Good Evidence (good + evidence)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Glucose Metabolic Disorder After Transplantation

J. P. Van Hooff
Better evidence on the relative merits of various immunosuppressive regimens for reducing diabetes while preserving overall outcomes is needed. See also article by Vincenti et al in this issue on page 1506. [source]

The potential for ,-opioid receptor agonists to be anti-emetic in humans: a review of clinical data

In animal models of vomiting, ,-opioid (MOP, OP3) receptors mediate both emesis and anti-emesis. ,-receptors within the blood,brain barrier, mediating anti-emesis, are more rapidly accessible to lipid-soluble ,-opioid receptor agonists such as fentanyl than to morphine, and fentanyl has broad-spectrum anti-emetic effects in a number of species. Whether a similar situation exists in humans is not known. A search was performed for clinical studies comparing the emetic side effects of opioids administered peri-operatively in an attempt to identify differences between morphine and more lipid-soluble ,-receptor-selective agonists such as fentanyl. Overall, the evidence appears to suggest that fentanyl and other phenylpiperidines are associated with less nausea and vomiting than morphine, but not all studies support this, and fentanyl-like drugs are associated with nausea and vomiting per se. Good evidence, however, exists to show that fentanyl and alfentanil do not cause more nausea and vomiting than the ultra fast-acting remifentanil. Because remifentanil is cleared rapidly post-operatively, such trials suggest that the emetic side effects of fentanyl and alfentanil are minimal. The clinical evidence, although limited, is at least consistent with the possibility that central ,-opioid receptors may mediate anti-emesis in humans. It is possible that the role of ,-opioid agonists in anti-emesis may become clearer in the future as a result of the use of peripheral ,-opioid receptor antagonists. [source]

Why there is better evidence for culture in fish than chimpanzees

K. N. Laland
Fish have comparatively small brains and are not renowned for their intelligence. Yet a series of laboratory experiments on the guppy reveals that they can be surprisingly good at learning from each other, and that social learning processes can mediate behavioural traditions analogous to the tool using traditions of different populations of chimpanzees. Transmission chain experiments have established that arbitrary and even maladaptive information can be socially transmitted among shoals of fish. Studies of behavioural innovation in guppies are strikingly consistent with findings of equivalent studies in primates. There are strong sex differences in innovatory tendencies and social learning abilities in guppies, which also parallel observations of primates. These studies suggest that the adage ,necessity is the mother of invention' may be a characteristic feature of animal innovation. When considered in combination with the findings of transfer experiments carried out on natural populations of fish, it becomes apparent that fish are an excellent model system for studies of animal social learning and culture. [source]

Comparative Effectiveness Research and Evidence-Based Health Policy: Experience from Four Countries

Context: The discussion about improving the efficiency, quality, and long-term sustainability of the U.S. health care system is increasingly focusing on the need to provide better evidence for decision making through comparative effectiveness research (CER). In recent years, several other countries have established agencies to evaluate health technologies and broader management strategies to inform health care policy decisions. This article reviews experiences from Britain, France, Australia, and Germany. Methods: This article draws on the experience of senior technical and administrative staff in setting up and running the CER entities studied. Besides reviewing the agencies' websites, legal framework documents, and informal interviews with key stakeholders, this analysis was informed by a workshop bringing together U.S. and international experts. Findings: This article builds a matrix of features identified from the international models studied that offer insights into near-term decisions about the location, design, and function of a U.S.-based CER entity. While each country has developed a CER capacity unique to its health system, elements such as the inclusiveness of relevant stakeholders, transparency in operation, independence of the central government and other interests, and adaptability to a changing environment are prerequisites for these entities' successful operation. Conclusions: While the CER entities evolved separately and have different responsibilities, they have adopted a set of core structural, technical, and procedural principles, including mechanisms for engaging with stakeholders, governance and oversight arrangements, and explicit methodologies for analyzing evidence, to ensure a high-quality product that is relevant to their system. [source]

The cost-effectiveness of cervical screening in Australia: what is the impact of screening at different intervals or over a different age range?

Rob Anderson
Abstract Objective: To estimate the cost-effectiveness of altering the currently recommended interval and age range for cervical screening of Australian women. Methods: The cost and effectiveness estimates of alternative screening strategies were generated using an established decision model. This model incorporated a Markov model (of the natural history of cervical cancer and pre-cancerous lesions) and decision trees which: ,mapped' the various pathways to cervical cancer screening; the follow-up of abnormal Pap test results; and the management of confirmed lesions. The model simulated a hypothetical large cohort of Australian women from age 15 to age 85 and calculated the accumulated costs and life-years under each screening strategy. Results: Our model estimated that moving from the current two-yearly screening strategy to annual screening (over the same age range) would cost $379,300 per additional life-year saved. Moving from the current strategy to three-yearly screening would yield $117,100 of savings per life-year lost (costs and effects both discounted at 5% per year), with a relatively modest (<5%) reduction in the total number of life-years saved by the program. Conclusions: Although moving to annual screening would save some additional lives, it is not a cost-effective strategy. Consideration should be given to increasing the recommended interval for cervical screening. However, the net value of any such shift to less effective (e.g. less frequent) and less costly screening strategies will require better evidence about the cost-effectiveness of strategies that encourage non-screeners or irregular screeners to have a Pap test more regularly. [source]

The Asymptomatic Carotid Surgery Trial: bigger study, better evidence

A. R. Naylor
Surgery works for asymptomatic disease [source]

Patient-assessed health outcome measures for diabetes: a structured review

A. M. Garratt
Abstract Aims To identify available disease-specific measures of health-related quality of life (HRQL) for diabetes and to review evidence for the reliability, validity and responsiveness of instruments. Methods Systematic searches were used to identify instruments. Instruments were assessed against predefined inclusion and exclusion criteria. Letters were sent to authors requesting details of further instrument evaluation. Information relating to instrument content, patients, reliability, validity and responsiveness to change was extracted from published papers. Results The search produced 252 references. Nine instruments met the inclusion criteria: Appraisal of Diabetes Scale (ADS), Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP-1, DHP-18), Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Measure (DQOL), Diabetes-Specific Quality of Life Scale (DSQOLS), Questionnaire on Stress in Diabetic Patients-Revised (QSD-R), Diabetes-39 (D-39) and Well-being Enquiry for Diabetics (WED). The shortest instrument (ADS) has seven items and the longest (WED) has 50 items. The ADS and ADDQoL are single-index measures. The seven multidimensional instruments have dimensions covering psychological well-being and social functioning but vary in the remainder of their content. The DHP-1 and DSQOLS are specific to Type 1 diabetes patients. The DHP-18 is specific to Type 2 diabetes patients. The DIMS and DQOL have weaker evidence for reliability and internal construct validity. Patients contributed to the content of the ADDQoL, DHP-1/18, DQOL, DSQOLS, D-39, QSD-R and WED. The authors of the ADDQoL, DHP-1/18, DQOL, DSQOLS gave explicit consideration to content validity. The construct validity of instruments was assessed through comparisons with instruments measuring related constructs and clinical and sociodemographic variables. None of the instruments has been formally assessed for responsiveness to changes in health. Conclusions Five of the diabetes-specific instruments have good evidence for reliability and internal and external construct validity: the ADDQoL, DHP-1/18, DSQOLS, D-39 and QSD-R. Instrument content should be assessed for relevance before application. The instruments should be evaluated concurrently for validity and responsiveness to important changes in health. [source]

A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers

ADDICTION, Issue 8 2010
Shade Agboola
ABSTRACT Aims To carry out a systematic review of the effectiveness of relapse prevention interventions (RPIs) among abstinent smokers who had completed an initial course of treatment or who had abstained unassisted, pooling only outcome data from similar follow-up time points. Methods We used the same search strategy as was used in Cochrane reviews of RPIs to identify randomized trials of behavioural and pharmacological studies of smoking RPIs published up to July 2008. Abstinence from smoking was defined as either continuous abstinence or point prevalence abstinence, measured at three follow-up time points: short term (1,3 months post randomization), medium term (6,9 months) and long term (12,18 months). Abstinence among pregnant/postpartum women was also measured at delivery or the last follow-up prior to delivery. Random effect meta-analysis was used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI). Results Thirty-six studies randomizing abstainers were included. Self-help materials appeared to be effective in preventing relapse at long-term follow up in initially unaided quitters (pooled OR 1.52; 95% CI 1.15 to 2.01, I2 = 0%, NNT = 11, 3 studies). Other behavioural interventions for relapse prevention appeared effective in the short term only. There were positive results for the use of pharmacotherapies for relapse prevention. Bupropion was effective at long-term follow-up (pooled OR 1.49; 95% CI 1.10 to 2.01; I2 = 0%; NNT = 11; 4 studies). Nicotine replacement therapy (NRT) was effective at medium-term (pooled OR 1.56; 95% CI 1.16 to 2.11; I2 = 37%; NNT = 14; 4 trials) and long-term follow-ups (pooled OR 1.33; 95% CI 1.08 to 1.63; I2 = 0%; NNT = 20; 4 trials). Single trials of extended treatment of Varenicline and rimonabant were also found to be effective at short-term and medium-term follow-ups. Conclusions Self-help materials appear to prevent relapse in initially unaided quitters. Use of NRT, bupropion and varenicline appears to be effective in preventing relapse following an initial period of abstinence or an acute treatment episode. There is currently no good evidence that behavioural support prevents relapse after initial unaided abstinence or following an acute treatment period. [source]

Analysis of nest occupancy and nest reproduction in two sympatric raptors: common buzzard Buteo buteo and goshawk Accipiter gentilis

ECOGRAPHY, Issue 5 2002
Oliver Krüger
Nest site selection can have important fitness consequences in birds. I analysed the habitat characteristics of 392 nests of two sympatric raptor species (common buzzard Buteo buteo and goshawk Accipiter gentilis) in Germany and their relation to nest occupation rate and nest reproductive success. For common buzzard, multivariate models explained only small proportions of the variance in nest occupation rate and nest reproductive success (13,19%). Important variables related to nest occupation rate were human disturbances, intra- and interspecific neighbour density, the amount of forested area and nest tree crown cover. Variables related to nest site reproductive success also included human disturbance, intra- and interspecific neighbour density and nest tree crown cover as well as nest distance to the nearest forest edge. In contrast, models for the goshawk explained a much higher proportion of the variation in nest occupation rate and nest reproductive success (41,43%). Important variables related to nest occupation rate were the remoteness of the nest site and direct human disturbance. Variables related to nest site reproductive success were remoteness of the nest site and good hunting habitat. Goshawks seem to be more sensitive to human disturbance than buzzards. A multiple discriminant analysis showed that nest site characteristics substantially overlapped between the species and there is a good evidence that competition for optimal nest sites occurs. Thus, buzzards might be constrained by the dominant goshawk in their nest site selection. [source]

Why promises and threats need each other

Christopher P. Reinders Folmer
Despite the pervasive use of promises and threats in social life, very little research has been devoted to examining the effectiveness of these interpersonal tactics in promoting cooperation in social dilemmas. Based on the Goal-Prescribes-Rationality principle, we hypothesized that cooperation should be most strongly enhanced when promises and threats are communicated in combination, rather than in isolation. Also, we hypothesized that the combination of promises and threats should be especially effective among individuals with prosocial rather than proself orientations. Two studies provided good evidence for the latter hypothesis, in that the combination of promises and threats was only effective in people with prosocial orientations, people who are concerned with equality and collective interest. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Prevotella intermedia lipopolysaccharide stimulates release of tumor necrosis factor-, through mitogen-activated protein kinase signaling pathways in monocyte-derived macrophages

Sung-Jo Kim
Abstract The purpose of this study was to investigate the effects of lipopolysaccharide from Prevotella intermedia, a major cause of inflammatory periodontal disease, on the production of tumor necrosis factor (TNF)-, and the expression of TNF-, mRNA in differentiated THP-1 cells, a human monocytic cell line. The potential involvement of the three main mitogen-activated protein kinase (MAPK) signaling pathways in the induction of TNF-, production was also investigated. Lipopolysaccharide from P. intermedia ATCC 25611 was prepared by the standard hot phenol,water method. THP-1 cells were incubated in the medium supplemented with phorbol myristate acetate to induce differentiation into macrophage-like cells. It was found that P. intermedia lipopolysaccharide can induce TNF-, mRNA expression and stimulate the release of TNF-, in differentiated THP-1 cells without additional stimuli. Treatment of the cells with P. intermedia lipopolysaccharide resulted in a simultaneous activation of three MAPKs [extracellular signal-related kinase 1/2 (ERK1/2), c-Jun N-terminal kinase 1/2 (JNK1/2) and p38]. Pretreatment of the cells with MAPK inhibitors effectively suppressed P. intermedia lipopolysaccharide-induced TNF-, production without affecting the expression of TNF-, mRNA. These data thus provided good evidence that the MAPK signaling pathways are required for the regulation of P. intermedia lipopolysaccharide-induced TNF-, synthesis at the level of translation more than at the transcriptional level. [source]

Look on the positive side!

Archaeal' membrane-bound nitrate reductases, The orientation, bioenergetics of, identification
Abstract Many species of Bacteria and Archaea respire nitrate using a molybdenum-dependent membrane-bound respiratory system called Nar. Classically, the ,Bacterial' Nar system is oriented such that nitrate reduction takes place on the inside of this membrane. However, the active site subunit of the ,Archaeal' Nar systems has a twin arginine (,RR') motif, which is a suggestion of translocation to the outside of the cytoplasmic membrane. These ,Archaeal' type of nitrate reductases are part of a group of molybdoenzymes with an ,RR' motif that are predicted to have an aspartate ligand to the molybdenum ion. This group includes selenate reductases and possible sequence signatures are described that serve to distinguish the Nar nitrate reductases from the selenate reductases. The ,RR' sequences of nitrate reductases of Archaea and some that have recently emerged in Bacteria are also considered and it is concluded that there is good evidence for there being both Archaeal and Bacterial examples of Nar-type nitrate reductases with an active site on the outside of the cytoplasmic membrane. Finally, the bioenergetic consequences of nitrate reduction on the outside of the cytoplasmic membrane have been explored. [source]

How much CAM is based on good evidence?

Edzard Ernst

Immune tolerance induction in patients with haemophilia A with inhibitors: a systematic review

HAEMOPHILIA, Issue 4 2003
J. Wight
Summary., In some patients with haemophilia A, therapeutically administered factor VIII (FVIII) comes to stimulate the production of antibodies (inhibitors) which react with FVIII to render it ineffective. As a result, FVIII cannot be used prophylactically and patients become liable to recurrent bleeds. There are two elements to the management of patients with inhibitors: the treatment of bleeding episodes, and attempts to abolish inhibitor production through the induction of immune tolerance. This paper reports a systematic review of the best available evidence of clinical effectiveness in relation to immune tolerance induction (ITI) in patients with haemophilia A with inhibitors. Owing to the lack of randomized controlled trials on this topic, broad inclusion criteria with regard to study design were applied in order to assess the best available evidence for each intervention. As a result of the clinical and methodological heterogeneity of the evidence, it was not appropriate to pool data across studies; instead, data were synthesized using tabulation and qualitative narrative assessment. The International Registry provides the most reliable estimate of the proportion of successful cases of ITI [48.7%, 95% confidence interval (CI) 42.6,52.7%]. The duration of effect is unclear, but relapses appear to be infrequent. The International Registry shows a rate of relapse of 15% at 15 years. The comparative effectiveness of different protocols is uncertain, as no trials have been undertaken which compare them directly. However, the evidence suggests that the Bonn protocol may be more effective than the Malmö or low-dose protocols. There is no good evidence that immunosuppressive drug regimens are effective. [source]

The changing face of HIV-associated lymphoma: what can we learn about optimal therapy inl the post highly active antiretroviral therapy era?

Alison Clayton
Abstract Epidemiological data indicate that the risk of developing non-Hodgkin lymphoma (NHL) in HIV positive individuals is related to age and CD4 count (i.e. degree of immunosuppression). The prognosis of patients with HIV-NHL has been shown to be linked to several features including age, stage, modified IPI, prior AIDS diagnosis, CD4 count, immunoblastic pathology, LDH, and HAART use. These features are, as would be expected, a mixture of prognostic factors relating to both the HIV, and to the NHL. Population studies indicate that the incidence of associated (HIV-NHL) may be reducing with the advent of HAART, although not all studies concur. However, most population-based studies have not as yet shown a significant improvement in the survival of patients with HIV-NHL with HAART. The optimal chemotherapy for these patients is unknown, although it is generally accepted that CNS prophylaxis is mandatory. There is currently no good evidence of any survival benefit with increased dose intensity from large RCT. However, it must be borne in mind that the large randomised studies comparing differing dose intensities were undertaken before the advent of effective HAART. There is some evidence that there may be a subset of good prognosis patients who may benefit from more intensive therapy.6 Given that the prognosis of patients with HIV can now be considerably improved with HAART, we cannot necessarily assume that the same results would apply with regard to chemotherapy dose intensity. There is some evidence that there is a survival benefit from the addition of HAART to chemotherapy, although this is retrospective. It is likely, however, that the reason for this is that the HAART improves the prognosis of the patients from their HIV, and therefore reduces the number of patients dying from other HIV-related illnesses whilst in remission from their lymphoma, as was seen in large numbers of patients in the earlier chemotherapy trials. It must not be forgotten that the prognosis of the patient's NHL is intimately linked to their prognosis with respect to the HIV. Although the number of patients with HIV-NHL is currently few, there is a need for more trials of chemotherapy, particularly now in the HAART era, when the prognosis from the point of view of the HIV has improved so much. In particular, the issue of dose intensity needs revisiting for patients whose overall prognosis can be improved by commencing HAART. Patients with HIV-NHL should be managed at specialist centres, and where possible should be managed as part of RCT. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Duloxetine in acute major depression: review of comparisons to placebo and standard antidepressants using dissimilar methods

Paolo Girardi
Abstract Background Randomized controlled trials (RCTs) of duloxetine (DLX), an inhibitor of both norepinephrine and serotonin transporters (SNRI), have tested its efficacy in acute major depressive disorder (MDD) versus placebo (PBO) or standard serotonin-reuptake inhibitors (SRIs) and require review, comparing analytical methods. Method Computerized searching to identify reports of RCTs of DLX in adult, acute MDD patients permitted meta-analytic pooling to estimate overall response and remission rates, to compare mixed-model, repeated measures (MMRM) versus last-observations-carried-forward (LOCF) analytical methods, and to assess relations of DLX dose to efficacy and adverse outcomes. Results We identified 17 RCTs involving 22 comparisons (DLX versus PBO [n,=,17) and DLX versus an SRI [n,=,16]), based on MMRM and LOCF methods that allowed estimates of response (,50% improvement of depression scores) or remission (final depression score ,7). There was a large overall DLX/PBO contrast (LOCF, RR,=,1.42 [CI: 1.31,1.53], p,<,0.0001, with a success rate of 65% [11/17]), and somewhat larger effects with MMRM in both response (MMRM: RR,=,1.48 [95%CI: 1.31,1.66] versus LOCF: RR,=,1.41 [CI: 1.28,1.56]; NNT 4.8 versus 6.5) and remission (MMRM: RR,=,1.61 [CI: 1.41,1.85] versus LOCF: RR,=,1.44 [CI: 1.27,1.63]; NNT,=,5.9 versus 8.9). Based on LOCF methods, dropout rates were similar with DLX and PBO (RR,=,1.04 [CI: 0.94,1.15]); DLX response was dose-dependent (r,=,+0.72, p,=,0.001), and RCT-dropout rates were inversely related to DLX dose, but possibly artifactually. Limitations RCTs involving DLX are limited, with few direct comparisons to standard antidepressants. Conclusions DLX has good evidence of efficacy in acute, adult MDD, especially at doses of 80,120,mg/day, but remains inadequately tested against standard alternatives. MMRM analyses yielded slightly superior FLX/PBO contrasts than older LOCF methods. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Treatment of osteopenia and osteoporosis in anorexia nervosa: A systematic review of the literature

Philip S. Mehler MD
Abstract Objective: To systematically review the evidence supporting treatment of osteopenia and osteoporosis in patients with anorexia nervosa (AN). Data sources: We identified controlled clinical studies of interventions for low bone mass in AN via searches of MEDLINE; the Cochrane Library; EMBASE; PsycINFO; and cumulative index to nursing and allied health literature. Outcomes of interest were changes in bone mineral density and fracture incidence. Results: Six randomized controlled trials (RCTs) and two cohort trials examined five classes of medical therapy on bone mineral density outcomes. One RCT of bisphosphonates showed no benefit and a second flawed RCT showed some benefit; one RCT showed a benefit of insulin-like growth factor-I; none of the five trials evaluating estrogen therapy showed benefit. Discussion: Although patients with AN are often losing bone mass when they should be optimizing bone growth, there is no good evidence to guide medicinal interventions. Therefore, early detection and weight restoration are of utmost importance whereas ongoing trials define effective therapies. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009 [source]

The role of family of origin food-related experiences in bulimic symptomatology

Elizabeth K. MacBrayer
Abstract Objective With the goal of developing a model relating family of origin experiences to maladaptive cognitions to bulimic symptom formation, the authors developed a measure of family of origin food-related experiences called the Family History Inventory. Method A number (N = 662) of sixth to eighth-grade adolescents completed the inventory, eating and dieting expectancy measures, and the Bulimia Test-Revised (BULIT-R). Results Fourteen scales were identified in the inventory. They emphasized family teasing about weight, negative maternal modeling regarding food, and family rules concerning eating. Eleven of the 14 scales correlated with the BULIT-R. Two superordinate factors called Family Teasing and Negative Maternal Modeling summarized 8 of the 14 subscales. Statistical tests were consistent with the hypothesis that eating and dieting expectancies mediate the influence of Family Teasing and Negative Maternal Modeling on bulimic symptomatology. Discussion There was good evidence for the validity of the Family History Inventory. The theoretical implications of the mediation tests are discussed. © 2001 by John Wiley & Sons, Inc. Int J Eat Disord 30: 149,160, 2001 [source]

Electroconvulsive Therapy and the Fear of Deviance

James Giles
After reaching the verge of obsolescence, electroconvulsive therapy (ECT) is once again on the increase. There remains, however, no sound theoretical basis for its use. By 1948 at least 50 different theories had been proposed to account for the workings of ECT. Today there are numerous more. Further, there is no good evidence for its therapeutic effectiveness. Although some studies show what are claimed to be positive results, others show significant amount of relapse, even with severe depression (the disorder against which ECT is supposed to be most effective), while even other studies show ECT to have little more effect than a placebo. Finally, there is much evidence for ECTs damaging effects, particularly to cognitive functioning like memory, general intelligence level, and perceptual abilities, and quite possibly to brain functioning. Some studies even suggest that the alleged therapeutic effects of ECT are essentially the effects of organic brain damage. The question, then, is why, despite these problems, does ECT continue to be used? ECTs salient features suggest an answer here. These are the features of dehumanization, power, control, punishment, and others, all of which can be traced back to the fear of deviant psychotic behavior. [source]

The impacts of changes in vegetation cover on dry season flow in the Kikuletwa River, northern Tanzania

P. K. T. Munishi
Abstract While the decrease in flow is obvious in the Kikuletwa River, the mechanism leading to the decrease is unclear. We assessed the influence of vegetation cover change on dry season flow in the Kikuletwa River. The combined cover of closed and open forests decreased by 68% while closed and open forests decreased by 56% and 64% respectively. Land under agroforestry decreased by 25%, while that under annual crops increased by 41%. Grasslands increased by 116% and riverine vegetation decreased by 53%. Daily dry season flow showed a slightly decreasing trend in one of the stations despite all of them receiving water from the Rundugai natural springs. On the other hand, low flow indices indicated no statistically significant changes in the long-term average flow and there was no identifiable change in the rainfall amount. The majority (93%) of the local people perceived a changing rainfall pattern and decline in dry season flow in the Kikuletwa River. Changes in the dry season flow then can be associated with the identified land cover changes. Further research to substantiate the local people perceptions is important as indigenous knowledge may be good evidence for ascertaining changes in the natural environment. [source]

Effects of assay conditions in life history experiments with Drosophila melanogaster

M. Ackermann
Selection experiments with Drosophila have revealed constraints on the simultaneous evolution of life history traits. However, the responses to selection reported by different research groups have not been consistent. Two possible reasons for these inconsistencies are (i) that different groups used different environments for their experiments and (ii) that the selection environments were not identical to the assay environments in which the life history traits were measured. We tested for the effect of the assay environment in life history experiments by measuring a set of Drosophila selection lines in laboratories working on life history evolution with Drosophila in Basel, Groningen, Irvine and London. The lines measured came from selection experiments from each of these laboratories. In each assay environment, we measured fecundity, longevity, development time and body size. The results show that fecundity measurements were particularly sensitive to the assay environment. Differences between assay and selection environment in the same laboratory or differences between assay environments between laboratories could have contributed to the differences in the published results. The other traits measured were less sensitive to the assay environment. However, for all traits there were cases where the measurements in one laboratory suggested that selection had an effect on the trait, whereas in other laboratories no such conclusion would have been drawn. Moreover, we provide good evidence for local adaptation in early fecundity for lines from two laboratories. [source]

Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease , evidence from systematic reviews of randomized controlled trials (second update, January 2006)

A. Mead
Abstract Aim, To update dietetic guidelines based on systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention). Methods, The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to January 2005 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomized controlled trials relating to diet and secondary prevention of CVD. Each review was critically appraised by at least two members of the UK Heart Health and Thoracic Dietitians Group. The quality and results of each review were discussed and summarized at a group meeting. Results, Evidence-based strategies that reduce cardiovascular events in those with CVD include reduction in saturated fat and substitution with unsaturated fats. Individuals who have suffered a myocardial infarction may also benefit from adopting a Mediterranean type diet and increasing intake of omega 3 fats, but it is not clear whether they are beneficial for all patients with CVD. There is no systematic review evidence to support the use of antioxidant vitamins supplements, low glycaemic index diets, or homocysteine lowering therapies in this group. Conclusion, There remains good evidence that reducing saturated fat reduces morbidity in patients with CVD. This advice is consistent for most manifestations of CVD, with the addition of Mediterranean dietary advice and increased omega 3 fats for those who have had a myocardial infarction. [source]

Aetiology of autism: findings and questions,

M. Rutter
Abstract Background Although there is good evidence that autism is a multifactorial disorder, an adequate understanding of the genetic and non-genetic causes has yet to be achieved. Methods Empirical research findings and conceptual reviews are reviewed with respect to evidence on possible causal influences. Results Much the strongest evidence concerns the importance of susceptibility genes, but such genes have yet to be identified. Specific somatic conditions (such as tuberous sclerosis and the fragile X anomaly) account for a small proportion of cases. Over recent decades there has been a major rise in the rate of diagnosed autism. The main explanation for this rise is to be found in better ascertainment and a broadening of the diagnostic concept. Nevertheless, some degree of true rise cannot be firmly excluded. However, the epidemiological evidence on the main hypothesized environmental explanation, namely the measles-mumps-rubella vaccine, is consistently negative. Conclusion Progress on the elucidation of the causes of autism will be crucially dependent on the combination of epidemiology with more basic science laboratory studies. [source]

Psychosocial Well-Being and Quality of Life Among Women Newly Diagnosed With Genital Herpes

Hayley Mark
ABSTRACT Objective: To assess the psychosocial well-being and quality of life among women with a new genital herpes simplex virus diagnosis. Design: Data were collected by a cross-sectional survey. Participants: Eighty-three women diagnosed with genital herpes simplex virus by culture, visual exam and/or a description of symptoms within the last 3 months were recruited from primary health care clinics by their provider. Measures: Participants completed the Hospital Anxiety and Depression Scale and the Recurrent Genital Herpes Quality of Life scale. Results: Thirty-four percent of the women qualified as "clinical cases" for depression, and 64% were designated as "anxiety cases" based on Hospital Anxiety and Depression Scale scoring methods. A majority of participants reported feeling ashamed about having herpes and worried about having an outbreak or giving herpes to someone else. Conclusions: Despite substantial progress toward understanding genital herpes simplex virus epidemiology and transmission, a diagnosis of genital herpes continues to cause considerable psychosocial morbidity and to impact quality of life. There is a dearth of good evidence on how best to intervene to minimize the psychological impact of a diagnosis. Experts recommend addressing both the medical and psychological aspects of infection by providing antiviral therapy, written material, and resources. [source]

Does continuous use of metformin throughout pregnancy improve pregnancy outcomes in women with polycystic ovarian syndrome?

Fauzia Haq Nawaz
Abstract Aim:, Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies in women of reproductive age. It is associated with hyperinsulinemia and insulin resistance which is further aggravated during pregnancy. This mechanism has a pivotal role in the development of various complications during pregnancy. In the past few years, metformin, an insulin sensitizer, has been extensively evaluated for induction of ovulation. Its therapeutic use during pregnancy is, however, a recent strategy and is a debatable issue. At present, evidence is inadequate to support the long-term use of insulin-sensitizing agents during pregnancy. It is a challenge for both clinicians and researchers to provide good evidence of the safety of metformin for long-term use and during pregnancy. This study aimed to evaluate pregnancy outcomes in women with PCOS who conceived while on metformin treatment, and continued the medication for a variable length of time during pregnancy. Methods:, This case-control study was conducted from January 2005 to December 2006 at the antenatal clinics of the Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan. The sample included 137 infertile women with PCOS; of these, 105 conceived while taking metformin (cases), while 32 conceived spontaneously without metformin (controls). Outcomes were measured in three groups of cases which were formed according to the duration of use of metformin during pregnancy. Comparison was made between these groups and women with PCOS who conceived spontaneously. Results:, All 137 women in this study had a confirmed diagnosis of PCOS (Rotterdam criteria). These women were followed up during their course of pregnancy; data forms were completed once they had delivered. Cases were divided into three groups: group A, 40 women who stopped metformin between 4,16 weeks of pregnancy; group B, 20 women who received metformin up until 32 weeks of gestation; and group C; 45 women who continued metformin throughout pregnancy. All the groups were matched by age, height and weight. Comparison was in terms of early and late pregnancy complications, intrauterine growth restriction and live birth rates. In groups A, B and C the rate of pregnancy-induced hypertension/pre-eclampsia was 43.7%, 33% and 13.9% respectively (P < 0.020). Rates of gestational diabetes requiring insulin treatment in groups A and B were 18.7% and 33.3% compared to 2.5% in group C (P < 0.004). The rate of intrauterine growth restriction was significantly low in group C: 2.5% compared to 19.2% and 16.6% in groups A and B respectively (P < 0.046). Frequency of preterm labor and live birth rate was significantly better in group C compared to groups A and B. Overall rate of miscarriages was 7.8%. Controls were comparable to group A in terms of early and late pregnancy complications. Conclusion:, In women with PCOS, continuous use of metformin during pregnancy significantly reduced the rate of miscarriage, gestational diabetes requiring insulin treatment and fetal growth restriction. No congenital anomaly, intrauterine death or stillbirth was reported in this study. [source]

The role of orthodontics in temporomandibular disorders

Summary, Temporomandibular Disorder (TMD) is the main cause of pain of non-dental origin in the oro-facial region including head, face and related structures. The aetiology and the pathophysiology of TMD is poorly understood. It is generally accepted that the aetiology is multifactorial, involving a large number of direct and indirect causal factors. Among such factors, occlusion is frequently cited as one of the major aetiological factors causing TMD. It is well known from epidemiologic studies that TMD-related signs and symptoms, particularly temporomandibular joint (TMJ) sounds, are frequently found in children and adolescents and show increased prevalence among subjects between 15 and 45 years old. Aesthetic awareness, the development of new aesthetic orthodontic techniques and the possibility of improving prosthetic rehabilitation has increased the number of adults seeking orthodontic treatment. The shift in patient age also has increased the likelihood of patients presenting with signs and symptoms of TMD. Because orthodontic treatment lasts around 2 years, orthodontic patients may complain about TMD during or after treatment and orthodontists may be blamed for causing TMD by unsatisfied patients. This hypothesis of causality has led to legal problems for dentists and orthodontists. For these reasons, the interest in the relationship between occlusal factors, orthodontic treatment and TMD has grown and many studies have been conducted. Indeed, claims that orthodontic treatment may cause or cure TMD should be supported by good evidence. Hence, the aim of this article is to critically review evidence for a possible association between malocclusion, orthodontic treatment and TMD. [source]

Fetal or Infantile Exposure to Ethanol Promotes Ethanol Ingestion in Adolescence and Adulthood: A Theoretical Review

ALCOHOLISM, Issue 6 2005
Norman E. Spear
Background: Despite good evidence that ethanol abuse in adulthood is more likely the earlier human adolescents begin drinking, it is unclear why the early onset of drinking occurs in the first place. A review of experimental studies with animals complemented by clinical, epidemiologic and experimental studies with humans supports the idea that precipitating conditions for ethanol abuse occur well before adolescence, in terms of very early exposure to ethanol as a fetus or infant. Experimental studies with animals indicate, accordingly, that ethanol intake during adolescence or adulthood is potentiated by much earlier exposure to ethanol as a fetus or infant. Methods: Two broad theoretical frameworks are suggested to explain the increase in affinity for ethanol that follows very early exposure to ethanol, one based on effects of mere exposure and the other on associative conditioning. Studied for 50 years or more in several areas of psychology, "effects of mere exposure" refers to enhanced preference expressed for flavors, or just about any stimuli, that are relatively familiar. An alternative framework, in terms of associative conditioning, is guided by this working hypothesis: During ethanol exposure the fetus or infant acquires an association between ethanol's orosensory (odor/taste) and pharmacological consequences, causing the animal subsequently to seek out ethanol's odor and taste. Results and Conclusions: The implication that ethanol has rewarding consequences for the fetus or young infant is supported by recent evidence with perinatal rats. Paradoxically, several studies have shown that such early exposure to ethanol may in some circumstances make the infant treat ethanol-related events as aversive, and yet enhanced intake of ethanol in adolescence is nevertheless a consequence. Alternative interpretations of this paradox are considered among the varied circumstances of early ethanol exposure that lead subsequently to increased affinity for ethanol. [source]

On the Demonstration of Blindsight in Monkeys

MIND & LANGUAGE, Issue 4 2006
The present paper reveals a problem in Cowey and Stoerig's case for blindsight in monkeys. The problem is that Cowey and Stoerig's results would only provide good evidence for blindsight if there is no difference between their two experimental paradigms with regard to the sorts of stimuli that are likely to come to consciousness. We show that the paradigms could differ in this respect, given the connections that have been shown to exist between working memory, perceptual load, attention, and consciousness. [source]

Dietary fiber, low-molecular-weight food constituents and colo-rectal inflammation in animal models , A review

Dieter Schrenk
Abstract This review provides an overview over studies in experimental animals aimed at elucidating the influence of dietary constituents on colo-rectal inflammation. Human studies as well as in vitro investigations will not be covered. In experimental animals, a variety of chemical treatments and genetic modifications, lead to various types of gut inflammation. In a number of these models, there is good evidence for an anti-inflammatory action of dietary tocopherols, certain polyphenols, and curcumin at relatively high oral doses. It has also been established, that oral application of fats and oils rich in n-3 PUFAs and/or conjugated linoleic acid (CLA) can attenuate certain types of colitis in experimental animal models. While the effect of dietary calcium on experimental colitis is less clear, there are hints indicating that certain high-fiber diets or diets rich in digestion-resistant carbohydrates ("fiber") can attenuate experimental colitis in animals, although contradictory results have been reported. In summary, the anti-inflammatory potency of dietary constituents on colon inflammation in experimental animals seems to be rather limited. The reasons for this lack of activity seem to be manifold including pharmacokinetic limitations and intestinal degradation of the compounds, in particular insufficient local, i. e., intra- or sub-mucosal levels of the effective compounds, and general limitations of animal models. [source]

An investigation of human brain tumour lipids by high-resolution magic angle spinning 1H MRS and histological analysis

Kirstie S. Opstad
Abstract NMR-visible lipid signals detected in vivo by 1H MRS are associated with tumour aggression and believed to arise from cytoplasmic lipid droplets. High-resolution magic angle spinning (HRMAS) 1H MRS and Nile Red staining were performed on human brain tumour biopsy specimens to investigate how NMR-visible lipid signals relate to viable cells and levels of necrosis across different grades of glioma. Presaturation spectra were acquired from 24 adult human astrocytoma biopsy samples of grades II (8), III (2) and IV (14) using HRMAS 1H MRS and quantified using LCModel to determine lipid concentrations. Each biopsy sample was then refrozen, cryostat sectioned, and stained with Nile Red, to determine the number of lipid droplets and droplet size distribution, and with Haematoxylin and Eosin, to determine cell density and percentage necrosis. A strong correlation (R,=,0.92, P,<,0.0001) was found between the number of Nile Red-stained droplets and the ,1.3,ppm lipid proton concentration by 1H MRS. Droplet sizes ranged from 1 to 10,µm in diameter, and the size distribution was constant independent of tumour grade. In the non-necrotic biopsy samples, the number of lipid droplets correlated with cell density, whereas in the necrotic samples, there were greater numbers of droplets that showed a positive correlation with percentage necrosis. The correlation between 1H MRS lipid signals and number of Nile Red-stained droplets, and the presence of lipid droplets in the non-necrotic biopsy specimens provide good evidence that the in vivo NMR-visible lipid signals are cytoplasmic in origin and that formation of lipid droplets precedes necrosis. Copyright © 2008 John Wiley & Sons, Ltd. [source]