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Human stones.

X-ray diffraction studies have shown that there are several different kinds of human urinary calculi, with different age, sex, period, and geographical distributions. Juvenile bladder stones are typically urate and oxalate in small boys in certain stone belts. They have disappeared in some areas, particularly in Britain, but are still common in Thailand. India. and Turkey. Their cause is unknown. Adult bladder stones, formerly common in elderly men, were largely of uric acid and were due to a faulty diet. Juvenile kidney stones are rare, except in Turkey where they are similar to juvenile bladder stones. Adult kidney stones are by far the most universally common, especially in technically developed communities. They are found in both sexes (equally at postmortem), and in the United States and in Czechoslovakia the average number of hospital entries for stones, relative to the whole population, is about 1 per 1000 per annum (increasing) although the incidence in different districts varies by 4 to 1 or more. Such stones are mainly calcium oxalates and calcium and MgNH(4) phosphates. The incidence among the administrative class is at least 20 times that among agricultural workers, relative to their numbers. Stones are reported also to be an occupational hazard for air pilots. It is probably that much more exercise and the drinking of more water to prevent kidney dehydration (spirits and coffee are not effective for this purpose) would lower the high rate of incidence. Moderate acidification would prevent phosphate supersaturation of the urine, but is not effective for oxalates. It seems certain that, once a suitable seed is formed, epitaxy is largely responsible for deposition from urines that would otherwise remain supersaturated until voided. This would explain the curioLls radial and layered texture of many stones. Laboratory experiments might suggest ways of preventing orientated overgrowth.

Calcium Phosphates↗

Ecology of insect host-parasitoid communities.

Although conclusive evidence is lacking for its establishment, the thesis that complexity adds stability to communities is probably accepted by the majority of ecologists. I believe this attitude found its origins in the indisputable fact that there are latitudinal and altitudinal changes in community complexity. As one progresses northward or southward from the equator, or higher in altitude in most parts of the world, one cannot help but notice that communities tend to become simpler, that is, there are fewer species per community. At the same time, these communities appear to become less stable. But perhaps this change in stability is in appearance only; they appear to be less stable because of the relatively greater number of individuals comprising each species population in temperate areas. Each population, because of its greater numbers, is therefore conspicuous, and changes in these numbers are noticed. We are particularly aware of such changes because populations in these areas of the world have been comparatively well studied. Many of the most studied populations include species of economic importance where changes in population numbers are vital to agricultural or forestry practices. Equatorial populations, on the other hand, contain smaller numbers of individuals of each species because of the greater number of species present. Number changes are simply not as noticeable because the population itself is not as obvious among the other populations. It may be that when (if ever) we have as much data on equatorial populations as we have on those of temperate climates, we will find fluctuations of equal relative magnitude (but not of equal numbers, of course). If, on the other hand, we really do find a correlation between complexity and stability, the suggestion by May (12) that stability permits complexity may be well worth investigating. Because of its organization and physical setting, the Rhopalomyia community I have studied might be expected to have considerable stability. In fact, however, it does not. Each of the populations in the community fluctuates greatly and irregularly in both percentages and numbers, and these populations apparently become locally extinct occasionally, because they sometimes cannot be found even in extensive collections. After studying several of the more important parasitoid species, it is evident to me that there is little or nothing about their interactions that might induce greater community stability. Each species seems to have evolved into the community with no higher purpose than simply to usurp what it can from some other member, and it does this by concentrating its energies on better competitive mechanisms rather than higher reproductive capacities. There are never empty niches to be filled by organisms having the "correct specifications" because new niches are created out of parts of older, broader niches which were occupied by other, more r-selected organisms. Thus, perhaps we have read too much into community organization. Perhaps the "ifiling of niches" is essentially nothing more than the haphazard result of competitive jostling among species; and that as communities develop, they are not necessarily programmed for such things as greater stability or better energy utilizationthe species merely become more closely packed.

Animals↗

Direct Comparison of Phosphate Uptake by Adnate and Loosely Attached Microalgae within an Intact Biofilm Matrix.

We report a direct comparison of phosphate uptake by adnate and loosely attached microalgae in an intact biofilm matrix, with resolution at the level of individual cells. Track scanning electron microscope autoradiography enabled assay of [P]phosphate uptake from the overlying water by adnate algae left undisturbed on mature leaves of the macrophyte Potamogeton illinoensis or on artificial plant mimics. The epiphyte communities developed in either phosphate-poor or moderately phosphate-enriched water, and they were assayed on both natural and artificial plants. All adnate taxa examined from both natural and artificial plants in both habitats took up significantly less radiolabel when assayed beneath the overlying matrix than when they were exposed to the water upon removal of the overstory material. Track scanning electron microscope autoradiography and track light microscope autoradiography were intercalibrated to enable comparison of [P]phosphate uptake by adnate and loosely attached components of the epiphyte matrix. Loosely attached cells on substrata from both habitats took up significantly more radiolabel than did underlying adnate cells, indicating that access to phosphate supplies from the water depended on the position of microbial cells in the matrix. In this short-term assay, the adnate microalgae were relatively isolated from the water column nutrient source.

Journal Article↗

Physicochemical parameters for growth of the sea ice bacteria Glaciecola punicea ACAM 611(T) and Gelidibacter sp. strain IC158.

The water activity and pH ranges for growth of Glaciecola punicea (a psychrophile) were extended when this organism was grown at suboptimal rather than optimal temperatures. No such extension was observed for Gelidibacter sp. strain IC158 (a psychrotolerant bacterium) at analogous temperatures. Salinity and pH may be primary physicochemical parameters controlling bacterial community development in sea ice.

Antarctic Regions↗

Summer diarrhoea in African infants and children.

Of 70 black South African infants and children with acute summer diarrhoea, 30 (43%) were infected with enteropathogenic serogroups of Escherichia coli (EPEC), 13 (19%) with enterotoxigenic Gram-negative bacilli, 12 (17%) with Salmonella sp., 6 (9%) with Shigella sp., and 3 (4%) with rotaviruses. 13 (19%) patients were infected simultaneously with more than one enteropathogen, and no pathogen was detected in 22 (31%). In addition, 6 (15%) of 41 unselected patients were excreting Campylobacter fetus. Of 30 age-matched controls drawn from the same population, 5 (17%) were infected with EPEC serotypes, and 1 each with Salmonella sp. and rotavirus. This study stresses the polymicrobial nature of paediatric diarrhoea in a developing community and shows the continued importance of EPEC in this setting.

Campylobacter fetus↗

Traveller's diarrhoea with a vengeance in children of UK immigrants visiting their parental homeland.

Six healthy children, born in the UK, travelled to their parental homeland and developed a severe form of traveller's diarrhoea. This was characterised by rapid loss of weight and chronic diarrhoea. On return to this country, investigation in 5 of them showed an abnormal, small intestinal mucosa. There was a high incidence of pathogens and potential pathogens found in stools and duodenal juice. Immunodeficiency was found in 2 of them. Small intestinal mucosal damage related to gut infection in previously well children appears to be of cardinal importance in the interaction between chronic diarrhoea and malnutrition. This observation may point the way to future research into the primary role of gut infection in the initiation of the cycle of malnutrition and chronic diarrhoea in developing communities.

Body Weight↗

Consultant paediatric outreach clinics--a practical step in integration.

Ten years' experience of paediatric outreach clinics is reviewed and evaluated. The advantages and disadvantages of paediatric outreach and its possible place in the new era of contracting and more developed community paediatric services are discussed. It is concluded that paediatric outreach increases parental and professional choice and access to paediatric consultant services, increases service flexibility, reduces unnecessary hospital visits, and enables more rational and relevant clinical decision making. Outreach is particularly relevant in areas of deprivation where paediatric needs are greatest.

Child↗

Lead poisoning in Gurkha soldiers in Hong Kong.

Investigation of an outbreak of lead-poisoning in 121 Gurkha soldiers showed that this was due to the contamination of chilli powder (cayenne pepper), a constituent of curry powder, with lead chromate. Comprehensive systems of food sampling are needed in developing communities.

Anemia↗

Barriers to uptake of services for coronary heart disease: qualitative study.

OBJECTIVES: To identify factors within the South Yorkshire coalfields that influence use of health services by people with angina. DESIGN: Qualitative study using semistructured individual and group interviews. SETTING: General practice and community settings in Barnsley and Rotherham health authorities. PARTICIPANTS: 14 patients with stable angina and nine primary care staff had individual interviews plus five community groups and one group of general practitioners. MAIN OUTCOME MEASURES: Barriers to accessing health services. RESULTS: A complex web of factors was identified that prevented, delayed, or facilitated referral to secondary care. Delay, denial, and self management by patients meant that the full extent of symptoms often remained hidden from general practitioners, resulting in a delayed or missed referral. Barriers identified fell into six categories: structural, personal, social and cultural, past experience and expectations, diagnostic confusion, and knowledge and awareness. CONCLUSIONS: Many of the factors influencing referral operate before general practitioners become involved. Community development could be one way of tackling inequalities and promoting sustainable change. Structural changes are needed to improve access and increase the acceptability of general practice services. Primary care staff should be educated to detect underreporting of symptoms and promote appropriate referral.

Aged↗

Age-period-cohort analysis of cervical cancer incidence in Hong Kong from 1972 to 2001 using maximum likelihood and Bayesian methods.

OBJECTIVE: To examine the secular effects of opportunistic screening for cervical cancer in a rich, developed community where most other such populations have long adopted organised screening. DESIGN, SETTING, AND PARTICIPANTS: The analysis was based on 15 140 cases of invasive cervical cancer from 1972 to 2001. The effects of chronological age, time period, and birth cohort were decomposed using both maximum likelihood and Bayesian methods. RESULTS: The overall age adjusted incidence decreased from 24.9 in 1972-74 to 9.5 per 100,000 in 1999-2001, in a log-linear fashion, yielding an average annual reduction of 4.0% (p<0.001) during the 30 year period. There were two second order and thus identifiable changes: (1) around the mid-1920s cohort curve representing an age-period interaction masquerading as a cohort change that denotes the first availability of Pap testing during the 1960s concentrated among women in their 40s; (2) a hook around the calendar years 1982-83 when cervical cytology became a standard screening test for pregnant women. CONCLUSIONS: Hong Kong's cervical cancer rates have declined since Pap tests first became available in the 1960s, most probably because of increasing population coverage over time and in successive generations in a haphazard fashion and punctuated by the systematic introduction of routine cytology as part of antenatal care in the 1980s.

Adult↗

A comprehensive "Healthy Schools Programme" to promote school health: the Hong Kong experience in joining the efforts of health and education sectors.

Both health and education are linked to economic performance. The success of education depends on good health, and vice versa. Modern education should help young people to determine values, and accept responsibility for their health and social behaviour. The success of health promotion in schools requires the joint efforts of both the health and education sectors. A comprehensive programme is needed to include teachers' training, curriculum development, community participation, changing policies and practices, and research. All these components are needed to build up a successful model of a health promoting school. The "Healthy Schools Programme" in Hong Kong gives a good example of close partnership between the health and education sectors, and moves towards a multidisciplinary approach and active learning towards health promotion.

Adolescent↗

Severe acute respiratory syndrome: a challenge for public health practice in Hong Kong.

Severe acute respiratory syndrome (SARS) is now a global challenge affecting more than 8000 patients in different continents. The dictum of public health practice especially for infectious disease is "prevention better than cure". It is especially true for SARS as the treatment strategies remain diverse and experimental. Maintaining a healthy and hygienic environment can be one of the effective public health measures to combat infectious disease. The major challenge is that some of the most important public health measures are to be taken outside the health sector. The community also needs to be strengthened and equipped with the health skills to promote better health and hygiene. There is also the need to create a supportive environment conducive to health for long term sustainability. The WHO approach of promoting health through setting approach would be one possible solution to face the challenge. This paper will describe some of the public health initiatives in Hong Kong through "setting approach" and "community development model" in helping the society fight against SARS. With the emergence of SARS, this might be the time to globalise public health medicine as an important component of medical practice.

Disease Outbreaks↗

Fluoride and health: dental caries, osteoporosis, and cardiovascular disease.

Water fluoridation is the preferred method of caries prevention. It should be promoted wherever technically feasible, whereas fluoridation of other vehicles, such as salt, milk, and sugar, should be considered (18) where no reticulated water supplies exist, as in many developing communities where caries prevalence is increasing sharply (7). Fluoride treatment of osteoporosis results in tangible improvement, but its pharmacological basis is incompletely understood and therapeutic doses are not tolerated indefinitely or by all patients. Epidemiological studies are needed to examine further the possible benefits of optimal fluoridation in relation to the prevalence off osteoporosis and heart disease.

Adult↗

A biopsy study of gallstones in Nigerian igbos.

Within 6 years, approximately 7,500 surgical specimens were collected at a central laboratory serving the Igbos of Nigeria. Only 28 specimens were gallbladders. Gallstones were found in 5 females and 2 males. As in other developing communities in which the diet consists largely of traditional foods, pigment stones outnumbered cholesterol stones, the ratio being 6:1. The know complications were single instances of carcinoma and rupture of the gallbladder.

Adult↗

Pediatric cardiopulmonary resuscitation. A review of 130 cases.

Cardiopulmonary resuscitation (CPR) records of 130 pediatric patients with cardiac arrest were reviewed. Ninety-six resuscitations were performed on patients hospitalized on the Medical and Surgical units of the Children's Hospital of Philadelphia (HP) and 34 on Emergency Department patients (EDPs). In HP, initial survival was 90%. In 27% of HPs, airway and breathing techniques alone were life saving. A mean of 2.45 drugs per patient were used for HP. In EDP, initial survival was 56%. There had been advanced CPR during the prehospital transport phase for the EDPs. All but two EDPs required drug management. The mean was 4.25 drugs per patient. Lidocaine and direct current defibrillation were used only rarely. Glucose was used frequently (33%) and should be considered in the list of essential resuscitation drugs. The necessity for resuscitation was most commonly associated with pulmonary diseases. These findings reflect differences between pediatric CPR and adult CPR, and suggest limitations in applying adult standards to infants and children. It is suggested that the medical community develop separate pediatric CPR courses as independent modules for those who assume responsibility for resuscitating children.

Adolescent↗

Admission to general hospital psychiatric wards in Italy. 1. A comparison between two catchment areas with differing provision of outpatient care.

Epidemiological comparisons carried out in Italian settings regarded very different areas. In this paper, we investigate the effects on the hospital activity of two different organizational models of care in two neighbouring areas in Northern Italy, Cremona and Mantua, very similar in sociodemographic features. Cremona is hospital oriented, while Mantua has well developed community services. All the patients of the catchment areas admitted during 1986 were studied. Age distribution for males, marital status, education and percentage of employed were very similar in the two samples. However, age distribution and mean age at the time of the first ever psychiatric admission for females were different, as well as the percentage of patients living alone and the percentage of patients discharged home. But the cogent finding was the number of admissions, much higher in Cremona than in Mantua, especially for some age groups. Some explanations of this strong difference, regarding two neighbouring and similar areas, are discussed.

Adolescent↗

An integrated approach to health care financing--the case of Chogoria Hospital.

A response to the increasing financial crisis for African hospitals is presented. The first measure is careful health care system design. Cost to the community can be reduced by cost-containment, income generation, and seeking of donations. Community ability to pay can be boosted by community financial development and community insurance. The final measure is continual appropriate level setting.

Budgets↗