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PubMed2001

Burkholderia cepacia: current clinical issues, environmental controversies and ethical dilemmas.

Burkholderia cepacia is a plant phytogen and is known as a hardy and versatile organism. Over the past two decades it has emerged as a pathogen in the cystic fibrosis (CF) community, with devastating effects. Pulmonary colonisation can lead to an accelerated decline in lung function. In some cases, it causes a rapid and progressive pneumonic illness termed "cepacia syndrome", which is untreatable and fatal. B. cepacia is inherently resistant to multiple antibiotics and highly transmissible and virulent strains have been identified. CF patients colonised with the organism have to be segregated from their peers to try to prevent cross-infection. However, the pathogenicity of B. cepacia is not limited to CF. Other groups, such as individuals with chronic granulomatous disease and immunocompromised patients are vulnerable and it has caused disease in healthy individuals. However, the agricultural and petrochemical industries are attempting to exploit properties of B. cepacia for use as a biopesticide and biodegradation agent. This article provides an up to date review of clinically based literature on the Burkholderia cepacia complex, highlighting clinical management issues for both cystic fibrosis and non-cystic fibrosis patients. The article also addresses the potential conflict between medicine and agriculture on plans to reintroduce strains of Burkholderia cepacia back into the environment.

Burkholderia Infections↗
PubMed1998

Environmental endocrine disruption: an effects assessment and analysis.

This report is an overview of the current state of the science relative to environmental endocrine disruption in humans, laboratory testing, and wildlife species. Background information is presented on the field of endocrinology, the nature of hormones, and potential sites for endocrine disruption, with specific examples of chemicals affecting these sites. An attempt is made to present objectively the issue of endocrine disruption, consider working hypotheses, offer opposing viewpoints, analyze the available information, and provide a reasonable assessment of the problem. Emphasis is placed on disruption of central nervous system--pituitary integration of hormonal and sexual behavioral activity, female and male reproductive system development and function, and thyroid function. In addition, the potential role of environmental endocrine disruption in the induction of breast, testicular, and prostate cancers, as well as endometriosis, is evaluated. The interrelationship of the endocrine and immune system is documented. With respect to endocrine-related ecological effects, specific case examples from the peer-reviewed literature of marine invertebrates and representatives of the five classes of vertebrates are presented and discussed. The report identifies some data gaps in our understanding of the environmental endocrine disruption issue and recommends a few research needs. Finally, the report states the U.S. Environmental Protection Agency Science Policy Council's interim position on endocrine disruption and lists some of the ongoing activities to deal with this matter.

Animals↗
PubMed1990

Impact of a natural disaster on a psychiatric inpatient population: clinical observations.

Natural disasters do not always lead to post-traumatic stress disorders (PTSD) for their victims, although stress-related symptoms are commonly reported as results of such disasters. The impact of a natural disaster on the treatment of a hospitalized psychiatric population has never been systematically evaluated. In the fall of 1986, severe river flooding caused evacuation of a 160-bed psychiatric facility. One hundred and twenty-one hospitalized patients were taken to nearby hospital facilities, and many were separated from their primary therapists, fellow patients or both. A mail survey two months post-evacuation assessed stress-related symptoms, the patients' opinions of the impact of the flood on their treatment and functioning, and the patients' views of the evacuation procedures. Patients also responded to questions about their cognitive and affective reactions during each phase of the disaster. Clear evidence of PTSD was not found with this population; however, the findings underscore the importance of keeping patients with familiar staff and peers when possible. Differences between this study and previous disaster studies are noted, and suggestions for coping with natural disasters in inpatient or residential psychiatric facilities are offered.

Crisis Intervention↗
PubMed2002

The motivating function of thinking about the future: expectations versus fantasies.

Two forms of thinking about the future are distinguished: expectations versus fantasies. Positive expectations (judging a desired future as likely) predicted high effort and successful performance, but the reverse was true for positive fantasies (experiencing one's thoughts and mental images about a desired future positively). Participants were graduates looking for a job (Study 1), students with a crush on a peer of the opposite sex (Study 2), undergraduates anticipating an exam (Study 3), and patients undergoing hip-replacement surgery (Study 4). Effort and performance were measured weeks or months (up to 2 years) after expectations and fantasies had been assessed. Implications for the self-regulation of effort and performance are discussed.

Achievement↗
PubMed2001

Health outcomes of asthma and COPD patients: the evaluation of a project to implement guidelines in general practice.

OBJECTIVE: To evaluate a project to implement guidelines on the management of patients with asthma or chronic obstructive pulmonany disease (COPD) in terms of the health outcomes of these patients. DESIGN: A before-and-after study of 1 year with a non-randomized but comparable reference group. SETTING: General practices in the Netherlands. STUDY PARTICIPANTS: Two-hundred and eighty patients from 14 practices in the intervention group and 90 patients from five practices in the reference group (receiving usual care). INTERVENTION: The project included a comprehensive implementation programme, involving identification of barriers, documentation of the care provided, specific education, feedback on compliance with the guidelines, and peer review. This project has been found to bring the process of care more in agreement with the guidelines. MAIN OUTCOME MEASURES: Mean peak expiratory flow rate (PEFR) as a percentage of the predicted value, number of days with a diurnal variation in PEFR > or = 15%, number of days with respiratory symptoms (all recorded by patients for a period of 14 days), and perceived health status (Nottingham Health Profile). RESULTS: After 1 year, the intervention group showed statistically significant improvements with regard to the mean PEFR, the diurnal variation in PEFR, respiratory symptoms and the pain score of the Nottingham Health Profile. Comparing the changes within the intervention group with the changes within the reference group, only a positive effect of the intervention on the mean PEFR was found. CONCLUSION: The comprehensive implementation programme improved the lung function and symptoms of asthma and COPD patients in the intervention group. However, in comparison with a reference group, the positive effect on the lung function was only small.

Adult↗
PubMed1987

Continuous epidural anesthesia for aortic surgery: thoughts on peer review and safety.

Continuous epidural anesthesia (CEPA) has been recommended on the basis of limited reported experience as being safe to use during elective peripheral revascularization. This study surveyed peer acceptance and safety by means of a questionnaire that was mailed to the 190 members of the Southern Association for Vascular Surgery (52% rate of response). Of the respondents, 42% used CEPA and 54% considered it safe; 895 cases were compiled without complication. Twenty-five consecutive patients undergoing abdominal aortic reconstruction were then studied under a prospective protocol, which measured left ventricular function perioperatively. Preanesthetic, nitroglycerin-induced volume loading averaged 3570 ml in 15 general anesthesia (GA) cases and 3463 ml in 10 CEPA cases. Intraoperative volumes averaged 4341 ml GA and 6350 ml CEPA; after correction for blood loss per administration, patients in whom CEPA was used received an average 3080 ml excess volume. Eighteen-hour postoperative volumes averaged 1750 ml GA and 3156 ml CEPA. In the GA cohort, cardiac index fell from 3.57 to 2.80 L/min-m2 and rebounded to 3.07 L/min-m2 after unclamping. Left ventricular stroke work index fell from 56 to 46 gm-m/m2 (p less than 0.05), remained greater than 45 throughout clamping, and rebounded to 51 after unclamping. In the CEPA cohort, cardiac index fell from 3.50 to 2.85 L/min-m2 after supplemental GA administration, fell to a low of 2.30 L/min-m2 and remained at that range throughout the study; left ventricular stroke work index fell from 50 to 35 gm-m/m2 and remained depressed throughout. All intraoperative values were significantly (p less than 0.001 to p less than 0.05) depressed from baseline values, and from before unclamping and onward they were significantly (p less than 0.01) depressed as compared with those of the GA cohort. The use of CEPA has moderate peer group acceptance and apparently few major technique-related complications in elective revascularization cases. In aortic surgical procedures, and when combined with GA, the use of CEPA results in greater total perioperative fluid volume administration and has the potential for subtle left ventricular dysfunction.

Anesthesia, Epidural↗
PubMed2005

HIV prevention programmes for female sex workers in Andhra Pradesh, India: outputs, cost and efficiency.

BACKGROUND: Female sex workers and their clients play a prominent role in the HIV epidemic in India. Systematic data on the outputs, cost and efficiency for HIV prevention programmes for female sex workers in India are not readily available to understand programme functioning and guide efficient use of resources. METHODS: Detailed output and cost data for the 2002-2003 fiscal year were obtained using standardised methods at 15 HIV prevention programmes for female sex worker in the state of Andhra Pradesh in southern India. The services provided and their relation to the total and unit economic costs were analysed using regression techniques. The trends for the number of sex workers provided services by the programmes since inception up to fiscal year 2004-2005 were examined. RESULTS: The 15 programmes provided services to 33941 sex workers in fiscal year 2002-2003 (range 803-6379, median 1970). Of the total number of contacts with sex workers, 41.6% were by peer educators and 58.4% by other programme staff. The number of sex worker contacts in a year by peer educators varied 74-fold across programmes as compared with a 2.7-fold variation in sex worker contacts by other programme staff. The annual economic cost of providing services to a sex worker varied 6-fold between programmes from Indian Rupees (INR) 221.8 (4.58 US dollars) to INR 1369 (28.29 US dollars) with a median of INR 660.9 (13.66 US dollars) and mean of INR 517.8 (10.70 US dollars). Personnel salaries made up 34.7% of the total cost, and recurrent goods made up 38.4% of which 82.1% was for condoms. The cost per sex worker provided services had a significant inverse relation with the number of sex workers provided services by a programme (p < 0.001, R2 = 0.75; power function). There was no correlation between the full time equivalents of programme staff and the number of sex workers provided services by the programmes, but there was a modest inverse correlation between the number of sex workers served and the average time spent with each sex worker in the year adjusted for the full-time equivalents of programme staff (p = 0.011, R2 = 0.40; exponential function). The average number of sex workers provided services annually by the first batch of 7 programmes started in early 1999 plateaued after the fourth fiscal year to 3500, whereas the 8 second-batch programmes started in late 2000 reached an average of 2000 sex workers in 2004-2005 with an increasing trend up to this fourth fiscal year. CONCLUSION: The HIV prevention efforts in this Indian state would benefit from standardisation of the highly variable services provided by peer educators, who form an important part of the sex worker programmes. The cost per sex worker served decreases with increasing number of sex workers served annually, but this has to be weighed against an associated modest trend of decrease in time spent with each sex worker in some programmes.

AIDS Serodiagnosis↗
PubMed1993

Behind closed doors: the data monitoring board in randomized clinical trials.

Many randomized clinical trials include a data and safety monitoring board (DSMB) that is responsible for reviewing accruing data, monitoring performance of the trial, assuring safety of the participants in the trial, and assessing the efficacy of treatment. The DSMB often makes recommendations about continuation of the trial or alteration of the protocol. Although such boards are very influential in both the conduct and interpretation of randomized clinical trials, there is no standard mode in which DSMBs operate nor do they routinely report publicly about their deliberations. This paper describes the composition of DSMBs as well as their functions. It concludes with a series of questions that needs to be addressed to ensure that the DSMBs operate effectively.

Aged↗
PubMed2002

Moss transcriptome and beyond.

The ancient land plant Physcomitrella patens is a model system that is becoming increasingly important for plant functional genomics because gene knockouts can be produced with relative ease. Recently, several EST-sequencing projects have been launched as a first step towards a thorough functional characterization of the moss. However, for careful comparison with other plant model systems, the complete genomic sequence is needed as well as the transcriptome.

Arabidopsis↗
PubMed2005

Heterotrimeric G proteins facilitate Arabidopsis resistance to necrotrophic pathogens and are involved in jasmonate signaling.

Heterotrimeric G proteins have been previously linked to plant defense; however a role for the Gbetagamma dimer in defense signaling has not been described to date. Using available Arabidopsis (Arabidopsis thaliana) mutants lacking functional Galpha or Gbeta subunits, we show that defense against the necrotrophic pathogens Alternaria brassicicola and Fusarium oxysporum is impaired in Gbeta-deficient mutants while Galpha-deficient mutants show slightly increased resistance compared to wild-type Columbia ecotype plants. In contrast, responses to virulent (DC3000) and avirulent (JL1065) strains of Pseudomonas syringae appear to be independent of heterotrimeric G proteins. The induction of a number of defense-related genes in Gbeta-deficient mutants were severely reduced in response to A. brassicicola infection. In addition, Gbeta-deficient mutants exhibit decreased sensitivity to a number of methyl jasmonate-induced responses such as induction of the plant defensin gene PDF1.2, inhibition of root elongation, seed germination, and growth of plants in sublethal concentrations of methyl jasmonate. In all cases, the behavior of the Galpha-deficient mutants is coherent with the classic heterotrimeric mechanism of action, indicating that jasmonic acid signaling is influenced by the Gbetagamma functional subunit but not by Galpha. We hypothesize that Gbetagamma acts as a direct or indirect enhancer of the jasmonate signaling pathway in plants.

Acetates↗
PubMed1988

Clinical applications of self-esteem and locus of control to adolescent health.

Self-esteem and locus of control are two associated constructs representing, respectively, a generalized self-evaluation and an assessment of personal control. Measures representing these constructs generally rely on self-report. These measures have been applied to adolescent health as predictors and outcomes. Most studies rely on chi 3, t-test, and ANOVA analysis and report mixed results in attaining significant group comparisons on issues including contraceptive use, adolescent pregnancy, and substance abuse. Few studies employ multiple regression or discriminant function analysis assessing the relative influence or predictive accuracy and sensitivity of these measures. Studies using these analyses report limited or nonsignificant contributions of these measures to clinical issues (e.g., adolescent fatherhood, adolescent pregnancy, substance abuse, medical management) relative to variables such as patient age, social class, parental attitudes, and peer relationships. Our discussion of these results addresses the validity of self-reports of self-esteem and locus of control versus observation procedures assessing these constructs by verbal and nonverbal presentation of self, analytic procedures appropriate to clinical prediction of behavior by person and situation characteristics, and procedures to advance the clinical adoption of behavioral measures.

Adolescent↗
PubMed2006

Considering user attitude in early Development of environmentally friendly technology: a case study of NoMix toilets.

Urine source separation (NoMix technology) has been proposed as a sustainable alternative to centralized wastewater treatment systems. Radical changes necessitate an early inclusion of sociological expertise, thus offering a real chance fortransdisciplinary collaboration. The practical aim of our survey is to find out how users accept and use existing NoMixtoilets and how this could be encouraged. We collected 1249 questionnaires from 2002 to 2004 in one Swiss school and one Swiss research institute. The technological immaturity of NoMix toilets was noted by many. Nevertheless, acceptance was high: 72% liked the idea and 86% would move into apartments with NoMix toilets. Moreover, most users found that NoMix toilets equal conventional toilets with respect to design (78%), hygiene (84%), and smell (78%). Like many other innovations, the NoMix technology only functions properly if it is used adequately, which we demonstrate for water saving and sitting to urinate. Many users adopted this behavior, e.g., 72% sat. Because perception and use of NoMix toilets is subjective, it can be influenced with certain measures such as good information and cleaning, or discussions with peers. We discuss the importance of social psychology for understanding the factors that influence the acceptance of environmentally friendly innovations.

Attitude↗
PubMed1982

Group therapy with sexually abused adolescents.

The sexually abused adolescent girl is attempting to cope with a disturbing past, threatening present, and disrupted future. She may also be feeling cut off or different from her friends at a time when, developmentally, peer contact is vital. This paper describes a group therapy experience offered to six 13 and 14 year old abuse victims in order to help them feel better about themselves, improve their social skills and reconnect with others their own age. The group focused on the girl's present, everyday functioning and the effects the family disturbances and abuse have had on them. The male and female co-therapists attempted to create an atmosphere of trust and mutual aid; discussions centered on the relationships among group members and the connections the girls make with their important others, including family, friends, and social agencies. As the sessions progressed, four main themes of concern emerged; the girls shared feelings of violation, loss, anger and, finally, hope for their future. The paper illustrates these themes, delineates some of the girls' group experiences, and changes they underwent, and points out some organizational issues for the therapists in running this type of group.

Adaptation, Psychological↗
PubMed1989

Family therapy: critique from a feminist perspective.

Family therapy is a powerful modality which, all too often, is used without awareness of its possible constricting, or even crippling, effects. Textbooks and articles about family therapy focus soley or mainly on the family system alone, thus obscuring the influence of school, workplace, neighborhood, peer group, class, race and sex. Theorists, who are predominantly male, have developed rigid and mechanical concepts which encourage formulations encompassing the family system alone. Power inequalities between men and women are ignored and socially programmed sex roles are reflected and reinforced by theory and practice. Thus family therapy may function to locate and contain, within the family, difficulties and distress derived from stresses outside the family. The negative effects of traditional sex roles on emotional growth, sexuality and the development of mutually gratifying male-female relationships are never dealt with. As a result, family therapy may contribute to men's straitjacketing and women's oppression. To fulfill its promise, family therapy research and teaching must move beyond shortsighted and narrowly conceptualized theories which could damage, rather than heal, families who are suffering.

Adult↗
PubMedDate not supplied

Adapted physical activities for the intellectually challenged adolescent: psychomotor characteristics and implications for programming and motor intervention.

Intellectually challenged adolescents with varying degrees of functioning share common behavioral and psychomotor characteristics. A specially designed instructional approach and positive social attitude are necessary when dealing with this population. Research reveals that many of these individuals have developmental delays in the acquisition of basic motor skills. When compared as a group to their non-handicapped peers, intellectually challenged adolescents display low physical fitness and have perceptual-motor difficulties, which affect their learning. The major difficulty these individuals are faced with stems from language comprehension barriers and their failure to grasp instructions. In addition, some possess physical characteristics, which pose constraints in learning and performing of motor skills. A social attitude of equality and acceptance plays a major role in their successful inclusion in society. Researchers agree that the limitations mentioned above, affect the motivation of these individuals and lead to a lack of opportunity for regular participation in movement, physical activities and sports. This situation leads to low performance in the motor domain and in other areas as well. This article describes the behavioral and psychomotor characteristics of intellectually challenged individuals and offers general and specific recommendations for instruction and intervention.

Adolescent↗
PubMed2005

Gender differences in predicting high-risk drinking among undergraduate students.

The purpose of this study was to examine gender differences in college students' high-risk drinking as measured by an estimated blood alcohol concentration (eBAC) based on gender, height, weight, self-reported number of drinks, and hours spent drinking. Using a developmental/contextual framework, high-risk drinking is conceptualized as a function of relevant individual characteristics, interpersonal factors, and contextual factors regularly mentioned in the college drinking literature. Individual characteristics include race, gender, and age; interpersonal characteristics include number of sexual partners and having experienced forced sexual contact. Finally, contextual factors include Greek membership, living off-campus, and perception of peer drinking behavior. This study is a secondary data analysis of 1,422 students at a large university in the Southeast. Data were gathered from a probability sample of students through a mail survey. A three-step hierarchical logistic regression analysis showed gender differences in the pathway for high-risk drinking. For men, high-risk drinking was predicted by a combination of individual characteristics and contextual factors. For women, interpersonal factors, along with individual characteristics and contextual factors, predicted high-risk drinking, highlighting the importance of understanding female sexual relationships and raising questions about women's risk-taking behavior. Implications for prevention and assessment are discussed.

Adolescent↗
PubMed1993

Hepatitis C virus infection among a cohort of Victorian injecting drug users.

OBJECTIVE: To describe the epidemiology of infection with hepatitis C virus (HCV) among injecting drug users (IDUs) in Victoria. DESIGN AND SUBJECTS: Subjects were current IDUs from a wide spectrum of age, sex and social background, enrolled in a prospective study of injecting drug use. They were contacted by peer workers through their social networks and through community agencies and prisons, and were regularly followed for interview and blood collection in the field. Sera were tested for presence of antibody to HCV (anti-HCV), for the presence of HCV RNA directly in serum, and for measures of liver function. The results were correlated with demographic variables. SETTING: Rural and metropolitan Victoria. MAIN OUTCOME MEASURES: Presence of anti-HCV and demonstration of HCV RNA. RESULTS: Two-thirds (68%, 206/303) of the current cohort of IDUs were seropositive for HCV, risk being particularly associated with duration of injecting, and independently for men with opiate use and prison history, and for women with a history of methadone therapy. HCV RNA was detected in 48% (76/160) by polymerase chain reaction (PCR); 61% (74/122) of these subjects were HCV seropositive and 5% (2/38) seronegative. Of 32 HCV seronegative subjects followed for a mean period of 291 days, five seroconverted to HCV, an incidence of 20 infections per 100 person-years. Those who seroconverted were older, more likely to be male, had been injecting longer, more often reported opiate use, and were more likely to be based in the country. Serum liver enzyme levels were higher and more likely to be abnormal in HCV seropositive than seronegative subjects, and were highest in those seropositive subjects in whom HCV RNA was detected. CONCLUSIONS: This population of IDUs has a very high rate of exposure to HCV, related to duration of injecting and independently to opiate use and prison history, perhaps reflecting increased risk in particular social networks. There is evidence of high rates of carriage of HCV, of continuing transmission of HCV, and of ongoing liver disease among these IDUs. If these IDUs are at all representative of all IDUs in Australia, we estimate that 80,000 current and former IDUs may be at risk of chronic liver disease from HCV, and that 8000-10,000 new infections may be occurring each year. Two subjects who were seronegative had HCV RNA detectable in sera. These data have important implications for screening programs and document the need for further measures to prevent spread of blood-borne viruses including HIV among IDUs.

Adult↗
PubMed1992

Supervised versus unsupervised exercise training following myocardial infarction and myocardial revascularisation procedures.

Exercise training is an important component of rehabilitative care for patients following myocardial infarction or myocardial revascularisation procedures. Participation of the patient in supervised exercise training, however, is not always practical, and home exercise training may be a reasonable alternative for low-risk patients. The relatively routine predischarge exercise test, performed for risk stratification, can identify low-risk patients and guide their exercise prescription during the early weeks at home. Advantages of home exercise training include increased availability and convenience and lower cost. Comparable improvements in functional capacity have been documented to result from home exercise and supervised group programmes. Drawbacks, however, involved the limited ability to teach patients the necessary safety precautions for exercise, the lack of opportunity to teach and encourage modification of coronary risk-related behaviours and lifestyles, and the lack of peer support. Several techniques have been proposed to overcome some limitations of home exercise and to encourage long-term adherence to the exercise regimen. Among these are telephone interaction between patients and nurses or other health professionals, transtelephonic exercise ECG recording, and the use of home exercise training videocassette. Comparative studies of the safety, efficacy, and costs of these approaches are needed; and means must be devised to provide the nonexercise-related information and counselling available to coronary patients in a supervised exercise setting.

Electrocardiography, Ambulatory↗