Mixed-field neutrons and gamma photons induce different changes in ileal bacteria and correlated sepsis in mice.

High doses of radiation induce septicaemia, from bacterial translocation, and death in animals. Mice were exposed to either comparable lethal (LD90/30) or sublethal (LD0/30) doses of mixed-field [n/(n + y) = 0.67] or pure 60Co gamma-photon radiation. The relative biological effectiveness of these comparable doses of radiation was 1.82, determined by probit analysis. Mice given a lethal dose of mixed-field radiation developed a significant (p < 0.01), 10(9)-fold increase in Gram-negative facultative bacteria in their ilea over values in control mice. In contrast, mice given a lethal dose of gamma-photon radiation developed a significant (p < 0.01) increase in only Gram-positive bacteria in their ilea, while the number of Gram-negative bacteria remained near values in control mice. Data correlated with bacteria that were isolated and identified from the livers of mice that were given comparable lethal doses (LD99/30) of mixed-field or gamma-photon radiation. In sublethally irradiated mice, fluctuation in the total number of bacteria was detected in their ilea during the first week following irradiation, after which the number approximated the value in control mice. This difference in the predominant facultative bacteria in ilea resulting from different qualities of radiation has important implications for the treatment of septicaemic-irradiated hosts.

Survival of irradiated mice treated with WR-151327, synthetic trehalose dicorynomycolate, or ofloxacin.

Spaceflight personnel need treatment options that would enhance survival from radiation and would not disrupt task performance. Doses of prophylactic or therapeutic agents known to induce significant short-term (30-day) survival with minimal behavioral (locomotor) changes were used for 180-day survival studies. In protection studies, groups of mice were treated with the phosphorothioate WR-151327 (200 mg/kg, 25% of the LD(10)) or the immunomodulator, synthetic trehalose dicorynomycolate (S-TDCM; 8 mg/kg), before lethal irradiation with reactor-generated fission neutrons and gamma-rays (n/gamma=1) or 60Co gamma-rays. In therapy studies, groups of mice received either S-TDCM, the antimicrobial ofloxacin, or S-TDCM plus ofloxacin after irradiation. For WR-151327 treated-mice, survival at 180 days for n/gamma=1 and gamma-irradiated mice was 90% and 92%, respectively; for S-TDCM (protection), 57% and 78%, respectively; for S-TDCM (therapy), 20% and 25%, respectively; for ofloxacin, 38% and 5%, respectively; for S-TDCM combined with ofloxacin, 30% and 30%, respectively; and for saline, 8% and 5%, respectively. Ofloxacin or combined ofloxacin and S-TDCM increased survival from the gram-negative bacterial sepsis that predominated in n/gamma=1 irradiated mice. The efficacies of the treatments depended on radiation quality, treatment agent and its mode of use, and microflora of the host.

Impact of a pharmacist/physician cooperative target drug monitoring program on prophylactic antibiotic prescribing in obstetrics and gynecology.

The pharmacist's role in promoting rational, cost-effective use of drugs has been described in the literature. In a target drug monitoring program (TDMP), a single agent or group of agents becomes targeted for review. Antibiotics have been the primary focus of TDMP because of their therapeutic impact and cost considerations. The objectives of this project were to assess the prophylactic antibiotic prescribing habits of OB/GYN physicians and to evaluate the impact of a pharmacist/physician cooperative TDMP on prophylactic antibiotic prescribing and cost. The study was conducted in three phases: 1) a retrospective chart review of 150 patients, 2) an in-service education session, and 3) a concurrent chart review of 107 patients. Patient selection, timing of preoperative dose, and use of single dose prophylaxis were according to criteria in greater than 90% of patients both before and after the in-service training. Compliance with recommended regimens increased from 45 to 73% after the in-service training. A cost savings was not realized because the physicians wished to use a regimen with anti-anaerobic coverage (i.e., cefotetan) rather than a less expensive agent. However, the cost of selection of resistant organisms must be considered when discouraging the use of multiple broad spectrum agents. Active involvement of the medical staff in a pharmacy-based TDMP produces a cooperative atmosphere in which to educate clinicians and promote rational prescribing habits.

Guinea worm disease in Northern Uganda: a major public health problem controllable through an effective water programme.

A modified cluster survey was conducted in northwestern Uganda in 1984 to provide descriptive epidemiological data on dracunculiasis in a water programme target area. A total of 2014 people participated from 58 randomly selected clusters. Interviewers elicited information on age and sex of household members, number, date of emergence and location of Guinea worms, and type of and distance from water source in an endemic area. The survey yielded an incidence rate of 193 cases/1000 people per year, and a prevalence rate of 43 active cases/1000. Respondents who reported using ponds, reservoirs, valley tanks or rivers as their primary water source had the highest attack rates; those using boreholes, the lowest. Adolescents and adults differed little in risk, but the disease was less common among young children. Guinea worm disease displayed a bimodal seasonal pattern. We concluded that the survey method used for determining dracunculiasis incidence was appropriate in this setting. The incidence of this disease may be significantly reduced in Uganda through the country's commitment to the International Drinking Water Supply and Sanitation Decade.

Estimating health service utilization, immunization coverage, and childhood mortality: a new approach in Uganda.

PIP: Interviews were conducted in the 75 households nearest to each of the 36 rural health facilities in Uganda's Mbale District in order to estimate childhood morbidity/mortality and the utilization of health services. Data were obtained on 2596 children under 5 years of age. There were 50 deaths in the 527 live births in the 12 months preceding the survey, giving an infant mortality rate of 95/1000. There were an additional 51 deaths among the 2069 children 1-4 years of age (25/1000). 34% of deaths among infants and 69% of deaths among children 1-4 years of age were associated with diarrhea. Of the 2495 children 0-4 years of age who were alive at the time of the survey, 506 (20%) had diarrhea in the 2 weeks preceding the survey and there was a diarrhea morbidity rate of 3.2 episodes/year/child. Only 60 (12%) of the children with diarrhea were treated with some form of oral rehydration; 314 (62%) were given drugs obtained from local pharmacies. Finally, only 38% of children 1-4 years of age and 21% of infants under 1 year of age were fully immunized for their age. These findings suggest high rates of childhood mortality and underutilization of preventive health services among households in the immediate vicinity of health facilities. This research approach can be used to facilitate program evaluation, even though the results cannot be generalized to the entire population of the district. It provides local health workers with an opportunity to assess their community's health needs and motivates them to improve health care delivery.^ieng

Comparative nutrition and health services for victims of drought and hostilities in the Ogaden: Somalia and Ethiopia, 1980-1981.

The civil chaos created by a combination of drought and hostilities in the Ogaden region of southern Ethiopia during the past five years has caused the majority of the indigenous, principally nomadic population to flee the area and seek refuge either in Somali refugee camps or in Ethiopian shelters for displaced persons. This paper compares the provision of basic food rations, selective feeding programs, primary health care, and preventive health measures between the two groups. During 1980-1981 Somalia received more international assistance per capita than Ethiopia. Large numbers of Western personnel provided health and nutrition services in Somali refugee camps, whereas no foreigners were involved in Ethiopian shelters. These disparities were largely due to inadequate publicity concerning the problems Ethiopia faces, partly resulting from real and perceived political limitations related to the Soviet presence in that country. Refugee needs in Somalia have been publicized far more adequately, partly due to that country's alignment with the West. The Ethiopians nevertheless demonstrated greater efficiency in assisting their disaster victims; camp services comparable to those in Somalia were available despite greater logistic difficulties and fewer donated resources. The effectiveness of relief operations in Somalia was reduced by political constraints on governmental agencies.

Mortality, nutritional status, and diet during the famine in Karaomoja, Uganda, 1980.

Drought and the cattle raiding associated with a breakdown of civil order caused a famine in Karamoja, Uganda, during 1980. In November-December, 1980, a study of mortality, nutritional status, and dietary conditions was undertaken in south Karamoja. Of 309 randomly selected children less than or equal to 110 cm in height 4.8% had acute malnutrition (less than 80% reference median weight-for-height). Interviews in 150 randomly selected households revealed that the crude mortality rate and the infant mortality rate during the previous year were increased almost 5-fold and 10-fold, respectively, above 1969 census data. Food supplied by the World Food Program was eaten the previous day by only half the families which were not self-sufficient in food. Relief officials' hopes that the 1981 cereal harvest might end the dependence on international aid were tempered by reports of further drought. Agricultural yield and food supplies should thus be monitored to assess the need for more international aid.