RESUMEN
BACKGROUND: Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. METHOD: Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. RESULTS: Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. CONCLUSIONS: Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.
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Estudios de Factibilidad , Discapacidad Intelectual , Humanos , Discapacidad Intelectual/rehabilitación , Adulto , Masculino , Femenino , Proyectos Piloto , Persona de Mediana Edad , Culinaria , Aceptación de la Atención de Salud , Educación del Paciente como Asunto/métodosRESUMEN
Aim: The aim of our study was to determine whether businesses can be identified that rank highly for their potential to improve coverage of out-of-hospital cardiac arrests (OHCAs) by automated external defibrillators (AEDs), both in public locations and private residences. Methods: The cohort comprised 10,422 non-traumatic OHCAs from 2014 to 2020 in Perth, Western Australia. We ranked 115 business brands (across 5,006 facilities) for their potential to supplement coverage by the 3,068 registered public-access AEDs in Perth, while accounting for AED access hours. Results: Registered public-access AEDs provided 100 m coverage of 23% of public-location arrests, and 4% of arrests in private residences. Of the 10 business brands ranked highest for increasing the coverage of public OHCAs, six brands were ranked in the top 10 for increased coverage of OHCAs in private residences. A public phone brand stood out clearly as the highest-ranked of all brands, with more than double the coverage-increase of the second-ranked brand. If all 115 business brands hosted AEDs with 24-7 access, 57% of OHCAs would remain without 100 m coverage for public arrests, and 92% without 100 m coverage for arrests in private residences. Conclusion: Many businesses that ranked highly for increased coverage of arrests in public locations also rank well for increasing coverage of arrests in private residences. However, even if the business landscape was highly saturated with AEDs, large gaps in coverage of OHCAs would remain, highlighting the importance of considering other modes of AED delivery in metropolitan landscapes.
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Envejecimiento/fisiología , Indicadores de Salud , Enfermedades Musculoesqueléticas/epidemiología , Anciano de 80 o más Años , Estudios de Cohortes , Inglaterra/epidemiología , Femenino , Humanos , Entrevistas como Asunto , Estudios Longitudinales , Masculino , Registros Médicos , Enfermedades Musculoesqueléticas/fisiopatología , FotograbarRESUMEN
BACKGROUND: Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favor of providing care in a variety of nonhospital settings, underpins the rationale behind care in the community. A major thrust toward community care has been the development of community mental health teams.
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Servicios Comunitarios de Salud Mental , Conducta Cooperativa , Trastornos Mentales/terapia , Grupo de Atención al Paciente , Humanos , Trastornos Mentales/epidemiología , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/terapia , Índice de Severidad de la Enfermedad , Recursos HumanosRESUMEN
Antecedentes: El cierre de asilos e instituciones para pacientes con enfermedades mentales, acompañado de las políticas gubernamentales que se centran en la reducción del número de camas hospitalarias para los pacientes con enfermedades mentales graves y que están a favor de la prestación de asistencia en una variedad de ámbitos extrahospitalarios, respalda el fundamento para la atención comunitaria. Un paso importante hacia la atención comunitaria ha sido el desarrollo de equipos comunitarios de salud mental (ECSM). Objetivos: Evaluar la efectividad de los Equipos Comunitarios de Salud Mental (ECSM) en el tratamiento de cualquier tipo de enfermedad mental grave en comparación con el tratamiento estándar de estas enfermedades sin estos equipos. (AU)
Asunto(s)
Trastorno de Personalidad Esquizoide/terapia , Centros Comunitarios de Salud Mental , Servicios Comunitarios de Salud Mental/métodos , Servicios Comunitarios de Salud Mental/provisión & distribución , Servicios Comunitarios de Salud Mental/tendencias , Salud Mental/tendenciasRESUMEN
OBJECTIVE: To assess the relationship between development in utero, assessed by birth weight, and muscle strength in young adult women as assessed by grip strength. METHODS: A total of 1563 participants aged 20-40 years in the Southampton Women's Survey had their grip strength measured during pregnancy. At recruitment to the survey the women had been asked to recall their birth weight or obtain it from their parents. For 536 women born in Southampton, birth weight was obtained from hospital records. Grip strength was related to birth weight using multiple linear regression analysis, adjusting for age, height, weight and reported physical activity. RESULTS: Grip strength increased with age, height, weight, physical activity and birth weight. In the mutually-adjusted model, grip strength increased by 1.10 kg per kilogram of birth weight (95% CI: 0.58-1.61 kg). In women with hospital birth weight data the relationship strengthened to 1.44 kg per kilogram of birth weight (95% CI: 0.50-2.38 kg). CONCLUSIONS: Grip strength in women in their twenties and thirties is at or approaching its peak. The association between grip strength and birth weight was remarkably similar to findings from other studies of women at younger and older ages. This indicates that in utero development has consequences for muscle strength throughout the life course, even allowing for the increase to peak muscle strength and then its decline as a woman ages.
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Peso al Nacer , Desarrollo Infantil , Fuerza de la Mano , Adulto , Estatura , Peso Corporal , Niño , Femenino , Humanos , Recién Nacido , Análisis de Regresión , Reino UnidoRESUMEN
BACKGROUND: Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favour of providing care in a variety of non-hospital settings, underpins the rationale behind care in the community. A major thrust towards community care has been the development of community mental health teams (CMHT). OBJECTIVES: To evaluate the effects of community mental health team (CMHT) treatment for anyone with serious mental illness compared with standard non-team management. SEARCH STRATEGY: We searched The Cochrane Schizophrenia Group Trials Register (March 2006). We manually searched the Journal of Personality Disorders, and contacted colleagues at ENMESH, ISSPD and in forensic psychiatry. SELECTION CRITERIA: We included all randomised controlled trials of CMHT management versus non-team standard care. DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed effects model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed effects model. MAIN RESULTS: CMHT management did not reveal any statistically significant difference in death by suicide and in suspicious circumstances (n=587, 3 RCTs, RR 0.49 CI 0.1 to 2.2) although overall, fewer deaths occurred in the CMHT group. We found no significant differences in the number of people leaving the studies early (n=253, 2 RCTs, RR 1.10 CI 0.7 to 1.8). Significantly fewer people in the CMHT group were not satisfied with services compared with those receiving standard care (n=87, RR 0.37 CI 0.2 to 0.8, NNT 4 CI 3 to 11). Also, hospital admission rates were significantly lower in the CMHT group (n=587, 3 RCTs, RR 0.81 CI 0.7 to 1.0, NNT 17 CI 10 to 104) compared with standard care. Admittance to accident and emergency services, contact with primary care, and contact with social services did not reveal any statistical difference between comparison groups. AUTHORS' CONCLUSIONS: Community mental health team management is not inferior to non-team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide. The evidence for CMHT based care is insubstantial considering the massive impact the drive toward community care has on patients, carers, clinicians and the community at large.
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Servicios Comunitarios de Salud Mental , Trastornos Mentales/terapia , Grupo de Atención al Paciente , Trastornos de la Personalidad/terapia , Causas de Muerte , Humanos , Trastornos Mentales/mortalidad , Trastornos de la Personalidad/mortalidad , Suicidio/estadística & datos numéricosRESUMEN
The frontal assessment battery (FAB) is a bedside test of executive function. It takes less than 10 minutes to administer and a low score indicates executive dysfunction. To determine whether the FAB could detect the more severe subcortical dementia that is a feature of PSP and differentiate it from other bradykinetic rigid syndromes, we studied 17 patients with progressive supranuclear palsy (PSP); 11 with multiple system atrophy (MSA) and 12 with Parkinson's disease (PD). We compared FAB scores with the results of more detailed tests of executive and general cognitive function.FAB scores were significantly lower in PSP than in MSA or PD (p=0.02 and p<0.001) and were also found to be significantly lower in MSA than in PD (p=0.047). We divided the study group into those with an FAB score <15 and those with an FAB score>/=5, regardless of the clinical diagnosis. While 82% of the PSP group had FAB scores of <15, such scores were recorded in only 36% of the MSA and 8% of the PD groups. The lexical fluency and motor series subscores of the FAB discriminated 70% of the PSP, MSA and PD patients. The FAB scores correlated with tests of executive function, as well as with scores on the Mattis Dementia Rating Scale, the Mini Mental State Examination and other tests of general cognitive function. A stepwise regression analysis revealed that across the groups, among the variables that correlated with FAB scores, alternating semantic fluency accounted for 80% of FAB variance.These results suggest that the FAB is a valid and easily applicable bedside test to discriminate executive dysfunction in these three frequently confused bradykinetic rigid syndromes.
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Trastornos del Conocimiento/diagnóstico , Lóbulo Frontal/fisiopatología , Rigidez Muscular/diagnóstico , Pruebas Neuropsicológicas/estadística & datos numéricos , Solución de Problemas/fisiología , Anciano , Trastornos del Conocimiento/etiología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Escala del Estado Mental/estadística & datos numéricos , Persona de Mediana Edad , Atrofia de Múltiples Sistemas/complicaciones , Rigidez Muscular/complicaciones , Examen Neurológico/métodos , Enfermedad de Parkinson/complicaciones , Estudios Prospectivos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Parálisis Supranuclear Progresiva/complicacionesRESUMEN
Low birth weight, a marker of adverse intrauterine circumstances, is known to be associated with a range of disease outcomes in later life, including coronary heart disease, hypertension, type 2 diabetes, and osteoporosis. However, it may also decrease the risk of other common conditions, most notably neoplastic disease. The authors describe the associations between birth weight, infant weight gain, and a range of mortality outcomes in the Hertfordshire Cohort. This study included 37,615 men and women born in Hertfordshire, United Kingdom, in 1911-1939; 7,916 had died by the end of 1999. For men, lower birth weight was associated with increased risk of mortality from circulatory disease (hazard ratio per standard deviation decrease in birth weight = 1.08, 95% confidence interval: 1.04, 1.11) and from accidental falls but with decreased risk of mortality from cancer (hazard ratio per standard deviation decrease in birth weight = 0.94, 95% confidence interval: 0.90, 0.98). For women, lower birth weight was associated with a significantly (p < 0.05) increased risk of mortality from circulatory and musculoskeletal disease, pneumonia, injury, and diabetes. Overall, a one-standard-deviation increase in birth weight reduced all-cause mortality risk by age 75 years by 0.86% for both men and women.
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Peso al Nacer , Enfermedades Cardiovasculares/mortalidad , Recién Nacido de Bajo Peso , Neoplasias/mortalidad , Adulto , Anciano , Enfermedades Cardiovasculares/etiología , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neoplasias/etiología , Factores de Riesgo , Aumento de PesoRESUMEN
BACKGROUND: Heavy users of psychiatric services, often defined as the population that uses the most beds, consume a large part of the resources used by the whole service, despite being relatively small in number. Any intervention that reduces heavy use is therefore likely to lead to significant savings, and enhancement of standard care using a form of intensive case management akin to assertive community treatment was thought to be a pragmatic strategy for testing in this group. METHODS: The effectiveness of enhanced community management (ECM) was compared with standard care alone in heavy users, who represented the 10% of patients with the highest number of hospital admissions and occupied bed days over the previous 6.5 years in an outer London borough. One hundred and ninety-three patients were randomly assigned to ECM or standard care and their use of services was determined after 1 and 2 years, with assessments of costs, clinical symptoms, needs, and social function made before entry into the study and after 1 and 2 years. RESULTS: Despite a 24 fold increase in community contacts in the study group, there were no significant differences between the two groups in any of the main outcome measures. Small savings on in-patient and day-hospital service costs were counterbalanced by the increased costs of outpatient and community care for the subjects assigned to ECM. Clinical outcome data derived from interviews in two-thirds of the subjects were similar in both groups. CONCLUSIONS: Providing additional intensive community focused care to a group of heavy users of psychiatric in-patient services in an outer London borough does not lead to any important clinical gains or reduced costs of psychiatric care.
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Manejo de Caso/economía , Servicios Comunitarios de Salud Mental/economía , Tiempo de Internación/economía , Readmisión del Paciente/economía , Trastornos Psicóticos/economía , Adolescente , Adulto , Control de Costos , Inglaterra , Femenino , Capacidad de Camas en Hospitales/economía , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Evaluación de Procesos y Resultados en Atención de Salud , Grupo de Atención al Paciente/economía , Trastornos Psicóticos/terapiaRESUMEN
BACKGROUND: Community mental health teams are now generally recommended for the management of severe mental illness but a comparative evaluation of their effectiveness is lacking. AIMS: To assess the benefits of community mental health team management in severe mental illness. METHOD: A systematic review was conducted of community mental health team management compared with other standard approaches. RESULTS: Community mental health team management is associated with fewer deaths by suicide and in suspicious circumstances (odds ratio=0.32, 95% Cl 0.09-1.12), less dissatisfaction with care (odds ratio=0.34, 95% Cl 0.2-0.59) and fewer drop-outs (odds ratio=0.61, 95% Cl 0.45-0.83). Duration of in-patient psychiatric treatment is shorter with community team management and costs of care are less, but there are no gains in clinical symptomatology or social functioning. CONCLUSIONS: Community mental health team management is superior to standard care in promoting greater acceptance of treatment, and may also reduce hospital admission and avoid deaths by suicide. This model of care is effective and deserves encouragement.
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Servicios Comunitarios de Salud Mental/organización & administración , Trastornos Mentales/terapia , Grupo de Atención al Paciente , Adolescente , Adulto , Anciano , Femenino , Costos de la Atención en Salud , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/mortalidad , Persona de Mediana Edad , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Resultado del TratamientoRESUMEN
We suggest that the diagnosis of mixed anxiety depression at syndromal level (i.e. both anxiety and depressive diagnoses present in the same person and given equal status) is valuable clinically and should be introduced into the formal classification of neurotic and mood disorders. Evidence is given from a systematic review that cothymia has a significantly worse outcome than either an anxiety or a depressive diagnosis alone (p < 0.0001). Long-term follow-up data in a 12-year outcome study of neurotic disorder reinforce this finding both with regard to social functioning and the clinical course of anxiety and depressive disorders; these were significantly worse (P < 0.001 and P < 0.02 respectively) in those with cothymia compared with single anxiety disorders. These outcome differences are much greater than those between anxiety and depressive disorders alone.
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Trastornos de Ansiedad/epidemiología , Trastorno Depresivo/epidemiología , Estudios Prospectivos , Terminología como Asunto , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Humanos , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
Organ-specific autoimmune diseases can be induced in rodents that do not normally spontaneously develop autoimmunity by using procedures that render the animals partially T cell deficient. Using a protocol of adult thymectomy followed by four doses of sublethal gamma irradiation, insulin-dependent diabetes can be induced in normal PVG.RT1(u) rats, an inbred congenic strain that has the same major histocompatibility complex (MHC) allotype as the spontaneously diabetic BB rat. Onset of the disease ranges from 3 to 18 weeks after the final dose of irradiation, with 98% of male and 70% of female animals becoming diabetic. This unit describes the induction of insulin-dependent diabetes in the rat. A modified protocol allows for the induction of a more severe form of the disease.
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Diabetes Mellitus Tipo 1/inmunología , Modelos Animales de Enfermedad , Depleción Linfocítica , Linfocitos T Reguladores/inmunología , Animales , Animales Congénicos , Relación Dosis-Respuesta en la Radiación , Rayos gamma/efectos adversos , Traumatismos Experimentales por Radiación/inmunología , Ratas , Ratas Mutantes , Linfocitos T Reguladores/efectos de la radiación , Timectomía/métodosRESUMEN
BACKGROUND: Closure of asylums and institutions for the mentally ill, coupled with government policies focusing on reducing the number of hospital beds for people with severe mental illness in favour of providing care in a variety of non-hospital settings underpins the rationale behind care in the community. A major thrust towards community care has been the development of community mental health teams (CMHT). OBJECTIVES: To evaluate the effects of community mental health team (CMHT) treatment for anyone with serious mental illness. SEARCH STRATEGY: Electronic searches of Biological Abstracts (1982-1997), the Cochrane Library (1998, Issue 2), EMBASE (1980-1997), MEDLINE (1966-1997), PsycLIT (1974-1997) and SCISEARCH (1997) were undertaken. The Journal of Personality Disorders was hand searched, and contact was made with colleagues at ENMESH, ISSPD and in forensic psychiatry. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials of CMHT management versus non-team standard care. DATA COLLECTION AND ANALYSIS: The selection of trials, assessment of quality and data extraction was undertaken independently and in parallel by two reviewers. Where possible the data were entered into RevMan and an intention-to-treat analysis undertaken. Tests of heterogeneity were undertaken. MAIN RESULTS: CMHT management may be associated with fewer deaths by suicide and in suspicious circumstances (OR 0.32 CI 0.09-1.12). It causes less people to be dissatisfied with their care (OR 0.34 CI 0.2-0.59) and to leave the studies early (OR 0.61 CI 0.45-0.83). No clear difference was found in admission rates, overall clinical outcomes and duration of in-patient hospital treatment, although this was partly a consequence of poorly presented data. REVIEWER'S CONCLUSIONS: Community mental health team management is not inferior to non-team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide.
Asunto(s)
Servicios Comunitarios de Salud Mental , Trastornos Mentales/terapia , Grupo de Atención al Paciente , Trastornos de la Personalidad/terapia , HumanosRESUMEN
BACKGROUND: Although there have been many changes in the diagnosis of anxiety and depressive disorders in the past 20 years there have been few comparative enquiries into the clinical outcome of greater diagnostic categories. We therefore compared the outcome of all studies which compared the outcome of specific anxiety and depressive disorders using the standard procedures of systematic review. METHOD: A Medline search was carried out of all studies comparing the outcome of anxiety and depressive disorders or mixed anxiety--depressive disorders in which information was available separately for each disorder. RESULTS: Eight studies satisfied the search criteria (all involving a period of observation of two years or greater); only one of these included randomisation of treatment and comparison between specific anxiety disorder outcome. There was a somewhat better outcome in patients with depressive disorders compared with anxiety ones, and strong evidence that both anxiety and depressive disorders singly had better outcomes than comorbid mixed disorders. CONCLUSION: Comorbid anxiety--depressive disorders have a poor outcome compared with single anxiety and depressive disorders, and there is some evidence that anxiety disorders have a worse outcome than depressive ones.
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Trastornos de Ansiedad/complicaciones , Trastorno Depresivo/complicaciones , Trastornos de Ansiedad/terapia , Trastorno Depresivo/terapia , Humanos , Pronóstico , Resultado del TratamientoRESUMEN
Purified rat CD4+ T cells were activated in vitro in the presence or absence of the glucocorticoid dexamethasone. They were then expanded in IL-2 and subsequently restimulated, this time in the absence of the hormone. The results indicate that the exposure of the cells to dexamethasone in the primary stimulation changed the cytokine synthesis induced by the secondary stimulation. The mRNA levels for IL-4, IL-10, and IL-13 were all increased by the pretreatment, whereas synthesis of IFN-gamma and TNF-alpha was diminished. Further studies in which IL-4 was used together with dexamethasone showed that the cytokine potentiated the effect of the hormone. These data suggest that the neuroendocrine system can influence the cytokine response to pathogens and autoantigens in a way that favors Th2-type reactions. There are similar implications for therapy with glucocorticoids, and these drugs may be expected to have long term immunologic effects as well as short-lived immunosuppressive ones. The production of a mouse mAb, MRC-OX81, against rat IL-4 is also described.
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Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/inmunología , Citocinas/biosíntesis , Dexametasona/farmacología , Glucocorticoides/farmacología , Células Th2/efectos de los fármacos , Células Th2/inmunología , Animales , Anticuerpos Monoclonales/biosíntesis , Secuencia de Bases , Concanavalina A/farmacología , Citocinas/genética , Cartilla de ADN/genética , Técnicas In Vitro , Interferón gamma/biosíntesis , Interferón gamma/genética , Interleucina-10/biosíntesis , Interleucina-10/genética , Interleucina-13/biosíntesis , Interleucina-13/genética , Interleucina-4/biosíntesis , Interleucina-4/genética , Activación de Linfocitos , Ratones , Datos de Secuencia Molecular , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas , Células TH1/efectos de los fármacos , Células TH1/inmunología , Factor de Necrosis Tumoral alfa/biosíntesis , Factor de Necrosis Tumoral alfa/genéticaRESUMEN
Previous experiments from this laboratory have shown that Lewis rats were protected from experimental allergic encephalomyelitis (EAE) induced by the injection of myelin basic protein (MBP) in Freund's complete adjuvant if they were treated with the encephalitogenic peptide of MBP covalently linked to mouse anti-rat immunoglobulin (Ig) D. It was suggested that this protection developed because the antibody-peptide conjugate targeted the peptide to B cells and that this mode of presentation induced a Th2-like T cell response that controlled the concomitant encephalitogenic Th1 reaction to the autoantigen. The current experiments were carried out to test this hypothesis and to examine the alternative explanation for the protective effect of the conjugate pretreatment, namely that it induced a state of nonresponsiveness in the autoantigenspecific T cells. It was shown that EAE induction was suppressed in Lewis rats when the antibody-peptide conjugate was injected intravenously 14 and 7 d before immunization with MBP in adjuvant, but that anti-MBP antibody titers were at least as high in these animals as in controls that were not pretreated with the conjugate before immunization. Lymph node cells from these pretreated animals, while proliferating in vitro to MBP as vigorously as those from controls, produced less interferon gamma and were very inferior in their ability to transfer disease after this in vitro activation. In contrast, these same lymph node cells from protected rats generated markedly increased levels of messenger RNA for interleukin (IL)-4 and IL-13. When these in vitro experiments were repeated using the encephalitogenic peptide rather than MBP as the stimulus, the proliferative response of lymph node cells from pretreated donors was less than that from controls but was still readily detectable in the majority of experiments. Furthermore, the cytokine expression induced by the peptide was similar to that elicited by whole MBP. While these results support the original hypothesis that the anti-IgD-peptide conjugate pretreatment protected rats from EAE by inducing a Th2-type cytokine response, a totally unexpected finding was that this pretreatment greatly reduced the level of leukocyte infiltration into the central nervous system. This result provides a direct explanation for the protective effect of the pretreatment, but it raises questions regarding migratory and homing patterns of leukocytes activated by different immunological stimuli.
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Autoantígenos/inmunología , Linfocitos B/inmunología , Citocinas/fisiología , Encefalomielitis Autoinmune Experimental/prevención & control , Linfocitos T/inmunología , Secuencia de Aminoácidos , Animales , Formación de Anticuerpos , Movimiento Celular , Encefalomielitis Autoinmune Experimental/inmunología , Femenino , Expresión Génica , Inmunoglobulina D/inmunología , Interleucina-13/genética , Interleucina-4/fisiología , Ganglios Linfáticos/inmunología , Activación de Linfocitos , Masculino , Datos de Secuencia Molecular , Proteína Básica de Mielina/química , Proteína Básica de Mielina/inmunología , Péptidos/inmunología , ARN Mensajero/genética , Ratas , Ratas Endogámicas Lew , Médula Espinal/inmunología , Bazo/inmunologíaRESUMEN
The delivery of humanitarian aid in wartime is difficult. However, it is essential that aid is provided in the most effective manner possible, targeted on those most in need whilst minimizing waste. Furthermore the delivery of aid should be sensitive to the future needs of the communities in conflict. This requires information on the needs of the vulnerable population. There is little experience of collecting data on the impact of war on a civilian population. The war in Bosnia disrupted surveillance of communicable disease. The local authorities were assisted by the World Health Organization in re-establishing surveillance. The data generated was valuable in planning interventions to minimise the possibility of major outbreaks of infection, reduce the impact of infectious disease and in guiding the humanitarian aid effort. The experience described suggests that public health surveillance of the civilian population in wartime is possible and useful. Besides the need for planning, the public health doctor in wartime has a role as an advocate for those suffering; this function can be carried out much more effectively if it is based on objective data collection rather than hearsay.