Intracerebroventricular Oxytocin Self-Administration in Female Rats.

Oxytocin (OT) is a neuromodulator that facilitates pair-bonding, maternal care and social approach. OT is considered to promote these social behaviours by enhancing the salience and reinforcing effects of relevant social stimuli. There is the additional possibility that OT per se may be rewarding. To test this, we investigated whether female rats would voluntarily self-administer OT. Female Long-Evans rats were ovariectomised and then received an oestrogen implant and an i.c.v. cannula. Rats were tested in an operant chamber with active and inactive levers. They were initially tested for 4 h/day on a fixed-ratio 5 schedule for self-administration of artificial cerebral spinal fluid (aCSF) for 5 days, followed by aCSF, or OT, at 1 or 10 ng/µl for another 5 days. Rats self-administering aCSF made 36.2 ± 6.2 active lever responses/4 h versus 14.9 ± 3.4 inactive responses. Responses for 1 ng/µl OT were similar. However, rats self-administering 10 ng/µl OT made significantly more active lever responses (67.8 ± 12.0 per 4 h), and received 121.4 ± 21.0 ng OT/4 h. To determine whether reduced anxiety contributes to the reinforcing effects of OT, rats received an infusion of aCSF or OT at 0.3 or 3.0 µg immediately before testing on the elevated plus maze. There was no effect of OT on anxiety as reflected by percentage time spent on the open arms, as well as no effect of OT on locomotion as measured either by the number of closed arm entries or the number of total arm entries. These results suggest that OT may be rewarding, and that this is not a result of the anxiolytic effects of OT.

Disseminated actinomycosis with spinal cord compression: report of two cases.

We studied two patients with vertebral actinomycosis and symptoms of spinal cord compression. Both patients had a chronic illness characterized by multiple draining skin lesions, weight loss, and progressive leg weakness. They responded to antibiotic therapy and corticosteroids without neurosurgical intervention. The patients were treated with antibiotics for 12 months, and remained well, without major neurologic disorder, for 2 years after stopping medication.

Surveillance for equity in maternal care in Zimbabwe.

The great hope and promise of post-independence efforts to promote equitable health care in Zimbabwe started with three years of dramatic improvement. Commitment to correcting inequities which were as discriminatory as any country in the world produced rapid extension of health centre infrastructure and the improvement of district hospitals. The major constraint was the entrenched pattern of sophisticated, high-technology health care left by colonial administrators which continued to monopolize resources. In spite of the excellent beginning, development of services for the poor was thwarted by recession, prolonged drought and external military destabilization. The cutbacks in funding for health care have been particularly severe as a result of economic adjustment policies imposed by IMF. Political pressure moved the health system toward private entrepreneurship returning to earlier patterns of discrimination in favour of whites and urban residents. Efforts to promote high-risk monitoring have had little impact among the poor and those living in remote areas. Equity has become symbolic rather than real. The government of Zimbabwe maintains a continuing commitment to the original goals of equity through primary health care. International agencies also would like to find a way to help reallocate services. There seems to be recognition that little will be accomplished in improving health conditions unless services are provided to those in greatest need. Disparities in maternal care are especially severe and can be improved only by building infrastructure to provide antenatal and perinatal services.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: Zimbabwe adopted the goal of equity in health care. A range of options for monitoring progress toward equity is available. Surveillance systems for monitoring equity characteristically are population-based. Population-based information can be used to identify priority subgroups, corrective action, and appropriate research questions. Equality of access and other social and health factors can be used to measure equity. Surveillance should stimulate community action. Self-financing health systems are appropriate only for those who can afford it. Public acceptance of equity requires social changes in attitudes. Cooperative relations between health services and local academic centers can contribute to local problem solving. Implementing a surveillance system for equity involves first conducting a Situation Analysis and setting priorities. Priority should be on carefully selected indicators. A list of biomedical, socioeconomic, and service indicators was provided. After independence in Zimbabwe some improvement was made in maternal mortality, infant mortality, and malnutrition. After independence, primary health care was promoted, but severe economic problems and the structural adjustment policies resulted in severe cuts to the social services. By 1987 there were 274 rural health centers, but funding was still lopsided in favor of curative care. Health center deliveries increased, but after a fee increase in 1988, there were declines. There was a shift to private medical care in urban areas. Inequities in health manpower were corrected by training health workers and reorienting the emphasis to prevention and health promotion. The number of deliveries with trained medical personnel and deliveries in health facilities increased by 1988. Immunization increased, albeit unevenly in poorer areas. Services for the poor were thwarted by recession, prolonged drought, and external military destabilization. Equity is only a symbol, unless a surveillance system can be established as a means of using limited resources to reach the most in need with targeted services.

Legionnaires' disease in Vermont, May to October 1977.

Thirty-two confirmed and 24 highly probable cases of Legionnaires' disease occurred in Vermont between May 1 and Oct 15, 1977. Confirmed cases had positive results for direct fluorescent antibody testing of lung tissue or fourfold rise in antibody titer. Highly probable cases had one elevated titer (greater than or equal to 1:256) and a compatible illness. Forty-eight (86%) had underlying chronic disease, and 22 (39%) were immunocompromised. Prominent early symptoms were fever, cough, chills, and malaise. All but one patient had verified pneumonia. Courses ranged from a pneumonia not requiring hospitalization to respiratory failure necessitating support with mechanical ventilation. Seventeen patients died. Although the clinical presentation was variable, rapid development of high fever and leukocytosis together with negative cultures of lower respiratory tract secretions strongly suggested the diagnosis in an epidemic setting.

The Vermont epidemic of Legionnaires' disease.

Sixty-nine laboratory-documented cases of Legionnaires' disease occurred in Vermont between 1 May and 31 December 1977. Clinical manifestations were similar to those in the 1976 Philadelphia epidemic. Case-control studies suggested that Legionnaires' disease patients were more likely to present with headache or diarrhea than were patients with pneumonia of presumed nonbacterial cause. The case-fatality ratio for patients treated with erythromycin was 4%, compared with 17% in patients not treated with erythromycin. Thirteen patients had been hospitalized throughout the 10 days preceding onset of illness, equaling the maximal known incubation period. This suggests either acquisition or reactivation of infection in the hospital. However, even during the week of peak disease activity, cases occurred in patients with no recent hospital contact. The only community factor possibly associated with acquisition was home air conditioning. This prevalence of seroreactivity to the Legionnaires' disease bacterium in various community populations was as high as 26%, suggesting a possible endemic area.

Quality assurance management methods applied to a local-level primary health care system in rural Nigeria.

Introduction. Management of primary health care (PHC) systems in less developed countries is often impeded by factors such as poorly trained personnel, limited financial resources, and poor worker morale. This study explored the ability of local-level PHC supervisors in rural Nigeria to use quality assurance (QA) management methods to improve the quality of the PHC system. Methods. PHC supervisors from Bama Local Government Area were trained for 3 days in the use of QA methods and tools. The supervisors targeted the supervisory system and the health information system (HIS) for improvement. Health worker performance in diarrhoea case management was assessed, using a simulated case, to measure the impact of supervision. A HIS audit assessed data collection forms used by 17 PHC facilities. Gaps in quality were monitored over a 2-month study period and flaws in work processes were modified. Results. PHC supervisors introduced a checklist during monthly visits to facilities to monitor how workers managed cases of diarrhoea. Performance in history-taking, physical examination, disease classification, treatment and counselling improved over the evaluation period. The HIS audit found that a variety of reporting forms were used at PHC facilities. After HIS reporting was standardized, the number of health facilities using a daily disease registry significantly improved during the study period. Conclusions. QA management methods were used by PHC supervisors in Nigeria to improve supervision and the HIS. QA management methods are appropriate for improving the quality of the PHC in Nigeria and in other less developed countries where at least a minimal PHC infrastructure exists.

Effect of nitrogen dioxide exposure on susceptibility to influenza A virus infection in healthy adults.

The effect of NO2 exposure and human susceptibility to respiratory virus infection was investigated in a placebo-controlled, randomized, double-blind trial conducted in an environmentally controlled research chamber over 3 yr. Healthy, nonsmoking, young adult volunteers who were seronegative to influenza A/Korea/82 (H3N2) virus were randomly assigned to breathe either filtered clean air (control group) or NO2 for 2 h/day for 3 consecutive days. The NO2 concentrations were 2 ppm (Year 1), 3 ppm (Year 2), and 1 or 2 ppm (Year 3). Live, attenuated cold-adapted (ca) influenza A/Korea/82 reassortant virus was administered intranasally to all subjects immediately after the second exposure. Only one of the 152 volunteers had any symptoms; this person had a low grade fever. Pulmonary function measurements and nonspecific airway reactivity to methacholine were unchanged after NO2 exposure, virus infection, or both. Infection was determined by virus recovery, a fourfold or greater increase in serum or nasal wash influenza-specific antibody titers, or both. The infection rates of the groups were 12/21 (2 ppm NO2) versus 15/23 (clean air) in Year 1, 17/22 (3 ppm NO2) versus 15/21 (clean air) in Year 2, and 20/22 (2 ppm) and 20/22 (1 ppm) versus 15/21 (clean air) in Year 3. Each group exposed to 1 or 2 ppm NO2 in the last year became infected more often (91%) than did the control group (71%), but the differences were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Sporadic community-acquired Legionnaires' disease in the United States. A case-control study.

One hundred patients with sporadic, community-acquired, serologically confirmed Legionnaires' disease were matched with control subjects known by the patients (acquaintance controls) and control subjects chosen from among patients with negative serodiagnostic tests for Legionnaires' disease (clinical controls). Each clinical control subject was also matched with an acquaintance control of his own. Legionnaires' disease patients had smoked more cigarettes, consumed more alcohol, and were more likely to have resided near excavation sites than acquaintance or clinical control subjects. Parallel differences between clinical controls and their acquaintances were not seen. Legionnaires' disease patients had traveled away from home for more time during the 2 weeks before onset of illness than had their acquaintances. The difference was of greater magnitude than that between clinical control subjects and their acquaintances. Legionnaires' disease patients were more likely to have resided near construction sites than clinical controls, and there were more construction workers among patients than among clinical control subjects.