The relationships between golf and health: a scoping review.

OBJECTIVE: To assess the relationships between golf and health. DESIGN: Scoping review. DATA SOURCES: Published and unpublished reports of any age or language, identified by searching electronic databases, platforms, reference lists, websites and from consulting experts. REVIEW METHODS: A 3-step search strategy identified relevant published primary and secondary studies as well as grey literature. Identified studies were screened for final inclusion. Data were extracted using a standardised tool, to form (1) a descriptive analysis and (2) a thematic summary. RESULTS AND DISCUSSION: 4944 records were identified with an initial search. 301 studies met criteria for the scoping review. Golf can provide moderate intensity physical activity and is associated with physical health benefits that include improved cardiovascular, respiratory and metabolic profiles, and improved wellness. There is limited evidence related to golf and mental health. The incidence of golfing injury is moderate, with back injuries the most frequent. Accidental head injuries are rare, but can have serious consequences. CONCLUSIONS: Practitioners and policymakers can be encouraged to support more people to play golf, due to associated improved physical health and mental well-being, and a potential contribution to increased life expectancy. Injuries and illnesses associated with golf have been identified, and risk reduction strategies are warranted. Further research priorities include systematic reviews to further explore the cause and effect nature of the relationships described. Research characterising golf's contribution to muscular strengthening, balance and falls prevention as well as further assessing the associations and effects between golf and mental health are also indicated.

Uterine artery pulsatility and resistivity indices in pregnancy: Comparison of MRI and Doppler US.

OBJECTIVE: The aim of this work was to evaluate whether the uterine arteries (UtA) could be identified and their flow profiles measured during a fetal MRI examination. A comparison was performed against same day sonographic Doppler assessment. METHODS: 35 normal, healthy, singleton pregnancies at 28-32 weeks gestation underwent routine Doppler examination, followed by MRI examination. The resistivity index (RI) and pulsatility index (PI) of the left and right UtA were measured using phase contrast MRI. Bland Altman statistics were used to compare MRI and ultrasound results. RESULTS: Sixty-nine comparable vessels were analysed. Six vessels were excluded due to artefact or technical error. Bland-Altman analysis demonstrated the ultrasound indices were comparable, although systematically lower than the MRI indices; Right UtA RI bias -0.03 (95% limits of agreement (LOA) -0.27 to +0.20), and left UtA RI bias -0.06 (95% LOA -0.26 to +0.14); Right UtA PI bias -0.06 (95% LOA -0.50 to +0.38), Left UtA PI bias -0.11 (95% LOA -0.54 to +0.32). The inter-rater agreement for the MRI derived PI and RI analysis was good. CONCLUSION: This study demonstrates that in the majority of early third trimester pregnancies, the uterine arteries can be identified, and their flow profiles measured using MRI, and that the derived PI and RI values are comparable with Doppler ultrasound values.

Rapid screening of embryonated chicken eggs for bluetongue virus infection with an antigen capture enzyme linked immunosorbent assay.

The sensitivity and specificity of an antigen capture ELISA have been compared with virus isolation in cell culture. Bluetongue virus (BLU) (serotype 23) from the blood of a sheep was titrated by inoculating embryonated chicken eggs (ECEs) and detecting viral antigen in chicken embryo livers using an antigen capture enzyme linked immunosorbent assay (ELISA) (Stanislawek et al., 1996. Detection by ELISA of bluetongue antigen directly in the blood of experimentally infected sheep. Vet. Microbiol. 52, 1-12). Five days after inoculation of ECEs with lysed red blood cells from the infected sheep the embryo livers were harvested and homogenised. The supernatant from the homogenate was used in the antigen capture ELISA to determine which livers were infected and the virus titre calculated as CEID50/ml packed red blood cells. These results were compared with a standard cell culture isolation protocol which passaged the liver homogenate supernatant through Aedes albopictus cells and up to three passages in BHK21 cells. The antigen capture ELISA showed 100% sensitivity and specificity with no false negatives or false positives when compared to cell culture isolation of the virus. The major advantage of the combination of ECE inoculation and antigen capture ELISA is the reduction in the time to less than 7 days from a maximum of 35 days for the ECE/cell culture system. The procedure is easy to undertake, cost effective and does not require expensive specialist cell culture facilities.

Laboratory and field studies of an antigen capture ELISA for bluetongue virus.

An improved bluetongue antigen capture ELISA (BTACE) technique was evaluated for its ability to detect the full range of 24 bluetongue (BLU) serotypes. The BTACE detected all 24 serotypes in cell culture fluids, including eight serotypes where the representative strains originated from both Australia and also from the South African reference collection. The amount of infectious virus required to obtain a positive BTACE result varied between 100-1000 TCID50. This was approximately 10-fold more sensitive than the antigen capture test described previously (Hosseini, M., Hawkes, R.A., Kirkland, P.D., Dixon, R., 1998. J. Virol. Methods 75, 39-46.). The BTACE method was compared with conventional passage in cell culture to detect the presence of virus in the tissues of embryonated chicken eggs (ECEs) which had been inoculated intravenously with the blood of sheep and cattle infected experimentally with the eight Australian serotypes of BLU (1, 3, 9, 15, 16, 20, 21, and 23). The BTACE method was at least as sensitive as the conventional cell culture detecting virus in ECEs, obviating the need for prolonged cell culture passage to detect the virus. A comparison of the amount of antigen detected in different embryo tissues indicated that liver homogenates gave the highest positive to negative ratios in the BTACE and were selected as the specimen of choice. In studies of sheep infected with all 24 South African reference BLU serotypes this new BTACE was able to detect viraemia with all serotypes. Finally, the BTACE was validated in surveillance programs for BLU in both New South Wales, Australia and in Yunnan Province, People's Republic of China. Blood samples from sentinel cattle were inoculated into ECEs. Homogenised ECE livers were tested by BTACE and those positive were passaged subsequently in cell culture for virus isolation and identification. This protocol led to the efficient isolation of field isolates of many serotypes. The high sensitivity and broad reactivity of the method indicates that it should be valuable for BLU diagnosis and surveillance programs.

Characterization of gp 50, a major glycoprotein present in rat brain synaptic membranes, with a monoclonal antibody.

Several cell lines secreting monoclonal antibodies (Mabs) against a major forebrain synaptic membrane (SM) glycoprotein, gp 50, have been raised. Western blots show that the Mabs react with a polypeptide doublet of Mrs 49 and 45 kDa. These polypeptides exist solely in a concanavalin A (Con A) binding form. Removal of the Con A receptors by digestion with endo-beta-N-acetylglucosaminidase H (endo H) lowers the Mrs of the glycoprotein doublet to 36.5 and 34 kDa. Western blots of 2D polyacrylamide gels indicate that gp 50 exists in several isoforms. Solid phase radioimmunoassay (RIA) and Western blots of brain subcellular fractions show the antigenic material to be concentrated in the SM fraction, but to be present in much lower amounts in synaptic junctions and postsynaptic densities. Gp 50 appears to be brain specific. Regional distribution studies show that it is present in all brain regions but is two-fold concentrated in cerebellum, brainstem and midbrain compared to forebrain. Immunocytochemical studies of several brain regions show that gp 50-like immunoreactivity is neuron specific and is concentrated in selected neuronal species, particularly granule cells. In both cerebellar and hippocampal granule cells gp 50-like immunoreactivity is localized in the perikarya and primary dendrites. Though immunocytochemistry did not show staining of synaptic regions this may be due to masking of the reactive epitope. The results are discussed in terms of the molecular properties of gp 50 and its subcellular localization in brain tissue.

Fundholding in general practice and financial risk.

OBJECTIVE: To estimate the financial effect of random yearly variations in need for services on fundholding practices with various list sizes. DESIGN: A simulation model was derived using historical data on general practitioner referrals for the 113 surgical procedures covered by the general practitioner fund, combined with data on the hospital prices for those procedures. PATIENTS: Resident population of Central Birmingham Health Authority. MAIN OUTCOME MEASURES: Expected expenditure on the relevant surgical procedures for the whole district and for practices with list sizes of 9000, 12,000, 15,000, 18,000, 21,000, or 24,000 for each of 100 simulated years. RESULTS: By using average hospital prices for the West Midlands region the mean (SD) annual expenditure for the 179,400 residents was 4,832,471 pounds (87,149 pounds); the random variation between the 5th and 95th most expensive years was 5.7% of the mean cost. For a practice with a list size of 9000 the values were 244,891 pounds (18,349 pounds), with a variation of 27.5%. With a list size of 24,000 the values were 652,762 pounds (32,512 pounds), with a variation of 15.3%. CONCLUSIONS: Random variations in need for inpatient services will have a significant financial impact on the practice fund. The problem will be particularly great for smaller practices. Additional measures are required to ensure that the scheme is not undermined and that the potential benefits are secured.

Transferring the costs of expensive treatments from secondary to primary care.

General practitioners, especially fundholders, are becoming increasingly concerned about being asked to prescribe treatments for their patients that are outside their therapeutic experience. They are concerned about the clinical responsibility for such prescribing and the effects on their budgets. In some specialties transferring the costs of expensive treatments from secondary to primary care (cost shifting) has become partly institutionalised because of the separate sources of funding for drugs prescribed in the two sectors. With increased efforts to control the rising costs of the drugs budget and the emergence of new expensive treatments, cost shifting will be a challenge to clinicians and purchasers as they strive for rational, cost effective prescribing. A review of the funding mechanisms for drugs prescribing and of the relation between the licensing process and the decision to support the use of a treatment in primary or secondary care is needed.

Effect of temperature of the sensitization process on the passive hemagglutination test for hepatitis B antibody.

The temperature at which the coupling of antigen to erythrocytes takes place is an important factor in the passive hemagglutination test for hepatitis B antibody. Erythrocytes sensitized at 16 C are much less sensitive for the detection of antibody than are those sensitized at 22 to 41 C.

Viral hepatitis and the drug cult: a brief socio-epidemiological study in Sydney.

Study of 141 individuals attending a Sydney drug referral centre revealed considerable psychosocial maladjustment in the group. Seventy-five per cent showed serological evidence of hepatitis B virus infection, past or present, as compared with 13% of control subjects. Antibody to hepatitis B core antigen was found to be twice as frequent as a serological marker of HBV infection, as antibody to hepatitis B surface antigen. Prevalence rates of antibody to hepatitis A virus were similar in the drug and control groups. Hepatitis possibly due to hepatitis non A non B virus infection, was found in 14% of those with clinical and biochemical hepatitis at the time of the study.

A comparison of laboratory and 'wild' strains of bluetongue virus--is there any difference and does it matter?

Bluetongue (BT) viruses (BTV) have been propagated in laboratory culture systems for more than 50 years, especially for the production of vaccines. An important outcome of the adaptation of these viruses to laboratory culture is attenuation of their virulence. As a consequence of this modification, it has been possible to produce vaccines that have reduced the clinical impact of BT in a number of countries. Unfortunately, the adaptation of these viruses has also introduced undesirable properties. In particular, modified live BT vaccine viruses have a high capacity to cross the ovine placenta and cause congenital abnormalities in the foetus. Modified strains of BTV have also been found in the semen of bulls and rams. It is possible that there are also other undesirable properties, including the potential to infect non-ruminant hosts. Because these characteristics are not properties of naturally occurring BTVs, the use of laboratory-adapted strains is not recommended when the biological properties of BTV are being studied.

Viral hepatitis A and B: a seroepidemiological study of a non-hepatitic Sydney population.

The age-specific prevalence rates of hepatitis A and B virus markers in 683 patients of all ages with non-hepatitic illnesses admitted to a Sydney hospital over the period from 1971 to 1974 were determined. The pattern of prevalence rates of hepatitis A antibody (anti-HAV) appeared to be a cumulative one, with steadily increasing rates in patients up to the age of 40 years. Thereafter a large increase in prevalence occurred. In contrast, prevalence rates for hepatitis B virus (HBV) markers were fairly uniform for all age groups. Antibody to core antigen (anti-HBc) was the most frequent marker of HBV infection. Prevalence rates in subjects of non-Anglo-Saxon origin were higher for both HAV and HBV markers.

Illness caused by a Barmah Forest-like virus in New South Wales.

Barmah Forest virus, a recently-discovered arbovirus which belongs to the alphavirus genus of the family Togaviridae, has been shown to cause infections in humans in New South Wales. The present report documents three patients in whom Barmah Forest viral infection appears to have resulted in illness. Barmah Forest virus or a closely-related alphavirus may, as are several other alphaviruses, be pathogenic.

The antibody response of institutionalized Down's syndrome patients to seven microbial antigens.

An earlier cross-sectional study had revealed that institutionalized Down's syndrome (DS) patients possessed much lower titres of hepatitis B surface antibodies (anti-HBs) than did their non-Down's (ND) counterparts. In an attempt to determine whether DS patients were generally deficient in humoral antibody response, the inmates of an institution for the mentally retarded (110 DS, seventy-eight ND) were immunized with tetanus, diphtheria (toxoids), influenza A, influenza B (inactivated vaccines), measles, mumps and rubella (attenuated vaccines), and tested for their antibody responses. The DS and ND groups did not respond differently to any of the seven antigens. Furthermore, there was no general relationship between the anti-HBs titres of inmates and their capacity to respond to the defined antigenic stimulus of any of the seven antigens. From these results it is apparent that a general humoral deficit in the DS group cannot explain their tendency to possess much lower anti-HBs titres than their ND counterparts upon becoming infected with the hepatitis B virus. When the antibody status and responses to immunization of the inmates who possessed anti-HBs were compared with those who had chronic HBsAg antigenaemia, there was no significant difference between the groups.

The seroepidemiology of hepatitis in Papua New Guinea. I. A long-term study of hepatitis A.

Sera from 988 subjects in four ecologic zones of the Sepik district and 219 subjects from four widely spaced altitudes of the bismarck range in Papua New Guinea were tested for antibody to the hepatitis A virus (anti-HAV) by radioimmunoassay. The Sepik district subjects, mostly children between three months and six years of age when first sampled in 1963, were re-bled on four occasions over the ensuing nine years. The Bismarck range population was sampled only in 1964. In the Sepik district, anti-HAV was detected infrequently before the age of three years and showed maximum increase in prevalence rates between 7-10 years, with little increase thereafter. Antibody acquisition rates also indicated peak transmission in this age group, with fewer conversions between three months and six years of age and in adulthood. There was a consistent, though unexplained tendency for HAV infections to occur more frequently in proximity to the Sepik river than in areas farther away, and in the lower altitudes of the Bismarck range. As determined by serial samples, anti-HAV detected in 1963-1964 was still present in 1972 in 118 out of 119 subjects.

Illness caused by a Kokobera-like virus in south-eastern Australia.

Three patients who lived in south-eastern Australia and who suffered acute polyarticular illnesses in the summer months of 1983-1984 and 1984-1985 are described. Two patients lived in the southwestern plains of New South Wales and one in Bairnsdale in eastern Victoria. Serological studies implicated Kokobera virus, a flavivirus, as the likely causative agent. This would appear to be the first report to indicate the pathogenicity of Kokobera virus.

Postnatal decline of maternally acquired rubella antibodies.

The postnatal decline of maternally acquired rubella antibody was studied in a large group of infants. A high degree of variability was found in the rate of antibody decline (half-life). Ninety-two babies had rubella antibody half-lives lying between 14 and 70 days and three had values considerably higher. There was no significant difference between the rubella antibody half-lives of the sexes. The antibody titre at birth was weakly correlated with both birth weight and gestational age. There was a highly significant positive correlation between the baby's antibody titre at birth and that of its mother. There was a positive relationship between the half-life and the persistence of rubella antibody. Some babies had no detectable antibody by 2 months whereas others still possessed antibody at 9 months. It was found that the relationship between the half-life and the rubella antibody titre at or near birth could be described by a rectangular hyperbola.

Postnatal decline of maternally acquired viral antibodies of different specificities.

The rates of decline (half-lives) of maternally acquired antibodies of two different specificities in a group of infants were found to be highly variable, ranging from 18 to 192 days for parainfluenza type 3 antibody (54 infants) and from 15 to 251 days for influenza A2 antibody (nine infants). For antibodies of both specificities approximately 75% of the half-lives were between 15 and 60 days. With parainfluenza type 3 antibody, and possibly with influenza A2 antibody, the half-lives were inversely proportional to the initial antibody titre of the babies' sera. This relationship could be described by a rectangular hyperbola. Babies with high antibody titres at birth lost this antibody rapidly whereas in babies with low initial titres antibody declined over a longer period.The half-lives of parainfluenza type 3 antibody and influenza A2 antibody were compared with that of rubella antibody in the same group of infants (previously published). Maternally acquired viral antibodies of different specificities did not necessarily decline at similar rates in any given child. In nine infants, maternally acquired antibodies of two different specificities (rubella and parainfluenza type 3) declined at significantly different rates in the same child. It is suggested that although the half-life of antibody of a given specificity is related to its concentration in the serum, it is independent of the level of serum antibodies of other specificities.

The response of institutionalized Down's syndrome subjects to enterovirus infections.

In a study comparing the responses of institutionalized Down's syndrome (DS) and non-Down's (ND) inmates to enterovirus infections, the frequency of wild enteric viruses and the excretion patterns of oral polio vaccine (OPV) viruses were similar in both groups. Antibody titres developed to poliovirus types 2 and 3 following vaccination were similar in DS and ND vaccinees, but the response to type I virus was significantly less in DS vaccinees. As judged by the development of poliovirus antibody in non-vaccinees, the spread of virus from OPV-immunized to unimmunized subjects in the institution was not noticeably different in DS and ND subjects. An unexpected finding was that the excretion patterns of all three serotypes of poliovirus were strikingly similar for each individual, although the patterns varied considerably from individual to individual. The similarity of excretion occurred despite wide differences within an individual in the titres of neutralizing serum antibodies to the three serotypes. It is suggested that the rate at which a given individual eliminates enteroviruses may be largely determined by factors, the activities of which are not reflected in serum antibody titres.

Arbovirus infection in humans in NSW: seroprevalence and pathogenicity of certain Australian bunyaviruses.

A sero epidemiological study was carried out on human sera from all regions of New South Wales for the presence of antibodies to nine bunyaviruses viz Aino, Akabane, Belmont, Gan Gan, Kowanyama, mapputta, Peaton, Tinaroo, Trubanaman and the orbivirus Corriparta. Neutralising antibodies were found in titres up to 1280 to Gan Gan and to 640 to Trubanaman viruses, prevalences 4.7% and 1.4% respectively. Neutralisation titres up to 40 were found to Belmont, Aino, Peaton and Corriparta viruses but the significance of these is uncertain since they may represent either non-specific inhibitors or cross reacting antibodies to related but currently unknown viruses. No antibodies were found to Akabane, Kowanyama, Mapputta or Tinaroo viruses in New South Wales sera. Gan Gan virus appeared to be pathogenic for man being associated with an acute epidemic polyarthritic like illness. Trubanaman virus is suspected of being pathogenic. This is the first report of the pathogenicity of these Australian bunyaviruses.