New estimates of influenza-related pneumonia and influenza hospitalizations among the elderly.

OBJECTIVES: The aim of this study is to present a method to provide accurate estimates of influenza-associated pneumonia and influenza (P&I) hospitalizations and costs for use in tracking the continuing burden of influenza. METHODS: We estimated influenza-associated P&I hospitalizations among the U.S. elderly population for six influenza seasons, 1990-91 through 1995-96, by applying a Poisson regression model to national influenza virus surveillance information and Medicare administrative data. This model is similar to that recently published by the U.S. National Centers for Disease Control and Prevention (CDC) to estimate influenza-related mortality. RESULTS: During the six years of the study, 318,666 (9.8%) of P&I hospitalizations were estimated to be associated with influenza: range = 25,819 to 70,068 per year; average annual cost = $372.3 million. Influenza A(H3N2) was associated with 73.9% of influenza-related P&I hospitalizations; influenza B with 21.3% and influenza A(H1N1) with 4.8%. CONCLUSIONS: Our estimates were consistent with the estimates of influenza-associated P&I mortality reported by CDC. Thus, we suggest that estimates of influenza-associated morbidity and costs based on virus surveillance and administrative data may be used for monitoring the impact of influenza and of intervention strategies.     

A daily process design study of attentional pain control strategies in the self-management of cancer pain.

This study investigated the use of attentional control strategies in the self-management of pain using daily process design methodology. Twenty six cancer patients with pain completed diaries 3 times daily for 10 days. Diaries incorporated measures of pain intensity, affect, coping, coping efficacy, and the novelty and predictability of pain, and participants completed a cross-sectional measure of catastrophizing. At the across-person level, focusing on pain was associated with increased negative affect, and the use of pain focusing strategies was positively correlated with experiencing pain that was novel in its location or quality. Distractions that were interesting, important and pleasant were positively correlated with positive affect, perceptions of control over pain and ability to decrease pain. Over-prediction of pain was positively correlated with catastrophizing, and negatively correlated with perceptions of control over and ability to decrease pain. The within-person analysis (ARIMA modelling) showed that catastrophizing moderated the effects of pain focusing strategies, novel pain and over-predictions of pain. Meta-analysis of the ARIMA models revealed that the within-person effects of using attentional strategies did not generalize across the sample. These findings indicated that the effects of distraction strategies are influenced by their motivational-affective significance rather than the frequency with which they are used, and provided further evidence that the threat value of pain influences the way in which people cope with their pain. Theoretical and clinical implications are discussed.     

George McBean

A study currently underway in Nepal aims to discover how quicklystandards of visual literacy can be improved by teaching severalkey clues to picture interpretation. Among non-literate populations,this could help to bring improvement to the effectiveness ofextension workers in health, and many other areas. It is notedthat research in the visual literacy field has given clear indicationsof the type of illustration most likely to be understood bypeople with limited exposure to printed materials. Such researchhas led to emphasis on a particular style of simplistic illustrationtypical of health and other development programmes in many thirdworld countries. However, it is hypothesized that increasedexposure to illustrated materials affects response. Making illustrationsmerely ‘understandable’ may not then be sufficientto challenge entrenched behaviour patterns which require morecreative and imaginative interpretations.     

Development and evaluation of NucliSens basic kit NASBA for diagnosis of parainfluenza virus infection with 'end-point' and 'real-time' detection

New methods for the detection of human parainfluenza viruses (HPIVs) were developed. These were based on nucleic acid sequence-based amplification (NASBA) and utilised the NucliSens Basic Kit. Primers and probes were selected from the haemagglutinin neuraminidase (HN) gene of HPIV1, HPIV2 and HPIV3, and from the phosphoprotein (P) of HPIV4a and -4b. Synthetic RNA, titrated control virus stocks and respiratory specimens (n=44) were utilised to evaluate performance of the assays. Detection of NASBA products was by probe hybridisation and electrochemiluminescence (ECL) ('end-point' detection) or using molecular beacons ('real-time' detection). The assays using ECL detection proved to be both sensitive and specific. Typically, less than or equal to 100 RNA copies or one TCID(50) input was detectable with no cross-reaction between the specific HPIV assays and other respiratory viruses. Results for clinical samples were concordant with those obtained by 'conventional' procedures by classical viral diagnostic methods. 'Real-time' detection utilised probes specific for either HPIV1 or HPIV3 with similar performance characteristics to the assays with 'end-point' detection. The feasibility of multiplexing targets together was confirmed using a combined HPIV1 and HPIV3 assay with good results for ECL and molecular beacon detection on control material and clinical samples.     

Effects of a Short-Term “Fat Adaptation with Carbohydrate Restoration” Diet on Metabolic Responses and Exercise Performance in Well-Trained Runners

Periodized carbohydrate availability can enhance exercise capacity, but the effects of short-term fat adaptation carbohydrate restoration (FACR) diets on metabolic responses and exercise performance in endurance athletes have not been conclusively determined. This study aimed to investigate the effect of a FACR diet on measures of resting metabolism, exercise metabolism, and exercise performance. Well-trained male runners (n = 8) completed a FACR dietary intervention (five days’ carbohydrate < 20% and fat > 60% energy, plus one-day carbohydrate ≥ 70% energy), and a control high-carbohydrate (HCHO) diet for six days (carbohydrate > 60% energy; fat < 20% energy) in a randomized crossover design. Pre- and post-intervention metabolic measures included resting metabolic rate (RMR), respiratory quotient (RQ), maximum fat oxidation rate during exercise (MFO), and maximum fat oxidation intensity (FATmax). Measures of exercise performance included maximal oxygen uptake (VO₂max), running economy (RE), and 5 km running time trial (5 km-TT). In FACR compared with HCHO, there were significant improvements in FATmax (p = 0.006) and RE (p = 0.048). There were no significant differences (p > 0.05) between FACR and HCHO in RMR, RQ, VO₂max, or 5 km-TT. Findings suggest that a short-term (six days) FACR diet may facilitate increased fat oxidation and submaximal exercise economy but does not improve 5 km-TT performance.     

Intrastriatal injection of DL-alpha-aminoadipate reduces kainate toxicity in vitro

Intrastriatal injection of the excitatory amino acid analogue DL-alpha-aminoadipate (100 micrograms in 2 microliters saline, pH 7.4) into anesthetized rats caused a significant reduction in striatal glutamine synthetase activity in the ipsilateral compared to the contralateral striatum 6 h after the injection. Striatal neurons were unaffected by this treatment, and by 24 h after the injection, glutamine synthetase activity had returned to normal. In contrast to the situation in vivo, incubation of coronal slices (which included the striatum) in vitro with DL-alpha-aminoadipate (1-3 mM) for periods of up to 1 h caused no change in glutamine synthetase activity. Increased doses of DL-alpha-aminoadipate coupled with longer incubation times led to widespread neuronal degeneration within the striatum. Preparation of coronal slices from striata which had been injected 6 h previously with DL-alpha-aminoadipate, and subsequently incubated with 300 microM kainate, showed a marked survival of some neurons particularly those ordering the injection tract. The toxicity of 500 microM N-methyl-D-aspartate in similar slices was unchanged. Conversely, co-incubation of DL-alpha-aminoadipate with excitotoxins in vitro provided protection of striatal cells against degeneration by N-methyl-D-aspartate, but not kainate. These findings suggest that, in vivo, DL-alpha-aminoadipate has a specific effect on glial cell metabolism which, in contrast to incubation of coronal slices with the compound in vitro, is not related to the amino acid antagonist properties associated with the D-isomer. Thus, the reduced toxicity of kainate observed in striatal slices following DL-alpha-aminoadipate injection in vivo may indicate a non-neuronal site of action of kainate.