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PubMed2002

[Availability of antidotes in the event of accidents or attacks with chemical weapons].

BACKGROUND: In this report, we aimed to determine the availability of six antidotes for victims of accidents or attacks with chemical weapons. MATERIAL AND METHOD: Telephone interviews with 6 Catalan hospitals and 8 hospitals from the community of Castilla y León. We evaluated the availability of antidotes in the hypothetical event of a massive intoxication with 600 affected people. RESULTS: Only 3 out of the 14 hospitals had all 6 antidotes. Only atropine and, in Catalan hospitals, sodium thiosulfate were available in enough quantities to treat all victims. With regard to the remaining antidotes, the percentage of treated patients would have been fewer than 50%. The less available antidote was hydroxocobalamine. CONCLUSIONS: We have found both qualitative and quantitative deficiencies of antidotes for the treatment of people intoxicated by chemical weapons.

Accidents↗

PubMed2001

Demand-feeding rhythm in rainbow trout and European catfish. Synchronisation by photoperiod and food availability.

The effect of light-dark (LD) cycle and food availability was tested on the demand-feeding rhythm of single and groups of rainbow trout and European catfish. Under LD and free food access, most trout and catfish displayed, respectively, a diurnal and a nocturnal pattern of demand-feeding activity, whereas a few fish or groups of fish switched from diurnalism to nocturnalism or vice versa. In both species held under constant lighting conditions and a restricted feeding (RF) cycle (RF 20:4), the demand-feeding rhythm rapidly synchronised to food availability. The demand-feeding rhythm was under endogenous control and, in rainbow trout, periodogram analysis suggested the existence of two oscillators, one synchronised by photoperiod (LEO) and the other by food (FEO). When submitted to both LD and RF cycles, LD was, at least in the rainbow trout, the dominant zeitgeber synchronising the demand-feeding rhythm. In catfish, food availability rapidly synchronised demand-feeding rhythm. Finally, in both species, the synchronisation of single fish to LD or feed availability appeared slower than that of groups of fish, supporting the idea that social organisation affects the circadian activity in fish.

Animals↗

PubMed1999

Market factors and the availability of community pharmacies.

The purpose of this study was to examine the relationships between the availability of community pharmacies and 4 types of market factors. A composite data set was created that linked, at the county level, data on: (1) type and number of pharmacies; (2) population characteristics; (3) payer variables; (4) health care system factors; and (5) competitive factors. In this exploratory study, secondary data were used to assess the association between the availability of community pharmacies and the influence of market factors. To assess the market influences on availability of community pharmacies, 2 regressions were performed. In 1 model, the number of community pharmacies per 10,000 population was the dependent variable, whereas the dependent variable in the other regression was the proportion of independently owned community pharmacies. The independent variables in each regression were the market factors--population characteristics, payer variables, health care system factors, and competitive variables. Squared terms were included for 8 of 15 market factors to account for nonlinearities in the relationships. Multiple market factors were correlated with both the number of community pharmacies and the proportion of independently owned pharmacies in an area. Several of the relationships were not linear and changed direction within the range of data. Counties with either a low or a high percentage of elderly people had fewer pharmacies and a lower proportion of independently owned pharmacies compared with counties with a moderate percentage of elderly people. Counties that were scarcely or highly rural had fewer community pharmacies but a higher proportion of independently owned pharmacies than counties that were moderately rural. Areas with a greater percentage of the population earning less than the poverty level had more pharmacies, especially independently owned ones. Fewer community pharmacies were found in areas with higher health maintenance organization penetration rates. The number of hospital admissions was positively associated with the number of pharmacies but negatively associated with the proportion of independently owned pharmacies. The availability of community pharmacies varies across the country. In light of the trend toward fewer independently owned pharmacies, potential problems in accessing pharmacy services could develop in certain areas, including those that are highly rural and those with a high percentage of people earning less than the poverty level. Future research and policy issues are identified.

Data Collection↗

PubMed1999

Choline availability alters embryonic development of the hippocampus and septum in the rat.

Choline availability in the diet during pregnancy alters fetal brain biochemistry with resulting behavioral changes that persist throughout the lifetime of the offspring. In the present study, the effects of dietary choline on cell proliferation, migration, and apoptosis in neuronal progenitor cells in the hippocampus and septum were analyzed in fetal brains at different stages of embryonic development. Timed-pregnant rats on day E12 were fed AIN-76 diet with varying levels of dietary choline for 6 days, and, on days E18 or E20, fetal brain sections were collected. We found that choline deficiency (CD) significantly decreased the rate of mitosis in the neuroepithelium adjacent to the hippocampus. An increased number of apoptotic cells were found in the region of the dentate gyrus of CD hippocampus compared to controls (5.5+/-0.7 vs. 1.9+/-0.3 apoptotic cells per section; p<0.01). Using a combination of bromodeoxyuridine (BrdU) labeling and an unbiased computer-assisted image analysis method, we found that modulation of dietary choline availability changed the distribution and migration of precursor cells born on E16 in the fimbria, primordial dentate gyrus, and Ammon's horn of the fetal hippocampus. CD also decreased the migration of newly born cells from the neuroepithelium into the lateral septum, thus indicating that the sensitivity of fetal brain to choline availability is not restricted to the hippocampus. We found an increase in the expression of TOAD-64 protein, an early neuronal differentiation marker, in the hippocampus of CD day E18 fetal brains compared to controls. These results show that dietary choline availability alters the timing of the genesis, migration, and commitment to differentiation of progenitor neuronal-type cells in fetal brain hippocampal regions known to be associated with learning and memory processes in adult brain.

Animals↗

PubMed2000

A bioluminescent Escherichia coli auxotroph for use in an in vitro lysine availability assay.

Microbiological methods have been used to determine the amino acid availability of a variety of animal feed and human food protein sources. Growth of Escherichia coli auxotrophs have been shown to yield a consistent linear response to lysine concentration when compared to chemical measures. Extent of total growth of E. coli lysine mutant (American Type Culture Collection #23812) when measured as optical density (OD) displays a lysine-dependent growth response that can be used to estimate lysine in feed proteins. However, typical OD-based growth studies for amino acid quantitation using the mutant may require anywhere from 12 to over 40 h. To develop an improved rapid method for lysine quantitation in protein sources, the plasmid pJHD500 carrying genes that encode for expression of bioluminescence and ampicillin resistance was transformed into the E. coli mutant by electroporation (set at 1.80 kV). The luminescence measured during early exponential growth allowed detectable differentiation of lysine concentration in the media in 4 h. When the luminescence method was compared with the conventional optical density lysine growth assay, the correlation coefficient was 0.989. Lysine availability valued for enzymatically hydrolyzed protein sources were comparable with availability measures using animal methods for lysine availability. This research shows potential applications for more rapid quantitative measurement of bioavailable lysine.

Animal Feed↗

PubMed2001

Legislation analysis according to WHO and INCB criteria on opioid availability: a comparative study of 5 countries and the state of Texas.

Opioids are not always available in many developing countries, including those in Latin America. In this study we analyzed the national laws on opioids and other controlled substances from Argentina, Colombia, Costa Rica, Peru, Mexico, and the state of Texas, according to the principles set by the World Health Organization (WHO) and the International Narcotics Control Board (INCB), as well as to the presence of over-regulations regarding their medical and scientific use. The six main principles outlined by WHO and INCB for opioid availability were analyzed by using a total of 17 criteria as shown in Table 3. The result scores ranged from 17/17 (full compliance with all criteria) to 0/17 (non-compliance). Results showed that with the exception of the state of Texas 16/17 (94%), the countries failed to adequately meet the INCB and WHO criteria: Argentina: 7/17 (41%); Colombia: 9 /17 (53%); Costa Rica: 9/17 (53%); Mexico: 4/17 (24%); and Peru: 7/17 (41%). In all 5 Latin American countries, national laws and regulations imposed limits on the number of days allowed for prescription, the potency of the dosage, and the number of doses allowed per day. In all cases, including Texas, there was confusion on the meaning and utilization of the terms physical dependence, psychological dependence, addiction, tolerance and abuse. In total, combining all cases, only 51% of the criteria were met. Additionally, all laws and regulations, especially in Argentina, include over regulations and statements that may further interfere with patient access to opioids. The prescription criteria were fully met by the state of Texas and all five countries. These results indicate that there is need to revise the existing laws and regulations in countries with opioid availability problems, and identify the potential barriers, which may be playing a significant role in the access to adequate treatment. Such review seeks to carefully consider all possible criteria, since partial resolution of legislative articles will not result in increased opioid availability.

Argentina↗

PubMed2003

The availability of drugs: what does it mean in Ugandan primary care.

Availability of drugs is often considered the most important element in quality of health care in rural African settings. Using material collected through mainly qualitative methods, this article examines drug availability in six primary health care units in southeastern Uganda. Emphasis is on the differing perspectives of three categories of actors: health planners/managers; health workers; and users of health services. The main concern is the availability of chloroquine and penicillin, especially injectable forms, and the needles and syringes for administering them. Health sector reforms have changed the conditions for managing, supplying, and using drugs through decentralization, user fees, and privatization. Patients were dissatisfied when they were not able to obtain all drugs prescribed at the health unit. Government health units both compete with, and use, local commercial sources of drugs. They need to attract patients and, with user fees, they are more able to supplement the drug kit supplies provided through the Ministry of Health. There is a need to revise policy in light of the new situation. Dialogue and realism are needed in order to create policies that respect both good medical treatment standards and the concerns of front line workers and their patients. The exercise of rethinking the meaning of drug availability in primary health care calls for methodologies examining the changing context of health care and the positions of different categories of actors, at national and district setting, to appreciate gaps existing between drug policy and practice.

Drugs, Essential↗

PubMed2001

Chemical availability of 137Cs and 90Sr in undisturbed lysimeter soils maintained under controlled and close-to-real conditions.

Chemical availability of 137Cs and 90Sr was determined in four undisturbed soils in a lysimeter study three and four years after deposition to the soil surface. The study was part of a larger project on radionuclide soil-plant interactions under well-defined conditions. The soil types were loam, silt loam, sandy loam and loamy sand, and were representatives of important European soil and climatic conditions. The lysimeters were installed in greenhouses with climatic and hydrological control, and were contaminated with 137Cs and 90Sr in an aerosol mixture simulating fallout from a nuclear accident. Soil samples were taken from several depths in each soil in 1997 and 1998 and the samples were sequentially extracted with H2O, NH4Ac, NH2OH.HCl, H2O2 and HNO3. Extractability of 137Cs decreased in the order: HNO3 > R-esidual > or = NH4Ac > H2O2 > or = NH2OH.HCl > or = H2O. More than 80% was found in the acid digestible or residual fractions, and 11-17% in labile fractions. Soil type differences were small. Extractability of 90Sr decreased in the order: NH4Ac > NH2OH.HCl > HNO3 > H2O2 approximately H2O. 31-58% was found in easily available fractions. Differences between soil types were quite small. The results suggest that availability of 137Cs for plant uptake and migration is low, whereas availability of 90Sr is rather high.

Agriculture↗

PubMed2003

A qualitative study of information about available options for childbirth venue and pregnant women's preference for a place of delivery.

AIM: To explore the level of information about possible venues for childbirth among pregnant women, and to establish the midwives' involvement in giving information and helping women to make choices about where they want to give birth. DESIGN: Qualitative study using tape-recorded unstructured interviews. SETTING: The South East of England. PARTICIPANTS: 33 pregnant women; 20 planning a hospital birth and 13 planning a home birth recruited between 32 and 42 weeks of pregnancy. FINDINGS: Women planning a home birth were well informed about the options available to them, while the majority of those planning a hospital birth were less informed about the availability of home birth and assumed that the hospital was the only option. Midwives did not initiate the discussion of availability of home birth but supported those who already knew and asked for it. CONCLUSIONS: Almost a decade after the adoption of Changing Childbirth (DoH 1993) recommendations as policy in England there is still evidence of lack of information among pregnant women regarding services available to them. In this study the midwives' reluctance to inform women about home birth as a possible venue for childbirth, has been demonstrated.

Adult↗

PubMed2002

The ubiquitin-proteasome pathway and the regulation of growth hormone receptor availability.

The number of growth hormone receptors (GHR) per cell are regulated and this feature plays a major role in the hormone responsiveness of the body. This article deals with the regulatory mechanisms underlying the availability of GHR for serum growth hormone. The availability of membrane proteins at the cell surface can be regulated at different locations within the cell: (1) The amount of protein synthesized in the endoplasmic reticulum (ER) is largely controlled by gene transcription. In addition, the ER quality control system regulates the exiting of properly folded proteins from the ER. (2) In the trans-Golgi network, proteins can either be diverted directly to the lysosomes or be transported to the cell surface. (3) At the plasma membrane, the endocytic machinery can select proteins for endocytosis via clathrin-coated pits or proteins may be subject to proteolysis, resulting in shedding of the extracellular domain. (4) In endosomes, internalized proteins are either recycled back to the plasma membrane or targeted to the lysosome for degradation. At each of these cellular locations the ubiquitin-proteasome pathway can specifically regulate protein levels via different mechanisms. In transfected Chinese hamster lung cells, GHR availability is determined by three factors: endocytosis (75%), shedding (10%), and other undetermined mechanisms (15%). As outlined in this article the level of GHR at the cell surface, defined as GHR availability, is mainly regulated by the ubiquitin-proteasome pathway.

Animals↗

PubMed2002

Changing patient characteristics with increased methadone maintenance availability.

Over the past several years there have been repeated calls for expansion of availability of methadone maintenance in several jurisdictions. Important stakeholders in the expansion of methadone maintenance treatment (MMT) are existing treatment providers. This study describes the impact of the rapid expansion in treatment availability in Ontario on the long-standing MMT program of the Centre for Addiction and Mental Health (CAMH). This expansion occurred through enlarging existing treatment programs, the provision of MMT in private physicians' offices and the establishment of new clinics. With expansion in the community, demand for the clinic-based treatment of the CAMH MMT program did not drop, in fact the patient population was able to continue to grow. There was a broadening of the patient profile in the program including patients who were better educated, more likely to be employed and less likely to be currently injecting (although with a significant history of past injection drug use). Moreover, in the face of these changes, excellent treatment retention was maintained. This suggests that the expansion in treatment availability did not impact negatively on the existing program but rather enabled access for a group of higher functioning opioid dependent patients who were previously being deterred from treatment entry by the large waiting lists and the need for priority access for pregnant and HIV positive heroin users. These findings should provide encouragement for MMT providers in jurisdictions anticipating or undergoing expansion of treatment availability.

Adult↗

PubMed2002

Cocaine use in New South Wales, Australia, 1996-2000: 5 year monitoring of trends in price, purity, availability and use from the illicit drug reporting system.

This paper describes trends in the price, purity, availability and use of cocaine in Sydney, Australia monitored by the Illicit Drug Reporting System (IDRS) between 1996 and 2000. The IDRS monitors illicit drug trends by means of triangulation of data from interviews with injecting drug users (IDU), reports of key informants, and analysis of indicator data. The price of a 'cap' of cocaine fell from 80 Australian dollars in 1997 to 50 Australian dollars in 1998, and remained at the lower price in subsequent years. Cocaine purity was high in all years (range 50-64%), and was highest in the 1997-1998 period. The availability of cocaine and its use by IDU increased substantially, 1997 and 1998, and remained high in subsequent years. The median number of cocaine use days also increased substantially between 1997 (4 days) and 1998 (25 days), and remained at higher levels than prior to 1998 in subsequent years. Cocaine use was primarily of powder, by injection, and strongly associated with existing heroin injectors. The availability and use of crack remained rare in Sydney. Use of cocaine among IDU was associated with more frequent injections, more injection-related health problems, higher levels of needle sharing, and higher levels of criminality. It is concluded that the use and availability of cocaine in Sydney increased substantially between 1997 and 1998, and has remained entrenched in the Sydney illicit drug market. The regular and formal monitoring of illicit drug trends enabled substantial changes in the cocaine market in Sydney to be detected, and the information to be fed back to the health and law enforcement sectors.

Adult↗

PubMed2003

Comparison of the effects of allopregnanolone with direct GABAergic agonists on ethanol self-administration with and without concurrently available sucrose.

Behavioral effects of ethanol are mediated by actions at multiple neurotransmitter receptors and signaling systems; prominent among these is the type A gamma-aminobutyric acid (GABA(A)) receptor. Previous work has shown that the GABAergic neuroactive steroid allopregnanolone enhances ethanol-reinforced instrumental responding in rat. In the current study, we compared the effects of allopregnanolone with the direct GABA(A) agonist muscimol and the direct type B GABA (GABA(B)) agonist baclofen in male Long-Evans rats lever pressing for a 10% ethanol solution in a limited-access procedure. The effects of concurrently available sucrose were also tested to determine the selectivity of these drugs for altering ethanol self-administration when an alternate reinforcer was available. In Experiment 1, we found that presession systemic administration of both muscimol (0.3 and 1 mg/kg) and baclofen (1 and 3 mg/kg) reduced responding for ethanol. In contrast, allopregnanolone (3 and 5.6 mg/kg) enhanced responding for ethanol. In Experiment 2, we found that a 1-mg/kg dose of baclofen reduced responding for ethanol, but not for sucrose, whereas both baclofen and muscimol, administered at a higher dose of 3 mg/kg, decreased both ethanol- and sucrose-reinforced responding. Allopregnanolone, at a dose of 5.6 mg/kg, but not of 3 mg/kg, selectively increased ethanol-reinforced responding, indicating a less robust effect of allopregnanolone on responding within the concurrent reinforcement procedure than that observed when ethanol alone was available. The results support the suggestion that direct agonist action at either the GABA(A) or the GABA(B) receptor decreases ethanol self-administration. Muscimol produces a nonselective decrease in instrumental responding, whereas baclofen may selectively reduce ethanol intake at lower doses, but not higher ones, possibly limiting its potential use for treatment of alcohol abuse in human beings. In contrast, allopregnanolone can selectively enhance ethanol self-administration in the presence of a concurrently available alternate reinforcer, indicating that the direct GABA(A) agonist muscimol and the allosteric GABA(A) modulator allopregnanolone do not produce similar behavioral effects on instrumental responding for ethanol reinforcement.

Alcohol Drinking↗

PubMed2003

How to measure comorbidity. a critical review of available methods.

The object of this article was to systematically review available methods to measure comorbidity and to assess their validity and reliability. A search was made in Medline and Embase, with the keywords comorbidity and multi-morbidity, to identify articles in which a method to measure comorbidity was described. The references of these articles were also checked, and using a standardized checklist the relevant data were extracted from these articles. An assessment was made of the content, concurrent, predictive and construct validity, and the reliability. Thirteen different methods to measure comorbidity were identified: one disease count and 12 indexes. Data on content and predictive validity were available for all measures, while data on construct validity were available for nine methods, data on concurrent validity, and interrater reliability for eight methods, and data on intrarater reliability for three methods. The Charlson Index is the most extensively studied comorbidity index for predicting mortality. The Cumulative Illness Rating Scale (CIRS) addresses all relevant body systems without using specific diagnoses. The Index of Coexisting Disease (ICED) has a two-dimensional structure, measuring disease severity and disability, which can be useful when mortality and disability are the outcomes of interest. The Kaplan Index was specifically developed for use in diabetes research. The Charlson Index, the CIRS, the ICED and the Kaplan Index are valid and reliable methods to measure comorbidity that can be used in clinical research. For the other indexes, insufficient data on the clinimetric properties are available.

Comorbidity↗

PubMed1999

Dopamine transporter availability and depressive symptoms during alcohol withdrawal.

Alcohol-related temporary depressive symptoms are hypothesized to be related to dopaminergic dysfunction. The aim of this study was to investigate whether or not depressive symptoms correlate with reduced dopamine transporter (DAT) availability. We studied the DAT availability in 28 alcoholic subjects with beta-CIT ([123-iodium]-2-betacarbomethoxy-3-beta-(4-iodophenyl)-tropa ne) single photon emission tomography (SPET) and found a reduction in DAT availability during withdrawal that subsequently showed a significant increase during sobriety. The relationship between DAT availability and Montgomery-Asberg Depression Rating scale scores, both during withdrawal and after sobriety, was assessed. The main finding was a statistically significant correlation between DAT variances and depressive symptom scores during both states. The findings indicate a possible dopaminergic etiology for depressive symptoms in alcohol withdrawal, which suggests that dopaminergic antidepressants might be beneficial in the treatment of alcohol withdrawal.

Adult↗

PubMed2002

Zinc availability from zinc lipoate and zinc sulfate in growing rats.

The purpose of this study was to investigate the effect of zinc lipoate and zinc sulfate on zinc availability in growing rats. 6 . 6 male albino rats were fed purified diets based on corn starch, egg albumen, sucrose, soy bean oil and cellulose over a 4-week period (diet Ia: 10 mg Zn/kg as zinc sulfate, diet Ib: 10 mg Zn/kg as zinc lipoate, diet IIa: 10 mg Zn/kg as zinc sulfate +0.4% phytic acid, diet IIb: 10 mg Zn/kg as zinc lipoate +0.4% phytic acid, diet IIIa: 20 mg Zn/kg as zinc sulfate + 0.4% phytic acid, diet IIIb: 20 mg Zn/kg as zinc lipoate + 0.4% phytic acid). Zinc lipoate and zinc sulfate both proved to be highly available zinc sources. When 0.4% phytic acid were present in the diets, apparent zinc absorption was generally depressed but was higher from zinc lipoate in tendency than from zinc sulfate. Comparable results were evident for femur zinc, plasma zinc and metallothionein concentrations in liver tissues. This indicates that zinc lipoate could be a valuable zinc source under conditions of low zinc availability. Nevertheless the absence or presence of phytic acid was a more important factor influencing zinc availability than the type of zinc source investigated.

Alkaline Phosphatase↗

PubMed2000

A comparison of iron availability from commercial iron preparations using an in vitro digestion/Caco-2 cell culture model.

The objectives of this study were to compare iron availability from commercial preparations of FeSO(4), ferrous gluconate, ferrous fumarate, and a polysaccharide-iron complex using an in vitro digestion/Caco-2 cell culture model. In addition, we sought to determine if calcium carbonate and calcium acetate (common phosphate binding agents) inhibited iron availability from an oral iron supplement when digested simultaneously. Caco-2 cell ferritin formation following exposure to simulated gastric and intestinal digests of the iron supplements was used as a measure of iron uptake and availability. Plates without cell monolayers were included in each replication of the experiment to measure the total amount of soluble iron that resulted from the in vitro digestion. Significantly more iron was taken up from the FeSO(4), ferrous gluconate, and ferrous fumarate than the polysaccharide-iron complex. Similar results comparing FeSO(4) and the polysaccharide-iron complex have been observed in humans. In addition, less iron was taken up from digests with calcium carbonate relative to calcium acetate even though similar amounts of soluble iron were observed in these experiments. The results indicate that when iron supplements and phosphate binders are consumed simultaneously, calcium acetate may be the preferred phosphate binder to maximize iron availability.

Journal Article↗

PubMed2003

Availability of acupuncture in the hospitals of a major academic medical center: a pilot study.

BACKGROUND: Acupuncture is widely used by the American public, but little is known about its availability and use in academic medical settings. We performed a pilot study to compare acupuncture services provided by hospitals affiliated with a major academic teaching institution, and a parallel survey of services provided through an acupuncture school in one city in New England. METHODS: Between December 2000 and July 2001, a telephone survey was conducted of the 13 hospitals affiliated with Harvard Medical School, and the clinics affiliated with the New England School of Acupuncture. RESULTS: Acupuncture was available in 8 of the 13 hospitals. Acupuncture was provided in ambulatory clinics in all eight hospitals, but was available to inpatients in only one hospital. Six hospitals delivered acupuncture through an outpatient pain treatment service, one through a women's health center, one through an HIV clinic, and one hospital delivered acupuncture through two services; a program in the anesthesia department and a multi-disciplinary holistic program in a primary care department. In contrast, the acupuncture school clinics provided services through an on-site clinic at the school, through acupuncture departments at two community-based hospitals, and through a network of 12 satellite acupuncture-dedicated clinics operating throughout the state. CONCLUSION: Acupuncture is available on a limited basis in a majority of the teaching hospitals in this city. At the acupuncture school clinics, there are few barriers to care. Future health care studies will need to examine the role of acupuncture in diverse geographic settings and to examine its impact on quality of care, teaching and its role in research in academic centers.

Academic Medical Centers↗