RESUMEN
In 1998, an outbreak of Campylobacter jejuni infections occurred in Kansas among persons attending a school luncheon; community cases were also reported. In a cohort study of luncheon attendees, 27 (17%) of 161 persons reported illness. Consuming gravy (relative risk [RR], 4.2; 95% confidence interval [CI], 1.5-11.7) or pineapple (RR, 2.4; 95% CI, 1.0-5.7) was associated with illness. Both foods were prepared in a kitchen that served 6 other schools where no illness was reported. A cafeteria worker at the luncheon had a diarrheal illness and was the likely source of the outbreak. The pulsed-field gel electrophoresis (PFGE) patterns of the isolates from the food handler and those of 8 lunch attendees were indistinguishable. Isolates from 4 community patients differed. This was the first use of PFGE in a Campylobacter outbreak in the United States; its use was critical in determining that community cases were not linked.
Asunto(s)
Infecciones por Campylobacter/microbiología , Campylobacter jejuni/genética , Diarrea/microbiología , Brotes de Enfermedades , Electroforesis en Gel de Campo Pulsado , Contaminación de Alimentos , Manipulación de Alimentos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Campylobacter/epidemiología , Niño , Preescolar , Estudios de Cohortes , ADN Bacteriano/análisis , Diarrea/epidemiología , Heces/microbiología , Femenino , Humanos , Lactante , Kansas/epidemiología , Masculino , Persona de Mediana Edad , Epidemiología MolecularRESUMEN
Local and state public health officials are called on to respond to environmental public health hazards just as they historically have been called on to respond to communicable disease outbreaks. Recent experience with metallic mercury spills in Kansas suggests that neither the legal authority nor the scientific knowledgebase is as well developed for response to environmental hazards as for communicable disease threats.
Asunto(s)
Exposición a Riesgos Ambientales/análisis , Sustancias Peligrosas , Intoxicación por Mercurio/prevención & control , Mercurio , Adulto , Niño , Femenino , Humanos , Lactante , Kansas , Mercurio/sangre , Práctica de Salud PúblicaRESUMEN
BACKGROUND: Radical prostatectomy (removal of the prostate gland and seminal vesicles) is usually considered a definitive treatment for localized prostate cancer. Although a sharp increase and wide geographic variation in radical prostatectomy rates have been recently documented, the reasons for this increase and the factors that make men diagnosed with the disease more likely to be treated surgically are not well known. PURPOSE: Our purpose was to examine trends in the use of surgical treatment for prostate cancer, as well as the factors associated with the choice of surgical treatment and how these factors changed in Wisconsin in the period 1989 through 1991. METHODS: We carried out a population-based cohort study. A cohort of Wisconsin men diagnosed from 1989 through 1991 with prostate cancer was identified through the Wisconsin cancer reporting system. To determine which men diagnosed with prostate cancer were treated with surgery, we linked prostate cancer records to the Wisconsin hospital discharge database. The outcome measured was radical prostatectomy within 6 months from the date of the diagnosis of prostate cancer. RESULTS: The yearly number of prostate cancer cases reported from 1989 through 1991 rose 33%, from 2468 to 3278. During the same period, the yearly number of radical prostatectomies rose 226%, from 283 to 922. Patients diagnosed in 1991 were twice as likely to have surgery as those diagnosed in 1989, the proportion of cases receiving surgical treatment rising from 12% to 25%. Patients who were white, less than 65 years of age, had a cancer reported to be at regional stage, and who were first reported by large hospitals were more likely to be treated surgically. CONCLUSIONS: The use of surgery to treat prostate cancer has increased dramatically in Wisconsin, doubling in a 3-year period, despite the fact that studies have not shown surgery to be more effective than other options for many patients. The increase observed in the rate of surgery was about the same across age, race, stage at diagnosis, and hospital size. The reasons for this increase are probably multifactorial. IMPLICATIONS: Risks, costs, and benefits of surgical treatment should be carefully compared with those of alternative management approaches. Patients should be enabled to make an informed decision, based on the current best evidence, on the treatment option they prefer.
Asunto(s)
Prostatectomía/tendencias , Neoplasias de la Próstata/cirugía , Anciano , Análisis de Varianza , Estudios de Cohortes , Humanos , Modelos Logísticos , Masculino , Registros Médicos , Persona de Mediana Edad , WisconsinAsunto(s)
Dieta Reductora/estadística & datos numéricos , Obesidad/epidemiología , Pérdida de Peso , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/dietoterapia , Vigilancia de la Población , Factores de Riesgo , Wisconsin/epidemiologíaRESUMEN
A study in Ethiopia's Wollo region showed that the drug budget was reasonable but that the procurement and utilization of supplies left much to be desired. Ways of rationalizing drug management are suggested in the light of the observations made.
Asunto(s)
Costos de los Medicamentos , Sistemas de Medicación/organización & administración , Preparaciones Farmacéuticas/administración & dosificación , Utilización de Medicamentos , Etiopía , Gastos en Salud , HumanosRESUMEN
In 1983 the authors carried out a survey in the Democratic Republic of São Tomé and Principe, analysing 1050 specimens of stools collected among the population from apparently healthy subjects chosen at random and in a number proportional to the distribution of the population in the regions of the country (about 1% of the population was examined). The examined subjects were divided into 3 age groups (0-3, 4-12, more than 12 years old), to have homogeneous groups in relation principally to modalities of life and nutritional patterns. There were 488 male subjects and 562 females. The survey was preceded by a sensitization of the people to the problem of intestinal parasites and by two preliminary surveys about the number of existing latrines and about people's believes and attitudes in relation to helmintiasis. The tests were made according to the modified Ritchie technique on fecal specimens preserved with 10% formol solution. The following results were found: a) Protozoa: Entamoeba coli, 43.0%; Iodamoeba buetschlii, 9.0%; Giardia intestinalis, 8.8%; Endolimax nana, 7.0%; E. histolytica, 5.5%; E. hartmanni, 2.5%; Chilomastix mesnili, 2.3%; Trichomonas intestinalis, 0.2%; Balantidium coli, 0.1%. b) Helminths: Trichuris trichiura, 87.7%; Ascaris lumbricoides, 64.3%; Ancylostomatidae, 40.5%; Strongyloides stercoralis, 6.8%; Hymenolepis diminuta, 0.3%; H. nana, 0.2%; Schistosoma haematobium, 0.2%. In 28.2% of the specimens (with more than 50% of subjects in some villages) eggs of Heterophyidae were found, very similar to Metagonimus yokogawai, but not yet identified by us, with the following characteristics: elliptical shape, average size 25 mu (22.2-27.7) X 18.5 mu (17-21), thick wall, operculum difficult to see, not sticking out from the outline but visible by focusing being in a different refractiveness, presence of a small polar knob, colour slightly brownish, asymmetric miracidium. Further investigations are necessary to identify the species of this trematode and to understand if it is a true human parasite or a pseudoparasite. The general results show the existence of a heavy fecal pollution all over the territory of the D.R. of São Tomé and Principe, connected with unhygienic life conditions, dangerous for health. This suggests to start urgently a sanitation program.