The basal SAR of a novel insulin receptor activator

The synthesis and SAR of analogues prepared from novel insulin receptor activator 1 are described. Changes to the dihydroxyquinone core were not tolerated while functionalization of the two indoles contained in 1 resulted in little effect upon activation of the insulin receptor.

In vivo behavior of peptide-specific T cells during mucosal tolerance induction: antigen introduced through the mucosa of the conjunctiva elicits prolonged antigen-specific T cell priming followed by anergy

The mucosa of the conjunctiva is an important site of entry for environmental Ags as well as Ags emanating from the eye itself. However, very little is known about T cell recognition of Ag introduced through this important mucosal site. We have characterized the in vivo process of CD4 T cell recognition of Ag delivered via the conjunctival mucosa. Application of soluble OVA to the conjunctiva of BALB/c mice induced potent T cell tolerance. APC-presenting OVA peptide in vivo was only found in the submandibular lymph node and not in other lymph nodes, spleen, or nasal-associated lymphoid tissue. Similarly, in TCR transgenic DO11. 10 adoptive transfer mice, OVA-specific CD4+ T cell clonal expansion was only observed in the submandibular lymph node following conjunctival application of peptide. These experiments thus define a highly specific lymphatic drainage pathway from the conjunctiva. OVA-specific T cell clonal expansion peaked at day 3 following initiation of daily OVA administration and gradually declined during the 10-day treatment period, but remained elevated compared with nontreated adoptive transfer mice. During this period, the T cells expressed activation markers, and proliferated and secreted IL-2 in vitro in response to OVA stimulation. In contrast, these cells were unable to clonally expand in vivo, or proliferate in vitro following a subsequent OVA/CFA immunization. These results suggest that Ag applied to a mucosal site can be efficiently presented in a local draining lymph node, resulting in initial T cell priming and clonal expansion, followed by T cell anergy.

Athletic drug testing: an analyst's view of science and the law

Detection of performance-enhancing drugs in sports has received increasing visibility. Athletic drug testing uses sophisticated technology and both interindividual (population) and intraindividual reference ranges to interpret data. An effective program must incorporate educational and adjudication components in addition to testing. The difficult interface between science and the law is evident in many recent sports arbitration decisions.

Wilt Pathogens of Solanaceae in Tanzania: Clavibacter michiganensis subsp. michiganensis, Pseudomonas corrugata, and Ralstonia solanacearum

Surveys of vegetables in the southern and northern growing regions of mainland Tanzania and Zanzibar during 1997 and 1998 indicated the presence of three wilt pathogens of tomato. Clavibacter michiganensis subsp. michiganensis (cause of bacterial canker) was isolated from wilting plants in the southern highlands and Lushoto District (Tanga Region, north) on selective King's medium B with polymyxin B (1). The identity of the isolates was confirmed by cultural, morphological, and biochemical characteristics and a plate-trapped antigen enzyme-linked immunosorbent assay (PTA-ELISA) kit (Pathoset 113-08, Adgen, Auchincruive, U.K.). Pathogenicity was confirmed by host inoculation. In addition, the bacterium was detected directly by the same methods in several sources of seed, including commercial farmers' saved seed and seed extracted from infected plants. Of 61 tomato seed lots tested, 18 samples were positive. Ralstonia solanacearum (cause of bacterial wilt) was isolated from tomato and potato by semiselective media and detected directly in stem and tuber tissues, respectively, by polymerase chain reaction and ELISA (4) in all vegetable-growing areas surveyed. In 1998, R. solanacearum was detected for the first time in Zanzibar on tomato and eggplant. Pathogenicity was confirmed by inoculation on and reisolation from tomato seedlings of cv. Money Maker. Only biovar 3 (2) occurred in tomato. Biovar 3 also was found in midaltitude potato. Biovar 2 has been found only in potato plants grown above 1,500 m. Pseudomonas corrugata (cause of pith necrosis) was isolated from tomato on semiselective media at only one location. From wilted tomato plants in the southern highlands, 38% of samples tested positive for C. michiganensis subsp. michiganensis and ≈ 10% for R. solanacearum. Of samples collected from the northern highlands, 43% tested positive for R. solanacearum. Wilt incidence of ≈35% was observed in tomato fields where the bacterial wilt pathogen was isolated in the northern highlands compared with gt;90% incidence and almost total crop loss in tomato fields of the southern highlands infected with bacterial canker. Although all three pathogens caused systemic wilt of plants, bacterial canker occasionally caused downward turning of lower leaves, unilateral wilting, and marginal necrosis of leaflets as well as fruit spotting. In general, wilts caused by C. michiganensis subsp. michiganensis, R. solanacearum, and P. corrugata were not readily differentiated in Tanzania prior to this research. Plants with pith browning had often been assumed to be infected by P. corrugata, until R. solanacearum was isolated (3) frequently from such plants. References: (1) Anonymous. OEPP/EPPO Bull. 22:219, 1992. (2) A. C. Hayward. J. Appl. Bacteriol. 27:265, 1964. (3) J. B. Jones et al., eds. 1991. Compendium of Tomato Diseases. The American Phytopathological Society, St. Paul, MN. (4) S. Seal and J. G. Elphinstone. Pages 35-57 in: Bacterial Wilt. The Disease and Its Causative Agent, Pseudomonas solanacearum. A. C. Hayward and G. L. Hartman, eds. CAB International, Wallingford, U.K. 1994.

Adamalysins. A family of metzincins including TNF-alpha converting enzyme (TACE)

The adamalysins are a family of proteins in the metzincin superfamily of metalloproteases, which also includes the matrix metalloproteinases. There are two subfamilies of adamalysins: the snake venom metalloproteases (SVMPs) and the ADAMs (proteins containing a disintegrin and metalloprotease domain). At least 23 ADAMs have been identified to date. The ADAMs are expressed by a wide variety of cell types, and are involved in functions as diverse as sperm-egg binding, myotube formation, neurogenesis, and proteolytic processing of cell surface proteins. An overview of the ADAM family and their functions will be presented. TACE is a unique member of the ADAM family that cleaves membrane-bound TNF-alpha to generate soluble TNF-alpha. Mice lacking proteolytically active TACE have been generated and characterized. The TACE knock-out results in perinatal lethality. Cells from the TACE-deficient mice release 80-90% less soluble TNF-alpha than do wild-type cells. Irradiated mice that are reconstituted with TACE knock-out hematopoeitic stem cells have markedly reduced levels of serum TNF-alpha following LPS challenge, compared to irradiated mice reconstituted with wild-type cells, suggesting that TACE is the major TNF-alpha converting enzyme in vivo. TACE-deficient cells are compromised in the generation of other soluble proteins that are produced as the result of cleavage of a membrane precursor form, suggesting that TACE is involved in multiple shedding events.

The efficacy and fetal-maternal cardiovascular effects of transdermal glyceryl trinitrate in the prophylaxis of pre-eclampsia and its complications: a randomized double-blind placebo-controlled trial

OBJECTIVES

Pre-eclampsia continues to be a major cause of maternal and perinatal mortality. A disorder of the nitric oxide system is implicated in the pathogenesis of this condition and preliminary studies have suggested a possible therapeutic role for nitric oxide donors in women with established pre-eclampsia. The aim of this study was to determine whether pre-eclampsia and its complications could be prevented by the long-term use of nitric oxide donors in a group of women identified to be at risk on the basis of abnormal uterine artery Doppler measurements.

STUDY DESIGN

We enrolled 40 healthy normotensive women at high risk of pre-eclampsia selected on the basis of abnormal uterine artery Doppler waveforms at 24-26 weeks of gestation. Women were randomly allocated to receive transdermal glyceryl trinitrate 5 mg-patches or equivalent placebo patches in a double-blind randomized study. The primary outcome measures were pre-eclampsia, fetal growth restriction, preterm delivery or small for gestational age/fetal growth restriction rates. Patches were worn daily from recruitment for 10 weeks or until delivery.

RESULTS

The primary outcomes were not significantly different in the placebo compared to the glyceryl trinitrate group. However, survival analysis of adverse events with gestation in both groups showed a significantly reduced risk of an adverse event in the glyceryl trinitrate group (p = 0.004), equating to a 73% reduction in hazard. There was no difference in maternal systolic and diastolic blood pressure, mean uterine artery resistance index and fetal umbilical and middle cerebral artery pulsatility indices between the groups.

CONCLUSIONS

Low-dose prophylactic transdermal glyceryl trinitrate commenced late in the second trimester did not reduce the incidence of pre-eclampsia, preterm delivery or fetal growth restriction, but may increase the likelihood of a complication-free pregnancy. Transdermal glyceryl trinitrate (5 mg/day) did not affect maternal cardiovascular, uterine artery or fetal arterial Doppler parameters.

[Abnormal response of growth hormone to oral glucose tolerance test in obesity]

In obesity, it is well known that basal growth hormone (GH) levels can be suppressed and they may show an impaired response to various stimuli like hypoglycemia, stress, and GHRH. However, the inhibitory effect of hyperglycemia on GH in this condition has not been well studied. We analyzed the GH response to an oral glucose tolerance test (OGTT) in 25 unselected patients with morbid obesity who were not diabetic, glucose intolerant or affected by renal or hepatic disease. Ten (40%) of the 25 subjects had an abnormal response of GH to the OGTT, expressed by a lack of suppression of GH levels below 2 micrograms/L within 60 minutes of glucose administration. Three subjects even had a paradoxal increase of GH levels of more than 50% of the basal level. There was no significant difference between these subjects regarding their age, BMI and, serum levels of glucose, insulin, C peptide, or insulin/glucose ratio. After weight loss, three of four patients normalized their GH response. Thus, we conclude that patients with morbid obesity frequently have an abnormal response of GH to OGTT (40% vs 4-8% in normal subjects). This finding must be taken into consideration when interpreting GH levels in these patients. A normalization of this response can be expected after weight loss.

Yearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients

BACKGROUND & AIMS

Guidelines on the type and frequency of follow-up of patients after curative surgery for colorectal cancer are unclear. The aim of this study was to determine the survival benefit of a planned follow-up program.

METHODS

Three hundred twenty-five patients who underwent curative resection of colorectal cancer were prospectively randomized to either intensive or standard follow-up. After stratification according to Dukes' stage and site in the colon or rectum, patients were randomized to intensive follow-up of yearly colonoscopy, computerized tomography (CT) of the liver, and chest radiography and clinical review and simple screening vs. structured clinical review and simple screening tests only.

RESULTS

On completion of 5-year follow-up, there was no significant difference in survival between the two groups. Yearly colonoscopy failed to detect any asymptomatic local recurrences. Only one asymptomatic curable metachronous colon tumor was detected. Liver CT resulted in earlier detection of hepatic metastases but did not increase the number of curative hepatectomies. Only 1 patient had an asymptomatic CT-detected liver metastasis, and another had an asymptomatic chest radiography-detected lung metastasis. Both had curative resections.

CONCLUSIONS

Yearly colonoscopy, liver CT, and chest radiography will not improve survival from colorectal cancer when added to symptom and simple screening review.

Peptide-specific T cell clonal expansion in vivo following immunization in the eye, an immune-privileged site

To visualize the primary antigen-specific T cell response to Ag introduced into the eye, we have used an adoptive transfer system in which a limiting number of OVA peptide (323-339)-specific T cells from a TCR-transgenic mouse were transferred into nonirradiated, syngeneic recipients and then tracked in vivo by staining for FACS analysis or immunohistochemistry with the clonotypic mAb KJ1-26. Following posterior chamber injection of Ag, KJ1-26+ cells accumulated primarily in the draining, submandibular lymph node (LN) within 3 days. Although reduced in number, by day 6 these cells were primarily in the paracortical regions and were able to proliferate and secrete IL-2 in response to Ag stimulation. In contrast, following i.v. injection of Ag, the KJ1-26+ cells accumulated in the paracortical regions of the LN to a comparable degree, but did not proliferate or secrete IL-2. The day 3 accumulation of KJ1-26+ cells in the submandibular LN was inhibited if the eye was removed within 5 h after injection of Ag. In the spleen, foci of KJ1-26+ cells were observed in the periarteriolar lymphoid sheaths at day 3; these were not observed to the same degree following other forms of immunization. These results demonstrate that the submandibular LN is the primary site for early clonal expansion of antigen-specific T cells following intraocular Ag administration and that these cells show changes consistent with immunity rather than tolerance.

Peptide-specific T cell clonal expansion in vivo following immunization in the eye, an immune-privileged site

To visualize the primary antigen-specific T cell response to Ag introduced into the eye, we have used an adoptive transfer system in which a limiting number of OVA peptide (323-339)-specific T cells from a TCR-transgenic mouse were transferred into nonirradiated, syngeneic recipients and then tracked in vivo by staining for FACS analysis or immunohistochemistry with the clonotypic mAb KJ1-26. Following posterior chamber injection of Ag, KJ1-26+ cells accumulated primarily in the draining, submandibular lymph node (LN) within 3 days. Although reduced in number, by day 6 these cells were primarily in the paracortical regions and were able to proliferate and secrete IL-2 in response to Ag stimulation. In contrast, following i.v. injection of Ag, the KJ1-26+ cells accumulated in the paracortical regions of the LN to a comparable degree, but did not proliferate or secrete IL-2. The day 3 accumulation of KJ1-26+ cells in the submandibular LN was inhibited if the eye was removed within 5 h after injection of Ag. In the spleen, foci of KJ1-26+ cells were observed in the periarteriolar lymphoid sheaths at day 3; these were not observed to the same degree following other forms of immunization. These results demonstrate that the submandibular LN is the primary site for early clonal expansion of antigen-specific T cells following intraocular Ag administration and that these cells show changes consistent with immunity rather than tolerance.

Estimating the completeness of under-5 death registration in Egypt

To evaluate the completeness of registration of infant and child deaths in Egypt, reinterviews were conducted with families who had reported a death of a child under age 5 in the five years before the survey for two national surveys recently conducted in Egypt: the United Nations PAPCHILD survey of 1990-1991 and the Egyptian Demographic and Health Survey (EDHS) of 1992. The survey instrument included questions regarding notification of the death at the local health bureau. If the family said the death had been notified, separate employees searched the health bureau records for the registration. Overall 57% of infant deaths were reported as notified and 68% of those death reports were found; the corresponding figures for child death were 89% and 74%. Using the percentage reported as notified as an estimate for completeness of registration, we adjusted upward the national infant and child mortality rates from registration data, giving values of 73 per 1,000 for infant mortality and 99 for 5qo for the period 1987-1990. These values are approximately 20% above the corresponding direct estimates from the PAPCHILD and EDHS surveys.

Estimating the completeness of under-5 death registration in Egypt

To evaluate the completeness of registration of infant and child deaths in Egypt, reinterviews were conducted with families who had reported a death of a child under age 5 in the five years before the survey for two national surveys recently conducted in Egypt: the United Nations PAPCHILD survey of 1990–1991 and the Egyptian Demographic and Health Survey (EDHS) of 1992. The survey instrument included questions regarding notification of the death at the local health bureau. If the family said the death had been notified, separate employees searched the health bureau records for the registration. Overall 57% of infant deaths were reported as notified and 68% of those death reports were found; the corresponding figuresfor child deaths were 89% and 74%. Using the percentage reported as notified as an estimate for completeness of registration, we adjusted upward the national infant and child mortality rates from registration data, giving values of 73 per 1,000 for infant mortality and 99 for 5q0 for the period 1987–1990. These values are approximately 20% above the corresponding direct estimates from the PAPCHILD and EDHS surveys.

HOOKLESS1, an ethylene response gene, is required for differential cell elongation in the Arabidopsis hypocotyl

Bending in plant tissues results from differential cell elongation. We have characterized Arabidopsis "hookless" mutants that are defective in differential growth in the hypocotyl. HOOKLESS1 was cloned and its predicted protein shows similarity to a diverse group of N-acetyltransferases. HOOKLESS1 mRNA is increased by treatment with ethylene and decreased in the ethylene-insensitive mutant ein2. High level expression of HOOKLESS1 mRNA results in constitutive hook curvature. The morphology of the hookless hypocotyl is phenocopied by inhibitors of auxin transport or by high levels of endogenous or exogenous auxin. Spatial patterns of expression of two immediate early auxin-responsive genes are altered in hookless1 mutants, suggesting that the ethylene response gene HOOKLESS1 controls differential cell growth by regulating auxin activity.

Otolith-semicircular canal interaction during postrotatory nystagmus in humans

The otolith-semicircular canal interaction during postrotatory nystagmus was studied in ten normal human subjects by applying fast, short-lasting, passive head and body tilts (15, 30, 45, or 90 degrees in the roll or pitch plane) 2 s after sudden stop from a constant-velocity rotation (100 degrees/s) about the earth-vertical axis in yaw. Eye movements were measured with three-dimensional magnetic search coils. Following the head tilt, activity in the semicircular canal primary afferents continues to reflect the postrotatory angular velocity vector in head-centered coordinates, whereas otolith primary afferents signal a different orientation of the head relative to gravity. Despite the change in head orientation relative to gravity, postrotatory eye velocity decayed closely along the axis of semicircular canal stimulation (horizontal in head coordinates) for large head tilts (90 degrees) and also for small head tilts (15-45 degrees) for reorientations in the pitch plane. Only for small head tilts (15-45 degrees) in the roll plane was there a reorientation of the eye rotation axis toward the gravitational vector. This reorientation was approximately compensatory for 15 degrees head tilts. For 30 degrees and 45 degrees head tilts the eye rotation axis tilted toward the gravitational vector by about the same amount as for 15 degrees head tilts. These results suggest that, with the exception of small head tilts in the roll plane, there was no compelling data showing a relationship between the eye rotation axis and head tilt and that postrotatory nystagmus is largely organized in head-centered rather than gravity-centered coordinates in humans. This indicates a rudimentary, nonlinear, and direction-specific interaction of semicircular canal and otolith signals in the central vestibular system in humans.

Immigration and social justice: towards a progressive European immigration policy?

"Stepping back from current debates over immigration in the new 'Fortress Europe', this paper examines moral and philosophical arguments for an alternative and more 'progressive' immigration policy. Despite recent interest within geography in principles of social justice, the extent to which such principles reach beyond particular societies or nations has rarely been considered explicitly. The notion of social justice may be extended to the question of immigration, without taking the position that migration should itself be seen as a 'human right'. Even within relatively conservative contractarian and communitarian conceptions of social justice, a number of suggestions can be made for 'progressive' policy options, in particular by focusing on the communal rights and duties of societies rather than the human rights of individual migrants."

The role of plant clinics in plant disease diagnosis and education in developing countries

The scarcity of literature in the realm of plant clinics operating in the developing world brought us to the decision to perform a survey in non-OECD countries in Africa, Asia and Oceania, Latin America and the Caribbean, and in central and southern Europe. Forty-one completed questionnaires that refer to 79 plant clinics were returned. The best-equipped clinics are operated by the international research bodies. By and large, this review shows that considerable progress has been achieved in the physical development of plant clinics in developing countries and in staffing them with well-trained personnel. Not surprisingly, however, many inadequacies and inconsistencies still need to be addressed before clinics can fully play their part in providing plant protection services to their clients. Success and constraining indicators in the diagnostic performance of the clinics are identified. A model of the'ideal plant clinic' is suggested.

Epidemiology of presenile Alzheimer's disease in Scotland (1974-88) I. non-random geographical variation

BACKGROUND

Factors that determine geographical differences in incidence rates of 'probable' presenile Alzheimer's disease (AD PSD) may help to clarify the possible role of the environment in its aetiology.

METHOD

We have ascertained the treated incidence of AD PSD in Scotland by scrutiny of hospital cassenotes and searched for cases outside hospital settings. Small area geographical analysis compared the observed distribution of cases (each allocated to one of Scotland's 898 postcode sectors) with the estimated random distribution of cases.

RESULTS

There was non-random geographical distribution of AD PSD but not of the comparison conditions (vascular dementia (VaD), motor neurone disease, prostatic or ovarian cancers). Substantial differences between Scottish regions were probably not attributable to methodological artefact, as other techniques of case finding showed the same regional differences.

CONCLUSIONS

The observed differences in incidence of AD PSD between Scotland's regions are real and some localities have a higher incidence, mostly in central Scotland.

Prevention of SIV infection in macaques by (R)-9-(2-phosphonylmethoxypropyl)adenine

The efficacy of pre- and postexposure treatment with the antiviral compound (R)-9-(2-phosphonylmethoxypropyl)adenine (PMPA) was tested against simian immunodeficiency virus (SIV) in macaques as a model for human immunodeficiency virus (HIV). PMPA was administered subcutaneously once daily beginning either 48 hours before, 4 hours after, or 24 hours after virus inoculation. Treatment continued for 4 weeks and the virologic, immunologic, and clinical status of the macaques was monitored for up to 56 weeks. PMPA prevented SIV infection in all macaques without toxicity, whereas all control macaques became infected. These results suggest a potential role for PMPA prophylaxis against early HIV infection in cases of known exposure.

Caretaker compliance with different antibiotic formulations for treatment of childhood pneumonia

To determine the effect of antibiotic formulations on compliance, 400 children, aged 2 months to 5 years, with a presumptive diagnosis of pneumonia, were randomly assigned to receive one of the following formulations of cotrimoxazole: 1. syrup accompanied by a 10-ml measuring cup; 2. syrup accompanied by a 5-ml measuring spoon; 3. tablets; 4. single-dose sachets of antibiotic powder. A research assistant visited the childs' home on the fourth day of therapy, asked the care-giver about compliance, and observed the care-giver prepare a dose of the medication. The remaining amount of medicine was measured, and when possible (n = 151), a urine specimen was tested for the presence of sulphamethoxazole. All of the care-givers reported giving at least one dose on the first day of therapy. By the fourth day, 82 per cent of those receiving syrup were still taking their medication compared to 71 and 55 per cent of those receiving sachets or tablets, respectively (P < 0.01). Of those who received syrup accompanied by a spoon, 38 per cent under-dosed the medicine by at least 30 per cent. Overall, compliance was highly correlated with the care-giver's report of difficulty in administering the medication. Additional research is needed to understand the obstacles encountered by care-givers in administering sachets and tablets. Meanwhile, the use of antibiotic syrup, accompanied by an appropriately sized measuring cup, appears to offer the greatest probability of medication compliance in the treatment of Egyptian children with pneumonia.

Diarrhoeal diseases in the White Mountain Apaches: clinical studies

Acute diarrhoeal diseases continue to be a major health problem in certain underprivileged populations in the United States, including native Americans living in reservations. To describe the features of patients with diarrhoeal diseases requiring medical care, those attending the medical facilities of the Fort Apache Indian Reservation, Whiteriver, Arizona, were studied during 1981-1985. Clinical and aetiological information was obtained on 535 patients which constitute a 20% sample of those attending the outpatient clinic and all 386 patients who required 550 hospitalizations. Rotavirus, enterotoxigenic Escherichia coli, and Shigella were the most common aetiologic agents, a pattern similar to that seen in the developing countries. The clinical features of diarrhoeal illness and the frequent associated occurrence of acute respiratory symptoms, however, were remarkably similar, regardless of aetiology.

Diarrhoeal diseases in the White Mountain Apaches: epidemiologic studies

Acute diarrhoeal disease in children is known to be a major public health problem among native Americans living in reservations in the southwestern part of the United States. This study was undertaken to describe the epidemiology and causative agents of diarrhoea more completely, with the expectation that this information may help in the ultimate control of the disease in this population. Three interrelated epidemiologic studies were carried out in the White Mountain Apache Tribe, Whiteriver, Arizona, during 1981-1985: a three-year longitudinal study on a cohort of 112 newborns, a longitudinal two-year study in a cohort of 200 families, and a case-control study on 1,072 children with diarrhoea attending a medical facility. Both epidemiologic and microbiological patterns of diarrhoeal disease were found to be very similar to those seen in developing countries, indicating the need for basic improvements in sanitation and hygiene in this population.

Community infection ratio as an indicator for tuberculosis control

The epidemiology of tuberculosis remains poorly understood. We investigated the relative importance of within-household and community transmission of infection among children aged 6 months to 14 years living in a Peruvian shanty-town. The prevalence of Mycobacterium tuberculosis exposure among 175 contact children (sharing a household with a person who had confirmed pulmonary tuberculosis) and 382 control children (living in nearby households free of active tuberculosis) was defined as the proportion of children with a positive purified protein derivative (PPD) skin-test. 97 (55%) contact children and 129 (34%) controls were PPD positive. Living in a contact household (odds ratio 1.74, 95% CI 1.11-2.73) and age (1.11, 1.06-1.18) were significant risk factors for PPD positivity. We calculated the community infection ratio (CIR) as the odds ratio of PPD-positive controls to PPD-positive contacts: CIR = [formula: see text] A low CIR therefore suggests mainly household spread of infection, whereas a high value suggests frequent transmission outside the household. The adjusted odds ratio (for age, sex, within-household correlation, and household size) was 0.40 (95% CI 0.26-0.64), compared with values of 0.18-0.37 in studies elsewhere. Currently recommended tuberculosis control strategies are suitable for areas with low CIRs. Different strategies may be needed for areas, such as that we studied, with high values.

Prevalence of sexual abuse among patients with functional disorders of the lower gastrointestinal tract

To evaluate the links between gastrointestinal disorders and sexual abuse, we asked 344 patients consulting in a specialized tertiary care university hospital or a gastroenterologist in private practice, if they had been sexually abused. Forty per cent of patients suffering from lower functional digestive disorder gave a history of having been victims of sexual abuse in contrast to only 10% of patients with organic diseases (P < 0.0003). The prevalence was similar in private practice and in the university hospital. Abused patients were more likely to complain of constipation (P < 0.03) and diarrhoea (P < 0.04). Anismus was more frequent in patients who had been sexually abused (P < 0.02). The prevalence of abuse was four times greater in patients with lower than with upper functional motor disorders of the gastrointestinal tract (P < 0.002). This study confirms the large prevalence of a past history of sexual abuse among patients consulting for gastrointestinal tract functional disorder, and this whatever the kind of recruitment may be. It shows the association to be much stronger in patients who have a lower rather than an upper gastrointestinal dysfunction, the major complaint of abused patients being constipation and diarrhoea.

Orientation of Listing's plane in normals and in patients with unilateral vestibular deafferentation

The parameters characterizing Listing's plane have been determined in a group of normal subjects, and in patients who have had unilateral vestibular deafferentation on the right or left side. All patients were well compensated. There was no statistically significant difference in the orientation of Listing's plane between either of these groups: Listing's plane was approximately perpendicular to the horizontal stereotaxic plane and showed a systematic temporal tilt, i.e., it tilted right for the right eye, and left for the left eye. We also found a considerable intersubject variability in the orientation of Listing's plane. The effect of this variability on the interpretation of three-dimensional eye position and velocity data is discussed.

Biofeedback re-education of faecal continence in children

The purpose of this prospective study was to see if pretreatment anorectal motility can predict successful correction of faecal incontinence with biofeedback. Forty-seven consecutive children, aged 5 to 18 years, were treated. They had been treated for idiopathic constipation with faecal impaction, but had remained incontinent (n = 15), had been operated for congenital anorectal malformations of high (n = 19) or low (n = 2) type, or had a number of organic congenital pelvic abnormalities (n = 11). This consecutive series represents our entire experience with biofeedback for faecal incontinence, in the period from January 1 1983 to December 31 1989. In each patient, at the first session, anorectal manometry was performed. Resting pressures in the rectum, upper anal canal and lower anal canal were measured. The threshold of rectal sensation during distension, the maximal pressure during voluntary sphincteric contraction and the time to half decrease of sphincteric pressure because of muscular fatigue were also noted. The patient was then asked to make a voluntary sphincteric contraction, while the rectum was being distended with the volume at threshold for rectal sensation. In subsequent sessions, the rectum was also distended but without warning the patient, who was congratulated when he or she contracted the sphincter immediately after onset of rectal distension. Full continence was the criterion used to classify re-education as a success. Improvement or no change in continence was considered as failure of the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Environmental change in refugee-affected areas of the Third World: the role of policy and research

This paper reviews the current nature of policy responses to environmental change in refugee assistance programmes. Based on a review of existing documentary material and a survey of UK-based NGOs, it is suggested that although refugee assistance agencies are aware of environmental issues, this is rarely translated into effective policy measures to identify and combat environmental degradation. Various existing methods used to calculate environmental impacts are considered, but a number of pitfalls are identified. It is suggested that little is known about the processes that lead to accelerated environmental change in situations of forced displacement, and that research providing deeper understanding of local environments and resource management systems is required for environmental policies to be effective.

The effects of growth hormone-releasing factor on food consumption in anorexia nervosa patients and normals

Current evidence from animal studies indicate that growth hormone-releasing factor (GRF) has direct effects on mechanisms controlling eating behavior. There is also evidence that eating disorder patients have abnormalities in their GRF-growth hormone (GH) axis. The present study investigated the possibility that GRF abnormalities contribute to the expression of abnormal eating patterns in anorexia nervosa (AN) patients, and that GRF has therapeutic potential in this regard. To this end, patients diagnosed with anorexia nervosa or combined anorexia nervosa/bulimia nervosa (AN/BN), as well as normal female subjects, were tested for their eating and GH responses following intravenous infusion of GRF (1 micrograms/kg) or placebo. Results indicated that GRF stimulates food consumption in AN patients and attenuates the elevated food consumption in AN/BN patients. These results are consistent with the notion that GRF abnormalities contribute to abnormal eating behavior, and provide preliminary evidence for the therapeutic potential of GRF in such conditions. The extent to which the present effects of GRF are dependent on nutritional status, GH actions, or direct central actions of GRF, are discussed.

Refugee migration and local economic development in Eastern Zambia

"This article examines the local socio-economic impact of the arrival of Mozambican refugees in the Eastern Province of Zambia. Previous studies of forced migration elsewhere in Africa have suggested that not only stresses, but also positive gains for local development may be felt in areas hosting significant numbers of refugees. It is suggested here that an appropriate framework from which to analyze the impact of refugees is to focus separately on the effects of population increase on the one hand, and the specific characteristics of refugees on the other. Using this distinction, a model is developed of potential beneficial changes resulting from the arrival of refugees. Key assumptions of this model are then identified to be of relevance to policies designed to promote local economic development under conditions of refugee migration."

Growth dynamics during the first two years of life: a prospective study in the Philippines

This study examines determinants of growth from birth to 24 months in a sample of approximately 3000 urban and rural Filipino children. Individual, household, and community data were collected bimonthly during the Cebu Longitudinal Health and Nutrition Survey. Separate longitudinal, multivariate models were used to identify determinants of weight in children from birth to 6 months and 6-24 months of age. Previous weight, male gender, mother's height, and season of the year showed significant positive associations with weight in all models. Full and mixed breast-feeding significantly increased weight, but the effects of breast-feeding declined as children got older. Breast-feeding had a direct growth-enhancing effect in addition to its indirect effect through the prevention of diarrheal morbidity. Detrimental effects of recent diarrheal morbidity were particularly important in the older age group, but these effects were mitigated by breast-feeding. Since infant feeding variables are included in the models, the results strongly suggest an effect of diarrheal morbidity on growth independent of its known effects on infant feeding and dietary intake. Febrile respiratory infections had important detrimental effects on weight in both age groups.

Theory-driven behavioral intervention research for the control of diarrheal diseases

Essentially all methods to reduce diarrheal morbidity and mortality require behavioral change. Research is required to design, implement and evaluate behavior-modifying interventions. Accumulated experience in the many involved disciplines should serve as a basis for this research. However, each of these disciplines is associated with different research perspectives and analytic assumptions; thus integration of these varied but potentially complementary experiences has been elusive. In the present paper, arguing that such perspectives and assumptions are embodied in discipline-based theory, we have developed a generic framework for the conduct of theory-based behavioral intervention research. We illustrate the application of this framework through two vignettes applying two of the theories and models to the development of hypothetical handwashing interventions.

Graphic summaries of expert knowledge for the medical curriculum: an experiment in second-year nephrology

This study was conducted to test the effects of Concept Graphics on learning in clinical nephrology. Second-year medical students were exposed to summaries of the major renal pathologies presented as text with, or without Concept Graphics for 30 minutes, followed by a quiz. Concept Graphics summarize diagnoses using icons that are metaphors of objects or processes. Of nine quiz questions, five were classified as correlation questions and four as memorization questions. The experimental group (n = 39) performed better than the controls (n = 33) in answering the correlation questions (p = 0.018). The experimental group mentioned more frequently than the controls two pathogonomic criteria of the nephritic syndrome (p = 0.02). Results of an opinion poll of the students, comparing sources used in their studies of nephrology were treated by correspondence analysis; the Concept Graphics ranked closest to the classification "very useful".

Frequency of late potentials on signal-averaged electrocardiograms during thallium stress testing in coronary artery disease

Late potentials detected by signal-averaged electrocardiography (SAECG) are an important noninvasive indicator identifying patients with previous myocardial infarction at risk for developing ventricular tachycardia. The role of myocardial ischemia in the development of late potentials is undefined. This study attempts to determine if late potentials on SAECG can be produced during scintigraphically proven ischemia. A signal-averaged electrocardiogram was obtained before and immediately after single-photon emission computed tomography thallium exercise testing in 51 patients. Reversible ischemia was documented in 25 cases with no significant changes in the parameters of SAECG; patients with previous myocardial infarction (n = 10) also had no significant changes from baseline. Multivariate analysis with respect to reversible ischemia and previous myocardial infarction was unrevealing. Patients with late potentials at baseline (n = 10) who developed reversible ischemia (n = 5) had a shorter QRS duration than those with late potentials at baseline and no reversible ischemia. The data indicate that exercise-induced scintigraphically proven ischemia does not alter SAECG even in the presence of previous myocardial infarction. Patients with late potentials at baseline may actually have a shortened QRS duration during reversible ischemia as opposed to the expected lengthening of the QRS.