Health care, information needs, and outreach: reaching Ohio's rural citizens.

As a rural state, Ohio has a vital interest in addressing rural health and information needs. NetWellness is a Web-based consumer health information service that focuses on the needs of the residents of Ohio. Health sciences faculty from the state's three Carnegie Research I universities--University of Cincinnati, Case Western Reserve University, and The Ohio State University--create and evaluate content and provide Ask an Expert service to all visitors. Through partnerships at the state and local levels, involving public, private, commercial, and noncommercial organizations, NetWellness has grown from a regional demonstration project in 1995 to a key statewide service. Collaboration with public libraries, complemented by alliances with kindergarten through twelfth grade agencies, makes NetWellness Ohio's essential health information resource.

Promoting women's health via the World Wide Web.

Women, as a segment of society at risk for chronic illnesses and complications from normal life events, such as pregnancy and menopause, are seeking information to improve their health status. One tool on the World Wide Web provided by a team of Ohio health care providers, including nurses, physicians, pharmacists, and dietitians, is the Ask an Expert feature of NetWellness. Designed as a consumer health information resource, NetWellness (www.netwellness.org) also is a valuable tool to health care professionals.

A model for enhancing worldwide personal health and wellness.

Individuals must increasingly take control of managing their own health affairs. This requires access to quality information that is not easily obtained from traditional social institutions. NetWellness is an electronic consumer health information service that provides a model for reaching the goal of enhancing personal health and quality of life. [1] We present a vision of consumer health information delivery in the 21st century, and a model for reaching that vision. Our experience to date, progressing through a five-phase model, is aimed at providing the best health information possible to the widest population possible.

An electronic consumer health library: NetWellness.

NetWellness is a community-based, consumer-defined grant program supporting the delivery of electronic health information to rural residents of southern Ohio and urban and suburban communities in the Greater Cincinnati tri-state region. NetWellness is a collaboratively developed and publicly and privately funded demonstration project. Information is delivered via ISDN, standard dial, dedicated network connections, and the Internet. TriState Online (Greater Cincinnati's Free-Net) and other southern Ohio Free-Nets are key access points in the larger project communities. The other access points are more than forty workstations distributed at public sites throughout the project's primary geographical area. Design strengths and limitations, training initiatives, technical issues, and the project's impact on medical librarianship are examined in this paper. Also discussed are ways of determining community needs and interest, building political alliances, finding and developing funding sources, and overcoming technical obstacles. NetWellness's Internet address is: http:@www.netwellness.org.

Aortitis with dissection complicating systemic lupus erythematosus.

A 31 yr old female under treatment for systemic lupus erythematosus complained of episodes of atypical chest pain radiating to the back. Subsequently she suddenly collapsed and died. Post mortem revealed a well-defined, localized area of non-giant cell aortitis extending from the supra-aortic ridge of the aortic valve to the ligamentum arteriosum. Active arteritis with fibrinoid necrosis and obliterative endarteritis of vasa vasorum had resulted in multiple infarcts of differing ages with associated inflammation and disruption of the aortic wall, culminating in aortic dissection and cardiac tamponade.

Dengue in the northern region of Queensland, 1981-1982.

During the dengue epidemic in northern Queensland in 1981 and 1982, type I dengue was serologically confirmed in 196 patients (mean age, 32.2 years) from the Cairns district. The most common symptoms were fever (99%), headache (92%), rash (91%), myalgia (93%), skin itching (75%) and arthralgia (60%). Haemorrhagic manifestations were noted in 14 patients. Most only showed skin petechiae. One patient also had bleeding from the gastrointestinal and urinary tracts. No cases of shock were recorded. Leucopenia was present in 57% of patients. A discussion on the relevance of these findings to dengue haemorrhagic fever/dengue shock syndrome is included. A serological survey after the epidemic suggests that approximately 7% of the population have antibodies to dengue as a result of the recent epidemic.

Melioidosis in Far North Queensland. A clinical and epidemiological review of twenty cases.

During the last 4 years, 20 cases of clinical melioidosis were diagnosed in the geographical area between Tully and Thursday Island. Sixteen were diagnosed by culture of Pseudomonas pseudomallei, and four by positive serology with appropriate clinical features. Most cases occurred during or after a heavy wet season. All patients were adult, and males predominated. Farmers and stockmen represented predisposed populations due to their prolonged soil contact. Ten patients were white Australians, six were Aborigines and four were Torres Strait Islanders. Twelve cases were first diagnosed by positive blood culture and four by sputum culture. The primary site of infection was pulmonary in 14 cases, genitourinary tract in one case, subcutaneous tissues in one case, and joints in two cases. In cases of fulminating infection metastatic abscesses were commonly found in many organs; typically lungs, liver, kidneys and spleen. Six patients had acute fulminating disease and died. Fourteen patients successfully responded to appropriate therapy, but relapse occurred in three, all of whom had an alcohol problem and showed poor drug compliance. The presence of diabetes mellitus in six patients confirmed the important known association of these two diseases. In three fulminating and four subacute infections the serology was negative at the time of diagnosis by culture. Antibiotic therapy for the different forms of this disease is reviewed, and a laboratory protocol for the rapid reporting of positive culture results is included.

The prevalence of human melioidosis in Northern Queensland.

Sera from 9,047 individuals from Northern Queensland were examined for the presence of hemagglutinating antibodies to Pseudomonas pseudomallei, the causative agent of melioidosis, and 512 (5.7%) were found to have titers of 1:40 or greater. The distribution of positive reactors in various groups was uneven, and significantly higher prevalences of positive antibody titers were found in the sera from Aborigines (7.9-10.6%), Torres Strait Islanders (7.8%), Vietnamese refugees (29%) and from persons with certain medical conditions including chronic alcoholism (15%), chronic infections (14.8%), diabetes mellitus (8.6%) and liver disease (12.9%). There were significantly fewer positive reactors (1.4%) amongst the armed forces stationed in Northern Queensland. At present, the boundaries of the major endemic region of Australia extend north from Rockhampton along the coast to Darwin and inland, west from Rockhampton to Tennant Creek in central Australia. Townsville was found to have the highest prevalence (5.2%) of positive reactors of all urban populations of Northern Queensland. The extent of the disease is such that it can no longer be considered a rare infection in Northern Queensland.

A case of premature labour due to Campylobacter jejuni infection.

A case history is described in which premature labour was thought to have been caused by chorioamnionitis secondary to infection with Campylobacter jejuni. The pathogenicity of this organism in the perinatal period and in pregnancy is discussed. Campylobacter species are known to cause abortion and stillbirth in cattle and sheep. The present case report supports previous evidence that Campylobacter jejuni can cause infection in utero and perinatally in man, leading to abortion and preterm labour. Sporadic accounts of case histories similar to the present have appeared in the literature, but the incidence and epidemiology of this infection in obstetric patients is still unclear.

Haemorrhagic manifestations with Sindbis infection. Case report.

Sindbis infection in man occurs rarely in Australia. Most recorded cases are either asymptomatic or result in a fever sometimes accompanied by a macular or vesicular rash. This case is of particular interest because of the severe haemorrhagic vesicular rash and the repeated recurrence of symptoms over a 5 month period together with the persistence of IgM antibodies to Sindbis virus.

Epidemic polyarthritis in northeastern Australia, 1978-1979.

In a study of epidemic polyarthritis in central and northern Queensland, clinical disease was observed most frequently in urban-dwelling adult females. Clinical and subclinical infections were detected year round, although the majority of clinical infections occurred between the months of January and June. In the communities studied, there were approximately 50 subclinical infections for each clinical infection. There was no detectable association between any HLA-A or HLA-B phenotypes and epidemic polyarthritis.

Will fenced pools save lives? A 10-year study from Mulgrave Shire, Queensland.

No community has measured baseline child-drowning rates, introduced protective safety legislation, and then assessed its effectiveness. One unique community in Northern Australia, Mulgrave Shire, has implemented rigidly-policed pool safety legislation since 1960; a study of the child drowning profiles therein is reported here to given an estimate of the efficacy of safety legislation. No child has drowned in a fenced pool either in Cairns or in Mulgrave Shires over the 10-year period of the survey. For Mulgrave Shire, no child has drowned during 9200 pool-years. Comparative studies of two neighbouring Shires, with different safety legislation policies (both in absolute safety regulations, and the spirit with which they are prosecuted), indicate that fatal and near-fatal pool accidents can be cut by at least half if safety legislation is effective. Special dangers apply to pools in caravan parks and multiunit dwellings.

Extragenital granuloma inguinale in North Queensland.

Two cases of extragenital granuloma inguinale are presented. A 41-year-old female presented with fever, a swollen knee joint and osteolytic lesions involving distal bones, and a 49-year-old male had multiple faecal fistulae in the lower abdomen with extensive involvement of pelvic organs. The diagnostic difficulties presented by such cases and the various types of extragenital pathology that have been described in this disease are discussed.

Fulminating systemic infection caused by Vibrio cholerae species which does not agglutinate with 0-1 V. cholerae antiserum.

A case of fatal septicaemia caused by Vibrio cholerae which did not agglutinate with 0 group 1 V. cholerae antiserum is presented. The illness occurred in a 64-year-old Aboriginal woman from Aurukun Mission in Cape York. The organism was isolated from multiple blood cultures and urine during life, and froma a large hepatic abscess found post mortem. The pathogenicity and epidemiology of the organism is discussed.

Non-toxigenic Corynebacterium diphtheriae causing subacute bacterial endocarditis: case report.

This is the case report of a 13-yr-old European child from a boarding school at Herberton, on the Atherton Tableland, who developed subacute bacterial endocarditis, with 6 blood cultures at different times growing a non-toxigenic strain of Corynebacterium diphtheriae.