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PubMed1988

Immunity against diphtheria and tetanus in the age group 30-70 years.

In Denmark, childhood primary vaccination against diphtheria and tetanus has been recommended since 1950. No routine revaccinations or general vaccination of adults have been offered. In most other western countries revaccinations are recommended later in childhood. However, death still occurs from diphtheria and tetanus in countries with such vaccination programs although it is generally accepted that protective immunity can be obtained by vaccination. On this basis the immunity against diphtheria and tetanus was assessed in a random sample of 351 subjects in the age range 30-70 years. Diphtheria antitoxin titres were determined by in vitro neutralization technique using VERO cells. 26% had diphtheria antitoxin titres below protective level (0.01 international antitoxin units/ml serum). The highest number of unprotected against diphtheria was found among 30-39 year old women (68%) and 60-69 year old subjects (36%). Tetanus titres were determined by a combination of ELISA technique and an in vivo neutralization assay. 51% were unprotected against tetanus (less than 0.01 international antitoxin units/ml serum). The highest number of unprotected against tetanus was found among 60-69 year old subjects (68%) and especially among females in this age group (77%). To avoid epidemics of diphtheria in the future the immunity among adults must be raised within the coming years. Thus, revaccination must be recommended and high attendance ensured. One revaccination is sufficient only when complete primary vaccination is documented.

Adult↗
PubMed1999

Intermediate filament proteins during carcinogenesis and apoptosis (Review).

The intermediate filament network spreading from the cell periphery to the nucleus forms dynamic linkages between nuclear matrix, actin microfilaments, and the extracellular matrix. The six different types (types I-VI) of IF proteins consisting of nearly 50 different proteins form at least nine different kinds of filaments depending on the tissue types: keratins, lamins, vimentin, desmin, neurofilaments, peripherin, alpha-internexin, glial fibrillary acidic protein and nestin. Their tissue specific expression in normal cells and differential expression/assembly in neoplasia has been of immense value in tumor diagnosis. At the same time, recent in vitro studies point out that keratins, lamins and vimentin are subject to caspase-mediated proteolysis in an apoptosis-related manner. We reviewed the experimentally demonstrated P4-P1 motif specificities of caspases in the selection of substrates in the IF protein family. In addition, we provided clues to possible cleavage of additional IF proteins during programmed cell death, based on acceptable cut site motifs indicated by searches using the PIR protein sequence database. The present review concludes with presentation of evidence on the emerging roles of IFs in association with intermediate filament associated proteins in the dynamic remodeling of the cell during development of neoplastic phenotype and execution of apoptosis.

Amino Acid Sequence↗
PubMed2000

National immunisation days for polio eradication in Uganda: did immunisation cards increase coverage?

OBJECTIVE: To analyse the effect of cards and of vitamin A supplementation on coverage for National Immunisation Days (NIDs). DESIGN: A retrospective ecological study. SETTING: A countrywide NIDs coverage before and after introduction of the NIDs cards and vitamin A supplementation in all districts of Uganda. METHODS: NIDs for polio eradication commenced in Uganda in 1996. Two rounds, one month apart are implemented yearly. During the second round of 1998 NIDs, cards were introduced nationally and vitamin supplementation was introduced in 24 of the 45 districts. We compared NIDs coverage before and after NIDs cards and NIDs coverage in districts that implemented vitamin A to those that did not. RESULTS: After introduction of NIDs cards, the national coverage rose from 97.7% to 106.9%, an increase of 9.2%. In those districts that implemented vitamin A supplementation, the NIDs coverage rose from 100.1% to 111.5%, an increase of 10.4%. In those districts that did not implement vitamin A, the NIDs coverage rose by 6.7% from 94.5% to 102.2%. Before the introduction of cards and vitamin A in 1996 and 1997, the NIDs coverage was between 92-96%. CONCLUSION: NIDs cards and vitamin A supplementation could have increased the NIDs national coverage.

Child, Preschool↗
PubMed1999

Effects of a commercial heat-shock process on Vibrio vulnificus in the American oyster, Crassostrea virginica, harvested from the Gulf Coast.

Oysters (Crassostrea virginica) harvested from the Gulf Coast, containing 10(2) to 10(4) most probable number (MPN) per gram of Vibrio vulnificus, were subjected to a commercial heat-shock process. After 1 to 4 min at internal oyster meat temperatures exceeding 50 degrees C, shellstock oysters were shucked, chilled, washed, and packed. V. vulnificus and total bacterial levels in Gulf Coast oysters were significantly reduced from 1 to 4 logs in the finished product. Similar reductions were not observed in shellstock oysters that were subject to conventional processing. Under the National Shellfish Sanitation Program, heat shocking is an acceptable process to use to assist in the shucking of shellstock. This research revealed that the heat-shock process may also serve to significantly reduce V. vulnificus in summer Gulf Coast oysters.

Animals↗
PubMed1986

[A population survey on a mass screening program for gastric cancer. 1. Population characteristics related to examination rates for the screening program].

The types of examination received for gastric cancer during the past 3 years have been surveyed by a self-administered questionnaire among residents of a small town near Kitakyushu City. Among 3660 surveyed, 2205 subjects who completed the questionnaire are analyzed in this study. Examination rates of mass screening for males were higher than those for females. Males in their forties and fifties and females in their forties through sixties have higher examination rates than other age groups. Higher examination rates were seen in public officials and employees who have opportunities to receive the screening program at work site. On the other hand, among people without a job and housewives who have opportunities to receive a screening program offered only by the town hall, examination rates of the mass screening program were low. More people with a family history of cancer death were examined than those without a similar family history. There was no difference in the examination rates by the mass screening program between the people who took care of their health and those who did not. In order to raise examination rates for the mass screening program, it is essential to improve the systems of this program which can be easily accepted, and to educate residents in order to stimulate motivation for screening.

Adult↗
PubMedDate not supplied

A new concept in radiology QA in a large setting.

Determining film quality has traditionally been carried out through review and evaluation of exam retakes. At best, such a system will tell which exam areas the technologist repeated most. Kaiser Permanente Northwest has 80 radiologic technologists and 30 radiologists who rotate through film reading. The program developed at Kaiser is directed toward general diagnostic film quality only and uses the services of two full-time quality assurance (QA) technologists. Working together, the radiologist and QA staff have created a standard of diagnostic image quality. A QA radiologist representative is available to work with the QA technologist if inconsistencies are raised. Every other month, a QA technologist makes a random selection for review of 50 exams performed by each technologist. These evaluations cover view rather than exam, with each view judged on its own merit. The purpose is to look for recurring problems in the technologist's performance. Copies of the review sheet go to each technologist's supervisor who forwards a copy to the technologist. Technologists can request help to understand why certain films meet or fail to meet quality standards. The QA technologists are available to give one-on-one help, and they also offer classes and demonstrations. In turn, radiologist fill out quality control (QC) slips as they read exams. The slips help to educate and correct specific problems, and are a direct communication link between radiologist and technologist. The QA program places importance on having the proper tools for taking quality films. The program also provides several levels of accountability although QA technologists are not responsible for its enforcement. Instead, they give feedback to supervisors who enforce performance levels. An appeals process is also in place. The program helps keep image quality acceptable to both hospital radiologists and customer requirements in the industry. In turn, the technologists use it to further their professional development.

Allied Health Personnel↗
PubMedDate not supplied

[Postoperative analgesia using the intravenous PCA technique. Results in the first 400 patients treated at a general hospital].

INTRODUCTION: PCA (patient controlled analgesia) has represented a remarkable advance in the treatment of postoperative pain. In this work we describe our experience with this analgesic technique. MATERIAL AND METHODS: One hundred patients undergoing thoracic and abdominal surgery were selected after giving information to the medical and nurse personnel. Pharmacologic agents used in this study were morphine (intravenous PCA) and fentanyl (epidural PCA). Starting of the perfusion pump was done by the anesthesiologist at the Recovery Unit and the treatment was continued by the nurse. Every morning the patients were visited and the degree of analgesia was recorded according to the following score: 1: no pain, and 5: intolerable pain. An anesthesiologist was permanently available. Later on, this study was expanded to 400 patients including other types of surgery. RESULTS: Mean duration of the treatment was 60 hours. The amount of analgesics administered varied among patients and was greater during the first postoperative hours specially in the group of patients treated with fentanyl. The mean degree of pain was 1.5 (grade 1 in 37.5% of cases and grade 5 in 3.5% of patients). Secondary effects were only nausea and vomiting. Inconvenient features of the technique were: patient's difficulties in the management of the technique (3 cases), and spontaneous loss of the program (1 case). Patient's acceptance of the technique was good. CONCLUSIONS: PCA analgesia has been successfully introduced in our hospital since it is effective, safe, easy to manage.

Adolescent↗
PubMed2003

Features of occupational rehabilitation systems in Australia: a map through the maze.

This review contributes to the limited literature on systems of occupational rehabilitation in Australia. Occupational rehabilitation is defined and features of occupational rehabilitation systems within the workers' compensation framework are described. Common features include: (a) the trend to workplace management, (b) preferred rehabilitation program settings and (c) widespread acceptance of some identified principles of occupational rehabilitation. Other features such as roles of stakeholders and participants, relationship of rehabilitation providers and employers, and the services provided have a number of variations in the Australian systems. Similarities and differences between features of Australian and North American systems are noted. Implications for occupational rehabilitation providers are discussed, and recommendations for practice and future research are made.

Australia↗
PubMed2004

Design and evaluation of a personal digital assistant- based alerting service for clinicians.

PURPOSE: This study describes the system architecture and user acceptance of a suite of programs that deliver information about newly updated library resources to clinicians' personal digital assistants (PDAs). DESCRIPTION: Participants received headlines delivered to their PDAs alerting them to new books, National Guideline Clearinghouse guidelines, Cochrane Reviews, and National Institutes of Health (NIH) Clinical Alerts, as well as updated content in UpToDate, Harrison's Online, Scientific American Medicine, and Clinical Evidence. Participants could request additional information for any of the headlines, and the information was delivered via e-mail during their next synchronization. Participants completed a survey at the conclusion of the study to gauge their opinions about the service. RESULTS/OUTCOME: Of the 816 headlines delivered to the 16 study participants' PDAs during the project, Scientific American Medicine generated the highest proportion of headline requests at 35%. Most users of the PDA Alerts software reported that they learned about new medical developments sooner than they otherwise would have, and half reported that they learned about developments that they would not have heard about at all. While some users liked the PDA platform for receiving headlines, it seemed that a Web database that allowed tailored searches and alerts could be configured to satisfy both PDA-oriented and e-mail-oriented users.

Attitude to Computers↗
PubMed2005

Peritoneal dialysis training: a multisensory approach.

Undertaking peritoneal dialysis (PD) therapy poses a challenge to all patients with renal failure. The potentially high risk of infection makes it essential that patients undertaking PD have adequate training and ongoing support. Over recent years, increasing numbers of elderly patients, patients with significant learning disabilities, and patients with marked comorbidities have been accepted onto renal replacement therapy programs. For those undertaking PD in particular, this has posed new educational challenges. The Community Dialysis Team recognized an area of weakness in their current training program for these patient groups. The degree of literacy skills as well as the volume of written material and the amount of medical terminology used did not result in a user-friendly training program. A collaborative approach involving various members of the multidisciplinary team designed an appropriate training program for patients with learning disabilities. The new program included (1) a photographic bag-exchange procedure; (2) the provision of simple, step-by-step instructions on audiotape; (3) a new assessment sheet where words were replaced with symbols; (4) a redesigned daily record sheet (used to monitor clinical parameters); and (5) a simple contact card. The quality of the new training program was assessed by a small pilot study evaluation. The reduction of training times and the satisfactory peritonitis rates suggest that the new multisensory training program could be successfully implemented. The use of pictorial aids and more symbols, with less focus on the written word, made PD training a viable option for many individuals, including elderly patients and those with learning disabilities. The increased use of pictorial aids and symbols may also be helpful in training patients where there is a language barrier as well as the pediatric population.

Comorbidity↗
PubMed2006

[So dangerous are not measles, mumps and rubella...A qualitative survey of causes of MMR vaccination refusal in the county of Vejle].

INTRODUCTION: The aim of this study was to investigate why parents in one county of Denmark leave vaccination against measles, mumps and rubella (MMR) undone, with special reference to evaluating the possibilities of increasing the acceptance of the MMR vaccination program. MATERIALS AND METHODS: Data were collected through semi-structured, tape-recorded telephone interviews. The interviewees were 17 strategically chosen parents of children 15 months and 12 years old who had not received the MMR vaccination in 2002. The method of analysis was Systematic Text Condensation. RESULTS: The parents had consulted many sources in their search for information about MMR vaccination. Many referred to their own or others' good experiences with going through the natural illnesses and bad experiences with vaccination. It is a common view that naturally occurring illnesses strengthen the immunity more effectively than vaccination does, and this approach is preferred by some of the parents. The risk of vaccination is viewed as greater than that of going through the natural illnesses. This, however, is not in accordance with scientific knowledge. There was no evidence that leaving vaccination undone was due to the parents' lack of knowledge, forgetfulness or lack of interest in MMR vaccination, and it was rare that only one reason was mentioned. CONCLUSION: The results of the study indicate that doctors can profit by preparing a dialogue with parents who are in doubt about MMR vaccination. Especially it seems that a profound knowledge of the scientific evidence of virus-caused diseases, of their risks and of immunology is necessary to balance parents' most essential misconceptions and their reasons for not choosing vaccination.

Adult↗
PubMed2006

Data entry workers perceptions and satisfaction response to the "stop and stretch" software program.

Cumulative Trauma Disorder (CTD) is a collection of chronic musculoskeletal disorders caused by frequent, sustained, and repetitive movements, most notably by computer usage at the workplace. A computer based break reminder program (Stop and Stretch) has been developed and installed to prevent CTDs caused by prolonged computer usage at the workplace. We investigated users' opinions to the Stop and Stretch program at their work place. 19 computer users were recruited as the subjects of the study. We conducted a survey after all the subjects used the Stop and Stretch program for one month. Among the nineteen subjects, 52.5% or 10 noticed a difference of symptoms after using the program; 63.3% or 12 thought the program had positive effect on their productivity; 100% or all 19 thought the program was easy to follow; 100% or all 19 thought it was helpful; 94.7% or18 were satisfied with the program; and the same value would recommend the program to others. When grouped into those who had prior experience with using stretch and exercise as part of their work routine15 subjects had no prior experience; and 14 participants within that group were satisfied or very satisfied with the program; 93.3% or 14 would recommend it to co-workers; and over half of those 15 thought the program is easy to use. The study provided insight to the response to using "stretch break software" and provided indicators of satisfaction with the Stop and Stretch program and that the program had sufficient usability and acceptance within a workplace setting which might be applied in other work settings similar to these.

Consumer Behavior↗
PubMed1991

Intensity of in-hospital care for persons with AIDS.

We evaluated the intensity of medical care for 30 consecutive AIDS patients at one hospital, using methodology based on the Delay Tool of Selker et al. Of 25 AIDS patients who survived hospitalization, 15 had at least one delay day in the hospital. Major factors associated with care that could have been provided at an alternative site included difficulty with skilled nursing facility placement in 20% of the patients, difficulty coordinating out-of-hospital care in 28%, and scheduling of outpatient surgical procedures in 12%. For the 15 patients who could have received some of their care at a lower intensity setting, a median of 7 hospital days could have been potentially saved with better coordination of outpatient care and increased availability of skilled nursing facilities. The five patients who died in hospital also used large amounts of resources and had long lengths of stay. Prior studies of non-AIDS patients revealed similar results, suggesting that, for reasons of quality of care, quality of life, and economics, policy-makers must develop managed care programs, skilled nursing facilities that accept AIDS patients, inpatient psychiatry facilities, and increased hospice availability.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[The need for specialization of II degree obstetricians and gynecologists in subspecialties created after the development of this basic branch of medicine].

The author points to the need of further training gynecologists in subspecialties resulting from the progress in this basic branch of medicine. It is particularly important to organize further training in gynecological oncology, reproductive endocrinology, maternal-fetal medicine (perinatology) and gynaecological urology. Accepting training in subspecialties, preparing programs and tests of skills and knowledge will give better results in specialist therapy of patients.

Education, Medical, Graduate↗
PubMed1985

Managing chronic airflow obstruction: Part II.

The results of a well-controlled international study have shown no benefit in life expectancy, rate or duration of hospitalizations, lung function, or quality of life when intermittent positive pressure breathing is compared with an air compressor to deliver aerosol bronchodilators. Patients who are accepted on a home oxygen program should be vigorously managed with standard treatment, and only if hypoxemia persists after a month of such therapy should ambulatory oxygen be considered.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Nonpulsatile ventricular assist bridging to transplantation.

Six patients accepted into a cardiac transplantation program have been supported with a Biomedicus LVAD. Five of the six patients deteriorated while awaiting a donor organ; the sixth was being supported with a device following mitral valve surgery and showed no recovery of ventricular function. In all cases the device was used only after all other therapeutic modalities had failed. The periods of support ranged from 2.5 to 31 days, mean of 10 days. Three patients underwent cardiac transplantation and all three have been discharged and are well. The three survivors were supported for 2.5, 3, and 31 days. Three deaths occurred in the patients supported for 5, 9, and 15 days, the causes being sepsis, massive cerebral embolism, and respiratory failure. Patients were for the most part maintained with some degree of heparinization, and hemolysis was a significant problem in only one patient and associated with a very small arterial return cannula. Flows were routinely maintained above 2.4 L/min/m2, and all showed recovery of other organ functions while being supported. The patient supported for 31 days was capable of limited mobilization by use of the removable drive system. The Biomedicus LVAD represents a relatively inexpensive support modality for patients awaiting cardiac transplantation.

Adult↗
PubMed1988

Use of alternative rules (other than the 1(2)s) for evaluating interlaboratory performance data.

Previous studies have documented the ineffectiveness of using either the group mean +/- 2 group standard deviations (SD) or the 1(2)s rule as the standard of acceptable performance in evaluating interlaboratory proficiency testing (PT) data. Using computer simulation of PT data, we evaluated the efficiency of 244 alternatives to the 1(2)s rule, all based on the PT population's mean and SD. Using the traditional interlaboratory PT format, we determined the ability of each rule to correctly identify both good and deficient intralaboratory performance. The rules are based on results from one to five PT samples "analyzed" at the same time. Because the effectiveness of the criteria set for acceptable performance in a PT program is influenced by the population SD, each rule's capabilities were examined for PT populations with interlaboratory SDs ranging from 1% through 10% of the population mean value. All rules achieve their maximum efficiency over a narrow range of interlaboratory SDs. For PT evaluations of intralaboratory performance to be optimally effective, selection of the rule must be based on the SD of the PT population.

Computers↗