Epidemiology and prevention of group A streptococcal infections: acute respiratory tract infections, skin infections, and their sequelae at the close of the twentieth century.
Infections of the upper respiratory tract and skin due to group A Streptococcus are common, and the organism is highly transmissible. In industrialized countries and to some extent in developing countries, control efforts continue to emphasize that group A streptococcal pharyngitis should be properly diagnosed and appropriately treated. In developing countries and in indigenous populations where the burden of group A streptococcal diseases appears greatest, the epidemiology is less completely defined and may differ from that in industrialized countries. There is a need for accurately collected epidemiological data from developing countries, which may also further clarify the pathogenesis of group A streptococcal infections and their sequelae. While proper treatment of group A streptococcal pharyngitis continues to be essential in all populations, it may be appropriate in developing countries to consider additional strategies to reduce rates of pyoderma. (+info)
Preventing the spread of antimicrobial resistance among bacterial respiratory pathogens in industrialized countries: the case for judicious antimicrobial use.
The spread of antimicrobial resistance is an important emerging health threat in developed countries. Widespread outpatient antimicrobial use leads to the spread of resistance among community-acquired pathogens such as Streptococcus pneumoniae. The Centers for Disease Control and Prevention and partner organizations have initiated a national campaign promoting more judicious antimicrobial use to decrease the spread of resistance. The initial focus is to improve management of respiratory tract infections, which account for most outpatient antimicrobial use. Survey and focus group results indicate that patient pressure and suboptimal diagnosis and treatment contribute to antibiotic overuse. To educate physicians, a series of "principles of judicious antibiotic use" have been developed that identify optimal approaches to management of common respiratory infections. Patient education materials and strategies to improve doctor-patient communication also have been developed. Several studies currently under way will evaluate the impact of intervention on antibiotic use practices and resistant carriage or infection. (+info)
International trends in rates of hypospadias and cryptorchidism.
Researchers from seven European nations and the United States have published reports of increasing rates of hypospadias during the 1960s, 1970s, and 1980s. Reports of increasing rates of cryptorchidism have come primarily from England. In recent years, these reports have become one focus of the debate over endocrine disruption. This study examines more recent data from a larger number of countries participating in the International Clearinghouse for Birth Defects Monitoring Systems (ICBDMS) to address the questions of whether such increases are worldwide and continuing and whether there are geographic patterns to any observed increases. The ICBDMS headquarters and individual systems provided the data. Systems were categorized into five groups based on gross domestic product in 1984. Hypospadias increases were most marked in two American systems and in Scandinavia and Japan. The increases leveled off in many systems after 1985. Increases were not seen in less affluent nations. Cryptorchidism rates were available for 10 systems. Clear increases in this anomaly were seen in two U.S. systems and in the South American system, but not elsewhere. Since 1985, rates declined in most systems. Numerous artifacts may contribute to or cause upward trends in hypospadias. Possible "real" causes include demographic changes and endocrine disruption, among others. (+info)
Epidemiology of Chlamydia pneumoniae infection in a randomly selected population in a developed country.
This cross-sectional study of 400 sera from a randomly selected adult population in Northern Ireland, using a microimmunofluorescence assay, demonstrated high overall seropositivity (70%) for IgG Chlamydia pneumoniae antibodies in developed populations. Seropositivity was shown to be unrelated to gender, age or smoking but there was an inverse trend between infection and educational level achieved as a measure of socio-economic status. IgG levels were also higher during the winter months suggesting seasonal variation of Chlamydia pneumoniae infection. The high prevalence of evidence of exposure to Chlamydia pneumoniae as described in this study may have implications for prevention of cardiovascular disease if further evidence conclusively determines that infection with this organism is a risk factor for cardiovascular disease. (+info)
Using perinatal audit to promote change: a review.
Close to half of all infant deaths world-wide now occur in the first week of life, almost all in developing countries, and the perinatal mortality rate (PNMR) is used as an indicator of the quality of health service delivery. Clinical audit aims to improve quality of care through the systematic assessment of practice against a defined standard, with a view to recommending and implementing measures to address specific deficiencies in care. Perinatal outcome audit evaluates crude or cause-specific PNMRs, reviewing secular trends over several years or comparing rates between similar institutions. However, the PNMR may not be a valid, reliable and sensitive indicator of quality of care at the institutional level in developing countries because of variations in the presenting case-mix, various confounding non-health service factors and the small number of deaths which occur. Process audit compares actual practice with standard (best) practice, based on the evidence of research or expert consensus. Databases reviewing the management of reproductive health problems in developing countries are currently being prepared so as to provide clinicians and health service managers with up-to-date information to support the provision of evidence-based care. Standard practice should be adapted and defined in explicit management guidelines, taking into account local resources and circumstances. Forms of process audit include the review of care procedures in cases which have resulted in a pre-defined adverse outcome, know as 'sentinel event audit'; and the review of all cases where a particular care activity was received or indicated, known as 'topic audit'. These are complementary and each depends on the quality of recorded data. The forum for comparing observed practice with the standard may be external, utilising an 'expert committee', or internal, in which care providers audit their own activities. Local internal audit is more likely to result in improvements in care if it is conducted in a structured and culturally sensitive way, and if all levels of staff are involved in reviewing activities and in formulating recommendations. However, further research is needed to identify the factors which determine the effectiveness and sustainability of perinatal audit in different developing country settings. (+info)
Environment, development and health: ideological metaphors of post-traditional societies?
Environment and health have become nearly interchangeable concepts in post-traditional societies. We are able to observe almost an obsession with them, as if individual changes in ways of life--important for the individual and significant for the culture though they may be--possessed the power to overthrow a system of economic relations that aims at growth in numerical terms rather than at development, enabling society to sustain its specific modes of private and public interaction. (+info)
Complications of varicella in a defined central European population.
AIMS: To describe complications of varicella requiring hospitalisation in a defined population (canton of Bern) and to compare the hospitalisation rates for varicella with published data. METHODS: Retrospective analysis of hospital records of patients less than 16 years of age admitted with complications of varicella to the hospitals serving this population (University Children's Hospital of Bern and the Wildermeth Children's Hospital of Biel, Switzerland), and calculation of hospitalisation rates for varicella and its complications based on birth rates and varicella antibody prevalence rates. RESULTS: From 1986 to 1996, 113 cases (median age, 5.6 years) were identified. Younger siblings were overrepresented (odds ratio (OR), 1.42; 95% confidence interval (CI), 1.09 to 1.84). Central nervous system (CNS) complications (26 patients; 23%) were found predominantly in previously healthy children (relative risk, 7.1; 95% CI, 1.01 to 49.86). Group A beta haemolytic streptococci were recovered from only one of 35 patients with bacterial complications. The hospitalisation rates for primary varicella (9.2/10(4) cases; 95% CI, 7.4 to 11/10(4), skin infections (2.0/10(4) cases; 95% CI, 1.2 to 2.9/10(4), and pneumonia (0.8/10(4) cases; 95% CI, 0.3 to 1.3/10(4)) were significantly lower than reported previously. The CNS complication rate (2.2/10(4) cases; 95% CI, 1.3 to 3.1/10(4) was among the highest rates reported. CONCLUSIONS: The low hospitalisation rate in comparison with studies from elsewhere indicates that there is a large regional variability in complications associated with varicella. Such data should be taken into consideration when local varicella immunisation strategies are developed. (+info)
Biotechnology: enhancing human nutrition in developing and developed worlds.
While the last 50 years of agriculture have focused on meeting the food, feed, and fiber needs of humans, the challenges for the next 50 years go far beyond simply addressing the needs of an ever-growing global population. In addition to producing more food, agriculture will have to deal with declining resources like water and arable land, need to enhance nutrient density of crops, and achieve these and other goals in a way that does not degrade the environment. Biotechnology and other emerging life sciences technologies offer valuable tools to help meet these multidimensional challenges. This paper explores the possibilities afforded through biotechnology in providing improved agronomic "input" traits, differentiated crops that impart more desirable "output" traits, and using plants as green factories to fortify foods with valuable nutrients naturally rather than externally during food processing. The concept of leveraging agriculture as green factories is expected to have tremendous positive implications for harnessing solar energy to meet fiber and fuel needs as well. Widespread adaptation of biotech-derived products of agriculture should lay the foundation for transformation of our society from a production-driven system to a quality and utility-enhanced system. (+info)