Recurrent localised cutaneous parapoxvirus infection in three cats.

CASE HISTORY: Three cats were presented with single proliferative lesions affecting one foot, which failed to heal after medical treatment, and recurred despite surgical resection. PATHOLOGICAL FINDINGS: Histologically, the lesions were proliferative and papillary. There was marked acanthosis, rete peg formation, and compact orthokeratosis, with large numbers of bacteria in the orthokeratotic scale. Some biopsies had multifocal keratinocyte swelling of the stratum granulosum, and amphophilic intracytoplasmic inclusions were present in some of the swollen cells. The dermis consisted of a light fibrous stroma with marked capillary proliferation. Parapoxviruses were detected in the lesions of all cats by electron microscopic examination. PCR analysis detected orf virus (contagious ecthyma virus) in two cats, and orf virus was cultured from one cat. DIAGNOSIS: Parapoxvirus infection in cats. CLINICAL RELEVANCE: Parapoxvirus infection should be considered as a differential diagnosis when dealing with proliferative, non-healing lesions on the feet of cats, especially cats in rural areas. The recovery of orf virus from a cat with typical poxvirus lesions extends the range of species affected by this virus.

Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians' offices.

CONTEXT: The US primary care safety net is composed of a loose network of community health centers, hospital outpatient departments, and physicians' offices. National data on how the mix of patients and services differ across sites are needed. OBJECTIVE: To develop and contrast national profiles of patient and service mix for primary care. DESIGN, SETTING, AND PATIENTS: Comparative analyses of 3 national surveys of primary care visits occurring in 1994: for data on physician's office visits, the National Ambulatory Medical Care Survey (NAMCS); for hospital outpatient department data, the National Hospital Ambulatory Medical Care Survey (NHAMCS); and for data on community health centers, the Bureau of Primary Health Care's 1994 Survey of Visits to Community Health Centers. A time trend analysis also was conducted using the 1998 NAMCS and NHAMCS. MAIN OUTCOME MEASURES: National estimates of primary care visit rates, types of patient presentation, patient case-mix, disposition of patients, and management interventions in 1994, and compared with 1998 data. RESULTS: The US population made 1.3 primary care visits per person in 1994, which accounted for 43.5% of all ambulatory visits to physicians' offices, community health centers, and hospital outpatient departments. Primary care visits per person were 20% lower for Hispanics and 33% lower for black, non-Hispanic persons compared with white, non-Hispanic persons. Visits to community health centers were more likely to be made by ethnic minorities, patients with Medicaid or no insurance, and rural dwellers than visits made to the other delivery sites. Visits at hospital outpatient departments were made by sicker populations and were characterized by less continuity than the other delivery sites. Controlling for patient mix, visits made to hospital outpatient departments were more commonly associated with imaging studies, minor surgery, and specialty referrals than those made to physicians' offices. In 1998, the US population made an estimated 3. 4 visits per person, 45.6% of which were primary care visits. National estimates of primary care visit rates and patient mix and practice pattern comparisons between hospital outpatient departments and physicians' offices were similar in 1998 and 1994. CONCLUSIONS: Expanding community health centers will likely improve access to primary care for vulnerable US populations. However, enhancing access to of physicians' offices is also needed to bolster the safety net. The greater service intensity and poorer continuity for primary care visits in hospital outpatient departments that we observed raises concern about the suitability of these clinics as primary care delivery sites. JAMA. 2000;284:2077-2083.

The health effects of moderate alcohol intake in humans: an epidemiologic review.

A large body of scientific evidence associates the moderate intake of alcohol with reduced mortality among middle-aged and older people in industrialized societies. This association is due largely to a reduced risk of death from coronary heart disease, which appears to outweigh any possible adverse effects of moderate drinking. The regular consumption of small amounts of alcohol is more healthful than the sporadic consumption of larger amounts. No beneficial effect of moderate drinking on mortality has been demonstrated in young adults (premenopausal women and men who have not reached their forties). It is theoretically possible that moderate drinking in young adulthood might reduce the risk of later heart disease; however, this has not been clearly demonstrated. For some individuals (e.g., those who cannot keep their drinking moderate, pregnant women, and those who are taking medications that may interact adversely with alcoholic beverages), the risks of alcohol consumption, even in moderation, outweigh any potential benefits. Because even small amounts of alcohol can impair judgment and coordination, no one should drink alcoholic beverages, even in moderation, before driving a motor vehicle or performing other activities that involve attention and skill.

A novel strategy for determining protective antigens of the parapoxvirus, orf virus.

We investigated the feasibility of using vaccinia virus (VAC) recombinants containing large multigene fragments of orf virus DNA to identify protective antigens of orf virus (OV). Sixteen OV strain NZ2 DNA fragments with an average size of 11.4 kb were recombined into VAC strain Lister. Each fragment was mapped relative to OV restriction endonuclease maps but was otherwise uncharacterized. Together the recombinants represent 95% of the OV genome in an overlapping manner. Immunofluorescence showed all 16 constructs expressed products recognized by OV antiserum and radioimmune precipitation with the same antiserum allowed the localization of the major antigens of OV to specific recombinants. These data indicated the approximate genomic locations of the genes encoding the OV major antigens and showed that their expression was authentic rather than resulting from read through from VAC sequences adjacent to the site of recombination. Vaccination of OV-naive sheep with the recombinant library provided protection against a subsequent challenge with virulent OV. These data confirm the feasibility of the proposed strategy.

The establishment of a genetic map of orf virus reveals a pattern of genomic organization that is highly conserved among divergent poxviruses.

The large differences between the G+C content of the orf virus genome and those of other characterized poxviruses have precluded the use of DNA hybridization to establish a gene map of orf virus. Here we have sequenced the ends of cloned restriction endonuclease fragments of the nZ2 strain of orf virus (OV) and used the translated sequences to search protein data bases. Sequence from 15 points found high-scoring matches to data base entries, including 18 vaccinia virus (VAC) genes. We also present 2 kb of sequence from a region near the right terminus of the OV genome and show that it encodes homologs of VAC genes, F9L and F10L. The data presented here in conjunction with published and as yet unpublished data have allowed the construction of a gene map of OV on which 37 genes have been placed. Thirty-two of these genes have homologs in VAC. Alignment of the OV gene map with that of VAC revealed that each OV gene and its VAC counterpart occurred in the same order and orientation on their respective genomes. The intervals between many of the points of sequence were also found to be strikingly similar. The conserved spacing of genes between OV and VAC within the central 88.2 kb of the 139-kb OV genome is not maintained in the termini where insertion, deletion, and translocation have occurred. Parallels are drawn between the data presented here and related data from swinepox virus and capripox virus.

The health corner: a community-based nursing model to maximize access to primary care.

America spends more than $700 billion per year on a health care system that is unparalleled in the technological advances it produces, yet many Americans do not receive the basic health care they need. Access to obtaining these health services can be affected by economic, structural, or personal barriers. This paper describes a primary health care delivery that addresses the specific health concerns of a neighborhood. The model forges a partnership with the community while developing collaborative relationships with area health providers. Targeted health services are offered in a community-based, nurse-managed site. Clients receive the basic health services they need, local providers expand their client base with "satellite locations," and the major medical institutions receive more appropriate referrals and have less unnecessary use of the emergency rooms.

Health risks associated with excessive warnings about alleged cancer risks.

As the adage states, "when everything is dangerous, nothing is." If the word carcinogen (cancer-causing agent) is used to designate a spectrum of products, chemicals, and other environmental exposures, then the classification cancer causing when referring to the results of human epidemiological studies becomes meaningless. Thus, the emerging "carcinogen-of-the-week" phenomenon is counterproductive in preventing the toll of human cancer in that it diverts attention from real causes.

Public policy on smoking and health: toward a smoke-free generation by the year 2000. A statement of a working group to the Subcommittee on Smoking of the American Heart Association.

On May 20, 1984, the Surgeon General challenged the health community to work toward attainment of a smoke-free society by the year 2000. The leadership of the nation's three major voluntary organizations joined numerous associations of health professionals in accepting the challenge. The Subcommittee on Smoking of the American Heart Association (AHA) has concluded that attaining this objective requires the development and implementation of public policies designed to facilitate the transition from a smoking to a nonsmoking society. To study the relevant issues and recommend appropriate policies, the subcommittee commissioned a working group of distinguished experts in the field of smoking and health to prepare a policy statement. The statement, published here, has received the enthusiastic endorsement of the Subcommittee on Smoking and the leadership of the AHA. The working group discusses and recommends four policies: Increase the federal cigarette excise tax. Eliminate or restrict tobacco advertising and other forms of promotion. Assure the rights of nonsmokers to clean air through legislative means. Identify mechanisms to ease and assist the transition of tobacco farmers to other crops or careers.

Promotion of tobacco products: issues and policy options.

During the past year, several prominent voluntary health organizations and professional medical associations have called for a ban on all forms of promotion of tobacco products. The proposal raises complex issues, ranging from determination of the effects of tobacco promotion to assessment of the constitutionality of banning advertising of a legal product. We identify the issues that underlie the concern of health professionals, review evidence addressing these issues, and describe and discuss frequently mentioned policy options, especially the ban proposal.