Goals for girls: a cluster-randomized trial to investigate a school-based sexual health programme amongst female learners in South Africa.

The delivery of comprehensive sexuality education to adolescents at school is recognized as a long-term strategy to support adolescent health. Suboptimal sexual and reproductive health (SRH) outcomes among South African adolescents necessitate the ongoing development and optimization of SRH education and promotion models. We conducted a cluster-randomized controlled trial amongst secondary schools (n = 38) in Cape Town, South Africa, to evaluate a sport-based, near-peer-led SRH curriculum, SKILLZ, amongst female learners (n = 2791). Biomedical (sexually transmitted infections [STIs], human immunodeficiency virus [HIV] and pregnancy) and socio-behavioural (social support, gender norms and self-concept) outcomes were assessed pre and post intervention. Attendance at SKILLZ was low and intervention participants did not show an improvement in SRH outcomes, with HIV and pregnancy incidence remaining stable and STI prevalence remaining high and increasing in both control and intervention arms. Although evidence of positive socio-behavioural measures was present at baseline, participants with high attendance showed further improvement in positive gender norms. SKILLZ did not demonstrate the capacity to significantly impact clinical SRH outcomes. Modest improvements in outcomes amongst high attenders suggest that the impact may be possible with improved attendance; however, in the absence of optimal attendance, alternative intervention strategies may be required to improve SRH outcomes amongst adolescents.

Testing hypotheses for maternal effects in Daphnia magna.

Maternal effects are widely observed, but their adaptive nature remains difficult to describe and interpret. We investigated adaptive maternal effects in a clone of the crustacean Daphnia magna, experimentally varying both maternal age and maternal food and subsequently varying food available to offspring. We had two main predictions: that offspring in a food environment matched to their mothers should fare better than offspring in unmatched environments, and that offspring of older mothers would fare better in low food environments. We detected numerous maternal effects, for example offspring of poorly fed mothers were large, whereas offspring of older mothers were both large and showed an earlier age at first reproduction. However, these maternal effects did not clearly translate into the predicted differences in reproduction. Thus, our predictions about adaptive maternal effects in response to food variation were not met in this genotype of Daphnia magna.

Relationships between growth and acute lower-respiratory infections in children aged less than 5 y in a highland population of Papua New Guinea.

One hundred fifty-six children in the highlands of Papua New Guinea aged less than 5 y, studied for a total of 7019 child-weeks, had an incidence of 1.3 episodes per child-year of acute lower-respiratory-tract infections (ALRIs). There was a marked age trend with an incidence of almost three times this average for children aged less than 6 mo. Those with low weight-for-age or low height-for-age had a higher ALRI incidence rate, with no evidence of cutoffs above which nutritional status had no effect; there was no association between low weight-for-height and increased risk of ALRI. A slow weight gain was not a significant risk factor in the short term but weight gain was reduced during episodes of ALRI.

Role of CYP1A2 in the toxicity of long-term phenacetin feeding in mice.

The mechanisms underlying phenacetin-induced toxicity and carcinogenicity are not clear. In particular, it is not known whether these effects are mediated by metabolic activation of the drug. CYP1A2 is known to metabolize phenacetin in vitro. To determine the role of this enzyme in vivo, the toxicity and carcinogenicity of phenacetin was examined in Cyp1a2-null mice (that lack CYP1A2). Six- to 8-week-old wild type (+/+) or null (-/-) mice were fed either a control diet, or one containing 1.25% phenacetin, ad libitum for up to 67 weeks. Representative groups of mice were examined for phenacetin-induced toxicity and carcinogenicity after 36, 48, 58, or 67 weeks of feeding. Consistent with the known role of CYP1A2 in phenacetin metabolism, plasma levels of phenacetin were higher and acetaminophen levels lower in the (-/-) mice fed phenacetin compared to phenacetin-fed (+/+) controls. Weight gain was significantly depressed in both groups of phenacetin-fed mice after 4 weeks of feeding, and continued to be lower for the remainder of the experiment, compared to controls. Hepatomegaly and splenomegaly were more severe in (-/-) mice but present in both genotypes fed phenacetin at all time points assessed. Histological analysis of liver, kidney, spleen, and urogenital tract also revealed a differential response in the (-/-) mice fed phenacetin compared to (+/+) mice fed the same diet. Further, mortality was the most severe in the (-/-) mice fed phenacetin than in all other groups. Despite significant toxicity in (-/-) mice fed phenacetin, only one renal carcinoma was found among them. Results from this work demonstrate that, in the absence of CYP1A2, phenacetin is more toxic than in controls. This provides evidence that metabolism of phenacetin by CYP1A2 alters toxicity in vivo, and suggests that alternate CYP1A2-independent metabolic pathways contribute to its toxicity.

In vivo and in vitro studies with sulfamate sweeteners.

The sweet compounds 2-methyl- and 3-methylcyclohexyl- and 2-cyclohexenylsulfamates were fed to Wistar albino rats. The urine (and feces in the case of 2-cyclohexenylsulfamate) was examined for possible amine, ketone, and alcohol metabolites. The total percent of metabolites formed was low and the hexenyl compound gave a particularly small quantity of metabolite. The results with these compounds are compared with those obtained from earlier in vivo studies with cyclamate and other sulfamates. In complementary in vitro studies, the four sweetest sulfamates, namely, cyclamate, cycloheptyl-, cyclooctyl-, and cyclopentylsulfamates were incubated with the cell-free extract of bacteria isolated from the feces of cyclamate fed rats. Some correlation was apparent between these in vitro experiments and previous in vivo studies. Preliminary mutagenicity testing (the Ames test) of some amines (corresponding to the sulfamates studied) has been carried out.

A review of measles admissions and deaths in the paediatric ward of Goroka Base Hospital during 1989.

We reviewed all measles cases admitted to the paediatric ward of Goroka Base Hospital in 1989, and also interviewed a sample of measles patients attending the paediatric outpatient department. Measles accounted for 11% of all paediatric admissions and 32% of deaths. The case fatality rate for measles was 17%. Children with nosocomial infections and children with low birthweight were more likely to die. The most common complications of measles were pneumonia and diarrhoea, pneumonia being the most common cause of death. Twelve cases of subacute sclerosing panencephalitis were admitted during the year (0.5% of paediatric admissions). Measles was underreported because it was frequently omitted from the discharge diagnosis, the emphasis being placed on the complications. The majority of children with measles admitted to the ward and seen in outpatients had not been vaccinated. Nosocomial infections could have been reduced if all paediatric admissions aged 6-35 months had been vaccinated on admission. We strongly endorse the policy of vaccinating children in Papua New Guinea against measles from the age of 6 months.

PIP: The authors reviewed all measles cases admitted to the pediatric ward of Goroka Base Hospital in 1989, and also interviewed a sample of measles patients attending the pediatric outpatient department. Measles accounted for 11% of all pediatric admissions and 32% of deaths. The case fatality rate for measles was 17%. Children with nosocomial infections and those of low birthweight were more likely to die. The most common complications of measles were pneumonia and diarrhea, pneumonia being the most common cause of death. 12 cases of subacute sclerosing panencephalitis were admitted during the year (0.5% of pediatric admissions). Measles was underreported because it was frequently omitted from the discharge diagnosis, the emphasis being placed on complications. The majority of children with measles admitted to the ward and seen as outpatients had not been vaccinated. Nosocomial infections could have been reduced if all pediatric admissions ages 6-35 months had been vaccinated on admission. The authors strongly endorse the policy of vaccinating children in Papua New Guinea against measles from the age of 6 months.

Clinical engineering education in the high technology hospital.

The application of high technology in the critical care field has created two potential approaches: (1) development of critical care technicians to coordinate clinical engineering educational support; and (2) modification of the hospital organization to streamline communications between the clinical engineers and those they support. At one university hospital studied from 1978 to 1982, both the use of high technology equipment and the number of critical care technicians approximately doubled. With emphasis on technician coordination of engineering support, the in-service education lectures increased 134%, while the engineering staff and the corrective maintenance workload remained unchanged.

Impact of active immunisation against enteritis necroticans in Papua New Guinea.

Enteritis necroticans, known locally as pigbel, has been a major cause of illness and death among children in the highlands of Papua New Guinea. After a successful trial of active immunisation against the beta toxin of the causative organism, Clostridium perfringens type C, immunisation of children was begun in 1980. The effects of the immunisation programme on pigbel admissions in 3 of the 5 major highland hospitals were assessed. In each of the centres studied the proportion of admissions due to enteritis necroticans dropped significantly after immunisation was introduced (p less than 0.001) and hospital admissions for pigbel in 1984-86, when immunisation was well established, were less than one fifth of previous figures.

Bacterial colonization of the upper respiratory tract and its association with acute lower respiratory tract infections in Highland children of Papua New Guinea.

Acute lower respiratory tract infection (ALRI) is the major cause of death among children in Papua New Guinea. This longitudinal study reports the bacteriologic findings for children observed in their hamlets. A total of 1,449 nasal swab specimens from 158 children less than 5 years of age who were studied intensively for 18 months were examined. Non-serotypable strains of Haemophilus influenzae were isolated from 91% of specimens, and serotypable strains were isolated from 35% (8% H. influenzae type b) of specimens. All children had acquired Streptococcus pneumoniae by the age of 3 months. The most frequently occurring serotypes of S. pneumoniae were 6, 19, and 23. Children more frequently carried invasive pneumococci during an episode of ALRI than when they were healthy. Also, children more frequently carried serotypable strains of H. influenzae during the 2 weeks preceding an episode of ALRI than when they were healthy. Between-children analyses showed that children who were susceptible to attacks of ALRI and those who were not susceptible had similar rates of carriage of bacteria.

Reduction in the incidence of acute bronchitis by an oral Haemophilus influenzae vaccine in patients with chronic bronchitis in the highlands of Papua New Guinea.

Following the administration of a standardized questionnaire, 62 adult patients with chronic bronchitis were enrolled into a double-blind controlled trial of an oral killed Haemophilus influenzae vaccine in the highlands of Papua New Guinea. A 3-day course of vaccine or placebo was given monthly for 3 consecutive months. Participants were monitored weekly over 12 months for acute exacerbations; early morning sputum specimens were collected monthly and during acute exacerbations. Density of colonization by H. influenzae and H. parainfluenzae was determined by standard quantitative and semiquantitative techniques, and the latter method (quadrant score) was used to determine the density of growth of pneumococci. A total of 30 patients received vaccine and 32 placebo. The incidence rate of acute bronchitis in the vaccine group (0.011 episodes/person-weeks) was significantly lower than that in the placebo group (0.021 episodes/person-weeks), but there was no difference between the two groups in the incidence rates of more severe disease. Vaccine efficacy was maximal at times of peak incidence of disease. There was no evidence of a decline in vaccine efficacy for acute bronchitis over the 12-month follow-up period. The number of viable H. influenzae in the sputum declined in both vaccine and placebo groups over the 12-month follow-up period. The average concentration of H. influenzae in the vaccine group fell below that in the placebo group within 1 to 2 months after first immunization and remained so for 12 months, although the difference between the two groups narrowed during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)