bluuebunny/crossref_metadata_2025 huggingface dataset:
Appropriate Sanitation Technology for the Decade in Africa
Authors: Diamant B.Z.
Published: September 2007

THE INTERNATIONAL Drinking Water Supply and Sanitation Decade, launched by the General Assembly of the United Nations on 10 November 1980, had been based on the severe findings of the Global Survey on Water Supply and waste water Disposal, carried out by the World Health Organisa tion during 1970-80. These findings revealed that only one out of four rural people living in the developing countries had safe drinking water, and only one out of five had proper sanitation facilities. The U.N. Decade has been launched with the goal of providing "Clean Water and Adequate Sanitation for All by 1990".

In order to achieve this goal, of one of the most ambitious U.N. programmes (estimated cost — $300 billion), the involved activities must be based on 4 major principles: The two components of the program me — water supply and sanitation — must be mutually and simultaneously developed; this development has to be carried out according to appropriate technology practices and mass-production techniques; the emph asis must be laid on the rural areas; adequate health education has to be included in all stages of the programme, namely, planning, design, construction, maintenance and surveillance.
The Core Curriculum in Diagnostic Radiology Residency Training
Authors: Heller Richard M. , Partain C. Leon , Kirchner Sandra G. , Winfield Alan C. , Chapman John E. , James A. Everette
Published: September 2007

THE CONSTRUCTION of a core curriculum in diagnostic radiology, medical imaging and radiological sciences requires an understanding of the historical context in which the current technological advances of the last two decades are seen in the perspective of traditional radiology. The future trainee in this discipline will require an additional background in physics, engineer ing and computer sciences as well as in-depth clinical kills in the basics of diagnostic imaging. The formula tion of future training programmes must provide appropriate experience in the newer imaging modali ties, such as computed tomography, real time ultra sound, digital radiology, nuclear magnetic resonance and positron emission tomography by building on a broad and complete foundation of core subjects. This communication will discuss a suggested core curriculum from the aspect of the desired results of the prog ramme.
Epidemiology of Motor Vehicle Accidents in a Developing Country — A Case of Oyo State of Nigeria
Authors: Jinadu M.K.
Published: September 2007

IN this paper morbidity and mortality data from motor vehicle accidents (MVA) or road traffic accidents (RTA) as known in the West and other epidemiological variables of the MVA in Oyo State of Nigeria, between 1979 to 1982, were studied. Popula tion exposure to severe MVA during the period was 34/100,000 of which 7.4 per the same population died. Over two-thirds of the MVA occur among children and young adults.

More accidents occur during the Christmas and Easter periods of the year and weekends. There were no seasonal variations in the pattern of the accidents. Commercial vehicles were responsible for a significant proportion of the accidents. The primary causes of the MVA were the drivers who lacked proper driving education, who were often impatient on the wheels, inexperienced and drunk.
Factors Influencing Nutritional Knowledge of Teachers
Authors: Yong Mazlan B.
Published: September 2007

THE RELATIONSHIPS of ethnicity, father's occupation, sex and respondent's academic major with nutritional health knowledge were studied on a sample of Malaysian teachers using a self-administered questionnaire. Results indicated that the level of nutritional health knowledge is low and dependent on sex but not on ethnicity, respond ent's academic major and father's occupation. The need for males and physical education majors to improve their levels of nutritional health knowledge is indicated.
Stigmatized Illnesses In Africa
Authors: Emeharole P.O.
Published: September 2007

THIS PAPER is an empirical documentation of an epidemiological approach for detecting stigmatised illness in a rural African community, without at the same time igniting the 'flame' of stigmatisation. A mobile team of public health professionals in Imo State of Nigeria in collaboration with the author, conduced a 'masked' health survey of a pilot area.

The goal was to detect new cases of leprosy and tuberculosis which had been confined to their 'shell' on account of stigmatisation syndrome often associated with the two ailments. This goal was camouflaged in a spectrum of screening and other prophylactic measures while the outcome (new cases) was determined by blind assessment.

An analysis of the outcome of the screening exercise performed on 7845 and 6468 villagers, screened for leprosy and tuberculosis respectively, resulted in an overall incidence of 2.0 and 2.2 new cases of leprosy and tuberculosis. This predicament was seen as being con founded in two 'mutable' variables, namely complacency on the part of the population at risk and inadequate surveillance on catchment areas by public health agencies. Suggestions advanced for improving control measures include a joint collaborative arrangement by the three-type authorities responsible for the three-sector battle against leprosy namely control measures, treatment of cases and rehabilitation of ex-lepers.
Genital Factors with Tetanus in Nigerian Women
Authors: Unuigbe J.A.
Published: September 2007

THIS STUDY considers 53 adult females treated for Tetanus infection at the University of Benin Teaching Hospital, Benin City, from 1978 to 1984. A total of 50 patients (94.3%) were in the repro ductive years; 33 (62.3%) were parous women; and a majority of 28 patients (52.8%) were illiterates whose level of hygiene was unacceptably low.

A significant proportion of patients (32.1%) had the Tetanus portal of entry clinically traceable to genital sepsis (notably postabortal and puerperal sepsis) while in 10 patients with no evident focus of Tetanus infec tion, 60% presented in the first half of the menstrual cycle. This finding draws attention to the probable aetiological role of the genital tract at menstruation as the source of Tetanus infection in a small but significant number of adult female patients in our community. Improved hygienic habits during menstruation should be emphasised to eliminate Tetanus infection in this group of women.
Skin Cancers in Australia's Northern Territory 1981-85
Authors: Saint-Yves Ian F.M. , Honari Morteza
Published: September 2007

SKIN CANCERS are commonly registered in the Northern Territory, where they largely affect the non-Aboriginal population. The trends in annual registration, the numbers and site distribution of Basal Cell carcinoma, Squamous Cell carcinoma and Malig nant Melanoma are described, together with the Age- Specific Incidence rates for these lesions. Some factors concerned with the low incidence of Malignant Mela noma are considered.
Juvenile Periodontitis (Periodontosis) in a Nigerian Teaching Hospital
Authors: Kulasekara Bertram
Published: September 2007

A STUDY OF the pattern of juvenile periodontitis (periodontosis) as observed in the University College Hospital, Ibadan was carried out, through a period of one year.

The age group was only confined from 14-25 years, and the patients selected for the study were only those patients in the above age group reporting to the Hospi tal's Dental Centre, immaterial of what the patients' main complaint was. It was revealed that there was a high rate of patients attending this Institution with juvenile periodontitis.

Further it is quite alarming to note that all the patients examined on their first visits had a clinically observable and detactable chronic gingivitis, some even transitioned to a chronic periodontitis. Routine investigations further revealed a few cases of undetected diabetes and one case of Papillon-Lefevre Syndrome (hyperkeratosis palmoplantaris).
Altered State of Consciousness in Adult Ethiopians: Analysis of Aetiological Factors
Authors: Endeshaw Yohannes , Haimanot Redda T.
Published: September 2007

A PROSPECTIVE STUDY to determine the rela tive incidence of diseases causing altered state of consciousness in patients admitted to the medi cal wards of the Tikur Anbessa University Teaching Hospital, Addis Ababa, Ethiopia was undertaken. 300 consecutive patients with altered state of consciousness were included in the study. The majority of patients were below 40 years of age. The causes for altered state of consciousness were metabolic in 125 (41.7%), infectious in 101 (33.7%) and neurological diseases in 64 (21.3%) patients. Hepatic encephalopathy, found in 74 patients (24.7%) was by far the commonest medical cause of altered state of consciousness. In 10 patients (3.3%) no definite diagnosis could be reached. 173 (57.7%) patients died. The age and disease patterns were found to be different from those seen in Europe and North America.
Infant Feeding in King Khalid University Hospital
Authors: Anokute Charles C.
Published: September 2007

SURVEY was carried out in King Khalid University Hospital between January 1985 and May 1986 to study the pattern of infant feeding. It was found that 76% of the respondents favoured breast-feeding while 58% preferred breast feeding only.

About 51 % of the mothers started weaning their chil dren between 6-12 months, while 21% weaned between 12-18 months. The most important reason for stopping breast-feeding was in order to have another pregnancy; this reason was more common among mothers who had female babies than males. An association was found between this reason and parity with an odds ratio of 2.9.
Growth Patterns in Saudi Arabian Children
Authors: Wong Simin Saedi , Al-Frayh Abdul Rahman
Published: September 2007

THE MEASUREMENTS of head and chest circumferences of 6623 Saudi Arabian pre-school children are presented for the first time. The data were collected through a large scale cross-sectional growth study carried out in Riyadh, the capital of the Kingdom of Saudi Arabia. The results indicate that the average head and chest circumference measurements of the girls were smaller than the boys in all age groups. The analysis of variance results confirmed that these differences were statisti cally significant.

The date indicated that among the average-build (the 50th centile) pre-schoolers, the head circumference measurements of the newborns were larger than the chest circumference measurement by 4.5%. By one year of age, these measurements were equal. After one year, the chest circumference grew larger than the head circumference. However, among the small-build pre- schoolers (the 3rd centile), the chest circumference measurements did not reach the head circumference measurements until nearly 30 months after birth.
Developing AIDS Counselling Services: Problems and Problem-Solving
Authors: Bor Robert , Miller Riva
Published: September 2007

AIDS counselling is vitally important in the pre vention of HIV transmission. It is also widely used in the context of patient management. Culturally sensitive counselling approaches need to be developed for the African setting. Establishing coun selling services requires problem-solving, managerial interventions and interpersonal skills, much the same as an AIDS counselling interview. A framework for problem-solving is described in this paper.
Water Contamination in North Cornwall: A Retrospective Cohort Study into the Acute and Short- Term Effects of the Aluminium Sulphate Incident in July 1988
Authors: Rowland A. , Grainger R. , Smith R. Stanwell , Hicks N. , Hughes A.
Published: September 2007

IN JULY 1988 the drinking water supply of part of Cornwall was contaminated with 20 tons of aluminium sulphate solution. Emergency measures ensured that aluminium sulphate levels in most parts of the water distribution system were rapidly reduced, but residents were supplied with water containing raised concentra tions of aluminium and other metals for at least a few days. A retrospective cohort study compared 480 individuals in the exposed area with 532 individuals resident in an area served by a different water supply. The exposed group were more likely to complain of all 18 symptoms in the questionnaire enquiry. They had a significantly higher relative risk of experiencing painful joints. These symptoms were reported by less than a quarter of the respondents exposed to contaminated water. This may represent a previously unrecognised acute effect of water contammation with aluminium sulphate, but the study does not exclude the possibility that the threshold for symptom reporting was lowered by anxiety and by the publicity associated with the incident. The overall response rate of the study was low (45%) and reflects the difficulties in both carrying out and interpreting environmental epidemiological studies of acute incidents.
Growth Patterns of Adolescents in Bahrain
Authors: Mater Ahmed M. , Alekri Sadiq A. , Mahdi Abdul-Rasool E. , Musaiger Abdulrahman O.
Published: September 2007

WEIGHT AND height of adolescents in Bahrain (15.5-19.5 years) was measured to evaluate their growth patterns. A cross-sectional survey was done on 825 students that represented 5% of total secondary students. The results showed that median height and weight of Bahraini adolescents were below the 50th percentiles of the Western standard. However, when compared with earlier surveys in Bahrain, the growth pattern has improved. This is because of improvement in health and in the environment.
Epidemiologic Studies of Diabetes Mellitus in Saudi Arabia - Part I — Screening of 3158 Males in King Saud University
Authors: Anokute Charles C.
Published: September 2007

A 14%, simple random sample of the King Saud University Community consisting of students, faculty and staff was screened for diabetes mellitus. The screening procedures used consisted of rine testing by means of the urine dipstick and blood glucose estimation in the fasting state by means of the reflomat glucose, a glucose oxidase meter. Participants whose fasting blood glucose (FBG) were 140 mg/dl or more were referred to the diabetes clinic for further evaluation and possible inclusion into the subsequent retrospective study. A period prevalence of 6.0% was observed for FBG > 140 mg/dl and all the referrals were confirmed for adult onset diabetes mellitus.

The prevalence was similar to that in the USA and suggested that the rapid socio-economic changes in Saudi Arabia made a minimal contribution to the prevalence of diabetes mellitus.
Some Sociodemographic Factors Influencing the Nutritional Awareness of the Saudi Teens and Adults: Preliminary Observations
Authors: Al-shoshan Ahmed A.
Published: September 2007

THREE HUNDRED and eleven (311) Saudi visitors (teenagers and adults) participated in a nutritional awareness and anthropometric study in a Health Week Exhibition campaign sponsored by the Ministry of Health in 1408 H (1988).

The study revealed that the average adult male and female heights were 167cm and 155cm against the American standard heights of 178cm and 163cm respectively. Adult females weighed more than males (43.2% vs 19.8%), and the married subjects of both sexes were heavier than the unmarried subjects (male: 15.4% vs 4.4%; female: 35.1% vs 8.1%).

A good number of subjects consumed a variety of foods from the four food groups daily which reflected a good trend in food and nutrition awareness. However, the study emphasizes the importance of nutrition education and propagation for the improvement of general health and nutritional status of the population.
Playground Injuries: A Scientific Appraisal of Popular Concerns
Authors: Ball David J. , King Karen L.
Published: September 2007

THE WIDESPREAD public concern in Britain over childhood injuries arising from playground accidents is examined using a new national data base on leisure accidents managed by the Department of Trade and Industry. Popular beliefs about the level of risk, the nature and cause of injury, and remedial measures are found to be unsupported by the analysis. Playground risks are comparatively low; accident causes are diverse and most involve long bone injuries and not head injuries as has been widely reported; and the cost of some popular risk reduction measures would seem to be incommensurate with the reasonably-antici pated risk reduction which they might afford. It is suggested that for those who wish to reduce risk further, consideration should be given to increasing public awareness of the many causes of risk, of the opportunities which the individual has to control risk, and of the inevitability of residual risk.
The Present and Future Handling of the Mentally Disturbed Offender (Part 1)
Authors: Wool Rosemary
Published: September 2007

POLICY IS firmly set at diverting mentally dis turbed offenders from the Criminal Justice System and into the care of the health or social services. Projects and research are in place designed to facilitate this with improved arrangements for psychia ric assessments.

Co-existence of the agencies involved in the treatment of mentally disturbed offenders implies readiness of each to accept patients whose security needs are downgraded. This would be facilitated by a review of medium security and long term provision. Meanwhile, th e Prison Service must seek to do what it can to care for those placed in its charge.
Perceptions and Reactions of The Public to Diarrhoea
Authors: Philipp Robin , Wood Neil , Heaton Kenneth W. , Hughes Anthony O.
Published: September 2007

A questionnaire about diarrhoea and how people react to it was answered by 400 people aged 16-70 years, most of whom were in employment (77% of respondents). There was wide varia tion in perceptions and reactions. Older persons and people in skilled trades were more likely to consider any increased bowel looseness or frequency of their usual bowel habit as diarrhoea, compared to younger persons and people in professional and managerial positions. Over half the respondents rated a single soft stool as diarrhoea, and almost a third accepted likewise an increased frequency of defaecation. The most unpleasant aspect of diarrhoea was considered to be incontinence with soiling of underclothes.

At the onset of diarrhoea, 16% of respondents would not wait even a day or two but would go straight to a pharmacist, and 8% would go direct to a doctor. Persons in professional and managerial positions were less likely to attend their doctor straight away than people in other occupational groups.

The findings show that for improved clinical management and public health surveillance, health professionals should not accept the term when it is used by patients, but seek details of their defaecation patterns and the form of their stools. Improved public education is needed as to self-help, appropriate treat ment and when to seek pharmaceutical and medical advice.
Insecticides Against Headlice in Glasgow
Authors: Lindsay Steven W. , Peock Susan
Published: September 2007

A postal questionnaire for describing current practices of insecticide usage for the prevention and treatment ofpediculosis was sent to 53 pharmacists in Glasgow. 91% returned completed questionnaires.

Between 19,000 to 36,000 bottles of insecticide against headlice were bought by the public in Glasgow in 1991. Most of these were sold in small volumes (less than 100 ml) and sales were highest during the autumn. Although pharmacists sold a range of different classes of insecticide, the most popular were those that contained malathion, the treatment for pediculosis recommended by the Health Board. Choice of treatment was probably influenced by advice given to the public by pharma cists and general practitioners. Clients preferred shampoo formulations. There was evidence that treatments were used prophylactically against headlice. However, there was little indication of large scale resistance to insecticides in the louse population. The results indicate that headlice remain a persist ent problem in Glasgow, despite the public adhering to the advice of health professionals.
Risk Factors for Spontaneous Abortion: A Preliminary Study on Saudi Women
Authors: Al-Ansary Lubna A. , Babay Zainab A.
Published: September 2007

A preliminary case-control study was conducted on Saudi women to detect possible risk factors for spontaneous abortion (SA). Two hundred and twenty six consecutive women hospitalised for SA and 226 women admitted for normal delivery and used as controls, were studied. Women with SA were significantly older at menarche (Relative Risk (RR) = 3.2), more frequently married to blood-related husbands (RR = 2.1) and husbands older than 50 years (RR = 2.4). Number of previous abortions related linearly to the risk of aborting spontaneously in the next pregnancy. Compared to primigravidas, the RR was 3.2 if the outcome of the most recent pregnancy was SA, and 0.8 if it was a livebirth. A family history of SA was more common among cases (RR = 4.6). Spontaneous abortion was also associated with daily consumption of more than 150 mg of caffeine, abdominal trauma, infection and fever during pregnancy. No significant association, however, emerged with mater nal age, social class, education, exposure to video display terminals, parity, use of contraception, diabetes or obesity. The application of these data in clinical practice and future research needs are discussed.
Pregnancy Experience, Knowledge of Pregnancy, Childbirth and Infant Care and Sources of Information among Obstetric Patients at King Khalid Hospital, Riyadh
Authors: Talal Jamil Hashim
Published: September 2007

One hundred obstetrics patients were interviewed at King Khalid Hospital (Saudi Arabia) concerning their current pregnancy experience, knowledge of pregnancy and child care and sources of information on these topics. Interviews were conducted and a short knowledge test given to nul liparous, primaparous and multiparous patients. The over all mean score of respondents was 50.4%. Significant information deficits existed in: the implications of pre scription drugs and dental care during pregnancy; time of conception; when to contact a physician for personal care. Nulliparous patients scored lower, and information deficits appeared in: when to call a physician for infant care, immunization for newborns and events during pregnancy. Respondents did not perceive physicians and nurses as significant sources of information when compared with alternative sources.
Knowledge, Attitude and Practice towards AIDS among civil servants in Nigeria
Authors: Okojie O.H. , Ogbeide O. , Nwulia A.
Published: September 2007

A study about knowledge, attitude and practice (KAP) towards AIDS was carried out amongst 340 randomly selected workers in Benin City in Nigeria using self-administered questionnaires.

Three hundred and thirty (97.1%) of the workers were aware of the existence of AIDS but only 50 (14.7%) had the correct knowledge of the aetiology of AIDS, and of these 29 (8.5%) had tertiary education. Generally there was a good knowledge of the different routes of transmission except for the erroneous belief by a high number, 125 (36.8%) and 129 (37.9%) that it could be transmitted through sharing of utensils and casual kissing respectively.

The attitude to AIDS sufferers is poor and 156 (45.9%) actually think they should be ostracized.

Twenty-one (6.2%) of the respondents still keep multiple sexual partners while 142 (41.8%) would willingly use the condom for safer sex.

There is therefore the need for an intensive and effective health education campaign to combat this deadly disease in the country.
HACCP implementation in food businesses: the need for a flexible approach
Authors: Ehiri John E , Morris George P
Published: September 2007

There is a considerable literature on microbiological hazards which cause food- borne diseases and illnesses, and factors which influence their occurrence and growth in foods. Similarly, stages in the food chain where foods may be mishandled, and practices which often lead to outbreaks of food-borne diseases are well documented. Although these hazards and practices can be controlled in order to prevent or minimise risks to health, food- borne diseases have continued to present a serious challenge to public health. Because the traditional approaches of inspection and end-product testing have proved inadequate in tack ling the problem of food-borne diseases, there is an urgent need to apply more rational and effective strategies. One such strategy is the Hazard Analysis, Critical Control Points (HACCP) system which is currently in international discussion. This paper examines the epidemio logical basis for the application of HACCP to food safety control and describes its advantages. It is concluded that to realise the objectives of HACCP, a flexible and simple approach is needed in its practical application across food businesses. Any argument that the system cannot be applied without fully developed and well structured food systems will ultimately reduce its potential usefulness in food safety control.
Simulation modelling for resource allocation and planning in the health sector
Authors: Lehaney Brian , Hlupic Vlatka
Published: September 2007

This paper provides a review of the use of simulation for resource planning in the health sector. Case examples of simulation in health are provided, and the modelling prob lems are explored. The successes and failures of simulation modelling in this context are examined, and an approach for improving the processes, and outcomes, by the use of soft systems methodology, is suggested.
Obesity in Bahraini Adults
Authors: Al-Mannai Awatif , Dickerson J W T , Morgan Jane B , Khalfan H.
Published: September 2007

In this study the prevalence of obesity and the demographic factors associated with it were analysed on 290 adult Bahraini individuals, of whom 137 were males and 153 were females. The overweight and obesity prevalence rates, using the Body Mass Index (BMI) as a criterion, were 26% and 16% in males and 29% and 31% in females, respec tively. The prevalence of underweight (BMI< 20) was 16.8% and 11.8% in the males and females respectively. The mean body fat percentage of females, calculated from the skinfold measurements, was 35%; the fat percentage of males was 18.6%. Bahraini women had greater fat deposition in the subscapular region than the amount reported for American women. Females and males living in urban areas had a greater tendency to be obese than those residing in rural areas. Marriage, ownership of a car as well as a large family (> 7 mem bers) were positively associated with obesity; unmarried women were more likely to be underweight than married women. The educational level was not associated with obesity in either the males or females. The age of adult females was not found to be associated with obesity, whereas in males the incidence of obesity was more frequent among those who were 50 years of age and above than under 50 years of age. Family monthly income was not asso ciated with the incidence of obesity. The high prevalence of overweight and obesity in the women reported in this study and the difference in the distribution of body fat suggest that genetics may be a determinant factor of this disorder in Bahrainis but certainly social fac tors are also important.
Raising food hygiene standards- could customer power and the new laws hold the key?
Authors: Leach J.C.
Published: September 2007

In September 1995 new general food hygiene regulations came into force. The new law, quite rightly, requires proprietors of food businesses to focus their thoughts and actions on risks to food safety. Proprietors are required to identify and assess risks and ensure that adequate management procedures are put into place to ensure food safety. This is a welcome move as contributing factors in most cases of food poisoning involve poor food hygiene practices. At the same time there has been a large increase in the amount of advice and guidance to local authority enforcement officers, particularly to assess risks to food safety when considering what action to take in any situation - the lower the risk the less appropriate it is to take legal action.

However, there are many conditions found in food premises which present little or no risk to health, such as routine cleanliness in non-high risk areas, but lower standards on these might be viewed by the public as inappropriate for food businesses. With an increasing amount of choice available to customers, proprietors and managers of food businesses need to be more aware than ever of the complex pattern of consumer demands including that of supplying a clean and safe product in its broadest sense. The notion of consumer sovereignty is not a new concept. Combined with the new laws could it hold the key to genuine improved standards in food hygiene? This article reviews the subject and draws attention to a research programme being undertaken at the University of Brighton to identify, compare and contrast factors which the public perceive as important in terms of food hygiene in public eating places with those considered important by professionals with an interest in the subject. The results could bring benefits to the catering industry and customers.
Exercise by prescription
Authors: Browne Derek
Published: September 2007

General Practitioners (GPs) see over 90% of their practice population in three years. Over 50% of the adult population is below the perceived level of physical activity as recognised by the Allied Dunbar Physical Activity score (Allied Dunbar, Health Education Authority and Sports Council, 1992). Physical fitness levels in adolescents and children are declining, while the incidence of obesity is increasing. GPs, with their Primary Health Care Team, are in a unique position to be able to discuss the health benefits of regular physical activity with their patients during the consultation and offer, if appropriate, a prescription for a course of physical activity to a local leisure centre or community activity centre.

Many communities have facilities for physical activity. These include leisure centres, schools, village and church halls, the home and the general practice surgery. A directory of resources for physical activity for all age groups should be available in the surgery waiting room area.

A community co-ordinator can network community facilities and resources to meet individual need. The co-ordinator can be funded by the general practice surgery, Health Authority, Local Authority, Parish or District Council. An agreed protocol for exercise prescription referrals to suitable community facilities can benefit patient health care for a variety of medical, surgical, social and mental conditions. Auditing exercise prescriptions shows a health benefit, with improved quality of living and reduced prescription medicines.
Home visits to elderly patients in Saudi Arabia
Authors: Al Shammari S.A.
Published: September 2007

The present study was conducted to examine the perception of participating physicians in hospital and primary health care (PHC) on the nature of illness that requires home visits, type and job description of health personnel that should make home visits and other prerequisites needed for successful home visits.

A predesigned questionnaire consisting of demographic and professional characteristics of doctors was sent confidentially to randomly selected PHC and hospital doctors during the period January to June 1994. The respondents were asked to give their opinion on the categories of health problems that necessitate home visits, job descriptions of various professionals needed and the prerequisites for the successful running of home visits.

Three hundred and ninety-six PHC and 238 hospital doctors participated in the study. PHC doctors were younger, having more females and less qualified than hospital doctors. Both PHC doctors and hospital doctors gave priority to bed-ridden patients and lowest priority to mobile chronically ill patients. PHC doctors were more keen on home visits than hospital doctors. More PHC doctors than their hospital counterparts would like nurses and health visitors to be involved in nursing procedures performed at home except when it comes to notifying doctors about patients' problems. In case of stroke more hospital doctors would like physiotherapists to be involved than PHC doctors and vice versa in the case of osteoarthritis. Most PHC doctors preferred occupational therapists involve ment in training patients and the modification of their environment to lead independent lives. More hospital doctors than their PHC counterparts preferred afternoon sessions for home visits.

The respondents' views in the present study can be made use of in establishing a home visit programme to the Saudi elderly in need of such services. In addition, the number, qualifications and responsibilities of the various professionals involved in the visit should be re-evaluated after adequate implementation.
Lessons to be learned: a case study approach
Authors: Donaldson D.
Published: September 2007

The case is presented of a 14 year old boy who developed severe anaemia at the onset of puberty caused by nutritional deficiency of vitamin B12 of about 10 years duration. The dietary intake comprised mainly chips, ice-cream, fruit and Coca-Cola - with small amounts of vitamin B 12 from occasional slices of chicken meat. His denial of abnormal nutritional intake, supported by his mother, delayed confirmation of the correct diagnosis. However, the true situation was eventually confessed - and following implementation of a normal diet he rapidly improved clinically, the haemoglobin value rose to normal and he subsequently remained well.
Taking the threat out of threatening questions
Authors: Vinten Gerald
Published: September 2007

A major threat to the validity and reliability of health and social surveys is that questions asked are regarded as threatening. This leads to the unpredictability of social desirability bias, which can skew responses in a variety of directions. The types of situations in which this may occur are outlined, together with a ten point approach that will assist in overcoming the problems.
Health Promotion, Environmental Health and Agenda 21
Authors: Scriven A. , Young S.
Published: September 2007

In 1992, at the Rio Earth Summit, many governments, including our own, committed themselves to developing local strategies for sustainable development in the form of Local Agenda 21. Sustainable development is discussed, as is the philosophy and practice of health promotion and environmental health. Common approaches are identified and the links in relation to key areas of activities, strategies, values and principles are outlined. Finally, recommendations are made and conclusions drawn in relation to the overlap between environmental health action, Agenda 21 strategies and health promotion practice.
Immunisation coverage at a well-baby clinic in the United Arab Emirates
Authors: Mcllvenny Shirley , Barr John
Published: September 2007

The United Arab Emirates Survey of Immunisation Coverage by UNICEF in 1990 showed that the coverage for UAE infants up to one year of age was 60%. The objective of this study was to determine factors associated with attendance and immunisation uptake at a well-baby clinic. A birth cohort of 665 infants were selected and their records examined to determine the factors such as gender, distance of housing area from clinic and access to other primary health care facilities. Only 22% attended all the scheduled visits and 54.3% of the sample completed the immunisation program within the correct time. The distance the infant lived from the clinic was the only factor significantly affecting immunisation uptake. The identification and targeting of groups at high risk of delayed completion of the immunisation program is a necessary risk factor in improving future surveillance.
Time Course of Trunk, Arm, Leg, and Functional Recovery After Ischemic Stroke
Authors: Verheyden Geert , Nieuwboer Alice , De Wit Liesbet , Thijs Vincent , Dobbelaere Jan , Devos Hannes , Severijns Deborah , Vanbeveren Stefanie , De Weerdt Willy
Published: September 2007

Background. Patterns of recovery provide useful information concerning the potential of physical recovery over time and therefore the setting of realistic goals for rehabilitation programs. Objective. To compare the time course of trunk recovery with the patterns of recovery of arm, leg, and functional ability. Methods . Consecutive stroke patients were recruited in 2 acute neurology wards. Participants were evaluated at 1 week, 1 month, and 3 and 6 months after stroke. Patients were assessed with the Trunk Impairment Scale, Fugl-Meyer arm and leg test, and Barthel Index. Results. Thirty-two patients were included in the study. There were no dropouts. Repeated measures analysis of the recovery patterns of motor and functional performance revealed the most striking improvement for all measures from 1 week to 1 month ( P value between .0021 and <.0001) and a significant improvement from 1 month to 3 months after stroke ( P value ranges from .0008 to <.0001). No significant improvement was found between 3 and 6 months after stroke for any of the measures. Statistical analysis revealed no significant difference between time course of trunk, arm, leg, and functional recovery ( P = .2565). No significant differences in level of motor and functional recovery were found at the different time points. Conclusions. Separate analyses of motor and functional recovery patterns after stroke confirm the importance of the first month for recovery. Contrary to common belief, the time course of recovery of the trunk is similar to the recovery of arm, leg, and functional ability.
CXCL10-CXCR3 interactions play an important role in the pathogenesis of acute graft-versus-host disease in the skin following allogeneic stem-cell transplantation
Authors: Piper Karen P. , Horlock Claire , Curnow S. John , Arrazi Julie , Nicholls Sarah , Mahendra Premini , Craddock Charles , Moss Paul A. H.
Published: September 2007

Acute graft-versus-host disease (aGVHD) remains a serious complication following allogeneic stem-cell transplantation (SCT), and is mediated by infiltration of alloreactive donor T cells into recipient tissue. Chemokines and their receptors play a central role in controlling the recruitment of T cells into discrete tissue sites, and determine the clinical features of GVHD in murine models. In this study, we have analyzed the serum concentration of molecules that control leukocyte migration in serial samples from 34 patients following allogeneic SCT. The chemokine CXCL10 (IP-10) was significantly elevated (> 2-fold) in serum at the time of aGVHD. Because the ligand for CXCL10 is CXCR3, the number of CXCR3+ T cells was determined in peripheral blood, but was not increased during episodes of GVHD. To investigate the role of chemokines in the recruitment of T cells to the anatomic site of GVHD, skin biopsies were stained for CXCL10 and CXCR3 expression. CXCL10 expression was observed in the basal keratinocytes of the epidermis in patients with GVHD together with positive staining for CXCR3 on cells in dermal infiltrates. These findings indicate that CXCL10 plays a central role in the pathogenesis of skin aGVHD by the recruitment of CXCR3+ T cells to the sites of inflammation.
FGFR-1 regulates angiogenesis through cytokines interleukin-4 and pleiotrophin
Authors: Magnusson Peetra U. , Dimberg Anna , Mellberg Sofie , Lukinius Agneta , Claesson-Welsh Lena
Published: September 2007

The role of fibroblast growth factors (FGFs) in blood vessel formation has remained unclear. We used differentiating stem-cell cultures (embryoid bodies) and teratomas to show that FGF receptor-1 (FGFR-1) exerts a negative regulatory effect on endothelial cell function in these models. Embryoid bodies lacking expression of FGFR-1 as a result of gene targeting (Fgfr-1−/−) displayed increased vascularization and a distinct, elongated vessel morphology. Teratomas derived from FGFR-1–deficient stem cells were characterized by an increased growth rate and abundant, morphologically distinct vessels. Transmission electron microscopy of the Fgfr-1−/− teratomas showed a compact and voluminous but functional endothelium, which anastomosed with the host circulation. The increased vascularization and altered endothelial cell morphology was dependent on secreted factor(s), based on the transfer of the Fgfr-1−/− vascular phenotype by conditioned medium to Fgfr-1+/− embryoid bodies. Antibody and transcript arrays showed down-regulation of interleukin-4 (IL-4) and up-regulation of pleiotrophin in Fgfr-1−/− embryoid bodies, compared with the heterozygous cultures. We used neutralizing antibodies to show that IL-4 and pleiotrophin act as negative and positive angiogenic regulators, respectively. We conclude that FGFR-1 negatively regulates endothelial cell function by altering the balance of modulatory cytokines.
Wnt signaling promotes hematoendothelial cell development from human embryonic stem cells
Authors: Woll Petter S. , Morris Julie K. , Painschab Matt S. , Marcus Rebecca K. , Kohn Aimee D. , Biechele Travis L. , Moon Randall T. , Kaufman Dan S.
Published: September 2007

Human embryonic stem cells (hESCs) provide an important means to effectively study soluble and cell-bound mediators that regulate development of early blood and endothelial cells in a human model system. Here, several complementary methods are used to demonstrate canonical Wnt signaling is important for development of hESC-derived cells with both hematopoietic and endothelial potential. Analyses using both standard flow cy-tometry, as well the more detailed high-throughput image scanning flow cytometry, characterizes sequential development of distinct early developing CD34brightCD31+Flk1+ cells and a later population of CD34dimCD45+ cells. While the CD34brightCD31+Flk1+ have a more complex morphology and can develop into both endothelial cells and hematopoietic cells, the CD34dimCD45+ cells have a simpler morphology and give rise to only hematopoietic cells. Treatment with dickkopf1 to inhibit Wnt signaling results in a dramatic decrease in development of cells with hematoendothelial potential. In addition, activation of the canonical Wnt signaling pathway in hESCs by coculture with stromal cells that express Wnt1, but not use of noncanonical Wnt5-expressing stromal cells, results in an accelerated differentiation and higher percentage of CD34brightCD31+Flk1+ cells at earlier stages of differentiation. These studies effectively demonstrate the importance of canonical Wnt signaling to mediate development of early hematoendothelial progenitors during human development.
Origins and unconventional behavior of neutrophils in developing zebrafish
Authors: Le Guyader Dorothée , Redd Michael J. , Colucci-Guyon Emma , Murayama Emi , Kissa Karima , Briolat Valérie , Mordelet Elodie , Zapata Agustin , Shinomiya Hiroto , Herbomel Philippe
Published: September 2007

The first leukocytes that arise in the development of vertebrate embryos are the primitive macrophages, which differentiate in the yolk sac and then quickly invade embryonic tissues. These macrophages have been considered to constitute a separate lineage, giving rise to no other cell type. Using an in vivo photoactivatable cell tracer in the transparent zebrafish (Danio rerio) embryo, we demonstrated that this lineage also gave rise to an equal or higher number of neutrophilic granulocytes. We were surprised to find that the differentiation of these primitive neutrophils occurs only after primitive myeloid progenitors have dispersed in the tissues. By 2 days after fertilization, these neutrophils have become the major leukocyte type found wandering in the epidermis and mesenchyme. Like the primitive macrophages, all primitive and larval neutrophils express PU.1 and L-plastin and they are highly attracted to local infections, yet only a small fraction of them phagocytose microbes, and to a much lesser extent per cell than the macrophages. They are also attracted to variously stressed or malformed tissues, suggesting a wider role than antimicrobial defense.
Lactobacillli expressing llama VHH fragments neutralise Lactococcusphages
Authors: Hultberg Anna , Tremblay Denise M , de Haard Hans , Verrips Theo , Moineau Sylvain , Hammarström Lennart , Marcotte Harold
Published: September 2007

Background

Bacteriophages infecting lactic acid bacteria (LAB) are widely acknowledged as the main cause of milk fermentation failures. In this study, we describe the surface-expression as well as the secretion of two functional llama heavy-chain antibody fragments, one binding to the major capsid protein (MCP) and the other to the receptor-binding proteins (RBP) of the lactococcal bacteriophage p2, by lactobacilli in order to neutralise lactococcal phages.

Results

The antibody fragment VHH5 that is directed against the RBP, was fused to a c-myc tag and expressed in a secreted form by a Lactobacillus strain. The fragment VHH2 that is binding to the MCP, was fused to an E-tag and anchored on the surface of the lactobacilli. Surface expression of VHH2 was confirmed by flow cytometry using an anti-E-tag antibody. Efficient binding of both the VHH2 and the secreted VHH5 fragment to the phage antigens was shown in ELISA. Scanning electron microscopy showed that lactobacilli expressing VHH2 anchored at their surface were able to bind lactococcal phages. A neutralisation assay also confirmed that the secreted VHH5 and the anchored VHH2 fragments prevented the adsorption of lactococcal phages to their host cells.

Conclusion

Lactobacilli were able to express functional VHH fragments in both a secreted and a cell surface form and reduced phage infection of lactococcal cells. Lactobacilli expressing llama heavy-chain antibody fragments represent a novel way to limit phage infection.
Correlation between CpG methylation profiles and hormone receptor status in breast cancers
Authors: Feng Weiwei , Shen Lanlan , Wen Sijin , Rosen Daniel G , Jelinek Jaroslav , Hu Xin , Huan Shaoyi , Huang Miao , Liu Jinsong , Sahin Aysegul A , Hunt Kelly K , Bast Robert C , Shen Yu , Issa Jean-Pierre J , Yu Yinhua
Published: September 2007

Introduction

Aberrant DNA methylation has been found frequently in human breast cancers, associated with the loss of expression of a number of regulatory genes for growth and correlated to clinical outcomes. The present study was undertaken to determine whether methylation of a set of growth-suppressor genes would correlate to the expression of estrogen receptors (ERs) and progesterone receptors (PRs).

Methods

We used a pyrosequencing methylation analysis to study the methylation of 12 known growth-suppressor genes in 90 pairs of malignant/normal breast tissues. We also examined the expression of ERs and PRs in those specimens by immunohistochemistry. Mutations of p53 in tumor cells were detected by direct sequencing.

Results

Twelve tumor-suppressor genes: ARHI, RASSF1A, HIN-1, RARβ2, hMLH1, 14-3-3 σ, RIZ1, p16, E-cadherin, RIL, CDH13, and NKD2 were selected for this methylation study. Five of them (RIL, HIN-1, RASSF1A, CDH13, and RARβ2) were frequently methylated in breast cancers (57%, 49%, 58%, 44%, and 17%, respectively) but not the normal breast (0–4%). Two panels of methylation profiles were defined. The methylation of the HIN-1/RASSFIA panel strongly correlated to the expression of ERs, PRs, and hormone receptors (HRs; which were defined as 'positive' if ERs and/or PRs were positive; p < 0.001). Conversely, the methylation of the RIL/CDH13 panel strongly correlated to negative ER, PR, and HR expression (p = 0.001, 0.025, and 0.001, respectively). The subset of triple-negative breast cancers (in other words, those with negative ER, PR, and HER-2/neu status) was positively associated with the methylation of the RIL/CDH13 panel and negatively associated with the HIN-1/RASSF1A panel. Mutations of p53 were found in nine breast tumors (11%), seven of which lacked methylation in both panels.

Conclusion

We have defined two panels (HIN-1/RASSFIA, and RIL/CDH13) of methylation profiles, which correlated, either positively or negatively, to HR status.