Showing papers by "World Health Organization published in 1995"
TL;DR: The human immunodeficiency virus epidemic is causing increases in the number of tuberculosis cases, particularly in Africa, although increases are also expected in Southeast Asia.
Abstract: This article describes the global epidemiology of tuberculosis and reviews recent estimates of tuberculosis incidence and mortality in the world. The highest prevalence of tuberculosis infection and estimated annual risk of tuberculosis infection are in sub-Saharan Africa and Southeast Asia. Overall, almost 3.8 million cases of tuberculosis were reported in the world in 1990, of which 49% were in Southeast Asia. From the period 1984 through 1986 to the period 1989 through 1991, notification rates increased in all World Health Organization regions, except the American and the European regions. In 1990, there were an estimated 7.5 million cases of tuberculosis and 2.5 million deaths worldwide. The human immunodeficiency virus epidemic is causing increases in the number of tuberculosis cases, particularly in Africa, although increases are also expected in Southeast Asia. In many industrialized countries, tuberculosis has recently failed to decline, and in eastern Europe and the former Soviet Union, cases and deaths are increasing. Drug resistance is a serious problem, especially in the United States. If worldwide control of tuberculosis does not improve, 90 million new cases and 30 million deaths are expected in the decade 1990 through 1999. (JAMA. 1995;273:220-226)
1,737 citations
Journal Article•
TL;DR: The age-specific prevalences of the major causes of blindness that are related to age indicate that the trend will be for an increase in such blindness over the decades to come, unless energetic efforts are made to tackle these problems.
Abstract: Globally, it is estimated that there are 38 million persons who are blind. Moreover, a further 110 million people have low vision and are at great risk of becoming blind. The main causes of blindness and low vision are cataract, trachoma, glaucoma, onchocerciasis, and xerophthalmia; however, insufficient data on blindness from causes such as diabetic retinopathy and age-related macular degeneration preclude specific estimations of their global prevalence. The age-specific prevalences of the major causes of blindness that are related to age indicate that the trend will be for an increase in such blindness over the decades to come, unless energetic efforts are made to tackle these problems. More data collected through standardized methodologies, using internationally accepted (ICD-10) definitions, are needed. Data on the incidence of blindness due to common causes would be useful for calculating future trends more precisely.
1,338 citations
TL;DR: The large difference in absolute CHD mortality rates at a given cholesterol level, however, indicates that other factors, such as diet, that are typical for cultures with a low CHD risk are also important with respect to primary prevention.
Abstract: Objective. —To compare the relationship between serum total cholesterol and long-term mortality from coronary heart disease (CHD) in different cultures. Design. —Total cholesterol was measured at baseline (1958 through 1964) and at 5- and 10-year follow-up in 12 467 men aged 40 through 59 years in 16 cohorts located in seven countries: five European countries, the United States, and Japan. To increase statistical power six cohorts were formed, based on similarities in culture and cholesterol changes during the first 10 years of follow-up. Main Outcome Measures. —Relative risks (RRs), estimated with Cox proportional hazards (survival) analysis, for 25-year CHD mortality for cholesterol quartiles and per 0.50-mmol/L (20-mg/dL) cholesterol increase. Adjustment was made for age, smoking, and systolic blood pressure. Results. —The age-standardized CHD mortality rates in the six cohorts ranged from 3% to 20%. The RRs for the highest compared with the lowest cholesterol quartile ranged from 1.5 to 2.3, except for Japan's RR of 1.1. For a cholesterol level of around 5.45 mmol/L (210 mg/dL), CHD mortality rates varied from 4% to 5% in Japan and Mediterranean Southern Europe to about 15% in Northern Europe. However, the relative increase in CHD mortality due to a given cholesterol increase was similar in all cultures except Japan. Using a linear approximation, a 0.50-mmol/L (20-mg/dL) increase in total cholesterol corresponded to an increase in CHD mortality risk of 12%, which became an increase in mortality risk of 17% when adjusted for regression dilution bias. Conclusion. —Across cultures, cholesterol is linearly related to CHD mortality, and the relative increase in CHD mortality rates with a given cholesterol increase is the same. The large difference in absolute CHD mortality rates at a given cholesterol level, however, indicates that other factors, such as diet, that are typical for cultures with a low CHD risk are also important with respect to primary prevention. (JAMA. 1995;274:131-136)
826 citations
TL;DR: The serological properties of six new pneumococcal capsular types are described and a table listing all 90 pneumococCal types and their cross-reactions is included.
Abstract: The serological properties of six new pneumococcal capsular types are described A table listing all 90 pneumococcal types and their cross-reactions is included
611 citations
TL;DR: The association between a new human herpesvirus-like agent and various forms of Kaposi's sarcoma was examined by PCR and the presence and expression of the virus was detected in some Kapos's tumours by Southern and northern blotting.
432 citations
TL;DR: Medical education in clinical pharmacology and pharmacotherapy should be based on the practical needs of future prescribes, should include the principles of rational therapeutics and problem solving, and should immunize students against the influences they are likely to encounter in their professional life.
Abstract: Irrational prescribing is a global problem. Rational prescribing cannot be defined without a method of measurement and a reference standard. The former is now available but the latter needs further development. Proven effective interventions to promote rational prescribing in developed countries are treatment protocols based on wide consultation and consensus, properly introduced and with a possibility of feedback; face-to-face education focussed on a particular prescribing problem in selected individuals; structured order forms; and focussed educational campaigns. Essential drugs lists are probably effective when based on consensus and used within a comprehensive educational programme. Printed materials alone are not effective. In most cases the usefulness of such strategies in developing countries has not been proven and should be studied. Medical education in clinical pharmacology and pharmacotherapy should be based on the practical needs of future prescribes, should include the principles of rational therapeutics and problem solving, and should immunize the students against the influences they are likely to encounter in their professional life, such as patient pressure, drug promotion and irrational prescribing by peers. Within the scope of a national formulary, specialist departments in teaching hospitals should define prescribing policies as the basis for prescribing, teaching, examinations and medical audit.
347 citations
TL;DR: A pronounced improvement in the population lipid profile in Mauritius was probably related to a change in the saturated fat content of a widely used cooking oil.
Abstract: Objective: To study changes in the prevalence of risk factors for cardiovascular disease after a five year population-wide intervention programme promoting a healthy lifestyle in a developing country. Design: Cross sectional cluster surveys in 1987 and 1992. Methodology included a two hour 75 g oral glucose tolerance test, measurement of body mass index, waist:hip ratio, basal lipid concentrations, and blood pressure; and a lifestyle questionnaire. Setting: Mauritius, in the Indian Ocean. Subjects: All adults aged 25-74 years residing in geographically defined clusters. Main outcome measures: Age standardised prevalence of categorical disease and risk factor conditions and mean levels and frequency distributions of continuous variables. Results: Response rates were 86.2% (5080/5892) in 1987 and 89.5% (5162/5770) in 1992. Significant decreases were found in the prevalence of hypertension (15.0% to 12.1% in men and 12.4% to 10.9% in women); cigarette smoking (58.2% to 47.2% and 6.9% to 3.7% respectively); and heavy alcohol consumption (38.2% to 14.4% and 2.6% to 0.6% respectively). Moderate leisure physical activity increased from 16.9% to 22.1% in men and from 1.3% to 2.7% in women. Mean population serum total cholesterol concentration fell appreciably from 5.5 mmol/l to 4.7 mmol/l (P Conclusions: Lifestyle intervention projects can be implemented and have positive effects in developing countries. A pronounced improvement in the population lipid profile in Mauritius was probably related to a change in the saturated fat content of a widely used cooking oil.
247 citations
TL;DR: Further evaluation of the meta-analytical method is needed if the qualitative and quantitative results it yields are to be better understood, and a meta-analysis demonstrating a protective effect from an intervention of more than 40% had a 60% probability of correctly predicting results of the same magnitude of the largest trial.
231 citations
TL;DR: Mice with homologous disruption of the gene coding for the ligand- binding chain of the interferon (IFN) gamma receptor and derived from a strain genetically resistant to infection with Leishmania major have been used to study the role of this cytokine in the differentiation of functional CD4+ T cell subsets in vivo and resistance to infection.
Abstract: Mice with homologous disruption of the gene coding for the ligand-binding chain of the interferon (IFN) gamma receptor and derived from a strain genetically resistant to infection with Leishmania major have been used to study further the role of this cytokine in the differentiation of functional CD4+ T cell subsets in vivo and resistance to infection. Wild-type 129/Sv/Ev mice are resistant to infection with this parasite, developing only small lesions, which resolve spontaneously within 6 wk. In contrast, mice lacking the IFN-gamma receptor develop large, progressing lesions. After infection, lymph nodes (LN) and spleens from both wild-type and knockout mice showed an expansion of CD4+ cells producing IFN-gamma as revealed by measuring IFN-gamma in supernatants of specifically stimulated CD4+ T cells, by enumerating IFN-gamma-producing T cells, and by Northern blot analysis of IFN-gamma transcripts. No biologically active interleukin (IL) 4 was detected in supernatants of in vitro-stimulated LN or spleen cells from infected wild-type or deficient mice. Reverse transcription polymerase chain reaction analysis with primers specific for IL-4 showed similar IL-4 message levels in LN from both types of mice. The IL-4 message levels observed were comparable to those found in similarly infected C57BL/6 mice and significantly lower than the levels found in BALB/c mice. Anti-IFN-gamma treatment of both types of mice failed to alter the pattern of cytokines produced after infection. These data show that even in the absence of IFN-gamma receptors, T helper cell (Th) 1-type responses still develop in genetically resistant mice with no evidence for the expansion of Th2 cells.
229 citations
Journal Article•
TL;DR: The use of body mass index (BMI = weight in kg/(height in metres)2) is described in this article as a measure of adult nutritional status, both of individuals and of communities.
Abstract: Adult malnutrition is much more widespread than is commonly recognized. Described in this article is the use of body mass index (BMI = weight in kg/(height in metres)2) as a measure of adult nutritional status, both of individuals and of communities. Concurrent assessment of the nutritional status of children and adults permits conclusions to be drawn about whether there is generalized undernutrition in a community or whether other factors (e.g., childhood infections or feeding practices) are more important in childhood malnutrition. Included is a tabular presentation that permits rapid assessment of both thinness or underweight (BMI values 25, 30 and 40). Examples of the use of BMI in both clinical and public health practice are also given.
225 citations
TL;DR: Results of the case-control study and characterization of food isolates identified pork tongue in jelly, a ready-to-eat meat product, as the major vehicle of this outbreak, and to a lesser extent, delicatessen products contaminated secondarily during handling in food stores.
Abstract: Two hundred seventy-nine cases of human listeriosis (92 pregnancy-related cases and 187 non-pregnancy-related cases) caused by a serovar 4b and phagovar 2389:2425:3274:2671:47:108:340 strain were identified in France between March and December 1992. Epidemiological investigations included a case-control study (not described here) and microbiological analyses of foods. Results of the case-control study and characterization of food isolates identified pork tongue in jelly, a ready-to-eat meat product, as the major vehicle of this outbreak, and to a lesser extent, delicatessen products contaminated secondarily during handling in food stores. As far as serotyping, phage typing, DNA macrorestriction pattern analysis (obtained by pulsed-field gel electrophoresis [PFGE]), and ribotyping are concerned, this epidemic strain is phenotypically and genomically closely related to strains responsible for major outbreaks of listeriosis previously observed in Europe and North America. The epidemic strain sensu stricto as defined by PFGE (2/1/3) displayed the same serovar, phagovar, ribovar, and ApaI and NotI PFGE patterns as the epidemic strains from outbreaks in Switzerland, California, and Denmark, but it consistently showed differences in the SmaI PFGE profile. This information greatly contributed to the identification of the major food vehicle (pork tongue in jelly) and further allowed exclusion of other foods (cheese) as possible sources of this major listeriosis epidemic.
TL;DR: The negative effects reported may be less evident in women using the COC for contraceptive purposes but may lead to discontinuation in some women and warrant further investigation.
Journal Article•
TL;DR: The present review article summarizes the discussions and recommendations made by the participants and discusses current and future approaches to the management of haemophilia and its complications, including prospects for genetic technology and gene therapy in developed and developing countries.
Abstract: Many rapid advances have been made in the diagnosis and therapy of haemophilia. Nevertheless, the condition still poses problems and challenges (e.g., joint disease, transfusion-transmitted diseases, inhibitors, provision of care in developing countries, and education and cost issues). WHO and the World Federation of Hemophilia held a joint meeting in Geneva, on 21-23 March 1994, to discuss and review current and future approaches to the management of haemophilia and its complications, including prospects for genetic technology and gene therapy in developed and developing countries. The present review article summarizes the discussions and recommendations made by the participants.
TL;DR: Results indicate that glucose intolerance in South Asians can no longer be regarded as a problem confined to migrant communities, and suggests important, modifiable risk factor(s) related to lifestyle.
Abstract: The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) and their relationship to age and obesity was estimated in the rural town of Shikarpur in Sindh Province, Pakistan by a population-based survey in 1994. Oral glucose tolerance tests were performed in a stratified random sample of 967 adults (387 men, 580 women) aged 25 years and above. The diagnoses of diabetes and IGT were made on the basis of WHO criteria. The response rate was 71% for men and 80% for women. The prevalence of diabetes was 16.2% (9.0% known, 7.2% newly diagnosed) in men, and 11.7% (6.3% known, 5.3% newly diagnosed) in women. The prevalence rose with age to a peak of 30% and 21% in 65-74 year-old men and women respectively. IGT was detected in 8.2% of men and 14.3% of women. Thus, total glucose intolerance (diabetes and IGT combined) was present in 25% of subjects examined. These results indicate that glucose intolerance in South Asians can no longer be regarded as a problem confined to migrant communities. Of the 72 subjects previously known to have diabetes, none was using insulin treatment, but 57 (79%) took oral hypoglycaemic agents. Central obesity and positive family history were strongly associated with diabetes, as was prevalence of hypertension. The association with central obesity was greater for women than for men, and suggests important, modifiable risk factor(s) related to lifestyle.
Journal Article•
TL;DR: The paper offers several avenues to be pursued to reduce the global spread of Ae.
Abstract: Aedes albopictus ranks second only to Ae. aegypti in importance to man as a vector of dengue and dengue haemorrhagic fever (DHF) which viruses place at risk a potential population of 2 billion people living in tropical and sub-tropical regions. Due to its predilection for breeding in a plethora of habitat within urban and suburban environs as well as peri-rural areas it is spreading rapidly where suitable breeding is available. It exhibits strain differences ranging from the cold-hardy to tropic loving, yet despite limited flight range, it has spread beyond the Orient to China, the Pacific, the Indian Ocean islands, the Americas, parts of continental Africa and into southern Europe. This has been done principally by means of transport of eggs in used tyres via rapid air and sea transport. Egg positive used tyres, when shipped, and later rehydrated by rainfall, produce adult mosquitoes within a few days rapidly infesting new areas. Although dengue and other vector-borne arboviral diseases have not been in Europe in epidemic form for many decades, travelers do not infrequently return from dengue endemic areas with dengue and other similar infections. Aedes albopictus is a potential vector of a number of arboviruses and can transmit them in a vertical or transvenereal manner in nature, thereby providing a means for their maintenance and transmission. Where Ae. albopictus newly occurs, the affected populace immediately are aware of a new daytime, nuisance biting mosquito and complaints addressed to local mosquito control authorities increase significantly. The biological characteristics of the mosquito make its spread within Europe highly probable. The paper offers several avenues to be pursued to reduce the global spread of Ae. albopictus, when examined within the context of Europe and the wider world community.
TL;DR: It is concluded that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method.
Abstract: The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This paper examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The paper focuses on payments by institutions (third parties) to providers. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. The authors conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide trade offs to offset the disadvantages of individual modes. Low income countries should avoid complex payment systems requiring higher levels of institutional development.
TL;DR: It is suggested that treatment of schoolchildren every 4 months may be necessary in this highly endemic area in order to have an impact on the intensity of intestinal nematode infections sufficient to be likely to reduce morbidity.
Abstract: The comparative efficacy of albendazole and mebendazole in the treatment of intestinal nematode infections were compared 3 weeks after treatment in a randomized trial among schoolchildren on Pemba Island, Tanzania. Egg counts were compared 3 weeks, 4 months and 6 months after treatment of 731 children seen on each occasion. Differences in the efficacies were apparent with some nematodes 21 d after treatment, but these were no longer apparent 4 months after treatment, and by 6 months intensities of infection were similar to pre-treatment levels. These findings suggest that treatment of schoolchildren every 4 months may be necessary in this highly endemic area in order to have an impact on the intensity of intestinal nematode infections sufficient to be likely to reduce morbidity.
TL;DR: The morphology, metabolism and pharmacological disruption of the Plasmodium digestive vacuole are reviewed, finding a number of attractive drug targets remain to be exploited.
TL;DR: Three major measures are indicated: high immunization coverage of target groups, prompt diagnosis and management of diphtheria cases, and rapid identification of close contacts with their effective management to prevent secondary cases.
Abstract: Following the introduction of routine immunization with diphtheria toxoid in the 1940s and 1950s, diphtheria incidence declined dramatically in countries of the industrialized world. At the beginning of the 1980s many of these countries were progressing toward elimination of the disease. However, since the mid-1980s there has been a striking resurgence of diphtheria in several countries of Eastern Europe. For 1993, WHO received reports of 15,211 diphtheria cases in Russia and 2,987 cases in Ukraine. The main reasons for the return of diphtheria in these countries were: decreasing immunization coverage among infants and children waning immunity to diphtheria in adults, movements of the population during the last few years, and an irregular supply of vaccines. The outbreak spread to neighboring countries and in 1993 cases were reported in Azerbaijan, Belarus, Estonia, Finland, Kazakhstan, Latvia, Lithuania, Poland, Tajikistan, Turkey, and Uzbekistan. Epidemiological patterns of diphtheria are changing in developing countries, and the disease seems to be following patterns seen in industrialized countries 30 to 40 years ago. In developing countries, routine immunization against diphtheria was introduced in the late 1970s with the Expanded Programme on Immunization. In these countries, coverage of infants with 3 doses of diphtheria toxoid reached 46% in 1985, and 79% in 1992. Recent diphtheria outbreaks in Algeria, China, Ecuator, Jordan, Lesotho and Sudan demonstrate a shift in the age distribution of cases to older children and adults. Rapid clinical and public health responses are required to control diphtheria outbreaks. Three major measures are indicated: high immunization coverage of target groups, prompt diagnosis and management of diphtheria cases, and rapid identification of close contacts with their effective management to prevent secondary cases.
TL;DR: Data suggest transfer from the latter to Listeria species, as well as the tet(M), tet(S), and aad6 genes are common in enterococci and streptococci, suggest uniform susceptibility to tetracycline, minocyCline, trimethoprim, and Streptomycin cannot be assumed any longer for Listerian species.
Abstract: To define the prevalence of antibiotic resistance in Listeria species pathogenic for humans and animals, 1100 isolates (60 from cases of listeriosis and 1040 from food and environment) collected worldwide were screened. Of the 61 tetracycline- and minocycline-resistant strains (37 Listeria monocytogenes), 57 harbored tet(M); 4 non-L. monocytogenes isolates contained tet(S). One Listeria innocua isolate was also resistant to streptomycin and contained the tet(M) and aad6 genes. An L. monocytogenes isolate was trimethoprim-resistant, a characteristic not reported previously in Listeria species, because of the presence of a yet-uncharacterized gene. Three clinical isolates of L. monocytogenes were resistant to low levels of streptomycin. Since the tet(M), tet(S), and aad6 genes are common in enterococci and streptococci, these data suggest transfer from the latter to Listeria species. Uniform susceptibility to tetracycline, minocycline, trimethoprim, and streptomycin cannot be assumed any longer for Listeria species.
Journal Article•
TL;DR: Experiences based on many thousands of patients treated with MDT over the past decade indicate extremely low relapse rates, and the elimination strategy envisages identifying and treating a total of about 5 million cases from 1994 to the year 2000.
Abstract: Leprosy is still an important problem in about 80 countries of Asia, Africa and Latin America, some 2.4 million persons being estimated to have the disease in 1994. The WHO-recommended standard multidrug therapy (MDT) was introduced in the 1980s and has been shown to be effective in combating the disease. Experiences based on many thousands of patients treated with MDT over the past decade indicate extremely low relapse rates (cumulative relapse rates around 1%). By the end of 1993, some 5.6 million patients had been cured, and the global cumulative MDT coverage of registered patients had reached 89%. The number of registered cases fell from 5.4 million in 1985 to 1.7 million in 1994. The significant progress made in leprosy control enabled the World Health Assembly in 1991 to set a goal for eliminating leprosy as a public health problem by the year 2000. One important epidemiological factor is that leprosy is very unevenly distributed: 80% of the problem is confined to only five countries and 92% to just 25 countries. The elimination strategy envisages identifying and treating with MDT a total of about 5 million cases from 1994 to the year 2000. The cost of dealing with these cases has been estimated at US$ 420 million, including US$ 150 million for the drugs.
TL;DR: CNS adverse drug events are dramatic, and case reports have influenced clinical opinion on the use of antimalarials, and data do not suggest a need to diminish the correct use of the quinoline and artemisinin derivatives.
Abstract: CNS adverse drug events are dramatic, and case reports have influenced clinical opinion on the use of antimalarials. Malaria also causes CNS symptoms, thus establishing causality is difficult.
TL;DR: The 'first-generation' vaccines, composed of killed parasites with or without adjuvant, have been derived using an empirical approach and the ' second-generation vaccines have been genetically constructed, using a more rational approach.
Abstract: Unlike some other parasites, Leishmania can be grown in cell-free media with ease. This simple cultivation and the use of killed parasites as skin-test antigens (leishmanin) for diagnosis in humans during the past several decades have prompted scientists to try using the killed parasites, with or without adjuvant, as vaccines or for immunotherapy. In addition, different recombinant molecules, either parasite fractions or genetically engineered organisms (i.e. Leishmania made avirulent by removing specific genes, or bacteria carrying and expressing leishmanial genes), are being investigated as potential future vaccines against leishmaniasis. The 'first-generation' vaccines, composed of killed parasites with or without adjuvant, have been derived using an empirical approach. The 'second-generation' vaccines have been genetically constructed, using a more rational approach. At present, the first-generation vaccines are at various stages of Phase I (safety), II (reactivity) or III (efficacy) trials in humans. Results are expected in 1-2 years. The second-generation vaccines are, however, only in a preclinical state and are not expected to reach clinical trials for at least 3 years. The Special Programme for Research and Training in Tropical Diseases (TDR) is actively involved in most clinical trials of the first-generation vaccines and supports many of the second-generation candidates. In the present article, the advantages and disadvantages of each approach to vaccine development are discussed and the progress being made is briefly reviewed.
TL;DR: In all countries, priority should be given to efforts to reach at least 90% coverage with three doses of diphtheria toxoid in children below one year of age, and in countries where diphTheria has been successfully controlled, immunity levels should be maintained by booster doses.
Abstract: In the past, diphtheria was considered one of the most serious childhood diseases because it took a heavy toll in health and life among preschool-aged children. Prior to the widespread availability of diphtheria toxoid, nearly 70% of cases were in children younger than 15 years of age. In the industrialized countries, immunization against diphtheria became widespread in the 1940s and 1950s. This led to a marked decrease in the incidence of diphtheria. There was also a decrease in circulating toxigenicCorynebacterium diphtheriae organisms, resulting in less natural boosting of antibody levels. This has led to gaps in the immunity of the adult population. Since 1990, diphtheria has made a spectacular comeback in several European countries, with a high proportion of cases in adults. In developing countries, immunization of infants with diphtheria toxoid was introduced within the Expanded Programme on Immunization in the late 1970s. Coverage rose slowly to 46% in 1985 and 79% in 1992. Because the pool of immunized persons is not yet large, the process of maintaining immunity still operates through natural mechanisms, including frequent skin infections caused byC. diphtheriae. But recently, several developing countries where coverage has been high for 5–10 years have reported diphtheria outbreaks. These outbreaks have been characterized by high case fatality rates, a large proportion of patients with complications, and their occurrence in both young and older age groups. In all countries, priority should be given to efforts to reach at least 90% coverage with three doses of diphtheria toxoid in children below one year of age. In countries where diphtheria has been successfully controlled, immunity levels should be maintained by booster doses.
TL;DR: In this paper, depressed patients and non-depressed controls were asked to generate specific memories in response to a series of positive and negative cue words and found no latency bias in recalling memories to negative cues over memories to positive cues.
Abstract: Findings addressing the issue of whether depressed individuals more readily recall negative than positive aspects of their past have been conflicting (Moore, Watts & Williams, 1988; Williams & Scott, 1988). A more consistent finding has been a tendency for depressed individuals to retrieve 'overgeneral' autobiographical memories (Brittlebank, Scott, Williams & Ferrier, 1993; Williams & Scott, 1988). In the current study depressed patients and non-depressed controls were asked to generate specific memories in response to a series of positive and negative cue words. No latency bias in recalling memories to negative cues over memories to positive cues was found. However, the more consistent finding that depressed patients have difficulty generating specific memories was supported.
TL;DR: The impact of a short problem-based training course in pharmacotherapy, using a WHO manual on the principles of rational prescribing, was measured in an international multi-centre randomised controlled study of 219 undergraduate medical students.
TL;DR: Due to the sensitivity of the RAPD technique, isolates can now be analyzed genetically, directly from fecal samples without further biological amplification, which represents a significant advance on current techniques.
Abstract: Genetic variation in 25 Cryptosporidium isolates was analyzed using the random amplified polymorphic DNA (RAPD) technique. Simple reproducible polymorphisms were generated (using five primers) from Cryptosporidium DNA that was free of contaminating bacterial DNA. The results generated by four of the five primers were statistically correlated (P < 0.001). The combined data from three primers were used to construct a phenogram using Jaccard's distance. Four groupings could be distinguished. Two C. serpentis isolates from snakes formed a distinct group of their own, whereas C. parvum isolates were divided into two main groups: one containing most human isolates and the other containing mostly domestic animals plus two remaining human isolates. Due to the sensitivity of the RAPD technique, isolates can now be analyzed genetically, directly from fecal samples without further biological amplification. This represents a significant advance on current techniques.
TL;DR: There is sufficient evidence to suggest that it is widely distributed and is found at significantly high prevalence in some populations of animals, and the public health threat of tuberculosis in Africa requires urgent investigation through collaborative veterinary/medical research programmes.
Abstract: The epidemiology of Mycobacterium bovis infection in animals and humans is described, together with a review of available reports on the distribution and prevalence of this mycobacteriosis in Africa. The significance of these reports is considered, with particular emphasis on the potential zoonotic importance of bovine tuberculosis as a cause for public health concern in Africa. Published data describing tuberculosis in Europe in the 1930s and 1940s show that bovine tuberculosis was considered to be a significant zoonosis: M. bovis was responsible for more than 50% of cervical lymphadenitis cases in children. Despite the paucity of information on M. bovis infection in Africa, there is sufficient evidence to suggest that it is widely distributed and is found at significantly high prevalence in some populations of animals. Some epidemiological conditions for the spread of M. bovis infection between animals and humans are very similar in Africa today to those in Europe in the 1930s, with the added and potent impact of the epidemic of human immunodeficiency virus infection. The public health threat of tuberculosis in Africa requires urgent investigation through collaborative veterinary/medical research programmes.
TL;DR: This first cross-cultural attempt to examine aspects of sexual lifestyles suggests that broad generalizations about multiple-partner sexual networking in particular regions are misleading.
Abstract: 18 sample surveys conducted in 1989-1993 of male and female respondents aged 15-49 years reporting sex with a nonregular partner in the preceding year were analyzed The proportion of men ranged from 4% to 47% and women from 1% to 19% In the five Asian sites 10-20 times more men than women reported nonregular sex Among the 18 surveys the proportion of men reporting five or more partners in the last 12 months varied from 0% in Sri Lanka and Hong Kong to 11% in Thailand; for women the level never exceeded 3% The proportion of male respondents with more than five nonmarital partners was consistently highest among those aged 25-34 years A significant relationship was found between the prevalence of premarital sex among 15-24 year old youths and the prevalence of nonregular sex among adults for both men and women (R2 = 043 for men; R2 = 057 for women) Prevalence of all men aged 15-49 years reporting commercial sex ranged from 1% to 25% with a median of 97% Among women the corresponding figures were <1% in nine countries but ranged up to 11% in Tanzania with a median of 13% In 1989-93 the proportion of men who never used a condom on these occasions in the last year varied from approximately 25% in Singapore to 80% in Togo Tanzania Manila and Rio In Lusaka and Burundi two areas where the HIV epidemic and the awareness of AIDS were already high more than 50% of men reported regular or occasional use of condoms Youthful age and unmarried status emerged as net predictors of risk behavior in eight of the 12 sex-specific study groups by multivariate analysis Among men significant positive associations between educational level and risk behavior were found in three of the six sites and among women in two of the four sites Regular alcohol drinking was also strongly correlated with risk behavior in most surveys but perceived vulnerability to HIV was not
TL;DR: Lens opacities were associated with lower levels of riboflavin, vitamin E, iron, and protein nutritional status, and the findings are compatible with the dietary intake and medical history results of the Lens Opacities Case-Control Study.
Abstract: Objective: To evaluate associations with biochemical indicators of nutritional and other risk factors in the Lens Opacities Case-Control Study. Design: Case-control study. Setting and Participants: The Lens Opacities CaseControl Study determined risk factors for cortical, nuclear, and posterior subcapsular opacities among 1380 participants aged 40 to 79 years. Data Collection: Vitamin E, selenium, and biochemistry profile determinations were performed on all patients; red blood cell enzymes and amino acids were measured in systematic samples of about25% of the Lens Opacities Case-Control Study population. Outcome: Laboratory test values in cases and controls were compared and expressed as odds ratios and 95% confidence intervals. Results: In polychotomous logistic regression analyses controlling for age and sex, the risk of opacities was reduced to less than one half in persons with higher levels of vitamin E (odds ratio, 0.44 for nuclear opacities), albumin-globulin ratio (odds ratio, 0.41 for mixed opacities), or iron (odds ratio, 0.43 for cortical opacities); higher uric acid levels increased risk (odds ratio, 1.74 for mixed opacities). Persons with opacities were twice as likely to have high glutathione reductase activity (with flavin adenine dinucleotide), which suggests low riboflavin status (odds ratio, 2.13). Most odds ratios for amino acids were under unity and were significantly decreased for glycine (0.36) and aspartic acid (0.31). Conclusions: Lens opacities were associated with lower levels of riboflavin, vitamin E, iron, and protein nutritional status. Higher levels of uric acid increased risk of mixed opacities. The findings for riboflavin, vitamin E, iron, and uric acid are compatible with the dietary intake and medical history results of the Lens Opacities Case-Control Study.