Immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children

Objective: To determine the immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children in north Queensland.
Methodology: A cross-sectional survey of immunity in a sample of children; 101 fully vaccinated Aboriginal and Torres Strait Island children, with a median age of 24.5 months, from 10 communities in North Queensland participated in this study. The main outcome measures were the prevalence of adequate antibody levels against hepatitis B, poliomyelitis and measles.
Results: Only 54% (95% Cl 44–63%) of the children had adequate immunity (10 m iu/mL) to hepatitis B, and one child had been infected despite vaccination. Although all the children (95% Cl 96–100%) had adequate immunity (i.e. neutralizing antibodies at a dilution of 1:8) to poliovirus 2, only 93% (95% Cl 86–96%) and 60% (95% Cl 50–69%) had adequate immunity to polioviruses 1 and 3, respectively. Nearly all (96%; 95% Cl 90–98%) of the children had adequate immunity (i.e. detectable IgG antibody) to measles.
Conclusions: Although a relatively low proportion of the children had adequate antibody levels against hepatitis B the clinical significance of this observation is uncertain. Further studies are needed to determine whether fully vaccinated Torres Strait Island children have been adequately protected and whether they require a booster dose of hepatitis B vaccine. A substantial proportion of fully vaccinated Aboriginal and Torres Strait Island children are inadequately protected against poliomyelitis, and therefore any such child with acute flaccid paralysis should be investigated fully for poliomyelitis. Vaccinated Aboriginal and Torres Strait Island children are well protected against measles, as are other Australian children.     

Magnetic resonance angiography findings in the early post-carotid endarterectomy period

This preliminary study was designed to investigate the ability of multiple axial volume three-dimensional fourier transform (3DFT) time-of-flight (TOF) magnetic resonance angiography (MRA) to depict the carotid bifurcation in the early post-carotid endarterectomy period. Five patients underwent intra-operative digital subtraction angiography (DSA) and carotid MRA within 5 days of carotid endarterectomy. An axial volume fast imaging in steady-state precession (FISP) gradient-echo 3DFT TOF carotid MRA technique in this limited series appeared to display accurately the surgically significant abnormalities at the carotid bifurcation after endarterectomy. However, in normal or near-normal intra-operative DSA studies, overestimation of internal carotid artery stenoses was encountered. Postoperative MRA demonstrates potential as a useful non-invasive investigation after carotid endarterectomy but should be interpreted with caution until larger studies become available.     

Precaution: belief, regulatory system, and overarching principle

The precautionary principle has been incorporated as a belief statement in international agreements for more than a decade. The 1998 Wingspread definition of the principle was the first to bring together four components that, in the past two years, have formed the elements of a broader, overarching approach to precaution that is a robust basis for its specific implementation: prompt action even in the face of scientific uncertainty, burden of proof and persuasion on proponents of potentially hazardous technologies, assessment of alternatives, and transparency. This broad approach to precaution is in direct conflict with the simplistic, easily manipulated principles and methods of risk-assessment-based risk management being exported by U.S. officialdom. In contrast to risk assessment, precaution, broadly defined, incorporates the full range of human intelligence in the task of protecting human health and the environment: flexibility, foresight, fairness, thoughtful consideration, and honesty.     

The prevalence, clinical relevance, and public health significance of subthreshold depressions.

Scientific evidence has accumulated during the last 15 years establishing that SD symptoms have a high prevalence in the general population and in clinically depressed patient cohorts studied cross-sectionally or followed longitudinally. The clinical relevance and public health importance of SD symptoms were confirmed when various investigators, including the authors' group at University of California, San Diego, found that SD symptoms are associated with a significant and pervasive impairment of psychosocial function when compared to no depressive symptoms. There is strong evidence that all levels of depressive symptom severity of unipolar MDD are associated with significant psychosocial impairment, which increases significantly and linearly with each increment in level of symptom severity. It is only when MDD patients are completely symptom free that psychosocial function returns to good or very good levels. The disability associated with depression is state dependent, and disability returns to good or normal levels only when all of the depressed patients' symptoms abate, because disability is present when even a few symptoms (i.e., SD symptoms) are detected. There is strong evidence during the long-term course of illness that major, minor, dysthymic, and subsyndromal symptoms wax and wane within the same patient and that these symptomatic periods are interspersed in the overall course with times when patients are remitted and symptom free. The modal longitudinal symptom status of MDD patients involves primarily subthreshold depressive symptoms, which are much more common than symptoms at the syndromal MDE level. The longitudinal systematic examination of the clinical relevance and high prevalence of SD symptoms helped establish the fact that the long-term symptomatic expression of MDD is dimensional, not categorical, in nature. Abatement of SD symptoms is of fundamental importance in defining full remission or recovery of MDEs. Ongoing residual SD symptoms during the recovery periods after an MDE are associated with psychosocial disability, more rapid MDE relapse, and a more severe chronic future course of illness, all of which indicate that when residual SD symptoms are present the MDE has not fully remitted and the disease is still active. When all depressive symptoms of an MDE abate for a minimum of 8 weeks, then full remission has been achieved. MDE remission defined in this way is associated with significant delay or even prevention of future episode relapse and a less severe, relapsing, and chronic future course. The authors submit that the research reviewed in this article heralds a new paradigm in understanding the progression of clinical depression through various overlapping stages of severity, which begin at the seemingly "subclinical" level of depressive symptoms. This conceptualization in turn dictates a public health approach, which emphasizes that treatment of MDD even at the deceptively mild levels of symptoms should be initiated or maintained.     

Environmental influences on energy balance-related behaviors: A dual-process view

Background  

Studies on the impact of the 'obesogenic' environment have often used non-theoretical approaches. In this journal's debate and in other papers authors have argued the necessity of formulating conceptual models for differentiating the causal role of environmental influences on behavior.     

Long-term results of the lateral tunnel Fontan operation

OBJECTIVES: Completion of a total cavopulmonary anastomosis with an intra-atrial lateral tunnel is known to yield good early and midterm results. In this study, we sought to determine the long-term outcome (10 years) after a lateral tunnel Fontan procedure. METHODS: Between October 1987 and December 1991, 220 patients (aged 11 months to 32 years) with a wide range of underlying diagnoses underwent a fenestrated or nonfenestrated lateral tunnel Fontan procedure at our institution. Current follow-up information was available for 196 patients (94%, mean follow-up = 10.2 +/- 0.6 years). Risk factor analysis included patient-related and procedure-related variables, with death, failure, and bradyarrhythmia or tachyarrhythmia as outcome parameters. RESULTS: There were 12 early deaths (<30 days or hospital death), 7 late deaths, 4 successful takedown operations, and 4 heart transplantations. Kaplan-Meier estimated survival was 93% at 5 years and 91% at 10 years, and freedom from failure was 90% at 5 years and 87% at 10 years. Freedom from new supraventricular tachyarrhythmia was 96% at 5 years and 91% at 10 years; freedom from new bradyarrhythmia was 88% at 5 years and 79% at 10 years. Three patients had evidence of protein-losing enteropathy. Multivariable risk factors for development of supraventricular tachyarrhythmia included heterotaxy syndrome, atrioventricular valve abnormalities, and preoperative bradyarrhythmia. Risk factors for bradyarrhythmia included systemic venous anomalies. The sole risk factor for late failure was a previous coarctation repair. CONCLUSION: The lateral tunnel Fontan procedure results in excellent long-term outcome even when used in patients with diverse anatomic diagnoses. The incidence of atrial tachyarrhythmia is low and mainly depends on the underlying cardiac morphology and preoperative arrhythmia. The good long-term outcome after an intracardiac lateral tunnel Fontan procedure should serve as a basis for comparison with other surgical alternatives.     

The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly,design of a cluster randomized controlled clinical trial

Background  

The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly.     

Model of normal prepubertal growth

Overheating may cause terminal apnoea and cot death. Rectal temperature and breathing patterns were examined in normal infants at home during the first 6 months of life. Twenty one infants had continuous overnight rectal temperature and breathing recordings for 429 nights (mean 20.4 nights, range 7-30) spaced over the first six months of life. Periods when breathing was 'regular' were directly marked on single night records. Sleep state was determined from respiratory variables. 'Regular' breathing was a reliable marker of 'quiet' sleep (specificity 93%). The duration of 'quiet' sleep increased from 6 to 22 minutes from two weeks to three months of age and then remained static, as did the proportion of sleep spent in the quiet phase (9% to 34%). Rectal temperature fell during 66% of quiet sleep and usually rose during rapid eye movement (REM) sleep. The drop in rectal temperature was maximal at the start of quiet sleep, whereas the maximum rise during REM sleep was reached after 10 to 15 minutes. Oscillations in rectal temperature are associated with changes in sleep and breathing state. The maturation of rectal temperature patterns during the first six months of life are closely related to a maturation of sleep state and breathing patterns.