The Role of Traditional Medicine in Primary Health Care in China

Report of a seminar on the utilization of traditional medicine in primary health care in the People's Republic of China. It discusses and examines the possibility of adopting comparable approaches in the provision of health services in other countries. Document in pdf format; Acrobat Reader required.

Determination of age from cemental incremental lines for forensic dentistry.

Determination of age from cemental incremental lines was evaluated in intact teeth obtained from 17 individuals aged 23-77 years. Mineralized 100 microm cross sections were subjected to one of three treatments: unstained, stained with Villanueva's blood stain, and stained with acridine orange. Ideal areas were selected by light microscopy and photographed. Countability of incremental lines from photographic enlargements were evaluated. The average number of years required for the eruption of a particular tooth was added to the incremental lines count to determine the estimated age for that individual. Results obtained from unstained mineralized 100 microm thick cross sections using differential interference microscopy (Nomarsky) provided the most countable lines. The accuracy and repeatability of the method is not dependent on tooth type or location, but on the average obtained from making as many counts as possible. This method can be applied to general populations regardless of systemic or periodontal health.

Physical activity, physical fitness and respiratory function--exercise and respiratory function.

The aim of the study was to establish patterns of respiratory function in Northern Ireland and to examine the relationship between physical activity, physical fitness and respiratory function. We identified 1600 adults over 16 yr using 2 stage probability sampling. Physical activity was measured using a questionnaire, physical fitness from oxygen uptake while walking on a treadmill, and respiratory function using spirometry. The main outcome measures were a physical activity profile based on computer assisted interview, physical fitness by predicted VO2max, Forced Vital Capacity (FVC) and Forced Expiratory Volume (FEV1). We found that the main findings were of relationships between activity and FVC and FEV 1 which remained after adjustment for possible confounders in men, and between fitness and FVC and FEV 1 in both men and women although these were not sustained after adjustment for possible confounders.

Levels of physical activity, physical fitness and their relationship in the Northern Ireland Health and Activity Survey.

The aim of the study was to describe the physical activity and physical fitness profile of the population of Northern Ireland and to explore the relationship between physical activity and physical fitness. This was a cross sectional population study using a two stage probability sample of the adult population of Northern Ireland (aged 16+). The main outcome measures were physical activity profile based on computer assisted interview. Physical fitness using estimation of VO2max by extrapolation from submaximal oxygen uptake while walking on a motor driven treadmill. We found that males were more vigorously active than females (M 21%:F 6%) with a steep gradient of decreasing activity with age: 49% (M 52%:F 46%) were regularly active up to at least moderate intensity. Males (mean predicted VO2max 44.4 mls/kg/min; 16-74 years) were fitter than females (mean predicted VO2max 34.0 mls/kg/min; 16-74 years) and while there was a decline in predicted VO2max with age, there was wide variation within each age category. There was no statistically significant relationship between current or past activity and fitness after adjustment for possible confounding factors, with the exception of a relationship between fitness and activity in males so that the difference between no activity and habitual vigorous activity in predicted VO2max was 4.4mls/kg/min (10.1%).

An inexpensive and reliable new haemoglobin colour scale for assessing anaemia.

AIM: To describe a new inexpensive method (the WHO Colour Scale) for estimating haemoglobin concentration from a drop of blood by means of a colour scale, and to compare its reliability with a standard laboratory method of measuring haemoglobin, and its clinical usefulness in field trials. METHODS: The new colour scale method was used to measure haemoglobin concentration in 1213 random venous blood samples from routine work in four laboratories (one each in the UK, South Africa, Thailand, and Switzerland). Limited field trials of the method for assessing clinical usefulness were done in a rural hospital (in South Africa) staffed by nurses, at two blood donor sessions (one each in South Africa and Thailand), and by nonlaboratory personnel in malaria clinics (in Thailand), following training and a short practice session. RESULTS: In the laboratory based comparability study the presence of anaemia was reliably detected using the new method with 91% sensitivity and 86% specificity. Clinically relevant levels of anaemia (mild to moderate, pronounced, and severe) were graded and serious anaemia (< 8 g/dl) was identified with an efficiency of 89%. The clinical trials showed the ease and reliability with which the colour scale could be used by non-laboratory persons after brief training. The blood donor trials showed it to be at least as reliable as the copper sulphate method with the advantage of being more convenient. CONCLUSIONS: The preliminary studies have shown that the WHO Colour Scale is a reliable screening method for detecting anaemia, especially for diagnosing serious anaemia. Following a brief training session health workers found it simple to use and, at a cost of about 1/10th that for traditional photometric analysis, it should be of value in "countries in need" for primary health centres, obstetrical management, paediatric clinics, tropical disease control programmes, blood transfusion donor selection, as well as for industrial health checks and epidemiological studies.

Physical fitness, lipids, and apolipoproteins in the Northern Ireland Health and Activity Survey.

The objective of this study was to investigate the relationship between physical fitness, lipids, and apolipoproteins in a cross-sectional study using a two-stage probability sample of the population of Northern Ireland. The main outcome measures were physical fitness using VO2max estimated by extrapolation from submaximal oxygen uptake while walking on a motor driven treadmill, and total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, HDL2 and HDL3, and Lp(a). There were no significant relationships with fitness, after adjustment for possible confounders, with the exception of a positive relationship with HDL2 in males (P < or = 0.01) and Lp(a) in females (P < or = 0.05). There was also a relationship between physical fitness and HDL:apo AI ratio in males and females after adjustment for possible confounders (P < or = 0.05). We concluded that there were few relationships between lipid parameters and physical fitness after adjustment for possible confounders. The relationship between physical fitness and Lp(a) in females suggests a benefit associated with physical fitness and the relationship between physical fitness and HDL:apo AI ratio was in keeping with improved HDL cholesterol transport.

Famciclovir: a new systemic antiviral agent for herpesvirus infections.

Acyclovir was the first antiviral drug approved for the treatment of herpes zoster. Several new antiviral agents have since been introduced, one of which is famciclovir. The pharmacokinetics of famciclovir allow a more convenient dosing schedule than the schedule used with acyclovir. Famciclovir is metabolized in the liver, but the P450 cytochrome system is not involved. Both acyclovir and famciclovir accelerate cutaneous healing, but studies suggest that famciclovir may reduce the severity of postherpetic neuralgia when compared with placebo. Famciclovir is currently approved only for use in immunocompetent patients, but clinical trials involving immunocompromised patients are in progress.

Physical activity, lipids, apolipoproteins, and Lp(a) in the Northern Ireland Health and Activity Survey.

In a cross-sectional study using a two-stage probability sample (N = 1,600) of the population of Northern Ireland, there was an inverse association between the highest recorded recent activity and total cholesterol (P < or = 0.01), LDL (P < or = 0.01), triglyceride (P < or = 0.05) and Chol:HDL ratio (P < or = 0.001) in males, and total cholesterol (P < or = 0.001), LDL (P < or = 0.001), and triglyceride (P < or = 0.01) in females; between habitual activity and HDL (P < or = 0.05) in males and total cholesterol (P < or = 0.05) and triglyceride (P < or = 0.01) in females. There was a relationship between the highest recorded activity and apoAI (P < or = 0.01) and apoB (P < or = 0.01) in males and with apoB (P < or = 0.001) in females; between habitual activity and apoAI (P < or = 0.01) and apoAII (P < or = 0.05) in males and apoB (P < or = 0.01) in females; between past activity and Lp(a) in females (P < or = 0.05). After adjustment for possible confounding factors, total cholesterol (P < or = 0.05) and LDL (P < or = 0.05) were unexpectedly higher in males who were active throughout life. Total cholesterol (P < or = 0.05) and LDL (P < or = 0.001) were higher in females with highest recorded activity and triglycerides lower (P < or = 0.05) in those habitually active. An association between highest recorded activity and apoAI (P < or = 0.01), and past activity and apoAI:apoB ratio (P < or = 0.05) was shown in males and in females, after adjustment, and between apoB (P < or = 0.05) and highest recorded activity.

Physical activity, physical fitness, blood pressure, and fibrinogen in the Northern Ireland health and activity survey.

STUDY OBJECTIVE: To investigate the relationship between physical activity, physical fitness, blood pressure, and fibrinogen. DESIGN: This was a cross sectional population study using a two stage probability sample. SETTING: Northern Ireland. PARTICIPANTS: A sample of 1600 subjects aged 16-74 years from the population of Northern Ireland. MAIN OUTCOME MEASURES: Physical activity profile from computer assisted interview using the Allied Dunbar national fitness survey scales. Physical fitness using estimation of VO2 max by extrapolation from submaximal oxygen uptake while walking on a motor driven treadmill. Systolic and diastolic blood pressure measured with a Hawksley random zero sphygmomanometer. Measurement of fibrinogen using the Clauss method. MAIN RESULTS: There were significant relationships between both current and past activity and blood pressure. These were of a magnitude that would have been clinically significant, but for the fact that, with the exception of the relationship between habitual activity and diastolic pressure (p = 0.03) and past activity and systolic pressure (p = 0.03) in men, they were not sustained after adjustment for the effect of age using analysis of variance. After adjustment for other potentially confounding factors using multiple regression, there was an inverse relationship between systolic blood pressure and past activity in men, so that those with a life-time of participation compared with a life-time of inactivity had a lower systolic blood pressure of 6 mmHg (p < 0.05). There was a highly significant (p < 0.001) inverse association between both systolic and diastolic blood pressure and physical fitness (VO2 max) which was not sustained after adjustment for possible confounding factors. There were relationships between fibrinogen and highest recorded activity (p < 0.001), habitual activity (p < 0.01), and past activity (p < 0.01) in men but no significant relationship in women. The relationship between fibrinogen and activity was no longer sustained after adjustment for possible confounding factors. There was a highly significant (p < 0.001) inverse relationship with physical fitness using VO2 max. This relationship was sustained after adjustment for possible confounding factors in both men (p < 0.05) and women (p < 0.001). CONCLUSIONS: There was a relationship between physical activity, physical fitness, and blood pressure but the relationship was greatly influenced by age. A reduction of 6 mmHg in systolic blood pressure associated with past activity is of clinical significance and supports the hypothesis that physical activity is of benefit in reducing cardiovascular risk. There was a lower level of fibrinogen in those who were most active but this relationship was not significant after adjustment for possible confounding factors. There was also a lower level of fibrinogen those who were most fit (VO2 max) and this relationship persisted even after adjustment for possible confounding factors.

Vitamin E and exercise in the Northern Ireland population.

Serum vitamin E, vitamin E/cholesterol and physical activity and fitness were examined in a representative cross section (n = 1600) of the Northern Ireland population as part of the Northern Ireland health and activity survey. Serum vitamin E levels were measured by high-performance liquid chromatography, cholesterol by an enzymatic method, physical activity profile was recorded by computer assisted interview and physical fitness was determined by estimation of VO2 max. The levels of serum vitamin E and vitamin E/cholesterol ratio in the Northern Irish population were similar or higher than in other populations with lower incidences of coronary heart disease. The assessment of activity showed that 75% of the population fell below recommended activity levels likely to confer a cardioprotective effect. A significant relationship (P = 0.01) was found in males between serum vitamin E levels and lifetime participation in physical activity. Otherwise no relationship was found between serum vitamin E or vitamin E/cholesterol ratio and physical activity or fitness in the population.

Total radical trapping antioxidant potential (TRAP) and exercise.

The relationship between physical activity, physical fitness and total radical trapping antioxidant potential (TRAP) was examined in the Northern Ireland Health and Activity Survey. This was a cross-sectional population study (n = 1600) using a two-stage probability sample of the population. TRAP was calculated using the sum of the individual serum antioxidant concentrations (urate, protein thiols, ascorbate, alpha tocopherol and bilirubin) multiplied by their respective stoichiometric values. Physical fitness was determined by estimation of VO2max by extrapolation from submaximal oxygen uptake, and physical activity was recorded by computer-assisted interview. Mean serum TRAP concentrations were significantly higher in males (653 +/- 8.2 mumol/l, mean +/- SEM) compared to females (564 +/- 8.0 mumol/l) (p < 0.0001). Both male and female smokers had significantly lower TRAP values than non-smokers (males p < 0.0001, females p = 0.02). In females, there was a positive relationship of TRAP with age (p < 0.001) and body mass index (p < 0.001) but a negative relationship with physical fitness (p < 0.05). The known beneficial effects of exercise and activity do not appear to be directly mediated through increased antioxidant status.

Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later.

OBJECTIVE: To investigate the cause of increasing rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection at a university hospital. DESIGN: Review of data collected by prospective hospital wide surveillance regarding rates of nosocomial MRSA colonization and infection. SETTING: A 700-bed university hospital providing primary and tertiary care. PATIENTS: Patients admitted to the hospital between 1986 and 1993 who were found to be infected or colonized with MRSA. MAIN OUTCOME MEASUREMENT: Rates of MRSA infection and colonization. RESULTS: MRSA infection or colonization was identified in 399 patients (0.18%) admitted during the 8-year study. There was no correlation between the annual rates of MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infections (P = .66). The frequency of both nosocomial and non-nosocomial cases increased significantly over the last 4 years of the study (P < .001 for trend). The ratio of patients who had acquired MRSA nosocomially to those admitted who already were infected or colonized decreased significantly during the study period (P = .002 for trend). There was a significant increase in the frequency of patients with MRSA being transferred from nursing homes and other chronic care facilities (P = .011). A cost-benefit analysis suggested that surveillance cultures of patients transferred from other healthcare facilities would save between $20,062 and $462,067 and prevent from 8 to 41 nosocomial infections. CONCLUSIONS: An increase in the incidence of nosocomial MRSA infection was associated with an increased frequency of transfer of colonized patients from nursing homes and other hospitals. The lack of correlation between rates of MRSA and MSSA infections suggested that MRSA infections significantly increased the overall rate of staphylococcal infection. Screening cultures of transfer patients from facilities with a high prevalence of MRSA may offer significant benefit by preventing nosocomial infections and reducing patient days spent in isolation.

A simple and reliable method for estimating haemoglobin.

A new colour scale has been advised for estimating haemoglobin levels by matching the blood samples with ten levels of haemoglobin (3, 4, 5, 6, 7, 8, 9, 10, 12, and 14 g/dl) on the scale. Preliminary results show good correlations with spectrophotometric readings. The new device is being field tested and if the initial promise is confirmed, will provide a simple and reliable method for estimating haemoglobin where laboratory facilities are not available.

Ascorbate and exercise in the Northern Ireland population.

The relationship between physical activity, physical fitness and serum ascorbate was examined in the Northern Ireland Health and Activity Survey. This was a cross sectional population study (n = 1600), using a two stage probability sample, of the population of N. Ireland. Physical activity profile was recorded by computer assisted interview and physical fitness was determined by estimation of VO2 max by extrapolation from submaximal oxygen uptake. Serum ascorbate was measured using a colorimetric reaction of 2,4 dinitrophenylhydrazine with dehydroascorbate. Mean serum ascorbate was greater in females than males (p < 0.001), and was lower in smokers than non-smokers in both males (p = 0.01) and females (p < 0.001). There was no statistically significant relationship between serum ascorbate and age, social class, body mass index, physical activity or physical fitness in males but there was a relationship with age (p < 0.01) and physical fitness (p < 0.05) in females.

Infestation et anémie ankylostomiennes : méthodologie de la lutte / Z. S. Pawlowski, G. A. Schad, G. J. Stott / Hookworm infection and anaemia : approaches to prevention and control

Guide détaillé des nombreuses mesures simples, efficaces et peu coûteuses permettant de réduire la prévalence et la gravité de l'anémie ankylostomienne. Cet ouvrage a principalement pour but d'aider les praticiens qui travaillent sur le terrain à dépister l'infestation et l'anémie qui en résulte et à appliquer des mesures appropriées, qu'il s'agisse de cas individuels ou de communautés entières. Etant donné que l'on a couramment tendance à sous-estimer l'importance de l'infestation ankylostomienne et à ne lui accorder qu'un rang de priorité limité, l'ouvrage cherche à y remédier en évoquant les principales conséquences de l'anémie ankylostomienne dans le domaine de la santé publique, en décrivant les remarquables résultats des mesures de lutte et en encourageant les scientifiques à s'intéresser davantage à cette maladie qui mérite de retenir leur attention. A cette fin, il expose les mesures simples pouvant être utilisées pour la lutte en fonction des nombreux facteurs complexes sur lesquels doit se fonder leur choix pour qu'elles soient efficaces. L'ouvrage, qui comporte sept chapitres, commence par donner des informations de base sur les cycles biologiques d'Ancylostoma duodenale et de Necator americanus, leurs caractéristiques aux différents stades et leur distribution géographique. Les chapitres suivants décrivent les aspects anatomo-pathologique et clinique de l'infestation et expliquent comment elle entraîne l'anémie. Une attention particulière est accordée aux facteurs qui déterminent le bilan du fer dans un groupe donné, y compris ceux qui peuvent occasionner une anémie sévère lorsque la charge ankylostomienne est faible. Un chapitre consacré à l'épidémiologie décrit les comportements, les conditions climatiques et les pratiques agricoles qui favorisent l'entretien et la propagation de l'infestation et distingue trois grands modes épidémiologiques de transmission. Cette classification des modes de transmission constitue le cadre des informations détaillées sur la prévention et la lutte qui sont exposées par la suite. La confirmation de l'infection étant particulièrement simple, les chapitres sur la prévention et la lutte s'attachent à donner aux agents de santé les renseignements qui peuvent les aider à déterminer quand il y a lieu de soupçonner une infection et à faire les investigations appropriées. Des chapitres distincts exposent les principes de la lutte, passent en revue les différents objectifs et options, qu'il s'agisse de réduire la mortalité et la morbidité dans l'immédiat ou d'apporter des améliorations à long terme et expliquent comment mener des enquêtes générales et spéciales. Parmi les stratégies de lutte qui y sont décrites figurent le traitement classique, le traitement ciblé, le traitement de masse et la distribution de suppléments de fer. Pour le traitement classique, des conseils détaillés sont donnés sur les médicaments et doses recommandés pour l'administration de fer et le traitement par les anthelmintiques présentés comme le fondement de la lutte contre l'anémie ankylostomienne. Le dernier chapitre, consacré à la pratique de la lutte, énumère les approches préconisées pour les trois principaux profils de l'anémie ankylostomienne. Trois annexes concluent l'ouvrage : elles décrivent et illustrent les différentes techniques de laboratoire et autres à utiliser pour les enquêtes sur l'infestation et l'anémie ankylostomiennes et expliquent comment déterminer la base de sondage, la taille de l'échantillon et les méthodes d'enquête les plus appropriées