Dyadic interventions to promote physical activity and reduce sedentary behaviour: systematic review and meta-analysis.

Several interventions have targeted dyads to promote physical activity (PA) or reduce sedentary behaviour (SB), but the evidence has not been synthesised. Sixty-nine studies were identified from MEDLINE, PsycINFO, and Web of Science, and 59 were included in the main meta-analyses (providing 72 independent tests). Intervention details, type of dyadic goal, participant characteristics, and methodological quality were extracted and their impact on the overall effect size was examined. Sensitivity analyses tested effect robustness to (a) the effects of other statistically significant moderators; (b) outliers; (c) data included for participants who were not the main target of the intervention. Dyadic interventions had a small positive, highly heterogeneous, effect on PA g = .203, 95% CI [0.123-0.282], compared to comparison conditions including equivalent interventions targeting individuals. Shared target-oriented goals (where both dyad members hold the same PA goal for the main target of the intervention) and peer/friend dyads were associated with larger effect sizes across most analyses. Dyadic interventions produced a small homogeneous reduction in SB. Given dyadic interventions promote PA over-and-above equivalent interventions targeting individuals, these interventions should be more widespread. However, moderating factors such as the types of PA goal and dyad need to be considered to maximise effects.

Health risks in wastewater irrigation: comparing estimates from quantitative microbial risk analyses and epidemiological studies.

The combination of standard quantitative microbial risk analysis (QMRA) techniques and 10,000-trial Monte Carlo risk simulations was used to estimate the human health risks associated with the use of wastewater for unrestricted and restricted crop irrigation. A risk of rotavirus infection of 10(-2) per person per year (pppy) was used as the reference level of acceptable risk. Using the model scenario of involuntary soil ingestion for restricted irrigation, the risk of rotavirus infection is approximately 10(-2) pppy when the wastewater contains < or =10(6) Escherichia coli per 100ml and when local agricultural practices are highly mechanised. For labour-intensive agriculture the risk of rotavirus infection is approximately 10(-2) pppy when the wastewater contains < or = 10(5) E. coli per 100ml; however, the wastewater quality should be < or = 10(4) E. coli per 100ml when children under 15 are exposed. With the model scenario of lettuce consumption for unrestricted irrigation, the use of wastewaters containing < or =10(4) E. coli per 100ml results in a rotavirus infection risk of approximately 10(-2) pppy; however, again based on epidemiological evidence from Mexico, the current WHO guideline level of < or =1,000 E. coli per 100ml should be retained for root crops eaten raw.

Guidelines for the safe use of wastewater in agriculture: revisiting WHO guidelines.

The use of wastewater in agriculture is occurring more frequently because of water scarcity and population growth. Often the poorest households rely on this resource for their livelihood and food security needs. However, there are negative health implications of this practice that need to be addressed. WHO developed Guidelines for the Safe Use of Wastewater in Agriculture in 1989. The Guidelines are currently being revised based on new data from epidemiological studies, quantitative microbial risk assessments and other relevant information. WHO guidelines must be practical and offer feasible risk management solutions that will minimize health threats and allow for the beneficial use of scarce resources. To achieve the greatest impact on health, guidelines should be implemented with other health measures such as: health education, hygiene promotion, provision of adequate drinking water and sanitation, and other health care measures.

Meeting the challenge of tobacco use within the Medicaid population.

The Wisconsin Medicaid Program, which purchases health care for Wisconsin's low income residents, has entered into a number of partnerships designed to systematically address tobacco use by Medicaid recipients. With the help of Wisconsin HMOs, a chart audit established an overall tobacco use prevalence of 45.7%, about double that of the general population. A direct survey of Medicaid recipients confirmed a rate of 45.0%. The chart audit also revealed a dramatic under-utilization of currently available Medicaid smoking cessation benefits. Plans are now being made to increase this utilization on a statewide basis. In addition, a partnership with the Wisconsin Women's Health Foundation and the Bureau of Family and Community Health Program within the Division of Public Health has resulted in a pilot project to address tobacco use by low income, pregnant women. Finally, a partnership with a specialized HMO serving those with disabilities and the Mental Health Association in Milwaukee County plans to address tobacco use by those with chronic and persistent mental illness.

Simultaneous determination of zidovudine and lamivudine in human serum using HPLC with tandem mass spectrometry.

A method employing high performance liquid chromatography (HPLC) with tandem mass spectrometry (MS) has been developed and validated for the simultaneous determination of clinically relevant levels of zidovudine (AZT) and lamivudine (3TC) in human serum. The method incorporates a fully automated ultrafiltration sample preparation step that replaces the solid-phase extraction step typically used for HPLC with UV detection. The calibration range of the dual-analyte LC-MS/MS method is 2.5-2,500 and 2.5-5,000 ng ml-1 for AZT and 3TC, respectively, using 0.25 ml of human serum. The lower limit of quantification was 2.5 ng ml-1 for each analyte, with a chromatographic run time of approximately 6 min. Overall accuracy, expressed as bias, and inter- and intra-assay precision are < +/- 7 and < 10% for AZT, and < +/- 5 and < 12.1% for 3TC over the full concentration ranges. A cross-validation study demonstrated that the LC-MS/MS method afforded equivalent results to established methods consisting of a radioimmuno-assay for AZT and an HPLC-UV method for 3TC. Moreover, the LC-MS/MS was more sensitive, allowed markedly higher-throughput, and required smaller sample volumes (for 3TC only). The validated method has been used to support post-marketing clinical studies for Combivir a combination tablet containing AZT and 3TC.

Browpexy: lateral orbicularis muscle fixation as an adjunct to upper blepharoplasty.

Lateral ptosis of the eyebrow is a major part of the complex changes that patients are seeking to improve with an upper blepharoplasty. Two hundred and eight patients have undergone a browpexy procedure at the time of blepharoplasty. This operative maneuver, which is performed through the blepharoplasty incision, prevents the brow from dropping below the superior orbital rim and creates a defined tarsal sulcus to produce a sculptured upper eyelid.

Mucosal injuries of the upper aerodigestive tract after smoking crack or freebase cocaine.

The introduction of "crack" and 'freebase" cocaine to the United States has resulted in an increased number of patients presenting to emergency rooms with cocaine-related burns of the upper aerodigestive tract. Because symptoms are nonspecific and histories often unreliable, the emergency room physician must keep a high index of suspicion for cocaine use when confronted with these types of patients. We present seven patients who had burns to the upper aerodigestive tract as a result of smoking crack or freebase cocaine. Two of seven patients underwent an emergency tracheotomy, probably because of delayed diagnosis and inadequate early medical intervention. This article reviews the history behind cocaine use, its different modes of administration, potential complications associated with smoking cocaine, diagnostic workup, and treatment options.

Early and delayed repair of orbitozygomatic complex fractures.

PURPOSE: The goal of this study was to review experience with early and delayed repair of orbitozygomatic complex fractures and develop guidelines for repair based on timing and extent of injury. PATIENTS AND METHODS: Records of patients with orbitozygomatic complex fractures over a 10-year period were reviewed for cause of injury, signs and symptoms, length of time from injury to repair, and method of repair. Results were evaluated by office examination and telephone interviews at least 6 months to 10 years after surgery. RESULTS: Seventy-eight patients who had undergone 81 surgical procedures were analyzed. The series consisted of 49 primary repairs (1 to 22 days postinjury), 10 delayed repairs using osteotomies at 21 days to 5 months postinjury, and 22 delayed repairs requiring onlay bone grafting from 4 months to 16 years postinjury. Forty patients (43 procedures) were available for follow-up. Early surgical intervention dramatically improved esthetic and functional outcomes, whereas late repair was less satisfactory. Hypoesthesia was not improved by surgery. Osteotomy and onlay grafting techniques were necessary for delayed treatment. CONCLUSION: Orbitozygomatic fractures can be repaired up to 21 days postinjury using primary reduction and fixation techniques. Osteotomies are required after 21 days and can be used successfully up to 4 months postinjury. After 4 months, successful repair requires onlay bone grafting.

Nasal-associated lymphoid tissue is an inductive site for rat tear IgA antibody responses.

The role of nasal-associated lymphoid tissue (NALT) as a mucosal inductive site for tear IgA antibody responses was investigated in the rat model. Fluorescent microspheres were shown to access and be taken up by NALT after intranasal of ocular-topical administration, although fewer microspheres were found in the latter case. Tear IgA anti-DNP antibody responses to dinitrophenylated Streptococcus pneumoniae were 6 micrograms/ml at day 7, 10 micrograms/ml at day 10, and were still detectable on day 21 (5 micrograms/ml) following ocular or gastrointestinal immunization. Intranasal immunization induced tear IgA responses which were 1.7-fold higher at day 7 (10 micrograms/ml), peaked by day 10 (14 micrograms/ml) and were still 1.6-fold higher (8 micrograms/ml) at day 21 than responses of ocular or gastrointestinal groups. These findings suggest that intranasal immunization may be more effective than ocular or gastrointestinal administration in eliciting tear IgA antibody responses and, taken together with the microsphere data, indicate that NALT can serve as an inductive site for ocular mucosal IgA responses.

Modification of native collagen reduces antigenicity but preserves cell compatibility.

Porcine intestinal collagen (ICL), derived from processed small intestine, is used as a part of a remodelable bilaminate biosynthetic vascular prosthesis. The process for the production of ICL involves mechanical cleaning of non-crosslinked porcine intestine (NC-ICL), disinfection with peracetic acid (PA-ICL), and crosslinking with 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (PA/EDC-ICL). Two model systems were investigated to evaluate the effect of these agents on the humoral response to NC-ICL. First, the antibody titers of rabbits immunized with NC-ICL, PA-ICL, and PA/EDC-ICL were determined, and second, the humoral response of canines receiving collagenous vascular implants was examined. Collagenous and noncollagenous fractions were extracted from NC-ICL, PA-ICL, and PA/EDC-ICL and separated by SDS-PAGE. PA and EDC treatment decreased the number of extractable proteins as compared to NC-ICL. Immunoblot techniques demonstrated anti-NC-ICL antibodies recognized multiple immunoreactive proteins in NC-ICL, but not in PA-ICL or PA/EDC-ICL; and rabbits immunized with NC-ICL produced higher antibody titers to ICL proteins than rabbits immunized with either PA-ICL or PA/EDC-ICL. It was, therefore, apparent that NC-ICL was more antigenic than either PA-ICL or PA/EDC-ICL. The humoral immune response of canines to PA/EDC-ICL fabricated vascular grafts was determined. At 4 weeks, 8 weeks, and 12 weeks postimplant, serum antibodies to ICL proteins or type I collagen could not be detected. These data demonstrate a reduced humoral immune response to PA/EDC-ICL. (c) 1996 John Wiley & Sons, Inc.

Phase II study of dibromodulcitol in colorectal, kidney, and other carcinomas.

In a phase II study dibromodulcitol (DBD), an alpha-omega dibrominated hexitol, was used to treat 99 previously treated patients with colon, rectal, kidney, and other tumors. Six patients were ineligible and 10 patients were nonevaluable for response. Aside from thrombocytopenia toxicity was moderate. Twenty-three patients had platelet nadirs of less than 50,000/mm3 and there were three thrombocytopenic-associated drug deaths. One of 21 rectal and 1 of 13 kidney cancer patients entered a remission. All but seven patients had received previous treatment with one or more cytotoxic agents. Previously treated patients with colorectal and kidney cancer appear to be resistant to DBD.

Quinidine-induced agranulocytosis.

In a 75-year-old man, agranulocytosis and septicemia developed after eight weeks of quinidine sulfate therapy. An IgG antibody requiring the presence of quinidine was shown by complement-dependent leukocytotoxicity and leukoagglutination reactions. The antibody did not cross-react with quinine and was active against WBCs obtained from normal subjects and from the patient himself.

Acute granulocytic leukemia in Hodgkin's disease.

Two cases of acute myeloblastic leukemia were observed in Hodgkin's disease patients two and five years following intensive radiation therapy. Sixteen additional cases of acute granulocytic leukemia occurring in radiation-treated Hodgkin's disease patients have been reported in the literature and are reviewed. It is suggested that the development of acute leukemia was related to irradiation in these patients, and that additional such cases could be expected with the use of intensive radiation and chemotherapy, a risk probably justified in view of the improved control of Hodgkin's disease achieved by these programs.