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Biomedical subjects

S C McCombie

Publications and source records attributed to S C McCombie.

10 recordsLinked to original sources
PubMed2002

Self-treatment for malaria: the evidence and methodological issues.

Malaria remains an important cause of death, especially in sub-Saharan Africa. Self-treatment with antimalarial drugs is a common practice that raises important issues for policy-makers. A number of important questions concerning factors related to self-treatment, adequacy of self-treatment and the role of self-treatment in malaria mortality remain unanswered. Although there are some common patterns, there is considerable diversity in treatment practices, even within a single country. Social science research on malaria treatment needs to move beyond description to evaluation of interventions. This will require a greater degree of methodological rigour and more attention to the generation of data that can be compared across time periods and studies. Definitions of malaria cases and the role of local disease categories in identifying cases need to be made more explicit. Illnesses should be classified by severity, using measures of perceived severity as well as biomedical signs of severity. Each treatment step should be considered in terms of four levels of analysis: who provided the treatment or advice, what the treatment was, where it was obtained and when it was taken in relationship to onset of illness.

Africa South of the Sahara↗
PubMed1996

Treatment seeking for malaria: a review of recent research.

A review of literature on treatment seeking for malaria was undertaken to identify patterns of care seeking, and to assess what is known about the adequacy of the treatments used. There is considerable variation in treatment seeking patterns, with use of the official sector ranging from 10-99% and self-purchase of drugs ranging from 4-87%. The majority of malaria cases receive some type of treatment, and multiple treatments are common. The response to most episodes begins with self-treatment, and close to half of cases rely exclusively on self-treatment, usually with antimalarials. A little more than half use the official health sector or village health workers at some point, with delays averaging three or more days. Exclusive reliance on traditional methods is extremely rare, although traditional remedies are often combined with modern medicines. Although use of antimalarials is widespread, underdosing is extremely common. Further research is needed to answer the question of what proportion of true malaria cases get appropriate treatment with effective antimalarial drugs, and to identify the best strategies to improve the situation. Interventions for the private and public sector need to be developed and evaluated. More information is needed on the specific drugs used, considering resistance patterns in a particular area. In order to guide future policy development, future studies should define the nature of self-treatment, record multiple treatments and attempt to identify the proportions of all cases who begin treatment with antimalarials at standardized time intervals. Hypothetical questions were found to be of limited usefulness in estimating rates of actual treatments. Whenever possible, studies should focus on actual episodes of illness and consider supplementing retrospective surveys with prospective diary-type methods. In addition, it is important to determine the specificity of local illness terms in identifying true malaria cases and the extent to which local perceptions of severity are consistent with clinical criteria for severity and symptoms of complicated malaria.

Drug Resistance↗
PubMed1989

The politics of immunization in public health.

The role of socio-political and psychological factors in the decision to immunize is explored using data collected in a county health department in the United States. Decisions regarding the administration of post-exposure immunizations for hepatitis A and rabies are described, and a tendency toward unnecessary use noted. At times these interventions function more to reduce the anxiety of a patient or clinician than they do to prevent an infection. These findings may have implications for analyses of clinical decision making that involve other types of interventions.

Decision Making, Organizational↗
PubMed1988

The epidemiology of S. sonnei and S. flexneri in Pima County, Arizona: an exploratory study.

Investigation of 189 cases of shigellosis reported to the Pima County, Arizona Health Department in 1986 revealed that 23 per cent of cases could be attributed to travel to Mexico, and 10 per cent to day care attendees and their household contacts. No source of infection or high-risk activity could be demonstrated for 43 per cent of the cases. Households in which S. flexneri occurred were more likely to be characterized by crowded living situations and to have no known source of infection.

Adolescent↗
PubMed1987

Folk flu and viral syndrome: an epidemiological perspective.

Public health officials and medical social scientists both recognize the importance of the relationship between culture and infectious disease. However, the divergence that exists between the medical model and the epidemiological model has not been well studied. During the course of enteric disease surveillance in the southwest United States, the categories 'flu' and 'viral syndrome' were identified. The relationship between 'flu', a popular illness category, and 'viral syndrome', part of the medical model, is discussed. From the standpoint of an epidemiologist, both of these concepts act as obstacles to disease investigation and control.

Attitude to Health↗
PubMed1986

The cultural impact of the 'AIDS' test: the American experience.

In March 1985 an ELISA test for serum antibodies to human T-cell leukemia/lymphotropic virus type III (HTLV-III) was licensed for use in screening commercial blood products. Controversy over the appropriate use and interpretation of this test continues, and some public health officials in the United States have advocated different counselling strategies for high and low risk individuals with the same test results. The response to AIDS illustrates that contagion has a social definition, even in the context of Western scientific medicine.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Tonsillectomy as a co-factor in the development of AIDS.

Hypotheses regarding the factors that predispose individuals to developing AIDS after exposure to HTLV-III/LAV are beginning to emerge. It is suggested here that surgical removal of tonsils in childhood may increase the risk of developing opportunistic infections after infection with this newly discovered retrovirus.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Measles: extinction or evolution?

The human body is the biological environment to which measles virus must adapt. In this paper the immunity conferred by vaccination is viewed as a selective force on the evolution of this virus. The possible consequences of this type of selection pressure include an increased Ro, antigenic variation, and immune depression.

Antigens, Viral↗
PubMedDate not supplied

Risk for measles related to immunization status in two Tucson high schools.

An outbreak of measles occurred in Tucson, AZ, in 1985; 112 of the 225 cases were among students at two large high schools. A review of the immunization records of all students at both schools was undertaken in order to assess the risk of a person contracting measles in relation to that person's immunization status. Two factors, the lack of an immunization record and immunization prior to 12 months of age, showed a positive association with contracting measles. The association was statistically significant at one high school but not the other. At the first high school, students who were immunized at 12 to 14 months of age had a greater risk of infection than those immunized at 15 months or older. However, age at immunization of 12 to 14 months was not associated with a significantly higher risk when persons with multiple doses of vaccine were excluded from the analysis. Students of both schools showed a lower attack rate for those who had received multiple doses of vaccine, but the difference was not statistically significant.

Adolescent↗