Systematic review to evaluate a potential association between helminth infection and physical stunting in children

Background

Despite considerable public health efforts over the past 20 years, childhood stunting (physical and/or cognitive) levels globally remain unacceptably high—at 22% amongst children under 5 years old in 2020. The aetiology of stunting is complex and still largely unknown. Helminths can cause significant mortality and morbidity and have often been cited as major causative agents for stunting, although their actual role in childhood stunting remains unclear. Our aim was to systematically review the current evidence to help support or refute the hypothesis that helminths cause physical stunting in children.

Methods

Inclusion criteria were as follows: infected with (and/or exposed to) helminths (soil-transmitted helminths, schistosomes or food-borne trematodes), children, pregnant or breastfeeding women as study participants (children included infants 0–1 year old, preschool-age children 1–5 years and school-age children > 5 years old), anthelmintic treatment intervention, stunting-related variables reported (e.g. height, height-for-age z-score, birth weight), helminth infection reported in relation to stunting, any geographic location, any date, peer-reviewed literature only. Exclusion criteria were: non-primary research, study protocols, studies with no new data, non-English language papers and animal (non-human) helminth studies. Seven databases were searched on 28 May 2021. Risk of bias was assessed for included studies and GRADE was used for studies included in RCT subgroup meta-analyses (in preschool-age children and pregnant women). This systematic review was registered with PROSPERO (CRD42021256201).

Results

Eighty studies were included in the analyses. No significant overall evidence was found in support of the hypothesis that helminths cause physical stunting in children, although there was some association with wasting.

Conclusions

Whilst analyses of the available literature to date failed to support a direct association between helminth infection and childhood stunting, there was significant heterogeneity between studies, and many had follow-up periods which may have been too short to detect impacts on growth. Most apparent was a lack of available data from key demographic groups wherein one may predict the greatest association of helminth infection with stunting—notably that of infants, preschool-age children, and pregnant or nursing women. Thus this review highlights the urgent need for further targeted empirical research amongst these potentially most vulnerable demographic groups.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-022-05235-5.

The Successful Implementation of Day Case Tonsillectomy

Objective Day case tonsillectomy is standard practice in many international centres, and is widespread across the UK. In Ireland, implementation has been slow for multiple reasons. Our unit aimed to introduce day case tonsillectomy, following a pilot programme. Following a year of implementation we have reaudited our practice. We hypothesised that day case tonsillectomy is a practical and favourable solution to facilitate access to surgery in the context of long waiting times for ENT surgery. Methods This was a prospective audit collecting data on day case tonsillectomy. All patients for day case tonsillectomy were selected in OPD according to our inclusion criteria. We recorded demographical data, surgical technique, length of stay, failed discharges, bleeding rate and readmission rate. Results There was one primary haemorrhage within 24 hours of surgery (0.08%). There were 16 secondary bleeds, giving a rate of 13.9%. Of these, four patients required a return to theatre for the cessation of bleeding (3.5%). There was no statistical significance in bleed rate between surgical technique. Failed discharge rate was 6%. The average time from extubation to discharge was 6 hours and 53 minutes. Conclusions Our experience of day case tonsillectomy is that it is safe, feasible and efficient in a selected group of patients. This can expedite long waiting times for tonsillectomy, and improve access to overnight beds for other cases. Our numbers represent the first unit in Ireland to have 2 year of experience with data showing successful implementation.

Interferon-gamma release assays for latent tuberculosis infection screening in Canadian federal correctional facilities

BACKGROUND: The correctional setting presents an opportunity for latent TB infection (LTBI) screening in an otherwise difficult to reach demographic. We evaluate factors associated with the fidelity of the tuberculin skin test (TST) and interferon-gamma release assay (IGRA), specifically the QuantiFERON^®-TB Gold In-Tube assay (QFT-GIT), explain factors associated with discordance, and report LTBI treatment outcomes.METHODS: We describe the association between demographic and clinical variables, and predictors of concordance with IGRA using univariate logistic regression in a population of TST-positive inmates. We report outcomes among those offered LTBI treatment.RESULTS: We observed concordance between TST and QFT-GIT in 90 of 306 (29.4%) inmates. Persons with TST+/QFT-GIT+ results were less likely to be male (OR 3.94, 95% CI 1.73-8.97) or have a BCG vaccination history (OR 0.34, 95% CI 0.12-0.95), and more likely to be foreign-born (P < 0.001). Of the 108 inmates offered LTBI treatment, 65 (60.1%) accepted and 51 (78.0%) completed. TST/QFT-GIT discordance has not been associated with disease during follow-up.CONCLUSION: Our findings suggest that TST/QFT-GIT discordance in Canadian federal inmates is common; however, low-risk of disease progression in those with discordance suggests that a shift towards IGRA-based screening is warranted and feasible.

Influences on childhood immunisation decision-making in London's Gypsy and Traveller communities

AIMS

Uptake of childhood immunisations is lower among Gypsy, Roma and Traveller (GRT) communities than in the general UK population. This small-scale study aimed to elicit insights from GRT mothers on their interaction with health services in London around childhood immunisations. The purpose was to inform a larger piece of work by the NHS England and Improvement (London) Public Health Commissioning Team to inform their planning to improve access to vaccination services for GRT communities in London.

STUDY DESIGN

An exploratory qualitative study using semi-structured interviews and a focus group.

METHODS

There was purposive sampling of mothers from any GRT background from south-west London using snowballing methods. One focus group and three interviews were conducted. A thematic analysis approach was used.

RESULTS

A total of nine women were recruited and seven participated between March and April 2018. Five themes were identified: adherence with antenatal care, self-declared parenting expertise, family support, childhood immunisations, keep children healthy but 'they say wait on the MMR until they are talking'.

CONCLUSION

Compliance with antenatal care, strong parenting beliefs and cohesive family support are strong influences on decision-making regarding immunisations. The women interviewed emphasised their own expertise in child rearing. This was occasionally at odds with the health advice provided by health professionals. The women widely shared their experiences of health professionals with other family and community members and this impacted on others' intention to vaccinate. These are key issues that should be considered when trying to improve uptake of immunisations in GRT families in a face-to-face manner. Equally, it warrants further exploration in a larger-scale study to see whether this reflects the wider community and in order to tailor supplementary immunisation activities to improve uptake.

Measles, mumps, rubella prevention: how can we do better?

INTRODUCTION

Measles, mumps, and rubella incidence decreased drastically following vaccination programs' implementation. However, measles and mumps' resurgence was recently reported, outbreaks still occur, and challenges remain to control these diseases.

AREAS COVERED

This qualitative narrative review provides an objective appraisal of the literature regarding current challenges in controlling measles, mumps, rubella infections, and interventions to address them.

EXPERT OPINION

While vaccines against measles, mumps, and rubella (including trivalent vaccines) are widely used and effective, challenges to control these diseases are mainly related to insufficient immunization coverage and changing vaccination needs owing to new global environment (e.g. traveling, migration, population density). By understanding disease transmission peculiarities by setting, initiatives are needed to optimize vaccination policies and increase vaccination coverage, which was further negatively impacted by COVID-19 pandemic. Also, awareness of the potential severity of infections and the role of vaccines should increase. Reminder systems, vaccination of disadvantaged, high-risk and difficult-to-reach populations, accessibility of vaccination, healthcare infrastructure, and vaccination services management should improve. Outbreak preparedness should be strengthened, including implementation of high-quality surveillance systems to monitor epidemiology. While the main focus should be on these public health initiatives to increase vaccination coverage, slightly more benefits could come from evolution of current vaccines.

The ‘new normal’: delivering childhood immunisations during the COVID-19 pandemic

Maintaining good coverage of childhood immunisations is vital. Dr Catherine Heffernan explains how practices in the London region are delivering a safe service to families

Factors Affecting Delivery of the HPV Vaccination: A Focus Group Study With NHS School-Aged Vaccination Teams in London

This study sought to identify barriers and facilitators to delivery of human papillomavirus (HPV) vaccination in schools. Four focus groups were conducted with 28 staff members, from four National Health Service school-aged vaccination (SAV) teams in London. Data were analyzed using thematic analysis. School engagement and support, and understanding and education about the vaccination (or conversely, a lack of) were identified as both barriers and facilitators. Limited school and team resources, fear of the vaccination, and poor consent form return were identified as barriers. Explanations for why some girls do not complete the vaccination series were provided. Individualizing approaches used to promote and encourage the vaccination was identified as a facilitating factor. Optimal delivery of the HPV vaccination program is dependent on school engagement and the allocation of time for SAV teams to promote vaccination uptake. Immunization program providers should work with schools to improve understanding and support of the HPV vaccination program.

Is partnership the answer? Delivering the national immunisation programme in the new English health system: a mixed methods study

Background

The English national health system experienced a major reorganisation in April 2013. This mixed methods study examined how staff managed to deliver the national immunisation programme within a new health infrastructure and explored the role and contribution of ‘partnership working’ to programme implementation.

Methods

A cross-sectional online questionnaire survey and a qualitative evaluation of an urban immunisation board were conducted in 2016. The questionnaire included 38 questions about immunisation responsibilities, collaboration, service evaluation and programme support. It was completed by 199 immunisation providers and 70 people involved in the management of the immunisation programme. The evaluation involved 12 semi-structured interviews, 3 observations of forum meetings and the review of forum meeting minutes. Descriptive statistical analysis of the survey data was performed using SPSS version 23 and qualitative data from both study components were uploaded to NVivo 11 and analysed thematically.

Results

Screening and Immunisation Teams were cited as responsible for programme leadership by 56% of survey respondents, but concerns were raised about their capacity to oversee larger geographies and a case made for decentralised accountability mechanisms. Only 44% of immunisation managers stated that poor performance was addressed adequately, and half of respondents thought that support given to providers was inadequate. Managers reported that partnership working improved the organisation (83%) and performance (78%) of immunisation, but stated it was more beneficial for information-sharing than implementation. A preference for a “locality working approach” with committees covering smaller health economies rather than larger commissioning areas was voiced. The immunisation board examined in the qualitative evaluation sought to achieve this by forging links with locally based steering committees, but also had to address internal challenges related to the role of the board and contribution of members to programmatic decision-making.

Conclusions

Key challenges in delivering the immunisation programme were rooted in the new health infrastructure, which had created greater distance between commissioners and providers and resulted in the fragmentation of programme responsibilities. Partnership working bridged gaps but more needs to be done to strengthen accountability mechanisms and ensure that collaborative activities are outcome oriented and sustainable in the shifting environment of reorganisation.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6400-6) contains supplementary material, which is available to authorized users.

Local health and social care responses to implementing the national cold weather plan

Background

The Cold Weather Plan (CWP) for England was launched by the Department of Health in 2011 to prevent avoidable harm to health by cold weather by enabling individuals to prepare and respond appropriately. This study sought the views of local decision makers involved in the implementation of the CWP in the winter of 2012/13 to establish the effects of the CWP on local planning. It was part of a multi-component independent evaluation of the CWP.

Methods

Ten LA areas were purposively sampled which varied in level of deprivation and urbanism. Fifty-two semi-structured interviews were held with health and social care managers involved in local planning between November 2012 and May 2013.

Results

Thematic analysis revealed that the CWP was considered a useful framework to formalize working arrangements between agencies though local leadership varied across localities. There were difficulties in engaging general practitioners, differences in defining vulnerable individuals and a lack of performance monitoring mechanisms.

Conclusions

The CWP was welcomed by local health and social care managers, and improved proactive winter preparedness. Areas for improvement include better integration with general practice, and targeting resources at socially isolated individuals in cold homes with specific interventions aimed at reducing social isolation and building community resilience.

A population-based study of tuberculosis case fatality in Canada: do Aboriginal peoples fare less well?

SETTING

The Province of Alberta, Canada.

OBJECTIVES

To explore trends in tuberculosis (TB) case fatality, compare TB case-fatality rates by population group and determine prognostic factors associated with TB-related death in Alberta from 1996 to 2012.

DESIGN

Retrospective cohort analysis.

RESULTS

During the study years, all-cause TB case fatality fell from 10.7% to 6.3%; the fall was attributable to a change in population structure, as there were more foreign-born and fewer older cases with time. A stable 2% of TB cases died without treatment. Compared to other population groups, Canadian-born Aboriginal case patients were more likely to die without treatment and to die younger. Of TB deaths that were TB-related, 68.9% occurred before or during the initial phase of treatment; of these, TB was a contributory cause of death in 77.5%, i.e., another medical condition was the primary cause of death. In multivariate analysis, age >64 years, aboriginality and miliary/disseminated or central nervous system disease were independent predictors for TB-related death.

CONCLUSION

Preventive therapy for those with latent tuberculous infection and a high-risk medical condition, early diagnosis of disease, and special support of older, Aboriginal or comorbid cases, once diagnosed, are necessary to further minimise TB case fatality in Alberta, Canada.

Control of contagious bovine pleuropneumonia: knowledge, attitudes, perceptions and practices in Narok district of Kenya

•

Pastoralists had traditional disease coping mechanisms.

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Some pastoralists had no knowledge of any prevention method and others would not know what to do or would do nothing in the event of an outbreak.

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Pastoralists perceived vaccination to be the solution to CBPP but vaccination was irregular.

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Vaccination exhibited adverse post-vaccination reactions and consequently 25.2% of pastoralists may resist subsequent vaccinations against CBPP.

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Pastoralists preferred CBPP vaccination at certain times of the year and that it is combined with other vaccinations.

CBPP is an important transboundary disease in sub-Saharan Africa whose control is urgent. Participatory data collection involving 52 focus group discussions in 37 village clusters and key informant interviews, a cross-sectional study involving 232 households and a post-vaccination follow up involving 203 households was carried out in 2006–2007 in Narok South district of Kenya. This was to investigate knowledge, attitudes, perceptions and practices (KAPP) associated with control of CBPP as well as the adverse post-vaccination reactions in animals in order to advice the control policy. The community perceived trans-boundary CBPP threat to their cattle. They had traditional disease coping mechanisms and were conversant with CBPP prevention and control with 49.8% (95%CI: 42.8–56.7%) giving priority to CBPP control. However, 12.9% (95%CI: 9.0–18.1%) of pastoralists had no knowledge of any prevention method and 10.0% (95%CI: 6.5–14.7%) would not know what to do or would do nothing in the event of an outbreak. Although 43.5% (95%CI: 37.1–50.2%) of pastoralists were treating CBPP cases with antimicrobials, 62.5% (95%CI: 52.1–71.7%) of them doubted the effectiveness of the treatments. Pastoralists perceived vaccination to be the solution to CBPP but vaccination was irregular due to unavailability of the vaccine. Vaccination was mainly to control outbreaks rather than preventive and exhibited adverse post-vaccination reactions among 70.4% (95%CI: 63.6–76.5%) of herds and 3.8% (95%CI: 3.5–4.2%) of animals. Consequently, nearly 25.2% (95%CI: 18.5–33.2%) of pastoralists may resist subsequent vaccinations against CBPP. Pastoralists preferred CBPP vaccination at certain times of the year and that it is combined with other vaccinations. In conclusion, pastoralists were not fully aware of the preventive measures and interventions and post-vaccination reactions may discourage subsequent CBPP vaccinations. Consequently there is need for monitoring and management of post vaccination reactions and awareness creation on CBPP prevention and interventions and their merits and demerits. CBPP vaccine was largely unavailable to the pastoralists and the preference of the pastoralists was for vaccination at specified times and vaccine combinations which makes it necessary to avail the vaccine in conformity with the pastoralists preferences. In addition, planning vaccinations should involve pastoralists and neighbouring countries. As the results cannot be generalized, further studies on CBPP control methods and their effectiveness are recommended.

Educational and skills-based interventions for preventing relationship and dating violence in adolescents and young adults

BACKGROUND

Educational and skills-based interventions are often used to prevent relationship and dating violence among young people.

OBJECTIVES

To assess the efficacy of educational and skills-based interventions designed to prevent relationship and dating violence in adolescents and young adults.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, six other databases and a trials register on 7 May 2012. We handsearched the references lists of key articles and two journals (Journal of Interpersonal Violence and Child Abuse and Neglect). We also contacted researchers in the field.

SELECTION CRITERIA

Randomised, cluster-randomised and quasi-randomised studies comparing an educational or skills-based intervention to prevent relationship or dating violence among adolescents and young adults with a control.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study eligibility and risk of bias. For each study included in the meta-analysis, data were extracted independently by GF and one other review author (either CH, JN, SH or DS). We conducted meta-analyses for the following outcomes: episodes of relationship violence, behaviours, attitudes, knowledge and skills.

MAIN RESULTS

We included 38 studies (15,903 participants) in this review, 18 of which were cluster-randomised trials (11,995 participants) and two were quasi-randomised trials (399 participants). We included 33 studies in the meta-analyses. We included eight studies (3405 participants) in the meta-analysis assessing episodes of relationship violence. There was substantial heterogeneity (I(2) = 57%) for this outcome. The risk ratio was 0.77 (95% confidence interval (CI) 0.53 to 1.13). We included 22 studies (5256 participants) in the meta-analysis assessing attitudes towards relationship violence. The standardised mean difference (SMD) was 0.06 (95% CI -0.01 to 0.15). We included four studies (887 participants) in the meta-analysis assessing behaviour related to relationship violence; the SMD was -0.07 (95% CI -0.31 to 0.16). We included 10 studies (6206 participants) in the meta-analysis assessing knowledge related to relationship violence; the results showed an increase in knowledge in favour of the intervention (SMD 0.44, 95% CI 0.28 to 0.60) but there was substantial heterogeneity (I(2) = 52%). We included seven studies (1369 participants) in the meta-analysis assessing skills related to relationship violence. The SMD was 0.03 (95% CI -0.11 to 0.17). None of the included studies assessed physical health, psychosocial health or adverse outcomes. Subgroup analyses showed no statistically significant differences by intervention setting or type of participants. The quality of evidence for all outcomes included in our meta-analysis was moderate due to an unclear risk of selection and detection bias and a high risk of performance bias in most studies.

AUTHORS' CONCLUSIONS

Studies included in this review showed no evidence of effectiveness of interventions on episodes of relationship violence or on attitudes, behaviours and skills related to relationship violence. We found a small increase in knowledge but there was evidence of substantial heterogeneity among studies. Further studies with longer-term follow-up are required, and study authors should use standardised and validated measurement instruments to maximise comparability of results.

Effective smoking cessation interventions for COPD patients: a review of the evidence

OBJECTIVES

To review the effectiveness of smoking cessation interventions offered to chronic obstructive pulmonary disease (COPD) patients, and identify barriers to quitting experienced by them, so that a more effective service can be developed for this group.

DESIGN

A rapid systematic literature review comprising computerized searches of electronic databases, hand searches and snowballing were used to identify both published and grey literature.

SETTING

A review of studies undertaken in north-western Europe (defined as: United Kingdom, Ireland, France, Germany, Benelux and Nordic countries).

PARTICIPANTS

COPD patients participating in studies looking at the effectiveness of smoking cessation interventions in this patient group, or exploring the barriers to quitting experienced by these patients.

METHOD

Quantitative and qualitative papers were selected according to pre-specified inclusion and exclusion criteria, critically appraised, and quantitative papers scored against the NICE Levels of Evidence standardized hierarchy.

MAIN OUTCOME MEASURE

Percentages of successful quitters and length of quit, assessed by self-report or biochemical analysis. Among qualitative studies, identified barriers to smoking cessation had to be explored.

RESULTS

Three qualitative and 13 quantitative papers were finally selected. Effective interventions and barriers to smoking cessation were identified. Pharmacological support with Buproprion combined with counselling was significantly more efficacious in achieving prolonged abstinence than a placebo by 18.9% (95% CI 3.6-26.4%). Annual spirometry with a brief smoking cessation intervention, followed by a personal letter from a doctor, had a significantly higher ≥1 year abstinence rate at three years among COPD patient smokers, compared to smokers with normal lung function (P < 0.001; z = 3.93). Identified barriers to cessation included: patient misinformation, levels of motivation, health beliefs, and poor communication with health professionals.

CONCLUSION

Despite the public health significance of COPD, there is a lack of high-quality evidence showing which smoking cessation support methods work for these patients. This review describes three effective interventions, as well as predictors of quitting success that service providers could use to improve quit rates in this group. Areas that would benefit from urgent further research are also identified.

Panzootics and the poor: devising a global livestock disease prioritisation framework for poverty alleviation

Panzootics such as highly pathogenic avian influenza and Rift Valley fever have originated from the South, largely among poor communities. On a global level, approximately two-thirds of those individuals living on less than US$2 per day keep livestock. Consequently, there is a need to better target animal health interventions for poverty reduction using an evidence-based approach. Therefore, the paper offers a three-step prioritisation framework using calculations derived from standard poverty measures: the poverty gap and the head count ratio. Data from 265 poor livestock-keeping households in Kenya informed the study. The results demonstrate that, across a spectrum of producers, the dependence upon particular species varies. Furthermore, the same livestock disease has differing impacts on the depth and severity of poverty. Consequently, animal health interventions need to account for variability in income effects at the species and disease levels.

Measuring and comparing constraints to improved biosecurity amongst GB farmers, veterinarians and the auxiliary industries

Constraints to the introduction of enhanced biosecurity systems are rarely considered in sufficient detail when population medicine specialists initiate new control schemes. The main objective of our research was to investigate and compare the different attitudes constraining improvement in biosecurity for cattle and sheep farmers, practising veterinary surgeons and the auxiliary industries in Great Britain (GB). This study was carried out utilizing farmer focus groups, a questionnaire survey of veterinary practitioners and a telephone survey of auxiliary industry representatives. It appears that farmers and veterinarians have their own relatively clear definitions for biosecurity in relation to some major diseases threatening GB agriculture. Overall, farmers believe that other stakeholders, such as the government, should make a greater contribution towards biosecurity within GB. Conversely, veterinary practitioners saw their clients' ability or willingness to invest in biosecurity measures as a major constraint. Veterinary practitioners also felt that there was need for additional proof of efficacy and/or the potential economic benefits of proposed farm biosecurity practices better demonstrated. Auxiliary industries, in general, were not certain of their role in biosecurity although study participants highlighted zoonoses as part of the issue and offered that most of the constraints operated at farm level.

The Parkinson's Disease Questionnaire (PDQ-39): evidence for a method of imputing missing data

BACKGROUND

The Parkinson's Disease Questionnaire (PDQ-39) is the most widely used Parkinson's specific measure of health status. It is increasingly used in treatment trials, sometimes as a primary end-point, where any missing data can potentially cause difficulties in analyses.

OBJECTIVES

The purpose of this article is to evaluate the Expectation Maximisation (EM) algorithm for the imputation of missing dimension scores on the 39-item PDQ-39.

METHODS

A postal survey of patients diagnosed with Parkinson's disease (PD). A total of 1,372 patients were surveyed and 839 (61.15%) questionnaires returned completed or partially completed. Of these, complete PDQ data were available in 715 (85.22%) cases. Data were deleted from this complete dataset and a sub-set of 200 respondents from this dataset and then imputed using the EM algorithm; results were then compared to the dataset before data deletion.

RESULTS

Results gained from imputation of data closely mirrored that of the complete dataset in each case. Descriptive statistics, mean scores and spread of scores were almost identical between original and imputed datasets. Furthermore, original and imputed datasets were highly correlated [intra-class correlation coefficient (ICC) = 0.93 or greater], and mean differences were small (+/-1.00).

CONCLUSIONS

The results suggest that the use of EM for the PDQ-39 provides data that closely mirrors the original when this has been deliberately removed. Consequently, EM is likely to be appropriate for trials using the PDQ that contains missing data points.

Management of respiration in MND/ALS patients: an evidence based review

This systematic review comprises an objective appraisal of the evidence in regard to the management of respiration in patients with motor neuron disease (MND/ALS). Studies were identified through computerised searches of 32 databases. Internet searches of websites of drug companies and MND/ALS research web sites, 'snow balling' and hand searches were also employed to locate any unpublished study or other 'grey literature' on respiration and MND/ALS. Since management of MND/ALS involves a number of health professionals and care workers, searches were made across multiple disciplines. No time frame was imposed on the search in order to increase the probability of identifying all relevant studies, although there was a final limit of March 2005. Recommendations for patient and carer-based guidelines for the clinical management of respiration for MND/ALS patients are suggested on the basis of qualitative analyses of the available evidence. However, these recommendations are based on current evidence of best practice, which largely comprises observational research and clinical opinion. There is a clear need for further evidence, in particular randomised and non-randomised controlled trials on the effects of non-invasive ventilation and additional larger scale cohort studies on the issues of initial assessment of respiratory symptoms, and management and timing of interventions.

Measuring outcomes for neurological disorders: a review of disease-specific health status instruments for three degenerative neurological conditions

Health-related quality-of-life measures have been increasingly used in research into neurological disorders in recent years. The aim of this paper is to provide an objective appraisal of the evidence in regard to disease-specific quality-of-life measures used in research on health interventions for three degenerative neurological disorders: multiple sclerosis, motor neurone disease/amyotrophic lateral sclerosis and Parkinson's disease. A comprehensive search strategy was developed to include nine relevant electronic databases. Only studies pertaining to patient-based outcome measurements in multiple sclerosis, motor neurone disease and Parkinson's disease were included. We identified 76 eligible studies. As studies consisted of descriptive and cross-sectional survey study designs, results were reported qualitatively rather than in the form of a meta-analysis. Four disease-specific measures were found for Parkinson's disease, 11 for multiple sclerosis and one for motor neurone disease. We conclude that health-related quality-of-life measures are useful in assessing the impact of treatments and interventions for neurological disorders. However, further research is needed on the development of instruments using psychometric methods and on the validation, utilization and responsiveness of instruments to change.

The Irish Media and the Lack of Public Debate on New Reproductive Technologies (NRTs) in Ireland

The aim of this article is to investigate the lack of public debate surrounding new reproductive technologies in Ireland. Despite, the controversy they have attracted for the past 20 years in Europe and in the USA, Ireland has remained conspicuously silent on the issues and ethical concerns that arise from the implications of the technologies. There is a multitude of reasons for the lack of Irish public debate, many of which are the result of various factors embedded with the current socio-economic changes. This article will argue that the Irish media is the platform for initiating debate. It has the power to be a channel not only for communication on the topic but can reflect and motivate public opinion. Ultimately, it could spark the public insistence on legislation by the Irish government.

Optimum pinch grips in the handling of dies

Handling roller-press dies has caused numerous work-related musculoskeletal disorders in the leather industry. The dies are quite large (0.61 x 0.30 m), heavy (3.5 kg) and are difficult to handle because of the large pinch span requirements (up to 16 cm). The purpose of this study was to determine the optimum pinch span and optimum crossbar angulation to minimize die handling forces. Five-finger pulp-pinch forces were measured on five males and five females with a force-sensitive-resistor instrumented glove while handling a simulated adjustable die. Maximum pinch forces occurred at pinch spans between 1.27 and 3.81 cm, with average female strengths being 57% of average male pinch strengths. Minimum pinch forces to hold the die occurred at a 45 degrees angulation and increased linearly as the angle approached 90 degrees or the normal vertical orientation. The simplest solution to redesigning the dies is to: (1) decrease the distance between the braces to less than 4 cm and (2) slant the braces at 45 degrees.

Changes in gravity influence rat postnatal motor system development: from simulation to space flight

Our research examines the role of the environment in postnatal nervous system development. Recently we have been studying the effects of changes in gravity on the motor system of rats from postnatal day (P) 2 to 31 using kinematic analysis of swimming, walking, and righting reflexes. Using the tail suspension model of weightlessness we identified sensitive and critical periods of motor system development corresponding to the time during which a motor skill is first achieved. Motor performance in suspended animals was marked by slow swimming, walking, and air-righting, all of which were characterized by hindlimb extension. (Walton et al, Neurosci. 52,763,1992). The critical periods identified in these studies contributed to determining the age of animals for a small payload, NIH.R3. This 9-day mission (STS-72) included 2 litters at P5, P7, or P15 at launch. The P7-16 and P15-24 groups were studied post-flight. On the landing day (R+0) surface righting, swimming and walking were slower in flight compared to control animals. Differences were more marked in the younger animals and the hindlimbs were more affected than the forelimbs with marked, prolonged extension of, at least, the ankle joint angle. Readaptation to 1G was slower in the P7-16 group with righting reflexes adapting first, walking last. We have shown that gravity is an important factor in postnatal nervous system development and that its affect depends on the age of the animal, duration of the perturbation, and the motor function studied.

Haida perspectives on living with non-insulin-dependent diabetes

OBJECTIVE

To understand the experience of Haida people living with non-insulin-dependent diabetes mellitus (NIDDM), in order to provide a basis for a culturally sensitive community-based approach to managing NIDDM.

DESIGN

Qualitative study using grounded theory.

SETTING

The villages of Skidegate and Old Massett in Haida Gwaii (Queen Charlotte Islands), British Columbia.

PARTICIPANTS

Nine focus groups met at the beginning and six at the end of the project. The focus groups had 8 to 12 members each and roughly the same number of men and women overall. The groups included people with diabetes, family members of people with diabetes, community leaders and elders.

FINDINGS

Conceptual findings related to the participants' views on the impact of NIDDM on their lives, their views on what life was like before the effects of NIDDM were felt and their beliefs about the prevention and treatment of NIDDM. Six themes recurred in the discussions: fear; grief and loss; the loss of and desire to regain control; food and eating; physical and personal strength; and traditional ways.

CONCLUSIONS

Insights into the illness experience of different cultural groups can inform program development and the creation of culturally sensitive health care interventions.

Galileo Multispectral Imaging of the North Polar and Eastern Limb Regions of the Moon

Multispectral images obtained during the Galileo probe's second encounter with the moon reveal the compositional nature of the north polar regions and the northeastern limb. Mare deposits in these regions are found to be primarily low to medium titanium lavas and, as on the western limb, show only slight spectral heterogeneity. The northern light plains are found to have the spectral characteristics of highlands materials, show little evidence for the presence of cryptomaria, and were most likely emplaced by impact processes regardless of their age.

The sialic acid and carbohydrate content and the synthesis of glycoprotein from radioactive precursors by tissues of the normal and diseases upper intestinal tract

The sialic acid and total hexose content of perorally obtained mucosal biopsies have been determined. Gastric mucosa has a higher content of sialic acid/mg protein and a lower content of total hexoses/mg protein than does jejunal mucosa. There were no differences chemically between gastric biopsies from subjects with or without peptic ulcers. Neither were there any differences between normal jejunal mucosa and jejunal mucosa from patients with untreated or treated coeliac disease. The studies of the incorporation of radioactive glucose into glycoprotein using all these tissues indicate that bacteria make a major in vitro contribution. This method is not suitable for study of de novo synthesis in either gastric or jejunal mucosa. Results are presented which suggest that bacteria may normally be present within the mucous layer of the stomach.