An outbreak of shigellosis at an outdoor music festival.

In August 1988, an estimated 3,175 women who attended a 5-day outdoor music festival in Michigan became ill with gastroenteritis caused by Shigella sonnei. Onset of illness peaked 2 days after the festival ended, and patients were spread throughout the United States by the time the outbreak was recognized. An uncooked tofu salad served on the last day was implicated as the outbreak vehicle (odds ratio = 3.

Childhood hospitalization for psychosocial reasons: the case of gastroenteritis.

Nonmedical factors are often important considerations when choosing treatment options for illness. High levels of childhood hospitalization are of concern for psychological as well as medical and economic reasons. This study compared medical and psychosocial attributes of children managed at home or in hospital for childhood gastroenteritis to identify factors differentiating type of care.

Communication skills training in undergraduate medicine.

Good communication with patients is now recognised as the cornerstone in effective medical practice. Medical students do not automatically acquire the art of good communication through clinical training. A new course to promote the development of communication skills at undergraduate level is described.

Psychological health status of mothers and the admission of children to hospital for gastroenteritis.

The prevalence of psychological distress was measured by the 30-item general health questionnaire in two populations of mothers: those who had children hospitalized for gastroenteritis and those who cared for children with gastroenteritis at home. Significant differences emerged, with mothers of hospitalized children reporting higher levels of psychological distress. There were no differences in severity of the children's illness between the two groups as indicated by blind ratings of symptomatology from six infectious diseases hospital doctors.

Complex dislocation of the metacarpo-phalangeal joint of the index finger: a comparison of the surgical approaches.

Complex dislocation of the index metacarpo-phalangeal joint almost always requires surgical intervention. Controversy exists as to the most suitable surgical approach to reduction: palmar or dorsal. We reviewed four cases and carried out dissections in eight cadaver hands to compare the surgical approaches.

Hepatitis B vaccination programs for hospital workers: results of a statewide survey.

To assess the implementation of hepatitis B virus (HBV) vaccination programs for hospital workers, we mailed questionnaires to all 229 licensed Michigan hospitals. The response rate was 96% (221/229); of these, 68% (150/221) had vaccination programs. Although multiple hospital characteristics were associated with the presence of a vaccination program, characteristics that independently predicted the presence of a program were medical school affiliation, nonpsychiatric specialty, and the existence of a hepatitis B immune globulin protocol.

Q fever. A call to heighten our index of suspicion.

The prevalence of Q fever infection is probably underestimated. In Michigan, the first two reported human cases of Q fever occurred in 1984. The case-patients lived in adjacent, rural counties and had multiple exposures to goats.

A measles outbreak at university medical settings involving health care providers.

In 1985, a measles outbreak involved 14 students and non-student contacts in Michigan. Eight transmissions occurred at university medical facilities; five of these were likely airborne transmissions. Medical students and a medical resident were involved in the outbreak's propagation.

Decreasing trends in Reye syndrome and aspirin use in Michigan, 1979 to 1984.

The incidence of Reye syndrome has been decreasing in Michigan, perhaps as a result of decreased aspirin use among children. To evaluate possible changes in the frequency of aspirin use, 199 families in Tecumseh, MI, with children younger than 18 years of age were interviewed by telephone in February 1981 and again in February 1983. Based on the reported use of medications for colds or influenza between 1981 and 1983, fewer parents gave aspirin (56% v 25%), but acetaminophen use did not change (59% v 55%).

Reye syndrome and juvenile rheumatoid arthritis in Michigan.

Reye syndrome (RS) is believed to occur infrequently among children receiving long-term aspirin therapy. We reviewed all cases of RS reported to the Michigan Department of Public Health during 1982 and 1983. Three of the 36 patients were receiving aspirin for the treatment of juvenile rheumatoid arthritis.

A simple method of obtaining equal leg length in total hip arthroplasty.

Leg length in total hip arthroplasty can be measured and equalized with no increase in operating time through the use of a method that is applicable to any of the standard approaches to the hip joint.

An outbreak of Pontiac fever related to whirlpool use, Michigan 1982.

Fourteen of 23 female members of a church group experienced an acute self-limited illness characterized by chills, fever, chest pain, cough, and nausea, consistent with the diagnosis of Pontiac fever. All 14 affected women had used a whirlpool located in the women's locker room during a racquetball party. Legionella pneumophila serogroup 6 was isolated from the women's whirlpool.

Optimized liquid-chromatographic determination of metronidazole and its metabolites in plasma.

Metronidazole and its known metabolites in plasma can be rapidly separated by a "high-pressure" liquid-chromatographic method that can also be adapted for rapid determination of tinidazole. Samples deproteinized with trichloroacetic acid (50 g/L final concentration) undergo isocratic separation on a reversed-phase C18 column eluted with an 8/92 (by vol) mixture of acetonitrile/KH2PO4 (5 mmol/L, pH 3.0).

Fluspirilene neuroleptic depot injections and indurations.

Local reactions at injection sites have limited the use of depot fluspirilene, an otherwise effective treatment for chronic schizophrenia. Thirty-nine reports of fluspirilene-treated patients were analyzed and the patients were examined for indurations. It was found that patients with indurations were given significantly higher doses and volumes of the drug.

Hemorrhagic colitis associated with a rare Escherichia coli serotype.

We investigated two outbreaks of an unusual gastrointestinal illness that affected at least 47 people in Oregon and Michigan in February through March and May through June 1982. The illness was characterized by severe crampy abdominal pain, initially watery diarrhea followed by grossly bloody diarrhea, and little or no fever. It was associated with eating at restaurants belonging to the same fast-food restaurant chain in Oregon (P less than 0.

Salmonellosis associated with marijuana: a multistate outbreak traced by plasmid fingerprinting.

In January and February of 1981, 85 cases of enteritis caused by Salmonella muenchen were reported from Ohio, Michigan, Georgia, and Alabama. Initial investigation failed to implicate a food source as a common vehicle, but in Michigan 76 per cent of the patients, in contrast to 21 per cent of the control subjects, admitted personal or household exposure to marijuana (P less than 0.001, relative risk = 20).

Treating depression in schizophrenic patients.

Successful intervention in the depressive reactions of schizophrenic patients depends on accurate diagnosis, careful observation, the use of many modalities of treatment, and the maintenance of therapist optimism. Therapy needs to be pragmatic and focused on the special needs of the individual patient.