Long COVID and return to work: a qualitative study

BACKGROUND

The COVID-19 pandemic has given rise to an increasing number of patients with 'long COVID'. Long COVID is the persistence of symptoms for weeks or months after an infection by SARS-CoV-2. It often impacts on the professional life of affected people.

AIMS

The aim of this study is to understand the experiences and needs of people with long COVID in relation to their return to work.

METHODS

A qualitative study, combining individual interviews and online forum discussions, was performed early 2021, as part of a larger mixed method study on the needs of long COVID patients in Belgium.

RESULTS

One hundred and thirty-four people participated in the study. Participants described various clinical symptoms precluding their return to work. They also face sceptical reactions from employers and colleagues and a lack of support from the social welfare system to facilitate their return to work. These barriers have various impacts, including psychological ones, likely to compromise the professional future of long COVID patients.

CONCLUSIONS

While the analysis of patients' experiences shows variation in long COVID patients' experiences with return to work, it may help occupational physicians and healthcare practitioners to better take up their crucial role in the return to work of long COVID patients, including raising employers' and colleagues' awareness of the specific difficulties related to long COVID.

Pathophysiology and mechanism of long COVID: a comprehensive review

BACKGROUND

After almost 2 years of fighting against SARS-CoV-2 pandemic, the number of patients enduring persistent symptoms long after acute infection is a matter of concern. This set of symptoms was referred to as "long COVID", and it was defined more recently as "Post COVID-19 condition" by the World health Organization (WHO). Although studies have revealed that long COVID can manifest whatever the severity of inaugural illness, the underlying pathophysiology is still enigmatic.

AIM

To conduct a comprehensive review to address the putative pathophysiology underlying the persisting symptoms of long COVID.

METHOD

We searched 11 bibliographic databases (Cochrane Library, JBI EBP Database, Medline, Embase, PsycInfo, CINHAL, Ovid Nursing Database, Journals@Ovid, SciLit, EuropePMC, and CoronaCentral). We selected studies that put forward hypotheses on the pathophysiology, as well as those that encompassed long COVID patients in their research investigation.

RESULTS

A total of 98 articles were included in the systematic review, 54 of which exclusively addressed hypotheses on pathophysiology, while 44 involved COVID patients. Studies that included patients displayed heterogeneity with respect to the severity of initial illness, timing of analysis, or presence of a control group. Although long COVID likely results from long-term organ damage due to acute-phase infection, specific mechanisms following the initial illness could contribute to the later symptoms possibly affecting many organs. As such, autonomic nervous system damage could account for many symptoms without clear evidence of organ damage. Immune dysregulation, auto-immunity, endothelial dysfunction, occult viral persistence, as well as coagulation activation are the main underlying pathophysiological mechanisms so far.

CONCLUSION

Evidence on why persistent symptoms occur is still limited, and available studies are heterogeneous. Apart from long-term organ damage, many hints suggest that specific mechanisms following acute illness could be involved in long COVID symptoms. KEY MESSAGESLong-COVID is a multisystem disease that develops regardless of the initial disease severity. Its clinical spectrum comprises a wide range of symptoms.The mechanisms underlying its pathophysiology are still unclear. Although organ damage from the acute infection phase likely accounts for symptoms, specific long-lasting inflammatory mechanisms have been proposed, as well.Existing studies involving Long-COVID patients are highly heterogeneous, as they include patients with various COVID-19 severity levels and different time frame analysis, as well.

[Fractures of tibial shaft and tibial head in winter sports]

BACKGROUND

Injuries in alpine skiing often affect the lower extremities, in particular the knee joint and lower leg. In addition to conventional radiological diagnostics, CT and, in the case of fractures of the knee joint area, MRI also play an important role. In the case of tibial head fractures, especially if there has been a dislocation mechanism, there is an increased risk of vascular and nerve injuries. Lower leg fractures are predestined for the development of a compartment syndrome. For these reasons, an exact survey of the vascular-nerve status and a monitoring of the soft tissues should be carried out.

THERAPY

In the further therapy, whether conservative or surgical, the soft tissue situation must also be included in the planning. In the case of tibial head fractures in particular, the choice of the right approach is essential for a good result in surgical therapy. Angle-stable plate osteosynthesis and screw osteosynthesis play the most important role as osteosynthesis methods in the knee joint area. In the case of fractures in the shaft area, medullary nail osteosynthesis or angle-stable plate systems are primarily used. In the case of severely compromised soft tissue or unstable situations, it may be necessary to apply an external fixator first. The initiated therapy should enable functional follow-up treatment as early as possible.

PREVENTION

Good physical fitness, driving-specific training, but also good core stabilization have a preventative effect against injuries. In addition, the correct material coordination between ski boot, binding and ski is important for accident prevention.

Supporting patient involvement in health service research: development of a methodological guidance

Background

The Belgian Health Care Knowledge Centre (KCE) issued a Position Paper in 2019 regarding the Patient Involvement (PI) in its researches as stakeholders. After previously investigating the organizational culture of the KCE, a key element for a successful implementation of PI was providing methodological guidance to the researchers.

Objectives

The objective of this study was to develop a methodological guidance for implementing PI into the practices of researchers at KCE.

Methods

In order to build a practical and effective process note, reflecting the needs and points of attention of all involved participants, different methods were combined: a literature review, workshops with the umbrellas of patient associations, patients and patient representatives, Delphi survey and a pilot project involving patients as research partners.

Results

The resulting guidance identified 5 prerequisites and conditions for implementation of patient involvement at the organisational level. The guidance also focused on how to involve patients (which patients, how, when, what for) and included general recommendations to researchers during the collaboration (communication, relational aspects, animation techniques, specific needs of patients). Recommendations for the reporting and evaluation of PI were also formulated. Alongside the guidance for researchers, supports for patients were also developed and validated by the patient associations.

Conclusions

The KCE guidance for PI in research could inspire other agencies willing to implement PI in their practices. Implementation will therefore require additional human and financial resources.

Key messages

Perspectives of long COVID patients on their (unmet) needs: a national quantitative and qualitative study

Introduction

After COVID-19, many people continue to experience various symptoms for several weeks, even after a mild acute phase, and encounter difficulties when confronted with the healthcare system. Patient associations asked the Belgian Health Care Knowledge Centre to investigate the needs of these patients to improve their management.

Purpose of research

An online quantitative survey was conducted in 2021 among Belgian patients with history of COVID-19; having/had persisting symptoms for at least 4 weeks. Alongside questions on symptoms, treatment and impact on employment, Health-Related Quality of Life (HRQoL) before and after COVID-19 was measured through the EQ-5D-5L. A regression analysis identified the factors associated with the impact of long COVID on HRQoL. The qualitative approach consisted in 33 interviews and forum discussions among 101 patients.

Results

1320 patients completed the online survey, most were symptomatic for more than 3 months. The average EQ-5D-5L index score was 0.85(95%CI:0.83-0.86) before and 0.65(95%CI:0.63-0.66) after infection. Duration, number and type of symptoms of long COVID significantly impacted HRQoL. More than half of the patients were unable to work. Qualitative part identified lack of empathy of health professionals, of systematic diagnostic approach, of interdisciplinary coordination. Patients felt misunderstood and developed their own diagnostic or treatment strategies. They questioned the value of medicine and resorted to non-reimbursed alternative therapies.

Conclusions

Long COVID has a significant impact on HRQoL and employment. Because of long COVID, patients were confronted, sometimes for the first time, with the imperfections of the health system. Better informing the health professionals on Long COVID patterns and management options, including reimbursement possibilities, and a comprehensive interdisciplinary assessment would give them the tools to respond to the needs of these patients.

Understanding how organisational culture supports patient involvement in a national research agency

Background

The Belgian Health Care Knowledge Centre (KCE) formally involves stakeholders in its researches since 2012. Patients are treated as one stakeholder amongst others, but it is recognized that patient involvement (PI) requires a different approach. The success of implementing PI depends, however, on the organizational culture towards PI.

Objectives

The objective of this study was to map the PI culture at KCE in the context of the development of organization-wide supported position statements about PI.

Methods

A nominal group technique was used to measure the PI culture at KCE. Arguments for and against PI and conditions for PI in different phases of the research process were collected. A literature review and interviews fed the draft position statements, for which support was assessed by means of a two-round Delphi process.

Results

Arguments in favour of PI in research related to the relevance of the scope, expertise with data collection, bringing in fresh ideas for study design, access to survey participants, validation of data analyses, adherence to recommendations. Disadvantages and risks included the lack of scientific knowledge of involved patients, resources requirements, conflicts of interest, and heterogeneity within patient populations. Conditions for meaningful PI referred to measures mitigating the identified disadvantages. Eighteen position statements supported by KCE could be formulated.

Conclusions

The KCE culture seems predominantly positive towards PI, although attitudes vary between researchers. KCE recognizes the potential value of PI in research, but considers the level of involvement to be contingent on the topic and phase in the research process.

Key messages

• Organizational culture towards patient involvement is a driver of successful researches.

• 18 position statements supported implementation of patient involvement in a national health agency.

[Somatic care in psychiatry : barriers perceived by patients and health professionals]

Disparities in access to, use of and delivery of somatic health care contribute to widening gaps in morbidity and mortality between psychiatric patients and the general population. We conducted a qualitative semi-structured interview study with psychiatric patients and health professionals from different psychiatric care settings to understand these poor physical health outcomes. Optimal somatic follow-up of patients with severe mental illness seems to be hampered by (1) provider-related elements (attitude, training, experiences); (2) organisational aspects (equipment, infrastructure, staff, pharmacy, communication networks); (3) psychiatric patient-related elements and (4) financial barriers.There is an urgent need for integrated somatic and psychiatric health care systems and for cultural change. Psychiatrists and somatic health care providers continue to view the mental and physical health of their patients as mutually exclusive responsibilities. A range of system changes will improve the quality of somatic health care for these vulnerable patients.

[Anterior cruciate ligament injury in adults : Diagnostics and treatment]

The anterior cruciate ligament (ACL) together with the posterior cruciate ligament is the central stabilizer of the knee. It stabilizes the tibia against increased anterior translation and internal rotation. With an incidence of 46/100,000 ACL tears are among the most common sports injuries in Germany. New prevention programs can reduce the risk of ACL injuries. Surgical treatment is recommended for young and athletic patients as it can also reduce the risk of further relevant injuries of the meniscus and cartilage. The standard of surgical treatment in Germany is the ACL reconstruction with an autologous tendon graft. In selected cases, the preservation of the ACL by arthroscopic refixation shows good results. Instead of the previously used purely time-based rehabilitation, function-based criteria are increasingly being included in the aftercare.

Recommendations for a Health literacy Policy Plan for Belgium: Learning from experiences of other countries

Background

In Belgium, the past decade has seen a large number of initiatives by various stakeholders to address health literacy (HL) at different levels, but an encompassing policy plan to coordinate efforts across sectors is missing. The Belgian Federal Public Service of Health, Food Chain Safety and Environment commissioned a study to investigate HL policy plans of other countries, with the intention to make recommendations for the development of a Belgian National Health Literacy Plan (NHLP).

Methods

To identify elements and criteria for a NHLP, a transversal analysis was performed of HL policies in Australia, Austria, Ireland, The Netherlands, Portugal, and Scotland, following a preliminary scoping review regarding the availability of relevant information. Information about HL policies was analysed using a combination of document analysis and key informant approach, structured by means of an analytical grid specifying methods, resources, goals, actors, beneficiaries, actions, timing, opportunities, threats, evaluation, monitoring and impact.

Results

Policy approaches and action plans on HL vary widely in scope, focus and depth. Three pathways to developing a national HL plan were identified: (1) a conceptual approach whereby targets are formulated at the national or federal level, showing the country's determination to improve HL throughout its political system, but with a weak leverage for action (A, AUS, P); (2) a pragmatic approach targeting the healthcare sector first but progressively broadening the scope towards other sectors (SCOT); (3) a delegated approach whereby the authorities delegate the initiatives regarding HL to an active and dynamic civil society (NL, IRL).

Conclusions

There is no single best way to coordinate efforts to address HL across sectors. Policy makers should consider the strengths and weaknesses within their country to develop a substantiated HL approach that best fits the country's situation.

[Operative treatment of cartilage lesions]

Cartilage damage is often associated with pain, reduced quality of life and decreased physical performance. In addition, even small cartilage lesions can lead to osteoarthritis. Since young active people are particularly affected, the correct treatment of cartilage damage plays an important role. Operative treatment includes bone marrow-stimulating procedures with or without a matrix, cell-based procedures and osteochondral graft transplantation. The choice of the best procedure depends on the localization, the size and the extent of the cartilage damage. In addition, especially in the treatment of cartilage damage to the lower limbs, the leg axis and loading relationships should be taken into account and possibly treated as well as additional joint instabilities. The following article gives an overview of the available surgical treatment possibilities as well as the correct indications and implementation. It also gives a brief projection of possible further treatment options associated with stem cells.

[Breast cancer screening : a tool for informed decision making]

INTRODUCTION

Our population has an intuitive approach of the screening and is mostly enthusiastic to participate. The related inquiries on breast cancer screening shows that most women misunderstood this advantages as well as disadvantages. Consequently, the Kenniscentrum (Brussels) started a study in order to present those in neutral messages.

METHODOLOGY

This aims allowing women to make an informed decision. These messages are obviously based on the best methodologies applied on Belgian data. The content of these messages is especially based on the IPDAS criteria (international Patient Decision Aid Standards).

RESULTS

Three visual graphical presentations including these messages were designed for four age brackets (40-49 y.,50-59 y.,60-69 y., 70-79 y.). The first visual presents the burden of breast cancer among other causes of death. The second is related to the impact of screening or no screening on detection and on mortality, this one computed over the ten years after the screening. The third visual shows consequences (positive or negative result, eventual additional investigations needed) of each mammography at short or mid-term.

DISCUSSION

This tool can be used in the context of informed decision or shared decision making. This tool is in the public domain and can be downloaded, in French or Dutch, on KCE (https://kce.fgov.be, tab breast).

Alignment does not influence cartilage T2 in asymptomatic knee joints

PURPOSE

To investigate whether the static knee alignment affects articular cartilage ultrastructures when measured using T2 relaxation among asymptomatic subjects.

METHODS

Both knee joints (n = 96) of 48 asymptomatic volunteers (26 females, 22 males; 25.4 ± 1.7 years; no history of major knee trauma or surgery) were evaluated clinically (Lysholm, Tegner) and by MRI (hip-knee-ankle angle, standard knee protocol, T2 mapping). Group (n = 4) division was as follows: neutral (<1° varus/valgus), mild varus (2°-4° varus), severe varus (>4° varus) and valgus (2°-4° valgus) deformity with n = 12 subjects/group; n = 24 knees/group. Regions of interest (ROI) for T2 assessment were placed within full-thickness cartilage across the whole joint surface and were divided respecting compartmental as well as functional joint anatomy.

RESULTS

Leg alignment was 0.7° ± 0.5° varus among neutral, 3.0° ± 0.6° varus among mild varus, 5.0° ± 1.1° varus among severe varus and 2.5° ± 0.7° valgus among valgus group subjects and thus significantly different. No differences between the groups emerged from clinical measures. No morphological pathology was detected in any knee joint. Global T2 values (42.3 ± 2.3; 37.7-47.9 ms) of ROIs placed within every knee joint per subject were not different between alignment groups or between genders, respectively.

CONCLUSION

Static frontal plane leg malalignment does not affect cartilage ultrastructure among young, asymptomatic individuals as measured by T2 quantitative imaging.

LEVEL OF EVIDENCE

Cross-sectional study, Level II-III.

Age does not influence the clinical outcome after high tibial osteotomy

PURPOSE

Valgus high tibial osteotomy (HTO) is an established procedure for the medial gonarthrosis. In several studies, many negative influencing factors were evaluated. However, until now, the factor "age" was examined only insufficiently. The aim of our study was to evaluate the factor age in predicting the functional outcome after HTO, and we hypothesized that valgus HTO leads to equal results in the treatment of varus osteoarthritis independent of the patient's age.

METHODS

We could generate 13 pairs of patients with a median age at operation of 57 (55-63) years (group A) versus patients 15 years younger with a median age of 42 (39-47) years (group B). The patients were matched according to the following criteria: age, gender, operation/osteosynthesis method, body mass index, same additional operations, and follow-up time. Evaluation of the patients was done by use of the Tegner and Lysholm score and visual analogue scale (VAS) as well as by subjective satisfaction of the patients.

RESULTS

The Lysholm score showed a significant improvement in group A from 41 (SD ± 12.3) to 65 (SD ± 23.8) points (p = 0.01) and in group B from 33 (SD ± 16.7) to 70 (SD ± 31.8) points (p = 0.007). Moreover, the VAS decreased significantly in group A from 77 (SD ± 15.3) to 36 (SD ± 21.3) points (p = 0.003) and in group B from 73 (SD ± 22.7) to 41 (SD ± 33.7) points (p = 0.02). However, there was no significant difference for both groups regarding the activity of the patients evaluated by the Tegner score (group A: preop.: 5 (1-9), follow-up: 3.5 (1-6); group B: preop.: 6 (3-9), follow-up: 4 (2-7)). Furthermore, there was no significant difference between both groups in view of the Lysholm, Tegner and VAS.

CONCLUSION

Valgus high tibial osteotomy is an effective procedure for the treatment of medial gonarthrosis independent of the patient's age. As a consequence, the age of the patient does not have to be taken into consideration for the indication of high tibial osteotomy.

LEVEL OF EVIDENCE

III.

Coexistence of Cushing syndrome from functional adrenal adenoma and Addison disease from immune-mediated adrenalitis

A 56-year-old woman presented with an incidental adrenal adenoma and physical examination findings that included moderate obesity, a slight cervicothoracic fat pad ("buffalo hump"), increased supraclavicular fat pads, and white abdominal striae. Biochemical workup revealed elevated levels of 24-hour urinary free cortisol but normal serum morning cortisol and suppressed levels of corticotropin, suggestive of adrenal-dependent Cushing syndrome. The resected adrenal gland revealed macronodular cortical hyperplasia with a dominant nodule. Other findings included an absent cortisol response to corticotropin stimulation, presence of serum anti-21-hydroxylase antibodies, and mononuclear cell infiltration--consistent with adrenalitis. The findings represent, to the authors' knowledge, the first known case of a patient with coexistent functional cortisol-secreting macronodular adrenal tumor resulting in Cushing syndrome and immune-mediated adrenalitis resulting in Addison disease.

The Belgian geriatric day hospitals as part of a care program for the geriatric patient: first results of the implementation at the national level

PURPOSE

In order to deliver individual, specialized and multidisciplinary care for older people, the Belgian national health authorities developed the care program for the geriatric patient. In that context, 48 geriatric day hospitals (GDHs) have been financed by the government since January 1st 2006. The main objective of this study is to describe the patient characteristics, facility features and activities related to the Belgian GDHs.

METHODS

A prospective, multicenter study was performed from October 1st till December 31st 2006 in all 48 GDHs. For each GDH a transversal data collection was carried out. In the same period all patients scheduled for the GDHs were registered and followed for 3 months. Therefore two questionnaires were developed using Filemaker software: one for each GDH and one for each patient. There were no exclusion criteria.

RESULTS

Six GDHs did not complete one or both questionnaires. Consequently, the results of 42 GDHs were included. GDHs with more years of activity had significantly more new patient contacts per day. Activities in the Belgian GDHs were mainly diagnostic with emphasis on geriatric syndromes and specific medical problems. The reason for admission to the GDH was often multifactorial. The syndromes that motivated patients 75 or older to visit the GDH were clearly geriatric (mainly cognitive disorders) and represent the principle public health problems in this age category. Despite the legal provision preserving GDHs for patients 75 years or older a quarter of all patients was younger than 75, presenting with a geriatric syndrome. The contribution of the general practitioners was limited.

CONCLUSIONS

Activities in the Belgian GDHs are mainly diagnostic with emphasis on geriatric syndromes (particularly cognitive disorders) and specific medical problems. More information is needed on the knowledge and expectations of general practitioners in order to establish a closer collaboration.

Trends in cannabis use and its determinants among teenagers in the French-speaking community of Belgium

BACKGROUND

Cannabis consumption among teenagers has undergone dramatic changes in Europe since the beginning of the 1990s. A number of behaviors associated with cannabis consumption, such as tobacco smoking, excessive drinking and truancy are developing too, each in their own way.

METHODS

To assess the evolution over time of the various types of cannabis consumption (both ever and weekly consumption) in relation to these determinants (age, sex, studies chosen, truancy, tobacco smoking and recurrent intoxication), we have analyzed the cross-sectional study on Health Behaviour in School-Aged Children in the French-speaking Belgian Community (12-17 years) since 1994. We used logistic models to analyze the evolution of the various types of cannabis consumption and to identify the associated factors. Finally, in order to demonstrate time trends, we tested for each type of consumption in the interactions between the significant predictive variables in each model and the survey year (1994-1998-2000).

RESULTS

Rates of ever use, past 30-day use and weekly use among the ever users have been increasing from 1994 to 2002 and reached, respectively, 22.0%, 11.6%, 6.8% and 32.9%. Cannabis ever use rose more noticeably among the general education students (adjusted OR (95%CI)): 3.08 (2.66-3.57) and among the truants: 4.57 (3.39-6.14). Weekly cannabis smoking rose most especially among the truants: 1.92 (1.34-2.78).

CONCLUSION

Truants should constitute a priority target for the prevention of cannabis consumption, while the phenomenon of truancy must be moreover examined in depth in order to more thoroughly identify the appropriate prevention programs organized both in and outside of the school environment.

Expression of hypothalamic-pituitary-thyroid axis related genes in the human skin

The skin is commonly affected in thyroid diseases, but the mechanism for this association is still unclear. As the skin expresses numerous neuroendocrine elements, we tested the additional cutaneous expression of mediators operating in the hypothalamic-pituitary-thyroid axis. We found significant expression of the thyroid-stimulating hormone receptor mRNA in cultured keratinocytes, epidermal melanocytes, and melanoma cells. The presence of thyroid-stimulating hormone receptor was confirmed by northern analyses and the thyroid-stimulating hormone receptor was found to be functionally active in cyclic adenosine monophosphate signal assays. Thyroid-stimulating hormone receptor expressing cells also expressed the sodium iodide symporter and thyroglobulin genes. We also found expression of deiodinases 2 and 3 (mainly deiodinase 2) in whole skin biopsy specimens, and in the majority of epidermal and dermal cells by reverse transcription-polymerase chain reaction followed by sequencing of the amplified gene segments. There was selective expression of the gene for thyroid-stimulating hormone beta; detection of the thyroid-releasing hormone gene was minimal and thyroid-releasing hormone receptor mRNA was not detected in most of the samples. Expression of functional thyroid-stimulating hormone receptor in the skin may have significant physiologic and pathologic consequences, particularly in autoimmune conditions associated with production of stimulating antibodies against the thyroid-stimulating hormone receptor. We conclude that the expanding list of neuroendocrine elements expressed in the skin supports a strong role for this system in cutaneous biology.

[Health inequalities: self-reported complaints and their predictors in pupils from Belgium]

BACKGROUND

This paper identifies socioeconomic and sociodemographic predictors of respiratory/allergic health problems and subjective complaints in adolescents in Belgium.

METHODS

A cross-sectional analysis of the 1998 cross-national study "Health Behaviour of School aged Children" (HBSC) in French-speaking Belgium was undertaken. The survey was based on a self-completed questionnaire concerning various aspects of physical, emotional and social health. The five health problems (asthma, any other respiratory difficulty, allergy, poor subjective health, overweight and depressed feeling) were considered present when a positive reply was given to close-end questions stating if the pupils suffered, or have suffered from these problems during the last six months. We analysed a representative sample of 12,012 pupils aged 11 to 19 years in fifth and sixth grades of primary school, and in all six grades of secondary school.

RESULTS

socioeconomics gradients were found for subjective ill health, depressed state and overweight (p<0.01). Depressed state and overweight were linearly associated with a family economic score. Respiratory difficulties and allergies were observed mainly in pupils in technical training.

CONCLUSION

Pupils with a lower economic score have a higher prevalence of subjective complaints. It remains important to define determinants of subjective ill health and moreover, to act upon these results by increasing accessibility to health services when necessary, by adapting some others to young people and by tailoring interventions to objective and self-perceived needs.

[Health behaviors among first degree students at the Free University of Brussels]

For several years, quality of life is used as a measure of health status. As university constitues a specific setting for young adults, the Health Service of the french-speaking Free University of Brussels initiated a survey in order to study health behaviours of students from the first grade. During the academic year 1998-99, 3,185 students were surveyed in the first degree, using an anonymous self-completed questionnaire with the following topics: health perception, weight, social support, emotional well-being, tobacco, alcohol, medicines, cannabis and ecstasy use as well as access to general practitioner. Body Mass Index was computed and emotional well-being was approached using CES-D scale. Results are presented by gender and faculty. Mutivariate analysis was also realised using logistic regression. In general, results confirm the data resulting from other studies in general population as well as at school. Nevertheless, results show that health is a problem for a minority of students and is a "whole" that has to be approached globally. Moreover, data give a basis to define priorities and strategies to improve students' physical and mental well-being at university. Results are also useful to better target these actions to those at needs.

Occupational therapy in pediatric lead exposure prevention

Environmental lead is a toxic substance that is affecting the growth and development of 3 to 4 million U.S. preschool children today, with effects ranging from learning disabilities to death. This review of environmental lead sources and effects on children provides a background for comprehensive prevention of childhood lead exposure. Prevention strategies at the child, family, and community levels allow for widespread protection of child health and development. Prevention begins with an understanding of the person-environment-occupation framework for the factors that contribute to children at risk for lead exposure. An open system model is presented with specific interventions at the child, family, and community levels, providing innovative, integrated contributions by occupational therapy practitioners for lead exposure prevention and health promotion of children who have been exposed to environmental lead.

[Cannabis consumption in young people living in Brussels: observational conclusions drawn from a preliminary study]

A qualitative study was carried out to explore the adolescents' representations of cannabis and related behaviors. Twenty-two young people aged 13 to 18 years and living in Brussels were interviewed using a half structured interview guideline. The analyse showed that there are three types of behaviors related to cannabis use: the non-users, the experimenters and the users. Parents, the school and peers seem to be specific determinants of cannabis use as well as the main information channels about this product. These preliminary results already lead ways to prevention: training of parents and teachers and school improvement.

Molecular phylogeny and evolution of Monilinia (Sclerotiniaceae) based on coding and noncoding rDNA sequences

The nuclear internal transcribed spacers, the 5.8S subunit, ~560 bp of the small subunit, and ~320 bp of the large subunit of the nuclear ribosomal DNA repeat from 17 species of Monilinia and eight species of closely related genera were sequenced. Phylogenies were constructed using maximum parsimony. The results support the hypothesis that Monilinia is not monophyletic. A fundamental distinction was found between the section Junctoriae and the section Disjunctoriae. Four evolutionary lineages were identified within the Disjunctoriae: one species on Crataegus, one group of species on dry stone fruits of rosaceous hosts, one group of species on capsular fruits of ericaceous hosts, and one group of species on sweet berry fruits of ericaceous hosts. Comparisons between branching topologies of hosts and Monilinia species suggest that although cospeciation among hosts and parasites has been the rule, several host jumps have taken place. Sclerotinia pirolae was determined to be a true member of the Disjunctoriae. The closest taxon groups to the Junctoriae were found to be Botrytis and Sclerotinia, with Ciborinia being the closest taxon group to the Disjunctoriae. There is evidence of an increased rate of ssrRNA evolution in the lineage of species that attack ericaceous berries.

The immune stimulatory protein 90K increases major histocompatibility complex class I expression in a human breast cancer cell line

90K is a widely expressed, secreted 90 kDa human serum protein found both in normal individuals and at elevated levels in the serum of cancer patients. Functional characterization revealed stimulatory effects of 90K on immune defense systems, such as natural killer and lymphokine-activated killer cell activity. Recently, experiments have shown that 90K expression in several tumor cell lines inversely correlates with tumor formation in athymic mice. The mechanism of this tumor suppressive effect is unknown. In the present study, we evaluated the ability of 90K to affect the expression of MHC class I molecules in the human breast cancer cell line EVSA-T. Treatment with 90K (1-50 micrograms/ml) caused the levels of MHC class I expression to increase approximately sixfold above control levels, as measured by flow cytometry. IFN-gamma was used as a positive control and yielded increased expression of MHC class I molecules approximately 8 times over control levels. These data demonstrate that 90K can directly affect the expression of molecules that are engaged in protective antitumor response.

Evaluation of the rapid Patho Dx Latex Strep Grouping Kit

A variety of clinical specimens from throat, nose, ear, eye, wounds, urine, and vagina were collected, cultured, and screened for beta-hemolytic streptococci. The Patho Dx Latex Strep Grouping Kit (Diagnostic Product Corp., Los Angeles, Calif.) technique was applied to colonies taken right from the primary cultures. Isolated strains were sent to the reference laboratory where they were grouped by standard techniques. The kappa coefficient of agreement between the Patho Dx Kit and the standard method was 0.958. We believe that, although better agreement was achieved by others with isolated colonies, a very good agreement is also achieved with primary cultures. The fact that the laboratory is able to report an accurate answer after only 24 h seems most advantageous.

TSH receptor structure

When solubilized, radiolabelled membrane preparations from FRTL-5 rat thyroid cells are applied to TSH affinity columns, two separate peaks of protein can be eluted by high salts/high pH and low pH buffers, respectively. Immunoprecipitation with monoclonal antibodies to the TSH receptor shows that both peaks contain proteins related to the TSH receptor. If extracts were from cells grown without TSH, one peak has a approximately 300 K and the other a approximately 70 K protein the 70 K protein can be derived from the purified 300 K protein in vitro. A 50 and 20 K protein can be derived from the 70 K protein. If extracts are from cells grown with TSH, the peaks contain a multiplicity of additional immuno-precipitable bands of approximately 200, 175, 130, 90, 50, 20 K etc. These bands are shown to result from the ability of TSH to increase the synthesis (3-4-fold) and degradation (2-3-fold) of the 300 and 70 K proteins. The 300/70 K protein fractions are reactive with monoclonal autoimmune thyroid stimulating antibodies and contain a specific disialo ganglioside. The ganglioside migrates near GM2, i.e., like a lower order ganglioside, and contains fucose. In translation experiments, the monoclonal antibodies to the TSH receptor identify a single mRNA component which produces a protein of approximately 220 K. This protein is not present in thyroid cells which have no functional TSH receptor and which cannot be surface labelled with monoclonal antibodies to the TSH receptor.(ABSTRACT TRUNCATED AT 250 WORDS)

The relation between oral contraceptive use and subsequent development of hyperprolactinemia

Serum prolactin levels were determined in 123 patients who presented with menstrual irregularities and/or infertility of more than 1 year's duration. Sixty-three patients had hyperprolactinemia with serum prolactin levels of 26 to 843 ng/ml (normal 5 to 22 ng/ml); 44.4% of this group of patients received oral contraceptive for a period of 2 months to 7 years. Sixty patients were normoprolactinemic, with serum prolactin levels of 3 to 22 ng/ml; 33.4% of this group received oral contraceptives for a period of 6 months to 7 years. The age of presentation, onset of symptoms, age at which they started on oral contraceptives, and duration of use were tabulated. The data were analyzed using chi 2 test corrected for continuity. There was no significant difference in age at the time of evaluation between oral contraceptive users and nonusers with hyperprolactinemia. The relative odds developing hyperprolactinemia were 2.64 times greater among women who has used oral contraceptives for more than 1 year and 6.25 times greater if this use started before the age of 25.

Phase I trial of chlorozotocin: attempted amelioration of myelotoxicity by glucose administration

Chlorozotocin is a new anticancer agent with the chloroethylnitrosourea cytotoxic moiety attached to the carbon-2 position of glucose. Like other chloroethylnitrosoureas, this agent produces delayed myelotoxicity which is dose-limiting. A phase I trial of chlorozotocin with administration of glucose was done in an attempt to modify the myelotoxicity. The patients received the first course of chlorozotocin (200 mg/m2) in the fasting state and then the second course of chlorozotocin with boluses of a 50% glucose solution. With the second course of chlorozotocin administration, the glucose concentration remained threefold greater than after the first course for at least 1 hour. The plasma half-life and apparent volume of distribution of chlorozotocin were similar following either course. The wbc, neutrophil, and platelet count nadirs after the first course of this agent were not significantly different than the nadirs after the second course. We were unable to modify the myelotoxicity of chlorozotocin with boluses of a 50% glucose solution.