[The quality of interdisciplinary communication]. / La qualità della comunicazione interdisciplinare.

Because of a continued increase of complex patients and the development of many areas of sub-specialities in medicine, the use and quality of interdisciplinary communication has been found to be lacking, especially between hospital and primary care physicians, causing a significant gap in the documentation, coverage and care of individual patients. The study focuses on state of the art interdisciplinary communication, with consideration given to current used tools and priorities. An ad hoc questionnaire surveyed 118 physicians about their profession, the types of patients, the frequency of complex cases, the tools used to communicate with each patient and how the physicians rated these tools. The rate of patients needing interdisciplinary communication is 17% of the entire patient sample, all of this percentage having complex health care needs (terminally ill, disabled, often without a personal support network). Physicians frequently used paper documents, despite their lack of quality, as well as the telephone to communicate with other colleagues. Computer devices were scarcely used. Many Doctors (71%) value the actual interdisciplinary communication of low quality, despite the fact that it is considered to have a significant influence on the quality of health care. New tools and methods are needed. For example, dedicated standards of multidisciplinary and multi-professional Continuing Medical Education (CME), as well as the use of computer tools allowing for shared clinical records.

Grazing incidence X-ray diffraction of a photoaligned nematic semiconductor.

Grazing incidence X-ray diffraction is used to find the thin film morphology of an extended molecule with an irregular alternating fluorene-thiophene structure, which is used to obtain linearly polarized electroluminescence and the photovoltaic effect. The material has a room temperature nematic glassy phase and is uniaxially aligned in the plane of the film using photoalignment techniques. Two distinct intermolecular separations of 0.45 and 1.5 nm are identified showing that the molecules are lamellar. The lamellae stack with only local order and the two short axes of the lamellae have no preferred orientation at the surface or bulk of the film. Neighboring molecules show a wide range of longitudinal displacements along the axis of the director, as expected for a nematic liquid crystal with no positional order. There is, however, a dominant feature corresponding to a longitudinal offset of 0.51 nm. Unlike some other fluorene-containing semiconductors where microphase separation of the side chains inhibits close packing of neighboring molecules, the lamellar structure and 0.45 intermolecular spacing found here allows pi-pi intermolecular interactions for efficient carrier transport. We obtain a room temperature hole mobility up to 3.4 x 10-3 cm2 V-1 s-1 using a time-of-flight technique.

Regulation of NADPH oxidase subunit p22(phox) by NF-kB in human aortic smooth muscle cells.

Accumulating evidence demonstrates the involvement of oxidative stress in the pathophysiology of cardiovascular diseases. The molecular mechanisms accountable for the increased production of reactive oxygen species remain uncertain. Among others, NADPH oxidase is one of the most important sources of superoxide in vascular cells. Here we investigate the role of NF-kB in the regulation of p22(phox) subunit and NADPH oxidase activity, in human aortic smooth muscle cells. Overexpression of p65/RelA or IKKbeta up-regulated p22(phox) gene promoter activity. Transcription factor pull-down assays demonstrated the physical interaction of p65/RelA protein with predicted NF-kB binding sites. Real time PCR and Western blotting analysis showed that p22(phox) mRNA and protein expression are significantly down-regulated by NF-kB decoy oligodeoxynucleotides and N-alpha-tosyl-l-phenylalanine chloromethyl ketone (TPCK). Lucigenin-enhanced chemiluminescence assay revealed that NF-kB inhibitors reduce the NADPH-dependent superoxide production. Regulation of NADPH oxidase by NF-kB may represent a possible mechanism whereby pro-inflammatory factors induce oxidative stress in atherosclerosis, hypertension, diabetes, stroke or heart failure.

Dentists' perceptions, attitudes, knowledge, and experience about child abuse and neglect in northeast Italy.

OBJECTIVE: The aim of this study was to analyze dentists' perceptions, attitudes, knowledge and experience about child abuse and neglect (CAN) in an area of northeast Italy and the factors affecting the recognition and reporting of CAN cases. MATERIAL AND METHODS: One hundred six dentists working in both public and private sectors in the provinces of Padua and Treviso were interviewed by a single operator. Descriptive and assessing association analyses were carried out. RESULTS: Dentists' perceptions about CAN is low, and these professionals have a poor attitude toward confronting it according to the code of conduct and laws. Available information and education are also poor Education affects the detection and the reporting of CAN cases in a relevant way. Female gender is another factor that affects the attitude and the perception of CAN. CONCLUSIONS: The results, which are consistent with other studies, show that there is a general lack of knowledge about CAN that prevents dentists from detecting and identifying suspected cases. Despite its frequent occurrence among dental patients, neglect is the least known and identified type of abuse. Education is the critical element in enhancing the ability of professionals to detect cases.

Antioxidant properties of some hydroalcoholic plant extracts with antiinflammatory activity.

The hydroalcoholic extracts of Calendula officinalis, Hypericum perforatum, Plantago lanceolata and Glycyrrhiza glabra which exhibited different anti-inflammatory activities were evaluated for the possible mode of action by studying their antioxidant potential. In the present study we investigated if standardized hydroalcoholic extracts of plants such as Calendula officinalis, Hypericum perforatum, Plantago lanceolata and Glycyrrhiza glabra produced by Hofigal Stock Company could modulate the respiratory burst of human activated neutrophils, as a consequence of their antioxidant capacity. Their antioxidant properties were measured using a colorimetric assay (Total Antioxidant Status kit). We demonstrated that Hypericum perforatum and Calendula officinalis hydroalcoholic extracts possessed a significant antioxidant activity while Plantago lanceolata and Glycyrrhiza glabra hydroalcoholic extracts had a minor antioxidant status. Using reactive oxygen species-generating systems (OZ-activated human PMN neutrophils), Calendula officinalis and Hypericum perforatum extracts showed strong reactive oxygen species scavenging property, Hypericum perforatum extract exhibing the highest scavenging activity. These results confirm the potential of Calendula officinalis and Hypericum perforatum investigated hydroalcoholic extracts as medicinal remedies to be used in different inflammatory/allergic diseases. These extracts could be a useful tool for obtaining new antioxidant/anti-inflammatory agents.

Clinical and epidemiological observations regarding the 1998 Kauai murine typhus outbreak.

Five cases of murine typhus occurring on southwestern Kauai in 1998 are described, following an investigation by the Department of Health. Two cases also had concurrent leptospirosis. Recent habitat changes of peridomestic animals and their fleas may have increased the risk for developing murine typhus. Increased suspicion of typhus by island physicians and more aggressive rodent control activities are recommended.

"KITS" for improved immunization of Kauai children.

Kauai physicians and District Health Office staff established a computerized tracking system in 1993 to improve immunization rates in Kauai-born infants. Comparison of 1995 and 1996 audit results of 1993- and 1994-born children showed completion rates for 9 antigens rose from 76% to 86%. Evolution and improvement of the tracking system are discussed. Recommendations for physicians are offered.

Mosaicism for a small supernumerary ring X chromosome in a dysmorphic, growth-retarded male: mos47,XXY/48,XXY, +r(X).

Supernumerary ring X [r(X)] chromosomes are often found in patients with Turner syndrome. The phenotypic effects of the r(X) chromosome are variable, and largely depend on the presence or absence of the X inactivation (XIST) locus. Ring(X) chromosomes in males are rare and have been previously reported in only four cases, with 47,XY, + r(X) or mos47,XY, +r(X)/46,XY karyotypes. These patients all had developmental delay and dysmorphic features. We describe a 2.5-year-old male patient with facial dysmorphia, growth retardation, microcephaly, global developmental delay, and microphallus. Cytogenetic analysis from peripheral blood lymphocytes and fibroblasts identified mosaicism for two cell lines: mos48,XXY, + r(?X)/47,XXY. Fluorescence in situ hybridization (FISH) with an X chromosome paint showed the ring chromosome to be X chromosome derived. This is the first case of an r(X) chromosome described in a 47,XXY patient. FISH analysis of the r(X) chromosome with an XIST probe showed that the XIST locus was absent. Functional disomy of genes in the r(X) chromosome most likely accounts for the abnormal phenotype in the proband.

Active surveillance and risk factors for leptospirosis in Hawaii.

A clinic-hospital-based leptospirosis surveillance program was conducted to determine the morbidity and risk factors in nonepidemic settings. The study was conducted on two islands, Kauai and Hawaii (Big Island), in the state of Hawaii for one year during 1988 and 1989. An active, more comprehensive case detection system was used on the Big Island that enabled us to determine the incidence of clinical disease. Subjects from both islands were used to conduct a case-control study for risk factors. One hundred seventy-two subjects from the Big Island (who presented with any two of the following symptoms: fever, headache, myalgia, or nausea/vomiting) were enrolled in the study. Twenty cases were diagnosed by culture, serology, or fluorescent antibody tissue staining at autopsy. Six cases required hospitalization and two succumbed to fatal infections. We estimated that these cases represented an annual incidence rate of 128 per 100,000 person-years in our target population. For 33 cases, 77 controls were matched for island, age, sex, and time of onset of illness. Interviews were conducted retrospectively in a double-blinded fashion with cases and controls and evaluated approximately 30 risk factors. Factors that were associated most strongly with development of leptospirosis were household use of rainwater catchment systems (P = 0.003), presence of skin cuts during the incubation period (P = 0.008), contact with cattle or the urine of cattle (P = 0.05 and P = 0.03, respectively), and handling of animal tissues (P = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

The hepatitis B immunization campaign for children in the Federated States of Micronesia.

Hepatitis B has long been recognized as hyperendemic among persons residing in the western Pacific. Effective control strategies have not been described. From December 1988 through October 1989, the Federated States of Micronesia (FSM) conducted a campaign to immunize children through age 6 years with three doses of hepatitis B (HB) vaccine. In addition, HB vaccination was incorporated into the routine immunization schedule for all children born in FSM, with the first dose given to newborns. Between December 1988 and October 1989, a total of 64,085 doses of HB vaccine were administered to the children. After the start of the campaign, the subject group was enlarged to include children through 15 years of age in the States of Yap and Kosrae. Fifty-nine percent of the enlarged group in all States received a complete series of HB vaccinations. During each client encounter, individual immunization records were examined and diphtheria-pertussis-tetanus, oral polio vaccine, and measles-mumps-rubella antigens were administered to children who were not adequately immunized. The annual immunization assessment for 1990 showed coverage improved significantly from previous years in every FSM State.

Leptospirosis on Kauai: investigation of a common source waterborne outbreak.

During the summer of 1987, a common source waterborne outbreak of leptospirosis occurred on the island of Kauai in the state of Hawaii. Eight leptospirosis cases were identified using the microscopic agglutination test. Methodologic weaknesses in this technique were responsible for the initial missed diagnosis on six of the eight cases. All cases had repeated exposure to the Waimea River. A wide array of animal reservoirs and optimal water conditions may have been factors in this outbreak.

Clinical and laboratory findings implicating palytoxin as cause of ciguatera poisoning due to Decapterus macrosoma (mackerel).

A near fatal case of ciguatera-related intoxication following consumption of smoked Decapterus macrosoma is documented. In addition to some of the hallmark symptoms of ciguatera poisoning, the patient exhibited acute respiratory distress and severe muscle spasms. Laboratory results showed large elevations in a number of blood enzymes, indicative of muscle damage. The responsible agent was extracted from corresponding fish samples and identified as palytoxin.