Evaluation of the Pulmonary Toxicity of Ambient Particulate Matter From Camp Victory, Iraq.

Anecdotal reports in the press and epidemiological studies suggest that deployment to Iraq and Afghanistan may be associated with respiratory diseases and symptoms in U.S. military personnel and veterans. Exposures during military operations were complex, but virtually all service members were exposed to high levels of respirable, geogenic dust. Inhalation of other dusts has been shown to be associated with adverse health effects, but the pulmonary toxicity of ambient dust from Iraq has not been previously studied. The relative toxicity of Camp Victory dust was evaluated by comparing it to particulate matter from northern Kuwait, a standard U.S. urban dust, and crystalline silica using a single intratracheal instillation in rats. Lung histology, protein levels, and cell counts were evaluated in the bronchoalveolar lavage fluid 1-150 d later. The Iraq dust provoked an early significant, acute inflammatory response. However, the level of inflammation in response to the Iraq dust, U.S. urban dust, and Kuwait dust rapidly declined and was nearly at control levels by the end of the study At later times, animals exposed to the Iraq, U.S. urban, or Kuwait dusts showed increased small airway remodeling and emphysema compared to silica-exposed and control animals without evidence of fibrosis or premalignant changes. The severity and persistence of pulmonary toxicity of these three dusts from the Middle East resemble those of a U.S. urban dust and are less than those of silica. Therefore, Iraq dust exposure is not highly toxic, but similar to other poorly soluble low-toxicity dusts.

Non-communicable diseases in an older, aging population: a developing country perspective (Jamaica).

UNLABELLED: Changes in the non-communicable disease (NCD) profile of older adults living in a rapidly-aging, developing country are described. METHODS: Data from a 2012 nationally representative survey of 2,943 older adults were used to determine the burden of NCDs important to elder health. Additionally, the percentage change in NCD prevalence over a 23-year period (1989-2012) was determined. RESULTS: In 2012, approximately 75.3% of the sample reported at least one NCD; 47.5% reported comorbidities. High blood pressure (61%), arthritis (35%) and diabetes (26%) were the most reported conditions, peaking in the 70-79 age group. Females reported higher rates of disease than males. Significant increases in prevalence occurred for all conditions except arthritis; the most significant were in diabetes (157%) and cancer (118%). CONCLUSION: Rapid increases in NCDs are of great public health importance. Strengthening of primary health care and improvements in human resources must occur if the well-being of older adults is to be improved.

Cardio-Vascular Disease and Cancer: A Dichotomy in Utilization of Clinical Preventive Services by Older Adults in a Developing Country.

Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services.

Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis.

We performed this systematic review to assess the analgesic efficacy of perioperative pregabalin. Subgroup analyses and meta-regression were performed to assess the impact of individual dose and frequency of pregabalin administration on analgesic efficacy. We included 55 studies. When all doses and administration regimens were combined, pregabalin was associated with a significant reduction in pain scores at rest and during movement and opioid consumption at 24 h compared with placebo {mean difference [95% confidence interval (CI)]=-0.38 (-0.57, -0.20), -0.47 (-0.76, -0.18), and -8.27 mg morphine equivalents (-10.08, -6.47), respectively}. Patients receiving pregabalin had less postoperative nausea and vomiting and pruritus compared with placebo [relative risk (RR) (95% CI)=0.62 (0.48, 0.80) and 0.49 (0.34, 0.70), respectively]. Sedation, dizziness, and visual disturbance were more common with pregabalin compared with placebo [RR (95% CI)=1.46 (1.08, 1.98), 1.33 (1.07, 1.64), and 3.52 (2.05, 6.04), respectively]. All doses of pregabalin tested (≤75, 100-150, and 300 mg) resulted in opioid sparing at 24 h after surgery. There were no significant differences in acute pain outcomes with pregabalin 100-300 mg between single preoperative dosing regimens and those including additional doses repeated after surgery. Data were insufficient to reach conclusions regarding persistent pain, but limited data available from two studies suggested that pregabalin might be effective for the reduction of neuropathic pain. In conclusion, this review suggests that pregabalin improves postoperative analgesia compared with placebo at the expense of increased sedation and visual disturbances.

RESPOND--A patient-centred programme to prevent secondary falls in older people presenting to the emergency department with a fall: protocol for a multicentre randomised controlled trial.

INTRODUCTION: Participation in falls prevention activities by older people following presentation to the emergency department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND programme, an intervention designed to improve older persons' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. DESIGN AND SETTING: A RCT at two tertiary referral EDs in Melbourne and Perth, Australia. PARTICIPANTS: 528 community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who require an interpreter or hands-on assistance to walk; live in residential aged care or >50 km from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or a history of psychosis; are receiving palliative care or are unable to use a telephone will be excluded. METHODS: Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates (1) a home-based risk factor assessment; (2) education, coaching, goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and (3) healthcare provider communication and community linkage delivered over 6 months. Primary outcomes are falls and fall injuries per person-year. DISCUSSION: RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease; however, evidence to support this approach in falls prevention is limited. TRIAL REGISTRATION NUMBER: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684).

Ageing of Jamaica's Population -- What Are the Implications for Healthcare?

The 2011 Census has confirmed the ageing of the Jamaican population. The over-60-year-old population has increased while the under 15-year population has decreased. Other demographic changes of note include the largest increase being in the old-old who are predominantly female. The demographic changes when considered with the increase in chronic disease indicate the need for consideration of healthcare specifically targeting the needs for older persons including increased prevention, continuous medical management, long term care and caregiver support.

Ageing of Jamaica's population - What are the implications for healthcare? / Envejecimiento de la población de Jamaica. ¿Cuáles son las implicaciones para la atención de la salud?

The 2011 Census has confirmed the ageing of the Jamaican population. The over 60-year old population has increased while the under 15-year old population has decreased. Other demographic changes of note include the largest increase being in the old-old who are predominantly female. The demographic changes when considered with the increase in chronic disease indicate the need for consideration of healthcare specifically targeting the needs for older persons including increased prevention, continuous medical management, long term care and caregiver support.

El censo de 2011 ha confirmado el envejecimiento de la población jamaicana. La población de más de 60 años de edad ha aumentado, mientras que la población por debajo de 15 años ha disminuido. Otros cambios demográficos notables incluyen un mayor aumento en el grupo de los ancianos mayores de 85 años, predominantemente femenino. Los cambios demográficos considerados junto con el aumento de las enfermedades crónicas indican la necesidad de tener en cuenta una atención de la salud dirigida específicamente a las necesidades de las personas mayores, que incluya mayor prevención, tratamiento médico continuo, así como apoyo a largo plazo a los cuidados y a los cuidadores de la salud.

Hypertension and Diabetes Prevalence in Older Persons in Jamaica, 2012.

The Jamaican population is experiencing both a demographic and epidemiological transition. This 2012 study of 2943 community dwelling persons over sixty years of age sought to determine the prevalence of hypertension and diabetes and how it has increased since the earlier 1989 study. Hypertension was the most prevalent non-communicable disease with 61.4% and had increased from 41.4% since 1989. It increased with age and was more common in females than males. Diabetes, at 26.3%, was the third most prevalent; it had increased by 157.1% since 1989. While the majority of affected persons were on medication, control of both diseases was less than adequate. Obesity was associated with both diseases. The paper discusses the implications for healthcare systems.

Hip fractures among indigenous Western Australians from 1999 to 2009.

BACKGROUND: Minimal trauma hip fractures are prevalent in Australia. The incidence rate and trend of hip fractures in Indigenous Western Australians have not been formally reported. AIMS: To evaluate incidence rates and trend of minimal trauma hip fractures in Indigenous and other Western Australians aged 40 years and over in 1999-2009 METHODS: Hip fracture data were obtained from an administrative database for all hospitalisations in Western Australia. Age-standardised incidence rates were calculated using direct standardisation, and standardised rate ratios were calculated using the indirect method. Trend in incidence rates were calculated using Poisson regression. RESULTS: In 1999-2009, 11,844 admissions for minimal trauma hip fractures were reported among Western Australians aged 40 years and over, of which 201 were recorded as indigenous. The age-standardised hip fracture rate was 273.0 (95% confidence interval (CI) 230.7-315.4) per 100,000 person-years for indigenous adults and 148.8 (95% CI 146.1-151.5) per 100,000 person-years for non-indigenous adults. The standardised morbidity ratio was 2.2 (95% CI 1.9-2.5). Over this period, age-standardised rates increased by an average of 7.2% per year among indigenous adults (P = 0.006), whereas non-indigenous rates fell by an average of 3.4% per year (P < 0.001). The relatively higher rates among indigenous adults were more evident in the younger age groups. CONCLUSION: There is a widening gap in minimal trauma hip fracture rates between indigenous and other Western Australians. This study demonstrates a need for public health review and management strategies to reduce falls and hip fracture in the indigenous community.

Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis.

BACKGROUND: The analgesic efficacy and adverse effects of a single perioperative dose of dexamethasone are unclear. We performed a systematic review to evaluate the impact of a single i.v. dose of dexamethasone on postoperative pain and explore adverse events associated with this treatment. METHODS: MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched for randomized, controlled studies that compared dexamethasone vs placebo or an antiemetic in adult patients undergoing general anaesthesia and reported pain outcomes. RESULTS: Forty-five studies involving 5796 patients receiving dexamethasone 1.25-20 mg were included. Patients receiving dexamethasone had lower pain scores at 2 h {mean difference (MD) -0.49 [95% confidence interval (CI): -0.83, -0.15]} and 24 h [MD -0.48 (95% CI: -0.62, -0.35)] after surgery. Dexamethasone-treated patients used less opioids at 2 h [MD -0.87 mg morphine equivalents (95% CI: -1.40 to -0.33)] and 24 h [MD -2.33 mg morphine equivalents (95% CI: -4.39, -0.26)], required less rescue analgesia for intolerable pain [relative risk 0.80 (95% CI: 0.69, 0.93)], had longer time to first dose of analgesic [MD 12.06 min (95% CI: 0.80, 23.32)], and shorter stays in the post-anaesthesia care unit [MD -5.32 min (95% CI: -10.49 to -0.15)]. There was no dose-response with regard to the opioid-sparing effect. There was no increase in infection or delayed wound healing with dexamethasone, but blood glucose levels were higher at 24 h [MD 0.39 mmol litre(-1) (95% CI: 0.04, 0.74)]. CONCLUSIONS: A single i.v. perioperative dose of dexamethasone had small but statistically significant analgesic benefits.

Validation of the Jamaican maternal sexual role modelling questionnaire / Validación del cuestionario sobre la modelación del rol sexual materno en Jamaica

OBJECTIVE: Urban Jamaican adolescent girls face significant risk for sexually transmitted infections including HIV. Studies from the United States of America have found that parents influence adolescents' sexual risk attitudes and behaviours through parent-child sexual communication and monitoring/ supervision. Data from an ongoing mother-daughter HIV risk reduction intervention study in Kingston, Jamaica identified an additional influence of adolescent girls' sexual risk - maternal sexual role modelling (MSRM). As no reliable and valid questionnaires existed to measure MSRM, one was developed. The objective of the current study was to evaluate the psychometric properties of the Jamaican Maternal Sexual Role Modelling questionnaire. METHOD: Data were collected from 209 Jamaican female adolescents recruited from Kingston, St Andrew and St Catherine parishes. RESULTS: The final 19-item Jamaican MSRM questionnaire was found to have excellent internal reliability (Cronbach's alpha = 0.89). Content validity expert ratings and modified kappa statistics were all 1.0. Principal component analysis identified a three-factor structure that accounted for 53.7% of the variance. Greater MSRM scale scores, indicating more positive and protective maternal sexual role modelling, were associated with less sexual experience, lower intentions to have sex, greater intentions to use condoms if having sex and greater condom use self-efficacy among adolescent girls. CONCLUSION: The MSRM scale was found to be a reliable and valid measure of Jamaican adolescent females' perceptions of their mothers' sexual role modelling. Further research is needed to assess the reliability and validity of the instrument with other populations.

OBJETIVO: Las jóvenes adolescentes urbanas de Jamaica, enfrentan un riesgo significativo de infecciones de trasmisión sexual, incluyendo el VIH. Estudios de los Estados Unidos de América han encontrado que los padres influyen en las conductas y actitudes de riesgo sexual de los adolescentes a través de la comunicación entre padres e hijos sobre asuntos de sexo, acompañada de supervisión y monitoreo. Datos obtenidos a partir de un estudio de intervención que se desarrolla actualmente en Kingston, Jamaica, para reducir el riesgo de VIH madre-hija, identificaron una influencia adicional de riesgo sexual entre las adolescentes: la modelación del rol sexual materno (MRSM). Como que no existían cuestionarios válidos y fiables para medir la MRSM, se desarrolló uno a propósito de este trabajo. El objetivo del presente estudio fue evaluar las propiedades psicométricas del cuestionario de la modelación del rol sexual materno jamaicano. MÉTODO: Se recopilaron datos de 209 adolescentes jamaicanas reclutadas en los distritos de Kingston, St Andrew y St Catherine. RESULTADOS: Se halló que el cuestionario final MRSM jamaicano de 19 ítems poseía excelente fiabilidad interna (alfa de Cronbach = 0.89). Las valoraciones (ratings) de los expertos con respecto a la validez del contenido, así como las estadísticas Kappa modificadas, fueron todas 1.0. El análisis del componente principal identificó una estructura de tres factores que daba cuenta del 53.7% de la varianza. Mayores puntuaciones de la escala MRSM, que indicaban una modelación del rol sexual materno más positiva y protectora, estuvieron asociadas con menor experiencia sexual, menos intenciones de tener sexo, más intenciones de usar condón a la hora de mantener relaciones sexuales, y mayor auto-eficacia en el uso de condón entre las adolescentes. CONCLUSIÓN: Se halló que la escala MRSM es fiable y constituye una medida válida de las percepciones que las adolescentes jamaicanas tienen en relación con la modelación del rol sexual de sus madres. Se necesita continuar las investigaciones a fin de evaluar la fiabilidad y validez del instrumento con otras poblaciones.

Validation of the Jamaican Maternal Sexual Role Modelling Questionnaire.

OBJECTIVE: Urban Jamaican adolescent girls face significant risk for sexually transmitted infections including HIV Studies from the United States ofAmerica have found that parents influence adolescents' sexual risk attitudes and behaviours through parent-child sexual communication and monitoring/supervision. Data from an ongoing mother-daughter HIVrisk reduction intervention study in Kingston, Jamaica identified an additional influence of adolescent girls' sexual risk - maternal sexual role modelling (MSRM). As no reliable and valid questionnaires existed to measure MSRM, one was developed. The objective of the current study was to evaluate the psychometric properties of the Jamaican Maternal Sexual Role Modelling questionnaire. METHOD: Data were collected from 209 Jamaican female adolescents recruited from Kingston, St Andrew and St Catherine parishes. RESULTS: The final 19-item Jamaican MSRM questionnaire was found to have excellent internal reliability (Cronbach's alpha = 0.89). Content validity expert ratings and modified kappa statistics were all 1.0. Principal component analysis identified a three-factor structure that accounted for 53.7% of the variance. Greater MSRM scale scores, indicating more positive and protective maternal sexual role modelling, were associated with less sexual experience, lower intentions to have sex, greater intentions to use condoms if having sex and greater condom use self-efficacy among adolescent girls. CONCLUSION: The MSRM scale was found to be a reliable and valid measure of Jamaican adolescent females'perceptions of their mothers'sexual role modelling. Further research is needed to assess the reliability and validity of the instrument with other populations.

Synthesis of hydroxylated steroid hormones via conjugate addition of a silyl-cuprate reagent.

The synthesis of several hydroxylated steroids via conjugate addition of Fleming's silyl-cuprate reagent, (PhMe2Si)2CuLi, a masked hydroxyl group, to the appropriate enone was studied. By this means 7 alpha-hydroxytestosterone (7) was obtained in good yield from 17 beta-hydroxyandrosta-4,6-dien-3-one (1a), though similar reactions on 17 beta-hydroxyandrosta-1,4-dien-3-one (8) gave a low yield of 1 alpha-hydroxytestosterone (13) chiefly through the poor conversion of the phenylsilyl intermediate into the halogenosilane. 3 beta,16 alpha-Dihydroxy-5 alpha-pregnan-20-one (18b) was obtained in a similar manner from 3 beta-hydroxy-5 alpha-pregn-16-en-20-one and 5 alpha-cholestane-1 alpha,3 alpha-diol(17) was produced from the 1-en-3-one (14) via conjugate addition of the silyl group, reduction of the carbonyl function, and oxidative removal of the silyl group.

Identifying students with learning disabilities: the effect of implementing statewide guidelines.

Methods for identifying students with learning disabilities continue to be an area of controversy. The present investigation examined the impact of implementing statewide guidelines for the identification of these students. Data were collected from multidisciplinary team reports on 718 students with learning disabilities who were referred and labeled during the 1983-84 school year (before implementation of statewide learning disability guidelines) and 790 students who were identified during 1987-88 (after implementation of the guidelines). The results of the study revealed that the statewide guidelines significantly changed the characteristics of students who were identified. After the implementation of the guidelines, students with much more severe academic problems were identified. These students were much more likely to have a severe discrepancy and be chronically failing in the regular classroom. However, even with explicit, widely accepted guidelines, approximately one third of all students identified in 1987-88 failed to meet the stated criteria for identification. The implications of these findings for professional practice and future research are discussed.

Factors influencing the identification of black and white students with learning disabilities.

This study examined the differential influence of an IQ cutoff and standard score or regression-based method for determining a severe discrepancy as eligibility criteria for the identification of black and white students with learning disabilities. Subjects were 218 white and 132 black students referred for possible learning disability services. The results of the study demonstrated that the use of a standard score method for determining a severe discrepancy and the use of an IQ cutoff above the range for mental retardation resulted in the disproportionate underrepresentation of black students meeting eligibility criteria. In contrast, when a regression-based method to determine a severe discrepancy was used, along with the absence of an IQ cutoff, no differences were discerned between the two groups. The implications of these findings for current practice are discussed.

Gliadin binding to rat and human enterocytes.

Binding of 125I-crude gluten digest (Frazer's fraction III. FF-III) and 125I-concanavalin A (Con A) to isolated rat enterocytes and of 125I-FF-III to human enterocytes was investigated. Specific binding of 125I-FF-III to rat enterocytes was observed but binding was not inhibited by any of a range of simple and complex saccharides. although casein and bovine serum albumin displaced FF-III at high concentrations. Con A also bound to enterocytes in a specific manner and was inhibited by alpha-methyl-D-mannoside, confirming a lectin-mediated interaction. 125I-FF-III exhibited quantitatively similar specific binding to both normal human and coeliac enterocytes. The primary interaction of gliadin peptides with the enterocyte surface membrane is not lectin-mediated and unlikely to be of fundamental importance in the pathogenesis of coeliac disease.

Reappraisal of the 'lectin hypothesis' in the aetiopathogenesis of coeliac disease.

The agglutinating properties of a crude gluten digest, purified gliadin fractions and established plant lectins were investigated using mammalian erythrocytes, rat enterocytes and normal and coeliac human enterocytes as the target systems. Gliadin preparations failed to cause agglutination of any of the cells tested, whereas established pure plant lectins were active cell agglutinins. These studies indicate that gliadin peptides do not interact with intestinal cells in a polyvalent, lectin-like manner and as such cannot be regarded as true lectins. Mucosal damage in coeliac disease is unlikely therefore to be related to lectin-like activity of gliadin.