[Detection of urate tubulointerstitial nephritis: contribution of diagnostic questionnaire]. / Raspoznovanie uratnogo tubulointerstitsial'nogo nefrita s ispol'zovaniem diagnosticheskoi ankety.

AIM: To develop a diagnostic questionnaire to identify individuals with uric acid hyperproduction and risk of urate tubulointerstitial nephritis (UTIN). MATERIALS AND METHODS: Clinical symptoms of 650 patients with verified hyperuricemia or hyperuricosemia have been summarized to design a special questionnaire which will be able to identify subjects to whom test for uricemia and uricosuria may be recommended to prevent onset and/or progression of UTIN. RESULTS: The questionnaire has been compiled which has rather high sensitivity and specificity in identification of persons with hyperuricemia and/or hyperuricosuria at risk to develop UTIN. CONCLUSION: The designed questionnaire allows to select subjects with existing UTIN or at UTIN risk both in population and individual studies.

Varicella serological status of healthcare workers as a guide to whom to test or immunize.

Only 1.6% of 1,331 hospital workers were seronegative for varicella-zoster virus (VZV), including 8.7% of those with a negative history and 0.5% of those with a positive history. Seronegativity was inversely related to age but unrelated to job category, exposure at work to VZV, country of origin, race, or gender.

[How to prevent post-traumatic stress disorder before traumatization occurs?]. / Comment prévenir l'apparition d'un trouble de stress post-traumatique avant un traumatisme?

OBJECTIVE: To provide an update on methods of preventing the onset of posttraumatic stress disorder (PTSD) before trauma occurs. METHOD: Survey and analysis of the literature (mainly articles) found in the Medline, Psychinfo, and Pilot databases. RESULTS: Most research focuses on identifying risk factors and reinforcing individual resistance as the prime means of preventing PTSD. The severity of the trauma is by far the most serious risk factor. To reinforce resistance and prevent the onset of PTSD, the army has favoured psychoeducational approaches. However, the literature survey has found no pretrauma prevention program for other high-risk occupations. CONCLUSION: The usefulness of identified risk factors for the primary prevention of PTSD is limited, since with the exception of the trauma itself, they play a minor role on the onset of severe-trauma PTSD. Psychoeducational approaches aimed at reinforcing the resistance of individuals at risk are promising, but their potential has to be further explored in individuals in high-risk trades. Finally, it has been suggested that other avenues of research in the primary prevention (pretrauma) of PTSD be explored. These include the identification of possible protection factors, the influence of genetic make-up and of biological variables, the cumulative effects of exposure to stressors, and the presence of chronic stressors.

Susceptibility to local infection in biological internal fixation. Experimental study of open vs minimally invasive plate osteosynthesis in rabbits.

Resistance to local infection after fracture fixation with plate osteosynthesis may be influenced by the implantation technique. It is known that the extent of the surgical approach to the bone can compromise the local defence capacity. We have investigated susceptibility to infection after a local bacterial challenge in rabbit tibiae using either the open surgical approach for 'biological' internal fixation of standard 2.0 dynamic compression plates or the method of minimally invasive plate osteosynthesis (MIPO), a percutaneous, tunnelling insertion technique preserving the integrity of the overlying soft tissue. After the wounds had been closed, various concentrations of Staphylococcus aureus were injected in the direct vicinity of the implants. The infection rate for the open surgical technique was 38.5% and that for the MIPO technique, 25%. This difference is not statistically significant (P > 0.05) suggesting that resistance to local infection associated with the MIPO method is at least equivalent to the open approach for plate osteosynthesis.

Vaccine preventable diseases and immunisations: a qualitative study of mothers' perceptions of severity, susceptibility, benefits and barriers.

This study investigated mothers' perceptions of vaccine-preventable diseases and associated vaccines in terms of perceived susceptibility, severity, benefits and barriers. A purposive sampling strategy was used to choose mothers whose only or youngest child was completely, incompletely (behind the recommended immunisation schedule) or partially (parents chose or advised not to have a specific immunisation) immunised or had no immunisations. Semi-structured interviews found that complete immunisers believed the risk of vaccines was lower than the risk from disease and that the likelihood of contracting many of these diseases was low. Incomplete immunisers perceived vaccines to be less effective in preventing disease and were often confused about which diseases the vaccines would protect against. Non-immunisers were more concerned about unknown, long-term side effects of vaccines than the diseases. Many mothers who did immunise believed that preventing diseases was not always possible and for diseases such as measles, mumps and rubella, it was not always necessary nor desirable. Vaccines were perceived as placing stress on the immune system rather than strengthening it. Important themes relating to barriers to the decision to immunise were a lack of 'balanced', detailed information and poor communication between health providers and parents. The major barrier to timely, age-appropriate immunisations was the occurrence of minor illnesses in the target child or the family. This study found that many mothers were balancing the risks of immunising with the risks of not immunising and this must be taken into account, along with factors such as difficulties in obtaining immunisations.

Optimal vaccine trial design when estimating vaccine efficacy for susceptibility and infectiousness from multiple populations.

Vaccination can have important indirect effects on the spread of an infectious agent by reducing the level of infectiousness of vaccinees who become infected. To estimate the effect of vaccination on infectiousness, one typically requires data on the contacts between susceptible and infected vaccinated and unvaccinated people. As an alternative, we propose a trial design that involves multiple independent and interchangeable populations. By varying the fraction of susceptible people vaccinated across populations, we obtain an estimate of the reduction infectiousness that depends only on incidence data from the vaccine and control groups of the multiple populations. One can also obtain from these data an estimate of the reduction of susceptibility to infection. We propose a vaccination strategy that is a trade-off between optimal estimation of vaccine efficacy for susceptibility and of vaccine efficacy for infectiousness. We show that the optimal choice depends on the anticipated efficacy of the vaccine as well as the basic reproduction number of the underlying infectious disease process. Smaller vaccination fractions appear desirable when vaccine efficacy is likely high and the basic reproduction number is not large. This strategy avoids the potential for too few infections to occur to estimate vaccine efficacy parameters reliably.

Strategies for community health intervention: promises, paradoxes, pitfalls.

This paper provides a rationale for intervening on shared determinants of health at the community level of analysis, presents strategies for intervening on shared determinant risks at the community-level of analysis, and illustrates through a case study of a youth program how a small-scale community intervention on shared determinants might work in practice. Although there is a long history of community intervention to improve health, high quality research on these interventions has been conducted only recently. In evaluating the usefulness of a community intervention, the distinction between relative risk and population-attributable risk is not always made clear. These two distinct types of risk are reviewed considering their implications for what risk factors are targeted by community interventions and what criteria are reasonable to apply in evaluating the utility of these interventions. A role for linking root cause analysis with attributable risk and interventions to reduce risk is presented.

Toward understanding the association of socioeconomic status and health: a new challenge for the biopsychosocial approach.

The association of socioeconomic status (SES) with morbidity and mortality is a ubiquitous finding in the health literature. One of the principal challenges for biobehavioral researchers is understanding the mechanisms that link SES with health outcomes. This article highlights possible pathways by which SES may influence health. It also provides a discussion of sociodemographic and geographical modifiers of the SES-health relationship and offers several potentially fruitful directions for future research.

Rethinking medicine: improving health outcomes with cost-effective psychosocial interventions.

Thoughts, feelings, and moods can have a significant effect on the onset of some diseases, the course of many, and the management of nearly all. Many visits to the doctor are occasioned by psychosocial distress. Even in those patients with organic medical disorders, functional health status is strongly influenced by mood, coping skills, and social support, yet the predominant approach in medicine is to treat people with physical and chemical treatments that neglect the mental, emotional, and behavioral dimensions of illness. This critical mismatch between the psychosocial health needs of people and the usual medical response leads to frustration, ineffectiveness, and wasted health care resources. There is emerging evidence that empowering patients and addressing their psychosocial needs can be health and cost effective. By helping patients manage not just their disease but also common underlying needs for psychosocial support, coping skills, and sense of control, health outcomes can be significantly improved in a cost-effective manner. Rather than targeting specific diseases or behavioral risk factors, these psychosocial interventions may operate by influencing underlying, shared determinants of health such as attitudes, beliefs, and moods that predispose toward health in general. Although the health care system cannot be expected to address all the psychosocial needs of people, clinical interventions can be brought into better alignment with the emerging evidence on shared psychosocial determinants of health by providing services that address psychosocial needs and improve adaptation to illness.

The role of social relations in health promotion.

In considering new paradigms for the prevention and treatment of disease and disability, we need to incorporate ways to promote social support and develop family and community strengths and abilities into our interventions. There is now a substantial body of evidence that indicates that the extent to which social relationships are strong and supportive is related to the health of individuals who live within such social contexts. A review of population-based research on mortality risk over the last 20 years indicates that people who are isolated are at increased mortality risk from a number of causes. More recent studies indicate that social support is particularly related to survival postmyocardial infarction. The pathways that lead from such socioenvironmental exposures to poor health outcomes are likely to be multiple and include behavioral mechanisms and more direct physiologic pathways related to neuroendocrine or immunologic function. For social support to be health promoting, it must provide both a sense of belonging and intimacy and must help people to be more competent and self-efficacious. Acknowledging that health promotion rests on the shoulders not only of individuals but also of their families and communities means that we must commit resources over the next decade to designing, testing, and implementing interventions in this area.

Person variables and health: personality predispositions and acute psychological states as shared determinants for disease.

This article reviews prospective evidence linking certain classes of person variables to multiple disease end points. Included in the review is a consideration of the effects of hostility and anger, emotional suppression, depression, fatalism, and pessimism on coronary heart disease, cancer, and acquired immunodeficiency syndrome. A model is presented that integrates several of these variables into an overall conceptual scheme. In addition, several variables are identified that appear to moderate the strength of the relationships that are found between person variables and health. The article concludes with some suggested directions for future research.

Endocarditis infecciosa y maniobras odontológicas instrumentales: su prevención / Endocarditis infectious and instrumental odontological operation: prevention

La EI es una enfermedad infecciosa que se presenta en pacientes que habitualmente tienen lesiones estructurales cardíacas. Basados en el conocimiento homeopático de terreno susceptible y en la acción de los nosodes se sugiere en este trabajo que el tratamiento de fondo más el nosode del germen bucal más habitual en EI post maniobras instrumentales odontológicas, serían de utilidad en la prevención de la EI en los pacientes portadores de lesiones y riesgo leve, en los cuales es mayor el riesgo de la acción tóxica de los antibióticos que el riesgo de contraer EI

Endocarditis infecciosa y maniobras odontológicas instrumentales: su prevención / Endocarditis infectious and instrumental odontological operation: prevention

La EI es una enfermedad infecciosa que se presenta en pacientes que habitualmente tienen lesiones estructurales cardíacas. Basados en el conocimiento homeopático de terreno susceptible y en la acción de los nosodes se sugiere en este trabajo que el tratamiento de fondo más el nosode del germen bucal más habitual en EI post maniobras instrumentales odontológicas, serían de utilidad en la prevención de la EI en los pacientes portadores de lesiones y riesgo leve, en los cuales es mayor el riesgo de la acción tóxica de los antibióticos que el riesgo de contraer EI (AU)

Different susceptibility to the IL-3 induced-protective effects between Strongyloides ratti and Nippostrongylus brasiliensis in C57BL/6 mice.

Repetitive administration of recombinant IL-3 induced protection against Strongyloides ratti but not against Nippostrongylus brasiliensis in C57BL/6 mice. Numbers of S. ratti were negligible from day 4 to day 6 post-infection in mice injected with IL-3, whereas N. brasiliensis burdens were almost equal from day 4 to day 6 between mice injected with IL-3 or with medium. Mice treated with IL-3 and then concurrently infected with S. ratti and N. brasiliensis were protected from intestinal S. ratti but not from N. brasiliensis. The numbers of intestinal mucosal mast cells were increased by the repetitive IL-3 treatment on one day after the final injection and was augmented by subsequent infection with both nematodes.