Vitamin A-fortified cooking oil reduces vitamin A deficiency in infants, young children and women: results from a programme evaluation in Indonesia.

Objective: To assess oil consumption, vitamin A intake and retinol status before and a year after the fortification of unbranded palm oil with retinyl palmitate.

Design: Pre-post evaluation between two surveys.

Setting: Twenty-four villages in West Java.

Serial measurements of hematologic counts during the active phase of human granulocytic ehrlichiosis.

To describe the changes that occur in blood count parameters during the natural course of human granulocytic ehrlichiosis, we designed a retrospective cross-sectional case study of 144 patients with human granulocytic ehrlichiosis and matched controls who had a different acute febrile illness. Patients from New York State and the upper Midwest were evaluated from June 1990 through December 1998. Routine complete blood counts and manual differential leukocyte counts of peripheral blood were performed on blood samples that were collected during the active illness, and values were recorded until the day of treatment with an active antibiotic drug.

Nutrition education and mega-dose vitamin A supplementation in Nepal.

Two approaches to improve vitamin A nutriture are compared: nutrition education and mega-dose capsule distribution. The impact of these programmes on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality are compared for approximately 40,000 children who were assigned to either intervention cohorts or a control group from 75 sites within seven districts in two ecological settings (Terai, or lowland, and hills) of Nepal. Twenty-four months after the implementation of the project, the reduction of risk of xerophthalmia was greater among children of mothers who were able to identify vitamin A-rich foods [relative risk (RR) = 0.

Effect of treatment of Helicobacter pylori infection on rosacea.

Objective: To evaluate the clearing and intensity of symptoms of rosacea 60 days after the treatment of Helicobacter pylori infection.

Design: Randomized, double-blind, placebo-controlled clinical trial.

Setting: The dermatology section of a large multispecialty clinic in the North Central United States.

Community-based screening for childhood lead poisoning. Identification of risk factors and susceptible populations in Duluth.

The purpose of this matched case-controlled study was to identify local risk factors and susceptible populations for childhood lead poisoning in Duluth, Minnesota. We mailed questionnaires to the parents of 20 children with known elevated capillary lead levels > or = 10 micrograms/dL; 76 age-matched controls had capillary lead levels < 10 micrograms/dL. The study identified these risk factors for elevated capillary lead levels in children: not attending daycare, having nonwhite parents, living in rental property in central Duluth, and moving with family three or more times in the previous five years.

Seroprevalence of human granulocytic ehrlichiosis among permanent residents of northwestern Wisconsin.

Four-hundred seventy-five permanent residents of Wisconsin were tested for antibodies to the agent of human granulocytic ehrlichiosis (HGE) by indirect immunofluorescent antibody (IFA) testing with Ehrlichia equi as antigen marker. Each resident completed a standard survey questionnaire about outdoor activities, animal and tick exposure, and any febrile illness during the preceding 12 months. Seventy-one serum samples (14.

Endoscopic surveillance of Barrett's esophagus: a cost-effectiveness comparison with mammographic surveillance for breast cancer.

Objective: Endoscopic surveillance of Barrett's esophagus is commonly practiced to detect malignancy in an early and curable stage. However, the cost-effectiveness of this practice has been questioned. To clarify this issue, we undertook a cost analysis of endoscopic surveillance to detect adenocarcinoma in Barrett's esophagus compared with mammography used to detect occult carcinoma of the breast, a widely accepted cancer surveillance technique.

Serological evidence of human granulocytic ehrlichiosis in Norway.

Human granulocytic ehriichoisis was first described in 1994. This tick-transmitted illness is increasingly recognized in the USA as well as in Europe in areas where ixodes ticks and Lyme borreliosis are endemic. Blood samples from 58 Norwegian patients with physician-diagnosed Lyme borreliosis were examined for the presence of antibodies to Ehrlichia equi, a surrogate marker of the agent of human granulocytic ehrlichiosis.

A guide for planning community-oriented health care: the health sector resource allocation model.

The objective of this study was to demonstrate the value of a planning model for the design and evaluation of community health services. The health status of Washtenaw County, Michigan was modeled. Data were obtained from the Michigan Department of Public Health, Medstat Systems, and the medical literature for 32 diseases or conditions, representing approximately 85% of causes of death and 56% of medical payments (excluding medication costs).

Clinical and laboratory characteristics of human granulocytic ehrlichiosis.

Objective: To characterize the clinical and laboratory features observed in patients with human granulocytic ehrlichiosis (HGE) and evaluate the utility of the diagnostic tools used to confirm the diagnosis.

Design: Retrospective case study of 41 patients with laboratory-diagnosed HGE.

Setting: A total of 228 patients from Minnesota and Wisconsin were evaluated between June 1990 and May 1995.

Impact of nutrition education and mega-dose vitamin A supplementation on the health of children in Nepal.

The impact on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality of two alternative approaches-nutrition education and mega-dose capsule distribution (6-12-month-olds: 100,000 IU; 1-5-year-olds: 200,000 IU)-in communities in Nepal are compared. Approximately 40,000 children from 75 locations in seven districts in two ecological settings (lowland and hills) took part in the study and were randomly allocated to intervention cohorts or a control group. At 24 months after the implementation of the project the reduction of risk for xerophthalmia was greater among children whose mothers were able to identify vitamin-A-rich foods (relative risk (RR) = 0.

Objective assessment of gastroesophageal reflux after short esophagomyotomy for achalasia with the use of manometry and pH monitoring.

The role of an antireflux procedure as an adjunct to esophagomyotomy for achalasia remains a subject of controversy. Little objective documentation exists of this operation's effect on sphincteric competence and the degree of postoperative gastroesophageal reflux. This report of esophageal manometry and 24-hour pH monitoring on 14 patients with esophageal achalasia whom we had previously treated by a short esophagomyotomy without an antireflux procedure provides such documentation.

Intestinal helminths and xerophthalmia in Nepal. A case-control study.

The study reports on 25 cases of xerophthalmia among children 6-120 months of age and single controls for which faecal egg counts were available as proxy for hookworm and Ascaris lumbricoides infection. The selection of cases and controls was performed by ophthalmic assistants. Controls were healthy children matched for sex, age, and neighbourhood of residence.

Ascariasis, hookworm infection and serum retinol amongst children in Nepal.

The study reports on the association between serum retinol levels and prevalence of two intestinal helminths in a random sample of 592 children, 6-120 months of age. Faecal analyses were performed by Kato thick-smear technique, recording the presence of hookworm and Ascaris lumbricoides eggs. Serum retinol levels were determined by high pressure liquid chromatography (HPLC) and expressed in micrograms/dl.

Intestinal helminths and risk of anaemia among Nepalese children.

Relationships between hookworm, A. lumbricoides and anaemia were studied utilising egg count in faecal specimens and haemoglobin levels from a cross-sectional sample of 641 Nepalese children, 6 to 120 months of age. Additional analyses were performed to assess the level of risk by age and worm load.

The impact of vitamin A supplementation on morbidity: a randomized community intervention trial.

A randomized community trial investigated the impact of vitamin A supplementation on symptoms of respiratory and enteric infections among Indonesian children aged 1 to 5 years. A sample of 450 villages had been randomized into 229 villages that received vitamin A distribution and 221 that were observed as controls. The prevalence rates of cough, fever, and diarrhea were reduced in the treatment villages compared with the control villages by 8%, 5%, and 11%, respectively, but the reduction was not statistically significant.

Nutritional and household risk factors for xerophthalmia in Aceh, Indonesia: a case-control study. The Aceh Study Group.

Risk factors for xerophthalmia were assessed in 466 subjects [38% with night blindness (XN), 60% with Bitot's spots (X1B), 2% with corneal xerophthalmia (X2 or X3)] under age 6 y and their village-age-sex-matched control subjects during a community trial. Socioeconomic status and hygiene standards were lowest for households of xerophthalmic children and highest for nonstudy households in the trial population, with values for control households lying in between (P less than 0.001 by linear trend).

Determinants of community-based coverage: periodic vitamin A supplementation. Aceh Study Group.

Factors related to preschool child receipt of vitamin A during the first year of a semi-annual vitamin A capsule delivery program were investigated in 229 villages in Aceh, Indonesia. Coverage was higher in villages which were more rural and less economically developed. Highest performance was achieved by village distributors who represented the local status quo in this rural area (farmers, or non-farmers with minimum education) rather than more upwardly mobile, highly educated residents.

Rapid epidemiologic assessment of cataract blindness. The Aravind Rapid Epidemiologic Assessment Staff.

A major constraint to obtaining reliable information about blindness and its causes in developing countries is the limited availability of ophthalmologists for diagnosis in population-based surveys. This study in rural south India assessed the feasibility of using non-ophthalmologists to make diagnoses in a population-based survey. Ten men in their early twenties with 12 years of schooling were recruited and trained as ophthalmic assistants through a six week course in basic ophthalmology.

Impact of vitamin A supplementation on childhood mortality. A randomised controlled community trial.

450 villages in northern Sumatra were randomly assigned to either participate in a vitamin A supplementation scheme (n = 229) or serve for 1 year as a control (n = 221). 25 939 preschool children were examined at baseline and again 11 to 13 months later. Capsules containing 200 000 IU vitamin A were distributed to preschool children aged over 1 year by local volunteers 1 to 3 months after baseline enumeration and again 6 months later.

Reversal of the effects of aging in soybean seeds.

Accelerated aging predisposed seeds to imbibition injury. Slowing the rate of hydration prevented the loss of germinability due to imbibition injury. Germinability of accelerated aged seeds (50 hours) was increased from 10 to 90% by controlling the rate of imbibition.

Interactions of community nutritional status and xerophthalmia in Indonesia.

In order to determine which community level factors best explain the variation in the prevalence of xerophthalmia, an analysis was done on risk factors of xerophthalmia from the Indonesian Nutritional Blindness Study (1976 to 1979). Because of the common belief that xerophthalmia is closely linked to malnutrition, and the fact that within the study itself, it was demonstrated that children with xerophthalmia had a much higher prevalence of malnutrition than normal children, the relationship between the prevalence of malnutrition and the prevalence of xerophthalmia was explored. Using two different statistical approaches the prevalence of malnutrition within a community could not be demonstrated to be a good predictor of the prevalence of xerophthalmia within that community.

Polychlorinated biphenyl contamination of nursing mothers' milk in Michigan.

The problem of environmental contamination by toxic substances and human exposure to these substances has attracted increased attention in recent years. Particular concern has centered on polychlorinated biphenyls (PCBs), which have become widespread environmental pollutants as well as contaminants of the human population. This paper reports data from a study of PCB contamination of nursing mothers' breast milk in Michigan.

Effect of investments in water supply and sanitation on health status: a threshold-saturation theory.

A general theory on the relationship between water supply and sanitation investments and health, the threshold-saturation theory, is proposed. The theory takes into consideration three variables: health status, socioeconomic status, and sanitation level, and attempts to encompass, for the first time in one general theoretical framework, numerous conflicting empirical findings. The two-tiered S-shaped logistic form of the relationship that is proposed assumes that at the lower end of the socioeconomic spectrum there is a threshold below which investments in community water supplies and/or excreta disposal facilities alone result in little detectable improvement in health status.