Improving rural health care in South Dakota

This study was designed to find ways to improve the quality of health care in rural settings. The study includes three components: a telephone survey of a rural community, a patient quiz, and interviews with ten rural family practice doctors in the southeast corner of South Dakota. This study was conducted in a rural community of about 1,500 people. The results of the survey suggest that rural health care can be improved by more education of the public on what is offered for preventative medicine, especially for the men 55 or younger, a female doctor who is willing to do obstetrical/gynecological services to meet the local demand, and physicians learning new procedures such as colonoscopy, colposcopy, and stress testing to better serve their patients.     

Rural health care networks in South Dakota

To address health care access concerns, a Regional Coordinated Care Network (RCCN) program, through Robert Wood Johnson Foundation Practice Sights Initiative funding, is being developed by the South Dakota Office of Rural Health. The intent of the initiative is to expand primary and preventive care and, hopefully, permanently reduce the number of Health Professional Shortage Areas (HPSAs) in the state by linking and enhancing providers and services. In rural areas such networking will be crucial for the delivery of health care. Surely, the impact on family physicians will be significant and salutary.     

Wound infection: a physician's perspective

Infection in a wound represents a colony count of 10(5) or greater. Contamination is the presence of many surface organisms. Moist wound healing, not dehydration, protects and prepares the wound for coverage and closure. Relief of pain is a critical factor in achieving healing: a biological or pharmaceutical device can achieve protection and facilitate healing.     

Combination Subsurface Irrigation and Drainage Systems in North-Central South Dakota

The 340,000 ha Lake Dakota Plain area in north-central South Dakota has the topographical and soil characteristics required for the use of combination subsurface drainage and irrigation systems. Corn yield data from a research site and a county-wide reporting service were used to determine that DRAINMOD, a water balance and corn yield estimation computer model, could be employed to assess the feasibility of using a combination system for the area. Three soils ranging in texture from a sandy loam to a silt loam and 19 years of climatic data were used in the feasibility analysis. Drain line spacings were determined for average yield goals of 90, 95, and 100% of estimated maximum corn yields for each soil. There are possibilities for the economical use of combination subsurface irrigation and drainage systems in the Lake Dakota Plain area.     

Tobacco use disorder]

PURPOSE: To compare first- and fourth-year medical students' opinions about primary care practice. METHOD: A cross-sectional survey was made of medical students at New York Medical College (NYMC) and East Carolina University School of Medicine (ECUSOM) over three years (1993-94, 1994-95, and 1995-96). Three consecutive classes of first-year students from both schools (n = 807), two consecutive classes of fourth-year NYMC students (n = 373), and three consecutive classes of fourth-year ECUSOM students (n = 221) were given a self-administered questionnaire about professional aspects of primary care practice. Responses to ten items about primary care practice were the independent variables in a logistic regression analysis. Career choice, categorized as primary care or non-primary care, was the dependent variable. Independent, two-tailed t-tests were employed to compare the responses of the first-year students interested in primary care careers with those of the fourth-year students interested in primary care careers. RESULTS: In all, 639 (79%) of the first-year students and 396 (67%) of the fourth-year students returned completed questionnaires. The first-year students interested in primary care careers were significantly more likely to believe that primary care practice has more prestige, has more intellectual stimulation, needs a large knowledge base, and involves work that is more important than that of non-primary care physicians, and were significantly more likely to disagree with the assertion that in primary care practice, physicians have more control over their working hours. With one exception (prestige of primary care practice), all these independent variables were significant for the fourth-year students as well. The comparison of the first- and fourth-year students indicated that the fourth-year students were significantly more likely to believe that primary care practice has more intellectual stimulation, needs a large knowledge base, and requires knowledge that non-primary care practice may not; they were also significantly more likely to disagree with the assertions that primary care practice is adequately compensated, has more prestige, and allows more control over working hours. CONCLUSION: It appears that students' positive perceptions about primary care practice may change as realistic perceptions about the professional demands on primary care physicians develop during medical school.     

Tobacco use is increasing in popular films

OBJECTIVE: To study the presentation of smoking in motion pictures. DESIGN: This study examined tobacco use in a random sample of five of the top 20 grossing films each year from 1990-1996 and combined these data with our earlier study of tobacco use in films that covered 1960-1990. MAIN OUTCOME MEASURES: Rate of tobacco use per minute of film, characters who are smoking, motivation to smoke. RESULTS: The overall rate of tobacco use appears to have "bottomed out" in the 1980s and is now increasing back to levels observed in the 1960s. The presentation of tobacco use in films is increasingly discordant with reality, because tobacco use in the population continues to drop. Films continue to portray smokers as successful white males, although portrayal of smoking among women is increasing. CONCLUSIONS: The gap between the representation of tobacco use in films and the reality of tobacco continues to widen, with the prevalence of smoking among lead characters four times the smoking prevalence among comparable individuals in society at large.     

Narcolepsy in children--a diagnostic and therapeutic challenge

Narcolepsy is a socially and psychologically disabling disease that most often develops in adolescence or early adulthood. In a number of studies about one-third of the patients had experienced the first symptoms before the age of 15. The diagnosis and subsequent treatment is usually not established until several years later, often ten to fifteen years after the appearance of the first symptoms. If unrecognized and untreated, narcolepsy may lead to serious psychological and social problems during childhood and early adulthood, which may in turn cause difficulties in social adjustment later in life. This stresses the importance of early diagnosis. The diagnosis is based on clinical and polysomnographic criteria. In children, however, the clinical symptoms and polysomnographic findings may be atypical, making it difficult to establish a definite diagnosis. Three patients, two five-year olds and one four and a half-year old, are presented to illustrate the problems and considerations which must be taken into account in the diagnosis and treatment of children with narcolepsy.     

Tobacco use among multi-ethnic Latino populations

The equine homologue of the leucocyte integrin LFA-1 (CD11a/CD18) has been characterized using a panel of four monoclonal antibodies (mAbs). The antibodies labelled almost all leukocytes, thymocytes and lymph node cells from normal horses, and immunoprecipitated two noncovalently associated polypeptides with molecular weights of 180 kDa and 100 kDa, respectively. The antigen recognized by one mAb could be precipitated by another in this cluster in a sequential immunoprecipitation assay. The mAbs, however, did not block the activities on lymphocyte function of one another. A mAb to the beta subunit of human LFA-1 cross-reacted with equine LFA-1, but an antibody to its alpha subunit did not, suggesting that the beta subunit of the leukocyte integrin may be more highly-conserved. Functionally, H20A and a human CD18 antibody (MHM23) inhibited phorbol ester-mediated homotypic lymphocyte aggregation, whereas mAb CZ3.2 induced rather than inhibited the homotypic cell aggregation. The formation of lymphocyte aggregates induced by CZ3.2 was not blocked by the inhibitory antibodies H20A or MHM23. CZ3.1 seemed to have little inducible or inhibitory effects on homotypic cell aggregation. The mAb CZ3.1 defined a unique LFA-1 determinant present on granulocytes, but absent on lymphocytes in members of an extended horse family, in contrast to the other antibodies which labelled both granulocytes and lymphocytes from these animals. In all other horses tested, no differences in reactivity of CZ3.1 and the other LFA-1 antibodies were observed when the antibodies were tested on lymphocytes or granulocytes. Our results indicate that common epitopes are shared' between human and equine LFA-1, and that the described panel of monoclonal antibodies identifies distinct determinants present on the equine LFA-1 molecule. The following monoclonal antibodies used in this study were given official workshop designations at the Second International Workshop on Equine Leukocyte Antigens (Lunn et al., 1998) CZ3.1 (Cor) = W45; CZ3.2 (Cor) = W77.     

Cystic fibrosis in Malay children--a report of three cases

A staining device for sectioned material supported on grids for viewing at the Transmission Electron Microscope is described. The method based in a double side sticky tape is inexpensive, rapid and clean. By using only pipettes and a double side sticky tape the best solution to the tedious problems of sections staining is obtained. The tape is discarded and the staining solution too. Precipitates have not been observed.     

Contraceptive use in South Africa under apartheid

The H4 minor histocompatibility antigen (HA) of mice includes a single immunogenic peptide presented by H-2Kb molecules that stimulates skin allograft rejection and is immunodominant in the stimulation of cytolytic T lymphocytes (CTL) specific for multiple minor HA. We have identified H4 mimotopes that are recognized by the H4-specific M9 CTL clone through the use of a random peptide library comprised of bacterial clones expressing an inducible fusion protein tailed with the octamer sequence SXIXFXXL. Eight discrete mimotopes were identified that sensitized RMA-S cells for lysis by M9 CTL down to concentrations of 10(-11) M. Comparable reactivity was observed with a short-term, H4-specific CTL line indicating that the mimotopes were not solely specific for the selecting M9 clone. All mimotopes included Gly at p2 and either Val or Ile at p4, suggesting a requirement for a hydrophobic residue with specific conformation. All mimotopes included either Arg or His at p7, implicating a requirement for a specific positively charged amino acid at that position. The sixth position was more variable with four of eight mimotopes having a Val residue with single mimotopes including alternative amino acids, the majority of which were hydrophobic. Analysis of mimotopes for hydrophobicity and charge by reverse-phase HPLC and capillary electrophoresis respectively indicated that (i) mimotopes with Val at both p4 and p6 were hydrophobically similar (but not identical) to the natural H4 peptide, and (ii) a S --> E substitution at p1 resulted in a peptide (EGIVFVRL) with charge characteristics equivalent to those of the natural H4 peptide.     

Clinical profile of cholera in young children--a hospital based report

Clinical profile of cholera was studied in children attending Diarrhea Training and Treatment Unit from January-December 1993. Out of a total 8714 cases of acute watery diarrhea, 64 children (0.7%) were suspected to have cholera on the basis of acute onset loose water/rice watery stools, high purge rate with or without excessive vomiting and/or severe dehydration. Stool culture was positive for cholera in 33 cases (51.6%). All the isolates were V. cholerae 01 biotype El Tor serotype Ogawa. Sixty four per cent of stool culture positive cases were below 5 years of age. The results assume importance because out of 28 children < 2 years with clinical suspicion of cholera, 11 cases (39.3%) were culture positive for V. cholerae, youngest child being 3 months old. Comparison of various parameters revealed that presence of vomiting > 4 episodes/ day (p < 0.005), frequency of stools >12/24 hours (p <0.002), rice watery stools (p < 0.01) and presence of severe dehydration (p < 0.01) were significant parameters associated with positive stool culture. Beside examination of stool sample by hanging drop method was an excellent diagnostic tool (p < 0.001) with a sensitivity of 51.5%, specificity 100% and positive predictive value of 100%. The isolates of V. cholerae were susceptible to furazolidone, cephelexin, nalidixic acid, norfloxacin and gentamicin. Our observations indicate that cholera is not uncommon in infants and young children. Like children in the older age group, acute onset diarrhea with watery/rice watery stools and high purge rate with or without excessive vomiting and/or rapid development of severe dehydration should arouse suspicion of cholera in younger children also. They should be investigated for cholera even in non-endemic areas and in the absence of cholera outbreaks.