Preventative Care in the Patient with Inflammatory Bowel Disease: What Is New?

Patients with inflammatory bowel disease (IBD) do not receive routine preventative care at the same rate as general medical patients. This patient population is at increased risk of vaccine preventable illness such as influenza and pneumococcal pneumonia. This review will discuss health maintenance needs and preventative care issues in patients with IBD.

The MSMV hypothesis: measles virus and multiple sclerosis, etiology and treatment.

Multiple sclerosis (MS) is a progressive disease characterised by periods of quiescence and exacerbation. It is found more often in northern and southern climates, rather than those closer to the equator, where it is especially rare, and, therefore, cannot be considered as an autoimmune disease. We present the MSMV Hypothesis, involving novel ideas which encompass an understanding of the blood brain barrier (BBB) function, the lymphocyte population, together with the viral presence in the CNS of what we are calling the multiple sclerosis measles virus (MSMV) that is the immediate cause of MS, and which exhibits a similar immunologic response of the systemic virus. We assume that the geographical distribution of MS is related to MSMV's sensitivity to ultraviolet light and that it is feasible to assume a viral etiology for MS based on this. The methodology employed is eclectic and grounded on several differing approaches: involved are the meta-analyses of two comprehensive studies on the effects of azathioprine in the treatment of a large number of MS patients undertaken since the early 1990s, a pioneering pilot study that examined the effects of azathioprine treatment on a smaller set of patients in the late 1960s; and, finally, we also outline the results of several experiments in cell culture on two MV strains using a new drug lead that has been shown to effectively stave off the progression of MS by interfering with the normal replication process of the MSMV. In the latter case, strain Edmonston (MV-E) was employed, along with strain Halle (MV-H), which was obtained from a lymph node of a patient with subacute sclerosing panencephalitis (SSPE), which mimics various aspects of the pathology of neurological diseases, including demyelination. An analogue of a metabolite of azathioprine (ESP) was evaluated for antiviral activity against these two viral strains. The results proved positive for the MV-H infected cells as syncytia formation was reduced in a dose-dependent manner, and under protocols which avoided toxic effects, following ESP treatment ranging from 66% with 1 microg/ml and to 25% with 0.1 microg/ml. Since ESP is an analogue of the active metabolite of azathioprine, which exhibits positive outcomes when administered to MS patients, we submit that this metabolite is acting on MSMV, in a similar fashion to the action of ESP on MV-H.

Response of parents to five killer diseases among children in a Yoruba community, Nigeria.

This paper examines the various ways through which adults' health beliefs and attitudes affect their responses to five major killer diseases during childhood. The data for the study were derived from in-depth interviews conducted between December 1988 and January 1989 in a Yoruba community, Nigeria. The diseases covered in the study include diarrhoea, measles, tetanus, pertussis and fever. It was observed that teething and food related causes were believed to be responsible for diarrhoea; the cause of measles and pertussis was generally unknown; tetanus was usually associated with convulsions; and fever was believed to be caused by roaming in the sun and by constipation. Herbal tea, modern drugs and prayers were the most commonly prescribed treatments for these diseases. It was observed that most mothers used alternative sources of health care, rather than hospitals, clinics and maternity centres, in their treatment of diseases among children. Prominent among the alternative sources were patent medicine stores where there were personalistic social interaction between clients and operators, free consultancy and flexible pricing. Parents' location at the time of a child's sickness, access to good advisers, the perceived seriousness of the sickness and religious beliefs of mothers were important determinants of their response. Avoidance of blame was noted to be a major motivating force in parents' search for potential sources of health care. The paper concludes that although some of the practices might have negative health implications, they could be usefully adapted to the goal of self-reliance in medical care as a strategy for attaining health for all by the year 2000.

Machakos Project Studies: agents affecting health of mother and child in a rural area of Kenya. XII. Beliefs and practices concerning treatment of measles and acute diarrhoea among the Akamba.

This sociological investigation, carried out within the framework of a medical research project, aimed at finding out what mothers believe about measles and diarrhoea and what they do when their children contract these diseases. Perceived aetiological notions about measles and diarrhoea were found to influence beliefs held and this led to their being classified among 'God's diseases', a classification which influenced adherence to traditional practices as well as the acceptability to seek modern care. It was found that mothers used modern medical care exclusively in 50% of measles cases and 63% of diarrhoea cases. In 48% of measles cases and 28% of diarrhoea cases, mothers combined modern and indigenous care. Use of indigenous care only was relatively rare. Withholding of water and milk from children with measles was practice by 62% of the mothers in the total sample. Variables like age and education did not influence the type of medical care mothers selected, but did influence use of certain traditional practices. Younger and better educated mothers were found to follow these practices much less than older and less educated mothers.