The performance of antibody detection for the diagnosis of schistosomiasis has been evaluated in Kenya. Approximately 1500 blood samples from 3 areas with endemic schistosomiasis (Schistosoma mansoni only, S. haematobium only, and a mixed infection area), and from a non-endemic control area, were tested for their antibody reactivity in an enzyme-linked immunosorbent assay (ELISA). The results were compared with infection status determined by parasitological examination. Two test antigens were used: unfractionated S. mansoni egg homogenate (SEA), and CEF6, a previously described, partially purified fraction of SEA containing 2 cationic antigens. The antigens prepared from eggs of Kenya and Puerto Rico S. mansoni isolates gave very similar results. Bloods from patients with S. haematobium infection cross-reacted significantly with the two S. mansoni antigen preparations, but reactivity against CEF6 appeared more specifically indicative of S. mansoni infection. Of 254 blood samples from schoolchildren in the non-endemic area, 100% gave ELISA optical density readings at 492 nm (OD492) < 0.20 against SEA, and 98% were < 0.20 against CEF6. With 887 blood samples from subjects of all ages in the area endemic for S. mansoni alone, using an ELISA OD492 cut-off point of 0.20, SEA and CEF6 had sensitivities of 94% and 97% respectively, and specificities of 64% and 59% respectively. Increasing the OD492 cut-off value reduced the sensitivity and increased the specificity of both test antigens. Specificity of both antigens was poor with samples from 234 children in an area endemic for both S. mansoni and S. haematobium (< 20% for both antigens at an OD492 cut-off value of 0.20).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Reasons American lesbians fail to seek traditional health care.

What reasons do lesbians have for not seeking health care? From three women's cultural events in 1990, a convenience sample was formed of 503 women (78% of whom were lesbians) who volunteered to complete a pretested qualitative and quantitative instrument. The reasons given for not seeking health care from traditional sources were that (a) low-cost, natural, or alternative care is not provided; (b) holistic care is not provided; (c) little preventive care and education are provided; (d) communication and respect are lacking; and (e) there are few women-managed clinics.

Attitude to Health↗

PubMedDate not supplied

Midwifery: umbilical cord care in pre-term babies.

A trial was undertaken to investigate infection rates and to measure cord separation time under four different cord care regimes in pre-term babies within the Neonatal Unit of Ninewells Hospital, Dundee. The evidence of the trial suggests that the present method of treating umbilical cords in pre-term babies with Sterets and Ster-zac powder is sound. More importantly, there is good evidence that a policy of leaving umbilical cords untreated cannot be recommended as safe practice within the unit. It is noted that the numbers in this trial (about 100) were not large, but the trial did run for a full year. Any further trials would need to be multicentered to obtain a larger sample set in a reasonable amount of time.

Anti-Bacterial Agents↗

PubMedDate not supplied

Decision making in thyroid and parathyroid surgery: the influence of imaging.

Surgical decision making is essentially based on experience, augmented by a management philosophy. In this manuscript we review concepts of thyroid and parathyroid surgical decision making in relation to diagnostic imaging input. These two endocrine glands have crucial anatomic associations, but very different pathologic conditions; it is the specific pathologic considerations that ultimately determine the decision-making process. For us, diagnostic imaging has enabled a more effective surgical decision-making process through thorough pre-operative planning. The strategy for parathyroid surgery is based upon the pathologic localization obtained by high resolution ultrasound. Thyroid surgical strategy is more heavily influenced by experience, and our policy is total thyroidectomy for all malignant and benign tumors with airway compression.

Adenoma↗