Urethral infection in a workplace population of East African men: evaluation of strategies for screening and management

Transport workers (n = 504) in Mombasa, Kenya, were screened for urethral infection by history, clinical examination, and laboratory testing of urethral swabs and first-catch urine specimens. The prevalence of Neisseria gonorrhoeae was 3.4%, Chlamydia trachomatis, 3.6%, and Trichomonas vaginalis, 6.0%; more than two-thirds of infections were asymptomatic. A complaint of urethral discharge, dysuria, or both was twice as sensitive as the sign of discharge on physical examination (34.5% vs. 15.5%) in identifying infection. A positive leukocyte esterase dipstick (LED) test on urine predicted infection with a sensitivity of 95.0% and a specificity of 59.3% in symptomatic men and with a sensitivity of 55.3% and a specificity of 82.8% in asymptomatic men. Demographic and behavioral factors were not independent predictors of infection. In resource-poor settings with high prevalences of urethral infection, an effective screening and management strategy would be to treat symptomatic men, as well as asymptomatic men with a positive LED test, for all three infections.

Potential chitinase activating factor from yeast cells of Candida albicans

Microsomal chitinase from yeast and hyphal cells of Candida albicans was activated endogenously by incubation at 30 degrees C and exogenously by trypsin. The putative activating factor of yeast cells was separated from chitinase activity by fractionation of lysed protoplasts on an Iodixanol density gradient. The vacuole fraction contained no significant chitinase activity, but was enriched in chitinase activating factor. Activity of microsomal chitinase increased upon incubation with this, but no other gradient factor. Results suggest that the regulatory system governing microsomal chitinase activity, like that governing chitin synthase, involves a 'vacuolar' activating factor in Candida albicans.

Characterization and functional activity of human Rh monoclonal antibodies

For quantification of the number of molecules of IgG anti-D bound to RBC, a combination of flow cytometry plus Sol-ELISA was found more accurate than Sol-ELISA alone. However, some Rh MAbs gave very low values of cell-bound IgG using flow cytometry. Monocyte-mediated haemolysis correlated well with the number of molecules of red cell-bound IgG1 anti-D. The monocyte phagocytosis assay was found more sensitive but less quantitative than the monocyte ADCC assay. Most monoclonal antibodies mediated little haemolysis by lymphocytes in ADCC assays, and haemolysis was not related to IgG concentration, titres or cell-bound IgG.

Acceptability of HIV vaccine trials in high-risk heterosexual cohorts in Mombasa, Kenya

OBJECTIVES

To ascertain the level of acceptance of a prophylactic HIV vaccine trial in high-risk HIV-seronegative heterosexual cohorts of men and women in Mombasa, Kenya, and to assess the anticipated effects of participation on risk behavior.

METHODS

Standardized questionnaire administered to a convenience sample of commercial sex workers and trucking company employees enrolled in prospective cohort studies.

RESULTS

Ninety-six per cent of respondents believed that HIV was a major problem in Kenya and 86% of men and 94% of women perceived themselves at risk. One hundred per cent of women and 84% of men expressed interest in participation in an HIV vaccine trial, after explanation of the experimental nature of the vaccine, double-blind placebo-controlled design, prolonged follow-up and potential change in serostatus. Seventeen per cent of men and 9% of women anticipated an increase in risk behavior as a result of participation.

CONCLUSION

The majority of individuals in two high-risk cohorts were interested in participating in Phase III efficacy trials of HIV vaccines. A significant minority anticipated an increase in risk behavior, which emphasizes the need for intensive counseling and education throughout a vaccine trial.

Photonic processors: a systems approach

Symbolic representations for the functional transforms are introduced as an aid in developing and optimizing the architecture of a photonic processor. As an example of the methodology that follows from the introduction of these symbols, a structural model of a processor whose design function is real-time extraction of the spatial information content from image data is discussed.

Use of the nurse-midwifery clinical data set for classification of subjects in birth center research

Current literature on the safety and efficacy of freestanding birth centers suggests that these centers are safe and have reduced costs for delivery of low-risk women compared with hospitals. Despite these findings, birth centers continue to arouse controversy and remain limited in number. Potential inequality of birth center and hospital subjects as to perinatal risk is cited as the major methodologic flaw in the current research on birth centers. Defining an appropriate comparison group is arguably the most important methodologic issue encountered in these investigations. Defining women as "low risk" according to standard perinatal risk tools is not an adequate measure of comparability, as these criteria are generally not equivalent to those defining birth center eligibility. The key is to identify groups for comparison that, at baseline, would be expected to have similar outcomes. To address this concern, a tool based on the American College of Nurse-Midwives' Nurse-Midwifery Clinical Data Set was developed to identify valid comparison subjects for birth center research. This tool focuses on birth center eligibility as opposed to traditionally defined risk. This article reviews the issues of population comparability in birth center research and presents the results of a validation study using this newly developed tool.

Making the alternative the mainstream. Maintaining a family-centered focus in a large freestanding birth center for low-income women

The BirthPlace program in San Diego, California, is an example of a successfully "mainstreamed" alternative maternity care program. It was developed to address an access to prenatal care problem in the county, and it has successfully integrated four systems of care: 1) a private practice of nurse-midwives and obstetricians, 2) the public community clinic system, 3) the tertiary university hospital, and 4) a freestanding birth center. It provides a model of care that, if replicated, could be an answer for ensuring universal access to maternity care in the United States. The BirthPlace program primarily serves a public-funded, Hispanic population, with certified nurse-midwives as the primary providers. The program's greatest challenge has been to maintain a personalized, family-centered focus, which has been the hallmark of freestanding birth centers to date, in the face of large numbers of clients and low reimbursement for care. The program has addressed the challenge of increasing access and cost-effectiveness while ensuring family-centered care through decentralized clinic management, informed consent, culturally sensitive care, and appropriate use of technology. However, in the face of an ever-changing health care system, balancing these issues will remain a constant challenge as we reshape our maternity care services.

Human leucocyte antigen (HLA) and malaria morbidity in a Gambian community

Human leucocyte antigen (HLA) class I and class II typing was performed on 177 children in a rural area of The Gambia who were followed for 2 years in a longitudinal study of malaria morbidity. A comparison was made between those who experienced an episode of clinical malaria in one or both years and those who showed no evidence of infection in either year. No convincing association was found between morbidity and class I phenotype. An overall association of morbidity with the distribution of class II haplotypes was seen, but association with individual DR-DQ haplotypes were not conclusive.

Health and geographic mobility among the recently widowed

The death of a spouse has been described as the most disruptive and difficult role transition that an individual confronts throughout the life course. Using data from the 1984 and 1986 waves of the Longitudinal Study of Aging conducted by the National Center for Health Statistics, we examined the probability of moving associated with changes in functional disability levels over a two-year period while controlling for recent widowhood. We found that the greater the increase in instrumental disability between 1984 and 1986, the greater the probability of a move. We also found that the event of becoming a widow greatly increases the probability of a move when health declines.

Specific anti-A responses of SCID mice populated with human lymphoid cells from peripheral blood, umbilical cord, bone marrow and spleen after immunization with group A erythrocytes [corrected]

Mice with severe combined immunodeficiency (SCID) were injected i.p. with 10 x 10(6) or 50 x 10(6) human leukocytes obtained from adult peripheral blood, umbilical cord blood, bone marrow and spleen from six group O individuals, together with allogeneic group A erythrocytes. Mice were bled every two weeks and levels of human IgG, IgM and anti-A were determined in the murine plasma. Spleen cells elicited the highest Ig levels (up to 5.2 mg/ml IgG) and umbilical cord the least (0-0.16 mg/ml IgG); maximum IgG levels were obtained at about 6-8 weeks after injection. Anti-A was detected in mice receiving adult peripheral blood or spleen leukocytes and immunizing erythrocytes 4-6 weeks after injection. Mice injected with the higher dose of leukocytes gave the best anti-A responses, but were more likely to develop tumours after 8 weeks.

Lymphadenopathy and hepatosplenomegaly in the 1st year in children infected by HIV-1 in Zaire

The children of 50 women positive for antibody to human immunodeficiency virus type 1 (HIV-1) and 42 children of antibody-negative mothers were examined for lymphadenopathy and hepatosplenomegaly at 3-month intervals during the 1st year of life. Lymphadenopathy was found to be significantly more frequent at 6 months (p less than 0.01), 9 months (p less than 0.001) and 12 months (p less than 0.01) in children who were subsequently shown to be infected with HIV-1. Hepatomegaly was seen more frequently (p less than 0.05) in the 1st year in HIV-1-infected children than in uninfected children. Splenomegaly was not more frequent in HIV-1-infected children in this area which is holoendemic for falciparum malaria.

Severe anaemia in pregnancy: a problem of primigravidae in rural Zaire

Haemoglobin levels were measured in 2950 pregnant women attending antenatal clinics in Kimpese, Bas Zaire. 72% were suffering from moderate anaemia (haemoglobin (Hb) 7-11 g/dl) and 3.7% from severe anaemia (Hb less than 7 g/dl) at their first visit, before receiving any haematinics or anti-malarial prophylaxis. Haemoglobin levels rose with both increasing parity (P less than 0.001) and age. Multiple regression analysis revealed that parity was significant but age was not. The fall in haemoglobin early in the second trimester was greatest in primigravidae and diminished with successive pregnancies until the fourth. One in 6 primigravidae approached labour with a haemoglobin level less than 7.7 g/dl. Thick blood smears were examined from 379 women who presented in the first and second trimester. 70% of primigravidae had malaria parasitaemia, compared with 13% of multigravidae (P less than 0.001). Early malaria prophylaxis in the first 2 pregnancies is an important primary health care objective if the contribution of malaria to the significant fall in haemoglobin in the second trimester is to be averted.

The second move: health and geographic mobility

Litwak and Longino (1987) proposed a life course typology of elderly migration in which the second type of move is associated with the development of chronic disabilities that make it difficult to perform everyday household tasks. We examined this intermediate type of move, classified between "amenity moves" in early retirement and "institutional" moves in late old age, a type of migration that had not been verified in existing research. Using data from the 1984 and 1986 waves of the Longitudinal Study of Aging by the National Center for Health Statistics, we tested the proposition that the proportion of moves increases with higher levels of instrumental functional disability over time. The probabilities generated by our model have an impressive range as predicted by Litwak and Longino in the second move portion of their model of retirement migration.

Contributions to the history of psychology: LXXIV. Edith Banfield Jackson: a pioneer in psychoanalysis

Edith Jackson, recipient of one of Sigmund Freud's coveted rings, served him well as an ambassador for psychoanalysis. As a child psychiatrist for 25 years at the Yale School of Medicine, she developed the rooming-in plan which allowed parents and newborns to be together from birth. With Anna Freud and Dorothy Burlingham, she opened the Jackson Nursery, a precursor of American daycare centers. Among the most important people in developing the field of child psychology, Edith was one of the early psychologists who recognized the importance of satisfying the emotional as well as the physical needs of the newborn.

Contributions to the history of psychology: XLIII. A tribute to Princess Marie Bonaparte

Princess Marie Bonaparte, the great-granddaughter of the brother of Napoleon Bonaparte and one of Sigmund Freud's closest friends, did more to promote psychoanalysis than most of Freud's dedicated disciples. It was her money and political influence that helped Freud escape Nazi-occupied Austria and that financed the Verlag, the publishing company that helped spread Freud's theories to the world. It was she also who preserved part of the history of psychoanalysis by purchasing the letters Freud wrote to Wilhelm Fliess.

Strategies for investigating effects of residential context. A study of depressed mood and major depression

This article calls attention to two procedures for investigating relationships between residential environments and behavior: geocoding of respondent data and a strategy based on age of respondent as an indicator of residential exposure. These procedures are illustrated in terms of data from the Eastern Baltimore Mental Health Survey (Baltimore site of the National Institute of Mental Health Epidemiologic Catchment Area Program) and 1980 census data from the Health Demographic Profile System.

Contributions to the history of psychology: XL. The Hampstead Wartime Nurseries

To learn the fate of the Hampstead Wartime Nurseries established by Anna Freud and Dorothy Burlingham during World War II, the writer visited the sites 40 yr. later. Although she found they no longer exist, she learned they served as the precursor to the existing Hampstead Therapy and Child Clinic, the largest training center in the world offering a subspecialty of child psychoanalysis. Some of Anna and Dorothy's major findings about children are included. Their burial sites demonstrate the friendship, dedication and devotion the two had.

Contributions to the history of psychology: XXXVII. Katherine Jones (1892-1983)

Katherine Jones, “recipient of a ring” and disciple of Sigmund Freud, deserves a place in psychoanalytic history. Without her, Ernest, her husband, might not have been able to write his three-volume biography of Sigmund Freud and quite possibly The International Psychoanalytic Journal, which furthered the psychoanalytic movement in England and America, might never have been printed. Her greatest contribution, the English translation of Freud's last significant book, Moses and Monotheism, merits credit long overdue.

Contributions to the history of psychology: XXXV. Dorothy Burlingham

Almost nothing is known about Manhattan-born Dorothy Tiffany Burlingham, designated by Sigmund Freud as one of his original trusted pioneers, a united small body to guard the kingdom and the policy of the Master. She was instrumental in helping the Freuds leave Austria after the Nazi takeover in 1938. In addition, had it not been for Dorothy Burlingham, psychology might have never known Erik Erikson.

Vitamin absorption in the in vivo intestine of normal and infected (Hymenolepis diminuta: Cestoda) rats

Uptake and serosal transfer of the vitamins thiamine, riboflavin and folic acid have been studied in vivo in normal and parasitized rats infected with Hymenolepis diminuta (Cestoda). Regional differences in intestinal uptake of all three vitamins in both uninfected and parasitized animals were not satistically significant. In the parasitized intestine mucosal uptake and serosal transfer of thiamine were significantly inhibited, with increased mucosal accumulation of the vitamin as luminal thiamine concentration increased. Apparent increased riboflavin mucosal uptake in parasitized animals, was not matched by the reduced serosal transfer, suggesting adsorption of the vitamin in the unstirred aqueous layers. Mucosal uptake of folic acid increased in the parasitized gut; serosal transfer and mucosal accumulation were not affected. These results, indicating vitamin malabsorption associated with infection by H. diminuta, are consistent with the parasite inhibiting mucosal passive transport mechanisms. This conclusion is supported by the changes in net water fluxes associated with vitamin uptake in the parasitized intestine.

Presumed histoplasmic maculopathy: clinical course and prognosis in nonphotocoagulated eyes

In this chapter, we have tried to identify some of the variables related to the visual prognosis in eyes with presumed histoplasmic maculopathy. We are cognizant that a constellation of other as yet unidentifiable variables also may play a role in the visual prognosis. Also, we have reported our visual results in patients who were nt photocoagulated. Many of these patients received corticosteroid therapy in some form, but we found it impossible to compare treatment ot nontreatment groups. Our results for visual prognosis is all nonphotocoagulated eyes are in general agreement with those available in the literature. For instance, Gass et al. [1] report 20 of 38 eyes (52.6 percent) with visual acuity of 20/200 or less. Also, this same study documents retention of 20/30 or better central vision in 13 of 38 eyes (34 percent), and the visual results in our study for all 54 nonphotocoagulated eyes parallel the reported findings of Schlaegel et al. [3] where 59 percent of eyes ended with a visual acuity of 20/200 or worse, 30 percent with vision of 20/50 or better, and 18 percent with vision of 20/30 or better...

Presumed histoplasmic maculopathy: xenon photocoagulation

Every investigation into the efficacy and role of photocoagulation in the management of PHM has been handicapped by the lack of a valid control series. In all first eyes, the results of photocoagulation are better than in second eyes. The increased salvage rate of central visual acuityof 20/50 or better in first eyes without photocoagulation is on the order of 15.8 percent to 28.6 percent-versus 25 to 38 percent in first eyes with photocoagulation (an average of 54 percent salvage rate for all first eyes). However, in second eyes, even though the number of eyes is small, it appears that nonphotocoagulated eyes do better than those that have been photocoagulated: 46 percent of nonphotocoagulated second eyes versus 33 percent of second eyes with photocoagulation retain central vision of 20/50 or better. Comparison of our results with some of the other published studies indicates some disparity in results [1-5], arising, most plausibly, from variations in the severity of the maculopathy just prior to photocoagulation. It is our contention that carefully designed prospective studies are needed, in which cases would be randomized for treatment in groups classified according to severity of the process (for example, size of SNV, proximity of SNV to fovea, and amount and location of subretinal hemorrhage). In order to obtain sufficient cases for analysis, a collaborative study may be essential in which the results and analysis of the cases are compiled by an independent party not involved in the treatment of evaluation of the patients. Despite this lack of clinical corroboration, it is my firm belief based on clinical experience that photocoagulation does have a role in the management of this vision-threatning process.