The first use of olives in Africa around 100,000 years ago

The olive tree was an iconic plant for most of the past Mediterranean civilizations, for which it had important economic value. Here we report the earliest use of fruits and wood from olive trees in Africa so far, around 100,000 years ago. These findings suggest the presence of olive trees on the Atlantic coast of Morocco during most of the last glacial period, and the use of olives by the early Homo sapiens for fuel management and most probably for consumption.

[Lymphatic filariasis transmission assessment survey in schools three years after stopping mass drug treatment with albendazole and ivermectin in the 7 endemic districts in Togo]

The aim of this study is to verify the level of transmission of lymphatic filariasis three years after stopping mass drug treatment in the 7 endemic districts in Togo. The survey was conducted in 2012 in Togo's 7 endemic districts grouped into four evaluation units (EU) using the WHO-recommended transmission assessment survey (TAS) protocol. Children aged 6-7 years were screened for Wuchereria bancofti antigen using the immunochromatographic card (ICT) method. A cluster sampling method was used to select eligible children in schools as the net primary-school enrolment ratio is greater than or equal to 75% in each of the four EUs. The number of children and schools to be selected in each EU, the randomization list for the selection of these children and the critical cut-off number of positive cases not to exceed were automatically generated using the Survey Sample Builder (SSB) tool, (NTD Support Center, Atlanta, Ga, USA). For confirmation, positive cases were subsequently tested for microfilaremia using nocturnal thick blood smear and for filarial antigen using Og4C3 antigen ELISA (TropBio ELISA Kit®, Townsville, Queensland, Australia). An EU is considered to have passed the test successfully (it is assumed that transmission can no longer be sustained), when the number of positive cases is below the critical cut-off number set by the SSB, which is roughly equivalent to 2% prevalence. Of the 1 706 children surveyed in Kpendjal-Tone's EU, 1 549 in Binah-Doufelgou's EU, 1 550 in Kozah's EU and the 1 575 in Amou-Haho's EU, 8 (0.46%), 1 (0.08%), 0 (0.00%) and 4 (0.25%) ICT positive cases respectively were detected. The number of positive ICT tests was well below 18, the critical cut number for each of the 4 EUs. All 13 ICT positive cases tested negative for nocturnal microfilaremia and Og4C3 ELISA. We conclude that all four EU passed the TAS with success, and the transmission of Wuchereria bancrofti is no longer likely to be sustained in the 7 endemic districts in Togo 3 years after stopping the MDA. A new TAS will be carried out in 2015, after which, if the results are still good, the country will submit a dossier to WHO for verification of the elimination of lymphatic filariasis.

Female urinary incontinence--the role of the general practitioner

SUBJECT

Urinary incontinence is a frequent disorder among adult females, but very few of the incontinent women have consulted a doctor.

DISCUSSION

This paper reviews and discusses the possible roles of the general practitioner in the diagnostic and therapeutic work with women with urinary incontinence. Some characteristics of general practice and the selection process from primary care to the specialist level are described. The selection process (gatekeeper function) of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital-based research back to general practice. Recommendations and guidelines for diagnosis or therapy developed at secondary or tertiary care levels may be inappropriate at the primary care level, with a significantly different clinical picture of this condition.

RESULTS

Several studies show that most women seeking help in general practice can be satisfactorily treated at this level of care with fairly simple treatments, and that treatment is effective also in the long term. Some women with urinary incontinence need to be referred primarily to a specialist, or later if the response to treatment is disappointing.

RECOMMENDATIONS

Based on literature studies and the authors' own experiences from clinical work and research, recommendations are presented for a basic evaluation and treatment of women with urinary incontinence who seek help in general practice.

A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests

In epidemiological surveys of female urinary incontinence, it is not feasible to demonstrate urine loss objectively. The aim of this study was to develop a valid epidemiological instrument (a severity index) for assessing the severity of incontinence. The severity index is based on information about frequency (four levels) and amount of leakage (two or three levels). By multiplication, an index value (1-8 or 1-12) is reached. This index value is further categorized into a severity index of three or four levels. The index was compared with the results of 315 pad-weighing tests performed by 265 women in hospital and general practice. Data from an epidemiological survey were also re-analyzed by applying the four-level severity index. Mean pad-weighing results (grams per 24 hours, 95% confidence interval) for the three-level severity index was slight (6; 2-9), moderate (17; 13-22), and severe (56; 44-67). For the four-level severity index, the results were slight (6; 2-9), moderate (23; 15-30), severe (52; 38-65), and very severe (122; 84-159). Spearman's correlation coefficient for pad-weighing results and the three-level severity index was 0.47 (P < 0.01) and for the four-level severity index 0.54 (P< 0.01). The four-level severity index gave a more balanced distribution among the women in the clinical materials, and data from the epidemiological survey showed that the four-level severity index identifies a sub-group of older women with very severe incontinence. The four-level severity index seems to be a valid representation of incontinence severity as measured by pad-weighing tests in women presenting for clinical care. It should be considered a potentially valid measure of incontinence severity in epidemiological studies. Neurourol. Urodynam. 19:137-145, 2000.

Female urinary incontinence: long-term follow-up after treatment in general practice

BACKGROUND

Several reports have been published showing that women with urinary incontinence (UI) can be taken care of and treated satisfactorily in general practice.

AIM

To find out whether the treatment of women with UI in general practice is effective also in the long term.

METHOD

One hundred and five women with UI who consulted their general practitioner (GP) were examined and treated according to a treatment protocol. Treatment options were pelvic floor exercises, electrical stimulation, oestrogen supplements, bladder training, and protective pads. Three to six years after inclusion, all women received a postal questionnaire to evaluate the long-term effectiveness of treatment. Women who had been referred to a specialist were excluded.

RESULTS

Eighty out of 82 eligible patients answered the questionnaire after a mean follow-up period of 56 months. Twenty-seven per cent were continent, 26% much better, 23% a little better, 21% unchanged, and 3% were worse compared with before the treatment. The median score on a 100 mm visual analogue scale was 16 compared with 31 before treatment, and the percentage of women that were 'much' or 'a great deal' bothered by UI was reduced from 35% to 12%. The percentage of women with severe UI was reduced from 59% to 30%, and the number of women using pads was reduced from 62% to 39%.

CONCLUSION

This study confirms that management of female UI in general practice is effective also in the long term.

Management in general practice significantly reduced psychosocial consequences of female urinary incontinence

Urinary incontinence is a common health problem among women, and a spectrum of psychosocial problems is associated with this disorder. We have investigated how psychosocial impact changed during a management programme for urinary incontinence in general practice. One hundred and five women seeking help for urinary incontinence were treated with conservative treatment options. Psychosocial consequences, grouped as mental distress (nine items), practical inconveniences (five items), and social restrictions (11 items) were noted before treatment, and after 3, 6 and 12 months follow-up. Urge symptoms, high degree of severity, and long duration were associated with higher psychosocial impact. During treatment, psychosocial impact was significantly reduced and the degree of impact in the three consequence groups was reduced to about one third compared with before treatment. In conclusion, changes in psychosocial impact during a management programme occur as a response to successful treatment. These findings support the view that female urinary incontinence can be successfully treated in general practice.

A study of female urinary incontinence in general practice. Demography, medical history, and clinical findings

The aim of this study was to provide valid data on the demography, medical history and clinical findings among adult women presenting with urinary incontinence to general practitioners. In a rural community in Norway, all women > 20 years who consulted their general practitioner for urinary incontinence during a 3 year period were included in a prospective study. A thorough medical history and both a general and focused clinical examination were undertaken. Gynecological examination, stress provocation test, and 48 h frequency/volume chart and pad weighing test were also performed. 105 women were included (4.4% of women > 20 years in the total population). Mean age was 57 years, 64% were postmenopausal. A lot of comorbidity was reported. Duration of incontinence was > 5 years in 49%. By a severity index, 64% were classified as severe, 28% as moderate and 8% as having slight incontinence. 59% were using protective pads or garments. Mean leakage per 24 h was 31 g. 38% had significant genital prolapse. Contractility of the pelvic floor muscles was weak in 28%. Diagnostic classification revealed 50% stress incontinence, 10% urge and 40% mixed incontinence. 42% of the patients were a great deal or much bothered by their incontinence. Patients with stress incontinence were less bothered than others. Women presenting with urinary incontinence at a primary care level are prevalent, and often have significant incontinence. It is a challenge for the general practitioners to investigate and treat these patients optimally.

The journey of incontinent women from community to university clinic; implications for selection bias, gatekeeper function, and primary care

BACKGROUND

The selection process of patients from community to hospitals may introduce bias into research and hamper the generalization of hospital-based research back to general practice.

OBJECTIVE

The objective of this study was to use female urinary incontinence as a model in an attempt to provide empirical support for selection bias.

METHOD

The analyses are based on three populations of incontinent women: community level (epidemiological survey, 535 women), primary care level (general practice, prospective clinical study, 105 women), and secondary care level (university hospital, prospective clinical study, 228 women).

RESULTS

The general practice patients were older and the hospital patients younger than those in the community. From community via general practice to hospital, there was an increase in duration, frequency of leakage, amount of leakage, severity and perceived impact of incontinence. Help-seeking at the primary care level was associated with increasing age and severity, and with urge symptoms and substantial impact. Referral from general practice to hospital level was only associated with age and urge symptoms.

CONCLUSION

The study provides empirical evidence to support the existence of selection bias. This phenomenon must not be overlooked when recommendations developed at the consultant level are presented at a level with a significantly different clinical picture of a condition.

Treatment of urinary incontinence in women in general practice: observational study

OBJECTIVE

To examine what is attainable when treating urinary incontinence in women in general practice.

DESIGN

Observational study with 12 months' follow up. Interview and clinical examination before, during, and after treatment of women seeking help for urinary incontinence in general practice.

SETTING

General practice in the rural district of Rissa, Norway.

SUBJECTS

105 women aged 20 or more with urinary incontinence.

INTERVENTIONS

Treatment with pelvic floor exercises, electrostimulation, oestrogen, anticholinergic drugs, bladder training, and protective pads.

MAIN OUTCOME MEASURES

Subjective and objective measures of urinary incontinence; number of patients referred to a specialist.

RESULTS

After 12 months' follow up 70% (69/99) of the women were cured or much better; the mean score on a 100 mm visual analogue scale decreased from 37 to 20 mm; and the proportion of women who were greatly bothered by their incontinence decreased by 62%. 20% (20/98) of women became continent, and the percentage of women with severe incontinence decreased from 64% (63/99) to 28% (27/98). Mean leakage per 24 hours measured by a pad test decreased from 28 g at the start of treatment to 13 g after 12 months. The number of light weight pads or sanitary towels decreased from 1.6 to 0.6 a day. In all, 17/105 (16%) patients were referred to a specialist.

CONCLUSIONS

Urinary incontinence in women can be effectively managed in general practice with fairly simple treatment. Most women will be satisfied with the results.

Female urinary incontinence--consultation behaviour and patient experiences: an epidemiological survey in a Norwegian community

The objective was to study explanatory factors for help-seeking among incontinent women, and what was the outcome of the treatment. A questionnaire was mailed to all 2366 women aged 20 or over in the rural community of Rissa, Norway. Women confirming incontinence gave information about duration, precipitating factors, frequency, amount of leakage, and impact. Questions about doctor consultation or planned consultation, treatment and results were included. Women with incontinence which had resolved without treatment were also recorded. A total of 77% answered the questionnaire. Twenty per cent of women with incontinence (n = 535) had consulted a doctor, 18% had planned to consult. Increasing age and duration, and urge/mixed type of incontinence were determinative factors for doctor consultation, while increasing severity and impact were determinative for planned consultation. Drugs, exercises, pads, and electrostimulation were all important treatment options: 21% were cured, 40% much better after treatment. Of all the women, 8% reported that they had been incontinent in the past, and only 18% of these had consulted a doctor.

Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity

Diagnostic questions about stress and urge incontinence were validated against a final diagnosis made by a gynecologist after urodynamic evaluation. Thereafter, an epidemiological survey was performed, using similar questions, and correcting the answers for lack of validity. Included were 250 incontinent women at the out-patient clinic and 535 women who reported incontinence in the epidemiological survey. The sensitivity for stress incontinence was 0.66 (95% confidence interval +/- 0.08), specificity 0.88 (+/- 0.06). The corresponding values for urge incontinence were 0.56 (+/- 0.15) and 0.96 (+/- 0.03), and for mixed incontinence 0.84 (+/- 0.10) and 0.66 (+/- 0.07). Using these indices of validity as corrective measures for the diagnostic distribution reported in the epidemiological survey, the percentage of stress incontinence increased from 51 to 77%, while mixed incontinence was reduced from 39 to 11%. Pure urge incontinence increased from 10 to 12%. Mixed incontinence will be overreported in epidemiological surveys. Correction for validity indicates that a larger majority than hitherto reported may have pure stress incontinence.

Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey

STUDY OBJECTIVE

The aim was to validate a simple severity index of female urinary incontinence for subsequent use in an epidemiological survey.

DESIGN

The index was created by multiplying the reported frequency (four levels) by the amount of leakage (two levels). The resulting index value (1-8) was further categorised into slight (1-2), moderate (3-4), and severe (6-8). It was validated against a 48 hour "pad weighing" test. Thereafter, an anonymous postal questionnaire survey was performed and the index was used to assess the severity of the leakage. A question about the impact of incontinence was also included.

SETTING

The outpatient clinic of the Department of Gynaecology and Obstetrics, Trondheim University Hospital and the rural community of Rissa, Norway.

PARTICIPANTS

Altogether 116 incontinent women referred to the clinic by their GP and all 2366 adult women living in Rissa.

RESULTS

The difference in median pad weights between moderate and slight incontinence was 9g/24h (95% confidence interval 0-27). The corresponding difference between severe and moderate incontinence was 17g/24h (95% CI 5-30). In the epidemiological survey 29.4% reported urinary incontinence (response rate 77%). The prevalence tended to be highest in middle life and old age. Forty six per cent were classified as slight, 27% moderate, and 27% severe. There was a strong correlation between severity and impact (R = 0.59, p < 0.001).

CONCLUSION

The severity index may be a useful tool for assessing the severity of female urinary incontinence in epidemiological surveys. It is confirmed that urinary incontinence is very prevalent in adult women, but most should not be regarded as potential patients.

[Exceptions for revoking the driver's license of alcohol intoxicated drivers at apprehension and during initial withdrawal]

Exceptions from the withdrawal of permission to drive should be allowed primarily to first offenders. In case of alcohol conspicuous first offenders a post-schooling course has a positive influence to exceptions, if a favourable prognosis for the future can be made especially in case of total abstinence instead of "Controlled Drinking": In spite of longstanding good reputation (minimum 25 years) exceptions to the withdrawal of permission to drive are excluded if the blood alcohol concentration exceeded 1.8/1000.

[Prevention of cardiovascular diseases in Rissa]

In 1986 the National Health Screening Service conducted cardiovascular risk factor screening of women and men aged 40-42 in Sør-Trøndelag county. In one of the municipalities, Rissa, the level of serum cholesterol was high (7.10 mmol/l in men and 6.64 mmol/l in women), as was the total coronary heart disease risk level. The local health authorities launched a health education programme which included population strategy efforts and a high risk intervention programme conducted by the primary health services. Screening of the next generation of women and men aged 40-42 three years later (in 1989) revealed highly significant lower serum cholesterol levels in both sexes (5.83 mmol/l in men and 5.55 mmol/l in women), and significant lower systolic blood pressure in men. Smoking habits had not changed significantly from the first to the second generation. For men, total coronary heart disease risk level was less than one half the level three years earlier. The attendance rate was high, between 80 and 90%, at both examinations.

Cluster headache: increased incorporation of (1-14C)arachidonic acid into phosphatidylserine in polymorphonuclear cells

Vasoactive metabolites deriving from arachidonic acid (AA) have been considered as putative mediators in the pathogenesis of various types of headache. In the present study we therefore compare the ability to synthesize AA containing precursor phospholipids in polymorphonuclear cells (PMNs) from healthy controls and cluster headache patients. 3.7% +/- 1.4 (mean +/- SD) of the (1-14C)AA incorporated into total PMN glycerophospholipids (GPLs) was recovered in the phosphatidylserine (PS) in a group of cluster headache patients (n = 12). This was almost twice the value of 1.9% +/- 0.8% found in a corresponding group of 24 healthy controls (p less than 0.001). A significant decrease in the incorporation of (1-14C)AA into phosphatidylcholine (PC) (p less than 0.01) and an increase in the incorporation of (1-14C)AA into phosphatidyletanolamine (PE) (p less than 0.05) were also found in cluster headache patients when compared to the control group. The increased incorporation of (1-14C)AA into PS in PMNs from this group of patients is interesting because PS plays an important role in the activation of protein kinase C, an enzyme involved in transmembrane signalling. The clinical implications of the present findings in cluster headache, if any, cannot yet be defined.

Shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating, and rhinorrhea

Three grown-up males with a long-lasting history of rather uniform, unilateral headache in the ocular-periocular area, in cluster fashion, are examined. Pain paroxysms of short duration (15-60 sec) appear up to 5-30 times per h. The headache is unilateral without side shift. Conjunctival injection appears at the very beginning of the attack and is partly massive, lasting the entire duration of the attack, and fading away at the end of it. Tearing (massive), forehead sweating (subclinical) and rhinorrhea, all on the symptomatic side, accompany the attack. In the youngest patient, the headache became chronic after clustering for six months initially, and after approximately 3 1/2 years it became bilateral. However, even in this patient, a clear unilateral pain preponderance prevails, and the autonomic disturbances are all on the original pain side. Attacks can partly be precipitated by chewing, eating (e.g. citrus fruits), moving the head, etc. The headache is completely refractory to drug therapy, including indomethacin.

Electronic pupillometry in healthy controls. Response to sympathicomimetics

The ocular sympathetic function was examined in 79 healthy volunteers (37 males and 42 females) by electronic pupillography. Pupillary diameters were first estimated under standard light conditions prior to drug application, these diameters being termed "basal values". Then, the pupils were stimulated pharmacologically by instillation of various sympathicomimetic drugs: tyramine tests were carried out in 42 individuals (24 females; 18 males), hydroxyamphetamine tests in 38 (22 females and 16 males), and phenylephrine tests in 43 individuals (23 females and 20 males). Generally, only a minor variation in the frequency of asymmetries was observed between sexes as well as between the various age groups, both when calculating the increase in pupillary diameter in millimeters, in per cent, and as the anisocoria index. In agreement with previous investigations, pupil size was found to diminish with age. The use of an age-matched control material is mandatory when comparing pupillographic recordings in patients in various categories, in the ordinary condition, as well as after topical drug administration.

Arachidonic acid metabolism in polymorphonuclear cells in headaches. A methodologic study

Prostaglandins and leukotrienes have been implicated in the pathogenesis of various types of headache, mainly because some, but not all, cyclo-oxygenase inhibitors are effective in their treatment. We have therefore investigated whether a pathologically changed turnover of arachidonic acid (AA)-containing phospholipids can be seen in headache patients, using isolated polymorphonuclear cells (PMNs) from healthy controls and patients with chronic paroxysmal hemicrania (CPH) and cluster headache. PMNs from healthy controls incorporated 55% of the added (1-14C)AA into total lipids, and 0.5% +/- 0.14% of this radioactivity was found in the phosphatidylserine (PS) fraction. PMNs from a cluster headache and a CPH patient showed 300% and 900% increase in PS labeling from AA, respectively. No other phospholipids showed any difference between controls and patients. The results are discussed in connection with membrane signal transduction via the PS-dependent protein kinase C.