Development of a competency framework for general practitioners with a special interest in musculoskeletal/rheumatology practice.
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Clinical Competence↗
Biomedical subjects
A Campbell
Publications and source records attributed to A Campbell.
Rurality and mental health: an Australian primary care study.
INTRODUCTION: Until recently, there has been a significant gap in the literature exploring the issues of the mental health needs for rural communities in Australia. In this study we investigated the prevalence of diagnosable psychological disorders in both a rural and a non-rural primary care sample in far north Queensland, Australia. METHOD: In a previous study we had screened some 300 GP attendees, on a number of sociodemographic variables and measures of psychological wellbeing, from four rural GP practices and one regional GP practice. Of these, 130 participants agreed to further follow up. In this study, 118 of the participants were selected and contacted by phone to complete the Composite International Diagnostic Interview-Short Form (CIDI-SF). The CIDI-SF diagnosis was then analysed in relation to the sociodemographic indicators that had previously been collected. RESULTS: The prevalence of diagnosable mental health disorders in the rural sample was found to be higher in comparison with the regional urban sample. The sociodemographic factors of rural residence, gender, and length of residence were associated with having a CIDI-SF diagnosis. CONCLUSION: Although there were a number of methodological limitations to this study, there did appear to be a significant relationship between rural location and the likelihood of receiving a CIDI-SF diagnosis. Why this might be the case is not clear, and we consider a number of explanations, but our finding suggests that further research in mental health should consider the issue of rurality as a key feature to be explored.
Adolescent↗
Diuretic-induced hypokalaemia in patients with hypertension.
We describe a 55 year-old woman with longstanding hypertension who developed hypokalaemia following diuretic treatment. Investigations revealed primary hyperaldosteronism due to an adrenal adenoma, and normal blood pressure was restored after surgical removal of the tumour. Primary hyperaldosteronism is a potentially curable cause of hypertension and should be considered in hypertensive patients who present with diuretic - induced hypokalaemia.
Adrenal Cortex Neoplasms↗
Maxillary midline diastema: a case report involving a combined orthodontic/maxillofacial approach.
This paper presents an orthodontic case of a large (14.5 mm) maxillary midline diastema that was related to the presence, and subsequent removal of 2 median maxillary supernumerary teeth and resulting bone loss. A combined orthodontic and maxillofacial approach involving bone grafting and fixed appliances was used to close the space. This episode of care was organized as interceptive treatment during development of the permanent dentition.
Child↗
Cyclooxygenase-2 expression predicts survival in malignant pleural mesothelioma.
The expression of cyclooxygenase 2 (COX-2) protein is increased in many tumours and may be associated with a more aggressive phenotype. We aimed to assess COX-2 expression in a large series of archival mesothelioma specimens. Archival tissue was obtained from 86 malignant pleural mesothelioma samples (histological subtype: 42 epithelial, 28 biphasic and 16 sarcomatoid). Overexpression of COX-2 was detected by immunohistochemical analysis. Positive staining was located in the cytoplasm of malignant tumour cells. Overall 51/86 (59%) tumour sections demonstrated COX-2 overexpression. The frequency varied with histological subtype with 31/42 (73%) of epithelial sections, 14/28 (50%) of biphasic sections and 6/16 (37%) of sarcomatoid sections recorded as positive. Kaplan Meier survival analysis indicated that overexpression of COX-2 was significantly related to improved prognosis (P < 0.001) and was an independent prognostic factor in multivariant analysis. Overexpression of COX-2 protein may confer a survival advantage in mesothelioma patients.
Adult↗
Particulate matter in polluted air may increase biomarkers of inflammation in mouse brain.
The etiology of neurodegenerative disorders is at present unknown. However, many of these disorders are associated with an increase in oxidative and inflammatory events. Although a small percentage of these disorders are familial cases linked to specific genetic defects, most are idiopathic. Thus, environmental factors are thought to play an important role in the onset and progression of such disorders. We have demonstrated that exposure (4 h, 5 days per week for 2 weeks) to concentrated airborne particulate matter increases inflammatory indices in brain of ovalbumin-sensitized BALB/c mice. Animals were divided into three exposure groups: filtered air (control), ultrafine particles, or fine and ultrafine particles. The levels of proinflammatory cytokines interleukin-1 alpha (IL-1alpha) and tumor necrosis factor alpha (TNF-alpha) were increased in brain tissue of mice exposed to particulate matter compared to that of control animals. Levels of the immune-related transcription factor NF-kappaB were also found to be substantially elevated in the brain of exposed groups compared with the control group. These data indicate that components of inhaled particulate matter may trigger a proinflammatory response in nervous tissue that could contribute to the pathophysiology of neurodegenerative diseases.
Air Pollutants↗
Repeat ovum pick-up and in vitro embryo production from adult ewes with and without FSH treatment.
Ovum pick-up (OPU) was performed three times on adult ewes after synchronization with (n = 4) or without (n = 4) FSH treatment to investigate the effects of FSH treatment on the number of ovarian follicles, oocytes recovered, oocyte quality and development in vitro. FSH treatment increased the number of ovarian follicles (85 vs 162) and oocytes recovered (33 vs 91), although recovery rate was similar for ewes with and without FSH (91/162, 56.2% and 33/85, 38.8% respectively). Of the oocytes recovered, those classified as grades I and II were similar between ewes with (78/91, 85.7%) and without FSH treatment (27/33, 81.8%). The number of ovarian follicles was similar after repeated OPU for ewes treated with FSH, but for ewes not treated with FSH the number of ovarian follicles decreased with repeated OPU. The number of oocytes recovered decreased for FSH-treated ewes only, while the oocyte recovery rate and proportion of oocytes classified as grades I and II were not affected by repeated OPU. Oocyte cleavage (46/78, 58.9% and 19/24, 79.2%) and blastocyst formation (35/46, 76.1% and 12/19, 63.2% respectively) were similar for ewes with and without FSH treatment. The number of ovarian follicles varied between ewes (p < 0.05) although the number of oocytes recovered and oocyte development in vitro were similar between ewes.
Animals↗
Chronic exposure to aluminum in drinking water increases inflammatory parameters selectively in the brain.
A link between aluminum (Al) exposure and age-related neurological disorders has long been proposed. Although the exact mechanism by which the metal may influence disease processes is unknown, there is evidence that exposure to Al causes an increase in both oxidative stress and inflammatory events. These processes have also been suggested to play a role in Alzheimer's disease (AD), and exposure to the metal may contribute to the disorder by potentiating these events. Al lactate (0.01, 0.1, and 1 mM) in drinking water for 10 weeks increased inflammatory processes in the brains of mice. The lowest of these levels is in the range found to increase the prevalence of AD in regions where the concentrations of the metal are elevated in residential drinking water (Flaten [2001] Brain Res. Bull. 55:187-196). Nuclear factor-kappaB as well as tumor necrosis factor-alpha (TNF-alpha) and interleukin 1alpha (IL-1alpha) levels were increased in the brains of treated animals. The mRNA for TNF-alpha was also up-regulated following treatment. Enhancement of glial fibrillary acidic protein levels and reactive microglia was seen in the striatum of Al-treated animals. The level of amyloid beta (Abeta40) was not significantly altered in the brains of exposed animals. Insofar as no parallel changes were observed in the serum or liver of treated animals, the proinflammatory effects of the metal may be selective to the brain. Al exposure may not be sufficient to cause abnormal production of the principal component of senile plaques directly but does exacerbate underlying events associated with brain aging and thus could contribute to progression of neurodegeneration.
Aluminum Compounds↗
The effect of copper on the death rate of Salmonella typhimurium DT104:30 in food substrates acidified with organic acids.
AIMS: The objective of this study was to investigate the effect of copper ions on the survival of Salmonella typhimurium DT104:30 in acidified liquid food substrates. METHODS AND RESULTS: The decimal reduction time (Dvalue) of Salm. typhimurium DT104:30 was determined in acidified liquid pig feed (LPF) and skimmed milk (SM) containing a range of copper concentrations (0-50 ppm). As copper concentration increased, the death rate of Salm. typhimurium DT104:30 increased. In LPF acidified with 150 mmol l-1 lactic acid the presence of 50 ppm copper resulted in a 10-fold increase in the death rate. CONCLUSIONS: The presence of copper salts in acidic liquid food substrates significantly increases the death rate of Salm. typhimurium DT104:30. SIGNIFICANCE AND IMPACT OF THE STUDY: This finding could influence policy on levels of copper in pig feed.
Acetic Acid↗
Retardation of brain aging by chronic treatment with melatonin.
Slowing the functional decline in the aging brain is not only relevant to nonpathological senescence but also to a broad range of neurodegenerative diseases. Although disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD) are not found in the young adult, they gradually manifest with increasing age. AD, in particular, is an increasing major public health concern as the population ages; therapies that delay disease onset will markedly reduce overall disease prevalence. Aging of the brain has been repeatedly associated with cumulative oxidative damage to macromolecules and to abnormal levels of inflammatory activity. Melatonin has attained increasing prominence as a candidate for ameliorating these changes occurring during senescence. Recent research has focused on supplementation with dietary melatonin designed to elucidate the specific key intracellular targets of age-related inflammatory events, and the optimal means of affording protection of these targets. This report summarizes the progress made in this area.
Aging↗
Evaluation of herd sampling for Salmonella isolation on midwest and northeast US dairy farms.
Epidemiologic investigations of Salmonella infections in dairy cattle often rely on testing fecal samples from individual animals or samples from other farm sources to determine herd infection status. The objectives of this project were to evaluate the effect of sampling frequency on Salmonella isolation and to compare Salmonella isolation and serogroup classification among sample sources on 12 US dairy farms sampled weekly for 7-8 weeks. Three herds per state were enrolled from Michigan, Minnesota, New York and Wisconsin based upon predefined herd-size criteria. Weekly samples were obtained from cattle, bulk tank milk, milk filters, water and feed sources and environmental sites. Samples were submitted to a central laboratory for isolation of Salmonella using standard laboratory procedures. The herd average number of cattle fecal samples collected ranged from 26 to 58 per week. Salmonella was isolated from 9.3% of 4049 fecal samples collected from cattle and 12.9% of 811 samples from other sources. Serogroup C1 was found in more than half of the samples and multiple serogroups were identified among isolates from the same samples and farms. The percentage of herd visits with at least one Salmonella isolate from cattle fecal samples increased with overall herd prevalence of fecal shedding. Only the three herds with an average fecal shedding prevalence of more than 15% had over 85% of weekly visits with at least one positive fecal sample. The prevalence of fecal shedding from different groups of cattle varied widely among herds showing that herds with infected cattle may be classified incorrectly if only one age group is tested. Testing environmental sample sources was more efficient for identifying infected premises than using individual cattle fecal samples.
Animals↗
Spontaneous pneumothorax: an unusual presentation of rheumatoid arthritis.
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Adult↗
The effect of fermented liquid feeding on the faecal microbiology and colostrum quality of farrowing sows.
This study investigated the effects of fermented liquid feed (FLF) on the lactic acid bacteria (LAB):Coliform (L:C) ratio in the faeces of farrowing sows and the quality of sow colostrum. Eighteen multiparous sows were randomly allocated to one of three dietary treatments for approximately 2 weeks prior to farrowing and for 3 weeks after parturition. The three dietary treatments were dry pelleted feed (DPF), nonfermented liquid feed (NFLF), and fermented liquid feed (FLF). A rifampicin-resistant mutant of Lactobacillus plantarum was used to ferment liquid feed. Coliforms and lactic acid bacteria (LAB) in the faeces of farrowing sows and piglets were estimated by standard microbiological techniques. Intestinal epithelial cells (IEC-6) and blood lymphocytes were used to evaluate the mitogenic activity of colostral samples taken at parturition. Results demonstrated that while the LAB population was not significantly affected by dietary treatment, significant differences in coliform population were observed in the sow faecal samples taken 7 days after parturition. Faeces excreted from sows fed FLF had significantly (P < 0.001) lower numbers of coliforms than sows fed NFLF or DF. Piglets from sows fed FLF excreted faeces that were higher in LAB (7.7 vs. 7.3 log10 CFU g (-1); P < 0.01) and lower in coliforms (7.5 vs. 8.1 log10 CFU g (-1); P < 0.001) than faeces from the piglets of DF-fed dams. Colostrum from sows fed FLF had a significantly greater (P < 0.001) mitogenic activity on both intestinal cells (IEC-6) (79326 +/- 3069 CPM) and blood lymphocytes (1903 +/- 204 CPM) compared with colostrum from dry feed fed sows (53433 +/- 1568 and 1231 +/- 61.4 CPM, respectively). The combined effects of enhanced maternal/passive immunity and the reduction in the level of environmental contamination with faecal pathogens, achieved by FLF, may be important in achieving improved health status for both sows and piglets.
Animal Feed↗
The effect of temperature on the growth and persistence of Salmonella in fermented liquid pig feed.
Two studies were conducted to investigate the effect of temperature on the fate of Salmonella enterica subsp. enterica serovar typhimurium DT104:30 in fermented liquid pig feed. These were (1) by co-inoculation of feed with S. typhimurium DT104:30 and Pediococcus pentosaceus, as the fermenting organism, and (2) by fermenting feed for 48, 72 or 96 h prior to inoculation with S. typhimurium DT104:30. In co-inoculated feed incubated at 20 degrees C, S. typhimurium DT104:30 persisted for at least 72 h. In contrast, in feed incubated at 30 degrees C, no S. typhimurium DT104:30 were detectable 48 h after inoculation. In prefermented feed, S. typhimurium DT104:30 died four to five times faster in feed maintained at 30 degrees C (D(value) 34-45 min) compared with feed maintained at 20 degrees C (D(value) 137-250 min). This was not entirely due to differences in lactic acid concentration as feed fermented for 72 or 96 h at 20 degrees C and feed fermented for 48 h at 30 degrees C contained similar concentrations of lactic acid (160-170 mM). Low numbers of S. typhimurium DT104:30 were still detectable in fermented feed 24 h after inoculation at 20 degrees C. In contrast, none were detectable 6-7 h after inoculation at 30 degrees C. The results of these studies indicate that it would be advisable for pig producers to control the temperature of liquid feed tanks to reduce the risk of Salmonella contamination.
Animal Feed↗
In vitro evaluation of dental bonding agents using shear and vibrational methods.
OBJECTIVE: To determine the suitability of two mechanical test methods for the in vitro evaluation of dental bonding agents. METHODS: The first method was the Iosipescu shear test in which a pure shear stress is induced in a notched beam sample, and the second was a multilayer vibrating reed test in which the effectiveness of bonding could be assessed by the magnitude of relative elastic modulus and mechanical damping factors. The tests were applied to bonded samples of high-copper amalgam, gallium alloy and composite resin with two different types of adhesive. Representative data is presented to show the capabilities of the test methods. RESULTS: Both methods were shown to generate more consistent data with lower scatter than that usually reported in this field. Each may be used to provide information of clinical relevance. CONCLUSION: With further development, these test methods could make a useful contribution to the assessment of dental bonding agents.
Composite Resins↗
Cetirizine and levocetirizine inhibit eotaxin-induced eosinophil transendothelial migration through human dermal or lung microvascular endothelial cells.
BACKGROUND: Several second-generation antihistamines have documented anti-inflammatory effects which appear independent of H1-receptor blockade. We investigated the inhibitory effect of cetirizine and its active enantiomer levocetirizine on eosinophil transendothelial migration (TEM) through monolayers of normal human dermal microvascular endothelial cells (HMVEC-d) or human lung microvascular endothelial cells (HMVEC-l). METHODS: HMVEC-d or HMVEC-l were grown to confluence on micropore filters in transwells inserted into a 24-well tissue culture dish. Eosinophils were isolated by density gradient centrifugation and negative immunomagnetic selection. Untreated eosinophils or eosinophils pre-incubated (30 min at 37 degrees C) with a concentration range of cetirizine or levocetirizine (10-5 to 10-9 m) were added to the upper chamber of the transwell which was incubated for 60 min at 37 degrees C. Both spontaneous eosinophil TEM and TEM to 100 ng/mL of human eotaxin in the lower chamber were assessed. RESULTS: Between 8 and 10% of the eosinophils added to the upper chamber underwent spontaneous TEM through HMVEC-d or HMVEC-l. The addition of eotaxin to the lower chamber enhanced eosinophil TEM through HMVEC-d or HMVEC-l monolayers to over 20%, i.e. an enhanced TEM of approximately 100% in each case. Pre-incubation of eosinophils with cetirizine or levocetirizine dose-dependently inhibited eosinophil TEM to eotaxin through both HMVEC-d or HMVEC-l with total inhibition of eotaxin-induced TEM observed at 10-8 m for HMVEC-d and 10-7 m for HMVEC-l. Both drugs gave a reduced but significant inhibition of eosinophil TEM at lower concentrations. No concentration of cetirizine or levocetirizine had any significant effect on expression of CD11b, CD18 or CD49d by either resting or eotaxin-stimulated eosinophils. Furthermore, no effect on spontaneous eosinophil TEM, or eosinophil viability was seen with any concentration of cetirizine or levocetirizine. CONCLUSION: Levocetirizine inhibits eotaxin-induced eosinophil TEM through both dermal and lung microvascular endothelial cells suggesting that, like cetirizine, levocetirizine has potential anti-inflammatory effects.
Acetates↗
Sleep disorders: a potential role in New Zealand motor vehicle accidents.
BACKGROUND: The potential role of sleep disorders in New Zealand motor vehicle accidents (MVA) has not been systematically studied. AIMS: To trial a recruitment method and document the frequency of sleep disorders in drivers attending an emergency department with injury following MVA. METHODS: Injured drivers admitted to Wellington Hospital Emergency Department were prospectively recruited by letter and follow-up telephone call. Data from a traffic accident, health and sleep questionnaire and polysomnography were collected and analysed using the SPSS statistical package. RESULTS: Of 120 eligible drivers, 40 (33%) completed the study protocol. The mean age of participants was 44 +/- 17 years. Non-participants were younger (mean age 33 +/- 14 years, P < 0.01) and more often of Asian or Pacific Island ethnicity (P < 0.01). Twenty-seven (67%) felt unrefreshed on waking and 10 (25%) had an elevated Epworth Sleepiness Score (> 10/24). Six (15%) felt drowsy or fell asleep prior to the accident. Sleep disorders were common (40%): obstructive sleep apnoea 14 (35.9%), periodic limb movements of sleep three (7.7%), sleep restriction (< 6 h sleep on a regular basis) five (12.5%), and insomnia one (2.5%). CONCLUSIONS: Daytime somnolence and sleep disorders were commonly found in drivers attending the Emergency Department after accidents resulting in injury. Driver fatigue and sleep disorders should be considered as a potential contributing factor in New Zealand MVAs. Recruitment of drivers following a MVA via the Emergency Department is challenging. Strategies to improve recruitment are discussed.
Accidents, Traffic↗
Regulation of E-cadherin expression by dexamethasone and tumour necrosis factor-alpha in nasal epithelium.
Asthma and rhinitis often coexist and share many clinical features. The extent of epithelial alteration in nasal inflammation is controversial. Cell-cell adhesion plays an important role in tissue morphogenesis and homeostasis and is mediated by the cadherin family. In human bronchial epithelial cells the authors have shown that tumour necrosis factor (TNF)-alpha induced a significant decrease of E-cadherin and beta-catenin expression. The addition of dexamethasone inhibited this decrease. The aim of the present study was to investigate the effect of TNF-alpha and dexamethasone on the regulation of E-cadherin, gamma-catenin and beta-catenin in human nasal epithelial cells (HNEC). A primary culture of HNEC, obtained from human nasal turbinates after surgery, was used. The quantitative and qualitative modulation of E-cadherin, gamma-catenin and beta-catenin expression was assessed by Western blot and immunofluorescence analysis. In order to assess the TNF-alpha-induced activation of HNEC, interleukin-8 and RANTES (regulated on activation, normal T-cell expressed and secreted) release was assessed by enzyme-linked immunosorbent assay. The results showed that TNF-alpha induced, a decrease in gamma-catenin and beta-catenin expression, but had no effect on E-cadherin expression. Immunofluorescence showed that TNF-alpha induced cytoplasmic localisation of E-cadherin, gamma-catenin and beta-catenin. Dexamethasone inhibited the effect of TNF-alpha and induced a three-fold increase in E-cadherin expression. These results suggest that the difference in nasal and bronchial epithelial cohesion may be due to the differential effect of tumour necrosis factor-alpha and dexamethasone on E-cadherin expression.
Blotting, Western↗