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PubMed1982

Menstrual irregularity in athletes: basic principles, evaluation, and treatment.

Recent advances in reproductive physiology have led to an understanding that the ovarian follicle controls the entire menstrual cycle. The most mature follicle, which is the best estrogen-producer, is most sensitive to gonadotropin stimulation and is destined to ovulate next. During the course of a training program, an athlete may be subjected to many factors including loss of weight and fat, low weight and fat, acute and chronic hormonal changes, and physical and emotional stresses. Each of these, alone or in combination, may be associated with menstrual irregularity or amenorrhea. Although menstrual irregularity and amenorrhea are common among athletes, these problems should always be evaluated thoroughly. It is dangerous to assume that such problems are either exercise-related or not serious. Athletes are not immune from developing significant pathology, which can be detected only if sought. Therapy is indicated for some women who have such menstrual dysfunction.

Anovulation↗
PubMed1991

The susceptibility of young adult Americans to vaccine-preventable infections. A national serosurvey of US Army recruits.

OBJECTIVE: Due to recent resurgences of measles, mumps, and rubella among young US adults, we sought to generate antibody prevalence data for national and military immunization policy evaluations. DESIGN: We used a questionnaire and serological survey of Army recruits to assess antibody status to measles, mumps, rubella, and varicella by enzyme-linked immunosorbent assay and to poliovirus types 1, 2, and 3 by microneutralization assay. SETTING: Basic training reception centers at Fort Benning, Ga., and Fort Jackson, SC. PATIENTS: The study included 1547 US Army recruits who were inducted during September and October 1989. OUTCOME MEASURES: Seronegativity by various demographic factors. RESULTS: Seronegativity rates, directly adjusted to the 15- to 24-year-old US population in 1980, were 20.7% for measles, 15.6% for mumps, 17.5% for rubella, and 6.9% for varicella. For measles, mumps, and rubella, susceptibility was less in females, blacks, and college-educated recruits, and varicella susceptibility was greater in females and blacks. Recruitment who were born after 1969 lacked measles, mumps, and rubella antibodies more often than older recruits. The adjusted seronegativity rates for poliovirus types 1, 2, and 3 were 2.3%, 0.6%, and 14.6%, respectively; trends by age, sex, and race-ethnicity were generally unremarkable. CONCLUSIONS: Among young adult Americans, susceptibility to measles, mumps, and rubella is unevenly distributed and may be substantial. Our findings support national objectives to further improve immunization coverage in school-age and adult populations and provide further impetus for legislation requiring college entrants to present evidence of having received at least two doses of measles vaccine, with one on or after entry into elementary school.

Adult↗
PubMed1987

Two-dimensional gel electrophoresis and immunoblotting of Campylobacter outer membrane proteins.

We characterized outer membrane proteins (OMPs) from selected Campylobacter jejuni, C. coli, and C. fetus strains by two-dimensional gel electrophoresis (2DGE), using isoelectric focusing and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), and by immunoblotting with immune rabbit serum. The flagellar band with a molecular mass of 63 kilodaltons (kDa) demonstrated previously by one-dimensional SDS-PAGE was shown by 2DGE to consist of one or several charge trains, depending upon the species, strain, and type of preparation studied; each of the individual peptides was found to be antigenic by immunoblotting. In contrast, in all of the strains studied, the major OMP (43 to 44 kDa) of C.jejuni and C. coli consisted of a single isomeric form which was weakly immunogenic. Several minor proteins (29 to 31 kDa) were found to be strongly immunogenic by immunoblotting. C. fetus strains possessed two major OMPs of 45 to 47 kDa, each of which consisted of either a single isomer or a major isomer comprising at least 90% of the major OMP. Serum-resistant strains of C. fetus possessed an acid-labile 100-kDa glycoprotein (pI, 4.1) which was markedly diminished or absent in serum-sensitive strains. These 2DGE analyses provide information that is useful in taxonomic and epidemiologic studies and for the purification of surface antigens for the development of campylobacter vaccines and may also facilitate the identification of specific virulence factors.

Bacterial Outer Membrane Proteins↗
PubMed1994

Evaluation of tuberculin reactivity in BCG-immunized siblings.

The purpose of the present study was to determine in BCG-immunized sibships < or = 14 yr of age whether the correlations of intensity of tuberculin reactivity support a genetic regulation of the response to BCG immunization. The study population consisted of 659 healthy children living in 265 households exposed to an adult with tuberculosis: 38 children did not have a BCG scar, 327 children had one BCG scar, and 294 had two BCG scars from vaccinations at birth and at 6 yr of age. There were 603 full siblings, 16 half-siblings, and 40 unrelated children. Tuberculin testing was performed by one trained nurse. Sibling correlations of the intensity of the tuberculin response were calculated after adjusting for various nongenetic covariates that could be important in predicting it. The sibling correlations were significant at the 1% significance level. There was no significant correlation of tuberculin reactivity among unrelated children in the same household. These results are consistent with genetic regulation of the development and persistence of tuberculin reactivity after BCG immunization.

Adolescent↗
PubMed1998

Total navy recruit health: making our sailors fit for the fleet.

Naval Hospital Great Lakes, Branch Medical Clinic, Recruit Training Command is the Navy's only recruit inprocessing point in the country. The clinic will medically inprocess approximately 54,000 new Navy recruits this year. In fiscal year 1995, the clinic inprocessed approximately 44,000 recruits, 35,000 males and 9,000 females. The Navy Medical Department is very concerned about total Navy recruit health. This includes a check on the present state of health of all sailors and teaching sailors how to stay healthy and take care of themselves during their naval careers. Navy medicine is also an integral part of the recruit training experience. Recruit training at Great Lakes is 9 weeks in duration. This article will describe the Navy's recruit medical inprocessing procedure to include the Sailor's Health Inventory Program, the Navy/Air Force Medical Entrance Test, immunizations, optometry, audiology, wellness education, gynecological examinations, medical assessment, and laboratory tests.

Female↗
PubMed2004

Effect of qi training on neutrophil function in young and elderly males.

OBJECTIVES: To examine the effect of qi training on neutrophil bactericidal function (superoxide generation and adhesion). METHODS: We studied the effects of one session of qi training on superoxide generation and adhesion of neutrophils immediately after (Post I), and 2 hours after qi training (Post II), in nine young and nine elderly male subjects. RESULTS: The qi training significantly enhanced the superoxide generation and adhesion of neutrophils, and there were significant differences at Post I compared to before qi training (Pre) in both groups. CONCLUSION: Our current observations show that qi training enhances superoxide generation and adhesion of neutrophils. It is supposed that qi training may increase the resistance of trained individuals against common infection and inflammation.

Adult↗
PubMed1997

Current status of polio eradication in Southern Africa.

During the 1990s, poliomyelitis transmission in 11 mainland and island nations of southern Africa appeared relatively low. However, the implementation of specific strategies recommended by the World Health Organization for eradicating polio in southern Africa began only in 1994. In 1995, oral poliovirus vaccine coverage (three doses) among infants was > or = 75% in all but 4 countries. National immunization days (NIDs) to control polio outbreaks were carried out in Namibia in 1994 and 1995. Angola, Botswana, and South Africa carried out subnational NIDs in 1995. All countries in southern Africa except Madagascar planned NIDs in 1996. Epidemiologic surveillance of acute flaccid paralysis (AFP) and laboratory surveillance of wild poliovirus was launched after nationwide training workshops in 7 mainland countries and is planned in the remaining countries by the end of 1996. Analysis of recommended performance indicators of AFP surveillance shows that substantial progress was made during 1994-1995, and the prospects for the certification of polio-free status in southern Africa on target appear good.

Adolescent↗
PubMedDate not supplied

Vaccine delivery management.

During the typical 12- to 18-month voyage of a vaccine from manufacturer to immunization site, many situations arise in which the cold chain may be interrupted. Extensive efforts have been made in the 1980s to ensure an uninterrupted cold chain through the use of improved equipment and better training of personnel. One important advance is the vaccine cold-chain monitor, which identifies weak spots in the cold chain and prevents the use of heat-damaged vaccine. Further improvements will require efforts by the recipient countries (e.g., better use of the private sector for transport and equipment management), by donor agencies (e.g., greater consideration of the operational and maintenance costs of the equipment selected and resolution of fuel shortages), and by industry (e.g., more appropriate packaging and pricing of vaccine, extension of the expiration period, and increased heat stability.

Cold Temperature↗
PubMed1987

Heart disease in marathon runners: a review.

Thirty-six cases of heart attack or sudden death in marathon runners have been reported in the world literature to date. The mean age of the runners was 43.8 yr (range = 18 to 70), the mean years' running was 6.8 yr (range = 0.5 to 29), and the mean best standard 42.2 km marathon time was 3 h 28 min (range = 2 h 33 min to 4 h 28 min). Coronary artery disease was diagnosed either clinically, angiographically, or at autopsy in 27 runners (75%), two of whom also had histological evidence of hypertrophic cardiomyopathy. Seventy-one percent of the runners with coronary artery disease had premonitory symptoms, and most ignored such symptoms and continued to train or race. Fifty percent of all cardiac events occurred either during or within 24 h of competitive running events or long training runs. The marathon running population does not constitute solely persons with excellent cardiovascular health. Marathon runners, especially those with a family history of heart disease and other coronary risk factors, should not consider themselves immune to either sudden death or to coronary heart disease and should seek medical advice immediately if they develop any symptoms suggestive of ischemic heart disease. Physicians should not assume that "physically fit" marathon runners cannot have serious, life-threatening cardiac disease.

Adolescent↗
PubMed2000

Homeopathy and naturopathy: practice characteristics and pediatric care.

OBJECTIVE: To describe the practice characteristics and pediatric care of homeopathic practitioners (HPs) and naturopathic doctors (NDs). DESIGN: Cross-sectional, descriptive survey. SETTING: Homeopathic and naturopathic practices in Massachusetts. PARTICIPANTS: Homeopathic practitioners (N = 42) and NDs (N = 23) identified from the yellow pages, regional and national society membership lists, schools, magazine advertisements, and by word-of-mouth. The response rate was 55% (23/42) for HPs and 65% (15/23) for NDs. MAIN OUTCOME MEASURES: Demographics, practice characteristics, fee structure, and amount of pediatric care. Practitioners were asked for their approach to childhood immunizations and to treating a febrile neonate. Data were analyzed using simple descriptive statistics. RESULTS: Almost all respondents were white. Among the HPs, 13 (57%) were licensed medical doctors. Naturopathic doctors and HPs reported having an average of only 25 to 40 patient visits per week, but children and adolescents accounted for up to one third of these visits. Nearly all reported treating children, but fewer than half of the practitioners reported any formal pediatric training. Initial patient visits typically lasted more than 1 hour and cost $140 to $150. Follow-up visits were scheduled every 4 to 6 weeks and lasted more than 30 minutes on average. Insurance covered less than one third of the patient visits, and sliding scale payments were offered by less than half of the respondents. Most practitioners reported that they did not actively recommend immunizations and fewer than half of the nonphysician practitioners reported that they would refer a 2-week-old neonate with a fever to a medical doctor or emergency medical facility. CONCLUSIONS: Many patients using homeopathy and naturopathy are children. Visits to these providers are frequent and fees are primarily paid out-of-pocket. Failure on the part of these providers to recommend immunizations or recognize potentially serious illnesses is cause for concern.

Adult↗
PubMed1987

Regulation of natural immunity (NK activity) by conditioning.

A paradigm is described for the conditioning of the NK response. Mice were exposed to a classical conditioning procedure in which saccharin and lithium chloride (LiCl) served as the conditioned stimulus (CS) paired with an injection of either poly I:C or cytoxan, the unconditioned stimulus (US). Poly I:C was used as the US for enhancement and cytoxan served as the US for suppression. Subsequent exposure to the CS either enhanced or suppressed the NK activity in the conditioned animals. Our studies showed that only one association was needed for the learning to take place, training to consumption of water was not necessary, and the conditioned (enhanced) response could be recalled as soon as 7 days after pairing of the US and CS.

Animals↗
PubMedDate not supplied

Status of quality improvement activities to improve immunization practices and delivery: findings from the immunization quality improvement symposium, October 2003.

The Centers for Disease Control and Prevention convened a symposium on 22-23 October 2003 to bring together investigators and stakeholders working to apply the quality improvement (QI) approaches to immunization delivery in individual medical practices. The goal was to identify effective program components and further development of model programs. A call for projects was widely disseminated; of 61 submissions received, eight projects were selected. Three of the eight programs used the "train the trainer" approach, three used site-specific training, one used a "practice collaborative" approach, and one employed the use of tracking and outreach workers to effect change. At the symposium, invited experts reviewed each program. Common program features that appeared effective included involvement of a variety of staff within the office environment, collection and review of site-specific performance measurements to identify gaps in delivery, periodic monitoring of performance measurement to revise interventions and maintain the improvements, and provision of formal continuing education credits. While research is needed on ways to promote and integrate QI into practices, it is likely that a variety of QI strategies will be shown to be effective, depending on the clinical settings. The field will benefit from standardized outcome measures, cost analysis, and evaluation, so comparisons can be made among different programs.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Research to support household and community IMCI. Report of a meeting, 22-24 January 2001, Baltimore, Maryland, USA.

The Integrated Management of Childhood Illness (IMCI) strategy combines improved case management of childhood illness with aspects of nutrition, immunization, disease prevention, and promotion of growth and development. The household and community component of IMCI was formulated to reach the numerous sick children who are ill and often die at home without ever being treated by a trained healthcare practitioner. In January 2001, USAID (Child Health Research Project and BASICS II) and the CORE Group sponsored a meeting in Baltimore, Maryland, to determine the research needed to implement household and community IMCI effectively. This paper summarizes the presentations at that meeting and highlights the research and programme priorities expressed using the three-element approach devised by the CORE Group and USAID (BASICS II and Child Survival Technical Support Project). Research priorities to improve partnerships between health facilities and the communities they serve (Element 1) include finding ways to increase community involvement and management of health facilities, establishing accurate costs for community IMCI services, and formulating cost-recovery mechanisms tailored to local circumstances. Programme priorities in Element 1 include establishment of systems for maintenance of an adequate supply of essential equipment and medicines, while retaining access for the poor and ensuring adequate referral mechanisms for severely-ill patients that include monitoring and incentives for the performance of health workers. Research priorities to increase appropriate, accessible care and information from community-based care providers (Element 2) consist of activities to design simplified IMCI guidelines for use by community health workers (CHWs) and volunteers and evaluation of the impact of using these guidelines on morbidity and mortality. Also a priority item in this category is experimenting with ways to teach mothers and families to care for sick children at home and strategies to improve the practice of medicine in the private sector. More research is also needed to improve the quality of nutritional and preventive health counselling given by CHWs and to find ways to make community IMCI interventions sustainable. Programme priorities in Element 2 include efforts at the national level to establish policies to improve care by traditional and private care providers and to define the position of volunteer workers in the national health system. Research priorities to integrate promotion of key family practices critical for public health (Element 3) are focused on determining which interventions are the most effective in reducing child morbidity and mortality at the household and community levels, finding the best methods of delivering these interventions, and implementing these and scaling up in essential service packages. Particular issues in child health, needing urgent attention from the research and programme communities, are HIV/AIDS and neonatal morbidity and mortality.

Child↗
PubMed1993

Sustainable agriculture and integrated pest management in China.

In developed countries, emphasis is being switched from high productivity through the use of high inputs to ecologically sustainable agriculture. In developing countries such as China priority must be given to increasing food production while simultaneously trying to optimize sustainability. Achievements in plant protection are being countered by continued evolution of the pest ecosystem, in part driven by application of pesticides or the introduction of new crop varieties. Future management of the agricultural ecosystem requires the development of a method of 'super-long-term' prediction to evaluate possible consequences of different strategies of plant protection. Crop plants with durable resistance to pests must be derived by conventional breeding or by using biotechnology and genetic engineering. Genetic vulnerability can also be reduced by techniques such as gene rotation and mixed cropping. Biological control of plant pests shows promise but requires ecological study of the relationships among crop, pest and natural enemy. Implementation of sustainable pest management will need training and education of farmers, extension workers and policy makers to deliver new information in the developing countries.

Agriculture↗
PubMed2003

A successful, long-term exercise program for women with fibromyalgia syndrome and chronic fatigue and immune dysfunction syndrome.

This article describes an ongoing, long-term clinical exercise program for women with fibromyalgia syndrome (FMS), some of whom also have chronic fatigue and immune dysfunction syndrome (CFIDS). The recorded outcomes from the most recent year of the program also are reported. Participants engaged in sessions lasting 50-70 minutes, 5 days per week; each session involved aerobic activity, resistance training, and other dynamic exercise. One group was in the program for 3 years and another group was in the program for 2 years. Program outcomes for the year (comparing beginning and end-of-year results) are presented for both groups on physical fitness, psychosocial, and FMS/CFIDS symptoms. The outcomes support that all of the women appear to have benefited from the program in numerous ways, suggesting that the program works. Also, those outcomes are in agreement with past research reported in this journal. Implications for clinical nurse specialists working with FMS/CFIDS patients are discussed.

Adult↗
PubMed2005

Molecular classification of tamoxifen-resistant breast carcinomas by gene expression profiling.

PURPOSE: To discover a set of markers predictive for the type of response to endocrine therapy with the antiestrogen tamoxifen using gene expression profiling. PATIENTS AND METHODS: The study was performed on 112 estrogen receptor-positive primary breast carcinomas from patients with advanced disease and clearly defined types of response (ie, 52 patients with objective response v 60 patients with progressive disease) from start of first-line treatment with tamoxifen. Main clinical end points are the effects of therapy on tumor size and time until tumor progression (progression-free survival [PFS]). RNA isolated from tumor samples was amplified and hybridized to 18,000 human cDNA microarrays. RESULTS: Using a training set of 46 breast tumors, 81 genes were found to be differentially expressed (P < or = .05) between tamoxifen-responsive and -resistant tumors. These genes were involved in estrogen action, apoptosis, extracellular matrix formation, and immune response. From the 81 genes, a predictive signature of 44 genes was extracted and validated on an independent set of 66 tumors. This 44-gene signature is significantly superior (odds ratio, 3.16; 95% CI, 1.10 to 9.11; P = .03) to traditional predictive factors in univariate analysis and also significantly related with a longer PFS in univariate (hazard ratio, 0.54; 95% CI, 0.31 to 0.94; P = .03) as well as in multivariate analyses (P = .03). CONCLUSION: Our data show that gene expression profiling can be used to discriminate between breast cancer patients with progressive disease and objective response to tamoxifen. Additional studies are needed to confirm if the predictive signature might allow identification of individual patients who could benefit from other (adjuvant) endocrine therapies.

Adult↗
PubMed2005

Immunotherapy of hypersensitivity to hymenoptera venom.

Insect sting allergy is a common condition with a risk of life-threatening anaphylaxis. After a severe reaction, the fear of being restung can significantly reduce quality of life. Venom immunotherapy (VIT) is a highly effective treatment of the underlying type I-sensitisation. This review addresses the mechanisms of immune modulation by VIT and outlines current clinical application. Although highly effective in the majority of patients, VIT fails in a few individuals. It can also cause systemic allergic side effects, restricting its application to physicians trained in the treatment of anaphylaxis. This review discusses several new strategies to overcome these problems, which are presently a promising focus of research. These include the use of new adjuvants, of recombinant and genetically engineered venom allergens, as well as vaccination with peptides.

Animals↗