Seroepidemiology of Toxoplasma gondii infection among Atayal aborigines and local animals in Nan-ao district, Ilan county and Jen-ai district, Nan-tou county, Taiwan

In this study, latex agglutination test (LAT) was used to detect sera anti-toxoplasma antibodies of Atayal aborigines and local animals in Nan-ao district, Ilan county and Jen-ai district, Nan-tou county as a measure of exposure to the Toxoplasma gondii. Out of 422 Atayal aborigines and 64 different animals were tested in Nan-ao district and 82 Atayal children in Jen-ai district were also screened, the positive rates for sera anti-toxoplasma antibodies were 21.8%, 17.2% and 15.9%, respectively. In Nan-ao district, neither were the positive rates significantly different in males (22.1%) and females (21.4%), nor in humans (21.8%) and dogs (19.6%) (P > 0.05). The seroprevalence in adults (28.3%) was significantly higher than that in children (18.7%) (P < 0.05), and the highest seropositive rate (38.1%) was in the age group 50-59 years and the lowest (7.7%) was in the age group 1-9 years. In general, the age pattern of prevalence is consistent with increasing duration of exposure to Toxoplasma gondii with age. For animals, the seropositive rate in dogs (19.6%) was also significantly higher than that in wild rats (7.7%) (P < 0.05). No significant difference in seropositive rate of Atayal children was observed between Nan-ao and Jen-ai districts (P > 0.05).     

Hypertension in Haitians: results of a pilot survey of a public teaching hospital multispecialty clinic

Little is known about hypertension in Haitians. We performed a pilot survey of ambulatory Haitian patients in a multispecialty clinic at a large public teaching hospital. Approximately 10% of the clinic population was of Haitian origin. Clinical data were collected on 88 consecutive Haitian patients. Of these 88, 77 (87.5%) were hypertensive (SBP > or = 140 or DBP > or = 90 mm Hg or taking antihypertensive medication). The characteristics of the hypertensive patients were: age 54.1 +/- 13.0 (s.d.) years; 27 men, 50 women; 12/64 (19%) smoked; 7/63 (11%) used alcohol. Diabetes was present in 21/77 (27%). In patients for whom height and weight were available, obesity was present in 52%. Using JNC V criteria, 18 (23%) had Stage 1, 16 (21%) Stage 2, 18 (23%) Stage 3, and 25 (33%) Stage 4 hypertension. Despite 63/77 (82%) being treated for hypertension, only 20 (26%) were controlled (< 140/< 90 mm Hg). Of those under treatment, 29 were taking one drug; 18 (two drugs); 12 (three drugs); and four (four drugs). Target organ damage was evident in 37 (48%), including coronary artery disease (8), CHF (6), chronic renal failure (15), stroke (9), and LVH by ECG (19). There was evidence of severe noncompliance in 32 (42%). We conclude that in this clinic sample, hypertension was highly prevalent and unusually severe in terms of blood pressure (BP) level, refractoriness to treatment, and target organ consequences. Further studies are indicated.     

Hypertension in the elderly

Residents living near a polyurethane foam manufacturing facility expressed concern to health officials over chemical emissions from the plant. Environmental monitoring of ambient air near the plant indicated the presence of toluene diisocyanate (TDI), which was used in foam production. Health officials collected blood samples from 113 residents and analyzed the blood sera for antibodies to TDI and related diisocyanates. Ten of the 113 residents (9%) had elevated levels of IgG or IgE antibodies specific for one or more diisocyanates. Exposure histories were taken from antibody-positive individuals to identify possible occupational exposure to TDI or the use of diisocyanate-containing consumer products. Exposure to TDI in ambient air may be responsible for the positive antibody responses detected in some residents of the community.     

Psychotherapy in the day clinic

Recently, the importance of psychiatric day hospital treatment is increasing in German psychiatry, as the regionalization and community-orientation of care advance and catchment areas become smaller. When a psychiatric department of a local general hospital is within easy reach of the patient's residence, the means for intensive treatment, as is available in a hospital, can be utilized during the day, while the patient spends a considerable amount of time (in fact, two thirds) in the familiar surroundings of his/her own home. This is applicable for many psychiatric conditions, including neuroses, personality disorders and psychosomatic diseases. As compared to conventional individual outpatient psychotherapy on the one hand and a distinct limited stay in a psychosomatic sanatorium far from home on the other hand, psychotherapy in a day hospital offers a promising additional way to provide effective and lasting professional help early and with a low threshold. The article summarizes the experience gained in a newly founded department of psychiatry and psychotherapy at a general hospital in one district of eastern Germany, where the staff is struggling to meet the needs of the catchment area in spite of a too small number of hospital beds.     

Hypertension in the elderly

Elevated blood pressure, especially isolated systolic hypertension, is increasingly frequent with advancing age, affecting 1/4 of all 80-year-olds. Systolic hypertension is associated with increased cardiovascular morbidity and mortality. Recent studies have clearly demonstrated that antihypertensive treatment in the elderly decreases cardiovascular morbidity and mortality (in absolute numbers several times more than in younger patients), without more frequent side effects or a decrease in quality of life. Hypertension in the elderly thus deserves proper attention and should be taken seriously.     

HIV antibody testing in the antenatal clinic

It is "standard" to analyze data from a clinical trial using a narrowly defined probabilistic mathematical model. This paper examines the ways in which mathematical models, in general, can be used in clinical research, the meaning of probability in the examination of clinical trials, and the philosophical flaws in the current "standard" method. An alternative formulation is proposed which is more flexible and which comes closer to meeting the needs of medical science. In this alternative formulation, significance tests are applied to the data from a study only as a first step to determine whether the data are worth further examination. After that, clinically relevant questions are answered with 50 and 95% confidence bounds. The initial significance test is tailored to be directed at a narrow class of hypotheses that, in turn, are dictated by clinical expectations.     

Urodynamic studies in the district general hospital

The information given by urodynamic investigations has been of practical value in clinical practice and we feel that the time and money spent has been worthwhile. The results are particularly useful in patients with neuropathic bladders, women and stress incontinence in whom detrusor instability is also suspected, young men with "obstructive" symptoms and in men with post-prostatectomy problems. Its value in te large group of women with frequency, urgency and nocturia is debatable given our present lack of satisfactory treatment for these patients.     

Hypertension and the obstetrician-gynecologist

Hypertension is a major risk factor for cardiovascular-related morbidity and death. Antihypertensive therapy markedly reduces the risk caused by elevated blood pressure. Earlier treatment of hypertensive patients should reduce deaths and morbidity even further. The obstetrician-gynecologist has the opportunity and responsibility to identify hypertensive patients early in the course of their disease. He must also confront the problem of elevated blood pressure associated with the use of oral contraceptives. In addition to its impact on the general population, chronic hypertension presents special problems during pregnancy. Pregnant women with elevated blood pressure have an increased fetal mortality rate and develop pre-eclampsia more frequently and earlier than nonhypertensive women. Antihypertensive treatment possibly increases fetal survival; when used appropriately, it definitely does not decrease fetal salvage. The appropriate use of antihypertensive therapy during pregnancy requires an understanding of the mechanism of action of these agents and recognition of side effects, especially those important during pregnancy.