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PubMed2002

A Belgian traveler who acquired yellow fever in the Gambia.

A 47-year-old Belgian woman acquired yellow fever during a 1-week vacation in The Gambia; she had never been vaccinated against yellow fever. She died of massive gastrointestinal bleeding 7 days after the onset of the first symptoms. This dramatic case demonstrates that it is important for persons to be vaccinated against yellow fever before they travel to countries where yellow fever is endemic, even if the country, like The Gambia, does not require travelers to be vaccinated.

Belgium↗
PubMed2002

A waterborne outbreak of Norwalk-like virus among snowmobilers-Wyoming, 2001.

In February 2001, episodes of acute gastroenteritis were reported to the Wyoming Department of Health from persons who had recently vacationed at a snowmobile lodge in Wyoming. A retrospective cohort study found a significant association between water consumption and illness, and testing identified Norwalk-like virus (NLV) in 8 of 13 stool samples and 1 well. Nucleotide sequences from the positive well-water specimen and 6 of the positive stool samples were identical. This multistrain NLV outbreak investigation illustrates the importance of NLV as a cause of waterborne illness and should encourage monitoring for NLVs in drinking water.

Caliciviridae Infections↗
PubMed2006

The development of endothermy during pouch life in the eastern barred bandicoot (Perameles gunnii), a marsupial.

Marsupials are born ectothermic and gradually become endothermic during pouch occupancy. In order to study the timing of this transition, we measured the metabolic rates of eight pouch-young eastern barred bandicoots (Perameles gunnii) at 25 degrees C (the thermoneutral zone of adults), at 35 degrees C (pouch temperature), and after injection with norepinephrine. From 5 to 7 wk of age, oxygen consumption (VO(2)) was higher at 35 degrees C than at 25 degrees C. At 8 wk, VO(2) was significantly higher at 25 degrees C than at 35 degrees C. Norepinephrine administration at 5 and 6 wk had no effect on metabolic rate, but at 8 wk, near pouch vacation, it resulted in a significant increase in metabolic rate. Our results indicate that signs of thermoregulation for P. gunnii begin at 7 wk, and at 8 wk the species is endothermic, that is, able to increase heat production in response to both cold and norepinephrine. The appearance of fur, first seen at the age of 6 wk and fully developed at 8 wk, coincides with the onset of endothermy.

Age Factors↗
PubMed2006

Epidemiologic study and containment of a nosocomial outbreak of severe acute respiratory syndrome in a medical center in Kaohsiung, Taiwan.

OBJECTIVE: We conducted an epidemiologic investigation at the beginning of a nosocomial outbreak of severe acute respiratory syndrome (SARS) to clarify the dynamics of SARS transmission, the magnitude of the SARS outbreak, and the impact of the outbreak on the community. METHODS: We identified all potential cases of nosocomially acquired SARS, linked them to the most likely infection source, and described the hospital containment measures. SETTING: A 2,300-bed medical center in Kaohsiung, Taiwan. RESULTS: A total of 55 cases of SARS were identified, and 227 hospital workers were quarantined. The index patient and neighboring patients were isolated. A chest physician team reviewed medical charts and chest radiographs and monitored the development of SARS in patients staying in the ward. The presence of underlying lung disease and immunocompromise in some patients made the diagnosis of SARS difficult. Some cases of SARS were diagnosed after the patients had died. Medical personnel were infected only if they cared for patients with unrecognized SARS, and caretakers played important roles in transmission of SARS to family members. As the number of cases of nosocomial SARS increased, the hospital closed the affected ward and expedited construction of negative-pressure rooms on other vacated floors for patient cohorting, and the last case in the hospital was identified 1 week later. CONCLUSIONS: Timely recognition of SARS is extremely important. However, given the limitations of SARS testing, possible loss of epidemic links, and the nonspecific clinical presentations in hospitalized patients, it is very important to establish cohorts of persons with low, medium, and high likelihoods of SARS acquisition. Rapid closure of affected wards may minimize the impact on hospital operations. Establishment of hospitals dedicated to appropriate treatment of patients with SARS might minimize the impact of the disease in future epidemics.

Aged↗
PubMed1996

A double-blind, placebo-controlled trial of the effect of fluoxetine on dietary intake in overweight women with and without binge-eating disorder.

This study examined mechanisms by which fluoxetine may reduce energy consumption and body weight. Women with binge-eating disorder (BED; n = 38) and age- and weight-matched women without BED (n = 32) monitored their dietary intake and concurrently recorded mood variables on a hand-held computer for 6 d of baseline and for 6 d after being randomly assigned to receive placebo or fluoxetine (60 mg). Fluoxetine reduced eating more than did the placebo on days 4-6 of treatment. The frequency of episodes was not affected, suggesting that fluoxetine affects satiety, not hunger. Fluoxetine did not preferentially reduce carbohydrate intake, did not affect snack consumption as compared with meal consumption, and did not affect negative-mood eating more than positive-mood eating, nor did fluoxetine affect subjects' mood ratings. Benefits of fluoxetine were of approximately equal magnitude for women with and without BED. However, women who reported higher energy consumption at baseline were more responsive to fluoxetine than were women who reported lower energy consumption at baseline, and binge-eating status was associated with greater energy consumption at all time points, including baseline. Fluoxetine affects dietary intake within 4 d of its consumption, and if future research shows that this remains true on repeated applications, this drug may be useful for short periods when difficulty with overeating is anticipated, such as during vacations.

Adult↗
PubMed2002

Effect of a school-based sun-protection intervention on the development of melanocytic nevi in children.

"Kidskin" was a 5-year (1995-1999), school-based intervention trial among first-grade children in Perth, Western Australia. It aimed to assess whether a sun-protection intervention could protect against nevus development on the trunk, face, and arms. Included were a control group, a "moderate intervention" group, and a "high intervention" group. Control schools taught the standard health curriculum, while intervention schools received a specially designed sun-protection curriculum over 4 years. The high intervention group also received program materials over summer vacations when sun exposure was likely to be highest and were offered low-cost sun-protective swimwear. After adjustment for baseline nevus counts and potential confounding, nevus counts on all body sites were slightly lower in both intervention groups relative to the control group at follow-up, although the differences were not statistically significant and the high intervention was no more protective. Children in the moderate and high intervention groups, respectively, had fewer nevi on the back (6%, 95% confidence interval (CI): 0, 12; 4%, 95% CI: -3, 11), chest (boys) (5%, 95% CI: -4, 13; 3%, 95% CI: -8, 14), face (11%, 95% CI: 0, 21; 9%, 95% CI: -6, 21), and arms (8%, 95% CI: -1, 17; 3%, 95% CI: -10, 14).

Child↗
PubMedDate not supplied

Pathophysiology of diarrheal disorders.

Travelers' diarrhea is only mild or moderate in the majority of cases. Consequently, severe fluid and electrolyte losses are encountered only rarely. Secretory, osmotic, and inflammatory processes in the intestine result in increased losses of fluid and electrolytes due to diarrhea. Disorders of intestinal motor activity, coupled with fluid secretion, may also have a role in causing an increase in the frequency of bowel movements. Several systemic symptoms, such as malaise, fatigue, anorexia, nausea, and fever, are commonly associated with diarrhea and contribute to significant morbidity, which is often sufficient to compromise effective participation in a vacation or business trip. Several putative mechanisms for the systemic symptoms associated with travelers' diarrhea are discussed in light of recent understanding of the enteric nervous system, intestinal neuropeptides and hormones, and other inflammatory mediators released from the bowel wall during enteric infections.

Biological Transport, Active↗
PubMed1993

Short-term treatment of traveler's diarrhea with norfloxacin: a double-blind, placebo-controlled study during two seasons.

Clinical efficacy of norfloxacin for treatment of traveler's diarrhea in 106 Finnish tourists vacationing in Morocco was evaluated during two different seasons. When the criteria for diagnosis of traveler's diarrhea were fulfilled, norfloxacin (400 mg) or a placebo was given orally, twice daily for 3 days. All symptoms and signs subsided sooner in the norfloxacin group. The clearest difference was observed in the duration of diarrhea: 1.2 days in the norfloxacin group vs. 3.3 days in the placebo group (P < .001). The duration of diarrhea due to particular species was as follows for the two groups: in cases due to Salmonella enterica, 1.1 vs 4.1 days (P < .01); in cases due to Campylobacter jejuni, 1.8 vs. 5.0 days (P < .01); and in cases due to enterotoxigenic Escherichia coli, 1.0 day vs. 3.1 days (P < .01). The rate of full recovery during administration of norfloxacin or a placebo was also greater among the norfloxacin recipients: 84% vs. 47% (P < .001). No significant adverse effects were reported. Norfloxacin proved to be safe and effective in therapy for traveler's diarrhea.

Adolescent↗
PubMed2002

Comparing the characteristics and attitudes of physicians in different primary care settings: The Ontario Walk-in Clinic Study.

BACKGROUND: In Canada, walk-in clinics (WICs) are a focus for debate about access to and the costs and quality of primary care. While WICs may offer patients easier access through longer hours and shorter waits, it has been argued that they may also lead to unnecessary utilization, duplication of services, lack of continuity of care, decreased quality and increased costs. OBJECTIVES: The main objectives were to analyse the characteristics and attitudes of physicians working in different family practice types including WICs. METHODS: We analysed the results of a 1998 survey of 728 primary care physicians in Ontario to compare physicians working in WICs with those working in solo and group family practices. RESULTS: Our survey found that few physicians worked most or all of their hours in WICs; most worked in WICs and other family practice types. Compared to family physicians in solo and group practices, physicians working in WICs saw more patients who were not their regular patients, patients without appointments and children. They reported slightly higher frequencies of problems such as backlogs (patient queues) and patients who had sought care from other doctors for the same problem. WIC physicians were less satisfied than other physicians with their relations with patients. They were, however, more satisfied with the availability of consultation, support staff, hours, income, and vacation coverage. Further, WIC physicians assessed the quality of care in WICs to be neither better nor worse than that in other family practices. CONCLUSIONS: We conclude that there are important similarities as well as differences, between physicians in WICs and those in more conventional family practices. The assessments of primary care physicians do not support the generally negative reputation of WICs. Instead, greater consideration should be given to the system-level issues which produce demand for WICs.

Ambulatory Care Facilities↗
PubMed1991

Excision and transposition of Tn5 as an SOS activity in Escherichia coli.

Excision and transposition of the Tn5 element in Escherichia coli ordinarily appear to occur by recA-independent mechanisms. However, recA(Prtc) genes, which encode RecA proteins that are constitutively activated to the protease state, greatly enhanced excision and transposition; both events appeared to occur concomitantly and without destruction of the donor DNA. The recombinase function of the RecA protein was not required. Transposition was accompanied by partial, and occasionally full, restoration of the functional integrity of the gene vacated by the excised Tn5. The stimulation of transposition was inhibited by an uncleavable LexA protein and was strongly enhanced by an additional role of the RecA(Prtc) protein besides its mediation of LexA cleavage. To account for the enhanced transposition, we suggest that (i) there may be a LexA binding site within the promoter for the IS50 transposase, (ii) activated RecA may cleave the IS50 transposition inhibitor, and (iii) the transposase may be formed by RecA cleavage of a precursor molecule.

Bacterial Proteins↗
PubMed1996

A longitudinal trial of weight training in the elderly: continued improvements in year 2.

We conducted a 2-year (42 weeks of consecutive training in each year, separated by 10 weeks of testing and vacation time) randomized, controlled trial of weight training in 142 healthy male and female subjects, aged 60 to 80 years. Measurements included dynamic strength, symptom-limited endurance in cycling, treadmill walking and stair climbing, muscle size, and bone mineral density and content of the lumbar spine and whole body. One hundred and thirteen subjects completed the study (57 exercise, 56 control), with a mean attendance of 85% among the exercisers. Muscle strength was unchanged in the control subjects but increased (collapsed across age and gender) from 32% (leg press) to 90% (military press) in the exercisers. Symptom-limited endurance in cycling, treadmill walking, and stair climbing increased in the exercisers by (mean +/- SE) 6.2 +/- 0.8%, 29.2 +/- 7.3%, and 57 +/- 12%, respectively; the only change in the controls was an unanticipated 33% increase in stair climbing performance during the first year. These values were unchanged in the controls. Cross-sectional area of the knee extensors increased by 8.7 +/- 0.9% in the trained subjects and was unchanged in controls. Measures of whole body, lumbar spine bone mineral density, and lumbar spine bone mineral content were unchanged in the exercisers, but whole body bone mineral content decreased by 1%. In contrast, there were small increases (< 4.0%) in bone mineral density among the controls. Long-term weight training proved to be a safe and well-tolerated mode of exercise for the elderly. Increased strength was associated with muscle hypertrophy in each year, and with increased endurance in cycling, walking, and stair climbing. There were no changes in bone mineral density but a small reduction in whole body bone mineral content.

Aged↗
PubMed2006

Snowbirds, sunbirds, and stayers: seasonal migration of elderly adults in Florida.

OBJECTIVE: Most migration statistics in the United States focus on changes in place of usual residence, thereby missing temporary moves such as business trips, vacations, and seasonal migration. In this article, we analyze the temporary in- and out-migration of elderly adults in Florida. Our primary objectives are to develop a methodology for estimating the number of temporary migrants and to analyze their demographic characteristics. METHODS: Using survey data, we estimated the number, timing, and duration of temporary moves and the origins, destinations, and characteristics of elderly temporary migrants. We compared the characteristics of temporary in-migrants, out-migrants, and non-migrants, and we used logistic regression analysis in order to evaluate differences in those characteristics. RESULT: We estimate that Florida had more than 800,000 elderly temporary in-migrants and more than 300,000 elderly temporary out-migrants at peak times in 2005. Income, education, employment, and health status were among the major determinants of temporary migration. DISCUSSION: The temporary migration of elderly adults has a major impact on the resident populations of both sending and receiving communities. This article presents a methodology for estimating temporary migration and provides insights into migratory patterns that cannot be achieved by focusing solely on changes in place of usual residence.

Aged↗
PubMed1989

Perceptions of caregivers about special respite services for the elderly.

Questionnaires were circulated to 48 family members who had arranged for respite care for ill elderly relatives. Caregiver families used their respite for vacations, personal business, freedom from caregiving, and surgery. Eighteen (78%) wished to participate in respite again because they thought it the best available arrangement to maintain their mental health during caregiving.

Aged↗
PubMed1999

Control of Boophilus annulatus (Acari: Ixodidae) on cattle using injectable microspheres containing ivermectin.

The efficacy of an injectable microsphere formulation of ivermectin for control of the cattle tick, Boophilus annulatus (Say), was tested on 2 groups of 6 Hereford heifers held on separate 7-ha, tick-infested, buffel grass pastures. Cattle in one pasture were injected subcutaneously in the neck with a controlled-release microsphere formulation of ivermectin at the rate of 2.4 mg AI/kg body weight; the other group was injected with carrier only. Beginning 4 wk after injection and continuing throughout the remainder of the test (16 wk), no engorged ticks (> or = 5.5 mm) were found on any of the treated cattle, whereas large numbers of engorged ticks were found on the untreated controls. During this period, a few ticks were recovered from untreated sentinel animals placed in the treatment pasture during 7-8 wk after treatment, but none were recovered from animals exposed from 11-12 wk or 14-15 wk. Large numbers of B. annulatus ticks were found on untreated sentinel cattle placed in the control pasture during these same periods. Although the cattle, pastures, and tick habitat were approximately equal, the treated cattle gained an average of 77 kg compared with an average of 42 kg for the control group. This technology offers a possible alternative to the current official program of dipping and vacating pastures for eradication of Boophilus sp. infestations from the quarantine zone in southern Texas. Larger scale testing is needed to determine the potential of the injectable microsphere formulation and to optimize its use in eradication or control strategies.

Analysis of Variance↗
PubMed1987

Etiological differences between subtypes of cutaneous malignant melanoma: Western Canada Melanoma Study.

From newly incident cases in Western Canada, 415 patients with superficial spreading melanoma (SSM), 128 with nodular melanoma (NM), and 56 with lentigo maligna melanoma (LMM) were interviewed, with age- and sex-matched controls chosen from the general population. The associations of these 3 subtypes with pigmentation, skin reaction to sun, different types of sun exposure, sunburn, and suntan were assessed. Compared to the other types, LMM occurred in older patients, and 75% of lesions occurred on the head and neck: It was less strongly related to pigmentation factors, intermittent sun exposure, and skin reaction to sun. The associations of SSM and NM with pigmentation, chronic sun exposure, skin reaction, and suntan were very similar: Both were associated with intermittent sun exposure, but SSM was more strongly related to vacation exposures than was NM. These results were compared with those from a similar Australian study. While LMM appears different in its etiology from SSM and NM, there is no strong evidence of major etiological differences between SSM and NM.

Adult↗
PubMed2005

Ultraviolet radiation exposure and risk of malignant lymphomas.

BACKGROUND: The incidence of malignant lymphomas has been increasing rapidly, but the causes of these malignancies remain poorly understood. One hypothesis holds that exposure to ultraviolet (UV) radiation increases lymphoma risk. We tested this hypothesis in a population-based case-control study in Denmark and Sweden. METHODS: A total of 3740 patients diagnosed between October 1, 1999, and August 30, 2002, with incident malignant lymphomas, including non-Hodgkin lymphoma, chronic lymphocytic leukemia, and Hodgkin lymphoma, and 3187 population controls provided detailed information on history of UV exposure and skin cancer and information on other possible risk factors for lymphomas. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by logistic regression. Statistical tests were two-sided. RESULTS: Multivariable-adjusted analyses revealed consistent, statistically significant negative associations between various measures of UV light exposure and risk of non-Hodgkin lymphoma. A high frequency of sun bathing and sunburns at age 20 years and 5-10 years before the interview and sun vacations abroad were associated with 30%-40% reduced risks of non-Hodgkin lymphoma (e.g., for sunbathing four times a week or more at age 20 versus never sunbathing, OR = 0.7, 95% CI = 0.6 to 0.9; for two or more sunburns a year at age 20 versus no sunburns, OR = 0.6, 95% CI = 0.5 to 0.8). These inverse associations increased in strength with increasing levels of exposure (all P(trend)< or =.01). Similar, albeit weaker, associations were observed for Hodgkin lymphoma. There were no clear differences among non-Hodgkin lymphoma subtypes, although associations were stronger for B-cell than for T-cell lymphomas. A history of skin cancer was associated with a doubling in risks of both non-Hodgkin and Hodgkin lymphoma. CONCLUSIONS: A history of high UV exposure was associated with reduced risk of non-Hodgkin lymphoma. The positive association between skin cancer and malignant lymphomas is, therefore, unlikely to be mediated by UV exposure.

Adult↗
PubMed2006

Calcium pectate chemistry controls growth rate of Chara corallina.

Pectin, a normal constituent of cell walls, caused growth rates to accelerate to the rates in living cells when supplied externally to isolated cell walls of Chara corallina. Because this activity was not reported previously, the activity was investigated. Turgor pressure (P) was maintained in isolated walls or living cells using a pressure probe in culture medium. Pectin from various sources was supplied to the medium. Ca and Mg were the dominant inorganic elements in the wall. EGTA or pectin in the culture medium extracted moderate amounts of wall Ca and essentially all the wall Mg, and wall growth accelerated. Removing the external EGTA or pectin and replacing with fresh medium returned growth to the original rate. A high concentration of Ca2+ quenched the accelerating activity of EGTA or pectin and caused gelling of the pectin, physically inhibiting wall growth. Low pH had little effect. After the Mg had been removed, Ca-pectate in the wall bore the longitudinal load imposed by P. Removal of this Ca caused the wall to burst. Live cells and isolated walls reacted similarly. It was concluded that Ca cross-links between neighbouring pectin molecules were strong wall bonds that controlled wall growth rates. The central role of Ca-pectate chemistry was illustrated by removing Ca cross-links with new pectin (wall "loosening"), replacing vacated cross-links with new Ca2+ ("Ca2+-tightening"), or adding new cross-links with new Ca-pectate that gelled ("gel tightening"). These findings establish a molecular model for growth that includes wall deposition and assembly for sustained growth activity.

Calcium↗
PubMed1981

A virologically studied epidemic of type A hepatitis in a school for the mentally retarded.

The occurrence of hepatitis A virus (HAV) infection in a small boarding school for mildly to moderately mentally retarded children in Umka, Yugoslavia, in the spring of 1979, six years after the last recognized occurrence, provided an opportunity to study the spread of the agent among 79 classroom and dormitory contacts. Only 51% of those who had entered subsequent to the prior outbreak had detectable antibody (anti-HAV) with immunoglobulin G predominance, and the proportion within the first six years of training did not vary. Both findings suggest a lack of endemicity during the interval. The outbreak ended spontaneously just before the summer vacation with an anti-HAV prevalence of 90%. The ratio of silent to overt cases was approximately 2:1. HAV was found in fecal samples from susceptible residents with inapparent infection as well as those with hepatitis. Among those with prior experience, there were no significant anti-HAV increases to suggest HAV reinfection in this group. Overall, 32% were seropositive for markers of past or chronic hepatitis B virus (HBV) infection, but this status did not correlate with sex, year of training, or HAV experience. Only one instance of HBV transmission was observed in the same interval as the 26 HAV infections.

Adolescent↗