How in the world is WHO doing?

The World Health Organization has chalked up some impressive victories in its 43 years but is nowhere near reaching its ambitious goal of "Health for All by the Year 2000." Uphill battles against some intractable health conundrums and shrinking financial resources face the Geneva, Switzerland-based organization, threatening its stated goal of guaranteeing universal health care within the decade.     

The cardiovascular and metabolic effects of bench stepping exercise in females.

The purpose of this investigation was to measure cardiovascular and metabolic responses to 20 min continuous bouts of "choreographed" bench stepping exercise in healthy females. Four frequently used bench heights were employed in a cross-over design: 15.2 cm (6 inches, B-6), 20.3 cm (8 inches, B-8), 25.4 cm (10 inches, B-10), and 30.5 cm (12 inches, B-12). Oxygen uptake (VO2) responses were significantly more pronounced in direct relationship to the bench height: B-12 greater than B-10 greater than B-8 greater than B-6 (P less than 0.05). Mean responses for VO2 ranged from 28.4 ml.kg-1.min-1 for B-6 to 37.3 ml.kg-1.min-1 for B-12. Interestingly, no difference was revealed for heart rate and the respiratory exchange ratio between B-12 and B-10 despite a higher VO2 for B-12 (B-12, B-10 greater than B-8 greater than B-6, P less than 0.05). The incorporation of 0.91 kg (2 lb) hand weights with exercise on the 20.3 cm bench elicited a modest but statistically significant increase in VO2 compared with no hand weights. No significant increase in VO2 was revealed for conditions that employed 0.45 kg (1 lb) hand weights. The results demonstrate that aerobic bench stepping is an exercise modality that provides sufficient cardiorespiratory demand for enhancing aerobic fitness and promoting weight loss in females.     

A review of computerized tomography evaluation of acetabular fractures--part 1

Computerized tomography is an established modality for use in the evaluation of acetabular fractures. As open reduction and internal fixation of acetabular fractures becomes more common, the need for an accurate understanding of the fracture anatomy is critical. An anatomic study of the innominate bone is reported and the relevant standard radiographic landmarks as seen with computerized tomography are illustrated.     

Single-dose tolerance to the behavioral effects of dibutyryl cyclic AMP in mice

The behavioral effects of varying doses of intraperitoneally administered dibutyryl cyclic AMP, cyclic AMP, adenosine, 5-AMP, and butyric acid were studied in male ICR mice. Behavioral parameters 25 min following treatment included measurement of spontaneous locomotor activity (SLMA) and rotarod performance, the latter providing an indication of neuromuscular coordination. Dibutyryl cyclic AMP produced a dose-related inhibition of SLMA with the largest dose, 75 mg/kg, decreasing activity by 89%. Adenosine and 5-AMP produced maximal inhibition of approximately 50–80% of SLMA at doses ranging from 75–250 mg/kg, while cyclic AMP decreased SLMA by 58% at only the highest dose, 250 mg/kg. Butyric acid failed to produce alterations in SLMA at doses ranging from 25–250 mg/kg. No compound altered neuromuscular coordination. Single-dose tolerance to the inhibitory effect of dibutyryl cyclic AMP on SLMA developed within 3 h and lasted at least 7 days. Adenosine failed to produce tolerance while cyclic AMP and 5-AMP exhibited only a slightly reduced effect following a second injection at intervals of 4 and 24 h. These results suggest that exogenous administration of dibutyryl cyclic AMP and its metabolites exert centrally mediated behavioral effects with selective development of single-dose tolerance to the dibutyryl derivative.     

Gender differences in supported employment

Questions about gender equity have been asked in many aspects of the disability field and have resulted in findings that women with disabilities have significantly different experiences than do men. We analyzed an existing database of information on supported employment and natural supports to ascertain whether gender plays an important role in the employment of people with mental retardation. The findings suggest that there are several important differences. Although women were perceived as being more socially appropriate on several dimensions, they worked in jobs traditionally stereotyped by gender. Women also typically worked fewer hours than did men and, therefore, earned less money, although not statistically significantly so. The pattern of findings suggests parallels with the broader society.     

Running and cocaine both upregulate dynorphin mRNA in medial caudate putamen

Physical activities such as long-distance running can be habit forming and associated with a sense of well-being to a degree that justifies comparison with drug-induced addictive behaviours. To understand molecular similarities and dissimilarities controlling these behaviours in humans we compared the effects of running in running wheels to the effects of chronic cocaine or morphine administration on mRNA levels in brain reward pathways in the inbred Fischer and Lewis rat strains. These strains are both inbred from the Sprague-Dawley strain; Lewis rats display a higher preference towards addictive drugs and running than do Fischer rats. After chronic cocaine or running a similar increase of dynorphin mRNA in medial caudate putamen was found in the Lewis rat, suggesting common neuronal adaptations in this brain region to both cocaine and running. Fischer and Lewis rats both responded to cocaine with increased dynorphin mRNA levels in medial caudate putamen. However, only Lewis rats increased dynorphin mRNA after running, possibly reflecting the much higher degree of running by the Lewis strain as compared to the Fischer strain. Moreover, the running-induced upregulation of dynorphin mRNA was blocked by the opioid receptor antagonist naloxone. We suggest that running increases dynorphin mRNA by a mechanism that involves endogenous opioids. The voluntary wheel-running model in rats might be used to study natural reward and compulsive behaviours and possibly also to screen candidate drugs for treatment of compulsive disorders.     

Babesiosis in a renal transplant recipient acquired through blood transfusion

BACKGROUND: The success of organ-replacement therapies has resulted in a population of chronically immunosuppressed but active people who experience increased vulnerability to tick-borne zoonoses. Several of these infections may be life threatening. Human babesiosis is an emerging zoonosis that is transmitted by the same tick that transmits Lyme disease and human granulocytic ehrlichiosis. METHODS: We briefly review these zoonoses and present a case of a renal transplant recipient who survived infection by Babesia microti contracted through blood transfusion. RESULTS: A recipient of a living-related renal transplant developed acute postoperative hemolytic anemia. The etiology of this anemia was diagnosed by peripheral red blood cell smear as Babesia microti. The patient was managed by a reduction in transplant immunosuppressive therapy and administration of clindamycin and quinine antimicrobials. CONCLUSIONS: Transplant patients may contract babesiosis after tick exposure and/or via blood transfusion. The diagnosis of babesiosis may be confused with malaria and should be included in the differential diagnosis of posttransplant hemolytic-uremic syndrome in organ transplant patients.     

Treatment of children and adolescents with stage II testicular and stages I and II ovarian malignant germ cell tumors: A Pediatric Intergroup Study--Pediatric Oncology Group 9048 and Children's Cancer Group 8891.

PURPOSE: To determine whether children with localized gonadal malignant germ cell tumors (MGCT) stage II testicular and stages I and II ovarian treated with four cycles of standard-dose cisplatin combined with etoposide and low-dose bleomycin (PEB) have an event-free survival (EFS) of at least 85% without significant toxicity. PATIENTS AND METHODS: Between May 1990 and July 1995, eligible pediatric patients with stage II or recurrent from stage I (as a stage II) testicular MGCT and stages I and II ovarian MGCT were enrolled onto this Pediatric Oncology Group and Children's Cancer Group study. PEB chemotherapy consisted of bleomycin 15 U/m2 on day 1, cisplatin 20 mg/m2/d on days 1 to 5, and etoposide 100 mg/m2/d on days 1 to 5. Patients received four cycles of therapy at 21-day intervals. RESULTS: Seventy-four patients with a median age of 10.5 years (range, 8.7 months to 16.7 years) were enrolled. Primary sites included: stage II testicular (n = 17), stage I ovarian (n = 41), and stage II ovarian MGCT (n = 16). Treatment with standard PEB resulted in 6-year EFS of 95% and overall survival (OS) of 95.7%. EFS and OS by primary site were as follows: stage II testicular, 100% and 100%; stage I ovarian, 95.1% and 95.1%; and stage II ovarian, 87.5% and 93.8%, respectively. Two patients died from recurrent disease, and one patient died of secondary acute myelocytic leukemia. Infrequent grade 3 to 4 hematologic toxicity was reported. No grade 3 to 4 renal, pulmonary, or ototoxicity was observed. CONCLUSION: Combination chemotherapy with PEB results in excellent EFS and OS with minimal toxicity in children and adolescents with localized gonadal MGCT.