Are patient ratings of chronic pain services related to treatment outcome?

Consumer ratings of satisfaction with treatment are rarely used as measures of treatment outcome. This study examined the relationships between service ratings and psychometric outcomes of patients receiving pain-management services in a tertiary teaching hospital. A group of 122 patients who completed a multidisciplinary pain-management program rated their satisfaction with and effectiveness of services received and changes in their pain condition and quality of life (QOL). They also completed pre- and posttreatment measures of pain severity, pain interference, depression, and disability. Pain severity, pain interference, and depression significantly decreased following treatment. The patients' ratings of services were significantly associated with outcome measures. Pre- to posttreatment changes in pain severity and pain interference were associated with treatment satisfaction and effectiveness, improvement in pain condition, and QOL. Pre- to posttreatment change in disability was significantly related to ratings of treatment effectiveness, improvement in pain condition, and quality of life. The findings suggest that pain intensity, pain interference, and disability are important outcome dimensions of pain-management programs.     

Lysis of RNA tumor viruses by human serum: direct antibody-independent triggering of the classical complement pathway.

In earlier studies we found that human serum, but not serum from multiple other species, inactivated and lysed oncornaviruses from a number of diverse sources in the apparent absence of antibody. A detailed analysis of the role of the human complement (C) system in mediating this lytic process indicates that human C1q interacts directly, in the absence of immunoglobulin, with oncornaviruses. Binding of C1 via C1q in this manner leads to activation of C1r, C1s, and thus of the classical C pathway. Integrity of the classical pathway is an absolute requirement for lysis although activation of the alternative pathway considerably amplifies the amount of lysis obtained, possibly through involvement of the C3b-dependent feedback mechanism. Activation of C is accompanied by deposition of C components on the viral surface and lysis on completion of the C reaction sequence. Thus in this system, the C1q subunit of C1 subserves a specific recognition function normally associated with antibody. This ability of human serum to inactivate oncornaviruses may represent a natural defense mechanism operative in vivo which deters expression of intact oncornaviruses in human malignancies.     

Genetic mapping of two loci affecting DDT resistance in the malaria vector Anopheles gambiae

Resistance to the insecticide DDT in the mosquito vectors of malaria has severely hampered efforts to control this disease and has contributed to the increase in prevalence of malaria cases seen in recent years. Over 90% of the 300-500 million annual cases of malaria occur in Africa, where the major vector is Anopheles gambiae. DDT resistance in the ZAN/U strain of An. gambiae is associated with an increased metabolism of the insecticide, catalysed by members of the glutathione S-transferase (GST) enzyme family, but the molecular mechanism underlying this metabolic resistance is not known. Genetic crosses show that resistance is autosomal and semidominant. We have used microsatellite markers to identify two quantitative trait loci (QTL), which together explain over 50% of the variance in susceptibility to DDT in the ZAN/U strain of An. gambiae. The first locus, rtd1, is on chromosome 3 between markers H341 and H88 and has a recessive effect with respect to susceptibility. The second locus, rtd2 is on chromosome 2L, close to marker H325 and has an additive genetic effect. The markers flanking these two QTL have been physically mapped to An. gambiae polytene chromosomes. They do not coincide with any of the GST genes that have been cloned and mapped in this species. Characterization of these QTL will lead to a clearer understanding of the mechanisms of metabolic resistance to DDT.     

IMMUNOPATHOGENICITY AND ONCOGENICITY OF MURINE LEUKEMIA VIRUSES : I. Induction of Immunologic Disease and Lymphoma in (BALB/c x NZB)F1 Mice by Scripps Leukemia Virus

This report clearly demonstrates that a systemic lupus erythematosus (SLE)-like syndrome and lymphoma can be induced in immunologically normal (BALB/c x NZB)F₁ mice by infection of neonates with a murine leukemia virus (MuLV) (Scripps leukemia virus [SLV] 60A) isolated from NZB lymphoblasts. SLV 60A was titered in vitro (XC test) and administered to newborn and adult (BALB/c x NZB)F₁ mice over six log₁₀ dilutions. Propagation of MuLV in the newborn recipients was indicated by greatly elevated serum Mu gs-1 levels which were proportional to the dose of virus given. The SLE-like syndrome was characterized by antinuclear antibodies (ANA) and immune complex-type glomerulonephritis. ANA production was related to the dose of virus and reached the highest levels at 8–16 wk. The incidence of glomerulonephritis was also correlated with the dose of virus and reached nearly 50% in the animals given the highest virus dose. Both titers of ANA and incidence of glomerulonephritis were greater in females than in males, although the amounts of Mu gs-1 in sera of both sexes were equal. The incidence of direct Coombs' positivity was not significantly affected by inoculation of this virus. The incidence and time of onset of thymocytic lymphoma were linearly related to the amount of virus inoculated. High serum Mu gs-1 levels predicted lymphoma development and reflected increases in the amount of infectious virus in the spleen. No induction of tumors, autoimmunity, or high serum Mu gs-1 levels followed administration of SLV 60A to 6-wk old (BALB/c x NZB)F₁ mice or inactivated 60A or active AKR virus to newborns.     

Paracetamol for feverish children: parental motives and experiences

Objective

The sale of paracetamol products for children is increasing, and more children are accidentally given overdoses, even though the use of paracetamol against fever is still under discussion. This study explores Danish parents’ use of paracetamol for feverish children and their motives for this use.

Design

A cross-sectional survey using structured interviews.

Setting

Four general practices located in city, suburb, and rural area.

Subjects

A total of 100 Danish parents with at least one child under the age of 10 years.

Main outcome measures

Number of parents administering paracetamol to feverish children, situations triggering medication of a child, parental views regarding fever and effects of paracetamol, and sources of information on fever treatment.

Results

Three in four parents use paracetamol for feverish children, mainly to reduce temperature, to decrease pain, and to help the child fall asleep. Highly educated parents medicate more often than less educated. Parents often fear fever but this does not clearly affect their use of paracetamol. Many parents believe in perceived beneficial effects of paracetamol, such as increased appetite and well-being, better sleep, and prevention of fever seizures. These expectations of paracetamol influence parental use of the drug. Parents’ main source of information on fever and paracetamol is their general practitioner (GP).

Conclusions

Danish parents regularly treat feverish children with paracetamol. Although parents contact their GP for advice on fever treatment, paracetamol is sometimes given to children on vague indications. Clearer information for parents on when to give paracetamol as fever treatment may help regulate its use.Key Words: Antipyretic, children, family practice, fever, gender, paracetamol, parents, primary healthcareThe sale of child-friendly paracetamol products is increasing in Denmark, even though use of paracetamol as treatment of fever is still being debated.

• Parents give paracetamol to improve well-being, appetite, and sleep of feverish children – research only vaguely supports this use.
• Highly educated parents medicate more often than less educated.
• Danish parents’ main source of information concerning fever and its treatment is their general practitioner.

Fever is a common symptom in childhood and a frequent reason for parents to contact their general practitioner (GP) [1]. Antipyretics are widely used for treating feverish children [2–5]. In Denmark, the most common antipyretic substance for children is paracetamol. The sale of child-friendly paracetamol products, i.e. suppositories and mixtures, has increased 23% in the last five years (55.9–68.4 defined daily doses (DDD)/1,000 inhabitants/year) [5,6].Paracetamol is considered a safe drug when taken in prescribed doses; however, overdosing may cause liver failure and death. Recent studies also show that intoxication in children happens after repeated doses only slightly above recommendations [7]. The number of Danish children (aged 0–11 years) hospitalized with paracetamol or acetylsalicylic acid (ASA) poisoning has increased from 23 in 1997 to 81 in 2006 [8].The use of paracetamol against fever is still under discussion [9,10]. Fever involves discomfort; however, the rise in body temperature is believed to assist the immune response against infection [11,12]. A minority of children experience fever seizures; these are often frightening to parents, but today if short-lasting they are considered benign [13]. Paracetamol has shown to be an effective analgesic and antipyretic; however, it is still unclear if the drug increases the well-being, the sleep, or the appetite of a feverish child [14–16]. Paracetamol has not yet proved effective in preventing fever seizures [13,17,18]. Conversely, no studies have documented a positive effect of not giving paracetamol to feverish children. NICE guidelines recommend use of paracetamol mainly in cases of fever and discomfort or pain [19].Internationally, numerous parents regularly give paracetamol against fever [2,3,20]. The most frequent reason for giving the drug to a feverish child is simply to lower the temperature. Some parents believe that paracetamol relieves their children of discomfort, and gives them more appetite and energy. [3,20,21]. Additionally, paracetamol may be a way of coping with a sick child in a busy daily life [20].Some parents fear that fever might harm their child by causing seizures, brain damage, and even death, if the temperature is high or rapidly rising. This unrealistic fear, termed fever phobia, may be linked to the wide use of antipyretics among parents [22–24]. For some parents fever is considered the disease in itself, and paracetamol is believed to cure the child [20].This study aimed at exploring:

1. to what extent and in which situations parents give their children antipyretics;
2. if parental views of the effects of paracetamol are consistent with existing evidence, and if their views influence the use of the drug;
3. if fever phobia is present among parents and if it motivates them to give paracetamol;
4. where parents seek information on handling a feverish child.

     

Student perceptions of a community engagement experience: exploration of reflections on social responsibility and professional formation

Physical therapy educators are challenged to emphasize the importance of social responsibility as a vital curricular element of professional development. Through reflection, students are able to identify core values, beliefs, and attitudes as part of the professional development process. The purpose of this study was to explore student perceptions and values of a community engagement experience based upon frequency of participation. This qualitative research report investigated student perceptions of the community experience following participation. Data collection tools included an open-ended questionnaire and focus group interviews. Comparisons were made across data for participants who engaged in the activity one time versus multiple times. Data analysis revealed participation in the community engagement experience had a positive impact on most participants. One time only participants demonstrated increased self-awareness, contemplating change, and capacity to serve while more than one time participants described a deeper understanding of community, impact on others, and professional transformation. Student involvement in community engagement activities combined with structured reflection provided meaningful insight into participants' personal beliefs. The results suggest incorporation of community-based learning experiences into academic curriculum may be beneficial in the students' preliminary understanding of social responsibility.