking cessation treatment. Sixty-two consecutively referred patients were evaluated and triaged to one of three standardized quitting protocols: motivational counseling; standard behavioral abstinence counseling; or abstinence counseling plus nicotine fading. Consultations included personalized self-quit materials and planned telephone follow-up to enhance compliance. Triage differentiated patients with different levels of quitting readiness and nicotine dependence. Six months after treatment, 27% of patients had quit smoking (informant-verified). Predictors of quit attempts were shorter smoking history and lower nicotine dependence. Variables predicting cessation or substantial reductions in estimated daily nicotine intake included higher educational level, stronger beliefs in smoking health harms, higher trait anxiety, a greater desire to quit and quitting self-efficacy, and the recall of direct quitting advice from the referring physician. Results compare favorably with those of more intensive treatments with similar patient groups. Recommendations are presented for controlled follow-up research to explore promising findings in this clinical report.

Adult↗
PubMed2006

Outcome after mitral valve repair for acute and healed infective endocarditis.

OBJECTIVE: To evaluate the long-term clinical and echocardiographic outcomes after mitral valve surgery for acute and healed infective endocarditis. METHODS: Of 37 consecutive patients presenting with native mitral valve endocarditis, mitral valve repair (MVRep) was feasible in 34 (92%) patients. In 17 (50%) patients, surgery was indicated during antibiotic therapy (acute endocarditis), whereas 17 (50%) underwent surgery after antibiotic therapy was completed (healed endocarditis). Patients were evaluated for early and long-term clinical and echocardiographic outcome. RESULTS: In-hospital death occurred in two (6%) patients and two (6%) died during follow-up, with a 2-year survival of 100% in healed endocarditis as compared to 76% (p=0.03) in patients undergoing surgery in acute endocarditis. No patient with acute endocarditis needed repeat mitral valve surgery. Three (9%) patients underwent re-operation because of early mitral regurgitation (n=1) or late recurrent endocarditis (n=2). The average grade of mitral regurgitation was 3.8+/-0.4 (all grades 3 to 4+) before surgery and 0.6+/-0.8 during follow-up (p<0.001). Significant reductions in left atrial (from 52+/-8mm to 46+/-8mm, p=0.004), left ventricular end-diastolic (from 61+/-8mm to 54+/-8mm, p=0.001), and end-systolic dimensions (from 41+/-8mm to 36+/-9 mm, p=0.02) were observed during follow-up, compared to preoperative dimensions. Of note, significant reverse remodeling was only observed in patients undergoing surgery in healed endocarditis. CONCLUSION: MVRep for mitral valve endocarditis is feasible with good clinical results, maintained valve competency with significant reductions in left atrial and left ventricular dimensions after surgery.

Acute Disease↗
PubMed2006

Cardioprotective medication is associated with improved survival in patients with peripheral arterial disease.

OBJECTIVES: We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease (PAD). BACKGROUND: Peripheral arterial disease is associated with increased cardiovascular morbidity and mortality. Treatment guidelines recommend aggressive management of risk factors and lifestyle modifications. However, the potential benefit of cardiac medication in patients with PAD remains ill defined. METHODS: In this prospective observational cohort study, 2,420 consecutive patients (age, 64 +/- 11 years, 72% men) with PAD (ankle-brachial index < or =0.90) were screened for clinical risk factors and cardiac medication. Follow-up end point was death from any cause. Propensity scores for statins, beta-blockers, aspirin, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, diuretics, nitrates, coumarins, and digoxin were calculated. Cox regression models were used to analyze the relation between cardiac medication and long-term mortality. RESULTS: Medical history included diabetes mellitus in 436 patients (18%), hypercholesterolemia in 581 (24%), smoking in 837 (35%), hypertension in 1,162 (48%), coronary artery disease in 1,065 (44%), and a history of heart failure in 214 (9%). Mean ankle-brachial index was 0.58 (+/-0.18). During a median follow-up of eight years, 1,067 patients (44%) died. After adjustment for risk factors and propensity scores, statins (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.36 to 0.58), beta-blockers (HR 0.68, 95% CI 0.58 to 0.80), aspirins (HR 0.72, 95% CI 0.61 to 0.84), and ACE inhibitors (HR 0.80, 95% CI 0.69 to 0.94) were significantly associated with a reduced risk of long-term mortality. CONCLUSIONS: On the basis of this observational longitudinal study, statins, beta-blockers, aspirins, and ACE inhibitors are associated with a reduction in long-term mortality in patients with PAD.

Atherosclerosis↗
PubMed2000

The biochemistry of chromium.

Chromium has been known to be a micronutrient for mammals for four decades, but progress in elucidating the role of chromium has proceeded slowly. However, recent studies have shed light on a potential role of chromium in maintaining proper carbohydrate and lipid metabolism at a molecular level. The oligopeptide chromodulin binds chromic ions in response to an insulin-mediated chromic ion flux, and the metal-saturated oligopeptide can bind to an insulin-stimulated insulin receptor, activating the receptor's tyrosine kinase activity. Thus, chromodulin appears to play a role in an autoamplification mechanism in insulin signaling. The molecular agent responsible for transporting chromium from mobile pools to insulin-sensitive cells is probably the metal transport protein transferrin. Chromium from the popular dietary supplement chromium picolinate enters cells via a different mechanism. Release of chromium from chromium picolinate for use in cells requires reduction of the chromic center, a process that can lead potentially to the production of harmful hydroxyl radicals.

Absorption↗