Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study

INTRODUCTION

The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness.

METHODS

Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken.

RESULTS

Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media.

CONCLUSIONS

Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.

Functional brain plasticity following childhood maltreatment: A longitudinal fMRI investigation of autobiographical memory processing

Altered autobiographical memory (ABM) processing characterizes some individuals with experiences of childhood maltreatment. This fMRI study of ABM processing evaluated potential developmental plasticity in neural functioning following maltreatment. Adolescents with (N = 19; MT group) and without (N = 18; Non-MT group) documented childhood maltreatment recalled specific ABMs in response to emotionally valenced cue words during fMRI at baseline (age 12.71 ± 1.48) and follow-up (14.88 ± 1.53 years). Psychological assessments were collected at both timepoints. Longitudinal analyses were carried out with BOLD signal changes during ABM recall and psychopathology to investigate change over time. In both groups there was relative stability of the ABM brain network, with some developmental maturational changes observed in cortical midline structures (ventromedial PFC (vmPFC), posterior cingulate cortex (pCC), and retrosplenial cortex (rSC). Significantly increased activation of the right rSC was observed only in the MT group, which was associated with improved psychological functioning. Baseline group differences in relation to hippocampal functioning, were not detected at follow-up. This study provides preliminary empirical evidence of functional developmental plasticity in children with documented maltreatment experience using fMRI. This suggests that altered patterns of brain function, associated with maltreatment experience, are not fixed and may reflect the potential to track a neural basis of resilience.

Comparison of Papile versus Laterality-Based Al-Abdi System to Predict Neurodevelopmental Impairment in Extreme Preterm Infants after Severe Germinal Matrix Hemorrhage-Intraventricular Hemorrhage: A Retrospective Comparative Observational Study

BACKGROUND AND PURPOSE

The traditional Papile classification system for severe germinal matrix hemorrhage-intraventricular hemorrhage is limited in objectivity and interrater variability for accurate prediction of neurodevelopmental impairment in extremely preterm infants. Many extremely preterm infants with severe germinal matrix hemorrhage-intraventricular hemorrhage are still offered "redirection of care" in spite of the recent evidence suggesting that many of these infants can have normal outcomes. Therefore, it is important to consider the laterality and extent of brain hemisphere involvement while classifying severe germinal matrix hemorrhage-intraventricular hemorrhage to predict neurodevelopmental impairment. The aim of the present study was to compare the Al-Abdi system with the Papile system for their accuracy in predicting neurodevelopmental impairment in extremely preterm infants with severe germinal matrix hemorrhage-intraventricular hemorrhage.

MATERIALS AND METHODS

This is a retrospective study of extremely preterm infants with severe germinal matrix hemorrhage-intraventricular hemorrhage admitted to a tertiary neonatal intensive care unit (2006-2016). Cranial sonograms were independently re-reviewed by 2 radiologists as per the Al-Abdi system. The prognostic statistical indices for both systems to predict neurodevelopmental impairment were calculated.

RESULTS

A total of 91 infants with severe germinal matrix hemorrhage-intraventricular hemorrhage survived, and 83 (median gestational age, 26.3 weeks; and median birth weight, 890 g) completed developmental assessment. The receiver operating characteristic areas under the curve to predict neurodevelopmental impairment by the Papile versus Al-Abdi systems were 0.702 versus 0.723, respectively (P = .474). Corresponding Al-Abdi cutoff scores of 19, 20, 21, and 22 demonstrated increased specificity (76.36%-85.45%) and correct classification (69.88%-72.29%) to predict moderate-to-severe neurodevelopmental impairment.

CONCLUSIONS

The Al-Abdi system is comparable with the Papile system for predicting neurodevelopmental impairment for extremely preterm infants with severe germinal matrix hemorrhage-intraventricular hemorrhage, with higher Al-Abdi scores being more specific. This finding may prove useful for neonatal health care providers and parents in their decision regarding "continuation of care." Future multicentric studies are warranted to ascertain the validity of individual Al-Abdi scores.

Media coverage of evidence outputs during the COVID-19 pandemic: findings from one national agency

Background

The COVID-19 Evidence Synthesis Team within the Health Information and Quality Authority (HIQA) in Ireland produced a range of evidence-based reports on a broad range of public health topics related to COVID-19. These evidence outputs (EO) arose directly from questions posed by policy makers and clinicians supporting Ireland's National Public Health Emergency Team (NPHET). Findings from these EOs informed the national response to the COVID-19 pandemic in Ireland and influenced international public health guidance. How research findings are presented through domestic news can influence behaviour and risk perceptions.

Methods

We investigated traditional media coverage of nine COVID-19 EOs and associated press releases, published (April to July 2020) by HIQA. NVivo was used for conceptual content analysis of manifest content. ‘Core messages' from each evidence output were proposed and 488 sources from national and regional broadcast, print, and online media were coded at the phrase level. The presence of political and public health actors in coverage were also coded.

Results

Coverage largely did not distort or misrepresent the results of the EOs, however, there was variability in terms of what content was reported on and to what extent different stakeholders were involved in the contextualization of the findings of the EOs. Coverage appeared to focus more on ‘human-interest' stories as opposed to more technical reports (e.g. focusing on viral load, antibodies, testing, etc.). Selective reporting and the variability in the use of quotes from governmental and public health stakeholders changed and contextualized results in different manners than perhaps originally intended in the press release.

Conclusions

Our findings provide a case-study of European media coverage of evidence reports produced by a national agency. Results highlighted several strengths and weaknesses of current communication efforts.

Psychological interventions for acute psychiatric inpatients with schizophrenia-spectrum disorders: A systematic review and meta-analysis

BACKGROUND

Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context.

METHODS

We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up.

RESULTS

Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%).

CONCLUSION

Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.

Nanoscale Motion of Soft Nanoparticles in Unentangled and Entangled Polymer Matrices

We have studied the motion of polyhedral oligomeric silsesquioxane (POSS) nanoparticles modified with poly(ethylene glycol) (PEG) arms immersed in PEG matrices of different molecular weight. Employing neutron spin echo spectroscopy in combination with pulsed field gradient (PFG) NMR we found the following. (i) For entangled matrices the center of mass mean square displacement (MSD) of the PEG-POSS particles is subdiffusive following a t^{0.56} power law. (ii) The diffusion coefficient as well as the crossover to Fickian diffusion is independent of the matrix molecular weight and takes place as soon as the center of mass has moved a distance corresponding to the particle radius-this holds also for unentangled hosts. (iii) For the entangled matrices Rubinstein's scaling theory is validated; however, the numbers indicate that beyond Rouse friction the entanglement constraints appear to strongly increase the effective friction even on the nanoparticle length scale imposing a caveat on the interpretation of microrheological experiments. (iv) The oligomer decorated PEG-POSS particles exhibit the dynamics of a Gaussian star with an internal viscosity that rises with an increase of the host molecular weight.

A telephone reminder intervention to improve breast screening information and access

OBJECTIVES

In the UK, women aged 50-70 are offered breast cancer screening every three years. Screening participation rates in London have been particularly low. Low rates have been associated with low socio-economic status, and some ethnic groups have been observed to be underserved by cancer screening. This paper reports on a telephone reminder intervention in London Newham, an area of high deprivation and ethnic diversity.

STUDY DESIGN

Observational study of planned intervention.

METHODS

Women invited for breast screening were telephoned to confirm receipt of the invitation letter, remind invitees of their upcoming appointment, and to provide further information. Aggregate data at general practice level on invitation to and attendance at breast screening and on numbers reached by telephone were analysed by logistic regression.

RESULTS

For the 29 participating GP practices (10,928 invitees) overall uptake in 2010 was higher compared to the previous screening round in 2007 (67% vs. 51%; p < 0.001). On average 59% of invitees were reached by the reminder calls. A 10% increase in women reached resulted in an 8% increase in the odds of women attending their screening appointment (95% CI: 5%-11%), after adjusting for 2007 attendance rates. Practices with a higher proportion of South Asian women were associated with a larger uptake adjusted for 2007 uptake and population reached by the telephone intervention, (4% increase in odds of attendance per 10% increase in South Asian population, CI 1%-7%, p = 0.003) while practices with a higher proportion of black women were associated with a smaller uptake similarly adjusted. (11% decrease in odds of attendance per 10% increase in black population, CI 9%-16%, p < 0.001).

CONCLUSIONS

A language- and culture-sensitive programme of reminder calls substantially improved breast cancer screening uptake.

Molecular scale dynamics of large ring polymers

We present neutron scattering data on the structure and dynamics of melts from polyethylene oxide rings with molecular weights up to ten times the entanglement mass of the linear counterpart. The data reveal a very compact conformation displaying a structure approaching a mass fractal, as hypothesized by recent simulation work. The dynamics is characterized by a fast Rouse relaxation of subunits (loops) and a slower dynamics displaying a lattice animal-like loop displacement. The loop size is an intrinsic property of the ring architecture and is independent of molecular weight. This is the first experimental observation of the space-time evolution of segmental motion in ring polymers illustrating the dynamic consequences of their topology that is unique among all polymeric systems of any other known architecture.

Abstract P5-01-09: Identification of Molecular Apocrine Triple Negative Breast Cancer Using a Novel 2-Gene Assay and Comparison with Androgen Receptor Protein Expression and Gene Expression Profiling by DASL

Background: The molecular apocrine (MA) subtype of breast cancer is identified by gene expression profiling. MA tumors are estrogen receptor (ER) negative and progesterone receptor (PR) negative, but still express estrogen responsive genes. The androgen receptor (AR) pathway may be driving growth in these tumors because androgen responsive genes are expressed in tumors with the MA gene signature. The MA gene signature is identified in approximately 10% of triple negative breast cancer (TNBC) and may predict patients with tumors responsive to agents that inhibit the AR pathway. AR protein expression, measured by immunohistochemistry (IHC), may be a surrogate for the MA gene signature, but to date, a careful comparison of gene expression profiles and AR protein expression has not been conducted. In this study, cohorts of TNBCs were assessed for the MA gene signature and these results were compared with AR IHC expression and with a novel gene expression assay that may predict tumors with the MA gene signature.

Methods: Formalin fixed, paraffin-embedded (FFPE) TNBC samples were commercially obtained. ER, PR and HER2 status of these samples was confirmed by IHC. AR expression was detected by IHC using two different antibody clones. Both staining intensity and percent positive cells were recorded for each sample. Gene expression data was collected from a cohort of TNBC FFPE samples using cDNA-mediated Annealing, Selection, extension, and Ligation (DASL) technology. A 2-gene classifier of the MA gene expression signature was derived by interrogating publically available gene expression data from ER-negative breast cancers. A reverse-transcriptase polymerase chain reaction (RT-PCR) assay to detect the 2-gene classifier was developed. Cell lines predicted to have the MA gene signature by the 2-gene assay were tested for sensitivity to R-1881 in vitro.

Results: Using computational approaches and publically available datasets, we confirmed the validity of the MA gene signature and estimated the prevalence to be between 12% and 37% in ER-negative breast tumors. The 2-gene classifier was 100% specific in determining MA tumors in a training set using gene expression data as a standard. In a validation set, the 2-gene assay was 66% correlative with AR IHC positivity when the IHC cut-off was set at 10% positive tumor cells. Cell lines predicted to express the MA gene signature by the 2-gene classifier proliferated in response to androgen. This effect was blocked by Flutamide.

Conclusions: These results indicate that AR IHC using a 10% cut-off may not completely correlate with the MA gene signature. Further refinement of AR IHC scoring criteria may produce greater specificity. Cell proliferation data suggests the 2-gene assay can predict tumors that will proliferate in response to androgen. Work is ongoing to determine the correlation between the 2-gene assay results, AR IHC and DASL gene expression data to fully understand the predictability of this assay. Understanding this correlation may allow use of simple clinical assays to accurately select patients responsive to agents that block AR signaling.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-01-09.

The Changing Arctic Cryosphere and Likely Consequences: An Overview

The Arctic cryosphere is a critically important component of the earth system, affecting the energy balance, atmospheric and ocean circulation, freshwater storage, sea level, the storage, and release of large quantities of greenhouse gases, economy, infrastructure, health, and indigenous and non-indigenous livelihoods, culture and identity. Currently, components of the Arctic cryosphere are subjected to dramatic change due to global warming. The need to document, understand, project, and respond to changes in the cryosphere and their consequences stimulated a comprehensive international assessment called “SWIPA”: Snow, Water, Ice, Permafrost in the Arctic. Some of the extensive key SWIPA chapters have been summarized and made more widely available to a global audience with multi-disciplinary interests in this Special Report of Ambio. In this article, an overview is provided of this Special Report in the context of the more detailed and wider scope of the SWIPA Report. Accelerated changes in major components of the Arctic cryosphere are documented. Evidence of feedback mechanisms between the cryosphere and other parts of the climate system are identified as contributing factors to enhanced Arctic warming while the growing importance of Arctic land-based ice as a contributor to global sea-level rise is quantified. Cryospheric changes will result in multifaceted and cascading effects for people within and beyond the Arctic presenting both challenges and opportunities.

Cues to sex- and stress-hormones in the human male face: functions of glucocorticoids in the immunocompetence handicap hypothesis

The stress-linked version of the immunocompetence handicap hypothesis has been proposed to account for inconsistencies in relationships between testosterone and immune response. The model has received some support from studies demonstrating roles of stress hormones in relationships between testosterone, immune function and secondary sexual ornamentation. Such work, however, has relied on artificial elevation of testosterone so may not reflect relationships in natural populations. We created human male facial stimuli on the basis of naturally co-occurring levels of salivary testosterone and the stress hormone cortisol. In Study 1 we tested female preferences for male faces with cues to combinations of the hormones across the menstrual cycle, and in Study 2 we tested perceptions of health and dominance in a novel set of facial stimuli. Females preferred cues to low cortisol, a preference that was strongest during the fertile phase of the menstrual cycle. The effects of cortisol on attractiveness and perceived health and dominance were contingent upon level of testosterone: the effects of the stress hormone were reduced when testosterone was high. We propose explanations for our results, including low cortisol as a cue to a heritable component of health, attractiveness as a predictor of low social-evaluative threat (and, therefore, low baseline cortisol) and testosterone as a proxy of male ability to cope efficiently with stressors.

Using PIV to determine relative pressures in a stenotic phantom under steady flow based on the pressure-poisson equation

Pressure gradient across a Gaussian-shaped 87% area stenosis phantom was estimated by solving the pressure Poisson equation (PPE) for a steady flow mimicking the blood flow through the human iliac artery. The velocity field needed to solve the pressure equation was obtained using particle image velocimetry (PIV). A steady flow rate of 46.9 ml/s was used, which corresponds to a Reynolds number of 188 and 595 at the inlet and stenosis throat, respectively (in the range of mean Reynolds number encountered in-vivo). In addition, computational fluid dynamics (CFD) simulation of the same flow was performed. Pressure drops across the stenosis predicted by PPE/PIV and CFD were compared with those measured by a pressure catheter transducer. RMS errors relative to the measurements were 17% and 10% for PPE/PIV and CFD, respectively.

Evidence for the stress-linked immunocompetence handicap hypothesis in human male faces

The stress-linked immunocompetence handicap hypothesis (SL-ICHH) of sexual selection incorporates a role of the stress hormone corticosterone (C; cortisol in humans) in relationships between testosterone (T), immunity and secondary sexual trait expression. In support of this, C has been shown to mediate and moderate relationships between T and immune response and to be inversely related to attractiveness in some avian species. We predicted that female preferences for cues to T in human male faces would be contingent upon co-occurring cortisol levels. In study 1, we tested relationships between T and cortisol and attractiveness, masculinity and health ratings of raw male faces. We found cortisol to be inversely related to attractiveness. In study 2, we tested female preferences for male faces that were parametrically manipulated on the basis of cues to naturally co-occurring levels of T and cortisol across the menstrual cycle. Women preferred cues to low cortisol in general and in the fertile phase of the cycle, and there was an interaction between T and cortisol in general and in the non-fertile phase. Results were consistent with the SL-ICHH but not the original immunocompetence handicap model: females expressed preferences for cues to cortisol but not for cues to T, except in interaction with the stress hormone. Results inform the SL-ICHH by demonstrating female preferences for low cortisol and the nature of its interaction with T in humans, as well as indicating the traits that may be signalled by different combinations of the hormones including immune response, current health and resource acquisition characteristics.

Grain-boundary-induced spin disorder in nanocrystalline gadolinium

Based on experimental magnetic-field-dependent neutron scattering data, we have calculated the autocorrelation function of the spin misalignment of nanocrystalline (160)gadolinium. The analysis suggests the existence of two characteristic length scales in the spin system: the smaller one is about 5 nm and is attributed to the defect cores of the grain boundaries, whereas the larger length scale is of the order of the average crystallite size D = 21 nm and presumably describes the response of the magnetization to the magnetic anisotropy field of the individual crystallites.

Bone disease of prematurity

Bone disease of prematurity is a complication of preterm birth. This article reviews the aetiology, treatment and prevention of bone disease of prematurity. Provision of adequate nutrition including energy, protein, and minerals is required for both treatment and prevention. Screening for bone disease is controversial. While further research is required quantitative ultrasound appears to be a promising tool for screening and monitoring response to therapy. Further research is needed before recommending physical activity to prevent bone disease of prematurity.

Melting glaciers: a major source of persistent organochlorines to subalpine Bow Lake in Banff National Park, Canada

Organochlorine pesticides and polychlorinated biphenyls (PCBs) are ubiquitous and persistent in the environment. They are known to concentrate in cold environments as a result of progressive evaporation from warm regions, and condensation in colder regions. In this study we show that melting glaciers supply 50 to 97% of the organochlorine inputs to a subalpine lake in Alberta, Canada, while contributing 73% of input water. Tritium analyses indicated that during the mid- to late summer warm period, at least 10% of the glacial melt originated from ice that was deposited in 1950-1970, when it was more contaminated with organochlorines. This finding suggests that climate warming may cause melting glaciers to become increasing sources of contaminants to freshwaters. Organochlorines from glacial streams were largely in dissolved form because the organic-poor glacial clays had a limited sorption capacity for the more hydrophobic chemicals.

Selenium status of cats in four regions of the world and comparison with reported incidence of hyperthyroidism in cats in those regions

OBJECTIVE

To assess selenium (Se) status of cats in 4 regions of the world and to compare results for Se status with reported incidence of hyperthyroidism in cats in those regions.

ANIMALS

50 cats (30 from 2 regions with an allegedly high incidence of hyperthyroidism and 20 from 2 regions in which the disease is less commonly reported).

PROCEDURE

Hematologic samples (heparinized whole blood, plasma, and RBC fractions) were obtained from 43 healthy euthyroid cats and 7 hyperthyroid cats. Plasma concentration of Se and activity of glutathione peroxidase (GPX) in whole blood and plasma were determined.

RESULTS

Plasma concentration of Se and GPX activity in whole blood or plasma did not differ significantly among cats from the 4 regions. However, cats had a plasma concentration of Se that was approximately 5 times the concentration reported in rats and humans. The GPX activity in whole blood or plasma in cats generally was higher than values reported in rats or humans.

CONCLUSIONS AND CLINICAL RELEVANCE

Cats have higher Se concentrations in plasma, compared with values for other species. However, Se status alone does not appear to affect the incidence of hyperthyroidism in cats. High Se concentrations may have implications for health of cats if such concentrations are influenced by the amount of that micronutrient included in diets.

Ecological Monitoring and Assessment Network's proposed core monitoring variables: an early warning of environmental change

This article reports on the evaluation of existing ecological monitoring variables from a variety of sources to select a suite of core variables suitable for monitoring at the Ecological Monitoring and Assessment Network (EMAN) sites located across Canada. The purpose of EMAN is to promote the acquisition of relevant and consistent data that can be used to report on national trends and provide an early warning of ecosystem change. Existing monitoring variables were evaluated in two steps. In the first step, three primary criteria were used to pre-screen preliminary variables. In the second step, a more detailed evaluation considered twenty criteria based on data quality, applicability, data collection methods, data analysis and interpretation, existing data and programs, and cost effectiveness to select a draft set of core monitoring variables (CMV). An ecological framework was developed to organize the CMV in a manner that permitted a gap analysis to confirm the CMV assessed a wide range of relevant environment components. The suite of CMV were then tested to determine their effectiveness in detecting ecosystem change caused by stressors with ecosystem responses that have been well documented in the literature. This project is part of a process lead by Environment Canada to select CMV to detect and track ecosystem change at EMAN sites. It is anticipated that the proposed CMV will undergo future discussion and development leading to the final selection of a suite of CMV for use at EMAN sites.

Gastroschisis: early enteral feeds may improve outcome

OBJECTIVE

Population-based retrospective review of gastroschisis from 1986 to 1996.

METHODS

This was a retrospective review of gastroschisis. Seventy cases were identified from the Birth Defects Registry of Western Australia (WA). Hospital medical records of live-born cases were reviewed.

RESULTS

The live-born incidence of gastroschisis in WA was 2.1 per 10,000 live births for the period 1986-96. The incidence in mothers aged less than 20 years was 8.3-fold that of women aged over 30 years (P < 0.0001). The incidence rate for the period 1995-96 was over twice the rate for 1986-88. Age at first enteral feed was significantly related with length of hospital stay and duration of total parental nutrition (TPN). Each day delay in commencing enteral feed was associated with an increase in hospital stay of 1.05 days and an increase in TPN duration of 1.06 days. The method of delivery of the infant, age at repair, length of anaesthetic time, duration of postoperative paralysis and gestational age was not associated with length of stay or TPN duration. The data were divided into two cohorts: (i) 1986-90; and (ii) 1991-96. There was a statistically significant reduction in hospital stay from a geometric mean of 45.7 (1986-90) to 22.9 days (1991-96).

CONCLUSIONS

Gastroschisis has a favourable outlook, with 89.7% survival of live births. Over the 10 year period studied, there has been a reduction in length of hospital stay and duration of TPN. The age at which the infant is first fed enteral feeds appears to be important in affecting the length of hospital stay and the duration of TPN, with delays associated with a longer hospital stay and longer TPN duration.

Frequencies of memory T cells specific for varicella-zoster virus, herpes simplex virus, and cytomegalovirus by intracellular detection of cytokine expression

Memory T cells specific for varicella-zoster virus (VZV), herpes simplex virus (HSV), and human cytomegalovirus (HCMV) were compared in immune adults by intracellular cytokine (ICC) detection. The mean percentages of CD4+ T cells were 0.11% for VZV and 0.22% for HSV by interferon (IFN)-gamma production; the frequency for HCMV was significantly higher at 1.21%. Percentages of VZV-, HSV-, and HCMV-specific CD4+ T cells were similar by use of tumor necrosis factor (TNF)-alpha. HCMV-stimulated CD8+ T cells produced IFN-gamma (1.11%) and TNF-alpha (1.71%); VZV- and HSV-specific CD8+ T cells were not detectable. VZV CD4+ T cell numbers were similar in young adults with natural or vaccine-induced immunity. VZV CD4+ T cells were significantly less frequent in older adults. Secondary varicella immunization did not increase VZV-specific CD4+ T cell frequencies by ICC assay. Numbers of memory T cells specific for herpesviruses may vary with sites of viral latency and with host age.

Comorbidity of autistic spectrum disorders in children with Down syndrome

The aim of the study was to identify the comorbidity of autistic spectrum disorders in a population of children with Down syndrome (DS). All children with DS within a defined population of South Birmingham were identified. The Asperger Syndrome Screening Questionnaire and the Child Autism Rating Scale were completed and diagnosis made according to ICD-10 criteria following interview and observation. Thirty-three of 58 identified children completed the measures, four of whom received a diagnosis of an autistic spectrum disorder. This is equivalent to a minimum comorbid rate of 7%. The questionnaire items concerning social withdrawal, restricted or repetitive interests, clumsiness, and unusual eye contact were associated with an autistic disorder. Of the remaining 29 participating children, 11 also displayed marked obsessional and ritualistic behaviours. The comorbid occurrence of autism and DS is at least 7%. It is important that these children are identified and receive appropriate education and support. A full assessment of social, language, and communication skills and behaviour is crucial, particularly in children with DS who appear different from other children with DS. Potential mechanisms accounting for this comorbidity are discussed.

Gender differences in muscular strength: an allometric model approach

Despite the fact that allometric modeling has been shown to be a more valid technique for group comparisons of body-size-adjusted muscular strength, no study to date has compared gender differences using absolute (no adjustment for body mass, BM), ratio (force/BM) and allometric (force/BMa) models for an active duty military population. Our purpose in this study was to use these models to compare gender differences in three strength tasks: maximal weight lifted to 152 cm height, maximal isometric force on an upright cable pull and maximal isometric handgrip force. Subjects were 989 and 987 active duty men and women, respectively, each of whom had fat-free mass (FFM) assessed hydrostatically. Results indicate that the ranges of gender difference in strength (%) were 57.9-103.7, 14.5-64.7 and 18.7-77.9 for absolute, ratio and allometrically scaled expressions, respectively, for BM and FFM. We conclude: 1. Men exhibit greater strength than women for all three indices regardless of model approach. 2. The magnitude of these differences is smaller when considering FFM rather than BM, but is larger when considering allometric vs. ratio models.

Analysis of prehospital pediatric and adult intubation

PURPOSE

Pediatric airway control, including endotracheal intubation (ETI), presents a clinical challenge in the prehospital setting. Endotracheal intubation is recommended for serious head injury (Glasgow Coma Scale score <=8). We evaluated the frequency of ETI in pediatric and adult patients with <=8 in the field, subsequently transported by a hospital-based, helicopter emergency medical service (HHEMS).

METHODS

A retrospective, descriptive study of pediatric patients (<=14 years) and adult patients with GCS <=8 transported by HHEMS from January 1988 through March 1994 was conducted. Significance was determined by chi-square analysis.

RESULTS

Inclusion criteria were met by 63 (15%) pediatric patients and 353 (85%) adults. Of the pediatric patients, 38 (60%) were intubated endotracheally; mean age was 7; mean injury severity score (ISS) was 28. Of adults, 267 (76%) were intubated endotracheally; mean age was 35; mean ISS was 33. A 16-percentage-point difference in frequency of successful ETI between groups was found to be significant (p <=0.01). Of 25 nonintubated pediatric (PED) patients, unsuccessful attempts were made on 20 (80%); 14 of 25 (56%) had significant head injuries evident on computerized tomography (CT) scan. Of 86 nonintubated adults, unsuccessful attempts were made on 29 (34%); 61 (71%) had significant head injuries.

CONCLUSIONS

Pediatric coma patients were not intubated with the same frequency as adults. This discrepancy between groups was secondary to a higher failure rate in the pediatric group. Intubation was attempted in 92% of pediatric patients versus 84% of the adults. Unsuccessful intubation attempts in the pediatric group, 20 of 58 (34%), were compared with 29 of 296 (9.8%) in the adult group. Difficulty in pediatric airway control may require an increased level of training and experience.

Self-defeating personality and depression: a closer look

55 men and 55 women were given Schill's Self-defeating Personality Scale, a measure of Beck's cognitive triad, and a measure of the personality dimensions of sociotropy and autonomy. The more characteristics of self-defeating personality endorsed, the more negative were subjects' cognitions about themselves, the world, and the future. Self-defeating men and women scored higher on sociotropy (social dependence), suggesting threats to relationships may be an important source of depression for them. Self-defeating women also scored higher on the autonomy subscales, suggesting threats to their independence may be a source of depression as well. Implications for treatment were discussed.

Chronic self-destructiveness and self-defeating personality: similarities and differences

This study attempts to determine whether the Chronic Self-Destructiveness Scale (CSDS; Kelley, Byrne, et al., 1985) would be better described as a measure of impulsiveness or self-defeating behavior in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., Rev. [DSM-III-R]; American Psychiatric Association, 1987) diagnostic sense. Subjects completed the CSDS, the Self-Defeating Scale (Schill, 1990), and measures of restraint, distress, and psychopathy. Based on the correlations among these scales, we suggest that the CSDS is better described as a measure of impulsiveness, poor judgment, and immediate gratification, rather than a measure of Self-Defeating Personality, which keeps the individual in a victim position.

Age-related differences in cell-mediated immunity to varicella-zoster virus among children and adults immunized with live attenuated varicella vaccine

Live attenuated varicella vaccine elicits protection against varicella-zoster virus (VZV), but adults require two doses to achieve optimal seroconversion rates. To assess the potential role of cell-mediated immunity (CMI), T cell proliferation to VZV antigen was compared in children and adults. Mean stimulation indices (SI) in two cohorts of 39 children tested 6 weeks after vaccination were 28.6 +/- 6.21 and 22.1 +/- 3.84, whereas 20 adult vaccines had a mean SI of 9.1 +/- 0.99 (P = .04). Vaccinees had significant increases in CMI after a second dose of vaccine. At 1 year, VZV CMI was significantly lower in adults after two doses (10.0 +/- 1.13 vs. 15.6 +/- 1.77; P = .02), even though 82% of children received one dose. Limitations in the adult helper T cell response to VZV antigens may explain the need for booster doses to elicit effective immunity and the more frequent occurrence of varicella when adult vaccines are exposed to wild type virus.

The Jaipur limb and foot

In the 12 years which have elapsed since the United Nations declared 1981 to be the Year of the Disabled, the number of amputees world-wide has risen alarmingly, continuing the pattern of the past 40 years, which have seen innumerable conflicts, large and small, with ever-increasing and indiscriminate use of 'improved' antipersonnel mines which have been sown in enormous numbers in rural areas. Even after fighting has ceased--as in Vietnam, which currently has some 200,000 amputees--fresh injuries are caused daily, often to children, by the long-delayed detonation of these weapons. Much of the research and development in prosthetics since World War II has concentrated on producing artificial limbs suitable for an affluent and industrialized society. These, being made from the most modern materials and incorporating the latest technology, are of necessity expensive even for affluent Americans or Europeans and quite out of reach for the 80 per cent of the world's amputees who live in the developing world and for the vast majority of whom these splendid prostheses may be entirely inappropriate. This article describes a foot and leg specifically designed to fit in with the customs and practices of just such people.

Self-defeating personality, depression, and pleasure from activities

Prior research has shown people who scored high on a measure of self-defeating personality experienced less pleasure from various activities and accomplishments. The present research replicated the initial study with 55 men and 60 women, while controlling for the effects of depression. Analyses indicated that, while depression and self-defeating personality were related, depression was not the entire answer for why people with self-defeating personality derive less pleasure from activities.

Commentary on health care reform and opportunities for dietitians

Health care in Canada is driven by global economic pressures. Financing solutions will be found through a national strategy for effective quality management of the health care delivery system. Achieving quality effectiveness will demand a new level of accountability and participation in planning from both users and providers. Restructuring and reform will support a shift from disease treatment and from traditional institutions to health promotion and primary care prevention in community based settings. Along with the shift in focus and delivery systems will be new opportunities for dietitians in new roles and in new settings. The specialized knowledge of dietitians, nourishing people under all life's circumstances, is highly valued by society. Now is not a time when dietitians can afford to be passive about our preferred role in the health system. This is a time to learn new skills and to move beyond the role boundaries of the past. This is a time to invest in research that leads to cost-effective, accountable practices.