Comparison of filtration staining (Bell) and thick smear (Kato) for the detection and quantitation of Schistosoma mansoni eggs in faeces

We compare results of one Bell and one Kato-Katz examination performed on each of 315 stool specimens from residents in an area in north-eastern Brazil endemic for schistosomiasis mansoni. The prevalence of schistosome infection detected by the Bell technique was 76% and by the Kato-Katz technique was 63%. 81% ($\text{44}\text{54}$) of the infections missed by a Kato-Katz smear were light infections (one to 50 epg range by Bell examination). Over-all, 55% ($\text{44}\text{80}$) of stools in this egg count range by the Bell technique were negative on a single Kato-Katz smear. This implies that five Kato-Katz smears per stool would ensure a 95% probability (0·55⁵ × 100) of detecting such light infections. However, a single Kato-Katz smear detected eggs in 97% ($\text{124}\text{128}$) of stools with a Bell count > 100 epg. For stools positive by both methods the egg counts per gram of stool were higher (p < 0·001) by Kato-Katz examination. Geometric mean egg counts for the infected population were 199 epg by the Kato-Katz and 92 epg by the Bell methods. 64% (59 v. 36) more persons were classified as heavily infected (> 400epg) by the Kato-Katz method than by the Bell method. The differing measurements of schistosome infection obtained with the Bell and Kato-Katz methods must be considered when comparing data on morbidity-infection relationships.     

Women have headaches, men have backaches: patterns of illness in an Appalachian community

In an Appalachian area in the United States, the incidence of women's headaches and men's backaches is not within normal patterns of medical statistics. Appalachian perceptions of disability contrast with the predominate society. Disability is inevitable and inevitably accompanies age. Virtually all incapacity is deemed disabling, but to be a 'deserving disabled person', one must be 'moral' and physically active. As 'goodchristians', members of the community must minister to the disabled and their families. Customarily rehabilitation is not viewed as a viable option. This initial exploration suggests psychosocial correlations and value orientation as preliminary explanations.     

Combination therapy for midtrimester abortion: Laminaria and analogues of prostaglandins

Thirty-four women 13–20 weeks pregnant were aborted by IM 15(S)-15 methyl prostaglandin E₂, 10 mcg every four hours. Thirteen women had pretreatment with intracervical laminaria tents. The use of laminaria tents produced a highly significant reduction in time to abortion without an increase in complications. A reduction in the dose of methyl PGE₂ required for abortion was also noted. Other investigators have already reported similar improved results with combinations of laminaria and analogues of prostaglandin and they deserve a wider clinical trial.     

Relationship of psychosocial factors to smoking behavior change in an intervention program

The relationship of stress and the “psychosocial assets” of adjustment, belief in personal control, and social support to the modification of smoking behavior was studied in a sample of 169 male smokers, aged 35 to 57, enrolled in a heart attack prevention program. Smokers were categorized as Continuing Successes, Recidivists, or Nonstoppers, depending on whether they stopped smoking and maintained cessation, stopped smoking and relapsed, or never stopped during the initial intervention phase. The participants were followed for 2 years. Variations in the following factors were used to significantly discriminate among the groups of smokers: stress, security, social support, number of cigarettes smoked at baseline and when smoking heaviest, and measures of belief in personal control. Discriminant function analysis demonstrated that the likelihood of being a Continuing Success is increased when there are, in combination (in decreasing order of importance): a high expectation of success; few cigarettes smoked upon entry into the program; low stress; ease of prior cessation attempts; a long period of prior abstinence; and a high degree of personal security. The results suggest that it is possible to predict which participants in a smoking control program will have problems with cessation and maintenance of cessation; and that smoking control programs can target intervention toward specific individual needs.     

Dietary Self-Monitoring Through Calorie Tracking but Not Through a Digital Photography App Is Associated with Significant Weight Loss: The 2SMART Pilot Study—A 6-Month Randomized Trial

BackgroundDietary self-monitoring (DSM) of foods and beverages is associated with weight loss in behavioral interventions; however, DSM may be burdensome, and adherence may decrease over time. Novel methods of DSM, including apps that track food using photographs, may decrease burden, increase DSM adherence, and improve weight loss.ObjectiveThe objective was to test a mobile photo DSM app compared to a calorie-tracking DSM app on tracking frequency and weight loss in a remotely delivered behavioral weight-loss intervention.DesignThis was a 6-month (October 2016 to April 2017) randomized trial.Participants/settingParticipants were adults (n=41) classified as overweight or obese (body mass index 25 to 49.9) from South Carolina.InterventionParticipants received remotely delivered twice-weekly behavioral weight-loss podcasts and tracked diet using a calorie-tracking DSM app (Calorie Group) or a photo DSM app (Photo Group).Main outcome measuresMain outcomes were the number of days diet was tracked, podcasts downloaded, and weight change at 6 weeks and 6 months.Statistical analysesResearchers used nonparametric Wilcoxon rank sum tests and χ² analysis to test for differences between groups at baseline; repeated-measures models to estimate weight change and Spearman correlations to determine relationships between DSM frequency, podcasts downloaded, and weight change at 6 months.ResultsThere were no differences between groups for the number of days that diet was recorded (P=0.18), which was low overall (<30% of days) but was statistically significantly and strongly correlated with weight change for all participants pooled (r=0.63; P<0.001) and for the calorie tracking group (r=0.70; P=0.004), but not the photo tracking group (r=0.51; P=0.06). Participants in both groups had significant weight loss at 6 months (Photo Group, –2.5±0.9 kg; P=0.008; Calorie Group –2.4±0.9 kg; P=0.007), with no differences between groups at either 6 weeks (P=0.66) or at 6 months (P=0.74).ConclusionsAs part of a remotely delivered weight loss intervention, frequency of DSM was significantly associated with overall weight loss for participants using a calorie DSM app but not a photo DSM app. DSM was low regardless of group and weight loss was significant, although minimal. Increasing user engagement with any DSM may be important to increase self-monitoring and improve weight loss.     

Perceived influence of different information sources on the decision-making of internal medicine house staff and faculty

To determine the extent to which different sources of information are perceived to influence common medical decisions, 10 interns, 22 senior residents and 9 faculty general internists rated the degree of influence of house staff, general internists, subspecialists, conferences, journal reading and past experience on their decisions concerning primary prevention (vaccination), secondary prevention (screening) and drug therapy. Analysis of variance of their questionnaire data supports the following conclusions: physicians at different stages of training rely on different sources of information; as physicians advance in training the influence of generalists wanes while that of subspecialists increases; subspecialists and past experience are perceived as primarily affecting therapeutic decisions; primary prevention appears least subject to influence by prevailing information sources; and the preference for reading begins early and increases as physicians advance in training. These data suggest that designing effective medical education requires considering the level of the physician's training and the nature of the medical decision.     

Coverage and patterns of ambulatory medical care use in Tlalpan, Mexico City

Health officials planned a stepped care system (regionalized) for Tlalpan, in the Federal District of Mexico (D.F.), to address problems of duplicated services, inappropriate use of available resources, increasing costs of medical care, and unmet health needs in the population. Cross-sectional surveys were carried out in the community, in health centers and in hospital based ambulatory services (outpatient department and emergency department) to obtain current, specific and valid information about need and utilization patterns. Users of the various services differed from each other and from the community by age, educational level, occupation, rights to prepaid care and utilization patterns. Emergency department users came back for care repeatedly and sought preventive services from the emergency department. Major reasons for attending the emergency department included respiratory and gastrointestinal problems, plus poisonings, accidents, and complications of pregnancy. Outpatient department users arrived without referral from medical sources and continued to return frequently for care. Users were mostly adults, particularly older adults, with problems of a more chronic nature, e.g. nervous system problems, genitourinary problems, etc. The health centers attended clients from the designated area of influence who had referred themselves to the center for care. Children were the most frequent clients with acute, common problems, e.g. diarrhea and respiratory problems. Health maintenance activities were assessed for which children received the most complete coverage, but some women lacked the necessary care for perinatal health and family planning. In general, health centers seemed to be functioning appropriately, although the magnitude of unattended need in their areas of influence must be investigated further.(ABSTRACT TRUNCATED AT 250 WORDS)     

Feeding behavior after hypothalamic 6-hydroxydopamine injections

6-Hydroxydopamine (6-OHDA) injection into the rat hypothalamus produces profound changes in eating behavior and body weight gain. Willis and Smith have demonstrated an anorexic effect of lateral hypothalamic (LH) 6-OHDA, which they correlate with local catecholamine release from degenerating axons just behind the lesion. Work from our own laboratory has recently demonstrated that 6-OHDA injection into the medial paraventricular nucleus (PVN) has an initial effect of stimulating daily food intake and body weight gain. It is suggested that this phenomenon, consistent with reports of enhanced eating with PVN injection of norepinephrine (NE), is due to 6-OHDA-induced release of endogenous NE. Subsequently, PVN 6-OHDA causes hypophagia and reduced body weight. Although histochemical and biochemical analyses reveal a 60-90% decrease in PVN norepinephrine and dopamine after 6-OHDA treatment, a close association between the precise degree of catecholamine loss and magnitude of behavioral response could not be detected.     

The low mortality rates of Chinese infants: Some plausible explanatory factors

The objectives of this paper are: (1) to describe the differential infant mortality rates between Chinese and white Americans; (2) to identify and evaluate the commonly suspected factors for the low infant mortality rates observed among Chinese in the United States; and (3) to explore alternative explanatory factors for the low death rates of Chinese infants by drawing upon a body of current sociomedical research regarding the effects of smoking and drinking of fetal development, preterm delivery and low birthweight in non-Chinese populations. Anthropological studies on Chinese pre- and post-natal health practices—both in Taiwan and in the United States—are also discussed.The data come primarily from U.S. birth and death records. Where available, both published and unpublished data on Chinese infant mortality from Hong Kong Colony, Taiwan Province and Mainland China, are also presented for purposes of comparison.     

Adverse consequences of hospitalization in the elderly

This study prospectively examines 502 general medical patients for evidence of side-effects of hospitalization unrelated to diagnosis or therapy of acute illness. Symptoms of depressed psychophysiologic functioning (confusion, falling, not eating, and incontinence) unrelated to acute medical diahnoses were found in 8.8% of the patients under 70 and in 40.5% of the elderly population (P < 0.0001). The rate of medical intervention secondary to these symptoms (psychotropic medications, restraints, nasogastric tubes, and forely catheters) was 37.9% among the young patients and 47.1% in the elderly group (P=0.4). The sample was too small to permit adequate empirical determination of the complication rate from medical intervention (thrombophlebitis, pulmonary embolus, aspiration pneumonia, urinary tract infection, septic shock) but estimates from the literature indicate that each of the interventions studied entails a complication rate of 25–30%. Combining the observed rate of functional symptoms development and intervention, and the literature rates of complications, yields a risk of complications of 1.0% for the young and 5.7% for the elderly (P < 0.0001). These data indicate that hospitalized elderly patients are at high risk of developing symptoms of depressed psychophysiologic functioning and of sustaining medical intervention as a result of these symptoms, with attendant medical complications. We suggest that the incidence of depressed psychophysiologic function needs to be assessed in patients treated outside the hospital, along with efficacy of treatment outside the hospital, to determine whether there are patients for whom hospitalization is not optimal therapy.     

Protection by antioxidants against the toxicity of ozone to microbial systems

Antioxidants of a wide range of chemical classes were shown to protect a bacterium and a protozoan against ozone toxicity.