Prevalence of syphilis and associated factors in the adult population treated at healthcare facilities in Vitória (ES), Brazil / Prevalência e fatores associados à sífilis em adultos atendidos em unidades de saúde de Vitória (ES), Brasil

Introduction: There are few population-sampling studies on the prevalence of syphilis in Brazil. Objectives: We aim to determine the seroprevalence of syphilis and identify factors associated with the infection in adult patients observed at six regional healthcare facilities in Vitória city, state of Espírito Santo, Brazil. Methods: A cross-sectional study was conducted between September 2010 and December 2011. For individuals included in the study, a Venereal Disease Research Laboratory (VDRL) test and two treponemal tests (immunochromatographic and IgG ELISA assays) were performed. Demographic data, history of sexually transmitted infections, and behavioral data were collected. Results: Of the 1,502 subjects included in the study, 47% were men and 53% were women. The mean age was 41.63±14.57 years. The prevalence of syphilis was (0.9%; 95%CI 0.4­1.3) when a diagnosis of syphilis was considered with VDRL titers equal to or greater than 1:8. However, the prevalence was higher (2.8%) when a positive VDRL test, regardless of the titer, was considered. A multivariate analysis showed a significant association between syphilis and homosexual or bisexual behavior [OR=6.80; 95%CI 1.00­46.20], prior history of sexually transmitted infection [OR=16.30; 95%CI 3.61­73.41], the presence of a tattoo [OR=6.21; 95%CI 1.49­ 25.84], and cocaine use [OR=6.80; 95%CI 1.15­40.30]. The prevalence of positive treponemal test was 10.4%. Conclusion: The seroprevalence of active syphilis in this population was similar to that observed in other populational studies in Brazil. The high prevalence of positive treponemal tests may be due to the positive serological memory of a cured infection, but the results may also be due to cases of early or late syphilis that were not detected by the VDRL test.

Introdução: Existem poucos estudos em amostras populacionais sobre a prevalência da sífilis no Brasil. Objetivos: Determinar a soroprevalência de sífilis e identificar fatores associados à infecção em pacientes adultos atendidos nas unidades das seis regiões de saúde do Município de Vitória, Estado do Espírito Santo. Métodos: Foi realizado um estudo transversal entre setembro de 2010 e dezembro de 2011. Para os indivíduos incluídos no estudo, foram realizados o teste Venereal Disease Research Laboratory (VDRL) e dois testes treponêmicos (imunocromatográfico e IgG ELISA). Foram coletados dados demográficos, histórico de infecções sexualmente transmissíveis e dados comportamentais. Resultados: Dos 1.502 indivíduos incluídos no estudo, 47% eram homens e 53% eram mulheres. A média de idade foi de 41,63±14,57 anos. A prevalência de sífilis foi de 0,9% (IC95% 0,4­1,3) quando considerado diagnóstico de sífilis com títulos de VDRL iguais ou superiores a 1:8. Porém, a prevalência foi maior (2,8%) quando considerado VDRL positivo, independente do título. Análise multivariada mostrou associação significativa da sífilis com comportamento homo ou bissexual [OR=6,80; IC95% 1,00­46,20], história prévia de infecções sexualmente transmissíveis [OR=16,30; IC95% 3,61­73,41], tatuagem [OR=6,21; IC95% 1,49­25,84] e uso de cocaína [OR=6,80; IC95% 1,15­40,30]. A prevalência de teste treponêmico positivo foi de 10,4%. Conclusão: A soroprevalência de sífilis ativa nesta população foi semelhante à observada em outros estudos populacionais no Brasil. A alta prevalência nos testes treponêmicos positivos pode ser devida a cicatriz sorológica de infecção curada, mas pode também estar associada a casos de sífilis primária ou tardia, que não foram detectados pelo teste de VDRL.

Nucleoprotein vaccine induces cross-protective cytotoxic T lymphocytes against both lineages of influenza B virus

PURPOSE: The influenza B virus diverges into two antigenically distinct lineages: B/Yamagata and B/Victoria. Influenza B is the dominant circulating virus during some influenza seasons, and recent data demonstrated that influenza A and B infection similarly cause severe clinical symptoms in hospitalized patients. Nucleoprotein (NP) is a good target for a universal influenza vaccine. This study investigated whether NP epitope variation within two lineages affects the dominant cytotoxic T lymphocyte (CTL) responses induced by vaccination and the resultant protective immunity. MATERIALS AND METHODS: The NP of B/Yamagata/16/1988, the representative strain of the Yamagata lineage, includes a dominant CTL epitope, FSPIRITFL, while B/Shangdong/7/1997 from the Victoria lineage has one amino acid difference in this sequence, FSPIRVTFL. Two recombinant replication-deficient adenovirus (rAd)-vectored vaccines expressing either NP were prepared (rAd/B-NP(I) and rAd/B-NP(V), respectively) and administered to BALB/c mice intranasally. To examine the efficacy of vaccination, antibody responses, CTL responses, and morbidity/mortality after challenge were measured. RESULTS: Both vaccines induce similar antibody and CD8 T-cell responses cross-reacting to both epitopes, and also confer cross-protection against both lineages regardless of amino acid difference. CONCLUSION: The rAd-vectored vaccine expressing the NP could be developed as universal influenza B vaccine which provides broader protection.

Effect of Ambrisentan Therapy on the Expression of Endothelin Receptor, Endothelial Nitric Oxide Synthase and NADPH Oxidase 4 in Monocrotaline-induced Pulmonary Arterial Hypertension Rat Model

BACKGROUND AND OBJECTIVES: Elevated endothelin (ET)-1 level is strongly correlated with the pathogenesis of pulmonary arterial hypertension (PAH). Expression level of nicotinamide adenine dinucleotide phosphate oxidase (NOX) 4 is increased in the PAH patients. Ambrisentan, a selective endothelin receptor A (ERA) antagonist, is widely used in PAH therapy. The current study was undertaken to evaluate the effects of ambrisentan treatment in the monocrotaline (MCT)-induced PAH rat model. METHODS: Rats were categorized into control group (C), monocrotaline group (M) and ambrisentan group (Am). The M and Am were subcutaneously injected 60 mg/kg MCT at day 0, and in Am, ambrisentan was orally administered the day after MCT injection for 4 weeks. The right ventricle (RV) pressure was measured and pathological changes of the lung tissues were observed by Victoria blue staining. Protein expressions of ET-1, ERA, endothelial nitric oxide synthase (eNOS) and NOX4 were confirmed by western blot analysis. RESULTS: Ambrisentan treatment resulted in a recovery of the body weight and RV/left ventricle+septum at week 4. The RV pressure was lowered at weeks 2 and 4 after ambrisentan administration. Medial wall thickening of pulmonary arterioles and the number of intra-acinar arteries were also attenuated by ambrisentan at week 4. Protein expression levels of ET-1 and eNOS were recovered at weeks 2 and 4, and ERA levels recovered at week 4. CONCLUSIONS: Ambrisentan administration resulted in the recovery of ET-1, ERA and eNOS protein expression levels in the PAH model. However, the expression level of NOX4 remained unaffected after ambrisentan treatment.

Evaluation of Waning Immunity at 6 Months after Both Trivalent and Quadrivalent Influenza Vaccination in Korean Children Aged 6–35 Months

BACKGROUND: The titer of influenza vaccine-induced antibodies declines over time, and younger children have lower immunogenicity and shorter duration of immunity. This study aimed to compare persistence of antibody at 6 months after influenza vaccination according to influenza virus strains, vaccine type, antigen dose, and primed status in children aged 6 to 35 months. METHODS: A total 124 healthy children aged 6 to 35 months were enrolled from September to December 2016 at 10 hospitals in Korea and randomly assigned to either a full dose of quadrivalent influenza vaccine or a half dose of trivalent influenza vaccine with Victoria B strain group. Hemagglutination inhibition antibody titers (that measure the seroprotection rates) were assessed for the recommended influenza strains at 6 months post vaccination. RESULTS: The seroprotection rates at 6 months for strains A (H1N1), A (H3N2), B/Yamagata, and B/Victoria were 88.7%, 97.4%, 36.6%, and 27.6%, respectively. The seroprotection rates for A (H1N1), A (H3N2) and B (Victoria) were 91.4%, 98.7% and 27.5% in a full dose of quadrivalent vaccine vs. 83.7%, 94.6% and 27.9% in a half dose trivalent vaccine, respectively. The seroprotection rate for the B (Yamagata) strain was 23.8% in the quadrivalent group and 14.0% in the trivalent group. CONCLUSION: Persistence of antibodies at 6 months was more favorable against the influenza A strains than against the B strains. Persistence of antibodies to additional B strain at 6 months was superior in the quadrivalent vaccine group. The immunity of primed children with different B strains was not superior to that of the unprimed group with another B strain.

Schistosoma mansoni Infection and Its Related Morbidity among Adults Living in Selected Villages of Mara Region, North-Western Tanzania: A Cross-Sectional Exploratory Study

Schistosoma mansoni is highly endemic in Tanzania and affects all age groups at different degrees. However, its control approach does not include adult individuals who are equally at risk and infected. To justify the inclusion of adult individuals in MDA programs in Tanzania, the present study focused on determining the prevalence of S. mansoni infection and its related morbidities among adult individuals. This was a cross sectional study conducted among 412 adult individuals aged 18–89 years living in selected villages of Rorya and Butiama districts located along the shoreline of the Lake Victoria. A pretested questionnaire was used to collect socio-demographic and socio-economic information of participants. Ultrasonographic examinations were conducted for all study participants using the Niamey protocol. A single stool sample was obtained from all study participants and examined for S. mansoni using the Kato-Katz technique. The study revealed a high prevalence of S. mansoni (56.3%), and the majority of infected individuals had a light intensity of infection. Ultrasonographic findings revealed that 22.4% of adult individuals had periportal fibrosis (PPF) (grade C–F), with 18.4% having grade C and D and 4% having grade E and F. Males had the highest prevalence of PPF (31.7% vs 10.8%, P < 0.001). Organomegaly was common with 28.5% and 29.6% having splenomegaly and hepatomegaly, respectively. S. mansoni infection and its related morbidities included PPF, hepatomegaly, and splenomegaly were common among adult individuals. To reduce the level of transmission of S. mansoni infection, planned mass drug administration campaigns should include adult individuals living in these villages.

Progesterone treatment for the prevention of preterm birth

Preterm birth (PTB) is defined as birth before 37 completed weeks of gestation, which occurs in approximately 10% of all pregnancies. Prior PTB history and short cervical length (CL) are the most significant predictors of PTB. Prior PTB history can increase the risk of recurrence of PTB more than two-fold in the next pregnancy. A short CL of less than 25 mm as measured by ultrasound between 16 and 24 weeks of gestation has been shown to be the most reliable predictor of an increased risk of PTB. Progesterone is one of the few proven effective methods of preventing PTB in women with a previous history of spontaneous PTB and women with a short CL. Progestins are available in natural micronized or synthetic formulations for intramuscular or vaginal (tablet or gel) administration. Several studies have reported that 17 hydroxyprogesterone caproate injection can prevent recurrent PTB in women with a previous history of PTB. Vaginal micronized natural progesterone has also been shown to be effective in preventing PTB in women with previous PTB history or with a short CL. At present, we are performing a multi-center, randomized trial in Korea (a multicenter, randomized, open-label, investigator-initiated trial of vaginal compared with intramuscular progesterone for the prevention of PTB in high-risk pregnant women: VICTORIA protocol) to compare the efficacy between vaginal progesterone and intramuscular injection of progesterone in women with a previous preterm history or short CL. This study will provide important information to both obstetricians and patients on whether a vaginal or intramuscular regimen is better for prevention of a recurrent PTB.

Socio-demographic profile of child and adolescent users of oral health services in Victoria, Australia / Perfil sociodemográfico de crianças e adolescentes usuários de serviços públicos de cuidado de saúde bucodental em Victoria, Austrália / Perfil sociodemográfico de niños y adolescentes usuarios de servicios públicos de atención en salud bucodental en Victoria, Australia

The aim of this study was to investigate the socio-demographic characteristics of the eligible population of users of public oral health care services in the Australian state of Victoria, aged 17 years or younger. The study was conducted as a secondary analysis of data collected from July 2008 to June 2009 for 45,728 young clients of public oral health care. The sample mean age was 8.9 (SD: 3.5) years. The majority (82.7%) was between 6 and 17 years of age, and 50.3% were males. The majority (76.6%) was Australian-born and spoke English at home (89.1%). The overall mean DMFT was 1.0 (SD: 2.1) teeth, with a mean dmft of 3.16 (SD: 5.79) teeth. Data indicate that, among six year olds in the Significant Caries Index (SiC) category, the mean dmft was 6.82 teeth. Findings corroborate social inequalities in oral health outcome and provide suggestions for oral health services to develop strategies and priorities to reduce inequalities in health and well-being, and better coordinate and target services to local needs.

O objetivo deste estudo foi investigar as características sociodemográficas de usuários do serviço público de saúde bucal no Estado de Vitória, Austrália, com até 17 anos de idade. O presente estudo é uma análise de dados secundários de 45.728 sujeitos que recorreram ao serviço público de saúde bucal entre julho de 2008 a junho de 2009. A idade média da amostra foi 8,9 (DP: 3,5) anos. A maioria dos sujeitos (82,7%) apresentava entre 6 e 17 anos de idade e 50,3% eram do gênero masculino. A maioria (76,6%) havia nascido na Austrália e falava inglês em casa (89,1%). O índice CPOD médio foi 1,0 (DP: 2,1) e o ceod 3,16 (DP: 5,79). Os dados indicam que entre as crianças de 6 anos categorizadas no Significant Caries Index (SiC), o índice ceod médio foi 6,82. Os achados demonstram desigualdade social nos desfechos de saúde bucal e fornecem sugestões para que os serviços de saúde bucal desenvolvam estratégias e prioridades para reduzir tais desigualdades na saúde e bem-estar, de forma a adequar os serviços às necessidades locais.

El objetivo de este estudio fue describir las características sociodemográficas de la población de usuarios de los servicios públicos de atención odontológica, de 17 o menos años de edad, en el estado australiano de Victoria. El estudio realiza un análisis secundario de los datos de 45.728 pacientes que asistieron a los servicios de atención odontológica públicos entre julio 2008 y junio 2009. El promedio de edad de la muestra fue 8,9 (s.d. 3,5) años. La mayoría (82,7 %) tenía entre 6 y 17 años de edad, y el 50,3 % fue de sexo masculino. La mayoría (76,6%) nació en Australia y hablaba inglés en casa (89,1%). El COPD promedio fue 1.0 (s.d. 2.1) dientes, con un ceod promedio de 3,16 (s.d. 5,79) dientes. A los 6 años de edad en la categoría de Índice de Caries Significativo, el dmft promedio fue de 6.82 dientes. Los resultados confirman desigualdades sociales en salud bucodental y proporcionan sugerencias para los servicios de salud bucodental, con el fin de desarrollar estrategias y prioridades tendientes a la reducción de desigualdades en salud y bienestar.

Implementation of a multi-level evaluation strategy: a case study on a program for international medical graduates / 보건의료교육평가

Evaluation of educational interventions is often focused on immediate and/or short-term metrics associated with knowledge and/or skills acquisition. We developed an educational intervention to support international medical graduates working in rural Victoria. We wanted an evaluation strategy that included participants' reactions and considered transfer of learning to the workplace and retention of learning. However, with participants in distributed locations and limited program resources, this was likely to prove challenging. Elsewhere, we have reported the outcomes of this evaluation. In this educational development report, we describe our evaluation strategy as a case study, its underpinning theoretical framework, the strategy, and its benefits and challenges. The strategy sought to address issues of program structure, process, and outcomes. We used a modified version of Kirkpatrick's model as a framework to map our evaluation of participants' experiences, acquisition of knowledge and skills, and their application in the workplace. The predominant benefit was that most of the evaluation instruments allowed for personalization of the program. The baseline instruments provided a broad view of participants' expectations, needs, and current perspective on their role. Immediate evaluation instruments allowed ongoing tailoring of the program to meet learning needs. Intermediate evaluations facilitated insight on the transfer of learning. The principal challenge related to the resource intensive nature of the evaluation strategy. A dedicated program administrator was required to manage data collection. Although resource-intensive, we recommend baseline, immediate, and intermediate data collection points, with multi-source feedback being especially illuminating. We believe our experiences may be valuable to faculty involved in program evaluations.

Usefulness of Interferon-Gamma Release Assay for Diagnosis of Tuberculous Fistulae in Ano

PURPOSE: Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula. METHODS: We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed. RESULTS: Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively. CONCLUSION: QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.

The Usefulness of Whole-blood Interferon-gamma Release Assay for the Diagnosis of Extra-pulmonary Tuberculosis / 결핵및호흡기질환

BACKGROUND: The whole-blood interferon-gamma release assay (QuantiFERON-TB Gold [QFT-G]: Cellestis, Carnegie, Victoria, Australia) has been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. In the present study, the usefulness of QFT-G was evaluated for the diagnosis of extra-pulmonary tuberculosis (EP-TB). METHODS: From June 2006 to February 2009, we evaluated the usefulness of QFT-G in patients (n=65) suspected with EP-TB, retrospectively. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the QFT-G assay were analyzed. RESULTS: EP-TB was diagnosed in 33 (51%) participants. The overall sensitivity, specificity, PPV, and NPV of the QFT-G assay for EP-TB were 78%, 79%, 81%, and 77%, respectively. Of the 33 with EP-TB, 14 (42%) were diagnosed with TB pleurisy, 7 (21%) with TB lymphadenitis, 7 (21%) with intestinal TB, and 5 (15%) with EP-TB in other sites. In subgroup analyses according by site of infection, the QFT-G showed 86% sensitivity, 64% specificity, and 78% NPV in TB pleurisy. On the other hand, the sensitivity, specificity, and NPV of the assay were 71%, 83% and 71%, respectively in TB lymphadenitis, and 86%, 100% and 88%, respectively in intestinal TB. Among the patients with suspected alternative site EP-TB, the sensitivity, specificity, and NPV of the assay were 50%, 80% and 67%, respectively. CONCLUSION: The QFT-G assay showed moderate diagnostic accuracy in EP-TB. However, negative QFT-G assay does not exclude EP-TB because of the low NPV of this assay.

Genetic Characteristics and Phylogenetic Analysis of Influenza Type B Viruses Isolated from Nasopharyngeal Suction Samples of Korean Patients

To investigate the genetic characteristics of human influenza type B viruses circulating in Chungbuk province, Korea, we tested 510 clinical samples of nasopharyngeal suction from pediatric patients diagnosed with respiratory illness between June 2007 and June 2008. Twelve out of thirty-six isolates were identified as type B influenza virus by RT-PCR and sequencing analysis. Interestingly, genetic characterization of type B viruses isolated in this study revealed that all type B influenza viruses were the Yamagata lineages, a vaccine strains of southern hemisphere during 2007~2008, rather than the Victoria lineage of northern hemisphere during 2007~2008. Furthermore, there were a total of twelve unique mutations (HA: H40Y, D/G230S, V252M and K272R and NA: P3H, P/T/S42Q, N59S) occurred in our type B isolates. These results suggest that relative high prevalence of type B viruses in Korea during 2007~2008 season might be due to the wrong vaccine strains selection. Taken together, the results of this study demonstrate continuous evolutions of human type B viruses by antigenic drift and also highlight the need to closely monitoring of influenza viruses to aid the early detection of potentially pandemic strains as well as underscore the need for new therapeutics.

Comparison of Major Procedures of Korean Mental Health Law with Other Developed Countries / 신경정신의학

OBJECTIVES : The Mental Health Act is an initiative aimed at changing and shaping mental health services and protecting human rights of persons with mental disorders. Since the Mental Health Act was legislated in 1995, four amendments have been made according to the issues that arose from public concerns. However, there are still many debates about the human rights protection of the mentally ill. This study aimed to provide information regarding major aspects of the Mental Health Act by comparing them among several developed countries. METHODS : Current Mental Health Acts of the state of Michigan in the United States, Scotland in England, the state of Victoria in Australia, and Japan were reviewed. Issues regarding the Korean Mental Health Act were collected from seminar materials, news media contents, and mental health professionals. RESULTS : The definition of subjects in Korean Mental Health Act was more inclusive than other countries and was derived from a medical classification of mental illness. Family members or guardians were granted important responsibilities for deciding the involuntary admission of mentally ill patients in Korea and Japan. In Western countries, Mental Health Review Tribunals or courts have the primary responsibility for important decisions about mentally ill patients. The regulation of immediate discharge after request by voluntarily admitted patients was not enacted in all countries except Korea. The mandatory procedure for involuntary admission in Western countries includes an individual case review with personal interview by a Mental Health Review Tribunal or court. CONCLUSION : The Korean Mental Health Act appears to meet the basic standards of Guidelines from international organizations. Our traditional culture and inherent health systems seem to influence the legal regulation of mental health service and might be related to the problems of human rights protection of mentally ill patients in Korea.

Effect of the bleaching light on whitening efficacy / 대한치과보존학회지

The aim of this study was to evaluate the influence of light energy on the tooth whitening effect of bleaching agent in vitro. Extracted human mandibular molars were sectioned to 2 fragments(mesial, distal) and lingual portions of crown were used in this study. All specimens were stained using a red wine for 24 hours and immersed in artificial saliva. Specimens divided into four groups, group 1 and 2 light-activated by LumaCool (LED, LumaLite, Inc., Spring Valley, USA), group 3 and 4 light-activated by FlipoWhite2 (Plasma acr lamp, Lokki, Australia). Group 1 and 3 bleached with LumaWhite(LumaLite, Inc., Spring Valley, USA), group 2 and 4 bleached with Polaoffice(SDI, Victoria, Australia). Bleaching treatment performed during 10 minutes every 24 hours and repeated 6 times. During bleaching treatment , distal fragments was light-activated(L) but mesial fragments was not(NL). Shade assessment employed before and after bleaching treatment using spectrophotometer. The results of the change in shade was compared and analysed between NL and L by using paired-sample T test with 95% level of confidence. There were no significant differences between NL and L with a few exceptions. In group 2, a* value more change in L, in group 3, b* value more change in L, in group 4, a* value less change in L. After bleaching, L* value and DeltaE increased in all groups and the value of a* and b* decreased in all groups. Within the limitation of this test conditions, the results of this study indicate that the light energy has no obvious improving impact on the tooth whitening effect of a bleaching agent.

Quality of care in government family planning clinic services in Colombo District.

OBJECTIVE: To assess the quality of care in government family planning clinic services in Colombo District. DESIGN: Descriptive cross-sectional study. SETTINGS: Government family planning clinics in the Colombo District. STUDY SAMPLE: The study was conducted in 23 government family planning clinics in the Colombo District selected through stratified sampling. 593 women visiting these clinics for family planning services were interviewed and 242 client-provider interactions were observed. MEASUREMENTS: Client exit interviews, observations of service delivery and clinic inventories were used as survey tools to assess the quality in preparedness of the clinics, the service delivery process and client satisfaction, as outcomes of the service. A set of indicators were identified for this purpose. RESULTS: The study showed deficiencies in infrastructure, interpersonal relations, privacy, information to clients, especially on side-effects and warning signs, and in the mechanisms to ensure continuity. The majority of clients were satisfied with many aspects of the service such as the family planning method received (94.5%), confidentiality of information shared with the provider (96.1%), competency of provider (97.5%), and physical access to clinics (92.3%). However, many were dissatisfied with the physical conditions of the clinics (> 20%), information received (12.5%), opportunity given to discuss their problems with the service providers (18.8%) and waiting times (26.6%). CONCLUSIONS: Government family planning clinic services need improvement through upgrading of clinic infrastructure, better planning and management of clinic services, regular training of service providers and establishing of a system to monitor service quality.

Legislation and development of traditional Chinese medicine in Victoria State of Australia / 中国针灸

This paper introduces the process of legislation of TCM in Victoria state of Australia, and expounds the significance of TCM legislation, and emphasizes that only TCM legislates, can it develops; and only standard TCM, can a good figure set up in people and larger contribution be made for human health.

The burden of group A streptococcal pharyngitis in Melbourne families.

BACKGROUND & OBJECTIVES: There are no recent data from industrialised countries documenting the incidence and costs of group A streptococcal (GAS) pharyngitis. Such data are important in developing policy regarding management (e.g., whether or not to use antibiotics to treat sore throat) and in planning preventive strategies, including preparing for the arrival of GAS vaccines. The present study was undertaken to estimate the incidence and costs of GAS pharyngitis in school aged children in Melbourne, Australia. We report here the results after initial 11 months of surveillance. METHODS: A total of 202 families (852 individuals) with at least one child aged 3 to 12 yr were enrolled across Melbourne in a family-based cohort study, and are being followed prospectively for 24 months. Surveillance data for acute GAS pharyngitis (including serology), throat carriage, and costs of the disease were collected. Additional cases of GAS pharyngitis have been ascertained to improve the precision of costing estimates. RESULTS: Cohort retention was 97 per cent. The spring, summer and winter carriage rates for children were 13.0, 8.0 and 16.0 per cent respectively. The incidence of GAS pharyngitis was 14 per 100 person-years for children. For every primary case there were 0.7 secondary cases and 24 per cent of families experienced at least one episode of GAS pharyngitis per year. Preliminary costing data suggest that 46 per cent of cases lead to school absenteeism and a high rate of antibiotic use. INTERPRETATION & CONCLUSION: The present data suggest that GAS pharyngitis remains very common in childhood, and that it has further implications in terms of secondary cases and costs.

Expression patterns of green fluorescent protein (GFP) after the intravenous injection with adenovirus vector in mouse organs / 대한내과학회지

BACKGROUND: The green fluorescent protein (GFP) from jelly fish, Aequorea victoria, has become a versatile reporter for monitoring gene expression in a variety of cells and organisms. Using GFP as a marker protein we studied whether there are any differencies in the expression patterns among organs in mouse after intravenous injection of adenovirus vectors with GFP gene. METHODS: Recombinant E1, E3-defective type 5 adenovirus vectors (2x10(8)/mouse) with CMV promoter and GFP gene were injected into mice via tail vein. On 3, 6, 9, 14, 21, 28 days after gene transfer, 5 mice per experiments were sacrificed by cervical dislocation and obtained liver, lung, heart, kidney, spleen, small intestine and bone. Half of them were examined by optical microscope after H-E stain. Another half were examined by fluorescent microscope after frozen section. Western blottings were done for each samples with anti-GFP monoclonal antibody and obtained GFP bands were quantitatively compared using Gel-Doc (Bio-Rad, USA) image analyzer. RESULTS: In all organs that we obtained, expression of GFPs are noticed 3 days after gene transfer and reached a maximum around 9th to 14th days, after then the intensities are slightly decreased but maintained until 28th days as determined by Western blotting. On fluorescent microscopic examination, GFPs are well and most frequently expressed on lung among all the examined organs. There are little expression of GFPs on liver parenchymal area around the sinusoids and central veins, although patchy expression of GFPs are observed along the liver capsules. GFPs are highly expressed around the splenic trabecula area but splenic pulp area, it is very sparsely expressed. GFPs are more frequently and highly expressed around the renal tubular area than gromerular area in kidneys. In small intestine, GFPs are expressed on mid portion of microvilli. GFPs are not expressed on myocardium except scanty expression on endocardium. Bone marrow showed GFPs but precise localization is difficult because bony spicules mashed bone marrow during the preparation of frozen section. No specific pathologic lesions possibly related with adenovirus administration are observed on microscopic examination of H-E stained specimens. CONCLUSIONS: GFPs can be detected in cells without the fixing and staining and a good marker to studying the kinetics and persistence of adenovirus mediated gene therapy. And there are different GFP expression patterns according to the organs after intravenous injection of adenovirus vectors with GFP gene in mouse.

Aging, food, culture and health.

International comparison of food intake and health studies amongst the aged is providing new insight into the importance of food culture in social context for healthy aging. At same time the possible variance in eating behavior compatible with good health requires consideration. The IUNS (International Union of Nutritional Sciences) FHILL (Food Habits in Later Life) Project, comprises (1) a morbidity study on about 2,000 elderly in 13 communities (now available on CD Rom) and (2) a mortality follow-up study. In the morbidity study, a total health assessment score or Later Life Status Score (LLSS) has been considered in relation to non-nutritional and nutritional factors. The elderly Greek cohorts aged 70+ in Melbourne. Australia (M = 94, F = 95) and Spata, Greece (M = 51, F = 53) have been used as a model for multivariate analyses to determine separately the importance of non-nutritional (well-being, memory, general health, medication-use, activities of daily living, exercise, social activity and social networks scores) and nutritional variables (intake of food groups g/day, food group variety scores, nutrients) in accounting for LLSS. A mortality follow-up study on the elderly cohort in Spata, Greece has also been completed and published. The findings from these preliminary analyses on the Greek cohorts will be reviewed as an example of how food culture may be influencing both quality of life and survival in Greek elderly. The most important non-nutritional determinants of LLSS in Greeks included: mobility and independence (exercise and activities of daily living), well-being and memory (collectively explained 80% of the variation of LLSS). For nutritional variables, a high intake and variety of plant foods (in particular vegetables, legumes and fruit); a high intake and variety of seafood and a low intake of meat emerged with statistical and biological significance. Results from the mortality study also agree with findings from the morbidity study--particularly the importance of the overall traditional greek food culture, with its emphasis on plant derived food of various kinds, as opposed to individual food categories, in protecting against premature death. Strategies are advanced which may optimise nutritionally related health problems amongst the aged around the globe.

Prevalence of late orchidopexy is consistent with some undescended testes being acquired.

To diagnose the incidence of orchidopexy versus age over a 15-year period, a study was conducted of all patients discharged from a single institution for orchidopexy with reference to age during operation. The hypothesis drawn was that some boys have acquired UDT and therefore, will present late despite recommendations for early diagnosis and treatment. The study was conducted on patients from Royal Children's Hospital, Melbourne (1980-94). The results suggested that while the optimal age for management of congenital UDT has been lowered to one to two years of age by under-graduate education, the persistence of a significant number of older children undergoing surgery suggests that some UDT's are acquired. It also showed that the proportion of orchidopexies performed in infancy increased over the 15-year period while the proportion performed in late childhood remained constant.