Medical Advisory Groups Research Articles

Exploring church members' perceptions towards physical activity, fruits and vegetables consumption, and church's role in health promotion: implications for the development of church-based health interventions.

The study explored the perceptions of church members towards physical activity (PA), the consumption of fruits and vegetables (FV), and the church's role in health promotion prior to the development of a church-based intervention for physical activity and fruit and vegetable consumption in Lagos, Nigeria. Sixteen focus group discussions (FGD) and eleven key Informant Interviews (KII) were conducted. Eight FGDs among adults and four among the youth and the elderly church members. Key informant interviews were held among church leaders and members of the church medical advisory. Study findings were categorized under thematic headings. Based on the data analysis, several key themes were identified: the knowledge of the concept of health and common health problems, opinions of physical activity, opinions of healthy eating and fruit and vegetable consumption, types and attitudes towards existing church-based health programs and the role of the church in health promotion and church-based health programs. Within each theme, several childthemes were noted such as the challenges with fruit and vegetable consumption, biblical support for physical activity and fruit & vegetable consumption, the role of the church leaders, program sustainability and barriers to participation. The participants perceived health not only as the absence of disease but as general well-being of the body and soul. Health was also related to the ability to perform religious activities. Common health problems included a mix of communicable and non-communicable diseases. They are aware that physical activity, fruits and vegetables are essential for healthy living. The youth saw it as a means of improving their physical appearance however the elderly expressed concerns about the possibility of associated trips and falls. Overall, they viewed fruits and vegetables as healthy foods while processed western foods were perceived as unhealthy. Fruits and vegetables were seen as beneficial primarily to aid food digestion, boost immunity, improve youthfulness, aid weight control and to prevent chronic disease. The study participants agreed that the church, as an institution, has a significant role to play in promoting the health of her members. Instituted health committees embedded within existing church structures often lead church-based health-promoting activities and are imperative for sustainability. Types of health programs included health talks, screening programs for common NCDs, sport competitions, distributions of FV during church ceremonies such as harvests, Lenten seasons, Love feasts and church bazaars. Health outreaches were seen as a means of evangelism, and it was unanimously agreed that the Bible supports PA and healthy eating. Generally, the respondents had positive attitudes towards church-based health programs and they advised that future programs include the use of technology and should be integrated into existing church activities to improve participation. The participants also noted that the opinion of the church leaders influences the behaviours of church members and their support is critical in the development and implementation of church-based health programs. Church members are aware that physical activity and the consumption of fruits and vegetables are important for healthy living and expressed support for church-based health programs. They believe that the Bible supports the promotion of PA and FV consumption as healthy behaviours. Program integration, the use of technology and support of church leaders and existing church medical advisory groups are imperative for developing and sustaining church-based health programs.

Editors' Note: Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study

In “Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study,” Martino et al. followed 715 children with chronic tic disorders (CTD) for up to 16 months and found that there was no significant association between group A streptococcus (GAS) pharyngeal exposures and tic exacerbations, although group A streptococcus exposure was associated with exacerbation of ADHD symptoms. On behalf of the European Immuno-Neuropsychiatric Association Scientific and Medical Advisory Group, Ubhi et al. praised the study but pointed out that because most patients had a previous diagnosis of Tourette syndrome, making it unlikely their tics were immune-mediated, these findings should not be used to refute the existence of immune-mediated tics or extrapolated to conclude immune-mediated tics are not associated with GAS exposure. Martino agreed that CTD are distinct from pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS/PANDAS) but noted there is growing evidence that CTD may be the result of immune-mediated mechanisms triggered by genetics and environmental exposures. Martino et al. and Ubhi et al. suggested there is a need for additional investigation into the relationship between GAS exposure and ADHD symptoms. In “Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study,” Martino et al. followed 715 children with chronic tic disorders (CTD) for up to 16 months and found that there was no significant association between group A streptococcus (GAS) pharyngeal exposures and tic exacerbations, although group A streptococcus exposure was associated with exacerbation of ADHD symptoms. On behalf of the European Immuno-Neuropsychiatric Association Scientific and Medical Advisory Group, Ubhi et al. praised the study but pointed out that because most patients had a previous diagnosis of Tourette syndrome, making it unlikely their tics were immune-mediated, these findings should not be used to refute the existence of immune-mediated tics or extrapolated to conclude immune-mediated tics are not associated with GAS exposure. Martino agreed that CTD are distinct from pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS/PANDAS) but noted there is growing evidence that CTD may be the result of immune-mediated mechanisms triggered by genetics and environmental exposures. Martino et al. and Ubhi et al. suggested there is a need for additional investigation into the relationship between GAS exposure and ADHD symptoms.

Reader Response: Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study.

The European Immuno-Neuropsychiatric Association Scientific and Medical Advisory Group welcomes this study that considered associations between exposure to group A streptococcus (GAS) and chronic tic disorders.1 This well-conducted study, with a balanced discussion, found no significant association between GAS and exacerbation of tics in children with chronic tic disorders. It is important that the study population was composed mainly of patients with a previous diagnosis of Tourette syndrome (90.8%). Thus, it is likely that the vast majority did not meet the diagnostic criteria for immune-mediated conditions, such as pediatric acute-onset neuropsychiatric syndrome/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS/PANDAS), which is differentiated from Tourette syndrome by presenting with an acute onset of several neuropsychiatric symptoms that may include tics or movement disorders. The results and conclusions should not therefore be used to refute the existence of immune-mediated conditions, including PANS/PANDAS, or to imply that these conditions do not similarly have an association with GAS infection. It is also interesting that an association between exacerbation of attention-deficit/hyperactivity disorder symptoms and GAS exposure was found, which we agree should be further investigated. The value of looking for GAS immune-mediated changes in the context of acute-onset tic disorders is not delineated by this study, and we feel that point should be highlighted.

Author Response: Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study.

We are grateful to the European Immuno-Neuropsychiatric Association Scientific and Medical Advisory Group for their interest and positive comments on our study. As correctly pointed out, our study exclusively enrolled patients with an established diagnosis of chronic tic disorders, the vast majority of whom had Tourette syndrome.1 Pediatric acute-onset neuropsychiatric syndrome/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANS/PANDAS) represent a clinical spectrum that is substantially different from the clinical course and phenotype of chronic tic disorders.2 There is growing evidence supporting a direct role of immune-mediated mechanisms in the pathogenesis of chronic, neurodevelopmental disorders such as Tourette syndrome, obsessive-compulsive disorder, and ADHD.3 Genetic and early environmental exposures might prompt a very early priming of neural and immune development, which might lead to altered trajectories of maturation and, ultimately, to behavioral abnormalities and hyperactive immune-inflammatory responses.3,4 Our study focused on the role of a specific exogenous trigger (group A streptococcus) in the temporal course of core behavioral features of chronic tic disorders during early adolescence. Our results do not refute a mechanistic link between immune and neural mechanisms during early development in chronic tic disorders. At the same time, we agree that our clinical overall message applies to chronic tic disorders but not to acute-onset behavioral presentations which encompass PANS/PANDAS.

A tactical analgesic option for Durham and Cleveland police firearms medics: the journey

Background: With an ever-increasing exposure to clinical situations, predominantly trauma, firearms medics at Durham and Cleveland police forces began to consider whether an increase in their scope of practice was needed; specifically, whether they could add analgesia administration to their clinical protocols. Considerations: The request was directed to the Tactical Medical Advisory Group (TMAG). This faculty comprises a clinical lead, emergency medicine doctors, military and civilian paramedics and tactical team medic (TTM) trainers. Analgesia in general was discussed, then potential analgesic agents were considered. The faculty agreed that the analgesic agent would have: to be available to all tactical team medics at all times, so should be highly portable); a minimal regulatory and training burden; a rapid effect with minimal side effects; and no conflict with prehospital medicine practice. Implementation: A 6-hour training course in methoxyflurane (Penthrox®) with summative assessments was designed and delivered by TMAG to all TTMs over a 4-week period. The chair of the TMAG agreed to be the signatory for the prescription-only medicine document and a standard operating procedure was drawn up. Sufficient stocks of methoxyflurane were then purchased and distributed across both police forces' armed response units, together with updated patient report forms, administration documents and feedback forms completed by TTMs after incidents.

Potential Conflict of Interest and Bias in the RACGP's Smoking Cessation Guidelines: Are GPs Provided with the Best Advice on Smoking Cessation for their Patients?

Patient visits are an important opportunity for general practitioners (GPs) to discuss the risks of smoking and cessation strategies. In Australia, the guidelines on cessation published by the Royal Australian College of General Practitioners (the Guidelines) represent a key resource for GPs in this regard. The predominant message of the Guidelines is that pharmacotherapy should be recommended as first-line therapy for smokers expressing an interest in quitting. This, however, ignores established evidence about the success of unassisted quitting. Our analysis of the Guidelines identifies a number of potential conflicts of interest which may have affected the advice provided. These include extensive funding by the pharmaceutical industry of sources cited to support the recommendations, and relations between members of the Guidelines Content Advisory Group and the pharmaceutical industry. Recommendations issued by professional bodies have enormous potential impact upon public health and there is a need for the highest levels of scrutiny and transparency in their development. Information about research cited in guidelines should include funding sources, and developers should be free of obvious conflicts of interest. Smoking remains the leading preventable cause of global mortality. Concerns related to pharmaceutical industry funding of research, scientific integrity and recommendations on smoking cessation by medical advisory groups clearly have implications beyond Australia.

P5-16-03: The Breast Cancer Novela, Se Valiente…Son Tus Senos, an Innovative Tool To Educate Latina Women about Breast Cancer.

Abstract Background The Hispanic population is the fastest growing population and largest minority group in the United States. Breast cancer remains the leading cause of cancer death among latina women in part because they are more frequently diagnosed at a later stage than non-Hispanic whites. Critical information about early detection, diagnosis and treatment options is often inaccessible due to cultural and language barriers. There is a need to reach the Hispanic community in new and compelling ways. The purpose of this initiative was to reach diverse Spanish speaking communities, particularly in New York City, with information about breast health and breast cancer that was culturally-sensitive, language appropriate, scientifically and medically accurate and, most importantly, relevant to the lives of the people in the community. Methods: Latina breast cancer survivors and non-survivors from diverse Hispanic communities were identified and three 8 person focus groups, two for non-survivors and one for survivors, were organized to explore breast cancer-related issues relevant to these communities. The women's personal stories and common issues and experiences as well as medical information reviewed by a medical advisory group, formed the basis for the development of a breast cancer novela. The novela is a popular Spanish-language comic book style publication widely distributed in the Hispanic communities. The breast cancer novela used the real life stories of the women to address barriers to accessing health care and empower women in Hispanic communities. A distribution plan was developed and a curriculum created for inperson educational seminars at community organizations. Surveys prior to and following the educational intervention were conducted. Results: We distributed over 25,000 novelas in Spanish to 478 sites within New York City and to 89 other sites throughout the U.S. We printed and distributed 2500 copies of an English version of the novela at the request of health providers. Attendees at a launch event helped identify distribution sites and educational seminar venues. Peer facilitators conducted these seminars, with the novela as the primary communication tool. The content of the workshops included information about breast health, risk, early detection, myths and realities about a diagnosis, managing relationships, survivorship and resources. To date, 17 seminars have been conducted and attended by more than 330 attendees. Results of the surveys as well as detailed information describing the distribution sites of the novela and feedback we received about its impact, will be presented at SABCS Discussion: Se Valiente… Son Tus Senos, is an innovative educational tool that conveys information about breast health, breast cancer detection, diagnosis, treatment and survivorship that is personal, relevant, compelling and accessible. The breast cancer novela serves as a vehicle to change information levels and increase women's knowledge and to provide health providers with insights that enable them to treat members of Spanish-speaking communities in a culturally competent manner. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-16-03.

Driving with a forearm plaster cast: patients’ perspective

Background:Forearm plaster casts are commonly used in orthopaedic practice for the treatment of fractures of the wrist and carpal bones. A common question put by patients seeks to clarify suitability...

Should older adults be screened for dementia?

The question of whether to screen for dementia and Alzheimer’s disease (AD) has been discussed in many forums throughout the world. Generally, medical advisory groups and policy-making groups have recognized the importance of early diagnosis but have uniformly avoided making recommendations to screen at-risk populations. This presentation reflects the support for reconsidering the importance of screening individuals at risk or above a certain age. In this statement, the majority of the authors support the consideration of dementia risk factors in individuals at age 50, with routine yearly screening after 75. Other authors remain concerned that the benefits of treatments of early disease do not yet support a general screening recommendation. These statements are made to encourage progress toward the development of a consensus regarding the widespread institution of screening policy. Accordingly, members of the worldwide scientific community are invited to add their perspective by contributing short commentaries (1500 words) on this subject.

The Veterans Administration: New Missions?

Over the past 25 years the federal government has invested some $50 billion in the operating funds and capitalization of the Veterans Administration component of the health care system. It is the largest health care system under centralized management in the United States today. That it will play a significant role in the provision of health services in the years to come seems incontestable. The American Medical Association has had sharp disagreements with some of the mandated policies of the Veterans Administration over the years. With other aspects of its mission there has been the utmost cooperation. It would seem appropriate to publish inThe Journal(p 1334) the third in a series of reports of the Special Medical Advisory Group of the Veterans Administration even as the two preceding reports have been published. Although the writer did not participate in the preparation of this material, having just been appointed

Report to the Secretary of HEW From the Medical Advisory Group on Cyclamates

The Medical Advisory Group on Cyclamates appointed by Secretary Finch met on Nov 17 and 18, 1969, with representatives of the Food and Drug Administration and the National Institutes of Health to review the currently available data on the possible harmful effects of these nonnutritive sweeteners in relation to their potential benefits. The group considered the data on carcinogenic, mutagenic, teratogenic, enzymatic, osmotic, and growth effects of cyclamates and on their possible adverse influence in interaction with other drugs. After carefully reviewing the evidence currently available, the Medical Advisory Group on Cyclamates unanimously supported the secretary's prohibition of the inclusion of cyclamates in beverages for general use, and in the future processing of general purpose foods and vegetables. It recognized, however, that in the medical management of individuals with diabetes (and particularly in the case of juvenile diabetes) or patients in whom weight reduction and control are essential for health,

Report to the secretary of HEW from the medical advisory group on cyclamates

Report to the secretary of HEW from the medical advisory group on cyclamates

Veterans Administration Medical Advisory Groups

Veterans Administration Medical Advisory Groups