Evaluation of human antibody responses to diphtheria toxin subunits A and B in various age groups

This study aimed to evaluate human antibody responses to diphtheria toxin subunits in various age groups. Antibodies against the intact diphtheria toxin and the diphtheria toxin subunits A and B were evaluated in 1319 individuals using a double-antigen ELISA. Although high levels of protection (83.6%, 95% CI 79.2-87.4) were found in children and adolescents, the middle-aged adult population was less protected (28.8%, 95% CI 24.3-33.6). An increase in age was associated with a decrease in the frequency of protected individuals in the 0-39-year age group (p <0.001). Anti-subunit B levels correlated well (p <0.01) with levels of antibodies against the intact toxin. In children aged < or =16 years, the intervals at which the peaks in geometric mean titres of anti-subunit B antibodies were observed were found to correlate with the ages at which booster doses are administered. Overall, males appeared to be more protected than females (OR 1.67, 95% CI 1.34-2.08, p <0.001). A small group of individuals had antibody levels of > or =0.1 IU/mL against the intact toxin, but did not have protective antibody against subunit B. Determination of anti-subunit B antibody levels should help in evaluating the effectiveness of diphtheria boosters and other aspects of diphtheria immunity.     

Pharmaceutical Policy and the Lay Public*

Almost every national and supranational health policy document accords high importance to the need to listen to and ‘empower’ patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient organisations, industry and, most recently, the media. Although the overall aim of health and pharmaceutical policy is to address the needs of all citizens, there are only a few, well organised groups who are actually consulted and involved in the policymaking process, often with the support of the industry. The reasons for this lack of citizen involvement in health and pharmaceutical policymaking are many, for example: there is no consensus about what public involvement means; there is a predominance of special interest groups with narrow, specific agendas; not all decision makers welcome lay participation; patients and professionals have different rationalities with regard to their views on medicine. Because the lay public and medicine users are not one entity, one of the many challenges facing policy makers today is to identify, incorporate and prioritise the many diverse needs. The authors recommend research which includes studies that look at: lay attitudes towards pharmaceutical policy; lay experiences of drug therapy and how it affects their daily lives; the problem of identifying lay representatives; the relationship between industry and the consumers; the effect of the media on medicine users and on pharmaceutical policy itself. The authors acknowledge that although lay involvement in policy is still in its infancy, some patient organisations have been successful and there are developments towards increased lay involvement in pharmaceutical policymaking. This article is the fourth in a series of articles on this topic that will appear in Pharmacy World & Science during 2005.     

On the significance of remodeling space and activation rate changes in bone remodeling

This paper quantifies the relative contributions of the remodeling space and the accumulation of Haversian canals to bone porosity at various ages. It also examines the importance of variations in the rate of bone remodeling that occur during growth and aging, and as a result of trauma and disease. The dependence of the remodeling space (cavities due to resorbing, reversing, and refilling BMUs) and the Haversian canal components of porosity on the Basic Multicellular Unit (BMU) activation frequency are mathematically formulated. A graph is developed using data for the cortex of the human rib which shows the extent to which porosity is primarily due to the remodeling space in children, and to accumulated Haversian canals in adults. It is shown that the diminution of activation frequency between birth and age 35 contributes to the concurrent increase in bone volume fraction, and the increase in activation frequency after age 35 contributes to the subsequent decline of bone volume fraction. An equation is derived for determining the time rate of change of activation frequency using two fluorochrome labels.     

汉正街特需医疗卫生服务需求探析

本文选择汉正街作个体户人群特需医疗卫生服务需求的典型调查。遁过432例分析及与调查人群平均需求率比较,揭示出个体户人群疾病频率低、文化层次低、自费医疗多的卫生现状,以及个体户人群的特需需求率较低和倾向预防性特需服务的需求特征。本文较多地讨论了个体户人群卫生现状、卫生需求的特性及共性,较深地思考了对个体户人群开展特需服务的策略。并结合医学社会化的大趋势理论,指出特需服务的可行和必行。     

Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome

Objectives: This study examines the efficacy of the predicting power for hospital mortality and functional outcome of three different scoring systems for head injury in a neurosurgical intensive care unit (NICU). Design: On the day of admission, data were collected from each patient to compute the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II and III, and Glasgow Coma Scale (GCS) scores. Hospital mortality was defined as the deaths of patients before discharge from hospital. Early mortality was defined as death before the 14th day after admission. Late mortality was defined as death after the 15th day from admission. Functional outcome was evaluated by Index of Independence in Activities of Daily Living (Index of ADL). Setting: An 8-bed NICU in a 1270-bed medical center in Taichung Veterans General Hospital. Patients and participants: Two hundred non-selected patients with acute head injury were included in our study in a consecutive period of 2 years. Patients less than 14 years old were not included. Interventions: None. Measurements and results: Sensitivity, specificity and correct prediction outcome were measured by the chi-square method in three scoring systems. The Youden index was also obtained. The best cut-off point in each scoring system was determined by the Youden index. The difference in Youden index was calculated by Z score. A difference was also considered if the probability value was less than 0.05. The area under Receiver Operating Characteristic (ROC) curve was computed. Then the area under ROC of each scoring system was compared by Z score. There was statistical significance if p was less than 0.05. For prediction of hospital mortality, the best cut-off points are 55 for APACHE III, 17 for APACHE II and 5 for GCS. The correct prediction outcome is 82.4% in APACHE III, 78.4% in APACHE II and 81.9% in the GCS. The Youden index has best cut-off points at 0.68 for APACHE III, 0.59 for APACHE II, and 0.56 for GCS. The area under Receiver Operating Characteristic (ROC) curve is 0.90 in the APACHE III, 0.84 in the APACHE II and 0.86 in the GCS. There are no statistical differences among APACHE III and II, and GCS in terms of correct prediction outcome, Youden Index and the area under the ROC curve. Other physiological variables excluding GCS in APACHE III and II (AP III-GCS, AP II-GCS) have less statistical value in the determination of mortality for acute head injury. For the prediction of late mortality, APACHE III and II yield significantly better results in the area under the ROC curve, correct prediction and Youden index than those of GCS. Other physiological variables (AP III-GCS and AP II-GCS) play an important role in the prediction of late mortality in APACHE scores. For prediction of the functional outcome of surviving patients with acute head injury, the APACHE III yields the best results of correct prediction outcome, Youden index and the area under the ROC curve. Conclusion: The APACHE III and II may not replace the role of GCS in cases of acute head injury for hospital or early mortality assessment. But for prediction of the late mortality, the APACHE III and II have better accuracy than GCS. Other physiological variables excluding GCS in the APACHE system play a crucial contribution for late mortality. GCS is simple, less time-consuming and economical for patients with acute head injury for the prediction of hospital and early mortality. The APACHE III provides better prediction for severe morbidity than GCS and APACHE II. Therefore, the APACHE III provides a good assessment not only for hospital and late mortality, but also for functional outcome. Received: 22 May 1995 Accepted: 2 September 1996     

Association of a genetic polymorphism in human apolipoprotein B-100 with intermediate density lipoprotein concentrations

Immunochemical techniques have been used to identify five antigenic (Ag) sites on apolipoprotein B-100 (apoB), the major protein constituent of very low density (VLDL), intermediate density (IDL), and low density lipoproteins (LDL). Each Ag site results from allelic variation at a specific locus of the apoB gene. In the present study, we assessed whether variations in the five Ag loci were associated with concentrations of plasma lipids or lipoprotein fractions measured by analytical ultracentrifugation in a group of 44 healthy men. Pair-wise analyses of the Ag markers revealed that Ag(a1/d), in association with either Ag(x/y) or Ag(t/z), is significantly related to plasma IDL-mass concentrations. In this cohort we detected no significant associations of the Ag alleles (singly or in combination) with plasma total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol, or mass of total VLDL or LDL. These results suggest that genetic variations in the apoB molecule may predispose to variations in concentrations of IDL that could have consequences for atherosclerotic risk.     

1600例住院病人死亡原因分析

[目的 ]探讨 160 0例住院病人的死亡原因及其分布特征 .[方法 ]收集 1995年 1月至 2 0 0 2年12月间 160 0例我院住院死亡病人资料 ,对死亡疾病构成比率、男女主要疾病死亡构成比率、汉族和朝鲜族主要疾病死亡构成比率及年龄构成比率进行统计 .[结果 ] 160 0例死亡病例的死亡原因中脑血管疾病占 2 4 9% ,恶性肿瘤占 2 3 4% ,消化系统疾病占 13 7% ,意外伤害和中毒占 10 3 % ,心血管疾病占9 2 % ;男性与女性主要疾病死亡分布不同 ,两者间有非常显者性差异 ;汉族与朝鲜族主要疾病死亡分布不同 ,两者间亦有非常显者性差异 ;年龄构成比中 61～ 70岁居首位 ,占 2 6 6% ,51～ 60岁占 18 0 % ,41～ 50岁占 16 8% ,71～ 80岁占 15 8% ,3 1～ 40岁占 10 8% .[结论 ]住院死亡的疾病构成因性别及民族不同 ,其分布不同     

12 840例小儿麻痹后遗症外科治疗统计分析

目的 :探讨我国现存小儿麻痹后遗症病人的年龄结构、医疗需求、手术类别及外科治疗的有关问题 ,为此类患者的治疗提供参考。方法 :回顾性分析了 1985年 9月～ 2 0 0 3年 5月之间手术治疗的小儿麻痹后遗症 12 840例 ,实施手术 3 15 62次。从病人初次手术年龄、手术部位、下肢瘫痪情况、步态及手术类别进行统计归类。结果 :首次手术年龄 2 5岁以下者 1172 1例 ,占同期病例总数的 91 2 9% ,其中下肢髋部手术占总手术的 15 2 8% ,膝部占 3 0 19% ,踝足占 48 73 % ,下肢均衡术占5 14 % ,上肢手术占 0 5 %。结论 :现存的小儿麻痹后遗症 70 %以上年龄 <3 5岁 ,5 0 %以上的农村患者既往未实施过正确的矫形手术治疗。对中国遗留的百万小儿麻痹后遗症进行系统的现代矫形外科治疗 ,仍是骨科界的一项艰巨任务     

Undergraduate and postgraduate dental students''reflection on learning'': a qualitative study

The aim of this study was to explore undergraduate and postgraduate dental students' understanding of a good learning experience by using 'reflection on learning' as described by Schon. Four groups of Year 4 BDS students and one group of postgraduate students in dental public health took part in a series of focus group discussions. The responses were grouped into four broad themes (a) active, practical and positive learning; (b) interactive/together learning; (c) personal learning; (d) theory into practice. Six educational models of good learning proposed by the students are described.