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PubMedDate not supplied

AIDS and prehospital personnel: knowledge and prevention of occupational exposure.

OBJECTIVES: Prehospital personnel, including law enforcement officers, paramedics, and fire-fighters, may be exposed to the human immunodeficiency virus (HIV) while working. This study of prehospital personnel sought to determine: 1) their knowledge of the acquired immune syndrome (AIDS) and HIV transmission; 2) the extent of AIDS training received; 3) self-assessment of risk for HIV infection; and 4) precautions adopted to reduce occupational risk of exposure to HIV. METHODS: A survey was administered to pre-hospital personnel in a large Southern California jurisdiction. The response rate was 41% (n = 1,756) in 10 city and county departments where respondents were employed. Law enforcement officers (44%), firefighters (44%), and paramedics (12%) comprised the sample. RESULTS: Respondents had accurate knowledge about AIDS, but incorrect perceptions about HIV transmission. A minority believed that HIV could be contracted from casual contact. Training relating to AIDS was not frequent. Preventive practices were infrequent in the work setting, with precautions used less than 50% of the time on eight of 10 measures. One-third of these prehospital personnel assessed their risk for HIV infection as medium to high, largely attributable to fear of occupational exposure. CONCLUSIONS: Improved educational programs regarding HIV/AIDS are needed for prehospital personnel to increase the use of preventive occupational practices in the field.

AIDS Serodiagnosis↗

PubMed1981

Immunological responses to training in conditioned runners.

1. We measured the concentrations of leucocyte subpopulations, immunoglobulins and complement in six well-conditioned runners before and after a typical 8-mile (12.8 km) training run at 70-75% of VO2 max. 2. Before running all components were within the normal range. Exercise failed to produce a significant rise in neutrophils. There was also no change in immunoglobulins or complement concentrations immediately or 24 h after exercise. Lymphocyte subpopulations were also unchanged except for a progressive rise in antibody-dependent cytotoxic effector cells (K-lymphocytes). 3. These results suggest chronic exercise training has no apparent adverse effect on circulating cellular or humoral immune components in healthy subjects. An increase in K-lymphocytes may provide added host defence capacity during periods of stress, although the mechanism of increase is unexplained.

Adult↗

PubMed1994

Using lot quality assessment techniques to evaluate quality of data in a community-based health information system.

We report here on the application of lot quality assessment (LQA) techniques by managers of a Save the Children (SC) Child Survival Project in Mbalachanda, Malawi, to evaluate data contained in a community-based health information system. By defining 'lots' as the health records for all households with children under 5 years old which were listed on the rosters of village health promoters supervised by a given community health supervisor, and by establishing criteria for 'acceptability' of samples drawn from these lots, we were able to identify and offer additional supervision to health workers (supervisors as well as village health promoters) who were not performing adequately. As LQA sampling procedures require that only a small sample be drawn from each lot, the assessment could be conducted easily and quickly. Health workers were found to have the greatest need for help in updating demographic data and information about home-based oral rehydration therapy (ORT) training sessions, and the least for help in recording children's immunization status. We conclude that LQA can be a useful supervisory tool for health programme managers.

Child Health Services↗

PubMedDate not supplied

Current opportunities and future challenges in child health in Papua New Guinea.

Papua New Guinea (PNG) is at a crossroads in child health care. We know how to treat or prevent most of the diseases causing child and maternal mortality, but we are failing to deliver the services to where most of the people are dying. There is much to be learnt from early achievements in the development of health services in PNG. Between the 1950s and 1970s the infant mortality rate fell from 250-500 per 1000 livebirths to 77-100 per 1000 livebirths. This occurred predominantly because of an emphasis on public health programs and cost-effective standard treatment. Now the public health services have deteriorated, vaccine coverage is poor and health workers are not fully using the standard treatment resources available to them. The greatest academic and practical challenges facing medicine in PNG are to implement effective and consistent delivery of vaccines, and nutritional, basic curative and maternal care to remote or impoverished communities. The other unmet prerequisites for improvement in health status are that communities participate in and take some responsibility for their health care needs. There are now unprecedented opportunities for collaboration with international partners, churches, non-government organizations and community groups to achieve these goals. Specific key strategies in child health include the more widespread utilization of the 10-Step Checklist, adoption of some of the World Health Organization Integrated Management of Childhood Illness strategies, increased output of child health nursing training, improving vaccine delivery and cold-chain services, and new immunization strategies for acute respiratory infections. The National Health Plan 2001-2010, launched in August 2000, emphasizes the vital importance of public health; the need for greater access to quality health services; improving clinical skills among health workers at all levels; and cooperation between all interested parties. By 2010 the National Health Plan must be judged not on how good the plan seemed on paper, but on whether there was a measurable reduction in maternal and child mortality over the first decade of this century.

Child↗

PubMed2006

Therapeutic benefits of Tai Chi exercise: research review.

The majority of studies on Tai Chi conducted between 1996 and 2004 had focused on health and well being of Tai Chi exercise for senior adults. The results show that Tai Chi may lead to improved balance, reduced fear of falling, increased strength, increased functional mobility, greater flexibility, and increased psychological well-being, sleep enhancement for sleep disturbed elderly individuals, and increased cardio functioning. Wang, Collet, and Lau did a systematic review on Tai Chi research and found some limitations or biases existing in some of the studies, and it was difficult to draw firm conclusions about the benefits reported. Therefore, more well-designed studies are needed in the future. There need to be studies on the effects on younger and middle-aged people. More longitudinal studies are needed, since time is an important factor of physical and psychological interventions. Studies on the effects of Tai Chi on the immune system and bone loss reduction are still very exploratory and will be especially useful for arthritis patients and others with immune disorders. Future studies should investigate outcomes associated with Tai Chi training as a function of different instructional techniques, different Tai Chi styles, different diagnostic groups, and different age groups. It is not yet clear which of the components in Tai Chi makes the exercise form especially effective for seniors. Tai Chi exercise is a relatively "low tech" approach to preventing disability and maintaining physical performance in older adults. The positive effects of Tai Chi may be due solely to its relaxing, meditative aspects. The current data suggest that Tai Chi can influence older individuals' functioning and well being and provide some appreciation for why this exercise form has been practiced by older Chinese for more than 3 centuries.

Accidental Falls↗

PubMedDate not supplied

Responding to child sexual abuse: the need for a balanced approach.

This article suggests a number of improvements in the reporting and investigation of child sexual abuse cases. The article begins with a reminder that our eagerness to protect children cannot be allowed to overcome our nation's commitment to fairness and due process. For both the alleged perpetrator and the child victim, much is at stake in these cases, and our system must strike a balance to protect the rights of both. Currently there is a problem with both underreporting of suspicions of child abuse and overreporting of cases that are unfounded or cannot be substantiated. Several recommendations are made to make reporting more accurate. These include: clarify reporting laws, expand and improve training for reporters, develop agency policies regarding reporting, modify liability and immunity rules, improve efforts at screening reports, and provide feedback to reporters. Finally, the article discusses the importance of interviewing children and offers some techniques for doing so properly. Issues of interpreting physical and behavioral signs of abuse are also discussed, and the importance of accurate record keeping is emphasized.

Child↗

PubMed1997

Evaluation of an algorithm for integrated management of childhood illness in an area of Kenya with high malaria transmission.

In 1993, the World Health Organization completed the development of a draft algorithm for the integrated management of childhood illness (IMCI), which deals with acute respiratory infections, diarrhoea, malaria, measles, ear infections, malnutrition, and immunization status. The present study compares the performance of a minimally trained health worker to make a correct diagnosis using the draft IMCI algorithm with that of a fully trained paediatrician who had laboratory and radiological support. During the 14-month study period, 1795 children aged between 2 months and 5 years were enrolled from the outpatient paediatric clinic of Siaya District Hospital in western Kenya; 48% were female and the median age was 13 months. Fever, cough and diarrhoea were the most common chief complaints presented by 907 (51%), 395 (22%), and 199 (11%) of the children, respectively; 86% of the chief complaints were directly addressed by the IMCI algorithm. A total of 1210 children (67%) had Plasmodium falciparum infection and 1432 (80%) met the WHO definition for anaemia (haemoglobin < 11 g/dl). The sensitivities and specificities for classification of illness by the health worker using the IMCI algorithm compared to diagnosis by the physician were: pneumonia (97% sensitivity, 49% specificity); dehydration in children with diarrhoea (51%, 98%); malaria (100%, 0%); ear problem (98%, 2%); nutritional status (96%, 66%); and need for referral (42%, 94%). Detection of fever by laying a hand on the forehead was both sensitive and specific (91%, 77%). There was substantial clinical overlap between pneumonia and malaria (n = 895), and between malaria and malnutrition (n = 811). Based on the initial analysis of these data, some changes were made in the IMCI algorithm. This study provides important technical validation of the IMCI algorithm, but the performance of health workers should be monitored during the early part of their IMCI training.

Algorithms↗

PubMed2005

Exploiting receptor biology for oral vaccination with biodegradable particulates.

The effective delivery of antigens via the oral route is an extremely desirable goal. Mucosal delivery of antigens stimulates mucosal and systemic immunity without affecting maternal antibodies and reduces the need for sterile needles or trained personnel. To date, there are very few commercially available oral vaccines and despite numerous reports in the scientific literature to show the success of biodegradable antigen carriers, none of these have achieved commercial status. Nevertheless, many studies have shown the great potential of biodegradable antigen carriers for oral vaccination in preclinical studies, but a more rational approach may be to specifically target antigen-loaded biodegradable microspheres to cells in the mucosal immune system which transport and process antigens for T cell recognition. Modern cell and molecular biology techniques have unearthed a wealth of information regarding important receptors involved in the capture of luminal antigens by microfold or membranous (M) cells and receptors on dendritic cells (DCs) which may allow future targeting of antigens to specific DC phenotypes, thus directing the immune response appropriately. In this review, we consider the use of currently available biodegradable antigen carriers and speculate on how these may be improved to more efficiently target mucosal effector sites.

Administration, Oral↗

PubMed2002

Nutritional status, iron-deficiency-related indices, and immunity of female athletes.

Nutritional status, iron-deficiency-related biochemical indices, and immunologic patterns of female Judo athletes and control subjects were evaluated. The subjects' 3-d food records showed that 41.0 kcal/kg of energy was consumed daily and the contributions of protein, fat, and carbohydrate to total energy intake were 12.5%, 29.2%, and 58.3%, respectively. The reported vitamin intakes of athletic subjects were above those of the recommended daily allowance, however, calcium and iron intakes were less than 100% of the recommended daily allowance. Intakes of energy, protein, phosphate, vitamin B1, and vitamin B2 were higher in the athletes than in the control subjects. Analysis using the Nutrient Adequacy Ratio and the Index of Nutritional Quality showed that athletic subjects had more desirable patterns than the control subjects. There was no any indication of anemia, which often occurs as a result of hemodilution in strenuously trained athletes. The subjects' immunologic patterns showed a slight immunosuppression. Iron, vitamin B1, niacin intakes were positively correlated with immunoglobulin (Ig) G levels in the athletes. The relation between nutrient intakes and the immune systems of endurance-trained athletes needs further investigation.

Adult↗

PubMed2026

Endurance training attenuates acute exercise-induced monocyte transcriptomic responses in adolescents: sex-specific molecular adaptations.

Circulating monocytes contribute to atherogenesis and vascular dysfunction. Although clinical cardiovascular disease presents in adulthood, its biological origins often begin in youth and differ substantially between females and males. Twelve males and nine females (13-17 yr) completed an acute exercise protocol consisting of 10, 2-min cycling bouts at 70% of maximal work rate interspersed with 1-min rest intervals, performed before and after an 8-wk supervised endurance training intervention with brief supplementary strength work (60 min/session, 3 sessions/wk). Blood was collected before and immediately after each exercise challenge. Peripheral blood monocytes were isolated, and whole transcriptome RNA sequencing (RNA-seq) was performed. Before training, acute exercise induced a markedly greater monocyte transcriptomic response in females compared with males [5,135 vs. 567 differentially expressed transcripts, false discovery rate (FDR) < 0.1]. Pathway analyses identified vascular function-related pathways in males, whereas females showed enrichment of pathways related to adipose tissue cross talk and oxidative metabolism. Following training, the acute transcriptomic response was markedly attenuated in both sexes (165 transcripts in males and 94 in females, FDR < 0.1), representing an ∼98% reduction in females and a ∼70% reduction in males relative to pre-training responses. These findings reveal sex-specific monocyte responses to acute exercise in youth and suggest that endurance exercise alters immune transcriptional responsiveness in pathways relevant to vascular and cardiovascular health.NEW & NOTEWORTHY Acute exercise induced a markedly greater monocyte transcriptomic response in female adolescents than in males. Females showed activation of pathways related to adipose tissue signaling and oxidative metabolism, whereas males exhibited vascular-function pathways. Following exercise training, the monocyte transcriptomic response to acute exercise was substantially attenuated in both sexes. These findings identify sex-specific immune transcriptional responses to exercise during adolescence with potential implications for cardiovascular health.

Humans↗

PubMed1994

Biochemical mechanisms to explain immunosuppression in well-trained and overtrained athletes.

Glutamine is utilized at a high rate by some cells of the immune system (including lymphocytes and macrophages) and is essential for the viability and normal functioning of these cells. Experiments on lymphocytes in vitro showed that the proliferative response of these cells was dependent on the concentration of glutamine and this suggests that a decrease in plasma glutamine concentration could be responsible, at least in part, for the reported impairment of immune function in various conditions. Much of the glutamine that enters the body is utilized by cells of the small intestine, so that muscle is an important source for the plasma glutamine, Hence, the plasma concentration of glutamine represents a "metabolic link" between skeletal muscle and cells of the immune system. Indeed, the flux-generating step of glutamino metabolism in cells of the immune system is considered to be located in skeletal muscle which synthesizes and stores glutamine. The flux generating step is probably the outward transport of glutamine across the plasma membrane. The rate of this transport process and therefore glutamine release from muscle is decreased in conditions associated with a reduction in immune function or activity in the rat such as sustained exercise. The plasma glutamine concentration in man is decreased in a number of pathological conditions, with the largest decrease recorded following major burns. It is also decreased after prolonged exercise (e.g. marathon run) and in the overtrained state. It is suggested, therefore, that sustained physical activity could damage the glutamine release process so that it does not respond adequately to increased glutamine requirement by the immune system.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2006

Immunization to protect the US Armed Forces: heritage, current practice, and prospects.

Americans serving with the US Armed Forces need protection from the dangerous infections that they can contract during training, based on occupation, during overseas deployment, or because of underlying health status. For over 230 years, the military health-care system has immunized troops to protect them personally and to help them accomplish their missions. Military researchers have invented, developed, and improved vaccines and immunization delivery methods against more than 20 diseases. This article consolidates content from several previous historical reviews, adds additional sources, and cites primary literature regarding military contributions and accomplishments. Discussion emphasizes smallpox, typhoid fever, tetanus, influenza, meningococcal disease, adenovirus, yellow fever, pneumococcal disease, and anthrax. Delivery issues include documentation, simultaneous immunization, seroscreening, safety surveillance, jet injection, and cold-chain management. Immunization policies for each major US conflict are described. Military immunization programs need to be individualized on the basis of personal contraindications and prior immunity. The proper conduct of military immunization programs respects the need for detailed education of military personnel, maximizes quality in immunization delivery, and supports quality clinical care to prevent and treat adverse events after immunization. Military immunization programs maintain the health of soldiers, marines, sailors, airmen, and coast guardsmen, the resources most critical to military success.

Bacterial Vaccines↗

PubMed1990

Chiropractors for and against vaccines.

The publications of philosophically conservative chiropractors document their allegiance to a posture of hostile opposition to health prevention based upon immunization procedures. The challenge to medical anthropology is to make sense of what seems scientifically senseless. This paper attempts to come to an understanding of this position by tracing professional attitudes which are derived from a history of political and economic conflict with the American medical establishment, which emanate from an explanatory model of disease causation that preserves a nineteenth century monocausal theory, and which reflect a process of cultural schizmogenesis. In preserving these heretical medical beliefs, conservative chiropractors, who are trained in the basic medical sciences, defend themselves by basing their opposition to immunization upon imperfections in vaccines that relate to the efficacy, safety and necessity of immunizations. Further, they persist in a belief that chiropractic spinal manipulation provides an alternative method for achieving immune status. This belief has not been subjected to testing in clinical trials or laboratory experiments, and thus becomes a matter of belief rather than of scientific verity. A refusal to advocate or submit to vaccines serves conservative chiropractors as an understandable cultural symbol, but it is a symbol with sinister health costs to those who translate it into non-immune status in a world otherwise still hostage to disease-producing organisms.

Attitude of Health Personnel↗

PubMed2000

Treadmill running produces both positive and negative physiological adaptations in Sprague-Dawley rats.

Exercise training produces a vast array of physiological adaptations, ranging from changes in metabolism to muscle mitochondrial biogenesis. Researchers studying the physiological effects of exercise often use animal models that employ forced exercise regimens that include aversive motivation, which could activate the stress response. This study examined the effect of forced treadmill running (8 wk) on several physiological systems that are sensitive to training and stress. Forced treadmill running produced both positive and negative physiological adaptations. Indicative of positive training adaptations, exercised male Sprague-Dawley rats had a decrease in body weight gain and an increase in muscle citrate synthase activity compared with sedentary controls. In contrast, treadmill running also resulted in the potentially negative adaptations of adrenal hypertrophy, thymic involution, decreased serum corticosteroid binding globulin, elevated lymphocyte nitrite concentrations, suppressed lymphocyte proliferation, and suppressed antigen-specific IgM. Such alterations in neuroendocrine tissues and immune responses are commonly associated with chronic stress. Thus treadmill running produces both positive training adaptations and potentially negative adaptations that are indicative of chronic stress. Researchers employing forced activity need to be aware that this type of exercise procedure also produces physiological adaptations indicative of chronic stress and that these changes could potentially impact other measures of interest.

Adaptation, Physiological↗

PubMed1995

Calculating a clinic's childhood immunization rate. Costs and returns.

OBJECTIVE: To analyze the cost of determining the pediatric immunization rate of a family practice clinic. DESIGN: Medical records audit and cost analysis. SETTING: A family medicine residency training clinic. PATIENTS/PARTICIPANTS: All clinic patients aged 2 months to 2 years, totaling 282 medical records. MAIN OUTCOME MEASURES: Cost and hours needed to complete the project, pediatric immunization rate, and barriers to pediatric immunizations. RESULTS: The total project cost was $1320.25. Sixty-nine percent of the study group was up-to-date on immunizations. Additional patients were found to have received immunizations from the local health department, which increased the immunization rate to 73.4%. The immunization rate declined significantly with age. The highest rate was 83% for children between the ages of 2 and 3 months. Immunization barriers included parental refusal, missed appointments, and inappropriate withholding of vaccinations. Only 13 records clearly documented why the child was behind on immunizations. CONCLUSIONS: Calculating a family practice clinic's immunization rate can be easy and has modest costs. The return is an awareness of immunization barriers and the potential to increase the childhood immunization rate.

Ambulatory Care Facilities↗

PubMed1996

The effect of strenuous exercise, calorie deficiency and sleep deprivation on white blood cells, plasma immunoglobulins and cytokines.

Moderate exercise appears to stimulate the immune system, but there is good evidence that intense exercise can cause immune deficiency. In the present study the authors examined the effect of continuous physical exercise (35% of VO2 max), calorie deficiency and sleep deprivation on the immune system of young men participating in a 5-7 days military training course. There was a two-three fold increase of neutrophils from day 1, the values remained high and decreased slightly at the end of the course. Monocyte counts also increased with a pattern similar to that of neutrophils. Eosinophils decreased to 30% of control and lymphocyte numbers decreased by 30-40%. All the major subgroups (CD4 T cells, CD8 T cells, B cells, NK cells) were reduced. Neutrophil function, as tested by measuring chemotaxis, was significantly stimulated during the first days of the course, in particular in the group with the lowest calorie intake. The mitogenic response of lymphocytes to PHA and Con A was variable, ranging from stimulation during one course to no effect in another course. Serum levels of immunoglobulins decreased significantly during the course. IgG was reduced by 6-7%, IgA by 10-20% and IgM by 20-35%. The authors found no changes of interleukin 1, 2 and 4 during the course, but a (12-20%) reduction (P less than 0.01) of interleukin 6, and an increase (P less than 0.01) of granulocyte-macrophage colony stimulating factor. Altogether the results from the ranger course present a mixed-up picture. The non-specific phagocyte-related immunity was enhanced. On the other hand, the data indicate that even a moderate physical activity, around the clock, caused significant suppression of a number of parameters reflecting the status of the specific, lymphocyte-related immunity. It is noteworthy, however, that there was no significantly increased infection rate during the course or in the first 4-5 weeks thereafter.

Acute-Phase Proteins↗

PubMedDate not supplied

[Education in primary health care. Diagnostic evaluation of teaching using microcomputers].

The use of microcomputers in medical education to assess the training process in Primary Health Care is analyzed. The experimental study consisted of 8 modules related to immunization campaigns, nursing care of healthy children, sanitation, nursing care of women, epidemiology and statistics, and nursing care of those diseases presenting the highest prevalence. The program is based on the basic software "Evaluation of Training", and designed in basic language. Each module consisted of a set of questions and each set had 3 different forms of feedback: the given form, the controlled form, and the form for searching. The independent variable of this investigation was the evaluation of training by microcomputers, and the dependent variable was the cognitive domain and development. The sample comprises 16 individuals studying on the eighth semester of a nursing course, and each group is made up by 8 students (a control group and an experimental group). Data obtained from this investigation were assessed by the test of nonparametric indicators. Results evidenced that the evaluation of training by a microcomputer provided a significantly higher performance in comparison with noncomputer assisted evaluation. Students were satisfied regarding the interaction with the microcomputer and with the performance of the evaluation. Further investigations in this field are recommended.

Computer-Assisted Instruction↗

PubMed1978

Effects of passive immunization against morphine on heroin self-administration.

Antimorphine antibodies produced in Rhesus monkeys immunized with morphine-6-hemisuccinate-BSA were passively administered to recipient monkeys trained to self-administer heroin and cocaine. Following antibody administration, changes in heroin self-administration behavior were observed which were similar to those achieved with low doses of naloxone. Both manipulations increased heroin self-administration without affecting cocaine responding.

Animals↗