Survey of food safety awareness among HIV positive individuals.

A survey was carried out by personal interview to assess the awareness of basic food hygiene and food safety amongst 77 HIV-positive individuals attending a single hospital. There was some confusion and lack of knowledge about aspects of food storage and despite the fact that 74% of subjects had modified their diet since learning their HIV status (mainly for nutritional reasons) only 25% reported receiving information on food safety. Of the subjects interviewed 96%, 66% and 23% were aware of the risks of infection from Salmonella, Listeria monocytogenes and Cryptosporidium, respectively; although most were not aware of the UK Government's advice on the consumption of eggs, soft cheese, pâté and cook-chill foods. Over 40% of those interviewed reported that they did not drink tap water (most drank bottled water instead), but few were aware of infections potentially transmitted through water. Although pets represent a potential source of a wide variety of infectious agents, there was a high level of awareness of this problem. This study highlights the need for improving the availability of information on food hygiene and infections acquired through food and water to HIV-positive individuals.

Legionnaires' disease surveillance: England and Wales, 1995.

One hundred and sixty cases of legionnaires' disease were reported to the PHLS Communicable Disease Surveillance Centre in 1995. Twenty cases (13%) were known to have died. Ninety cases (56%) were associated with travel (in the United Kingdom or abroad), four were associated with a stay in hospital, and the remaining 66 were presumed to have acquired infection in the community. One hundred and twenty-three cases (77%) occurred sporadically. Three community outbreaks and one outbreak at an industrial site were detected in England and Wales. One outbreak and five clusters were detected among visitors to Turkey, Spain, and Italy. Seven cases and one outbreak of nonpneumonic legionellosis were also reported. Cases of travel associated legionnaires' disease continue to account for the largest proportion of the total reported in 1995 and the number of hospital acquired cases continues to decline. A cause for concern in 1995 was a fall in the proportion of cases diagnosed by culture of the organism (from 16% in 1994 to only 9% in 1995). This corresponded with a small increase in the proportion of cases diagnosed solely by detection of antigen to L. pneumophila serogroup 1 in urine.

The changing clinical pattern of Reye's syndrome 1982-1990.

OBJECTIVE: To describe trends in the clinical pattern of Reye's syndrome in the British Isles between 1982 and 1990; and to determine the relation between any changes and the June 1986 warnings against the use of aspirin in children. DESIGN: Development, and application to reported cases, of a scoring system designed such that patients showing the typical clinical and pathological features of 'classical' Reye's syndrome scored highly. The relations between 'Reye scores' and a number of explanatory variables were explored using multivariable analysis. SETTING: British Isles. SUBJECTS: 445 cases fulfilling the Reye's syndrome case definition reported to the surveillance scheme between January 1982 and December 1990. MAIN OUTCOME MEASURE: Individual 'Reye score'. RESULTS: Cases with high scores were more likely to have occurred in the 4 1/2 year period before June 1986 compared with the subsequent period (p < 0.006). Numbers of cases in the low and intermediate score categories declined by about 50% after June 1986, whereas those in the high category fell by 79%. High scorers were more likely to have received aspirin (p < 0.0001) and were older than intermediate and low scorers (p < 0.008). No relation was identified between score and season of onset. CONCLUSIONS: The decline in Reye's syndrome after the aspirin warnings cannot be explained entirely, as has been proposed, by improved diagnosis of 'Reye-like' inherited metabolic and other disorders: this would not account for the greater decline of the high scoring subgroup which also contained those cases most likely to resemble 'classical' Reye's syndrome and to have received aspirin. This study provides further evidence for the role of aspirin in a subset of cases meeting the standard diagnostic criteria for Reye's syndrome and supports the need to consider this disorder as a heterogeneous group of conditions including Reye-like inherited metabolic disorders.

A survey of health education material for the primary prevention of congenital toxoplasmosis.

We have assessed health education material for the prevention of congenital toxoplasmosis in terms of its epidemiological and clinical information and preventive advice. Nineteen leaflets and booklets were evaluated: fourteen were produced locally, ten for patients and four for professionals; and five were distributed nationally, including two sponsored booklets and one produced by the Department of Health. Material was compared with 'standards' derived from recently published reviews of toxoplasmosis and the Department of Health's booklet. The amount of information about toxoplasmosis, and the advice on how to avoid it, differed widely. Some booklets contained factual errors and some of the advice was impractical and even hazardous. Booklets contained on average between a fifth and a half of the standard desired for epidemiological and clinical information and preventive advice. Leaflets devoted to toxoplasmosis were more informative than general guides. Presentation was assessed informally: medical terminology inappropriate for a 'lay' audience was used, booklets were published in English only, and the date of publication was not printed. Health education is an important means of primary prevention of disability caused by congenital toxoplasmosis. Our study suggests that it has not received the scientific appraisal and commitment needed to make it effective.

Survey of local policies for prevention of congenital toxoplasmosis.

District policies for the primary and secondary prevention of congenital toxoplasmosis in England, Wales, Jersey, and the Isle of Man were surveyed in 1992. Consultants in communicable disease control were asked to describe past, present, and proposed prenatal screening programmes and current health education policies. One hundred and eighty-seven out of 196 districts responded to a postal questionnaire. One district had a prenatal screening programme for toxoplasmosis and five were discussing possible programmes. Over half (55%) had never had a programme or considered introducing one and 68 (36%) districts had decided against screening. Fifty-four per cent of districts had health education policies on toxoplasmosis, and most of these provided leaflets in antenatal clinics. A sample of districts that in 1992 were considering or had not ruled out screening was followed up in February 1994. None had implemented a screening policy. All but one district, therefore, are following the recommendation by a working group of the Royal College of Obstetricians and Gynaecologists that prenatal screening for toxoplasmosis should not be introduced in the United Kingdom. The value of current health education policies in the primary prevention of congenital toxoplasmosis needs to be assessed.

Collective responsibility in health care.

Traditional medical ethics, developed to apply to the contingencies of individual fee-for-service medical practice, do not always seem to speak to the problems of the new forms and locations of health care: the medical team, the hospital, the organized health-care profession, and the society as a whole as guarantor of all health care and education. It is the purpose of this issue of The Journal of Medicine and Philosophy to articulate guidelines for describing and attributing responsibility for health care in these collective providers. This introduction attempts to provide the conceptual apparatus for a discussion of collective responsibility in health care, by the elucidation of the multiple meanings of "responsibility" and the articulation of three standard models for collective responsibility. In the light of these models, the question is put: can the health-care professions and their various subunits and institutions accept and exercise moral responsibility for health care? Its importance is stressed, and its answer left to the contributors.

KIE: A conceptual approach to the attribution of responsibility within the collective bodies that provide health care is presented. The model of collective responsibility most applicable to health care systems is the authorization model within which a set of established rules delineates responsibility of individuals within the group. The author believes a developed structure of responsibilities in hospitals and within care teams should be implemented. Members of the health care professions are held responsible for the improvement of care within the practitioner's immediate situation rather than for the social problem of equity in the distribution of services.

Seasonal changes in malnutrition and diarrheal disease among preschool children in El Salvador.

The nutritional status of preschool children in a rural El Salvadoran population was assessed quarterly for 1 year using height, weight and arm circumference measurements in order to define seasonal changes in malnutrition. Seasonal patterns in the incidence of reported malnutrition and diarrheal disease from the local clinic serving the study population and on the national level for EL Salvador were also assessed and were compared with field measurements. Results indicated a similar seasonal increase in both measured malnutrition and in the reported incidence of malnutrition and diarrheal disease occurring at the onset of the rainy season. The results confirm the existence and indicate the magnitude of seasonal changes in malnutrition and diarrheal disease in a preschool population.

Surveillance projects for selected diseases.

Disease surveillance systems constitute the foundation of appropriate health plans. Surveillance data collection components at best are dependent on a series of contingencies. In developing countries scattered static health centres may result in biased and practically unusable data. A system is here described for collecting data from a sample of persons chosen for their statistical representation of the entire population. Monthly interviews can provide both prevalence and incidence data at low cost using paramedical personnel. Continuing work in this area could provide developing countries with alternative methods of defining their population-nutrition-communicable disease problems.

A prospective study of the effects of ultralow volume (ULV) aerial application of malathion on epidemic Plasmodium falciparum malaria. IV. Epidemiologic aspects.

In the Miragoane Valley of Haiti a consistent pattern in the incidence of Plasmodium falciparum malaria over a 10-year period made it possible to predict an annual outbreak and perform a prospective study to test the effects of aerial ultralow volume (ULV) malathion on epidemic levels of this disease. At the end of October 1972, after epidemic levels (100 cases/month/10,000 population) had been reached, spray operations were begun. The first spray cycle produced a sharp and immediate drop in populations of the vector Anopheles albimanus, followed 4 weeks later by a decrease in the incidence of malaria throughout the valley. Although the incidence of malaria was similar in sprayed and unsprayed areas prior to the effect of ULV malathion (176.1 and 198.7 cases/month/10,000 population, respectively), it was significantly different during the subsequent 3 months (16.8 cases/month/10,000 population in sprayed areas and 65.4 in unsprayed; p less than 0.001). Travel histories indicated that only 4% of all cases had spent a night away from home during the 4 weeks prior to onset of symptoms; therefore, we concluded that these incidence data represent malaria transmission in the valley. Results of the study indicate that aerial spraying of ULV malathion can interrupt epidemic transmission of P. falciparum malaria by a susceptible vector.