The prevalence of epilepsy follows the distribution of onchocerciasis in a west Ugandan focus

A study was made to determine whether skeletal alterations usually produced by rapid maxillary expansion may be compensated for in time by growth and/or comprehensive orthodontic treatment. In 30 patients, orthodontic treatment was started with rapid maxillary expansion, followed by fixed appliances, not combined with any other form of orthopedic device. Mean treatment time was 3.1 years. Nine measurements from the Ricketts analysis were studied, based on lateral cephalometric radiographs. Records were taken before orthodontic treatment and after completion of active therapy. A statistical analysis was made of the nine variables used, reflecting the vertical and anteroposterior skeletal proportions of the face, contrasting the changes before and after treatment. Of all the variables studied, the four that change with age according to the Ricketts analysis (mandibular plane angle, maxillary height, facial depth and facial convexity), yielded statistically significant differences after treatment, indicative of normal growth. The five remaining variables that remain constant with age according to the Ricketts analysis (facial axis, lower facial height, total facial height, palatal plane inclination and maxillary depth) showed no significant changes after treatment, also indicative of normal growth.     

Willingness to pay for community-based ivermectin distribution: a study of three onchocerciasis-endemic communities in Nigeria

OBJECTIVE: To determine the willingness to pay (WTP) for local ivermectin distribution in a community financing framework. METHOD: Contingent valuation in three communities in Nigeria, using randomly selected household heads. WTP was elicited using a bidding game, and for collecting information on the households' socio-economic status, level of knowledge, priority ranking and perception of risk of contracting the disease, structured questionnaires were used. Ordinary least squares (OLS) multiple regression analysis was used to analyse factors associated with WTP. RESULTS: Between 92.1% and 93.3 % of respondents were willing to pay amounts ranging from 5 Naira (US$ 0.06) to 100 Naira (US$ 1.25) (median: 20 Naira, US$ 0.25) in the three communities, more than three times the modelled unit direct cost of distributing ivermectin by the communities themselves. Occupation of the respondent, marital status, average monthly expenditure on health care, manifestations of onchocerciasis, the type of savings scheme embarked on by the respondent, age-group, level of education and type of property were statistically significant (P < 0.05) variables affecting WTP. CONCLUSION: This study shows that there is WTP for local ivermectin distribution in the three study communities, and that it should be assessed before instituting community-directed treatment with ivermectin.     

The head nodule and ocular onchocerciasis in Africa

In a population survey in 1970/72 the prevalence of head nodules was found to be 1.7% in 1098 cases of onchocerciasis in the rain-forest and 0.6% in 1128 cases in the Sudan-savanna of Cameroon. In a follow-up survey in the same villages 3-4 years later more attention was given to the detection of head nocules, and the corresponding prevalences were 5.5 and 5.0%. In the follow-up survey a strong associated was demonstrated between the presence of head nodules and lesions of both the anterior and posterior segments of the eye. The relative risks of having eye lesions in patients with head nodules compared with those without were 2.9 and 7.5 in the rain-forest and savanna respectively. In a group of 483 clinic cases with ocular onchocerciasis from the savanna palpable head nodules were detected in 23.6%, and in a further 140 selected cases from the same area with posterior segment eye lesions, head nodules were detected in 31.4%. Confirmation of the onchocercal origin of the nodules was obtained in doubtful cases by biopsy. Many head nodules probably remain undetected in onchocerciasis surveys. They are often very small, flat, and hard, and tightly adherent to the under-lying periosteum, and the patient will often point out the presence of a nodule even when none has been detected after careful examination. The presence of a head nodule has long been one of the recognized "risk factors" associated with a high prevalence of blindness in Central America, but there have been no detailed studied in African onchocerciasis. A trial is in progress to assess the effect of nodulectomy on the development of ocular lesions.     

Rapid assessment of prevalence of cataract blindness at district level

AIM: To find an optimal cluster size and number of clusters for a reasonable estimate of the prevalence of cataract blindness in people aged > or = 50 years in 19 rural districts of a state in India. MATERIALS: Cluster sampling methodology was used in 19 rural districts of Karnataka State, India. In each district, 15 clusters were randomly selected and 90 people aged > or = 50 years were examined in each cluster. As a result the visual acuity and lens status of a total of 22,218 people were assessed. METHODS: For each district, the design effect for cluster size ranging from 20 to 90 was calculated and the optimal cluster size and the required number of clusters to achieve an accuracy of 1% errors and 80% confidence was assessed. RESULTS: The age and gender adjusted prevalence of cataract blindness varied from 1.58% to 7.24%, which justifies district level surveys. The design effect is nearly 1.5 for clusters of sizes 30 and 40. With an average prevalence of 4.93% with 1% error and 80% confidence level, the optimal number of clusters is 37 and 28 for a cluster size of 30 and 40 respectively and the average sample size for a district around 1100. CONCLUSIONS: Rapid assessments for cataract blindness in those aged > or = 50 years can be conducted at district level in India with existing resources and at affordable costs. These provide reliable data, essential for effective monitoring and planning. Other parameters, for instance, surgical coverage can also be assessed. The availability of standardized software for data entry and analysis and strict adherence to survey procedures is essential.     

The prevalence of dourine in southern Africa

You are supposed to draw the conclusions and take the actions. My own belief is that we have a continuing obligation to provide a high quality education to as many qualified applicants as we effectively can. At this time we enjoy a unique opportunity that combines large numbers of qualified applicants with a substantial number of excellent training programs, and an unprecedented public demand for more and better health care. We must state clearly the public need for ophthalmologic eye care and must provide the manpower to deliver such care. Most importantly, we must not forget what it's all about: The philosophy of Mount Carmel is service to God through service to man, a service which is based on a belief in, and love for God. This love provides the finest medical and spiritual care for each patient without discrimination. The primary objective is to relieve suffering and to promote and to restore health in a Christian manner, which demands competence, mercy, love, and respect.     

Eosinophil sequestration and activation are associated with the onset and severity of systemic adverse reactions following the treatment of onchocerciasis with ivermectin

To investigate the role of eosinophil activation and sequestration in the development and severity of adverse reactions after the treatment of Onchocerca volvulus infection, 40 O. volvulus-infected Ghanaians were randomized to receive placebo or standard- or high-dose ivermectin. Subjects were examined for typical physiologic and clinical events before and up to 48 h after treatment. Plasma samples were tested for interleukin (IL)-5 and eosinophil degranulation products (e.g., eosinophil-derived neurotoxin, EDN). After treatment, peripheral eosinophil counts declined in ivermectin-treated groups (P<.001), whereas circulating levels of IL-5 (P<.01) and EDN (P<.05) increased. Cumulative levels of IL-5 and EDN correlated with reaction scores (P<.01). High-dose ivermectin was associated with more-severe reactions, more-profound eosinopenia, and higher circulating levels of IL-5 and EDN, compared with the standard dose. These results suggest that eosinophil sequestration and activation/degranulation are associated with the initiation and severity of ivermectin-associated adverse reactions.     

Chloroquine in Africa: critical assessment and recommendations for monitoring and evaluating chloroquine therapy efficacy in sub-Saharan Africa

Chloroquine-resistant malaria is a major public health threat in sub-Saharan Africa. While a few countries have already replaced chloroquine as the first-line therapy for uncomplicated malaria or are in the process of doing so, other countries are faced with the complicated task of assessing the current status of drug resistance, making national policy-level decisions about whether to replace chloroquine or not, and initiating a monitoring system to track changes in the efficacy of malaria therapy. There is currently no standardized approach for collecting and interpreting data on therapy efficacy. There is also no agreement as to how much chloroquine resistance or treatment failure is acceptable and how much warrants a change in treatment policy. Using data collected in 10 sites in eastern and southern Africa between 1990 and 1996, we have assessed the therapeutic response to chloroquine and investigated predictors of clinical success or failure. Based on these experiences and analyses, a standardized protocol for in vivo studies of the efficacy of malaria therapy and for approaches to designing monitoring systems are proposed. The process of making policy-level decisions based on data collected by these systems is also discussed.     

A method to determine the coverage of ivermectin distribution in onchocerciasis-control programmes

AIM: To study the refractive status and corneal topography in Down's syndrome. METHOD: A matched cohort subgroup of 50 individuals with Down's syndrome in the Manchester area aged 15-22 years was studied by refraction, corneal topography, A-scan biometry, slit lamp examination, and orthoptic examination. RESULTS: (1) A linear relation was found between axial length and spherical equivalent refraction. There was no statistical relation between keratometry and the axial length. (2) 80% of the group had a hyperopic refraction (mean +2.46 D, range +0.5 to +7.5 D); 18% were myopic (mean -2.75 D, range -0.5 to -8.0 D); and 2% were emmetropic (within plus or minus 0.5 D of zero). The overall mean spherical equivalent refraction was +1.43 (SD 2.86) D. 63% of eyes could see 6/12 or better and 66% of the individuals had a binocular vision of 6/12 or better. (3) Corneal topography was generally of a regular "bow tie" pattern, but there was a high incidence of oblique cylinders. Mean cylinder strength was 1.14 (1.15) D. (4) The prevalence of overt keratoconus was 2%. 6% had corneal topography with inferior steepening which may be a preclinical keratoconic process. CONCLUSIONS: In this cohort of late teenagers with Down's syndrome, emmetropisation has failed to occur in most individuals. In a similar aged group of non-disabled individuals one would expect about 83% emmetropic (plus or minus 0.25 D), 13% myopic, and 4% hyperopic. The wide spread of oblique cylinders and the small proportion of with the rule astigmatism is probably related to this failure of emmetropisation. The prevalence of 2% keratoconus in Down's syndrome compares with that found by other authors of between 5.5 and 15%. The 6% with inferior steepening on topography will be followed up over the next few years to see if there is any development of clinical keratoconus. Hence we will see if corneal topography is useful as a screening tool for preclinical keratoconus in this high risk group.     

Geographical distribution of HBs Ag in Africa

The incidence of HBs Ag carrier is high in Africa. The HBs Ag subtypes vary in 5 mean areas of the Africa continent. The subtype ayw4(a3) is the most characteristic African subtype, being found with a striking frequency in West Africa (88.8%). In North Africa ayw2(a21) is predominant as in other mediterranean countries. In Saharan area mixed types of HBs Ag are found, intermediary between North and West Africa. In Central Africa y is predominantly associated with w2(a21) or with w4(a3). In east and South Africa ad is largely predominant and the most widespread subtype is adw2(a21). No adr, nor adw4 were found in Africa.     

The prevalence of rheumatoid arthritis in affluent and poor urban communities of Pakistan

Using previously applied methods a survey of joint symptoms was undertaken among 4232 adults, evenly distributed between affluent and poor areas of Karachi, Pakistan. Only six cases of definite rheumatoid arthritis (RA) (1958 ARA criteria) were identified in the 245 persons who complained of joint problems of at least 4 weeks duration. The prevalence was 0.9 [confidence interval (CI) 0.21-3.61] and 1.98 (CI 0.55-5.1) per thousand in the poor and affluent districts, respectively. These were substantially less than prevalence rates reported in the West but were similar to figures derived from other developing countries. There was no obvious impact of current living standards on the findings. The relative paucity of older female subjects in both the affluent and poor communities may account at least in part for the low rates observed. The infrequency of rheumatoid nodules in Southern Asians with RA illustrates the difficulty of applying existing diagnostic criteria to this community.     

Identifying and selecting target problems for clinical interventions: A problem-solving model.

Target problem identification and selection are crucial components of all therapeutic endeavors. In this article, the authors describe some of the factors that negatively impinge on the validity of this process, as well as delineate a conceptual model geared toward facilitating the therapist's effectiveness when engaged in these clinical tasks. The model is based on a problem-solving framework, whereby the clinician is conceived of as the problem solver, and the discrepancy between the client's goal state and current state (i.e., presence of distress) represents the problem to be solved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considerations in selecting a digital camera for orthodontic records

Insulin promoter factor 1 (IPF1) is a key factor both for the regulation of insulin gene expression and for the development of the pancreas. In this study 88 patients with non-insulin-dependent diabetes mellitus (NIDDM) who were diagnosed as diabetic at less than 40 years of age, 55 patients with insulin-dependent-diabetes (IDDM), and 67 normal control subjects were analysed for variants in the upstream region of the IPF1 gene by direct sequencing. A novel single nucleotide insertion polymorphism was found in a guanine triplet at 108 bp upstream of the translation start site. The G insertion allele (G4 allele) was found to be common in the Japanese population, at a frequency of 0.50. The prevalence of G3 homozygotes was higher in IDDM patients (35%) and lower in NIDDM patients (17%) than in normal control subjects (28%, p=0.049). In the NIDDM group, the ratio of insulin treatment tended to be higher in subjects homozygous for the G3 allele, although the genotype was not significantly associated with basal C-peptide levels. The polymorphism is unlikely to be a major contributor to the insulin deficiency of diabetes. However, the polymorphic locus, or an unknown mutation which is in linkage disequilibrium with the polymorphism, could be involved in the pathophysiology of diabetes. The high heterozygosity may be useful for genetic linkage studies of other mutations within and near the IPF1 gene.     

Multivariate time of peak effects assessment for use in selecting time of testing in acute neurotoxicity studies

One of the aims of conducting observational assessments shortly following administration of a test compound is to provide information regarding the profile of acute neurotoxic effects. By limiting the time of peak effects (TOPE) determination to a time range-finding study using only gait and arousal as the end-points for determining time of peak effects, as was proposed in the IPCS/WHO Collaborative Study on Neurobehavioral Screening Methods protocol, it is possible that the time of testing selected for the acute study proper may underestimate other neurotoxic effects which show a different time course. We explored the feasibility of including measures of autonomic activity as well as clonic/tonic movements in the TOPE determination in two experiments using chlorpyrifos and carbaryl as test compounds. A scoring system based on the original operational definitions provided in the IPCS/WHO protocol was devised. Results indicated that there were considerable differences in the time course for autonomic effects and convulsive behavior in comparison to effects on gait and arousal. It is concluded that the use of a multivariate approach for TOPE determination may provide a more comprehensive empirical basis for selecting a testing time for studies designed to profile acute neurotoxic effects.     

Caries and fluorosis prevalence in communities with different concentrations of fluoride in the water

The need to defluoridate and fluoridate the water supplies in areas with drinking water naturally containing above-optimal (>/=2.5 mg/l) and suboptimal (相似文献   

Rapid assessment of drug abuse in Ethiopia

A study of drug and substance abuse at Addis Ababa and in 24 towns across Ethiopia was conducted from June to November 1995. Five categories of respondents were selected for the study: street children, commercial sex workers and street vendors; medical, social and public health workers; law enforcement officials; leaders of religious institutions and educational establishments, youth leaders and personnel of non-governmental organizations providing social service to communities; and focus groups comprised of men and women from the various places covered in the study. All categories of respondents agreed that the problem of substance abuse was becoming increasingly serious in Ethiopia; that adolescents and young adults were the most affected group; and that addictive substances were easily obtainable in the country. The study also found that there was a significant increase in the number of Ethiopians chewing khat (Catha edulis). Khat, previously known to grow mainly in the eastern part of Ethiopia, was widely cultivated in all parts of the country. Khat consumption, traditionally confined to a certain segment of the population, had become popular among all segments of the population. Some of the respondents reported that khat-chewing often led to the abuse of illicit substances.     

Rapid assessment of drug abuse in Cameroon

The present paper describes a rapid assessment that was carried out in Cameroon from March to November 1994 and presents a summary of the findings and recommendations. It was the first rapid assessment study conducted by Cameroon in collaboration with the Economic Community of Central African States, with technical assistance from the World Health Organization and the support of the United Nations International Drug Control Programme. It was hoped that the study would help to fill gaps in the information available on drug abuser profiles, the types of drugs abused and the response of the community to drug abuse in Cameroon. In focus group discussions, key informant interviews and interviews with drug abusers, it was revealed that Cameroon was not only used by drug traffickers as a transit country, but was also a drug-consuming country. The drug consumers were both males and females from all age groups. The drugs consumed ranged from traditional drugs to imported cocaine and heroin. Cannabis was the most frequently consumed drug, followed by amphetamine-type tablets and a broad range of pharmaceuticals. Solvents were mainly consumed by street children in northern Cameroon. Local beer and gin also held a special place in society. In order to tackle the existing problems, programmes offering preventive education and alternative forms of recreation for youth were necessary, and national policies on demand and supply reduction should be harmonized.     

Rapid assessment of drug abuse in Kenya

A country-wide needs assessment study undertaken in 1994 by the Government of Kenya and the United Nations International Drug Control Programme (UNDCP) revealed that drug abuse has permeated all strata of Kenyan society, youth and young adults being the most affected groups. The traditional cultural values and discipline of African society prescribed the circumstances under which drugs and intoxicants could be obtained, used and consumed. Perhaps as a result of the erosion of the powers of censure and control at the family and community levels, fewer stigmas are associated today with the use of intoxicants (especially alcohol and tobacco). One of the main recommendations of the study is that the Government of Kenya should set up specific demand reduction programmes to enlighten and educate the public on the problem of drug abuse. The need for a reassessment of government policy on the treatment of addicts is stressed, and it is suggested that the establishment of non-stigmatizing treatment and rehabilitation centres should be considered. Intersectoral collaboration between different government departments and non-governmental organizations is also proposed.