Influenza vaccination: a collaborative effort to improve the health of the community.

BACKGROUND: The need to improve influenza vaccination delivery in our community became painfully clear during the winter of 1997-1998 when high rates of respiratory illness led to congestion in the emergency department and a critical shortage of hospital beds. In response, the local hospital and the Department of Health launched a collaborative program to increase influenza vaccine coverage in the community. METHODS: The partnership was designed to increase the number of citizens receiving influenza vaccine and to moderate the severity of lower respiratory tract illness during the winter season. A variety of methods were used to increase public awareness, enhance vaccine delivery, and create a relatively seamless service for the community. RESULTS: During three seasons, influenza vaccination rates increased by a relative 150%. This represented immunization of 16% of the entire community and more than 75% of residents older than 65 years. Hospital employee vaccination rates also rose from 34% to 58%. When compared with other hospitals in the county, the campaign reduced the average number of annual visits to the emergency department for all respiratory diagnoses by 34% and exacerbations of chronic obstructive pulmonary disease by 46%. CONCLUSIONS: This influenza vaccination program illustrates the potential for synergy that exists between local departments of health and community hospitals in successfully increasing vaccine delivery to the community. Furthermore, it also suggests that such efforts can be successful in reducing use of the emergency department, resulting in a positive impact on the health of the community.     

Effective prophylaxis for recurrent urinary tract infections during pregnancy.

Effective prevention of recurrent urinary tract infections (UTIs) and possible acute pyelonephritis is of major importance during pregnancy. During 39 pregnancies, 33 women with a history of recurrent UTIs (and, in some instances, pyelonephritis) received postcoital prophylaxis consisting of a single oral dose of either cephalexin (250 mg) or nitrofurantoin macrocrystals (50 mg). While 130 UTIs occurred during a mean observation period of 7 months before prophylaxis, only a single UTI occurred during pregnancy after prophylaxis; this difference was highly significant. Thus the use of one of these effective regimens is strongly recommended for any pregnant woman with a history of recurrent UTIs. The treatment's effectiveness can be explained by two features of the two antibacterial agents involved: both reach high bactericidal concentrations in the urinary tract and induce no (or minimal) resistance in the introital gram-negative bacterial flora.     

Vasoactive intestinal peptide (VIP) activation of nuclear protein kinase C in purified nuclei of rat splenocytes

We have examined the actions of vasoactive intestinal peptide (VIP) and certain other known immune modulators on a nuclear pool(s) of protein kinase C (PKC) in isolated rat splenocyte nuclei. Rat splenocyte nuclei pure by enzymatic and electron microscope criteria demonstrated a time- and concentration-dependent activation of nuclear PKC (nPKC) by VIP. A biphasic pattern of three bell-shaped curves was observed with peak phosphorylation at 10⁻¹⁵, 10⁻⁹ and 10⁻⁶M VIP. The phosphorylation of endogenous nuclear substrates was characterized as a PKC-mediated event by use of three known PKC inhibitors, 1-(5-isoquinolinylsulfonyl)-2-methylpiperazine (H-7), sphingosine, and staurosporine, which produced similar phosphate incorporation measurements. Also, this activity was blocked with the addition of a monoclonal antibody to PKC. Inhibitors of the ability of VIP to activate nPKC included somatostatin, 8-bromo-cAMP, peripheral benzodiazepine receptor modulators, and the PKC inhibitors, sphingosine and staurosporine. These data have direct relevance to our knowledge of cell-mediated immunity.     

Service needs of youths released from a state psychiatric facility as perceived by service providers and families

The following article reports on the results of service needs assessments of a cohort of youths released from a state psychiatric facility as perceived by service providers and families/caregivers. Families as well as service providers consistently agreed on three service areas of high need—psychotherapy for the child, family therapy and parent skill training. However, families perceived a need for a number of other services that are not traditionally provided by the mental health system such as after school recreation activities and self-help and support groups for the child. The discrepancies between service providers and families' perceptions of assessed needs may lead to families dropping out of service due to the unresponsiveness of the services in meeting their perceived needs. Steps that service providers need to take to be more responsive to the needs of families are discussed.This study was funded by a grant from the Office of Program Evaluation and Research, Ohio Department of Mental Health.     

In vivo MRI of cancer cell fate at the single-cell level in a mouse model of breast cancer metastasis to the brain.

Metastasis (the spread of cancer from a primary tumor to secondary organs) is responsible for most cancer deaths. The ability to follow the fate of a population of tumor cells over time in an experimental animal would provide a powerful new way to monitor the metastatic process. Here we describe a magnetic resonance imaging (MRI) technique that permits the tracking of breast cancer cells in a mouse model of brain metastasis at the single-cell level. Cancer cells that were injected into the left ventricle of the mouse heart and then delivered to the brain were detectable on MR images. This allowed the visualization of the initial delivery and distribution of cells, as well as the growth of tumors from a subset of these cells within the whole intact brain volume. The ability to follow the metastatic process from the single-cell stage through metastatic growth, and to quantify and monitor the presence of solitary undivided cells will facilitate progress in understanding the mechanisms of brain metastasis and tumor dormancy, and the development of therapeutics to treat this disease.     

Overcoming complications of breast implants.

Having nice breasts is important to many women and their self-images. For those women who have had congenital deformities, were not blessed naturally with the shape they wanted, have had experiences that have adversely affected breast tissue, or have had a mastectomy as a result of breast cancer, breast implants can provide a boost in self-confidence. This article provides an overview of breast implant issues and treatments, and reviews breast implant complications, their potential causes and treatments.