A foodborne outbreak of cyclosporiasis caused by imported raspberries.

BACKGROUND: Cyclospora cayetanensis is a recently recognized parasite that causes prolonged diarrheal illness. Its modes of transmission have not been fully determined, although some investigations before 1996 implicated water. Outbreaks of cyclosporiasis in the United States in 1996 and 1997 are evidence of the increasing incidence of this disease. This report describes an outbreak of cyclosporiasis in persons who attended a luncheon on May 23, 1996, near Charleston, South Carolina. METHODS: In this retrospective cohort study, we interviewed all 64 luncheon attendees and the chef regarding food and beverage exposures. A case of cyclosporiasis was defined as diarrhea (> or = 3 loose stools per day or > or = 2 loose stools per day if using antimotility drugs) after attending the luncheon. We identified sporadic cases of cyclosporiasis and traced the implicated food. RESULTS: Of 64 luncheon attendees, 38 (59%) met the case definition. Persons who ate raspberries (relative risk [RR] = 5.4; 95% confidence interval [CI], 2.2-13.2) or potato salad (RR = 1.8; 95% CI, 1.2-2.6) were at significantly increased risk for illness. The population attributable risk percentages were 73% for raspberries and 20% for potato salad. Cyclospora oocysts were found in stools from 11 (85%) of the 13 case patients submitting specimens for testing. Implicated raspberries originated in Guatemala. CONCLUSIONS: Our investigation is one of the first studies to implicate a specific food (raspberries) as a vehicle for transmission of Cyclospora. Because of the apparent increasing incidence of cyclosporiasis in the United States, family physicians should consider testing for Cyclospora in any patient with prolonged, unexplained diarrhea.

Emotional support for cancer patients: what do patients really want?

For many cancer patients and their families the experience of cancer is an intensely stressful one. Emotional support is important for most cancer patients during their illness and can be gained from different people and services. This study evaluates patients' attitudes to different sources of support and rates their satisfaction with sources already used. A total of 431 patients completed a questionnaire covering the use of different sources, including individuals, support groups and information sources. The questionnaire also incorporated validated measurements of anxiety, depression and locus of control. The results revealed that the three most important sources of emotional support were senior registrars (73%) and family (73%), followed by consultants (63%). Patients would prefer doctor- and nurse-led support groups to patient only-led groups (26% vs 12%). Pamphlets, such as the BACUP booklets, proved the most important of the informational sources sought (50%). A total of 86% of patients were satisfied or very satisfied with the emotional support received. Patients who expressed dissatisfaction with their emotional support were significantly more likely to be anxious and depressed (P < 0.001). Patients who used information sources were more likely to have a higher locus of control over the course of their disease. These results show how important the doctor's role is in the provision of emotional support.

Retention of patients who entered methadone maintenance via an interim methadone clinic.

Time in treatment is considered an important predictor of good outcomes for drug abuse treatment. Patient retention would be of particular concern for low-service types of treatment. Interim methadone maintenance was developed as an alternative to waiting lists and as a method of providing HIV risk-reduction services to heroin addicts waiting for treatment, and does not include the regular counseling required in comprehensive methadone treatment. This analysis compares the retention of patients first admitted to an interim methadone clinic versus that of patients admitted directly to a comprehensive methadone clinic. The two groups did not differ with regard to demographic characteristics and drug of abuse at the time of admission. The two groups did not differ with respect to demographics. The three-, six-, and 12-month retention rates of patients first admitted to the interim clinic were 78%, 69%, and 62%, respectively. The three-, six-, and 12-month retention rates for patients admitted directly to a traditional methadone clinic were 84%, 76%, and 68%, respectively. Life-table analysis revealed that the two groups did not differ significantly with regard to retention (p = 0.17). Interim treatment does not appear to adversely affect overall retention in treatment. Three- and six-month retention rates of interim clinic patients fall within the range of six-month nationwide retention rates reported by the GAO. Factors associated with discharge from treatment are examined for both groups.

The many faces of AIDS: opportunities for intervention.

Social and cultural issues may have a profound impact on different populations' responses to the AIDS epidemic. To maximize their own effectiveness, clinicians need to be aware of special needs and concerns.

Indicators of nutritional status among clients from a New York City methadone treatment center.

As the AIDS epidemic in the United States moves steadily into the IV drug-abusing population, knowledge of factors related to immune suppression and disease progression gain in public health importance. Indicators of nutritional status, consisting of anthropometric and hematologic data as well as demographic data, were obtained from a random sample of 130 clients in a New York City methadone treatment center. Subjects for this study were selected according to the entry criteria established for inclusion in a large-scale study of the role of nutritional factors and cell-mediated immunity in a group at high risk of HIV seropositivity. Our results indicate a larger than U.S. population-average heterogeneity for Body Mass Index, hematocrit, and hemoglobin concentration, parameters which are conventionally thought to be proxies for general nutritional status. The findings indicate that while some methadone treatment clients are at low nutritional risk, others are probably at very high risk of adverse drug-nutrient and drug-body habitus interactions as well as being at high risk of acquiring infections commonly associated with HIV-related immunodeficiency.

Developing strategies for AIDS prevention research with black and Hispanic drug users.

More than 8 of 10 intravenous drug users infected with the human immunodeficiency virus (HIV) are black or Hispanic. Recognizing that sociocultural factors affect HIV transmission, public health officials have called for interventions designed for ethnic-racial minority groups. Considered in this paper are the nature and extent of AIDS among ethnic-racial minorities and the cultural aspects of drug use and sexual behavior related to HIV transmission. That drug users and their associates are practicing safer needle use is evident; that they are changing their sexual behavior is less so. Calling for rapid advances in knowledge and expanded efforts in intervention, Federal agencies have instituted numerous programs to support innovative research and demonstration projects in ethnic-racial minority communities. Needed are studies that (a) describe the phenomena of drug use and sexual behavior among ethnic-racial minority populations, (b) establish the efficacy of culturally specific AIDS prevention strategies in drug treatment and community settings, and (c) demonstrate new ways of recruiting, treating, and reducing relapse among drug users.

Psychosocial reactions of persons with the acquired immunodeficiency syndrome.

The psychosocial impact of the acquired immunodeficiency syndrome (AIDS) on patients follows the situational distress model of crisis, transitional state, and deficiency state. Repeated crises in AIDS modify this reaction, and patients may experience a final adjustment, the preparation for death. Additional psychosocial problems are caused by the intensified prejudice against homosexual men and drug addicts. Society itself has been disrupted by the new information about sexual behavior that has been brought to light by AIDS, indicating that primitive sexual taboos still influence modern society. Understanding the various psychosocial reactions to AIDS offers opportunities for social progress and personal growth.

Differential control of ethylene-induced gene expression and respiration in carrot roots.

Ethylene treatment of carrot roots elicits a developmental program encompassing an increase in respiration rate and changes in gene expression. Both phenomena are potentiated when ethylene is administered in O(2). Our previous studies showed that both respiration and a number of ethylene specific mRNAs increase together in response to ethylene through some 21 hours, whereas thereafter respiration continues to rise, while the level of induced mRNAs drops. Herein we ask whether an experimentally effected drop in the respiration rate within the first 21 hours caused by the withdrawal of ethylene, or substitution of air for O(2) in the continued presence of ethylene, is linked to a drop in the level of ethylene-induced mRNA. Quantitative estimation of two ethylene evoked mRNAs by dot blot hybridization with appropriate cDNA clones has shown that under the specified treatment the induced mRNA levels remain constant while the respiration rate drops, suggesting that gene expression, as reflected in induced mRNA levels, and respiration rate are separately regulated facets of the ethylene response.

Ethylene-regulated gene transcription in carrot roots.

The plant hormone ethylene elicits many biochemical changes in target tissues. To investigate ethylene effects on expression of genetic information, cDNA clones corresponding to ethylene-induced carrot root mRNAs were constructed and isolated. RNA dot blot analysis showed that for the three clones studied peak cytosolic mRNA prevalence occurred at 21 h of treatment followed thereafter by rapid messenger decay. DNA filter excess hybridization to in vitro synthesized nuclear RNA showed that the ethylene-induced mRNA increase is engendered by transcription of previously quiescent genes. The kinetics and magnitude of changes in mRNA prevalence parallel changes in transcriptional activity; therefore the ethylene effect is primarily at the level of transcription. In vivo pulse labelling with [(35)S]-methionine showed that between 18 and 27 h of ethylene treatment a 2.5 fold increase in translational efficiency occurred for one message studied. The resulting protein is the predominant protein synthesized in carrots treated with ethylene for 27 h. Thus ethylene seemingly exerts multiple regulatory controls on the expression of genetic information.

A simple preparation of N-phosphorylated lysine and arginine.

An improved specific synthesis of N-epsilon-phospholysine is described. Phosphorylation under basic conditions of the copper chelate of L-lysine with phosphorus oxychloride and subsequent removal of the copper ion affords N-epsilon-phospholysine as the sole phosphorylated product. Similar treatment of L-arginine yields N-omega-phosphoarginine as the sole product which is identical to that produced enzymatically.