Health and Social Services for Older People II (HeSSOP II): Changing Profiles from 2000 to 2004

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From Ageism to Age Equality - Addressing the Challenges: Conference Proceedings

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Vom Finanz- zum Wissenschaftsbetrug : Methode, den Irrungen in der medizinischen Literatur beizukommen [From financial to scientific fraud : Methods to detect discrepancies in the medical literature].

Fraud is as old as Mankind. There are an enormous number of historical documents which show the interaction between truth and untruth; therefore it is not really surprising that the prevalence of publication discrepancies is increasing. More surprising is that new cases especially in the medical field generate such a huge astonishment. In financial mathematics a statistical tool for detection of fraud is known which uses the knowledge of Newcomb and Benford regarding the distribution of natural numbers. This distribution is not equal and lower numbers are more likely to be detected compared to higher ones. In this investigation all numbers contained in the blinded abstracts of the 2009 annual meeting of the Swiss Society of Anesthesia and Resuscitation (SGAR) were recorded and analyzed regarding the distribution. A manipulated abstract was also included in the investigation. The χ(2)-test was used to determine statistical differences between expected and observed counts of numbers. There was also a faked abstract integrated in the investigation. A p<0.05 was considered significant. The distribution of the 1,800 numbers in the 77 submitted abstracts followed Benford's law. The manipulated abstract was detected by statistical means (difference in expected versus observed p<0.05). Statistics cannot prove whether the content is true or not but can give some serious hints to look into the details in such conspicuous material. These are the first results of a test for the distribution of numbers presented in medical research.

The Rare Cancer Network: achievements from 1993 to 2012.

The Rare Cancer Network (RCN), founded in 1993, performs research involving rare tumors that are not common enough to be the focus of prospective study. Over 55 studies have either been completed or are in progress.The aim of the paper is to present an overview of the 30 studies done through the RCN to date, organized by disease site. Five studies focus on breast pathology, including sarcoma, lymphoma, phyllodes tumor, adenoid cystic carcinoma, and ductal carcinoma in situ in young women. Three studies on prostate cancer address prostatic small cell carcinoma and adenocarcinoma of young and elderly patients. Six studies on head and neck cancers include orbital and intraocular lymphoma, mucosal melanoma, pediatric nasopharyngeal carcinoma, olfactory neuroblastoma, and mucosa-associated lymphoid tissue lymphoma of the salivary glands. There were 4 central nervous system studies on patients with cerebellar glioblastoma multiforme, atypical and malignant meningioma, spinal epidural lymphoma and myxopapillary ependymoma. Outside of these disease sites, there is a wide variety of other studies on tumors ranging from uterine leiomyosarcoma to giant cell tumors of the bone. The studies done by the RCN represent a wide range of rare pathologies that were previously only studied in small series or case reports. With further growth of the RCN and collaboration between members our ability to analyze rare tumors will increase and result in better understanding of their behavior and ultimately help direct research that may improve patient outcomes.

Surgical indication in Schistosomiasis mansoni portal hypertension: follow-up from 1985 to 2001

The study had the objective to evaluate the benefits of surgical indication for portal hypertension in schistosomiasis patients followed from 1985 to 2001. Schistosoma mansoni eggs were confirmed by at least six stool examinations or rectal biopsy. Clinical examination, abdominal ultrasonography, and digestive endoscopy confirmed the diagnosis of esophageal varices. A hundred and two patients, 61.3% male (14-53 years old) were studied. Digestive hemorrhage, hypersplenism, left hypochondrial pain, abdominal discomfort, and hypogonadism were, in a decreasing order, the major signs and symptoms determining surgical indication. Among the surgical techniques employed, either splenectomy associated to splenorenal anastomosis or azigoportal desvascularization, esophageal gastric descompression and esophageal sclerosis were used. Follow-up of patients revealed that, independent on the technique utilized, a 9.9% of death occurred, caused mainly by digestive hemorrhage due to the persistence of post-treatment varices. The authors emphasize the benefits of elective surgical indication allowing a normal active life.

Epidemiological features of rotavirus infection in Goiânia, Goiás, Brazil, from 1986 to 2000

A total of 2,605 faecal specimens from children up to 10 years old with or without diarrhoea were collected. Samples were obtained from 1986 to 2000 in hospitals, outpatient clinics and day-care centers in Goiânia, Goiás. Two methodologies for viral detection were utilized: a combined enzyme immunoassay for rotavirus and adenovirus and polyacrylamide gel electrophoresis. Results showed 374 (14.4%) faecal specimens positive for Rotavirus A, most of them collected from hospitalized children. A significant detection rate of rotavirus during the period from April to August, dry season in Goiânia, and different frequencies of viral detection throughout the years of study were also observed. Rotavirus was significantly related to hospitalization and to diarrhoeal illness in children up to 24 months old. This study reinforces the importance of rotavirus as a cause of diarrhoea in children and may be important in regards to the implementation of rotavirus vaccination strategies in our country.

Development of place navigation in rats from weaning to puberty.

Young hooded rats were trained to escape onto a hidden platform after swimming in a pool of opaque water. Subjects 21, 28, 35, 42, and 64 days of age on the first training day were given 28 trials on 5 consecutive days. Half of the rats were required to localize the platform in relation to external room cues only ("place only" condition) and the other half were helped by the presence of a visible cue on the platform ("cue + place" condition). A deficiency in place navigation was observed in the 21- and 28-day groups; they showed slow escape and took circuitous routes more often than older rats. This deficiency was related to a poor spatial bias toward the training position when the subjects were allowed to swim for 30 s in the absence of the platform, at the end of the 28-trial training period (probe trial). The 35-day group showed adult-like learning ability in both training conditions, but failed to show searching behavior during the probe trial after having been trained in the presence of the proximal cue. Only rats older than 40 days showed typical adult behavior such as swimming directly toward the platform from any starting position and localized searching around the absent platform's position during the probe trial, no matter what the training conditions were. These results suggest that central nervous system structures responsible for place learning in the rat are functional from around 32 days of age, but fail to trigger searching behavior following cued training before the sixth week.

The relationship between muscle strength and physiological age: a cross-sectional study in boys aged from 11 to 15.

OBJECTIVE: To investigate the relationships between isokinetic knee flexor and extensor muscle strength and physiological and chronological age in young soccer players. MATERIAL AND METHODS: Seventy-nine young, healthy, male soccer players (mean+/-standard deviation age: 12.78+/-2.88, range: 11 to 15) underwent a clinical examination (age, weight, height, body mass index and Tanner puberty stage) and an evaluation of bilateral knee flexor and extensor muscle strength on an isokinetic dynamometer. Participation in the study was voluntary. RESULTS: The peak torque increased progressively (by 50%) between the ages of 11 and 15 and most significantly between 12 to 14. The knee flexor/extensor ratios only decreased significantly between 14 and 15 years of age. Puberty stage was the most important determinant of the peak torque level (ahead of chronological age, weight and height) for all angular velocities (p<0.0001). Muscle strength increased significantly between Tanner stages 1 and 5, with the greatest increase between stages 2 and 4. CONCLUSION: The present study showed that isokinetic muscle strength increases most between 12 and 13 years of age and between Tanner stages 2 and 3. There was strong correlation between muscle strength and physiological age.

Weaning made easy: moving from milk to family meals

This booklet provides advice about the stages involved in helping babies make the move from milk only to joining in family meals.

RXR: from partnership to leadership in metabolic regulations.

Vitamin A signaling occurs through nuclear receptors recognizing diverse forms of retinoic acid (RA). The retinoic acid receptors (RARs) bind all-trans RA and its 9-cis isomer (9-cis RA). They convey most of the activity of RA, particularly during embryogenesis. The second subset of receptors, the rexinoid receptors (RXRs), binds 9-cis RA only. However, RXRs are obligatory DNA-binding partners for a number of nuclear receptors, broadening the spectrum of their biological activity to the corresponding nuclear receptor-signaling pathways. The present chapter more particularly focuses on RXR-containing transcriptional complexes for which RXR is not only a structural component necessary for DNA binding but also acts as a ligand-activated partner. After positioning RXR among the nuclear receptor superfamily in the first part, we will give an overview of three major signaling pathways involved in metabolism, which are sensitive to RXR activation: LXR:RXR, FXR:RXR, and PPAR:RXR. The third and last part is focused on RXR signaling and its potential role in metabolic regulation. Indeed, while the nature of the endogenous ligand for RXR is still in question, as we will discuss herein, a better understanding of RXR activities is necessary to envisage the potential therapeutic applications of synthetic RXR ligands.

Getting a good start: healthy eating from one to five

This booklet outlines advice on many key nutritional issues for children aged one to five. It includes information on how to provide a healthy, balanced diet for this age group, guidance on suitable snacks and drinks, feeding a vegetarian child, vitamin supplements and iron, making the most of mealtimes and how to deal with fussy eaters.

A New Partnership in Education: From Consultation to Legislation in the Nineties

"In the nineties, dialogue in the Irish education system has been frenetic and painful at times. But it has gradually led to an extraordinary cohesion and partnership in the system. The book tracks the major consultations - and confrontations - of the nineties and it explores the personalities and policies of the protagonists - ministers, officials, leaders of Church bodies and third-level institutions, representatives of teachers' unions and parents' organisations." "All of the important consultation documents of the decade are here, the various drafts of the Green and White Papers - some benign, some infamous - the Bills, the Acts. The big issues are expertly set forth - intermediate structures and regionalisation, school governance and boards of management, the role of the Churches, higher education and the abolition of tuition fees."-This resource was contributed by The National Documentation Centre on Drug Use.

From genomes to vaccines via the proteome

An effective vaccine against schistosomiasis mansoni would be a valuable control tool and the high levels of protection elicited in rodents and primates by radiation-attenuated cercariae provide proof of principle. A major obstacle to vaccine development is the difficulty of identifying the antigens that mediate protection, not least because of the size of the genome at 280Mb DNA encoding 14,000 to 20,000 genes. The technologies collectively called proteomics, including 2D electrophoresis, liquid chromatography and mass spectrometry, now permit any protein to be identified provided there is extensive DNA data, and preferably a genome sequence. Applied to soluble (cytosolic) proteins from schistosomes, proteomics reveals the great similarity in composition between life cycle stages, with several WHO vaccine candidates amongst the most abundant constituents. The proteomic approach has been successfully applied to identify the secretions used by cercaria to penetrate host skin, the gut secretions of adult worms and the proteins exposed on the tegument surface. Soluble proteins can also be separated by 2D electrophoresis before western blotting to identify the full range of antigenic targets present in a parasite preparation. The next step is to discover which target proteins represent the weak points in the worm's defences.

Whole-person care: from rhetoric to reality. Achieving parity between mental and physical health.

The report presents evidence on a range of factors affecting disparity between mental and physical health, and includes case studies and examples of good practice to illustrate some of the key issues and solutions. It should be seen as the first stage of an on-going process over the next 5"10 years that will deliver parity for mental health and make whole-person care a reality. It builds on the Implementation Framework for the Mental Health Strategy in providing further analysis of why parity does not currently exist, and the actions required to bring it about. A parity approach should enable NHS and local authority health and social care services to provide a holistic, whole person response to each individual, whatever their needs, and should ensure that all publicly funded services, including those provided by private organisations, give people's mental health equal status to their physical health needs. Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that this influence works in both directions. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems. Mental health affects physical health and vice versa. The report makes a series of key recommendations for the UK government, policy-makers and health professionals. Recommendations include: The government and the NHS Commissioning Board should work together to give people equivalent levels of access to treatment for mental health problems as for physical health problems, agreed standards for waiting times, and agreed standards for emergency/crisis mental healthcare. Action to promote good mental health and to address mental health problems needs to start at the earliest stage of a person's life and continue throughout the life course. Preventing premature mortality " there must be a major focus on improving the physical health of people with mental health problems. Public health programmes must include a focus on the mental health dimension of issues commonly considered as physical health concerns, such as smoking, obesity and substance misuse. Commissioners need to regard liaison doctors (who work across physical and mental healthcare) as an absolute necessity rather than an optional luxury. NHS and social care commissioners should commission liaison psychiatry and liaison physician services to drive a whole-person, integrated approach to healthcare in acute, secure, primary care and community settings, for all ages. Mental health services and mental health research must receive funding that reflects the prevalence of mental health problems and their cost to society. Mental illness is responsible for the largest proportion of the disease burden in the UK (22.8%), larger than that of cardiovascular disease (16.2%) or cancer (15.9%). However, only 11% of the NHS budget was spent on NHS services to treat mental health problems for all ages during 2010/11. Culture, attitudes and stigma " zero-tolerance policies in relation to discriminatory attitudes or behaviours should be introduced in all health settings to help combat the stigma that is still attached to mental illness within medicine. Political and managerial leadership is required at all levels. There should be a mechanism at national level for driving a parity approach to relevant policy areas across government; all local councils should have a lead councillor for mental health; all providers of specialist mental health services should have a board-level lead for physical health and all providers of physical healthcare services should have a board-level lead for mental health. The General Medical Council (GMC) and Nursing and Midwifery Council (NMC) should consider how medical and nursing study and training could give greater emphasis to mental health. Mental and physical health should be integrated within undergraduate medical education.This resource was contributed by The National Documentation Centre on Drug Use.