Factors associated with the health status of internally displaced persons in northern Uganda

Background:

Globally, there are over 24 million internally displaced persons (IDPs) who have fled their homes due to violence and insecurity but who remain within their own country. There have been up to 2 million IDPs in northern Uganda alone. The objective of this study was to investigate factors associated with mental and physical health status of IDPs in northern Uganda.

Methods:

A cross-sectional survey was conducted in November 2006 in IDP camps in the Gulu and Amuru districts of northern Uganda. The study outcome of physical and mental health was measured using the SF-8 instrument, which produces physical (PCS) and mental (MCS) component summary measures. Independent demographic, socio-economic, and trauma exposure (using the Harvard Trauma Questionnaire) variables were also measured. Multivariate regression linear regression analysis was conducted to investigate associations of the independent variables on the PCS and MCS outcomes.

Results:

1206 interviews were completed. The respective mean PCS and MCS scores were 42.2 (95% CI 41.32 to 43.10) and 39.3 (95% CI 38.42 to 40.13), well below the instrument norm of 50, indicating poor health. Variables with negative associations with physical or mental health included gender, age, marital status, income, distance of camp from home areas, food security, soap availability, and sense of safety in the camp. A number of individual trauma variables and the frequency of trauma exposure also had negative associations with physical and mental health.

Conclusions:

This study provides evidence on the impact on health of deprivation of basic goods and services, traumatic events, and fear and uncertainty amongst displaced and crisis affected populations.

Slow magnetohydrodynamic waves in the solar atmosphere

There is increasingly strong observational evidence that slow magnetoacoustic modes arise in the solar atmosphere, either as propagating or standing waves. Sunspots, coronal plumes and coronal loops all appear to support slow modes. Here we examine theoretically how the slow mode may be extracted from the magnetohydrodynamic equations, considering the special case of a vertical magnetic field in a stratified medium: the slow mode is described by the Klein-Gordon equation. We consider its application to recent observations of slow waves in coronal loops.

The use of botulinum toxin type-B in the treatment of patients who have become unresponsive to botulinum toxin type-A -- initial experiences

The increasing use of botulinum toxin type-A, especially for focal dystonia and spasticity has highlighted the issue of secondary non-responsiveness. Within the last few years botulinum toxin type-B (Myobloc/Neurobloc) has become commercially available as an alternative to type-A. This paper discusses our initial experience of botulinum toxin type-B in a total of 63 individuals who attended our botulinum clinic. Thirty-six patients had cervical dystonia and a secondary non-response to type-A toxin. Thirteen of these patients (36%) had a reasonable clinical response to Neurobloc and continue to have injections. The other 23 patients either had no response, or a poor response, or had unacceptable side effects and ceased treatment. A small number of people with blepharospasm, hemifacial spasm and foot dystonia also had a disappointing response to injection. Twenty patients with spasticity were also type-A resistant. Seven of these show some continuing response to type-B, without unacceptable side effects. These findings demonstrate that botulinum toxin type-B has a place in the management of patients who have become non-responsive to type-A, but overall the responses to type-B toxin were disappointing.

Hypopituitary patients prefer a touch-screen to paper quality of life questionnaire

Health Related Quality of Life questionnaires are frequently used for research, however only recently has their use been recommended in the routine clinical management of pituitary patients. Questionnaires frequently have complex scoring systems, and may be cumbersome, limiting widespread application. Touch-screen technology can overcome these limitations. We have developed a touch-screen 'Questions on Life Satisfaction-Hypopituitarism' QLS-H (Flash 5 Action script, program design by IG) questionnaire and compared its use and accuracy with a paper version questionnaire in 50 pituitary patients who were attending routine clinics. The HRQoL Z-score for the patient group was lower than the average for the normal UK population, as might be predicted for this patient group. There was no statistically significant difference between scores obtained by the touch-screen and paper questionnaires; mean (SD) Z score was -1.33 (1.4) for touch-screen and -1.26 (1.5) for paper. The touch-screen was preferred by 80% of patients, and quicker to complete (<5min). Additionally, there were significant errors in 14 (28%) of manually scored paper questionnaires.

IN CONCLUSION

Touch-screen QLS-H questionnaires have advantages over the paper version for the routine clinical assessment of patients with hypopituitarism.

Guidelines for evaluating the efficacy and safety of live anticoccidial vaccines, and obtaining approval for their use in chickens and turkeys

These guidelines are intended to aid those engaged in poultry research in the design, implementation and interpretation of laboratory, floor-pen and field studies for the assessment of the efficacy and safety of live anticoccidial vaccines for immunization of chickens and turkeys against Eimeria species. In addition to efficacy and safety requirements, manufacture, quality control and licensing considerations are discussed. The guidelines do not address subunit vaccines comprising non-viable material, but many of the principles described will be relevant to such vaccines if they are developed in the future. Guidelines are available in some countries for avian vaccines of bacterial or viral origin but specific standards for anticoccidial vaccines in poultry have not, as far as we know, been produced. Information is provided on general requirements of registration authorities (based upon regulations applicable in the European Union and the USA) for obtaining marketing authorizations for vaccines. These guidelines may assist poultry specialists in providing specific information for administrators involved in the decision-making process leading to registration of new vaccines, and are intended to facilitate the worldwide adoption of consistent, standard procedures.

Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit

BACKGROUND

The USCOM ultrasonic cardiac output monitor (USCOM Pty Ltd, Coffs Harbour, NSW, Australia) is a non-invasive device that determines cardiac output by continuous-wave Doppler ultrasound. The aim of this study was to evaluate the accuracy of the USCOM device compared with the thermodilution technique in intensive care patients who had just undergone cardiac surgery.

METHODS

We conducted a prospective study in the 18-bed intensive care unit of a 600-bed tertiary referral hospital. Twenty-four mechanically ventilated patients were studied immediately following cardiac surgery. We evaluated the USCOM monitor by comparing its output with paired measurements obtained by the standard thermodilution technique using a pulmonary artery catheter.

RESULTS

Forty paired measurements were obtained in 22 patients. We were unable to obtain an acceptable signal in the remaining two patients. Comparison of the two techniques showed a bias of 0.18 and limits of agreement of -1.43 to 1.78. The agreement may not be as good between techniques at higher cardiac output values.

CONCLUSIONS

The USCOM monitor has a place in intensive care monitoring. It is accurate, rapid, safe, well-tolerated, non-invasive and cost-effective. The learning curve for skill acquisition is very short. However, during the learning phase the USCOM monitor measurements are rather 'operator dependent'. Its suitability for use in high and low cardiac output states requires further validation.

Evolutionary genetics of island and mainland species of Rhagada (Gastropoda: Pulmonata) in the Pilbara Region, Western Australia

Mainland species of the camaenid genus Rhagada, endemic to northern Western Australia, have relatively large, non-overlapping geographic ranges. In contrast, over much smaller distances in the Dampier Archipelago, several locally endemic, morphologically distinctive species occur with intermingled ranges. To test alternative origins of the unusual local diversity, we compared allozymes at 21 loci in 12 archipelago populations and 14 mainland populations, representing 14 species. Genetic distances were consistently low, averaging 0.019 (range 0.000–0.051) within species, and only 0.043 (range 0.001–0.133) between species. In the Dampier Archipelago, the average genetic distance between species was even smaller (0.023). This result was indistinguishable from the within-species comparisons, highlighting the disconnection between morphological diversification and levels of molecular genetic divergence. A pattern of isolation by distance among all comparisons within the archipelago also suggests a historic cohesiveness of the species in the Dampier Archipelago. Although providing no resolution of relationships among mainland populations, a neighbour-joining tree provided further support for an in situ morphological radiation in the Dampier Archipelago, transcending variation seen over much larger distances on the mainland.

Pharmacokinetics and tolerability of a bioadhesive buccal testosterone tablet in hypogonadal men

OBJECTIVE

A phase I single centre, open label study of the pharmacokinetics and tolerability of a buccal testosterone tablet (COL 1621) was carried out.

DESIGN

Twelve testosterone-deficient males were treated with the buccal tablet twice daily for 7 consecutive days. Multiple blood samples were drawn for testosterone, dihydrotestosterone (DHT), bioavailable testosterone and sex hormone-binding globulin (SHBG).

RESULTS

After COL 1621, means+/-S.D. serum testosterone level increased to a peak concentration of 26.6+/-5.8 nmol/l (7.7+/-1.7 ng/ml) at 4.8+/-5.8 h and stayed in the eugonadal range. Steady state was achieved within the first 24 h and was maintained in the normal range. The bioavailable testosterone, DHT and free testosterone index followed a pattern very similar to that of testosterone. The mean serum testosterone to DHT ratio was within the normal male range throughout treatment. There was only one treatment-related adverse event (headache). Two-thirds of patients indicated that treatment with COL 1621 was acceptable and that the tablet was convenient to use. Six patients (50.0%) preferred COL 1621 to their previous testosterone replacement therapy, two patients gave preference to their previous treatment and three patients found both treatments to be equally acceptable. Data for one patient was not available.

CONCLUSION

We conclude that COL 1621 can efficiently elevate serum testosterone and DHT levels in hypogonadal men within the first day of application, achieve a steady state within 24 h and maintain serum testosterone in the normal range with a twice-daily treatment regimen. COL 1621 provides an effective alternative oral testosterone replacement therapy that gives physiological levels of testosterone and is well tolerated by the patients.

CD4+ and CD8+ cells accumulate in the brains of acquired immunodeficiency syndrome patients with human immunodeficiency virus encephalitis

To test the hypothesis that CD4+ T lymphocytes accumulate in brains of end-stage acquired immunodeficiency syndrome (AIDS) patients, we examined T-lymphocyte subsets in the CA1, CA3, and CA4 regions of the hippocampus of AIDS patients with (n = 10) and without (n = 11) human immunodeficiency virus encephalitis (HIVE) plus controls (n = 7). HIV p24 antigen was common in monocytic cells and rare in activated/memory CD45RO+ lymphocytes. Hippocampal activated/memory CD45RO+ T lymphocytes significantly increased (P <.001) in seven of the eight hippocampal subregions with hippocampal HIVE (1.14 +/- 1.4 T cells/high-power field [hpf]), but AIDS hippocampus without HIVE were similar to controls (0.03 +/- 0.07 T cells/hpf and 0.03 +/- 0.09 T cells/hpf, respectively). CD45RO+ and CD3+ lymphocytes were similar in numbers and distribution, whereas CD4+ and CD8+ lymphocytes were weakly immunoreactive and less frequent. All four lymphocyte subtypes were present in perivascular spaces and microglial nodules of HIVE, and had direct contact with neurons. Monocytes, microglia, and multinucleated giant cells were immunoreactive for CD4 in AIDS cases with hippocampal HIVE but microglia in remaining AIDS cases and controls were CD4-. CD68+ macrophages significantly increased in hippocampus of HIVE patients (P <.05) and were predominately perivascular in the absence of local HIVE. These studies show that CD4+ T lymphocytes, as well as CD8+ T lymphocytes, participate in the local inflammatory response of HIVE in end-stage AIDS patients, and suggest that their recruitment requires local HIV infection. The perineuronal location of CD4+ cells provides the potential for lymphocyte-mediated neuronal injury or trans-receptor-mediated neuronal infection.

Swing wave-wave interaction: coupling between fast magnetosonic and Alfvén waves

We suggest a mechanism of energy transformation from fast magnetosonic waves propagating across a magnetic field to Alfvén waves propagating along the field. The mechanism is based on swing wave-wave interaction [T. V. Zaqarashvili, Astrophys. J. Lett. 552, 107 (2001)]. The standing fast magnetosonic waves cause a periodical variation in the Alfvén speed, with the amplitude of an Alfvén wave being governed by Mathieu's equation. Consequently, subharmonics of Alfvén waves with a frequency half that of magnetosonic waves grow exponentially in time. It is suggested that the energy of nonelectromagnetic forces, which are able to support the magnetosonic oscillations, may be transmitted into the energy of purely magnetic oscillations. Possible astrophysical applications of the mechanism are briefly discussed.

Perceptual fusion and fragmentation of complex tones made inharmonic by applying different degrees of frequency shift and spectral stretch

Global pitch depends on harmonic relations between components, but the perceptual coherence of a complex tone cannot be explained in the same way. Instead, it has been proposed that the auditory system responds to a common pattern of equal spacing between components, but is only sensitive to deviations from this pattern over a limited range [Roberts and Brunstrom, J. Acoust. Soc. Am. 104, 2326-2338 (1998)]. This hypothesis predicts that spectral fusion will be largely unaffected either by frequency shifting a harmonic stimulus (because equal spacing is preserved), or by small degrees of spectral stretch (because significant deviations from equal spacing only cumulate over large spectral distances). Complex tones were either shifted by 0%-50% of F0 (200 Hz+/-10%) or stretched by 0%-12% of F0 (100 Hz+/-10%). Subjects heard a complex followed by a pure tone in a continuous loop. One of the components 2-11 was mistuned by +/- 4%, and subjects adjusted the pure tone to match its pitch. Broadly consistent with our hypothesis, frequency shifts had relatively little effect on hit rates and only large degrees of stretch reduced them substantially. The implications for simultaneous grouping are explored with reference to an autocorrelation model of auditory processing.

Parallel synthesis and biological activity of a new class of high affinity and selective delta-opioid ligand

A considerable number of research papers describing the synthesis and testing of the delta opioid receptor (DOR) ligands, SNC-80 and TAN-67, and analogues of these two compounds, have been published in recent years. However, there have been few reports of the discovery of completely new structural classes of selective DOR ligand. By optimising a hit compound identified by high throughput screening, a new series of tetrahydroisoquinoline sulphonamide-based delta opioid ligands was discovered. The main challenge in this series was to simultaneously improve both affinity and physicochemical properties, notably aqueous solubility. The most active ligand had an affinity (IC(50)) of 6 nM for the cloned human DOR, representing a 15-fold improvement relative to the original hit 1 (IC(50) 98 nM). Compounds from this new series show good selectivity for the DOR over mu and kappa opioid receptors. However the most active and selective compounds had poor aqueous solubility. Improved aqueous solubility was obtained by replacing the phthalimide group in 1 by basic groups, allowing the synthesis of salt forms. A series of compounds with improved affinity and solubility relative to 1 was identified and these compounds showed activity in an in vivo model of antinociception, the formalin paw test. In the case of compound 19, this analgesic activity was shown to be mediated primarily via a DOR mechanism. The most active compound in vivo, 46, showed superior potency in this test compared to the reference DOR ligand, TAN-67 and similar potency to morphine (68% and 58% inhibition in Phases 1 and 2, respectively, at a dose of 10 mmol/kg i.v.).

A new century approach for alcohol screen in the insurance industry

Several recent studies point to the value of using combinations of biochemical markers for the identification of alcohol abuse. The Early Detection of Alcohol Consumption (EDAC) test uses a statistical method that combines the results of several routine laboratory tests to form a metabolic fingerprint for each subject. In this study, we evaluated the use of the EDAC test as a screening tool to assess heavy drinking in insurance applicants. The EDAC was calculated by linear discriminate function analysis using the results of 14 routine tests including liver enzymes, lipids, proteins, and blood sugars. We collected and analyzed 1680 random samples at Heritage Laboratories (Olathe, Kan). Alcohol Detection Services (Brookfield, Wis) and Millennium Strategies (Madison, Wis) collaborated in the data analysis and interpretation of laboratory tests results. Ninety-three percent of applicants showed a negative EDAC test. The 7% (n = 134) who screened positive for the EDAC test were then reflexed to carbohydrate deficient transferin (CDT) and whole blood associated acetaldehyde (WBAA). Sixteen percent (22/134) showed a positive confirmatory test. Among these 16% of subjects, 41% (9/22) showed no elevations in liver enzymes or HDL-C results. Four of these subjects were among the top one third with the highest elevations for the CDT test in the entire group and one of them was positive for both the CDT and WBAA tests. These results suggest that the EDAC screen may provide an efficient alternative screening tool for the identification of heavy alcohol consumption not HBA as it identifies applicants with both normal or abnormal liver enzymes and HDL-C.