A Randomized, Controlled Trial of an Aerosolized Vaccine against Measles.

Background Aerosolized vaccine can be used as a needle-free method of immunization against measles, a disease that remains a major cause of illness and death. Data on the immunogenicity of aerosolized vaccine against measles in children are inconsistent. Methods We conducted an open-label noninferiority trial involving children 9.0 to 11.9 months of age in India who were eligible to receive a first dose of measles vaccine. Children were randomly assigned to receive a single dose of vaccine by means of either aerosol inhalation or a subcutaneous injection. The primary end points were seropositivity for antibodies against measles and adverse events 91 days after vaccination. The noninferiority margin was 5 percentage points. Results A total of 1001 children were assigned to receive aerosolized vaccine, and 1003 children were assigned to receive subcutaneous vaccine; 1956 of all the children (97.6%) were followed to day 91, but outcome data were missing for 331 children because of thawed specimens. In the per-protocol population, data on 1560 of 2004 children (77.8%) could be evaluated. At day 91, a total of 662 of 775 children (85.4%; 95% confidence interval [CI], 82.5 to 88.0) in the aerosol group, as compared with 743 of 785 children (94.6%; 95% CI, 92.7 to 96.1) in the subcutaneous group, were seropositive, a difference of -9.2 percentage points (95% CI, -12.2 to -6.3). Findings were similar in the full-analysis set (673 of 788 children in the aerosol group [85.4%] and 754 of 796 children in the subcutaneous group [94.7%] were seropositive at day 91, a difference of -9.3 percentage points [95% CI, -12.3 to -6.4]) and after multiple imputation of missing results. No serious adverse events were attributable to measles vaccination. Adverse-event profiles were similar in the two groups. Conclusions Aerosolized vaccine against measles was immunogenic, but, at the prespecified margin, the aerosolized vaccine was inferior to the subcutaneous vaccine with respect to the rate of seropositivity. (Funded by the Bill and Melinda Gates Foundation; Measles Aerosol Vaccine Project Clinical Trials Registry-India number, CTRI/2009/091/000673 .).

Psychomotor symptoms of schizophrenia map on the cerebral motor circuit

Schizophrenia is a devastating disorder thought to result mainly from cerebral pathology. Neuroimaging studies have provided a wealth of findings of brain dysfunction in schizophrenia. However, we are still far from understanding how particular symptoms can result from aberrant brain function. In this context, the high prevalence of motor symptoms in schizophrenia such as catatonia, neurological soft signs, parkinsonism, and abnormal involuntary movements is of particular interest. Here, the neuroimaging correlates of these motor symptoms are reviewed. For all investigated motor symptoms, neural correlates were found within the cerebral motor system. However, only a limited set of results exists for hypokinesia and neurological soft signs, while catatonia, abnormal involuntary movements and parkinsonian signs still remain understudied with neuroimaging methods. Soft signs have been associated with altered brain structure and function in cortical premotor and motor areas as well as cerebellum and thalamus. Hypokinesia is suggested to result from insufficient interaction of thalamocortical loops within the motor system. Future studies are needed to address the neural correlates of motor abnormalities in prodromal states, changes during the course of the illness, and the specific pathophysiology of catatonia, dyskinesia and parkinsonism in schizophrenia.

The effect of alcohol consumption on mortality among idiosyncratic drug induced liver injury (IDILI) patients

Severe liver injury (SLI) due to drugs is a frequent cause of catastrophic illness and hospitalization. Due to significant morbidity, mortality, and excess medical care costs, this poses a challenge as a public health problem. The role of associated risk factors like alcohol consumption in contributing to the high mortality remains to be studied. This study was conducted to assess the impact of alcohol use on mortality in IDILI patients, while adjusting for age, gender, race/ethnicity, and education level. The data from this study indicate only a small excess risk of death among IDILI patients using alcohol, but the difference was not statistically significant. The major contribution of this study to the field of public health is that it excludes a large hazard of alcohol consumption on the mortality among idiosyncratic drug induced liver injury (IDILI) patients. ^

Enteroaggregative Escherichia coli as a cause of acute diarrhea

Enteroaggregative Escherichia coli (EAEC) are considered an important emerging enteric and food-borne pathogen. The groups importantly affected by EAEC include international travelers, children in the developing world, and patients with HIV infection. EAEC does not commonly cause diarrheal illness in all hosts. ^ The reasons for the observed clinical variation in EAEC infection are multifactorial and are dependant on the pathogen, the inoculum ingested and the host susceptibility. A major obstacle in identifying the mechanism of pathogenesis for EAEC is the heterogeneity in virulence of strains. No EAEC virulence gene is consistently present in all diarrheagenic strains. However, a recent report suggests that a package of plasmid borne and chromosomal virulence factors are under the control of the described transcriptional activator aggR. Although the exact inoculum required for EAEC diarrheal illness is not known, a volunteer study has shown that oral ingestion of 10 10 cfu of virulent EAEC elicited diarrhea. Ongoing studies are being conducted to better define the exact infectious dose. There are also host factors associated with increased susceptibility of persons to diarrheal illness with EAEC. ^ The following three manuscripts: (1) review EAEC as an emerging enteric pathogen; (2) identify EAEC as a cause of acute diarrhea among different subpopulations worldwide; (3) identify virulence characteristics and the molecular epidemiology of EAEC isolates among travelers with diarrheal illness and describe the pathogenesis of EAEC infection. ^

Spirituality of Thai Buddhists with chronic cardiovascular disease

Background. Advances in medical technology contribute to the survival rate of a growing number of persons with chronic illnesses. Individuals with chronic cardiovascular disease (chronic CVD) are among other chronically ill persons who add to the need for healthcare services. They need to cope and live with the chronic conditions and find a new balance to make sense of their lives. Thai Buddhists with chronic CVD may use their religious resources to cope with their illnesses because religious beliefs are reflected in patterns of living. The aims of the study were to: (a) explore how Thai Buddhists with chronic CVD construct the spiritual aspects of the illness experience, (b) explore how Thai Buddhists with chronic CVD may use their spiritual/religious resources as a means of coping with the illness, and (c) explore the impacts of spiritual/religious beliefs and/or practices on the daily lives of Thai Buddhists with chronic CVD. ^ Methods. Ethnography was employed and data were collected from December 1, 2007 to May 31, 2008 using in-depth interviews with 20 participants. Field notes were also recorded. ^ Findings. Three categories emerged from the study data: set of spiritual and biomedical beliefs and practices, integrated meanings, and positive consequences of the integration of spiritual and biomedical beliefs and practices. ^ Conclusions. The findings of the study suggest the importance of understanding and integrating spiritual needs into care of patients with chronic CVD. The findings revealed that the participants constructed ideas of their illness and meanings for living and coping with the illness, and integrated spiritual and biomedical beliefs and practices, resulting in positive outcomes. Further research could test interventions which facilitate such coping; for example, using reflective thinking and group support. Other studies might explore how age affects Buddhist views of the illness. ^

Occupational performance of Mexican Americans with end-stage-renal-disease living on dialysis in the lower Rio Grande Valley

The number of people with end-stage-renal-disease (ESRD) and living with dialysis is a growing public health concern. Most studies about the impact of ESRD on people’s lives have placed attention on the medical and clinical dimension of ESRD. Very few have given attention to the environmental and cultural context in which people with ESRD live, the adaptation that these individuals must make to adjust to living with ESRD and dialysis, or the occupations in which they engage. Additionally these studies have not focused on Mexican Americans who are disproportionately affected by this illness and condition. This qualitative study explores the needs, perceptions, and issues facing Mexican Americans with ESRD living with dialysis as well as their families. Participants were residents of the Lower Rio Grande Valley and included individuals with ESRD, family members, and the healthcare providers who give care to them. The Health Belief Model and Lifestyle Performance Model served as the theoretical frameworks. The study also explored the daily occupations of this population. ^ In-depth interviews were conducted on 15 Mexican Americans with ESRD living with dialysis, 15 family members, and six dialysis healthcare providers. A video documentary of the day-to-day life of three individuals with ESRD and their families was produced. Such data do not currently exist and will greatly enhance the understanding of the human experience of living with ESRD. The results suggest that a collective effort of the family unit is at work to deal with the demands of dialysis. An imbalance and disharmony exist among the occupational activities, which creates occupational deprivation and disruption for both the individuals and family members. Implications for practice and recommendations for further research are described. ^

Effectiveness of Texas Children's Hospital's Saturday Wellness Program for Children with special health care needs

Children with Special Health Care Needs comprise approximately 13% of children within the state of Texas. In addition to their primary diagnosis, it is estimated that approximately 18% of these children with special health care needs are overweight. Many times parents of children with special health care needs are extremely busy dealing with the daily responsibilities required to care for a child with a chronic illness, and thus, lose connections with their local communities and available resources for health needs such as obesity. Texas Children’s Hospital’s Wellness Program for Children with Special Health Care Needs is a family-centered wellness program to prevent obesity in this population; however, no formal evaluation of the program has been conducted. The purpose of this study was to assess the effectiveness of the Texas Children’s Saturday Wellness Program on weight status, nutrition knowledge, and the frequency of physical activity of children who participated in the program. A secondary data analysis was conducted with 50 children with special health care needs and their families who participated in the program during 2007 and 2008. A pre post-test study design was used with data collected immediately before and after participation in the 4 week program. Data measures included demographics (age, race, etc.), anthropometrics (height and weight), a quality of life survey focusing on nutrition and physical activity behaviors, and a knowledge survey on physical activity and nutrition. Of 50 participants, 33 (66%) completed the program. Children participating in the program showed a significant decrease in BMI (mean=29.83 to mean=29.22, BMI z score p<0.01), as well as frequency of physical activity (p<0.05) and knowledge (p<0.01). Texas Children’s Hospital’s wellness program for children with special health care needs provided a promising structure for a wellness program within a multi-ethnic special needs population; however, long term effect research is needed with a larger sample size and more comprehensive outcomes and process measures. Nonetheless, this program indicates the effectiveness and feasibility of a family-based approach to weight loss in children with special needs.^

Host risk factors for rifamycin-resistant clostridium difficile infection: A case control study

Objective. To evaluate the host risk factors associated with rifamycin-resistant Clostridium difficile (C. diff) infection in hospitalized patients compared to rifamycin-susceptible C.diff infection.^ Background. C. diff is the most common definable cause of nosocomial diarrhea affecting elderly hospitalized patients taking antibiotics for prolonged durations. The epidemiology of Clostridium difficile associated disease is now changing with the reports of a new hypervirulent strain causing hospital outbreaks. This new strain is associated with increased disease severity and mortality. The conventional therapy for C. diff includes metronidazole and vancomycin but high recurrence rates and treatment failures are now becoming a major concern. Rifamycin antibiotics are being developed as a new therapeutic option to treat C. diff infection after their efficacy was established in a few in vivo and in vitro studies. There are some recent studies that report an association between the hypervirulent strain and emerging rifamycin resistance. These findings assess the need for clinical studies to better understand the efficacy of rifamycin drugs against C. diff.^ Methods. This is a hospital-based, matched case-control study using de-identified data drawn from two prospective cohort studies involving C. diff patients at St Luke's Hospital. The C. diff isolates from these patients are screened for rifamycin resistance using agar dilution methods for minimum inhibitory concentrations (MIC) as part of Dr Zhi-Dong Jiang's study. Twenty-four rifamycin-rifamycin resistant C. diff cases were identified and matched with one rifamycin susceptible C. diff control on the basis of ± 10 years of age and hospitalization 30 days before or after the case. De-identified data for the 48 subjects was obtained from Dr Kevin Garey's clinical study at St Luke's Hospital enrolling C. diff patients. It was reviewed to gather information about host risk factors, outcome variables and relevant clinical characteristic.^ Results. Medical diagnosis at the time of admission (p = 0.0281) and history of chemotherapy (p = 0.022) were identified as a significant risk factor while hospital stay ranging from 1 week to 1 month and artificial feeding were identified as an important outcome variable (p = 0.072 and p = 0.081 respectively). Horn's Index assessing the severity of underlying illness and duration of antibiotics for cases and controls showed no significant difference.^ Conclusion. The study was a small project designed to identify host risk factors and understand the clinical implications of rifamycin-resistance. The study was underpowered and a larger sample size is needed to validate the results.^

INFECTION: ITS ECOLOGICAL DETERMINANTS AMONG CHILDREN IN NORTHERN CHILE

In developing countries, infection and malnutrition, and their interaction effects, account for the majority of childhood deaths and chronic deficits in growth and development. To promote child health, the causal determinants of infection and malnutrition and cost-effective interventions must be identified. To this end, medical examinations of 988 children (age two weeks to 14 years) living at three altitudes (coastal < 300m; sierra (TURN) 3,000m; and altiplano > 4,000m) in Chile's northermost Department of Arica revealed that 393 (40%) of the youngsters harbored one or more infections. When sorted by region and ethnicity, indigenous children of the highlands had infection rates 50% higher than children of Spanish descent living near the coast.^ An ecological model was developed and used to examine the causal path of infection and measure the effect of single and combined environmental variables. Family variables significantly linked to child health included maternal health, age and education. Significant child determinants of infection included the child's nutrient intake and medical history. When compared to children well and free of disease, infected youngsters reported a higher incidence of recent illness and a lower intake of basic foodstuffs. Traditional measures of child health, e.g. birth condition, weaning history, maternal fertility, and family wealth, did not differentiate between well and infected children.^ When height, weight, arm circumference, and subcapular skinfold measurements were compared, infected children, regardless of age, had smaller arm circumferences, the statistical difference being the greatest for males, age nine to eleven. Height and weight, the traditional growth indices, did not differentiate between well and infected groups.^ Infection is not determined by a single environmental factor or even a series of variables. Child health is ecological in nature and cannot be improved independent of changes in the environment that surrounds the child. To focus on selected child health needs, such as feeding programs or immunization campaigns, without simultaneously attending to the environment from which the needs arose is an inappropriate use of time, personnel, and money. ^

Malvinas a 30 años del conflicto : Un análisis sobre las propuestas de enseñanza en formato digital

Este artículo trata de definir los límites y posibilidades de los nuevos textos digitales en la enseñanza de la historia, especialmente de algunas propuestas didácticas producidas por el gobierno nacional, cuyo contenido versa sobre la guerra de Malvinas. ¿Cuáles son los nuevos significados que este tipo de textos digitales aportan a la enseñanza y el aprendizaje de la Guerra de las Malvinas? ¿Qué discursos y narrativas sobre Malvinas se presentan explícitos e implícitos en estos textos digitales? ¿Hay algún cambio entre estas narraciones que emergen en el 30 aniversario de la guerra en comparación con las narrativas anteriores? Son algunas de las preguntas que tratamos de resolver, a pesar de que los textos en formato digital para la enseñanza de la historia, parecen ser muy caóticos y poseen otro régimen de producción, lectura y propiedad, diferente al de los materiales curriculares impresos. Como primera aproximación al análisis podemos observar como las políticas educativas nacionales actuales en Argentina refuerzan el discurso de los derechos y la soberanía sobre las islas, introduciendo además, elementos nuevos que buscan un acercamiento emocional a la causa y desdibujan en parte, la enseñanza de la complejidad de Malvinas

Malvinas a 30 años del conflicto : Un análisis sobre las propuestas de enseñanza en formato digital

Este artículo trata de definir los límites y posibilidades de los nuevos textos digitales en la enseñanza de la historia, especialmente de algunas propuestas didácticas producidas por el gobierno nacional, cuyo contenido versa sobre la guerra de Malvinas. ¿Cuáles son los nuevos significados que este tipo de textos digitales aportan a la enseñanza y el aprendizaje de la Guerra de las Malvinas? ¿Qué discursos y narrativas sobre Malvinas se presentan explícitos e implícitos en estos textos digitales? ¿Hay algún cambio entre estas narraciones que emergen en el 30 aniversario de la guerra en comparación con las narrativas anteriores? Son algunas de las preguntas que tratamos de resolver, a pesar de que los textos en formato digital para la enseñanza de la historia, parecen ser muy caóticos y poseen otro régimen de producción, lectura y propiedad, diferente al de los materiales curriculares impresos. Como primera aproximación al análisis podemos observar como las políticas educativas nacionales actuales en Argentina refuerzan el discurso de los derechos y la soberanía sobre las islas, introduciendo además, elementos nuevos que buscan un acercamiento emocional a la causa y desdibujan en parte, la enseñanza de la complejidad de Malvinas

Malvinas a 30 años del conflicto : Un análisis sobre las propuestas de enseñanza en formato digital

Este artículo trata de definir los límites y posibilidades de los nuevos textos digitales en la enseñanza de la historia, especialmente de algunas propuestas didácticas producidas por el gobierno nacional, cuyo contenido versa sobre la guerra de Malvinas. ¿Cuáles son los nuevos significados que este tipo de textos digitales aportan a la enseñanza y el aprendizaje de la Guerra de las Malvinas? ¿Qué discursos y narrativas sobre Malvinas se presentan explícitos e implícitos en estos textos digitales? ¿Hay algún cambio entre estas narraciones que emergen en el 30 aniversario de la guerra en comparación con las narrativas anteriores? Son algunas de las preguntas que tratamos de resolver, a pesar de que los textos en formato digital para la enseñanza de la historia, parecen ser muy caóticos y poseen otro régimen de producción, lectura y propiedad, diferente al de los materiales curriculares impresos. Como primera aproximación al análisis podemos observar como las políticas educativas nacionales actuales en Argentina refuerzan el discurso de los derechos y la soberanía sobre las islas, introduciendo además, elementos nuevos que buscan un acercamiento emocional a la causa y desdibujan en parte, la enseñanza de la complejidad de Malvinas

The organizations transcomplejas from the perspective of the nursing

El propósito del artículo es el análisis de las organizaciones transcomplejas desde la perspectiva de la Enfermería, en el contexto del paradigma de la complejidad. Todos los cuestionamientos realizados a las ciencias de la modernidad fueron necesarios para dar al mundo desarrollos de enorme significación, como es el paradigma de la complejidad donde se rescata la idea de la totalidad universal y con ella el holismo dentro de las organizaciones, si se consideran estas como organismos vivo; y este aplicado al campo de la salud donde los profesionales del cuidado de la salud entre ellos la enfermería ha aceptado la perspectiva de salud holística como, más que la ausencia de enfermedad, como la realización individual. La humanidad vive una crisis de fragmentación que conduce a sentimientos y emociones destructivas de la armonía y del arte de vivir en equilibrio. La perspectiva holistica se preocupa de promover la salud mediante la prevención y se aplica a las personas que se recuperan de una enfermedad y desean aprender a prevenir su repetición y mejorar su estatus de salud futura. Así, la enfermería estudia la totalidad o la salud de los humanos, reconociendo que los humanos están en continua interacción con su medio ambiente

Malvinas a 30 años del conflicto : Un análisis sobre las propuestas de enseñanza en formato digital

Este artículo trata de definir los límites y posibilidades de los nuevos textos digitales en la enseñanza de la historia, especialmente de algunas propuestas didácticas producidas por el gobierno nacional, cuyo contenido versa sobre la guerra de Malvinas. ¿Cuáles son los nuevos significados que este tipo de textos digitales aportan a la enseñanza y el aprendizaje de la Guerra de las Malvinas? ¿Qué discursos y narrativas sobre Malvinas se presentan explícitos e implícitos en estos textos digitales? ¿Hay algún cambio entre estas narraciones que emergen en el 30 aniversario de la guerra en comparación con las narrativas anteriores? Son algunas de las preguntas que tratamos de resolver, a pesar de que los textos en formato digital para la enseñanza de la historia, parecen ser muy caóticos y poseen otro régimen de producción, lectura y propiedad, diferente al de los materiales curriculares impresos. Como primera aproximación al análisis podemos observar como las políticas educativas nacionales actuales en Argentina refuerzan el discurso de los derechos y la soberanía sobre las islas, introduciendo además, elementos nuevos que buscan un acercamiento emocional a la causa y desdibujan en parte, la enseñanza de la complejidad de Malvinas

Fundamentos antropológicos de las tecnologías biomédicas no terapéuticas

The important developments in technology in all areas of human life have generated high expectations and hopes with regard to the health sector. Science and technology have favored the development of incredible therapeutic treatments to help resolve numerous problems relating to illness and disability. Nonetheless, many developments in the therapeutic realm have given rise to discussions over the possibility of whether this same scientific and technological progress could be beneficial even for those who may not be sick. One may ask: why not apply the same knowledge and technology used for treatment of illness for conditions where therapy is not necessary, but there is a desire to care for, improve and enhance human person? These new horizons offered by biomedical technologies undoubtedly express a deep desire of every person for health, happiness, and a long life. In order to offer a response to these questions, current biomedical technologies and those in development offer a wide range of possibilities. Therefore, in this investigation we attempt to identify and define four areas of non-therapeutic treatment: illness prevention, health promotion, improving human nature, and human enhancement. These four areas, which do not directly regard illness, give rise to a series of questions, which range from those regarding the meaning of health and illness to those concerning anthropological questions, such as situations and conditions that must be taken into account so human dignity is respected. The treatment, improvement and enhancement of the human being imply clarifying in scientific and technological terms the truth and meaning of the human person as such. This research identifies and looks at the relationship between the four anthropological cornerstones which non-therapeutic biomedical technologies should be based upon so as not to impact or violate the dignity of the human person. This research presents the anthropological boundaries which non-therapeutic biomedical technologies should take into consideration so as not to alter or violate the dignity of the human person. At the same time, the research proposes an anthropological foundation on which to build a code of ethics for non-therapeutic biomedical technologies. El gran desarrollo de las tecnologías en todos los ámbitos de la vida del hombre ha generado una gran expectativa y esperanza en lo que se refiere a la salud. Ciencia y técnica están aportando grandes beneficios en materia terapéutica, ayudando a resolver muchos problemas concernientes a la enfermedad y a la discapacidad. Pero este desarrollo que se ha producido en el ámbito terapéutico nos conduce a la formulación de preguntas sobre las posibilidades que esos avances técnico-científicos pueden aportar en beneficio del hombre, cuando no se encuentra enfermo: ¿por qué no pueden aplicarse los conocimientos y tecnologías usados en terapia a un ámbito diferente, no terapéutico, con el fin de mantener, mejorar o incluso potenciar al hombre? Ciertamente los nuevos horizontes que abren las Tecnologías Biomédicas encuentran repercusión en el deseo de bienestar, de felicidad e incluso de prolongación de la vida presente en todos los hombres. Para responder a esta pregunta las Tecnologías Biomédicas han desarrollado y están desarrollando una gama muy amplia de posibilidades. En este trabajo intentamos organizar en cuatro áreas los conceptos de los tratamientos no-terapéuticos: prevención de la enfermedad, promoción de la salud, mejoramiento de la naturaleza humana y potenciación del hombre. Estas cuatro áreas, que no se refieren directamente a la enfermedad, generan una serie de interrogantes que van desde las preguntas sobre el significado de salud y enfermedad, hasta las cuestiones antropológicas relativas a la posibilidad y las condiciones que se han de dar para que tales acciones respeten la dignidad humana. Cuidar, mejorar y potenciar al hombre implica que los objetivos de la ciencia y de la técnica mantengan siempre claros los valores y la realidad del hombre en cuanto tal. ... Este Trabajo de Investigación presenta los límites antropológicos dentro de los cuales deben moverse las Tecnologías Biomédicas no-terapéuticas para no alterar el ser ni menoscabar la dignidad del hombre. Y ofrece los fundamentos antropológicos sobre los cuales se pueda construir un código ético y deontológico para las Tecnologías Biomédicas no-terapéuticas.