Population policies and reproductive patterns in Vietnam.

Background: Vietnam's population policy since the 1980s had stipulated a limit on family size to two children, born 3-5 years apart, and recommends a minimum age of 19 for the mother of a first child. We analysed trends in the timing of marriages and births, and in fertility and abortion rates, among women born between 1945 and 1970, to assess the impact of these policies on reproductive patterns.

Methods: Reproductive histories were recorded in a random sample of 1432 married women aged 15-49 in a rural province in northern Vietnam.

Staff and patient attitudes to tuberculosis and compliance with treatment: an exploratory study in a district in Vietnam.

Setting: The study, a collaboration between the National Tuberculosis Institute, Hanoi, Vietnam and the Karolinska Institutet, Stockholm, Sweden, was carried out in a district of Quang Ninh Province in North Vietnam.

Objectives: To describe tuberculosis (TB) services, attitudes of staff, and attitudes of patients considered as defaulters to TB treatment.

Design: Two focus group discussions were carried out with staff at the district hospital.

Improving drug use through continuing education: a randomized controlled trial in Zambia.

The objective of this study was to evaluate the impact of three continuing education seminars (within a period of 4 months) on the quality of patient management and rational drug use. The study was designed as a randomized controlled trial. Prescribers in 16 general health centers were allocated to an intervention (eight health centers) or a control (eight health centers) group.

Effects of "group detailing" on the prescribing of lipid-lowering drugs: a randomized controlled trial in Swedish primary care.

The objective was to study the effect of "academic group detailing" on the prescribing of lipid-lowering drugs in Swedish primary care. A randomized controlled trial was conducted, randomization being by group. Groups of doctors at 134 community health centres were randomly allocated to an intervention and a control group.

Respiratory infection with Chlamydia pneumoniae in middle-aged and older adult outpatients.

This study was undertaken to characterize the epidemiology and clinical presentation of infection with Chlamydia pneumoniae in a population composed primarily of middle-aged and older adults. Pharyngeal swabs and acute and convalescent phase sera were obtained from outpatients presenting with signs and symptoms of an acute respiratory infection. Sera were examined using the micro-immunofluorescence (MIF) test to detect antibody to Chlamydia pneumoniae and complement fixation tests to detect Mycoplasma pneumoniae, influenza A virus, influenza B virus, respiratory syncytial virus and adenovirus.

Human immunodeficiency virus type-1 infection in Zambian children with tuberculosis: changing seroprevalence and evaluation of a thioacetazone-free regimen.

Setting: This study was conducted at the Department of Paediatrics and Child Health, University Teaching Hospital (UTH), in Lusaka, Zambia.

Objectives: To monitor the seroprevalence of HIV type-1 in children with tuberculosis and to evaluate the response to anti-tuberculosis therapy using a thioacetazone-free treatment regimen.

Design: A prospective cross-sectional study of all consecutive newly diagnosed cases of TB in children from 1 month-15 years of age seen at the University Teaching Hospital (UTH) in Lusaka, Zambia between 1 October 1991 and 31 May 1992.

Protective effect of BCG against tuberculous meningitis and miliary tuberculosis: a meta-analysis.

The protective effect of BCG against tuberculosis (TB) estimated in randomized controlled trials and observational studies ranges from negative to close to a 100%. One of the many explanations offered for this is that different immunological mechanisms may be associated with protective effect against different forms and sites of disease. In this investigation, we recalculated vaccine protective effect separately for pulmonary disease and for meningeal/miliary disease in randomized controlled trials and case-control studies, tested for heterogeneity in site-specific estimates of protective effect and calculated a summary measure when appropriate.

HIV, BCG and TB in children: a case control study in Lusaka, Zambia.

Even before the onset of the HIV epidemic, studies reported large variations in the protective effect of BCG against TB. The current HIV/AIDS epidemic has increased the incidence of tuberculosis in many countries in sub-Saharan Africa. Thus, local estimates of the effectiveness of BCG are needed which take prevalence of HIV into account for planning strategies for vaccination and TB control programmes.

Seroprevalence of human immunodeficiency virus type 1 infection in Zambian children with tuberculosis.

Descriptions in the medical literature of human immunodeficiency virus type 1 (HIV-1) in children with tuberculosis (TB) are scanty. This study determined the seroprevalence of HIV-1 in 237 hospitalized children between the ages of 1 month and 14 years with a clinical diagnosis of TB (125 males and 112 females) and in 242 control children (149 males and 93 females). The overall HIV-1 seroprevalence rate in patients with TB was 37% (88 of 237) compared with 10.

On the variation in conceptions among primary care physicians regarding hypercholesterolaemia: a phenomenographic analysis.

Twenty primary care physicians at 12 health centres in Sweden were interviewed in a semi-structured way. Analysis was conducted using a phenomenographic method. Concerning the general attitude towards cardiovascular disease (CVD), there were two categories of answers; (A) CVD is a big threat to public health, and the health care system should play an active role in treatment and prevention, and (B) CVD is a symptom of normal aging with little or no need for active health care intervention.

Randomization by group in studying the effect of drug information in primary care.

Drug information is a technology which is rarely evaluated. Practical and ethical considerations limit the use of a classical experimental method (a randomized controlled trial) in studying the effect of drug information in primary care. An alternative approach, randomization by group, is preferable for several reasons: it avoids contamination of the control group; the effect of information can be evaluated in the natural working environment; and the impact of information is increased via diffusion.

Experimental evaluation of the effects of drug information on antibiotic prescribing: a study in outpatient care in an area of Sri lanka.

The intervention level of epidemiology is useful for studying effects in health systems research. Due to practical and ethical reasons, it is often difficult to apply experimental methods such as classical randomized clinical trials in the field. However with alternative approaches such as 'randomization by group' some of these problems can be overcome.

Second occurrence of spinal epidural metastases.

We reviewed records of 79 men with spinal epidural metastases diagnosed from July 1984 to July 1989, imaged by myelography or MRI, and treated with radiation therapy. Thirteen men (16%) had second epidural metastases. The mean time between lesions that developed within two vertebral bodies of a prior lesion was 2.

Drug use and the role of patients and prescribers.

In order to move towards rational drug use in any national or local setting the methods of inquiry have to be expanded. Both the public and private sector have to be addressed. In the latter the pharmacists might be studied using a tracer, fictitious client.

Operational evaluation of the efficacy of vaccines by the case control method.

To maintain high efficacy and cost-effectiveness of health interventions, such as immunization programs and health information, systematic and careful evaluation is necessary. This is particularly relevant when health resources are scarce, as in most developing countries. Whereas vaccines used in immunization programs are generally evaluated for efficacy and safety prior to their application in routine health service, very little attention is paid to continuous or operational evaluation.

Paediatric prescribing in out-patient care. An example from Sri Lanka.

Few drug utilization studies have been focused on children in developing countries, where they constitute a large part of the total population. The present study describes prescribing in 5 outpatient departments (15 practitioners) in an area of Sri Lanka over a period of seven months. It includes a random sample of 2484 paediatric consultations.

Maternity care routines in a teaching hospital in Zambia.

At the University Teaching Hospital, Lusaka, Zambia, 59 uncomplicated, vaginally delivered mothers, were studied with regard to maternity care during the antenatal period and delivery. Information was collected from antenatal cards, labour records, observations during delivery and interviews with mothers. The average of more than five antenatal visits indicates that there was a sufficient demand for health care.

Maternal smoking in relation to the incidence of early neonatal jaundice.

A case-control study was carried out to investigate the association between maternal smoking during pregnancy and the risk of early neonatal jaundice. A total of 1,569 cases of neonatal jaundice (2.7% of all singleton births) were identified from the 1984 Washington State birth certificates as having a bilirubin level greater than 10 mg/dl within the first 2 days of life.

Community- and hospital-acquired pneumonia associated with Chlamydia TWAR infection demonstrated serologically.

Serum specimens from 198 patients with pneumonia hospitalized in Seattle between October 1980 and April 1981 were retrospectively tested for antibody against a recently described Chlamydia organism called TWAR. They had been previously tested for antibody for some viruses and Mycoplasma. Twenty (10%) had serologic evidence of recent TWAR infection.

Fatal radiation hepatitis: a case report and review of the literature.

A case of fatal radiation hepatitis occurring after treatment with 2200 rad given by the moving strip technique is presented. This fatality occurred in a 28-year-old woman with persistent ovarian carcinoma despite prolonged chemotherapy. Scans of the liver using computerized tomography, 99mTc sulfur colloid, and 99mTc diisopropyl iminodiacetic acid showed abnormalities only in sulfur colloid uptake and these resolved late in the course.

Brain involvement in chronic lymphocytic leukemia.

Cerebral infiltration due to chronic lymphocytic leukemia is rare. Leukemic infiltration of the brain can be diagnosed by computed tomography, and the response to treatment can be monitored. Leukemic cerebral infiltrates may occur as areas of variable attenuation that usually enhance following intravenous contrast medium administration.