A cluster of meningococcal disease on a school bus following epidemic influenza.

An outbreak of meningococcal disease among children on a school bus offered the opportunity to study a proposed association between this infection and preceding influenza infection. Five students who rode the bus became ill with invasive group C meningococcus. Transmission was limited to the bus; there was no evidence for school transmission. All five students reported influenza-like symptoms within several weeks before the development of meningococcal disease. School absenteeism, principally due to upper respiratory tract illness, was higher during the 3 weeks before the outbreak of meningococcal disease than during any period in the preceding 3 1/2 years, suggesting an unusually severe outbreak of respiratory illness. A case-control study comparing students with and without influenza symptoms revealed that the outbreak of respiratory disease was due to B/Ann Arbor/1/86 influenza (geometric mean titers, 86 for 80 patients and 33 for 47 controls [P = .0007]). These data add to the evidence suggesting that influenza respiratory infection predisposes to meningococcal disease.

Outbreak of Legionnaires' disease associated with a display whirlpool spa.

BACKGROUND: Recognized outbreaks of Legionnaires' disease (LD) are rare; when they occur, they provide opportunities to understand the epidemiology of the illness and improve prevention strategies. We investigated a population-based outbreak. METHODS: After the confirmation of LD in October 1996 in five people in neighbouring towns in southwest Virginia, active surveillance for additional cases was undertaken. A case-control study was conducted to identify exposures associated with illness, followed by a cohort study among employees of the facility at which the source of the outbreak was located in order to assess unrecognized exposure and illness. Samples of likely sources of LD in the facility were cultured for LEGIONELLA: RESULTS: In all, 23 laboratory-confirmed cases of LD were eventually identified. Of the 15 cases in the case-control study, 14 (93%) reported visiting a home-improvement store, compared with 12 (27%) of 45 controls (matched odds ratio [MOR] = 23.3; 95% CI : 3-182). Among home-improvement centre patrons, 10 (77%) of 13 cases questioned recalled either visiting or walking by a display whirlpool spa, compared with 3 (25%) of 12 controls (MOR = 5.5; 95% CI : 0.7-256.0). Two cases' sputum isolates were an exact match, by monoclonal antibody subtyping and arbitrarily primed polymerase chain reaction, to a whirlpool spa filter isolate from the store. Employees reporting more exposure to the display spas were more likely to report symptoms of LD or to have an elevated titre. CONCLUSIONS: This investigation shows that LD can be transmitted from a whirlpool spa used for display only, and highlights the need for minimizing the risk of transmission of LD from all water-filled spas. Key messages This paper describes an investigation of a population-based outbreak of Legionnaires' disease (LD). A case-control study first identified a home-improvement store as the likely source of the outbreak. An environmental investigation later confirmed that finding, as two cases' sputum isolates were an exact match, by monoclonal antibody subtyping and arbitrarily primed polymerase chain reaction, to a whirlpool spa filter isolate from the store. The spa was intended and used for display only.

Need for power and women's careers over 14 years: structural power, job satisfaction, and motive change.

Previous findings by D. G. Winter (1988) relating the need for Power to choice and attainment of power-relevant careers (teaching, including college; psychotherapy; journalism; and business management) were successfully replicated among 118 female collage seniors, 69 of whom returned mailed questionnaires 14 years later. High n Power women reported both more power-relevant job satisfaction and dissatisfaction; n Power predicted career progression only for women in power-relevant careers. Those women holding relational power jobs and those in structural power roles who reported higher overall job satisfaction increased in n Power over 14 years. Power-motivated women in different structural power roles reported contrasting satisfactions and career progression.

Need for achievement and women's careers over 14 years: evidence for occupational structure effects.

Previous research has demonstrated that achievement-motivated people perform better under working conditions of challenge, autonomy, and rapid feedback. These achievement-congenial conditions characterize entrepreneurial business and, among those occupations traditionally filled by women, teaching. Achievement motivation was measured in 117 women as college seniors and again 14 years later. Senior-year achievement motivation predicted later employment in teaching (including college). Career-involved women who had been highly achievement-motivated in college valued status mobility and working with people and reported job satisfaction from competition with a standard of excellence; however, women in different career situations differed in the relations between their achievement motivation in college and their later work values, job perceptions, and sources of satisfaction. Women highly achievement-motivated in adulthood valued achievement-congenial working conditions and status mobility and described job satisfaction from competition with a standard of excellence, especially if they were supervisors. Professors and businesswomen showed larger increases in achievement motivation over 14 years than did women otherwise employed. Thus, achievement motivation predicts women's career outcomes when their values and work situations, along with sex-differentiated occupational structures, are considered. Occupational structure effects on motives over time are discussed.

Feeling Indecent: Breast Cancer Screening Resistance of Mexican-descent Women.

This grounded theory study investigated how Mexican-descent women's traditional cultural beliefs, values, and norms regarding the propriety of their behavior and that of their health care providers influence their decision to participate in breast cancer screening. Thirty-four women (aged 49-81 years old) were interviewed in five focus groups using theoretical sampling across levels of acculturation and socioeconomic status. We discovered that the women's basic social-psychological problem is that screening is an insensitive procedure that violates their cultural standards by requiring inappropriate behavior. The risk involved is 'feeling indecent' since both touching one's breast and breast exposure to health care providers is prohibited according to cultural norms for respectable female behavior. Thus, women resist participating in breast cancer screening to avoid feeling indecent.

Food supply, grazing activity and growth rate in the limpet Patella vulgata L.: a comparison between exposed and sheltered shores.

The limpet Patella vulgata L. is an important microphagous grazer on intertidal rocky shores of north-west Europe, occurring across the wave exposure gradient. Groups of P. vulgata were selected at mid-tide level of two exposed shores and two sheltered, fucoid dominated shores on the Isle of Man, British Isles, and manipulated to equivalent densities and population structure. The level of grazing activity and growth rate were determined over a 1-year period. At the same time, the abundance of epilithic microalgae, measured as the concentration of chlorophyll a, was determined as an estimate of food supply. Microagal abundance showed a seasonal pattern in both exposed and sheltered conditions, with higher levels in winter compared to summer. In both seasons, the microalgal resource was more abundant on the sheltered shore studied. The level of grazing activity in P. vulgata showed a seasonal pattern on the exposed but not the sheltered shores. Averaged over the year, grazing activity on the exposed shores was over double that on sheltered shores. Thus, in sheltered conditions, food supply for limpets was high and grazing activity low; in exposed conditions, food supply was low and grazing activity high. The growth rate of P. vulgata, measured as increase in shell length, showed no significant difference between exposed and sheltered shores. Growth rate was also determined in P. vulgata at natural densities. Although the overall density declined with decreasing exposure to wave action, the density per unit area of grazeable substance was higher in shelter. In these populations, the mean growth rate was over twice as high on exposed compared to sheltered shores.

Epidemiology of raccoon rabies in Virginia, 1984 to 1989.

Geographical and temporal trends in reports of rabid raccoons (Procyon lotor) in Virginia were summarized for 1984 to 1989; 3,256 raccoons were submitted for rabies testing, of which 1,053 (32.3%) had rabies. Both the absolute number of rabid raccoons and the percent of rabid raccoons (number rabid divided by number submitted) were examined for seasonal and yearly trends. Geographically, the epidemic moved eastward and southward in the state. The seasonal trend showed bimodal peaks in late winter and early fall and a seasonal low in summer. The percent of rabies positive raccoons peaked 1 mo earlier than the absolute number of rabies positive raccoons. The peak in the number of rabies positive raccoons occurred in 1987, while the percent of rabies positive raccoons peaked in 1986. These trends were used to recommend timing and placement of oral vaccine as one strategy to control raccoon rabies in wildlife.

A study of techniques for the distribution of oral rabies vaccine to wild raccoon populations.

This study evaluates a technique for delivering an oral rabies vaccine to wild raccoon (Procyon lotor) populations. Various baits and attractants were first tested on caged raccoons and baiting trials were then conducted in two distinct physiographic regions of Virginia (USA), the coastal plain and the Piedmont plateau. Raccoon population density studies preceded the field trials. Each polyurethane sponge bait distributed contained approximately 200 mg tetracycline as a tissue biomarker, and was presented in an outer bag with a fish-based attractant. Baits were frozen until used and distributed from an aeroplane throughout two 4-km2 sites in each region. One site received 450 baits/km2 and the other 120 baits/km2. Postbaiting evaluation included the direct observation of baits in the field and the examination of teeth and bone from trapped and hunted animals for evidence of the biomarker. Between 30% and 73% of the captured animals showed evidence of bait consumption. The proportion of animals with evidence of bait uptake changed when areas adjacent to the actual baiting site were included. The percentage of animals taking baits was not related to the density of baits that were distributed.

Rabies in rodents and lagomorphs in the United States, 1971-1984: increased cases in the woodchuck (Marmota monax) in mid-Atlantic states.

A review of surveillance data on animal rabies from the Centers for Disease Control revealed 104 cases of rabies in rodents and lagomorphs for 1971 through 1984 in the United States; 80% of these were reported between 1980 and 1984. Woodchucks (Marmota monax) accounted for 64% of the cases. Most of the cases of rabies in woodchucks were associated with an epizootic of rabies in raccoons (Procyon lotor) in the mid-Atlantic states. In rabies endemic areas, humans exposed to woodchucks should receive rabies postexposure prophylaxis if the animal is not available for testing. The decision to administer postexposure prophylaxis to humans exposed to other rodents and lagomorphs should take into consideration the epidemiology of rabies in the exposing species.

Acceptance of simulated oral rabies vaccine baits by urban raccoons.

In summer 1986, a study was conducted to evaluate raccoon (Procyon lotor) acceptance of oral baits that could be used for rabies vaccination. One thousand wax-coated sponge bait cubes were filled with 5 mg of a seromarker (iophenoxic acid), placed in polyethylene bags, and hand-distributed in an 80 ha area within an urban National Park in Washington, D. C. (USA). After 3 wk, target and nontarget animals were trapped and blood samples collected to evaluate bait uptake. Thirty-three of 52 (63%) raccoons had elevated blood iodine levels indicating they had eaten at least one bait, 13 (25%) were negative, and six (12%) had marginal values. These results indicate that sponge baits hand-placed at a density of 12.4/ha can reach a significant proportion of an urban raccoon population. Implications for oral rabies vaccination of raccoons are discussed.

Existential hazards of the multicultural individual: defining and understanding "cultural homelessness".

Cultural homelessness (CH) is the authors' term to describe unique experiences and feelings reported by some multicultural individuals. Ethnically related concepts found in the cross-cultural and multiethnic literature (e.g., marginality, intercultural effectiveness, ethnic enclaves, reference group) are used to explain how CH may arise from cross-cultural tensions within the ethnically mixed family and between the family and its culturally different environment, especially due to geographic moves. CH is conceptualized as a situationally imposed developmental challenge, forcing the child to accommodate to contradictory and changing norms, values, verbal and nonverbal communication styles, and attachment processes. Culturally homeless individuals may enjoy a broader, stronger cognitive and social repertoire because of their multiple cultural frames of reference. However, code-switching,complexities may lead to emotional and social confusion, which, if internalized, may result in self-blame and shame. Culturally encoded emotion labeling may be disrupted, leading to alexithymia.

Feeling healthy: so why should Mexican-descent women screen for breast cancer?

Mexican-descent women are at particular risk of late-stage breast cancer diagnosis by being the least likely of the major U.S. Hispanic subgroups to undergo breast cancer screening. This grounded theory study investigated how cultural health beliefs regarding the causes and nature of breast cancer influence women's decision to participate in screening. Thirty-four women (age 49 to 81) were interviewed in five focus groups using theoretical sampling across levels of acculturation and socioeconomic status. Analysis of the most prevalent cultural health beliefs led to a discovery that the core problem Mexican-descent women face is that they perceive there is no reason to participate in breast cancer screening when they are "feeling healthy." In addition, women who subjectively and cognitively feel healthy and otherwise have no evidence of illness according to their cultural health beliefs are unlikely to risk feeling ill rather than healthy by seeking to discover breast cancer through screening.