Electrophoretic protein typing of Campylobacter jejuni subspecies ≪ Doylei ≫ (nitrate-negative campylobacter-like organisms) from human faeces and gastric mucosa

Twenty-seven strains comprising 23 clinical isolates of nitrate negative campylobacters (NNC) from Australia, South Africa, the United Kingdom and the Federal Republic of Germany, a representative of the CNW (catalase negative/weak) group and reference strains of three other Campylobacter species, were ckaracterized by one-dimensional SDS-polyacrylamide gel electrophoresis of cellular proteins. The protein patterns were highly reproducible, and were used as the basis for a numerical analysis which showed that the reference strain (NCTC 11951) of Campylobacter jejuni subspecies doylei , and 20 NNC isolates formed a distinct group at the 74% similarity level. The protein patterns showed unexpectedly low similarity between subspecies doylei and the type strain of Campylobacter jejuni and revealed that some NNC strains were quite distinct from subspecies doylei . Four electrophoresic (EP) types (I–IV) were identified from phenons formed at the 81% similarity level. Three of these (I, III, IV) corresponded to geographical location of strain isolation but the type II strains were from diverse locations. The correlation observed between EP-type, catalase production and sensitivity to 2, 3, 5, triphenyltetrazolium chloride indicated these latter two tests might be useful for biotyping within the subspecies.     

Bladder cancer and the consumption of alcoholic beverages in Spain

The relationship between bladder cancer and alcohol consumption was investigated in a case-control study conducted in 546 patients (453 males and 53 females) with diagnoses of papillary urothelial carcinoma during 1978–1982 at La Paz hospital (Madrid), and an equal number of controls matched for age, sex and date of admission to the hospital. The results showed that the risk of bladder cancer does not increase with the intake of beer, wine and spirit beverages. However, a high risk of bladder cancer was associated with consumption of wine mixed with gaseosa (a refreshment beverage consisiting of carbonated water plus artificial sweeteners).     

Study of endemic scrapie in a flock of ≪ ile de France≫ sheep

An Ile de France flock was studied over a period of 5 years. The authors found similar results concerning incidence and age of onset of scrapie to those found in the English literature. A close relationship was established between the age of the dam at parturition and the age of the progeny at onset of scrapie. In the later years of our study, scrapie was detected in younger animals than in the earlier years, suggesting a phenomenon of genetic anticipation . Increased fecundity in this endemically affected flock might represent a form of selection which favorises the occurrence and maintenance of the disease within the flock.Corresponding author.     

Quantification of risk factors in Hospital infection at a surgical service

In this paper we have analyzed several risk factors for developing nosocomial infections at a Surgical Service of the Hospital Clinico Universitario San Cecilio 2>, based on a retrospective follow-up program designed specifically for this study. Of all patients admitted to the Service from January 1 to June 17, 1987, we examined the following variables: age, sex, cause of admission, emergency or non-emergency admission, operation and related variables. The overall rate of nosocomial infections was 16.46%. The most significant risk factors we found were operation , which had a linear correlation coefficient of '0.929 (p < 0.01) with hospital infection when stratified by its lenght, advanced age ( >60 years old), especially in non-operated patients, and chemoprophylaxis. Such risk factors were ascertained taking into account the confounding effect produced by the variables studied in this survey.Corresponding author.     

A survey on factors affecting acceptance of measles vaccine

The reasons for the low level of acceptance of measles vaccine were investigated through interviews with the mothers at the time of their children enrollment in the first year of attendance at several nursery schools in Milan city and its suburbs. Data were also collected on the natural disease.Only 192 (13.8%) of the 1386 children included in the study had already suffered natural measles and 45 of them before the age of 12 months. Of the total, 10% of the children had been vaccinated, more in the city of Milan than in the suburbs. Approximately one-half of the vaccinations had been administered by family doctors and the other half in Public Health facilities. Less than half of the vaccinations administered in the city of Milan proved to have been registered in Public Health Office records. The frequency of vaccinated children was significantly higher among mothers with higher levels of education than among those with lower levels of education.The reasons for the lack of vaccination most. frequently given by the mothers of the 1247 unvaccinated children were ignorance about the vaccine (38% of the mothers) and the belief that measles is an innocuous disease (36%). These were followed by fear of post-vaccinal reactions and advice against measles vaccine given, in most cases, by family doctors. The frequency of responses for each one of these reasons was significantly different in Milan with respect to the suburbs. This difference was also evident in the comparisons between mothers with higher levels of education with respect to mothers with low levels of education.Corresponding author.     

Epidemiological diagnosis of asthma: Methodological considerations of prevalence evaluation

Within an epidemiological survey on Chronic Obstructive Pulmonary Disease, before reporting data on the prevalence of bronchial asthma we checked the group of subjects defined as pathological by means of a suitable questionnaire and a group of normals as a control.We evaluated the sensitivity and specificity of the questionnaire, in comparison with a clinical evaluation made by two physicians and controlled the relationship among their results, non-specific bronchial hyperreactivity and skin tests. In particular the correspondence between diagnosis made by physicians from a clinical evaluation and that obtained by questionnaire was not satisfactory.We suggest the importance of employing physicians for an epidemiological approach to asthma, in absence of a valid objective criterion.Corresponding author.     

Molecular epidemiology of human rotavirus infections

Recognition of rotaviruses as a major aetiological agent of acute gastroenteritis in infants and young children has prompted the investigation of their epidemiology by molecular techniques. Genome analysis by electrophoretic separation of the RNA segments has been widely used to distinguish virus isolates and to monitor patterns of virus transmission. Examination of virus isolates from different epidemics has clearly demonstrated the existance of extensive genomic variation in viruses circulating in large communities; with the co-circulation of a number of viruses of differing electrophoretype. Preliminary studies using the more advanced techniques of oligonucleotide mapping and hybridization analysis have suggested that variation among the viruses may occur by processes involving both drift and shift . Because of their ease and specificity the new hybridization analysis techniques should greatly facilitate both the rapid diagnosis of rotavirus infections, and the solution of many epidemiological and evolutionary questions. Continued and expanded use of molecular techniques for the study of the epidemiology of rotavirus infections will be required to manage future outbreaks and to effect long term control measures.     

Paralytic poliomyelitis in Italy (1981–85)

Fifteen cases of presumptive poliomyelitis occurring in Italy between 1981–85 were studied in order to differentiate between paralysis caused by poliovirus and that of different etiology. Out of seven confirmed cases three were temporally associated with vaccination .Three aspects are discussed: i) the need for a careful differential diagnosis of paralytic cases; ii) the overconcern about the problem of vaccine-associated cases: iii) the risk connected with re-importation of wild poliovirus strains.     

The role of surgery in transmitting ≪ post-transfusion hepatitis ≫

The role of surgery as an additional risk in transmitting post-transfusion hepatitis was investigated in a retrospective study on acute hepatitis occurring in 77 transfused patients, 293 transfused and operated patients and 243 hepatitis cases with history of surgery without transfusion.Hepatitis A patients admitted to the same centres in the same period were utilized as controls. In transfused patients the percentage of NANB hepatitis was higher than that of type B (61.0% vs. 36.4%), while in the operated not transfused group the percentage of type B was twice that of type NANB (63.4% vs. 32.5%).In transfused and operated cases intermediate values were observed. The age-adjusted measures of association between exposures and the different hepatitis types showed a lack of effect of transfusion and a dominant role of surgery in transmitting type B hepatitis. In contrast, NANB post-transfusional cases were actually a mixture of post-transfusional and post-surgical cases, since both these exposures were found to be significantly associated with the disease.Our results suggest that studies on the incidence and the etiology of post-transfusion hepatitis should take into account the risk of surgical exposure which might have occurred.Corresponding author.     

Cluster analysis of antibiotic susceptibility patterns of clinical isolates as a tool in nosocomial infection surveillance

Hospital infections represent a major epidemiological problem. The first step in the detection of nosocomial infections consists in assessing the probability that two or more isolates from different patients are similar or different. Many methods are available for typing purposes. Among these, antibiotic susceptibility patterns do not need extra cost or extra work and are available on line every moment they are needed. A mathematical technique of elaboration is proposed for disk zone sizes, in order to assess the probability of two or more clinical isolates to be the same strain. Antibiograms performed according to Kirby-Bauer are evaluated detecting zone sizes by a computer controlled device and then submitted to cluster analysis. Similarity of strains is reported in a dendrogram, in which strains are successively fused. Strains that share a common susceptibility pattern are considered a cluster . At last, epidemiological maps are constructed for each group of strains, in which all the isolates are reported, ordered for patients, plotted on the day the specimen was collected, drawn in a different shape according to the source of specimen, and shadowed by the pattern of its cluster. This method of reporting data directly allows to detect cross infections among patients and can be used as a first typing step before other more expensive procedures.Corresponding author.     

Risk factors for A.I.D.S. among homosexual men in France

To identify risk factors for A.I.D.S. among homosexual men in France, a highrisk group in a moderate-incidence area, we undertook a case-control study in Paris and its suburbs. Fifty-three cases were compared to 99 controls from a venereal disease clinic and 79 controls from the staff of an amateur gay broadcasting station.In our univariate analysis, cases were more likely than controls to belong to upper socio-economical classes, to have used local corticosteroids, to have regularly inhaled nitrites, to report history of syphilis and of herpes infections, to have higher level of promiscuity with occasional partners ( one night stands ), and to have had sexual encounters in the U.S.A.. In the multivariate analysis, history of syphilis and promiscuity with occasional partners appeared to be the main risk factors, as well as the use of local corticosteroids, especially during the prodrome period.The correlation between promiscuity and disease risk was weak in our study when we did not discriminate between occasional and regular sex partners, contrary to that found in epidemiological studies of A.I.D.S. and H.,I.V.-seropositivity in high,incidence areas. In association with the history of syphilis, the development of the syndrome in our moderate-incidence country is more correlated to the contact with one-night-stand partners rather than to the total number of the sex partners. The public health policies in our area should be adapted to these findings. Otherwise they may be less efficient than hoped.     

Young adult mortality as an index: Associations with income and social indicators

In an effort to find an indicator for use in studies of the epidemiological impact of drug abuse in California in the late 1960s, we recognized that, for comparative analyses, cause specific mortality was less attractive than total mortality of the population group principally affected, young adults. This paper examines the all cause mortality; and its major components for young adults, age 15–24, (Young Adult Mortality, YAM) for the U.S. as it varied over time and for various countries in relation with income and social indicators. Between 1961 and 1969 in the United States a striking overall increase occurred (40.6%) with motor vehicle accidents a dominant cause which neither accounted for, all the increase, nor for the racial gradients. Male rates are higher than female rates. In the U.K. a steep and persistent social class gradient has been shown. Comparative studies done among countries whose vital statistics are reported to the World Health Organization, were analyzed in relation to international social and economic indicators. Countries with a Per Capita Income (GNP/person) below $3,000 show a striking increase in mortality from diseases with decreasing income, but above $3000 GNP/person environmental (non-disease) causes of death begin to increase, so that total mortality increases with increasing incomes. Two distinct groups of industrialized countries can be identified, seven with low mortality, and ten with high mortality. Per capita expenditure on education and ethnic homogeneity appear to be the social indicators which best discriminate between these two groups of countries.     

Production of serum-opacity factor by Streptococcus pyogenes strains isolated from pharyngitis in children prevalence of ≪rheumatogenic≫ M types among of-negative strains

Two hundred ten S. pyogenes strains isolated in 1979, 1980 and 1984 from children with pharyngitis were here examined for properties which might be relevant to their rheumatogenic potential. Strains were first tested for the production of streptococcal serum-opacity factor and, among those scored as OF-negative, the presence was then verified of M types which have been epidemiologically related to rheumatic fever. Members of rheumatogenic M types are present among strains causing pharyngitis in children; which, however, also include a considerable proportion of OF-positive, probably non-rheumatogenic, strains. The results are discussed in the light of the low incidence of rheumatic fever in this country.     

Current evaluation of the contribution of self-examination to secondary prevention of breast cancer

The state of art in the problem of BSE and its role in breast cancer early diagnoses in analysed. Advantages and disadvantages of this method and a complex of socio-psychologic problems arising in healthy population due to its introduction are discussed. The absence of scientifically grounded data on the importance of BSE for early diagnosis of breast cancer suggests the necessity of further investigations in order to identify its efficacy. Such data can be obtained only on the basis of randomized population study with estimation of efficacy by the decrease of breast cancer mortality in population. Under the auspices of the WHO such investigation has been conducted in Leningrad and in Moscow (USSR). Methods or investigation applied are described in short.     

Von Amerika lernen?-Managed Health Care, Erfahrungen bei der Eind?mmung der Gesundheitskosten am Beispiel von Medicaid in Massachusetts, USA

Zusammenfassung Die Implementierung wettbewerbsbasierter Verfahren zur medizinischen Leistungserbringung in den USA hat unter der Bezeichnung Managed Health Care (MHC) ein Bündel von Kontrollmassnahmen entstehen lassen, deren Ansatz, Ziel und Auswirkungen in Hinblick auf das verhalten der Anbieter und Anspruchsberechtigten an einem Beispiel dargestellt wird.

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Summary Managed Health Care is characterized by a number of different control mechanisms aiming at cost containment in health care delivery. The means and consequences of its application are discussed using the approach of the state of Massachusetts to improve care delivery for Medicaid eligibles as an example and problems unsolved are specified.

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Résumé Managed Health Care est une stratégie visant la réduction des coûts médicaux, implantée dans le cadre du programme Medicaid du Massachusetts. Les principes de cette stratégie, basée sur la concurrence entre prestateurs médicaux, sont décrits, analysés et discutés.

     

The Intendedness of Pregnancy: A Concept in Transition

Background: Although interest in the intendedness or the planning status of a pregnancy goes back many centuries, it is only since 1941 that questions about these issues have been asked systematically in large-scale surveys. More recently, questions about intendedness have become standard features of the National Survey of Family Growth and of the Pregnancy Risk Assessment Monitoring System (PRAMS). Interest in and concern about the large numbers of unintended pregnancies reported in those surveys resulted in an Institute of Medicine report on the subject and the inclusion of a national health objective for increasing the proportion of pregnancies that are intended in Healthy People 2000 and Healthy People 2010. Needs: The terms, intended, unintended, mistimed, wanted, unwanted, and planned are often used without significant attention being paid to their meaning or how they are derived from survey questions. There is a particular need to distinguish between terms that define attitudes and those that define behaviors. In addition, research has revealed that women are often happy despite experiencing an unintended pregnancy and that contraceptive failures do not always result in a report of an unintended pregnancy. Objectives: Researchers have begun to ask questions about the meaning of the intendedness concept and its relationship to what women express as their feelings about pregnancies and births. This article, and this entire issue, is an attempt to make the reader aware of the current issues in this area and to suggest additional research that is needed to enable policy makers and program planners to design programs that will better assist couples in meeting their fertility goals.     

Accidents in the school environment in Milan,a five year survey

Data regarding 11,541 cases of school accidents (from kindergarten to senior high school) that required hospital attention for treatment were examined. The information was obtained from the records of the a School Medicine Service of the City of Milan , and covered five school years (from 1980–81 to 1984–85). The surveyed population included over 160,000 subjects for each year. After computer processing, data regarding type of school, year, age of the victim, place of the accident and type of lesions were obtained.The frequency of accidents was highest (about 2%) among kindergarten pupils, while in senior high school the lowest frequency (less than 1 %) was accompanied by the greatest percentage of hospitalizations (about 6%). From our results it appears that most accidents occur in school gyms (around 50%), and that the percentage of sprains and fractures is also highest in this area. School gyms can therefore be considered as a primary target for any prevention activity.Corresponding author.     

The Cultural Dimension in Childhood

This article emphasizes the fact that culture surrounds and influences the young people in child and youth care programs all the time, and that child and youth care workers must become cultural mediators for the culturally undernourished when assisting youth in care. This work must add to psychological pedagogics and social pedagogics a third new dimension, cultural pedagogics. Through raising and answering a series of six questions concerning culture, the author hopes to stimulate better practice and educational training in the cultural preparation of young people receiving child care services.     

Comparative disappearance of dioxathion,malathion, oxydemetonmethyl and dialifor from Florida citrus leaf and fruit surfaces

Surface residue disappearance rates of dioxathion, malathion, oxydemetonmethyl, and dialifor were the same for fruit and leaves, and they increase with temperature. Disappearance rates were in the order of malathion Oxydemetonmethyl dialifor dioxathion. Malaoxon was present in relatively constant amounts under dry, cool, clear conditions but was not detected under wet, hot, cloudy conditions.Florida Agricultural Experiment Stations Journal Series No. 2098.     

In vitro susceptibility of mycelial and yeast forms of Penicillium marneffei to amphotericin B,fluconazole, 5-fluorocytosine and itraconazole

The mycelial (25°C) and yeast-like (37°C) forms of Penicillium marneffei clinical and type strains were investigated for their in vitro susceptibility to amphotericin B (AmB), 5-fluorocytosine (5-FC), fluconazole (FLU) and itraconazole (ITZ), using Bacto antibiotic medium 3, yeast-nitrogen, Sabouraud's dextrose (pH 5.7) and high resolution (pH 7.1) broth media (1ml/tube), respectively. Results indicated that the minimal inhibitory and minimal fungicidal concentrations (MICs and MFCs) for the mycelial cultures of P. marneffei to AmB were in the range 0.78–1.56 and 0.78–3.125 g/ml, respectively, as against 3.125–25 g (MICs) for the yeast form cultures. The MFCs to AmB for the yeast form were one dilution higher. The MICs to FLU were generally lower for the yeast form (6.25–25 g) than the mycelial form (25–50 g/ml), whereas MFCs for the mycelial cultures were > 100 g as compared to 6.25–100 g for their yeast form. The MICs for the mycelial form to 5-FC ranged from < 0.195–0.39 g. Higher MICs (6.25 g) were recorded for their yeast form. The MFCs to 5-FC for the yeast form were 25–100 g/ml. The MICs for the mycelial form to ITZ ranged from < 0.195 to 3.125 g/ml. Higher values (< 0.195–50 g) were recorded for their yeast-like form. The MFCs to ITZ for mycelial and yeast forms ranged from < 0.195–0.39 and 25–100 g/ml, respectively. Results indicate that P. marnefei's yeast form is more sensitive to FLU and ITZ (8 of 10 strains) while the mycelial form displayed greater susceptibility to AmB and 5-FC. The MICs for ITZ remained steady in SD medium, pH 5.7 to 7.1. However, some strains gave higher MIC values (0.39–1.56 g/ml) when tested in the HR.