Economic and demographic research on malaria: a review of the evidence

The primary objective of malaria control is to reduce deaths and illness from the disease. Elimination of infection is far more difficult. However, in most developing countries where malaria is endemic, there are few reliable data on levels, differences and trends in malaria mortality, and its relative importance as a cause of death or illness in endemic communities. The large-scale efforts and resources being devoted to delivery of essential care to mothers and young children in most countries make it important to have a better understanding of the extent of cause-specific child mortality levels in different epidemiological conditions so that appropriate interventions can be targeted at high risk groups and properly evaluated according to their contribution to mortality reduction. As per capita resources necessary in relation to the scale of the problem remain scarce, governments are finding that they must use their available resources more efficiently in meeting their health objectives. In the case of malaria, there are far too few empirical data documenting the marginal costs and benefits of alternative interventions and their response to an expansion (or contraction) of services, and to the level of endemicity and distribution of disease. Equally important, the literature on private costs of malaria (treatment, transportation etc) provides incomplete guidance to gains from control unless the authors begin to examine the policy implications of their results; for example, in many countries there is accumulating evidence that private expenditures outweigh public expenditures on health. What effect does this mix have on infectious diseases like malaria where public sector expenditures on prevention are so important in affecting incidence?

Compliance with diphtheria, tetanus, and pertussis immunisation in Bangladesh: factors identifying high risk groups

OBJECTIVE

To evaluate factors associated with non-compliance with having second vaccination against diphtheria, tetanus, and pertussis in a treatment centre in Dhaka to determine which children were most at risk of not completing immunisation.

DESIGN

Cohort study of infants given first dose of the vaccine and followed up six weeks later to ascertain compliance with having second dose. Factors associated with non-compliance were evaluated.

SETTING

Dhaka treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh.

SUBJECTS

136 unimmunised children aged 6 weeks to 23 months who lived within reach of the treatment centre. At time of the six week follow up 16 of the children could not be traced and seven had died.

INTERVENTIONS

All children received their first dose of the vaccine. In each case health education workers had informed the mother about the value of immunisation, and she was given clear instructions to bring the child back after four weeks for the second dose.

MAIN OUTCOME MEASURE

Rate of non-compliance with advice to return child for second vaccination.

RESULTS

46 of 113 children (41%) received the second dose of the vaccine. Factors most closely associated with mothers' failure to comply with the second dose were lack of education and low income. Children whose mothers knew most about immunisation at first interview were more likely to have their second dose.

CONCLUSIONS

Preventive health care services such as immunisation are appropriately offered in treatment centres, but compliance among children varies with socioeconomic status and mother's education. Further research should be aimed at ways to make health education more effective among uneducated parents.

Left ventricular function after total correction of tetralogy of Fallot

Conflicting data are available concerning left ventricular (LV) function in patients after total correction of tetralogy of Fallot (TOF). The response to afterload stress determined by methoxamine challenge and the peak systolic blood pressure-end-systolic volume relationship were evaluated echocardiographically in 20 postoperative TOF patients (age range 9 to 15 years, mean 12 +/- 2). All patients were without significant residual shunts or pulmonary stenosis. Results were compared with those in 10 control subjects (age range 9 to 15 years, mean 11 +/- 2). The TOF group had higher mean end-diastolic (76.9 +/- 14.4 vs 66.2 +/- 7.2 ml.m-2 P less than 0.05) and mean end-systolic (36.7 +/- 8.5 vs 29.6 +/- 3.9 ml.m-2, P less than 0.05) volumes than controls. Stroke volume index (SVI) and LV ejection fraction were similar in the two groups. In normal subjects, methoxamine caused a decrease in SVI in seven out of 10 patients and a mild increase in three; the mean value of SVI at rest was not significantly different from the mean value at peak pressor effect (36.5 +/- 4.4 vs 35.9 +/- 4.0 ml.m-2, P = NS). In the TOF group, methoxamine induced a reduction in SVI in all patients; the mean value of SVI at peak pressor effect was significantly lower than the mean value at rest (31.3 +/- 5.4 vs 40.2 +/- 6.9 ml.m-2, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

DNA sequence of the nucleoside triphosphate phosphohydrolase I (NPH I) of the Choristoneura biennis entomopoxvirus

The DNA sequence of an open reading frame (ORF) corresponding to a Choristoneura biennis entomopoxvirus putative late gene was determined. Residing within an 8-kp EcoRI viral genomic fragment, this ORF is 1944 nucleotides long, encoding a basic protein (pI 9.83) with a predicted molecular weight of 76,000 Da. Computer analysis indicates a 36.4% homology between this ORF and the vaccinia nucleoside triphosphate phosphohydrolase I (NHP I) gene, with substantially greater homology (60%) in two domains believed to be involved in ATP binding. The entomopoxvirus ORF contains 78% AT residues; and like other poxvirus late genes, it possesses the conserved TAAAT motif at the 5' terminus of the gene.

Immunologic methods for the detection of benzo[a]pyrene metabolites in urine

Two monoclonal antibodies (10C10 and 4D5) have been developed from the spleen cells of Balb/c mice immunized with 6-aminobenzo[a]pyrene covalently coupled to bovine serum albumin. These antibodies have been used in an immunoassay for the detection of benzo[a]pyrene and its metabolites in mouse urine. The antibodies were characterized in terms of sensitivity and specificity by competitive enzyme-linked immunosorbent assay (ELISA). With both antibodies, 50% inhibition of antibody binding is at 4 pmol of BP. The antibodies also cross-react with a number of BP metabolites as well as with several other polycyclic aromatic hydrocarbons (PAHs) including pyrene, 1-aminopyrene, and 7,12-dimethylbenz[a]anthracene but with different sensitivities. These results suggest that this assay will detect multiple PAH metabolites in urine. To test the assay on biological samples, mice were treated with [3H]BP, and urine was collected and digested with beta-glucuronidase and aryl sulfatase. Several methods were used to isolate BP and its metabolites from the urine, including ethyl acetate extraction, Sep-pak C18 cartridge chromatography, XAD2 resin chromatography, and immunoaffinity chromatography with antibody 4D5. Analysis of the urine extracts with antibody 4D5 gave 50% inhibition at 12-15 pmol of metabolites. Thus, quantitation of metabolites in this sample by competitive ELISA against a standard curve of BP would have underestimated actual metabolite levels by about 70%. This assay will be applied to the analysis of urines from individuals with environmental or occupational exposure. Since humans are usually exposed to BP in complex mixtures of PAHs, multiple metabolites may be present in the urine, making absolute quantitation difficult. This assay should thus serve as a general indicator of exposure to this class of chemicals.

Chemotherapy: principles in practice--a case study of the Philippines

This paper reports on the principles that form the basis of chemotherapy and examines the operational considerations that affect their practice in a developing country like the Philippines, where malaria endemicity is synonymous with difficult topography, poor public health infrastructure, and alternative means of obtaining medication. The practice of using microscopic diagnosis for radical treatment is followed routinely and uniformly. Where policy dictates that all fever cases be screened, the result is an overload of the system and a corresponding delay in the slide-examination rate which makes such microscopic diagnosis cease to serve as a basis for prompt radical treatment and control in transmission.

Tactics of manipulation

Manipulation is one means by which environments are altered to correspond to characteristics of individuals. We conducted two studies to identify the manipulation tactics that people use to elicit and terminate the actions of others. Factor analyses of four instruments revealed six types of tactics: charm, silent treatment, coercion, reason, regression, and debasement. Tactics of manipulation showed strong individual difference consistency across contexts. The charm tactic, however, was used more frequently for behavioral elicitation, whereas the coercion and silent treatment tactics were used more frequently for behavioral termination. Manipulation tactics covaried significantly across self-based and observer-based data sources with personality scales of Neuroticism, Extraversion, Ambitious-Lazy, Arrogant-Unassuming, Quarrelsome-Agreeable, and Calculating and with characteristics of subjects' social environments. We draw implications for an interactionist framework of person-environment correspondence, for an expansion of the taxonomic task that faces personality psychology, and for identifying links between personality and other scientific disciplines.

Transtracheal migration of an intravertebral Steinmann pin to the left bronchus

Foreign body aspiration only rarely occurs by migration into the lung from other sites in the body. This report describes the migration of an intracervical Steinmann pin through the posterior tracheal membrane into the left bronchus and its successful removal via the rigid bronchoscope.

Tactics of manipulation

Manipulation is one means by which environments are altered to correspond to characteristics of individuals. We conducted two studies to identify the manipulation tactics that people use to elicit and terminate the actions of others. Factor analyses of four instruments revealed six types of tactics: charm, silent treatment, coercion, reason, regression, and debasement. Tactics of manipulation showed strong individual difference consistency across contexts. The charm tactic, however, was used more frequently for behavioral elicitation, whereas the coercion and silent treatment tactics were used more frequently for behavioral termination. Manipulation tactics covaried significantly across self-based and observer-based data sources with personality scales of Neuroticism, Extraversion, Ambitious-Lazy, Arrogant-Unassuming, Quarrelsome-Agreeable, and Calculating and with characteristics of subjects' social environments. We draw implications for an interactionist framework of person-environment correspondence, for an expansion of the taxonomic task that faces personality psychology, and for identifying links between personality and other scientific disciplines.

Blue toe syndrome

Blue toe syndrome is easily misdiagnosed because the cyanotic mottling resembles localized bruising from minor foot trauma. Clinicians who think of circulatory problems are sometimes led astray because the patient looks healthy and presents with excellent peripheral pulses. Appropriate laboratory studies can lead to a correct diagnosis. Endarterectomy or graft replacement of the diseased arterial segment is usually the preferred treatment.

[Expression of class II HLA antigens (HLA-DR, DQW1, DQW3) in normal skin and cutaneous pathology]

We report the cutaneous expression of class II HLA antigens disclosed by immunohistochemical staining of normal and lesional skin with monoclonal antibodies (MoAbs) reacting with HLA-DR, DQW1 and DQW3 antigens. Briefly, we disclosed: on normal human skin: 1) The Langerhans cells (LC) HLA-DR+, DQW1+; 2) the acrosyringium HLA-DR+, DQW1+, DQW3+; 3) the dermal vessel endothelial cells HLA-DR+. On lesional skin: 1) The LC were found HLA-DQW3+ in the lesional skin of some cutaneous diseases; this expression was never shown on LC of normal human skin; 2) the epidermal keratinocytes disclosed an uniform membrane expression of HLA-DR antigens in some cutaneous diseases; this kind of expression was not found by immunostaining with MoAbs directed against HLA-DQ antigens; 3) in psoriatic lesions some keratinocytes disclosed an heterogeneous expression of HLA-DR, DQW1 and DQW3 antigens; 4) tumoral cells from cutaneous malignant melanomas were shown to be HLA-DR+, DQW1+, DQW3+. The HLA-DQW3 expression on the LC of lesional skin is in favour with a modulation of HLA-DQW3 expression by unknown factors present in pathological skin. The HLA-DR expression on epidermal keratinocytes suggests a functional collaboration of keratinocytes with LC in the genetic restriction of cutaneous immune reactions.

Reactivity pattern of anti-CD1 and anti-HLA class II monoclonal antibodies with human eccrine sweat glands

The known cross-reactivity of monoclonal antibodies prepared against CD1 and HLA-DR antigens with skin components prompted us to study the reactivity pattern of human eccrine sweat glands with a panel of monoclonal antibodies directed against CD1 antigens (OKT6, BL6, D-47) and against HLA-class II antigens (anti-DR, BL2, LEU-10, IV-D12, MAJA-7). The labelling pattern of eccrine glands with the panel of monoclonal antibodies used in this study permits to establish three different antigenic compartments on eccrine glands: 1) acrosyringium and distal part of dermal duct anti-DR+, BL2+, LEU-10+, IV-D12+; 2) proximal part of dermal duct MAJA-7+; 3) secretory part D-47+. The immunological markers used in this work provide a useful tool for investigation of eccrine gland differentiation and human eccrine glandular pathology.

Enhanced fibrinolytic activity during cardiopulmonary bypass in open-heart surgery in man is caused by extrinsic (tissue-type) plasminogen activator

The nature of the enhanced blood fibrinolytic activity which is known to occur during cardiopulmonary bypass is not understood. We show here that the cause is an increase in extrinsic (tissue-type) plasminogen activator. In six patients, the nature of the enhanced blood fibrinolytic activity that evolved during cardiopulmonary bypass was characterized by differential inhibition using the fibrin plate method and was shown to be C1-inactivator-resistant (extrinsic-activator activity). The C1-inactivator-resistant-activator activity was completely quenched by an antibody against extrinsic (tissue-type) plasminogen activator but not by antiurokinase, proving that the activity was due to the presence of extrinsic (tissue-type) plasminogen activator. The concentration of extrinsic (tissue-type) plasminogen activator increased during cardiopulmonary bypass and disappeared rapidly thereafter. Fibrinogen, plasminogen and alpha 2-antiplasmin were not consumed during cardiopulmonary bypass, while no increase or occasionally a moderate one in fibrinogen degradation products occurred. This is in accord with the property of extrinsic (tissue-type) plasminogen activator which activates plasminogen predominantly at sites where fibrin is present and not in the free circulation.

Effects of the gelatin plasma substitutes Haemaccel, Plasmagel and Plasmion (Geloplasma) on collagen-, ADP- and adrenaline-induced aggregation of human platelets in vitro

The effect of some gelatin plasma substitutes (Haemaccel, plasmagel and Plasmion (Geloplasma), which are widely used in Europe) on collagen-, ADP- and adrenaline-induced platelet aggregation in human PRP in vitro was studied under controlled conditions (pH, electrolyte composition). Haemaccel inhibited these aggregations, both in citrated as well as in heparinised PRP, whereas they were enhanced by both Plasmagel and Plasmion as compared to the appropriate control. Increasing teh concentration of the inducer overcame the inhibition by Haemaccel. Haemaccel inhibited, while Plasmion enhanced 14C-serotonin release induced by collagen, ADP or adrenaline. Also in the presence of indomethacin (90 muM) Haemaccel inhibited aggregation induced by high concentrations of collagen and the primary aggregation induced by ADP and adrenaline, while Plasmion enhanced these aggregations induced by ADP and adrenaline, while Plasmion enhanced these aggregations. The inhibition by Haemaccel was not caused by binding of Ca2+ to haemaccel.

Calcific pulmonic stenosis in adulthood: treatment by valve replacement (porcine xenograft) with postoperative hemodynamic evaluation

Clinical and morphologic features are described in a 56-year-old man in whom severe, isolated pulmonic valve stenosis was treated by valve replacement with a porcine prosthesis. The calcific deposits were located on the ventricular aspect of the pulmonic valve, opposite the location (arterial aspect) of calcific deposits on stenotic aortic valves, and calcific deposits also were present in the tricuspid valve anulus.

Heart rate and avoidance conditioned activity in rats

In accordance with the determination of base-line heart rate and running in an activity wheel, 14 Long-Evans male rats were given ten 30 minute sessions of Immobile-Avoid conditioning followed by 30 minute sessions of Active-Avoid conditioning. Control Ss were yoked to the experimental Ss. Experimental Ss made significantly fewer responses in the immobile-avoid period and significantly more responses in the active-avoid period than did the yoked control Ss. Heart rate was correlated with skeletal activity both for experimental and control Ss. For experimental Ss, low heart rate was concomitant with a low amount of activity in the immobile-avoid peroid and high heart rate was concomitant with greater skeletal activity in the active-avoid period. These results support the position that heart rate is secondary to responses of the somatic-motor system and that heart rate during immobile-avoid or active avoid conditioning is more closely related to the level of somatic-motor activity than to the emotional stress which purportedly motivates instrumental avoidance behavior.

[Tuberculosis infection and the use of oral and intradermal BCG in school children of Laranjal Paulista, São Paulo, Brazil]

Foi pesquisado no 2.° semestre de 1969, o índice de infecção tuberculosa nos escolares de nível primário da sede municipal de Laranjal Paulista, SP, com faixa etária de 7 a 15 anos. Utilizou-se PPD RT23 com 2UT (0,04 mcg) de acordo com a 2.ª recomendação do Serviço Nacional de Tuberculose, sendo encontrado nível de 8% de reatores fortes o que sugere necessidade de intensificação local do controle da tuberculose. Houve diferenças significativas a 5% quanto à cor e grupo etário, predominando nos "não brancos" e nos de 11 a 15 anos, o mesmo não ocorrendo, entretanto, quanto ao sexo. Os reatores e seus conviventes foram encaminhados ao Dispensário de Tuberculose. Foi também pesquisada a viragem tuberculínica pelo BCG oral e intradérmico, comparados com grupo controle, encontrando-se resultados significantes. O resultado verificado no grupo que tomou BCG por via intradérmica foi quase duas vezes maior que os observados no grupo de BCG oral. Não houve diferenças quanto ao sexo e grupo etário, mas o grupo "não branco" mostrou-se mais reativo. Não foram definidas estatisticamente as reações pós-vacinais e a expectativa populacional foi considerada dentro da esperada para atividades desse tipo.

Organ visualization with the "gamma camera"

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