Prevalence of asthma and respiratory symptoms in south-central Durban, South Africa

The prevalence of asthma and respiratory symptoms in south-central Durban, one of the most heavily polluted areas of South Africa, has been determined using a cross-sectional survey of 213 households in the communities of Merewent (97% Indians) and Austerville (98% coloreds). The study population consisted of 367 children (less than 17 years old) and 693 adults. About 10% of the children and 12% of adults reported doctor diagnosed asthma. The self-reported prevalence rates for wheezing (37–40%) and attacks of shortness of breath with wheeze (16–28%) were much higher than that for doctor diagnosed asthma and common co-occurrence of the three symptoms is found. The prevalence rates for other respiratory symptoms include 33–35% for chronic cough, 31–32% for chronic phlegm, 44–50% for frequent blocked-runny nose, and 16–27% for sinusitis. Factors in the community that were associated with asthma, wheeze and shortness of breath with wheeze among the adult population included cigarette smoking, use of insecticides (coils and pump spray) and home ownership. An association between asthma among children and a number of household risk factors including dampness, carpet, pets or use of pesticides was not apparent in the community. Asthma prevalence was strongly correlated with missing of school by children (odds ratio (OR): 44; 95% confidence interval (CI): 13–141). The study serves to draw attention to a growing but neglected public health problem in urban areas of Africa.     

MGA5 Health Utilities Index: Further Evidence of Responsiveness

Quality adjusted life years (QALYs) are well recognized as a valid measure for outcomes in cost-effectiveness analyses. However, it is difficult to obtain a summary utility score from health status measure such as the SF-36.
OBJECTIVE: To predict a summary utility score (represented by HUI) from the scores on the SF-36.
METHODS: A structural equation framework was applied to data collected from 1992 to 1995 on the Southern California Kaiser Permanente population (n = 5,794). An instrumental variable (IV) method mitigated the endogeneity in estimating the HUI(MarkII). Socioeconomic and disease variables were used as covariates. A split-sample analysis provided cross-validation.
RESULT: This model predicted 33.68% of the observed variance in HUI index scores with an adjusted R²of 0.3335. Observed HUI index scores were distributed with a mean of 0.7963 and std. deviation of 0.1796. Parameter estimates of most of the SF-36 components (except General Health & Social Functioning) showed statistical significance at α= 0.05 level. People with high chronic disease scores were found to have low SF-36 scores, and parameter estimates of this covariate were also found statistically significant at α= 0.05 level in all structural equations. However, all the socioeconomic variables showed statistical insignificance. Comparison of "Forecasting" and "Estimation" sub-samples showed satisfactory results during cross-validation.
CONCLUSION: Result of this study provides a quantitative link between two important measures of health status. The present model can be used to estimate overall health utility summary scores from previous studies using the SF-36.     

Educating Health Professionals in Obstetrics and Gynecology Regarding Rapid Human Immunodeficiency Virus (HIV) Testing in Labor and Delivery: A Local Initiative

Although, the Centers for Disease Control and the American College of Obstetricians and Gynecologists have advised rapid HIV testing for laboring women of unknown human immunodeficiency virus (HIV) status since 2004 to ensure that results are known prior to delivery, physicians and hospital staff have been slow to follow the recommendation. A multi-component intervention was implemented to educate physicians and hospital staff. There was low baseline knowledge (<50% correct) in the areas of HIV prevalence, use of rapid testing in the prevention of perinatal HIV transmission, and treatment. On 9 out of 14 items, participants demonstrated a >35% increase in correct responses from pre-test to 3?month post-test. Baseline knowledge among obstetric health care providers about how to diagnose and treat newly diagnosed pregnant women was low. Brief exposure to an educational program yielded a marked increase in knowledge that was sustained over 3?months. Educating health professionals in obstetrics and gynecology regarding rapid human immunodeficiency virus (HIV) testing in Labor and Delivery: A local initiative.     

Non-digestible oligosaccharides and calcium absorption in girls with adequate calcium intakes

Non-digestible oligosaccharides such as inulin and oligofructose have been shown to consistently increase calcium absorption in experimental animals, but data in humans are less clear-cut. The objective of this study was to assess the effect of 8 g/d of oligofructose or a mixture of inulin and oligofructose on calcium absorption in girls at or near menarche. A total of fifty-nine subjects were studied using a balanced, randomized, cross-over design. They received, in random order, 8 g/d placebo (sucrose), oligofructose or the mixture inulin+oligofructose for 3 weeks, separated by a 2-week washout period. Throughout the study, subjects consumed a total of approximately 1500 mg/d dietary calcium, by adding two glasses of calcium-fortified orange juice to their diet. Four grams of placebo, oligofructose or the mixture inulin+oligofructose was added to each glass of orange juice immediately before it was consumed. At the end of each 3-week adaptation period, calcium absorption was measured, using a dual stable isotope technique, from the cumulative fractional excretion of an oral and an intravenous tracer over 48 hours. Calcium absorption was significantly higher in the group receiving the inulin+oligofructose mixture than in the placebo group v. P=0.01), but no significant difference was seen between the oligofructose group and the placebo group v. P=NS). We conclude that modest intakes of an inulin+oligofructose mixture increases calcium absorption in girls at or near menarche.     

Transdermal oxybutynin: a new treatment for overactive bladder

Overactive bladder has been successfully treated with oral anticholinergic drugs such as oxybutynin chloride. Although oral oxybutynin has been effective in controlling urinary urge incontinence and in decreasing incontinence episodes, adverse events, particularly dry mouth, often cause patients to discontinue oral therapy and to endure incontinence. Transdermal oxybutynin (Oxytrol, Watson Pharmaceuticals) is applied twice-weekly to maintain the efficacy of oral oxybutynin while significantly minimising side effects (e.g., dry mouth) that complicate therapy. By avoiding hepatic and gastrointestinal metabolism of oxybutynin, less N-desethyloxybutynin (N-DEO), the compound thought to be responsible for anticholinergic side effects, such as dry mouth, is produced. The new transdermal oxybutynin formulation offers patients with urinary incontinence an effective, safe and well-tolerated option for managing the symptoms of overactive bladder.     

Pain after barium enema: effect of CO2 and air on double-contrast study

One hundred fifty-one consecutive patients scheduled for double-contrast barium enema studies were assigned randomly to insufflation with either air or carbon dioxide (CO2) in a double-blind, prospective trial. Within 24 hours after the enema study, the patients were contacted by telephone by an interviewer, who completed a standard questionnaire. Radiographs from the enema studies were assessed for quality by two radiologists. Pain experienced after the procedure was graded from 0 (none) to 4 (severe). Clinically relevant (grades 2-4) pain was experienced by 30% of patients after insufflation with room air, compared with 11% of patients in whom CO2 was used for insufflation (P = .005). The mean pain score for CO2 was 0.4, and for room air, 1.2 (P less than .005). Although five patients experienced grade 4 pain after insufflation with air, no patient reported severe pain after CO2 insufflation. Post-evacuation films confirmed there was significantly less residual gas in the CO2 group. The quality of radiographs was equal in the two groups. CO2 has advantages for use in the double-contrast barium enema examination.     

Excretory urography with iohexol: evaluation in children

A multicenter clinical study was conducted using iohexol, a second-generation nonionic contrast medium, for excretory urography performed in 130 children. Doses of iohexol (300 mg iodine/ml) ranged between 150 and 660 mgI/kg (0.5 and 2.2 ml/kg). Iohexol was tolerated well, and no significant adverse reactions occurred. Sixty-five iohexol urograms were evaluated to determine the minimum dose for adequate visualization of the kidneys and collecting systems. A dose greater than 300 mgI/kg (1.0 ml/kg) always resulted in a urogram of diagnostic quality, while visualization was insufficient for diagnosis in 10% of studies done with doses of 150-300 mgI/kg (0.5-1.0 ml/kg). Another 65 iohexol urograms were compared in a blinded manner with a similar number of studies performed using iothalamate meglumine at comparable iodine concentration and dose. Visualization of calyces and pelvoinfundibular structures achieved with iohexol was rated better with statistical significance, but there was no difference in visualization of the renal parenchyma or ureters. Use of iohexol in excretory urography may be advantageous in children who are at greatest risk for an adverse reaction to contrast media or in those most likely to benefit from use of a low osmolality contrast agent.     

Interobserver variation in the interpretation of abdominal radiographs

A total of 140 sets of abdominal radiographs were reviewed independently by four qualified diagnostic radiologists. The degree of interobserver agreement was determined by calculating kappa values for 19 commonly used radiographic signs and diagnoses. There was fair to excellent interobserver agreement for 11 signs and diagnoses and poor agreement for the remaining eight. The signs and diagnoses for which agreement is poor cannot be considered reliable and include particularly large bowel obstruction and nonspecific gas pattern.     

Glandular schwannoma in a 17-month-old child

Glandular schwannoma is an infrequent tumor, especially in the pediatric age group. We report a case in which the tumor developed in the retroperitoneum of a 17-month-old girl without stigmata of Von Recklinghausen's disease (VRD). She presented a local recurrence and bone and pulmonary metastases at 11, 23, and 30 months, respectively, after tumor resection. The pathologic findings in the original tumor did not permit us to predict its potential to metastasize. The ultrastructural characteristics of both glandular and schwannian elements are described. The rarity of this neoplasia in children and the absence of histological parameters of aggressiveness are emphasized.