Softening of cattle hoof soles and swelling of heel horn by environmental agents.

Bovine soles and shavings from the heel were used in laboratory tests that examined the softening and swelling effects of rainwater, cow slurry (faeces plus urine), urine, silage effluent, and washings from recently laid concrete. Formalin, glutaraldehyde and butyraldehyde were compared for their ability to prevent softening induced by water, urine or urea plus 2-mercaptoethanol. Exposure to rainwater, slurry or urine for 72 h softened the soles on average by 16, 13 and 14 Shore Durometer Units. Silage effluent had less softening effect on soles (7 Shore Durometer Units), and pre-treating heel shavings with silage effluent reversed the swelling effect of water. Washings and scrapings taken from 3- and 7-d-old concrete surfaces prepared from Portland cement, caused swelling in heel shavings by a factor of 1.5 and 1.3. Formaldehyde, glutaraldehyde and butyraldehyde pre-treatment reduced the sole softening effect of urea plus 2-mercaptoethanol in cow soles. Formaldehyde and glutaraldehyde pre-treatment reduced the sole softening effect of urine, and formaldehyde was effective at reducing concrete washings-induced swelling. The findings are relevant to solar bruising and ulceration in cattle.

The Aberdeen Indian Health Service infant mortality study: design, methodology, and implementation.

Of all Indian Health Service areas, the Aberdeen Area has consistently had the highest infant mortality rate. Among some tribes in this area the rate has exceeded 30/ 1000 live birth and half the infant deaths have been attributed to Sudden Infant Death Syndrome,a rate four to five times higher than the national average. The Indian Health Service, Centers for Disease Control and Prevention, National Institute of Child Health and Human Development, and the Aberdeen Area Tribal Chairmen's Health Board collaborated to investigate these high rates with the goals of refining the ascertainment of the causes of death, improving cause-specific infant mortality rates and identifying factors contributing to the high rates. Ten of the 19 tribes or tribal communities, representing 66%of the area population, participated in a 4-year prospective case-control study of infants who died after discharge from the hospital. Infant care practices and socio-demographic, economic, medical, health care, and environmental factors were examined. The study included parental interviews, death scene investigations, autopsies, neuropathology studies, medical chart abstractions, blood cotinine assays, and a surveillance system for infant deaths. Controls were the previous and subsequent infants born on the case mother's reservation. From December 1,1992 until November 30,1996,72 infant deaths were investigated. This report describes the study methods and the model employed for involving the community and multiple agencies to study the problem of infant mortality among Northern Plains Indians. Data gathered during the investigations are being analyzed and will be published at a later date.

Gestational diabetes mellitus: now is the time for detection and treatment.

The extent of universal screening for gestational diabetes and the incidence of gestational diabetes mellitus (GDM) by diagnosis were analyzed in four primary-care sites. The medical records of 798 women were reviewed to identify the presence of historical risk factors, familial determinants, and biophysical attributes associated with GDM and to determine whether screening and diagnostic tests consistent with national criteria had been completed, as well as to obtain the method of delivery and the weight and overall medical status of the infants. Of the 798 women, less than 60% underwent screening. Overall, 1.5% of the women were diagnosed with GDM, seven of whom were identified through screening. Eighty-nine infants were classified as large for gestational age, 61 of whom weighed more than 4,000 g. Of these 61 infants with macrosomia, 61% were born to women who either were not screened or had negative screening results. Most of these women had risk factors consistent with GDM. The likelihood that a substantial proportion of these women would have delivered normal-sized infants had they undergone proper screening, diagnosis, and treatment prompted us to conclude that universal screening for GDM should be adopted.

A study of 'routine' gonorrhea cultures in a family practice.

A varying, but significant, incidence of "asymptomatic" gonorrhea in women has been reported by numerous investigators and is one rationale for collecting specimens during pelvic examinations for screening gonorrhea cultures. There is a lack of research evidence, however, to document the value of such cultures in all settings. In this retrospective study of gonorrhea cultures in a family practice, all of the cultures performed in one year were reviewed. Of the 219 clinically asymptomatic women who had screening cultures ordered, only two (0.9 percent) had culture-positive results, and both were known to be recent contacts of men with confirmed gonorrhea and hence would have had a screening culture ordered anyway. This finding opens to serious question the value of routinely screening women for gonorrhea by culturing vaginal specimens in all circumstances and suggests that thorough history and examination alone, supplemented by cultures only when clinically indicated, would suffice in certain settings.

A checklist system for critical review of medical literature.

In order to teach critical review of medical literature, an approach was devised in a family practice residency setting for teaching students and doctors to review medical literature quickly while remaining critical of what is read. This is done through the use of a simple checklist which guides the user in reading an article. Such a checklist is readily modified to suit individual needs, is self-explanatory, and lends itself to use in journal club settings as well as in private reading.

Gluten in pills: a hazard for patients with celiac disease.

It has recently been recognized that many pharmaceutical products contain gluten. Patients with celiac disease are at risk of acute illness if they are treated with such products. This paper lists the products available in Canada, according to the "Compendium of Pharmaceuticals and Specialties, 1985", that contain gluten and the Canadian manufacturers who stated that they do not use gluten as an excipient.

Minor tranquillizers in somatic disorders.

Conclusive evidence of improved outcome due to adjunctive anxiolytic therapy in some somatic conditions is lacking. However, such therapy may facilitate patient management without being "curative". The resulting improved feeling of well-being may be of value in the management of gastrointestinal disorders, migraine and myocardial infarction. Negative effects may be observed in acute respiratory conditions, especially during acute exacerbations of chronic conditions, with the administration of benzodiazepines; hence they should be used with caution. The use of these agents in treating persons with hypertension seems to be of no value and may even be detrimental. Careful evaluation of each case is desirable, and treatment should be planned with its termination in mind.