A spoonful of sugar...: improving adherence to tuberculosis treatment using financial incentives.

OBJECTIVE: To determine whether incentives increase adherence to directly observed therapy (DOT) for tuberculosis (TB) treatment. METHODS: The TB program gave a five-dollar grocery coupon for each DOT appointment kept to 55 patients who had missed at least 25% of DOT doses over a 4-week period. Treatment completion rates were compared with an historic control group of 52 patients who began treatment a year earlier, who would have been eligible for incentives but did not receive them. RESULTS: Incentive program patients were more likely than control patients to complete therapy within 32 weeks (OR 5.73, 95%CI 2.25-14.84) and 52 weeks (OR 7.29, 95%CI 2.45-22.73). CONCLUSION: Patient incentives can increase adherence to DOT in TB programs.

Evaluating the basidiomycetes Poria medula-panis and Wolfiporia cocos for xylanase production.

Xylanase, oxidative enzymes and iron-binding compounds were detected in the filtrates of Wolfiporia cocos and Poria medula-panis grown in wheat bran liquid medium. Xylanase and iron-binding compounds were produced at high levels by the brown-rot fungus (BR) W. cocos and at low levels by the white-rot fungus (WR) P. medula-panis. Phenoloxidase was produced only by P. medula-panis. Polyacrylamide gel electrophoresis (PAGE) (SDS-PAGE) showed a wide variety of bands for extracellular proteins produced by W.cocos, with low molecular weight (<30 kDa) and minor bands with molecular weight above 45 kDa. Two bands with xylanase activity derived from W. cocos extracts were detected in the gels, whereas many different bands with xylanase activity were found in the extracts from P. medula-panis. P. medula-panis is a selective lignin degrader, whereas W. cocos preferentially removes cellulose from wood.

Rubella outbreaks among Hispanics in North Carolina: lessons learned from a field investigation.

OBJECTIVE: To describe the epidemiology and the lessons learned from two simultaneous, but unrelated, outbreaks of rubella in North Carolina affecting mostly Hispanic immigrants of Mexican origin. METHODS: A case and contact investigation was conducted at industrial work sites and Hispanic communities between March 26 and June 15, 1996, using both structured and informal interviews. Active surveillance was conducted at hospitals, clinical laboratories, primary care physicians' offices, local health departments, and migrant health centers to identify additional cases. Rubella specific IgM testing was performed by the North Carolina State Laboratory to confirm cases. Vaccination clinics were conducted in communities and at work sites with a large Hispanic population in affected counties to reduce the number of susceptible persons. RESULTS: Eighty-three confirmed cases of rubella were reported: 75 cases from the first outbreak and 8 from the second. The mean age of cases from both outbreaks was 24 and 20 years, respectively. Only three cases occurred among children under five years of age, two in the first outbreak and one in the second. Seventy-one (95%) cases in the first outbreak and all 8 cases in the second outbreak were Hispanics; 21 (28%) cases from the first and 3 (37%) from the second outbreak were females, and a total of 65 (78%) cases from both outbreaks were industrial workers. Six women with confirmed cases in the first outbreak were pregnant at the time of exposure. No females cases were pregnant in the second outbreak. CONCLUSIONS: The outbreaks in North Carolina confirmed the persistent susceptibility to rubella in Hispanics and persons migrating from countries where the rubella vaccine is not used for routine childhood vaccination. The ultimate goal of rubella vaccination programs is to prevent fetal infection and congenital rubella syndrome (CRS). Thus, to eliminate rubella from the United States, efforts should focus on understanding new emerging patterns of disease transmission and vaccinating susceptible adults in settings where they congregate.