Ventilation, indoor air quality, and health in homes undergoing weatherization.

Ventilation standards, health, and indoor air quality have not been adequately examined for residential weatherization. This randomized trial showed how ASHRAE 62-1989 (n=39 houses) and ASHRAE 62.2-2010 (n=42 houses) influenced ventilation rates, moisture balance, indoor air quality, and self-reported physical and mental health outcomes. Average total airflow was nearly twice as high for ASHRAE 62.2-2010 (79 vs. 39 cfm). Volatile organic compounds, formaldehyde and carbon dioxide were all significantly reduced for the newer standard and first-floor radon was marginally lower, but for the older standard, only formaldehyde significantly decreased. Humidity in the ASHRAE 62.2-2010 group was only about half that of the ASHRAE 62-1989 group using the moisture balance metric. Radon was higher in the basement but lower on the first floor for ASHRAE 62.2-2010. Children in each group had fewer headaches, eczema, and skin allergies after weatherization and adults had improvements in psychological distress. Indoor air quality and health improve when weatherization is accompanied by an ASHRAE residential ventilation standard, and the 2010 ASHRAE standard has greater improvements in certain outcomes compared to the 1989 standard. Weatherization, home repair, and energy conservation projects should use the newer ASHRAE standard to improve indoor air quality and health.

Altered microstructure integrity of the amygdala in schizophrenia: a bimodal MRI and DWI study.

BACKGROUND: The amygdala plays a central role in the fronto-limbic network involved in the processing of emotions. Structural and functional abnormalities of the amygdala have recently been found in schizophrenia, although there are still contradictory results about its reduced or preserved volumes. METHOD: In order to address these contradictory findings and to further elucidate the possibly underlying pathophysiological process of the amygdala, we employed structural magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI), exploring amygdalar volume and microstructural changes in 69 patients with schizophrenia and 72 matched healthy subjects, relating these indices to psychopathological measures. RESULTS: Measuring water diffusivity, the apparent diffusion coefficients (ADCs) for the right amygdala were found to be significantly greater in patients with schizophrenia compared with healthy controls, with a trend for abnormally reduced volumes. Also, significant correlations between mood symptoms and amygdalar volumes were found in schizophrenia. CONCLUSIONS: We therefore provide evidence that schizophrenia is associated with disrupted tissue organization of the right amygdala, despite partially preserved size, which may ultimately lead to abnormal emotional processing in schizophrenia. This result confirms the major role of the amygdala in the pathophysiology of schizophrenia and is discussed with respect to amygdalar structural and functional abnormalities found in patients suffering from this illness.

Peritoneal malignant mesothelioma: case report.

Our study reports peritoneal diffuse malignant mesothelioma (DMM) in a 43 years old male patient, with no exposure to asbestos in his medical history; the partner of the patient was also not exposed to asbestos. The exposure to X-rays was also excluded. Different pathogenic mechanisms for the pathogenesis of a peritoneal diffuse malignant mesothelioma in this patient can be hypothesized, for example, SV40 infection and genetic susceptibility; a minimal domestic exposure to asbestos can be not excluded. Therefore, further studies in a larger number of subjects are necessary to determine whether one or all of these hypothetic pathogenic mechanisms are more significant for the development of malignant mesothelioma.

Expression of phage P4 integrase is regulated negatively by both Int and Vis.

Phage P4 int gene encodes the integrase responsible for phage integration into and excision from the Escherichia coli chromosome. Here, the data showing that P4 int expression is regulated in a complex manner at different levels are presented. First of all, the Pint promoter is regulated negatively by both Int and Vis, the P4 excisionase. The N-terminal portion of Int appears to be sufficient for such a negative autoregulation, suggesting that the Int N terminus is implicated in DNA binding. Second, full-length transcripts covering the entire int gene could be detected only upon P4 infection, whereas in P4 lysogens only short 5'-end covering transcripts were detectable. On the other hand, transcripts covering the 5'-end of int were also very abundant upon infection. It thus appears that premature transcription termination and/or mRNA degradation play a role in Int-negative regulation both on the basal prophage transcription and upon infection. Finally, comparison between Pint-lacZ transcriptional and translational fusions suggests that Vis regulates Int expression post-transcriptionally. The findings that Vis is also an RNA-binding protein and that Int may be translated from two different start codons have implications on possible regulation models of Int expression.

Predictors of early leaving from the cotton spinning mill environment in newly hired workers.

OBJECTIVE: This longitudinal study aimed to identify the predictors of leaving during the first year of employment from the cotton spinning mill environment in newly hired workers. METHODS: One hundred and ninety eight consecutively appointed new employees were investigated by questionnaire, lung function test, and skin test. They were examined before employment and at the end of the 1st week, and the 1st, 3rd, 6th, and 12th month after starting work and when possible before leaving their job. 572 personal dust sampling and 191 endotoxin measurements were performed to assess the environmental exposure. For the univariate analysis chi2, Student t tests, ANOVA, and Kruskall Wallis tests were used. Cox proportional hazards analysis was used to identify factors associated with leaving the job. RESULTS: Fifty three per cent of workers left the mill environment during their first working year. Work related lower respiratory tract symptoms reported at the third month were associated with an increase rate of leaving the industry compared to those remaining in the industry (25% v 4.8%; p<0.005). Having respiratory symptoms at the first month of work predicted those leaving the industry at some point in the next 11 months. According to the Cox model, increasing age and having work related lower respiratory tract symptoms were found to be predictors for leaving job at the first working year. Atopic status, dust and endotoxin levels, and lung function changes were not consistently predictive of workers who left the industry in the follow up period. CONCLUSION: This study demonstrated that work related respiratory symptoms can predict workers likely to leave the cotton mill environment during the first year of employment, but atopy or acute lung function changes do not.

Rubella seroprevalence among first-grade primary school students in a district in Istanbul, Turkey.

OBJECTIVES: Rubella vaccination is not included in the national immunization programme of Turkey. However, it is on the market and is recommended, mainly by the private sector, at the age of 12-15 months. Introduction of the rubella vaccine without achieving high coverage has the risk of shifting the mean age of rubella infection among the unvaccinated population to reproductive ages. The aim of this study was to evaluate the seroprevalance of rubella and the factors associated with seropositivity among primary school students in Umraniye, a district of Istanbul. METHODS: Blood samples were collected from 489 students in 70 primary schools of Umraniye. Parents completed a concise questionnaire assessing sociodemographic characteristics and measles, mumps and rubella vaccination status. RESULTS: Among the students screened, 163 (33.3%, 95% confidence intervals 29.2-37.7%) were susceptible to rubella. When sociodemographic variables were evaluated, paternal education was the only variable associated with seronegativity. As the level of paternal education increased, seronegativity rates decreased. This finding may suggest that rubella vaccination is practiced more commonly among children whose fathers are better educated. CONCLUSIONS: Surveillance and control of rubella and congenital rubella syndrome must be set as public health priorities in Turkey, particularly given that rubella vaccination is practiced partially in the country.

Assessment of sociodemographic factors and socio-economic status affecting the coverage of compulsory and private immunization services in Istanbul, Turkey.

OBJECTIVES: The primary objective of this study was to determine the coverage of the Expanded Programme of Immunization (EPI) of the Ministry of Health and the coverage of private vaccines in the Umraniye Health District in order to establish approaches for improving vaccination services. Other objectives were to define the areas that present higher risks for non-vaccination and to determine the factors that influence vaccination coverage. METHODS: A '30 x 7' cluster sampling design was adopted as the sampling method. Thirty streets were selected at random from each health care region. Sociodemographic and socio-economic characteristics of the population, utilization of vaccination services and vaccination status of children under the age of 5 years were determined by face-to-face interviews. Odds ratios for the sociodemographic and socio-economic characteristics, health centre region and inner country immigration were assessed as possible related factors with the vaccination coverage rates for children under 5 years and under 1 year using the backward elimination method in logistic regression. RESULTS: Vaccination coverage was as follows: hepatitis B third dose, 84.6%; Bacille Calmette-Guérin, 94.8%; diphtheria, tetanus, pertussis (DPT) third dose, 90.1%; oral polio virus (OPV) third dose, 90.0%; measles, 88.7%; DPT booster dose, 79.1%; OPV booster dose, 79.0%; measles, mumps, rubella (MMR), 13.3%; haemophilus influenza type b (Hib), 9.3%; and Varicella vaccine, 3.3%. The full vaccination rates for children under 5 years and under 1 year were 68.3 and 79.5%, respectively. Higher socio-economic status was associated with a higher rate of full vaccination and private vaccination for children under 5 years of age. CONCLUSIONS: Full vaccination rates for children aged less than 1 year and less than 5 years were higher in our district than in Istanbul. However, we did not meet the EPI aims for any of the vaccines, and differences were observed in vaccination coverage rates between different socio-economic groups in the district. Therefore, an intervention programme should be considered to achieve the EPI's goals, particularly in socio-economically disadvantaged groups. Also, the coverage of private vaccination (MMR, Hib, Varicella) is low and more children from higher socio-economic groups receive these vaccines.

Aspergillus surveillance project at a large tertiary-care hospital.

A one-year surveillance project was conducted at a large tertiary hospital, which had extensive indoor renovation and extensive demolition/building at several nearby sites. This study collected viable fungi samples in the hospital every six days and analysed 74 duct dust samples for Aspergillus fumigatus mycelial asp f1 protein. Mean total fungi were 257.8 cfu/m3 outdoors, 53.2 cfu/m3 in all indoor samples and 83.5 cfu/m3 in the bone marrow transplant patient rooms. Mean total aspergillus was 6.8 cfu/m3 outdoors, 12.1 cfu/m3 in all indoor samples and 7.3 cfu/m3 in the bone marrow transplant patient rooms. The five most prevalent Aspergillus species collected inside the hospital (mean cfu/m3) were Aspergillus niger 7.57 cfu/m3, Aspergillus candidus 1.72 cfu/m3, Aspergillus flavus 0.97 cfu/m3, A. fumigatus 0.88 cfu/m3 and Aspergillus glaucus 0.45 cfu/m3. In rooms undergoing duct cleaning, mean A. fumigatus concentrations were 11.0 cfu/m3. Forty-eight of 74 (65%) duct dust samples had measurable levels of asp f1 protein, with a mean level of 0.41 ppm and maximum level of 1.94 ppm. Three major incidents involved increased hospital aspergillus concentrations. A. niger levels reached 680 cfu/m3 in an organ transplant room after a water leak from a ceiling pipe. Total aspergillus concentrations rose to 77 cfu/m3 in a bone marrow transplant patient room after improper sealing and water infiltration of the unit's dedicated high-efficiency particulate air filter system. Total aspergillus levels of 160 cfu/m3 were recorded in a renovation area during wood cutting. The higher concentrations of aspergillus seen inside the hospital compared with outdoors and the various moisture/HEPA filter/renovation incidents suggest that numerous small to moderate sources of aspergillus exist in the hospital.

Resistance against contraception or medical contraceptive methods: a qualitative study on women and men in Istanbul.

OBJECTIVES: This research was carried out to reveal the attitudes of men and women about contraception in the Umraniye district of Istanbul. METHODS: Focus group discussions were used for data collection. Data from 20 groups of married people (ten groups of men and ten of women) living in Umraniye were analyzed. RESULTS: Most people attending the focus groups in the study were against having 'too many' children. Economic constraints appear to be a leading influencing factor for limiting the number of children. Urbanization also seems to have a strong influence on people's knowledge and attitudes about contraception. Culture and religious beliefs were not found to be major barriers to contraception in general, but they would influence the selection of the type of a certain contraceptive method. More specifically, culture and religious beliefs were barriers to use of medical methods, and they were the main reasons for use of the withdrawal method, which is the most common method used in Turkey. CONCLUSIONS: Men and women are not resistant to contraception, but they are reluctant to use medical methods. The provision of contraceptive services, with special attention to cultural and religious beliefs and values, and the inclusion of appropriate counseling and education sessions during service delivery, may give clients new options and increase the use of medical methods.

Minimizing missed opportunities: an approach to decrease the unmet need for family planning.

OBJECTIVES: The aim of the study was to determine the participants with unmet need and to show that family planning consultancy given to women and men attending the first-level health facilities would increase contraceptive usage and reduce unmet need for family planning. METHODS: All married women aged 15-49 years and men having wives of the same age group attending the health centers for any service other than family planning were included in the study. Among 2021 attendants, a total of 1701 participated in the study (84.2%). Participants were interviewed after they took the services for which they attended. At the end of the inquiries, all willing participants were referred to the family planning unit in the same building. RESULTS: The unmet need (need for any or more effective contraceptive methods) was 43.1%. All participants with unmet need were referred to the family planning unit in the same building and willing participants were given family planning services. Of the participants, 23.9% attended the family planning unit and 17.8% took services immediately at the time of the attendance. CONCLUSIONS: Linking family planning services with other health services can be a cheap and practical way to reduce the unmet need.

Recombinant bacterial cells as efficient biocatalysts for the production of nucleosides.

The preparation of nucleosides as well as their base-modified analogues using purified nucleoside phosphorylase enzymes or, more conveniently, using whole bacterial cells is described. The development of genetically modified strains of Escherichia coli, able to over-produce Uridine-phosphorylase and Purine-nucleoside-phosphorylase in the same cells, improves the specific biocatalytic activity and the consequent industrial scale approach.

[Second-line chemotherapy and new drugs for ovarian carcinoma]. / Chemioterapia di seconda linea e nuovi farmaci nel carcinoma ovarico.

Epithelial ovarian carcinoma represents a prototypic example of neoplastic disease sharing at the same time good chemosensitivity as well as marked propensity to relapse. If in one hand the definition of almost clear-cut guidelines has been reached in the setting of first-line therapy (i.e., cytoreductive surgery followed by first-line chemotherapy), more difficult to discern for the oncologist remains the choice of treatment in the occasion(s) of relapse(s). This article focuses on this particular setting of disease, analyzing the specific criteria of choice of drug or their combinations; the definite criteria followed for the use of platinum compounds in the second line of treatment, even if already utilized in the front line therapy, are also analyzed. Specific attention has also been paid in the definition of the role of single parameter as a "prognosticator" and/or as "predictor" of response. The Authors emphasize how clinical definitions remain the more reliable, simple, reproducible tools in therapeutical decision making.

Fludarabine phosphate as an active and well tolerated salvage therapy in an elderly heavily pretreated Hodgkin's disease patient: a case report.

Up to two thirds of all patients affected by advanced Hodgkin's disease will be cured by chemotherapy alone or by combined chemoradiation modalities. High-dose chemotherapy with autologous stem cell rescue may be potentially curative for patients progressing under frontline chemotherapy or developing early relapse of disease. In spite of this, an unacceptably high percentage of these high-risk patients will relapse after salvage treatments and die of their disease. Fludarabine phosphate is an adenosine nucleoside analog highly active in chronic lymphocytic leukemia and low-grade non-Hodgkin's lymphomas. There are only few data in the literature concerning its use in the management of Hodgkin's disease. We report the case of an elderly, heavily pretreated Hodgkin's disease patient in progression under third-line chemotherapy who experienced good palliation of her B symptoms and a major clinical response of her refractory bone lesions with the administration of fludarabine as monotherapy. The treatment was well tolerated, without grade 4 hematological toxicity or opportunistic infections. The duration of clinical remission and systemic symptom palliation was 9 and 11 months, respectively. Further evaluation of fludarabine phosphate as salvage therapy in relapsed/refractory elderly Hodgkin's disease patients is needed.

Lead, chromium, and cadmium exposure during abrasive blasting.

An evaluation of lead, cadmium, and chromium exposure was conducted during abrasive blasting of a steel bridge to remove paint in preparation for repainting. Airborne lead concentrations were measured at several locations inside the containment structure, as well as near the workers' breathing zones. Airborne cadmium and chromium were also measured in the containment area. Blood lead levels were monitored in each worker. Airborne lead and cadmium levels in containment exceeded the Occupational Safety and Health Administration's permissible exposure limits by factors of 219 and 3.1, respectively. The use of supplied air-blasting helmets will not effectively reduce workers' lead exposure to the permissible exposure limits when airborne levels are as high as were measured in this study. Studies are needed to evaluate additional engineering controls and alternative paint removal methods. Evaluation of workers' exposure to lead and other hazardous metals is needed for projects involving abrasive blasting. Medical surveillance for cadmium and lead may be necessary for similar projects.

Hemoglobinopathies in the district of Antalya, Turkey.

A screening program was conducted to ascertain the incidence of hemoglobinopathies in the district of Antalya, Turkey. The survey sample was selected from the household registration forms of health centers by systematic random sampling. Heparinized blood samples were collected from 1,616 subjects from 884 families. The prevalence of beta thalassemia traits with increased Hb A2 was 10.2%. This is higher than that found in previous studies performed in Antalya. The prevalence of abnormal hemoglobins (Hbs) was found to be 0.8%. Four subjects had Hb AS; five had Hb D-Los Angeles (B 121 [GH4] Glu-Gln); one had Hb Ube-2 (68 [E1] Ans-Asp), one had Hb P-Nilotic (fusion between B 22 and) and two had Hb D-like variants.

Erythrocyte glucose-6-phosphate dehydrogenase (1.1.1.49) deficiency in Antalya province, Turkey: an epidemiologic and biochemical study.

Glucose-6-phosphate dehydrogenase (1.1.1.49) activity was assessed in 1986-1988 in blood samples from 1,521 individuals from 375 families living an Antalya city and adjacent villages by Beutler's fluorescence spot test. The families were randomly selected by the State Statistical Institute. Complete deficiency occurred in 7.4% of males and 1.8% of females. Mean enzyme activity was 6.77 +/- 1.07 IU/g Hb in normals and ranged between 0 and 0.48 IU/g Hb in those considered deficient. Kinetic measurements made with partially purified enzyme showed that GdB+ and GdB- variants were present in normal and in deficient subjects, respectively.