Decision-making under uncertainty in environmental health policy: new approaches

Decision-making in environmental health policy is a complex procedure even in well-known conditions. Thus, in the case of uncertainty, decision-making becomes a hurdle race. We address scientific uncertainty, methods to reduce uncertainty, biomedical doubt and science communication, and the role of stakeholders, activists, lobbies and media that together influence policy decisions. We also consider the major responsibility and role of the medico-scientific community in this process. This community can and should teach the principle of scientific uncertainty to all stakeholders, advise policy-makers and underline the ethical issues, considering that our brains are not only the deposit of our humanity but also the route to environmental health and societal harmony.

Evaluation of the Changes in Some Liver Function and Haematological Parameters in MSG Fed Rats.

The effect of Monosodium glutamate (MSG) was evaluated on hepatic functions and haematological parameters in adult Wistar albino rats. The rats were randomly assigned into four (4) groups of five rats each. Group 1 served as the control while groups 2, 3 and 4 were fed diets supplemented with MSG at doses of 0.5, 1.0 and 5.0% per Kg of diet respectively. Following the 28 days of feeding, the rats were sacrificed and blood samples were collected for analyses. The haematological parameters except PCV were estimated using haematocytometer while the biochemical parameters were determined using Randox enzymatic kit. There was no significant difference (p>0.05) in PCV, WBC, RBC, total protein, albumin, direct and conjugated bilirubin in the rats fed with MSG at all levels of supplementation when compared with the control group. The Alkaline phosphatase (ALP) and Alanine aminotransferase (ALT) activities were increased with increase level of MSG and ranged from 35.00±0.17 - 59.00±1.23 U/L and 6.4-11.9 U/L respectively. There was no significant (p>0.05) difference in the levels of both serum ALP and ALT activities in the group fed 0.5% MSG when compared with the control group while there were significant (p>0.05) increase in the other treatment groups (1 and 5% MSG supplemented diets groups). The results therefore suggest that MSG at the levels of supplementation in the diets of the rats had no effect on the haematological indices but increased the liver function enzymes in the serum as the level of MSG increased in the diet.

What is the Role of Epidural Injections in the Treatment of Lumbar Discogenic Pain: A Systematic Review of Comparative Analysis with Fusion

BACKGROUND: Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing discogenic pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery. METHODS: A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar discogenic pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V. RESULTS: Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar. CONCLUSIONS: The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity pain for patients with lumbar discogenic pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments.

Detection of Mycobacterium tuberculosis growth by direct microscopic observation has a lower cost, higher sensitivity and higher diagnostic value than liquid and solid media cultures.

Background: Culture is needed to confirm tuberculosis but results are generally obtained after several weeks. Objectives: We compared a direct microscopic observation technique for detection of mycobacterial culture positivity (MODS) with the classic solid and MB/BacT cultures in terms of sensitivity, contamination rate, speed and cost on 488 samples. Results: The sensitivity of the MODS technique - 99,2% (162 positive samples) was higher than MB/BacT 78,4% (125 positive samples) and solid culture 69,6% (113 positive samples) P < 0.005 for all comparisons. The median times to positivity were 21, 13.3 and 3 days on solid media, B/BacT and MODS respectively. Conclusions: The MODS technique is faster and more sensitive than both solid media and MB/BacT culture.

Association between obesity and impaired glucose tolerance in new providence adolescents as demonstrated by the HbA1c test / Asociación entre la obesidad y los trastornos de tolerancia a la glucosa entre los adolescentes de nueva providencia según lo demostrado por la prueba de HbA1c

OBJECTIVE: To explore the association between obesity and the development of impaired glucose tolerance (IGT) in Bahamian adolescents. METHODS: Eight hundred and seventy-three adolescents were randomly selected from five high schools in New Providence. Each student's weight, height, and waist and hip circumferences were recorded to determine body mass index (BMI). Individuals with BMIs above the 84th and 95th percentiles were classified as overweight and obese, respectively. Venous blood samples were collected from each subject and haemoglobin Ai c (HbAi c) levels were measured using a direct immunoassay method. The criterion established by the International Expert Committee for the diagnosis of IGT (HbA i c concentration of 6.0-6.4%) was used. An analysis of covariance was performed to evaluate the relationship between obesity and IGT, and a logistic regression analysis predicted the risk of IGT based on BMI classification. RESULTS: Of the 861 adolescents who completed the study, 15.0% were classified as overweight, 15.2% as obese and 7.9% as severely obese. The overall cumulative prevalence of IGT based on HbAi c levels was 16 100 cases per 100 000 adolescents and was greater in males than in females. Higher percentages of overweight and obese students were identified as having IGT compared with their normal-weight counterparts. An analysis of covariance with post hoc analyses revealed that severely obese males and females, respectively were almost 26 (OR = 25.54, 95%CI 9.92, 65.77) or 23 (OR = 22.96, 95% CI 9.81, 53.73) times more likely to develop IGT than their normal-weight counterparts (p < 0.005). CONCLUSION: The data show a strong positive association between IGT and obesity among Bahamian adolescents.

OBJETIVO: Explorar la asociación entre la obesidad y el desarrollo de trastornos de tolerancia a la glucosa (IGT) en los adolescentes de Bahamas. MÉTODOS: Ochocientos setenta y tres adolescentes fueron seleccionados aleatoriamente de cinco escuelas secundarias en Nueva Providencia. Se registraron peso, altura, y las circunferencias de cintura y cadera de cada estudiante, para determinar el índice de masa corporal (IMC). Las personas con IMC por encima de los percentiles 84 y 95 fueron clasificados como con sobrepeso y obesos, respectivamente. Se obtuvieron muestras de sangre venosa de cada sujeto, y se midieron los niveles de hemoglobina A 1c (HbAc utilizando un método de inmunoensayo directo. Se utilizó el criterio establecido por el Comité Internacional de expertos para el diagnóstico de IGT (concentración de HbA 1c de 6.0-6.4%). Se realizó un análisis de covarianza para evaluar la relación entre la obesidad y IGT, y un análisis de regresión logística para predecir el riesgo de IGT sobre la base de la clasificación del IMC. RESULTADOS: De los 861 adolescentes que completaron el estudio, 15.0% fueron clasificados como con sobrepeso, 15.2% como obesos, y 7.9% como extremadamente obesos. La prevalencia acumulativa general de IGT basada en los niveles de HbA 1c fue 16 100 casos por 100 000 adolescentes, y fue mayor en los varones que en las mujeres. Mayores porcentajes de estudiantes con sobrepeso y obesidad fueron identificados con IGT en comparación con sus contrapartes de peso normal. Un análisis de covarianza con análisis post-hoc reveló que los varones y hembras extremadamente obesos, respectivamente, fueron casi 26 (OR = 25.54, 95%CI 9.92, 65.77) o 23 (OR = 22.96, 95% CI 9.81, 53.73) veces más propensas a desarrollar IGT que sus contrapartes de peso normal (p < 0.05). CONCLUSIÓN: Los datos muestran una fuerte asociación positiva entre IGT y obesidad entre los adolescentes de las Bahamas.

Recurrent Spontaneous Pneumothorax Following Helicopter Travel In High Altitude Areas.

A young healthy soldier, non smoker with no previous lung disease, presented with two separate episodes of primary spontaneous pneumothorax within six months, both preceded by low level helicopter travel during high altitude postings. This diagnosis must be considered in patients with acute onset chest pain and dyspnoea even when other risk factors are seemingly absent. Recurrence is common and so this differential must be kept in mind even after complete treatment of a previous episode.

A universal microscope manipulator / Um manipulador microscópico universal

A modified and improved model of a mechanical manipulator for observation of pinned and mounted insects is described. This device allows movement of the observed object around three perpendicular axes in the field of vision at all magnifications of stereomicroscopes. The main improvement of this new model is positioning of the guiding knobs for rotating around two of the axes next to each other, allowing faster and easier manipulation of the studied object. Thus, one of the main advantages of this device is the possibility to rotate the specimen without the need to refocus. The device enables easily reaching a precession deviation in the intersection point of axes up to 0.5 mm in the process of assembling.

Um modelo modificado e melhorado de um manipulador mecânico para observação de insetos fixados e montados é descrito. Este dispositivo permite o movimento do objeto observado em torno de três eixos perpendiculares no campo de visão para todas as ampliações do microscópio. A principal melhoria deste novo modelo é o posicionamento dos botões de rotação em torno dos dois eixos ao lado do outro, permitindo uma rápida e fácil manipulação do objeto estudado. Assim, uma das principais vantagens deste dispositivo é a possibilidade de girar o espécime sem a necessidade de mudar o foco. O dispositivo permite facilmente chegar a um desvio de precisão no ponto de interseção dos eixos de até 0,5 mm no processo de montagem.

Consumer Protection Act – Awareness.

Background: With the inclusion of health care services under Consumer Protection Act, a spurt in litigations arising out of breach in medical/dental profession is seen. Thus, it becomes imperative for health professionals today to be aware of such laws. Objective: To assess and compare the awareness about Consumer Protection Act among dentists (dentists in teaching institutions and dentists in private practice.) Material and Methods: A questionnaire survey was carried out on a total of 224 dentists [112 dentists in teaching institutions (DTI)] from Manipal and Mangalore and 112 dentists in private practice (DPP) from Udupi and Mangalore, Karnataka, India]. Statistical Analysis was done using SPSS version 10. Chi- square test was used to compare between the categorical variables (P<0.05). Results: A total of 69.6% of DTI and 76.8% of DPP reported to be aware of Consumer Protection Act but subsequent analysis of responses did not reveal the same. Awareness (> 75%) about rules and regulations of Consumer Protection Act was found to be low in both the dentist group. No difference was seen in awareness based on gender, degree and type of practice (P>0.05). Significantly higher percentage of DPP as compared to DTI (90.7% Vs 69.2% ; P< 0.05) were observed to rely upon regular consent. Conclusion: There is a need to raise the awareness of health professionals about such laws so that their increased professional concern and practice conforms to welfare of patients.

Effectiveness of a school dental education program in improving oral health knowledge and oral hygiene practices and status of 12- to 13-year-old school children.

Background: Children with poor oral health are 12 times more likely to have restricted-activity days. Dental health education [DHE], with the objective of improving the oral hygiene of the participants, would have obvious merits. Objectives: To determine the effectiveness of school DHE, conducted at repeated and differing intervals, in improving oral health knowledge, practices, oral hygiene status, and the gingival health of schoolchildren belonging to two socioeconomic classes. Materials and Methods: This 36-week duration study assessed the effectiveness of school DHE conducted every three weeks against every six weeks on oral health knowledge, practices, oral hygiene status and gingival health of 415, 12- to 13-year-old schoolchildren belonging to social classes I and V. Of the three selected schools of each social class, one each was subjected to the intervention of either three or six weeks or was a control, respectively. Oral health knowledge and practices were evaluated using a questionnaire. Oral hygiene and gingival health were assessed using plaque and gingival indices. Statistical Analysis Used: Friedman's test was used for the longitudinal analysis of data. ANOVA and Student's t test were used for continuous data. Results: Plaque and Gingival score reductions were highly significant in intervention schools, and were not influenced by the socioeconomic status. When oral health knowledge was evaluated, highly significant changes were seen in intervention schools; more significantly in schools receiving more frequent interventions. The socioeconomic status influenced the oral hygiene aids used and the frequency of change of toothbrush. Controls showed no significant changes throughout. Conclusions: The DHE program conducted at three-week intervals was more effective than that conducted at six-week intervals in improving oral health knowledge, practices, oral hygiene status, and gingival health of schoolchildren.

Development of height-weight based equation for assessment of body composition in Sri Lankan children.

Objective. To develop a height and weight based equation to estimate total body water (TBW) in Sri Lankan children. Methods. Cross sectional descriptive study done involving 5-15 year old healthy children. Height and weight were measured. TBW was assessed using isotope dilution method (D2O) and fat free mass (FFM) calculated. Multiple regression analysis was used to develop prediction equation and validated using PRESS statistical technique. Height, weight and sex code (male=1; female=0) were used as prediction variables. Results. This study provides height and weight equation for the prediction of TBW in Sri Lankan children. To the best of our knowledge there are no published height weight prediction equations validated on South Asian populations. Conclusion. Results of this study need to be affirmed by more studies on other closely related populations by using multicomponent body composition.

Imipramine induced elevation of prolactin levels in patients with HIV/AIDS improved their immune status / La elevación de niveles de prolactina mediante inducción con imipramina mejoró el estatus inmune de pacientes con VIH/SIDA

Prolactin is known to have significant immunomodulatory properties. Imipramine, a monoamine oxidase inhibitor, stimulates prolactin production because it decreases dopamine which inhibits secretion of prolactin. The study objective was to determine if use of imipramine can result in immunological benefits for HIV-positive patients by restoration and preservation of immunological function. A cohort of 19 retroviral positive patients was identified for the prospective study which continued for a 28-week period. Three patients dropped out before the study began. Inclusion criteria accepted only patients on the same highly active antiretroviral therapy (HAART) regimen for a nine-month period and who had reached a plateau with respect to the CD4 cell count and also had no prior history of antidepressant use for a 12-month period. This study had a "before and after" design, patients serving as their own control. The study drug imipramine was prescribed for a 12-week period up to visit 4, and then discontinued for 4-weeks (washout period) at which time blood investigations were done at visit 5. Finally, patients were prescribed the study drug for a further 12-week period to the end of the trial (visit 7). At the 95 per cent probability level, significant differences in average prolactin and CD4 levels from visit 4 to the end of the trial period were recorded. Results showed a trend of prolactin levels decreasing after washout (p = 0.015) and increasing by the end of the trial period once imipramine dispensation had recommenced (p = 0.006). With respect to the CD4 cell count, there was a significant increase after wash-out (p = 0.022). These results indicate a trend to immune boosting in HIV-positive patients who had obtained the maximum response from HAART.

Se sabe que la prolactina posee importantes propiedades inmunomudolatorias. La imipramina, un inhibidor de la monoamino oxidasa, estimula la producción de la prolactina porque disminuye la dopamina, que a su vez inhibe la secreción de prolactina. El objetivo de este estudio fue determinar si el uso de la imipramina puede traer beneficios inmunológicos a los pacientes VIH positivos mediante la restauración y preservación de la función inmunológica. Se identificó una cohorte de 19 pacientes retrovirales positivos, a fin de realizar este estudio prospectivo que continuó por un período de 28 semanas Tres pacientes se retiraron antes de que el estudio comenzara. Los criterios de inclusión aceptaban sólo pacientes que tuvieran el mismo régimen de terapia antiretroviral altamente activa (HAART) por un período de nueve meses, que hubieran alcanzado un nivel de estabilización con respecto al conteo de células CD4, y que no hubieran además tenido con anterioridad una historia de uso de anti-depresantes por espacio de 12 meses. Este estudio tuvo un diseño "antes y después", sirviendo los pacientes como su propio control. La imipramina para el estudio fue prescrita por un período de 12 semanas hasta la visita 4, y luego descontinuada por 4 semanas para un reposo farmacológico (período de lavado), realizándose entonces pruebas de sangre en la visita 5. Finalmente se prescribió el medicamento de estudio a los pacientes por un nuevo período de 12 semanas hasta el final del ensayo (visita 7). En el nivel de probabilidad del 95 por ciento, se registraron diferencias significativas en los niveles promedio de prolactina y CD4 desde la visita 4 hasta el final del período de ensayo. Los resultados mostraron una tendencia de los niveles de prolactina a descender tras el lavado (p = 0.015) y a aumentar hacia el final del período de ensayo, una vez que la dispensación de imipramina hubiese recomenzado (p = 0.006). Con respecto al conteo de células de CD4, hubo un aumento significativo luego del lavado (p = 0.022).

Synergistic ototoxicity due to noise exposure and aminoglycoside antibiotics.

Acoustic exposure to high intensity and/or prolonged noise causes temporary or permanent threshold shifts in auditory perception, reflected by reversible or irreversible damage in the cochlea. Aminoglycoside antibiotics, used for treating or preventing life-threatening bacterial infections, also induce cytotoxicity in the cochlea. Combined noise and aminoglycoside exposure, particularly in neonatal intensive care units, can lead to auditory threshold shifts greater than simple summation of the two insults. The synergistic toxicity of acoustic exposure and aminoglycoside antibiotics is not limited to simultaneous exposures. Prior acoustic insult which does not result in permanent threshold shifts potentiates aminoglycoside ototoxicity. In addition, exposure to subdamaging doses of aminoglycosides aggravates noise-induced cochlear damage. The mechanisms by which aminoglycosides cause auditory dysfunction are still being unraveled, but likely include the following: 1) penetration into the endolymphatic fluid of the scala media, 2) permeation of nonselective cation channels on the apical surface of hair cells, and 3) generation of toxic reactive oxygen species and interference with other cellular pathways. Here we discuss the effect of combined noise and aminoglycoside exposure to identify pivotal synergistic events that can potentiate ototoxicity, in addition to a current understanding of aminoglycoside trafficking within the cochlea. Preventing the ototoxic synergy of noise and aminoglycosides is best achieved by using non-ototoxic bactericidal drugs, and by attenuating perceived noise intensity when life-saving aminoglycoside therapy is required.

Periodontal disease as a risk factor in pre-term low birth weight--an assessment of gynecologists' knowledge: a pilot study.

BACKGROUND: Pre-term low birth weight (PLBW) is a condition having tremendous financial impact on health care systems as well as the affected families. Studies suggest that 18.2% of all PLBW cases may be attributable to periodontal disease. OBJECTIVES: To assess gynecologists' knowledge of periodontal disease as a risk factor in PLBW and their knowledge with regard to the oral manifestations of periodontal disease. MATERIALS AND METHODS: A questionnaire survey was conducted on gynecologists in the city of Mangalore. The respondents were divided into four groups--those practicing only in medical colleges, those having only a private practice, those practicing in both medical colleges and in private practice, and post-graduate students of gynecology in the medical colleges in the city. STATISTICAL ANALYSIS USED: The Chi-square test for proportions was used to test the differences between the groups. RESULTS: Out of a total of 142 gynecologists, 93 participated in the survey. Group II respondents were omitted from the statistical analysis as the response rate was only 18.8%. Periodontal disease was considered to be a risk factor in PLBW by 52 (59.8%) respondents while 13 (14.9%) stated that it was not a risk factor at all. Sixty-seven (77%) respondents stated that bleeding/enlargement of the gingivae was a sign of periodontal infection. CONCLUSIONS: Respondents' knowledge was high regarding the oral manifestations of periodontal disease but was low regarding periodontal disease as a risk factor in PLBW.

Use of skin-fold thickness in Sri Lankan children: comparison of several prediction equations.

OBJECTIVE: There are many prediction equations available in the literature for the assessment of body composition from skinfold thickness (SFT). This study aims to cross validate some of those prediction equations to determine the suitability of their use on Sri Lankan children. METHODS: Height, weight and SFT of 5 different sites were measured. Total body water was assessed using the isotope dilution method (D2O). Percentage Fat mass (%FM) was estimated from SFT using prediction equations described by five authors in the literature. RESULTS: Five to 15 year old healthy, 282 Sri Lankan children were studied. The equation of Brook gave Ihe lowest bias but limits of agreement were high. Equations described by Deurenberg et al gave slightly higher bias but limits of agreement were narrowest and bias was not influence by extremes of body fat. Although prediction equations did not estimate %FM adequately, the association between %FM and SFT measures, were quite satisfactory. CONCLUSION: We conclude that SFT can be used effectively in the assessment of body composition in children. However, for the assessment of body composition using SFT, either prediction equations should be derived to suit the local populations or existing equations should be cross-validated to determine the suitability before its application.

Trends in the incidence of type I diabetes mellitus worldwide / Tendencias en la incidencia de la diabetes mellitus de tipo i a nivel mundial

The incidence of Type I diabetes mellitus in children has increased worldwide over the past 50 years. This increase has occurred in rich and poor countries in Europe, Asia, the Americas and Oceania. Rapid increases in incidence in genetically stable populations eg Finland and Sardinia imply that environmental factors are of paramount importance as driving forces in this changing trend. The significance of these trends and putative aetiological factors are reviewed.

La incidencia de la diabetes mellitus de tipo I en los niños ha aumentado a nivel mundial en los últimos 50 años. Este aumento ha tenido lugar tanto en los países ricos como en los países pobres de Europa, Asia, las AmØricas y Ocean a. Los rápidos aumentos de incidencia en las poblaciones genéticamente estables, tales como Finlandia y Sardinia, implican que los factores ambientales desempeñan un papel primordial como fuerzas impulsoras de esta tendencia cambiante. Se examinan la significación de estas tendencias y los factores etiológicos putativos.

Nomenclatura de alergia revisada para uso global: Relatório do Comitê de Revisão de Nomenclatura / Revised nomenclature for allergy for global use: Report of the Nomenclature

A nomenclatura proposta no relatório de outubro de 2003 do Comitê de Revisão de Nomenclatura da World Allergy Organization é uma atualização da Nomenclatura Revisada para Declaração da Situação da Alergia da Academia Européia de Alergologia e Imunologia Clínica (European Academy of Allergology and Clinical Immunology Revised Nomenclature for Allergy Position Statement), publicada em 2001. A nomenclatura pode ser usada independentemente do órgão alvo ou da faixa etária do paciente e se baseia nos mecanismos que desencadeiam e medeiam as reações alérgicas. Supõe-se que, conforme o conhecimento sobre as causas básicas e os mecanismos for se aprimorando, a nomenclatura virá a precisar de revisão

Supramolecular organization of the sperm plasma membrane during maturation and capacitation / 亚洲男科学杂志(英文版)

<p><b>AIM</b>In the present study, a variety of high resolution microscopy techniques were used to visualize the organization and motion of lipids and proteins in the sperm's plasma membrane. We have addressed questions such as the presence of diffusion barriers, confinement of molecules to specific surface domains, polarized diffusion and the role of cholesterol in regulating lipid rafts and signal transduction during capacitation.</p><p><b>METHODS</b>Atomic force microscopy identified a novel region (EqSS) within the equatorial segment of bovine, porcine and ovine spermatozoa that was enriched in constitutively phosphorylated proteins. The EqSS was assembled during epididymal maturation. Fluorescence imaging techniques were then used to follow molecular diffusion on the sperm head.</p><p><b>RESULTS</b>Single lipid molecules were freely exchangeable throughout the plasma membrane and showed no evidence for confinement within domains. Large lipid aggregates, however, did not cross over the boundary between the post-acrosome and equatorial segment suggesting the presence of a molecular filter between these two domains.</p><p><b>CONCLUSION</b>A small reduction in membrane cholesterol enlarges or increases lipid rafts concomitant with phosphorylation of intracellular proteins. Excessive removal of cholesterol, however, disorganizes rafts with a cessation of phosphorylation. These techniques are forcing a revision of long-held views on how lipids and proteins in sperm membranes are assembled into larger complexes that mediate recognition and fusion with the egg.</p>