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PubMed2006

[Changes in the patterns of disease after the epidemiological transition in health in Chile, 1950-2003].

BACKGROUND: During the twentieth century there was a change in the pattern of diseases in Europe, with an increase in the incidence of allergies and autoimmune disorders, that paralleled a decrease of infectious conditions. The Hygiene hypothesis proposes that these phenomena are causally related. AIM: To evaluate the epidemiological changes of allergic, autoimmune, and infectious diseases in Chile between 1950 and 2003. MATERIAL AND METHODS: Search for the incidence and prevalence of these diseases in the national records published by the Ministry of Health, as well as through a systematic search of national literature using PubMed and Scielo as search engines. RESULTS: The annual incidence of tuberculosis, rheumatic fever, measles, and typhoid fever has progressively diminished in Chile since 1970. Figures for the national prevalence for asthma, rheumatoid arthritis, and type I diabetes are scarce and difficult to compare, but clearly show an increasing epidemiological trend in the last 20 years. CONCLUSIONS: The national figures suggest that, although the country has only recently gone through an epidemiological transition in health problems, there are detectable changes that show the same trends described in Europe.

Adolescent↗

PubMed2006

Human immunodeficiency virus and depression in primary care: a clinical review.

BACKGROUND: Human immunodeficiency virus (HIV)-infected individuals are at increased risk of developing depression. Depressive syndromes in these patients pose a challenge both diagnostically and therapeutically. These syndromes reflect both the presence of preexisting mood disorders and the development of depressive syndromes subsequent to HIV infection. DATA SOURCES: A search of the literature to 2005 was performed using the PubMed and Ovid search engines. English- and Portuguese-language articles were identified using the following keywords: HIV or AIDS and depression, mental illness, suicide, fatigue, psychiatry, and drug interactions. Additional references were identified through bibliography reviews of relevant articles. DATA SYNTHESIS: The clinical presentation and differential diagnosis of depressive symptoms in HIV illness and the role of HIV in the development of these conditions are reviewed. Management issues including suicide assessment and treatment options are then discussed, and potentially important pharmacokinetic interactions are reviewed. CONCLUSIONS: Individuals with HIV show higher rates of depression. This phenomenon may be due to a preexisting psychiatric disorder or to the HIV infection. Untreated depression symptoms may lead to non-compliance with drug regimens or increased high-risk behaviors. Given the adverse sequelae of untreated depressions in HIV illness, identification and management of depression are integral components of comprehensive HIV care.

Journal Article↗

PubMedDate not supplied

Gaps in the childhood malaria burden in Africa: cerebral malaria, neurological sequelae, anemia, respiratory distress, hypoglycemia, and complications of pregnancy.

Evaluations of the African childhood malaria burden do not fully quantify the contributions of cerebral malaria (CM), CM-associated neurological sequelae, malarial anemia, respiratory distress, hypoglycemia, and pregnancy-related complications. We estimated the impact of these malaria manifestations on members of the African population < 5 years old. Calculations were based on an extensive literature review that used National Library of Medicine search engines, other bibliographic sources, and demographic data. In sub-Saharan Africa, CM annually affects 575,000 children < 5 years of age and 110,000 (approximately 19% case fatality rate [CFR]) die. Childhood survivor, of CM experience developmental and behavioral impairments: each year, 9,000-19,000 children (> 2% of survivors of CM) < 5 years of age in Africa experience neurological complications lasting > 6 months. Severe malarial anemia heavily burdens hospitals with rising admission and CFRs and with treatments that are complicated by limited and sometimes contaminated blood supplies. Severe malarial anemia occurs 1.42-5.66 million times annually and kills 190,000-974,000 (> 13% CFR) children < 5 years of age annually. Respiratory distress, hypoglycemia, and overlapping clinical manifestations cause 1.12-1.99 million cases and > 225,000 (> 18% CFR) additional deaths among African children with malaria. Maternal, placental, or fetal malaria infection during pregnancy adversely affects development and survival of fetuses and newborns through low birth weight (LBW), maternal anemia, and possibly abortion and stillbirth. Between 167,000 and 967,000 cases of malaria-associated LBW occur yearly; malaria-induced LBW kills 62,000-363,000 (> 38% CFR) newborns each year. All the gaps in the burden comprise 0.4-1.7 million deaths annually, > 50% of which are due to severe malarial anemia. These malaria-induced medical problems constitute major clinical, public health, and research challenges in that they may contribute to more than double the mortality than is generally acknowledged.

Africa South of the Sahara↗

PubMedDate not supplied

Mature sacrococcygeal teratoma: a case report and literature review.

BACKGROUND: Sacrococcygeal teratomas are derived from embryonic germ cell layers. They present mostly in infancy and are extremely rare in adults; with an associated risk of malignancy. Modern imaging technique may be helpful to delineate the extent of the mass but surgical excision is generally indicated at the time of detection. PATIENTS AND METHODS: A case report is presented with a review of literature utilising MEDLINE, Microsoft Net and Yahoo search engines. RESULTS: A three day old female baby presented with a mature sacrococcygeal teratoma containing well-developed limb buds. She had surgical excision and primary repair with good results. A two-year follow up utilising serial serum alpha-fetoprotein assay and CT Scan revealed no evidence of tumour recurrence. CONCLUSION: Sacrococcygeal teratoma is a rare tumour that may be benign or malignant. Complete excision is the primary therapy and is adequate if the tumour is benign. Chemotherapy and radiotherapy are however indicated in malignant cases and in recurrence after previous excision.

Biopsy↗

PubMed2006

GEDA: new knowledge base of gene expression in drug addiction.

Abuse of drugs can elicit compulsive drug seeking behaviors upon repeated administration, and ultimately leads to the phenomenon of addiction. We developed a procedure for the standardization of microarray gene expression data of rat brain in drug addiction and stored them in a single integrated database system, focusing on more effective data processing and interpretation. Another characteristic of the present database is that it has a systematic flexibility for statistical analysis and linking with other databases. Basically, we adopt an intelligent SQL querying system, as the foundation of our DB, in order to set up an interactive module which can automatically read the raw gene expression data in the standardized format. We maximize the usability of this DB, helping users study significant gene expression and identify biological function of the genes through integrated up-to-date gene information such as GO annotation and metabolic pathway. For collecting the latest information of selected gene from the database, we also set up the local BLAST search engine and nonredundant sequence database updated by NCBI server on a daily basis. We find that the present database is a useful query interface and data-mining tool, specifically for finding out the genes related to drug addiction. We apply this system to the identification and characterization of methamphetamine-induced genes' behavior in rat brain.

Animals↗

PubMed2004

Analysis of on-line clinical laboratory manuals and practical recommendations.

CONTEXT: On-line clinical laboratory manuals are a valuable resource for medical professionals. To our knowledge, no recommendations currently exist for their content or design. OBJECTIVE: To analyze publicly accessible on-line clinical laboratory manuals and to propose guidelines for their content. DESIGN: We conducted an Internet search for clinical laboratory manuals written in English with individual test listings. Four individual test listings in each manual were evaluated for 16 data elements, including sample requirements, test methodology, units of measure, reference range, and critical values. Web sites were also evaluated for supplementary information and search functions. RESULTS: We identified 48 on-line laboratory manuals, including 24 academic or community hospital laboratories and 24 commercial or reference laboratories. All manuals had search engines and/or test indices. No single manual contained all 16 data elements evaluated. An average of 8.9 (56%) elements were present (range, 4-14). Basic sample requirements (specimen and volume needed) were the elements most commonly present (98% of manuals). The frequency of the remaining data elements varied from 10% to 90%. CONCLUSIONS: On-line clinical laboratory manuals originate from both hospital and commercial laboratories. While most manuals were user-friendly and contained adequate specimen-collection information, other important elements, such as reference ranges, were frequently absent. To ensure that clinical laboratory manuals are of maximal utility, we propose the following 13 data elements be included in individual test listings: test name, synonyms, test description, test methodology, sample requirements, volume requirements, collection guidelines, transport guidelines, units of measure, reference range, critical values, test availability, and date of latest revision.

Abstracting and Indexing↗

PubMed1998

Pediatric resources on the Internet.

This article introduces the podiatric physician interested in pediatrics to the resources available on the Internet. It surveys search engines, gateway sites on the World Wide Web leading to a wealth of pediatric information and services, and features such as electronic mail, news-groups, and Gopher sites. Examples illustrate how such resources can be helpful to the practicing podiatrist.

Child↗

PubMedDate not supplied

Doctors, patients and the Internet: time to grasp the nettle.

The Internet, the fastest growing technology in society, has been driven by the public's hunger for fast, cheap communication. The modern patient increasingly presents to their doctor with an Internet diagnosis and treatment plan, obtained from a website with inaccurate or highly biased information. Doctors have limited access to the Internet in the workplace and often find it difficult to answer specific medical questions using routine search engines. The Internet provides an unparalleled opportunity to revolutionise medical education, bedside decision-making, patient records and communication between professionals and patients. Coordination between government, the Royal Colleges and the healthcare industry is required to develop the necessary software and hardware to help doctors and patients use the Internet to their advantage.

Humans↗

PubMed1997

Haunts on the Web for physician executives.

Listed here are some medical management and health care related Web sites on the Internet worth visiting, as well as favorite search engines and how to use them. From health care systems and hospitals, to health plans and insurers, the industry is using Web technology to promote programs and outcomes, and to provide information on health and wellness.

Computer Communication Networks↗

PubMed1997

Open your laboratory to the Internet.

The Internet can open many opportunities for laboratories. A wide variety of information resources are available via the Web, which can be researched more quickly and efficiently with a search engine. A laboratory can pursue marketing and advertising of its services on the Web as well. Consultation and collaboration can be accomplished via e-mail, listservs, and newsgroups. An Intranet can be created on a local area network to share electronic data within an organization. In addition, the rapid technological advances make the possibilities for tomorrow's communications limitless.

Communications Media↗

PubMed1998

Using informatics principles and tools to harness research evidence for patient care: evidence-based informatics.

With the huge worldwide investment in biomedical research during the past 50 years, there are many important advances in health care knowledge each year. Unfortunately, it commonly takes over 20 years for even the most important of these advances to be widely integrated into clinical practice. Many potentially remediable factors are responsible for this dilemma in research transfer, including defective continuing education for health professionals and patients; increasingly complex medical regimens; diminishing resources for health care; and inadequate evidence management. The principles and procedures of health informatics can help overcome some of these barriers to research transfer, particularly such evidence management tasks as retrieving, processing, summarizing, disseminating and applying evidence for clinical care. Evidence retrieval has been improved by better indexing and electronic search engines, by improved access from clinical and other settings, and by integration of evidence into clinical decision support systems. Evidence processing has been greatly accelerated by streamlined methods of critical appraisal of research and by centralization of these procedures for the development of current awareness publications and cumulative "best evidence" databases. The Cochrane Collaboration has revolutionized the summarization (systematic review) of evidence. The internet has provided access to patients, practitioners, and policy makers, alike. Direct-from-patient automated data collection promises to move the connection between evidence and practice to a higher level. In all of these innovations, health care practice is most likely to be enhanced by intertwining best evidence with best informatics techniques.

Databases as Topic↗

PubMed1999

The chronobiology, chronopharmacology, and chronotherapeutics of pain.

Data for this review of chronobiology, chronopharmacology, chronotherapeutics and pain were derived from electronic searches of the medical literature (Medline) utilizing both Silver Platter and OVID search engines. Further information was obtained from personal conversations with members of the International Society for Chronobiology involved in chronopharmacology and pain research and reviews of non-Medline-referenced materials and journals such as Chronobiologia and the Annual Review of Chronopharmacology. A variety of data from proceedings were available, but was not utilized because of their nonreferred status and the relative unavailability of such sources; however, peer-reviewed, published proceedings have been included in this review. A total of 62 studies were identified as relevant to this review of biological rhythms and pain; of these, only 6 were conducted by nurses. Studies were broadly categorized by purpose as experimental chronobiology in humans (9), experimental chronobiology in animals (12), clinical chronobiology (25), chronopharmacology in animals (6), chronopharmacology in humans (6), and chronotherapeutic interventions (4). All statistically significant findings were reported at the p < 0.05 level.

Acute Disease↗

PubMed1999

Dieffenbachia species exposures: an evidence-based assessment of symptom presentation.

The literature often ascribes significant morbidity to Dieffenbachia exposures. However, poison center experience suggests a discordant view from that presented in the literature. This project determined if the symptoms described in the literature were consistent with clinical practice. To profile the symptoms reported in the literature, an extensive literature search using Medline and Webspirs (http:/(/)infoshare.library.pitt.edu/webspirs /webspirs.htm) was conducted to identify publications that described Dieffenbachia toxicity. Standard toxicology references and medical botany texts found in poison centers were used to profile symptoms in the tertiary literature; and an Internet search using the Savvy Search program (http:/(/)www.guaraldi.cs.colostate.edu:20 00) to search simultaneously all other search engines. The symptom information was compared to AAPCC TESS (1993-1996) symptom data reported on Dieffenbachia exposure reports. Twenty-three reference sources profiled the literature perspective on Dieffenbachia exposures. AAPCC TESS contained 10,796 Dieffenbachia exposures, and 34.7% of the reports documented symptoms. Oral irritation was reported in 18.2% of the reports and 92.6% of the queried literature listed this symptom (18.2%/92.6%). Additionally dermal pain = 8.7%/63.0%; vomiting = 2.6%/18.5%; erythema = 2.5%/5.3%; throat irritation = 2.3%/22.2%; dermal edema = 2.2%/3.7%; pruritus = 2.1%/7.4%; ocular irritation = 1.7%/44.4%; rash = 1.2%/29.6%; cough/choke = 1.1%/3.7%; loss of speech = 0%/29.6%; salivation = 0%/29.6%; respiratory obstruction = 0%/48.1%; death = 0%/11.18%. When multiple symptoms occurred the most common toxidrome was oral and throat irritation that occurred in 2.9% of the AAPCC TESS reports. There is similarity between the literature and the clinical experience with regard to the irritant properties of Dieffenbachia species, but there is also significant disparity because the literature fails to put the symptoms into a clinical frequency perspective. In general, the literature portrays Dieffenbachia exposures associated with more morbidity and mortality than what was reported in the AAPCC TESS clinical practice data.

Data Collection↗

PubMed1999

Quality criteria and access characteristics of Web sites: proposal for the design of a health Internet directory.

The increasing volume of information available on the Internet today is a problem for health care professionals who want to access rapidly data of high quality. Usual search engines and directories are not sufficient to satisfy their needs. Moreover, the information published by Web sites is not always guaranteed. Some institutions around the word deal with the definition of a set of criteria for the evaluation of medical Web sites. We base our current work on the technologies we developed previously in order to integrate sources of information of various kinds using the "Unified Medical Language System" knowledge bases. This paper focuses on quality criteria and access characteristics Web sites should satisfy to be registered in a "Health Internet Directory". The design of such a system is proposed and discussed.

Abstracting and Indexing↗

PubMed2000

Sildenafil and the Internet.

PURPOSE: The Internet is changing the way medicine is being practiced and challenging our notions of the doctor-patient relationship. We analyze the development of online prescriptions and propose guidelines for the sale of sildenafil over the Internet. MATERIALS AND METHODS: Using MEDLINE, Medscape and Lexis-Nexis search engines we reviewed pertinent materials from January 1996 to July 1999 focusing on the keywords Viagra, prescription and Internet. The review included press releases, law review articles, case law, medical literature, pending litigation, proposed legislation, and federal and state statutes. RESULTS: Online prescriptions are an outgrowth of the mail order drug business. This development continues the historic innovations in communications and transportation that have enabled physicians to practice medicine over long distances while maintaining ties to hospitals and other specialists. While the sale of sildenafil over the Internet may be profitable and convenient, it raises a variety of legal, ethical and safety concerns. Many federal and state organizations have addressed the issue without establishing a clear standard. CONCLUSIONS: A clear distinction exists between online prescriptions and pharmacies. While it may be acceptable for sildenafil to be sold over the Internet given current technologies, it must be done within the confines of a traditional doctor-patient relationship. Online prescriptions must be limited to patients who live in states in which the prescribing physician is licensed. Failure to establish a doctor patient relationship in this context breeches ethical standards, and may give rise to potential civil and criminal liabilities.

Erectile Dysfunction↗

PubMed2000

Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study.

European physicians treat benign prostatic hyperplasia (BPH) with saw palmetto extract (SPE), while American physicians generally disregard SPE because "research is lacking." The authors investigated this discrepancy with a literature search and a clinical trial. The literature search began with MEDLINE, then expanded to "alternative" databases, including AGRICOLA, EMBASE, IBIS, and Cochrane, plus a manual search of unindexed herbal journals. The clinical trial was an experimental case study in which a 67-year-old man with symptomatic BPH was randomly administered SPE (160 mg standardized extract twice daily) or placebo. Outcome measures included the American Urological Association Symptom Index (AUASI), serum prostate-specific antigen, and prostate volume. Our expanded literature search revealed 58 clinical trials, whereas MEDLINE yielded only 19 clinical trials, or 33% of the total. Our clinical trial measured a baseline AUASI score of 20, which improved to 7 after unblinded administration of SPE. Subsequent double-blinded placebo produced a score of 14, and final single-blinded allotment of SPE produced a score of 11. Prostate-specific antigen was 10.3 ng/mL at baseline and 10.7 ng/mL at trial's conclusion. Baseline prostatic volume was 92 mL, and end volume was 75 mL. In conclusion, MEDLINE proved inadequate as a stand-alone search engine for locating information about an herbal medicine. Our experimental case study, similar to N = 1 research methodology, proved suitable for clinical evaluation of an herbal medicine in a rural private practice. SPE improved the patient's BPH. Unstandardized look-alike herbs may act as nontherapeutic placebos and may undermine consumer confidence in herbal medicine.

Aged↗

PubMed1999

An information retrieval service to support clinical decision-making at the point of care.

The information retrieval systems currently available in general practice, such as Medline, and web search engines are passive and relatively difficult to access during consultations. Emergent technologies, including the National Electronic Library for Health, offer opportunities for more active decision support. We examine the extent to which information retrieval could support primary care consultations by examining the impact of the new technology at different stages of the consultation. We advocate a system whereby professional organisations concerned with quality of care, such as the Royal College of General Practitioners, might contribute the the process.

Decision Support Systems, Clinical↗

PubMed2000

Measuring the readership of a health-related Website.

A national database of telemedicine was set up with the sponsorship of the British government to provide a source of information to anyone researching the field or proposing a telemedicine project. To monitor the readership of the database we subscribed to a free Internet service called Extreme Tracking. Since the Website was launched there have been over 9000 visits from over 5000 different Internet addresses. The peak was in the week after launch, when it had 400 visitors in four days. Subsequently, the number of visits tailed off slightly, but nine months later the database was still attracting about 800 visits per month. The majority of visits were via links from other Websites. Of the 288 different Websites identified, the one operated by the UK National Health Service (NHS) Information Authority generated the most visits, suggesting that many readers were from within the NHS. The second most common form of referral was from search engines. Most visits were on weekdays and during normal UK working hours. Taken together with the fact that the Internet domain that generated most visits was the '.uk' one, we concluded that most readers were based in the UK and accessed the site as part of their jobs rather than as a spare-time activity. This is encouraging for the take-up of telemedicine in the UK.

Bibliometrics↗