Patterns of preference and practice: bridging actors in wildfire response networks in the American Northwest.

The roles of bridging actors in emergency response networks can be important to disaster response outcomes. This paper is based on an evaluation of wildfire preparedness and response networks in 21 large-scale wildfire events in the wildland-urban interface near national forests in the American Northwest. The study investigated how key individuals in responder networks anticipated seeking out specific people in perceived bridging roles prior to the occurrence of wildfires, and then captured who in fact assumed these roles during actual large-scale events. It examines two plausible, but contradictory, bodies of theory-similarity and dissimilarity-that suggest who people might seek out as bridgers and who they would really go to during a disaster. Roughly one-half of all pre-fire nominations were consistent with similarity. Yet, while similarity is a reliable indicator of how people expect to organise, it does not hold up for how they organise during the real incident.

Exposure to Echinococcus multilocularis, Toxocara canis, and Toxocara cati in Austria: a nationwide cross-sectional seroprevalence study.

Despite emerging risks for the spread of zoonotic diseases, data on human exposure to Echinococcus multilocularis and Toxocara spp., the causative parasites of the two most important helminthozoonoses in Central Europe, are limited. To investigate risk factors and exposure, we conducted a nationwide, cross-sectional serological study in 1046 healthy individuals, of which 425 were soldiers and 621 were civilians. Serum samples and information on possible risk factors for exposure, including previous foreign military assignments, residential area, animal contact, and regular outdoor activities, were obtained. Immunoglobulin G antibodies against Echinococcus multilocularis and Toxocara spp. were examined with an enzyme-linked immunosorbent assay (ELISA). Samples reactive in the ELISA for antibodies against Echinococcus multilocularis were considered positive only after confirmation by western blot. Overall, 66 (6.3%) individuals tested positive in the serologic screening for Toxocara spp. Occupational animal contact was the only risk factor significantly associated with a higher risk for being seropositive. None of the individuals were positive for antibodies against Echinococcus multilocularis. In conclusion, the present study demonstrates that exposure to Toxocara spp. is widespread in Austria and occupational animal contact is a risk factor for seropositivity.

High prevalence of antibodies against Leptospira spp. in male Austrian adults: a cross-sectional survey, April to June 2009.

To assess the distribution of specific antibodies against Leptospira spp. in Austrian adults, we conducted an explorative nationwide cross-sectional serological study in 400 healthy individuals. Antibody titres against Leptospira spp. were determined in a microscopic agglutination test using a panel of 14 serovar cultures. Sera of 18 participants were excluded because the samples were unsuitable for testing; the remaining 382 participants comprised 166 professional soldiers and 216 civilians. Overall, 88 (23%) individuals tested positive in serological screening. The subjects' sera reacted most frequently with serovars Canicola (16.5%) and Hardjo (11.8%). Epidemiological information was obtained from a questionnaire: no correlation was found for area of residence, travel abroad, regular outdoor activities, occupational animal contact, or ownership of companion animals. The proportion of seropositive samples was significantly lower among professional soldiers (15.7%) than among civilians (28.7%) (p=0.003). Our data demonstrate serological evidence of a high rate of exposure to Leptospira spp. among the Austrian population. No increased risk of exposure to Leptospira spp. was detected in military personnel.

Seroprevalence and asymptomatic carriage of Leishmania spp. in Austria, a non-endemic European country.

Leishmaniasis is a rare disease in Central Europe and is diagnosed almost exclusively in travellers or migrants coming from tropical or subtropical countries. We conducted an explorative cross-sectional serological study, using a commercial ELISA, in 1048 healthy Austrian individuals to assess the distribution of specific antibodies against Leishmania spp. in humans in Austria. Overall, 47 individuals (4.5%) tested positive, and an additional 32 (3.1%) showed borderline results. After 12 months, sera from 42 of the 79 individuals who had initially tested seropositive/borderline were tested by ELISA a second time: 18 were persistently positive, nine were borderline. Those whose sera were persistently positive/borderline were then screened for potential carrier status using a commercial oligochromatographic PCR test to detect parasite DNA. Four samples were PCR positive and were subjected to a second PCR allowing parasite identification after DNA sequencing: two samples were identified as Leishmania donovani/infantum complex and Leishmania (Viannia) guyanensis, respectively. Epidemiological information was obtained with a questionnaire: no correlation was found for the number of holiday trips within the previous 6 months, but a significant risk of exposure to Leishmania spp. was found for travel to the New World, particularly to the Caribbean. Our data demonstrate that Leishmania spp. seroprevalence in non-endemic countries has been considerably underestimated.

Pre- and post-pandemic prevalence of antibodies to the 2009 pandemic influenza A (H1N1) virus in Austrian adults.

Antibody prevalence to the 2009 pandemic influenza A (H1N1) virus was determined in a sample of the Austrian population to assess the post-pandemic seropositivity rate, the infection attack rate, and the proportion of subclinical infections during the 2009/2010 influenza pandemic in Austrian adults. A total of 480 sera from individuals aged between 18 and 57 years from all nine federal states of Austria were collected between April and June 2010. Information on demographic characteristics, vaccination history, and history of suspected or verified influenza virus infection was ascertained. Antibodies were determined using a commercial ELISA and compared with 80 age-matched adult sera collected before the pandemic began. The overall seropositivity rate was 28% and was highest among young adults aged 18-29 years, followed by adults aged 50-57 years. Among seropositive unvaccinated individuals, infection was asymptomatic in more than 80%. Extrapolation to the overall Austrian adult population indicates that more than 1.3 million persons aged 18-57 years became infected in 2009. Compared with the pre-pandemic seropositivity rate, the infection rate was highest among young adults but low in those aged 30-57 years. Among 69 individuals previously vaccinated with the 2009 pandemic influenza A (H1N1) virus, 71% had specific antibodies. The study demonstrates that infection rates based on surveillance of clinical cases considerably underestimated the infection attack rate during the 2009 H1N1 pandemic in Austria and that vaccination against this virus elicited long-lasting seropositivity in more than 70% of adults.

Differential responsiveness to alcohol odor in human neonates: effects of maternal consumption during gestation.

Previous human and animal studies have shown that specific memories arise during prenatal life as a function of fetal processing of chemosensory stimuli present in the amniotic fluid. Furthermore, the animal literature indicates that fetal exposure to alcohol modifies subsequent neonatal and infantile responsiveness toward the sensory attributes of the drug. The main goal of the present study was to analyze whether differential maternal alcohol consumption during pregnancy affects neonatal reactivity to ethanol odor. To achieve this goal, an initial experiment examined how healthy human neonates respond to olfactory stimuli. In this first experiment, newborns (postpartum age: 24-48 h) were evaluated in terms of motor responsiveness elicited by repetitive stimulation with either alcohol or lemon odors. Infants exhibited a marked increase in duration of overall body and head and facial activity when the odorants were first presented. In four successive trials, behavioral responsiveness progressively declined until reaching baseline values. The introduction of a novel odorant served to dishabituate the motor responses under analysis. In the second experiment newborn's reactivity to the mentioned odorants was evaluated as a function of maternal self-reported patterns of consumption of alcohol during gestation. Mothers were classified as frequent or infrequent drinkers. Babies born to frequent drinkers exhibited heightened reactivity toward ethanol odor when compared to newborns delivered by infrequent drinkers. No differences emerged when comparing the responses of both groups of infants elicited by a non-ethanol stimulus such as lemon. The results coupled with prior human and animal research suggest the possibility of intrauterine experience with alcohol odor that yields a sensory memory likely to be retrieved immediately after birth.

The efficacy of self-monitoring of blood glucose in NIDDM subjects. A criteria-based literature review.

OBJECTIVE: To determine the efficacy of self-monitoring of blood glucose (SMBG) in NIDDM patients from studies published during the years 1976-1996. RESEARCH DESIGN AND METHODS: A systematic literature search was conducted. The selected studies were assessed for their methodological quality and reviewed on the reported efficacy and on the following topics: characteristics of the study population, follow-up duration, nature of the efficacy measures, use of a therapy decision scheme, nature of the intervention, nature of the SMBG device, patient instruction, type of SMBG regime, assessment of the frequency of self-measurement, and whether feedback was given on the measured glucose levels. Studies with positive conclusions on the efficacy of SMBG were compared with studies with negative conclusions on the basis of the these characteristics to determine which factors could have contributed to the results. RESULTS: Of the 11 studies identified, only 4 met all quality criteria. Six of the studies were randomized controlled trials, of which only one showed positive conclusions regarding the efficacy of SMBG. Although the studies differed on most topics, no factor could be identified as responsible for the results of the studies. CONCLUSIONS: The efficacy of SMBG in NIDDM patients is still questionable and should be tested in a rigorous high-quality randomized controlled trial, for which some recommendations are given.

Exercises: which ones are worth trying, for which patients, and when?

STUDY DESIGN: Criteria-based review. SUMMARY OF BACKGROUND DATA: Reviews based on trials published up to 1990 conclude that the efficacy of exercise therapy in patients with low back pain is questionable. OBJECTIVES: To determine from recently published trials the efficacy of exercises in patients with acute, subacute, or chronic back pain. METHODS: A Medline search for randomized trials concerning exercise therapy in patients with back pain published from 1991 until the first quarter of 1995 was conducted. All studies were given a method score (maximum, 100 points). RESULTS: Eleven randomized trials were included: four in acute back pain, one in subacute, and six in patients with chronic back pain. Three trials had method scores lower than 40 points. For acute back pain, two trials with high method scores (> 50 points) reported no efficacy of flexion or extension exercises; two trials of the McKenzie type of exercises reported positive results but had low method scores. For subacute pain, one trial (> 50 points) reported positive results of exercises with a graded activity program. For chronic back pain, three trials reported positive results with different types of exercises; two trials reported better results with intensive exercising compared with low grade exercising, but after 12 months, this effect had disappeared. In chronic pain, no relation between method score and conclusions could be found. CONCLUSIONS: In acute back pain, exercise therapy is ineffective, whereas in subacute back pain, exercises with a graded activity program, and in chronic back pain, intensive exercising, deserve attention. More research on McKenzie therapy, on exercises with a graded activity program, and on different types of exercising in patients with chronic back pain is necessary.

A randomized trial of exercise therapy in patients with acute low back pain. Efficacy on sickness absence.

STUDY DESIGN: A randomized, placebo-controlled trial in which patients received either usual care by a general practitioner (information and analgesics), or placebo physiotherapy given by a physiotherapist, or exercise therapy given by a physiotherapist. OBJECTIVE: To assess the efficacy of exercise therapy on sickness absence from work in patients with acute low back pain. SUMMARY OF BACKGROUND DATA: Exercise therapy during the nonchronic phase of back pain is considered to reduce sickness absence, but this opinion is controversial. METHODS: Patients with acute nonspecific low back pain and a paid job were included for analysis. Sickness absence (number of days) was checked monthly during the 1-year follow-up period and compliance was also assessed. RESULTS: From 40 general practices 363 patients who were gainfully employed were included. In the exercise therapy group the percentage of patients with sickness absence was higher and the duration of absence was longer than in the placebo and usual care groups, but these differences were not significant. Indications of more absence in the exercise therapy group appeared to be based largely on a greater number of patients with absences during the first 3 months. Patients in the exercise group who had not reported sick at entry had more sickness absences during the follow-up year than patients in the usual care and placebo group. Good compliance did not affect the results. CONCLUSIONS: Exercise therapy for patients with acute low back pain does not reduce sickness absence.

A randomized, placebo-controlled trial of exercise therapy in patients with acute low back pain.

To assess the efficacy of exercise therapy for acute low back pain, a randomized, placebo-controlled trial was performed in 40 Dutch general practices. Patients received either exercise instruction with advice for daily life by a physiotherapist; placebo ultrasound therapy by a physiotherapist; or usual care by the general practitioner. All patients received analgesic agents and information on low back pain before randomization. Four hundred seventy-three patients were included. No differences in number of recurrences, functional health status, or medical care usage could be found among the three groups. In the exercise group, duration of recurrences was shorter and patients were less tired during the first 3 months than in the usual care group, but no differences were found between the exercise and placebo groups. It was concluded that exercise therapy for patients with acute low back pain has no advantage over usual care from the general practitioner.