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Joyce, A

Costs and Cost Analysis; Hospitalization; Nursing Audit; Nursing Care; Nursing, Supervisory; Patient Care Planning; Systematic Reviews as Topic

Systematic review: you can afford it.

Isaacs, H L

Canada; Delivery of Health Care; History, 19th Century; History, 20th Century; Indians, North American; Medicine, Traditional; New York; United States; Humans

American Indian medicine and contemporary health problems. I. Toward improved health care for native Americans. Comparative perspective on American Indian medicine concepts.

Bachrach, H M

Humans; Emotions; Mental Disorders; Motivation; Object Attachment; Personality; Professional-Patient Relations; Prognosis; Psychoanalytic Therapy; Superego

"Analyzability": a systematic review of the clinical and quantitative literature.

Delgado, M

Allied Health Personnel; Child Guidance Clinics; Community Mental Health Centers; Culture; Hispanic or Latino; Inservice Training; Massachusetts; Puerto Rico; Workforce; Humans

An educational program on Puerto Rican culture for non-Hispanic staff.

Evans, T E

Black or African American; Civil Rights; Decision Making; Financing, Government; Minority Groups; National Institutes of Health (U.S.); Research Support as Topic; United States; Humans

Sounding board. Taxation without representation: on the health bureaucracy and black people.

Shaikh, W

Child; Humans; Adenoidectomy; Evaluation Studies as Topic; Tonsillectomy

A systematic review of the literature on evaluative studies of tonsillectomy and adenoidectomy.

Wilson, P R

Humans; Acute Disease; Pain; Pain Management; Practice Guidelines as Topic

Clinical practice guideline: acute pain management.

Marchant, A

Humans; Adjuvants, Immunologic; Antigens, Bacterial; Bacteria; Cell Adhesion; Cell Adhesion Molecules; Endothelium, Vascular; Integrins; Neutrophils

Adhesion molecules in antibacterial defenses: effects of bacterial extracts.

Adhesion of polymorphonuclear leukocytes (PMN) to vascular endothelium is one of the first events in their response against local bacterial infection. Different adhesion molecules sequentially mediate PMN adherence to endothelium and extravasation into inflamed tissues. We show that bacterial extracts OM-85 BV and OM-89 increase the expression of adhesion molecules at the surface of PMN and we suggest that this upregulation could be linked to the beneficial effect of bacterial extracts in the prevention of respiratory tract infections.

Haughey, B H

Humans; Analysis of Variance; Carcinoma, Squamous Cell; Combined Modality Therapy; Endoscopy; Head and Neck Neoplasms; Missouri; Neoplasms, Second Primary; Prevalence; Prospective Studies; Registries; Retrospective Studies; Time Factors

Meta-analysis of second malignant tumors in head and neck cancer: the case for an endoscopic screening protocol.

A meta-analysis was performed on data from the Washington University Department of Otolaryngology Head and Neck Tumor Registry and 24 studies reporting synchronous and metachronous malignancies in head and neck cancer patients. The overall second malignant tumor (second primary) prevalence was 14.2% in 40,287 patients, the majority of tumors being metachronous. Site relationships between index tumors and second primaries revealed significantly high risks along the digestive tract axis or the respiratory tract axis, although lung second primaries were prevalent in all groups. Head and neck second primaries were the largest group, being significantly more common in the oral cavity, oropharynx, and hypopharynx than in the larynx. Oral cavity index tumors showed the highest overall rate of second primary formation. Half of all aerodigestive tract second primaries are detected by 2 years from index tumor presentation, but non-aerodigestive tract tumors are common beyond 5 years. A significantly higher detection rate was proven for the prospective panendoscopy studies. We recommend routine interval endoscopic intervention within 2 years of treatment for optimum detection of second primaries in head and neck cancer patients. Also, a lifetime of clinical surveillance is suggested for aerodigestive tract second neoplasms in oral cavity, oropharynx, and hypopharynx cancer patients and for lung and non-aerodigestive tract neoplasms in larynx cancer patients.

Schanfield, M S

Chi-Square Distribution; Cluster Analysis; Emigration and Immigration; Gene Frequency; Genetic Variation; Haplotypes; History, Ancient; Immunoglobulin Gm Allotypes; Immunoglobulin kappa-Chains; Indians, North American; Indians, South American; Linguistics; Siberia; Humans

Immunoglobulin allotypes (GM and KM) indicate multiple founding populations of Native Americans: evidence of at least four migrations to the New World.

On the basis of GM and KM typing and language, approximately 28,000 Amerindians were divided into 4 groups of populations: non-Nadene South American (8 groups), non-Nadene North American (7 groups), Nadene (4 groups), and Eskaleuts (6 groups). These groups were compared to four groups of Asian populations. The distribution of GM haplotypes differed significantly among and within these groups as measured by chi-square analysis. Furthermore, as reflected in a maximum linkage cluster analysis, Amerindian populations in general cluster along geographic divisions, with Eskaleuts and Nadenes clustering with the Asian populations and non-Nadene North American and non-Nadene South American populations forming two additional clusters. Based on GM haplotype data and other genetic polymorphisms, the divisions appear to reflect populations that entered the New World at different times. It appears that the South American non-Nadene populations are the oldest, characterized by the haplotypes GM*A G and GM*X G, whereas later North American non-Nadene populations are characterized by high frequencies of GM*A G and low frequencies of GM*X G and GM*A T. In contrast, Eskaleuts appear to have only GM*A G and GM*A T. The Nadene speakers have GM*X G and GM*A T in higher and approximately equal frequencies. Maximum linkage cluster analysis places the Alaskan Athapaskans closest to northwestern Siberian populations and the Eskaleuts closest to the Chukchi, their closest Asian neighbor. These analyses, when combined with other data, suggest that, in the peopling of the New World, at least four separate migrant groups crossed Beringia at various times. It appears likely that the South American non-Nadene entered the New World before 17,000 years B.P. and that the North American non-Nadene entered in the immediate postglacial period, with the Eskaleut and Nadene arriving at a later date.

Anderson, C R

Animals; Cats; Dogs; Animals, Wild; Anti-Bacterial Agents; Bites and Stings; Clinical Protocols; Decision Trees; Emergency Medical Services; Family Practice; Rabies; Tetanus; Wound Infection; Humans

Animal bites. Guidelines to current management.

Several factors need to be considered when evaluating animal bites. These include type of animal involved, specific nature of the wound, circumstances of the attack, interval between injury and treatment, and location of the bite. Of concern are direct destruction of tissue and risk of infection. Use of antibiotic prophylaxis is controversial, but most authorities agree that it is needed for hand wounds, puncture wounds, or "dirty" wounds of any type in any location. The choice of antibiotic is also controversial, but initial empirical treatment generally relies on broad-spectrum coverage. Rabies prophylaxis is indicated for bites by carnivorous wild animals, bats, and unvaccinated domestic animals. Review of the patient's tetanus status is mandatory.

Pamilo, P

Animals; Behavior, Animal; Biological Evolution; Hymenoptera; Infertility; Models, Biological; Sex Ratio

Evolution of the sterile caste.

Biased sex ratios are expected to affect the conditions of the evolution of worker behaviour in malehaploid populations. In a subsocial, malehaploid species an association to female-biased brood sex ratios favours the evolution of worker behaviour. There are various reasons to expect such an association. The critical worker efficiency threshold required for worker behaviour to evolve is lower when looked at from the viewpoint of the mother than from that of the daughter. In this mother-daughter conflict, the mother can expect some help from her other offspring to resolve the conflict in her favour. In semisocial species the sex ratio biases have a less significant role and the worker behaviour can evolve more easily in malehaploid than in diploid populations. Furthermore, limited dispersal (due to the risks attached to it) is expected to favour worker behaviour in malehaploid but inbreeding in diploid populations. In addition to the genetic mechanisms that determine the critical worker efficiency threshold, it is essential to pay attention to those ecological factors that affect the actual worker efficiency in nature. Several such factors exist but it is not easy to associate them with the common occurrence of eusocial species in the Hymenoptera.

Walker, B

Black or African American; Environmental Health; National Institutes of Health (U.S.); Research Support as Topic; Societies, Scientific; Training Support; United States; Humans

Environmental health and African Americans.

As environmental health has taken on immensely increased significance in the prevention of disease, dysfunction, and premature death, its boundaries have been anything but stable. This instability, along with a multitude of demographic, social, and economic currents, have brought into stark relief the increasing demand for scientists who have the skills and knowledge to perform environmental risk assessment and implement effective risk management policies and services. Despite this demand far too few African Americans want, or are prepared, to pursue careers in sciences. This paper describes efforts to address this problem and suggests why such initiatives may not yield the desired results.

Simes, R J

Female; Humans; Information Services; Ovarian Neoplasms; Quality of Health Care; Guidelines as Topic

Improving cancer care: transferring clinical research into practice through treatment guidelines.

Wybran, J

Humans; Adjuvants, Immunologic; Bacteria; Biological Factors; Cytokines; Cytotoxicity, Immunologic; Dose-Response Relationship, Drug; Interferon-gamma; Interleukin-2; Killer Cells, Natural; Tumor Necrosis Factor-alpha

Activation of natural killer cells and cytokine production in humans by bacterial extracts (OM-85 BV).

The influence of Broncho-Vaxom (BV) on different immune parameters was investigated in vitro on human peripheral blood mononuclear cells (PBMC). It was found that BV enhances the natural killer (NK) activity of PBMC and increases their spontaneous and phytohemagglutin (PHA)-induced production of tumor-necrosis factor--alpha and interleukin-2 as well as the PHA-stimulated production of interferon-gamma. These immunostimulating actions of BV on NK activity and cytokine production can contribute to the understanding of the enhancement of the body's defense mechanisms against respiratory tract infections.

Bessler, W G

Animals; Mice; Adjuvants, Immunologic; Antigens, Bacterial; B-Lymphocytes; Bacteria; Bacterial Outer Membrane Proteins; Cytotoxicity, Immunologic; Gram-Negative Bacteria; Lymphocyte Activation; Macrophage Activation; Mice, Inbred BALB C; Peptides

Biological activity of bacterial surface components: bacterial extracts and defined bacterial cell wall components as immunomodulators.

Bacterial extracts obtained from pathogenic strains occurring in lung infections (Broncho Vaxom) or urogenital infections (Urovaxom) as well as defined surface components of Gram-negative bacteria purified from bacteria or obtained by chemical synthesis were tested for their immunomodulatory properties in a murine system. The bacterial extracts were able to act as immunogens inducing an antigen-specific response. Both the bacterial extracts and the purified bacterial cell wall components constituted polyclonal activators of murine splenic B cells, as demonstrated by proliferation assays measuring the incorporation of [3H]thymidine into DNA. They were also able to act as immunoadjuvants increasing the SRBC and the BSA-TNP specific immune response, and could induce tumor cytotoxicity in bone marrow-derived macrophages. The results show that bacterial extracts and defined bacterial surface components constitute immunogens as well as immunomodulators in vitro and in vivo.

Palma-Carlos, A G

Humans; Adjuvants, Immunologic; Administration, Oral; Asthma; Bacteria; Immune Tolerance; Immunoglobulin G; Immunoglobulin M; Recurrence; Respiratory Tract Infections

Immunomodulation with bacterial extracts in respiratory diseases.

A lyophilized bacterial extract (Broncho-Vaxom) has been studied in a large number of models and found to induce specific and nonspecific responses by oral administration. It stimulates the systemic and local immune response. It activates the macrophages that play a key part in the immune system, modulates the immunoglobulin level, and potentiates the lymphocyte response to phytohemagglutinin (PHA) and other mitogens. The effect of this bacterial extract on T-lymphocyte subpopulations is currently under study.

Humans; Ambulatory Care; Angioplasty, Balloon; Aorta; Blood Vessel Prosthesis; Brachiocephalic Trunk; Clinical Protocols; Femoral Artery; Iliac Artery; Mesenteric Arteries; Popliteal Artery; Radiology, Interventional; Renal Artery

Guidelines for percutaneous transluminal angioplasty. Standards of Practice Committee of the Society of Cardiovascular and Interventional Radiology.

Binder, L S

Educational Measurement; Evaluation Studies as Topic; Hispanic or Latino; Pilot Projects; School Admission Criteria; Schools, Medical; Texas; Humans

Recruitment and preparation program for Hispanic applicants.

Hudson, T

Hispanic or Latino; Hospital Bed Capacity, 300 to 499; Hospitals, Public; Mexico; Public Relations; Texas; Humans

Hispanic health issues are #1 at border hospital.

Prieto, D O

Education, Medical; Health Status; Indians, North American; Medically Underserved Area; United States; Humans

Native Americans in medicine: the need for Indian healers.

Gallman, B W

Africa; Black or African American; Black People; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; Physicians; Schools, Medical; South Carolina; United States; Humans

From Africa to South Carolina: a brief review of the contributions of Africans and African-Americans to medicine.

Klapchuk, V V

Adult; Female; Humans; Male; Middle Aged; Combined Modality Therapy; Exercise Therapy; Health Resorts; Lung Diseases, Obstructive; Psychophysiology; Rehabilitation, Vocational

[Incorporation of the elements of job-related training into the sanatorium and health resort treatment of patients with chronic nonspecific lung diseases].

Taylor, B

Child, Preschool; Female; Humans; Infant; Infant, Newborn; Pregnancy; Age Factors; Bronchitis; Hospitalization; Maternal-Fetal Exchange; Mothers; Respiratory Tract Diseases; Smoking; Socioeconomic Factors; Tobacco Smoke Pollution

Maternal smoking during pregnancy and lower respiratory tract illness in early life.

In a national study of 12,743 children maternal, but not paternal, smoking was confirmed as having a significant influence on the reported incidence of bronchitis and admission to hospital for lower respiratory tract illness during the first five years of life. Reported rates of admissions to hospital for lower respiratory tract diseases were found to be as high in children born to mothers who stopped smoking during pregnancy as in those whose mothers smoked continuously both during and after pregnancy. Rates of admissions to hospital for lower respiratory tract diseases in children whose mothers started smoking only postnatally were no higher than in those whose mothers remained non-smokers. Postnatal smoking seemed to exert a significant influence on the reported incidence of bronchitis, but less than smoking during pregnancy. These findings suggest that maternal smoking influences the incidence of respiratory illnesses in children mainly through a congenital effect, and only to a lesser extent through passive exposure after birth.

Udezue, E O

Adult; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Antibodies; Black People; England; Fluorescent Antibody Technique; Immunity, Maternally-Acquired; Malaria; Nigeria; Plasmodium falciparum; Time Factors

Persistence of malarial antibody in Nigerian children born in the UK and its clinical relevance.

Immunofluorescent malarial antibody was measured in Nigerian children born in the UK, who had never been to any malarious country. Their antibody titres were compared to those of their mothers, taking into account the age of the children, the length of the mother's stay in the UK, and any revisits by the mothers to malarious areas. Antibody prevalence and titre fell with increasing age of the children. Their serum positivity rates were 82% in the first six months, 40% in the second six months and 9% at two years. Titres were generally low and declined similarly with age, from an initial geometric mean of 40 and 27 and 16, respectively, at the corresponding ages above. The clinical relevance of this finding to emigrant families returning home is briefly discussed.

Butler, T

Animals; Female; Rabbits; Endocarditis, Bacterial; Gram-Negative Bacteria; Immunosuppression Therapy; Liver; Methylprednisolone; Sepsis; Spleen; Splenectomy; Disease Models, Animal

Enhancement of experimental bacteremia and endocarditis caused by dysgonic fermenter (DF-2) bacterium after treatment with methylprednisolone and after splenectomy.

The dysgonic fermenter-2 bacterium is a newly recognized fastidious gram-negative bacillus that causes bacteremia and sometimes endocarditis in immunocompromised persons after they are bitten by dogs. To develop an experimental model of this infection, we placed polyethylene catheters across the aortic valves of New Zealand white rabbits, which were inoculated intravenously the next day with dysgonic fermenter-2 bacteria. After 1 week, the rabbits were killed and the endocardial vegetations were homogenized for quantitative culture. Large inocula (1.3 X 10(10) to 2.1 X 10(10) viable bacteria) were required to produce infected vegetations. All infected rabbits had negative blood cultures at the time of autopsy and most developed serum agglutinins against dysgonic fermenter-2 bacteria. Three daily injections of methylprednisolone (30 mg/kg), starting the day before inoculation, significantly increased the incidence of endocarditis and the number of bacteria per gram of infected vegetation (P less than 0.05). Treatment with methylprednisolone prolonged the initial bacteremia and caused significant increases in the numbers of bacteria per gram of blood, spleen, and liver compared with those of untreated controls (P less than 0.05). Rabbits that had previously undergone splenectomy showed prolongation of the initial bacteremia but no significant increase in the incidence of infected vegetations. These results showed that the dysgonic fermenter-2 bacterium is a pathogen that causes endocarditis in rabbits but that it requires a large inoculum and produces blood culture-negative infections. Treatment with methylprednisolone enhances infection by prolonging the initial bacteremia and probably by diminishing bactericidal activity in the vegetations.

Kimura, M

History of Medicine; Animals

Protein polymorphism as a phase of molecular evolution.

Jefferson, R S

Black or African American; Newspapers as Topic; Periodicals as Topic; Race Relations; Radio; United States; Humans

The black press: asset or liability to black people?

Pick, R

Animals; Male; Adaptation, Biological; Aorta, Thoracic; Arteriosclerosis; Body Weight; Chickens; Cholesterol; Cottonseed Oil; Diet, Atherogenic; Environment; Hypercholesterolemia; Oils; Organ Size; Testis

Effect of environmental changes on the development of hypercholesterolemia and atherosclerosis in cholesterol oil fed cockerels.

Thoday, J M

Animals; Analysis of Variance; Diptera; Environment; Genetic Variation; Models, Biological; Phenotype; Temperature

Environmental and genetical contributions to class difference: a model experiment.

Flies were divided into two groups on the basis of the number of their bristles, and raised under different environmental (temperature) conditions. In each generation, offspring of the two groups were retained in their group or transferred to the other group, depending on the number of their bristles. After nine generations it was found that the genetic component of the intergroup difference was 42 percent; the portion of the intragroup variance that was genetic phenomena.

Jefferson, R S

Black or African American; Communication; Race Relations; Television; United States; Humans

A critique of syndicated television and its effect on black people.

Merritt, J C

Attitude of Health Personnel; Black or African American; Demography; District of Columbia; Physicians; Socioeconomic Factors; Humans

Attitudes of black physicians toward poor black people.

Einarson, T R

Humans; Anti-Anxiety Agents; Benzodiazepines; Systematic Reviews as Topic

Systematic review of the benzodiazepines.

Koch, K

Calcium; Calcium Compounds; Disinfection; Hydrogen-Ion Concentration; Oxides; Parvoviridae; Poliovirus; Sewage; Sterilization

[Removal of polio- and parvovirus in sewage-sludge by lime-treatment (author's transl)].

Lime (CaO) applied as conditioner for dewatering municipal sewage sludge in filter-presses is suitable to disinfect sewage sludge with respect to virus. A pH-rise to more than 12 followed by release of ammonia inactivates Polio- and Bovine Parvovirus. Addition of 3 kg CaO and more per m3 of raw sludge inactivates Poliovirus within 30 minutes. 7.5 kg CaO per m3 of anaerobically digested sludge are required to inactivate Polio-virus within 5 days and Bovine Parvovirus within 24 hours. Parvovirus seems to be more sensitive against free ammonia than Poliovirus, but less sensitive against high pH-values.

Brinkmann, E

Dental Implantation, Endosseous; Dental Porcelain; Denture Design

[Ceramic pin implants: indications and uses].

Black or African American; Hispanic or Latino; Indians, North American; Leadership; Minority Groups; Nursing; United States; Humans

Contemporary minority leaders in nursing: Afro-American, Hispanic, Native American perspectives.

Cambefort, J P

Animals; Female; Male; Age Factors; Cercopithecus; Chlorocebus aethiops; Culture; Feeding Behavior; Group Structure; Learning; Papio

A comparative study of culturally transmitted patterns of feeding habits in the chacma baboon Papio ursinus and the vervet monkey Cercopithecus aethiops.

Japanese workers have studied social acquisition patterns of new feeding habits in Macaca fuscata which they have termed precultural. The present study investigates the same phenomenon in the chacma baboon and the vervet monkey in their natural habitat. The questions addressed are: (1) How a new feeding habit enters a troop and by which age and sex category, also how it is propagated? (2) When individuals are permitted with a choice between palatable and unpalatable food, can they learn by demonstration only or do they have to pass through a direct learning process? (3) Can the results from the above questions be explained by social parameters such as the social structure of the individual species? It was found that juvenile baboons discover new food and that after the discovery propagation is instantaneous. In vervets discovery is random among the age classes and propagation is slow and takes place through certain 'pivot' individuals. Both species fail to learn about palatability by demonstration but have to go through a direct learning process. This contrasts strongly with the forest baboon Mandrillus sphinx that have been shown to learn by demonstration. Socially, baboon juveniles stay closer to each other than the adults who force them to live at the periphery of the troop. Vervets again forage without precise sub-group formation. The link between social and cultural propagation and social structure is discussed on the basis of these findings.

Spitzer, J B

Hispanic or Latino; Speech Discrimination Tests; Speech Reception Threshold Test; Humans

The development of a picture speech reception threshold test in Spanish for use with urban U.S. residents of Hispanic background.

The need for an development of a test for measurement of Speech Reception Threshold (SRT) in Spanish are described. The test consists of 51 familiar bisyllabic words, some of which are cognates of English. The aim is development of a test, the vocabulary and procedure of which could be used with patients of diverse Hispanic backgrounds, and for which the administering audiologist need not be able to speak or understand Spanish.

Illingworth, R

Child; Humans; Benzodiazepines; Dreams; Somnambulism; Systematic Reviews as Topic

Systemic review of the benzodiazepines.

Gueyffier, F

Humans; Cohort Studies; Hypertension; Meta-Analysis as Topic; Risk Factors

INDANA: a meta-analysis on individual patient data in hypertension. Protocol and preliminary results.

The overall effect of antihypertensive drug treatment has been well documented. The proportion of patients who benefit varies according to their baseline cardiovascular risk, and is small for the majority of people treated. Some investigators propose limiting the treatment target population to patients at high cardiovascular risk, but several assumptions must be made to justify this procedure. The INDANA project is a meta-analysis based on individual patient data, and thus offers the opportunity to check the validity of these assumptions. Its main objective is to identify responders (and non-responders) in the drug treatment of hypertension. The rationale and methods for such an approach are presented here, with the solution for some technical problems. The conclusion of the data collection has shown that the project is feasible. The results of the main analysis should be available in 1996, and should contribute to the selection of responders and to the individualization of the treatment of hypertension.

Ross, J

Attitude to Health; Communication; Cultural Characteristics; Demography; Hispanic or Latino; Language; Marketing of Health Services; Medically Uninsured; Planning Techniques; United States; Humans

Hispanic Americans. Who are they, where are they, and how do we talk to them?

Oxman, A D

Humans; Clinical Laboratory Techniques; Data Collection; Diabetes Mellitus; Diagnosis, Computer-Assisted; Drug Prescriptions; Drug Therapy, Computer-Assisted; Hospitals; Hypertension; Preventive Health Services; Professional Practice; Quality of Health Care; Smoking Cessation; Treatment Outcome

No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.

To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes.

Broug-Holub, E

Animals; Male; Rats; Adjuvants, Immunologic; Administration, Oral; Bacteria; Cytokines; Macrophages, Alveolar; Nitric Oxide; Rats, Wistar

Changes in cytokine and nitric oxide secretion by rat alveolar macrophages after oral administration of bacterial extracts.

Oral administration of the bacterial immunomodulator Broncho-Vaxom (OM-85), a lysate of eight bacteria strains commonly causing respiratory disease, has been shown to enhance the host defence of the respiratory tract. In this study we examined the effect of orally administered (in vivo) OM-85 on stimulus-induced cytokine and nitric oxide secretion by rat alveolar macrophages in vitro. The results show that alveolar macrophages isolated from OM-85-treated rats secreted significantly more nitric oxide, tumour necrosis factor-alpha (TNF-alpha) and IL-1 beta upon in vitro stimulation with lipopolysaccharide (LPS), whereas, in contrast, LPS-induced IL-6 secretion was significantly lower. The observed effects of in vivo OM-85 treatment on stimulus-induced cytokine secretion in vitro are not due to a direct effect of OM-85 on the cells, because in vitro incubation of alveolar macrophages with OM-85 did not result in altered activity, nor did direct intratracheal instillation of OM-85 in the lungs of rats result in altered alveolar macrophage activity in vitro. It is hypothesized that oral administration of OM-85 leads to priming of alveolar macrophages in such a way that immune responses are non-specifically enhanced upon stimulation. The therapeutic action of OM-85 may therefore result from an enhanced clearance of infectious bacteria from the respiratory tract due to increased alveolar macrophage activity.

Polla, B S

Humans; Adjuvants, Immunologic; Antigens, Bacterial; Bacteria; Bacterial Proteins; Escherichia coli; Heat-Shock Proteins

Presence of hsp65 in bacterial extracts (OM-89): a possible mediator of orally-induced tolerance?

Heat shock proteins (HSP) have been implicated in rodent models of autoimmunity, particularly arthritis, and there is suggestive though inconclusive evidence that they may also play a role in human autoimmune disease. The simplest hypothesis is based on molecular mimicry due to the amino-acid sequence homology between mammalian and microbial HSP. Recently OM-89, an extract of several strains of Escherichia coli, has shown some efficacy in the treatment of rheumatoid arthritis (RA) when taken orally. Using species-specific antibodies, we show here that OM-89 contains the 65 kDa HSP (hsp65), while hsp65 was not detected in another bacterial extract containing other microorganisms, including Staphylococcus aureus (OM-85). We suggest that if the human homologue of hsp65 is a relevant target antigen in the human disease, the efficacy of the preparation could be due to induction of oral tolerance or to switching the Th1 response towards Th2. Alternatively, even if the human hsp65 is not a target molecule in RA joints, OM-89 may evoke bystander suppression of joint inflammation via induction of TGF beta-secreting effector cells. These hypotheses should be tested in further studies.

Reed, J

Black or African American; Coronary Disease; Physician's Role; Research; Schools, Medical; Societies; Humans

The role of African-American medical/professional organizations and historically black medical schools in research to reduce CHD in African Americans.

Kegler, M C

Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Diabetes Mellitus; Hospitalization; North Carolina; Prevalence; Black or African American; White

The burden of diabetes in North Carolina.

Grimshaw, J M

Humans; Outcome and Process Assessment, Health Care; Practice Guidelines as Topic

Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations.

Although interest in clinical guidelines has never been greater, uncertainty persists about whether they are effective. The debate has been hampered by the lack of a rigorous overview. We have identified 59 published evaluations of clinical guidelines that met defined criteria for scientific rigour; 24 investigated guidelines for specific clinical conditions, 27 studied preventive care, and 8 looked at guidelines for prescribing or for support services. All but 4 of these studies detected significant improvements in the process of care after the introduction of guidelines and all but 2 of the 11 studies that assessed the outcome of care reported significant improvements. We conclude that explicit guidelines do improve clinical practice, when introduced in the context of rigorous evaluations. However, the size of the improvements in performance varied considerably.

Adult; Aged; Female; Humans; Male; Middle Aged; Age Factors; Asia; Black People; Blood Pressure; Body Mass Index; Caribbean Region; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Hypertension; Physical Fitness; Prevalence; Prospective Studies; Sex Characteristics; Social Class; United Kingdom; White People

UK Prospective Diabetes Study. XII: Differences between Asian, Afro-Caribbean and white Caucasian type 2 diabetic patients at diagnosis of diabetes. UK Prospective Diabetes Study Group.

Clinical and biochemical variables and prevalence of complications at diagnosis of diabetes were assessed in 5098 Type 2 diabetic patients in the UK Prospective Diabetes Study of whom 82% were white Caucasian, 10% Asian of Indian origin, and 8% Afro-Caribbean. The Asian patients were (p < 0.001) younger (mean age 52.3, 47.0, 51.0 years), less obese (BMI 29.3, 26.7, 27.9 kg m-2), had a greater waist-hip ratio, lower blood pressure (systolic 145, 139, 144, diastolic 87, 86, 89 mmHg) and prevalence of hypertension. They were more often sedentary (19, 39, 15%), more often abstained from alcohol (21, 55, 25%) and had a greater prevalence of first degree relatives with known diabetes (36, 44, 34%). The Afro-Caribbean patients had (p < 0.001) higher fasting plasma glucose (11.9, 11.3, 12.5 mmol l-1), more severely impaired beta-cell function (45, 35, 28% normal) and less impaired insulin sensitivity (23, 19, 27% normal) by homeostasis model assessment, lower triglyceride (1.8, 1.8, 1.3 mmol l-1), and higher HDL-cholesterol (1.05, 1.03, 1.17 mmol l-1). Prevalence of a history of myocardial infarction, stroke or intermittent claudication at diagnosis was similar. The prevalence of ischaemic ECG (Minnesota code), microalbuminuria (urine albumin > 50 mg l-1), retinopathy ('191' grading of retinal photographs), and neuropathy (abnormal vibration perception threshold or absent leg reflexes) was also similar. At diagnosis of Type 2 diabetes there were no differences in prevalence of complications between white Caucasian, Asian, and Afro-Caribbean patients although differences were found in other clinical and biochemical variables.

Orcel, B

Aged; Aged, 80 and over; Female; Humans; Male; Acute Disease; Adjuvants, Immunologic; Bacteria; Bronchitis; Chronic Disease; Double-Blind Method; Homes for the Aged; Immunization; Incidence; Nursing Homes; Prospective Studies

Oral immunization with bacterial extracts for protection against acute bronchitis in elderly institutionalized patients with chronic bronchitis.

Acute bronchitis is a major source of morbidity in elderly patients. The purpose of this study was to assess the preventive effects of oral immunisation with a bacterial extract. Three hundred and fifty four patients with chronic bronchitis, living in institutions for the elderly (aged > 65 yrs), were included in a randomized, placebo-controlled, double-blind study. The purpose of the study was to assess preventive effects of OM-85 BV (an immunostimulating agent consisting of lyophilized fractions of eight of the most common pathogens isolated in respiratory tract infections) against acute lower respiratory tract infections. Two hundred and ninety patients completed the study (143 taking placebo and 147 taking OM-85 BV). There was a 28% reduction in the number of lower respiratory tract infections in the patients treated with OM-85 BV; this was entirely due to 40% reduction in the number of episodes of acute bronchitis (p < 0.01), with no difference in the number of episodes of pneumonia and bronchopneumonia. A larger number of patients in the OM-85 BV group were free of acute bronchitis throughout the 6 month study period (96 vs 69) and there was a 28% reduction in the number of antibiotic prescriptions in the OM-85 BV treated group. These results suggest that OM-85 BV has a protective effect against acute bronchitis in elderly patients living in institutions.

Reilly, T

Adult; Humans; Male; Body Height; Ergometry; Intervertebral Disc; Physical Exertion; Spine; Weight-Bearing; Sports

Spinal shrinkage in fast bowling.

The load on the spine during physical activities may be reflected in decreases in stature, referred to as shrinkage. Spinal shrinkage reflects the creep behaviour of the intervertebral discs and vertebral end-plate compression when loaded. This study was concerned with shrinkage induced during practices corresponding to fast bowling in cricket, an activity associated with risk of back injury. Eight cricketers (aged 19-24 years), all free of back pain, acted as subjects. They were first trained for measurement on the stadiometer until 10 consecutive recordings of stature with SD < 0.5 mm could be produced. A 20 min period of standing was used for standardization purposes prior to experimental work which took place indoors between 12:00 and 16:00 hours. The experimental conditions were (i) standing for 30 min; (ii) bowling for 30 min at a rate of once every 30 s from a 14 m run-up; (iii) a run-up (without bowling) of 14 m for 30 min once every 30 s; (iv) inverted at an angle of 50 degrees for 5 min; (v) inverted at an angle of 50 degrees for 5 min prior to bowling once every 30 s for 30 min from a 14 m run-up. These conditions were presented to the subject on five separate days. Stature was not affected by the 30 min standing, used for control purposes (mean shrinkage 0.1 mm). Bowling caused a decrease in stature of 2.30 (+/- 1.58) mm in 30 min (p < 0.05). Stature did not decrease significantly (mean shrinkage 0.29 mm) when only the run-up was performed (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Shively, C A

Animals; Female; Coronary Artery Disease; Macaca fascicularis; Ovary; Risk Factors

Social status and coronary artery atherosclerosis in female monkeys.

While coronary heart disease is the leading cause of death in women in the United States, research in the area is lacking, especially concerning psychosocial risk factors. The purpose of this experiment was to study the effect of a known psychosocial risk factor in female monkeys, social status, and the effect of alteration of social status on coronary artery atherosclerosis. In previous experiments it has been demonstrated that social status is an enduring characteristic of the individual and that socially subordinate female monkeys have poor ovarian function and exacerbated coronary artery atherosclerosis. In the present experiment, adult female monkeys were fed an atherogenic diet and housed in small social groups, and social status was altered in half of the animals (subordinates became dominant and dominants became subordinate). The manipulation of social status had minimal effects on risk factors but significantly affected coronary artery atherosclerosis, supporting the hypothesis that social status affects atherogenesis in these females. However, all animals that changed social positions had worsened coronary artery atherosclerosis whether they became dominant or became subordinate, and this effect was independent of ovarian function. Subordinates that became dominant had 44% more and dominants that became subordinate had 500% more atherosclerosis than their counterparts that did not change social status. Thus, modification of this psychosocial risk factor was not effective in reducing coronary artery atherosclerosis. The manipulation of social status may have deleteriously altered a complex interaction between individuals and their psychosocial environment.

Thomas, C S

Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Age Factors; Black People; Commitment of Mentally Ill; Cross-Cultural Comparison; Cross-Sectional Studies; England; Ethnicity; Europe; Incidence; India; Mental Disorders; Pakistan; Patient Admission; Risk Factors; Sex Factors; Socioeconomic Factors; West Indies

Psychiatric morbidity and compulsory admission among UK-born Europeans, Afro-Caribbeans and Asians in central Manchester.

Psychiatric admissions in Central Manchester of Europeans, Afro-Caribbeans, and Asians (within three age-bands) were studied over four years. Among the Afro-Caribbean group there were more single or unemployed persons than in either the Asian or European groups, which suggested greater socio-economic disadvantage. Rates for first admissions and readmissions among Afro-Caribbeans were greater; among Asians they were similar except for the 16-29-year age-group, who tended to have lower rates than Europeans. A higher proportion of Afro-Caribbeans and Asians were psychotic. In the Afro-Caribbean group, the raised rates of admission were largely attributable to increased rates of schizophrenia. The highest rate occurred in second-generation (UK-born) Afro-Caribbeans and was nine times that among Europeans. The police were more frequently involved in the admissions of Afro-Caribbeans compared with Europeans or Asians. Higher proportions of Afro-Caribbeans and Asians who were readmitted were detained under the Mental Health Act 1983, when compared with Europeans.

Rotimi, C

Alleles; Angiotensinogen; Black or African American; Black People; Hypertension; Jamaica; Nigeria; Peptidyl-Dipeptidase A; Polymorphism, Genetic; United States; Humans

Polymorphisms of renin-angiotensin genes among Nigerians, Jamaicans, and African Americans.

Within the context of an international collaborative study of the evolution of hypertension in the black diaspora, we determined the allelic distribution of hypertension candidate genes for the renin-angiotensin system in three populations of African origin. The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) and the M235T and T174M variants of the angiotensinogen (AGT) gene were examined in individuals from Nigeria, Jamaica, and the United States. Large differences in the prevalence of hypertension were recorded in door-to-door surveys, ranging from 16% in Nigeria to 33% in the United States. The frequency of the D allele was similar in all groups (54%, 59%, and 63% in Nigeria, Jamaica, and the United States, respectively). The 235T allele of the AGT gene was found in 81% of US and Jamaican blacks and 91% of Nigerians; very little variation was seen for the T174M marker. Despite large differences in hypertension rates, genetic variation at the index loci among these groups was modest. Overall, the frequency of the ACE*D allele was only slightly higher than that reported for European and Japanese populations, whereas the AGT 235T allele was twice as common. Compared with blacks in the western hemisphere, Nigerians had a higher frequency of the 235T allele, which is consistent with 25% European admixture in Jamaica and the United States. The results indicate the potential for etiologic heterogeneity in genetic factors related to hypertension across ethnic groups while suggesting that environmental exposures most likely explain the gradient in risk in the comparison among black populations.

Jacquier-Sarlin, M R

Humans; Adjuvants, Immunologic; Bacteria; Calcium; Carrier Proteins; Cells, Cultured; Cytosol; Endoplasmic Reticulum Chaperone BiP; Enzyme Inhibitors; Heat-Shock Proteins; Molecular Chaperones; Monocytes; Protein Kinase C; Second Messenger Systems; Superoxides

Selective induction of the glucose-regulated protein grp78 in human monocytes by bacterial extracts (OM-85): a role for calcium as second messenger.

Heat shock/stress proteins (HSP) act as molecular chaperones, protect cells from injury, and are involved in the immune response. We investigated the effects of the immunomodulating bacterial extracts OM-85 on the stress response in normal human peripheral blood monocytes. While OM-85 did not induce the classical HSP, we show here, using 2D gel electrophoresis combined with immunoblotting, the induction of the glucose regulated protein grp78 (the immunoglobulin heavy chain binding protein BiP) along with the described accumulation of pro-interleukin-1 beta. The increased Ca2+ mobilization observed with OM-85 is the likely second messenger for grp78 induction. Recent studies are in favor of a protective role of grp78 against cytokine-mediated cytotoxicity and apoptosis. We suggest that grp78 induction following exposure to OM-85 explains, at least in part, the immunodulatory and protective effects of the bacterial extracts.

Lindeman, S

Female; Humans; Male; Incidence; Mortality; Physicians; Sex Factors; Suicide

A systematic review on gender-specific suicide mortality in medical doctors.

So far no comprehensive systematic review has been published about epidemiologic studies on suicides among medical practitioners. The aim here is to describe the variation of published estimates of relative risk of doctors to die from suicide.

Widdison, A L

Humans; Cholecystectomy, Laparoscopic; Cholelithiasis; Systematic Reviews as Topic

A systematic review of the effectiveness and safety of laparoscopic cholecystectomy.

Law, C M

Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Birth Weight; Blood Pressure; Regression Analysis

Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature.

To assess the strength of evidence for an inverse relationship between blood pressure and birth weight.

Black, N A

Female; Humans; Clinical Trials as Topic; Cohort Studies; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Treatment Outcome; Urinary Incontinence, Stress

The effectiveness of surgery for stress incontinence in women: a systematic review.

To determine the methodological quality of studies evaluating surgery for stress incontinence, the effectiveness of different procedures and the frequency of complications associated with each procedure.

Worrall, G

Humans; Canada; Confidence Intervals; Data Interpretation, Statistical; England; Evaluation Studies as Topic; Evidence-Based Medicine; Follow-Up Studies; Hypertension; Information Storage and Retrieval; MEDLINE; Practice Guidelines as Topic; Primary Health Care; Randomized Controlled Trials as Topic; Research Design; Treatment Outcome; United States

The effects of clinical practice guidelines on patient outcomes in primary care: a systematic review.

To assess the evidence for the effectiveness of clinical practice guidelines (CPGs) in improving patient outcomes in primary care.

Gibbons, R J

Adolescent; Aged; Child; Female; Humans; Male; Blood Gas Analysis; Cardiology; Coronary Disease; Electrocardiography; Exercise Test; Mass Screening; Myocardial Infarction; Prognosis; Risk Assessment; Societies, Medical; United States

ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing).

Segawa, R

California; Ethnobotany; Herbicides; Indians, North American; Pesticide Residues; Plants; Humans

Residues of forestry herbicides in plants of importance to California Native Americans.

Meade, M O

Research Design; Systematic Reviews as Topic

Selecting and appraising studies for a systematic review.

After thoroughly searching the potentially relevant literature for a systematic review, reviewers face the sequential tasks of selecting studies for inclusion and appraising these studies. Methodical, impartial, and reliable strategies are necessary for these two tasks because systematic reviews are retrospective exercises and are therefore prone to both bias and random error. To plan for study selection, reviewers begin with a focused clinical question and choose selection criteria that reflect this question. A detailed selection protocol that specifies the study designs and publication status of articles to be included is often helpful. Selection criteria are itemized on customized forms and are used to examine each potentially relevant primary study, usually by two different reviewers. In planning the critical appraisal of included studies, reviewers decide which clinical and methodologic study features require documentation. After choosing methods for evaluating study quality, reviewers construct customized appraisal forms and an explicit protocol for the actual evaluation. Some of the techniques commonly used to minimize the potential for error in study appraisal include duplicate, independent examination; blinding to study results and other identifying features of each article; and correspondence with study authors to clarify issues. Ultimately, primary studies should be selected, appraised, and reported in sufficient detail to allow readers to judge the applicability of the review to clinical practice and to clarify the strength of the inferences that can be drawn from the review.

Gorodetsky, E

Animals; Cats; Dogs; Age Factors; Alberta; Animal Welfare; Attitude; Breeding; Data Collection; Euthanasia; Hospitals, Animal; Interviews as Topic; Manitoba; Saskatchewan; Seasons; Social Class; Surveys and Questionnaires; Humans

Epidemiology of dog and cat euthanasia across Canadian prairie provinces.

Calpin, C

Child; Child, Preschool; Female; Humans; Infant, Newborn; Male; Administration, Inhalation; Adrenal Cortex Hormones; Asthma; Double-Blind Method; Glucocorticoids; Peak Expiratory Flow Rate; Placebos

Effectiveness of prophylactic inhaled steroids in childhood asthma: a systemic review of the literature.

There has been no systematic appraisal of the evidence regarding the effectiveness of prophylactic inhaled steroids in childhood asthma.

Spinelli, S L

Genes, Fungal; Genes, Lethal; Models, Chemical; Mutation; Phosphotransferases (Alcohol Group Acceptor); Ribonucleotides; RNA Splicing; RNA, Fungal; RNA, Transfer; RNA, Transfer, Leu; RNA, Transfer, Tyr; Saccharomyces cerevisiae; Saccharomyces cerevisiae Proteins; Tumor Protein, Translationally-Controlled 1

A conditional lethal yeast phosphotransferase (tpt1) mutant accumulates tRNAs with a 2'-phosphate and an undermodified base at the splice junction.

tRNA splicing is essential in yeast and humans and presumably all eukaryotes. The first two steps of yeast tRNA splicing, excision of the intron by endonuclease and joining of the exons by tRNA ligase, leave a splice junction bearing a 2'-phosphate. Biochemical analysis suggests that removal of this phosphate in yeast is catalyzed by a highly specific 2'-phosphotransferase that transfers the phosphate to NAD to form ADP-ribose 1"-2" cyclic phosphate. 2'-Phosphotransferase catalytic activity is encoded by a single essential gene, TPT1, in the yeast Saccharomyces cerevisiae. We show here that Tpt1 protein is responsible for the dephosphorylation step of tRNA splicing in vivo because, during nonpermissive growth, conditional lethal tpt1 mutants accumulate 2'-phosphorylated tRNAs from eight different tRNA species that are known to be spliced. We show also that several of these tRNAs are undermodified at the splice junction residue, which is always located at the hypermodified position one base 3' of the anticodon. This result is consistent with previous results indicating that modification of the hypermodified position occurs after intron excision in the tRNA processing pathway, and implies that modification normally follows the dephosphorylation step of tRNA splicing in vivo.

Bakhshi, S S

Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Asia; Black People; Disease Notification; England; Ethnicity; Incidence; Retrospective Studies; Tuberculosis; West Indies; White People

The epidemiology of tuberculosis by ethnic group in Birmingham and its implications for future trends in tuberculosis in the UK.

To describe the epidemiology of tuberculosis (TB) in Birmingham, UK, by ethnic group and to assess the implications of the findings for future trends in TB in the UK.

Kulkarni, K

Adolescent; Adult; Female; Humans; Male; Blood Glucose; Diabetes Mellitus, Type 1; Glycated Hemoglobin; Guideline Adherence; Nutritional Physiological Phenomena; Outcome Assessment, Health Care; Patient Satisfaction; Practice Guidelines as Topic; Quality of Life

Nutrition Practice Guidelines for Type 1 Diabetes Mellitus positively affect dietitian practices and patient outcomes. The Diabetes Care and Education Dietetic Practice Group.

Assess the acceptance and ease of use of Nutrition Practice Guidelines for Type 1 Diabetes Mellitus by dietitians in a variety of settings; determine if nutrition care activities of dietitians change when practice guidelines are available; measure changes in patient control of blood glucose level, measured as glycated hemoglobin (HbA1c); compare patient satisfaction with care and perceptions about quality of life.

Keenan, S P

Humans; Cost-Benefit Analysis; Data Interpretation, Statistical; Health Care Costs; Health Services Research; Intermediate Care Facilities; MEDLINE; Reproducibility of Results; Retrospective Studies; United States

A systematic review of the cost-effectiveness of noncardiac transitional care units.

To critically appraise and summarize the studies examining the cost-effectiveness of noncardiac transitional care units (TCUs).

McArthur, J

Humans; Evidence-Based Medicine; Nursing Research; Review Literature as Topic

The systematic review: an essential element of an evidence based approach to nursing.

Consistent with a move towards evidence based practice, systematic review of research relating to effective health care practices is having an increasing influence on health care decision making at all levels. This paper explains the systematic review as a specific type of literature review, one that contrasts with less rigorous approaches to assessing current best available research evidence. The use of this process to achieve effective nursing practice is discussed in the context of systematic review in medicine and health services in general. It is asserted that, in the 'information age', understanding and being able to assess the quality of systematic reviews is an essential area of nursing research.

Weaver, A J

Humans; Documentation; Periodicals as Topic; Psychiatry; Religion; Research Design

A systematic review of research on religion in four major psychiatric journals: 1991-1995.

Vickers, A

Humans; Acupuncture Therapy; Clinical Trials as Topic; Cross-Cultural Comparison; Data Collection; Data Interpretation, Statistical; Publication Bias; Randomized Controlled Trials as Topic; Treatment Outcome

Do certain countries produce only positive results? A systematic review of controlled trials.

To determine whether clinical trials originating in certain countries always have positive results.

Eaton, C B

Adolescent; Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Confidence Intervals; Exercise; Health Promotion; Odds Ratio; Primary Health Care; Randomized Controlled Trials as Topic; Walking

A systematic review of physical activity promotion in primary care office settings.

To assess the efficacy of physical activity promotion in primary care office settings.

Demark-Wahnefried, W

Black or African American; Health Education; Information Services; Neoplasms; Rural Population; United States; Humans

Awareness of cancer-related programs and services among rural African Americans.

African Americans are at increased risk for cancer and represent an important target population for programs such as Healthy People 2000, the Cancer Information Service (CIS), and the 5 a Day for Better Health Initiative. Yet, awareness of such programs among rural blacks is unknown. This study assessed awareness of these programs and determined related knowledge and beliefs among rural African Americans. It was undertaken as part of the baseline survey for the Black Churches United for Better Health project, a National Cancer Institute-funded initiative. A minority of respondents (n = 3737) demonstrated name recognition of Healthy People 2000 (23.4%), the CIS (42.4%), and the 5 a Day Program (40.7%). Far fewer (7.4%) were able to correctly identify the recommended daily number of servings of fruits and vegetables. Reported family history of cancer was associated with a greater tendency believe that eating more fruits and vegetables can prevent disease. These findings underscore the need for efforts to reach the rural black community with culturally sensitive and stage appropriate cancer prevention messages. Knowledge of family history of cancer may play an important role in targeting subgroups and delivering effective cancer prevention messages.

Bours, G J

Aged; Aged, 80 and over; Humans; Aftercare; Chronic Disease; Clinical Trials as Topic; Frail Elderly; Netherlands; Patient Discharge; Quality of Life

The effects of aftercare on chronic patients and frail elderly patients when discharged from hospital: a systematic review.

The purpose of this systematic review was an assessment of the efficacy of aftercare in chronic patients and the frail elderly when discharged from hospital, as regards quality of life, compliance, costs, medical consumption and quality of care. In pursuit of this goal, 17 publications on the effects of aftercare after discharge from hospital were examined. A systematic assessment of methodological quality by two blinded independent reviewers resulted in a consensus score (0-100 points), based on four categories: the study population, description of the interventions, measurement of the outcome and the analysis and presentation of the data. Only three of the 17 studies scored more than 50 points, indicating that most of the studies were of poor methodological quality. The most prevalent methodological problems were that co-interventions were not avoided, a placebo group was lacking, the assessment was not blinded and the analysis was not made on the basis of the intention-to-treat principle. The majority of the studies did not report clear beneficial effects in favour of the intervention group. The positive effects reported were limited to costs and quality of care.

Harry, T C

Humans; Black People; Sexually Transmitted Diseases; United Kingdom

Sexual ill-health among blacks in the UK.

Sharma, S

Female; Humans; Male; Middle Aged; Black People; Caribbean Region; Coronary Disease; Diet; Diet Surveys; United Kingdom

Nutrient intakes among UK African-Caribbeans: changing risk of coronary heart disease.

Kunz, R

Adult; Aged; Female; Humans; Male; Middle Aged; Age Distribution; Asian People; Case-Control Studies; Cohort Studies; Confidence Intervals; Confounding Factors, Epidemiologic; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Gene Expression; Genotype; Germany; Incidence; Odds Ratio; Peptidyl-Dipeptidase A; Polymorphism, Genetic; Sex Distribution; White People

Association between the angiotensin-converting enzyme-insertion/deletion polymorphism and diabetic nephropathy: a methodologic appraisal and systematic review.

Recent studies have implicated a variant of the angiotensin-converting enzyme gene (ACE), associated with increased activity of this enzyme, in the development and progression of diabetic nephropathy. This study provides a systematic review of all cross-sectional, case-control, and cohort studies in patients with insulin-dependent (IDDM) or non-insulin-dependent (NIDDM) diabetes mellitus of any race, examining the relationship between the ACE-insertion/deletion polymorphism and nephropathy. Nineteen studies in 21 populations published between 1994 and 1997 presenting data on 5336 patients were reviewed. Two investigators independently assessed the studies on methodologic quality, performance of study, and association between the ACE-insertion/deletion polymorphism and nephropathy. Separate analyses of the relationship between genotype and allele frequencies were performed for patients with IDDM and NIDDM by race, using Peto's odds ratio. In Caucasians with IDDM, pooling was not performed due to heterogeneity of the studies, but among the homogeneous studies, no association was detected. Likewise, no association was observed in Caucasian patients with NIDDM (odds ratio [OR], 1.10; 95% confidence interval [95% CI], 0.83 to 1.45). In Asian patients with NIDDM, the risk of nephropathy was increased in the presence of the DD or ID genotype (OR, 1.88; 95% CI, 1.42 to 2.85). Although this analysis fails to confirm an association between the ACE-insertion/deletion genotype and nephropathy in Caucasians with NIDDM or IDDM, a role for this genetic marker in Asian patients cannot be ruled out. However, due to methodologic limitations of individual studies, no definite conclusions can be drawn from this analysis. Clearly, more rigorous methodology needs to be applied in future studies.

Bath, F J

Humans; Acute Disease; Cerebrovascular Disorders; Evaluation Studies as Topic; Publishing; Quality Control; Randomized Controlled Trials as Topic

Quality of full and final publications reporting acute stroke trials: a systematic review.

Several studies have shown that the quality of reporting of trials throughout medicine is variable and often poor. We report on the quality of the final reports of randomized controlled trials (RCTs) of drug therapies assessed in acute stroke.

Schneck, S A

Family; Physician's Role; Physician-Patient Relations; Humans

"Doctoring" doctors and their families.

Being selected to provide medical care to other physicians or their family members represents not only a gratifying professional recognition of competence by one's peers but also a challenge. Many personal and psychological factors may influence the medical care of physicians. III physicians may have difficulty with role reversal and "the VIP syndrome," while treating physicians may have to deal with their own anxiety and issues such as confidentiality, privacy, empathy, and intrusion by a physician-relative into the care of medical family members. Based on experience with more than 200 physician-patients and many adult family members of physicians, suggestions are offered for care of these patient groups.

Boni, M

Animals; Dogs; Mice; Rabbits; Antibodies, Bacterial; Antigens, Bacterial; Cote d'Ivoire; Coxiella burnetii; Dog Diseases; Fluorescent Antibody Technique, Indirect; France; Martinique; Q Fever; Senegal; Seroepidemiologic Studies; Sheep; French Guiana

Survey of seroprevalence of Q fever in dogs in the southeast of France, French Guyana, Martinique, Senegal and the Ivory Coast.

A serological survey was carried out on 429 dogs belonging to the French military in France, French Guyana, Martinique, Senegal and the Ivory Coast. Serology against phase I and II antigens of Coxiella burnetii, the intracellular zoonotic bacterium was performed using indirect immunofluorescence techniques. Specific antibodies were found in dogs from France (9.8%), Senegal (11.6%), Ivory Coast (8.3%), French Guyana (5.2%) but not in those from Martinique. The seroprevalence among 77 dogs who had contact with sheep compared with 352 dogs who had had no contact, demonstrated a significantly higher seroprevalence in the former. Our results indicate that dogs, living close to sheep, may be infected by Coxiella burnetii and should be considered as possible sources of infection for humans.

Spinelli, S L

Animals; Mice; Adenosine Diphosphate Ribose; Cyclic ADP-Ribose; Escherichia coli; Escherichia coli Proteins; NAD; Phosphotransferases (Alcohol Group Acceptor); RNA Splicing; RNA, Transfer; Saccharomyces cerevisiae; Saccharomyces cerevisiae Proteins; Structure-Activity Relationship; Tumor Protein, Translationally-Controlled 1

Transient ADP-ribosylation of a 2'-phosphate implicated in its removal from ligated tRNA during splicing in yeast.

The last step of tRNA splicing in yeast is catalyzed by Tpt1 protein, which transfers the 2'-phosphate from ligated tRNA to NAD to produce ADP-ribose 1"-2"-cyclic phosphate (Appr>p). Structural and functional TPT1 homologs are found widely in eukaryotes and, surprisingly, also in Escherichia coli, which does not have this class of tRNA splicing. To understand the possible roles of the Tpt1 enzymes as well as the unusual use of NAD, the reaction mechanism of the E. coli homolog KptA was investigated. We show here that KptA protein removes the 2'-phosphate from RNA via an intermediate in which the phosphate is ADP-ribosylated followed by a presumed transesterification to release the RNA and generate Appr>p. The intermediate was characterized by analysis of its components and their linkages, using various labeled substrates and cofactors. Because the yeast and mouse Tpt1 proteins, like KptA protein, can catalyze the conversion of the KptA-generated intermediate to both product and the original substrate, these enzymes likely use the same reaction mechanism. Step 1 of this reaction is strikingly similar to the ADP-ribosylation of proteins catalyzed by a number of bacterial toxins.

Fabre-Jonca, N

Humans; Cytochalasin D; Intracellular Fluid; Keratinocytes; Microtubule-Associated Proteins; Skin Neoplasms; Up-Regulation

Upregulation and redistribution of E-MAP-115 (epithelial microtubule-associated protein of 115 kDa) in terminally differentiating keratinocytes is coincident with the formation of intercellular contacts.

Microtubules are involved in the positioning and movement of organelles and vesicles and therefore play fundamental roles in cell polarization and differentiation. Their organization and properties are cell-type specific and are controlled by microtubule-associated proteins (MAP). E-MAP-115 (epithelial microtubule-associated protein of 115 kDa) has been identified as a microtubule-stabilizing protein predominantly expressed in epithelial cells. We have used human skin and primary keratinocytes as a model to assess a putative function of E-MAP-115 in stabilizing and reorganizing the microtubule network during epithelial cell differentiation. Immunolabeling of skin sections indicated that E-MAP-115 is predominantly expressed in the suprabasal layers of the normal epidermis and, in agreement with this observation, is relatively abundant in squamous cell carcinomas but barely detectable in basal cell carcinomas. In primary keratinocytes whose terminal differentiation was induced by increasing the Ca2+ concentration of the medium, E-MAP-115 expression significantly increased during the first day, as observed by northern and western blot analysis. Parallel immunofluorescence studies showed an early redistribution of E-MAP-115 from microtubules with a paranuclear localization to cortical microtubules organized in spike-like bundles facing intercellular contacts. This phenomenon is transient and can be reversed by Ca2+ depletion. Treatment of cells with cytoskeleton-active drugs after raising the Ca2+ concentration indicated that E-MAP-115 is associated with a subset of stable microtubules and that the cortical localization of these microtubules is dependent on other microtubules but not on strong interactions with the actin cytoskeleton or the plasma membrane. The mechanism whereby E-MAP-115 would redistribute to and stabilize cortical microtubules used for the polarized transport of vesicles towards the plasma membrane, where important reorganizations take place upon stratification, is discussed.

Hansen, A C

Black or African American; History, 19th Century; History, 20th Century; History, Ancient; Ophthalmology; United States; Humans

African Americans in ophthalmology.

Humans; Elbow; Electrodiagnosis; Ulnar Nerve; Ulnar Nerve Compression Syndromes; Practice Guidelines as Topic

Practice parameter for electrodiagnostic studies in ulnar neuropathy at the elbow: summary statement. American Association of Electrodiagnostic Medicine, American Academy of Physical Medicine and Rehabilitation, American Academy of Neurology.

Lutz, S

Health Services Accessibility; Hispanic or Latino; Hospitals, Public; Mexico; Texas; Humans

Findings on Hispanic health no surprise to border hospital.

Siwicki, B

Health Care Reform; Hispanic or Latino; Politics; Puerto Rico; United States; Humans

Baquero strives to increase awareness of Hispanic healthcare issues.

Goldstein, M A

Blue Cross Blue Shield Insurance Plans; Hispanic or Latino; Hospitals; Independent Practice Associations; Los Angeles; Urban Health Services; Humans

Calif. insurer, hospital, IPA ally to serve Hispanic market.

Eastwood, A J

Humans; Ambulatory Care; Asthma; Delivery of Health Care; Health Services Research; Hospitalization; Policy Making; State Medicine; Treatment Outcome; United Kingdom; Randomized Controlled Trials as Topic

Organisation of asthma care: what difference does it make? A systematic review of the literature.

To evaluate the effectiveness of different forms of organisation (delivery) of asthma care.

Japsen, B

Chicago; Hispanic or Latino; Hospital Shared Services; Managed Care Programs; Organizational Affiliation; Humans

Hispanic connection. Two Chicago hospitals link to aid underserved group.

Brown, J

Air Ambulances; California; Evaluation Studies as Topic; Family; Program Development; Surveys and Questionnaires; Transportation of Patients; Humans

Family member ride-alongs during interfacility transport.

A significant portion of the Air Med Team (AMT) flight missions involves interfacility transport of the ill or injured to receiving facilities with comprehensive resources available for their care. In an effort to help meet the psychologic needs of our patients and their families, AMT developed a Family Member Ride-Along program that allows family members or significant others to accompany patients during interfacility transport. The purpose of this study was to evaluate the ride-along program from the perspective of the family member passenger (FMP) who has accompanied a patient during transport.

Cummings, J P

Humans; Centers for Medicare and Medicaid Services, U.S.; Coronary Disease; Data Collection; Decision Making, Organizational; Evidence-Based Medicine; Health Care Rationing; Insurance, Health, Reimbursement; Laser Therapy; Myocardial Revascularization; Surgery Department, Hospital; Technology Assessment, Biomedical; Treatment Outcome; United States; United States Food and Drug Administration

Transmyocardial laser revascularization: a qualitative systematic review.

To evaluate the status of transmyocardial laser revascularization (TMLR) from an evidence-based perspective to help hospitals make resource management decisions.

McIntosh, H M

Adult; Child; Humans; Antimalarials; Artemisinins; Chemistry, Pharmaceutical; Malaria, Cerebral; Malaria, Falciparum; Odds Ratio; Quinine; Randomized Controlled Trials as Topic; Research Design; Sesquiterpenes; Survival Analysis

Treatment of severe malaria with artemisinin derivatives. A systematic review of randomised controlled trials.

This systematic review of randomised or pseudorandomised trials aimed at summarising the effectiveness and safety of artemisinin drugs for treating severe falciparum malaria in adults and children. Survival was better with artemisinin drugs in 1.265 patients compared with 1.183 treated with quinine (OR: 0.68; 95% CI: 0.55-0.84). However, the difference is barely significant when only studies with adequate concealment of allocation at enrolment are included in the analysis (OR: 0.77; 95% CI: 0.61-0.98). In 1784 patients with cerebral malaria, mortality was also lower with artemisinin drugs overall (OR: 0.70; 95% CI: 0.55-0.90), but not significantly better than quinine in studies reporting adequate concealment of allocation. No difference in neurological sequelae has been demonstrated. Artemisinin drugs clear parasites from the blood faster than quinine. Adverse effects are similarly common with artemisinin drugs and quinine, although reporting varies between trials. There is no evidence from this review that any one artemisinin derivative is better than the others, but comparative studies are few, small and heterogeneous.

Fergusson, D

Adult; Humans; Middle Aged; Blood Donors; Blood Transfusion; Blood Transfusion, Autologous; Costs and Cost Analysis; Evaluation Studies as Topic; Postoperative Complications

Economic evaluations of technologies to minimize perioperative transfusion: a systematic review of published studies. International Study of Peri-operative Transfusion (ISPOT) investigators.

Hinton, R G

Arizona; Hospital Bed Capacity, 100 to 299; Indians, North American; Libraries, Hospital; Library Services; Humans

Library services for those who serve Native Americans: Navajo, Hopi, Pima, Maricopa, Papago, Uintah and Ouray.

deForest, M E

Culture; Hispanic or Latino; Mexico; Personnel Administration, Hospital; Humans

Hospital managers must consider cultural habits of Hispanic workers.

Chambré, S M

Black or African American; Hispanic or Latino; Organizations; Personnel Management; Personnel Selection; United States; Volunteers; Humans

Recruiting Black and Hispanic volunteers: a qualitative study of organizations' experiences.

Todd, J G

Government; Health Services, Indigenous; History, 19th Century; History, 20th Century; Indians, North American; Public Policy; United States; Humans

Implications of policy and management decisions for Native Americans.

Weinstein, A

Florida; Hispanic or Latino; Hospital Bed Capacity, 300 to 499; Hospitals; Marketing of Health Services; Planning Techniques; Humans

How a south Florida hospital targeted Hispanic consumers.

Last month's "Case in Point" presented AMI Parkway Regional Medical Center, a 412-bed acute care hospital in North Miami Beach, Fla. The hospital's administration has recognized the ethnic make-up of the South Florida market (white, black and Hispanic) and wants to increase its penetration into the large and potentially lucrative Latin market. The hospital is one of six in South Florida that are owned by American Medical International Inc., Los Angeles. Parkway recently completed a modernization and development program that resulted in an expanded emergency department, state-of-the-art critical care units, a cost-saving ambulatory unit and facilities for outpatient and community education programs. Positioned in a fiercely competitive market, Parkway has adopted an aggressive marketing posture. The marketing function has been elevated to one of six hospital divisions, sharing equal footing with finance, professional services, administrative services, nursing and human resources. Given the hospital's reputation for action and the previous success of programs based on market research, the assistant administrator for marketing and business development secured support for research on the Latin market.

Westberg, J

Age Factors; Attitude to Health; Cultural Characteristics; Educational Status; Health Services, Indigenous; Hispanic or Latino; Morbidity; Patient Education as Topic; Risk Factors; United States; Humans

Patient education for Hispanic Americans.

Hispanic Americans are the second largest minority in the United States, and this population is growing rapidly. Given that there are some important differences between Hispanic culture and mainstream U.S. culture, providing effective patient education to Hispanics requires being aware of their special characteristics and needs. Only limited information is now available about Hispanic Americans. In this paper, some of the data and their implications for patient education are presented and discussed. For example, Hispanic Americans are not receiving the health care services they need and want, so patient educators will probably need to reach out to them. Morbidity and mortality data and risk prevalence data are examined with an eye toward identifying health problems that are likely to need attention when caring for this population. The available literature is reviewed and suggestions are offered for providing effective patient education to Hispanics. Much more needs to be learned about the Hispanic Americans. Patient educators who have been working with Hispanics need to report on their efforts, and, if the lack of literature on patient education programs for Hispanics reflects a shortage of programs for Hispanics, this situation also needs to be remedied.

Bekker, H

Humans; Abstracting and Indexing; Decision Support Techniques; Evidence-Based Medicine; Information Storage and Retrieval; MEDLINE; Patient Selection; Research Design

Informed decision making: an annotated bibliography and systematic review.