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PubMed1993

The public health significance of dietary fructose.

It is increasingly appreciated that some foods and food components, including fructose, have specific health benefits and/or potential risks. This recognition is associated with varied health claims and cautionary statements that can drive dynamic changes in food manufacture, selection, consumption, and views about food safety. It is imperative that the scientific and public health communities develop clear standards for evaluating potential benefits and risks, a process for accurately conveying sound public health information to consumers, and a mechanism for monitoring future changes in the food supply and relating these changes to potential health effects. In this paper we discuss specific and general considerations about the health effects of dietary fructose and provide a perspective on their public health significance. On the basis of currently available information, there is little basis for recommending increased or decreased use of fructose in the general food supply or in products for special dietary use.

Dietary Carbohydrates↗
PubMed2005

Longitudinal examination of homebound older adults who experience heightened food insufficiency: effect of diabetes status and implications for service provision.

PURPOSE: Healthful eating is important for optimal diabetes self-care. However, the level of food sufficiency may influence the degree of adherence to dietary self-care behaviors through the affordability of nutritionally appropriate food. This study examines whether homebound older adults with diabetes were at greater risk for heightened food insufficiency over 1 year, despite regular receipt of home-delivered meals. DESIGN AND METHODS: This was a longitudinal study of a randomly recruited sample of 268 homebound older adults in the Nutrition and Function Study (NAFS) who regularly received home-delivered meals and completed baseline and 1-year in-home assessments. Based on an economic context model, self-reported data were collected on fundamental and proximate factors, food-sufficiency status, and intervening events. Determinants of heightened food insufficiency were examined with multivariate logistic regression models. RESULTS: Not only did food-sufficiency status diminish over time in this sample, but it became or remained worse for older adults with diabetes. In addition to diabetes status, heightened food insufficiency was associated with perceived inadequacy of economic resources. IMPLICATIONS: Health care providers and nutrition programs should attempt to identify high-risk older adults - those who have diabetes and are at risk of food insufficiency - and develop community linkages and strategies that integrate nutrition with diabetes care plans, thus supporting a multidisciplinary, chronic care model to improve diabetes management and outcomes.

Aged↗
PubMed2001

The quality of care by private practitioners for sexually transmitted diseases in Uganda.

One of the limited number of strategies available to reduce the spread of human immunodeficiency virus (HIV) infections in sub-Saharan Africa is the effective treatment of other, curable, sexually transmitted diseases (STDs). At present, a large proportion of people with STDs either treat themselves at home or seek treatment from private sector practitioners (PSPs) rather than use publicly funded services. A randomized controlled trial of the efficacy of a behavioural intervention with or without improved STD services is being carried out in Masaka, a rural area of south-western Uganda. The trial involves three groups, each covering six parishes. People living in one group of parishes receive information, education and communication activities (IEC) to increase public awareness regarding STDs and HIV/AIDS. The second group receives the same IEC interventions with improved treatment of STDs by both public and private service providers. The third group receives community development activities unrelated to HIV. In order to improve our understanding of how the quality of care provided by PSPs might be ameliorated, we interviewed 36 PSPs in the trial area, and made an assessment of the care they were providing. We also carried out six focus group discussions with patients to obtain their opinions on private services. PSPs in the intervention arm of the trial, who had attended meetings dealing with the syndromic management of STDs, referred to syndromes 82% of the time compared with 12% in the control arms, a mean difference of 70% (p < 0.001); stocked locally appropriate antibiotics 76% of the time compared with 52%, a mean difference of 24% (p < 0.001); and are more likely to prescribe appropriate drugs 82% of the time compared with 27%, a mean difference of 55% (p < 0.001). This small study suggests that PSPs can help improve the management of STDs.

Anti-Infective Agents↗
PubMed1995

Physical activity, illness and nutritional status among adults in a rural Ethiopian community.

BACKGROUND: From Africa, our knowledge on how malnutrition and diseases influence the ability to work is limited. In a one-year population-based study, we investigated the effects of nutritional status, illness and socioeconomic factors on the activity pattern in a rural population in southern Ethiopia. METHODS: From July 1991 to June 1992, 226 people (109 men and 117 women) from the Elka na Mataramofa village in the Rift Valley were examined every 3 months. Information on the occurrence of illness and measurement of nutritional status were collected every 3 months. At the same time we interviewed each person for seven consecutive days to assess the pattern of activities. RESULTS: Men and women had a mean estimated energy expenditure (SD) of 2937 kcal (951) and 1977 (513) kcal, respectively. The mean body mass index (BMI) (SD) was 19.7 (2.3) for men and 20.0 (2.6) for women. Men showed a significant seasonal variation in estimated energy expenditure that was highest during the pre-harvest time. Women did not show such a seasonal variation. In a multivariate analysis, sex, age, state of nutrition, period prevalence and severity of diseases and seasonality influenced estimated energy expenditures. CONCLUSIONS: Both low BMI and illness are significantly associated with low estimated energy expenditure. Most likely, this represents an example of the vicious circle of malnutrition, disease and activity that affects subsistence farming communities. Development work that improves the state of nutrition and health of the adult population may therefore enhance the work performance of rural populations.

Adult↗
PubMed1984

Incidence and cumulative frequency of endemic Lyme disease in a community.

We conducted an epidemiological study of the cumulative frequency and incidence of Lyme disease in a summer community on Fire Island, New York, an area endemic for the disease. Fifteen (7.5%) of 200 persons studied in the community in 1982 reported a history of Lyme disease. An indirect immunofluorescent antibody assay showed that seventeen (9.7%) of 176 persons had serological evidence of exposure to the Lyme spirochete, including six of the 15 persons with a history of Lyme disease. Seven (0.7%-1.2%) of 600-1,000 persons in the community developed clinical symptoms and serological evidence of Lyme disease during the summer season, including two (1%) of the 200 persons in the study group. Four (3.1%) of 129 persons who had sera collected before and after the summer season demonstrated fourfold or greater rises in IgG antibody titers to the Lyme spirochete, including 2 (1.6%) persons without symptoms of Lyme disease. We conclude that the incidence of Lyme disease can be appreciably higher in endemic areas than previously recognized and that subclinical or inapparent seroconversion may occur after infection.

Adolescent↗
PubMed1995

Antibody responses against Escherichia coli heat-labile toxin and colonization factor antigens I and II in Argentinian children.

Serum antibody responses against Escherichia coli heat-labile enterotoxin (LT) and colonization factor antigens (CFAs) I and II were studied in 84 children < 5 years old living in two communities. These villages differed in the quality of their drinking water. Children from both communities developed significantly increased antibody titers against LT and CFA/II but not against CFA/I during 3 months of follow-up. The magnitude of the anti-LT response was significantly higher in children from Zaiman than in those from Las Dolores. Antibody titers rose to maximum levels during the second year of age and reached relatively constant levels in children aged 2-5 years, probably due to repeated exposure to enterotoxigenic E. coli strains. Antibody levels of 30 children were followed for 2 years; increases in anti-LT and anti-CFA titers varied in the different age groups.

Age Factors↗
PubMed1984

The Pima Infant Feeding Study: breast feeding and gastroenteritis in the first year of life.

In 1978, a retrospective study of infant feeding was conducted among 257 Pima Indian women of reproductive age, who were residing on the Gila River Reservation, Arizona. With data on infant feeding patterns from 683 infants born 1950-1977 to the Pima Indian women, infants were classified into one of five feeding groups based on the duration breast-fed and time of introduction and duration bottle-fed. History of severe diarrhea/diarrhea with dehydration/diarrhea and vomiting was abstracted from the infant's medical record and classified as a case of gastroenteritis. The risk of developing a first such episode during the first year of life was compared between the exclusively bottle-fed and each of the other four feeding groups. The odds ratio of gastroenteritis during the first year was significantly less than unity for infants exclusively breast-fed for four months before adjustment (odds ratio = 0.49) and after adjustment for adverse social conditions and seasonality (odds ratio = 0.51). Similarly, univariate analysis and multiple logistic regression analysis of gastroenteritis from birth through four months revealed estimates of the odds ratio that were significantly less than unity for infants exclusively breast-fed for four months (odds ratio = 0.33 and 0.30, respectively). Although a trend of decreasing gastroenteritis with increasing breast feeding was noted across all other feeding groups, the rates of first episodes of gastroenteritis did not significantly differ among all other feeding groups and the bottle-fed. Thus, exclusive breast feeding for four months is associated with reduced risk of early first episodes of gastroenteritis among infants in a less developed community in the United States.

Adolescent↗
PubMed1998

Neonatal nutritional assessment by a method independent of precise maturity determination.

Data from a previous study were analysed to develop a new model for neonatal nutritional evaluation which is independent of precise maturity determination. Birth weights and arm/head ratios were recorded for each infant recruited for the study. Both indices were correlated by simple regression analysis with gestational age as the independent variable. Birth weight showed highly significant correlation with gestational age (r = 0.77; P < 0.001). Arm/head ratio was also correlated with birth weight with highly significant correlation coefficient (r = 0.81; P < 0.001). The regression line of arm/head ratio on birth weight, with the demarcated 95 per cent confidence spread, formed the new model for neonatal nutritional assessment. The model had a sensitivity of 80.54 per cent and specificity of 90.22 per cent using nutritional status determined by clinical features as reference. Since the model is independent of precise maturity determination, which limits the potential usefulness of several methods of neonatal nutritional assessment, it is recommended as a rapid, simple, and reliable appropriate health technology for developing communities.

Anthropometry↗
PubMed2001

Post-infective diarrhoea.

When diarrhoea caused by gastroenteritis persists for more than two weeks it is referred to as persistent diarrhoea in developing countries. Whilst the Control of Diarrhoeal Diseases programme has decreased mortality from acute diarrhoea, mortality from persistent diarrhoea has not been so responsive. A number of factors have been identified which are determinants for the progression of an acute episode to one which persists in developing communities. In one study from west Africa, current infection with Cryptosporidium parvum was the most significant factor. In studies from Brazil and India, continuing infection with enteropathogenic Escherichia coli was identified in 50% of infants with persistent diarrhoea. Persistent small intestinal mucosal damage is of key importance in such children. Management of established cases is complex and difficult. However, there is clear evidence that zinc is involved in the recovery of small intestinal mucosa after injury. Zinc supplementation may indeed significantly reduce the duration of persistent diarrhoea. However, the whole question of public health supplementation with zinc, vitamin A, or other supplements, is contentious at present.

Animals↗
PubMed1990

Optimizing radiation worker protection: the practical application of risk analysis.

This paper presents the concepts of equivalent risk and risk minimization in optimizing radiation worker protection. When prescribing worker protection requirements and identifying work restrictions, all significant contributions to worker risk should be considered, not just the risk associated with radiation dose. This approach requires a practical application of risk analysis that allows comparison of a variety of risks. Examples of the types of worker risks that must be evaluated are given, and the author proposes that the scientific community develops a methodology for risk comparison that can be implemented via an expert system to facilitate risk analysis and decision making.

Humans↗
PubMed1994

The identification of continuing education needs for community rehabilitation workers in a rural health district in the Republic of South Africa.

Based on the principle that education is a lifelong process, the paper presents the identification of continuing education needs of community rehabilitation workers, who recently completed a 2-year certificate course in a rural health district of the Republic of South Africa. The need for a new cadre of worker in the rehabilitation field, namely a community-rehabilitation worker (CRW), was advocated by WHO in 1981. The CRW works at the community level to address the needs of disabled people, as part of primary health care services. The nominal group technique (NGT) and a focused group discussion was done with the community rehabilitation workers (n = 8) and their supervisors (n = 5), to identify learning needs that should be addressed through a continuing education programme. Focused group discussions involving people with disabilities and their family members (n = 45), from villages where the CRWs work, were carried out to discover their opinions on skills that the community rehabilitation workers still needed. The results show a strong correlation between the needs identified by the three groups, viz, skills in advocacy and public education, social work, community development and organizational development.

Certification↗
PubMedDate not supplied

The effect of feeding four different formulae on stool weights in prolonged dehydrating infantile gastroenteritis.

Prolonged diarrhea following an acute episode of dehydrating gastroenteritis in infants is often treated by the empirical removal of both cow's milk protein and lactose from the feed, as they both have been implicated in the prolongation of diarrhea. In order to assess the efficacy of this policy and to determine whether there are any advantages in using a lactose-free semi-elemental feed in this situation, infants with prolonged dehydrating gastroenteritis from a developing community in South Africa were studied. Male black children between the ages of 6 weeks and 2 years with prolonged dehydrating gastroenteritis (requiring intravenous fluids for longer than 72 h to maintain hydration) were randomly assigned to receive one of four feeds if the stool weight was greater than 30 g/kg body weight/24 h on the fourth day of admission. The four formula feeds were a partially modified cow's milk formula; a lactose-free, casein-containing formula; a lactose-free, soy-protein-containing formula; and a lactose-free, whey-hydrolysate-containing formula. Stool weights were measured for the following 3 days. Seventy-two children were enrolled into the study. Stool weights were similar in the four groups at the start of the trial, and fell significantly over the trial period in those groups receiving the lactose-free feeds. Mean stool weight in the cow's milk formula group did not change. Thus, it appears that the continued feeding of a cow's milk-based lactose-containing formulae to infants with prolonged dehydrating gastroenteritis adversely affects their recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1997

Neurological surgery at New York University Medical Center.

New york university Medical Center underwent a complex evolution in a rapidly growing and dynamic city. Care for the hospital-based poor resulted in international preeminence in surgical techniques. Neurosurgery at New York University has also evolved to meet the demands of the Medical Center and the community. Developments in high technology surgery and telecommunications will provide an international resource and trainees who are prepared to face the challenges of practice in the next century.

History, 19th Century↗
PubMedDate not supplied

Vaginal infections in diabetic women: is empiric antifungal therapy appropriate?

BACKGROUND: Diabetes mellitus is reported to predispose women to vaginal candidiasis and hence patients attending busy diabetic clinics are often treated empirically with antifungal agents for genital symptoms. GOAL OF THIS STUDY: To investigate the etiology of vaginal infections in diabetic women and to determine appropriateness of empiric antifungal therapy for symptomatic women. DESIGN: Prospective study performed on consecutive patients attending two diabetic clinics. SETTING: Diabetic clinics serving developing communities belonging to two ethnic groups. STUDY POPULATION: Two hundred and one women (101 African and 100 Indian) comprising 90 women with symptoms of pruritus vulvae and/or vaginal discharge and 111 asymptomatic women. RESULTS: Candidiasis (50% vs. 24%; P = 0.012) and bacterial vaginosis (28% vs. 8%; P = 0.017) occurred significantly more frequently in symptomatic African women compared to asymptomatic African women. Among Indian women bacterial vaginosis (28% vs. 5%; P = 0.026) occurred more frequently in symptomatic women. The prevalence of trichomoniasis was similar in symptomatic and asymptomatic women of both ethnic groups. Mixed vaginal infections were detected significantly more often in African compared to Indian women (24% vs. 5%; P = 0.03). CONCLUSION: In diabetic women with genital symptoms, an attempt at diagnosis should be made prior to commencement of therapy. However, in busy clinics with overstressed facilities where investigations cannot be performed, the use of empiric antifungal therapy alone is not appropriate and consideration should be given to the use of an antifungal plus a nitroimidazole agent which would be effective for both trichomoniasis and bacterial vaginosis.

Adolescent↗
PubMed2001

Reinvesting in social justice: a capital idea for public health nursing?

Social justice is a core ethical principle of public health nursing; yet, nurses' work as social activists has largely diminished over the past century. Reengagement in social justice activities is essential to change the current social, economic, and health differentials perpetuated by market justice ideologies. Social capital has emerged in the public health literature as a promising concept for developing community interventions that diminish disparities. Public health nurses, however, must be wary of uncritically adopting social capital as a panacea for inequalities; advocating for interventions seeking to build social capital may be as harmful as the inequalities themselves.

Ethics, Nursing↗
PubMed1998

Immunization coalitions that work: training for public health professionals.

Coalition development is a major strategy to increase immunization rates. However, if local and state coalitions are to succeed, their staffs need training and technical assistance in coalition development, community planning, and program implementation. The National Coalition Training Institute trains key health agency staff in 87 state, territorial, and urban sites to perform needs assessments, use data to guide planning, plan comprehensive strategies, and evaluate their coalitions. The curriculum is based on training needs that are identified by a national survey of immunization coalitions, effective approaches, and participant evaluation. According to evaluations conducted during its first year, the National Coalition Training Institute is meeting the needs of participants.

Curriculum↗
PubMed2026

Uniform processing and analysis of IGVF massively parallel reporter assay data with MPRAsnakeflow.

As researchers and clinicians seek to identify human genomic alterations relevant to traits and disorders, identifying and aggregating evidence providing mechanistic support for associations between alterations and phenotypes remains challenging. In particular, the study of noncoding genomic variation remains a major challenge because of the lack of accurate functional annotation for activity in a given context and across alleles. Experimental evidence is critical for prioritizing and interpreting functional effects of genetic alterations. Massively parallel reporter assays (MPRAs) have emerged as a powerful high-throughput approach, enabling quantification of regulatory element activity and allelic effects, as well as systematic dissection of gene regulatory logic and variant effects across different contexts. However, the diversity of MPRA designs, lack of standardized formats, and many potential processing parameters hamper data integration, reproducibility, and meta-analyses across studies. To address these challenges, the Impact of Genomic Variation on Function (IGVF) Consortium established an MPRA focus group to develop community standards, including harmonized file formats, and robust analysis pipelines for a wide range of library types and experimental designs. Here, we present these formats and comprehensive computational tools, MPRAlib and MPRAsnakeflow, for uniform processing from raw sequencing reads to counts, processing, and visualization. Using diverse MPRA data sets, we investigated technical variability sources including barcode sequence bias, outlier barcodes, and delivery method (episomal vs. lentiviral). Our results establish best practices for MPRA data generation and analysis, facilitating robust, reproducible research and large-scale integration. The presented tools and standards are publicly available, providing a foundation for future collaborative efforts in regulatory genomics.

Humans↗
PubMed1999

The introduction of patient process re-engineering in the Peterborough Hospitals NHS Trust.

Patient process recognition and re-engineering (PPR) has become a major concern of recent health care development and management. This paper discusses the position of the National Health Service (NHS) in the UK; where it is at present and where it aims to be. It suggests that the work of the current government in developing community care is central to the work of both the Leicester Royal Infirmary and the Peterborough Hospitals NHS Trust, when building relationships between primary (community) and secondary (hospital) health care provision. This paper aims to examine whether and how PPR can improve patient processes in the NHS. It does this through a case study of PPR in Peterborough Hospital.

Delivery of Health Care, Integrated↗