Human African trypanosomiasis: an emerging public health crisis

There is a dramatic resurgence of human African trypanosomiasis (HAT) in sub-Saharan Africa. T.b. gambiense is spreading epidemically in large areas of Central Africa, especially the Southern Sudan, Congo-Zaire, Angola, Uganda and the Central African Republic. Devastating epidemics of T.b. rhodesiense have occurred in south-eastern Uganda. The causes of the re-emergence of sleeping sickness as a public health problem include widespread civil disturbance and war, declining economies, reduced health financing and the dismantling of disease control programmes. Despite the inevitably fatal outcome without treatment, HAT is often given low priority by donors and national governments. The advances made in diagnosis, treatment and vector control have not been sufficiently implemented. To limit the human impact in some of the poorest communities in Africa, endemic countries will require external support to implement strategies for disease control. Donor agencies, NGOs and mission organisations could play an important role in supporting control efforts. National authorities will need to control and co-ordinate these efforts with assistance from WHO and the international community.     

Leptospirosis in an urban setting: case report and review of an emerging infectious disease

Leptospiosis is a common zoonosis affecting most mammals. Leptospirosis has protean manifestations ranging from a flu-like illness to fulminant hepatic and renal failure culminating in death. Although the diagnosis is often not considered upon presentation, the literature suggests that leptospirosis is a reemerging infectious disease in urban centers throughout the industrialized world. It will be incumbent upon Emergency Physicians to include this spirochetal disease in the differential diagnosis of febrile patients with appropriate risk factors and symptomatology. We present the case of a 36 year-old woman who presented to the Emergency Department with fever and hypotension. We review the literature on leptospirosis with specific focus on risk factors and pathogenesis, clinical manifestations, diagnosis, treatment, and outcome.     

Decentralization in the New York City Department of Health: reorganization of a public health agency

Since the World War I era there has existed within the New York City Department of Health a basic internal struggle between staff directing the bureaus at the central office and the district health officers operating field health centers throughout the city. Recently, in a five-year period, there was a dramatic reorganization of the Department which markedly affected its orientation and programs. In 1972 a new Commissioner initiated a reorganization of the Department which succeeded in decentralizing field operations in contrast to earlier efforts which had failed to reach this objective. The roles of bureaus and districts were redefined, with the latter receiving budgetary authority, authority to supervise personnel, assignment of health managers, and the implementation of a district cost accounting system. While operational decentralization has occurred, policy setting and resource allocation in response to local needs remain central functions.     

Overweight schoolchildren in New York State: prevalence and characteristics

OBJECTIVES: Childhood overweight is an increasing public health concern. This study was undertaken to determine the prevalence of overweight in elementary school children in New York State and to identify characteristics associated with child fatness. METHODS: Weight, height, triceps skinfold, midarm circumference, and a 24-hour dietary recall were taken on 1797 second- and fifth-grade students from 51 randomly selected schools in New York State outside of New York City. Parents completed a brief questionnaire. RESULTS: In comparison with 1974 and 1980 national reference data, up to twice the expected percentages of children had values above the 85th, 90th, and 95th percentiles for body mass index, triceps skinfold, and arm fat area. Regression analyses suggested that children who tended to be fatter were members of low socioeconomic status, two-parent (but not single-parent) households; those with few or no siblings; those who ate school lunch; and those who skipped breakfast. CONCLUSIONS: The findings suggest that overweight is a problem among many elementary school children in New York State and that sociodemographic characteristics may be useful for targeting preventive efforts.     

Tuberculosis in the newborn: an emerging disease

During the last three years 172 diagnostic laparoscopies (DL) were performed at our department in patients with an acute abdomen of unclear causes. This corresponds to 17% of all patients who underwent operation due to an acute abdomen in the same period. Always the indication for a diagnostic laparoscopy arose then, when the cause or the localization of the acute abdomen could not be found by conventional diagnostic methods. The advantages of DL were either the confirmation (93%) or the exclusion (7%) of the diagnosis "acute abdomen", the exact localization and simultaneously a definitive operative treatment of the cause by minimal invasive interventions (n = 109/65%). In these patients with acute abdomen the main causes were acute inflammations of gallbladder (n = 48) and appendix (n = 29), ulcus perforations (n = 9) and ileus (n = 9). The conversion rate amounted to 2.7%, the postoperative complication rate to 11% and the lethality rate to 1.8% in these patients. A new indication is the so-called "bedside laparoscopy" as means to control the postoperative course of mesenteric embolism (n = 9) and diffuse peritonitis (n = 3) in order to avoid the stress of a second-look operation for these seriously ill patients or to secure the indication for relaparotomy.     

Prenatal care utilization in New York City: comparison of measures and assessment of their significance for urban health

Short-term exposure to the air pollutant ozone results in severe injury to the nares, trachea, and centriacinus. Long-term exposure however, leads to a state of tolerance that is characterized by remodeling in the centriacinar airways and markedly reduced cell necrosis and inflammation. This remodeling consists of hypertrophy and hyperplasia of Clara cells with a 2- to 5-fold increase in the intracellular content of the major protein synthesized by the Clara cell, Clara cell secretory protein (CCSP). Previous in vitro studies suggest that CCSP may moderate inflammation and bind reactive cytotoxicants. This study tested whether acute and chronic exposure to ozone alters the normal level of expression of the CCSP gene. Rats were exposed to ozone, 1 ppm 8 h nightly, for up to 90 days. Immunohistochemistry demonstrated repopulation of the alveolar ducts with CCSP positive Clara cells and an increase in the intensity of immunoreactive CCSP within Clara cells. The results showed that (1) CCSP mRNA expression, GAPDH, and beta-actin do not change as a result of ozone injury, (2) mRNA levels are more variable as a result of ozone injury and (3) CCSP mRNA expression increases with age.     

Urinary infection and pregnancy: a public health problem?

A clinical case of carditis associated with Mycoplasma pneumoniae infection in a 65 year-old woman is reported in order to stress some clinical features and therapeutic problems; during a 5-year follow-up. On the basis of this experience it is possible to state that in the pathogenesis an autoimmune mechanism probably plays an important role, whereas in therapy specific antibiotics are not effective and a long-term treatment with anti-inflammatory drugs is necessary.     

Human papillomavirus as an etiological factor in cervical cancer: significance for health care practice

The migration of substances from rubber packaging materials into drug products can be significant with certain packaging materials in contact with organic solvent systems. Recommendations for testing drug products for leachables are continually evolving to address new developments. Testing packaging materials using simulated solvents is not always an acceptable protocol for the pharmaceutical industry. We describe a rational strategy for evaluation of the drug product for packaging extractables. A profile of the extractables from rubber packaging materials was made with a range of organic solvents and stress conditions to provide information on substances to target in the drug product. The drug product was evaluated to determine if the matrix would cause interferences that might inhibit detection of the found extractables. Analytical methods were selected based on these findings. The procedures were validated according to FDA guidelines. A stability program using time and storage conditions as variables provided information for acceptance criteria. This same strategy can be used on other types of pharmaceuticals and packaging materials.     

New York State: A case study in organizing psychology.

An analysis of efforts to organize the directors of psychology at the medical schools in New York State provides an interesting case study of the evolution of psychology's standing in medical school settings. Factors that facilitated this process, and organizational and professional dynamics that impeded it, are discussed. Timidity and lethargy are viewed as major factors that must be overcome in the ongoing efforts to build on what has been accomplished. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The association between previous 305-day milk yield and disease in New York State dairy cows

Logistic regression was used to examine the association between milk yield and disease. We studied 8070 cows of second or higher parity from 25 New York State Holstein herds, calving between June 1990 and November 1993. Previous 305-d mature equivalent milk yield was used because most of the disorders studied occurred too early in lactation for current milk yield to be considered. Seven disorders were studied: retained placenta, metritis, ovarian cyst, milk fever, ketosis, abomasal displacement, and mastitis. A separate model was used for each disorder. Each model included, in additional to milk yield, parity, calving season, and heard. Results showed that higher milk yield was not a risk factor for any disease except mastitis. However, the association between higher previous milk yield and mastitis does not necessarily imply causation.     

Dermatophilus dermatitis enzootic in deer in New York State and vicinity

Bis-(4-methyl-1-homopiperazinylthiocarbonyl)-disulphide (FLA-63) inhibits in vitro purified bovine adrenal medullary dopamine beta-hydroxylase (BDH) concentration-dependently; 50% inhibition is produced by 2 x 10(-6)M FLA-63. Spectrophotometric experiments show that FLA-63 is reduced by ascorbate very likely to the corresponding dithiocarbamate-derivative, which acts as a Cu++-chelator. Cu++-ions are able to completely abolish the inhibition of the DBH caused by FLA-63 in concentrations up to 2.5 x 10(-6)M. It is concluded that FLA-63 inhibits the DBH mainly in its reduced form via the formation of a chelate-complex with copper ions derived from the DBH.     

Supracervical and total abdominal hysterectomy trends in New York State: 1990-1996

To describe practice trends for total abdominal hysterectomy (TAH) and supracervical abdominal hysterectomy (SCH) in New York State and to identify fiscal features associated with these two operations, all inpatient discharges for TAH and SCH performed for benign indications from 1990 to 1996 were reviewed using the Statewide Planning and Resource Cooperative System, a centralized data reporting system. For each year examined, the number of TAHs and SCHs performed, the procedure rates adjusted for the total New York State female population, and the per diem charge (calculated from mean institutional charge as a function of average length of stay) were evaluated. While the TAH rate declined in New York State, from 34.0 in 1990 to 28.4 in 1996 (P = .01), the SCH rate increased nearly five-fold during the same period, from 0.62 to 3.07 (P = .0003). Patients tended to be discharged later following SCH than for TAH, although by 1996, the LOS for both operations was equivalent. The per diem institutional charge for SCH was consistently higher than for TAH in each year studied. The changes in charge and relative frequency of TAH and SCH in New York State invite further study to describe these trends more fully.     

Catastrophe and public health: reasons for an impasse]

ANOTHER PUBLIC HEALTH CRISIS: Coming into public view after the AIDS transfusion and the mad cow crises, asbestos-related health risks have provoked an atmosphere of panic incompatible with calmly planned public health prevention programs. The avalanche of passionate reactions has led to an inextricable dead-end situation. SCAPEGOATS: Faultfinders have accused a long list of scapegoats--scientists, physicians, experts, public health officials, industrial leaders and the media--but court actions do not favor rigorous analysis of health safety dispositions. What is needed is a pondered examination of the sinister chain of events which has made such a wasteful situation possible. MEETING PUBLIC DEMANDS: Prohibiting asbestos cannot solve the problem once and for all. Asbestos removal programs must be conducted in terms of a solid risk/benefit analysis and more generally, management of environment-related health risks must be based on specific and credible measures. Without a real rehabilitation of environmental medicine, there is a genuine risk of seeing crisis situations override public health decision making.