Home About us Contact
|
Home About us Contact | ||
|
|
||
Preventative Strategies (preventative + strategy)
Selected AbstractsChronic lung disease in human immunodeficiency virus (HIV) infected children,PEDIATRIC PULMONOLOGY, Issue 1 2008Heather J. Zar Abstract The development of chronic lung disease is common in HIV-infected children. The spectrum of chronic HIV-associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X-ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non-specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV-infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease. Pediatr Pulmonol. 2008; 43:1,10. © 2007 Wiley-Liss, Inc. [source] The pattern of self-poisoning among Lebanese children and adolescents in two tertiary care centres in LebanonACTA PAEDIATRICA, Issue 6 2009Durriyah Sinno Abstract Aim: Self-poisoning in childhood and adolescence is a major problem for health authorities all over the world. The objective of this study was to determine the pattern of self-poisoning in Lebanese children and adolescents. Materials and methods: This prospective study included all cases of poisoning in individuals aged 0,18 years who presented to the emergency department of two major hospitals in Beirut, Lebanon over a period of 1 year. Participants were divided into two age groups (0,12 years and 12,18 years). These cases were followed to record the applied treatment and whether the patient was admitted or discharged. Results: There were 110 self-poisoning incidents, of which 74 (67%) were in female patients. The predominant type of poisoning was with pharmaceutical products (68.2%). Accidental self-poisoning was significantly more common in the younger age group among both genders compared with the older age group (p < 0.0001). There were significantly more poisoned male children (72%) than male adolescents (28%) (p = 0.003); whereas among females, poisoned adolescents were significantly more common (64%) than poisoned children (36%) (p = 0.009). Moreover, poisoning with pharmaceuticals was significantly higher in the young male group compared to the older age group and older female group compared to the younger age group (p = 0.0007 and p = 0.01, respectively). In total, 78% of patients were discharged home following basic observation, charcoal or gastric lavage. Conclusion: Female adolescents are more at risk of deliberate self-intoxication after the age of 12 years compared to males, whereas males younger than 12 years are more likely to suffer from accidental poisoning. Preventative strategies include screening adolescents at high risk of self-harm in order to offer adequate counselling, while providing anticipatory guidance for parents of children in the younger age group. [source] Animal models of diabetes mellitusDIABETIC MEDICINE, Issue 4 2005D. A. Rees Abstract Animal models have been used extensively in diabetes research. Early studies used pancreatectomised dogs to confirm the central role of the pancreas in glucose homeostasis, culminating in the discovery and purification of insulin. Today, animal experimentation is contentious and subject to legal and ethical restrictions that vary throughout the world. Most experiments are carried out on rodents, although some studies are still performed on larger animals. Several toxins, including streptozotocin and alloxan, induce hyperglycaemia in rats and mice. Selective inbreeding has produced several strains of animal that are considered reasonable models of Type 1 diabetes, Type 2 diabetes and related phenotypes such as obesity and insulin resistance. Apart from their use in studying the pathogenesis of the disease and its complications, all new treatments for diabetes, including islet cell transplantation and preventative strategies, are initially investigated in animals. In recent years, molecular biological techniques have produced a large number of new animal models for the study of diabetes, including knock-in, generalized knock-out and tissue-specific knockout mice. [source] Advances in the treatment of root dentine sensitivity: mechanisms and treatment principlesENDODONTIC TOPICS, Issue 1 2006D.G. GILLAM There are limited studies specifically on the prevalence of root dentine hypersensitivity or root sensitivity per se; most of the published information relates to the prevalence of dentine hypersensitivity (DH). Several investigators have suggested that there may be some justification on the basis of differing pathologies of distinguishing between those individuals complaining of DH who have relatively healthy mouths with those who complain of DH as a result of periodontal disease and/or its treatment. It is generally recognized that those individuals diagnosed with periodontal disease and having periodontal therapy including scaling procedures may have a higher prevalence than those who present with healthy mouths and evidence of gingival recession. The availability of a vast array of treatments, however, would indicate either that there is no one effective desensitizing agent for completely resolving the discomfort or that the condition, due to its highly subjective nature, is difficult to treat irrespective of the available treatment options. The importance of implementing preventative strategies in identifying and eliminating predisposing factors in particularly erosive factors (e.g. dietary acids) cannot be ignored if the practitioner is going to treat this troublesome clinical condition successfully. This paper will review the published literature and provide information as to the prevalence of the condition, its etiology and causal factors, as well as recommendations for the clinical management of the problem. [source] A systematic review of the epidemiology of status epilepticusEUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2004R. F. M. Chin Population-based data on the incidence, aetiology, and mortality associated with status epilepticus (SE) are required to develop preventative strategies for SE. Through a systematic review, we aimed to assess the methodological quality as well as similarities, and differences between available population based studies in order to arrive at conclusions on the epidemiology of SE. All population-based studies where primary outcome was incidence, aetiology or mortality of SE were identified through a systematic search and synthesized. Methodological quality of studies were independently rated by two examiners using a unique scoring system. Seven population-based projects on SE yielding nine published reports and five abstracts were reviewed. Quality scores were in the range of 19,34 with a possible maximum of 40 (kappa scores 0.67,1.0). The incidence of SE has a bimodal distribution with peaks in children aged less than a year and the elderly. Most SE were acute symptomatic. Short-term mortality was 7.6,22% and long-term mortality was 43%. Age and aetiology were the major determinants of mortality. There are few population-based studies on SE but most are of good quality. Most studies are primarily or exclusively based on adult populations. There is limited information on the association of ethnicity and socio-economic status and SE. [source] Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Cindy Stern BHS(Hons) Abstract Aim, Falls can cause serious physical and emotional injuries to patients leading to poor quality of life and increased length of hospital stay. The aim of this study was to present the best available evidence regarding the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls. Methods, A systematic review of randomised controlled trials was undertaken to determine the effectiveness of interventions that were designed to reduce the incidence of falls in older acute-care patients. Only trials published between 1998 and 2008 were considered. Results, Only seven studies were included in the review, indicating the evidence on this topic is sparse. There is some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients: ,,A multidisciplinary multifactorial intervention program consisting of falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days ,,A one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ,,A targeted fall risk factor reduction intervention that includes a fall risk factor screen, recommended interventions encompassing local advice and a summary of the evidence There is also some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications, can reduce the amount of falls in patients following surgery for femoral neck fracture. Conclusion, There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high-quality research is needed in order to ascertain effective fall-prevention strategies in acute-care facilities. [source] Pharmaceutical strategies to prevent ventilator-associated pneumoniaJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 4 2003Roisin McCrory ABSTRACT The increasing incidence of hospital-acquired (nosocomial) infection is a disturbing phenomenon resulting in significant patient mortality and putting considerable strain on healthcare budgets and personnel. One particularly serious aspect of nosocomial infection is that of ventilator-associated pneumonia (VAP). This arises in patients who receive mechanical ventilation within the intensive care unit. The quoted incidence of VAP varies widely (5,67%) and the reported mortality of patients with VAP is in the range of 24,71%. This review will examine the many factors that account for these wide ranges reported, including the patient population under investigation, the causative organism, the method of diagnosis, interventions employed and preventative strategies. The use of bioactive and drug-impregnated biomaterials for endotracheal tube construction is discussed as novel approaches to the prevention of VAP. [source] Chemoprevention of colorectal cancerALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2004E. D. J. Courtney Summary Colorectal cancer is a disease with a high mortality at present, due to the late stage at which many cases present. Attention is therefore focusing on preventative strategies for colorectal cancer given that polyps appear to be identifiable and treatable precursor lesions of this disease. Endoscopic polypectomy has been shown to reduce the incidence of colorectal cancer and there is a good case for endoscopic screening of the general population. However, this will require a large amount of manpower and resources and its success will also depend on the overall compliance of the population. Epidemiological studies have shown that individuals reporting a regular intake of aspirin and other non-steroidal anti-inflammatory drugs have a reduced risk of developing colorectal polyps and cancer. Similarly, a number of natural substances, such as calcium and folate, when supplemented regularly in the diet, have also been linked to a possible decreased incidence of colorectal cancer. This has led to the concept of using such agents to reduce the number of cases of colorectal cancer. In this article, we review the current evidence for the use of these and other agents for the chemoprevention of colorectal cancer, together with theories as to their possible mechanisms of action. [source] Premature arthritis is a distinct type II collagen phenotypeARTHRITIS & RHEUMATISM, Issue 5 2010Peter Kannu Mutations in the gene encoding type II collagen (COL2A1) give rise to a spectrum of phenotypes predominantly affecting cartilage and bone. These chondrodysplasias are typically characterized by disproportionately short stature, eye abnormalities, cleft palate, and hearing loss. It is less recognized that mutations in COL2A1 can also present as degenerative joint disease in the absence of any other phenotypic clues. We report 2 Australian families presenting with an isolated arthritis phenotype, segregating as a dominant trait affecting both large and small joints, prior to age 30 years. Sequencing of COL2A1 in the propositi revealed 2 sequence changes resulting in glycine substitutions in the triple-helical domain of type II collagen. We review the increasing evidence implicating COL2A1 mutations in individuals presenting with isolated degenerative joint disease, aiming to alert physicians who assess these patients to this possibility. The importance of finding a COL2A1 mutation in such patients lies in the subsequent ability to accurately assess recurrence risks, offer early (including prenatal) diagnosis, and provide information regarding the natural history of the condition. Most importantly, it enables at-risk individuals to be identified for implementation of preventative strategies (i.e., weight loss, joint-friendly exercise programs) and early ameliorative management of their condition. [source] Ultraviolet radiation intensity predicts the relative distribution of dermatomyositis and anti,Mi-2 autoantibodies in womenARTHRITIS & RHEUMATISM, Issue 8 2009Lori A. Love Objective Because studies suggest that ultraviolet (UV) radiation modulates the myositis phenotype and Mi-2 autoantigen expression, we conducted a retrospective investigation to determine whether UV radiation may influence the relative prevalence of dermatomyositis and anti,Mi-2 autoantibodies in the US. Methods We assessed the relationship between surface UV radiation intensity in the state of residence at the time of onset with the relative prevalence of dermatomyositis and myositis autoantibodies in 380 patients with myositis from referral centers in the US. Myositis autoantibodies were detected by validated immunoprecipitation assays. Surface UV radiation intensity was estimated from UV Index data collected by the US National Weather Service. Results UV radiation intensity was associated with the relative proportion of patients with dermatomyositis (odds ratio [OR] 2.3, 95% confidence interval [95% CI] 0.9,5.8) and with the proportion of patients expressing anti,Mi-2 autoantibodies (OR 6.0, 95% CI 1.1,34.1). Modeling of these data showed that these associations were confined to women (OR 3.8, 95% CI 1.3,11.0 and OR 17.3, 95% CI 1.8,162.4, respectively) and suggests that sex influences the effects of UV radiation on autoimmune disorders. Significant associations were not observed in men, nor were UV radiation levels related to the presence of antisynthetase or anti,signal recognition particle autoantibodies. Conclusion This first study of the distribution of myositis phenotypes and UV radiation exposure in the US showed that UV radiation may modulate the clinical and immunologic expression of autoimmune disease in women. Further investigation of the mechanisms by which these effects are produced may provide insights into pathogenesis and suggest therapeutic or preventative strategies. [source] Preventing Fractures in Large Rural Centres: Sociodemographic Sub-Groups at Risk of Osteoporosis from their LifestyleAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2000Hedley G. Peach ABSTRACT Middle-aged people living in non-metropolitan Victoria have higher hospitalisation rates from osteoporotic fractures than those in metropolitan areas. This may reflect a higher prevalence of lifestyle risk factors for osteoporosis. One-fifth of Victoria's non-metropolitan population live in ,large rural centres'. The aim of the present study was to identify the sociodemographic sub-groups in a ,large rural centre' at risk of osteoporosis because of their lifestyle. Adults on Ballarat's electoral rolls were invited to complete a questionnaire and have their height and weight measured. A total of 335 eligible people participated in the present study (67% response). The sub-groups at risk of osteoporosis were identified using logistic regression analyses. Among women, being single/separated/divorced/ widowed was associated with being underweight and having low dietary calcium. A lack of exercise was associated with not completing high school and smoking with being aged 25,44 years. Among men, low dietary calcium was associated with not completing high school and smoking was associated with being employed in a non-professional/ non-managerial occupation. These sub-groups must be considered when planning preventative strategies for people in ,large rural centres'. [source] PREVENTING FRACTURES IN LARGE RURAL CENTRES: SOCIODEMOGRAPHIC SUB-GROUPS AT RISK OF OSTEOPOROSIS FROM THEIR LIFESTYLEAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2000Hedley G. Peach ABSTRACT: Middle-aged people living in non-metropolitan Victoria have higher hospitalisation rates from osteoporotic fractures than those in metropolitan areas. This may reflect a higher prevalence of lifestyle risk factors for osteoporosis. One-fifth of Victoria's non-metropolitan population live in ,large rural centres'. The aim of the present study was to identify the sociodemographic sub-groups in a ,large rural centre' at risk of osteoporosis because of their lifestyle. Adults on Ballarat's electoral rolls were invited to complete a questionnaire and have their height and weight measured. A total of 335 eligible people participated in the present study (67% response). The sub-groups at risk of osteoporosis were identified using logistic regression analyses. Among women, being single/separated/divorced/ widowed was associated with being underweight and having low dietary calcium. A lack of exercise was associated with not completing high school and smoking with being aged 25,44 years. Among men, low dietary calcium was associated with not completing high school and smoking was associated with being employed in a non-professional/ non-managerial occupation. These sub-groups must be considered when planning preventative strategies for people in ,large rural centres'. [source] Seasonal variation and meteotropism in suicide: clinical relevance of findings and implications for researchACTA NEUROPSYCHIATRICA, Issue 1 2002A. Preti Seasonal asymmetry in yearly suicide occurrence is a long-observed phenomenon in psychiatric, suicidological and sociological research, and the effects of seasonal factors on suicidal behaviour have been the focus of a number of earlier studies. Taking into account limitations of data and methods, these studies have in general favoured interpretations based on psychosocial factors. Recent studies have challenged the widely held notion that seasonal effects on suicide are not influenced by age, gender or the circumstances of the act. The suicides committed with violent methods have been shown to follow clearer seasonal patterns than suicides by less violent methods, and differences have been found between male and female cycles of occurrence. The seasonal occurrence of suicides has also been found to differ significantly between the young and the elderly. The use of inappropriate statistics or age- and gender-biased samples may have hidden a seasonal component in some previous studies on attempted suicide. The absence of seasonality in earlier studies on attempted suicide was interpreted as depending upon the minor relevance of psychiatric and biological factors in non-fatal self-harm. However, recent studies have reported clear seasonality in attempted suicide samples, with older people showing greater seasonal effect. Recent literature after 1985 on seasonal variation and weather or climate influence in attempted and completed suicide is reviewed. Suggestions for research and the development of more effective preventative strategies are offered. [source] GENES, CALCIUM AND MODIFYING FACTORS IN HYPERTROPHIC CARDIOMYOPATHYCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 1-2 2006Tatiana Tsoutsman SUMMARY 1Familial hypertrophic cardiomyopathy (FHC) is a primary disorder of the myocardium characterized by remarkable diversity in clinical presentations, ranging from no symptoms to severe heart failure and sudden cardiac death. 2Over the past 15 years, at least 11 genes have been identified, defects of which cause FHC. Most of these genes encode proteins that comprise the basic contractile unit of the heart (i.e. the sarcomere). 3Genetic studies are now beginning to have a major impact on the diagnosis in FHC, as well as in guiding treatment and preventative strategies. Although much is known about which genes cause disease, relatively little is known about the molecular steps leading from the gene defect to the clinical phenotype and what factors modify the expression of the mutant genes. 4Concurrent studies in cell culture and animal models of FHC are now beginning to shed light on the signalling pathways involved in FHC and the role of both environmental and genetic modifying factors. Calcium dysregulation appears to be important in the pathogenesis of FHC. 5Understanding these basic molecular mechanisms will ultimately improve our knowledge of the basic biology of heart muscle function and will therefore provide new avenues for diagnosis and treatment not only for FHC, but also for a range of human cardiovascular diseases. [source] Invasive group A, B, C and G streptococcal infections in Denmark 1999,2002: epidemiological and clinical aspectsCLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2005K. Ekelund Abstract Group A streptococci (GAS) have been described frequently as an emerging cause of severe invasive infections in population-based surveillance studies, whereas the descriptions of group B, C and G streptococci (GBS, GCS and GGS) have been less frequent. Enhanced surveillance for invasive GAS, GBS, GCS and GGS was performed in Denmark in 1999,2002. A detailed questionnaire was completed for 1237 (98%) of 1260 invasive infections. GAS infections dominated (40%), followed by GGS (32%), GBS (23%) and GCS (6%). Most (74%) patients had predisposing factors, and there were no significant differences between the four serogroups when comparing the prevalence of cancer, diabetes mellitus, chronic heart or lung diseases, immunodeficiency or alcohol abuse. The overall case fatality rate at day 30 was 21%, increasing significantly to 59% for patients with streptococcal toxic shock syndrome (STSS). STSS was significantly more frequent in GAS patients (10%) than in GCS (4%), GBS (2%) and GGS (2%) patients. Regression analyses showed that, despite a younger median age among GAS patients, the probability of developing septic shock and mortality was significantly higher among GAS patients than among GBS and GGS patients. These analyses showed no significant differences between GAS and GCS infections. Invasive infections caused by GAS, GBS, GCS and GGS are still a major challenge for clinicians. Continued epidemiological and microbiological surveillance is important to assess the development of these infections and to improve preventative strategies. [source] Cytomegalovirus in transplantation , challenging the status quoCLINICAL TRANSPLANTATION, Issue 2 2007Jay A Fishman Abstract:, Background:, Cytomegalovirus (CMV) infection of solid organ transplant (SOT) recipients causes both ,,direct'' and ,,indirect'' effects including allograft rejection, decreased graft and patient survival, and predisposition to opportunistic infections and malignancies. Options for CMV prevention include pre-emptive therapy, whereby anti-CMV agents are administered based on sensitive viral assays, or universal prophylaxis of all at-risk patients. Each approach has advantages and disadvantages in terms of efficacy, costs, and side effects. Standards of care for prophylaxis have not been established. Methods:, A committee of international experts was convened to review the available data regarding CMV prophylaxis and to compare preventative strategies for CMV after transplantation from seropositive donors or in seropositive recipients. Results:, Pre-emptive therapy requires frequent monitoring with subsequent treatment of disease and associated costs, while universal prophylaxis results in greater exposure to potential toxicities and costs of drugs. The advantages of prophylaxis include suppressing asymptomatic viremia and prevention of both direct and indirect effects of CMV infection. Meta analyses reveal decreased in mortality for patients receiving CMV prophylaxis. Costs associated with prophylaxis are less than for routine monitoring and pre-emptive therapy. The optimal duration of antiviral prophylaxis remains undefined. Extended prophylaxis may improve clinical outcomes in the highest-risk patient populations including donor-seropositive/recipient-seronegative renal transplants and in CMV-infected lung and heart transplantation. Conclusions:, Prophylaxis is beneficial in preventing direct and indirect effects of CMV infection in transplant recipients, affecting both allograft and patient survival. More studies are necessary to define optimal prophylaxis regimens. [source] Pursuing paradoxical proconvulsant prophylaxis for epileptogenesisEPILEPSIA, Issue 7 2009Caren Armstrong Summary There are essentially two potential treatment options for any acquired disorder: symptomatic or prophylactic. For acquired epilepsies that follow a variety of different brain insults, there remains a complete lack of prophylactic treatment options, whereas at the same time these epilepsies are notoriously resistant, once they have emerged, to symptomatic treatments with antiepileptic drugs. The development of prophylactic strategies is logistically challenging, both for basic researchers and clinicians. Nevertheless, cannabinoid-targeting drugs provide a very interesting example of a system within the central nervous system (CNS) that can have very different acute and long-term effects on hyperexcitability and seizures. In this review, we outline research on cannabinoids suggesting that although cannabinoid antagonists are acutely proconvulsant, they may have beneficial effects on long-term hyperexcitability following brain insults of multiple etiologies, making them promising candidates for further investigation as prophylactics against acquired epilepsy. We then discuss some of the implications of this finding on future attempts at prophylactic treatments, specifically, the very short window within which prevention may be possible, the possibility that traditional anticonvulsants may interfere with prophylactic strategies, and the importance of moving beyond anticonvulsants,even to proconvulsants,to find the ideal preventative strategy for acquired epilepsy. [source] Collaboration, facilities and communities in day care services for older peopleHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2001Sarah Burch BA Abstract Collaborative working in care for older people is often seen as a desirable goal. However, there can be problems with this approach. This paper reports on a single blind randomized controlled trial which was carried out to compare outcomes of rehabilitation in two settings: a day hospital and social services day centres augmented by visiting therapists. The subjects were 105 older patients. Principal outcome measures were the Barthel Index, Philadelphia Geriatric Centre Morale Scale and the Caregiver Strain Index. Two aspects of the trial are examined here. Firstly, we investigated whether trial patients were more disabled than regular day centre attendees. Levels of health and well being amongst trial patients were compared with those of a random sample of 20 regular attendees from both of the participating day centres and an additional voluntary sector day centre. Secondly, key staff from the different settings were interviewed to assess how well the day centre model had worked in practice. Trial patients were significantly more disabled than regular day centre attendees according to the Barthel Index (P < 0.001), but this difference was no longer significant after three months of treatment. The day centre model had several problems, principally discharge policy, acceptability, facilities and attitudes of staff and regular attendees. Positive aspects of the day centre model, as well as successful rehabilitation, included shared skills, knowledge and resources. This paper suggests that collaborative working in day centres requires multipurpose facilities. If health staff maintain a permanent presence, benefits can include improved joint working, easier access to health care and the use of rehabilitative therapy as a preventative strategy. Day care settings can be analyzed as representing different types of communities. Allowing older users a greater degree of choice in facilities may increase the acceptability of care. [source] Nontherapeutic Male Circumcision: Tackling the Difficult IssuesTHE JOURNAL OF SEXUAL MEDICINE, Issue 8 2009Caryn L. Perera BA (Lib & Info Mgt), Grad Cert EBP ABSTRACT Introduction., Male circumcision is the most commonly performed surgical procedure in the world. Circumcision may be performed to treat an underlying pathological process ("therapeutic circumcision"). However there may be religious, cultural, and social indications. Aim., This article addresses the religious, cultural, social, and ethical issues surrounding nontherapeutic male circumcision (NTMC). Main Outcome Measures., Any religious, social, cultural, or ethical issues relating to NTMC. Methods., Because of the absence of high level evidence, a concise literature review was undertaken to identify articles published between January 1990 and February 2009 summarizing current knowledge on NTMC. Results., There are complex religious, cultural, social, and prophylactic incentives for NTMC. The procedure may have associated clinical and psychosocial adverse events and raises such ethical issues as bodily integrity and consent. Because of the strength of the incentives for NTMC, there may be important implications in denying patients the procedure. Several important issues must be considered when introducing mass circumcision as a preventative strategy for HIV/AIDS. Conclusion., When assessing whether NTMC will benefit or harm a patient, clinicians must take his religious, cultural, and social circumstances into account. Males requiring mandatory religious or cultural NTMC are likely to suffer significant harm if they do not receive circumcision and should be considered separately to males in general. Perera CL, Bridgewater FHG, Thavaneswaran P, and Maddern GJ. Nontherapeutic male circumcision: Tackling the difficult issues. J Sex Med 2009;6:2237,2243. [source] Nutrition and allergic diseaseCLINICAL & EXPERIMENTAL ALLERGY REVIEWS, Issue 5 2006S. Tricon Summary The prevalence of asthma and allergic diseases has increased dramatically over the past few decades with the highest incidence occurring in children. Most asthma and related atopic disorders have their origins in early life. Thus, it is imperative to understand the early life origins of the disease in order to identify targets for prevention and early intervention. Although atopic diseases have genetic determinants, the increased incidence of these diseases has occurred far too rapidly for genetic changes to explain the increase. This, most likely, results from changes in environmental influences acting on a pre-existent genetic susceptibility. One of the environmental changes over the last 20,40 years that could have contributed to the recent increase in atopic diseases is diet. Food allergy is often one of the earliest manifestations of atopy, and sensitization to food is a risk factor for the subsequent appearance of respiratory allergy and asthma. However, studies investigating the effects of dietary restrictions on the prevention of allergy have been disappointing. On the other hand, current data suggests that exclusive breastfeeding should be encouraged for at least 4,6 months in infants at both high and low risk of atopy. Increased risk of asthma has also been observed in low birth weight infants, suggesting that under-nutrition can detrimentally alter foetal development. Epidemiological and immunological studies also suggest that dietary modification or supplementation in the foetal and early life could reduce the development of atopic diseases. The current dietary hypotheses relate to antioxidants, lipids, electrolytes and probiotics. The aims of this report are: (i) to assess the best methods to analyse nutrient intake and nutrient status; (ii) to review the existing epidemiological evidence for an association between dietary intake (nutrients and food) and allergic diseases; and (iii) to define the windows of opportunity for nutritional supplementation to be used as a preventative strategy for asthma and allergy. [source] Eye injuries in rural Victoria, AustraliaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 7 2009Simon Raymond MPH Abstract Background:, Eye injury causes significant morbidity and is a leading cause of blindness worldwide. This study investigates the incidence, spectrum and patterns of eye injury presenting to a rural hospital in Victoria, Australia. Methods:, A retrospective review of the medical records of all patients presenting with eye injury to the emergency department of Mildura Base Hospital, Victoria, Australia in year 2004 was conducted. As the emergency department of Mildura Base Hospital also acts as the outpatient department for this hospital, the series included all patients treated for eye injury at Mildura Base Hospital in year 2004, including admissions. Results:, There were 435 patients present to Mildura Base Hospital emergency department for eye injury in 2004, which represented approximately 1% of the population of Mildura. The majority of eye injuries were superficial. Fifty-six (13%) patients required specialist attention. Most patients were male (83%) and were middle-aged. The most common locations where eye injuries took place were residential homes (47%) and workplaces (32%). The most common causes of eye injuries were trade tools and machinery (47%), followed by chemicals (12%) and branches/sticks/twigs (11%). Of particular concern for Mildura is that approximately one-quarter of the patients treated at Mildura Base Hospital for eye injury in 2004 had been treated at Mildura Base Hospital for a separate episode of eye injury in the past. Conclusion:, Eye injuries represent a significant socioeconomic burden. This research contributes to the knowledge required for the design and implementation of effective preventative strategy. [source] | ||||||||||||||||||||||