[Establish a predictive modeling under antiviral therapy for hepatitis B e antigen seroconversion in chronic hepatitis B].

Objective: To explore the predictive factors by demonstrating a predictive modeling under antiviral therapy for hepatitis B e antigen seroconversion in HBeAg-positive chronic hepatitis B patients. Methods: 198 cases with HBeAg-positive chronic hepatitis B were enrolled. Fatty liver, family history of hepatitis B, age, sex, drinking history, HBsAg, HBeAg, HBV-DNA levels, total bilirubin (TBil), CD4/CD8, albumin (ALB), alanine amino transferase (ALT) levels were used as a predictor variables of HBeAg seroconversion. Serological seroconversion of HBeAg was observed at 144 weeks of antiviral therapy. Predictive factors of HBeAg seroconversion was analyzed by logistic regression analysis, and the receiver operating characteristic curve was plotted. Results: HBeAg seroconversion rate was 36.87%. Univariate analysis demonstrated that fatty liver (χ(2) = 35.377; P < 0.001), family history of hepatitis B (χ(2) = 15.687; P < 0.001), the levels of HBeAg (t = 5.034; P < 0.001), HBsAg (t = 3.454; P < 0.001) and HBV-DNA levels (Z = 4.651; P < 0.001) were predictor variables of HBeAg seroconversion. Multivariate analysis showed that family history of hepatitis B, fatty liver, HBV-DNA levels and HBeAg were independent predictors of HBeAg seroconversion. The established logistic regression model for HBeAg through regression analysis was logit P = 9.623-1.228 × family history of hepatitis B - 1.726 × fatty liver - 0.764 × HBV-DNA levels - 0.146 × HBeAg and area under curve was 0.875. When the cut-off value was -0.9350, the sensitivity and specificity were 92.70%, 75.50%, 83.22%, respectively. Conclusion: Family history of hepatitis B, fatty liver, HBV-DNA levels and HBeAg may be independent predictors of HBeAg seroconversion at 144 weeks of antiviral therapy in HBeAg-positive chronic hepatitis B patients.

The Evolution of School Health and Nutrition in the Education Sector 2000-2015 in sub-Saharan Africa.

STUDY OBJECTIVES: To document the progression of school health and nutrition and its integration within the education sector in sub-Saharan Africa between 2000 and 2015. BACKGROUND: School health and nutrition programs have contributed to "Education for All" objectives by helping ensure that children benefit from quality education and reach their educational potential. METHODS: Analysis of education sector plans (ESPs) in terms of the Focusing Resources on Effective School Health (FRESH) framework and the World Bank Systems Approach for Better Education Results (SABER) School Health survey from a set of countries in sub-Saharan Africa. RESULTS: Between 2000 and 2015, the presence and scope of school health and nutrition as reflected in the four FRESH pillars grew substantially in ESPs. Three of these pillars have large, upfront costs. The fourth pillar requires recurring annual budgetary allotments. CONCLUSION: Governments clearly recognize that evidence-based, contextually designed school health and nutrition programs can contribute to education sector goals. Moving into the post-2015 era, these programs can also help draw the last 10% of children into school and enhance their readiness to learn.

Does diving affect the hearing of Asian military divers? A study in the Republic of Singapore Navy.

OBJECTIVE: This study examined whether military diving during a National Serviceman's two-year term of service affected his hearing threshold levels. METHODS: A retrospective cohort study was designed to examine the hearing thresholds of divers (mean age 20.9 years) who enlisted between 2001 and 2010 (n = 748). Their pre-enlistment and pre-discharge audiograms were collected. All made dives using scuba dive sets, averaged 200 dives over two years and depths of 30 meters of sea water/msw or less. RESULTS: The divers' hearing levels in the left ear were not affected except for a marginal decrease in hearing level at the 2kHz level. There was a marginal decrease in hearing level in 0.5, 1 and 2 kHz in the right ear. These changes are physiologically insignificant. There were more low-frequency (0.5, 1 and 2 kHz) changes compared to high-frequency (4 and 8 kHz) changes in both ears, with a larger number of changes noted in the right ear, as compared to the left. However, no diver had a hearing threshold increase greater than 20dB or exceeded the hearing threshold levels required of military divers. CONCLUSION: There was no decrease of clinical significance in hearing function of the Republic of Singapore Navy national serviceman naval divers after diving for two years.

MRI findings in cervical spinal cord type II neurological decompression sickness: a case report.

Decompression illness affecting the cervical spinal cord is uncommon. We report a case that presented with mixed signs and symptoms of cervical myelopathy and Type II neurological decompression sickness. This presented a diagnostic dilemma that required the use of magnetic resonance imaging (MRI) scan to elucidate the underlying cause. Cervical spine MRI revealed the presence of tiny hypointensities and edema within the spinal cord that corresponded to the clinical findings. The patient recovered with residual neurological deficits after hy-perbaric oxygen (HBO2) therapy. To our knowledge, these MRI findings have yet to been described in literature and we recommend the use of MRI to assist diving physicians in the management of complex cases as long as it does not delay recompression.

Grading of evidence of the effectiveness of health promotion interventions.

AIMS: Grading of evidence of the effectiveness of health promotion interventions remains a priority to the practise of evidence-based health promotion. Several authors propose grading the strength of evidence based on a hierarchy: convincing, probable, possible and insufficient; or strong, moderate, limited and no evidence. Although these grading hierarchies provide simple and straightforward rankings, the terms that describe the categories in the hierarchies, however, do not explain, in an explicit manner, in what way the strength of the evidence in one category is more, or less, superior than that in another. METHODS: To enhance the explanatory power of the hierarchy, we propose that evidence be classified into three grades, each with a short explanatory note on the basis of three criteria: the degree of association between the intervention under study and the outcome factors, the consistency of the findings from different studies, and whether there is a known cause-effect mechanism for the intervention under study and the outcome factors. CONCLUSION: For more in-depth grading, a three-grade expanded hierarchy is also recommended. Examples are given to illustrate our proposed grading schemes.

The skin prick test results of 977 patients suffering from chronic rhinitis in Hong Kong.

OBJECTIVES: To evaluate the prevalence of aetiological allergens identifiable by skin prick test alone in patients suffering from chronic rhinitis in Hong Kong, and also compare the clinical history and symptoms of skin prick test-positive versus skin prick test-negative patients. DESIGN: Prospective study. SETTING: Otorhinolaryngology clinic in Queen Mary Hospital of Hong Kong. PATIENTS: A total of 977 patients suffering from chronic rhinitis were recruited into the study. Skin prick test was performed with a panel of allergens including house dust mites, cockroach, cat, dog, moulds, and pollens. MAIN OUTCOME MEASURES: Skin prick test results and their correlation with symptoms. RESULTS: Of the 977 patients, 651 (67%) had positive skin prick test reactions. The commonest allergen was house dust mite which was positive in 63% of the 977 patients and 95% of those 651 skin prick test-positive patients. The other allergens were in order of cockroach (23%), cat (14%), dog (5%), pollen (4%), and mould (3%). Compared with skin prick test-negative patients, skin prick test-positive patients were more likely to have earlier age of onset of the chronic rhinitis, association with asthma, more severe symptom in the morning, more severe symptoms of itchy nose, sneezing, nasal discharge, itchy eye, and watery eye. CONCLUSIONS: Identifiable aeroallergens could be detected in 67% chronic rhinitis patients by skin prick test alone. House dust mites were the most prevalent causative allergen. There were significant differences of patterns of clinical history and symptoms severity between skin prick test-positive and skin prick test-negative patients.

Plasma gastrin measurement cannot be used to diagnose a gastrinoma in patients on either proton pump inhibitors or histamine type-2 receptor antagonists.

BACKGROUND: Patients with a gastrinoma are treated with proton pump inhibitors (PPI) and histamine type-2 receptor antagonists (H2). In order to diagnose a gastrinoma these drugs must be discontinued, but this increases the risk of gastrointestinal perforation. We aimed to determine if a gastrinoma could be diagnosed without cessation of PPI/H2 therapy. METHODS: In all, 90 patients (controls and patients diagnosed with a gastrinoma both on and off PPI/H2 therapy) were recruited, and plasma gastrin measured. RESULTS: Patients with a gastrinoma on PPI/H2 medication had a significantly higher fasting plasma gastrin concentration than control patients on PPI/H2 medication (298+/-33 versus 204+/-30 pmol/L, P = 0.01). However, there was substantial overlap between gastrin levels in these two groups. CONCLUSION: This study confirms that a gastrinoma cannot be diagnosed on the basis of a fasting plasma gastrin assay while patients remain on PPI/H2 therapy.

A visual field abnormality: ocular or cerebral cause?

The visual field can be affected by disorders involving any part of the visual pathway, from the retina to the striate cortex. The pattern of visual field damage can indicate the location of the disorder. The case is presented here of an 8-year-old girl with congenital glaucoma. Initial perimetry appeared consistent with glaucomatous field loss; however, this evolved into a homonymous quadrantanopia, indicating the presence of a cerebral lesion as the cause. Computed tomography and magnetic resonance imaging scans detected a large middle cranial fossa arachnoid cyst. Postoperatively there was resolution of the visual field defects secondary to the arachnoid cyst. The pattern of field loss was pivotal in this patient's management. Attention must be paid when caring for the patient with a chronic disease to ensure that concurrent conditions are diagnosed.

Motorcycle ownership and injury in China.

BACKGROUND: China has made tremendous progress in its economic development in the past two decades. Accompanying this economic development has been an evident shift in the modes of transport, from walking and cycling to the use of motorcycles and, increasingly, four-wheel vehicles. Such changes are likely to have also produced changes in the patterns and numbers of road traffic injuries, including increases in motorcycle injuries. However, such changes have not been well documented. The work described in this paper sought, therefore, to document the changes in motorcycle ownership, motorcyclist mortality and injury rates in China since 1987. METHODS: National traffic ownership and injury data from 1987 to 2001 were obtained from the National Bureau for Traffic Administration. Additionally, traffic ownership and injury records from 1997 to 2001 were collected from local police offices from 20 counties in Guangxi Region. Population data were obtained from the national and county statistics bureaus. Motorcycle ownership, fatality and injury trends over time were calculated. RESULTS: Nationally, motorcycles accounted for 23.4% of all registered motor vehicles in 1987, increasing to 63.2% in 2001. Motorcyclist fatalities and injuries increased 5.5-fold and 9.3-fold, respectively, between 1987 and 2001. In 1987, 7.5% of all traffic fatalities and 8.8% of all traffic injuries were sustained by motorcyclists, with the corresponding proportions increasing to 18.9% and 22.8%, respectively, in 2001. The changing proportions of both traffic fatalities and injuries sustained by motorcyclists were positively correlated with the change in the proportion of motorcycles among all motor vehicles. In the 20 counties in Guangxi, motorcyclist fatality and injury rates also increased between 1997 and 2001. Moreover, these rates were considerably higher than the national rates. CONCLUSIONS: Motorcyclist injury in China is a serious public health problem. Motorcyclist fatalities and injuries are likely to continue to increase unless appropriate intervention programmes are implemented.

Involving the general public in priority setting: experiences from Australia.

The discussion over whether community preferences have a legitimate role to play in priority setting has been highly polarised. Skeptics warn of the risk of establishing a 'dictatorship of the uninformed', while advocates proclaim the legitimacy of the participatory process. The one group who appears not to be consulted in this debate is the citizens themselves. In this study, a convenience sample of 373 citizens attending two medical clinics in central Sydney were surveyed about whether the general public has a legitimate role to play in informing priority setting in health care. Respondents were presented with three different levels of priority setting: across health care programmes, across medical procedures, and at a global level. To assist respondents in understanding the choices and trade-offs involved, they were given information about current levels of funding and the cost-effectiveness of each alternative. Respondents were asked whether they felt the preferences of the general public should be used to inform priority setting at each level. Of particular interest was the question of whether their willingness to use public preferences depended on the level of priority setting. Respondents were also asked about who else's preferences should be used to inform priority setting at each level. The results suggest that the public overwhelmingly want their preferences to inform priority-setting decisions in health care. This was seen to be particularly important in informing decisions about how to prioritise across broad health care programmes and about the criteria to be used to allocate funds across different population groups. In contrast, the preferences of medical professionals and health service managers were rated most highly in relation to the prioritisation of different treatments and medical procedures. In most cases, however, respondents did not advocate the use of one particular group's preferences. Even when the preferences of the general public were considered most important, it was felt that any decision-making process needed to be informed by the preferences of a range of groups. The preferences of politicians were viewed as least important to processes of priority setting in health care.

What constitutes treatment effectiveness? -- the differential judgements of Chinese Aaustralian patients and doctors.

Analysis of interviews and focus groups with users of traditional Chinese medicine (TCM) and ethnic Chinese general practitioners (GPs) in Sydney, Australia, demonstrated the concept of treatment effectiveness held by users had four aspects: diagnosis, intervention, outcome and prevention of recurrence. Respondents assessed orthodox medicine and TCM utilizing all four aspects. Orthodox medicine was considered effective for diagnosis and valued for the speed of its intervention. However, respondents regretted its failure to use food in treatment. Orthodox medicine was considered best for symptom relief but TCM was considered to be better at dealing with root causes of illness and was consequently better at preventing illness recurring. Respondents saw prevention as illness specific contrasting with the lifestyle prevention espoused by orthodox medicine. Respondents criticized TCM in Australia because of the perceived low expertise of practitioners and poor herb quality. GPs valued accurate diagnosis and symptom relief but were less concerned about root causes of illness and did not see food as a treatment intervention.

Regional and postnatal heterogeneity of activity-dependent long-term changes in synaptic efficacy in the dorsal striatum.

High-frequency activation of excitatory striatal synapses produces lasting changes in synaptic efficacy that may contribute to motor and cognitive functions. While some of the mechanisms responsible for the induction of long-term potentiation (LTP) and long-term depression (LTD) of excitatory synaptic responses at striatal synapses have been characterized, much less is known about the factors that govern the direction of synaptic plasticity in this brain region. Here we report heterogeneous activity-dependent changes in the direction of synaptic strength in subregions of the developing rat striatum. Neurons in the dorsolateral region of the anterior striatum tended to express LTD after high-frequency afferent stimulation (HFS) in slices from animals aged P15-P34. However, HFS in dorsolateral striatum from P12-P14 elicited an N-methyl-D-aspartate (NMDA) receptor-dependent form of LTP. Synapses in the dorsomedial anterior striatum exhibited a propensity to express an NMDA-receptor dependent form of LTP across the entire developmental time period examined. The NMDA receptor antagonist (+/-)-2-amino-5-phosphopentanoic acid (APV) inhibited evoked excitatory postsynaptic potentials recorded in striatum obtained from P12-P15 rats but had little effect in striatum from older animals. The expression of multiple forms of synaptic plasticity in the striatum suggests mechanisms by which this brain region plays pivotal roles in the acquisition or encoding of some forms of motor sequencing and stereotypical behaviors.

Role of pertussis toxin-sensitive G-proteins in synaptic transmission and plasticity at corticostriatal synapses.

The role of pertussis toxin (PTX)-sensitive G-proteins in corticostriatal synaptic transmission and long-term synaptic depression (LTD) was examined using extracellular field potential and whole cell voltage-clamp recordings in striatal slices. High-frequency stimulation (HFS) produced LTD, defined as long-lasting decreases both in synaptically driven population spikes (PSs) measured with field potential recording and in excitatory postsynaptic currents (EPSCs) measured with whole cell recording. Striatal LTD could not be induced in slices obtained from rats that had received a unilateral intrastriatal injection of PTX. However, LTD could be induced in slices obtained from paired control slices. Furthermore, striatal LTD was prevented by pretreatment with N-ethylmaleimide (NEM), another compound that disrupts the function of PTX-sensitive G-proteins. NEM, itself, also potentiated PS and EPSC amplitudes. In addition, NEM increased the frequency and amplitude of both spontaneous and miniature EPSCs and decreased the paired-pulse facilitation ratio, suggesting that it may act on both pre- and postsynaptic sites. The findings suggest that PTX-sensitive G-proteins have multiple roles at corticostriatal synapses, including regulation of synaptic transmission at both pre- and postsynaptic sites, and a key role in striatal LTD.

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home.

PURPOSE: To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia. METHODS: Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns. RESULTS: The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups. CONCLUSIONS: There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration.

OBJECTIVE: To determine the nature and frequency of polypoidal choroidal vasculopathy (PCV) in a series of patients suspected of having neovascularized age-related macular degeneration (AMD). METHODS: A prospective analysis of 167 consecutive, newly diagnosed patients aged 55 years or older with presumed neovascularized AMD was performed. All patients were examined with fundus biomicroscopy as well as fluorescein and indocyanine green angiography. RESULTS: Choroidal neovascularization secondary to AMD was diagnosed in 154 (92.2%) of 167 patients; 13 (7.8%) patients had PCV. The patients affected by PCV were younger than those with AMD (P = .01). Peripapillary choroidal neovascularization was seen in 3 (1.9%) of 154 patients with AMD and 3 (23.1%) of 13 patients with PCV (P = .006). Significant drusen were present in 63 (70%) of 90 fellow eyes with unilateral AMD compared with only 1 (16.7%) of 6 eyes with PCV (P = .02). Only 5 patients with AMD (3.2%) were nonwhite compared with 3 patients with PCV (23.1%) (P = .02). CONCLUSIONS: A measurable number of elderly patients with findings suggestive of neovascularized AMD and serosanguineous macular manifestations will instead have PCV. Polypoidal choroidal vasculopathy can occur in any sex or race, but is more commonly seen in the peripapillary area, without associated drusen, and in nonwhite patients. It is important to differentiate AMD from PCV because there are significant differences in the demographic risk profile, natural course, visual prognosis, and management of these patients.

Nursing as a career choice: perceptions of school students speaking Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese at home.

Australia is a multicultural society and nowhere is this more evident than in Sydney where 25% of the population speaks a language other than English. In one of the largest area health services in New South Wales, the five most frequently spoken languages at home are Arabic, Serbo-Croatian, Spanish, Turkish or Vietnamese, with these language groups comprising 12% of Sydney's population. Yet nurses speaking one of these five languages comprise less than 1% of the nursing workforce. A cost-effective method of addressing the shortage of nurses speaking languages other than English is to recruit students who already speak another language into the profession. This study examined high school students' perceptions of nursing in order to determine appropriate methods of recruiting students speaking one of these languages. Implications for the design of recruitment campaigns are also discussed.

A longitudinal study of smoking in year 7 and 8 students speaking English or a language other than English at home in Sydney, Australia.

OBJECTIVE: To compare the rates and predictors of smoking uptake between adolescents speaking English and those speaking a language other than English (LOTE) at home. DESIGN: A cross-sectional survey of year 7 and 8 students (aged 12 and 13 years) was conducted in 1994 and repeated 12 months later. A cohort of students was identified with respondents at baseline matched at follow up. chi 2 and logistic regression were used for analysis. SETTING: 38 schools in southern, east, and northern Sydney, Australia. SUBJECTS: Year 7 and 8 students in the schools were included and examined on two occasions, with complete data for 5947 (80%) students at baseline and 6177 (98%) students at a 12-month follow up. Records were able to be matched perfectly for 3513 respondents (59%). MAIN OUTCOME MEASURES: Smoking rates and predictors of smoking uptake among students speaking English or a LOTE at home. RESULTS: At baseline, 6.1% of students surveyed were smokers. Twelve months later, 15.8% of student surveyed were smokers. There were significantly lower smoking rates among students speaking a LOTE at home compared with those speaking English at home at baseline and at 12 months. Using matched data, for students speaking English at home, five variables were significant predictors of smoking uptake: thinking it acceptable to smoke, perceived benefits of smoking, and having a brother, sister, or close friend who smokes. For students speaking a LOTE, the only predictor was the smoking status of close friends. CONCLUSIONS: Despite the higher smoking prevalence among men with a non-English-speaking background, and the reported strong association between fathers' smoking status and smoking onset of their children, adolescents speaking a LOTE at home were significantly less likely to be smokers than their English-speaking counterparts. Thus, there would seem to be a delay of smoking onset among students speaking a LOTE at home. The smoking rates among respondents speaking a LOTE at home in this study are lower than those obtained from the studies conducted in Europe and the United States. Effective smoking prevention interventions need to be implemented at an early stage of adolescence.

Elective neck dissection versus observation in the treatment of early oral tongue carcinoma.

BACKGROUND: The aim of the present review is to evaluate the results of elective neck dissection and "watchful waiting" in the surgical treatment of stages I and II squamous cell carcinoma of oral tongue. METHODS: This is a retrospective study of patients with surgical treatment between January 1980 and December 1994. RESULTS: There were 63 patients including those with 34 T1 and 29 T2 carcinoma. The first sites of tumor recurrence were 5 (8%) local, 17 (27%) regional, 2 (3%) distant, 1 (2%) locoregional, and 1 (2%) both regional and distant. Of the 30 NO neck patients who had no elective neck dissection, the regional recurrence rate was 47%, and eventually 23% died of tumor related to regional recurrence. Elective neck dissection significantly reduced the regional recurrence rate to 9% and also significantly reduced the regional recurrence related mortality to 3%. Elective neck dissection also increased the 5-year disease-free actuarial survival rate to 86% compared with 55% for "watchful waiting." CONCLUSIONS: Regional recurrence was the most common cause of failure after surgical treatment of oral tongue carcinoma. Elective neck dissection significantly reduced mortality due to regional recurrence and also increased the overall survival. There was no significant difference between elective radical neck dissection and selective I, II, and III neck dissection in the improvement of treatment results. This retrospective study suggests that elective selective I, II, III neck dissection is a treatment strategy of choice for stages I and II carcinoma of the oral tongue. A prospective randomized study is worthwhile to further evaluate the benefit of elective neck dissection in the treatment of early carcinoma of the tongue.