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PubMed1993

Medical students' exposure and immunity to vaccine-preventable diseases.

BACKGROUND: This study was conducted to assess medical students' immunity to vaccine-preventable diseases, their exposure to these diseases, and their attitudes toward immunity to vaccine-preventable diseases. METHODS: A cross-sectional, mailed survey was conducted of all 249 senior medical students in the 1991 graduating class at the University of Minnesota, Minneapolis. Two mailings were sent during the autumn of their senior year. RESULTS: The response rate was 77.5%. More than 90% of the students reported that they were immune to measles, mumps, rubella, and hepatitis B but only 23% were immune to influenza. Fewer than half of the students had ever been queried about their immune status prior to clinical clerkships. One third of the students had had a needlestick exposure during their clinical training (including 8% to a known hepatitis B carrier) and only 52% of these were reported by the student. Ten percent to 20% of the students felt that immunity to measles, mumps, and rubella was only somewhat or not very important. Less than one third of the students felt that immunity to influenza was important for themselves as health care providers. CONCLUSION: This study documented inadequate levels of immunity among medical students to certain vaccine-preventable diseases, that exposure to vaccine-preventable diseases was fairly common during clinical training, and that medical students often had inadequate attitudes about immunity to vaccine-preventable diseases. These findings have implications for medical school immunization policies and curriculum content.

Adult↗

PubMed1991

Traditional birth attendants in an endemic area of tetanus neonatorum in Thailand: pitfalls in the control program.

A survey of the characteristics of traditional birth attendants in Krabi Province, Thailand, where the incidence rate of tetanus neonatorum was the highest in the country, was conducted in order to obtain background information necessary for planning a training curriculum and to evaluate previous training courses. Five second year medical students were used as research assistants. After the questionnaire was constructed and tested, the students went to visit a sample of 116 traditional birth attendants (TBAs) to interview them about their personal backgrounds, techniques and practices in delivery and beliefs and attitudes towards midwifery. The study revealed that these TBAs were a mixture of Buddhist and Islamic females whose literacy rate was 53 percent. Ninety-one per cent knew about the availability of an injection for antenatal care at the health center, but only about half knew that it was for tetanus prevention. More than half provided antenatal care at their own home but 85 per cent conducted delivery at the client's home. About eighty per cent of the TBAs claimed that sterilization of instruments was performed. However, dressing of the umbilical cord was done inappropriately using various kinds of powders by about 40 per cent. The majority of TBAs had experience with complicated labors but only 30 per cent were referred, perhaps, due to excessive self-confidence and supernatural beliefs. The trained TBAs possessed a higher level of knowledge of immunization and sterile techniques for cord cutting and dressing of the stumps of the umbilical cord than the untrained group. However, knowledge of sterilization of instruments was not significantly different, indicating a need to improve teaching in this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Asepsis↗

PubMedDate not supplied

Evaluation of cold chain system in Chandigarh during PPI campaign 2001-2002.

OBJECTIVE: To evaluate the maintenance of cold chain system (CCS) in intensified pulse polio immunization (IPPI) programme, during December 2001 and January 2002 in Union Territory (UT) Chandigarh. MATERIALS & METHODS: A Cross sectional time bound study was conducted in seven centres, where OPV vials were stored prior to IPPI and 20 IPPI Booths in UT, Chandigarh. Booths were selected by stratified random sampling technique. The status of cold chain equipments was assessed at headquarter of IPPI, 6 regional (distribution) centres, 20 IPPI posts and 5 house to house teams. RESULTS: The cold chain sickness rate was found to be 9.7% in January, 2002. There were reports of breakdown of cold chain maintenance due to defective plugs and sockets, faults in thermostat, leakage of gas. But all vaccine samples picked up randomly were reported potent, as per the test reports provided by Central Research Institute (CRI), Kasauli during the period of study. OBSERVATION & DISCUSSION: Temperature charting and cold chain maintenance was found satisfactory, but necessity of improvement, specially regarding the handling of vaccines by the female health worker. Lids of vaccine carriers not closed tightly, frequent opening of lids during immunization, direct exposure of vaccine to atmospheric temperature, keeping the vaccine vial in hand or pocket. More emphasis is to be given on maintenance of cold chain system in orientation training programme of all Health functionaries before the Intensified Pulse Polio Immunization (IPPI) programme.

Cryopreservation↗

PubMed1997

Exercise immunology: practical applications.

During the last 95 years, 629 papers (60% in the 1990s) dealing specifically with exercise and immunology have been published. Major findings of practical importance in terms of public health and athletic endeavor include: (a) In response to acute exercise (the most frequently studied area of exercise immunology), a rapid interchange of immune cells between peripheral lymphoid tissues and the circulation occurs. The response depends on many factors, including the intensity, duration, and mode of exercise, concentrations of hormones and cytokines, change in body temperature, blood flow, hydration status, and body position. Of all immune cells, natural killer (NK) cells, neutrophils, and macrophages (of the innate immune system) appear to be most responsive to the effects of acute exercise, both in terms of numbers and function. In general, acute exercise bouts of moderate duration (< 60 min) and intensity (< 60% VO2max) are associated with fewer perturbations and less stress to the immune system than are prolonged, high-intensity sessions. (b) In response to long-term exercise training, the only finding to date reported with some congruity between investigators is a significant elevation in NK cell activity. Changes in the function of neutrophils, macrophages, and T and B cells in response to training have been reported inconsistently, but there is some indication that neutrophil function is suppressed during periods of heavy training. (c) Limited data suggest that unusually heavy acute or chronic exercise may increase the risk of upper respiratory tract infection (URTI), while regular moderate physical activity may reduce URTI symptomatology. (d) Work performance tends to diminish with most systemic infectious, and clinical case studies and animal data suggest that infection severity, relapse, and myocarditis may result when patients exercise vigorously. (e) Although regular exercise has many benefits for HIV-infected individuals, helper T cell counts and other immune measures are not enhanced significantly. (f) Data suggest that the incidence and mortality rates for certain types of cancer are lower among active subjects. The role of the immune system may be limited, however, depending on the sensitivity of the specific tumor to cytolysis, the stage of cancer, the type of exercise program, and many other complex factors. (g) As individuals age, they experience a decline in most cell- mediated and humoral immune responses. Two human studies suggest that immune function is superior in highly conditioned versus sedentary elderly subjects. (h) Mental stress, undernourishment, quick weight loss, and improper hygiene have each been associated with impaired immunity. Athletes who are undergoing heavy training regimens should realize that each of these factors has the potential to compound the effect that exercise stress is having on their immune systems.

Aging↗

PubMed1989

The influence of regular physical activity on the cell-mediated immunity in pigs.

The influence of moderate regular physical activity on the cell-mediated immunity was studied in growing pigs. Ten animals were subjected to physical training on a large animal treadmill, and 10 were kept in their pens throughout a 12-week experimental period. Regardless of whether the pigs underwent training or not, a whole blood lymphocyte stimulation test performed at 3 stages of the experiment revealed an equal ability of the cells to respond to stimulation induced by pokeweed mitogen and phytohaemaglutinin. The influence of serum from the pigs of the trained and untrained groups was studied in a stimulation test with purified mononuclear cells obtained from 2 healthy control pigs. The results indicated that no additional serum factors released by the physical training altered the blastogenic response of these lymphocytes. It is concluded that moderate exercise should not be regarded as a stressor which alters the cellular immunity in pigs.

Animals↗

PubMed2006

Lipopolysaccharide and interleukin-1beta decrease sucrose intake but do not affect expression of place preference in rats.

Immune system activation has been shown to induce decreased interest in pleasurable stimuli. Studies of this phenomenon have assessed the effect of cytokines or lipopolysaccharide (LPS) on behavior maintained by primary reinforcers, stimuli, such as palatable solutions, that effectively reinforce behavior without prior training. The studies reported in this paper replicated findings of immune system activation decreasing intake of a palatable solution and assessed the effects of immune activation on behavior maintained by a conditioned reinforcer, a stimulus paired with a the palatable solution. Using a conditioned place preference procedure, the effects of LPS and interleukin-1beta (IL-1beta) on sucrose intake (primary reinforcer) and preference for a sucrose-paired environment (conditioned reinforcer) were tested. LPS and IL-1beta decreased sucrose intake but had no effect on the expression of a sucrose-induced place preference, indicating a differential effect of immune system activation on appetitive behaviors maintained by primary and conditioned reinforcers. Finally, it was shown that a sucrose-induced place preference is sensitive to the motivational state of the subjects at the time of testing; a sucrose-induced place preference was demonstrated if rats were tested when water deprived but not if tested after free access to water.

Animals↗

PubMed1994

Prenatal tetanus immunization and other practices associated with neonatal tetanus.

The relationship between neonatal tetanus (NT) on one hand, and maternal tetanus immunization and other prenatal and natal practices on the other hand, was examined in a case-control study done at San Lazaro Hospital (SLH) in Manila from late 1990 to mid 1991. Included as cases were 54 patients diagnosed as NT on the basis of WHO criteria, and 50 controls who were patients 0-4 months of age, hospitalized at SLH during the study period and with no past history of tetanus. The result showed that the following were statistically associated with the risk of NT: home delivery (OR = 30.5); delivered by a traditional birth attendant (OR = 5.2); use of instrument other than scissors to cut the cord (OR = 19.3); traditional birth attendant who dressed the cord (OR = 12.7); and having less than two doses of tetanus toxoid (OR = 15.3). The need to intensify prenatal tetanus immunization, health education of the mothers as well as the training of birth attendants is evident from this study if NT has to be prevented.

Case-Control Studies↗

PubMedDate not supplied

A practical guide to establishing vaccine administration services in community pharmacies.

OBJECTIVE: This article describes requisite components of a community pharmacy-based vaccine administration program and provides resources for obtaining training and materials to facilitate implementation in the pharmacy. DATA SOURCES: Published medical literature accessed via Medline; interviews of pharmacists who initiated vaccine administration programs; government publications; professional publications including manuals and newsletters; and the resources of the Washington State Board of Pharmacy. DATA SYNTHESIS: Pharmacists in several states have initiated vaccine-administration programs for adults, adolescents, and children within their pharmacies with acceptance by patients, third party payers, and other health professionals. In some states, collaborative prescribing agreements between physicians or nurse practitioners and pharmacists enable pharmacists to implement high-volume immunization clinics as well as individual patients services. Standardized training is available from several sources, and in most settings vaccine administration services can be implemented with low initial investment. CONCLUSION: Vaccine administration may soon become an integral function in community pharmacists responsibilities for the health and well-being of patients.

Adolescent↗

PubMed1994

Potential impact of physical activity and sport on the immune system--a brief review.

Description is given of methods that can evaluate the main functional elements of the immune system. Acute responses to exercise depend on the intensity and duration of the required activity relative to the individual's fitness level. Moderate endurance exercise causes either no change or an enhancement of such indices as total leucocyte count, granulocyte, monocyte, lymphocyte and natural killer cell count, total T cell count, helper:suppressor cell ratio, cell proliferation in response to mitogens, serum immunoglobulin levels, and in vitro immunoglobulin production. However, exhausting exercise tends to produce adverse changes in these same indices, particularly if the physical activity is accompanied by environmental or competitive stress. Moderate, appropriately graded training reduces reactions to any given absolute intensity of exercise. When pursuing a more demanding training regimen, it is important that the exerciser optimize immune responses. If athletic preparation is pursued to the level of staleness and/or muscle damage, it can have substantial negative implications for many aspects of immune function, including resistance to acute infections, HIV infections, ageing, cancer and other conditions influenced by the immune system.

Antibody Formation↗

PubMed2000

Exercise immunology: future directions for research related to athletes, nutrition, and the elderly.

This article examines three questions related to exercise immunology: 1) Can exercise attenuate changes in the immune system related to aging? The few research papers available suggest that the answer may be "yes", but exercise training may have to be long-term and of sufficient volume to induce changes in body weight and fitness before any change in immunity can be expected in old age. 2) Is the athlete an immunocompromised host? For most athletes, probably not, although the answer may be 'yes' during certain periods when the athlete exceeds normal training limits or competes in endurance events. Most studies have reported that the immune systems of athletes and nonathletes in the resting state are more similar than disparate with the exception of natural killer cell activity which tends to be elevated in athletes. Infection risk may be more related to the acute changes in immunity that occur following heavy exercise, but this hypothesis has not been sufficiently studied. 3) Are nutrition supplements effective countermeasures to exercise-induced inflammation and immunosuppression? Except for carbohydrate, the answer at this time for all other nutrients studied is 'no'. While data from the vitamin and mineral studies have been negative, and those involving glutamine conflicting, several investigations indicate that carbohydrate compared to placebo ingestion is associated with attenuated hormonal and immune responses.

Aged↗

PubMed1993

Relaxation training and psychoimmunological status of bereaved spouses. A pilot study.

The death of a family member is one of the most stressful and disruptive life events. Although the literature abounds with subjective pieces concerning bereavement, little is known about the complex biological processes that follow in its wake. However, there is a growing body of evidence that psychological distress may compromise immunocompetence and that support strategies may enhance immune function. Our exploratory study examined the influence of relaxation training on the immunological and psychological status (including anxiety and depression) of bereaved spouses. Nine female spouses, all survivors of patients who died from cancer, were recruited from two hospice programs to participate in this relaxation-training program. Standardized psychological instruments and immunological assays were completed at three data-collection points: before the initiation of the relaxation training (approximately 6 weeks after the death of the spouse); at the conclusion of the training; and 4 weeks after the relaxation training. The subjects received a 1-h relaxation-training program weekly for 4 weeks. It included progressive muscle relaxation training and guided imagery supervised by a psychiatric nurse clinical specialist. The results indicated that the relaxation-training program was well-received by the subjects, with promising psychoimmunological trends that merit more rigorous investigation. This exploratory study has demonstrated the feasibility of conducting a relaxation-training intervention for bereaved spouses and has laid the foundation for continuing research to study the physiological and psychological responses of the bereaved.

Adult↗

PubMed2000

Qualitative study of clinic staff members' experiences using an immunization registry.

OBJECTIVES: To examine individual clinic staff members' experiences with using an immunization registry and to compare staff members' perceptions of immunization registries across different provider sites. DESIGN: Cross-sectional survey using in-depth interviews and direct observation. SETTINGS: The pediatric department of an urban community health center and 2 urban hospital-based pediatric primary care clinics. PARTICIPANTS: Twenty-five subjects were recruited using maximum variation sampling at each site. The subjects included clerks, clinic assistants, licensed practical nurses, a nurse practitioner, and registered nurses. MAIN OUTCOME MEASURES: Clinic staff members' perceptions of an immunization registry and frequency of registry use. RESULTS: Differences were observed in subjects' perceptions of an immunization registry across provider sites. Although most subjects had positive attitudes toward the registry, they did not necessarily believe that the registry decreased their workload. The ability to access immunization registry data and actual use of the registry seem to be related to training of clinic personnel, location of the registry terminal, and helpfulness and availability of registry staff. CONCLUSION: Obtaining the opinions of immunization registry users is an important strategy to evaluate the usefulness of a registry in a site and target possible areas for improvement.

Attitude to Health↗

PubMed1998

Temporary suppression of cell-mediated immunity in standardbred horses with decreased athletic capacity.

Eighty Standardbred horses, originating from 5 training campuses, with decreased athletic performance in association with symptoms such as intermittent fever and mild pharyngitis were examined. As control animals, 10 horses from a stable with normally performing horses were used. Virus isolation and clinico-chemical and serological tests were performed. Lymphocyte proliferation tests were carried out to evaluate the capacity of the cell-mediated immunity. In addition, a bioassay for equine type I interferon, as a marker for early viral infections, was established. No specific microbe could be linked to these symptoms, but there was a temporary suppression of the cell-mediated immunity, which might be explained by the serological evidence of an EHV-2 and/or rhinovirus infection.

Animals↗

PubMed1997

Exercise, immunology and upper respiratory tract infections.

The literature reveals a paradoxical response of the immune and host defense systems to endurance exercise apparent stimulation following long-term regular training and suppression in response to acute exposure to exhaustive endurance exercise. Several epidemiological surveys have confirmed a clinical manifestation of immunosuppression in the form of increased incidence of upper respiratory tract infection symptoms following participation in competitive marathon and ultramarathon running events. Prerace training status and racing intensity have been related to the incidence of this symptomatology during the postrace fortnight. Nutritional intervention studies have shown the antioxidant nutrient, vitamin C, to be effective in reducing the incidence of upper respiratory tract infection symptoms following competitive distance events. Laboratory studies have revealed this vitamin to be the first line of defense in neutralizing the auto-oxidative activity of phagocytes. It is hypothesized that exercise-induced neuroendocrine stimulation of the oxidative burst in neutrophils increases the rate of release of reactive oxygen species and that these are, in turn, neutralized by high plasma ascorbate levels. Enhancing intrinsic antioxidant defense by increasing exogenous antioxidant intake is thus theorized to be of long-term benefit to serious endurance athletes engaged in heavy training and competition.

Antioxidants↗

PubMed2000

Special feature for the Olympics: effects of exercise on the immune system: modification of immune responses to exercise by carbohydrate, glutamine and anti-oxidant supplements.

Immunosuppression in athletes involved in heavy training is undoubtedly multifactorial in origin. Training and competitive surroundings may increase the athlete's exposure to pathogens and provide optimal conditions for pathogen transmission. Heavy prolonged exertion is associated with numerous hormonal and biochemical changes, many of which potentially have detrimental effects on immune function. Furthermore, improper nutrition can compound the negative influence of heavy exertion on immunocompetence. An athlete exercising in a carbohydrate-depleted state experiences larger increases in circulating stress hormones and a greater perturbation of several immune function indices. The poor nutritional status of some athletes may predispose them to immunosuppression. For example, dietary deficiencies of protein and specific micronutrients have long been associated with immune dysfunction. Although it is impossible to counter the effects of all of the factors that contribute to exercise-induced immunosuppression, it has been shown to be possible to minimize the effects of many factors. Athletes can help themselves by eating a well-balanced diet that includes adequate protein and carbohydrate, sufficient to meet their energy requirements. This will ensure a more than adequate intake of trace elements without the need for special supplements. Consuming carbohydrate (but not glutamine or other amino acids) during exercise attenuates rises in stress hormones, such as cortisol, and appears to limit the degree of exercise-induced immunosuppression, at least for non-fatiguing bouts of exercise. Evidence that high doses of anti-oxidant vitamins can prevent exercise-induced immunosuppression is also lacking.

Antioxidants↗

PubMed1994

Exercise-induced enhancement of immune function in the rat.

BACKGROUND: There have been many anecdotal reports that regular, moderate exercise confers some protective immunity against infection. There has been little scientific evidence to support this. It is also unclear whether training alters lymphocyte trafficking from the spleen to the periphery after a bout of exhaustive exercise. METHODS AND RESULTS: To determine the effect of moderate training on in vivo antibody production, using rats as an animal model, we gradually trained 18 rats using a swimming protocol for a 4-week period after injection and booster with Keyhole limpet hemocyanin antigen. There were 9 age-matched controls. At the conclusion of training, both groups underwent a short-term exhaustive swim. The trained group showed marked enhancement of IgM and IgG production. After short-term exercise, both groups had acute lymphocytosis, mainly T(suppressor)/cytolytic and natural killer cells with decreases in T(helper) (trained), B cells, and the Th-to-Ts ratio. The changes in the splenocyte subsets were the opposite of the changes in the peripheral blood. With respect to function, after exhaustive exercise, there was a slight increase in mitogenesis and interleukin-2 receptor expression to concanavalin A (untrained more than trained) compared with controls. CONCLUSIONS: Regular, moderate training enhances antibody production to specific de novo antigen both early and late. In addition, short-term exercise leads to selective release of immune cells from the spleen and results in slightly enhanced function of splenocytes. Direct stimulation by the sympathetic nervous system and catecholamines is the proposed mechanism for the changes seen after short-term exercise and possibly antibody production during training.

Animals↗

PubMed2002

Factors influencing immunization status in primary care clinics.

BACKGROUND AND OBJECTIVES: National standards and goals for childhood immunization rates are well established. Yet, despite clear standards and goals, physicians do not achieve the desired rate (90%) for immunization coverage. This study examined factors related to immunization status for 2-year-old children in pediatric and family practice settings. METHODS: Specially trained personnel used computer software to audit 2,552 records from 42 practices in Northeast Florida throughout 1997-1999. Immunization records were judged as either complete or incomplete, and factors related to immunization status were studied. Clinic type and 18 immunization practice standards were reviewed for effect on immunization status. RESULTS: The probability of complete immunization status for children in pediatric clinics was greater than for those in family practice clinics. Multivariate logistic regression revealed that use of semiannual audits (odds ratio [OR]=2.00, confidence interval [CI]=1.65-2.42) was the most important factor for immunization completion. This was followed by availability of discounted immunizations (OR=.44, CI=.27-.73) and the use of an immunization tracking system (OR= 1.48, CI= 1.18-1.70). Factors that were not found to contribute included clinic type and the remaining 15 practice standards. CONCLUSIONS: Considering the significant factors, immunization status was not affected by the type of clinic providing immunizations. Based on this analysis, family physicians should implement tracking systems and should perform semiannual audits to match the success of pediatricians in immunizing children. Neither group met nationally established goals for administration of immunizations for 2-year-old children.

Child Health Services↗

PubMed1995

[The ultramicroscopic characteristics of the cells of the thymus and of the inguinal lymph nodes in white rats subjected to intensive physical loading after preliminary training and without it].

Single physical load (fifty minutes long swimming with further increase) causes destructive changes in the immune system organs, demonstrated on the cellular level--increase of perinuclear space, appearance of vacuoles in the cell cytoplasm and destruction of mitochondria cysts. Five weeks long preliminary training of the animals with six times a week use of continuously increasing physical loads contributed in appearance of lymphocytes with altered shape of the nucleus: great number of mitochondria, many with destructed cysts was found. Besides, cells with signs of destruction were demonstrated. The use of the same volume physical load for a more long time during the training and correction of the diet with vegetable products, containing biologically active substances helped to prevent unfavorable changes on the cellular level.

Animals↗