Pandemic preparedness from the perspective of Occupational Health professionals

BACKGROUND

Prior to any infectious disease emergence as a public health concern, early occupational preparedness is crucial for protecting employees from novel pathogens- coronavirus disease 2019 (COVID-19) is no different.

AIMS

This study ascertains how occupational safety and health (OSH)/Human Resource (HR) professionals in the Republic of Ireland had managed to prepare their workplaces prior to the advent of COVID-19.

METHODS

As part of a larger COVID-19 workplace study, online focus groups were conducted with OSH/HR professionals. Collected data were transcribed verbatim and entered into NVivo for thematic analysis incorporating intercoder reliability testing.

RESULTS

Fifteen focus groups were conducted with OSH/HR professionals (n = 60) from various occupational settings. Three levels of organizational preparedness were identified: 'early awareness and preparation'; 'unaware and not ready' and 'aware, but not ready'. Most organizations were aware of the COVID-19 severity, but not fully prepared for the pandemic, especially stand-alone enterprises that may not have sufficient resources to cope with an unanticipated crisis. The experiences shared by OSH professionals illustrate their agility in applying risk management and control skills to unanticipated public/occupational health crises that arise.

CONCLUSIONS

General pandemic preparedness such as the availability of work-from-home policies, emergency scenario planning and prior experience in workplace outbreaks of infectious diseases were helpful for workplace-associated COVID-19 prevention. This is the first study conducted with OSH/HR professionals in Ireland regarding COVID-19 preparedness in workplaces, which provides valuable insights into research literature, as well as empirical experience for the preparation of future public health emergencies.

Environmental life cycle assessment of production of the high intensity sweetener steviol glycosides from Stevia rebaudiana leaf grown in Europe: The SWEET project

PURPOSE

There is an increasing interest in the use of non-nutritive sweeteners to replace added sugar in food and beverage products for reasons of improving consumer health. Much work has been done to understand safety of sweeteners, but very little on sustainability. To address that gap, this study presents the results of a life cycle assessment (LCA) of production of rebaudioside A 60%, 95% pure (RA60) steviol glycoside mix from Stevia rebaudiana leaf grown in Europe.

METHODS

An attributional cradle-to-factory-gate life cycle assessment was conducted on growing of stevia leaves and extraction of steviol glycosides in Europe. Primary data were used from a case study supply chain. Results are reported in impact categories from the ReCiPe 2016 (H) method, with focus given to global warming potential, freshwater eutrophication, water consumption, and land use. Impacts are expressed both in terms of production mass and sweetness equivalence, a common metric for understanding high intensity sweetener potency. Sweetness equivalence of RA60 is typically 200 to 300 times that of sugar. Comparison of environmental impact is made to sugar (sucrose) produced from both cane and beets. The research is part of the EU project SWEET (sweeteners and sweetness enhancers: impact on health, obesity, safety, and sustainability).

RESULTS AND DISCUSSION

Global warming potential for production of RA60 was found to be 20.25 kgCO₂-eq/kg_RA60 on a mass basis and 0.081 kgCO₂-eq/kg_SE on a sweetness equivalence basis. Field production of stevia leaves was found to be the main source of impact for most impact categories, and for all four focus categories. Extraction of the RA60 was the main source of impact for the others. Leaf processing and seedling propagation were minor contributors to life cycle impact. Removal of international transport from the supply chain reduced global warming potential by 18.8%. Compared with sugar on a sweetness equivalence basis, RA60 has approximately 5.7% to 10.2% the impact for global warming potential, 5.6% to 7.2% the impact for land use, and is lower across most other impact categories.

CONCLUSION

This is the first LCA of steviol glycoside mix RA60 produced from leaf in Europe. The results indicate that RA60 can be used to reduce environmental impact of providing a sweet taste by replacing sugar across all impact categories. However, it is important to note that specific formulations in which RA60 is used will have a bearing on the final environmental impact of any food or beverage products. For solid foods, this requires further research.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11367-022-02127-9.

COVID-19 workplace impacts - Irish OSH professionals experience and observations

Background

COVID-19 has had a significant impact on workers, arising from adaptations to control measures and consequent behaviour changes that minimise disease spread in the workplace. From an occupational safety & health (OSH) perspective, understanding how adaptations and behaviour changes have impacted workers is relevant to how organisations can preserve the health of their workers when adapting to future health emergencies.

Methods

Semi-structured qualitative focus groups were conducted during April/May 2021. Participants were Irish OSH practitioners. Participants volunteered from industrial sectors (public & private) as defined by the Central Statistics Office. Participants (n = 60) partook in one of sixteen, two-hour focus groups (4-6 participants per focus group) with each comprising four themes for discussion: organisational preparedness; organisational impacts; worker impacts; and the future of OSH. Thematic analyses were performed using NVivo.

Results

Most participants started developing adaptation measures in February/March 2020. Organisations with an international presence started developing adaptation measures earlier. As OSH professionals, most participants felt personally prepared for the challenges induced by the pandemic but did not anticipate the impact it had on their workload. Nearly all participants indicated that isolation, loneliness, fear, and anxiety had a negative impact on their co-workers' mental health. Many OSH practitioners indicated that their co-workers had responded well to the pandemic, and that positive behaviour changes and new adaptation measures had been sustained from the first wave through the third wave of the pandemic in Ireland.

Conclusions

Workplace mental health evaluations and worker wellbeing initiatives must be prioritised post-pandemic. OSH will need to re-evaluate its relationship with organisational human resources in the future.

Key messages

Irish OSH practitioners responded well to the challenge presented by COVID-19 to protect their co-workers and maintain organisational continuity.

COVID-19 has had a negative impact on the mental health of Irish workers as they respond to preserve their organisation’s operations. This will need to be addressed by organisations post-pandemic.

COVID-19 prevention and control measures in workplace settings: a rapid review and meta-analysis

 

Workplaces are high-risk environments for SARS-CoV-2 outbreaks and subsequent community transmission. Identifying, understanding, and implementing effective workplace SARS-CoV-2 infection prevention and control (IPC) measures is critical to protect workers, their families, and communities. A rapid review and meta-analysis were conducted to synthesize evidence assessing the effectiveness of COVID-19 IPC measures implemented in global workplace settings through April 2021. Medline, Embase, PubMed, and Cochrane Library were searched for studies that quantitatively assessed the effectiveness of workplace COVID-19 IPC measures. Included studies comprised varying empirical designs and occupational settings. Measures of interest included surveillance measures, outbreak investigations, personal protective equipment (PPE), changes in work arrangements, and worker education. Sixty-three studies from international healthcare, nursing home, meatpacking, manufacturing, and office settings were included, accounting for ∼280,000 employees. Meta-analyses showed that comprehensive measures (0.2% positivity; 95%CI 0-0.4%) were associated with lower post-intervention employee COVID-19 positivity estimates than single measures like asymptomatic PCR testing (1.7%; 95%CI 0.9-2.9%) and universal masking (24%; 95%CI 3.4-55.5%). Modelling studies showed that combinations of (i) timely and widespread contact tracing and case isolation, (ii) facilitating smaller worker cohorts, and (iii) effective use of PPE can reduce workplace transmission. Comprehensive COVID-19 IPC measures incorporating swift contact tracing and case isolation, PPE, and facility zoning, can effectively prevent workplace outbreaks. Masking alone should not be considered as sufficient protection from SARS-CoV-2 outbreaks in workplace environments at high risk of virus transmission.

Key messages

Comprehensive contact tracing, syndromic surveillance, regular testing, PPE, and zoning measures can prevent COVID-19 outbreaks in the workplace.

Masking alone should not be considered as sufficient protection from SARS-CoV-2 outbreaks in workplace environments at high risk of virus transmission.

Quantifying the impact of regional variations in COVID-19 infections and hospitalisations across Ireland

Background

As most COVID-19 transmission occurs locally, targeted measures where the likelihood of infection and hospitalization is highest may be a prudent risk management strategy. To date, in the Republic of Ireland, a regional comparison of COVID-19 cases and hospitalizations has not been completed. Here, we investigate (i) the variation in rates of confirmed infection and hospital admissions within geographical units of the Republic of Ireland and (ii) frequency of deviations in risk of infection or risk of hospitalization.

Methods

We analyzed routinely collected, publicly available data available from the National Health Protection and Surveillance Centre and Health Service Executive from nine geographical units, known as Community Health Organization areas. The observational period included 206 14-day periods (1 September 2020–15 April 2021).

Results

A total of 206 844 laboratory-confirmed cases and 7721 hospitalizations were reported. The national incidence of confirmed infections was 4508 [95% confidence interval (CI) 4489–4528] per 100 000 people. The risk of hospital admission among confirmed cases was 3.7% (95% CI 3.5–3.9). Across geographical units, the likelihood that rolling 14-day risk of infection or hospitalization exceeded national levels was 9–86% and 0–88%, respectively. In the most affected regions, we estimate this resulted in an excess of 15 180 infections and 1920 hospitalizations.

Conclusions

Responses to future COVID-19 outbreaks should consider the risk and harm of infection posed to people living in specific regions. Given the recent surges of COVID-19 cases in Europe, every effort should be made to strengthen local surveillance and to tailor community-centred measures to control transmission.

Identifying sources of measurement error in assessing dietary intakes - Results of a multi-country ring-trial

BACKGROUND AND AIMS

Epidemiological investigations include dietary intakes as primary exposures or potential confounders. To reduce bias, data collection protocols include the administration of questionnaires together with measurements of biomarkers. Some error, however, remains and needs to be considered in the analysis and interpretation of results. The European Food Safety Authority supported a ring-trial to compare the precision and reproducibility of dietary assessment methods applied in Europe.

METHODS AND RESULTS

Software applications used to collect 24-hour recalls and food records in six countries (Estonia, Italy, Latvia, Portugal, Spain, and Sweden) were assessed. The intake of 256 foods was identically reported to each method. Experienced interviewers participated and were instructed to repeat national protocols closely. The error in recording quantities, compared with reference values, was variable but in about 60% of recorded quantities was in the range of ±20%. Errors were however unsystematic and independent of the food type or quantification method used - although food pictures performed better. The reproducibility of some tools was limited. The methods generally captured additional ingredients (usually flavoring agents), but not sweetening agents or fortification and failed to record packaging information in about 60% of the cases.

CONCLUSION

In a design that eliminated respondent bias, this study indicates that softwares, supporting databases and interviewers generally introduce random error in dietary assessments. The inclusion of large sample sizes and food pictures to quantify portions, together with enhanced attention on interviewers' training, standardisation of procedures and regular tool upgrades are essential in assuring a study's quality and comparability.

Diabetes-related major lower limb amputation incidence is strongly related to diabetic foot service provision and improves with enhancement of services: peer review of the South-West of England

AIMS

To investigate the relationship between high diabetes-related lower limb amputation incidence and foot care services in the South-West region of England.

METHODS

The introduction of 10 key elements of foot care service provision in one area of the South-West resulted in stabilization of foot ulcer incidence and sustained reduction in amputation incidence from 2007. Services introduced included administrative support, standardized general practice foot screening, improved community podiatry staffing, hospital multidisciplinary foot clinics, effective care pathways, availability of an orthotist and audit. Peer reviews of the region's diabetes foot care services were undertaken to assess delivery of these service provisions and compare this with major amputation incidence in other regions with data provided by Yorkshire and Humber Public Health Observatory Hospital Episode Statistics. Recommendations were made to improve service provision. In 2015 changes in service provision and amputation incidence were reviewed.

RESULTS

Initial reviews in 2013 showed that the 3-year diabetes-related major amputation incidence correlated inversely with adequate delivery of diabetes foot care services (P=0.0024, adjusted R² =0.51). Repeat reviews in 2015 found that two or more foot care service improvements were reported by six diabetes foot care providers, with improvement in outcomes. The negative relationship between major amputation incidence and service provision remained strong both in the period 2012-2015 and in the year 2015 only (P ≤0.0012, adjusted R² =0.56, and P= 0.0005, R² =0.62, respectively).

CONCLUSIONS

Major diabetes-related lower limb amputation incidence is significantly inversely correlated with foot care services provision. Introduction of more effective service provision resulted in significant reductions in major amputation incidence within 2 years. Failure to improve unsatisfactory service provision resulted in continued high amputation incidence.

Analysis of head impacts during sub-elite hurling practice sessions

The reported incidence of head and neck injuries in hurling is 0.12 per 1000 hours, but no previous research has quantified head impact characteristics in this sport. Here, a wireless accelerometer and gyroscope captured head impacts, in 20 senior club level hurling players. Peak linear and rotational acceleration and impact location were recorded during three hurling training sessions, each player participating once. A mean of 27.9 impacts (linear acceleration >10g) per player, per session were recorded; 1314 impacts during a total exposure time of 247 minutes. Only 2.6% impacts had peak linear acceleration of >70g and 6.2% had peak rotational acceleration >7900 rad/s². There were significant differences in the number and magnitude of impacts, quantified by the accelerometer, between three training sessions of differing intensity (ŋ2 0.03-0.09, p < 0.001). This study represents a first step in quantifying head impacts during hurling, demonstrating the feasibility of this technology in the field. The sensors were able to discriminate between sessions of varying intensity. These data can be used to develop athlete monitoring protocols and may be useful in developing innovative helmet-testing standards for hurling. The potential for this technology to provide feedback has clinical utility for team medical personnel.

International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries

Objectives

To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries.

Background

Results from clinical trials suggest significant variation in care across the world. However, international comparisons in “real world” registries are limited.

Methods

We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries.

Results

Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%).

Conclusions

The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.

Dispersal pattern and dispersion of adult and nymph stink bugs (Hemiptera: Pentatomidae) in wheat and corn

Euschistus servus (Say) can develop a generation on wheat, Triticum aestivum L., before moving to corn, Zea mays L., where it can be a pest. Because effective management methods are unknown, this study sought to describe the spatial distribution and dispersal of E. servus in the wheat and corn interface. In addition, Oebalus pugnax (F.) densities were documented in both crops. Wheat fields adjacent to the corn were sampled before harvest and stink bugs were marked using a product containing egg whites. Dispersal into the adjacent corn was measured using grid sampling, and dispersion was measured over time using an immunoassay targeting egg albumin on E. servus collected in corn. Dispersion was measured using Anselin Local Moran's I for unmarked stink bugs only. O. pugnax was prominent in wheat but was rarely recovered from corn. In contrast, E. servus was common in wheat during both years and dispersed into the adjacent corn. E. servus nymph and adult densities increased quadratically over time in corn in 2011. In contrast, E. servus nymph densities decreased over time in corn in 2012, while adult densities remained static. Most aggregations of E. servus nymphs and adults were located on the edge of the corn, directly adjacent to the harvested wheat. This is likely the first study to directly document the movement of E. servus nymphs to the adjacent crop. Movement from wheat to corn was not consistent between the years and may have been influenced by factors such as variations in weather, timing of wheat harvest, or other available alternative hosts.

246 ASSOCIATION OF SINGLE NUCLEOTIDE POLYMORPHISMS WITHIN THE BOVINE HEAT SHOCK PROTEIN 70 GENE AND CALVING RATES

Heat shock proteins (Hsp) are induced by various stressors such as heat, cold, toxins, and oxygen deprivation. Our objective was to determine the relationship among polymorphisms in the Hsp70 gene, forage system, and calving rates. Genomic DNA for 77 cows was purified from the buffy coats of EDTA-treated whole blood. The cows were Angus (n = 20), Brahman (n = 26), and reciprocal crosses (n = 31). Cows were assigned to and remained on their respective forage system for the duration of the experiment (8 years). Forage systems were endophyte-infected toxic tall fescue (E+) or common bermudagrass (CB). Specific primers for bovine Hsp70 (HSP1778F: CGCTGGAGTCGTACGCCTTC; HSP2326R: CTTGGAAGTAAACAGAAACGGG) were used for PCR amplification of a 523-base segment (based on GenBank accession number U09861). The PCR product was sequenced in both directions. Seven single nucleotide polymorphisms (SNP) were identified, and they were located at base positions 1851 (n = 6), 1902 (n = 4), 1917 (n = 4), 1926 (n =4), 2033 (n = 20), 2087 (n = 6), and 2098 (n =4). Concentrations of Hsp70, Julian date, and lifetime calving rate were analyzed by ANOVA, with each SNP represented as the main effect in the model. Two SNP resulted in altered peptide sequences, also known as mis-sense mutations (1926, aspartic acid to glutamic acid, and 2033, glycine to alanine). Five unique haplotypes were deduced based on the SNP profile (GCGCGCT, GCGCCCT, ACGCGCT, GCGCGGT, GTTGGCA, respectively, for haplotype 1, 2, 3, 4, and 5). Plasma concentrations of Hsp70 were affected by an interaction (P < 0.05) between Hsp70 haplotype and forage system. Cows with haplotypes 4 and 5 consuming fescue had higher plasma Hsp70 concentrations than other cows (5.4, 5.1, 3.8, 5.1, 5.2, 5.1, 5.7, 4.2, 22.4, and 9 MSE 1.5 ng mL-1, respectively, for 1-5 CB and 1-5 E+). That same interaction tended (P < 0.09) to be associated with lifetime calving percentage. Cows with haplotype 4 consuming bermudagrass had the lowest calving rate (58%). These results suggest that the Hsp70 gene in cattle is polymorphic, and those polymorphisms are related to cattle fertility.

Synthetic analogs of FTY720 [2-amino-2-(2-[4-octylphenyl]ethyl)-1,3-propanediol] differentially regulate pulmonary vascular permeability in vivo and in vitro

Novel therapies are needed to address the vascular endothelial cell (EC) barrier disruption that occurs in inflammatory diseases such as acute lung injury (ALI). We previously demonstrated the potent barrier-enhancing effects of both sphingosine 1-phosphate (S1P) and the structurally similar compound FTY720 [2-amino-2-(2-[4-octylphenyl]ethyl)-1,3-propanediol] in inflammatory lung injury. In this study, we examined the therapeutic potential of several novel FTY720 analogs to reduce vascular leak. Similar to S1P and FTY720, the (R)- and (S)-enantiomers of FTY720 phosphonate and enephosphonate analogs produce sustained EC barrier enhancement in vitro, as seen by increases in transendothelial electrical resistance (TER). In contrast, the (R)- and (S)-enantiomers of FTY720-regioisomeric analogs disrupt EC barrier integrity in a dose-dependent manner. Barrier-enhancing FTY720 analogs demonstrate a wider protective concentration range in vitro (1-50 microM) and greater potency than either S1P or FTY720. In contrast to FTY720-induced EC barrier enhancement, S1P and the FTY720 analogs dramatically increase TER within minutes in association with cortical actin ring formation. Unlike S1P, these FTY720 analogs exhibit differential phosphorylation effects without altering the intracellular calcium level. Inhibitor studies indicate that barrier enhancement by these analogs involves signaling via G(i)-coupled receptors, tyrosine kinases, and lipid rafts. Consistent with these in vitro responses, the (S)-phosphonate analog of FTY720 significantly reduces multiple indices of alveolar and vascular permeability in a lipopolysaccharide-mediated murine model of ALI (without significant alterations in leukocyte counts). These results demonstrate the capacity for FTY720 analogs to significantly decrease pulmonary vascular leakage and inflammation in vitro and in vivo.

Validity and reproducibility of a computerised tool for assessing the iron, calcium and vitamin C intake of Belgian women

OBJECTIVE

To determine the relative validity of a newly developed iron intake assessment tool, designed specifically to assess iron, calcium and vitamin C intake.

DESIGN

Estimates of iron, calcium and vitamin C intake from a computerised iron intake assessment tool compared with those from 11-day estimated dietary records.

SETTING

Region of Ghent (N= +/- 225,000), a city in Flanders, the Dutch-speaking part of Belgium.

SUBJECTS

In all, 50 women aged 18-39 y, participating in a large-scale epidemiological study on iron intake and iron status.

MAIN RESULTS

Mean dietary iron intake from the 11-day food record, the unadjusted dietary iron intake assessment tool and the adjusted tool was, respectively, 10.5 +/- 2.7, 10.4 +/- 4.3 and 9.6 +/- 2.9 mg. For the different nutrients, the correlation coefficients vary from 0.45 to 0.60 for adjusted intake. The mean difference of iron intake by the two methods (0.8 +/- 2.9 mg) did not differ significantly from zero. The new method correctly classified 38% (iron), 38% (calcium) and 58% (vitamin C) of the subjects to the correct tertile. The correlation coefficients ranged from 0.48 for adjusted vitamin C intake to 0.73 for adjusted calcium intake between two administrations.

CONCLUSION

The newly developed instrument can be used to assess mean group intakes of iron, calcium and vitamin C in women consuming a Western diet. However, since the ranking capability of the new tool is rather weak, further refinement of the tool is required to produce a robust method for assessing iron, calcium and vitamin C intakes of individuals.

SPONSORSHIP

This research was supported by the Belgian National Fund for Scientific Research/Flemish Division (Fund No G.0152.01).

Expression, purification and preliminary X-ray analysis of the BRCT domain from Rhp9/Crb2

The BRCT domain from Rhp9 (a Schizosaccharomyces pombe DNA-damage checkpoint protein) has been expressed, purified and crystallized. Overexpression in bacterial cells was achieved by minimizing aeration during host cell growth. A robotic screen was used to determine the solubility parameters; concentration of the protein was achieved by exploiting this information. Single crystals suitable for X-ray analysis were obtained in two forms by vapour diffusion (trigonal, unit-cell parameters a = b = 228.04, c = 70.42 A, and tetragonal, P4/m Laue group symmetry, unit-cell parameters a = b = 72.3, c = 91.1 A).

Importance of inoculum size and sampling effect in rapid antigen detection for diagnosis of Streptococcus pyogenes pharyngitis

Current recommendations suggest that negative rapid Streptococcus pyogenes antigen tests be backed up with a culture, reflecting evidence that culture may have a higher sensitivity and also that testing of a second swab may yield a different (i.e., a positive) result because of variation in sample size or distribution. If the latter is common, the sensitivities of current antigen detection tests might be improved by simply increasing the amount of sample tested. The present study assessed the effect of antigen testing of two swabs extracted together compared to independent testing of each swab extracted separately for children with clinical pharyngitis. S. pyogenes grew from one or both swabs for 198 (37%) of 537 children. The combined culture was significantly (P < 0.05) more sensitive than culture of either swab alone. Compared to combined culture, antigen testing of two swabs extracted and tested together was significantly more sensitive than two single swab extractions (94.1 versus 80%; P = 0.03); however, the specificity was decreased (81.5 versus 89.8 to 92.7%; P < 0.05). This study suggests that sample size and/or uneven sample distribution may have influenced the apparent sensitivities of prior studies that compared antigen tests to a single plate culture. A strategy, such as the one used in the present study, that increases the sample size available for antigen testing (i.e., extraction of samples from both swabs) may improve detection rates to a level that will better approximate true disease status and obviate the need for backup cultures if specificity can be improved.

Dysphoric subjective response to neuroleptics in schizophrenia: relationship to extrapyramidal side effects and symptomatology

OBJECTIVE

Subjective reports of dysphoric responses to neuroleptic medication are common in clinical practice. However, cognitive and affective side effects of neuroleptic medications are difficult to differentiate from the symptoms of schizophrenia. We sought to elucidate the relative contribution of extrapyramidal side effects and symptomatology to dysphoric response.

METHOD

Fifty clinically stable outpatients with schizophrenia attending a rehabilitation centre were assessed for extrapyramidal side effects and symptomatology before completing the drug attitude inventory (DAI).

RESULTS

Presence of extrapyramidal side effects, found in 28 patients (Z = -1.99, p = 0.05), and severity of negative symptoms (r = -0.47, p = 0.001) were independently associated with dysphoric response, explaining a significant proportion of the variance (R = 0. 53, R(2) = 25.2%, F = 9.27, df = 2, p = 0.0004).

CONCLUSIONS

Patients who report a dysphoric response which they associate with neuroleptic medications have more extrapyramidal side effects and more severe negative symptoms. While these responses may be part of the negative symptoms of the illness or due to other factors such as depression, we raise the possibility that they may be clinically indistinguishable from, and be a subjective measure of, the so-called 'neuroleptic-induced deficit syndrome'.

Reversal of P-glycoprotein mediated multidrug resistance by novel anthranilamide derivatives

We have synthesised and evaluated a series of anthranilamide based modulators of P-glycoprotein. These studies have identified XR9576(2), a potent inhibitor of P-glycoprotein in vitro and in vivo. The general synthesis and the SAR of these compounds are described.

Metabolizable energy of high non-starch polysaccharide-maintenance and weight-reducing diets in men: experimental appraisal of assessment systems

We have examined the reliability of several food energy assessment systems for healthy men. The predictions of metabolizable energies were compared with determinations made in energy balance studies with three maintenance diets (12 MJ/d); one of the diets was moderate in non-starch polysaccharide (NSP; 2.1% of gross energy) and two were higher in NSP (3.5-4.6% of gross energy). A fourth diet was a submaintenance (6 MJ/d) high NSP (7% gross energy) diet. Discrepancies between the different food energy assessment systems and the determined metabolizable energy values ranged between 0 and 15%. With the maintenance diets, the Atwater specific factor system had errors generally within 6% of the determined value and a limit of agreement (bias +2SD) for diets of 10%. This accuracy compares with errors of 2% for both the originally published assessment of this system and a more recent general formula; both systems were without bias with increasing NSP content of the diets but the latter had limits of agreement within 3%. In contrast, the Atwater general, the European general and a recent FDA general formula showed increasing bias with increasing NSP intake. All of the general energy assessment systems overpredicted metabolizable energy from the high NSP submaintenance diet, which shows that even the least biased and most reliable energy assessment system that we identified applies to maintenance diets only; thus a correction has to be made for submaintenance diets.

Elderly care. Early warning system

In one area in Merseyside, primary care teams were only identifying elderly people with dementia in times of crisis, resulting in earlier than necessary residential or nursing home placements. Employing a social worker to work with primary care teams as a specialist care manager for this group has resulted in earlier and more appropriate care in the view of both carers and care workers. Following the appointment, interviews with 10 carers revealed that eight out of 10 patients were now receiving health and social care when nine out of 10 had previously received none.

Defective insulin secretion in hepatocyte nuclear factor 1alpha-deficient mice

Mutations in the gene for the transcription factor hepatocyte nuclear factor (HNF) 1alpha cause maturity-onset diabetes of the young (MODY) 3, a form of diabetes that results from defects in insulin secretion. Since the nature of these defects has not been defined, we compared insulin secretory function in heterozygous [HNF-1alpha (+/-)] or homozygous [HNF-1alpha (-/-)] mice with null mutations in the HNF-1alpha gene with their wild-type littermates [HNF-1alpha (+/+)]. Blood glucose concentrations were similar in HNF-1alpha (+/+) and (+/-) mice (7.8+/-0.2 and 7.9+/-0.3 mM), but were significantly higher in the HNF-1alpha (-/-) mice (13.1+/-0.7 mM, P < 0.001). Insulin secretory responses to glucose and arginine in the perfused pancreas and perifused islets from HNF-1alpha (-/-) mice were < 15% of the values in the other two groups and were associated with similar reductions in intracellular Ca2+ responses. These defects were not due to a decrease in glucokinase or insulin gene transcription. beta cell mass adjusted for body weight was not reduced in the (-/-) animals, although pancreatic insulin content adjusted for pancreas weight was slightly lower (0.06+/-0.01 vs. 0.10+/-0.01 microg/mg, P < 0.01) than in the (+/+) animals. In summary, a null mutation in the HNF-1alpha gene in homozygous mice leads to diabetes due to alterations in the pathways that regulate beta cell responses to secretagogues including glucose and arginine. These results provide further evidence in support of a key role for HNF-1alpha in the maintenance of normal beta cell function.

Quality of life in schizophrenia: insight and subjective response to neuroleptics

The relationship between quality of life, insight, and subjective response to neuroleptics was assessed in a selected group of clinically stable outpatients with schizophrenia. A significant portion of the variance in these individuals' quality of life was explained by a combination of protracted illness duration and the presence of a dysphoric response to neuroleptics. However, there was no significant relationship between quality of life and the level of insight these individuals had into the nature of their illness. The development of treatment strategies to alleviate neuroleptic-induced dysphoria may enable outpatients with schizophrenia to benefit from rehabilitation programs devised to improve quality of life.

Sequential changes of auditory processing during target detection: motor responding versus mental counting

Brain potentials evoked to non-targets in an auditory target detection task changed in amplitude, duration, polarity, and scalp topography as a function of position in the stimulus sequence relative to the target. (1) A negative prestimulus readiness like-potential, or RP, the poststimulus N100, and a late slow wave to non-targets immediately after the target were reduced in amplitude compared to non-targets immediately before the target. The amplitudes of these potentials after the target then increased in size as a linear function of the number of non-targets in the sequence. (2) The amplitudes of the positive components, P50 and P200, were larger to non-targets immediately after the target than to non-targets immediately before the targets. P50 amplitude then decreased to subsequent non-targets in the sequence in a linear manner; P200 amplitude was reduced equivalently to all subsequent non-targets. (3) The duration of the P200 component could extend into the time domain when the P300 to targets would occur. The P200 component to non-targets was therefore designated 'P200/300'. The duration of the P200/300 component was shorter to non-targets immediately after the target than to non-targets immediately before the targets. P200/300 duration then extended in a linear manner to subsequent non-targets in the sequence and approached the peak latency of the P300 evoked by targets. (4) The anterior/posterior scalp distribution of P50 and the polarity of the late slow wave to non-targets changed as a function of non-target position in the sequence. The subject's response to the targets (button press or mental count) influenced these sequential effects. Linear trends for sequence were present in the press but not the count conditions for the amplitude of the RP, N100, and P300; linear trends for P50, P200/300 duration, and the late slow wave were found in both the press and count conditions. Reaction time was speeded as a function of the number of preceding targets. These dynamic changes in the processing of auditory signals were attributed to an interaction of attention and the subjective expectancies for both the appearance of a target stimulus and the requirement to make a motor response.

Is the rat a suitable model for humans on studies of cereal digestion?

OBJECTIVES

To compare the extent of starch digestion from barley flake and flour in humans and rat. Is the rat a useful model?

DESIGN

Four healthy male ileostomy volunteers consumed, in random order, flapjacks containing flaked barley on one occasion and barley flour on another. Ileostomy fluid was collected for analysis of starch and nonstrach polysaccharide (NSP) hourly for 12 h. The ratio of starch to NSP in ileostomy fluid was compared with that in the terminal ileum of eight randomly selected male rats consuming the flaked barley flapjack and another eight rats consuming the barley flour flapjack.

RESULTS

After consuming flaked barley the terminal ileal starch-NSP ratio was 20 times lower in rats than in ileostomists and was 0.04 (s.e.m. 0.006) g/g compared with 0.89 (s.e.m. 0.05) g/g respectively. By contrast the starch-NSP ratio was very low after consuming the barley flour in both species; however the ratio was still lower in rats than in ileostomists and was 0.02 (s.e.m. 0.01) g/g compared with 0.05 (s.e.m. 0.01) g/g respectively. Using the NSP as an indigestible marker, starch from barley flake that resisted small intestinal digestion was calculated to be 0.7 (s.e.m. 0.02)% in rats compared with a higher value of 17 (s.e.m. 1)% in ileostomists.

CONCLUSION

The cell walls of barley flake limit the extent of starch digestion in humans but in rats this appears not to be a limiting factor. In the present instance it was not possible to extrapolate results from rats to humans.

Guidelines for producing patient information literature

This article provides practical information on developing patient information literature. The step-by-step approach provided by the authors should be of use to nurses who are currently involved in producing such literature or who are looking at ways of effectively disseminating information to patients on specific topics.

Quality of life in schizophrenia: relationship to sociodemographic factors, symptomatology and tardive dyskinesia

The influence of sociodemographic, clinical and treatment factors on the quality of life of patients with schizophrenia has yet to be fully defined. We evaluated the quality of life of patients with schizophrenia who were attending a catchment area rehabilitation centre, in order to establish its clinical correlates. These patients had a poor to moderate quality of life which was inversely related to negative symptom severity, illness duration, the cumulative length of previous hospitalization and patient age. Patients residing in hostels or group homes had a poorer quality of life than those living independently or with their family. The presence of tardive dyskinesia was associated with a poorer quality of life. This association merits further investigation.

Circadian patterns of total 24-h hydrogen and methane excretion in humans ingesting nonstarch polysaccharide (NSP) diets and the implications for indirect calorimetric and D2 18O methodologies

OBJECTIVES

To quantify the relationship between substrate fermentation and total 24-h H2 and CH4 excretion on mixed diets and to assess errors incurred in the calculation of energy expenditure and fuel selection by the exclusion of these gases from standard calculations.

DESIGN AND SUBJECTS

Twelve healthy, lean men were studied over two consecutive dietary periods of 3 weeks. Measurements of total H2 and CH4 excretion were made during 24h within a whole body calorimeter. Subjects were fed a diet containing 16 g or 38 g of nonstarch polysaccharide (NSP) and 16 g or 19 g resistant starch (RS). Colonic fermentation was measured by balance techniques during the two dietary treatments.

RESULTS

There was an inverse non-linear relationship between H2 and CH4 excretion on both diets (r2 = 0.53; P < 0.001), but absolute excretion did not increase significantly as the intake of NSP and RS (from 28 +/- 3 and 48 +/- 4 g/day) increased. No relationship was found between daytime and 24-h measurements of H2 and CH4. H2 and CH4 excretion introduces an error of less than 0.2% and 1% in calculations of energy expenditure and CO2 production from the standard human equations used in indirect calorimetric (IC) and doubly labelled water (DLW) methodologies respectively, and less than 2% in fuel utilisation calculated as % non-protein energy expenditure from IC.

CONCLUSIONS

This study provides evidence that neither daytime nor total 24-h rates of H2 or CH4 excretion accurately predict degree of fermentation of NSP+RS in either individual subjects or groups of subjects, probably because of changes in the stochiometry of the fermentation process.

Resistant enterococci: a prospective study of prevalence, incidence, and factors associated with colonization in a university hospital

OBJECTIVE

To determine the prevalence of gastrointestinal tract colonization with antibiotic-resistant enterococci at ward entry and to study the incidence and risk factors for nosocomial acquisition of colonization with resistant enterococci.

DESIGN

A prospective cohort study conducted between February 1 and March 15, 1993.

METHODS

Rectal cultures were obtained within 24 hours of admission or transfer onto the study wards and repeated at weekly intervals and at the time of discharge. Patients harboring antibiotic-resistant enterococci at the time of admission or after admission were compared to patients who were not colonized with these organisms. Clinical and epidemiologic risk factors for colonization were abstracted prospectively by daily chart review. Following a univariate analysis of risk factors associated with colonization, a multivariate statistical analysis using three separate models was done.

SETTING

A 1,125-bed, tertiary-care teaching hospital in North Carolina.

PATIENTS

A total of 350 patients admitted to two general medical wards and the medical intensive care unit during the study period.

RESULTS

Antibiotic-resistant enterococci were isolated from 52 patients: 19 were colonized at admission to the study, and 33 later acquired resistant strains. At the time of admission, 5.4% of the patients were colonized with ampicillin-resistant enterococci (ARE), including 1.1% that were colonized with vancomycin-resistant enterococci. Prior hospitalization was associated with colonization with ARE at admission (P = .01). Independent risk factors for nosocomial acquisition of ARE included treatment with more than three antibiotics, empiric use of antibiotics, use of third-generation cephalosporins, and the use of enteral tube feedings. Antibiotics used prophylactically were not associated with resistant enterococcal colonization.

CONCLUSIONS

Our data help to elucidate the epidemiology of gastrointestinal tract colonization with resistant enterococci. We hypothesize that surveillance and control programs will be more likely to succeed if targeted at patients receiving more than three antibiotics, empiric antibiotics, and enteral tube feedings (Infect Control and Hosp Epidemiol 1996;17:36-41).

Comparison of BioStar Strep A OIA optical immune assay, Abbott TestPack Plus Strep A, and culture with selective media for diagnosis of group A streptococcal pharyngitis

We directly compared three techniques for the diagnosis of group A streptococcal pharyngitis in 500 symptomatic children seen in the Emergency Department or Child Care Clinic of The Children's Hospital of Denver. Throats were vigorously swabbed with two rayon swabs, which were transported immediately to the Microbiology Laboratory. Each swab was cultured aerobically on Strep A Isolation Agar (Remel) and then tested for antigen-one swab by the Strep A OIA optical immune assay (BioStar) and the other by the TestPack Plus Strep A (Abbott) technique. Each test was performed blind to the others. The refrigerated pledget was cultured in Todd-Hewitt broth if an antigen test was positive and both direct plate cultures were negative (the "gold standard" was any culture positive). All isolates were serologically grouped. Of 500 complete patient cultures, 151 (30%) were positive for group A streptococcal growth. The two antigen tests gave comparable results with an average sensitivity of 83%. Each was significantly (P < 0.02) less sensitive than its corresponding culture. The BioStar Strep A OIA optical immune assay produced significantly (P < 0.003) more false-positive results than did the Abbott test. Rapid antigen testing is not sensitive enough to eliminate the need for backup cultures.

Influence of the physical form of barley grain on the digestion of its starch in the human small intestine and implications for health

It has been suggested that incomplete digestion of cereal starch explains the low energy values of certain cereals of large particle size. We used human subjects with ileostomies to investigate the digestion of barley and to determine whether the physical form of barley affects stomal excretion of starch, glucooligosaccharides, nitrogen, fat, and calculated energy. Only 2 +/- 1% of starch remained undigested after finely milled barley was eaten, but after flaked barley was eaten 17 +/- 1% resisted digestion, partly as oligosaccharides (G1-G10) but largely as intact unpitted starch granules bound by intact cell walls. The calculated energy excretion from the stoma was three times higher after flaked than after milled barley [51.5 decreasing to 15.3 kJ/g nonstarch polysaccharide (NSP, P < 0.001]. NSP, starch, and fat made almost equal contributions to the higher energy excretion. It is concluded that possibly the botanical source of cereals and certainly processing, other than retrogradation of the starch, are important determinants of starch digestibility and energy value. Possible clinical implications are introduced.

Synthesis and muscarinic activities of 1,2,4-thiadiazoles

A series of novel 1,2,4-thiadiazoles bearing a mono- or bicyclic amine at C5 were prepared. Quinuclidine and 1-azabicyclo[2.2.1]heptane derivatives were synthesized by reaction of the lithium enolate of the 3-methoxycarbonyl compounds followed by ester hydrolysis and decarboxylation. The receptor-binding affinity and efficacy of these compounds as muscarinic ligands was assessed by radioligand binding assays using [3H]-N-methylscopolamine and [3H]oxotremorine-M. Optimal agonist affinity was observed for 3'-methyl compounds. Smaller substituents (H) retained efficacy with reduced affinity while larger groups led to substantially lower efficacy. The observed binding affinity was influenced both by the conformational energy of rotation around the C3-C5' bond and the steric requirement of the mono- or bicyclic amine.

Abnormal perception of food size in anorexia nervosa

The hypothesis that patients with anorexia nervosa exaggerate the perceived size of food was tested. Video recordings of five items of food and four neutral objects of a similar size were made such that the size of each object increased steadily from half to twice its normal size. Each of the nine objects was placed on a ledge inside a dummy television screen next to the video screen, the food items alternating with the neutral objects, and 20 female patients with anorexia nervosa and 20 female controls matched for age were asked to adjust the size of the video recording to that of the real object. Although there was no overall difference in perceptual accuracy between patients and controls, both groups perceived the food items as being bigger than the neutral objects, the patients exaggerating the size of the food significantly more than the controls. These results imply that patients with anorexia might start eating more easily when admitted if their food were presented as small portions on large plates.

An open study of the safety and efficacy of enoxacin in complicated urinary tract infections

Thirty-one patients with serious or complicated urinary tract infections were treated with oral enoxacin for between four and eight days. Twenty-five patients with microbiologically confirmed infections completed treatment with 400 mg enoxacin twice daily and at the end of treatment all urine cultures were negative. At short term follow-up, five to nine days after therapy, 21 of the 25 patients were still infection free. In total, reinfection or relapse occurred in 12 patients during the four to six weeks follow up period after termination of treatment. Significant side-effects (nausea and vomiting) occurred in only one patient.