Knowledge of and compliance with privileged communication and child-abuse- reporting laws.

Mental health practitioners have been criticized for possessing less than adequate knowledge of their legal obligations. An exploratory survey involving 98 respondents was conducted to assess whether this criticism was justified. Results show that a significant proportion of psychologists, psychiatrists and social workers are unaware of 2 of the most basic laws that apply to their professions: the right of privileged communications and the requirement of reporting child abuse. With regard to the latter, it is shown that even among those practitioners who are aware of it, a majority still refuse to comply with it in a hypothetical case. This survey suggests that a significant proportion of mental health professionals are either ignorant of or ignore their legal obligations. The pressing need for more adequate graduate and continuing professional training in these matters is emphasized. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assay of oral vaccination of dogs against rabies in Tunisia with the vaccinal strain SADBern

The possibility of immunizing dogs orally against rabies, using SADBern, an attenuated strain, was tested on dogs in the field in Tunisia. This strain induced high neutralizing antibody titres and conferred to all vaccinated dogs total resistance against a challenge with a Maghrebian strain. However, an excretion of virus of vaccinal origin was observed in one dog, hampering the use of SADBern in dogs. Nevertheless, this work demonstrates for the first time that dogs in developing countries, especially those which are inaccessible to parenteral vaccination, could be efficiently immunized against rabies by the oral route.     

Efficacy of the first oral vaccination against fox rabies in Slovenia

Fox population reduction was the first measure undertaken to control rabies in foxes, but this proved unsuccessful. The promising results of oral immunisation of foxes against rabies in some European countries encouraged the authorization of the first rabies vaccination of foxes in the field in Slovenia, in October 1988. In the present study, intervention analysis is used to evaluate the results of this vaccination campaign. The analysis took into account the cyclic nature of fox rabies and the possible effects of variability in the fox carcass submission rate. The results confirmed the decrease in fox rabies after the launch of the vaccination campaign. The reduction was independent of both cyclic oscillations in fox rabies and variability in carcass submission rate, thus indicating a positive net effect of the vaccination.     

Short duration of neutralizing antibody titers after pre-exposure rabies vaccination with suckling mouse brain vaccine

OBJECTIVE: To determine whether a Pasteurella haemolytica A1 mutant that is unable to produce membrane lipoproteins has reduced susceptibility to complement-mediated killing, and to characterize the mutant strain. SAMPLE POPULATION: 12 sera from cattle resistant to P haemolytica challenge exposure after vaccination with P haemolytica or its antigens, or after natural exposure. PROCEDURES: Complement-mediated killing assays were performed, using wild-type and mutant strains and, as antibody source, various immune sera from cattle that were resistant to P haemolytica challenge exposure. Antibody response to whole-cell antigens produced by mutant and wild-type strains, production of outer membrane proteins and iron-regulated outer membrane proteins by the 2 strains, and growth of the 2 strains in various media were analyzed. RESULTS: Compared with wild-type P haemolytica, the lipoprotein mutant strain had increased susceptibility to bovine complement-mediated killing. Aside from the lipoproteins that are not produced by the mutant, immunoblot analysis did not reveal differences between immunoreactive antigens that are produced by the 2 strains. Some iron-regulated, outer membrane proteins, which usually are only produced by P haemolytica under iron-deficient conditions, were produced constitutively by the mutant. The mutant grew to a lower final cell density and at a lower rate under conditions likely to reflect those encountered in vivo. CONCLUSIONS: Lack of 3 membrane lipoproteins resulted in enhanced susceptibility to bovine complement-mediated killing. Site-specific mutagenesis of genes encoding P haemolytica membrane lipoproteins alters production of iron-regulated outer membrane proteins by P haemolytica. Growth characteristics of the mutant suggested that it may have reduced capacity for survival in vivo.     

Oral rabies vaccination of red foxes and golden jackals in Israel: preliminary bait evaluation

Field trials were conducted in late April to early May of 1995 and 1996 in central Israel to assess the potential for controlling rabies in red foxes (Vulpes vulpes) and golden jackals (Canis aureus) by using vaccine-laden baits. Of the bait types which were field tested, polymer fish meal baits were selected as the most suitable for both species. Fish meal baits containing tetracycline hydrochloride, an oral biomarker, were distributed by four-wheel-drive vehicle at a density of approximately 30 baits/km2 in two test areas of 35 km2. Of the animals which were trapped and euthanized seven to ten days after treatment, 65% of foxes and 56% of jackals gave positive results when tested for the biomarker. These results indicate the potential effectiveness of oral rabies vaccination of these species in Israel and possibly elsewhere in the Middle East, where rabies is a problem in wild canids.     

Postinfectious antirabic vaccination of children with duck embryo vaccine and heterologous rabies hyperimmunity serum (author's transl)

After contact with a rabies-infected rabbit, 31 Persons were submitted to complete vaccination treatment with duck embryo vaccine, comprising of injections of 1.0 ml each every fast night and two booster injections of 1.0 ml each, which were administered 10 and 20 days, respectively, after the end of the 14 days' vaccination series. After performance of intracutaneous and ophthalmic tests, 18 children received heterologous rabies immunserum (Behring) in a dose of 0.2 ml per kg of body weight before the beginning of the vaccination series. Six weeks after the start of the vaccination series neutralizing and complement-fixing antibodies (rate of conversion 100 per cent) were detected in all patients. The mean titre of neutralizing antibodies (mouse test 200 LD 50 Fixed virus, strain CVS) amounted to 1:140, that of complement-fixing antibodies to 1:41. Severe incompatibility reactions were not observed. Outpatient treatment with duck embryo vaccine therefore seems to be fully justified.     

Prevention of the spread of rabies to wildlife by oral vaccination of raccoons in Massachusetts

OBJECTIVE: To evaluate the use of bait containing rabies vaccine to create a barrier of rabies-vaccinated raccoons in Massachusetts and to determine the effectiveness of various bait distribution strategies in halting the spread of rabies. DESIGN: Prospective study. SAMPLE POPULATION: Free-ranging raccoons. PROCEDURE: Baits were distributed twice yearly in a 207-km2 (80-mi2) area in the vicinity of the Cape Cod Canal. Bait density and distribution strategy varied among 3 treatment areas. Raccoons were caught in live traps after bait distribution and anesthetized; blood samples were obtained to measure serum antibody titers to rabies virus. Vaccination rates were determined by the percentage of captured raccoons with antibody titers to rabies virus > or = 1:5. In addition, raccoons with clinical signs of illness inside the vaccination zone and adjacent areas were euthanatized and submitted for rabies testing. RESULTS: The percentage of vaccinated raccoons differed significantly among the following 3 areas with various bait densities: high-density area with uniform bait distribution (103 baits/km2 [267 baits/mi2]) = 37%; low-density area with additional targeted bait distribution (93 baits/km2 [240 baits/mi2]) = 67%; and, high-density area with additional targeted bait distribution (135 baits/km2 [350 baits/mi2]) = 77%. Nineteen animals with rabies (15 raccoons, 3 skunks, 1 cat) were reported in the area just outside of the vaccination zone, but only 1 raccoon with rabies was reported from inside the vaccination zone. CLINICAL IMPLICATIONS: In this suburban study area, an approximate vaccination rate of 63% was sufficient to halt the spread of rabies in free-ranging raccoons. Compared with uniform bait distribution, targeting raccoon habitats increased vaccination rates.     

Bats, cats, and rabies in an urban community

Bats are the primary vectors of rabies in humans in the United States. In the urban environment they generally are found within buildings where they may bite people or be attacked by cats or dogs. Given the high probability that any bat that bites a person may be rabid, antirabies prophylaxis should be administered as soon as possible after the incident. This should not be delayed pending laboratory results on the bat. Children should be taught to avoid contact with moribund bats. Cats are more likely to be involved with rabid bats than dogs, but they are less likely to be vaccinated against rabies. The occasional rabid cat in an urban community may have acquired its infection from a bat. Therefore, it is vital that communities enforce rabies vaccination for cats as well as dogs.     

Memory, awareness and learning in general anesthesia

Enough information concerning memory and other cognitive functions in total anesthesia is available in the literature. Some basic theories about neuronal mechanisms of memory and consciousness are known. An attempt trying to bridge the gap between psychological and biologic levels is the usage of anesthetics in pharmacologic tests enabling the study of their influence on awareness and memory in humans. With the help of this approach it is possible to inquire into the psychological mechanisms and to demonstrate the influence of anesthetics on them. 44 patients were included in the study, operated on in inhalation anesthesia. The effects of anesthesia on awareness, consciousness, learning and memory in our study sample were following: 1. No episode of awareness was observed during the study; 2. There was an improvement of the memory quotient (MQ) following total inhalation anesthesia (p < 0.05); 3. The pain threshold significantly decreased after anesthesia (p < 0.001); 4. There exists a learning mechanism in total anesthesia more efficient in the group of patients auditively learning pain related words (p < 0.05) comparing to the control group of patients auditively learning pain nonrelated words; 5. Statistical analysis of the number of remembered pain related words and pain nonrelated words revealed significantly higher number of words in the first group of pain related words (p < 0.001). (Tab. 3, fig. 6, Ref. 22.)     

Epidemiology of renal cell carcinoma in Connecticut, 1935-1973

Data on over 3,700 patients with renal cell carcinoma, reported to the Connecticut Tumor Registry from 1935 through 1973, were used to assess incidence, survival, and associations of risk with demographic characteristics. Incidence increased over time among men, but not among women; a birth cohort effect suggesting increasing incidence rate over time was demonstrated for men. A comparison of male and female age-specific incidence rates indicated that, in the 15- to 39-year-old age group, men were three times more likely than women to develop the disease; after age 40, renal cell carcinoma was diagnosed in men twice as often as in women. Survival probability has increased from 1940 to the present time. A high density of persons per square mile was associated with a higher-than-expected incidence. No trends in incidence according to socioeconomic status were observed.     

Evaluation of the safety, immunogenicity, and pharmacokinetic profile of a new, highly purified, heat-treated equine rabies immunoglobulin, administered either alone or in association with a purified, Vero-cell rabies vaccine

A clinical evaluation of a new, purified, heat-treated equine rabies immunoglobulin (PHT-Erig), F(ab')2 preparation, was carried out in Thailand and in the Philippines-two countries where rabies is endemic. An initial prospective, randomised, controlled trial (Study 1), compared the safety and pharmacokinetics (serum concentrations of rabies antibodies) after administration either of PHT-Erig or of a commercially-available, equine rabies immune globulin (Erig PMC). A second trial (Study 2) simulated post-exposure rabies prophylaxis by using a reference cell culture vaccine, the purified Vero-cell rabies vaccine (PVRV), administered in association with either Erig PMC or PHT-Erig. In Study 1, 27 healthy, Thai adults received a 40 IU kg(-1) dose of either Erig PMC (n = 12) or PHT-Erig (n = 15) via the intramuscular (i.m.) route; half of the dose was injected into the deltoid area and the other half into the buttocks. Serum for rabies antibody determination and F(ab')2 concentration was collected at hours (H) 0, 6 and 12, and on day (D) 2, 3, 4, 6, 8, 10, 12 and 15. Both products were safe, with no serious adverse events, and in particular, no anaphylactic reactions or serum sickness was reported. A statistical comparison of the pharmacokinetic parameters did not demonstrate bioequivalence of the two products. Nonetheless, the relative bioavailability of 93% and the similar absorption rates suggest the pharmacokinetic profiles of Erig and PHT-Erig are similar. The antibody level in either group were low throughout the 15-day study period. The geometric mean titer (GMT) values ranged from group 0.027-0.117 IU ml(-1) in the Erig group and from 0.029 to 0.072 IU ml(-1) in the PHT-Erig. There was no significant difference between the evolution of GMT values for the two groups. In Study 2, 71 healthy volunteers received 40 IU kg(-1) via the intramuscular route of either Erig PMC (n = 36) or PHT-Erig (n = 35) on D0, in association with five doses of PVRV on D0, D3, D7, D14 and D28. The safety evaluation was performed during the 28-day follow-up and serum samples for anti-rabies antibody titration were collected on D0 (before injection) D3, D7, D14 and D28. No serious reactions were reported in either group. In particular, no immediate (anaphylactic type) or delayed (serum sickness) allergic reactions were observed. Over the 28-day follow-up period, GMT profiles of the two groups were statistically equivalent. On D14, 100% of the subjects had protective antibody titers (anti-rabies antibodies > or = 0.5 IU ml(-1), which is the WHO-recommended level of seroconversion), and Erig PMC and PHT-Erig were indistinguishable according to the clinical definition chosen. On D28, the GMT values were 33.2 IU ml(-1) (95% CI, 23.8-46.1 IU ml(-1)) in the Erig PMC/PVRV group and 31.4 IU ml(-1) (95% confidence interval, CI, 23.4-42.2 IU ml(-1)) in the PHT-Erig/PVRV group, showing evidence of adequate vaccine-induced antibody responses in both groups. The increased purity, the heat-treatment step introduced in the manufacturing process of PHT-Erig, and the good clinical results substantiate the use of this new generation, purified equine F(ab')2 preparation in the post-exposure prophylaxis of rabies.     

Pathogenicity of different rabies virus variants inversely correlates with apoptosis and rabies virus glycoprotein expression in infected primary neuron cultures

The mouse-adapted rabies virus strain CVS-24 has stable variants, CVS-B2c and CVS-N2c, which differ greatly in their pathogenicity for normal adult mice and in their ability to infect nonneuronal cells. The glycoprotein (G protein), which has previously been implicated in rabies virus pathogenicity, shows substantial structural differences between these variants. Although prior studies have identified antigenic site III of the G protein as the major pathogenicity determinant, CVS-B2c and CVS-N2c do not vary at this site. The possibility that pathogenicity is inversely related to G protein expression levels is suggested by the finding that CVS-B2c, the less pathogenic variant, expresses at least fourfold-higher levels of G protein than CVS-N2c in infected neurons. Although there is some difference between CVS-B2c- and CVS-N2c-infected neurons in G protein mRNA expression levels, the differential expression of G protein appears to be largely determined by posttranslational mechanisms that affect G protein stability. Pulse-chase experiments indicated that the G protein of CVS-B2c is degraded more slowly than that of CVS-N2c. The accumulation of G protein correlated with the induction of programmed cell death in CVS-B2c-infected neurons. The extent of apoptosis was considerably lower in CVS-N2c-infected neurons, where G protein expression was minimal. While nucleoprotein (N protein) expression levels were similar in neurons infected with either variant, the transport of N protein into neuronal processes was strongly inhibited in CVS-B2c-infected cells. Thus, downregulation of G protein expression in neuronal cells evidently contributes to rabies virus pathogenesis by preventing apoptosis and the apparently associated failure of the axonal transport of N protein.     

Time, awareness, and order of presentation in opinion change.

Primacy-recency was investigated as a function of time interval interpolated between the presentation of the opposing arguments and of the level of awareness of the manipulatory intent of the experimenter. Utilizing the pretest—experimental treatment—posttest design, 210 Ss were made differentially aware of the manipulatory intent of the experimenter. Half of the Ss were read the opposing arguments in immediate succession while the other half had a 2-week time interval interpolated between the argument presentations. Results indicated that those Ss who were unaware of manipulatory intent yielded a significant recency effect. Recency was minimized with those Ss who were made differentially aware of manipulatory intent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors determining compliance with tuberculosis treatment in an urban environment, Tamatave, Madagascar

SETTING: Patient compliance remains one of the main obstacles that need to be overcome by tuberculosis control programmes, in the developing world as well as in industrialised countries. A better understanding of the various factors accounting for treatment default could help to achieve better compliance from patients. OBJECTIVES: To increase the understanding of the determining factors of default in an urban environment where medical facilities are accessible. Different kinds of determinants were studied: objective socio-demographic factors, subjective psychological factors, attitudes and behaviour of patients in relation to chemotherapy, quality of relationships with the medical staff, knowledge and attitudes regarding tuberculosis. DESIGN: Risk factors for default were assessed by a retrospective case-control study in a sample of 38 patients who had not completed treatment for pulmonary tuberculosis, compared with 111 controls who had completed treatment under comparable conditions. RESULTS: Default appears to be significantly linked to transportation time, the sex of the patient, patient information and the quality of communication between patients and health workers. False addresses given by patients are both a methodological bias and a risk factor for future default. CONCLUSION: Improved communication skills and attention from the medical staff could encourage more patients to complete their TB treatment.     

Time trend of female breast carcinoma in situ by race and histology in Connecticut, USA

BACKGROUND: Surgical procedures used to remove genital warts (cryotherapy, electrodesiccation) are painful. Attempts to reduce the discomfort of surgery by prior lidocaine infiltration anesthesia are compromised by the pain of the infiltration. OBJECTIVE: Our purpose was to determine the efficacy of topically applied lidocaine/prilocaine cream to reduce the pain of lidocaine infiltration and the pain associated with cryotherapy to remove genital warts. METHODS: Men, scheduled for removal of genital warts by cryotherapy, were randomly selected to receive one of three treatments: (1) lidocaine/prilocaine cream application, (2) 1% lidocaine infiltration, and (3) lidocaine/prilocaine cream application followed by infiltration of 1% lidocaine. RESULTS: Application of lidocaine/prilocaine cream for 15 minutes markedly reduced the pain of lidocaine infiltration. The combination of lidocaine/prilocaine cream followed by infiltration of 1% lidocaine gave greater pain relief from the cryotherapy than did either anesthetic alone. CONCLUSION: The application of lidocaine/prilocaine cream as an adjunct to lidocaine infiltration reduced the pain of infiltration and the pain associated with cryotherapy for the removal of genital warts.     

Infection with T-lymphotropic virus in Dutch blood donors, 1993-1996]

Infection with human T-lymphotrophic virus (HTLV) type 1 causes a neurological disorder or leukaemia in a minority of infected persons. Since January 1993 the Dutch blood banks screen each donation for presence of HTLV-1 infection. Approximately 4,000,000 donations from 700,000 donors have been tested. The numbers of confirmed HTLV-1 positive donors were: 1993: 15; 1994: 6; 1995: 8; 1996: 3. In 1995 one case of HTLV-2 infection was detected as well. In 26/32 (81%) of the HTLV-1 positive cases either the donor or his/her partner originated from HTLV-1 endemic areas. The introduction of HTLV screening prevents the silent spread of HTLV via blood transfusion.