Maternal understanding of diarrhoea-related dehydration and its influence on ORS use in Indonesia

Dehydration resulting from diarrhoea remains a significant cause of death for young children in developing countries such as Indonesia. Although Oral Rehydration Solution (ORS) is effective in preventing and treating dehydration, its use in home treatment is not widespread. This study sought to assess whether mothers' understanding of diarrhoea-related dehydration influenced their use of ORS in home treatment. One hundred mothers of children under the age of five years in rural Indonesia were surveyed using a structured questionnaire, administered in an interview format in their homes. Only 38 (38%) of the mothers surveyed could identify two or more correct signs of dehydration. Significant relationship was found between maternal knowledge of correct signs of dehydration and the use of ORS in home treatment (OR 3.36, 95% CI 1.24, 10.63). Resulting recommendations include improved health education programming for mothers of young children, as well as future programme evaluation and intervention studies.     

Modelling the epidemiology and transmission of Verocytotoxin-producing Escherichia coli serogroups O26 and O103 in two different calf cohorts

Mathematical models are constructed to investigate the population dynamics of Verocytotoxin-producing Escherichia coli (VTEC) serogroups O26 and O103 in two different calf cohorts. We compare the epidemiological characteristics of these two serogroups within the same calf cohort as well as the same serogroups between the two calf cohorts. The sources of infection are quantified for both calf cohort studies. VTEC serogroups O26 and O103 mainly differ in the rate at which calves acquire infection from sources other than infected calves, while infected calves typically remain infectious for less than 1 week regardless of the serogroups. Fewer than 20% of VTEC-positive samples are the result of calf-to-calf transmission. PFGE typing data are available for VTEC-positive samples to further subdivide the serogroup data in one of the two calf cohort studies. For serogroup O26 but not O103, there is evidence for unequal environmental exposure to infection with different PFGE types.     

Cost differences between academic and nonacademic hospitals: a case study of surgical procedures

Decreased public funding, a competitive healthcare market, and higher patient care costs have been blamed for the present financial challenges that confront academic health centers. The authors examined the costs associated with graduate medical education, particularly, indirect medical education expenses in the operating room. The results indicate that it is more costly for teaching hospitals to provide surgical care to patients in the operating room. The academic health center's indirect graduate medical expenses only covered a portion of the increased costs. If the missions of academic health centers are perceived as a public good, policy makers must design a system that more appropriately compensates academic health centers for the additional costs associated with surgical procedures in graduate medical education.     

Colorectal Cancer Screening Among Midwestern Community-Based Residents: Indicators Of Success

Screening reduces the rate of death and morbidity resulting from CRC. Although CRC screening rates are low relative to other cancer screening tests, rates appear to be increasing: In 2004, 57% of adults ≥ 50 years reported up-to-date CRC screening test use; 14 states and Washington DC showed rates in excess of 60%. Identification of indicators of success and challenges remaining are important for universal goal achievement. The purpose of this study was to identify system and individual-level indicators of up-to-date CRC screening in a geographic area that reports higher uptake rates. Random-digit-dialing methods were used to survey a population-based community sample (N = 1033) of Midwestern adults ages 50 to 79 for CRC screening uptake in spring 2005. Adjusted odds ratio estimates were obtained using multivariate logistic regression. In total, about 62.6% of the sample reported up-to-date CRC screening. Compliant attitudes toward physicians’ screening recommendations were important indicators for up-to-date CRC screening; other individual-level psychosocial factors included beliefs about testing responsibility and testing safety. Non-current CRC screening was linked with testing anxiety and lack of perceived need for healthy people to test. System-level indicators associated with up-to-date CRC screening included reliance on physicians as the primary source for health information, family/personal history of bowel disease, regular physician visits, and participation in other cancer screening tests, controlling for age. Although population-based studies generally emphasize health system-level factors, individual-level attitudes such as feelings of responsibility to screen and adherence to physicians’ screening recommendations are important contributors to up-to-date CRC screening patterns.     

Reduced anti-PRP antibody response to Hib immunisation in preterm (<32 weeks) UK infants who received inactivated polio (eIPV)

A vaccine containing inactivated polio (eIPV) (Pediacel) is now used in the UK. The effect of the eIPV on other components is not well understood. We studied Haemophilus influenzae type b (Hib) and tetanus responses in preterm infants, <32 weeks gestation at birth, immunised with the (then) standard UK primary vaccines and either oral polio vaccine (OPV) or eIPV and analysed the effect showing reduced Hib responses with eIPV.     

Corticosteroid treatment and functional improvement in Duchenne muscular dystrophy: long-term effect

OBJECTIVE: To determine and compare the long-term effects of prednisone and deflazacort on the functional status of children with Duchenne muscular dystrophy. DESIGN: A total of 49 boys with Duchenne muscular dystrophy, between the age of 12 and 15 yrs, who were observed over a 7-yr period were reviewed retrospectively. Eighteen had been treated with prednisone, 12 with deflazacort, and 19 had no drug treatment. All boys treated with steroids received medication for >2 yrs before losing their ambulation. Lower and upper limb motor functions, pulmonary function, prevalence of surgery for scoliosis, and side effects were compared. RESULTS: Boys in the steroid groups were significantly more functional and performed better on all tests than boys not treated (P < 0.05). There was no significant difference between the deflazacort- and prednisone-treated groups (P > 0.05). The number of boys having scoliosis surgery in treated groups was significantly less than nontreated boys (P < 0.05). The control group's pulmonary capacity was decreasing and significantly less than both prednisone- and deflazacort-treated boys. Both deflazacort and prednisone had beneficial effect on pulmonary function and scoliosis. Cataracts, hypertension, behavioral changes, excessive weight gain, and vertebral fracture were noted as serious side effects. CONCLUSIONS: Prednisone and deflazacort have a significant beneficial effect on slowing the disease progress. Their usage in Duchenne muscular dystrophy may prolong ambulation and upper limb function with similar potency. Both steroids also improve pulmonary function, in addition to delaying the need for spinal interventions, with similar therapeutic profiles.     

Selective alpha-2 adrenoceptor blockade by SK&F 86466: in vitro characterization of receptor selectivity

SK&F 86466 (6-chloro-N-methyl-2,3,4,5-tetrahydro-1-H-3-benzazepine) is a potent and selective antagonist at alpha-2 adrenoceptors. Prejunctional alpha-2 adrenoceptor antagonism can be demonstrated either by blockade of the alpha-2 adrenoceptor-mediated neuroinhibitory effect of clonidine or B-HT 920 in the guinea-pig atrium [receptor dissociation constant (KB) = 13-17 nM] or by potentiation of nerve-evoked release of [3H]norepinephrine from prelabeled guinea-pig atria, dog splenic artery or rabbit ear artery. Blockade of the postjunctional alpha-2 adrenoceptor was also seen, as demonstrated by a parallel shift to the right of the concentration-response curve for B-HT 920 as a constrictor agent in the dog saphenous vein. The KB for SK&F 86466 in this test system was 42 nM. The affinity of SK&F 86466 for the alpha-1 adrenoceptor is much lower, with a KB of 900 nM against norepinephrine-mediated constriction in the rabbit ear artery, or 1100 nM vs. SK&F 89748-induced constriction in the dog saphenous vein. The alpha-2/alpha-1 adrenoceptor selectivity ratio of SK&F 86466 is comparable to that obtained with agents such as yohimbine, making SK&F 86466 a useful tool for characterization of alpha-2 adrenoceptors and for investigation of their physiological role.