The microbiological quality of drinking water sold on the streets in Kumasi, Ghana

AIM

The aim of this study was to assess the microbiological quality of Ghanaian bottled and plastic-bagged drinking water sold on the streets of Metropolitan Kumasi, Ghana.

METHODS AND RESULTS

Eight bottled, 88 factory-filled plastic sachet and 40 hand-filled hand-tied polythene-bagged drinking waters were examined for the presence of heterotrophic bacteria total viable counts (TVCs), indicators of faecal contamination (total coliforms, faecal coliforms and enterococci) and for lead, manganese and iron. Heterotrophic bacteria were found in all three types of water with TVCs per millilitre ranging from 1 to 460 for bottled water, 2-6.33 x 10(5) for factory-bagged sachet water and 2.33 x 10(3)-7.33 x 10(12) for hand-filled hand-tied bagged water. None of the microbial indicators of faecal contamination were detected in bottled water, whereas 4.5% of the factory-bagged sachets contained total coliforms and 2.3% faecal coliforms, and 42.5% of the hand-filled hand-tied bags contained total coliforms, 22.5% faecal coliforms and 5% enterococci. Iron was found in all three types of drinking water but at concentrations well within the WHO recommendations. Lead and manganese were not detected.

CONCLUSION

Ghanaian bottled water is of good microbiological quality but some factory-bagged sachet and hand-filled hand-tied polythene-bagged drinking water are of doubtful quality.

SIGNIFICANCE AND IMPACT OF THE STUDY

Factory-bagged sachets and hand-filled hand-tied bags of drinking water sold in Ghana should be monitored for microbiological contamination, with the aim of raising standards in the industry and re-assuring the public.

Genetic diversity of Campylobacter jejuni isolates from farm animals and the farm environment

The genetic diversity of Campylobacter jejuni isolates from farm animals and their environment was investigated by multilocus sequence typing (MLST). A total of 30 genotypes, defined by allelic profiles (assigned to sequence types [STs]), were found in 112 C. jejuni isolates originating in poultry, cattle, sheep, starlings, and slurry. All but two of these genotypes belonged to one of nine C. jejuni clonal complexes previously identified in isolates from human disease and retail food samples and one clonal complex previously associated with an environmental source. There was some evidence for the association of certain clonal complexes with particular farm animals: isolates belonging to the ST-45 complex predominated among poultry isolates but were absent among sheep isolates, while isolates belonging to the ST-61 and ST-42 complexes were predominant among sheep isolates but were absent from the poultry isolates. In contrast, ST-21 complex isolates were distributed among the different isolation sources. Comparison with MLST data from 91 human disease isolates showed small but significant genetic differentiation between the farm and human isolates; however, representatives of six clonal complexes were found in both samples. These data demonstrate that MLST and the clonal complex model can be used to identify and compare the genotypes of C. jejuni isolates from farm animals and the environment with those from retail food and human disease.

Group psychotherapy and people with dementia

Psychotherapy and counselling approaches are being used increasingly with people with dementia, but there has been little structured research into the effectiveness of such work. This research reports findings from the evaluation of six, ten-week long psychotherapy groups for people with dementia in the south of England. Measures of depression and anxiety were taken independently of the clinical work at four time points: six weeks before the group began, at the start of the group, at the end of the group and at follow-up after a gap of ten-weeks. Forty-two participants entered the project at different points, of whom 19 completed the baseline, intervention and follow-up phases of the project. Analysis of the data for depression and anxiety levels using a repeated measures ANOVA showed a statistically significant treatment effect for Cornell depression scores which was maintained at follow-up and a similar reduction in anxiety as measured by the rating for anxiety in dementia (RAID) which was borderline for significance. Although not all people with dementia would be suitable for group psychotherapy, nevertheless this research provides some of the first clear evidence that group psychotherapy may have a role to play in reducing levels of depression and anxiety of people with mild and moderate levels of dementia.

Cattle and sheep farms as reservoirs of Campylobacter

AIM

This is a review of the natural Campylobacter colonization and transmission among ruminant livestock in the dairy farm environment.

METHODS AND RESULTS

Using cultural detection methods and enumeration techniques the distribution of Campylobacter in ruminant animals at birth, on the farm, at slaughter and in the farm environment have been examined. Colonization and shedding rates are higher among young animals while patterns of shedding in adult animals may be seasonal. Stored and land-dispersed slurries provide a reservoir for scavenging birds and flies and a source for runoff.

CONCLUSIONS

The dairy farm plays a significant role in the dissemination of Campylobacter subtypes that can cause disease in the human community.

SIGNIFICANCE AND IMPACT OF STUDY

An understanding of the role of the dairy farm in the environmental cycle of Campylobacter is required in order to devise intervention strategies.

Contextual risk factors for the common mental disorders in Britain: a multilevel investigation of the effects of place

STUDY OBJECTIVE

To test hypotheses about associations between area level exposures and the prevalence of the most common mental disorders (CMD) in Britain. A statistically significant urban-rural gradient was predicted, but not a socioeconomic gradient, in the prevalence of CMD after adjusting for characteristics of individual respondents. The study tested the hypothesis that the effects of area level exposures would be greatest among those not in paid employment.

DESIGN

Cross sectional survey, analysed using multilevel logistic and linear regression. CMD were assessed using the General Health Questionnaire (GHQ). Electoral wards were characterised using the Carstairs index, the Office of National Statistics (ONS) Classification of Wards, and population density.

SETTING

England, Wales, and Scotland.

PARTICIPANTS

Nearly 9000 adults aged 16-74 living in 4904 private households, nested in 642 electoral wards.

MAIN RESULTS

Little evidence was found of statistically significant variance in the prevalence of CMD between wards, which ranged from 18.8% to 29.5% (variance 0.035, SE 0.026) (p=0.11). Associations between CMD and characteristics of wards, such as the Carstairs index, only reached statistical significance among those who were economically inactive (adjusted odds ratio for top v bottom Carstairs score quintile 1.58, 95% CI 1.08 to 2.31) (p<0.05).

CONCLUSIONS

There may be multiple pathways linking socioeconomic inequalities and ill health. The effects of place of residence on mental health are greatest among those who are economically inactive and hence more likely to spend the time at home.

Calcium signaling and uterine contractility

Changes in Ca(2+) signals within the myometrium have important functional consequences, as they determine contractility. We show that the basic phasic nature of uterine contractions, which is essential for successful labor, is critically dependent on Ca(2+) influx through voltage-gated L-type Ca(2+) channels, and hence in turn, on membrane potential. Thus changes in ion channel expression around term will play an important role in governing uterine excitability and contractility. There remains uncertainty about which channels are present in human myometrium and the nature of the pacemaker mechanism that initiates the action potential. The sarcoplasmic reticulum may augment, to a small extent, the necessary increase in [Ca(2+)] for contraction when agonists stimulate the uterus, but its main role appears to be to control excitability, acting as a negative feedback mechanism to limit contractions. Myosin light chain kinase activity and phosphorylation of myosin are essential components in the pathway of uterine contraction, once Ca(2+) has been elevated. Modulation of myosin light chain phosphatase activity can also influence contractions, but the effects are small compared with those modulating myosin light chain kinase. Ca(2+)-sensitizing pathways may not be utilized much in modulating normal phasic uterine activity, and caution is needed in extrapolating from in vitro experiments to in vivo conditions, especially because there may be redundant pathways. There is a need to study appropriate physiologic preparations, but these are not always available (eg, preterm laboring myometrium) and to combine functional studies with modern molecular approaches, to advance our understanding to a new level, from which better therapeutics will be developed.

Management of HIV and hepatitis B or C co-infection in 15 HIV treatment centres. Disparity between protocols and practice

Our aim was to ascertain current guidelines and clinical practices prevalent in HIV treatment centres in the North Thames Region of England on the care of patients co-infected with HIV and hepatitis B or C. A self-completed postal survey of clinic guidelines and retrospective case-note reviews was performed. Fifteen of the 27 units completed the survey and generally had clinic guidelines consistent with current national guidelines. Stated policy was usually to screen HIV patients for hepatitis B virus (HBV) and hepatitis C virus (HCV) and to offer specific therapy for the hepatitis as well as the HIV. Many units were unable to contribute cases to the case-note review, probably through lack of case-identification, and therefore 11 units contributed 27 case-note reviews on HIV/HBV and five units contributed 11 case-note reviews on HIV/HCV. Fifty-six percent (25/45) of patients of HBV patients were HBeAg+ve and 88% (22/25) of these had received specific hepatitis B therapy although for 59% (13/22) this was with lamivudine as part of a highly active antiretroviral therapy regimen. None of the HIV/HCV patients had received or been referred for HCV-specific therapy. Testing for hepatitis A immunity in HBV or HCV patients with a view to vaccination was done in only 50% although 96% of HIV/HCV patients had been screened for HBV. There are significant differences between the clinics' intended and actual management of HIV and chronic viral hepatitis co-infection.

A national audit of radiotherapy in head and neck cancer

AIMS

To undertake a national audit of radiotherapy practice in head and neck cancer to estimate compliance with published guidelines and national standards.

METHODS

A two-part electronic data entry form was distributed to all U.K. radiotherapy centres in September 2000. The first part examined the centres' policies for managing interruptions, the second collected summaries of the management of 50 consecutive patients treated in each centre for head and neck cancer. The outcome measures were: frequency and causes of interruptions to therapy: policy and compliance with policy for managing interruptions; prolongation; and time between first visit to clinic and start of treatment.

RESULTS

Fifty-five out of 56 centres returned data on a total of 2553 patients. Overall, 1467 (55%) patients had one or more treatment interruptions. Of patients whose treatment was interrupted, 56% still completed on time due to compensatory steps, but in 32% no attempted compensation was undertaken. Seven centres had no policy for dealing with treatment interruptions. Centres whose policies included treatment on bank (public) holidays achieved higher compliance and fewer prolonged cases than those whose policies did not. Average time from first visit to head and neck oncology clinic to starting radiotherapy was 40 days; six centres had an average wait of less than 28 days.

CONCLUSIONS

This audit demonstrates wide variations in the quality of care between centres, failure to comply with guidelines for compensation for gaps and failure to meet national targets (for waiting times) that have serious implications both for patient outcomes and for the success of the National Cancer Plan.

Perceptual differences regarding health and environmental problems and their remedies in two states of the former Czechoslovakia

In the framework of the Central European Study on Air pollution and Respiratory Health (CESAR), a risk perception and risk communication study was carried out in a total of 25 areas in Bulgaria, the Czech Republic, Hungary, Poland, Romania and the Slovak Republic. This paper is focused on the differences of perception between the Czech (CR) and the Slovak Republic (SR), and the other involved countries. The analysis is based on the data of a structured risk perception questionnaire survey of a random population sample. 6,043 completed questionnaires were collected from the total number of 14,400 distributed ones in 25 areas of the 6 countries. The risk perception was different in the CR and the SR, mainly concerning local environment and health of children in the CR and drug abuse including alcohol consumption and AIDS in the SR. In both countries environmental and health problems were seen as important, but the perceived responsibility for finding a solution was placed with different kinds of institutions.

Butter as an indicator of regional persistent organic pollutant contamination: further development of the approach using polychlorinated dioxins and furans (PCDD/Fs), and dioxin-like polychlorinated biphenyls (PCBs)

The potential for use of butter as a widely available, relatively uniform lipid-rich matrix for the determination of spatial distributions of persistent organic pollutants has already been demonstrated. The present study determines the contributions to toxicity equivalence (TEQ) from polychlorinated dioxins and furans (PCDD/Fs) and polychlorinated biphenyls (PCBs) using butter samples from 24 countries world wide. Concentrations of PCDD/Fs and dioxin-like PCBs ranged from 0.07 to 5.69 pg SigmaWHO-TEQ g(-1) lipid. For most samples, PCDD/F TEQ fell within ranges reported for European dairy products over the last decade (0.3-2 pg x g(-1) lipid I-TEQ), though a single sample from Spain was a notable exception. Other than this sample, the highest values were recorded for samples from the Netherlands and Italy, with those from India, China and Tunisia also being relatively high. The contribution from non-ortho-PCBs was particularly significant in samples from Germany, Austria, Italy, the Czech Republic, Tunisia, India and Argentina. Although overall TEQs were generally highest in European and Mediterranean butters, elevated levels were also apparent in industrializing regions of Asia (India, China) and Latin America (Argentina). More detailed regional studies would be necessary to identify likely dioxin and PCB sources in each case. Nevertheless, this study supports the utility of butter as a monitoring matrix that may be especially applicable in regions for which monitoring programmes are currently lacking.

Factors affecting the extent of dermal absorption of solvent vapours: a human volunteer study

OBJECTIVES

We have previously reported that solvent vapours can be absorbed through the skin and that the extent varies markedly and depends on the chemical. For some chemicals, the extent of absorption is significant, e.g. for 1-methoxy-2-propanol dermal absorption accounts for up to 14% of the total absorbed dose after 8 h exposure at the OES. We have conducted a second study using 2-butoxyethanol to investigate the influence of temperature, humidity and clothing on the dermal absorption of vapours. As for the first study, the extent of dermal absorption was determined by biological monitoring to measure the resultant body burden of the chemical.

METHODS

Four volunteers were exposed on nine occasions. For eight of these exposures they wore air-fed half-masks to supply clean air for the inhalation route. The 'baseline' conditions (one 'whole body' and one 'skin only' exposure) were 25 degrees C, 40% relative humidity with volunteers wearing shorts and T-shirt. For each subsequent exposure, a single parameter was changed: humidity (60%, 65%), temperature (20 degrees C, 30 degrees C) or clothing (minimal and overalls). Finally, a 'industrial scenario' was conducted where volunteers wore overalls over their shorts and T-shirts and environmental conditions reflected high temperature and high humidity (30 degrees C, 60%), such as might be encountered in a tank-cleaning operation or similar.

RESULTS

Results show that 'baseline' dermal absorption of 2-butoxyethanol vapour was, on average, 11% of the total absorbed dose. Higher temperature (30 degrees C, mean 14%, P = 0.03) and greater humidity (65% RH, mean 13%, P = 0.1) increased dermal absorption. The wearing of whole-body overalls did not attenuate absorption (mean 10%). By combining several factors together in the 'industrial scenario', dermal absorption of vapours was significantly increased with a mean of 39% of the total absorbed dose.

CONCLUSIONS

The work has shown that dermal absorption of vapours can be significant and that environmental conditions may affect the absorption. Some types of protective clothing may not be suitable to reduce absorption. The possibility of dermal absorption of vapours should be considered particularly for workers in high vapour concentration conditions where control of exposure relies on respiratory protection.

Australian doctors and their postgraduate qualifications

BACKGROUND

A key activity for doctors is lifelong learning. This may be as part of professional development, vocational registration, formal postgraduate study, e.g. university diplomas and degrees, or vocational training which leads to fellowship of a professional college. However, there are significant barriers of time and cost that prevent many doctors from participating in lifelong learning.

METHOD

We examined the range of basic and postgraduate qualifications held by a representative sample of 1198 doctors provided by the HIC of Australian doctors.

DISCUSSION

Significant numbers of general practitioners practise without a formal postgraduate qualification in general practice, unlike our specialist colleagues. However, postgraduate studies are undertaken in a variety of other formats and qualifications.

The unilateral opaque maxillary sinus on computed tomography

Computed tomography (CT) is the imaging method of choice for conditions that affect the paranasal sinuses. We reviewed all paranasal CT scans in the ear nose and throat (ENT) and maxillofacial surgery departments in 1 year. Of these 372 scans, unilateral opacity of the maxillary sinus was seen in 20 cases. Neoplastic disease was diagnosed in six of these, four of which were malignant. We describe the cases of neoplastic disease, particularly features of the history, examination, and scans that should alert the clinician to the possibility of sinister pathology. We emphasise the importance of nasendoscopic examination in the accurate assessment of sinonasal disease.

Determinants of 2,000 m rowing ergometer performance in elite rowers

This study examined the physiological determinants of performance during rowing over 2,000 m on an ergometer in finalists from World Championship rowing or sculling competitions from all categories of competion rowing (19 male and 13 female heavyweight, 4 male and 5 female lightweight). Discontinuous incremental rowing to exhaustion established the blood lactate threshold, maximum oxygen consumption (VO(2max)) and power at VO(2max); five maximal strokes assessed maximal force, maximal power and stroke length. These results were compared to maximal speed during a 2,000 m ergometer time trial. The strongest correlations were for power at VO(2max), maximal power and maximal force (r=0.95; P<0.001). Correlations were also observed for VO(2max) (r=0.88, P<0.001) and oxygen consumption (VO(2)) at the blood lactate threshold (r=0.87, P=0.001). The physiological variables were included in a stepwise regression analysis to predict performance speed (metres per second). The resultant model included power at VO(2max), VO(2) at the blood lactate threshold, power at the 4 mmol x l(-1) concentration of blood lactate and maximal power which together explained 98% of the variance in the rowing performance over 2,000 m on an ergometer. The model was validated in 18 elite rowers, producing limits of agreement from -0.006 to 0.098 m x s(-1) for speed of rowing over 2,000 m on the ergometer, equivalent to times of -1.5 to 6.9 s (-0.41% to 1.85%). Together, power at VO(2max), VO(2) at the blood lactate threshold, power at 4 mmol x l(-1) blood lactate concentration and maximal power could be used to predict rowing performance.

Development and evolution of inner ear sensory epithelia and their innervation

The development and evolution of the inner ear sensory patches and their innervation is reviewed. Recent molecular developmental data suggest that development of these sensory patches is a developmental recapitulation of the evolutionary history. These data suggest that the ear generates multiple, functionally diverse sensory epithelia by dividing a single sensory primordium. Those epithelia will establish distinct identities through the overlapping expression of genes of which only a few are currently known. One of these distinctions is the unique pattern of hair cell polarity. A hypothesis is presented on how the hair cell polarity may relate to the progressive segregation of the six sensory epithelia. Besides being markers for sensory epithelia development, neurotrophins are also expressed in delaminating cells that migrate toward the developing vestibular and cochlear ganglia. These delaminating cells originate from multiple sites at or near the developing sensory epithelia and some also express neuronal markers such as NeuroD. The differential origin of precursors raises the possibility that some sensory neurons acquire positional information before they delaminate the ear. Such an identity of these delaminating sensory neurons may be used both to navigate their dendrites to the area they delaminated from, as well as to help them navigate to their central target. The navigational properties of sensory neurons as well as the acquisition of discrete sensory patch phenotypes implies a much more sophisticated subdivision of the developing otocyst than the few available gene expression studies suggest.

Oral and dermal exposure to propetamphos: a human volunteer study

Propetamphos ((E)-O-2-isopropylcarbonyl-1-methylvinyl-O-methylethyl phosphoramidothioate) is an organophosphate pesticide (OP) and has been used as an active ingredient in sheep dip where there is the potential for significant dermal exposure during dipping. Biological monitoring of exposure to propetamphos has until recently relied on the measurement of cholinesterase activity in plasma. Following the development of a novel method for the determination of propetamphos metabolites in urine, it is now possible to biologically monitor exposure using urine samples. This paper describes a human volunteer study involving oral and dermal exposure to propetamphos.

Exposure to the organophosphate diazinon: data from a human volunteer study with oral and dermal doses

Biological monitoring of occupational exposure to diazinon is possible by the determination of blood cholinesterase activity and by the measurement of metabolites in urine. However, there is little data to aid in the interpretation of results. This study gave oral (11 microg kg(-1) (36 nmol kg(-1)) body weight) and occluded dermal (100 mg (329 micromol)) doses of diazinon to five volunteers and analysed blood and urine samples for plasma and erythrocyte cholinesterase and urinary dialkyl phosphate (DAP) metabolites of diazinon: diethyl phosphate (DEP) and diethyl thiophosphate (DETP). Following oral and dermal exposure, peak urinary DAP levels occurred at 2 and 12 h, respectively. The apparent urinary elimination half-lives of DAP metabolites following oral and dermal exposure were approximately 2 and 9 h, respectively. Approximately 60% of the oral dose and 1% of the dermal dose was excreted as urinary DAP metabolites, with 90% of the dermal dose being recovered from the skin surface. On a group basis, there was no statistically significant mean depression in plasma or erythrocyte cholinesterase when compared with pre-exposure levels for either dosing experiment. The observed elimination kinetics of diazinon metabolites suggest a biological monitoring strategy for occupational exposure to diazinon based on urine samples collected at the end of shift.

Biological monitoring of exposure to organophosphate pesticides

Organophosphates (OPs) are readily absorbed through the skin and biological monitoring is an essential component of any comprehensive assessment of exposure. This paper presents a summary of our experience in a wide range of occupational studies. Additionally, we have conducted studies of non-occupational exposure and human volunteer studies looking at the kinetics of chlorpyrifos, propetamphos, diazinon and malathion. In non-occupationally exposed people, 95% of urinary alkyl phosphates do not exceed 72 micromol/mol creatinine. In occupationally exposed people, the corresponding 95th percentile of total urinary alkyl phosphates is 122 micromol/mol creatinine. In volunteer studies with 1 mg oral doses of chlorpyifos, diazinon and propetamphos the mean peak values were 160, 750 and 404 micromol/mol creatinine, respectively, and were not associated with any reduction in blood cholinesterase activity. The levels of OP metabolites seen in urine from workers potentially exposed to OPs are generally low and unlikely to cause significant reduction in blood cholinesterase activity.

Biguanide-atovaquone synergy against Plasmodium falciparum in vitro

The synergistic potential of a range of biguanides, their triazine metabolites, tetracyclines, and pyrimethamine in combination with atovaquone has been assessed. All five biguanides tested interacted synergistically with atovaquone against Plasmodium falciparum in vitro. All of the other compounds tested were either additive or antagonistic.