Objective. To identify the differential diagnostic difficulties in acute abdominal pain at the emergency department and during hospitalization. Material andmethods. Patients with abdominal pain ...lasting for up to 7 days were registered during 1997-2000 and re-evaluated one year after discharge (n=2851). Results. Diagnoses with low sensitivity at the emergency department but markedly increased sensitivity at discharge were non-specific abdominal pain with a sensitivity value at the emergency department of 0.43, appendicitis 0.80, gallstones 0.68, constipation 0.74 and peptic ulcer 0.26. Corresponding -values were 0.48, 0.74, 0.84, 0.88 and 0.93, respectively. Malignancy, gynaecological complaints, dyspepsia, urinary tract infection and diverticulitis displayed fairly good concordance between the preliminary and discharge judgements, but the predictive diagnostic value was still low at discharge. Sensitivity values at discharge were 0.40, 0.75, 0.73, 0.77 and 0.83, respectively. Among 479 surgically treated patients, 104 initially received a diagnosis usually not requiring surgery and had a median delay until operation of 22 h (95% CI 30-50 h), compared with 8 h (12-18 h) for referrals. Conclusions. Non-specific abdominal pain is the main differential diagnostic problem in the emergency department also for diagnoses requiring surgery. Constipation is a diagnostic pitfall and when making this diagnosis a careful re-evaluation is necessary.
Background
It has previously been reported that weak serum IgG but elevated IgA antibody responses against H. pylori may be associated with risk of gastric cancer (GC) development. To search for ...potential immunologic markers for GC, we analyzed antibody responses against H. pylori in risk groups of cancer development.
Material and Methods
Sera and stomach biopsies collected from H. pylori‐infected GC patients as well as from patients with gastric ulcer (GU), atrophic gastritis, intestinal metaplasia (IM) and duodenal ulcer and from H. pylori‐infected control subjects without atrophy or IM, and in addition from H. pylori‐negative subjects were analyzed for IgG and IgA antibodies against three different H. pylori antigen preparations, that is, membrane protein (MP), urease, and CagA.
Results
We observed an increased serum IgA/IgG titer ratio against H. pylori anti‐MP in GC and GU patients, and against CagA in Hp‐infected GC patients and risk groups. Female patients with GC had a higher serum anti‐MP IgA/IgG titer ratio and a higher proportion of poorly differentiated cancer compared with male patients. As earlier observed, the non‐tumorous mucosa of H. pylori‐infected GC patients contained considerably lower levels of total IgA and H. pylori‐specific IgA compared with H. pylori‐infected controls. Similarly, we observed decreased specific mucosal anti‐MP IgA response in patients with IM.
Conclusion
We observed several differences in local and systemic immunologic responses against H. pylori in H. pylori‐infected GC patients and putative GC risk group patients compared with H. pylori‐infected controls. These findings may be of importance in efforts to identify risk groups of GC or early stages of GC.
Under det senaste decenniet har idéburna offentliga partnerskap (IOP) – ett ramverk för samverkan mellan kommuner och idéburna organisationer – blivit ett allt vanligare sätt att tillhandahålla ...välfärdsinsatser. Ett område där samverkansformen användes tidigt var i arbetet med så kallade utsatta EU/EESmedborgare. Här har IOP inneburit en tredje väg mellan en generös respektive restriktiv tolkning av målgruppens rättigheter. Syftet med denna artikel är att genom djupintervjuer med representanter för idéburna organisationer belysa ett fält av problematiker som uppstår genom lokala IOP. Artikeln bygger på fallbeskrivningar av IOP i tre kommuner – Göteborg, Lund och Malmö. Utifrån dessa argumenterar vi för att ramverket medför en påtaglig volatilitet som påverkar den idéburna partens handlingsutrymme: IOP-formen etablerar en oförmedlad konjunkturkänslighet för socialt arbete som är direkt beroende av lokala maktförhållanden och händelseutvecklingar.
Over the last decade, IOPs – a framework for collaboration between municipalities and NGOs – have become a common way of organizing certain welfare services. One area where this institutional arrangement was used early on was in relation to EU/EEA citizens without right of residence. Here, IOPs have provided a “third-way” between a generous and restrictive interpretation of the target group’s social rights. The purpose of this article is to highlight, through interviews with representatives of NGOs, a field of problems related to IOPs. The article is based on case descriptions of IOPs in three municipalities - Gothenburg, Lund and Malmö. Based on these, we argue that IOPs entail a significant volatility in that IOP form establishes a precarious institutional status for certain forms of social work, making these increasingly dependent on local power relations and developments.
Snakebites are a public health problem in Nicaragua: it is a tropical developing country, venomous snakes are present and there are reports of snakebites treated both in the formal and informal ...health care system. We aimed to produce an incidence map using data reported by the health care system that would be used to allocate resources. However, this map may suffer from case detection bias and decisions based on this map will neglect snakebite victims who do not receive healthcare. To avoid this error, we try to identify where underreporting is likely based on available information.
The Nicaraguan municipalities are categorized by precipitation, altitude and geographical location into regions of assumed homogenous snake prevalence. Socio-economic and healthcare variables hypothesized to be related to underreporting of snakebites are aggregated into an index. The environmental region variable, the underreporting index and three demographic variables (rurality, sex and age distribution) are entered in a Poisson regression model of municipality-level snakebite incidence. In this model, the underreporting index is non-linearly associated with snakebite incidence, a finding we attribute to underreporting in the most deprived municipalities. The municipalities with the worst scoring on the underreporting index and those with combined low reported incidence and large rural population are identified as likely underreporting. 3,286 snakebite cases were reported in 2005-2009, corresponding to a 5-year incidence of 56 bites per 100,000 inhabitants (municipality range: 0-600 cases per 100,000 inhabitants).
Using publicly available data, we identified areas likely to be underreporting snakebites and highlighted these areas instead of leaving them "white" on the incidence map. The effects of the case detection bias on the distribution of resources against snakebites could decrease. Although not yet verified empirically, our study provides an example of how snake bite epidemiology may be investigated in similar settings worldwide at a low cost.
In this paper, I approach the political and philosophical similarities and differences between late eighteenth-century thinkers John Thelwall and William Godwin from the point of view of their ...respective choices for the genre of political communication. I approach their thought and its expression by weaving an interpretation of what they were saying with a reflection on how and to whom they were speaking. This, I contend, helps us clarify further the thought of each thinker and track the changes in their conception of equality in the framework of political communication. As the 1790s unfolded, both thinkers, I argue, tried to diversify their audience, be generally more inclusive, and re-think the hierarchies of relationship between authors/speakers and their audience in their political communication. Nevertheless, they did so asymmetrically and in different ways: Thelwall quickly started tapping into popular culture, especially oral culture, while Godwin chose the modes of fiction and the conversational essay. By making these choices, both authors enacted a different understanding and practice of political education, and political equality.
Background: We have previously demonstrated that Helicobacter pylori infection is associated with an increased number of CD4+CD25high regulatory T cells in the gastric and duodenal mucosa. In this ...study, we determined the number and localization of CD4+ cells expressing the regulatory T‐cell‐specific transcription factor FOXP3 in the antrum and duodenum of duodenal ulcer patients, asymptomatic carriers, and uninfected individuals. We also determined gene expression levels of FOXP3 as well as anti‐ and proinflammatory cytokines before and after H. pylori eradication.
Methods: Cellular FOXP3 expression was studied by immunofluorescence and flow cytometry, and transcription levels of FOXP3, interleukin (IL)‐10, transforming growth factor‐β, CD4, and interferon‐γ were analyzed by real‐time reverse transcription‐polymerase chain reaction.
Results: We found an increased (6‐fold) frequency of CD4+FOXP3+ T cells in H. pylori‐infected gastric mucosa; interestingly 26% of these cells did not co‐express CD25. The increase of FOXP3‐expressing T cells in the antrum of infected individuals was dependent on the presence of H. pylori, since eradication therapy resulted in 4‐fold lower levels of FOXP3 and IL‐10 mRNA in the antrum. Furthermore, higher numbers of CD4+FOXP3+ T cells were found in areas of duodenal gastric metaplasia in the duodenum of duodenal ulcer patients compared to duodenal gastric metaplasia of asymptomatic individuals and healthy mucosa in both patient groups. In duodenal ulcer patients, the CD4+FOXP3+ T cells were more highly associated to aggregates in the duodenal mucosa.
Conclusion: The numbers of CD4+FOXP3+ T cells are increased and localized in CD4+ T‐cell aggregates in areas of duodenal gastric metaplasia in duodenal ulcer patients.
Helicobacter pylori has been implicated as a possible etiologic factor in gastric cancer. This case control study was performed to determine the association between H. pylori and gastric cancer, ...taking into account the possibility of confounding by other background factors.
Sera were collected from 112 incident case patients with gastric cancer and 103 control patients with nongastroenterological diseases, who were frequency-matched with respect to age and sex. Immunoglobulin G antibodies to H. pylori were identified using the HM-CAP immunoassay (Enteric Products Inc., Wesbury, NY).
The prevalence of H. pylori seropositivity was significantly higher (P = 0.002) among case patients than control patients. The odds ratio (OR) was 2.60 (95% confidence interval, 1.35-5.02). The increased OR associated with H. pylori infection was confined to tumors with a noncardia location (OR, 3.06) and men (OR, 4.27). OR increased with decreasing age at cancer diagnosis to reach 9.33 in patients < 60 years of age. Multivariate logistic regression analysis was used as control for potential confounding, but the elevated OR associated with H. pylori infection remained significantly increased.
The results support the hypothesis of H. pylori infection as an independent risk indicator of gastric cancer.
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