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PubMedDate not supplied

Clinical correlates of ventricular and sulcal size on cranial magnetic resonance imaging of 3,301 elderly people. The Cardiovascular Health Study. Collaborative Research Group.

To identify potential risk factors for and clinical manifestations of ventricular and sulcal enlargement on cranial magnetic resonance imaging (MRI), 3,301 community-dwelling people 65 years or older without a history of stroke or transient ischemic attack underwent extensive standardized evaluations and MRI. In the multivariate model, increased age and white matter grade on MRI were the dominant risk factors for ventricular and sulcal grade. For ventricular grade, other than race, for which non-Blacks had higher grades, models for men and women shared no other factors. For sulcal grades, models for men and women shared variables reflecting cigarette smoking and diabetes. Clinical features were correlated more strongly with ventricular than sulcal grade and more strongly for women than men. Significant age-adjusted correlations between ventricular grade and the Digit-Symbol Substitution Test were found for men and women. Prospective studies will be needed to extend findings of this cross-sectional analysis.

Age Distribution↗
PubMed2006

Forensic drug intelligence: an important tool in law enforcement.

Organised criminality is a great concern for national/international security. The demonstration of complex crimes is increasingly dependant on knowledge distributed within law-enforcement agencies and scientific disciplines. This separation of knowledge creates difficulties in reconstructing and prosecuting such crimes. Basic interdisciplinary research in drug intelligence combined with crime analysis, forensic intelligence, and traditional law enforcement investigation is leading to important advances in crime investigation support. Laboratory results constitute one highly dependable source of information that is both reliable and testable. Their operational use can support investigation and even provide undetected connections or organisation of structure. The foremost difficulties encountered by drug analysts are not principally of a chemical or analytical nature, but methodologies to extract parameters or features that are deemed to be crucial for handling and contextualising drug profiling data. An organised memory has been developed in order to provide accurate, timely, useful and meaningful information for linking spatially and temporally distinct events on a national and international level (including cross-border phenomena). Literature has already pointed out that forensic case data are amenable for use in an intelligence perspective if data and knowledge of specialised actors are appropriately organised, shared and processed. As a particular form of forensic case data, the authors' research focuses on parameters obtained through the systematic physical and chemical profiling of samples of illicit drugs. The procedure is used to infer and characterise links between samples that originate from the same and different seizures. The discussion will not, however, focus on how samples are actually analysed and compared as substantial literature on this topic already exists. Rather, attention is primarily drawn to an active and close collaboration between magistrates, forensic scientists, law enforcement investigators and crime analysts from different institutions with the aim of generating, using and validating relevant profiling case data as integral part of investigative and crime analysis processes. Original advances are highlighted through experiences from criminal investigations of offences related to the unlawful importation, exportation, supply and possession of illicit drugs.

Journal Article↗
PubMedDate not supplied

Mucosal tissue injury in cancer therapy. More than muscositis and mouthwash.

PURPOSE: The purpose of this article is as follows: 1) to describe the characteristics and scope of mucosal tissue injury associated with cancer treatment; 2) to discuss recent advances in related basic and clinical science; and 3) to articulate research needs and opportunities to be addressed through collaborative interdisciplinary research. OVERVIEW: Mucosal tissue injury is both a direct and indirect consequence of cancer therapy, with manifestations that include damage and a number of other potentially serious sequelae. Current research in mucosal tissue injury is focused on the biology, immunology, and genetics of mucosal injury; clinical problems; assessment and management; and processes and outcomes of care. CLINICAL IMPLICATIONS: Results from these various areas of research enhance the understanding of the mechanisms of mucosal tissue injury, provide direction for the development of policy and for clinical practice, and help to define research needs and opportunities. Future research on the complex process of mucosal tissue injury will be interdisciplinary and will cross the boundaries among basic, translational, and clinical science.

Antineoplastic Agents↗
PubMedDate not supplied

Isotope methods for management of shared aquifers in northern Africa.

Access to fresh water is one of the major issues of northern and sub-Saharan Africa. The majority of the fresh water used for drinking and irrigation is obtained from large ground water basins where there is minor contemporary recharge and the aquifers cross national borders. These aquifers include the Nubian Aquifer System shared by Chad, Egypt, Libya, and Sudan; the Iullemeden Aquifer System, extending over Niger, Nigeria, Mali, Benin, and Algeria; and the Northwest Sahara Aquifer System shared by Algeria, Libya, and Tunisia. These resources are subject to increased exploitation and may be severely stressed if not managed properly as witnessed already by declining water levels. In order to make appropriate decisions for the sustainable management of these shared water resources, planners and managers in different countries need an improved knowledge base of hydrological information. Three technical cooperation projects related to aquifer systems will be implemented by the International Atomic Energy Agency, in collaboration with the United Nations Educational, Scientific and Cultural Organization and United Nations Development Programme/Global Environmental Facility. These projects focus on isotope hydrology studies to better quantify ground water recharge and dynamics. The multiple isotope approach combining commonly used isotopes 18O and 2H together with more recently developed techniques (chlorofluorocarbons, 36Cl, noble gases) will be applied to improve the conceptual model to study stratification and ground water flows. Moreover, the isotopes will be an important indicator of changes in the aquifer due to water abstraction, and therefore they will assist in the effort to establish a sustainable ground water management.

Africa↗
PubMed2005

A variance component analysis on recombination rate in the COGA pedigrees.

We estimated the crossover frequency in 1,232 gametes from 356 subjects in pedigrees from the Collaborative Study on the Genetics on Alcoholism. We examined the effect of covariates including age, ethnicity, and years with ALDX1 on recombination rate, and found a positive correlation between recombination rate and years with ALDX1. By variance-component analysis, we estimated the heritability of recombination rate to be around 0.5, and provided suggestive evidence for a locus linked to recombination rate.

Alcoholism↗
PubMed2005

A multi-centre survey on the team concept of instrument design in gyn-endoscopy.

The objective of this study is to evaluate the current role of gynaecologists in the design of gynaecological endoscopic instruments. The study is a cross -sectional observational study conducted in the UK, the USA, Canada & Germany. Each leader of the Department of Obstetrics & Gynaecology in 1014 hospitals in the above countries participated in the study. The current role in conceptual design and the expression of design concepts were measured. One hundred and eighty-four centres were analysed due to a Pareto effect. 91% admit that a better conceptual design can improve the overall safety of gynaecological endoscopy. 98% believe the design team should include engineers, gynaecologists and gynaecological ancillary staff. Only 18% of the centres have been involved in the design of gynaecological endoscopic instruments. A brilliant response came from the University of Michigan where collaboration already exists between the gynaecological minimally invasive surgeons and the school of engineering. The current role of gynaecologists in the design of gynaecological endoscopic instruments is passive because of the difficulty with design expression rather than conceptual design. The respondents therefore expressed the need for a design team to improve the ergonomics of endoscopic instruments and thereby improve the overall safety of gynaecological endoscopic surgery. The team concept of instrument design, taken to its logical conclusion, leads to the proposition of a global design team by 2005 so as to involve all the stakeholders of gyn-endoscopic instruments.

Journal Article↗
PubMed2005

A longitudinal assessment of inter-sectoral participation in a community-based diabetes prevention programme.

To understand the development of inter-sectoral participation in the three intervention municipalities of Stockholm Diabetes Prevention Programme (SDPP) case studies with a longitudinal assessment were conducted using the spidergram method, document analysis and group discussions. At three time points, the members of the local steering committees assessed the extent of participation from narrow to wide inter-sectoral participation in five key areas: planning, resources, leadership, network and implementation. Wide participation of various interest groups was recognised in planning and implementing activities whereas local resources, the representation of the leadership and the extent of the network were perceived as more restricted. Expert involvement varied during the programme period but was not regarded as exerting control over the local programmes. Participation within the local steering committees decreased, with a stronger focus on the project co-ordinator and other local partners in latter years. The extent of partner engagement increased due to focusing on activities approaching multi-sector collaboration and institutionalisation. Overall, communication and shared responsibility appeared critical in influencing both the development and perception of participation. In conclusion, to understand the dynamic process of participation at different times, areas and levels, the development and use of evaluation designs combining different methods and information sources throughout the lifespan of a project are recommended.

Communication↗
PubMed2003

Cooperation of transmembrane segments during the integration of a double-spanning protein into the ER membrane.

While membrane insertion of single-spanning membrane proteins into the endoplasmic reticulum (ER) is relatively well understood, it is unclear how multi-spanning proteins integrate. We have investigated the cotranslational ER integration of a double-spanning protein that is derived from leader peptidase. Both transmembrane (TM) segments are inserted into the membrane by the Sec61 channel. While the first, long and hydrophobic TM segment (TM1) inserts into the lipid bilayer on its own, the second, shorter TM anchor (TM2) collaborates with TM1 during its integration. TM1 diffuses away from the Sec61 complex in the absence of TM2, but is close to Sec61 when TM2 arrives inside the channel. These data suggest that the exit of a weak TM segment from the Sec61 channel into the lipid phase can be facilitated by its interaction with a previously integrated strong and stabilizing TM anchor.

Amino Acid Sequence↗
PubMed1994

Two decades of Mexican ethnobotany and research in plant drugs.

A renewed interest in the systematic study of indigenous medicines and associated medicinal plants arose in the 1970s. In Mexico the government established a national pharmaceutical industry to make use of the valuable colonial heritage of traditional practices combined with European medical concepts and resources. In 1975 the Mexican Institute for the Study of Medical Plants was created to integrate botanical, chemical and pharmacological studies on the Mexican flora. It compiled a database on ethnobotanical information relating to Mexican medicinal plants from the medical literature of the 16th to 19th centuries. A second database contained information on medicinal plants in current use. A medicinal herbarium was established. Taxonomical studies led to classification of the 11,000 voucher specimens in the herbarium and cross-referencing of the information with other databanks. A core group of 1000 plants used in traditional medicine throughout Mexico for almost 400 years was identified. Most of these are used to treat common diseases or basic health problems, usually given orally as decoctions or infusions. 95% of the plants used traditionally are from wild species. Information was collected from almost 3000 small Indian communities over four years on three aspects of traditional medicine--the healer, the disease categories recognized and the therapeutic resources in use. Plants with reported medicinal activity were selected for laboratory screening according to the frequency and commonality of their use, geographical distribution and seasonal availability. Screening involves a collaboration between chemists and pharmacologists: plant extracts are sequentially assayed and fractionated until the pure compound is isolated. Several active compounds are usually obtained from the same extract, frequently from the aqueous fractions. Ethnomedical information influences which plants are selected for screening and the type of assay used.

Medicine, Traditional↗
PubMedDate not supplied

Somatization in children and adolescents.

OBJECTIVE: To review the empirical literature on somatization in the pediatric age group, emphasizing prevalence, influence on health care utilization, issues in the development of somatization, comorbidity with other psychiatric disorders, assessment, and treatment. METHOD: One hundred nineteen studies and reports addressing medically unexplained somatic symptoms in children and adolescents were compiled via MEDLINE search and extensive cross-referencing. All available controlled studies were included, as were selected case reports and collections of cases. Selected citations from the adult literature were chosen for relevance to pediatric somatization. RESULTS: Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting. DSM-III-R-defined somatization disorder is rare, and pseudoneurological symptoms are unusual. Patients may be at risk for potentially dangerous, costly, and unnecessary medical investigations and treatments, and they may excessively utilize health care services. CONCLUSION: Our current understanding of pediatric somatization and its consequences is limited. Collaboration between mental health professionals and primary health care providers is essential. Consistent terminology, developmentally appropriate classification, and systematic future research will be necessary for the development of successful prevention and treatment strategies.

Adolescent↗
PubMed2002

Wake of September 11th attacks: implications for research, policy and practice.

The National Consortium for African American Children (NCAAC) held a National Forum on Bioterrorism and Children on November 6, 2001 in Washington, DC. Convened in the wake of the September 11th attacks on New York City and the Pentagon, this unprecedented conference assembled a cross-section of professionals in child advocacy, health, mental health, insurance, economics, law enforcement, and media technology. The ensuing discussion focused on issues surrounding biological agents, their impact on children and youth, and the strategies needed to protect the health and mental health of children and families in the event of a large-scale bioterrorist crisis. Lessons learned as well as the implications of the terrorist acts from the tragic events of September 11th formed the backdrop for engaging dialogue among various industry executives and professionals. Accounts of personal experiences during the unprecedented tragedy of 9-11 were shared and provided a context for heightened preparedness planning for children and adults. A collaborative statement was also presented by NCAAC, the National Medical Association, the Association of Black Psychologists, and the National Black Media Coalition. This forum was hailed as a model for communities of color to join and help bolster broad-based coalition building to ensure the availability of culturally and linguistically appropriate messages, services, and support. As intended, the forum devoted significant attention to the special needs of children, their caregivers and families and provided for an invaluable interchange which is slated to evolve into a national action plan to address the imminent dangers facing our nation's children.

Black or African American↗
PubMed2006

Impact of German National Reference Centres on monitoring of antibiotic resistance.

Currently 15 National Reference Centres (NRCs) and 59 associated consiliary laboratories make up the "infection and epidemiological network" of the Robert-Koch-Institute (RKI), Berlin. Every 3 years evaluation of the NRCs by independent assessors determines, whether funding by the RKI will be continued or new applications for NRCs will be considered. Central tasks of the NRCs are (i) the development, improvement, and standardization of diagnostic methods, (ii) diagnosis and molecular epidemiological typing of outbreak-related pathogens, (iii) establishment and maintenance of a collection of reference strains, (iv) advisory service for diagnostic routine laboratories, (v) collaborations with other European reference centres and WHO reference laboratories, if applicable, (vi) collaboration with and support of the RKI in case of epidemiological studies and surveillance projects, (vii) active support of the RKI outbreak investigation task force, and (viii) surveillance and epidemiological analysis of development of pathogen virulence and antimicrobial resistance. The following section focuses on monitoring of resistance of bacterial pathogens of special importance in particular NRCs, especially those dealing with bacterial infections.

Academies and Institutes↗
PubMed2005

Aging with spinal cord injury.

The years after SCI may be associated with acceleration of the aging process because of diminished physiologic reserves and increased demands on functioning body systems. Clinicians with expertise in the treatment and prevention of SCI-specific secondary complications need to collaborate with gerontologists and primary care specialists and need to invest in the training of future physicians to ensure a continuum of accessible, cost-effective, and high-quality care that meets the changing needs of the SCI population. Managed care payers often do not adequately cover long-term disability needs to prevent secondary SCI-specific complications. In this era of increasing accountability, evidence-based clinical practice guidelines are needed to document scientific evidence and professional consensus to effectively diagnose, treat, and manage clinical conditions; to reduce unnecessary testing and procedures; and to improve patient outcomes. Longitudinal research is needed to minimize cohort effects that contribute to misinterpretation of cross-sectional findings as representative of long-term changes in health and functioning. However, longitudinal studies confound chronologic age, time since injury, and environmental change. Thus, time-sequential research, which controls for such confounding effects, is essential, as is research on the effects of gender,culture, and ethnicity. If we consider how much progress has been made over the past 50 years with respect to SCI mortality related to infectious disease, we can expect to achieve even greater progress against the effects of aging in the next 50 years. Recent developments in molecular biology regarding growth and neuro-trophic factors are bringing us closer to the goal of repairing the damaged spinal cord. The challenge remains for rehabilitation professionals to provide the most comprehensive and holistic approach to long-term follow-up, with an emphasis on health promotion and disease prevention, to postpone functional decline and enhance QOL.

Aged↗
PubMed2001

Cross talk: interview with Al Gilman.

Alfred Goodman Gilman was born in the same year (1941) that his father and Louis Goodman published the first edition of The Pharmacological Basis of Therapeutics. Pharmacology has thus always been part of his life, and in his own career he has focused primarily on cell signaling. For the past twenty years, he has chaired the Department of Pharmacology at UT Southwestern, and his long list of accomplishments includes a Nobel Prize (1994) for his work on G proteins. In 1998, Gilman embarked on his most ambitious program of research yet, bringing dozens of leading investigators from the cell signaling community to Dallas in order to plan out a ten-year project aiming "to understand as completely as possible the relationships between sets of inputs and outputs in signaling cells." Now directing the full-fledged, federally funded Alliance for Cellular Signaling, Gilman stresses that a solid database for constructing a "virtual cell" will depend on extensive collaboration from the entire signaling community. (For a complete Program Summary, and to register for membership in the Alliance, consult www.cellularsignaling.org.) The luminaries that were invited to the Dallas planning meeting, in fact, were greeted at the door with a note from Gilman exhorting them: please check EGO at door.

History, 20th Century↗
PubMed2003

Frequency and clinical consequences of extremely high maternal serum PAPP-A levels.

A multicentre study was carried out to determine the frequency and clinical consequences of extremely high maternal serum pregnancy-associated plasma protein (PAPP)-A. There was a total of 79 pregnancies with PAPP-A exceeding 5.0 multiples of the gestation-specific median in a series of 46 776 pregnancies tested (0.2%) at the 7 collaborating centres. Five pregnancies were lost to follow-up, one miscarried and one with Noonan's syndrome was terminated. Of the remaining 72 that ended in a live birth, one infant had gastroschisis and five pregnancies had obstetric complications: pre-eclampsia, pregnancy-induced hypertension, gestational diabetes and two with growth retardation. Among women with high PAPP-A and no complications or adverse outcomes, there was no evidence of a substantial change in the levels of other Down syndrome markers or the extent of nuchal translucency. Three analytical methods were used to assay PAPP-A and yielded different frequencies of extremely high levels (0.05%, 0.4% and 0.6%) possibly owing to cross-reaction with another substance. We conclude that women with high PAPP-A can be reassured that there is no reason to suppose that the outcome of pregnancy will differ from those with normal levels, provided other markers are normal. If, as more centres move their Down syndrome screening practice to the first trimester, additional cases emerge with Noonan's syndrome or gastroschisis and raised PAPP-A, this advice will need to be modified.

Adult↗
PubMed1995

The population survey as a tool for assessing family health in the Keewatin region, NWT, Canada.

The population survey is an important tool in community health assessment, including the physical and psychological aspects of family health. It provides data on health status and health determinants not available from vital statistics and health service utilization. The Keewatin Health Assessment Study (KHAS), which was designed in collaboration with the Keewatin Regional Health Board (KRHB), surveyed a representative sample of the predominantly Inuit population in 8 communities in the central Canadian Arctic. The entire survey included 874 individuals in all age groups, of whom 440 were children and adolescents under 18 years of age, and consisted of questionnaires, clinical examination and laboratory tests. Of the large number of variables on which data were collected, some were of particular relevance to the health of children and the well-being of the family, including: (1) Child growth and development; (2) Nutrition and diet; (3) Social pathologies: suicide attempts and sexual abuse; (4) Oral health; and (5) Audiologic health. In addition to providing cross-sectional data, survey participants constitute a cohort which, if followed up longitudinally, can be used to determine the incidence of specific conditions and identify risk factors which promote or prevent their occurrence. An example of such a cohort study is one on acute respiratory infection. Surveys serve many functions--providing data for planning and evaluation, promoting community awareness of health issues, and addressing basic research questions. The KHAS is one of several surveys launched over the past several years which jointly will begin to provide a circumpolar perspective on the health of Inuit people.

Adolescent↗
PubMedDate not supplied

The Medical Outcomes Study: a nursing perspective.

The authors analyze the Medical Outcomes Study framework as a means of measuring the effectiveness of a multidimensional, interdisciplinary health care delivery system. The potential for this model to measure outcomes resulting from the interventions of nurses is demonstrated. The similarities between variables in the Medical Outcomes Study (MOS) framework and in research in nursing are presented. Modifications in the framework are suggested that would represent the collaboration among physicians, nurses, and allied health practitioners and the influence of their interaction on patient outcomes. The authors also suggest adding the domain of societal outcomes to include such outcome variables as cost. These modifications will enhance future health outcomes research based on the MOS conceptual framework and will encourage investigations of the interactive effects of health care providers on patient outcomes.

Cross-Sectional Studies↗
PubMedDate not supplied

[Bipolar obsessive-compulsive disorder: confirmation of results of the "ABC-OCD" survey in 2 populations of patient members versus non-members of an association].

Clinical data are largely focused on depressive comorbidity in OCD. However in practice, treating resistant or severe OCD sufferers revealed many cases who seem to have an authentic OCD with a hidden comorbid bipolar disorder. Most reports had evaluated the OCD comorbidity in unipolar and bipolar mood disorders (Kruger et al., 1995; Chen et Dilsaver, 1995). The only investigation in clinical population focused on the reverse issue was conducted in Pisa. Perugi et al. (1997) have showed in a consecutive series of 315 OCD outpatients, that 15.7% presented a bipolar comorbidity, mostly with BP-II disorder. Further analyses suggested that when comorbidity occurs with bipolar and unipolar depression, it has a differential impact on the clinical picture and course of OCD. The rate of bipolar comorbidity in OCD was analyzed in a recent epidemiological survey undertaken by the French Association of patients suffering from OCD (FA-OCD or AFTOC in French). In a sample of 453 OCD patients, 76% had suffered from a major depression, 11% from bipolar disorder (DSM IV mania or hypomania), 30% from hypomania (cases that obtained a score > or = 10 on the self-rated Angst Hypomania Checklist). According to the score > or = 10 on Self-rated Questionnaire for Cyclothymic Temperament, 50% were classified as cyclothymic. The self-assessment of soft-bipolar dimensions, such as hypomania and cyclothymia was previously validated in a multi-site study in major depression (Hantouche et al., 1998). Further analyses showed that comorbidity with soft bipolarity was characterized by significant interactions with high levels of impulsivity, anger attacks and suicidal behavior. In order to confirm these data, another cohort (n = 175 patients treated by psychiatrists for OCD) was formed and named "PSY-OCD". Comparative analyses between the two populations allowed showing very few demographic and clinical differences. The frequency rate of "bipolar OCD" was equivalent in both populations: BP-II disorder (DSM IV criteria) was present in 11% of FA-OCD and 16% of PSY-OCD. Furthermore using the Hypomania Checklist showed that BP-II disorder rate (score > or = 10) was higher: 32% of in both populations. Cyclothymic rate was also globally higher, but significant difference was obtained: 56% of FA-OCD versus 45% of PSY-OCD (p = 0.02). Moreover, mood switching rate under anti-OCD drugs was equivalent in both OCD populations (respectively 38% and 33%, p = ns). In case of BP comorbidity, patients had presented a greater number of concurrent major depressive episodes and suicidal attempts. When concurrent depression was considered, the rate diagnosis of soft bipolarity was 2.5 fold, and the number of suicidal attempts augmented by 7 fold (by comparison versus non-depressed OCD). Despite very early descriptions (since the beginning of the last century) of particular relationships between so-called "psychasthenia, folie de doute, folie raisonnante" and "circular and intermittent madness or cyclothymia", a few attention has been devoted to this complex pattern of comorbidity. The comparative data deriving from the collaborative survey with patients who are members of AFTOC and with a cohort of psychiatric outpatients, confirm the reality of bipolar-OCD comorbidity, which is largely under-recognized in clinical practice. More in depth analyses are now undertaken in order to investigate the characteristics of "bipolar OCD" by comparison to "non bipolar OCD".

Adolescent↗