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PubMed2004

Parallels and distinctions between T and NKT cell development in the thymus.

NKT cells are emerging as an extremely influential regulatory subset of T lymphocytes that are functionally and developmentally distinct from their mainstream counterparts. Like other T cells, NKT cells are thymus-dependent but their apparently unique pathway of differentiation is poorly characterized. Given the strong association between NKT cell deficiency and increased incidences of autoimmunity and cancer it is imperative that the mechanisms by which NKT cells are generated becomes better understood. This review examines what is known about NKT cell development in the thymus and highlights elements of the pathway that differ significantly from mainstream T-cell development. It is here that NKT cell-specific disorders may originate and may best be addressed.

Animals↗

PubMedDate not supplied

Why cardioverter-defibrillator implantation might not be the best idea for your elderly patient.

Over the last decade, implantable cardioverter-defibrillators (ICDs) have become a part of mainstream clinical practice, with improvements in survival in a broad range of patients. Given the overall limited life expectancy of elderly patients, their frequent comorbidities, and the complications associated with ICD implantation, it may not be reasonable to expect results with ICD implantation in the elderly to be comparable to that found in the clinical trials. In this paper, the authors review the available scientific literature and discuss why mainstream ICD use in the elderly may not be advisable.

Aged↗

PubMed2004

Regulatory challenges to global harmonization and expanded access to concentrates: how will regulators balance the increasing cost of new safety requirements with the desire to increase the availability of affordable product?

The provision of concentrates of the deficient coagulation factors is an essential component of the provision of comprehensive haemophilia care. Their safety, quality and efficacy need to be assured independently of the measures dictated by the market and the individual manufacturers. Over the past 20 years, this assurance has become the role of regulatory authorities, which in the developed world have generated a framework that assesses haemophilia products as medicines in the highest category of risk relative to other therapeutic agents. Systems of official regulation mandating standards and other measures are now coupled with voluntary standards adopted by industry bodies as additional features of a comprehensive nexus of arrangements contributing to product quality and risk minimization. Currently, the regulation of products for haemophilia in less developed economies relies on reference to decisions in the first-world authorities. This may not always result in optimal outcomes as most of the haemophilia care in the developing world is through local plasma and cryoprecipitate, which are not subject to the oversight of mainstream regulators. Furthermore, the emergence of companies based outside the developed world and seeking to supply the emerging economies of the developing world with haemophilia concentrates has necessitated new strategies for regulation that are independent of the established frameworks. Overall, the principles used by mainstream agencies may be applied in all environments seeking to assure the quality of haemophilia care. Applied properly, they can contribute to maintaining the delivery of a form of therapy that is nowadays amongst the safest in therapeutic practice. A rigid interpretation can seriously impede access to treatment, and therefore the development of independent expertise and appropriate strategies in assuring product safety and quality in the developing world is essential if patient safety and access to products can be assured.

Blood Coagulation Factors↗

PubMed2006

Working across boundaries: clinical outcomes for an integrated mental health service for people with intellectual disabilities.

BACKGROUND: The Mental Health Service for People with Learning Disabilities (MHSPLD) is a service development in keeping with UK government policy that promotes cross agency working and access to mainstream mental health services for people with intellectual disabilities. We aimed to show whether the service model brought about improvements in people's mental state and level of functioning. METHODS: Community and inpatient groups were compared across three time points using a range of clinical outcome measures that assessed psychiatric symptoms, risk, needs and level of functioning. RESULTS: Inpatients and community groups had similar mental health problems, but inpatients had higher unmet needs and lower functioning, and were at greater risk. There were significant improvements across the range of outcome measures in both groups. CONCLUSIONS: Working with mainstream mental health services and across health and social service boundaries delivers effective mental health care for people with intellectual disabilities.

Activities of Daily Living↗

PubMed2005

Alternative futures for health economics: implications for nursing management.

As nursing has been subject to successive waves of 'managerialism' there has been a drive on the part of government and elements within the profession to enhance the science base and promote cost-effective health care interventions. This has generated new interest in the 'economics of nursing' as efficiency and 'value for money' are viewed as necessary precondition for the provision of a high quality nursing service. As an academic subject health economics has brought an elegant set of theories to bear on the topic of health and health care. However, mainstream health economics is premised on a series of simplifying assumptions that, if applied uncritically, can induce a range of unintended and adverse consequences. This paper asks how ideas developed in one sphere (health economics) can be become influential in another (nursing management and practice) and it seeks explanations in the theories of Michel Foucault, specifically in his exploration of the reciprocal relationship between power and knowledge. How are our assumptions about what is possible and desirable shaped, how far do mechanisms of surveillance and self-subjugation extend? A range of alternative economic approaches have been developed which challenge many mainstream health economics assumptions. Some of these are better suited to the complex social environment present within health care. Nurses, nurse managers and researchers should question the assumptions of dominant economic models and explore a range of economic frameworks when planning services and evaluating their practice.

Attitude to Health↗

PubMed1998

Vietnamese-speaking injecting drug users in Melbourne: the need for harm reduction programs.

While research on aspects of injecting drug use (IDU), including injecting and sexual risks for HIV transmission, has been progressing in 'mainstream' Australian populations, there has been little among non-English speaking background (NESB) communities in Australia, particularly the South-East Asian communities, of which the Vietnamese is the largest. This exploratory study employed and trained peer workers to recruit and interview IDUs of Vietnamese origin in Melbourne on a wide range of subjects related to risks associated with their drug using, as an initial assessment of risk-taking behaviours for blood-borne viruses among Vietnamese-speaking IDUs. A finger-prick blood sample was taken where possible to measure antibody status to HIV, HBV and HCV. The profile which emerged was not dissimilar to that of their English-speaking counterparts prior to the benefit of currently available harm-reduction programs. A relatively isolated group whose social world often related only to other Vietnamese-speaking drug users, they were engaging in unsafe sex and unsafe injecting and were unfamiliar with procedures for cleaning injecting equipment and where they could seek out information and services, including needle exchanges. This study has identified an urgent need not only to promote currently available information and services to this group, but also to provide culturally relevant education and other harm-reduction measures needed to prevent transmission of HIV, other BBVs and STDs. The study has highlighted the lack of responsiveness of mainstream health services to the needs of Vietnamese-speaking IDUs.

Adolescent↗

PubMed2001

Dirty questions: Indigenous health and 'Western research'.

OBJECTIVE: This paper explores both Indigenous and non-indigenous critiques of 'Western' research frameworks in an Aboriginal health context. It also discusses the 'reform' of Aboriginal health research practices since the 1980s, particularly in relation to the development of ethical guidelines. METHOD: The text is based on both archival research and a critical review of secondary literature. CONCLUSIONS AND IMPLICATIONS: It is argued here that efforts to reform the practices of mainstream Indigenous health research since the 1980s have oscillated between taking concrete steps towards actually changing research practice and placing too great a reliance on written guidelines and positive rhetoric. In offering this analysis, the paper argues for a more challenging conception of reforming mainstream research, involving an emphasis on shifts in institutional arrangements as well local research practices.

Australia↗

PubMed2003

A review of tobacco interventions for Indigenous Australians.

OBJECTIVE: To conduct a review of interventions to reduce the harm resulting from tobacco use among Indigenous Australians and to discuss the likely effect of a range of tobacco interventions if conducted in this population. METHODS: A systematic review of medical literature and an audit of information from 32 government departments, non-government organisations and indigenous health organisations, which was completed in March 2001. RESULTS: A number of small tobacco programs had been conducted. Only four tobacco interventions had been evaluated in indigenous communities: a trial of training health professionals in conducting a brief intervention for smoking cessation; a trial of a CD-ROM on tobacco for use with indigenous schoolchildren; a qualitative evaluation of the effect of a mainstream advertising campaign on Indigenous people; and a pilot study of smoke-free workplaces, evaluated by qualitative methods. None of these studies assessed smoking cessation as an outcome. Two of these studies were unable to conclusively show any effect of the interventions; training health professionals in delivering a brief intervention resulted in some changes to practice and the evaluation of the mainstream advertising campaign showed that following the campaign, knowledge about tobacco had increased. CONCLUSIONS: There was a major lack of research on and evaluation of tobacco interventions for Indigenous Australians. IMPLICATIONS: More research and evaluation is required to ensure that tobacco interventions are appropriate and effective for Indigenous people. It is time to cease chronicling the ill health of Indigenous Australians and time to ensure the availability of well-evaluated, effective tobacco programs.

Adolescent↗

PubMed2006

Financing climate change adaptation.

This paper examines the topic of financing adaptation in future climate change policies. A major question is whether adaptation in developing countries should be financed under the 1992 United Nations Framework Convention on Climate Change (UNFCCC), or whether funding should come from other sources. We present an overview of financial resources and propose the employment of a two-track approach: one track that attempts to secure climate change adaptation funding under the UNFCCC; and a second track that improves mainstreaming of climate risk management in development efforts. Developed countries would need to demonstrate much greater commitment to the funding of adaptation measures if the UNFCCC were to cover a substantial part of the costs. The mainstreaming of climate change adaptation could follow a risk management path, particularly in relation to disaster risk reduction. 'Climate-proofing' of development projects that currently do not consider climate and weather risks could improve their sustainability.

Developing Countries↗

PubMed1996

Social support as road map and vehicle: an analysis of data from focus group interviews with a group of African American women.

As part of a larger study of the impact of a social support intervention on pregnancy outcome for lower-income African American women, 6 African American women (a medical social worker, a physician's assistant, 2 community outreach workers, a lactation consultant, and a health project representative) participated in focus group discussions concerning the unique social support needs of lower-income African American women during pregnancy. Transcripts of focus group interviews were analyzed using qualitative content analysis. Emergent themes included strengths of African American communities, deficiencies in social support for many lower-income African American women, the meaning of pregnancy for African American women, the ability of many pregnant women to "make it" without visible means of support, young women's locations "inside" and "outside" of "mainstream" life, and the importance of social support as a mechanism for guiding and transporting "lost souls" back into the mainstream.

Black or African American↗

PubMed2002

An ecological perspective of breastfeeding in an indigenous community.

PURPOSE: To describe the sociocultural patterns that promote breastfeeding or weaning in the Ojibwe community, which has very low breastfeeding rates compared to the general population. DESIGN: A focused ethnographic approach with an ecological framework provided community level data. Semi-structured interviews (N = 52) were conducted in an urban Ojibwe community and with three groups of women: health or social service providers, women currently breastfeeding, or people who acted as resources. METHODS: Data were analyzed using an ethnographic approach. Group summaries were compiled and community-level patterns were identified. FINDINGS: Four patterns were identified that encompassed the influences of (a) Ojibwe and mainstream cultures (traditions), (b) communication-related barriers from a variety of sources (mixed messages), (c) socioeconomic issues (life circumstances) and (d) social support (nurturing and supporting). CONCLUSIONS: The values and practices of the studied group were not always congruent with those of the larger mainstream culture. Successful breastfeeding promotion and intervention programs based on culturally relevant perspectives are needed.

Anthropology, Cultural↗

PubMed2006

Acculturation and sexual function in Canadian East Asian men.

INTRODUCTION: Recent studies have demonstrated the importance of considering acculturation when investigating the sexuality of East Asian women in North America. Moreover, bidimensional assessment of both heritage and mainstream cultural affiliations provides significantly more information about sexual attitudes than simple unidimensional measures, such as length of residency in the Western culture. AIM: The goal of this study was to extend the findings in women to a sample of East Asian men. MAIN OUTCOME MEASURES: Self-report measures of sexual behaviors, sexual responses, and sexual satisfaction. METHODS: Euro-Canadian (N = 124) and East Asian (N = 137) male university students privately completed a battery of questionnaires in exchange for course credit. Results. Group comparisons revealed East Asian men to have significantly lower liberal sexual attitudes and experiences, and a significantly lower proportion had engaged in sexual intercourse compared with the Euro-Canadian sample. In addition, the East Asian men had significantly higher Impotence and Avoidance subscale scores on the Golombok Rust Inventory of Sexual Satisfaction, a measure of sexual dysfunction. Focusing on East Asian men alone, mainstream acculturation, but not length of residency in Canada, was significantly related to sexual attitudes, experiences, and responses. CONCLUSIONS: Overall, these data replicate the findings in women and suggest that specific acculturation effects over and above length of residency should be included in the cultural assessment of men's sexual health.

Acculturation↗

PubMed2003

Restriction of amino acid change in influenza A virus H3HA: comparison of amino acid changes observed in nature and in vitro.

We introduced 248 single-point amino acid changes into hemagglutinin (HA) protein of the A/Aichi/2/68 (H3N2) strain by a PCR random mutation method. These changes were classified as positive or negative according to their effect on hemadsorption activity. We observed following results. (i) The percentage of surviving amino acid changes on the HA1 domain that did not abrogate hemadsorption activity was calculated to be ca. 44%. In nature, it is estimated to be ca. 39.6%. This difference in surviving amino acid changes on the HA protein between natural isolates and in vitro mutants might be due to the immune pressure against the former. (ii) A total of 26 amino acid changes in the in vitro mutants matched those at which mainstream amino acid changes had occurred in the H3HA1 polypeptide from 1968 to 2000. Of these, 25 were positive. We suggest that the majority of amino acid changes on the HA protein during evolution might be restricted to those that were positive on the HA of A/Aichi/2/68. (iii) We constructed two-point amino acid changes on the HA protein by using positive mutants. These two-point amino acid changes with a random combination did not inhibit hemadsorption activity. It is possible that an accumulation of amino acid change might occur without order. (iv) From the analysis of amino acids participating in mainstream amino acid change, each antigenic site could be further divided into smaller sites. The amino acid substitutions in the gaps between these smaller sites resulted in mostly hemadsorption-negative changes. These gap positions may play an important role in maintaining the function of the HA protein, and therefore amino acid changes are restricted at these locations.

Amino Acid Sequence↗

PubMed2005

Perinatal and postnatal factors in very preterm infants and subsequent cognitive and motor abilities.

BACKGROUND: Many children born very preterm have cognitive and minor motor problems later, even if attending mainstream schools. OBJECTIVE: To examine associations between this suboptimal performance and perinatal and postnatal clinical factors. PARTICIPANTS AND METHODS: A geographically determined cohort of 280 infants born at less than 32 weeks gestation in 1991-92 in Liverpool, free of major disability and attending mainstream school at 7 years of age. A perinatal and postnatal data set were obtained from the clinical records retrospectively. Measurements of height, weight, and head circumference at 7 years were made, together with assessments of intelligence (Wechsler intelligence scale for children, IQ) and motor impairment (Movement assessment battery for children, MABC). RESULTS: Multiple regression analysis showed IQ at 7 years to be independently significantly related to gestation, persistence of the arterial duct (PDA), and head circumference at 7 years. MABC was only significantly related to gestation. PDA was related to periventricular haemorrhage (OR 2.7, 95% confidence interval (CI) 1.3 to 5.8) and parenchymal lesions including ventriculomegaly (OR 4.1, 95% CI 1.5 to 11.4). CONCLUSION: Cognitive ability in children born preterm is significantly related to gestation, but may also be related to the effects of PDA on early brain development, through either periventricular haemorrhage/ventriculomegaly or other disturbance of early brain growth.

Anthropometry↗

PubMed1995

Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters.

OBJECTIVE: To measure and compare perceived financial burden, use of services, and perceived unmet service needs of supporters of demented and non-demented elderly people. DESIGN: Comparison study of age and sex matched demented and non-demented elderly people and their supporters. SETTING: 25 primary health care teams in Dundee. SUBJECTS: 114 community resident elderly (age over 65) people with dementia, 114 age and sex matched comparators, and the main informal supporter of each elderly person. MAIN OUTCOME MEASURES: Carers' perceptions of financial impact of looking after an old person, service use (from a list of locally available services), unmet service needs, and needs for three types of generic service (help with supervision, housework, or personal care). RESULTS: Financial impact was low, except for extra household expense in the dementia group. There was significantly greater use of mainstream domiciliary and day care services in the dementia group. Dementia was nevertheless associated with a high level of unmet need, mainly for more mainstream support and help with supervision of the elderly person. CONCLUSION: Supervisory care for demented elderly people should be further developed within an expanded domiciliary service to meet supporters needs.

Aged↗

PubMed2004

Professional responsibilities of biomedical scientists in public discourse.

This article describes how a small but vocal group of biomedical scientists propagates the views that either HIV is not the cause of AIDS, or that it does not exist at all. When these views were rejected by mainstream science, this group took its views and arguments into the public domain, actively campaigning via newspapers, radio, and television to make its views known to the lay public. I describe some of the harmful consequences of the group's activities, and ask two distinct ethical questions: what moral obligations do scientists who hold such minority views have with regard to a scientifically untrained lay audience, and what moral obligations do mainstream newspapers and government politicians have when it comes to such views. The latter question will be asked because the "dissidents" succeeded for a number of years in convincing the South African government of the soundness of their views. The consequences of their stance affected millions of HIV infected South Africans severely.

Acquired Immunodeficiency Syndrome↗

PubMed2003

The Australian cigarette brand as product, person, and symbol.

OBJECTIVE: To examine, for dominant Australian cigarette brands, brand identity (overriding brand vision), brand positioning (brand identity elements communicated to the consumer), brand image (consumers' brand perceptions) and brand equity (financial value). DESIGN: Tobacco industry documents, articles from retail trade publications since 1990, and current brand advertising from retail trade publications were searched for information about Australian brands. RESULTS: Cigarette manufacturers benefit from their competitors' brand equity as well as their own. The industry sees Australian smokers as far less brand loyal and strongly oriented to "low tar". A few predominantly local brands dominate the market, with variation by state. Successful Australian brands exist in one of three categories: premium, mainstream, and supervalue. Their brand identity essence is as follows. Premium: quality. Mainstream: a good humoured "fair go" for ordinary Australians. Supervalue: value for money. All supervalue brand identities also include freedom, escape, mildness, an aspirational attitude, blue tones, and waterside scenes. Brand image and brand identity is frequently congruent, even when marketing is restricted, and brand image is generally more positive for a smoker's own brand. CONCLUSIONS: Tobacco control activities have undermined cigarette brand equity. Further research is needed regarding brand loyalty, low tar, and brand categories. Smokers may respond more positively to tobacco control messages consistent with the identities of their chosen brand, and brand-as-organisation elements may assist. Further marketing restrictions should consider all elements of brand identity, and aim to undermine brand categories.

Advertising↗

PubMed1995

Exposing young guinea pigs to sidestream tobacco smoke decreases rapidly adapting receptor responsiveness.

We exposed 21 young guinea pigs to 5 wk of either sidestream tobacco smoke (SS) or filtered air (FA). The exposure started on day 8 of life and ended at 41-45 days of life. The animals were then anesthetized, and lung rapidly adapting receptor (RAR) and slowly adapting receptor (SAR) activities and peak tracheal pressure (TP) were examined in response to mainstream smoke. SS exposure did not alter baseline RAR activity. Low-nicotine smoke increased RAR activity in the FA but not in the SS group. High-nicotine smoke increased RAR activity in both groups but more so in the FA than in the SS group. Baseline TP was lower in the SS group. Both low- and high-nicotine smoke increased TP but more so in the FA than in the SS group. The increase in RAR activity preceded the increase in TP. SS exposure increased baseline SAR activity but did not affect the variable responses of SARs to low- and high-nicotine smoke. We suggest that exposing guinea pigs to SS during development diminishes the responsiveness of RARs to acute inhalation of mainstream smoke.

Administration, Inhalation↗