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PubMed1978

[Is preventive medicine a government task?].

Health care of the citizens (sanitary police) belongs to the classical tasks of the public authorities ( = state). Primary prevention is a joint task of the state and the individual, but it only can be fully effective if the state participates in the organization and coordination. The most significant examples are immunization and prophylaxis of road accidents while preventive medical examinations can be left to the individual's own responsibility. It is no primary task of the state to carry them out and pay for them. The state creates the necessary basis for effective prevention by means of training and further education of the health personnel, continued evaluation of preventive measures, setting up statistical instruments, coordination of nationwide activities, active cooperation in publicity campaigns for preventive measures (mass media) and promoting research. Simultaneously, the citizen's own responsibility should be activated by persuasive measures. As little use as possible should be made of compulsory measures.

Government↗

PubMed2006

Analysis of peripheral blood mononuclear cells gene expression in endurance horses by cDNA-AFLP technique.

The knowledge of molecular mechanisms of stress response in athlete horses can allow us to plan an appropriate and high-grade training to obtain better performance and to preserve horse welfare. It is well known that excessive muscular exercise can lead to a number of responses which may be associated with modification of the mRNA levels for a number of metabolic genes such as those involved in the immune response. In the present study cDNA-AFLP technique was applied to Arab endurance horses under stressing conditions to visualise variations of transcriptional profiles; 49 transcript derived fragments (TDFs), differentially expressed, were cloned and sequenced. Four of these showed high sequence similarity with genes probably involved in exercise-induced stress response and resulted to be not sequenced in the horse. Their modulation was confirmed by RT-PCR and the full-length transcripts were isolated by RACE-PCR. The mRNAs sequences obtained were included in the GenBank database as Equus caballus interleukin 8 (IL8), E. caballus retinoblastoma binding protein 6 mRNA (RBBP6), E. caballus eukaryotic translation initiation factor 4 gamma 3 (eIF4G3) and E. caballus heat shock protein 90 (Hsp90). The expression pattern of these genes was verified in other endurance horses under stressing conditions, strengthening the hypothesis of their real involvement in exercise stress-induced response.

Animals↗

PubMed2005

Effectiveness of the 2003-2004 influenza vaccine among U.S. military basic trainees: a year of suboptimal match between vaccine and circulating strain.

Effectiveness of the 2003-2004 influenza vaccine was evaluated at five military basic training centers throughout the United States. Data from surveillance conducted in December and January 2003-2004 in this highly vaccinated population were evaluated. During this period, 10.6% (37/350) of specimens were positive for influenza A. A 14-day period after vaccination was considered the period prior to immune protection; vaccine effectiveness (VE) was calculated based on febrile respiratory illness presentation and laboratory confirmation of influenza before or after this 14-day period. Thirty-two cases presented within 14 days of vaccination, and five cases presented beyond 14 days from vaccination. VE in this population was estimated to be 94.4% for laboratory-confirmed influenza. In contrast, VE was only 13.9% for influenza-like illness (ILI) without a laboratory confirmation.

Adult↗

PubMed2006

Primary care house staff attitudes toward osteoporosis management.

OBJECTIVE: This study assessed possible institutional and patient-related factors influencing the delivery of postmenopausal osteoporosis (PMO) care and the diagnostic priority placed on addressing PMO, relative to other common medical conditions, by primary care house staff at our institution. METHODS: A questionnaire was designed and distributed to eligible house staff at our institution. RESULTS: Approximately 50% (n = 52) of the house staff participated. The supervising clinic attending, patients' lack of insurance, accessibility to medical care, comorbid conditions, and university formulary were reported to influence decisions regarding osteoporosis care. Osteoporosis was ranked 6th of 7 medical issues (hypertension, coronary artery disease, diabetes, hypercholesterolemia, adult immunizations, osteoporosis, thyroid disease) to address during a comprehensive medical visit. CONCLUSIONS: Our institution's primary care house staff reported multiple influences on decision making regarding osteoporosis care, and an overall low priority to address this issue. Based on PMO's associated morbidity and mortality, primary care training programs are challenged to put resources toward optimizing house staff delivery of osteoporosis care.

Attitude of Health Personnel↗

PubMed2006

The effect of bovine colostrum supplementation on salivary IgA in distance runners.

Secretory IgA in saliva (s-IgA) is a potential mucosal immune correlate of upper respiratory tract infection (URTI) status. Nutritional supplements may improve mucosal immunity, and could be beneficial to athletes who are at increased risk of URTI. In this study, 35 distance runners (15 female, 20 male, age 35 to 58 y) consumed a supplement of either bovine colostrum or placebo for 12 wk. Saliva samples were taken prior to training at baseline, monthly during supplementation, and 2 wk post supplementation. Median levels of s-IgA increased by 79% in the colostrum group after 12 wk intervention, and the time-dependent change from baseline value was significant (P = 0.0291). This significance was still apparent after adjusting for training volume and self-reporting of upper respiratory symptoms. This study has demonstrated increased s-IgA levels among a cohort of athletes following colostrum supplementation. While this result is statistically significant, its physiological interpretation must be viewed with caution due to the small numbers in this study and the large variability in s-IgA levels.

Adult↗

PubMed1998

Exercise and resistance to infection.

Epidemiological data suggest that endurance athletes are at increased risk for upper respiratory tract infection (URTI) during periods of heavy training and the 1- to 2-week period following race events. Moderate exercise training has been associated with a reduction in incidence of URTI. There is growing evidence that for several hours subsequent to heavy exertion, several components of both the innate (e.g., natural killer cell activity and neutrophil oxidative burst activity) and adaptive (e.g., T and B cell function) immune system exhibit suppressed function. The immune response to heavy exertion is transient, and further research on the mechanisms underlying the immune response to prolonged and intensive endurance exercise is necessary before meaningful clinical applications can be drawn. Some attempts have been made through chemical or nutritional means (e.g., indomethacin, glutamine, vitamin C, and carbohydrate supplementation) to attenuate immune changes following intensive exercise to lower the risk of infection.

Exercise↗

PubMed1991

The role of autonomic nervous system and inflammatory mediators in nasal hyperreactivity: a review.

The last decade has seen a marked increase in the number of otolaryngologists-head and neck surgeons who have been trained to perform rhinologic surgery. This includes both rhinoseptoplasty and endoscopic sinus surgery. A better understanding of the pathophysiology of rhinitis and sinusitis has also kept pace with this rapid expansion of surgical intervention. For example, significant advances have taken place in our knowledge of the local immune system in the nose, particularly in regard to mucosal and submucosal mast cells and the development of protective antibodies in the nasal mucosa against viral and bacterial infections. We have far more understanding of the complex innervation of the blood vessels and glands in the nasal mucosa and their receptors, and, most recently, a tremendous increase of scientific data has accumulated on the effect of neuropeptides on the nasal mucous membrane. It is imperative that rhinologic surgeons have an understanding and appreciation of the complex patterns of sensory and autonomic innervation of the nose to better evaluate the medical, allergic, and surgical treatment of acute and chronic rhinitis and sinusitis. This discussion will focus on recent advances in our understanding of the biochemical substances that are released by both the autonomic nervous system and the sensory nervous system in the nasal mucosa. The effect of these mediators on both vascular smooth muscle and the seromucinous glands of the nose will be considered. Finally, the dynamic interaction between the inflammatory mediators released by sensory nerves so-called tachykinins-- and the immune system and mast cell degranulation will be considered.

Autonomic Nervous System↗

PubMed2002

[Microbial warfare and bioterrorism].

Infectious diseases have been used as warfares since ancient times. Since the 1920s military organizations have studied bacteria of anthrax, plague, tularemia, botulism, brucelloses, glander, Q-fever, and smallpox virus, Filo-, Arena-, Bunyaviruses causing hemorrhagic fever or Alphaviruses eliciting encephalitis. These can be dispersed by aerosol. Salmonellae, Shigellae, Vibrio cholerae, distinguished Escherichia coli strains are suitable to contaminate food, water, pharmaceutical products. Fanatical groups or terrorist individuals deploy microbe weapons. In the future, genetically engineered recombinant microbes could be used with genomes containing multiple resistance elements to antimicrobial compounds and additional virulence factors. These become resistant to all known treatment regimens, vaccination and the host immune response. Microbial terrorist attacks result in an outbrake on a restricted area with large number of casualties. The disease course is severe and unusual followed by high mortality. Identification of microbes is complicated and delayed. Most countries have neither laboratories at high biosafety level nor specially trained personnel. Physicians might misdiagnose these diseases. Health care systems with minimal elasticity face difficulties in maintaining mass quarantine. A considerable part of health care workers leave hospitals. No plan is available to stockpile medicines. Robust surveillance and laboratory systems coordinated at international level must be established. All health care personnel should be trained periodically to gain practical skills. Additional standards governing working conditions with selected microbes will be enforced by law. Related scientific data might be published with restricted access only.

Animals↗

PubMed1997

Tuberculosis care in community care organizations in sub-Saharan Africa: practice and potential.

SETTING: Community care organizations in sub-Saharan Africa. OBJECTIVES: To evaluate current tuberculosis (TB) care in community health care organizations in sub-Saharan Africa, to assess their potential contribution to tuberculosis care, and to develop a model for expanded community participation in effective TB control. DESIGN: Quantitative assessment of tuberculosis care and cross-sectional assessment of qualitative measures in 14 community care organizations in Uganda, Zambia, South Africa and Malawi. RESULTS: The community care organizations assessed mainly provided care for human immunodeficiency virus (HIV) and aquired immune deficiency syndrome (AIDS) patients, and received funding from non-governmental organizations. Shortcomings in tuberculosis care included delays in diagnosis (which was often not based on sputum examination), drug shortages, low completion rates, high default rates, inadequate recording, little interaction with government tuberculosis programmes, and inadequate training of staff. However, one organization that provided primarily tuberculosis care and collaborated closely with the district tuberculosis programme and hospital attained a high treatment completion rate. The strong points of the community care organizations that favour a potential role of community participation in tuberculosis care were accessibility and staff motivation. CONCLUSION: Despite most community care organizations' shortcomings in tuberculosis care, they do have the potential to improve the care of tuberculosis patients, thus reducing the load on overstretched health facilities. Their potential impact on tuberculosis control depends on their population coverage and sustainability. HIV/AIDS community care organizations with strengthened management of tuberculosis care could serve as a model for expanded community participation in tuberculosis control. Operational research is needed to assess the feasibility and cost-effectiveness of community-based TB care.

AIDS-Related Opportunistic Infections↗

PubMed2025

Discovery of novel diagnostic biomarkers of hepatocellular carcinoma associated with immune infiltration.

OBJECTIVE: Diagnosis of hepatocellular carcinoma (HCC) remains challenging for clinicians. Machine learning approaches and big data analyses are viable strategies for identifying HCC diagnostic markers. MATERIALS AND METHODS: In this study, we downloaded mRNA expression profiles of HCC from the GEO database and used random forest and machine learning algorithms, such as least absolute shrinkage and selection operator, to screen for reliable diagnostic genes. Disease Ontology, Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Set Enrichment Analysis enrichment analyses were performed to explore differential gene functions and disease pathways. CIBERSORT was performed to calculate the immune cell infiltration of HCC and the correlation between diagnostic genes and immune cells. Cell experiments were performed to evaluate the function of R-spondin 3 (RSPO3) in HCC cells. Immunohistochemical staining was used to evaluate the protein expression of CD138, CD206 and iNOS. RESULTS: The results indicated that extracellular matrix protein 1 (ECM1), Niemann-Pick C1-Like 1 (NPC1L1) and RSPO3 were down-regulated in HCC compared with the normal group (p < 0.05), which was validated in clinical tissue samples. Moreover, ECM1, NPC1L1 and RSPO3 had high diagnostic values (AUC > 0.75) for HCC in both training and test groups. Immuno-infiltration analysis revealed that ECM1 and RSPO3 were highly positively correlated with neutrophil and macrophage M2 levels, whereas they were negatively correlated with Tregs. RSPO3-si affected cell proliferation and apoptosis in HCC. Furthermore, RSPO3 exhibited a positive correlation with tumour progression, the proportion of plasma cells and M2 macrophages in mice, while showing a negative association with M1 macrophages. CONCLUSION: The present study identified ECM1, NPC1L1 and RSPO3 as new diagnostic biomarkers for HCC based on normal and diseased samples from HCC, meanwhile the pro-oncogenic function of RSPO3 and its regulation on immune infiltration have been confirmed.

Carcinoma, Hepatocellular↗

PubMed2004

Moderate exercise may attenuate some aspects of immunosenescence.

BACKGROUND: Immunosenescence is related to the deterioration of many immune functions, which may be manifested in increased susceptibility to infection, cancer, and autoimmunity. Lifestyle factors, such as diet or physical activity, may influence the senescence of the immune system. It is widely accepted that moderate physical activity may cause beneficial effects for physical and psychological health as well as for the immune system activity in aged people. METHODS: Thirty elderly women aged 62 to 86 were subjected to a two-years authorized physical activity program. Peripheral blood lymphocytes distribution and the production of cytokines involved in the immune response development and regulation (IL-2, IL-4 and IFN-gamma) were investigated. The same parameters were evaluated in two control groups of women: a sedentary group of 12 elderly women selected for the second round of the physical activity program and in a group of 20 sedentary young women. Flow cytometry methods were used for the examination of surface markers on peripheral blood lymphocytes and intracellular cytokines expression. RESULTS: The distribution of the main lymphocytes subpopulations in the peripheral blood of elderly women did not show changes after long-term moderate physical training. The percentage of lymphocytes expressing intracellular IL-2 was higher in the group of women attending 2-years physical activity program than in the control group of elderly sedentary women, and it was similar to the value estimated in the group of young sedentary women. There was no difference in the intracellular expression of IL-4 and IFN-gamma between the active and elderly sedentary women. CONCLUSIONS: Our results suggest that moderate, long-term physical activity in elderly women may increase the production of IL-2, an important regulator of the immune response. This may help ameliorate immunosenescence in these women.

Journal Article↗

PubMedDate not supplied

Smallpox: a disease of the past? Consideration for midwives.

Smallpox infection was often more severe in pregnant women than in non-pregnant women or in men, regardless of vaccination status. Women with smallpox infection during pregnancy have higher rates of abortions, stillbirths, and preterm deliveries than women without the disease. Pregnant women have high incidences of hemorrhagic-type and flat-type smallpox, which are associated with extremely high fatality rates. Although smallpox was eradicated in the late 1970s, current international concern exists regarding the potential use of smallpox virus as an agent for bioterrorism. This manuscript reviews clinical aspects of smallpox, smallpox immunization, and outcomes in pregnant women.

Abortion, Spontaneous↗

PubMed1988

Physiological consequences of antiserum-mediated experimental demyelination in CNS.

To study the pathophysiology of immunologically mediated demyelination in the central nervous system (CNS), we injected 20 to 30 microliters of polyclonal antigalactocerebroside serum (AGC) into the lower thoracic dorsal column of the spinal cord in 20 Wistar rats. AGC-injected spinal cords contained areas of fascicular demyelination adjacent to the focus of axonal degeneration at the injection site. Somatosensory evoked potentials were recorded serially after tibial nerve stimulation. In 85% of AGC-injected animals, the following characteristics were observed by 3 days after injection: (1) decreased amplitude of the cortically generated potential (P15); (2) failure of transmission of high-frequency (50 Hz) impulses (rate-dependent block); (3) delayed conduction velocity of the compound action potentials through the lesion. None of these changes was seen in 90% of 20 rats injected with normal saline or control rabbit sera. In 7 rats with acrylamide-induced axonopathy or wallerian degeneration, the rate-dependent block was not observed. The onset of clinical symptoms (hindlimb ataxia) in AGC-injected rats was best correlated with development of the rate-dependent block. Clinical recovery was observed by 14 days after injection concurrent with restoration of P15 amplitude, when the rate-dependent block and decreased conduction velocities were unchanged. High-frequency-resistant conduction was re-established much later than clinical recovery in 3 rats. These findings suggest that failure of high-frequency impulse transmission may produce clinical symptoms and that a central adaptive mechanism to remodulated trains of impulses plays a role in clinical recovery from CNS demyelination.

Acrylamide↗

PubMed2003

Risk factors associated with neonatal tetanus in Ibadan, Nigeria--a revisit.

To identify major risk factors associated with recent occurrence of neonatal tetanus (NNT) in Ibadan Nigeria, 140 cases matched 1:1 with controls were recruited into the study from the major referral hospitals. Maternal age (<20 years), low paternal education, low socio-economic status, primiparity and delivery outside health facilities were associated with significantly increased risk for NNT. Lack of trained attendant at delivery, the type of instrument used to cut the cord and the presence of livestock within the family compound also significantly increased the risk for NNT. Antenatal clinic (ANC) was attended by 86.4% of mothers of cases but only 25.6% of these mothers received full immunization. Three out of four mothers of cases who attended ANC did so with a frequency of 5 to 20 times indicating missed opportunities for immunization. Data also suggest that the main reason for failure to receive full immunization was ignorance on the mothers' part, which reflects inadequate health education by the health system. The study case fatality rate was 79.4 percent. Risk factors observed in this population are generally known, indicating that the problem has not yet received adequate attention. Effort needs to be made towards providing the masses with formal education as well as health education, targeting the population at grass root level. Improving access to antenatal care services as well as improving the quality of these services; outreach efforts on immunization would contribute in no small measure to reducing the incidence of neonatal tetanus in this community.

Case-Control Studies↗

PubMed1983

Primary child care adapted to community needs.

Primary health care services for children should be adapted to the different and varying needs of the community. Specially trained nurses and other health workers can make an important contribution to the primary care of children.

Child↗

PubMed1995

Public health impact of Rwandan refugee crisis: what happened in Goma, Zaire, in July, 1994? Goma Epidemiology Group.

The flight of 500,000-800,000 Rwandan refugees into the North Kivu region of Zaire in July, 1994, overwhelmed the world's response capacity. During the first month after the influx, almost 50,000 refugees died, an average crude mortality rate of 20-35 per 10,000 per day. This death rate was associated with explosive epidemics of diarrhoeal disease caused by Vibrio cholerae 01 and Shigella dysenteriae type 1. 3-4 weeks after the influx of refugees, acute malnutrition rates among children under 5 years old ranged between 18 and 23%. Children with a recent history of dysentery and those in households headed by women were at higher risk of malnutrition. A well-coordinated relief programme, based on rapidly acquired health data and effective interventions, was associated with a steep decline in death rates to 5 to 8 per 10,000 per day by the second month of the crisis. The prevention of high mortality due to diarrhoeal disease epidemics in displaced populations relies primarily on the prompt provision of adequate quantities of disinfected water, basic sanitation, community outreach, and effective case management of ill patients. In the emergency phase, effective, low-technology measures include bucket chlorination at untreated water sources, designated defaecation areas, active case-finding through community outreach, and oral rehydration. Relief agencies must place increased emphasis on training personnel in relevant skills to address major public health emergencies caused by population displacement.

Child, Preschool↗

PubMed1995

Child health surveillance: enlarging the role of the family doctor.

The family doctor looks after the family as a unit of care. This includes not only curative care but also disease prevention and health promotion. One of the areas is child health. He is in an ideal position to participate in child health surveillance as a member of the primary health care team. The tasks involved in child health surveillance include growth monitoring, monitoring of developmental progress, prevention of disease by immunisation, health education, nutrition education, developmental guidance and injury prevention. To meet the expanding role of the family doctor in child health surveillance, he needs adequate training and continuing education.

Adolescent↗

PubMed2006

Resistance exercise does not affect the serum concentrations of cell adhesion molecules.

BACKGROUND: Cell adhesion molecules are proteins expressed on the surface of a variety of cells and mediate the leucocyte response to inflammation. Some of these molecules are released to the plasma as soluble forms, whose presence indicates the degree of vascular endothelial activation or dysfunction. Increased concentrations of soluble adhesion molecules are thought to hamper the immune response and mediate the atherosclerotic inflammatory process. Studies on the effect of exercise on the concentrations of soluble adhesion molecules have almost exclusively used aerobic exercise. AIM: To assess the effect of resistance exercise on the serum concentrations of five cell adhesion molecules during and immediately after 30 min of exercise in lean and obese participants. METHODS: Fourteen healthy young men (eight lean and six obese) performed 3 sets of 10 resistance exercises with 10-12 repetitions at 70-75% of one repetition maximum in a circuit training fashion. Venous blood samples were drawn at baseline and at the end of the first, second and third sets. The serum concentrations of vascular cell adhesion molecule-1, intercellular cell adhesion molecule-1, E-selectin, P-selectin and L-selectin were measured in a biochip array analyser. RESULTS: No significant changes were observed in the concentrations of these cell adhesion molecules during exercise, or between lean and obese participants. CONCLUSION: Our data indicate that resistance exercise of moderate to high intensity does not affect the serum concentrations of cell adhesion molecules in healthy young lean or obese men, suggesting no considerable negative effect on immune function.

Adult↗